WorldWideScience

Sample records for care service hubs

  1. North West Surrey's locality hubs - delivering integrated care

    OpenAIRE

    Compton, Lisa; Wilkinson, Peter; Lawn, Liz

    2017-01-01

    Introduction: North West Surrey CCG (NWSCCG) is establishing Locality Hubs – physical buildings offering a fully integrated GP-led, multi-disciplinary ‘one-stop-shop’ services in the community for a defined cohort of frail elderly patients with multiple core morbidities. Hubs will ultimately deliver proactive and reactive care, available 24 hours a day, 365 days a year.The key drivers are;Ageing population, people living longer & more people living with chronic conditionsCost & demand...

  2. Visioning for secondary palliative care service hubs in rural communities: a qualitative case study from British Columbia's interior

    Directory of Open Access Journals (Sweden)

    Hanlon Neil

    2009-10-01

    Full Text Available Abstract Background As the populations of many developed nations continue to age at rapid rates it is becoming increasingly important to enhance palliative care service delivery in order to meet anticipated demand. Rural areas face a number of challenges in doing this, and thus dedicated attention must be given to determining how to best enhance service delivery in ways that are sensitive to their particular needs. The purposes of this article are to determine the vision for establishing secondary palliative care service hubs (SPCH in rural communities through undertaking a case study, and to ascertain the criteria that need to be considered when siting such hubs. Methods A rural region of British Columbia, Canada was selected for primary data collection, which took place over a five-month period in 2008. Formal and informal palliative care providers (n = 31 were interviewed. A purposeful recruitment strategy was used to maximize occupational and practice diversity. Interviews were conducted by phone using a semi-structured guide. Interviews were audio recorded and transcribed verbatim. Data were managed using NVivo8™ software and analyzed thematically, using investigator triangulation to strengthen interpretation. Results Four themes emerged from the dataset: (1 main SPCH features; (2 determining a location; (3 value-added outcomes; and (4 key considerations. It was found that participants generally supported implementing a SPCH in the rural region of focus. Several consistent messages emerged, including that: (1 SPCHs must create opportunities for two-way information exchange between specialists and generalists and communities; (2 SPCHs should diffuse information and ideas throughout the region, thus serving as a locus for education and a means of enhancing training opportunities; and (3 hubs need not be physical sites in the community (e.g., an office in a hospice or hospital, but may be virtual or take other forms based upon local needs

  3. Strategies for contracting gas storage and hub services

    International Nuclear Information System (INIS)

    Auld, J.

    1996-01-01

    The many efficiencies that can be gained by the natural gas industry in effectively using storage, were demonstrated. The circumstances under which the natural gas industry uses storage and how Market Centres or Hub Services can be strategically used in offering companies the highest flexibility in a tough marketplace, were explained. For example, in North America, storage played an important role during the winter of 95/96, which will be remembered for its extreme cold. That year provided the first true opportunity to test the natural gas delivery system since deregulation in 1985. The fact that natural gas supplies continued to be delivered throughout the entire winter was attributed to the use of stored gas held in reserves to meet the severe demand. The companies that did well, relied on storage and also on the services offered by Hub Services which increased margins for all players in the natural gas industry. Using storage, companies can ensure that field deliveries of gas are kept constant by having storage facilities absorb the swings in market demand. The companies that learn to use storage effectively can create competitive edges over their competition and provide more value to their customers. The three main categories of hub services were also described. These are parking (interruptible storage), gas loans (stored gas can be offered to customers on a term basis for low daily rates), and title exchange (the transfer of gas between buyer and seller). The strategic use of parking, loaned gas, title exchange, direct connections, and InterHub Services can provide customers even greater benefits than are provided by storage-based services. 6 figs

  4. How Big is Too Big for Hubs: Marginal Profitability in Hub-and-Spoke Networks

    Science.gov (United States)

    Ross, Leola B.; Schmidt, Stephen J.

    1997-01-01

    Increasing the scale of hub operations at major airports has led to concerns about congestion at excessively large hubs. In this paper, we estimate the marginal cost of adding spokes to an existing hub network. We observe entry/non-entry decisions on potential spokes from existing hubs, and estimate both a variable profit function for providing service in markets using that spoke as well as the fixed costs of providing service to the spoke. We let the fixed costs depend upon the scale of operations at the hub, and find the hub size at which spoke service costs are minimized.

  5. Networked remote area dental services: a viable, sustainable approach to oral health care in challenging environments.

    Science.gov (United States)

    Dyson, Kate; Kruger, Estie; Tennant, Marc

    2012-12-01

    This study examines the cost effectiveness of a model of remote area oral health service. Retrospective financial analysis. Rural and remote primary health services. Clinical activity data and associated cost data relating to the provision of a networked visiting oral health service by the Centre for Rural and Remote Oral Health formed the basis of the study data frameset. The cost-effectiveness of the Centre's model of service provision at five rural and remote sites in Western Australia during the calendar years 2006, 2008 and 2010 was examined in the study. Calculations of the service provision costs and value of care provided were made using data records and the Fee Schedule of Dental Services for Dentists. The ratio of service provision costs to the value of care provided was determined for each site and was benchmarked against the equivalent ratios applicable to large scale government sector models of service provision. The use of networked models have been effective in other disciplines but this study is the first to show a networked hub and spoke approach of five spokes to one hub is cost efficient in remote oral health care. By excluding special cost-saving initiatives introduced by the Centre, the study examines easily translatable direct service provision costs against direct clinical care outcomes in some of Australia's most challenging locations. This study finds that networked hub and spoke models of care can be financially efficient arrangements in remote oral health care. © 2012 The Authors. Australian Journal of Rural Health © National Rural Health Alliance Inc.

  6. Sharing environmental models: An Approach using GitHub repositories and Web Processing Services

    Science.gov (United States)

    Stasch, Christoph; Nuest, Daniel; Pross, Benjamin

    2016-04-01

    The GLUES (Global Assessment of Land Use Dynamics, Greenhouse Gas Emissions and Ecosystem Services) project established a spatial data infrastructure for scientific geospatial data and metadata (http://geoportal-glues.ufz.de), where different regional collaborative projects researching the impacts of climate and socio-economic changes on sustainable land management can share their underlying base scenarios and datasets. One goal of the project is to ease the sharing of computational models between institutions and to make them easily executable in Web-based infrastructures. In this work, we present such an approach for sharing computational models relying on GitHub repositories (http://github.com) and Web Processing Services. At first, model providers upload their model implementations to GitHub repositories in order to share them with others. The GitHub platform allows users to submit changes to the model code. The changes can be discussed and reviewed before merging them. However, while GitHub allows sharing and collaborating of model source code, it does not actually allow running these models, which requires efforts to transfer the implementation to a model execution framework. We thus have extended an existing implementation of the OGC Web Processing Service standard (http://www.opengeospatial.org/standards/wps), the 52°North Web Processing Service (http://52north.org/wps) platform to retrieve all model implementations from a git (http://git-scm.com) repository and add them to the collection of published geoprocesses. The current implementation is restricted to models implemented as R scripts using WPS4R annotations (Hinz et al.) and to Java algorithms using the 52°North WPS Java API. The models hence become executable through a standardized Web API by multiple clients such as desktop or browser GIS and modelling frameworks. If the model code is changed on the GitHub platform, the changes are retrieved by the service and the processes will be updated

  7. Googling Service Boundaries for Endovascular Clot Retrieval Hub Hospitals in a Metropolitan Setting: Proof-of-Concept Study.

    Science.gov (United States)

    Phan, Thanh G; Beare, Richard; Chen, Jian; Clissold, Benjamin; Ly, John; Singhal, Shaloo; Ma, Henry; Srikanth, Velandai

    2017-05-01

    There is great interest in how endovascular clot retrieval hubs provide services to a population. We applied a computational method to objectively generate service boundaries for such endovascular clot retrieval hubs, defined by traveling time to hub. Stroke incidence data merged with population census to estimate numbers of stroke in metropolitan Melbourne, Australia. Traveling time from randomly generated addresses to 4 endovascular clot retrieval-capable hubs (Royal Melbourne Hospital [RMH], Monash Medical Center [MMC], Alfred Hospital [ALF], and Austin Hospital [AUS]) estimated using Google Map application program interface. Boundary maps generated based on traveling time at various times of day for combinations of hubs. In a 2-hub model, catchment was best distributed when RMH was paired with MMC (model 1a, RMH 1765 km 2 and MMC 1164 km 2 ) or with AUS (model 1c, RMH 1244 km 2 and AUS 1685 km 2 ), with no statistical difference between models ( P =0.20). Catchment was poorly distributed when RMH was paired with ALF (model 1b, RMH 2252 km 2 and ALF 676 km 2 ), significantly different from both models 1a and 1c (both P AUS was superior to that of RMH, MMC, and ALF in catchment distribution and travel time. The method was also successfully applied to the city of Adelaide demonstrating wider applicability. We provide proof of concept for a novel computational method to objectively designate service boundaries for endovascular clot retrieval hubs. © 2017 American Heart Association, Inc.

  8. Natural Gas Market Hubs

    Data.gov (United States)

    Department of Homeland Security — A hub is a physical transfer point for natural gas where several pipelines are connected. A market center is a hub where the operator offers services that facilitate...

  9. THE ROLE OF AUTOMOBILE TRANSPORT IN HUBS SERVICE

    Directory of Open Access Journals (Sweden)

    Kirill Iurievich Bely

    2015-09-01

    Full Text Available Article contains approaches to development and functioning of transport-logistic nodes – hubs – in modern conditions. There is hub classification and examples of them on different transport modes. An important component in providing reliability of hub work is automobile transport.

  10. PolarHub: A Global Hub for Polar Data Discovery

    Science.gov (United States)

    Li, W.

    2014-12-01

    This paper reports the outcome of a NSF project in developing a large-scale web crawler PolarHub to discover automatically the distributed polar dataset in the format of OGC web services (OWS) in the cyberspace. PolarHub is a machine robot; its goal is to visit as many webpages as possible to find those containing information about polar OWS, extract this information and store it into the backend data repository. This is a very challenging task given huge data volume of webpages on the Web. Three unique features was introduced in PolarHub to make it distinctive from earlier crawler solutions: (1) a multi-task, multi-user, multi-thread support to the crawling tasks; (2) an extensive use of thread pool and Data Access Object (DAO) design patterns to separate persistent data storage and business logic to achieve high extendibility of the crawler tool; (3) a pattern-matching based customizable crawling algorithm to support discovery of multi-type geospatial web services; and (4) a universal and portable client-server communication mechanism combining a server-push and client pull strategies for enhanced asynchronous processing. A series of experiments were conducted to identify the impact of crawling parameters to the overall system performance. The geographical distribution pattern of all PolarHub identified services is also demonstrated. We expect this work to make a major contribution to the field of geospatial information retrieval and geospatial interoperability, to bridge the gap between data provider and data consumer, and to accelerate polar science by enhancing the accessibility and reusability of adequate polar data.

  11. The FUTUREVOLC Supersite's e-Infrastructure - A multidisciplinary data hub and data service for Icelandic Volcanoes

    Science.gov (United States)

    Vogfjörd, Kristín S.; Sigmundsson, Freysteinn; Sverrisson, Sverrir Th.; Sigurdsson, Sigurdur F.; Ófeigsson, Benedikt G.; Arnarsson, Ólafur S.; Kristinsson, Ingvar; Ilyinskaya, Evgenia; Oddsdóttir, Thorarna Ýr; Bergsveinsson, Sölvi Th.; Hjartansson, Kristján R.

    2014-05-01

    The FUTUREVOLC volanological supersite will establish a data hub and dataservice, where researchers, hazard managers and other stake holders can freely obtain access to multidisciplinary data and products on activity, unrest and eruptions at Icelandic volcanoes. The supersite is firmly founded on close interaction between the main Icelandic volcanological research and monitoring institutions, in coordination with expertise from European researchers participating in FUTUREVOLC. The hub is located at the Icelandic Meteorological Office (IMO), an institution responsible for monitoring and archiving data on all natural hazards in Iceland and, which also has a mandate as the state volcano observatory. This association will ensure a long-term sustainable data service. The data accessible at the hub include in-situ and space-based observations, products and models from all the relevant disciplines contributing to volcanological research and local as well as cross-border hazard management, i.e. Earth sciences, atmospheric science, hydrology, remote sensing and space science. Access to the data will be in compliance with the access policy of the GEO (Group on Earth Observations), providing registered users with easy and timely access to data and products of documented quality. This commitment has already led to the acceptance of FUTUREVOLC as a permanent geohazard supersite by CEOS (Committee on Earth Observation Satellites), which will ensure access to additional satellite data and products on Icelandic volcanoes. To facilitate services to seismological data at the supersite hub, the IMO is reconstructing its existing data base and utilizing the SeisComp3 software to manage waveform and parameter data. The accompanying ArcLink component will be used to provide access to event data and waveforms. Access to GPS data will be provided by the GSAC web service which has been installed at the IMO through collaboration with UNAVCO. If appropriate, the format and data base

  12. Why primary care practices should become digital health information hubs for their patients.

    Science.gov (United States)

    Baird, Aaron; Nowak, Samantha

    2014-11-25

    Two interesting health care trends are currently occurring: 1) patient-facing technologies, such as personal health records, patient portals, and mobile health apps, are being adopted at rapid rates, and 2) primary care, which includes family practice, is being promoted as essential to reducing health care costs and improving health care outcomes. While these trends are notable and commendable, both remain subject to significant fragmentation and incentive misalignments, which has resulted in significant data coordination and value generation challenges. In particular, patient-facing technologies designed to increase care coordination, often fall prey to the very digital fragmentation issues they are supposed to overcome. Additionally, primary care providers are treating patients that may have considerable health information histories, but generating a single view of such multi-source data is nearly impossible. We contribute to this debate by proposing that primary care practices become digital health information hubs for their patients. Such hubs would offer health data coordination in a medically professional setting with the benefits of expert, trustworthy advice coupled with active patient engagement. We acknowledge challenges including: costs, information quality and provenance, willingness-to-share information and records, willingness-to-use (by both providers and patients), primary care scope creep, and determinations of technical and process effectiveness. Even with such potential challenges, we strongly believe that more debate is needed on this topic prior to full implementation of various health information technology incentives and reform programs currently being designed and enacted throughout the world. Ultimately, if we do not provide a meaningful way for the full spectrum of health information to be used by both providers and patients, especially early in the health care continuum, effectively improving health outcomes may remain elusive. We view

  13. Guiding Principles for Data Architecture to Support the Pathways Community HUB Model.

    Science.gov (United States)

    Zeigler, Bernard P; Redding, Sarah; Leath, Brenda A; Carter, Ernest L; Russell, Cynthia

    2016-01-01

    The Pathways Community HUB Model provides a unique strategy to effectively supplement health care services with social services needed to overcome barriers for those most at risk of poor health outcomes. Pathways are standardized measurement tools used to define and track health and social issues from identification through to a measurable completion point. The HUB use Pathways to coordinate agencies and service providers in the community to eliminate the inefficiencies and duplication that exist among them. Experience with the Model has brought out the need for better information technology solutions to support implementation of the Pathways themselves through decision-support tools for care coordinators and other users to track activities and outcomes, and to facilitate reporting. Here we provide a basis for discussing recommendations for such a data infrastructure by developing a conceptual model that formalizes the Pathway concept underlying current implementations. The main contribution is a set of core recommendations as a framework for developing and implementing a data architecture to support implementation of the Pathways Community HUB Model. The objective is to present a tool for communities interested in adopting the Model to learn from and to adapt in their own development and implementation efforts. Experience with the Community Health Access Project (CHAP) data base system (the core implementation of the Model) has identified several issues and remedies that have been developed to address these issues. Based on analysis of issues and remedies, we present several key features for a data architecture meeting the just mentioned recommendations. Presentation of features is followed by a practical guide to their implementation allowing an organization to consider either tailoring off-the-shelf generic systems to meet the requirements or offerings that are specialized for community-based care coordination. Looking to future extensions, we discuss the

  14. Dynamic hubs show competitive and static hubs non-competitive regulation of their interaction partners.

    Directory of Open Access Journals (Sweden)

    Apurv Goel

    Full Text Available Date hub proteins have 1 or 2 interaction interfaces but many interaction partners. This raises the question of whether all partner proteins compete for the interaction interface of the hub or if the cell carefully regulates aspects of this process? Here, we have used real-time rendering of protein interaction networks to analyse the interactions of all the 1 or 2 interface hubs of Saccharomyces cerevisiae during the cell cycle. By integrating previously determined structural and gene expression data, and visually hiding the nodes (proteins and their edges (interactions during their troughs of expression, we predict when interactions of hubs and their partners are likely to exist. This revealed that 20 out of all 36 one- or two- interface hubs in the yeast interactome fell within two main groups. The first was dynamic hubs with static partners, which can be considered as 'competitive hubs'. Their interaction partners will compete for the interaction interface of the hub and the success of any interaction will be dictated by the kinetics of interaction (abundance and affinity and subcellular localisation. The second was static hubs with dynamic partners, which we term 'non-competitive hubs'. Regulatory mechanisms are finely tuned to lessen the presence and/or effects of competition between the interaction partners of the hub. It is possible that these regulatory processes may also be used by the cell for the regulation of other, non-cell cycle processes.

  15. Quadratic Assignment of Hubs in p-Hub Median Problem

    DEFF Research Database (Denmark)

    Gelareh, Shahin

    We introduce Generalized p-Hub Median Problem (GpHMP) that seeks to locate p hub nodes and install p distinct hub facilities/operators on the hubs while discount factor resulted by consolidation of flow on the hub links depends on the facilities/operators that are installed/operating on both hub...

  16. Liner Shipping Hub Network Design in a Competitive Environment

    DEFF Research Database (Denmark)

    Gelareh, Shahin; Nickel, Stefan; Pisinger, David

    A new mixed integer programming formulation is proposed for hub-and-spoke network design in a competitive environment. It addresses competition between a newcomer liner service provider and an alliance, both operating on hub-and-spoke networks. The newcomer company maximizes its market share...... — proportional to service time and transportation cost —by locating a predefined number of hubs at candidate ports and designing its network. While general-purpose solvers do not solve instances of even small size, an accelerated lagrangian method coupled with a primal heuristic obtains very good bounds. Our...

  17. DisasterHub: A mobile application for enabling crowd generated data fusion in Earth Observation disaster management services

    Science.gov (United States)

    Tsironis, Vassilis; Herekakis, Themistocles; Tsouni, Alexia; Kontoes, Charalampos Haris

    2016-04-01

    by DisasterHub, an application proposal that won the MYGEOSS Second Call for Innovative Apps (http://beyond-eocenter.eu/index.php/ann-blog/197-disasterhub-mygeoss). DisasterHub will fill the gap by introducing a mobile application that will act as a middleware between mobile users and BEYOND services, building on the concept of citizen observatories in support of Copernicus, GEO, GEOSS, and UN-SPIDER. In this context the roadmap for generating beneficial EO services through DisasterHub is sketched in two main branches: (i) ingestion, processing and fusion of big multimodal data with additional spatiotemporal evidences (originated from Core Copernicus, GEO, GEOSS) for deriving higher value DRR and EMS products, (ii) interlinking the web and mobile platforms for the exchange and ease access of the societies to open EO/crowd generated data. The benefited communities will be effectively enlarged through DisasterHub mobile app. Mutually the BEYOND ecosystem will profit from the large amount of tagged information returned from the field, forming a unique input to the production chains and assimilation of predictive modeling. In conclusion DisasterHub will showcase in the EO community an enhanced EO services ecosystem with a software infrastructure for easy access of mobile users to the real-time monitoring and early-warning systems of BEYOND and tools for incorporating crowd-sourced data with open geospatial and socioeconomic data via open/linked data ingestion mechanisms (APIs), retrieved from the GEOSS Data-CORE, Copernicus and other EU portals.

  18. A novel virtual hub approach for multisource downstream service integration

    Science.gov (United States)

    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.

  19. Using the CER Hub to ensure data quality in a multi-institution smoking cessation study.

    Science.gov (United States)

    Walker, Kari L; Kirillova, Olga; Gillespie, Suzanne E; Hsiao, David; Pishchalenko, Valentyna; Pai, Akshatha Kalsanka; Puro, Jon E; Plumley, Robert; Kudyakov, Rustam; Hu, Weiming; Allisany, Art; McBurnie, MaryAnn; Kurtz, Stephen E; Hazlehurst, Brian L

    2014-01-01

    Comparative effectiveness research (CER) studies involving multiple institutions with diverse electronic health records (EHRs) depend on high quality data. To ensure uniformity of data derived from different EHR systems and implementations, the CER Hub informatics platform developed a quality assurance (QA) process using tools and data formats available through the CER Hub. The QA process, implemented here in a study of smoking cessation services in primary care, used the 'emrAdapter' tool programmed with a set of quality checks to query large samples of primary care encounter records extracted in accord with the CER Hub common data framework. The tool, deployed to each study site, generated error reports indicating data problems to be fixed locally and aggregate data sharable with the central site for quality review. Across the CER Hub network of six health systems, data completeness and correctness issues were prevalent in the first iteration and were considerably improved after three iterations of the QA process. A common issue encountered was incomplete mapping of local EHR data values to those defined by the common data framework. A highly automated and distributed QA process helped to ensure the correctness and completeness of patient care data extracted from EHRs for a multi-institution CER study in smoking cessation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  20. The home hemodialysis hub: physical infrastructure and integrated governance structure.

    Science.gov (United States)

    Marshall, Mark R; Young, Bessie A; Fox, Sally J; Cleland, Calli J; Walker, Robert J; Masakane, Ikuto; Herold, Aaron M

    2015-04-01

    An effective home hemodialysis program critically depends on adequate hub facilities and support functions and on transparent and accountable organizational processes. The likelihood of optimal service delivery and patient care will be enhanced by fit-for-purpose facilities and implementation of a well-considered governance structure. In this article, we describe the required accommodation and infrastructure for a home hemodialysis program and a generic organizational structure that will support both patient-facing clinical activities and business processes. © 2015 International Society for Hemodialysis.

  1. Solving Hub Network Problem Using Genetic Algorithm

    Directory of Open Access Journals (Sweden)

    Mursyid Hasan Basri

    2012-01-01

    Full Text Available This paper addresses a network problem that described as follows. There are n ports that interact, and p of those will be designated as hubs. All hubs are fully interconnected. Each spoke will be allocated to only one of available hubs. Direct connection between two spokes is allowed only if they are allocated to the same hub. The latter is a distinct characteristic that differs it from pure hub-and-spoke system. In case of pure hub-and-spoke system, direct connection between two spokes is not allowed. The problem is where to locate hub ports and to which hub a spoke should be allocated so that total transportation cost is minimum. In the first model, there are some additional aspects are taken into consideration in order to achieve a better representation of the problem. The first, weekly service should be accomplished. Secondly, various vessel types should be considered. The last, a concept of inter-hub discount factor is introduced. Regarding the last aspect, it represents cost reduction factor at hub ports due to economies of scale. In practice, it is common that the cost rate for inter-hub movement is less than the cost rate for movement between hub and origin/destination. In this first model, inter-hub discount factor is assumed independent with amount of flows on inter-hub links (denoted as flow-independent discount policy. The results indicated that the patterns of enlargement of container ship size, to some degree, are similar with those in Kurokawa study. However, with regard to hub locations, the results have not represented the real practice. In the proposed model, unsatisfactory result on hub locations is addressed. One aspect that could possibly be improved to find better hub locations is inter-hub discount factor. Then inter-hub discount factor is assumed to depend on amount of inter-hub flows (denoted as flow-dependent discount policy. There are two discount functions examined in this paper. Both functions are characterized by

  2. Liner shipping hub network design in a competitive environment

    DEFF Research Database (Denmark)

    Gelareh, Shahin; Nickel, Stefan; Pisinger, David

    2010-01-01

    A mixed integer programming formulation is proposed for hub-and-spoke network design in a competitive environment. It addresses the competition between a newcomer liner service provider and an existing dominating operator, both operating on hub-and-spoke networks. The newcomer company maximizes i...

  3. Managing effective and efficient hub operations : a study of ground time management

    NARCIS (Netherlands)

    Yunita, Theresia

    2009-01-01

    This Logistics Design Project was carried out at KLM Aircraft Services (AS), from February 2008 - April 2009. The project focuses on ideal description of KLM operational controls for daily executions at the hub and within the AS processes. The daily execution at the hub is managed by the Hub Control

  4. Maritime Domain Awareness Architecture Management Hub Strategy

    National Research Council Canada - National Science Library

    2008-01-01

    This document provides an initial high level strategy for carrying out the responsibilities of the national Maritime Domain Awareness Architecture Management Hub to deliver a standards based service...

  5. CER Hub: An informatics platform for conducting comparative effectiveness research using multi-institutional, heterogeneous, electronic clinical data.

    Science.gov (United States)

    Hazlehurst, Brian L; Kurtz, Stephen E; Masica, Andrew; Stevens, Victor J; McBurnie, Mary Ann; Puro, Jon E; Vijayadeva, Vinutha; Au, David H; Brannon, Elissa D; Sittig, Dean F

    2015-10-01

    Comparative effectiveness research (CER) requires the capture and analysis of data from disparate sources, often from a variety of institutions with diverse electronic health record (EHR) implementations. In this paper we describe the CER Hub, a web-based informatics platform for developing and conducting research studies that combine comprehensive electronic clinical data from multiple health care organizations. The CER Hub platform implements a data processing pipeline that employs informatics standards for data representation and web-based tools for developing study-specific data processing applications, providing standardized access to the patient-centric electronic health record (EHR) across organizations. The CER Hub is being used to conduct two CER studies utilizing data from six geographically distributed and demographically diverse health systems. These foundational studies address the effectiveness of medications for controlling asthma and the effectiveness of smoking cessation services delivered in primary care. The CER Hub includes four key capabilities: the ability to process and analyze both free-text and coded clinical data in the EHR; a data processing environment supported by distributed data and study governance processes; a clinical data-interchange format for facilitating standardized extraction of clinical data from EHRs; and a library of shareable clinical data processing applications. CER requires coordinated and scalable methods for extracting, aggregating, and analyzing complex, multi-institutional clinical data. By offering a range of informatics tools integrated into a framework for conducting studies using EHR data, the CER Hub provides a solution to the challenges of multi-institutional research using electronic medical record data. Copyright © 2015. Published by Elsevier Ireland Ltd.

  6. Flow Merging and Hub Route Optimization in Collaborative Transportation

    Directory of Open Access Journals (Sweden)

    Kerui Weng

    2014-01-01

    Full Text Available This paper studies the optimal hub routing problem of merged tasks in collaborative transportation. This problem allows all carriers’ transportation tasks to reach the destinations optionally passing through 0, 1, or 2 hubs within limited distance, while a cost discount on arcs in the hub route could be acquired after paying fixed charges. The problem arises in the application of logistics, postal services, airline transportation, and so forth. We formulate the problem as a mixed-integer programming model, and provide two heuristic approaches, respectively, based on Lagrangian relaxation and Benders decomposition. Computational experiments show that the algorithms work well.

  7. Location of an intermediate hub for port activities

    Science.gov (United States)

    Burciu, Ş.; Ştefănică, C.; Roşca, E.; Dragu, V.; Ruscă, F.

    2015-11-01

    An intermediate hub might increase the accessibility level of ports but also hinterland and so it can be considered more than a facility with a transhipment role. These hubs might lead to the development of other transport services and enhance their role in gathering and covering economic centres within hinterlands and also getting the part of logistic facility for the ports, with effects on port utilization and its connectivity to global economy. A new location for a hub terminal leads to reduced transport distances within hinterland, with decreased transport costs and external effects, so with gains in people's life quality. Because the production and distribution systems are relatively fixed on short and medium term and the location decisions are strategic and on long term, the logistic chains activities location models have to consider the uncertainties regarding the possible future situations. In most models, production costs are considered equal, the location problem reducing itself to a problem that aims to minimize the total transport costs, meaning the transport problem. The main objective of the paper is to locate a hub terminal that links the producers of cereals that are going to be exported by naval transportation with the Romanian fluvial-maritime ports (Galaţi, Brăila). GIS environment can be used to integrate and analyse a great amount of data and has the ability of using functions as location - allocation models necessary both to private and public sector, being able to determine the optimal location for services like factories, warehouses, logistic platforms and other public services.

  8. Redesigning the regulatory framework for ambulatory care services in New York.

    Science.gov (United States)

    Chokshi, Dave A; Rugge, John; Shah, Nirav R

    2014-12-01

    care services. From the state government's perspective, this clarification requires better reporting from new health care entities (eg, retail clinics), connections with regional and state health information technology hubs, and coordination among state agencies. A uniform nomenclature also would improve consumers' understanding of rights and responsibilities. Finally, the regulatory mechanisms employed-from mandatory reporting to licensure to regional planning to the certificate of need-should remain flexible and match the degree of consensus regarding the appropriate regulatory path. Few other states have embarked on a wide-ranging assessment of their regulation of ambulatory care services. By moving toward adopting the regulatory approach described here, New York aims to balance sound oversight with pluralism and innovation in health care delivery. © 2014 Milbank Memorial Fund.

  9. Virtual Hubs for facilitating access to Open Data

    Science.gov (United States)

    Mazzetti, Paolo; Latre, Miguel Á.; Ernst, Julia; Brumana, Raffaella; Brauman, Stefan; Nativi, Stefano

    2015-04-01

    In October 2014 the ENERGIC-OD (European NEtwork for Redistributing Geospatial Information to user Communities - Open Data) project, funded by the European Union under the Competitiveness and Innovation framework Programme (CIP), has started. In response to the EU call, the general objective of the project is to "facilitate the use of open (freely available) geographic data from different sources for the creation of innovative applications and services through the creation of Virtual Hubs". In ENERGIC-OD, Virtual Hubs are conceived as information systems supporting the full life cycle of Open Data: publishing, discovery and access. They facilitate the use of Open Data by lowering and possibly removing the main barriers which hampers geo-information (GI) usage by end-users and application developers. Data and data services heterogeneity is recognized as one of the major barriers to Open Data (re-)use. It imposes end-users and developers to spend a lot of effort in accessing different infrastructures and harmonizing datasets. Such heterogeneity cannot be completely removed through the adoption of standard specifications for service interfaces, metadata and data models, since different infrastructures adopt different standards to answer to specific challenges and to address specific use-cases. Thus, beyond a certain extent, heterogeneity is irreducible especially in interdisciplinary contexts. ENERGIC-OD Virtual Hubs address heterogeneity adopting a mediation and brokering approach: specific components (brokers) are dedicated to harmonize service interfaces, metadata and data models, enabling seamless discovery and access to heterogeneous infrastructures and datasets. As an innovation project, ENERGIC-OD will integrate several existing technologies to implement Virtual Hubs as single points of access to geospatial datasets provided by new or existing platforms and infrastructures, including INSPIRE-compliant systems and Copernicus services. ENERGIC OD will deploy a

  10. The hub-and-spoke organization design revisited: a lifeline for rural hospitals.

    Science.gov (United States)

    Elrod, James K; Fortenberry, John L

    2017-12-13

    Characterized by declining populations, high poverty, reduced employment opportunities, and high numbers of uninsured residents, rural communities pose significant challenges for healthcare providers desirous of addressing these medically underserved areas. Such difficult environments, in fact, have forced the closure of many rural hospitals across America, with scores facing the same threat, compelling intensive efforts to identify pathways which will yield an improved future. Collaborations with stronger urban or suburban healthcare institutions offer a prudent avenue for rural hospitals to continue serving their patients. Such relationships can be structured in many different ways, but Willis-Knighton Health System found that its use of the hub-and-spoke organization design set the stage for the institution to cast a vital lifeline to neighboring rural hospitals, affording the relatively seamless integration and assimilation of partner facilities into its network, ensuring continuity of services in remote regions. This article supplies an overview of the hub-and-spoke network and discusses Willis-Knighton Health System's use of it to facilitate the establishment of productive partnerships with rural hospitals. The delivery of healthcare services in rural environments is essential, but with small community hospitals increasingly being under threat, the outlook is not particularly attractive. Partnerships with better positioned healthcare entities offer significant hope, but care must be taken to structure these arrangements optimally. Willis-Knighton Health System found utility and value in its hub-and-spoke organization design, with the insights presented in this account potentially offering a pathway for others to follow as they go about addressing the healthcare needs of rural populations.

  11. Capacitated Hub Routing Problem in Hub-and-Feeder Network Design: Modeling and Solution Algorithm

    OpenAIRE

    Gelareh , Shahin; Neamatian Monemi , Rahimeh; Semet , Frédéric

    2015-01-01

    International audience; In this paper, we address the Bounded Cardinality Hub Location Routing with Route Capacity wherein eachhub acts as a transshipment node for one directed route. The number of hubs lies between a minimum anda maximum and the hub-level network is a complete subgraph. The transshipment operations take place atthe hub nodes and flow transfer time from a hub-level transporter to a spoke-level vehicle influences spoketo-hub allocations. We propose a mathematical model and a b...

  12. Looking Into Pandora's Box: The Content Of Sci-Hub And Its Usage

    OpenAIRE

    Greshake, Bastian

    2017-01-01

    Despite the growth of Open Access, potentially illegally circumventing paywalls to access scholarly publications is becoming a more mainstream phenomenon. The web service Sci-Hub is amongst the biggest facilitators of this, offering free access to around 62 million publications. So far it is not well studied how and why its users are accessing publications through Sci-Hub. By utilizing the recently released corpus of Sci-Hub and comparing it to the data of  ~28 million downloads done through ...

  13. Transaction hubs: can tame energy market communications

    Energy Technology Data Exchange (ETDEWEB)

    Hamilos, C.

    2002-07-01

    The nature and function of transaction hubs is described in view of their growing usefulness as electric industry deregulation takes hold and with it the urgent requirement for trading partners to exchange information quickly and efficiently. The paper stresses the many difficulties involved in communications between trading partners since each partner operates under a different set of business rules, with the result that there are 'language differences' to overcome, not to mention the sheer volume of data that must be handled. To make it all work, companies turn increasingly to products like communication hubs. They are able to overcome the fact that different companies have different systems, different data formats and different business rules, and are able to help companies to package, transmit, receive and process information. The principal advantage of a hub is that no one has to learn anyone else's interface. Everyone can continue to use their own data format and transaction models. The hub supplies the protocols and processing rules needed to work with any of the partners connected to the hub. In order to achieve the level of efficiency and reliability required in a hub, certain design principles must be satisfied. These are : scalability, facilities for load balancing, availability of standard routine services, ability to recognize a process as consisting of various transactions, and a transaction as belonging to a specific process, ability to allow the user to configure expiration times around the business processes according to market rules, facility to easily configure validation rules, ability to handle exceptions, ability to interoperate with many middle-ware products, and to manage work flow in a manner that is transparent to operating personnel.

  14. Sci-Hub provides access to nearly all scholarly literature.

    Science.gov (United States)

    Himmelstein, Daniel S; Romero, Ariel Rodriguez; Levernier, Jacob G; Munro, Thomas Anthony; McLaughlin, Stephen Reid; Greshake Tzovaras, Bastian; Greene, Casey S

    2018-03-01

    The website Sci-Hub enables users to download PDF versions of scholarly articles, including many articles that are paywalled at their journal's site. Sci-Hub has grown rapidly since its creation in 2011, but the extent of its coverage has been unclear. Here we report that, as of March 2017, Sci-Hub's database contains 68.9% of the 81.6 million scholarly articles registered with Crossref and 85.1% of articles published in toll access journals. We find that coverage varies by discipline and publisher, and that Sci-Hub preferentially covers popular, paywalled content. For toll access articles, we find that Sci-Hub provides greater coverage than the University of Pennsylvania, a major research university in the United States. Green open access to toll access articles via licit services, on the other hand, remains quite limited. Our interactive browser at https://greenelab.github.io/scihub allows users to explore these findings in more detail. For the first time, nearly all scholarly literature is available gratis to anyone with an Internet connection, suggesting the toll access business model may become unsustainable. © 2018, Himmelstein et al.

  15. Enriching the tactical network design of express service carriers with fleet scheduling characteristics

    NARCIS (Netherlands)

    Meuffels, W.J.M.; Fleuren, H.A.; Cruijssen, F.C.A.M.; Dam, E.R.

    2010-01-01

    Express service carriers provide time-guaranteed deliveries of parcels via a network consisting of nodes and hubs. In this, nodes take care of the collection and delivery of parcels, and hubs have the function to consolidate parcels in between the nodes. The tactical network design problem assigns

  16. The BioHub Knowledge Base: Ontology and Repository for Sustainable Biosourcing.

    Science.gov (United States)

    Read, Warren J; Demetriou, George; Nenadic, Goran; Ruddock, Noel; Stevens, Robert; Winter, Jerry

    2016-06-01

    The motivation for the BioHub project is to create an Integrated Knowledge Management System (IKMS) that will enable chemists to source ingredients from bio-renewables, rather than from non-sustainable sources such as fossil oil and its derivatives. The BioHubKB is the data repository of the IKMS; it employs Semantic Web technologies, especially OWL, to host data about chemical transformations, bio-renewable feedstocks, co-product streams and their chemical components. Access to this knowledge base is provided to other modules within the IKMS through a set of RESTful web services, driven by SPARQL queries to a Sesame back-end. The BioHubKB re-uses several bio-ontologies and bespoke extensions, primarily for chemical feedstocks and products, to form its knowledge organisation schema. Parts of plants form feedstocks, while various processes generate co-product streams that contain certain chemicals. Both chemicals and transformations are associated with certain qualities, which the BioHubKB also attempts to capture. Of immediate commercial and industrial importance is to estimate the cost of particular sets of chemical transformations (leading to candidate surfactants) performed in sequence, and these costs too are captured. Data are sourced from companies' internal knowledge and document stores, and from the publicly available literature. Both text analytics and manual curation play their part in populating the ontology. We describe the prototype IKMS, the BioHubKB and the services that it supports for the IKMS. The BioHubKB can be found via http://biohub.cs.manchester.ac.uk/ontology/biohub-kb.owl .

  17. Joint Hub Network Development

    OpenAIRE

    Cruijssen, F.C.A.M.; Borm, P.E.M.; Dullaert, W.; Hamers, H.J.M.

    2007-01-01

    This paper introduces a framework for joint hub network development. Building a joint physical hub for transhipment of goods is expensive and therefore involves considerable risks for the cooperating companies. In a practical setting, it is unlikely that an entire network will be built at once. Rather, the partners will have a more cautious attitude and build the hub facilities one-by-one. In the proposed framework, every time a new hub is introduced, partners will have the opportunity to dec...

  18. Hub and Axis

    OpenAIRE

    Hansen, Gary Alan

    2010-01-01

    The project is for the central building of a community center used by the communities of Blacksburg and Christiansburg. The building is a space configured as a hub that uses axes to determine entering, exiting and vertical movement. The hub configuration of the building is in concentric rings around the atrium in both space and materials. As materials were brought into the building, they enhanced the strong axial configuration and emphasized the layers surrounding the central hub space of ...

  19. Innovation Hub How-To

    DEFF Research Database (Denmark)

    Berger, Andreas; Brem, Alexander

    2016-01-01

    in establishing an innovative environment: carefully considering the decision to set up such a center, hiring the right people, designing a framework for effective output, creating a buffer from bureaucratic distractions, securing a leader to champion the effort, focusing on business outcomes, fostering...... disruptive over incremental innovation, and being patient. Regardless of where an innovation hub is established, the key to success lies in hiring creative, intrinsically motivated staff and then giving them the freedom to do what they do best....

  20. Retention in Differentiated Care: Multiple Measures Analysis for a Decentralized HIV Care and Treatment Program in North Central Nigeria

    Science.gov (United States)

    Agaba, Patricia A; Genberg, Becky L; Sagay, Atiene S; Agbaji, Oche O; Meloni, Seema T; Dadem, Nancin Y; Kolawole, Grace O; Okonkwo, Prosper; Kanki, Phyllis J; Ware, Norma C

    2018-01-01

    Objective Differentiated care refers collectively to flexible service models designed to meet the differing needs of HIV-infected persons in resource-scarce settings. Decentralization is one such service model. Retention is a key indicator for monitoring the success of HIV treatment and care programs. We used multiple measures to compare retention in a cohort of patients receiving HIV care at “hub” (central) and “spoke” (decentralized) sites in a large public HIV treatment program in north central Nigeria. Methods This retrospective cohort study utilized longitudinal program data representing central and decentralized levels of care in the Plateau State Decentralization Initiative, north central Nigeria. We examined retention with patient- level (retention at fixed times, loss-to-follow-up [LTFU]) and visit-level (gaps-in-care, visit constancy) measures. Regression models with generalized estimating equations (GEE) were used to estimate the effect of decentralization on visit-level measures. Patient-level measures were examined using survival methods with Cox regression models, controlling for baseline variables. Results Of 15,650 patients, 43% were enrolled at the hub. Median time in care was 3.1 years. Hub patients were less likely to be LTFU (adjusted hazard ratio (AHR)=0.91, 95% CI: 0.85-0.97), compared to spoke patients. Visit constancy was lower at the hub (−4.5%, 95% CI: −3.5, −5.5), where gaps in care were also more likely to occur (adjusted odds ratio=1.95, 95% CI: 1.83-2.08). Conclusion Decentralized sites demonstrated better retention outcomes using visit-level measures, while the hub achieved better retention outcomes using patient-level measures. Retention estimates produced by incorporating multiple measures showed substantial variation, confirming the influence of measurement strategies on the results of retention research. Future studies of retention in HIV care in sub-Saharan Africa will be well-served by including multiple measures

  1. Bridging the chronic care gap: HealthOne Mt Druitt, Australia

    Directory of Open Access Journals (Sweden)

    Justin McNab

    2015-09-01

    Full Text Available HealthOne was part of a state-wide initiative to invest in new community-based facilities for collocating services. The HealthOne Mount Druitt is a virtual hub and spoke organisation established in 2006 in a socially disadvantaged part of Western Sydney based out of a new community health hub. The model is based on ‘virtual’ care planning and aims to improve coordination of care for older people with complex health needs, reduce unnecessary hospitalisations and ensure appropriate referral to community and specialist health services. General practitioner liaison nurses (GPLNs work closely with clients as well as general practitioners (GPs and other health care providers. Primary health care providers reported improved communication and coordination of services, and there have been lower levels of utilisation of the emergency department (ED for patients following enrolment in the programme. HealthOne provides an example of how a virtual organisation together with highly skilled care coordinators can overcome some of the barriers to providing integrated care created by fragmented funding streams and care delivery systems.

  2. Aircraft Propeller Hub Repair

    Energy Technology Data Exchange (ETDEWEB)

    Muth, Thomas R [ORNL; Peter, William H [ORNL

    2015-02-13

    The team performed a literature review, conducted residual stress measurements, performed failure analysis, and demonstrated a solid state additive manufacturing repair technique on samples removed from a scrapped propeller hub. The team evaluated multiple options for hub repair that included existing metal buildup technologies that the Federal Aviation Administration (FAA) has already embraced, such as cold spray, high velocity oxy-fuel deposition (HVOF), and plasma spray. In addition the team helped Piedmont Propulsion Systems, LLC (PPS) evaluate three potential solutions that could be deployed at different stages in the life cycle of aluminum alloy hubs, in addition to the conventional spray coating method for repair. For new hubs, a machining practice to prevent fretting with the steel drive shaft was recommended. For hubs that were refurbished with some material remaining above the minimal material condition (MMC), a silver interface applied by an electromagnetic pulse additive manufacturing method was recommended. For hubs that were at or below the MMC, a solid state additive manufacturing technique using ultrasonic welding (UW) of thin layers of 7075 aluminum to the hub interface was recommended. A cladding demonstration using the UW technique achieved mechanical bonding of the layers showing promise as a viable repair method.

  3. Gas and LNG trading hubs, hub indexation and destination flexibility in East Asia

    International Nuclear Information System (INIS)

    Shi, Xunpeng; Padinjare Variam, Hari Malamakkavu

    2016-01-01

    In the East Asian gas markets, issues like gas trading hubs, hub indexed pricing, and destination flexibility are being debated. This paper examines the impact of a change in East Asia's pricing benchmark and contract flexibility on the regional and global gas markets. The paper uses the Nexant World Gas Model, a linear program with global cost minimization as the objective. To our knowledge, this study on hub competition, price benchmark change and contract flexibility improvement in East Asia will be the first in the literature and have real policy relevance. The results show that both price benchmark change and contract flexibility improvements will create an overall benefit for the world and East Asia importers, but the impacts are different among exporters and importers. However, there is no evidence of competition among different benchmark hubs and no evidence that destination restrictions cause the “Asia Premium”. It implies that removal of destination clauses has higher priority than the change to hub indexation for Japan, Korea and Chinese Taipei, but both should be treated equally in China. The study also suggests that East Asian importers should cooperate among themselves and with exporters to facilitate the hub creation and contract changes in East Asia. - Highlights: •Gas trading hubs in Japan and China are not mutually exclusive. •Both price benchmark changes and contract flexibility improvements are beneficial. •The “Asian Premium” is not caused by destination restriction. •Destination flexibility is much more important than hub indexation in East Asia except China. •Hub indexation is as important as destination flexibility in China due to pipeline imports.

  4. Application of hydraulically assembled shaft coupling hubs to large agitators

    International Nuclear Information System (INIS)

    Murray, W.E.; Anderson, T.D.; Bethmann, H.K.

    1991-01-01

    This paper describes the basis for and implementation of hydraulically assembled shaft coupling hubs for large tank-mounted agitators. This modification to the original design was intended to minimize maintenance personnel exposure to ionizing radiation and also provide for disassembly capability without damage to shafts or hubs. In addition to realizing these objectives, test confirmed that the modified couplings reduced agitator shaft end runouts approximately 65%, thereby reducing bearing loads and increasing service life, a significant enhancement for a nuclear facility. 5 refs

  5. Brokered virtual hubs for facilitating access and use of geospatial Open Data

    Science.gov (United States)

    Mazzetti, Paolo; Latre, Miguel; Kamali, Nargess; Brumana, Raffaella; Braumann, Stefan; Nativi, Stefano

    2016-04-01

    Open Data is a major trend in current information technology scenario and it is often publicised as one of the pillars of the information society in the near future. In particular, geospatial Open Data have a huge potential also for Earth Sciences, through the enablement of innovative applications and services integrating heterogeneous information. However, open does not mean usable. As it was recognized at the very beginning of the Web revolution, many different degrees of openness exist: from simple sharing in a proprietary format to advanced sharing in standard formats and including semantic information. Therefore, to fully unleash the potential of geospatial Open Data, advanced infrastructures are needed to increase the data openness degree, enhancing their usability. In October 2014, the ENERGIC OD (European NEtwork for Redistributing Geospatial Information to user Communities - Open Data) project, funded by the European Union under the Competitiveness and Innovation framework Programme (CIP), has started. In response to the EU call, the general objective of the project is to "facilitate the use of open (freely available) geographic data from different sources for the creation of innovative applications and services through the creation of Virtual Hubs". The ENERGIC OD Virtual Hubs aim to facilitate the use of geospatial Open Data by lowering and possibly removing the main barriers which hampers geo-information (GI) usage by end-users and application developers. Data and services heterogeneity is recognized as one of the major barriers to Open Data (re-)use. It imposes end-users and developers to spend a lot of effort in accessing different infrastructures and harmonizing datasets. Such heterogeneity cannot be completely removed through the adoption of standard specifications for service interfaces, metadata and data models, since different infrastructures adopt different standards to answer to specific challenges and to address specific use-cases. Thus

  6. Virtual Campus Hub technology

    DEFF Research Database (Denmark)

    Vercoulen, Frank; Badger, Merete; Monaco, Lucio

    This deliverable briefly describes which technological components have been delivered for the Virtual Campus Hub and how they can be used. A detailed discussion of the technical details of the components, how they were realized and how they fit the VCH concept can be found in deliverables D5.......4. Virtual Campus Hub Technology Evaluation Report and D6.7 The Virtual Campus Hub Concept....

  7. Modelagem para localização de hubs no transporte de encomendas expressas Modelling for location hubs in the express cargo transport

    Directory of Open Access Journals (Sweden)

    Javier Antonio Timaná Alamo

    2006-12-01

    Full Text Available Na presente pesquisa se propõe um modelo matemático de programação linear com variáveis binárias 0/1, para projetar a configuração de uma rede de distribuição de encomendas expressas, visando minimizar os custos e garantindo um bom nível de serviço. O modelo, que é uma modificação da formulação proposta por O’Kelly, define as posições dos hubs, a alocação deles às demais instalações físicas e a construção de roteiros com apenas uma parada intermediária, o que confere mais agilidade ao atendimento da demanda de transporte de carga. Considera-se a instalação de um único hub maior (Hub Principal, que serve como ponto de transbordo para os fluxos de carga entre as distintas regiões de um território, e um conjunto de terminais regionais (mini-hubs, servindo como ponto de conexão, unicamente, para os fluxos de carga existentes em um determinado raio de cobertura. Foram propostas extensões que incluem uma restrição da capacidade operacional do Hub Principal, para evitar seu congestionamento, e duas diferentes estratégias de induzir o aumento de fluxo de carga manipulado pelos mini-hubs. O modelo proposto e suas extensões foram aplicados ao estudo de um caso real, obtendo-se resultados consistentes e uma redução significativa no custo total da rede de distribuição da empresa analisada.This study proposes a mathematical model of linear programming with binary variables 0/1 to project the configuration of a distribution network for express cargo which aims to minimize costs and guarantee a high level of service. The model, which is a modification of the formulation proposed by O’Kelly, defines the position of the hubs, their allocation regarding the other physical installations, and the building of itineraries with only one intermediate stop, which increases agility in meeting the demand of cargo transport. It assumes the installation of a single, major hub (Main Hub, which serves as the transfer point for

  8. Permasalahan P-Hub Median Dengan Lintasan Terpendek

    OpenAIRE

    Pasaribu, Raja David

    2013-01-01

    Hub are facilities that serve as sorting, switching, and transhipment in a transportation network. P-hub median problem is a discrete case location allocation problem which all hub is fully connected. In this paper will be intoduced Mixed Integrer Linear Programming (MILP) formulation models of cost for p-hub median problem allocation for uncapacitaced single allocation p-hub median(USApHMP). In this paper also introduced Floyd-Warshall shortest path algorithm to solve p-hub median problems a...

  9. Using the Contextual Hub Analysis Tool (CHAT) in Cytoscape to Identify Contextually Relevant Network Hubs.

    Science.gov (United States)

    Muetze, Tanja; Lynn, David J

    2017-09-13

    Highly connected nodes in biological networks are called network hubs. Hubs are topologically important to the structure of the network and have been shown to be preferentially associated with a range of phenotypes of interest. The relative importance of a hub node, however, can change depending on the biological context. Here, we provide a step-by-step protocol for using the Contextual Hub Analysis Tool (CHAT), an application within Cytoscape 3, which enables users to easily construct and visualize a network of interactions from a gene or protein list of interest, integrate contextual information, such as gene or protein expression data, and identify hub nodes that are more highly connected to contextual nodes than expected by chance. © 2017 by John Wiley & Sons, Inc. Copyright © 2017 John Wiley & Sons, Inc.

  10. Using hub technology to facilitate information system integration in a health-care enterprise.

    Science.gov (United States)

    Gendler, S M; Friedman, B A; Henricks, W H

    1996-04-01

    The deployment and maintenance of multiple point-to-point interfaces between a clinical information system, such as a laboratory information system, and other systems within a healthcare enterprise is expensive and time consuming. Moreover, the demand for such interfaces is increasing as hospitals consolidate and clinical laboratories participate in the development of regional laboratory networks and create host-to-host links with laboratory outreach clients. An interface engine, also called a hub, is an evolving technology that could replace multiple point-to-point interfaces from a laboratory information system with a single interface to the hub, preferably HL7 based. The hub then routes and translates laboratory information to other systems within the enterprise. Changes in application systems in an enterprise where a centralized interface engine has been implemented then amount to thorough analysis, an update of the enterprise's data dictionary, purchase of a single new vendor-supported interface, and table-based parameter changes on the hub. Two other features of an interface engine, support for structured query language and information store-and-forward, will facilitate the development of clinical data repositories and provide flexibility when interacting with other host systems. This article describes the advantages and disadvantages of an interface engine and lists some problems not solved by the technology. Finally, early developmental experience with an interface engine at the University of Michigan Medical Center and the benefits of the project on system integration efforts are described, not the least of which has been the enthusiastic adoption of the HL7 standard for all future interface projects.

  11. Contextual Hub Analysis Tool (CHAT): A Cytoscape app for identifying contextually relevant hubs in biological networks.

    Science.gov (United States)

    Muetze, Tanja; Goenawan, Ivan H; Wiencko, Heather L; Bernal-Llinares, Manuel; Bryan, Kenneth; Lynn, David J

    2016-01-01

    Highly connected nodes (hubs) in biological networks are topologically important to the structure of the network and have also been shown to be preferentially associated with a range of phenotypes of interest. The relative importance of a hub node, however, can change depending on the biological context. Here, we report a Cytoscape app, the Contextual Hub Analysis Tool (CHAT), which enables users to easily construct and visualize a network of interactions from a gene or protein list of interest, integrate contextual information, such as gene expression or mass spectrometry data, and identify hub nodes that are more highly connected to contextual nodes (e.g. genes or proteins that are differentially expressed) than expected by chance. In a case study, we use CHAT to construct a network of genes that are differentially expressed in Dengue fever, a viral infection. CHAT was used to identify and compare contextual and degree-based hubs in this network. The top 20 degree-based hubs were enriched in pathways related to the cell cycle and cancer, which is likely due to the fact that proteins involved in these processes tend to be highly connected in general. In comparison, the top 20 contextual hubs were enriched in pathways commonly observed in a viral infection including pathways related to the immune response to viral infection. This analysis shows that such contextual hubs are considerably more biologically relevant than degree-based hubs and that analyses which rely on the identification of hubs solely based on their connectivity may be biased towards nodes that are highly connected in general rather than in the specific context of interest. CHAT is available for Cytoscape 3.0+ and can be installed via the Cytoscape App Store ( http://apps.cytoscape.org/apps/chat).

  12. Optimal hub location in pipeline networks

    Energy Technology Data Exchange (ETDEWEB)

    Dott, D.R.; Wirasinghe, S.C.; Chakma, A. [Univ. of Calgary, Alberta (Canada)

    1996-12-31

    This paper discusses optimization strategies and techniques for the location of natural gas marketing hubs in the North American gas pipeline network. A hub is a facility at which inbound and outbound network links meet and freight is redirected towards their destinations. Common examples of hubs used in the gas pipeline industry include gas plants, interconnects and market centers. Characteristics of the gas pipeline industry which are relevant to the optimization of transportation costs using hubs are presented. Allocation techniques for solving location-allocation problems are discussed. An outline of the research in process by the authors in the field of optimal gas hub location concludes the paper.

  13. LOCATING HUBS IN TRANSPORT NETWORKS: AN ARTIFICIAL INTELLIGENCE APPROACH

    OpenAIRE

    Dušan Teodorović; Milica Šelmić; Ivana Vukićević

    2014-01-01

    Hub facilities serve as switching and transshipment points in transportation and communication networks as well as in logistic systems. Hub networks have an influence on flows on the hub-to-hub links and ensure benefit from economies of scale in inter-hub transportation. The key factors for designing a successful hub-and-spoke network are to determine the optimal number of hubs, to properly locate hubs, and to allocate the non-hubs to the hubs. This paper presents the model to determine the l...

  14. Joint Hub Network Development

    NARCIS (Netherlands)

    Cruijssen, F.C.A.M.; Borm, P.E.M.; Dullaert, W.; Hamers, H.J.M.

    2007-01-01

    This paper introduces a framework for joint hub network development. Building a joint physical hub for transhipment of goods is expensive and therefore involves considerable risks for the cooperating companies. In a practical setting, it is unlikely that an entire network will be built at once.

  15. Southwest Regional Climate Hub and California Subsidiary Hub assessment of climate change vulnerability and adaptation and mitigation strategies

    Science.gov (United States)

    Emile Elias; Caiti Steele; Kris Havstad; Kerri Steenwerth; Jeanne Chambers; Helena Deswood; Amber Kerr; Albert Rango; Mark Schwartz; Peter Stine; Rachel Steele

    2015-01-01

    This report is a joint effort of the Southwest Regional Climate Hub and the California Subsidiary Hub (Sub Hub). The Southwest Regional Climate Hub covers Arizona, California, Hawai‘i and the U.S. affiliated Pacific Islands, Nevada, New Mexico, and Utah and contains vast areas of western rangeland, forests, and high-value specialty crops (Figure 1). The California Sub...

  16. Experimental Investigation of a Helicopter Rotor Hub Wake

    Science.gov (United States)

    Reich, David; Elbing, Brian; Schmitz, Sven

    2013-11-01

    A scaled model of a notional helicopter rotor hub was tested in the 48'' Garfield Thomas Water Tunnel at the Applied Research Laboratory Penn State. The main objectives of the experiment were to understand the spatial- and temporal content of the unsteady wake downstream of a rotor hub up to a distance corresponding to the empennage. Primary measurements were the total hub drag and velocity measurements at three nominal downstream locations. Various flow structures were identified and linked to geometric features of the hub model. The most prominent structures were two-per-revolution (hub component: scissors) and four-per-revolution (hub component: main hub arms) vortices shed by the hub. Both the two-per-revolution and four-per-revolution structures persisted far downstream of the hub, but the rate of dissipation was greater for the four-per-rev structures. This work provides a dataset for enhanced understanding of the fundamental physics underlying rotor hub flows and serves as validation data for future CFD analyses.

  17. Hub exchange operations in intermodal hub-and spoke networks: A performance comparison of rail-rail exchange facilities

    OpenAIRE

    Bontekoning, Y.M.

    2006-01-01

    The implementation of hub-and-spoke networks in intermodal transport is suggested as one of the potential solutions for helping to increase the intermodal market share. Traditionally, trains are shunted at hubs; this is a time-consuming process. Since the early 1990s a new type of intermodal terminal, specifically designed for fast tran-shipment at nodes in hub-and-spoke networks, has been introduced in Europe. These hub terminals could replace this time-consuming shunting. Studies on the new...

  18. The application of design criteria for locating a hub configured supply chain for a restaurant cluster in the Stellenbosch area

    Directory of Open Access Journals (Sweden)

    Claudia B. Struwig

    2013-06-01

    Full Text Available Restaurants, in general, utilise numerous suppliers. Normally they deliver on different days in the week and at different times during the day, logistically not an optimum approach. Not only does the current practice cause frequent interruptions, but by segregating the food supply chain unnecessary traffic is generated. This article investigated the need for developing a third party supplier hub, the best positioning of that hub and the most economical routes to the customers. With the aim of providing non-franchised restaurants with the necessary leverage to become market leaders, the hub is planned to only service the restaurants within the vicinity of the Stellenbosch area. In such a hub-configured supply chain, the suppliers would be delivering to the proposed hub, from where once-off deliveries to all the restaurants may be made on days and/or times determined by them. In order to investigate the benefits of providing such a hub structure, a systematic implementation approach was used. The first step was to do market research in order to establish the need for such a hub. That is, the viability of the hub from a restaurant’s perspective was established. The next step entailed the investigation of the design criteria needed in determining a favourable hub location. Four possible hub locations were identified. The Clark and Wright’s savings algorithm was then used to determine the optimal hub location and the feasibility of the results was verified with the aid of a global positioning system (GPS device. The last steps followed involved the determination of an effective hub floor plan that may be utilised, possible products that can be supplied to the restaurants and the necessary assets needed to provide the hub’s service. Finally, by incorporating all these facets, a cost analysis was done to determine the hub’s profitability.

  19. MyGeoHub: A Collaborative Geospatial Research and Education Platform

    Science.gov (United States)

    Kalyanam, R.; Zhao, L.; Biehl, L. L.; Song, C. X.; Merwade, V.; Villoria, N.

    2017-12-01

    Scientific research is increasingly collaborative and globally distributed; research groups now rely on web-based scientific tools and data management systems to simplify their day-to-day collaborative workflows. However, such tools often lack seamless interfaces, requiring researchers to contend with manual data transfers, annotation and sharing. MyGeoHub is a web platform that supports out-of-the-box, seamless workflows involving data ingestion, metadata extraction, analysis, sharing and publication. MyGeoHub is built on the HUBzero cyberinfrastructure platform and adds general-purpose software building blocks (GABBs), for geospatial data management, visualization and analysis. A data management building block iData, processes geospatial files, extracting metadata for keyword and map-based search while enabling quick previews. iData is pervasive, allowing access through a web interface, scientific tools on MyGeoHub or even mobile field devices via a data service API. GABBs includes a Python map library as well as map widgets that in a few lines of code, generate complete geospatial visualization web interfaces for scientific tools. GABBs also includes powerful tools that can be used with no programming effort. The GeoBuilder tool provides an intuitive wizard for importing multi-variable, geo-located time series data (typical of sensor readings, GPS trackers) to build visualizations supporting data filtering and plotting. MyGeoHub has been used in tutorials at scientific conferences and educational activities for K-12 students. MyGeoHub is also constantly evolving; the recent addition of Jupyter and R Shiny notebook environments enable reproducible, richly interactive geospatial analyses and applications ranging from simple pre-processing to published tools. MyGeoHub is not a monolithic geospatial science gateway, instead it supports diverse needs ranging from just a feature-rich data management system, to complex scientific tools and workflows.

  20. Composite hub/metal blade compressor rotor

    Science.gov (United States)

    Yao, S.

    1978-01-01

    A low cost compressor rotor was designed and fabricated for a small jet engine. The rotor hub and blade keepers were compression molded with graphite epoxy. Each pair of metallic blades was held in the hub by a keeper. All keepers were locked in the hub with circumferential windings. Feasibility of fabrication was demonstrated in this program.

  1. A new transport hub

    CERN Multimedia

    Corinne Pralavorio

    2016-01-01

    CERN’s new Mobility Centre, allowing you to switch easily from one mode of transport to another, has just been officially opened.   Inauguration of the CERN Mobility Centre by Martin Steinacher, Director for Finance and Human Resources, and Lluis Miralles, Head of the SMB department. CERN’s new Mobility Centre, on the car park next to the Globe of Science and Innovation was officially opened on Tuesday, 22 March. The centre brings together all of CERN’s transport options in a single location. "Our aim is to create an intermodal hub where CERN users and personnel can switch from one mode of transport to another, and from CERN transport to public transport," explains Lluis Miralles, head of the Site Management and Buildings (SMB) department. The Mobility Centre incorporates the CERN bike and car rental services, the self-service car- and bike-sharing schemes, and SIXT car rental facilities (for long-distance journeys). It is located right ne...

  2. Data Collection and Management with ENSITE HUB: ENSITE HUB Version 1.0

    Science.gov (United States)

    2017-08-01

    ER D C/ CE RL S R- 17 -1 4 Engineer Site Identification for the Tactical Environment (ENSITE) Data Collection and Management with ENSITE...and Management with ENSITE HUB ENSITE HUB Version 1.0 Juliana M. Wilhoit, Natalie R. Myers, and George W. Calfas Construction Engineering Research...and standardized manner. With such a tool, CB planners (as well as designers, operators, and manag - ers) can rapidly assess possible current and

  3. Experimental Investigation of a Helicopter Rotor Hub Flow

    Science.gov (United States)

    Reich, David

    The rotor hub system is by far the largest contributor to helicopter parasite drag and a barrier to increasing helicopter forward-flight speed and range. Additionally, the hub sheds undesirable vibration- and instability-inducing unsteady flow over the empennage. The challenges associated with rotor hub flows are discussed, including bluff body drag, interactional aerodynamics, and the effect of the turbulent hub wake on the helicopter empennage. This study was conducted in three phases to quantify model-scale rotor hub flows in water tunnels at The Pennsylvania State University Applied research lab. The first phase investigated scaling and component interaction effects on a 1:17 scale rotor hub model in the 12-inch diameter water tunnel. Effects of Reynolds number, advance ratio, and hub geometry configuration on the drag and wake shed from the rotor hub were quantified using load cell measurements and particle-image velocimetry (PIV). The second phase focused on flow visualization and measurement on a rotor hub and rotor hub/pylon geometry in the 12-inch diameter water tunnel. Stereo PIV was conducted in a cross plane downstream of the hub and flow visualization was conducted using oil paint and fluorescent dye. The third phase concentrated on high accuracy load measurement and prediction up to full-scale Reynolds number on a 1:4.25 scale model in the 48-inch diameter water tunnel. Measurements include 6 degree of freedom loads on the hub and two-component laser-Doppler velocimetry in the wake. Finally, results and conclusions are discussed, followed by recommendations for future investigations.

  4. The NCAR Digital Asset Services Hub (DASH): Implementing Unified Data Discovery and Access

    Science.gov (United States)

    Stott, D.; Worley, S. J.; Hou, C. Y.; Nienhouse, E.

    2017-12-01

    The National Center for Atmospheric Research (NCAR) Directorate created the Data Stewardship Engineering Team (DSET) to plan and implement an integrated single entry point for uniform digital asset discovery and access across the organization in order to improve the efficiency of access, reduce the costs, and establish the foundation for interoperability with other federated systems. This effort supports new policies included in federal funding mandates, NSF data management requirements, and journal citation recommendations. An inventory during the early planning stage identified diverse asset types across the organization that included publications, datasets, metadata, models, images, and software tools and code. The NCAR Digital Asset Services Hub (DASH) is being developed and phased in this year to improve the quality of users' experiences in finding and using these assets. DASH serves to provide engagement, training, search, and support through the following four nodes (see figure). DASH MetadataDASH provides resources for creating and cataloging metadata to the NCAR Dialect, a subset of ISO 19115. NMDEdit, an editor based on a European open source application, has been configured for manual entry of NCAR metadata. CKAN, an open source data portal platform, harvests these XML records (along with records output directly from databases) from a Web Accessible Folder (WAF) on GitHub for validation. DASH SearchThe NCAR Dialect metadata drives cross-organization search and discovery through CKAN, which provides the display interface of search results. DASH search will establish interoperability by facilitating metadata sharing with other federated systems. DASH ConsultingThe DASH Data Curation & Stewardship Coordinator assists with Data Management (DM) Plan preparation and advises on Digital Object Identifiers. The coordinator arranges training sessions on the DASH metadata tools and DM planning, and provides one-on-one assistance as requested. DASH Repository

  5. Soft hub for bearingless rotors

    Science.gov (United States)

    Dixon, Peter G. C.

    1991-01-01

    Soft hub concepts which allow the direct replacement of articulated rotor systems by bearingless types without any change in controllability or need for reinforcement to the drive shaft and/or transmission/fuselage attachments of the helicopter were studied. Two concepts were analyzed and confirmed for functional and structural feasibility against a design criteria and specifications established for this effort. Both systems are gimballed about a thrust carrying universal elastomeric bearing. One concept includes a set of composite flexures for drive torque transmittal from the shaft to the rotor, and another set (which is changeable) to impart hub tilting stiffness to the rotor system as required to meet the helicopter application. The second concept uses a composite bellows flexure to drive the rotor and to augment the hub stiffness provided by the elastomeric bearing. Each concept was assessed for weight, drag, ROM cost, and number of parts and compared with the production BO-105 hub.

  6. Health Care Services

    Science.gov (United States)

    Misuse and Addiction Prevention Finance & Management Services Health Care Services Juvenile Justice , 2017 Warning - A phone number that was once used for the Denali KidCare program is now being used to ask people for their credit card number in order to win a prize. The phone number related to this

  7. Omni directional mobile robot capable of variable foot printing based on hub type drive module

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hyo Joong; Cho, Chang Nho; Kim, Hwi Su; Song, Jae Bok [Korea Univ., Seoul (Korea, Republic of)

    2012-03-15

    In recent years, an increased amount of research has been carried out on mobile robots to improve the performance of service robots. Mobile robots maximize the mobility of service robots, thus allowing them to work in different areas. However, conventional service robots have their center of mass placed high above the ground, which may cause them to fall when moving at high speed. Furthermore, hub type actuators, which are often used for mobile robots, are large and expensive. In this study, we propose a mobile robot with a hub type actuator unit and a variable footprint mechanism. The proposed variable footprint mechanism greatly improves the stability and mobility of the robot, allowing it to move freely in a narrow space and carry out various tasks. The performance of the proposed robot is verified experimentally.

  8. Fleet deployment, network design and hub location of liner shipping companies

    DEFF Research Database (Denmark)

    Gelareh, Shahin; Pisinger, David

    2011-01-01

    A mixed integer linear programming formulation is proposed for the simultaneous design of network and fleet deployment of a deep-sea liner service provider. The underlying network design problem is based on a 4-index (5-index by considering capacity type) formulation of the hub location problem...

  9. Home Care Services

    Science.gov (United States)

    Home care is care that allows a person with special needs stay in their home. It might be for people who are getting ... are chronically ill, recovering from surgery, or disabled. Home care services include Personal care, such as help ...

  10. Schools as Community Hubs: Policy Contexts, Educational Rationales, and Design Challenges

    Science.gov (United States)

    McShane, Ian; Watkins, Jerry; Meredyth, Denise

    2012-01-01

    There is increasing interest in making more effective use of schools as community hubs, both in Australia and internationally. Investment in shared facilities aims to engage parents and local communities in schooling, encourage civic participation, co-ordinate educational and community services and overcome disadvantages of location or service…

  11. Supervised hub-detection for brain connectivity

    DEFF Research Database (Denmark)

    Kasenburg, Niklas; Liptrot, Matthew George; Reislev, Nina Linde

    2016-01-01

    , but can smooth discriminative signals in the population, degrading predictive performance. We present a novel hub-detection optimized for supervised learning that both clusters network nodes based on population level variation in connectivity and also takes the learning problem into account. The found......A structural brain network consists of physical connections between brain regions. Brain network analysis aims to find features associated with a parameter of interest through supervised prediction models such as regression. Unsupervised preprocessing steps like clustering are often applied...... hubs are a low-dimensional representation of the network and are chosen based on predictive performance as features for a linear regression. We apply our method to the problem of finding age-related changes in structural connectivity. We compare our supervised hub-detection (SHD) to an unsupervised hub...

  12. Capacitated Bounded Cardinality Hub Routing Problem: Model and Solution Algorithm

    OpenAIRE

    Gelareha, Shahin; Monemic, Rahimeh Neamatian; Semetd, Frederic

    2017-01-01

    In this paper, we address the Bounded Cardinality Hub Location Routing with Route Capacity wherein each hub acts as a transshipment node for one directed route. The number of hubs lies between a minimum and a maximum and the hub-level network is a complete subgraph. The transshipment operations take place at the hub nodes and flow transfer time from a hub-level transporter to a spoke-level vehicle influences spoke- to-hub allocations. We propose a mathematical model and a branch-and-cut algor...

  13. Home care services for sick children

    DEFF Research Database (Denmark)

    Castor, Charlotte; Hallström, Inger; Hansson, Eva Helena

    2017-01-01

    as challenging for healthcare professionals in home care services used to providing care predominately for adults. DESIGN: An inductive qualitative design. METHOD: Seven focus group interviews were performed with 36 healthcare professionals from multidisciplinary home care services. Data were analysed stepwise......AIMS AND OBJECTIVES: To explore healthcare professionals' conceptions of caring for sick children in home care services. BACKGROUND: Families often prefer home care to hospital care, and the number of home care services for children is increasing. Caring for children at home has been recognised...... using a phenomenographic analysis. RESULTS: Three description categories emerged: "A challenging opportunity", "A child perspective", and "Re-organise in accordance with new prerequisites." Providing home care services for children was conceived to evoke both professional and personal challenges...

  14. Environmental and self-sufficiency assessment of the energy metabolism of tourist hubs on Mediterranean Islands: The case of Menorca (Spain)

    International Nuclear Information System (INIS)

    Sanyé-Mengual, Esther; Romanos, Héctor; Molina, Catalina; Oliver, M. Antònia; Ruiz, Núria; Pérez, Marta; Carreras, David; Boada, Martí; Garcia-Orellana, Jordi; Duch, Jordi; Rieradevall, Joan

    2014-01-01

    Energy performance of island tourism has been analyzed in the literature. However, tourist services tend to concentrate in tourist hubs, especially where mass tourism predominates (e.g., Mediterranean), and the energy metabolism of these systems has not yet been assessed. The present paper models and estimates the energy metabolism of tourist hubs in the Menorca Island (Spain) by integrating social, geographical and environmental methods. Mobility (both external and internal) and consumption of lodging services were characterized through surveys to users (tourists) and business managers. An environmental assessment evaluated CO 2 emissions, and energy self-sufficiency potential was estimated via GIS data. The results indicate that, on average, a tourist consumes 4756 MJ with associated emissions of 277 kg of CO 2 per stay (20 days on average). Of all the energy flows, external mobility contributes the most to total emissions (77%). For every day spent in a tourist hub, a tourist consumes between 29 MJ and 93 MJ in lodging services, consumption that could be 100% satisfied by photovoltaic systems, and these systems would result in positive effects for the island. Sustainable tourism management might focus on promoting environmentally friendly transportation, energy efficient practices, and environmental communication through ecolabeling. - Highlights: • We modeled the entire energy metabolism of tourist hubs in islands. • Results showed that a tourist in Menorca consumes from 4000 to 6000 MJ per trip. • External mobility (trip to the island) accounts for 77% of the total CO 2 emissions. • Photovoltaic systems could provide enough power to achieve self-sufficiency. • Tourists at hotel hubs have higher energy consumption than other types of hubs

  15. Telefacturing Based Distributed Manufacturing Environment for Optimal Manufacturing Service by Enhancing the Interoperability in the Hubs

    Directory of Open Access Journals (Sweden)

    V. K. Manupati

    2017-01-01

    Full Text Available Recent happenings are surrounding the manufacturing sector leading to intense progress towards the development of effective distributed collaborative manufacturing environments. This evolving collaborative manufacturing not only focuses on digitalisation of this environment but also necessitates service-dependent manufacturing system that offers an uninterrupted approach to a number of diverse, complicated, dynamic manufacturing operations management systems at a common work place (hub. This research presents a novel telefacturing based distributed manufacturing environment for recommending the manufacturing services based on the user preferences. The first step in this direction is to deploy the most advanced tools and techniques, that is, Ontology-based Protégé 5.0 software for transforming the huge stored knowledge/information into XML schema of Ontology Language (OWL documents and Integration of Process Planning and Scheduling (IPPS for multijobs in a collaborative manufacturing system. Thereafter, we also investigate the possibilities of allocation of skilled workers to the best feasible operations sequence. In this context, a mathematical model is formulated for the considered objectives, that is, minimization of makespan and total training cost of the workers. With an evolutionary algorithm and developed heuristic algorithm, the performance of the proposed manufacturing system has been improved. Finally, to manifest the capability of the proposed approach, an illustrative example from the real-time manufacturing industry is validated for optimal service recommendation.

  16. Contextual Hub Analysis Tool (CHAT: A Cytoscape app for identifying contextually relevant hubs in biological networks [version 2; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Tanja Muetze

    2016-08-01

    Full Text Available Highly connected nodes (hubs in biological networks are topologically important to the structure of the network and have also been shown to be preferentially associated with a range of phenotypes of interest. The relative importance of a hub node, however, can change depending on the biological context. Here, we report a Cytoscape app, the Contextual Hub Analysis Tool (CHAT, which enables users to easily construct and visualize a network of interactions from a gene or protein list of interest, integrate contextual information, such as gene expression or mass spectrometry data, and identify hub nodes that are more highly connected to contextual nodes (e.g. genes or proteins that are differentially expressed than expected by chance. In a case study, we use CHAT to construct a network of genes that are differentially expressed in Dengue fever, a viral infection. CHAT was used to identify and compare contextual and degree-based hubs in this network. The top 20 degree-based hubs were enriched in pathways related to the cell cycle and cancer, which is likely due to the fact that proteins involved in these processes tend to be highly connected in general. In comparison, the top 20 contextual hubs were enriched in pathways commonly observed in a viral infection including pathways related to the immune response to viral infection. This analysis shows that such contextual hubs are considerably more biologically relevant than degree-based hubs and that analyses which rely on the identification of hubs solely based on their connectivity may be biased towards nodes that are highly connected in general rather than in the specific context of interest.   Availability: CHAT is available for Cytoscape 3.0+ and can be installed via the Cytoscape App Store (http://apps.cytoscape.org/apps/chat.

  17. Development of Europe's gas hubs: Implications for East Asia

    Directory of Open Access Journals (Sweden)

    Xunpeng Shi

    2016-10-01

    Full Text Available Gas trading hubs have been initially developed in the US in 1980s, UK in 1990s, more recently in European in the 2000s and mulled in East Asia now. Due to its freshness and diversification in nationality, governance and culture, the European hub experience can offer valuable lessons for East Asia. This paper seeks to advance understanding of gas hub development in Europe and provide lessons for East Asia. The European experience highlights that market liberalization and transition of gas pricing mechanism are necessary in creating the competitive markets that are needed for functional gas hubs. Political will and regulations further safeguard the competition environment needed for hub development. Natural factors, such as significant domestic production and culture could have a significant impact on the hub development and transition of pricing mechanism. In East Asia, the path to gas trading hubs might be more difficult than in Europe but a growing market creates an opportunity to start new terms with new contracts. Nevertheless, East Asian needs to work hard to development its indigenous gas or LNG trading hubs.

  18. Virtual Campus Hub technical evaluation report

    DEFF Research Database (Denmark)

    Vercoulen, Frank; Badger, Merete; Monaco, Lucio

    This report describes and discusses the technical achievements of the Virtual Campus Hub project and formulates a brief agenda for the future.......This report describes and discusses the technical achievements of the Virtual Campus Hub project and formulates a brief agenda for the future....

  19. Multiple-Localization and Hub Proteins

    Science.gov (United States)

    Ota, Motonori; Gonja, Hideki; Koike, Ryotaro; Fukuchi, Satoshi

    2016-01-01

    Protein-protein interactions are fundamental for all biological phenomena, and protein-protein interaction networks provide a global view of the interactions. The hub proteins, with many interaction partners, play vital roles in the networks. We investigated the subcellular localizations of proteins in the human network, and found that the ones localized in multiple subcellular compartments, especially the nucleus/cytoplasm proteins (NCP), the cytoplasm/cell membrane proteins (CMP), and the nucleus/cytoplasm/cell membrane proteins (NCMP), tend to be hubs. Examinations of keywords suggested that among NCP, those related to post-translational modifications and transcription functions are the major contributors to the large number of interactions. These types of proteins are characterized by a multi-domain architecture and intrinsic disorder. A survey of the typical hub proteins with prominent numbers of interaction partners in the type revealed that most are either transcription factors or co-regulators involved in signaling pathways. They translocate from the cytoplasm to the nucleus, triggered by the phosphorylation and/or ubiquitination of intrinsically disordered regions. Among CMP and NCMP, the contributors to the numerous interactions are related to either kinase or ubiquitin ligase activity. Many of them reside on the cytoplasmic side of the cell membrane, and act as the upstream regulators of signaling pathways. Overall, these hub proteins function to transfer external signals to the nucleus, through the cell membrane and the cytoplasm. Our analysis suggests that multiple-localization is a crucial concept to characterize groups of hub proteins and their biological functions in cellular information processing. PMID:27285823

  20. Creating Service Concepts for Finnish Elderly Care : Case: Virtual Interactive Care Service

    OpenAIRE

    Nwagu, Promise

    2016-01-01

    This thesis looks at creating service concept by evaluating the research project of Virtual Interactive Care Service. The research project was initiated and implemented by the author together with Hovi Group Oy and Suomen kotilääkäripalvelu Oy. The goal was to provide a virtual care service business that uses interactive and stimulating activities to improve the wellbeing of elderly people in Finland. The study employed qualitative research method by reviewing existing works particularly...

  1. A framework for creating an ICT knowledge hub in Zimbabwe: A holistic approach in fostering economic growth

    Directory of Open Access Journals (Sweden)

    Gilbert Mahlangu

    2018-01-01

    Full Text Available ICT knowledge hubs are important resources for a country to grow towards an innovative economy. Their growth has been viewed as a node point for techno-prenuership development and economic sustainability by many countries. The purpose of this study was to establish how Zimbabwe as a developing country should move towards the creation of an ICT knowledge hub that will promote economic growth in line with the Zimbabwe Agenda for Sustainable Socio-Economic Transformation (ZimAsset economic blueprint crafted in 2013. A qualitative research design was used whereby literature was conducted to establish models for ICT Knowledge hub creation while two focus group discussions were held with academia, research agents and software developers to achieve face validity and in-depth interviews were held with officials from The Ministry of ICT Postal and Courier services. The consensus was reached on the need for creating a focal point which will act as a cyber-port where ICT driven solutions can be obtained based on the industry needs. The focus group discussions settled for four components in creating an ICT knowledge hub. These are planning function, development function, management function and co-ordinating function. The research also established that the Ministry of ICT and Courier services in Zimbabwe has set up an innovation fund to encourage and reward innovation and craftsmanship in Zimbabwe mainly targeted at the youths. The government acquired the high-performance computing facility which is stationed at the University of Zimbabwe. The ICT hub should be used to facilitate access and use of this resource. Every country should therefore strive to create its own centre of innovation which enables it to gain maximum utility from its indigenous people in order to fully utilise ICTs for industry development and spearhead economic growth. The study recommends that there is need for establishing an ICT Knowledge hub in the country.

  2. Adoption of Lean Thinking and Service Improvement for Care Home Service

    OpenAIRE

    Chuang-Chun Chiou

    2014-01-01

    Ageing population is a global trend; therefore the need of care service has been increasing dramatically. There are three basic forms of service delivered to the elderly: institution, community, and home. Particularly, the institutional service can be seen as an extension of medical service. The nursing home or so-called care home which is equipped with professional staff and facilities can provide a variety of service including rehabilitation service, short-term care, and long term care. Sim...

  3. Regional Hub port development : the case of Montevideo, Uruguay

    OpenAIRE

    Wilmsmeier, Gordon; Martínez Zarzoso, Inmaculada; Fiess, Norbert

    2011-01-01

    This paper reflects on port development in Uruguay in an environment of trilateral interport competition. The regional characteristics of port development in terms of their geographical, functional and operational characteristics are discussed by analysing the port system’s evolution. The case of Montevideo as the success or failure of a regional hub port development strategy is analysed in detail. Particular attention is given to the evolution and impact of the liner shipping service network...

  4. Hub location proplems under polyhedral demand uncertainty

    OpenAIRE

    Meraklı, Merve

    2015-01-01

    Cataloged from PDF version of thesis. Includes bibliographical references (leaves 69-74). Thesis (M.S.): Bilkent University, Department of Industrial Engineering, İhsan Doğramacı Bilkent University, 2015. Hubs are points of consolidation and transshipment in many-to-many distribution systems that bene t from economies of scale. In hub location problems, the aim is to locate hub facilities such that each pairwise demand is satis ed and the total cost is minimized. The problem...

  5. Competition and coordination in the U.S. airline hub-to-hub markets: An industry pre-merger case study

    Directory of Open Access Journals (Sweden)

    Prasun Bhattacharjee

    2016-04-01

    Full Text Available Purpose: This paper investigates the nature of conduct that existed in the U.S. airline hub-to-hub markets prior to the recent merger wave of the legacy carriers. We explore the strategic importance of network carrier hubs in form of “spheres of influence” on airline market conduct. We also simultaneously recognize the overgrowing role played by Low Cost Carriers (LCC over the years by estimating two conduct parameters - one in markets where LCCs directly compete head-to-head with legacy carriers and the other for markets which LCCs do not serve but has presence in the hub airports or adjacent airports comprising the market endpoints. Thus our supply side framework also sheds some light on the issue of perfect contestability in airline industry. Design/methodology/approach: We estimate a structural oligopoly model for differentiated products with competitive interactions using DB1B data for first quarter of 2004. Findings: Our results imply that the nature of competition is more aggressive relative to Bertrand behavior in hub-to-hub markets and that these markets are less than perfectly contestable. Originality/value: This paper adds to the empirical literature of airline competition by enabling estimation of the actual conduct parameter assuming firm price setting behavior in presence of product differentiation. Contrary to existing literature on airline competition, a structural model enables us to systematically separate out effects of demand, cost and strategic factors on observed airline prices.

  6. Numerical study of hub taper angle on podded propeller performance

    International Nuclear Information System (INIS)

    Islam, M.F.; Veitch, B.; Bose, N.; Liu, P.

    2005-01-01

    Presently, the majority of podded propulsion systems are of the pulling type, because this type provides better hydrodynamic efficiency than the pushing type. There are several possible explanations for the better overall performance of a puller type podded propulsor. One is related to the difference in hub shape. Puller and pusher propellers have opposite hub taper angles, hence different hub and blade root shape. These differences cause changes in the flow condition and possibly influence the overall performance. The current study focuses on the variation in performance of pusher and puller propellers with the same blade sections, but different hub taper angles. A hyperboloidal low order source doublet steady/unsteady time domain panel method code was modified and used to evaluate effects of hub taper angle on the open water propulsive performance of some fixed pitch screw propellers used in podded propulsion systems. The modified code was first validated against measurements of two model propellers in terms of average propulsive performance and good agreement was found. Major findings include significant effects of hub taper angle on propulsive performance of tapered hub propellers and noticeable effects of hub taper angle on sectional pressure distributions of tapered hub propeller blades. (author)

  7. Lessons from tele-emergency: improving care quality and health outcomes by expanding support for rural care systems.

    Science.gov (United States)

    Mueller, Keith J; Potter, Andrew J; MacKinney, A Clinton; Ward, Marcia M

    2014-02-01

    Tele-emergency services provide immediate and synchronous audio/video connections, most commonly between rural low-volume hospitals and an urban "hub" emergency department. We performed a systematic literature review to identify tele-emergency models and outcomes. We then studied a large tele-emergency service in the upper Midwest. We sent a user survey to all seventy-one hospitals that used the service and received 292 replies. We also conducted telephone interviews and site visits with ninety clinicians and administrators at twenty-nine of these hospitals. Participants reported that tele-emergency improves clinical quality, expands the care team, increases resources during critical events, shortens time to care, improves care coordination, promotes patient-centered care, improves the recruitment of family physicians, and stabilizes the rural hospital patient base. However, inconsistent reimbursement policy, cross-state licensing barriers, and other regulations hinder tele-emergency implementation. New value-based payment systems have the potential to reduce these barriers and accelerate tele-emergency expansion.

  8. Community care and social services.

    OpenAIRE

    Renwick, D.

    1996-01-01

    The aim of community care is to enable people with various types of disability to live in their own homes, rather than in institutions. This involves the provision of support and services at home by various agencies. After a critical report in 1986 identified problems with coordination and flexibility of community care services, the white paper Caring for People (1989) stated the government's aim to provide a "needs led," responsive range of services, promoting maximum independence of those w...

  9. Developmental Changes in Brain Network Hub Connectivity in Late Adolescence.

    Science.gov (United States)

    Baker, Simon T E; Lubman, Dan I; Yücel, Murat; Allen, Nicholas B; Whittle, Sarah; Fulcher, Ben D; Zalesky, Andrew; Fornito, Alex

    2015-06-17

    The human brain undergoes substantial development throughout adolescence and into early adulthood. This maturational process is thought to include the refinement of connectivity between putative connectivity hub regions of the brain, which collectively form a dense core that enhances the functional integration of anatomically distributed, and functionally specialized, neural systems. Here, we used longitudinal diffusion magnetic resonance imaging to characterize changes in connectivity between 80 cortical and subcortical anatomical regions over a 2 year period in 31 adolescents between the ages of 15 and 19 years. Connectome-wide analysis indicated that only a small subset of connections showed evidence of statistically significant developmental change over the study period, with 8% and 6% of connections demonstrating decreased and increased structural connectivity, respectively. Nonetheless, these connections linked 93% and 90% of the 80 regions, respectively, pointing to a selective, yet anatomically distributed pattern of developmental changes that involves most of the brain. Hub regions showed a distinct tendency to be highly connected to each other, indicating robust "rich-club" organization. Moreover, connectivity between hubs was disproportionately influenced by development, such that connectivity between subcortical hubs decreased over time, whereas frontal-subcortical and frontal-parietal hub-hub connectivity increased over time. These findings suggest that late adolescence is characterized by selective, yet significant remodeling of hub-hub connectivity, with the topological organization of hubs shifting emphasis from subcortical hubs in favor of an increasingly prominent role for frontal hub regions. Copyright © 2015 the authors 0270-6474/15/359078-10$15.00/0.

  10. Flow Structures within a Helicopter Rotor Hub Wake

    Science.gov (United States)

    Elbing, Brian; Reich, David; Schmitz, Sven

    2015-11-01

    A scaled model of a notional helicopter rotor hub was tested in the 48'' Garfield Thomas Water Tunnel at the Applied Research Laboratory Penn State. The measurement suite included total hub drag and wake velocity measurements (LDV, PIV, stereo-PIV) at three downstream locations. The main objective was to understand the spatiotemporal evolution of the unsteady wake between the rotor hub and the nominal location of the empennage (tail). Initial analysis of the data revealed prominent two- and four-per-revolution fluid structures linked to geometric hub features persisting into the wake far-field. In addition, a six-per-revolution fluid structure was observed in the far-field, which is unexpected due to the lack of any hub feature with the corresponding symmetry. This suggests a nonlinear interaction is occurring within the wake to generate these structures. This presentation will provide an overview of the experimental data and analysis with particular emphasis on these six-per-revolution structures.

  11. Air network performance and hub competitive position: evaluation of primary airports in East and South-East Asia

    NARCIS (Netherlands)

    Burghouwt, G.; de Wit, J.; Veldhuis, J.; Matsumoto, H.

    2009-01-01

    The growth of hub-and-spoke operations has changed the structure of competition among airlines and airports, meaning that airlines now compete both directly (air services from A to B) as well as indirectly (services from A to B via H). Traditional measures of airport performance, such as passenger

  12. Improving Customer Service in Elderly Care

    OpenAIRE

    Nielsen, Chris

    2015-01-01

    The elderly care sector is increasingly facing more competition and demanding customers. This leads to a growing pressure on elderly care home providers to find new and improved solutions that will enhance their level of customer service. The will ensure that the elderly service provider is remaining competitive in the elderly care service marketplace. The purpose of this thesis is to identify areas for improvements and propose implementable solutions for enhancing the elderly care custom...

  13. Channel Bonding in Linux Ethernet Environment using Regular Switching Hub

    Directory of Open Access Journals (Sweden)

    Chih-wen Hsueh

    2004-06-01

    Full Text Available Bandwidth plays an important role for quality of service in most network systems. There are many technologies developed to increase host bandwidth in a LAN environment. Most of them need special hardware support, such as switching hub that supports IEEE Link Aggregation standard. In this paper, we propose a Linux solution to increase the bandwidth between hosts with multiple network adapters connected to a regular switching hub. The approach is implemented as two Linux kernel modules in a LAN environment without modification to the hardware and operating systems on host machines. Packets are dispatched to bonding network adapters for transmission. The proposed approach is backward compatible, flexible and transparent to users and only one IP address is needed for multiple bonding network adapters. Evaluation experiments in TCP and UDP transmission are shown with bandwidth gain proportionally to the number of network adapters. It is suitable for large-scale LAN systems with high bandwidth requirement, such as clustering systems.

  14. Home Care Services: Questions to Ask

    Science.gov (United States)

    Healthy Lifestyle Healthy aging Home care services range from medical care to help with daily household chores. If ... 12, 2017 Original article: http://www.mayoclinic.org/healthy-lifestyle/healthy-aging/in-depth/home-care-services/art- ...

  15. Logistics hubs: an integration of transport infrastructure

    CSIR Research Space (South Africa)

    Botha, M

    2008-07-01

    Full Text Available " that have jumped on the band wagon pushing for logistics hubs to be established in their regions or within their areas of jurisdiction. The feasibility of a logistics hub is dependent on a number of criteria with access to ideally more than two...

  16. From “Comprehensive Transportation Hub” to “City New Sitting Room”---Overall the design about Jinan East district comprehensive transportation hub

    Science.gov (United States)

    Lv, Jie; Guo, Jianmin; Li, Jin

    2017-08-01

    integrated transport hub or high-speed rail station often talked about, often known as the “city portal” and the title of “city window”, so the comprehensive transportation hub or the high-speed rail station of a city is very important to a region or a provincial. At the same time, it reflects that the managers and users of a city only focus on the comprehensive transportation hub of transportation service function and ignore her cities attributes and functions. Jinan east district comprehensive transportation hub in the beginning of design is given a feature that it has to serve both the traffic and city. We are trying to build a new center for Jinan east new town, the window to welcome people, the city hall of hospitality.

  17. Service Users' Involvement and Engagement in Interprofessional Care.

    Science.gov (United States)

    Kaini, B K

    2016-01-01

    Interprofessional care is joint working between health care professionals by pooling their skills, knowledge and expertise, to make joint decisions and learn from each other for the benefits of service users and healthcare professionals. Service users involvement is considered as one of the important aspects of planning, management and decision making process in the delivery of health care to service users. Service users' involvement is not the same as public involvement and partnership arrangements in health care. The active involvement and engagement of service users in health care positively contributes to improve quality of care, to promote better health and to shape the future of health services. Service users are always at the centre of health care professionals' values, work ethics and roles. Moreover, service users centred interprofessional team collaboration is very important to deliver effective health services.

  18. An Endosymbiotic Evolutionary Algorithm for the Hub Location-Routing Problem

    Directory of Open Access Journals (Sweden)

    Ji Ung Sun

    2015-01-01

    Full Text Available We consider a capacitated hub location-routing problem (HLRP which combines the hub location problem and multihub vehicle routing decisions. The HLRP not only determines the locations of the capacitated p-hubs within a set of potential hubs but also deals with the routes of the vehicles to meet the demands of customers. This problem is formulated as a 0-1 mixed integer programming model with the objective of the minimum total cost including routing cost, fixed hub cost, and fixed vehicle cost. As the HLRP has impractically demanding for the large sized problems, we develop a solution method based on the endosymbiotic evolutionary algorithm (EEA which solves hub location and vehicle routing problem simultaneously. The performance of the proposed algorithm is examined through a comparative study. The experimental results show that the proposed EEA can be a viable solution method for the supply chain network planning.

  19. Learning Graphical Models With Hubs.

    Science.gov (United States)

    Tan, Kean Ming; London, Palma; Mohan, Karthik; Lee, Su-In; Fazel, Maryam; Witten, Daniela

    2014-10-01

    We consider the problem of learning a high-dimensional graphical model in which there are a few hub nodes that are densely-connected to many other nodes. Many authors have studied the use of an ℓ 1 penalty in order to learn a sparse graph in the high-dimensional setting. However, the ℓ 1 penalty implicitly assumes that each edge is equally likely and independent of all other edges. We propose a general framework to accommodate more realistic networks with hub nodes, using a convex formulation that involves a row-column overlap norm penalty. We apply this general framework to three widely-used probabilistic graphical models: the Gaussian graphical model, the covariance graph model, and the binary Ising model. An alternating direction method of multipliers algorithm is used to solve the corresponding convex optimization problems. On synthetic data, we demonstrate that our proposed framework outperforms competitors that do not explicitly model hub nodes. We illustrate our proposal on a webpage data set and a gene expression data set.

  20. Lean GHTorrent : GitHub data on demand

    NARCIS (Netherlands)

    Gousios, G.; Vasilescu, B.N.; Serebrenik, A.; Zaidman, A.

    2014-01-01

    In recent years, GitHub has become the largest code host in the world, with more than 5M developers collaborating across 10M repositories. Numerous popular open source projects (such as Ruby on Rails, Homebrew, Bootstrap, Django or jQuery) have chosen GitHub as their host and have migrated their

  1. Identification of promising Twin Hub networks : Report of Work Package 1 of the Intermodal rail freight Twin hub Network Northwest Europe - project (final report)

    NARCIS (Netherlands)

    Kreutzberger, E.D.; Konings, J.W.; Meijer, S.; Witteveen, C.; Meijers, B.M.; Pekin, E.; Macharis, C.; Kiel, J.; Kawabata, Y.; Vos, W.

    2014-01-01

    This report is the first deliverable of the project Intermodal Rail Freight Twin Hub Network Northwest Europe. We call its subject Twin hub network and the organisational entity to carry out the actions the Twin hub project. The project is funded by INTERREG NWE (programme IVb). Its work started in

  2. Location of Urban Logistic Terminals as Hub Location Problem

    Directory of Open Access Journals (Sweden)

    Jasmina Pašagić Škrinjar

    2012-09-01

    Full Text Available In this paper the problems of locating urban logistic terminals are studied as hub location problems that due to a large number of potential nodes in big cities belong to hard non-polynomial problems, the so-called NP-problems. The hub location problems have found wide application in physical planning of transport and telecommunication systems, especially systems of fast delivery, networks of logistic and distribution centres and cargo traffic terminals of the big cities, etc. The paper defines single and multiple allocations and studies the numerical examples. The capacitated single allocation hub location problems have been studied, with the provision of a mathematical model of selecting the location for the hubs on the network. The paper also presents the differences in the possibilities of implementing the exact and heuristic methods to solve the actual location problems of big dimensions i.e. hub problems of the big cities.

  3. Altered cortical hubs in functional brain networks in amyotrophic lateral sclerosis.

    Science.gov (United States)

    Ma, Xujing; Zhang, Jiuquan; Zhang, Youxue; Chen, Heng; Li, Rong; Wang, Jian; Chen, Huafu

    2015-11-01

    Cortical hubs are highly connected nodes in functional brain networks that play vital roles in the efficient transfer of information across brain regions. Although altered functional connectivity has been found in amyotrophic lateral sclerosis (ALS), the changing pattern in functional network hubs in ALS remains unknown. In this study, we applied a voxel-wise method to investigate the changing pattern of cortical hubs in ALS. Through resting-state fMRI, we constructed whole-brain voxel-wise functional networks by measuring the temporal correlations of each pair of brain voxels and identified hubs using the graph theory method. Specifically, a functional connectivity strength (FCS) map was derived from the data on 20 patients with ALS and 20 healthy controls. The brain regions with high FCS values were regarded as functional network hubs. Functional hubs were found mainly in the bilateral precuneus, parietal cortex, medial prefrontal cortex, and in several visual regions and temporal areas in both groups. Within the hub regions, the ALS patients exhibited higher FCS in the prefrontal cortex compared with the healthy controls. The FCS value in the significantly abnormal hub regions was correlated with clinical variables. Results indicated the presence of altered cortical hubs in the ALS patients and could therefore shed light on the pathophysiology mechanisms underlying ALS.

  4. Ponseti treatment in the management of clubfoot deformity - a continuing role for paediatric orthopaedic services in secondary care centres.

    Science.gov (United States)

    Docker, Charles E J; Lewthwaite, Simon; Kiely, Nigel T

    2007-07-01

    The Ponseti technique is a well-proven way of managing paediatric clubfoot deformity. We describe a management set-up which spreads the care between secondary and tertiary care with no loss of quality. In our audit of the first 2 years of Ponseti casting in the treatment of idiopathic congenital talipes equinovarus (CTEV, clubfoot) deformity, we identified 77 feet having been treated in 50 patients. Forty-nine feet were treated primarily in Oswestry, a tertiary referral centre for paediatric orthopaedic conditions, and 13 feet were treated in conjunction with the physiotherapy department at one of the region's district general hospitals (Leighton Hospital, Crewe, Cheshire). Similar good results and low requirement for surgical interventions other than Achilles tenotomy, which forms part of the Ponseti regimen, were found in both cohorts. This 'hub-and-spoke' approach would appear to be efficient in terms of resource utilisation. Additional benefits for patients and their carers include ease of access to services and reduced financial and transport burdens.

  5. Optimum hub height of a wind turbine for maximizing annual net profit

    International Nuclear Information System (INIS)

    Lee, Jaehwan; Kim, Dong Rip; Lee, Kwan-Soo

    2015-01-01

    Highlights: • Annual Net Profit was proposed to optimize the hub height of a wind turbine. • Procedures of the hub height optimization method were introduced. • Effect of local wind speed characteristics on optimum hub height was illustrated. • Effect of rated power on optimum hub height was negligible in the range 0.75–3 MW. • Rated speed and cut-out speed had great effects on optimum hub height. - Abstract: The optimization method of the hub height, which can ensure the economic feasibility of the wind turbine, is proposed in this study. Annual Net Profit is suggested as an objective function and the optimization procedure is developed. The effects of local wind speed and wind turbine power characteristics on the optimum hub height are investigated. The optimum hub height decreased as the mean wind speed and wind shear exponent increased. Rated power had little effect on optimum hub height; it follows that the economies of scale are negligible in the rated power range of 0.75–3 MW. Among the wind turbine power characteristics, rated speed and cut-out speed most strongly affected the optimum hub height

  6. Evaluation of an aged care nurse practitioner service: quality of care within a residential aged care facility hospital avoidance service.

    Science.gov (United States)

    Dwyer, Trudy; Craswell, Alison; Rossi, Dolene; Holzberger, Darren

    2017-01-13

    Reducing avoidable hospitialisation of aged care facility (ACF) residents can improve the resident experience and their health outcomes. Consequently many variations of hospital avoidance (HA) programs continue to evolve. Nurse practitioners (NP) with expertise in aged care have the potential to make a unique contribution to hospital avoidance programs. However, little attention has been dedicated to service evaluation of this model and the quality of care provided. The purpose of this study was to evaluate the quality of an aged care NP model of care situated within a HA service in a regional area of Australia. Donabedian's structure, process and outcome framework was applied to evaluate the quality of the NP model of care. The Australian Nurse Practitioner Study standardised interview schedules for evaluating NP models of care guided the semi-structured interviews of nine health professionals (including ACF nurses, medical doctors and allied health professionals), four ACF residents and their families and two NPs. Theory driven coding consistent with the Donabedian framework guided analysis of interview data and presentation of findings. Structural dimensions identified included the 'in-reach' nature of the HA service, distance, limitations of professional regulation and the residential care model. These dimensions influenced the process of referring the resident to the NP, the NPs timely response and interactions with other professionals. The processes where the NPs take time connecting with residents, initiating collaborative care plans, up-skilling aged care staff and function as intra and interprofessional boundary spanners all contributed to quality outcomes. Quality outcomes in this study were about timely intervention, HA, timely return home, partnering with residents and family (knowing what they want) and resident and health professional satisfaction. This study provides valuable insights into the contribution of the NP model of care within an aged care

  7. Computing Services and Assured Computing

    Science.gov (United States)

    2006-05-01

    fighters’ ability to execute the mission.” Computing Services 4 We run IT Systems that: provide medical care pay the warfighters manage maintenance...users • 1,400 applications • 18 facilities • 180 software vendors • 18,000+ copies of executive software products • Virtually every type of mainframe and... chocs electriques, de branchez les deux cordons d’al imentation avant de faire le depannage P R IM A R Y SD A S B 1 2 PowerHub 7000 RST U L 00- 00

  8. Home Health Care: Services and Cost

    Science.gov (United States)

    Widmer, Geraldine; And Others

    1978-01-01

    Findings from a study of home care services in one New York district document the value and relatively modest costs of home health care for the chronically ill and dependent elderly. Professional nurses coordinated the care, but most of the direct services were provided by home health aides and housekeepers. (MF)

  9. Students' perspectives to health care services in lithuania

    OpenAIRE

    Brancevič, Jolita

    2016-01-01

    Students' Perspectives to Health Care Services in Lithuania Introduction. The Rights of Patients and Compensation for the Damage to Their Health Act defines health care services as safe and effective means to take care of health, identify, diagnose and treat diseases and provide nursing services. The aims set out in a policy of health care services are fairly broad and, among others, include the improvement of both the quality and the availability of health care services. The issues of increa...

  10. Report on survey on international hub

    International Nuclear Information System (INIS)

    Ebisawa, Hirobumi; Hoshino, Junko; Hashimoto, Kazuichiro; Okada, Sohei

    2011-06-01

    Japan Atomic Energy Agency (JAEA) is promoting initiative to form an international hub in line with its aim to accept more researchers/engineers from all over the world. Establishment of 'the Committee for JAEA Internationalization Initiative' was planned in 2010 so as to intensify this initiative, and in February, 2010, we visited research institutions in Europe, which include European Organization for Nuclear Research (CERN), the construction site of ITER in Cadarache, and Rutherford Appleton Laboratory (RAL), with the intention to survey and learn their advanced activities and systems in regard to the International Hub, so that the committee will be able to make fruitful discussion. This report describes strategy taken in each institution for an International Hub, and the state of each institution regarding acceptance and management of overseas researchers and engineers, research environment, living environment/health and welfare, and PR activities/coexistence with the local community. (author)

  11. Virtual Replication of IoT Hubs in the Cloud: A Flexible Approach to Smart Object Management

    Directory of Open Access Journals (Sweden)

    Simone Cirani

    2018-03-01

    Full Text Available In future years, the Internet of Things is expected to interconnect billions of highly heterogeneous devices, denoted as “smart objects”, enabling the development of innovative distributed applications. Smart objects are constrained sensor/actuator-equipped devices, in terms of computational power and available memory. In order to cope with the diverse physical connectivity technologies of smart objects, the Internet Protocol is foreseen as the common “language” for full interoperability and as a unifying factor for integration with the Internet. Large-scale platforms for interconnected devices are required to effectively manage resources provided by smart objects. In this work, we present a novel architecture for the management of large numbers of resources in a scalable, seamless, and secure way. The proposed architecture is based on a network element, denoted as IoT Hub, placed at the border of the constrained network, which implements the following functions: service discovery; border router; HTTP/Constrained Application Protocol (CoAP and CoAP/CoAP proxy; cache; and resource directory. In order to protect smart objects (which cannot, because of their constrained nature, serve a large number of concurrent requests and the IoT Hub (which serves as a gateway to the constrained network, we introduce the concept of virtual IoT Hub replica: a Cloud-based “entity” replicating all the functions of a physical IoT Hub, which external clients will query to access resources. IoT Hub replicas are constantly synchronized with the physical IoT Hub through a low-overhead protocol based on Message Queue Telemetry Transport (MQTT. An experimental evaluation, proving the feasibility and advantages of the proposed architecture, is presented.

  12. Nurses' Needs for Care Robots in Integrated Nursing Care Services.

    Science.gov (United States)

    Lee, Jai-Yon; Song, Young Ae; Jung, Ji Young; Kim, Hyun Jeong; Kim, Bo Ram; Do, Hyun-Kyung; Lim, Jae-Young

    2018-05-13

    To determine the need for care robots among nurses and to suggest how robotic care should be prioritized in an integrated nursing care services. Korea is expected to be a super-aged society by 2030. To solve care issues with elderly inpatient caused by informal caregivers, the government introduced 'integrated nursing care services'; these are comprehensive care systems staffed by professionally trained nurses. To assist them, a care robot development project has been launched. The study applied a cross-sectional survey. In 2016, we conducted a multi-center survey involving 302 registered nurses in five hospitals including three tertiary and two secondary hospitals in Korea. The questionnaire consisted of general characteristics of nurses and their views on and extents of agreement about issues associated with robotic care. Trial center nurses and those with ≥10 years of experience reported positively on the prospects for robotic care. The top three desired primary roles for care robots were 'measuring/monitoring', 'mobility/activity' and 'safety care'. 'Reduction in workload', especially in terms of 'other nursing services' which were categorized as non-value-added nursing activities, was the most valued feature. The nurses approved of the aid by care robots but were concerned about device malfunction and interruption of rapport with patients. Care robots are expected to be effective in integrated nursing care services, particularly in 'measuring/monitoring'. Such robots should decrease nurses' workload and minimize non-value-added nursing activities efficiently. No matter how excellent care robots are, they must co-operate with and be controlled by nurses. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  13. Numerical investigation of hub clearance flow in a Kaplan turbine

    Science.gov (United States)

    Wu, H.; Feng, J. J.; Wu, G. K.; Luo, X. Q.

    2012-11-01

    In this paper, the flow field considering the hub clearance flow in a Kaplan turbine has been investigated through using the commercial CFD code ANSYS CFX based on high-quality structured grids generated by ANSYS ICEM CFD. The turbulence is simulated by k-ω based shear stress transport (SST) turbulence model together with automatic near wall treatments. Four kinds of simulations have been conducted for the runner geometry without hub clearance, with only the hub front clearance, with only the rear hub clearance, and with both front and rear clearance. The analysis of the obtained results is focused on the flow structure of the hub clearance flow, the effect on the turbine performance including hydraulic efficiency and cavitation performance, which can improve the understanding on the flow field in a Kaplan turbine.

  14. Numerical investigation of hub clearance flow in a Kaplan turbine

    International Nuclear Information System (INIS)

    Wu, H; Feng, J J; Wu, G K; Luo, X Q

    2012-01-01

    In this paper, the flow field considering the hub clearance flow in a Kaplan turbine has been investigated through using the commercial CFD code ANSYS CFX based on high-quality structured grids generated by ANSYS ICEM CFD. The turbulence is simulated by k-ω based shear stress transport (SST) turbulence model together with automatic near wall treatments. Four kinds of simulations have been conducted for the runner geometry without hub clearance, with only the hub front clearance, with only the rear hub clearance, and with both front and rear clearance. The analysis of the obtained results is focused on the flow structure of the hub clearance flow, the effect on the turbine performance including hydraulic efficiency and cavitation performance, which can improve the understanding on the flow field in a Kaplan turbine.

  15. A versatile framework for cooperative hub network development

    NARCIS (Netherlands)

    Cruijssen, F.C.A.M.; Borm, P.; Dullaert, W.; Hamers, H.

    2010-01-01

    This paper introduces a framework for cooperative hub network development. Building a joint physical hub for the transshipment of goods is expensive and, therefore, involves considerable risks for cooperating companies. In a practical setting, it is unlikely that an entire network will be built at

  16. A versatile framework for cooperative hub network development

    NARCIS (Netherlands)

    Cruijssen, Frans; Borm, Peter; Dullaert, Wout; Hamers, Herbert

    This paper introduces a framework for cooperative hub network development. Building a joint physical hub for the transshipment of goods is expensive and, therefore, involves considerable risks for cooperating companies. In a practical setting, it is unlikely that an entire network will be built at

  17. Experiencing health care service quality: through patients' eyes.

    Science.gov (United States)

    Schembri, Sharon

    2015-02-01

    The primary aim of the present study was to consider health care service quality from the patients' perspective, specifically through the patient's eyes. A narrative analysis was performed on 300 patient stories. This rigorous analysis of patient stories is designed to identify and describe health care service quality through patients' eyes in an authentic and accurate, experiential manner. The findings show that there are variant and complex ways that patients experience health care service quality. Patient stories offer an authentic view of the complex ways that patients experience health care service quality. Narrative analysis is a useful tool to identify and describe how patients experience health care service quality. Patients experience health care service quality in complex and varying ways.

  18. UNMET NEED IN TURKEY: HOME CARE SERVICE

    Directory of Open Access Journals (Sweden)

    Nuket SUBASI

    2006-02-01

    Full Text Available Home care services can be provided as an alternative to institutional care to people, in case of their demand, who need care because of aging and chronic diseases. Structured home care service in health system does not exist in Turkey. Relatives try to provide care at home to those people. In this cross-sectional study, household was selected as a sampling unit, determining prevalence of home care at the households and gathering some information about home care in Cankaya district of Ankara was intended. It was found that in one-month period before this study was carried out, home care services were provided at 8.7% of the households in Cankaya district. 62.5% of people who received home care service were women, 15.3% of them were belonging to 65-74 age group; 31.7% of those were illiterate and 12.5% had no social and health insurance. Among people, 15.4% were receiving home care after surgical operation, 15.4% were receiving care because of stroke and cerebrovascular diseases and 9.6% were cancer patients. 81.7% of adults who were taken care at home were found to be dependent at different levels while performing daily living activities, the most common treatment method was detected as oral medication (81.4%. These people were in need of preventive, curative and rehabilitative and supportive services. A home care service model, which takes into consideration the social characteristics of the country, should be developed at this district where there is a large elderly population. [TAF Prev Med Bull 2006; 5(1.000: 19-31

  19. How health service delivery guides the allocation of major trauma patients in the intensive care units of the inclusive (hub and spoke) trauma system of the Emilia Romagna Region (Italy). A cross-sectional study

    Science.gov (United States)

    Volpi, Annalisa; Gordini, Giovanni; Ventura, Chiara; Barozzi, Marco; Caspani, Maria Luisa Rita; Fabbri, Andrea; Ferrari, Anna Maria; Ferri, Enrico; Giugni, Aimone; Marino, Massimiliano; Martino, Costanza; Pizzamiglio, Mario; Ravaldini, Maurizio; Russo, Emanuele; Trabucco, Laura; Trombetti, Susanna; De Palma, Rossana

    2017-01-01

    Objective To evaluate cross-sectional patient distribution and standardised 30-day mortality in the intensive care units (ICU) of an inclusive hub and spoke trauma system. Setting ICUs of the Integrated System for Trauma Patient Care (SIAT) of Emilia-Romagna, an Italian region with a population of approximately 4.5 million. Participants 5300 patients with an Injury Severity Score (ISS) >15 were admitted to the regional ICUs and recorded in the Regional Severe Trauma Registry between 2007 and 2012. Patients were classified by the Abbreviated Injury Score as follows: (1) traumatic brain injury (2) multiple injuriesand (3) extracranial lesions. The SIATs were divided into those with at least one neurosurgical level II trauma centre (TC) and those with a neurosurgical unit in the level I TC only. Results A higher proportion of patients (out of all SIAT patients) were admitted to the level I TC at the head of the SIAT with no additional neurosurgical facilities (1083/1472, 73.6%) compared with the level I TCs heading SIATs with neurosurgical level II TCs (1905/3815; 49.9%). A similar percentage of patients were admitted to level I TCs (1905/3815; 49.9%) and neurosurgical level II TCs (1702/3815, 44.6%) in the SIATs with neurosurgical level II TCs. Observed versus expected mortality (OE) was not statistically different among the three types of centre with a neurosurgical unit; however, the best mean OE values were observed in the level I TC in the SIAT with no neurosurgical unit. Conclusion The Hub and Spoke concept was fully applied in the SIAT in which neurosurgical facilities were available in the level I TC only. The performance of this system suggests that competition among level I and level II TCs in the same Trauma System reduces performance in both. The density of neurosurgical centres must be considered by public health system governors before implementing trauma systems. PMID:28965094

  20. International Education Hubs: Collaboration for Competitiveness and Sustainability

    Science.gov (United States)

    Knight, Jane

    2014-01-01

    This chapter focuses on the development of education hubs, a recent phenomenon in international higher education. Three models of hubs are examined in relation to the forces, risks, and opportunities of globalization and how local and international collaborations are essential for both global competitiveness and sustainability.

  1. Improving care planning and coordination for service users with medical co-morbidity transitioning between tertiary medical and primary care services.

    Science.gov (United States)

    Cranwell, K; Polacsek, M; McCann, T V

    2017-08-01

    WHAT IS KNOWN ON THE SUBJECT?: Mental health service users with medical co-morbidity frequently experience difficulties accessing and receiving appropriate treatment in emergency departments. Service users frequently experience fragmented care planning and coordinating between tertiary medical and primary care services. Little is known about mental health nurses' perspectives about how to address these problems. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Emergency department clinicians' poor communication and negative attitudes have adverse effects on service users and the quality of care they receive. The findings contribute to the international evidence about mental health nurses' perspectives of service users feeling confused and frustrated in this situation, and improving coordination and continuity of care, facilitating transitions and increasing family and caregiver participation. Intervention studies are needed to evaluate if adoption of these measures leads to sustainable improvements in care planning and coordination, and how service users with medical co-morbidity are treated in emergency departments in particular. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Effective planning and coordination of care are essential to enable smooth transitions between tertiary medical (emergency departments in particular) and primary care services for service users with medical co-morbidity. Ongoing professional development education and support is needed for emergency department clinicians. There is also a need to develop an organized and systemic approach to improving service users' experience in emergency departments. Introduction Mental health service users with medical co-morbidity frequently experience difficulties accessing appropriate treatment in medical hospitals, and often there is poor collaboration within and between services. Little is known about mental health nurses' perspectives on how to address these problems. Aim To explore mental health nurses

  2. Development of an improved low profile hub seal refurbishment tool

    International Nuclear Information System (INIS)

    Wagg, L.

    1997-01-01

    The hub seal area of a fuel channel feeder coupling can be exposed to oxygen in the atmosphere if protective measures are not taken during maintenance outages. Exposure to oxygen can lead to pitting of the hub seal area. Although this is a rare occurrence, the resulting possibility of the feeder coupling leakage led to the development of a feeder hub refurbishment tool. To reduce time and man-rem exposure during feeder hub seal refurbishment, an improved low profile hub seat refurbishing tool has been developed. The improved tool design will allow for quick and controlled removal of material, and the restoration of a roll-burnished finish equivalent to the original requirements. The new tool can be used in maintenance operations, with the end fitting present, as well as under retube-type circumstances, with the end fitting removed. (author)

  3. Integrated technology rotor/flight research rotor hub concept definition

    Science.gov (United States)

    Dixon, P. G. C.

    1983-01-01

    Two variations of the helicopter bearingless main rotor hub concept are proposed as bases for further development in the preliminary design phase of the Integrated Technology Rotor/Flight Research Rotor (ITR/FRR) program. This selection was the result of an evaluation of three bearingless hub concepts and two articulated hub concepts with elastomeric bearings. The characteristics of each concept were evaluated by means of simplified methodology. These characteristics included the assessment of stability, vulnerability, weight, drag, cost, stiffness, fatigue life, maintainability, and reliability.

  4. E-hubs: the new B2B (business-to-business) marketplaces.

    Science.gov (United States)

    Kaplan, S; Sawhney, M

    2000-01-01

    Electronic hubs--Internet-based intermediaries that host electronic marketplaces and mediate transactions among businesses--are generating a lot of interest. Companies like Ariba, Chemdex, and Commerce One have already attained breathtaking stock market capitalizations. Venture capitalists are pouring money into more business-to-business start-ups. Even industrial stalwarts like GM and Ford are making plans to set up their own Web markets. As new entrants with new business models pour into the business-to-business space, it's increasingly difficult to make sense of the landscape. This article provides a blueprint of the e-hub arena. The authors start by looking at the two dimensions of purchasing: what businesses buy--manufacturing inputs or operating inputs--and how they buy--through systematic sourcing or spot sourcing. They classify B2B e-hubs into four categories: MRO hubs, yield managers, exchanges, and catalog hubs, and they discuss each type in detail. Drilling deeper into this B2B matrix, the authors look at how e-hubs create value--through aggregation and matching--and explain when each mechanism works best. They also examine the biases of e-hubs. Although many e-hubs are neutral--they're operated by independent third parties--some favor the buyers or sellers. The authors explain the differences and discuss the pros and cons of each position. The B2B marketplace is changing rapidly. This framework helps buyers, sellers, and market makers navigate the landscape by explaining what the different hubs do and how they add the most value.

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

    Science.gov (United States)

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

    2015-11-01

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

  6. Human factors related to time-dependent infection control measures: "Scrub the hub" for venous catheters and feeding tubes.

    Science.gov (United States)

    Caspari, Lindsay; Epstein, Elizabeth; Blackman, Amy; Jin, Li; Kaufman, David A

    2017-06-01

    The use of catheter hub decontamination protocols is a common practice to reduce central line-associated bloodstream infections. However, few data exist on the most effective disinfection procedure prior to hub access accounting for human factors and time-dependent practices in real time in the clinical setting. An observational design with a multimodal intervention was used in this study in a neonatal intensive care unit. Direct observations on nurse compliance of scrub times with decontamination when accessing of venous catheter and feeding tube hubs were conducted during 3 phases: (1) baseline period prior to any interventions; (2) during an educational intervention phase; and (3) during a timer intervention period when using a timing device, either an actual timer or music button. Overall, both education and the timing device interventions increased the mean scrub time ± SD of venous catheter hubs. Mean baseline scrub times of 10 ± 5 seconds were lower compared with 23 ± 12 seconds after educational intervention (P music button use (P observed with scrub times of feeding tubes. Time-based infection control measures, such as scrubbing the hub, must be implemented with aids that qualify specific times to account for human factors, to ensure adherence to time-dependent measures aimed at decreasing nosocomial infections. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  7. Commissioning of specialist palliative care services in England.

    Science.gov (United States)

    Lancaster, Harriet; Finlay, Ilora; Downman, Maxwell; Dumas, James

    2018-03-01

    Some failures in end-of-life care have been attributed to inconsistent provision of palliative care across England. We aimed to explore the variation in commissioning of services by Clinical Commissioning Groups (CCGs) using a data collection exercise. We sent a Freedom of Information request in the form of an open questionnaire to all 209 CCGs in England to assess their commissioning of palliative and end-of-life care services, mainly focused on the provision of specialist palliative care services. 29 CCGs provided information about the number of patients with some form of palliative care needs in their population. For specialist palliative care services, CCGs allocated budgets ranging from £51.83 to £2329.19 per patient per annum. 163 CCGs (77.90%) currently commission 7-day admission to their specialist palliative care beds. 82.84% of CCGs commission 7-day specialist palliative care services in patients' own homes and out-of-hours services rely heavily on hospice provision. 64 CCGs (31.37%) commission pain control teams, the majority of whom only operate in regular working hours. 68.14% of CCGs reported commissioning palliative care education of any sort for healthcare professionals and 44.85% of CCGs had no plans to update or review their palliative care services. The most important finding from this exercise is that the information CCGs hold about their population and services is not standardised. However, information based on data that are more objective, for example, population and total budget for palliative care, demonstrate wide variations in commissioning. 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/.

  8. Multi-Item Distribution Policies with Supply Hub and Lateral Transshipment

    OpenAIRE

    Zhong Jin-Hong; Jiang Rui-Xuan; Zheng Gui

    2015-01-01

    Supply Hub is defined as the horizontal coordination among the suppliers while lateral transshipment is a horizontal coordination policy among the retailers. By considering the Supply Hub and lateral transshipment simultaneously, ones can reduce the total cost of the supply chain system and improve the response to customer requirement and the customers’ satisfaction. We investigate the distribution policies for the supply chain which consists of multisuppliers, single Supply Hub, and multidis...

  9. Revisiting date and party hubs: novel approaches to role assignment in protein interaction networks.

    Directory of Open Access Journals (Sweden)

    Sumeet Agarwal

    2010-06-01

    Full Text Available The idea of "date" and "party" hubs has been influential in the study of protein-protein interaction networks. Date hubs display low co-expression with their partners, whilst party hubs have high co-expression. It was proposed that party hubs are local coordinators whereas date hubs are global connectors. Here, we show that the reported importance of date hubs to network connectivity can in fact be attributed to a tiny subset of them. Crucially, these few, extremely central, hubs do not display particularly low expression correlation, undermining the idea of a link between this quantity and hub function. The date/party distinction was originally motivated by an approximately bimodal distribution of hub co-expression; we show that this feature is not always robust to methodological changes. Additionally, topological properties of hubs do not in general correlate with co-expression. However, we find significant correlations between interaction centrality and the functional similarity of the interacting proteins. We suggest that thinking in terms of a date/party dichotomy for hubs in protein interaction networks is not meaningful, and it might be more useful to conceive of roles for protein-protein interactions rather than for individual proteins.

  10. Home Care Services and the Rural Elderly.

    Science.gov (United States)

    Hayslip, Bert, Jr.; And Others

    1980-01-01

    Independent studies examined a needs v an agency perspective on home health care service needs within a rural county. Interviews with 299 elderly, aged 60-93, revealed there were substantial needs for home health care services and the desire for services varied with residence within the county. (Author)

  11. Classification of gene expression data: A hubness-aware semi-supervised approach.

    Science.gov (United States)

    Buza, Krisztian

    2016-04-01

    Classification of gene expression data is the common denominator of various biomedical recognition tasks. However, obtaining class labels for large training samples may be difficult or even impossible in many cases. Therefore, semi-supervised classification techniques are required as semi-supervised classifiers take advantage of unlabeled data. Gene expression data is high-dimensional which gives rise to the phenomena known under the umbrella of the curse of dimensionality, one of its recently explored aspects being the presence of hubs or hubness for short. Therefore, hubness-aware classifiers have been developed recently, such as Naive Hubness-Bayesian k-Nearest Neighbor (NHBNN). In this paper, we propose a semi-supervised extension of NHBNN which follows the self-training schema. As one of the core components of self-training is the certainty score, we propose a new hubness-aware certainty score. We performed experiments on publicly available gene expression data. These experiments show that the proposed classifier outperforms its competitors. We investigated the impact of each of the components (classification algorithm, semi-supervised technique, hubness-aware certainty score) separately and showed that each of these components are relevant to the performance of the proposed approach. Our results imply that our approach may increase classification accuracy and reduce computational costs (i.e., runtime). Based on the promising results presented in the paper, we envision that hubness-aware techniques will be used in various other biomedical machine learning tasks. In order to accelerate this process, we made an implementation of hubness-aware machine learning techniques publicly available in the PyHubs software package (http://www.biointelligence.hu/pyhubs) implemented in Python, one of the most popular programming languages of data science. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  12. Multiperiod Hierarchical Location Problem of Transit Hub in Urban Agglomeration Area

    Directory of Open Access Journals (Sweden)

    Ting-ting Li

    2017-01-01

    Full Text Available With the rapid urbanization in developing countries, urban agglomeration area (UAA forms. Also, transportation demand in UAA grows rapidly and presents hierarchical feature. Therefore, it is imperative to develop models for transit hubs to guide the development of UAA and better meet the time-varying and hierarchical transportation demand. In this paper, the multiperiod hierarchical location problem of transit hub in urban agglomeration area (THUAA is studied. A hierarchical service network of THUAA with a multiflow, nested, and noncoherent structure is described. Then a multiperiod hierarchical mathematical programming model is proposed, aiming at minimizing the total demand weighted travel time. Moreover, an improved adaptive clonal selection algorithm is presented to solve the model. Both the model and algorithm are verified by the application to a real-life problem of Beijing-Tianjin-Hebei Region in China. The results of different scenarios in the case show that urban population migration has a great impact on the THUAA location scheme. Sustained and appropriate urban population migration helps to reduce travel time for urban residents.

  13. Integrated working between residential care homes and primary care: a survey of care homes in England

    Directory of Open Access Journals (Sweden)

    Gage Heather

    2012-11-01

    levels of respect for the experience and knowledge of care home staff. Conclusions Care homes are a hub for a wide range of NHS activity, but this is ad hoc with no recognised way to support working together. Integration between care homes and local health services is only really evident at the level of individual working relationships and reflects patterns of collaborative working rather than integration. More integrated working between care homes and primary health services has the potential to improve quality of care in a cost- effective manner, but strategic decisions to create more formal arrangements are required to bring this about. Commissioners of services for older people need to capitalise on good working relationships and address idiosyncratic patterns of provision to care homes.The low response rate is indicative of the difficulty of undertaking research in care homes.

  14. Design and Development of an Integrated Workstation Automation Hub

    Energy Technology Data Exchange (ETDEWEB)

    Weber, Andrew; Ghatikar, Girish; Sartor, Dale; Lanzisera, Steven

    2015-03-30

    Miscellaneous Electronic Loads (MELs) account for one third of all electricity consumption in U.S. commercial buildings, and are drivers for a significant energy use in India. Many of the MEL-specific plug-load devices are concentrated at workstations in offices. The use of intelligence, and integrated controls and communications at the workstation for an Office Automation Hub – offers the opportunity to improve both energy efficiency and occupant comfort, along with services for Smart Grid operations. Software and hardware solutions are available from a wide array of vendors for the different components, but an integrated system with interoperable communications is yet to be developed and deployed. In this study, we propose system- and component-level specifications for the Office Automation Hub, their functions, and a prioritized list for the design of a proof-of-concept system. Leveraging the strength of both the U.S. and India technology sectors, this specification serves as a guide for researchers and industry in both countries to support the development, testing, and evaluation of a prototype product. Further evaluation of such integrated technologies for performance and cost is necessary to identify the potential to reduce energy consumptions in MELs and to improve occupant comfort.

  15. Estimating Implementation and Operational Costs of an Integrated Tiered CD4 Service including Laboratory and Point of Care Testing in a Remote Health District in South Africa

    Science.gov (United States)

    Cassim, Naseem; Coetzee, Lindi M.; Schnippel, Kathryn; Glencross, Deborah K.

    2014-01-01

    Background An integrated tiered service delivery model (ITSDM) has been proposed to provide ‘full-coverage’ of CD4 services throughout South Africa. Five tiers are described, defined by testing volumes and number of referring health-facilities. These include: (1) Tier-1/decentralized point-of-care service (POC) in a single site; Tier-2/POC-hub servicing processing 600 samples/day and serving >100 or >200 health-clinics, respectively. The objective of this study was to establish costs of existing and ITSDM-tiers 1, 2 and 3 in a remote, under-serviced district in South Africa. Methods Historical health-facility workload volumes from the Pixley-ka-Seme district, and the total volumes of CD4 tests performed by the adjacent district referral CD4 laboratories, linked to locations of all referring clinics and related laboratory-to-result turn-around time (LTR-TAT) data, were extracted from the NHLS Corporate-Data-Warehouse for the period April-2012 to March-2013. Tiers were costed separately (as a cost-per-result) including equipment, staffing, reagents and test consumable costs. A one-way sensitivity analyses provided for changes in reagent price, test volumes and personnel time. Results The lowest cost-per-result was noted for the existing laboratory-based Tiers- 4 and 5 ($6.24 and $5.37 respectively), but with related increased LTR-TAT of >24–48 hours. Full service coverage with TAT cost-per-result of $32.32 and $15.88 respectively. A single district Tier-3 laboratory also ensured ‘full service coverage’ and Implementing a single Tier-3/community laboratory to extend and improve delivery of services in Pixley-ka-Seme, with an estimated local ∼12–24-hour LTR-TAT, is ∼$2 more than existing referred services per-test, but 2–4 fold cheaper than implementing eight Tier-2/POC-hubs or providing twenty-seven Tier-1/POCT CD4 services. PMID:25517412

  16. Long term care needs and personal care services under Medicaid: a survey of administrators.

    Science.gov (United States)

    Palley, H A; Oktay, J S

    1991-01-01

    Home and community based care services constitute a public initiative in the development of a long term care service network. One such home based initiative is the personal care service program of Medicaid. The authors conducted a national survey of administrators of this program. They received a response from 16 administrators of such programs in 1987-1988. The responses raise significant issues regarding training, access to and equity of services, quality of services, administrative oversight and the coordination of home-based care in a network of available services. Based on administrator responses, the authors draw several conclusions.

  17. Predicting the binding patterns of hub proteins: a study using yeast protein interaction networks.

    Directory of Open Access Journals (Sweden)

    Carson M Andorf

    Full Text Available Protein-protein interactions are critical to elucidating the role played by individual proteins in important biological pathways. Of particular interest are hub proteins that can interact with large numbers of partners and often play essential roles in cellular control. Depending on the number of binding sites, protein hubs can be classified at a structural level as singlish-interface hubs (SIH with one or two binding sites, or multiple-interface hubs (MIH with three or more binding sites. In terms of kinetics, hub proteins can be classified as date hubs (i.e., interact with different partners at different times or locations or party hubs (i.e., simultaneously interact with multiple partners.Our approach works in 3 phases: Phase I classifies if a protein is likely to bind with another protein. Phase II determines if a protein-binding (PB protein is a hub. Phase III classifies PB proteins as singlish-interface versus multiple-interface hubs and date versus party hubs. At each stage, we use sequence-based predictors trained using several standard machine learning techniques.Our method is able to predict whether a protein is a protein-binding protein with an accuracy of 94% and a correlation coefficient of 0.87; identify hubs from non-hubs with 100% accuracy for 30% of the data; distinguish date hubs/party hubs with 69% accuracy and area under ROC curve of 0.68; and SIH/MIH with 89% accuracy and area under ROC curve of 0.84. Because our method is based on sequence information alone, it can be used even in settings where reliable protein-protein interaction data or structures of protein-protein complexes are unavailable to obtain useful insights into the functional and evolutionary characteristics of proteins and their interactions.We provide a web server for our three-phase approach: http://hybsvm.gdcb.iastate.edu.

  18. Mental health care roles of non-medical primary health and social care services.

    Science.gov (United States)

    Mitchell, Penny

    2009-02-01

    Changes in patterns of delivery of mental health care over several decades are putting pressure on primary health and social care services to increase their involvement. Mental health policy in countries like the UK, Australia and New Zealand recognises the need for these services to make a greater contribution and calls for increased intersectoral collaboration. In Australia, most investment to date has focused on the development and integration of specialist mental health services and primary medical care, and evaluation research suggests some progress. Substantial inadequacies remain, however, in the comprehensiveness and continuity of care received by people affected by mental health problems, particularly in relation to social and psychosocial interventions. Very little research has examined the nature of the roles that non-medical primary health and social care services actually or potentially play in mental health care. Lack of information about these roles could have inhibited development of service improvement initiatives targeting these services. The present paper reports the results of an exploratory study that examined the mental health care roles of 41 diverse non-medical primary health and social care services in the state of Victoria, Australia. Data were collected in 2004 using a purposive sampling strategy. A novel method of surveying providers was employed whereby respondents within each agency worked as a group to complete a structured survey that collected quantitative and qualitative data simultaneously. This paper reports results of quantitative analyses including a tentative principal components analysis that examined the structure of roles. Non-medical primary health and social care services are currently performing a wide variety of mental health care roles and they aspire to increase their involvement in this work. However, these providers do not favour approaches involving selective targeting of clients with mental disorders.

  19. Climate programs update: USDA Southwest Regional Climate Hub update

    Science.gov (United States)

    PROGRAM OVERVIEW: The overarching goal of the USDA SW Climate Hub is to assist farmers, ranchers and foresters in addressing the effects of climate change including prolonged drought, increased insect outbreaks and severe wildfires. In the first year of operations, the SW Climate Hub (est. Februa...

  20. Hub Status and Indexation of Container Ports

    Directory of Open Access Journals (Sweden)

    Yong-An Park

    2015-06-01

    This study develops two sub-indexes of port classification and capacity, and combines cases of these two sub-indexes into various types in order to find a proper port hub index. The paper demonstrates how different types of port hub index are useful measurements for evaluating outputs and inputs of container ports. In a case analysis we show that the indexes of period variables and lagged variables have more explanatory power with regard to changes of port throughputs and high correlation with inputs.

  1. Managed Care for Children: Effect on Access to Care and Utilization of Health Services.

    Science.gov (United States)

    Szilagyi, Peter G.

    1998-01-01

    Reviews what is known about the effect of managed care on access to health services, as well as utilization of hospital care, emergency department visits, primary care services, and specialty pediatric services. The effect of managed care appears dependent on several factors and, thus, is likely to vary according to the population served. (SLD)

  2. Rigid-flexible coupling dynamics of three-dimensional hub-beams system

    International Nuclear Information System (INIS)

    Liu Jinyang; Lu Hao

    2007-01-01

    In the previous research of the coupling dynamics of a hub-beam system, coupling between the rotational motion of hub and the torsion deformation of beam is not taken into account since the system undergoes planar motion. Due to the small longitudinal deformation, coupling between the rotational motion of hub and the longitudinal deformation of beam is also neglected. In this paper, rigid-flexible coupling dynamics is extended to a hub-beams system with three-dimensional large overall motion. Not only coupling between the large overall motion and the bending deformation, but also coupling between the large overall motion and the torsional deformation are taken into account. In case of temperature increase, the longitudinal deformation caused by the thermal expansion is significant, such that coupling between the large overall motion and the longitudinal deformation is also investigated. Combining the characteristics of the hybrid coordinate formulation and the absolute nodal coordinate formulation, the system generalized coordinates include the relative nodal displacement and the slope of each beam element with respect to the body-fixed frame of the hub, and the variables related to the spatial large overall motion of the hub and beams. Based on precise strain-displacement relation, the geometric stiffening effect is taken into account, and the rigid-flexible coupling dynamic equations are derived using velocity variational principle. Finite element method is employed for discretization. Simulation of a hub-beams system is used to show the coupling effect between the large overall motion and the torsional deformation as well as the longitudinal deformation. Furthermore, conservation of energy in case of free motion is shown to verify the formulation

  3. Relationship between home care service use and changes in the care needs level of Japanese elderly.

    Science.gov (United States)

    Kato, Gohei; Tamiya, Nanako; Kashiwagi, Masayo; Sato, Mikiya; Takahashi, Hideto

    2009-12-21

    With the introduction of long-term care insurance (LTCI) in Japan, more home care services are available for the community-dwelling elderly. To deliver effective home care services, it is important to know the effects of service use. In this study, as the first step to determine this, we sought to describe different home service use in the sustained/improved group and deteriorated group in their care needs levels, and to report the relationship between the use of home care services and changes in care needs levels. The participants included 624 of a total of 1,474 users of LTCI services in one city in Japan. Home care service users were stratified into a 'lower care needs level subgroup' and a 'higher care needs level subgroup' based on the baseline care needs level. Simple statistical comparison and multiple logistic regression analyses in which the change in care needs level was set as a dependent variable were performed. Gender, age, and baseline care needs level were designated as control variables. Home based services were treated as independent variables. In this study, home care services consisted of home help, home bathing services, a visiting nurse, home rehabilitation, nursing home daycare, health daycare, loan of medical devices, respite stay in a nursing home, respite stay in a health care facility, respite stay in a sanatorium-type medical care facility, and medical management by a physician. In the lower care needs level subgroup, age (OR = 1.04, CI, 1.01-1.08), use of respite stay in a nursing home (OR = 2.55; CI, 1.43-4.56), and the number of types of long-term care services (OR = 1.33; CI, 1.02-1.74) used during an 11 month period were significantly related to a deterioration of the user's care needs level. In the higher care needs level subgroup, use of medical management by a physician (OR = 6.99; CI, 1.42-41.25) was significantly related to a deterioration of the user's care needs level. There were no home based services significantly related to

  4. Developing a Business Plan for Critical Care Pharmacy Services.

    Science.gov (United States)

    Erstad, Brian L; Mann, Henry J; Weber, Robert J

    2016-11-01

    Critical care medicine has grown from a small group of physicians participating in patient care rounds in surgical and medical intensive care units (ICUs) to a highly technical, interdisciplinary team. Pharmacy's growth in the area of critical care is as exponential. Today's ICU requires a comprehensive pharmaceutical service that includes both operational and clinical services to meet patient medication needs. This article provides the elements for a business plan to justify critical care pharmacy services by describing the pertinent background and benefit of ICU pharmacy services, detailing a current assessment of ICU pharmacy services, listing the essential ICU pharmacy services, describing service metrics, and delineating an appropriate timeline for implementing an ICU pharmacy service. The structure and approach of this business plan can be applied to a variety of pharmacy services. By following the format and information listed in this article, the pharmacy director can move closer to developing patient-centered pharmacy services for ICU patients.

  5. Barriers to emergency obstetric care services

    DEFF Research Database (Denmark)

    Echoka, Elizabeth; Makokha, Anselimo; Dubourg, Dominique

    2014-01-01

    Introduction: Pregnancy-related mortality and morbidity in most low and middle income countries can be reduced through early recognition of complications, prompt access to care and appropriate medical interventions following obstetric emergencies. We used the three delays framework to explore...... barriers to emergency obstetric care (EmOC) services by women who experienced life threatening obstetric complications in Malindi District, Kenya. Methods: A facility-based qualitative study was conducted between November and December 2010. In-depth interviews were conducted with 30 women who experienced...... decision to seek care and in reaching an appropriate care facility. The "first" delay was due to lack of birth preparedness, including failure to identify a health facility for delivery services regardless of antenatal care and to seek care promptly despite recognition of danger signs. The "second" delay...

  6. Reviewing the Justice and Security Hub Modality as Piloted in Liberia

    Directory of Open Access Journals (Sweden)

    Rory Keane

    2012-11-01

    Full Text Available ‘The Republic of Bangui’ or ‘the Republic of Monrovia’ are phrases we sometimes hear from practitioners to describe post conflict countries where very few services exist outside the capital city. This is especially the case for security – the critical public good in post conflict countries. In response to the need to bring security services closer to the citizens who often need them most, the Government of Liberia and the United Nations are piloting a new approach financed by the UN Peacebuilding Fund (PBF – the so-called ‘Justice and Security Hubs’. The donor community and the United Nations are watching closely. If this works, there is indication from UN officials that the model could potentially be replicated in other settings such as the East of the Democratic Republic of the Congo (DRC, Haiti and the northern states of South Sudan. If the hub concept is capable of being adapted and successful elsewhere, the United Nations will not only have added a new instrument to its peacekeeping toolkit but will also firmly demonstrate how the UN Peacebuilding Fund can in essence be catalytic in fostering long-term and comprehensive approaches to peacebuilding. This practice note outlines the process of developing and constructing the first hub in Liberia, which is due to be partly operational by the end of 2012, and provides a prognosis on its chances for success.

  7. Fixed-axis electric sail deployment dynamics analysis using hub-mounted momentum control

    Science.gov (United States)

    Fulton, JoAnna; Schaub, Hanspeter

    2018-03-01

    The deployment dynamics of a spin stabilized electric sail (E-sail) with a hub-mounted control actuator are investigated. Both radial and tangential deployment mechanisms are considered to take the electric sail from a post-launch stowed configuration to a fully deployed configuration. The tangential configuration assumes the multi-kilometer tethers are wound up on the exterior of the spacecraft hub, similar to yo-yo despinner configurations. The deployment speed is controlled through the hub rate. The radial deployment configuration assumes each tether is on its own spool. Here both the hub and spool rate are control variables. The sensitivity of the deployment behavior to E-sail length, maximum rate and tension parameters is investigated. A constant hub rate deployment is compared to a time varying hub rate that maintains a constant tether tension condition. The deployment time can be reduced by a factor of 2 or more by using a tension controlled deployment configuration.

  8. Improving Healthcare in Pediatric Oncology: Development and Testing of Multiple Indicators to Evaluate a Hub-And-Spoke Model.

    Science.gov (United States)

    Zucchetti, Giulia; Bertorello, Nicoletta; Angelastro, Angela; Gianino, Paola; Bona, Gianni; Barbara, Affif; Besenzon, Luigi; Brach Del Prever, Adalberto; Pesce, Fernando; Nangeroni, Marco; Fagioli, Franca

    2017-06-01

    Purpose The hub-and-spoke is a new innovation model in healthcare that has been adopted in some countries to manage rare pathologies. We developed a set of indicators to assess current quality practices of the hub-and-spoke model adopted in the Interregional Pediatric Oncology Network in Northwest Italy and to promote patient, family, and professional healthcare empowerment. Methods Literature and evidence-based clinical guidelines were reviewed and multiprofessional team workshops were carried out to highlight some important issues on healthcare in pediatric oncology and to translate them into a set of multiple indicators. For each indicator, specific questions were formulated and tested through a series of questionnaires completed by 80 healthcare professionals and 50 pediatric patients and their parents. Results The results highlighted a positive perception of healthcare delivered by the hub-and-spoke model (M HP = 156, M Pat = 93, M Par = 104). Based on the participants' suggestions, some quality improvements have been implemented. Conclusions This study represents the first attempt to examine this new model of pediatric oncology care through the active involvement of patients, families, and healthcare professionals. Suggestions for adopting a hub-and-spoke model in pediatric oncology in other regions and countries are also highlighted.

  9. Nonlinear analysis of the GFRP material wheel hub

    Directory of Open Access Journals (Sweden)

    Dong Yun-Feng

    2015-01-01

    Full Text Available In this paper, the current bicycle wheel was replaced by the ones which composed by the wheel hub with Glassfiber Reinforced Plastic (alkali free thin-walled cylinder material, hereinafter referred to as GFRP material and the protective components made up of rubber outer pneumatic pad. With the help of the basic theory of elastic-plastic mechanics, the finite element “Nonlinear buckling” analysis of the wheel was carried out. The results show that the maximum elastic deformation of the wheel hub and the critical value of buckling failure load were restricted by the elasticity under the condition of external loads. Considering with the tensile strength and elastic modulus of the GFRP value of the material, it is demonstrated that the material is feasible to be used for wheel hub.

  10. Quantitative comparison of measurements of urgent care service quality.

    Science.gov (United States)

    Qin, Hong; Prybutok, Victor; Prybutok, Gayle

    2016-01-01

    Service quality and patient satisfaction are essential to health care organization success. Parasuraman, Zeithaml, and Berry introduced SERVQUAL, a prominent service quality measure not yet applied to urgent care. We develop an instrument to measure perceived service quality and identify the determinants of patient satisfaction/ behavioral intentions. We examine the relationships among perceived service quality, patient satisfaction and behavioral intentions, and demonstrate that urgent care service quality is not equivalent using measures of perceptions only, differences of expectations minus perceptions, ratio of perceptions to expectations, and the log of the ratio. Perceptions provide the best measure of urgent care service quality.

  11. Can home care services achieve cost savings in long-term care for older people?

    Science.gov (United States)

    Greene, V L; Ondrich, J; Laditka, S

    1998-07-01

    To determine whether efficient allocation of home care services can produce net long-term care cost savings. Hazard function analysis and nonlinear mathematical programming. Optimal allocation of home care services resulted in a 10% net reduction in overall long-term care costs for the frail older population served by the National Long-Term Care (Channeling) Demonstration, in contrast to the 12% net cost increase produced by the demonstration intervention itself. Our findings suggest that the long-sought goal of overall cost-neutrality or even cost-savings through reducing nursing home use sufficiently to more than offset home care costs is technically feasible, but requires tighter targeting of services and a more medically oriented service mix than major home care demonstrations have implemented to date.

  12. Improving the delivery of preventive care services.

    Science.gov (United States)

    Hung, Dorothy Y

    2007-05-01

    Performance of preventive services is an important indicator of high-quality health care, but many recommended services are not regularly offered in primary care practices. Health risk assessments, counseling, and referral to community-based programs help address risk behaviors, many of which are leading causes of preventable death and disability in the United States. This study examined various influences on the delivery of preventive services designed to address smoking, excessive consumption of alcohol, unhealthy diets, and sedentary lifestyles. More than 300 health care providers in 52 practices nationwide have contributed data to this study. Staff participation in quality improvement enhanced work relationships and also diminished the effect of practice size on the performance of preventive care. The use of nurse practitioners, allied health professionals, clinician reminders, and patient registries were positively associated with care delivery.

  13. Long-Term Care Services for Veterans

    Science.gov (United States)

    2017-02-14

    includes but is not limited to home physical , occupational, or speech therapy ; wound care; and intravenous (IV) care. A VA physician determines that a...restoring/rehabilitating the veteran’s health, such as skilled nursing care, physical therapy , occupational therapy , and IV therapy Same as HBPC... geriatric evaluation,  palliative care,  adult day health care,  homemaker/home health aide care,  respite care, Long-Term Care Services for

  14. Ponseti Treatment in the Management of Clubfoot Deformity – A Continuing Role for Paediatric Orthopaedic Services in Secondary Care Centres

    Science.gov (United States)

    Docker, Charles EJ; Lewthwaite, Simon; Kiely, Nigel T

    2007-01-01

    INTRODUCTION The Ponseti technique is a well-proven way of managing paediatric clubfoot deformity. We describe a management set-up which spreads the care between secondary and tertiary care with no loss of quality. PATIENTS AND METHODS In our audit of the first 2 years of Ponseti casting in the treatment of idiopathic congenital talipes equinovarus (CTEV, clubfoot) deformity, we identified 77 feet having been treated in 50 patients. Forty-nine feet were treated primarily in Oswestry, a tertiary referral centre for paediatric orthopaedic conditions, and 13 feet were treated in conjunction with the physiotherapy department at one of the region's district general hospitals (Leighton Hospital, Crewe, Cheshire). RESULTS Similar good results and low requirement for surgical interventions other than Achilles tenotomy, which forms part of the Ponseti regimen, were found in both cohorts. CONCLUSIONS This ‘hub-and-spoke’ approach would appear to be efficient in terms of resource utilisation. Additional benefits atients and their carers include ease of access to services and reduced financial and transport burdens. PMID:17688726

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

    Science.gov (United States)

    Ryu, Jeong-Im; Kim, Kisook

    2018-06-20

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

  16. Assessing inspection sensitivity as it relates to damage tolerance in composite rotor hubs

    Science.gov (United States)

    Roach, Dennis P.; Rackow, Kirk

    2001-08-01

    Increasing niche applications, growing international markets, and the emergence of advanced rotorcraft technology are expected to greatly increase the population of helicopters over the next decade. In terms of fuselage fatigue, helicopters show similar trends as fixed-wing aircraft. The highly unsteady loads experienced by rotating wings not only directly affect components in the dynamic systems but are also transferred to the fixed airframe structure. Expanded use of rotorcraft has focused attention on the use of new materials and the optimization of maintenance practices. The FAA's Airworthiness Assurance Center (AANC) at Sandia National Labs has joined with Bell Helicopter andother agencies in the rotorcraft industry to evaluate nondestructive inspection (NDI) capabilities in light of the damage tolerance of assorted rotorcraft structure components. Currently, the program's emphasis is on composite rotor hubs. The rotorcraft industry is constantly evaluating new types of lightweight composite materials that not only enhance the safety and reliability of rotor components but also improve performance and extended operating life as well. Composite rotor hubs have led to the use of bearingless rotor systems that are less complex and require less maintenance than their predecessors. The test facility described in this paper allows the structural stability and damage tolerance of composite hubs to be evaluated using realistic flight load spectrums of centrifugal force and bending loads. NDI was integrated into the life-cycle fatigue tests in order to evaluate flaw detection sensitivity simultaneously wiht residual strength and general rotor hub peformance. This paper will describe the evolving use of damage tolerance analysis (DTA) to direct and improve rotorcraft maintenance along with the related use of nondestructive inspections to manage helicopter safety. OVeralll, the data from this project will provide information to improve the producibility, inspectability

  17. Mechanical Design, Analysis, and Testing of a Two-Bladed Wind Turbine Hub

    Energy Technology Data Exchange (ETDEWEB)

    Cotrell, J.

    2002-06-01

    Researchers at the National Wind Technology Center (NWTC) in Golden, Colorado, began performing the Unsteady Aerodynamics Experiment in 1993 to better understand the unsteady aerodynamics and structural responses of horizontal-axis wind turbines. The experiment consists of an extensively instrumented, downwind, three-bladed, 20-kilowatt wind turbine. In May 1995, I received a request from the NWTC to design a two-bladed hub for the experiment. For my thesis, I present the results of the mechanical design, analysis, and testing of the hub. The hub I designed is unique because it runs in rigid, teetering, or independent blade-flapping modes. In addition, the design is unusual because it uses two servomotors to pitch the blades independently. These features are used to investigate new load reduction, noise reduction, blade pitch optimization, and yaw control techniques for two-bladed turbines. I used a methodology by G. Phal and W. Bietz to design the hub. The hub meets all the performance specifications except that it achieves only 90% of the specified teeter range. In my thesis, I focus on the analysis and testing of the hub body. I performed solid-mechanics calculations, ran a finite-element analysis simulation, and experimentally investigated the structural integrity of the hub body.

  18. Barriers to formal emergency obstetric care services' utilization.

    Science.gov (United States)

    Essendi, Hildah; Mills, Samuel; Fotso, Jean-Christophe

    2011-06-01

    Access to appropriate health care including skilled birth attendance at delivery and timely referrals to emergency obstetric care services can greatly reduce maternal deaths and disabilities, yet women in sub-Saharan Africa continue to face limited access to skilled delivery services. This study relies on qualitative data collected from residents of two slums in Nairobi, Kenya in 2006 to investigate views surrounding barriers to the uptake of formal obstetric services. Data indicate that slum dwellers prefer formal to informal obstetric services. However, their efforts to utilize formal emergency obstetric care services are constrained by various factors including ineffective health decision making at the family level, inadequate transport facilities to formal care facilities and insecurity at night, high cost of health services, and inhospitable formal service providers and poorly equipped health facilities in the slums. As a result, a majority of slum dwellers opt for delivery services offered by traditional birth attendants (TBAs) who lack essential skills and equipment, thereby increasing the risk of death and disability. Based on these findings, we maintain that urban poor women face barriers to access of formal obstetric services at family, community, and health facility levels, and efforts to reduce maternal morbidity and mortality among the urban poor must tackle the barriers, which operate at these different levels to hinder women's access to formal obstetric care services. We recommend continuous community education on symptoms of complications related to pregnancy and timely referral. A focus on training of health personnel on "public relations" could also restore confidence in the health-care system with this populace. Further, we recommend improving the health facilities in the slums, improving the services provided by TBAs through capacity building as well as involving TBAs in referral processes to make access to services timely. Measures can also be

  19. SUN HUB – ENERGY HUB FOR OUTDOOR TABLES

    DEFF Research Database (Denmark)

    Poulsen, Peter Behrensdorff; Benatto, Gisele Alves dos Reis; Riedel, Nicholas

    2017-01-01

    connections, providing opportunity to stream music via Bluetooth and play it from a handheld device to the table and lastly to provide LED lighting on the table during the dark hours. 3 prototypes of the system was built and tested at the Roskilde Festival 2017. Electrical logger units were built into the 3...... on festivals where people camps for several days it can be hard to have your portable units charged. In this this work we report a solar powered hub, as an add-on to a table in the urban environment for charging mobile phones and tablets and other handheld devices through USBs, charging laptops through AC...

  20. Multiple Hub Network Choice in the Liberalized European Market

    Science.gov (United States)

    Berechman, Joseph; deWit, Jaap

    1997-01-01

    A key question that so far has received relatively little attention in the germane literature is that of the changes at various airports as a result of the EU liberalization policies. That is, presently, most major European airports still benefit from the so-called home-carrier phenomenon where the country's publicly or semi-publicly owned carrier uses the country's main airport as its gateway hub and, consequently, the home-carrier is also the principal user of this airport (in terms of proportion of total aircraft movements, number of passengers transported, connections, slots ownership, etc.). The country's main airport has substantially benefited from these monopoly conditions of airline captivity, strongly determined by the bilateral system of international air transport regulation. Therefore, European major airports were used to operate in essentially different markets, compared to the increasingly competitive markets of their home based carriers. This partly explains relative stability of transport volumes and financial results of European major airports compared to the relatively volatile financial results of most European national airlines. However, the liberalization of European aviation is likely to change this situation. Market access is open now to all community carriers, i.e. carriers with majority ownership and effective control in the hands of EU citizens. Ticket prices are free, governments can only intervene in case of dumping or excessive pricing. A community airline can choose its seat in any of the 15 member states. Licensing procedures are harmonized between member states. In the last few months community carriers have had unrestricted route access within the EU. Most probably this development will be extended to countries inside and outside Europe. Last year the European Commission got the mandate to start negotiations with 10 other European countries. In the meantime the EC has also started negotiations with the USA on so-called soft rights

  1. A systematic review of integrated working between care homes and health care services

    Science.gov (United States)

    2011-01-01

    Background In the UK there are almost three times as many beds in care homes as in National Health Service (NHS) hospitals. Care homes rely on primary health care for access to medical care and specialist services. Repeated policy documents and government reviews register concern about how health care works with independent providers, and the need to increase the equity, continuity and quality of medical care for care homes. Despite multiple initiatives, it is not known if some approaches to service delivery are more effective in promoting integrated working between the NHS and care homes. This study aims to evaluate the different integrated approaches to health care services supporting older people in care homes, and identify barriers and facilitators to integrated working. Methods A systematic review was conducted using Medline (PubMed), CINAHL, BNI, EMBASE, PsycInfo, DH Data, Kings Fund, Web of Science (WoS incl. SCI, SSCI, HCI) and the Cochrane Library incl. DARE. Studies were included if they evaluated the effectiveness of integrated working between primary health care professionals and care homes, or identified barriers and facilitators to integrated working. Studies were quality assessed; data was extracted on health, service use, cost and process related outcomes. A modified narrative synthesis approach was used to compare and contrast integration using the principles of framework analysis. Results Seventeen studies were included; 10 quantitative studies, two process evaluations, one mixed methods study and four qualitative. The majority were carried out in nursing homes. They were characterised by heterogeneity of topic, interventions, methodology and outcomes. Most quantitative studies reported limited effects of the intervention; there was insufficient information to evaluate cost. Facilitators to integrated working included care home managers' support and protected time for staff training. Studies with the potential for integrated working were longer in

  2. Predicting highly-connected hubs in protein interaction networks by QSAR and biological data descriptors

    Science.gov (United States)

    Hsing, Michael; Byler, Kendall; Cherkasov, Artem

    2009-01-01

    Hub proteins (those engaged in most physical interactions in a protein interaction network (PIN) have recently gained much research interest due to their essential role in mediating cellular processes and their potential therapeutic value. It is straightforward to identify hubs if the underlying PIN is experimentally determined; however, theoretical hub prediction remains a very challenging task, as physicochemical properties that differentiate hubs from less connected proteins remain mostly uncharacterized. To adequately distinguish hubs from non-hub proteins we have utilized over 1300 protein descriptors, some of which represent QSAR (quantitative structure-activity relationship) parameters, and some reflect sequence-derived characteristics of proteins including domain composition and functional annotations. Those protein descriptors, together with available protein interaction data have been processed by a machine learning method (boosting trees) and resulted in the development of hub classifiers that are capable of predicting highly interacting proteins for four model organisms: Escherichia coli, Saccharomyces cerevisiae, Drosophila melanogaster and Homo sapiens. More importantly, through the analyses of the most relevant protein descriptors, we are able to demonstrate that hub proteins not only share certain common physicochemical and structural characteristics that make them different from non-hub counterparts, but they also exhibit species-specific characteristics that should be taken into account when analyzing different PINs. The developed prediction models can be used for determining highly interacting proteins in the four studied species to assist future proteomics experiments and PIN analyses. Availability The source code and executable program of the hub classifier are available for download at: http://www.cnbi2.ca/hub-analysis/ PMID:20198194

  3. Microfluidic hubs, systems, and methods for interface fluidic modules

    Science.gov (United States)

    Bartsch, Michael S; Claudnic, Mark R; Kim, Hanyoup; Patel, Kamlesh D; Renzi, Ronald F; Van De Vreugde, James L

    2015-01-27

    Embodiments of microfluidic hubs and systems are described that may be used to connect fluidic modules. A space between surfaces may be set by fixtures described herein. In some examples a fixture may set substrate-to-substrate spacing based on a distance between registration surfaces on which the respective substrates rest. Fluidic interfaces are described, including examples where fluid conduits (e.g. capillaries) extend into the fixture to the space between surfaces. Droplets of fluid may be introduced to and/or removed from microfluidic hubs described herein, and fluid actuators may be used to move droplets within the space between surfaces. Continuous flow modules may be integrated with the hubs in some examples.

  4. [eLearning service for home palliative care].

    Science.gov (United States)

    Sakuyama, Toshikazu; Komatsu, Kazuhiro; Inoue, Daisuke; Fukushima, Osamu

    2008-12-01

    In order to support the home palliative care learning, we made the eLearning service for home palliative care (beta version) and tried to teach the palliative care to the medical staffs in the community. The various learners (such as nurses, pharmacists and the like) accessed to the online learning and used this eLearning service. After the learners finished eLearning for home palliative care, some questionnaires were distributed to the learners and analyzed by us. The analysis of questionnaires revealed that almost all were satisfied with our eLearning services. Especially the learners were not only interested in using the skills of opioids and the management of pain control, but they had a good cognition for the usage of opioids.

  5. ABACUS and AQME: Semiconductor Device and Quantum Mechanics Education on nanoHUB.org

    OpenAIRE

    Klimeck, Gerhard; Vasileska, Dragica

    2009-01-01

    The ABACUS and AQME on-line tools and their associated wiki pages form one-stop shops for educators and students of existing university courses. They are geared towards courses like "introduction to Semiconductor Devices" and "Quantum Mechanics for Engineers". The service is free to anyone and no software installation is required on the user's computer. All simulations, including advanced visualization are performed at a remote computer. The tools have been deployed on nanoHUB.org in August 2...

  6. Developing a culturally appropriate mental health care service for Samoa.

    Science.gov (United States)

    Enoka, Matamua Iokapeta Sina; Tenari, Aliilelei; Sili, Tupou; Peteru, Latama; Tago, Pisaina; Blignault, Ilse

    2013-06-01

    Mental Health Care Services are part of the National Health Services for Samoa. Their function is to provide mental health care services to the population of Samoa, which numbers 180,000 people. However, like many other countries in the Pacific region, mental health is considered a low priority. The mental health budget allocation barely covers the operation of mental health care services. More broadly, there is a lack of political awareness about mental health care services and mental health rarely becomes an issue of deliberation in the political arena. This article outlines the recent development of mental health care services in Samoa, including the Mental Health Policy 2006 and Mental Health Act 2007. It tells the story of the successful integration of aiga (family) as an active partner in the provision of care, and the development of the Aiga model utilizing Samoan cultural values to promote culturally appropriate family-focused community mental health care for Samoa. Mental Health Care Services today encompass both clinical and family-focused community mental health care services. The work is largely nurse-led. Much has been achieved over the past 25 years. Increased recognition by government and increased resourcing are necessary to meet the future health care needs of the Samoan people. Copyright © 2012 Wiley Publishing Asia Pty Ltd.

  7. Midwest gas and power markets, hubs, pipelines, and interconnects

    International Nuclear Information System (INIS)

    Wirick, J.

    2001-01-01

    The existing interstate pipelines and proposed pipeline projects for the Chicago hub area were illustrated. The presentation explained why energy suppliers in the current competitive market need to balance and manage energy and transportation services for gas-fired power generators in terms of hourly winter and summer peaking services. The new infrastructure of the energy market will include new pipelines, storage and balancing to meet the ever increasing power demand. One of the options to meet power demand is to increase natural gas supply, transportation, storage, and hourly balancing capabilities. Other options are to build nuclear or coal-fired power generating facilities, or to go with renewables such as solar and wind power. Energy conservation and the reduction of natural gas usage per capita is another option to eliminate blackouts. This presentation also addressed the role that local distribution companies (LDC) and unbundling will play in the choice of these options. tabs., figs

  8. Assessing the market for long-term care services.

    Science.gov (United States)

    Rice, J A; Taylor, S

    1984-02-01

    Traditionally, long-term care services have been used by a diverse marketplace. The chronically ill, developmentally disabled, mentally ill and aging population has looked to long-term care support services as a means of physical and emotional support. Much of the time these services were housed together for the sake of efficiency. The enormous burden these services are creating on the economy, and the growing aging population, have forced the recognition that long-term care service delivery systems must change. Alternate programming for long-term care services that reach out into the community and into individual homes is becoming an attractive approach to meeting the growing demands of the marketplace. Home health, specialized housing and creative funding mechanisms such as HMOs, are examples of initiatives undertaken by healthcare organizations that view diversification as a vehicle for survival. Market research techniques that have been used in other industries are being adapted to the healthcare industry to ensure the proper mix of services that are demanded by older, more knowledgeable consumers. The programs of the future will be market driven, with the ability of the individual to pay for such services playing a significant role. The healthcare provider of today is in a position to serve the community in new ways. By becoming an integral link in the long-term care system and by developing new programs, the organization can serve as a catalyst for change. It is up to the governing bodies and managers of these facilities to become visionaries and to accept responsibility for assessing the market for long-term care services and to guide their organization into the future.

  9. DigitalHub: A Repository Focused on the Future.

    Science.gov (United States)

    Ilik, Violeta; Hebal, Piotr; Olson, Anton; Wishnetsky, Susan; Pastva, Joelen; Kubilius, Ramune; Shank, Jonathan; Gutzman, Karen; Chung, Margarita; Holmes, Kristi

    2018-01-01

    The DigitalHub scholarly repository was developed and launched at the Galter Health Sciences Library for the Feinberg School of Medicine and the greater Northwestern Medicine community. The repository was designed to allow scholars the ability to create, share, and preserve a range of citable digital outputs. This article traces the evolution of DigitalHub's development and engagement activities, highlighting project challenges, innovations, success stories, and the team-based approach that was employed to successfully achieve project goals.

  10. Family-centred care delivery: comparing models of primary care service delivery in Ontario.

    Science.gov (United States)

    Mayo-Bruinsma, Liesha; Hogg, William; Taljaard, Monica; Dahrouge, Simone

    2013-11-01

    To determine whether models of primary care service delivery differ in their provision of family-centred care (FCC) and to identify practice characteristics associated with FCC. Cross-sectional study. Primary care practices in Ontario (ie, 35 salaried community health centres, 35 fee-for-service practices, 32 capitation-based health service organizations, and 35 blended remuneration family health networks) that belong to 4 models of primary care service delivery. A total of 137 practices, 363 providers, and 5144 patients. Measures of FCC in patient and provider surveys were based on the Primary Care Assessment Tool. Statistical analyses were conducted using linear mixed regression models and generalized estimating equations. Patient-reported FCC scores were high and did not vary significantly by primary care model. Larger panel size in a practice was associated with lower odds of patients reporting FCC. Provider-reported FCC scores were significantly higher in community health centres than in family health networks (P = .035). A larger number of nurse practitioners and clinical services on-site were both associated with higher FCC scores, while scores decreased as the number of family physicians in a practice increased and if practices were more rural. Based on provider and patient reports, primary care reform strategies that encourage larger practices and more patients per family physician might compromise the provision of FCC, while strategies that encourage multidisciplinary practices and a range of services might increase FCC.

  11. Reimbursement for school nursing health care services: position statement.

    Science.gov (United States)

    Lowe, Janet; Cagginello, Joan; Compton, Linda

    2014-09-01

    Children come to school with a variety of health conditions, varying from moderate health issues to multiple, severe chronic health illnesses that have a profound and direct impact on their ability to learn. The registered professional school nurse (hereinafter referred to as school nurse) provides medically necessary services in the school setting to improve health outcomes and promote academic achievement. The nursing services provided are reimbursable services in other health care settings, such as hospitals, clinics, and home care settings. The National Association of School Nurses (NASN) believes that school nursing services that are reimbursable nursing services in other health care systems should also be reimbursable services in the school setting, while maintaining the same high quality care delivery standards. Traditionally, local and state tax revenues targeted to fund education programs have paid for school nursing health services. School nurses are in a strategic position to advocate for improving clinical processes to better fit with community health care providers and to align reimbursements with proposed changes. Restructuring reimbursement programs will enable health care funding streams to assist in paying for school nursing services delivered to students in the school setting. Developing new innovative health financing opportunities will help to increase access, improve quality, and reduce costs. The goal is to promote a comprehensive and cost-effective health care delivery model that integrates schools, families, providers, and communities.

  12. Incremental Optimization of Hub and Spoke Network for the Spokes’ Numbers and Flow

    Directory of Open Access Journals (Sweden)

    Yanfeng Wang

    2015-01-01

    Full Text Available Hub and spoke network problem is solved as part of a strategic decision making process which may have a profound effect on the future of enterprises. In view of the existing network structure, as time goes on, the number of spokes and the flow change because of different sources of uncertainty. Hence, the incremental optimization of hub and spoke network problem is considered in this paper, and the policy makers should adopt a series of strategies to cope with the change, such as setting up new hubs, adjusting the capacity level of original hubs, or closing some original hubs. The objective is to minimize the total cost, which includes the setup costs for the new hubs, the closure costs, and the adjustment costs for the original hubs as well as the flow routing costs. Two mixed-integer linear programming formulations are proposed and analyzed for this problem. China Deppon Logistics as an example is performed to present computational analysis, and we analyze the changes in the solutions driven by the number of spokes and the flow. The tests also allow an analysis to consider the effect of variation in parameters on network.

  13. Developing a costing framework for palliative care services.

    Science.gov (United States)

    Mosoiu, Daniela; Dumitrescu, Malina; Connor, Stephen R

    2014-10-01

    Palliative care services have been reported to be a less expensive alternative to traditional treatment; however, little is known about how to measure the cost of delivering quality palliative care. The purpose of this project was to develop a standardized method for measuring the cost of palliative care delivery that could potentially be replicated in multiple settings. The project was implemented in three stages. First, an interdisciplinary group of palliative care experts identified standards of quality palliative care delivery in the inpatient and home care services. Surveys were conducted of government agencies and palliative care providers to identify payment practices and budgets for palliative care services. In the second phase, unit costs were defined and a costing framework was designed to measure inpatient and home-based palliative care unit costs. The final phase was advocacy for inclusion of calculated costs into the national funding system. In this project, a reliable framework for determining the cost of inpatient and home-based palliative care services was developed. Inpatient palliative care cost in Romania was calculated at $96.58 per day. Home-based palliative care was calculated at $30.37 per visit, $723.60 per month, and $1367.71 per episode of care, which averaged 45 visits. A standardized methodology and framework for costing palliative care are presented. The framework allows a country or provider of care to substitute their own local costs to generate cost information relevant to the health-care system. In Romania, this allowed the palliative care provider community to advocate for a consistent payment system. Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  14. Sci-Hub: What Librarians Should Know and Do about Article Piracy.

    Science.gov (United States)

    Hoy, Matthew B

    2017-01-01

    The high cost of journal articles has driven many researchers to turn to a new way of getting access: "pirate" article sites. Sci-Hub, the largest and best known of these sites, currently offers instant access to more than 58 million journal articles. Users attracted by the ease of use and breadth of the collection may not realize that these articles are often obtained using stolen credentials and downloading them may be illegal. This article will briefly describe Sci-Hub and how it works, the legal and ethical issues it raises, and the problems it may cause for librarians. Librarians should be aware of Sci-Hub and the ways it may change their patrons' expectations. They should also understand the risks Sci-Hub can pose to their patrons and their institutions.

  15. Zoning Districts - Volusia County HUB Zones

    Data.gov (United States)

    NSGIC Local Govt | GIS Inventory — Historically Underutilized Business (HUB) Zones in Volusia County. Go to http://www.sba.gov/hubzone or contact the Department of Economic Development (386) 248-8048...

  16. The ethics of advertising for health care services.

    Science.gov (United States)

    Schenker, Yael; Arnold, Robert M; London, Alex John

    2014-01-01

    Advertising by health care institutions has increased steadily in recent years. While direct-to-consumer prescription drug advertising is subject to unique oversight by the Federal Drug Administration, advertisements for health care services are regulated by the Federal Trade Commission and treated no differently from advertisements for consumer goods. In this article, we argue that decisions about pursuing health care services are distinguished by informational asymmetries, high stakes, and patient vulnerabilities, grounding fiduciary responsibilities on the part of health care providers and health care institutions. Using examples, we illustrate how common advertising techniques may mislead patients and compromise fiduciary relationships, thereby posing ethical risks to patients, providers, health care institutions, and society. We conclude by proposing that these risks justify new standards for advertising when considered as part of the moral obligation of health care institutions and suggest that mechanisms currently in place to regulate advertising for prescription pharmaceuticals should be applied to advertising for health care services more broadly.

  17. ABACUS and AQME: Semiconducor Device and Quantum Mechanics Education on nanoHUB.org

    OpenAIRE

    Klimeck, Gerhard; Vasileska, Dragica

    2009-01-01

    The ABACUS and AQME on-line tools and their associated wiki pages form one-stop shops for educators and students of existing university courses. They are geared towards courses like “introduction to Semiconductor Devices” and “Quantum Mechanics for Engineers”. The service is free to anyone and no software installation is required on the user’s computer. All simulations, including advanced visualization are performed at a remote computer. The tools have been deployed on nanoHUB.org in August 2...

  18. Influence of home care services on caregivers' burden and satisfaction.

    Science.gov (United States)

    Kim, Eun-Young; Yeom, Hyun-E

    2016-06-01

    To examine the factors affecting the burden and satisfaction of family caregivers, focusing on the beneficial impacts of home care service use. Long-term care for older patients is a multifaceted process that brings both burden and satisfaction to family caregivers. It is expected that home care services offered by the Korean long-term care insurance may contribute to decreasing the burden of family caregivers and enhancing their satisfaction by assisting with practical caregiving tasks. A cross-sectional study. A convenience sample of 157 family caregivers was recruited from five home care service agencies in South Korea. Information about the caregivers, caregiving history, older care recipients and use of home care services was assessed. The effects of home care service use on caregiving burden and satisfaction were tested using hierarchical multiple regression analyses after adjusting for the characteristics of the caregivers, caregiving history and older care recipients. There was no significant influence of home care service use on reducing caregiving burden or on increasing caregivers' satisfaction. Although several factors were associated with caregiving burden and satisfaction, family functioning was the most unique factor to significantly affect both caregiving burden and satisfaction. Home care services might not automatically have a positive impact on caregivers' burden and satisfaction, but maintaining healthy family functioning is an important issue for family caregivers. The findings highlight the important need to reconsider ways to provide home care services and to develop nursing interventions to reinforce supportive family functioning. Practical strategies for providing home care services should be developed through a concrete assessment of the family dynamics and the needs of family caregivers. Health professionals should play a pivotal role in performing the assessment and in developing interventions to strengthen supportive family functioning

  19. City Hub : a cloud based IoT platform for Smart Cities

    OpenAIRE

    Lea, Rodger; Blackstock, Michael

    2014-01-01

    Cloud based Smart City hubs are an attractive approach to addressing some of the complex issues faced when deploying PaaS infrastructure for Smart Cities. In this paper we introduce the general notion of IoT hubs and then discusses our work to generalize our IoT hub as a Smart City PaaS. Two key issues are identified, support for hybrid public/private cloud and interoperability. We briefly describe our approach to these issues and discuss our experiences deploying two cloud-based Smart City h...

  20. Idea Hubs as Nexus of Collective Creativity in Digital Innovation

    DEFF Research Database (Denmark)

    Ciriello, Raffaele; Richter, Alexander

    2015-01-01

    Digital innovation radically transforms the nature of corporate innovation practices, implying a growing need for deeper understanding its origins and outcomes. In this paper, we conceptualize the focal points of social networking in digital innovation as idea hubs. We focus our analysis...... on instances of idea hubs in two multinational European software companies, where we conducted a case study over a two-year period, and collected data in form of interviews, digital documents, and participant observations. In doing so, we identify a set of social networking practices in which idea hubs serve...... of digital artifacts individuals can choose from, offline interaction still plays a major role in facilitating digital innovation....

  1. The delivery of primary care services.

    NARCIS (Netherlands)

    Wilson, A.; Windak, A.; Oleszczyk, M.; Wilm, S.; Hasvold, T.; Kringos, D.

    2015-01-01

    This chapter will be devoted to the dimensions which have been grouped in the framework as “process” and that focus on essential features of service delivery in primary care. In addition to the breadth of services delivered, a comparative overview will be provided of variation in access to services,

  2. Connectome hubs at resting state in children and adolescents: Reproducibility and psychopathological correlation

    Directory of Open Access Journals (Sweden)

    João Ricardo Sato

    2016-08-01

    Full Text Available Functional brain hubs are key integrative regions in brain networks. Recently, brain hubs identified through resting-state fMRI have emerged as interesting targets to increase understanding of the relationships between large-scale functional networks and psychopathology. However, few studies have directly addressed the replicability and consistency of the hub regions identified and their association with symptoms. Here, we used the eigenvector centrality (EVC measure obtained from graph analysis of two large, independent population-based samples of children and adolescents (7–15 years old; total N = 652; 341 subjects for site 1 and 311 for site 2 to evaluate the replicability of hub identification. Subsequently, we tested the association between replicable hub regions and psychiatric symptoms. We identified a set of hubs consisting of the anterior medial prefrontal cortex and inferior parietal lobule/intraparietal sulcus (IPL/IPS. Moreover, lower EVC values in the right IPS were associated with psychiatric symptoms in both samples. Thus, low centrality of the IPS was a replicable sign of potential vulnerability to mental disorders in children. The identification of critical and replicable hubs in functional cortical networks in children and adolescents can foster understanding of the mechanisms underlying mental disorders.

  3. Home health services in primary care: What can we do?

    Directory of Open Access Journals (Sweden)

    Yasemin Çayır

    2013-01-01

    Full Text Available Home health services is to give examination, diagnosis,treatment, and rehabilitation services to the patients whobedridden, have difficulties to access health facility due toa variety of chronic or malignant disease by professionalhealth care team. Family physicians that providing healthcare in primary care is responsible for to determine whowill need home health care services, and to make homevisit on a regular basis among registered patients in theirpopulations. It is seems that the biggest shortcoming thecontent and scope of this service is not yet a standard. Inthis article, how home health services should be given willbe discussed.Key words: Primary health care, home health care, bedriddenpatient

  4. Experimental Investigation of Diffuser Hub Injection to Improve Centrifugal Compressor Stability

    Science.gov (United States)

    Skoch, Gary J.

    2004-01-01

    Results from a series of experiments to investigate whether centrifugal compressor stability could be improved by injecting air through the diffuser hub surface are reported. The research was conducted in a 4:1 pressure ratio centrifugal compressor configured with a vane-island diffuser. Injector nozzles were located just upstream of the leading edge of the diffuser vanes. Nozzle orientations were set to produce injected streams angled at 8, 0 and +8 degrees relative to the vane mean camber line. Several injection flow rates were tested using both an external air supply and recirculation from the diffuser exit. Compressor flow range did not improve at any injection flow rate that was tested. Compressor flow range did improve slightly at zero injection due to the flow resistance created by injector openings on the hub surface. Leading edge loading and semi-vaneless space diffusion showed trends similar to those reported earlier from shroud surface experiments that did improve compressor flow range. Opposite trends are seen for hub injection cases where compressor flow range decreased. The hub injection data further explain the range improvement provided by shroud-side injection and suggest that different hub-side techniques may produce range improvement in centrifugal compressors.

  5. A Hub Matrix Theory and Applications to Wireless Communications

    Directory of Open Access Journals (Sweden)

    Kung HT

    2007-01-01

    Full Text Available This paper considers communications and network systems whose properties are characterized by the gaps of the leading eigenvalues of for a matrix . It is shown that a sufficient and necessary condition for a large eigen-gap is that is a "hub" matrix in the sense that it has dominant columns. Some applications of this hub theory in multiple-input and multiple-output (MIMO wireless systems are presented.

  6. The Virtual Campus Hub Concept

    DEFF Research Database (Denmark)

    Badger, Merete; Prag, Sidsel-Marie Winther; Monaco, Lucio

    of Technology in Sweden, Politecnico di Torino in Italy, and Eindhoven University of Technology in the Netherlands. The project is partially funded by the European Commission under the 7th Framework Programme (project no. RI-283746). This report describes the final concept of Virtual Campus Hub. It gives...

  7. Soft Power and Cultural Diplomacy: Emerging Education Hubs in Asia

    Science.gov (United States)

    Lee, Jack T.

    2015-01-01

    Several education hubs have emerged in Asia and the Middle East in recent years with a specific focus on cross-border higher education. Through considerable efforts in policy planning and generous funding, these hubs aim to transform a country or city into an eminent destination for education, research, and training. The inherent design of these…

  8. Assessment of quality of care in family planning services in Jimma ...

    African Journals Online (AJOL)

    Background: Providing quality of care in family planning services is an important task for care providers so as to increase service utilization and coverage; however, little is known about the existing quality of care in such services. Objective: To assess quality of care in family planning services in Jimma Zone, southwest ...

  9. Analysis of Sci-Hub downloads of computer science papers

    Directory of Open Access Journals (Sweden)

    Andročec Darko

    2017-07-01

    Full Text Available The scientific knowledge is disseminated by research papers. Most of the research literature is copyrighted by publishers and avail- able only through paywalls. Recently, some websites offer most of the recent content for free. One of them is the controversial website Sci-Hub that enables access to more than 47 million pirated research papers. In April 2016, Science Magazine published an article on Sci-Hub activity over the period of six months and publicly released the Sci-Hub’s server log data. The mentioned paper aggregates the view that relies on all downloads and for all fields of study, but these findings might be hiding interesting patterns within computer science. The mentioned Sci-Hub log data was used in this paper to analyse downloads of computer science papers based on DBLP’s list of computer science publications. The top downloads of computer science papers were analysed, together with the geographical location of Sci-Hub users, the most downloaded publishers, types of papers downloaded, and downloads of computer science papers per publication year. The results of this research can be used to improve legal access to the most relevant scientific repositories or journals for the computer science field.

  10. Perceptions of the care received from Australian palliative care services: A caregiver perspective.

    Science.gov (United States)

    Pidgeon, Tanya M; Johnson, Claire E; Lester, Leanne; Currow, David; Yates, Patsy; Allingham, Samuel F; Bird, Sonia; Eagar, Kathy

    2018-04-01

    ABSTRACTBackground:Caregiver satisfaction and experience surveys help health professionals to understand, measure, and improve the quality of care provided for patients and their families. Our aim was to explore caregiver perceptions of the care received from Australian specialist palliative care services. Caregivers of patients receiving palliative care in services registered with Australia's Palliative Care Outcomes Collaboration were invited to participate in a caregiver survey. The survey included the FAMCARE-2 and four items from the Ongoing Needs Identification: Caregiver Profile questionnaire. Surveys were completed by 1,592 caregivers from 49 services. Most respondents reported high satisfaction and positive experiences. Caregivers receiving care from community-based palliative care teams were less satisfied with the management of physical symptoms and comfort (odds ratio [OR] = 0.29; 95% confidence interval [CI95%] = 0.14, 0.59), with patient psychological care (OR = 0.56; CI95% = 0.32, 0.98), and with family support (OR = 0.52; CI95% = 0.35, 0.77) than caregivers of patients in an inpatient setting. If aged over 60 years, caregivers were less likely to have their information needs met regarding available support services (OR = 0.98; CI95% = 0.97, 0.98) and carer payments (OR = 0.99; CI95% = 0.98, 1.00). Also, caregivers were less likely to receive adequate information about carer payments if located in an outer regional area (OR = 0.41; CI95% = 0.25, 0.64). With practical training, caregivers receiving care from community services reported inadequate information provision to support them in caring for patients (OR = 0.60; CI95% = 0.45, 0.81). While our study identified caregivers as having positive and satisfactory experiences across all domains of care, there is room for improvement in the delivery of palliative care across symptom management, as well as patient and caregiver support, especially in community settings. Caregiver surveys can facilitate the

  11. Using hybrid latent class model for city-HUBs´users behaviour analysis

    OpenAIRE

    Di Ciommo, Floridea; Monzón de Cáceres, Andrés; Oña, Rocío de; Oña López, Juan de; Hernández del Olmo, Sara

    2014-01-01

    Data from an attitudinal survey and stated preference ranking experiment conducted in two urban European interchanges (i.e. City-HUBs) in Madrid (Spain) and Thessaloniki (Greece) show that the importance that City-HUBs users attach to the intermodal infrastructure varies strongly as a function of their perceptions of time spent in the interchange (i.e.intermodal transfer and waiting time). A principal components analysis allocates respondents (i.e. city-HUB users) to two classes with substant...

  12. Paramedic-Initiated Home Care Referrals and Use of Home Care and Emergency Medical Services.

    Science.gov (United States)

    Verma, Amol A; Klich, John; Thurston, Adam; Scantlebury, Jordan; Kiss, Alex; Seddon, Gayle; Sinha, Samir K

    2018-01-01

    We examined the association between paramedic-initiated home care referrals and utilization of home care, 9-1-1, and Emergency Department (ED) services. This was a retrospective cohort study of individuals who received a paramedic-initiated home care referral after a 9-1-1 call between January 1, 2011 and December 31, 2012 in Toronto, Ontario, Canada. Home care, 9-1-1, and ED utilization were compared in the 6 months before and after home care referral. Nonparametric longitudinal regression was performed to assess changes in hours of home care service use and zero-inflated Poisson regression was performed to assess changes in the number of 9-1-1 calls and ambulance transports to ED. During the 24-month study period, 2,382 individuals received a paramedic-initiated home care referral. After excluding individuals who died, were hospitalized, or were admitted to a nursing home, the final study cohort was 1,851. The proportion of the study population receiving home care services increased from 18.2% to 42.5% after referral, representing 450 additional people receiving services. In longitudinal regression analysis, there was an increase of 17.4 hours in total services per person in the six months after referral (95% CI: 1.7-33.1, p = 0.03). The mean number of 9-1-1 calls per person was 1.44 (SD 9.58) before home care referral and 1.20 (SD 7.04) after home care referral in the overall study cohort. This represented a 10% reduction in 9-1-1 calls (95% CI: 7-13%, p home care referral and 0.79 (SD 6.27) after home care referral, representing a 7% reduction (95% CI: 3-11%, p home care records were included in the analysis, the reductions in 9-1-1 calls and ambulance transports to ED were attenuated but remained statistically significant. Paramedic-initiated home care referrals in Toronto were associated with improved access to and use of home care services and may have been associated with reduced 9-1-1 calls and ambulance transports to ED.

  13. Features analysis for identification of date and party hubs in protein interaction network of Saccharomyces Cerevisiae

    Directory of Open Access Journals (Sweden)

    Araabi Babak N

    2010-12-01

    Full Text Available Abstract Background It has been understood that biological networks have modular organizations which are the sources of their observed complexity. Analysis of networks and motifs has shown that two types of hubs, party hubs and date hubs, are responsible for this complexity. Party hubs are local coordinators because of their high co-expressions with their partners, whereas date hubs display low co-expressions and are assumed as global connectors. However there is no mutual agreement on these concepts in related literature with different studies reporting their results on different data sets. We investigated whether there is a relation between the biological features of Saccharomyces Cerevisiae's proteins and their roles as non-hubs, intermediately connected, party hubs, and date hubs. We propose a classifier that separates these four classes. Results We extracted different biological characteristics including amino acid sequences, domain contents, repeated domains, functional categories, biological processes, cellular compartments, disordered regions, and position specific scoring matrix from various sources. Several classifiers are examined and the best feature-sets based on average correct classification rate and correlation coefficients of the results are selected. We show that fusion of five feature-sets including domains, Position Specific Scoring Matrix-400, cellular compartments level one, and composition pairs with two and one gaps provide the best discrimination with an average correct classification rate of 77%. Conclusions We study a variety of known biological feature-sets of the proteins and show that there is a relation between domains, Position Specific Scoring Matrix-400, cellular compartments level one, composition pairs with two and one gaps of Saccharomyces Cerevisiae's proteins, and their roles in the protein interaction network as non-hubs, intermediately connected, party hubs and date hubs. This study also confirms the

  14. Functional Hubs in Mild Cognitive Impairment

    Science.gov (United States)

    Navas, Adrián; Papo, David; Boccaletti, Stefano; Del-Pozo, F.; Bajo, Ricardo; Maestú, Fernando; Martínez, J. H.; Gil, Pablo; Sendiña-Nadal, Irene; Buldú, Javier M.

    We investigate how hubs of functional brain networks are modified as a result of mild cognitive impairment (MCI), a condition causing a slight but noticeable decline in cognitive abilities, which sometimes precedes the onset of Alzheimer's disease. We used magnetoencephalography (MEG) to investigate the functional brain networks of a group of patients suffering from MCI and a control group of healthy subjects, during the execution of a short-term memory task. Couplings between brain sites were evaluated using synchronization likelihood, from which a network of functional interdependencies was constructed and the centrality, i.e. importance, of their nodes was quantified. The results showed that, with respect to healthy controls, MCI patients were associated with decreases and increases in hub centrality respectively in occipital and central scalp regions, supporting the hypothesis that MCI modifies functional brain network topology, leading to more random structures.

  15. MODELS AND METHODS FOR LOGISTICS HUB LOCATION: A REVIEW TOWARDS TRANSPORTATION NETWORKS DESIGN

    Directory of Open Access Journals (Sweden)

    Carolina Luisa dos Santos Vieira

    Full Text Available ABSTRACT Logistics hubs affect the distribution patterns in transportation networks since they are flow-concentrating structures. Indeed, the efficient moving of goods throughout supply chains depends on the design of such networks. This paper presents a literature review on the logistics hub location problem, providing an outline of modeling approaches, solving techniques, and their applicability to such context. Two categories of models were identified. While multi-criteria models may seem best suited to find optimal locations, they do not allow an assessment of the impact of new hubs on goods flow and on the transportation network. On the other hand, single-criterion models, which provide location and flow allocation information, adopt network simplifications that hinder an accurate representation of the relationshipbetween origins, destinations, and hubs. In view of these limitations we propose future research directions for addressing real challenges of logistics hubs location regarding transportation networks design.

  16. Combining service marketing and strategic alliances in health care.

    Science.gov (United States)

    Lazarus, I R

    1993-11-01

    With or without federal health care reform to impact the delivery of health care services in the U.S., hospitals must commit to service marketing and strategic alliances as a fundamental business strategy. Service marketing not only differentiates the provider, but with the proper programs in place, it may actually facilitate the formation of strategic alliances. The combination of these strategies will be particularly effective in preparing for any health care policy change.

  17. Epidemics in Complex Networks: The Diversity of Hubs

    Science.gov (United States)

    Kitsak, Maksim; Gallos, Lazaros K.; Havlin, Shlomo; Stanley, H. Eugene; Makse, Hernan A.

    2009-03-01

    Many complex systems are believed to be vulnerable to spread of viruses and information owing to their high level of interconnectivity. Even viruses of low contagiousness easily proliferate the Internet. Rumors, fads, and innovation ideas are prone to efficient spreading in various social systems. Another commonly accepted standpoint is the importance of the most connected elements (hubs) in the spreading processes. We address following questions. Do all hubs conduct epidemics in the same manner? How does the epidemics spread depend on the structure of the network? What is the most efficient way to spread information over the system? We analyze several large-scale systems in the framework of of the susceptible/infective/removed (SIR) disease spread model which can also be mapped to the problem of rumor or fad spreading. We show that hubs are often ineffective in the transmission of virus or information owing to the highly heterogeneous topology of most networks. We also propose a new tool to evaluate the efficiency of nodes in spreading virus or information.

  18. Care satisfaction among older people receiving public care and service at home or in special accommodation.

    Science.gov (United States)

    Karlsson, Staffan; Edberg, Anna-Karin; Jakobsson, Ulf; Hallberg, Ingalill R

    2013-02-01

    To explore care satisfaction in relation to place of living, health-related quality of life, functional dependency and health complaints among people 65 years or older, receiving public care and service. The concept public care and service concerns formal care from the municipality, including home help, home nursing care, rehabilitation and a special accommodation. To be able to provide care and service of high quality to older people, knowledge about factors influencing their experience of satisfaction with the care is essential. Cross-sectional, including comparison and correlation. One-hundred sixty-six people receiving public care and service from the municipality were interviewed regarding demography, functional ability, perceived health complaints and care. Health-related quality of life was measured with SF-12, and self-rated care satisfaction was measured with a questionnaire. Low self-rated care satisfaction was associated with dependency in Instrumental Activities of Daily Living, blindness, faeces incontinence and anxiety, while high self-rated care satisfaction was associated with dependency in Personal Activities of Daily Living. Those at home rated an overall higher care satisfaction and were more satisfied with care continuity and personal relations; they thought that the staff had more time and were more respectful and quiet, than the ratings by those in a special accommodation (equivalent to a nursing home). Care satisfaction and health-related quality of life among older people was more associated with functional impairment and health complaints than to whether care and service was received at home or in a special accommodation. An approach using intervention focused on functional ability and health complaints is important for development of improved care satisfaction for older people receiving public care and service. © 2013 Blackwell Publishing Ltd.

  19. Influence of Hub Parameters on Joining Forces and Torque Transmission Output of Plastically-Joined Shaft-Hub-Connections with a Knurled Contact Surface

    Directory of Open Access Journals (Sweden)

    Lukáš Suchý

    2018-04-01

    Full Text Available A knurled interference fit is a machine part connection made by a plastic joining, which includes the advantages of commonly-used shaft-hub-connections. The combination of the friction and form fit, which are responsible for torque transmission, results in a higher power density than conventional connections. In this paper, parameter gaps are bridged with the aim of enhance the design calculation of the knurled interference fit. Experimental investigations on the shaft chamfer angle (100Cr6 and hub-diameter-ratio (AlSi1MgMn were performed. The analytical approaches are developed for calculating the joining force and maximal torque capacity by accounting for experimentally investigated loss of load transmission at high hub-diameter-ratios and high shaft chamfer angles. The presented calculation approach is an accurate tool for the assessment of early machine designs of the knurled interference fit and helps to save from having to perform time-extensive tests.

  20. Economic Impact of the Dutch Gas Hub Strategy on the Netherlands

    International Nuclear Information System (INIS)

    Harris, D.; Bazelon, C.; Humphreys, B.; Dickson, P.

    2010-09-01

    Since the discovery of the Groningen gas field in 1959, the Netherlands has been a key player in the European gas market. The Netherlands has built up a large onshore and offshore Exploration and Production sector, it has a highly developed gas transmission and distribution network, and is a major exporter of gas to other EU Member States. The Netherlands has considerable expertise in all parts of the gas supply chain, and is a world centre for Research and development in natural gas supply and use. More recently construction has begun on terminals to allow the import of Liquid Natural Gas to the Netherlands. However, Dutch gas reserves are now in decline, and the Netherlands will become a net importer of gas around 2025. The Dutch government wishes to capitalise on the existing industry and skills and sustain the Netherlands' place in the European gas industry beyond the life of the existing gas fields. In November 2009 the Minister of Economic Affairs published a paper describing the strategy of turning the Netherlands into a 'Gas Hub' or 'gas roundabout' for north-west Europe. The Dutch government intends that the gas hub would capitalise on the existing skills and industry, increase competition and security of supply in the Dutch gas market, create employment and make a significant contribution to the Dutch economy. The Dutch Ministry of Economic Affairs, Agriculture and Innovation has commissioned The Brattle Group to perform an analysis of the economic impact of the gas hub concept. The study has several aims including: To analyse the current contribution of the Dutch gas sector to the economy; To assess the Strengths, Weaknesses, Opportunities and Threats associated with the gas hub strategy; To quantify the benefits of the gas hub strategy to the Dutch economy. Note that the aim of the study is to define in more detail what a successful Dutch gas hub strategy would look like, to assess the strengths and weakness of the Dutch gas sector in achieving a

  1. Customer service: the key to remaining competitive in managed care.

    Science.gov (United States)

    Howard, J E

    2000-01-01

    The health care industry is undergoing a rapid transformation to meet the ever-increasing needs and demands of its patient population. Employers and managed care organizations are demanding better service and higher quality care, while providers are trying to tackle reimbursement cutbacks, streamlining of services, and serving a diverse population. Providers have begun to realize that to overcome these obstacles and meet the needs of their health plans and consumers, they must focus on the demands of their customers. Health care organizations have found they can meet the demands of both the consumer and the managed care industry through initiating and maintaining a customer service program. This essay explains the importance of customer service and its link to success in the managed care environment.

  2. A service model for delivering care closer to home.

    Science.gov (United States)

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

    2011-04-01

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

  3. The Banana Genome Hub

    Science.gov (United States)

    Droc, Gaëtan; Larivière, Delphine; Guignon, Valentin; Yahiaoui, Nabila; This, Dominique; Garsmeur, Olivier; Dereeper, Alexis; Hamelin, Chantal; Argout, Xavier; Dufayard, Jean-François; Lengelle, Juliette; Baurens, Franc-Christophe; Cenci, Alberto; Pitollat, Bertrand; D’Hont, Angélique; Ruiz, Manuel; Rouard, Mathieu; Bocs, Stéphanie

    2013-01-01

    Banana is one of the world’s favorite fruits and one of the most important crops for developing countries. The banana reference genome sequence (Musa acuminata) was recently released. Given the taxonomic position of Musa, the completed genomic sequence has particular comparative value to provide fresh insights about the evolution of the monocotyledons. The study of the banana genome has been enhanced by a number of tools and resources that allows harnessing its sequence. First, we set up essential tools such as a Community Annotation System, phylogenomics resources and metabolic pathways. Then, to support post-genomic efforts, we improved banana existing systems (e.g. web front end, query builder), we integrated available Musa data into generic systems (e.g. markers and genetic maps, synteny blocks), we have made interoperable with the banana hub, other existing systems containing Musa data (e.g. transcriptomics, rice reference genome, workflow manager) and finally, we generated new results from sequence analyses (e.g. SNP and polymorphism analysis). Several uses cases illustrate how the Banana Genome Hub can be used to study gene families. Overall, with this collaborative effort, we discuss the importance of the interoperability toward data integration between existing information systems. Database URL: http://banana-genome.cirad.fr/ PMID:23707967

  4. Identifying barriers to emergency care services.

    Science.gov (United States)

    Cannoodt, Luk; Mock, Charles; Bucagu, Maurice

    2012-01-01

    This paper aims to present a review of published evidence of barriers to emergency care, with attention towards both financial and other barriers. With the keywords (financial) accessibility, barriers and emergency care services, citations in PubMed were searched and further selected in the context of the objective of this article. Forty articles, published over a period of 15 years, showed evidence of significant barriers to emergency care. These barriers often tend to persist, despite the fact that the evidence was published many years ago. Several publications stressed the importance of the financial barriers in foregoing or delaying potentially life-saving emergency services, both in poor and rich countries. Other publications report non-financial barriers that prevent patients in need of emergency care (pre-hospital and in-patient care) from seeking care, from arriving in the proper emergency department without undue delay or from receiving proper treatment when they do arrive in these departments. It is clear that timely access to life-saving and disability-preventing emergency care is problematic in many settings. Yet, low-cost measures can likely be taken to significantly reduce these barriers. It is time to make an inventory of these measures and to implement the most cost-effective ones worldwide. Copyright © 2011 John Wiley & Sons, Ltd.

  5. Care and Service at Home for Persons With Dementia in Europe.

    Science.gov (United States)

    Bökberg, Christina; Ahlström, Gerd; Leino-Kilpi, Helena; Soto-Martin, Maria E; Cabrera, Esther; Verbeek, Hilde; Saks, Kai; Stephan, Astrid; Sutcliffe, Caroline; Karlsson, Staffan

    2015-09-01

    To describe available and utilized formal care and service at home for persons with dementia, from diagnosis to end-of-life stage, in eight European countries. A descriptive cross-country design concerning eight European countries as a part of the European research project RightTimePlaceCare. The research team in each country used a mapping system to collect country-specific information concerning dementia care and service system. The mapping system consists of 50 types of care and service activities. Sixteen of the 50 predefined activities concerning care and service at home were selected for this study and subdivided into three categories, following the stages of dementia. Availability was reported to be higher than utilization, and the findings indicated more similarities than differences among the eight countries involved. Even though there were several available activities of "basic care and services" and "healthcare interventions," they were utilized by few in most countries. Furthermore, "specialized dementia care and services" were sparsely available and even more sparsely utilized in the participating countries. The findings indicated that persons with dementia in Europe received formal care and service on a general, basic level but seldom adjusted to their specific needs. This study describes the gap between service provision and utilization enabling nurses to develop individually adjusted care plans for persons with dementia during the progress of the disease. The findings do not include matters of quality of care or how to best organize effective care and services. However, the activities of care and services presented here should shed light on what room there is for improvement when it comes to enabling persons with dementia to go on living at home. © 2015 Sigma Theta Tau International.

  6. Urban-rural disparity in utilization of preventive care services in China.

    Science.gov (United States)

    Liu, Xiang; Li, Ningxiu; Liu, Chaojie; Ren, Xiaohui; Liu, Danping; Gao, Bo; Liu, Yuanyuan

    2016-09-01

    Preventive care service is considered pivotal on the background of demographic ageing and a rise in chronic diseases in China. The disparity in utilization of preventive care services between urban and rural in China is a serious issue. In this paper, we explored factors associated with urban-rural disparity in utilization of preventive care services in China, and determined how much of the urban-rural disparity was attributable to each determinant of utilization in preventive care services. Using representative sample data from China Health and Nutrition Survey in 2011 (N = 12,976), the present study performed multilevel logistic model to examine the factors that affected utilization of preventive care services in last 4 weeks. Blinder-Oaxaca decomposition method was applied to divide the utilization of preventive care disparity between urban and rural residents into a part that can be explained by differences in observed covariates and unobserved part. The percentage of rural residents utilizing preventive care service in last 4 weeks was lower than that of urban residents (5.1% vs 9.3%). Female, the aged, residents with higher education level and household income, residents reporting self-perceived illness in last 4 weeks and physician-diagnosed chronic disease had higher likelihood of utilizing preventive care services. Household income was the most important factor accounting for 26.6% of urban-rural disparities in utilization of preventive care services, followed by education (21.5%), self-perceived illness in last 4 weeks (7.8%), hypertension (4.4%), diabetes (3.3%), other chronic diseases (0.8%), and health insurance (-1.0%). Efforts to reduce financial barriers for low-income individuals who cannot afford preventive services, increasing awareness of the importance of obtaining preventive health services and providing more preventive health services covered by health insurance, may help to reduce the gap of preventive care services utilization between

  7. Care Services in Periurban Ghana

    Directory of Open Access Journals (Sweden)

    Paa Kobina Turkson

    2011-01-01

    Full Text Available The study used logistic regression modelling to determine predictors of satisfaction with delivery of animal health care services for 889 clients (livestock and poultry keepers in periurban Ghana. Of the 15 indicators tested as predictors of satisfaction in this study, 8 were included in the best fit model. These were accessibility, availability of services, service charge, effectiveness, efficiency, quality of services, meeting client needs, and getting help. Efficiency and effectiveness were perceived by the respondents to be synonymous, as were service quality and effectiveness, as suggested by ORs>10 when cross tabulated. Therefore, one or the other could be used in future studies but not both to avoid collinearity. The identified predictors could be targeted for improvement in quality of service delivery to livestock and poultry keepers in Ghana.

  8. Models for Primary Eye Care Services in India

    Directory of Open Access Journals (Sweden)

    Vasundhra Misra

    2015-01-01

    In the current situation, an integrated health care system with primary eye care promoted by government of India is apparently the best answer. This model is both cost effective and practical for the prevention and control of blindness among the underprivileged population. Other models functioning with the newer technology of tele-ophthalmology or mobile clinics also add to the positive outcome in providing primary eye care services. This review highlights the strengths and weaknesses of various models presently functioning in the country with the idea of providing useful inputs for eye care providers and enabling them to identify and adopt an appropriate model for primary eye care services.

  9. HIV protein sequence hotspots for crosstalk with host hub proteins.

    Directory of Open Access Journals (Sweden)

    Mahdi Sarmady

    Full Text Available HIV proteins target host hub proteins for transient binding interactions. The presence of viral proteins in the infected cell results in out-competition of host proteins in their interaction with hub proteins, drastically affecting cell physiology. Functional genomics and interactome datasets can be used to quantify the sequence hotspots on the HIV proteome mediating interactions with host hub proteins. In this study, we used the HIV and human interactome databases to identify HIV targeted host hub proteins and their host binding partners (H2. We developed a high throughput computational procedure utilizing motif discovery algorithms on sets of protein sequences, including sequences of HIV and H2 proteins. We identified as HIV sequence hotspots those linear motifs that are highly conserved on HIV sequences and at the same time have a statistically enriched presence on the sequences of H2 proteins. The HIV protein motifs discovered in this study are expressed by subsets of H2 host proteins potentially outcompeted by HIV proteins. A large subset of these motifs is involved in cleavage, nuclear localization, phosphorylation, and transcription factor binding events. Many such motifs are clustered on an HIV sequence in the form of hotspots. The sequential positions of these hotspots are consistent with the curated literature on phenotype altering residue mutations, as well as with existing binding site data. The hotspot map produced in this study is the first global portrayal of HIV motifs involved in altering the host protein network at highly connected hub nodes.

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

    Science.gov (United States)

    Eiriz, Vasco; Figueiredo, José António

    2005-01-01

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

  11. A comparison of the home-care and healthcare service use and costs of older Australians randomised to receive a restorative or a conventional home-care service.

    Science.gov (United States)

    Lewin, Gill; Allan, Janine; Patterson, Candice; Knuiman, Matthew; Boldy, Duncan; Hendrie, Delia

    2014-05-01

    Restorative home-care services, or re-ablement home-care services as they are now known in the UK, aim to assist older individuals who are experiencing difficulties in everyday living to optimise their functioning and reduce their need for ongoing home care. Until recently, the effectiveness of restorative home-care services had only been investigated in terms of singular outcomes such as length of home-care episode, admission to hospital and quality of life. This paper reports on a more complex and perhaps more significant measure--the use and cost of the home-care and healthcare services received over the 2-year period following service commencement. Seven hundred and fifty older individuals referred for government-funded home care were randomly assigned to a restorative or standard service between June 2005 and August 2007. Health and aged care service data were sourced and linked via the Western Australian Data Linkage System. Restorative clients used fewer home-care hours (mean [SD], 117.3 [129.4] vs. 191.2 [230.4]), had lower total home-care costs (AU$5570 vs. AU$8541) and were less likely to be approved for a higher level of aged care (N [%], 171 [55.2] vs. 249 [63.0]) during follow-up. They were also less likely to have presented at an emergency department (OR = 0.69, 95% CI = 0.50-0.94) or have had an unplanned hospital admission [OR (95% CI), 0.69 (0.50-0.95)]. Additionally, the aggregated health and home-care costs of the restorative clients were lower by a factor of 0.83 (95% CI 0.72-0.96) over the 2-year follow-up (AU$19,090 vs. AU$23,428). These results indicate that at a time when Australia is facing the challenges of population ageing and an expected increase in demand for health and aged care services, the provision of a restorative service when an older person is referred for home care is potentially a more cost-effective option than providing conventional home care. © 2014 The Authors. Health and Social Care in the Community published by John

  12. Energy flow modeling and optimal operation analysis of the micro energy grid based on energy hub

    International Nuclear Information System (INIS)

    Ma, Tengfei; Wu, Junyong; Hao, Liangliang

    2017-01-01

    Highlights: • Design a novel architecture for energy hub integrating power hub, cooling hub and heating hub. • The micro energy grid based on energy hub is introduced and its advantages are discussed. • Propose a generic modeling method for the energy flow of micro energy grid. • Propose an optimal operation model for micro energy grid with considering demand response. • The roles of renewable energy, energy storage devices and demand response are discussed separately. - Abstract: The energy security and environmental problems impel people to explore a more efficient, environment friendly and economical energy utilization pattern. In this paper, the coordinated operation and optimal dispatch strategies for multiple energy system are studied at the whole Micro Energy Grid level. To augment the operation flexibility of energy hub, the innovation sub-energy hub structure including power hub, heating hub and cooling hub is put forward. Basing on it, a generic energy hub architecture integrating renewable energy, combined cooling heating and power, and energy storage devices is developed. Moreover, a generic modeling method for the energy flow of micro energy grid is proposed. To minimize the daily operation cost, a day-ahead dynamic optimal operation model is formulated as a mixed integer linear programming optimization problem with considering the demand response. Case studies are undertaken on a community Micro Energy Grid in four different scenarios on a typical summer day and the roles of renewable energy, energy storage devices and demand response are discussed separately. Numerical simulation results indicate that the proposed energy flow modeling and optimal operation method are universal and effective over the entire energy dispatching horizon.

  13. Report on survey on international Hub

    International Nuclear Information System (INIS)

    Ebisawa, Hirobumi; Hoshino, Junko; Hashimoto, Kazuichiro; Okada, Sohei

    2011-03-01

    Japan Atomic Energy Agency (JAEA) is promoting initiative to form an international Center of Excellence in line with its aim to accept more researchers/engineers from all over the world. Establishment of 'the Committee for JAEA Internationalization Initiative' was planned in 2010 so as to intensify this initiative, and in February, 2010, we visited research institutions in Europe, which include European Organization for Nuclear Research (CERN), the construction site of ITER in Cadarache, and Rutherford Appleton Laboratory (RAL), with the intention to survey and learn their advanced activities and systems in regard to the International Hub, so that the committee will be able to make fruitful discussion. This report describes strategy taken in each institution for an International Hub, and the state of each institution regarding acceptance and management of overseas researchers and engineers, research environment, living environment/health and welfare, and PR activities/coexistence with the local community. (author)

  14. Emergency residential care settings: A model for service assessment and design.

    Science.gov (United States)

    Graça, João; Calheiros, Maria Manuela; Patrício, Joana Nunes; Magalhães, Eunice Vieira

    2018-02-01

    There have been calls for uncovering the "black box" of residential care services, with a particular need for research focusing on emergency care settings for children and youth in danger. In fact, the strikingly scant empirical attention that these settings have received so far contrasts with the role that they often play as gateway into the child welfare system. To answer these calls, this work presents and tests a framework for assessing a service model in residential emergency care. It comprises seven studies which address a set of different focal areas (e.g., service logic model; care experiences), informants (e.g., case records; staff; children/youth), and service components (e.g., case assessment/evaluation; intervention; placement/referral). Drawing on this process-consultation approach, the work proposes a set of key challenges for emergency residential care in terms of service improvement and development, and calls for further research targeting more care units and different types of residential care services. These findings offer a contribution to inform evidence-based practice and policy in service models of residential care. Copyright © 2017 Elsevier Ltd. All rights reserved.

  15. Decision Makers' Allocation of Home-Care Therapy Services: A Process Map

    Science.gov (United States)

    Poss, Jeff; Egan, Mary; Rappolt, Susan; Berg, Katherine

    2013-01-01

    ABSTRACT Purpose: To explore decision-making processes currently used in allocating occupational and physical therapy services in home care for complex long-stay clients in Ontario. Method: An exploratory study using key-informant interviews and client vignettes was conducted with home-care decision makers (case managers and directors) from four home-care regions in Ontario. The interview data were analyzed using the framework analysis method. Results: The decision-making process for allocating therapy services has four stages: intake, assessment, referral to service provider, and reassessment. There are variations in the management processes deployed at each stage. The major variation is in the process of determining the volume of therapy services across home-care regions, primarily as a result of financial constraints affecting the home-care programme. Government funding methods and methods of information sharing also significantly affect home-care therapy allocation. Conclusion: Financial constraints in home care are the primary contextual factor affecting allocation of therapy services across home-care regions. Given the inflation of health care costs, new models of funding and service delivery need to be developed to ensure that the right person receives the right care before deteriorating and requiring more costly long-term care. PMID:24403672

  16. Modeling and optimization of a network of energy hubs to improve economic and emission considerations

    International Nuclear Information System (INIS)

    Maroufmashat, Azadeh; Elkamel, Ali; Fowler, Michael; Sattari, Sourena; Roshandel, Ramin; Hajimiragha, Amir; Walker, Sean; Entchev, Evgueniy

    2015-01-01

    Energy hubs that incorporate a variety of energy generation and energy transformation technologies can be used to provide the energy storage needed to enable the efficient operation of a ‘smart energy network’. When these hubs are combined as a network and allowed to exchange energy, they create efficiency advantages in both financial and environmental performance. Further, the interconnectedness of the energy network design provides an added layer of reliability. In this paper, a complex network of energy hubs is modeled and optimized under different scenarios to examine both the financial viability and potential reduction of greenhouse gas emissions. Two case studies consisting of two and three energy hubs within a network are considered. The modeling Scenarios vary according to the consideration of distributed energy systems and energy interaction between energy hubs. In the case of a network of two energy hubs, there is no significant economic or emissions benefit with only a 0.5% reduction in total cost and 3% reduction in CO_2 emission. In the case of a network of three energy hubs, there is a significant economic benefit ranging from 11% to 29%, and 11% emission reduction benefit, as well as a 13% reduction in natural gas consumption. - Highlights: • The generic form of the modified energy hub concept with network model is presented. • Two case studies are presented to demonstrate the benefits of energy hub network. • Distributed energy is shown to provide economic and environmental advantages. • Multi criteria optimization of the economic and environmental performance is done.

  17. Factors shaping intersectoral action in primary health care services.

    Science.gov (United States)

    Anaf, Julia; Baum, Fran; Freeman, Toby; Labonte, Ron; Javanparast, Sara; Jolley, Gwyn; Lawless, Angela; Bentley, Michael

    2014-12-01

    To examine case studies of good practice in intersectoral action for health as one part of evaluating comprehensive primary health care in six sites in South Australia and the Northern Territory. Interviews with primary health care workers, collaborating agency staff and service users (Total N=33); augmented by relevant documents from the services and collaborating partners. The value of intersectoral action for health and the importance of partner relationships to primary health care services were both strongly endorsed. Factors facilitating intersectoral action included sufficient human and financial resources, diverse backgrounds and skills and the personal rewards that sustain commitment. Key constraining factors were financial and time limitations, and a political and policy context which has become less supportive of intersectoral action; including changes to primary health care. While intersectoral action is an effective way for primary health care services to address social determinants of health, commitment to social justice and to adopting a social view of health are constrained by a broader health service now largely reinforcing a biomedical model. Effective organisational practices and policies are needed to address social determinants of health in primary health care and to provide a supportive context for workers engaging in intersectoral action. © 2014 Public Health Association of Australia.

  18. SEQUenCE: a service user-centred quality of care instrument for mental health services.

    Science.gov (United States)

    Hester, Lorraine; O'Doherty, Lorna Jane; Schnittger, Rebecca; Skelly, Niamh; O'Donnell, Muireann; Butterly, Lisa; Browne, Robert; Frorath, Charlotte; Morgan, Craig; McLoughlin, Declan M; Fearon, Paul

    2015-08-01

    To develop a quality of care instrument that is grounded in the service user perspective and validate it in a mental health service. The instrument (SEQUenCE (SErvice user QUality of CarE)) was developed through analysis of focus group data and clinical practice guidelines, and refined through field-testing and psychometric analyses. All participants were attending an independent mental health service in Ireland. Participants had a diagnosis of bipolar affective disorder (BPAD) or a psychotic disorder. Twenty-nine service users participated in six focus group interviews. Seventy-one service users participated in field-testing: 10 judged the face validity of an initial 61-item instrument; 28 completed a revised 52-item instrument from which 12 items were removed following test-retest and convergent validity analyses; 33 completed the resulting 40-item instrument. Test-retest reliability, internal consistency and convergent validity of the instrument. The final instrument showed acceptable test-retest reliability at 5-7 days (r = 0.65; P Service Satisfaction Scale (r = 0.84, P internal consistency (Cronbach's alpha = 0.87). SEQUenCE is a valid, reliable scale that is grounded in the service user perspective and suitable for routine use. It may serve as a useful tool in individual care planning, service evaluation and research. The instrument was developed and validated with service users with a diagnosis of either BPAD or a psychotic disorder; it does not yet have established external validity for other diagnostic groups. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

  19. Disrupted Nodal and Hub Organization Account for Brain Network Abnormalities in Parkinson's Disease.

    Science.gov (United States)

    Koshimori, Yuko; Cho, Sang-Soo; Criaud, Marion; Christopher, Leigh; Jacobs, Mark; Ghadery, Christine; Coakeley, Sarah; Harris, Madeleine; Mizrahi, Romina; Hamani, Clement; Lang, Anthony E; Houle, Sylvain; Strafella, Antonio P

    2016-01-01

    The recent application of graph theory to brain networks promises to shed light on complex diseases such as Parkinson's disease (PD). This study aimed to investigate functional changes in sensorimotor and cognitive networks in Parkinsonian patients, with a focus on inter- and intra-connectivity organization in the disease-associated nodal and hub regions using the graph theoretical analyses. Resting-state functional MRI data of a total of 65 participants, including 23 healthy controls (HCs) and 42 patients, were investigated in 120 nodes for local efficiency, betweenness centrality, and degree. Hub regions were identified in the HC and patient groups. We found nodal and hub changes in patients compared with HCs, including the right pre-supplementary motor area (SMA), left anterior insula, bilateral mid-insula, bilateral dorsolateral prefrontal cortex (DLPFC), and right caudate nucleus. In general, nodal regions within the sensorimotor network (i.e., right pre-SMA and right mid-insula) displayed weakened connectivity, with the former node associated with more severe bradykinesia, and impaired integration with default mode network regions. The left mid-insula also lost its hub properties in patients. Within the executive networks, the left anterior insular cortex lost its hub properties in patients, while a new hub region was identified in the right caudate nucleus, paralleled by an increased level of inter- and intra-connectivity in the bilateral DLPFC possibly representing compensatory mechanisms. These findings highlight the diffuse changes in nodal organization and regional hub disruption accounting for the distributed abnormalities across brain networks and the clinical manifestations of PD.

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

    Science.gov (United States)

    Ng, Sandy; Russell-Bennett, Rebekah

    2015-01-01

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

  1. A collaborative scheduling model for the supply-hub with multiple suppliers and multiple manufacturers.

    Science.gov (United States)

    Li, Guo; Lv, Fei; Guan, Xu

    2014-01-01

    This paper investigates a collaborative scheduling model in the assembly system, wherein multiple suppliers have to deliver their components to the multiple manufacturers under the operation of Supply-Hub. We first develop two different scenarios to examine the impact of Supply-Hub. One is that suppliers and manufacturers make their decisions separately, and the other is that the Supply-Hub makes joint decisions with collaborative scheduling. The results show that our scheduling model with the Supply-Hub is a NP-complete problem, therefore, we propose an auto-adapted differential evolution algorithm to solve this problem. Moreover, we illustrate that the performance of collaborative scheduling by the Supply-Hub is superior to separate decision made by each manufacturer and supplier. Furthermore, we also show that the algorithm proposed has good convergence and reliability, which can be applicable to more complicated supply chain environment.

  2. The Bromhead Care Home Service: the impact of a service for care home residents with dementia on hospital admission and dying in preferred place of care.

    Science.gov (United States)

    Garden, Gill; Green, Suzanne; Pieniak, Susan; Gladman, John

    2016-04-01

    People with dementia have worse outcomes associated with hospital admission, are more likely to have interventions and are less likely to be offered palliative care than people without dementia. Advance care planning for care home residents has been shown to reduce hospital admissions without increasing mortality. Studies have shown that staff confidence in managing delirium, a common reason for admission, improves with training. A service combining education for care home staff and advance care planning for care home residents with dementia was introduced to care homes in Boston, UK. There were improvements in staff confidence in recognition, prevention, management and knowledge of factors associated with delirium and dysphagia. 92% of carers rated the service >9/10. Admissions fell by 37% from baseline in the first year and 55% in the second and third years. All but one resident died in the preferred place of care. © 2016 Royal College of Physicians.

  3. Comparison of the effectiveness of analytical wake models for wind farm with constant and variable hub heights

    International Nuclear Information System (INIS)

    Wang, Longyan; Tan, Andy C.C.; Cholette, Michael; Gu, Yuantong

    2016-01-01

    Highlights: • The effectiveness of three analytical wake models is studied. • The results of the analytical wake models are compared with the CFD simulations. • The results of CFD simulation are verified by comparison to the offshore wind farm observation data. • The onshore wind farm with both constant and different hub height turbines are analyzed. • PARK model is able to predict the total wind farm power production well with tuned surface roughness value. - Abstract: Extensive power losses of wind farm have been witnessed due to the wake interactions between wind turbines. By applying analytical wake models which describe the wind speed deficits in the wake quantitatively, the power losses can be regained to a large extent through wind farm layout optimization, and this has been extensively reported in literature. Nevertheless, the effectiveness of the analytical wake models in predicting the wind farm power production have rarely been studied and compared for wind farm with both constant and variable wind turbine hub heights. In this study, the effectiveness of three different analytical wake models (PARK model, Larsen model and B-P model) is thoroughly compared over a wide range of wake properties. After the validation with the observation data from offshore wind farm, CFD simulations are used to verify the effectiveness of the analytical wake models for an onshore wind farm. The results show that when using the PARK model the surface roughness value (z 0 ) must be carefully tuned to achieve good performance in predicting the wind farm power production. For the other two analytical wake models, their effectiveness varies depending on the situation of wind farm (offshore or onshore) and the wind turbine hub heights (constant or variable). It was found that the results of B-P model agree well with the CFD simulations for offshore wind farm, but not for the onshore wind farm. The Larsen model is more accurate for the wind farm with variable wind turbine

  4. The management of health care service quality. A physician perspective.

    Science.gov (United States)

    Bobocea, L; Gheorghe, I R; Spiridon, St; Gheorghe, C M; Purcarea, V L

    2016-01-01

    Applying marketing in health care services is presently an essential element for every manager or policy maker. In order to be successful, a health care organization has to identify an accurate measurement scale for defining service quality due to competitive pressure and cost values. The most widely employed scale in the services sector is SERVQUAL scale. In spite of being successfully adopted in fields such as brokerage and banking, experts concluded that the SERVQUAL scale should be modified depending on the specific context. Moreover, the SERVQUAL scale focused on the consumer's perspective regarding service quality. While service quality was measured with the help of SERVQUAL scale, other experts identified a structure-process-outcome design, which, they thought, would be more suitable for health care services. This approach highlights a different perspective on investigating the service quality, namely, the physician's perspective. Further, we believe that the Seven Prong Model for Improving Service Quality has been adopted in order to effectively measure the health care service in a Romanian context from a physician's perspective.

  5. Costs of stroke and stroke services: Determinants of patient costs and a comparison of costs of regular care and care organised in stroke services

    Directory of Open Access Journals (Sweden)

    Koopmanschap Marc A

    2003-02-01

    Full Text Available Abstract Background Stroke is a major cause of death and long-term disability in Western societies and constitutes a major claim on health care budgets. Organising stroke care in a stroke service has recently been demonstrated to result in better health effects for patients. This paper discusses patient costs after stroke and compares costs between regular and stroke service care. Methods Costs were calculated within the framework of the evaluation of three experiments with stroke services in the Netherlands. Cost calculations are base on medical consumption data and actual costs. Results 598 patients were consecutively admitted to hospital after stroke. The average total costs of care per patient for the 6 month follow-up are estimated at €16,000. Costs are dominated by institutional and accommodation costs. Patients who die after stroke incur less costs. For patients that survive the acute phase, the most important determinants of costs are disability status and having a partner – as they influence patients' stroke careers. These determinants also interact. The most efficient stroke service experiment was most successful in co-ordinating patient flow from hospital to (nursing home, through capacity planning and efficient discharge procedures. In this region the costs of stroke service care are the same as for regular stroke care. The other experiments suffered from waiting lists for nursing homes and home care, leading to "blocked beds" in hospitals and nursing homes and higher costs of care. Costs of co-ordination are estimated at about 3% of total costs of care. Conclusion This paper demonstrates that by organising care for stroke patients in a stroke service, better health effects can be achieved with the same budget. In addition, it provides insight in need, predisposing and enabling factors that determine costs of care after stroke.

  6. Fatigue based design and analysis of wheel hub for Student formula car by Simulation Approach

    Science.gov (United States)

    Gowtham, V.; Ranganathan, A. S.; Satish, S.; Alexis, S. John; Siva kumar, S.

    2016-09-01

    In the existing design of Wheel hub used for Student formula cars, the brake discs cannot be removed easily since the disc is mounted in between the knuckle and hub. In case of bend or any other damage to the disc, the replacement of the disc becomes difficult. Further using OEM hub and knuckle that are used for commercial vehicles will result in increase of unsprung mass, which should be avoided in Student formula cars for improving the performance. In this design the above mentioned difficulties have been overcome by redesigning the hub in such a way that the brake disc could be removed easily by just removing the wheel and the caliper and also it will have reduced weight when compared to existing OEM hub. A CAD Model was developed based on the required fatigue life cycles. The forces acting on the hub were calculated and linear static structural analysis was performed on the wheel hub for three different materials using ANSYS Finite Element code V 16.2. The theoretical fatigue strength was compared with the stress obtained from the structural analysis for each material.

  7. Matrix logistics indicators assessment of distributed transport hub

    Directory of Open Access Journals (Sweden)

    Igor Arefyev

    2014-06-01

    Full Text Available Background: The paper is devoted to the distributed transport hub substantiation and assessment. The paper  was an example of the technique and form an array of logistical factors as variables that determine this condition. Experience in organizing multimodal transport showed that the "bottleneck" of transport logistics are items of cargo handling ports, terminals, freight stations and warehouses. At the core of the solution of these problems is the problem of estimating the variables determine the Multi-purpose Hubs. The aim is to develop a method of forming the system of logistical multiplying factors determine the role of each of the types in the technologiacal process of distributed Multi-purpose Hubs. Methods: The assessment model for the formation of Distributed Transport Units  can be based on formal methods to predict the behavior of complex systems engineering complexes. Then one of the approaches to the solution of the problem may be the matrix method of technological factors. Results and conclusions: The proposed methodology of the selection and validation of logistic coefficients has the practical importance in the models development for assessing the condition and behavior of Distributed Transport.

  8. SPARK: Sparsity-based analysis of reliable k-hubness and overlapping network structure in brain functional connectivity.

    Science.gov (United States)

    Lee, Kangjoo; Lina, Jean-Marc; Gotman, Jean; Grova, Christophe

    2016-07-01

    Functional hubs are defined as the specific brain regions with dense connections to other regions in a functional brain network. Among them, connector hubs are of great interests, as they are assumed to promote global and hierarchical communications between functionally specialized networks. Damage to connector hubs may have a more crucial effect on the system than does damage to other hubs. Hubs in graph theory are often identified from a correlation matrix, and classified as connector hubs when the hubs are more connected to regions in other networks than within the networks to which they belong. However, the identification of hubs from functional data is more complex than that from structural data, notably because of the inherent problem of multicollinearity between temporal dynamics within a functional network. In this context, we developed and validated a method to reliably identify connectors and corresponding overlapping network structure from resting-state fMRI. This new method is actually handling the multicollinearity issue, since it does not rely on counting the number of connections from a thresholded correlation matrix. The novelty of the proposed method is that besides counting the number of networks involved in each voxel, it allows us to identify which networks are actually involved in each voxel, using a data-driven sparse general linear model in order to identify brain regions involved in more than one network. Moreover, we added a bootstrap resampling strategy to assess statistically the reproducibility of our results at the single subject level. The unified framework is called SPARK, i.e. SParsity-based Analysis of Reliable k-hubness, where k-hubness denotes the number of networks overlapping in each voxel. The accuracy and robustness of SPARK were evaluated using two dimensional box simulations and realistic simulations that examined detection of artificial hubs generated on real data. Then, test/retest reliability of the method was assessed

  9. Barriers to Accessing Eye Care Services in the Federal Capital ...

    African Journals Online (AJOL)

    This study was carried out to determine the barriers to accessing eye care services in the Federal ... 153(61.7%), others were high cost of services, lack of money, non-availability of eye care services, long ... Barrier studies are being conducted.

  10. Determinants of psychology service utilization in a palliative care outpatient population.

    Science.gov (United States)

    Azuero, Casey; Allen, Rebecca Sue; Kvale, Elizabeth; Azuero, Andres; Parmelee, Patricia

    2014-06-01

    Research has demonstrated that treating cancer patients' psychological and physical health leads to improved overall health. This may be especially true for palliative care patients facing serious illness. This study examines the proportion and determinants of psychology service utilization in an outpatient palliative care population. Data from an existing clinical database in an outpatient palliative clinic utilizing a collaborative care model to deliver psychology services were explored. This study was framed by Andersen's Behavioral Model of Health Service Use, which incorporates three main components: predisposing, enabling, and need factors to model health service utilization. The sample (N = 149) was majority middle aged, female, and White with a primary diagnosis of cancer. Cross-tabulations were conducted to determine how many patients who met screening criteria for depression or anxiety sought psychology services. Logistic regression analyses were conducted to assess for predisposing, enabling, and need factor determinants of psychology service utilization. Among patients who met criteria for moderate depression or anxiety, 50% did not access readily available psychology services. Enabling factors were the strongest determinant of psychology utilization. Factors associated with need for psychology services (i.e., emotional distress and psychological symptom burden) did not reach significance in determining psychology service use. This study extends current knowledge about psychology utilization to palliative care outpatients receiving care within a collaborative care model. Directions for future research include further investigation of care models that optimize enabling strategies to enhance access to these services, and examination of patient-reported barriers to receiving this care. Copyright © 2013 John Wiley & Sons, Ltd.

  11. Enhancing Health-Care Services with Mixed Reality Systems

    Science.gov (United States)

    Stantchev, Vladimir

    This work presents a development approach for mixed reality systems in health care. Although health-care service costs account for 5-15% of GDP in developed countries the sector has been remarkably resistant to the introduction of technology-supported optimizations. Digitalization of data storing and processing in the form of electronic patient records (EPR) and hospital information systems (HIS) is a first necessary step. Contrary to typical business functions (e.g., accounting or CRM) a health-care service is characterized by a knowledge intensive decision process and usage of specialized devices ranging from stethoscopes to complex surgical systems. Mixed reality systems can help fill the gap between highly patient-specific health-care services that need a variety of technical resources on the one side and the streamlined process flow that typical process supporting information systems expect on the other side. To achieve this task, we present a development approach that includes an evaluation of existing tasks and processes within the health-care service and the information systems that currently support the service, as well as identification of decision paths and actions that can benefit from mixed reality systems. The result is a mixed reality system that allows a clinician to monitor the elements of the physical world and to blend them with virtual information provided by the systems. He or she can also plan and schedule treatments and operations in the digital world depending on status information from this mixed reality.

  12. Surface-micromachined rotatable member having a low-contact-area hub

    Science.gov (United States)

    Rodgers, M. Steven; Sniegowski, Jeffry J.; Krygowski, Thomas W.

    2003-11-18

    A surface-micromachined rotatable member formed on a substrate and a method for manufacturing thereof are disclosed. The surface-micromachined rotatable member, which can be a gear or a rotary stage, has a central hub, and an annulus connected to the central hub by an overarching bridge. The hub includes a stationary axle support attached to the substrate and surrounding an axle. The axle is retained within the axle support with an air-gap spacing therebetween of generally 0.3 .mu.m or less. The rotatable member can be formed by alternately depositing and patterning layers of a semiconductor (e.g. polysilicon or a silicon-germanium alloy) and a sacrificial material and then removing the sacrificial material, at least in part. The present invention has applications for forming micromechanical or microelectromechanical devices requiring lower actuation forces, and providing improved reliability.

  13. Surface--micromachined rotatable member having a low-contact-area hub

    Science.gov (United States)

    Rodgers, M. Steven; Sniegowski, Jeffry J.

    2002-01-01

    A surface-micromachined rotatable member formed on a substrate and a method for manufacturing thereof are disclosed. The surface-micromachined rotatable member, which can be a gear or a rotary stage, has a central hub, and an annulus connected to the central hub by an overarching bridge. The hub includes a stationary axle support attached to the substrate and surrounding an axle. The axle is retained within the axle support with an air-gap spacing therebetween of generally 0.3 .mu.m or less. The rotatable member can be formed by alternately depositing and patterning layers of a semiconductor (e.g. polysilicon or a silicon-germanium alloy) and a sacrificial material and then removing the sacrificial material, at least in part. The present invention has applications for forming micromechanical or microelectromechanical devices requiring lower actuation forces, and providing improved reliability.

  14. A Collaborative Scheduling Model for the Supply-Hub with Multiple Suppliers and Multiple Manufacturers

    Directory of Open Access Journals (Sweden)

    Guo Li

    2014-01-01

    Full Text Available This paper investigates a collaborative scheduling model in the assembly system, wherein multiple suppliers have to deliver their components to the multiple manufacturers under the operation of Supply-Hub. We first develop two different scenarios to examine the impact of Supply-Hub. One is that suppliers and manufacturers make their decisions separately, and the other is that the Supply-Hub makes joint decisions with collaborative scheduling. The results show that our scheduling model with the Supply-Hub is a NP-complete problem, therefore, we propose an auto-adapted differential evolution algorithm to solve this problem. Moreover, we illustrate that the performance of collaborative scheduling by the Supply-Hub is superior to separate decision made by each manufacturer and supplier. Furthermore, we also show that the algorithm proposed has good convergence and reliability, which can be applicable to more complicated supply chain environment.

  15. A Collaborative Scheduling Model for the Supply-Hub with Multiple Suppliers and Multiple Manufacturers

    Science.gov (United States)

    Lv, Fei; Guan, Xu

    2014-01-01

    This paper investigates a collaborative scheduling model in the assembly system, wherein multiple suppliers have to deliver their components to the multiple manufacturers under the operation of Supply-Hub. We first develop two different scenarios to examine the impact of Supply-Hub. One is that suppliers and manufacturers make their decisions separately, and the other is that the Supply-Hub makes joint decisions with collaborative scheduling. The results show that our scheduling model with the Supply-Hub is a NP-complete problem, therefore, we propose an auto-adapted differential evolution algorithm to solve this problem. Moreover, we illustrate that the performance of collaborative scheduling by the Supply-Hub is superior to separate decision made by each manufacturer and supplier. Furthermore, we also show that the algorithm proposed has good convergence and reliability, which can be applicable to more complicated supply chain environment. PMID:24892104

  16. Understanding patient e-loyalty toward online health care services.

    Science.gov (United States)

    Martínez-Caro, Eva; Cegarra-Navarro, Juan Gabriel; Solano-Lorente, Marcelina

    2013-01-01

    Public health institutions are making a great effort to develop patient-targeted online services in an attempt to enhance their effectiveness and reduce expenses. However, if patients do not use those services regularly, public health institutions will have wasted their limited resources. Hence, patients' electronic loyalty (e-loyalty) is essential for the success of online health care services. In this research, an extended Technology Acceptance Model was developed to test e-loyalty intent toward online health care services offered by public health institutions. Data from a survey of 256 users of online health care services provided by the public sanitary system of a region in Spain were analyzed. The research model was tested by using the structural equation modeling approach. The results obtained suggest that the core constructs of the Technology Acceptance Model (perceived usefulness, ease of use, and attitude) significantly affected users' behavioral intentions (i.e., e-loyalty intent), with perceived usefulness being the most decisive antecedent of affective variables (i.e., attitude and satisfaction). This study also reveals a general support for patient satisfaction as a determinant of e-loyalty intent in online health care services. Policy makers should focus on striving to get the highest positive attitude in users by enhancing easiness of use and, mainly, perceived usefulness. Because through satisfaction of patients, public hospitals will enlarge their patient e-loyalty intent, health care providers must always work at obtaining satisfied users and to encourage them to continue using the online services.

  17. A note on hierarchical hubbing for a generalization of the VPN problem

    NARCIS (Netherlands)

    N.K. Olver (Neil)

    2016-01-01

    textabstractRobust network design refers to a class of optimization problems that occur when designing networks to efficiently handle variable demands. In this context, Fréchette et al. (2013) recently explored hierarchical hubbing: a routing strategy involving a multiplicity of "hubs" connected to

  18. A note on hierarchical hubbing for a generalization of the VPN problem

    NARCIS (Netherlands)

    Olver, Neil

    2016-01-01

    Robust network design refers to a class of optimization problems that occur when designing networks to efficiently handle variable demands. In this context, Fréchette et al. (2013) recently explored hierarchical hubbing: a routing strategy involving a multiplicity of "hubs" connected to terminals

  19. Maternity Care Services Provided by Family Physicians in Rural Hospitals.

    Science.gov (United States)

    Young, Richard A

    The purpose of this study was to describe how many rural family physicians (FPs) and other types of providers currently provide maternity care services, and the requirements to obtain privileges. Chief executive officers of rural hospitals were purposively sampled in 15 geographically diverse states with significant rural areas in 2013 to 2014. Questions were asked about the provision of maternity care services, the physicians who perform them, and qualifications required to obtain maternity care privileges. Analysis used descriptive statistics, with comparisons between the states, community rurality, and hospital size. The overall response rate was 51.2% (437/854). Among all identified hospitals, 44.9% provided maternity care services, which varied considerably by state (range, 17-83%; P maternity care, a mean of 271 babies were delivered per year, 27% by cesarean delivery. A mean of 7.0 FPs had privileges in these hospitals, of which 2.8 provided maternity care and 1.8 performed cesarean deliveries. The percentage of FPs who provide maternity care (mean, 48%; range, 10-69%; P maternity care who are FPs (mean, 63%; range, 10-88%; P maternity care services in US rural hospitals, including cesarean deliveries. Some family medicine residencies should continue to train their residents to provide these services to keep replenishing this valuable workforce. © Copyright 2017 by the American Board of Family Medicine.

  20. Robust Energy Hub Management Using Information Gap Decision Theory

    DEFF Research Database (Denmark)

    Javadi, Mohammad Sadegh; Anvari-Moghaddam, Amjad; Guerrero, Josep M.

    2017-01-01

    This paper proposes a robust optimization framework for energy hub management. It is well known that the operation of energy systems can be negatively affected by uncertain parameters, such as stochastic load demand or generation. In this regard, it is of high significance to propose efficient...... tools in order to deal with uncertainties and to provide reliable operating conditions. On a broader scale, an energy hub includes diverse energy sources for supplying both electrical load and heating/cooling demands with stochastic behaviors. Therefore, this paper utilizes the Information Decision Gap...

  1. Socioeconomic inequalities in the access to and quality of health care services

    Directory of Open Access Journals (Sweden)

    Bruno Pereira Nunes

    2014-12-01

    Full Text Available OBJECTIVE To assess the inequalities in access, utilization, and quality of health care services according to the socioeconomic status. METHODS This population-based cross-sectional study evaluated 2,927 individuals aged ≥ 20 years living in Pelotas, RS, Southern Brazil, in 2012. The associations between socioeconomic indicators and the following outcomes were evaluated: lack of access to health services, utilization of services, waiting period (in days for assistance, and waiting time (in hours in lines. We used Poisson regression for the crude and adjusted analyses. RESULTS The lack of access to health services was reported by 6.5% of the individuals who sought health care. The prevalence of use of health care services in the 30 days prior to the interview was 29.3%. Of these, 26.4% waited five days or more to receive care and 32.1% waited at least an hour in lines. Approximately 50.0% of the health care services were funded through the Unified Health System. The use of health care services was similar across socioeconomic groups. The lack of access to health care services and waiting time in lines were higher among individuals of lower economic status, even after adjusting for health care needs. The waiting period to receive care was higher among those with higher socioeconomic status. CONCLUSIONS Although no differences were observed in the use of health care services across socioeconomic groups, inequalities were evident in the access to and quality of these services.

  2. Association of British Clinical Diabetologists (ABCD): survey of specialist diabetes care services in the UK, 2000. 3. Podiatry services and related foot care issues.

    Science.gov (United States)

    Winocour, P H; Morgan, J; Ainsworth, A; Williams, D R R

    2002-07-01

    To examine the provision of, and variations in, podiatry and other services for diabetic foot care in the UK. A postal survey of secondary care providers of diabetes services in the UK in 2000. Following two reminders a 77% response rate was achieved. The responses indicated that 97% had a state-registered podiatrist attached to the service, providing three (median) sessions each week for diabetes care, although only 44% had availability at all diabetic clinics, and only 3% had availability at paediatric diabetic services. Podiatry access at all diabetic clinics increased the likelihood of associated preventative as opposed to reactive ('trouble shooting') care (P podiatry input to patient education was common (84%), only 6% had received formal training in education. Guidelines and strategies for management of active foot problems were available in 50-74% of cases. Orthotic input was highly variable, and absent in 15% of responses. Podiatrist fitting and application of foot protective apparatus was only recorded in 22-61% of responses. Access to isotopic and/or MR foot imaging and peripheral angiography and angioplasty was recorded in 75-83% of responses. Separate specialist foot clinics were available in 49%, and where this was the case the use of newer foot ulcer healing applications was higher (P podiatry support to diabetes care over the last 10 years, the level of access and the nature of the services provided is much less than recommended in many advisory documents. The strategy of a co-ordinated 'team' approach to foot care still takes place in less than 50% of centres. There are clear regional differences in diabetes foot care services. Both providers and purchasers of diabetes services may not have given sufficient attention to this area, given the relatively small number of documented bids for service improvements in this area, and the very low success rate of such bids.

  3. Quality assessment of child care services in primary health care settings of Central Karnataka (Davangere District

    Directory of Open Access Journals (Sweden)

    Rashmi

    2010-01-01

    Full Text Available Background: Infectious disease and malnutrition are common in children. Primary health care came into being to decrease the morbidity. Quality assessment is neither clinical research nor technology assessment. It is primarily an administrative device used to monitor performance to determine whether it continues to remain within acceptable bounds. Aims and Objectives: To assess the quality of service in the delivery of child health care in a primary health care setting. To evaluate client satisfaction. To assess utilization of facilities by the community. Materials and Methods: Study Type: Cross-sectional community-based study. Quality assessment was done by taking 30-50%, of the service provider. Client satisfaction was determined with 1 Immunization and child examination-90 clients each. Utilization of services was assessed among 478 households. Statistical Analysis: Proportions, Likert′s scale to grade the services and Chi-square. Results: Immunization service: Identification of needed vaccine, preparation and care was average. Vaccination technique, documentation, EPI education, maintenance of cold chain and supplies were excellent. Client satisfaction was good. Growth monitoring: It was excellent except for mother′s education andoutreach educational session . Acute respiratory tract infection care: History, physical examination, ARI education were poor. Classification, treatment and referral were excellent. Client satisfaction was good. Diarrheal disease care: History taking was excellent. But examination, classification, treatment, ORT education were poor. Conclusion: Mothers education was not stressed by service providers. Service providers′ knowledge do not go with the quality of service rendered. Physical examination of the child was not good. Except for immunization other services were average.

  4. Exploring hubness in Regional Trade Agreements

    NARCIS (Netherlands)

    Vaal, A. de

    2016-01-01

    In the plethora of Regional Trade Agreements (RTAs) some countries take in a more central position than others in the sense that some countries are much more engaged with other countries through RTAs. Furthermore, the position of some countries is that of a hub: they have (many) trade

  5. [Relationship of the effectiveness of care management services and burdens of primary family caregivers].

    Science.gov (United States)

    Lee, Chia-Ling; Liu, Li-Fan; Chen, Shuh-Sin; Lin, Hsiu-Chun

    2014-02-01

    In Taiwan, long-term care management centers hold primary responsibility for administering long-term care services, assisting with long-term care placements, and sharing the care burden with family caregivers in need. Research into the effectiveness of current care management services and the effectiveness of these services in reducing care burdens remains limited. This study investigates the relationship among care management center service effectiveness, care management personnel, and burdens in relation to the provision of care services from the prospective of caregivers. A purposive sampling method and structured questionnaire survey were used to conduct telephone interviews with 154 home caregivers who had been transferred from care management centers to homecare service centers. Participants expressed overall satisfaction with care management centers and with the services provided by these centers. Satisfaction toward the care managers' professional competence was associated with lower physical burden for caregivers. Participants' psychological and social burdens were associated with overall satisfaction with the care management centers and their satisfaction with the services provided by care managers. The implementation of care management services has improved satisfaction. However, center services remain inadequate to reduce the psychological and social burdens of caregivers. Greater focus on these two aspects will be critical to the successful implementation of the proposed intensive care management model and multiple services intervention in order to meet the complex care needs of home service recipients and their primary caregivers.

  6. Gas and LNG pricing and trading hub in East Asia: An introduction

    Directory of Open Access Journals (Sweden)

    Xunpeng Shi

    2016-10-01

    Full Text Available This paper summarizes the four papers in the special issues on ‘Gas and LNG pricing and trading hub in East Asia’. The papers examine lessons and experience from European hub development, other commodity, the Japanese history on developing of futures markets and inter-fuel substitution in East Asia. The papers finds that liquid futures market is the key to formulate benchmark prices while a well-developed spot market is the foundation; political will and strong leadership are required to overcome the power of incumbents and to restructure the gas market that impede the the development of competitive markets; and East Asia needs to develop its indigenous gas or LNG trading hubs even in low oil prices period and its developing market allows easier changes in new contracts than in existing ones. This hub development requires governments to go through tough domestic market reforms, including liberalization and cooperation with each other and with gas exporters.

  7. Medium-term energy hub management subject to electricity price and wind uncertainty

    International Nuclear Information System (INIS)

    Najafi, Arsalan; Falaghi, Hamid; Contreras, Javier; Ramezani, Maryam

    2016-01-01

    Highlights: • A new model for medium-term energy hub management is proposed. • Risk aversion is considered in medium-term energy hub management. • Stochastic programing is used to solve the medium-term energy hub management problem. • Electricity price and wind uncertainty are considered. - Abstract: Energy hubs play an important role in implementing multi-carrier energy systems. More studies are required in both their modeling and operating aspects. In this regard, this paper attempts to develop medium-term management of an energy hub in restructured power systems. A model is presented to manage an energy hub which has electrical energy and natural gas as inputs and electrical and heat energy as outputs. Electricity is procured in various ways, either purchasing it from a pool-based market and bilateral contracts, or producing it from a Combined Heat and Power (CHP) unit, a diesel generator unit and Wind Turbine Generators (WTGs). Pool prices and wind turbine production are subject to uncertainty, which makes energy management a complex puzzle. Heat demand is also procured by a furnace and a CHP unit. Energy hub managers should make decisions whether to purchase electricity from the electricity market and gas from the gas network or to produce electricity using a set of generators to meet the electrical and heat demands in the presence of uncertainties. The energy management objective is to minimize the total cost subject to several technical constraints using stochastic programming. Conditional Value at Risk (CVaR), a well-known risk measure, is used to reduce the unfavorable risk of costs. In doing so, the proposed model is illustrated using a sample test case with actual prices, load and wind speed data. The results show that the minimum cost is obtained by the best decisions involving the electricity market and purchasing natural gas for gas facilities. Considering risk also increases the total expected cost and decreases the CVaR.

  8. Managed Care Approaches to Children's Services within Public Systems of Care.

    Science.gov (United States)

    Pumariega, Andres; Fallon, Theodore, Jr.

    This report presents two discussions of conceptual and infrastructure issues that state mental health systems serving children with emotional disturbances must consider to make an effective transition towards a managed care organization of services under Medicaid. The first discussion, "Clinical Experiences in Managed Care Implementation for…

  9. Marketing service guarantees for health care.

    Science.gov (United States)

    Levy, J S

    1999-01-01

    The author introduces the concept of service guarantees for application in health care and differentiates between explicit, implicit, and conditional vs. unconditional types of guarantees. An example of an unconditional guarantee of satisfaction is provided by the hospitality industry. Firms conveying an implicit guarantee are those with outstanding reputations for products such as luxury automobiles, or ultimate customer service, like Nordstrom. Federal Express and Domino's Pizza offer explicit guarantees of on-time delivery. Taking this concept into efforts to improve health care delivery involves a number of caveats. Customers invited to use exceptional service cards may use these to record either satisfaction or dissatisfaction. The cards need to provide enough specific information about issues so that "immediate action could be taken to improve processes." Front-line employees should be empowered to respond to complaints in a meaningful way to resolve the problem before the client leaves the premises.

  10. Hub network design for sparse travel demand within the African aviation industry

    CSIR Research Space (South Africa)

    Ssamula, B

    2007-07-01

    Full Text Available and analysed to reveal that the best option for a hub network is the so-called geo-political network. A geo-political network is where hubs are created in the North, South, East and West of Africa, at airports with strong political influence, high passenger...

  11. Design and Analysis of Wind Turbine Blade Hub using Aluminium Alloy AA 6061-T6

    Science.gov (United States)

    Ravikumar, S.; Jaswanthvenkatram, V.; Sai kumar, Y. J. N. V.; Sohaib, S. Md.

    2017-05-01

    This work presents the design and analysis of horizontal axis wind turbine blade hub using different material. The hub is very crucial part of the wind turbine, which experience the loads from the blades and the loads were transmitted to the main shaft. At present wind turbine is more expensive and weights more than a million pounds, with the nacelle, rotor hub and blades accounting for most of the weight. In this work Spheroidal graphite cast iron GGG 40.3 is replaced by aluminium alloy 6061-T6 to enhance the casting properties and also to improve the strength-weight ratio. This transition of material leads to reduction in weight of the wind turbine. All the loads caused by wind and extreme loads on the blades are transferred to the hub. Considering the IEC 61400-1 standard for defining extreme loads on the hub the stress and deflection were calculated on the hub by using Finite element Analysis. Result obtained from ANSYS is compared and discussed with the existing design.

  12. Service quality perceptions in primary health care centres in Greece

    Science.gov (United States)

    Papanikolaou, Vicky; Zygiaris, Sotiris

    2012-01-01

    Abstract Context  The paper refers to the increased competition between health care providers and the need for patient‐centred services in Greece. Using service quality methodology, this paper investigates service quality perceptions of patients in Greek public primary health centres. Objective  To test the internal consistency and applicability of SERVQUAL in primary health care centres in Greece. Strategy  SERVQUAL was used to examine whether patients have different expectations from health care providers and whether different groups of patients may consider some dimensions of care more important than others. Results  The analysis showed that there were gaps in all dimensions measured by SERVQUAL. The largest gap was detected in empathy. Further analysis showed that there were also differences depending on gender, age and education levels. A separate analysis of expectations and perceptions revealed that this gap was because of differences in patients’ perceptions rather than expectations. Discussion and conclusions  This paper raises a number of issues that concern the applicability of SERVQUAL in health care services and could enhance current discussions about SERVQUAL improvement. Quality of health care needs to be redefined by encompassing multiple dimensions. Beyond a simple expectations–perceptions gap, people may hold different understandings of health care that, in turn, influence their perception of the quality of services. PMID:22296402

  13. Service quality perceptions in primary health care centres in Greece.

    Science.gov (United States)

    Papanikolaou, Vicky; Zygiaris, Sotiris

    2014-04-01

    The paper refers to the increased competition between health care providers and the need for patient-centred services in Greece. Using service quality methodology, this paper investigates service quality perceptions of patients in Greek public primary health centres. To test the internal consistency and applicability of SERVQUAL in primary health care centres in Greece. SERVQUAL was used to examine whether patients have different expectations from health care providers and whether different groups of patients may consider some dimensions of care more important than others. The analysis showed that there were gaps in all dimensions measured by SERVQUAL. The largest gap was detected in empathy. Further analysis showed that there were also differences depending on gender, age and education levels. A separate analysis of expectations and perceptions revealed that this gap was because of differences in patients' perceptions rather than expectations. THIS paper raises a number of issues that concern the applicability of SERVQUAL in health care services and could enhance current discussions about SERVQUAL improvement. Quality of health care needs to be redefined by encompassing multiple dimensions. Beyond a simple expectations-perceptions gap, people may hold different understandings of health care that, in turn, influence their perception of the quality of services. © 2012 John Wiley & Sons Ltd.

  14. Prison hospice and pastoral care services in California.

    Science.gov (United States)

    Linder, John F; Knauf, Keith; Enders, Sheila R; Meyers, Frederick J

    2002-12-01

    Hospice at the California Medical Facility (CMF) Vacaville dates back to the mid-1980s, when the acquired immune deficiency syndrome (AIDS) epidemic began to be felt throughout California's Department of Corrections. Vacaville has served for decades as the principal location for delivering health services to California's incarcerated men. Informal hospice-like services were inspired by Elisabeth Kubler-Ross and through inmate and community calls for more humane care for dying inmates. By 1990, efforts to formally establish a hospice were under way. In 1996, a 17-bed, state-licensed hospice began caring for dying inmates. An interdisciplinary team plans and delivers the care, meeting weekly to admit and review patients. The Pastoral Care Services (PCS) inmate volunteer program, with more than 50 trained participants, provides care and comfort to dying patients in hospice and to ill patients on the general medicine service. PCS volunteers perform many duties, including sitting vigil with actively dying inmates. Inmates enrolling in hospice have to forgo further curative therapy, consent to the program in writing, and have a 6-month or less survival prognosis; patients are not required to have a do-not-resuscitate (DNR) order, but are encouraged to consider one. Training for physicians, staff and PCS volunteers is provided by the University of California, Davis faculty of the West Coast Center for Palliative Education. Bereavement services are provided for PCS volunteers, other inmate "family" and staff. Family and friends of the deceased in the free community are followed by phone, mail, and primarily through referral to resources in their local area.

  15. Facility Focus: Food Service.

    Science.gov (United States)

    College Planning & Management, 2002

    2002-01-01

    Describes the Hawthorn Court Community Center at Iowa State University, Ames, and the HUB-Robeson Center at Pennsylvania State University. Focuses on the food service offered in these new student-life buildings. Includes photographs. (EV)

  16. Accuracy of Caregiver Proxy Reports of Home Care Service Use.

    Science.gov (United States)

    Chappell, Neena L; Kadlec, Helena

    2016-12-01

    Although much of the research on service use by older adults with dementia relies on proxy reports by informal caregivers, little research assesses the accuracy of these reports, and that which does exist, does not focus on home care services. This brief report compares proxy reports by family caregivers to those with dementia with provincial Ministry of Health records collected for payment and monitoring. The four home care services examined include home nursing care, adult day care, home support, and respite care. Data come from a province-wide study of caregivers in British Columbia, Canada. Caregiver reports are largely consistent with Ministry records, ranging from 81.0% agreement for home support to 96.6% for respite care. Spouses living with the care recipient (the vast majority of the sample) are the most accurate. Others, whether living with the care recipient or not, have only a 50-50 chance of being correct.

  17. Estimated time spent on preventive services by primary care physicians

    Directory of Open Access Journals (Sweden)

    Gradison Margaret

    2008-12-01

    Full Text Available Abstract Background Delivery of preventive health services in primary care is lacking. One of the main barriers is lack of time. We estimated the amount of time primary care physicians spend on important preventive health services. Methods We analyzed a large dataset of primary care (family and internal medicine visits using the National Ambulatory Medical Care Survey (2001–4; analyses were conducted 2007–8. Multiple linear regression was used to estimate the amount of time spent delivering each preventive service, controlling for demographic covariates. Results Preventive visits were longer than chronic care visits (M = 22.4, SD = 11.8, M = 18.9, SD = 9.2, respectively. New patients required more time from physicians. Services on which physicians spent relatively more time were prostate specific antigen (PSA, cholesterol, Papanicolaou (Pap smear, mammography, exercise counseling, and blood pressure. Physicians spent less time than recommended on two "A" rated ("good evidence" services, tobacco cessation and Pap smear (in preventive visits, and one "B" rated ("at least fair evidence" service, nutrition counseling. Physicians spent substantial time on two services that have an "I" rating ("inconclusive evidence of effectiveness", PSA and exercise counseling. Conclusion Even with limited time, physicians address many of the "A" rated services adequately. However, they may be spending less time than recommended for important services, especially smoking cessation, Pap smear, and nutrition counseling. Future research is needed to understand how physicians decide how to allocate their time to address preventive health.

  18. KINEMATIC ANALYSES OF THE GOLF SWING HUB PATH AND ITS ROLE IN GOLFER/CLUB KINETIC TRANSFERS

    Directory of Open Access Journals (Sweden)

    Steven M. Nesbit

    2009-06-01

    Full Text Available This study analyzed the fundamental geometric and kinematic characteristics of the swing hub path of the golf shot for four diverse subjects. In addition, the role of the hub path geometry in transferring the kinetic quantities from the golfer to the club were investigated. The hub path was found to have a complex geometry with significantly changing radii, and a constantly moving center-of-curvature during the downswing for all subjects. While the size and shape of the hub path differed considerably among the subjects, a three phase radius-based pattern was revealed that aligned with distinct stages of the downswing. Artificially controlling and optimizing the hub path of the better golfer in the group indicated that a non-circular hub path was superior to a constant radius path in minimizing the kinetic loading while generating the highest possible club head velocity. The shape and purpose of the hub path geometry appears to result from a complex combination of achieving equilibrium between the golfer and the club, and a purposeful configuring of the path to control the outward movement of the club while minimizing the kinetic loading on the golfer yet transferring the maximum kinetic quantities to the club. Describing the downswing relative to the hub path phasing is presented and was found to be informative since the phases align with significant swing, kinetic and kinematic markers. These findings challenge golf swing modeling methodologies which fix the center-of-curvature of the hub path thus constraining it to constant radius motion

  19. Community participation in health service reform: the development of an innovative remote Aboriginal primary health-care service.

    Science.gov (United States)

    Reeve, Carole; Humphreys, John; Wakerman, John; Carroll, Vicki; Carter, Maureen; O'Brien, Tim; Erlank, Carol; Mansour, Rafik; Smith, Bec

    2015-01-01

    The aim of this study was to describe the reorientation of a remote primary health-care service, in the Kimberley region of Australia, its impact on access to services and the factors instrumental in bringing about change. A unique community-initiated health service partnership was developed between a community-controlled Aboriginal health organisation, a government hospital and a population health unit, in order to overcome the challenges of delivering primary health care to a dispersed, highly disadvantaged Aboriginal population in a very remote area. The shared goals and clear delineation of responsibilities achieved through the partnership reoriented an essentially acute hospital-based service to a prevention-focussed comprehensive primary health-care service, with a focus on systematic screening for chronic disease, interdisciplinary follow up, health promotion, community advocacy and primary prevention. This formal partnership enabled the primary health-care service to meet the major challenges of providing a sustainable, prevention-focussed service in a very remote and socially disadvantaged area.

  20. 38 CFR 17.35 - Hospital care and medical services in foreign countries.

    Science.gov (United States)

    2010-07-01

    ... VETERANS AFFAIRS MEDICAL Hospital Or Nursing Home Care and Medical Services in Foreign Countries § 17.35 Hospital care and medical services in foreign countries. The Secretary may furnish hospital care and... associated with and held to be aggravating a service-connected disability; (b) If the care is furnished to a...

  1. Abnormal hubs of white matter networks in the frontal-parieto circuit contribute to depression discrimination via pattern classification.

    Science.gov (United States)

    Qin, Jiaolong; Wei, Maobin; Liu, Haiyan; Chen, Jianhuai; Yan, Rui; Hua, Lingling; Zhao, Ke; Yao, Zhijian; Lu, Qing

    2014-12-01

    Previous studies had explored the diagnostic and prognostic value of the structural neuroimaging data of MDD and treated the whole brain voxels, the fractional anisotropy and the structural connectivity as classification features. To our best knowledge, no study examined the potential diagnostic value of the hubs of anatomical brain networks in MDD. The purpose of the current study was to provide an exploratory examination of the potential diagnostic and prognostic values of hubs of white matter brain networks in MDD discrimination and the corresponding impaired hub pattern via a multi-pattern analysis. We constructed white matter brain networks from 29 depressions and 30 healthy controls based on diffusion tensor imaging data, calculated nodal measures and identified hubs. Using these measures as features, two types of feature architectures were established, one only included hubs (HUB) and the other contained both hubs and non hubs. The support vector machine classifiers with Gaussian radial basis kernel were used after the feature selection. Moreover, the relative contribution of the features was estimated by means of the consensus features. Our results presented that the hubs (including the bilateral dorsolateral part of superior frontal gyrus, the left middle frontal gyrus, the bilateral middle temporal gyrus, and the bilateral inferior temporal gyrus) played an important role in distinguishing the depressions from healthy controls with the best accuracy of 83.05%. Moreover, most of the HUB consensus features located in the frontal-parieto circuit. These findings provided evidence that the hubs could be served as valuable potential diagnostic measure for MDD, and the hub-concentrated lesion distribution of MDD was primarily anchored within the frontal-parieto circuit. Copyright © 2014 Elsevier Inc. All rights reserved.

  2. TYPE PROJECTS HUB - AN INTERNATIONAL MODEL OF DEVELOPMENT OF THE ENTREPRENEURIAL ENVIRONMENT

    Directory of Open Access Journals (Sweden)

    Rozalia Nistor

    2014-06-01

    Full Text Available Impact Hub is a global network of local spaces and communities designed to facilitate sustainable impact through collaboration. Local Impact Hubs are autonomous companies that offer co-working spaces, programming, events platforms, and communities of individuals and organizations with ideas to build a better world. Hub was established in 2005 in London with the aim of creating a space dedicated to inspire, connect and enable people to achieve a sustainable entrepreneurial idea. The idea was simple: There are a lot of people with good ideas for a "better world". What seem to be missing are places to help these people to move from intent to action and to find like-minded for a greater impact. In Romania about four years ago, first opened in Bucharest office space hubs in Romania (for entrepreneurs in technology and business where teams from different companies could collaborate. The idea to open a hub in Bucharest focused on social innovation and entrepreneurship appeared some time ago in the context in which part of the team now has worked since 2010 at the initiation and growth of a community to support social entrepreneurship. In all this diversity, there is a common mission: “we can create if we put all our innovation capacity in the common goal to create a positive impact through our work?”

  3. Which need characteristics influence healthcare service utilization in home care arrangements in Germany?

    Science.gov (United States)

    Dorin, Lena; Turner, Suzi C; Beckmann, Lea; große Schlarmann, Jörg; Faatz, Andreas; Metzing, Sabine; Büscher, Andreas

    2014-05-22

    We see a growing number of older adults receiving long-term care in industrialized countries. The Healthcare Utilization Model by Andersen suggests that individual need characteristics influence utilization. The purpose of this study is to analyze correlations between need characteristics and service utilization in home care arrangements. 1,152 respondents answered the questionnaire regarding their integration of services in their current and future care arrangements. Care recipients with high long-term care needs answered the questionnaire on their own, the family caregiver assisted the care recipient in answering the questions, or the family caregiver responded to the questionnaire on behalf of the care recipient. They were asked to rank specific needs according to their situation. We used descriptive statistics and regression analysis. Respondents are widely informed about services. Nursing services and counseling are the most used services. Short-term care and guidance and training have a high potential for future use. Day care, self-help groups, and mobile services were the most frequently rejected services in our survey. Women use more services than men and with rising age utilization increases. Long waiting times and bad health of the primary caregiver increases the chance of integrating services into the home care arrangements. The primary family caregiver has a high impact on service utilization. This indicates that the whole family should be approached when offering services. Professionals should react upon the specific needs of care dependents and their families.

  4. Disrupted nodal and hub organization account for brain network abnormalities in Parkinson’s disease

    Directory of Open Access Journals (Sweden)

    Yuko Koshimori

    2016-11-01

    Full Text Available The recent application of graph theory to brain networks promises to shed light on complex diseases such as Parkinson’s disease. This study aimed to investigate functional changes in sensorimotor and cognitive networks in parkinsonian patients, with a focus on inter- and intra-connectivity organization in the disease-associated nodal and hub regions using the graph theoretical analyses. Resting-state functional MRI data of a total of 65 participants, including 23 healthy controls and 42 patients, were investigated in 120 nodes for local efficiency, betweenness centrality, and degree. Hub regions were identified in the healthy control and patient groups. We found nodal and hub changes in patients compared with healthy controls, including the right pre-supplementary motor area, left anterior insula, bilateral mid-insula, bilateral dorsolateral prefrontal cortex, and right caudate nucleus. In general, nodal regions within the sensorimotor network (i.e. right pre-supplementary motor area and right mid-insula displayed weakened connectivity, with the former node associated with more severe bradykinesia, and impaired integration with default mode network regions. The left mid-insula also lost its hub properties in patients. Within the executive networks, the left anterior insular cortex lost its hub properties in patients, while a new hub region was identified in the right caudate nucleus, paralleled by an increased level of inter- and intra-connectivity in the bilateral dorsolateral prefrontal cortex possibly representing compensatory mechanisms. These findings highlight the diffuse changes in nodal organization and regional hub disruption accounting for the distributed abnormalities across brain networks and the clinical manifestations of Parkinson’s disease.

  5. Nutrition services in managed care: new paradigms for dietitians.

    Science.gov (United States)

    Laramee, S H

    1996-04-01

    Managed care systems are transforming the health care system in the United States. Dietitians will need to review practice opportunities in new and different settings, and develop additional skills to make a successful transition to the transformed health care environment. The shift in health care financing from a fee-for-service model to a capitated system will have the most dramatic impact on the profession. Not all the answers are available, but the focus for the future is clear--customer satisfaction, outcomes research, and cost-effective nutrition services.

  6. Patients' perceptions of services and preferences for care in amyotrophic lateral sclerosis: A review.

    LENUS (Irish Health Repository)

    Foley, Geraldine

    2012-02-01

    Abstract Service providers and service users often have different perspectives on health and social care services. We have undertaken a systematic review of empirical data between 1988 and March 2011 relating to ALS service users\\' perspectives on health and social care services. Forty-seven texts were extracted and a narrative synthesis conducted. Few studies have explored ALS patients\\' experiences in relation to their satisfaction with services. Our review showed that ALS patients expect dignified care but they are often dissatisfied with health care services and have unmet expectations of their care. Most studies of decision-making and preferences for care have focused on end-of-life intervention. Various factors influence preferences for care from the service user perspective and people with ALS may adjust their use of services as they negotiate change. In conclusion, further research on the timeliness of services to meet changing needs of service users is required. The service user experience of allied health care services prior to end-of-life care also warrants investigation. Service providers need to support people with ALS as they negotiate feelings of acceptance and independence. Research to identify the key parameters of the ALS patient experience of services is required.

  7. Analysis and Modeling of Ground Operations at Hub Airports

    Science.gov (United States)

    Atkins, Stephen (Technical Monitor); Andersson, Kari; Carr, Francis; Feron, Eric; Hall, William D.

    2000-01-01

    Building simple and accurate models of hub airports can considerably help one understand airport dynamics, and may provide quantitative estimates of operational airport improvements. In this paper, three models are proposed to capture the dynamics of busy hub airport operations. Two simple queuing models are introduced to capture the taxi-out and taxi-in processes. An integer programming model aimed at representing airline decision-making attempts to capture the dynamics of the aircraft turnaround process. These models can be applied for predictive purposes. They may also be used to evaluate control strategies for improving overall airport efficiency.

  8. Development of a Community-Based Palliative Care Model for Advance Cancer Patients in Public Health Centers in Busan, Korea.

    Science.gov (United States)

    Kim, Sook-Nam; Choi, Soon-Ock; Shin, Seong Hoon; Ryu, Ji-Sun; Baik, Jeong-Won

    2017-07-01

    A feasible palliative care model for advance cancer patients is needed in Korea with its rapidly aging population and corresponding increase in cancer prevalence. This study describes the process involved in the development of a community-based palliative care (CBPC) model implemented originally in a Busan pilot project. The model development included steps I and II of the pilot project, identification of the service types, a survey exploring the community demand for palliative care, construction of an operational infrastructure, and the establishment of a service delivery system. Public health centers (including Busan regional cancer centers, palliative care centers, and social welfare centers) served as the regional hubs in the development of a palliative care model. The palliative care project included the provision of palliative care, establishment of a support system for the operations, improvement of personnel capacity, development of an educational and promotional program, and the establishment of an assessment system to improve quality. The operational infrastructure included a service management team, provision teams, and a support team. The Busan Metropolitan City CBPC model was based on the principles of palliative care as well as the characteristics of public health centers that implemented the community health projects. The potential use of the Busan CBPC model in Korea should be explored further through service evaluations.

  9. Modeling the Association Between Home Care Service Use and Entry Into Residential Aged Care: A Cohort Study Using Routinely Collected Data.

    Science.gov (United States)

    Jorgensen, Mikaela; Siette, Joyce; Georgiou, Andrew; Warland, Andrew; Westbrook, Johanna

    2018-02-01

    To examine home care service-related and person-based factors associated with time to entry into permanent residential aged care. Longitudinal cohort study using routinely collected client management data. A large aged care service provider in New South Wales and the Australian Capital Territory, Australia. A total of 1116 people aged 60 years and older who commenced home care services for higher-level needs between July 1, 2015 and June 30, 2016. Survival analysis methods were used to examine service-related and person-based factors that were associated with time between first home care service and entry into permanent residential aged care. Predictors included service hours per week, combination of service types, demographics, needs, hospital leave, and change in care level. Cluster analysis was used to determine patterns of types of services used. By December 31, 2016, 21.1% of people using home care services had entered into permanent residential care (n = 235). After adjusting for significant factors such as age and care needs, each hour of service received per week was associated with a 6% lower risk of entry into residential care (hazard ratio = 0.94, 95% confidence interval 0.90-0.98). People who were predominant users of social support services, those with an identified carer, and those born in a non-main English-speaking country also remained in their own homes for longer. Greater volume of home care services was associated with significantly delayed entry into permanent residential care. This study provides much-needed evidence about service outcomes that could be used to inform older adults' care choices. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

  10. Care coordinators: a controlled evaluation of an inpatient mental health service innovation.

    Science.gov (United States)

    Stewart, Malcolm W; Wilson, Michael; Bergquist, Karla; Thorburn, John

    2012-02-01

    The study aimed to evaluate the impact of introducing designated care coordinators into an acute mental health inpatient unit in terms of service delivery, clinical outcomes, and service user and significant other perceptions. A pre-post-controlled design was implemented with a consecutive sample of 292 service users admitted and staying more than 5 days in two wards, with care coordinators introduced in one ward. Data were obtained from clinical records, standard measures, and service user and significant other surveys. Care coordinator input was associated with significant improvements in service delivery and stronger involvement of significant others and community resources. Care-coordinated clients showed significantly better clinical outcomes, including the Health of Nations Outcome Scales behaviour subscale, less time in the intensive care subunit, less community crisis team input in the week following discharge, and lower rates of readmission in the month following discharge. Care-coordinated service users and their significant others gave higher ratings of service delivery, outcome, and satisfaction. The results indicate that designated care coordinators significantly improve care processes, outcomes, and service user experience in acute inpatient mental health settings. © 2011 The Authors. International Journal of Mental Health Nursing © 2011 Australian College of Mental Health Nurses Inc.

  11. Why do European companies have Innovation Hubs in Silicon Valley

    DEFF Research Database (Denmark)

    Berger, Andreas; Brem, Alexander

    2017-01-01

    Innovation hubs are gaining high attention in recent years, especially from European companies. Silicon Valley has been deemed as one of the most attractive and successful environments for establishing innovation hubs. This article highlights examples of companies from Europe that made the step...... to California—namely, Volkswagen, Swisscom, BMW, Axel Springer, Munich Re, and Innogy SE (RWE Group). Based on these companies’ experiences, recommendations are given on how companies might approach a setup in Silicon Valley for long-term success....

  12. Evaluating the Effectiveness of Intervention in Long-Term Aphasia Post-Stroke: The Experience from CHANT (Communication Hub for Aphasia in North Tyneside)

    Science.gov (United States)

    Mumby, Katharyn; Whitworth, Anne

    2012-01-01

    Background: Despite recognition of the need for increased long-term support for people with aphasia following stroke, there remains limited evidence for effective service-level interventions. Aims: To evaluate the outcomes and experiences of people participating in the Communication Hub for Aphasia in North Tyneside (CHANT), a 2-year partnership…

  13. Democratic Citizenship and Service Learning: Advancing the Caring Self.

    Science.gov (United States)

    Rhoads, Robert A.

    2000-01-01

    Discusses how service learning can promote the development of a "caring self" in college students by drawing on the ideas of John Dewey, George Herbert Mead, and contemporary critical theorists. Links this caring self to democratic citizenship and uses students' narratives to illustrate how it develops through service learning contexts.…

  14. Characteristics of care management agencies affect expenditure on home help and day care services: A population-based cross-sectional study in Japan.

    Science.gov (United States)

    Feng, Mei; Igarashi, Ayumi; Noguchi-Watanabe, Maiko; Yoshie, Satoru; Iijima, Katsuya; Yamamoto-Mitani, Noriko

    2017-11-01

    The financial interests of care management agencies can affect how care managers assist clients' use of long-term care insurance services. The present study examined the relationship between clients' service expenditures, and whether the home help and day care service agencies belonged to the same organization as the care management agency. Population-based data were obtained from a suburban municipality in Japan. We investigated 4331 persons with care needs certificates (levels 1-5), including those using home help (n = 1780) or day care (n = 2141) services. Data on the service expenditures, and clients' and agencies' characteristics were analyzed using multiple linear regression analyses controlling for potential confounders. Home help service users spent an average of US$558.1 ± 590.1 for home help service, and day care service users spent US$665.0 ± 415.9 for day care service. Living alone, living in a condominium/apartment, higher care needs, more severe cognitive impairment and lower use of other services were associated with higher home help service expenditure. Day care service expenditure increased with older age, female sex, higher care needs, more severe cognitive impairment and higher physical function. Clients whose service agencies and care management agencies belonged to the same organization had higher expenditures, even after adjusting for confounders (home help: β = 0.126, P = 0.007; day care: β = 0.085, P = 0.002, respectively). Financial interests of care management agencies might significantly influence clients' service expenditure. We should develop an effective system to minimize this influence. Geriatr Gerontol Int 2017; 17: 2224-2231. © 2017 Japan Geriatrics Society.

  15. Public health capacity in the provision of health care services.

    Science.gov (United States)

    Valdmanis, Vivian; DeNicola, Arianna; Bernet, Patrick

    2015-12-01

    In this paper, we assess the capacity of Florida's public health departments. We achieve this by using bootstrapped data envelopment analysis (DEA) applied to Johansen's definition of capacity utilization. Our purpose in this paper is to measure if there is, theoretically, enough excess capacity available to handle a possible surge in the demand for primary care services especially after the implementation of the Affordable Care Act that includes provisions for expanded public health services. We measure subunit service availability using a comprehensive data source available for all 67 county health departments in the provision of diagnostic care and primary health care. In this research we aim to address two related research questions. First, we structure our analysis so as to fix budgets. This is based on the assumption that State spending on social and health services could be limited, but patient needs are not. Our second research question is that, given the dearth of primary care providers in Florida if budgets are allowed to vary is there enough medical labor to provide care to clients. Using a non-parametric approach, we also apply bootstrapping to the concept of plant capacity which adds to the productivity research. To preview our findings, we report that there exists excess plant capacity for patient treatment and care, but question whether resources may be better suited for more traditional types of public health services.

  16. Biaxial wheel/hub test facility. Proceedings

    Energy Technology Data Exchange (ETDEWEB)

    Fischer, G.; Grubisic, V. [eds.

    2000-07-01

    The 4{sup th} meeting aims to exchange the experience and knowledge of engineers during several presentations and discussions about new developments required for a reliable, time and cost reducing validation of the wheel/hub assembly. Tremendous development of the wheel performance, described by the ratio of the rated load (kg) versus the wheel weight (kg) had taken place during the last 5000 years. Starting from the ratio of 3 for wooden 2-piece-disc-wheels in Mesopotamia it needed nearly 1000 years to increase the ratio to approx 5 at light-weight spoke wheels for fighting carriages, found in the grave of king Tutenchamon in Egypt. Modern light alloy wheels of commercial vehicles reach values up to 160 kg/kg. Additionally the comlex design of the modern systems for cars and commercial vehicles comprising wheel, brake, hub, bearing, spindle and hub carrier, including different materials and their treatment, fasteners, press-fits, require an appropriate testing procedure. The variable loading conditions, caused by operational wheel forces, brake and torque moments including heating, may result in changing tolerances and press-fits during operation and consequently in different damage mechanisms. This can be simulated in the Biaxial Wheel Test Machine, whereby corresponding load programs are necessary. An overview about all biaxial test machines in usage at the end of 1999 is shown in the introduction. The total number is 17 for cars, 7 for commercial vehicles and 1 for trains. The six presentations of this meeting were consequently concentrated on: (a) recommendations for a standardization of load programs of the German Wheel Committee, (b) the simulation of brake and torque events and (c) the possibility for a numerical stress analyses and fatigue life assessment. (orig./AKF)

  17. Comparative efficiency of wind turbines with different heights of rotor hubs: performance evaluation for Latvia

    International Nuclear Information System (INIS)

    Bezrukovs, V P; Zacepins, A J; Bezrukovs, V V

    2014-01-01

    Performance evaluation of wind turbines (WT) for different heights of the rotor hub is made based on the wind speed and direction data obtained in 2009–2013 on-shore in the north of Latvia using a LOGGER 9200 Symphonie measurement system mounted on a 60 m mast. Based on the measurement analysis results, wind speed distribution curves have been modelled for heights of up to 200 m using power and logarithmic (log) law approximation methods. The curves for the modelled Weibull's parameters are plotted in dependence on height. The efficiency comparison is made for different WT types taking into account the distribution of the wind energy potential in height in the Latvian territory. The annual electric energy production was calculated for the WTs with different heights of rotor hubs. In the calculations the technical data on the following WT types were used: E-3120 (50 kW, hub height 20.5/30.5/36.5/42.7 m), E-33 (330 kW, hub height 37/44/49/50 m), E-48 (800 kW, hub height 50/60/75 m) and E-82 (2.3 MW, hub height of 78/85/98/108/138 m)

  18. Puertos, espacio y globalización: el desarrollo de hubs en México

    Directory of Open Access Journals (Sweden)

    Carlos Daniel Martner Peyrelongue

    2010-01-01

    Full Text Available Los puertos hubs se presentan como el nuevo paradigma de desarrollo del transporte y el comercio marítimo internacional en la globalización. Prácticamente todos los países latinoamericanos anuncian megaproyectos para el desarrollo de puertos hubs en sus litorales, generando grandes expectativas de desarrollo regional, con un débil sustento tanto teórico como empírico. En este sentido, el presente trabajo busca contribuir a la caracterización del modelo de puertos hubs en países periféricos dentro de la economíamundo capitalista, aludiendo, en especial, al caso mexicano. Se trata de aportar elementos de análisis para reconocer, a grandes rasgos, las posibilidades del desarrollo de hubs en los litorales mexicanos, desde la perspectiva de los estudios regionales y la geografía del transporte.

  19. Service Users' and Caregivers' Perspectives on Continuity of Care in Out-of-Hours Primary Care.

    LENUS (Irish Health Repository)

    Gallagher, Niamh

    2012-12-20

    Modernization policies in primary care, such as the introduction of out-of-hours general practice cooperatives, signify a marked departure from many service users\\' traditional experiences of continuity of care. We report on a case study of accounts of service users with chronic conditions and their caregivers of continuity of care in an out-of-hours general practice cooperative in Ireland. Using Strauss and colleagues\\' Chronic Illness Trajectory Framework, we explored users\\' and caregivers\\' experiences of continuity in this context. Whereas those dealing with "routine trajectories" were largely satisfied with their experiences, those dealing with "problematic trajectories" (characterized by the presence of, for example, multimorbidity and complex care regimes) had considerable concerns about continuity of experiences in this service. Results highlight that modernization policies that have given rise to out-of-hours cooperatives have had a differential impact on service users with chronic conditions and their caregivers, with serious consequences for those who have "problematic" trajectories.

  20. Portable Desktop Apps with GitHub Electron

    CERN Multimedia

    CERN. Geneva

    2016-01-01

    Wouldn't it be nice if you could develop applications that work everywhere, regardless of Operating System or Platform? Even better, what if you could employ the same front-end technologies you use for your web/mobile apps? Meet GitHub Electron.

  1. Youth with special health care needs: transition to adult health care services.

    Science.gov (United States)

    Oswald, Donald P; Gilles, Donna L; Cannady, Mariel S; Wenzel, Donna B; Willis, Janet H; Bodurtha, Joann N

    2013-12-01

    Transition to adult services for children and youth with special health care needs (CYSHCN) has emerged as an important event in the life course of individuals with disabilities. Issues that interfere with efficient transition to adult health care include the perspectives of stakeholders, age limits on pediatric service, complexity of health conditions, a lack of experienced healthcare professionals in the adult arena, and health care financing for chronic and complex conditions. The purposes of this study were to develop a definition of successful transition and to identify determinants that were associated with a successful transition. The 2007 Survey of Adult Transition and Health dataset was used to select variables to be considered for defining success and for identifying predictors of success. The results showed that a small percentage of young adults who participated in the 2007 survey had experienced a successful transition from their pediatric care.

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

    Science.gov (United States)

    Koike, Soichi; Furui, Yuji

    2013-04-01

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

  3. Pharmacist Advancement of Transitions of Care to Home (PATCH) Service.

    Science.gov (United States)

    Trang, Joseph; Martinez, Amanda; Aslam, Sadaf; Duong, Minh-Tri

    2015-11-01

    There is a paucity of literature on a well-defined role of a pharmacist in different aspects of transition of care service (TCS). Although health care institutions have specific details on the discharge process, there is a need for a sustainable TCS with a well-defined role of pharmacists. To describe the impact of a pharmacist-led TCS on acute health care utilization, clinic quality indicators, and identification and resolution of medication-related problems (MRPs). A pharmacist-managed TCS service, referred to as the Pharmacist Advancement of Transitions of Care to Home (PATCH) service, was established at an academic medical center, where high-risk patients received a postdischarge phone call from a pharmacist followed by a face-to-face meeting with the pharmacist and the patient's primary care provider (PCP). In a prospective transitions of care group (n = 74), outcomes of patients such as acute health care utilization (an emergency department visit or an inpatient readmission, within 30 days post discharge), clinic quality indicators, and identification and resolution of MRPs were compared to a retrospective control group (n = 87) who received the standard of care. Utilization of acute health care services was significantly lower in the prospective group compared to the retrospective control group (23% vs 41.4%; P = .013). A total of 49 MRPs were discovered in patients who received the TCS. Pharmacists play an integral role in improving the transitions of care to reduce acute health care utilization. In addition, they may improve care transitions by optimizing clinic quality indicators and by identifying and resolving MRPs.

  4. A novel method to identify hub pathways of rheumatoid arthritis based on differential pathway networks.

    Science.gov (United States)

    Wei, Shi-Tong; Sun, Yong-Hua; Zong, Shi-Hua

    2017-09-01

    The aim of the current study was to identify hub pathways of rheumatoid arthritis (RA) using a novel method based on differential pathway network (DPN) analysis. The present study proposed a DPN where protein‑protein interaction (PPI) network was integrated with pathway‑pathway interactions. Pathway data was obtained from background PPI network and the Reactome pathway database. Subsequently, pathway interactions were extracted from the pathway data by building randomized gene‑gene interactions and a weight value was assigned to each pathway interaction using Spearman correlation coefficient (SCC) to identify differential pathway interactions. Differential pathway interactions were visualized using Cytoscape to construct a DPN. Topological analysis was conducted to identify hub pathways that possessed the top 5% degree distribution of DPN. Modules of DPN were mined according to ClusterONE. A total of 855 pathways were selected to build pathway interactions. By filtrating pathway interactions of weight values >0.7, a DPN with 312 nodes and 791 edges was obtained. Topological degree analysis revealed 15 hub pathways, such as heparan sulfate/heparin‑glycosaminoglycan (HS‑GAG) degradation, HS‑GAG metabolism and keratan sulfate degradation for RA based on DPN. Furthermore, hub pathways were also important in modules, which validated the significance of hub pathways. In conclusion, the proposed method is a computationally efficient way to identify hub pathways of RA, which identified 15 hub pathways that may be potential biomarkers and provide insight to future investigation and treatment of RA.

  5. Hub location problems in transportation networks

    DEFF Research Database (Denmark)

    Gelareh, Shahin; Nickel, Stefan

    2011-01-01

    In this paper we propose a 4-index formulation for the uncapacitated multiple allocation hub location problem tailored for urban transport and liner shipping network design. This formulation is very tight and most of the tractable instances for MIP solvers are optimally solvable at the root node....... also introduce fixed cost values for Australian Post (AP) dataset....

  6. Mothers' health services utilization and health care seeking ...

    African Journals Online (AJOL)

    Background: data from different studies showed health care behaviour and estimated per capita health care expenditure for the general population, but the specific data for infants at different levels of care are lacking. The objectives of this study were to describe mothers' health service utilization during pregnancy and ...

  7. Role of governance in creating a commodity hub: A comparative analysis

    Directory of Open Access Journals (Sweden)

    M.P. Haris

    2016-10-01

    Full Text Available The body of work on natural gas hubs has been expanding rapidly in recent years, with most of the current work examining the creation of gas hubs focusing on either the European experience or the North American experience. In this paper, we adopt a different perspective and place the focus on experience of hub building from other international commodities. We analyse three commodities - crude oil, iron ore and coal, and draw experience on the role of governance in development of hub based prices. In particular, we propose that the role of governance is different at different stages of the pricing transition to market based pricing. Governance could play an important role at the initial stage, building the relevant soft and physical infrastructure which facilitates the reaping of first mover advantage. As the market develops, private sector players may prefer less involvement of governance, which may distort markets. With market stabilization, governance should be focused on maintaining stable rules and regulation for private sector development, as well as monitoring for further changes in global trends. To facilitate the building of a benchmark price, the public sector should adopt a long-term and overarching view on industry growth.

  8. Income-Related Inequalities in Access to Dental Care Services in Japan.

    Science.gov (United States)

    Nishide, Akemi; Fujita, Misuzu; Sato, Yasunori; Nagashima, Kengo; Takahashi, Sho; Hata, Akira

    2017-05-12

    Background : This study aimed to evaluate whether income-related inequalities in access to dental care services exist in Japan. Methods : The subjects included beneficiaries of the National Health Insurance (NHI) in Chiba City, Japan, who had been enrolled from 1 April 2014 to 31 March 2015. The presence or absence of dental visits and number of days spent on dental care services during the year were calculated using insurance claims submitted. Equivalent household income was calculated using individual income data from 1 January to 31 December 2013, declared for taxation. Results : Of the 216,211 enrolled subjects, 50.3% had dental care during the year. Among those with dental visits, the average number of days (standard deviation) spent on dental care services per year was 7.7 (7.1). Low income was associated with a decreased rate of dental care utilization regardless of age and sex. However, there was a significant inverse linear association between the number of days spent on dental care services and income levels for both sexes. Conclusions : There were income-related inequalities in access to dental care services, regardless of the age group or sex, within the Japanese universal health insurance system.

  9. Excitatory Neuronal Hubs Configure Multisensory Integration of Slow Waves in Association Cortex

    Directory of Open Access Journals (Sweden)

    Satoshi Kuroki

    2018-03-01

    Full Text Available Summary: Multisensory integration (MSI is a fundamental emergent property of the mammalian brain. During MSI, perceptual information encoded in patterned activity is processed in multimodal association cortex. The systems-level neuronal dynamics that coordinate MSI, however, are unknown. Here, we demonstrate intrinsic hub-like network activity in the association cortex that regulates MSI. We engineered calcium reporter mouse lines based on the fluorescence resonance energy transfer sensor yellow cameleon (YC2.60 expressed in excitatory or inhibitory neurons. In medial and parietal association cortex, we observed spontaneous slow waves that self-organized into hubs defined by long-range excitatory and local inhibitory circuits. Unlike directional source/sink-like flows in sensory areas, medial/parietal excitatory and inhibitory hubs had net-zero balanced inputs. Remarkably, multisensory stimulation triggered rapid phase-locking mainly of excitatory hub activity persisting for seconds after the stimulus offset. Therefore, association cortex tends to form balanced excitatory networks that configure slow-wave phase-locking for MSI. Video Abstract: : Kuroki et al. performed cell-type-specific, wide-field FRET-based calcium imaging to visualize cortical network activity induced by multisensory inputs. They observed phase-locking of cortical slow waves in excitatory neuronal hubs in association cortical areas that may underlie multisensory integration. Keywords: wide-field calcium imaging, multisensory integration, cortical slow waves, association cortex, phase locking, fluorescence resonance energy transfer, spontaneous activity, excitatory neuron, inhibitory neuron, mouse

  10. Extraversion modulates functional connectivity hubs of resting-state brain networks.

    Science.gov (United States)

    Pang, Yajing; Cui, Qian; Duan, Xujun; Chen, Heng; Zeng, Ling; Zhang, Zhiqiang; Lu, Guangming; Chen, Huafu

    2017-09-01

    Personality dimension extraversion describes individual differences in social behaviour and socio-emotional functioning. The intrinsic functional connectivity patterns of the brain are reportedly associated with extraversion. However, whether or not extraversion is associated with functional hubs warrants clarification. Functional hubs are involved in the rapid integration of neural processing, and their dysfunction contributes to the development of neuropsychiatric disorders. In this study, we employed the functional connectivity density (FCD) method for the first time to distinguish the energy-efficient hubs associated with extraversion. The resting-state functional magnetic resonance imaging data of 71 healthy subjects were used in the analysis. Short-range FCD was positively correlated with extraversion in the left cuneus, revealing a link between the local functional activity of this region and extraversion in risk-taking. Long-range FCD was negatively correlated with extraversion in the right superior frontal gyrus and the inferior frontal gyrus. Seed-based resting-state functional connectivity (RSFC) analyses revealed that a decreased long-range FCD in individuals with high extraversion scores showed a low long-range functional connectivity pattern between the medial and dorsolateral prefrontal cortex, middle temporal gyrus, and anterior cingulate cortex. This result suggests that decreased RSFC patterns are responsible for self-esteem, self-evaluation, and inhibitory behaviour system that account for the modulation and shaping of extraversion. Overall, our results emphasize specific brain hubs, and reveal long-range functional connections in relation to extraversion, thereby providing a neurobiological basis of extraversion. © 2015 The British Psychological Society.

  11. PERSEUS-HUB: Interactive and Collective Exploration of Large-Scale Graphs

    Directory of Open Access Journals (Sweden)

    Di Jin

    2017-07-01

    Full Text Available Graphs emerge naturally in many domains, such as social science, neuroscience, transportation engineering, and more. In many cases, such graphs have millions or billions of nodes and edges, and their sizes increase daily at a fast pace. How can researchers from various domains explore large graphs interactively and efficiently to find out what is ‘important’? How can multiple researchers explore a new graph dataset collectively and “help” each other with their findings? In this article, we present Perseus-Hub, a large-scale graph mining tool that computes a set of graph properties in a distributed manner, performs ensemble, multi-view anomaly detection to highlight regions that are worth investigating, and provides users with uncluttered visualization and easy interaction with complex graph statistics. Perseus-Hub uses a Spark cluster to calculate various statistics of large-scale graphs efficiently, and aggregates the results in a summary on the master node to support interactive user exploration. In Perseus-Hub, the visualized distributions of graph statistics provide preliminary analysis to understand a graph. To perform a deeper analysis, users with little prior knowledge can leverage patterns (e.g., spikes in the power-law degree distribution marked by other users or experts. Moreover, Perseus-Hub guides users to regions of interest by highlighting anomalous nodes and helps users establish a more comprehensive understanding about the graph at hand. We demonstrate our system through the case study on real, large-scale networks.

  12. Improving palliative care outcomes for Aboriginal Australians: service providers' perspectives.

    Science.gov (United States)

    Shahid, Shaouli; Bessarab, Dawn; van Schaik, Katherine D; Aoun, Samar M; Thompson, Sandra C

    2013-07-23

    Aboriginal Australians have a lower rate of utilisation of palliative care services than the general population. This study aimed to explore care providers' experiences and concerns in providing palliative care for Aboriginal people, and to identify opportunities for overcoming gaps in understanding between them and their Aboriginal patients and families. In-depth, qualitative interviews with urban, rural and remote palliative care providers were undertaken in inpatient and community settings in Western Australia. Interviews were audio-recorded, transcribed verbatim and coded independently by two researchers with QSR NVivo 10 software used to help manage data. Data analysis was informed by multiple theoretical standpoints, including the social ecological model, critical cultural theories and the 'cultural security' framework. Thematic analysis was carried out that identified patterns within data. Fifteen palliative care providers were interviewed. Overall they reported lack of understanding of Aboriginal culture and being uncertain of the needs and priorities of Aboriginal people during end-of-life care. According to several participants, very few Aboriginal people had an understanding of palliative care. Managing issues such as anger, denial, the need for non-medical support due to socioeconomic disadvantage, and dealing with crises and conflicts over funeral arrangements were reported as some of the tensions between Aboriginal patients and families and the service providers. Early referral to palliative care is important in demonstrating and maintaining a caring therapeutic relationship. Paramount to meeting the needs for Aboriginal patients was access to appropriate information and logistical, psychological and emotional support. These were often seen as essential but additional to standard palliative care services. The broader context of Aboriginal history and historical distrust of mainstream services was seen to impinge on Aboriginal people's willingness and

  13. Improving palliative care outcomes for Aboriginal Australians: service providers’ perspectives

    Science.gov (United States)

    2013-01-01

    Background Aboriginal Australians have a lower rate of utilisation of palliative care services than the general population. This study aimed to explore care providers’ experiences and concerns in providing palliative care for Aboriginal people, and to identify opportunities for overcoming gaps in understanding between them and their Aboriginal patients and families. Methods In-depth, qualitative interviews with urban, rural and remote palliative care providers were undertaken in inpatient and community settings in Western Australia. Interviews were audio-recorded, transcribed verbatim and coded independently by two researchers with QSR NVivo 10 software used to help manage data. Data analysis was informed by multiple theoretical standpoints, including the social ecological model, critical cultural theories and the ‘cultural security’ framework. Thematic analysis was carried out that identified patterns within data. Results Fifteen palliative care providers were interviewed. Overall they reported lack of understanding of Aboriginal culture and being uncertain of the needs and priorities of Aboriginal people during end-of-life care. According to several participants, very few Aboriginal people had an understanding of palliative care. Managing issues such as anger, denial, the need for non-medical support due to socioeconomic disadvantage, and dealing with crises and conflicts over funeral arrangements were reported as some of the tensions between Aboriginal patients and families and the service providers. Conclusion Early referral to palliative care is important in demonstrating and maintaining a caring therapeutic relationship. Paramount to meeting the needs for Aboriginal patients was access to appropriate information and logistical, psychological and emotional support. These were often seen as essential but additional to standard palliative care services. The broader context of Aboriginal history and historical distrust of mainstream services was seen to

  14. Variation in critical care services across North America and Western Europe

    NARCIS (Netherlands)

    Wunsch, Hannah; Angus, Derek C.; Harrison, David A.; Collange, Olivier; Fowler, Robert; Hoste, Eric A. J.; de Keizer, Nicolette F.; Kersten, Alexander; Linde-Zwirble, Walter T.; Sandiumenge, Alberto; Rowan, Kathryn M.

    2008-01-01

    Objective: Critical care represents a large percentage of healthcare spending in developed countries. Yet, little is known regarding international variation in critical care services. We sought to understand differences in critical care delivery by comparing data on the distribution of services in

  15. Identifying profiles of service users in housing services and exploring their quality of life and care needs

    NARCIS (Netherlands)

    Bitter, N.A.; Roeg, D.P.K.; Van Nieuwenhuizen, Ch.; Van Weeghel, J.

    2016-01-01

    Background Housing services aim to support people with mental illness in their daily life and recovery. As the level of recovery differs between service users, the quality of life and care needs also might vary. However, the type and amount of care and support that service users receive do not

  16. Identifying profiles of service users in housing services and exploring their quality of life and care needs.

    Science.gov (United States)

    Bitter, Neis A; Roeg, Diana P K; van Nieuwenhuizen, Chijs; van Weeghel, Jaap

    2016-11-23

    Housing services aim to support people with mental illness in their daily life and recovery. As the level of recovery differs between service users, the quality of life and care needs also might vary. However, the type and amount of care and support that service users receive do not always match their recovery. In order to improve the quality of care, this study aims to explore whether subgroups of service users exist based on three dimensions of recovery and to examine and compare the quality of life and care needs of the persons in these subgroups. Latent class analysis was performed with data from 263 service users of housing services in the Netherlands. Classes were based on three variables: personal recovery (Mental Health Recovery Measure), social recovery (Social Functioning Scale), and clinical recovery (Brief Symptom Inventory). Subsequently, the quality of life (MANSA) and care needs (CANSAS) of the different classes were analysed by the use of descriptive and inferential statistics. Three classes could be distinguished. Class 1 (45%) comprised of people who score the highest of the three classes in terms of personal and social recovery and who experience the least number of symptoms. People in class 2 (44%) and class 3 (11%) score significantly lower on personal and social recovery, and they experience significantly more symptoms compared to class 1. The distinction between class 2 and 3 can be made on the significantly higher number of symptoms in class 3. All three classes differ significantly on quality of life and unmet needs. The quality of life of service users of housing services needs improvement, as even persons in the best-recovered subgroup have a lower quality of life than the average population. Workers of housing services need to be aware of the recovery of a client and what his or her individual needs and goals are. Furthermore, better care (allocation) concerning mental and physical health and rehabilitation is needed. Care should be

  17. The evolution of the MasAgro hubs

    NARCIS (Netherlands)

    Camacho-Villa, Tania Carolina; Almekinders, Conny; Hellin, Jon; Martinez-Cruz, Tania Eulalia; Rendon-Medel, Roberto; Guevara-Hernández, Francisco; Beuchelt, Tina D.; Govaerts, Bram

    2016-01-01

    Purpose: Little is known about effective ways to operationalize agricultural innovation processes. We use the MasAgro program in Mexico (which aims to increase maize and wheat productivity, profitability and sustainability), and the experiences of middle level ‘hub managers’, to understand how

  18. Allocation of home care services by municipalities in Norway: a document analysis.

    Science.gov (United States)

    Holm, Solrun G; Mathisen, Terje A; Sæterstrand, Torill M; Brinchmann, Berit S

    2017-09-22

    In Norway, elder care is primarily a municipal responsibility. Municipal health services strive to offer the 'lowest level of effective care,' and home healthcare services are defined as the lowest level of care in Norway. Municipalities determine the type(s) of service and the amount of care applicants require. The services granted are outlined in an individual decision letter, which serves as a contract between the municipality and the home healthcare recipient. The purpose of this study was to gain insight into the scope and duration of home healthcare services allocated by municipalities and to determine where home care recipients live in relation to home healthcare service offices. A document analysis was performed on data derived from 833 letters to individuals allocated home care services in two municipalities in Northern Norway (Municipality A = 500 recipients, Municipality B = 333 recipients). In Municipality A, 74% of service hours were allotted to home health nursing, 12% to practical assistance, and 14% to support contact; in Municipality B, the distribution was 73%, 19%, and 8%, respectively. Both municipalities allocated home health services with no service end date (41% and 85% of the total services, respectively). Among recipients of "expired" services, 25% in Municipality A and 7% in Municipality B continued to receive assistance. Our findings reveal that the municipalities adhered to the goal for home care recipients to remain at home as long as possible before moving into a nursing home. The findings also indicate that the system for allocating home healthcare services may not be fair, as the municipalities lacked procedures for revising individual decisions. Our findings indicate that local authorities should closely examine how they design individual decisions and increase their awareness of how long a service should be provided.

  19. Spatial Accessibility to Health Care Services: Identifying under-Serviced Neighbourhoods in Canadian Urban Areas.

    Directory of Open Access Journals (Sweden)

    Tayyab Ikram Shah

    Full Text Available Urban environments can influence many aspects of health and well-being and access to health care is one of them. Access to primary health care (PHC in urban settings is a pressing research and policy issue in Canada. Most research on access to healthcare is focused on national and provincial levels in Canada; there is a need to advance current understanding to local scales such as neighbourhoods.This study examines spatial accessibility to family physicians using the Three-Step Floating Catchment Area (3SFCA method to identify neighbourhoods with poor geographical access to PHC services and their spatial patterning across 14 Canadian urban settings. An index of spatial access to PHC services, representing an accessibility score (physicians-per-1000 population, was calculated for neighborhoods using a 3km road network distance. Information about primary health care providers (this definition does not include mobile services such as health buses or nurse practitioners or less distributed services such as emergency rooms used in this research was gathered from publicly available and routinely updated sources (i.e. provincial colleges of physicians and surgeons. An integrated geocoding approach was used to establish PHC locations.The results found that the three methods, Simple Ratio, Neighbourhood Simple Ratio, and 3SFCA that produce City level access scores are positively correlated with each other. Comparative analyses were performed both within and across urban settings to examine disparities in distributions of PHC services. It is found that neighbourhoods with poor accessibility scores in the main urban settings across Canada have further disadvantages in relation to population high health care needs.The results of this study show substantial variations in geographical accessibility to PHC services both within and among urban areas. This research enhances our understanding of spatial accessibility to health care services at the neighbourhood

  20. 32 CFR 728.71 - Ex-service maternity care.

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 5 2010-07-01 2010-07-01 false Ex-service maternity care. 728.71 Section 728.71... FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Other Persons § 728.71 Ex-service maternity... certified by medical authorities that the pregnancy existed prior to entry into service (EPTE), maternity...

  1. Description of the Implementation of Home Care Servicer at RS Murni Teguh, Medan

    OpenAIRE

    Manalu, Ayu P Sary

    2014-01-01

    Home care service constitutes providing service and nurses’ equipment for patients and their families at home in order to keep their health, education, prevention from diseases, palliative therapy, and rehabilitation. Home care service at RS Murni Teguh, Medan, has its specification in management, compared with home care service in other places. The objective of the research was to find out the description of the implementation of home care service at RS Murni Teguh, Medan. The research used ...

  2. 76 FR 10328 - Grant of Authority for Subzone Status; Vestas Nacelles America, Inc. (Wind Turbine Nacelles, Hubs...

    Science.gov (United States)

    2011-02-24

    ... Status; Vestas Nacelles America, Inc. (Wind Turbine Nacelles, Hubs, Blades and Towers), Brighton, Denver...-purpose subzone at the wind turbine nacelle, hub, blade and tower manufacturing and warehousing facilities... status for activity related to the manufacturing and warehousing of wind turbine nacelles, hubs, blades...

  3. 78 FR 20314 - Jefferson Island Storage & Hub, L.L.C.; Notice of Filing

    Science.gov (United States)

    2013-04-04

    ... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Docket No. PR13-44-000] Jefferson Island Storage & Hub, L.L.C.; Notice of Filing Take notice that on March 28, 2013, Jefferson Island Storage & Hub, L.L.C. filed to revise its Statement of Operating Conditions to among others, update...

  4. When Is Hub Gene Selection Better than Standard Meta-Analysis?

    Science.gov (United States)

    Langfelder, Peter; Mischel, Paul S.; Horvath, Steve

    2013-01-01

    Since hub nodes have been found to play important roles in many networks, highly connected hub genes are expected to play an important role in biology as well. However, the empirical evidence remains ambiguous. An open question is whether (or when) hub gene selection leads to more meaningful gene lists than a standard statistical analysis based on significance testing when analyzing genomic data sets (e.g., gene expression or DNA methylation data). Here we address this question for the special case when multiple genomic data sets are available. This is of great practical importance since for many research questions multiple data sets are publicly available. In this case, the data analyst can decide between a standard statistical approach (e.g., based on meta-analysis) and a co-expression network analysis approach that selects intramodular hubs in consensus modules. We assess the performance of these two types of approaches according to two criteria. The first criterion evaluates the biological insights gained and is relevant in basic research. The second criterion evaluates the validation success (reproducibility) in independent data sets and often applies in clinical diagnostic or prognostic applications. We compare meta-analysis with consensus network analysis based on weighted correlation network analysis (WGCNA) in three comprehensive and unbiased empirical studies: (1) Finding genes predictive of lung cancer survival, (2) finding methylation markers related to age, and (3) finding mouse genes related to total cholesterol. The results demonstrate that intramodular hub gene status with respect to consensus modules is more useful than a meta-analysis p-value when identifying biologically meaningful gene lists (reflecting criterion 1). However, standard meta-analysis methods perform as good as (if not better than) a consensus network approach in terms of validation success (criterion 2). The article also reports a comparison of meta-analysis techniques applied to

  5. When is hub gene selection better than standard meta-analysis?

    Directory of Open Access Journals (Sweden)

    Peter Langfelder

    Full Text Available Since hub nodes have been found to play important roles in many networks, highly connected hub genes are expected to play an important role in biology as well. However, the empirical evidence remains ambiguous. An open question is whether (or when hub gene selection leads to more meaningful gene lists than a standard statistical analysis based on significance testing when analyzing genomic data sets (e.g., gene expression or DNA methylation data. Here we address this question for the special case when multiple genomic data sets are available. This is of great practical importance since for many research questions multiple data sets are publicly available. In this case, the data analyst can decide between a standard statistical approach (e.g., based on meta-analysis and a co-expression network analysis approach that selects intramodular hubs in consensus modules. We assess the performance of these two types of approaches according to two criteria. The first criterion evaluates the biological insights gained and is relevant in basic research. The second criterion evaluates the validation success (reproducibility in independent data sets and often applies in clinical diagnostic or prognostic applications. We compare meta-analysis with consensus network analysis based on weighted correlation network analysis (WGCNA in three comprehensive and unbiased empirical studies: (1 Finding genes predictive of lung cancer survival, (2 finding methylation markers related to age, and (3 finding mouse genes related to total cholesterol. The results demonstrate that intramodular hub gene status with respect to consensus modules is more useful than a meta-analysis p-value when identifying biologically meaningful gene lists (reflecting criterion 1. However, standard meta-analysis methods perform as good as (if not better than a consensus network approach in terms of validation success (criterion 2. The article also reports a comparison of meta-analysis techniques

  6. When is hub gene selection better than standard meta-analysis?

    Science.gov (United States)

    Langfelder, Peter; Mischel, Paul S; Horvath, Steve

    2013-01-01

    Since hub nodes have been found to play important roles in many networks, highly connected hub genes are expected to play an important role in biology as well. However, the empirical evidence remains ambiguous. An open question is whether (or when) hub gene selection leads to more meaningful gene lists than a standard statistical analysis based on significance testing when analyzing genomic data sets (e.g., gene expression or DNA methylation data). Here we address this question for the special case when multiple genomic data sets are available. This is of great practical importance since for many research questions multiple data sets are publicly available. In this case, the data analyst can decide between a standard statistical approach (e.g., based on meta-analysis) and a co-expression network analysis approach that selects intramodular hubs in consensus modules. We assess the performance of these two types of approaches according to two criteria. The first criterion evaluates the biological insights gained and is relevant in basic research. The second criterion evaluates the validation success (reproducibility) in independent data sets and often applies in clinical diagnostic or prognostic applications. We compare meta-analysis with consensus network analysis based on weighted correlation network analysis (WGCNA) in three comprehensive and unbiased empirical studies: (1) Finding genes predictive of lung cancer survival, (2) finding methylation markers related to age, and (3) finding mouse genes related to total cholesterol. The results demonstrate that intramodular hub gene status with respect to consensus modules is more useful than a meta-analysis p-value when identifying biologically meaningful gene lists (reflecting criterion 1). However, standard meta-analysis methods perform as good as (if not better than) a consensus network approach in terms of validation success (criterion 2). The article also reports a comparison of meta-analysis techniques applied to

  7. Using assistive technology services at differing levels of care: healthy older couples' perceptions.

    Science.gov (United States)

    Harrefors, Christina; Axelsson, Karin; Sävenstedt, Stefan

    2010-07-01

    The aim of the study was to describe healthy older couples' perceptions of using assistive technology services when needing assistance with care. The use of information technology-based assistive technology services in elder care has increased as a result of an increase of care performed in private homes. The use of assistive technology services in care of older people at home has been evaluated as something positive by patients, relatives and nursing staff, while as resistance to their increased use has also been noted. Twelve healthy couples, aged over 70 years, from northern Sweden were interviewed in 2005 about their perceptions of using assistive technology services in the case of being in need of assistance with personal care. Open, individual semi-structured interviews supported by written vignettes describing three levels of caring needs were used and the data analysed with content analysis. The findings were interpreted as one main theme with three categories: Asset or threat depends on caring needs and abilities. Three categories were identified within the theme: Assistive technology services provide an opportunity; The consequences of using assistive technology services are hard to anticipate; and Fear of assistive technology services when completely dependent on care. Trust and security in the care of older people who are severely ill, dependent on care and living at home should be a hallmark in using assistive technology services. Human presence is an important dimension and must be considered when developing concepts for use of assistive technology services.

  8. Wave Transformation for International Hub Port Planning (Transformasi Gelombang untuk Perencanaan Pelabuhan Hub Internasional

    Directory of Open Access Journals (Sweden)

    Denny Nugroho Sugianto

    2015-02-01

    Full Text Available Indonesia merupakan salah satu negara kepulauan terbesar di dunia sehingga peran pelabuhan sangat vital dalam pembangunan ekonomi. Pelabuhan bukan hanya sekedar sebagai pelengkap infrastruktur, melainkan harus direncanakan dan dikelola dengan baik serta memperhatikan fenomena dinamika perairan laut seperti pola gelombang laut. Data gelombang laut menjadi faktor penting dalam perencanaan tata letak dan tipe bangunan pantai karena dipengaruhi oleh tinggi gelombang signifikan, tunggang pasang surut dan transformasi gelombang. Penelitian ini mengalisis karaketristrik dan bentuk transformasi gelombang untuk perencanaan Pelabuhan Hub Internasional, sebagai studi kasus adalah pelabuhan di Kuala Tanjung, Kabupaten Batu Bara. Pelabuhan di Kuala Tanjung merupakan salah satu dari 2 pelabuhan hub internasional yang direncanakan akan dibangun oleh pemerintah Indonesia. Metode yang digunakan adalah metode kuantitatif yang dilakukan dengan perhitungan statistik dan pemodelan matematik dengan modul hydrodinamic dan spectral wave untuk mengetahui arah penjalaran dan transformasi gelombang. Hasil dari data ECMWF selama 1999–Juni 2014, diketahui tinggi gelombang signifikan (Hs maksimum mencapai 1,69 m dan periode maksimum 8 detik. Karakteristik gelombang termasuk klasifikasi gelombang laut transisi dengan nilai d.L-1 berkisar anrata 0,27–0,48 dan berdasarkan periodenya diklasifikasikan sebagai gelombang gravitasi.Transformasi gelombang terjadi akibat pendangkalan dengan koefesian pendangkalan Ks 0,93–0,98 dan proses refraksi gelombang dengan koefesien Kr 0,97–0,99. Tinggi gelombang pecah Hb sebesar 1,24 meter dengan kedalaman gelombang pecah db sebesar 1,82 meter. Efektifitas desain bangunan terminal di Pelabuhan Kuala Tanjung secara keseluruhan untuk sepanjang musim sebesar 79,8% atau dapat dikatakan cukup efektif dalam meredam gelombang. Kata kunci: transformasi gelombang, tinggi dan periode gelombang, pelabuhan Indonesia is one of the largest

  9. The East African Resilience Innovation Hub | IDRC - International ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Project leadership The Resilience Innovation Hub will be housed within a ... Region at the Levy Mwanawasa Regional Centre, Lusaka -Conflict Early Warning and ... Authority on Development, Addis Ababa This initiative will support innovative ...

  10. Access to primary health care services for Indigenous peoples: A framework synthesis.

    Science.gov (United States)

    Davy, Carol; Harfield, Stephen; McArthur, Alexa; Munn, Zachary; Brown, Alex

    2016-09-30

    Indigenous peoples often find it difficult to access appropriate mainstream primary health care services. Securing access to primary health care services requires more than just services that are situated within easy reach. Ensuring the accessibility of health care for Indigenous peoples who are often faced with a vast array of additional barriers including experiences of discrimination and racism, can be complex. This framework synthesis aimed to identify issues that hindered Indigenous peoples from accessing primary health care and then explore how, if at all, these were addressed by Indigenous health care services. To be included in this framework synthesis papers must have presented findings focused on access to (factors relating to Indigenous peoples, their families and their communities) or accessibility of Indigenous primary health care services. Findings were imported into NVivo and a framework analysis undertaken whereby findings were coded to and then thematically analysed using Levesque and colleague's accessibility framework. Issues relating to the cultural and social determinants of health such as unemployment and low levels of education influenced whether Indigenous patients, their families and communities were able to access health care. Indigenous health care services addressed these issues in a number of ways including the provision of transport to and from appointments, a reduction in health care costs for people on low incomes and close consultation with, if not the direct involvement of, community members in identifying and then addressing health care needs. Indigenous health care services appear to be best placed to overcome both the social and cultural determinants of health which hamper Indigenous peoples from accessing health care. Findings of this synthesis also suggest that Levesque and colleague's accessibility framework should be broadened to include factors related to the health care system such as funding.

  11. Emerging Education Hubs: The Case of Singapore

    Science.gov (United States)

    Sidhu, Ravinder; Ho, K.-C.; Yeoh, Brenda

    2011-01-01

    In anticipation of a globalising post-Fordist political economy, countries and universities are increasingly pursuing strategic transnational education and research alliances. This article analyses the Global Schoolhouse, a key education policy platform that aims to transform Singapore into a knowledge and innovation hub by establishing networks…

  12. Integrating Social Services and Home-Based Primary Care for High-Risk Patients.

    Science.gov (United States)

    Feinglass, Joe; Norman, Greg; Golden, Robyn L; Muramatsu, Naoko; Gelder, Michael; Cornwell, Thomas

    2018-04-01

    There is a consensus that our current hospital-intensive approach to care is deeply flawed. This review article describes the research evidence for developing a better system of care for high-cost, high-risk patients. It reviews the evidence that home-centered care and integration of health care with social services are the cornerstones of a more humane and efficient system. The article describes the strengths and weaknesses of research evaluating the effects of social services in addressing social determinants of health, and how social support is critical to successful acute care transition programs. It reviews the history of incorporating social services into care management, and the prospects that recent payment reforms and regulatory initiatives can succeed in stimulating the financial integration of social services into new care coordination initiatives. The article reviews the literature on home-based primary care for the chronically ill and disabled, and suggests that it is the emergence of this care modality that holds the greatest promise for delivery system reform. In the hope of stimulating further discussion and debate, the authors summarize existing viewpoints on how a home-centered system, which integrates social and medical services, might emerge in the next few years.

  13. Waves, currents and sediment transport modelling at the Wave Hub site

    OpenAIRE

    Gonzalez-Santamaria, Raul

    2013-01-01

    Primary supervisory team: Qingping Zou and Shunqi Pan This research project uses an integrated modelling system to investigate the effects of a wave farm on nearshore sediment transport at the Wave Hub site. The Wave Hub project is a large scale demonstration site for the development of the operation of arrays of wave energy generation devices located at the southwest coast of the UK where multiple field measurements took place. Particular attention of this study was paid to th...

  14. [Current Status of Home Visit Programs: Activities and Barriers of Home Care Nursing Services].

    Science.gov (United States)

    Oh, Eui Geum; Lee, Hyun Joo; Kim, Yukyung; Sung, Ji Hyun; Park, Young Su; Yoo, Jae Yong; Woo, Soohee

    2015-10-01

    The purpose of this study was to examine the current status of home care nursing services provided by community health nurses and to identify barriers to the services. A cross-sectional survey was conducted with three types of community health care nurses. Participants were 257 nurses, 46 of whom were hospital based home care nurses, 176 were community based visiting nurses, and 35 were long term care insurance based visiting nurses. A structured questionnaire on 7 domains of home care nursing services with a 4-point Likert scale was used to measure activities and barriers to care. Data were analyzed using SPSS WIN 21.0 program. Hospital based home care nurses showed a high level of service performance activity in the domain of clinical laboratory tests, medications and injections, therapeutic nursing, and education. Community based visiting nurses had a high level of service performance in the reference domain. Long term care insurance based visiting nurses showed a high level of performance in the service domains of fundamental nursing and counseling. The results show that although health care service provided by the three types of community health nurse overlapped, the focus of the service is differentiated. Therefore, these results suggest that existing home care services will need to be utilized efficiently in the development of a new nursing care service for patients living in the community after hospital discharge.

  15. Does integrated care lead to both improved service quality and lower care cost

    Science.gov (United States)

    Waldeyer, Regina; Siegel, Achim; Daul, Gisela; Gaiser, Karin; Hildebrandt, Helmut; Köster, Ingrid; Schubert, Ingrid; Stunder, Brigitte; Stützle, Yvonne

    2010-01-01

    Purpose and context ‘Gesundes Kinzigtal’ is one of the few population-based integrated care approaches in Germany, organising care across all health service sectors and indications. The management company and its contracting partners (the physicians’ network in the region and two statutory health insurers) strive to reach a higher quality of care at a lower overall cost as compared with the German standard. During its first two years of operation (2006–2007), the Kinzigtal project achieved surprisingly positive financial results compared with its reference value. To gain independent evidence on the quality aspects of the system, the management company and its partners provided a remarkable budget for its evaluation by independent scientific institutions. Case description and data sources We will present interim results of a population-based controlled cohort study. In this study, quality of care is checked by relying on health and service quality indicators that have been constructed from health insurers’ administrative data (claims data). Interim results are presented for the intervention region (Kinzigtal area) and the control region (the rest of Baden-Württemberg, i.e., Southwest Germany). Preliminary conclusions and discussion The evaluation of ‘Gesundes Kinzigtal’ is in full progress. Until now, there is no evidence that the surprisingly positive financial results of the Kinzigtal system have been achieved at the expense of care quality. Rather, Gesundes Kinzigtal Integrated Care seems to be about to increasingly realize comparative advantages regarding health service quality (in comparison to the control region).

  16. netCare, a new collaborative primary health care service based in Swiss community pharmacies.

    Science.gov (United States)

    Erni, Pina; von Overbeck, Jan; Reich, Oliver; Ruggli, Martine

    2016-01-01

    The Swiss Pharmacists Association has launched a new collaborative project, netCare. Community pharmacists provide a standard form with structured triage based on decision trees and document findings. As a backup, they can collaborate with physicians via video consultation. The aim of the study was to evaluate the impact of this service on the Swiss health care system. All pharmacists offering netCare completed two training courses, a course covering the most common medical conditions observed in primary health care and a specific course on all of the decision trees. The pharmacists were free to decide whether they would provide the usual care or offer netCare triage. The patient was also free to accept or refuse netCare. Pharmacists reported the type of ailment, procedure of the consultation, treatment, patient information and outcomes of the follow-up call on a standardized form submitted to the study center. Pharmacists from 162 pharmacies performed 4118 triages over a period of 21 months. A backup consultation was needed for 17% of the cases. In follow-up calls, 84% of the patients who were seen only by pharmacists reported complete relief or symptom reduction. netCare is a low-threshold service by which pharmacists can manage common medical conditions with physician backup, if needed. This study showed that a pharmacist could resolve a large proportion of the cases. However, to be efficient and sustainable, this service must be fully integrated into the health care system. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. Billing third party payers for pharmaceutical care services.

    Science.gov (United States)

    Poirier, S; Buffington, D E; Memoli, G A

    1999-01-01

    To describe the steps pharmacists must complete when seeking compensation from third party payers for pharmaceutical care services. Government publications; professional publications, including manuals and newsletters; authors' personal experience. Pharmacists in increasing numbers are meeting with success in getting reimbursed by third party payers for patient care activities. However, many pharmacists remain reluctant to seek compensation because they do not understand the steps involved. Preparatory steps include obtaining a provider/supplier number, procuring appropriate claim forms, developing data collection and documentation systems, establishing professional fees, creating a marketing plan, and developing an accounting system. To bill for specific patient care services, pharmacists need to collect the patient's insurance information, obtain a statement of medical necessity from the patient's physician, complete the appropriate claim form accurately, and submit the claim with supporting documentation to the insurer. Although many claims from pharmacists are rejected initially, pharmacists who work with third party payers to understand the reasons for denial of payment often receive compensation when claims are resubmitted. Pharmacists who follow these guidelines for billing third party payers for pharmaceutical care services should notice an increase in the number of paid claims.

  18. Hubs and spokes in Regional Trade Agreements

    NARCIS (Netherlands)

    Vaal, A. de

    2017-01-01

    In the plethora of Regional Trade Agreements (RTAs) some countries are involved in much more RTAs than others. Furthermore, some countries take in a position as a hub: they have trade agreements with many other countries, while their partner countries are much less involved in RTA relations. Even

  19. A systematic review of the evidence on home care reablement services.

    Science.gov (United States)

    Legg, Lynn; Gladman, John; Drummond, Avril; Davidson, Alex

    2016-08-01

    To determine whether publically funded 'reablement services' have any effect on patient health or use of services. Systematic review of randomized controlled trials and non-randomized studies in which reablement interventions were compared with no care or usual care in people referred to public-funded personal care services. Data sources included: Cochrane Central Register of Controlled Trials, EPOC register of studies, trials registers, Medline, EMBASE, and CINHAL. Searches were from 2000 up to end February 2015. Not applicable. Investigators' definition of the target population for reablement interventions. Use of publically funded personal care services and dependence in personal activities of daily living. We found no studies fulfilling our inclusion criteria that assessed the effectiveness of reablement interventions. We did note the lack of an agreed understanding of the nature of reablement. Reablement is an ill-defined intervention targeted towards an ill-defined and potentially highly heterogeneous population/patient group. There is no evidence to suggest it is effective at either of its goals; increasing personal independence or reducing use of personal care services. © The Author(s) 2015.

  20. Service user involvement in mental health care: an evolutionary concept analysis.

    Science.gov (United States)

    Millar, Samantha L; Chambers, Mary; Giles, Melanie

    2016-04-01

    The concept of service user involvement is an evolving concept in the mental health-care literature. This study sought to explore and analyse the concept of service user involvement as used in within the field of mental health care. An evolutionary concept analysis was conducted using a literature-based sample extracted from an electronic database search. One hundred and thirty-four papers met the inclusion criteria and were analysed to discover key attributes, antecedents and consequences of service user involvement and to produce a definition of the concept. Five key attributes of service user involvement within the context of mental health care were identified: a person-centred approach, informed decision making, advocacy, obtaining service user views and feedback and working in partnership. Clarity of the attributes and definition of the concept of service user involvement aims to promote understanding of the concept among key stakeholders including mental health professionals, service users and community and voluntary organizations. The findings of the research have utility in the areas of theory and policy development, research on service user involvement in mental health care and service user involvement in mental health practice. Directions for further research regarding the concept are identified. © 2015 John Wiley & Sons Ltd.

  1. Publishing and sharing of hydrologic models through WaterHUB

    Science.gov (United States)

    Merwade, V.; Ruddell, B. L.; Song, C.; Zhao, L.; Kim, J.; Assi, A.

    2011-12-01

    Most hydrologists use hydrologic models to simulate the hydrologic processes to understand hydrologic pathways and fluxes for research, decision making and engineering design. Once these tasks are complete including publication of results, the models generally are not published or made available to the public for further use and improvement. Although publication or sharing of models is not required for journal publications, sharing of models may open doors for new collaborations, and avoids duplication of efforts if other researchers are interested in simulating a particular watershed for which a model already exists. For researchers, who are interested in sharing models, there are limited avenues to publishing their models to the wider community. Towards filling this gap, a prototype cyberinfrastructure (CI), called WaterHUB, is developed for sharing hydrologic data and modeling tools in an interactive environment. To test the utility of WaterHUB for sharing hydrologic models, a system to publish and share SWAT (Soil Water Assessment Tool) is developed. Users can utilize WaterHUB to search and download existing SWAT models, and also upload new SWAT models. Metadata such as the name of the watershed, name of the person or agency who developed the model, simulation period, time step, and list of calibrated parameters also published with individual model.

  2. Designing services for frequent attenders to the emergency department: a characterisation of this population to inform service design.

    Science.gov (United States)

    Jacob, Rebecca; Wong, Mai Luen; Hayhurst, Catherine; Watson, Peter; Morrison, Cecily

    2016-08-01

    Frequent attendance to the emergency department (ED) is a growing public health concern. Designing services for frequent attenders poses challenges, given the heterogeneous nature of this group. This was a two-part observational study identifying frequent attenders from ED records. The first stage studied trends and developed personas with emphasis on differentiating moderate frequent attenders (attending between 5 and 20 times per year) and extreme frequent attenders (attending more than 20 times). Stage 2 included a case note review of 100 consecutive frequent attenders. Results showed an increase in frequent attendance from 2.59% to 4.12% over 8 years. Moderate frequent attenders accounted for 97%. Of the 100 frequent attenders studied, 45% had medically unexplained symptoms (MUS), associated with younger age (p0.05). In conclusion, the ED is a useful hub for identifying frequent attenders with MUS, particularly among moderate frequent attenders; service design for this group should consider a 'whole-systems approach' with integration between primary and secondary care, including specialist liaison psychiatry services where appropriate. © 2016 Royal College of Physicians.

  3. Mapping the changed hubs and corresponding functional connectivity in idiopathic restless legs syndrome.

    Science.gov (United States)

    Liu, Chunyan; Wang, Jiaojian; Hou, Yue; Qi, Zhigang; Wang, Li; Zhan, Shuqin; Wang, Rong; Wang, Yuping

    2018-05-01

    The hubs of the brain network play a key role in integrating and transferring information between different functional modules. However, whether the changed pattern in functional network hubs contributes to the onset of leg discomfort symptoms in restless legs syndrome (RLS) patients remains unclear. Using resting-state functional magnetic resonance imaging (rs-fMRI) and graph theory methods, we investigated whether alterations of hubs can be detected in RLS. First, we constructed the whole-brain voxelwise functional connectivity and calculated a functional connectivity strength (FCS) map in each of 16 drug-naive idiopathic RLS patients and 26 gender- and age-matched healthy control (HC) subjects. Next, a two-sample t test was applied to compare the FCS maps between HC and RLS patients, and to identify significant changes in FCS in RLS patients. To further elucidate the corresponding changes in the functional connectivity patterns of the aberrant hubs in RLS patients, whole-brain resting-state functional connectivity analyses for the hub areas were performed. The hub analysis revealed decreased FCS in the cuneus, fusiform gyrus, paracentral lobe, and precuneus, and increased FCS in the superior frontal gyrus and thalamus in idiopathic drug-naive RLS patients. Subsequent functional connectivity analyses revealed decreased functional connectivity in sensorimotor and visual processing networks and increased functional connectivity in the affective cognitive network and cerebellar-thalamic circuit. Furthermore, the mean FCS value in the superior frontal gyrus was significantly correlated with Hamilton Anxiety Rating Scale scores in RLS patients, and the mean FCS value in the fusiform gyrus was significantly correlated with Hamilton Depression Rating Scale scores. These findings may provide novel insight into the pathophysiology of RLS. Copyright © 2018 Elsevier B.V. All rights reserved.

  4. Altered network hub connectivity after acute LSD administration

    Directory of Open Access Journals (Sweden)

    Felix Müller

    Full Text Available LSD is an ambiguous substance, said to mimic psychosis and to improve mental health in people suffering from anxiety and depression. Little is known about the neuronal correlates of altered states of consciousness induced by this substance. Limited previous studies indicated profound changes in functional connectivity of resting state networks after the administration of LSD. The current investigation attempts to replicate and extend those findings in an independent sample. In a double-blind, randomized, cross-over study, 100 μg LSD and placebo were orally administered to 20 healthy participants. Resting state brain activity was assessed by functional magnetic resonance imaging. Within-network and between-network connectivity measures of ten established resting state networks were compared between drug conditions. Complementary analysis were conducted using resting state networks as sources in seed-to-voxel analyses. Acute LSD administration significantly decreased functional connectivity within visual, sensorimotor and auditory networks and the default mode network. While between-network connectivity was widely increased and all investigated networks were affected to some extent, seed-to-voxel analyses consistently indicated increased connectivity between networks and subcortical (thalamus, striatum and cortical (precuneus, anterior cingulate cortex hub structures. These latter observations are consistent with findings on the importance of hubs in psychopathological states, especially in psychosis, and could underlay therapeutic effects of hallucinogens as proposed by a recent model. Keywords: LSD, fMRI, Functional connectivity, Networks, Hubs

  5. Pinoy Nutrition Hub: The Philippine Experience in Addressing Moderate Malnutrition

    International Nuclear Information System (INIS)

    Ramos, Arlo; Fuentes, Eureka; Duque, Yvonette; Soriano, Nezer; Gomez, Marijo

    2014-01-01

    Full text: • Objective: Malnutrition is a persistent problem in the Philippines. The 2011 survey of the Food and Nutrition Research Institute reported that 3 out of 10 children are malnourished. Data shows 20.2% of children 0-47 months are underweight while 33.6% are stunted. This rate is higher in depressed areas in the country. PD Hearth is a time and tested effective program model to address malnutrition. But the PDH has minimum standards that need to be followed in the program implementation. However, a developing country like the Philippines has limitations in its resources and implementations. This paper aims to share the Philippine experience in addressing moderate malnutrition through a contextualized and modified PD Hearth approach. The specific objectives of this paper are: - to describe the challenges in implementing PD Hearth in the context of the Philippines; - to describe the innovations and modifications in the PD Hearth; - and, to illustrate the successful intervention of the PNH program against malnourished children in the community. • Methods: The Pinoy Nutrition Hub model is an innovation of PD Hearth approach. The first step was the participatory approach evaluation of existing programs on MNCHN in the communities. The next step was for the stakeholders to identify the gaps and address them. This was followed by gathering lessons learned and good practices that arose from implementing PD Hearth. Innovations were adopted to address restrictions and maximize learning in its implementation. The contextualized approach was called Pinoy Nutrition Hub (PNH). • Outcomes: - The PNH was piloted in three Area Development Programs (ADP) that represent the three island groups of the Philippines. All three ADPs reported improvement in the weight of the malnourished children enrolled in the program. Below is an illustration of the how the actual weight of children in the Visayas ADP increased. Figure 1 (Display Omitted). Average Weight of Malnourished

  6. A State Cyber Hub Operations Framework

    Science.gov (United States)

    2016-06-01

    current and future decision support. Finally, the Hub operations team must track and report key performance indictors ( KPIs ) (established by the state...Region); then mutually agreed-upon core KPIs should be identified and reported at this time. The goal of the Act Element is to implement the decision...Force Headquarters Page 58 JIE Joint Information Environment JMC JIE Management Construct KPI Key Performance Indicator LEA Law Enforcement

  7. Overcoming Language Barriers in Health Care: Costs and Benefits of Interpreter Services

    Science.gov (United States)

    Jacobs, Elizabeth A.; Shepard, Donald S.; Suaya, Jose A.; Stone, Esta-Lee

    2004-01-01

    Objectives. We assessed the impact of interpreter services on the cost and the utilization of health care services among patients with limited English proficiency. Methods. We measured the change in delivery and cost of care provided to patients enrolled in a health maintenance organization before and after interpreter services were implemented. Results. Compared with English-speaking patients, patients who used the interpreter services received significantly more recommended preventive services, made more office visits, and had more prescriptions written and filled. The estimated cost of providing interpreter services was $279 per person per year. Conclusions. Providing interpreter services is a financially viable method for enhancing delivery of health care to patients with limited English proficiency. PMID:15117713

  8. The Association between Freedom of Choice and Effectiveness of Home Care Services.

    Science.gov (United States)

    Steffansson, Marina; Pulliainen, Marjo; Kettunen, Aija; Linnosmaa, Ismo; Halonen, Miikka

    2016-03-31

    The aim of this paper is to study home care clients' freedom to choose their services, as well the association between the effectiveness of home care services and freedom of choice, among other factors. A structured postal survey was conducted among regular home care clients (n = 2096) aged 65 or older in three towns in Finland. Freedom of choice was studied based on clients' subjective experiences. The effectiveness of the services was evaluated by means of changes in the social-care-related quality of life. Regression analyses were used to test associations. As much as 62% of home care recipients reported having some choice regarding their services. Choosing meals and visiting times for the care worker were associated with better effectiveness. The basic model, which included needs and other factors expected to have an impact on quality of life, explained 15.4% of the changes in quality of life, while the extended model, which included the freedom-of-choice variables, explained 17.4%. The inclusion of freedom-of-choice variables increased the adjusted coefficient of determination by 2%. There was a significant positive association between freedom of choice and the effectiveness of public home care services. Freedom of choice does not exist for all clients of home care who desire it. By changing social welfare activities and structures, it is possible to show respect for clients' opinions and to thereby improve the effectiveness of home care services.

  9. Library and information services: impact on patient care quality.

    Science.gov (United States)

    Marshall, Joanne Gard; Morgan, Jennifer Craft; Thompson, Cheryl A; Wells, Amber L

    2014-01-01

    The purpose of this paper is to explore library and information service impact on patient care quality. A large-scale critical incident survey of physicians and residents at 56 library sites serving 118 hospitals in the USA and Canada. Respondents were asked to base their answers on a recent incident in which they had used library resources to search for information related to a specific clinical case. Of 4,520 respondents, 75 percent said that they definitely or probably handled patient care differently using information obtained through the library. In a multivariate analysis, three summary clinical outcome measures were used as value and impact indicators: first, time saved; second, patient care changes; and third, adverse events avoided. The outcomes were examined in relation to four information access methods: first, asking librarian for assistance; second, performing search in a physical library; third, searching library's web site; or fourth, searching library resources on an institutional intranet. All library access methods had consistently positive relationships with the clinical outcomes, providing evidence that library services have a positive impact on patient care quality. Electronic collections and services provided by the library and the librarian contribute to patient care quality.

  10. Orbital Hub: a concept for human spaceflight beyond ISS operations

    Science.gov (United States)

    Jahnke, Stephan S.; Maiwald, Volker; Philpot, Claudia; Quantius, Dominik; Romberg, Oliver; Seboldt, Wolfgang; Vrakking, Vincent; Zeidler, Conrad

    2018-04-01

    The International Space Station (ISS) is the greatest endeavour in low-Earth orbit since the beginning of the space age and the culmination of human outposts like Skylab and Mir. While a clear schedule has yet to be drafted, it is expected that ISS will cease operation in the 2020s. What could be the layout for a human outpost in LEO with lessons learnt from ISS? What are the use cases and applications of such an outpost in the future? The System Analysis Space Segment group of the German Aerospace Center investigated these and other questions and developed the Orbital Hub concept. In this paper an overview is presented of how the overall concept has been derived and its properties and layouts are described. Starting with a workshop involving the science community, the scientific requirements have been derived and Strawman payloads have been defined for use in further design activities. These design activities focused on Concurrent Engineering studies, where besides DLR employees participants from the industry and astronauts were involved. The result is an expandable concept that is composed of two main parts, the Base Platform, home for a permanent crew of up to three astronauts, and the Free Flyer, an uncrewed autonomous research platform. This modular approach provides one major advantage: the decoupling of the habitat and payload leading to increased quality of the micro-gravity environment. The former provides an environment for human physiology experiments, while the latter allows science without the perturbations caused by a crew, e.g. material experiments or Earth observation. The Free Flyer is designed to operate for up to 3 months on its own, but can dock with the space station for maintenance and experiment servicing. It also has a hybrid propulsion system, chemical and electrical, for different applications. The hub's design allows launch with just three launches, as the total mass of all the hub parts is about 60,000 kg. The main focus of the design is

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

    Science.gov (United States)

    Burton, Elissa; Lewin, Gill; Boldy, Duncan

    2013-04-01

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

  12. Availability and Primary Health Care Orientation of Dementia-Related Services in Rural Saskatchewan, Canada.

    Science.gov (United States)

    Morgan, Debra G; Kosteniuk, Julie G; Stewart, Norma J; O'Connell, Megan E; Kirk, Andrew; Crossley, Margaret; Dal Bello-Haas, Vanina; Forbes, Dorothy; Innes, Anthea

    2015-01-01

    Community-based services are important for improving outcomes for individuals with dementia and their caregivers. This study examined: (a) availability of rural dementia-related services in the Canadian province of Saskatchewan, and (b) orientation of services toward six key attributes of primary health care (i.e., information/education, accessibility, population orientation, coordinated care, comprehensiveness, quality of care). Data were collected from 71 rural Home Care Assessors via cross-sectional survey. Basic health services were available in most communities (e.g., pharmacists, family physicians, palliative care, adult day programs, home care, long-term care facilities). Dementia-specific services typically were unavailable (e.g., health promotion, counseling, caregiver support groups, transportation, week-end/night respite). Mean scores on the primary health care orientation scales were low (range 12.4 to 17.5/25). Specific services to address needs of rural individuals with dementia and their caregivers are limited in availability and fit with primary health care attributes.

  13. Allocation of Rehabilitation Services for Older Adults in the Ontario Home Care System.

    Science.gov (United States)

    Armstrong, Joshua J; Sims-Gould, Joanie; Stolee, Paul

    Background: Physiotherapy and occupational therapy services can play a critical role in maintaining or improving the physical functioning, quality of life, and overall independence of older home care clients. Despite their importance, however, there is limited understanding of the factors that influence how rehabilitation services are allocated to older home care clients. The aim of this pilot study was to develop a preliminary understanding of the factors that influence decisions to allocate rehabilitation therapy services to older clients in the Ontario home care system, as perceived by three stakeholder groups. Methods: Semi-structured interviews were conducted with 10 key informants from three stakeholder groups: case managers, service providers, and health system policymakers. Results: Drivers of the allocation of occupational therapy and physiotherapy for older adults included functional needs and postoperative care. Participants identified challenges in providing home care rehabilitation to older adults, including impaired cognition and limited capacity in the home care system. Conclusions: Considering the changing demands for home care services, knowledge of current practices across the home care system can inform efforts to optimize rehabilitation services for the growing number of older adults. Further research is needed to advance the understanding of, and optimize rehabilitation service allocation to, older frail clients with multiple morbidities. Developing novel decision-support mechanisms and standardized clinical care pathways for older client populations may be beneficial.

  14. Quantifying low-value services by using routine data from Austrian primary care.

    Science.gov (United States)

    Sprenger, Martin; Robausch, Martin; Moser, Adrian

    2016-12-01

    Open debates about the reduction of low-value services, unnecessary diagnostic tests and ineffective therapeutic procedures and initiatives like "Choosing Wisely "in the USA and Canada are still absent in Austria. The objectives of this study are: (i) to establish a list of ineffective or low-value services possibly provided in Austrian primary care, (ii) to explore how many of these services are quantifiable using routine data and (iii) to estimate the number of affected beneficiaries and avoidable costs arising from the provision of these services. In May 2014, we identified low-value care services relevant for primary care in Austria. For our analysis we used routine data sets from the Austrian health insurance. All analysis refer to the insured population of the Lower Austrian Sickness Fund (n = 1 168 433) in the year 2013. (i) We found 453 low-value services possibly offered in Austrian primary care. (ii) Only 34 (7.5%) services were quantifiable using routine data. (iii) In the year 2013, these 34 services were provided to at least 246 131 beneficiaries and the estimated avoidable costs arising were at least 11.38 million Euros. This accounts for 1.2% of overall spending of the Lower Austrian Sickness Fund for drugs and services provided by primary care doctors in the year 2013. The absence of a homogeneous, transparent and accessible coding system for diagnosis in Austrian primary care restrained our assessment. However, our study findings illustrate the potential utility and limitations of using claims-based measures to identify low-value care. © The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

  15. Socioeconomic disparities in home health care service access and utilization: a scoping review.

    Science.gov (United States)

    Goodridge, Donna; Hawranik, Pamela; Duncan, Vicky; Turner, Hollie

    2012-10-01

    Home health care services are expanding at a rapid pace in order to meet the needs of the growing population of older adults and those with chronic illnesses. Because of current restrictions on home health care as an insured service in some countries, individuals may be required to pay for some or all of their home care services out of pocket. These payments may potentially limit access to needed home care services for persons in the lowest socioeconomic strata. Previous research demonstrates a clear socioeconomic gradient in access to acute and primary care services, where those most in need of services are the most disadvantaged and under-serviced. There has been little attention paid thus far, however, to the way in which socioeconomic status may affect the receipt of home health care services. To determine what is known from existing literature about socioeconomic disparities in home health care access and utilization. A scoping review was used to map the extent and nature of the literature in this area. A search of the databases CINAHL, Medline, SocIndex and Sociological Abstracts as well as Dissertations International. A total of 206 potentially relevant articles were published between 2000 and April 2011. Two reviewers independently reviewed the articles, leaving 15 research articles to be included in the scoping review. The majority of articles reported secondary analyses of administrative datasets related to utilization of home health care. Several studies examined access and utilization using qualitative approaches. The distinction between professional and supportive home care services was not always clear in the articles. Individual and composite measures of socioeconomic status were reported, with the most frequently used indicator being income. Several studies used more complex composite ecological indicators of socieconomic status. There was general agreement that utilization of home health services favored persons with greater economic disadvantage

  16. Research on the cultivation path of smart home-based care service mode in Internet+ vision

    Directory of Open Access Journals (Sweden)

    Peng Qingchao

    2016-01-01

    Full Text Available Home-based care for the aged is an effective method to solve the problem of caring the aged in China. This thesis analyzes some problems existing in the development of current home-based care service for the aged in our country and the positive effects brought by Internet+ in home-based care service. It proposes a new service mode of care for the aged--Internet+ home-based care service, and explains the establishment of this system and the responsibilities of the participants. Also, it explores the path to realize the establishment of Internet+ home-based care service mode so as to promote the healthy development of home-based care service in China.

  17. [Organization of health services and tuberculosis care management].

    Science.gov (United States)

    Barrêto, Anne Jaquelyne Roque; de Sá, Lenilde Duarte; Nogueira, Jordana de Almeida; Palha, Pedro Fredemir; Pinheiro, Patrícia Geórgia de Oliveira Diniz; de Farias, Nilma Maria Porto; Rodrigues, Débora Cezar de Souza; Villa, Tereza Cristina Scatena

    2012-07-01

    The scope of this study was to analyze the discourse of managers regarding the relationship between the organization of the health services and tuberculosis care management in a city in the metropolitan region of João Pessoa, State of Pernambuco. Using qualitative research in the analytical field of the French line of Discourse Analysis, 16 health workers who worked as members of the management teams took part in the study. The transcribed testimonials were organized using Atlas.ti version 6.0 software. After detailed reading of the empirical material, an attempt was made to identify the paraphrasic, polyssemic and metaphoric processes in the discourses, which enabled identification of the following discourse formation: Organization of the health services and the relation with TB care management: theory and practice. In the discourse of the managers the fragmentation of the actions of control of tuberculosis, the lack of articulation between the services and sectors, the compliance of the specific activities for TB, as well as the lack of strategic planning for management of care of the disease are clearly revealed. In this respect, for the organization of the health services to be effective, it is necessary that tuberculosis be considered a priority and acknowledged as a social problem in the management agenda.

  18. The deep-sea hub of the ANTARES neutrino telescope

    Energy Technology Data Exchange (ETDEWEB)

    Anghinolfi, M. [INFN Sezione di Genova, Via Dodecaneso 33, I-16146 Genova (Italy); Calzas, A. [Centre de Physique des Particules de Marseille (CNRS/IN2P3), Universite de la Mediterranee, 13288 Marseille (France); Dinkespiler, B. [Centre de Physique des Particules de Marseille (CNRS/IN2P3), Universite de la Mediterranee, 13288 Marseille (France); Cuneo, S. [INFN Laboratori Nazionali del Sud, Via S. Sofia 44, I-95123 Catania (Italy); Favard, S. [Centre de Physique des Particules de Marseille (CNRS/IN2P3), Universite de la Mediterranee, 13288 Marseille (France); Hallewell, G. [Centre de Physique des Particules de Marseille (CNRS/IN2P3), Universite de la Mediterranee, 13288 Marseille (France)]. E-mail: gregh@cppm.in2p3.fr; Jaquet, M. [Centre de Physique des Particules de Marseille (CNRS/IN2P3), Universite de la Mediterranee, 13288 Marseille (France); Musumeci, M. [INFN Laboratori Nazionali del Sud, Via S. Sofia 44, I-95123 Catania (Italy); Papaleo, R. [INFN Laboratori Nazionali del Sud, Via S. Sofia 44, I-95123 Catania (Italy); Raia, G. [INFN Laboratori Nazionali del Sud, Via S. Sofia 44, I-95123 Catania (Italy); Valdy, P. [IFREMER - Institut francais de recherche pour l' exploitation de la mer, Centre de La Seyne, 83500 La Seyne sur mer (France); Vernin, P. [DSM-DAPNIA, CEA SACLAY, 91191 Gif sur Yvette Cedex (France)

    2006-11-15

    The ANTARES neutrino telescope, currently under construction at 2500 m depth off the French Mediterranean coast, will contain 12 detection lines, powered and read out through a deep-sea junction box (JB) hub. Electrical energy from the shore station is distributed through a transformer with multiple secondary windings and a plugboard with 16 deep sea-mateable electro-optic connectors. Connections are made to the JB outputs using manned or remotely operated submersible vehicles. The triply redundant power management and slow control system is based on two identical AC-powered systems, communicating with the shore through 160 Mb/s fibre G-links and a third battery-powered system using a slower link. We describe the power and slow control systems of the underwater hub.

  19. The deep-sea hub of the ANTARES neutrino telescope

    International Nuclear Information System (INIS)

    Anghinolfi, M.; Calzas, A.; Dinkespiler, B.; Cuneo, S.; Favard, S.; Hallewell, G.; Jaquet, M.; Musumeci, M.; Papaleo, R.; Raia, G.; Valdy, P.; Vernin, P.

    2006-01-01

    The ANTARES neutrino telescope, currently under construction at 2500 m depth off the French Mediterranean coast, will contain 12 detection lines, powered and read out through a deep-sea junction box (JB) hub. Electrical energy from the shore station is distributed through a transformer with multiple secondary windings and a plugboard with 16 deep sea-mateable electro-optic connectors. Connections are made to the JB outputs using manned or remotely operated submersible vehicles. The triply redundant power management and slow control system is based on two identical AC-powered systems, communicating with the shore through 160 Mb/s fibre G-links and a third battery-powered system using a slower link. We describe the power and slow control systems of the underwater hub

  20. Gravity drives the evolution of infrared dark hubs: JVLA observations of SDC13

    Science.gov (United States)

    Williams, G. M.; Peretto, N.; Avison, A.; Duarte-Cabral, A.; Fuller, G. A.

    2018-05-01

    Context. Converging networks of interstellar filaments, that is hubs, have been recently linked to the formation of stellar clusters and massive stars. Understanding the relationship between the evolution of these systems and the formation of cores and stars inside them is at the heart of current star formation research. Aims: The goal is to study the kinematic and density structure of the SDC13 prototypical hub at high angular resolution to determine what drives its evolution and fragmentation. Methods: We have mapped SDC13, a 1000 M⊙ infrared dark hub, in NH3(1,1) and NH3(2,2) emission lines, with both the Jansky Very Large Array and Green Bank Telescope. The high angular resolution achieved in the combined dataset allowed us to probe scales down to 0.07 pc. After fitting the ammonia lines, we computed the integrated intensities, centroid velocities and line widths, along with gas temperatures and H2 column densities. Results: The mass-per-unit-lengths of all four hub filaments are thermally super-critical, consistent with the presence of tens of gravitationally bound cores identified along them. These cores exhibit a regular separation of 0.37 ± 0.16 pc suggesting gravitational instabilities running along these super-critical filaments are responsible for their fragmentation. The observed local increase of the dense gas velocity dispersion towards starless cores is believed to be a consequence of such fragmentation process. Using energy conservation arguments, we estimate that the gravitational to kinetic energy conversion efficiency in the SDC13 cores is 35%. We see velocity gradient peaks towards 63% of cores as expected during the early stages of filament fragmentation. Another clear observational signature is the presence of the most massive cores at the filaments' junction, where the velocity dispersion is largest. We interpret this as the result of the hub morphology generating the largest acceleration gradients near the hub centre. Conclusions: We

  1. Utilization of maternal health care services in post-conflict Nepal

    Directory of Open Access Journals (Sweden)

    Bhandari TR

    2015-08-01

    Full Text Available Tulsi Ram Bhandari, Prabhakaran Sankara Sarma, Vellappillil Raman Kutty Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India Background: Despite a decade-long armed conflict in Nepal, the country made progress in reducing maternal mortality and is on its way to achieve the Millennium Development Goal Five. This study aimed to assess the degree of the utilization of maternal health care services during and after the armed conflict in Nepal.Methods: This study is based on Nepal Demographic and Health Survey data 2006 and 2011. The units of analysis were women who had given birth to at least one child in the past 5 years preceding the survey. First, we compared the utilization of maternal health care services of 2006 with that of 2011. Second, we merged the two data sets and applied logistic regression to distinguish whether the utilization of maternal health care services had improved after the peace process 2006 was underway.Results: In 2011, 85% of the women sought antenatal care at least once. Skilled health workers for delivery care assisted 36.1% of the women, and 46% of the women attended postnatal care visit at least once. These figures were 70%, 18.7%, and 16%, respectively, in 2006. Similarly, women were more likely to utilize antenatal care at least once (odds ratio [OR] =2.18, confidence interval [CI] =1.95–2.43, skilled care at birth (OR =2.58, CI =2.36–2.81, and postnatal care at least once (OR =4.13, CI =3.75–4.50 in 2011.Conclusion: The utilization of maternal health care services tended to increase continuously during both the armed conflict and the post-conflict period in Nepal. However, the increasing proportion of the utilization was higher after the Comprehensive Peace Process Agreement 2006. Keywords: antenatal care, armed conflict, Nepal, post-conflict, postnatal care, skilled care at birth

  2. Reconstructing continuity of care in mental health services : a multilevel conceptual framework

    NARCIS (Netherlands)

    Wierdsma, Andre; Mulder, Cornelis; de Vries, Sanne; Sytema, Sjoerd

    Continuity of mental health care is a key issue in the organization and evaluation of services for patients with disabling chronic conditions. Over many years, health services researchers have been exploring the conceptual boundaries between continuity of care and other service characteristics. On

  3. P-1139 - Increased utilization of health care services after psychotherapy

    DEFF Research Database (Denmark)

    Fenger, Morten Munthe; Mortensen, Erik Lykke; Poulsen, Stig Bernt

    2012-01-01

    Background Psychotherapeutic treatment is associated with significant reduction of symptoms in patients, and it is generally assumed that treatment improves health and decreases the need for additional health care. The present study investigates the long-term changes in utilization of health care...... services for patients referred to psychotherapeutic treatment in 2004 and 2005. Method The study was a matched control study, which included 716 consecutive patients and 15,220 matched controls. Data from a comprehensive set of health care services were collected from central registries for an observation...... period of four years before intake and four years after ended treatment. Changes in utilization of health care services in eight health parameters were analyzed with t-test and with ANCOVA one and four year pre-post treatment. Results Of the 761 patients, 216 patients did not show up for treatment, while...

  4. Strategic analysis on establishing a natural gas trading hub in China

    Directory of Open Access Journals (Sweden)

    Xiaoguang Tong

    2014-12-01

    Full Text Available Since 2010, the LNG importing price premium in the Asia–Pacific markets has become increasingly high, generating great effects on the economic development in China. In addition, the natural gas dependence degree is expanding continuously, making it extremely urgent to establish a natural gas trading hub in China, with the aim to ensure national energy security, to gain the pricing power, and to build the regional benchmark prices. Through a comparative analysis of internal strength/weakness and external competitiveness, we concluded that with intensively-issued supporting policies on the natural gas sector, the initiation of spot and futures markets, the rapid growth of gas production and highly-improved infrastructures, as well as Shanghai's advantageous location, China has more advantages in establishing an Asian Natural Gas Trading Hub than other counties like Singapore, Japan and Malaysia. Moreover, based on the SWOT (strength, weakness, opportunity and threat and the marketization process analysis, the following strategies were presented: to impel the establishment of a natural gas trading hub depending on the gas supply condition, to follow the policies to complete the gas storage system, to form regional communities by taking comparative advantages, and to reinforce the marketization reform and regulation system establishment with foreign experiences for reference. This study rationalized the necessity and practicality of establishing a natural gas trading hub in China and will help China make a proper decision and find a periodical strategic path in this sector.

  5. Transformation by stealth: the retargeting of home care services in Finland.

    Science.gov (United States)

    Kröger, Teppo; Leinonen, Anu

    2012-05-01

    This paper analyses the trends and changes that home care services for older people have undergone during the last two decades in Finland. The data used come from national social care statistics, covering the time period from 1990-2010. The results show that, in contrast to many other European nations that have expanded their home care provisions, the coverage levels in Finland have dropped dramatically during this period. Those with the highest needs do receive increased amounts of support, but others have become excluded from publicly funded home care provisions and often need to rely on family members. In most localities, public service provision is focused on personal care, and no longer covers household tasks. This major change of the character of the service is connected to three other recent trends that structure current provisions: the amalgamation of home-based social and healthcare services, the marketisation and emerging privatisation of care and the integration of informal family care into the formal care system. Overall, the changes represent weakening defamilisation, that is, decreasing public responsibility for the needs of many older people and, correspondingly, an increasing reliance on family carers. This full-scale transformation of home care has taken place without any real policy debate or major modification of legislation. No actual decision was ever made to thoroughly alter the character of home care in Finland: the transformation happened by stealth. © 2011 Blackwell Publishing Ltd.

  6. Adolescent health care: improving access by school-based service.

    Science.gov (United States)

    Gonzales, C; Mulligan, D; Kaufman, A; Davis, S; Hunt, K; Kalishman, N; Wallerstein, N

    1985-10-01

    Participants in this discussion of the potential of school-based health care services for adolescents included family medicine physicians, school health coordinators, a school nurse, and a community worker. It was noted that health care for adolescents tends to be either inaccessible or underutilized, largely because of a lack of sensitivity to adolescent culture and values. An ideal service for adolescents would offer immediate services for crises, strict confidentiality, ready access to prescribed medications, a sliding-scale scheme, and a staff that is tolerant of divergent values and life-styles. School-based pilot adolescent clinics have been established by the University of New Mexico's Department of Family, Community, and Emergency Medicine to test the community-oriented health care model. On-site clinics provide urgent medical care, family planning, pregnancy testing, psychological counseling, alcohol and drug counseling, and classroom health education. Experience with these programs has demonstrated the necessity for an alliance among the health team and the school administration, parents, and students. Financial, ethical, and political factors can serve as constraints to school-based programs. In some cases, school administrators have been resistant to the provision of contraception to students on school grounds and parents have been unwilling to accept the adolescent's right to confidentiality. These problems in part stem from having 2 separate systems, each with its own values, orientation, and responsibilities, housed in 1 facility. In addition, there have been problems generating awareness of the school-based clinic among students. Health education theater groups, peer counseling, and student-run community services have been effective, however, in increasing student participation. It has been helpful to mold clinic services to meet the needs identified by teenagers themselves. There is an interest not only in curative services, but in services focused

  7. 76 FR 44573 - Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service...

    Science.gov (United States)

    2011-07-26

    ... DEPARTMENT OF AGRICULTURE Food and Nutrition Service Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service Payment Rates, and Administrative Reimbursement Rates for Sponsoring Organizations of Day Care Homes for the Period July 1, 2011 Through June 30, 2012 Correction In notice document 2011-18257 appearin...

  8. Culture and long-term care: the bath as social service in Japan.

    Science.gov (United States)

    Traphagan, John W

    2004-01-01

    A central feature of Japan's approach to community-based care of the elderly, including long-term home health care, is the emphasis on providing bath facilities. For mobile elders, senior centers typically provide a public bathing facility in which people can enjoy a relaxing soak along with friends who also visit the centers. In terms of in-home long-term care, visiting bath services are provided to assist family care providers with the difflcult task of bathing a frail or disabled elder--a task made more problematic as a result of the Japanese style of bathing. I argue that the bath, as social service, is a culturally shaped solution to a specific problem of elder care that arises in the Japanese context as a result of the importance of the bath in everyday life for Japanese. While the services may be considered specific to Japan, some aspects of bathing services, particularly the mobile bath service, may also have applicability in the United States.

  9. CE: Original Research: Primary Care Providers and Screening for Military Service and PTSD.

    Science.gov (United States)

    Mohler, Kristin Michelle; Sankey-Deemer, Cydnee

    2017-11-01

    : Background: Most veterans have the option of receiving their health care from the Veterans Health Administration or through primary care providers in the private sector. However, there is some evidence that fewer than half of community-based, private sector primary care and mental health providers screen their patients for military service, particularly in rural areas, leaving these veterans less likely to be screened for posttraumatic stress disorder (PTSD) and other military service-related conditions. To determine whether primary care providers in the private sector are screening patients for military service and subsequent PTSD. We designed and piloted a survey to determine whether primary care providers in a rural Pennsylvania region routinely screen for military service and service-related PTSD. We distributed the survey to a convenience sample of more than 250 primary care providers in central and western Pennsylvania through the U.S. Postal Service, via Facebook, and via work e-mails for those who worked in a local health system. Among 50 eligible respondents, only four (8%) said they screen all their patients for military service, and 20 (40%) reported screening none; only two respondents (4%) screened all their patients who have served in the military for PTSD, and 30 (60%) screened none. Veterans who rely on private sector providers may not receive evidence-based care for military service-related health problems, including PTSD. To improve care for these patients, providers in the private sector should be educated on why all patients should be screened for military service, how to conduct such screening properly, and veterans' general health concerns.

  10. A model for ageing-home-care service process improvement

    OpenAIRE

    Yu, Shu-Yan; Shie, An-Jin

    2017-01-01

    The purpose of this study was to develop an integrated model to improve service processes in ageing-home-care. According to the literature, existing service processes have potential service failures that affect service quality and efficacy. However, most previous studies have only focused on conceptual model development using New Service Development (NSD) and fail to provide a systematic model to analyse potential service failures and facilitate managers developing solutions to improve the se...

  11. The Flexible Care Service: a third-sector service for older people with mental health needs.

    Science.gov (United States)

    Ryder, Elaine

    2015-01-01

    Demographic patterns indicate that by 2030, one in five people in England will be over 65. Together with the fact that as people age they are more likely to suffer from comorbidities, it is of paramount importance that local services are designed to meet the needs of individual older people. The Flexible Care Service is a resource for older people with mental health problems. Through the use of client case studies, the Department of Health's 'six Cs' (care, compassion, competence, communication, courage and commitment) are used as a framework to demonstrate how a third-sector service such as Flexible Care can offer a person-centred approach in order to meet the diverse needs of individual clients. The framework is also used to demonstrate the high level of skills needed by flexible carers in order to provide this support.

  12. Transfer of patients from health care centres to special care services: analysis of travel distances in Nordic countries.

    Science.gov (United States)

    Vuori, Jari; Kylänen, Marika; Tritter, Jonathan

    2010-12-01

    This paper highlights the importance of analysing patient transportation in Nordic circumpolar areas. The research questions we asked are as follows: How many Finnish patients have been transferred to special care intra-country and inter-country in 2009? Does it make any difference to health care policymakers if patients are transferred inter-country? We analysed the differences in distances from health care centres to special care services within Finland, Sweden and Norway and considered the health care policy implications. An analysis of the time required to drive between service providers using the "Google distance meter" (http://maps.google.com/); conducting interviews with key Finnish stakeholders; and undertaking a quantitative analyses of referral data from the Lapland Hospital District. Finnish patients are generally not transferred for health care services across national borders even if the distances are shorter. Finnish patients have limited access to health care services in circumpolar areas across the Nordic countries for 2 reasons. First, health professionals in Norway and Sweden do not speak Finnish, which presents a language problem. Second, the Social Insurance Institution of Finland does not cover the expenditures of travel or the costs of medicine. In addition, it seems that in circumpolar areas the density of Finnish service providers is greater than Swedish ones, causing many Swedish citizens to transfer to Finnish health care providers every year. However, future research is needed to determine the precise reasons for this.

  13. Immigrants' use of primary health care services for mental health problems.

    Science.gov (United States)

    Straiton, Melanie; Reneflot, Anne; Diaz, Esperanza

    2014-08-13

    Equity in health care across all social groups is a major goal in health care policy. Immigrants may experience more mental health problems than natives, but we do not know the extent to which they seek help from primary health care services. This study aimed to determine a) the rate immigrants use primary health care services for mental health problems compared with Norwegians and b) the association between length of stay, reason for immigration and service use among immigrants. National register data covering all residents in Norway and all consultations with primary health care services were used. We conducted logistic regression analyses to compare Norwegians' with Polish, Swedish, German, Pakistani and Iraqi immigrants' odds of having had a consultation for a mental health problem (P-consultation). After accounting for background variables, all immigrants groups, except Iraqi men had lower odds of a P-consultation than their Norwegian counterparts. A shorter length of stay was associated with lower odds of a P-consultation. Service use varies by country of origin and patterns are different for men and women. There was some evidence of a possible 'healthy migrant worker' effect among the European groups. Together with previous research, our findings however, suggest that Iraqi women and Pakistanis in particular, may experience barriers in accessing care for mental health problems.

  14. nanoHUB.org: Experiences and Challenges in Software Sustainability for a Large Scientific Community

    Directory of Open Access Journals (Sweden)

    Lynn Zentner

    2014-07-01

    Full Text Available The science gateway nanoHUB.org, funded by the National Science Foundation (NSF, serves a large scientific community dedicated to research and education in nanotechnology with community-contributed simulation codes as well as a vast repository of other materials such as recorded presentations, teaching materials, and workshops and courses. Nearly 330,000 users annually access over 4400 items of content on nanoHUB, including 343 simulation tools. Arguably the largest nanotechnology facility in the world, nanoHUB has led the way not only in providing open access to scientific code in the nanotechnology community, but also in lowering barriers to the use of that code, by providing a platform where developers are able to easily and quickly deploy code written in a variety of languages with user-friendly graphical user interfaces and where users can run the latest versions of codes transparently on the grid or other powerful resources without ever having to download or update code. Being a leader in open access code deployment provides nanoHUB with opportunities and challenges as it meets the current and future needs of its community. This paper discusses the experiences of nanoHUB in addressing and adapting to the changing landscape of scientific software in ways that best serve its community and meet the needs of the largest portion of its user base.

  15. Home care services for sick children: Healthcare professionals' conceptions of challenges and facilitators.

    Science.gov (United States)

    Castor, Charlotte; Hallström, Inger; Hansson, Helena; Landgren, Kajsa

    2017-09-01

    To explore healthcare professionals' conceptions of caring for sick children in home care services. Families often prefer home care to hospital care, and the number of home care services for children is increasing. Caring for children at home has been recognised as challenging for healthcare professionals in home care services used to providing care predominately for adults. An inductive qualitative design. Seven focus group interviews were performed with 36 healthcare professionals from multidisciplinary home care services. Data were analysed stepwise using a phenomenographic analysis. Three description categories emerged: "A challenging opportunity", "A child perspective", and "Re-organise in accordance with new prerequisites." Providing home care services for children was conceived to evoke both professional and personal challenges such as feelings of inadequacy and fear and professional growth such as increased competence and satisfaction. Conceptions of whether the home or the hospital was the best place for care differed. Adapting to the child's care was conceived as important. Cooperation with paediatric departments and a well-functioning team work were important organisational aspects. Providing home care for children was a challenging but rewarding task for healthcare professionals used to care for adults. To provide care with a child perspective was experienced as important even though there were conflicting conceptions of how this should be done. Close cooperation with paediatric departments and teamwork were prerequisites that make up for the low number of paediatric patients and facilitate confidence and competence. A sufficient number of referred children and enabling healthcare professionals to be part of the re-organising and implementation processes might facilitate the home care services for sick children. Enough time and good teamwork must be emphasised. Early referrals, continuous cooperation with paediatric clinics complemented with

  16. Air ambulance services--integrated emergency care.

    Science.gov (United States)

    Ferdinand, M

    1994-10-01

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

  17. Symptoms of burnout among staff of direct service care

    OpenAIRE

    ZICHOVÁ, Eliška

    2017-01-01

    This dissertation was focused on burnout syndrome among the staff of direct service care. The degree of burnout was estimated using Copenhagen Burnout Inventory questionnaire which was completed by the respondents from six Prague homes for seniors. The burnout incidence in this group was 30-45 %, whereas it was only 18-32 % among Czech Army employees who were studied for comparison. The staff of direct service care had significantly higher degree of personal, work-related, client-related and ...

  18. [Quality management is associated with high quality services in health care].

    Science.gov (United States)

    Nielsen, Tenna Hassert; Riis, Allan; Mainz, Jan; Jensen, Anne-Louise Degn

    2013-12-09

    In these years, quality management has been the focus in order to meet high quality services for the patients in Danish health care. This article provides information on quality management and quality improvement and it evaluates its effectiveness in achieving better organizational structures, processes and results in Danish health-care organizations. Our findings generally support that quality management is associated with high quality services in health care.

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

    Science.gov (United States)

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

    1997-01-01

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

  20. Characteristics of Indigenous primary health care service delivery models: a systematic scoping review.

    Science.gov (United States)

    Harfield, Stephen G; Davy, Carol; McArthur, Alexa; Munn, Zachary; Brown, Alex; Brown, Ngiare

    2018-01-25

    Indigenous populations have poorer health outcomes compared to their non-Indigenous counterparts. The evolution of Indigenous primary health care services arose from mainstream health services being unable to adequately meet the needs of Indigenous communities and Indigenous peoples often being excluded and marginalised from mainstream health services. Part of the solution has been to establish Indigenous specific primary health care services, for and managed by Indigenous peoples. There are a number of reasons why Indigenous primary health care services are more likely than mainstream services to improve the health of Indigenous communities. Their success is partly due to the fact that they often provide comprehensive programs that incorporate treatment and management, prevention and health promotion, as well as addressing the social determinants of health. However, there are gaps in the evidence base including the characteristics that contribute to the success of Indigenous primary health care services in providing comprehensive primary health care. This systematic scoping review aims to identify the characteristics of Indigenous primary health care service delivery models. This systematic scoping review was led by an Aboriginal researcher, using the Joanna Briggs Institute Scoping Review Methodology. All published peer-reviewed and grey literature indexed in PubMed, EBSCO CINAHL, Embase, Informit, Mednar, and Trove databases from September 1978 to May 2015 were reviewed for inclusion. Studies were included if they describe the characteristics of service delivery models implemented within an Indigenous primary health care service. Sixty-two studies met the inclusion criteria. Data were extracted and then thematically analysed to identify the characteristics of Indigenous PHC service delivery models. Culture was the most prominent characteristic underpinning all of the other seven characteristics which were identified - accessible health services, community

  1. Service Line Management: A New Paradigm in Health Care System

    Directory of Open Access Journals (Sweden)

    Rafat Rezapour Nasrabad

    2016-12-01

    Full Text Available Health care organizations are required to implement modern management practices and approaches due to the importance of improving quality and increasing efficiency of health care services. Service line management of healthcare services is one of the new approaches that managers of health sectors are interested in. The “service line” approach will organize the management of inpatient and outpatient in clinical services focusing on patient diagnostic clusters. Services specific in each patient diagnostic cluster will be offered by a multidisciplinary team including nurses, physicians, and so no. Accordingly, the present study aims to evaluate the features, process and benefits of service line management approach in the provision of health services. In this descriptive study, internal and external scientific database have been reviewed and the necessary data have been extracted from the latest research projects and related scientific documents. The results showed that the new management approach is based on a paradigm shift from traditional health care system management to healthcare service line management with a focus on managers’ competencies. Four specific manager’s competencies in this new management model are: conceptual, collaborative, interpersonal, and leadership competencies. Theses competencies should be developed in health system managers so as to lead to organizational excellency and improvement of health service quality. The health sector managers should strengthen these four key competencies and act on them. Then they will become effective leaders and managers in the health system.

  2. Personal care services provided to children with special health care needs (CSHCN) and their subsequent use of physician services.

    Science.gov (United States)

    Miller, Thomas R; Elliott, Timothy R; McMaughan, Darcy M; Patnaik, Ashweeta; Naiser, Emily; Dyer, James A; Fournier, Constance J; Hawes, Catherine; Phillips, Charles D

    2013-10-01

    Medicaid Personal Care Services (PCS) help families meet children's needs for assistance with functional tasks. However, PCS may have other effects on a child's well-being, but research has not yet established the existence of such effects. To investigate the relationship between the number of PCS hours a child receives with subsequent visits to physicians for evaluation and management (E&M) services. Assessment data for 2058 CSHCN receiving PCS were collected in 2008 and 2009. Assessment data were matched with Medicaid claims data for the period of 1 year after the assessment. Zero-inflated negative binomial and generalized linear multivariate regression models were used in the analyses. These models included patient demographics, health status, household resources, and use of other medical services. For every 10 additional PCS hours authorized for a child, the odds of having an E&M physician visit in the next year were reduced by 25%. However, the number of PCS hours did not have a significant effect on the number of visits by those children who did have a subsequent E&M visit. A variety of demographic and health status measures also affect physician use. Medicaid PCS for CSHCN may be associated with reduced physician usage because of benefits realized by continuity of care, the early identification of potential health threats, or family and patient education. PCS services may contribute to a child's well-being by providing continuous relationships with the care team that promote good chronic disease management, education, and support for the family. Copyright © 2013 Elsevier Inc. All rights reserved.

  3. The impact of health care professionals' service orientation on patients' innovative behavior.

    Science.gov (United States)

    Henrike, Hannemann-Weber; Schultz, Carsten

    2014-01-01

    The increasing availability of medical information and the rising relevance of patient communities drive the active role of health consumers in health care processes. Patients become experts on their disease and provide valuable stimuli for novel care solutions. Medical encounters evolve toward a more collaborative health care service process, where patients are accepted as equal partners. However, the patient's active role depends on the interaction with the involved health care professionals. The aim of this article is to examine whether the service orientation of health care professionals and their proactive and adaptive work behavior and the extent of shared goals within the necessary interdisciplinary health professional team influence patients' innovative behavior. We address six rare diseases and use interview and survey data to test theoretically derived hypotheses. The sample consists of 86 patients and their 160 health care professionals. Sixty patients provided additional information via interviews. Patients' innovative behavior is reflected by the number of generated ideas as well as the variety of ideas. The service orientation of work teams plays an important role in the innovation process of patients. As hypothesized, the extent of shared goals within the health care teams has a direct effect on patients' idea generation. Work adaptivity and proactivity and shared goals both reinforce the positive effect of service orientation. Furthermore, significant associations between the three independent variables and the second outcome variable of patient's idea variety are confirmed. The study underlines (1) the important role of patients within health care service innovation processes, (2) the necessity of a service-oriented working climate to foster the development of innovative care solutions for rare diseases, and (3) the need for an efficient cooperation and open mindset of health care professionals to motivate and support patient innovation.

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

    OpenAIRE

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

    2017-01-01

    Introduction: There is limited evidence of the benefits of information and communication technology (ICT) to support integrated aged care services. Objectives: We undertook a case study to describe carelink+, a centralised client service management ICT system implemented by a large aged and community care service provider, Uniting. We sought to explicate the care-related information exchange processes associated with carelink+ and identify lessons for organisations attempting to use ICT to su...

  5. Hub River: A private power prototype

    International Nuclear Information System (INIS)

    Sachs, J.L.

    1992-01-01

    This article examines the challenges of financing an independent power project in a developing country. The oil-fired plant is to be located on the Hub River in Baluchistan on the Arabian Sea coast. The topics of the article include a description of the team that put the project together, the financing plans, the risk in the face of political unrest and change of governments, and the beginning of construction of the project

  6. Scope of neonatal care services in major Nigerian hospitals

    African Journals Online (AJOL)

    2015-10-12

    Oct 12, 2015 ... Quality of newborn care by level of services offered is a critical determinant of ... natal unit capacity, personnel, trainings in newborn cardio-pulmonary ... The availability of surfactant replacement service was also solicited.

  7. Addressing congestion on single allocation hub-and-spoke networks

    Directory of Open Access Journals (Sweden)

    Ricardo Saraiva de Camargo

    2012-12-01

    Full Text Available When considering hub-and-spoke networks with single allocation, the absence of alternative routes makes this kind of systems specially vulnerable to congestion effects. In order to improve the design of such networks, congestion costs must be addressed. This article deploys two different techniques for addressing congestion on single allocation hub-and-spoke networks: the Generalized Benders Decomposition and the Outer Approximation method. Both methods are able to solve large scale instances. Computational experiments show how the adoption of advanced solution strategies, such as Pareto-optimal cut generation on the Master Problem branch-and-bound tree, may be decisive. They also demonstrate that the solution effort is not only associated with the size of the instances, but also with their combination of the installation and congestion costs.

  8. Strategies to Improve Stroke Care Services in Low- and Middle-Income Countries

    DEFF Research Database (Denmark)

    Pandian, Jeyaraj Durai; William, Akanksha G; Kate, Mahesh P

    2017-01-01

    subsidies. Adherence to secondary preventive drugs is affected by limited availability and affordability, emphasizing the importance of primary prevention. Training of paramedics, care-givers and nurses in post-stroke care is feasible. CONCLUSION: In this systematic review, we found several reports...... on evidence-based implementable stroke services in LMICs. Some strategies are economic, feasible and reproducible but remain untested. Data on their outcomes and sustainability is limited. Further research on implementation of locally and regionally adapted stroke-services and cost-effective secondary......BACKGROUND: The burden of stroke in low- and middle-income countries (LMICs) is large and increasing, challenging the already stretched health-care services. AIMS AND OBJECTIVES: To determine the quality of existing stroke-care services in LMICs and to highlight indigenous, inexpensive, evidence...

  9. Antenatal care services utilization among women of reproductive ...

    African Journals Online (AJOL)

    Methods: A cross-sectional study was carried out between September and October 2013 among 425 women of reproductive age using a multi-stage sampling technique. Results: Almost all the respondents (93.9%) were aware of antenatal care services. A good proportion of the mothers (90.1%) used antenatal services, ...

  10. Volunteers in Specialist Palliative Care: A Survey of Adult Services in the United Kingdom

    Science.gov (United States)

    Burbeck, Rachel; Low, Joe; Sampson, Elizabeth L.; Bravery, Ruth; Hill, Matthew; Morris, Sara; Ockenden, Nick; Payne, Sheila

    2014-01-01

    Abstract Background: Worldwide, the demand for specialist palliative care is increasing but funding is limited. The role of volunteers is underresearched, although their contribution reduces costs significantly. Understanding what volunteers do is vital to ensure services develop appropriately to meet the challenges faced by providers of palliative care. Objective: The study's objective is to describe current involvement of volunteers with direct patient/family contact in U.K. specialist palliative care. Design: An online survey was sent to 290 U.K. adult hospices and specialist palliative care services involving volunteers covering service characteristics, involvement and numbers of volunteers, settings in which they are involved, extent of involvement in care services, specific activities undertaken in each setting, and use of professional skills. Results: The survey had a 67% response rate. Volunteers were most commonly involved in day care and bereavement services. They entirely ran some complementary therapy, beauty therapy/hairdressing, and pastoral/faith-based care services, and were involved in a wide range of activities, including sitting with dying patients. Conclusions: This comprehensive survey of volunteer activity in U.K. specialist palliative care provides an up-to-date picture of volunteer involvement in direct contact with patients and their families, such as providing emotional care, and the extent of their involvement in day and bereavement services. Further research could focus on exploring their involvement in bereavement care. PMID:24475743

  11. Models of care and organization of services.

    Science.gov (United States)

    Markova, Alina; Xiong, Michael; Lester, Jenna; Burnside, Nancy J

    2012-01-01

    This article examines the overall organization of services and delivery of health care in the United States. Health maintenance organization, fee-for-service, preferred provider organizations, and the Veterans Health Administration are discussed, with a focus on structure, outcomes, and areas for improvement. An overview of wait times, malpractice, telemedicine, and the growing population of physician extenders in dermatology is also provided. Copyright © 2012 Elsevier Inc. All rights reserved.

  12. S. R. Ranganathan's Theory of Reference Service.

    Science.gov (United States)

    Varghese, Manoj M.

    A study of S. R. Ranganathan's theory of reference service is undertaken by using an historical methodology. It was evident from the literature review that Ranganathan had established that reference service was the most important work and served as the hub of all library practices. There were six factors that were repeatedly considered by…

  13. Development of passive-controlled HUB (teetered brake & damper mechanism) of horizontal axis wind turbine

    Energy Technology Data Exchange (ETDEWEB)

    Shimizu, Yukimaru; Kamada, Yasunari; Maeda, Takao [Mie Univ. (Japan)

    1997-12-31

    For the purpose of the improvement of reliability of the Mega-Watt wind turbine, this paper indicates the development of an original mechanism for the passive-controlled hub, which has the effects of braking and damping on aerodynamic forces. This mechanism is useful for variable speed control of the large wind turbine. The passive-controlled hub is the combination of two mechanisms. One is the passive-teetered and damping mechanism, and the other is the passive-variable-pitch mechanism. These mechanism are carried out by the combination of the teetering and feathering motions. When the wind speed exceeds the rated wind speed, the blade is passively teetered in a downwind direction and, simultaneously, a feathering mechanism, which is linked to the teetering mechanism through a connecting rods, is activated. Testing of the model horizontal axis wind turbine in a wind tunnel showed that the passive-controlled hub mechanism can suppress the over-rotational speed of the rotor. By the application of the passive-controlled hub mechanism, the maximum rotor speed is reduced to about 60%.

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

    Science.gov (United States)

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

    2017-04-10

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

  15. Gas and LNG pricing and trading hub in East Asia: An introduction

    OpenAIRE

    Shi, Xunpeng

    2017-01-01

    This paper summarizes the four papers in the special issues on ‘Gas and LNG pricing and trading hub in East Asia’. The papers examine lessons and experience from European hub development, other commodity, the Japanese history on developing of futures markets and inter-fuel substitution in East Asia. The papers finds that liquid futures market is the key to formulate benchmark prices while a well-developed spot market is the foundation; political will and strong leadership are required to over...

  16. Services Use of Children and Adolescents before Admission to Psychiatric Inpatient Care.

    Science.gov (United States)

    Zechmeister-Koss, Ingrid; Winkler, Roman; Fritz, Corinna; Thun-Hohenstein, Leonhard; Tuechler, Heinz

    2016-06-01

    Although 20% of children and adolescents in Europe suffer from overt mental health problems, their illness-related service utilisation is often unknown. If at all, existing research has only addressed the health care sector while services requirements in mental health care go far beyond the health care system, including the social, the educational and the criminal justice system. This paper aims at describing the service contact patterns of children and adolescents within and outside the health care sector before they are admitted to a child and adolescent mental health hospital. Additionally, we evaluate the private out-of-pocket payments that occur for primary carers. A cohort of consecutive admissions to a child and adolescent hospital in Austria was prospectively analysed. We collected data on service use and out-of-pocket expenses before hospital admission from primary carers through face-to-face interviews using an adapted version of the European Child and Adolescent Mental Health Service Receipt Inventory (EU-CAMHSRI). Clinical data came from validated questionnaires (CBCL, YSR) and from the anamnestic documentation. Ninety percent from a cohort of 441 patients had some contact with services or took medication before they were admitted to hospital. Most often, services in the health care outpatient setting were used. Outside of the health care system, support in school, as well as counselling services, were used most frequently, whereas the persons hardly sought support in living or employment. Roughly 32,400 per 100 patients was spent privately, yet these out-of pocket expenses were very unevenly distributed. Service use and out-of-pocket spending increased with social status and were gender-specific. The more severe external behaviour symptoms were, the more non-health care services were used. Mentally ill children and adolescents use a broad range of services across sectors before admission to hospital. Service use is associated with specific symptoms of

  17. FEM analysis of hollow hub forming in rolling extrusion process

    Directory of Open Access Journals (Sweden)

    J. Bartnicki

    2014-10-01

    Full Text Available In this paper are presented the results of numerical calculations of rolling extrusion process of a hollow hub. As the flanges manufacturing at both sides of the product is required, in the analyzed process of rolling extrusion, a rear bumper was implemented as additional tool limiting axial metal flow. Numerical calculations of the hub forming process were conducted basing on finite element method, applying software Deform3D and Simufact in conditions of three dimensional state of strain. The obtained satisfactory results show that it is possible to conduct the further research works of experimental character, with the application of a modernized aggregate for the rolling extrusion process PO-2.

  18. Models of home care services for persons with dementia: a narrative review.

    Science.gov (United States)

    Low, Lee-Fay; Fletcher, Jennifer

    2015-10-01

    Worldwide trends of increasing dementia prevalence, have put economic and workforce pressures to shifting care for persons with dementia from residential care to home care. We reviewed the effects of the four dominant models of home care delivery on outcomes for community-dwelling persons with dementia. These models are: case management, integrated care, consumer directed care, and restorative care. This narrative review describes benefits and possible drawbacks for persons with dementia outcomes and elements that comprise successful programs. Case management for persons with dementia may increase use of community-based services and delay nursing home admission. Integrated care is associated with greater client satisfaction, increased use of community based services, and reduced hospital days however the clinical impacts on persons with dementia and their carers are not known. Consumer directed care increases satisfaction with care and service usage, but had little effect on clinical outcomes. Restorative models of home care have been shown to improve function and quality of life however these trials have excluded persons with dementia, with the exception of a pilot study. There has been a little research into models of home care for people with dementia, and no head-to-head comparison of the different models. Research to inform evidence-based policy and service delivery for people with dementia needs to evaluate both the impact of different models on outcomes, and investigate how to best deliver these models to maximize outcomes.

  19. Is it time to abandon care planning in mental health services? A qualitative study exploring the views of professionals, service users and carers.

    Science.gov (United States)

    Brooks, Helen L; Lovell, Karina; Bee, Penny; Sanders, Caroline; Rogers, Anne

    2018-06-01

    It has been established that mental health-care planning does not adequately respond to the needs of those accessing services. Understanding the reasons for this and identifying whose needs care plans serve requires an exploration of the perspectives of service users, carers and professionals within the wider organizational context. To explore the current operationalization of care planning and perceptions of its function within mental health services from the perspectives of multiple stakeholders. Participants included 21 mental health professionals, 29 service users and 4 carers from seven Mental Health Trusts in England. All participants had experience of care planning processes within secondary mental health-care services. Fifty-four semi-structured interviews were conducted with participants and analysed utilizing a qualitative framework approach. Care plans and care planning were characterized by a failure to meet the complexity of mental health needs, and care planning processes were seen to prioritize organizational agendas and risk prevention which distanced care planning from the everyday lives of service users. Care planning is recognized, embedded and well established in the practices of mental health professionals and service users. However, it is considered too superficial and mainly irrelevant to users for managing mental health in their everyday lives. Those responsible for the planning and delivery of mental health services should consider ways to increase the relevance of care planning to the everyday lives of service users including separating risk from holistic needs assessment, using support aids and utilizing a peer workforce in this regard. © 2017 The Authors Health Expectations published by John Wiley & Sons Ltd.

  20. UNMET NEEDS FOR HEALTH CARE SERVICES IN BULGARIA

    Directory of Open Access Journals (Sweden)

    Elka Atanasova

    2016-09-01

    Full Text Available Background: In all European countries, an important policy objective is the equity of access to health care. The factors that affect access to health care can differ as the demand- and supply-side factors. Moreover, there are many tools to assess the extent of inequity in access to services. One simple tool is the assessing reports of unmet needs for health care. Purpose: The study has two objectives: to examine the evidence of self-reported unmet needs and to analyze the relationship between foregone medical care and both type of residence and socioeconomic status. Materials and Methods: We use data from the European Union Statistics on Income and Living Conditions. The access to health care is measured using the concept of unmet need for medical examination or treatment during the last 12 months. The relationship between foregone medical care and both type of residence and socioeconomic status is examined through the representative survey conducted in 2014. Results: The Eurostat results show that treatment costs are the most common reason for foregone medical care in Bulgaria. We observe a gradual decrease in the share of people who reported having unmet needs due to being too expensive. According to the 2014 survey, significant differences between urban and rural areas as well as among the income groups are identified. The results show the problems in access to health care services mainly in small towns and villages. Conclusion: Although major essential changes were made in the Bulgarian health care system, the equity problems remain an important challenge to policy-makers.

  1. 75 FR 15495 - Agency Information Collection (Application for Furnishing Long-Term Care Services to...

    Science.gov (United States)

    2010-03-29

    ... (Application for Furnishing Long- Term Care Services to Beneficiaries of Veterans Affairs, and Residential Care... Furnishing Long-Term Care Services to Beneficiaries of Veterans Affairs, VA Form 10-1170. b. Residential Care... application used by a residential care facility or home that wishes to provide residential home care to...

  2. 25 CFR 20.508 - What must the social services agency do when a child is placed in foster care, residential care...

    Science.gov (United States)

    2010-04-01

    ... PROGRAMS Child Assistance Foster Care § 20.508 What must the social services agency do when a child is placed in foster care, residential care or guardianship home? The social services agency must make... placed in foster care, residential care or guardianship home? 20.508 Section 20.508 Indians BUREAU OF...

  3. Continuous Integration for Concurrent MOOSE Framework and Application Development on GitHub

    Directory of Open Access Journals (Sweden)

    Andrew E. Slaughter

    2015-11-01

    Full Text Available For the past several years, Idaho National Laboratory’s MOOSE framework team has employed modern software engineering techniques (continuous integration, joint application/framework source code repos- itories, automated regression testing, etc. in developing closed-source multiphysics simulation software (Gaston et al., 'Journal of Open Research Software' vol. 2, article e10, 2014. In March 2014, the MOOSE framework was released under an open source license on GitHub, significantly expanding and diversifying the pool of current active and potential future contributors on the project. Despite this recent growth, the same philosophy of concurrent framework and application development continues to guide the project’s development roadmap. Several specific practices, including techniques for managing multiple repositories, conducting automated regression testing, and implementing a cascading build process are discussed in this short paper. Special attention is given to describing the manner in which these practices naturally synergize with the GitHub API and GitHub-specific features such as issue tracking, Pull Requests, and project forks.

  4. Incorporating Multifaceted Mental Health Prevention Services in Community Sectors-of-Care

    Science.gov (United States)

    Gewirtz, Abigail H.; August, Gerald J.

    2008-01-01

    This article proposes a framework for embedding prevention services into community sectors-of-care. Community sectors-of-care include both formal and grassroot organizations distributed throughout a community that provide various resources and services to at-risk children and their families. Though the child population served by these…

  5. Speak Up: Help Prevent Errors in Your Care: Laboratory Services

    Science.gov (United States)

    SpeakUP TM Help Prevent Errors in Your Care Laboratory Services To prevent health care errors, patients are urged to... SpeakUP TM ... are more likely to get better faster. To help prevent health care mistakes, patients are urged to “ ...

  6. Characteristics of steady vibration in a rotating hub-beam system

    Science.gov (United States)

    Zhao, Zhen; Liu, Caishan; Ma, Wei

    2016-02-01

    A rotating beam features a puzzling character in which its frequencies and modal shapes may vary with the hub's inertia and its rotating speed. To highlight the essential nature behind the vibration phenomena, we analyze the steady vibration of a rotating Euler-Bernoulli beam with a quasi-steady-state stretch. Newton's law is used to derive the equations governing the beam's elastic motion and the hub's rotation. A combination of these equations results in a nonlinear partial differential equation (PDE) that fully reflects the mutual interaction between the two kinds of motion. Via the Fourier series expansion within a finite interval of time, we reduce the PDE into an infinite system of a nonlinear ordinary differential equation (ODE) in spatial domain. We further nondimensionalize the ODE and discretize it via a difference method. The frequencies and modal shapes of a general rotating beam are then determined numerically. For a low-speed beam where the ignorance of geometric stiffening is feasible, the beam's vibration characteristics are solved analytically. We validate our numerical method and the analytical solutions by comparing with either the past experiments or the past numerical findings reported in existing literature. Finally, systematic simulations are performed to demonstrate how the beam's eigenfrequencies vary with the hub's inertia and rotating speed.

  7. Robots and service innovation in health care.

    Science.gov (United States)

    Oborn, Eivor; Barrett, Michael; Darzi, Ara

    2011-01-01

    Robots have long captured our imagination and are being used increasingly in health care. In this paper we summarize, organize and criticize the health care robotics literature and highlight how the social and technical elements of robots iteratively influence and redefine each other. We suggest the need for increased emphasis on sociological dimensions of using robots, recognizing how social and work relations are restructured during changes in practice. Further, we propose the usefulness of a 'service logic' in providing insight as to how robots can influence health care innovation. The Royal Society of Medicine Press Ltd 2011.

  8. Dental Care Presents The Highest Level Of Financial Barriers, Compared To Other Types Of Health Care Services.

    Science.gov (United States)

    Vujicic, Marko; Buchmueller, Thomas; Klein, Rachel

    2016-12-01

    The Affordable Care Act is improving access to and the affordability of a wide range of health care services. While dental care for children is part of the law's essential health benefits and state Medicaid programs must cover it, coverage of dental care for adults is not guaranteed. As a result, even with the recent health insurance expansion, many Americans face financial barriers to receiving dental care that lead to unmet oral health needs. Using data from the 2014 National Health Interview Survey, we analyzed financial barriers to a wide range of health care services. We found that irrespective of age, income level, and type of insurance, more people reported financial barriers to receiving dental care, compared to any other type of health care. We discuss policy options to address financial barriers to dental care, particularly for adults. Project HOPE—The People-to-People Health Foundation, Inc.

  9. Cloud based emergency health care information service in India.

    Science.gov (United States)

    Karthikeyan, N; Sukanesh, R

    2012-12-01

    A hospital is a health care organization providing patient treatment by expert physicians, surgeons and equipments. A report from a health care accreditation group says that miscommunication between patients and health care providers is the reason for the gap in providing emergency medical care to people in need. In developing countries, illiteracy is the major key root for deaths resulting from uncertain diseases constituting a serious public health problem. Mentally affected, differently abled and unconscious patients can't communicate about their medical history to the medical practitioners. Also, Medical practitioners can't edit or view DICOM images instantly. Our aim is to provide palm vein pattern recognition based medical record retrieval system, using cloud computing for the above mentioned people. Distributed computing technology is coming in the new forms as Grid computing and Cloud computing. These new forms are assured to bring Information Technology (IT) as a service. In this paper, we have described how these new forms of distributed computing will be helpful for modern health care industries. Cloud Computing is germinating its benefit to industrial sectors especially in medical scenarios. In Cloud Computing, IT-related capabilities and resources are provided as services, via the distributed computing on-demand. This paper is concerned with sprouting software as a service (SaaS) by means of Cloud computing with an aim to bring emergency health care sector in an umbrella with physical secured patient records. In framing the emergency healthcare treatment, the crucial thing considered necessary to decide about patients is their previous health conduct records. Thus a ubiquitous access to appropriate records is essential. Palm vein pattern recognition promises a secured patient record access. Likewise our paper reveals an efficient means to view, edit or transfer the DICOM images instantly which was a challenging task for medical practitioners in the

  10. Research on the cultivation path of smart home-based care service mode in Internet+ vision

    OpenAIRE

    Peng Qingchao

    2016-01-01

    Home-based care for the aged is an effective method to solve the problem of caring the aged in China. This thesis analyzes some problems existing in the development of current home-based care service for the aged in our country and the positive effects brought by Internet+ in home-based care service. It proposes a new service mode of care for the aged--Internet+ home-based care service, and explains the establishment of this system and the responsibilities of the participants. Also, it explor...

  11. Shared care between specialised psychiatric services and primary care: The experiences and expectations of General Practitioners in Ireland.

    LENUS (Irish Health Repository)

    Agyapong, Vincent Israel Opoku

    2012-04-17

    Objective. The study aims to explore the views of General Practitioners in Ireland on shared care between specialised psychiatric services and primary care. Method. A self-administered questionnaire was designed and posted to 400 randomly selected General Practitioners working in Ireland. Results. Of the respondents, 189 (94%) reported that they would support a general policy on shared care between primary care and specialised psychiatric services for patients who are stable on their treatment. However, 124 (61.4%) reported that they foresaw difficulties for patients in implementing such a policy including: a concern that primary care is not adequately resourced with allied health professionals to support provision of psychiatric care (113, 53.2%); a concern this would result in increased financial burden on some patients (89, 48.8%); a lack of adequate cooperation between primary care and specialised mental health services (84, 41.8%); a concern that some patients may lack confidence in GP care (55, 27.4%); and that primary care providers are not adequately trained to provide psychiatric care (29, 14.4% ). Conclusion. The majority of GPs in Ireland would support a policy of shared care of psychiatric patients; however they raise significant concerns regarding practical implications of such a policy in Ireland.

  12. Coffee Shops, Classrooms and Conversations: public engagement and outreach in a large interdisciplinary research Hub

    Science.gov (United States)

    Holden, Jennifer A.

    2014-05-01

    Public engagement and outreach activities are increasingly using specialist staff for co-ordination, training and support for researchers, they are also becoming expected for large investments. Here, the experience of public engagement and outreach a large, interdisciplinary Research Hub is described. dot.rural, based at the University of Aberdeen UK, is a £11.8 million Research Councils UK Rural Digital Economy Hub, funded as part of the RCUK Digital Economy Theme (2009-2015). Digital Economy research aims to realise the transformational impact of digital technologies on aspects of the environment, community life, cultural experiences, future society, and the economy. The dot.rural Hub involves 92 researchers from 12 different disciplines, including Geography, Hydrology and Ecology. Public Engagement and Outreach is embedded in the dot.rural Digital Economy Hub via an Outreach Officer. Alongside this position, public engagement and outreach activities are compulsory part of PhD student contracts. Public Engagement and Outreach activities at the dot.rural Hub involve individuals and groups in both formal and informal settings organised by dot.rural and other organisations. Activities in the realms of Education, Public Engagement, Traditional and Social Media are determined by a set of Underlying Principles designed for the Hub by the Outreach Officer. The underlying Engagement and Outreach principles match funding agency requirements and expectations alongside researcher demands and the user-led nature of Digital Economy Research. All activities include researchers alongside the Outreach Officer are research informed and embedded into specific projects that form the Hub. Successful public engagement activities have included participation in Café Scientifique series, workshops in primary and secondary schools, and online activities such as I'm a Scientist Get Me Out of Here. From how to engage 8 year olds with making hydrographs more understandable to members of

  13. Care Models of eHealth Services: A Case Study on the Design of a Business Model for an Online Precare Service.

    Science.gov (United States)

    van Meeuwen, Dorine Pd; van Walt Meijer, Quirine J; Simonse, Lianne Wl

    2015-03-24

    With a growing population of health care clients in the future, the organization of high-quality and cost-effective service providing becomes an increasing challenge. New online eHealth services are proposed as innovative options for the future. Yet, a major barrier to these services appears to be the lack of new business model designs. Although design efforts generally result in visual models, no such artifacts have been found in the literature on business model design. This paper investigates business model design in eHealth service practices from a design perspective. It adopts a research by design approach and seeks to unravel what characteristics of business models determine an online service and what are important value exchanges between health professionals and clients. The objective of the study was to analyze the construction of care models in-depth, framing the essential elements of a business model, and design a new care model that structures these elements for the particular context of an online pre-care service in practice. This research employs a qualitative method of an in-depth case study in which different perspectives on constructing a care model are investigated. Data are collected by using the visual business modeling toolkit, designed to cocreate and visualize the business model. The cocreated models are transcribed and analyzed per actor perspective, transactions, and value attributes. We revealed eight new actors in the business model for providing the service. Essential actors are: the intermediary network coordinator connecting companies, the service dedicated information technology specialists, and the service dedicated health specialist. In the transactions for every service providing we found a certain type of contract, such as a license contract and service contracts for precare services and software products. In addition to the efficiency, quality, and convenience, important value attributes appeared to be: timelines, privacy and

  14. Health care: a community concern? : developments in the organization of Canadian health services

    National Research Council Canada - National Science Library

    Crichton, Anne

    1997-01-01

    ... Canadian Health Care Organizational Policies 1967-86 IV Service Delivery Systems and Their Response to the Need for Change to a Collective Care Organization 9. Care in the Doctor's Office 10. Support Services for Physicians in General Practice 11. Medical Practice Organization: Alternative Medical Care Delivery Models 12. Evolution of Public H...

  15. Up-to-Date on Preventive Care Services Under Affordable Care Act: A Trend Analysis From MEPS 2007-2014.

    Science.gov (United States)

    Hong, Young-Rock; Jo, Ara; Mainous, Arch G

    2017-08-01

    The utilization of preventive care services has been less than optimal. As part of an effort to address this, the Affordable Care Act (ACA) mandated that private health insurance plans cover evidence-based preventive services. To evaluate whether the provisions of ACA have increased being up-to-date on recommended preventive care services among privately insured individuals aged 18-64. Multivariate linear regression models were used to examine trends in prevalence of being up-to-date on selected preventive services, diagnosis of health conditions, and health expenditures between pre-ACA (2007-2010) and post-ACA (2011-2014). Adjusted difference-in-difference analyses were used to estimate changes in those outcomes in the privately insured that differed from changes in the uninsured (control group). After the passage of ACA, up-to-date rates of routine checkup (2.7%; 95% confidence interval, 0.8%-4.7%; P=0.007) and flu vaccination (5.9%; 95% confidence interval, 4.2%-7.6%; Ppreventive care services. Additional efforts may be required to take full advantage of the elimination of cost-sharing under the ACA.

  16. Mental health service users' experiences of mental health care: an integrative literature review.

    Science.gov (United States)

    Newman, D; O'Reilly, P; Lee, S H; Kennedy, C

    2015-04-01

    A number of studies have highlighted issues around the relationship between service users and providers. The recovery model is predominant in mental health as is the recognition of the importance of person-centred practice. The authors completed an in-depth search of the literature to answer the question: What are service users' experiences of the mental health service? Three key themes emerged: acknowledging a mental health problem and seeking help; building relationships through participation in care; and working towards continuity of care. The review adds to the current body of knowledge by providing greater detail into the importance of relationships between service users and providers and how these may impact on the delivery of care in the mental health service. The overarching theme that emerged was the importance of the relationship between the service user and provider as a basis for interaction and support. This review has specific implications for mental health nursing. Despite the recognition made in policy documents for change, issues with stigma, poor attitudes and communication persist. There is a need for a fundamental shift in the provider-service user relationship to facilitate true service-user engagement in their care. The aim of this integrative literature review was to identify mental health service users' experiences of services. The rationale for this review was based on the growing emphasis and requirements for health services to deliver care and support, which recognizes the preferences of individuals. Contemporary models of mental health care strive to promote inclusion and empowerment. This review seeks to add to our current understanding of how service users experience care and support in order to determine to what extent the principles of contemporary models of mental health care are embedded in practice. A robust search of Web of Science, the Cochrane Database, Science Direct, EBSCO host (Academic Search Complete, MEDLINE, CINAHL Plus

  17. Network performance, hub connectivity potential, and competitive position of primary airports in Asia/Pacific region

    NARCIS (Netherlands)

    Matsumoto, H.; Veldhuis, J.; de Wit, J.; Burghouwt, G.

    2008-01-01

    Recently, hub-and-spoke network configurations are more and more developed in the Asia/Pacific region. In this paper, it is argued that the measurement of network performance in hub-and-spoke systems should take into account the quantity and quality of both direct and indirect connections. The

  18. Teaching wound care to family medicine residents on a wound care service

    Directory of Open Access Journals (Sweden)

    Little SH

    2013-08-01

    Full Text Available Sahoko H Little,1,2 Sunil S Menawat,1,3 Michael Worzniak,1 Michael D Fetters2 1Oakwood Annapolis Family Medicine Residency, Wayne, Michigan, USA; 2University of Michigan, Department of Family Medicine, Ann Arbor, Michigan, USA; 3Ghent Family Medicine Residency, Eastern Virginia Medical School, Norfolk, Virginia, USA Abstract: Primary care physicians often care for patients with chronic wounds, and they can best serve patients if they have knowledge and proficient skills in chronic wound care, including sharp debridement. The Oakwood Annapolis Family Medicine Residency in Michigan, USA developed a Wound Care Service, incorporating wound care training during the surgical rotation. Effectiveness of the wound care training was evaluated through pre- and posttesting of residents, to assess changes in knowledge and comfort in treating chronic wounds. The results demonstrate significant improvement in residents’ knowledge and comfort in wound care. This innovation demonstrates the feasibility of educating residents in chronic wound care through hands-on experience. Keywords: wound care education, primary care, residency education, surgery rotation, curriculum development

  19. A Three-Legged Stool or Race? Governance Models for NOAA RISAs, DOI CSCs, and USDA Climate Hubs

    Science.gov (United States)

    Foster, J. G.

    2014-12-01

    NOAAs Regional Integrated Sciences and Assessments (RISA) Teams, DOIs Climate Science Centers (CSCs), and USDAs Regional Climate Hubs (RCHs) have common missions of integrating climate and related knowledge across scientific disciplines and regions to create "actionable" information that decision-makes can use to manage climate risks and impacts at state and local scales. However, the sponsoring agency programs, university investigators, and local federal officials govern each differently. The three models of program and center governance are 1) exclusively university (RISAs), 2) a hybrid of Federal government and (host) university (CSCs,), and 3) exclusively Federal (Hubs). Each model has it's advantages and disadvantages in terms of legal definition and authority, scientific mission requirements and strategies, flexibility and legitimacy to conduct research and to collaborate regionally with constituencies, leadership and governance approach and "friction points,", staff capacity and ability to engage stakeholders, necessity to deliver products and services, bureaucratic oversight, performance evaluation, and political support at Congressional, state, and local levels. Using available sources of information and data, this paper will compare and contrast the strengths and weakness of these three regional applied climate science center governance models.

  20. A Three-Legged Stool or Race? Governance Models for NOAA RISAs, DOI CSCs, and USDA Climate Hub

    Science.gov (United States)

    Foster, J. G.

    2014-12-01

    NOAAs Regional Integrated Sciences and Assessments (RISA) Teams, DOIs Climate Science Centers (CSCs), and USDAs Regional Climate Hubs (RCHs) have common missions of integrating climate and related knowledge across scientific disciplines and regions to create "actionable" information that decision-makes can use to manage climate risks and impacts at state and local scales. However, the sponsoring agency programs, university investigators, and local federal officials govern each differently. The three models of program and center governance are 1) exclusively university (RISAs), 2) a hybrid of Federal government and (host) university (CSCs,), and 3) exclusively Federal (Hubs). Each model has it's advantages and disadvantages in terms of legal definition and authority, scientific mission requirements and strategies, flexibility and legitimacy to conduct research and to collaborate regionally with constituencies, leadership and governance approach and "friction points,", staff capacity and ability to engage stakeholders, necessity to deliver products and services, bureaucratic oversight, performance evaluation, and political support at Congressional, state, and local levels. Using available sources of information and data, this paper will compare and contrast the strengths and weakness of these three regional applied climate science center governance models.

  1. Child Health Care Services in Austria.

    Science.gov (United States)

    Kerbl, Reinhold; Ziniel, Georg; Winkler, Petra; Habl, Claudia; Püspök, Rudolf; Waldhauser, Franz

    2016-10-01

    We describe child health care in Austria, a small country in Central Europe with a population of about 9 million inhabitants of whom approximately 1.7 million are children and adolescents under the age of 20 years. For children and adolescents, few health care indicators are available. Pediatric and adolescent health provision, such as overall health provision, follows a complex system with responsibilities shared by the Ministry of Health, 19 social insurance funds, provinces, and other key players. Several institutions are affiliated with or cooperate with the Ministry of Health to assure quality control. The Austrian public health care system is financed through a combination of income-based social insurance payments and taxes. Pediatric primary health care in Austria involves the services of general pediatricians and general practitioners. Secondary care is mostly provided by the 43 children's hospitals; tertiary care is (particularly) provided in 4 state university hospitals and 1 private university hospital. The training program of residents takes 6 years and is completed by a final examination. Every year, this training program is completed by about 60 residents. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Review of research on AFPM hub motor

    Directory of Open Access Journals (Sweden)

    Jianguo DAI

    2018-02-01

    Full Text Available The industrialization of new energy vehicles is an important way to promote the sustainable development of automobile industry, and it is also the key measure to solve the problems of energy and environment. As an important type of new energy vehicles, electric vehicles will play an important role in the future competition in the automotive industry, especially in the field of electric vehicle driven by wheel. With the advantages of compact structure, high power density, low working noise and good heat dissipation performance, the AFPM motor has gradually become the preferred object of the hub driving device. Based on the statement of the technical development and research status about AFPM motor, this paper mainly analyzes the engineering application and technical problems of AFPM motor in hub drive, especially the matching of AFPM motor with other systems and the problem of heat dissipation at high load conditions, and looks forward to the key role in the future development of the automotive industry. This paper will play a certain reference and guiding role in the application of AFPM motor in the field of new energy vehicles.

  3. Impact of Pharmacists in a Community-Based Home Care Service: A Pilot Program.

    Science.gov (United States)

    Walus, Ashley N; Woloschuk, Donna M M

    2017-01-01

    Historically, pharmacists have not been included on home care teams, despite the fact that home care patients frequently experience medication errors. Literature describing Canadian models of pharmacy practice in home care settings is limited. The optimal service delivery model and distribution of clinical activities for home care pharmacists remain unclear. The primary objective was to describe the impact of a pharmacist based at a community home care office and providing home visits, group education, and telephone consultations. The secondary objective was to determine the utility of acute care clinical pharmacy key performance indicators (cpKPIs) in guiding home care pharmacy services, in the absence of validated cpKPIs for ambulatory care. The Winnipeg Regional Health Authority hired a pharmacist to develop and implement the pilot program from May 2015 to July 2016. A referral form, consisting of consultation criteria used in primary care practices, was developed. The pharmacist also reviewed all patient intakes and all patients waiting in acute care facilities for initiation of home care services, with the goal of addressing issues before admission to the Home Care Program. A password-protected database was built for data collection and analysis, and the data are presented in aggregate. A total of 197 referrals, involving 184 patients, were received during the pilot program; of these, 62 were excluded from analysis. The majority of referrals (95 [70.4%]) were for targeted medication reviews, and 271 drug therapy problems were identified. Acceptance rates for the pharmacist's recommendations were 90.2% (74 of 82 recommendations) among home care staff and 47.0% (55 of 117 recommendations) among prescribers and patients. On average, 1.5 cpKPIs were identified for each referral. The pilot program demonstrated a need for enhanced access to clinical pharmacy services for home care patients, although the best model of service provision remains unclear. More research

  4. Service user involvement in care planning: the mental health nurse's perspective.

    Science.gov (United States)

    Anthony, P; Crawford, P

    2000-10-01

    A dissonance between espoused values of consumerism within mental health care and the 'reality' of clinical practice has been firmly established in the literature, not least in terms of service user involvement in care planning. In order to begin to minimize such dissonance, it is vital that mental health nurse perceptions of service user involvement in the core activity of care planning are better understood. The main findings of this qualitative study, which uses semistructured interviews, suggest that mental health nurses value the concept of user involvement but consider it to be problematic in certain circumstances. The study reveals that nurses hold similar views about the 'meaning' of patient involvement in care planning but limited resources, individual patients characteristics and limitations in nursing care are the main inhibiting factors. Factors perceived as promoting and increasing user involvement included: provision of accurate information, 'user-friendly' documentation, mechanisms for gaining service user feedback, and high staff morale.

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

    Directory of Open Access Journals (Sweden)

    Heather E Douglas

    2017-04-01

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

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

    Science.gov (United States)

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

    2017-01-01

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

  7. [Comparison of Patients and their Care in Urban and Rural Specialised Palliative Home Care - A Single Service Analysis].

    Science.gov (United States)

    Heckel, M; Stiel, S; Frauendorf, T; Hanke, R M; Ostgathe, C

    2016-07-01

    Specialised outpatient palliative care teams (in Germany called SAPV) aim to ensure best possible end-of-life care for outpatients with complex needs. Information on the influence of living areas (rural vs. urban) on patient and care related aspects is rare. This study aims to explore differences between palliative care patients in urban and rural dwellings concerning their nursing and service characteristics. A retrospective data analysis of documentary data for 502 patients supplied by SAPV team from December 2009 to June 2012 was conducted. Patients and care characteristics were investigated by frequency analysis and were compared for both groups of urban and rural dwelling patients (T test, Chi², Fisher's exact test p care, disease and service related aspects of palliative home care could be detected. An exception is that the rate of re-admittance to hospital is higher for rural dwelling patients (Fisher's exact test p=0.022). Although predominantly presumed, the single service analysis shows - except for the re-admittance rate to hospital - no considerable differences between palliative care patients regarding their living area. Our findings indicate that patients cared for in rural and urban settings have similar needs and impose similar requirements on palliative care teams. © Georg Thieme Verlag KG Stuttgart · New York.

  8. Provision of NHS generalist and specialist services to care homes in England: review of surveys.

    Science.gov (United States)

    Iliffe, Steve; Davies, Susan L; Gordon, Adam L; Schneider, Justine; Dening, Tom; Bowman, Clive; Gage, Heather; Martin, Finbarr C; Gladman, John R F; Victor, Christina; Meyer, Julienne; Goodman, Claire

    2016-03-01

    The number of beds in care homes (with and without nurses) in the United Kingdom is three times greater than the number of beds in National Health Service (NHS) hospitals. Care homes are predominantly owned by a range of commercial, not-for-profit or charitable providers and their residents have high levels of disability, frailty and co-morbidity. NHS support for care home residents is very variable, and it is unclear what models of clinical support work and are cost-effective. To critically evaluate how the NHS works with care homes. A review of surveys of NHS services provided to care homes that had been completed since 2008. It included published national surveys, local surveys commissioned by Primary Care organisations, studies from charities and academic centres, grey literature identified across the nine government regions, and information from care home, primary care and other research networks. Data extraction captured forms of NHS service provision for care homes in England in terms of frequency, location, focus and purpose. Five surveys focused primarily on general practitioner services, and 10 on specialist services to care home. Working relationships between the NHS and care homes lack structure and purpose and have generally evolved locally. There are wide variations in provision of both generalist and specialist healthcare services to care homes. Larger care home chains may take a systematic approach to both organising access to NHS generalist and specialist services, and to supplementing gaps with in-house provision. Access to dental care for care home residents appears to be particularly deficient. Historical differences in innovation and provision of NHS services, the complexities of collaborating across different sectors (private and public, health and social care, general and mental health), and variable levels of organisation of care homes, all lead to persistent and embedded inequity in the distribution of NHS resources to this population

  9. Analysis of Eye Care Services in Yemen

    OpenAIRE

    Saleh A. Al-Akily; Mutahar Y. Al-Shaer; Mahfouth A. Bamashmus; Abdulmoghni O. Al-Barrag; Tawfik K. Alkhatib; Hisham A. Al-Akhlee

    2017-01-01

    Purpose: The objective of this study was to undertake an analysis of the eye care services situation in Yemen and to assess ophthalmic human resources, eye units’ ownership and ophthalmic equipments. Methods: Eye care providers were surveyed by a standardized questionnaire which was sent to the 184 eye units in governmental, university, military, private and charity clinics and hospitals in Yemen and covered the period between 01 January to 31 December 2012. The questionnaire determined l...

  10. GeoTrust Hub: A Platform For Sharing And Reproducing Geoscience Applications

    Science.gov (United States)

    Malik, T.; Tarboton, D. G.; Goodall, J. L.; Choi, E.; Bhatt, A.; Peckham, S. D.; Foster, I.; Ton That, D. H.; Essawy, B.; Yuan, Z.; Dash, P. K.; Fils, G.; Gan, T.; Fadugba, O. I.; Saxena, A.; Valentic, T. A.

    2017-12-01

    Recent requirements of scholarly communication emphasize the reproducibility of scientific claims. Text-based research papers are considered poor mediums to establish reproducibility. Papers must be accompanied by "research objects", aggregation of digital artifacts that together with the paper provide an authoritative record of a piece of research. We will present GeoTrust Hub (http://geotrusthub.org), a platform for creating, sharing, and reproducing reusable research objects. GeoTrust Hub provides tools for scientists to create `geounits'--reusable research objects. Geounits are self-contained, annotated, and versioned containers that describe and package computational experiments in an efficient and light-weight manner. Geounits can be shared on public repositories such as HydroShare and FigShare, and also using their respective APIs reproduced on provisioned clouds. The latter feature enables science applications to have a lifetime beyond sharing, wherein they can be independently verified and trust be established as they are repeatedly reused. Through research use cases from several geoscience laboratories across the United States, we will demonstrate how tools provided from GeoTrust Hub along with Hydroshare as its public repository for geounits is advancing the state of reproducible research in the geosciences. For each use case, we will address different computational reproducibility requirements. Our first use case will be an example of setup reproducibility which enables a scientist to set up and reproduce an output from a model with complex configuration and development environments. Our second use case will be an example of algorithm/data reproducibility, where in a shared data science model/dataset can be substituted with an alternate one to verify model output results, and finally an example of interactive reproducibility, in which an experiment is dependent on specific versions of data to produce the result. Toward this we will use software and data

  11. Home health nursing care services in Greece during an economic crisis.

    Science.gov (United States)

    Adamakidou, T; Kalokerinou-Anagnostopoulou, A

    2017-03-01

    The purpose of this review was to describe public home healthcare nursing services in Greece. The effectiveness and the efficiency of home healthcare nursing are well documented in the international literature. In Greece, during the current financial crisis, the development of home healthcare nursing services is the focus and interest of policymakers and academics because of its contribution to the viability of the healthcare system. A review was conducted of the existing legislation, the printed and electronic bibliography related to the legal framework, the structures that provide home health care, the funding of the services, the human resources and the services provided. The review of the literature revealed the strengths and weaknesses of the existing system of home health care and its opportunities and threats, which are summarized in a SWOT analysis. There is no Greek nursing literature on this topic. The development of home health nursing care requires multidimensional concurrent and combined changes and adjustments that would support and strengthen healthcare professionals in their practices. Academic and nursing professionals should provide guidelines and regulations and develop special competencies for the best nursing practice in home health care. At present, in Greece, which is in an economic crisis and undergoing reforms in public administration, there is an undeniable effort being made to give primary health care the position it deserves within the health system. There is an urgent need at central and academic levels to develop home healthcare services to improve the quality and efficiency of the services provided. © 2016 International Council of Nurses.

  12. Occupational Health Services Integrated in Primary Health Care in Iran.

    Science.gov (United States)

    Rafiei, Masoud; Ezzatian, Reza; Farshad, Asghar; Sokooti, Maryam; Tabibi, Ramin; Colosio, Claudio

    2015-01-01

    A healthy workforce is vital for maintaining social and economic development on a global, national and local level. Around half of the world's people are economically active and spend at least one third of their time in their place of work while only 15% of workers have access to basic occupational health services. According to WHO report, since the early 1980s, health indicators in Iran have consistently improved, to the extent that it is comparable with those in developed countries. In this paper it was tried to briefly describe about Health care system and occupational Health Services as part of Primary Health care in Iran. To describe the health care system in the country and the status of occupational health services to the workers and employers, its integration into Primary Health Care (PHC) and outlining the challenges in provision of occupational health services to the all working population. Iran has fairly good health indicators. More than 85 percent of the population in rural and deprived regions, for instance, have access to primary healthcare services. The PHC centers provide essential healthcare and public-health services for the community. Providing, maintaining and improving of the workers' health are the main goals of occupational health services in Iran that are presented by different approaches and mostly through Workers' Houses in the PHC system. Iran has developed an extensive network of PHC facilities with good coverage in most rural areas, but there are still few remote areas that might suffer from inadequate services. It seems that there is still no transparent policy to collaborate with the private sector, train managers or provide a sustainable mechanism for improving the quality of services. Finally, strengthening national policies for health at work, promotion of healthy work and work environment, sharing healthy work practices, developing updated training curricula to improve human resource knowledge including occupational health

  13. Stochastic optimization of energy hub operation with consideration of thermal energy market and demand response

    International Nuclear Information System (INIS)

    Vahid-Pakdel, M.J.; Nojavan, Sayyad; Mohammadi-ivatloo, B.; Zare, Kazem

    2017-01-01

    Highlights: • Studying heating market impact on energy hub operation considering price uncertainty. • Investigating impact of implementation of heat demand response on hub operation. • Presenting stochastic method to consider wind generation and prices uncertainties. - Abstract: Multi carrier energy systems or energy hubs has provided more flexibility for energy management systems. On the other hand, due to mutual impact of different energy carriers in energy hubs, energy management studies become more challengeable. The initial patterns of energy demands from grids point of view can be modified by optimal scheduling of energy hubs. In this work, optimal operation of multi carrier energy system has been studied in the presence of wind farm, electrical and thermal storage systems, electrical and thermal demand response programs, electricity market and thermal energy market. Stochastic programming is implemented for modeling the system uncertainties such as demands, market prices and wind speed. It is shown that adding new source of heat energy for providing demand of consumers with market mechanism changes the optimal operation point of multi carrier energy system. Presented mixed integer linear formulation for the problem has been solved by executing CPLEX solver of GAMS optimization software. Simulation results shows that hub’s operation cost reduces up to 4.8% by enabling the option of using thermal energy market for meeting heat demand.

  14. Customer assessment of long-term care pharmacy provider services.

    Science.gov (United States)

    Clark, Thomas R

    2008-09-01

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

  15. Penentuan Pelabuhan Hub untuk Crude Palm Oil (CPO Ekspor di Indonesia

    Directory of Open Access Journals (Sweden)

    Eko Andi Haranto

    2013-03-01

    Full Text Available CPO (Crude Palm Oil merupakan salah satu komoditi ekspor terbesar di Indonesia. Moda angkut darat dan sungai menjadi pilihan untuk didistribusikan menuju calon pelabuhan hub. Tugas Akhir ini bertujuan untuk merencanakan pola operasi armada pengangkut CPO, dan penentuan pelabuhan hub untuk ekspor CPO. Metode Transportasi digunakan untuk memilih pabrik pengolahan CPO sebagai pemasok utama. Dari hasil analisis didapatkan bahwa penggunaan moda darat menggunakan truk lebih optimal dibandingkan menggunakan tongkang hal ini dikarenakan kondisi sungai di Kalimantan Tengah yang dangkal. Dengan menggunakan metode transportasi didapatkan empat lokasi pabrik pengolahan minyak kelapa sawit. Pelabuhan hub yang terpilih berlokasi di Bagendang dan Bumi Harjo. Kedua titik tersebut dipilih karena sudah memiliki tangki timbun dan dermaga untuk ekspor CPO, selain itu pemilihan berdasarkan hasil analisa didapatkan biaya dari Pabrik PT. ATLANTIS ke Pelabuhan Bagendang dengan truk berukuran 10 ton memerlukan biaya sebesar Rp. 333.016,25/TRIP/TRUK. Pabrik PT. ATLANTIS II ke Pelabuhan Bagendang Rp. 237.868,75/TRIP/TRUK. Pabrik PT. TIGER ke Pelabuhan Bumi Harjo Rp. 475.737,50/TRIP/TRUK. PT. TIGER II merupakan pabrik yang dapat melakukan pengiriman langsung menggunakan tongkang berukuran 1800 DWT melewati sungai Barito, dengan biaya Rp.123.007.828,27,- /voyage.

  16. 75 FR 2595 - Proposed Information Collection (Application for Furnishing Long-Term Care Services to...

    Science.gov (United States)

    2010-01-15

    ... (Application for Furnishing Long- Term Care Services to Beneficiaries of Veterans Affairs, and Residential Care... comments for information needed to determine non-Federal nursing home or residential care home... information technology. Titles: a. Application for Furnishing Long-Term Care Services to Beneficiaries of...

  17. Opportunities and Challenges of Cloud Computing to Improve Health Care Services

    Science.gov (United States)

    2011-01-01

    Cloud computing is a new way of delivering computing resources and services. Many managers and experts believe that it can improve health care services, benefit health care research, and change the face of health information technology. However, as with any innovation, cloud computing should be rigorously evaluated before its widespread adoption. This paper discusses the concept and its current place in health care, and uses 4 aspects (management, technology, security, and legal) to evaluate the opportunities and challenges of this computing model. Strategic planning that could be used by a health organization to determine its direction, strategy, and resource allocation when it has decided to migrate from traditional to cloud-based health services is also discussed. PMID:21937354

  18. Opportunities and challenges of cloud computing to improve health care services.

    Science.gov (United States)

    Kuo, Alex Mu-Hsing

    2011-09-21

    Cloud computing is a new way of delivering computing resources and services. Many managers and experts believe that it can improve health care services, benefit health care research, and change the face of health information technology. However, as with any innovation, cloud computing should be rigorously evaluated before its widespread adoption. This paper discusses the concept and its current place in health care, and uses 4 aspects (management, technology, security, and legal) to evaluate the opportunities and challenges of this computing model. Strategic planning that could be used by a health organization to determine its direction, strategy, and resource allocation when it has decided to migrate from traditional to cloud-based health services is also discussed.

  19. Care Models of eHealth Services: A Case Study on the Design of a Business Model for an Online Precare Service

    Science.gov (United States)

    2015-01-01

    Background With a growing population of health care clients in the future, the organization of high-quality and cost-effective service providing becomes an increasing challenge. New online eHealth services are proposed as innovative options for the future. Yet, a major barrier to these services appears to be the lack of new business model designs. Although design efforts generally result in visual models, no such artifacts have been found in the literature on business model design. This paper investigates business model design in eHealth service practices from a design perspective. It adopts a research by design approach and seeks to unravel what characteristics of business models determine an online service and what are important value exchanges between health professionals and clients. Objective The objective of the study was to analyze the construction of care models in-depth, framing the essential elements of a business model, and design a new care model that structures these elements for the particular context of an online pre-care service in practice. Methods This research employs a qualitative method of an in-depth case study in which different perspectives on constructing a care model are investigated. Data are collected by using the visual business modeling toolkit, designed to cocreate and visualize the business model. The cocreated models are transcribed and analyzed per actor perspective, transactions, and value attributes. Results We revealed eight new actors in the business model for providing the service. Essential actors are: the intermediary network coordinator connecting companies, the service dedicated information technology specialists, and the service dedicated health specialist. In the transactions for every service providing we found a certain type of contract, such as a license contract and service contracts for precare services and software products. In addition to the efficiency, quality, and convenience, important value attributes

  20. Adolescents perception of reproductive health care services in Sri Lanka

    Science.gov (United States)

    Agampodi, Suneth B; Agampodi, Thilini C; UKD, Piyaseeli

    2008-01-01

    Background Adolescent health needs, behaviours and expectations are unique and routine health care services are not well geared to provide these services. The purpose of this study was to explore the perceived reproductive health problems, health seeking behaviors, knowledge about available services and barriers to reach services among a group of adolescents in Sri Lanka in order to improve reproductive health service delivery. Methods This qualitative study was conducted in a semi urban setting in Sri Lanka. A convenient sample of 32 adolescents between 17–19 years of age participated in four focus group discussions. Participants were selected from four midwife areas. A pre-tested focus group guide was used for data collection. Male and female facilitators conducted discussions separately with young males and females. All tape-recorded data was fully transcribed and thematic analysis was done. Results Psychological distresses due to various reasons and problems regarding menstrual cycle and masturbation were reported as the commonest health problems. Knowledge on existing services was very poor and boys were totally unaware of youth health services available through the public health system. On reproductive Health Matters, girls mainly sought help from friends whereas boys did not want to discuss their problems with anyone. Lack of availability of services was pointed out as the most important barrier in reaching the adolescent needs. Lack of access to reproductive health knowledge was an important reason for poor self-confidence among adolescents to discuss these matters. Lack of confidentiality, youth friendliness and accessibility of available services were other barriers discussed. Adolescents were happy to accept available services through public clinics and other health infrastructure for their services rather than other organizations. A demand was made for separate youth friendly services through medical practitioners. Conclusions and recommendations

  1. Adolescents perception of reproductive health care services in Sri Lanka

    Directory of Open Access Journals (Sweden)

    Agampodi Thilini C

    2008-05-01

    Full Text Available Abstract Background Adolescent health needs, behaviours and expectations are unique and routine health care services are not well geared to provide these services. The purpose of this study was to explore the perceived reproductive health problems, health seeking behaviors, knowledge about available services and barriers to reach services among a group of adolescents in Sri Lanka in order to improve reproductive health service delivery. Methods This qualitative study was conducted in a semi urban setting in Sri Lanka. A convenient sample of 32 adolescents between 17–19 years of age participated in four focus group discussions. Participants were selected from four midwife areas. A pre-tested focus group guide was used for data collection. Male and female facilitators conducted discussions separately with young males and females. All tape-recorded data was fully transcribed and thematic analysis was done. Results Psychological distresses due to various reasons and problems regarding menstrual cycle and masturbation were reported as the commonest health problems. Knowledge on existing services was very poor and boys were totally unaware of youth health services available through the public health system. On reproductive Health Matters, girls mainly sought help from friends whereas boys did not want to discuss their problems with anyone. Lack of availability of services was pointed out as the most important barrier in reaching the adolescent needs. Lack of access to reproductive health knowledge was an important reason for poor self-confidence among adolescents to discuss these matters. Lack of confidentiality, youth friendliness and accessibility of available services were other barriers discussed. Adolescents were happy to accept available services through public clinics and other health infrastructure for their services rather than other organizations. A demand was made for separate youth friendly services through medical practitioners

  2. Adolescents perception of reproductive health care services in Sri Lanka.

    Science.gov (United States)

    Agampodi, Suneth B; Agampodi, Thilini C; Ukd, Piyaseeli

    2008-05-03

    Adolescent health needs, behaviours and expectations are unique and routine health care services are not well geared to provide these services. The purpose of this study was to explore the perceived reproductive health problems, health seeking behaviors, knowledge about available services and barriers to reach services among a group of adolescents in Sri Lanka in order to improve reproductive health service delivery. This qualitative study was conducted in a semi urban setting in Sri Lanka. A convenient sample of 32 adolescents between 17-19 years of age participated in four focus group discussions. Participants were selected from four midwife areas. A pre-tested focus group guide was used for data collection. Male and female facilitators conducted discussions separately with young males and females. All tape-recorded data was fully transcribed and thematic analysis was done. Psychological distresses due to various reasons and problems regarding menstrual cycle and masturbation were reported as the commonest health problems. Knowledge on existing services was very poor and boys were totally unaware of youth health services available through the public health system. On reproductive Health Matters, girls mainly sought help from friends whereas boys did not want to discuss their problems with anyone. Lack of availability of services was pointed out as the most important barrier in reaching the adolescent needs. Lack of access to reproductive health knowledge was an important reason for poor self-confidence among adolescents to discuss these matters. Lack of confidentiality, youth friendliness and accessibility of available services were other barriers discussed. Adolescents were happy to accept available services through public clinics and other health infrastructure for their services rather than other organizations. A demand was made for separate youth friendly services through medical practitioners. Adolescent health services are inadequate and available services

  3. Continuity of care as experienced by mental health service users - a qualitative study

    Directory of Open Access Journals (Sweden)

    Eva Biringer

    2017-11-01

    Full Text Available Abstract Background People who struggle with mental health problems can provide valuable insight into understanding and improving the coordination of mental health and welfare services. The aims of the study were to explore service users’ experiences and perceptions of continuity of care within and across services relevant to personal recovery, to elicit which dimensions of continuity of care are most essential to service users, and to generate ideas for improving service users’ experiences of continuity of care. Methods In the context of a hermeneutic-phenomenological approach, ten service users at a community mental health centre were interviewed about their experiences of continuity of care in and across services. Eight of these were re-interviewed two years later. A collaborative research approach was adopted. Data were analysed by means of a data-driven stepwise approach in line with thematic analysis. Results Following the analysis five themes representing experiences of continuity of care were developed. Each theme ranged from poor to good experiences of continuity of care: Relationship – from experiencing frequent setbacks and anxiety due to breaks in relationships, to feeling safe in an ongoing personal relationship; Timeliness – from experiencing frustrating waiting times with worsening of problems, to getting help when needed; Mutuality – from having a one-sided struggle, to a situation in which both professionals and service users take initiatives; Choice – from not having the opportunity to make practical arrangements within the context of one’s everyday life, to having an array of support options to choose from; Knowledge – from feeling confused and insecure because one does not know what is happening, to feeling safe because one is informed about what is going to happen. Participants provided a range of suggestions for improving experiences of continuity of care. Conclusions A discrepancy between aspects of

  4. Patients' perceptions of service quality dimensions: an empirical examination of health care in New Zealand.

    Science.gov (United States)

    Clemes, M D; Ozanne, L K; Laurensen, W L

    2001-01-01

    The 1984 liberalization of the New Zealand economy has resulted in a health care sector that has become very competitive (Zwier and Clarke, 1999). The private sector is now able to supply health care services and, as a result, a greater value is being placed on patient satisfaction (Zwier and Clarke, 1999). However, despite the increasing focus on customer satisfaction, research into health care patients' perceptions of the dimensions of service quality is scarce. This can be problematic, as quality of care is an essential issue in the strategic marketing of health care services (Turner and Pol, 1995). This study takes a step towards addressing this deficiency by identifying patients' perceptions of the dimensions of service quality in health care. The findings of this study are based on the empirical analysis of a sample of 389 respondents interviewed by telephone. The findings indicate that the service quality dimensions identified in this health care specific study differ in number and dimensional structure from the widely adopted service quality dimensions first identified by Parasuraman, Berry and Zeithaml (1988): reliability, responsiveness, assurance, empathy and tangibles. The service quality dimensions identified in this study were: reliability, tangibles, assurance, empathy, food, access, outcome, admission, discharge and responsiveness. In addition, health care patients perceive the service quality dimensions relating to the core product in health care delivery (for example, outcome and reliability) as more important than the service quality dimensions relating to the peripheral product in health care delivery (for example, food, access and tangibles). Finally, the results of this study suggest that patients with different geographic, demographic, and behavioristic characteristics have different needs and wants during health care delivery and therefore perceive different service quality dimensions as important.

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

    Science.gov (United States)

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

    2016-05-10

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

  6. Patients' satisfaction with eye care services in a Nigerian Teaching ...

    African Journals Online (AJOL)

    ... will recommend the hospital to others strongly, 145 (47.2%) will do so hesitantly. Conclusion: Majority of the patients were satisfied with the services received. The major dissatisfaction points were cost of services and inadequate toilet facilities. Key words: Developing country, eye care services, patient satisfaction ...

  7. Barriers to Accessing Good Eye Care Services in Nigeria: A Focus ...

    African Journals Online (AJOL)

    Certain forms of blindness can be prevented if the right steps and treatments are applied at the right times, but this is not always possible due to the challenges patients face in accessing eye care services. The aim of this study was to explore and identify the barriers in accessing good eye care services in Anambra State ...

  8. Clients' perception of service quality of care in health facilities in ...

    African Journals Online (AJOL)

    Introduction: Clients perception of service quality is important for utilization of health services. Clients with positive perception are more likely to comply with treatment and to continue to use health care services. Assessing clients' perception of services offered is crucial for improving delivery and organization of the services.

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

    Science.gov (United States)

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

    2016-10-01

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

  10. Analysis of Food Hub Commerce and Participation Using Agent-Based Modeling: Integrating Financial and Social Drivers.

    Science.gov (United States)

    Krejci, Caroline C; Stone, Richard T; Dorneich, Michael C; Gilbert, Stephen B

    2016-02-01

    Factors influencing long-term viability of an intermediated regional food supply network (food hub) were modeled using agent-based modeling techniques informed by interview data gathered from food hub participants. Previous analyses of food hub dynamics focused primarily on financial drivers rather than social factors and have not used mathematical models. Based on qualitative and quantitative data gathered from 22 customers and 11 vendors at a midwestern food hub, an agent-based model (ABM) was created with distinct consumer personas characterizing the range of consumer priorities. A comparison study determined if the ABM behaved differently than a model based on traditional economic assumptions. Further simulation studies assessed the effect of changes in parameters, such as producer reliability and the consumer profiles, on long-term food hub sustainability. The persona-based ABM model produced different and more resilient results than the more traditional way of modeling consumers. Reduced producer reliability significantly reduced trade; in some instances, a modest reduction in reliability threatened the sustainability of the system. Finally, a modest increase in price-driven consumers at the outset of the simulation quickly resulted in those consumers becoming a majority of the overall customer base. Results suggest that social factors, such as desire to support the community, can be more important than financial factors. An ABM of food hub dynamics, based on human factors data gathered from the field, can be a useful tool for policy decisions. Similar approaches can be used for modeling customer dynamics with other sustainable organizations. © 2015, Human Factors and Ergonomics Society.

  11. Price elasticity of expenditure across health care services.

    Science.gov (United States)

    Duarte, Fabian

    2012-12-01

    Policymakers in countries around the world are faced with rising health care costs and are debating ways to reform health care to reduce expenditures. Estimates of price elasticity of expenditure are a key component for predicting expenditures under alternative policies. Using unique individual-level data compiled from administrative records from the Chilean private health insurance market, I estimate the price elasticity of expenditures across a variety of health care services. I find elasticities that range between zero for the most acute service (appendectomy) and -2.08 for the most elective (psychologist visit). Moreover, the results show that at least one third of the elasticity is explained by the number of visits; the rest is explained by the intensity of each visit. Finally, I find that high-income individuals are five times more price sensitive than low-income individuals and that older individuals are less price-sensitive than young individuals. Copyright © 2012 Elsevier B.V. All rights reserved.

  12. Home care clients in the last year of life: is material deprivation associated with service characteristics?

    Science.gov (United States)

    Goodridge, Donna; Buckley, Alan; Marko, Josh; Steeves, Megan; Turner, Hollie; Whitehead, Steve

    2011-09-01

    To compare demographic, social, medical, and health care characteristics of home care clients in the last year of life by quintile of deprivation and examine associations between material deprivation and service characteristics. This retrospective study used administrative data for 700 clients who died while receiving home care services. Outcome measures were the receipt of supportive or palliative home care. Associations were assessed using multiple logistic regression. Material deprivation was not associated with either the hours of home care received or the receipt of supportive home care services. Clients with dementia or stroke, those were older than 80 years and those who were single were less likely to receive palliative care services than other groups. Inequalities in allocation of home care services based on age, diagnosis, and marital status, but not material deprivation, suggest the need to carefully match service with need at the end of life.

  13. DAVINC3I: moving towards responsive hub network designs

    NARCIS (Netherlands)

    Ossevoort, R.; Keizer, de M.; Vorst, van der J.G.A.J.; Wenink, E.

    2013-01-01

    The Dutch floricultural sector is generally appreciated for its world leadership; the Netherlands is the flower trading hub for the European market. There are two trends affecting this position. First, virtualisation makes trade flows relatively footloose and flexible. Moreover, it enables the use

  14. Physicians' perceptions about the quality of primary health care services in transitional Albania

    NARCIS (Netherlands)

    Kellici, Neritan; Dibra, Arvin; Mihani, Joana; Kellici, Suela; Burazeri, Genc

    AIM: To date, the available information regarding the quality of primary health care services in Albania is scarce. The aim of our study was to assess the quality of primary health care services in Albania based on physicians' perceptions towards the quality of the services provided to the general

  15. The Role of Telemedicine in Providing Thoracic Oncology Care to Remote Areas of British Columbia.

    Science.gov (United States)

    Humer, Michael F; Campling, Barbara G

    2017-08-01

    The purpose of this study is to review the role of telemedicine in providing oncology care; we describe our long-standing, high-volume telemedicine experience. The Interior Health Thoracic Surgical Group (IHTSG) uses telemedicine, through Virtual Thoracic Surgical Clinics (VTSC), to provide service to remote patients. The IHTSG serves a population of 1.01 million people over an area of 807,538 km 2 (1.3 persons/km 2 ) in the Interior and North of British Columbia, Canada. Between 2003 and 2015, the IHTSG conducted 15,073 telemedicine patient encounters at 63 geographic sites. Telemedicine saved these patients a total travel distance of 11.5 million km-an average of 766 km per patient. VTSC supports and strengthens the Hub and Spoke model of healthcare delivery-patients residing remotely can easily access centrally delivered service. Telemedicine makes specialized care available to all patients by overcoming a major impediment to access, namely distance.

  16. Research dedusting efficiency of the inertial hub with adjustable parameters

    Directory of Open Access Journals (Sweden)

    Sharapov Rashid

    2016-01-01

    Full Text Available Production of construction materials every year production increases, thus increasing emissions pollutants into the atmosphere subjected to cleaning. At the enterprises of building materials production equipment becoming outdated both morally and physically exhausted their useful life. Technological design standards in the operation of purification equipment has undergone a number of changes. There are a large number of works devoted to the theory of cyclone separation. They examined calculation method and to determine the minimum size of particles is separated completely from the air stream in a cyclone. In theory, the high efficiency cyclones are relatively small separation of particles from the air stream. The experiments show that certain fractions of full capture occurs from the cyclones and out relatively large particles. Designed dust device hubs. They capture dust particles with low specific density and smaller than 5–10 microns. Rational use of hubs is achieved in the aspiration systems high performance. They are placed in front of or between the filter and the cyclone filter. Hub much reduces the amount of dust-laden air directed onto a thin cleaning. This reduces energy consumption for manufacturing as a whole, as well as, due to a possible decrease in performance fine filters, reducing their initial cost, metal consumption, maintenance costs and reduce the area occupied by them.

  17. Real-Time Monitoring and Fault Diagnosis of a Low Power Hub Motor Using Feedforward Neural Network

    Directory of Open Access Journals (Sweden)

    Mehmet Şimşir

    2016-01-01

    Full Text Available Low power hub motors are widely used in electromechanical systems such as electrical bicycles and solar vehicles due to their robustness and compact structure. Such systems driven by hub motors (in wheel motors encounter previously defined and undefined faults under operation. It may inevitably lead to the interruption of the electromechanical system operation; hence, economic losses take place at certain times. Therefore, in order to maintain system operation sustainability, the motor should be precisely monitored and the faults are diagnosed considering various significant motor parameters. In this study, the artificial feedforward backpropagation neural network approach is proposed to real-time monitor and diagnose the faults of the hub motor by measuring seven main system parameters. So as to construct a necessary model, we trained the model, using a data set consisting of 4160 samples where each has 7 parameters, by the MATLAB environment until the best model is obtained. The results are encouraging and meaningful for the specific motor and the developed model may be applicable to other types of hub motors. The prosperous model of the whole system was embedded into Arduino Due microcontroller card and the mobile real-time monitoring and fault diagnosis system prototype for hub motor was designed and manufactured.

  18. The relationship between staff skill mix, costs and outcomes in intermediate care services

    Directory of Open Access Journals (Sweden)

    Martin Graham P

    2010-07-01

    Full Text Available Abstract Background The purpose of this study was to assess the relationship between skill mix, patient outcomes, length of stay and service costs in older peoples' intermediate care services in England. Methods We undertook multivariate analysis of data collected as part of the National Evaluation of Intermediate Care Services. Data were analysed on between 337 and 403 older people admitted to 14 different intermediate care teams. Independent variables were the numbers of different types of staff within a team and the ratio of support staff to professionally qualified staff within teams. Outcome measures include the Barthel index, EQ-5D, length of service provision and costs of care. Results Increased skill mix (raising the number of different types of staff by one is associated with a 17% reduction in service costs (p = 0.011. There is weak evidence (p = 0.090 that a higher ratio of support staff to qualified staff leads to greater improvements in EQ-5D scores of patients. Conclusions This study provides limited evidence on the relationship between multidisciplinary skill mix and outcomes in intermediate care services.

  19. The influence of hubs in the structure of a neuronal network during an epileptic seizure

    Science.gov (United States)

    Rodrigues, Abner Cardoso; Cerdeira, Hilda A.; Machado, Birajara Soares

    2016-02-01

    In this work, we propose changes in the structure of a neuronal network with the intention to provoke strong synchronization to simulate episodes of epileptic seizure. Starting with a network of Izhikevich neurons we slowly increase the number of connections in selected nodes in a controlled way, to produce (or not) hubs. We study how these structures alter the synchronization on the spike firings interval, on individual neurons as well as on mean values, as a function of the concentration of connections for random and non-random (hubs) distribution. We also analyze how the post-ictal signal varies for the different distributions. We conclude that a network with hubs is more appropriate to represent an epileptic state.

  20. Facilitators and Barriers for Successful Implementation of Interconception Care in Preventive Child Health Care Services in the Netherlands

    NARCIS (Netherlands)

    Sijpkens, M.K. (Meertien K.); E.A.P. Steegers (Eric); Rosman, A.N. (Ageeth N.)

    2016-01-01

    textabstractObjectives Successful implementation of preconception and interconception care contributes to optimizing pregnancy outcomes. While interconception care to new mothers could potentially be provided by Preventive Child Health Care services, this care is currently not routinely available in

  1. A Home-Based Palliative Care Consult Service for Veterans.

    Science.gov (United States)

    Golden, Adam G; Antoni, Charles; Gammonley, Denise

    2016-11-01

    We describe the development and implementation of a home-based palliative care consult service for Veterans with advanced illness. A retrospective chart review was performed on 73 Veterans who received a home-based palliative care consult. Nearly one-third were 80 years of age or older, and nearly one-third had a palliative diagnosis of cancer. The most common interventions of the consult team included discussion of advance directives, completion of a "do not resuscitate" form, reduction/stoppage of at least 1 medication, explanation of diagnosis, referral to home-based primary care program, referral to hospice, and assessment/support for caregiver stress. The home-based consult service was therefore able to address clinical and psychosocial issues that can demonstrate a direct benefit to Veterans, families, and referring clinicians. © The Author(s) 2015.

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

    Science.gov (United States)

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

    2017-08-01

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

  3. Utilization of legal and financial services of partners in dementia care study.

    Science.gov (United States)

    Shrestha, Srijana; Judge, Katherine S; Wilson, Nancy L; Moye, Jennifer A; Snow, A Lynn; Kunik, Mark E

    2011-03-01

    Financial and legal services are unique needs of persons with dementia and their caregivers. This study examines their need for legal and financial assistance and the kinds of legal and financial services provided within Partners in Dementia Care, a telephone-based, care coordination and support service intervention delivered through a partnership between Veterans Affairs (VA) medical centers and local Alzheimer's Association chapters. Based on comprehensive assessment, and needs prioritization, care coordinators collaboratively planned action steps (specific behavioral tasks) with each caregiver/person with dementia to address the dyad's identified unmet needs. Results show that 51 (54.8%) of 93 dyads reported a need for legal and financial services. Action steps related to legal and financial need included education or assistance with legal services (27.27%), nonhealth-related financial benefits (32.32%), health-related financial benefits (21.21%), financial management/planning (9.09%), and financial support (10.1%). Comparable numbers of action steps were directed to VA (41.4%) and non-VA (58.6%) services.

  4. Medicaid Home Care Services and Survival in New York City

    Science.gov (United States)

    Albert, Steven M.; Simone, Bridget; Brassard, Andrea; Stern, Yaakov; Mayeux, Richard

    2005-01-01

    Purpose: New York City's Medicaid Home Care Services Program provides an integrated program of housekeeping and personal assistance care along with regular nursing assessments. We sought to determine if this program of supportive care offers a survival benefit to older adults. Design and Methods: Administrative data from New York City's Medicaid…

  5. 78 FR 17777 - Proposed Information Collection (Application for Furnishing Long-Term Care Service to...

    Science.gov (United States)

    2013-03-22

    ... (Application for Furnishing Long- Term Care Service to Beneficiaries of Veterans Affairs, and Residential Care.... Application for Furnishing Long-Term Care Services to Beneficiaries of Veterans Affairs, VA Form 10-1170. b. Residential Care Home Program--Sponsor Application, VA Form 2407. OMB Control Number: 2900-0616. Type of...

  6. Primary Caregivers Satisfaction and its Related Factors in Home Health Care Services

    Directory of Open Access Journals (Sweden)

    Shu-Ping Wei

    2011-06-01

    Conclusion: This study showed that the overall perceived performance is higher than expectation for home health care service provided. The primary caregiver who was older than 30 years, who had lower education level, and other than siblings showed higher satisfaction. The four items that need improving included “home health care nurses will provide detailed description of services,” “home health care nurses will provide knowledge of illness,” “home health care nurses can complete the promised tasks,” and “home health care nurses will actively inquire patient’s conditions and needs.”

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

    Science.gov (United States)

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

    2018-01-01

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

  8. Quality of emergency rooms and urgent care services: user satisfaction.

    Science.gov (United States)

    Lima, Cássio de Almeida; Santos, Bruna Tatiane Prates dos; Andrade, Dina Luciana Batista; Barbosa, Francielle Alves; Costa, Fernanda Marques da; Carneiro, Jair Almeida

    2015-01-01

    To evaluate the quality of emergency rooms and urgent care services according to the satisfaction of their users. A cross-sectional descriptive study with a quantitative approach. The sample comprised 136 users and was drawn at random. Data collection took place between October and November 2012 using a structured questionnaire. Participants were mostly male (64.7%) aged less than 30 years (55.8%), and the predominant level of education was high school (54.4%). Among the items evaluated, those that were statistically associated with levels of satisfaction with care were waiting time, confidence in the service, model of care, and the reason for seeking care related to acute complaints, cleanliness, and comfortable environment. Accessibility, hospitality, and infrastructure were considered more relevant factors for patient satisfaction than the cure itself.

  9. Expectations of Health Care Professionals Regarding the Services

    Directory of Open Access Journals (Sweden)

    Somayeh Hanafi

    2015-10-01

    Full Text Available Background: The provision of accurate and timely drug information to health care professionals is an important mechanism to promote safe and effective drug therapy for patients. World’s Drug and Poison Information Centers (DPICs are mainly affiliated to hospitals, rather rarely with faculties of pharmacy or with faculties of medicine and other related organizations.Methods: Data was collected from a questionnaire which was distributed among 400 health care providers in April 2009. Data were analyzed using SPSS software (version 17.Results: Medical reference books and drug information textbooks (36.7% and expert colleagues (29.7% were the “most commonly” used drug information resources. In addition, 77.8% of respondents “almost never” use DPICs. About 77% of respondents were non- acquainted with these centers’ activities. Five expectations were considered ‘very important’ by respondents: Provide information on IV drugs incompatibilities (74%, Provide drug interaction information (70.1%, Provide new drugs information (56.5%, Education/training of health care professionals regarding rational drug therapy and prevention of medication errors (54.9%, Providing information on dosage forms of drugs available in Iran (53.5%.Conclusion: Being non acquaintance with services of DPIC centers can be considered as the most important reason of not using them. Considering “announcement of availability of drugs in pharmacy” as one of the activities of DPICs, shows that the health care professionals are not acquainted with real services of these centers. It shows an urgent need for culture building activities to introduce them to these centers services.

  10. Interventions to provide culturally-appropriate maternity care services: factors affecting implementation.

    Science.gov (United States)

    Jones, Eleri; Lattof, Samantha R; Coast, Ernestina

    2017-08-31

    The World Health Organization recently made a recommendation supporting 'culturally-appropriate' maternity care services to improve maternal and newborn health. This recommendation results, in part, from a systematic review we conducted, which showed that interventions to provide culturally-appropriate maternity care have largely improved women's use of skilled maternity care. Factors relating to the implementation of these interventions can have implications for their success. This paper examines stakeholders' perspectives and experiences of these interventions, and facilitators and barriers to implementation; and concludes with how they relate to the effects of the interventions on care-seeking outcomes. We based our analysis on 15 papers included in the systematic review. To extract, collate and organise data on the context and conditions from each paper, we adapted the SURE (Supporting the Use of Research Evidence) framework that lists categories of factors that could influence implementation. We considered information from the background and discussion sections of papers included in the systematic review, as well as cost data and qualitative data when included. Women's and other stakeholders' perspectives on the interventions were generally positive. Four key themes emerged in our analysis of facilitators and barriers to implementation. Firstly, interventions must consider broader economic, geographical and social factors that affect ethnic minority groups' access to services, alongside providing culturally-appropriate care. Secondly, community participation is important in understanding problems with existing services and potential solutions from the community perspective, and in the development and implementation of interventions. Thirdly, respectful, person-centred care should be at the core of these interventions. Finally, cohesiveness is essential between the culturally-appropriate service and other health care providers encountered by women and their

  11. Social Support and the Receipt of Home Care Services.

    Science.gov (United States)

    Chappell, Neena L.

    1985-01-01

    Compares differences between elderly who use formal home care services and those who do not. Data revealed users as less healthy and less active and as receiving more assistance from both formal and informal sources. Suggests that formal and informal services complement rather than substitute for one another. (NRB)

  12. Occupational Therapy experience in family care in a primary health care service

    Directory of Open Access Journals (Sweden)

    Gisele Baissi

    2013-08-01

    Full Text Available Occupational therapy is presented as the core knowledge involved in the remodeling and strengthening of Primary Health Care in the Brazilian Unified Health Care System (Sistema Único de Saúde – SUS. In this study, we aimed to describe the interventions in the process of occupational therapy in supervised family care in a primary health care service in the municipality of Várzea Paulista, São Paulo state. In this case study, the moments of care were described and analyzed in light of narratives on the supervised practice of occupational therapy with a family. The results showed forms of intervention that characterize the process of occupational therapy focused on family health needs in favor of creativity and the role for changes in health practices in everyday life. Through the accomplishment of occupational activities directed to self-care, Occupational Therapy can aid families to cope with daily life adversity.

  13. Children With Special Health Care Needs: Child Health and Functioning Outcomes and Health Care Service Use.

    Science.gov (United States)

    Caicedo, Carmen

    This study describes health, functioning, and health care service use by medically complex technology-dependent children according to condition severity (moderately disabled, severely disabled, and vegetative state). Data were collected monthly for 5 months using the Pediatric Quality of Life Generic Core Module 4.0 Parent-Proxy Report. Health care service use measured the number of routine and acute care office visits (including primary and specialty physicians), emergency department visits, hospitalizations, nursing health care services, special therapies, medications, medical technology devices (MTDs), and assistive devices. Child physical health was different across the condition severity groups. The average age of the children was 10.1 years (SD, 6.2); the average number of medications used was 5.5 (SD, 3.7); the average number of MTDs used was 4.2 (SD, 2.9); and the average number of assistive devices used was 4.3 (SD, 2.7). Severely disabled and vegetative children were similar in age (older) and had a similar number of medications, MTDs, and assistive devices (greater) than moderately disabled children. The advanced practice nurse care coordinator role is necessary for the health and functioning of medically complex, technology-dependent children. Copyright © 2016 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

  14. Intensive care survivors' experiences of ward-based care: Meleis' theory of nursing transitions and role development among critical care outreach services.

    Science.gov (United States)

    Ramsay, Pam; Huby, Guro; Thompson, Andrew; Walsh, Tim

    2014-03-01

    To explore the psychosocial needs of patients discharged from intensive care, the extent to which they are captured using existing theory on transitions in care and the potential role development of critical care outreach, follow-up and liaison services. Intensive care patients are at an increased risk of adverse events, deterioration or death following ward transfer. Nurse-led critical care outreach, follow-up or liaison services have been adopted internationally to prevent these potentially avoidable sequelae. The need to provide patients with psychosocial support during the transition to ward-based care has also been identified, but the evidence base for role development is currently limited. Twenty participants were invited to discuss their experiences of ward-based care as part of a broader study on recovery following prolonged critical illness. Psychosocial distress was a prominent feature of their accounts, prompting secondary data analysis using Meleis et al.'s mid-range theory on experiencing transitions. Participants described a sense of disconnection in relation to profound debilitation and dependency and were often distressed by a perceived lack of understanding, indifference or insensitivity among ward staff to their basic care needs. Negotiating the transition between dependence and independence was identified as a significant source of distress following ward transfer. Participants varied in the extent to which they were able to express their needs and negotiate recovery within professionally mediated boundaries. These data provide new insights into the putative origins of the psychosocial distress that patients experience following ward transfer. Meleis et al.'s work has resonance in terms of explicating intensive care patients' experiences of psychosocial distress throughout the transition to general ward-based care, such that the future role development of critical care outreach, follow-up and liaison services may be more theoretically informed

  15. Providers of antenatal care services in Ghana: evidence from Ghana demographic and health surveys 1988-2014.

    Science.gov (United States)

    Dickson, Kwamena Sekyi; Darteh, Eugene Kofuor Maafo; Kumi-Kyereme, Akwasi

    2017-03-14

    Antenatal care is one of the three most essential care - antenatal, delivery and post-natal, given to women during pregnancy and has the potential to contribute towards the achievement of the Sustainable Development Goal (SDG) target 3.1- reducing the global maternal mortality ratio to less than 70 per 100,000 and target 3.8 - achieve universal health coverage. The main objective is to examine the contribution of the various providers of antenatal care services in Ghana from 1988 to 2014. The study uses data from all the six rounds of the Ghana Demographic and Health Survey (GDHS). Binary logistic regression models were applied to examine the association between background characteristics of respondents and providers of antenatal care services. The results show that majority of antenatal care services were provided by nurses over the period under review. The proportion of women who received antenatal care services from nurses improved over the period from 55% in 1988 to 89.5% in 2014. Moreover, there was a decline in antenatal care services provided by traditional birth attendants and women who did not receive antenatal care services from any service provider over the years under review. It was observed that women from rural areas were more likely to utilise antenatal care services provided by traditional birth attendants, whilst those from urban areas were more likely to utilise antenatal care from doctors and nurses. To further improve access to and utilisation of antenatal care services provided by nurses and doctors it is recommended that the Ghana Health Service and the Ministry of Health should put in place systems aimed at improving on the quality of care given such as regular training workshops for health personnel and assessment of patient's satisfaction with services provided. Also, they should encourage women in rural areas especially those from the savannah zone to utilise antenatal care services from skilled providers through social and behaviour

  16. Service innovations breaking institutionalized rules of health care

    DEFF Research Database (Denmark)

    Wallin, Arto; Fuglsang, Lars

    2017-01-01

    .e. regulations, normative rules, and cultural-cognitive beliefs) protecting the field by introducing digitally enabled service innovations into health care markets. Design/methodology/approach – The study is qualitative and interpretative in nature and utilizes case study as a research strategy. The paper...... is based on data that were collected through narrative interviews and document analysis from seven new ventures participating in a start-up accelerator program. Findings – Results indicate that service innovations that require a change in the institutional structures of the health care system are enacted...... through three highly iterative key processes: institutional sensemaking that creates an understanding of prevailing institutional arrangements and that constructs meaning for institutional change efforts, theorization of change through linguistic device, and modifications of institutions by building...

  17. Utilization of maternal health-care services by tribal women in Kerala.

    Science.gov (United States)

    Jose, Jinu Annie; Sarkar, Sonali; Kumar, S Ganesh; Kar, Sitanshu Sekhar

    2014-01-01

    The coverage of maternal care services among the tribal women in Kerala is better as compared to other states in India. This study was done to identify the factors contributing to better coverage of maternal care services among the tribal women in Kerala and to study the reasons for remaining differences that exists in utilization of services between tribal and non-tribal pregnant women. This was a descriptive cum qualitative study conducted in Thariode Gramapanchayat in the Wayanad district of Kerala. Among all women who had registered their pregnancies in the 5 sub-centres under CHC Thariode and had delivered between September 2009 and October 2010, equal numbers of tribal and non-tribal ante-natal women, 35 each were interviewed in-depth using a semi-structured questionnaire. Quantitative data was analysed using SPSS Version 16.0. Content analysis was done for qualitative data. The determinants of utilization in tribal women were general awareness, affordability, accessibility and quality of services along with motivation by health workers. Among tribal antenatal women, 85% utilized maternal health care facilities fully compared to 100% among non-tribal women. Lower levels of education and lack of transport facilities were prime factors contributing to under utilization by tribal women. Affordable, accessible and good quality of services in the public health system in Kerala and motivation by health workers were important contributing factors for better utilization of maternal care services.

  18. Factors affecting maternal health care services utilization in rural ...

    African Journals Online (AJOL)

    Results: Mother's age at birth, mother's educational level, sex of head of household, household wealth status, employment/work status of mothers, region, religion, birth order and partner's/husband's level of educational were found to be predictors of utilization of delivery care and postnatal care services. Religion and sex of ...

  19. Quantifying the demand for hospital care services: a time and motion study.

    Science.gov (United States)

    van Oostveen, Catharina J; Gouma, Dirk J; Bakker, Piet J; Ubbink, Dirk T

    2015-01-22

    The actual amount of care hospitalised patients need is unclear. A model to quantify the demand for hospital care services among various clinical specialties would avail healthcare professionals and managers to anticipate the demand and costs for clinical care. Three medical specialties in a Dutch university hospital participated in this prospective time and motion study. To include a representative sample of patients admitted to clinical wards, the most common admission diagnoses were selected from the most recent update of the national medical registry (LMR) of ICD-10 admission diagnoses. The investigators recorded the time spent by physicians and nurses on patient care. Also the costs involved in medical and nursing care, (surgical) interventions, and diagnostic procedures as an estimate of the demand for hospital care services per hospitalised patient were calculated and cumulated. Linear regression analysis was applied to determine significant factors including patient and healthcare outcome characteristics. Fifty patients on the Surgery (19), Pediatrics (17), and Obstetrics & Gynecology (14) wards were monitored during their hospitalization. Characteristics significantly associated with the demand for healthcare were: polypharmacy during hospitalization, complication severity level, and whether a surgical intervention was performed. A set of predictors of the demand for hospital care services was found applicable to different clinical specialties. These factors can all be identified during hospitalization and be used as a managerial tool to monitor the patients' demand for hospital care services and to detect trends in time.

  20. Request of pharmaceutical care service in a private owned community pharmacy.

    Directory of Open Access Journals (Sweden)

    Pires CF

    2006-03-01

    Full Text Available Pharmacists, more than drug producer, is being a co-responsible for drug therapy and promoter of the rational use of medicines, enhancing their role. Appearance of a new philosophy, pharmaceutical care, came to organize, enhance and allowing this new role of the pharmacist in primary health care. Objectives of the present study were to determine the existence and to characterize the request for pharmaceutical care services and to assess the wiliness to pay for these services in a privately owned community pharmacy. An interview following a check-list was used by researchers to gather data. In 236 interviewed customers, 88.1% did not know the term ‘pharmaceutical care’, 67.2% showed to be interested on the service. Regarding the wiliness to pay, 39.9% conditioned it to the amount, and 10.1% stated that they would pay for the service. This allows us to conclude than in this setting, a demand existed, what allows repeating this survey in other settings, what lead us to the necessity of defining a standard of practice in Brazil, and in the rest of the world, to provide care to those who need it.

  1. The development of gas hubs in Europe

    International Nuclear Information System (INIS)

    Miriello, Caterina; Polo, Michele

    2015-01-01

    This paper investigates the development of wholesale markets for natural gas at the different stages of market liberalization. We identify three steps in the process: wholesale trade initially develops to cope with balancing needs when the shippers and suppliers segments become more fragmented; once the market becomes more liquid, it turns out to be a second source of gas procurement in alternative to long term contracts; finally, to manage price risk financial instruments are traded. We review in detail the different regulatory measures that must be introduced to create an efficient and functioning wholesale gas market. Finally, we analyze the evolution of gas hubs in the UK, the Netherlands, Germany and Italy in terms of market rules and market liquidity. We argue that each of these country cases can be easily located into the evolutionary path we have highlighted at the beginning, with the UK and the Netherlands leading the process, Germany and Italy constrained by limited supply; Italy is also showing an interesting counterfactual. -- Highlights: •The paper illustrates development paths for natural gas hubs in Europe. •Wholesale trade increases with competition. •The regulatory settings of UK, Netherlands, Germany and Italy are reviewed. •Each country is located into the evolutionary path highlighted in the analytical framework

  2. Skilled antenatal care service utilization and its association with the ...

    African Journals Online (AJOL)

    Data were entered into EPI info version 7 statistical software and exported to STATA ... Conclusions: Skilled ANC service utilization is the joint effect of individual and ... analysis, skilled antenatal care service, women's health development team ...

  3. Optimal integrated sizing and planning of hubs with midsize/large CHP units considering reliability of supply

    International Nuclear Information System (INIS)

    Moradi, Saeed; Ghaffarpour, Reza; Ranjbar, Ali Mohammad; Mozaffari, Babak

    2017-01-01

    Highlights: • New hub planning formulation is proposed to exploit assets of midsize/large CHPs. • Linearization approaches are proposed for two-variable nonlinear CHP fuel function. • Efficient operation of addressed CHPs & hub devices at contingencies are considered. • Reliability-embedded integrated planning & sizing is formulated as one single MILP. • Noticeable results for costs & reliability-embedded planning due to mid/large CHPs. - Abstract: Use of multi-carrier energy systems and the energy hub concept has recently been a widespread trend worldwide. However, most of the related researches specialize in CHP systems with constant electricity/heat ratios and linear operating characteristics. In this paper, integrated energy hub planning and sizing is developed for the energy systems with mid-scale and large-scale CHP units, by taking their wide operating range into consideration. The proposed formulation is aimed at taking the best use of the beneficial degrees of freedom associated with these units for decreasing total costs and increasing reliability. High-accuracy piecewise linearization techniques with approximation errors of about 1% are introduced for the nonlinear two-dimensional CHP input-output function, making it possible to successfully integrate the CHP sizing. Efficient operation of CHP and the hub at contingencies is extracted via a new formulation, which is developed to be incorporated to the planning and sizing problem. Optimal operation, planning, sizing and contingency operation of hub components are integrated and formulated as a single comprehensive MILP problem. Results on a case study with midsize CHPs reveal a 33% reduction in total costs, and it is demonstrated that the proposed formulation ceases the need for additional components/capacities for increasing reliability of supply.

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

    Science.gov (United States)

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

    2017-11-01

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

  5. Emergency mobile care service: trauma epidemiology in prehospital care

    Directory of Open Access Journals (Sweden)

    Mateus Kist Ibiapino

    2017-06-01

    Full Text Available Objective: to characterize trauma victims assisted by the Mobile Emergency Care Service (SAMU 192 in the city of Ilhéus, Bahia, Brazil. Method: this is a descriptive and retrospective study in which 1,588 records of traumatic events were analyzed from the following variables: sex, age, day of the week, period of the day, trauma mechanism, topography and type of injuries, revised trauma score, type of mobile unit used, professional responsible for care, time to hospital care, procedures performed and deaths. Results: there was a predominance of male victims (69.5% and age between 18 and 37 (46.5%. Occurrences were concentrated at weekends (37.8% and in the evening (52.0%. It revealed traffic accidents (41.3% as the main mechanism of trauma, among which prevailed the involvement of motorcycles (73.0%. Regarding the topographic distribution of lesions, the majority affected the limbs (58.2%. The most adopted conducts in prehospital care were immobilization (26.3% and compression dressing (25.9%. The deaths accounted for 2.7% of the total sample. Conclusion: The population most affected by traumatic events in Ilhéus shown to be composed of young men involved in traffic accidents, mainly motorcyclists, during the weekends.

  6. Optimal Scheduling of a Multi-Carrier Energy Hub Supplemented By Battery Energy Storage Systems

    DEFF Research Database (Denmark)

    Javadi, Mohammad Sadegh; Anvari-Moghaddam, Amjad; Guerrero, Josep M.

    2017-01-01

    This paper introduces a management model for optimal scheduling of a multi-carrier energy hub. In the proposed hub, three types of assets are considered: dispersed generating systems (DGs) such as micro-combined heat and power (mCHP) units, storage devices such as battery-based electrical storage...... systems (ESSs), and heating/cooling devices such as electrical heater, heat-pumps and absorption chillers. The optimal scheduling and management of the examined energy hub assets in line with electrical transactions with distribution network is modeled as a mixed-integer non-linear optimization problem....... In this regard, optimal operating points of DG units as well as ESSs are calculated based on a cost-effective strategy. Degradation cost of ESSs is also taken into consideration for short-term scheduling. Simulation results demonstrate that including well-planned energy storage options together with optimal...

  7. 76 FR 71920 - Payment for Home Health Services and Hospice Care by Non-VA Providers

    Science.gov (United States)

    2011-11-21

    ... concerning the billing methodology for non-VA providers of home health services and hospice care. The proposed rulemaking would include home health services and hospice care under the VA regulation governing... to ``RIN 2900-AN98--Payment for home health and services and hospice care by non-VA providers...

  8. [Professional's expectations to improve quality of care and social services utilization in geriatric oncology].

    Science.gov (United States)

    Antoine, Valéry; de Wazières, Benoît; Houédé, Nadine

    2015-02-01

    Coordination of a multidisciplinary and multi-professional intervention is a key issue in the management of elderly cancer patients to improve health status and quality of life. Optimizing the links between professionals is needed to improve care planning, health and social services utilization. Descriptive study in a French University Hospital. A 6-item structured questionnaire was addressed to professionals involved in global and supportive cares of elderly cancer patients (name, location, effective health care and services offered, needs to improve the quality of their intervention). After the analysis of answers, definition of propositions to improve cares and services utilization. The 37 respondents identified a total of 166 needs to improve quality of care in geriatric oncology. Major expectations were concerning improvement of global/supportive cares and health care services utilization, a better coordination between geriatric teams and oncologists. Ten propositions, including a model of in-hospital health care planning, were defined to answer to professional's needs with the aim of optimizing cancer treatment and global cares. Identification of effective services and needs can represent a first step in a continuous program to improve quality of cares, according to the French national cancer plan 2014-2019. It allows federating professionals for a coordination effort, a better organization of the clinical activity in geriatric oncology, to optimize clinical practice and global cares. Copyright © 2014 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

  9. The impact of care management information technology model on quality of care after Coronary Artery Bypass Surgery: "Bridging the Divides".

    Science.gov (United States)

    Weintraub, William S; Elliott, Daniel; Fanari, Zaher; Ostertag-Stretch, Jennifer; Muther, Ann; Lynahan, Margaret; Kerzner, Roger; Salam, Tabassum; Scherrer, Herbert; Anderson, Sharon; Russo, Carla A; Kolm, Paul; Steinberg, Terri H

    Reducing readmissions and improving metrics of care are a national priority. Supplementing traditional care with care management may improve outcomes. The Bridges program was an initial evaluation of a care management platform (CareLinkHub), supported by information technology (IT) developed to improve the quality and transition of care from hospital to home after Coronary Artery Bypass Surgery (CABG) and reduce readmissions. CareLink is comprised of care managers, patient navigators, pharmacists and physicians. Information to guide care management is guided by a middleware layer to gather information, PLR (ColdLight Solutions, LLC) and presented to CareLink staff on a care management platform, Aerial™ (Medecision). In addition there is an analytic engine to help evaluate and guide care, Neuron™ (Coldlight Solutions, LLC). The "Bridges" program enrolled a total of 716 CABG patients with 850 admissions from April 2013 through March 2015. The data of the program was compared with those of 1111 CABG patients with 1203 admissions in the 3years prior to the program. No impact was seen with respect to readmissions, Blood Pressure or LDL control. There was no significant improvement in patients' reported outcomes using either the CTM-3 or any of the SAQ-7 scores. Patient follow-up with physicians within 1week of discharge improved during the Bridges years. The CareLink hub platform was successfully implemented. Little or no impact on outcome metrics was seen in the short follow-up time. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Differences in home-based palliative care service utilisation of people with cancer and non-cancer conditions.

    Science.gov (United States)

    Kralik, Debbie; Anderson, Barbara

    2008-11-01

    To identify home-based palliative care service utilisation by people with cancer and non-cancer conditions. Palliative care knowledge and skill have been derived from working with people with cancer. People with chronic conditions are now referred for home-based palliative care; however, there has been few studies published that have explored the impact of service utilisation by people with end-stage chronic conditions. The Australia-modified Karnofsky Performance Status (AKPS) scale was calculated for each person upon referral for home-based palliative care services to determine the functional capacity of the individual at the point of referral. Clients were divided into those with cancer diagnosis and those with non-cancer diagnosis. Service utilisation of the individual client was determined until separation from the palliative care service. The study was undertaken in 2007. The majority of people with cancer (63%) and non-cancer (71%) were assessed as having an AKPS score between 50-60. Thirty-one cancer clients (18·7%) and three non-cancer clients (7·1%) had an AKPS score between 70-90. This suggests that people with cancer are referred to palliative care services earlier than people with non-cancer conditions. People with non-cancer conditions were substantially higher users of home-based palliative care services over a longer period of time. Home-based palliative care service utilisation was higher for people with non-cancer conditions. Cost analysis research is recommended to delineate the actual costs of home-based palliative care service provision between people with cancer and non-cancer conditions. There is growing awareness of the need for palliative care services for people with non-cancer conditions. However, these services are provided for longer periods of time for this client group. Implications for practice are that the palliative care needs of people with non-cancer conditions may not be met within current palliative care service provision

  11. Developing services to support parents caring for a technology-dependent child at home.

    Science.gov (United States)

    Kirk, S; Glendinning, C

    2004-05-01

    A group of children with complex health care needs have emerged as a result of medical advances and government policies emphasizing the community as the arena for care. Some of these children remain dependent on the medical technology that enabled them to survive and require care of a complex and intensive nature to be carried out by their parents at home. To explore the experiences of families caring at home for a technology-dependent child; to examine their needs for practical and other support; and to examine how far services are currently meeting these needs. Methods In-depth interviews were conducted with the parents of 24 technology-dependent children and with 44 health, social care and other professionals. Services in the community were not sufficiently developed to support this group of families. Major problems were identified in the purchasing and provision of both short-term care/home support services and specialist equipment/therapies in the community. Service provision could be poorly planned and co-ordinated at an operational level and few families had a designated key worker. Parents felt that professionals did not always recognize either the emotional costs entailed in providing care of this nature or their expertise in caregiving. Information-giving to parents was often described as poor and participants reported that hospital professionals failed to negotiate the transfer of caregiving responsibility to parents. Services need to work in partnership with families and with each other at both strategic and operational levels, to develop integrated and co-ordinated services that can meet the needs of this group of families.

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

    Science.gov (United States)

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

    2011-01-01

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

  13. Home and community care services: a major opportunity for preventive health care

    Directory of Open Access Journals (Sweden)

    Lujic Sanja

    2010-05-01

    Full Text Available Abstract Background In Australia, the Home and Community Care (HACC program provides services in the community to frail elderly living at home and their carers. Surprisingly little is known about the health of people who use these services. In this study we sought to describe health-related factors associated with use of HACC services, and to identify potential opportunities for targeting preventive services to those at high risk. Methods We obtained questionnaire data from the 45 and Up Study for 103,041 men and women aged 45 years and over, sampled from the general population of New South Wales, Australia in 2006-2007, and linked this with administrative data about HACC service use. We compared the characteristics of HACC clients and non-clients according to a range of variables from the 45 and Up Study questionnaire, and estimated crude and adjusted relative risks for HACC use with generalized linear models. Results 4,978 (4.8% participants used HACC services in the year prior to completing the questionnaire. Increasing age, female sex, lower pre-tax household income, not having a partner, not being in paid work, Indigenous background and living in a regional or remote location were strongly associated with HACC use. Overseas-born people and those speaking languages other than English at home were significantly less likely to use HACC services. People who were underweight, obese, sedentary, who reported falling in the past year, who were current smokers, or who ate little fruit or vegetables were significantly more likely to use HACC services. HACC service use increased with decreasing levels of physical functioning, higher levels of psychological distress, and poorer self-ratings of health, eyesight and memory. HACC clients were more likely to report chronic health conditions, in particular diabetes, stroke, Parkinson's disease, anxiety and depression, cancer, heart attack or angina, blood clotting problems, asthma and osteoarthritis

  14. Antenatal care service utilization and associated factors in Metekel ...

    African Journals Online (AJOL)

    socioeconomic and some obstetric factors have been stated by few studies in other areas, the factors associated with low utilization of Antenatal care in Metekel Zone are not well assed before. Therefore, the objective of this study was to assess the status of Antenatal care service utilization and associated factors among ...

  15. Transforming Data into Practical Information: Using Consumer Input to Improve Home-Care Services

    Science.gov (United States)

    Applebaum, Robert; Kunkel, Suzanne; Wilson, Ken

    2007-01-01

    Purpose: As funds have increased for the provision of in-home care, so too have concerns about the quality of services. In response, care management agencies and home-care providers have developed an array of monitoring activities designed to ensure the quality of services. In this article, we show how an area agency on aging both collected and…

  16. Developing a framework of service convenience in health care: An exploratory study for a primary care provider.

    Science.gov (United States)

    Tuzovic, Sven; Kuppelwieser, Volker

    2016-01-01

    From retail health clinics and online appointment scheduling to (mobile) kiosks that enable patient check-in and automate the collection of copays and open balances, convenience has become an important topic in the health care sector over the last few years. While service convenience has also gained much interest in academia, one common limitation is that authors have adopted a "goods-centered" perspective focusing primarily on retail settings. Results of this exploratory study reveal that health care service convenience encompasses seven different dimensions: decision, access, scheduling, registration and check-in, transaction, care delivery, and postconsultation convenience. Implications and future research suggestions are discussed.

  17. Development and Psychometric Testing of a Novel Food Service Satisfaction Questionnaire for Food Service Staff of Aged Care Homes.

    Science.gov (United States)

    Miller, M; Hamilton, J; Scupham, R; Matwiejczyk, L; Prichard, I; Farrer, O; Yaxley, A

    2018-01-01

    Food service staff are integral to delivery of quality food in aged care homes yet measurement of their satisfaction is unable to be performed due to an absence of a valid and reliable questionnaire. The aim of this study was to develop and perform psychometric testing for a new Food Service Satisfaction Questionnaire developed in Australia specifically for use by food service staff working in residential aged care homes (Flinders FSSQFSAC). A mixed methods design utilizing both a qualitative (in-depth interviews, focus groups) and a quantitative approach (cross sectional survey) was used. Content validity was determined from focus groups and interviews with food service staff currently working in aged care homes, related questionnaires from the literature and consultation with an expert panel. The questionnaire was tested for construct validity and internal consistency using data from food service staff currently working in aged care homes that responded to an electronic invitation circulated to Australian aged care homes using a national database of email addresses. Construct validity was tested via principle components analysis and internal consistency through Cronbach's alpha. Temporal stability of the questionnaire was determined from food service staff undertaking the Flinders FSSQFSAC on two occasions, two weeks apart, and analysed using Pearson's correlations. Content validity for the Flinders FSSQFSAC was established from a panel of experts and stakeholders. Principle components analysis revealed food service staff satisfaction was represented by 61-items divided into eight domains: job satisfaction (α=0.832), food quality (α=0.871), staff training (α=0.922), consultation (α=0.840), eating environment (α=0.777), reliability (α=0.695), family expectations (α=0.781) and resident relationships (α=0.429), establishing construct validity in all domains, and internal consistency in all (α>0.5) except for "resident relationships" (α=0.429). Test

  18. Health-enabling technologies for pervasive health care: on services and ICT architecture paradigms.

    Science.gov (United States)

    Haux, Reinhold; Howe, Jurgen; Marschollek, Michael; Plischke, Maik; Wolf, Klaus-Hendrik

    2008-06-01

    Progress in information and communication technologies (ICT) is providing new opportunities for pervasive health care services in aging societies. To identify starting points of health-enabling technologies for pervasive health care. To describe typical services of and contemporary ICT architecture paradigms for pervasive health care. Summarizing outcomes of literature analyses and results from own research projects in this field. Basic functions for pervasive health care with respect to home care comprise emergency detection and alarm, disease management, as well as health status feedback and advice. These functions are complemented by optional (non-health care) functions. Four major paradigms for contemporary ICT architectures are person-centered ICT architectures, home-centered ICT architectures, telehealth service-centered ICT architectures and health care institution-centered ICT architectures. Health-enabling technologies may lead to both new ways of living and new ways of health care. Both ways are interwoven. This has to be considered for appropriate ICT architectures of sensor-enhanced health information systems. IMIA, the International Medical Informatics Association, may be an appropriate forum for interdisciplinary research exchange on health-enabling technologies for pervasive health care.

  19. 20 CFR 638.510 - Health care and services.

    Science.gov (United States)

    2010-04-01

    ... UNDER TITLE IV-B OF THE JOB TRAINING PARTNERSHIP ACT Center Operations § 638.510 Health care and services. The center operator shall provide a health program, including basic medical, dental, and mental...

  20. Assessment of Emergency Obstetric Care Services in Ibadan ...

    African Journals Online (AJOL)

    AJRH Managing Editor

    ORIGINAL RESEARCH ARTICLE ... Nigeria's high maternal mortality has been attributed to poor utilization of obstetric care services to handle ... Poor obstetric outcome in middle and low-income ... Evidence also showed that access to.

  1. Evaluating sociodemographic and medical conditions of patients under home care service

    Directory of Open Access Journals (Sweden)

    Tolga Önder

    2015-09-01

    Full Text Available Objective: In our study, we aimed to reveal medical conditions and the sociodemographic conditions of patients under home care service. Methods: Our study is planned on 52 patients who are under home care service at Sarıkamış State Hospital between June 2013 and May 2014. Patients' sex, education, social security status, comorbid diseases and general health status were recorded. Results: Fifty-two patients enrolled. 21 of them (40.4% were men, 31 of them (59.6 % were women. It is revealed that In 36 patients (69.2% did not receive formal education throughout their lives, while16 (30.8% of them had only primary education. All female patients were housewives. The most frequent diseases in home care patients were cerebrovascular disease in 18 (34.6% subjects, Alzheimer's disease in 9 (17.3%, and chronic obstructive pulmonary disease in 4 (7.7% d. 38 patients (73.1% needed routine follow-up. Most of the patients (61.5% had green card health insurance. Only 6 patients (11.5% were in need of narcotic analgesics. Thirteen patients had pressure ulcers due to immobilization. Evaluating the exercise capacity of the patients; 43 (82.7% could not dressed themselves, 38 (73.1% could not use phone. Thirty-two patients had urinary incontinence and 31 had fecal incontinence. Conclusion: Today, population of patients who need home care service is increasing due to ease access to home care service and increase in survival. For a better care of patients, home care providers should be well educated and differences on features of patients and medical conditions it should be taken into consideration.

  2. Evaluation of health care service quality in Poland with the use of SERVQUAL method at the specialist ambulatory health care center

    Directory of Open Access Journals (Sweden)

    Manulik S

    2016-08-01

    Full Text Available Stanisław Manulik,1 Joanna Rosińczuk,2 Piotr Karniej3 1Non-Public Health Care Institution, “Ambulatory of Cosmonauts” Ltd. Liability Company, 2Department of Nervous System Diseases, Faculty of Health Science, 3Department of Organization and Management, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland Introduction: Service quality and customer satisfaction are very important components of competitive advantage in the health care sector. The SERVQUAL method is widely used for assessing the quality expected by patients and the quality of actually provided services.Objectives: The main purpose of this study was to determine if patients from state and private health care facilities differed in terms of their qualitative priorities and assessments of received services.Materials and methods: The study included a total of 412 patients: 211 treated at a state facility and 201 treated at a private facility. Each of the respondents completed a 5-domain, 22-item SERVQUAL questionnaire. The actual quality of health care services in both types of facilities proved significantly lower than expected.Results: All the patients gave the highest scores to the domains constituting the core aspects of health care services. The private facility respondents had the highest expectations with regard to equipment, and the state facility ones regarding contacts with the medical personnel.Conclusion: Health care quality management should be oriented toward comprehensive optimization in all domains, rather than only within the domain identified as the qualitative priority for patients of a given facility. Keywords: health care service quality, patients’ expectations, qualitative priorities, outpatient health care facilities

  3. Racial/Ethnic Differences in Use of Health Care Services for Diabetes Management

    Science.gov (United States)

    Chandler, Raeven Faye; Monnat, Shannon M.

    2015-01-01

    Research demonstrates consistent racial/ethnic disparities in access to and use of health care services for a variety of chronic conditions. Yet we know little about whether these disparities exist for use of health care services for diabetes management. Racial/ethnic minorities disproportionately suffer from diabetes, complications from diabetes,…

  4. Sustainability of a Primary Care-Driven eConsult Service.

    Science.gov (United States)

    Liddy, Clare; Moroz, Isabella; Afkham, Amir; Keely, Erin

    2018-03-01

    Excessive wait times for specialist appointments pose a serious barrier to patient care. To improve access to specialist care and reduce wait times, we launched the Champlain BASE (Building Access to Specialists through eConsultation) eConsult service in April 2011. The objective of this study is to report on the impact of our multiple specialty eConsult service during the first 5 years of use after implementation, with a focus on growth and sustainability. We conducted a cross-sectional study of all eConsult cases submitted between April 1, 2011 and April 30, 2016, and measured impact with system utilization data and mandatory close-out surveys completed at the end of each eConsult. Impact indicators included time interval to obtain specialist advice, effect of specialist advice on the primary care clinician's course of action, and rate of avoidance of face-to-face visits. A total of 14,105 eConsult cases were directed to 56 different medical specialty groups, completed with a median response time of 21 hours, and 65% of all eConsults were resolved without a specialist visit. We observed rapid growth in the use of eConsult during the study period: 5 years after implementation the system was in use by 1,020 primary care clinicians, with more than 700 consultations taking place per month. This study presents the first in-depth look at the growth and sustainability of the multispecialty eConsult service. The results show the positive impact of an eConsult service and can inform other regions interested in implementing similar systems. © 2018 Annals of Family Medicine, Inc.

  5. Home hospitalization in the spectrum of community geriatric care.

    Science.gov (United States)

    Stessman, J; Hammerman-Rozenberg, R; Cohen, A

    1997-04-01

    The Home Hospitalization Programme was initiated in Jerusalem in 1991 to provide intensive medical care at home in order to prevent or shorten hospitalizations. The programme was based upon regular home visits by physicians, and nursing assessment to determine the need for regular nursing care. Primary-care physicians and nurses were renumerated by a global monthly fee, and were on 24-h call in addition to their periodic visits. Patients were recruited by senior geriatric physicians from acute hospital wards, as well as from the community, at the family doctor's request. Ancillary services available to the home hospitalization team included laboratory and electrocardiographic testing, specialty consultations, physical occupational or speech therapy, social work and home help up to 3 h daily. Monthly visits by a senior physician provided oversight and further consultation. Home hospitalization grew out of the continuing care division of the Clalit Sick Fund, a health maintenance organization providing umbrella medical insurance and ambulatory care. The programme grew synergistically with the other facilities of continuing care to encompass a network of comprehensive services to acute, subacute and chronic patients both at home and in institutional settings. In 4 years this network succeeded in establishing the focus of subacute intensive care in the community, achieving high levels of patient and family satisfaction, as well as striking economic advantages. In its first 2 years of operation home hospitalization saved S4 million due to reduced hospital utilization, and preliminary data for the subsequent 2 years indicated that this trend continued. Home hospitalization became the hub of a far-reaching system of supportive, intensive and humane care in the community.

  6. Agency ownership, patient payment source, and length of service in home care, 1992 2000.

    Science.gov (United States)

    Han, Beth; McAuley, William J; Remsburg, Robin E

    2007-08-01

    Little is known about whether an association exists between agency ownership and length of service among home care patients with different payment sources. This study investigated how for-profit and not-for-profit agencies responded to policy changes in the 1990s with respect to length of service. We examined length of service among 37,364 home care patients using the 1992, 1994, 1996, 1998, and 2000 National Home and Hospice Care Surveys. We used Kaplan-Meier methods and Cox regression models. After we adjusted for patient and agency characteristics, our results revealed that agency ownership was not associated with length of service for patients with private insurance, Medicare, Medicaid, Medicare plus Medicaid, or Medicare plus private insurance. This finding was consistent from 1992 through 2000. Length of service among patients with Medicare decreased significantly from 1998 through 2000, but length of service among patients with Medicaid did not change significantly from 1992 through 2000. Agency ownership is not associated with patient length of service in home care. Regardless of the policy changes in the home care arena in the 1990s, for-profit and not-for-profit home health agencies behaved similarly with regard to length of service among patients within differently structured payment systems.

  7. 25 CFR 20.509 - What must the social services worker do when a child is placed in foster care or residential care...

    Science.gov (United States)

    2010-04-01

    ... home or residential care facility to law enforcement and protective services in accordance with tribal... Assistance Foster Care § 20.509 What must the social services worker do when a child is placed in foster care... tribal or state licensed foster home or residential care facility evaluating how the home has fulfilled...

  8. Health care needs and use of health care services among newly arrived Syrian refugees: a cross-sectional study.

    Science.gov (United States)

    Oda, Anna; Tuck, Andrew; Agic, Branka; Hynie, Michaela; Roche, Brenda; McKenzie, Kwame

    2017-05-03

    Canada welcomed 33 723 Syrian refugees between November 2015 and November 2016. This paper reports the results of a rapid assessment of health care needs and use of health care services among newly arrived Syrian refugees in Toronto. A cross-sectional study was conducted in Toronto among Syrian refugees aged 18 years or more who had been in Canada for 12 months or less. Participants were recruited initially through distribution of flyers in hotels and through direct referrals and communication with community and settlement agency partners, and then through snowball sampling. We collected sociodemographic information and data on self-perceived physical health and mental health, unmet health care needs and use of health care services. A total of 400 Syrian refugees (221 women [55.2%] and 179 men [44.8%]) were enrolled. Of the 400, 209 (52.2%) were privately sponsored refugees, 177 (44.2%) were government-assisted refugees, and 12 (3.0%) were refugees under the Blended Visa Office-Referred Program. They reported high levels of self-perceived physical and mental health. Over 90% of the sample saw a doctor in their first year in Canada, and 79.8% had a family doctor they saw regularly. However, almost half (49.0%) of the respondents reported unmet health care needs, with the 3 most common reasons reported being long wait times, costs associated with services and lack of time to seek health care services. Many factors may explain our respondents' high levels of self-perceived physical and mental health during the first year of resettlement, including initial resettlement support and eligibility for health care under the Interim Federal Health Program. However, newly arrived Syrian refugees report unmet health care needs, which necessitates more comprehensive care and management beyond the initial resettlement support. Copyright 2017, Joule Inc. or its licensors.

  9. Implementing integrated services for people with epilepsy in primary care in Ethiopia: a qualitative study.

    Science.gov (United States)

    Catalao, Raquel; Eshetu, Tigist; Tsigebrhan, Ruth; Medhin, Girmay; Fekadu, Abebaw; Hanlon, Charlotte

    2018-05-21

    In order to tackle the considerable treatment gap for epilepsy in many low- and middle-income countries (LMICs), a task sharing model is recommended whereby care is integrated into primary health services. However, there are limited data on implementation and impact of such services in LMICs. Our study aimed to explore the perspectives of service users and caregivers on the accessibility, experience and perceived impact of epilepsy treatment received in a task-shared model in a rural district of Ethiopia. A qualitative study was carried out using interviews with purposively sampled service users (n = 13) and caregivers (n = 3) from a community-ascertained cohort of people with epilepsy receiving integrated services in primary care in rural Ethiopia. Interviews followed a topic guide with questions regarding acceptability, satisfaction, barriers to access care, pathways through care and impact of services. Framework analysis was employed to analyse the data. Proximity of the new service in local primary health centers decreased the cost of transportation for the majority of service users thus improving access to services. First-hand experience of services was in some cases associated with a willingness to promote the services and inform others of the existence of effective biomedical treatment for epilepsy. However, most service users and their caregivers continued to seek help from traditional healers alongside biomedical care. Most of the care received was focused on medication provision with limited information provided on how to manage their illness and its effects. Caregivers and service users spoke about the high emotional and financial burden of the disease and lack of ongoing practical and emotional support. The majority of participants reported clinical improvement on medication, which in over half of the participants was associated with ability to return to money generating activities. Task-sharing improved the accessibility of epilepsy care for

  10. Costs of stroke and stroke services: Determinants of patient costs and a comparison of costs of regular care and care organised in stroke services

    NARCIS (Netherlands)

    M.A. Koopmanschap (Marc); W.J.M. Scholte op Reimer (Wilma); J.D.H. van Wijngaarden (Jeroen); N.J.A. van Exel (Job)

    2003-01-01

    textabstractBACKGROUND: Stroke is a major cause of death and long-term disability in Western societies and constitutes a major claim on health care budgets. Organising stroke care in a stroke service has recently been demonstrated to result in better health effects for patients.

  11. WHAT IS CONTROLLING THE FRAGMENTATION IN THE INFRARED DARK CLOUD G14.225–0.506?: DIFFERENT LEVELS OF FRAGMENTATION IN TWIN HUBS

    Energy Technology Data Exchange (ETDEWEB)

    Busquet, Gemma; Girart, Josep Miquel [Institut de Ciències de l’Espai (CSIC-IEEC), Campus UAB, Carrer de Can Magrans, S/N, E-08193, Cerdanyola del Vallès, Catalunya (Spain); Estalella, Robert [Departament d’Astronomia i Meteorologia, Institut de Ciències del Cosmos (ICC), Universitat de Barcelona (IEEC-UB), Martí i Franquès, 1, E-08028 Barcelona, Catalunya (Spain); Palau, Aina [Instituto de Radioastronomía y Astrofísica, Universidad Nacional Autónoma de México, P.O. Box 3-72, 58090 Morelia, Michoacán, México (Mexico); Liu, Hauyu Baobab; Ho, Paul T. P. [Academia Sinica Institute of Astronomy and Astrophysics, Taipei, Taiwan (China); Zhang, Qizhou [Harvard-Smithsonian Center for Astrophysics, 60 Garden Street, Cambridge, MA 02138 (United States); De Gregorio-Monsalvo, Itziar [European Southern Observatory (ESO), Karl-Schwarzschild-Str. 2, D-85748 Garching (Germany); Pillai, Thushara [Max Planck Institut für Radioastronomie, Auf dem Hügel 69, D-53121 Bonn (Germany); Anglada, Guillem, E-mail: busquet@ice.cat [Instituto de Astrofísica de Andalucía, CSIC, Glorieta de la Astronomía, s/n, E-18008, Granada (Spain)

    2016-03-20

    We present observations of the 1.3 mm continuum emission toward hub-N and hub-S of the infrared dark cloud G14.225–0.506 carried out with the Submillimeter Array, together with observations of the dust emission at 870 and 350 μm obtained with APEX and CSO telescopes. The large-scale dust emission of both hubs consists of a single peaked clump elongated in the direction of the associated filament. At small scales, the SMA images reveal that both hubs fragment into several dust condensations. The fragmentation level was assessed under the same conditions and we found that hub-N presents 4 fragments while hub-S is more fragmented, with 13 fragments identified. We studied the density structure by means of a simultaneous fit of the radial intensity profile at 870 and 350 μm and the spectral energy distribution adopting a Plummer-like function to describe the density structure. The parameters inferred from the model are remarkably similar in both hubs, suggesting that density structure could not be responsible for determining the fragmentation level. We estimated several physical parameters, such as the level of turbulence and the magnetic field strength, and we found no significant differences between these hubs. The Jeans analysis indicates that the observed fragmentation is more consistent with thermal Jeans fragmentation compared with a scenario in which turbulent support is included. The lower fragmentation level observed in hub-N could be explained in terms of stronger UV radiation effects from a nearby H ii region, evolutionary effects, and/or stronger magnetic fields at small scales, a scenario that should be further investigated.

  12. WHAT IS CONTROLLING THE FRAGMENTATION IN THE INFRARED DARK CLOUD G14.225–0.506?: DIFFERENT LEVELS OF FRAGMENTATION IN TWIN HUBS

    International Nuclear Information System (INIS)

    Busquet, Gemma; Girart, Josep Miquel; Estalella, Robert; Palau, Aina; Liu, Hauyu Baobab; Ho, Paul T. P.; Zhang, Qizhou; De Gregorio-Monsalvo, Itziar; Pillai, Thushara; Anglada, Guillem

    2016-01-01

    We present observations of the 1.3 mm continuum emission toward hub-N and hub-S of the infrared dark cloud G14.225–0.506 carried out with the Submillimeter Array, together with observations of the dust emission at 870 and 350 μm obtained with APEX and CSO telescopes. The large-scale dust emission of both hubs consists of a single peaked clump elongated in the direction of the associated filament. At small scales, the SMA images reveal that both hubs fragment into several dust condensations. The fragmentation level was assessed under the same conditions and we found that hub-N presents 4 fragments while hub-S is more fragmented, with 13 fragments identified. We studied the density structure by means of a simultaneous fit of the radial intensity profile at 870 and 350 μm and the spectral energy distribution adopting a Plummer-like function to describe the density structure. The parameters inferred from the model are remarkably similar in both hubs, suggesting that density structure could not be responsible for determining the fragmentation level. We estimated several physical parameters, such as the level of turbulence and the magnetic field strength, and we found no significant differences between these hubs. The Jeans analysis indicates that the observed fragmentation is more consistent with thermal Jeans fragmentation compared with a scenario in which turbulent support is included. The lower fragmentation level observed in hub-N could be explained in terms of stronger UV radiation effects from a nearby H ii region, evolutionary effects, and/or stronger magnetic fields at small scales, a scenario that should be further investigated

  13. Dynamically Allocated Hub in Task-Evoked Network Predicts the Vulnerable Prefrontal Locus for Contextual Memory Retrieval in Macaques.

    Directory of Open Access Journals (Sweden)

    Takahiro Osada

    2015-06-01

    Full Text Available Neuroimaging and neurophysiology have revealed that multiple areas in the prefrontal cortex (PFC are activated in a specific memory task, but severity of impairment after PFC lesions is largely different depending on which activated area is damaged. The critical relationship between lesion sites and impairments has not yet been given a clear mechanistic explanation. Although recent works proposed that a whole-brain network contains hubs that play integrative roles in cortical information processing, this framework relying on an anatomy-based structural network cannot account for the vulnerable locus for a specific task, lesioning of which would bring impairment. Here, we hypothesized that (i activated PFC areas dynamically form an ordered network centered at a task-specific "functional hub" and (ii the lesion-effective site corresponds to the "functional hub," but not to a task-invariant "structural hub." To test these hypotheses, we conducted functional magnetic resonance imaging experiments in macaques performing a temporal contextual memory task. We found that the activated areas formed a hierarchical hub-centric network based on task-evoked directed connectivity, differently from the anatomical network reflecting axonal projection patterns. Using a novel simulated-lesion method based on support vector machine, we estimated severity of impairment after lesioning of each area, which accorded well with a known dissociation in contextual memory impairment in macaques (impairment after lesioning in area 9/46d, but not in area 8Ad. The predicted severity of impairment was proportional to the network "hubness" of the virtually lesioned area in the task-evoked directed connectivity network, rather than in the anatomical network known from tracer studies. Our results suggest that PFC areas dynamically and cooperatively shape a functional hub-centric network to reallocate the lesion-effective site depending on the cognitive processes, apart from

  14. The state of primary care in the United States of America and lessons for primary care groups in the United Kingdom.

    Science.gov (United States)

    Koperski, M

    2000-04-01

    The health care system of the United States of America (USA) is lavishly funded and those with adequate insurance usually receive excellent attention. However, the system is fragmented and inequitable. Health workers often find it difficult to separate vocational roles from business roles. Care tends to focus on the acute rather than the chronic, on 'episodes of illness' rather than 'person-centred' care, on short-term fixes rather than long-term approaches, on scientific/technical solutions rather than discourse or the 'art of healing', and on individual health rather than population health. The majority of US doctors are trained in the 'hightech' hospital paradigm and there is no equivalent of the United Kingdom (UK) general practitioner (GP), who lies at the hub of a primary health care team (PHCT) and who is charged with taking a long-term view, co-ordinating health care for individual patients, and acting as patient advocate without major conflicting financial incentives. However, primary care groups/trusts (PCGs) could learn from US management and training techniques, case management, NHS Direct equivalents, and the effects of poorly developed PHCTs. PCGs could develop the UK's own version of utilisation management. A cash-limited, unified budget within an underfunded National Health Service poses threats to general practice. In both the USA and the UK, primary care is a prominent tool in new attempts at cost control. PCGs offer the opportunity of better integration with public health and social services, but threaten GPs' role as independent advocates by giving them a rationing role. Managed care has forced a similar role onto our US counterparts with consequent public displeasure and professional disillusion. UK GPs will have to steer a careful course if they are to avoid a similar fate.

  15. Evaluating a primary care psychology service in Ireland: a survey of stakeholders and psychologists.

    Science.gov (United States)

    Corcoran, Mark; Byrne, Michael

    2017-05-01

    Primary care psychology services (PCPS) represent an important resource in meeting the various health needs of our communities. This study evaluated the PCPS in a two-county area within the Republic of Ireland. The objectives were to (i) examine the viewpoints of the service for both psychologists and stakeholders (healthcare professionals only) and (ii) examine the enactment of the stepped care model of service provision. Separate surveys were sent to primary care psychologists (n = 8), general practitioners (GPs; n = 69) and other stakeholders in the two counties. GPs and stakeholders were required to rate the current PCPS. The GP survey specifically examined referrals to the PCPS and service configuration, while the stakeholder survey also requested suggestions for future service provision. Psychologists were required to provide information regarding their workload, time spent on certain tasks and productivity ideas. Referral numbers, waiting lists and waiting times were also obtained. All 8 psychologists, 23 GPs (33% response rate) and 37 stakeholders (unknown response rate) responded. GPs and stakeholders reported access to the PCPS as a primary concern, with waiting times of up to 80 weeks in some areas. Service provision to children and adults was uneven between counties. A stepped care model of service provision was not observed. Access can be improved by further implementation of a stepped care service, developing a high-throughput service for adults (based on a stepped care model), and employing a single waiting list for each county to ensure equal access. © 2016 John Wiley & Sons Ltd.

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

    Directory of Open Access Journals (Sweden)

    Chang-Yu Chiang

    2013-11-01

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

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

    Science.gov (United States)

    Su, Chuan-Jun; Chiang, Chang-Yu

    2013-11-12

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

  18. The East African Resilience Innovation Hub | CRDI - Centre de ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    The hub will explore several research streams to examine why interventions succeed or fail, and how individuals, communities, and states can cope with and overcome conflict and violence. Researchers will also look at how to support peacemaking processes and increase disaster prevention efforts. Their work will respond ...

  19. Income inequality, disinvestment in health care and use of dental services.

    Science.gov (United States)

    Bhandari, Bishal; Newton, Jonathan T; Bernabé, Eduardo

    2015-01-01

    To explore the interrelationships between income inequality, disinvestment in health care, and use of dental services at country level. This study pooled national estimates for use of dental services among adults aged 18 years or older from the 70 countries that participated in the World Health Survey from 2002 to 2004, together with aggregate data on national income (GDP per capita), income inequality (Gini coefficient), and disinvestment in health care (total health expenditure and dentist-to-population ratio) from various international sources. Use of dental services was defined as having had dental problems in the last 12 months and having received any treatment to address those needs. Associations between variables were explored using Pearson correlation coefficients and linear regression. Data from 63 countries representing the six WHO regions were analyzed. Use of dental services was negatively correlated with Gini coefficient (Pearson correlation coefficient -0.48, P dental services was attenuated but remained significant after adjustments for GDP per capita, total health expenditure, and dentist-to-population ratio (regression coefficient -0.36; 95% CI -0.57, -0.15). This study shows an inverse relationship between income inequality and use of dental services. Of the two indicators of disinvestment in health care assessed, only dentist-to-population ratio was associated with income inequality and use of dental services. © 2014 American Association of Public Health Dentistry.

  20. Effects of home-based long-term care services on caregiver health according to age.

    Science.gov (United States)

    Chen, Ming-Chun; Kao, Chi-Wen; Chiu, Yu-Lung; Lin, Tzu-Ying; Tsai, Yu-Ting; Jian, Yi-Ting Zhang; Tzeng, Ya-Mei; Lin, Fu-Gong; Hwang, Shu-Ling; Li, Shan-Ru; Kao, Senyeong

    2017-10-23

    Caregiver health is a crucial public health concern due to the increasing number of elderly people with disabilities. Elderly caregivers are more likely to have poorer health and be a care recipient than younger caregivers. The Taiwan government offers home-based long-term care (LTC) services to provide formal care and decrease the burden of caregivers. This study examined the effects of home-based LTC services on caregiver health according to caregiver age. This cross-sectional study included a simple random sample of care recipients and their caregivers. The care recipients had used LTC services under the Ten-Year Long-Term Care Project (TLTCP) in Taiwan. Data were collected through self-administered questionnaires from September 2012 to January 2013. The following variables were assessed for caregivers: health, sex, marital status, education level, relationship with care recipient, quality of relationship with care recipient, job, household monthly income, family income spent on caring for the care recipient (%) and caregiving period. Furthermore, the following factors were assessed for care recipients: age, sex, marital status, education level, living alone, number of family members living with the care recipient, quality of relationship with family and dependency level. The health of the caregivers and care recipients was measured using a self-rated question (self-rated health [SRH] was rated as very poor, poor, fair, good and very good). The study revealed that home nursing care was significantly associated with the health of caregivers aged 65 years or older; however, caregivers aged less than 65 who had used home nursing care, rehabilitation or respite care had poorer health than those who had not used these services. In addition, the following variables significantly improved the health of caregivers aged 65 years or older: caregiver employment, 20% or less of family income spent on caregiving than 81%-100% and higher care recipient health. The