Full Text Available Abstract Background In our region (Eastern South Limburg, The Netherlands an open access echocardiography service started in 2002. It was the first service of this kind in The Netherlands. Our study aims were: (1 to evaluate demand for the service, participation, indications, echocardiography outcomes, and management by the general practitioner (GP; (2 to analyse changes in indications and outcomes over the years. Methods (1 Data from GP request forms, echocardiography reports and a retrospective GP questionnaire on management (response rate 83% of 625 consecutive patients (Dec. 2002 - March 2007 were analysed cross-sectionally. (2 For the analysis of changes over the years, data from GP request forms and echocardiography reports of the first and last 250 patients that visited the service between Dec. 2002 and Feb. 2008 (n = 1001 were compared. Results The echocardiography service was used by 81% of the regional GPs. On average, a GP referred one patient per year to the service. Intended indications for the service were dyspnoea (32%, cardiac murmur (59%, and peripheral oedema (17%. Of the other indications (22%, one-third was for evaluation of suspected left ventricular hypertrophy (LVH. Expected outcomes were left ventricular dysfunction (LVD (43%, predominantly diastolic and valve disease (25%. We also found a high proportion of LVH (50%. Only 24% of all echocardiograms showed no relevant disease. The GP followed the cardiologist's advice to refer the patient for further evaluation in 71%. In recent patients, more echocardiography requests were done for 'cardiac murmur' and 'other' indications, but less for 'dyspnoea'. The proportions of patients with LVD, LVH and valve disease decreased and the proportion of patients with no relevant disease increased. The number of advices by the cardiologists increased. Conclusion Overall, GPs used the open access echocardiography service efficiently (i.e. with a high chance of finding relevant pathology
We would like to inform you that between 10 November and 15 December 2014, the access cards service in Building 55 will be disrupted, as the GS Department has decided to improve the facilities for users of this building. During the work, you will find the registration, biometric registration and dosimeter exchange services on the second floor of Building 55 and the vehicle sticker service on the ground floor along with the access cards service. We thank you for your understanding and apologise for any inconvenience caused.
Full Text Available Adolescents represent a large proportion of the population. As they mature and become sexually active, they face more serious health risks. Most face these risks with too little factual information, too little guidance about sexual responsibility and multiple barriers to accessing health care. A typical descriptive and explanatory design was used to determine what the characteristics of an accessible adolescent health service should be. Important results and conclusions that were reached indicate that the adolescent want a medical doctor and a registered nurse to be part of the health team treating them and they want to be served in the language of their choice. Family planning, treatment of sexually transmitted diseases and psychiatric services for the prevention of suicide are services that should be included in an adolescent accessible health service. The provision of health education concerning sexual transmitted diseases and AIDS is a necessity. The service should be available thought out the week (included Saturdays and within easy reach. It is recommended that minor changes in existing services be made, that will contribute towards making a health delivery service an adolescent accessible service. An adolescent accessible health service can in turn make a real contribution to the community’s efforts to improve the health of its adolescents and can prove to be a rewarding professional experience to the health worker.
Harkins, Judith E; Strauss, Karen Peltz
Access to emergency services is mandated by Title II of the Americans with Disabilities Act (ADA). The Department of Justice oversees the accessibility of public safety answering points (PSAPs), popularly called 9-1-1 centers. The Federal Communications Commission (FCC) has at least two roles in emergency number access: (1) as regulator of the ADA's Title IV on telecommunications access, and (2) as regulator of communications companies with regard to support of and interconnection with PSAPs. The rules of both agencies contributed significantly to the improvement during the 1990s of access to 9-1-1 for people who are deaf, hard of hearing, or speech disabled. However, as new technologies for text wireless communications and relay services have moved quickly to Internet protocol (IP)-based technologies over the past 5-8 years, the use of traditional wireline telephones and text telephones among deaf, hard of hearing, and speech-disabled people has declined. PSAPs cannot be contacted via the newer forms of telecommunications, such as e-mail, instant messaging, and IP-based forms of relay services, including video relay services. The gap between the technology supported by policy and the technologies currently being used by deaf and hard of hearing people has become a serious problem that is difficult to solve because of the separate jurisdictions of the two agencies, the need for coordination within the FCC, technological challenges, and funding issues. In this article, the key policy and technology challenges will be analyzed and recommendations made for short-and long-term solutions to this dilemma.
Targeted neonatal echocardiography refers to a focused assessment of myocardial performance and hemodynamics directed by a specific clinical question. It has become the standard of care in many parts of the world, but practice is variable, and there has been a lack of standardized training and evaluation to date. Targeted neonatal echocardiography was first introduced to Canada in 2006. The purpose of this study was to examine the characteristics of targeted neonatal echocardiography practice and training methods in Canadian neonatal intensive care units (NICUs).
Sang, Jian; Zhao, Yong-Heng; Cui, Chen-Zhou
With the development of technologies and the implementation of large quantity of astronomical observation projects, astronomy faces data avalanche and has entered an information era. A basic aim of the Virtual Observatory is to provide uniform access to highly distributed, complicated, huge astronomical datasets, and to realize federation of global astronomical data resources, so that astronomers can obtain required data efficiently and conveniently for their research. China Virtual Observatory (China-VO) project designs and implements astronomical data access services based on Grid technology, and provides uniform interface to Grid client application. In this paper, we introduce the data access service toolkit development using Globus Toolkit, the Grid services encapsulation of catalogs according to the latest astronomical data standards recommended by International Virtual Observatory Alliance, the implements of catalog Cone Search access service. Furthermore, we also introduce how to construct other Grid services using above data access services.
Full Text Available 2–4 million Muslims attend Hajj each year over last 4–5 years. Umra visitors are seen all along most the year. This creates high demand on all services provided specially the medical. The majority of Hajjes are elderly with co morbidities. They are subject to intense emotional, spiritual & physical endurance during the short period of Hajj season. For the last 4 years King Abdulla Medical City (KAMC is the centre of care for almost all cardiac services provided in Makkah. Echocardiography is a pivotal & integral part of any cardiology service, providing important information about morphology, function & possible etiology in many cases. There is an increasing demand on echo service in KAMC especially during Hajj season. Our service model is unique to meet this increasing demand during Hajj season. To report: we report the service set up. The volume of cases done our experience & challenges met during last four years. The service is provided between first & 15th of Dhul Haja each year. The service is 24 h divided into 12 h shifts. The two shifts are adequately covered by well trained echocardiographers & experienced non-invasive consultant cardiologists. This staff is distributed within the various cardiology clinical areas, to insure rapid response. The studies are done Philips (i30, Epic7 machines. Data acquired is transmitted by special ports/WiFi to our echo lab (Xcelera system where the data is stored & available for viewing & reporting. Reports are created by the responsible consultants using a number of dedicated stations. Viewing stations are well distributed over the whole hospital. The results of this abstract are analyzed using simple Microsoft office tools. Between years 2011 and 2015 there is exponential increase of echo studies done in KAMC, with similar increase in the number of studies done among Hajjes. There was an increase in the number of echo machines, echocardiographers & consultants (See Tables and Graphs attached
Lusi Herawati Sunyoto Usman Mark Zuidgeest
as indicators. Flowmap tool is used to analyze catchment area of each health facility using different transport modes choice:becak and public transport for poor group and motorcycle and car for non-poor group with different travel time within 30, 60 and more than 60 minutes. It is concluded that there was an accessibility difference between poor and non-poor group. The accessibility to the health facilities of poor group was lower than non-poor group. This condition occurred because the government policy of equitable access to health service facility did not pay attention to accessibility of poor group.
Language HTTP Hypertext Transfer Protocol HTTPS Secure Hypertext Transfer Protocol IDS intrusion detection system IEEE Institute for Electrical and...so we limit our focus to a subset of these services in order to convey the basic concepts of the framework. Specifically, we focus on Hypertext ...Transfer Protocol (HTTP), Secure Hypertext Transfer Protocol (HTTPS), and Internet Relay Chat (IRC). We also constrain our work in terms of network size
Full Text Available This paper addresses methodology and tools applied to the monitoring of accessibility services in digital television at a time when the principles of accessibility and design are being considered in all new audiovisual media communication services. The main objective of this research is to measure the quality and quantity of existing accessibility services offered by digital terrestrial television (DTT. The preliminary results, presented here, offer the development of a prototype for automatic monitoring and a methodology for obtaining quality measurements, along with the conclusions drawn by initial studies carried out in Spain. The recent approval of the UN Convention on the Rights of Persons with Disabilities gives special relevance to this research because it provides valuable guidelines to help set the priorities to improve services currently available to users.
Dean, Richard A.; Levesque, Allen H.
The rapid introduction of digital wireless networks is an important part of the emerging digital communications scene. The introduction of Digital Cellular, LEO and GEO Satellites, and Personal Communications Services poses both a challenge and an opportunity for the data user. On the one hand wireless access will introduce significant new portable data services such as personal notebooks, paging, E-mail, and fax that will put the information age in the user's pocket. On the other hand the challenge of creating a seamless and transparent environment for the user in multiple access environments and across multiple network connections is formidable. A summary of the issues associated with developing techniques and standards that can support transparent and seamless data services is presented. The introduction of data services into the radio world represents a unique mix of RF channel problems, data protocol issues, and network issues. These problems require that experts from each of these disciplines fuse the individual technologies to support these services.
DUAN Lei; SHEN Liren
Web services is used in Experimental Physics and Industrial Control System (EPICS). Combined with EPICS Channel Access protocol, Web services' high usability, platform independence and language independence can be used to design a fully transparent and uniform software interface layer, which helps us complete channel data acquisition, modification and monitoring functions. This software interface layer, a cross-platform of cross-language,has good interopcrability and reusability.
At least since the early 1990s, academic libraries have been merging Circulation and various other related functions into a single department typically labeled "Access Services." In many cases, however, that merger has proven to be administrative rather than functional, with minimal integration of common workflows. This article describes…
This article serves as a primer for assessment and evaluation design by describing the range of methods commonly employed in library settings. Quantitative methods, such as counting and benchmarking measures, are useful for investigating the internal operations of an access services department in order to identify workflow inefficiencies or…
Meng, Wei; Li, Fengmin; Pan, Juchen; Song, Song; Bian, Jiali
The development of mobile computing, cloud computing and distributed computing meets the growing individual service needs. Facing with complex application system, it's an urgent problem to ensure real-time, dynamic, and fine-grained data access control. By analyzing common data access control models, on the basis of mandatory access control model, the paper proposes a service-oriented access control model. By regarding system services as subject and data of databases as object, the model defines access levels and access identification of subject and object, and ensures system services securely to access databases.
This article defines the elements of Access Services, explains the importance of those aspects in the library, and proposes a course centered on Access Services for library schools. The areas of circulation, interlibrary loan, course reserves, collection maintenance, and public relations are core components of Access Services. Each of those…
A. Salustri (Alessandro)
textabstractIn the studies reported in this thesis, stress echocardiography (either with exercise or with pharmacological agents) and myocardial perfusion scintigraphy have been performed in different groups of patients and in different clinical conditions. Some practical aspects on the protocols of
Bailey, M. D.; Crumbly, C.
The evolving nature of the NASA space enterprise compels the agency to develop new and innovative space systems concepts. NASA, working with increasingly strained budgets and a declining manpower base, is attempting to transform from operational activities to procurement of commercial services. NASA's current generation reusable launch vehicle, the Shuttle, is in transition from a government owned and operated entity to a commercial venture to reduce the civil servant necessities for that program. NASA foresees its second generation launch vehicles being designed and operated by industry for commercial and government services. The "service" concept is a pioneering effort by NASA. The purpose the "service" is not only to reduce the civil servant overhead but will free up government resources for further research and enable industry to develop a space business case so that industry can sustain itself beyond government programs. In addition, NASA desires a decreased responsibility thereby decreasing liability. The Second Generation Reusable Launch Vehicle (RLV) program is implementing NASA's Space Launch Initiative (SLI) to enable industry to develop the launch vehicles of the future. The Alternate Access to Station (AAS) project office within this program is chartered with enabling industry to demonstrate an alternate access capability for the International Space Station (ISS). The project will not accomplish this by traditional government procurement methods, not by integrating the space system within the project office, or by providing the only source of business for the new capability. The project funds will ultimately be used to purchase a service to take re-supply cargo to the ISS, much the same as any business might purchase a service from FedEx to deliver a package to its customer. In the near term, the project will fund risk mitigation efforts for enabling technologies. AAS is in some ways a precursor to the 2nd Generation RLV. By accomplishing ISS resupply
... 47 Telecommunication 2 2010-10-01 2010-10-01 false Network access services revenues. 36.213 Section 36.213 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES... Income Accounts Operating Revenues § 36.213 Network access services revenues. (a) End User...
Kaklanis, Nikolaos; Votis, Konstantinos; Tzovaras, Dimitrios
This paper presents the Cloud4all Service Synthesizer Tool, a framework that enables efficient orchestration of accessibility services, as well as their combination into complex forms, providing more advanced functionalities towards increasing the accessibility of end-users with various types of functional limitations. The supported services are described formally within an ontology, enabling, thus, semantic service composition. The proposed service composition approach is based on semantic matching between services specifications on the one hand and user needs/preferences and current context of use on the other hand. The use of automatic composition of accessibility services can significantly enhance end-users' accessibility, especially in cases where assistive solutions are not available in their device.
Olsen, Rasmus Løvenstein; Schwefel, Hans-Peter; Hansen, Martin Bøgsted
Remote access to dynamically changing information elements is a required functionality for various network services, including routing and instances of context-sensitive networking. Three fundamentally different strategies for such access are investigated in this paper: (1) a reactive approach......, network delay characterization) and specific requirements on mismatch probability, traffic overhead, and access delay. Finally, the analysis is applied to the use-case of context-sensitive service discovery....
Reviews the origin, current state of development, and subject coverage of the secondary access services available to American social scientists, including bibliographic services for the various academic disciplines and a large variety of specialized services for subdisciplines and interdisciplinary fields. A 10-item reference list accompanies the…
Acevedo-Polakovich, Ignacio David; Bell, Bailey; Gamache, Peter; Christian, Allison S.
Although Lesbian, Gay, Bisexual, Transgender, Queer and/or Questioning (LGBTQ) youth experience alarming rates of behavioral and social problems, service use among these youth is disproportionately low. It is likely that decreased service accessibility plays a causal role in service underutilization among LGBTQ youth. To expand the existing…
Bruce, C J; Friedman, P A
This article describes currently available intracardiac ultrasound (ICE) technology contrasting it with intravascular ultrasound (IVUS) highlighting their differences. Clinical applications in the electrophysiologic and cardiac catheterization laboratory are discussed and current limitations addressed. Intracardiac echocardiography (ICE) is possible because lower frequency transducers (in contrast to higher frequency IVUS devices) have been miniaturized and mounted onto catheters capable of percutaneous insertion into the heart. These lower frequency transducers are capable of enhanced tissue penetration, permitting high-resolution 2D "whole heart" imaging. Also, with the introduction of the newest phased array transducer, Doppler hemodynamic data in addition to high resolution imaging can also be obtained. ICE facilitates electrophysiologic procedures by guiding transseptal catheterization, enabling endocardial anatomy visualization and targeting of arrhythmogenic substrate, ensuring optimal ablation electrode/tissue contact and promptly diagnosing procedural complications. Promising non-electrophysiologic applications include guidance of percutaneous closure of septal defects, percutaneous mitral balloon valvuloplasty and complex cardiac biopsy. Current limitations include monoplanar imaging, narrow field of view, and relatively large size of the catheter. Intra-cardiac imaging is now a clinical tool and has the potential to play an important role in diagnostic and therapeutic interventional procedures. Further refinement and miniaturization of these transducers, through continued technological progress, will make way for primary operator controlled, integrated ultrasound-guided interventional devices.
National Aeronautics and Space Administration — We propose to investigate the feasibility and value of the "Software as a Service" paradigm in facilitating access to Earth Science numerical models. We...
Robbins Kay A
Full Text Available Abstract Background Many bioinformatics algorithms and data sets are deployed using web services so that the results can be explored via the Internet and easily integrated into other tools and services. These services often include data from other sites that is accessed either dynamically or through file downloads. Developers of these services face several problems because of the dynamic nature of the information from the upstream services. Many publicly available repositories of bioinformatics data frequently update their information. When such an update occurs, the developers of the downstream service may also need to update. For file downloads, this process is typically performed manually followed by web service restart. Requests for information obtained by dynamic access of upstream sources is sometimes subject to rate restrictions. Findings SideCache provides a framework for deploying web services that integrate information extracted from other databases and from web sources that are periodically updated. This situation occurs frequently in biotechnology where new information is being continuously generated and the latest information is important. SideCache provides several types of services including proxy access and rate control, local caching, and automatic web service updating. Conclusions We have used the SideCache framework to automate the deployment and updating of a number of bioinformatics web services and tools that extract information from remote primary sources such as NCBI, NCIBI, and Ensembl. The SideCache framework also has been used to share research results through the use of a SideCache derived web service.
Mu, X.; Wu, J.; Li, T.; Zhong, Y.; Gao, X.
Web service can bring together applications running on diverse platforms, users can access and share various data, information and models more effectively and conveniently from certain web service platform. Cloud computing emerges as a paradigm of Internet computing in which dynamical, scalable and often virtualized resources are provided as services. With the rampant growth of massive data and restriction of net, traditional web services platforms have some prominent problems existing in development such as calculation efficiency, maintenance cost and data security. In this paper, we offer a spatial statistics service based on Microsoft cloud. An experiment was carried out to evaluate the availability and efficiency of this service. The results show that this spatial statistics service is accessible for the public conveniently with high processing efficiency.
... be provided in a timely fashion. (iii) Format. A LEC shall provide access to its directory assistance... to allow competing providers full use of these services. (d) Branding of operator services...
Full Text Available With wide adoption of Service Computing and Mobile Computing, people tend to invoke services with mobile devices, requiring accurate and real-time feedback from services at any time and any place. Among these services, some are private to limited users and require identity authorization before use; hence secure access control in wireless network should be provided. To address the challenge, in this study, we propose the architecture and protocols of a system of access to private services for mobile clients, which combines the technologies of trusted computing, Diffie-Hellman key agreement protocol, digital certificate, DES data encryption algorithm and twice verification. We further show the implementation of the proposed system, in which we have realized the authentication and authorization of mobile clients and then secure data transfer between mobile clients in the unsafe Internet and private services in the Intranet.
Full Text Available This paper examines the development of the Open Access movement in scholarly communication, with particular attention to some of the rhetorical strategies and policy mechanisms used to promote it to scholars and scientists. Despite the majority of journal publishers’ acceptance of author self-archiving practices, and the minimal time commitment required by authors to successfully self-archive their work in disciplinary or institutional repositories, the majority of authors still by and large avoid participation. The paper reviews the strategies and arguments used for increasing author participation in open access, including the role of open access mandates. We recommend a service-oriented approach towards increasing participation in open access, rather than rhetoric that speculates on the benefits that open access will have on text/data mining innovation. In advocating for open access participation, we recommend focusing on its most universal and tangible purpose: increasing public open (gratis access to the published results of publicly funded research. Researchers require strong institutional support to understand the copyright climate of open access self-archiving, user-friendly interfaces and useful metrics, such as repository usage statistics. We recommend that mandates and well-crafted and responsive author support services at universities will ultimately be required to ensure the growth of open access. We describe the mediated deposit service that was developed to support author self-archiving in Spectrum: Concordia University Research Repository. By comparing the number of deposits of non-thesis materials (e.g. articles and conference presentations that were accomplished through the staff-mediated deposit service to the number of deposits that were author-initiated, we demonstrate the relative significance of this service to the growth of the repository.
U.S. Environmental Protection Agency — This EnviroAtlas web service includes maps that illustrate factors affecting transit accessibility, and indicators of accessibility. Accessibility measures how...
American Society of Echocardiography Join Ase Member Portal Log In Membership Member Portal Log In Join ASE Renew Benefits Rates FASE – Fellow of the American Society of Echocardiography Member Referral Program FAQs Initiatives Advocacy ...
Gowling, Sarah; Persson, Jennie; Holt, Genevieve; Ashbourne, Sue; Bloomfield, James; Shortland, Hannah; Bate, Clare
IAPT (Improving Access to Psychological Therapies) is a national programme aimed at increasing availability of evidence based psychological therapies in the NHS. IAPT is primarily for people who have mild to moderate, common mental health difficulties such as depression, anxiety, phobias and post traumatic stress disorder (PTSD). The programme seeks to use the least intrusive method of care possible to treat people at the time when it will be of most help to them. Individuals are able to self-refer into most IAPT services or alternatively can request to be referred by their GP or other services in the community. Richmond Wellbeing Service (RWS) is one such IAPT Service and this research is based on our work to promote accessibility of the service to one of the harder to reach population groups - older adults. We know that IAPT services could have a positive impact on older adults as it is believed on average, 25% of over 65 year olds face common mental health problems. However, only a third of these people discuss this with their GP and so are less likely to be referred to an IAPT Service. In relation to the above, this project was designed to look at increasing access for older adults into Richmond Wellbeing Service (RWS) specifically to improve access to the RWS by older adults by 100. The overall goal was to increase older adult (65+) referral rates by 20% over a year, in raw number this would translate to an increase of 100 over a year period, and in percentage terms an average of 8% of total referrals. Results yielded an increase of 39 referrals between baseline and test period. The majority of this increase had occurred in the final five months of the projects duration(31). Interestingly the number of older adults in the older age band (85+) almost doubled within this period (from 12 to 21). In total, in percentage terms this translates to an an increase of OA referrals from 6% up to 6.7%, as above we are aiming for 8% or an additional increase of 61 patients
Eleri, Ewah Otu; Ugwu, Okechukwu; Onuvae, Precious
Nigeria experiences a remarkable paradox -- the abundance of energy resources and widespread energy poverty. Only about 40% of the population has access to the country’s grid electricity. About 72% of the population depends on traditional fuelwood for cooking. Despite this, government financing of energy services that benefits majority of Nigeria’s population has been grossly inadequate. Private sector investments and donor support have not fared better. This paper examines the current level of energy poverty in Nigeria. It analyses the level of government, private sector and donor funding for energy services that benefit the poor. It further reviews international best practices in expanding access for pro poor energy services. The paper finds a significant decline in political interest for expanding electricity services to rural areas. Even though ambitious policy reforms have commenced, agreed programmes are not implemented effectively. Not only are investments in rural electrification in decline, there is no history of annual budgeting for cooking energy programmes. The paper recommends a number of action points for expanding access to energy services that benefit the poor. These include the development and launching of a new national rural electrification strategy; establishment of a national cooking energy programme; and the development of clear policy incentives to support private sector investment in energy services for the poor. It calls on the Nigerian Central Bank of Nigeria to set aside 10% of the existing power intervention fund for pro poor energy financing; and the Nigerian Electricity Regulatory Commission to establish a clear framework for the utilization of the Consumer Assistance Fund. Other recommendations include the use of a proportion of the Ecological Fund to finance cooking energy; establishment of a donor’s platform on pro poor energy; and the mobilization of civil society in providing community-level energy services.
Srirama, Satish Narayana
It is now feasible to host basic web services on a smart phone due to the advances in wireless devices and mobile communication technologies. While the applications are quite welcoming, the ability to provide secure and reliable communication in the vulnerable and volatile mobile ad-hoc topologies is vastly becoming necessary. The paper mainly addresses the details and issues in providing secured communication and access control for the mobile web service provisioning domain. While the basic message-level security can be provided, providing proper access control mechanisms for the Mobile Host still poses a great challenge. This paper discusses details of secure communication and proposes the distributed semantics-based authorization mechanism.
Full Text Available Abstract Background Assessment of physical access to health services is extremely important for planning. Complex methods that incorporate data inputs from road networks and transport systems are used to assess physical access to healthcare in industrialised countries. However, such data inputs hardly exist in many developing countries. Straight-line distances between the service provider and resident population are easily obtained but their relationship with driving distance and travel time is unclear. This study aimed to investigate the relationship between different measures of physical access, including straight-line distances, road distances and travel time and the impact of these measures on the vaccination of children in Yemen. Methods Coordinates of houses and health facilities were determined by GPS machine in Urban and rural areas in Taiz province, Yemen. Road distances were measured by an odometer of a vehicle driven from participants' houses to the nearest health centre. Driving time was measured using a stop-watch. Data on children's vaccination were collected by personal interview and verified by inspecting vaccination cards. Results There was a strong correlation between straight-line distances, driving distances and driving time (straight line distances vs. driving distance r = 0.92, p Conclusion Straight-line distances, driving distances and driving time are strongly linked and associated with vaccination uptake. Straight-line distances can be used to assess physical access to health services where data inputs on road networks and transport are lacking. Impact of physical access is clear in Yemen, highlighting the need for efforts to target vaccination and other preventive healthcare measures to children who live away from health facilities.
Dirk von Suchodoletz
Full Text Available The changing world of IT services opens the chance to more tightly integrate digital long-term preservation into systems, both for commercial and end users. The emergence of cloud offerings re-centralizes services, and end users interact with them remotely through standardized (web-client applications on their various devices. This offers the chance to use partially the same concepts and methods to access obsolete computer environments and allows for more sustainable business processes. In order to provide a large variety of user-friendly remote emulation services, especially in combination with authentic performance and user experience, a distributed system model and architecture is required, suitable to run as a cloud service, allowing for the specialization both of memory institutions and third party service providers.The shift of the usually non-trivial task of the emulation of obsolete software environments from the end user to specialized providers can help to simplify digital preservation and access strategies. Besides offering their users better access to their holdings, libraries and archives may gain new business opportunities to offer services to a third party, such as businesses requiring authentic reproduction of digital objects and processes for legal reasons. This paper discusses cloud concepts as the next logical step for accessing original digital material. Emulation-as-a-Service (EaaS fills the gap between the successful demonstration of emulation strategies as a long term access strategy and it’s perceived availability and usability. EaaS can build upon the ground of research and prototypical implementations of previous projects, and reuse well established remote access technology.In this article we develop requirements and a system model, suitable for a distributed environment. We will discuss the building blocks of the core services as well as requirements regarding access management. Finally, we will try to present a
Niniek Lely Pratiwi
Full Text Available Background: The MDG target to increase maternal health will be achieved when 50% of maternal deaths can be prevented through improvment the coverage of K1, K4, to make sure that midwife stay in the village improve the delivery by health workers in health facilities, increase coverage long-term contraceptive methods participant as well as family and community empowerment in health. Methods: This study is a further analysis of Riskesdas in 2010 to assess how big the accessibility of services in family planning in Indonesia. Results: Women of 3–4 children in rural greater and prevalence (27.1% compared to women who live in urban areas (25.0%. The main reason of not using contraception mostly because they want to have children 27.0% in urban, 28.2% rural whereas, the second reason is the fear of side effects 23.1% in urban, 16.5% rural. There is 10% of respondent did not use contraceptives, because they did not need it. Health seeking behavior of pregnant women with family planning work status has a significant relationship (prevalence ratio 1.073. The jobless mothers has better access to family planning services compared to working mother. Conclusions: Accessibility of family planning services is inadequate, because not all rural ‘Poskesdes’ equipped with infrastructure and family planning devices, a lack of knowledge of family planning in rural areas. Health seeking behavior of family planning services is mostly to the midwives, the scond is to community health centers and than polindes, ‘poskesdes’ as the ranks third.
This statement explores the ethical considerations surrounding the provision of fertility services to transgender individuals and concludes that denial of access to fertility services is not justified.
Usage of condition data in ATLAS is extensive for offline reconstruction and analysis (e.g. alignment, calibration, data quality). The system is based on the LCG Conditions Database infrastructure, with read and write access via an ad hoc C++ API (COOL), a system which was developed before Run 1 data taking began. The infrastructure dictates that the data is organized into separate schemas (assigned to subsystems/groups storing distinct and independent sets of conditions), making it difficult to access information from several schemas at the same time. We have thus created PL/SQL functions containing queries to provide content extraction at multi-schema level. The PL/SQL API has been exposed to external clients by means of a Java application providing DB access via REST services, deployed inside an application server (JBoss WildFly). The services allow navigation over multiple schemas via simple URLs. The data can be retrieved either in XML or JSON formats, via simple clients (like curl or Web browsers).
Formica, Andrea; Gallas, E. J.
Usage of condition data in ATLAS is extensive for offline reconstruction and analysis (e.g. alignment, calibration, data quality). The system is based on the LCG Conditions Database infrastructure, with read and write access via an ad hoc C++ API (COOL), a system which was developed before Run 1 data taking began. The infrastructure dictates that the data is organized into separate schemas (assigned to subsystems/groups storing distinct and independent sets of conditions), making it difficult to access information from several schemas at the same time. We have thus created PL/SQL functions containing queries to provide content extraction at multi-schema level. The PL/SQL API has been exposed to external clients by means of a Java application providing DB access via REST services, deployed inside an application server (JBoss WildFly). The services allow navigation over multiple schemas via simple URLs. The data can be retrieved either in XML or JSON formats, via simple clients (like curl or Web browsers).
Formica, Andrea; The ATLAS collaboration
Usage of Conditions Data in ATLAS is extensive for offline reconstruction and analysis (e.g.: alignment, calibration, data quality). The system is based on the LCG Conditions Database infrastructure, with read and write access via an ad hoc C++ API (COOL), a system which was developed before Run 1 data taking began. The infrastructure dictates that the data is organized into separate schemata (assigned to subsystems/groups storing distinct and independent sets of conditions), making it difficult to access information from several schemata at the same time. We have thus created PL/SQL functions containing queries to provide content extraction at multi-schema level. The PL/SQL API has been exposed to external clients by means of a Java application providing DB access via RESTful services, deployed inside an application server (JBoss WildFly). The services allow navigation over multiple schemata via simple URLs. The data can be retrieved either in XML or JSON formats, via simple clients (like curl or Web browser...
Formica, Andrea; The ATLAS collaboration
Usage of Conditions Data in ATLAS is extensive for offline reconstruction and analysis (for example: alignment, calibration, data quality). The system is based on the LCG Conditions Database infrastructure, with read and write access via an ad hoc C++ API (COOL), a system which was developed before Run 1 data taking began. The infrastructure dictates that the data is organized into separate schemas (assigned to subsystems/groups storing distinct and independent sets of conditions), making it difficult to access information from several schemas at the same time. We have thus created PL/SQL functions containing queries to provide content extraction at multi-schema level. The PL/SQL API has been exposed to external clients by means of an intermediate java application server (JBoss), where an application delivering access to the DB via RESTful services has been deployed. The services allow navigation over multiple schema content, via simple URLs. The queried data can be retrieved either in XML or JSON formats, vi...
Full Text Available The flexibility of the MOOC service allows students to learn at their own time, place and pace, enhancing continuous communication and interaction between all participants in knowledge and community building. This model especially benefits people with disabilities, which can improve therefore their level of employability and social inclusion, reaching a better quality of life. Unfortunately the access to MOOC platforms present severe barriers: there is a lack of accessibility on the learning resources, the communicating tools and personalized user interfaces. All these issues add extra difficulties such as the need to develop specific digital or even social skills for students with functional diversity. In this context, MOOCs are leading a revolutionary computer and mobile-based scenario along with social technologies that will emerge new kinds of learning applications that enhance communication and collaboration processes. For that reason, this paper describes the need for designing an information model and related specifications to support a new strategy for delivering accessible MOOC courses to learners with special needs, in terms of their preferences and context of use based on a particular application profile. This user profile’s design is based on standard metadata schemas, data that provides information about other data, regarding the achievement of accessibility from content to user preferences.
Full Text Available Cloud computing is a set of resources and services offered by Internet. It provides all kinds of services for end user. One of the most important services provided by cloud computing is an Email (Data Storage and File Sharing. Employees or any Committee of Institution are very interested in sharing documents with group members. There is possibility of creating one group to share information with all. So, in everybody’s registered email id, they will get notification for it. Here, everybody have their own mail id. In this research paper, a model is discussed which allow one email id and two users sharing same Email id. This mechanism is like Joint access of single bank account between two members.
The existence of a right to healthcare or, at least, access to healthcare services, is a right that exists in terms of the Bill of Rights in the Constitution of the Republic of South Africa, 1996. This article explores the scope and ambit of the right and its meaning within the context of both of constitutional directives, the duties imposed upon the State to progressively realise the right for its citizens and the practical implications of the right with reference to existing healthcare infrastructure in the Republic of South Africa.
CERN has recently experienced several computer security incidents caused by people opening VPN connections and (unknown to them) allowing malicious software to enter CERN. VPN should be used to connect to CERN only in extreme and exceptional circumstances and it is formally discouraged as a general solution. If incidents continue, the availability of the service will need to be reviewed. Recommended methods of connecting to CERN from the Internet for common functionalities such as e-mail, access to CERN web or file servers and interactive sessions on CERN systems are described at http://cern.ch/security/vpn
Brown, K E; Newby, K; Caley, M; Danahay, A; Kehal, I
Sexual health service access is fundamental to good sexual health, yet interventions designed to address this have rarely been implemented or evaluated. In this article, pilot evaluation findings for a targeted public health behavior change intervention, delivered via a website and web-app, aiming to increase uptake of sexual health services among 13-19-year olds are reported. A pre-post questionnaire-based design was used. Matched baseline and follow-up data were identified from 148 respondents aged 13-18 years. Outcome measures were self-reported service access, self-reported intention to access services and beliefs about services and service access identified through needs analysis. Objective service access data provided by local sexual health services were also analyzed. Analysis suggests the intervention had a significant positive effect on psychological barriers to and antecedents of service access among females. Males, who reported greater confidence in service access compared with females, significantly increased service access by time 2 follow-up. Available objective service access data support the assertion that the intervention may have led to increases in service access. There is real promise for this novel digital intervention. Further evaluation is planned as the model is licensed to and rolled out by other local authorities in the United Kingdom.
Buck, Thomas [University Hospital Essen (Germany). West German Heart Center; Franke, Andreas [Klinikum Region Hannover - Klinikum Siloah, Hannover (Germany). Dept. of Cardiology, Angiology and Intensive Care Medicine; Monaghan, Mark J. (eds.) [King' s College Hospital, London (United Kingdom)
Presents tips and tricks for beginners and experts Provides educational material for 3D training courses Features comprehensively illustrated cases Includes an accompanying DVD with video clips of all sample cases Three-dimensional echocardiography is the most recent fundamental advancement in echocardiography. Since real-time 3D echocardiography became commercially available in 2002, it has rapidly been accepted in echo labs worldwide. This book covers all clinically relevant aspects of this fascinating new technology, including a comprehensive explanation of its basic principles, practical aspects of clinical application, and detailed descriptions of specific uses in the broad spectrum of clinically important heart disease. The book was written by a group of well-recognized international experts in the field, who have not only been involved in the scientific and clinical evolution of 3D echocardiography since its inception but are also intensively involved in expert training courses. As a result, the clear focus of this book is on the practical application of 3D echocardiography in daily clinical routine with tips and tricks for both beginners and experts, accompanied by more than 150 case examples comprehensively illustrated in more than 800 images and more than 500 videos provided on a DVD. In addition to an in-depth review of the most recent literature on real-time 3D echocardiography, this book represents an invaluable reference work for beginners and expert users of 3D echocardiography. - Tips and tricks for beginners and experts - Educational material for 3D training courses - Comprehensively illustrated cases - DVD with video clips of all sample cases.
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Racher, Frances E; Vollman, Ardene Robinson
Access to health services is a major concern across North America and abroad, with particular salience for the residents of rural and remote areas and the health professionals committed to providing services to them. Intrinsic to this discussion is clarification of the phenomenon of access to health services, a concept that remains nebulous and obscure to consumers, health care providers, and policymakers alike. Multiple understandings of access to health services impedes progress in the development of policy, the creation of programs, and the transformation of health services. Considerable discussion of theory concerning access to health services is articulated in public or community health literature and that of other disciplines; however, limited attention to this topic is apparent in nursing literature. This report articulates definitions, dimensions, and frameworks of access to health services from available literature and existing theory. Further, key points are identified and discussed for consideration in nursing research on the term access and implications for practice.
... priority access service by commercial mobile radio service providers. 64.402 Section 64.402... Policies and procedures for the provision of priority access service by commercial mobile radio service providers. Commercial mobile radio service providers that elect to provide priority access service...
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McGrail, Matthew R; Russell, Deborah J; Humphreys, John S
Objective Improving access to primary health care (PHC) remains a key issue for rural residents and health service planners. This study aims to show that how access to PHC services is measured has important implications for rural health service and workforce planning.Methods A more sophisticated tool to measure access to PHC services is proposed, which can help health service planners overcome the shortcomings of existing measures and long-standing access barriers to PHC. Critically, the proposed Index of Access captures key components of access and uses a floating catchment approach to better define service areas and population accessibility levels. Moreover, as demonstrated through a case study, the Index of Access enables modelling of the effects of workforce supply variations.Results Hypothetical increases in supply are modelled for a range of regional centres, medium and small rural towns, with resulting changes of access scores valuable to informing health service and workforce planning decisions.Conclusions The availability and application of a specific 'fit-for-purpose' access measure enables a more accurate empirical basis for service planning and allocation of health resources. This measure has great potential for improved identification of PHC access inequities and guiding redistribution of PHC services to correct such inequities.What is known about the topic? Resource allocation and health service planning decisions for rural and remote health settings are currently based on either simple measures of access (e.g. provider-to-population ratios) or proxy measures of access (e.g. standard geographical classifications). Both approaches have substantial limitations for informing rural health service planning and decision making.What does this paper add? The adoption of a new improved tool to measure access to PHC services, the Index of Access, is proposed to assist health service and workforce planning. Its usefulness for health service planning is
Full Text Available Background and purpose: Pharmacetical care has been shifted from product or drug oriented paradigm into patient oriented to ensure that every custumer will be able get the most effective medication. This research aimed was to explore the relationship between pharmaceutical services and satisfaction of customers accessing the pharmacy services in Denpasar. Methods: This research was analytic study using cross sectional design. The sample consists of 116 customers taken from 20 pharmacies at Denpasar. Data was collected using self-administered questionnaires. Data was analyzed using logistic regression. Results: The analysis indicated that the level of customer satisfaction was 46.55%. There was a significant relationship between pharmacy appearance (OR=12.819, 95%CI: 2.791-58.870, drug information services (OR=16.157, 95%CI: 3.279-79.620, the availability of drugs (OR=6.811, 95%CI: 1.571-29.460, and speed of service (OR=43.432, 95%CI: 7.197-262.095 with satisfaction levels of customers. Conclusion: It is recommended that there is an upgrade of facilities in order to enhance customer satisfaction including an increase in staff numbers attending to customers that are able to provide adequate information so as to optimize service provision. Keywords: pharmaceutical services, customer satisfaction, pharmacy, Denpasar
textabstractTwo-dimensional echocardiography is a commonly used non-invasive method for the assessment of left ventricular function. It provides precise information on both global and segmental myocardial function by displaying endocardial motion and wall thickening. Dobutamine stress echocardiograp
The present paper discusses the importance, objectives and major developments in open access initiatives. It further examines the specific use of digital information services including the digital reference service. The paper also highlights the various steps taken in this direction at the Central Library of IIT Madras.
Full Text Available In this paper we tackle the mobility issue in IP Multimedia Subsystem (IMS. Although IMS was designedto integrate different access networks, mobility management among these networks is still unresolved. We propose a novel hybrid mobility management scheme, based on tight cooperation between fast handovers for mobile IPv6 (FMIPv6 and session initiation protocol (SIP to ensure an uninterrupted real-time service. Moreover, the new Media Independent Handover (MIH service is integrated into IMS architecture in order to perform intelligent and accurate horizontal and vertical handovers. We investigate two handover cases: selected handover and forced handover. Selected handover takes place when user equipment (UE is connected to the network via two interfaces at the same time and decides to upgrade the quality of its connection following a given criterion (i.e. cost, bandwidth…etc without having any difficulty in the previous link. As far as forced handover is concerned, it occurs when thesignal reaches a critical level and UE is forced to make a handover in order to maintain the ongoing communication. This case is managed in two phases. The first one or the fast phase is handled by FMIPv6 protocol to preserve as soon as possible packets of the ongoing communication. The second one or the slow phase is handled by SIP protocol to optimize packet delivery route. By doing so, we exploit the benefits of both network layer and application mobility protocols to ensure a continuous session over the two networks without imposing new elements to the network. Through a comparison with other mobility mechanisms, we show in the analytic analysis that our hybrid scheme presents better results in terms of handover latency and packet loss.
Full Text Available Abstract Background Admissions for Ambulatory Care Sensitive Conditions (ACSCs are considered preventable admissions, because they are unlikely to occur when good preventive health care is received. Thus, high rates of admissions for ACSCs among the elderly (persons aged 65 or above who qualify for Medicare health insurance are signals of poor preventive care utilization. The relevant geographic market to use in studying these admission rates is the primary care physician market. Our conceptual model assumes that local market conditions serving as interventions along the pathways to preventive care services utilization can impact ACSC admission rates. Results We examine the relationships between market-level supply and demand factors on market-level rates of ACSC admissions among the elderly residing in the U.S. in the late 1990s. Using 6,475 natural markets in the mainland U.S. defined by The Health Resources and Services Administration's Primary Care Service Area Project, spatial regression is used to estimate the model, controlling for disease severity using detailed information from Medicare claims files. Our evidence suggests that elderly living in impoverished rural areas or in sprawling suburban places are about equally more likely to be admitted for ACSCs. Greater availability of physicians does not seem to matter, but greater prevalence of non-physician clinicians and international medical graduates, relative to U.S. medical graduates, does seem to reduce ACSC admissions, especially in poor rural areas. Conclusion The relative importance of non-physician clinicians and international medical graduates in providing primary care to the elderly in geographic areas of greatest need can inform the ongoing debate regarding whether there is an impending shortage of physicians in the United States. These findings support other authors who claim that the existing supply of physicians is perhaps adequate, however the distribution of them across
Radigan, Marleen; Wang, Rui; Chen, Yu; Xiang, Jiani
Access to peer advocates is increasingly available to youth and their caregivers who are receiving services in the public mental health system. This study examines associations between reported access to a youth or family advocate and perceptions of satisfaction with mental health services. A cross-sectional survey of youth (N = 768) and caregivers (N = 1,231) who utilized public mental health services in New York State in 2012 was conducted. The survey includes items on access to youth or family advocates and degree of satisfaction with mental health services. A greater proportion of youth or caregivers with access to peer advocates compared to those without access responded positively on the satisfaction domains of access to services, appropriateness of services, participation in services and overall/global satisfaction. Access to peer advocates was also positively associated with agreement on the psychotropic medication comprehension domain for youth and on perceptions of child functioning and social connectedness for caregivers compared to those without access. This study adds to the growing understanding of the important role peer advocates play in engaging youth with mental health needs and their caregivers in mental health services.
Jetton, Lora Lennertz; Bailey, Alberta S.
This article updates a previous article published in 1992 that described the role of the access services manager in policy formation. Since that time, the access services department and mission has matured and evolved to a prominent position within the library organization. Technological changes and innovation in the marketplace of wired and…
Kersaint, Gladis; Dogbey, James; Barber, Jeff; Kephart, David
This study investigated outcomes (achievement, attitude, and retention) of college algebra students who had access to an online tutoring resource using a pre-posttest control group design. Students in the experimental groups were provided access to an online tutoring service unlike the students in the control group. Both groups had access to other…
Rosa E. Lillo
Full Text Available We examine the service mechanism of two queueing models with two units in tandem. In the first model, customers who complete service in Unit 1 must wait in an intermediate buffer until the ongoing service in Unit II ends. In the second model, jobs can be pre-positioned in an intermediate buffer to await service in Unit II. Under the assumption of phase-type service times, the steady-state regime of the service system is studied in detail.
Wolfswinkel, R.N. van
In the current broadband market there are many new developments regarding both services and the broadband infrastructures carrying those services. This paper will address what the requirements of services are towards broadband networks. The focus will be on the requirements of triple play related se
Akinci, Fevzi; Healey, Bernard J
Using the concept of social marketing, this study examined the determinants of access to primary health care services in order to better understand the perceived access problems and unmet service needs of an entire city in Northeastern Pennsylvania. Consistent with previous research, lack of access to health insurance coverage represents an important financial barrier to access to health care services in this community. This study also highlights the role of perceived need in explaining the presence or absence of a physician consultation.While increased attention to access issues at the national level is important, there also needs to be more emphasis on collecting local data for local decision-making regarding access issues.
Austen, Sally; McGrath, Melissa
Long-distance travel to provide mental health services for deaf people has implications for efficiency, safety, and equality of service. However, uptake of Telemental Health (TMH) has been slow in both deaf and general mental health services. A quantitative study was used to investigate access to TMH and whether staff confidence, experience, or…
... information services. 54.621 Section 54.621 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED... § 54.621 Access to advanced telecommunications and information services. (a) Twenty-five percent of the... service support equal to 50 percent of the monthly cost of advanced telecommunications and...
Bendycki, N; Zeroske, J
Marketing plans that do not include an analysis of customer service, access and capacity issues are incomplete documents. Unresolved customer service, access and capacity issues can undermine an otherwise well-designed marketing plan. The medical and administrative leadership of the group practice or clinical department must work together to identify customer service, access and capacity issues which are affecting the practice's ability to respond to the needs of the marketplace. Someone with marketing expertise can provide valuable input to this process. The resulting solutions need to be developed which are realistic and in keeping with the general marketing direction of the practice.
Liu, Hong; Dittmann, Lars; Gliese, Ulrik Bo
The furture broadband wireless asynchronous transfer mode (ATM) networks must provide seamless extension of multimedia services from the wireline ATM networks. This requires an effecient wireless access protocol to fulfill varying Quality-og-Service (QoS) requirements for multimedia applications....... In this paper, we propose a multiple access protocol using centralized and distributed channel access control techniques to provide QoS guarantees for multimedia services by taking advantage of the characteristics of different kinds of ATM traffics. Multimedia traffic, including constant bit rate (CBR...
Full Text Available The aim of the study was to explore the patterns of dental health services access in children under twelve years of age in Peru. Data from 25,285 children under 12 years who participated in the Demographic and Family Health Survey of 2014 were reviewed. An exploratory spatial analysis was performed to project the proportions of children with access to dental health services, according to national regions, type of health service and urban or rural place of residence. The results show that of the total sample, 26.7% had access to dental health services in the last six months, 39.6% belonged to the age group 0-4 years, 40.6% lived in the Andean region and 58.3% lived in urban areas. The regions of Huancavelica, Apurimac, Ayacucho, Lima and Pasco had the highest percentages of access nationwide. In conclusion, there is low access to dental health services in the population under 12 years of age in Peru. The spatial distribution of access to dental health services allows regions to be identified and grouped according to similar access patterns, in order to better focus public health actions.
Huffer, E.; Hertz, J.; Kusterer, J.
The corpus of Earth Science data products at the Atmospheric Science Data Center at NASA's Langley Research Center comprises a widely heterogeneous set of products, even among those whose subject matter is very similar. Two distinct data products may both contain data on the same parameter, for instance, solar irradiance; but the instruments used, and the circumstances under which the data were collected and processed, may differ significantly. Understanding the differences is critical to using the data effectively. Data distribution services must be able to provide prospective users with enough information to allow them to meaningfully compare and evaluate the data products offered. Semantic technologies - ontologies, triple stores, reasoners, linked data - offer functionality for addressing this issue. Ontologies can provide robust, high-fidelity domain models that serve as common schema for discovering, evaluating, comparing and integrating data from disparate products. Reasoning engines and triple stores can leverage ontologies to support intelligent search applications that allow users to discover, query, retrieve, and easily reformat data from a broad spectrum of sources. We argue that because of the extremely complex nature of scientific data, data distribution systems should wholeheartedly embrace semantic technologies in order to make their data accessible to a broad array of prospective end users, and to ensure that the data they provide will be clearly understood and used appropriately by consumers. Toward this end, we propose a distribution system in which formal ontological models that accurately and comprehensively represent the ASDC's data domain, and fully leverage the expressivity and inferential capabilities of first order logic, are used to generate graph-based representations of the relevant relationships among data sets, observational systems, metadata files, and geospatial, temporal and scientific parameters to help prospective data consumers
Sutton, Stuart A.
Explores the development of the ERIC (Educational Resources Information Center) dataset and the relationship between that dataset and the disparate services that have emerged as a result of the Internet and the Web. Discusses the technical infrastructure; database content; services and resources; creating a unified knowledge base; and metadata…
Grut, Lisbet; Sanudi, Lifah; Braathen, Stine Hellum; Jürgens, Thomas; Eide, Arne H.
Tuberculosis occurs in all populations, but with higher prevalence in poor contexts. Vulnerable groups, including individuals with disability, run a particular risk due to poorer access to information and health services. Studying access to tuberculosis services for vulnerable groups in poor contexts may provide useful insight into the quality of such services in low-income contexts. This article aims to present a contextual understanding of access to tuberculosis services for people with disabilities in one district in southern Malawi. A qualitative method with semi-structured interviews and site observations was applied. In all, 89 participants were interviewed: 47 persons with disability, 11 parents/guardians of youths with disability, and the remaining 31 comprising eight health workers, four community rehabilitation assistants and volunteers, and 19 leaders in the community.Our main findings are that lack of information and knowledge, and considerable confusion related to tuberculosis, its cause and how to protect oneself, are major barrier to accessing services. Disease awareness and personal risk perception are key factors in this regard. Further findings concerns the pathways to tuberculosis related health services, in particular having a test and completing the treatment. The combination of lack of knowledge and barriers in accessing tests implies substantial availability and access problems.It is of importance to understand the combined impact of individual, social, contextual, and systems barriers to fully address the complexity of accessing tuberculosis services for vulnerable groups in poor populations. Lack of disability specific strategies in the local health services may be part of the reason why individuals with disability to not access such services. PMID:25830950
Grut, Lisbet; Sanudi, Lifah; Braathen, Stine Hellum; Jürgens, Thomas; Eide, Arne H
Tuberculosis occurs in all populations, but with higher prevalence in poor contexts. Vulnerable groups, including individuals with disability, run a particular risk due to poorer access to information and health services. Studying access to tuberculosis services for vulnerable groups in poor contexts may provide useful insight into the quality of such services in low-income contexts. This article aims to present a contextual understanding of access to tuberculosis services for people with disabilities in one district in southern Malawi. A qualitative method with semi-structured interviews and site observations was applied. In all, 89 participants were interviewed: 47 persons with disability, 11 parents/guardians of youths with disability, and the remaining 31 comprising eight health workers, four community rehabilitation assistants and volunteers, and 19 leaders in the community.Our main findings are that lack of information and knowledge, and considerable confusion related to tuberculosis, its cause and how to protect oneself, are major barrier to accessing services. Disease awareness and personal risk perception are key factors in this regard. Further findings concerns the pathways to tuberculosis related health services, in particular having a test and completing the treatment. The combination of lack of knowledge and barriers in accessing tests implies substantial availability and access problems.It is of importance to understand the combined impact of individual, social, contextual, and systems barriers to fully address the complexity of accessing tuberculosis services for vulnerable groups in poor populations. Lack of disability specific strategies in the local health services may be part of the reason why individuals with disability to not access such services.
Full Text Available Tuberculosis occurs in all populations, but with higher prevalence in poor contexts. Vulnerable groups, including individuals with disability, run a particular risk due to poorer access to information and health services. Studying access to tuberculosis services for vulnerable groups in poor contexts may provide useful insight into the quality of such services in low-income contexts. This article aims to present a contextual understanding of access to tuberculosis services for people with disabilities in one district in southern Malawi. A qualitative method with semi-structured interviews and site observations was applied. In all, 89 participants were interviewed: 47 persons with disability, 11 parents/guardians of youths with disability, and the remaining 31 comprising eight health workers, four community rehabilitation assistants and volunteers, and 19 leaders in the community.Our main findings are that lack of information and knowledge, and considerable confusion related to tuberculosis, its cause and how to protect oneself, are major barrier to accessing services. Disease awareness and personal risk perception are key factors in this regard. Further findings concerns the pathways to tuberculosis related health services, in particular having a test and completing the treatment. The combination of lack of knowledge and barriers in accessing tests implies substantial availability and access problems.It is of importance to understand the combined impact of individual, social, contextual, and systems barriers to fully address the complexity of accessing tuberculosis services for vulnerable groups in poor populations. Lack of disability specific strategies in the local health services may be part of the reason why individuals with disability to not access such services.
Plante, Raymond; Harrison, Paul; Tody, Doug
An application that queries or consumes descriptions of VO resources must be able to recognize a resource's support for standard IVOA protocols. This specification describes how to describe a service that supports any of the four fundamental data access protocols -- Simple Cone Search (SCS), Simple Image Access (SIA), Simple Spectral Access (SSA), Simple Line Access (SLA) -- using the VOResource XML encoding standard. A key part of this specification is the set of VOResource XML extension schemas that define new metadata that are specific to those protocols. This document describes in particular rules for describing such services within the context of IVOA Registries and data discovery as well as the VO Standard Interface (VOSI) and service self-description. In particular, this document spells out the essential markup needed to identify support for a standard protocol and the base URL required to access the interface that supports that protocol.
Juliana Pires Ribeiro
Full Text Available The objective of this study was to evaluate accessibility to primary health care services in the state of Goiás. A descriptive cross-sectional study was conducted based on secondary data from the National Program to Improve Access to and Quality of Primary Health Care. The study sample was composed of health professionals from 1,216 primary health care units. Results showed that 68.5% of the health units miss a screening room, thus considerably damaging prompt decision-making by professionals. The lack of medical offices in 2% of the sites hinders the primary health care services accessibility in Goiás. As regards opening hours and work shifts, 86% of the units are open five days a week in eight-hour shifts, which does not favor accessibility for users. This study confirms the lack of accessibility to health services and the need for additional investments to strengthen primary health care.
Full Text Available Seamless handover across different access technologies is very important in the future wireless networks. To optimize vertical handover in heterogeneous networks, IEEE 802.21 standard defines Media Independent Handover (MIH services. The MIH services can be a new target to attackers, which will be the main concern for equipment vendors and service providers. In this paper, we focus specifically on security of Media Independent Information Service (MIIS and present a new access authentication scheme with user anonymity for MIIS. The protocol can be used to establish a secure channel between the mobile node and the information server. Security and performance of the protocol are also analyzed in this paper.
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... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Access to information and translation... Trafficking in Persons § 1100.33 Access to information and translation services for victims of severe forms of... reasonable access to translation services and/or oral interpreter services in the event the victim is...
... telephone companies involved in a merger or acquisition. (1) Notwithstanding the requirements of § 69.3(e)(9... resulting from the merger or acquisition of telephone properties are to be made effective on the next annual access tariff filing effective date following consummation of the merger or acquisition transaction,...
Without a birth certificate, no identity card can be issued and without identity card, there is no access to formal financial services. This link seems to be trivial in industrialized countries, where the ability of the individual to participate in economic life is rarely hindered by a lack of identification. In many developing countries, however, access to financial services is often denied, because potential customers cannot be identified based upon official identity documents-a basic due d...
Full Text Available Abstract The availability of bioinformatics web-based services is rapidly proliferating, for their interoperability and ease of use. The next challenge is in the integration of these services in the form of workflows, and several projects are already underway, standardizing the syntax, semantics, and user interfaces. In order to deploy the advantages of web services with locally installed tools, here we describe a collection of proxy client tools for 42 major bioinformatics web services in the form of European Molecular Biology Open Software Suite (EMBOSS UNIX command-line tools. EMBOSS provides sophisticated means for discoverability and interoperability for hundreds of tools, and our package, named the Keio Bioinformatics Web Service (KBWS, adds functionalities of local and multiple alignment of sequences, phylogenetic analyses, and prediction of cellular localization of proteins and RNA secondary structures. This software implemented in C is available under GPL from http://www.g-language.org/kbws/ and GitHub repository http://github.com/cory-ko/KBWS. Users can utilize the SOAP services implemented in Perl directly via WSDL file at http://soap.g-language.org/kbws.wsdl (RPC Encoded and http://soap.g-language.org/kbws_dl.wsdl (Document/literal.
Oshita, Kazuki; Arakawa, Kazuharu; Tomita, Masaru
The availability of bioinformatics web-based services is rapidly proliferating, for their interoperability and ease of use. The next challenge is in the integration of these services in the form of workflows, and several projects are already underway, standardizing the syntax, semantics, and user interfaces. In order to deploy the advantages of web services with locally installed tools, here we describe a collection of proxy client tools for 42 major bioinformatics web services in the form of European Molecular Biology Open Software Suite (EMBOSS) UNIX command-line tools. EMBOSS provides sophisticated means for discoverability and interoperability for hundreds of tools, and our package, named the Keio Bioinformatics Web Service (KBWS), adds functionalities of local and multiple alignment of sequences, phylogenetic analyses, and prediction of cellular localization of proteins and RNA secondary structures. This software implemented in C is available under GPL from http://www.g-language.org/kbws/ and GitHub repository http://github.com/cory-ko/KBWS. Users can utilize the SOAP services implemented in Perl directly via WSDL file at http://soap.g-language.org/kbws.wsdl (RPC Encoded) and http://soap.g-language.org/kbws_dl.wsdl (Document/literal).
Full Text Available Abstract Background Access to health care can be described along four dimensions: geographic accessibility, availability, financial accessibility and acceptability. Geographic accessibility measures how physically accessible resources are for the population, while availability reflects what resources are available and in what amount. Combining these two types of measure into a single index provides a measure of geographic (or spatial coverage, which is an important measure for assessing the degree of accessibility of a health care network. Results This paper describes the latest version of AccessMod, an extension to the Geographical Information System ArcView 3.×, and provides an example of application of this tool. AccessMod 3 allows one to compute geographic coverage to health care using terrain information and population distribution. Four major types of analysis are available in AccessMod: (1 modeling the coverage of catchment areas linked to an existing health facility network based on travel time, to provide a measure of physical accessibility to health care; (2 modeling geographic coverage according to the availability of services; (3 projecting the coverage of a scaling-up of an existing network; (4 providing information for cost effectiveness analysis when little information about the existing network is available. In addition to integrating travelling time, population distribution and the population coverage capacity specific to each health facility in the network, AccessMod can incorporate the influence of landscape components (e.g. topography, river and road networks, vegetation that impact travelling time to and from facilities. Topographical constraints can be taken into account through an anisotropic analysis that considers the direction of movement. We provide an example of the application of AccessMod in the southern part of Malawi that shows the influences of the landscape constraints and of the modes of transportation on
Poljski, Carolyn; Quiazon, Regina; Tran, Chau
Drawing on the research and advocacy work being conducted by the Multicultural Centre for Women's Health (MCWH), a national community-based organization in Victoria, Australia, the paper analyzes female international students' experiences with accessing sexual and reproductive health information and services. Accessibility of sexual and…
Wray, Christina C.
Providing accessible library services and instruction to distance users with disabilities can seem daunting. This article, which grew out of a webinar presented by the author to the Health Science Special Interest Group of ACRL, provides practical strategies to help content creators utilize built-in accessibility features and provides a resources…
Full Text Available The presence of rationing of financial services in the developing countries is a major obstacle to achieving sustainable growth. In recent years there have been co-ordinated efforts to increase the level of financial inclusion, i.e. to reduce the supply-side constraints restricting access to finance. This paper aims to understand household's latent behaviour decision making in accessing financial services, by analysing an entry level Mzansi account in South Africa. The willingness to access financial services is not taken as given, but it is instead defined by perceptions and attitudes. The Mzansi intervention is appealing to individuals with basic but insufficient financial education. Aspirations seem to be very influential in revealing the choice of financial services and to this end, Mzansi is perceived as a pre-entry account not meeting the aspirations of individuals aiming to climb up the financial services ladder.
Main, M. L.; Foltz, D.; Firstenberg, M. S.; Bobinsky, E.; Bailey, D.; Frantz, B.; Pleva, D.; Baldizzi, M.; Meyers, D. P.; Jones, K.; Spence, M. C.; Freeman, K.; Morehead, A.; Thomas, J. D.
With high-resolution network transmission required for telemedicine, education, and guided-image acquisition, the impact of errors and transmission rates on image quality needs evaluation. METHODS: We transmitted clinical echocardiograms from 2 National Aeronautics and Space Administration (NASA) research centers with the use of Motion Picture Expert Group-2 (MPEG-2) encoding and asynchronous transmission mode (ATM) network protocol over the NASA Research and Education Network. Data rates and network quality (cell losses [CLR], errors [CER], and delay variability [CVD]) were altered and image quality was judged. RESULTS: At speeds of 3 to 5 megabits per second (Mbps), digital images were superior to those on videotape; at 2 Mbps, images were equivalent. Increasing CLR caused occasional, brief pauses. Extreme CER and CDV increases still yielded high-quality images. CONCLUSIONS: Real-time echocardiographic acquisition, guidance, and transmission is feasible with the use of MPEG-2 and ATM with broadcast quality seen above 3 Mbps, even with severe network quality degradation. These techniques can be applied to telemedicine and used for planned echocardiography aboard the International Space Station.
Gowling, Sarah; Persson, Jennie; Holt, Genevieve; Ashbourne, Sue; Bloomfield, James; Shortland, Hannah; Bate, Clare
IAPT (Improving Access to Psychological Therapies) is a national programme aimed at increasing availability of evidence based psychological therapies in the NHS. IAPT is primarily for people who have mild to moderate, common mental health difficulties such as depression, anxiety, phobias and post traumatic stress disorder (PTSD). The programme seeks to use the least intrusive method of care possible to treat people at the time when it will be of most help to them. Individuals are able to self...
Full Text Available Abstract Background The SEED integrates many publicly available genome sequences into a single resource. The database contains accurate and up-to-date annotations based on the subsystems concept that leverages clustering between genomes and other clues to accurately and efficiently annotate microbial genomes. The backend is used as the foundation for many genome annotation tools, such as the Rapid Annotation using Subsystems Technology (RAST server for whole genome annotation, the metagenomics RAST server for random community genome annotations, and the annotation clearinghouse for exchanging annotations from different resources. In addition to a web user interface, the SEED also provides Web services based API for programmatic access to the data in the SEED, allowing the development of third-party tools and mash-ups. Results The currently exposed Web services encompass over forty different methods for accessing data related to microbial genome annotations. The Web services provide comprehensive access to the database back end, allowing any programmer access to the most consistent and accurate genome annotations available. The Web services are deployed using a platform independent service-oriented approach that allows the user to choose the most suitable programming platform for their application. Example code demonstrate that Web services can be used to access the SEED using common bioinformatics programming languages such as Perl, Python, and Java. Conclusions We present a novel approach to access the SEED database. Using Web services, a robust API for access to genomics data is provided, without requiring large volume downloads all at once. The API ensures timely access to the most current datasets available, including the new genomes as soon as they come online.
... network as primary care providers (PCPs), specialists, hospitals, skilled nursing facilities, home health... services in accordance with § 422.113. (10) Prevailing patterns of community health care delivery... contracting network providers must do so consistent with the prevailing community pattern of health...
J.F. François (Joseph); I. Wooton
textabstractWe examine interaction between trade in goods and market power in domestic trade and distribution, developing a model that highlights this interaction. Theory points to an expected linkage between service sector competition and goods trade, one supported by econometrics involving import
Handa, Kozue; Dairoku, Hitoshi; Toriyama, Yoshiko
This study investigates the priority needs of museum service accessibility for visually impaired visitors. For this purpose, conjoint analysis was utilized. Four conjoint attributes of museum services were selected: A--facilities for wayfinding; B--exhibitions and collections including objects for touching, hearing, smelling, etc.; C--information…
... carrier that is not a rural telephone company under 47 U.S.C. 153(37). (5) The rate for interstate... such services by the competing ILEC or (2) The lower of: (i) The benchmark rate described in paragraph..., 2002, the benchmark rate for a CLEC's interstate switched exchange access services will be $0.025...
Mier, Sharon; Boone, Matthew; Shropshire, Sonya
Although the severity of psychological problems among college students and the demand for campus counseling services has increased, many students who could benefit from mental health services still do not access them. This article describes Community Consultation and Intervention, a program designed to support students who are unlikely to access…
... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Exemption of the Immigration and....99 Exemption of the Immigration and Naturalization Service Systems-limited access. (a) The following systems of records of the Immigration and Naturalization Service are exempt from 5 U.S.C. 552a (c) (3)...
Brown, K. E.; Newby, K.; Caley, M.; Danahay, A.; Kehal, I.
Sexual health service access is fundamental to good sexual health, yet interventions designed to address this have rarely been implemented or evaluated. In this article, pilot evaluation findings for a targeted public health behavior change intervention, delivered via a website and web-app, aiming to increase uptake of sexual health services among…
Wendy V. Norman
Full Text Available Background. Providing equitable access to the full range of reproductive health services over wide geographic areas presents significant challenges to any health system. We present a review of a service provision model which has provided improved access to abortion care; support for complex issues experienced by women seeking nonjudgmental family planning health services; and a mechanism to collect information on access barriers. The toll-free pregnancy options service (POS of British Columbia Women’s Hospital and Health Centre sought to improve access to services and overcome barriers experienced by women seeking abortion. Methods. We describe the development and implementation of a province-wide toll-free telephone counseling and access facilitation service, including establishment of a provincial network of local abortion service providers in the Canadian province of British Columbia from 1998 to 2010. Results. Over 2000 women annually access service via the POS line, networks of care providers are established and linked to central support, and central program planners receive timely information on new service gaps and access barriers. Conclusion. This novel service has been successful in addressing inequities and access barriers identified as priorities before service establishment. The service provided unanticipated benefits to health care planning and monitoring of provincial health care related service delivery and gaps. This model for low cost health service delivery may realize similar benefits when applied to other health care systems where access and referral barriers exist.
Full Text Available In Internet of Things, computing and processing of information is the core supporting. In this paper, we introduce “Service-Oriented Computing” to solve the computing and processing of information in IoT. However, a key challenge in service-oriented environment is the design of effective access control schemas.We put forward a model of Workflow -oriented Attributed Based Access Control (WABAC, and an access control framework based on WABAC model. WABAC model grants and adapts permissions to subjects according to subject atttribute, resource attribute, environment attribute and current task, meeting access control request of SOC. Using the approach presented can effectively enhance the access control security for SOC applications, and prevent the abuse of subject permissions.
Kamb, L.; Weertman, B.; Trabant, C.
To meet the data management and access challenges of EarthScope, the IRIS Data Management Center is building a broad range of new and leveraged data discovery and access services. This collection of SOAP- based and REST-style web services support both the EarthScope Data Portal and IRIS DMC's operational needs. The services provide access to station metadata, waveform inventory and data, and data products from the SPADE product archive. The EarthScope Data Portal provides a single point of access to all data and products from three EarthScope component data centers: IRIS (USArray), UNAVCO (PBO), and ICDP (SAFOD). The Portal allows users to search for EarthScope stations and data matching specific search constraints. Selected data and data products can be added to a data cart for final packaging and download to the user's machine. Defining a single common service interface for all of the EarthScope components was one of the primary challenges of the Portal's development. This poster presents the design and implementation of the IRIS data access web services as it applies to the EarthScope Portal as well as a standalone service framework for the IRIS DMC.
Maria Vieira de Lima Saintrain
Full Text Available ABSTRACT The Brazilian National Health System guarantees universal access to health services. However, this universal access is not always achieved, making relevant studies that evaluate access to health care and the way gender influence this access. Objective: Identify the influence of gender in the access to dental services and goods such as consultation, toothbrush, toothpaste and dental prostheses use in Brazil’s Northeast region. Methods: Cross-sectional, quantitative and population coverage study, with the population of Guaiuba municipality. Data were collected by Community Health Agents from July 2007 to February 2008. We used the Community Oral Health Indicator to verify the access to oral health services, oral hygiene, dental visit, use and need of dental prosthesis. Data were analyzed using SPSS 15.0 software, using the chi-square test and significance level of 5%. Results: 2581 people participated, with a mean age of 24.42 years (SD± 19, 365, with 1628 female (63.1%. Among the interviewees, 2,341 (90.7% had access to a toothbrush, 2272 (88.0% to toothpaste, and 1175 (45.5% to a dental appointment. The need for dental prosthesis was higher in women, 581 (35.7% versus 221 (23.2% men and their access [354 (60.9%] versus [96 (43.4%] with p<0.05. Conclusion: The access to health services and dental treatment presents gender as an influence factor. Women have most of the needs and benefits. The edentulism affects mostly the population with a poor access to dental prosthesis.
Altunay, Mine; /Fermilab; Byrd, Gregory T.; Brown, Doug E.; Dean, Ralph A.; /North Carolina State U.
A collaboration is a collection of services that work together to achieve a common goal. Although collaborations help when tackling difficult problems, they lead to security issues. First, a collaboration is often performed by services that are drawn from different security domains. Second, a service interacts with multiple peer services during the collaboration. These interactions are not isolated from one another--e.g., data may flow through a sequence of different services. As a result, a service is exposed to multiple peer services in varying degrees, leading to different security threats. We identify the types of interactions that can be present in collaborations, and discuss the security threats due to each type. We propose a model for representing the collaboration context so that a service can be made aware of the existing interactions. We provide an access control model for a service participating in a collaboration. We couple our access control model with a policy model, so that the access requirements from collaborations can be expressed and evaluated.
Full Text Available Abstract Background International research shows that injecting drug users (IDUs can encounter many barriers when they try to access drug treatment and other services. However, the existing literature is mostly quantitative and does not consider the kinds of factors that injectors themselves identify as enabling them to access and benefit from services. Responding to this gap in knowledge, our paper explores IDUs' own suggestions for improving service engagement and their reports of other factors enabling them to seek help. Methods Semi-structured qualitative interviews were conducted with 75 current illicit drug injectors in three geographically diverse areas of West Yorkshire, England. Recruitment was through needle exchange programmes, with additional snowball sampling to ensure inclusivity of gender, ethnicity and primary drug injected. Transcribed data were analysed thematically using Framework. Results Although participants were often satisfied with current access to services, they made three broad suggestions for improving engagement. These were: providing more services (more providers and more forms of support; better operation of existing services (including better communication systems and more flexibility around individual needs; and staffing-related improvements (particularly, less judgemental and more understanding staff attitudes. Other factors identified as important enablers of help seeking were: having supporting relationships (particularly with family members; personal circumstances/life events (especially becoming a parent; and an injector's state of mind (such as feeling motivated and positive. Conclusion A range of practical suggestions for improving IDUs' access to drug treatment and other services are identified.
Lu, Shijun; Du, Songming; Ren, Zhoupeng; Zhao, Jing; Chambers, Christina; Wang, Jinfeng; Ma, Guansheng
This study assessed the association between accessibility of catering service venues and adolescents' alcohol use over the previous 30 days. The data were collected from cross-sectional surveys conducted in 2014, 2223 students at 27 high schools in Chaoyang and Xicheng districts, Beijing using self-administered questionnaires to collect the adolescents information on socio-demographic characteristics and recent alcohol experiences. The accessibility of, and proximity to, catering service venues were summarized by weights, which were calculated by multiplication of the type-weight and the distance-weight. All sampled schools were categorized into three subgroups (low, middle, and high geographic density) based on the tertile of nearby catering service venues, and a multi-level logistic regression analysis was performed to explore variance between the school levels. Considering the setting characteristics, the catering service venues weighted value was found to account for 8.6% of the school level variance of adolescent alcohol use. The odds ratios (OR) and 95% confidence intervals (CI) of drinking over the past 30-days among adolescents with medium and high accessibility of catering service venues were 1.17 (0.86, 1.57) and 1.47 (1.06, 2.02), respectively (p catering service venues around schools in China. Results suggest that the greater accessibility of catering service venues around schools is associated with a growing risk of recent drinking.
Full Text Available This study assessed the association between accessibility of catering service venues and adolescents’ alcohol use over the previous 30 days. The data were collected from cross-sectional surveys conducted in 2014, 2223 students at 27 high schools in Chaoyang and Xicheng districts, Beijing using self-administered questionnaires to collect the adolescents information on socio-demographic characteristics and recent alcohol experiences. The accessibility of, and proximity to, catering service venues were summarized by weights, which were calculated by multiplication of the type-weight and the distance-weight. All sampled schools were categorized into three subgroups (low, middle, and high geographic density based on the tertile of nearby catering service venues, and a multi-level logistic regression analysis was performed to explore variance between the school levels. Considering the setting characteristics, the catering service venues weighted value was found to account for 8.6% of the school level variance of adolescent alcohol use. The odds ratios (OR and 95% confidence intervals (CI of drinking over the past 30-days among adolescents with medium and high accessibility of catering service venues were 1.17 (0.86, 1.57 and 1.47 (1.06, 2.02, respectively (p < 0.001 for trend test. This study addressed a gap in the adolescent drinking influence by the catering service venues around schools in China. Results suggest that the greater accessibility of catering service venues around schools is associated with a growing risk of recent drinking.
Sundaravel, Anu Swapna
The Space Physics Interactive Data Resource (SPIDR) is a web-based interactive tool developed by NOAA's National Geophysical Data Center to provide access to historical space physics datasets. These data sets are widely used by physicists for space weather modeling and predictions. Built on a distributed network of databases and application servers, SPIDR offers services in two ways: via a web page interface and via a web service interface. SPIDR exposes several SOAP-based web services that client applications implement to connect to a number of data sources for data download and processing. At present, the usage of the web services has been difficult, adding unnecessary complexity to client applications and inconvenience to the scientists who want to use these datasets. The purpose of this study focuses on improving SPIDR's web interface to better support data access, integration and display. This is accomplished in two ways: (1) examining the needs of scientists to better understand what web services they require to better access and process these datasets and (2) developing a client application to support SPIDR's SOAP-based services using the Kepler scientific workflow system. To this end, we identified, designed and developed several web services for filtering the existing datasets and created several Kepler workflows to automate routine tasks associated with these datasets. These workflows are a part of the custom NGDC build of the Kepler tool. Scientists are already familiar with Kepler due to its extensive use in this domain. As a result, this approach provides them with tools that are less daunting than raw web services and ultimately more useful and customizable. We evaluated our work by interviewing various scientists who make use of SPIDR and having them use the developed Kepler workflows while recording their feedback and suggestions. Our work has improved SPIDR such that new web services are now available and scientists have access to a desktop
Full Text Available Abstract Background High-rate pacing is a valid stress test to be used in conjunction with echocardiography; it is independent of physical exercise and does not require drug administration. There are two main applications of pacing stress in the echo lab: the noninvasive detection of coronary artery disease through induction of a regional transient dysfunction; and the assessment of contractile reserve through peak systolic pressure/ end-systolic volume relationship at increasing heart rates to assess global left ventricular contractility. Methods The pathophysiologic rationale of pacing stress for noninvasive detection of coronary artery disease is obvious, with the stress determined by a controlled increase in heart rate, which is a major determinant of myocardial oxygen demand, and thereby tachycardia may exceed a fixed coronary flow reserve in the presence of hemodynamically significant coronary artery disease. The use of pacing stress echo to assess left ventricular contractile reserve is less established, but promising. Positive inotropic interventions are mirrored by smaller end-systolic volumes and higher end-systolic pressures. An increased heart rate progressively increases the force of ventricular contraction (Bowditch treppe or staircase phenomenon. To build the force-frequency relationship, the force is determined at different heart rate steps as the ratio of the systolic pressure (cuff sphygmomanometer/end-systolic volume index (biplane Simpson rule. The heart rate is determined from ECG. Conclusion Two-dimensional echocardiography during pacing is a useful tool in the detection of coronary artery disease. Because of its safety and ease of repeatability noninvasive pacing stress echo can be the first-line stress test in patients with permanent pacemaker. The force-frequency can be defined as up- sloping (normal when the peak stress pacing systolic pressure/end-systolic volume index is higher than baseline and intermediate stress
This article describes urban women's role and access to sanitation and a safe water supply in Indonesia, and links potential improvements in women's health to improved access to urban infrastructure. In 1996, USAID discovered that morbidity was higher in female-headed households in urban areas. Female-headed households were only 6.5% of total households, but had 27% more illnesses than male-headed ones. USAID's study found that the health related problems of women were related to their poverty, illiteracy, lack of resources, and lack of access to the cleanest drinking water and wastewater disposal. Age was not a factor. Women had less access to clean drinking water, bathing, and toilet facilities. The USAID mission determined that its gender neutral approach to providing services was not reaching the neediest group. Women needed greater access to healthy urban environmental structures. The USAID shifted its erroneous assumption that female-headed households were headed by mostly old and widowed women and redesigned its infrastructure development to ensure that female-headed households received improved water and sanitation services. The USAID Mission also changed its practices by including women in planning and management of urban infrastructure services. The change was based on the belief that women decision-makers would improve how water, sanitation, and solid waste disposal services were provided. The Mission targeted 20% of its program funds for community participation of women. This effort will provide valuable insight into the role of women in urban service delivery.
Full Text Available This study integrated accessibility and location-allocation models in geographic information systems as a proposed strategy to improve the spatial planning of public health services. To estimate the spatial accessibility, we modified the two-step floating catchment area (2SFCA model with a different impedance function, a Gaussian weight for competition among service sites, a friction coefficient, distances along a street network based on the Dijkstra's algorithm and by performing a vectorial analysis. To check the accuracy of the strategy, we used the data from the public sterilization program for the dogs and cats of Bogot´a, Colombia. Since the proposed strategy is independent of the service, it could also be applied to any other public intervention when the capacity of the service is known. The results of the accessibility model were consistent with the sterilization program data, revealing that the western, central and northern zones are the most isolated areas under the sterilization program. Spatial accessibility improvement was sought by relocating the sterilization sites using the maximum coverage with finite demand and the p-median models. The relocation proposed by the maximum coverage model more effectively maximized the spatial accessibility to the sterilization service given the non-uniform distribution of the populations of dogs and cats throughout the city. The implementation of the proposed strategy would provide direct benefits by improving the effectiveness of different public health interventions and the use of financial and human resources.
Polo, Gina; Acosta, C Mera; Ferreira, Fernando; Dias, Ricardo Augusto
This study integrated accessibility and location-allocation models in geographic information systems as a proposed strategy to improve the spatial planning of public health services. To estimate the spatial accessibility, we modified the two-step floating catchment area (2SFCA) model with a different impedance function, a Gaussian weight for competition among service sites, a friction coefficient, distances along a street network based on the Dijkstra's algorithm and by performing a vectorial analysis. To check the accuracy of the strategy, we used the data from the public sterilization program for the dogs and cats of Bogot´a, Colombia. Since the proposed strategy is independent of the service, it could also be applied to any other public intervention when the capacity of the service is known. The results of the accessibility model were consistent with the sterilization program data, revealing that the western, central and northern zones are the most isolated areas under the sterilization program. Spatial accessibility improvement was sought by relocating the sterilization sites using the maximum coverage with finite demand and the p-median models. The relocation proposed by the maximum coverage model more effectively maximized the spatial accessibility to the sterilization service given the non-uniform distribution of the populations of dogs and cats throughout the city. The implementation of the proposed strategy would provide direct benefits by improving the effectiveness of different public health interventions and the use of financial and human resources.
Colucci, Erminia; Minas, Harry; Szwarc, Josef; Guerra, Carmel; Paxton, Georgia
Refugee young people have been identified as a group with high risk for mental health problems, due to their experience of trauma, forced migration, and stressors associated with settlement. A high prevalence of mental health problems is reported in this group, however some research suggests refugee young people have low rates of mental health service access. There is little information available on barriers and facilitators to mental service delivery for this group. Using data from 15 focus groups and five key informant interviews with a total of 115 service providers from 12 agencies in Melbourne, Australia, this paper explores barriers and facilitators to engaging young people from refugee backgrounds with mental health services. Eight key themes emerged: cultural concepts of mental health, illness, and treatment; service accessibility; trust; working with interpreters; engaging family and community; the style and approach of mental health providers; advocacy; and continuity of care.
Ethelwynn L. Stellenberg
Full Text Available Background: Inequalities in healthcare between population groups of South Africa existed during the apartheid era and continue to exist both between and within many population groups. Accessibility and affordability of healthcare is a human right.Objectives: The aim of the study was to explore and describe accessibility, affordability and the use of health services by the mixed race (coloured population in the Western Cape, South Africa.Method: A cross-sectional descriptive, non-experimental study with a quantitative approach was applied. A purposive convenient sample of 353 participants (0.6% was drawn from a population of 63 004 economically-active people who lived in the residential areas as defined for the purpose of the study. All social classes were represented. The hypothesis set was that there is a positive relationship between accessibility, affordability and the use of health services. A pilot study was conducted which also supported the reliability and validity of the study. Ethics approval was obtained from the University of Stellenbosch and informed consent from respondents. A questionnaire was used to collect the data.Results: The hypothesis was accepted. The statistical association between affordability (p = < 0.01, accessibility (p = < 0.01 and the use of health services was found to be significant using the Chi-square (χ² test.Conclusion: The study has shown how affordability and accessibility may influence the use of healthcare services. Accessibility is not only the distance an individual must travel to reach the health service point but more so the utilisation of these services. Continuous Quality Management should be a priority in healthcare services, which should be user-friendly.
The relationship between disability and poverty has been described in different contexts. Nevertheless, the basic characteristics of this relationship have not yet been fully established. The social exclusion and discrimination against people with disabilities increase the risk of poverty and reduce the access to basic opportunities such as health and education. This study examines the impact of a health limitation and poverty in the access to health care services in Colombia. Data from the C...
Pang, Joseph W. M.; Tobagi, Fouad A.; Boyd, Stephen
The demand for integrated services local area networks is increasing at a rapid pace with the advent of many new and exciting applications: office and factory automation, distributed computing, and multimedia communications. To support these new applications, it is imperative to integrate traffic with diverse statistical characteristics and differing delay requirements on the same network. An attractive approach for integrating traffic has been adopted in two token passing local area network standards, the IEEE 802.4 token bus standard and FDDI. The idea is to control the transmissions of each station based on a distributed timing algorithm, so as to achieve the following goals: (1) to limit the token cycles so that time-critical traffic can be accommodated, and (2) to allocate pre-specified bandwidths to different stations when the network is overloaded. We have investigated the analysis and design of this protocol. In this paper, we generalize the transmission control algorithm used previously. The major advantages of the generalization over the original protocol are: (1) it provides a much expanded design space, (2) it guarantees convergent behavior, and (3) it gives meaningful insights into the dynamics of the basic control algorithm.
Full Text Available INTRODUCTION: Numerous studies report high levels of stigma and discrimination experienced by obese/overweight women within the health care system and society at large. Despite general practice being the most utilised point of access for health care services, there is very little international or national exploration of the experiences of large-bodied women (LBW accessing these services. The aim of this study was to explore LBW's experiences of accessing general practice services in New Zealand. METHODS: This is a qualitative, descriptive, feminist study. Local advertising for participants resulted in eight self-identified, large-bodied women being interviewed. A post-structural feminist lens was applied to the data during thematic analysis. FINDINGS: The women in this study provided examples of verbal insults, inappropriate humour, negative body language, unmet health care needs and breaches of dignity from health care providers in general practice. Seven themes were identified: early experiences of body perception, confronting social stereotypes, contending with feminine beauty ideals, perceptions of health, pursuing health, respecting the whole person, and feeling safe to access care. CONCLUSION: Pressure for body size vigilance has, in effect, excluded the women in this study from the very locations of health that they are 'encouraged' to attend-including socialising and exercising in public, screening opportunities that require bodily exposure, and accessing first point of care health services.
Yoon, Jong P
The advent of smartphones in recent years has changed the wireless landscape. Smartphones have become a platform for online user interface to cloud databases. Cloud databases may provide a large set of user-private and sensitive data (i.e., objects), while smartphone users (i.e., subjects) provide location-sensitive information. Secure and private services in wireless accessing to cloud databases have been discussed actively for the past recent years. However, the previous techniques are unsatisfactory for dynamism of moving subjects' wireless accesses. In this paper, we propose a novel technique to dynamically generate virtual private databases (VPD) for each access by taking subjects' location and time information into account. The contribution of this paper includes a privacy-preserving access control mechanism for dynamism of wireless access.
It is essential for the strategy of open access self-archiving that scientific authors are given comprehensive information on publisher copyright policies. DINI, the German Initiative for Networked Information, has developed a German (and potentially multilingual) interface to the English SHERPA/RoMEO service to provide additional information on German publishers' open access policies. As a next step, this interface was enhanced to an integration layer combining different sources on publisher copyright policies. This integration layer can be used in many different contexts. Together with the SHERPA/RoMEO team, DINI aims to build an international support structure for open access information.
Full Text Available Abstract It is essential for the strategy of open access self-archiving that scientific authors are given comprehensive information on publisher copyright policies. DINI, the German Initiative for Networked Information, has developed a German (and potentially multilingual interface to the English SHERPA/RoMEO service to provide additional information on German publishers' open access policies. As a next step, this interface was enhanced to an integration layer combining different sources on publisher copyright policies. This integration layer can be used in many different contexts. Together with the SHERPA/RoMEO team, DINI aims to build an international support structure for open access information.
Meskarpour-Amiri, Mohammad; Dopeykar, Nooredin; Ameryoun, Ahmad; Mehrabi Tavana, Ali
Background: Timely access to cardiovascular health services is necessary to prevent heart damages. The present study examined inequality in geographical distribution of cardiovascular health services in Iran. Methods: Present study is a cross-sectional study conducted using demographic data from all Iranian provinces (31 provinces) from 2012 census by the Statistics Center of Iran (SCI). The Gini coefficients of CCU beds and cardiologists were used to assess equality in access to cardiovascular health services in Iran. MS Excel software was used to calculate Gini coefficients. Results: The proportions of CCU bed and cardiologist per 100,000 population were 4.88 and 1.27, respectively; also the Gini coefficients were 0.129 and 0.045, respectively. Conclusion: Descriptive statistics showed a skewness in distribution of pubic cardiovascular health services in Iran, though Gini coefficient revealed no significant inequality. However, equal distribution of CCU beds and cardiovascular specialists does not mean they are sufficiently available in Iran. PMID:28210585
Davies, Mark; Nowotka, Michał; Papadatos, George; Dedman, Nathan; Gaulton, Anna; Atkinson, Francis; Bellis, Louisa; Overington, John P
ChEMBL is now a well-established resource in the fields of drug discovery and medicinal chemistry research. The ChEMBL database curates and stores standardized bioactivity, molecule, target and drug data extracted from multiple sources, including the primary medicinal chemistry literature. Programmatic access to ChEMBL data has been improved by a recent update to the ChEMBL web services (version 2.0.x, https://www.ebi.ac.uk/chembl/api/data/docs), which exposes significantly more data from the underlying database and introduces new functionality. To complement the data-focused services, a utility service (version 1.0.x, https://www.ebi.ac.uk/chembl/api/utils/docs), which provides RESTful access to commonly used cheminformatics methods, has also been concurrently developed. The ChEMBL web services can be used together or independently to build applications and data processing workflows relevant to drug discovery and chemical biology.
Privacy-aware search of outsourced data ensures relevant data access in the untrusted domain of a public cloud service provider. Subscriber of a public cloud storage service can determine the presence or absence of a particular keyword by submitting search query in the form of a trapdoor. However, these trapdoor-based search queries are limited in functionality and cannot be used to identify secure outsourced data which contains semantically equivalent information. In addition, trapdoor-based...
Gallego, Gisselle; Dew, Angela; Lincoln, Michelle; Bundy, Anita; Chedid, Rebecca Jean; Bulkeley, Kim; Brentnall, Jennie; Veitch, Craig
In Australia and around the world, people with disability and their carers living in rural areas face additional challenges compared to their urban-dwelling counterparts. This cross-sectional study explored current access to therapy services for people with disability living in western New South Wales as reported by their primary carers. Data were collected using an online and paper survey distributed to carers, from December 2012 until June 2013. Information was sought about the carers, the person they care for, access to physiotherapy, speech pathology, occupational therapy and psychology services. A total of 166 carers participated. Respondents were mostly the carers of a son or daughter (83.6%) , the person they care for had an average age of 17.6 years (range 1-69 years) and more than half were males (56%). The majority of people with disability (73.5%) had received therapy services in the last 2 years. Waiting time and distance travelled to access physiotherapy, speech and occupational therapy services varied. People with disability had to wait an average of 6.6 months to receive speech pathology and had to travel an average of 2.6 hours to receive physiotherapy. The main provider of all services was the specialist disability government department, except for psychology, which is mainly provided in the private sector. From the carers' perspective, availability and accessibility to services are limited. Carers noted that availability of services was more restricted once people with disability reached adulthood. Lack of choice and frustration with the lack of availability of specialist disability services was reported frequently. Carers believed that timely allied health intervention prevented the development of more severe or complicated conditions that had a greater impact on carers, families, communities and the person with disabilities.
Sundari Ravindran, T K; Fonn, Sharon
A social franchise in health is a network of for-profit private health practitioners linked through contracts to provide socially beneficial services under a common brand. The early 21st century has seen considerable donor enthusiasm for promoting social franchises for the provision of reproductive health services. Based on a compendium of descriptive information on 45 clinical social franchises, located in 27 countries of Africa, Asia and Latin America, this paper examines their contribution to universal access to comprehensive reproductive health services. It finds that these franchises have not widened the range of reproductive health services, but have mainly focused on contraceptive services, and to a lesser extent, maternal health care and abortion. In many instances, coverage had not been extended to new areas. Measures taken to ensure sustainability ran counter to the objective of access for low-income groups. In almost two-thirds of the franchises, the full cost of all services had to be paid out of pocket and was unaffordable for low-income women. While standards and protocols for quality assurance were in place in all franchises, evidence on adherence to these was limited. Informal interviews with patients indicated satisfaction with services. However, factors such as difficulties in recruiting franchisees and significant attrition, franchisees' inability to attend training programmes, use of lay health workers to deliver services without support or supervision, and logistical problems with applying quality assurance tools, all raise concerns. The contribution of social franchises to universal access to reproductive health services appears to be uncertain. Continued investment in them for the provision of reproductive health services does not appear to be justified until and unless further evidence of their value is forthcoming.
Lopresti, Edmund F; Jinks, Andrew; Simpson, Richard C
Telerehabilitation (TR) services for assistive technology evaluation and training have the potential to reduce travel demands for consumers and assistive technology professionals while allowing evaluation in more familiar, salient environments for the consumer. Sixty-five consumers received TR services for augmentative and alternative communication or alternative computer access, and consumer satisfaction was compared with twenty-eight consumers who received exclusively in-person services. TR recipients rated their TR services at a median of 6 on a 6-point Likert scale TR satisfaction questionnaire, although individual responses did indicate room for improvement in the technology. Overall satisfaction with AT services was rated highly by both in-person (100% satisfaction) and TR (99% satisfaction) service recipients.
Shannon C. Treiber
Full Text Available Purpose: There is much evidence-based research proving the effectiveness of contrast echocardiography, but there are still questions and concerns about its specific uses. This study tested the effectiveness of contrast echocardiography in defining the left ventricular endocardial border. Methods: From 30 patients, a total of 60 echocardiograms –– 30 with and 30 without use of contrast –– were retrospectively reviewed by four blinded cardiologists with advanced training in echocardiography. No single cardiologist reviewed contrast and noncontrast images of the same patient. Each set of 30 echocardiograms was then studied for wall-motion scoring. Visualization of left ventricular wall segments and a global visualization confidence level of interpretation were recorded. Results: Of all wall segments (N = 510, 91% were visualized in echocardiograms with use of contrast, whereas 75% of the walls were visualized in echocardiograms without contrast (P < 0.001. Of 30 examinations, 17 contrast echocardiograms were read with high confidence compared to 6 without contrast use (P = 0.004. The number of walls visualized with contrast was increased in 18 patients (60%, whereas noncontrast echocardiograms yielded more visualized walls in 6 patients (20%, P = 0.002. Conclusions: This study demonstrates that contrast is valuable to echocardiographic imaging. Its use should be supported throughout echocardiography clinics and encouraged in certain patients for whom resting and stress echocardiography results without contrast often prove uninterpretable.
Wilson, Erin C.; Arayasirikul, Sean; Johnson, Kelly
Low access to HIV care and support has led to survival rates for transwomen that are half that of other populations at risk for HIV. Within the population, HIV disproportionately impacts African American transwomen. Interventions to increase access to HIV care and support are needed to better serve those most affected and vulnerable within the population. We conducted a study of barriers and facilitators to care and support services for African American transwomen to fill a gap in the literature to improve access for this particularly impacted population. A total of 10 in-depth interviews were conducted with African American transwomen living with HIV who lived outside the metro area of San Francisco. Three overarching thematic topics emerged-gender stigma, peer, and institutional distrust - giving insight into African American transwomen's barriers to HIV care and support services. A number of factors within these themes impacted access, such as whether organizations offered gender-related care, the geography of organizations as it relates to safe transportation and location, confidentiality and trust of peers and organizations, and trauma. Specific instrumental, institutional and emotional supports are provided that that may increase access to care and support services for African American transwomen living with HIV. PMID:24817835
While previous literature has emphasized the importance of energy and public infrastructure services for economic development, questions surrounding the implications of unequal spatial distribution in access to these resources remain, particularly in the developing country context. This dissertation provides evidence on the nature, origins and implications of this distribution uniting three strands of research from the development and political economy, regional science and energy economics fields. The dissertation unites three papers on the nature of spatial inequality of access to energy and infrastructure with further implications for conflict risk , the historical institutional and biogeographical determinants of current distribution of access to energy and public infrastructure services and the response of households to fuel price changes over time. Chapter 2 uses a novel survey dataset to provide evidence for spatial clustering of public infrastructure non-functionality at schools by geopolitical zone in Nigeria with further implications for armed conflict risk in the region. Chapter 3 investigates the drivers of the results in chapter 2, exploiting variation in the spatial distribution of precolonial institutions and geography in the region, to provide evidence for the long-term impacts of these factors on current heterogeneity of access to public services. Chapter 4 addresses the policy implications of energy access, providing the first multi-year evidence on firewood demand elasticities in India, using the spatial variation in prices for estimation.
This paper outlines elements of demand for financial services among recent Latino immigrants, summarizes key factors contributing to their financial segregation, and describes products, services and administrative practices that have been used successfully by depository institutions. Throughout the research and paper particular attention has been paid to the New England region.
van Berchum, M.; Kraaikamp, Emilie
Data Archiving and Networked Services (DANS) promotes sustained access to digital research data. For this purpose, DANS encourages researchers to archive and reuse data in a sustained form. In the online archiving system EASY research data is stored in a permanent and sustainable manner, according t
Herkenhöner, Ralph; De Meer, Hermann; Jensen, Meiko;
with trade secret protection. In this paper, we present an automated architecture to enable exercising the right of access in the domain of inter-organizational business processes based on Web Services technology. Deriving its requirements from the legal, economical, and technical obligations, we show...
H.A. ten Hove; W. Los
The EU funded project BioCASE (contract nr. EVR1-CT-2001-40017) has established a web-based information service providing researchers with unified access to biological collections in Europe while leaving control of the information with the collection holders. The BioCASE project was based on the pre
Houben, S.A.; Baken, N.; Herve, P.; Smets, R.
We examined efficiency within wireless access options for mobile devices and discovered that a classic pitfall is revisited. As with the proliferation of services in incumbents’ portfolios, leading to a number of coexisting so-called ‘stove-pipes’, we see an isomorphic phenomenon evolving in multimo
Maryland State Dept. of Education, Baltimore. Div. of Library Development and Services.
Prepared as a part of an ongoing effort to make Maryland public libraries readily accessible to the handicapped, this directory identifies equipment, services, and facilities available to library users who are confined to wheel chairs and others who have difficulty with steps or stairs. Supplied by the administrators of Maryland's 24 public…
Huis, Marloes; Hansen, Nina; Otten, Sabine; Lensink, Bernardus
Investing in women’s economic empowerment to increase gender equality and to reduce poverty are relevant goals of the United Nations. Herein offering access to microfinance services (i.e., micro loan, training) to women is considered an important means to strengthen women’s position. However, previo
Valencia-Garcia, Dellanira; Simoni, Jane M.; Alegria, Margarita; Takeuchi, David T.
Objective: We examined whether individual-level social capital--the intangible resources in a community available through membership in social networks or other social structures and perceived trust in the community--was associated with acculturation, depression and anxiety symptoms, and perceived access to services among women of Mexican…
Tolppanen, Bradley P.; Derr, Janice
The results of a recently conducted Web-based survey of Access Services department supervisors are presented in this article. The survey, which was completed by 94 respondents, identified 19 core tasks completed by student assistants and further found a high overall approval of student assistant job performance. The information generated by the…
Studer Ferreira, Lucio; Pichon, Dominique; Hatefi, Atoosa; Gomes, Andre; Dimitrova, Desislava; Braun, Torsten; Karagiannis, Georgios; Karimzadeh, Morteza; Branco, Monica; Correia, Luis M.
This paper addresses the novel notion of offering a radio access network as a service. Its components may be instantiated on general purpose platforms with pooled resources (both radio and hardware ones) dimensioned on-demand, elastically and following the pay-per-use principle. A novel architecture
Full Text Available Maternal mortality can be prevented if mothers had routine obstetric care and access to emergency obstetric services. However, in accessing healthcare most expecting mothers will have to struggle with distance and financial problems. The study sought to; assess the barriers that discourage women from accessing antenatal, delivery and postnatal services in the Cape coast Metropolis and give recommendations to inform policy. Questionnaire was administered to 150 pregnant women and nursing mothers with babies less than one year from ten communities in the Cape Coast Metropolis. An institutional questionnaire was administered at the University of Cape Coast Hospital which provides health care services to the communities. The study revealed that challenges such as money (16.7%, distance (15.4%, and the behaviour of health personnel (20% were the dominant barriers to accessing antenatal, delivery and post natal services in the Cape Cost Metropolis. These barriers lead to the inability of 14% of pregnant women and nursing mothers with babies less than one year to adhere to the minimum antenatal visitation number of 5 recommended by the Royal College of Obstetricians and Gynaecologists. Again 15.3% of these respondents were delivered by Traditional Birth Attendants and family members, whiles 5.8% were unable to adhere to the minimum postnatal visitation of two times. NGO’s and government organizations for women should organize training programmes aimed at improving the livelihood or employment for women in these communities.
The dynamics of our everyday life and the ubiquitous presence of information services create increasing demands for mobile access. Advanced mobile devices are now equipped with a sizeable screen, which opens the door to novel ways of interaction besides speech. This thesis investigates the advantage
Harris, Colleen S.
The former Associate Head of Access and Delivery Services of the North Carolina State University Libraries reports on successful use of matrix management techniques for the Circulation and Reserves unit of the department. Despite their having fallen out of favor in much of the management literature, matrix management principles are useful for…
Heradstveit Bård E
Full Text Available Abstract Background Intraosseous access (IO is a method for providing vascular access in out-of-hospital resuscitation of critically ill and injured patients when traditional intravenous access is difficult or impossible. Different intraosseous techniques have been used by our Helicopter Emergency Medical Services (HEMS since 2003. Few articles document IO use by HEMS physicians. The aim of this study was to evaluate the use of intraosseous access in pre-hospital emergency situations handled by our HEMS. Methods We reviewed all medical records from the period May 2003 to April 2010, and compared three different techniques: Bone Injection Gun (B.I.G® - Waismed, manual bone marrow aspiration needle (Inter V - Medical Device Technologies and EZ-IO® (Vidacare, used on both adults and paediatric patients. Results During this seven-year period, 78 insertion attempts were made on 70 patients. Overall success rates were 50% using the manual needle, 55% using the Bone Injection Gun, and 96% using the EZ-IO®. Rates of success on first attempt were significantly higher using the EZ-IO® compared to the manual needle/Bone Injection Gun (p Conclusions Newer intraosseous techniques may enable faster and more reliable vascular access, and this can lower the threshold for intraosseous access on both adult and paediatric patients in critical situations. We believe that all emergency services that handle critically ill or injured paediatric and adult patients should be familiar with intraosseous techniques.
Naseem, Mustafa; Shah, Altaf H; Khiyani, Muhammad Faheem; Khurshid, Zohaib; Zafar, Muhammad Sohail; Gulzar, Shabnam; AlJameel, AlBandary H.; Khalil, Hesham S.
Summary Background The prevalence of oral diseases including dental caries and periodontal conditions is remarkably higher in people with disabilities. The provision of accessible oral health services for people with learning disabilities may be challenging. Objectives The objectives of the review were to identify barriers in accessing oral health care that persists within society, enabling or disabling people with learning disabilities. Methods Using the Arksey O’Malley framework, a scoping review was conducted on PubMed/Medline, OVIDSP, and EMBASE. Studies were evaluated and short-listed based on the inclusion criteria, which consisted of: (1) study participants or population with learning disabilities, (2) aged 16 years or over, (3) reporting on access to oral health services, (4) published in the English language. Those that justified the inclusion criteria were carefully chosen after a blind peer-reviewed process when relevance and quality were debated. Results Nine studies were eventually included from searches. Tabulation of data was done under the heading of study type, outcomes, the year of publication and patient selection. The majority of studies provided a biomedical overview of access for adults with learning disabilities. Conclusions The concept of access for people with disability is still ill-defined and obscure. Access to oral health care and needs of people with learning disabilities are complex and multi-facet. PMID:28149451
Mesay Hailu Dangisso
Full Text Available Background: Despite the expansion of health services and community-based interventions in Ethiopia, limited evidence exists about the distribution of and access to health facilities and their relationship with the performance of tuberculosis (TB control programmes. We aim to assess the geographical distribution of and physical accessibility to TB control services and their relationship with TB case notification rates (CNRs and treatment outcome in the Sidama Zone, southern Ethiopia. Design: We carried out an ecological study to assess physical accessibility to TB control facilities and the association of physical accessibility with TB CNRs and treatment outcome. We collected smear-positive pulmonary TB (PTB cases treated during 2003–2012 from unit TB registers and TB service data such as availability of basic supplies for TB control and geographic locations of health services. We used ArcGIS 10.2 to measure the distance from each enumeration location to the nearest TB control facilities. A linear regression analysis was employed to assess factors associated with TB CNRs and treatment outcome. Results: Over a decade the health service coverage (the health facility–to-population ratio increased by 36% and the accessibility to TB control facilities also improved. Thus, the mean distance from TB control services was 7.6 km in 2003 (ranging from 1.8 to 25.5 km between kebeles (the smallest administrative units and had decreased to 3.2 km in 2012 (ranging from 1.5 to 12.4 km. In multivariate linear regression, as distance from TB diagnostic facilities (b-estimate=−0.25, p<0.001 and altitude (b-estimate=−0.31, p<0.001 increased, the CNRs of TB decreased, whereas a higher population density was associated with increased TB CNRs. Similarly, distance to TB control facilities (b-estimate=−0.27, p<0.001 and altitude (b-estimate=−0.30, p<0.001 were inversely associated with treatment success (proportion of treatment completed or cured cases
de Castro, Ricardo Dias; Rangel, Marianne de Lucena; da Silva, Marcos André Azevedo; de Lucena, Brunna Thaís Lucwu; Cavalcanti, Alessandro Leite; Bonan, Paulo Rogério Ferreti; Oliveira, Julyana de Araújo
The Specialized Dental Clinics (SDCs) represent the first government initiative in Latin America aimed at providing specialized oral health services. This study sought to evaluate the organizational accessibility to specialized oral health care services in Brazil and to understand the factors that may be associated with accessibility from the user's perspective. This epidemiological, cross-sectional and quantitative study was conducted by means of interviews with individuals who sought specialized public oral health services in the city of João Pessoa, Paraíba, Brazil, and consisted of a sample of 590 individuals. Users expressed a favorable view of the classification and resolutive nature of specialized services offered by Brazilian public health. The binary logistic regression analysis revealed weak points highlighting the difficulty involved in obtaining such treatments leading to unfavorable evaluations. In the resolutive nature item, difficulty in accessing the location, queues and lack of materials and equipment were highlighted as statistically significant unfavorable aspects. While many of the users considered the service to be resolutive, weaknesses were mentioned that need to be detected to promote improvements and to prevent other health models adopted worldwide from reproducing the same flaws.
de Castro, Ricardo Dias; Rangel, Marianne de Lucena; da Silva, Marcos André Azevedo; de Lucena, Brunna Thaís Lucwu; Cavalcanti, Alessandro Leite; Bonan, Paulo Rogério Ferreti; Oliveira, Julyana de Araújo
The Specialized Dental Clinics (SDCs) represent the first government initiative in Latin America aimed at providing specialized oral health services. This study sought to evaluate the organizational accessibility to specialized oral health care services in Brazil and to understand the factors that may be associated with accessibility from the user’s perspective. This epidemiological, cross-sectional and quantitative study was conducted by means of interviews with individuals who sought specialized public oral health services in the city of João Pessoa, Paraíba, Brazil, and consisted of a sample of 590 individuals. Users expressed a favorable view of the classification and resolutive nature of specialized services offered by Brazilian public health. The binary logistic regression analysis revealed weak points highlighting the difficulty involved in obtaining such treatments leading to unfavorable evaluations. In the resolutive nature item, difficulty in accessing the location, queues and lack of materials and equipment were highlighted as statistically significant unfavorable aspects. While many of the users considered the service to be resolutive, weaknesses were mentioned that need to be detected to promote improvements and to prevent other health models adopted worldwide from reproducing the same flaws. PMID:27775584
Kirsch, Peter; Breen, Paul
We wish to highlight outputs of a project conceived from a science requirement to improve discovery and access to Antarctic meteorological data in near real-time. Given that the data was distributed in both spatial and temporal domains and is to be accessed across several science disciplines, the creation of an interoperable, OGC compliant web service was deemed the most appropriate approach. We will demonstrate an implementation of the OGC SOS Interface Standard to discover, browse, and access Antarctic meteorological data-sets. A selection of programmatic (R, Perl) and web client interfaces utilizing open technologies ( e.g. jQuery, Flot, openLayers ) will be demonstrated. In addition we will show how high level abstractions can be constructed to allow the users flexible and straightforward access to SOS retrieved data.
This document concerns the award of a contract for security and access control services. The Finance Committee is invited to agree to the negotiation of a contract with ENTREPRISE TECHNIQUE DE SECURITE (FR), the lowest bidder, for the provision of security and access control services for three years for a total amount of 7 105 750 euros (11 078 466 Swiss francs), not subject to revision until 1 July 2008, with options for additional services, for an additional amount of 192 420 euros (300 000 Swiss francs), not subject to revision until 1 July 2008, bringing the total amount to 7 298 170 euros (11 378 466 Swiss francs), not subject to revision until 1 July 2008. The contract will include options for two one-year extensions beyond the initial three-year period. The rate of exchange used is that stipulated in the tender
Full Text Available Introduction: One of the most important components of emergency medical services (EMS which plays a major role in reducing mortality and disability of victims is access to healthcare services. Equitable access to healthcare services requires providing essential andaccessible services for all people without imposing any financial burden on them. The aim of this study was to determine and prioritize the components of access to EMS in Iran.Methods: This study is a descriptive and cross-sectional study that has done in the first half of 2010 in Iran using DEMATEL method. The data about the access components of EMS in different systems was collected using researcher-made questionnaire. Afterwards, a sample of30 Iranian experts in EMS who were selected using purposive sampling method were asked to evaluate the suggestions and revise the collected components using their scientific, practical and visionary experience. Then, the components were identified using Delphi method. The priority of components was depicted using MATLAB and Edraw Max 5 softwares.Results: Capitation, third party insurance, insurance for non-traffics cases, the budget of some especial organizations such as the tobacco companies, etc., distribution of facilities based on the characteristics of each region and distribution of facilities in urban areas based on the population density were determined as access components. Also, The components of third party insurance and capitation were determined as the most affecting and affected access components with the coordinates (1.44 and 1.44 and (0.09 and -0.09 respectively, on the pre-hospital emergency access components graph.Conclusion: Given the limited resources to access EMS, alternatives should be taken into consideration. Considering the high number of deaths from traffic accidents in Iran, part of car insurance premiums should be allocated to provide emergency services for people injured. Some Iranian organizations such as tobacco
Full Text Available INTRODUCTION: Literature suggests that good quality health care access can have a positive impact on the health of people with serious mental illness (SMI, but literature relating to patterns of access by this group is equivocal. AIM: This study was designed to explore health care access patterns in a group of people with SMI and to compare them with a general New Zealand population group, in order for health providers to understand how they might contribute to positive health outcomes for this group. METHODS: The study surveyed 404 mental health consumers aged 18-65 years receiving care from one district health board in Auckland about their patterns of health care access. Results were compared with those from the New Zealand Health Survey of the general population. RESULTS: Findings suggest that the SMI consumer respondents had poorer physical health than the general population respondents, accessed health care services in more complex ways and were more particular about who they accessed for their care than the general population respondents. There was some concern from SMI consumers around discrimination from health care providers. The study also suggested that some proactive management with SMI consumers for conditions such as metabolic syndrome was occurring within the health care community. DISCUSSION: The first point of access for SMI consumers with general health problems is not always the family general practitioner and so other health professionals may sometimes need to consider the mental and physical health of such consumers in a wider context than their own specialism.
We undertook a postal survey of GPs to establish their current access to radiological and endoscopic tests. More than one fifth of GPs do not have direct access to abdominal (n = 42, 21.4%) or pelvic (n = 49, 24.6%) ultrasound in the public system. Where access is available public patients have an average 14 week waiting period. In stark contrast in the private system virtually all GPs have direct access (n = 159, 99.2% and n = 156, 98.8% respectively for abdominal and pelvic ultrasound) with an average wait of just over four days. Direct access to CT scan in the public system is available to the minority of GPs, e.g. n = 31, 18.4% for chest scan, in the public system; even where available, there is an average 12 week wait for this. In comparison 151 (88.6%) GPs have access to CT chest scanning in the private sector with an average waiting time of 5.4 working days. Such limited access to diagnostics impacts on the delivery of a quality service.
Kershaw, Philip; Ananthakrishnan, Rachana; Cinquini, Luca; Lawrence, Bryan; Pascoe, Stephen; Siebenlist, Frank
Network data access services such as OPeNDAP enable widespread access to data across user communities. However, without ready means to restrict access to data for such services, data providers and data owners are constrained from making their data more widely available. Even with such capability, the range of different security technologies available can make interoperability between services and user client tools a challenge. OPeNDAP is a key data access service in the infrastructure under development to support the CMIP5 (Couple Model Intercomparison Project Phase 5). The work is being carried out as part of an international collaboration including the US Earth System Grid and Curator projects and the EU funded IS-ENES and Metafor projects. This infrastructure will bring together Petabytes of climate model data and associated metadata from over twenty modelling centres around the world in a federation with a core archive mirrored at three data centres. A security system is needed to meet the requirements of organisations responsible for model data including the ability to restrict data access to registered users, keep them up to date with changes to data and services, audit access and protect finite computing resources. Individual organisations have existing tools and services such as OPeNDAP with which users in the climate research community are already familiar. The security system should overlay access control in a way which maintains the usability and ease of access to these services. The BADC (British Atmospheric Data Centre) has been working in collaboration with the Earth System Grid development team and partner organisations to develop the security architecture. OpenID and MyProxy were selected at an early stage in the ESG project to provide single sign-on capability across the federation of participating organisations. Building on the existing OPeNDAP specification an architecture based on pluggable server side components has been developed at the BADC
Salgado, J.; Osuna, P.; Guainazzi, M.; Barbarisi, I.; Arviset, C.
In an action led by the ESA-VO project and VO-France, the International Virtual Observatory Alliance (IVOA) is defining the access to spectral line data bases, both theoretical and observational. Two standards are in development, the SLAP (Simple Line Access Protocol) document and the Atomic and Molecular Spectral Line Data Model document. The first standard defines uniform access to spectral line data bases while the second specifies a common universal language for information interchange. The SLAP and the already existing SSAP (Simple Spectrum Access Protocol), integrated into the same VO application, are a powerful combination for astronomical spectral studies. Some very well known spectral line data bases have already implemented SLAP services on their servers, e.g., the NIST Atomic Spectra Database (theoretical), LERMA (observational) or the IASD (Infrared Astronomical Spectral Database) (observational). Other projects, such as ALMA (Atacama Large Millimeter Array), are preparing their databases to be as close as possible to the Spectral Line Data Model and are planning to expose their data in SLAP format. We summarize the content of both the SLAP and AM Line Data Model documents and how these SLAP services have been integrated in VOSpec, the VO reference application for spectral access developed by the ESA-VO team.
Mold, Freda; de Lusignan, Simon
Online access to medical records and linked services, including requesting repeat prescriptions and booking appointments, enables patients to personalize their access to care. However, online access creates opportunities and challenges for both health professionals and their patients, in practices and in research. The challenges for practice are the impact of online services on workload and the quality and safety of health care. Health professionals are concerned about the impact on workload, especially from email or other online enquiry systems, as well as risks to privacy. Patients report how online access provides a convenient means through which to access their health provider and may offer greater satisfaction if they get a timely response from a clinician. Online access and services may also result in unforeseen consequences and may change the nature of the patient-clinician interaction. Research challenges include: (1) Ensuring privacy, including how to control inappropriate carer and guardian access to medical records; (2) Whether online access to records improves patient safety and health outcomes; (3) Whether record access increases disparities across social classes and between genders; and (4) Improving efficiency. The challenges for practice are: (1) How to incorporate online access into clinical workflow; (2) The need for a business model to fund the additional time taken. Creating a sustainable business model for a safe, private, informative, more equitable online service is needed if online access to records is to be provided outside of pay-for-service systems.
Coles, Daniel; Yu, Dapeng; Wilby, Robert L.; Green, Daniel; Herring, Zara
This paper describes the development of a method that couples flood modelling with network analysis to evaluate the accessibility of city districts by emergency responders during flood events. We integrate numerical modelling of flood inundation with geographical analysis of service areas for the Ambulance Service and the Fire & Rescue Service. The method was demonstrated for two flood events in the City of York, UK to assess the vulnerability of care homes and sheltered accommodation. We determine the feasibility of emergency services gaining access within the statutory 8- and 10-min targets for high-priority, life-threatening incidents 75% of the time, during flood episodes. A hydrodynamic flood inundation model (FloodMap) simulates the 2014 pluvial and 2015 fluvial flood events. Predicted floods (with depth >25 cm and areas >100 m2) were overlain on the road network to identify sites with potentially restricted access. Accessibility of the city to emergency responders during flooding was quantified and mapped using; (i) spatial coverage from individual emergency nodes within the legislated timeframes, and; (ii) response times from individual emergency service nodes to vulnerable care homes and sheltered accommodation under flood and non-flood conditions. Results show that, during the 2015 fluvial flood, the area covered by two of the three Fire & Rescue Service stations reduced by 14% and 39% respectively, while the remaining station needed to increase its coverage by 39%. This amounts to an overall reduction of 6% and 20% for modelled and observed floods respectively. During the 2014 surface water flood, 7 out of 22 care homes (32%) and 15 out of 43 sheltered accommodation nodes (35%) had modelled response times above the 8-min threshold from any Ambulance station. Overall, modelled surface water flooding has a larger spatial footprint than fluvial flood events. Hence, accessibility of emergency services may be impacted differently depending on flood mechanism
Santhana Vannan, S.; Cook, R. B.; Wei, Y.
In recent years user access to data and information is increasingly handled through tools, services, and applications. Standards-based services have facilitated this development. These service-based methods to access data has boosted the use of data and in increasingly complex ways. The Oak Ridge National Laboratory Distributed Active Archive Center (ORNL DAAC) has taken the approach of service-based access to data and visualization for distribution and visualization of its terrestrial ecology data, including MODIS (Moderate Resolution Imaging Spectroradiometer) remote sensing data products. The MODIS data products are highly useful for field research. The spectral, spatial and temporal characteristics of MODIS products have made them an important data source for analyzing key science questions relating to Earth system processes at multiple spatial and temporal scales. However, MODIS data volume and the complexity in data format make it less usable in some cases. To solve this usability issue, the ORNL DAAC has developed a system that prepares and distributes subsets of selected MODIS land products in a scale and format useful for field researchers. Web and Web service tools provide MODIS subsets in comma-delimited text format and in GIS compatible GeoTIFF format. Users can download and visualize MODIS subsets for a set of pre-defined locations, order MODIS subsets for any land location or automate the process of subset extraction using a SOAP-based Web service. The MODIS tools and services can be extended to support the large volume of data that would be produced by the various decadal survey missions. http://daac.ornl.gov/MODIS . The ORNL DAAC has also created a Web-based Spatial Data Access Tool (SDAT) that enables users to browse, visualize, and download a wide variety of geospatial data in various user-selected spatial/temporal extents, formats, and projections. SDAT is based on Open Geospatial Consortium (OGC) Web service standards that allows users to
Full Text Available Abstract Background In the past fifteen years there has been a wave of closures of small maternity services in Canada and other developed nations which results in the need for rural parturient women to travel to access care. The purpose of our study is to systematically document newborn and maternal outcomes as they relate to distance to travel to access the nearest maternity services with Cesarean section capabililty. Methods Study population is all women carrying a singleton pregnancy beyond 20 weeks and delivering between April 1, 2000 and March 31, 2004 and residing outside of the core urban areas of British Columbia. Maternal and newborn data was linked to specific geographic catchments by the B.C. Perinatal Health Program. Catchments were stratified by distance to nearest maternity service with Cesarean section capabililty if greater than 1 hour travel time or level of local service. Hierarchical logistic regression was used to test predictors of adverse newborn and maternal outcomes. Results 49,402 cases of women and newborns resident in rural catchments were included. Adjusted odds ratios for perinatal mortality for newborns from catchments greater than 4 hours from services was 3.17 (95% CI 1.45-6.95. Newborns from catchments 2 to 4 hours, and 1 to 2 hours from services generated rates of 179 and 100 NICU 3 days per thousand births respectively compared to 42 days for newborns from catchments served by specialists. Conclusions Distance matters: rural parturient women who have to travel to access maternity services have increased rates of adverse perinatal outcomes.
Eide, Arne H.; Mannan, Hasheem; Khogali, Mustafa; van Rooy, Gert; Swartz, Leslie; Munthali, Alister; Hem, Karl-Gerhard; MacLachlan, Malcolm; Dyrstad, Karin
There is an increasing awareness among researchers and others that marginalized and vulnerable groups face problems in accessing health care. Access problems in particular in low-income countries may jeopardize the targets set by the United Nations through the Millennium Development Goals. Thus, identifying barriers for individuals with disability in accessing health services is a research priority. The current study aimed at identifying the magnitude of specific barriers, and to estimate the impact of disability on barriers for accessing health care in general. A population based household survey was carried out in Sudan, Namibia, Malawi, and South Africa, including a total of 9307 individuals. The sampling strategy was a two-stage cluster sampling within selected geographical areas in each country. A listing procedure to identify households with disabled members using the Washington Group six screening question was followed by administering household questionnaires in households with and without disabled members, and questionnaires for individuals with and without disability. The study shows that lack of transport, availability of services, inadequate drugs or equipment, and costs, are the four major barriers for access. The study also showed substantial variation in perceived barriers, reflecting largely socio-economic differences between the participating countries. Urbanity, socio-economic status, and severity of activity limitations are important predictors for barriers, while there is no gender difference. It is suggested that education reduces barriers to health services only to the extent that it reduces poverty. Persons with disability face additional and particular barriers to health services. Addressing these barriers requires an approach to health that stresses equity over equality. PMID:25993307
Eide, Arne H; Mannan, Hasheem; Khogali, Mustafa; van Rooy, Gert; Swartz, Leslie; Munthali, Alister; Hem, Karl-Gerhard; MacLachlan, Malcolm; Dyrstad, Karin
There is an increasing awareness among researchers and others that marginalized and vulnerable groups face problems in accessing health care. Access problems in particular in low-income countries may jeopardize the targets set by the United Nations through the Millennium Development Goals. Thus, identifying barriers for individuals with disability in accessing health services is a research priority. The current study aimed at identifying the magnitude of specific barriers, and to estimate the impact of disability on barriers for accessing health care in general. A population based household survey was carried out in Sudan, Namibia, Malawi, and South Africa, including a total of 9307 individuals. The sampling strategy was a two-stage cluster sampling within selected geographical areas in each country. A listing procedure to identify households with disabled members using the Washington Group six screening question was followed by administering household questionnaires in households with and without disabled members, and questionnaires for individuals with and without disability. The study shows that lack of transport, availability of services, inadequate drugs or equipment, and costs, are the four major barriers for access. The study also showed substantial variation in perceived barriers, reflecting largely socio-economic differences between the participating countries. Urbanity, socio-economic status, and severity of activity limitations are important predictors for barriers, while there is no gender difference. It is suggested that education reduces barriers to health services only to the extent that it reduces poverty. Persons with disability face additional and particular barriers to health services. Addressing these barriers requires an approach to health that stresses equity over equality.
Arne H Eide
Full Text Available There is an increasing awareness among researchers and others that marginalized and vulnerable groups face problems in accessing health care. Access problems in particular in low-income countries may jeopardize the targets set by the United Nations through the Millennium Development Goals. Thus, identifying barriers for individuals with disability in accessing health services is a research priority. The current study aimed at identifying the magnitude of specific barriers, and to estimate the impact of disability on barriers for accessing health care in general. A population based household survey was carried out in Sudan, Namibia, Malawi, and South Africa, including a total of 9307 individuals. The sampling strategy was a two-stage cluster sampling within selected geographical areas in each country. A listing procedure to identify households with disabled members using the Washington Group six screening question was followed by administering household questionnaires in households with and without disabled members, and questionnaires for individuals with and without disability. The study shows that lack of transport, availability of services, inadequate drugs or equipment, and costs, are the four major barriers for access. The study also showed substantial variation in perceived barriers, reflecting largely socio-economic differences between the participating countries. Urbanity, socio-economic status, and severity of activity limitations are important predictors for barriers, while there is no gender difference. It is suggested that education reduces barriers to health services only to the extent that it reduces poverty. Persons with disability face additional and particular barriers to health services. Addressing these barriers requires an approach to health that stresses equity over equality.
Julián Vargas J
Full Text Available Objective: To understand the characteristics of access to the General System of Social Security in health (SGSS, from the perspective of doctors, nurses, administrators and users. Methodology: based on the grounded theory we present a study in six cities in Colombia: Barranquilla, Bucaramanga, Bogota, Leticia, Medellín and Pasto, for which interviews were conducted in-depth with health professionals involved in service delivery and focus groups with service users. Results: The findings indicate that insurance has become an end in itself, and being affiliated to SGSSS does not guarantee effective access to services. The dominance of the market, the financial profitability of insurers, imposed cost-containment mechanisms over the right to health. There are limitations from the rules, benefit plans that create geographical, economic and cultural barriers from the various actors involved in the chain of decisions. Additionally, display individual and institutional ethical shortcomings, clientelism and corruption in the management of resources, coupled with poverty and geographical dispersion of communities, mean that further limiting access to health services.
Bellamy, Kim; Ostini, Remo; Martini, Nataly; Kairuz, Therese
The difficulties that resettled refugees experience in accessing primary health-care services have been widely documented. In most developed countries, pharmacists are often the first health-care professional contacted by consumers; however, the ability of refugees to access community pharmacies and medication may be limited. This review systematically reviewed the literature and synthesised findings of research that explored barriers and/or facilitators of access to medication and pharmacy services for resettled refugees. This review adhered to guidelines for systematic reviews by PRISMA (preferred reporting items for systematic reviews and meta-analyses). Databases were searched during March 2014 and included Scopus, ProQuest Sociological Abstracts, PubMed, Embase and APAIS Health. The Australian and International grey literature was also explored. Nine studies met the quality and inclusion criteria. The research reported in seven of the nine studies was conducted in the US, one was conducted in Australia and the other in the UK. The majority of studies focussed on South-east Asian refugees. Themes identified across the studies included language and the use of interpreters; navigating the Western health-care system; culture and illness beliefs; medication non-adherence; use of traditional medicine; and family, peer and community support. There is a significant paucity of published research exploring barriers to medication and pharmacy services among resettled refugees. This systematic review highlights the need for appropriate interpreting and translation services, as well as pharmacy staff demonstrating effective cross-cultural communication skills.
Full Text Available Private sector is recognized as the driving force and the engine for economic growth in many countries. It delivers important goods and services, provides jobs, generates revenue for public sector, and creates and maintains infrastructure. SMEs in particular create jobs and lead to more equitable distribution of incomes. In Uzbekistan the share of SMEs in GDP steadily increased from 30% in 2000 to 54% in 2012. The sector accounts for 75% of total employment in the country and it is forecasted that SMEs will add around half a million of new jobs in 2013.Despite these improvements, SMEs’ productivity and competitiveness potential have been affected by regulatory and institutional constraints. Access to adequate financial services is a key component for sustainable growth of the private sector, economic diversification and creation of more and better jobs. Adequate access to finance includes not only bank loans, but also a host of financing instruments that are geared to meet the diverse needs of enterprises and entrepreneurs with different characteristics and profiles. In addition, access to a broader range of efficient and reliable financial services, including electronic payment services, enables enterprises to manage the financial resources available to them more effectively.
Vegas Olmos, Juan José; Pang, Xiaodan; Lebedev, Alexander
. In this paper, we will present the Marie Curie Framework Program 7 project “Wireless and wireline service convergence in next generation optical access networks” (WISCON), which focuses on the conception and study of novel architectures for wavelength-division-multiplexing (WDM) optical multi-modulation format...... radio-over-fiber (RoF) systems; this is a promising solution to implement broadband seamless wireless -wireline access networks. This project successfully concluded in autumn 2013, and is being follow up by another Marie Curie project entitled “flexible edge nodes for dynamic optical interconnection...
Full Text Available This article discusses the role of social networks and sociability in poor people's access to goods and services obtained from outside the markets. The article uses qualitative information from research into social networks of poor individuals living in segregated places in São Paulo, as well as a control group of middle-class individuals. The results show the importance of networks and suggest that the help that mediates such access depends upon the types of ties and trust involved, as well as the cost of providing the help. The observed processes tend to reiterate inequalities, establishing circularities of poverty reproduction.
Full Text Available Abstract Background Immigration is not a new phenomenon but, rather, has deep roots in human history. Documents from every era detail individuals who left their homelands and struggled to reestablish their lives in other countries. The aim of this study was to explore and understand the experience of Iranian immigrants who accessed Canadian health care services. Research with immigrants is useful for learning about strategies that newcomers develop to access health care services. Methods The research question guiding this study was, “What are the processes by which Iranian immigrants learn to access health care services in Canada?” To answer the question, a constructivist grounded theory approach was applied. Initially, unstructured interviews were conducted with 17 participants (11 women and six men who were adults (at least 18 years old and had immigrated to Canada within the past 15 years. Eight participants took part in a second interview, and four participants took part in a third interview. Results Using a constructivist grounded theory approach, “tackling the stumbling blocks of access” emerged as the core category. The basic social process (BSP, becoming self-sufficient, was a transitional process and had five stages: becoming a stranger; feeling helpless; navigating/seeking information; employing strategies; and becoming integrated and self-sufficient. We found that “tackling the stumbling blocks of access” was the main struggle throughout this journey. Some of the immigrants were able to overcome these challenges and became proficient in accessing health care services, but others were unable to make the necessary changes and thus stayed in earlier stages/phases of transition, and sometimes returned to their country of origin. Conclusion During the course of this journey a substantive grounded theory was developed that revealed the challenges and issues confronted by this particular group of immigrants. This process explains
Ksairi, Nassar; Tomasin, Stefano; Debbah, Mérouane
We propose a novel multiple-access technique to overcome the shortcomings of the current proposals for the future releases of Long-Term Evolution (LTE). We provide a unified radio access system that efficiently and flexibly integrates both traditional cellular services and machine-to-machine (M2M) connections arising from Internet-of-Things (IoT) applications. The proposed solution, referred to as multi-service oriented multiple access (MOMA), is based on a) establishing separate classes of u...
Background Improving access to safe abortion is an essential strategy in the provision of universal access to reproductive health care. Australians are largely supportive of the provision of abortion and its decriminalization. However, the lack of data and the complex legal and service delivery situation impacts upon access for women seeking an early termination of pregnancy. There are no systematic reviews from a health services perspective to help direct health planners and policy makers to...
Keceli, Feyza; Ayanoglu, Ender
When the stations in an IEEE 802.11 infrastructure Basic Service Set (BSS) employ Transmission Control Protocol (TCP) in the transport layer, this exacerbates per-flow unfair access which is a direct result of uplink/downlink bandwidth asymmetry in the BSS. We propose a novel and simple analytical model to approximately calculate the per-flow TCP congestion window limit that provides fair and efficient TCP access in a heterogeneous wired-wireless scenario. The proposed analysis is unique in that it considers the effects of varying number of uplink and downlink TCP flows, differing Round Trip Times (RTTs) among TCP connections, and the use of delayed TCP Acknowledgment (ACK) mechanism. Motivated by the findings of this analysis, we design a link layer access control block to be employed only at the Access Point (AP) in order to resolve the unfair access problem. The novel and simple idea of the proposed link layer access control block is employing a congestion control and filtering algorithm on TCP ACK packets...
Full Text Available Abstract-Broadband access networks have become an essential part of worldwide communication systems because of the exponential growth of broadband services such as video on demand high definition TV internet protocol TV and video conferencing. Exponential growth in the volume of wireless data boosted by the growing popularity of mobile devices such as smartphone and tablets has forced the telecommunication industries to rethink the way networks are currently designed and to focus on the development of high-capacity mobile broadband networks. In response to this challenge researchers have been working toward the development of an integrated wireless optical broadband access network. Two major candidate technologies which are currently known for their high capacity as well as quality of service QoS for multimedia traffic are passive optical networks PON and fourth generation 4G wireless networks. PON is a wired access technology well known for its cost efficiency and high capacity whereas 4G is a wireless broadband access technology which has achieved broad market acceptance because of its ease of deployment ability to offer mobility and its cost efficiency. Integration of PON and 4G technologies in the form of wireless-optical broadband access networks offers advantages such as extension of networks in rural areas support for mobile broadband services and quick deployment of broadband networks. These two technologies however have different design architectures for handling broadband services that require quality of service. For example 4G networks use traffic classification for supporting different QoS demands whereas the PON architecture has no such mechanism to differentiate between types of traffic. These two technologies also differ in their power saving mechanisms. Propose a service class mapping for the integrated PON-4G network which is based on the MG1 queuing model and class-based power saving mechanism which significantly improves the
Quinn, P.; Pilone, D.
A host of new services are revolutionizing discovery, visualization, and access of NASA's Earth science data holdings. At the same time, web browsers have become far more capable and open source libraries have grown to take advantage of these capabilities. Earthdata Search is a web application which combines modern browser features with the latest Earthdata services from NASA to produce a cutting-edge search and access client with features far beyond what was possible only a couple of years ago. Earthdata Search provides data discovery through the Common Metadata Repository (CMR), which provides a high-speed REST API for searching across hundreds of millions of data granules using temporal, spatial, and other constraints. It produces data visualizations by combining CMR data with Global Imagery Browse Services (GIBS) image tiles. Earthdata Search renders its visualizations using custom plugins built on Leaflet.js, a lightweight mobile-friendly open source web mapping library. The client further features an SVG-based interactive timeline view of search results. For data access, Earthdata Search provides easy temporal and spatial subsetting as well as format conversion by making use of OPeNDAP. While the client hopes to drive adoption of these services and standards, it provides fallback behavior for working with data that has not yet adopted them. This allows the client to remain on the cutting-edge of service offerings while still boasting a catalog containing thousands of data collections. In this session, we will walk through Earthdata Search and explain how it incorporates these new technologies and service offerings.
Ana Cléia Margarida Tonhá
Full Text Available The aim of this study was to analyze people's perception on the access to health services in the southern outskirts of the Integrated Region for the Development of the Federal District (RIDE/DF, as per its acronym in Portuguese. A descriptive, cross-sectional, epidemiological and population-based study with a household survey design was carried out in 2010 and 2011. A semi-structured questionnaire, previously validated, was applied. A total of 605 individuals who lived in the southern outskirts of the Federal District were interviewed, of which 311 (51.4% were female, 215 (35.8% had incomplete primary education, 163 (40.9% sought health services in Primary Care Units and 166 (45.5% sought health services in another municipality. Access to health services in the region is influenced by social and economic conditions and by the place of living. These findings allow managers to better study the setting, review care services provided and meet health needs of that population.
Candey, R. M.; Bilitza, D.; Chimiak, R.; Cooper, J. F.; Garcia, L. N.; Harris, B. T.; Hills, H. K.; Johnson, R. C.; Kovalick, T. J.; Lal, N.; Leckner, H. A.; Liu, M. H.; McGuire, R. E.; Papitashvili, N. E.; Roberts, D. A.; Yurow, R. E.
The primary data and orbit services of NASA's Space Physics Data Facility (SPDF) now or soon to be supporting direct and correlative analysis of MMS survey and burst science data products are discussed in the McGuire et.al. paper "SPDF Data and Orbit Services Supporting Open Access, Use and Archiving of MMS Data." This present paper will review additional services and elements of the SPDF program relevant to SPDF's support of MMS and SPDF's broader long-term role as an active heliophysics final archive. Specific topics include - Additional detail on options and APIs for accessing data in SPDF; - Status and plans for the Common Data Format (CDF) and ISTP/SPDF metadata standard, including extension of the metadata standard to planned science data in netCDF from the upcoming GOLD and ICON missions; - Future missions to be supported by SPDF; - Overview and status of MMS and other data descriptions in the Heliophysics Data Portal (HDP)/Virtual Space Physics Observatory (VSPO) - Status and plans for the OMNI database and services, as baseline solar wind data for interpreting magnetospheric data such as that of MMS; - An overview of SPDF's ingest and archiving architecture, including our ongoing effort to bring online legacy heliophysics data originally archived at NSSDC. All SPDF data and services are available from the SPDF home page at http://spdf.gsfc.nasa.gov .
Due to the continued incidents and growing security risks associated with the service, access to CERN using the VPN (Virtual Private Network) service will be discontinued as of Tuesday, 29 January 2008. In addition, new registrations are no longer accepted. For further information see: http://cern.ch/security/vpn. Users are requested to stop using VPN immediately and to start to use the recommended alternative methods for connecting to CERN from the Internet. An outline of these methods and a set of FAQs are available at: http://cern.ch/security/Internet IT Department
Due to the continued incidents and growing security risks from the service, access to CERN using the VPN (Virtual Private Network) service will be discontinued on Tuesday 29th January 2008. In addition, new registrations will no longer be accepted. Further information is linked from: http://cern.ch/security/vpn Users are requested to stop using VPN immediately and start using the recommended alternative methods for connecting to CERN from the Internet. These are outlined together with a set of FAQs at: http://cern.ch/security/Internet IT Department
Cristina Livia Iancu
Full Text Available This paper presents a solution for accessing web services in a light-secure way. Because the payload of the messages is not so sensitive, it is taken care only about protecting the user name and the password used for authentication and authorization into the web services system. The advantage of this solution compared to the common used SSL is avoiding the overhead related to the handshake and encryption, providing a faster response to the clients. The solution is intended for Windows machines and is developed using the latest stable Microsoft technologies.
Nieto Masot Ana
Full Text Available As the competent laws on Health and Education of the Extremaduran Government read, all the Extremaduran people have the right to their benefits, irrespective of their social, economic and cultural characteristics. Nevertheless, in the Region of Extremadura there are still differences between the rural and urban areas, so, studying how the Extremaduran people can access, with the same conditions, to those services considered basic, such as health and education, is very significant. Using techniques as Network Analyst and the interpolation method IDW, we can note that in Extremadura there are still zones with a very-far- from- laws reality, rural areas with a difficult access to the named services and equipment due to the location on low developed in population and economy areas, and very far from the main communication roads
Joo, Young-Sang; Park, Chang-Gyu; Kim, Seok-Hun; Lee, Jae-Han
The conceptual design of in-service inspection (ISI) and repair for KALIMER-600 reactor system and components has been performed. The basic concept and strategy of ISI and repair has been described for considering the design characteristics of KALIMER-600 and the intents of the ASME XI Division 3. The postulated failure defects for main components and structures are estimated and evaluated for KALIMER-600 safety and reliability. The assessment of the ISI performance, accessibility and maintainability has been analyzed and reviewed.
Full Text Available Background and Objectives: Citizens choose their health care services not only depending on their needs, but also on where they are located. The location of the services is especially important in the case of mental health due to the specific features of mental disorders. This article provides an analysis of temporal access by road to outpatient mental health centres in Andalusia (Spain with a view to improving accessibility for the greatest volume of population possible. Methods: Firstly, accessibility by road to the outpatient mental health centres was calculated in terms of time by establishing journey times using the ArcGIS Geographical Information System´s (GIS Network Analyst module. These journey times by road enabled travel times to be established for these sections, temporal accessibility areas to be plotted from each of the outpatient mental health centres and the number of people included in each accessibility area to be calculated. Results: The accessibility analysis enabled the sitting of the centres to be evaluated for 2006, a comparison to be made with 2011 (with six new facilities having been set up since 2006 and new locations for the siting of these six new facilities to be proposed. Conclusions: This study has enabled the optimum territorial locations to be proposed for the six mental health centres created between 2006 and 2011 that would allow travel times to be reduced for the greatest numbers of people possible. It can be stated on the basis of this study that, if territorial criteria had been taken into account, 97,720 inhabitants would have seen their travel times to their nearest mental health centres reduced using the same resources.
Tobia, R C; Bierschenk, N F; Knodel, L C; Bowden, V M
A project to increase access to drug and biomedical information through electronic linkage of drug information and library services to three patient-care areas is described. In February 1987, microcomputer work stations were installed in the Bexar County Hospital District's hospital emergency department, medical residents' office, and ambulatory-care clinic, as well as in The University of Texas Health Science Center's library reference area and drug information service office. Drug information was available on compact disk through the Micromedex Computerized Clinical Information System (CCIS) database, which includes DRUGDEX, POISINDEX, EMERGINDEX, and IDENTIDEX. Each work station was also connected to the library's computer via modem, allowing access to the Library Information System, books, journals, audiovisual materials, miniMEDLINE, and an electronic mail system. During the six-month project, the system was used 5487 times by 702 people. The system was successful in providing drug and other information in clinical settings and in introducing clinical staff members to new information technology. To increase access to the system after the project ended, the CD-ROM version was discontinued, and the distributed tape version of CCIS for VAX computers was added to the library's online information system, making drug information more available throughout the campus and teaching hospitals. In 1988-89 an average of 200 people accessed the tape version of CCIS each month. Although it is difficult to replace the convenience of an onsite library, at least some drug and biomedical information needs in the clinical setting can be met through computer networking.
Tansley, Gavin; Schuurman, Nadine; Amram, Ofer; Yanchar, Natalie
Injury is a leading cause of the global disease burden, accounting for 10 percent of all deaths worldwide. Despite 90 percent of these deaths occurring in low and middle-income countries (LMICs), the majority of trauma research and infrastructure development has taken place in high-income settings. Furthermore, although accessible services are of central importance to a mature trauma system, there remains a paucity of literature describing the spatial accessibility of emergency services in LMICs. Using data from the Service Provision Assessment component of the Demographic and Health Surveys of Namibia and Haiti we defined the capabilities of healthcare facilities in each country in terms of their preparedness to provide emergency services. A Geographic Information System-based network analysis method was used to define 5- 10- and 50-kilometer catchment areas for all facilities capable of providing 24-hour care, higher-level resuscitative services or tertiary care. The proportion of a country's population with access to each level of service was obtained by amalgamating the catchment areas with a population layer. A significant proportion of the population of both countries had poor spatial access to lower level services with 25% of the population of Haiti and 51% of the population of Namibia living further than 50 kilometers from a facility capable of providing 24-hour care. Spatial access to tertiary care was considerably lower with 51% of Haitians and 72% of Namibians having no access to these higher-level services within 50 kilometers. These results demonstrate a significant disparity in potential spatial access to emergency services in two LMICs compared to analogous estimates from high-income settings, and suggest that strengthening the capabilities of existing facilities may improve the equity of emergency services in these countries. Routine collection of georeferenced patient and facility data in LMICs will be important to understanding how spatial access
... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Must information and reservation services... Must information and reservation services of carriers be accessible to individuals with hearing impairments? (a) If, as a carrier, you provide telephone reservation and information service to the...
Full Text Available This work presents an architecture to help designing and deploying smart mobility applications. The proposed solution builds on the experience already matured by the authors in different fields: crowdsourcing and sensing done by users to gather data related to urban barriers and facilities, computation of personalized paths for users with special needs, and integration of open data provided by bus companies to identify the actual accessibility features and estimate the real arrival time of vehicles at stops. In terms of functionality, the first “monolithic” prototype fulfilled the goal of composing the aforementioned pieces of information to support citizens with reduced mobility (users with disabilities and/or elderly people in their urban movements. In this paper, we describe a service-oriented architecture that exploits the microservices orchestration paradigm to enable the creation of new services and to make the management of the various data sources easier and more effective. The proposed platform exposes standardized interfaces to access data, implements common services to manage metadata associated with them, such as trustworthiness and provenance, and provides an orchestration language to create complex services, naturally mapping their internal workflow to code. The manuscript demonstrates the effectiveness of the approach by means of some case studies.
Sandra Lúcia Vieira Ulinski Aguilera
Full Text Available The aim of this study was to identify and analyze inequities in the access to specialized services in the municipalities of the metropolitan area of Curitiba, Paraná, Brazil. This is an ecological study. In its preparatory stage, this study focused on the socioeconomic, epidemiologic, healthcare network and sectoral financing network profiles of the 26 municipalities comprising this area. Factor analysis was employed to obtain the six principal components, and a synthetic index was calculated from them, allowing municipalities to be ranked according to living conditions and health situation. Primary data was collected from 24 municipalities, regarding their capacity, directed and repressed demand of specialized healthcare services. The context analysis revealed accentuated intermunicipal inequities. The synthetic index allowed municipalities to be classified in four relatively homogeneous groups regarding living and health conditions. Municipalities located in Vale do Ribeira obtained the worse outcomes for the Living Conditions and Health Situation Synthetic Index, as well as the higher repressed demand for specialized healthcare services. The geographical distance from the capital showed to contribute to worse living and health conditions and greater difficulties in access to healthcare services.
Kannan, Jayanthkumar; Chun, Byung-Gon
This paper introduces the notion of a secure data capsule, which refers to an encapsulation of sensitive user information (such as a credit card number) along with code that implements an interface suitable for the use of such information (such as charging for purchases) by a service (such as an online merchant). In our capsule framework, users provide their data in the form of such capsules to web services rather than raw data. Capsules can be deployed in a variety of ways, either on a trusted third party or the user's own computer or at the service itself, through the use of a variety of hardware or software modules, such as a virtual machine monitor or trusted platform module: the only requirement is that the deployment mechanism must ensure that the user's data is only accessed via the interface sanctioned by the user. The framework further allows an user to specify policies regarding which services or machines may host her capsule, what parties are allowed to access the interface, and with what parameter...
Pervez, Zeeshan; Ahmad, Mahmood; Khattak, Asad Masood; Lee, Sungyoung; Chung, Tae Choong
Privacy-aware search of outsourced data ensures relevant data access in the untrusted domain of a public cloud service provider. Subscriber of a public cloud storage service can determine the presence or absence of a particular keyword by submitting search query in the form of a trapdoor. However, these trapdoor-based search queries are limited in functionality and cannot be used to identify secure outsourced data which contains semantically equivalent information. In addition, trapdoor-based methodologies are confined to pre-defined trapdoors and prevent subscribers from searching outsourced data with arbitrarily defined search criteria. To solve the problem of relevant data access, we have proposed an index-based privacy-aware search methodology that ensures semantic retrieval of data from an untrusted domain. This method ensures oblivious execution of a search query and leverages authorized subscribers to model conjunctive search queries without relying on predefined trapdoors. A security analysis of our proposed methodology shows that, in a conspired attack, unauthorized subscribers and untrusted cloud service providers cannot deduce any information that can lead to the potential loss of data privacy. A computational time analysis on commodity hardware demonstrates that our proposed methodology requires moderate computational resources to model a privacy-aware search query and for its oblivious evaluation on a cloud service provider. PMID:27571421
Pervez, Zeeshan; Ahmad, Mahmood; Khattak, Asad Masood; Lee, Sungyoung; Chung, Tae Choong
Privacy-aware search of outsourced data ensures relevant data access in the untrusted domain of a public cloud service provider. Subscriber of a public cloud storage service can determine the presence or absence of a particular keyword by submitting search query in the form of a trapdoor. However, these trapdoor-based search queries are limited in functionality and cannot be used to identify secure outsourced data which contains semantically equivalent information. In addition, trapdoor-based methodologies are confined to pre-defined trapdoors and prevent subscribers from searching outsourced data with arbitrarily defined search criteria. To solve the problem of relevant data access, we have proposed an index-based privacy-aware search methodology that ensures semantic retrieval of data from an untrusted domain. This method ensures oblivious execution of a search query and leverages authorized subscribers to model conjunctive search queries without relying on predefined trapdoors. A security analysis of our proposed methodology shows that, in a conspired attack, unauthorized subscribers and untrusted cloud service providers cannot deduce any information that can lead to the potential loss of data privacy. A computational time analysis on commodity hardware demonstrates that our proposed methodology requires moderate computational resources to model a privacy-aware search query and for its oblivious evaluation on a cloud service provider.
Gupta, V.; Gupta, N.; Gupta, S.; Field, E.; Maechling, P.
hosted these Web Services as a part of the SCEC Community Modeling Environment (SCEC/CME) ITR Project (http://www.scec.org/cme). We have implemented Web Services for several of the reasons sited previously. For example, we implemented a FORTRAN-based Earthquake Rupture Forecast (ERF) as a Web Service for use by client computers that don't support a FORTRAN runtime environment. We implemented a Generic Mapping Tool (GMT) Web Service for use by systems that don't have local access to GMT. We implemented a Hazard Map Calculator Web Service to execute Hazard calculations that are too computationally intensive to run on a local system. We implemented a Coordinate Conversion Web Service to enforce a standard and consistent method for converting between UTM and Lat/Lon. Our experience developing these services indicates both strengths and weakness in current Web Service technology. Client programs that utilize Web Services typically need network access, a significant disadvantage at times. Programs with simple input and output parameters were the easiest to implement as Web Services, while programs with complex parameter-types required a significant amount of additional development. We also noted that Web services are very data-oriented, and adapting object-oriented software into the Web Service model proved problematic. Also, the Web Service approach of converting data types into XML format for network transmission has significant inefficiencies for some data sets.
Full Text Available Abstract Background This paper explores the geographical accessibility of health services in urban and rural areas of the South West of England, comparing two measures of geographical access and characterising the areas most remote from hospitals. Straight-line distance and drive-time to the nearest general practice (GP and acute hospital (DGH were calculated for postcodes and aggregated to 1991 Census wards. The correlation between the two measures was used to identify wards where straight-line distance was not an accurate predictor of drive-time. Wards over 25 km from a DGH were classified as 'remote', and characterised in terms of rurality, deprivation, age structure and health status of the population. Results The access measures were highly correlated (r2>0.93. The greatest differences were found in coastal and rural wards of the far South West. Median straight-line distance to GPs was 1 km (IQR = 0.6–2 km and to DGHs, 12 km (IQR = 5–19 km. Deprivation and rates of premature limiting long term illness were raised in areas most distant from hospitals, but there was no evidence of higher premature mortality rates. Half of the wards remote from a DGH were not classed as rural by the Office for National Statistics. Almost a quarter of households in the wards furthest from hospitals had no car, and the proportion of households with access to two or more cars fell in the most remote areas. Conclusion Drive-time is a more accurate measure of access for peripheral and rural areas. Geographical access to health services, especially GPs, is good, but remoteness affects both rural and urban areas: studies concentrating purely on rural areas may underestimate geographical barriers to accessing health care. A sizeable minority of households still had no car in 1991, and few had more than one car, particularly in areas very close to and very distant from hospitals. Better measures of geographical access, which integrate public and private transport
Kershaw, Philip; Lawrence, Bryan; Lowe, Dominic; Norton, Peter; Pascoe, Stephen
CEDA (Centre for Environmental Data Archival) based at STFC Rutherford Appleton Laboratory is host to the BADC (British Atmospheric Data Centre) and NEODC (NERC Earth Observation Data Centre) with data holdings of over half a Petabyte. In the coming months this figure is set to increase by over one Petabyte through the BADC's role as one of three data centres to host the CMIP5 (Coupled Model Intercomparison Project Phase 5) core archive of climate model data. Quite apart from the problem of managing the storage of such large volumes there is the challenge of collating the data together from the modelling centres around the world and enabling access to these data for the user community. An infrastructure to support this is being developed under the US Earth System Grid (ESG) and related projects bringing together participating organisations together in a federation. The ESG architecture defines Gateways, the web interfaces that enable users to access data and data serving applications organised into Data Nodes. The BADC has been working in collaboration with US Earth System Grid team and other partners to develop a security system to restrict access to data. This provides single sign-on via both OpenID and PKI based means and uses role based authorisation facilitated by SAML and OpenID based interfaces for attribute retrieval. This presentation will provide an overview of the access control architecture and look at how this has been implemented for CEDA. CEDA has developed an expertise in data access and information services over several years through a number of projects to develop and enhance these capabilities. Participation in CMIP5 comes at a time when a number of other software development activities are coming to fruition. New services are in the process of being deployed alongside services making up the system for ESG. The security system must apply access control across this heterogeneous environment of different data services and technologies. One strand
Thepaut, Jean-Noel; Dee, Dick
In November 2014, The European Centre for Medium-range Weather Forecasts (ECMWF) signed an agreement with the European Commission to deliver two of the Copernicus Earth Observation Programme Services on the Commission's behalf. The ECMWF delivered services - the Copernicus Climate Change Service (C3S) and Atmosphere Monitoring Service (CAMS) - will bring a consistent standard to how we monitor and predict atmospheric conditions and climate change. They will maximise the potential of past, current and future earth observations - ground, ocean, airborne, satellite - and analyse these to monitor and predict atmospheric conditions and in the future, climate change. With the wealth of free and open data that the services provide, they will help business users to assess the impact of their business decisions and make informed choices, delivering a more energy efficient and climate aware economy. These sound investment decisions now will not only stimulate growth in the short term, but reduce the impact of climate change on the economy and society in the future. C3S is in its proof of concept phase and through its Climate Data Store will provide • global and regional climate data reanalyses; • multi-model seasonal forecasts; • customisable visual data to enable examination of wide range of scenarios and model the impact of changes; • access to all the underlying data, including climate data records from various satellite and in-situ observations. In addition, C3S will provide key indicators on climate change drivers (such as carbon dioxide) and impacts (such as reducing glaciers). The aim of these indicators will be to support European adaptation and mitigation policies in a number of economic sectors. At the heart of the Service is the provision of open access to a one stop shop (the Climate Data Store) of climate data and modelling, analysing more than 20 Essential Climate Variables to build a global picture of our past, present and future climate and developing
Doczi, Julian, Dorr, Tobias; Mason, Nathaniel; Scott, Andrew
In this new working paper, the authors focus specifically on what would be necessary to achieve High Level Panel-style goals and targets for water, energy and transport, if these were to be eventually adopted by world leaders. In all three cases, much of the advocacy - and the proposed High Level Panel goals - have emphasized the need to strive for universal and sustainable access to at least basic levels of services from these sectors. Many of the proposals for post-2015 goals and targets appear ambitious, but what would it take to achieve them? This paper assesses what is needed to achieve goals for universal and sustainable access to infrastructure, specifically water, energy and transport. Using illustrative goals and targets, the paper reviews the development challenges in each sector, and what will be necessary to overcome the barriers to universal and sustainable access to water, energy and transport infrastructure services, in the areas of governance, finance, capacity development and environmental protection. The paper ends with general conclusions about infrastructure in the post-2015 development agenda.
Guimarães, Luisa; Giovanella, Lígia
This article explores the health policy repercussions of countries' regional integration into the European Union. The aim is to review the regulation of access in other countries, with the conclusion of the single European market and the free circulation of persons, services, goods, and capital. The article begins by reviewing the various forms of integration and describes the expansion and institutionalization of Community agencies. The repercussions of European integration on health policies and regulation of access are analyzed. Market impacts on health result from Treaty directives and internal policy adjustments to free circulation. Health services access is gradually regulated and granted by rulings. Projects along borders illustrate the dynamics where differences are used to achieve comprehensive care. In the oldest integration experience, the market regulation has generated intentional and non-intentional impacts on the health policies of member states, regardless of the organizational model. Knowledge and analysis of this experience signals challenges for the Southern Cone Common Market (Mercosur) and adds to future debates and decisions.
Thin Zaw Phyu Phyu
Full Text Available Abstract Background Inequity of accessibility to and utilization of reproductive health (RH services among youths is a global concern, especially in resource-limited areas. The level of inequity also varies by cultural and socio-economic contexts. To tailor RH services to the needs of youths, relevant solutions are required. This study aimed to assess baseline information on access to and utilization of RH services and unmet needs among youths living in resource-limited, suburban communities of Mandalay City, Myanmar. Methods A community-based, cross-sectional study was conducted in all resource-limited, suburban communities of Mandalay City, Myanmar. A total of 444 randomly selected youths aged between 15 and 24 years were interviewed for three main outcomes, namely accessibility to and utilization of RH services and youth's unmet needs for these services. Factors associated with these outcomes were determined using multivariate logistic regression. Results Although geographical accessibility was high (79.3%, financial accessibility was low (19.1% resulting in a low overall accessibility (34.5% to RH services. Two-thirds of youths used some kind of RH services at least once in the past. Levels of unmet needs for sexual RH information, family planning, maternal care and HIV testing were 62.6%, 31.9%, 38.7% and 56.2%, respectively. Youths living in the south or south-western suburbs, having a deceased parent, never being married or never exposed to mass media were less likely to access RH services. Being a young adult, current student, working as a waste recycler, having ever experienced a sexual relationship, ever being married, ever exposed to mass media, having a high knowledge of RH services and providers or a high level of accessibility to RH services significantly increased the likelihood of utilization of those services. In addition to youths’ socio-demographic characteristics, exposure to mass media, norm of peer exposure and knowledge
Liu, Xiayang; Cook, Glenda; Cattan, Mima
As Chinese immigrants in the United Kingdom age, they experience an increasing need to access health and care services. It has, however, been reported that older Chinese immigrants have difficulties in accessing these services. This study explored the experiences of this population in using health and care services and the strategies that they adopted to address their difficulties. A grounded theory method with a two-staged research design was used. Stage 1 explored the participants' experiences of ageing and use of health and social care services through focus group interviews. Stage 2 investigated the strategies individuals used to support access to and use of services through individual interviews. Forty-four older Chinese people and 15 supporters participated in interviews during August 2011 and May 2013. These older Chinese immigrants were challenged in knowing about and in accessing services. Their difficulties were attributed to language barriers, lack of information and instrumental support, and emotional and cultural issues regarding use of health and care services. Their supporters facilitated access to services and acted as a bridge between the service and the user; therefore, they were given the title 'Bridge People'. Bridge People have different backgrounds: family and friends, public sector workers and staff from community-based Chinese organisations. The defining attributes of these supporters were: bilinguality, bicultural, multifunctionality and accessibility. There is no charge for this support; and the relationship between the Bridge Person and recipient involves trust and influence over decisions regarding use of health and care services. Bridge People should be recognised and identified by health, social care and housing services to promote engagement and use of services by older immigrant Chinese people.
Gele, Abdi A; Torheim, Liv Elin; Pettersen, Kjell Sverre; Kumar, Bernadette
Despite the high prevalence of type 2 diabetes in some immigrant and refugee communities in Norway, there is very little information available on their utilization of diabetes prevention interventions, particularly for women from Somali immigrant communities. A qualitative study of 30 Somali immigrant women aged 25 years and over was carried out in the Oslo area. Unstructured interviews were used to explore women's knowledge of diabetes, their access to preventive health facilities, and factors impeding their reception of preventive health programs targeted for the prevention of type 2 diabetes. The study participants were found to have a good knowledge of diabetes. They knew that a sedentary lifestyle and unhealthy diet are among the risk factors for diabetes. Regardless of their knowledge, participants reported a sedentary lifestyle accompanied with the consumption of an unhealthy diet. This was attributed to a lack of access to tailored physical activity services and poor access to health information. Considering gender-exclusive training facilities for Somali immigrant women and others with similar needs, in addition to access to tailored health information on diet, may encourage Somali women to adopt a healthy lifestyle, and it will definitely contribute to a national strategy for the prevention of diabetes.
GI-cat ideal users are data providers or service providers within the geoscience community. The former have their data already available through an access service (e.g. an OGC Web Service) and would have it published through a standard catalog service, in a seamless way. The latter would develop a catalog broker and let users query and access different geospatial resources through one or more standard interfaces and Application Profiles (AP) (e.g. OGC CSW ISO AP, CSW ebRIM/EO AP, etc.). GI-cat actually implements a broker components (i.e. a middleware service) which carries out distribution and mediation functionalities among "well-adopted" catalog interfaces and data access protocols. GI-cat also publishes different discovery interfaces: the OGC CSW ISO and ebRIM Application Profiles (the latter coming with support for the EO and CIM extension packages) and two different OpenSearch interfaces developed in order to explore Web 2.0 possibilities. An extended interface is also available to exploit all available GI-cat features, such as interruptible incremental queries and queries feedback. Interoperability tests performed in the context of different projects have also pointed out the importance to enforce compatibility with existing and wide-spread tools of the open source community (e.g. GeoNetwork and Deegree catalogs), which was then achieved. Based on a service-oriented framework of modular components, GI-cat can effectively be customized and tailored to support different deployment scenarios. In addition to the distribution functionality an harvesting approach has been lately experimented, allowing the user to switch between a distributed and a local search giving thus more possibilities to support different deployment scenarios. A configurator tool is available in order to enable an effective high level configuration of the broker service. A specific geobrowser was also naturally developed, for demonstrating the advanced GI-cat functionalities. This client
Hernandez, Stephen H A; Bedrick, Edward J; Parshall, Mark B
We investigated perceptions of stigma and barriers associated with accessing mental health services among active component U.S. Air Force officer and enlisted nursing personnel (N = 211). The Britt and Hoge et al Stigma scale and Hoge et al Barriers to Care scale were administered via an anonymous, online survey. Stigma items pertained to concerns that might affect decisions to seek mental health treatment. Most of the sample agreed with the items "Members of my unit might have less confidence in me" and "My unit leadership might treat me differently." Approximately 20% to 46% agreed with the other four stigma items. Officer nursing personnel were significantly more likely than enlisted to agree that accessing mental health services would be embarrassing, harm their career, or cause leaders to blame them for the problem (p ≤ 0.03 for each comparison). Getting time off from work for treatment and scheduling appointments were perceived as barriers by 41% and 21% of respondents, respectively. We conclude that proportions of Air Force nursing personnel reporting concerns about potential stigmatizing consequences of seeking mental health care are substantial and similar to ranges previously reported by military service members screening positive for mental health problems after deployment.
Dittmann, Jana; Steinebach, Martin; Wohlmacher, Petra; Ackermann, Ralf
Digital watermarking is well known as enabling technology to prove ownership on copyrighted material, detect originators of illegally made copies, monitor the usage of the copyrighted multimedia data and analyze the spread spectrum of the data over networks and servers. Research has shown that data hiding techniques can be applied successfully to other application areas like manipulations recognition. In this paper, we show our innovative approach for integrating watermark and cryptography based methods within a framework of new application scenarios spanning a wide range from dedicated and user specific services, "Try&Buy" mechanisms to general means for long-term customer relationships. The tremendous recent efforts to develop and deploy ubiquitous mobile communication possibilities are changing the demands but also possibilities for establishing new business and commerce relationships. Especially we motivate annotation watermarks and aspects of M-Commerce to show important scenarios for access control. Based on a description of the challenges of the application domain and our latest work we discuss, which methods can be used for establishing services in a fast convenient and secure way for conditional access services based on digital watermarking combined with cryptographic techniques. We introduce an example scenario for digital audio and an overview of steps in order to establish these concepts practically.
Sanmartin, Claudia; Pierre, Fritz; Tremblay, Stéphane
Waiting for care has been and continues to be a major issue for the healthcare sector in Canada. While considerable gains have been made regarding valid and reliable information on waiting times, gaps remain. Statistics Canada continues to provide information regarding patients' experiences in accessing care at the national and provincial levels, including how long individuals waited for specialized services, through the Health Services Access Survey. The survey offers several advantages, including waiting time information that is comparable across time and space, enhanced patient information and information regarding patients' experiences in waiting for care. The results for 2005 indicate that median waiting time for all specialized services was between 3 and 4 weeks and remained relatively stable between 2003 and 2005. Waiting times for specialist visits did not vary by income. In addition to being asked how long they waited, individuals were asked about their experiences in waiting for care. While the majority of individuals waiting for care indicated that their waiting time was acceptable, there continues to be a proportion of Canadians who feel they are waiting an unacceptably long time for care. Between 11% and 18% of individuals waiting for care indicated that their life was affected by waiting.
Full Text Available Research indicates that people living in rural and remote areas of Canada face challenges to accessing health services. This article reports on a community-engaged research project conducted by investigators at Memorial University of Newfoundland in collaboration with the Rural Secretariat Regional Councils and Regional Partnership Planners for the Corner Brook–Rocky Harbour and Stephenville–Port aux Basques Rural Secretariat Regions of Newfoundland and Labrador. The aim of this research was to gather information on barriers to accessing health services, to identify solutions to health services’ access issues and to inform policy advice to government on enhancing access to health services. Data was collected through: (1 targeted distribution of a survey to communities throughout the region, and (2 informal ‘kitchen table’ discussions to discuss health services’ access issues. A total of 1049 surveys were collected and 10 kitchen table discussions were held. Overall, the main barriers to care listed in the survey included long wait times, services not available in the area and services not available at time required. Other barriers noted by survey respondents included transportation problems, financial concerns, no medical insurance coverage, distance to travel and weather conditions. Some respondents reported poorer access to maternal/child health and breast and cervical screening services and a lack of access to general practitioners, pharmacy services, dentists and nurse practitioners. Recommendations that emerged from this research included improving the recruitment of rural physicians, exploring the use of nurse practitioners, assisting individuals with travel costs, developing specialist outreach services, increasing use of telehealth services and initiating additional rural and remote health research. Keywords: rural, remote, healthcare, health services, social determinants of health
Ganle, John Kuumuori; Fitzpatrick, Raymond; Otupiri, Easmon; Parker, Michael
Poor access to and use of skilled delivery services have been identified as a major contributory factor to poor maternal and newborn health in sub-Saharan African countries, including Ghana. However, many previous studies that examine norms of childbirth and care-seeking behaviours have focused on identifying the norms of non-use of services, rather than factors, that can promote service use. Based on primary qualitative research with a total of 185 expectant and lactating mothers, and 20 healthcare providers in six communities in Ghana, this paper reports on strategies that can be used to overcome health system barriers to the use of skilled delivery services. The strategies identified include expansion and redistribution of existing maternal health resources and infrastructure, training of more skilled maternity caregivers, instituting special programmes to target women most in need, improving the quality of maternity care services provided, improving doctor-patient relationships in maternity wards, promotion of choice, protecting privacy and patient dignity in maternity wards and building partnerships with traditional birth attendants and other non-state actors. The findings suggest the need for structural changes to maternity clinics and routine nursing practices, including an emphasis on those doctor-patient relational practices that positively influence women's healthcare-seeking behaviours. Copyright © 2015 John Wiley & Sons, Ltd.
Sklansky, Mark; Tang, Alvin; Levy, Denis; Grossfeld, Paul; Kashani, Iraj; Shaughnessy, Robin; Rothman, Abraham
The maternal psychological impact of fetal echocardiography may be deleterious in the face of newly diagnosed congenital heart disease. This questionnaire-based study prospectively examined the psychological impact of both normal and abnormal fetal echocardiography. Normal fetal echocardiography decreased maternal anxiety, increased happiness, and increased the closeness women felt toward their unborn children. In contrast, when fetal echocardiography detected congenital heart disease, maternal anxiety typically increased, and mothers commonly felt less happy about being pregnant. However, among women who had recently delivered infants with congenital heart disease, those who had had fetal echocardiography during the pregnancy felt less responsible for their infants' defects and tended to have improved their relationships with the infants' fathers after the prenatal diagnosis of congenital heart disease. Further study of the psychological and medical impact of fetal echocardiography will be necessary to define and optimize the clinical value of this powerful diagnostic tool.
Palanisamy, G.; Krassovski, M.; Devarakonda, R.; Santhana Vannan, S.
The current climate debate is highlighting the importance of free, open, and authoritative sources of high quality climate data that are available for peer review and for collaborative purposes. It is increasingly important to allow various organizations around the world to share climate data in an open manner, and to enable them to perform dynamic processing of climate data. This advanced access to data can be enabled via Web-based services, using common "community agreed" standards without having to change their internal structure used to describe the data. The modern scientific community has become diverse and increasingly complex in nature. To meet the demands of such diverse user community, the modern data supplier has to provide data and other related information through searchable, data and process oriented tool. This can be accomplished by setting up on-line, Web-based system with a relational database as a back end. The following common features of the web data access/search systems will be outlined in the proposed presentation: - A flexible data discovery - Data in commonly used format (e.g., CSV, NetCDF) - Preparing metadata in standard formats (FGDC, ISO19115, EML, DIF etc.) - Data subseting capabilities and ability to narrow down to individual data elements - Standards based data access protocols and mechanisms (SOAP, REST, OpenDAP, OGC etc.) - Integration of services across different data systems (discovery to access, visualizations and subseting) This presentation will also include specific examples of integration of various data systems that are developed by Oak Ridge National Laboratory's - Climate Change Science Institute, their ability to communicate between each other to enable better data interoperability and data integration. References:  Devarakonda, Ranjeet, and Harold Shanafield. "Drupal: Collaborative framework for science research." Collaboration Technologies and Systems (CTS), 2011 International Conference on. IEEE, 2011. [2
Bobiller-Chaumon, Marc-Eric; Sandoz-Guermond, Françoise
The aim of this paper is to determine the expectations that French-speaking disabled persons have for electronic administrative sites (utility). At the same time, it is a matter of identifying the difficulties of use that the manipulation of these E-services poses concretely for blind people (usability) and of evaluating the psychosocial impacts on the way of life of these people with specific needs. We show that the lack of numerical accessibility is likely to accentuate the social exclusion of which these people are victim by establishing a numerical glass ceiling.
Mboya, Beati; Temu, Florence; Awadhi, Bayoum; Ngware, Zubeda; Ndyetabura, Elly; Kiondo, Gloria; Maridadi, Janneth
Introduction Currently, Tanzania's HIV prevalence is 5.7%. Gender inequality and Gender Based Violence (GBV) are among factors fuelling the spread of HIV in Tanzania. This study was conducted to assess universal access to HIV prevention services among GBV survivors in Iringa and Dar-es-Salaam where HIV prevalence is as high as 14.7% and 9% respectively compared to a national average of 5.7%. Methods In 2010, a mixed methods study using triangulation model was conducted in Iringa and Dar-es-Sa...
Cognitive radio transceiver can opportunistically access the underutilized channels of primary systems for new wireless services. The secondary transmission may be interrupted by the primary user\\'s transmission. To facilitate the delay analysis of such secondary packet transmission, we study the resulting extended delivery time for a fixed-size secondary packet that includes both transmission time and waiting time. In particular we derive the exact distribution functions of extended delivery time of secondary transmission for both continuous sensing and periodic sensing cases. Selected numerical results are presented for illustrating the mathematical formulation.
Rockhill, Anna; Green, Beth L; Newton-Curtis, Linda
The complex issues associated with barriers to treatment entry for parents who are involved with child welfare has not been well explored. Accessing timely treatment is now critical for these parents since the introduction of the Adoption and Safe Families Act of 1997, limiting the time until a permanency decision is made. Using a longitudinal, qualitative approach, substance-abusing parents from 15 families, their relevant family members, and service providers were interviewed approximately every 3 months over an 18-month period. The experiences of these parents add to our knowledge of the unique barriers this population faces, and expands our understanding of the mechanisms by which certain barriers may delay treatment.
Pattison, Ian; Green, Daniel; Yu, Dapeng; Bosher, Lee; Wilby, Rob; Yang, Lili; Ryley, Tim
Urban areas are increasingly susceptible to surface water flooding, with more intense precipitation and intensification of land development. Flooding has both direct impacts i.e. locations inundated with water, and indirect impacts i.e. transport networks, utility e.g. electricity/water services etc. The direct areas flooded evolve in space through the event, and are predicted by standard inundation models. However, the wider indirect impacts and the spatial-temporal patterns are less constrained and it is these that are needed to manage the impacts in real-time. This paper focusses on the Category One responders of the Fire and Rescue and Ambulance Services in the City of Leicester, East Midlands, UK. Leicester is ranked 16th out of 4215 settlements at risk of surface water flooding in the UK based upon the population at risk (15,200 people) (DEFRA, 2009). The analysis undertaken involved overlaying the flood extent with the Integrated Transport Network (ITN) data within a GIS framework. Then a simple transport routing algorithm was used to predict the travel time from specific nodes representing ambulance or fire stations to different parts of the city. Flood magnitudes with 1:20, 1:100 and 1:1000 return periods have been investigated. Under a scenario of no flooding, 100% of the city is accessible by the six fire stations in the city. However, in the 1 in 20 year surface water flood event the peak inundation results in 66.5% being accessible in the 10 minute permitted time and 6% is totally inaccessible. This falls to 40% and 13% respectively for the 1 in 100 year event. Maps show the area of the city that are accessible by two or more stations within the permitted response time, which shows these areas are the most resilient to surface water flooding. However, it isn't just the peak water depths at every location which impacts accessibility within the city but the spatial-temporal patterns of the inundation. The areas within the 10 minute response time expand
Duda, Catherine; Rajaram, Kumar; Barz, Christiane; Rosenthal, J Thomas
There has been an increasing emphasis on health care efficiency and costs and on improving quality in health care settings such as hospitals or clinics. However, there has not been sufficient work on methods of improving access and customer service times in health care settings. The study develops a framework for improving access and customer service time for health care settings. In the framework, the operational concept of the bottleneck is synthesized with queuing theory to improve access and reduce customer service times without reduction in clinical quality. The framework is applied at the Ronald Reagan UCLA Medical Center to determine the drivers for access and customer service times and then provides guidelines on how to improve these drivers. Validation using simulation techniques shows significant potential for reducing customer service times and increasing access at this institution. Finally, the study provides several practice implications that could be used to improve access and customer service times without reduction in clinical quality across a range of health care settings from large hospitals to small community clinics.
Osadchiy, Alexey Vladimirovich; Prince, Kamau; Guerrero Gonzalez, Neil;
, wavelength division multiplexed, unicast channels composed of four radio-over-fiber channels operating at 5 GHz carrier frequency with 250 Mbaud phase shift keying modulation and four 10 Gb/s baseband amplitude shift keying channels; while the broadcast channels were four 10 Gbaud DQPSK channels......We propose a passive optical network architecture based on coherent detection for converged delivery of broadcast services from a dedicated remote broadcast server and user-specific services from a local central office. We experimentally demonstrate this architecture with mixed traffic types....... The broadcast channels were transmitted over 78 km of single mode fiber to a central office where they were multiplexed with the unicast channels for further fiber transmission over 34-km to reach the access network. Successful detection of all channels is demonstrated....
Ghanadan, Rebecca Hansing
Since the 1990s, power sector reforms have become paramount in energy policy, catalyzing a debate in Africa about market-based service provision and the effects of reforms on access. My research seeks to move beyond the conceptual divide by grounding attention not in abstract 'market forces' but rather in how development institutions shape energy services and actually practice policy on the ground. Using the case of Tanzania, a country known for having instituted some of the most extensive reforms and a 'success story' in Africa, I find that reforms are creating large burdens and barriers for access and use of services, including: increasing costs, enforcement pressures, and measures to impose 'market' discipline. However, I also find that many of the most significant outcomes are not found in direct 'market' changes, but rather how reforms are selective, partial, and shaped by the wider needs and claims of the institutions driving reforms, so that questions of how reforms are implemented, how they are measured, and who tells the story become as important as the policies themselves. Using a multiple-arenas framework, including (i) a household and community level study of urban energy conditions, (ii) a study of service and management conditions at the national electric utility, (iii) an examination of the international policy process, and (iv) a study of the history of electricity services across colonial, post-independence, and reform periods, I show that African energy reforms are a technical and political project connecting energy to international investments, donor aid programs, and elite interests within national governments. Energy reforms also involve fundamental service changes that are reorganizing how the costs and benefits of energy systems are distributed, allocated, and managed. The effects of reform extend beyond formal services to have wide-reaching repercussions within natural resources, and uneven social dynamics on the ground. These features point
Full Text Available Deepti Radia,1 Ibrahim Momoh,2 Richard Dillon,1 Yvonne Francis,1 Laura Cameron,1 Toni-Lee Fagg,1 Hannah Overland,1 Susan Robinson,1 Claire N Harrison11Haematology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK; 2Bupa Home Healthcare, Harlow, UKAbstract: This article describes the initiation and evolution of the Rapid-Access Anemia Clinic (RAAC at Guy's and St Thomas' Hospitals, London, UK. This clinic was set up to provide diagnosis and treatment, and to coordinate investigative procedures, where necessary, into the underlying causes of anemia. Initially piloted with anemic preoperative orthopedic patients, the clinic now treats a wide range of conditions, deriving from both internal and external referrals. Treatment includes dietary advice, supplementation with iron, vitamin B12 and folate, and blood transfusion. Most patients at the RAAC need iron replacement, the majority of which require intravenous (IV iron. Therefore the first-line IV iron-administration protocol is carefully considered to ensure viability of the service and patient satisfaction. Four IV irons available in the UK are discussed, with explanation of the benefits and drawbacks of each product and the reasoning behind the IV iron choice at different stages of the RAAC's development. Costs to the service, affected by IV iron price and administration regimen, are considered, as well as the product's contraindications. Finally, the authors reflect on the success of the RAAC and how it has improved patients' quality-of-treatment experience, in addition to benefiting the hospital and National Health Service in achieving specific health-care mandates and directives. Drawing from the authors' experiences, recommendations are given to assist others in setting up and providing a successful rapid-access anemia service or similar facility.Keywords: hemoglobin, iron deficiency, ferric carboxymaltose, iron sucrose, iron dextran, iron isomaltoside
McGuire, R. E.; Bilitza, D.; Candey, R. M.; Chimiak, R.; Cooper, J. F.; Garcia, L. N.; Harris, B. T.; Johnson, R. C.; Kovalick, T. J.; Lal, N.; Leckner, H. A.; Liu, M. H.; Papitashvili, N. E.; Roberts, D. A.; Yurow, R. E.
NASA's Space Physics Data Facility (SPDF) project is now serving MMS definitive and predictive interactive orbit plots, listings and conjunction calculations through our SSCWeb and 4D Orbit Viewer services. In March 2016 and in parallel with the MMS Science Data Center (SDC) at LASP, SPDF will begin publicly serving a complete set of MMS Level-2 and higher, survey and burst-mode science data products from all four spacecraft and all instruments. The initial Level-2 data available will be from September 2015 to early February 2016, with Level-2 products subsequently validated and publicly available with an approximate one month lag. All MMS Level-2 and higher data products are produced in standard CDF format with standard ISTP/SPDF metadata and will be served by SPDF through our CDAWeb data service, including our web services and associated APIs for IDL and Matlab users, and through direct FTP/HTTP directory browse and file downloads. SPDF's ingest, archival preservation and active serving of current MMS science data is part of our role as an active heliophysics final archive. SPDF's ingest of complete and current science data products from other active heliophysics missions with SPDF services will help enable coordinated and correlative MMS science analysis by the open international science community with current data from THEMIS, the Van Allen Probes and other missions including TWINS, Cluster, ACE, Wind, >120 ground magnetometer stations as well as instruments on the NOAA GOES and POES spacecraft. Please see the related Candey et.al. paper on "SPDF Ancillary Services and Technologies Supporting Open Access, Use and Archiving of MMS Data" for other aspects of what SPDF is doing. All SPDF data and services are available from the SPDF home page at http://spdf.gsfc.nasa.gov .
Cristina Marques de Almeida Holanda
Full Text Available This study seeks to identify the formation of social support networks of people with physical disabilities, and how these networks can help facilitate access to health services and promote social inclusion. It is a cross-sectional study, with data collected via a form applied to physically disabled persons over eighteen years of age registered with the Family Health Teams of the municipal district of João Pessoa in the state of Paraíba. It was observed that the support networks of these individuals predominantly consist of family members (parents, siblings, children, spouses and people outside the family (friends and neighbors. However, 50% of the interviewees declared that they could not count on any support from outside the family. It was observed that the support network contributes to access to the services and participation in social groups. However, reduced social inclusion was detected, due to locomotion difficulties, this being the main barrier to social interaction. Among those individuals who began to interact in society, the part played by social support was fundamental.
Holanda, Cristina Marques de Almeida; De Andrade, Fabienne Louise Juvêncio Paes; Bezerra, Maria Aparecida; Nascimento, João Paulo da Silva; Neves, Robson da Fonseca; Alves, Simone Bezerra; Ribeiro, Kátia Suely Queiroz Silva
This study seeks to identify the formation of social support networks of people with physical disabilities, and how these networks can help facilitate access to health services and promote social inclusion. It is a cross-sectional study, with data collected via a form applied to physically disabled persons over eighteen years of age registered with the Family Health Teams of the municipal district of João Pessoa in the state of Paraíba. It was observed that the support networks of these individuals predominantly consist of family members (parents, siblings, children, spouses) and people outside the family (friends and neighbors). However, 50% of the interviewees declared that they could not count on any support from outside the family. It was observed that the support network contributes to access to the services and participation in social groups. However, reduced social inclusion was detected, due to locomotion difficulties, this being the main barrier to social interaction. Among those individuals who began to interact in society, the part played by social support was fundamental.
Fonseca, Luciara Leão Viana; Nehmy, Rosa Maria Quadros; Mota, Joaquim Antônio César
Oral healthcare provided by the Unified Health System (SUS) faces the challenge of attending the epidemiological profile of Brazil's adult population. Qualitative research using semi-structured interviews was conducted to understand the experiences, expectations and perception of SUS users to services in Diamantina, State of Minas Gerais, and content analysis was used to assess the data. Discussion of the results was based on dialogue between the symbolic interactionism of Goffman and Bourdieu's concept of habitus. The results show that the users did not give importance to dental care during childhood and adolescence because care was unknown to them. There was no offer of treatment besides dental extraction. Today, they value teeth and suffer the embarrassment caused by rotten teeth. However, access to dental restoration via SUS is not possible. For their children, they perceive better access to information and care, but for specialized procedures there are barriers. They express resignation both in relation to the poor state of the teeth and the difficulties of access to dental care, which can be understood by the constant exclusion experienced by them in the past, shaping their actions in the present. It was concluded that oral health in SUS should incorporate the social value and the aesthetic dimension of teeth as a social right.
Svetlana A. Firsova
Full Text Available Introduction: this article explores the pedagogical technology employed to teach medical students foundations of work with MICROSOFT ACCESS databases. The above technology is based on integrative approach to the information modeling in public health practice, drawing upon basic didactic concepts that pertain to objects and tools databases created in MICROSOFT ACCESS. The article examines successive steps in teaching the topic “Queries in MICROSOFT ACCESS” – from simple queries to complex ones. The main attention is paid to such components of methodological system, as the principles and teaching methods classified according to the degree of learners’ active cognitive activity. The most interesting is the diagram of the relationship of learning principles, teaching methods and specific types of requests. Materials and Methods: the authors used comparative analysis of literature, syllabi, curricula in medical informatics taught at leading medical universities in Russia. Results: the original technique of training in putting queries with databases of MICROSOFT ACCESS is presented for analysis of information models in practical health care. Discussion and Conclusions: it is argued that the proposed pedagogical technology will significantly improve the effectiveness of teaching the course “Medical Informatics”, that includes development and application of models to simulate the operation of certain facilities and services of the health system which, in turn, increases the level of information culture of practitioners.
Kraft, Angelina; Sens, Irina; Löwe, Peter; Dreyer, Britta
Globally resolvable, persistent digital identifiers have become an essential tool to enable unambiguous links between published research results and their underlying digital resources. In addition, this unambiguous identification allows citation. In an ideal research world, any scientific content should be citable and the coherent content, as well as the citation itself, should be persistent. However, today's scientists do not just produce traditional research papers - they produce comprehensive digital collections of objects which, alongside digital texts, include digital resources such as research data, audiovisual media, digital lab journals, images, statistics and software code. Researchers start to look for services which allow management of these digital resources with minimum time investment. In light of this, we show how the German National Library of Science and Technology (TIB) develops supportive frameworks to accompany the life cycle of scientific knowledge generation and transfer. This includes technical infrastructures for • indexing, cataloguing, digital preservation, DOI names and licencing for text and digital objects (the TIB DOI registration, active since 2004) and • a digital repository for the deposition and provision of accessible, traceable and citeable research data (RADAR). One particular problem for the management of data originating from (collaborating) research infrastructures is their dynamic nature in terms of growth, access rights and quality. On a global scale, systems for access and preservation are in place for the big data domains (e.g. environmental sciences, space, climate). However, the stewardship for disciplines without a tradition of data sharing, including the fields of the so-called long tail, remains uncertain. The RADAR - Research Data Repository - project establishes a generic end-point data repository, which can be used in a collaborative way. RADAR enables clients to upload, edit, structure and describe their
Dijk, E.M.S.; Doorn, P.K.
Data Archiving and Networked Services (DANS) is the national Dutch organization for permanent access to research data, with a focus on the humanities and social sciences. DANS offers three services to the scholarly community: DataverseNL, EASY, and NARCIS. DataverseNL is intended to support data man
Littlefield, Lyn; Giese, Jill
The Australian Government's Better Access to Mental Health Care initiative introduced mental health reforms that included the availability of Medicare-funded psychology services. The mental health initiative has resulted in a huge uptake of these services, demonstrating the strong community demand for psychological treatment. The initiative has…
Huff-Eibl, Robyn; Miller-Wells, John; Begay, Wendy
This article describes the process and role frontline access and public service staff play in needs assessment and evaluation of user services, specifically in understanding the voice of the customer. Information includes how the University of Arizona Libraries have incorporated daily data collection into the strategic planning process, resources…
... Research for Women, Infants, Children and Youth Grant Under the Ryan White HIV/AIDS Program AGENCY: Health... Part D Comprehensive Services and Access to Research for Women, Infants, Children, and Youth for... services to women, infants, children, and youth in the Charlotte, North Carolina and surrounding...
Full Text Available Introduction: Knowledge about experiences in accessing HIV services among persons with disabilities who are living with HIV in sub-Saharan Africa is limited. Although HIV transmission among persons with disabilities in Africa is increasingly acknowledged, there is a need to bring to life the experiences and voices from persons with disabilities living with HIV to raise awareness of programme implementers and policy makers about their barriers in accessing HIV services. This paper explores how the barriers faced by persons with disabilities living with HIV impede their ability to access HIV-related services and manage their disease. Methods: We conducted focus group discussions with 76 persons (41 females; 35 males with physical, visual and/or hearing impairments who were living with HIV in Ghana, Uganda and Zambia (2012–2013. We explored challenges and facilitators at different levels (individual, psychosocial and structural of access to HIV services. Transcripts were analyzed using a framework analysis approach. Results: Persons with disabilities living with HIV encountered a wide variety of challenges in accessing HIV services. Delays in testing for HIV were common, with most waiting until they were sick to be tested. Reasons for delayed testing included challenges in getting to the health facilities, lack of information about HIV and testing, and HIV- and disability-related stigma. Barriers to HIV-related services, including care and treatment, at health facilities included lack of disability-friendly educational materials and sign interpreters, stigmatizing treatment by providers and other patients, lack of skills to provide tailored services to persons with disabilities living with HIV and physically inaccessible infrastructure, all of which make it extremely difficult for persons with disabilities to initiate and adhere to HIV treatment. Accessibility challenges were greater for women than men due to gender-related roles. Challenges were
This slide presentation reviews some of the processes that NASA uses to make the remote sensing data easy to use over the World Wide Web. This work involves much research into data formats, geolocation structures and quality indicators, often to be followed by coding a preprocessing program. Only then are the data usable within the analysis tool of choice. The Goddard Earth Sciences Data and Information Services Center is deploying a variety of data access services that are designed to dramatically shorten the time consumed in the data preparation step. On-the-fly conversion to the standard network Common Data Form (netCDF) format with Climate-Forecast (CF) conventions imposes a standard coordinate system framework that makes data instantly readable through several tools, such as the Integrated Data Viewer, Gridded Analysis and Display System, Panoply and Ferret. A similar benefit is achieved by serving data through the Open Source Project for a Network Data Access Protocol (OPeNDAP), which also provides subsetting. The Data Quality Screening Service goes a step further in filtering out data points based on quality control flags, based on science team recommendations or user-specified criteria. Further still is the Giovanni online analysis system which goes beyond handling formatting and quality to provide visualization and basic statistics of the data. This general approach of automating the preparation steps has the important added benefit of enabling use of the data by non-human users (i.e., computer programs), which often make sub-optimal use of the available data due to the need to hard-code data preparation on the client side.
van de Ven, Wynand P M M
In a recent article in this journal Simon-Tuval, Horev and Kaplan argue that in order to improve the protection of consumers there might be a need to impose a threshold on the medical loss ratio (MLR) for voluntary health insurance (VHI) in Israel . Their argument is that VHI in Israel covers several essential services that are not covered by the mandatory benefits package due to budget constraints, while there are market failures in the VHI market that justify regulation to assure consumer protection such as high accessibility to high quality coverage. In this commentary it will be argued that in addition to market failures there are also government failures. It is doubtful whether imposing a threshold on MLR is effective because of government failures. It can be even counter-productive. Therefore, alternative regulatory measures are discussed to promote the protection of the beneficiaries. If essential services covered by VHI are unaffordable for some low-income people, government can extend the current mandatory basic health insurance so that it covers all essential services. If there is a budget restriction, the amount of government funds could be increased, or the health plans could be allowed to request an additional flat rate premium, set by them and to be paid by the consumer directly to their health plan. Also, effective out-of-pocket payments could be introduced. Subsidies could be given to low-income people to compensate for their additional expenses under the mandatory health insurance. If these changes are adopted, then the government would no longer be held responsible for access to benefits outside the mandatory health insurance. Accordingly, all VHI could be sold on the normal free insurance market, just as other types of indemnity insurance. In addition, the Israeli health insurance and healthcare markets could be made more competitive by introducing procompetitive regulation. This would increase the efficiency and affordability of healthcare.
Nokulunga H. Cele
Full Text Available Background: Homosexual patients are affected by social factors in their environment, and as a result may not have easy access to existing health care services. Prejudice against homosexuality and homosexual patients remains a barrier to them seeking appropriate healthcare. The concern is that lesbians and gays might delay or avoid seeking health care when they need it because of past discrimination or perceived homophobia within the health care thereby putting their health at risk.Aim of the study: The aim of the study was to explore and describe the experiences of homosexual patients utilising primary health care (PHC services in Umlazi in the province ofKwaZulu-Natal (KZN.Method: A qualitative, exploratory, descriptive study was conducted which was contextual innature. Semi-structured interviews were conducted with 12 participants. The findings of this study were analysed using content analysis.Results: Two major themes emerged from the data analysis, namely, prejudice against homosexual patients by health care providers and other patients at the primary health care facilities, and, homophobic behaviour from primary health care personnel.Conclusion: Participants experienced prejudice and homophobic behaviour in the course of utilising PHC clinics in Umlazi, which created a barrier to their utilisation of health services located there. Nursing education institutions, in collaboration with the National Department of Health, should introduce homosexuality and anti-homophobia education programmes during the pre-service and in-service education period. Such programmes will help to familiarise health care providers with the health care needs of homosexual patients and may decrease homophobic attitudes.
John Kuumuori Ganle
Full Text Available While a number of studies have examined the factors affecting accessibility to and utilisation of healthcare services by persons with disability in general, there is little evidence about disabled women's access to maternal health services in low-income countries and few studies consult disabled women themselves to understand their experience of care and the challenges they face in accessing skilled maternal health services. The objective of this paper is to explore the challenges women with disabilities encounter in accessing and using institutional maternal healthcare services in Ghana.A qualitative study was conducted in 27 rural and urban communities in the Bosomtwe and Central Gonja districts of Ghana with a total of 72 purposively sampled women with different physical, visual, and hearing impairments who were either lactating or pregnant at the time of this research. Semi-structured in-depth interviews were used to gather data. Attride-Stirling's thematic network framework was used to analyse the data. Findings suggest that although women with disability do want to receive institutional maternal healthcare, their disability often made it difficult for such women to travel to access skilled care, as well as gain access to unfriendly physical health infrastructure. Other related access challenges include: healthcare providers' insensitivity and lack of knowledge about the maternity care needs of women with disability, negative attitudes of service providers, the perception from able-bodied persons that women with disability should be asexual, and health information that lacks specificity in terms of addressing the special maternity care needs of women with disability.Maternal healthcare services that are designed to address the needs of able-bodied women might lack the flexibility and responsiveness to meet the special maternity care needs of women with disability. More disability-related cultural competence and patient-centred training for
Brown, Alison M C; Pirotta, Marie
Prioritisation of clients requesting physiotherapy in Victorian community health services has occurred in the absence of a uniform evidence-based prioritisation process. The effect of the varying prioritisation procedures on client outcomes is unknown. This two-part study sought to answer two questions: what are the current prioritisation practices? And what is the evidence for prioritisation? Staff of Victorian community health services offering physiotherapy (n=67) were sent a structured questionnaire regarding their prioritisation practices. The questionnaire data revealed a wide range of poorly defined criteria and methods of assessment for prioritisation. The evidence for prioritisation and the use of specific prioritisation criteria were examined via a literature search. The literature suggested the use of acute severe pain, interference with activities of daily living and falls as indicators of need for priority service. The lack of uniformity found in determining priority of access reflects the complexity of determining need and the lack of research and validated tools to assist decision making. Further research into prioritisation criteria is required to determine their validity and if their use in a prioritisation tool would actually improve outcomes for clients.
Andersson, Jens K.; Nyberg, Christian; Kihl, Maria
The trend of the service architectures developed in telecommunications today is that they should be open in the sense that they can communicate over the borders of different networks. Instead of each network having their own service architecture with their own applications, all networks should be able to use the same applications. 3GPP, the organization developing specifications for the 3G networks has specified the standard Open Service Access (OSA), as a part of the 3G specification. OSA offers different Application Protocol Interfaces that enable an application that resides outside a network to use the capabilities of the network. This paper analyses the performance of an OSA gateway. It is examined how the overload control can be dealt with in a way to best satisfy the operators and the 3'rd parties. There are some guiding principles in the specifications, but a lot of decisions have to be made by the implementors of application servers and OSA gateways. Proposals of different requirements for an OSA architecture exist such as, minimum amount of accepted calls per second and time constraint for the maximal total delay for an application. Maximal and fair throughput have to be prioritized from the 3'rd parties view, but profit is the main interest from the operators point of view. Therefore this paper examines a priority based proposal of an overload control mechanism taking these aspects and requirements into account.
Full Text Available Abstract Echocardiography is increasingly used in the management of the critically ill patient as a non-invasive diagnostic and monitoring tool. Whilst in few countries specialized national training schemes for intensive care unit (ICU echocardiography have been developed, specific guidelines for ICU physicians wishing to incorporate echocardiography into their clinical practice are lacking. Further, existing echocardiography accreditation does not reflect the requirements of the ICU practitioner. The WINFOCUS (World Interactive Network Focused On Critical UltraSound ECHO-ICU Group drew up a document aimed at providing guidance to individual physicians, trainers and the relevant societies of the requirements for the development of skills in echocardiography in the ICU setting. The document is based on recommendations published by the Royal College of Radiologists, British Society of Echocardiography, European Association of Echocardiography and American Society of Echocardiography, together with international input from established practitioners of ICU echocardiography. The recommendations contained in this document are concerned with theoretical basis of ultrasonography, the practical aspects of building an ICU-based echocardiography service as well as the key components of standard adult TTE and TEE studies to be performed on the ICU. Specific issues regarding echocardiography in different ICU clinical scenarios are then described. Obtaining competence in ICU echocardiography may be achieved in different ways – either through completion of an appropriate fellowship/training scheme, or, where not available, via a staged approach designed to train the practitioner to a level at which they can achieve accreditation. Here, peri-resuscitation focused echocardiography represents the entry level – obtainable through established courses followed by mentored practice. Next, a competence-based modular training programme is proposed: theoretical
Sanfilippo, Anthony J; Bewick, David; Chan, K L; Cujec, Bibiana; Dumesnil, J G; Honos, George; Munt, Brad; Sasson, Zion; Tam, James; Tomlinson, Charles; Aboguddah, Ayman; Ahmed, Shaheeda; Ali, Mohamed; Arsenault, Marie; Ascah, Kathryn; Ashton, Tom; Baird, Michael; Basmadjian, Arsene; Beique, Francois; Blakeley, Michael; Blais, Marie-Josee; Burggraf, Gary; Burwash, Ian; Cochrane, Jessica; Fagan, Susan; Giannoccaro, Peter; Hughes, William; Jones, Alan; Jue, John; Koilpillai, Chris; Leblanc, Marie-Helene; Londry, Colleen; Morgan, Dennis; O'Reilly, Michael; Sawchuk, Corey; Siu, Samuel; Sochowski, Randy; Tremblay, Guy; Welikovitch, Lisa; Yu, Eric
Recognizing the central role of echocardiographic examinations in the assessment of most cardiac disorders and the need to ensure the provision of these services in a highly reliable, timely, economical and safe manner, the Canadian Cardiovascular Society and Canadian Society of Echocardiography undertook a comprehensive review of all aspects influencing the provision of echocardiographic services in Canada. Five regional panels were established to develop preliminary recommendations in the five component areas, which included the echocardiographic examination, the echocardiographic laboratory and report, the physician, the sonographer and indications for examinations. Membership in the panels was structured to recognize the regional professional diversity of individuals involved in the provision of echocardiography. In addition, a focus group of cardiac sonograhers was recruited to review aspects of the document impacting on sonographer responsibilities and qualification. The document is intended to be used as a comprehensive and practical reference for all of those involved in the provision of echocardiography in Canada.
Full Text Available Accurate delineation of the variable left atrial anatomy is of utmost importance during anatomically based ablation procedures for atrial fibrillation targeting the pulmonary veins and possibly other structures of the atria. Intracardiac echocardiography allows real-time visualisation of the left atrium and adjacent structures and thus facilitates precise guidance of catheter-based ablation of atrial fibrillation. In patients with abnormal anatomy of the atria and/or the interatrial septum, intracardiac ultrasound might be especially valuable to guide transseptal access. Software algorithms like CARTOSound (Biosense Webster, Diamond Bar, USA offer the opportunity to reconstruct multiple two-dimensional ultrasound fans generated by intracardiac echocardiography to a three-dimensional object which can be merged to a computed tomography or magnetic resonance imaging reconstruction of the left atrium. Intracardiac ultrasound reduces dwell time of catheters in the left atrium, fluoroscopy, and procedural time and is invaluable concerning early identification of potential adverse events. The application of intracardiac echocardiography has the great capability to improve success rates of catheter-based ablation procedures.
Meertens, C. M.; Mattioli, G. S.; Miller, M.; Boler, F. M.; Crosby, C. J.; Mencin, D.; Phillips, D. A.; Snett, L.
The wealth of data from geodetic observing systems, especially the Plate Boundary Observatory (PBO), presents major data management challenges. The challenges are driven by ingenious new uses of Global Positioning System (GPS) data, demands for higher-rate, lower latency data, the need for continued access and long term preservation of archival data, the expansion of data users into other science, engineering and commercial arenas, and the growth of enhanced products that expand the utility of the data. To meet these challenges, UNAVCO has established a comprehensive suite of data services encompassing sensor network data operations, data product generation (through the activities of partners at Massachusetts Institute of Technology, Central Washington University, New Mexico Institute of Mining and Technology, and the University of California, San Diego - UCSD), data management, access and archiving, and advanced cyberinfrastructure. PBO sensor systems include 1,100 continuously operating GPS stations, 79 borehole geophysical sites (with a combination of strainmeters, tiltmeters, seismometers, pore pressure gauges, and meteorological sensors), and 6 long baseline strainmeters. Imaging data acquired for EarthScope include large volumes of satellite synthetic aperture radar (SAR) and airborne LiDAR data. Core data products such as daily GPS position time series and derived crustal motion velocities have been augmented with real-time data streams and positions calculated every second from 367 PBO stations. Higher rate (5 Hz) data files are available for applications such as GPS seismology. Efforts are underway with UCSD to integrate GPS and accelerometers at a subset of PBO sites to increase the reliability and capability of the observations. These observations have utility for research and hazards mitigation. Ingenious methods of GPS data analysis, developed by the University of Colorado and the University Corporation for Atmospheric Research, measure snow depth
Kuppusamy, K S; Aghila, G; 10.5121/ijcseit.2012.2109
The smartphone usage among people is increasing rapidly. With the phenomenal growth of smartphone use, smartphone theft is also increasing. This paper proposes a model to secure smartphones from theft as well as provides options to access a smartphone through other smartphone or a normal mobile via Short Message Service. This model provides option to track and secure the mobile by locking it. It also provides facilities to receive the incoming call and sms information to the remotely connected device and enables the remote user to control the mobile through SMS. The proposed model is validated by the prototype implementation in Android platform. Various tests are conducted in the implementation and the results are discussed.
Ploeg, Jenny; Denton, Margaret; Hutchison, Brian; McAiney, Carrie; Moore, Ainsley; Brazil, Kevin; Tindale, Joseph; Wu, Amina; Lam, Annie
The purpose of the study examined in this article was to understand how non-physician health care professionals working in Canadian primary health care settings facilitate older persons' access to community support services (CSSs). The use of CSSs has positive impacts for clients, yet they are underused from lack of awareness. Using a qualitative description approach, we interviewed 20 health care professionals from various disciplines and primary health care models about the processes they use to link older patients to CSSs. Participants collaborated extensively with interprofessional colleagues within and outside their organizations to find relevant CSSs. They actively engaged patients and families in making these linkages and ensured follow-up. It was troubling to find that they relied on out-of-date resources and inefficient search strategies to find CSSs. Our findings can be used to develop resources and approaches to better support primary health care providers in linking older adults to relevant CSSs.
McCann Terence V
Full Text Available Abstract Background Despite the emergence of mental health problems during adolescence and early adulthood, many young people encounter difficulties accessing appropriate services. In response to this gap, the Australian Government recently established new enhanced primary care services (headspace that target young people with emerging mental health problems. In this study, we examine the experience of young people with depression accessing one of these services, with a focus on understanding how they access the service and the difficulties they encounter in the process. Method Individual, in-depth, audio-recorded interviews were used to collect data. Twenty-six young people with depression were recruited from a headspace site in Melbourne, Australia. Interpretative phenomenological analysis was used to analyse the data. Results Four overlapping themes were identified in the data. First, school counsellors as access mediators, highlights the prominent role school counsellors have in facilitating student access to the service. Second, location as an access facilitator and inhibitor. Although the service is accessible by public transport, it is less so to those who do not live near public transport. Third, encountering barriers accessing the service initially. Two main service access barriers were experienced: unfamiliarity with the service, and delays in obtaining initial appointments for ongoing therapy. Finally, the service’s funding model acts as an access facilitator and barrier. While the model provides a low or no cost services initially, it limits the number of funded sessions, and this can be problematic. Conclusions Young people have contrasting experiences accessing the service. School counsellors have an influential role in facilitating access, and its close proximity to public transport enhances access. The service needs to become more prominent in young people’s consciousness, while the appointment system would benefit from
Full Text Available The target of the Open Geospatial Consortium (OGC is interoperability of geographic information, which means creating opportunities to access geodata in a consistent, standardized way. In the domain of sensor data, the target will be picked up within the OGC Sensor Web Enablement Initiative and especially reached through the Sensor Observation Service (SOS standard. This one defines a service for a standardized access to time series data and is usually used for in situ sensors (like discharge gauges and climate stations. Although the standard considers raster data, no implementation of the standard for raster data exists presently. In this paper an OGC-compliant Sensor Observation Service for a standardized access to raster data is described. A data model was developed that enables effective storage of the raster data with the corresponding metadata in a database, reading this data in an efficient way, and encoding it with result formats that the SOS-standard provides.
Crettenden, Ian; Poz, Mario Dal; Buchan, James
This editorial introduces the 'Right time, Right place: improving access to health service through effective retention and distribution of health workers' thematic series. This series draws from studies in a range of countries and provides new insights into what can be done to improve access to health through more effective human resources policies, planning and management. The primary focus is on health workforce distribution and retention.
Full Text Available The worldwide Sensor Web comprises observation data from diverse sources. Each data provider may process and assess datasets differently before making them available online. This information is often invisible to end users. Therefore, publishing observation data with quality descriptions is vital as it helps users to assess the suitability of data for their applications. It is also important to capture contextual information concerning data quality such as provenance to trace back incorrect data to its origins. In the Open Geospatial Consortium (OGC’s Sensor Web Enablement (SWE framework, there is no sufficiently and practically applicable approach how these aspects can be systematically represented and made accessible. This paper presents Q-SOS—an extension of the OGC’s Sensor Observation Service (SOS that supports retrieval of observation data together with quality descriptions. These descriptions are represented in an observation data model covering various aspects of data quality assessment. The service and the data model have been developed based on open standards and open source tools, and are productively being used to share observation data from the TERENO observatory infrastructure. We discuss the advantages of deploying the presented solutions from data provider and consumer viewpoints. Enhancements applied to the related open-source developments are also introduced.
Kibria, Mirza Golam; Villardi, Gabriel Porto; Ishizu, Kentaro; Kojima, Fumihide; Yano, Hiroyuki
In this paper, we study inter-operator spectrum sharing and intra-operator resource allocation in shared spectrum access communication systems and propose efficient dynamic solutions to address both inter-operator and intra-operator resource allocation optimization problems. For inter-operator spectrum sharing, we present two competent approaches, namely the subcarrier gain-based sharing and fragmentation-based sharing, which carry out fair and flexible allocation of the available shareable spectrum among the operators subject to certain well-defined sharing rules, traffic demands, and channel propagation characteristics. The subcarrier gain-based spectrum sharing scheme has been found to be more efficient in terms of achieved throughput. However, the fragmentation-based sharing is more attractive in terms of computational complexity. For intra-operator resource allocation, we consider resource allocation problem with users' dissimilar service requirements, where the operator supports users with delay constraint and non-delay constraint service requirements, simultaneously. This optimization problem is a mixed-integer non-linear programming problem and non-convex, which is computationally very expensive, and the complexity grows exponentially with the number of integer variables. We propose less-complex and efficient suboptimal solution based on formulating exact linearization, linear approximation, and convexification techniques for the non-linear and/or non-convex objective functions and constraints. Extensive simulation performance analysis has been carried out that validates the efficiency of the proposed solution.
This is a practical description of how replacement valves are assessed using echocardiography. Normal transthoracic appearances including normal variants are described. The problem of differentiating normal function, patient–prosthesis mismatch and pathological obstruction in aortic replacement valves with high gradients is discussed. Obstruction and abnormal regurgitation is described for valves in the aortic, mitral and right-sided positions and when to use echocardiography in suspected infective endocarditis. The roles of transoesophageal and stress echocardiography are described and finally when other imaging techniques may be useful. PMID:27600454
Funiciello, Francesca; Rosenau, Matthias; Sagnotti, Leonardo; Scarlato, Piergiorgio; Tesei, Telemaco; Trippanera, Daniele; Spires, Chris; Drury, Martyn; Kan-Parker, Mirjam; Lange, Otto; Willingshofer, Ernst
The EC policy for research in the new millennium supports the development of european-scale research infrastructures. In this perspective, the existing research infrastructures are going to be integrated with the objective to increase their accessibility and to enhance the usability of their multidisciplinary data. Building up integrating Earth Sciences infrastructures in Europe is the mission of the Implementation Phase (IP) of the European Plate Observing System (EPOS) project (2015-2019). The integration of european multiscale laboratories - analytical, experimental petrology and volcanology, magnetic and analogue laboratories - plays a key role in this context and represents a specific task of EPOS IP. In the frame of the WP16 of EPOS IP working package 16, European geosciences multiscale laboratories aims to be linked, merging local infrastructures into a coherent and collaborative network. In particular, the EPOS IP WP16-task 4 "Data services" aims at standardize data and data products, already existing and newly produced by the participating laboratories, and made them available through a new digital platform. The following data and repositories have been selected for the purpose: 1) analytical and properties data a) on volcanic ash from explosive eruptions, of interest to the aviation industry, meteorological and government institutes, b) on magmas in the context of eruption and lava flow hazard evaluation, and c) on rock systems of key importance in mineral exploration and mining operations; 2) experimental data describing: a) rock and fault properties of importance for modelling and forecasting natural and induced subsidence, seismicity and associated hazards, b) rock and fault properties relevant for modelling the containment capacity of rock systems for CO2, energy sources and wastes, c) crustal and upper mantle rheology as needed for modelling sedimentary basin formation and crustal stress distributions, d) the composition, porosity, permeability, and
Repondek-Liberska, M; Janiak, K; Wloch, A
Ectopia cordis is an extremely rare congenital abnormality occurring in 5.5 to 7.9 per 1 million live births with high lethality. Between January 1995 and October 1997 eight cases of ectopia cordis were diagnosed at our institute before birth. On the basis of echocardiography the fetal heart anatomy was categorized as either normal heart anatomy (NHA; n = 3) or congenital heart defect (CHD; n = 5). In the majority of cases (seven of eight) other abnormalities were present. Some reports have described ectopia cordis being diagnosed in the first trimester of pregnancy. In our study group the average gestational age at diagnosis was 26 weeks. The prenatal diagnosis of isolated ectopia cordis is easy; counseling the patient, the perinatal management including term, place, and method of delivery, and optimal care of the newborn are more difficult. Ectopia cordis is a malformation that pediatricians rarely encounter, even at pediatric cardiology centers. Much more frequently it is a problem for sonographers and obstetricians; however, pediatric cardiologists should be aware of diagnostic algorithm for such cases, especially when additional abnormalities are present.
Lesley; De; Pietri; Federico; Mocchegiani; Chiara; Leuzzi; Roberto; Montalti; Marco; Vivarelli; Vanni; Agnoletti
Liver transplantation(LT) has become the standard of care for patients with end stage liver disease. The allocation of organs, which prioritizes the sickest patients, has made the management of liver trans-plant candidates more complex both as regards their comorbidities and their higher risk of perioperative complications. Patients undergoing LT frequently display considerable physiological changes during the pro-cedures as a result of both the disease process and the surgery. Transoesophageal echocardiography(TEE), which visualizes dynamic cardiac function and overall contractility, has become essential for perioperative LT management and can optimize the anaesthetic management of these highly complex patients. More-over, TEE can provide useful information on volume status and the adequacy of therapeutic interventions and can diagnose early intraoperative complications, such as the embolization of large vessels or development of pulmonary hypertension. In this review, directed at clinicians who manage TEE during LT, we show why the procedure merits a place in challenging anaesthetic environment and how it can provide essential information in the perioperative management of compromised patients undergoing this very complex surgical procedure.
Ploeg, Jenny; Denton, Margaret; Hutchison, Brian; McAiney, Carrie; Moore, Ainsley; Brazil, Kevin; Tindale, Joseph; Lam, Annie
Abstract Objective To understand how family physicians facilitate older patients’ access to community support services (CSSs) and to identify similarities and differences across primary health care (PHC) models. Design Qualitative, multiple-case study design using semistructured interviews. Setting Four models of PHC delivery, specifically 2 family health teams (FHTs), 4 non-FHTs family health organizations, 4 fee-for-service practices, and 2 community health centres in urban Ontario. Participants Purposeful sampling of 23 family physicians in solo and small and large group practices within the 4 models of PHC. Methods A multiple-case study approach was used. Semistructured interviews were conducted and data were analyzed using within- and cross-case analysis. Case study tactics to ensure study rigour included memos and an audit trail, investigator triangulation, and the use of multiple, rather than single, case studies. Main findings Three main themes were identified: consulting and communicating with the health care team to create linkages; linking patients and families to CSSs; and relying on out-of-date resources and ineffective search strategies for information on CSSs. All participants worked with their team members; however, those in FHTs and community health centres generally had a broader range of health care providers available to assist them. Physicians relied on home-care case managers to help make linkages to CSSs. Physicians recommended the development of an easily searchable, online database containing available CSSs. Conclusion This study shows the importance of interprofessional teamwork in primary care settings to facilitate linkages of older patients to CSSs. The study also provides insight into the strategies physicians use to link older persons to CSSs and their recommendations for change. This understanding can be used to develop resources and approaches to better support physicians in making appropriate linkages to CSSs. PMID:28115458
Dijk, E.M.S.; Doorn, P.K.
Data Archiving and Networked Services (DANS) promotes sustained access to digital research data in the Netherlands. Researchers can deposit their data through the online archiving system EASY. Via the portal NARCIS the research data are shown in context, namely in relation to publications, and other
Choi, Stephanie; Boyle, Eleanor; Cairney, John;
speaking counterparts. For accessing specialist care, we found that those who were identified as homosexual/gay, non-English speakers, immigrants, having low income and residing in rural area were two times less likely to use these services. However, being a homosexual/gay, being an immigrant, and having...
Du, Qinghe; Zhao, Weidong; Li, Weimin; Zhang, Xuelin; Sun, Bo; Song, Houbing; Ren, Pinyi; Sun, Li; Wang, Yichen
The prosperity of e-health is boosted by fast development of medical devices with wireless communications capability such as wearable devices, tiny sensors, monitoring equipments, etc., which are randomly distributed in clinic environments. The drastically-increasing population of such devices imposes new challenges on the limited wireless resources. To relieve this problem, key knowledge needs to be extracted from massive connection attempts dispersed in the air towards efficient access control. In this paper, a hybrid periodic-random massive access (HPRMA) scheme for wireless clinical networks employing ultra-narrow band (UNB) techniques is proposed. In particular, the proposed scheme towards accommodating a large population of devices include the following new features. On one hand, it can dynamically adjust the resource allocated for coexisting periodic and random services based on the traffic load learned from signal collision status. On the other hand, the resource allocation within periodic services is thoroughly designed to simultaneously align with the timing requests of differentiated services. Abundant simulation results are also presented to demonstrate the superiority of the proposed HPRMA scheme over baseline schemes including time-division multiple access (TDMA) and random access approach, in terms of channel utilization efficiency, packet drop ratio, etc., for the support of massive devices' services.
Jarcuska, P.; Bobakova, D.; Uhrin, J.; Bobak, L.; Babinska, I.; Kolarcik, P.; Veselska, Z.; Madarasova-Geckova, A.
The health of Roma has been found to be poorer than that of the majority population. The aim of this study was to explore the differences between Roma and non-Roma regarding perceived barriers in accessing health services. Furthermore, we aimed to assess the association between self-rated health sta
Full Text Available Abstract Background Patients with psychosocial problems may benefit from a variety of community, educational, recreational and voluntary sector resources, but GPs often under-refer to these through lack of knowledge and time. This study evaluated the acceptability and effectiveness of graduate primary care mental health workers (GPCMHWs facilitating access to voluntary and community sector services for patients with psychosocial problems. Methods Patients with psychosocial problems from 13 general practices in London were referred to a GPCMHW Community Link scheme providing information and support to access voluntary and community resources. Patient satisfaction, mental health and social outcomes, and use of primary care resources, were evaluated. Results 108 patients consented to take part in the study. At three-month follow-up, 63 (58% had made contact with a community service identified as suitable for their needs. Most were satisfied with the help provided by the GPCMHW in identifying and supporting access to a suitable service. There was a reduction in the number of patients with a probable mental health problem on the GHQ-12 from 83% to 52% (difference 31% (95% CI, 17% – 44%. Social adjustment improved and frequencies of primary care consultations and of prescription of psychotropic medications were reduced. Conclusion Graduates with limited training in mental health and no prior knowledge of local community resources can help patients with psychosocial problems access voluntary and community services, and patients value such a scheme. There was some evidence of effectiveness in reducing psychosocial and mental health problems.
Full Text Available Background: Health care access is complex and multi-faceted and, as a basic right, equitable access and services should be available to all user groups.Objectives: The aim of this article is to explore how service delivery impacts on access to healthcare for vulnerable groups in an urban primary health care setting in South Africa.Methods: A descriptive qualitative study design was used. Data were collected through semi-structured interviews with purposively sampled participants and analysed through thematic content analysis.Results: Service delivery factors are presented against five dimensions of access according to the ACCESS Framework. From a supplier perspective, the organisation of care in the study setting resulted in available, accessible, affordable and adequate services as measured against the DistrictHealth System policies and guidelines. However, service providers experienced significant barriers in provision of services, which impacted on the quality of care, resulting in poor client and provider satisfaction and ultimately compromising acceptability of service delivery. Although users found services to be accessible, the organisation of services presented them with challenges in the domains of availability, affordability and adequacy, resulting in unmet needs, low levels of satisfaction and loss of trust. These challenges fuelled perceptions of unacceptable services.Conclusion: Well developed systems and organisation of services can create accessible, affordable and available primary healthcare services, but do not automatically translate into adequate and acceptable services. Focussing attention on how services are delivered might restore the balance between supply (services and demand (user needs and promote universal and equitable access.
Abortion is unlawful in Ireland except where it is necessary to save the life of the mother. The right to life of the unborn child is safeguarded under Article 40.3.3 degrees of Bunreacht na hEireann (the Irish Constitution). In 2003 the European Convention on Human Rights was incorporated into Irish domestic legislation, subject to the provisions of the Irish Constitution. The aim of this paper is to consider the potential impact of the ECHR on access to abortion services within the State. This paper commences with discussion of the statutory prohibition on abortion and the Constitutional provisions concerning the protection afforded to the unborn child. It will then be necessary to examine the implications for Ireland of recent European Court of Human Rights' decisions, in particular the recent judgment in A, B & C v Ireland, regarding the right to legal abortions given the unique nature of the legal status of the ECHR and its relationship with the Irish Constitution.
Regan, Jemma L
A case study comprised of formal interviews, formal observations and informal discussions investigated the motivations and experiences accessing dementia care health and social care services for a Muslim, Pakistani male with dementia. Motivations derived from 'desperation' and an inability to access support from family or religious community. Experiences of accessing services were mostly negative. Dementia services were ill-informed about how to support persons with young onset dementia, with pre-existing mental health conditions, from an ethnic minority. Education and training to remove barriers to all dementia care services is required for persons with dementia, their families and within dementia services and religious communities.
Agha, Sohail; Gage, Anastasia; Balal, Asma
With declining levels of international donor funding for financing reproductive health programmes, developing country governments and international donors are looking towards private sector strategies to expand the supply of quality reproductive health services. One of the challenges of a health franchise is to improve the quality of services provided by independent private practitioners. Private providers are more likely to abide by the quality standards set by a franchiser if they see a financial benefit resulting from franchise participation. This study was conducted to measure whether (a) there were improvements in perceived quality of care and perceived access to health facilities once these facilities became part of a franchise and (b) improvements in perceived quality and perceived access were associated with increased client loyalty to franchised clinics. Franchisees were given basic reproductive health training for seven days and services marketing training for two days. Exit interviews were conducted with male and female clients at health facilities. A pre-test measurement was taken in April 2001, prior to the start of project activities. A post-test measurement was taken in February/March 2002, about 9 months after the pre-test. Multilevel regression analysis, which takes the hierarchical structure of the data into account, was used for the analysis. After taking provider-level variation into account and controlling for client characteristics, the analyses showed significant improvements in perceived quality of care and perceived access to services. Private provider participation in a franchise network helps improve client perceptions of quality of, and access to, services. Improvements in client perceptions of quality and access contribute to increased client loyalty to franchised clinics. Once increased client loyalty translates into higher client volumes, providers are likely to see the benefits of franchise participation. In turn, this should lead to
Full Text Available Introduction: In South Africa, there are renewed efforts to strengthen primary health care and community health worker (CHW programmes. This article examines three South African CHW programmes, a small local non-governmental organisation (NGO, a local satellite of a national NGO, and a government-initiated service, that provide a range of services from home-based care, childcare, and health promotion to assist clients in overcoming poverty-related barriers to health care. Methods: The comparative case studies, located in Eastern Cape and Gauteng, were investigated using qualitative methods. Thematic analysis was used to identify factors that constrain and enable outreach services to improve access to care. Results: The local satellite (of a national NGO, successful in addressing multi-dimensional barriers to care, provided CHWs with continuous training focused on the social determinants of ill-health, regular context-related supervision, and resources such as travel and cell-phone allowances. These workers engaged with, and linked their clients to, agencies in a wide range of sectors. Relationships with participatory structures at community level stimulated coordinated responses from service providers. In contrast, an absence of these elements curtailed the ability of CHWs in the small NGO and government-initiated service to provide effective outreach services or to improve access to care. Conclusion: Significant investment in resources, training, and support can enable CHWs to address barriers to care by negotiating with poorly functioning government services and community participation structures.
Aline Blaya MARTINS
Full Text Available Abstract Objective This research evaluated whether having dental treatment available in the primary health care centers of the Brazilian Unified Health System was associated with greater satisfaction with the services accessed. The offering of dental care within the health service that elders usually access may improve their satisfaction with the services as a whole. Material and method In this cross-sectional study, 401 elders living in the districts of Lomba do Pinheiro and Partenon in Porto Alegre, Brazil were interviewed. Elders were selected using a cluster sampling design process from census tract drawings. Result Poisson Regression revealed that age and dental treatment supply were associated with outcome, and age, number of teeth, and the presence of dental treatment were associated with a higher prevalence of satisfaction with health services. Conclusion These results provide new contributions for health system qualification because this study demonstrated the importance of having dental treatment available to improve the satisfaction of older people with the Primary Health Care (PHC services accessed.
Lobach, David F.; Willis, Janese M.; Macri, Jennifer M.; Simo, Jessica; Anstrom, Kevin J.
Increasing emphasis is being placed on the importance of information technology to improve the safety and quality of healthcare. However, concern is growing that these potential benefits will not be equally distributed across the population because of a widening digital divide along racial and socioeconomic lines. In this pilot study, we surveyed 31 Medicaid beneficiaries to ascertain their interest in and projected use of a healthcare patient Internet portal. We found that most Medicaid beneficiaries (or their parents/guardians) were very interested in accessing personal health information about themselves (or their dependents) online. Additionally, they were interested in accessing healthcare services online. We also found that many Medicaid beneficiaries have Internet access, including a slight majority with access to high-speed Internet connections. Our study revealed significant concern about the privacy of online health information. PMID:17238393
Full Text Available Objective – To examine interlibrary loan (ILL request rates for open access (OA materials and determine how OA may affect resource sharing. This research updates the author’s previous study. Design – Quantitative analysis. Setting – A large, urban, public research university library system in the United States of America. Subjects – 1,557 open access ILL material requests among 23,531 total ILL requests submitted during the 2012 and 2013 fiscal years (July 2011-June 2013. Methods – The library has tracked and recorded OA requests that appear among ILL material requests since 2009. Using OCLC’s ILLiad software to manage ILL requests, they have implemented two custom routines. One routine is for open access searching on standard items, and uses software plugins to search across various open resources. All materials published prior to 1923 are treated as being in the public domain, so requests for these materials are automatically routed to this queue. The second custom routine is used for searching for OA electronic theses and dissertations, and is employed when the requested resource is not found in the library’s subscription resources. Other article requests are routed to the RapidILL service for open access availability. Main Results – The research presented reveals that ILL requests for OA materials exhibited a steady increase year over year, while overall ILL requests decreased slightly. This finding is true both for the fiscal years reported in this study and also the years since the author’s original study in 2011 (Baich, 2012. Of the 1,557 OA requests examined, 72% (n=1,135 were for journal articles, 8% (n=125 were for books or book chapters, 9% (n=140 were for theses or dissertations, 3% (n=54 were for conference papers, and 7% (n=105 were for reports. Library staff typically fill these article requests using gold OA or green OA sources. The researcher notes the difficulty in refining by source, though confirmed that
Full Text Available Background. Tuberculosis (TB remains a significant global public health problem with known gender-related (male versus female disparities. We reviewed the qualitative evidence (written/spoken narrative for gender-related differences limiting TB service access from symptom onset to treatment initiation. Methods. Following a systematic process, we searched 12 electronic databases, included qualitative studies that assessed gender differences in accessing TB diagnostic and treatment services, abstracted data, and assessed study validity. Using a modified “inductive coding” system, we synthesized emergent themes within defined barriers and delays limiting access at the individual and provider/system levels and examined gender-related differences. Results. Among 13,448 studies, 28 studies were included. All were conducted in developing countries and assessed individual-level barriers; 11 (39% assessed provider/system-level barriers, 18 (64% surveyed persons with suspected or diagnosed TB, and 7 (25% exclusively surveyed randomly sampled community members or health care workers. Each barrier affected both genders but had gender-variable nature and impact reflecting sociodemographic themes. Women experienced financial and physical dependence, lower general literacy, and household stigma, whereas men faced work-related financial and physical barriers and community-based stigma. Conclusions. In developing countries, barriers limiting access to TB care have context-specific gender-related differences that can inform integrated interventions to optimize TB services.
Keceli, Feyza; Ayanoglu, Ender
We present the station-based unfair access problem among the uplink and the downlink stations in the IEEE 802.11e infrastructure Basic Service Set (BSS) when the default settings of the Enhanced Distributed Channel Access (EDCA) parameters are used. We discuss how the transport layer protocol characteristics alleviate the unfairness problem. We design a simple, practical, and standard-compliant framework to be employed at the Access Point (AP) for fair and efficient access provisioning. A dynamic measurement-based EDCA parameter adaptation block lies in the core of this framework. The proposed framework is unique in the sense that it considers the characteristic differences of Transmission Control Protocol (TCP) and User Datagram Protocol (UDP) flows and the coexistence of stations with varying bandwidth or Quality-of-Service (QoS) requirements. Via simulations, we show that our solution provides short- and long-term fair access for all stations in the uplink and downlink employing TCP and UDP flows with non-...
Peltier, Jennifer; Hansford, Wes
The MCM Designers' Access Service (MIDAS) allows designers to obtain prototype and small quantities of MCMs. To date the service has processed designs from industry, government and major universities. The service currently accesses processes at the following MCM-D foundries: nChip/Flextronics in San Jose, CA; Micromodule Systems in Cupertino, CA; and IBM Microelectronics in Hopewell Junction, NY. MIDAS provides a low cost service achieved through a multiproject environment where the customers share tooling and substrate manufacturing costs. The service offers design support, distributes foundry design kits, groups the projects onto regularly scheduled runs, places orders and supplies fully assembled modules. As well, MIDAS offers a limited selection of open tooled, second-level packages, bare tested die, and test sockets to aid with the design process. Often when investigating implementation of MCMs into a working system designers need a prototype. In many cases a foundry prefers to handle only high volume orders or imposes minimum purchase quantities. These may likely exceed the entire project budget. MIDAS functions as a technology enabler by supplying the designers with an interface `transparent' to the fabricator and common to multiple vendors. Foundries prefer to work with a single source who coordinates the details of multiple orders to spare valuable overhead. By completing front-end foundry tasks such as data preparation and mask fabrication and by grouping multiple users together on a run, MIDAS serves this purpose. Certain design conditions such as footprint size and I/O ring, layer stacking and number of layers exist to establish uniformity amongst the unrelated customers. This paper discusses the history of the service, the operating guidelines and presents an overview of how to access the service for MCM fabrication.
Corbett A Michelle
Full Text Available Abstract Background Much research has shown that the homeless have higher rates of substance abuse problems than housed populations and that substance abuse increases individuals' vulnerability to homelessness. However, the effects of housing policies on drug users' access to housing have been understudied to date. This paper will look at the "unofficial" housing policies that affect drug users' access to housing. Methods Qualitative interviews were conducted with 65 active users of heroin and cocaine at baseline, 3 and 6 months. Participants were purposively sampled to reflect a variety of housing statuses including homeless on the streets, in shelters, "doubled-up" with family or friends, or permanently housed in subsidized, unsubsidized or supportive housing. Key informant interviews and two focus group interviews were conducted with 15 housing caseworkers. Data were analyzed to explore the processes by which drug users receive information about different housing subsidies and welfare benefits, and their experiences in applying for these. Results A number of unofficial policy mechanisms limit drug users' access to housing, information and services, including limited outreach to non-shelter using homeless regarding housing programs, service provider priorities, and service provider discretion in processing applications and providing services. Conclusion Unofficial policy, i.e. the mechanisms used by caseworkers to ration scarce housing resources, is as important as official housing policies in limiting drug users' access to housing. Drug users' descriptions of their experiences working with caseworkers to obtain permanent, affordable housing, provide insights as to how access to supportive and subsidized housing can be improved for this population.
Morton, Cory M; Simmel, Cassandra; Peterson, N Andrew
This study investigates the relationship between concentrations of on- and off-premises alcohol outlets and rates of child abuse and neglect. Additionally, the study seeks to locate protective features of a neighborhood's built environment by investigating the potentially moderating role that access to substance abuse treatment and prevention services plays in the relationship between alcohol outlet density and child maltreatment. Using a cross-sectional design, this ecological study utilized data from 163 census tracts in Bergen County, New Jersey, on reports of child abuse and neglect, alcohol outlets, substance abuse treatment and prevention facilities, and the United States Census to investigate the linkages between socioeconomic structure, alcohol availability, and access to substance abuse service facilities on rates of child abuse and neglect. Findings indicate areas with a greater concentration of on-premises alcohol outlets (i.e., bars) had higher rates of child neglect, and those with easier access to substance abuse services had lower rates of neglect, controlling for neighborhood demographic and socioeconomic structure. Additionally, the relationship between on-premises alcohol outlet density and rates of child neglect was moderated by the presence of substance abuse service facilities. A greater concentration of off-premises outlets (i.e., liquor stores) was associated with lower rates of physical abuse. Findings suggest that the built environment and socioeconomic structure of neighborhoods have important consequences for child well-being. The implications for future research on the structural features of neighborhoods that are associated with child well-being are discussed.
Keefe, Robert H; Brownstein-Evans, Carol; Rouland Polmanteer, Rebecca S
This article identifies variables at the micro/individual, mezzo/partner/spouse and family, and macro/health care-system levels that inhibit mothers at risk for perinatal mood disorders from accessing health and mental health care services. Specific recommendations are made for conducting thorough biopsychosocial assessments that address the mothers' micro-, mezzo-, and macro-level contexts. Finally, the authors provide suggestions for how to intervene at the various levels to remove access barriers for mothers living with perinatal mood disorders as well as their families.
Burwash, Ian G; Basmadjian, Arsene; Bewick, David; Choy, Jonathan B; Cujec, Bibiana; Jassal, Davinder S; MacKenzie, Scott; Nair, Parvathy; Rudski, Lawrence G; Yu, Eric; Tam, James W
Guidelines for the provision of echocardiography in Canada were jointly developed and published by the Canadian Cardiovascular Society and the Canadian Society of Echocardiography in 2005. Since their publication, recognition of the importance of echocardiography to patient care has increased, along with the use of focused, point-of-care echocardiography by physicians of diverse clinical backgrounds and variable training. New guidelines for physician training and maintenance of competence in adult echocardiography were required to ensure that physicians providing either focused, point-of-care echocardiography or comprehensive echocardiography are appropriately trained and proficient in their use of echocardiography. In addition, revision of the guidelines was required to address technological advances and the desire to standardize echocardiography training across the country to facilitate the national recognition of a physician's expertise in echocardiography. This paper summarizes the new Guidelines for Physician Training and Maintenance of Competency in Adult Echocardiography, which are considerably more comprehensive than earlier guidelines and address many important issues not previously covered. These guidelines provide a blueprint for physician training despite different clinical backgrounds and help standardize physician training and training programs across the country. Adherence to the guidelines will ensure that physicians providing echocardiography have acquired sufficient expertise required for their specific practice. The document will also provide a framework for other national societies to standardize their training programs in echocardiography and will provide a benchmark by which competency in adult echocardiography may be measured.
Full Text Available Abstract Background Recently, intracardiac echocardiography emerged as a useful tool in the electrophysiology laboratories for guiding transseptal left heart catheterizations, for avoiding thromboembolic and mechanical complications and assessing the ablation lesions characteristics. Although the value of ICE is well known, it is not a universal tool for achieving uncomplicated access to the left atrium. We present a case in which ICE led to interruption of a transseptal procedure because several risk factors for mechanical complications were revealed. Case presentation A case of a patient with paroxysmal atrial fibrillation and atrial flutter, and distorted intracardiac anatomy is presented. Intracardiac echocardiography showed a small oval fossa abouting to an enlarged aorta anteriorly. A very small distance from the interatrial septum to the left atrial free wall was seen. The latter two conditions were predisposing to a complicated transseptal puncture. According to fluoroscopy the transseptal needle had a correct position, but the intracardiac echo image showed that it was actually pointing towards the aortic root and most importantly, that it was virtually impossible to stabilize it in the fossa itself. Based on intracardiac echo findings a decision was made to limit the procedure only to ablation of the cavotricuspid isthmus and not to proceed further so as to avoid complications. Conclusion This case report illustrates the usefulness of the intracardiac echocardiography in preventing serious or even fatal complications in transseptal procedures when the cardiac anatomy is unusual or distorted. It also helps to understand the possible mechanisms of mechanical complications in cases where fluoroscopic images are apparently normal.
This report examines key issues related to electricity access in Africa, through the lens of selected case studies of countries that have successfully managed to increase access significantly in a short period of time, backed up with more general regional analysis. On the basis of this overview and analysis, the report makes a number of recommendations on priorities and necessary actions by countries and the donor community as to how the electricity access challenges may be addressed.
Morton, Cory M
This study investigates how the relationship between dense concentrations of alcohol retailers and high rates of child maltreatment may be moderated by the presence of substance abuse service facilities. Using a cross-sectional design, the study utilized data from Bergen County, New Jersey on child maltreatment reports, alcohol-selling retailers, substance abuse service facilities, and the United States Census. Findings indicate child maltreatment rates were higher in neighborhoods with lower socioeconomic status and those with greater alcohol outlet density. Neighborhoods with easily accessed substance abuse service facilities had lower rates of child maltreatment. Additionally, the relationship between child maltreatment and alcohol outlet density was moderated by the presence of substance abuse service facilities. The study findings highlight the relevance of making primary prevention approaches readily available and using multi-sector collaboration to reduce child maltreatment.
Full Text Available It is recognized and accepted that social economy has a significant contribution within the area of social inclusion policies. The intervention areas regarded are extremely diverse: professional education and training, employment policies, social and socio‐medical services, social insurances, the banking and cultural environment,leisure activities, proximity services designed for the population with social exclusion risk etc. This study focuses on some of the ways where social economy mechanisms could be introduced in the field of health protection from Romania.Accepting and recognizing the utility of the mutual insurance type structures is desirable for the increase of the preconditions of a real equity within the access tothe health care services, including the vulnerable groups, without endangering social solidarity, focusing on the service needs and guaranteeing the active participation to the formation and management of the funds thus created.
Lovett, Andrew; Haynes, Robin; Sünnenberg, Gisela; Gale, Susan
Accessibility to general practitioner (GP) surgeries was investigated in a population study of East Anglia (Cambridgeshire, Norfolk and Suffolk) in the United Kingdom. Information from patient registers was combined with details of general practitioner surgery locations, road network characteristics, bus routes and community transport services, and a geographical information system (GIS) was used to calculate measures of accessibility to surgeries by public and private transport. Outcome measures included car travel times and indicators of the extent to which bus services could be used to visit GP surgeries. These variables were aggregated for wards or parishes and then compared with socio-economic characteristics of the populations living in those areas. The results indicated that only 10% of residents faced a car journey of more than 10 min to a GP. Some 13% of the population could not reach general medical services by daily bus. For 5% of the population, the car journey to the nearest surgery was longer than 10 min and there was no suitable bus service each weekday. In the remoter rural parishes, the lowest levels of personal mobility and the highest health needs indicators were found in the places with no daytime bus service each weekday and no community transport. The overall extent of accessibility problems and the existence of inverse care law effects in some rural localities have implications for the NHS, which aims to provide an equitable service to people wherever they live. The research also demonstrates the potential of patient registers and GIS as research and planning tools, though the practical difficulties of using these data sources and techniques should not be underestimated.
Full Text Available Introduction. Men who have sex with men (MSM are disproportionately impacted by HIV globally. Easily accessible combination HIV prevention strategies, tailored to the needs of MSM, are needed to effectively address the AIDS pandemic. Methods and Materials. We conducted a cross-sectional study among MSM (n=3748 from 145 countries from April to August 2012. Using multivariable random effects models, we examined factors associated with acceptability of preexposure prophylaxis (PrEP and access to condoms, lubricants, HIV testing, and HIV treatment. Results. Condoms and lubricants were accessible to 35% and 22% of all respondents, respectively. HIV testing was accessible to 35% of HIV-negative respondents. Forty-three percent of all HIV-positive respondents reported that antiretroviral therapy was easily accessible. Homophobia, outness, and service provider stigma were significantly associated with reduced access to services. Conversely, community engagement, connection to gay community, and comfort with service providers were associated with increased access. PrEP acceptability was associated with lower PrEP-related stigma, less knowledge about PrEP, less outness, higher service provider stigma, and having experienced violence for being MSM. Conclusions. Ensuring HIV service access among MSM will be critical in maximizing the potential effectiveness of combination approaches, especially given the interdependence of both basic and newer interventions like PrEP. Barriers and facilitators of HIV service access for MSM should be better understood and addressed.
Kurklinsky, Andrew; Mankad, Sunil
Recent technologic advances in 3-dimensional (3D) echocardiography, using parallel processing to scan a pyramidal volume, have allowed for a superior ability to describe valvular anatomy using both transthoracic and transesophageal echocardiography. Although still in evolution and at an early phase of adaptation with respect to its clinical application, 3D echocardiography has emerged as an important clinical tool in the assessment of valvular heart disease. Three-dimensional echocardiography provides unique perspectives of valvular structures by presenting "en face" views of valvular structures, allowing for a better understanding of the topographical aspects of pathology, and a refined definition of the spatial relationships of intracardiac structures. Three-dimensional echocardiography makes available indices not described by 2D echocardiography and has been demonstrated to be superior to 2D echocardiography in a variety of valvular disease scenarios. The information gained from 3D echocardiography has especially made an impact in guiding clinical decisions in the evaluation of mitral valve (MV) disease. The decision of early surgery in degenerative MV disease is based on the suitability of repair, and the suitability of repair is generally based on echocardiography. The superior understanding of MV anatomy afforded by 3D echocardiography has been shown to be quite valuable in this setting. This review will describe the contemporary use of 3D echocardiography in the assessment of valvular heart disease, including MV, aortic, tricuspid, and prosthetic valve abnormalities. This article illustrates how 3D echocardiography can complement current echocardiography techniques in the management of valvular heart disease.
Nadash, Pamela; Miller, Edward Alan; Porell, Frank W; Birchander, Ellen; Glickman, Lillian; Burr, Jeffrey A
This article describes the online Management of Aging Services Masters Program at the University of Massachusetts Boston and reports on a recent Program review. The Program has experienced rapid growth, evolving from seven matriculating students in 2003 to 108 in 2012. It has graduated 125 students and boasts a 78% completion rate. The authors describe the Program and report on faculty and student perceptions of performance. The Program demonstrates sound pedagogical practice for online education, incorporating techniques to foster community and encourage students and faculty interaction. Distance learning holds considerable promise for expanding access to gerontological education to reach future aging services professionals.
Xiang, Yu; Zhou, Kun; Yang, Liu; Pan, Lei; Liao, Zhen-wan; Zhang, Qiang
In this paper, we demonstrate a novel multi-service wired/wireless integrated access architecture of cloud radio access network (C-RAN) based on radio-over-fiber passive optical network (RoF-PON) system, which utilizes scalable multiple- frequency millimeter-wave (MF-MMW) generation based on tunable optical frequency comb (TOFC). In the baseband unit (BBU) pool, the generated optical comb lines are modulated into wired, RoF and WiFi/WiMAX signals, respectively. The multi-frequency RoF signals are generated by beating the optical comb line pairs in the small cell. The WiFi/WiMAX signals are demodulated after passing through the band pass filter (BPF) and band stop filter (BSF), respectively, whereas the wired signal can be received directly. The feasibility and scalability of the proposed multi-service wired/wireless integrated C-RAN are confirmed by the simulations.
Fransen, Koos; Deruyter, Greet; De Maeyer, Philippe
Mobility presents a variety of opportunities as it allows users to access locations and services, and to meet people beyond their immediate surroundings. While the concept of mobility primarily focuses on the ease of moving, accessibility delineates the actual potential to participate in out-of-home activities. As a result, accessibility is a complex concept with a multitude of foci. This complexity is presented in the first section, which explains the general concept of accessibility, how it...
Nanda, Navin C.; Kapur, K. K.; Kapoor, Poonam Malhotra
Simulation allows interactive transthoracic echocardiography (TTE) learning using a virtual three-dimensional model of the heart and may aid in the acquisition of the cognitive and technical skills needed to perform TTE. The ability to link probe manipulation, cardiac anatomy, and echocardiographic images using a simulator has been shown to be an effective model for training anesthesiology residents in transesophageal echocardiography. A proposed alternative to real-time reality patient-based learning is simulation-based training that allows anesthesiologists to learn complex concepts and procedures, especially for specific structures such as aortic valve. PMID:27397455
Transthoracic echocardiography has become a major imaging tool for the diagnosis and management of canine and feline cardiovascular diseases. During the last decade, more recent advances in ultrasound technology with the introduction of newer imaging modalities, such as tissue Doppler imaging, strain and strain rate imaging, and 2-dimensional speckle tracking echocardiography, have provided new parameters to assess myocardial performance, including regional myocardial velocities and deformation, ventricular twist, and mechanical synchrony. An outline of these 4 recent ultrasound techniques, their impact on the understanding of right and left ventricular function in small animals, and their application in research and clinical settings are given in this article.
Colombo, Chiara; Tamborini, Gloria; Pepi, Mauro; Alimento, Marina; Fiorentini, Cesare
This review covers the role of three-dimensional (3D) echocardiography in the diagnosis of heart valve disease. Several factors have contributed to the evolution of this technique, which is currently a simple and routine method: rapid evolution in probe and computer technologies, demonstration that 3D data sets allowed more complete and accurate evaluation of cardiac structures, emerging clinical experience indicating the strong potential particularly in valve diseases, volume and function of the two ventricle measurements and several other fields. This report will review current and future applications of 3D echocardiography in mitral, aortic and tricuspid valve diseases underlying both qualitative (morphologic) and quantitative advantages of this technique.
Christensen, John M.; Mackenzie, Gordon A.; Nygaard, Ivan;
This report examines key issues related to electricity access in Africa, through the lens of selected case studies of countries that have successfully managed to increase access significantly in a short period of time, backed up with more general regional analysis. On the basis of this overview...
The demand for knowledge of productive health and the current status of productive health services provided by relevant governmental institutions were qualitatively and quantitatively studied. The study identified the key factors that influenced the demand for the productive health services and results of the services. It also discussed the effective approaches to control, planning and sustainable development of the reproductive health services for the floating populations.
Madden, H C E; Phillips-Howard, P A; Hargreaves, S C; Downing, J; Bellis, M A; Vivancos, R; Morley, C; Syed, Q; Cook, P A
HIV disproportionately affects vulnerable populations such as black and minority ethnic groups, men who have sex with men (MSM) and migrants, in many countries including those in the UK. Community organisations in the UK are charitable non-governmental organisations with a proportion of the workforce who volunteer, and provide invaluable additional support for people living with HIV (PLWHIV). Information on their contribution to HIV care in vulnerable groups is relatively sparse. Data generated from an enhanced HIV surveillance system in North West England, UK, was utilised for this study. We aimed to determine the characteristics of individuals who chose to access community services in addition to clinical services (1375 out of 4195 records of PLWHIV in clinical services). Demographic information, risk factors including residency status, uniquely gathered in this region, and deprivation scores were examined. Multivariate logistic regression modelling was conducted to predict the relative effect of patient characteristics on attendance at community services. Attendance at community services was highest in those living in the most, compared with least, deprived areas (prefugees (AOR = 5.75, 95% CI 3.3-10.03; pmigrant workers (AOR = 5.48, 95% CI 2.22-13.51; pmigrant populations, community services are vital for the management of HIV in black and minority groups. Paradoxically, this coincides with increasing funding pressures on these services.
Haslinger, Florian; Dupont, Aurelien; Michelini, Alberto; Rietbrock, Andreas; Sleeman, Reinoud; Wiemer, Stefan; Basili, Roberto; Bossu, Rémy; Cakti, Eser; Cotton, Fabrice; Crawford, Wayne; Diaz, Jordi; Garth, Tom; Locati, Mario; Luzi, Lucia; Pinho, Rui; Pitilakis, Kyriazis; Strollo, Angelo
Easy, efficient and comprehensive access to data, data products, scientific services and scientific software is a key ingredient in enabling research at the frontiers of science. Organizing this access across the European Research Infrastructures in the field of seismology, so that it best serves user needs, takes advantage of state-of-the-art ICT solutions, provides cross-domain interoperability, and is organizationally and financially sustainable in the long term, is the core challenge of the implementation phase of the Thematic Core Service (TCS) Seismology within the EPOS-IP project. Building upon the existing European-level infrastructures ORFEUS for seismological waveforms, EMSC for seismological products, and EFEHR for seismological hazard and risk information, and implementing a pilot Computational Earth Science service starting from the results of the VERCE project, the work within the EPOS-IP project focuses on improving and extending the existing services, aligning them with global developments, to at the end produce a well coordinated framework that is technically, organizationally, and financially integrated with the EPOS architecture. This framework needs to respect the roles and responsibilities of the underlying national research infrastructures that are the data owners and main providers of data and products, and allow for active input and feedback from the (scientific) user community. At the same time, it needs to remain flexible enough to cope with unavoidable challenges in the availability of resources and dynamics of contributors. The technical work during the next years is organized in four areas: - constructing the next generation software architecture for the European Integrated (waveform) Data Archive EIDA, developing advanced metadata and station information services, fully integrate strong motion waveforms and derived parametric engineering-domain data, and advancing the integration of mobile (temporary) networks and OBS deployments in
Echocardiography is the imaging modality of choice for the assessment of patients with valvular heart disease. Echocardiographic advancements may have particular impact on the assessment and management of patients with valvular heart disease. This review will summarize the current literature on advancements, such as three-dimensional echocardiography, strain imaging, intracardiac echocardiography, and fusion imaging, in this patient population.
Full Text Available Background. Health literacy is the ability to access, understand, and use information and services for good health. Among people with chronic conditions, health literacy requirements for effective self-management are high. The Optimising Health Literacy and Access (Ophelia study engaged diverse organisations in the codesign of interventions involving the Health Literacy Questionnaire (HLQ needs assessment, followed by development and evaluation of interventions addressing identified needs. This study reports the process and outcomes of one of the nine organisations, the Royal District Nursing Service (RDNS. Methods. Participants were home nursing clients with diabetes. The intervention included tailored diabetes self-management education according to preferred learning style, a standardised diabetes education tool, resources, and teach-back method. Results. Needs analysis of 113 quota-sampled clients showed difficulties managing health and finding and appraising health information. The service-wide diabetes education intervention was applied to 24 clients. The intervention was well received by clients and nurses. Positive impacts on clients’ diabetes knowledge and behaviour were seen and nurses reported clear benefits to their practice. Conclusion. A structured method that supports healthcare services to codesign interventions that respond to the health literacy needs of their clients can lead to evidence-informed, sustainable practice changes that support clients to better understand effective diabetes self-management.
Conway, Sue; Norman, Ralph; Morley, Jo; Weerasuriya, Rona; Osborne, Richard H.; Beauchamp, Alison
Background. Health literacy is the ability to access, understand, and use information and services for good health. Among people with chronic conditions, health literacy requirements for effective self-management are high. The Optimising Health Literacy and Access (Ophelia) study engaged diverse organisations in the codesign of interventions involving the Health Literacy Questionnaire (HLQ) needs assessment, followed by development and evaluation of interventions addressing identified needs. This study reports the process and outcomes of one of the nine organisations, the Royal District Nursing Service (RDNS). Methods. Participants were home nursing clients with diabetes. The intervention included tailored diabetes self-management education according to preferred learning style, a standardised diabetes education tool, resources, and teach-back method. Results. Needs analysis of 113 quota-sampled clients showed difficulties managing health and finding and appraising health information. The service-wide diabetes education intervention was applied to 24 clients. The intervention was well received by clients and nurses. Positive impacts on clients' diabetes knowledge and behaviour were seen and nurses reported clear benefits to their practice. Conclusion. A structured method that supports healthcare services to codesign interventions that respond to the health literacy needs of their clients can lead to evidence-informed, sustainable practice changes that support clients to better understand effective diabetes self-management. PMID:27668261
A.E. van den Bosch (Annemien); A.H.J. Koning (Anton); F.J. Meijboom (Folkert); J.S. McGhie (Jackie); M.L. Simoons (Maarten); P.J. van der Spek (Peter); A.J.J.C. Bogers (Ad)
textabstractBACKGROUND: This pilot study was performed to evaluate whether virtual reality is applicable for three-dimensional echocardiography and if three-dimensional echocardiographic 'holograms' have the potential to become a clinically useful tool. METHODS: Three-dimensional echocardiographic d
Stralen, Marijn van
In this thesis we aim at automating the analysis of 3D echocardiography, mainly targeting the functional analysis of the left ventricle. Manual analysis of these data is cumbersome, time-consuming and is associated with inter-observer and inter-institutional variability. Methods for reconstruction o
National Aeronautics and Space Administration — Global Science & Technology, Inc. (GST) proposes to investigate information processing and delivery technologies to provide near-real-time Web-based access to...
Full Text Available Private sector provision of basic services (water, energy, financial services and housing for people in developing countries is a necessity if we really want to try to curb poverty. However, ‘traditional’ private funding is not spontaneously directed towards these sectors, largely as a result of rejecting the idea that poor population groups should ‘pay’ for essential services; an issue that has often been the subject of opposition campaigns mounted by social stakeholders. Nevertheless, there are many, many examples to show that given the impact of these services on their quality of life, consumers in these countries - and especially those at the ‘bottom of the pyramid’ - are prepared to pay for them as long as they have access to a high-quality service. In these sectors, the nominal cost of the service concerned matters much less than its opportunity cost and the impact it will have on the lives of those who benefit from it. Very often, this service may even be paid for in advance as a way of enabling families to gain greater control over the expenditure they can devote to obtaining it.It is, however, important to distinguish between the supply of essential services and those of consumer goods, and - of course - to avoid abuses. In any event, the possibility of building financially-balanced models is what governs the process of securing sufficient funding from local and international financial institutions. In this area, as in others, the way forward is probably the happy medium: avoiding the excesses of overpricing, but accepting the need to maintain profitable economic models. These should enable investors to receive a level of profit that encourages them to continue and increase their investment, thereby increasing the number of recipients as quickly as possible. Aspiring to build social models that reject the ambition to achieve a reasonable profit and rule out any distribution of dividends to shareholders is to condemn the
Full Text Available The authors report a study concerning student and instructor attitudes toward accessing library resources and services from within course management systems (CMS. In spring 2008, the authors conducted semi-structured interviews with a small population of students and instructors at the University of California, Berkeley (UCB and at Colorado State University (CSU. They asked participants to respond to examples of library integrations in course management systems at other institutions and to report their local experiences with both the campus CMS and library services. Participant responses frequently challenged and complicated the authors’ assumptions about best practices in integrating a library presence and library services in CMS. The interview findings are discussed thematically, in relation to higher education and library literature, and can inform librarians’ efforts to integrate an effective library presence in a campus course management system. This study might be readily adapted for implementation at other institutions.
Tatani Solange Bernardes
Full Text Available OBJECTIVE: The purpose of this study is to evaluate the impact of transeophageal echocardiography on management of patients at low-risk for cardiogenic embolism to prevent new potential cardiovascular sources of emboli. METHODS: We studied 69 patients with ischemic stroke at low-risk for cardiogenic embolism. Transeophageal echocardiography was performed to access: left atrium enlargement; communication or aneurysm of the interatrial septum; patent foramen ovale; spontaneous echo contrast or intracavitary thrombi; the presence of intraaortic atherosclerotic plaques or thrombi; significant valvar morphologic alteration or dysfunction; left ventricle enlargement, hypertrophy, or contractile abnormality. Transesophageal echocardiography altered clinical management, and we adopted anticoagulant therapy or another procedure apart from the use of acetylsalicylic acid. RESULTS: Transeophageal echocardiography detected at least one abnormality in 40 cases (58%. Clinical conduct was adjusted after the performance of transesophageal echocardiography in 11 patients (15.9%; anticoagulation was added in 10 cases and surgical correction in one patient. CONCLUSION: Transeophageal echocardiography was a very useful tool in the secondary prevention for stroke in patients at low risk for cardiogenic embolism.
Holder, Reynaldo; Fabrega, Ricardo
Moving towards Universal Access to Health and Universal Health Coverage (UAH/UHC) is an imperative task on the health agenda for the Americas. The Directing Council of the Pan American Health Organization (PAHO) recently approved resolution CD53.R14, titled Strategy for Universal Access to Health and Universal Health Coverage. From the perspective of the Region of the Americas, UAH/UHC "imply that all people and communities have access, without any kind of discrimination, to comprehensive, appropriate and timely, quality health services determined at the national level according to needs, as well as access to safe, affordable, effective, quality medicines, while ensuring that the use of these services does not expose users to financial hardship, especially groups in conditions of vulnerability". PAHO's strategic approach to UAH/UHC sets out four specific lines of action toward effective universal health systems. The first strategic line proposes: a) implementation of integrated health services delivery networks (IHDSNs) based on primary health care as the key strategy for reorganizing, redefining and improving healthcare services in general and the role of hospitals in particular; and b) increasing the response capacity of the first level of care. An important debate initiated in 2011 among hospital and healthcare managers in the region tried to redefine the role of hospitals in the context of IHSDNs and the emerging UAH/UHC movement. The debates resulted in agreements around three main propositions: 1) IHSDNs cannot be envisioned without hospitals; 2) The status-quo and current hospital organizational culture makes IHSDNs inviable; and 3) Without IHSDNs, hospitals will not be sustainable. This process, that predates the approval of PAHO's UAH/UHC resolution, now becomes more relevant with the recognition that UAH/UHC cannot be attained without a profound change in healthcare service and particularly in hospitals. In this context, a set of challenges both for
Full Text Available Abstract Introduction Over the past four decades, the Indonesian health care system has greatly expanded and the health of Indonesian people has improved although the rich-poor gap in health status and service access remains an issue. The government has been trying to address these gaps and intensify efforts to improve the health of the poor following the economic crisis in 1998. Methods This paper examines trends and levels in socio-economic inequity of health and identifies critical factors constraining efforts to improve the health of the poor. Quantitative data were taken from the Indonesian Demographic Health Surveys and the National Socio-Economic Surveys, and qualitative data were obtained from interviews with individuals and groups representing relevant stakeholders. Results The health of the population has improved as indicated by child mortality decline and the increase in community access to health services. However, the continuing prevalence of malnourished children and the persisting socio-economic inequity of health suggest that efforts to improve the health of the poor have not yet been effective. Factors identified at institution and policy levels that have constrained improvements in health care access and outcomes for the poor include: the high cost of electing formal governance leaders; confused leadership roles in the health sector; lack of health inequity indicators; the generally weak capacity in the health care system, especially in planning and budgeting; and the leakage and limited coverage of programs for the poor. Conclusions Despite the government's efforts to improve the health of the poor, the rich-poor gap in health status and service access continues. Factors at institutional and policy levels are critical in contributing to the lack of efficiency and effectiveness for health programs that address the poor.
Kangolle Alfred CT
Full Text Available Abstract Background Cancer is a rapidly increasing problem in developing countries. Access, quality and efficiency of cancer services in developing countries must be understood to advance effective cancer control programs. Health services research can provide insights into these areas. Discussion This article provides an overview of oncology health services in developing countries. We use selected examples from peer-reviewed literature in health services research and relevant publicly available documents. In spite of significant limitations in the available data, it is clear there are substantial barriers to access to cancer control in developing countries. This includes prevention, early detection, diagnosis/treatment and palliation. There are also substantial limitations in the quality of cancer control and a great need to improve economic efficiency. We describe how the application of health data may assist in optimizing (1 Structure: strengthening planning, collaboration, transparency, research development, education and capacity building. (2 Process: enabling follow-up, knowledge translation, patient safety and quality assurance. (3 Outcome: facilitating evaluation, monitoring and improvement of national cancer control efforts. There is currently limited data and capacity to use this data in developing countries for these purposes. Summary There is an urgent need to improve health services for cancer control in developing countries. Current resources and much-needed investments must be optimally managed. To achieve this, we would recommend investment in four key priorities: (1 Capacity building in oncology health services research, policy and planning relevant to developing countries. (2 Development of high-quality health data sources. (3 More oncology-related economic evaluations in developing countries. (4 Exploration of high-quality models of cancer control in developing countries. Meeting these needs will require national, regional and
Full Text Available Lauren Gray Gilstrap,1 R Sacha Bhatia,2 Rory B Weiner,3 David M Dudzinski3 1Division of Cardiology, Brigham and Women's Hospital, Boston, MA, USA; 2Institute for Health Systems Solutions, Women's College Hospital, Toronto, ON, Canada; 3Cardiology Division, Massachusetts General Hospital, Boston, MA, USA Abstract: Stress echocardiography is a noninvasive cardiovascular diagnostic test that provides functional and hemodynamic information in the assessment of a number of cardiac diseases. Performing stress echocardiography with a pharmacologic agent such as dobutamine allows for simulation of increased heart rate and increased myocardial physiologic demands in patients who may be unable to exercise due to musculoskeletal or pulmonary comorbidities. Dobutamine stress echocardiography (DSE, like exercise echocardiography, has found its primary application in ischemic heart disease, with roles in identification of obstructive epicardial coronary artery disease, detection of viable myocardium, and assessment of the efficacy of anti-ischemic medical therapy in patients with known coronary artery disease. DSE features prominently in the evaluation and management of valvular heart disease by helping to assess the effects of mitral and aortic stenoses, as well as a specific use in differentiating true severe valvular aortic stenosis from pseudostenosis that may occur in the setting of left ventricular systolic dysfunction. DSE is generally well tolerated, and its side effects and contraindications generally relate to consequences of excess inotropic and/or chronotropic stimulation of the heart. The aim of this paper is to review the indications, contraindications, advantages, disadvantages, and risks of DSE. Keywords: stress echocardiography, dobutamine, coronary artery disease, myocardial ischemia
Ngo, C.; Membrey, P.; Demchenko, Y.; de Laat, C.
Cloud computing is developing as a new wave of ICT technologies, offering a common approach to on-demand provisioning of computation, storage and network resources which are generally referred to as infrastructure services. Most of currently available commercial Cloud services are built and organize
Annis, Paul M.; Palmer, Lance; Goetz, Joseph
Service-learning projects are a cornerstone of student experiential learning. Such programs have proven to be mutually beneficial to communities and students within a variety of family and consumer sciences courses. However, there is a paucity of literature addressing service-learning efforts within the field of financial planning. There is an…
Tania Cristina Morais Santa Barbara Rehem
Full Text Available The aim of this study is to analyze and understand the reasons for the occurrence of sensitive hospitalizations in accordance with users. Qualitative study conducted with users who were admitted to Pedreira General Hospital, in São Paulo. The data was collected through semi structured interviews and thereafter, transcribed and processed in the electronic program Alceste. When analyzing the content, the access was seized fundamentally as an empirical category, bringing up problems that later deserved, from the Brazilian Ministry of Health, a specific Program to improve the quality and access to primary care. The hierarchical and pyramidal organization shape from the health system in the city of São Paulo can be one of the important aspects for the access matter and established as an important restricting factor in the primary care role in reducing or even preventing the occurrence of these hospitalizations.
Pichlhöfer, Otto; Maier, Manfred
The Austrian health-care system is characterized by free provider choice and uncontrolled access to all levels of care. Using primary data, the ECOHCARE study shows that hospitalization rates for the secondary and tertiary care levels in Austria are both 4.4 times higher than those reported from the USA using a similar methodology. At the same time, essential functions of the primary care sector are weak. We propose that regulating access to secondary and tertiary care and restricting free provider choice to the primary care level would both reverse over utilization and strengthen the primary care sector.
Davis, Brian N.; Werpy, Jason; Friesz, Aaron M.; Impecoven, Kevin; Quenzer, Robert; Maiersperger, Tom; Meyer, David J.
Current methods of searching for and retrieving data from satellite land remote sensing archives do not allow for interactive information extraction. Instead, Earth science data users are required to download files over low-bandwidth networks to local workstations and process data before science questions can be addressed. New methods of extracting information from data archives need to become more interactive to meet user demands for deriving increasingly complex information from rapidly expanding archives. Moving the tools required for processing data to computer systems of data providers, and away from systems of the data consumer, can improve turnaround times for data processing workflows. The implementation of middleware services was used to provide interactive access to archive data. The goal of this middleware services development is to enable Earth science data users to access remote sensing archives for immediate answers to science questions instead of links to large volumes of data to download and process. Exposing data and metadata to web-based services enables machine-driven queries and data interaction. Also, product quality information can be integrated to enable additional filtering and sub-setting. Only the reduced content required to complete an analysis is then transferred to the user.
Full Text Available This paper discusses the convergence of digital broadcasting and Internet technologies, by elaborating on the design, implementation, and performance evaluation of a hybrid terrestrial/satellite networking infrastructure, enabling triple-play services access in rural areas. At local/district level, the paper proposes the exploitation of DVB-T platforms in regenerative configurations for creating terrestrial DVB/IP backhaul between the core backbone (in urban areas and a number of intermediate communication nodes distributed within the DVB-T broadcasting footprint (in rural areas. In this way, triple play services that are available at the core backbone, are transferred via the regenerative DVB-T/IP backhaul to the entire district and can be accessed by rural users via the corresponding intermediate node. On the other hand, at regional/national level, the paper proposes the exploitation of a satellite interactive digital video broadcasting platform (DVB S2/RCS as an overlay network that interconnects the regenerative DVB-T/IP platforms, as well as individual users, and services providers, to each other. Performance of the proposed hybrid terrestrial/satellite networking environment is validated through experimental tests that were conducted under real transmission/reception conditions (for the terrestrial segment and via simulation experiments (for the satellite segment at a prototype network infrastructure.
Prabhu, Neeta T
The goal of this study was to elicit the views of patients or parents\\/caregivers of patients with disabilities regarding access to dental care. A questionnaire was generated both from interviews with patients\\/parents\\/caregivers already treated under sedation or general anesthesia as well as by use of the Delphi technique with other stakeholders. One hundred thirteen patients from across six community dental clinics and one dental hospital were included. Approximately, 38% of the subjects used a general dental practitioner and 35% used the community dental service for their dental care, with only 27% using the hospital dental services. Overall waiting time for an appointment at the secondary care setting was longer than for the primary care clinics. There was a high rate of parent\\/caregiver satisfaction with dental services and only five patients reported any difficulty with travel and access to clinics. This study highlights the need for a greater investment in education and training to improve skills in the primary dental care sector.
Aleman, Alicia; Olsen, Lola; Ritz, Scott; Morahan, Michael; Cepero, Laurel; Stevens, Tyler
NASA's Global Change Master Directory provides the scientific community with the ability to discover, access, and use Earth science data, data-related services, and climate diagnostics worldwide. The GCMD offers descriptions of Earth science data sets using the Directory Interchange Format (DIF) metadata standard; Earth science related data services are described using the Service Entry Resource Format (SERF); and climate visualizations are described using the Climate Diagnostic (CD) standard. The DIF, SERF and CD standards each capture data attributes used to determine whether a data set, service, or climate visualization is relevant to a user's needs. Metadata fields include: title, summary, science keywords, service keywords, data center, data set citation, personnel, instrument, platform, quality, related URL, temporal and spatial coverage, data resolution and distribution information. In addition, nine valuable sets of controlled vocabularies have been developed to assist users in normalizing the search for data descriptions. An update to the GCMD's search functionality is planned to further capitalize on the controlled vocabularies during database queries. By implementing a dynamic keyword "tree", users will have the ability to search for data sets by combining keywords in new ways. This will allow users to conduct more relevant and efficient database searches to support the free exchange and re-use of Earth science data. http://gcmd.nasa.gov/
Ayden I Scheim
Full Text Available Introduction: Free or low-cost HIV testing, condoms, and lubricants are foundational HIV prevention strategies, yet are often inaccessible for men who have sex with men (MSM. In the global context of stigma and poor healthcare access, transgender (trans MSM may face additional barriers to HIV prevention services. Drawing on data from a global survey of MSM, we aimed to describe perceived access to prevention services among trans MSM, examine associations between stigma and access, and compare access between trans MSM and cisgender (non-transgender MSM. Methods: The 2014 Global Men's Health and Rights online survey was open to MSM (inclusive of trans MSM from any country and available in seven languages. Baseline data (n=3857 were collected from July to October 2014. Among trans MSM, correlations were calculated between perceived service accessibility and anti-transgender violence, healthcare provider stigma, and discrimination. Using a nested matched-pair study design, trans MSM were matched 4:1 to cisgender MSM on age group, region, and HIV status, and conditional logistic regression models compared perceived access to prevention services by transgender status. Results: About 3.4% of respondents were trans men, of whom 69 were included in the present analysis. The average trans MSM participant was 26 to 35 years old (56.5%; lived in western Europe, North America, or Oceania (75.4%; and reported being HIV-negative (98.6%. HIV testing, condoms, and lubricants were accessible for 43.5, 53.6, and 26.1% of trans MSM, respectively. Ever having been arrested or convicted due to being trans and higher exposure to healthcare provider stigma in the past six months were associated with less access to some prevention services. Compared to matched cisgender controls, trans MSM reported significantly lower odds of perceived access to HIV testing (OR=0.57, 95% CI=0.33, 0.98 and condom-compatible lubricants (OR=0.54, 95% CI=0.30, 0.98. Conclusions: This first
Krüsi, Andrea; Pierre, Leslie; Smith, Adrienne; Small, Will; Shannon, Kate
Abstract Purpose: Little is known about trans womens' experiences accessing gender-segregated health and housing services, particularly services for marginalized individuals living in poverty. As such, we conducted a qualitative investigation into experiences of accessing women-specific health and housing services among trans women and two-spirit persons in a downtown neighborhood of Vancouver, Canada. Methods: Between June 2012 and May 2013 interviews were conducted with 32 trans women and two-spirit individuals who had accessed women-specific health and/or housing services. Participants were recruited from four open prospective cohorts of sex workers and individuals who use drugs. Interview data were analyzed using a participatory analysis approach with two participants who were hired as research assistants. Results: Participants were generally able to access women-specific services in the neighborhood. However, there were reports of discrimination related to gender identity, discrimination based on gender expression (e.g., requirement of a feminine gender expression), and lack of staff intervention in harassment from other service users. Conclusion: Trans women and two-spirit persons in our study relied upon services for their health and safety and, therefore, exclusion from women-specific services had potentially severe adverse consequences such as homelessness and sexual violence. Recommendations to improve accessibility, including policy development and procedural recommendations, are put forth. PMID:27575593
Raquel de Souza Ramos
Full Text Available Objective: the judicialization of health is incorporated into the daily work of health institutions in Brazil through the court orders for access. In this study, the objective was to describe the contents of the social representations of access, through judicialization, for the health professionals. Method: qualitative study based on Social Representations Theory, involving 40 professionals, at a teaching hospital and at the center for the regulation of beds and procedures in Rio de Janeiro. Forty semistructured interviews were held, to which the thematic-categorical content analysis technique was applied. Results: the health professionals' attitude towards the reality the judicialization imposes is negative, but they acknowledge this resource as necessary in view of the public health crisis. Judicialization is considered a strategy to exercise citizenship that superimposes individual on collective law, increases social inequalities in access and compromises the efficacy of health policies. Conclusion: considering social representation as a determinant of practices, the representations that emerged can contribute to the change of the professionals' practices. Improvements in user care should be promoted, characterized as one of the main challenges to advance in universal access to health.
Following work by the editorial team, notably Surg Lt Cdr M O'Shea, and with funding from the Wellcome Trust, every edition of this Journal dating back to the first edition in 1915 is available on our website. This article gives details of how to access it.
Ramos, Raquel de Souza; Gomes, Antonio Marcos Tosoli; de Oliveira, Denize Cristina; Marques, Sergio Corrêa; Spindola, Thelma; Nogueira, Virginia Paiva Figueiredo
Objective: the judicialization of health is incorporated into the daily work of health institutions in Brazil through the court orders for access. In this study, the objective was to describe the contents of the social representations of access, through judicialization, for the health professionals. Method: qualitative study based on Social Representations Theory, involving 40 professionals, at a teaching hospital and at the center for the regulation of beds and procedures in Rio de Janeiro. Forty semistructured interviews were held, to which the thematic-categorical content analysis technique was applied. Results: the health professionals' attitude towards the reality the judicialization imposes is negative, but they acknowledge this resource as necessary in view of the public health crisis. Judicialization is considered a strategy to exercise citizenship that superimposes individual on collective law, increases social inequalities in access and compromises the efficacy of health policies. Conclusion: considering social representation as a determinant of practices, the representations that emerged can contribute to the change of the professionals' practices. Improvements in user care should be promoted, characterized as one of the main challenges to advance in universal access to health. PMID:27143542
... visible at all times in the building and returned upon departure. II. What action is the agency taking... access information which has been submitted to EPA under all sections of the Toxic Substances Control Act... INFORMATION CONTACT: For technical information contact: Pamela Moseley, Information Management Division...
This paper focuses on approaches by non-government organisations (NGOs) to reach primary school-aged children excluded from access to the conventional state education system. It highlights recent shifts in international literature and agency priorities from the portrayal of NGO provision as a (non-formal) "alternative" to (formal) state…
This toolkit serves as a comprehensive resource on the issue of higher education access and success for homeless students, including information on understanding homeless students, assisting homeless students in choosing a school, helping homeless students pay for application-related expenses, assisting homeless students in finding financial aid…
Kiran K. Patnaik
Full Text Available Problem statement: OGSA-DAI middleware allows data resources to be federated and accessed via web services on the web or within grids or clouds. It provides a client API for writing programs that access the exposed databases. Migrating existing applications to the new technology and using a new API to access the data of DBMS with BLOB is difficult and discouraging. A JDBC Driver is a much convenient alternative to existing mechanism and provides an extension to OGSA-DAI middleware and allows applications to use databases exposed in a grid through the OGSA-DAI 3.0. However, the driver does not support Binary Large Objects (BLOB. Approach: The driver is enhanced to support BLOB using the OGSA-DAI Client API. It transforms the JDBC calls into an OGSA-DAI workflow request and sends it to the server using Web Services (WS. The client API of OGSA-DAI uses activities that are connected to form a workflow and executed using a pipeline. This workflow mechanism is embedded into the driver. The WS container dispatches the request to the OGSA-DAI middleware for processing and the result is then transformed back to an instance of ResultSet implementation using the OGSA-DAI Client API, before it is returned to the user. Results: Test on handling of BLOBs (images, flash files and videos ranging from size 1 KB to size 2 GB were carried out on Oracle, MySQL and PostgreSQL databases using our enhanced JDBC driver and it performed well. Conclusion: The enhanced JDBC driver now can offer users, with no experience in Grid computing specifically on OGSA-DAI, the possibility to give their applications the ability to access databases exposed on the grid with minimal effort.
National Aeronautics and Space Administration — Aquilent, Inc. proposes to support the effort of Virtual Space Physics Observatory (VSPO) by developing services to expand the VSPO search capabilities, developing...
Badano, L P; Di Chiara, A; Werren, M; Sabbadini, C; Fioretti, P M
Echocardiography is changing from an operative modality in which most images are stored in analog fashion on videotape into one with most data stored digitally. This transition is accelerating today, fueled by several factors. First, there is widespread recognition of the value of digital storage of echocardiograms, including random access to studies as well as to images within a study, side-by-side comparison with prior studies, easier quantification, and multiplication and remote transmission of images without degradation. Second, continuous improvement of the cost/performance ratio of modern computers makes routine digital echocardiography both feasible and affordable. Finally, the formulation and acceptance within the industry of the DICOM image formatting standard for echocardiography. The acceptance of this standard allows the echo-labs around the world to be free to choose individual echo-machines on the basis of their individual merits for their laboratories with the assurance that these machines will be able to communicate with each other by an internationally agreed upon standard. Advantages of digital echocardiography are overwhelming and there is little doubt that this approach will be essential for the proper utilization of this technique. The technology will undoubtedly continue to change. Those who are waiting for it to be perfected may be waiting for a long time.
Evans, J. D.; Valente, E. G.
We are building a scalable, cloud computing-based infrastructure for Web access to near-real-time data products synthesized from the U.S. National Polar-Orbiting Environmental Satellite System (NPOESS) Preparatory Project (NPP) and other geospatial and meteorological data. Given recent and ongoing changes in the the NPP and NPOESS programs (now Joint Polar Satellite System), the need for timely delivery of NPP data is urgent. We propose an alternative to a traditional, centralized ground segment, using distributed Direct Broadcast facilities linked to industry-standard Web services by a streamlined processing chain running in a scalable cloud computing environment. Our processing chain, currently implemented on Amazon.com's Elastic Compute Cloud (EC2), retrieves raw data from NASA's Moderate Resolution Imaging Spectroradiometer (MODIS) and synthesizes data products such as Sea-Surface Temperature, Vegetation Indices, etc. The cloud computing approach lets us grow and shrink computing resources to meet large and rapid fluctuations (twice daily) in both end-user demand and data availability from polar-orbiting sensors. Early prototypes have delivered various data products to end-users with latencies between 6 and 32 minutes. We have begun to replicate machine instances in the cloud, so as to reduce latency and maintain near-real time data access regardless of increased data input rates or user demand -- all at quite moderate monthly costs. Our service-based approach (in which users invoke software processes on a Web-accessible server) facilitates access into datasets of arbitrary size and resolution, and allows users to request and receive tailored and composite (e.g., false-color multiband) products on demand. To facilitate broad impact and adoption of our technology, we have emphasized open, industry-standard software interfaces and open source software. Through our work, we envision the widespread establishment of similar, derived, or interoperable systems for
Menon-Johansson, Anatole S; Cohen, Charlotte; Jones, Rachael; Nwokolo, Nneka; McOwan, Alan; Barton, Simon E.; Mandalia, Sundhiya; Sullivan, Ann K.
Abstract Background Increasing access to sexual health services is a key objective for the Department of Health (DH) in England and Wales. In 2006 the DH published ten high impact changes (HICs) designed to enhance 48-hour access to genitourinary medicine services. However, there is limited evidence on the effectiveness of the proposed interventions. We therefore evaluated the implementation of five HICs in three sexual health clinics over four years. These HICs included a t...
Okafor, Maria C
The diversification and aging of the US population has been at the root of many political and policy debates in recent years. Of particular interest has been the place of immigrants in an aging society, and what rights these immigrants are entitled to. The objective of this article is to describe the current avenues and barriers to access of services for immigrant elders and examine potential solutions for reform. The article begins with a historical overview of the policy issue, followed by the current status of the issue in the United States and suggestions for reform.
Full Text Available Contrast echocardiography by rendering better imaging of the borders of cardiac chambers is a useful tool for evaluating cardiac function, mass, myocardial vascularization, microvascular structure (small vessel vasculature and viability. Contrast was first started to be used for patients with suboptimal image quality. It can be used in detecting defects in myocardial blood supply in patients with chest pain and determining the success of interventionalprocedures. It can also be of help in demonstrating myocardial viability after reperfusion treatment in patients who had myocardial infarction. It is expected to be used more widely in invasive cardiology for decision making, guiding and determining the success of the procedures. Advances in imaging techniques , development of contrast materials for evaluation of left system, contrast echocardiography may become a routine clinical practice.
Faletra, Francesco Fulvio; Ramamurthi, Alamelu; Dequarti, Maria Cristina; Leo, Laura Anna; Moccetti, Tiziano; Pandian, Natesa
Three-dimensional (3D) transesophageal echocardiography (TEE) is subject to the same types of artifacts encountered on two-dimensional TEE. However, when displayed in a 3D format, some of the artifacts appear more "realistic," whereas others are unique to image acquisition and postprocessing. Three-dimensional TEE is increasingly used in the setting of percutaneous catheter-based interventions and ablation procedures, and 3D artifacts caused by the metallic components of catheters and devices are particularly frequent. Knowledge of these artifacts is of paramount relevance to avoid misinterpretation of 3D images. Although artifacts and pitfalls on two-dimensional echocardiography are well described and classified, a systematic description of artifacts in 3D transesophageal echocardiographic images and how they affect 3D imaging is still absent. The aim of this review is to describe the most relevant artifacts on 3D TEE, with particular emphasis on those occurring during percutaneous interventions for structural heart disease and ablation procedures.
Izumo, Masaki; Akashi, Yoshihiro J
Since the introduction of transcatheter structural heart intervention, the term "structural heart disease" has been widely used in the field of cardiology. Structural heart disease refers to congenital heart disease, valvular heart disease, and cardiomyopathy. In structural heart disease, valvular heart disease is frequently identified in the elderly. Of note, the number of patients who suffer from aortic stenosis (AS) and mitral regurgitation (MR) is increasing in developed countries because of the aging of the populations. Transcatheter aortic valve replacement and percutaneous mitral valve repair has been widely used for AS and MR, individually. Echocardiography is the gold standard modality for initial diagnosis and subsequent evaluation of AS and MR, although the difficulties in assessing patients with these diseases still remain. Here, we review the clinical usefulness and prognostic impact of exercise echocardiography on structural heart disease, particularly on AS and MR.
夏春涛; 杨艳丽; 曹利峰
为解决Web Services访问控制问题,分析了传统访问控制模型在Web Services应用中的不足,给出了面向Web Services 的基于属性的访问控制模型ABAC(Attribute Based Access Control)的定义,设计了ABAC访问控制架构,并利用可扩展的访问控制标记语言XACML( eXtensible Access Control Markup Language)实现了细粒度的Web Services访问控制系统.系统的应用有效保护了Web Services资源.%To deal with access control for web services, the problem of application of traditional access control model in web services is analysed, then the definition of web services-oriented attribute-based access control ( ABAC) model is presented, and the architecture of ABAC is designed. Furthermore, the fine-grained access control system for web services is implemented with XACML, the application of the system has effectively protected the resources of web services.
Full Text Available The aim of the study was to investigate the influence of accessibility of services and health related factors on Quality of Life (QoL of school children with Cerebral Palsy (CP in Latvia. 80 children 47 boys and 33 girls with CP and their parents from all regions of Latvia took part in the study. Mean age of participants was 11,7 (SD± 3,5 years. 50 children without diagnosed chronic diseases formed the control group. Validated evaluation tools were used in the study (KIDSCREEN-52, GMFCS- E&R. The results show lower QoL in children with CP in comparison with their healthy peers and European children. QoL is influenced by the level of gross motor functions, lack of coordination of services, lack of rehabilitation infrastructure and presence of environmental barriers in Latvia.
Wagner, Vincent; Bertrand, Karine; Flores-Aranda, Jorge; Acier, Didier; Brunelle, Natacha; Landry, Michel; Brochu, Serge
Substance addiction in young adults is particularly problematic. Yet, much remain at stake in understanding the specifics of this population's access to services. The objective of this study is to explore young adults' initiation of substance misuse treatment. Our study sample was composed of 35 individuals aged 18 to 30 with problematic psychoactive substance use who have been identified in criminal courts, hospital emergency departments, and Health and Social Services Centers in Québec (Canada). A thematic analysis was performed on the 62 semi-structured interviews conducted with participants. Three components emerged. First, personal elements-expectations, individual motivations, perceptions of use, and capacity to control it-influence initiation of substance misuse treatment. Second, family and peers have noticeable influences. Finally, system characteristics and prior care experiences also shape the process. Consideration should be given to tailor interventions that can reach young adults and encourage them to initiate appropriate care.
Gilstrap LG; Bhatia RS; Weiner RB; Dudzinski DM
Lauren Gray Gilstrap,1 R Sacha Bhatia,2 Rory B Weiner,3 David M Dudzinski3 1Division of Cardiology, Brigham and Women's Hospital, Boston, MA, USA; 2Institute for Health Systems Solutions, Women's College Hospital, Toronto, ON, Canada; 3Cardiology Division, Massachusetts General Hospital, Boston, MA, USA Abstract: Stress echocardiography is a noninvasive cardiovascular diagnostic test that provides functional and hemodynamic information in the assessment of a number of cardiac...
Contrast echocardiography by rendering better imaging of the borders of cardiac chambers is a useful tool for evaluating cardiac function, mass, myocardial vascularization, microvascular structure (small vessel vasculature) and viability. Contrast was first started to be used for patients with suboptimal image quality. It can be used in detecting defects in myocardial blood supply in patients with chest pain and determining the success of interventionalprocedures. It can also be of help in de...
Full Text Available Abstract Background NICE recommends computerised cognitive behavioural therapy (cCBT for the treatment of several mental health problems such as anxiety and depression. cCBT may be one way that services can reduce waiting lists and improve capacity and efficiency. However, there is some doubt about the extent to which the National Health Service (NHS in the UK is embracing this new health technology in practice. This study aimed to investigate Scottish health service infrastructure and policies that promote or impede the implementation of cCBT in the NHS. Methods A telephone survey of lead IT staff at all health board areas across Scotland to systematically enquire about the ability of local IT infrastructure and IT policies to support delivery of cCBT. Results Overall, most of the health boards possess the required software to use cCBT programmes. However, the majority of NHS health boards reported that they lack dedicated computers for patient use, hence access to cCBT at NHS sites is limited. Additionally, local policy in the majority of boards prevent staff from routinely contacting patients via email, skype or instant messenger, making the delivery of short, efficient support sessions difficult. Conclusions Conclusions: Overall most of the infrastructure is in place but is not utilised in ways that allow effective delivery. For cCBT to be successfully delivered within a guided support model, as recommended by national guidelines, dedicated patient computers should be provided to allow access to online interventions. Additionally, policy should allow staff to support patients in convenient ways such as via email or live chat. These measures would increase the likelihood of achieving Scottish health service targets to reduce waiting time for psychological therapies to 18 weeks.
Njuki, Rebecca; Timothy, Abuya; James, Kimani; Kanya, Lucy; Korongo, Allan; Mukanya, Collins; Bracke, Piet; Bellows, Ben; Warren, Charlotte
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. Background - Current assessments on Output-Based Aid (OBA) programs have paid limited attention to the experiences and perceptions of the healthcare providers and facility managers. This study examines the knowledge, a...
Ken Russell Coelho
Full Text Available Safety-net settings across the country have grappled with providing adequate access to specialty care services. San Francisco General Hospital and Trauma Center, serving as the city's primary safety-net hospital, has also had to struggle with the same issue. With Healthy San Francisco, the City and County of San Francisco's Universal Healthcare mandate, the increased demand for specialty care services has placed a further strain on the system. With the recent passage of California Proposition 1D, infrastructural funds are now set aside to assist in connecting major hospitals with primary care clinics in remote areas all over the state of California, using telemedicine. Based on a selected sample of key informant interviews with local staff physicians, this study provides further insight into the current process of e-referral which uses electronic communication for making referrals to specialty care. It also identifies key services for telemedicine in primary and specialty care settings within the San Francisco public health system. This study concludes with proposals for a framework that seek to increase collaboration between the referring primary care physician and specialist, to prioritize institution of these key services for telemedicine.
Chipman, Jonathan; Drohan, Brian; Blackford, Amanda; Parmigiani, Giovanni; Hughes, Kevin; Bosinoff, Phil
Cancer risk prediction tools provide valuable information to clinicians but remain computationally challenging. Many clinics find that CaGene or HughesRiskApps fit their needs for easy- and ready-to-use software to obtain cancer risks; however, these resources may not fit all clinics' needs. The HughesRiskApps Group and BayesMendel Lab therefore developed a web service, called "Risk Service", which may be integrated into any client software to quickly obtain standardized and up-to-date risk predictions for BayesMendel tools (BRCAPRO, MMRpro, PancPRO, and MelaPRO), the Tyrer-Cuzick IBIS Breast Cancer Risk Evaluation Tool, and the Colorectal Cancer Risk Assessment Tool. Software clients that can convert their local structured data into the HL7 XML-formatted family and clinical patient history (Pedigree model) may integrate with the Risk Service. The Risk Service uses Apache Tomcat and Apache Axis2 technologies to provide an all Java web service. The software client sends HL7 XML information containing anonymized family and clinical history to a Dana-Farber Cancer Institute (DFCI) server, where it is parsed, interpreted, and processed by multiple risk tools. The Risk Service then formats the results into an HL7 style message and returns the risk predictions to the originating software client. Upon consent, users may allow DFCI to maintain the data for future research. The Risk Service implementation is exemplified through HughesRiskApps. The Risk Service broadens the availability of valuable, up-to-date cancer risk tools and allows clinics and researchers to integrate risk prediction tools into their own software interface designed for their needs. Each software package can collect risk data using its own interface, and display the results using its own interface, while using a central, up-to-date risk calculator. This allows users to choose from multiple interfaces while always getting the latest risk calculations. Consenting users contribute their data for future
Saha, Somen; Annear, Peter Leslie
It is a challenge for the poor to overcome the barriers to accessing health services. Membership-based microfinance with associated health programmes can improve health outcomes for the poor. This study reviewed the evidence published between 1993 and 2013 on the role of membership-based microfinance with associated health programmes in improving health outcomes for the poor in South Asia. A total of 661 papers were identified and 26 selected for inclusion, based on the relevance and rigour of the research methods. Of these 26, five were evidence reviews. Of the remaining 21 papers, 12 were from India, seven from Bangladesh, and one each from Sri Lanka and Indonesia. Three papers addressed more than one theme. Five key themes emerged from the review: (i) the impact of microfinance programmes on the social and economic situation of the poor; (ii) the impact of microfinance programmes on community health; (iii) the impact of integrated microfinance health programmes on raising client awareness; (iv) the impact of integrated microfinance health programmes on financing health care; and (v) the impact of integrated microfinance health programmes on affordable health-care products and services. The review provides new evidence on the pathways through which microfinance helps to improve population health and value for money for such programmes. Among countries with large populations in the informal sector, there is a strong case for policy-makers to support these groups in providing access to life-saving health care among the poor.
Lapão, Luís Velez; Correia, Artur
This paper addresses the role of international telemedicine services in supporting the evacuation procedures from Cape Verde to Portugal, enabling better quality and cost reductions in the management of the global health system. The Cape Verde, as other African countries, health system lacks many medical specialists, like pediatric cardiologists, neurosurgery, etc. In this study, tele-cardiology shows good results as diagnostic support to the evacuation decision. Telemedicine services show benefits while monitoring patients in post-evacuation, helping to address the lack of responsive care in some specialties whose actual use will help save resources both in provision and in management of the evacuation procedures. Additionally, with tele-cardiology collaborative service many evacuations can be avoided whereas many cases will be treated and followed locally in Cape Verde with remote technical support from Portugal. This international telemedicine service enabled more efficient evacuations, by reducing expenses in travel and housing, and therefore contributed to the health system's improvement. This study provides some evidence of how important telemedicine really is to cope with both the geography and the shortage of physicians.
Wagstaff, Amanda E.; Polo, Antonio J.
Depression is more common among adolescents of ethnic minority backgrounds, who also are less likely to receive professional help. This article presents information about prevalence of depression and service use across ethnic groups, and then outlines several promising intervention programs that are designed for adolescents suffering from…
Background: Supported decision-making and personal budgets for services are the new paradigms. Method: Supported decision-making proposals from the Australian State of Victoria are analysed against international trends to determine the viability of laws reflecting new international norms of the United Nations Convention on the Rights of Persons…
Full Text Available Introduction: Evidence suggests that people who inject drugs often begin their drug use and injecting practices in adolescence, yet there are limited data available on the HIV epidemic and the responses for this population. The comprehensive package of interventions for the prevention, treatment and care of HIV infection among people who inject drugs first laid out in 2009 (revised in 2012 by World Health Organization, United Nations Office of Drugs and Crime and Joint United Nations Programme on HIV/AIDS, does not consider the unique needs of adolescent and young people. In order to better understand the values and preferences of young people who inject drugs in accessing harm reduction services and support, we undertook a series of community consultations with young people with experience of injecting drugs during adolescence. Methods: Community consultations (4–14 persons were held in 14 countries. Participants were recruited using a combined criterion and maximum variation sampling strategy. Data were analyzed using collaborative qualitative data analysis. Frequency analysis of themes was conducted. Results: Nineteen community consultations were organized with a total of 132 participants. All participants had experienced injecting drugs before the age of 18. They had the following age distribution: 18–20 (37%, 21–25 (48% and 26–30 (15%. Of the participants, 73.5% were male while 25.7% were female, with one transgender participant. Barriers to accessing the comprehensive package included: lack of information and knowledge of services, age restrictions on services, belief that services were not needed, fear of law enforcement, fear of stigma, lack of concern, high cost, lack of outreach, lack of knowledge of HCV/TB and lack of youth friendly services. Conclusions: The consultations provide a rare insight into the lived experiences of adolescents who inject drugs and highlight the dissonance between their reality and current policy and
Sundari Ravindran, T K
Universal access to sexual and reproductive health services is one of the goals of the International Conference on Population and Development of 1994. The Millennium Development Goals were intended above all to end poverty. Universal access to health and health services are among the goals being considered for the post-2015 agenda, replacing or augmenting the MDGs. Yet we are not only far from reaching any of these goals but also appear to have lost our way somewhere along the line. Poverty and lack of food security have, through their multiple linkages to health and access to health care, deterred progress towards universal access to health services, including for sexual and reproductive health needs. A more insidious influence is neoliberal globalisation. This paper describes neoliberal globalisation and the economic policies it has engendered, the ways in which it influences poverty and food security, and the often unequal impact it has had on women as compared to men. It explores the effects of neoliberal economic policies on health, health systems, and universal access to health care services, and the implications for access to sexual and reproductive health. To be an advocate for universal access to health and health care is to become an advocate against neoliberal globalisation.
Tang, Ming; Fu, Songnian; Shum, Perry Ping
A novel broadcasting scheme for WDM-PON based fiber access networks is proposed in this paper and downstream system experiments has been demonstrated. The broadcasting data is generated via subcarrier modulation technique. By using a delayed interferometer, the un-modulated continuous-wave carrier is separated and acts as the seeder for FP-LD injection locking and direct modulation, which is compatible with current WDM-PON infrastructures. In experiments, 2.5 Gb/s broadcasting data and 2.5 Gb/s point-to-point data are successfully integrated and transmitted in a typical WDM-PON structure with good performance.
Full Text Available Este artículo presenta los aspectos principales del desarrollo histórico y de asuntos actuales en el mercado suramericano de acceso a Internet: los acuerdos de interconexión para el intercambio de tráfico local y regional en Suramérica, los incentivos que tienen los proveedores de acceso a Internet para mantener o modificar la naturaleza de los acuerdos y los métodos de recuperación de costos en los puntos de intercambio de tráfico. El artículo también identifica algunas amenazas a la estabilidad de los puntos de intercambio de tráfico y las ilustra con dos casos. / This paper presents the main aspects of the historical development and the current issues at stake in the South American Internet access market: the interconnection schemes for the exchange of local and regional traffic in the South American region, the incentives Internet access providers have for keeping or modifying the nature of the agreements, and the cost recovery methods at the traffic exchange points. Some threats to the stability of the scheme for domestic traffic exchange adopted throughout the region are also identified and subsequently illustrated with country-cases.
Full Text Available Digital forensics tools have many potential applications in the curation of digital materials in libraries, archives and museums (LAMs. Open source digital forensics tools can help LAM professionals to extract digital contents from born-digital media and make more informed preservation decisions. Many of these tools have ways to display the metadata of the digital media, but few provide file-level access without having to mount the device or use complex command-line utilities. This paper describes a project to develop software that supports access to the contents of digital media without having to mount or download the entire image. The work examines two approaches in creating this tool: First, a graphical user interface running on a local machine. Second, a web-based application running in web browser. The project incorporates existing open source forensics tools and libraries including The Sleuth Kit and libewf along with the Flask web application framework and custom Python scripts to generate web pages supporting disk image browsing.
This paper proposes an access control model for Web services. The integration of the security model into Web services can realize dynamic right changes of security access control on Web services for improving static access control at present. The new model provides view policy language to describe access control policy of Web services. At the end of the paper we describe an infrastructure of integration of the security model into Web services to enforce access control polices of Web services.%提出了一种用于Web服务的访问控制模型，这种模型和Web服务相结合，能够实现Web服务下安全访问控制权限的动态改变，改善目前静态访问控制问题。新的模型提供的视图策略语言VPL用于描述Web服务的访问控制策略。给出了新的安全模型和Web服务集成的结构，用于执行Web服务访问控制策略。
Alfonso Iracheta Cenecorta
Full Text Available The insufficient supply of serviced land at affordable prices for the urban poor and the need for regularization of the consequent illegal occupations in urban areas are two of the most important issues on the Latin American land policy agenda. Taking a structural/integrated view on the functioning of the urban land market in Latin America, this paper discusses the nexus between the formal and the informal land markets. It thus exposes the perverse feedback effects that curative regularization policies may have on the process by which irregularity is produced in the first place. The paper suggests that a more effective approach to the provision of serviced land for the poor cannot be resolved within the prevailing (curative regularization programs. These programs should have the capacity to mobilize the resources that do exist into a comprehensive program that links regularization with fiscal policy, including the exploration of value capture mechanisms.
stores, barber shops, fast-food restaurants , and many other retail operations on military installations, as well as online shopping. Active-duty...them on the installation because of their convenience and relatively low cost, but added that some of these services had recently been closed or had...the exchange; (2) convenience of locations of the exchange; (3) availability of medical and dental care; (4) ability to get medical and dental care
Justina A. Onumah
Full Text Available It has been established that smallholder farmers have minimal access to various support services that would have otherwise enabled them to increase their output levels. The focus of this paper is to identify and quantify the impact of various support services on the production levels of cocoa in the Eastern region of Ghana. A cross sectional survey of 190 cocoa farmers was obtained using a two-stage sampling technique (purposive and random. Descriptive statistics and an OLS regression model were used to analyse and discuss the results of the study. The various support services identified included labour services, financial services, technical assistance, farmer group support services, Research and Development (R&D institutional support services, extension services and input support services. The services that significantly influenced output levels of cocoa were extension services, labour supply and technical assistance, among other variables including farm size and quantity of agrochemical used. It is recommended that access to these support services be improved in order to realise an increase in output for the smallholder cocoa farmer.
Nasser N. Khamiss
Full Text Available This paper evaluates the performance of sending Triple play Services over hybrid networks. The network performance factors will be considered by observing the network`s availability, packet loss, delay and throughput. These evaluations will be tested over different network scenario, where the last mile media services suggested to be delivered over telephone twisted pair by means of using ADSL. The attention will be concerned for services over cable, where a proposal of using bandwidth efficient turbo trellis coded modulation (TTCM in ADSL DMT systems instead of the multidimensional 16-state Trellis Coded Modulation (MTCM that is given as an option in Asymmetric Digital Subscriber Lines (ADSL standard based on discrete multitone (DMT techniques. The results show that by using turbo codes, it can obtain 6 dB coding gain for a bit error rate (BER of 10-6 in AWGN channels and more than 6.8 dB coding gain for a BER of 10-7 using a concatenated coding scheme.
Beck, Charlotte; Wernham, Connie
Employment has been proven to be an effective recovery tool and therapeutic intervention for those with severe and enduring mental health conditions. Aside from monetary reward, employment is a means of structuring time and provides a sense of worth and achievement, which enhances self-esteem and confidence. A social identity is developed through employment, encouraging social support and increasing social networks. Securing employment can bring about improved quality of life and positive change in one's social circumstances; therefore it can reduce symptoms associated with mental illness and potentially prevent re-offending, as the individual develops a sense of independence, self-efficacy, and value. Barriers to employment exist for forensic mental health service users and therefore it is imperative that employment needs are addressed at the earliest possible stage in recovery. An evaluation of employment activities across two forensic mental health units revealed a lack of appropriate employment opportunities for service users, and those roles available were not implemented in line with recommended best practice. In response to this issue several enterprises were established to offer opportunities for service users to engage in meaningful employment and develop skills that a future employer would value. Each enterprise responds to a business need within the units to ensure sustainability of services. The enterprises are essentially micro-businesses with social objectives whose surpluses are reinvested for the purpose of increasing opportunities for service users. The enterprises are underpinned by the philosophy of the Individual Placement and Support (IPS) model; empirical evidence suggests that the IPS model is the most effective intervention, based on the 'place then train' philosophy. The model recommends a focus upon rapid job search to achieve competitive employment for those who want to work; opportunities sourced should be consistent with individual
Lancellotti, Patrizio; Price, Susanna; Edvardsen, Thor
of echocardiography in acute cardiovascular care. In this document, we describe the practical applications of echocardiography in patients with acute cardiac conditions, in particular with acute chest pain, acute heart failure, suspected cardiac tamponade, complications of myocardial infarction, acute valvular heart...... disease including endocarditis, acute disease of the ascending aorta and post-intervention complications. Specific issues regarding echocardiography in other acute cardiovascular care scenarios are also described....
Lancellotti, Patrizio; Price, Susanna; Edvardsen, Thor
of echocardiography in acute cardiovascular care. In this document, we describe the practical applications of echocardiography in patients with acute cardiac conditions, in particular with acute chest pain, acute heart failure, suspected cardiac tamponade, complications of myocardial infarction, acute valvular heart...... disease including endocarditis, acute disease of the ascending aorta and post-intervention complications. Specific issues regarding echocardiography in other acute cardiovascular care scenarios are also described....
Lancellotti, Patrizio; Price, Susanna; Edvardsen, Thor
of echocardiography in acute cardiovascular care. In this document, we describe the practical applications of echocardiography in patients with acute cardiac conditions, in particular with acute chest pain, acute heart failure, suspected cardiac tamponade, complications of myocardial infarction, acute valvular heart...... disease including endocarditis, acute disease of the ascending aorta and post-intervention complications. Specific issues regarding echocardiography in other acute cardiac care scenarios are also described....
Allen, D G
Echocardiography is the accepted term for the study of cardiac ultrasound. Although a relatively new tool for the study of the heart in man it has already found wide acceptance in the area of cardiac research and in the study of clinical cardiac disease. Animals had often been used in the early experiments with cardiac ultrasound, but only recently has echocardiography been used as a research and clinical tool in veterinary medicine. In this report echocardiography is used in the research of ...
侯永波; 王国祥; 谭胜; 刘金东
目的：总结经食管超声心动图（TEE）引导下，微创经胸室间隔缺损（VSD）封堵治疗的临床经验。方法11例 VSD 患者接受微创经胸封堵治疗，年龄3～6岁，体重12～65 kg，VSD 直径3～8 mm。手术在 TEE 引导，胸骨下段小切口微创下进行，于右心室表面选择适当的穿刺点，建立输送轨道并完成 VSD 封堵。术后密切随访1～6个月。结果11例中9例一次性安放成功，2例首次安放有残余分流，术中更换大号伞；心内操作时间10～36 min，平均（21±12）min。全部患者均于术后4～5天出院，随访1～6个月，效果良好。11例患者均无心律失常、残余分流等并发症发生。结论TEE 引导下微创经胸 VSD 封堵是一种安全有效的治疗方法，但远期结果有待进一步观察。%Abstrat: Objectve To summarize the clinical experience of transcatheter closure of ventricular septal defects (VSD) through minimally invasive port -access surgery guided by transesophageal echocardiography (TEE).Methods A total of 11 patients aged from 3 to 6, weighting 12 kg to 65 kg were subjected to transcatheter closure of VSD with a diameter ranging from 3 mm to 8 mm.The surgery was performed under the guidance of TEE, where a small transthoracic incision was made.A proper site was chosen at the surface of the right ventricle for punctuation, in order to establish de-livery pathway.Patients were closely followed up for 1 to 6 months.Results Among the patients were nice ones who successfully completed the surgery at one time.Residual shunts were seen in two cases which required the replacement of larger occluders.The time of intracardiac procedures was 10 -36 min [(21 ±12)min].All patients were discharged 4 to 5 days after operation.During fellow -up period, neither arrhythmia nor residual shunt occurred.Conclusion Tran-sthoracic minimally invasive closure is a safe and efficient method for the treatment of VSD.Meanwhile, long -term fel
Norman, Laura M.; Villarreal, Miguel L.; Lara-Valencia, Francisco; Yuan, Yongping; Nie, Wenming; Wilson, Sylvia; Amaya, Gladys; Sleeter, Rachel
Socio-environmental vulnerable populations are often unrepresented in land-use planning yet have great potential for loss when exposed to changes in ecosystem services. Administrative boundaries, cultural differences, and language barriers increase the disassociation between land-use management and marginalized populations living in the U.S.–Mexico borderlands. This paper describes the development of a Modified Socio-Environmental Vulnerability Index (M-SEVI), using determinants from binational census and neighborhood data that describe levels of education, access to resources, migratory status, housing, and number of dependents, to provide a simplified snapshot of the region's populace that can be used in binational planning efforts. We apply this index at the SCW, located on the border between Arizona, USA and Sonora, Mexico. For comparison, the Soil and Water Assessment Tool is concurrently applied to assess the provision of erosion- and flood control services over a 9-year period. We describe how this coupling of data can form the base for an ecosystem services assessment across political boundaries that can be used by land-use planners. Results reveal potential disparities in environmental risks and burdens throughout the binational watershed in residential districts surrounding and between urban centers. The M-SEVI can be used as an important first step in addressing environmental justice for binational decision-making.
Murri, R; Franceschi, S; Ravizza, M; Fiore, S; Bini, T; Mussini, C; Fasolo, M; Liuzzi, G; Ippolito, G; D'Arminio Monforte, A
The objective of the study was to evaluate the access to Papanicolau (Pap) tests of HIV-infected women in Italy. A cross-sectional survey on a cohort of HIV-infected women seen at 27 HIV clinics was performed. At each clinic a female physician involved in the care of HIV-infected women was asked questions on clinic and patients' characteristics and on access to Pap tests. The outcome of the study was to find the percentage of women who had not had a Pap test before coming to the HIV clinic and the percentage having had a Pap test in 2001. In the survey, 7,600 HIV-infected women were represented. Women who came to the clinic without having ever had a Pap test were 62+/-22%, while women who had had a Pap test in 2001 were 43+/-36%. Women who reported never having had a Pap test before coming to the HIV clinic were more often from the south than the north of Italy (17.9+/-49% from the north, 18+/-53% from the center and 9.3+/-83.9% from the south; p<0.001). This a difference disappeared when comparing the women who had had a Pap test in 2001 (28+/-39.6% from the north, 31.6+/-44.2% from the center and 25.6+/-45.7% from the south; p=0.88). Despite the published guidelines in Italy, only 38% of women had ever had a Pap test before coming to the HIV clinic and only 43% had had a Pap test in 2001. Strategies aimed to improve these proportions should be rapidly implemented at all levels of care organization.
Hong, Geu Ru; Shin, Dong Gu [Yeungnam University College of Medicine, Daegu (Korea, Republic of)
Echocardiography is one of the most frequently used techniques for diagnosing cardiovascular diseases. Over the last twenty years, technological advances have enabled the application of high-quality imaging. Important recent developments have occurred in echocardiography that are already being used clinically. Equipment and hardware is now available to produce real time three-dimensional and contrast enhanced imaging. Tissue Doppler and stress echocardiography have provided potential benefit to analyze hemodynamic information of heart. This review discusses each of these new developments and their potential impact on the practice of echocardiography and cardiology in general.
Full Text Available Abstract Background In Finland like in many other countries, employers are legally obliged to organize occupational health services (OHS for their employees. Because employers bear the costs of OHS it could be that in spite of the legal requirement OHS expenditure is more determined by economic performance of the company than by law. Therefore, we explored whether economic performance was associated with the companies' expenditure on occupational health services. Methods We used a prospective design to predict expenditure on OHS in 2001 by a company's economic performance in 1999. Data were provided by Statistics Finland and expressed by key indicators for profitability, solidity and liquidity and by the Social Insurance Institution as employers' reimbursement applications for OHS costs. The data could be linked at the company level. Regression analysis was used to study associations adjusted for various confounders. Results Nineteen percent of the companies (N = 6 155 did not apply for reimbursement of OHS costs in 2001. The profitability of the company represented by operating margin in 1999 and adjusted for type of industry was not significantly related to the company's probability to apply for reimbursement of the costs in 2001 (OR = 1.00, 95%CI: 0.99 to 1.01. Profitability measured as operating profit in 1999 and adjusted for type of industry was not significantly related to costs for curative medical services (Beta -0.001, 95%CI: -0.00 to 0.11 nor to OHS cost of prevention in 2001 (Beta -0.001, 95%CI: -0.00 to 0.00. Conclusion We did not find a relation between the company's economic performance and expenditure on OHS in Finland. We suppose that this is due to legislation obliging employers to provide OHS and the reimbursement system both being strong incentives for employers.
Full Text Available Abstract Background Patient choice and access to health care is compromised by many barriers including travel distance. Individuals with the human immunodeficiency virus (HIV can seek free specialist care in Britain, without a referral, providing flexible access to care services. Willingness to travel beyond local services for preferred care has funding and service implications. Data from an enhanced HIV surveillance system were used to explore geodemographic and clinical factors associated with accessing treatment services. Methods We extracted data on the location, type and frequency of care services utilized by HIV positive persons (n = 3983 accessing treatment in north west England between January 1st 2005 and June 30th 2006. Individuals were allocated a deprivation score and grouped by urban/rural residence, and distance to care services was calculated. Analysis identified independent predictors of distance travelled (general linear modelling and, for those bypassing their nearest clinic, the probability of accessing a specialist service (logistic regression, SPSS ver 14. Inter-relationships between variables and distance travelled were visualised using detrended correspondence analysis (PC-ORD ver 4.1. Results HIV infected persons travelled an average of 4.8 km (95% confidence intervals (CI 4.6–4.9 per trip and had on average 6 visits (95% CI 5.9–6.2 annually for care. Longer trips were made by males (4.8 km vs 4.5 km, white people (6.2 km, the young (>15 years, 6.8 km and elderly (60+ years, 6.3 km, those on multiple therapy (5.3 km vs 4.0 km, and the more affluent living in rural areas (16.1 km, P Conclusion Distance travelled, and type of HIV services used, were associated with socioeconomic status, even after accounting for ethnicity, route of infection and age. Thus despite offering an 'equitable' service, travel costs may advantage those with higher income.
Tiago Tribolet de Abreu
Full Text Available Tiago Tribolet de Abreu, Sonia Mateus, Cecilia Carreteiro, Jose CorreiaLaboratorio de Ultrasonografia Cardiaca e Neurovascular, Hospital do Espirito Santo-Evora, E. P. E., PortugalBackground: The role of transesophageal echocardiography (TEE in the evaluation of acute stroke patients is still ill-defined. We conducted a prospective observational study to find the prevalence of TEE findings that indicate anticoagulation as beneficial, in acute ischemic stroke patients without indication for anticoagulation based on clinical, electrocardiographic and transthoracic echocardiography (TTE findings.Methods: We prospectively studied all patients referred to our laboratory for TTE and TEE. Patients were excluded if the diagnosis was not acute ischemic stroke or if they had an indication for anticoagulation based on clinical, electrocardiographic, or TTE data. Patients with TEE findings that might indicate anticoagulation as beneficial were identified.Results: A total of 84 patients with acute ischemic stroke and without indication for anticoagulation based on clinical and electrocardiographic or TTE data were included in the study. Findings indicating anticoagulation as beneficial were found in 32.1%: spontaneous echo contrast (1.2%, complex aortic atheroma (27.4%, thrombus (8.3%, and simultaneous patent foramen ovale and atrial septal aneurysm (2.4%.Conclusions: The results of our study show that TEE can have therapy implications in 32.1% of ischemic stroke patients in sinus rhythm and with TTE with no indication for anticoagulation.Keywords: acute ischemic stroke, transesophageal echocardiography, transthoracic echocardiography, therapy
Full Text Available Echocardiography is ideally suited to guide fluid resuscitation in critically ill patients. It can be used to assess fluid responsiveness by looking at the left ventricle, aortic outflow, inferior vena cava and right ventricle. Static measurements and dynamic variables based on heart–lung interactions all combine to predict and measure fluid responsiveness and assess response to intravenous fluid esuscitation. Thorough knowledge of these variables, the physiology behind them and the pitfalls in their use allows the echocardiographer to confidently assess these patients and in combination with clinical judgement manage them appropriately.
Statistics for Library and Information Services, written for non-statisticians, provides logical, user-friendly, and step-by-step instructions to make statistics more accessible for students and professionals in the field of Information Science. It emphasizes concepts of statistical theory and data collection methodologies, but also extends to the topics of visualization creation and display, so that the reader will be able to better conduct statistical analysis and communicate his/her findings. The book is tailored for information science students and professionals. It has specific examples of dataset sets, scripts, design modules, data repositories, homework assignments, and a glossary lexicon that matches the field of Information Science. The textbook provides a visual road map that is customized specifically for Information Science instructors, students, and professionals regarding statistics and visualization. Each chapter in the book includes full-color illustrations on how to use R for the statistical ...
Andrulis, D P
Urban communities continue to face formidable historic challenges to improving public health. However, reinvestment initiatives, changing demographics, and growth in urban areas are creating changes that offer new opportunities for improving health while requiring that health systems be adapted to residents' health needs. This commentary suggests that health care improvement in metropolitan areas will require setting local, state, and national agendas around 3 priorities. First, health care must reorient around powerful population dynamics, in particular, cultural diversity, growing numbers of elderly, those in welfare-workplace transition, and those unable to negotiate an increasingly complex health system. Second, communities and governments must assess the consequences of health professional shortages, safety net provider closures and conversions, and new marketplace pressures in terms of their effects on access to care for vulnerable urban populations; they must also weigh the potential value of emerging models for improving those populations' care. Finally, governments at all levels should use their influence through accreditation, standards, tobacco settlements, and other financing streams to educate and guide urban providers in directions that respond to urban communities' health care needs.
During the upcoming Summer 2016 meeting of the ESIP Federation (July 19-22), OpenDAP will hold a Developers and Users Workshop. While a broad set of topics will be covered, a key focus is capitalizing on recent EOSDIS-sponsored advances in Hyrax, OPeNDAPs own software for server-side realization of the DAP2 and DAP4 protocols. These Hyrax advances are as important to data users as to data providers, and the workshop will include hands-on experiences of value to both. Specifically, a balanced set of presentations and hands-on tutorials will address advances in1.server installation,2.server configuration,3.Hyrax aggregation capabilities,4.support for data-access from clients that are HTTP-based, JSON-based or OGC-compliant (especially WCS and WMS),5.support for DAP4,6.use and extension of server-side computational capabilities, and7.several performance-affecting matters. Topics 2 through 7 will be relevant to data consumers, data providers and notably, due to the open-source nature of all OPeNDAP software to developers wishing to extend Hyrax, to build compatible clients and servers, and/or to employ Hyrax as middleware that enables interoperability across a variety of end-user and source-data contexts. A session for contributed talks will elaborate the topics listed above and embrace additional ones.
Andersen, Helle Elisabeth
-internal dialectic, and created at the boundaries that a society creates between “normals” and “outsiders”. This project explores what it means to be infected with HIV/AIDS and/or disabled in Uganda and how this affects a person’s identity. The lower social value of disabled persons prevents them from participating......This project is based on five weeks’ ethnographically inspired fieldwork in May 2006 in the Republic of Uganda. The study started out with the hypothesis that there was some kind of discrimination going on in the interaction between health workers at HIV/AIDS clinics, and person with disabilities...... as important issues regarding attendance at these services for PWDs. Those obstacles are there, but according to my fieldwork the physical barriers in the “healthcare system” do not seem to be as important as barriers outside the “healthcare system”. These barriers are constituted through a complex external...
Full Text Available Purpose: To understand the reasons why people in rural south India with visual impairment arising from various ocular diseases do not seek eye care. Materials and Methods: A total of 5,573 persons above the age of 15 were interviewed and examined in the South Indian state of Andhra Pradesh covering the districts of Adilabad, West Godavari and Mahaboobnagar. A pre-tested structured questionnaire on barriers to eye care was administered by trained field investigators. Results: Of the eligible subjects, 1234 (22.1%, N=5573 presented with distant visual acuity < 20/60 or equivalent visual field loss in the better eye. Of these, 898 (72.7%, N=1234 subjects had not sought treatment despite noticing a decrease in vision citing personal, economic and social reasons. The analysis also showed that the odds of seeking treatment was significantly higher for literates [odds ratio (OR 1.91, 95% confidence interval (CI 1.38 to 2.65], for those who would be defined as blind by visual acuity category (OR 1.35, 95% CI 0.96 to 1.90 and for those with cataract and other causes of visual impairment (OR 1.50, 95% CI 1.11 to 2.03. Barriers to seeking treatment among those who had not sought treatment despite noticing a decrease in vision over the past five years were personal in 52% of the respondents, economic in 37% and social in 21%. Conclusion: Routine planning for eye care services in rural areas of India must address the barriers to eye care perceived by communities to increase the utilization of services.
Lehnert, K. A.; Carbotte, S. M.; Ferrini, V.; Hsu, L.; Arko, R. A.; Walker, J. D.; O'hara, S. H.
Substantial volumes of data in the Earth Sciences are collected in small- to medium-size projects by individual investigators or small research teams, known as the 'Long Tail' of science. Traditionally, these data have largely stayed 'in the dark', i.e. they have not been properly archived, and have therefore been inaccessible and underutilized. The primary reason has been the lack of appropriate infrastructure, from adequate repositories to resources and support for investigators to properly manage their data, to community standards and best practices. Lack of credit for data management and for the data themselves has contributed to the reluctance of investigators to share their data. IEDA (Integrated Earth Data Applications), a NSF-funded data facility for solid earth geoscience data, has developed a comprehensive suite of data services that are designed to address the concerns and needs of investigators. IEDA's data publication service registers datasets with DOI and ensures their proper citation and attribution. IEDA is working with publishers on advanced linkages between datasets in the IEDA repository and scientific online articles to facilitate access to the data, enhance their visibility, and augment their use and citation. IEDA's investigator support ranges from individual support for data management to tools, tutorials, and virtual or face-to-face workshops that guide and assist investigators with data management planning, data submission, and data documentation. A critical aspect of IEDA's concept has been the disciplinary expertise within the team and its strong liaison with the science community, as well as a community-based governance. These have been fundamental to gain the trust and support of the community that have lead to significantly improved data preservation and access in the communities served by IEDA.
Full Text Available Every year, 3-5% of pregnant mothers in South Africa lose their babies to a stillbirth or neonatal death. These mothers need adequate services to prevent complications in their grieving process. Most of these babies are lost in hospital settings, so the treatment medical staff provide is vital. This study examined mothers’ experiences of accessing hospital, religious, formal and social services after a stillbirth or neonatal death. An exploratory research design was used to conduct applied research. A semi-structured interview schedule was used with a sample of 15 mothers who had lost a baby in the last 5 years. The findings were analysed quantitatively and qualitatively. The primary focus of this article is the quantitative findings relating to hospital services. The sample was small and these results cannot be generalised, but some conclusions are reached and recommendations are made to service providers in hospitals working with mothers who have lost babies. Mothers generally experienced the support services from hospitals as inadequate, compared to what hospitals could offer. Mothers that receive support after the loss of a baby generally cope better. This support thus assists them in the grieving process. Hospital staff can be trained to provide these services. Opsomming In Suid-Afrika verloor 3-5% swanger moeders hulle babas deur stilgeboorte of neonatale dood. Hierdie moeders benodig voldoende dienste om komplikasies in die rouproses te verhoed. Die behandeling deur mediese personeel is uiters belangrik omdat die meeste van dié babas in ‘n hospitaalopset sterf. Hierdie studie het moeders se ervarings van die toeganklikheid van hospitaal-, godsdienstige, formele en sosiale dienste na die dood van hulle babas deur stilgeboorte of neonatale dood ondersoek. Toegepaste navorsing is met behulp van ‘n verkennende navorsingsontwerp gedoen. ‘n Semi-gestruktureerde onderhoudskedule is gebruik met ‘n steekproef van 15 moeders wat
Kutschka, Ingo; Sheikh, Ahmad Y; Sista, Ramachandra; Hendry, Stephen L; Chun, Hyung J; Hoyt, Grant; Kutschka, Werner; Pelletier, Marc P; Quertermous, Tom; Wu, Joseph C; Robbins, Robert C
Acquisition of echocardiographic data from rodents is subject to wide variability due to variations in technique. We hypothesize that a dedicated imaging platform can aid in standardization of technique and improve the quality of images obtained. We constructed a device consisting of a boom-mounted steel platform frame (25 x 35 x 3 cm) on which a transparent polyethylene membrane is mounted. The animal is placed onto the membrane and receives continual inhaled anesthesia via an integrated port. The membrane allows for probe positioning from beneath the animal to obtain standard echo-views in left lateral decubitus or prone positions. The frame can be set at any desired angle ranging from 0 to 360 degrees along either the long or short axis. Adult male Sprague-Dawley rats (n = 5) underwent echocardiography (General Electric, Vivid 7, 14 MHz) using the platform. The device allowed for optimal positioning of animals for a variety of standard echocardiographic measurements. Evaluations among all animals showed minimal variability between two different operators and time points. We tested the feasibility of the device for supporting the assessment of cardiac function in a disease model by evaluating a separate cohort of adult male spontaneously hypertensive rats (n = 5) that underwent left anterior descending coronary artery ligation. Serial echocardiography demonstrated statistically significant decreases of fractional shortening and ejection fraction (p rats. Future studies will focus on improving this technology to allow for standardized high-throughput echocardiographic analysis in small animal models of disease.
Full Text Available Transesophageal echocardiography (TEE is a semi-invasive, monitoring and diagnostic tool, which is used in the perioperative management of cardiac surgical and hemodynamically unstable patients. The low degree of invasiveness and the capacity to visualize and assimilate dynamic information that can change the course of the patient management is an important advantage of TEE. Although TEE is reliable, comprehensive, credible, and cost-effective, it must be performed by a trained echocardiographer who understands the indications and the potential complications of the procedure, and has the ability to achieve proper acquisition and interpretation of the echocardiographic data. Adequate knowledge of the physics of ultrasound and the TEE machine controls is imperative to optimize image quality, reduce artifacts, and prevent misinterpretation of diagnosis. Two-dimensional (2D and Motion (M mode imaging are used for obtaining anatomical information, while Doppler and Color Flow imaging are used for information on blood flow. 3D technology enables us to view the cardiac structures from different perspectives. Despite the recent advances of 3D TEE, a sharp, optimized 2D image is pivotal for the reconstruction. This article describes the relevant underlying physical principles of ultrasound and focuses on a systematic approach to instrumentation and use of controls in the practical use of transesophageal echocardiography.
Kim, Kyeong Soo
The current practice of shaping subscriber traffic using a token bucket filter by Internet service providers may result in a severe waste of network resources in shared access networks; except for a short period of time proportional to the size of a token bucket, it cannot allocate excess bandwidth among active subscribers even when there are only a few active subscribers. To better utilize the network resources in shared access networks, therefore, we recently proposed and analyzed the perfo...
Møller, J E; Søndergaard, E; Poulsen, S H;
To assess the association between color M-mode flow propagation velocity and the early diastolic mitral annular velocity (E(m)) obtained with tissue Doppler echocardiography and to assess the prognostic implications of the indexes, echocardiography was performed on days 1 and 5, and 1 and 3 months...
A. Nemes (Attila)
textabstractThe aim of this thesis was to study the advances in the evaluation of cardiovascular function by 2D and real-time 3D stress echocardiography and vascular stiffness measurements. Stress echocardiography is a widely used non-invasive stress modality for the detection of coronary artery dis
K.Y.E. Leung (Esther); M. van Stralen (Marijn); M.G. Danilouchkine (Mikhail); G. van Burken (Gerard); M.L. Geleijnse (Marcel); J.H.C. Reiber (Johan); N. de Jong (Nico); A.F.W. van der Steen (Ton); J.G. Bosch (Johan)
textabstractReal-time three-dimensional (3D) ultrasound imaging has been proposed as an alternative for two-dimensional stress echocardiography for assessing myocardial dysfunction and underlying coronary artery disease. Analysis of 3D stress echocardiography is no simple task and requires considera
Full Text Available Cardiomyopathies are common cardiac disorders that primarily affect cardiac muscle resulting in cardiac dysfunction and heart failure. Transgenic mouse disease models have been developed to investigate the cellular mechanisms underlying heart failure and sudden cardiac death observed in cardiomyopathy cases and to explore the therapeutic outcomes in experimental animals in vivo. Echocardiography is an essential diagnostic tool for accurate and noninvasive assessment of cardiac structure and function in experimental animals. Our laboratory has been among the first to apply high-frequency research echocardiography on transgenic mice with cardiomyopathies. In this work, we have summarized our and other studies on assessment of systolic and diastolic dysfunction using conventional echocardiography, pulsed Doppler, and tissue Doppler imaging in transgenic mice with various cardiomyopathies. Estimation of embryonic mouse hearts has been performed as well using this high-resolution echocardiography. Some technical considerations in mouse echocardiography have also been discussed.
Thomas W. Hennessy
Full Text Available Important health disparities have been documented among the peoples of the Arctic and subarctic, including those related to limited access to in-home improved drinking water and sanitation services. Although improving water, sanitation and hygiene (WASH has been a focus of the United Nations for decades, the Arctic region has received little attention in this regard. A growing body of evidence highlights inequalities across the region for the availability of in-home drinking WASH services and for health indicators associated with these services. In this review, we highlight relevant data and describe an initiative through the Arctic Council's Sustainable Development Working Group to characterize the extent of WASH services in Arctic nations, the related health indicators and climate-related vulnerabilities to WASH services. With this as a baseline, efforts to build collaborations across the Arctic will be undertaken to promote innovations that can extend the benefits of water and sanitation services to all residents.
赵云; 朱文玲; 倪超; 郭丽琳; 曾勇; 方理刚
Objective To evaluate the predictive value of atherosclerotic aortic plaques in coronary artery disease (CAD) Methods In 50patients with suspected coronary artery disease, transesophageal echocardiography was performed to examine their thoracic aortas 2 weeks before or after coronary angiography. In the cases of coronary angiography studied, stenosis of the coronary artery ≥ 50 % was considered to be due to coronary artery disease,whereas the thickness of the intima ≥ 1.3 mm was taken to be the criteria for the presence of an atherosclerotic aortic plaque on the transesophageal echocardiographic test. Results Among the 50 patients, 37 cases were diagnosed as CAD and 13 cases were considered to be normal. The plaques of the thoracic aorta were observed in 34cases in the CAD group and 3 cases in the normal group. The sensitivity and specificity of aortic plaques for CAD were 91.9 % and 76.9%, respectively. The positive and negative predictive values of the aortic plaques for CAD were 91.9% and 76.9%, respectively. The accuracy was 88.0%. 80 percent of the patients with single- yes sel disease had thoracic aortic plaques, 92 percent of the patients with two-vessel disease and 100 percent of the patients with three-vessel disease had thoracic aortic plaques. There was a significant difference in the thickness of aortic intimas between the normal group and the CAD group. Conclusions Detectingatherosclerotic plaques in the thoracic aorta with transesophageal echocardiography may be of great value in predicting the presence and extent of coronary artery disease.
Lindholm, D. M.; Wilson, A.
reference implementation of the data model and server framework (with a RESTful service interface) in the Scala programming language. Scala can be thought of as the next generation of Java. It runs on the Java Virtual Machine and can directly use Java code. Scala improves upon Java's object-oriented capabilities and adds support for functional programming paradigms which are particularly well suited for scientific data analysis. The Scala implementation of LaTiS can be thought of as a Domain Specific Language (DSL) which presents an API that better matches the semantics of the problems scientific data users are trying to solve. Instead of working with bytes, ints, or arrays, the data user can directly work with data as "time series" or "spectra". LaTiS provides many layers of abstraction with which users can interact to support a wide variety of data access and analysis needs.
Full Text Available Emergency contraception pills (ECP are among the 13 essential commodities in the framework for action established by the UN Commission on Life-Saving Commodities for Women and Children. Despite having been on the market for nearly 20 years, a number of barriers still limit women's access to ECP in low- and middle-income countries (LMIC including limited consumer knowledge and poor availability. This paper reports the results of a review to synthesise the current evidence on service delivery strategies to improve access to ECP.A narrative synthesis methodology was used to examine peer reviewed research literature (2003 to 2013 from diverse methodological traditions to provide critical insights into strategies to improve access from a service delivery perspective. The studies were appraised using established scoring systems and the findings of included papers thematically analysed and patterns mapped across all findings using concept mapping.Ten papers were included in the review. Despite limited research of adequate quality, promising strategies to improve access were identified including: advance provision of ECP; task shifting and sharing; intersectoral collaboration for sexual assault; m-health for information provision; and scale up through national family planning programs.There are a number of gaps in the research concerning service delivery and ECP in LMIC. These include a lack of knowledge concerning private/commercial sector contributions to improving access, the needs of vulnerable groups of women, approaches to enhancing intersectoral collaboration, evidence for social marketing models and investment cases for ECP.
Full Text Available Planning for sustainable cities involves supporting compact, energy-efficient urban form as well as maintaining attractive and liveable urban landscapes. Attractive cities depend highly on services provided by ecosystems, especially cultural ecosystem services (ES, which give direct benefits to urban citizens. Therefore, access to a diversity of urban functions and publicly available ES by walking and public transport should be considered when planning for sustainable cities. This could be facilitated by user-friendly planning support models. The aim of this study was to develop a GIS-based model for assessing accessibility to ES, more specifically, water-related cultural ecosystem services (WCES, via walking and public transport, with input from stakeholders. The model was applied to the Stockholm region in Sweden. Travel times and census data were used to derive measures and maps of accessibility to prioritised WCES in the region, today and in urbanisation scenarios for 2050. The results showed how access to WCES varied spatially within the region. The number of potential visitors to different WCES sites now and in the future urbanisation scenarios was estimated, and areas in need for future development of the public transport system as well as WCES were identified. The GIS-based accessibility model has potential to be used as planning support in urban planning.
Vohra, Rini; Madhavan, Suresh; Sambamoorthi, Usha; St Peter, Claire
This cross-sectional study examined perceived access to services, quality of care, and family impact reported by caregivers of children aged 3-17 years with autism spectrum disorders, as compared to caregivers of children with other developmental disabilities and other mental health conditions. The 2009-2010 National Survey of Children with…
褚孔统; 宋建宇; 王国强
The network transmission protocol of Oracle database is analyzed. Then, a method for the secure access to the Oracle database using proxy service is proposed to meet the high-standard confidentiality requirements of specific industries. The proxy service is used to capture the access- ing requests of Oracle database, encrypt messsages for transmission, decode and re-direct them to the Oracle database. The method can be used to secure the access to the Oracle database.%分析了Oracle数据库网络传输协议,提出了使用代理服务解决特定行业高保密要求的Oracle数据库安全访问方法。通过截获Oracle数据库访问请求,对报文进行加密传输、解析并重定向,达到Oracle数据库的安全访问目的。
贺正求; 张叶琳; 张雷刚; 石川
提出了一种基于角色映射的服务组合访问控制体系架构，用来解决服务组合过程中的访问控制问题。架构主要由服务组合访问控制中心和若干服务组合访问控制节点组成，服务组合访问控制中心的核心功能是建立和维护各服务所在安全域之间的角色映射信息，并从全局角度协调服务组合中的访问控制，服务组合访问控制节点是对各安全域访问控制系统的抽象，是访问控制的实施点，具有独立性。在此基础上，架构采用广泛应用于分布式环境的“推模式”授权机制，在实现服务组合中各服务之间的安全调用与协同的同时，又能在很大程度上保持各服务所在安全域的相对独立性和安全性，因而提出的架构具有较好的适应能力和可扩展性。%An access control architecture based on role mapping for service composition is proposed to solve the access control problem in service composition process. The architecture is composed of an access control center and some access control nodes. The core functions of the access control center are to set up and maintain the role mapping information among the security domains,and harmonize the access control for the service composition from the global perspective. The access control node is an abstraction for the access control system of each security domain,and it is the execution point for access control with independence. Furthermore,the architecture adopts an authoriza-tion mechanism called“push mode” that is widely applied in distributed environment. Consequently,not only the access control of service composition can be well implemented in the architecture,but also the independence and security of the participant domains can be pre-served. Thus the applicability and extensibility of the proposed architecture is finer relatively.
Buckley, Claire M
Lower extremity amputation (LEA) is a complication of diabetes and a marker of the quality of diabetes care. Clinical and sociodemographic determinants of LEA in people with diabetes are well known. However, the role of service-related factors has been less well explored. Early referral to secondary healthcare is assumed to prevent the occurrence of LEA. The objective of this study is to investigate a possible association between the timing of patient access to secondary healthcare services for diabetes management, as a key marker of service-related factors, and LEA in patients with diabetes.
Full Text Available Background Innovators have piloted improvements in communication, changed patterns of practice and patient empowerment from online access to electronic health records (EHR. International studies of online services, such as prescription ordering, online appointment booking and secure communications with primary care, show good uptake of email consultations, accessing test results and booking appointments; when technologies and business process are in place. Online access and transactional services are due to be rolled out across England by 2015; this review seeks to explore the impact of online access to health records and other online services on the quality and safety of primary health care.Objective To assess the factors that may affect the provision of online patient access to their EHR and transactional services, and the impact of such access on the quality and safety of health care.Method Two reviewers independently searched 11 international databases during the period 1999–2012. A range of papers including descriptive studies using qualitative or quantitative methods, hypothesis-testing studies and systematic reviews were included. A detailed eligibility criterion will be used to shape study inclusion .A team of experts will review these papers for eligibility, extract data using a customised extraction form and use the Grading of Recommendations Assessment, Development and Evaluation (GRADE instrument to determine the quality of the evidence and the strengths of any recommendation. Data will then be descriptively summarised and thematically synthesised. Where feasible, we will perform a quantitative meta-analysis.Prospero (International Prospective Register of Systematic Reviews registration number: crd42012003091.
Whalen, Edward A.
This document serves as the final report for the Flight Services and Aircraft Access task order NNL14AA57T as part of NASA Environmentally Responsible Aviation (ERA) Project ITD12A+. It includes descriptions of flight test preparations and execution for the Active Flow Control (AFC) Vertical Tail and Insect Accretion and Mitigation (IAM) experiments conducted on the 757 ecoDemonstrator. For the AFC Vertical Tail, this is the culmination of efforts under two task orders. The task order was managed by Boeing Research & Technology and executed by an enterprise-wide Boeing team that included Boeing Research & Technology, Boeing Commercial Airplanes, Boeing Defense and Space and Boeing Test and Evaluation. Boeing BR&T in St. Louis was responsible for overall Boeing project management and coordination with NASA. The 757 flight test asset was provided and managed by the BCA ecoDemonstrator Program, in partnership with Stifel Aircraft Leasing and the TUI Group. With this report, all of the required deliverables related to management of this task order have been met and delivered to NASA as summarized in Table 1. In addition, this task order is part of a broader collaboration between NASA and Boeing.
Bellamy, Kim; Ostini, Remo; Martini, Nataly; Kairuz, Therese
Introduction There are challenges associated with selecting a qualitative research approach. In a field abundant with terminology and theories, it may be difficult for a pharmacist to know where and how to begin a qualitative research journey. The purpose of this paper is to provide insight into generic qualitative research and to describe the journey of data collection of a novice qualitative researcher in the quest to answer her research question: 'What are the barriers to accessing medicines and pharmacy services for resettled refugees in Queensland, Australia?' Methodology Generic qualitative research draws on the strengths of one or more qualitative approaches. The aim is to draw out participants' ideas about things that are 'outside themselves'; rather than focussing on their inner feelings the research seeks to understand a phenomenon, a process, or the perspectives of participants. Sampling is designed to obtain a broad range of opinions about events and experiences and data collection includes interviews, questionnaires or surveys; thematic analysis is often used to analyse data. When to use Generic qualitative research provides an opportunity to develop research designs that fit researchers' epistemological stance and discipline, with research choices, including methodology and methods, being informed by the research question. Limitations Generic qualitative research is one of many methodologies that may be used to answer a research question and there is a paucity of literature about how to do it well. There is also debate about its validity as a qualitative methodology.
Plu, Isabelle; Gignon, Maxime; Emery, Sophie; Purssell-François, Irène; Moutel, Grégoire; Hervé, Christian
Healthcare networks which purpose is to manage patients through better coordination of the care, need to develop a communication strategy to be recognized by the public and by healthcare professionals and to be inserted in the healthcare landscape. We firstly will present legal requirements related to external communication of healthcare networks. Then, we will describe the different tools which can be used to communicate about healthcare networks in its area, with the example from a healthcare network for health services accessibility. In the French Public health code, the legal status and the ethical charter of the healthcare network have to be delivered to the healthcare professionals in its area and to the patients. Moreover, the example healthcare network informed collectively and individually the healthcare professionals of its area about its activities. It made it known to the public by the way of departmental prevention manifestations and health education sessions in community social associations. From these examples, we will conduct an ethical reflection on the modalities and stakes of the external communication of healthcare networks.
Jill M Hagey
Full Text Available Introduction: Avoiding unintended pregnancies is important for the health of adolescents living with HIV and has the additional benefit of preventing potential vertical HIV transmission. Health facility providers represent an untapped resource in understanding the barriers and facilitators adolescents living with HIV face when accessing contraception. By understanding these barriers and facilitators to contraceptive use among adolescent females living with HIV, this study aimed to understand how best to promote contraception within this marginalized population. Methods: We conducted structured in-depth interviews with 40 providers at 21 Family AIDS Care & Education Services - supported clinics in Homabay, Kisumu and Migori counties in western Kenya from July to August 2014. Our interview guide explored the providers’ perspectives on contraceptive service provision to adolescent females living with HIV with the following specific domains: contraception screening and counselling, service provision, commodity security and clinic structure. Transcripts from the interviews were analyzed using inductive content analysis. Results: According to providers, interpersonal factors dominated the barriers adolescent females living with HIV face in accessing contraception. Providers felt that adolescent females fear disclosing their sexual activity to parents, peers and providers, because of repercussions of perceived promiscuity. Furthermore, providers mentioned that adolescents find seeking contraceptive services without a male partner challenging, because some providers and community members view adolescents unaccompanied by their partners as not being serious about their relationships or having multiple concurrent relationships. On the other hand, providers noted that institutional factors best facilitated contraception for these adolescents. Integration of contraception and HIV care allows easier access to contraceptives by removing the stigma of coming
An integrated tiered service delivery model (ITSDM based on local CD4 testing demands can improve turn-around times and save costs whilst ensuring accessible and scalable CD4 services across a national programme.
Deborah K Glencross
Full Text Available The South African National Health Laboratory Service (NHLS responded to HIV treatment initiatives with two-tiered CD4 laboratory services in 2004. Increasing programmatic burden, as more patients access anti-retroviral therapy (ART, has demanded extending CD4 services to meet increasing clinical needs. The aim of this study was to review existing services and develop a service-model that integrated laboratory-based and point-of-care testing (POCT, to extend national coverage, improve local turn-around/(TAT and contain programmatic costs.NHLS Corporate Data Warehouse CD4 data, from 60-70 laboratories and 4756 referring health facilities was reviewed for referral laboratory workload, respective referring facility volumes and related TAT, from 2009-2012.An integrated tiered service delivery model (ITSDM is proposed. Tier-1/POCT delivers CD4 testing at single health-clinics providing ART in hard-to-reach areas (350-1500 tests/day, serving ≥ 200 health-clinics. Tier-6 provides national support for standardisation, harmonization and quality across the organization.The ITSDM offers improved local TAT by extending CD4 services into rural/remote areas with new Tier-3 or Tier-2/POC-Hub services installed in existing community laboratories, most with developed infrastructure. The advantage of lower laboratory CD4 costs and use of existing infrastructure enables subsidization of delivery of more expensive POC services, into hard-to-reach districts without reasonable access to a local CD4 laboratory. Full ITSDM implementation across 5 service tiers (as opposed to widespread implementation of POC testing to extend service can facilitate sustainable 'full service coverage' across South Africa, and save>than R125 million in HIV/AIDS programmatic costs. ITSDM hierarchical parental-support also assures laboratory/POC management, equipment maintenance, quality control and on-going training between tiers.
Full Text Available Background: There insufficient information regarding access and participation of immigrant women in Spain in sexual and reproductive health programs. Recent studies show their lower participation rate in gynecological cancer screening programs; however, little is known about the participation in other sexual and reproductive health programs by immigrant women living in rural areas with high population dispersion. Objectives: The objective of this study is to explore the perceptions of midwives who provide these services regarding immigrant women's access and participation in sexual and reproductive health programs offered in a rural area. Design: A qualitative study was performed, within a larger ethnographic study about rural primary care, with data collection based on in-depth interviews and field notes. Participants were the midwives in primary care serving 13 rural basic health zones (BHZ of Segovia, a region of Spain with high population dispersion. An interview script was designed to collect information about midwives’ perceptions on immigrant women's access to and use of the healthcare services that they provide. Interviews were recorded and transcribed with participant informed consent. Data were analyzed based on the qualitative content analysis approach and triangulation of results with fieldwork notes. Results: Midwives perceive that immigrants in general, and immigrant women in particular, underuse family planning services. This underutilization is associated with cultural differences and gender inequality. They also believe that the number of voluntary pregnancy interruptions among immigrant women is elevated and identify childbearing and childrearing-related tasks and the language barrier as obstacles to immigrant women accessing the available prenatal and postnatal healthcare services. Conclusions: Immigrant women's underutilization of midwifery services may be linked to the greater number of unintended pregnancies, pregnancy
Full Text Available Transesophageal echocardiography has been shown to provide unique information about cardiac anatomy, function, hemodynamics and blood flow and is relatively easy to perform with a low risk of complications. Echocardiographic evaluation of the tricuspid and pulmonary valves can be achieved with two-dimensional and Doppler imaging. Transesophageal echocardiography of these valves is more challenging because of their complex structure and their relative distance from the esophagus. Two-dimensional echocardiography allows an accurate visualization of the cardiac chambers and valves and their motion during the cardiac cycle. Doppler echocardiography is the most commonly used diagnostic technique for detecting and evaluating valvular regurgitation. The lack of good quality evidence makes it difficult to recommend a validated quantitative approach but expert consensus recommends a clinically useful qualitative approach. This review ennumerates probe placement, recommended cross-sectional views, flow patterns, quantitative equations including the clinical approach to the noninvasive quantification of both stenotic and regurgitant lesions.
Kjaergaard, Jesper; Hastrup Svendsen, Jesper; Sogaard, Peter
BACKGROUND: Arrhythmogenic right ventricular (RV) cardiomyopathy (ARVC) is a regional disease of the RV myocardium with variable degrees of left ventricular involvement. Three-dimensional echocardiography and Doppler tissue imaging (DTI) are new echocardiographic modalities for the evaluation...... of global and regional function, but the diagnostic potential remains to be assessed. METHODS: Twenty patients with previously established ARVC were evaluated by 3-dimensional echocardiography and DTI, and compared with 32 age- and sex-matched control subjects. RESULTS: Using 3-dimensional echocardiography...... showed decreased regional systolic strain, but with wide variation in the measurements. CONCLUSION: Three-dimensional echocardiography identifies decreased RV ejection fraction in ARVC. Assessment of regional contractility by DTI is limited by wide variation. Echocardiographic evaluation...
Cooper, Robert M; Shahzad, Adeel; Newton, James;
Alcohol septal ablation (ASA) in hypertrophic obstructive cardiomyopathy reduces left ventricular outflow tract gradients. A third of patients do not respond; inaccurate localisation of the iatrogenic infarct can be responsible. Transthoracic echocardiography (TTE) using myocardial contrast can b...
Nielsen, Dorte Guldbrand; O'Neill, Lotte; Jensen, Signe
Context: Transthoracic echocardiography (TTE) is a widely used cardiac imaging technique that all cardiologists should be able to perform competently. Traditionally, TTE competence has been assessed by unstructured observation or in test situations separated from daily clinical practice. An objec...
Ke, Chih-Kun; Lin, Zheng-Hua
The progress of information and communication technologies (ICT) has promoted the development of healthcare which has enabled the exchange of resources and services between organizations. Organizations want to integrate mobile devices into their hospital information systems (HIS) due to the convenience to employees who are then able to perform specific healthcare processes from any location. The collection and merage of healthcare data from discrete mobile devices are worth exploring possible ways for further use, especially in remote districts without public data network (PDN) to connect the HIS. In this study, we propose an optimal mobile service which automatically synchronizes the telecare file resources among discrete mobile devices. The proposed service enforces some technical methods. The role-based access control model defines the telecare file resources accessing mechanism; the symmetric data encryption method protects telecare file resources transmitted over a mobile peer-to-peer network. The multi-criteria decision analysis method, ELECTRE (Elimination Et Choice Translating Reality), evaluates multiple criteria of the candidates' mobile devices to determine a ranking order. This optimizes the synchronization of telecare file resources among discrete mobile devices. A prototype system is implemented to examine the proposed mobile service. The results of the experiment show that the proposed mobile service can automatically and effectively synchronize telecare file resources among discrete mobile devices. The contribution of this experiment is to provide an optimal mobile service that enhances the security of telecare file resource synchronization and strengthens an organization's mobility.
Couet Jacques; Roussel Élise; Drolet Marie-Claude; Lachance Dominic; Plante Eric; Arsenault Marie
Abstract Background Dobutamine stress echocardiography is used to investigate a wide variety of heart diseases in humans. Dobutamine stress echocardiography has also been used in animal models of heart disease despite the facts that the normal response of healthy rat hearts to this type of pharmacological stress testing is unknown. This study was performed to assess this normal response. Methods 15 normal adult male Wistar rats were evaluated. Increasing doses of dobutamine were infused intra...
Full Text Available Background: Echocardiography has been a popular modality used to aid in the diagnosis of infective endocarditis (IE with the modified Duke criteria. We evaluated the necessity between the uses of either a transthoracic echocardiography (TTE or transesophageal echocardiography (TEE in patients with a body mass index (BMI greater than or equal to 25 kg/m2 and less than 25 kg/m2. Methods: A single-centered, retrospective study of 198 patients between 2005 and 2012 diagnosed with IE based on modified Duke criteria. Patients, required to be above age 18, had undergone an echocardiogram study and had blood cultures to be included in the study. Results: Among 198 patients, two echocardiographic groups were evaluated as 158 patients obtained a TTE, 143 obtained a TEE, and 103 overlapped with TEE and TTE. Out of these patients, 167 patients were included in the study as 109 (65% were discovered to have native valve vegetations on TEE and 58 (35% with TTE. TTE findings were compared with TEE results for true negatives and positives to isolate valvular vegetations. Overall sensitivity of TTE was calculated to be 67% with a specificity of 93%. Patients were further divided into two groups with the first group having a BMI ≥25 kg/m2 and the subsequent group with a BMI <25 kg/m2. Patients with a BMI ≥25 kg/m2 who underwent a TTE study had a sensitivity and specificity of 54 and 92%, respectively. On the contrary, patients with a BMI < 25 kg/m2 had a TTE sensitivity and specificity of 78 and 95%, respectively. Conclusions: Patients with a BMI <25 kg/m2 and a negative TTE should refrain from further diagnostic studies, with TEE strong clinical judgment is warranted. Patients with a BMI ≥ 25 kg/m2 may proceed directly to TEE as the initial study, possibly avoiding an additional study with a TTE.
Full Text Available Abstract Background The existence of publicly-accessible datasets comprised a significant opportunity for health services research to evolve into a science that supports health policy making and evaluation, proper inter- and intra-organizational decisions and optimal clinical interventions. This paper investigated the role of publicly-accessible datasets in the enhancement of health care systems in the developed world and highlighted the importance of their wide existence and use in the Middle East and North Africa (MENA region. Discussion A search was conducted to explore the availability of publicly-accessible datasets in the MENA region. Although datasets were found in most countries in the region, those were limited in terms of their relevance, quality and public-accessibility. With rare exceptions, publicly-accessible datasets - as present in the developed world - were absent. Based on this, we proposed a gradual approach and a set of recommendations to promote the development and use of publicly-accessible datasets in the region. These recommendations target potential actions by governments, researchers, policy makers and international organizations. Summary We argue that the limited number of publicly-accessible datasets in the MENA region represents a lost opportunity for the evidence-based advancement of health systems in the region. The availability and use of publicly-accessible datasets would encourage policy makers in this region to base their decisions on solid representative data and not on estimates or small-scale studies; researchers would be able to exercise their expertise in a meaningful manner to both, policy makers and the public. The population of the MENA countries would exercise the right to benefit from locally- or regionally-based studies, versus imported and in 'best cases' customized ones. Furthermore, on a macro scale, the availability of regionally comparable publicly-accessible datasets would allow for the
Victoria Pattison de Menil
Full Text Available The gap in Kenya between need and treatment for mental disorders is wide, and private providers are increasingly offering services, funded in part by private health insurance (PHI. Chiromo, a 30-bed psychiatric hospital in Nairobi, forms part of one of the largest private psychiatric providers in East Africa. The study evaluated the effects of insurance on service use and charge, questioning implications on access to care. Data derive from invoices for 455 sequential patients, including 12-month follow-up. Multi-linear and binary logistic regressions explored the effect of PHI on readmission, cumulative length of stay, and treatment charge. Patients were 66.4% male with a mean age of 36.8 years. Half were employed in the formal sector. 70% were admitted involuntarily. Diagnoses were: substance use disorder 31.6%; serious mental disorder 49.5%; common mental disorder 7%; comorbid 7%; other 4.9%. In addition to daily psychiatric consultations, two-thirds received individual counselling or group therapy; half received lab tests or scans; and 16.2% received ECT. Most took a psychiatric medicine. Half of those on antipsychotics were given only brands. Insurance paid in full for 28.8% of patients. Mean length of stay was 11.8 days and, in 12 months, 16.7 days (median 10.6. 22.2% were readmitted within 12 months. Patients with PHI stayed 36% longer than those paying out-of-pocket and had 2.5 times higher odds of readmission. Mean annual charge per patient was Int$ 4,262 (median Int$ 2,821. Insurers were charged 71% more than those paying out-of-pocket--driven by higher fees and longer stays. Chiromo delivers acute psychiatric care each year to approximately 450 people, to quality and human rights standards higher than its public counterpart, but at considerably higher cost. With more efficient delivery and wider insurance coverage, Chiromo might expand from its occupancy of 56.6% to reach a larger population in need.
Full Text Available Transoesophageal echocardiography (TEE is a semi invasive imaging modality rapidly gained credence and popularity in the cardiothoracic centers worldwide by mid 1990s. It has also been found to be useful in some noncardiac surgical procedures, in particular in the management of neurosurgical patients and haemodynamically unstable patients in intensive care units (ICUs. The principal goal of basic transoesophageal echocardiographic examination encompass a broad range of anatomic imaging including the diagnosis of air embolism, causes of haemodynamic instability, ventricular size and function, volume status, and complications from invasive procedures, as well as the clinical impact or etiology of pulmonary dysfunction in ICU. TEE is relatively cheap and semi-invasive, but it should not be used as a stand-alone device but as a tool which provides data in addition to the data acquired from other forms of monitoring. The establishment of TEE in perioperative neuro anaesthetic care though recent, may result in a significant change in the role of the anaesthetsiologist who, using TEE can provide new information which may change the course and the outcome of surgical procedures.
Miller, Douglas; Li, Peng; Gordon, David; Armstrong, William
The purpose of this study was to search for histologically identifiable lesions associated with myocardial contrast echocardiography (MCE) in rats. Diagnostic ultrasound scans with 1:4 end-systolic triggering provided a short-axis view of the left ventricle in rats at 1.5 MHz with 1.45-μs pulses of 1.7 Mechanical Index. Two relatively high doses (500 μl/kg) of OptisonTM ultrasound contrast agent were given 5 min apart during 10 min of MCE. One day after scanning, rats were sacrificed and the hearts fixed for histology. Slides were scored blind by a pathologist, and photomicrographs in the anterior half of the heart sections were characterized by digital image analysis. Microlesions identified by inflammatory infiltrates were scattered primarily over the anterior half of the sections. Pathologically, there was inflammatory cell infiltration in areas of 0.6+/-0.5% of the sections for shams and 3.6+/-3.6% for MCE (P<0.01). Analysis of the photographs from the anterior wall found microlesion areas of 0.5+/-0.8% for shams and 7.4+/-5.0% for MCE (P<0.02). Diagnostic MCE at high Mechanical Index has a potential for causing microscale lesions in the myocardium by nucleation of microcavitation. [Work supported by NIH Grant EB0338.
Kienle, R D; Thomas, W P; Rishniw, M
Eight healthy, adult cats were examined with biplane transesophageal echocardiography (TEE). Cats were sedated with a combination of diazepam and propofol and were examined using a 5 mm x 80 cm pediatric biplane TEE probe. Consistent images were obtained at three imaging depths within the esophagus. The caudal position provided satisfactory short-axis images of the left ventricle and heart base. The middle position provided the best long-axis views of the left atrium, left ventricle, and aorta and allowed Doppler examination of transmitral left ventricular inflow. The cranial position provided satisfactory imaging of the aorta and pulmonary artery and allowed Doppler examination of right ventricular and left ventricular outflow. Biplane TEE provides an additional method of imaging the feline heart which is complimentary to other imaging techniques and the images obtained were similar to those reported for dogs. Although TEE offers a slight advantage over transthorcic imaging for Doppler examination, the quality of the images of heart base structures was not as consistently superior to transthoracic images in cats as reported in dogs.
Simoons Maarten L
Full Text Available Abstract Background This pilot study was performed to evaluate whether virtual reality is applicable for three-dimensional echocardiography and if three-dimensional echocardiographic 'holograms' have the potential to become a clinically useful tool. Methods Three-dimensional echocardiographic data sets from 2 normal subjects and from 4 patients with a mitral valve pathological condition were included in the study. The three-dimensional data sets were acquired with the Philips Sonos 7500 echo-system and transferred to the BARCO (Barco N.V., Kortrijk, Belgium I-space. Ten independent observers assessed the 6 three-dimensional data sets with and without mitral valve pathology. After 10 minutes' instruction in the I-Space, all of the observers could use the virtual pointer that is necessary to create cut planes in the hologram. Results The 10 independent observers correctly assessed the normal and pathological mitral valve in the holograms (analysis time approximately 10 minutes. Conclusion this report shows that dynamic holographic imaging of three-dimensional echocardiographic data is feasible. However, the applicability and use-fullness of this technology in clinical practice is still limited.
Ajay Kumar Jha
Full Text Available Improved cosmetic appearance, reduced pain and duration of post-operative stay have intensified the popularity of minimally invasive cardiac surgery (MICS; however, the increased risk of stroke remains a concern. In conventional cardiac surgery, surgeons can visualize and feel the cardiac structures directly, which is not possible with MICS. Transesophageal echocardiography (TEE is essential during MICS in detecting problems that require immediate correction. Comprehensive evaluation of the cardiac structures and function helps in the confirmation of not only the definitive diagnosis, but also the success of surgical treatment. Venous and aortic cannulations are not under the direct vision of the surgeon and appropriate positioning of the cannulae is not possible during MICS without the aid of TEE. Intra-operative TEE helps in the navigation of the guide wire and correct placement of the cannulae and allows real-time assessment of valvular pathologies, ventricular filling, ventricular function, intracardiac air, weaning from cardiopulmonary bypass and adequacy of the surgical procedure. Early detection of perioperative complications by TEE potentially enhances the post-operative outcome of patients managed with MICS.
Full Text Available Abstract Transthoracic echocardiography is a primary non-invasive modality for investigation of heart transplant recipients. It is a versatile tool which provides comprehensive information about cardiac structure and function. Echocardiographic examinations can be easily performed at the bedside and serially repeated without any patient's discomfort. This review highlights the usefulness of Doppler echocardiography in the assessment of left ventricular and right ventricular systolic and diastolic function, of left ventricular mass, valvular heart disease, pulmonary arterial hypertension and pericardial effusion in heart transplant recipients. The main experiences performed by either standard Doppler echocardiography and new high-tech ultrasound technologies are summarised, pointing out advantages and limitations of the described techniques in diagnosing acute allograft rejection and cardiac graft vasculopathy. Despite the sustained efforts of echocardiographic technique in predicting the biopsy state, endocardial myocardial biopsies are still regarded as the gold standard for detection of acute allograft rejection. Conversely, stress echocardiography is able to identify accurately cardiac graft vasculopathy and has a recognised prognostic in this clinical setting. A normal stress-echo justifies postponement of invasive studies. Another use of transthoracic echocardiography is the monitorisation and the visualisation of the catheter during the performance of endomyocardial biopsy. Bedside stress echocardiography is even useful to select appropriately heart donors with brain death. The ultrasound monitoring is simple and effective for monitoring a safe performance of biopsy procedures.
Ryman, Tove K; Trakroo, Ajay; Ekka, J B; Watkins, Margaret
Recommended childhood vaccines have typically been provided through routine immunization programs. Recently, implementation of strategies that use campaign-like features for providing all the recommended childhood immunizations have been utilized to increase vaccination coverage. Between January 2006 and January 2008, Assam, India, conducted Immunization Weeks (IWs), a periodic campaign-like approach for providing the recommended childhood vaccines generally administered through the routine Universal Immunization Program (UIP). Using data from a household vaccination coverage survey conducted in 5 districts of Assam in late-2007/early-2008 among children 12-28 months of age, a secondary analysis was conducted for a subset of children with vaccination cards to assess the impacts of implementing the IW-strategy. Sixty-five percent of the 3310 surveyed children received at least one vaccine dose through an IW. Without IWs, coverage would likely have been lower for all vaccines (e.g., 75% measles vaccine coverage including IWs doses and an estimated 61% without IWs). The proportion of children receiving at least one IW dose was significantly different depending on the child's residence; 72% in hard-to-reach char areas, 66% in rural areas and 53% in urban areas (p=0.01). Overall, 2085 (63%) of children were fully vaccinated; of these 60% received a combination of IW and UIP doses, 35% received doses only through the UIP, and 5% received doses only through IWs. A delay in administration later than the recommended ages was found for both UIP doses and for IW doses (e.g., for measles vaccine, UIP doses were 6.9 weeks delayed and IW doses 13.6 weeks delayed). Among this sample of vaccinated children, IWs appeared to increase vaccination coverage and improve access to services in hard-to-reach areas. However, the UIP appeared to be a better system for ensuring that children received all doses in the recommended vaccination series.
The \\'accuracy\\' of age, blood pressure, clinical features, duration and diabetes (ABCD(2)) scoring by non-stroke specialists referring patients to a daily Rapid Access Stroke Prevention (RASP) service is unclear, as is the accuracy of ABCD(2) scoring by trainee residents. In this prospective study, referrals were classified as \\'confirmed TIAs\\' if the stroke specialist confirmed a clinical diagnosis of possible, probable or definite TIA, and \\'non-TIAs\\' if patients had a TIA mimic or completed stroke. ABCD(2) scores from referring physicians were compared with scores by experienced stroke specialists and neurology\\/geriatric medicine residents at a daily RASP clinic; inter-observer agreement was examined. Data from 101 referrals were analysed (mean age=60.0years, 58% male). The median interval between referral and clinic assessment was 1day. Of 101 referrals, 52 (52%) were \\'non-TIAs\\': 45 (86%) of 52 were \\'TIA mimics\\' and 7 (14%) of 52 were completed strokes. There was only \\'fair\\' agreement in total ABCD(2) scoring between referring physicians and stroke specialists (κ=0.37). Agreement was \\'excellent\\' between residents and stroke specialists (κ=0.91). Twenty of 29 patients scored as \\'moderate to high risk\\' (score 4-6) by stroke specialists were scored \\'low risk\\' (score 0-3) by referring physicians. ABCD(2) scoring by referring doctors is frequently inaccurate, with a tendency to underestimate stroke risk. These findings emphasise the importance of urgent specialist assessment of suspected TIA patients, and that ABCD(2) scores by non-stroke specialists cannot be relied upon in isolation to risk-stratify patients. Inter-observer agreement in ABCD(2) scoring was \\'excellent\\' between residents and stroke specialists, indicating short-term training may improve accuracy.
Alvarado Lagunas, Elias
Full Text Available Objective. Analyze the distribution infrastructure potable water and health in the state of Nuevo Leon. Materials and methods. To this end, the territorial distribution of the company is analyzed using a geographic information system (GIS in order to demonstrate the existing territorial gap in the formulation of public policy in the hydraulic and health sectors. Results. We show that municipalities with greater social marginalization (no running water or access to health services tend to have the worst health outcomes. Conclusion. It is located in Nuevo Leon there is an unequal distribution of material and human resources in the drinking water and health, as there is a high concentration of these resources in the metropolitan area and the consequent neglect of the municipalities of the periphery. Objetivo. Analizar la distribución de la infraestructura de los sistemas de agua potable y de salud en el estado de Nuevo León. Materiales y métodos. Para tal fin, se analiza la distribución territorial de la entidad mediante un sistema de información geográfica (SIG con el objeto de demostrar la carencia territorial existente en la formulación de las políticas públicas en los sectores hidráulico y de la salud. Resultados. Se demuestra que los municipios con mayor marginación social (sin agua potable ni acceso a servicios de salud tienden a presentar los peores resultados sanitarios. Conclusión. Se encuentra que en Nuevo León existe una distribución desigual de los recursos materiales y humanos en los sistemas de agua potable y de salud, ya que existe una alta concentración de estos recursos en el área metropolitana y el consecuente descuido de los municipios de la periferia.
Recommendations for standards in transthoracic two-dimensional echocardiography in the dog and cat. Echocardiography Committee of the Specialty of Cardiology, American College of Veterinary Internal Medicine.
Thomas, W P; Gaber, C E; Jacobs, G J; Kaplan, P M; Lombard, C W; Moise, N S; Moses, B L
Recommendations are presented for standardized imaging planes and display conventions for two-dimensional echocardiography in the dog and cat. Three transducer locations ("windows") provide access to consistent imaging planes: the right parasternal location, the left caudal (apical) parasternal location, and the left cranial parasternal location. Recommendations for image display orientations are very similar to those for comparable human cardiac images, with the heart base or cranial aspect of the heart displayed to the examiner's right on the video display. From the right parasternal location, standard views include a long-axis four-chamber view and a long-axis left ventricular outflow view, and short-axis views at the levels of the left ventricular apex, papillary muscles, chordae tendineae, mitral valve, aortic valve, and pulmonary arteries. From the left caudal (apical) location, standard views include long-axis two-chamber and four-chamber views. From the left cranial parasternal location, standard views include a long-axis view of the left ventricular outflow tract and ascending aorta (with variations to image the right atrium and tricuspid valve, and the pulmonary valve and pulmonary artery), and a short-axis view of the aortic root encircled by the right heart. These images are presented by means of idealized line drawings. Adoption of these standards should facilitate consistent performance, recording, teaching, and communicating results of studies obtained by two-dimensional echocardiography.
Velicu Bogdan Calin
Full Text Available The advances in technology hold great potential for helping Romanian government respond to its challenges namely, better service delivery, better procurement, efficient working and better communication with citizens and businesses. While the European Commission develops the main strategies on eGovernment, every member state has the freedom to identify its own necessities and decide according to specific social, administrative and economic context. Designing, cost setting, choosing the best supply channels or communicating with involved actors, are all marketing instruments which, if used accordingly, can ensure modern and efficient public services. This paper presents an analysis of the degree of development of public services available at the www.e-guvernare.ro portal, the single point of access for specific Romanian electronic public services.
Altobelli, Emma; Vittorini, Pierpaolo; Leuter, Cinzia; Bianchini, Valeria; Angelone, Anna Maria; Aloisio, Federica; Cofini, Vincenza; Zazzara, Francesca; Di Orio, Ferdinando
Natural disasters, such as the earthquake that occurred in the province of L'Aquila in central Italy, in 2009, generally increase the demand for healthcare. A survey was conducted to assess perception of health status an d use of health services in a sample of L'Aquila's resident population, five years after the event, and in a comparison population consisting of a sample of the resident population of Avezzano, a town in the same region, not affected by the earthquake. No differences were found in perception of health status between the two populations. Both groups reported difficulties in accessing specialized healthcare and rehabilitation services.
Huey, Laura; Broll, Ryan; Hryniewicz, Danielle; Fthenos, Georgios
As "access brokers" to resources for their clients, homeless shelter workers are often in a position to aid victimized homeless women in securing medical and psychological services post-victimization. Given high rates of victimization within this population, we would expect that a routine part of a shelter's case management process would involve queries regarding victimization. Through in-depth qualitative interviews with 42 victimized homeless women in Chicago and Detroit, we sought to discover the extent to which such queries were pursued by staff at their current shelter. What we found is that women are seldom asked to provide a complete history that includes experiences of violent victimization and its effects. From these results, we make several recommendations aimed at improving homeless victims' access to services.
Birol, Fatih [International Energy Agency, Paris (France); Brew-Hammond, Abeeku (University of Science and Technology (Ghana
The UN Secretary General established the Sustainable Energy for All initiative in order to guide and support efforts to achieve universal access to modern energy, rapidly increase energy efficiency, and expand the use of renewable energies. Task forces were formed involving prominent energy leaders and experts from business, government, academia and civil society worldwide. The goal of the Task Forces is to inform the implementation of the initiative by identifying challenges and opportunities for achieving its objectives. This report contains the findings of Task Force One which is dedicated to the objective of achieving universal access to modern energy services by 2030. The report shows that universal energy access can be realized by 2030 with strong, focused actions set within a coordinated framework.
Full Text Available Abstract Background Increasing urbanization and population density, and persisting inequities in health outcomes across socioeconomic groupings have raised concerns internationally regarding the health of the urban poor. These concerns are also evident in Cambodia, which prompted the design of a study to identify and describe the main barriers to access to health services by the poor in the capital city, Phnom Penh. Sources and Methods Main sources of data were through a household survey, followed by in-depth qualitative interviews with mothers, local authorities and health centre workers in four very poor communities in Phnom Penh. Main findings Despite low incomes and education levels, the study communities have moderate levels of access to services for curative and preventive care. However, qualitative findings demonstrate that households contextualize poor health and health access in terms of their daily living conditions, particularly in relation to environmental conditions and social insecurity. The interactions of low education, poor living conditions and high food costs in the context of low and irregular incomes reinforce a pattern of “living from moment to moment” and results in a cycle of disadvantage and ill health in these communities. There were three main factors that put poor communities at a health disadvantage; these are the everyday living conditions of communities, social and economic inequality and the extent to which a society assesses and acts on inequities in their health care access. Conclusions In order to improve access to health and health services for the urban poor, expansion of public health functions and capacities will be required, including building partnerships between health providers, municipal authorities and civil society.
Osadchiy, Alexey Vladimirovich; Prince, Kamau; Tafur Monroy, Idelfonso
In this paper we present long-reach fiber access links supporting transmission of Worldwide Interoperability for Microwave Access (WiMAX) compliant signals. We present bi-directional full-duplex transmission of 256-state quadrature amplitude modulation (256-QAM) modulated WiMAX-compliant signals...
Shaefer, H Luke; Miller, Matthew
Nearly one-third of U.S. citizens lack access to basic preventive and primary oral health care services, which is primarily the result of the high costs of care and the uneven geographic distribution of dental providers. This article examines the case for and against one possible solution to address these barriers to oral health care: the introduction of a mid-level dental provider (MDP) position within the dental field.
M Khalili; Gh. Moradi; Rahimi, A.
Extended Abstract1- Introduction In addition to general diseases, texture and material oldness, complexity and density of the building, have exposed the inhabitants of the historical texture of cities like Yazd to dangers such as earthquake and fire. Thus, in this type of texture, the supplementary and health-medical land uses like emergency has special importance regarding the roles they play. Accessing the medical services especially the emergency requires special attention to the connecti...
Giansanti, Daniele; Morelli, Sandra
Digital tele-echocardiography (T-E) has the potentiality to allow relevant change in health care organization. The purpose of the paper is to analyze the scientific development around the digital T-E to explore the successful applications and individuate the limits which hamper the routine introduction in the National Health Care System (NHCS). A literature review was carried out by searching for studies from 1988 to 2008. The studies have been investigated according to four crucial issues: a) the employment of the digital T-E versus the traditional videotape registrations; b) the evolution of the telecommunication network and T-E; c) the quality assessment of the images after transmission; d) the economical legal and social impact of the T-E. The analysis showed a generalized increased diffusion of the digital T-E thanks to the wonderful development of the information technology. This diffusion was sometimes also accompanied by investigation studies on the diagnostic accuracy and on cost-benefit analysis with special care to the economical and social impact. The study examined some points which need to be improved to allow a better introduction of the T-E in the NHCS as a routine exam. Among these two were the most important. The first was the lacking of an easy and automatic methodology for the image quality assessment alternative to the currently used methods which are highly complex, expensive and needing a long time to be applied. The second was the lacking of a properly designed methodology for the health technology assessment in T-E, the latter, as it is well known is a very complex and heterogeneous system embedding parts from telematics, bioengineering, and medical physics.
Full Text Available Digital tele-echocardiography (T-E has the potentiality to allow relevant change in health care organization. The purpose of the paper is to analyze the scientific development around the digital T-E to explore the successful applications and individuate the limits which hamper the routine introduction in the National Health Care System (NHCS. A literature review was carried out by searching for studies from 1988 to 2008. The studies have been investigated according to four crucial issues: a the employment of the digital T-E versus the traditional videotape registrations; b the evolution of the telecommunication network and T-E; c the quality assessment of the images after transmission; d the economical legal and social impact of the T-E. The analysis showed a generalized increased diffusion of the digital T-E thanks to the wonderful development of the information technology. This diffusion was sometimes also accompanied by investigation studies on the diagnostic accuracy and on cost-benefit analysis with special care to the economical and social impact. The study examined some points which need to be improved to allow a better introduction of the T-E in the NHCS as a routine exam. Among these two were the most important. The first was the lacking of an easy and automatic methodology for the image quality assessment alternative to the currently used methods which are highly complex, expensive and needing a long time to be applied. The second was the lacking of a properly designed methodology for the health technology assessment in T-E, the latter, as it is well known is a very complex and heterogeneus system embedding parts from telematics, bioengineering, and medical physics.
Macor, Franco; Zottarel, Gabriella; Antonini-Canterin, Francesco; Mimo, Renata; Pavan, Daniela; Cervesato, Eugenio; Nicolosi, Gianluigi; Zanuttini, Domenico
The present study was designed: (1) to establish the effects of transesophageal echocardiography (TEE) on arterial oxygen saturation (SAO(2)%); (2) to verify the possible clinical consequences of this phenomenon; and (3) to study the possibility of predicting modifications of SAO(2)% by clinical or hemodynamic variables or by specific factors related to the TEE procedure. We prospectively studied 116 unselected patients, aged 61 +/- 12 years, who underwent diagnostic TEE for various clinical indications. Thirty-seven patients had mitral valve disease, 19 aortic valve disease, 14 combined mitroaortic disease, 8 congenital heart disease, and 38 other cardiovascular diseases. Eight patients were affected by chronic obstructive pulmonary disease. Ninety-seven patients were sedated by 4 +/- 2 mg of diazepam IV SAO(2)% (5-min average) (Ohmeda Biox 3700 pulse oxymeter finger probe), heart rate (HR), and blood pressure (BP) were considered during baseline transthoracic examination, after pharmacological sedation but before the introduction of the probe, and finally during TEE. Neither clinical complications nor major arrhythmias were observed. Baseline SAO(2)%, HR and BP were, respectively, 93.6 +/- 3.3%, 76 +/- 14 beats/min, and 129 +/- 20/75 +/- 10 mmHg. Pharmacological sedation did not modify SAO(2)%, HR, and BP (P > 0.1). During TEE a small but significant reduction in SAO(2)% by an average of 1.2 +/- 3.2% was observed (P 0.1 for both systolic and diastolic). The changes of SAO(2)% and HR were not interrelated and were not related to the duration of the procedure and to any of the clinical and hemodynamic variables taken into consideration. TEE can induce a small but significant drop in SAO(2)% and a small increase in HR even without any clinical relevance. No clinical or hemodynamic variable or specific factors related to the TEE procedure were related to these changes.
Full Text Available BACKGROUND : S tructural abnormalities of the heart and great vessels are fairly common congenital lab normalities with the incidenceof8 in 1000 live births. With the advent of real time scanners fetal cardia can atomy can be analyze d echocardiographically. The earlier diagnosis will make an impact on clinical management of fetus with congenital heart disease. It helps intimely triage and optimal management of specific congenital heart disease either structural , functional orarrhythmia . OBJECTIVES : This study was conducted to note the spectrum of congenital heart diseases detected on fetal echo in pregnant mothers referred with high risk for CHD sand to assess the outcome of prenatally detected congenital heart diseases. MATERIAL S AND METHODS : T he study is aprospective descriptive study conducted in a tertiary care pediatric hospital in Mumbai over period of one year . P regnant mothers were referred for fetal echo , where pregnancy was considered as high risk for CHDs due to maternal , fetalfactorsorabnormallevel 1 scan.Fetal echowas performed by a trained pediatric cardiologistat 18 to 20 week of gestation using HP sonos 2000 echocardiographicmachinewith3/3.5 Hz transducer. Cardiac lesionsandoutcome of pregnancy was noted by postnatal follow - up of patients. RESULTS : A total of 170 patients underwent fetal echo , 13 patients have not delivered and 48 were lost to follow - up. Fetal echo was normal in 130(76.4% and abnormalities were detected in 40(23.5%.Structural anomalies were seen in 24(14.1% , arrhythmia in 5(2.9% and functional abnormalities in 11(6.4%.On outcome analysis84 (77.1% arealive , IUD /terminationof pregnancyoccurred in 18(16.5% , neonatal death in 6 (5.5% , infant death in 1 (0.9%. CONCLUSIONS : All ranges of CHDs can be diagnosed by fetal echocardiography . O utcome of prenatally detected complex congenital heart disease is poor ; nonetheless earlier detection provides a n opportunity for early interventions and
贾红阳; 郭力; 李晓霞; 杨章远; 姜林; 陈晓青
对Web权限控制进行了研究分析和应用。首先分析了进行权限控制的必要性；介绍了进行权限控制的几种实现形式，包括利用Web Server本身权限管理工具，通过在ASP/PHP页面中嵌入权限认证代码，或是将二者结合；最后，基于Apache服务器开发了图形化的权限管理系统，并已将它应用在Internet石化信息服务系统中。该软件可以方便地完成增删改用户/组，为用户/组设定权限，限制某些IP对本系统的访问等功能；并可以方便地移植到其他类似系统中。%Web Access Control is analyzed and applied to information service system in this article. First, the need of Access Control is discussed. Second, a few of implementation methods are introduced . Web servers have access control functions by itself. In addition, we may insert some codes in ASP/PHP page to check access rights. CGI/ISAPI may use either or both of the above methods. As to Internet Petrochemical Information Service System, we design and complete a software to finish this job. It has a series of functions such as add, delete, edit users/groups' information, grant or revoke access to users/groups, allow or deny some IPs to access the information system, etc. It can also be applied to other similar information systems conveniently.
Niu Hongli; Tian Miaomiao; Ma Anning; Wang Chunping; Zhang Liang
Background Since 2009,health reform had launched in China and essential public health services were provided for all residents to ensure service equity and accessibility,and to achieve sustained population-wide health improvement.This study aimed to investigate the differences and determinants among populations with different characteristics access to essential public health services in China,especially hypertension people and children aged 0-6 years.Methods A cross-sectional study with socio-demographic data analysis was undertaken to estimate distribution characteristics of receiving essential public health services of hypertension patients and children.Regular follow-ups and effective blood pressure control reflected the effective management for hypertension patients,and for children,public services provided were vaccination on schedule and regular physical check-up.Logistic regression was used to determine the predictors for effective management.Results A total of 1 505 hypertension patients and 749 children were involved; 39.14％ of hypertension participants could control their blood pressure in the normal range,and the rate in urban areas (43.61％) was higher than that in rural (31.88％).And 34.68％ of them could receive more than 4 times follow-ups by the medical technician.Of 754 children,79.84％ could receive the periodic physical examination and 98.40％ had vaccinated regularly.Children living in rural areas were more likely to have regular check-ups (83.96％) and regular vaccination (nearly 99％).Overall,geographic location and education level were the determinants of people access to essential public health services.Conclusions Implementation of the health reform since 2009 has headed China's public health system in the right direction and promoted the improvement of public health system development.Our study highlights the growing needs for more public health services in China,and China's public health system needs to be greatly improved in
Morton, J. J.; Ferrini, V. L.
The Marine Geoscience Data System (MGDS, www.marine-geo.org) operates an interactive digital data repository and metadata catalog that provides access to a variety of marine geology and geophysical data from throughout the global oceans. Its Marine-Geo Digital Library includes common marine geophysical data types and supporting data and metadata, as well as complementary long-tail data. The Digital Library also includes community data collections and custom data portals for the GeoPRISMS, MARGINS and Ridge2000 programs, for active source reflection data (Academic Seismic Portal), and for marine data acquired by the US Antarctic Program (Antarctic and Southern Ocean Data Portal). Ensuring that these data are discoverable not only through our own interfaces but also through standards-compliant web services is critical for enabling investigators to find data of interest.Over the past two years, MGDS has developed several new RESTful web services that enable programmatic access to metadata and data holdings. These web services are compliant with the EarthCube GeoWS Building Blocks specifications and are currently used to drive our own user interfaces. New web applications have also been deployed to provide a more intuitive user experience for searching, accessing and browsing metadata and data. Our new map-based search interface combines components of the Google Maps API with our web services for dynamic searching and exploration of geospatially constrained data sets. Direct introspection of nearly all data formats for hundreds of thousands of data files curated in the Marine-Geo Digital Library has allowed for precise geographic bounds, which allow geographic searches to an extent not previously possible. All MGDS map interfaces utilize the web services of the Global Multi-Resolution Topography (GMRT) synthesis for displaying global basemap imagery and for dynamically provide depth values at the cursor location.
Sohns, Jan M; Kowallick, Johannes T; Joseph, Arun A; Merboldt, K Dietmar; Voit, Dirk; Fasshauer, Martin; Staab, Wieland; Frahm, Jens; Lotz, Joachim; Unterberg-Buchwald, Christina
This prospective study of eight healthy volunteers evaluates peak flow velocities (PFV) in the ascending aorta using real-time phase-contrast magnetic resonance imaging (MRI) in comparison to cine phase-contrast MRI and echocardiography. Flow measurements by echocardiography and cine phase-contrast MRI with breath-holding were performed according to clinical standards. Real-time phase-contrast MRI at 40 ms temporal resolution and 1.3 mm in-plane resolution was based on highly undersampled radial fast low-angle shot (FLASH) sequences with image reconstruction by regularized nonlinear inversion (NLINV). Evaluations focused on the determination of PFV. Linear regressions and Bland-Altman plots were used for comparisons of methods. When averaged across subjects, real-time phase-contrast MRI resulted in PFV of 120±20 cm s(-1) (mean ± SD) in comparison to 122±16 cm s(-1) for cine MRI and 124±20 cm s(-1) for echocardiography. The maximum deviations between real-time phase-contrast MRI and echocardiography ranged from -20 to +14 cm s(-1) (cine MRI: -10 to +12 cm s(-1)). Thus, in general, real-time phase-contrast MRI of cardiac outflow revealed quantitative agreement with cine MRI and echocardiography. The advantages of real-time MRI are measurements during free breathing and access to individual cardiac cycles.
Ruschhaupt, D G; Sodt, P C; Hutcheon, N A; Arcilla, R A
The M-mode and two-dimensional echocardiograms of 40 young patients were analyzed to compare the mean circumferential fiber shortening velocity (Vcf) of the left ventricle calculated separately by two methods. The mean circumferential fiber shortening velocity was derived from the M-mode echocardiogram as minor axis shortening/ejection time and derived from the two-dimensional echocardiogram as actual circumference change/ejection time. With computer assistance, circumference was determined from the short-axis two-dimensional echocardiographic images during end-diastole and end-systole. Good correlations were obtained between the left ventricular diameter derived by M-mode echocardiography and the vertical axis during end-diastole (r = 0.79) and end-systole (r = 0.88) derived by two-dimensional echocardiography. Likewise, high correlations were noted between diameter and circumference in end-diastole (r = 0.89) and end-systole (r = 0.88). However, comparison of Vcf obtained by M-mode echocardiography with that obtained by two-dimensional echocardiography showed only fair correlation (r = 0.68). Moreover, the diameter/circumference ratio determined in end-diastole and end-systole differed significantly (p less than 0.001), possibly owing to the change in geometry of the ventricular sector image during systole. Although Vcf derived by M-mode echocardiography is a useful index of left ventricular performance, it does not truly reflect the circumference change during systole.
DAI Hai-long; GUANG Xue-feng; XIAO Zhi-cheng; ZHANG Ming
Objective To review the updated research progress about the application of echocardiography in resynchronization treatment of chronic heart failure patients.Data sources The data used in this review were from PubMed,published in English and using the key terms "heart failure","echocardiography" and "cardiac resynchronization therapy".Study selection Relevant articles were reviewed and selected to address the stated purpose.Results Increasing numbers of studies have suggested the importance of echocardiography in resynchronization treatment of chronic heart failure patients.Echocardiography can evaluate atrioventricular,inter- and intra-ventricular mechanical dyssynchrony before cardiac resynchronization therapy (CRT),as a guidance to assess the optimal left ventricular (LV) pacing location,optimize the atrioventricular and interventricular delays and predict response to CRT.Conclusions Echocardiography is both non invasive and easily repeatable,and plays a crucial role in appraisal of heart synchronism,instruction of actuator placement,optimization of the device procedure,and prediction of the response to CRT.Chin Med J 2012; 125(19):3548-3555
Sorantin, Erich, E-mail: firstname.lastname@example.org [Division of Pediatric Radiology, Department of Radiology, Medical University Graz, Auenbruggerplatz 34, A-8036 Graz (Austria); Heinzl, Bernd [Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Medical University Graz, Auenbruggerplatz 34, A-8036 Graz (Austria)
Congenital heart defects (CHD) occur in less than one percent of all newborns. Echocardiography represents the imaging modality of choice for morphological and functional assessment. In childhood the different CHD types can be diagnosed trustfully and can be performed bedside. In the follow-up of CHD cross sectional imaging plays an important role and therefore it is essential for the radiologist to know the features, challenges and limitations of echocardiography. Within this review article a systematic approach for morphological and functional assessment of the heart will is given along with representative example images. In addition, typical echocardiographic findings in common CHD is presented. In older children, adolescents and grown-ups with CHD (GUCH) echocardiography suffers from limitations – partially due to skeletal deformations and lung emphysema. In particular right ventricular function assessment is not always possible by echocardiography. Therefore strengths and limitations of echocardiography will be discussed the role of cardiac magnetic resonance imaging (cMRI) and cardiac computed tomography (cCT) emphasized.
Stakisaitis, Donatas; Spokiene, Indre; Juskevicius, Jonas; Valuckas, Konstantinas Povilas; Baiardi, Paola
Currently in Europe, approximately 30 million people suffer from rare diseases, and a major problem is that many patients do not have access to quality healthcare for their disorders. Moreover, there is also a lack of quality information and a networking system aimed at supporting interaction among patients, clinicians, researchers, pharmaceutical industries, and governmental bodies. The purpose of this article is to inform physicians, public health care professionals, and other health care providers about EuOrphan service, the aim of which is to ensure easier access to quality information on rare diseases and their treatment. A set of web-based services is available at www.euorphan.com where information for target-users on treatments and products available worldwide for rare disease care as well as indications about healthcare centers are provided. Moreover, the service aims at providing consultancies for pharmaceutical companies to ultimately support the European legislation in bringing new drugs of a high ethical standard to the market and to exert a positive impact on the large population of patients suffering from rare diseases in Europe. The services provided by EuOrphan can facilitate concrete networking among patients, patient associations, doctors, and companies and also support the organization of clinical trials. In this perspective, EuOrphan could become a very valuable tool for globalizing the information about the availability of treatment (authorized or under development) of orphan patients.
Le Sage, Margie Rodríguez
Despite the mandated and moral imperative to advance linguistic competence in all health care contexts, leadership that addresses this area of practice and study in end-of-life and palliative care is not readily obvious. Because social work is ideally suited to lead efforts to advance linguistically-accessible end-of-life and palliative care, social workers are encouraged to assume the challenge. This article focuses on topics that are elementary yet central to discussions on language diversity and leadership initiatives to advance language access in end-of-life and palliative care contexts: importance and function of language, extent of language diversity, inequity related to language diversity, mandates and standards related to language access, and approaches and competencies that contribute positively to language access.
... this proceeding reflects the ongoing problems that consumers have in finding and controlling these... accessible devices or accessibility solutions in marketing efforts, through their customer service centers... accessible devices or accessibility solutions in marketing efforts, through their customer service...
Full Text Available BACKGROUND: In Bangladesh DOTS has been provided free of charge since 1993, yet information on access to TB services by different population group is not well documented. The objective of this study was to assess and compare the socio economic position (SEP of actively detected cases from the community and the cases being routinely detected under National Tuberculosis Control Programme (NTP in Bangladesh. METHODS AND FINDINGS: SEP was assessed by validated asset item for each of the 21,427 households included in the national tuberculosis prevalence survey 2007-2009. A principal component analysis generated household scores and categorized in quartiles. The distribution of 33 actively identified cases was compared with the 240 NTP cases over the identical SEP quartiles to evaluate access to TB services by different groups of the population. The population prevalence of tuberculosis was 5 times higher in the lowest quartiles of population (95.4, 95% CI: 48.0-189.7 to highest quartile population (19.5, 95% CI: 6.9-55.0. Among the 33 cases detected during survey, 25 (75.8% were from lower two quartiles, and the rest 8 (24.3% were from upper two quartiles. Among TB cases detected passively under NTP, more than half of them 137 (57.1% were from uppermost two quartiles, 98 (41% from the second quartile, and 5 (2% in the lowest quartile of the population. This distribution is not affected when adjusted for other factors or interactions among them. CONCLUSIONS: The findings indicate that despite availability free of charge, DOTS is not equally accessed by the poorer sections of the population. However, these figures should be interpreted with caution since there is a need for additional studies that assess in-depth poverty indicators and its determinants in relation to access of the TB services provided in Bangladesh.
Alexe Dan Iulian
Full Text Available Discriminating the type of ratio between a basic kinesis-therapeutic service available to the population and its corresponding costs in different EU areas. Performing a comparative analysis of the costs for different types of massage for the European market for the relaxation-recovery services can offer new data and reference points to future specialists in these areas when they plan and design their access on such a competitive market. Knowledge of the massage services, of the national economic characteristic, of the principles governing the recovery-rehabilitation –relaxation activities in every EU country can reveal real and positive evidences for the professional career orientation, but also regarding the massage service appreciation within such a large market, as the European Union’s. For the same type of basic kinesis-therapeutic service available to the population (massage, establishing extreme limits for the corresponding costs can represent a challenge difficult to accomplish at the level of EU areas, and this aspect shows, in our opinion, a lack of financial stability and “standardization” of the services for which a kinesiotherapist is trained and specialized.
"If You Tell People That You Had Sex with a Fellow Man, It Is Hard to Be Helped and Treated": Barriers and Opportunities for Increasing Access to HIV Services among Men Who Have Sex with Men in Uganda.
Rhoda K Wanyenze
Full Text Available Despite the high HIV prevalence among men who have sex with men (MSM in sub-Saharan Africa, little is known about their access to HIV services. This study assessed barriers and opportunities for expanding access to HIV services among MSM in Uganda.In October-December 2013, a cross-sectional qualitative study was conducted in 12 districts of Uganda. Semi-structured in-depth interviews were conducted with 85 self-identified MSM by snowball sampling and 61 key informants including HIV service providers and policy makers. Data were analysed using manifest content analysis and Atlas.ti software.Three quarters of the MSM (n = 62, 72.9% were not comfortable disclosing their sexual orientation to providers and 69 (81.1% felt providers did not respect MSM. Half (n = 44, 51.8% experienced difficulties in accessing health services. Nine major barriers to access were identified, including: (i unwelcoming provider behaviours; (ii limited provider skills and knowledge; (iii negative community perceptions towards MSM; (iv fear of being exposed as MSM; (v limited access to MSM-specific services; (vi high mobility of MSM, (vii lack of guidelines on MSM health services; viii a harsh legal environment; and ix HIV related stigma. Two-thirds (n = 56, 66% participated in MSM social networks and 86% of these (48 received support from the networks to overcome barriers to accessing services.Negative perceptions among providers and the community present barriers to service access among MSM. Guidelines, provider skills building and use of social networks for mobilization and service delivery could expand access to HIV services among MSM in Uganda.
myocardial velocities, but no changes in SR, strain or isovolumic acceleration could be observed [II and III]. Tissue Doppler echocardiography of the RV free wall in non-massive pulmonary embolism quantifies degree of RV dysfunction, and supports the existence of the McConnell sign of mid-ventricular RV...... structure including significant dilatation, but is well tolerated with only mild reduction in measures of global RV systolic function as estimated by 2D echocardiography in an experimental animal model. Regional RV myocardial function is also only mildly reduced. Also no differences in global or regional RV......This thesis summarizes a series of studies performed in order to assess the clinical usefulness of a novel echocardiographic technology that allows non-invasive assessment of regional right ventricular myocardial velocities and deformation: tissue Doppler echocardiography. While the technology...
Full Text Available Progress in the fields of fetal cardiology and fetal surgery have been seen not only in singleton pregnancies but also in multiple pregnancies. Proper interpretation of prenatal echocardiography is critical to clinical decision making, family counseling and perinatal management for obstetricians, maternal fetal medicine specialists, neonatologists and pediatric cardiologists. Fetal echocardiography is one of the most challenging and time-consuming prenatal examinations to perform, especially in multiple gestations. Performing just the basic fetal exam in twin gestations may take an hour or more. Thus, it is not practical to perform this exam in all cases of multiple gestations. Therefore our review and recommendations are related to fetal echocardiography in twin gestation.
Conghai, Fan; Fengchao, Zhang; Chengjing, Shan; Cheng, Wen; Yunji, Wang; Xiaobo, Li
Sevoflurane is shown to be safe and effective in pediatric echocardiography. This study explores the optimum level in pediatric echocardiography. One hundred and twenty children, with an age range of 35 days-3 years, were included in this study. The children with severe cyanotic congenital heart disease or severe pneumonia, which was Grade I or II according to the American College of Physicians Guideline Grading, were excluded. All children received the anesthesia with sevoflurane. The inhalation anesthesia level decreased from 2.5 to 1.0 %, with a decrement of 0.5 %. The induction time (T0), echocardiography time (T1), and time to awakening (T2) in each child were recorded, and the changes in the blood pressure, heart rate, breath, and oxygen saturation in each child were also monitored. The Ramsay scale scoring during anesthesia and the case number of failure in echocardiography in each group were also recorded. When the level of sevoflurane inhalation was maintained at 1.0 %, the childrens' scores were low, including 8 incompliant children, and p sevoflurane inhalation level increased. When the sevoflurane inhalation increased to 1.5 %, the children could sleep with stable blood pressure, and no dysphoria occurred during the echocardiography. When the sevoflurane inhalation level increased to 2.5 %, the Ramsay scores did not increase. However, the T2 significantly increased (p blood pressure and heart rate in each group did not change significantly. With the premise of safety and efficacy in children, the optimum level of sevoflurane in pediatric echocardiography was 1.5-2.0 %.
Full Text Available Background: Smokers are four times more likely to stop smoking with the help of an NHS Stop Smoking Service (SSS. However attendance is in decline, possibly due to the increase in popularity of e-cigarettes. SSS’s will support smokers who choose to use e-cigarettes as part of a quit attempt, therefore interventions are needed to encourage continued access and uptake of SSS. Aim: To design an evidence based intervention (Stop-app to increase referrals, 4 week quit rates and reduce ‘did not attend’ (DNA rates within SSS. Methods/Results: In Phase 1 we collected data to explore the barriers and facilitators to people using SSS. Smokers and ex-smokers identified a number of barriers, including a lack of knowledge about what happens at the service; the belief that there would be ’scare tactics’, ‘nagging’, that the service would be unfriendly and clinical; and a lack of perceived efficacy of the service. In Phase 2, data from extant literature and phase 1 were subject to behavioural analysis as outlined by the Behaviour Change Wheel framework. A range of factors were identified as needing to change. These aligned with capability (e.g. a lack of knowledge about the benefits of SSS, opportunity (e.g. beliefs that SSS are not easy to access and to motivation to act (e.g. beliefs that they did not need and would not benefit from SSS. We describe the content development process, illustrating the choice of 19 ‘Behaviour Change Techniques’ included in our digital intervention. In Phase 3 we assessed the acceptability of the proposed intervention by interviewing stop smoking service advisors and non-NHS provider sites (e.g. library services and children’s centres. Findings from interviews are presented and have been used to consider the best path for implementation of the web-app within service provision. Conclusion: The ‘Stop –app’ is in development and will be accessible online, linking with the SSS booking system used by Public
Krishnan, Sundar; Schmidt, Gregory A
In critically ill patients, the right ventricle is susceptible to dysfunction due to increased afterload, decreased contractility, or alterations in preload. With the increased use of point-of-care ultrasonography and a decline in the use of pulmonary artery catheters, echocardiography can be the ideal tool for evaluation and to guide hemodynamic and respiratory therapy. We review the epidemiology of right ventricular failure in critically ill patients; echocardiographic parameters for evaluating the right ventricle; and the impact of mechanical ventilation, fluid therapy, and vasoactive infusions on the right ventricle. Finally, we summarize the principles of management in the context of right ventricular dysfunction and provide recommendations for echocardiography-guided management.
Naji, Peyman; Patel, Krishna; Griffin, Brian P; Desai, Milind Y
Stress echocardiography is increasingly used in the management of patients with valvular heart disease and can aid in evaluation, risk stratification and clinical decision making in these patients. Evaluation of symptoms, exercise capacity and changes in blood pressure can be done during the exercise portion of the test, whereas echocardiographic portion can reveal changes in severity of disease, pulmonary artery pressure and left ventricular function in response to exercise. These parameters, which are not available at rest, can have diagnostic and prognostic importance. In this article, we will review the indications and diagnostic implications, prognostic implications, and clinical impact of stress echocardiography in decision making and management of patients with valvular heart disease.
李怀明; 王慧佳; 符林
For the problem of current access control strategies difficultly guaranteeing the flexibility of authorization of complex E-government system for Web service,this paper proposes an organization-based access control model for Web services on the basis of the research of the organization-based 4 level access control model. The model takes organization as the core and studies the issue of access control and authorization management from the perspective of management. Through importing the position agent and authorization unit in the model,the authorization can be adjusted according to the change of the environment context information to implement the dynamic authorization,while taking advantage of the state migration of authorization units,provides support for workflow patterns. Furthermore,the model divides permissions into service permissions and service attribute permissions, and achieves fine-grained resource protection. Application examples show that the model can commendably fit the complex organization structure in E-government system. Moreover,it can make authorization more efficient and flexible meanwhile protecting the Web service resources.%针对现有访问控制策略难以保障面向Web服务的复杂电子政务系统授权的灵活性问题，在研究基于组织的四层访问控制模型(OB4LAC)的基础上，提出一种基于组织的Web服务访问控制模型。以组织为核心，从管理的视角研究访问控制与授权管理问题。通过引入岗位代理和授权单元，使授权随着环境上下文信息的变化而调整，从而实现动态授权，同时利用授权单元的状态迁移，对工作流模式提供支持。并且模型将权限分为服务权限和服务属性权限2级，实现细粒度的资源保护。应用实例结果表明，该模型能够契合电子政务系统中的复杂组织结构，在保护Web服务资源的同时，使得授权更加高效和灵活。
Full Text Available Abstract Background Despite massive scale up of funds from global health initiatives including the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund and other donors, the ambitious target agreed by G8 leaders in 2005 in Gleneagles to achieve universal access to HIV/AIDS treatment by 2010 has not been reached. Significant barriers to access remain in former Soviet Union (FSU countries, a region now recognised as a priority area by policymakers. There have been few empirical studies of access to HIV/AIDS services in FSU countries, resulting in limited understanding and implementation of accessible HIV/AIDS interventions. This paper explores the multiple access barriers to HIV/AIDS services experienced by a key risk group-injecting drug users (IDUs. Methods Semi-structured interviews were conducted in two FSU countries-Ukraine and Kyrgyzstan-with clients receiving Global Fund-supported services (Ukraine n = 118, Kyrgyzstan n = 84, service providers (Ukraine n = 138, Kyrgyzstan n = 58 and a purposive sample of national and subnational stakeholders (Ukraine n = 135, Kyrgyzstan n = 86. Systematic thematic analysis of these qualitative data was conducted by country teams, and a comparative synthesis of findings undertaken by the authors. Results Stigmatisation of HIV/AIDS and drug use was an important barrier to IDUs accessing HIV/AIDS services in both countries. Other connected barriers included: criminalisation of drug use; discriminatory practices among government service providers; limited knowledge of HIV/AIDS, services and entitlements; shortages of commodities and human resources; and organisational, economic and geographical barriers. Conclusions Approaches to thinking about universal access frequently assume increased availability of services means increased accessibility of services. Our study demonstrates that while there is greater availability of HIV/AIDS services in Ukraine and Kyrgyzstan, this does not equate with greater
Abstract Background Despite massive scale up of funds from global health initiatives including the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) and other donors, the ambitious target agreed by G8 leaders in 2005 in Gleneagles to achieve universal access to HIV\\/AIDS treatment by 2010 has not been reached. Significant barriers to access remain in former Soviet Union (FSU) countries, a region now recognised as a priority area by policymakers. There have been few empirical studies of access to HIV\\/AIDS services in FSU countries, resulting in limited understanding and implementation of accessible HIV\\/AIDS interventions. This paper explores the multiple access barriers to HIV\\/AIDS services experienced by a key risk group-injecting drug users (IDUs). Methods Semi-structured interviews were conducted in two FSU countries-Ukraine and Kyrgyzstan-with clients receiving Global Fund-supported services (Ukraine n = 118, Kyrgyzstan n = 84), service providers (Ukraine n = 138, Kyrgyzstan n = 58) and a purposive sample of national and subnational stakeholders (Ukraine n = 135, Kyrgyzstan n = 86). Systematic thematic analysis of these qualitative data was conducted by country teams, and a comparative synthesis of findings undertaken by the authors. Results Stigmatisation of HIV\\/AIDS and drug use was an important barrier to IDUs accessing HIV\\/AIDS services in both countries. Other connected barriers included: criminalisation of drug use; discriminatory practices among government service providers; limited knowledge of HIV\\/AIDS, services and entitlements; shortages of commodities and human resources; and organisational, economic and geographical barriers. Conclusions Approaches to thinking about universal access frequently assume increased availability of services means increased accessibility of services. Our study demonstrates that while there is greater availability of HIV\\/AIDS services in Ukraine and Kyrgyzstan, this does not equate with
Gerdts, Eva; Okin, Peter M; Boman, Kurt;
The value of performing echocardiography in hypertensive patients with electrocardiographic left ventricular hypertrophy (LVH) is uncertain.......The value of performing echocardiography in hypertensive patients with electrocardiographic left ventricular hypertrophy (LVH) is uncertain....
Full Text Available Aim: To analyze changes in access to health care and its determinants in the immigrant and native-born populations in Spain, before and during the economic crisis. Methods: Comparative analysis of two iterations of the Spanish National Health Survey (2006 and 2012. Outcome variables were: unmet need and use of different healthcare levels; explanatory variables: need, predisposing and enabling factors. Multivariate models were performed (1 to compare outcome variables in each group between years, (2 to compare outcome variables between both groups within each year, and (3 to determine the factors associated with health service use for each group and year. Results: unmet healthcare needs decreased in 2012 compared to 2006; the use of health services remained constant, with some changes worth highlighting, such as the decline in general practitioner visits among autochthons and a narrowed gap in specialist visits between the two populations. The factors associated with health service use in 2006 remained constant in 2012. Conclusion: Access to healthcare did not worsen, possibly due to the fact that, until 2012, the national health system may have cushioned the deterioration of social determinants as a consequence of the financial crisis. Further studies are necessary to evaluate the effects of health policy responses to the crisis after 2012.
Wenzel, Suzanne L; Rhoades, Harmony; Harris, Taylor; Winetrobe, Hailey; Rice, Eric; Henwood, Ben
Homeless persons suffer disproportionately high rates of HIV infection, and moving into permanent supportive housing (PSH) can provide a stable base from which to access needed prevention services. However, little is known about HIV risk or prevention behavior during this critical time of transition. The current study investigated STI and HIV risk and prevention behavior and recent use of prevention and treatment services (i.e., education, testing, medication) among homeless persons preparing to move into PSH. Data come from interviews with 421 homeless adults before they moved into PSH. Thirty-seven percent of the respondents were sexually active; of those, 75.7% reported unprotected sex. Nearly two-thirds (64%) reported past year HIV testing and 40% reported testing for another STI. Fewer than one-third (31%) of respondents reported receiving posttest counseling at their last HIV test. HIV seropositivity was self-reported by 10%. Among those persons who were HIV-positive, 57.1% reported less than 100% antiretroviral (ARV) adherence. Among HIV-negative respondents, less than 1% had been prescribed preexposure prophylaxis (PrEP). Less than half (46.4%) of the sample reported any HIV prevention education in the past year. This population of homeless adults about to move into PSH report high rates of HIV risk behavior, but low rates of HIV prevention education and very little PrEP utilization. Further, low rates of ARV adherence among HIV-positive respondents indicate significant risk for HIV transmission and acquisition. Entering PSH is a period of transition for homeless persons when integrated care is critically important to ensure positive health outcomes, but these data suggest that PrEP and other HIV prevention services are poorly accessed among this population. As such, multipronged services that integrate PrEP and other HIV prevention services are needed to prevent transmission and acquisition of HIV in this high-risk, vulnerable population and ensure the
Munyewende, Pascalia; Rispel, Laetitia C; Harris, Bronwyn; Chersich, Matthew
We present qualitative data from a 2005 exploratory study, recently published studies, and an analysis of the Department of Health's strategic plan to highlight the need for a broader policy debate on health-care access for migrants in South Africa. We conducted in-depth interviews with 15 Zimbabwean women living in inner-city Johannesburg to document the special characteristics of this group of migrants, enquiring about their perceptions of HIV risk, and experiences of health services in South Africa. We identified access barriers, namely perceptions of relatively low HIV risk, severely constrained financial circumstances, uncertain legal status, and experiences of unresponsive health workers. We recommend that migrant-health rights be placed on South Africa's policy agenda, migrants be included in HIV prevention programs and that health workers be sensitized to the needs of migrants.
Crawford, Natalie D.; Amesty, Silvia; Rivera, Alexis V.; Harripersaud, Katherine; Turner, Alezandria; Fuller, Crystal M.
Objectives: In an effort to reduce HIV transmission among injection drug users (IDUs), New York State deregulated pharmacy syringe sales in 2001 through the Expanded Syringe Access Program by removing the requirement of a prescription. With evidence suggesting pharmacists' ability to expand their public health role, a structural,…
Schooley, Benjamin L; Horan, Thomas A; Lee, Pamela W; West, Priscilla A
This multimethod pilot study examined patient and practitioner perspectives on the influence of spatial barriers to healthcare access and the role of health information technology in overcoming these barriers. The study included a survey administered to patients attending a Department of Veterans Affairs (VA) health visit, and a focus group with VA care providers. Descriptive results and focus group findings are presented. Spatial distance is a significant factor for many rural veterans when seeking healthcare. For this sample of rural veterans, a range of telephone, computer, and Internet technologies may become more important for accessing care as Internet access becomes more ubiquitous and as younger veterans begin using the VA health system. The focus group highlighted the negative impact of distance, economic considerations, geographic barriers, and specific medical conditions on access to care. Lack of adequate technology infrastructure was seen as an obstacle to utilization. This study discusses the need to consider distance, travel modes, age, and information technology infrastructure and adoption when designing health information technology to care for rural patients.
Crawford, Natalie D.; Amesty, Silvia; Rivera, Alexis V.; Harripersaud, Katherine; Turner, Alezandria; Fuller, Crystal M.
Objectives: In an effort to reduce HIV transmission among injection drug users (IDUs), New York State deregulated pharmacy syringe sales in 2001 through the Expanded Syringe Access Program by removing the requirement of a prescription. With evidence suggesting pharmacists' ability to expand their public health role, a structural, pharmacy-based…
Full Text Available The aim of this study was to quantify the error associated with different accessibility methods commonly used by public health researchers. Network distances were calculated from each household to the nearest GP our study area in the UK. Household level network distances were assigned as the gold standard and compared to alternate widely used accessibility methods. Four spatial aggregation units, two centroid types and two distance calculation methods represent commonly used accessibility calculation methods. Spearman's rank coefficients were calculated to show the extent which distance measurements were correlated with the gold standard. We assessed the proportion of households that were incorrectly assigned to GP for each method. The distance method, level of spatial aggregation and centroid type were compared between urban and rural regions. Urban distances were less varied from the gold standard, with smaller errors, compared to rural regions. For urban regions, Euclidean distances are significantly related to network distances. Network distances assigned a larger proportion of households to the correct GP compared to Euclidean distances, for both urban and rural morphologies. Our results, stratified by urban and rural populations, explain why contradicting results have been reported in the literature. The results we present are intended to be used aide-memoire by public health researchers using geographical aggregated data in accessibility research.
Heloisa Amaral Gaspar
Full Text Available Echocardiography is a key tool for hemodynamic assessment in Intensive Care Units (ICU. Focused echocardiography performed by nonspecialist physicians has a limited scope, and the most relevant parameters assessed by focused echocardiography in Pediatric ICU are left ventricular systolic function, fluid responsiveness, cardiac tamponade and pulmonary hypertension. Proper ability building of pediatric emergency care physicians and intensivists to perform focused echocardiography is feasible and provides improved care of severely ill children and thus should be encouraged.
National Aeronautics and Space Administration — TerraMetrics, Inc., proposes an SBIR Phase I R/R&D program to investigate and develop a key web services architecture that provides data processing, storage and...
Full Text Available A review of the history and evolution of the Centre for Continuing Education and Extension Services and the various programmes it has developed to support the work of the College of The Bahamas.
Morton, Cory M.
This study investigates how the relationship between dense concentrations of alcohol retailers and high rates of child maltreatment may be moderated by the presence of substance abuse service facilities. Using a cross-sectional design, the study utilized data from Bergen County, New Jersey on child maltreatment reports, alcohol-selling retailers, substance abuse service facilities, and the United States Census. Findings indicate child maltreatment rates were higher in neighborhoods with lower...
Full Text Available Sharon Brownie,1,2 Andrew P Hills,3,4 Rachel Rossiter51Workforce and Health Services, Griffith Health, Griffith University, Gold Coast, QLD, Australia; 2Oxford PRAXIS Forum, Green Templeton College, Oxford University, Oxford, United Kingdom; 3Allied Health Research, Mater Research Institute – The University of Queensland and Mater Mothers' Hospital, South Brisbane, QLD, Australia; 4Griffith Health Institute, Griffith Health, Griffith University, Gold Coast, QLD, Australia; 5MMHN and Nurse Practitioner Programs, School of Nursing and Midwifery, University of Newcastle, Callaghan, NSW, AustraliaAbstract: Globally, nations are confronted with the challenge of providing affordable health services to populations with increasing levels of noncommunicable and chronic disease. Paradoxically, many nations can both celebrate increases in life expectancy and bemoan parallel increases in chronic disease prevalence. Simply put, despite living longer, not all of that time is spent in good health. Combined with factors such as rising levels of obesity and related noncommunicable disease, the demand for health services is requiring nations to consider new models of affordable health care. Given the level of disease burden, all staff, not just doctors, need to be part of the solution and encouraged to innovate and deliver better and more affordable health care, particularly preventative primary health care services. This paper draws attention to a range of exemplars to encourage and stimulate readers to think beyond traditional models of primary health service delivery. Examples include nurse-led, allied health-led, and student-led clinics; student-assisted services; and community empowerment models. These are reported for the interest of policy makers and health service managers involved in preventative and primary health service redesign initiatives.Keywords: primary health care planning, community health care, nurse-led clinics, allied health personnel
Czapka, Elżbieta Anna; Sagbakken, Mette
Background Poles constitute the largest group of migrants in Norway. Research confirms a steady inflow and a minimal outflow of Polish migrants. One of the key aspects of migrants’ structural integration is access to health care services. This study explored barriers to and facilitators of Polish migrants’ access to Norwegian health care services. Methods A qualitative interview-based study was carried out between November 2013 and July 2014. The study is part of a larger, ongoing mixed-metho...
Pinals, Debra A; Appelbaum, Paul S; Bonnie, Richard; Fisher, Carl E; Gold, Liza H; Lee, Li-Wen
The American Psychiatric Association, ("APA"), with more than 36,000 members at present, is the Nation's leading organization of physicians who specialize in psychiatry. APA provides for education and advocacy and develops policy through Position Statements. It promotes enhanced knowledge of particular topics relevant to psychiatric practice and patient care through Resource Documents. Since 1993, the APA has developed various positions and resource materials related to firearms and mental illness, incorporating evolving themes as new issues emerge. This paper reflects the APA's 2014 Position Statement on Firearm Access, Acts of Violence and the Relationship to Mental Illness and Mental Health Services.
Cosyns, Bernard; Garbi, Madalina; Separovic, Jadranka; Pasquet, Agnes; Lancellotti, Patrizio
The update of the Echocardiography Core Syllabus of European Association of Cardiovascular Imaging (EACVI) is now available online. The Echocardiography Core Syllabus enumerates the elements of knowledge to be taught, represents a framework for the development of local training curricula and provides expected learning outcomes to the echocardiography learner.
Allan, Diane E.; Funk, Laura M.; Reid, R. Colin; Cloutier-Fisher, Denise
Existing research on the health care utilization patterns of older Canadians suggests that income does not usually restrict an individual's access to care. However, the role that income plays in influencing access to health services by older adults living in rural areas is relatively unknown. This article examines the relationship between income…
Neskovic Aleksandar N
Full Text Available Abstract A number of studies have suggested that stress-echocardiography may be used for prognostic stratification in patients with idiopathic dilated cardiomyopathy. There is no consensus on which protocol or which measurements of left ventricular contractile reserve to use. The most frequently used protocol is low-dose dobutamine stress-echocardiography, and most commonly used measures of left ventricular systolic performance are ejection fraction, wall motion score index and cardiac power output. Stress-echocardiography has been shown to predict improvement in cardiac function in patients with recently diagnosed dilated cardiomyopathy, as well as to predict which patients will benefit from the treatment with beta-blockers. Most importantly, stress-echocardiography can identify patients with worse prognosis in terms of cardiac death and need for transplantation. Additionally, contractile reserve is closely correlated with maximal oxygen consumption and can even be used for further stratification in patients with maximal oxygen consumption between 10 and 14 ml/kg/min. Future studies are needed for head-to-head comparison of various protocols in an attempt to make standardization in the assessment of patients with dilated cardiomyopathy.
Sharma, Vishal; Newby, David E; Stewart, Ralph A H; Lee, Mildred; Gabriel, Ruvin; Van Pelt, Niels; Kerr, Andrew J
Stress echocardiography is recommended for the assessment of asymptomatic patients with severe valvular heart disease (VHD) when there is discrepancy between symptoms and resting markers of severity. The aim of this study is to determine the prognostic value of exercise stress echocardiography in patients with common valve lesions. One hundred and fifteen patients with VHD (aortic stenosis (n=28); aortic regurgitation (n=35); mitral regurgitation, (n=26); mitral stenosis (n=26)), and age- and sex-matched controls (n=39) with normal ejection fraction underwent exercise stress echocardiography. The primary endpoint was a composite of death or hospitalization for heart failure. Asymptomatic VHD patients had lower exercise capacity than controls and 37% of patients achieved 60 mmHg) was associated with an increased risk of death or hospital admission (14% vs 1%, P<0.0001). The assessment of contractile reserve did not offer additional predictive value. In conclusion, an abnormal stress echocardiogram is associated with death and hospitalization with heart failure at 2 years. Stress echocardiography should be considered as part of the routine follow-up of all asymptomatic patients with VHD.
Ying WU; Feng TAO; Tao LIU; Ling ZANG; Shi-long LIU
Objectives To explore the method and operating skill of fetal echocardiography in diagnosing cardiac malposition. Methods 91 consecutive fetuses were studied (control: 50 cases, cardiac malposition : 41 cases) between 2003 and 2008. The position of fetal heart was evaluated according to the fetal posture and the visceral situs by fetal routine scan-ning. The detailed echocardiography should be performed in the differential diagnosis of cardiac lesions when the heart was found to be abnormal position. Results In the control group, all fetuses were levocardia. 39 cases of cardiac mal-positions were detected by fetal echocardiography, included 25 fetuses with dextrocardia, 6 mesocard, 5 with levover-sion of heart, 3 common heart of conjoined twins and 2 extrathorax heart. Two of dextroversion were missed by fetal routine scanning, but found by autopsy or operation after birth. Conclusions When the abnormal visceral situs was found by fetal routine scanning, there is exceedingly high incidence of cardiac malpositions. Proficiently operating skill of fetal echocardiography is helpful to detect abnormal fetal cardiac position.
Full Text Available Abstract Objective The aim of this study was to evaluate the diagnostic potential of low-dose adenosine stress echocardiography in detection of myocardial viability. Background Vasodilation through low dose dipyridamole infusion may recruit contractile reserve by increasing coronary flow or by increasing levels of endogenous adenosine. Methods Forty-three patients with resting dyssynergy, due to previous myocardial infarction, underwent low-dose adenosine (80, 100, 110 mcg/kg/min in 3 minutes intervals echocardiography test. Gold standard for myocardial viability was improvement in systolic thickening of dyssinergic segments of ≥ 1 grade at follow-up. Coronary angiography was done in 41 pts. Twenty-seven patients were revascularized and 16 were medically treated. Echocardiographic follow up data (12 ± 2 months were available in 24 revascularized patients. Results Wall motion score index improved from rest 1.55 ± 0.30 to 1.33 ± 0.26 at low-dose adenosine (p Conclusion Low-dose adenosine stress echocardiography test has high diagnostic potential for detection of myocardial viability in the group of patients with left ventricle dysfunction due to previous myocardial infarction. Low dose adenosine stress echocardiography may be adequate alternative to low-dose dobutamine test for evaluation of myocardial viability.
Full Text Available Abstract Background Prompt, correct diagnosis and treatment with health information are essential components of reproductive tract infection (RTI and sexually transmitted infection (STI services. This study aims to describe care seeking behaviour and barriers to accessing RTI/STI services among female sex workers (FSWs in Laos. Methods A cross-sectional survey using closed and open-ended questions was performed in six districts along Road 9, traversing Savannakhet province from Thailand to Vietnam. In total, 407 FSWs were interviewed. The data were analyzed and presented descriptively. Multiple logistic regression analysis was applied to assess associations between respondents' background characteristics and care seeking behaviour. Results About half of the respondents (49% were less than or equal to 19 years of age, and 50% had started or completed secondary school. Fifty-eight percent had been engaged in sex work for less than 1 year. Eighty-six percent of the respondents reported RTI/STI signs or symptoms currently or in the last 3 months but only two-thirds of those with symptoms sought treatment. Source of treatment for the last RTI/STI episode was the drop-in centre (53% followed by a public hospital (23%, private clinic (12%, private pharmacy (9%, and herbalist (2%. The main barriers to service use were long waiting time, inconvenient location of the clinic, not knowing where to get the services needed, and negative attitudes among healthcare providers. Care seeking behaviour was associated with longer duration of sex work (OR = 2.6, 95%CI 1.52-5.36. Forty-four percent received health information from peer educators, 34% from fellow friends, 26% from a pimp, and 26% had received information from a healthcare provider during the visit. Conclusion There were several barriers to accessing RTI/STI services and they were related to both structural and individual factors. Innovative STI service strategies to inform FSWs about the importance of
陈兴蜀; 胡亮; 陈广瑞; 陈林
针对传统安全检测工具难以接入云计算虚拟网络环境为不同租户提供安全检测服务的问题，研究了安全检测服务动态接入虚拟网络的方法。通过安全检测服务多进程化、网络功能虚拟化（NFV）技术构建了安全检测服务资源池，从而使安全检测服务器可以并行提供多个服务进程，之后利用软件定义网络（SDN）技术实现了安全检测服务动态接入虚拟网络的方法，使得安全检测服务可以按需、动态地接入租户网络以提供安全服务。实验结果表明：该方法在不破坏租户原有虚拟网络环境隔离性前提下，可以有效地将传统安全检测工具云化、并行地为多租户提供按需动态的安全服务。%To ensure the traditional security detecting tool to adapt virtual network of cloud compu-ting,a method of dynamic accessing into virtual network for security tool was studied.Through pro-viding security detecting service in multi-processes and based on NVF technology,the security detec-ting server could serve parallelly in multi-service processes.Besides,a method of dynamic accessing into virtual network for security detecting tool was implemented based on SDN.Consequently,the se-curity detecting service could access tenant network to provide security services dynamically and on de-mand.The results show that the method clouded the traditional security detecting tool effectively and provide parallel,on-demand and dynamic security service for tenants.
The concepts of permission value and quantified-role are introduced to build a fine-grained Web services access control model. By defining the resources of Web services, service attributes and access modes set, the definitions of permissions set is expanded. The definition and distribution of permission values are studied, and the validation and representation of quantified-role are analysed. The concept of ' behaviour value' of Web services user is proposed, and the correlation between the behaviour values with the role quantity of a user is established. The dynamic calculation of behaviour value and the adjustment of users permissions are achieved based on users behaviours and the context.%引入权限量值和量化角色的概念,建立一个细粒度的Web服务访问控制模型.通过定义Web服务和服务属性资源以及访问模式集,扩展权限集的定义;研究Web服务权限量值的定义和分配,以及量化角色的验证和表示形式;提出Web服务主体的行为量值的概念,建立与主体的角色量值的关联,实现根据Web服务主体的行为和上下文环境动态计算行为量值并调整主体权限的方法.
Lisabeth D Finn
Full Text Available BackgroundHigher cancer morbidity and mortality rates for the Indigenous population comparedto the overall Australian population has underlined the critical need to improve accessfor Aboriginal people to cancer treatment services. This paper describes anIndigenous Women’s Cancer Support Group (IWCSG established to supportIndigenous people with cancer and their carers/relatives and to facilitate Aboriginalaccess to cancer screening and treatment. Preliminary findings from an evaluation ofthe group are presented.MethodsThe study employed qualitative research methods to describe IWCSG operations andinvestigate the group’s effectiveness. It included one-on-one interviews with 11Geraldton-based health service providers, the IWCSG coordinator, and 10 womenwho have been linked to IWCSG support, as well as observation of group meetings.ResultsDescriptive outcomes relate to group operations, group effectiveness, group benefitsand future development of the group. A cultural strength of IWCSG is its ability tooperate confidentially behind the scenes, providing emotional support and practicalhelp directly to Indigenous people concerned about privacy and shame issues. Theimportant cultural role IWCSG plays in overcoming communication and othercultural barriers to accessing cancer treatment was unanimously recognised by healthservice providers. Aboriginal women supported by IWCSG spoke about an increasedsense of safety, trust and support in accessing and navigating mainstream cancerservices. A critical issue emerging from the research is the need for further development of effective collaborative working relationships between IWCSGmembers and health service providers.ConclusionsThe IWCSG has the potential to inform an effective model for facilitating Indigenousaccess both to cancer treatment and to mainstream treatment for a variety of healthproblems. Future research is required to explore the applicability of Indigenoussupport groups and to focus on the
recommendations and passed them into law. As a result, the transformation process of Cherry Point into a Naval Health Clinic was initiated. Cost and Access...tenant activities. The hospital is staffed and equipped to meet the primary medical needs of approximately 15,000 .aGranpsA’r Lvelmd E Nle beeica0 Caso ...areas, an Ambulatory Procedures Unit, six off-site medical support facilities, and a number of specialized clinics throughout the MCB. Construction of the
Djordjevic-Dikic, Ana; Ostojic, Miodrag; Beleslin, Branko; Nedeljkovic, Ivana; Stepanovic, Jelena; Stojkovic, Sinisa; Petrasinovic, Zorica; Nedeljkovic, Milan; Saponjski, Jovica; Giga, Vojislav
Objective The aim of this study was to evaluate the diagnostic potential of low-dose adenosine stress echocardiography in detection of myocardial viability. Background Vasodilation through low dose dipyridamole infusion may recruit contractile reserve by increasing coronary flow or by increasing levels of endogenous adenosine. Methods Forty-three patients with resting dyssynergy, due to previous myocardial infarction, underwent low-dose adenosine (80, 100, 110 mcg/kg/min in 3 minutes intervals) echocardiography test. Gold standard for myocardial viability was improvement in systolic thickening of dyssinergic segments of ≥ 1 grade at follow-up. Coronary angiography was done in 41 pts. Twenty-seven patients were revascularized and 16 were medically treated. Echocardiographic follow up data (12 ± 2 months) were available in 24 revascularized patients. Results Wall motion score index improved from rest 1.55 ± 0.30 to 1.33 ± 0.26 at low-dose adenosine (p < 0.001). Of the 257 segments with baseline dyssynergy, adenosine echocardiography identified 122 segments as positive for viability, and 135 as necrotic since no improvement of systolic thickening was observed. Follow-up wall motion score index was 1.31 ± 0.30 (p < 0.001 vs. rest). The sensitivity of adenosine echo test for identification of viable segments was 87%, while specificity was 95%, and diagnostic accuracy 90%. Positive and negative predictive values were 97% and 80%, respectively. Conclusion Low-dose adenosine stress echocardiography test has high diagnostic potential for detection of myocardial viability in the group of patients with left ventricle dysfunction due to previous myocardial infarction. Low dose adenosine stress echocardiography may be adequate alternative to low-dose dobutamine test for evaluation of myocardial viability. PMID:12812523
Weidenbach, Michael; Wild, Florentine; Scheer, Kathrin; Muth, Gerhard; Kreutter, Stefan; Grunst, Gernoth; Berlage, Thomas; Schneider, Peter
Two-dimensional (2D) echocardiography is a user-dependent technique that poses some inherent problems to the beginner. The first problem for beginners is spatial orientation, especially the orientation of the scan plane in reference to the 3-dimensional (3D) geometry of the heart. The second problem for beginners is steering of the ultrasound probe. We have designed a simulator to teach these skills. On a computer screen a side-by-side presentation of a 3D virtual reality scene on the right side and a 2D echocardiographic view on the left side is given. The virtual scene consists of a 3D heart and an ultrasound probe with scan plane. The 2D echocardiographic image is calculated from 3D echocardiographic data sets that are registered with the heart model to achieve spatial and temporal congruency. The displayed 2D echocardiographic image is defined and controlled by the orientation of the virtual scan plane. To teach hand-eye coordination we equipped a dummy transducer with a 3D tracking system and placed it on a dummy torso. We have evaluated the usability of the simulator in an introductory course for final-year medical students. The simulator was graded realistic and easy to use. According to a subjective self-assessment by a standardized questionnaire the aforementioned skills were imparted effectively.
General Services Administration — BusinessUSA connects businesses to government services and information. The API provides access to resource abstracts including programs, services, data, events, and...
佘明辉; 杨斌; 赵东风
针对多个用户共享一个统计复用的系统时,在轮询多址通信系统的门限服务中,必须采用适当的服务规则(如预约或轮询)的问题.采用嵌入马尔可夫链理论和概率母函数的方法,对轮询排队系统的门限服务用两种不同的分析方法进行分析,得到了相同的门限服务排队系统的平均排队队长和平均循环周期的解析结果.计算机模拟结果表明了仿真与理论的一致性.%Aiming the problens at multiple users to share a multiplexing systems, in polling multi-access communication system of threshold services , appropriate service rules must adcpted ( such as reservation or interruptdriven ). Adopt embedded markov chain theory and probability generating function method of pollers forunreachable threshold service queuing system with two different analysis methods are analyzed and the same threshold service queuing system mean queue length and average cycles of analytical results. Computer simulation results show that the simulation and theory are consistency.
This Annual Status Report describes the design, development and implementation of the Minority On-Line Information Service (MOLIS) project by Federal Information Exchange, Inc. for the period of April 1, 1991 to March 31, 1992. Summary information detailing developments prior to this reporting period will also be included to establish a comprehensive perspective of the project. The goal of the MOLIS project, was to develop, design, pilot test on-line access to current information on minority colleges and universities and federal minority opportunities. Federal Information Exchange, Inc. (FIE), a diversified information services company recognized by researchers and educators as a leader in the field of information delivery services, was awarded a 5 year small business research grant to develop and implement MOLIS. Since April 29, 1991, the inauguration of its on-line service, MOLIS has provided current information on 138 Black and Hispanic colleges and universities -- including faculty and student profiles, financial data, research centers and equipment information, pre-college and education programs, emerging capabilities, enrollment data, administrative personnel data, and current events -- as well as minority opportunities from 8 participating federal agencies.
Full Text Available Abstract Background Effective confirmation of pregnancy is a basic component of reproductive health services. It is a prerequisite for accessing antenatal care (AnC if the pregnancy is wanted and abortion services if the pregnancy is unwanted. This study examined the role of urine pregnancy testing in the timing of presentation for pregnancy-care. Method A cross-sectional study was conducted among 158 women presenting for antenatal care and 164 women presenting for abortion at public sector clinics in Cape Town, South Africa. Results The median gestational age at first presentation was 23 weeks for AnC clients and 13 weeks for abortion clients. Obtaining a urine pregnancy test of one's own accord was associated with a decrease in the gestational age at presentation of 3.6 and 1.4 weeks for antenatal and abortion clients, respectively, independently of all other factors. Conclusion Given the proven clinical benefit and public health impact of early presentation for antenatal and abortion services, strategies to decrease gestational age at presentation for pregnancy care should be given priority. 'Fast-track' urine pregnancy testing services should be established in public sector clinics in South Africa.
Telecom networks to exchange for ip,however,how to inherit the traditional network services is a big problem now.Accessing network in the distanceis a necessary servicewhile the traditional networktransformatinginto NGN,andplaying extremely important role at telcom operators’ benefit distribution.We talk about how torealisethe service of accessing network in the distanceby as way,and analyses every solution’ s pros and cons,finding the most rational solution.%通信交换网络正朝着宽带化、IP化的方向发展,传统网络的业务继承问题日显突出。受端入网作为通信网软交换改造必不可少的业务,在固网运营商和移动网运营商的利益分配中扮演着极其重要的角色。对受端入网的AS方式的各种解决方案进行了探讨,分析其利弊,从中找出最合理的解决方案。
Pergament, Deborah; Ilijic, Katie
This chapter is an overview of the current status of the law in the United States regarding prenatal genetic testing with an emphasis on issues related to professional liability and other challenges affecting patient access to prenatal genetic testing. The chapter discusses the roles that federal regulations, promulgated by the Centers for Medicare and Medicaid Services (CMS), the Food and Drug Administration (FDA) and the Federal Trade Commission (FTC), play in the regulation of prenatal genetic tests. The chapter discusses tort litigation based on allegations of malpractice in the provision of prenatal genetic testing and how courts have analyzed issues related to causation, damages and mitigation of damages. The chapter provides reference information regarding how individual states address causes of action under the tort theories of wrongful birth and wrongful life. The chapter concludes with a discussion of future legal issues that may affect clinical prenatal genetic testing services arising from the continued expansion of prenatal genetic testing, legal restrictions on access to abortion and the potential development of embryonic treatments.
Rashid, Arif; Matthews, Nigel Shaun; Cowgill, Helen
Up to a quarter of the general population has experienced temporomandibular joint disorder (TMD) at some point in time. Physiotherapy has been used in the management of TMD for many years, but evidence supporting its clinical effectiveness is limited. We investigated the perceived effectiveness of physiotherapy for patients with TMD among consultants in oral and maxillofacial surgery (OMFS) and the accessibility of these services in the United Kingdom (UK). Information was gathered from a postal or electronic questionnaire sent to the 356 OMFS consultants listed on the British Association of Oral and Maxillofacial Surgeons' website. A total of 208 responded (58%) and 72% considered physiotherapy to be effective. Amongst these respondents, jaw exercises (79%), ultrasound (52%), manual therapy (48%), acupuncture (41%) and laser therapy (15%) were considered to be effective. Twenty-eight percent of respondents did not consider physiotherapy to be effective. Reasons for this included lack of knowledge or expertise of the physiotherapist (41%) and lack of awareness of the benefits of physiotherapy (28%). In relation to access to physiotherapy services, 10% of respondents had a designated physiotherapist for patients with TMD, 89% could refer directly to physiotherapy and 7% worked in an environment that provided training for physiotherapists. Patients were prescribed jaw exercises by 69% of respondents. Despite limited evidence to support its effectiveness, approximately three-quarters of OMFS consultants in the UK regard physiotherapy to be beneficial in the management of TMD.
Full Text Available Abstract Background and aim There are a significant number of Turkish speaking immigrants living in London. Their special health issues including women's health, mental health, and alcohol and smoking habits has been assessed. The aim of this study was to explore the ongoing challenges in access to health care services and its impact on Quality of Life of immigrants. Material and methods This cross-sectional population-based study was conducted between March and August 2010 with Turkish immigrants (n = 416 living in London. Of these, 308 (74% were Turkish and 108 (26% were Turkish Cypriots. All healthy or unhealthy adults of 17-65 years of age were enrolled. A structured questionnaire with 44 items in five subcategories and 26-items WHOQOL BREF were used. Results Mean duration of stay for Turkish Cypriots (26.9 ± 13.9 years was significantly longer than Turkish immigrants (13.3 ± 7.5 (p Conclusions The results of this study demonstrate how the health and well-being of members of the Turkish speaking community living in London are affected by social aspects of their lives. Providing culturally competent care and interpretation services and advocacy may improve the accessibility of the health care.
Full Text Available This chapter is an overview of the current status of the law in the United States regarding prenatal genetic testing with an emphasis on issues related to professional liability and other challenges affecting patient access to prenatal genetic testing. The chapter discusses the roles that federal regulations, promulgated by the Centers for Medicare and Medicaid Services (CMS, the Food and Drug Administration (FDA and the Federal Trade Commission (FTC, play in the regulation of prenatal genetic tests. The chapter discusses tort litigation based on allegations of malpractice in the provision of prenatal genetic testing and how courts have analyzed issues related to causation, damages and mitigation of damages. The chapter provides reference information regarding how individual states address causes of action under the tort theories of wrongful birth and wrongful life. The chapter concludes with a discussion of future legal issues that may affect clinical prenatal genetic testing services arising from the continued expansion of prenatal genetic testing, legal restrictions on access to abortion and the potential development of embryonic treatments.
Junqueira, Simone Rennó; Frias, Antônio Carlos; Zilbovicius, Celso; Araujo, Maria Ercilia de
The Health Department of São Paulo, Brazil, has developed a Health Necessities Index (HNI) to identify priority areas for providing health assistance. In 2008, a survey of the status of oral health was conducted. The objective of this ecological study was to analyze the status of oral health in relation to the HNI. The variables, stratified by the age of 5, 12 and 15 years old were: percentage of individuals with difficulty of access to dental care services; DMFT and DMFS; prevalence of the need for tooth extraction and treatment of dental caries. Data were analyzed for the 25 Health Technical Supervision Units (HTS). The Statistical Covariance Test was used as well as the Pearson correlation coefficient and linear regression model. A positive correlation was observed between high scores of the HNI and difficulty of access to services. In the HTS with high scores of HNI a higher incidence of dental caries was observed, a greater need for tooth extractions and low caries-free incidence. In order to improve health conditions of the population it is mandatory to prioritize actions in areas of social deprivation.
Edwards, Andrew G; Teoh, Mark; Hodges, Ryan J; Palma-Dias, Ricardo; Cole, Stephen A; Fung, Alison M; Walker, Susan P
The benefits of fetoscopic laser photocoagulation (FLP) for treatment of twin-to-twin transfusion syndrome (TTTS) have been recognized for over a decade, yet access to FLP remains limited in many settings. This means at a population level, the potential benefits of FLP for TTTS are far from being fully realized. In part, this is because there are many centers where the case volume is relatively low. This creates an inevitable tension; on one hand, wanting FLP to be readily accessible to all women who may need it, yet on the other, needing to ensure that a high degree of procedural competence is maintained. Some of the solutions to these apparently competing priorities may be found in novel training solutions to achieve, and maintain, procedural proficiency, and with the increased utilization of 'competence based' assessment and credentialing frameworks. We suggest an under-utilized approach is the development of collaborative surgical services, where pooling of personnel and resources can improve timely access to surgery, improve standardized assessment and management of TTTS, minimize the impact of the surgical learning curve, and facilitate audit, education, and research. When deciding which centers should offer laser for TTTS and how we decide, we propose some solutions from a collaborative model.
... any other CMRS callers. d. Definitions. As used in this appendix: 1. Authorizing agent refers to a... PAS to affected entities and individuals. 8. Enlarge the role of the Telecommunications Service... Assessment Team Leaders; (iii) Federal, state and local personnel with continuity of...
Graham, Carrie L.; Scharlach, Andrew E.; Price Wolf, Jennifer
Background: Villages represent an emerging consumer-driven social support model that aims to enhance the social engagement, independence, and well-being of community-dwelling seniors through a combination of social activities, volunteer opportunities, service referral, and direct assistance. This study aimed to assess the perceived impact of…
...) (1) and (5) would impede the protective responsibilities of the Service and could result in death or... ongoing investigative or law enforcement activities by the premature disclosure of information related to... could result in death or serious injury to USMS and other law enforcement personnel, prisoners...
Delphinanto, A.; Koonen, A.M.J.; Peeters, M.E.; Hartog, F.T.H. den
The current service- and device discovery protocols are not platform- and network independent. Therefore, proxy servers will be needed to extend the range of IP-based discovery protocols to non-IP domains. We developed an architecture of a proxy that enables Universal Plug and Play (UPnP) devices an
Mars, Tomaz; Mikolavcic, Helena; Salobir, Barbara; Podbregar, Matej
Patients with advanced idiopathic pulmonary artery hypertension have often a chronic pericardial effusion. It is the result of increased transudation and impaired re-absorption due to elevated venous pressure. These patients have pre-existent symptoms and signs of chronic right heart failure. High degree of suspicion is required to detect of development of an atypical form of tamponade with isolated compression of left heart chambers as shown in present case report. Transthoracic echocardiography provides a rapid access to the correct diagnosis, a prompt relief of symptoms following the ultrasound guided pericardiocentesis and important diagnostic tool for regular follow up of patients thereafter as shown in our case report.
Ostrenga, D.; Liu, Z.; Kempler, S. J.; Vollmer, B.; Teng, W. L.
The Precipitation Data and Information Services Center (PDISC) (http://disc.gsfc.nasa.gov/precipitation or google: NASA PDISC), located at the NASA Goddard Space Flight Center (GSFC) Earth Sciences (GES) Data and Information Services Center (DISC), is home of the Tropical Rainfall Measuring Mission (TRMM) data archive. For over 15 years, the GES DISC has served not only TRMM, but also other space-based, airborne-based, field campaign and ground-based precipitation data products to the precipitation community and other disciplinary communities as well. The TRMM Multi-Satellite Precipitation Analysis (TMPA) products are the most popular products in the TRMM product family in terms of data download and access through Mirador, the GES-DISC Interactive Online Visualization ANd aNalysis Infrastructure (Giovanni) and other services. The next generation of TMPA, the Integrated Multi-satellitE Retrievals for GPM (IMERG) to be released in 2014 after the launch of GPM, will be significantly improved in terms of spatial and temporal resolutions. To better serve the user community, we are preparing data services and samples are listed below. To enable scientific exploration of Earth science data products without going through complicated and often time consuming processes, such as data downloading, data processing, etc., the GES DISC has developed Giovanni in consultation with members of the user community, requesting quick search, subset, analysis and display capabilities for their specific data of interest. For example, the TRMM Online Visualization and Analysis System (TOVAS, http://disc2.nascom.nasa.gov/Giovanni/tovas/) has proven extremely popular, especially as additional datasets have been added upon request. Giovanni will continue to evolve to accommodate GPM data and the multi-sensor data inter-comparisons that will be sure to follow. Additional PDISC tool and service capabilities being adapted for GPM data include: An on-line PDISC Portal (includes user guide, etc
Full Text Available Abstract Background The dichotomy employed vs. unemployed is still a relevant, but rather crude measure of status in current labour markets. Also, studies concerning the association of employment status with health have to specify the type of the employment as well as the characteristics of the unemployment. This study aims to reveal differences and potential inequalities in physician visits among seven groups in the core-periphery structures of the labour markets. Methods A total of 16 000 Finns responded to a postal survey in 2003. Their visits to physicians in public primary health care, occupational health care, private health services, hospital outpatient clinics and dental care services during previous year were measured as indicators of service utilisation. Participants were classified as employees having a permanent or fixed-term and full-time or part-time contract and as those experiencing short-term, prolonged or long-term unemployment. Differences in the one-year coverage of physician visits between these groups of employees were analysed using logistic regression analyses where differences in the need for services were controlled for by including demographics and self-rated health assessments in the models. Results Permanently employed respondents had visited a physician most often, and the need-adjusted regression models showed significantly lower odds ratios for a visit among fixed-term employees (OR 0.65, 95% CI 0.53–0.81 and in particular among the long-term unemployed (OR 0.21, 95% CI 0.14–0.31. A stratified analysis according to health care sector showed the lowest odds ratios in occupational health care and private physicians (ORs between 0.05 and 0.73 and also low odds ratios for dentists (ORs between 0.45 and 0.91, whereas visits to public primary health care were more common among non-permanent employees and the unemployed (ORs between 1.46 and 2.39. Conclusion The use of physician services varies according to labour
Prem K Mony
Full Text Available BACKGROUND: As part of efforts to reduce maternal deaths in Karnataka state, India, there has been a concerted effort to increase institutional deliveries. However, little is known about the quality of care in these healthcare facilities. We investigated the availability and distribution of emergency obstetric care (EmOC services in eight northern districts of Karnataka state in south India. METHODS & FINDINGS: We undertook a cross-sectional study of 444 government and 422 private health facilities, functional 24-hours-a-day 7-days-a-week. EmOC availability and distribution were evaluated for 8 districts and 42 taluks (sub-districts during the year 2010, based on a combination of self-reporting, record review and direct observation. Overall, the availability of EmOC services at the sub-state level [EmOC = 5.9/500,000; comprehensive EmOC (CEmOC = 4.5/500,000 and basic EmOC (BEmOC = 1.4/500,000] was seen to meet the benchmark. These services however were largely located in the private sector (90% of CEmOC and 70% of BemOC facilities. Thirty six percent of private facilities and six percent of government facilities were EmOC centres. Although half of eight districts had a sufficient number of EmOC facilities and all eight districts had a sufficient number of CEmOC facilities, only two-fifths of the 42 taluks had a sufficient number of EmOC facilities. With the private facilities being largely located in select towns only, the 'non-headquarter' taluks and 'backward' taluks suffered from a marked lack of coverage of these services. Spatial mapping further helped identify the clustering of a large number of contiguous taluks without adequate government EmOC facilities in northeastern Karnataka. CONCLUSIONS: In conclusion, disaggregating information on emergency obstetric care service availability at district and subdistrict levels is critical for health policy and planning in the Indian setting. Reducing maternal deaths will require
Sharma, Sunjay; Bohn, Des; Mikroyiannakis, Iphigenia; Trowbridge, Joslyn; Thompson, Donna; Bell, Robert; Rutka, James
Neurosurgical emergencies require expedient access to definitive care at neurosurgical centers. Neurosurgical resources in province of Ontario are highly centralized, and subsequently, most patients with neurosurgical emergencies will present to non-neurosurgical centers. From 2000-2010, metrics demonstrated the organization of neurosurgical resources might not be optimal. In response to this a program entitled Provincial Neurosurgery Ontario (PNO)- was formed to address these issues in cooperation with neurosurgeons, hospitals and the provincial government. PNO worked with multiple stakeholders to implement interventions to not only prevent out of country transfer, but to also improve the flow of neurosurgical patients in the province and potentially improve outcome. The main interventions undertaken by PNO were: 1) implementation and development of a province-wide tele-radiology system; 2) development of neurosurgery as a provincially-funded program; 3) significant outreach to non-neurosurgical centers; and 4) specialized funding packages for highly specialized level care. This report provides background on the challenges faced by neurosurgery in the province of Ontario and the process developed to address these challenges. Finally, we describe the impact provincial strategies have had on improving access to emergency neurosurgical care in the Ontario.
Nassehi, M. Mehdi
Local Area Networks are in common use for data communications and have enjoyed great success. Recently, there is a growing interest in using a single network to support many applications in addition to traditional data traffic. These additional applications introduce new requirements in terms of volume of traffic and real-time delivery of data which are not met by existing networks. To satisfy these requirements, a high-bandwidth tranmission medium, such as fiber optics, and a distributed channel access scheme for the efficient sharing of the bandwidth among the various applications are needed. As far as the throughput-delay requirements of the various application are concerned, a network structure along with a distributed channel access are proposed which incorporate appropriate scheduling policies for the transmission of outstanding messages on the network. A dynamic scheduling policy was devised which outperforms all existing policies in terms of minimizing the expected cost per message. A broadcast mechanism was devised for the efficient dissemination of all relevant information. Fiber optic technology is considered for the high-bandwidth transmisison medium.
Goeman, Dianne; Conway, Sue; Norman, Ralph
organisations in the codesign of interventions involving the Health Literacy Questionnaire (HLQ) needs assessment, followed by development and evaluation of interventions addressing identified needs. This study reports the process and outcomes of one of the nine organisations, the Royal District Nursing Service...... (RDNS). Methods. Participants were home nursing clients with diabetes. The intervention included tailored diabetes self-management education according to preferred learning style, a standardised diabetes education tool, resources, and teach-back method. Results. Needs analysis of 113 quota......-sampled clients showed difficulties managing health and finding and appraising health information. The service-wide diabetes education intervention was applied to 24 clients. The intervention was well received by clients and nurses. Positive impacts on clients' diabetes knowledge and behaviour were seen...
Stahl, Douglas C.; Evans, Richard M.; Afrin, Lawrence B.; DeTeresa, Richard M.; Ko, Dave; Mitchell, Kevin
Electronic discovery of the clinical trials being performed at a specific research center is a challenging task, which presently requires manual review of the center’s locally maintained databases or web pages of protocol listings. Near real-time automated discovery of available trials would increase the efficiency and effectiveness of clinical trial searching, and would facilitate the development of new services for information providers and consumers. Automated discovery efforts to date hav...
Prem K Mony; Jayanna Krishnamurthy; Annamma Thomas; Kiruba Sankar; Ramesh, B. M.; Stephen Moses; James Blanchard; Lisa Avery
BACKGROUND: As part of efforts to reduce maternal deaths in Karnataka state, India, there has been a concerted effort to increase institutional deliveries. However, little is known about the quality of care in these healthcare facilities. We investigated the availability and distribution of emergency obstetric care (EmOC) services in eight northern districts of Karnataka state in south India. METHODS & FINDINGS: We undertook a cross-sectional study of 444 government and 422 private health fac...
Full Text Available Introduction: Improvements in the availability and effectiveness of highly active antiretroviral therapy (HAART have prolonged the lives of people living with HIV/AIDS. However, mortality rates have remained high among populations that encounter barriers to accessing and adhering to HAART, notably people who use drugs. This population consequently has a high burden of illness and complex palliative and supportive care needs, but is often unable to access these services due to anti-drug policies and discrimination. In Vancouver, Canada, the Dr. Peter Centre (DPC, which operates a 24-bed residential HIV/AIDS care facility, has sought to improve access to palliative and supportive care services by adopting a comprehensive harm reduction strategy, including supervised injection services. We undertook this study to explore how the integration of comprehensive harm reduction services into this setting shapes access to and engagement with care. Methods: Qualitative interviews were conducted with 13 DPC residents between November 2010 and August 2011. Interviews made use of a semistructured interview guide which facilitated discussion regarding how the DPC Residence's model of care (a shaped healthcare access, (b influenced healthcare interactions and (c impacted drug use practices and overall health. Interview transcripts were analysed thematically. Results: Participant accounts highlight how the harm reduction policy altered the structural-environmental context of healthcare services and thus mediated access to palliative and supportive care services. Furthermore, this approach fostered an atmosphere in which drug use could be discussed without the risk of punitive action, and thus increased openness between residents and staff. Finally, participants reported that the environmental supports provided by the DPC Residence decreased drug-related risks and improved health outcomes, including HAART adherence and survival. Conclusions: This study highlights
Stahl, Douglas C; Evans, Richard M; Afrin, Lawrence B; DeTeresa, Richard M; Ko, Dave; Mitchell, Kevin
Electronic discovery of the clinical trials being performed at a specific research center is a challenging task, which presently requires manual review of the center's locally maintained databases or web pages of protocol listings. Near real-time automated discovery of available trials would increase the efficiency and effectiveness of clinical trial searching, and would facilitate the development of new services for information providers and consumers. Automated discovery efforts to date have been hindered by issues such as disparate database schemas, vocabularies, and insufficient standards for easy intersystem exchange of high-level data, but adequate infrastructure now exists that make possible the development of applications for near real-time automated discovery of trials. This paper describes the current state (design and implementation) of the Web Services Specification for Publication and Discovery of Clinical Trials as developed by the Technology Task Force of the Association of American Cancer Institutes. The paper then briefly discusses a prototype web service-based application that implements the specification. Directions for evolution of this specification are also discussed.
Ting, Jacky S L; Tsang, Albert H C; Ip, Andrew W H; Ho, George T S
This paper presents an innovative electronic medical records (EMR) system, RF-MediSys, which can perform medical information sharing and retrieval effectively and which is accessible via a 'smart' medical card. With such a system, medical diagnoses and treatment decisions can be significantly improved when compared with the conventional practice of using paper medical records systems. Furthermore, the entire healthcare delivery process, from registration to the dispensing or administration of medicines, can be visualised holistically to facilitate performance review. To examine the feasibility of implementing RF-MediSys and to determine its usefulness to users of the system, a survey was conducted within a multi-disciplinary medical service organisation that operates a network of medical clinics and paramedical service centres throughout Hong Kong Island, the Kowloon Peninsula and the New Territories. Questionnaires were distributed to 300 system users, including nurses, physicians and patients, to collect feedback on the operation and performance of RF-MediSys in comparison with conventional paper-based medical record systems. The response rate to the survey was 67%. Results showed a medium to high level of user satisfaction with the radiofrequency identification (RFID)-based EMR system. In particular, respondents provided high ratings on both 'user-friendliness' and 'system performance'. Findings of the survey highlight the potential of RF-MediSys as a tool to enhance quality of medical services and patient safety.
Garcia de la Hera, Manuela; Davo, Maria Carmen; Ballester-Añón, Rosa; Vioque, Jesus
The benefits of HIV treatment (Highly Active Antiretroviral Therapy [HAART]) have been less apparent in injecting drug users (IDUs), most probably as a result of poor adherence to treatment. We explored factors related to HIV treatment adherence as reported by 23 IDU-HIV patients and nine health professionals from healthcare services in Alicante and Valencia, Spain. We carried out a qualitative study based on personal interviews. Health professionals reported the lack of coordination among hospital services and difficulties in accessibility to nonspecialized services for IDU-HIV patients as relevant factors for treatment adherence. Their perception of a patient's likelihood of treatment adherence was also considered to influence the decision to prescribe HAART. A better treatment adherence was reported by those IDU-HIV patients with a good doctor-patient relationship and by women with family responsibilities. Patients considered the side effects of HIV treatment, the lack of social support, and the active use of recreational drugs as relevant factors to explain incompliance. Interventions and training of health providers should be aimed at the reduction of barriers in patient-provider communication and the overcoming of stereotypes, thus avoiding discriminatory attitudes in treatment in this vulnerable population.
Li, Yan; Dai, Shifang; Chang, Xiangmao
In group-based fiber-wireless (FiWi) access networks, where wireless clients are divided into several groups according to their interested Internet services, VoD services will meet new challenges considering the diversity of video requesting probability for each wireless group. In this paper, we categorize wireless groups into "video-hot" group with great interest in VoD services and "video-cold" group with infrequent video requesting. For video requests from "video-hot" groups, we firstly propose an energy-efficient optical network unit (ONU) selection approach to reduce ONU power consumption by selecting a subset of ONUs to support such requests, then our previously proposed rebroadcast and patching scheme can be effectively applied. For video requests from "video-cold" groups, a batched multicasting scheme is presented for energy and bandwidth saving. Both of the VoD schemes mentioned in this study are with the aim to minimize worst-case playback delay (WPD) which is particularly important as Internet users. In view of that some ONUs may need to handle video requests from two kinds of group, optimal ONU channel assignment aims to minimize weighted overall WPD is also studied. The efficiency of the work is finally demonstrated by the simulations.
Panopoulos, Dimitrios; Sachpazidis, Ilias; Rizou, Despoina; Menary, Wayne; Cardenas, Jose; Psarras, John
Peru, officially classified as a middle-income country, has benefited from sustained economic growth in recent years. However, the benefits have not been seen by the vast majority of the population, particularly Peru's rural population. Virtually all of the nation's rural health-care centres are cut off from the rest of the country, so access to care for most people is not only difficult but also costly. MEDNET attempts to redress this issue by developing a medical health network with the help of the collaboration medical application based on TeleConsult & @HOME medical database for vital signs. The expected benefits include improved support for medics in the field, reduction of patient referrals, reduction in number of emergency interventions and improved times for medical diagnosis. An important caveat is the emphasis on exploiting the proposed infrastructure for education and social enterprise initiatives. The project has the full support of regional political and health authorities and, importantly, full local community support.
Nosè, M; Turrini, G; Barbui, C
In the populations of refugees and asylum seekers hosted in high-income countries, access to mental health care and psychotropic drugs, is a major challenge. A recent Swedish cross-sectional register study has explored this phenomenon in a national cohort of 43 403 young refugees and their families from Iraq, Iran, Eritrea, Ethiopia, Somalia and Afghanistan. This register study found lower rates of dispensed psychotropic drugs among recently settled refugees, as compared with Swedish-born residents, with an increase in the use with duration of residence. In this commentary, the results of this survey are discussed in view of their global policy implications for high-income countries hosting populations of refugees and asylum seekers.
Chandraratna, P A N; Mohar, Dilbahar S; Sidarous, Peter F
Accumulation of fluid within the pericardial sac results in elevation of intrapericardial pressure with consequent cardiac compression or tamponade. Cardiac tamponade is a life-threatening condition which requires urgent evacuation of pericardial effusion (PE). Current pericardial evacuation techniques and approaches are varied. Echocardiography provides valuable insights into identifying patients who are suitable candidates and further facilitates pericardiocentesis by improving guidance techniques. Several previous publications have provided excellent reviews of the pathophysiology of cardiac tamponade. We review the clinical presentation and role of echocardiography for diagnosis of tamponade. We focus on medical and surgical approaches for the removal of PE. Moreover, as the clinical and hemodynamic consequences of PE depend on the volume and the rate of accumulation of PE, we review the various scenarios of "small" PE resulting in cardiac tamponade.