WorldWideScience

Sample records for care demand case

  1. [Supply and demand in home health care].

    Science.gov (United States)

    Braga, Patrícia Pinto; de Sena, Roseni Rosângela; Seixas, Clarissa Terenzi; de Castro, Edna Aparecida Barbosa; Andrade, Angélica Mônica; Silva, Yara Cardoso

    2016-03-01

    The changes in the demographic and epidemiologic profiles of the Brazilian population and the need to rethink the health care model have led many countries like Brazil to consider Home Care (HC) as a care strategy. However, there is a gap between the supply of HC services, the demand for care and the health needs manifested by the population. Thus, this article analyzes scientific output regarding the status of the relation between supply, demand and the needs related to home health care. This work is based on an integrative review of the literature in the following databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Latin America and the Caribbean Literature on Health and Science (Lilacs), Medical Literature Analysis and Retrieval System Online (Medline) and Web of Science. Despite the fact that few articles refer to the issue in question, there is evidence indicating that health demands and needs are seldom taken into account either in a quantitative or qualitative approach when developing the organization of HC services. The analysis would indicate that there is a national and international deficit in the supply of HC services considering the demand for health care and needs currently prevailing. PMID:26960102

  2. Demand for antenatal care in South Africa.

    Science.gov (United States)

    Kirigia, J M; Lambo, E; Sambo, L G

    2000-01-01

    On May,24 1994, the then South African president, Mr. Nelson Mandela, declared that all health care for children under the age of 6 years, and pregnant women would be free. Unfortunately, there has been no significant decrease in maternal, perinatal and infant mortality. Thus, there is a need of research into the factors that influence the demand for antenatal services. The objectives of this paper are to (a) establish the determinants of individual pregnant women's choice to seek antenatal care; and (b) deal with potential endogeneity bias in the relationship between the decision to seek pre-natal care and perceived health status. The joint determination of consumption of antenatal care and pregnant woman's health status requires estimation of a simultaneous system. To help mitigate the simultaneity bias and avoid the inconsistency inherent in the application of Ordinary least Squares (OLS) method to simultaneous equations systems, we used Two-Stage Probit Maximum Likelihood Estimator Method. In the antenatal structural-form equation, the coefficients for TOILET, AGE, OCCUPATION, EMPLOYMENT, SMOKER, METHODS and QUALITY were statistically significant at P risk-lovers or risk-neutral are unlikely to consume preventive and promotive health care, including antenatal care. Thus, there is need to put in place incentives that would convert seemingly risk-lovers to risk-averters. (2) Programmes aimed at reducing women unemployment and general working conditions would improve use of pre-natal care. (3) Improvements in perceived quality of care at the health facilities that offer antenatal care is needed to boost the consumption of antenatal care and probably other forms of health care. PMID:17650027

  3. Overweight and obesity and the demand for primary physician care

    OpenAIRE

    Gupta, Nabanita Datta; Greve, Jane

    2009-01-01

    The standard economic model for the demand for health care predicts that unhealthy behaviour such as being overweight or obese should increase the demand for medical care, particularly as clinical studies link obesity to a number of serious diseases. In this paper, we investigate whether overweight or obese individuals demand more medical care than normal weight individuals by estimating a finite mixture model which splits the population into frequent and non-frequent users of primary physici...

  4. Demand of elderly people for residential care: an exploratory study

    NARCIS (Netherlands)

    P. van Bilsen; J. Hamers; W. Groot; C. Spreeuwenberg

    2006-01-01

    Background: Because of the rapid aging population, the demand for residential care exceeds availability. This paper presents the results of a study that focuses on the demand of elderly people for residential care and determinants (elderly people's personal characteristics, needs and resources) that

  5. Intermittent Demand Forecasting in a Tertiary Pediatric Intensive Care Unit.

    Science.gov (United States)

    Cheng, Chen-Yang; Chiang, Kuo-Liang; Chen, Meng-Yin

    2016-10-01

    Forecasts of the demand for medical supplies both directly and indirectly affect the operating costs and the quality of the care provided by health care institutions. Specifically, overestimating demand induces an inventory surplus, whereas underestimating demand possibly compromises patient safety. Uncertainty in forecasting the consumption of medical supplies generates intermittent demand events. The intermittent demand patterns for medical supplies are generally classified as lumpy, erratic, smooth, and slow-moving demand. This study was conducted with the purpose of advancing a tertiary pediatric intensive care unit's efforts to achieve a high level of accuracy in its forecasting of the demand for medical supplies. On this point, several demand forecasting methods were compared in terms of the forecast accuracy of each. The results confirm that applying Croston's method combined with a single exponential smoothing method yields the most accurate results for forecasting lumpy, erratic, and slow-moving demand, whereas the Simple Moving Average (SMA) method is the most suitable for forecasting smooth demand. In addition, when the classification of demand consumption patterns were combined with the demand forecasting models, the forecasting errors were minimized, indicating that this classification framework can play a role in improving patient safety and reducing inventory management costs in health care institutions. PMID:27562485

  6. Individual decisions and efficiency in health care demand

    OpenAIRE

    Lukas, Daniel

    2013-01-01

    Individual decision-making and the generation of medical demand are crucial subjects in healthcare economics. The following scientific discussion can be classified into these threads. The demand for health care services is typically connected to characteristic imperfections reflecting a bias between an objective and a subjective assessment of a specific demand situation or externally caused frictions. For that reason, the realized demand is not necessarily connected to an efficient allocation...

  7. Preparing Psychotherapy Students for the New Demands of Managed Care.

    Science.gov (United States)

    Chambliss, Catherine

    The wildly varying utilization and quality control practices that make up "managed care" make it difficult to generalize new rules and requirements. Information that can aid counselor trainees in understanding the demands of managed health care is presented. The text explores the following questions: (1) "What do managed care companies want?" and…

  8. Overweight and Obesity and the Demand for Primary Physician Care

    DEFF Research Database (Denmark)

    Datta Gupta, Nabanita; Greve, Jane

    The standard economic model for the demand for health care predicts that unhealthy behaviour such as being overweight or obese should increase the demand for medical care, particularly as clinical studies link obesity to a number of serious diseases. In this paper, we investigate whether overweight...... or obese individuals demand more medical care than normal weight individuals by estimating a finite mixture model which splits the population into frequent and non-frequent users of primary physician (GP) services according to the individual's latent health status. Based on a sample of wage-earners aged 25......-60 years drawn from the National Health Interview (NHI) survey 2000 and merged to Danish register data, we compare differences in the impact of being overweight and obese relative to being normal weight on the demand for primary physician care. Estimated bodyweight effects vary across latent classes...

  9. Health Care Demand in the Presence of Discrete Price Changes

    OpenAIRE

    Gerfin, Michael; Kaiser, Boris; Schmid, Christian

    2014-01-01

    Deductibles in health insurance generate nonlinear budget sets and dynamic incentives. This paper uses detailed individual claims data from a large Swiss insurance company to estimate the response in health care demand to the discrete price increase that is generated by resetting the deductible at the start of each calendar year. We use a regression discontinuity type framework based on daily data to estimate the change in health care demand right before and right after the turn of the year. ...

  10. The Demand for Child Care Services in Canada

    OpenAIRE

    Henriques, I; Vaillancourt, F.

    1986-01-01

    This Paper Examines the Determinants of the Demand for Child Care Services in Canada. Using Survey Data Collected for 1981 by Statistics Canada and Probit Analysis We Find That the Likelihood of Using Child Care Services Increases with Variables Such As the Education of the Mother and the Age of the Child and Decreases with the Number of Children in the Family.

  11. Charting the demand for pharmacists in the managed care era.

    Science.gov (United States)

    Knapp, K K

    1999-07-01

    The demand for pharmacists in the changing health care market is discussed. The Pharmacy Manpower Project (PMP) evolved out of concerns raised in the late 1980s, when the demand for pharmacists exceeded the supply. PMP collects, analyzes, and disseminates data on pharmacy work force variables. PMP's Subcommittee to Study Demand Issues was formed after the publication in 1995 of the Pew Health Professions Commission report projecting dramatic surpluses of pharmacists. In 1996-97, the PMP subcommittee held a series of sessions to discuss the future demand for pharmacists and their services. The panel identified a wide range of work force projections, but it concluded that medication management problems in the context of increasing prescription numbers and the emergence of data-driven health care support a scenario of a steadily increasing demand for pharmacists and pharmaceutical services. The data did not show that higher penetration by managed care is associated with smaller pharmacy staffs or job loss in institutions. There is little reason to expect the dramatic downsizing of the pharmacy work force predicted by the third report of the Pew Commission. However, retaining pharmacy roles that are useful to the system and satisfying to pharmacists will require a continuation of current proactive measures by the profession. PMID:10683127

  12. Supply and demand for long-term care services from the perspective of leaders of health care institutions1

    Science.gov (United States)

    Samoliński, Bolesław

    2015-01-01

    Introduction Poland's transition into the stage of intensive population aging imposes changes in demand for different forms of care (including long-term). The proportion of dependent persons (requiring care) in the population continues to increase. The number of people aged 80 and above (in 2013 – 1.48 million) will double by 2050 and reach 3.54 million. The research objective was to gain knowledge on the supply and demand of different institutionalized forms of care services from the healthcare system perspective. Material and methods A computer-assisted personal interview (CAPI) survey was carried out on a Poland-wide quota sample of health care and nursing centres operating within the healthcare system. The respondent group consisted of 96 directors of health care facilities. Results In the opinion of more than a half of surveyed directors, supply of health care and nursing centres in their region is insufficient in terms of the needs of both patients and elderly people. In the context of patients, the deficit is observed primarily in health care and treatment centres, long-term nursing care and health care institutions, whereas for the elderly people the main concern is availability of nursing care, day care or social aid centres. More than half of surveyed institutions admit patients requiring care on an ongoing basis; however, in the case of health care and treatment centres more than a year-long waiting time proved to be a frequent phenomenon. In the opinion of the surveyed directors, the key factors influencing the number of available places and waiting time are insufficient financing and personnel deficit. Conclusions Introduction of multiple changes to the operation of the care system in Poland is necessary in order to improve its availability, effectiveness and quality. Achievement of this objective requires implementation of a cohesive and integrated system dedicated to monitoring and diagnosing both the supply and demand for different forms of care

  13. Demand for orthodontic treatment among 9-18 year-olds seeking dental care in Dar-es-Salaam, Tanzania.

    OpenAIRE

    Mugonzibwa, E.A.; Kuijpers-Jagtman, A. M.; Hof, M.A. van 't; Kikwilu, E.

    2004-01-01

    OBJECTIVE: To investigate the demand for orthodontic treatment among 9-18 olds seeking dental care in Dar-es-Salaam, Tanzania. DESIGN: Case-control, interview and clinical study. SETTINGS: Children seeking dental care. MAIN OUTCOME MEASURES: Demand for orthodontic treatment. RESULTS: Most of the children (85%) in the case group attended the dental clinic because of crowding. Aesthetic impairment (AC grades 8-10) and severe malocclusions (DHC grades 4-5) were higher in cases than in controls b...

  14. Hypertensive patients in primary health care: access, connection and care involved in spontaneous demands.

    Science.gov (United States)

    Girão, Ana Lívia Araújo; Freitas, Consuelo Helena Aires de

    2016-06-01

    Objective To assess the impacts of inclusion of care for spontaneous demands in the treatment of hypertensive patients in primary health care. Methods Third generation qualitative assessment survey conducted with 16 workers in a Primary Care Health Unit (PHCU) of the city of Fortaleza, state of Ceara, in the period between July and September of 2015. To collect data, systematic field observation and semi-structured interviews were used, and the stages of thematic content analysis were adopted for data analysis. Results Participants revealed that access, connection and care are fundamental to the treatment of hypertension. However, they said that the introduction of free access for spontaneous demands compromised the flow of care in the hypertension programs. Conclusion A dichotomy between the practice of care recommended by health policies and the one existing in the reality of PHCUs was shown, causing evident losses to the care of hypertensive patients in primary care. PMID:27253602

  15. Geriatric restorative care - the need, the demand and the challenges

    Directory of Open Access Journals (Sweden)

    Roopa R Nadig

    2011-01-01

    Full Text Available Increased life expectancy is causing an explosion of the aging population that will continue now and in the foreseeable future. Improved quality of life at old age will demand tooth retention and consequently the need for restorative care. Retaining teeth disease free and maintaining them amidst multitude of risk factors associated with old age, is a multi- faceted challenge. This review article discusses the etiology of various dental diseases seen in older dentate population and their management keeping in mind the special needs of these matured people, so as to render a professional service that is sensitive and caring.

  16. Health care on demand: four telehealth priorities for 2016.

    Science.gov (United States)

    Grube, Mark E; Kaufman, Kenneth; Clarin, Dan; O'Riordan, Jason

    2016-01-01

    Consumers who are accustomed to on-demand, virtual services are looking for more convenient ways to access health care. Giving patients the opportunity to connect with physicians remotely can promote higher patient satisfaction and engagement. Telehealth options may have a high start-up cost, but that cost is likely well-justified by the potential to enhance quality, outcomes, and customer attraction and satisfaction/retention over the long-term. PMID:26863834

  17. Patterns of Health Care Expenditures, Utilization and Demand for Medical Care in Sample Philippine Households

    OpenAIRE

    Bautista, Cristina M.

    1995-01-01

    Due to tight fiscal budget, health care planners have started to explore alternative financing mechanisms. These alternatives can be effectively implemented given thorough understanding of mechanisms that direct household demand for health care. This paper investigates the factors of households’ health seeking behavior to determine the implications for health care financing reforms. In addition, it looks into the responsiveness of households to changes in prices and income. Insights of househ...

  18. Supplier-Induced Demand in Japan's At-home Care Industry: Evidence from Micro-level Survey on Care Receivers

    OpenAIRE

    NOGUCHI Haruko; SATOSHI Shimizutani

    2005-01-01

    We observed a remarkable increase in elderly care expenses in Japan after the introduction of public elderly care insurance in 2000. This study explores the possibility that a greater number of care providers under the deregulation of the entry policy stimulated care utilization. We take advantage of an original household-level survey data on care receivers to address the existence of supplier-induced demand in Japan's elderly at-home care market, by distinguishing between demand for care rec...

  19. Pricing, demanders, and the supply of health care.

    Science.gov (United States)

    Maynard, A

    1979-01-01

    This paper is divided into three substantive sections. In the first section the conventional neoclassical paradigm is augmented by consideration of the agency relationship in which the physician is considered not only as the agent who controls the supply of health care, but also as the decision maker who articulates demand because patients forego this role and rely on "expert" advice. The next section is concerned with the effects of pricing on consumer demand and draws on the available empirical evidence to present estimates of price elasticity, cross elasticity, and other characteristics of the choice process. This analysis is completed by integrating the agency relationship into the discussion and arguing that if the policy objectives are expenditure containment and greater efficiency in resource utilization, the price mechanism should be used to affect the behavior of the primary demander and the supplier: the physician. In the final section the implications of this analysis are discussed in the contexts of two competing perspectives: the liberal market perspective and the collective "needology" perspective, and an attempt is made to distinguish some of the characteristics of the two views of the world. PMID:422291

  20. Estimating tourism demand: the case of FYROM

    OpenAIRE

    Biljana Petrevska

    2013-01-01

    The paper underlines the importance of applying forecasting methods in estimation of tourism trends. In this respect, two quantitative methods were used: (1) the method of exponential smoothing, through two of its variants: Double Exponential Smoothing and the Holt-Winters Smoothing; and (2) the Box-Jenkins methodology, through several alternative specifications. The result of the research is a medium-term estimation of foreign tourism demand for destinations in the Former Yugoslav Republic o...

  1. Market Design for Rapid Demand Response - The Case of Kenya

    OpenAIRE

    Kurt Nielsen; Tseganesh Wubale Tamirat

    2014-01-01

    We suggest a market design for rapid demand response in electricity markets. The solution consists of remotely controlled switches, meters, forecasting models as well as a flexible auction market to set prices and select endusers job by job. The auction market motivates truth-telling and makes it simple to involve the endusers in advance and to activate demand response immediately. The collective solution is analyzed and economic simulations are conducted for the case of Kenya. Kenya has been...

  2. A person-centred segmentation study in elderly care: towards efficient demand-driven care.

    Science.gov (United States)

    Eissens van der Laan, M R; van Offenbeek, M A G; Broekhuis, H; Slaets, J P J

    2014-07-01

    Providing patients with more person-centred care without increasing costs is a key challenge in healthcare. A relevant but often ignored hindrance to delivering person-centred care is that the current segmentation of the population and the associated organization of healthcare supply are based on diseases. A person-centred segmentation, i.e., based on persons' own experienced difficulties in fulfilling needs, is an elementary but often overlooked first step in developing efficient demand-driven care. This paper describes a person-centred segmentation study of elderly, a large and increasing target group confronted with heterogeneous and often interrelated difficulties in their functioning. In twenty-five diverse healthcare and welfare organizations as well as elderly associations in the Netherlands, data were collected on the difficulties in biopsychosocial functioning experienced by 2019 older adults. Data were collected between March 2010 and January 2011 and sampling took place based on their (temporarily) living conditions. Factor Mixture Model was conducted to categorize the respondents into segments with relatively similar experienced difficulties concerning their functioning. First, the analyses show that older adults can be empirically categorized into five meaningful segments: feeling vital; difficulties with psychosocial coping; physical and mobility complaints; difficulties experienced in multiple domains; and feeling extremely frail. The categorization seems robust as it was replicated in two population-based samples in the Netherlands. The segmentation's usefulness is discussed and illustrated through an evaluation of the alignment between a segment's unfulfilled biopsychosocial needs and current healthcare utilization. The set of person-centred segmentation variables provides healthcare providers the option to perform a more comprehensive first triage step than only a disease-based one. The outcomes of this first step could guide a focused and

  3. Prenatal Care Demand and its Effects on Birth Outcomes by Birth Defect Status in Argentina

    OpenAIRE

    Wehby, George L.; Murray, Jeffrey C.; Castilla, Eduardo E.; Lopez-Camelo, Jorge S.; Ohsfeldt, Robert L.

    2008-01-01

    Our objective was to identify determinants of prenatal care demand and evaluate the effects of this demand on low birth weight and preterm birth. Delay in initiating prenatal care was modeled as a function of pregnancy risk indicators, enabling factors, and regional characteristics. Conditional maximum likelihood (CML) estimation was used to model self-selection into prenatal care use when estimating its effectiveness. Birth registry data was collected post delivery on infants with and withou...

  4. Child health care demand in a developing country

    OpenAIRE

    Hallman, Kelly

    1999-01-01

    This study examines how quality, price, and access to curative health care influence use of modern public, modern private, and traditional providers among 3,000 children age 0-2 years in Cebu, Philippines. The analysis relies on a series of household, community, and health facility surveys conducted in 33 rural and urban communities during 1983-1986. The inclusion of data on potential health care users and available providers makes it possible to investigate the impact of the health care envi...

  5. Case Study: Integrating Consumer Demand to Improve Shipments Forecasts

    OpenAIRE

    Charles W. Chase, Jr.

    2005-01-01

    The consumer-packaged goods industry (CPG) gives high priority to linking forecasts of consumer demand to shipments forecasts, in order to capture the impact of marketing activities on factory shipments. In this case study of a CPG company, Charlie Chase shows how to consider marketing and replenishment strategies jointly rather than individually, Copyright International Institute of Forecasters, 2005

  6. Demanding Customers: Consumerist Patients and Quality of Care

    OpenAIRE

    Fang, Hai; Miller, Nolan; Rizzo, John A.; Zeckhauser, Richard

    2008-01-01

    Consumerism arises when patients acquire and use medical information from sources apart from their physicians, such as the Internet and direct-to-patient advertising. Consumerism has been hailed as a means of improving quality. This need not be the result. Consumerist patients place additional demands on their doctors' time, thus imposing a negative externality on other patients. Our theoretical model has the physician treat both consumerist and ordinary patient under a binding time budget. R...

  7. Overweight and Obesity Among Wage-Earners and the Demand for Primary Physician Care

    DEFF Research Database (Denmark)

    Datta Gupta, Nabanita; Greve, Jane

    The standard economic model for the demand for health care predicts that unhealthy behaviour such as being  overweight or obese should increase the demand for medical care, particularly as clinical studies link obesity to a number of serious diseases. In this paper, we investigate whether...... overweight or obese individuals demand more medical care than their normal weight individuals by estimating a finite mixture model which splits the population into frequent and non-frequent users of primary physician (GP) services according to the individual's latent health status. Based on a sample of wage......-earners aged 25-60 years drawn from the National Health Interview (NHI) survey 2000 and merged to Danish register data, we compare differences in the impact of being overweight or obese relative to being normal weight on the demand for primary physician care. Estimated bodyweight effects vary across latent...

  8. Evaluation of Demands and Needs For Dental Care in a Sample of the Turkish Population

    OpenAIRE

    Pekiner, Filiz; Gumru, Birsay; Borahan, Mehmet Oguz; Aytugar, Emre

    2010-01-01

    Objectives: To evaluate the demands and needs for dental care and to identify the level of dental and periodontal status in patients of different age groups visiting the Faculty of Dentistry, Marmara University, Istanbul, Turkey. Methods: A total of 1000 first-visit patients (517 female and 483 male) were examined and questioned. The main complaint of each patient was recorded and considered to be a measure of demand for dental care. The World Health Organization’s (WHO) basic methods were us...

  9. Demand, Selection and Patient Outcomes in German Acute Care Hospitals

    OpenAIRE

    Schwierz, Christoph; Augurzky, Boris; Focke, Axel; Wasem, Jürgen

    2008-01-01

    In times of peak demand hospitals may fail to deliver the high standard of treatment quality that they are able to offer their patients at regular times. To assess the magnitude of these effects, this study analyzes the effects of low staff-to-patients ratios on patient outcomes empirically. We use the variation of patient admissions over time as a proxy for varying staff level. Further, we control for within diagnosis unobservable variation in severity across days with as opposed to days wit...

  10. Demand, Competition and Redistribution in Swedish Dental Care

    OpenAIRE

    Chirico Willstedt, Gabriella

    2015-01-01

    Essay 1: Individuals with higher socioeconomic status (SES) also tend to enjoy better health. Evidence from the economics literature suggests that a potential mechanism behind this “social health gradient” is that human capabilities, that form SES, also facilitate health-promoting behaviors. This essay empirically investigates the significance of socioeconomic differences in health behaviors, using dental care consumption as an operationalization of health investments. I focus on adults at an...

  11. Dental Care Demand: Age-Specific Estimates for the Population 65 Years of Age and Over

    OpenAIRE

    Conrad, Douglas A

    1983-01-01

    This paper derives estimates of the demand for dental care among the U.S. population 65 years of age and over. The analysis is unique in that it focuses on a segment of the population with particular relevance to future policy regarding dental insurance coverage and distinguishes determinants of dental care demand by type of service. The empirical estimates suggest that the use of dental service by elderly persons does respond to price changes and that price-elasticity of demand varies signif...

  12. Health insurance and the demand for medical care: Instrumental variable estimates using health insurer claims data.

    Science.gov (United States)

    Dunn, Abe

    2016-07-01

    This paper takes a different approach to estimating demand for medical care that uses the negotiated prices between insurers and providers as an instrument. The instrument is viewed as a textbook "cost shifting" instrument that impacts plan offerings, but is unobserved by consumers. The paper finds a price elasticity of demand of around -0.20, matching the elasticity found in the RAND Health Insurance Experiment. The paper also studies within-market variation in demand for prescription drugs and other medical care services and obtains comparable price elasticity estimates. PMID:27107371

  13. Estimates of Price and Income Elasticities of At-home Care Demand in Japan: Evidence Based on a Contingent Valuation Method and Actual Demand(in Japanese)

    OpenAIRE

    SHIMIZUTANI Satoshi; Noguchi, Haruko

    2004-01-01

    Due to rapid aging of the country's citizens, Japan faces an enormous long-term care future demand. To control care demand and maintain the current long-term care insurance, policies should be based on price and income elasticities obtained from empirical studies in Japan. This study is meant to provide valuable information that should be incorporated into actual policy-making; it aims to prevent a catastrophe due to explosion of care demand. In the paper we focus on estimating price and inco...

  14. Residential water demand with endogenous pricing: The Canadian Case

    Science.gov (United States)

    Reynaud, Arnaud; Renzetti, Steven; Villeneuve, Michel

    2005-11-01

    In this paper, we show that the rate structure endogeneity may result in a misspecification of the residential water demand function. We propose to solve this endogeneity problem by estimating a probabilistic model describing how water rates are chosen by local communities. This model is estimated on a sample of Canadian local communities. We first show that the pricing structure choice reflects efficiency considerations, equity concerns, and, in some cases, a strategy of price discrimination across consumers by Canadian communities. Hence estimating the residential water demand without taking into account the pricing structures' endogeneity leads to a biased estimation of price and income elasticities. We also demonstrate that the pricing structure per se plays a significant role in influencing price responsiveness of Canadian residential consumers.

  15. Industrial energy policy: a case study of demand in Kuwait

    International Nuclear Information System (INIS)

    The purpose behind building the industrial energy demand model was to enable assessment of the impact of potential policy options and to forecast future energy demand under various assumptions, including the impact of the possible removal of energy subsidies in accordance with the World Trade Organization (WTO) agreement. The results of the model, based on three scenarios, underline several important issues: With nominal energy prices staying the same (the status quo) and with inflation and economic growth continuing to expand (i.e. baseline scenario), it is expected that industrial demand will grow. In this sector, energy consumption is projected to grow at an annual growth rate of about 3.5 per cent throughout the forecast period. In the moderate scenario, however, this drops to 1.9 per cent and when all energy subsidies are removed as in the case of the extreme scenario, the energy consumption is projected to grow by only 1.5 per cent annually throughout the same period. Moreover, with regards to inter-fuel substitution, the model forecast indicates that electricity and natural gas consumption will decline, while the consumption of oil products will increase in all scenarios. The results of the model also indicate that the changing price structure of energy resources should be done in a comprehensive manner. In other words, electricity prices should be adjusted upwards instantly with the adjustment of oil products' prices and natural gas otherwise, a massive inter-fuel substitution will occur within the various consuming industries. (author)

  16. Electric Power Demand Forecasting: A Case Study of Lucknow City

    Directory of Open Access Journals (Sweden)

    A.K. Bhardwaj and R.C. Bansal

    2011-03-01

    Full Text Available The study of forecasting identifies the urgent need for special attention in evolving effective energy policies to alleviate an energy famine in the near future. Since power demand is increasing day by day in entire world and it is also one of the fundamental infrastructure input for the development, its prospects and availability sets significant constraints on the socio-economic growth of every person as well as every country. A care full long-term power plan is imperative for the development of power sector. This need assumes more importance in the state of Uttar Pradesh where the demand for electrical energy is growing at a rapid pace. This study analyses the requirement of electricity with respect to the future population for the major forms of energy in the Lucknow city in Uttar Pradesh state of India. A model consisting of significant key energy indicators have been used for the estimation. Model wherever required refined in the second stage to remove the effect of auto-correlation. The accuracy of the model has been checked using standard statistical techniques and validated against the past data by testing for ‘expost’ forecast accuracy.

  17. The roles of Medicaid and economic factors in the demand for nursing home care.

    OpenAIRE

    Reschovsky, J D

    1998-01-01

    OBJECTIVE: To examine nursing home demand, focusing on how Medicaid affects demand, the role of economic variables, and on important interactions between explanatory factors. DATA SOURCES: From the 1989 National Long Term Care Survey, a nationally representative sample of community-based and institutionalized elderly persons with disabilities (N = 3,837). Survey data are merged with state- and county-level data on Medicaid policy and local market conditions. STUDY DESIGN: Sample members are c...

  18. Issues facing the future health care workforce: the importance of demand modelling.

    Science.gov (United States)

    Segal, Leonie; Bolton, Tom

    2009-01-01

    This article examines issues facing the future health care workforce in Australia in light of factors such as population ageing. It has been argued that population ageing in Australia is affecting the supply of health care professionals as the health workforce ages and at the same time increasing the demand for health care services and the health care workforce.However, the picture is not that simple. The health workforce market in Australia is influenced by a wide range of factors; on the demand side by increasing levels of income and wealth, emergence of new technologies, changing disease profiles, changing public health priorities and a focus on the prevention of chronic disease. While a strong correlation is observed between age and use of health care services (and thus health care workforce), this is mediated through illness, as typified by the consistent finding of higher health care costs in the months preceding death.On the supply side, the health workforce is highly influenced by policy drivers; both national policies (eg funded education and training places) and local policies (eg work place-based retention policies). Population ageing and ageing of the health workforce is not a dominant influence. In recent years, the Australian health care workforce has grown in excess of overall workforce growth, despite an ageing health workforce. We also note that current levels of workforce supply compare favourably with many OECD countries. The future of the health workforce will be shaped by a number of complex interacting factors.Market failure, a key feature of the market for health care services which is also observed in the health care labour market - means that imbalances between demand and supply can develop and persist, and suggests a role for health workforce planning to improve efficiency in the health services sector. Current approaches to health workforce planning, especially on the demand side, tend to be highly simplistic. These include historical

  19. Inventory control in case of unknown demand and control parameters.

    OpenAIRE

    Janssen, E.

    2010-01-01

    This thesis deals with unknown demand and control parameters in inventory control. Inventory control involves decisions on what to order when and in what quantity. These decisions are based on information about the demand. Models are constructed using complete demand information; these models ensure that a certain service level is achieved. However, in real life the demand information is not known completely. Often, only some historical demand observations are available, and these are used to...

  20. Demand and Supply–Based Operating Modes—A Framework for Analyzing Health Care Service Production

    Science.gov (United States)

    Lillrank, Paul; Groop, P Johan; Malmström, Tomi J

    2010-01-01

    Context: The structure of organizations that provide services should reflect the possibilities of and constraints on production that arise from the market segments they serve. Organizational segmentation in health care is based on urgency and severity as well as disease type, bodily function, principal method, or population subgroup. The result is conflicting priorities, goals, and performance metrics. A managerial perspective is needed to identify activities with similar requirements for integration, coordination, and control. Methods: The arguments in this article apply new reasoning to the previous literature. Findings: The method used in this article to classify health care provision distinguishes different types of health problems that share generic constraints of production. Conclusions: The analysis leads to seven different demand-supply combinations, each with its own operational logic. These are labeled demand and supply–based operating modes (DSO modes), and constitute the managerial building blocks of health care organizations. The modes are Prevention, Emergency, One visit, Project, Elective, Cure, and Care. As analytical categories the DSO modes can be used to understand current problems. Several operating modes in one unit create managerial problems of conflicting priorities, goals, and performance metrics. The DSO modes are constructed as managerially homogeneous categories or care platforms responding to general types of demand, and supply constraints. The DSO modes bring methods of industrial management to bear on efforts to improve health care. PMID:21166870

  1. Demanding Patient or Demanding Encounter?: A Case Study of a Cancer Clinic

    OpenAIRE

    Stacey, Clare Louise; Henderson, Stuart; MacArthur, Kelly R; Dohan, Daniel

    2009-01-01

    This paper explores the sociological relevance of demanding encounters between doctors and patients. Borrowing from Potter and McKinlay's (2005) reconceptualization of the doctor-patient relationship, we suggest an analytic shift away from `demanding patients' toward `demanding encounters'. Such a shift places provider-patient conflict within a broader sociocultural context, emphasizing constraints facing both doctor and patient as they interact in a clinical setting. Specifically, through an...

  2. Improving Forecasting Accuracy in the Case of Intermittent Demand Forecasting

    Directory of Open Access Journals (Sweden)

    Daisuke Takeyasu

    2014-06-01

    Full Text Available In making forecasting, there are many kinds of data. Stationary time series data are relatively easy to make forecasting but random data are very difficult in its execution for forecasting. Intermittent data are often seen in industries. But it is rather difficult to make forecasting in general. In recent years, the needs for intermittent demand forecasting are increasing because of the constraints of strict Supply Chain Management. How to improve the forecasting accuracy is an important issue. There are many researches made on this. But there are rooms for improvement. In this paper, a new method for cumulative forecasting method is proposed. The data is cumulated and to this cumulated time series, the following method is applied to improve the forecasting accuracy. Trend removing by the combination of linear and 2nd order non-linear function and 3rd order non-linear function is executed to the production data of X-ray image intensifier tube device and Diagnostic X-ray image processing apparatus. The forecasting result is compared with those of the non-cumulative forecasting method. The new method shows that it is useful for the forecasting of intermittent demand data. The effectiveness of this method should be examined in various cases.

  3. An analysis of the demand for regular dental health care: implications for marketing.

    Science.gov (United States)

    Rutsohn, P; Ibrahim, N A

    2000-01-01

    The more information a dentist has concerning factors that affect the demand or lack of demand for dental care the greater his or her capability to profile client markets. Logically the more exact the profiling of clients (potential clients) the better able the dentist is to develop a marketing program that is responsive to various market segments. In this paper the authors report findings extracted from an extensive health assessment survey which shed light on factors influencing the demand for dental services. Responses from 1934 residents of a large southeastern metropolitan area were analyzed. Statistical analyses of the data were conducted to determine whether or not a relationship existed between dental care utilization and the presence/absence of dental insurance, gender, racial/ethnic background, and household income. The potential implications these factors may have on marketing a dental practice are explored and recommendations presented. PMID:11010218

  4. Labor Supply and the Demand for Child Care: An Intertemporal Approach

    OpenAIRE

    Minagawa, Junichi; Upmann, Thorsten

    2006-01-01

    In this paper, we present a model of a one parent–one child household where parental decisions on labor supply, leisure, and the demand for private and public child care are simultaneously endogenized and intertemporally determined. We characterize the path of the optimal decisions and investigate the impact of various public child care fees and of the quality of public child care services on the parent’s time allocation and the child’s performance level. Our results show that different publi...

  5. Concept for IT Demand Management: Case UPM-Kymmene Oyj

    OpenAIRE

    Laitinen, Pekka

    2016-01-01

    IT demand management creates the foundation for the operation of every IT department. The demand is generated by many different sources. The IT department must be able to respond to the demand with adequate resources and capabilities. Controlled demand management positively affects the cost management, resource allocation and the ability to respond to business needs more proactively. This research was commissioned by UPM-Kymmene. The main purpose was to increase the transparency and visib...

  6. ANALYSIS ON AGRICULTRUAL INFORMATION DEMAND --Case of Jilin Province

    Institute of Scientific and Technical Information of China (English)

    ZHANG Hui-min; JIANG Hui-ming

    2005-01-01

    With the rapid development of agricultural informalization in the world, the demand of agricultural information has been a focus in the international agriculture and information fields. Based on the investigation, this paper presented the four characteristics of the demand of agricultural information in China, including regionality, seasonality, great potential demand and variation in kind and level. The factors influencing the demand of agricultural information were analyzed by the Optimized Less Square (OLS) method. The result shows that, of all factors influcing agricultural information demand, the most important one is economy, the second is facility of information pass,and knowledge and education of user, credit of agricultural information service system and production situation follow. Taking Jilin Province as an example, this article also elaborated the agricultural information demand status, and deduced the regression model of agricultural information demand and verified it by the survey in rural Jilin.

  7. Integrated care as an organisational challenge: an exploratory case study (poster presentation)

    OpenAIRE

    Pless, Sam; Dessers, Ezra; Corvers, Benny; Van Hootegem, Geert

    2014-01-01

    Introduction: Integrated care is aimed towards more demand-driven and cost-conscious health systems. The multidisciplinary research project CORTEXS brings together expertise on organization sciences and integrated care [1]. Aims: In order to gain a better grasp of the connection of the concept of integrated care with principles of organisational design, we conducted an exploratory case study on task division and allocation in a regional hospital [2]. Case study: The study is specifica...

  8. An Alternative Determinant of Warehouse Space Demand: A Case Study

    OpenAIRE

    Asieh Mansour; Marvin C. Christensen

    2001-01-01

    A unique approach is used to assess the demand for warehouse space. Typically, demand for warehouse space has been modeled using population or employment measures. Unlike previous work, warehouse inventory, rather than employment, is used to model space demand. Warehouse inventory is proxied by data on freight shipments. Detailed information on the location and freight activity of manufacturing plants and distribution centers across the United States, Dallas, Los Angeles, and Seattle is used....

  9. The Role of Demand Factors in Utilization of Professional Care during Childbirth: Perspectives from Yemen

    OpenAIRE

    Töres Theorell; Annica Kempe; Fatoom Noor-Aldin Alwazer

    2011-01-01

    Background. Utilization of professional care during childbirth by women in low-income countries is important for the progress towards MDG 5. In Yemen, home births have decreased minimally during the past decades. Objective. The study investigates the influence of socio-demographic, birth outcome and demand factors on women's future preference of a home or institutional childbirth. Method. We interviewed 220 women with childbirth experience in urban/rural Yemen. We performed bivariate chi-squa...

  10. Nonparametric checks for count data models: an application to demand for health care in Spain

    OpenAIRE

    Álvarez, Begoña; Delgado, Miguel A.

    1997-01-01

    This paper presents model specification checking procedures for count data regression models which are consistent in the direction of nonparametric alternatives. The discussion is motivated in the context of a model of demand for health care in Spain. The parameters of the regression model are estimated by maximum likelihood based on Poisson and Negative Binomial specifications as well as by ordinary least squares and semiparametric generalized least squares. However, our interest is not only...

  11. Ebola cases and health system demand in Liberia.

    Directory of Open Access Journals (Sweden)

    John M Drake

    2015-01-01

    Full Text Available In 2014, a major epidemic of human Ebola virus disease emerged in West Africa, where human-to-human transmission has now been sustained for greater than 12 months. In the summer of 2014, there was great uncertainty about the answers to several key policy questions concerning the path to containment. What is the relative importance of nosocomial transmission compared with community-acquired infection? How much must hospital capacity increase to provide care for the anticipated patient burden? To which interventions will Ebola transmission be most responsive? What must be done to achieve containment? In recent years, epidemic models have been used to guide public health interventions. But, model-based policy relies on high quality causal understanding of transmission, including the availability of appropriate dynamic transmission models and reliable reporting about the sequence of case incidence for model fitting, which were lacking for this epidemic. To investigate the range of potential transmission scenarios, we developed a multi-type branching process model that incorporates key heterogeneities and time-varying parameters to reflect changing human behavior and deliberate interventions in Liberia. Ensembles of this model were evaluated at a set of parameters that were both epidemiologically plausible and capable of reproducing the observed trajectory. Results of this model suggested that epidemic outcome would depend on both hospital capacity and individual behavior. Simulations suggested that if hospital capacity was not increased, then transmission might outpace the rate of isolation and the ability to provide care for the ill, infectious, and dying. Similarly, the model suggested that containment would require individuals to adopt behaviors that increase the rates of case identification and isolation and secure burial of the deceased. As of mid-October, it was unclear that this epidemic would be contained even by 99% hospitalization at the

  12. Demand Constraints and New Demands: Regulations, Markets and Institutions Efficiency (A Case Study for Cape Verde

    Directory of Open Access Journals (Sweden)

    Bernardo Reynolds Pacheco de Carvalho

    2014-08-01

    Full Text Available Economic efficiency is a key issue in economic research and for policy design, and certainly for food security challenges. In the food system dynamics the understanding of changes and trends is crucial to improve our capacity to deal with the objectives of sustainable development and quality of life. Food system efficiency evaluation is necessary with regard to production and consumption efficiencies as well as market and governance dilemmas. Regulations and institutional efficiency are crucial aspects that are frequently forgotten, and efforts should be made to improve the capacity to deal with those methodological needs. In many situations, in the real world, data and measurements are difficult or even impossible to get in numeric or quantitative terms. Frequently, a qualitative evaluation is the only way to proceed, but measurements and numeric references are still important, mainly when changes over time are central to the research. The actual paper follows a structural food system model (WFSE – World Food Security Equation and a general equilibrium approach (ICI model – induced changes and innovation model to show in a country case study (Cape Verde the important role of markets and institutions as compared to regulation practices directed to improve economic efficiency subject to demand behavior. Cape Verde is a very challenging country with regard to the food security status (where natural resources are very poor for agricultural production but with great success in global and macro terms in the last 10 years. The main problems nowadays are clearly at local level. The present research tries to highlight the global achievements and explore local assessment efforts on food consumption conditions. A specific region is studied, in the island of Santo Antão, one of the most important production regions. Three different production systems were compared mainly with regard to their respective influence on consumption habits, incomes and

  13. Overcoming job demands to deliver high quality care in a hospital setting across Europe: The role of teamwork and positivity

    OpenAIRE

    Montgomery Anthony; Panagopoulou Efharis; Costa Patricia

    2014-01-01

    Health care professionals deal on a daily basis with several job demands – emotional, cognitive, organizational and physical. They must also ensure high quality care to their patients. The aim of this study is to analyse the impact of job demands on quality of care and to investigate team (backup behaviors) and individual (positivity ratio) processes that help to shield that impact. Data was collected from 2,890 doctors and nurses in 9 European countries by means of questionnaires. Job ...

  14. The old care paradigm is dead, long live the new sustainable care paradigm: how can GP commissioning consortia meet the demand challenges of 21st century healthcare?

    OpenAIRE

    Mackenzie, James

    2011-01-01

    There are many challenges facing the health system in the 21st century – the majority of which are related to managing demand for health services. To meet these challenges emerging GP commissioning consortia will need to take a new approach to commissioning health services – an approach that moves beyond the current acute-centred curative paradigm of care to a new sustainable paradigm of care that focuses on primary care, integrated services and upstream prevention to manage demand. A key par...

  15. Energy demand modelling and GHG emission reduction: case study Croatia

    DEFF Research Database (Denmark)

    Pukšec, Tomislav; Mathiesen, Brian Vad; Novosel, Tomislav;

    2013-01-01

    and develop new energy policy towards energy efficiency and renewable energy sources, in order to comply with all of the presented tasks. Planning future energy demand, considering various policy options like regulation, fiscal and financial measures, becomes one of the crucial issues of future...... national energy strategy. This paper analyses Croatian long term energy demand and its effect on the future national GHG emissions. For that purpose the national energy demand model was constructed (NeD model). The model is comprised out of six modules each representing one sector, following Croatian...... national energy balance; industry, transport, households, services, agriculture and construction. For three of the modules (industry, transport and households) previously developed long term energy demand models were used, while for the remaining three new models were constructed. As an additional feature...

  16. Managing the growing energy demand - The case of Egypt

    Energy Technology Data Exchange (ETDEWEB)

    El-Kholy, Hosni; Faried, Ragy

    2010-09-15

    The electric energy consumption rate in Egypt has an average increase of 7% per year through the last three decades. In order to satisfy the ever increasing energy demand, several actions were, and have to be taken. These actions have to be carried out in parallel. The one having the greatest effect is the measures carried out for energy conservation and loss reduction. Diversifying the energy source such as utilization of Renewable Energy technologies can contribute to satisfying the demand and extending the hydro-carbon reserves life. Regional integration of electrical networks will save expenditures used to build additional power plants.

  17. Price elasticity of demand for cigarettes : The Case of Sweden

    OpenAIRE

    Ahmed, Sadeq Mohamed; Vaziri, Kamran

    2014-01-01

    Due to health problems and the negative externalities associated with cigarette consumption, many governments try to discourage cigarette consumption by increasing its price through taxation. However, cigarette, like the other addictive goods, is viewed as that it is not sensitive to demand rules and the market forces. This study analyses the effect of price increase on cigarette consumption. We used Swedish time series data from 1970 to 2010. Our results reveal that though cigarette is addic...

  18. Demand response in liberalized electricity markets - the Nordic case

    International Nuclear Information System (INIS)

    The liberalization of the Nordic electricity markets started with the deregulation of the Norwegian market, and the later inclusion of Sweden, Denmark and Finland in The Nord Pool area has provided a truly international marketplace, where prices are quoted for all the Nordic countries except Iceland. The structure of the Norwegian supply side was a favorable starting point for the liberalization process with many independent (hydropower) producers and, following the Energy Act of 1991, the vertical separation of competitive production on the one hand and regulated transmission / distribution one the other hand (implemented as a requirement of separation of financial accounts). Moreover, since the mid 1990s (unregulated) retail competition has provided market based price-signals to customers, even to individual households. In this paper we will focus on the potential benefits of demand flexibility in order to enhance the performance of the electricity market in attaining optimal operation and development of the electricity system. These benefits will depend on the price elasticity of the demand. However, whether it is possible to act on price changes also depends on the information provided to and from the customers. Especially for short run flexibility, this may require two way communication devises for larger customer groups, which raises questions like who is to pay for the investments needed, and who will benefit from them. Demand response also depends on the marginal signals resulting from the different contracts offered to the customers. Today this includes ''variable'' price, spot price (based on Nord Pool Elspot) and fixed price contracts. Customer flexibility depends on the possibility of substitution for instance to other fuels / alternative energy provisions. Finally, flexibility will differ between customer classes, for instance households, industry, power intensive industry etc. In this paper we investigate demand response and customer flexibility in

  19. Synthesizing Econometric Evidence: The Case of Demand Elasticity Estimates.

    Science.gov (United States)

    DeCicca, Philip; Kenkel, Don

    2015-06-01

    Econometric estimates of the responsiveness of health-related consumer demand to higher prices are often key ingredients for risk policy analysis. We review the potential advantages and challenges of synthesizing econometric evidence on the price-responsiveness of consumer demand. We draw on examples of research on consumer demand for health-related goods, especially cigarettes. We argue that the overarching goal of research synthesis in this context is to provide policy-relevant evidence for broad-brush conclusions. We propose three main criteria to select among research synthesis methods. We discuss how in principle and in current practice synthesis of research on the price-elasticity of smoking meets our proposed criteria. Our analysis of current practice also contributes to academic research on the specific policy question of the effectiveness of higher cigarette prices to reduce smoking. Although we point out challenges and limitations, we believe more work on research synthesis in this area will be productive and important. PMID:25809022

  20. Demands, constructions and challenges experienced by occupational therapists in primary health care

    Directory of Open Access Journals (Sweden)

    Fernanda dos Reis

    2014-05-01

    Full Text Available Objective: To understand the demands, constructions and challenges experienced by occupational therapists in primary health care in Fortaleza city, Ceará, Brazil. Methods: This is a qualitative study conducted with 13 occupational therapists of the Support Centers for Family Health. It used the focus group method in March 2011 at the headquarters of the Regional Council of Physiotherapy and Occupational Therapy – 6th Region. After the thematic analysis of the material, with theoritical contributions of occupational therapy and collective health, the following categories emerged: construction of work processes; demand and assisted population; contributions and challenges of the occupational therapists. Results: It could be observed that occupational therapists encouraged teams to perform joint actions through health promotion activities for priority groups and created room for planning the construction of comprehensive care between healthcare teams and users, highlighting the challenges of the territory as a space for interdisciplinary achievements, where the problem resolution requires sensitivity and recognition by the professional categories in field. Conclusion: It is understood that diversities and specificities inherent to the territory relate to the needs, and the community daily routine, in addition to the field stresses, counters the team work logic, implying fragility in the actions of supporters. doi:10.5020/18061230.2013.p356

  1. Operational resilience of reservoirs to climate change, agricultural demand, and tourism: A case study from Sardinia.

    Science.gov (United States)

    Mereu, Simone; Sušnik, Janez; Trabucco, Antonio; Daccache, Andre; Vamvakeridou-Lyroudia, Lydia; Renoldi, Stefano; Virdis, Andrea; Savić, Dragan; Assimacopoulos, Dionysis

    2016-02-01

    Many (semi-) arid locations globally, and particularly islands, rely heavily on reservoirs for water supply. Some reservoirs are particularly vulnerable to climate and development changes (e.g. population change, tourist growth, hydropower demands). Irregularities and uncertainties in the fluvial regime associated with climate change and the continuous increase in water demand by different sectors will add new challenges to the management and to the resilience of these reservoirs. The resilience of vulnerable reservoirs must be studied in detail to prepare for and mitigate potential impacts of these changes. In this paper, a reservoir balance model is developed and presented for the Pedra e' Othoni reservoir in Sardinia, Italy, to assess resilience to climate and development changes. The model was first calibrated and validated, then forced with extensive ensemble climate data for representative concentration pathways (RCPs) 4.5 and 8.5, agricultural data, and with four socio-economic development scenarios. Future projections show a reduction in annual reservoir inflow and an increase in demand, mainly in the agricultural sector. Under no scenario is reservoir resilience significantly affected, the reservoir always achieves refill. However, this occurs at the partial expenses of hydropower production with implications for the production of renewable energy. There is also the possibility of conflict between the agricultural sector and hydropower sector for diminishing water supply. Pedra e' Othoni reservoir shows good resilience to future change mostly because of the disproportionately large basin feeding it. However this is not the case of other Sardinian reservoirs and hence a detailed resilience assessment of all reservoirs is needed, where development plans should carefully account for the trade-offs and potential conflicts among sectors. For Sardinia, the option of physical connection between reservoirs is available, as are alternative water supply measures

  2. Creating demand for cataract services: a Cambodian case study

    Directory of Open Access Journals (Sweden)

    Seng Sophal

    2006-12-01

    Full Text Available Following decades of civil disturbance in Cambodia, by the early 1990s there were few doctors remaining in the country, and little in the way of eye care services.With NGO support, training centres were established to train medical graduates and nurses as ‘basic eye doctors’ and ‘basic eye nurses’. These workers were then placed in provincial eye units to serve the eye care needs of those provinces. However, it soon became clear that, despite evidence that blindness, including cataract blindness, was prevalent, patients were not attending these provincial eye units. Attention was therefore given to finding out more about the barriers preventing patients benefiting from these services.

  3. Characterization of the elastic displacement demand: Case study - Sofia city

    International Nuclear Information System (INIS)

    The results of the study on the seismic site response in a part of the metropolitan Sofia are discussed. The neo-deterministic seismic hazard assessment procedure has been used to compute realistic synthetic waveforms considering four earthquake scenarios, with magnitudes M = 3.7, M = 6.3 and M = 7.0. Source and site specific ground motion time histories are computed along three investigated cross sections, making use of the hybrid approach, combining the modal summation technique and the finite differences scheme. Displacement and acceleration response spectra are considered. These results are validated against the design elastic displacement response spectra and displacement demand, recommended in Eurocode 8. The elastic response design spectrum from the standard pseudo-acceleration, versus natural period, Tn, format is converted to the Sa - Sd format. The elastic displacement response spectra and displacement demand are discussed with respect to the earthquake magnitude, the seismic source-to-site distance, seismic source mechanism, and the local geological site conditions. (author)

  4. Influence of the demand information quality on planning process accuracy in supply chain. Case studies

    Directory of Open Access Journals (Sweden)

    Natalia Szozda

    2013-06-01

    Full Text Available Background: Identification and analysis of factors that affect the accuracy of demand planning process across the supply chain is one of the most important problems which influence the effectiveness of its material and information flows. Material and methods: On the basis of demand planning process investigation authors define the main elements affecting the right supply chain performance level and investigate the possible connections between demand information quality and demand planning process accuracy. Later, an overview of some recent developments in the analyzed research area is provided. Results: Based on the literature review, there is described the defined factors impact on the accuracy of demand plan in each echelon for case companies. There are considered three cases. The examples illustrate supply chains of different manufacturing companies. The focus is placed on demand planning across the supply chains. The issue of determining the accuracy of future sales plans in each echelon of supply chains and factors affecting it are raised. Taking into account the case companies demand planning process analyses, there are defined possible quality measures, that are possible to be used when forecasting the customer demand. Conclusions: One of the most important and difficult planning area in the companies is becoming planning demand. Errors in planning are reflected not just in the business resource planning but also in the entire supply chain. Presented cases show that many factors affect the proper demand planning process in the supply chain, like e.g.  information technologies, lead-time, or number of supplied materials. As it can be seen from the case studies, the model of collecting information from the market plays an important role in the demand planning process.

  5. Forecasting demand for single-period products : A case study in the apparel industry

    NARCIS (Netherlands)

    Mostard, Julien; Teunter, Ruud; de Koster, Rene

    2011-01-01

    The problem considered is that of forecasting demand for single-period products before the period starts. We study this problem for the case of a mail order apparel company that needs to order its products pre-season. The lack of historical demand data implies that other sources of data are needed.

  6. Clinical demand in an emergency care unit according to the Manchester triage system

    Directory of Open Access Journals (Sweden)

    Aline Santos Diniz

    2014-06-01

    Full Text Available The general objective of the present study is to identify the clinical demand of patients cared for by nursing professionals according to the risk classification of an Emergency Care Unit, following the Manchester triage system. It is a quantitative descriptive study whose sample was composed of 364 patient records. The data was analyzed via the Statistical Package for the Social Sciences, using descriptive, bivariate statistics and Spearman’s correlation. The patient’s main complaints were: “Adult indisposition,” “Problems with the limbs,” “Abdominal pain,” and “Headaches.” There was inverse correlation between age and risk classification (rs = -0.14 p=0,005, and time of admittance and risk classification (rs = -1.02, p=0.046. We conclude that the patients classified according to risk presented urgent and non-urgent complaints. The higher the patient’s age and the later in the day they were admitted, the more severe their clinical condition.   doi: 10.5216/ree.v16i2.21700.

  7. Demand forecast: a case study at a meat agribusiness in west Santa Catarina

    Directory of Open Access Journals (Sweden)

    Cleunice Zanella

    2016-03-01

    Full Text Available Based on demand forecasts, companies plan production, financial and personnel scenarios, both in the long and short term. The forecasts are essential, especially for companies working with a push production system, for which there is no sale of collateral. They should therefore plan their production and financial systems with the aim of meeting the demand forecast of their products or services. Thus, this study was conducted at a meat agribusiness located in Chapecó, in the state of Santa Catarina, in order to analyze the demand forecasting methods used by the company. It is a case study with a qualitative approach. Data collection was conducted through semi-structured interviews with the operations manager, commercial manager and analysts who respond to the demand forecasts made. The main results highlight the use of both quantitative and qualitative methods, as well as indicating the importance of demand forecasts for the planning of the company

  8. Effect of Pressure dependent demand on pipe network analysis: A case study

    Directory of Open Access Journals (Sweden)

    MINAKSHI SHRIVASTAVA

    2014-01-01

    Full Text Available Water distribution network is most important part of world’s infrastructure. In the present work, analysis for proposed site of school of planning and architecture, Bhopal is done by using demand based analysis and the design is further analyzed for pressure dependent demand. Detailed study of variation of threshold pressure with power function is carried out .Complete site is divided into two zones having two separate water tank for supply and the analysis is done by varying threshold pressure and power function in case of pressure dependent demand by using commercial pipe network analysis software.

  9. Quality Competition and a Demand Spillover Effect: A Case of Product Differentiated Duopoly

    OpenAIRE

    Tsuyoshi Toshimitsu

    2012-01-01

    Employing the price-quality competition model in a horizontally differentiated products market, we analyze how a demand spillover effect associated with upgrading the quality level of a product affects the strategic relationship between firms and the property of a subgame perfect Nash equilibrium. In particular, we show that the strategic relationship depends on the degree of a demand spillover effect. Then, we consider the cases of second-best policy and cooperative quality choice. Furthermo...

  10. Use of demand forecast in operational purchasing : case: Vaisala corporation component level forecast purchasing

    OpenAIRE

    Oksanen, Tuomas

    2015-01-01

    This thesis is a case study of Vaisala, a Finnish technology company. Vaisala uses LEAN manufacturing models and assemble-to-order production strategy to better serve its customers. Material availability is ensured by using an enterprise resource planning program and component specific forecasting that is derived from demand forecast. A demand forecast offers the possibility to make the operations more efficient but still offer the customers’ higher value through better delivery times. It...

  11. Forecasting need and demand for home health care: a selective review.

    Science.gov (United States)

    Sharma, R K

    1980-01-01

    THREE MODELS FOR FORECASTING HOME HEALTH CARE (HHC) NEEDS ARE ANALYZED: HSA/SP model (Health Systems Agency of Southwestern Pennsylvania); Florida model (Florida State Department of Health and Rehabilitative Services); and Rhode Island model (Rhode Island Department of Community Affairs). A utilization approach to forecasting is also presented.In the HSA/SP and Florida models, need for HHC is based on a certain proportion of (a) hospital admissions and (b) patients entering HHC from other sources. The major advantage of these models is that they are relatively easy to use and explain; their major weaknesses are an imprecise definition of need and an incomplete model specification.The Rhode Island approach defines need for HHC in terms of the health status of the population as measured by chronic activity limitations. The major strengths of this approach are its explicit assumptions and its emphasis on consumer needs. The major drawback is that it requires considerable local area data.The utilization approach is based on extrapolation from observed utilization experience of the target population. Its main limitation is that it is based on current market imperfections; its major advantage is that it exposes existing deficiencies in HHC.The author concludes that each approach should be tested empirically in order to refine it, and that need and demand approaches be used jointly in the planning process. PMID:6893631

  12. Case management for long-term and acute medical care

    OpenAIRE

    Capitman, John A.

    1988-01-01

    Case management has developed as an administrative service for controlling costs and improving the quality of health and social service delivery. Long-term care case management combined with service expansion has been examined in some detail with varied results. Less research has focused on case management for users of high-cost medical care. This overview highlights five programs and patient groups where integrated delivery and/or financing of medical and long-term care services are being de...

  13. Research on the Demands of Long-term Care Service for the Elderly and Its Inlfuencing Factors:A Case of Shannxi Province%老年人长期照护服务的需求意愿分析及对策建议--基于陕西省的调查

    Institute of Scientific and Technical Information of China (English)

    翟绍果; 郭锦龙

    2013-01-01

    In order to understand the demands of long-term care service for the elderly and its inlfuencing factors, random sampling is used in the questionnaire survey on urban and rural elderly in Shaanxi Province. The result shows that the demands of the elderly appear as diversiifed due to the difference of gender, physical health, spiritual life, and the current way of pension. The main factors inlfuencing needs of the elderly are gender, the ability to take care of themselves, spiritual life, current pension ways, whether the current service comprehensive, whether they satisifed with the current service. Therefore, in order to effectively meet the needs of long-term care service for the elderly, we must make efforts to increase the income of the elderly, formulate and improve relevant laws and policies, mobilize all social sectors to participate actively, and shape the healthy and active aging view.%为了解老年人长期照护服务的需求意愿及其影响因素,本文采用随机抽样方法对陕西省城乡老年人作了问卷调查。研究发现,老年人的需求意愿因性别、身体健康状况、精神生活、当前养老方式等的不同而呈现出多样化特征;影响老年人需求的因素依次是性别、生活能否自理、精神生活、当前养老方式、当前长期照护服务是否全面、对当前长期照护服务是否满意等。为有效满足老年人的长期照护服务需求,须努力增加老年人收入,制定并完善相关法律政策,调动社会各方力量积极参与,塑造全新的健康老龄观和积极老龄观。

  14. Care production for tuberculosis cases:analysis according to the elements of the Chronic Care Model

    OpenAIRE

    Daiane Medeiros da Silva; Hérika Brito Gomes de Farias; Tereza Cristina Scatena Villa; Lenilde Duarte de Sá; Maria Eugênia Firmino Brunello; Jordana Almeida Nogueira

    2016-01-01

    Abstract OBJECTIVE: To analyze the care provided to tuberculosis cases in primary health care services according to the elements of the Chronic Care Model. METHOD: Cross-sectional study conducted in a capital city of the northeastern region of Brazil involving 83 Family Health Strategy professionals.A structured tool adapted to tuberculosis-related care in Brazil was applied.Analysis was based on the development of indicators with capacity to produce care varying between limited and optimum...

  15. Is Health Care demand rationed by income and other determinants? An empirical assessment for Italy

    OpenAIRE

    R. Bardazzi

    2009-01-01

    This paper offers an empirical assessment of the determinants of healthcare demand in Italy for a detailed range of services. Our approach relies on the literature using two-part models to study healthcare demand. An econometric hurdle model is applied to study the demand for healthcare, providing insight into how relevant socio-economic variables are in determining both the decision to contact and how frequently to use a service, and the choice between public and the private providers. An i...

  16. A methodological proposal to research patients’ demands and pre-test probabilities using paper forms in primary care settings

    Directory of Open Access Journals (Sweden)

    Gustavo Diniz Ferreira Gusso

    2013-04-01

    Full Text Available Objective: The purpose of this study is to present a methodology for assessing patients’ demands and calculating pre-test probabilities using paper forms in Primary Care. Method: Most developing countries do not use Electronic Health Records (EHR in primary care settings. This makes it difficult to access information regarding what occurs within the health center working process. Basically, there are two methodologies to assess patients’ demands and problems or diagnosis stated by doctors. The first is based on single attendance at each appointment, while the second is based on episodes of care; the latter deals with each problem in a longitudinal manner. The methodology developed in this article followed the approach of confronting the ‘reason for the appointment’ and ‘the problem registered’ by doctors. Paper forms were developed taking this concept as central. All appointments were classified by the International Classification of Primary Care (ICPC. Discussion: Even in paper form, confrontation between ‘reason for the appointment’ and ‘problem registered’ is useful for measuring the pre-test probabilities of each problem-based appointment. This approach can be easily reproduced in any health center and enables a better understanding of population profile. Prevalence of many illnesses and diseases are not known in each reality, and studies conducted in other settings, such as secondary and tertiary care, are not adequate for primary health care. Conclusion: This study offers adequate technology for primary health care workers that have potential to transform each health center into a research-led practice, contributing directly to patient care.

  17. Demand for Health Care Services in Uganda: Implications for Poverty Reduction

    OpenAIRE

    Kasirye, Ibrahim; Ssewanyana, Sarah; Nabyonga, Juliet; Lawson, David

    2004-01-01

    Using the 2002/03 Uganda National Household Survey data we empirically examine the nature and determinants of individuals' decision to seek care on condition of illness reporting. The major findings include: cost of care is regressive and sustainability reduces the health care utilization for any formal provider by the poorer individuals afters controlling for other factors. In other words, even among public facilities cost of care remains a barrier to utilization of these services. Second, t...

  18. Mass Housing and Changings in Housing Demand, Case of Diyarbakir, Turkey

    OpenAIRE

    Sinemillioglu, M. Oguz; Akýn, Can Tuncay; Özyýlmaz, Havva

    2005-01-01

    The aim of this study is to analyze changings in housing demand, especially in term of house size in Diyarbakýr case, in Turkey. Though Housing in Turkey is in a free market system, there is a Mass Housing Administration (TOKÝ) has been doing mass houses for, relatively, middle class income people. Diyarbakýr, one of the cities that TOKÝ has done two thousand houses, has taken too much migration, so that the demand in housing form and structure has different alterations. This process should b...

  19. Optimal demand reponse to water pricing policies under limited water supply in irrigation: a case study

    Science.gov (United States)

    Grießbach, Ulkrike; Stange, Peter; Schuetze, Niels

    2015-04-01

    Due to climate change, extreme weather conditions such as droughts may have an increasing impact on irrigated agriculture. To cope with the higher demand of water, a new decision support framework is developed which focuses on an integrated management of both irrigation water supply and demand. For modeling the regional water demand, local stochastic water demand functions are used which are derived from optimized agronomic response on farms scale. These functions take into account different soil types, crops, stochastically generated climate scenarios considering different economic conditions, e.g., variable and fixed costs. This generic approach enables the consideration of both multiple crops at farm scale as well as of the aggregated response to water pricing at a regional scale for full and deficit irrigation systems. Within the SAPHIR (SAxonian Platform for High Performance IRrigation) project a prototype of a decision support system is developed and applied for a case study in Saxony which helps to evaluate combined water supply and demand management policies on a regional level.

  20. Labor Supply Heterogeneity and Demand for Child Care of Mothers with Young Children

    NARCIS (Netherlands)

    Apps, Patricia F.; Kabátek, J.; Rees, Ray; van Soest, A.H.O.

    2012-01-01

    This paper introduces a static structural model of hours of market labor supply, time spent on child care and other domestic work, and bought in child care for married or cohabiting mothers with pre-school age children. The father's behavior is taken as given. The main goal is to analyze the sensiti

  1. DEMAND FLUCTUATION IN OFF SEASON : Case Study of Summit Hotel, Lalitpur, Nepal

    OpenAIRE

    Maharjan, Anju

    2012-01-01

    Seasonality is known as one of the most typical features of the tourism industry, affecting positively or negatively on tourism including the hotel industry. Seasonality demands have been a major problem for the hotel industry and have had a negative impact, such as, difficulties in gaining access to capital, low returns on investment and the inefficient use of resources. The phenomenon of seasonality imposes greater risks for tourism. This thesis concerned with a case study of a three st...

  2. Simulating the impact of pricing policies on residential water demand: a Southern France case study

    OpenAIRE

    Rinaudo, J.D.; Neverre, N.; Montginoul, M.

    2012-01-01

    The case study conducted in this paper looks at residential water pricing from three different points of view. It first describes existing urban water-pricing practices in Southern France, emphasizing that pricing is not yet being used as a tool for providing economic incentives to save water. It then looks at the observed impact of pricing on water consumption, through an econometric analysis of a cross-sectional data set. The analysis suggests that demand, with an estimated price elasticity...

  3. The reduction of energy demand from the existing stock of school buildings. An italian case study

    OpenAIRE

    P. Gallo; Romano, R.

    2012-01-01

    The paper will focus on the existing school stock building recovery in order to reduce the energy demand. The work analyze the actual legislative Italian situation and describes an expressive case study of a sustainable recovery of a building school situated in the Lucca city that is partner in the project TEENERGY, founded by EU Commission in the MED Programme, that have as principal objectives to create a transnational network among Public Authorities, Universities, technical bodies and sc...

  4. A COINTEGRATION ANALYSIS OF AIR TRAVEL DEMAND: THE CASE OF INTERNATIONAL AIR TRAVEL DEMAND BETWEEN MOROCCO AND EUROPEAN UNION

    Directory of Open Access Journals (Sweden)

    Elmostafa Erraitab

    2016-03-01

    Full Text Available Europe is the most important source of tourism for Morocco. The purpose of this paper is to investigate the short and long-run determinants of air travel demand from European Union to Morocco. In order to analyze the air travel demand, we used the relevant macroeconomic variables, such as the origin countries’ income, i.e. Europe and the real exchange rate between the origin and host country. Annual data from the two countries, covering the period 1970-2012, are used. The ADF unit root test was used to examine the degree of variables integration. The Johansen maximum likelihood procedure was used to determine the number of co-integrating vectors in the VAR model. An error correction model was estimated to explain the air travel demand determinants between Morocco and the EU both in short and long-run. The estimated error correction model provides strong evidence that European GDP, real exchange rate fluctuations and regulatory environment are the main factors affecting air travel demand in Morocco.

  5. The old care paradigm is dead, long live the new sustainable care paradigm: how can GP commissioning consortia meet the demand challenges of 21st century healthcare?

    Science.gov (United States)

    Mackenzie, James

    2011-07-01

    There are many challenges facing the health system in the 21st century - the majority of which are related to managing demand for health services. To meet these challenges emerging GP commissioning consortia will need to take a new approach to commissioning health services - an approach that moves beyond the current acute-centred curative paradigm of care to a new sustainable paradigm of care that focuses on primary care, integrated services and upstream prevention to manage demand. A key part of this shift is the recognition that the health system does not operate in a vacuum and that strategic commissioning decisions must take account of wider determinants of health and well-being, and operate within the finite limits of the planet's natural resources. The sustainable development principle of balancing financial, social and environmental considerations is crucial in managing demand for health services and ensuring that the health system is resilient to risks of resource uncertainty and a changing climate. Building sustainability into the governance and contracting processes of GP commissioning consortia will help deliver efficiency savings, impact on system productivity, manage system risk and help manage demand through the health co-benefits of taking a whole systems approach to commissioning decisions. Commissioning services from providers committed to corporate social responsibility and sustainable business practices allows us to move beyond a health system that cures people reactively to one in which the health of individuals and populations is managed proactively through prevention and education. The opportunity to build sustainability principles into the culture of GP commissioning consortia upfront should be seized now to ensure the new model of commissioning endures and is fit for the future. PMID:25949650

  6. Improving Demand-oriented Quality Care in Family Planning--A Review of Practice and Experience in Family Planning Programme of Qianjiang, Hubei

    Institute of Scientific and Technical Information of China (English)

    Jia-yuan LIAO; Meng-ye PENG; Er-sheng GAO

    2003-01-01

    @@ With the mainstreaming being the demand from the people at reproductive age, we systematically analyzed the ideas and ways to implement quality care (QC) in family planning (FP) in Qianjiang, including advocating the conception of quality care, carrying out health education and counseling, strengthening capacity building of service system and reforming measurement of the evaluation and other aspects. The demand-oriented QC in FP has met personalized and verified demands from people of reproductive age satisfactorily, and kept the fertility rate at a lower level while uplifting satisfaction of the public. The demand-oriented QC in FP in Qianjiang county proved to be a successful and great worth practice.

  7. Identification, Evaluation and Control of Physically Demanding Patient-Handling Tasks in an Acute Care Facility

    OpenAIRE

    Callison, Myrna

    2007-01-01

    Work-related musculoskeletal disorders (WMSDs) are prevalent among health care workers worldwide and underreporting among nurses may mask the true impact of these injuries. Nursing staff are consistently among the top 10 occupations at risk for experiencing WMSDs and patient-handling tasks are the precipitating event in the majority of back injuries experienced among nursing staff. Existing research has focused on patient-handling issues within long-term care facilities, and identify...

  8. The difficult, demanding, and demented AIDS patient in long-term care

    OpenAIRE

    DUBLER, NANCY NEVELOFF

    2000-01-01

    Demented AIDS patients in long-term care present interconnected medical, ethical, and management problems. The patient's right to care must be considered in the context of the obligations owed to other residents and to staff members. A principled analysis should focus on substantive and procedural issues: the concept of autonomy must be modified by notions of accommodation to the needs of others; procedural fairness should guide discussions. A dynamic analysis should identify the various part...

  9. The caregiving bind: concealing the demands of informal care can undermine the caregiving identity.

    Science.gov (United States)

    Moore, Helen; Gillespie, Alex

    2014-09-01

    Disagreements and misunderstandings between informal caregivers and care-receivers have been widely reported, but the causes are unclear. The present article compares the views of people with acquired brain injury and their main informal caregivers (28 dyads, n = 56). First, we report a quantitative analysis finding that the majority of disagreements were about caregivers' identity. Caregivers saw themselves as less confident, less intelligent, more embarrassed, more independent and more overprotective than care-receivers rated them to be. Caregivers understood the care-receivers' ratings but disagreed with them' Second, we report a qualitative analysis focussing on how caregivers felt themselves to be perceived by significant others. Caregivers felt that the care-receiver, family members, the general public, health services and even friends often have negative views of them. The 'caregiving bind' is proposed as a cause of caregivers' negative identity. It arises when caregivers try to protect the care-receiver's identity by concealing the extent of informal care provision, with the unintended consequence of undermining the prospects of the caregiver receiving positive social recognition for the challenging work of caregiving. The caregiving bind has implications for therapy and points to the potential of friends and health services to provide caregivers with positive social recognition. PMID:24996218

  10. Issue Salience and the Domestic Legitimacy Demands of European Integration. The Cases of Britain and Germany

    Directory of Open Access Journals (Sweden)

    Henrike Viehrig

    2008-04-01

    Full Text Available The salience of European issues to the general public is a major determinant of the domestic legitimacy demands that governments face when they devise their European policies. The higher the salience of these issues, the more restrictive will be the legitimacy demands that governments have to meet on the domestic level. Whereas the domestic legitimacy of European policy can rest on a permissive consensus among the public in cases of low issue salience, it requires the electorate’s explicit endorsement in cases of high issue salience. Polling data from Britain and Germany show that the salience of European issues is clearly higher in Britain than in Germany. We thus conclude that British governments face tougher domestic legitimacy demands when formulating their European policies than German governments. This may contribute to accounting for both countries’ different approaches to the integration process: Germany as a role model of a pro-integrationist member state and, in contrast, Britain as the eternal 'awkward partner'.

  11. Choosing the Standard of Care in Private Individual Defamation Cases.

    Science.gov (United States)

    Caudill, Susan

    1989-01-01

    Examines private individual defamation cases that include discussion of whether the reasonably prudent publisher/editor or the reasonably prudent person should set the standard of care when negligence is at issue. Considers the implication of judicial reasoning in adopting one standard of care rather than the other. (RS)

  12. Modelling catchment areas for secondary care providers: a case study.

    Science.gov (United States)

    Jones, Simon; Wardlaw, Jessica; Crouch, Susan; Carolan, Michelle

    2011-09-01

    Hospitals need to understand patient flows in an increasingly competitive health economy. New initiatives like Patient Choice and the Darzi Review further increase this demand. Essential to understanding patient flows are demographic and geographic profiles of health care service providers, known as 'catchment areas' and 'catchment populations'. This information helps Primary Care Trusts (PCTs) to review how their populations are accessing services, measure inequalities and commission services; likewise it assists Secondary Care Providers (SCPs) to measure and assess potential gains in market share, redesign services, evaluate admission thresholds and plan financial budgets. Unlike PCTs, SCPs do not operate within fixed geographic boundaries. Traditionally, SCPs have used administrative boundaries or arbitrary drive times to model catchment areas. Neither approach satisfactorily represents current patient flows. Furthermore, these techniques are time-consuming and can be challenging for healthcare managers to exploit. This paper presents three different approaches to define catchment areas, each more detailed than the previous method. The first approach 'First Past the Post' defines catchment areas by allocating a dominant SCP to each Census Output Area (OA). The SCP with the highest proportion of activity within each OA is considered the dominant SCP. The second approach 'Proportional Flow' allocates activity proportionally to each OA. This approach allows for cross-boundary flows to be captured in a catchment area. The third and final approach uses a gravity model to define a catchment area, which incorporates drive or travel time into the analysis. Comparing approaches helps healthcare providers to understand whether using more traditional and simplistic approaches to define catchment areas and populations achieves the same or similar results as complex mathematical modelling. This paper has demonstrated, using a case study of Manchester, that when estimating

  13. Primary care psychiatry: the case for action.

    OpenAIRE

    Shepherd, M.

    1991-01-01

    Since the introduction of the National Health Service a number of epidemiological enquiries have established the importance of mental disorders in the field of primary care. Examples are provided from the work of the General Practice Research Unit at the Institute of Psychiatry in London. The results furnish a rational basis for collaborative action between research workers, general practitioners and policy makers.

  14. Eugene's Story: A Case for Caring.

    Science.gov (United States)

    Urban, Vicki Dodds

    1999-01-01

    As this story about a mischievous, underachieving 10th grader shows, meeting standards and showing caring, compassion, and respect are not mutually exclusive. Unless students experience a positive, supportive climate, some may never achieve minimal standards or realize their full potential. The author later discovered she had inspired Eugene to…

  15. An Optimization of (Q,r Inventory Policy Based on Health Care Apparel Products with Compound Poisson Demands

    Directory of Open Access Journals (Sweden)

    An Pan

    2014-01-01

    Full Text Available Addressing the problems of a health care center which produces tailor-made clothes for specific people, the paper proposes a single product continuous review model and establishes an optimal policy for the center based on (Q,r control policy to minimize expected average cost on an order cycle. A generic mathematical model to compute cost on real-time inventory level is developed to generate optimal order quantity under stochastic stock variation. The customer demands are described as compound Poisson process. Comparisons on cost between optimization method and experience-based decision on Q are made through numerical studies conducted for the inventory system of the center.

  16. Determining the effectiveness of the Delphi method for quantifying the drivers of demand for health and social care

    OpenAIRE

    Yang, He

    2013-01-01

    This paper focuses on research of the Delphi method used in the Centre for Workforce Intelligence (CfWI). In the CfWI, the Delphi method is applied to quantify the uncertainties for the future workforce demand and supply modelling in health and social care. The objective of this research is to review and assess the strengths and weaknesses of the Delphi method as applied to recent CfWI projects, and to make recommendations for improving this method. The Strategic Options Development and Analy...

  17. Balanced scorecard application in the health care industry: a case study.

    Science.gov (United States)

    Kocakülâh, Mehmet C; Austill, A David

    2007-01-01

    Balanced scorecards became a popular strategic performance measurement and management tool in the 1990s by Robert Kaplan and David Norton. Mainline companies accepted balanced scorecards quickly, but health care organizations were slow to adopt them for use. A number of problems face the health care industry, including cost structure, payor limitations and constraints, and performance and quality issues that require changes in how health care organizations, both profit and nonprofit, manage operations. This article discusses balanced scorecards generally from theoretical and technical views, and why they should be used by health care organizations. The authors argue that balanced scorecards are particularly applicable to hospitals, clinics, and other health care companies. Finally, the authors perform a case study of the development, implementation, and use of balance scorecards by a regional Midwestern health care system. The positive and negative aspects of the subject's balanced scorecard are discussed. Leaders in today's health care industry are under great pressure to meet their financial goals. The industry is faced with financial pressures from consumers, insurers, and governments. Inflation in the industry is much higher than it is within the overall economy. Employers can no longer bear the burden of rising group health insurance costs for its employees. Too many large companies have used bankruptcy law as a shield to reduce or shift some of their legal obligations to provide health insurance coverage to present or retired employees. Stakeholders of health care providers are demanding greater control over costs. As the segment of un- or underinsured within the United States becomes larger as a percentage of the population, voters are seriously beginning to demand some form of national health insurance, which will drastically change the health care industry. PMID:18972988

  18. Information Technology Framework for Pharmaceutical Supply Chain Demand Management: a Brazilian Case Study

    Directory of Open Access Journals (Sweden)

    Pedro Domingos Antoniolli

    2016-01-01

    Full Text Available The paper aims at proposing an information technology framework for demand management within a dyad on the supply chain pharmaceutical industry. The paper adopts the exploratory study as research method, involving a producer of generic drugs and its main distributor. Data was collected by semi - structured interviews. In pharmaceu tical supply chain, sharing information boosted by information technology translates into greater flexibility and reliability, lower costs, obtained through more reliable forecasting, and lower inventory requirements. There are few initiatives involving In formation Technology (IT applied to demand management in pharmaceutical supply chains available in the literature. It was found that the IT framework proposed in this research is adherent to the demand management of the focused pharmaceutical dyad. Other assumption was that, if partners processes integration exist, better supply chain performance is achieved. It was found that, by means of proposed tools and solutions, such as RFID and involved partners applications integration, this goal could be achieved . Because of the chosen research approach, results may be restricted to these specific dyadic processes. Further application of the proposed IT framework have to be tested. The paper identifies demand management strategic and operational processes that can reach a better performance by using the proposed IT framework. Based on the literature, were identified which IT requirements should be met to demand management processes optimization. Additionally, were applied questionnaires and interviews to the focuse d dyad personnel, to corroborate the data identified in the literature. Answers found in the case study link literature elements with those stated by respondents. Finally, based on this, was conceived an IT framework composed of three elements: 1. One spec ific for infrastructure, to enable data and systems interoperability among SC participants, considering a

  19. Managing Medical Costs by Reducing Demand for Services: The Missing Element in Health Care Reform.

    Science.gov (United States)

    Kelly, Edward K.; And Others

    1994-01-01

    It is argued that higher education institutions can play a major role in health care reform by providing campus cultures that foster healthy lifestyle choices and in turn reduce medical costs. Specific issues discussed include elimination of unnecessary tests, focus on special high-risk populations, and use of advance directives. (MSE)

  20. Parents and offspring in an evolutionary game: the effect of supply on demand when costs of care vary

    OpenAIRE

    Grodzinski, Uri; Johnstone, Rufus A

    2011-01-01

    Current models of parent–offspring communication do not explicitly predict the effect of parental food supply on offspring demand (ESD). However, existing theory is frequently interpreted as predicting a negative ESD, such that offspring beg less when parental supply is high. While empirical evidence largely supports this interpretation, several studies have identified the opposite case, with well-fed offspring begging more than those in poorer condition. Here, we show that signalling theory ...

  1. The Effect Of Supplemental Insurance On Health Care Demand With Multiple Information: A Latent Class Analysis

    OpenAIRE

    Dardanoni V; Li Donni P

    2009-01-01

    The Medicare program, which provides insurance coverage to the elderly in the United States, does not protect them fully against high out-of-pocket costs. For this reason private supplementary insurance, named Medigap, has been available to cover Medicare gaps. This paper studies how Medigap affects the utilization of health care services. The decision to take out supplemental insurance is likely to be infuenced by unobservable attributes such as actual risk type and insurance preferences. Em...

  2. Students experienced help from preservative care. A reflective case study of two nursing students caring from a nursing framework on good care for older people

    Directory of Open Access Journals (Sweden)

    Jan S. Jukema

    2015-11-01

    Full Text Available Background: The practice of nursing is shaped partly by nurses’ professional perspective of good care, guided by a nursing framework. An example is the framework of preservative care, which defines good nursing care for vulnerable older people in nursing homes. Currently we lack an understanding of how this framework could help nurses in training; it may be a useful developmental aid for undergraduate nursing students but so far there are no empirical data to support this. Aim: The purpose of this study is to explore how helpful a particular framework can be in the learning journey of two undergraduate nursing students. The study draws on narrative and reflective accounts, guided by the question: ‘How does preservative care as a framework of good care help two undergraduate nursing students develop their caring for older people?’ Methods: This was a reflective case study, in which two students – experienced registered nurses (non-graduates following a part-time education programme – reflected on their practices, using preservative care as a framework for taking care of older people. They kept reflective journals and received constructive feedback from the author of the preservative care framework (the first author. Their data were analysed in three steps. Findings: Both students reported gaining profound help from the framework in their evaluations of daily practices, although they rated the help differently in terms of demanding and rewarding experiences. The framework was particularly helpful in developing qualities in three domains: person-centredness, professional role and specific nursing competencies. Conclusions: The results of our study indicate how using a particular nursing framework made a difference to the practice of two undergraduate nursing students. Exploring the meaning and place of particular nursing frameworks in nursing education is necessary to establish their potential benefits for students. Implications for

  3. A case study of ethanol water demand during industrial phase in Brazil

    Science.gov (United States)

    Hernandes, T.; Scarpare, F. V.; Guarenghi, M.; Pereira, T.; Galdos, M. V.

    2012-12-01

    Thayse A. D. Hernandesb, Fábio V. Scarparea, Marjorie M. Guarenghib, Tássia P. Pereirab, Marcelo V. Galdosa a Laboratório Nacional de Ciência e Tecnologia do Bioetanol - CTBE/CNPEM, Caixa Postal 6170, 13083-970 Campinas, São Paulo, Brazil, E-mail: fabio.scarpare@bioetanol.org.br b Faculdade de Engenharia Mecânica, Unicamp, Cidade Universitária "Zeferino Vaz", CEP 13083-860, Campinas, SP, Brazil In São Paulo State, the water resources have being used by sugarcane industry responsibly, through high reuse rates that may reach 95% during industrial process. The average amount of catchment water stays around 2.0 m3 Mg 1 of industrial sugarcane stalk. However, in some modern mills which use higher technical level of closed water circuit, the standard goal for sugarcane industry, 1.0 m3 Mg 1 can be reached. In some regions where the uptake water for industrial segment is high as in São Paulo State, water use assessment is desired for sustainable ethanol production. Thus, two regions in São Paulo State with two plants each were taken as a case study aiming to assess ethanol water demand during the industrial phase. Araraquara was the first study region where the water demand was classified as in critical condition in 2010 according to the Water and Electrical Energy Department of São Paulo State (DAEE). The industrial activities were responsible for 50% of the water catchment. Araçatuba was the second study region where water demand was classified as being of concern (DAEE) due to high percentage of catchment water for industrial activities, around 90%. Data regarding the amount of millable cane processed, days of the plant operation, ratio of cane used for ethanol production in 2010/2011 season were used for direct water demand estimation considering different water catchment scenarios of 2.0, 1.0 and 0.7 (technological development prediction scenario) m3 Mg-1 of millable cane. For indirect water demand estimation, data regarding installed capacity of each

  4. Embracing case management for computerization of care pathways.

    Science.gov (United States)

    Mei, Jing; Li, Jing; Yu, Yiqin; Li, Xiang; Liu, Haifeng; Xie, Guotong

    2014-01-01

    The computerization of care pathways (CPs) has drawn considerable attention, for improving quality of health care and reducing costs. A well-known big challenge of implementing CPs is their flexibility and ad hoc variations in execution of clinical tasks. We observe that case management suits well to address this problem, and this paper proposes a CMMN-based CP model, where CMMN (Case Management Model and Notation) is becoming an industry standard. Via an experimental experience on modelling CHF (congestive heart failure) ambulatory CP, we illustrate that the usage of case management paves the way to popularize CPs, particularly for its quick deployment and execution in industrial products. PMID:25160134

  5. Confronting evidence: individualised care and the case for shared decision-making.

    LENUS (Irish Health Repository)

    Ryan, P

    2014-11-01

    In many clinical scenarios there exists more than one clinically appropriate intervention strategy. When these involve subjective trade-offs between potential benefits and harms, patients\\' preferences should inform decision-making. Shared decision-making is a collaborative process, where clinician and patient reconcile the best available evidence with respect for patients\\' individualized care preferences. In practice, clinicians may be poorly equipped to participate in this process. Shared decision-making is applicable to many conditions including stable coronary artery disease, end-of-life care, and numerous small decisions in chronic disease management. There is evidence of more clinically appropriate care patterns, improved patient understanding and sense of empowerment. Many trials reported a 20% reduction in major surgery in favour of conservative treatment, although demand tends to increase for some interventions. The generalizability of international evidence to Ireland is unclear. Considering the potential benefits, there is a case for implementing and evaluating shared decision-making pilot projects in Ireland.

  6. [Individualised care plan during extracorporeal membrane oxygenation. A clinical case].

    Science.gov (United States)

    Call Mañosa, S; Pujol Garcia, A; Chacón Jordan, E; Martí Hereu, L; Pérez Tejero, G; Gómez Simón, V; Estruga Asbert, A; Gallardo Herrera, L; Vaquer Araujo, S; de Haro López, C

    2016-01-01

    An individualised care plan is described for a woman diagnosed with pneumonia, intubated, and on invasive mechanical ventilation, who was admitted to the Intensive Care Unit for extracorporeal membrane oxygenation (ECMO). A nursing care plan was designed based on Marjory Gordon functional patterns. The most important nursing diagnoses were prioritised, using a model of clinical reasoning model (Analysis of the current status) and NANDA taxonomy. A description is presented on, death anxiety, impaired gas exchange, decreased cardiac output, dysfunctional gastrointestinal motility, risk for disuse syndrome, infection risk, and bleeding risk. The principal objectives were: to reduce the fear of the family, achieve optimal respiratory and cardiovascular status, to maintain gastrointestinal function, to avoid immobility complications, and to reduce the risk of infection and bleeding. As regards activities performed: we gave family support; correct management of the mechanical ventilation airway, cardio-respiratory monitoring, skin and nutritional status; control of possible infections and bleeding (management of therapies, care of catheters…). A Likert's scale was used to evaluate the results, accomplishing all key performance indicators which were propose at the beginning. Individualised care plans with NNN taxonomy using the veno-venous ECMO have not been described. Other ECMO care plans have not used the same analysis model. This case can help nurses to take care of patients subjected to veno-venous ECMO treatment, although more cases are needed to standardise nursing care using NANDA taxonomy. PMID:27137415

  7. Emergency care outcomes of acute chemical poisoning cases in Rawalpindi

    Institute of Scientific and Technical Information of China (English)

    Ibrar Rafique; Umbreen Akhtar; Umar Farooq; Mussadiq Khan; Junaid Ahmad Bhatti

    2016-01-01

    Objective: To assess the emergency care outcomes of acute chemical poisoning cases in tertiary care settings in Rawalpindi, Pakistan. Methods: The data were extracted from an injury surveillance study conducted in the emergency departments (ED) of three tertiary care hospitals of Rawalpindi city from July 2007 to June 2008. The World Health Organization standard reporting questionnaire (one page) was used for recording information. Associations of patients' characteristics with ED care outcomes, i.e., admitted vs. discharged were assessed using logistic regression models. Results: Of 62 530 injury cases reported, chemical poisoning was identified in 434 (0.7%) cases. The most frequent patient characteristics were poisoning at home (61.9%), male gender (58.6%), involving self-harm (46.0%), and youth aged 20–29 years (43.3%). Over two-thirds of acute poisoning cases (69.0%) were admitted. Acute poisoning cases were more likely to be admitted if they were youth aged 10–19 years [odds ratio (OR)=4.41], when the poisoning occurred at home (OR=21.84), and was related to self-harm (OR=18.73) or assault (OR=7.56). Conclusions: Findings suggest that controlling access of poisonous substances in youth and at homes might reduce related ED care burden. Safety promotion agencies and emergency physicians can use these findings to develop safety messages.

  8. Case managers optimize patient safety by facilitating effective care transitions.

    Science.gov (United States)

    Carr, Dana Deravin

    2007-01-01

    In this new era of patient safety, the case manager, as an advocate and facilitator of care, has a pivotal role on the front line of healthcare delivery. Effective communication and collaboration between disciplines is key to the promotion of patient safety, and ultimately the avoidance of life-threatening medical errors. Across the healthcare continuum and within hospitals in particular, patients are routinely transferred from one service to another, from one level of care to another, or from one provider to another. As patients are stabilized and transitioned through the hospital system, there are multiple hand-offs of care or care transitions that can often expose the patient to fragmented service and increase the risk of communication breakdown. Ineffective hand-offs can result in a disruption of continuity between one level of care and the next. In a culture that places a strong emphasis on patient safety, case managers can facilitate opportunities that ease care transitions whereby a change in venue is no longer perceived as a disruption in the flow of care but rather is viewed as a coordinated changeover where cautious and comprehensive communication sets the tone for the continued delivery of safe and effective healthcare. PMID:17413671

  9. Solidarity by demand? Exit and voice in international medical travel - the case of Indonesia.

    Science.gov (United States)

    Ormond, Meghann

    2015-01-01

    Globally, more patients are intentionally travelling abroad as consumers for medical care. However, while scholars have begun to examine international medical travel's (IMT) impacts on the people and places that receive medical travellers, study of its impacts on medical travellers' home contexts has been negligible and largely speculative. While proponents praise IMT's potential to make home health systems more responsive to the needs of market-savvy healthcare consumers, critics identify it as a way to further de-politicise the satisfaction of healthcare needs. This article draws from work on political consumerism, health advocacy and social movements to argue for a reframing of IMT not as a 'one-off' statement about or an event external to struggles over access, rights and recognition within medical travellers' home health systems but rather as one of a range of critical forms of on-going engagement embedded within these struggles. To do this, the limited extant empirical work addressing domestic impacts of IMT is reviewed and a case study of Indonesian medical travel to Malaysia is presented. The case study material draws from 85 interviews undertaken in 2007-08 and 2012 with Indonesian and Malaysian respondents involved in IMT as care recipients, formal and informal care-providers, intermediaries, promoters and policy-makers. Evidence from the review and case study suggests that IMT may effect political and social change within medical travellers' home contexts at micro and macro levels by altering the perspectives, habits, expectations and accountability of, and complicity among, medical travellers, their families, communities, formal and informal intermediaries, and medical providers both within and beyond the container of the nation-state. Impacts are conditioned by the ideological foundations underpinning home political and social systems, the status of a medical traveller's ailment or therapy, and the existence of organised support for recognition and

  10. Improvement of energy demand forecasts using swarm intelligence: The case of Turkey with projections to 2025

    International Nuclear Information System (INIS)

    The energy supply and demand should be closely monitored and revised the forecasts to take account of the progress of liberalization, energy efficiency improvements, structural changes in industry and other major factors. Medium and long-term forecasting of energy demand, which is based on realistic indicators, is a prerequisite to become an industrialized country and to have high living standards. Energy planning is not possible without a reasonable knowledge of past and present energy consumption and likely future demands. Energy demand management activities should bring the demand and supply closer to a perceived optimum. Turkey's energy demand has grown rapidly almost every year and is expected to continue growing. However, the energy demand forecasts prepared by the Turkey Ministry of Energy and Natural Resources overestimate the demand. Recently many studies are performed by researchers to forecast the energy demand of Turkey. Particle swarm optimization (PSO) technique has never been used for such a study. In this study a model is proposed, using PSO-based energy demand forecasting (PSOEDF), to forecast the energy demand of Turkey more efficiently. Although there are other indicators as well, gross domestic product (GDP), population, import and export are used as basic energy indicators of energy demand. In order to show the accuracy of the algorithm, a comparison is made with the ant colony optimization (ACO) energy demand estimation model which is developed for the same problem. (author)

  11. Improvement of energy demand forecasts using swarm intelligence: The case of Turkey with projections to 2025

    Energy Technology Data Exchange (ETDEWEB)

    Uenler, Alper [Department of Information Management Systems, KKK Per. Bsk., Yuecetepe 06100, Ankara (Turkey)

    2008-06-15

    The energy supply and demand should be closely monitored and revised the forecasts to take account of the progress of liberalization, energy efficiency improvements, structural changes in industry and other major factors. Medium and long-term forecasting of energy demand, which is based on realistic indicators, is a prerequisite to become an industrialized country and to have high living standards. Energy planning is not possible without a reasonable knowledge of past and present energy consumption and likely future demands. Energy demand management activities should bring the demand and supply closer to a perceived optimum. Turkey's energy demand has grown rapidly almost every year and is expected to continue growing. However, the energy demand forecasts prepared by the Turkey Ministry of Energy and Natural Resources overestimate the demand. Recently many studies are performed by researchers to forecast the energy demand of Turkey. Particle swarm optimization (PSO) technique has never been used for such a study. In this study a model is proposed, using PSO-based energy demand forecasting (PSOEDF), to forecast the energy demand of Turkey more efficiently. Although there are other indicators as well, gross domestic product (GDP), population, import and export are used as basic energy indicators of energy demand. In order to show the accuracy of the algorithm, a comparison is made with the ant colony optimization (ACO) energy demand estimation model which is developed for the same problem. (author)

  12. Improvement of energy demand forecasts using swarm intelligence: The case of Turkey with projections to 2025

    International Nuclear Information System (INIS)

    The energy supply and demand should be closely monitored and revised the forecasts to take account of the progress of liberalization, energy efficiency improvements, structural changes in industry and other major factors. Medium and long-term forecasting of energy demand, which is based on realistic indicators, is a prerequisite to become an industrialized country and to have high living standards. Energy planning is not possible without a reasonable knowledge of past and present energy consumption and likely future demands. Energy demand management activities should bring the demand and supply closer to a perceived optimum. Turkey's energy demand has grown rapidly almost every year and is expected to continue growing. However, the energy demand forecasts prepared by the Turkey Ministry of Energy and Natural Resources overestimate the demand. Recently many studies are performed by researchers to forecast the energy demand of Turkey. Particle swarm optimization (PSO) technique has never been used for such a study. In this study a model is proposed, using PSO-based energy demand forecasting (PSOEDF), to forecast the energy demand of Turkey more efficiently. Although there are other indicators as well, gross domestic product (GDP), population, import and export are used as basic energy indicators of energy demand. In order to show the accuracy of the algorithm, a comparison is made with the ant colony optimization (ACO) energy demand estimation model which is developed for the same problem

  13. Improvement of energy demand forecasts using swarm intelligence: The case of Turkey with projections to 2025

    Energy Technology Data Exchange (ETDEWEB)

    Unler, Alper [Department of Information Management Systems, KKK Per. Bsk., Yuecetepe 06100, Ankara (Turkey)], E-mail: aunler@kkk.tsk.mil.tr

    2008-06-15

    The energy supply and demand should be closely monitored and revised the forecasts to take account of the progress of liberalization, energy efficiency improvements, structural changes in industry and other major factors. Medium and long-term forecasting of energy demand, which is based on realistic indicators, is a prerequisite to become an industrialized country and to have high living standards. Energy planning is not possible without a reasonable knowledge of past and present energy consumption and likely future demands. Energy demand management activities should bring the demand and supply closer to a perceived optimum. Turkey's energy demand has grown rapidly almost every year and is expected to continue growing. However, the energy demand forecasts prepared by the Turkey Ministry of Energy and Natural Resources overestimate the demand. Recently many studies are performed by researchers to forecast the energy demand of Turkey. Particle swarm optimization (PSO) technique has never been used for such a study. In this study a model is proposed, using PSO-based energy demand forecasting (PSOEDF), to forecast the energy demand of Turkey more efficiently. Although there are other indicators as well, gross domestic product (GDP), population, import and export are used as basic energy indicators of energy demand. In order to show the accuracy of the algorithm, a comparison is made with the ant colony optimization (ACO) energy demand estimation model which is developed for the same problem.

  14. Brain-oriented care in the NICU: a case study.

    Science.gov (United States)

    Bader, Lisa

    2014-01-01

    With the advances of technology and treatment in the field of neonatal care, researchers can now study how the brains of preterm infants are different from full-term infants. The differences are significant, and the outcomes are poor overall for premature infants as a whole. Caregivers at the bedside must know that every interaction with the preterm infant affects brain development-it is critical to the developmental outcome of the infant. The idea of neuroprotection is not new to the medical field but is a fairly new idea to the NICU. Neuroprotection encompasses all interventions that promote normal development of the brain. The concept of brain-oriented care is a necessary extension of developmental care in the NICU. By following the journey of 26-week preterm twin infants through a case study, one can better understand the necessity of brain-oriented care at the bedside. PMID:25161134

  15. Care in Family Relations : The Case of Surrogacy Leave

    OpenAIRE

    Burri, Susanne

    2015-01-01

    The advance of reproductive technologies, like surrogacy arrangements, confronts courts with new demands and dilemmas. This contribution analyses the potential of EU law towards a better and more balanced reconciliation of work, private and family life when no national law applies. In two recent cases of the Court of Justice of the EU on leave for surrogacy mothers, the Advocates General Kokott and Wahl published diverging opinions on similar prejudicial questions of national courts. These op...

  16. Transforming Cultures of Care: A Case Study in Organizational Change

    Science.gov (United States)

    Purvis, Karyn; Cross, David; Jones, Daren; Buff, Gary

    2012-01-01

    The authors report on a small organizational case study highlighting the dimensions of trauma-informed care, the processes of organizational change, and the growth of caregiver expertise. The article is framed by the notion of caregiving cultures, which refers to the beliefs, languages, and practices of caregivers and caregiving organizations.…

  17. A Framework for Sustainable Urban Water Management through Demand and Supply Forecasting: The Case of Istanbul

    OpenAIRE

    Murat Yalçıntaş; Melih Bulu; Murat Küçükvar; Hamidreza Samadi

    2015-01-01

    The metropolitan city of Istanbul is becoming overcrowded and the demand for clean water is steeply rising in the city. The use of analytical approaches has become more and more critical for forecasting the water supply and demand balance in the long run. In this research, Istanbul’s water supply and demand data is collected for the period during 2006 and 2014. Then, using an autoregressive integrated moving average (ARIMA) model, the time series water supply and demand forecasting model is ...

  18. Influence of the demand information quality on planning process accuracy in supply chain. Case studies

    OpenAIRE

    Natalia Szozda; Sylwia Werbińska-Wojciechowska

    2013-01-01

    Background: Identification and analysis of factors that affect the accuracy of demand planning process across the supply chain is one of the most important problems which influence the effectiveness of its material and information flows. Material and methods: On the basis of demand planning process investigation authors define the main elements affecting the right supply chain performance level and investigate the possible connections between demand information quality and demand plannin...

  19. The impact of climate change on the BRICS economies: The case of insurance demand.

    Science.gov (United States)

    Ranger, N.; Surminski, S.

    2012-04-01

    Session ERE5.1 Climate change impact on economical and industrial activities The impact of climate change on the BRICS economies: The case of insurance demand. Over the past decade, growth in the BRICS (Brazil, Russia, India, China and South Africa) economies has been a key driver of global economic growth. Current forecasts suggest that these markets will continue to be areas of significant growth for a large number of industries. We consider how climate change may influence these trends in the period to 2030, a time horizon that is long in terms of strategic planning in industry, but relatively short for climate change analysis, where the impacts are predicted to be most significant beyond around 2050. Based on current evidence, we expect climate change to affect the BRICS economies in four main ways: 1. The impact of physical climatic changes on the productivity of climate-sensitive economic activity, the local environment, human health and wellbeing, and damages from extreme weather. 2. Changing patterns of investment in climate risk management and adaptation 3. Changing patterns of investments in areas affected by greenhouse gas (GHG) mitigation policy, 4. The impacts of the above globally, including on international trade, growth, investment, policy, migration and commodity prices, and their impacts on the BRICS. We review the evidence on the impacts of climate change in the BRICS and then apply this to one particular industry sector: non-life insurance. We propose five potential pathways through which climate change could influence insurance demand: economic growth; willingness to pay for insurance; public policy and regulation; the insurability of natural catastrophe risks; and new opportunities associated with adaptation and greenhouse gas mitigation. We conclude that, with the exception of public policy and regulation, the influence of climate change on insurance demand to 2030 is likely to be small when compared with the expected growth due to rising

  20. From demand side management (DSM) to energy efficiency services: A Finnish case study

    International Nuclear Information System (INIS)

    Energy conservation is expected to contribute significantly to climate change mitigation and energy security. Traditionally, energy companies have had strong role in providing Demand Side Management (DSM) measures. However, after energy market liberalization in Europe, energy companies' DSM activities declined. In response, the EU issued Directive (2006/32/EC) on energy end-use efficiency and energy services (ESD) to motivate energy companies to promote energy efficiency and conservation, closely followed by Directive (2012/27/EU) on energy efficiency (EED), requiring the setting up energy efficiency obligation schemes. Despite strong political and economic motivation, energy companies struggle to develop energy efficiency services in liberalised energy markets due to conflicting institutional demands, which arise from contradicting policy requirements and customer relations. The main challenges in developing new innovative energy efficiency services, evidenced by an in-depth case study, were (1) the unbundling of energy company operations, which makes it difficult to develop services when the contribution of several business units is required and (2) the distrust among energy end-users, which renders the business logic of energy saving contract models self-contradictory. On the basis of the research, avenues out of these dilemmas are suggested. -- Highlights: •Energy companies struggle to become energy service provides •We explore the development of new energy saving business solutions •Dispersed organisational structure leaves energy saving business as isolated function •Strong consumer scepticism towards energy companies as providers of energy saving •More emphasis on the changing company-customer relationship is needed

  1. The impact of future energy demand on renewable energy production – Case of Norway

    International Nuclear Information System (INIS)

    Projections of energy demand are an important part of analyses of policies to promote conservation, efficiency, technology implementation and renewable energy production. The development of energy demand is a key driver of the future energy system. This paper presents long-term projections of the Norwegian energy demand as a two-step methodology of first using activities and intensities to calculate a demand of energy services, and secondly use this as input to the energy system model TIMES-Norway to optimize the Norwegian energy system. Long-term energy demand projections are uncertain and the purpose of this paper is to illustrate the impact of different projections on the energy system. The results of the analyses show that decreased energy demand results in a higher renewable fraction compared to an increased demand, and the renewable energy production increases with increased energy demand. The most profitable solution to cover increased demand is to increase the use of bio energy and to implement energy efficiency measures. To increase the wind power production, an increased renewable target or higher electricity export prices have to be fulfilled, in combination with more electricity export. - Highlights: • Projections to 2050 of Norwegian energy demand services, carriers and technologies. • Energy demand services calculated based on intensities and activities. • Energy carriers and technologies analysed by TIMES-Norway. • High renewable target results in more wind power production and electricity export. • Increased energy efficiency is important for a high renewable fraction

  2. Implications of the introduction of laboratory demand management at primary care clinics in South Africa on laboratory expenditure

    Directory of Open Access Journals (Sweden)

    Ozayr H. Mahomed

    2016-02-01

    Full Text Available Background: Diagnostic health laboratory services are regarded as an integral part of the national health infrastructure across all countries. Clinical laboratory tests contribute substantially to health system goals of increasing quality of care and improving patient outcomes.Objectives: This study aimed to analyse current laboratory expenditures at the primary healthcare (PHC level in South Africa as processed by the National Health Laboratory Service and to determine the potential cost savings of introducing laboratory demand management.Methods: A retrospective cross-sectional analysis of laboratory expenditures for the 2013/2014 financial year across 11 pilot National Health Insurance health districts was conducted. Laboratory expenditure tariff codes were cross-tabulated to the PHC essential laboratory tests list (ELL to determine inappropriate testing. Data were analysed using a Microsoft Access database and Excel software.Results: Approximately R35 million South African Rand (10% of the estimated R339 million in expenditures was for tests that were not listed within the ELL. Approximately 47% of expenditure was for laboratory tests that were indicated in the algorithmic management of patients on antiretroviral treatment. The other main cost drivers for non-ELL testing included full blood count and urea, as well as electrolyte profiles usually requested to support management of patients on antiretroviral treatment.Conclusions: Considerable annual savings of up to 10% in laboratory expenditure are possible at the PHC level by implementing laboratory demand management. In addition, to achieve these savings, a standardised PHC laboratory request form and some form of electronic gatekeeping system that must be supported by an educational component should be implemented.

  3. Revisiting the causes of stress in social work:sources of job demands, control and support in personalised adult social care

    OpenAIRE

    Wilberforce, Mark; Jacobs, Sally; Challis, David; Manthorpe, Jill; Stevens, Martin; Jasper, Rowan; Fernandez, Jose-Luis; Glendinning, Caroline; Jones, Karen; Knapp, Martin; Moran, Nicola Elizabeth; Netten, Ann

    2014-01-01

    Social workers in adult social care are at particular risk of job-related stress, although the contribution of different organisational and policy changes to this phenomenon is subject to debate. This paper explores a theoretical framework from the occupational psychology literature (the Job Demand/Control Model) to identify the characteristics of those most at risk of stress, in a sample of 249 social workers and other care managers working in English adult social services from the Individua...

  4. The business case for health-care quality improvement.

    Science.gov (United States)

    Swensen, Stephen J; Dilling, James A; Mc Carty, Patrick M; Bolton, Jeffrey W; Harper, Charles M

    2013-03-01

    The business case for health-care quality improvement is presented. We contend that investment in process improvement is aligned with patients' interests, the organization's reputation, and the engagement of their workforce. Four groups benefit directly from quality improvement: patients, providers, insurers, and employers. There is ample opportunity, even in today's predominantly pay-for-volume (that is, evolving toward value-based purchasing) insurance system, for providers to deliver care that is in the best interest of the patient while improving their financial performance. PMID:23429226

  5. Uptake of meningococcal conjugate vaccine among adolescents in large managed care organizations, United States, 2005: Demand, supply and seasonality

    Science.gov (United States)

    2009-01-01

    Background In February 2005, the US Advisory Committee on Immunization Practices recommended the new meningococcal conjugate vaccine (MCV4) for routine use among 11- to 12-year-olds (at the preadolescent health-care visit), 14- to 15-year-olds (before high-school entry), and groups at increased risk. Vaccine distribution started in March; however, in July, the manufacturer reported inability to meet demand and widespread MCV4 shortages were reported. Our objectives were to determine early uptake patterns among target (11-12 and 14-15 year olds) and non-target (13- plus 16-year-olds) age groups. A post hoc analysis was conducted to compare seasonal uptake patterns of MCV4 with polysaccharide meningococcal (MPSV4) and tetanus diphtheria (Td) vaccines. Methods We analyzed data for adolescents 11-16 years from five managed care organizations participating in the Vaccine Safety Datalink (VSD). For MCV4, we estimated monthly and cumulative coverage during 2005 and calculated risk ratios. For MPSV4 and Td, we combined 2003 and 2004 data and compared their seasonal uptake patterns with MCV4. Results Coverage for MCV4 during 2005 among the 623,889 11-16 years olds was 10%. Coverage for 11-12 and 14-15 year olds was 12% and 11%, respectively, compared with 8% for 13- plus 16-year-olds (p < 0.001). Of the 64,272 MCV4 doses administered from March-December 2005, 73% were administered June-August. Fifty-nine percent of all MPSV4 doses and 38% of all Td doses were administered during June-August. Conclusion A surge in vaccine uptake between June and August was observed among adolescents for MCV4, MPSV4 and Td vaccines. The increase in summer-time vaccinations and vaccination of non-targeted adolescents coupled with supply limitations likely contributed to the reported shortages of MCV4 in 2005. PMID:19887009

  6. Uptake of meningococcal conjugate vaccine among adolescents in large managed care organizations, United States, 2005: Demand, supply and seasonality

    Directory of Open Access Journals (Sweden)

    Wortley Pascale M

    2009-11-01

    Full Text Available Abstract Background In February 2005, the US Advisory Committee on Immunization Practices recommended the new meningococcal conjugate vaccine (MCV4 for routine use among 11- to 12-year-olds (at the preadolescent health-care visit, 14- to 15-year-olds (before high-school entry, and groups at increased risk. Vaccine distribution started in March; however, in July, the manufacturer reported inability to meet demand and widespread MCV4 shortages were reported. Our objectives were to determine early uptake patterns among target (11-12 and 14-15 year olds and non-target (13- plus 16-year-olds age groups. A post hoc analysis was conducted to compare seasonal uptake patterns of MCV4 with polysaccharide meningococcal (MPSV4 and tetanus diphtheria (Td vaccines. Methods We analyzed data for adolescents 11-16 years from five managed care organizations participating in the Vaccine Safety Datalink (VSD. For MCV4, we estimated monthly and cumulative coverage during 2005 and calculated risk ratios. For MPSV4 and Td, we combined 2003 and 2004 data and compared their seasonal uptake patterns with MCV4. Results Coverage for MCV4 during 2005 among the 623,889 11-16 years olds was 10%. Coverage for 11-12 and 14-15 year olds was 12% and 11%, respectively, compared with 8% for 13- plus 16-year-olds (p Conclusion A surge in vaccine uptake between June and August was observed among adolescents for MCV4, MPSV4 and Td vaccines. The increase in summer-time vaccinations and vaccination of non-targeted adolescents coupled with supply limitations likely contributed to the reported shortages of MCV4 in 2005.

  7. Implementation of integrated care for diabetes mellitus type 2 by two Dutch care groups: A case study

    OpenAIRE

    Busetto, Loraine; Luijkx, Katrien; Huizing, Anna; Vrijhoef, H.J.M.

    2015-01-01

    Background Even though previous research has demonstrated improved outcomes of integrated care initiatives, it is not clear why and when integrated care works. This study aims to contribute to filling this knowledge gap by examining the implementation of integrated care for type 2 diabetes by two Dutch care groups. Methods An embedded single case study was conducted including 26 interviews with management staff, care purchasers and health professionals. The Context + Mechanism = Outcome Model...

  8. Implementation of integrated care for diabetes mellitus type 2 by two Dutch care groups: a case study

    OpenAIRE

    Busetto, Loraine; Luijkx, Katrien; Huizing, Anna; Vrijhoef, Bert

    2015-01-01

    Background Even though previous research has demonstrated improved outcomes of integrated care initiatives, it is not clear why and when integrated care works. This study aims to contribute to filling this knowledge gap by examining the implementation of integrated care for type 2 diabetes by two Dutch care groups. Methods An embedded single case study was conducted including 26 interviews with management staff, care purchasers and health professionals. The Context + Mechanism = Outcome Model...

  9. Urban water demand with fixed volumetric charging in a large municipality: the case of Brisbane, Australia

    OpenAIRE

    Hoffmann, Mark; Worthington, Andrew; Higgs, Helen

    2006-01-01

    This paper uses suburb-level quarterly data to model residential water demand in Brisbane, Australia, from 1998 to 2003. In this system, residential consumption is charged using a fixed annual service fee with no water entitlement followed by a fixed volumetric charge per kilolitre. Water demand is specified as average quarterly household water consumption and the demand characteristics include the marginal price of water, household income and size, and the number of rainy and warm days. The ...

  10. Linking Agricultural Trade, Land Demand and Environmental Externalities: Case of Oil Palm in South East Asia

    OpenAIRE

    Othman, Jamal

    2003-01-01

    Reduction of support measures affecting soybean oil in the major soybean producing countries, as a consequence of WTO rules, coupled with rising demand for palm oil in non-traditional palm oil importing countries may lead to pronounced increases in agricultural land demand for oil palm expansion in Malaysia and Indonesia – two main palm oil producing and exporting countries. However, it is expected that the effects on agricultural land demand and consequently impact upon the environment will ...

  11. Service-oriented decisions on inventory levels in the case of incomplete demand information

    OpenAIRE

    Ramaekers, Katrien; Janssens, Gerrit K.

    2012-01-01

    New products without historical demand information or slow-moving items with little such information cause difficulties in defining inventory management policies facing demand uncertainty. The classical approach using the Normal distribution for describing the random demand during lead time might lead to a degraded level of customer service. But the choice for other types of distributions is also no option, so it is realistic that the full functional form of the distribution is unknown, but t...

  12. Linking activity-based travel demand models and traffic assignment: A Flemish case study

    OpenAIRE

    Ramaekers, Katrien; Kochan, Bruno; BELLEMANS, Tom; JANSSENS, Davy; Wets, Geert

    2008-01-01

    A custom agent-based simulation framework is developed that combines the fields of traffic demand modeling and traffic assignment, applied to the region of Flanders (Belgium). The framework uses an activity-based approach to model traffic demand and an assignment module that is linked to the traffic demand module. Activity data for the framework is provided by a large scale survey, conducted on 2500 households in the study area. The agent-based simulation model consists of over six million ag...

  13. The demand impacts of chicken contamination publicity-a case study

    OpenAIRE

    Dahlgran, Roger A.; Fairchild, Dean G.

    2002-01-01

    Adverse publicity regarding food contamination can depress demand, causing lost producer revenue. This study addresses the magnitude of those losses through the analysis of the impact of TV and print news coverage of bacterial contamination of chicken in the United States. An inverse demand model for chicken is estimated using weekly data from 1982 through 1991. Our findings indicate adverse publicity about salmonella contamination of chicken depressed the demand for chicken, but that the eff...

  14. Effect of policy-based bioenergy demand on southern timber markets: A case study of North Carolina

    International Nuclear Information System (INIS)

    Key factors driving renewable energy demand are state and federal policies requiring the use of renewable feedstocks to produce energy (renewable portfolio standards) and liquid fuels (renewable fuel standards). However, over the next decade, the infrastructure for renewable energy supplies is unlikely to develop as fast as both policy- and market-motivated renewable energy demands. This will favor the use of existing wood as a feedstock in the first wave of bioenergy production. The ability to supply wood over the next decade is a function of the residual utilization, age class structure, and competition from traditional wood users. Using the North Carolina Renewable Portfolio Standard as a case study, combined with assumptions regarding energy efficiency, logging residual utilization, and traditional wood demands over time, we simulate the impacts of increased woody biomass demand on timber markets. We focus on the dynamics resulting from the interaction of short-run demand changes and long-term supply responses. We conclude that logging residuals alone may be unable to meet bioenergy demands from North Carolina's Renewable Portfolio Standard. Thus, small roundwood (pulpwood) may be used to meet remaining bioenergy demands, resulting in increased timber prices and removals; displacement of traditional products; higher forest landowner incomes; and changes in the structure of the forest resource. (author)

  15. Effect of policy-based bioenergy demand on southern timber markets: A case study of North Carolina

    Energy Technology Data Exchange (ETDEWEB)

    Abt, Robert C.; Abt, Karen L.; Cubbage, Frederick W.; Henderson, Jesse D. [Research Economist, Southern Research Station, US Forest Service, 30141 Cornwallis Rd., Research Triangle Park, NC 27709 (United States)

    2010-12-15

    Key factors driving renewable energy demand are state and federal policies requiring the use of renewable feedstocks to produce energy (renewable portfolio standards) and liquid fuels (renewable fuel standards). However, over the next decade, the infrastructure for renewable energy supplies is unlikely to develop as fast as both policy- and market-motivated renewable energy demands. This will favor the use of existing wood as a feedstock in the first wave of bioenergy production. The ability to supply wood over the next decade is a function of the residual utilization, age class structure, and competition from traditional wood users. Using the North Carolina Renewable Portfolio Standard as a case study, combined with assumptions regarding energy efficiency, logging residual utilization, and traditional wood demands over time, we simulate the impacts of increased woody biomass demand on timber markets. We focus on the dynamics resulting from the interaction of short-run demand changes and long-term supply responses. We conclude that logging residuals alone may be unable to meet bioenergy demands from North Carolina's Renewable Portfolio Standard. Thus, small roundwood (pulpwood) may be used to meet remaining bioenergy demands, resulting in increased timber prices and removals; displacement of traditional products; higher forest landowner incomes; and changes in the structure of the forest resource. (author)

  16. Effect of policy-based bioenergy demand on southern timber markets: A case study of North Carolina

    International Nuclear Information System (INIS)

    Key factors driving renewable energy demand are state and federal policies requiring the use of renewable feedstocks to produce energy (renewable portfolio standards) and liquid fuels (renewable fuel standards). However, over the next decade, the infrastructure for renewable energy supplies is unlikely to develop as fast as both policy- and market-motivated renewable energy demands. This will favor the use of existing wood as a feedstock in the first wave of bioenergy production. The ability to supply wood over the next decade is a function of the residual utilization, age class structure, and competition from traditional wood users. Using the North Carolina Renewable Portfolio Standard as a case study, combined with assumptions regarding energy efficiency, logging residual utilization, and traditional wood demands over time, we simulate the impacts of increased woody biomass demand on timber markets. We focus on the dynamics resulting from the interaction of short-run demand changes and long-term supply responses. We conclude that logging residuals alone may be unable to meet bioenergy demands from North Carolina's Renewable Portfolio Standard. Thus, small roundwood (pulpwood) may be used to meet remaining bioenergy demands, resulting in increased timber prices and removals; displacement of traditional products; higher forest landowner incomes; and changes in the structure of the forest resource.

  17. Modeling and Dynamical Analysis of the Water Resources Supply-Demand System: A Case Study in Haihe River Basin

    Directory of Open Access Journals (Sweden)

    Chongli Di

    2014-01-01

    Full Text Available The relationship between water resources supply and demand is very complex and exhibits nonlinear characteristics, which leads to fewer models that can adequately manage the dynamic evolution process of the water resources supply-demand system. In this paper, we propose a new four-dimensional dynamical model to simulate the internal dynamic evolution process and predict future trends of water supply and demand. At the beginning, a new four-dimensional dynamical model with uncertain parameters is established. Then, the gray code hybrid accelerating genetic algorithm (GHAGA is adopted to identify the unknown parameters of the system based on the statistic data (1998–2009. Finally, the dynamical analysis of the system is further studied by Lyapunov-exponent, phase portraits, and Lyapunov exponent theory. Numerical simulation results demonstrate that the proposed water resources supply-demand system is in a steady state and is suitable for simulating the dynamical characteristics of a complex water supply and demand system. According to the trends of the water supply and demand of several nonlinear simulation cases, the corresponding measures can be proposed to improve the steady development of the water resources supply-demand system.

  18. A Framework for Sustainable Urban Water Management through Demand and Supply Forecasting: The Case of Istanbul

    Directory of Open Access Journals (Sweden)

    Murat Yalçıntaş

    2015-08-01

    Full Text Available The metropolitan city of Istanbul is becoming overcrowded and the demand for clean water is steeply rising in the city. The use of analytical approaches has become more and more critical for forecasting the water supply and demand balance in the long run. In this research, Istanbul’s water supply and demand data is collected for the period during 2006 and 2014. Then, using an autoregressive integrated moving average (ARIMA model, the time series water supply and demand forecasting model is constructed for the period between 2015 and 2018. Three important sustainability metrics such as water loss to supply ratio, water loss to demand ratio, and water loss to residential demand ratio are also presented. The findings show that residential water demand is responsible for nearly 80% of total water use and the consumption categories including commercial, industrial, agriculture, outdoor, and others have a lower share in total water demand. The results also show that there is a considerable water loss in the water distribution system which requires significant investments on the water supply networks. Furthermore, the forecasting results indicated that pipeline projects will be critical in the near future due to expected increases in the total water demand of Istanbul. The authors suggest that sustainable management of water can be achieved by reducing the residential water use through the use of water efficient technologies in households and reduction in water supply loss through investments on distribution infrastructure.

  19. Diagnosis of penile fracture in primary care: a case report

    OpenAIRE

    Ozcan, Sevgi; Akpinar, Ersin

    2009-01-01

    Introduction Penile fracture has been reported with sexual intercourse, masturbation, rolling over or falling on to the erect penis. Classically the history is with a sudden snap, pain, detumescence and a hematoma of the penis with deformity. Immediate surgical treatment is recommended. The patients may delay the admission due to fear and embarrassment or the condition may usually be underreported. Case presentation A 32-year-old man presented to primary care complaining of discoloration of p...

  20. [Case management. The nursing business of care or cost].

    Science.gov (United States)

    Sandhu, B K; Duquette, A; Kérouac, S; Rouillier, L

    1992-01-01

    Less money spent on health services, cost-effectiveness, better productivity and more efficiency are some of the driving forces of contemporary "neo-liberalism" and political trends. How can nursing services and the profession's human values adapt in this difficult context? The authors describe the newest modality of patient care delivery system: nursing case management. They examine the factors and assumptions that led up to its development and point out the validity of asking some serious questions before embarking on the euphoria of case management. PMID:1291932

  1. Culturally responsive middle school science: A case study of needs, demands, and challenges

    Science.gov (United States)

    Woodrow, Kelli Ellen

    2007-12-01

    Culturally responsive programming has been proposed as a remedy for the well-documented disconnect between schools and the ethnically and culturally diverse students who attend them. These programs often focus on creating instructional materials and pedagogical practices that are aligned with the knowledges, perspectives and practices of these students. This study builds on that literature and examines the needs, demands, and challenges of developing a culturally responsive health science program for ethnically and culturally diverse urban middle school students. I approached this problem through a content analysis of the intended curriculum and a microethnography of the enacted curriculum. In my analysis of the intended curriculum, I adapted a science textbook analysis instrument created by the American Association for the Advancement of Science (AAAS) to include criteria related to identified features of culturally responsive education. Using these modified analytic criteria, I found that the pilot drafts of the curricular materials excelled in the areas of engaging students in relevant phenomenon but lacked many of these specifically culturally responsive elements. Recommendations were made to redress these deficiencies. In my analysis of the enacted curriculum, I observed in five eighth grade classrooms where the program was being implemented. I used participant observation, audio and video tape recordings, artifacts, and interviews over a six-month period to investigate teacher/student interactions, the social organization of the classrooms, and students' culturally distinctive knowledge resources---or what is sometimes referred to as their "funds of knowledge." I found that the affective interactions between teachers and students were precursors to any reform, and that students and teachers similarly defined these interactions as "teacher care." In addition, I found that the social organization of the classroom often privileged official content and ways of

  2. Effects and side-effects of integrating care: the case of mental health care in the Netherlands

    NARCIS (Netherlands)

    Hutschemaekers, Giel J.M.; Tiemens, Bea G.; Winter, M. de

    2007-01-01

    Purpose Description and analysis of the effects and side-effects of integrated mental health care in the Netherlands. Context of case Due to a number of large-scale mergers, Dutch mental health care has become an illustration of integration and coherence of care services. This process of integrati

  3. A stable demand for money despite financial crisis: The case of Venezuela.

    OpenAIRE

    Bjørnland, Hilde C.

    2003-01-01

    This paper investigates the demand for broad money in Venezuela, over a period of financial crisis and substantial exchange rate fluctuations. The analysis shows that there exist a long run relationship between real money, real income, inflation, the exchange rate and the domestic interest rate, that remains stable over major policy changes and large shocks. The long run properties emphasize that both inflation and exchange rate depreciations have negative effects on real money demand. The lo...

  4. DEMAND ESTIMATION IN THE PRESENCE OF AN UNOBSERVABLE PRODUCT ATTRIBUTE: THE CASE OF MINT QUALITY

    OpenAIRE

    Toro-Gonzalez, Daniel; Yan, Jia; Gallardo, Rosa Karina; McCluskey, Jill J.

    2012-01-01

    This article estimates the demand for mint-flavored gum products using grocery store sales data and accounting for consumers’ valuation of quality. Unobserved product attributes, such as flavor quality, are important elements to consider when estimating the demand for gum. The estimation results suggest that gum is an inelastic product. A positive relationship between willingness to pay and unobserved quality was identified, implying that gum industry should be able to command a premium for h...

  5. An analysis of the poor's demand patterns during rising prices : the case of Bophelong / Dorah Dubihlela

    OpenAIRE

    Dubihlela, Dorah

    2012-01-01

    This study investigated the demand patterns of poor households during a period of rising prices. Focus was on three main constructs namely the poor, rising prices and the demand patterns. The study was on Bophelong, a township in South Africa. This study was conducted from an empirical, quantitative approach which was preceded by a literature review. The main objective of conducting the literature review was to provide a theoretical framework for questionnaire design and empirical work. Cross...

  6. Drug Innovations and Welfare Measures Computed from Market Demand: The Case of Anti-Cholesterol Drugs

    OpenAIRE

    Abe Dunn

    2010-01-01

    The pharmaceutical industry is characterized as having substantial investment in R&D and a large number of new product introductions, which poses special problems for price measurement caused by the quality of drug products changing over time. This paper applies recent demand estimation techniques to construct a constant- quality price index for anti-cholesterol drugs. Demand is estimated using a nationally representative sample of individuals over the period 1996 to 2007 that includes detail...

  7. A nexus perspective on competing land demands: wider lessons from a UK policy case study

    OpenAIRE

    Sharmina, Maria; Hoolohan, Claire; Bows-Larkin, Alice; Burgess, Paul J.; Colwill, James; Gilbert, Paul; Howard, David; Knox, Jerry; Anderson, Kevin

    2016-01-01

    As nations develop policies for low-carbon transitions, conflicts with existing policies and planning tools are leading to competing demands for land and other resources. This raises fundamental questions over how multiple demands can best be managed. Taking the UK as an empirical example, this paper critiques current policies and practices to explore the interdependencies at the water-energy-food nexus. It considers how current land uses and related policies affect the UK’s resilience to cli...

  8. Evaluating the Demand Patterns for Irrigation Water: The Case of Western Macedonia

    OpenAIRE

    Michailidis, Anastasios; Arabatzis, Garyfallos; Kamenidou, Irene

    2003-01-01

    This article is concerned with the management of water resources in the region of Western Macedonia. Taking into account the great importance of agriculture as the principal consumer of water in the region, as well as the drastic increase in regional water consumption over the last decade, a related study evaluating the demand patterns for irrigated water can prove to be extremely valuable. This paper examines the demand patterns and probable trends for irrigated water using the Discrete Sequ...

  9. Farmers' behaviours and trends in agricultural water demand: The case of the irrigated Mitidja plain (Algeria)

    OpenAIRE

    Imache, A.; Le Goulven, P.; Bouarfa, S.; Chabaca, M.; Daniell, K.A.

    2008-01-01

    The work presented in this paper is based on decisions related to farm irrigation practices on the Mitidja Plain in Algeria. In order to determine irrigation water demand evolution, attempts are made to identify the important parameters on which farm irrigation decision-making is based. The resulting global water demand trends taking farmers' behaviours into account are then characterised. The Mitidja plain covers 1400 km² and provides Algiers with much agricultural produce. The irrigated ...

  10. 2009 reference case scenario : Canadian energy demand and supply to 2020 : an energy market assessment

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2009-07-01

    The National Energy Board regulates the construction and operation of interprovincial and international oil and gas pipelines and power lines as well as the tolls and tariffs for the pipelines under its jurisdictions. The import and export of natural gas is also regulated by the NEB. The NEB examined the possible energy futures that might unfold for Canadians up to the year 2020. The factors that affect the supply of crude oil, natural gas, liquefied natural gas, electricity and coal in the short term were examined to determine the outlook for deliverability through 2020. The growing demand for energy was reviewed along with the adequacy of future energy supplies, and related issues of emerging technologies, energy infrastructure and energy exports. This assessment provided separate production outlooks for hydrocarbons, electricity and coal and outlined the key uncertainties to the supply outlook. The likely impact of recent economic, energy and policy trends on energy demand and supply were considered. It was concluded that energy markets in Canada will continue to function well. Energy prices will provide appropriate market signals for the development of energy resources to meet Canadian and export demand. A significant portion of Canadian demand for energy will be met by fossil fuels. However, the demand to move towards greener energy fuels should result in fewer greenhouse gas emissions. 1 tab., 27 figs.

  11. 2009 reference case scenario : Canadian energy demand and supply to 2020 : an energy market assessment

    International Nuclear Information System (INIS)

    The National Energy Board regulates the construction and operation of interprovincial and international oil and gas pipelines and power lines as well as the tolls and tariffs for the pipelines under its jurisdictions. The import and export of natural gas is also regulated by the NEB. The NEB examined the possible energy futures that might unfold for Canadians up to the year 2020. The factors that affect the supply of crude oil, natural gas, liquefied natural gas, electricity and coal in the short term were examined to determine the outlook for deliverability through 2020. The growing demand for energy was reviewed along with the adequacy of future energy supplies, and related issues of emerging technologies, energy infrastructure and energy exports. This assessment provided separate production outlooks for hydrocarbons, electricity and coal and outlined the key uncertainties to the supply outlook. The likely impact of recent economic, energy and policy trends on energy demand and supply were considered. It was concluded that energy markets in Canada will continue to function well. Energy prices will provide appropriate market signals for the development of energy resources to meet Canadian and export demand. A significant portion of Canadian demand for energy will be met by fossil fuels. However, the demand to move towards greener energy fuels should result in fewer greenhouse gas emissions. 1 tab., 27 figs.

  12. Estimation of Water Demand of Agriculture Sector by Water-Yield Function (Case Study: Sistan Province

    Directory of Open Access Journals (Sweden)

    Zahra Ghaffari Moghadam

    2015-12-01

    Full Text Available I n this study, yield-water and profit function was used to obtain water demand function in agriculture sector. The results showed that the ratio of actual to potential Evapotranspiration had positive, significant effect on the ratio of actual to potential yield for wheat and barley. Also, square ratio of actual to potential Evapotranspiration had negative, significant relationship. After estimation of product function, water demand function for agriculture sector was obtained by profit function. Price elasticity of water demand for agriculture was -1.10 being less than -1 and showing that price policies can be an important factor in the control of non-optimum use of their valuable inputs.

  13. The case for conserving oil resources: the fundamentals of supply and demand

    International Nuclear Information System (INIS)

    This article summarises the evidence for an oil price shock and argues that oil producers, both OPEC and non-OPEC, need to cut back oil production more, in order to conserve oil for the future and to avert sudden extreme movements in oil prices in the next five-to-ten years. Four physical fundamentals determine long-run changes in oil prices: supply, demand, technology and substitutes. We show that supply, technology and substitutes are limited and demand is growing strongly. As demand pushes against supply, prices will rise rapidly. It would be better to conserve oil now, in order to have a smoother transition to higher-priced oil in the future. In addition, oil is such a valuable resource for the worlds economies in general, that we should conserve it for future generations. The world, in its haste for economic growth, should support OPEC conservation efforts. (author)

  14. Demand for road-fuel in a small developing economy: The case of Sri Lanka

    Energy Technology Data Exchange (ETDEWEB)

    Chandrasiri, Sunil [Department of Economics, University of Colombo, P.O. Box. 1490, Colombo 3 (Sri Lanka)]. E-mail: sunilch@sltnet.lk

    2006-09-15

    This paper estimates the demand for road fuel (petrol and auto-diesel) in the context of a small developing economy-Sri Lanka. The data set covers a period of 39 years from 1964 to 2002 representing both close economy and open economy policy regimes. The estimation procedure is based on seemingly unrelated regression equation (SURE) methodology mainly to capture substitutability of petrol and diesel in road transportation. The effect of auto-fuel prices on vehicle demand is also analyzed as a part of the analysis. In addition to confirming existing evidence on road-fuel demand, the findings reveal some interesting evidence with respect to own-price elasticity, cross-price elasticity, lag effects, income and vehicle mix variables.

  15. Demand for road-fuel in a small developing economy: The case of Sri Lanka

    International Nuclear Information System (INIS)

    This paper estimates the demand for road fuel (petrol and auto-diesel) in the context of a small developing economy-Sri Lanka. The data set covers a period of 39 years from 1964 to 2002 representing both close economy and open economy policy regimes. The estimation procedure is based on seemingly unrelated regression equation (SURE) methodology mainly to capture substitutability of petrol and diesel in road transportation. The effect of auto-fuel prices on vehicle demand is also analyzed as a part of the analysis. In addition to confirming existing evidence on road-fuel demand, the findings reveal some interesting evidence with respect to own-price elasticity, cross-price elasticity, lag effects, income and vehicle mix variables

  16. Health care expenditures and gross domestic product: the Turkish case.

    Science.gov (United States)

    Sülkü, Seher Nur; Caner, Asena

    2011-02-01

    Our study examines the long-term relationship among per capita gross domestic product (GDP), per capita health expenditures and population growth rate in Turkey during the period 1984-2006, employing the Johansen multivariate co-integration technique. Related previous studies on OECD countries have mostly excluded Turkey-itself an OECD country. The only study on Turkey examines the period 1984-1998. However, after 1998, major events and policy changes that had a substantial impact on income and health expenditures took place in Turkey, including a series of reforms to restructure the health and social security system. In contrast to earlier findings in the literature, we find that the income elasticity of total health expenditures is less than one, which indicates that health care is a necessity in Turkey during the period of analysis. According to our results, a 10% increase in per capita GDP is associated with an 8.7% increase in total per capita health expenditures, controlling for population growth. We find that the income elasticity of public health expenditures is less than one. But, in the case of private health care expenditures, the elasticity is greater than one, meaning that private health care is a luxury good in Turkey. PMID:20151170

  17. The Pediatric Home Care/Expenditure Classification Model (P/ECM): A Home Care Case-Mix Model for Children Facing Special Health Care Challenges

    OpenAIRE

    Phillips, Charles D

    2015-01-01

    Case-mix classification and payment systems help assure that persons with similar needs receive similar amounts of care resources, which is a major equity concern for consumers, providers, and programs. Although health service programs for adults regularly use case-mix payment systems, programs providing health services to children and youth rarely use such models. This research utilized Medicaid home care expenditures and assessment data on 2,578 children receiving home care in one large sta...

  18. Mental health problems in Pakistani society as a consequence of violence and trauma: a case for better integration of care

    Directory of Open Access Journals (Sweden)

    Muhammad Tahir Khalily

    2011-10-01

    Full Text Available Objectives: This paper discusses the increasing incidence of mental health problems in Pakistan, and specifically in the Swat valley, in relation to the growing insurgency and current violence in Pakistani society. The paper argues that the health care system's response in Pakistan is not adequate to meet the current challenges and that changes in policy are needed to build mental health care services as an important component of the basic health package at primary care level in the public sector.Method: This paper reviews the existing mental health situation in Pakistan with reference to the findings of a case study in the Swat valley in Khyber Pukhtoonkhwa Pakistan. The figures presented in the case study are used to support the need for an integrated national mental health policy.Conclusion: Mental health care needs to be incorporated as a core service in primary care and supported by specialist services. There is a strong need to provide adequate training for general practitioners and postgraduate training for mental health professionals to meet the current demands. A collaborative network between stakeholders in the public and private sector, as well as non-governmental organisations are required that promotes mental health care and advocates for changes in mental health policy.

  19. Mental health problems in Pakistani society as a consequence of violence and trauma: a case for better integration of care

    Directory of Open Access Journals (Sweden)

    Muhammad Tahir Khalily

    2011-10-01

    Full Text Available Objectives: This paper discusses the increasing incidence of mental health problems in Pakistan, and specifically in the Swat valley, in relation to the growing insurgency and current violence in Pakistani society. The paper argues that the health care system's response in Pakistan is not adequate to meet the current challenges and that changes in policy are needed to build mental health care services as an important component of the basic health package at primary care level in the public sector. Method: This paper reviews the existing mental health situation in Pakistan with reference to the findings of a case study in the Swat valley in Khyber Pukhtoonkhwa Pakistan. The figures presented in the case study are used to support the need for an integrated national mental health policy. Conclusion: Mental health care needs to be incorporated as a core service in primary care and supported by specialist services. There is a strong need to provide adequate training for general practitioners and postgraduate training for mental health professionals to meet the current demands. A collaborative network between stakeholders in the public and private sector, as well as non-governmental organisations are required that promotes mental health care and advocates for changes in mental health policy.

  20. Information Technology Framework for Pharmaceutical Supply Chain Demand Management: a Brazilian Case Study

    OpenAIRE

    Pedro Domingos Antoniolli

    2016-01-01

    The paper aims at proposing an information technology framework for demand management within a dyad on the supply chain pharmaceutical industry. The paper adopts the exploratory study as research method, involving a producer of generic drugs and its main distributor. Data was collected by semi - structured interviews. In pharmaceu tical supply chain, sharing information boosted by information technology translates into greater flexibility and reliabil...

  1. Equity in health care financing: The case of Malaysia

    Directory of Open Access Journals (Sweden)

    Sach Tracey H

    2008-06-01

    Full Text Available Abstract Background Equitable financing is a key objective of health care systems. Its importance is evidenced in policy documents, policy statements, the work of health economists and policy analysts. The conventional categorisations of finance sources for health care are taxation, social health insurance, private health insurance and out-of-pocket payments. There are nonetheless increasing variations in the finance sources used to fund health care. An understanding of the equity implications would help policy makers in achieving equitable financing. Objective The primary purpose of this paper was to comprehensively assess the equity of health care financing in Malaysia, which represents a new country context for the quantitative techniques used. The paper evaluated each of the five financing sources (direct taxes, indirect taxes, contributions to Employee Provident Fund and Social Security Organization, private insurance and out-of-pocket payments independently, and subsequently by combined the financing sources to evaluate the whole financing system. Methods Cross-sectional analyses were performed on the Household Expenditure Survey Malaysia 1998/99, using Stata statistical software package. In order to assess inequality, progressivity of each finance sources and the whole financing system was measured by Kakwani's progressivity index. Results Results showed that Malaysia's predominantly tax-financed system was slightly progressive with a Kakwani's progressivity index of 0.186. The net progressive effect was produced by four progressive finance sources (in the decreasing order of direct taxes, private insurance premiums, out-of-pocket payments, contributions to EPF and SOCSO and a regressive finance source (indirect taxes. Conclusion Malaysia's two tier health system, of a heavily subsidised public sector and a user charged private sector, has produced a progressive health financing system. The case of Malaysia exemplifies that policy makers

  2. Equity in health care financing: The case of Malaysia

    Science.gov (United States)

    Yu, Chai Ping; Whynes, David K; Sach, Tracey H

    2008-01-01

    Background Equitable financing is a key objective of health care systems. Its importance is evidenced in policy documents, policy statements, the work of health economists and policy analysts. The conventional categorisations of finance sources for health care are taxation, social health insurance, private health insurance and out-of-pocket payments. There are nonetheless increasing variations in the finance sources used to fund health care. An understanding of the equity implications would help policy makers in achieving equitable financing. Objective The primary purpose of this paper was to comprehensively assess the equity of health care financing in Malaysia, which represents a new country context for the quantitative techniques used. The paper evaluated each of the five financing sources (direct taxes, indirect taxes, contributions to Employee Provident Fund and Social Security Organization, private insurance and out-of-pocket payments) independently, and subsequently by combined the financing sources to evaluate the whole financing system. Methods Cross-sectional analyses were performed on the Household Expenditure Survey Malaysia 1998/99, using Stata statistical software package. In order to assess inequality, progressivity of each finance sources and the whole financing system was measured by Kakwani's progressivity index. Results Results showed that Malaysia's predominantly tax-financed system was slightly progressive with a Kakwani's progressivity index of 0.186. The net progressive effect was produced by four progressive finance sources (in the decreasing order of direct taxes, private insurance premiums, out-of-pocket payments, contributions to EPF and SOCSO) and a regressive finance source (indirect taxes). Conclusion Malaysia's two tier health system, of a heavily subsidised public sector and a user charged private sector, has produced a progressive health financing system. The case of Malaysia exemplifies that policy makers can gain an in depth

  3. The impact of case mix on timely access to appointments in a primary care group practice.

    Science.gov (United States)

    Ozen, Asli; Balasubramanian, Hari

    2013-06-01

    At the heart of the practice of primary care is the concept of a physician panel. A panel refers to the set of patients for whose long term, holistic care the physician is responsible. A physician's appointment burden is determined by the size and composition of the panel. Size refers to the number of patients in the panel while composition refers to the case-mix, or the type of patients (older versus younger, healthy versus chronic patients), in the panel. In this paper, we quantify the impact of the size and case-mix on the ability of a multi-provider practice to provide adequate access to its empanelled patients. We use overflow frequency, or the probability that the demand exceeds the capacity, as a measure of access. We formulate problem of minimizing the maximum overflow for a multi-physician practice as a non-linear integer programming problem and establish structural insights that enable us to create simple yet near optimal heuristic strategies to change panels. This optimization framework helps a practice: (1) quantify the imbalances across physicians due to the variation in case mix and panel size, and the resulting effect on access; and (2) determine how panels can be altered in the least disruptive way to improve access. We illustrate our methodology using four test practices created using patient level data from the primary care practice at Mayo Clinic, Rochester, Minnesota. An important advantage of our approach is that it can be implemented in an Excel Spreadsheet and used for aggregate level planning and panel management decisions. PMID:23076360

  4. Modeling of gas demand using degree-day concept: case study for Ankara

    International Nuclear Information System (INIS)

    The demand for natural gas is rapidly increasing in Turkey, as it is in the rest of the world. However, natural gas reserves and production are rather limited in Turkey.The bulk of the Turkish gas demand is met by imports. Russia currently accounts for 69% of Turkey's gas supplies. Physical shortages might occur; supplies for industrial production and household consumption could temporarily run short. Also, fluctuations in consumption might occur due to climatic reasons or peak daily industrial energy demand. Underground gas storage is a necessity in order to regulate these seasonal, daily, and hourly fluctuations. In order to effectively design and utilize underground gas storage, it is necessary to identify the market requirements. In this study, Ankara was chosen as a pilot region due to its strategical importance of being the capital city of Turkey, and a wide range of marketing surveys for the last seven years was performed. All of the factors influencing the gas consumption and the relationships between these factors were analyzed. How does gas demand behave in extremely cold weather? How does the industrial part of the city act in the consumption behavior? What are the plans of the Municipality of Ankara, responsible for the execution of the natural gas distribution project in Ankara? A model was developed based on degree-day (DD) concept, including the annual number of customers, average DDs, and the usage per customer. A history matching study was performed to verify the results of the model with the measured consumption data for the last seven years. Comparisons showed that the calculated consumption by DD model and measured daily consumption were in good agreement. Finally, by using the developed approach, the gas demand was forecasted for Ankara up to 2005. The results of this study can be used to design underground gas storage facility near Ankara. (author)

  5. Analysis of place distribution of urban services, based on people demanding (case study: Estahban city

    Directory of Open Access Journals (Sweden)

    Kh. Bazi

    2013-01-01

    Full Text Available Extended abstract1- IntroductionIn recent decades as the population in cities of country, which had been influenced by natural population growth of cities and migration of people in towns and rural to middle cities and metro polices, increases city spaces and infrastructures, which are needed have not been equipped.Urban services are the means for managing urban development and a prominent cause in continuing city life, which without it the life of citizens has been stopped. Its optimal and systematic distribution consistent with the people’s demands in the process of urban planning is very important.Urban services have been considered as one of clear indicators of civilization from many years ago.Today as the civilization increases, urban services and their qualities have been regarded by experts, planners and citizens, so urban services have been followed by urbanization development.2- Methodology In this study through library studies, referring to the relevant agencies, field observation and analysis and evaluation the questionnaire given to residents of various neighborhoods in Estahban city with SPSS were presented.To evaluate the proportion of urban services and people demand six neighborhoods were chosen among 15 neighborhoods of Estahban. (Two neighborhoods of each region. These neighborhoods were chosen based on place- cluster sampling and also economic-social conditions of them and detailed plan of Estahban. In this research a wealthy neighborhood and poor neighborhood were chosen in each region. By using general Cochran formula we obtained 300 sample size . So 300 questionnaires had been distributed among the residents.3- DiscussionAfter 1350, Estahban city faces numerous problems in supplying urban services, because of population growth, physical development in addition to injustice distribution of urban services. These problems have also been strengthened by people who live in more deprived parts of the township to use the urban

  6. Emissions associated with meeting the future global wheat demand: A case study of UK production under climate change constraints

    International Nuclear Information System (INIS)

    Highlights: • Conflicts between adapting to climate change, food security and reducing emissions. • Climate change likely to limit wheat production in the southern hemisphere. • Climate change yield benefits marginally increase emissions per unit of product. • Improved yield will result in higher total production emissions. • Production-based inventories discourage an increase in production. - Abstract: Climate change, population growth and socio-structural changes will make meeting future food demands extremely challenging. As wheat is a globally traded food commodity central to the food security of many nations, this paper uses it as an example to explore the impact of climate change on global food supply and quantify the resulting greenhouse gas emissions. Published data on projected wheat production is used to analyse how global production can be increased to match projected demand. The results show that the largest projected wheat demand increases are in areas most likely to suffer severe climate change impacts, but that global demand could be met if northern hemisphere producers exploit climate change benefits to increase production and narrow their yield gaps. Life cycle assessment of different climate change scenarios shows that in the case of one of the most important wheat producers (the UK) it may be possible to improve yields with an increase of only 0.6% in the emission intensity per unit of wheat produced in a 2 °C scenario. However, UK production would need to rise substantially, increasing total UK wheat production emissions by 26%. This demonstrates how national emission inventories and associated targets do not incentivise minimisation of global greenhouse gas emissions while meeting increased food demands, highlighting a triad of challenges: meeting the rising demand for food, adapting to climate change and reducing emissions

  7. Leadership models in health care - a case for servant leadership.

    Science.gov (United States)

    Trastek, Victor F; Hamilton, Neil W; Niles, Emily E

    2014-03-01

    Our current health care system is broken and unsustainable. Patients desire the highest quality care, and it needs to cost less. To regain public trust, the health care system must change and adapt to the current needs of patients. The diverse group of stakeholders in the health care system creates challenges for improving the value of care. Health care providers are in the best position to determine effective ways of improving the value of care. To create change, health care providers must learn how to effectively lead patients, those within health care organizations, and other stakeholders. This article presents servant leadership as the best model for health care organizations because it focuses on the strength of the team, developing trust and serving the needs of patients. As servant leaders, health care providers may be best equipped to make changes in the organization and in the provider-patient relationship to improve the value of care for patients. PMID:24486078

  8. 25 CFR 20.506 - What information is required in the foster care case file?

    Science.gov (United States)

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false What information is required in the foster care case file... FINANCIAL ASSISTANCE AND SOCIAL SERVICES PROGRAMS Child Assistance Foster Care § 20.506 What information is required in the foster care case file? At a minimum the following information is required: (a)...

  9. The (in)accuracy of travel demand forecasts in the case of no-build alternatives

    DEFF Research Database (Denmark)

    Nicolaisen, Morten Skou; Næss, Petter

    . Congestion in the no-build alternative is assumed to be unbearable if new capacity is not added to the road network, while actual travel demand is typically lower. This is problematic, since an overestimation of benefits for road projects will, ceteris paribus, make it more difficult to argue for other means......Impact appraisals of major transport infrastructure projects rely extensively on the accuracy of forecasts for the expected construction costs and travel time savings. The latter of these further depend on the accuracy of forecasts for the expected travel demand in both the build and no...... study of 35 road projects in Denmark and the United Kingdom. The sample is based on road projects for which traffic impact studies have been prepared for the no-build alternative, but where the projects had not yet been built at the time of the forecast target year. Data sources for expected travel...

  10. Does Trade Help to Explain Tourism Demand? The Case of Portugal

    Directory of Open Access Journals (Sweden)

    Nuno Carlos LEITÃO

    2010-03-01

    Full Text Available The tourism industry has expanded in recent years due to internal and external environmental forces. These forces, income, trade, consumer price, and geographical distance are interconnected. Accounting for imperfect competition and increasing returns to scale, the new trade theory offers the explanation of dynamic gains from international trade. A large number of studies attempt to test the hypothesis that there is a link between trade and tourism. Most of the studies show that trade and tourism are positively correlated. This paper specifies static and dynamic panel demand models for tourism in Portugal and estimates demand equations using tourist inflow data for the period 1995-2006. We find that bilateral trade, immigration, border, and geographical distance between Portugal and countries of origin are the main determinants of tourism to Portugal. The dynamic panel data approach indicates that trade, population, and income are more important determinants than relative price.

  11. Anaphylaxis cases presenting to primary care paramedics in Quebec.

    Science.gov (United States)

    Kimchi, Nofar; Clarke, Ann; Moisan, Jocelyn; Lachaine, Colette; La Vieille, Sebastien; Asai, Yuka; Joseph, Lawrence; Mill, Chris; Ben-Shoshan, Moshe

    2015-12-01

    Data on anaphylaxis cases in pre-hospital settings is limited. As part of the Cross Canada Anaphylaxis Registry (C-CARE), we assessed anaphylaxis cases managed by paramedics in Outaouais, Quebec. A software program was developed to prospectively record demographic and clinical characteristics as well as management of cases meeting the definition of the anaphylaxis. Univariate and multivariate logistic regressions were compared to assess factors associated with severity of reactions and epinephrine use. Among 33,788 ambulance calls of which 23,486 required transport, 104 anaphylaxis cases were identified (anaphylaxis rate of 0.31% [95%CI, 0.25%, 0.37%] among all ambulance calls and 0.44% [95%CI, 0.36%, 0.54%] among those requiring transport). The median age was 46.8 years and 41.3% were males. The common triggers included food (32.7% [95%CI, 24.0%, 42.7%]), drugs (24.0% [16.4%, 33.6%]), and venom (17.3% [10.8%, 26.2%]). Among all reactions, 37.5% (95%CI, 28.4%, 47.6%) were severe. Epinephrine was not administered in 35.6% (95%CI, 26.6%, 45.6%) of all cases. Males were more likely to have severe reactions (Odds ratio [OR]: 2.50 [95%CI, 1.03, 6.01]). Venom-induced reactions and severe anaphylaxis were more likely to be managed with epinephrine (OR: 6.9 [95%CI, 1.3, 35.3] and 4.2 [95%CI, 1.5, 12.0], respectively). This is the first prospective study evaluating anaphylaxis managed by paramedics. Anaphylaxis accounts for a substantial proportion of the cases managed by paramedics in Outaouais, Quebec and exceeds prior reports of the proportion of Quebec emergency room visits attributed to anaphylaxis. Although guidelines recommend prompt use of epinephrine for all cases of anaphylaxis, more than a third of cases did not receive epinephrine. It is crucial to develop educational programs targeting paramedics to promote the use of epinephrine in all cases of anaphylaxis regardless of the specific trigger. PMID:26734462

  12. Reliability-Based Marginal Cost Pricing Problem Case with Both Demand Uncertainty and Travelers’ Perception Errors

    OpenAIRE

    Shaopeng Zhong; Lihui Zhang; Max Bushell

    2013-01-01

    Focusing on the first-best marginal cost pricing (MCP) in a stochastic network with both travel demand uncertainty and stochastic perception errors within the travelers’ route choice decision processes, this paper develops a perceived risk-based stochastic network marginal cost pricing (PRSN-MCP) model. Numerical examples based on an integrated method combining the moment analysis approach, the fitting distribution method, and the reliability measures are also provided to demonstrate the impo...

  13. Estimating demand in search markets: the case of online hotel bookings

    OpenAIRE

    Koulayev, Sergei

    2009-01-01

    In this paper, we emphasize that choice sets generated by a search process have two properties: first, they are limited; second, they are endogenous to preferences. Both factors lead to biased estimates in a static demand framework that takes choice sets as given. To correct for this bias, we estimate a structural model of search for differentiated products, using a unique dataset of consumer online search for hotels. Within a nested logit utility model, we show that the mean utility function...

  14. Effect of organic contract farming on labor demand. A study case in the Western Uganda

    OpenAIRE

    Céline Guimas

    2012-01-01

    In order to fully evaluate the impacts of organic contract farming scheme, spillovers on the local community, including people that do not directly participate in such scheme, need to be evaluated. One of these spillovers is the creation of employment opportunities and this is the focus of this study. An increase in labor demand may limit conversion to organic farming in country where labor supply is scarce. However, in a country like Uganda where rural poor are often underemployed and have n...

  15. Opportunities for Western Food Products in China: The Case of Orange Juice Demand

    OpenAIRE

    Chen, Xuqi; Gao, Zhifeng; House, Lisa

    2013-01-01

    The rapid income per capita of Chinese consumers and increasing demand for nearly all agricultural products have attracted western food industries to focus on this booming and huge market. This research investigated the perspectives of western food products in China's market, with focus on one representative western food-orange juice, by studying the Chinese consumer knowledge, perceptions, and willingness to pay (WTP) for different types of orange juice products. Though the Chinese consumers...

  16. Building energy demand aggregation and simulation tools:a Danish case study

    OpenAIRE

    GIANNIOU, Panagiota; Heller, Alfred; Rode, Carsten

    2015-01-01

    Nowadays, the minimization of energy consumption and the optimization of efficiency of the overall energy grid have been in the agenda of most national and international energy policies. At the same time, urbanization has put cities under the microscope towards achieving cost-effective energy savings due to their compact and highly dense form. Thus, accurate estimation of energy demand of cities is of high importance to policy-makers and energy planners. This calls for automated methods that ...

  17. The role of income in money demand during hyper-inflation: the case of Yugoslavia

    OpenAIRE

    Mladenović, Zorica; Nielsen, Bent

    2009-01-01

    During extreme hyper-inflations productivity tends to fall dramatically. Yet, in models of money demand in hyper-inflation variables such as real income has been given a somewhat passive role, either assuming it exogenous or to have a negligible role. In this paper we use an empirical methodology based on cointegrated vector autoregressions to analyse data from the extreme Yugoslavian episode to investigate the role of income. The analysis suggests that even in extreme hyper-in...

  18. The role of income in money demand during hyper-inflation: the case of Yugoslavia.

    OpenAIRE

    Mladenović, Zorica; Nielsen, Bent

    2009-01-01

    During extreme hyper-inflations productivity tends to fall dramatically. Yet, in models of money demand in hyper-inflation variables such as real income has been given a somewhat passive role, either assuming it exogenous or to have a negligible role. In this paper we use an empirical methodology based on cointegrated vector autoregressions to analyse data from the extreme Yugoslavian episode to investigate the role of income. The analysis suggests that even in extreme hyper-in...

  19. Anticipated Inflation, Real Disturbances and Money Demand: The Case of Chinese Hyperinflation, 1946-49

    OpenAIRE

    Tallman, Ellis W; De-piao Tang; Ping Wang

    2001-01-01

    This paper re-examines the dynamics of hyperinflation extending the standard Cagan framework. In our theoretical model, we allow the relative price of capital goods in units of consumption goods to vary in order to examine interactions between the real and monetary sectors. The theory generates empirically testable implications that suggest expanding the standard Caganian money demand function to include both anticipated inflation and relative price effects in a nonlinear fashion. Employing d...

  20. Implementing Innovation in Planning Practice: The Case of Travel Demand Forecasting

    OpenAIRE

    Newmark, Gregory Louis

    2011-01-01

    Travel demand modeling is a core technology of transportation planning and has been so for half a century. This technology refers to the structured use of mathematical formulae and spatial data to forecast the likely travel impacts of possible transportation, land use, and demographic scenarios. Although this planning practice is pervasive, critics have long argued that is has been resistant to innovation. As the policy scenarios explored through modeling become increasingly complex, parti...

  1. Criterion and Predictive Validity of Revealed and Stated Preference Data: The Case of Music Concert Demand

    OpenAIRE

    John C. Whitehead; Douglas Noonan; Elizabeth Marquardt

    2012-01-01

    We survey concert-goers during the season and gather revealed preference and ex-ante stated preference data. We then survey the same concert goers after the season and gather additional ex-post revealed preference data. Comparing ex-ante stated preference data to the ex-post revealed preference data we find respondents overstate their concert attendance behavior. An ex-ante revealed-stated preference demand model with a stated preference adjustment predicts the revealed preference concerts ac...

  2. Energy demand and environmental implications in urban transport — Case of Delhi

    Science.gov (United States)

    Bose, Ranjan Kumar

    A simple model of passenger transport in the city of Delhi has been developed using a computer-based software called—Long Range Energy Alternatives Planning (LEAP) and the associated Environmental Database (EDB) model. The hierarchical structure of LEAP represents the traffic patterns in terms of passenger travel demand, mode (rail/road), type of vehicle and occupancy (persons per vehicle). Transport database in Delhi together with fuel consumption values for the vehicle types, formed the basis of the transport demand and energy consumption calculations. Emission factors corresponding to the actual vehicle types and driving conditions in Delhi is introduced into the EDB and linked to the energy consumption values for estimating total emission of CO, HC, NO x, SO 2 Pb and TSP. The LEAP model is used to estimate total energy demand and the vehicular emissions for the base year-1990/91 and extrapolate for the future—1994/95, 2000/01, 2004/05 and 2009/10, respectively. The model is run under five alternative scenarios to study the impact of different urban transport policy initiatives that would reduce total energy requirement in the transport sector of Delhi and also reduce emission. The prime objective is to arrive at an optimal transport policy which limits the future growth of fuel consumption as well as air pollution.

  3. Pneumothoraces in a Neonatal Tertiary Care Unit: Case Series

    Directory of Open Access Journals (Sweden)

    Rehan Ali

    2013-01-01

    Full Text Available Objective: Neonatal pneumothoraces are associated with high mortality. Prompt recognition to minimize its complications is paramount for ultimate outcome of these babies.Methods: A retrospective case series study was carried out at Aga khan University Hospital, from January 2010 to December 2010 to determine the etiology and outcome of neonates with pneumothorax in a neonatal tertiary care unit.Results: Ten neonates diagnosed radiologically with pneumothoraces were included. M: F ratio was 1:2.3. Birth weight ranged from 1750-3600 grams with a mean of 2100 grams. The occurrence of pneumothoraces was 50% on the left side, 20% on right, and 30% were bilateral. Primary etiology included pneumonia and sepsis (30%, hyaline membrane disease (20%, meconium aspiration syndrome (20% and congenital diaphragmatic hernia (10%. Spontaneous pneumothoraces were present in 20% of cases. In our study, the incidence of neonatal pneumothoraces was 2.5/1000 births compared to 10-15/1000 in Denmark, 10-20/1000 in Turkey and 6.3/1000 from Vermont Oxford Group. Despite the small number of cases, one incidental finding was the occurrence of pneumothorax, which declined in elective cesarean section after 37 weeks gestation i.e., 1.3 of 1000 births. Mortality was 60% determined mainly by the primary etiology and other co-morbid conditions.Conclusion: The study showed a higher number of mortality cases (60%. Although, it was difficult to draw a conclusion from the limited number of cases, there may be a benefit on neonatal respiratory outcome to be obtained by better selection of mothers and by waiting until 37 weeks before performing elective cesarean section. Adequate clinician training in soft ventilation strategies will reduce the occurrence of pneumothoraces.

  4. Solidarity by demand? Exit and voice in international medical travel - The case of Indonesia

    NARCIS (Netherlands)

    Ormond, M.E.

    2015-01-01

    Globally, more patients are intentionally travelling abroad as consumers for medical care. However, while scholars have begun to examine international medical travel's (IMT) impacts on the people and places that receive medical travellers, study of its impacts on medical travellers' home contexts ha

  5. New methods for solving a vertex p-center problem with uncertain demand-weighted distance: A real case study

    Directory of Open Access Journals (Sweden)

    Javad Nematian

    2015-04-01

    Full Text Available Vertex and p-center problems are two well-known types of the center problem. In this paper, a p-center problem with uncertain demand-weighted distance will be introduced in which the demands are considered as fuzzy random variables (FRVs and the objective of the problem is to minimize the maximum distance between a node and its nearest facility. Then, by introducing new methods, the proposed problem is converted to deterministic integer programming (IP problems where these methods will be obtained through the implementation of the possibility theory and fuzzy random chance-constrained programming (FRCCP. Finally, the proposed methods are applied for locating bicycle stations in the city of Tabriz in Iran as a real case study. The computational results of our study show that these methods can be implemented for the center problem with uncertain frameworks.

  6. How to manage external demands in hospitals--the case of atrium MC.

    Science.gov (United States)

    Blume, L H K; van Weert, N J H W; Delnoij, D M J

    2015-09-01

    In all modern healthcare systems, it is difficult for hospitals to keep pace with the increasing number of clinical guidelines. In the Netherlands, this poses a specific problem, as the national quality regulator holds hospital boards responsible for compliance with guidelines. We sought to address this problem by constructing a centralized database of guidelines. Due to the enormous number and the inter-relatedness of the guidelines, this task was larger and more complex than anticipated. This raises questions regarding the feasibility of adhering to external demands and concerning effective management by hospital executive boards of compliance with clinical guidelines. PMID:26384228

  7. PROFILE OF POISONING CASES IN A TERTIARY CARE HOSPITAL, TAMILNADU

    Directory of Open Access Journals (Sweden)

    Karikalan

    2014-10-01

    Full Text Available BACKGROUND AND OBJECTIVES: Poisoning is an important public health problem causing significant morbidity and mortality throughout the world. Knowledge of general pattern of poisoning in a particular region will help in early diagnosis and treatment of cases, thus decreasing the rate of mortality and morbidity. Information available in our locality with regard to acute poisoning is limited. The present study was carried out with the objective to investigate the pattern of acute poisoning cases in a tertiary care hospital in Coimbatore, Tamilnadu. MATERIALS AND METHODS: A retrospective analysis of all acute poisoning cases admitted to the emergency department of Karpagam Faculty of Medical Sciences and Research from April 2003 to March 2004 was done to study the pattern of poisoning. Data regarding age, sex, marital status, occupation, religion, locality, route of exposure, time elapsed after intake, circumstances of poisoning, name of poisonous substance, chemical type, duration of hospitalization and outcome were collected and analyzed. RESULTS: All reported cases were found to be suicidal poisoning. Majority of cases were in the age group of 11 – 20 years. Females (112 cases, 70% outnumbered males (48 cases, 30%. Students attempted to commit suicide much commoner than others followed by house wives and daily wage laborers. The commonest poison consumed was cow dung powder. The mortality rate was higher among those consumed rat killer poison (37.5%. CONCLUSION: This study adds information to the existing data which may help to develop prevention strategies. Health education to adolescents at school and college level about poisoning, regular counseling program for all high school children either by an in house trained faculty or a child psychologist and early detection of risk taking behavior in adolescents may to some extent prevent deliberate self-harm in teenagers. Ban on cow dung powder sales in grocery shops should be followed by district

  8. Transitional care in skilled nursing facilities: a multiple case study

    OpenAIRE

    Toles, Mark; Colón-Emeric, Cathleen; Naylor, Mary D; Barroso, Julie; Anderson, Ruth A.

    2016-01-01

    Background Among hospitalized older adults who transfer to skilled nursing facilities (SNF) for short stays and subsequently transfer to home, twenty two percent require additional emergency department or hospital care within 30 days. Transitional care services, that provide continuity and coordination of care as older adults transition between settings of care, decrease complications during transitions in care, however, they have not been examined in SNFs. Thus, this study described how exis...

  9. Cost-efficient demand-pull policies for multi-purpose technologies – The case of stationary electricity storage

    International Nuclear Information System (INIS)

    Highlights: • A definition of multi-purpose technologies (MPTs) is proposed. • Opportunities for a cost-efficient demand-pull policy strategy for MPTs are derived. • The multi-purpose character of stationary electricity storage (SES) is shown. • An exemplary profitability assessment of one SES technology supports the argument. - Abstract: Stationary electricity storage technologies (SES) allow to increase the shares of intermittent renewable energy technologies in electricity networks. As SES currently exhibit high costs, policy makers have started introducing demand-pull policies in order to foster their diffusion and drive these technologies further down the learning curve. However, as observed in the case of renewable energy technologies, demand-pull policies for technologies can come at high costs in cases where the profitability gap that needs to be covered by the policy support is large. Yet, SES can create value in multiple distinct applications in the power system – making it a “multi-purpose technology”. We argue that policy makers can make use of the multi-purpose character of SES to limit costs of demand-pull policies. We propose a policy strategy which grants support based on the profitability gap in the different applications, thereby moving down the learning curve efficiently. To support our argumentation, we firstly conduct a comprehensive literature review of SES applications exemplifying the multi-purpose character of these technologies. Second, we assess the profitability of one SES technology (vanadium redox flow battery) in five SES applications, highlighting a strong variation of the profitability gap across these applications

  10. Development of an interactive model for planning the care workforce for Alberta: case study

    Directory of Open Access Journals (Sweden)

    Bloom Judy

    2012-08-01

    Full Text Available Abstract Introduction In common with other jurisdictions, Alberta faces challenges in ensuring a balance in health worker supply and demand. As the provider organization with province-wide responsibility, Alberta Health Services needed to develop a forecasting tool to inform its position on key workforce parameters, in the first instance focused on modeling the situation for Registered Nurses, Licensed Practical Nurses and health care aides. This case study describes the development of the model, highlighting the choices involved in model development. Case description A workforce planning model was developed to test the effect of different assumptions (for instance about vacancy rates or retirement and different policy choices (for example about the size of intakes into universities and colleges, different composition of the workforce. This case study describes the choices involved in designing the model. The workforce planning model was used as part of a consultation process and to develop six scenarios (based on different policy choices. Discussion and evaluation The model outputs highlighted the problems with continuation of current workforce strategies and the impact of key policy choices on workforce parameters. Conclusions Models which allow for transparency of the underlying assumptions, and the ability to assess the sensitivity of assumptions and the impact of policy choices are required for effective workforce planning.

  11. Price Elasticity of the Residential Water Demand. Case-Study: Investment Project in Cluj County, Romania

    Directory of Open Access Journals (Sweden)

    Vasile Iuliu CIOMOŞ

    2012-06-01

    Full Text Available In Romania, local authorities and the newly established Regional Operators one of them being S.C. Compania de Apă Someş S.A., are required to fully comply with EU regulations concerning water and wastewater quality. In order to meet these requirements in due time, a lot of investment projects have to be prepared and implemented. The financing of these investments requires a progressive increase of the tariffs. In the last ten years, in Romania, the tariffs for the water services have been significantly augmented, more than in any other East European country. In the same time, a substantial reduction of the residential water consumption, measured in liters per capita per day, has been observed. In this article, the price elasticity of residential water demand for water services was analyzed, given its importance in the framework of the feasibility studies for investments to be made in order to insure compliance with EU water and wastewater Directives. In the same time, considerations with regard to the evolution of the tariff for water services and of the residential water demand are provided, with the aim of better explaining the context in which these variables evolve.

  12. Recreation Demands of Customers in Thermal Tourism Establishments: Case of Balikesir Province

    Directory of Open Access Journals (Sweden)

    Mehmet KAÇAR

    2014-08-01

    Full Text Available Evaluate recreation demand of customers who lodge in thermal hotels at Balıkesir province. Thermal tourism addresses to people who want to be healthier or aim to have sustainable health level. Parallel to the alternative tourism trend, in recent years there is an increase in number of tourists who visits to thermal facilities for daily trip or for a longer time period. In this study it is aimed to evaluate planning and developing spare time activities for customers who lodge in thermal facilities. The population of this research consist thermal hotel customers at Balikesir region from September to December in 20 13. Sample includes 400 customers who stay Asya Pamukcu Hotel Balikesir . In this research, “Customers‟ Recreational Demand Determination Survey” is applied which consists of questions related to spare time activities and questioner is developed by conside ring expert opinion and test re - test technique. The obtained data from survey is analyzed by SPSS 17 software. According to results, it is shown that, customers activities are insufficient related to spare times. Another result obtained from this researc h is that customers are willing to have recreational components in thermal facilities. Furthermore, it is shown that customers need information about thermal practices.

  13. Reliability-Based Marginal Cost Pricing Problem Case with Both Demand Uncertainty and Travelers’ Perception Errors

    Directory of Open Access Journals (Sweden)

    Shaopeng Zhong

    2013-01-01

    Full Text Available Focusing on the first-best marginal cost pricing (MCP in a stochastic network with both travel demand uncertainty and stochastic perception errors within the travelers’ route choice decision processes, this paper develops a perceived risk-based stochastic network marginal cost pricing (PRSN-MCP model. Numerical examples based on an integrated method combining the moment analysis approach, the fitting distribution method, and the reliability measures are also provided to demonstrate the importance and properties of the proposed model. The main finding is that ignoring the effect of travel time reliability and travelers’ perception errors may significantly reduce the performance of the first-best MCP tolls, especially under high travelers’ confidence and network congestion levels. The analysis result could also enhance our understanding of (1 the effect of stochastic perception error (SPE on the perceived travel time distribution and the components of road toll; (2 the effect of road toll on the actual travel time distribution and its reliability measures; (3 the effect of road toll on the total network travel time distribution and its statistics; and (4 the effect of travel demand level and the value of reliability (VoR level on the components of road toll.

  14. Money-in-the-Utility-Function: Model Simulations and Money Demand Estimation in the Case of the Republic of Macedonia

    Directory of Open Access Journals (Sweden)

    Ivanov Mile

    2015-03-01

    Full Text Available This paper aims to reassess and analyze the dynamic interactions between money, prices and economic activity in the case of the Republic of Macedonia. The first part of the paper simulates the property of the superneutrality of money, based on Sidrauski’s (1967 framework. The second part presents the money demand estimations on the monetary aggregate M2 for the period from 2002 to 2012, using the cointegration approach. Following Cziráky and Gillman (2006, we examine the validity of the Fisher equation in the case of Macedonia. The Fisher equation does not hold in the case of Macedonia, so the inflation rate must be included in the money demand specification. The estimated cointegration equation is in line with economic theory. The cointegration equation shows income elasticity less than unity (0,81, small and negative interest rate semi-elasticity (-0.17 and negative elasticity with respect to inflation. The short-run dynamics reveal that only 2,70% of the disequilibrium is corrected in a single quarter. The properties of stability imply that the M2 aggregate may serve as a proper policy indicator.

  15. Contrasting electricity demand with wind power supply: case study in Hungary

    International Nuclear Information System (INIS)

    We compare the demand of a large electricity consumer with supply given by wind farms installed at two distant geographic locations. Obviously such situation is rather unrealistic, however our main goal is a quantitative characterization of the intermittency of wind electricity. The consumption pattern consists of marked daily and weekly cycles interrupted by periods of holidays. In contrast, wind electricity production has neither short-time nor seasonal periodicities. We show that wind power integration over a restricted area cannot provide a stable base load supply, independently of the excess capacity. Further essential result is that the statistics are almost identical for a weekly periodic pattern of consumption and a constant load of the same average value. The length of both adequate supply and shortfall intervals exhibits a scale-free (power-law) frequency distribution, possible consequences are shortly discussed. (author)

  16. Contrasting electricity demand with wind power supply: case study in Hungary

    Energy Technology Data Exchange (ETDEWEB)

    Kiss, P.; Janosi, I. M. [Department of Physics of Complex Systems, Lorand Eotvos University, Pazmany P. s. 1/A, H-1117 Budapest (Hungary); Varga, L. [E.ON Hungaria Ltd., Roosevelt ter 7-8, H-1051 Budapest (Hungary)

    2009-07-01

    We compare the demand of a large electricity consumer with supply given by wind farms installed at two distant geographic locations. Obviously such situation is rather unrealistic, however our main goal is a quantitative characterization of the intermittency of wind electricity. The consumption pattern consists of marked daily and weekly cycles interrupted by periods of holidays. In contrast, wind electricity production has neither short-time nor seasonal periodicities. We show that wind power integration over a restricted area cannot provide a stable base load supply, independently of the excess capacity. Further essential result is that the statistics are almost identical for a weekly periodic pattern of consumption and a constant load of the same average value. The length of both adequate supply and shortfall intervals exhibits a scale-free (power-law) frequency distribution, possible consequences are shortly discussed. (author)

  17. Contrasting Electricity Demand with Wind Power Supply: Case Study in Hungary

    Directory of Open Access Journals (Sweden)

    Imre M. Jánosi

    2009-09-01

    Full Text Available We compare the demand of a large electricity consumer with supply given by wind farms installed at two distant geographic locations. Obviously such situation is rather unrealistic, however our main goal is a quantitative characterization of the intermittency of wind electricity. The consumption pattern consists of marked daily and weekly cycles interrupted by periods of holidays. In contrast, wind electricity production has neither short-time nor seasonal periodicities. We show that wind power integration over a restricted area cannot provide a stable baseload supply, independently of the excess capacity. Further essential result is that the statistics are almost identical for a weekly periodic pattern of consumption and a constant load of the same average value. The length of both adequate supply and shortfall intervals exhibits a scale-free (power-law frequency distribution, possible consequences are shortly discussed.

  18. A Dynamic Interactive Social Chart in Dementia CareAttuning Demand and Supply in the Care for Persons with Dementia and their Carers.

    Science.gov (United States)

    Dröes, R M; Meiland, F J M; Doruff, C; Varodi, I; Akkermans, H; Baida, Z; Faber, E; Haaker, T; Moelaert, F; Kartseva, V; Tan, Y H

    2005-01-01

    We-centric services may play an important role in the field of care and support for elderly persons with dementia and their carers. They may solve problems, such as fragmentation of care, gaps in the continuum of care and welfare services, and inefficient and uncustomized service delivery to patients and carers. In the FRUX Health Care pilot opportunities for we-centric, context-sensitive service bundles in the field of dementia care will be explored. The service on which we focus in this paper is a dynamic interactive social chart for dementia care (DEM-DISC). The feasibility of DEM-DISC will be investigated from a domain specific content perspective (needs, offerings, information and advice), an ICT perspective (ontology and application), a user perspective (persons with dementia, their carers and professionals/organizations), and an organisational perspective (necessary collaboration, governance and control, business modelling). A first demonstrator (validator) of the DEM-DISC will be designed, built and evaluated. Future possibilities to connect DEM-DISC to actual service delivery will be explored. In this paper we discuss the most important research questions from the different perspectives and the methods used to answer them. PMID:15923777

  19. Co-Adapting Water Demand and Supply to Changing Climate in Agricultural Water Systems, A Case Study in Northern Italy

    Science.gov (United States)

    Giuliani, M.; Li, Y.; Mainardi, M.; Arias Munoz, C.; Castelletti, A.; Gandolfi, C.

    2013-12-01

    Exponentially growing water demands and increasing uncertainties in the hydrologic cycle due to changes in climate and land use will challenge water resources planning and management in the next decade. Improving agricultural productivity is particularly critical, being this sector the one characterized by the highest water demand. Moreover, to meet projected growth in human population and per-capita food demand, agricultural production will have to significantly increase in the next decades, even though water availability is expected to decrease due to climate change impacts. Agricultural systems are called to adapt their strategies (e.g., changing crop patterns and the corresponding water demand, or maximizing the efficiency in the water supply modifying irrigation scheduling and adopting high efficiency irrigation techniques) in order to re-optimize the use of limited water resources. Although many studies have assessed climate change impacts on agricultural practices and water management, most of them assume few scenarios of water demand or water supply separately, while an analysis of their reciprocal feedbacks is still missing. Moreover, current practices are generally established according to historical agreements and normative constraints and, in the absence of dramatic failures, the shift toward more efficient water management is not easily achievable. In this work, we propose to activate an information loop between farmers and water managers to improve the effectiveness of agricultural water management practices by matching the needs of the farmers with the design of water supply strategies. The proposed approach is tested on a real-world case study, namely the Lake Como serving the Muzza-Bassa Lodigiana irrigation district (Italy). A distributed-parameter, dynamic model of the system allows to simulate crop growth and the final yield over a range of hydro-climatic conditions, irrigation strategies and water-related stresses. The spatial component of the

  20. Getting into hot water Problematizing hot water service demand: The case of Old Cairo

    Science.gov (United States)

    Culhane, Thomas Henry

    This dissertation analyzes hot water demand and service infrastructure in two neighboring but culturally distinct communities of the urban poor in the inner-city area of central Cairo. The communities are the Historic Islamic Cairo neighborhood of Darb Al Ahmar at the foot of Al-Azhar park, and the Zurayib neighborhood of Manshiyat Nasser where the Coptic Zabaleen Recyclers live. The study focuses on the demand side of the hot water issue and involves consideration of built-environment infrastructures providing piped water, electricity, bottled gas, sewage, and the support structures (wiring and plumbing) for consumer durables (appliances such as hot water heaters, stoves, refrigerators, air conditioners) as well as water pumps and water storage tanks. The study asks the questions "How do poor communities in Cairo value hot water" and "How do cost, infrastructure and cultural preferences affect which attributes of hot water service are most highly preferred?". To answer these questions household surveys based primarily on the World Bank LSMS modules were administered by professional survey teams from Darb Al Ahmar's Aga Khan Trust for Culture and the Zabaleen's local NGO "Spirit of Youth" in their adjacent conununities in and surrounding historic Cairo. In total 463 valid surveys were collected, (231 from Darb Al Ahmar, 232 from the Zabaleen). The surveys included a contingent valuation question to explore Willingness to Pay for improved hot water service; the surveys queried household assets as proxies for income. The dissertation's findings reveal that one quarter of the residents of Darb Al Ahmar and two-thirds of the residents of Manshiyet Nasser's Zabaleen lack conventional water heating service. Instead they employ various types of stoves and self-built contraptions to heat water, usually incurring considerable risk and opportunity costs. However the thesis explores the notion that this is rational "satisficing" behavior; despite the shortcomings of such self

  1. Multicriterial Hierarchy Methods Applied in Consumption Demand Analysis. The Case of Romania

    Directory of Open Access Journals (Sweden)

    Constantin Bob

    2008-03-01

    Full Text Available The basic information for computing the quantitative statistical indicators, that characterize the demand of industrial products and services are collected by the national statistics organizations, through a series of statistical surveys (most of them periodical and partial. The source for data we used in the present paper is an statistical investigation organized by the National Institute of Statistics, "Family budgets survey" that allows to collect information regarding the households composition, income, expenditure, consumption and other aspects of population living standard. In 2005, in Romania, a person spent monthly in average 391,2 RON, meaning about 115,1 Euros for purchasing the consumed food products and beverage, as well as non-foods products, services, investments and other taxes. 23% of this sum was spent for purchasing the consumed food products and beverages, 21.6% of the total sum was spent for purchasing non-food goods and 18,1%  for payment of different services. There is a discrepancy between the different development regions in Romania, regarding total households expenditure composition. For this reason, in the present paper we applied statistical methods for ranking the various development regions in Romania, using the share of householdsí expenditure on categories of products and services as ranking criteria.

  2. Intensive Care in India: The Indian Intensive Care Case Mix and Practice Patterns Study

    Science.gov (United States)

    Divatia, Jigeeshu V.; Amin, Pravin R.; Ramakrishnan, Nagarajan; Kapadia, Farhad N.; Todi, Subhash; Sahu, Samir; Govil, Deepak; Chawla, Rajesh; Kulkarni, Atul P.; Samavedam, Srinivas; Jani, Charu K.; Rungta, Narendra; Samaddar, Devi Prasad; Mehta, Sujata; Venkataraman, Ramesh; Hegde, Ashit; Bande, BD; Dhanuka, Sanjay; Singh, Virendra; Tewari, Reshma; Zirpe, Kapil; Sathe, Prachee

    2016-01-01

    Aims: To obtain information on organizational aspects, case mix and practices in Indian Intensive Care Units (ICUs). Patients and Methods: An observational, 4-day point prevalence study was performed between 2010 and 2011 in 4209 patients from 124 ICUs. ICU and patient characteristics, and interventions were recorded for 24 h of the study day, and outcomes till 30 days after the study day. Data were analyzed for 4038 adult patients from 120 ICUs. Results: On the study day, mean age, Acute Physiology and Chronic Health Evaluation (APACHE II) and sequential organ failure assessment (SOFA) scores were 54.1 ± 17.1 years, 17.4 ± 9.2 and 3.8 ± 3.6, respectively. About 46.4% patients had ≥1 organ failure. Nearly, 37% and 22.2% patients received mechanical ventilation (MV) and vasopressors or inotropes, respectively. Nearly, 12.2% patients developed an infection in the ICU. About 28.3% patients had severe sepsis or septic shock (SvSpSS) during their ICU stay. About 60.7% patients without infection received antibiotics. There were 546 deaths and 183 terminal discharges (TDs) from ICU (including left against medical advice or discharged on request), with ICU mortality 729/4038 (18.1%). In 1627 patients admitted within 24 h of the study day, the standardized mortality ratio was 0.67. The APACHE II and SOFA scores, public hospital ICUs, medical ICUs, inadequately equipped ICUs, medical admission, self-paying patient, presence of SvSpSS, acute respiratory failure or cancer, need for a fluid bolus, and MV were independent predictors of mortality. Conclusions: The high proportion of TDs and the association of public hospitals, self-paying patients, and inadequately equipped hospitals with mortality has important implications for critical care in India.

  3. Technology and Logistics in Health Care Services : A Case Study of Länssjukhuset Ryhov

    OpenAIRE

    Tolic, Biljana; Hanaeus, Amanda

    2015-01-01

    Background: Swedish hospitals face intensified challenges due to elevated demands from patients, demographic changes and cost constraints. Furthermore, patient safety is negatively affected by the relatively high rate of health care associated infections (HAIs). Thus, enforced preventive measures have to be undertaken to improve medical institutions’ ability to provide a qualitative and safe health care. Hence, logistics and technology solutions are gaining presence in modern day medical inst...

  4. Shifting the burden of health care finance: a case study of public-private partnership in Singapore.

    Science.gov (United States)

    Lim, Meng-Kin

    2004-07-01

    Since becoming independent in 1965, Singapore has attained high standards in health care provision while successfully transferring a substantial portion of the health care burden to the private sector. The government's share of total health care expenditure contracted from 50% in 1965 to 25% in 2000. At first glance, the efficiency-driven health care financing reforms which emphasize individual over state responsibility appear to have been implemented at the expense of equity. On closer examination, however, Singaporeans themselves seem unconcerned about any perceived inequity of the system. Indeed, they appear content to pay part of their medical expenses, plus additional monies if they demand a higher level of services. In fact, access to needed care for the poor is explicitly guaranteed. Mechanisms also exist to protect against financial impoverishment resulting from catastrophic illness. Singapore's experience provides an interesting case study in public-private partnership, illustrating how a hard-headed approach to health policy can achieve national health goals while balancing efficiency and equity concerns. PMID:15484609

  5. Industrial water demand management and cleaner production potential: a case of three industries in Bulawayo, Zimbabwe

    Science.gov (United States)

    Gumbo, Bekithemba; Mlilo, Sipho; Broome, Jeff; Lumbroso, Darren

    The combination of water demand management and cleaner production concepts have resulted in both economical and ecological benefits. The biggest challenge for developing countries is how to retrofit the industrial processes, which at times are based on obsolete technology, within financial, institutional and legal constraints. Processes in closed circuits can reduce water intake substantially and minimise resource input and the subsequent waste thereby reducing pollution of finite fresh water resources. Three industries were studied in Bulawayo, Zimbabwe to identify potential opportunities for reducing water intake and material usage and minimising waste. The industries comprised of a wire galvanising company, soft drink manufacturing and sugar refining industry. The results show that the wire galvanising industry could save up to 17% of water by recycling hot quench water through a cooling system. The industry can eliminate by substitution the use of toxic materials, namely lead and ammonium chloride and reduce the use of hydrochloric acid by half through using an induction heating chamber instead of lead during the annealing step. For the soft drink manufacturing industry water intake could be reduced by 5% through recycling filter-backwash water via the water treatment plant. Use of the pig system could save approximately 12 m 3/month of syrup and help reduce trade effluent fees by Z30/m 3 of “soft drink”. Use of a heat exchanger system in the sugar refining industry can reduce water intake by approximately 57 m 3/100 t “raw sugar” effluent volume by about 28 m 3/100 t “raw sugar”. The water charges would effectively be reduced by 52% and trade effluent fees by Z3384/100 t “raw sugar” (57%). Proper equipment selection, equipment modification and good house-keeping procedures could further help industries reduce water intake and minimise waste.

  6. Interactive Energy Demand Analysis: A Case Study of Shanxi Province, PRC

    OpenAIRE

    Vallance, B.; Weigkricht, E.

    1988-01-01

    Within the framework of collaboration between IIASA's Advanced Computer Applications project (ACA) and the State Science and Technology Commission of the People's Republic of China (SSTCC), ACA has developed an integrated set of information and decision support system for development planning in China. The system is implemented for a case study of Shanxi, a province in north central China, which is very rich in coal and several mineral resources, but is still at an early stage of development,...

  7. Massive gastric dilatation caused by eating binges demanding surgical intervention: a case report

    Directory of Open Access Journals (Sweden)

    Lemke, Johannes

    2014-11-01

    Full Text Available The clinical picture of an acute abdomen is frequently encountered in emergency medicine. In most cases abdominal pathologies underlie this condition, however, also extra-abdominal diseases may present or cause an acute abdomen. The fact that this condition is potentially life-threatening highlights the importance of instant action. Here, we report on the case of a young woman that presented with an acute abdomen in our clinic. Imaging revealed a massively distended stomach reaching the lesser pelvis. Initially, the etiology for the gastric dilatation remained unsolved. On the same day we performed an explorative laparotomy in which massive amounts of clotted, undigested food was recovered via a gastrotomy. Postoperatively, upon psychiatric consultation, an eating disorder with daily eating binges could be revealed as being the cause for the acute and dramatic gastric dilatation. The patient fully recovered from surgery and psychiatric co-treatment was initiated. This unique case report demonstrates how a psychiatric condition may lead to an acute abdomen, however, it also emphasizes the importance of prompt diagnosis and adequate therapy to avoid complications and allowing for full recovery.

  8. Usual hospital care versus post-abortion care for women with unsafe abortion: a case control study from Sri Lanka

    OpenAIRE

    Arambepola, Carukshi; Lalini C. Rajapaksa; Galwaduge, Chandani

    2014-01-01

    Background Good quality post-abortion-care (PAC) is essential to prevent death and long-term complications following unsafe abortion, especially in countries with restrictive abortion laws. We assessed the PAC given to women following an unsafe abortion, compared to the routine hospital care following spontaneous abortion or unintended pregnancy carried to term in Sri Lanka. Methods A case–control study was conducted in Sri Lanka among 171 cases following unsafe abortion, 638 controls followi...

  9. Equity in health care financing: The case of Malaysia

    OpenAIRE

    Sach Tracey H; Whynes David K; Yu Chai

    2008-01-01

    Abstract Background Equitable financing is a key objective of health care systems. Its importance is evidenced in policy documents, policy statements, the work of health economists and policy analysts. The conventional categorisations of finance sources for health care are taxation, social health insurance, private health insurance and out-of-pocket payments. There are nonetheless increasing variations in the finance sources used to fund health care. An understanding of the equity implication...

  10. Maternal Health Care: The Case of Iron Supplementation in India

    OpenAIRE

    Khan, Rana Ejaz Ali; Raza, Muhammad Ali

    2013-01-01

    Prenatal care is an essential segment of maternal health-care. In this paper an attempt has been made to examine the socioeconomic determinants of maternal iron supplementation and sufficient maternal iron supplementation as components of prenatal care. Micro-data having 25999 and 19764 observations for two models, i.e. maternal iron supplementation and maternal sufficient iron supplementation respectively has been taken from Indian Demographic and Health Survey (IDHS) 2005-06. To estimate th...

  11. Reforming health care : a case for stay well health insurance

    OpenAIRE

    Bogetic, Zeljko; Heffley, Dennis

    1993-01-01

    All countries - whether industrial, developing, or in transition to a market economy - are interested in health care reform. A central focus of reform everywhere is to make patients more responsive to health care costs without diluting the protection offered by public or private insurance. Conventional insurance offers customers little incentive to monitor their own use of health care services or to adopt and maintain better health habits. The authors describe an alternative health insurance ...

  12. Is there a demand for physical activity interventions provided by the health care sector? Findings from a population survey

    Directory of Open Access Journals (Sweden)

    Walter Lars

    2010-01-01

    Full Text Available Abstract Background Health care providers in many countries have delivered interventions to improve physical activity levels among their patients. Thus far, less is known about the population's interest to increase their physical activity levels and their opinion about the health care provider's role in physical activity promotion. The aims of this paper were to investigate the self-reported physical activity levels of the population and intention to increase physical activity levels, self-perceived need for support, and opinions about the responsibilities of both individuals and health care providers to promote physical activity. Methods A regional public health survey was mailed to 13 440 adults (aged 18-84 years living in Östergötland County (Sweden in 2006. The survey was part of the regular effort by the regional Health Authorities. Results About 25% of the population was categorised as physically active, 38% as moderately active, 27% as somewhat active, and 11% as low active. More than one-third (37% had no intentions to increase their physical activity levels, 36% had thought about change, while 27% were determined to change. Lower intention to change was mainly associated with increased age and lower education levels. 28% answered that physical activity was the most important health-related behaviour to change "right now" and 15% of those answered that they wanted or needed support to make this change. Of respondents who might be assumed to be in greatest need of increased activity (i.e. respondents reporting poor general health, BMI>30, and inactivity more than one-quarter wanted support to make improvements to their health. About half of the respondents who wanted support to increase their physical activity levels listed health care providers as a primary source for support. Conclusions These findings suggest that there is considerable need for physical activity interventions in this population. Adults feel great responsibility for

  13. Improvement in hearing after chiropractic care: a case series

    Directory of Open Access Journals (Sweden)

    Di Duro Joseph O

    2006-01-01

    Full Text Available Abstract Background The first chiropractic adjustment given in 1895 was reported to have cured deafness. This study examined the effects of a single, initial chiropractic visit on the central nervous system by documenting clinical changes of audiometry in patients after chiropractic care. Case presentation Fifteen patients are presented (9 male, 6 female with a mean age of 54.3 (range 34–71. A Welch Allyn AudioScope 3 was used to screen frequencies of 1000, 2000, 4000 and 500 Hz respectively at three standard decibel levels 20 decibels (dB, 25 dB and 40 dB, respectively, before and immediately after the first chiropractic intervention. Several criteria were used to determine hearing impairment. Ventry & Weinstein criteria of missing one or more tones in either ear at 40 dB and Speech-frequency criteria of missing one or more tones in either ear at 25 dB. All patients were classified as hearing impaired though greater on the right. At 40 dB using the Ventry & Weinstein criteria, 6 had hearing restored, 7 improved and 2 had no change. At 25 dB using the Speech-frequency criteria, none were restored, 11 improved, 4 had no change and 3 missed a tone. Conclusion A percentage of patients presenting to the chiropractor have a mild to moderate hearing loss, most notably in the right ear. The clinical progress documented in this report suggests that manipulation delivered to the neuromusculoskeletal system may create central plastic changes in the auditory system.

  14. On-demand d-modafinil may be an effective treatment option for lifelong premature ejaculation: a case report.

    Science.gov (United States)

    Serefoglu, E C

    2016-02-01

    Premature ejaculation (PE) is considered to be the most common form of male sexual dysfunction. Given that acute oral administration of d-isomer of modafinil (d-modafinil) can extend the latency to ejaculation in rats without suppressing sexual behaviour, the effects of on-demand d-modafinil treatment were examined on a 30-year-old male patient with lifelong PE. The patient was instructed to take d-modafinil 100 mg 3 h prior to the sexual relation for four times and was invited for a control visit. The patient was re-evaluated 2 weeks later. He reported that his IELT increased to 15 min. He reported heartburn and insomnia when he used d-modafinil for the first time; however, these symptoms were transient and did not recur after the initial dose. Overall, he reported considerable improvement and noted that he feels much better with the treatment. Based on this limited data, on-demand d-modafinil seems to be an effective treatment for men with lifelong PE. The side effects were transient and mild in the reported case. Further randomised clinical trials are necessary to elucidate the therapeutic concept of this drug in patients with lifelong PE. PMID:25735219

  15. Labour supply in the home care industry: A case study in a Dutch region.

    Science.gov (United States)

    Breedveld, Elly J; Meijboom, Bert R; de Roo, Aad A

    2006-04-01

    Health organizations have started to become more market-driven. Therefore, it is important for health organizations to analyse the competitive dynamics of their industrial structure. However, relevant theories and models have mainly been developed for organizations acting in the profit sector. In this paper, we adapt Porter's 'five forces model' to the home care industry. In particular, we modify the (determinants of the) bargaining power of labour suppliers. We then apply the modified Porter-model to the home care industry in the Netherlands for the period of 1987-1997 with special attention for labour supply. The new instrument clarifies the complexity of the supply chains and value systems of the home care industry. As can be illustrated by developments in the home care industry in the province of North Brabant during the 1990s, competition between home care providers has influenced labour market relations, but so do other factors as well. Between 1987 and 1997, the bargaining power of labour suppliers was relatively limited. After 1997, however, the demand for home care personnel has increased strongly. In spite of the present economic recession, scarcity on this labour market seems to prevail in the longer term due to a growing demand for home care services. PMID:16011857

  16. Forecast combinations for intermittent demand

    OpenAIRE

    Fotios PETROPOULOS; Kourentzes, Nikos

    2015-01-01

    Intermittent demand is characterised by infrequent demand arrivals, where many periods have zero demand, coupled with varied demand sizes. The dual source of variation renders forecasting for intermittent demand a very challenging task. Many researchers have focused on the development of specialised methods for intermittent demand. However, apart from a case study on hierarchical forecasting, the effects of combining, which is a standard practice for regular demand, have not been investigated...

  17. Palliative care communication curriculum: what can students learn from an unfolding case?

    Science.gov (United States)

    Goldsmith, Joy; Wittenberg-Lyles, Elaine; Shaunfield, Sara; Sanchez-Reilly, Sandra

    2011-06-01

    Limited attention to palliative care communication training is offered to medical students. In this work, we pursued unfolding case responses and what they indicated about student tendencies to use palliative care communication as well as what medical students can learn from their own reflective practice about palliative care. Findings showed an overwhelming trend for students to avoid palliative care communication or inclusion of topics including advance directives, place of care, family support, and dying. Instead, students relied heavily on the SPIKES protocol, communication that was strategically vague and ambiguous, and discussions that centered on specialty care and referral. In reflecting on their own case study responses, students noted an absence of direct communication about prognosis, no coordination of care, late hospice entry, and patient pain resulting from communication inefficacies. Future research should focus on the development of formal and adaptive curriculum structures to address these communication needs. PMID:21071434

  18. Describing Long-Term Electricity Demand Scenarios in the Telecommunications Industry: A Case Study of Japan

    Directory of Open Access Journals (Sweden)

    Yusuke Kishita

    2016-01-01

    Full Text Available Due to the rapid expansion of information and communication technology (ICT usage, the telecommunications industry is faced with a challenge to promote green ICT toward achieving a low-carbon society. One critical obstacle in planning long-term strategies for green ICT is the uncertainty of various external factors, such as consumers’ lifestyle and technological advancement. To tackle this issue, this paper employs a scenario planning method to analyze electricity consumption in the telecommunications industry, where both changes in various external factors and energy-saving measures are assumed. We propose a model to estimate future electricity consumption of the telecommunications industry using a statistical approach. In a case study, we describe four scenarios that differ in the diffusion of ICT and the technological advancement of ICT equipment in order to analyze the electricity consumption in Japan’s telecommunications industry to 2030. The results reveal that the electricity consumption in 2030 becomes 0.7–1.6-times larger than the 2012 level (10.7 TWh/year. It is also shown that the most effective measures to reduce the electricity consumption include improving the energy efficiency of IP (Internet Protocol communication equipment and mobile communication equipment.

  19. Making the Case for Public-Private Child Care Partnerships: Child Care Partnership Project. [Videotape].

    Science.gov (United States)

    Finance Project, Washington, DC.

    The quality of child care in the United States has important implications for school preparedness, welfare reform, economic vitality, and the quality of family life. In this 8-minute videotape, business leaders describe why child care makes good business sense. Visuals explain the importance of early childhood for school and life success, and the…

  20. Managed care and medical education: hard cases and hard choices.

    Science.gov (United States)

    Friedman, E

    1997-05-01

    As managed care becomes more and more dominant in U.S. health care, it is coming into conflict with medical education. There are historical reasons for this: medical education traditionally excluded physicians who chose to work in health plans, and for profit managed care has tended to avoid subsidizing medical education. In order to improve the climate, three changes are necessary: medical education must understand the tense history of discord between the two; distinctions must be made between responsible and irresponsible managed care plans; and medical educators should not assume they own the moral high ground. Arrogance, a gross oversupply of physicians and especially specialists, scandals and fraud, an often callous attitude toward the poor, and other sins can be laid at medical education's door. The worse threat for both sides is that the public and payers could simply abandon both, leading to underfunding for health professions education, a society that does not trust its health care system, and the loss of superb teaching organizations. To prevent this, managed care and medical education should work together to solve several difficult problems: how to shrink the medical education infrastructure; how to report honestly the uses to which medical education funds are put; and how to identify and end irresponsible behavior on the part of health plans and medical education entities alike. If the two sides can exercise leadership in these areas, they will be able to protect and enhance the singular place of honor that medical education holds in this society. PMID:9159575

  1. THE DEMAND FOR NUTRITIONALLY-ENHANCED VARIETIES AND IMPLICATIONS FOR FOOD PRODUCT COMPETITION: THE CASE OF ORANGE JUICE

    OpenAIRE

    Dooley, Ryan; Eales, James S.; Binkley, James K.

    2000-01-01

    This study focused on consumer demand for orange juice, for both frozen concentrate and refrigerated, by major brands and nutritional enhancement. Demand for calcium-enhanced orange juice and standard orange juice were compared. Estimation involved system of demand equations and included the role of demographics.

  2. A Case Report for a Complex Denture Case on a Special Care Patient with Osteogenesis Imperfecta.

    Science.gov (United States)

    Sawyer, Colin; Drysdale, David

    2015-05-01

    This case report presents a patient with Dentogenesis Imperfecta (DI) associated with Osteogenesis Imperfecta (OI) and its subsequent dental manifestations. The patient in this report (see Figure 1) has spent his life living with his disability type III OI (also known as brittle bone disease) and its degenerative affects. The patient is independent and enjoys his social life but felt his existing dentures were having an adverse effect on the quality of his life. The patient attended Dorset County Hospitals Special Care Dentistry and on clinical examination it was noted the patient was partially dentate with a class III malocclusion and brownish discoloration of the remaining teeth caused by enamel hypoplasia. Treatment for this patient would entail making a maxillary complete denture and a mandibular partial chrome denture, normally quite simple tasks but due to the DI and its dental manifestations, the treatment would be complicated. This case demonstrates how a complex case treated by a collaborative dental team using their different skills and knowledge can lead to a successful and rewarding treatment for both patient and team. PMID:26556263

  3. Hospital-based palliative care: A case for integrating care with cure

    Directory of Open Access Journals (Sweden)

    Priya Darshini Kulkarni

    2011-01-01

    Full Text Available The reason that probably prompted Dame Cicely Saunders to launch the palliative care movement was the need to move away from the impersonal, technocratic approach to death that had become the norm in hospitals after the Second World War. Palliative care focuses on relieving the suffering of patients and families. Not limited to just management of pain, it includes comprehensive management of any symptom, which affects the quality of life. Care is optimized through early initiation and comprehensive implementation throughout the disease trajectory. Effective palliative care at the outset can help accelerate a positive clinical outcome. At the end of life, it can enhance the opportunity for the patient and family to achieve a sense of growth, resolve differences, and find a comfortable closure. It helps to reduce the suffering and fear associated with dying and prepares the family for bereavement.

  4. Why caretakers bypass Primary Health Care facilities for child care - a case from rural Tanzania

    Directory of Open Access Journals (Sweden)

    Kahabuka Catherine

    2011-11-01

    Full Text Available Abstract Background Research on health care utilization in low income countries suggests that patients frequently bypass PHC facilities in favour of higher-level hospitals - despite substantial additional time and financial costs. There are limited number of studies focusing on user's experiences at such facilities and reasons for bypassing them. This study aimed to identify factors associated with bypassing PHC facilities among caretakers seeking care for their underfive children and to explore experiences at such facilities among those who utilize them. Methods The study employed a mixed-method approach consisting of an interviewer administered questionnaires and in-depth interviews among selected care-takers seeking care for their underfive children at Korogwe and Muheza district hospitals in north-eastern Tanzania. Results The questionnaire survey included 560 caretakers. Of these 30 in-depth interviews were conducted. Fifty nine percent (206/348 of caretakers had not utilized their nearer PHC facilities during the index child's sickness episode. The reasons given for bypassing PHC facilities were lack of possibilities for diagnostic facilities (42.2%, lack of drugs (15.5%, closed health facility (10.2%, poor services (9.7% and lack of skilled health workers (3.4%. In a regression model, the frequency of bypassing a PHC facility for child care increased significantly with decreasing travel time to the district hospital, shorter duration of symptoms and low disease severity. Findings from the in-depth interviews revealed how the lack of quality services at PHC facilities caused delays in accessing appropriate care and how the experiences of inadequate care caused users to lose trust in them. Conclusion The observation that people are willing to travel long distances to get better quality services calls for health policies that prioritize quality of care before quantity. In a situation with limited resources, utilizing available resources to

  5. Why caretakers bypass Primary Health Care facilities for child care - a case from rural Tanzania

    OpenAIRE

    Kahabuka Catherine; Kvåle Gunnar; Moland Karen; Hinderaker Sven

    2011-01-01

    Abstract Background Research on health care utilization in low income countries suggests that patients frequently bypass PHC facilities in favour of higher-level hospitals - despite substantial additional time and financial costs. There are limited number of studies focusing on user's experiences at such facilities and reasons for bypassing them. This study aimed to identify factors associated with bypassing PHC facilities among caretakers seeking care for their underfive children and to expl...

  6. Experiences of Emotion Management in Medical Care (Case Study: Toronto

    Directory of Open Access Journals (Sweden)

    Masoud Kianpour

    2013-02-01

    pastoral and spiritual care for patients, their relatives, and other medical personnel. Approximately 50 chaplains work in different Toronto hospitals, of whom 21 individuals were selected using purpose f ul sampling : a non-random method o f sampling in which the researcher selects “in f ormation-rich” cases f or in-depth interview. The author tried to collect data as records of action-in-process from a variety of people. Because the in-depth responses obtained by qualitative studies cannot be easily categorized, analysis must rely less on counting and correlating and more on interpretation, summary and integration. Therefore, more than anything else, the findings of this study are supported by quotations and case descriptions. The method of data analysis is qualitative description, with a phenomenological inclination: that is, the goal is to describe emotion management experiences as they are lived and felt by chaplains.     Discussion of Results & Conclusions   Chaplains who participated in this study are between the ages of 33 and 65. The average age is approximately 52. Also, 11 chaplains work part-time and 10 chaplains work full-time. 18 of the 21 chaplains in the sample are women. Recruiting more than 3 male chaplains was not possible due to the fact that hospital chaplaincy is a job predominantly occupied by women. In terms of ethnicity, the majority of the respondents are white, with European and Anglo-Saxon backgrounds. However, the sample also includes two Asian chaplains (with Chinese and Indian backgrounds and one from the Caribbean Islands. Moreover, the sample includes chaplains from five different religions and faith traditions. The majority of the chaplains are Christian, including five chaplains belonging to the Anglican Church, three to the Roman Catholic Church, two to the United Church of Canada, and one to the Baptist Church. The remaining four Christian chaplains did not specify their Church. Several of the chaplains are church ministers. Also

  7. February 2016 critical care case of the month

    Directory of Open Access Journals (Sweden)

    Stewart TM

    2016-02-01

    Full Text Available No abstract available. Article truncated after the first page. A 32 year-old, previously healthy, female hospital visitor had been participating in a family care conference regarding her critically ill grandmother admitted to the cardiac intensive care unit. During the care conference, she felt unwell and had some mild chest discomfort; she collapsed and cardiopulmonary resuscitation (CPR was initiated (1. Upon arrival of the code team, she was attached to the monitor and mask ventilation was initiated. Her initial rhythm is shown in Figure 1. In addition to DC cardioversion which of the following should be administered immediately? 1. Lidocaine; 2. Magnesium sulfate; 3. Procainamide ; 4. 1 and 3; 5. All of the above. ...

  8. Evaluation of moral case deliberation at the Dutch Health Care Inspectorate: a pilot study

    OpenAIRE

    Seekles, Wike; Widdershoven, Guy; Robben, Paul; van Dalfsen, Gonny; Molewijk, Bert

    2016-01-01

    Background Moral case deliberation (MCD) as a form of clinical ethics support is usually implemented in health care institutions and educational programs. While there is no previous research on the use of clinical ethics support on the level of health care regulation, employees of regulatory bodies are regularly confronted with moral challenges. This pilot study describes and evaluates the use of MCD at the Dutch Health Care Inspectorate (IGZ). The objective of this pilot study is to investig...

  9. Branding in senior care home services in China and Finland : Comparative case study in private sector

    OpenAIRE

    Kittilä, Petri

    2011-01-01

    ABSTRACT Kittilä, Petri 2011. Branding in senior care home services in China and Finland: Comparative case study in private sector. Bachelor’s Thesis. Kemi-Tornio University of Applied Sciences. Business and Culture. Pages 88. Appendix 1. The objective of this thesis was to study how the private sector senior care home services are branded and how significant the care homes see the brand building. In addition, my objective was to study differences in service branding between China and...

  10. Opportunities for Automated Demand Response in Wastewater Treatment Facilities in California - Southeast Water Pollution Control Plant Case Study

    Energy Technology Data Exchange (ETDEWEB)

    Olsen, Daniel; Goli, Sasank; Faulkner, David; McKane, Aimee

    2012-12-20

    This report details a study into the demand response potential of a large wastewater treatment facility in San Francisco. Previous research had identified wastewater treatment facilities as good candidates for demand response and automated demand response, and this study was conducted to investigate facility attributes that are conducive to demand response or which hinder its implementation. One years' worth of operational data were collected from the facility's control system, submetered process equipment, utility electricity demand records, and governmental weather stations. These data were analyzed to determine factors which affected facility power demand and demand response capabilities The average baseline demand at the Southeast facility was approximately 4 MW. During the rainy season (October-March) the facility treated 40% more wastewater than the dry season, but demand only increased by 4%. Submetering of the facility's lift pumps and centrifuges predicted load shifts capabilities of 154 kW and 86 kW, respectively, with large lift pump shifts in the rainy season. Analysis of demand data during maintenance events confirmed the magnitude of these possible load shifts, and indicated other areas of the facility with demand response potential. Load sheds were seen to be possible by shutting down a portion of the facility's aeration trains (average shed of 132 kW). Load shifts were seen to be possible by shifting operation of centrifuges, the gravity belt thickener, lift pumps, and external pump stations These load shifts were made possible by the storage capabilities of the facility and of the city's sewer system. Large load reductions (an average of 2,065 kW) were seen from operating the cogeneration unit, but normal practice is continuous operation, precluding its use for demand response. The study also identified potential demand response opportunities that warrant further study: modulating variable-demand aeration loads, shifting

  11. [The Home Care Doctor Today is "STRIKE" - Considering Care of Terminal Stage Patients with Cancer through a Case Report].

    Science.gov (United States)

    Ogihara, Miyoko; Yamaoka, Keita; Fujimaki, Yoko; Watanabe, Mutsuko; Hirohara, Masayoshi; Kushida, Kazuki

    2015-12-01

    Although many patients wish to remain in their familiar home environment while undergoing cancer treatment, many obstacles prevent a patient from receiving cancer care at home. With early-stage cancer, the patients may better accept the diagnosis and have a greater will to fight the illness. However as time proceeds, progression or recurrence of cancer may occur, and eventually, proactive treatments will not be available. This progression results in great physical and mental strain on the patients and their family. At all stages of such progression, opportunities exist for a care provider to assist with overcoming potential obstacles by openly communicating with the patients, talking through the patients' experiences, and understanding their feelings. However, on diagnosis, cancer patients must often face the reality that they have very little time left to live. When transiting medical care from their long-trusted hospital to a home care base, a new physician must be selected and other decisions related to their care must be quickly made. Transferring responsibility to a good home care provider can greatly influence a patient's emotional state. This paper reports one such case in which the patients died in their homes with the best comfort and possible outcome. PMID:26809394

  12. Bacterial transmission from lens storage cases to contact lenses - Effects of lens care solutions and silver impregnation of cases

    NARCIS (Netherlands)

    Vermeltfoort, Pit B. J.; Hooymans, Johanna M. M.; Busscher, Henk J.; van der Mei, Henny C.

    2008-01-01

    The killing efficacies of multipurpose lens care solutions on planktonic and biofilm bacteria grown in polypropylene contact lens storage cases with and without silver impregnation and effects on bacterial transmission from storage cases to silicone hydrogel contact lenses were investigated. For tra

  13. 45 CFR 302.52 - Distribution of support collected in Title IV-E foster care maintenance cases.

    Science.gov (United States)

    2010-10-01

    ... foster care maintenance cases. 302.52 Section 302.52 Public Welfare Regulations Relating to Public... Distribution of support collected in Title IV-E foster care maintenance cases. Effective October 1, 1984, the... collected in foster care maintenance cases shall be treated in accordance with the provisions of §...

  14. Neonatal Intensive Care for Low Birthweight Infants: Costs and Effectiveness. Health Technology Case Study 38.

    Science.gov (United States)

    Congress of the U.S., Washington, DC. Office of Technology Assessment.

    After a brief introduction delineating the scope of the case study, chapter 1 summarizes findings and conclusions about the costs and effectiveness of neonatal intensive care in the United States. Chapter 2 inventories the national supply of neonatal intensive care units and describes recent trends in use and costs. Chapter 3 reviews mortality and…

  15. Reduction of Behavioral Psychological Symptoms of Dementia by Multimodal Comprehensive Care for Vulnerable Geriatric Patients in an Acute Care Hospital: A Case Series.

    Science.gov (United States)

    Honda, Miwako; Ito, Mio; Ishikawa, Shogo; Takebayashi, Yoichi; Tierney, Lawrence

    2016-01-01

    Management of Behavioral and Psychological Symptoms of Dementia (BPSD) is a key challenge in geriatric dementia care. A multimodal comprehensive care methodology, Humanitude, with eye contact, verbal communication, and touch as its elements, was provided to three geriatric dementia patients for whom conventional nursing care failed in an acute care hospital. Each episode was evaluated by video analysis. All patients had advanced dementia with BPSD. Failure of care was identified by patient's shouting, screaming, or abrupt movements of limbs. In this case series, conventional care failed for all three patients. Each element of care communication was much shorter than in Humanitude care, which was accepted by the patients. The average of the elements performed during the care was eye contact 0.6%, verbal communication 15.7%, and touch 0.1% in conventional care and 12.5%, 54.8%, and 44.5% in Humanitude care, respectively. The duration of aggressive behavior of each patient during care was 25.0%, 25.4%, and 66.3% in conventional care and 0%, 0%, and 0.3% in Humanitude, respectively. In our case series, conventional care was provided by less eye contact, verbal communication, and touch. The multimodal comprehensive care approach, Humanitude, decreased BPSD and showed success by patients' acceptance of care. PMID:27069478

  16. Prevalence of Nontuberculous Mycobacteria among Extrapulmonary Tuberculosis Cases in Tertiary Care Centers in Northern India

    OpenAIRE

    A. K. Maurya; Nag, V. L.; S Kant; R A S Kushwaha; Kumar, M.; SINGH, A.K.; T N Dhole

    2015-01-01

    The reports of nontuberculous mycobacteria (NTM) associated with extrapulmonary diseases are increasing in tertiary care hospitals. Despite a significant increase in knowledge about NTM infections, they still represent a diagnostic and therapeutic challenge. The aim of this study is to know the prevalence of NTN among extrapulmonary tuberculosis cases in tertiary care centers in Northern India. A total of 227 culture positive isolates from 756 cases were tested for niacin production and catal...

  17. Clean air renewable energy (CARE) coalition : a case study

    International Nuclear Information System (INIS)

    This paper highlights the opportunity for new partnerships between business and non-governmental organizations in the field of sustainable development through the growing convergence of interests. The authors also briefly describe both Suncor Energy and the Pembina Institute for Appropriate Development stances on sustainable development. Since 1990, both organizations have collaborated on the future of the emerging renewable energy industry. Renewable energy represents an energy source diversification through the regional creation of jobs and improved air quality and associated benefits resulting from the reductions in greenhouse gas emissions. The Clean Air Renewable Energy Coalition (Coalition) was established in December 2000 in order to assess the barriers to capital investment in the renewable energy industry. It was revealed that the international community as a whole was further ahead than Canada in terms of renewable support, production and export of technology and services. Some of the challenges facing the industry are: low demand for renewables and low supply. The coalition allowed for the joint identification of desired policy changes, such as new tax incentives for renewable energy supply and demand. Efforts were made in inviting the support of industry, municipalities and environmental non governmental organizations. The list of members that have joined the coalition to date was shown. The coalition is asking for consumer green energy credit, designed for the creation of demand and the education of the general public, and producer incentives to increase supply. The proposals were explained, as well as the strategic principles underlying them. A new tax incentive was announced in the December 2001 Canadian federal budget. The authors concluded by mentioning some future opportunities and the lessons learned on the importance of the right partners, of broad-based advocacy, of targeted and focuses messages, and of evolutionary change

  18. Estimating the net electricity energy generation and demand using the ant colony optimization approach. Case of Turkey

    International Nuclear Information System (INIS)

    This paper presents Turkey's net electricity energy generation and demand based on economic indicators. Forecasting model for electricity energy generation and demand is first proposed by the ant colony optimization (ACO) approach. It is multi-agent system in which the behavior of each ant is inspired by the foraging behavior of real ants to solve optimization problem. Ant colony optimization electricity energy estimation (ACOEEE) model is developed using population, gross domestic product (GDP), import and export. All equations proposed here are linear electricity energy generation and demand (linearACOEEGE and linear ACOEEDE) and quadratic energy generation and demand (quadraticACOEEGE and quadratic ACOEEDE). Quadratic models for both generation and demand provided better fit solution due to the fluctuations of the economic indicators. The ACOEEGE and ACOEEDE models indicate Turkey's net electricity energy generation and demand until 2025 according to three scenarios. (author)

  19. Estimating the net electricity energy generation and demand using the ant colony optimization approach. Case of Turkey

    Energy Technology Data Exchange (ETDEWEB)

    Toksari, M. Duran [Engineering Faculty, Industrial Engineering Department, Erciyes University, 38039 Kayseri (Turkey)

    2009-03-15

    This paper presents Turkey's net electricity energy generation and demand based on economic indicators. Forecasting model for electricity energy generation and demand is first proposed by the ant colony optimization (ACO) approach. It is multi-agent system in which the behavior of each ant is inspired by the foraging behavior of real ants to solve optimization problem. Ant colony optimization electricity energy estimation (ACOEEE) model is developed using population, gross domestic product (GDP), import and export. All equations proposed here are linear electricity energy generation and demand (linear{sub A}COEEGE and linear ACOEEDE) and quadratic energy generation and demand (quadratic{sub A}COEEGE and quadratic ACOEEDE). Quadratic models for both generation and demand provided better fit solution due to the fluctuations of the economic indicators. The ACOEEGE and ACOEEDE models indicate Turkey's net electricity energy generation and demand until 2025 according to three scenarios. (author)

  20. Estimating the net electricity energy generation and demand using the ant colony optimization approach: Case of Turkey

    Energy Technology Data Exchange (ETDEWEB)

    Toksari, M. Duran [Engineering Faculty, Industrial Engineering Department, Erciyes University, 38039 Kayseri (Turkey)], E-mail: dtoksari@erciyes.edu.tr

    2009-03-15

    This paper presents Turkey's net electricity energy generation and demand based on economic indicators. Forecasting model for electricity energy generation and demand is first proposed by the ant colony optimization (ACO) approach. It is multi-agent system in which the behavior of each ant is inspired by the foraging behavior of real ants to solve optimization problem. Ant colony optimization electricity energy estimation (ACOEEE) model is developed using population, gross domestic product (GDP), import and export. All equations proposed here are linear electricity energy generation and demand (linear{sub A}COEEGE and linear ACOEEDE) and quadratic energy generation and demand (quadratic{sub A}COEEGE and quadratic ACOEEDE). Quadratic models for both generation and demand provided better fit solution due to the fluctuations of the economic indicators. The ACOEEGE and ACOEEDE models indicate Turkey's net electricity energy generation and demand until 2025 according to three scenarios.

  1. Technological progress and long-term energy demand - a survey of recent approaches and a Danish case

    DEFF Research Database (Denmark)

    Klinge Jacobsen, Henrik

    2001-01-01

    This paper discusses di!erent approaches to incorporating technological progress in energy-economy models and the e!ecton long-term energy demand projections. Approaches to modelling based on an exogenous annual change of energy e$ciencyto an endogenous explanation of innovation for energy...... technologies are covered. Technological progress is an important issue for modelling long-term energy demand and is often characterised as the main contributor to the di!erent energy demand forecasts from di!erent models. New economic theoretical developments in the "elds of endogenous growth and industrial...... description, two models of residential energy demand in Denmark are compared. A Danish macroeconometric model is compared to a technological vintage model that is covering electric appliances and residential heating demand. The energy demand projection of the two models diverges, and the underlying...

  2. Estimating the net electricity energy generation and demand using the ant colony optimization approach: Case of Turkey

    International Nuclear Information System (INIS)

    This paper presents Turkey's net electricity energy generation and demand based on economic indicators. Forecasting model for electricity energy generation and demand is first proposed by the ant colony optimization (ACO) approach. It is multi-agent system in which the behavior of each ant is inspired by the foraging behavior of real ants to solve optimization problem. Ant colony optimization electricity energy estimation (ACOEEE) model is developed using population, gross domestic product (GDP), import and export. All equations proposed here are linear electricity energy generation and demand (linearACOEEGE and linear ACOEEDE) and quadratic energy generation and demand (quadraticACOEEGE and quadratic ACOEEDE). Quadratic models for both generation and demand provided better fit solution due to the fluctuations of the economic indicators. The ACOEEGE and ACOEEDE models indicate Turkey's net electricity energy generation and demand until 2025 according to three scenarios

  3. Some new evidence on the determinants of money demand in developing countries – A case study of Tunisia

    OpenAIRE

    Ben Salha, Ousama; Jaidi, Zied

    2013-01-01

    The present paper aims at examining the money demand function in Tunisia during the period 1981-2011. Unlike previous conventional money demand studies, the major components of real income are considered in this paper. Using the ARDL bounds testing approach, results reveal evidence of cointegration between broad money demand and its determinants, namely final consumption expenditure, expenditure on investment goods, export expenditure and interest rate. In the long-run, final consumption expe...

  4. An economic analysis of tourism demand and innovative tourism products: A case study of Lampang province in Thailand

    OpenAIRE

    Komsan Suriya

    2012-01-01

    This study used various quantitative methods to investigate tourism demand for Lampang province in Thailand. It aimed at five aspects: database of tourists, the tourism demand, the revisit of tourists, tourism expenditure and key success factors for innovative tourism products. The results reflected all these aspects. The scope and methodology of this study may construct a principle in economic analysis of tourism demand and innovative tourism products in general.

  5. Factor Input Demand Subject to Economic and Environmental Risk: The Case of Nitrogen Fertilizer in Corn Production

    OpenAIRE

    Carriker, Gordon L.

    1993-01-01

    Nitrogen (N) fertilizer demand in relation to economic and environmental risks associated with N-fertilizer management are examined. Both nominal and environmental damage-adjusted net returns distributions are evaluated using stochastic dominance analysis. Results suggest that, in the absence of environmental risk, N demand becomes more elastic as farmers become more risk averse. When environmental risk is introduced to the decision-making process, N demand becomes even more elastic.

  6. Obtaining a critical care pharmacist position: a marketing case study.

    Science.gov (United States)

    Stratton, T P; Wu, B; Nakagawa, R S

    1993-06-01

    Marketing theory is used to explain how Pharmacy Department managers at a Vancouver-area hospital secured a new ICU pharmacist position in a period of severe fiscal constraint. Market segmentation, target marketing and pull marketing strategy were combined to obtain support for the new position. Improved drug information services for ICU nurses were promoted to Nursing Administration and enhanced pharmacotherapy monitoring was promoted to the two critical care physicians primarily responsible for patient care in the ICU. These physicians and Nursing Administration voiced their support for the new position to the V.P. of Nursing (the functional officer for Pharmacy), who then promoted the new position to Hospital Administration. A half-time DUR commitment by the ICU pharmacist was offered to Hospital Administration, expanding this already successful service and guaranteeing cost recovery for the new position. Hospital Administration approved the new ICU clinical pharmacist position in a budget which saw other hospital departments lose several positions. PMID:10126865

  7. April 2016 critical care case of the month

    OpenAIRE

    Sultan S

    2016-01-01

    No abstract available. Article truncated after 150 words. History of Present Illness: The patient is a 22-year-old African-American man who was initially seen following a rapid response team called to the neonatal intensive care unit for a seizure. He was visiting his newborn child. The nurses described the seizure as tonic-clonic which resolved spontaneously without treatment before the rapid response team arrived. Past Medical History, Family History and Social History: The patient has a pa...

  8. Intrathecal analgesia and palliative care: A case study

    Directory of Open Access Journals (Sweden)

    Naveen S Salins

    2010-01-01

    Full Text Available Intrathecal analgesia is an interventional form of pain relief with definite advantages and multiple complications. Administration of intrathecal analgesia needs a good resource setting and expertise. Early complications of intrathecal analgesia can be very distressing and managing these complications will need a high degree of knowledge, technical expertise and level of experience. Pain control alone cannot be the marker of quality in palliative care. A holistic approach may need to be employed that is more person and family oriented.

  9. Resource allocation in health care processes: A case study

    OpenAIRE

    Kauhanen, Antti; Kulvik, Martti; Kulvik, Silja; Maijanen, Sirpa; Martikainen, Olli; Ranta, Paula

    2013-01-01

    This paper utilizes queuing models to analyze health care processes. We extend previous queuing models to allow for i) heterogeneous resources, ii) resource allocation to various tasks, and iii) teams (complementary resources). We model a process of one clinical unit. We use the model to analyze how resource allocation affects both process performance and utilization of resources. This approach emphasizes how allocation of resources to tasks affects process performance. We illustrate how the ...

  10. Energy Demand

    OpenAIRE

    Stehfest, E. et al.

    2014-01-01

    Key policy issues – How will energy demand evolve particularly in emerging and medium- and low- income economies? – What is the mix of end-use energy carriers to meet future energy demand? – How can energy efficiency contribute to reducing the growth rate of energy demand and mitigate pressures on the global environment?

  11. Energy Demand

    NARCIS (Netherlands)

    Stehfest, E. et al.

    2014-01-01

    Key policy issues – How will energy demand evolve particularly in emerging and medium- and low- income economies? – What is the mix of end-use energy carriers to meet future energy demand? – How can energy efficiency contribute to reducing the growth rate of energy demand and mitigate pressures on t

  12. 民族高校女职工围绝经期症状及保健需求调查分析%Investigation and Analysis of Perimenopausal Symptoms and Health Care Demand of the Nationalities University Women

    Institute of Scientific and Technical Information of China (English)

    余学红

    2016-01-01

    目的::了解民族高校妇女的围绝经期症状及保健需求情况,为围绝经期妇女保健工作提供科学依据.方法:采用问卷调查的方法,对民族高校647例40~60岁妇女进行调查.结果:调查对象围绝经期相关症状发生率为77.13%,其主要症状依次为:记忆力下降(65.84%)、情绪波动(64.30%)、失眠(63.83%)、潮热(58.73%)、月经紊乱(54.40%)等.各年龄组围绝经期症状发生率比较,差异有统计学意义(p<0.05),且随着年龄增大,其发生率逐渐增高.围绝经期妇女保健需求主要为定期全面体检和预防骨质疏松;希望得到围绝经期健康咨询与指导的妇女占53.48%.结论:民族高校妇女围绝经期相关症状发生率高,对围绝经期保健知识及服务需求迫切.相关卫生服务部门应高度重视,实施干预模式,加强对民族高校围绝经期妇女的健康管理,积极开展全科医疗卫生保健服务,以提高围绝经期妇女的生活质量.%Objective:To understand the situation of perimenopausal symptoms and health care demand in nationalities university women, to community perimenopause women's health care and provide scientific basis for. Methods: Using the method of questionnaire survey was conducted on the 647 cases of 40 ~60 years old women in university . Results:The survey of menopausal symptoms, occurrence rate is 77. 13%, the incidence of main symptoms were:the decline of memory (65. 84%), mood swings (64. 30%), insomnia (63. 83%), fever (58. 73%), menstrual disorder (54. 40%). Each age group of perimenopausal symptoms occur rate compares difference to have statistical sense (p< 0. 05), increases with age, the incidence rate increase. Perimenopausal health care demand mainly for the regular physical examination and prevention of osteoporosis, hope to get the perimenopausal health counseling and guidance of perimenopausal women accounted for 53. 48%. Conclusion: the perimenopausal symptoms of

  13. Case finding for COPD in primary care: a qualitative study of the views of health professionals

    Directory of Open Access Journals (Sweden)

    Haroon S

    2015-08-01

    Full Text Available Shamil Haroon, Rachel E Jordan, David A Fitzmaurice, Peymane AdabSchool of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UKBackground: Chronic obstructive pulmonary disease (COPD is common but largely underdiagnosed. Case-finding initiatives have been evaluated in primary care, but few studies have explored the views of service providers on implementing them in practice.Aim: To explore the views of primary health care providers on case finding for COPD.Methods: A total of 20 semi-structured interviews were conducted from March 2014 to September 2014 among general practitioners, nurses, and managers from practices participating in a large COPD case-finding trial based in primary care in the West Midlands, UK. Participants’ views were sought to explore perceived benefits, harms, barriers, and facilitators to implementing COPD case finding in practice. Interviews were transcribed and analyzed using the framework method.Results: Participants felt that case finding improves patient care but also acknowledged potential harms to providers (increase in workload and to patients (overdiagnosis. Insufficient resources, poor knowledge of COPD, and limited access to diagnostic services were viewed as barriers to diagnosis, while provision of community respiratory services, including COPD specialist nurses, and support from secondary care were thought to be facilitators. Participants also expressed a need for more education on COPD for both patients and clinicians.Conclusion: Care providers believe that early detection of COPD improves patient care but also has accompanying harms. Barriers to diagnosing COPD, such as insufficient expertise in primary care and limited access to diagnostic services in the community, should be explored and addressed. The knowledge and attitudes of the public about COPD and its symptoms should also be investigated to inform future education and awareness-raising strategies.Keywords: chronic

  14. “Souls of the ancestor that knock us out” and other tales. A qualitative study to identify demand-side factors influencing malaria case management in Cambodia

    Directory of Open Access Journals (Sweden)

    O’Connell Kathryn A

    2012-10-01

    Full Text Available Abstract Background Appropriate case management of suspected malaria in Cambodia is critical given anti-malarial drug resistance in the region. Improving diagnosis and the use of recommended malarial treatments is a challenge in Cambodia where self-treatment and usage of drug cocktails is widespread, a notable difference from malaria treatment seeking in other countries. This qualitative study adds to the limited evidence base on Cambodian practices, aiming to understand the demand-side factors influencing treatment-seeking behaviour, including the types of home treatments, perceptions of cocktail medicines and reasons for diagnostic testing. The findings may help guide intervention design. Methods The study used in-depth interviews (IDIs (N = 16 and focus group discussions (FGDs (N = 12 with Cambodian adults from malaria-endemic areas who had experienced malaria fever in the previous two weeks. Data were analysed using NVivo software. Results Findings suggest that Cambodians initially treat suspected malaria at home with home remedies and traditional medicines. When seeking treatment outside the home, respondents frequently reported receiving a cocktail of medicines from trusted providers. Cocktails are perceived as less expensive and more effective than full-course, pre-packaged medicines. Barriers to diagnostic testing include a belief in the ability to self-diagnose based on symptoms, cost and reliance on providers to recommend a test. Factors that facilitate testing include recommendation by trusted providers and a belief that anti-malarial treatment for illnesses other than malaria can be harmful. Conclusions Treatment-seeking behaviour for malaria in Cambodia is complex, driven by cultural norms, practicalities and episode-related factors. Effective malaria treatment programmes will benefit from interventions and communication materials that leverage these demand-side factors, promoting prompt visits to facilities for suspected

  15. Choice of an Optimal Management Strategy of Transport Demand Using Multi-Criteria Analysis: City of Zagreb Case Study

    Directory of Open Access Journals (Sweden)

    Ljupko Šimunović

    2013-03-01

    Full Text Available After initial enthusiasm by motor vehicles, society is lately increasingly noticing their shortcomings. Traffic problems caused by excessive use of cars, still represent a very serious and widespread problem, particularly in cities. Public opinion expresses dissatisfaction with the quality of the environment and traffic conditions. As the most important demand, the demand for human health stands out in the first place, and, consequently, the demand for sustainable transport development. The fact that the EU is involved in solving traffic problems by means of various directives and scientific research projects, points out the seriousness of the problem. Two solutions which are mainly used for solving traffic problems in cities are the construction or extension of existing transport infrastructure and traffic demand management (TDM. Traffic demand management is a new paradigm, which aims at reducing or transforming of traffic demand through reduction of unnecessary drives by cars and improvement of more efficient, healthier and, above all, cleaner forms of public and non-motorized transport. There is a whole range of methods for traffic demand management, such as Park & Ride system, carpooling, carsharing, priority for the vehicles with specified number of passenger – HOV, teleworking, congestion charging, charging for use of road infrastructure, bicycling infrastructure improvement, etc. The topic of the work focuses on the choice of optimal traffic demand management strategies in the city of Zagreb using multi-criteria analysis.

  16. Psychosocial issues in palliative care: A review of five cases

    OpenAIRE

    Onyeka, Tonia C

    2010-01-01

    Palliative care is not just vital in controlling symptoms of the patient’s disease condition, but also aims to extend the patient’s life, giving it a better quality. However, several times in the course of management, the psychosocial impact of cancer, HIV/AIDS, and other life-limiting disease conditions may not be noticed and dealt with during the admission period, thereby giving rise to a more complex situation than the disease condition itself. This article aims to review some psychosocial...

  17. Effectiveness of a nurse-led case management home care model in Primary Health Care. A quasi-experimental, controlled, multi-centre study

    Directory of Open Access Journals (Sweden)

    Morilla-Herrera JC

    2008-09-01

    Full Text Available Abstract Background Demand for home care services has increased considerably, along with the growing complexity of cases and variability among resources and providers. Designing services that guarantee co-ordination and integration for providers and levels of care is of paramount importance. The aim of this study is to determine the effectiveness of a new case-management based, home care delivery model which has been implemented in Andalusia (Spain. Methods Quasi-experimental, controlled, non-randomised, multi-centre study on the population receiving home care services comparing the outcomes of the new model, which included nurse-led case management, versus the conventional one. Primary endpoints: functional status, satisfaction and use of healthcare resources. Secondary endpoints: recruitment and caregiver burden, mortality, institutionalisation, quality of life and family function. Analyses were performed at base-line, and at two, six and twelve months. A bivariate analysis was conducted with the Student's t-test, Mann-Whitney's U, and the chi squared test. Kaplan-Meier and log-rank tests were performed to compare survival and institutionalisation. A multivariate analysis was performed to pinpoint factors that impact on improvement of functional ability. Results Base-line differences in functional capacity – significantly lower in the intervention group (RR: 1.52 95%CI: 1.05–2.21; p = 0.0016 – disappeared at six months (RR: 1.31 95%CI: 0.87–1.98; p = 0.178. At six months, caregiver burden showed a slight reduction in the intervention group, whereas it increased notably in the control group (base-line Zarit Test: 57.06 95%CI: 54.77–59.34 vs. 60.50 95%CI: 53.63–67.37; p = 0.264, (Zarit Test at six months: 53.79 95%CI: 49.67–57.92 vs. 66.26 95%CI: 60.66–71.86 p = 0.002. Patients in the intervention group received more physiotherapy (7.92 CI95%: 5.22–10.62 vs. 3.24 95%CI: 1.37–5.310; p = 0.0001 and, on average, required fewer

  18. Effectiveness of a nurse-led case management home care model in Primary Health Care. A quasi-experimental, controlled, multi-centre study

    Science.gov (United States)

    Morales-Asencio, JM; Gonzalo-Jiménez, E; Martin-Santos, FJ; Morilla-Herrera, JC; Celdráan-Mañas, M; Carrasco, A Millán; García-Arrabal, JJ; Toral-López, I

    2008-01-01

    Background Demand for home care services has increased considerably, along with the growing complexity of cases and variability among resources and providers. Designing services that guarantee co-ordination and integration for providers and levels of care is of paramount importance. The aim of this study is to determine the effectiveness of a new case-management based, home care delivery model which has been implemented in Andalusia (Spain). Methods Quasi-experimental, controlled, non-randomised, multi-centre study on the population receiving home care services comparing the outcomes of the new model, which included nurse-led case management, versus the conventional one. Primary endpoints: functional status, satisfaction and use of healthcare resources. Secondary endpoints: recruitment and caregiver burden, mortality, institutionalisation, quality of life and family function. Analyses were performed at base-line, and at two, six and twelve months. A bivariate analysis was conducted with the Student's t-test, Mann-Whitney's U, and the chi squared test. Kaplan-Meier and log-rank tests were performed to compare survival and institutionalisation. A multivariate analysis was performed to pinpoint factors that impact on improvement of functional ability. Results Base-line differences in functional capacity – significantly lower in the intervention group (RR: 1.52 95%CI: 1.05–2.21; p = 0.0016) – disappeared at six months (RR: 1.31 95%CI: 0.87–1.98; p = 0.178). At six months, caregiver burden showed a slight reduction in the intervention group, whereas it increased notably in the control group (base-line Zarit Test: 57.06 95%CI: 54.77–59.34 vs. 60.50 95%CI: 53.63–67.37; p = 0.264), (Zarit Test at six months: 53.79 95%CI: 49.67–57.92 vs. 66.26 95%CI: 60.66–71.86 p = 0.002). Patients in the intervention group received more physiotherapy (7.92 CI95%: 5.22–10.62 vs. 3.24 95%CI: 1.37–5.310; p = 0.0001) and, on average, required fewer home care visits (9

  19. Digital transformation in home care. A case study.

    Science.gov (United States)

    Bennis, Sandy; Costanzo, Diane; Flynn, Ann Marie; Reidy, Agatha; Tronni, Catherine

    2007-01-01

    Simply implementing software and technology does not assure that an organization's targeted clinical and financial goals will be realized. No longer is it possible to roll out a new system--by solely providing end user training and overlaying it on top of already inefficient workflows and outdated roles--and know with certainty that targets will be met. At Virtua Health's Home Care, based in south New Jersey, implementation of their electronic system initially followed this more traditional approach. Unable to completely attain their earlier identified return on investment, they enlisted the help of a new role within their health system, that of the nurse informaticist. Knowledgeable in complex clinical processes and not bound by the technology at hand, the informaticist analyzed physical workflow, digital workflow, roles and physical layout. Leveraging specific tools such as change acceleration, workouts and LEAN, the informaticist was able to redesign workflow and support new levels of functionality. This article provides a view from the "finish line", recounting how this role worked with home care to assimilate information delivery into more efficient processes and align resources to support the new workflow, ultimately achieving real tangible returns. PMID:19195281

  20. Health, Quality of Care and Quality of Life: A Case of Frail Older Adults

    Science.gov (United States)

    Hsieh, Chang-Ming

    2009-01-01

    This study explores the relationship between health, quality of care of geriatric case management and quality of life for the purpose of furthering the understanding of the relationship between quality of life and geriatric case management. Using survey data from a group of frail older adults, this study assesses the relative merit of two…

  1. Case Finding of Mild Cognitive Impairment and Dementia and Subsequent Care; Results of a Cluster RCT in Primary Care.

    Directory of Open Access Journals (Sweden)

    Pim van den Dungen

    Full Text Available Despite a call for earlier diagnosis of dementia, the diagnostic yield of case finding and its impact on the mental health of patients and relatives are unclear. This study assessed the effect of a two-component intervention of case finding and subsequent care on these outcomes.In a cluster RCT we assessed whether education of family physicians (FPs; trial stage 1 resulted in more mild cognitive impairment (MCI and dementia diagnoses among older persons in whom FPs suspected cognitive decline and whether case finding by a practice nurse and the FP (trial stage 2 added to this number of diagnoses. In addition, we assessed mental health effects of case finding and subsequent care (trial stage 2. FPs of 15 primary care practices (PCPs = clusters judged the cognitive status of all persons ≥ 65 years. The primary outcome, new MCI and dementia diagnoses by FPs after 12 months as indicated on a list, was assessed among all persons in whom FPs suspected cognitive impairment but without a formal diagnosis of dementia. The secondary outcome, mental health of patients and their relatives, was assessed among persons consenting to participate in trial stage 2. Trial stage 1 consisted of either intervention component 1: training FPs to diagnose MCI and dementia, or control: no training. Trial stage 2 consisted of either intervention component 2: case finding of MCI and dementia and care by a trained nurse and the FP, or control: care as usual.Seven PCPs were randomized to the intervention; eight to the control condition. MCI or dementia was diagnosed in 42.3% (138/326 of persons in the intervention, and in 30.5% (98/321 in the control group (estimated difference GEE: 10.8%, OR: 1.51, 95%-CI 0.60-3.76. Among patients and relatives who consented to stage 2 of the trial (n = 145; 25%, there were no differences in mental health between the intervention and control group.We found a non-significant increase in the number of new MCI diagnoses. As we cannot exclude

  2. Case Finding of Mild Cognitive Impairment and Dementia and Subsequent Care; Results of a Cluster RCT in Primary Care

    Science.gov (United States)

    van den Dungen, Pim; Moll van Charante, Eric P.; van de Ven, Peter M.; van Marwijk, Harm W. J.; van der Horst, Henriëtte E.; van Hout, Hein P. J.

    2016-01-01

    Purpose Despite a call for earlier diagnosis of dementia, the diagnostic yield of case finding and its impact on the mental health of patients and relatives are unclear. This study assessed the effect of a two-component intervention of case finding and subsequent care on these outcomes. Methods In a cluster RCT we assessed whether education of family physicians (FPs; trial stage 1) resulted in more mild cognitive impairment (MCI) and dementia diagnoses among older persons in whom FPs suspected cognitive decline and whether case finding by a practice nurse and the FP (trial stage 2) added to this number of diagnoses. In addition, we assessed mental health effects of case finding and subsequent care (trial stage 2). FPs of 15 primary care practices (PCPs = clusters) judged the cognitive status of all persons ≥ 65 years. The primary outcome, new MCI and dementia diagnoses by FPs after 12 months as indicated on a list, was assessed among all persons in whom FPs suspected cognitive impairment but without a formal diagnosis of dementia. The secondary outcome, mental health of patients and their relatives, was assessed among persons consenting to participate in trial stage 2. Trial stage 1 consisted of either intervention component 1: training FPs to diagnose MCI and dementia, or control: no training. Trial stage 2 consisted of either intervention component 2: case finding of MCI and dementia and care by a trained nurse and the FP, or control: care as usual. Results Seven PCPs were randomized to the intervention; eight to the control condition. MCI or dementia was diagnosed in 42.3% (138/326) of persons in the intervention, and in 30.5% (98/321) in the control group (estimated difference GEE: 10.8%, OR: 1.51, 95%-CI 0.60–3.76). Among patients and relatives who consented to stage 2 of the trial (n = 145; 25%), there were no differences in mental health between the intervention and control group. Conclusions We found a non-significant increase in the number of new MCI

  3. Reasons for not finalising child sexual abuse cases in alternative care : social workers' perceptions / Veronica Grunder

    OpenAIRE

    Grunder, Veronica

    2014-01-01

    Dealing with child sexual abuse cases, is an integral part of the social workers job. Due to the nature of the abuse and the provisions made by the Children’s Act, 38 of 2005, as amended, to safeguard the child victim, many social workers remove children of child sexual abuse cases and place them in alternative care. The aim of this study is to explore the perceptions of social workers on the reasons why child sexual abuse cases in alternative care is not finalized. Some of the factors tha...

  4. Complementary therapy in chronic wound management: a holistic caring case study and praxis model.

    Science.gov (United States)

    Popoola, Mercy Mammah

    2003-01-01

    Holistic caring consists of providing care to each aspect of a patient's life through the use of therapeutic caring and complementary or alternative healing modalities. Since nursing consists of caring for the whole person and not just the disease process, consideration of a patient's physical, emotional, social, economic, spiritual, and cultural needs is necessary in dealing with any chronic health problem such as chronic wounds. In this model case studies presentation, the purpose of this article is to discuss the importance of the holistic caring approach and the use of complementary and alternative medicine or therapeutic modalities in chronic wound management. The use or role of theory in practice will also be discussed to emphasize the holistic caring praxis model used in the holistic assessment and holistic plan of care for the cases presented. This article also presents a framework that will help wound care and holistic nurses move from simply the positivist-modernist philosophy to begin to embrace the postmodernist philosophy. PMID:12784899

  5. How to implement process-oriented care: a case study on the implementation of process-oriented in-hospital stroke care.

    OpenAIRE

    Vos, L; van Oostenbrugge, R.J.; Limburg, M.; Merode, G.G. van; Groothuis, S.

    2009-01-01

    Dutch hospitals are in the midst of a transition towards process-oriented organisation to realise optimal and undisturbed care processes. Between 2004 and 2007, the University Hospital of Maastricht conducted a case study implementing process-oriented in-hospital stroke unit care. The case study consisted of four steps: (1) process analysis; (2) identification of bottlenecks; (3) setting goals for process-oriented care, and selection of coordination measures; and (4) implementation and evalua...

  6. Psychosocial issues in palliative care: A review of five cases

    Directory of Open Access Journals (Sweden)

    Tonia C Onyeka

    2010-01-01

    Full Text Available Palliative care is not just vital in controlling symptoms of the patient′s disease condition, but also aims to extend the patient′s life, giving it a better quality. However, several times in the course of management, the psychosocial impact of cancer, HIV/AIDS, and other life-limiting disease conditions may not be noticed and dealt with during the admission period, thereby giving rise to a more complex situation than the disease condition itself. This article aims to review some psychosocial issues and measures that can be taken to address them. It highlights the various roles and the importance of the clinician, nurse, social worker, and other members of the multidisciplinary team in tackling these issues and will help healthcare professionals in this field achieve better practice in the future.

  7. Analysing the Costs of Integrated Care: A Case on Model Selection for Chronic Care Purposes

    OpenAIRE

    Carreras, Marc; Sánchez-Pérez, Inma; Ibern, Pere; Coderch, Jordi; Inoriza, José María

    2016-01-01

    Background: The objective of this study is to investigate whether the algorithm proposed by Manning and Mullahy, a consolidated health economics procedure, can also be used to estimate individual costs for different groups of healthcare services in the context of integrated care.Methods: A cross-sectional study focused on the population of the Baix Empordà (Catalonia-Spain) for the year 2012 (N = 92,498 individuals). A set of individual cost models as a function of sex, age and morbidity burd...

  8. End-of-life care in a COPD patient awaiting lung transplantation: a case report

    Directory of Open Access Journals (Sweden)

    Schols Jos MGA

    2010-04-01

    Full Text Available Abstract COPD is nowadays the main indication for lung transplantation. In appropriately selected patients with end stage COPD, lung transplantation may improve quality of life and prognosis of survival. However, patients with end stage COPD may die while waiting for lung transplantation. Palliative care is important to address the needs of patients with end stage COPD. This case report shows that in a patient with end stage COPD listed for lung transplantation offering palliative care and curative-restorative care concurrently may be problematic. If the requirements to remain a transplantation candidate need to be met, the possibilities for palliative care may be limited. Discussing the possibilities of palliative care and the patient's treatment preferences is necessary to prevent that end-of-life care needs of COPD patients dying while listed for lung transplantation are not optimally addressed. The patient's end-of-life care preferences may ask for a clear distinction between the period in which palliative and curative-restorative care are offered concurrently and the end-of-life care period. This may be necessary to allow a patient to spend the last stage of life according to his or her wishes, even when this implicates that lung transplantation is not possible anymore and the patient will die because of end stage COPD.

  9. Monitored anesthesia care in a case of pheochromocytoma and atrial myxoma

    OpenAIRE

    Manvikar, Laxmi P.; Adhye, Bharati A.

    2012-01-01

    Anesthesia for a patient with pheochromocytoma is challenging; irrespective of whether it is a diagnosed case for planned surgery or an occult case, it can be a nightmare. The patient may be given anesthesia for removal of the primary tumor or for surgery other than for the removal of the primary tumor. Hemodynamic derangements like hypertension and arrhythmia can be catastrophic. Monitored anesthesia care, though used for many cases, is unusual for a patient with diagnosed pheochromocytoma, ...

  10. Integrating urban form and demographics in water-demand management: an empirical case study of Portland, Oregon

    OpenAIRE

    Vivek Shandas; G Hossein Parandvash

    2010-01-01

    Theories of water-resource management suggest that water demand is mediated by three interacting factors: technological innovations, pricing structures, and individual behaviors and demographics. While these factors provide useful insights for ongoing water conservation strategies, such as outreach and education campaigns, pricing schemes, and incentives aimed at residential developments, few studies examine the relationship between land-use planning and water demand. This paper reports the r...

  11. Nitrate Pollution Externality Associated with Increased Corn Demand for Ethanol: a Case Study of Olmsted County in Minnesota

    OpenAIRE

    Harpankar, Kshama

    2008-01-01

    Land use practices generate various environmental externalities. With the increased interest in biofuel production, it is imperative to understand the benefits and costs associated with resource allocation choices made for biofuel production. This paper contributes to the full cost accounting of biofuels research by estimating potential nitrate pollution cost associated with land use change that may result from increasing corn prices due to demand from ethanol producers. The increased demand ...

  12. Climate change and its role in forecasting energy demand in buildings: A case study of Douala City, Cameroon

    Indian Academy of Sciences (India)

    Modeste Kameni Nematchoua; Gh R Roshan; René Tchinda; T Nasrabadi; Paola Ricciardi

    2015-02-01

    The foremost role of a building is to assure the comfort of its occupants. The thermal comfort of a building depends on the outdoor climate and requires a demand in energy for heating and cooling. In this paper, demand of energy (heating/cooling) in the buildings is discussed in Douala, Cameroon. Daily data of the last 40 years coming from five weather stations of Cameroon have been studied. Some forecasts have been carried out with 14 GCM models, associated to three future climate scenarios B1, A2, and A1B. However, only INCM3 of General Circulation Model (GCM) and A2 scenario was used. Energy demand in buildings is valued by HDD (heating degree day) and CDD (cooling degree day) indices. Obtained results show that the temperature evolves more quickly in dry season than in rainy season in Douala. Climate rise indicates an increasing demand of energy in the buildings for cooling. Global Douala heating shows a definite effect on outdoor comfort. From 2045 to 2075, the demand of energy for cooling will be superior to 50%. The total demand in energy for heating in the buildings is estimated to be 67.882 kcal from 1970 to 2000 and will be around 67.774 kcal from 2013 to 2043.

  13. A case study: the clinical application of quadrangular dialogue--a caring in nursing teaching model.

    Science.gov (United States)

    Sumner, Jane F

    2004-01-01

    Teaching caring in nursing is expected of nursing faculty, but the practical application is rarely explained. It has been regarded as the moral responsibility of faculty to teach in a caring way. This case study relates how one faculty applied the concepts to quadrangular dialogue a caring model of nursing education to the experience of baccalaureate student nurses in their first clinical rotation. The components of quadrangular dialogue will be described, and applied to a specific patient who was cared for by students in one semester. This model is developed from Habermas' (1995) Theory of Communicative Action and Moral Consciousness, Bishop and Scudder's (1990) Triadic Dialogue and a caring in nursing paradigm developed by this author. It explains how the patient, nursing student and nursing faculty are all first person in the interaction, while the illness is object. By acknowledging the humanness of participants, validation and fulfillment for each follow. PMID:16646898

  14. Assessing general practitioners' care of adult patients with learning disability: case-control study.

    OpenAIRE

    Whitfield, M.; Langan, J; Russell, O

    1996-01-01

    OBJECTIVE--To compare general practitioners' care of adult patients with learning disability with that of control patients in the same practice. DESIGN--Case-control study of patients and controls by a structured interview study of general practitioners. SETTING--Avon. PATIENTS--78 adult patients with learning disability and 78 age and sex matched controls--cared for by 62 general practitioners. MAIN MEASURES--Number and content of consultations and opinions of the general practitioners. RESU...

  15. Retrospective analysis of the intoxication cases followed in an intensive care unit

    OpenAIRE

    Taş, Nilay; Yağan, Özgür; YANCAR DEMİR, Esra; MUTLU, Tuğçe; ENGİNYURT, Özgür

    2015-01-01

    Intoxications occur accidentally or due to suicide attempts and some cases are evaluated in Intensive Care Unit (ICU). In this study, we aimed to evaluate the patients older than 18 years old who were admitted to our second level intensive care unit from emergency department between 2010-2013. All the patients with prediagnosis of poisoning who were admitted to ICU were evaluated with respect to their demographic properties, etiology of poisoning, substance that exposured, Glasgow Coma Scale ...

  16. Evaluation of Suicide and Intoxication Cases Admitted to our Newly Opened Intensive Care Unit

    OpenAIRE

    Nalan Muhammedoğlu; Gökçen Başaranoğlu; Yaşar Gökhan Gül; Mehmet Toptaş; Sevim Baltalı; Bengü Özütürk

    2014-01-01

    Aim: The aim of this study was to evaluate the suicide and intoxication cases between April 2011 and April 2013. Methods: We retrospectively analyzed hospital records of patients who were admitted to our intensive care unit due to suicide and intoxication. The age, sex, intoxication causes, laboratory analyses, treatment refusal rates, and the prognosis were evaluated. Results: A total of 308 patients (105 males, 203 females) were admitted to the intensive care unit. The mean age of t...

  17. August 2016 critical care case of the month

    Directory of Open Access Journals (Sweden)

    Deangelis JL

    2016-08-01

    Full Text Available No abstract available. Article truncated at 150 words. History of Present Illness: The patient is a previously healthy, albeit anxious, 15-year-old girl seen by her primary care physician. She has had several months of general malaise and ongoing fatigue and an increased frequency in night terrors over the past few weeks. Her family attributes this to stress of school and her new job. She was noted to have lost 3 kg in the previous nine weeks. PMH, SH, and FH: Her PMH was unremarkable. She is a student and denies smoking, drinking or drug abuse. Her family history is noncontributory. Physical Examination: Vital signs: BP 100/60 mm Hg, P 90 beats/min and regular, R 16 breaths/min, T 100.8 ºF, BMI 15; Diffuse, non-tender lymphadenopathy through the submandibular and upper anterior cervical chains; Lungs: clear; Heart: regular rhythm without murmur: Abdomen: slightly rounded and firm. Which of the following are diagnostic considerations at this time? 1. Anorexia nervosa 2. ...

  18. Saving More Teeth—A Case for Personalized Care

    Directory of Open Access Journals (Sweden)

    Alexandre R. Vieira

    2015-02-01

    Full Text Available Background: Certain risk factors such as tobacco use, diabetes, genetic variations on the IL1 gene, and other inflammatory conditions are hypothesized to predict tooth loss in patients treated in a large medical center. Tooth loss trends are hypothesized to be greater in patients with more risk factors. Methods: DNA samples for 881 individuals were taken from the Dental Registry and DNA Repository at University of Pittsburgh School of Dental Medicine. Clinical data for all 4137 subjects in the registry were also available. SNP genotyping was performed on the samples for IL1α (rs1800587 and IL1β (rs1143634. IL1 positive status was determined as having one or more of the recessive alleles for either SNP. Tooth loss status was determined based on dental records and data gathered for age, sex, ethnicity, and self-reported medical history. Various statistical analyses were performed on the data including genetic association analysis by the PLINK software, chi-square, Mann-Whitney U, and ANOVA tests to determine significance. Results: Tooth loss averages increased with age by all risk factors (smoking, diabetes, hypertension, and interleukin genotypes; p = 4.07E-13 and by number of risk factors (p = 0.006. Increased tooth loss is associated with age and number of risk factors including diabetes, tobacco use, IL1+, and cardiovascular disease. Conclusion: These trends suggest that older patients and those with more risk factors should seek further preventive care to reduce future tooth loss.

  19. A Randomized Controlled Trial of Hospital-based Case Management in Cancer Care

    DEFF Research Database (Denmark)

    Wulff, Christian N; Vedsted, Peter; Søndergaard, Jens

    2012-01-01

    BACKGROUND: Case management (CM) models based on experienced nurses are increasingly used to improve coordination and continuity of care for patients with complex health care needs. Anyway, little is known about the effects of hospital-based CM in cancer care.Aim.To analyse the effects of hospital......-based CM on (i) GPs' evaluation of information from the hospital and collaboration with the hospital staff and (ii) patients' contacts with GPs during daytime and out of hours. DESIGN: A randomized controlled trial allocated 280 colorectal cancer patients 1:1 to either a control group or CM intervention...

  20. Application of residual modification approach in seasonal ARIMA for electricity demand forecasting: A case study of China

    International Nuclear Information System (INIS)

    Electricity demand forecasting could prove to be a useful policy tool for decision-makers; thus, accurate forecasting of electricity demand is valuable in allowing both power generators and consumers to make their plans. Although a seasonal ARIMA model is widely used in electricity demand analysis and is a high-precision approach for seasonal data forecasting, errors are unavoidable in the forecasting process. Consequently, a significant research goal is to further improve forecasting precision. To help people in the electricity sectors make more sensible decisions, this study proposes residual modification models to improve the precision of seasonal ARIMA for electricity demand forecasting. In this study, PSO optimal Fourier method, seasonal ARIMA model and combined models of PSO optimal Fourier method with seasonal ARIMA are applied in the Northwest electricity grid of China to correct the forecasting results of seasonal ARIMA. The modification models forecasting of the electricity demand appears to be more workable than that of the single seasonal ARIMA. The results indicate that the prediction accuracy of the three residual modification models is higher than the single seasonal ARIMA model and that the combined model is the most satisfactory of the three models. - Highlights: ► Three residual modification models are proposed to improve the precision of seasonal ARIMA. ► Accurate electricity demand forecast is helpful for a power production sector to come to a correct and reasonable decision. ► The results conclude that the residual modification approaches could enhance the prediction accuracy of seasonal ARIMA. ► The modification models could be applied to forecast electricity demand.

  1. Stochastic model of forecasting spare parts demand

    OpenAIRE

    Ivan S. Milojević; Rade V. Guberinić

    2012-01-01

    If demand is known for the whole planning period (complete information), then this type of demand or a supply system is deterministic. In the simplest cases, the demand per time unit is constant. If demand levels change over time following a precisely determined and pre-known principle, this type of demand is also classified as deterministic. This quality of demand is very rare. In most cases demand is the product of a process, for example TMS maintenance, whose progression cannot be predicte...

  2. Distribution network design under demand uncertainty using genetic algorithm and Monte Carlo simulation approach: a case study in pharmaceutical industry

    Science.gov (United States)

    Izadi, Arman; Kimiagari, Ali Mohammad

    2014-05-01

    Distribution network design as a strategic decision has long-term effect on tactical and operational supply chain management. In this research, the location-allocation problem is studied under demand uncertainty. The purposes of this study were to specify the optimal number and location of distribution centers and to determine the allocation of customer demands to distribution centers. The main feature of this research is solving the model with unknown demand function which is suitable with the real-world problems. To consider the uncertainty, a set of possible scenarios for customer demands is created based on the Monte Carlo simulation. The coefficient of variation of costs is mentioned as a measure of risk and the most stable structure for firm's distribution network is defined based on the concept of robust optimization. The best structure is identified using genetic algorithms and 14 % reduction in total supply chain costs is the outcome. Moreover, it imposes the least cost variation created by fluctuation in customer demands (such as epidemic diseases outbreak in some areas of the country) to the logistical system. It is noteworthy that this research is done in one of the largest pharmaceutical distribution firms in Iran.

  3. Streptococcus salivarius meningitis after dental care: case report

    Directory of Open Access Journals (Sweden)

    Maira Zoppelletto

    2012-12-01

    Full Text Available Introduction. Streptococcus salivarius is a common commensal of the oral mucosa, associated with infections in different sites. Meningitis due to this species are described in a few occasions . In this study refer to a case recently diagnosed in our hospital for treatment of a subsequent dental caries. Case report. A man of 35 years, presents to the emergency room with fever, headache, confusion, marked nuchal rigor.Anamnesis is the treatment of dental caries on the previous day.The blood count showed 24.7x109 / L with WBC 22.9x109 / L (92.9% neutrophils. The lumbar puncture CSF noted cloudy with 15.0 x 109 / L WBC, glicorrachia 5 g / L, protidorrachia 6.5 g / L. Microscopic examination showed numerous granulocytes and prevalence of Gram-positive cocci.The pneumococcal antigen was negative.The blood cultures before starting antibiotic therapy, were negative. CSF was isolated from the culture of a Streptococcus salivarius. To antibiotic therapy started in the ED, after lumbar puncture is associated with the Ampicillin Ceftriaxone and continued for 15 days to improve the patient’s general condition, then resigned in the 17 th day. Materials and methods. From CSF inoculated in blood agar plates and chocolate agar alpha hemolytic colonies were isolated, catalysis negative, optochin resistant. The biochemical identification performed with Phoenix (BD and confirmed by PCR Pan bacterial (16S rDNA bacterial strain identified as Streptococcus salivarius.The antibiogram performed with Phoenix (BD according to the CLSI guidelines indicated sensitivity to penicillin, vancomycin, cefotaxime, cefepime, and chloramphenicol. Conclusions. Meningitis by Streptococcus salivarius was found in a few cases, mainly related to the transmission of health personnel from the oral cavity during lumbar punctures performed without the use of surgical masks. The following bacterial meningitis in dental treatment having a low incidence and often fatal course be suspected by

  4. A Case of Congenital Tuberculosis in a Tertiary Care Hospital

    Directory of Open Access Journals (Sweden)

    Ishrat Jahan

    2011-07-01

    Full Text Available Congenital tuberculosis is an unusual and severe clinical presentation of Mycobacterium tuberculosis (MTB infection. It is usually difficult to diagnose and treat. We report a tenweek-old male infant who had presented with fever, difficulty in breathing, abdominal distension, convulsion, low weight gain since one month of his age. The diagnosis was made by demonstration of MTB bacilli in the gastric aspirate of baby and chest radiography. Treatment with the four drug regimen including streptomycin was initiated, but the baby died on the third day of ATT. This case gives an account of difficulties in diagnosis and therapeutic management of congenital tuberculosis and alerts for development of protocols that foresee these difficulties.

  5. An integrated approach to health care costs: the case of American Can.

    Science.gov (United States)

    Silvers, J B; Haslinger, J

    1984-01-01

    Faced with numerous health care options, corporations are searching for plans which provide necessary benefits while containing costs. This article examines the case of the American Can Company where, since 1978, a new approach has produced mutual economic gains and employee satisfaction. American Can's efforts involved differential pricing and encouraged responsible selection by employees. The company was one of several studied by the Health Systems Management Center at Case Western Reserve University under contract with the Business Roundtable Health Initiatives Task Force. Such studies provide insight for other companies seeking ways to attack burgeoning corporate health care costs. This article is one of a series reporting the results of these studies. PMID:10272752

  6. Enabling Precision Medicine With Digital Case Classification at the Point-of-Care

    Directory of Open Access Journals (Sweden)

    Patrick Obermeier

    2016-02-01

    Full Text Available Infectious and inflammatory diseases of the central nervous system are difficult to identify early. Case definitions for aseptic meningitis, encephalitis, myelitis, and acute disseminated encephalomyelitis (ADEM are available, but rarely put to use. The VACC-Tool (Vienna Vaccine Safety Initiative Automated Case Classification-Tool is a mobile application enabling immediate case ascertainment based on consensus criteria at the point-of-care. The VACC-Tool was validated in a quality management program in collaboration with the Robert-Koch-Institute. Results were compared to ICD-10 coding and retrospective analysis of electronic health records using the same case criteria. Of 68,921 patients attending the emergency room in 10/2010–06/2013, 11,575 were hospitalized, with 521 eligible patients (mean age: 7.6 years entering the quality management program. Using the VACC-Tool at the point-of-care, 180/521 cases were classified successfully and 194/521 ruled out with certainty. Of the 180 confirmed cases, 116 had been missed by ICD-10 coding, 38 misclassified. By retrospective application of the same case criteria, 33 cases were missed. Encephalitis and ADEM cases were most likely missed or misclassified. The VACC-Tool enables physicians to ask the right questions at the right time, thereby classifying cases consistently and accurately, facilitating translational research. Future applications will alert physicians when additional diagnostic procedures are required.

  7. Using New Instruments of Clustering Policy in the Health Care System. The Case of Poland

    Science.gov (United States)

    Romaniuk, Piotr; Holecki, Tomasz; Woźniak-Holecka, Joanna

    2016-01-01

    The issue of clusters as a form of organization of market entities has recently attracted an increasing attention of health care management theoreticians and practitioners. In our opinion the existing theoretical basis gives a foundation for considering clusters as a source of potential for increasing the effectiveness of health policy and health care organizations. It can be assumed that in case of health care clusters there is a possibility of interregional diffusion of innovation, based on ventures undertaken on the health care market, increasing not only the potential of the entities in the cluster, but also of its surroundings and subcontractors. It is possible to realize the idea of a flexible health care implemented regionally with the use of modern techniques of communication, knowledge transfer and high specialization. Nonetheless, in case of Poland the potential of clustrification remains untapped, being characterized by a limited actions of public and private bodies, marginal role of non-profit sector organizations and limited engagement of R&D sector. This is because a general distrust in the cluster formula, and the lack of relevant knowledge among local officials and health business leaders. For this reason the process of clustrification among health care entities requires external support through the increased efforts to create a system of legal and tax preferences for cluster initiatives and provision of organizational support in terms of know-how, targeted particularly at bodies and individuals, who may act as cluster leaders.

  8. Using New Instruments of Clustering Policy in the Health Care System. The Case of Poland.

    Science.gov (United States)

    Romaniuk, Piotr; Holecki, Tomasz; Woźniak-Holecka, Joanna

    2016-01-01

    The issue of clusters as a form of organization of market entities has recently attracted an increasing attention of health care management theoreticians and practitioners. In our opinion the existing theoretical basis gives a foundation for considering clusters as a source of potential for increasing the effectiveness of health policy and health care organizations. It can be assumed that in case of health care clusters there is a possibility of interregional diffusion of innovation, based on ventures undertaken on the health care market, increasing not only the potential of the entities in the cluster, but also of its surroundings and subcontractors. It is possible to realize the idea of a flexible health care implemented regionally with the use of modern techniques of communication, knowledge transfer and high specialization. Nonetheless, in case of Poland the potential of clustrification remains untapped, being characterized by a limited actions of public and private bodies, marginal role of non-profit sector organizations and limited engagement of R&D sector. This is because a general distrust in the cluster formula, and the lack of relevant knowledge among local officials and health business leaders. For this reason the process of clustrification among health care entities requires external support through the increased efforts to create a system of legal and tax preferences for cluster initiatives and provision of organizational support in terms of know-how, targeted particularly at bodies and individuals, who may act as cluster leaders. PMID:27445815

  9. Derivation of travel demand forecasting models for low population areas: the case of Port Said Governorate, North East Egypt

    Directory of Open Access Journals (Sweden)

    Ahmed Mohamed Semeida

    2014-06-01

    Full Text Available In the last decades, there has been substantial development in modeling techniques of travel demand estimation. For low population areas the external trip estimation is important but usually neglected in travel demand modeling process. In Egypt, the researches in this field are scarce due to lack of data. Accordingly, this paper aims to identify and estimate the main variables that affect the travel demand in low population areas, and to develop models to predict them. The study focused on the Port Said Governorate in North East Egypt. A special questionnaire had been prepared in 2010 depending on interviews of passengers at basic taxi terminals in Port Said. And 2211 filled questionnaires were offering for research. To analyze the data, two modeling procedures were used. One is the multiple linear regression and the other is the generalized linear modeling (GLM applying normal distributions. It is found that GLM procedure offers more suitable and accurate approach than the linear regression for developing number of trips. The final demand models have statistics within the acceptable regions and, also, they are conceptually reasonable. These results are so important for Egyptian highway authorities to improve the efficiency of highway transportation system in Egypt.

  10. Comparison of particle swarm optimization and other metaheuristics on electricity demand estimation: A case study of Iran

    International Nuclear Information System (INIS)

    The importance of energy demand estimation stems from energy planning, formulating strategies and recommending energy policies. Most often, energy demand is mathematically formulated by socio-economic indicators. The challenging problem is to determine the optimal or near optimal weighting factors. Inspired by social behavior of bird flocking or fish schooling, PSO (particle swarm optimization) is a population-based search technique which has attracted significant attention to tackle the complexity of difficult optimization problems. This paper studies the performance of different PSO variants for estimating Iran's electricity demand. Seven PSO variants namely, original PSO, PSO-w (PSO with weighting factor), PSO-cf (PSO with constriction factor), PSO-rf (PSO with repulsion factor), PSO-vc (PSO with velocity control), CLPSO (comprehensive learning PSO) and a MPSO (modified PSO), are used to find the unknown weighting factors based on the data from 1982 to 2003. The validation process is then conducted by testing the optimized models by using the data from 2004 to 2009. It is seen that PSO-vc produces more promising results than the other variants, HS (harmony search) and ABSO (artificial bee swarm optimization) algorithms in terms of MAPE (mean absolute percentage error). This value is obtained 2.47 and 2.50 for the exponential and quadratic models, respectively. - Highlights: • Electricity demand estimation is modelled using socio-economic indicators. • Different PSO variants are investigated in terms of accuracy. • Exponential model can estimate the Iran's electricity demand with high accuracy. • PSO with velocity control produces more accurate result than the others

  11. Modeling framework for estimating impacts of climate change on electricity demand at regional level: Case of Greece

    International Nuclear Information System (INIS)

    This paper focuses on the potential upcoming impacts of climate change in the 21st century on electricity demand at regional/national levels for regions where topography and location result in large differences in local climate. To address this issue, a regional climate model, PRECIS, has been used to predict future climatic conditions under different emissions scenarios (namely A2 and B2 of the IPCC special report on emissions scenarios (SRES)) as an input to a multiple regression model of the sensitivity of electricity demand in the Greek interconnected power system to climate and socio-economic factors. The economic development input to the multiple regression model follows the same storylines of the SRES scenarios upto 2100 and includes sub-scenarios to cover larger and smaller economic development rates. The results of the analysis indicate an increase of the annual electricity demand attributable solely to climate change of 3.6-5.5% under all scenarios examined, most of which results from increased annual variability with substantial increases during the summer period that outweighs moderate declines estimated for the winter period. This becomes more pronounced if inter-annual variability, especially of summer months, is taken into consideration. It was also found that in the long run, economic development will have a strong effect on future electricity demand, thus increasing substantially the total amount of energy consumed for cooling and heating purposes. This substantial increase in energy demand with strong annual variability will lead to the need for inordinate increases of installed capacity, a large percentage of which will be underutilized. Thus, appropriate adaptation strategies (e.g. new investments, interconnections with other power systems, energy saving programmes, etc.) need to be developed at the state level in order to ensure the security of energy supply

  12. Recognizing meningococcal disease: the case for further research in primary care.

    OpenAIRE

    Granier, S.; Owen, P; Stott, N. C.

    1998-01-01

    Most studies describing the clinical presentation of meningococcal disease use data derived from hospital-based studies. This paper reviews current knowledge on the presentation of meningococcal disease from a primary care perspective. In a small proportion of cases with classical features, making the diagnosis may be relatively simple. In many cases, however, the general practitioner (GP) is faced with the difficulty of discriminating between the rare patient with life-threatening illness an...

  13. Citizen participation in the reform of health care policy: a case example.

    Science.gov (United States)

    Macfarlane, D

    1996-01-01

    The trend toward greater citizen participation in health care policy reform has its roots in the consumerism of the 1960s. This era witnessed the beginning of a dispersion of power in health care and an increase in the number and variety of stakeholders involved in the policy development process. Using the reform Ontario's long-term care policy as a case example, this paper offers observations about the benefits and challenges of participative policy-making. Despite the challenges and the paucity of hard evidence pointing to benefits, the author concludes that broad citizen participation in health care policy reform is a desirable goal. However, the capacity for genuine collaboration remains underdeveloped and requires more systematic refinement. PMID:10159410

  14. Short-run and long-run elasticities of electricity demand in the public sector: A case study of the United States Navy bases

    Science.gov (United States)

    Choi, Jino

    Numerous studies have examined the elasticities of electricity demand---residential as well as commercial and industrial---in the private sector. However, no one appears to have examined the behavior of the public sector demand. This study aims to fill that gap and to provide insights into the electricity demand in the public sector, using the U.S. Navy bases as a case study. This study examines electricity demand data of 38 Navy activities within the United States for a 16-year time period from 1985 through 2000. The Navy maintains a highly diverse shore infrastructure to conduct its mission and to support the fleet. The types of shore facilities include shipyards, air stations, aviation depots, hospital, and many others. These Navy activities are analogous to commercial or industrial organizations in the private sector. In this study, I used a number of analytical approaches to estimate short-run and long-run elasticities of electricity demand. Estimation using pooled data was rejected because it failed the test for homogeneity. Estimation using the time series data of each Navy activity had several wrong signs for coefficients. The Stein-rule estimator did not differ significantly from the separate cross-section estimates because of the strong rejection of the homogeneity assumption. The iterative Bayesian shrinkage estimator provided the most reasonable results. The empirical findings from this study are as follows. First, the Navy's electricity demand is price elastic. Second, the price elasticities appear to be lower than those of the private sector. The short-run price elasticities for the Navy activities ranged from -0.083 to -0.157. The long-run price elasticities ranged from -0.151 to -0.769.

  15. Reenacted Case Scenarios for Undergraduate Healthcare Students to Illustrate Person-Centered Care in Dementia

    Science.gov (United States)

    Bradley, Sandra L.; De Bellis, Anita; Guerin, Pauline; Walters, Bonnie; Wotherspoon, Alison; Cecchin, Maggie; Paterson, Jan

    2010-01-01

    Healthcare practitioners have suggested that interpreting person-centered care for people who have dementia to undergraduate students requires guidance in practical application. This article describes the production of a written and digital interdisciplinary educational resource for tertiary students. It uses real-life case scenarios provided by…

  16. Medication Abortion within a Student Health Care Clinic: A Review of the First 46 Consecutive Cases

    Science.gov (United States)

    Godfrey, Emily M.; Bordoloi, Anita; Moorthie, Mydhili; Pela, Emily

    2012-01-01

    Objective: Medication abortion with mifepristone and misoprostol has been available in the United States since 2000. The authors reviewed the first 46 medication abortion cases conducted at a university-based student health care clinic to determine the safety and feasibility of medication abortion in this type of clinical setting. Participants:…

  17. Making the Case to Managed Care: The Science of Marketing Biologics

    OpenAIRE

    APPLEBY, CHUCK

    2004-01-01

    Making a case when biotechs market their products to their most cost-conscious customers — managed care organizations — is far different than what a traditional pharmaceutical company might do with HMO partners. It’s all about the science. Not the cost.

  18. Case Management as a Significant Component of Usual Care Psychotherapy for Youth with Disruptive Behavior Problems

    Science.gov (United States)

    Zoffness, Rachel; Garland, Ann; Brookman-Frazee, Lauren; Roesch, Scott

    2009-01-01

    Youth with disruptive behavior problems (DBPs) represent the majority of youth served in usual care (UC) psychotherapy, and are at high risk for maladaptive outcomes. Little is known about UC psychotherapeutic strategies utilized with this population. Researchers and clinicians suggest that case management (CM) is a major activity occurring in…

  19. Case management for at-risk elderly patients in the English integrated care pilots: observational study of staff and patient experience and secondary care utilisation

    Directory of Open Access Journals (Sweden)

    Martin Roland

    2012-07-01

    Full Text Available Introduction: In 2009, the English Department of Health appointed 16 integrated care pilots which aimed to provide better integrated care. We report the quantitative results from a multi-method evaluation of six of the demonstration projects which used risk profiling tools to identify older people at risk of emergency hospital admission, combined with intensive case management for people identified as at risk. The interventions focused mainly on delivery system redesign and improved clinical information systems, two key elements of Wagner's Chronic Care Model. Methods: Questionnaires to staff and patients. Difference-in-differences analysis of secondary care utilisation using data on 3,646 patients and 17,311 matched controls, and changes in overall secondary care utilisation. Results: Most staff thought that care for their patients had improved. More patients reported having a care plan but they found it significantly harder to see a doctor or nurse of their choice and felt less involved in decisions about their care. Case management interventions were associated with a 9% increase in emergency admissions. We found some evidence of imbalance between cases and controls which could have biased this estimate, but simulations of the possible effect of unobserved confounders showed that it was very unlikely that the sites achieved their goal of reducing emergency admissions. However, we found significant reductions of 21% and 22% in elective admissions and outpatient attendance in the six months following an intervention, and overall inpatient and outpatient costs were significantly reduced by 9% during this period. Area level analyses of whole practice populations suggested that overall outpatient attendances were significantly reduced by 5% two years after the start of the case management schemes. Conclusion: Case management may result in improvements in some aspects of care and has the potential to reduce secondary care costs. However, to improve

  20. Case management for at-risk elderly patients in the English integrated care pilots: observational study of staff and patient experience and secondary care utilisation

    Directory of Open Access Journals (Sweden)

    Martin Roland

    2012-07-01

    Full Text Available Introduction: In 2009, the English Department of Health appointed 16 integrated care pilots which aimed to provide better integrated care. We report the quantitative results from a multi-method evaluation of six of the demonstration projects which used risk profiling tools to identify older people at risk of emergency hospital admission, combined with intensive case management for people identified as at risk. The interventions focused mainly on delivery system redesign and improved clinical information systems, two key elements of Wagner's Chronic Care Model.Methods: Questionnaires to staff and patients. Difference-in-differences analysis of secondary care utilisation using data on 3,646 patients and 17,311 matched controls, and changes in overall secondary care utilisation.Results: Most staff thought that care for their patients had improved. More patients reported having a care plan but they found it significantly harder to see a doctor or nurse of their choice and felt less involved in decisions about their care. Case management interventions were associated with a 9% increase in emergency admissions. We found some evidence of imbalance between cases and controls which could have biased this estimate, but simulations of the possible effect of unobserved confounders showed that it was very unlikely that the sites achieved their goal of reducing emergency admissions. However, we found significant reductions of 21% and 22% in elective admissions and outpatient attendance in the six months following an intervention, and overall inpatient and outpatient costs were significantly reduced by 9% during this period. Area level analyses of whole practice populations suggested that overall outpatient attendances were significantly reduced by 5% two years after the start of the case management schemes.Conclusion: Case management may result in improvements in some aspects of care and has the potential to reduce secondary care costs. However, to improve

  1. Energy demand, emissions forecasts and mitigation strategies modeled over a medium-range horizon: The case of the land transportation sector in Metro Manila

    International Nuclear Information System (INIS)

    Transportation contributes to resource depletion and has other negative impacts on the environment. The present study presents models of energy demand and environmental emissions for the land transportation sector in Metro Manila, Philippines from 2010 to 2040 using the “Long Range Energy Alternatives Planning (LEAP)” tool. The study projected energy demand and CO2, CO, HC, NOx and PM10 emissions for Business-As-Usual (BAU) and alternative scenarios and compared the results while aiming to determine optimal transportation policies to reduce energy demand and emissions. The results indicated that the adoption of EURO 4 emission standards provides the greatest reduction in energy use at 10.8%, while the best cases for the various gas emissions were split among different options. In addition, a combination of all of the alternatives is expected to lower energy use by 27.8% and to reduce CO2, CO, HC, NOx and PM10 by 30.3%, 60.3%, 59.0%, 48.2% and 66.4%, respectively. The analytical framework employed herein could be applied to other cities to evaluate and prioritize strategies to reduce future energy requirements and emissions. - Highlights: • End use demand and impacts of road transportation are alarming. • Implementing a combination of the scenarios decreases energy demand by 27.8%. • Imposing Euro IV emission standards might reduce pollutants by up to 53.7%. • The best cases for various emissions are achieved by different options. • This model is useful for analyzing energy trajectories and mitigation options

  2. Price Elasticity of Demand and Capacity-Restraint Transit Fare Strategy: A Case Study of Bangkok Mass Transit System

    Directory of Open Access Journals (Sweden)

    Ackchai Sirikijpanichkul

    2015-01-01

    Full Text Available Traffic congestion is a chronic problem of Bangkok. Similar to other metropolises, the city perpetually seeks for alternatives to road travel. Mass rapid transit seems to be the only way out that is expected to mitigate traffic congestion in the city. However, without common fare system, travelers need to pay an initial entrance fee every time they enter each transit system. This excess cost tapers the demand and affects the efficient use of the system. This research investigates the influence of fare price on transit use which is measured by price elasticity of demand and proposes the optimum fare price if the common fare is used. The analysis is based on the findings from the stated preference survey techniques. Finally, the conclusion on fare level that encourage more patronage, maintain service quality and operator revenue is addressed.

  3. Responding to water demand strategies : case study in the Lower Orange catchment management area (LOCMA) / C.M. Gouws.

    OpenAIRE

    Gouws, Catharina Maria

    2010-01-01

    This study is an investigation into water management policies in South Africa, their effect on water users and the perceptions users have of these policies. The investigation begins with an exposition of concepts such as water demand management (WDM), as well as integrated water resource management (IWRM). A sub-discourse of the main theme is the societal tendency to neglect its common property. Garret Hardin's groundbreaking observations on the "tragedy of the commons" (1968) are explored in...

  4. Price Elasticity of Demand and Capacity-Restraint Transit Fare Strategy: A Case Study of Bangkok Mass Transit System

    OpenAIRE

    Ackchai Sirikijpanichkul; Sarintorn Winyoopadit

    2015-01-01

    Traffic congestion is a chronic problem of Bangkok. Similar to other metropolises, the city perpetually seeks for alternatives to road travel. Mass rapid transit seems to be the only way out that is expected to mitigate traffic congestion in the city. However, without common fare system, travelers need to pay an initial entrance fee every time they enter each transit system. This excess cost tapers the demand and affects the efficient use of the system. This research investigates the influenc...

  5. Assessing ecological land use and water demand of river systems: a case study in Luanhe River, North China

    OpenAIRE

    Yan, D. H.; Wang, G; H. Wang; T. L. Qin

    2012-01-01

    Economic and social development has greatly increased ecological water demand and modified land use of river systems worldwide, causing overall degradation of many of these systems. In this study, theoretical and technical frameworks for regionalization on the eco-environmental function of river systems are formulated and applied to the Luanhe River system. Based on its eco-environmental functions, this river can be regionalized into four types of first-class functional areas: ecological pres...

  6. Quantifying and reducing uncertainty in land use change model projections : Case studies on the implications of increasing bioenergy demands

    OpenAIRE

    Verstegen, J.A.

    2016-01-01

    Land use change is a central issue in the sustainability debate, because of its impacts on e.g. climate change, water availability and quality, soil quality and erosion, and biodiversity. Continuing population growth, shifting diets towards higher meat consumption and increasing bioenergy demands call for the exploration of possibilities for sustainable land use change pathways with minimal negative impacts. Land use change models are tools that support such explorations by projecting the spa...

  7. How to calculate forecast accuracy for stocked items with a lumpy demand : A case study at Alfa Laval

    OpenAIRE

    Ragnerstam, Elsa

    2016-01-01

    Inventory management is an important part of a good functioning logistic. Nearly all the literature on optimal inventory management uses criteria of cost minimization and profit maximization. To have a well functioning forecasting system it is important to have a balance in the inventory. But, it exist different factors that can results in uncertainties and difficulties to maintain this balance. One important factor is the customers’ demand. Over half of the stocked items are in stock to prev...

  8. On the Inclusion of Energy-Shifting Demand Response in Production Cost Models: Methodology and a Case Study

    OpenAIRE

    O'Connell, Niamh; Hale, Elaine; Doebber, Ian; Jorgenson, Jennie

    2015-01-01

    In the context of future power system requirements for additional flexibility, demand response (DR) is an attractive potential resource. Its proponents widely laud its prospective benefits, which include enabling higher penetrations of variable renewable generation at lower cost than alternative storage technologies, and improving economic efficiency. In practice, DR from the commercial and residential sectors is largely an emerging, not a mature, resource, and its actual costs and benefits n...

  9. Product structure metrics as an indicator of demand-supply chain efficiency : case study in the cellular network industry

    OpenAIRE

    Kaski, Timo

    2002-01-01

    Product structure affects demand-supply chain performance, this is almost self-evident. But how to develop better product structures? Which design alternative is the best among several options? Markets define the number of product variants needed. Therefore, limiting product variations is not a feasible solution. This research made an effort to develop a method to guide product structure development and to quantify comparison of alternative design implementations. The study aimed at reducing ...

  10. Comprehensive evaluation on housing market supply and demand based on principal component analysis: the case of Xi'an, China

    Directory of Open Access Journals (Sweden)

    Jianping Yang

    2013-01-01

    Full Text Available At present, China's housing prices and structures have been severe distorted, which have been done serious harm on the development of national economy and people's lives, the government has implemented the most strictest macro-control. This paper applies the correlation and principal component analysis on the supply demand of housing market. Aims to points out clear direction for the implementation of macro-control policies in the future.

  11. Improving Supply Chain in North -American Liner Board market through Demand Chain managment : Case of Metsä Board

    OpenAIRE

    Sakko, Auli

    2014-01-01

    The objective of this thesis research is to explore the US customer demand and seek better customer and market understanding, and consequently, facilitate implementing the optimal stock levels in the market. Additionally, this thesis investigates which improvements are necessary for utilizing the common stock supply model in the US, and how the maximal availability is achieved for the US customers. The research method in this thesis is qualitative. The theoretical framework was created th...

  12. The effect of location and facility demand on the marginal cost of delivered wood chips from energy crops: A case study of the state of Tennessee

    International Nuclear Information System (INIS)

    Cost-supply curves for delivered wood chips from short rotation woody crops were calculated for 21 regularly-spaced locations spanning the state of Tennessee. These curves were used to systematically evaluate the combined effects of location and facility demand on wood chip feedstock costs in Tennessee. The cost-supply curves were developed using BRAVO, a GIS-based decision support system which calculates marginal cost of delivering wood chips to a specific location given road network maps and maps of farmgate prices and supplies of woody chips from short rotation energy crops. Marginal costs of delivered chips varied by both facility location in the state and facility demand. Marginal costs were lowest in central Tennessee unless the facility demand was greater than 2.7 million dry Mg per year (3 million dry tons per year) in which case west Tennessee was the lowest cost region. Marginal costs rose rapidly with increasing facility demand in the mountainous eastern portion of the state. Transportation costs accounted for 18 to 29% of the delivered cost and ranged between $8 and $18/dry Mg ($7 and $16/dry ton). Reducing the expected farmer participation rate from 100% to 50% or 25% dramatically raised the marginal costs of feedstock supply in the east and central regions of the state. The analysis demonstrates the need to use geographically-specific information when projecting the potential costs and supplies of biomass feedstock

  13. The effect of location and facility demand on the marginal cost of delivered wood chips from energy crops: a case study of the State of Tennessee

    International Nuclear Information System (INIS)

    Cost-supply curves for delivered wood chips from short rotation woody crops were calculated for 21 regularly spaced locations spanning the state of Tennessee. These curves were used to systematically evaluate the combined effects of location and facility demand on wood chip feedstock costs in Tennessee. The cost-supply curves were developed using BRAVO, a GIS-based decision support system which calculates marginal cost of delivering wood chips to a specific location given road network maps and maps of farm-gate prices and supplies of wood chips from short rotation energy crops. Marginal costs of delivered chips varied by both facility location in the state and facility demand. Marginal costs were lowest in central Tennessee, unless the facility demand was greater than 2,700 000 dry Mg/y (3 000 000 dry t/y) in which case west Tennessee was the lowest cost region. Marginal costs rose rapidly with increasing facility demand in the mountainous eastern portion of the state. Transportation costs accounted for 18-29% of the delivered cost and ranged between $8 and 18/dry Mg ($7 and 16/dry t). Reducing the expected farmer participation rate from 100 to 50 or 25% dramatically raised the marginal costs of feedstock supply in the east and central regions of the state. The analysis demonstrates the need to use geographically-specific information when projecting the potential costs and supplies of biomass feedstock. (author)

  14. Opportunities for Open Automated Demand Response in Wastewater Treatment Facilities in California - Phase II Report. San Luis Rey Wastewater Treatment Plant Case Study

    Energy Technology Data Exchange (ETDEWEB)

    Thompson, Lisa; Lekov, Alex; McKane, Aimee; Piette, Mary Ann

    2010-08-20

    This case study enhances the understanding of open automated demand response opportunities in municipal wastewater treatment facilities. The report summarizes the findings of a 100 day submetering project at the San Luis Rey Wastewater Treatment Plant, a municipal wastewater treatment facility in Oceanside, California. The report reveals that key energy-intensive equipment such as pumps and centrifuges can be targeted for large load reductions. Demand response tests on the effluent pumps resulted a 300 kW load reduction and tests on centrifuges resulted in a 40 kW load reduction. Although tests on the facility?s blowers resulted in peak period load reductions of 78 kW sharp, short-lived increases in the turbidity of the wastewater effluent were experienced within 24 hours of the test. The results of these tests, which were conducted on blowers without variable speed drive capability, would not be acceptable and warrant further study. This study finds that wastewater treatment facilities have significant open automated demand response potential. However, limiting factors to implementing demand response are the reaction of effluent turbidity to reduced aeration load, along with the cogeneration capabilities of municipal facilities, including existing power purchase agreements and utility receptiveness to purchasing electricity from cogeneration facilities.

  15. Tracking the evolution of hospice palliative care in Canada: A comparative case study analysis of seven provinces

    Directory of Open Access Journals (Sweden)

    Richards Judy-Lynn

    2010-06-01

    of the established system of care were taken, often out of necessity. Three kinds of circumventions were identified from the data: (1 interventions to shift the system (e.g., the role of advocacy; (2 service innovations (e.g., educational initiatives; and (3 new alternative structures (e.g., the establishment of independent hospice organizations. Overall, the evolution of HPC across the case study provinces has been markedly slow, but steady and continuous. Conclusions HPC in Canada remains at the margins of the health care system. Its integration into the primary health care system may ensure dedicated and ongoing funding, enhanced access, quality and service responsiveness. Though demographics are expected to influence HPC demand in Canada, our study confirms that concerned citizens, advocacy organizations and local champions will continue to be the agents of change that make the necessary and lasting impacts on HPC in Canada.

  16. Opportunities for Automated Demand Response in California Agricultural Irrigation

    Energy Technology Data Exchange (ETDEWEB)

    Olsen, Daniel [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Aghajanzadeh, Arian [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); McKane, Aimee [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2015-08-01

    Pumping water for agricultural irrigation represents a significant share of California’s annual electricity use and peak demand. It also represents a large source of potential flexibility, as farms possess a form of storage in their wetted soil. By carefully modifying their irrigation schedules, growers can participate in demand response without adverse effects on their crops. This report describes the potential for participation in demand response and automated demand response by agricultural irrigators in California, as well as barriers to widespread participation. The report first describes the magnitude, timing, location, purpose, and manner of energy use in California. Typical on-­farm controls are discussed, as well as common impediments to participation in demand response and automated demand response programs. Case studies of demand response programs in California and across the country are reviewed, and their results along with overall California demand estimates are used to estimate statewide demand response potential. Finally, recommendations are made for future research that can enhance the understanding of demand response potential in this industry.

  17. Brain lesions in eclampsia: A series of 39 cases admitted in an Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Y Brouh

    2016-01-01

    Full Text Available The aim of this study was to identify the encephalic lesions in the eclampsia occurrences. Within a period of 18 months, computed tomography (CT of the brain was performed in all patients admitted in intensive care for eclampsia. These CTs were analyzed and intracerebral lesions were identified. Thirty-nine patients were included. We noted 10 cases of ischemic stroke, 9 cases of cerebral edema, and 3 cases of hemorrhagic stroke and subarachnoid hemorrhage. The CT scan came back to normal in 20 eclamptic patients. Overall, delays in obstetric and intensive care and time of completion of the CT were long. CT has allowed highlighting in patients with eclampsia varied intracerebral lesions. The early performance of the CT is therefore essential for a better support of patients.

  18. Palliative care: a case study and reflections on some spiritual issues.

    Science.gov (United States)

    Ireland, Jillian

    Being aware of notions of spirituality and ethnicity are perhaps at no time as important in nursing as at the end of a patient's life. This paper reflects on a case study of a patient receiving palliative care who was a nurse from Africa. One key reflection that arose from this case is 'what is spirituality?' How this is expressed is a dynamic process, and cannot necessarily be captured by a one-off question and answer session. The following case study highlights that what we want at the end of life, or may think we would want is not at all fixed. Therefore, nurses caring for dying patients need to be open-minded, and check regularly that the patient's chosen pathway is being followed. Also, there must be space for patients to change their minds. Tools are available and might be usefully adapted to suit individual patients' needs. PMID:20220674

  19. Integrating Web-Based Applications into Aged Care: Two Case Studies and Discussion.

    Science.gov (United States)

    Rehm, Imogen C; Musić, Selma; Carlsson, Anthony; Scanlan, Faye; Silver, Mark; Bhar, Sunil S

    2016-09-01

    In anticipation of the growing need for adequate mental health care for older adults in residential aged care facilities, psychologists are challenged to overcome several barriers that impede the uptake and delivery of their services in such settings. Information and communication technologies (ICT) have strong potential to overcome some of these barriers by supporting the delivery of evidence-based psychosocial treatments for common psychogeriatric issues. This paper presents two case studies that illustrate when and how psychologists can use various ICT applications (e.g., tablet devices, web-based applications) integrated with cognitive behavioural and reminiscence-based therapies. Both case studies demonstrate that ICT can effectively support the therapeutic alliance, enhance therapeutic engagement, and individualize treatment delivery to accommodate the needs of elderly patients. It is hoped that these case studies will encourage clinicians to consider using ICT to augment therapy with their elderly patients. PMID:27073103

  20. Demand Uncertainty

    DEFF Research Database (Denmark)

    Nguyen, Daniel Xuyen

    untested destinations. The option to forecast demands causes firms to delay exporting in order to gather more information about foreign demand. Third, since uncertainty is resolved after entry, many firms enter a destination and then exit after learning that they cannot profit. This prediction reconciles......This paper presents a model of trade that explains why firms wait to export and why many exporters fail. Firms face uncertain demands that are only realized after the firm enters the destination. The model retools the timing of uncertainty resolution found in productivity heterogeneity models. This...... the high rate of exit seen in the first years of exporting. Finally, when faced with multiple countries in which to export, some firms will choose to sequentially export in order to slowly learn more about its chances for success in untested markets....

  1. Courts and health care rationing: the case of the Brazilian Federal Supreme Court.

    Science.gov (United States)

    Wang, Daniel W L

    2013-01-01

    The recognition that access to health care is a constitutional right in Brazil has resulted in a situation in which citizens denied treatments by the public health care system have brought lawsuits against health authorities, claiming that their right to health was violated. This litigation forces the courts to decide between a patient-centred and a population-centred approach to public health - a choice that forces the courts to assess health care rationing decisions. This article analyses the judgments of the Brazilian Federal Supreme Court in right to health cases, arguing that the Court's recent decisions have been contrary to their long-standing stance against rationing. In 2009, the Court organized a public hearing to discuss this topic with civil society and established criteria to determine when rationing would be legal. However, I argue that these criteria for health care rationing do not adequately address the most difficult health care distribution dilemmas. They force the health care system to keep their rationing criteria implicit and make population-centred concerns secondary to individual-centred ones. PMID:23040509

  2. Case-management for nursing care of patient with stroke: a cross-cultural critical reflective analysis

    OpenAIRE

    Theofanidis, Dimitrios

    2016-01-01

    Introduction: Stroke remains a heavy financial burden on health care systems around the world. Yet, health care reforms have called for sophisticated management systems in order to provide high-quality care on equal terms for the entire population within a cost-conscious environment.  Aim: The main aim of this discussion paper is to define and reflect cross-culturally on the merits of the Case-Management (CM) approach for contemporary stroke care delivery. Methods: Critical refle...

  3. A mathematical programming framework for energy planning in services' sector buildings under uncertainty in load demand: The case of a hospital in Athens

    International Nuclear Information System (INIS)

    The aim of this paper is to provide an integrated modeling and optimization framework for energy planning in large consumers of the services' sector based on mathematical programming. The power demand is vaguely known and the underlying uncertainty is modeled using elements from fuzzy set theory. The defined fuzzy programming model is subsequently transformed to an equivalent multi-objective problem, where the minimization of cost and the maximization of demand satisfaction are the objective functions. The Pareto optimal solutions of this problem are obtained using a novel version of the ε-constraint method and represent the possibly optimal solutions of the original problem under uncertainty. In the present case, in order to select the most preferred Pareto optimal solution, the minimax regret criterion is properly used to indicate the preferred configuration of the system (i.e. the size of the installed units) given the load uncertainty. Furthermore, the paper proposes a model reduction technique that can be used in similar cases and further examines its effect in the final results. The above methodology is applied to the energy rehabilitation of a hospital in the Athens area. The technologies under consideration include a combined heat and power unit for providing power and heat, an absorption unit and/or a compression unit for providing cooling load. The obtained results demonstrate that, increasing the degree of demand satisfaction, the total annual cost increases almost linearly. Although data compression allows obtaining realistic results, the size of the proposed units might be slightly changed

  4. Effective Clinical Practices in Managed Care Findings From Ten Case Studies

    OpenAIRE

    Suzanne Felt-Lisk; Kleinman, Lawrence C.

    2000-01-01

    Presents findings from a study designed to look at how some of the nation's high-performing HMOs have achieved their success. Notes that delivering high-quality care is a driving force for nearly all of the plans studied, as is a culture of respect for clinicians. For printed copies call The Commonwealth Fund at (888) 777-2744, ask for publication number 427. The plan-specific summary reports are also available in a volume titled "Effective Clinical Practices in Managed Care: Ten Case Studies...

  5. Transforming Perioperative Care: The Case for a Novel Curriculum for Anesthesiology Resident Training.

    Science.gov (United States)

    Alem, Navid; Cohen, Neal; Cannesson, Maxime; Kain, Zeev

    2016-06-15

    Currently, perioperative health care is undergoing transformative changes. One prospect for the specialty of anesthesiology is a reorientation of resident education to focus more on the entire spectrum of perioperative care as exemplified by the perioperative surgical home (PSH). To advance this novel paradigm for patients and anesthesiologists, one must also consider further incorporating the competencies fundamental to the PSH during residency training. As such, the purpose of this case report is to outline the successful implementation of a comprehensive PSH curriculum for anesthesiology residents. PMID:27166744

  6. Cultural responsiveness in long-term-care case management: moving beyond competence.

    Science.gov (United States)

    Werkmeister-Rozas, Lisa; Klein, Waldo C

    2009-01-01

    Case mangers must deal with the ever-changing makeup of their client population as well as those who provide managed services to these clients. There is great ethnocultural diversity in the elder population, and statistics contend that it will only increase with time. Similarly, the majority of long-term-care providers have been consistently female and of color. Providing culturally competent services becomes more complex when long-term-care providers and clients possess different identities, countries of origins, and social statuses. This article examines a framework that addresses the complex, multidimensional and bidirectional process that occurs between providers and consumers of any cultural makeup called cultural responsiveness. PMID:19353981

  7. Barriers to implementation of a redesign of information transfer and feedback in acute care: results from a multiple case study

    OpenAIRE

    van Leijen-Zeelenberg, Janneke E; van Raak, Arno JA; Duimel-Peeters, Inge GP; Kroese, Mariëlle EAL; Brink, Peter RG; Ruwaard, Dirk; Vrijhoef, Hubertus JM

    2014-01-01

    Background Accurate information transfer is an important element of continuity of care and patient safety. Despite the demonstrated urge for improvement of communication in acute care, there is a lack of data on improvements of communication. This study aims to describe the barriers to implementation of a redesign of the existing model for information transfer and feedback. Methods A case study with six cases (i.e. acute care chains), using mixed methods was carried out in the Netherlands. Th...

  8. 锦州市围生期妇女保健需求的调查分析%Survey of perinatal health care demand in Jinzhou

    Institute of Scientific and Technical Information of China (English)

    王怡涵; 王红霞; 侯晓瑛; 卢静; 宫建美

    2016-01-01

    Objective To understand perinatal health care and demand status, and explore the influence factors of perinatal health in Jinzhou area. Methods Randomly investigate 996 mothers from three hospital in Jinzhou. Results Seeking pregnancy health service demand rate: general hospital of obstetrics and gynecology accounted for 52.2%(520/996), maternity hospitals accounted for 39.5%(393/996), family planning services accounted for 8.3% (83/996). Good crowd in pregnancy cognition, > 30 65.3% (297/455), 30 years old or less accounted for 34.7% (158/455). Medical personnel in maternal knowledge acquirement accounted for 33.2% (331/996), pregnant women school training accounted for 23.9% (238/996), network way accounted for 16.2% (161/996), the relatives and friends accounted for 10.7% (107/996), books accounted for 10.8% (108/996), the other way accounted for 5.1% (51/996).The related factors of postpartum depression are marital status, antenatal education, the way of breastfeeding. Conclusions The family planning service has not fully played its efficiency. Women under t he age of 30 need to enhance conciousness about health care before pregnancy. The network platform still has space to play education function. It′s necessary that puerperal nursing routine should add postnatal depression questionnaire in the future.%目的:了解锦州地区妇女围生期保健需求,并探讨影响妇女围生期健康的相关因素。方法随机选取996例产后复查的产妇,对其一般情况、孕前保健认知和信息获取途径情况、孕产期知识获取途径情况和产后抑郁情况进行问卷调查。结果寻求孕前保健服务的需求率:综合性医院妇产科占52.2%(520/996),妇产科专科医院占39.5%(393/996),计划生育服务所占8.3%(83/996)。在围孕期认知良好的人群中,>30岁占65.3%(297/455),≤30岁占34.7%(158/455)。在孕产期知识获取途径中医务人员占33.2%(331/996

  9. Meeting energy demand in a developing economy without damaging the environment-A case study in Sabah, Malaysia, from technical, environmental and economic perspectives

    International Nuclear Information System (INIS)

    The challenges faced by the developing countries are unique in that they need to meet the increasing energy demands for their economic growths at a competitive price without damaging the environments. In this paper, a case study on the electricity demand issue in Sabah, Malaysia, is presented to investigate potential solutions in addressing this current need for a typical developing economy from the technical, economical and environmental perspectives. Sabah, one of the 13 states in Malaysia, is currently experiencing a serious power shortage, especially at the east coast. A 300 MW coal plant is proposed by the electricity utility company. However, the proposal has been rejected in the past several years due to the negative environmental impacts of the plant. In this paper, a number of alternative solutions were evaluated and proposed with respect to the viability of technologies, financial return and minimum environmental impact in terms of GHG emission.

  10. Meeting energy demand in a developing economy without damaging the environment. A case study in Sabah, Malaysia, from technical, environmental and economic perspectives

    International Nuclear Information System (INIS)

    The challenges faced by the developing countries are unique in that they need to meet the increasing energy demands for their economic growths at a competitive price without damaging the environments. In this paper, a case study on the electricity demand issue in Sabah, Malaysia, is presented to investigate potential solutions in addressing this current need for a typical developing economy from the technical, economical and environmental perspectives. Sabah, one of the 13 states in Malaysia, is currently experiencing a serious power shortage, especially at the east coast. A 300 MW coal plant is proposed by the electricity utility company. However, the proposal has been rejected in the past several years due to the negative environmental impacts of the plant. In this paper, a number of alternative solutions were evaluated and proposed with respect to the viability of technologies, financial return and minimum environmental impact in terms of GHG emission. (author)

  11. Electrical network capacity support from demand side response: Techno-economic assessment of potential business cases for small commercial and residential end-users

    International Nuclear Information System (INIS)

    Demand Side Response (DSR) is recognised for its potential to bring economic benefits to various electricity sector actors, such as energy retailers, Transmission System Operators (TSOs) and Distribution Network Operators (DNOs). However, most DSR is provided by large industrial and commercial consumers, and little research has been directed to the quantification of the value that small (below 100 kW) commercial and residential end-users could accrue by providing DSR services. In particular, suitable models and studies are needed to quantify potential business cases for DSR from small commercial and residential end-users. Such models and studies should consider the technical and physical characteristics of the power system and demand resources, together with the economic conditions of the power market. In addition, the majority of research focuses on provision of energy arbitrage or ancillary services, with very little attention to DSR services for network capacity support. Accordingly, this paper presents comprehensive techno-economic methodologies for the quantification of three capacity-based business cases for DSR from small commercial and residential end-users. Case study results applied to a UK context indicate that, if the appropriate regulatory framework is put in place, services for capacity support to both DNOs and TSOs can result into potentially attractive business cases for DSR from small end-users with minimum impact on their comfort level. -- Highlights: •We present three business cases for DSR from domestic and commercial end-users. •A comprehensive techno-economic methodology is proposed for the quantification of each DSR business cases. •The regulatory implications associated with each business case are discussed

  12. Two Case Studies Using Mock-Ups for Planning Adult and Neonatal Intensive Care Facilities

    Directory of Open Access Journals (Sweden)

    Sue Hignett

    2010-01-01

    Full Text Available This paper describes two case studies using a 5-step protocol to determine functional space requirements for cardiac and neonatal intensive care clinical activities. Functional space experiments were conducted to determine the spatial requirements (defined as the minimumsized rectangle to encompass the Link Analysis. The data were collected with multi-directional filming and analysed frame-by-frame to plot the movements between the nurses and other components in the space. The average clinical functional space for the adult critical care unit was 22.83m2 (excluding family and hygiene space and in-room storage. The average functional clinical space for neonatal intensive care unit was 13.5m2 (excluding circulation and storage. The use of the 5-step protocol is reviewed, with limitations in case study 1 addressed in case study 2. The findings from both case studies have been incorporated into government guidance and achieved knowledge transfer by being implemented in building design.

  13. The Business Case for Palliative Care: Translating Research Into Program Development in the U.S.

    Science.gov (United States)

    Cassel, J. Brian; Kerr, Kathleen M.; Kalman, Noah S.; Smith, Thomas J.

    2015-01-01

    Specialist palliative care (PC) often embraces a “less is more” philosophy that runs counter to the revenue-centric nature of most health care financing in the U.S. A special business case is needed in which the financial benefits for organizations such as hospitals and payers are aligned with the demonstrable clinical benefits for patients. Based on published studies and our work with PC programs over the past 15 years, we identified 10 principles that together form a business model for specialist PC. These principles are relatively well established for inpatient PC but are only now emerging for community-based PC. Three developments that are key for the latter are the increasing penalties from payers for overutilization of hospital stays, the variety of alternative payment models such as accountable care organizations, which foster a population health management perspective, and payer-provider partnerships that allow for greater access to and funding of community-based PC. PMID:26297853

  14. First cases of exclusive paternal care in stink bugs (Hemiptera: Pentatomidae

    Directory of Open Access Journals (Sweden)

    Gustavo S. Requena

    2010-01-01

    Full Text Available We describe paternal care in two pentatomid bugs, Lopadusa (Lopadusa augur Stål, 1860 and Edessa nigropunctata Berg, 1884. Field and laboratory observations showed that males remain with their eggs and early hatched nymphs, while females abandon the eggs after oviposition. Guarding males defensive behaviors towards their clutches were similar to those described for guarding females of pentatomids. Since there is no detailed information on the internal phylogeny of Pentatomidae, it is not possible to make a robust inference on whether paternal care in L. augur and E. nigropunctata has arisen independently or not. If the latter, the two new cases of paternal care we describe here represent the fifth event of independent evolution of this rare behavioral trait in Heteroptera.

  15. The Business Case for Palliative Care: Translating Research Into Program Development in the U.S.

    Science.gov (United States)

    Cassel, J Brian; Kerr, Kathleen M; Kalman, Noah S; Smith, Thomas J

    2015-12-01

    Specialist palliative care (PC) often embraces a "less is more" philosophy that runs counter to the revenue-centric nature of most health care financing in the U.S. A special business case is needed in which the financial benefits for organizations such as hospitals and payers are aligned with the demonstrable clinical benefits for patients. Based on published studies and our work with PC programs over the past 15 years, we identified 10 principles that together form a business model for specialist PC. These principles are relatively well established for inpatient PC but are only now emerging for community-based PC. Three developments that are key for the latter are the increasing penalties from payers for overutilization of hospital stays, the variety of alternative payment models such as accountable care organizations, which foster a population health management perspective, and payer-provider partnerships that allow for greater access to and funding of community-based PC. PMID:26297853

  16. An Analysis of 19 International Case Studies of Stress Prevention Through Work Reorganization Using the Demand/Control Model

    Science.gov (United States)

    Karasek, Robert A.

    2004-01-01

    Nineteen international case studies of workplace stress prevention initiatives are analyzed. The focus of these cases, which span a variety of workplaces and locations, is on preventing stress through work reorganization rather than remedial approaches for stress relief. It is found that the majority of the occupations represented in the case…

  17. Clinician challenges in providing health care for a morbidly obese family member: a bariatric case study.

    Science.gov (United States)

    Beitz, Janice M

    2015-01-01

    Morbid obesity is a chronic disease affecting millions of Americans. The disorder is likely to increase in prevalence because currently one third of the American population is obese. Many factors are associated with morbid obesity, including psychological (eg, depression), physiological (eg, hypothyroidism) mechanisms, sleep disorders (eg, sleep apnea), drug therapy (antidepressants, antidiabetic agents, steroids), and genetics. Increasing numbers of morbidly obese patients are requiring critical care, presenting major challenges to professional staff across the disciplines. This manuscript presents a case study describing the experiences of a morbidly obese woman in the final years of her life from the perspective of her health professional relative. The patient typifies many of the major risk factors for morbid obesity; her story reveals many of the issues faced as she revolved in and out of the critical care and acute care system. Her substantive health problems affected multiple body systems and included hypothyroidism, congestive heart failure, hyperlipidemia, and subclinical Cushing's Syndrome, likely related to previous medical therapy (cortisone) for rheumatic fever in childhood. The case description addresses many integumentary system issues the patient experienced; skin injuries and infections that can pose serious life-threatening situations for the morbidly obese patient must be prevented or treated efficiently. Health professionals can learn a great deal and improve the care they provide by listening to morbidly obese patients. PMID:25581606

  18. Assessing ecological land use and water demand of river systems: a case study in Luanhe River, North China

    Directory of Open Access Journals (Sweden)

    D. H. Yan

    2012-08-01

    Full Text Available Economic and social development has greatly increased ecological water demand and modified land use of river systems worldwide, causing overall degradation of many of these systems. In this study, theoretical and technical frameworks for regionalization on the eco-environmental function of river systems are formulated and applied to the Luanhe River system. Based on its eco-environmental functions, this river can be regionalized into four types of first-class functional areas: ecological preservation areas, habitat restoration areas, ecological buffer areas and development and utilization areas. Considering the overall eco-environmental functions, we assessed the ecological land use of the Luanhe River system. The total area of basic ecological land use is 876.98 km2; the restrictive ecological land use is 1745.52 km2; ecological land use of the river system returned from farmland is 284.25 km2; and that returned from construction land is 17.35 km2. The average minimum ecological flow of mainstreams in upper and middle reaches of the Luanhe River is 4.896 m3 s−1 based on the habitat method. And the recommended minimum and suitable annual ecological water demand of channels in the lower reaches are 391 million m3 and 819.5 million m3, respectively. The evaporation and seepage consumption and vegetation consumption in riparian zones of the Luanhe River system are approximately 132.6 million m3 and 145.3 million m3 per year, respectively. Our results suggest that is crucial to regulate the instream ecological water use of the Luanhe River's mainstream starting from the Panjiakou-Daheiting Reservoir system. We recommend accelerating ecological land-use planning and strengthening the regulation of ecological water use on this river system focusing on important lower reaches under the condition of competitive water demand.

  19. Building integrated care systems: a case study of Bidasoa Integrated Health Organisation

    Directory of Open Access Journals (Sweden)

    Nuria Toro Polanco

    2015-06-01

    Full Text Available Introduction: This paper analyses the implementation of integrated care policies in the Basque Country through the deployment of an Integrated Health Organisation in Bidasoa area during the period 2011–2014. Structural, functional and clinical integration policies have been employed with the aim to deliver integrated and person-centred care for patients, especially for those living with chronic conditions. Methods: This organisational case study used multiple data sources and methods in a pragmatic and reflexive manner to build a picture of the organisational development over a 4-year period. In order to measure the progress of integration three concepts have been measured: (i readiness for chronicity measured with Assessment of Readiness for Chronicity in Healthcare Organisations tool; (ii collaboration between clinicians from different care levels measured with the D'Amour Questionnaire, and (iii overall impact of integration through several indicators based on the Triple Aim Framework. Results: The measurement of organisational readiness for chronicity showed improvements in five of the six areas under evaluation. Similarly the collaboration between professionals of different care levels showed a steady improvement in each of the 10 items. Furthermore, the Triple Aim-based indicators showed a better experience of care in terms of patients’ perceptions of care coordination; a reduction in hospital utilisation, particularly for patients with complex chronic conditions; and cost-containment in terms of per capita expenditure. Conclusion: There is a significant amount of data that shows that Bidasoa Integrated Health Organisation has progressed in terms of delivering integrated care for chronic conditions with a positive impact on several Triple Aim outcomes.

  20. Building integrated care systems: a case study of Bidasoa Integrated Health Organisation

    Directory of Open Access Journals (Sweden)

    Nuria Toro Polanco

    2015-06-01

    Full Text Available Introduction: This paper analyses the implementation of integrated care policies in the Basque Country through the deployment of an Integrated Health Organisation in Bidasoa area during the period 2011–2014. Structural, functional and clinical integration policies have been employed with the aim to deliver integrated and person-centred care for patients, especially for those living with chronic conditions.Methods: This organisational case study used multiple data sources and methods in a pragmatic and reflexive manner to build a picture of the organisational development over a 4-year period. In order to measure the progress of integration three concepts have been measured: (i readiness for chronicity measured with Assessment of Readiness for Chronicity in Healthcare Organisations tool; (ii collaboration between clinicians from different care levels measured with the D'Amour Questionnaire, and (iii overall impact of integration through several indicators based on the Triple Aim Framework.Results: The measurement of organisational readiness for chronicity showed improvements in five of the six areas under evaluation. Similarly the collaboration between professionals of different care levels showed a steady improvement in each of the 10 items. Furthermore, the Triple Aim-based indicators showed a better experience of care in terms of patients’ perceptions of care coordination; a reduction in hospital utilisation, particularly for patients with complex chronic conditions; and cost-containment in terms of per capita expenditure.Conclusion: There is a significant amount of data that shows that Bidasoa Integrated Health Organisation has progressed in terms of delivering integrated care for chronic conditions with a positive impact on several Triple Aim outcomes.

  1. Modernisation as a professionalising strategy: the case of critical care in England.

    Science.gov (United States)

    Green, Judith; Durand, Mary Alison; Hutchings, Andrew; Black, Nick

    2011-09-01

    There has been broad agreement about how to characterise the processes of 'modernisation' of the public sector in welfare societies, but rather less consensus on the impact of this modernisation on professionals. This paper takes critical care in England as a case study to explore how professionals in one setting account for the changes associated with modernisation. In contrast to reports from other arenas, critical care professionals were positive about the processes and outcomes of 'modernisation' in general, and there was a surprising lack of nostalgia in their accounts of organisational changes. However, joking comments suggested considerable scepticism about the initiatives explicitly associated with the national organisation that was charged with 'modernising' critical care, the Modernisation Agency. We suggest that the relative optimism of staff is in part explained by historical and political contingencies which meant that critical care, as a relatively new clinical specialty, benefited in tangible ways from modernisation. Further, all staff groups were able to attribute gains, rather than losses, in autonomy and authority to the modernisation of critical care. Their accounts suggest that modernisation can be a professionalising strategy, with responses to change being neither resistant nor compliant, but sceptically strategic. PMID:21314690

  2. Demand response in energy markets

    International Nuclear Information System (INIS)

    Improving the ability of energy demand to respond to wholesale prices during critical periods of the spot market can reduce the total costs of reliably meeting demand, and the level and volatility of the prices. This fact has lead to a growing interest in the short-run demand response. There has especially been a growing interest in the electricity market where peak-load periods with high spot prices and occasional local blackouts have recently been seen. Market concentration at the supply side can result in even higher peak-load prices. Demand response by shifting demand from peak to base-load periods can counteract the market power in the peak-load. However, demand response has so far been modest since the current short-term price elasticity seems to be small. This is also the case for related markets, for example, green certificates where the demand is determined as a percentage of the power demand, or for heat and natural gas markets. This raises a number of interesting research issues: 1) Demand response in different energy markets, 2) Estimation of price elasticity and flexibility, 3) Stimulation of demand response, 4) Regulation, policy and modelling aspects, 5) Demand response and market power at the supply side, 6) Energy security of supply, 7) Demand response in forward, spot, ancillary service, balance and capacity markets, 8) Demand response in deviated markets, e.g., emission, futures, and green certificate markets, 9) Value of increased demand response, 10) Flexible households. (BA)

  3. The Impact of Direct Provision Accommodation for Asylum Seekers on Organisation and Delivery of Local Primary Care and Social Care Services: A Case Study

    LENUS (Irish Health Repository)

    Pieper, Hans-Olaf

    2011-05-15

    Abstract Background Many western countries have policies of dispersal and direct provision accommodation (state-funded accommodation in an institutional centre) for asylum seekers. Most research focuses on its effect on the asylum seeking population. Little is known about the impact of direct provision accommodation on organisation and delivery of local primary care and social care services in the community. The aim of this research is to explore this issue. Methods In 2005 a direct provision accommodation centre was opened in a rural area in Ireland. A retrospective qualitative case study was designed comprising in-depth interviews with 37 relevant stakeholders. Thematic analysis following the principles of framework analysis was applied. Results There was lack of advance notification to primary care and social care professionals and the community about the new accommodation centre. This caused anxiety and stress among relevant stakeholders. There was insufficient time to plan and prepare appropriate primary care and social care for the residents, causing a significant strain on service delivery. There was lack of clarity about how primary care and social care needs of the incoming residents were to be addressed. Interdisciplinary support systems developed informally between healthcare professionals. This ensured that residents of the accommodation centre were appropriately cared for. Conclusions Direct provision accommodation impacts on the organisation and delivery of local primary care and social care services. There needs to be sufficient advance notification and inter-agency, inter-professional dialogue to manage this. Primary care and social care professionals working with asylum seekers should have access to training to enhance their skills for working in cross-cultural consultations.

  4. Spatial heterogeneity in utilities, equity and collective efficiency: the case of rural electrification and demand side management

    International Nuclear Information System (INIS)

    This thesis has for object the evolution of the economic optimum in the electric industry under spatial equity constraint that present a strong spatial heterogeneity of its supply conditions. One analyses the evolution of the rural electrification regime in France both in terms of economic and social efficiency. We examine the rationality of extending the sectoral optimization under equity constraint to the rationalization of electricity end-uses in the heterogeneous space of rural electricity supply. To this question are given two responses. The firsts pertains to modify the incentives in the institutional regime of rural electrification so the MDE may be integrated in the strategies of rural electrification syndicates. One inspire from incentives mechanisms of the anglo-saxon DSM practice. The second is statistical zoning method of demand and distribution grid whose object is to localize action basins for large scale MDE projects. (author)

  5. A case of intensive care unit-acquired weakness after emergency surgery for acute abdomen

    OpenAIRE

    Tominaga, Tetsuro; Nonaka, Takashi; Takeshita, Hiroaki; Honda, Yuichiro; Nagura, Hiroki; Shiraishi, Toshio; Kunizaki, Masaki; Sumida, Yorihisa; Hidaka, Shigekazu; Sawai,Terumitsu; Nagayasu, Takeshi

    2016-01-01

    Introduction Surgeons often perform surgery for patients who are critically ill. Intensive care unit (ICU)-acquired weakness (ICUAW) is a condition in which systemic and prolonged muscle weakness occurs and causes worse short-term and long-term outcomes. Presentation of case A 60-year-old woman with sudden nausea and vomiting presented to our hospital and developed shock. Abdominal CT showed thickness of the descending colon and ascites. She was diagnosed with sepsis due to descending colon c...

  6. A case of intensive care unit-acquired weakness after emergency surgery for acute abdomen

    OpenAIRE

    Tetsuro Tominaga; Takashi Nonaka; Hiroaki Takeshita; Yuichiro Honda; Hiroki Nagura; Toshio Shiraishi; Masaki Kunizaki; Yorihisa Sumida; Shigekazu Hidaka; Terumitsu Sawai; Takeshi Nagayasu

    2016-01-01

    Introduction: Surgeons often perform surgery for patients who are critically ill. Intensive care unit (ICU)-acquired weakness (ICUAW) is a condition in which systemic and prolonged muscle weakness occurs and causes worse short-term and long-term outcomes. Presentation of case: A 60-year-old woman with sudden nausea and vomiting presented to our hospital and developed shock. Abdominal CT showed thickness of the descending colon and ascites. She was diagnosed with sepsis due to descending co...

  7. Body condition and physical care scales in three cases of dog hoarding from Belgrade

    Directory of Open Access Journals (Sweden)

    Vučinić Marijana

    2007-01-01

    Full Text Available In the spring of 2006 Belgrade city officials were planning to take steps to reduce the city’s stray dog population. The plan was to sterilize (spay or neuter, microchip and vaccinate about 5000 dogs during the next two years. The plan was set to kick into action at the start of September in 2006, with a monthly goal of spaying or neutering at least 255 dogs. Taking the program one step further, approximately 15000 dog owners will be given free microchips for their dogs, among them owners of private dogs' shelters, too. A professional team of four members was formed with the aim to visit all private shelters for dogs in Belgrade. The team found three cases of dog hoarding. In all of them, hoarders claimed to possess a "no-kill" shelter for dogs. These hoarders were likely to exhibit characteristics between overwhelmed caregivers and rescuer hoarders. These cases of hoarding are described in this paper from the dog abuse aspect. The two parts of Tufts Animal Care and Condition (TACC scales were used for this purpose (body condition and physical care scales. Body condition and physical care were evaluated in 429 dogs (220 dogs in the first, 157 dogs in the second and 52 dogs in the third hoarder. There were significant differences (P<0.0001 only for body condition of dogs in three cases of hoarders. Inadequate diet was the main reason for this state. Physical care of dogs ranged from borderline to terrible without significant differences between three cases of animal hoarding.

  8. Notation of Depression in Case Records of Older Adults in Community Long-Term Care

    OpenAIRE

    Proctor, Enola K

    2008-01-01

    Although significant numbers of social service clients experience mental health problems, virtually no research has examined the responsiveness of social service agencies to mental disorder. This article examines the extent to which client depression is reflected in records of a public social service agency, community long-term care (CLTC). Researchers assessed new, consenting CLTC clients for depression using standardized research criteria in a telephone interview. Agency case records were a...

  9. Invasive Pulmonary Aspergillosis in the Intensive Care Unit: A Case Report

    OpenAIRE

    Mehmet Akif Yazar; Aytuna Kuzucuoğlu,; Mehmet Barış Açıkgöz

    2016-01-01

    SUMMARY Invasive pulmonary aspergillosis (IPA) is an infection rarely seen in intensive care units (ICU). We aimed to discuss the case of IPA found in a patient followed up in our ICU due to chronic obstructive pulmonary disease (COPD). A 58-year old patient diagnosed with COPD has been admitted to our ICU due to respiratory failure. There were not any other diseases except from COPD. In his radiological imaging there were diffuse bilateral infiltrates in the ...

  10. Connection, Regulation, and Care Plan Innovation: A Case Study of Four Nursing Homes

    OpenAIRE

    Colón-Emeric, Cathleen S.; Lekan-Rutledge, Deborah; Utley-Smith, Queen; Ammarell, Natalie; Bailey, Donald; Piven, Mary L.; Corazzini, Kirsten; Anderson, Ruth A.

    2006-01-01

    We describe how connections among nursing home staff impact the care planning process using a complexity science framework. We completed six-month case studies of four nursing homes. Field observations (n = 274), shadowing encounters (n = 69), and in-depth interviews (n = 122) of 390 staff at all levels were conducted. Qualitative analysis produced a conceptual/thematic description and complexity science concepts were used to produce conceptual insights. We observed that greater levels of sta...

  11. Servant leadership: a case study of a Canadian health care innovator

    OpenAIRE

    Vanderpyl TH

    2012-01-01

    Tim H VanderpylSchool of Global Leadership, Regent University, Virginia Beach, VA, USAAbstract: Both servant leadership and innovation are easier to theorize than to actually implement in practice. This article presents a case study of a Canadian health care executive who led a remarkable turnaround of St Michael's Health Centre, a floundering and almost bankrupt nursing home. In less than 7 years, Kevin Cowan turned around the finances and changed numerous broken relationships into s...

  12. The Effect Of Customer Demand And Supplier Performance In Competitive Strategy And Business Performance Case Of Fixed Broadband In Indonesia

    Directory of Open Access Journals (Sweden)

    Rina D. Pasaribu

    2015-08-01

    Full Text Available Broadband telecommunication is significantly important to support and improve countrys competitiveness level. However Indonesia performance especially in Fixed Broadband is poor as the penetration rate is very low and far behind from other ASEAN countries. The industry is served by multi operators with one dominant operator. This dominant operator will be studied representing the industry in this study. A qualitative study Pasaribu et al. 2015 related to this paper has found that poor fulfillment of Customer Demand and poor Supplier Performance are two dominant external factors that cause the low performance. A model is proposed to frame the work it consists of four variables Customer Demand Supplier Performance Competitive Strategy and Business Performance. This study aims is use that Pasaribu et al. model directly to business units level to identify and analyze the relationships within the model and significance level of each relationship accordingly. By understanding the priority levels the improvement program could be more effectively planned and implemented. This study is expected to contribute on Fixed Broadband research wich is still very rare especially in Indonesia The research methodology is quantitative methods using survey technique. The respondents are management and customers of the dominant operator business units. Clustering by province regions gave 32 samples from the population of 58 business units. Partial Least Square modelling was used to analise the datas. The main result of this study is that the most significant relationship in the model is Supplier Performance to Competitive Strategy. Furthermore from indicators of Supplier Performance it was found that Quality Relationship has a very high effect among other indicators. By prioritizing these significant constructs it could be expected the related improvement program could be more effective.

  13. Scenario Analyses of Road Transport Energy Demand: A Case Study of Ethanol as a Diesel Substitute in Thailand

    Directory of Open Access Journals (Sweden)

    Atsushi Fukuda

    2011-01-01

    Full Text Available Ethanol is conventionally used as a blend with gasoline due to its similar properties, especially the octane number. However, ethanol has also been explored and used as a diesel substitute. While a low-blend of ethanol with diesel is possible with use of an emulsifier additive, a high-blend of ethanol with diesel may require major adjustment of compression-ignition (CI diesel engines. Since dedicated CI engines are commercially available for a high-blend ethanol in diesel (ED95, a fuel mixture comprised of 95% ethanol and 5% additive, this technology offers an option for an oil-importing country like Thailand to reduce its fossil import by use of its own indigenous bio-ethanol fuel. Among many strong campaigns on ethanol utilization in the transportation sector under Thailand’s Alternative Energy Strategic Plan (2008–2022, the Thai Ministry of Energy has, for the first time, conducted a demonstration project with ethanol (ED95 buses on the Thai road system. The current investigation thus aims to assess and quantify the impact of using this ED95 technology to reduce fossil diesel consumption by adjusting the commercially available energy demand model called the Long range Energy Alternatives Planning system (LEAP. For this purpose, first, the necessary statistical data in the Thai transportation sector were gathered and analyzed to construct the predicative energy demand model. Then, scenario analyses were conducted to assess the benefit of ED95 technology on the basis of energy efficiency and greenhouse gas emission reduction.

  14. Prudent care of head trauma in the elderly: a case report

    OpenAIRE

    Ross, Allen GP

    2014-01-01

    Introduction Severe traumatic brain injury is a major public health problem that accounts for one-third of all deaths due to trauma in the United States. This case report illustrates some of the challenges faced by the elderly in accessing essential emergency services for traumatic brain injury. Case presentation A 74-year-old Caucasian man presented with head trauma at his local acute care hospital (level III/IV) in Canada at 2:30 PM. He was triaged at 4:00 PM and was seen by the emergency r...

  15. Case and Relation (CARE based Page Rank Algorithm for Semantic Web Search Engines

    Directory of Open Access Journals (Sweden)

    N. Preethi

    2012-05-01

    Full Text Available Web information retrieval deals with a technique of finding relevant web pages for any given query from a collection of documents. Search engines have become the most helpful tool for obtaining useful information from the Internet. The next-generation Web architecture, represented by the Semantic Web, provides the layered architecture possibly allowing data to be reused across application. The proposed architecture use a hybrid methodology named Case and Relation (CARE based Page Rank algorithm which uses past problem solving experience maintained in the case base to form a best matching relations and then use them for generating graphs and spanning forests to assign a relevant score to the pages.

  16. Sustaining food self-sufficiency of a nation: The case of Sri Lankan rice production and related water and fertilizer demands.

    Science.gov (United States)

    Davis, Kyle Frankel; Gephart, Jessica A; Gunda, Thushara

    2016-04-01

    Rising human demand and climatic variability have created greater uncertainty regarding global food trade and its effects on the food security of nations. To reduce reliance on imported food, many countries have focused on increasing their domestic food production in recent years. With clear goals for the complete self-sufficiency of rice production, Sri Lanka provides an ideal case study for examining the projected growth in domestic rice supply, how this compares to future national demand, and what the associated impacts from water and fertilizer demands may be. Using national rice statistics and estimates of intensification, this study finds that improvements in rice production can feed 25.3 million Sri Lankans (compared to a projected population of 23.8 million people) by 2050. However, to achieve this growth, consumptive water use and nitrogen fertilizer application may need to increase by as much as 69 and 23 %, respectively. This assessment demonstrates that targets for maintaining self-sufficiency should better incorporate avenues for improving resource use efficiency. PMID:26474766

  17. Climate-related electricity demand-side management in oil-exporting countries--the case of the United Arab Emirates

    International Nuclear Information System (INIS)

    The oil crisis of the 1970s has increased the concern about the continuity of oil imports flow to major oil-importing developed countries. Numerous policy measures including electricity demand-side management (DSM) programs have been adopted in such countries. These measures aim at reducing the growing need for electricity power that increases the dependency on imported foreign oil and damages the environment. On the other hand, the perception that energy can be obtained at very low cost in oil-rich countries led to less attention being paid to the potential of DSM policies in these countries. This paper discusses such potential using the case of the United Arab Emirates (UAE). Since air conditioning is a major source of electric energy consumption, the relationship between climate conditions and electric energy consumption is considered. An electricity demand model is constructed using time series techniques. The fitted model seems to represent these relationships rather well. Forecasts for electricity consumption using the estimated model indicate that a small reduction in cooling degrees requirement might induce a significant reduction in electric energy demand. Hence, a DSM program is proposed with policy actions to include, among others, measures to reduce cooling degrees requirement

  18. [Dental care in cross-cultural networks-- case management--approaches in group prevention].

    Science.gov (United States)

    Robke, F J

    2000-01-01

    Oral epidemiology studies of previous years have shown an increasing difference in caries cases in respect of different social strata. Thus, frequency of caries cases is related to social status. High rates of caries prevalence are found especially among children from typical areas of welfare problems. Already, today every fifth child is born into a family of immigrants. In areas of typical social deprivation their share is about 40% and more. Since the previous educational campaigns for social fringe groups have hardly shown any positive effect on dental health, new strategies are necessary. In a community of Hanover with low socio-economic status and a generally high caries level, the treatment strategies of dental care for the young have centred on the case-management approaches of social welfare programmes since the early 90s. Beside the expanded basic preventive programme, which includes application of a fluoride varnish for children, social compensatory measures with intercultural networks are also being taken. This concept shows very clearly that the dental health of children living in areas of social disorganisation can be effectively improved by means of these strategies. For the future, dental care for these children requires more intercultural competence and more knowledge of social welfare work by adolescent dental care providers. PMID:11037670

  19. Prevalence of multidrug resistance among retreatment pulmonary tuberculosis cases in a tertiary care hospital, Hyderabad, India

    Directory of Open Access Journals (Sweden)

    Subhakar Kandi

    2013-01-01

    Full Text Available Background: India is one of the high tuberculosis (TB burden countries in the world. India ranks second in harboring multi drug resistant (MDR-TB cases. About 50,000 of MDR cases are recorded in retreatment pulmonary TB cases. This study was conducted in a tertiary care facility (Government General and Chest Hospital in Hyderabad, India. Objectives: Toassess: Proportion of the TB patients having MDR-TB at the initiation of retreatment regimen; the prevalence of isoniazid (INH resistance in this geographical area. Materials and Methods: An analytical, observational, prospective cohort study of patients attending the out-patient department from December 2010 to March 2011. Results: Sputum samples from 100 patients were subjected to acid fast bacilli (AFB culture and drug sensitivity testing. Of these, 28 (28% were MDR-TB, 42 (42% were non-MDR-TB and 39% being INH resistance. Conclusions: In conclusion, one third of the retreatment pulmonary TB cases attending a tertiary care institute for TB will be MDR-TB at the initiation of treatment and there is a need to include ethambutol in the continuation phase of new TB case treatment in view of high INH resistance.

  20. Case management lessons from a public/private partnership to finance long-term care.

    Science.gov (United States)

    Mahoney, K

    1992-01-01

    In June of 1987, Connecticut's State Task Force on Private and Public Responsibilities for Financing Long-Term Care for the Elderly released its final report. This Governor's Commission, concluding that neither the private nor the public sector had much short-term hope of solving this difficult problem alone, recommended the creation of a public/private partnership. As this partnership was forged, some unique insights were gained into the functions of case management. This case study shows how case management can help coordinate the private and public roles, but it also raises some research questions which must be tackled before case management can fulfill its promise to help stretch and conserve scarce resources. PMID:1467793

  1. Implementation of integrated care for diabetes mellitus type 2 by two Dutch care groups : A case study

    NARCIS (Netherlands)

    Busetto, Loraine; Luijkx, Katrien; Huizing, Anna; Vrijhoef, H.J.M.

    2015-01-01

    Background Even though previous research has demonstrated improved outcomes of integrated care initiatives, it is not clear why and when integrated care works. This study aims to contribute to filling this knowledge gap by examining the implementation of integrated care for type 2 diabetes by two Du

  2. Appraisal of cooperation with a palliative care case manager by general practitioners and community nurses: a cross-sectional questionnaire study.

    OpenAIRE

    Plas, A.G.M. van der; Onwuteaka-Philipsen, B.D.; Vissers, K.C.; Deliens, L.; Jansen, W.J.J.; Francke, A.L.

    2016-01-01

    Aims: To investigate how general practitioners and community nurses value the support that they receive from a nurse case manager with expertise in palliative care, whether they think the case manager is helpful in realizing appropriate care and what characteristics of the patient and case management are associated with this view. Background: For sustainable palliative care in an ageing society, basic palliative care is provided by generalists and specialist palliative care is reserved for co...

  3. Case study of supply induced demand: the case of provision of imaging scans (computed tomography and magnetic resonance) at Unimed-Manaus

    International Nuclear Information System (INIS)

    Objective: to present the experience of a health plan operator (Unimed-Manaus) in Manaus, Amazonas, Brazil, with the accreditation of imaging services and the demand induced by the supply of new services (Roemer's Law). Methods: this is a retrospective work studying a time series covering the period from January 1998 to June 2004, in which the computed tomography and the magnetic resonance imaging services were implemented as part of the services offered by that health plan operator. Statistical analysis consisted of a descriptive and an inferential part, with the latter using a mean parametric test (Student T-test and ANOVA) and the Pearson correlation test. A 5% alpha and a 95% confidence interval were adopted. Results: at Unimed-Manaus, the supply of new imaging services, by itself, was identified as capable of generating an increased service demand, thus characterizing the phenomenon described by Roemer. Conclusion: the results underscore the need to be aware of the fact that the supply of new health services could bring about their increased use without a real demand. (author)

  4. Case study of supply induced demand: the case of provision of imaging scans (computed tomography and magnetic resonance) at Unimed-Manaus

    Energy Technology Data Exchange (ETDEWEB)

    Andrade, Edson de Oliveira; Andrade, Elizabeth Nogueira de, E-mail: dredsonandrade@gmail.co [Universidade Federal do Amazonas (UFAM), Manaus, AM (Brazil); Gallo, Jose Hiran [Universidade do Porto (U.Porto) (Portugal)

    2011-03-15

    Objective: to present the experience of a health plan operator (Unimed-Manaus) in Manaus, Amazonas, Brazil, with the accreditation of imaging services and the demand induced by the supply of new services (Roemer's Law). Methods: this is a retrospective work studying a time series covering the period from January 1998 to June 2004, in which the computed tomography and the magnetic resonance imaging services were implemented as part of the services offered by that health plan operator. Statistical analysis consisted of a descriptive and an inferential part, with the latter using a mean parametric test (Student T-test and ANOVA) and the Pearson correlation test. A 5% alpha and a 95% confidence interval were adopted. Results: at Unimed-Manaus, the supply of new imaging services, by itself, was identified as capable of generating an increased service demand, thus characterizing the phenomenon described by Roemer. Conclusion: the results underscore the need to be aware of the fact that the supply of new health services could bring about their increased use without a real demand. (author)

  5. Complex Care Management to Decrease Emergency Department Utilization: A Case Study of the Homeless Patient Aligned Care Team Demonstration Project at VA Greater Los Angeles Healthcare System

    OpenAIRE

    Patel, Beena Ishwar

    2013-01-01

    This quality improvement (QI) dissertation is a case study of the homeless-oriented Patient Centered Medical Home demonstration program, referred to as the Homeless Patient Aligned Care Team (HPACT) at West Los Angeles VA Medical Center (WLA). The WLA HPACT program was implemented to address the complex needs of the homeless and at-risk for homelessness population using the Patient Centered Medical Home model (PCMH) - a multi-disciplinary, team-based approach to primary care. Unlike tradition...

  6. On the Inclusion of Energy-Shifting Demand Response in Production Cost Models: Methodology and a Case Study

    Energy Technology Data Exchange (ETDEWEB)

    O' Connell, Niamh [Technical Univ. of Denmark, Lyngby (Denmark); Hale, Elaine [National Renewable Energy Lab. (NREL), Golden, CO (United States); Doebber, Ian [National Renewable Energy Lab. (NREL), Golden, CO (United States); Jorgenson, Jennie [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2015-07-20

    In the context of future power system requirements for additional flexibility, demand response (DR) is an attractive potential resource. Its proponents widely laud its prospective benefits, which include enabling higher penetrations of variable renewable generation at lower cost than alternative storage technologies, and improving economic efficiency. In practice, DR from the commercial and residential sectors is largely an emerging, not a mature, resource, and its actual costs and benefits need to be studied to determine promising combinations of physical DR resource, enabling controls and communications, power system characteristics, regulatory environments, market structures, and business models. The work described in this report focuses on the enablement of such analysis from the production cost modeling perspective. In particular, we contribute a bottom-up methodology for modeling load-shifting DR in production cost models. The resulting model is sufficiently detailed to reflect the physical characteristics and constraints of the underlying flexible load, and includes the possibility of capturing diurnal and seasonal variations in the resource. Nonetheless, the model is of low complexity and thus suitable for inclusion in conventional unit commitment and market clearing algorithms. The ability to simulate DR as an operational resource on a power system over a year facilitates an assessment of its time-varying value to the power system.

  7. A rare case of sigmoid volvulus complicating pregnancy in a Tertiary care centre: a case report

    OpenAIRE

    Rajarajeswari Ramalingam; Soundarajan Pradiba; Antony Michael

    2016-01-01

    Intestinal obstruction complicating pregnancy is an extremely rare complication during pregnancy. Volvulus of the sigmoid colon is the most common cause of intestinal obstruction complicating pregnancy accounting for upto 44% of the aetiology. We report a case of sigmoid volvulus complicating pregnancy in a woman with 34 weeks amenorrhoea which was diagnosed early in spite of its late presentation and successfully managed with resection and primary anastamosis. Sigmoid volvulus complicating p...

  8. In demand

    Energy Technology Data Exchange (ETDEWEB)

    Coleman, B. [Bridgestone Ltd. (United Kingdom)

    2005-11-01

    The paper explains how good relationships can help alleviate potential tyre shortages. Demand for large dump truck tyres (largely for China) has increased by 50% within 12 months. Bridgestone's manufacturing plants are operating at maximum capacity. The company supplies tyres to all vehicles at Scottish Coal's opencast coal mines. Its Tyre Management System (TMS) supplied free of charge to customers helps maximise tyre life and minimise downtime from data on pressure, tread and general conditions fed into the hand-held TMS computer. 3 photos.

  9. 海南省长期照护保险需求分析与制度构想%Analysis on the Demands of Long-term Care and the Construction of Insurance System in ;Hainan

    Institute of Scientific and Technical Information of China (English)

    雷丽华

    2015-01-01

    With the growing problems of population aging in Hainan, the long-term care for the disabled older people has been shifted from family responsibilities to social problems. In this paper, the author analyzes the demands of long-term care in Hainan, calculates the expenditures of long-term care, and puts forward suggestions to build a long-term care insurance system on the aspects of financing channels of insurance funds and standardized care assessment system.%随着海南省老龄化的日趋严重,老年失能人员的长期照护问题已从家庭责任转变为社会问题。本文分析了海南老年长期照护服务的需求,测算了长期照护的费用,从保险资金的筹资渠道、规范化的护理评估体系等方面提出了建立长期照护保险制度的建议。

  10. Strategies used by case managers supporting frail, community-dwelling older persons, to engage primary care physicians in interprofessional collaboration

    OpenAIRE

    Van Durme, Thérèse; Cès, Sophie; Karam, Marlène; Macq, Jean; RCN 2014 Annual International Nursing Research Conference

    2014-01-01

    Background and aim Although it is known that case management for frail older persons (FOP) is more likely to foster positive outcomes when the case manager works closely with the primary care physicians (PCP) [1], engaging PCPs to collaborate is often a difficult process, especially when the case management function is new [2]. The aim of this study was to provide insight on how newly implemented case management projects managed to engage FOPs’ PCP in the case management process, (to what ext...

  11. Scrub Typhus in Adults – A Case Series from a Tertiary Care Hospital

    Directory of Open Access Journals (Sweden)

    Sudhakar M K

    2011-04-01

    Full Text Available Introduction: Scrub typhus is a zoonosis caused by the rickettsial bacteria Orientia tsutsugamushi. The disease in endemic in many parts of India and continues to be a public health problem. Materials and Methods: This study describes the clinical profile of eight consecutive scrub typhus positive cases admitted in a tertiary care hospital. After complete physical examination, complete blood count, liver function tests, renal function tests, urine analysis, blood & urine cultures were done in all cases. In all the cases, scrub typhus was diagnosed using a rapid single step immunochromatographic assay. Results: Of eight cases five were females and three were males. Fever was the chief present symptom in all the cases. Other signs and symptoms were headache, myalgia, cough, hepatosplenomegaly, abdominal pain and lymphadenopathy. Eschar was present in all the cases. Liver enzymes were elevated in all the patients. Hypotension, thrombocytopenia, hepatic dysfunction, hypoalbuminemia, hematuria and proteinuria were the complications observed. All cases were successfully treated with doxycycline and there was no mortality. Conclusion: Our report emphasizes the fact that a diagnosis of scrub typhus should be suspected when a patient presents with fever and laboratory evidence of liver dysfunction, as early detection of the disease could reduce morbidity and mortality.

  12. Care for Amish and Mennonite children with cystic fibrosis: a case series

    Directory of Open Access Journals (Sweden)

    Anbar Ran D

    2009-01-01

    Full Text Available Abstract Background Published articles have described a lack of willingness to allow preventative measures, as well as other types of modern therapies, as an obstacle to providing medical care for Amish and Mennonite populations. Methods We present data regarding the 12 Amish and Mennonite patients at the SUNY Upstate Medical University Pediatric Cystic Fibrosis Center and three representative case reports. Results Families of patients from these communities receiving care at our Center have accepted preventive therapy, acute medical interventions including home intravenous antibiotic administration, and some immunizations for their children with cystic fibrosis, which have improved the health of our patients. Some have even participated in clinical research trials. Health care education for both the child and family is warranted and extensive. Significant Cystic Fibrosis Center personnel time and fundraising are needed in order to address medical bills incurred by uninsured Amish and Mennonite patients. Conclusion Amish and Mennonite families seeking care for cystic fibrosis may choose to utilize modern medical therapies for their children, with resultant significant improvement in outcome.

  13. Servant leadership: a case study of a Canadian health care innovator

    Directory of Open Access Journals (Sweden)

    Vanderpyl TH

    2012-02-01

    Full Text Available Tim H VanderpylSchool of Global Leadership, Regent University, Virginia Beach, VA, USAAbstract: Both servant leadership and innovation are easier to theorize than to actually implement in practice. This article presents a case study of a Canadian health care executive who led a remarkable turnaround of St Michael's Health Centre, a floundering and almost bankrupt nursing home. In less than 7 years, Kevin Cowan turned around the finances and changed numerous broken relationships into strategic alliances. Under his leadership, St Michael's Health Centre went from being one of the most underperforming health care organizations in Canada, to one of the most innovative. This article describes some of Cowan's strategies and argues that a servant leadership approach has a direct impact on an organization's ability to innovate. As far as the author is aware, this is the first published article on this specific change effort, which presents a unique perspective on the topics of servant leadership and innovation.Keywords: servant leadership, innovation, Canada, health care, case study

  14. A simulation model approach to analysis of the business case for eliminating health care disparities

    Directory of Open Access Journals (Sweden)

    Tunceli Kaan

    2011-03-01

    Full Text Available Abstract Background Purchasers can play an important role in eliminating racial and ethnic disparities in health care. A need exists to develop a compelling "business case" from the employer perspective to put, and keep, the issue of racial/ethnic disparities in health care on the quality improvement agenda for health plans and providers. Methods To illustrate a method for calculating an employer business case for disparity reduction and to compare the business case in two clinical areas, we conducted analyses of the direct (medical care costs paid by employers and indirect (absenteeism, productivity effects of eliminating known racial/ethnic disparities in mammography screening and appropriate medication use for patients with asthma. We used Markov simulation models to estimate the consequences, for defined populations of African-American employees or health plan members, of a 10% increase in HEDIS mammography rates or a 10% increase in appropriate medication use among either adults or children/adolescents with asthma. Results The savings per employed African-American woman aged 50-65 associated with a 10% increase in HEDIS mammography rate, from direct medical expenses and indirect costs (absenteeism, productivity combined, was $50. The findings for asthma were more favorable from an employer point of view at approximately $1,660 per person if raising medication adherence rates in African-American employees or dependents by 10%. Conclusions For the employer business case, both clinical scenarios modeled showed positive results. There is a greater potential financial gain related to eliminating a disparity in asthma medications than there is for eliminating a disparity in mammography rates.

  15. Public procurement as a demand-side innovation policy tool in China - a national level case study

    OpenAIRE

    Yanchao Li

    2011-01-01

    The Chinese government announced explicitly in the National S&T Program (2006-2020) to utilize public procurement to spur 'endogenous innovation', following which many actions have been taken by related government agencies. This paper aims to answer two questions through a qualitative case study at the national level: How has IOPP become an innovation policy tool in China under the circumstances and development trends of its national innovation system? What is China's current national IOPP me...

  16. Assessing CSR and Applying Social Life Cycle Assessment: A case study on Biochemical Oxygen Demand Online Monitor

    OpenAIRE

    Wan, He

    2012-01-01

    Wuhan China and Borlänge Sweden collaborate to promote sustainable business growths. This thesis, being part of sustainable business project, aims to understand how business can contribute to sustainable development and explore mechanisms of social life cycle assessment. In an effort to answer research questions and further to achieve the general purpose, a BOD online monitor case study is described and analyzed by applying both qualitative and quantitative approaches. Data collection is base...

  17. Medical acupuncture enhances standard wilderness medical care: a case study from the Inca Trail, Machu Picchu, Peru, April 2, 1997.

    Science.gov (United States)

    Frank, B L

    1997-08-01

    This case report shows the integration of medical acupuncture into the standard medical care of a wilderness emergency situation. Despite conventional medical attention, a trekker suffering from an extremely painful conjunctivitis continued to suffer severe eye pain. The addition of medical acupuncture to his care resolved his eye pain promptly, enabling him to continue his trekking activities without further distress. Acupuncture has many potential applications to enhance the effects of standard medical care in wilderness and third world travel settings. PMID:11990157

  18. Demand-side management energy saving potential in commercial and governmental/institutional sectors and its impact on power planning : a case study of central grid of Oman

    Energy Technology Data Exchange (ETDEWEB)

    Malik, A.S.; Al-Khrousi, A.R.; Al-Hindi, M.; Al-Mahrouqi, Y. [Sultan Qaboos Univ., Al-Khod (Oman). College of Engineering

    2006-07-01

    The results of Demand-Side Management (DSM) energy saving potential in commercial, government and institutional sectors of Oman were presented along with an evaluation of its impact on generation capacity and energy savings. DSM was defined as electricity demand management by methods such as peak clipping, valley filling, load shifting, and strategic conservation. Peak clipping reduces electricity demand during on-peak periods of the day, thus lowering the peak demand that utilities must meet. In contrast, valley filling increases the electrical load during off-peak periods. Load shifting refers to the movement of loads from peak periods to off-peak periods without any shift in energy use. Strategic load growth aims to increase the load in the future, while strategic conservation aims to decrease the load in the future without any shift in demand to another time. The purpose of DSM is to influence the amount or timing of customers' energy use. It has a positive environmental outlook and provides the best solution between load growth and increasing constraints on new and existing generation, transmission and distribution capacity. Resource options for DSM include energy efficiency options, such as energy efficient appliances, lighting, high efficiency heating, ventilating and air conditioning. Other options include load management and tariffs such as time-of-use incentives. The goal of electricity planning is to meet the load forecast with high reliability at a minimum cost. DSM economic energy savings potential is worked out from both the customer point of view and the electric utility's point of view. The study showed that the use of DSM in commercial and government sectors is economically justified from the customer point of view. DSM programs in the government and commercial sectors reduced the energy consumption to 21 and 38 per cent respectively. The discounted payback period of investment in efficient lighting and air-conditioning was between 4

  19. Using information technology for an improved pharmaceutical care delivery in developing countries. Study case: Benin.

    Science.gov (United States)

    Edoh, Thierry Oscar; Teege, Gunnar

    2011-10-01

    One of the problems in health care in developing countries is the bad accessibility of medicine in pharmacies for patients. Since this is mainly due to a lack of organization and information, it should be possible to improve the situation by introducing information and communication technology. However, for several reasons, standard solutions are not applicable here. In this paper, we describe a case study in Benin, a West African developing country. We identify the problem and the existing obstacles for applying standard ECommerce solutions. We develop an adapted system approach and describe a practical test which has shown that the approach has the potential of actually improving the pharmaceutical care delivery. Finally, we consider the security aspects of the system and propose an organizational solution for some specific security problems. PMID:21519942

  20. Inappropriate antibiotic prescribing and demand for antibiotics in patients with upper respiratory tract infections is hardly different in female versus male patients as seen in primary care

    DEFF Research Database (Denmark)

    Bagger, Kathrine; Nielsen, Anni Brit Sternhagen; Siersma, Volkert;

    2015-01-01

    Background: Unnecessary prescribing of antibiotics is a major public health concern. General practitioners (GPs) prescribe most antibiotics, often for upper respiratory tract infections (URTIs), and have in general been shown to prescribe antibiotics more often to women. No studies have examined...... unnecessary antibiotics demonstrated a demand for antibiotics, but no gender difference was found in this group. Conclusion: This study indicated a high rate of unnecessary antibiotic prescribing for URTIs in general practice, but overall found no gender differences in receiving unnecessary antibiotic...

  1. PROFILE OF POISONING CASES IN A TERTIARY CARE HOSPITAL , TELANGANA , INDIA

    Directory of Open Access Journals (Sweden)

    Naresh

    2015-05-01

    Full Text Available BACKGROUND : Poisoning with various substances is an important cause of death and disability worldwide . The types of poisons that are encountered in the emergency medicine departments encompass a wide range of substances . Apparently , geographic location , socio - demographic factors , ease of availability of poisons and many other cryptic factors contribute to the wide spectrum of substances that cause poisoning . Pesticides , drugs and chemicals are reported to be the most commo nly used poisons in India . Management of poisoning is quite challenging for the health care professionals globally . Factors such as the uncertainty in the identification of allegedly consumed poison , varied clinical features and the need for timely access to specific information for treatment , complicates poisoning management . This study was therefore conducted to explore the clinical features , management and outcomes of poisoning cases reporting to a tertiary care centre in south India . OBJECTIVE : To ident ify the spectrum of poisons and evaluate their clinical manifestations , medical management and clinical outcomes . METHODOLOGY : All cases of poisoning that were reported at a tertiary care hospital in South India for a period of 18 months from January 1 , 20 13 to June 30 , 2014 were included in this study . A data abstraction sheet was designed to document demographic details ( age and gender , poison consumed , duration of stay in the hospital , clinical features , treatment administered , need for life support and patient outcomes . RESULTS : A total of 145 poisoning cases were reported during the study period . Among them , 58 . 5% were males and 41 . 3% were females . Majority of victims were in the age group of 21 - 30 years . Intentional poisoning was observed in 86 . 2% , whereas the rest were accidental poisonings . Organophosphorus ( OP poisoning was the most common poisoning encountered in this study . It accounted for 25 . 5% of the total

  2. Treatment of 31 Cases of Infant Respiratory Tract Infection by Health-care Tuina plus Medicated Bath

    Institute of Scientific and Technical Information of China (English)

    LI Jie; WU Xue-fei

    2003-01-01

    Thirty-one cases of infant respiratory tract infection were treated by no-pain health-care Tuina plus medicated bath. Since the therapeutic effects were satisfactory, so parents and infants are willing to accept.

  3. Pattern of seizure cases in tertiary care hospitals in Karnataka state of India

    Directory of Open Access Journals (Sweden)

    Nitin Joseph

    2013-01-01

    Full Text Available Background: The prevalence and incidence of epilepsy is higher in developing countries than in developed countries. Understanding pattern and risk factors of seizure cases will help in suggesting appropriate preventive measures. Objectives: This study was carried out to assess the pattern of seizure, its management and compliance with treatment. Materials and Methods: Data from medical records of seizure cases in three tertiary care hospitals of Mangalore city in south India admitted from January 2006 to December 2011 were collected and analyzed. Results: Nearly half (44.4% of the 196 cases belonged to productive age group (15-45 years and 2/3 rd (60.7% were males. Majority (>80% cases were unskilled workers and of low socio-economic status groups. Family history of seizures was present in 8.4% cases. Mean age of onset of seizure was found to be 19.9 years. Proportion of generalized tonic clonic seizure cases was 78.1%. Secondary seizures were seen in 66 (33.7% cases with the most common cause being trauma to the head (24.2%. Refractory seizures were present in 2.7% cases. Monotherapy was the most commonly followed treatment regimen and phenytoin was the most popular anti-epileptic drug (AED used. Non-compliance with AEDs was seen in 18.1% cases and was more among patients on polytherapy (P = 0.032. Conclusion: Seizure manifestations and treatment compliance vary widely in the studied population. In depth analysis of each seizure type will give more information about the factors associated with it.

  4. Towards personalized integrated dementia care: a qualitative study into the implementation of different models of case management

    OpenAIRE

    Van Mierlo, Lisa D; Meiland, Franka JM; van Hout, Hein PJ; Dröes, Rose-Marie

    2014-01-01

    Background The aim of this process evaluation was to provide insight into facilitators and barriers to the delivery of community-based personalized dementia care of two different case management models, i.e. the linkage model and the combined intensive case management/joint agency model. These two emerging dementia care models differ considerably in the way they are organized and implemented. Insight into facilitators and barriers in the implementation of different models is needed to create ...

  5. An HMO-Sponsored Primary Care-Based Disease Management and Case Management Initiative: Economic and Selected Clinical Outcomes

    OpenAIRE

    Jaan Sidorov; Franz Joseph Fisher; Sabrina Girolami; Otto Wolke

    2002-01-01

    Objective: To describe the cost savings achieved in a health maintenance organization (HMO)-sponsored primary care-based case management and disease management programs. Methods: The HMO-sponsored programs recruited patients in the primary care setting and relied on clinical guidelines and HMO-employed patient education nurses and case management nurses. Total per member per month (PMPM) charges for medical services and changes in selected clinical outcomes before and after entry into HMO-spo...

  6. Pulmonary interstitial emphysema presenting in a woman on the intensive care unit: case report and review of literature

    OpenAIRE

    Jovaisa Tomas; Sherren Peter B

    2011-01-01

    Abstract Introduction Pulmonary interstitial emphysema is a life-threatening form of ventilator-induced lung injury. We present one of the few reported adult cases of pulmonary interstitial emphysema in a woman with respiratory failure admitted to our intensive care unit. Case presentation An 87-year-old Caucasian woman with a diagnosis of community-acquired pneumonia was admitted to our intensive care unit requiring invasive ventilation. The combination of a poor oxygenation index and bilate...

  7. Antimicrobial Stewardship in the Post-Acute Long-Term Care Setting: Case Discussion and Updates.

    Science.gov (United States)

    Brandt, Nicole J; Heil, Emily

    2016-07-01

    Improving the use of antimicrobial medications in the post-acute long-term care setting is critical for combating resistance and reducing adverse events in older adults. Antimicrobial stewardship refers to a set of commitments and actions designed to optimize the treatment of infectious diseases while minimizing the adverse effects associated with antimicrobial medication use. The Centers for Disease Control and Prevention recommend all nursing homes take steps to improve antimicrobial prescribing practices and reduce inappropriate use. The current article highlights initiatives and clinical considerations through a case discussion. [Journal of Gerontological Nursing, 42 (7), 10-14.]. PMID:27337183

  8. Governance issues in the transition to accountable care: a case study of Silver Cross Hospital.

    Science.gov (United States)

    Morrissette, Stephen G

    2012-01-01

    Recent developments in healthcare reform legislation and in the private-payer marketplace have increased impetus toward clinical integration. Industry changes require that healthcare delivery institutions confront fundamental scope and scale structural issues that may lead to increased vertical integration. To accomplish integration, firms must decide the organizational form of integration (alliance or merger/acquisition). One form of integration, accountable care organizations (ACOs), has featured prominently in recent legislation. Clinical integration and ACOs present significant shared-governance challenges that must be understood by hospital boards. The author outlines these governance issues using a case study of Silver Cross Hospital's governance structure for its ACO. PMID:23216264

  9. Validating Design Knowledge in the Home: A Successful Case-study Of Dementia Care

    OpenAIRE

    Long, J; Brostoff, S

    2004-01-01

    This paper reports research, which aims to validate design knowledge, as the products of a structured analysis and design method (MUSE – Lim and Long, 1994). The products or ‘containers’ of the method (MUSE(C)) are used in the re-design of a range of domestic technologies, intended to support dementia care in the home. The case-study is judged a success. An evaluation showed the technologies to be more effective following re-design. The design products were shown to be correctly operationalis...

  10. Measures of spatial accessibility to health care in a GIS environment: synthesis and a case study in the Chicago region

    OpenAIRE

    Wei Luo; Fahui Wang

    2003-01-01

    This article synthesizes two GIS-based accessibility measures into one framework, and applies the methods to examining spatial accessibility to primary health care in the Chicago ten-county region. The floating catchment area (FCA) method defines the service area of physicians by a threshold travel time while accounting for the availability of physicians by their surrounded demands. The gravity-based method considers a nearby physician more accessible than a remote one and discounts a physici...

  11. Participatory Demand-supply Systems

    OpenAIRE

    Rezaee, S.A.; Oey, M.A.; Nevejan, C.I.M.; Brazier, F.M.

    2015-01-01

    Introducing the notion of Participatory Demand-Supply (PDS) systems as socio-technical systems, this paper focuses on a new approach to coordinating demand and supply in dynamic environments. A participatory approach to demand and supply provides a new frame of reference for system design, for which the engagement of all stakeholders plays an important role, as does distributed ICT. This approach has been applied to an industrial case to explore new opportunities enabled by distributed ICT fo...

  12. Comparing Dutch Case management care models for people with dementia and their caregivers: The design of the COMPAS study

    Directory of Open Access Journals (Sweden)

    MacNeil Vroomen Janet

    2012-05-01

    Full Text Available Abstract Background Dementia care in the Netherlands is shifting from fragmented, ad hoc care to more coordinated and personalised care. Case management contributes to this shift. The linkage model and a combination of intensive case management and joint agency care models were selected based on their emerging prominence in the Netherlands. It is unclear if these different forms of case management are more effective than usual care in improving or preserving the functioning and well-being at the patient and caregiver level and at the societal cost. The objective of this article is to describe the design of a study comparing these two case management care models against usual care. Clinical and cost outcomes are investigated while care processes and the facilitators and barriers for implementation of these models are considered. Design Mixed methods include a prospective, observational, controlled, cohort study among persons with dementia and their primary informal caregiver in regions of the Netherlands with and without case management including a qualitative process evaluation. Inclusion criteria for the cohort study are: community-dwelling individuals with a dementia diagnosis who are not terminally-ill or anticipate admission to a nursing home within 6 months and with an informal caregiver who speaks fluent Dutch. Person with dementia-informal caregiver dyads are followed for two years. The primary outcome measure is the Neuropsychiatric Inventory for the people with dementia and the General Health Questionnaire for their caregivers. Secondary outcomes include: quality of life and needs assessment in both persons with dementia and caregivers, activity of daily living, competence of care, and number of crises. Costs are measured from a societal perspective using cost diaries. Process indicators measure the quality of care from the participant’s perspective. The qualitative study uses purposive sampling methods to ensure a wide variation of

  13. Turning Risks into Opportunities in Contract Management: A Case Study in the Health Care Industry

    Directory of Open Access Journals (Sweden)

    Elizabeth McVicker

    2011-01-01

    Full Text Available Problem statement: This case study presented students with a situation based in the healthcare industry, highlighting the importance of contract review, clear communications and interestbased negotiations in order to avoid the costly consequences that could be associated with contract related disputes. The case allowed students to understand how clearly written contracts play a deciding role in the success of business partnerships. Students practiced negotiation skills while discussing the performance clauses of the contract and considering effective amendments to that contract with the purpose of extending a business relationship. Approach: The author interviewed a project manager working for a preferred implementation vendor which had a contract with a large hospital provider in Colorado and California. The purpose of the interview and the case study focused on contract law, contract management, enterprise risk management and negotiation skills. The case study is based on class room use with practical, real-life contract management scenarios. Results: The team projects submitted for this case study in case management highlighted the receptivity of students in understanding the benefit of preserving business relationships, avoiding litigation and carefully wording the specifics of complex contracts. The students excelled in practicing interest-based bargaining skills and writing contract amendments that reflected the specifics of the complex contract problem presented. Conclusion/Recommendations: Case studies focused on real business situations resonate well with upper division students in business law classes; the complexities of the situations and of the contract language did not deter students from brainstorming solutions to the problems presented and in writing amendments to the contract such that the business relationship was preserved. The results of the students’ work on this case study problem were presented to the

  14. Assessing rainfall trends and remote drivers in regional climate change projections: The demanding test case of Tasmania

    International Nuclear Information System (INIS)

    Understanding and modelling Tasmanian rainfall variability and making future projections of Tasmanian rainfall are challenging tasks. Tasmania has spatially and temporally complex rainfall patterns. Rainfall variability is influenced by a complex suite of remote drivers and these influences vary by season. The Climate Futures for Tasmania high-resolution model simulations project small changes to annual rainfall averaged over Tasmania, but larger changes to the spatial patterns and seasonality of rainfall. A case study of changes to summer rainfall under a high greenhouse gas emission scenario is shown here. The projected summer decrease in rainfall in the western rainfall region is consistent with the southerly movement and intensification of the subtropical ridge as well as an enhancement of the high phase of the Southern Annular Mode. The increase along the east coastal strip is consistent with an increase in blocking in the Tasman Sea as well as an increase in sea surface temperature, relative humidity and convective rainfall. We propose that projections of rainfall for places like Tasmania are strengthened through dynamical downscaling and also the analysis of the rainfall mechanisms within the model at all length scales.

  15. Disaster medicine. A guide for medical care in case of disasters. 3. rev. ed.

    International Nuclear Information System (INIS)

    This guide was first published in 1982. The 2003 edition takes account of new research, of practical experience in natural disasters, and of the organisational plans of the German civil service units. All factors are considered which are important for successful medical care in case of natural disasters, large-scale accidents, and war. Among the new issues that are considered in this volume is the new European situation with regard to national safety, the new German legislation on civil safety, the hazards of an increasingly technological society, and the options and requirements for protection of the population in case of emergencies. After the Chernobyl accident, the focus in the field of nuclear radiation has shifted to radiation protection problems. There are new chapters on stress management during and after emergency shifts which take account of the experience gained in major disasters. (orig.)

  16. Demand and characteristics of a psychiatric 24-hour emergency service performed by mandatory rotation of licensed psychiatrists in Swiss primary care

    OpenAIRE

    Chmiel C; Rosemann T; Senn O

    2014-01-01

    Corinne Chmiel, Thomas Rosemann, Oliver SennInstitute of General Practice and Health Services Research, University of Zurich, Raemistrasse, Zurich, SwitzerlandBackground: To investigate characteristics of and satisfaction with psychiatric 24-hour emergency primary care performed by mandatory rotation of licensed psychiatrists as a viable baseline for possible reorganizational measures.Methods: This was a questionnaire-based cross-sectional study (November 2010–April 2011). The numbe...

  17. Cost recovery of NGO primary health care facilities: a case study in Bangladesh

    Directory of Open Access Journals (Sweden)

    Alam Khurshid

    2010-06-01

    Full Text Available Abstract Background Little is known about the cost recovery of primary health care facilities in Bangladesh. This study estimated the cost recovery of a primary health care facility run by Building Resources Across Community (BRAC, a large NGO in Bangladesh, for the period of July 2004 - June 2005. This health facility is one of the seven upgraded BRAC facilities providing emergency obstetric care and is typical of the government and private primary health care facilities in Bangladesh. Given the current maternal and child mortality in Bangladesh and the challenges to addressing health-related Millennium Development Goal (MDG targets the financial sustainability of such facilities is crucial. Methods The study was designed as a case study covering a single facility. The methodology was based on the 'ingredient approach' using the allocation techniques by inpatient and outpatient services. Cost recovery of the facility was estimated from the provider's perspective. The value of capital items was annualized using 5% discount rate and its market price of 2004 (replacement value. Sensitivity analysis was done using 3% discount rate. Results The cost recovery ratio of the BRAC primary care facility was 59%, and if excluding all capital costs, it increased to 72%. Of the total costs, 32% was for personnel while drugs absorbed 18%. Capital items were17% of total costs while operational cost absorbed 12%. Three-quarters of the total cost was variable costs. Inpatient services contributed 74% of total revenue in exchange of 10% of total utilization. An average cost per patient was US$ 10 while it was US$ 67 for inpatient and US$ 4 for outpatient. Conclusion The cost recovery of this NGO primary care facility is important for increasing its financial sustainability and decreasing donor dependency, and achieving universal health coverage in a developing country setting. However, for improving the cost recovery of the health facility, it needs to increase

  18. A model approach for analysing trends in energy supply and demand at country level: case study of industrial development in China

    International Nuclear Information System (INIS)

    Ideally, national energy supply and demand choices would be based on comprehensive models and predictions of the energy sources, energy transformations, energy carriers and energy end-uses expected to play major roles into the foreseeable future (20-40 years). However, in many cases, the necessary detailed, high quality, consistent and timely data is not available for such comprehensive models to be constructed, in particular in large and complex developing economies expected to be major energy users in the near future. In the developing countries that are the focus of UNIDO's work, attention has been concentrated on making progress simultaneously on two fronts: (a) a dramatic decrease in energy intensity, particularly in activities linked to industrial production and (b) a major increase in the contribution of local renewable energy to limit growth in fossil fuel use. National policies need to be oriented towards a strict and strategic monitoring of the respective energy matrices with a simultaneous focus on both fronts. Robust assessments of industrial development trends throughout the whole 20-40 year transition phase are needed to achieve both objectives. Until more comprehensive energy-related models can be built up, to overcome the limited availability of data at country level it is proposed that a simple energy supply and demand model analysis consisting of three phases be used for identifying the consistency of future scenarios and corresponding policy requirements. This model analysis, which is a dynamic exercise, consists, first, of an analysis at aggregate level of the current and future national energy matrices; secondly, an analysis of perspectives for decreasing the energy intensity of the most inefficient systems or industrial sectors; and thirdly, an analysis of perspectives for increasing the supply and cost-effectiveness of sustainable energy sources. As an illustration of this model approach, the case of China is analysed with emphasis on the

  19. Rapid spread of complex change: a case study in inpatient palliative care

    Directory of Open Access Journals (Sweden)

    Filipski Marta I

    2009-12-01

    Full Text Available Abstract Background Based on positive findings from a randomized controlled trial, Kaiser Permanente's national executive leadership group set an expectation that all Kaiser Permanente and partner hospitals would implement a consultative model of interdisciplinary, inpatient-based palliative care (IPC. Within one year, the number of IPC consultations program-wide increased almost tenfold from baseline, and the number of teams nearly doubled. We report here results from a qualitative evaluation of the IPC initiative after a year of implementation; our purpose was to understand factors supporting or impeding the rapid and consistent spread of a complex program. Methods Quality improvement study using a case study design and qualitative analysis of in-depth semi-structured interviews with 36 national, regional, and local leaders. Results Compelling evidence of impacts on patient satisfaction and quality of care generated 'pull' among adopters, expressed as a remarkably high degree of conviction about the value of the model. Broad leadership agreement gave rise to sponsorship and support that permeated the organization. A robust social network promoted knowledge exchange and built on an existing network with a strong interest in palliative care. Resource constraints, pre-existing programs of a different model, and ambiguous accountability for implementation impeded spread. Conclusions A complex, hospital-based, interdisciplinary intervention in a large health care organization spread rapidly due to a synergy between organizational 'push' strategies and grassroots-level pull. The combination of push and pull may be especially important when the organizational context or the practice to be spread is complex.

  20. 我国失能老人的长期照料需求与供给分析%Long - term Care of Chinese Disabled Elderly Demand and Supply Analysis

    Institute of Scientific and Technical Information of China (English)

    苏群; 彭斌霞

    2014-01-01

    The data used in this study is from China Health and Retirement Longitudinal Survey(CHRALS)in 2011. Through analyzing the demand and supply of long - term care of disabled elder,this article shows the current life situation of disabled elderly and puts up with policies to solve the contradiction between supply and demand. The result shows that 13. 02 percent elder those activity of daily living are damaged,and must rely on others to provide care for life. As the growth of the age,the likelihood of disability increased. The rural people have more demand of long - term care than the urban. Womenˊs care needs are more 2. 33 percent than menˊs. Most disabled elderly rely mainly on family - based care;institutional care resources are scarce,structural imbalanced;and community care is at an early stage of development. Based on disabled elderly own special characteristics and economic and social environment,our country should continue to encourage and support family caregivers,while vigorously explore the development of appropriate community care services.%本文利用2011年“中国健康与养老追踪调查(CHRALS)”的数据,通过对我国失能老人的照料需求与供给的分析,揭示出我国失能老人的生活现状并针对供需之间的矛盾提出解决的对策。研究结果表明我国有13.02℅的老年人由于日常生活活动能力受损,表现为失能状态,需要他人提供日常生活照料;随着年龄的增长,失能的可能性加大;农村照料需求高于城镇,女性的照料需求比男性高出2.33℅。大多数失能老人主要依靠家庭照料为主;机构照料资源匮乏,结构失调;社区照料更是处于起步发展阶段。基于失能老人自身特征及我国特殊的经济社会环境,应建立以家庭照料为基础,社区照料和机构照料相融合的长期照料服务体系。

  1. Palliative and Supportive Care in Acrometastasis to the Hand: Case Series

    Directory of Open Access Journals (Sweden)

    Narendra Kumar

    2011-01-01

    Full Text Available Acrometastasis to the hand is an unusual presentation which might mimic an infectious, inflammatory, or a metabolic pathology. We herein describe a case series of three patients of acrometastasis to the hand. We encountered three cases of acrometastasis to the hand attending the departmental clinics from 2007 to 2010. The median age at presentation was noted to be 55 years. All were males. The primaries included squamous cell carcinoma of the skin, larynx, and esophagus. In two patients, acrometastasis was detected at presentation and in one it was detected 2 years postcompletion of radical therapy. Two patients were offered palliative radiation to acrometastasis, and best supportive care was given to one. Palliation achieved after radiation was noted to be modest to good. The brief report highlights the importance of the clinical awareness of metastatic dissemination to unusual sites in the face of increasing cancer survivorship. Acrometastasis portends a poor prognosis with limited survival, and optimal integration of the best supportive care is mandatory. A short course of hypofractionated palliative radiation therapy results in modest to good palliation.

  2. Addressing barriers to perinatal care: a case study of the Access to Maternity Care Committee in Washington State.

    OpenAIRE

    Schleuning, D; Rice, G.; Rosenblatt, R. A.

    1991-01-01

    Access to obstetrical services has deteriorated in recent years, as large numbers of physicians have discontinued or restricted obstetrical practice. In Washington State, one response to this access crisis has been the establishment of the Access to Maternity Care Committee (AMCC), an ad hoc group composed primarily of private sector obstetrical providers and representatives of State government responsible for the delivery of health care to women and children. The major objectives of the AMCC...

  3. Meeting increased demand.

    Science.gov (United States)

    Blair, Andrew

    2004-07-01

    of people affected by arthritis will increase by nearly 50%. A huge increase in numbers affected with musculoskeletal conditions will require significant increases in health care resources, including hospital beds and facilities, orthopaedic surgeons and other health care professionals. New Zealand has been slow to acknowledge and plan for the increased demand for health services which is looming. Growing New Zealand's economy will help, but alone will not be enough. It is more than just finding the financial resources to better meet the demand. The enormous demands on the availability of treatment resources including hospital facilities and trained health care professionals must be addressed. There are major workforce issues to be faced. The change in population distribution between young and old will have an impact and it will be necessary to ensure that there are sufficient numbers of properly trained health care professionals available at all levels. It is hoped that improvements in preventative care programmes and new technologies and treatment techniques may reduce the rate of demand. As the health of our population is improved through targeted programmes dealing with obesity, diabetes, smoking and accident prevention, it may be possible to reallocate or change the focus of resources within the health and hospital sectors. Many countries are developing national strategies for their aging population. Clearly the New Zealand Government needs to move swiftly to develop a plan to manage the increased burden that is developing as a result of the aging population. That plan must create an environment which facilitates, encourages and supports greater private investment in healthcare facilities and healthcare delivery. Incentives must be created to motivate individuals to take greater responsibility for their healthcare needs and the funding of it. The development of a long term strategy to meet the challenges of the aging population is a priority. PMID:19195249

  4. Effectiveness of Case Management for 'At Risk' Patients in Primary Care: A Systematic Review and Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Jonathan Stokes

    Full Text Available An ageing population with multimorbidity is putting pressure on health systems. A popular method of managing this pressure is identification of patients in primary care 'at-risk' of hospitalisation, and delivering case management to improve outcomes and avoid admissions. However, the effectiveness of this model has not been subjected to rigorous quantitative synthesis.We carried out a systematic review and meta-analysis of the effectiveness of case management for 'at-risk' patients in primary care. Six bibliographic databases were searched using terms for 'case management', 'primary care', and a methodology filter (Cochrane EPOC group. Effectiveness compared to usual care was measured across a number of relevant outcomes: Health--self-assessed health status, mortality; Cost--total cost of care, healthcare utilisation (primary and non-specialist care and secondary care separately, and; Satisfaction--patient satisfaction. We conducted secondary subgroup analyses to assess whether effectiveness was moderated by the particular model of case management, context, and study design. A total of 15,327 titles and abstracts were screened, 36 unique studies were included. Meta-analyses showed no significant differences in total cost, mortality, utilisation of primary or secondary care. A very small significant effect favouring case management was found for self-reported health status in the short-term (0.07, 95% CI 0.00 to 0.14. A small significant effect favouring case management was found for patient satisfaction in the short- (0.26, 0.16 to 0.36 and long-term (0.35, 0.04 to 0.66. Secondary subgroup analyses suggested the effectiveness of case management may be increased when delivered by a multidisciplinary team, when a social worker was involved, and when delivered in a setting rated as low in initial 'strength' of primary care.This was the first meta-analytic review which examined the effects of case management on a wide range of outcomes and

  5. What is the role of a case manager in community aged care? A qualitative study in Australia.

    Science.gov (United States)

    You, Emily Chuanmei; Dunt, David; Doyle, Colleen

    2016-07-01

    This study aimed to explore the perceptions of case managers about their roles in providing community aged care in Australia. Purposeful sampling was used and 33 qualitative semi-structured interviews with 47 participants were conducted. Participants were drawn from a list of all case managers working in aged care organisations that provided publicly funded case-managed community aged care programmes in the State of Victoria, Australia. Participant selection criteria included age, gender, job titles, professional backgrounds, practice locations, organisational attributes and organisational size. Data collection was implemented between September 2012 and March 2013. Thematic analysis was performed. Participants believed that case managers performed diverse roles based on clients' needs. They also articulated 16 important roles of case managers, including advisors, advocates, carers, communicators, co-ordinators, educators, empowering clients, engaging clients and families, liaising with people, managing budgets, navigators, negotiators, networking with people, facilitators, problem solvers and supporters. However, they were concerned about brokers, mediators and counsellors in terms of the terminology or case managers' willingness to perform these roles. Moreover, they perceived that neither gatekeepers nor direct service provision was case managers' role. The findings of this study suggest that case managers working in community aged care sectors may be more effective if they practised the 16 roles aforementioned. With the value of helping rather than obstructing clients to access services, they may not act as gatekeepers. In addition, they may not provide services directly as opposed to their peers working in medical care settings. The findings will also assist organisations to design job descriptions specifying case managers' roles and associated job responsibilities. Clear job descriptions will further benefit the organisations in staff recruitment, orientation

  6. Economic techniques to estimate the demand for sustainable products: a case study for fair trade and organic coffee in the United Kingdom

    OpenAIRE

    Galarraga, Ibon; Markandya, Anil

    2004-01-01

    The hedonic approach is used in this paper to estimate how much is paid for the fair trade/organic characteristic of the coffee in the British market. This information is later combined with the Quantity Based Demand System (QBDS) model -developed by the authors- and the Almost Ideal Demand System (AIDS) (Deaton and Muellbauer, 1980) to completely determine the demand function for different coffees. The QBDS model is easier to handle and less data demanding than the AIDS model in this study. ...

  7. Clinical demand for and access to images and interpretations of chest radiographs in a medical intensive care unit serviced by an integrated PACS-radiology information system

    Science.gov (United States)

    Shile, Peter E.; Kundel, Harold L.; Seshadri, Sridhar B.; Carey, Bruce; Kishore, Sheel; Brikman, Inna; Feingold, Eric R.; Lanken, Paul N.

    1994-05-01

    Digital communication systems have been proposed as a means of improving the flow of information between radiologists and other physicians. In the intensive care unit (ICU), physicians require more rapid access to images and interpretations than physicians in most other hospital settings. Thus these systems must be designed to ensure that rapid exchange of radiological information can be achieved. To better define system design for the electronic communication of radiological information to ICUs, this study examined bottlenecks in information flow through an integrated PACS-Radiology Information System.

  8. Differences in clinical and epidemiological features between tuberculosis cases notified in primary and tertiary health care

    Directory of Open Access Journals (Sweden)

    Pâmela Curbani

    2014-04-01

    Full Text Available Objective: To compare, on the basis of clinical, radiological and epidemiological aspects, all cases of tuberculosis (TB diagnosed in the tertiary healthcare services to those diagnosed at the primary healthcare providers in the municipality of Vitória-ES. Methods: Cross- sectional, retrospective study, with analysis of the SINAN’s database, to identify all cases among residents of the municipality of Vitória-ES and diagnosed with TB in 2006 and 2007. Patients were divided into two groups: cases diagnosed in Primary Health Care (PHC and those diagnosed in Tertiary Health Care (THC. For statistical analysis, it was used the software STATA CORP 9.0. Results: 338 patients were identified; 207 (61.24% of these were diagnosed in PHC and 131 (38.76% in THC. The pulmonary form was predominant in both groups. However, the extrapulmonary form presented higher frequency in the THC group. When analyzing the results of sputum smear, the positivity was found in 114 (55.07% patients of the PHC and in 57 (43.51% of THC. Regarding the positive cultures, 119 (57.48% patients diagnosed in PHC and only 38 (29% in THC tested positive. Conclusion: There is evidence of high proportion of patients with TB communicated as “new cases” in THC in the city and it was observed a predominance of the pulmonary form in both groups - PHC and THC, although the extrapulmonary form was more frequent in the latter. doi:10.5020/18061230.2013.p251

  9. Examining the potential of natural gas demand-side measures to benefit customers, the distribution utility, and the environment: two case studies from Europe

    International Nuclear Information System (INIS)

    The aim of this paper is to demonstrate how integrated resource planning (IRP) oriented to the gas sector can be applied both in new networks and in mature networks, and to present the advantages of its application. One case study is described, in the western central region of Portugal, to illustrate the results of a pilot project on natural gas IRP implementation in a new network in the European Union (EU). The city of Burg, Germany, with a mature gas network with district heating was also analysed in terms of IRP potential. The most important phases of the integrated resource plan definition and implementation (especially those oriented to the demand-side) are presented, namely, the definition of the most efficient technologies (including solar energy), fuel-switching possibilities, a detailed study of the impacts in the economy, environment and society, and the policy incentives necessary to motivate the gas utility companies to perform IRP. In the main case study, the suggested implementation plan would lead to a reduction of around 4.7% in natural gas consumption. Additionally, 13.3% of cost-effective fuel switching from other competing forms of energy to natural gas can be achieved. A proposed EU energy services directive on mandatory energy-efficiency activities for gas and electricity distribution utilities in the EU, will promote the large-scale implementation of the proposed approach in Europe. (author)

  10. Demand generation and social mobilisation for integrated community case management (iCCM and child health: Lessons learned from successful programmes in Niger and Mozambique

    Directory of Open Access Journals (Sweden)

    Alyssa B Sharkey

    2014-11-01

    Full Text Available We present the approaches used in and outcomes resulting from integrated community case management (iCCM programmes in Niger and Mozambique with a strong focus on demand generation and social mobilisation. We use a case study approach to describe the programme and contextual elements of the Niger and Mozambique programmes. Awareness and utilisation of iCCM services and key family practices increased following the implementation of the Niger and Mozambique iCCM and child survival programmes, as did care–seeking within 24 hours and care–seeking from appropriate, trained providers in Mozambique. These approaches incorporated interpersonal communication activities and community empowerment/participation for collective change, partnerships and networks among key stakeholder groups within communities, media campaigns and advocacy efforts with local and national leaders. iCCM programmes that train and equip community health workers and successfully engage and empower community members to adopt new behaviours, have appropriate expectations and to trust community health workers’ ability to assess and treat illnesses can lead to improved care–seeking and utilisation, and community ownership for iCCM.

  11. Demand for private health insurance: Is there a quality gap?

    OpenAIRE

    Costa-i-Font, Joan; Garcia, Jaume

    2001-01-01

    Quality of care is qualified as a main determinant of the demand for voluntary private health insurance (PHI) in National Health Systems (NHS). This paper provides new evidence on the influence of the quality gap between public and private health insurance and other demand determinants in the demand for PHI in Catalonia. The demand for PHI is modelled as a demand for health care quality. Unlike previous studies, the database employed allows for the development of a link bet...

  12. Cerebral Malaria Treated with Artemisinin in the Intensive Care Unit: A Case Report.

    Science.gov (United States)

    Çizmeci, Elif Ayşe; Kelebek Girgin, Nermin; Ceylan, Ilkay; Tuncel, Tekin; Alver, Oktay; Akalin, Emin Halis

    2016-01-01

    Malaria is a parasitic disease that is starting to be encountered in intensive care units (ICU) worldwide, owing to increasing globalisation. Severe malaria caused by Plasmodium falciparum, is characterised by cerebral malaria, acute renal failure, hypoglycaemia, severe anaemia, splenomegaly and alveolar oedema. We present the case of a 25-yr old male patient who presented to the Emergency Department of Uludag University in Bursa, Turkey in the winter of 2014 with complaints of fever for three days. His medical history revealed a 14-month stay in Tanzania. Staining of blood smears revealed characteristic gametocytes in accordance with P. falciparum infection. The day after admission, he had an epileptic seizure after which his Glasgow Coma Scale was 6, so he was intubated and transferred to the ICU. A computerized tomography scan revealed findings of cerebral oedema. Intravenous mannitol was administered for 6 days. Intravenous artemisinin was continued for 10 days. Due to refractory fevers, anti-malarial treatment was switched to quinine and doxycycline on the 14th day and on the 16th day the fevers ceased. This case emphasizes that cerebral malaria should be suspected in cases of seizures accompanying malaria, and treatment should be initiated in the ICU. Furthermore, resistance of P. falciparum to artemisinin should be in mind when a response to therapy is lacking. PMID:27095978

  13. Cerebral Malaria Treated with Artemisinin in the Intensive Care Unit: A Case Report

    Directory of Open Access Journals (Sweden)

    Elif Ayşe ÇİZMECİ

    2016-03-01

    Full Text Available Malaria is a parasitic disease that is starting to be encountered in intensive care units (ICU worldwide, owing to increasing globalisation. Severe malaria caused by Plasmodium falciparum, is characterised by cerebral malaria, acute renal failure, hypoglycaemia, severe anaemia, splenomegaly and alveolar oedema. We present the case of a 25-yr old male patient who presented to the Emergency Department of Uludag University in Bursa, Turkey in the winter of 2014 with complaints of fe­ver for three days. His medical history revealed a 14-month stay in Tanzania. Staining of blood smears revealed characteristic gametocytes in accordance with P. falciparum infection. The day after admission, he had an epileptic seizure after which his Glasgow Coma Scale was 6, so he was intubated and transferred to the ICU. A computerized tomography scan revealed findings of cerebral oedema. Intravenous mannitol was administered for 6 days. Intravenous artemisinin was continued for 10 days. Due to refractory fevers, anti-malarial treatment was switched to quinine and doxycycline on the 14th day and on the 16th day the fe­vers ceased. This case emphasizes that cerebral malaria should be suspected in cases of seizures accompanying malaria, and treatment should be initiated in the ICU. Furthermore, resistance of P. falciparum to artemisinin should be in mind when a response to therapy is lacking.

  14. Cerebral Malaria Treated with Artemisinin in the Intensive Care Unit: A Case Report

    Science.gov (United States)

    ÇİZMECİ, Elif Ayşe; KELEBEK GİRGİN, Nermin; CEYLAN, Ilkay; TUNCEL, Tekin; ALVER, Oktay; AKALIN, Emin Halis

    2016-01-01

    Malaria is a parasitic disease that is starting to be encountered in intensive care units (ICU) worldwide, owing to increasing globalisation. Severe malaria caused by Plasmodium falciparum, is characterised by cerebral malaria, acute renal failure, hypoglycaemia, severe anaemia, splenomegaly and alveolar oedema. We present the case of a 25-yr old male patient who presented to the Emergency Department of Uludag University in Bursa, Turkey in the winter of 2014 with complaints of fever for three days. His medical history revealed a 14-month stay in Tanzania. Staining of blood smears revealed characteristic gametocytes in accordance with P. falciparum infection. The day after admission, he had an epileptic seizure after which his Glasgow Coma Scale was 6, so he was intubated and transferred to the ICU. A computerized tomography scan revealed findings of cerebral oedema. Intravenous mannitol was administered for 6 days. Intravenous artemisinin was continued for 10 days. Due to refractory fevers, anti-malarial treatment was switched to quinine and doxycycline on the 14th day and on the 16th day the fevers ceased. This case emphasizes that cerebral malaria should be suspected in cases of seizures accompanying malaria, and treatment should be initiated in the ICU. Furthermore, resistance of P. falciparum to artemisinin should be in mind when a response to therapy is lacking. PMID:27095978

  15. Estimates of Elasticity of Rural Residents' Demand for Health Care%农村居民卫生服务需求弹性研究

    Institute of Scientific and Technical Information of China (English)

    周忠良; 苏延芳; 高建民; 周志英; 徐玲; 张耀光

    2011-01-01

    文章利用第三次和第四次国家卫生服务入户调查在县级层面的数据,采用固定效应模型对面板数据进行分析,测算了县级层面门诊服务和住院服务的自价格弹性、交叉价格弹性和收入弹性.针对如何提高农村居民基本医疗卫生服务利用给出了相应的政策建议.%Using the county-level panel data from the third and the fourth National Health Service Surveys, the fixed effect models were employed to calculate the own-price elasticity, cross-price elasticity and the income elasticity of demand for outpatient service and inpatient service. Some political recommendations were made to improve the basic health service utilization in rural areas.

  16. Learning by doing. Training health care professionals to become facilitator of moral case deliberation.

    Science.gov (United States)

    Stolper, Margreet; Molewijk, Bert; Widdershoven, Guy

    2015-03-01

    Moral case deliberation (MCD) is a dialogue among health care professionals about moral issues in practice. A trained facilitator moderates the dialogue, using a conversation method. Often, the facilitator is an ethicist. However, because of the growing interest in MCD and the need to connect MCD to practice, healthcare professionals should also become facilitators themselves. In order to transfer the facilitating expertise to health care professionals, a training program has been developed. This program enables professionals in health care institutions to acquire expertise in dealing with moral questions independent of the expertise of an (external) ethicist. Over the past 10 years, we developed a training program with a specific mix of theory and practice, aiming to foster the right attitude, skills and knowledge of the trainee. The content and the didactics of the training developed in line with the philosophy of MCD: pragmatic hermeneutics, dialogical ethics and Socratic epistemology. Central principles are: 'learning by doing', 'reflection instead of ready made knowledge', and 'dialogue on dialogue'. This paper describes the theoretical background and the didactic content of the current training. Furthermore, we present didactic tools which we developed for stimulating active learning. We also go into lessons we learned in developing the training. Next, we provide some preliminary data from evaluation research of the training program by participants. The discussion highlights crucial aspects of educating professionals to become facilitators of MCD. The paper ends with concluding remarks and a plea for more evaluative evidence of the effectiveness and meaning of this training program for doing MCD in institutions. PMID:25218568

  17. Survival of the project: a case study of ICT innovation in health care.

    Science.gov (United States)

    Andreassen, Hege K; Kjekshus, Lars Erik; Tjora, Aksel

    2015-05-01

    From twenty years of information and communication technology (ICT) projects in the health sector, we have learned one thing: most projects remain projects. The problem of pilotism in e-health and telemedicine is a growing concern, both in medical literature and among policy makers, who now ask for large-scale implementation of ICT in routine health service delivery. In this article, we turn the question of failing projects upside down. Instead of investigating the obstacles to implementing ICT and realising permanent changes in health care routines, we ask what makes the temporary ICT project survive, despite an apparent lack of success. Our empirical material is based on Norwegian telemedicine. Through a case study, we take an in-depth look into the history of one particular telemedical initiative and highlight how ICT projects matter on a managerial level. Our analysis reveals how management tasks were delegated to the ICT project, which thus contributed to four processes of organisational control: allocating resources, generating and managing enthusiasm, system correction and aligning local practice and national policies. We argue that the innovation project in itself can be considered an innovation that has become normalised in health care, not in clinical, but in management work. In everyday management, the ICT project appears to be a convenient tool suited to ease the tensions between state regulatory practices and claims of professional autonomy that arise in the wake of new public management reforms. Separating project management and funding from routine practice handles the conceptualised heterogeneity between innovation and routine within contemporary health care delivery. Whilst this separation eases the execution of both normal routines and innovative projects, it also delays expected diffusion of technology. PMID:25795426

  18. Evaluation of Suicide and Intoxication Cases Admitted to our Newly Opened Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Nalan Muhammedoğlu

    2014-09-01

    Full Text Available Aim: The aim of this study was to evaluate the suicide and intoxication cases between April 2011 and April 2013. Methods: We retrospectively analyzed hospital records of patients who were admitted to our intensive care unit due to suicide and intoxication. The age, sex, intoxication causes, laboratory analyses, treatment refusal rates, and the prognosis were evaluated. Results: A total of 308 patients (105 males, 203 females were admitted to the intensive care unit. The mean age of the patients was 27.45±10.26 years (males: 28.70±9.86 years, females: 26.80±10.43 years. There were only 4 patients over 65 years of age. 275 patients had drug intoxication (antidepressant drug, pain killer, antibiotic, etc. and 33 patients had other causes of intoxication. When analyzing the prognosis; a total of 234 patients were discharged after initial treatment and 57 patients were discharged due to treatment refusal. 15 patients were referred for inpatient psychiatric treatment, 1 patient to the Alcohol and Drug Addiction Treatment Center (AMATEM and 1 patient was referred to İstanbul University Medical Faculty due to acute hepatic failure. Conclusion: The patients admitted to our intensive care unit due to suicide and intoxications were mainly females (65.9% and individuals of young age (median age: 27.45 years. Female patients had used antidepressants for suicide attempts and males had used antiflu-acetaminophen combinations. No mortality was observed. (The Me­di­cal Bul­le­tin of Ha­se­ki 2014; 52:153-7

  19. Identifying cases of undiagnosed, clinically significant COPD in primary care: qualitative insight from patients in the target population

    OpenAIRE

    Leidy, Nancy K.; Kim, Katherine; Bacci, Elizabeth D.; Yawn, Barbara P.; Mannino, David M.; Thomashow, Byron M; Barr, R Graham; Rennard, Stephen I; Houfek, Julia F; Han, Meilan K.; Meldrum, Catherine A.; Make, Barry J.; Bowler, Russ P; Steenrod, Anna W.; Murray, Lindsey T

    2015-01-01

    Background: Many cases of chronic obstructive pulmonary disease (COPD) are diagnosed only after significant loss of lung function or during exacerbations. Aims: This study is part of a multi-method approach to develop a new screening instrument for identifying undiagnosed, clinically significant COPD in primary care. Methods: Subjects with varied histories of COPD diagnosis, risk factors and history of exacerbations were recruited through five US clinics (four pulmonary, one primary care). Ph...

  20. Insights into the impact and use of research results in a residential long-term care facility: a case study

    OpenAIRE

    Cranley Lisa A; Birdsell Judy M; Norton Peter G; Morgan Debra G; Estabrooks Carole A

    2012-01-01

    Abstract Background Engaging end-users of research in the process of disseminating findings may increase the relevance of findings and their impact for users. We report findings from a case study that explored how involvement with the Translating Research in Elder Care (TREC) study influenced management and staff at one of 36 TREC facilities. We conducted the study at ‘Restwood’ (pseudonym) nursing home because the Director of Care engaged actively in the study and TREC data showed that this ...

  1. An Analysis of Gap in TQM Indicators in Health Care Institutions (Case: Isfahan Khorshid Hospital

    Directory of Open Access Journals (Sweden)

    M Sadr-Bafghi

    2009-01-01

    Full Text Available Introduction: Many organizations, especially, service organizations, relative to their goals and mission, have a special view towards quality phenomena and its management and are turning to approaches such as TQM to help manage their business. This study examined the TQM indicators gap in Isfahan Khorshid hospital. As fuzzy set theory is better than the logical theory for estimating the linguistic factors, this paper tries to apply fuzzy approach to quality management in hospitals and analyzes the gap between personnel expectations and perception. Methods: This paper analyzes medical total quality management in a case (Internal Section of Khorshid Hospital, based on gap analysis model and fuzzy logic. A questionnaire was therefore applied to measure expectations and perceptions of hospital personnel. Results: This study results show that on the whole, there is a significant difference between TQM expectations and perceptions among K`horshid hospital personnel. Conclusions: Spurred by impressive results in other industries, this compelling and logical approach has begun to penetrate the thinking of health care accrediting agencies, business coalitions, private foundations and leading health care organizations. However, before making a commitment to TQM, hospital decision makers should thoroughly understand what it is they are committing to, and solve the main barriers such as the conflict between hospital management philosophies and TQM philosophies.

  2. Socio-political constraints on primary health care: a case study from Java.

    Science.gov (United States)

    Williams, G; Satoto

    1980-01-01

    The Alma-Ata 1978 conference emphasized the importance of the concept of primary health care in the health system and overall socioeconomic development of the community. However, theories of development generally do not allow for the complexity of human conditions, and the relevance of contact with the village people. This paper presents the experience of a PHC (primary health care) project on the northern coast of central Java. The case illustrates some of the institutional and sociopolitical constraints which the Indonesian government may face in implementing a PHC program in the next few years, such as village politics; the reluctance of men to allow women to participate in the decision-making process of the program, and; the reluctance of land-owning farmers to allow landless villagers in the decision-making process. The following conditions would create a most favorable sociopolitical climate for starting a PHC program in Indonesia: 1) at the village level, non-pamong desa (village elders), women and landless villagers are encouraged to participate in decision-making processes which affect their interests and to take on positions of responsibility in village affairs; 2) there is a process of frank, 2-way communication marked by mutual respect between government agencies at regency and subdistrict levels village-level organization, and 3) supra-village authorities allow village institution to develop at their own pace, intervening only when interests of poor and underprivileged groups are endangered. PMID:12261889

  3. Evolving paradigm of illnesses presented to medical Intensive Care Unit in body builders: Cases from tertiary care center

    OpenAIRE

    Sunil Kumar Garg

    2015-01-01

    Bodybuilding is the use of progressive resistance exercise to control and develop one′s musculature. With the rise in number of persons adopting this activity, there is evolving paradigm of illnesses presented to intensive care in this population subset. Strict adherence to details of bodybuilding and avoidance of unsupervised medications are essential to prevent untoward effects.

  4. Evolving paradigm of illnesses presented to medical Intensive Care Unit in body builders: Cases from tertiary care center.

    Science.gov (United States)

    Garg, Sunil Kumar

    2015-04-01

    Bodybuilding is the use of progressive resistance exercise to control and develop one's musculature. With the rise in number of persons adopting this activity, there is evolving paradigm of illnesses presented to intensive care in this population subset. Strict adherence to details of bodybuilding and avoidance of unsupervised medications are essential to prevent untoward effects. PMID:25878431

  5. Evolving paradigm of illnesses presented to medical Intensive Care Unit in body builders: Cases from tertiary care center

    Directory of Open Access Journals (Sweden)

    Sunil Kumar Garg

    2015-01-01

    Full Text Available Bodybuilding is the use of progressive resistance exercise to control and develop one′s musculature. With the rise in number of persons adopting this activity, there is evolving paradigm of illnesses presented to intensive care in this population subset. Strict adherence to details of bodybuilding and avoidance of unsupervised medications are essential to prevent untoward effects.

  6. 'Healthy gums do matter': A case study of clinical leadership within primary dental care.

    Science.gov (United States)

    Moore, D; Saleem, S; Hawthorn, E; Pealing, R; Ashley, M; Bridgman, C

    2015-09-25

    The Health and Social Care Act 2012 heralded wide reaching reforms intended to place clinicians at the heart of the health service. For NHS general dental practice, the conduits for this clinical leadership are the NHS England local professional networks. In Greater Manchester, the local professional network has developed and piloted a clinician led quality improvement project: 'Healthy Gums DO Matter, a Practitioner's Toolkit'. Used as a case study, the project highlighted the following facilitators to clinical leadership in dentistry: supportive environment; mentoring and transformational leadership; alignment of project goals with national policy; funding allowance; cross-boundary collaboration; determination; altruism; and support from wider academic and specialist colleagues. Barriers to clinical leadership identified were: the hierarchical nature of healthcare, territorialism and competing clinical commitments. PMID:26404983

  7. Restorative green outdoor environments at acute care hospitals - case studies in Denmark

    DEFF Research Database (Denmark)

    Abdul Shukor, Shureen Faris Binti

    facilities. The findings from the literature review revealed that there are two types of publications (peer-reviewed and best practice guidelines) that have offered recommendations for the design of GOEs at healthcare facilities. After the review process, seven main themes were derived which contained 22...... improvements they would like to see. Among the recommendations from the employees was easy access, a window view of the GOE and private spaces for staff. The inclusion of water features was the most popular. The preference for sun and fresh air indicates that many hospital users would like to spend time...... care hospitals and the proposal of a design survey tool (the CDR). The tool can be used as a quick guide for professionals dealing with the design and management of healthcare facilities when evaluating either existing or future GOEs. Based on the results of the CDR and the study of the five cases...

  8. Case-finding of dementia in general practice and effects of subsequent collaborative care; design of a cluster RCT

    Directory of Open Access Journals (Sweden)

    van den Dungen Pim

    2012-08-01

    Full Text Available Abstract Background In the primary care setting, dementia is often diagnosed relatively late in the disease process. Case finding and proactive collaborative care may have beneficial effects on both patient and informal caregiver by clarifying the cause of cognitive decline and changed behaviour and by enabling support, care planning and access to services. We aim to improve the recognition and diagnosis of individuals with dementia in general practice. In addition to this diagnostic aim, the effects of case finding and subsequent care on the mental health of individuals with dementia and the mental health of their informal carers are explored. Methods and design Design: cluster randomised controlled trial with process evaluation. Participants: 162 individuals ≥ 65 years, in 15 primary care practices, in whom GPs suspect cognitive impairment, but without a dementia diagnosis. Intervention; case finding and collaborative care: 2 trained practice nurses (PNs invite all patients with suspected cognitive impairment for a brief functional and cognitive screening. If the cognitive tests are supportive of cognitive impairment, individuals are referred to their GP for further evaluation. If dementia is diagnosed, a comprehensive geriatric assessment takes place to identify other relevant geriatric problems that need to be addressed. Furthermore, the team of GP and PN provide information and support. Control: GPs provide care and diagnosis as usual. Main study parameters: after 12 months both groups are compared on: 1 incident dementia (and MCI diagnoses and 2 patient and caregiver quality of life (QoL-AD; EQ5D and mental health (MH5; GHQ 12 and caregiver competence to care (SSCQ. The process evaluation concerns facilitating and impeding factors to the implementation of this intervention. These factors are assessed on the care provider level, the care recipient level and on the organisational level. Discussion This study will provide insight

  9. A review of 151 cases of pediatric noncystic fibrosis bronchiectasis in a tertiary care center

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    Banjar Hanaa

    2007-01-01

    Full Text Available Objective: This study was conducted to review the etiological factors and diseases associated with pediatric noncystic fibrosis bronchiectasis in a tertiary care center in Saudi Arabia. Materials and Methods: A retrospective review of all patients with confirmed noncystic fibrosis (Non-CF bronchiectasis by chest X-ray and/or CT chest in a pulmonary clinic during the period 1993-2005 at a tertiary care center in Riyadh. Results: A total of 151 cases were diagnosed as Non-CF bronchiectasis. Seventy-five (49.7% were male, 76 (50.3% were female; 148 (98% are alive and 3 (2% died. The southwestern regions constituted 72 (50% of the cases. There was a period of (5 ± 3.2 years between the start of symptoms and diagnosis of bronchiectasis. More than two-thirds of the patients had cough, tachypnea, wheezing, sputum production and failure to thrive. Ninety-one (60% had associated diseases: Pulmonary diseases in 48 (32%, immunodeficiency in 27 (18%, central nervous system anomalies in 10 (7%, cardiac in 10 (7% and asthma in 103 (68% of the patients. Left lower lobe was commonly involved in 114 (76% patients. Sixty-eight (67% were found to have sinusitis. More than two-thirds of patients had two or more associated diseases. Forty-nine (32% developed gastroesophageal reflux. Hemophilus influenza was cultured in 56 (37%, strept pneumoniae in 25 (17% and pseudomonas aeruginosa in 24 (16% of the patients. Eighty percent of the patients who had pulmonary function test had abnormal changes. Disease progression was related to development of symptoms before 5 years of age, persistent atelectasis and right lower lobe involvement ( P < 0.05. Conclusion: Non-CF bronchiectasis should be included in the differential diagnosis of recurrent chest infection in Saudi Arabia. Early diagnosis and identification of associated diseases is needed to prevent progression of the disease.

  10. The accuracy of clinical malaria case reporting at primary health care facilities in Honiara, Solomon Islands

    Directory of Open Access Journals (Sweden)

    Kunimitsu Ayano

    2009-04-01

    Full Text Available Abstract Background The accuracy of malaria case reporting is challenging due to restricted human and material resources in many countries. The reporting often depends on the clinical diagnosis because of the scarcity of microscopic examinations. Particularly, clinical malaria case reporting by primary health care facilities (local clinics, which constitutes the baseline data of surveillance, has never previously been sufficiently evaluated. In order to improve the malaria reporting system to the level required to eventually eliminate this disease, this study estimates the gaps between the records of clinics and government statistics regarding the incidence of clinical malaria, and then also examines some factors that might explain the data discrepancy, including such variables as clinic staffing and record keeping. Methods All medical records for outpatients in 2007, handwritten by nurses, were collected from local clinics in Honiara, the capital of the Solomon Islands. The all-monthly clinical malaria cases were then recalculated. The corresponding monthly data in official statistics were provided by the government. Next, in order to estimate any data discrepancy, the ratio of the cases recorded at clinics to the cases reported to the government was determined on the monthly basis. Finally, the associations between the monthly discrepancy and other variables were evaluated by a multiple regression analysis. Results The mean data discrepancy between the records of clinics and government statistics was 21.2% (n = 96. Significant associations were observed between the discrepancy and the average number of patients (coefficient: 0.05, 95%CI: 0.31, 0.07, illegible handwriting (coefficient: 0.09, 95%CI: 0.04, 0.15, the use of tally sheets (coefficient:-0.38, 95%CI: -0.54, -0.22, and the clinic level (coefficient:-0.48, 95%CI:-0.89,-0.06. Conclusion The findings of this study demonstrate the huge data discrepancy between the records of clinics and

  11. The accuracy of clinical malaria case reporting at primary health care facilities in Honiara, Solomon Islands

    Science.gov (United States)

    Kunimitsu, Ayano

    2009-01-01

    Background The accuracy of malaria case reporting is challenging due to restricted human and material resources in many countries. The reporting often depends on the clinical diagnosis because of the scarcity of microscopic examinations. Particularly, clinical malaria case reporting by primary health care facilities (local clinics), which constitutes the baseline data of surveillance, has never previously been sufficiently evaluated. In order to improve the malaria reporting system to the level required to eventually eliminate this disease, this study estimates the gaps between the records of clinics and government statistics regarding the incidence of clinical malaria, and then also examines some factors that might explain the data discrepancy, including such variables as clinic staffing and record keeping. Methods All medical records for outpatients in 2007, handwritten by nurses, were collected from local clinics in Honiara, the capital of the Solomon Islands. The all-monthly clinical malaria cases were then recalculated. The corresponding monthly data in official statistics were provided by the government. Next, in order to estimate any data discrepancy, the ratio of the cases recorded at clinics to the cases reported to the government was determined on the monthly basis. Finally, the associations between the monthly discrepancy and other variables were evaluated by a multiple regression analysis. Results The mean data discrepancy between the records of clinics and government statistics was 21.2% (n = 96). Significant associations were observed between the discrepancy and the average number of patients (coefficient: 0.05, 95%CI: 0.31, 0.07), illegible handwriting (coefficient: 0.09, 95%CI: 0.04, 0.15), the use of tally sheets (coefficient:-0.38, 95%CI: -0.54, -0.22), and the clinic level (coefficient:-0.48, 95%CI:-0.89,-0.06). Conclusion The findings of this study demonstrate the huge data discrepancy between the records of clinics and government statistics in

  12. Case managers discuss ethics: dilemmas of an emerging occupation in long-term care in the United States.

    Science.gov (United States)

    Kane, R A; Penrod, J D; Kivnick, H Q

    1994-01-01

    As case management programs mature, ethical questions undoubtedly arise. Yet there are few, if any, standards by which case managers can guide their actions and decisions. In this article, the authors present the results of a survey of 251 frontline case managers in 10 states who were asked to describe the ethical challenges they face. The respondents were conscious of struggling with difficult, even life-and-death decisions involving important choices in their clients' lives. Generally, the case managers were committed to the ideology of respect for client autonomy but found themselves making uneasy compromises with the concept at every turn. Ethical issues arose not only with the client but also with the client's family, colleagues, and providers. Case managers, long-term care providers, and governmental policymakers could all benefit from both theoretical and practical explorations of desirable approaches to individual and societal long-term care decisions. PMID:8000320

  13. Seniors’ perspectives on care: a case study of the Alex Seniors health clinic, Calgary

    OpenAIRE

    Shaw, Marta; Rypien, Candace; Drummond, Neil; Harasym, Patricia; Nixon, Lara

    2015-01-01

    Background Primary care initiatives face an imperative to not only reduce barriers to care for their patients but also to uniquely accommodate the complex needs of at-risk patient populations. Patient-centered multidisciplinary care team models for primary care, like the Alex Seniors Clinic, are one approach for providing comprehensive care for marginalized seniors. The purpose of this qualitative study was to explore patient perspectives on the responsiveness of the Alex Seniors Clinic to th...

  14. Profile of Cancer Cases at a Tertiary Care Level Teaching Hospital in Rural Western Maharashtra, India

    Directory of Open Access Journals (Sweden)

    Jayant D Deshpande , Kailash K Singh , Deepak B Phalke

    2012-01-01

    Full Text Available Background: Cancer is one of the major public health problems worldwide. Prevalence and pattern of cancer is known to vary from region to region. Epidemiological information on cancer including the pattern is an important basis for determining the priorities for cancer control in any population group. Objective: Present work is an attempt to study magnitude, profile and some epidemiological aspects in relation to cancer cases at a tertiary care level teaching hospital in rural area. Method: All records were studied and analyzed. A total of 1106 patients were treated during the period studied. A proforma was used to collect data such as age, sex, place of residence, type of cancers and treatment given. The data collected were entered into MS-Excel sheets and analysis was carried out. The information obtained was tabulated analyzed using the software GraphPad Instat demo version. Results: A total of 1106 cancer patients were treated during the January 2010 to December 2010. Among these, 626(56.60 were females and 480(43.39 were females. In males, the common cancers were oral cavity cancers, lung cancers and GIT cancers. The most common cancers among females were the cervical carcinomas, which constituted 32.10% of the total number of cancers cases followed by cancers of breast. Almost 2/3rd of cases occurred in the age group of 41 to 70 years. Maximum frequency was observed in 51–60 year age group in both sexes. Maximum numbers (74.59% of the cases were from rural area. The main methods of cancer treatment were surgery, chemotherapy and radiotherapy, used alone or in combination. Conclusion: Tobacco and alcohol related cancers predominated in males. In females, cervical cancer predominated over breast cancer. Human behavior is a major determinant in the successful control of cancer. Understanding cancer magnitude, risk and trends will be of help in cancer control.

  15. Investigation on Demands of Medical and Health Care Personnel from Vocational Colleges in Guangxi%广西高职高专医疗卫生人才需求调查

    Institute of Scientific and Technical Information of China (English)

    冯艺萍

    2012-01-01

    设计统一用人单位招聘意向调查表,对广西区内102家医药类用人单位进行问卷调查。结果显示.99.02%的用人单位招聘需求呈持续增长的态势。招聘的专业类型受医院级别及规模的影响。各类型用人单位薪酬无显著性差异(P〉0.05),具有良好综合素质的毕业生受到用人单位的青睐。%Aim:To get the idea of employing units' demand status on the vocational medical and health care personnel under the new medical system in Guangxi, so as to provide reference for the personnel cultivation. Methods Carried out questionnaire survey on 102 regional recruitment units with uniform questionnaire of employment intent. Result.. The employing demand tendency of 99.02 % employing units is continuously increasing, the demand for the major types are related with the ranks and scales of the hospital, and no significant difference in the salary, and the graduates with good comprehensive quality are favored by recruit units. Conclusion: To cultivate highly talent, pragmatic individuals who are not afraid to get down to work and stay at it until the job is done well, vocational colleges still have more to do in renewing the education ideas and making adjustment in course content and teaching mode.

  16. Appraisal of cooperation with a palliative care case manager by general practitioners and community nurses: a cross-sectional questionnaire study.

    NARCIS (Netherlands)

    Plas, A.G.M. van der; Onwuteaka-Philipsen, B.D.; Vissers, K.C.; Deliens, L.; Jansen, W.J.J.; Francke, A.L.

    2016-01-01

    Aims: To investigate how general practitioners and community nurses value the support that they receive from a nurse case manager with expertise in palliative care, whether they think the case manager is helpful in realizing appropriate care and what characteristics of the patient and case managemen

  17. Individual fish rhythm directs group feeding: a case study with sea bass juveniles (Dicentrarchus labrax) under self-demand feeding conditions

    OpenAIRE

    Millot, Sandie; Begout, Marie-laure

    2009-01-01

    The long term influence of individual biological rhythms on group feed demand behaviour was investigated in European sea bass (Dicentrarchus labrax) held under controlled environmental conditions with an on-demand feeding system. The experiment was realized over 219 days with 190 fish distributed on 4 tanks. Sea bass had a mean body mass comprised between 139 g to 183 g. The number of feed demand acts by each individual was calculated daily, and the population could thus be partitioned into t...

  18. THE MANAGEMENT OF AN ADOLESCENT WITH CONDUCT PROBLEMS IN A PRIMARY CARE CLINIC – A CASE REPORT

    Directory of Open Access Journals (Sweden)

    KHAIRANI O

    2009-01-01

    Full Text Available Purpose: To describe the management of mild conduct problems in an adolescent at the primary care level. Case report: A 16 year old girl presented with conduct problems with impending school suspension. The cause of her behavioural problems was mainly related to poor parenting skills of her parents and anger in herself. She was successfully managed with counselling and improvement of parenting styles in her parents. Conclusion: This case report illustrates the opportunity for family physicians to manage simple conduct problems at primary care level.

  19. Demand elasticity increase for reducing social welfare losses due to transfer capacity restriction: A test case on Italian cross-border imports

    International Nuclear Information System (INIS)

    The paper is aimed at showing how demand-side policies for increasing inner demand elasticity could help in reducing market inefficiencies generated by transfer limits on interconnections, with a special regard to energy imports dependent countries. In order to develop the studies in a realistic environment, a model for the Italian electricity market has been developed. Test results show effects of variations in demand elasticity on the national social surplus and congestion costs. It will be shown how an increase of demand elasticity can counterbalance the need of additional transfer capacity in reducing cross-border congestions. (author)

  20. Analyzing the impacts of final demand changes on total output using input-output approach: The case of Japanese ICT sectors

    Science.gov (United States)

    Zuhdi, Ubaidillah

    2014-03-01

    The purpose of this study is to analyze the impacts of final demand changes on total output of Japanese Information and Communication Technologies (ICT) sectors in future time. This study employs one of analysis tool in Input-Output (IO) analysis, demand-pull IO quantity model, in achieving the purpose. There are three final demand changes used in this study, namely (1) export, (2) import, and (3) outside households consumption changes. This study focuses on "pure change" condition, the condition that final demand changes only appear in analyzed sectors. The results show that export and outside households consumption modifications give positive impact while opposite impact could be seen in import change.

  1. Cytopathology of neoplastic meningitis: A series of 66 cases from a tertiary care center

    Directory of Open Access Journals (Sweden)

    Gurdeep Singh

    2013-01-01

    Full Text Available Background: Neoplastic meningitis (NM is a condition characterized by leptomeningeal involvement by metastatic carcinoma. Detection of exfoliated malignant cells in cerebrospinal fluid (CSF due to meningeal metastasis is frequently associated with diverse neurologic presentations. Materials and Methods: In this retrospective study of all cases of NM diagnosed in CSF samples over a 20-year period at a tertiary care referral center, the cytomorphologic features were reviewed. Results: Sixty six cases of NM were identified of which 36 already had an established diagnosis of malignancy while in 30 patients, there was no previously known tumor. The most common known primary in the former group was breast followed by ovary. Single cell pattern, cellular cannibalism, moderate cytoplasm and rounded nuclei were seen in breast and lung tumors. Papillary architecture and cytoplasmic vacuolation were seen in the ovarian primaries. Melanin pigment was seen in malignant melanoma. Conclusion: CSF cytology is an important tool for diagnosis of NM. Cytomorphologic features helped in diagnosis and for prediction of the primary site. Correct identification of this condition is important as it has therapeutic and prognostic implications.

  2. Case management for patients with chronic systolic heart failure in primary care: The HICMan exploratory randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Kunz Cornelia U

    2010-05-01

    Full Text Available Abstract Background Chronic (systolic heart failure (CHF represents a clinical syndrome with high individual and societal burden of disease. Multifaceted interventions like case management are seen as promising ways of improving patient outcomes, but lack a robust evidence base, especially for primary care. The aim of the study was to explore the effectiveness of a new model of CHF case management conducted by doctors' assistants (DAs, equivalent to a nursing role and supported by general practitioners (GPs. Methods This patient-randomised controlled trial (phase II included 31 DAs and employing GPs from 29 small office-based practices in Germany. Patients with CHF received either case management (n = 99 consisting of telephone monitoring and home visits or usual care (n = 100 for 12 months. We obtained clinical data, health care utilisation data, and patient-reported data on generic and disease-specific quality of life (QoL, SF-36 and KCCQ, CHF self-care (EHFScBS and on quality of care (PACIC-5A. To compare between groups at follow-up, we performed analyses of covariance and logistic regression models. Results Baseline measurement showed high guideline adherence to evidence-based pharmacotherapy and good patient self-care: Patients received angiotensin converting enzyme inhibitors (or angiotensin-2 receptor antagonists in 93.8% and 95%, and betablockers in 72.2% and 84%, and received both in combination in 68% and 80% of cases respectively. EHFScBS scores (SD were 25.4 (8.4 and 25.0 (7.1. KCCQ overall summary scores (SD were 65.4 (22.6 and 64.7 (22.7. We found low hospital admission and mortality rates. EHFScBS scores (-3.6 [-5.7;-1.6] and PACIC and 5A scores (both 0.5, [0.3;0.7/0.8] improved in favour of CM but QoL scores showed no significant group differences (Physical/Mental SF-36 summary scores/KCCQ-os [95%CI]: -0.3 [-3.0;2.5]/-0.1 [-3.4;3.1]/1.7 [-3.0;6.4]. Conclusions In this sample, with little room for improvement regarding evidence

  3. Development and dissemination of collaborative family-oriented services: the case of community/day residential care in Israel.

    Science.gov (United States)

    Elizur, Yoel

    2012-03-01

    The initiation, development, and dissemination of family-oriented programs are a unifying thread that highlights family therapy's contribution to the fields of mental/physical health and social services. These demanding tasks require an ecosystemic vision, a supportive larger context, and a range of skills. This article delineates the evolution of community and day residential care in Israel by examining processes at different ecological levels: the formulation and implementation of national social policy, the follow-up of two family-oriented facilities, one of which thrived while the other eventually closed, and the residential care provided to 1 family with 3 children. The analysis of this multilevel data highlights 4 facilitating/obstructing factors that have had major impact on family-oriented programs: support by both national and local sociopolitical-professional administration, program's management autonomy, staff training, support and development, and effective facility leadership that establishes and nurtures family-oriented organizational structure and culture. PMID:22428716

  4. Case Study: Evidence-Based Interventions Enhancing Diabetic Foot Care Behaviors among Hospitalized DM Patients

    Directory of Open Access Journals (Sweden)

    Titis Kurniawan

    2011-01-01

    Full Text Available Background: Improving diabetic patients’ foot care behaviors is one of the most effective strategies in minimizing diabetic foot ulceration and its further negative impacts, either in diabetic hospitalized patients or outpatients.Purpose: To describe foot care knowledge and behaviors among hospitalized diabetic patients, to apply selected foot care knowledge and behaviors improvement evidence, and to evaluate its effectiveness.Method: Four diabetic patients who were under our care for at least three days and could communicate in Thai language were selected from a surgical ward in a university hospital. The authors applied educational program based on patients’ learning needs, provided diabetic foot care leaflet, and assisted patients to set their goal and action plans. In the third day of treatment, we evaluated patients’ foot care knowledge and their goal and action plan statements in improving foot care behaviors.Result: Based on the data collected among four hospitalized diabetic patients, it was shown that all patients needed foot care behaviors improvement and the educational program improved hospitalized patients’ foot care knowledge and their perceived foot care behaviors. The educational program that combined with goal setting and action plans method was easy, safe, and seemed feasibly applicable for diabetic hospitalized patients.Conclusion: The results of this study provide valuable information for improvement of hospitalized diabetic patients’ foot care knowledge and behaviors. The authors recommend nurses to use this evidence-based practice to contribute in improving the quality of diabetic care.Keywords: Intervention, diabetic foot care, hospitalized diabetic patients

  5. Investigation on Health Care Service Demand Among Elderly People in the Minority Area%少数民族地区老年人健康保健服务需求调查

    Institute of Scientific and Technical Information of China (English)

    陈先波; 叶亚怀; 高红; 金新政

    2011-01-01

    Objective To understand health care service demand among elderly people in the minority area, and to provide reference for enacting relevant measure.Method Cluster random sampling method was used to conduct a household survey on the elderly in Luoping Country, Yunnan.Result Only 30.0% of the elderly people who felt mild diseases went to community health service center or street health service center.Medical skill was chosen as a primary consideration of medical institutions in 30.9% participants.The most wanted health care services were self-help first -aid, real time health monitoring, regular examination,health education, and health record.Conclusion It is urgent to improve the community health service system to meet the increasing demand of health care service among the elderly population in the minority area.%目的 了解少数民族地区老年人健康服务需求状况,为制定相关措施提供参考.方法 采用整群随机抽样的方法,对云南省罗平县的老年人进行入户问卷调查.用PASW Statistics 18.0统计软件进行分析处理.结果老年人选择到社区、街道卫生服务中心就诊仅占30.0%,将医疗水平作为选择就诊要考虑因素的响应比为30.9%,最希望得到的健康保健服务项目是自助呼救、健康实时监测、定期检查、健康教育、健康档案等.结论 急需完善社区卫生服务体系以满足少数民族地区老年人较高的健康保健服务需求.

  6. Dwellers' health care consciousness and community nursing demand in suburb of Jiujiang city%郊区居民保健意识及社区护理需求调查

    Institute of Scientific and Technical Information of China (English)

    廖晓春

    2009-01-01

    目的 调查江西省九江市市郊农村居民健康保健意识、社区护理需求等.方法 采用问卷调查法,于2008年3-5月抽取九江市市郊2个村的农村家庭进行问卷调查.结果 农村居民健康知识缺乏,居民迫切需要的社区护理项目有5项,分别为一般常见病的简单处理241人,占87.2%;社区紧急救护251人,占86.6%;社区的健康教育250人,占86.2%;老年慢性病护理253人,占83.1%;上门基础护理232人,占80.0%.结论 农村居民保健意识有待提高,社区护理需求大,应结合地区特点,尽快加强农村社区护理服务.%Objective To study the dwellers' health care consciousness and community nursing demand in suburb of Jiujiang city. Methods Dwellers from two different villages were interviewed at their home with questionnaires during March to May of 2008. Results The dwellers were deficient in health care consciousness. There were five most urgent needs of community nursing programs: simple handling of the common diseases(87.2%), first aid in community(86. 6%); community health education (86. 2%), chronic illness nursing for old people (83. 1%) and basic nursing at home (80. 0%). Conclusion The dwellers' health care consciousness ought to be improved. Dwellers' demand of community nursing is enormous. Suburb community nursing ought to be strengthened according to district's characteristic.

  7. An Ode to Stuart Hall's "The Supply of Demand": The Case of Post-Secondary Education in Ontario Fifty Years Later

    Science.gov (United States)

    FitzGerald Murphy, Maggie

    2016-01-01

    Despite the fact that over fifty years have passed since its publication, Stuart Hall's article "The Supply of Demand" (1960), is remarkably relevant today. The central message that society must not be blinded by "prosperity" such that it no longer envisions and demands a better world is especially pertinent in light of the…

  8. An Econometric Analysis of Electricity Demand Response to Price Changes at the Intra-Day Horizon: The Case of Manufacturing Industry in West Denmark

    DEFF Research Database (Denmark)

    Møller, Niels Framroze; Møller Andersen, Frits

    2015-01-01

    The use of renewable energy implies a more variable supply of power. Market effciency may improve if demand can absorb some of this variability by being more flexible, e.g. by responding quickly to changes in the market price of power. To learn about this, in particular, whether demand responds a...

  9. VESICOVAGINAL FISTULA: OUR EXPERIENCE OF 47 CASES IN A TERTIARY CARE HOSPITAL OF WEST BENGAL

    Directory of Open Access Journals (Sweden)

    Biswajit

    2016-06-01

    Full Text Available Vesicovaginal Fistula (VVF, an abnormal communication between the urinary bladder and vagina, is one of the most distressing and embarrassing health problem for the ladies. The present observational study was planned to inquire into the demographic and aetiologic pattern of vesicovaginal fistula and the long-term success rate of its surgical management following different techniques of repair in a tertiary care centre of West Bengal, India. MATERIAL AND METHODS A total of 47 patients with vesicovaginal fistula presented at our hospital over a span of nine years, were observed during their course of treatment. The patients were evaluated with clinical history, physical examination, routine laboratory investigations, intravenous urogram and cystoscopy. Then the patients had undergone operation by vaginal or abdominal route. Patients were discharged from the hospital with per urethral catheter. On 21st post-operative day, routine cystogram was done in every patient before catheter removal to exclude the failure of the operation. RESULT Of the observed 47 patients, 66% were tracked back to their obstetric causes and 34% patients could be linked up to gynaecological aetiology like a complication of hysterectomy or after brachytherapy for carcinoma of cervix. In 23.4% of patients, the repair of fistula was done by vaginal route, whereas in 76.6% cases by abdominal approach. Overall success rate of surgical repair was 87.3%, which is comparable to the success rate mentioned in literature. CONCLUSION In spite of a decline in the incidence of vesicovaginal fistula in the western world, it is still highly prevalent in the developing countries. Prolonged obstructive labour was found as the most common aetiology of this devastating condition in our region. Timely intervention with meticulous surgical technique is essential for an acceptable success rate in fistula repair surgery. However, improved obstetric care, institutional delivery, high literacy rate

  10. Observation on dengue cases from a virus diagnostic laboratory of a tertiary care hospital in north India

    OpenAIRE

    Om Prakash; Desh Deepak Singh; Geetika Mishra; Shantanu Prakash; Arvind Singh; Shikha Gupta; Jasmeet Singh; Danish Nasar Khan; Parul Jain; Anamika Vishal; Manoj Kumar Pandey; Amita Jain

    2015-01-01

    Background & objectives: The epidemiology of dengue fever (DF) is complex in the Indian subcontinent as all the four serotypes are circulating. This study reports observations on dengue cases from a virus diagnostic laboratory of a north Indian tertiary care hospital catering to areas in and around Lucknow, Uttar Pradesh. Methods: Serum samples were obtained from suspected cases of dengue referred to the virus diagnostic laboratory during 2011 to 2013, and detailed history was taken on a ...

  11. Clinical characteristics and outcomes of patients with acute myelogenous leukemia admitted to intensive care: a case-control study

    OpenAIRE

    Roze des Ordons, Amanda L; Chan, Kris; Mirza, Imran; Townsend, Derek R; Bagshaw, Sean M

    2010-01-01

    Background There is limited epidemiologic data on patients with acute myelogenous (myeloid) leukemia (AML) requiring life-sustaining therapies in the intensive care unit (ICU). Our objectives were to describe the clinical characteristics and outcomes in critically ill AML patients. Methods This was a retrospective case-control study. Cases were defined as adult patients with a primary diagnosis of AML admitted to ICU at the University of Alberta Hospital between January 1st 2002 and June 30th...

  12. Familial Dysautonomia, Report of 3 Cases from Iran and a Discussion about Their General and Anaesthesia Care

    Directory of Open Access Journals (Sweden)

    Badiozaman Radpay

    2015-04-01

    Full Text Available Background: Familial Dysautonomia (FD is a rare hereditary syndrome which is an autosomal recessive trait that typically affects Jewish children. Important signs and symptoms of the disorder include; diminished pain perception, absence of overflow tears, hypotonia, fainting cardiac arrhythmias and autonomic crisis.Cases Report: In this article we reported 3 cases of FD syndrome which had presented for surgical operation followed by a discussion about general care of these patients as well as Anesthesia considerations.

  13. Familial Dysautonomia, Report of 3 Cases from Iran and a Discussion about Their General and Anaesthesia Care

    OpenAIRE

    Badiozaman Radpay; Mahtab Poor Zamany Nejat Kermany; Ali Asghar Halimi-Asl

    2015-01-01

    Background: Familial Dysautonomia (FD) is a rare hereditary syndrome which is an autosomal recessive trait that typically affects Jewish children. Important signs and symptoms of the disorder include; diminished pain perception, absence of overflow tears, hypotonia, fainting cardiac arrhythmias and autonomic crisis.Cases Report: In this article we reported 3 cases of FD syndrome which had presented for surgical operation followed by a discussion about general care of these patients as well as...

  14. Holistic approach to management of innovation : a home care case study

    OpenAIRE

    Borgiel, Katarzyna; Latortue, Xavier; Minel, Stéphanie; Merlo, Christophe

    2013-01-01

    Introduction of information and communication technologies (ICT) in home care organizations is seen as a way of improving work efficiency and care quality. In recent years many research project have been undertaken in order to create models of existing processes and to design appropriate technological tools. This paper argues for the need of global and systemic approach for innovation management in home care in relation to the implementation of ICT devices. After describing the home care acti...

  15. Cost recovery of NGO primary health care facilities: a case study in Bangladesh

    OpenAIRE

    Alam Khurshid; Ahmed Shakil

    2010-01-01

    Abstract Background Little is known about the cost recovery of primary health care facilities in Bangladesh. This study estimated the cost recovery of a primary health care facility run by Building Resources Across Community (BRAC), a large NGO in Bangladesh, for the period of July 2004 - June 2005. This health facility is one of the seven upgraded BRAC facilities providing emergency obstetric care and is typical of the government and private primary health care facilities in Bangladesh. Give...

  16. Economic crisis and counter-reform of universal health care systems: Spanish case

    OpenAIRE

    Paulo Antônio de Carvalho Fortes; Regina Ribeiro Parizi Carvalho; Marília Cristina Prado Louvison

    2015-01-01

    The economic crisis that has been affecting Europe in the 21st century has modified social protection systems in the countries that adopted, in the 20th century, universal health care system models, such as Spain. This communication presents some recent transformations, which were caused by changes in Spanish law. Those changes relate to the access to health care services, mainly in regards to the provision of care to foreigners, to financial contribution from users for health care services, ...

  17. Transforming Medical Care: Case Study of an Exemplary, Small Medical Group

    OpenAIRE

    Solberg, Leif I.; Hroscikoski, Mary C.; Sperl-Hillen, JoAnn M.; Harper, Peter G.; Crabtree, Benjamin F.

    2006-01-01

    PURPOSE Most published descriptions of organizations providing or improving quality of care concern large medical groups or systems; however, 90% of the medical care in the United States is provided by groups of no more than 20 physicians. We studied one such group to determine the organizational and cultural attributes that seem related to its achievements in care quality.

  18. Depression case management by practice nurses in primary care: an audit

    OpenAIRE

    Ekers, David; Wilson, Rea

    2008-01-01

    Introduction Depression is a common and debilitating condition. A body of evidence exists about improving depression outcomes in primary care, using collaborative care models. Such approaches, however, have not been routinely adopted within general practice settings. In this paper we outline the results of an audit of an enhanced care initiative that trained practice nurses to deliver such approaches.

  19. Process evaluation to explore internal and external validity of the "Act in Case of Depression" care program in nursing homes.

    NARCIS (Netherlands)

    Leontjevas, R.; Gerritsen, D.L.; Koopmans, R.T.C.M.; Smalbrugge, M.; Vernooij-Dassen, M.J.F.J.

    2012-01-01

    BACKGROUND: A multidisciplinary, evidence-based care program to improve the management of depression in nursing home residents was implemented and tested using a stepped-wedge design in 23 nursing homes (NHs): "Act in case of Depression" (AiD). OBJECTIVE: Before effect analyses, to evaluate AiD proc

  20. Case management for high-intensity service users: towards a relational approach to care co-ordination.

    Science.gov (United States)

    McEvoy, Phil; Escott, Diane; Bee, Penny

    2011-01-01

    This study is based on a formative evaluation of a case management service for high-intensity service users in Northern England. The evaluation had three main purposes: (i) to assess the quality of the organisational infrastructure; (ii) to obtain a better understanding of the key influences that played a role in shaping the development of the service; and (iii) to identify potential changes in practice that may help to improve the quality of service provision. The evaluation was informed by Gittell's relational co-ordination theory, which focuses upon cross-boundary working practices that facilitate task integration. The Assessment of Chronic Illness Care Survey was used to assess the organisational infrastructure and qualitative interviews with front line staff were conducted to explore the key influences that shaped the development of the service. A high level of strategic commitment and political support for integrated working was identified. However, the quality of care co-ordination was variable. The most prominent operational factor that appeared to influence the scope and quality of care co-ordination was the pattern of interaction between the case managers and their co-workers. The co-ordination of patient care was much more effective in integrated co-ordination networks. Key features included clearly defined, task focussed, relational workspaces with interactive forums where case managers could engage with co-workers in discussions about the management of interdependent care activities. In dispersed co-ordination networks with fewer relational workspaces, the case managers struggled to work as effectively. The evaluation concluded that the creation of flexible and efficient task focused relational workspaces that are systemically managed and adequately resourced could help to improve the quality of care co-ordination, particularly in dispersed networks. PMID:21143543

  1. The evaluation of cases with pneumothorax in the neonatal intensive care unit

    Directory of Open Access Journals (Sweden)

    Müsemma Karabel

    2013-09-01

    Full Text Available Objectives: Early diagnosis and treatment is essentialin reducing mortality in newborns with pneumothorax. Inthis study, newborns with a diagnosis of pneumothorax inneonatal intensive care unit of our hospital were evaluatedand aimed to increase the awareness of physicians.Methods: 12 cases with pneumothorax were evaluatedretrospectively. The gender, birth weight, gestational age,mode of delivery, the presence of underlying disease,pneumothorax localization, implementation of the surfactantand mechanical ventilation and existence or absenceof mortality were recorded.Results: During the study, pneumothorax was detected12 patients. Male/female ratio was 1.4. Eight of the patientshad born with cesarean delivery, the mean birthweight of cases was 2623±912 g and, 66.7% of caseswere term babies. Pneumothorax was observed in thefirst week of life in all patients and it occurred spontaneouslyin 4 patients. The frequency of bilateral pneumothoraxwas 41.7%. For the treatment, closed tube drainagewas performed in 9 patients. The overall mortality ratewas 66.7%. Half of the patients who died had congenitalanomalies such as diaphragmatic eventration (n=1,hydrocephalus (n=1, encephalocel (n=1, non-immunehydrops fetalis (n=1.Conclusion: Additional congenital anomalies, such asPDAs and persistent pulmonary hypertension were foundto be effective on mortality in neonates with pneumothorax.Although, it is a life-threatening condition, the emergencytreatment is life saving. Therefore, in patients withrisk factors, keeping pneumothorax in mind is also thefirst step of the treatment. J Clin Exp Invest 2013; 4 (3:289-292Key words: Newborn, respiratuar distress, pneumothorax,treatment, outcome

  2. A retrospective study of 296 cases of intra uterine fetal deaths at a tertiary care centre

    Directory of Open Access Journals (Sweden)

    Neetu Singh

    2013-04-01

    Full Text Available Background: To identify the risk factors and to streamline preventive and management protocols for IUD. Methods: This was a retrospective study from January 2011 to December 2012 which was conducted at G.S.V.M. Medical College, Kanpur. IUD was defined as fetal death beyond 20 weeks of gestation and/or birth weight > 500g. Maternal and fetal records were analysed. Mode of delivery and associated complications were studied. Results: Total number of deliveries were 7310.Incidence of IUD at our centre was 40 per 1000. 55.73% were antepartum and 11.06% were intra partum. In 33.44% cases, no causes were identified. Among the identifiable causes, very severe anemia (16.55% and hypertensive disorders (10.81% were most common followed by placental causes (12.16%.Congenital malformations were responsible for 9.45% cases .Induction was done in 151 patients,111 patients had spontaneous onset of labour and caesarean section was done in 34 patients. The most devastating complication of IUD was DIC found in 14 patients (3.71%. Conclusions: The present study is an effort to compile a profile of maternal, fetal and placental causes culminating to IUD at our centre. This emphasizes the importance of proper antenatal care and identification of risk factors and its treatment. Institutional deliveries should be promoted to prevent intrapartum fetal deaths .A substantial number of IUD are still labeled as unexplained, hence cannot be prevented. Decrease in the incidence of IUD would significantly reduce the perinatal mortality. [Int J Reprod Contracept Obstet Gynecol 2013; 2(2.000: 141-146

  3. Efficiency and quality of care in nursing homes: an Italian case study.

    Science.gov (United States)

    Garavaglia, Giulia; Lettieri, Emanuele; Agasisti, Tommaso; Lopez, Silvano

    2011-03-01

    This study investigates efficiency and quality of care in nursing homes. By means of Data Envelopment Analysis (DEA), the efficiency of 40 nursing homes that deliver their services in the north-western area of the Lombardy Region was assessed over a 3-year period (2005-2007). Lombardy is a very peculiar setting, since it is the only Region in Italy where the healthcare industry is organised as a quasi-market, in which the public authority buys health and nursing services from independent providers-establishing a reimbursement system for this purpose. The analysis is conducted by generating bootstrapped DEA efficiency scores for each nursing home (stage one), then regressing those scores on explanatory variables (stage two). Our DEA model employed two input (i.e. costs for health and nursing services and costs for residential services) and three output variables (case mix, extra nursing hours and residential charges). In the second-stage analysis, Tobit regressions and the Kruskall-Wallis tests of hypothesis to the efficiency scores were applied to define what are the factors that affect efficiency: (a) the ownership (private nursing houses outperform their public counterparts); and (b) the capability to implement strategies for labour cost and nursing costs containment, since the efficiency heavily depends upon the alignment of the costs to the public reimbursement system. Lastly, even though the public institutions are less efficient than the private ones, the results suggest that public nursing homes are moving towards their private counterparts, and thus competition is benefiting efficiency. PMID:20922483

  4. Up against the System: A Case Study of Young Adult Perspectives Transitioning from Pediatric Palliative Care

    Directory of Open Access Journals (Sweden)

    Karen Cook

    2013-01-01

    Full Text Available Advances in pediatric care have not provided the interdisciplinary support services required by those young adults with pediatric life-threatening conditions (pedLTCs who live beyond childhood but have limited expectations to live past early adulthood. These young adults, the first generation to live into adulthood, face multiple challenges transitioning from a plethora of pediatric palliative services to scant adult health services. In a case study, using an innovative bulletin board focus group, we describe the complex interplay of the health, education, and social service sectors in this transition. Our descriptions include system deficits and strengths and the young adults’ resilience and coping strategies to overcome those deficits and move forward with their lives. Young adults with pedLTC need knowledgeable providers, coordinated and accessible services, being respected and valued, and services and supports that promote independence. We recommend implementation of multidisciplinary solutions that are focused on young adult priorities to ensure seamless access to resources to support these young adults’ health, educational, vocational, and social goals. The input and voice of young adults in the development of these services are imperative to ensure that multisystem services support their needs and life goals.

  5. Retrospective study of severe cases of leptospirosis admitted in the intensive care unit

    Directory of Open Access Journals (Sweden)

    Ittyachen A

    2007-01-01

    Full Text Available Objectives: Evaluate patient demographics, risk factors, complications, seropositivity, treatment and outcome among leptospirosis patients. Design: Retrospective analysis of 104 patients admitted in the intensive care unit (ICU with a clinical suspicion of leptopirosis. Setting: Ten-bedded medical ICU in a medical school situated in a rural area endemic for leptospirosis. Main Outcome Measures: Seropositivity for leptospirosis, patient demographics, risk factors, complications, treatment and survival. Results: One hundred and four patients were admitted with a clinical suspicion of leptospirosis. Fifty-three (50.7% were serologically confirmed cases. Males dominated both groups. Most of the admissions were in the monsoon season. Exposure to moist soil was the main risk factor. The mortality in the seronegative group was 26.8% while it was only 3.8% in the seropositive group. Multi-organ dysfunction syndrome, primarily acute respiratory distress syndrome with thromboctyopenia and renal failure were the causes for mortality. All the patients who died presented late into the illness. Conclusions: The initial diagnosis of leptospirosis depends on a high index of clinical suspicion, routinely available diagnostic tests being unreliable in the initial period. A reliable, unsophisticated test should be developed for early detection of this disease. As leptospirosis in its early stage mimics other tropical infections, both medical professionals and the general public (especially with risk of occupational exposure should be educated about the disease and the need to seek early medical intervention.

  6. DOES GENERIC ADVERTISING WRAP DEMAND CURVATURE?

    OpenAIRE

    Weaver, Robert D.; Chin, Ming-Chin

    2002-01-01

    This paper reconsiders the impacts of generic advertising on commodity prices that may be induced through demand effects. Rather than considering a simple demand shift, we consider the possibility that advertising leads to a change in the curvature of the demand curve. In this case, generic advertising is shown to affect both the level of market prices as well as their volatility. Based on parametric tests, we find that the demand elasticity appears to be affected by the intensity of generic ...

  7. Oferta e demanda por média complexidade/SUS: relação com atenção básica Supply and demand of the medium-complexity/SUS: relation with primary health care

    Directory of Open Access Journals (Sweden)

    Maria Raquel Gomes Maia Pires

    2010-06-01

    Full Text Available Investiga-se a configuração da oferta e demanda por serviços de média complexidade do Distrito Federal (DF e municípios de Goiás próximos à Brasília - entorno. Nossa hipótese é de que a organização da oferta dos serviços de atenção básica (AB do DF e entorno sobrecarrega os serviços de média complexidade (MC, diminuindo a equidade no acesso. Objetivamos analisar a demanda por serviços de MC no DF e sua relação com a AB; quantificar a procedência, problema de saúde, motivo da procura, tempo de deslocamento e procedimentos realizados em pessoas que buscam atendimento nos hospitais do DF; indicar prioridades de mudanças na gestão do SUS para ampliação do acesso. Avaliação por triangulação de métodos, complementaridade das abordagens qualitativa e quantitativa. Estudo da oferta mediante análise dos sistemas de informação do SUS e da demanda por meio de survey com 1.585 usuários de sete hospitais do DF. Ocorre subutilização da oferta de serviços do DF, com duplicidade de ações básicas entre os hospitais e os centros de saúde. Recomenda-se revisão na regionalização e hierarquização dos serviços de saúde do DF e Goiás, bem como investimentos na incorporação de tecnologias para a atenção básica.This work aims at investigating the supply and demand of the medium-complexity services from the Federal District and surrounding municipalities from the state of Goiás. Our hypothesis is that the services organization offer of primary care (PC from the Federal District (DF and its surroundings overloads the medium-complexity services (MC, contributing to less equity in terms of communities access. Our objective is to analyze the demand for MC (medium-complexity services in DF (Federal District and its relation with PC (Primary Care; to quantify the origin, health problem, reason, transportation time and performed procedures of the ones who go to the Federal District hospitals; to set up priorities of

  8. Analyzing the impacts of final demand changes on total output using input-output approach: The case of Japanese ICT sectors

    International Nuclear Information System (INIS)

    The purpose of this study is to analyze the impacts of final demand changes on total output of Japanese Information and Communication Technologies (ICT) sectors in future time. This study employs one of analysis tool in Input-Output (IO) analysis, demand-pull IO quantity model, in achieving the purpose. There are three final demand changes used in this study, namely (1) export, (2) import, and (3) outside households consumption changes. This study focuses on ''pure change'' condition, the condition that final demand changes only appear in analyzed sectors. The results show that export and outside households consumption modifications give positive impact while opposite impact could be seen in import change

  9. Rationing in the intensive care unit in case of full bed occupancy: a survey among intensive care unit physicians

    OpenAIRE

    Oerlemans, Anke J. M.; Wollersheim, Hub; van Sluisveld, Nelleke; van der Hoeven, Johannes G; Dekkers, Wim J. M.; Zegers, Marieke

    2016-01-01

    Background Internationally, there is no consensus on how to best deal with admission requests in cases of full ICU bed occupancy. Knowledge about the degree of dissension and insight into the reasons for this dissension is lacking. Information about the opinion of ICU physicians can be used to improve decision-making regarding allocation of ICU resources. The aim of this study was to: Assess which factors play a role in the decision-making process regarding the admission of ICU patients; Asse...

  10. Estimation of the building energy loads and LNG demand for a cogeneration-based community energy system: A case study in Korea

    International Nuclear Information System (INIS)

    Highlights: • We estimated energy demand of building groups in a town using an in-house tool. • We developed an operation simulator to match supply–demand processes of energy. • Detailed technological information to operate the CES is provided by the simulation. • LNG demand is forecasted for the expansion of the CES up to 14 years in the future. - Abstract: We analyzed energy consumption by a newly constructed part of a city in Korea to forecast the LNG demand for 14 years. The electricity, heating, cooling, and hot-water demands for a cogeneration-based CES (Community Energy System) accommodating 86,000 people in 29,000 houses are estimated using load models developed through direct measurements and statistical surveys. Based on published occupancy rates and forecasts of the rate of increase in energy consumption by third parties through independent study, the energy demands were driven in the form of 8760-h time series for each of the 14 years. Next, we simulate the demand–supply matching processes of a specifically chosen cogeneration engine for the CES to forecast the LNG consumption and the electricity trade for each year. We simulated the demand–supply matching processes with an automation tool specifically developed for this study. The methodology we established in this study can be applied to similar problems which may arise anywhere in the world

  11. Severe imported malaria in an intensive care unit: a review of 59 cases

    Directory of Open Access Journals (Sweden)

    Santos Lurdes C

    2012-03-01

    Full Text Available Abstract Background In view of the close relationship of Portugal with African countries, particularly former Portuguese colonies, the diagnosis of malaria is not a rare thing. When a traveller returns ill from endemic areas, malaria should be the number one suspect. World Health Organization treatment guidelines recommend that adults with severe malaria should be admitted to an intensive care unit (ICU. Methods Severe cases of malaria in patients admitted to an ICU were reviewed retrospectively (1990-2011 and identification of variables associated with in-ICU mortality performed. Malaria prediction score (MPS, malaria score for adults (MSA, simplified acute physiology score (SAPSII and a score based on WHO's malaria severe criteria were applied. Statistical analysis was performed using StataV12. Results Fifty nine patients were included in the study, all but three were adults; 47 (79,6% were male; parasitaemia on admission, quantified in 48/59 (81.3% patients, was equal or greater than 2% in 47 of them (97.9%; the most common complications were thrombocytopaenia in 54 (91.5% patients, associated with disseminated intravascular coagulation (DIC in seven (11.8%, renal failure in 31 (52.5% patients, 18 of which (30.5% oliguric, shock in 29 (49.1% patients, liver dysfunction in 27 (45.7% patients, acidaemia in 23 (38.9% patients, cerebral dysfunction in 22 (37.2% patients, 11 of whom with unrousable coma, pulmonary oedema/ARDS in 22 (37.2% patients, hypoglycaemia in 18 (30.5% patients; 29 (49.1% patients presented five or more dysfunctions. The case fatality rate was 15.2%. Comparing the four scores, the SAPS II and the WHO score were the most sensitive to death prediction. In the univariate analysis, death was associated with the SAPS II score, cerebral malaria, acute renal and respiratory failure, DIC, spontaneous bleeding, acidosis and hypoglycaemia. Age, partial immunity to malaria, delay in malaria diagnosis and the level of parasitaemia were

  12. Intensive medical student involvement in short-term surgical trips provides safe and effective patient care: a case review

    Directory of Open Access Journals (Sweden)

    Macleod Jana B

    2011-09-01

    Full Text Available Abstract Background The hierarchical nature of medical education has been thought necessary for the safe care of patients. In this setting, medical students in particular have limited opportunities for experiential learning. We report on a student-faculty collaboration that has successfully operated an annual, short-term surgical intervention in Haiti for the last three years. Medical students were responsible for logistics and were overseen by faculty members for patient care. Substantial planning with local partners ensured that trip activities supplemented existing surgical services. A case review was performed hypothesizing that such trips could provide effective surgical care while also providing a suitable educational experience. Findings Over three week-long trips, 64 cases were performed without any reported complications, and no immediate perioperative morbidity or mortality. A plurality of cases were complex urological procedures that required surgical skills that were locally unavailable (43%. Surgical productivity was twice that of comparable peer institutions in the region. Student roles in patient care were greatly expanded in comparison to those at U.S. academic medical centers and appropriate supervision was maintained. Discussion This demonstration project suggests that a properly designed surgical trip model can effectively balance the surgical needs of the community with an opportunity to expose young trainees to a clinical and cross-cultural experience rarely provided at this early stage of medical education. Few formalized programs currently exist although the experience above suggests the rewarding potential for broad-based adoption.

  13. Capacity of middle management in health-care organizations for working with people—the case of Slovenian hospitals

    OpenAIRE

    Skela Savič, Brigita; Robida, Andrej

    2013-01-01

    Background Effective human resources management plays a vital role in the success of health-care sector reform. Leaders are selected for their clinical expertise and not their management skills, which is often the case at the middle-management level. The purpose of this study was to examine the situation in some fields that involve working with people in health-care organizations at middle-management level. Methods The study included eight state-owned hospitals in Slovenia. A cross-sectional ...

  14. Doença de alzheimer e demandas de cuidados: o que os enfermeiros sabem? Mal de Alzheimer y demandas de cuidados: ¿Cuánto saben los enfermeros? Alzheimer diseases and care demands: what do nurses know?

    Directory of Open Access Journals (Sweden)

    Silvana Poltroniere

    2011-06-01

    is to unveil nurses' knowledge of Alzheimer's Diseases (AD and the demands of care for patients and their families. It is a descriptive and exploratory study with a qualitative approach. Data were collected through semistructured interviews. Data saturation occurred after interviewing eleven nurses in two private hospitals. Six categories emerged from the content analysis: AD characterization, risk factors, ways to diagnose, complications, treatment medication, patient and family care. It was observed that nurses have partial knowledge regarding AD, focusing their care action only on the clinical changes of the cause of admission. They recognize signs and symptoms but show themselves only as supporting assistants when they should act more autonomously while dealing with care demands and family support.

  15. Towards healthcare business intelligence in long-term care: an explorative case study in the Netherlands.

    OpenAIRE

    Spruit, M; Vroon, R.; Batenburg, R.

    2014-01-01

    This research contributes to the domain of long-term care by exploring knowledge discovery techniques based on a large dataset and guided by representative information needs to better manage both quality of care and financial spendings, as a next step towards more mature healthcare business intelligence in long-term care. We structure this exploratory research according to the steps of the CRoss Industry Standard Process for Data Mining (CRISP-DM) process. Firstly, we interview 22 experts to ...

  16. The Nordic maintenance care program – case management of chiropractic patients with low back pain: A survey of Swedish chiropractors

    Directory of Open Access Journals (Sweden)

    Jørgensen Kristian

    2008-06-01

    Full Text Available Abstract Background Chiropractic treatment for low back pain (LBP can often be divided into two phases: Initial treatment of the problem to attempt to remove pain and bring it back into its pre-clinical or maximum improvement status, and "maintenance care", during which it is attempted to maintain this status. Although the use of chiropractic maintenance care has been described and discussed in the literature, there is no information as to its precise indications. The objective of this study is to investigate if there is agreement among Swedish chiropractors on the overall patient management for various types of LBP-scenarios, with a special emphasis on maintenance care. Method The design was a mailed questionnaire survey. Members of the Swedish Chiropractors' Association, who were participants in previous practice-based research, were sent a closed-end questionnaire consisting of nine case scenarios and six clinical management alternatives and the possibility to create one's own alternative, resulting in a "nine-by-seven" table. The research team defined its own pre hoc choice of "clinically logical" answers based on the team's clinical experience. The frequency of findings was compared to the suggestions of the research team. Results Replies were received from 59 (60% of the 99 persons who were invited to take part in the study. A pattern of self-reported clinical management strategies emerged, largely corresponding to the "clinically logical" answers suggested by the research team. In general, patients of concern would be referred out for a second opinion, cases with early recovery and without a history of previous low back pain would be quickly closed, and cases with quick recovery and a history of recurring events would be considered for maintenance care. However, also other management patterns were noted, in particular in the direction of maintenance care. Conclusion To a reasonable extent, Swedish chiropractors participating in this

  17. Economic crisis and counter-reform of universal health care systems: Spanish case

    Science.gov (United States)

    Fortes, Paulo Antônio de Carvalho; Carvalho, Regina Ribeiro Parizi; Louvison, Marília Cristina Prado

    2015-01-01

    The economic crisis that has been affecting Europe in the 21st century has modified social protection systems in the countries that adopted, in the 20th century, universal health care system models, such as Spain. This communication presents some recent transformations, which were caused by changes in Spanish law. Those changes relate to the access to health care services, mainly in regards to the provision of care to foreigners, to financial contribution from users for health care services, and to pharmaceutical assistance. In crisis situations, reforms are observed to follow a trend which restricts rights and deepens social inequalities. PMID:26083942

  18. Economic crisis and counter-reform of universal health care systems: Spanish case

    Directory of Open Access Journals (Sweden)

    Paulo Antônio de Carvalho Fortes

    2015-01-01

    Full Text Available The economic crisis that has been affecting Europe in the 21st century has modified social protection systems in the countries that adopted, in the 20th century, universal health care system models, such as Spain. This communication presents some recent transformations, which were caused by changes in Spanish law. Those changes relate to the access to health care services, mainly in regards to the provision of care to foreigners, to financial contribution from users for health care services, and to pharmaceutical assistance. In crisis situations, reforms are observed to follow a trend which restricts rights and deepens social inequalities.

  19. Economic crisis and counter-reform of universal health care systems: Spanish case.

    Science.gov (United States)

    Fortes, Paulo Antônio de Carvalho; Carvalho, Regina Ribeiro Parizi; Louvison, Marília Cristina Prado

    2015-01-01

    The economic crisis that has been affecting Europe in the 21st century has modified social protection systems in the countries that adopted, in the 20th century, universal health care system models, such as Spain. This communication presents some recent transformations, which were caused by changes in Spanish law. Those changes relate to the access to health care services, mainly in regards to the provision of care to foreigners, to financial contribution from users for health care services, and to pharmaceutical assistance. In crisis situations, reforms are observed to follow a trend which restricts rights and deepens social inequalities. PMID:26083942

  20. Diabetes Case Management in Primary Care: The New Brunswick Experience and Expanding the Practice of the Certified Diabetes Educator Nurse into Primary Care.

    Science.gov (United States)

    Jones, Shelley L

    2015-08-01

    The role of the outreach diabetes case manager in New Brunswick, Canada, was first developed in the Moncton Area of Horizon Health Network in response to a physician-identified gap between patients' diagnoses of diabetes and their attendance at the local diabetes education centre. This model of collaborative interprofessional practice increases support for primary care providers and people living with diabetes in that they are being provided the services of certified diabetes educators who can address knowledge gaps with respect to evidence-based guidelines and best practice, promote advancement of diabetes and chronic-disease management therapies and support adherence to treatment plans and self-management practices. This report chronicles a review of the implementation, expansion and evaluation of the outreach diabetes case manager model in the province of New Brunswick, Canada, along with the rationale for development of the role for registered nurses in other jurisdictions. PMID:25797113

  1. [Three cases of lung cancer presenting with spinal cord paralysis as the initial manifestation-symptom control, nursing care, and coordination of home medical care].

    Science.gov (United States)

    Isono, Hisayo; Hayakawa, Naoko; Inoue, Akiko; Onose, Akira

    2013-12-01

    Bone metastasis from lung cancer accounts for approximately 30% of all metastatic bone tumors. The median survival time of patients with stage IV lung cancer with bone metastases is 5.5 months and that of patients without bone metastases is 7.5 months. Here, we report 3 cases of spinal cord paralysis. All cases were assessed according to the Tokuhashi score. As the predicted survival time of these patients was mental health care), and coordinated home medical care. Patient management was mediated by a multidisciplinary medical team. However, all 3 patients were unable to return home and died in the hospital within 1-2 months after the onset of spinal cord paralysis. Spinal metastases can be expected not only in patients with lung cancer but also in patients with other types of carcinomas. Early diagnosis and treatment and accurate prognosis prediction are essential. Rapid responses and cooperation from experts are required, and increased awareness regarding spinal metastases among health professionals is essential. PMID:24712141

  2. Simulation of Electricity Demand Function in Agricultural Sector: An Application of Genetic Algorithm (Case Study: Electricity-Fed Wells of Iran

    Directory of Open Access Journals (Sweden)

    Hossein Sadeghi

    2014-11-01

    Full Text Available Due to several problems arisen from consumption of gas oil, it is necessary to electricity substitute fossil fuels in agriculture wells in Iran. Problems such as lack of opportune and adequate supply of fuel, air and soil pollution, noise pollution and huge costs of installation, operation and maintenance imply the necessity of replacing gas oil systems by electricity-consuming ones in agriculture sector of Iran.However, it is essential to study on the demand of electricity, nowadays, substituting other energy sources.As water wells are the main electricity consumersin agriculture sector, the estimation of energy demand function would be beneficial for policy makers to achieve their goals. The present paper investigates on energy demand function in agriculture sector of Iran.Genetic algorithm techniques are appliedto estimate electricity demand in agricultural sector in three forms: linear, quadratic and exponential equations. Based on the conventional criteria, the exponential model is selected as the best model for estimation. Furthermore, electricity demand of agricultural sector is forecasted under three scenarios for years next three years.

  3. Towards healthcare business intelligence in long-term care: an explorative case study in the Netherlands

    NARCIS (Netherlands)

    Spruit, M.R.; Vroon, R.; Batenburg, R.S.

    2014-01-01

    This research contributes to the domain of long-term care by exploring knowledge discovery techniques based on a large dataset and guided by representative information needs to better manage both quality of care and financial spendings, as a next step towards more mature healthcare business intellig

  4. Towards healthcare business intelligence in long-term care: an explorative case study in the Netherlands.

    NARCIS (Netherlands)

    Spruit, M.; Vroon, R.; Batenburg, R.

    2014-01-01

    This research contributes to the domain of long-term care by exploring knowledge discovery techniques based on a large dataset and guided by representative information needs to better manage both quality of care and financial spendings, as a next step towards more mature healthcare business intellig

  5. Caring for people during mass casualty – the dengue case in Rio de Janeiro, Brazil

    OpenAIRE

    Isabel CF da Cruz

    2008-01-01

    Although the nurse’s role during a disaster, or a epidemy as dengue, may vary, the nursing care focuses on essential care from a perspective of what is best for all patients. Triage is pointed out as one of the tasks that the nurse can manage with success.

  6. Promoting Collaboration in Health Care Teams through Interprofessional Education: A Simulation Case Study

    Science.gov (United States)

    Ekmekci, Ozgur

    2013-01-01

    This simulation study explores how the integration of interprofessional components into health care curriculum may impact professional stereotyping and collaborative behavior in care delivery teams comprised of a physician, a registered nurse, a physician's assistant, a physical therapist, and a radiation therapist. As part of the agent-based…

  7. Improving quality for maternal care - a case study from Kerala, India

    Science.gov (United States)

    Vlad, Ioana; Paily, VP; Sadanandan, Rajeev; Cluzeau, Françoise; Beena, M; Nair, Rajasekharan; Newbatt, Emma; Ghosh, Sujit; Sandeep, K; Chalkidou, Kalipso

    2016-01-01

    Background: The implementation of maternal health guidelines remains unsatisfactory, even for simple, well established interventions. In settings where most births occur in health facilities, as is the case in Kerala, India, preventing maternal mortality is linked to quality of care improvements. Context: Evidence-informed quality standards (QS), including quality statements and measurable structure and process indicators, are one innovative way of tackling the guideline implementation gap. Having adopted a zero tolerance policy to maternal deaths, the Government of Kerala worked in partnership with the Kerala Federation of Obstetricians & Gynaecologists (KFOG) and NICE International to select the clinical topic, develop and initiate implementation of the first clinical QS for reducing maternal mortality in the state. Description of practice: The NICE QS development framework was adapted to the Kerala context, with local ownership being a key principle. Locally generated evidence identified post-partum haemorrhage as the leading cause of maternal death, and as the key priority for the QS. A multidisciplinary group (including policy-makers, gynaecologists and obstetricians, nurses and administrators) was established. Multi-stakeholder workshops convened by the group ensured that the statements, derived from global and local guidelines, and their corresponding indicators were relevant and acceptable to clinicians and policy-makers in Kerala. Furthermore, it helped identify practical methods for implementing the standards and monitoring outcomes. Lessons learned: An independent evaluation of the project highlighted the equal importance of a strong evidence-base and an inclusive development process. There is no one-size-fits-all process for QS development; a principle-based approach might be a better guide for countries to adapt global evidence to their local context.

  8. Improving quality for maternal care - a case study from Kerala, India [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Ioana Vlad

    2016-02-01

    Full Text Available Background: The implementation of maternal health guidelines remains unsatisfactory, even for simple, well established interventions. In settings where most births occur in health facilities, as is the case in Kerala, India, preventing maternal mortality is linked to quality of care improvements. Context: Evidence-informed quality standards (QS, including quality statements and measurable structure and process indicators, are one innovative way of tackling the guideline implementation gap. Having adopted a zero tolerance policy to maternal deaths, the Government of Kerala worked in partnership with the Kerala Federation of Obstetricians & Gynaecologists (KFOG and NICE International to select the clinical topic, develop and initiate implementation of the first clinical QS for reducing maternal mortality in the state. Description of practice: The NICE QS development framework was adapted to the Kerala context, with local ownership being a key principle. Locally generated evidence identified post-partum haemorrhage as the leading cause of maternal death, and as the key priority for the QS. A multidisciplinary group (including policy-makers, gynaecologists and obstetricians, nurses and administrators was established. Multi-stakeholder workshops convened by the group ensured that the statements, derived from global and local guidelines, and their corresponding indicators were relevant and acceptable to clinicians and policy-makers in Kerala. Furthermore, it helped identify practical methods for implementing the standards and monitoring outcomes. Lessons learned: An independent evaluation of the project highlighted the equal importance of a strong evidence-base and an inclusive development process. There is no one-size-fits-all process for QS development; a principle-based approach might be a better guide for countries to adapt global evidence to their local context.

  9. Palliative care in the home: a case study of secondary histiocytic sarcoma in a 3-year-old child

    Directory of Open Access Journals (Sweden)

    Zuzana Karabová

    2013-12-01

    Full Text Available This article describes the medical, psychological, and social challenges encountered during home-based, family-centred palliative care of a 3-year-old female with secondary histiocytic sarcoma diagnosed during treatment for T-cell acute lymphoblastic leukaemia. Histiocytic sarcoma is an exceedingly rare cancer in adults, but even less frequent and highly aggressive when presenting as a secondary cancer in children. Comprehensive, multidisciplinary paediatric hospice care services are not widely available across Slovakia,thus limiting the number of patients and families offered such highly specialized end-of-life care. This case study illustrates the primary benefits for the child and family of such a program as well as the impact on the medical and nursing professionals working in the fi eld of paediatric haematology-oncology.

  10. Children with chickenpox:a care of 42 cases%42例小儿水痘护理体会

    Institute of Scientific and Technical Information of China (English)

    陈玉婷

    2014-01-01

    Objective To investigate the methods of care chickenpox in children. Methods Isolation of children, and to give calamine lotion and topical acyclovir ointment, pruritus obvious oral antihistamines. Care items including general care, barrier nursing, nursing fever, skin and blister care, diet care, psychological care, and close observation the changes to prevent complications. Results Of the 42 patients were cured after treatment 7d 23 cases, the cure rate was 54.76%, the total effective 33 cases, the total effective rate was 78.75%, 14d after treatment cured 37 cases, the cure rate was 88.1%, the total effective 42 cases, the total efficiency was 100.00%. Rash face healed without scar formation. Conclusion Variety attentive care measures and calamine lotion and ointment acyclovir topical, has good efficacy, fewer side effects, is one of the better way to treat children with chickenpox.%目的:探讨小儿水痘的护理方法。方法隔离患儿,并给予炉甘石洗剂及阿昔洛韦软膏外用,皮肤瘙痒明显者可口服抗组胺药。包括:一般护理、隔离护理、发热护理、皮肤与水疱护理、饮食护理、心理护理,并密切观察病情变化,以防并发症的发生。结果42例患儿治疗7d后痊愈23例,痊愈率为54.76%,总有效33例,总有效率78.75%,治疗14d后痊愈37例,痊愈率为88.1%,总有效率42例,总有效率为100.00%。皮疹面愈合良好,无瘢痕形成。结论多种细心护理措施和炉甘石洗剂及阿昔洛韦软膏外用,疗效好,副作用较少,是治疗小儿水痘的较好方法之一。

  11. An econometric analysis of electricity demand response to price changes at the intra-day horizon: The case of manufacturing industry in West Denmark

    Directory of Open Access Journals (Sweden)

    Niels Framroze Møller

    2015-06-01

    Full Text Available The use of renewable energy implies a more variable supply of power. Market efficiency may improve if demand can absorb some of this variability by being more flexible, e.g. by responding quickly to changes in the market price of power. To learn about this, in particular, whether demand responds already within the same day, we suggest an econometric model for hourly consumption- and price time series. This allows for multi-level seasonality and that information about day-ahead prices does not arrive every hour but every 24th hour (as a vector of 24 prices. We confront the model with data from the manufacturing industry of West Denmark (2007-2011. The results clearly suggest a lack of response. The policy implication is that relying exclusively on hourly price response by consumers for integrating volatile renewable electricity production is questionable. Either hourly price variation has to increase considerably or demand response technologies be installed.

  12. Demandas de atendimento psiquiátrico em um hospital universitário Demandas de lo atendimiento psiquiátrico en un hospital universitario Demands of psychiatric care in a university hospital

    Directory of Open Access Journals (Sweden)

    Naiara Gajo Silva

    2011-09-01

    la necesidad de la interconsulta de enfermería psiquiátrica en este hospital.This is a cross-sectional study that aimed to describe the psychiatric demand in a university hospital in the city of Cuiabá, state of Mato Grosso, Brazil, and to know the current situation of the service to this demand. The data were collected from the inpatient medical records in a university hospital, from June to August, 2009, in a total of 551 records. Despite being considered by the literature as unprepared, nursing is the professional category that most identifies the psychiatric demand in this hospital. The treatment plan to this demand was restricted to medication, nine evaluations of psychology and thirteen consultation-liaison psychiatric service, without a significant involvement of nursing. The approach of emotional and/or mental aspects results in the improvement in the quality of nursing care, and there is a need for the nurses to qualify for that. To make it happen, we propose a reflection on the need for the consultation-liaison psychiatric service in this hospital.

  13. Intracranial halo pin penetration causing brain injury secondary to poor halo care technique: a case report and literature review.

    Science.gov (United States)

    Male, Kishore Reddy; Guha, Abhijit; James, Stuart; Ahuja, Sashin

    2008-01-01

    : This is a case report of intra cranial penetration by halo pins resulting in cerebritis and fits secondary to incorrect halo care by the patient and his family. Halo pin penetration into the skull with brain injury is itself a rare incident. Previously documented case reports were in patients with a previous cranioplasties and they were highlight the fact that halo not to be used in cranioplasty patients. Cranial penetration of the halo pins has generally been secondary to a fall/medical condition as epilepsy. This incident how ever highlights the fact the halo care itself along with proper techniques used for tightening the halo pins by the carer plays a crucial role in preventing complications such as this. PMID:19068118

  14. Critical care during epidemics

    OpenAIRE

    Rubinson, Lewis; O'Toole, Tara

    2005-01-01

    We recommend several actions that could improve hospitals' abilities to deliver critical care during epidemics involving large numbers of victims. In the absence of careful pre-event planning, demand for critical care services may quickly exceed available intensive care unit (ICU) staff, beds and equipment, leaving the bulk of the infected populace without benefit of potentially lifesaving critical care. The toll of death may be inversely proportional to the ability to augment critical care c...

  15. Nonmaternal Care's Association With Mother's Parenting Sensitivity: A Case of Self-Selection Bias?

    Science.gov (United States)

    Nomaguchi, Kei M; Demaris, Alfred

    2013-06-01

    Although attachment theory posits that the use of nonmaternal care undermines quality of mothers' parenting, empirical evidence for this link is inconclusive. Using data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development (N = 1,233), the authors examined the associations between nonmaternal care characteristics and maternal sensitivity during the first 3 years of children's lives, with special attention to selection effects and moderation by resource levels. Findings from fixed-effects regression models suggested that, on average, there is little relationship between nonmaternal care characteristics and maternal sensitivity, once selection factors are held constant. Some evidence of moderation effects was found, however. Excellent-quality care is related to more sensitivity for mothers with lower family income. Poor-quality care is related to lower sensitivity for single mothers, but not partnered mothers. In sum, nonmaternal care characteristics do not seem to have as much influence on mothers' parenting as attachment theory claims. PMID:23772093

  16. The case for home based telehealth in pediatric palliative care: a systematic review

    Directory of Open Access Journals (Sweden)

    Bradford Natalie

    2013-02-01

    Full Text Available Abstract Background Over the last decade technology has rapidly changed the ability to provide home telehealth services. At the same time, pediatric palliative care has developed as a small, but distinct speciality. Understanding the experiences of providing home telehealth services in pediatric palliative care is therefore important. Methods A literature review was undertaken to identify and critically appraise published work relevant to the area. Studies were identified by searching the electronic databases Medline, CINAHL and Google Scholar. The reference list of each paper was also inspected to identify any further studies. Results There were 33 studies that met the inclusion criteria of which only six were pediatric focussed. Outcome measures included effects on quality of life and anxiety, substitution of home visits, economic factors, barriers, feasibility, acceptability, satisfaction and readiness for telehealth. While studies generally identified benefits of using home telehealth in palliative care, the utilisation of home telehealth programs was limited by numerous challenges. Conclusion Research in this area is challenging; ethical issues and logistical factors such as recruitment and attrition because of patient death make determining effectiveness of telehealth interventions difficult. Future research in home telehealth for the pediatric palliative care population should focus on the factors that influence acceptance of telehealth applications, including goals of care, access to alternative modes of care, perceived need for care, and comfort with using technology.

  17. Citizenship and people living with dementia: A case for the ethics of care.

    Science.gov (United States)

    Brannelly, Tula

    2016-05-01

    The ethics of care is an emerging field of interest in many disciplines, including care for people with dementia. The ethics of care as proposed by Joan Tronto is a political argument for care together with a set of principles, the integrity of care, to guide and critique practice. This two-pronged approach enables on one hand, a political, complex and situated examination of inequality, and on the other hand the integrity of care provides a set of principles to guide inclusive citizenship practices. This approach has the significant advantage of recognition of the fight that people with dementia face to achieve rights and citizenship as an issue of social justice. In this paper, three challenges to citizenship are discussed in relation to people with dementia using an ethics of care lens: (a) citizenship as a relationship between the individual and the state; (b) citizenship as a practice and (c) citizenship as identity and belonging. I propose that citizenship can be achieved by promoting inclusion in defining and creating policy, research and practice. PMID:27170583

  18. Perfil da demanda em um serviço de Oftalmologia de atenção primária Demand profile in an Ophthalmologic primary care service

    Directory of Open Access Journals (Sweden)

    Márcia Abelin Vargas

    2010-04-01

    Full Text Available OBJETIVO: Para melhorar os serviços de saúde é importante conhecer o perfil da demanda. Para isso, buscou-se: 1 Identificar os principais motivos de procura por atendimento oftalmológico em Unidade de Atenção Primária; 2 Analisar as frequências dos diagnósticos,bem como os motivos de encaminhamento de pacientes para outros serviços de Oftalmologia. MÉTODOS: Estudo descritivo e retrospectivo de 1.010 pacientes atendidos durante o período de 6 meses. Parâmetros: idade e sexo do paciente, motivo da consulta,diagnóstico (CID-10 e frequência de encaminhamentos. Os dados foram obtidos através da análise dos prontuários e das fichas de atendimento com os registros do CID-10. Alguns pacientes, de ambos os gêneros, apresentavam alterações anatômico-funcionais que foram agrupadas em mais de um grupo de diagnóstico. RESULTADOS: Houve um predomínio do sexo feminino (61,5% e da faixa etária de 10 a 19 anos de idade (16,7%, seguida do grupo de pacientes entre 40 a 49 anos de idade (16,5%. O principal motivo da consulta foi a baixa de acuidade visual (37,4%, seguida da revisão dos óculos (19,0%. Também foram frequentes a queixa de cefaléia (15,8%, prurido (10,4%, ardência / irritação (7,8% e olho vermelho (7,2%.Apresentaram exame normal, 8,1% dos pacientes e entre os exames anormais a maior frequência foi de erros refracionais (70,0%. e presbiopia (31,9%. Foram encaminhados 90 (8,9% pacientes. O principal motivo de encaminhamento foi a necessidade de cirurgia. CONCLUSÃO: O principal motivo da busca de um atendimento neste serviço básico de oftalmologia foi a baixa acuidade visual que na grande maioria das vezes foi ocasionada por erro refracional e/ou presbiopia. Poucos foram os casos não resolvidos no local do atendimento.PURPOSE: To improve health services it is necessary to know the demand profile. This study was carried out with the objectives of: to identify the main reasons to seek an ophthalmologic primary care

  19. Prioritizing Surgical Care on National Health Agendas: A Qualitative Case Study of Papua New Guinea, Uganda, and Sierra Leone.

    OpenAIRE

    Dare, Anna J.; Katherine C Lee; Josh Bleicher; Elobu, Alex E; Kamara, Thaim B; Osborne Liko; Samuel Luboga; Akule Danlop; Gabriel Kune; Lars Hagander; Andrew J M Leather; Gavin Yamey

    2016-01-01

    Little is known about the social and political factors that influence priority setting for different health services in low- and middle-income countries (LMICs), yet these factors are integral to understanding how national health agendas are established. We investigated factors that facilitate or prevent surgical care from being prioritized in LMICs.We undertook country case studies in Papua New Guinea, Uganda, and Sierra Leone, using a qualitative process-tracing method. We conducted 74 semi...

  20. Exploring malaria case mangement of underfive children at households and public primary health care facilities in Kibaha district, Tanzania

    OpenAIRE

    Nsimba, Stephen ED

    2003-01-01

    Background: Chloroquine (CQ) was the first line drug for treating malaria in Tanzania until 2001 when it was replaced with sulfadoxine/pyrimethamine (SP). The first four studies (I -IV) were conducted before the policy change, and the last one (V) after. Aim: To explore different aspects of malaria case management of underfives in households and at primary health care facilities in the Kibaha district. Materials and methods: Four cross-sectional studies (I, II, IV & V) we...