Hydraulic Control Method for Heating Systems of High-Rise Buildings

Science.gov (United States)

Makarov, D.; Chernenkov, V.; Likhachev, I.

2017-11-01

The following article reflects the ideas of possibility to increase energy efficiency of heating systems in high-rise buildings. The article also includes the principle ways of high-rise building heating systems operation as well as traditional engineering decisions aimed at the elimination of the increased pressure effect in heaters. The main disadvantages of such decisions are also presented for the reader. Moreover, the article offers the way of operation for the above-mentioned systems together with the equipment that implements this operation. An economic impact from such energy-saving technology application has been also evaluated.

France: Health System Review.

Science.gov (United States)

Chevreul, Karine; Berg Brigham, Karen; Durand-Zaleski, Isabelle; Hernandez-Quevedo, Cristina

2015-01-01

This analysis of the French health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The French population has a good level of health, with the second highest life expectancy in the world for women. It has a high level of choice of providers, and a high level of satisfaction with the health system. However, unhealthy habits such as smoking and harmful alcohol consumption remain significant causes of avoidable mortality. Combined with the significant burden of chronic diseases, this has underscored the need for prevention and integration of services, although these have not historically been strengths of the French system. Although the French health care system is a social insurance system, it has historically had a stronger role for the state than other Bismarckian social insurance systems. Public financing of health care expenditure is among the highest in Europe and out-of-pocket spending among the lowest. Public insurance is compulsory and covers the resident population; it is financed by employee and employer contributions as well as increasingly through taxation. Complementary insurance plays a significant role in ensuring equity in access. Provision is mixed; providers of outpatient care are largely private, and hospital beds are predominantly public or private non-profit-making. Despite health outcomes being among the best in the European Union, social and geographical health inequities remain. Inequality in the distribution of health care professionals is a considerable barrier to equity. The rising cost of health care and the increasing demand for long-term care are also of concern. Reforms are ongoing to address these issues, while striving for equity in financial access; a long-term care reform including public coverage of long-term care is still pending. World Health Organization 2015 (acting as the host organization for, and secretariat of, the

An Interconnection of Armed Conflict and Health Service system in Rolpa District of Nepal

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Sachin Kumar Ghimire

2009-08-01

Full Text Available The health service system is the part of the political system. Likewise, political systems should be an integral part of the health system. Contrary to this, local political tussle, national level power conflicts, long-term civil war, and crises in the bureaucracy have led to the continuous ignorance of people’s health issues in Rolpa. War is always detrimental for people's health, health service system and social well-being of the population. The chronic condition of exclusion prevalent in large section of the society is the “favorable” fertile ground to capitalize the expectations toward inclusive and healthy condition in Rolpa. The process of capitalizing such historical exclusion in the name of “revolution” gives rise to new sects of political actors. However, rising expectations and aspirations toward “equitable society” have been resulting in severe frustrations because no significant changes have been done to address the general living conditions of people. The continuous rise and fall of expectations after all lead to infinitive journey of producing ill health that could be extremely detrimental to people's expectation, even to live a normal life as a human.

Prospects for development of heat supply systems in high-rise districts

Science.gov (United States)

Zhila, Viktor; Solovyeva, Elena

2018-03-01

The article analyzes the main advantages and disadvantages of centralized and decentralized heat supply systems in high-rise districts. The main schemes of centralized heat supply systems are considered. They include centralized heat supply from boiler houses, centralized heat supply from autonomous heat sources, heat supply from roof boiler houses and door-to-door heating supply. For each of these variant, the gas distribution systems are considered and analyzed. These systems vary depending on the heat source location. For each of these systems, technical and economic indicators are taken into account, the analysis of which allows choosing the best option for districts where high-rise buildings predominate.

Modern trends in the health care system of Russia: drop or rise

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Yuliya Zh. Sadykova

2017-01-01

Full Text Available In the period of the existence of post-soviet Russia, the health care system has remained and remains one of the most important and, at the same time, the problem element of it. We have to admit that not always medical services, offered by our state, are positive, if we consider them, for example, through the concept of “quality”. Undoubtedly, this is determined by the existing medical structure, starting with the number of different hospital establishments and ending with the degree of qualification and competence of medical specialists.Thus, the purpose of this article is a comprehensive analysis of the healthcare system that was established in the Russian Federation in 1990–2015, the object of the study is the entire Russian health care system, and the subject is specific statistical data on the hospital beds and hospitals in Russia.Problems of health development, as well as various methodological issues of statistical research, including the accounting of hospital facilities, hospital beds, doctors in the context of specialties, morbidity are considered in the works of both domestic and foreign scientists (V.Medic, M. Tokmachev, G. Ulumbekova, S. Banin, McKee Martin and others.The main directions of development of the national medicine for the specified period of time, its characteristic features and problems of concern that cause dysfunction in the work of the health care protection mechanism for the citizens were identified in the context of the dynamics in such statistical indexes as the total number of hospital and outpatient clinics, hospital beds in them, the number of doctors and the state of morbidity of the population, published by the Federal State Statistics Service.As a research task, attempts were made to assess the impact of changes in these indexes on the state of Russian health care over the period as a whole. Moreover, the work revealed the main content concepts on this topic, explained the nominal structure of the

Use of formwork systems in high-rise construction

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Kurakova, Oksana

2018-03-01

Erection of high quality buildings and structures within a reasonable time frame is the crucial factor for the competitiveness of any construction organization. The main material used in high-rise construction is insitu reinforced concrete. The technology of its use is directly related to the use of formwork systems. Formwork systems and formwork technologies basically determine the speed of construction and labor intensity of concreting operations. Therefore, it is also possible to achieve the goal of reducing the construction time and labor intensity of works performed by improving the technology of formwork systems use. Currently there are unresolved issues in the area of implementation of monolithic technology projects, and problems related to the selection of a formwork technology, high labor intensity of works, poor quality of materials and structures, etc. are the main ones. The article presents organizational and technological measures, by means of which introduction it is possible to shorten the duration of construction. A comparison of operations performed during formwork installation according to the conventional technology and taking into account the implemented organizational and technological measures is presented. The results of a comparative analysis of economic efficiency assessments are also presented on the example of a specific construction project before and after the implementation of the above mentioned measures. The study showed that introduction of the proposed organizational and technological model taking into account optimization of reinforcing and concreting works significantly improves the efficiency of a high-rise construction project. And further improvement of technologies for the use of insitu reinforced concrete is a promising direction in the construction of high-rise buildings.

Use of formwork systems in high-rise construction

Directory of Open Access Journals (Sweden)

Kurakova Oksana

2018-01-01

Full Text Available Erection of high quality buildings and structures within a reasonable time frame is the crucial factor for the competitiveness of any construction organization. The main material used in high-rise construction is insitu reinforced concrete. The technology of its use is directly related to the use of formwork systems. Formwork systems and formwork technologies basically determine the speed of construction and labor intensity of concreting operations. Therefore, it is also possible to achieve the goal of reducing the construction time and labor intensity of works performed by improving the technology of formwork systems use. Currently there are unresolved issues in the area of implementation of monolithic technology projects, and problems related to the selection of a formwork technology, high labor intensity of works, poor quality of materials and structures, etc. are the main ones. The article presents organizational and technological measures, by means of which introduction it is possible to shorten the duration of construction. A comparison of operations performed during formwork installation according to the conventional technology and taking into account the implemented organizational and technological measures is presented. The results of a comparative analysis of economic efficiency assessments are also presented on the example of a specific construction project before and after the implementation of the above mentioned measures. The study showed that introduction of the proposed organizational and technological model taking into account optimization of reinforcing and concreting works significantly improves the efficiency of a high-rise construction project. And further improvement of technologies for the use of insitu reinforced concrete is a promising direction in the construction of high-rise buildings.

Embedding research in health systems: lessons from complexity theory.

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Caffrey, Louise; Wolfe, Charles; McKevitt, Christopher

2016-07-22

Internationally, there has been increasing focus on creating health research systems. This article aims to investigate the challenges of implementing apparently simple strategies to support the development of a health research system. We focus on a case study of an English National Health Service Hospital Trust that sought to implement the national recommendation that health organisations should introduce a statement about research on all patient admission letters. We apply core concepts from complexity theory to the case study and undertake a documentary analysis of the email dialogue between staff involved in implementing this initiative. The process of implementing a research statement in patient admission letters in one clinical service took 1 year and 21 days. The length of time needed was influenced firstly by adaptive self-organisation, underpinned by competing interests. Secondly, it was influenced by the relationship between systems, rather than simply being a product of issues within those systems. The relationship between the health system and the research system was weaker than might have been expected. Responsibilities were unclear, leading to confusion and delayed action. Conventional ways of thinking about organisations suggest that change happens when leaders and managers change the strategic vision, structure or procedures in an organisation and then persuade others to rationally implement the strategy. However, health research systems are complex adaptive systems characterised by high levels of unpredictability due to self-organisation and systemic interactions, which give rise to 'emergent' properties. We argue for the need to study how micro-processes of organisational dynamics may give rise to macro patterns of behaviour and strategic organisational direction and for the use of systems approaches to investigate the emergent properties of health research systems.

A Blueprint for Innovation to Achieve Health System Transformation.

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Snowdon, Anne W

2017-01-01

Global health systems are challenged by escalating costs and growing demands for care created by the demands of aging populations and rising rates of chronic illness which place unsustainable pressure on health systems to meet population health needs. To overcome these challenges, transformational change is needed to strengthen health system performance and sustainability. Innovation is widely viewed as the strategy to drive transformational change in health systems; yet to date, innovation has lacked a clearly defined focus or agenda to achieve transformation. An actionable innovation agenda is needed to achieve transformational change for health systems. The key conditions for success as an innovation strategy are examined, including clearly defined innovation objectives, key milestones, and actionable steps every system stakeholder must pursue in order to guide the innovation agenda and ultimately accelerate the transformational changes needed for a sustainable healthcare system that delivers value to populations.

Mental health issues from rising sea level in a remote coastal region of the Solomon Islands: current and future.

Science.gov (United States)

Asugeni, James; MacLaren, David; Massey, Peter D; Speare, Rick

2015-12-01

There is little published research about mental health and climate change in the Pacific, including Solomon Islands. Solomon Islands has one of the highest rates of sea-level rise globally. The aim of this research was to document mental health issues related to sea-level rise for people in East Malaita, Solomon Islands. A cross-sectional study was carried out in six low-lying villages in East Malaita, Solomon Islands. The researcher travelled to villages by dugout canoe. In addition to quantitative, closed-ended questions, open-ended questions with villagers explored individual and community responses to rising sea level. Of 60 people asked, 57 completed the questionnaire. Of these, 90% reported having seen a change in the weather patterns. Nearly all participants reported that sea-level rise is affecting them and their family and is causing fear and worry on a personal and community level. Four themes emerged from the qualitative analysis: experience of physical impacts of climate change; worry about the future; adaptation to climate change; government response needed. Given predictions of ongoing sea-level rise in the Pacific it is essential that more research is conducted to further understand the human impact of climate change for small island states which will inform local, provincial and national-level mental health responses. © The Royal Australian and New Zealand College of Psychiatrists 2015.

Unequal ‘Partners’. AIDS, Academia, and the Rise of Global Health

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Johanna T. Crane

2010-12-01

Full Text Available The last decade has seen the proliferation of “global health” departments, centers, programs, and majors across top research universities in North America and Europe. This trend has been particularly pronounced in the United States, where it is connected to America′s new role as a major sponsor of HIV treatment in Africa. This paper describes the rise of “global health” as a research, funding, and training priority within U.S. academic medicine, and the increasing desirability of “global health partnerships” with institutions in sub-Saharan Africa. Leading spokespersons emphasize that “partnership” with poor nations is central to the mission of global health, an ethic that distinguishes it from older, more paternalistic traditions of international health and tropical medicine. However, at the same time, the field of academic global health depends on steep inequalities for its very existence, as it is the opportunity to work in impoverished, low-tech settings with high disease burdens that draws North American researchers and clinicians to global health programs and ensures their continued funding. This paradox – in which inequality is both a form of suffering to be redressed and a professional, knowledge-generating, opportunity to be exploited – makes the partnerships to which global health aspires particularly challenging.

Peak Oil, Food Systems, and Public Health

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Parker, Cindy L.; Kirschenmann, Frederick L.; Tinch, Jennifer; Lawrence, Robert S.

2011-01-01

Peak oil is the phenomenon whereby global oil supplies will peak, then decline, with extraction growing increasingly costly. Today's globalized industrial food system depends on oil for fueling farm machinery, producing pesticides, and transporting goods. Biofuels production links oil prices to food prices. We examined food system vulnerability to rising oil prices and the public health consequences. In the short term, high food prices harm food security and equity. Over time, high prices will force the entire food system to adapt. Strong preparation and advance investment may mitigate the extent of dislocation and hunger. Certain social and policy changes could smooth adaptation; public health has an essential role in promoting a proactive, smart, and equitable transition that increases resilience and enables adequate food for all. PMID:21778492

The rise of governmentality in the Italian National Health System: physiology or pathology of a decentralized and (ongoing) federalist system?

Science.gov (United States)

Lega, Federico; Sargiacomo, Massimo; Ianni, Luca

2010-11-01

In this paper, we aim to discuss the implications and lessons that can be learnt from the ongoing process of federalism affecting the Italian National Health System (INHS). Many countries are currently taking decisions concerning the decentralization or re-centralization of their health-care systems, with several key issues that are illustrated in the recent history of the INHS. The decentralization process of INHS has produced mixed results, as some regions took advantage of it to strengthen their systems, whereas others were not capable of developing an effective steering role. We argue that the mutual reinforcement of the decentralization and recentralization processes is not paradoxical, but is actually an effective way for the State to maintain control over the equity and efficiency of its health-care system while decentralizing at a regional level. In this perspective, we provide evidence backing up some of the assumptions made in previous works as well as new food-for thought - specifically on how governmentality and federalism should meet - to reshape the debate on decentralization in health care.

Canada: Health system review.

Science.gov (United States)

Marchildon, Gregory

2013-01-01

Canada is a high-income country with a population of 33 million people. Its economic performance has been solid despite the recession that began in 2008. Life expectancy in Canada continues to rise and is high compared with most OECD countries; however, infant and maternal mortality rates tend to be worse than in countries such as Australia, France and Sweden. About 70% of total health expenditure comes from the general tax revenues of the federal, provincial and territorial governments. Most public revenues for health are used to provide universal medicare (medically necessary hospital and physician services that are free at the point of service for residents) and to subsidise the costs of outpatient prescription drugs and long-term care. Health care costs continue to grow at a faster rate than the economy and government revenue, largely driven by spending on prescription drugs. In the last five years, however, growth rates in pharmaceutical spending have been matched by hospital spending and overtaken by physician spending, mainly due to increased provider remuneration. The governance, organization and delivery of health services is highly decentralized, with the provinces and territories responsible for administering medicare and planning health services. In the last ten years there have been no major pan-Canadian health reform initiatives but individual provinces and territories have focused on reorganizing or fine tuning their regional health systems and improving the quality, timeliness and patient experience of primary, acute and chronic care. The medicare system has been effective in providing Canadians with financial protection against hospital and physician costs. However, the narrow scope of services covered under medicare has produced important gaps in coverage and equitable access may be a challenge in these areas. World Health Organization 2013 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and

Social determinants of health inequalities: towards a theoretical perspective using systems science.

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Jayasinghe, Saroj

2015-08-25

A systems approach offers a novel conceptualization to natural and social systems. In recent years, this has led to perceiving population health outcomes as an emergent property of a dynamic and open, complex adaptive system. The current paper explores these themes further and applies the principles of systems approach and complexity science (i.e. systems science) to conceptualize social determinants of health inequalities. The conceptualization can be done in two steps: viewing health inequalities from a systems approach and extending it to include complexity science. Systems approach views health inequalities as patterns within the larger rubric of other facets of the human condition, such as educational outcomes and economic development. This anlysis requires more sophisticated models such as systems dynamic models. An extension of the approach is to view systems as complex adaptive systems, i.e. systems that are 'open' and adapt to the environment. They consist of dynamic adapting subsystems that exhibit non-linear interactions, while being 'open' to a similarly dynamic environment of interconnected systems. They exhibit emergent properties that cannot be estimated with precision by using the known interactions among its components (such as economic development, political freedom, health system, culture etc.). Different combinations of the same bundle of factors or determinants give rise to similar patterns or outcomes (i.e. property of convergence), and minor variations in the initial condition could give rise to widely divergent outcomes. Novel approaches using computer simulation models (e.g. agent-based models) would shed light on possible mechanisms as to how factors or determinants interact and lead to emergent patterns of health inequalities of populations.

Modeling work of the dispatching service of high-rise building as queuing system

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Dement'eva, Marina; Dement'eva, Anastasiya

2018-03-01

The article presents the results of calculating the performance indicators of the dispatcher service of a high-rise building as a queuing system with an unlimited queue. The calculation was carried out for three models: with a single control room and brigade of service, with a single control room and a specialized service, with several dispatch centers and specialized services. The aim of the work was to investigate the influence of the structural scheme of the organization of the dispatcher service of a high-rise building on the amount of operating costs and the time of processing and fulfilling applications. The problems of high-rise construction and their impact on the complication of exploitation are analyzed. The composition of exploitation activities of high-rise buildings is analyzed. The relevance of the study is justified by the need to review the role of dispatch services in the structure of management of the quality of buildings. Dispatching service from the lower level of management of individual engineering systems becomes the main link in the centralized automated management of the exploitation of high-rise buildings. With the transition to market relations, the criterion of profitability at the organization of the dispatching service becomes one of the main parameters of the effectiveness of its work. A mathematical model for assessing the efficiency of the dispatching service on a set of quality of service indicators is proposed. The structure of operating costs is presented. The algorithm of decision-making is given when choosing the optimal structural scheme of the dispatching service of a high-rise building.

Wearable medical systems for p-Health.

Science.gov (United States)

Teng, Xiao-Fei; Zhang, Yuan-Ting; Poon, Carmen C Y; Bonato, Paolo

2008-01-01

Driven by the growing aging population, prevalence of chronic diseases, and continuously rising healthcare costs, the healthcare system is undergoing a fundamental transformation, from the conventional hospital-centered system to an individual-centered system. Current and emerging developments in wearable medical systems will have a radical impact on this paradigm shift. Advances in wearable medical systems will enable the accessibility and affordability of healthcare, so that physiological conditions can be monitored not only at sporadic snapshots but also continuously for extended periods of time, making early disease detection and timely response to health threats possible. This paper reviews recent developments in the area of wearable medical systems for p-Health. Enabling technologies for continuous and noninvasive measurements of vital signs and biochemical variables, advances in intelligent biomedical clothing and body area networks, approaches for motion artifact reduction, strategies for wearable energy harvesting, and the establishment of standard protocols for the evaluation of wearable medical devices are presented in this paper with examples of clinical applications of these technologies.

Non-communicable diseases, mental ill-health: Is it a failure of the food system?

Science.gov (United States)

Crawford, Michel A

2013-01-01

The rise in brain disorders and mental ill-health is the most serious crisis facing the survival of humanity. Starting from an understanding of the origins of the nervous system and the brain, together with its nutritional requirements, the present direction of the food system since World War II (WWII) can be seen as departing from the biological essence of brain chemistry and its nutritional needs. Such advances in the food system would lead to epigenetic changes. Improper maternal/foetal nutrition is considered in this manner to lead to heart disease, stroke and diabetes in later life. Is there any reason why the brain would not be similarly susceptible to a nutritional background departing from its specific needs? The changing food system likely bears responsibility for the rise in mental ill health that has now overtaken all other burdens of ill health. Its globalisation is threatening civil society. © The Author(s) 2015.

Design of solar systems in high-rise buildings

Science.gov (United States)

Kolosov, Alexander; Chudinov, Dmitry; Yaremenko, Sergey

2018-03-01

Nowadays, the renovation program is being implemented in the megapolises of Russia. Innovative high-rise buildings are built instead of morally and physically obsolete houses, where non-traditional renewable energy sources are used to the fullest extent, under the effect of which they are located. The possibility to use solar systems with variation of their design parameters is considered. It is established that solar systems have high technical potential. The share of heat load, that is provided by using solar energy, varies from 4 to 84% depending on the time of the year. Economic indicators restrain the use of such panels. The payback period is about 8 years at the current cost for thermal energy.

The Rise of Mental Health Nursing : A History of Psychiatric Care in Dutch Asylums, 1890-1920

NARCIS (Netherlands)

Boschma, Geertje

2003-01-01

The Rise of Mental Health Nursing onderzoekt de tegenstrijdigheden in de op het ziekenhuis georiënteerde inrichtingszorg, die rond 1900 opkwam. Bovendien illustreert het boek de sociale complexiteit van de psychiatrische zorg. Op basis van archiefmateriaal uit vier Nederlandse psychiatrische

Rising to the challenge of health care reform with entrepreneurial and intrapreneurial nursing initiatives.

Science.gov (United States)

Wilson, Anne; Whitaker, Nancy; Whitford, Deirdre

2012-05-31

Health reform worldwide is required due to the largely aging population, increase in chronic diseases, and rising costs. To meet these needs, nurses are being encouraged to practice to the full extent of their skills and take significant leadership roles in health policy, planning, and provision. This can involve entrepreneurial or intrapreneurial roles. Although nurses form the largest group of health professionals, they are frequently restricted in their scope of practice. Nurses can help to improve health services in a cost effective way, but to do so, they must be seen as equal partners in health service provision. This article provides a global perspective on evolving nursing roles for innovation in health care. A historical overview of entrepreneurship and intrapreneurship is offered. Included also is discussion of a social entrepreneurship approach for nursing, settings for nurse entre/intrapreneurship, and implications for research and practice.

Does public insurance provide better financial protection against rising health care costs for families of children with special health care needs?

Science.gov (United States)

Yu, Hao; Dick, Andrew W; Szilagyi, Peter G

2008-10-01

Health care costs grew rapidly since 2001, generating substantial economic pressures on families, especially those with children with special health care needs (CSHCN). To examine how the growth of health care costs affected financial burden for families of CSHCN between 2001 and 2004 and to determine the extent to which health insurance coverage protected families of CSHCN against financial burden. In 2001-2004, 5196 families of CSHCN were surveyed by the national Medical Expenditure Panel Survey (MEPS). The main outcome was financial burden, defined as the proportion of family income spent on out-of-pocket (OOP) health care expenditures for all family members, including OOP costs and premiums. Family insurance coverage was classified as: (1) all members publicly insured, (2) all members privately insured, (3) all members uninsured, (4) partial coverage, and (5) a mix of public and private with no uninsured periods. An upward trend in financial burden for families of CSHCN occurred and was associated with growth of economy-wide health care costs. A multivariate analysis indicated that, given the economy-wide increase in medical costs between 2001 and 2004, a family with CSHCN was at increased risk in 2004 for having financial burden exceeding 10% of family income [odds ratio (OR) = 1.39; P financial burden exceeding 20% of family income. Over 15% of families with public insurance had financial burden exceeding 10% of family income compared with 20% of families with private insurance (P financial burden of >10% or 20% of family income than privately-insured families. Rising health care costs increased financial burden on families of CSHCN in 2001-2004. Public insurance coverage provided better financial protection than private insurance against the rapidly rising health care costs for families of CSHCN.

Rising U.S. income inequality, gender and individual self-rated health, 1972-2004.

Science.gov (United States)

Zheng, Hui

2009-11-01

The effect of income inequality on health has been a contested topic among social scientists. Most previous research is based on cross-sectional comparisons rather than temporal comparisons. Using data from the General Social Survey and the U.S. Census Bureau, this study examines how rising income inequality affects individual self-rated health in the U.S. from 1972 to 2004. Data are analyzed using hierarchical generalized linear models. The findings suggest a significant association between income inequality and individual self-rated health. The dramatic increase in income inequality from 1972 to 2004 increases the odds of worse self-rated health by 9.4 percent. These findings hold for three measures of income inequality: the Gini coefficient, the Atkinson Index, and the Theil entropy index. Results also suggest that overall income inequality and gender-specific income inequality harm men's, but not women's, self-rated health. These findings also hold for the three measures of income inequality. These findings suggest that inattention to gender composition may explain apparent discrepancies across previous studies.

The Rise of Post-truth Populism in Pluralist Liberal Democracies: Challenges for Health Policy

Science.gov (United States)

Speed, Ewen; Mannion, Russell

2017-01-01

Recent years have witnessed the rise of populism and populist leaders, movements and policies in many pluralist liberal democracies, with Brexit and the election of Trump the two most recent high profile examples of this backlash against established political elites and the institutions that support them. This new populism is underpinned by a post-truth politics which is using social media as a mouthpiece for ‘fake news’ and ‘alternative facts’ with the intention of inciting fear and hatred of ‘the other’ and thereby helping to justify discriminatory health policies for marginalised groups. In this article, we explore what is meant by populism and highlight some of the challenges for health and health policy posed by the new wave of post-truth populism. PMID:28812811

Construction Costs Assessment of Structural Systems for Low-Rise and Social Welfare Housing

Directory of Open Access Journals (Sweden)

Carrillo Julián

2015-09-01

Full Text Available A comparative analysis of the costs related to the construction of low-rise, low-cost and social welfare housing was carried out. The study included three of the most commonly used structural systems for low-rise housing in Latin America, such as the traditional system of confined masonry walls, concrete walls conventionally reinforced with welded-wire meshes and concrete walls reinforced with steel fiber. The cost comparison was carried out by budgets analysis, which were performed based on construction quantities, unit prices and particular items for each structural system. It was found in the study that, from an economic point of view, the systems of concrete walls reinforced with welded-wire meshes or steel fibers are more advantageous than confined masonry systems. In addition, the integral comparison of the three structural systems demonstrates that the industrialized system of steel fiber reinforced concrete walls allows obtaining greater advantages of cleaning and sustainability, faster construction, lower cost and a more attractive scenario for builders investing in such projects.

Resilience of Infrastructure Systems to Sea-Level Rise in Coastal Areas: Impacts, Adaptation Measures, and Implementation Challenges

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Beatriz Azevedo de Almeida

2016-11-01

Full Text Available Expansive areas of low elevation in many densely populated coastal areas are at elevated risk of storm surges and flooding due to torrential precipitation, as a result of sea level rise. These phenomena could have catastrophic impacts on coastal communities and result in the destruction of critical infrastructure, disruption of economic activities and salt water contamination of the water supply. The objective of the study presented in this paper was to identify various impacts of sea level rise on civil infrastructures in coastal areas and examine the adaptation measures suggested in the existing literature. To this end, a systemic review of the existing literature was conducted in order to identify a repository of studies addressing sea level rise impacts and adaptation measures in the context of infrastructure systems. The study focused on three infrastructure sectors: water and wastewater, energy, and road transportation. The collected information was then analyzed in order to identify different categories of sea level rise impacts and corresponding adaptation measures. The findings of the study are threefold: (1 the major categories of sea level rise impacts on different infrastructure systems; (2 measures for protection, accommodation, and retreat in response to sea level rise impacts; and (3 challenges related to implementing adaptation measures.

The Rise of Post-truth Populism in Pluralist Liberal Democracies: Challenges for Health Policy

Directory of Open Access Journals (Sweden)

Ewen Speed

2017-04-01

Full Text Available Recent years have witnessed the rise of populism and populist leaders, movements and policies in many pluralist liberal democracies, with Brexit and the election of Trump the two most recent high profile examples of this backlash against established political elites and the institutions that support them. This new populism is underpinned by a post-truth politics which is using social media as a mouthpiece for ‘fake news’ and ‘alternative facts’ with the intention of inciting fear and hatred of ‘the other’ and thereby helping to justify discriminatory health policies for marginalised groups. In this article, we explore what is meant by populism and highlight some of the challenges for health and health policy posed by the new wave of post-truth populism.

Rise, stagnation, and rise of Danish women's life expectancy

DEFF Research Database (Denmark)

Lindahl-Jacobsen, Rune; Rau, Roland; Jeune, Bernard

2016-01-01

Health conditions change from year to year, with a general tendency in many countries for improvement. These conditions also change from one birth cohort to another: some generations suffer more adverse events in childhood, smoke more heavily, eat poorer diets, etc., than generations born earlier...... favor forecasts that hinge on cohort differences. We use a combination of age decomposition and exchange of survival probabilities between countries to study the remarkable recent history of female life expectancy in Denmark, a saga of rising, stagnating, and now again rising lifespans. The gap between...... female life expectancy in Denmark vs. Sweden grew to 3.5 y in the period 1975-2000. When we assumed that Danish women born 1915-1945 had the same survival probabilities as Swedish women, the gap remained small and roughly constant. Hence, the lower Danish life expectancy is caused by these cohorts...

The Child Health Care System of Croatia.

Science.gov (United States)

Mestrovic, Julije; Bralic, Irena; Simetin, Ivana Pavic; Mujkic, Aida; Radonić, Marija; Rodin, Urelija; Trošelj, Mario; Stevanović, Ranko; Benjak, Tomislav; Pristaš, Ivan; Mayer, Dijana; Tomić, Branimir

2016-10-01

The Republic of Croatia is a Parliamentary Republic with a population of 4.2 million people that sits on the Adriatic coast within Central Europe. Gross domestic product is approximately 60% of the European Union average, which in turn, limits health service spending. The health system is funded through universal health insurance administered by the Croatian Health Insurance Fund based on the principles of social solidarity and reciprocity. The children of Croatia are guaranteed access to universal primary, hospital, and specialist care provided by a network of health institutions. Pediatricians and school medicine specialists provide comprehensive preventive health care for both preschool and school-aged children. Despite the Croatian War of Independence in the late 20th century, indicators of child health and measures of health service delivery to children and families are steadily improving. However, similar to many European countries, Croatia is experiencing a rise in the "new morbidities" and is responding to these new challenges through a whole society approach to promote healthy lifestyles and insure good quality of life for children. Copyright © 2016 Elsevier Inc. All rights reserved.

Health system strengthening and hypertension management in China.

Science.gov (United States)

Huang, Kehui; Song, Yu Ting; He, Yong Huan; Feng, Xing Lin

2016-01-01

Non-communicable diseases are the leading causes of global burden of diseases, and hypertension is one of the most important risk factors. Hypertension prevalence doubled in China in the past decade and affects more than 300 million Chinese people. In the review we systematically searched peer-reviewed publications that link health system level factors with hypertension management in China and provide the current knowledge on how to improve a country's health system to manage the hypertension epidemic. A framework was developed to guide the review. The database of PubMed, CNKI were systematically searched from inception to April 13, 2016. Two authors independently screened the searched results for inclusion, conducted data extraction and appraised the quality of studies. Key findings were described according to the framework. Five hundred seventy-two publications were identified, where 11 articles were left according to the inclusion and exclusion criteria. The study periods range from 2010 to 2015. All about 11 researches linked health system factors to the outcome of hypertension management. And the outcomes were just focused on the awareness, treatment and control of hypertension but not hypertension incidence. One study is about the role of health system governance, investigating the performance of different organized community health care centers; three studies were about health financing comparing differences in insurance coverage; three studies were about health information practicing the hypertension guidelines of China or the WHO, and the rest three about mechanisms of health service delivery. No researches were identified about physical resources for health and human resources for health. Hypertension prevalence has been rising rapidly in China and the management of hypertension in China is a detection problem rather than treatment problem. Limited evidence shows the positive effect of health system factors on hypertension management and joint efforts

[A health system's neoliberal reform: evidence from the Mexican case].

Science.gov (United States)

López-Arellano, Oliva; Jarillo-Soto, Edgar C

2017-07-27

This study addressed the shaping of Mexico's health system in recent years, with an analysis of the social determination conditioning the system's current formulation, the consequences for the population's living and working conditions, and the technical and legal reform measures that shaped the system's transformation. The article then analyzes the survival of social security institutions and the introduction of an individual insurance model and its current implications and consequences. From the perspective of the right to health, the article compares the measures, resources, and interventions in both health care models and highlights the relevance of the social security system for Popular Insurance. The article concludes that the measures implemented to reform the Mexican health system have failed to achieve the intended results; on the contrary, they have led to a reduction in interventions, rising costs, and a decrease in the installed capacity and professional personnel for the system's operation, thus falling far short of solving the problem, rather aggravating the inequities without solving the system's structural contradictions. Health systems face new challenges, inevitably requiring that the analyses be situated in a broader framework rather than merely focusing on the functional, administrative, and financial operation of the systems in the respective countries.

Sea level rise impacts on wastewater treatment systems along the U.S. coasts

Science.gov (United States)

Hummel, M.; Berry, M.; Stacey, M. T.

2017-12-01

As sea levels rise, coastal communities will experience more frequent and persistent nuisance flooding, and some low-lying areas may be permanently inundated. Critical components of lifeline infrastructure networks in these areas are also at risk of flooding, which could cause significant service disruptions that extend beyond the flooded zone. Thus, identifying critical infrastructure components that are vulnerable to sea level rise is an important first step in developing targeted investment in protective actions and enhancing the overall resilience of coastal communities. Wastewater treatment plants are typically located at low elevations near the coastline to minimize the cost of collecting consumed water and discharging treated effluent, which makes them particularly susceptible to coastal flooding. For this analysis, we used geographic information systems to assess the vulnerability of wastewater infrastructure to various sea level rise projections at the national level. We then estimated the number of people who would lose wastewater services, which could be more than three times as high as previous predictions of the number of people at risk of direct flooding due to sea level rise. We also considered several case studies of wastewater infrastructure in mid-sized cities to determine how topography and system configuration (centralized versus distributed) impact vulnerability. Overall, this analysis highlights the widespread vulnerability of wastewater infrastructure in the U.S. and demonstrates that local disruptions to infrastructure networks may have far-ranging impacts on areas that do not experience direct flooding.

The rise of neoliberalism: how bad economics imperils health and what to do about it.

Science.gov (United States)

Labonté, Ronald; Stuckler, David

2016-03-01

The 2008 global financial crisis, precipitated by high-risk, under-regulated financial practices, is often seen as a singular event. The crisis, its recessionary consequences, bank bailouts and the adoption of 'austerity' measures can be seen as a continuation of a 40-year uncontrolled experiment in neoliberal economics. Although public spending and recapitalisation of failing banks helped prevent a 1930s-style Great Depression, the deep austerity measures that followed have stifled a meaningful recovery for the majority of populations. In the short term, these austerity measures, especially cuts to health and social protection systems, pose major health risks in those countries under its sway. Meanwhile structural changes to the global labour market, increasing under-employment in high-income countries and economic insecurity elsewhere, are likely to widen health inequities in the longer term. We call for four policy reforms to reverse rising inequalities and their harms to public health. First is re-regulating global finance. Second is rejecting austerity as an empirically and ethically unjustified policy, especially given now clear evidence of its deleterious health consequences. Third, there is a need to restore progressive taxation at national and global scales. Fourth is a fundamental shift away from the fossil fuel economy and policies that promote economic growth in ways that imperil environmental sustainability. This involves redistributing work and promoting fairer pay. We do not suggest these reforms will be politically feasible or even achievable in the short term. They nonetheless constitute an evidence-based agenda for strong, public health advocacy and practice. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Comparison of vacuum rise time, vacuum limit accuracy, and occlusion break surge of 3 new phacoemulsification systems.

Science.gov (United States)

Han, Young Keun; Miller, Kevin M

2009-08-01

To compare vacuum rise time, vacuum limit accuracy, and occlusion break surge of 3 new phacoemulsification machines. Jules Stein Eye Institute and Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA. The vacuum rise time under normal and enhanced aspiration modes, vacuum limit accuracy, and occlusion break surge of the Infiniti Vision System, Stellaris Vision Enhancement System, and WhiteStar Signature Phacoemulsification System were tested. Vacuum rise time and limit accuracy were measured at limit settings of 400 mm Hg and 600 mm Hg. Surge area was recorded at vacuum limit settings of 200 mm Hg, 300 mm Hg, 400 mm Hg, and 500 mm Hg. The Infiniti had the fastest vacuum rise times under normal and enhanced aspiration modes. At 4 seconds, the vacuum limit accuracy was greatest with the Infiniti at the 400 mm Hg limit and the Signature at the 600 mm Hg limit. The Stellaris did not reach either vacuum target. The Infiniti performed better than the other 2 machines during testing of occlusion break surge at all vacuum limit settings above 200 mm Hg. Under controlled laboratory test conditions, the Infiniti had the fastest vacuum rise time, greatest vacuum limit accuracy at 400 mm Hg, and least occlusion break surge. These results can be explained by the lower compliance of the Infiniti system.

Accidents Preventive Practice for High-Rise Construction

Directory of Open Access Journals (Sweden)

Goh Kai Chen

2016-01-01

Full Text Available The demand of high-rise projects continues to grow due to the reducing of usable land area in Klang Valley, Malaysia. The rapidly development of high-rise projects has leaded to the rise of fatalities and accidents. An accident that happened in a construction site can cause serious physical injury. The accidents such as people falling from height and struck by falling object were the most frequent accidents happened in Malaysian construction industry. The continuous growth of high-rise buildings indicates that there is a need of an effective safety and health management. Hence, this research aims to identify the causes of accidents and the ways to prevent accidents that occur at high-rise building construction site. Qualitative method was employed in this research. Interview surveying with safety officers who are involved in highrise building project in Kuala Lumpur were conducted in this research. Accidents were caused by man-made factors, environment factors or machinery factors. The accidents prevention methods were provide sufficient Personal Protective Equipment (PPE, have a good housekeeping, execute safety inspection, provide safety training and execute accidents investigation. In the meanwhile, interviewees have suggested the new prevention methods that were develop a proper site layout planning and de-merit and merit system among sub-contractors, suppliers and even employees regarding safety at workplace matters. This research helps in explaining the causes of accidents and identifying area where prevention action should be implemented, so that workers and top management will increase awareness in preventing site accidents.

Modelling Morphological Response of Large Tidal Inlet Systems to Sea Level Rise

NARCIS (Netherlands)

Dissanayake, P.K.

2011-01-01

This dissertation qualitatively investigates the morphodynamic response of a large inlet system to IPCC projected relative sea level rise (RSLR). Adopted numerical approach (Delft3D) used a highly schematised model domain analogous to the Ameland inlet in the Dutch Wadden Sea. Predicted inlet

Rise of Health Consumerism in China and Its Effects on Physicians' Professional Identity and the Physician-Patient Relationship and Communication.

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Tang, Lu; Guan, Mengfei

2018-05-01

The physician-patient relationship in China is highly strained. This study examined the professional identity of physicians and their perceptions of the physician-patient relationship against the backdrop of the rise of health consumerism in China. Structured interviews with 29 physicians found that the marketization of medical care and the rise of health consumerism caused physicians to have a conflicted professional identity. The traditional bureaucratic relationship between physicians and patients based on implicit trust was gradually replaced by an arm's length relationship characterized by self-interest, opportunism, and mistrust. In addition, the transition from physician-centered communication to patient-centered communication in China was tenacious. Theoretical and practical implications of the current study are discussed.

Effects of Sea Level Rise on Groundwater Flow Paths in a Coastal Aquifer System

Science.gov (United States)

Morrissey, S. K.; Clark, J. F.; Bennett, M. W.; Richardson, E.; Stute, M.

2008-05-01

Changes in groundwater flow in the Floridan aquifer system, South Florida, from the rise in sea level at the end of the last glacial period may be indicative of changes coastal aquifers will experience with continued sea level rise. As sea level rises, the hydraulic head near the coast increases. Coastal aquifers can therefore experience decreased groundwater gradients (increased residence times) and seawater intrusion. Stable isotopes of water, dissolved noble gas temperatures, radiocarbon and He concentrations were analyzed in water collected from 68 wells in the Floridan aquifer system throughout South Florida. Near the recharge area, geochemical data along groundwater flow paths in the Upper Floridan aquifer show a transition from recently recharged groundwater to glacial-aged water. Down gradient from this transition, little variation is apparent in the stable isotopes and noble gas recharge temperatures, indicating that most of the Upper Floridan aquifer contains groundwater recharged during the last glacial period. The rapid 120-meter rise in sea level marking the end of the last glacial period increased the hydraulic head in the Floridan aquifer system near the coast, slowing the flow of groundwater from the recharge area to the ocean and trapping glacial-aged groundwater. The raised sea level also flooded half of the Florida platform and caused seawater to intrude into the Lower Floridan. This circulation of seawater in the Lower Floridan continues today as our data indicate that the groundwater is similar to modern seawater with a freshwater component entering vertically from the recharge area to the Upper Floridan.

Population health in an era of rising income inequality: USA, 1980-2015.

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Bor, Jacob; Cohen, Gregory H; Galea, Sandro

2017-04-08

Income inequality in the USA has increased over the past four decades. Socioeconomic gaps in survival have also increased. Life expectancy has risen among middle-income and high-income Americans whereas it has stagnated among poor Americans and even declined in some demographic groups. Although the increase in income inequality since 1980 has been driven largely by soaring top incomes, the widening of survival inequalities has occurred lower in the distribution-ie, between the poor and upper-middle class. Growing survival gaps across income percentiles since 2001 reflect falling real incomes among poor Americans as well as an increasingly strong association between low income and poor health. Changes in individual risk factors such as smoking, obesity, and substance abuse play a part but do not fully explain the steeper gradient. Distal factors correlated with rising inequality including unequal access to technological innovations, increased geographical segregation by income, reduced economic mobility, mass incarceration, and increased exposure to the costs of medical care might have reduced access to salutary determinants of health among low-income Americans. Having missed out on decades of income growth and longevity gains, low-income Americans are increasingly left behind. Without interventions to decouple income and health, or to reduce inequalities in income, we might see the emergence of a 21st century health-poverty trap and the further widening and hardening of socioeconomic inequalities in health. Copyright © 2017 Elsevier Ltd. All rights reserved.

Medical tourism and its impact on the US health care system.

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Forgione, Dana A; Smith, Pamela C

2007-01-01

The health care industry within the United States continues to face unprecedented increases in costs, along with the task of providing care to an estimated 46 million uninsured or underinsured patients. These patients, along with both insurers and employers, are seeking to reduce the costs of treatment through international outsourcing of medical and surgical care. Knows as medical tourism, this trend is on the rise, and the US health care system has not fully internalized the effects this will have on its economic structure and policies. The demand for low-cost health care services is driving patients to seek treatment on a globally competitive basis, while balancing important quality of care issues. In this article, we outline some of the issues facing legislators, health care policy makers, providers, and health service researchers regarding the impact of medical tourism on the US health care system.

Rising labor costs, earnings management, and financial performance of health care providers around the world.

Science.gov (United States)

Dong, Gang Nathan

2015-01-01

Amid increasing interest in how government regulation and market competition affect the cost and financial sustainability in health care sector, it remains unclear whether health care providers behave similarly to their counterparts in other industries. The goal of this chapter is to study the degree to which health care providers manipulate accruals in periods of financial difficulties caused, in part, by the rising costs of labor. We collected the financial information of health care provider in 43 countries from 1984 to 2013 and conducted a pooled cross-sectional study with country and year fixed-effects. The empirical evidence shows that health care providers with higher wage costs are more likely to smooth their earnings in order to maintain financial sustainability. The finding of this study not only informs regulators that earnings management is pervasive in health care organizations around the world, but also contributes to the studies of financial booktax reporting alignment, given the existing empirical evidence linking earnings management to corporate tax avoidance in this very sector.

Strengthening the Health System to Better Confront Noncommunicable Diseases in India

Directory of Open Access Journals (Sweden)

Antonio Duran

2011-01-01

Full Text Available The paper emphasizes the vital need to address the rising burden of noncommunicable diseases (NCDs in India with a health systems approach. The authors argue that adoption of such approach may soon be imperative. Applying the health systems framework developed by the WHO in 2000 to NCDs means in summary re-examining the planning and organization of the entire health system, from service provision to financing, from information generation to ensuring adequate supply of pharmaceuticals/technologies or human resources, from improving facility management to performance monitoring. Using this framework the authors seek to highlight core issues and identify possible policy actions required. The challenge is to ensure the best implementation of what works, aligning the service provision function with the financial incentives, ensuring leadership/stewardship by the government across local/municipal, state or regional and national level while involving stakeholders. A health system perspective would also ensure that action against NCD goes hand in hand with tackling the remaining burden from communicable diseases, maternal, child health and nutrition issues.

Current pulse: can a production system reduce medical errors in health care?

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Printezis, Antonios; Gopalakrishnan, Mohan

2007-01-01

One of the reasons for rising health care costs is medical errors, a majority of which result from faulty systems and processes. Health care in the past has used process-based initiatives such as Total Quality Management, Continuous Quality Improvement, and Six Sigma to reduce errors. These initiatives to redesign health care, reduce errors, and improve overall efficiency and customer satisfaction have had moderate success. Current trend is to apply the successful Toyota Production System (TPS) to health care since its organizing principles have led to tremendous improvement in productivity and quality for Toyota and other businesses that have adapted them. This article presents insights on the effectiveness of TPS principles in health care and the challenges that lie ahead in successfully integrating this approach with other quality initiatives.

Medicare's prospective payment system for hospitals: new evidence on transitions among health care settings

OpenAIRE

Qian, Xufeng; Russell, Louise B.; Valiyeva, Elmira; Miller, Jane E.

2007-01-01

Previous studies of Medicare’s prospective payment system for hospitals (PPS), introduced in 1983, evaluated only its first few years, using data collected during the hospital stay to control for patients’ health. We examine transitions among health care settings over a full decade following implementation of PPS, using survival models and a national longitudinal survey with independent information on health. We find that the rate of discharge from hospitals to nursing homes continued to rise...

[The dimension of the paradigm of complexity in health systems].

Science.gov (United States)

Fajardo-Ortiz, Guillermo; Fernández-Ortega, Miguel Ángel; Ortiz-Montalvo, Armando; Olivares-Santos, Roberto Antonio

2015-01-01

This article presents elements to better understand health systems from the complety paradigm, innovative perspective that offers other ways in the conception of the scientific knowledge prevalent away from linear, characterized by the arise of emerging dissociative and behaviors, based on the intra and trans-disciplinarity concepts such knowledges explain and understand in a different way what happens in the health systems with a view to efficiency and effectiveness. The complexity paradigm means another way of conceptualizing the knowledge, is different from the prevalent epistemology, is still under construction does not separate, not isolated, is not reductionist, or fixed, does not solve the problems, but gives other bases to know them and study them, is a different strategy, a perspective that has basis in the systems theory, informatics and cybernetics beyond traditional knowledge, the positive logics, the newtonian physics and symmetric mathematics, in which everything is centered and balanced, joint the "soft sciences and hard sciences", it has present the Social Determinants of Health and organizational culture. Under the complexity paradigm the health systems are identified with the following concepts: entropy, neguentropy, the thermodynamic second law, attractors, chaos theory, fractals, selfmanagement and self-organization, emerging behaviors, percolation, uncertainty, networks and robusteness; such expressions open new possibilities to improve the management and better understanding of the health systems, giving rise to consider health systems as complex adaptive systems. Copyright © 2015. Published by Masson Doyma México S.A.

Lateral Load-Resisting System Using Mass Timber Panel for High-Rise Buildings

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Zhiyong Chen

2017-07-01

Full Text Available As global interest in using engineered wood products in tall buildings intensifies due to the “green” credential of wood, it is expected that more tall wood buildings will be designed and constructed in the coming years. This, however, brings new challenges to the designers. One of the major challenges is how to design lateral load-resisting systems (LLRSs with sufficient stiffness, strength, and ductility to resist strong wind and earthquakes. In this study, an LLRS using mass timber panel on a stiff podium was developed for high-rise buildings in accordance with capacity-based design principle. The LLRS comprises eight shear walls with a core in the center of the building, which was constructed with structural composite lumber and connected with dowel-type connections and wood–steel composite system. The main energy dissipating mechanism of the LLRS was detailed to be located at the panel-to-panel interface. This LLRS was implemented in the design of a hypothetical 20-storey building. A finite element (FE model of the building was developed using general-purpose FE software, ABAQUS. The wind-induced and seismic response of the building model was investigated by performing linear static and non-linear dynamic analyses. The analysis results showed that the proposed LLRS using mass timber was suitable for high-rise buildings. This study provided a valuable insight into the structural performance of LLRS constructed with mass timber panels as a viable option to steel and concrete for high-rise buildings.

Reducing Technology-Induced Errors: Organizational and Health Systems Approaches.

Science.gov (United States)

Borycki, Elizabeth M; Senthriajah, Yalini; Kushniruk, Andre W; Palojoki, Sari; Saranto, Kaija; Takeda, Hiroshi

2016-01-01

Technology-induced errors are a growing concern for health care organizations. Such errors arise from the interaction between healthcare and information technology deployed in complex settings and contexts. As the number of health information technologies that are used to provide patient care rises so will the need to develop ways to improve the quality and safety of the technology that we use. The objective of the panel is to describe varying approaches to improving software safety from and organizational and health systems perspective. We define what a technology-induced error is. Then, we discuss how software design and testing can be used to improve health information technologies. This discussion is followed by work in the area of monitoring and reporting at a health district and national level. Lastly, we draw on the quality, safety and resilience literature. The target audience for this work are nursing and health informatics researchers, practitioners, administrators, policy makers and students.

The Rise of Post-truth Populism in Pluralist Liberal Democracies: Challenges for Health Policy.

Science.gov (United States)

Speed, Ewen; Mannion, Russell

2017-02-12

Recent years have witnessed the rise of populism and populist leaders, movements and policies in many pluralist liberal democracies, with Brexit and the election of Trump the two most recent high profile examples of this backlash against established political elites and the institutions that support them. This new populism is underpinned by a post-truth politics which is using social media as a mouthpiece for 'fake news' and 'alternative facts' with the intention of inciting fear and hatred of 'the other' and thereby helping to justify discriminatory health policies for marginalised groups. In this article, we explore what is meant by populism and highlight some of the challenges for health and health policy posed by the new wave of post-truth populism. © 2017 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Socioecological Aspects of High-rise Construction

Science.gov (United States)

Eichner, Michael; Ivanova, Zinaida

2018-03-01

In this article, the authors consider the socioecological problems that arise in the construction and operation of high-rise buildings. They study different points of view on high-rise construction and note that the approaches to this problem are very different. They also analyse projects of modern architects and which attempts are made to overcome negative impacts on nature and mankind. The article contains materials of sociological research, confirming the ambivalent attitude of urban population to high-rise buildings. In addition, one of the author's sociological survey reveals the level of environmental preparedness of the university students, studying in the field of "Construction of unique buildings and structures", raising the question of how future specialists are ready to take into account socioecological problems. Conclusion of the authors: the construction of high-rise buildings is associated with huge social and environmental risks, negative impact on the biosphere and human health. This requires deepened skills about sustainable design methods and environmental friendly construction technologies of future specialists. Professor M. Eichner presents in the article his case study project results on implementation of holistic eco-sustainable construction principles for mixed-use high-rise building in the metropolis of Cairo.

The capitalist world-system and international health.

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Elling, R H

1981-01-01

A number of world health problems which have been discretely considered in the past are viewed in this paper as interwoven with each other and with the functioning of the capitalist political-economic world-system. Thus, climactic explanations ("tropical medicine"), and even poverty when conceived in cultural terms or as a structural problem resident entirely within a single nation, are seen as inadequate for understanding any or all of the problems discussed briefly here: poor general health levels in peripheral and semi-peripheral nations, especially rising infant mortality rates in countries such as Brazil; comerciogenic malnutrition; dumping and exploitative sale of drugs, pesticides and other products banned or restricted in core nations; genocidal and other threatening approaches to population control; export of hazardous and polluting industry to peripheral and semi-peripheral nations; similar export of human experimentation; the sale of irrelevant, high medical technology to countries lacking basic public health measures, the "brain drain", and medical imperialism. Also discounted are moralistic inveighing, complaints about inadequate information and its transfer, discussions of bureaucratic bumbling or inter-agency politics and professional rivalries, various forms of victim-blaming, and other explanations and corrective approaches which ignore class structure and the control, distribution, and expropriation of resources in nations and the world-system. The framework suggests the importance of a worldwide cultural hegemony, including a medical cultural hegemony, established by and in the service of the ruling classes. Socialist-oriented nations which are quasi-independent of the capitalist world-system are seen as suffering less from its effects. This suggests that we should conceive of world socialist health and world capitalist health, rather than any kind of unified phenomenon called "international health".

Effect of health system reforms in Turkey on user satisfaction.

Science.gov (United States)

Stokes, Jonathan; Gurol-Urganci, Ipek; Hone, Thomas; Atun, Rifat

2015-12-01

In 2003, the Turkish government introduced major health system changes, the Health Transformation Programme (HTP), to achieve universal health coverage (UHC). The HTP leveraged changes in all parts of the health system, organization, financing, resource management and service delivery, with a new family medicine model introducing primary care at the heart of the system. This article examines the effect of these health system changes on user satisfaction, a key goal of a responsive health system. Utilizing the results of a nationally representative yearly survey introduced at the baseline of the health system transformation, multivariate logistic regression analysis is used to examine the yearly effect on satisfaction with health services. During the 9-year period analyzed (2004-2012), there was a nearly 20% rise in reported health service use, coinciding with increased access, measured by insurance coverage. Controlling for factors known to contribute to user satisfaction in the literature, there is a significant (P < 0.001) increase in user satisfaction with health services in almost every year (bar 2006) from the baseline measure, with the odds of being satisfied with health services in 2012, 2.56 (95% confidence interval (CI) of 2.01-3.24) times that in 2004, having peaked at 3.58 (95% CI 2.82-4.55) times the baseline odds in 2011. Additionally, those who used public primary care services were slightly, but significantly (P < 0.05) more satisfied than those who used any other services, and increasingly patients are choosing primary care services rather than secondary care services as the provider of first contact. A number of quality indicators can probably help account for the increased satisfaction with public primary care services, and the increase in seeking first-contact with these providers. The implementation of primary care focused UHC as part of the HTP has improved user satisfaction in Turkey.

Sea Level Rise Impacts on Wastewater Treatment Systems Along the U.S. Coasts

Science.gov (United States)

Hummel, Michelle A.; Berry, Matthew S.; Stacey, Mark T.

2018-04-01

As sea levels rise, coastal communities will experience more frequent and persistent nuisance flooding, and some low-lying areas may be permanently inundated. Critical components of lifeline infrastructure networks in these areas are also at risk of flooding, which could cause significant service disruptions that extend beyond the flooded zone. Thus, identifying critical infrastructure components that are exposed to sea level rise is an important first step in developing targeted investment in protective actions and enhancing the overall resilience of coastal communities. Wastewater treatment plants are typically located at low elevations near the coastline to minimize the cost of collecting consumed water and discharging treated effluent, which makes them particularly susceptible to coastal flooding. For this analysis, we used geographic information systems to assess the exposure of wastewater infrastructure to various sea level rise projections at the national level. We then estimated the number of people who would lose wastewater services, which could be more than five times as high as previous predictions of the number of people at risk of direct flooding due to sea level rise. We also performed a regional comparison of wastewater exposure to marine and groundwater flooding in the San Francisco Bay Area. Overall, this analysis highlights the widespread exposure of wastewater infrastructure in the United States and demonstrates that local disruptions to infrastructure networks may have far-ranging impacts on areas that do not experience direct flooding.

Consumerism and wellness: rising tide, falling cost.

Science.gov (United States)

Domaszewicz, Alexander

2008-01-01

Annual employer-sponsored health plan cost increases have been slowing incrementally due to slowing health care utilization--a phenomenon very likely tied to the proliferation of health management activities, wellness programs and other consumerism strategies. This article describes the sharp rise in recent years of consumer-directed health plans (CDHPs) and explains what developments must happen for genuine consumer-directed health care to realize its full potential. These developments include gathering transparent health care information, increasing consumer demand for that information and creating truly intuitive data solutions that allow consumers to easily access information in order to make better health care decisions.

United Kingdom (England): Health system review.

Science.gov (United States)

Boyle, Seán

2011-01-01

The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. Various indicators show that the health of the population has improved over the last few decades. However, inequalities in health across socioeconomic groups have been increasing since the 1970s. The main diseases affecting the population are circulatory diseases, cancer, diseases of the respiratory system and diseases of the digestive system. Risk factors such as the steadily rising levels of alcohol consumption, the sharp increases in adult and child obesity and prevailing smoking levels are among the most pressing public health concerns, particularly as they reflect the growing health inequalities among different socioeconomic groups. Health services in England are largely free at the point of use. The NHS provides preventive medicine, primary care and hospital services to all those ordinarily resident. Over 12% of the population is covered by voluntary health insurance schemes, known in the United Kingdom as private medical insurance (PMI), which mainly provides access to acute elective care in the private sector. Responsibility for publicly funded health care rests with the Secretary of State for Health, supported by the Department of Health. The Department operates at a regional level through 10 strategic health authorities (SHAs), which are responsible for ensuring the quality and performance of local health services within their geographic area. Responsibility for commissioning health services at the local level lies with 151 primary care

Socioecological Aspects of High-rise Construction

Directory of Open Access Journals (Sweden)

Eichner Michael

2018-01-01

Full Text Available In this article, the authors consider the socioecological problems that arise in the construction and operation of high-rise buildings. They study different points of view on high-rise construction and note that the approaches to this problem are very different. They also analyse projects of modern architects and which attempts are made to overcome negative impacts on nature and mankind. The article contains materials of sociological research, confirming the ambivalent attitude of urban population to high-rise buildings. In addition, one of the author’s sociological survey reveals the level of environmental preparedness of the university students, studying in the field of "Construction of unique buildings and structures", raising the question of how future specialists are ready to take into account socioecological problems. Conclusion of the authors: the construction of high-rise buildings is associated with huge social and environmental risks, negative impact on the biosphere and human health. This requires deepened skills about sustainable design methods and environmental friendly construction technologies of future specialists. Professor M. Eichner presents in the article his case study project results on implementation of holistic eco-sustainable construction principles for mixed-use high-rise building in the metropolis of Cairo.

Internet infrastructures and health care systems: a qualitative comparative analysis on networks and markets in the British National Health Service and Kaiser Permanente.

Science.gov (United States)

Séror, Ann C

2002-12-01

The Internet and emergent telecommunications infrastructures are transforming the future of health care management. The costs of health care delivery systems, products, and services continue to rise everywhere, but performance of health care delivery is associated with institutional and ideological considerations as well as availability of financial and technological resources. to identify the effects of ideological differences on health care market infrastructures including the Internet and telecommunications technologies by a comparative case analysis of two large health care organizations: the British National Health Service and the California-based Kaiser Permanente health maintenance organization. A qualitative comparative analysis focusing on the British National Health Service and the Kaiser Permanente health maintenance organization to show how system infrastructures vary according to market dynamics dominated by health care institutions ("push") or by consumer demand ("pull"). System control mechanisms may be technologically embedded, institutional, or behavioral. The analysis suggests that telecommunications technologies and the Internet may contribute significantly to health care system performance in a context of ideological diversity. The study offers evidence to validate alternative models of health care governance: the national constitution model, and the enterprise business contract model. This evidence also suggests important questions for health care policy makers as well as researchers in telecommunications, organizational theory, and health care management.

Strengthening health system to improve immunization for migrants in China.

Science.gov (United States)

Fang, Hai; Yang, Li; Zhang, Huyang; Li, Chenyang; Wen, Liankui; Sun, Li; Hanson, Kara; Meng, Qingyue

2017-07-01

Immunization is the most cost-effective method to prevent and control vaccine-preventable diseases. Migrant population in China has been rising rapidly, and their immunization status is poor. China has tried various strategies to strengthen its health system, which has significantly improved immunization for migrants. This study applied a qualitative retrospective review method aiming to collect, analyze and synthesize health system strengthening experiences and practices about improving immunizations for migrants in China. A conceptual framework of Theory of Change was used to extract the searched literatures. 11 searched literatures and 4 national laws and policies related to immunizations for migrant children were carefully studied. China mainly employed 3 health system strengthening strategies to significantly improve immunization for migrant population: stop charging immunization fees or immunization insurance, manage immunization certificates well, and pay extra attentions on immunization for special children including migrant children. These health system strengthening strategies were very effective, and searched literatures show that up-to-date and age-appropriate immunization rates were significantly improved for migrant children. Economic development led to higher migrant population in China, but immunization for migrants, particularly migrant children, were poor. Fortunately various health system strengthening strategies were employed to improve immunization for migrants in China and they were rather successful. The experiences and lessons of immunization for migrant population in China might be helpful for other developing countries with a large number of migrant population.

Tank 241-SY-101 surface level rise remediation test and evaluation plan for transfer system

International Nuclear Information System (INIS)

BAUER, R.E.

1999-01-01

The purpose of this testing and evaluation plan (TEP) is to provide the high level guidance on testing requirements for ensuring that the equipment and systems to be implemented for remediation of the SY-101 waste level rise USQ are effective

Effect of health system reforms in Turkey on user satisfaction

Directory of Open Access Journals (Sweden)

Jonathan Stokes

2015-12-01

Full Text Available In 2003, the Turkish government introduced major health system changes, the Health Transformation Programme (HTP, to achieve universal health coverage (UHC. The HTP leveraged changes in all parts of the health system, organization, financing, resource management and service delivery, with a new family medicine model introducing primary care at the heart of the system. This article examines the effect of these health system changes on user satisfaction, a key goal of a responsive health system. Utilizing the results of a nationally representative yearly survey introduced at the baseline of the health system transformation, multivariate logistic regression analysis is used to examine the yearly effect on satisfaction with health services. During the 9–year period analyzed (2004–2012, there was a nearly 20% rise in reported health service use, coinciding with increased access, measured by insurance coverage. Controlling for factors known to contribute to user satisfaction in the literature, there is a significant (P < 0.001 increase in user satisfaction with health services in almost every year (bar 2006 from the baseline measure, with the odds of being satisfied with health services in 2012, 2.56 (95% Confidence Interval (CI of 2.01–3.24 times that in 2004, having peaked at 3.58 (CI, 2.82–4.55 times the baseline odds in 2011. Additionally, those who used public primary care services were slightly, but significantly (P < 0.05 more satisfied than those who used any other services, and increasingly patients are choosing primary care services rather than secondary care services as the provider of first contact. A number of quality indicators can probably help account for the increased satisfaction with public primary care services, and the increase in seeking first–contact with these providers. The implementation of primary care focused UHC as part of the HTP has improved user satisfaction in Turkey.

Special considerations for testing rising rotating stem MOVs

International Nuclear Information System (INIS)

Moffa, A.

1992-01-01

Rising stem gate and globe valves have one plane of motion: linear. The stem is either pushed or pulled into position. For rising and rotating stems however, there are two planes of motion: linear and rotational. The stem is twisted in addition to being pushed or pulled into position. Typical motor operated valve (MOV) sizing equations account only for the linear requirements of the valve to open or close. Theoretical calculations performed for a two-dimensional system predict that in the running load region, rotational torque requirements far exceed the linear requirements. To validate the theoretical model, torque testing of rising rotating stem valves was preformed, using Liberty Technologies Valve Operation Test and Evaluation System (VOTES). Theoretical and empirical data have produced a new perspective for operational requirements and a guideline for testing rising rotating stem valves

Defining Health in the Era of Value-based Care: Lessons from England of Relevance to Other Health Systems.

Science.gov (United States)

Gentry, Sarah; Badrinath, Padmanabhan

2017-03-06

The demand for healthcare is rising due to aging populations, rising chronic disease prevalence, and technological innovations. There are currently more effective and cost-effective interventions available than can be afforded within limited budgets. A new way of thinking about the optimal use of resources is needed. Ensuring that available resources are used for interventions that provide outcomes that patient's most value, rather than a focus just on effectiveness and cost-effectiveness, may help to ensure that resources are used optimally. Value-based healthcare puts what patients value at the center of healthcare. It helps ensure that they receive the care that can provide them with outcomes they think are important and that limited resources are focused on high-value interventions. In order to do this, we need flexible definitions of 'health', personalized and tailored to patient values. We review the current status of value-based health care in England and identify lessons applicable to a variety of health systems. For this, we draw upon the work of the National Institute for Health and Care Excellence (NICE), the National Health Service (NHS), Right Care Initiative, and our local experience in promoting value-based health care for specific conditions in our region. Combining the best available evidence with open and honest dialogue between patients, clinicians, and others, whilst requiring considerable time and resources are essential to building a consensus around the value that allows the best use of limited budgets. Values have been present in healthcare since its beginnings. Placing value and values at the center of healthcare could help to ensure available resources are used to provide the greatest possible benefit to patients.

Rising workload or rising work pressure in general practice in the Netherlands.

NARCIS (Netherlands)

Bakker, D.H. de; Hutten, J.B.F.; Steultjens, M.; Schellevis, F.

2002-01-01

Background: General practice in the Netherlands seems to be in a crisis. Worries about shortages of GP's, the first strike of general practitioners in 2001 and the rapid increase of triage systems in out of hours care are signs that work pressure and/or workload are rising. But systematic evidence

The energy-saving anaerobic baffled reactor membrane bioreactor (EABR-MBR) system for recycling wastewater from a high-rise building.

Science.gov (United States)

Ratanatamskul, Chavalit; Charoenphol, Chakraphan

2015-01-01

A novel energy-saving anaerobic baffled reactor-membrane bioreactor (EABR-MBR) system has been developed as a compact biological treatment system for reuse of water from a high-rise building. The anaerobic baffled reactor (ABR) compartment had five baffles and served as the anaerobic degradation zone, followed by the aerobic MBR compartment. The total operating hydraulic retention time (HRT) of the EABR-MBR system was 3 hours (2 hours for ABR compartment and very short HRT of 1 hour for aerobic MBR compartment). The wastewater came from the Charoen Wisawakam building. The results showed that treated effluent quality was quite good and highly promising for water reuse purposes. The average flux of the membrane was kept at 30 l/(m2h). The EABR-MBR system could remove chemical oxygen demand, total nitrogen and total phosphorus from building wastewater by more than 90%. Moreover, it was found that phosphorus concentration was rising in the ABR compartment due to the phosphorus release phenomenon, and then the concentration decreased rapidly in the aerobic MBR compartment due to the phosphorus uptake phenomenon. This implies that phosphorus-accumulating organisms inside the EABR-MBR system are responsible for biological phosphorus removal. The research suggests that the EABR-MBR system can be a promising system for water reuse and reclamation for high-rise building application in the near future.

Recent progress in sensor-enhanced health information systems - slowly but sustainably.

Science.gov (United States)

Marschollek, Michael

2009-12-01

The use of health-enabling technologies is regarded as one important means to face some of the challenges which accompany the demographic change with an expected rise in multi-morbidity and an increased need of care. A precondition for the sensible use of these technologies is their integration in existing information system structures, and - preferably - the enhancement of these into sensor-enhanced health information systems (seHIS). The aim of this review is to report on recent progress in seHIS, and thus to identify relevant areas of research that have to be addressed to provide patient-centered services in a semantically interoperable environment. A literature search in PubMed/Medline was combined with a manual search of papers (n = 1004) in three prominent health/medical informatics journals and one biomedical engineering journal starting from the year 2007. Despite a multitude of papers that present advanced systems using health-enabling technologies, only few papers could be identified that explicitly describe the design of seHIS or the integration of health-enabling technologies into health information systems. Recurring statements emphasise the importance of the following areas of research: patient-centered care using all available sources of information, data security, the stringent use of data representation and device connectivity standards, and adequate methods for data fusion and diagnostic analysis. There is a broad range of research in health-enabling technologies, often focused on specific diseases. The transition from current institution-centered health information systems to person-centered seHIS will be gradual, yet unavoidable for tapping the full potential of health-enabling technologies. seHIS is a growing field of research, and many ambitious challenges are still open. This literature review gives a brief outline of the most frequently mentioned research foci.

The rise and fall of an opt-out system.

Science.gov (United States)

Nordfalk, Francisca; Hoeyer, Klaus

2018-04-01

In Denmark, citizens participate in register-based research without the possibility of opting out. However, in 1995 it was made possible for Danish citizens to register an opt-out called 'researcher protection' [ forskerbeskyttelse], which implied that researchers could not contact people to invite them to participate in research projects, such as clinical trials or questionnaries, based on their registrations in national registers. Data already registered could still be used for research. In 2014, this possibility of opt-out was revoked by law. The aims of this paper are to understand how the Danish researcher protection system came about, why it was terminated and what we can we learn from this example. We conducted a descriptive analysis of a copy of the former researcher protection register along with policies and media debate surrounding the rise and revocation of the researcher protection system. Our results show how both the inception and the abolishment of researcher protection appear to be ad hoc and without specified criteria of success. An examination of the recorded entries in the researcher protection registry could have led to changes in its administration as an alternative to its total abolition. In future opt-out systems, there should be focus on monitoring register practices and the purpose and criteria for evaluation must be defined prior to implementation.

A livability rating system of a high-rise housing and its computer simulation

Science.gov (United States)

Liu, Zhengrui

2017-09-01

Aiming at the problems in housing choosing and purchasing in the high-rise residential buildings, this paper considers the factors that affect various livable degrees and analyzes the important degrees of the factors through the Analytic Hierarchy Process (AHP), quantifying the various factors by 10 point scoring system. Accordingly, this paper puts forward a habitable housing index, validating the correctness of the indicators by simulating the process of housing choosing through computer program.

Disposal of Kitchen Waste from High Rise Apartment

Science.gov (United States)

Ori, Kirki; Bharti, Ajay; Kumar, Sunil

2017-09-01

The high rise building has numbers of floor and rooms having variety of users or tenants for residential purposes. The huge quantities of heterogenous mixtures of domestic food waste are generated from every floor of the high rise residential buildings. Disposal of wet and biodegradable domestic kitchen waste from high rise buildings are more expensive in regards of collection and vertical transportation. This work is intended to address the technique to dispose of the wet organic food waste from the high rise buildings or multistory building at generation point with the advantage of gravity and vermicomposting technique. This innovative effort for collection and disposal of wet organic solid waste from high rise apartment is more economical and hygienic in comparison with present system of disposal.

System impact research - increasing public health and health care system performance.

Science.gov (United States)

Malmivaara, Antti

2016-01-01

Interventions directed to system features of public health and health care should increase health and welfare of patients and population. To build a new framework for studies aiming to assess the impact of public health or health care system, and to consider the role of Randomized Controlled Trials (RCTs) and of Benchmarking Controlled Trials (BCTs). The new concept is partly based on the author's previous paper on the Benchmarking Controlled Trial. The validity and generalizability considerations were based on previous methodological studies on RCTs and BCTs. The new concept System Impact Research (SIR) covers all the studies which aim to assess the impact of the public health system or of the health care system on patients or on population. There are two kinds of studies in System Impact Research: Benchmarking Controlled Trials (observational) and Randomized Controlled Trials (experimental). The term impact covers in particular accessibility, quality, effectiveness, safety, efficiency, and equality. System Impact Research - creating the scientific basis for policy decision making - should be given a high priority in medical, public health and health economic research, and should also be used for improving performance. Leaders at all levels of health and social care can use the evidence from System Impact Research for the benefit of patients and population. Key messages The new concept of SIR is defined as a research field aiming at assessing the impacts on patients and on populations of features of public health and health and social care systems or of interventions trying to change these features. SIR covers all features of public health and health and social care system, and actions upon these features. The term impact refers to all effects caused by the public health and health and social care system or parts of it, with particular emphasis on accessibility, quality, effectiveness, adverse effects, efficiency, and equality of services. SIR creates the

Beyond the bench and the bedside: economic and health systems dimensions of global childhood cancer outcomes.

Science.gov (United States)

Denburg, Avram E; Knaul, Felicia M; Atun, Rifat; Frazier, Lindsay A; Barr, Ronald D

2014-03-01

Globally, the number of new cases of childhood cancer continues to rise, with a widening gulf in outcomes across countries, despite the availability of effective cure options for many pediatric cancers. Economic forces and health system realities are deeply embedded in the foundation of disparities in global childhood cancer outcomes. A truly global effort to close the childhood cancer divide therefore requires systemic solutions. Analysis of the economic and health system dimensions of childhood cancer outcomes is essential to progress in childhood cancer survival around the globe. The conceptual power of this approach is significant. It provides insight into how and where pediatric oncology entwines with broader political and economic conditions, and highlights the mutual benefit derived from systems-oriented solutions. © 2013 Wiley Periodicals, Inc.

Building a durable response to HIV/AIDS: implications for health systems.

Science.gov (United States)

Atun, Rifat; Bataringaya, Jacqueline

2011-08-01

The remarkable rise in investments for HIV control programs in 2003-2010 enabled an unprecedented expansion of access to HIV services in low-income and middle-income countries. By the end of 2010, more than 5.2 million people were receiving antiretroviral therapy (ART), which transformed HIV infection, once a death sentence, into a long-term illness. The rapid expansion in the number of persons receiving ART means that health systems must continue to provide acute life-saving care for those with advanced HIV/AIDS although also providing chronic care services to expanding cohorts of more stable patients who are doing well on ART. This expansion also means a transition from an emergency response to the epidemic, characterized by a public health approach, to a more integrated and durable approach to HIV prevention, care, and treatment services that fosters individualized care for those requiring long-term antiretroviral treatment. Yet most low-income and middle-income countries, which have weak health systems, are poorly prepared to make this transition. In this article, we highlight the challenges health systems face in developing a sustained and durable response to HIV/AIDS. The article analyses the readiness of health systems to combine rapid expansion of ART access with long-term treatment and continuity of care for a growing cohort of patients. We argue that effective management of a transition from an emergency AIDS response to long-term programatic strategies will require a paradigm shift that enables leveraging investments in HIV to build sustainable health systems for managing large cohorts of patients receiving ART although meeting the immediate needs of those who remain without access to HIV treatment and care.

Potential application of a centralized solar water-heating system for a high-rise residential building in Hong Kong

International Nuclear Information System (INIS)

Chow, T.T.; Fong, K.F.; Chan, A.L.S.; Lin, Z.

2006-01-01

There is a growing, government-led trend of applying renewable energy in Hong Kong. One area of interest lies in the wider use of solar-energy systems. The worldwide fast development of building-integrated solar technology has prompted the design alternative of fixing the solar panels on the external facades of buildings. In Hong Kong, high-rise buildings are found everywhere in the urban districts. How to make full use of the vertical facades of these buildings to capture the most solar radiation can be an important area in the technology promotion. In this numerical study, the potential application of a centralized solar water-heating system in high-rise residence was evaluated. Arrays of solar thermal collectors, that occupied the top two-third of the south and west facades of a hypothetical high-rise residence, were proposed for supporting the domestic hot-water system. Based on typical meteorological data, it was found that the annual efficiency of the vertical solar collectors could reach 38.4% on average, giving a solar fraction of 53.4% and a payback period of 9.2 years. Since the solar collectors were able to reduce the heat transmission through the building envelope, the payback was in fact even shorter if the energy saving in air-conditioner operation was considered

The Rise of the Professional Field of Medicine in Sweden

Directory of Open Access Journals (Sweden)

Carina Carlhed

2013-12-01

Full Text Available This article is an analysis of conditions enabling the rise of the professional field of medicine in Sweden. The analysis is based mainly on second- ary data, while the use of primary data is restricted to official statistics. Primarily, it aims to study the conditions promoting professionalization in medicine. Important exogenous conditions were derived from early emerging nation state administration structures concerning policy and governance of public health, as well as a delegated supervision of professional health activities to the medical profession and the organization of a public national health care system. Professionalization strategies such as social organization of the medical profession and their use of a variety of legitimizing resources as tools for jurisdictional claims are considered as endogenous conditions. Broadly, the analysis shows a close relationship between the growth of professionalization in the field of medicine and the development of state prosperity in the Swedish welfare state. 

Justification of directions of technological and price audit systems changes for the purpose of high-rise construction innovating

Science.gov (United States)

Rogacheva, Yana; Panenkov, Andrey; Petrikova, Zinaida; Nezhnikova, Ekaterina

2018-03-01

Improving the quality of high-rise buildings under modern conditions should be based not only on compliance with the norms of technical regulations, but also on ensuring energy efficiency, environmental friendliness, and intellectuality, which can be achieved only through the introduction of innovations at all stages of the life cycle of the investment project. Authors of this article justified the need for a mechanism of technological and price audit of projects. They also suggested the model of life cycle of organizational and economic changes, connected with implantation of the mechanism of projects audit. They showed innovation character of ecological high-rise construction for the whole life cycle. Authors also made proposals to change the audit system for high-rise construction projects in the focus of its environmental friendliness.

Justification of directions of technological and price audit systems changes for the purpose of high-rise construction innovating

Directory of Open Access Journals (Sweden)

Rogacheva Yana

2018-01-01

Full Text Available Improving the quality of high-rise buildings under modern conditions should be based not only on compliance with the norms of technical regulations, but also on ensuring energy efficiency, environmental friendliness, and intellectuality, which can be achieved only through the introduction of innovations at all stages of the life cycle of the investment project. Authors of this article justified the need for a mechanism of technological and price audit of projects. They also suggested the model of life cycle of organizational and economic changes, connected with implantation of the mechanism of projects audit. They showed innovation character of ecological high-rise construction for the whole life cycle. Authors also made proposals to change the audit system for high-rise construction projects in the focus of its environmental friendliness.

Leasing instruments of high-rise construction financing

Science.gov (United States)

Aleksandrova, Olga; Ivleva, Elena; Sukhacheva, Viktoria; Rumyantseva, Anna

2018-03-01

The leasing sector of the business economics is expanding. Leasing instruments for high-rise construction financing allow to determine the best business behaviour in the leasing economy sector, not only in the sphere of transactions with equipment and vehicles. Investments in high-rise construction have a multiplicative effect. It initiates an active search and leasing instruments use in the economic behaviour of construction organizations. The study of the high-rise construction sector in the structure of the leasing market participants significantly expands the leasing system framework. The scheme of internal and external leasing process factors influence on the result formation in the leasing sector of economy is offered.

Reforms are needed to increase public funding and curb demand for private care in Israel's health system.

Science.gov (United States)

Chernichovsky, Dov

2013-04-01

Historically, the Israeli health care system has been considered a high-performance system, providing universal, affordable, high-quality care to all residents. However, a decline in the ratio of physicians to population that reached a modern low in 2006, an approximate ten-percentage-point decline in the share of publicly financed health care between 1995 and 2009, and legislative mandates that favored private insurance have altered Israel's health care system for the worse. Many Israelis now purchase private health insurance to supplement the state-sponsored universal care coverage, and they end up spending more out of pocket even for services covered by the entitlement. Additionally, many publicly paid physicians moonlight at private facilities to earn more money. In this article I recommend that Israel increase public funding for health care and adopt reforms to address the rising demand for privately funded care and the problem of publicly paid physicians who moonlight at private facilities.

HiRISE: The People's Camera

Science.gov (United States)

McEwen, A. S.; Eliason, E.; Gulick, V. C.; Spinoza, Y.; Beyer, R. A.; HiRISE Team

2010-12-01

The High Resolution Imaging Science Experiment (HiRISE) camera, orbiting Mars since 2006 on the Mars Reconnaissance Orbiter (MRO), has returned more than 17,000 large images with scales as small as 25 cm/pixel. From it’s beginning, the HiRISE team has followed “The People’s Camera” concept, with rapid release of useful images, explanations, and tools, and facilitating public image suggestions. The camera includes 14 CCDs, each read out into 2 data channels, so compressed images are returned from MRO as 28 long (up to 120,000 line) images that are 1024 pixels wide (or binned 2x2 to 512 pixels, etc.). This raw data is very difficult to use, especially for the public. At the HiRISE operations center the raw data are calibrated and processed into a series of B&W and color products, including browse images and JPEG2000-compressed images and tools to make it easy for everyone to explore these enormous images (see http://hirise.lpl.arizona.edu/). Automated pipelines do all of this processing, so we can keep up with the high data rate; images go directly to the format of the Planetary Data System (PDS). After students visually check each image product for errors, they are fully released just 1 month after receipt; captioned images (written by science team members) may be released sooner. These processed HiRISE images have been incorporated into tools such as Google Mars and World Wide Telescope for even greater accessibility. 51 Digital Terrain Models derived from HiRISE stereo pairs have been released, resulting in some spectacular flyover movies produced by members of the public and viewed up to 50,000 times according to YouTube. Public targeting began in 2007 via NASA Quest (http://marsoweb.nas.nasa.gov/HiRISE/quest/) and more than 200 images have been acquired, mostly by students and educators. At the beginning of 2010 we released HiWish (http://www.uahirise.org/hiwish/), opening HiRISE targeting to anyone in the world with Internet access, and already more

Public policy, health system, and community actions against illness as platforms for response to NCDs in Tanzania : a narrative review

NARCIS (Netherlands)

Metta, Emmy; Msambichaka, Beverly; Mwangome, Mary; Nyato, Daniel J; Dieleman, Marjolein; Haisma, Hinke; Klatser, Paul; Geubbels, Eveline

2014-01-01

BACKGROUND: Most low- and middle- income countries are facing a rise of the burden of non-communicable diseases (NCDs) alongside the persistent burden of infectious diseases. This narrative review aims to provide an inventory of how the existing policy environment, health system, and communities are

Public policy, health system, and community actions against illness as platforms for response to NCDs in Tanzania: a narrative review

NARCIS (Netherlands)

Metta, Emmy; Msambichaka, Beverly; Mwangome, Mary; Nyato, Daniel J.; Dieleman, Marjolein; Haisma, Hinke; Klatser, Paul; Geubbels, Eveline

2014-01-01

Most low- and middle- income countries are facing a rise of the burden of non-communicable diseases (NCDs) alongside the persistent burden of infectious diseases. This narrative review aims to provide an inventory of how the existing policy environment, health system, and communities are addressing

Health system challenges in organizing quality diabetes care for urban poor in South India.

Science.gov (United States)

Bhojani, Upendra; Devedasan, Narayanan; Mishra, Arima; De Henauw, Stefaan; Kolsteren, Patrick; Criel, Bart

2014-01-01

Weak health systems in low- and middle-income countries are recognized as the major constraint in responding to the rising burden of chronic conditions. Despite recognition by global actors for the need for research on health systems, little attention has been given to the role played by local health systems. We aim to analyze a mixed local health system to identify the main challenges in delivering quality care for diabetes mellitus type 2. We used the health system dynamics framework to analyze a health system in KG Halli, a poor urban neighborhood in South India. We conducted semi-structured interviews with healthcare providers located in and around the neighborhood who provide care to diabetes patients: three specialist and 13 non-specialist doctors, two pharmacists, and one laboratory technician. Observations at the health facilities were recorded in a field diary. Data were analyzed through thematic analysis. There is a lack of functional referral systems and a considerable overlap in provision of outpatient care for diabetes across the different levels of healthcare services in KG Halli. Inadequate use of patients' medical records and lack of standard treatment protocols affect clinical decision-making. The poor regulation of the private sector, poor systemic coordination across healthcare providers and healthcare delivery platforms, widespread practice of bribery and absence of formal grievance redress platforms affect effective leadership and governance. There appears to be a trust deficit among patients and healthcare providers. The private sector, with a majority of healthcare providers lacking adequate training, operates to maximize profit, and healthcare for the poor is at best seen as charity. Systemic impediments in local health systems hinder the delivery of quality diabetes care to the urban poor. There is an urgent need to address these weaknesses in order to improve care for diabetes and other chronic conditions.

Health system challenges in organizing quality diabetes care for urban poor in South India.

Directory of Open Access Journals (Sweden)

Upendra Bhojani

Full Text Available BACKGROUND: Weak health systems in low- and middle-income countries are recognized as the major constraint in responding to the rising burden of chronic conditions. Despite recognition by global actors for the need for research on health systems, little attention has been given to the role played by local health systems. We aim to analyze a mixed local health system to identify the main challenges in delivering quality care for diabetes mellitus type 2. METHODS: We used the health system dynamics framework to analyze a health system in KG Halli, a poor urban neighborhood in South India. We conducted semi-structured interviews with healthcare providers located in and around the neighborhood who provide care to diabetes patients: three specialist and 13 non-specialist doctors, two pharmacists, and one laboratory technician. Observations at the health facilities were recorded in a field diary. Data were analyzed through thematic analysis. RESULT: There is a lack of functional referral systems and a considerable overlap in provision of outpatient care for diabetes across the different levels of healthcare services in KG Halli. Inadequate use of patients' medical records and lack of standard treatment protocols affect clinical decision-making. The poor regulation of the private sector, poor systemic coordination across healthcare providers and healthcare delivery platforms, widespread practice of bribery and absence of formal grievance redress platforms affect effective leadership and governance. There appears to be a trust deficit among patients and healthcare providers. The private sector, with a majority of healthcare providers lacking adequate training, operates to maximize profit, and healthcare for the poor is at best seen as charity. CONCLUSIONS: Systemic impediments in local health systems hinder the delivery of quality diabetes care to the urban poor. There is an urgent need to address these weaknesses in order to improve care for diabetes

The Health Halo Trend in UK Television Food Advertising Viewed by Children: The Rise of Implicit and Explicit Health Messaging in the Promotion of Unhealthy Foods

Science.gov (United States)

Harrold, Joanne; Halford, Jason; Boyland, Emma

2018-01-01

Monitoring the creative content within food marketing to children is strongly advocated by public health authorities, but few studies address the prevalence of health-related messaging in television adverts. Food and beverage adverts (n = 18,888 in 2008, n = 6664 in 2010) from UK television channels popular with children were coded and analyzed. Physical-activity depiction displayed an 18.8 percentage point increase from 2008 (4.4%) to 2010 (23.2%). Of the food adverts containing physical-activity depiction in 2010, 81.1% were for non-core foods. The appearance of health claims in food adverts in 2010 increased 4.1 percentage points from 2008 levels (20.7% to 24.8%) where the majority of food adverts featuring health and nutrition claims were for non-core foods (58.3%). Health-related (e.g., health/nutrition, weight loss/diet) appeals were used in 17.1% of food adverts during peak child-viewing times, rising to 33.0% of adverts shown on dedicated children’s channels in 2010. Implicit (physical activity) and explicit (health claims) health messages are increasingly prevalent in UK television food advertising viewed by children, and are frequently used to promote unhealthy foods. Policy makers in the UK should consider amendments to the existing statutory approach in order to address this issue. PMID:29558457

The Health Halo Trend in UK Television Food Advertising Viewed by Children: The Rise of Implicit and Explicit Health Messaging in the Promotion of Unhealthy Foods.

Science.gov (United States)

Whalen, Rosa; Harrold, Joanne; Child, Simon; Halford, Jason; Boyland, Emma

2018-03-20

Monitoring the creative content within food marketing to children is strongly advocated by public health authorities, but few studies address the prevalence of health-related messaging in television adverts. Food and beverage adverts ( n = 18,888 in 2008, n = 6664 in 2010) from UK television channels popular with children were coded and analyzed. Physical-activity depiction displayed an 18.8 percentage point increase from 2008 (4.4%) to 2010 (23.2%). Of the food adverts containing physical-activity depiction in 2010, 81.1% were for non-core foods. The appearance of health claims in food adverts in 2010 increased 4.1 percentage points from 2008 levels (20.7% to 24.8%) where the majority of food adverts featuring health and nutrition claims were for non-core foods (58.3%). Health-related (e.g., health/nutrition, weight loss/diet) appeals were used in 17.1% of food adverts during peak child-viewing times, rising to 33.0% of adverts shown on dedicated children's channels in 2010. Implicit (physical activity) and explicit (health claims) health messages are increasingly prevalent in UK television food advertising viewed by children, and are frequently used to promote unhealthy foods. Policy makers in the UK should consider amendments to the existing statutory approach in order to address this issue.

Active Wireless System for Structural Health Monitoring Applications.

Science.gov (United States)

Perera, Ricardo; Pérez, Alberto; García-Diéguez, Marta; Zapico-Valle, José Luis

2017-12-11

The use of wireless sensors in Structural Health Monitoring (SHM) has increased significantly in the last years. Piezoelectric-based lead zirconium titanate (PZT) sensors have been on the rise in SHM due to their superior sensing abilities. They are applicable in different technologies such as electromechanical impedance (EMI)-based SHM. This work develops a flexible wireless smart sensor (WSS) framework based on the EMI method using active sensors for full-scale and autonomous SHM. In contrast to passive sensors, the self-sensing properties of the PZTs allow interrogating with or exciting a structure when desired. The system integrates the necessary software and hardware within a service-oriented architecture approach able to provide in a modular way the services suitable to satisfy the key requirements of a WSS. The framework developed in this work has been validated on different experimental applications. Initially, the reliability of the EMI method when carried out with the proposed wireless sensor system is evaluated by comparison with the wireless counterpart. Afterwards, the performance of the system is evaluated in terms of software stability and reliability of functioning.

Health systems around the world - a comparison of existing health system rankings.

Science.gov (United States)

Schütte, Stefanie; Acevedo, Paula N Marin; Flahault, Antoine

2018-06-01

Existing health systems all over the world are different due to the different combinations of components that can be considered for their establishment. The ranking of health systems has been a focal points for many years especially the issue of performance. In 2000 the World Health Organization (WHO) performed a ranking to compare the Performance of the health system of the member countries. Since then other health system rankings have been performed and it became an issue of public discussion. A point of contention regarding these rankings is the methodology employed by each of them, since no gold standard exists. Therefore, this review focuses on evaluating the methodologies of each existing health system performance ranking to assess their reproducibility and transparency. A search was conducted to identify existing health system rankings, and a questionnaire was developed for the comparison of the methodologies based on the following indicators: (1) General information, (2) Statistical methods, (3) Data (4) Indicators. Overall nine rankings were identified whereas six of them focused rather on the measurement of population health without any financial component and were therefore excluded. Finally, three health system rankings were selected for this review: "Health Systems: Improving Performance" by the WHO, "Mirror, Mirror on the wall: How the Performance of the US Health Care System Compares Internationally" by the Commonwealth Fund and "the Most efficient Health Care" by Bloomberg. After the completion of the comparison of the rankings by giving them scores according to the indicators, the ranking performed the WHO was considered the most complete regarding the ability of reproducibility and transparency of the methodology. This review and comparison could help in establishing consensus in the field of health system research. This may also help giving recommendations for future health rankings and evaluating the current gap in the literature.

Field monitoring of column shortenings in a high-rise building during construction.

Science.gov (United States)

Choi, Se Woon; Kim, Yousok; Kim, Jong Moon; Park, Hyo Seon

2013-10-24

The automatic monitoring of shortenings of vertical members in high-rise buildings under construction is a challenging issue in the high-rise building construction field. In this study, a practical system for monitoring column shortening in a high-rise building under construction is presented. The proposed monitoring system comprises the following components: (1) a wireless sensing system and (2) the corresponding monitoring software. The wireless sensing system comprises the sensors and energy-efficient wireless sensing units (sensor nodes, master nodes, and repeater nodes), which automate the processes for measuring the strains of vertical members and transmitting the measured data to the remote server. The monitoring software enables construction administrators to monitor real-time data collected by the server via an Internet connection. The proposed monitoring system is applied to actual 66-floor and 72-floor high-rise buildings under construction. The system enables automatic and real-time measurements of the shortening of vertical members, which can result in more precise construction.

System impact research – increasing public health and health care system performance

Science.gov (United States)

Malmivaara, Antti

2016-01-01

Abstract Background Interventions directed to system features of public health and health care should increase health and welfare of patients and population. Aims To build a new framework for studies aiming to assess the impact of public health or health care system, and to consider the role of Randomized Controlled Trials (RCTs) and of Benchmarking Controlled Trials (BCTs). Methods The new concept is partly based on the author's previous paper on the Benchmarking Controlled Trial. The validity and generalizability considerations were based on previous methodological studies on RCTs and BCTs. Results The new concept System Impact Research (SIR) covers all the studies which aim to assess the impact of the public health system or of the health care system on patients or on population. There are two kinds of studies in System Impact Research: Benchmarking Controlled Trials (observational) and Randomized Controlled Trials (experimental). The term impact covers in particular accessibility, quality, effectiveness, safety, efficiency, and equality. Conclusions System Impact Research – creating the scientific basis for policy decision making - should be given a high priority in medical, public health and health economic research, and should also be used for improving performance. Leaders at all levels of health and social care can use the evidence from System Impact Research for the benefit of patients and population.Key messagesThe new concept of SIR is defined as a research field aiming at assessing the impacts on patients and on populations of features of public health and health and social care systems or of interventions trying to change these features.SIR covers all features of public health and health and social care system, and actions upon these features. The term impact refers to all effects caused by the public health and health and social care system or parts of it, with particular emphasis on accessibility, quality, effectiveness, adverse effects, efficiency

Salt marsh persistence is threatened by predicted sea-level rise

Science.gov (United States)

Crosby, Sarah C.; Sax, Dov F.; Palmer, Megan E.; Booth, Harriet S.; Deegan, Linda A.; Bertness, Mark D.; Leslie, Heather M.

2016-11-01

Salt marshes buffer coastlines and provide critical ecosystem services from storm protection to food provision. Worldwide, these ecosystems are in danger of disappearing if they cannot increase elevation at rates that match sea-level rise. However, the magnitude of loss to be expected is not known. A synthesis of existing records of salt marsh elevation change was conducted in order to consider the likelihood of their future persistence. This analysis indicates that many salt marshes did not keep pace with sea-level rise in the past century and kept pace even less well over the past two decades. Salt marshes experiencing higher local sea-level rise rates were less likely to be keeping pace. These results suggest that sea-level rise will overwhelm most salt marshes' capacity to maintain elevation. Under the most optimistic IPCC emissions pathway, 60% of the salt marshes studied will be gaining elevation at a rate insufficient to keep pace with sea-level rise by 2100. Without mitigation of greenhouse gas emissions this potential loss could exceed 90%, which will have substantial ecological, economic, and human health consequences.

Denmark: Health system review

DEFF Research Database (Denmark)

Juul, Annegrete; Krasnik, Allan; Rudkjøbing, Andreas

The Health Systems in Transition (HiT) series provide detailed descriptions of health systems in the countries of the WHO European Region as well as some additional OECD countries. An individual health system review (HiT) examines the specific approach to the organization, financing and delivery...... of health services in a particular country and the role of the main actors in the health system. It describes the institutional framework, process, content, and implementation of health and health care policies. HiTs also look at reforms in progress or under development and make an assessment of the health...... system based on stated objectives and outcomes with respect to various dimensions (health status, equity, quality, efficiency, accountability)....

Mapping Sea Level Rise Behavior in an Estuarine Delta System: A Case Study along the Shanghai Coast

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H.Q. Cheng

2018-02-01

Full Text Available Sea level rise (SLR is a major projected threat of climate change that is expected to affect developing coastal cities located in estuarine delta regions. Shanghai is one such city, being located in the Yangtze River Delta (YRD. It is difficult, however, for decision-makers to implement adaptation due to the uncertain causes, magnitudes, and timings of SLR behaviors. This paper attempts to map the causes and magnitudes of SLR behaviors on a decadal scale. We analyze the tidal level records from 11 tidal gauge stations and the corresponding bathymetry measurements around these stations since 1921. We identify three new SLR behaviors along the Shanghai coast due to anthropogenic geomorphologic changes (AGCs, besides the well-known eustatic sea level rise (ESLR, tectonic subsidence (TS, and urban land subsidence (ULS. The first new behavior is regional sea level rise (RSLR, which occurs as a result of land reclamation and deep waterway regulation. The second is regional sea level fall (RSLF, which occurs because the channel bed is eroded due to sediment supply decline in the river catchment. The last SLR behavior is local tidal datum rise (LTDR. Thus, we project that the magnitude of SLR for the Shanghai coast ranges from 10 cm to 16 cm from 2011 to 2030. Clarifying SLR behaviors is important to aid local decision-makers in planning structural and non-structural measures to combat escalating flood damage costs in an estuarine delta system; this field is full of future challenges. Keywords: Sea level rise behavior, Anthropogenic geomorphologic change, Local tidal datum, Flood management, Adaptation

Structural health monitoring on medium rise reinforced concrete building using ambient vibration method

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Kamarudin, A. F.; Mokhatar, S. N.; Zainal Abidin, M. H.; Daud, M. E.; Rosli, M. S.; Ibrahim, A.; Ibrahim, Z.; Noh, M. S. Md

2018-04-01

Monitoring of structural health from initial stage of building construction to its serviceability is an ideal practise to assess for any structural defects or damages. Structural integrity could be intruded by natural destruction or structural deterioration, and worse if without remedy action on monitoring, building re-assessment or maintenance is taken. In this study the application of ambient vibration (AV) testing is utilized to evaluate the health of eighth stories medium rise reinforced concrete building in Universiti Tun Hussein Onn Malaysia (UTHM), based comparison made between the predominant frequency, fo, determined in year 2012 and 2017. For determination of fo, popular method of Fourier Amplitude Spectra (FAS) was used to transform the ambient vibration time series by using 1 Hz tri-axial seismometer sensors and City SharkII data recorder. From the results, it shows the first mode frequencies from FAS curves indicate at 2.04 Hz in 2012 and 1.97 Hz in 2017 with only 3.14% of frequency reduction. However, steady state frequencies shown at the second and third modes frequencies of 2.42 Hz and 3.31 Hz by both years. Two translation mode shapes were found at the first and second mode frequencies in the North-South (NS-parallel to building transverse axis) and East-West (EsW-parallel to building longitudinal axis) components, and the torsional mode shape shows as the third mode frequency in both years. No excessive deformation amplitude was found at any selective floors based on comparison made between three mode shapes produced, that could bring to potential feature of structural deterioration. Low percentages of natural frequency disparity within five years of duration interval shown by the first mode frequencies under ambient vibration technique was considered in good health state, according to previous researchers recommendation at acceptable percentages below 5 to 10% over the years.

Space-planning and structural solutions of low-rise buildings: Optimal selection methods

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Gusakova, Natalya; Minaev, Nikolay; Filushina, Kristina; Dobrynina, Olga; Gusakov, Alexander

2017-11-01

The present study is devoted to elaboration of methodology used to select appropriately the space-planning and structural solutions in low-rise buildings. Objective of the study is working out the system of criteria influencing the selection of space-planning and structural solutions which are most suitable for low-rise buildings and structures. Application of the defined criteria in practice aim to enhance the efficiency of capital investments, energy and resource saving, create comfortable conditions for the population considering climatic zoning of the construction site. Developments of the project can be applied while implementing investment-construction projects of low-rise housing at different kinds of territories based on the local building materials. The system of criteria influencing the optimal selection of space-planning and structural solutions of low-rise buildings has been developed. Methodological basis has been also elaborated to assess optimal selection of space-planning and structural solutions of low-rise buildings satisfying the requirements of energy-efficiency, comfort and safety, and economical efficiency. Elaborated methodology enables to intensify the processes of low-rise construction development for different types of territories taking into account climatic zoning of the construction site. Stimulation of low-rise construction processes should be based on the system of approaches which are scientifically justified; thus it allows enhancing energy efficiency, comfort, safety and economical effectiveness of low-rise buildings.

Two-stage commercial evaluation of engineering systems production projects for high-rise buildings

Science.gov (United States)

Bril, Aleksander; Kalinina, Olga; Levina, Anastasia

2018-03-01

The paper is devoted to the current and debatable problem of methodology of choosing the effective innovative enterprises for venture financing. A two-stage system of commercial innovation evaluation based on the UNIDO methodology is proposed. Engineering systems account for 25 to 40% of the cost of high-rise residential buildings. This proportion increases with the use of new construction technologies. Analysis of the construction market in Russia showed that the production of internal engineering systems elements based on innovative technologies has a growth trend. The production of simple elements is organized in small enterprises on the basis of new technologies. The most attractive for development is the use of venture financing of small innovative business. To improve the efficiency of these operations, the paper proposes a methodology for a two-stage evaluation of small business development projects. A two-stage system of commercial evaluation of innovative projects allows creating an information base for informed and coordinated decision-making on venture financing of enterprises that produce engineering systems elements for the construction business.

Two-stage commercial evaluation of engineering systems production projects for high-rise buildings

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Bril Aleksander

2018-01-01

Full Text Available The paper is devoted to the current and debatable problem of methodology of choosing the effective innovative enterprises for venture financing. A two-stage system of commercial innovation evaluation based on the UNIDO methodology is proposed. Engineering systems account for 25 to 40% of the cost of high-rise residential buildings. This proportion increases with the use of new construction technologies. Analysis of the construction market in Russia showed that the production of internal engineering systems elements based on innovative technologies has a growth trend. The production of simple elements is organized in small enterprises on the basis of new technologies. The most attractive for development is the use of venture financing of small innovative business. To improve the efficiency of these operations, the paper proposes a methodology for a two-stage evaluation of small business development projects. A two-stage system of commercial evaluation of innovative projects allows creating an information base for informed and coordinated decision-making on venture financing of enterprises that produce engineering systems elements for the construction business.

Slovenia: Health System Review.

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Albreht, Tit; Pribakovic Brinovec, Radivoje; Josar, Dusan; Poldrugovac, Mircha; Kostnapfel, Tatja; Zaletel, Metka; Panteli, Dimitra; Maresso, Anna

2016-06-01

This analysis of the Slovene health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The health of the population has improved over the last few decades. While life expectancy for both men and women is similar to EU averages, morbidity and mortality data show persistent disparities between regions, and mortality from external causes is particularly high. Satisfaction with health care delivery is high, but recently waiting times for some outpatient specialist services have increased. Greater focus on preventive measures is also needed as well as better care coordination, particularly for those with chronic conditions. Despite having relatively high levels of co-payments for many services covered by the universal compulsory health insurance system, these expenses are counterbalanced by voluntary health insurance, which covers 95% of the population liable for co-payments. However, Slovenia is somewhat unique among social health insurance countries in that it relies almost exclusively on payroll contributions to fund its compulsory health insurance system. This makes health sector revenues very susceptible to economic and labour market fluctuations. A future challenge will be to diversify the resource base for health system funding and thus bolster sustainability in the longer term, while preserving service delivery and quality of care. Given changing demographics and morbidity patterns, further challenges include restructuring the funding and provision of long-term care and enhancing health system efficiency through reform of purchasing and provider-payment systems. World Health Organization 2016 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).

Home birth integration into the health care systems of eleven international jurisdictions.

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Comeau, Amanda; Hutton, Eileen K; Simioni, Julia; Anvari, Ella; Bowen, Megan; Kruegar, Samantha; Darling, Elizabeth K

2018-02-13

The purpose of this study was to develop assessment criteria that could be used to examine the level of integration of home birth within larger health care systems in developed countries across 11 international jurisdictions. An expert panel developed criteria and a definition to assess home birth integration within health care systems. We selected jurisdictions based on the publications that were eligible for inclusion in our systematic review and meta-analysis on planned place of birth. We sent the authors of the included publications a questionnaire about home birth practitioners and practices in their respective health care system at the time of their studies. We searched published peer-reviewed, non-peer-reviewed, and gray literature, and the websites of professional bodies to document information about home birth integration in each jurisdiction based on our criteria. Where information was lacking, we contacted experts in the field from the relevant jurisdiction. Home birth is well integrated into the health care system in British Columbia (Canada), England, Iceland, the Netherlands, New Zealand, Ontario (Canada), and Washington State (USA). Home birth is less well integrated into the health care system in Australia, Japan, Norway, and Sweden. This paper is the first to propose criteria for the evaluation of home birth integration within larger maternity care systems. Application of these criteria across 11 international jurisdictions indicates differences in the recognition and training of home birth practitioners, in access to hospital facilities, and in the supplies and equipment available at home births, which give rise to variation in the level of integration across different settings. Standardized criteria for the evaluation of systems integration are essential for interpreting planned home birth outcomes that emerge from contextual differences. © 2018 Wiley Periodicals, Inc.

Primary health care and public health: foundations of universal health systems.

Science.gov (United States)

White, Franklin

2015-01-01

The aim of this review is to advocate for more integrated and universally accessible health systems, built on a foundation of primary health care and public health. The perspective outlined identified health systems as the frame of reference, clarified terminology and examined complementary perspectives on health. It explored the prospects for universal and integrated health systems from a global perspective, the role of healthy public policy in achieving population health and the value of the social-ecological model in guiding how best to align the components of an integrated health service. The importance of an ethical private sector in partnership with the public sector is recognized. Most health systems around the world, still heavily focused on illness, are doing relatively little to optimize health and minimize illness burdens, especially for vulnerable groups. This failure to improve the underlying conditions for health is compounded by insufficient allocation of resources to address priority needs with equity (universality, accessibility and affordability). Finally, public health and primary health care are the cornerstones of sustainable health systems, and this should be reflected in the health policies and professional education systems of all nations wishing to achieve a health system that is effective, equitable, efficient and affordable. © 2015 S. Karger AG, Basel.

Taking Her Breath Away: The Rise of COPD in Women

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... Disparities Taking Her Breath Away: The Rise of COPD in Women Disparities in Lung Health Series More ... the U.S. live with chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema. Millions more ...

The Health Halo Trend in UK Television Food Advertising Viewed by Children: The Rise of Implicit and Explicit Health Messaging in the Promotion of Unhealthy Foods

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Rosa Whalen

2018-03-01

Full Text Available Monitoring the creative content within food marketing to children is strongly advocated by public health authorities, but few studies address the prevalence of health-related messaging in television adverts. Food and beverage adverts (n = 18,888 in 2008, n = 6664 in 2010 from UK television channels popular with children were coded and analyzed. Physical-activity depiction displayed an 18.8 percentage point increase from 2008 (4.4% to 2010 (23.2%. Of the food adverts containing physical-activity depiction in 2010, 81.1% were for non-core foods. The appearance of health claims in food adverts in 2010 increased 4.1 percentage points from 2008 levels (20.7% to 24.8% where the majority of food adverts featuring health and nutrition claims were for non-core foods (58.3%. Health-related (e.g., health/nutrition, weight loss/diet appeals were used in 17.1% of food adverts during peak child-viewing times, rising to 33.0% of adverts shown on dedicated children’s channels in 2010. Implicit (physical activity and explicit (health claims health messages are increasingly prevalent in UK television food advertising viewed by children, and are frequently used to promote unhealthy foods. Policy makers in the UK should consider amendments to the existing statutory approach in order to address this issue.

Islamophobia and Public Health in the United States.

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Samari, Goleen

2016-11-01

Anti-Muslim sentiments are increasingly common globally and in the United States. The recent rise in Islamophobia calls for a public health perspective that considers the stigmatized identity of Muslim Americans and health implications of Islamophobic discrimination. Drawing on a stigma, discrimination, and health framework, I expand the dialogue on the rise of Islamophobia to a discussion of how Islamophobia affects the health of Muslim Americans. Islamophobia can negatively influence health by disrupting several systems-individual (stress reactivity and identity concealment), interpersonal (social relationships and socialization processes), and structural (institutional policies and media coverage). Islamophobia deserves attention as a source of negative health outcomes and health disparities. Future public health research should explore the multilevel and multidimensional pathways between Islamophobia and population health.

Belgium: Health system review.

Science.gov (United States)

Gerkens, Sophie; Merkur, Sherry

2010-01-01

The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. The Belgian population continues to enjoy good health and long life expectancy. This is partly due to good access to health services of high quality. Financing is based mostly on proportional social security contributions and progressive direct taxation. The compulsory health insurance is combined with a mostly private system of health care delivery, based on independent medical practice, free choice of physician and predominantly fee-for-service payment. This Belgian HiT profile (2010) presents the evolution of the health system since 2007, including detailed information on new policies. While no drastic reforms were undertaken during this period, policy-makers have pursued the goals of improving access to good quality of care while making the system sustainable. Reforms to increase the accessibility of the health system include measures to reduce the out-of-pocket payments of more vulnerable populations (low-income families and individuals as well as the chronically ill). Quality of care related reforms have included incentives to better integrate different levels of care and the establishment of information systems, among others. Additionally, several measures on pharmaceutical products have aimed to reduce costs for both the National Institute for Health and Disability Insurance (NIHDI) and patients, while maintaining the quality of care. World Health Organization 2010, on behalf of the European Observatory on health systems and Policies.

The Debate over eHealth

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Gaddi, Antonio Vittorino

2014-01-01

The future of eHealth and telemedicine has recently become a much debated and controversial subject. It is widely believed that eHealth will play an increasingly important role in shaping healthcare systems in the twenty-first century. The rising burden of chronic diseases and the potential of eHealth for cutting costs and improving quality and safety of health services make eHealth a great opportunity for providing more efficient health care.

BRIC Health Systems and Big Pharma: A Challenge for Health Policy and Management.

Science.gov (United States)

Rodwin, Victor G; Fabre, Guilhem; Ayoub, Rafael F

2018-01-02

BRIC nations - Brazil, Russia, India, and China - represent 40% of the world's population, including a growing aging population and middle class with an increasing prevalence of chronic disease. Their healthcare systems increasingly rely on prescription drugs, but they differ from most other healthcare systems because healthcare expenditures in BRIC nations have exhibited the highest revenue growth rates for pharmaceutical multinational corporations (MNCs), Big Pharma. The response of BRIC nations to Big Pharma presents contrasting cases of how governments manage the tensions posed by rising public expectations and limited resources to satisfy them. Understanding these tensions represents an emerging area of research and an important challenge for all those who work in the field of health policy and management (HPAM). © 2018 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Changes of Global Infectious Disease Governance in 2000s: Rise of Global Health Security and Transformation of Infectious Disease Control System in South Korea

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Eun Kyung CHOI

2016-12-01

Full Text Available This paper focus upon the changes of global infectious disease governance in 2000s and the transformation of infectious disease control system in South Korea. Traditionally, infectious disease was globally governed by the quarantine regulated by the international conventions. When an infectious disease outbreak occurred in one country, each country prevented transmission of the disease through the standardized quarantine since the installation of international sanitary convention in 1892. Republic of Korea also organized the infectious disease control system with quarantine and disease report procedure after the establishment of government. Additionally, Korea National Health Institute(KNIH was founded as research and training institute for infectious disease. However, traditional international health regulation system faced a serious challenge by the appearance of emerging and re-emerging infectious disease in 1990s. As a result, global infectious disease governance was rapidly changed under the demand to global disease surveillance and response. Moreover, global health security frame became important after 2001 bioterror and 2003 SARS outbreak. Consequently, international health regulation was fully revised in 2005, which included not only infectious disease but also public health emergency. The new international health regime was differently characterized in several aspects; reinforcement of global cooperation and surveillance, enlargement of the role of supranational and international agencies, and reorganization of national capacity. KNIH was reorganized with epidemic control and research since late 1990s. However, in 2004 Korea Center for Disease Control and Prevention(KCDC was established as a disease control institution with combining quarantine and other functions after 2003 SARS outbreak. KCDC unified national function against infectious disease including prevention, protection, response and research, as a national representative in

Changes of Global Infectious Disease Governance in 2000s: Rise of Global Health Security and Transformation of Infectious Disease Control System in South Korea.

Science.gov (United States)

Choi, Eun Kyung; Lee, Jong-Koo

2016-12-01

This paper focus upon the changes of global infectious disease governance in 2000s and the transformation of infectious disease control system in South Korea. Traditionally, infectious disease was globally governed by the quarantine regulated by the international conventions. When an infectious disease outbreak occurred in one country, each country prevented transmission of the disease through the standardized quarantine since the installation of international sanitary convention in 1892. Republic of Korea also organized the infectious disease control system with quarantine and disease report procedure after the establishment of government. Additionally, Korea National Health Institute(KNIH) was founded as research and training institute for infectious disease. However, traditional international health regulation system faced a serious challenge by the appearance of emerging and re-emerging infectious disease in 1990s. As a result, global infectious disease governance was rapidly changed under the demand to global disease surveillance and response. Moreover, global health security frame became important after 2001 bioterror and 2003 SARS outbreak. Consequently, international health regulation was fully revised in 2005, which included not only infectious disease but also public health emergency. The new international health regime was differently characterized in several aspects; reinforcement of global cooperation and surveillance, enlargement of the role of supranational and international agencies, and reorganization of national capacity. KNIH was reorganized with epidemic control and research since late 1990s. However, in 2004 Korea Center for Disease Control and Prevention(KCDC) was established as a disease control institution with combining quarantine and other functions after 2003 SARS outbreak. KCDC unified national function against infectious disease including prevention, protection, response and research, as a national representative in disease control. The

Modal–Physical Hybrid System Identification of High-rise Building via Subspace and Inverse-Mode Methods

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Kohei Fujita

2017-08-01

Full Text Available A system identification (SI problem of high-rise buildings is investigated under restricted data environments. The shear and bending stiffnesses of a shear-bending model (SB model representing the high-rise buildings are identified via the smart combination of the subspace and inverse-mode methods. Since the shear and bending stiffnesses of the SB model can be identified in the inverse-mode method by using the lowest mode of horizontal displacements and floor rotation angles, the lowest mode of the objective building is identified first by using the subspace method. Identification of the lowest mode is performed by using the amplitude of transfer functions derived in the subspace method. Considering the resolution in measuring the floor rotation angles in lower stories, floor rotation angles in most stories are predicted from the floor rotation angle at the top floor. An empirical equation of floor rotation angles is proposed by investigating those for various building models. From the viewpoint of application of the present SI method to practical situations, a non-simultaneous measurement system is also proposed. In order to investigate the reliability and accuracy of the proposed SI method, a 10-story building frame subjected to micro-tremor is examined.

POPULATION HEALTH AND THE RISE OF CONSUMERISM.

Science.gov (United States)

2015-09-01

Earlier this summer, we convened a panel of health care executives and industry experts to consider how hospitals can balance the demands of high-value, more efficient care with the emergence of the savvy health care consumer. Their insights and words of advice are eye-opening.

Methods of erection of high-rise buildings

Science.gov (United States)

Cherednichenko, Nadezhda; Oleinik, Pavel

2018-03-01

The article contains the factors determining the choice of methods for organizing the construction and production of construction and installation work for the construction of high-rise buildings. There are also indicated specific features of their underground parts, characterized by powerful slab-pile foundations, large volumes of earthworks, reinforced bases and foundations for assembly cranes. The work cycle is considered when using reinforced concrete, steel and combined skeletons of high-rise buildings; the areas of application of flow, separate and complex methods are being disclosed. The main conditions for the erection of high-rise buildings and their components are singled out: the choice of formwork systems, delivery and lifting of concrete mixes, installation of reinforcement, the formation of lifting and transporting and auxiliary equipment. The article prescribes the reserves of reduction in the duration of construction due to the creation of: complex mechanized technologies for the efficient construction of foundations in various soil conditions, including in the heaving, swelling, hindered, subsidence, bulk, water-saturated forms; complex mechanized technologies for the erection of monolithic reinforced concrete structures, taking into account the winter conditions of production and the use of mobile concrete-laying complexes and new generation machines; modular formwork systems, distinguished by their versatility, ease, simplicity in operation suitable for complex high-rise construction; more perfect methodology and the development of a set of progressive organizational and technological solutions that ensure a rational relationship between the processes of production and their maximum overlap in time and space.

Switzerland: Health System Review.

Science.gov (United States)

De Pietro, Carlo; Camenzind, Paul; Sturny, Isabelle; Crivelli, Luca; Edwards-Garavoglia, Suzanne; Spranger, Anne; Wittenbecher, Friedrich; Quentin, Wilm

2015-01-01

This analysis of the Swiss health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The Swiss health system is highly complex, combining aspects of managed competition and corporatism (the integration of interest groups in the policy process) in a decentralized regulatory framework shaped by the influences of direct democracy. The health system performs very well with regard to a broad range of indicators. Life expectancy in Switzerland (82.8 years) is the highest in Europe after Iceland, and healthy life expectancy is several years above the European Union (EU) average. Coverage is ensured through mandatory health insurance (MHI), with subsidies for people on low incomes. The system offers a high degree of choice and direct access to all levels of care with virtually no waiting times, though managed care type insurance plans that include gatekeeping restrictions are becoming increasingly important. Public satisfaction with the system is high and quality is generally viewed to be good or very good. Reforms since the year 2000 have improved the MHI system, changed the financing of hospitals, strengthened regulations in the area of pharmaceuticals and the control of epidemics, and harmonized regulation of human resources across the country. In addition, there has been a slow (and not always linear) process towards more centralization of national health policy-making. Nevertheless, a number of challenges remain. The costs of the health care system are well above the EU average, in particular in absolute terms but also as a percentage of gross domestic product (GDP) (11.5%). MHI premiums have increased more quickly than incomes since 2003. By European standards, the share of out-of-pocket payments is exceptionally high at 26% of total health expenditure (compared to the EU average of 16%). Low and middle-income households contribute a greater share of their income to

Rising Health Expenditure Due to Non-Communicable Diseases in India: An Outlook.

Science.gov (United States)

Barik, Debasis; Arokiasamy, Perianayagam

2016-01-01

With ongoing demographic transition, epidemiological transition has been emerged as a growing concern in India. The share of non-communicable disease in total disease burden has increased from 31% in 1990 to 45% in 2010. This paper seeks to explore the health scenario of India in the wake of the growing pace of non-communicable diseases such as diabetes and hypertension among Indian population using data from health and morbidity survey of the National Sample Survey Organisation (2004) and notifies about the resource needed to tackle this growing health risk. Given the share of private players (70%) in Indian health system, results indicate a higher private expenditure, mostly out-of-pocket expense, on account of non-communicable diseases. A timely look into the matter may tackle a more dreadful situation in near future.

Malta: Health system review.

Science.gov (United States)

Azzopardi Muscat, Natasha; Calleja, Neville; Calleja, Antoinette; Cylus, Jonathan

2014-01-01

This analysis of the Maltese health system reviews the developments in its organization and governance, health financing, health-care provision, health reforms and health system performance. The health system in Malta consists of a public sector, which is free at the point of service and provides a comprehensive basket of health services for all its citizens, and a private sector, which accounts for a third of total health expenditure and provides the majority of primary care. Maltese citizens enjoy one of the highest life expectancies in Europe. Nevertheless, non-communicable diseases pose a major concern with obesity being increasingly prevalent among both adults and children. The health system faces important challenges including a steadily ageing population, which impacts the sustainability of public finances. Other supply constraints stem from financial and infrastructural limitations. Nonetheless, there exists a strong political commitment to ensure the provision of a healthcare system that is accessible, of high quality, safe and also sustainable. This calls for strategic investments to underpin a revision of existing processes whilst shifting the focus of care away from hospital into the community. World Health Organization 2014 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).

Ukraine: health system review.

Science.gov (United States)

Lekhan, Valery; Rudiy, Volodymyr; Shevchenko, Maryna; Nitzan Kaluski, Dorit; Richardson, Erica

2015-03-01

This analysis of the Ukrainian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Since the country gained independence from the Soviet Union in 1991, successive governments have sought to overcome funding shortfalls and modernize the health care system to meet the needs of the population's health. However, no fundamental reform of the system has yet been implemented and consequently it has preserved the main features characteristic of the Semashko model; there is a particularly high proportion of total health expenditure paid out of pocket (42.3 % in 2012), and incentives within the system do not focus on quality or outcomes. The most recent health reform programme began in 2010 and sought to strengthen primary and emergency care, rationalize hospitals and change the model of health care financing from one based on inputs to one based on outputs. Fundamental issues that hampered reform efforts in the past re-emerged, but conflict and political instability have proved the greatest barriers to reform implementation and the programme was abandoned in 2014. More recently, the focus has been on more pressing humanitarian concerns arising from the conflict in the east of Ukraine. It is hoped that greater political, social and economic stability in the future will provide a better environment for the introduction of deep reforms to address shortcomings in the Ukrainian health system. World Health Organization 2015 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).

Active Wireless System for Structural Health Monitoring Applications

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Ricardo Perera

2017-12-01

Full Text Available The use of wireless sensors in Structural Health Monitoring (SHM has increased significantly in the last years. Piezoelectric-based lead zirconium titanate (PZT sensors have been on the rise in SHM due to their superior sensing abilities. They are applicable in different technologies such as electromechanical impedance (EMI-based SHM. This work develops a flexible wireless smart sensor (WSS framework based on the EMI method using active sensors for full-scale and autonomous SHM. In contrast to passive sensors, the self-sensing properties of the PZTs allow interrogating with or exciting a structure when desired. The system integrates the necessary software and hardware within a service-oriented architecture approach able to provide in a modular way the services suitable to satisfy the key requirements of a WSS. The framework developed in this work has been validated on different experimental applications. Initially, the reliability of the EMI method when carried out with the proposed wireless sensor system is evaluated by comparison with the wireless counterpart. Afterwards, the performance of the system is evaluated in terms of software stability and reliability of functioning.

Austria: health system review.

Science.gov (United States)

Hofmarcher, Maria M; Quentin, Wilm

2013-01-01

This analysis of the Austrian health system reviews recent developments in organization and governance, health financing, health-care provision, health reforms and health-system performance. The Austrian health system provides universal coverage for a wide range of benefits and high-quality care. Free choice of providers and unrestricted access to all care levels (general practitioners, specialist physicians and hospitals) are characteristic features of the system. Unsurprisingly, population satisfaction is well above EU average. Income-related inequality in health has increased since 2005, although it is still relatively low compared to other countries. The health-care system has been shaped by both the federal structure of the state and a tradition of delegating responsibilities to self-governing stakeholders. On the one hand, this enables decentralized planning and governance, adjusted to local norms and preferences. On the other hand, it also leads to fragmentation of responsibilities and frequently results in inadequate coordination. For this reason, efforts have been made for several years to achieve more joint planning, governance and financing of the health-care system at the federal and regional level. As in any health system, a number of challenges remain. The costs of the health-care system are well above the EU15 average, both in absolute terms and as a percentage of GDP. There are important structural imbalances in healthcare provision, with an oversized hospital sector and insufficient resources available for ambulatory care and preventive medicine. This is coupled with stark regional differences in utilization, both in curative services (hospital beds and specialist physicians) and preventative services such as preventive health check-ups, outpatient rehabilitation, psychosocial and psychotherapeutic care and nursing. There are clear social inequalities in the use of medical services, such as preventive health check-ups, immunization or dentistry

Development of national standards related to the integrated safety and security of high-rise buildings

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Voskresenskaya, Elena; Vorona-Slivinskaya, Lubov

2018-03-01

The article considers the issues of developing national standards for high-rise construction. The system of standards should provide industrial, operational, economic and terrorist safety of high-rise buildings and facilities. Modern standards of high-rise construction should set the rules for designing engineering systems of high-rise buildings, which will ensure the integrated security of buildings, increase their energy efficiency and reduce the consumption of resources in construction and operation.

Rising tides, rising gates: The complex ecogeomorphic response of coastal wetlands to sea-level rise and human interventions

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Sandi, Steven G.; Rodríguez, José F.; Saintilan, Neil; Riccardi, Gerardo; Saco, Patricia M.

2018-04-01

Coastal wetlands are vulnerable to submergence due to sea-level rise, as shown by predictions of up to 80% of global wetland loss by the end of the century. Coastal wetlands with mixed mangrove-saltmarsh vegetation are particularly vulnerable because sea-level rise can promote mangrove encroachment on saltmarsh, reducing overall wetland biodiversity. Here we use an ecogeomorphic framework that incorporates hydrodynamic effects, mangrove-saltmarsh dynamics, and soil accretion processes to assess the effects of control structures on wetland evolution. Migration and accretion patterns of mangrove and saltmarsh are heavily dependent on topography and control structures. We find that current management practices that incorporate a fixed gate for the control of mangrove encroachment are useful initially, but soon become ineffective due to sea-level rise. Raising the gate, to counteract the effects of sea level rise and promote suitable hydrodynamic conditions, excludes mangrove and maintains saltmarsh over the entire simulation period of 100 years

Rising Health Expenditure due to Non-communicable Diseases in India: An Outlook

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Debasis Barik

2016-11-01

Full Text Available Abstract: With ongoing demographic transition, epidemiological transition in India has been emerged as a growing concern in India. The share of non-communicable disease in total disease burden has increased from 31 per cent in 1990 to 45 per cent in 2010. This paper seeks to explore the health scenario of India in the wake of the growing pace of non-communicable diseases like diabetes, hypertension among Indian population using data from health and morbidity survey of the National Sample Survey Organisation (2004 and notifies about the resource needed to tackle this growing health risk. Given the share of private players (70 per cent in Indian health system, results indicate a higher private expenditure, mostly out-of-pocket expense, on account of non-communicable diseases. A timely look into the matter may tackle a more dreadful situation in near future.

On the merging rates of envelope-deprived components of binary systems which can give rise to supernova events

International Nuclear Information System (INIS)

Tornambe, Amedo

1989-01-01

We derive theoretical rates of mergings of envelope-deprived components of binary systems, which can give rise to supernova events. The effects of the various assumptions one is forced to make on the physical properties of the progenitor system and of its evolutionary behaviour through common envelope phases are discussed. Four cases have been analysed: CO-CO, He-CO, He-He double degenerate mergings and He star-CO dwarf merging. (author)

Fiber Reinforced Concrete (FRC) for High Rise Construction: Case Studies

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Gharehbaghi, Koorosh; Chenery, Rhea

2017-12-01

Due to its material element, Fiber Reinforced Concrete (FRC) could be stronger than traditional Concrete. This is due to FRC internal material compounds and elements. Furthermore, FRC can also significantly improve flexural strength when compared to traditional Concrete. This improvement in flexural strength can be varied depending on the actual fibers used. Although not new, FRC is gradually gaining popularity in the construction industry, in particular for high rise structures. This is due to its flexural strength, especially for high seismic zones, as it will provide a better solution then reinforced Concrete. The main aim of this paper is to investigate the structural importance of FRC for the high rise construction. Although there has been numerous studies and literature in justifying the FRC for general construction; this paper will consider its use specifically for high rise construction. Moreover, this paper will closely investigate eight case studies from Australian and United States as a part of the FRC validation for high rise construction. In doing so, this paper will examine their Structural Health Monitoring (SHM) to determine their overall structural performance.

Creating a 21st-century intelligent health system.

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Newt, Gingrich; Nancy, Desmond

2008-02-01

In most areas of life, Americans enjoy the ease and convenience offered by advances in technology, communications, and transportation. Every day we experience the 21st-century model of America, which is one of effectiveness, accuracy, speed, flexibility, efficiency, lower cost, more choices, and greater achievement. We can shop online, compare prices for goods and services, and when decisions need to be made, we have access to a wide array of information sources to assist in making those decisions. In short, Americans enjoy great latitude in our power to determine what is best for us. This is not, however, the case when it comes to health and healthcare. In our current healthcare system, individuals are dependent on a structure that has resisted the natural progress and modernization achieved by market-oriented, 21st-century industries. The information age has been leaving health behind. Although it is the nature of a science- and technology-based entrepreneurial free market to provide more choices of higher quality at lower cost, in the healthcare sector, prices continue to rise, quality is inconsistent, and individuals lack the information, incentives, and power to make choices.

Development of national standards related to the integrated safety and security of high-rise buildings

Directory of Open Access Journals (Sweden)

Voskresenskaya Elena

2018-01-01

Full Text Available The article considers the issues of developing national standards for high-rise construction. The system of standards should provide industrial, operational, economic and terrorist safety of high-rise buildings and facilities. Modern standards of high-rise construction should set the rules for designing engineering systems of high-rise buildings, which will ensure the integrated security of buildings, increase their energy efficiency and reduce the consumption of resources in construction and operation.

Methods of erection of high-rise buildings

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Cherednichenko Nadezhda

2018-01-01

Full Text Available The article contains the factors determining the choice of methods for organizing the construction and production of construction and installation work for the construction of high-rise buildings. There are also indicated specific features of their underground parts, characterized by powerful slab-pile foundations, large volumes of earthworks, reinforced bases and foundations for assembly cranes. The work cycle is considered when using reinforced concrete, steel and combined skeletons of high-rise buildings; the areas of application of flow, separate and complex methods are being disclosed. The main conditions for the erection of high-rise buildings and their components are singled out: the choice of formwork systems, delivery and lifting of concrete mixes, installation of reinforcement, the formation of lifting and transporting and auxiliary equipment. The article prescribes the reserves of reduction in the duration of construction due to the creation of: complex mechanized technologies for the efficient construction of foundations in various soil conditions, including in the heaving, swelling, hindered, subsidence, bulk, water-saturated forms; complex mechanized technologies for the erection of monolithic reinforced concrete structures, taking into account the winter conditions of production and the use of mobile concrete-laying complexes and new generation machines; modular formwork systems, distinguished by their versatility, ease, simplicity in operation suitable for complex high-rise construction; more perfect methodology and the development of a set of progressive organizational and technological solutions that ensure a rational relationship between the processes of production and their maximum overlap in time and space.

Mental health care system optimization from a health-economics perspective: where to sow and where to reap?

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Lokkerbol, Joran; Weehuizen, Rifka; Mavranezouli, Ifigeneia; Mihalopoulos, Cathrine; Smit, Filip

2014-06-01

Health care expenditure (as % of GDP) has been rising in all OECD countries over the last decades. Now, in the context of the economic downturn, there is an even more pressing need to better guarantee the sustainability of health care systems. This requires that policy makers are informed about optimal allocation of budgets. We take the Dutch mental health system in the primary care setting as an example of new ways to approach optimal allocation. To demonstrate how health economic modelling can help in identifying opportunities to improve the Dutch mental health care system for patients presenting at their GP with symptoms of anxiety, stress, symptoms of depression, alcohol abuse/dependence, anxiety disorder or depressive disorder such that changes in the health care system have the biggest leverage in terms of improved cost-effectiveness. Investigating such scenarios may serve as a starting point for setting an agenda for innovative and sustainable health care policies. A health economic simulation model was used to synthesize clinical and economic evidence. The model was populated with data from GPs' national register on the diagnosis, treatment, referral and prescription of their patients in the year 2009. A series of `what-if' analyses was conducted to see what parameters (uptake, adherence, effectiveness and the costs of the interventions) are associated with the most substantial impact on the cost-effectiveness of the health care system overall. In terms of improving the overall cost-effectiveness of the primary mental health care system, substantial benefits could be derived from increasing uptake of psycho-education by GPs for patients presenting with stress and when low cost interventions are made available that help to increase the patients' compliance with pharmaceutical interventions, particularly in patients presenting with symptoms of anxiety. In terms of intervention costs, decreasing the costs of antidepressants is expected to yield the biggest

Reactive rise in blood pressure upon cuff inflation: cuff inflation at the arm causes a greater rise in pressure than at the wrist in hypertensive patients.

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Charmoy, Alexia; Würzner, Grégoire; Ruffieux, Christiane; Hasler, Christopher; Cachat, François; Waeber, Bernard; Burnier, Michel

2007-10-01

Cuff inflation at the arm is known to cause an instantaneous rise in blood pressure, which might be due to the discomfort of the procedure and might interfere with the precision of the blood pressure measurement. In this study, we compared the reactive rise in blood pressure induced by cuff inflation when the cuff was placed at the upper arm level and at the wrist. The reactive rise in systolic and diastolic blood pressure to cuff inflation was measured in 34 normotensive participants and 34 hypertensive patients. Each participant was equipped with two cuffs, one around the right upper arm (OMRON HEM-CR19, 22-32 cm) and one around the right wrist (OMRON HEM-CS 19, 17-22 cm; Omron Health Care Europe BV, Hoofddorp, The Netherlands). The cuffs were inflated in a double random order (maximal cuff pressure and position of the cuff) with two maximal cuff pressures: 180 and 240 mmHg. The cuffs were linked to an oscillometric device (OMRON HEM 907; Omron Health Care). Simultaneously, blood pressure was measured continuously at the middle finger of the left hand using photoplethysmography. Three measurements were made at each level of blood pressure at the arm and at the wrist, and the sequence of measurements was randomized. In normotensive participants, no significant difference was observed in the reactive rise in blood pressure when the cuff was inflated either at the arm or at the wrist irrespective of the level of cuff inflation. Inflating a cuff at the arm, however, induced a significantly greater rise in blood pressure than inflating it at the wrist in hypertensive participants for both systolic and diastolic pressures (Pblood pressure response to cuff inflation was independent of baseline blood pressure. The results show that in hypertensive patients, cuff inflation at the wrist produces a smaller reactive rise in blood pressure. The difference between the arm and the wrist is independent of the patient's level of blood pressure.

RADIOMETRIC CALIBRATION OF MARS HiRISE HIGH RESOLUTION IMAGERY BASED ON FPGA

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Y. Hou

2016-06-01

Full Text Available Due to the large data amount of HiRISE imagery, traditional radiometric calibration method is not able to meet the fast processing requirements. To solve this problem, a radiometric calibration system of HiRISE imagery based on field program gate array (FPGA is designed. The montage gap between two channels caused by gray inconsistency is removed through histogram matching. The calibration system is composed of FPGA and DSP, which makes full use of the parallel processing ability of FPGA and fast computation as well as flexible control characteristic of DSP. Experimental results show that the designed system consumes less hardware resources and the real-time processing ability of radiometric calibration of HiRISE imagery is improved.

Greece: Health system review.

Science.gov (United States)

Economou, Charalambos

2010-01-01

The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. The health status of the Greek population has strongly improved over the last few decades and seems to compare relatively favourably with other OECD and European Union (EU) countries. The health system is a mixture of public integrated, public contract and public reimbursement models, comprising elements from both the public and private sectors and incorporating principles of different organizational patterns. Access to services is based on citizenship as well as on occupational status.The system is financed by the state budget, social insurance contributions and private payments.The largest share of health expenditure constitutes private expenditure, mainly in the form of out of pocket payments which is also the element contributing most to the overall increase in health expenditure. The delivery of health care services is based on both public and private providers. The presence of private providers is more obvious in primary care,especially in diagnostic technologies, private physicians' practices and pharmaceuticals. Despite success in improving the health of the population, the Greek health care system faces serious structural problems concerning the organization, financing and delivery of services. It suffers from the absence of cost-containment measures and defined criteria for funding, resulting in sickness funds experiencing economic constraints and budget deficits. The high percentage of private expenditure goes against the principle of fair

Natural dissolved organic matter dynamics in karstic aquifer: O'Leno Sink-Rise system, Florida, USA

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Jin, J.; Zimmerman, A. R.

2010-12-01

Natural dissolved organic matter (NDOM) dynamics in karstic aquifer remain poorly understood due to the inaccessibility and heterogeneity of the subsurface. Because the Santa Fe River sinks into the Floridan Aquifer and emerges 6 km down gradient, the O'Leno Sink-Rise system in Northern Florida provides an ideal setting to study NDOM transformation in groundwater. Water samples were collected at both high and low temporal resolutions over 3 years from the River Sink, Rise, and a series of shallow and deep wells. Analyses of dissolved organic and inorganic carbon, stable isotopic, and spectrophotometry (excitation-emission matrix or EEM) show that reversals of hydrologic head gradient in the conduit and matrix are closely related to the delivery of NDOM to the aquifer. In addition, the relative influence of biotic and abiotic processes varies along spatiotemporal gradients; regions of the aquifer with greatest connectivity to surface water (new NDOM and terminal electron acceptor supply) see the most microbial transformation of NDOM, while those with least connectivity see relatively greater abiotic transformation of NDOM. A source water mixing model was established for the Sink-Rise system using Mg2+ and SO42- concentrations from three end-members identified as allogenic recharge, upwelling deep water, and shallow groundwater of the Upper Floridan Aquifer. Biogeochemical processes were quantified after accounting for changes that occurred due to source water mixing, according to the model. In addition to NDOM remineralization by subsurface microbes which occurred mostly during wet periods, adsorption of NDOM onto aquifer materials as well as release of NDOM from aquifer materials was also observed. During wet periods when DOC-rich conduit water entered the matrix, progressive NDOM remineralization was found along the preferential flow paths from the conduits into the matrices. Both biotic and abiotic NDOM transformation processes were found to control channel

Poland health system review.

Science.gov (United States)

Sagan, Anna; Panteli, Dimitra; Borkowski, W; Dmowski, M; Domanski, F; Czyzewski, M; Gorynski, Pawel; Karpacka, Dorota; Kiersztyn, E; Kowalska, Iwona; Ksiezak, Malgorzata; Kuszewski, K; Lesniewska, A; Lipska, I; Maciag, R; Madowicz, Jaroslaw; Madra, Anna; Marek, M; Mokrzycka, A; Poznanski, Darius; Sobczak, Alicja; Sowada, Christoph; Swiderek, Maria; Terka, A; Trzeciak, Patrycja; Wiktorzak, Katarzyna; Wlodarczyk, Cezary; Wojtyniak, B; Wrzesniewska-Wal, Iwona; Zelwianska, Dobrawa; Busse, Reinhard

2011-01-01

Since the successful transition to a freely elected parliament and a market economy after 1989, Poland is now a stable democracy and is well represented within political and economic organizations in Europe and worldwide. The strongly centralized health system based on the Semashko model was replaced with a decentralized system of mandatory health insurance, complemented with financing from state and territorial self-government budgets. There is a clear separation of health care financing and provision: the National Health Fund (NFZ) the sole payer in the system is in charge of health care financing and contracts with public and non-public health care providers. The Ministry of Health is the key policy-maker and regulator in the system and is supported by a number of advisory bodies, some of them recently established. Health insurance contributions, borne entirely by employees, are collected by intermediary institutions and are pooled by the NFZ and distributed between the 16 regional NFZ branches. In 2009, Poland spent 7.4% of its gross domestic product (GDP) on health. Around 70% of health expenditure came from public sources and over 83.5% of this expenditure can be attributed to the (near) universal health insurance. The relatively high share of private expenditure is mostly represented by out-of-pocket (OOP) payments, mainly in the form of co-payments and informal payments. Voluntary health insurance (VHI) does not play an important role and is largely limited to medical subscription packages offered by employers. Compulsory health insurance covers 98% of the population and guarantees access to a broad range of health services. However, the limited financial resources of the NFZ mean that broad entitlements guaranteed on paper are not always available. Health care financing is overall at most proportional: while financing from health care contributions is proportional and budgetary subsidies to system funding are progressive, high OOP expenditures

Bulgaria health system review.

Science.gov (United States)

Dimova, Antoniya; Rohova, Maria; Moutafova, Emanuela; Atanasova, Elka; Koeva, Stefka; Panteli, Dimitra; van Ginneken, Ewout

2012-01-01

In the last 20 years, demographic development in Bulgaria has been characterized by population decline, a low crude birth rate, a low fertility rate, a high mortality rate and an ageing population. A stabilizing political situation since the early 2000s and an economic upsurge since the mid-2000s were important factors in the slight increase of the birth and fertility rates and the slight decrease in standardized death rates. In general, Bulgaria lags behind European Union (EU) averages in most mortality and morbidity indicators. Life expectancy at birth reached 73.3 years in 2008 with the main three causes of death being diseases of the circulatory system, malignant neoplasms and diseases of the respiratory system. One of the most important risk factors overall is smoking, and the average standardized death rate for smoking-related causes in 2008 was twice as high as the EU15 average. The Bulgarian health system is characterized by limited statism. The Ministry of Health is responsible for national health policy and the overall organization and functioning of the health system and coordinates with all ministries with relevance to public health. The key players in the insurance system are the insured individuals, the health care providers and the third party payers, comprising the National Health Insurance Fund, the single payer in the social health insurance (SHI) system, and voluntary health insurance companies (VHICs). Health financing consists of a publicprivate mix. Health care is financed from compulsory health insurance contributions, taxes, outofpocket (OOP) payments, voluntary health insurance (VHI) premiums, corporate payments, donations, and external funding. Total health expenditure (THE) as a share of gross domestic product (GDP) increased from 5.3% in 1995 to 7.3% in 2008. At the latter date it consisted of 36.5% OOP payments, 34.8% SHI, 13.6% Ministry of Health expenditure, 9.4% municipality expenditure and 0.3% VHI. Informal payments in the health

Fukushima after the Great East Japan Earthquake: lessons for developing responsive and resilient health systems

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Fukuma, Shingo; Ahmed, Shahira; Goto, Rei; Inui, Thomas S; Atun, Rifat; Fukuhara, Shunichi

2017-01-01

all three prefectures to those in Japan as a whole. Although we found a sharp rise in ambulance calls in Iwate and Miyagi, we did not see such a rise in Fukushima: a finding which may indicate limited responsiveness to acute demand because of pre–existing restricted capacity in emergency ambulance services. Conclusions We analyze changes in indicators of health and health systems infrastructure in Fukushima before and five years following the disaster, and explored health systems’ strengths and vulnerabilities. Spikes in mortality rates for selected non–infectious conditions common among older individuals were observed compared to the national trends. The results suggest that poorer reserves in the health care delivery system in Fukushima limited its capacity to effectively meet sudden unexpected increases in demand generated by the disaster. PMID:28400956

INFORMATION MODELING OF LIFE CYCLE OF HIGH-RISE CONSTRUCTION PROJECTS

Directory of Open Access Journals (Sweden)

Gusakova Elena Aleksandrovna

2018-02-01

Full Text Available To date, many years’ experience in the construction and operation of high-rise buildings has been accumulated. Its analysis reveals not only the engineering and organizational-technological specifics of such projects, but also systemic gaps in the field of management. In the implementation of large-scale and unique projects for high-rise buildings, the problems and tasks of improving approaches to managing the full life cycle of projects and methods, which will improve their competitiveness, become topical. The systems being used have largely exhausted their resource efficiency, which is associated with automation of traditional “inherited” processes and management structures, as well as development of IT-systems focused on digitalization of the activities of construction company, rather than the project. To solve these problems, it is proposed to carry out: reengineering of the schemes of information interaction between the project’s participants; formation of integrated digital environment for the life cycle of the project; development of systems for integrating data management and project management. Subject: problems, approaches and methods of digitalization of project’s life cycle management in relation to the specifics and features of high-rise buildings. Research objectives: substantiation of the most perspective approaches and methods of information modeling of high-rise construction as the basis for managing the full life cycle of the given project. Materials and methods: the experience of digitalization of design, construction, operation and development of high-rise buildings, presented in specialized literature, is analyzed. The methods for integrating information models of various stages of project’s life cycle and for information interaction of project’s participants are considered. Results: the concept of forming a single digital environment for the project is proposed, taking into account the features of the life

Is the global rise of asthma an early impact of anthropogenic climate change?

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Paul John Beggs

Full Text Available The increase in asthma incidence, prevalence, and morbidity over recent decades presents a significant challenge to public health. Pollen is an important trigger of some types of asthma, and both pollen quantity and season depend on climatic and meteorological variables. Over the same period as the global rise in asthma, there have been considerable increases in atmospheric carbon dioxide concentration and global average surface temperature. We hypothesize anthropogenic climate change as a plausible contributor to the rise in asthma. Greater concentrations of carbon dioxide and higher temperatures may increase pollen quantity and induce longer pollen seasons. Pollen allergenicity can also increase as a result of these changes in climate. Exposure in early life to a more allergenic environment may also provoke the development of other atopic conditions, such as eczema and allergic rhinitis. Although the etiology of asthma is complex, the recent global rise in asthma could be an early health effect of anthropogenic climate change.

Integrating Social impacts on Health and Health-Care Systems in Systemic Seismic Vulnerability Analysis

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Kunz-Plapp, T.; Khazai, B.; Daniell, J. E.

2012-04-01

This paper presents a new method for modeling health impacts caused by earthquake damage which allows for integrating key social impacts on individual health and health-care systems and for implementing these impacts in quantitative systemic seismic vulnerability analysis. In current earthquake casualty estimation models, demand on health-care systems is estimated by quantifying the number of fatalities and severity of injuries based on empirical data correlating building damage with casualties. The expected number of injured people (sorted by priorities of emergency treatment) is combined together with post-earthquake reduction of functionality of health-care facilities such as hospitals to estimate the impact on healthcare systems. The aim here is to extend these models by developing a combined engineering and social science approach. Although social vulnerability is recognized as a key component for the consequences of disasters, social vulnerability as such, is seldom linked to common formal and quantitative seismic loss estimates of injured people which provide direct impact on emergency health care services. Yet, there is a consensus that factors which affect vulnerability and post-earthquake health of at-risk populations include demographic characteristics such as age, education, occupation and employment and that these factors can aggravate health impacts further. Similarly, there are different social influences on the performance of health care systems after an earthquake both on an individual as well as on an institutional level. To link social impacts of health and health-care services to a systemic seismic vulnerability analysis, a conceptual model of social impacts of earthquakes on health and the health care systems has been developed. We identified and tested appropriate social indicators for individual health impacts and for health care impacts based on literature research, using available European statistical data. The results will be used to

Circumpolar Inuit health systems.

Science.gov (United States)

Ellsworth, Leanna; O'Keeffe, Annmaree

2013-01-01

The Inuit are an indigenous people totalling about 160,000 and living in 4 countries across the Arctic - Canada, Greenland, USA (Alaska) and Russia (Chukotka). In essence, they are one people living in 4 countries. Although there have been significant improvements in Inuit health and survival over the past 50 years, stark differences persist between the key health indicators for Inuit and those of the national populations in the United States, Canada and Russia and between Greenland and Denmark. On average, life expectancy in all 4 countries is lower for Inuit. Infant mortality rates are also markedly different with up to 3 times more infant deaths than the broader national average. Underlying these statistical differences are a range of health, social, economic and environmental factors which have affected Inuit health outcomes. Although the health challenges confronting the Inuit are in many cases similar across the Arctic, the responses to these challenges vary in accordance with the types of health systems in place in each of the 4 countries. Each of the 4 countries has a different health care system with varying degrees of accessibility and affordability for Inuit living in urban, rural and remote areas. To describe funding and governance arrangements for health services to Inuit in Canada, Greenland, USA (Alaska) and Russia (Chukotka) and to determine if a particular national system leads to better outcomes than any of the other 3 systems. Literature review. It was not possible to draw linkages between the different characteristics of the respective health systems, the corresponding financial investment and the systems' effectiveness in adequately serving Inuit health needs for several reasons including the very limited and inadequate collection of Inuit-specific health data by Canada, Alaska and Russia; and second, the data that are available do not necessarily provide a feasible point of comparison in terms of methodology and timing of the available data

Health System Measurement Project

Data.gov (United States)

U.S. Department of Health & Human Services — The Health System Measurement Project tracks government data on critical U.S. health system indicators. The website presents national trend data as well as detailed...

Building Public Health Capacity through Online Global Learning

Science.gov (United States)

Madhok, Rajan; Frank, Erica; Heller, Richard Frederick

2018-01-01

Rising disease burden and health inequalities remain global concerns, highlighting the need for health systems strengthening with a sufficient and appropriately trained workforce. The current models for developing such a workforce are inadequate and newer approaches are needed. In this paper we describe a model for public health capacity building…

Increased Hospitalizations for Neuropathies as Indicators of Zika Virus Infection, according to Health Information System Data, Brazil.

Science.gov (United States)

Barcellos, Christovam; Xavier, Diego Ricardo; Pavão, Ana Luiza; Boccolini, Cristiano Siqueira; Pina, Maria Fatima; Pedroso, Marcel; Romero, Dalia; Romão, Anselmo Rocha

2016-11-01

Evidence is increasing that Zika virus can cause extensive damage to the central nervous system, affecting both fetuses and adults. We sought to identify traces of possible clinical manifestations of nervous system diseases among the registers of hospital admissions recorded in the Brazilian Unified Health System. Time series of several diagnoses from the International Classification of Diseases, 10th Revision, were analyzed by using control diagrams, during January 2008-February 2016. Beginning in mid-2014, we observed an unprecedented and significant rise in the hospitalization rate for congenital malformations of the nervous system, Guillain-Barré syndrome, encephalitis, myelitis, and encephalomyelitis. These conditions are compatible with viral infection and inflammation-associated manifestations and may have been due to the entrance of Zika virus into Brazil. These findings show the necessity of adequately diagnosing and treating suspected cases of Zika virus infection and also that health surveillance systems can be improved by using routine data.

Adapting to Rising Sea Level: A Florida Perspective

Science.gov (United States)

Parkinson, Randall W.

2009-07-01

Global climate change and concomitant rising sea level will have a profound impact on Florida's coastal and marine systems. Sea-level rise will increase erosion of beaches, cause saltwater intrusion into water supplies, inundate coastal marshes and other important habitats, and make coastal property more vulnerable to erosion and flooding. Yet most coastal areas are currently managed under the premise that sea-level rise is not significant and the shorelines are static or can be fixed in place by engineering structures. The new reality of sea-level rise and extreme weather due to climate change requires a new style of planning and management to protect resources and reduce risk to humans. Scientists must: (1) assess existing coastal vulnerability to address short term management issues and (2) model future landscape change and develop sustainable plans to address long term planning and management issues. Furthermore, this information must be effectively transferred to planners, managers, and elected officials to ensure their decisions are based upon the best available information. While there is still some uncertainty regarding the details of rising sea level and climate change, development decisions are being made today which commit public and private investment in real estate and associated infrastructure. With a design life of 30 yrs to 75 yrs or more, many of these investments are on a collision course with rising sea level and the resulting impacts will be significant. In the near term, the utilization of engineering structures may be required, but these are not sustainable and must ultimately yield to "managed withdrawal" programs if higher sea-level elevations or rates of rise are forthcoming. As an initial step towards successful adaptation, coastal management and planning documents (i.e., comprehensive plans) must be revised to include reference to climate change and rising sea-level.

IT Requirements Integration in High-Rise Construction Design Projects

Science.gov (United States)

Levina, Anastasia; Ilin, Igor; Esedulaev, Rustam

2018-03-01

The paper discusses the growing role of IT support for the operation of modern high-rise buildings, due to the complexity of managing engineering systems of buildings and the requirements of consumers for the IT infrastructure. The existing regulatory framework for the development of design documentation for construction, including high-rise buildings, is analyzed, and the lack of coherence in the development of this documentation with the requirements for the creation of an automated management system and the corresponding IT infrastructure is stated. The lack of integration between these areas is the cause of delays and inefficiencies both at the design stage and at the stage of putting the building into operation. The paper proposes an approach to coordinate the requirements of the IT infrastructure of high-rise buildings and design documentation for construction. The solution to this problem is possible within the framework of the enterprise architecture concept by coordinating the requirements of the IT and technological layers at the design stage of the construction.

Newly discovered hydrothermal system on the Alarcón Rise, Mexico

Science.gov (United States)

Paduan, J. B.; Clague, D. A.; Caress, D. W.; Lundsten, L.; Martin, J. F.; Nieves-Cardoso, C.

2012-12-01

The Alarcón Rise lies at the mouth of the Gulf of California, and is the last segment of the East Pacific Rise before the plate boundary redirects into the gulf. As part of MBARI's expedition to the gulf in 2012, the neovolcanic zone of the entire ridge segment was mapped by MBARI's mapping AUV. 110 potential hydrothermal chimneys were identified in the new high resolution maps, and 70 were visited with the ROV Doc Ricketts, after having been sought in vain without the maps on an expedition in 2003. Two active vent fields were found, and have been named Meyibó and Ja sít from local native languages. They lie 2.5km apart at ~2300m depth, and are associated with a large, young sheet flow 1/3 of the way along the ridge from the south, on the most inflated part of the ridge. The southern field, Meyibó, contains 14 active chimneys (confirmed with ROV observations) nestled in grabens of several highly fractured cones surrounded by the sheet flow, and generally aligned with its discontinuous, 8km-long fissure system. The northern field, Ja sít, is a broad cluster of 8 active chimneys (also confirmed) rising above the sheet flow's channel system, more than 150m from the fissure. The chimneys stand as tall as 18 m. The most vigorous vent "black smoke" (mineral-rich fluid) >300°C and others are bathed in "white smoke". The active chimneys are populated with bacterial mat and dense clumps of Riftia pachyptila with tubes as long as 1.5m. Abundant limpets, Bythograea thermydron and galatheid crabs, and the pink vent fish Thermarces cerberus were on and near the giant tube worms. Alvinellid worms were observed at 2 chimneys. Some cracks in nearby lava flows vented clear fluid and were populated with tubeworms or Calyptogena magnifica clams. Several chimneys exhibited signs of waning activity: dead tubeworms were still attached and only a minor portion of the edifice supported bacterial mat and live tubeworms. Inactive chimneys are more numerous (48 were confirmed with ROV

Complex systems thinking in emergency medicine: A novel paradigm for a rapidly changing and interconnected health care landscape.

Science.gov (United States)

Widmer, Matthew A; Swanson, R Chad; Zink, Brian J; Pines, Jesse M

2017-12-27

The specialty of emergency medicine is experiencing the convergence of a number of transformational forces in the United States, including health care reform, technological advancements, and societal shifts. These bring both opportunity and uncertainty. 21ST CENTURY CHALLENGES: Persistent challenges such as the opioid epidemic, rising health care costs, misaligned incentives, patients with multiple chronic diseases, and emergency department crowding continue to plague the acute, unscheduled care system. The traditional approach to health care practice and improvement-reductionism-is not adequate for the complexity of the twenty-first century. Reductionist thinking will likely continue to produce unintended consequences and suboptimal outcomes. Complex systems thinking provides a perspective and set of tools better suited for the challenges and opportunities facing public health in general, and emergency medicine more specifically. This article introduces complex systems thinking and argues for its application in the context of emergency medicine by drawing on the history of the circumstances surrounding the formation of the specialty and by providing examples of its application to several practice challenges. © 2017 John Wiley & Sons, Ltd.

Health, Health Care, and Systems Science: Emerging Paradigm.

Science.gov (United States)

Janecka, Ivo

2017-02-15

Health is a continuum of an optimized state of a biologic system, an outcome of positive relationships with the self and others. A healthy system follows the principles of systems science derived from observations of nature, highlighting the character of relationships as the key determinant. Relationships evolve from our decisions, which are consequential to the function of our own biologic system on all levels, including the genome, where epigenetics impact our morphology. In healthy systems, decisions emanate from the reciprocal collaboration of hippocampal memory and the executive prefrontal cortex. We can decide to change relationships through choices. What is selected, however, only represents the cognitive interpretation of our limited sensory perception; it strongly reflects inherent biases toward either optimizing state, making a biologic system healthy, or not. Health or its absence is then the outcome; there is no inconsequential choice. Public health effort should not focus on punitive steps (e.g. taxation of unhealthy products or behaviors) in order to achieve a higher level of public's health. It should teach people the process of making healthy decisions; otherwise, people will just migrate/shift from one unhealthy product/behavior to another, and well-intended punitive steps will not make much difference. Physical activity, accompanied by nutrition and stress management, have the greatest impact on fashioning health and simultaneously are the most cost-effective measures. Moderate-to-vigorous exercise not only improves aerobic fitness but also positively influences cognition, including memory and senses. Collective, rational societal decisions can then be anticipated. Health care is a business system principally governed by self-maximizing decisions of its components; uneven and contradictory outcomes are the consequences within such a non-optimized system. Health is not health care. We are biologic systems subject to the laws of biology in spite of

Community Psychology as a Process of Citizen Participation in Health Policy Comment on "The Rise of Post-truth Populism in Pluralist Liberal Democracies: Challenges for Health Policy".

Science.gov (United States)

Taggart, Danny

2017-06-25

This brief commentary discusses a recent paper by Speed and Mannion that explores "The Rise of post truth populism in liberal democracies: challenges for health policy." It considers their assertion that through meaningful democratic engagement in health policy, some of the risks brought about by an exclusionary populist politics can be mediated. With an overview of what participation means in modern healthcare policy and implementation, the field of community psychology is presented as one way to engage marginalized groups at risk of exploitation or exclusion by nativist populist policy. © 2018 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

[The rise and fall of an physician entrepreneur].

Science.gov (United States)

Dörnyei, Sándor

2002-01-01

In 1927 one of the most up-to-date and most beautiful sanatoriums of Central Europe was built on the hills of Buda by László Jakab MD (1875-1940), who at that time had already run - since 1909 - a successful health-resort, the rather popular and successful "Liget-Sanatorium": following a period of expansion and flourishing, his enterprise bankrupted. (The building itself was renewed after World War II - it served first as a hospital for tuberculosis patients and later as a university clinic for internal medicine.) This article tells the story of an entrepreneur physician, including his former and more successful attempts to run a health-care business, and gives detailed account of the rise and fall of private health-resort in prewar Hungary.

Estonia: health system review.

Science.gov (United States)

Lai, Taavi; Habicht, Triin; Kahur, Kristiina; Reinap, Marge; Kiivet, Raul; van Ginneken, Ewout

2013-01-01

This analysis of the Estonian health system reviews recent developments in organization and governance, health financing, health-care provision, health reforms and health system performance. Without doubt, the main issue has been the 2008 financial crisis. Although Estonia has managed the downturn quite successfully and overall satisfaction with the system remains high, it is hard to predict the longer-term effects of the austerity package. The latter included some cuts in benefits and prices, increased cost sharing for certain services, extended waiting times, and a reduction in specialized care. In terms of health outcomes, important progress was made in life expectancy, which is nearing the European Union (EU) average, and infant mortality. Improvements are necessary in smoking and alcohol consumption, which are linked to the majority of avoidable diseases. Although the health behaviour of the population is improving, large disparities between groups exist and obesity rates, particularly among young people, are increasing. In health care, the burden of out-of-pocket payments is still distributed towards vulnerable groups. Furthermore, the number of hospitals, hospital beds and average length of stay has decreased to the EU average level, yet bed occupancy rates are still below EU averages and efficiency advances could be made. Going forwards, a number of pre-crisis challenges remain. These include ensuring sustainability of health care financing, guaranteeing a sufficient level of human resources, prioritizing patient-centred health care, integrating health and social care services, implementing intersectoral action to promote healthy behaviour, safeguarding access to health care for lower socioeconomic groups, and, lastly, improving evaluation and monitoring tools across the health system. World Health Organization 2013 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).

Building more effective sea level rise models for coastal management

Science.gov (United States)

Kidwell, D.; Buckel, C.; Collini, R.; Meckley, T.

2017-12-01

For over a decade, increased attention on coastal resilience and adaptation to sea level rise has resulted in a proliferation of predictive models and tools. This proliferation has enhanced our understanding of our vulnerability to sea level rise, but has also led to stakeholder fatigue in trying to realize the value of each advancement. These models vary in type and complexity ranging from GIS-based bathtub viewers to modeling systems that dynamically couple complex biophysical and geomorphic processes. These approaches and capabilities typically have the common purpose using scenarios of global and regional sea level change to inform adaptation and mitigation. In addition, stakeholders are often presented a plethora of options to address sea level rise issues from a variety of agencies, academics, and consulting firms. All of this can result in confusion, misapplication of a specific model/tool, and stakeholder feedback of "no more new science or tools, just help me understand which one to use". Concerns from stakeholders have led to the question; how do we move forward with sea level rise modeling? This presentation will provide a synthesis of the experiences and feedback derived from NOAA's Ecological Effects of Sea level Rise (EESLR) program to discuss the future of predictive sea level rise impact modeling. EESLR is an applied research program focused on the advancement of dynamic modeling capabilities in collaboration with local and regional stakeholders. Key concerns from stakeholder engagement include questions about model uncertainty, approaches for model validation, and a lack of cross-model comparisons. Effective communication of model/tool products, capabilities, and results is paramount to address these concerns. Looking forward, the most effective predictions of sea level rise impacts on our coast will be attained through a focus on coupled modeling systems, particularly those that connect natural processes and human response.

The Rise of Mobile Technology on the Financial Sector in Zimbabwe

OpenAIRE

Paul Mupfiga; Tafadzwa Padare

2017-01-01

The emergence of technology has revolted the way that the financial industry operates and the increasing use of mobile gadgets has changed the banking system from the traditional brick and mortar building to a virtual system. The sudden rise in use and innovation of smart mobile phones, mobile personal computers, tablets and various other mobile electronic gadgets has resulted in the rise of mobile financial products. Rapid quickening innovative headways are making completely new business sug...

[The health system of Ecuador].

Science.gov (United States)

Lucio, Ruth; Villacrés, Nilhda; Henríquez, Rodrigo

2011-01-01

This paper describes the health conditions in Ecuador and, in more detail, the characteristics of the Ecuadorian health system, including its structure and coverage, its financial sources, the physical, material and human resources available, and the stewardship activities developed by the Ministry of Public Health. It also describes the structure and content of its health information system, and the participation of citizens in the operation and evaluation of the health system. The paper ends with a discussion of the most recent policy innovations implemented in the Ecuadorian system, including the incorporation of a chapter on health into the new Constitution which recognizes the protection of health as a human right, and the construction of the Comprehensive Public Health Network.

Anthropogenic sea level rise and adaptation in the Yangtze estuary

Science.gov (United States)

Cheng, H.; Chen, J.; Chen, Z.; Ruan, R.; Xu, G.; Zeng, G.; Zhu, J.; Dai, Z.; Gu, S.; Zhang, X.; Wang, H.

2016-02-01

Sea level rise is a major projected threat of climate change. There are regional variations in sea level changes, depending on both naturally the tectonic subsidence, geomorphology, naturally changing river inputs and anthropogenic driven forces as artificial reservoir water impoundment within the watershed and urban land subsidence driven by ground water depletion in the river delta. Little is known on regional sea level fall in response to the channel erosion due to the sediment discharge decline by reservoir interception in the upstream watershed, and water level rise driven by anthropogenic measures as the land reclamation, deep waterway regulation and fresh water reservoir construction to the sea level change in estuaries. Changing coastal cities are situated in the delta regions expected to be threatened in various degrees. Shanghai belongs to those cities. Here we show that the anthropogenic driven sea level rise in the Yangtze estuary from the point of view of the continuous hydrodynamic system consisted of river catchment, estuary and coastal sea. Land subsidence is cited as 4 mm/a (2011-2030). Scour depth of the estuarine channel by upstream engineering as Three Gauge Dam is estimated at 2-10 cm (2011-2030). The rise of water level by deep waterway and land reclamation is estimated at 8-10 cm (2011-2030). The relative sea level rise will be speculated about 10 -16 cm (2011-2030), which these anthropogenic sea level changes will be imposed into the absolute sea level rise 2 mm/a and tectonic subsidence 1 mm/a measured in 1990s. The action guideline to the sea level rise strategy in the Shanghai city have been proposed to the Shanghai government as (1) recent actions (2012-2015) to upgrade the city water supply and drainage engineering and protective engineering; (2) interim actions (2016-2020) to improve sea level monitoring and early warning system, and then the special, city, regional planning considering sea level rise; (3) long term actions (2021

Eliciting a policy response for the rising epidemic of overweight-obesity in India.

Science.gov (United States)

Khandelwal, S; Reddy, K S

2013-11-01

India is experiencing multiple transitions with respect to nutrition patterns, epidemiology and demography. Along with staggering childhood undernutrition, a rapid rise in chronic diseases and their risk factors including overweight-obesity (O-O), among all sections of society, is compounding India's health challenges. We present an overview of the O-O scenario (prevalence, determinants) and profile existing initiatives to address this modifiable risk factor in India. Urgent attention from all sectors, committed resources, policy support and targeted actions are warranted to combat the dual burden of malnutrition. The health systems should be reoriented and strengthened, in addition to enabling actions in other sectors, to address prevention and control of non-communicable diseases and associated risk factors like O-O. © 2013 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of the International Association for the Study of Obesity.

46 CFR 111.20-5 - Temperature rise.

Science.gov (United States)

2010-10-01

... COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) ELECTRICAL ENGINEERING ELECTRIC SYSTEMS-GENERAL REQUIREMENTS Transformer Construction, Installation, and Protection § 111.20-5 Temperature rise. (a) The... than 40 degrees C, the transformer must be derated so that the total temperature stated in this section...

Circumpolar Inuit health systems

Directory of Open Access Journals (Sweden)

Leanna Ellsworth

2013-08-01

Full Text Available Background . The Inuit are an indigenous people totalling about 160,000 and living in 4 countries across the Arctic – Canada, Greenland, USA (Alaska and Russia (Chukotka. In essence, they are one people living in 4 countries. Although there have been significant improvements in Inuit health and survival over the past 50 years, stark differences persist between the key health indicators for Inuit and those of the national populations in the United States, Canada and Russia and between Greenland and Denmark. On average, life expectancy in all 4 countries is lower for Inuit. Infant mortality rates are also markedly different with up to 3 times more infant deaths than the broader national average. Underlying these statistical differences are a range of health, social, economic and environmental factors which have affected Inuit health outcomes. Although the health challenges confronting the Inuit are in many cases similar across the Arctic, the responses to these challenges vary in accordance with the types of health systems in place in each of the 4 countries. Each of the 4 countries has a different health care system with varying degrees of accessibility and affordability for Inuit living in urban, rural and remote areas. Objective . To describe funding and governance arrangements for health services to Inuit in Canada, Greenland, USA (Alaska and Russia (Chukotka and to determine if a particular national system leads to better outcomes than any of the other 3 systems. Study design . Literature review. Results . It was not possible to draw linkages between the different characteristics of the respective health systems, the corresponding financial investment and the systems’ effectiveness in adequately serving Inuit health needs for several reasons including the very limited and inadequate collection of Inuit-specific health data by Canada, Alaska and Russia; and second, the data that are available do not necessarily provide a feasible point of

Health systems research in the time of health system reform in India: a review.

Science.gov (United States)

Rao, Krishna D; Arora, Radhika; Ghaffar, Abdul

2014-08-09

Research on health systems is an important contributor to improving health system performance. Importantly, research on program and policy implementation can also create a culture of public accountability. In the last decade, significant health system reforms have been implemented in India. These include strengthening the public sector health system through the National Rural Health Mission (NRHM), and expansion of government-sponsored insurance schemes for the poor. This paper provides a situation analysis of health systems research during the reform period. We reviewed 9,477 publications between 2005 and 2013 in two online databases, PubMed and IndMED. Articles were classified according to the WHO classification of health systems building blocks. Our findings indicate the number of publications on health systems progressively increased every year from 92 in 2006 to 314 in 2012. The majority of papers were on service delivery (40%), with fewer on information (16%), medical technology and vaccines (15%), human resources (11%), governance (5%), and financing (8%). Around 70% of articles were lead by an author based in India, the majority by authors located in only four states. Several states, particularly in eastern and northeastern India, did not have a single paper published by a lead author located in a local institution. Moreover, many of these states were not the subject of a single published paper. Further, a few select institutions produced the bulk of research. Of the foreign author lead papers, 77% came from five countries (USA, UK, Canada, Australia, and Switzerland). The growth of published research during the reform period in India is a positive development. However, bulk of this research is produced in a few states and by a few select institutions Further strengthening health systems research requires attention to neglected health systems domains like human resources, financing, and governance. Importantly, research capacity needs to be strengthened in

Short Lived Climate Pollutants cause a Long Lived Effect on Sea-level Rise: Analyzing climate metrics for sea-level rise

Science.gov (United States)

Sterner, E.; Johansson, D. J.

2013-12-01

utilizes an upwelling diffusion energy balance model and focuses on the thermosteric part of sea-level rise. Example GSP results are 244, 15 and 278 for BC, CH4 and N2O for a time horizon of 100 years. Compare GWP and GTP values of 405, 24 and 288 as well as 62, 4.5 and 252. The main result of the study is that no climate forcer is in any absolute sense short lived when it comes to Sea Level impacts. All of the examined climate forcers have considerable influence on the thermosteric SLR, and the closely linked ocean heat content, on the time scale of centuries. The reason for this is that heat, once it has been induced by the climate drivers and warmed the surface ocean, is transported down into the slowly mixing oceans. References: Shindell, D. et al. Simultaneously mitigating near-term climate change and improving human health and food security. Science 335, 183-189 (2012). Bond, T. C. et al. Bounding the role of black carbon in the climate system: A scientific assessment. Journal of Geophysical Research: Atmospheres 118 5380-5552 (2013). Hu, A., Xu, Y., Tebaldi, C., Washington, W. M. & Ramanathan, V. Mitigation of short-lived climate pollutants slows sea-level rise. Nature Climate Change 3, 730-734 (2013).

Development of the eHealth Literacy Assessment Toolkit, eHLA

DEFF Research Database (Denmark)

Lauritzen, Dorthe Furstrand; Kayser, Lars

2015-01-01

In a world with rising focus on the use of eHealth, the match between the competences of the individual and the demands of eHealth systems becomes increasingly important, thus making assessment of eHealth literacy as a measure of user competences a vital element. We propose the eHealth Literacy...

State of the Carbon Cycle - Consequences of Rising Atmospheric CO2

Science.gov (United States)

Moore, D. J.; Cooley, S. R.; Alin, S. R.; Brown, M. E.; Butman, D. E.; French, N. H. F.; Johnson, Z. I.; Keppel-Aleks, G.; Lohrenz, S. E.; Ocko, I.; Shadwick, E. H.; Sutton, A. J.; Potter, C. S.; Yu, R. M. S.

2016-12-01

The rise of atmospheric CO2, largely attributable to human activity through fossil fuel emissions and land-use change, has been dampened by carbon uptake by the ocean and terrestrial biosphere. We outline the consequences of this carbon uptake as direct and indirect effects on terrestrial and oceanic systems and processes for different regions of North America and the globe. We assess the capacity of these systems to continue to act as carbon sinks. Rising CO2 has decreased seawater pH; this process of ocean acidification has impacted some marine species and altered fundamental ecosystem processes with further effects likely. In terrestrial ecosystems, increased atmospheric CO2 causes enhanced photosynthesis, net primary production, and increased water-use efficiency. Rising CO2 may change vegetation composition and carbon storage, and widespread increases in water use efficiency likely influence terrestrial hydrology and biogeochemical cycling. Consequences for human populations include changes to ecosystem services including cultural activities surrounding land use, agricultural or harvesting practices. Commercial fish stocks have been impacted and crop production yields have been changed as a result of rising CO2. Ocean and terrestrial effects are contingent on, and feedback to, global climate change. Warming and modified precipitation regimes impact a variety of ecosystem processes, and the combination of climate change and rising CO2 contributes considerable uncertainty to forecasting carbon sink capacity in the ocean and on land. Disturbance regime (fire and insects) are modified with increased temperatures. Fire frequency and intensity increase, and insect lifecycles are disrupted as temperatures move out of historical norms. Changes in disturbance patterns modulate the effects of rising CO2 depending on ecosystem type, disturbance frequency, and magnitude of events. We discuss management strategies designed to limit the rise of atmospheric CO2 and reduce

State of the Carbon Cycle - Consequences of Rising Atmospheric CO2

Science.gov (United States)

Moore, David J.; Cooley, Sarah R.; Alin, Simone R.; Brown, Molly; Butman, David E.; French, Nancy H. F.; Johnson, Zackary I.; Keppel-Aleks; Lohrenz, Steven E.; Ocko, Ilissa;

SPS Injection and Beam Quality for LHC Heavy Ions With 150 ns Kicker Rise Time

CERN Document Server

Goddard, Brennan; Ducimetière, Laurent; Kotzian, Gerd; Uythoven, Jan; Velotti, Francesco

2016-01-01

As part of the LHC Injectors Upgrade project for LHC heavy ions, the SPS injection kicker system rise time needs reduction below its present 225 ns. One technically challenging option under consideration is the addition of fast Pulse Forming Lines in parallel to the existing Pulse Forming Networks for the 12 kicker magnets MKP-S, targeting a system field rise time of 100 ns. An alternative option is to optimise the system to approach the existing individual magnet field rise time (2-98%) of 150 ns. This would still significantly increase the number of colliding bunches in LHC while minimising the cost and effort of the system upgrade. The observed characteristics of the present system are described, compared to the expected system rise time, together with results of simulations and measurements with 175 and 150 ns injection batch spacing. The expected beam quality at injection into LHC is quantified, with the emittance growth and simulated tail population taking into account expected jitter and synchronisatio...

Building health research systems to achieve better health

Directory of Open Access Journals (Sweden)

González Block Miguel

2006-11-01

Full Text Available Abstract Health research systems can link knowledge generation with practical concerns to improve health and health equity. Interest in health research, and in how health research systems should best be organised, is moving up the agenda of bodies such as the World Health Organisation. Pioneering health research systems, for example those in Canada and the UK, show that progress is possible. However, radical steps are required to achieve this. Such steps should be based on evidence not anecdotes. Health Research Policy and Systems (HARPS provides a vehicle for the publication of research, and informed opinion, on a range of topics related to the organisation of health research systems and the enormous benefits that can be achieved. Following the Mexico ministerial summit on health research, WHO has been identifying ways in which it could itself improve the use of research evidence. The results from this activity are soon to be published as a series of articles in HARPS. This editorial provides an account of some of these recent key developments in health research systems but places them in the context of a distinguished tradition of debate about the role of science in society. It also identifies some of the main issues on which 'research on health research' has already been conducted and published, in some cases in HARPS. Finding and retaining adequate financial and human resources to conduct health research is a major problem, especially in low and middle income countries where the need is often greatest. Research ethics and agenda-setting that responds to the demands of the public are issues of growing concern. Innovative and collaborative ways are being found to organise the conduct and utilisation of research so as to inform policy, and improve health and health equity. This is crucial, not least to achieve the health-related Millennium Development Goals. But much more progress is needed. The editorial ends by listing a wide range of topics

Public policy, health system, and community actions against illness as platforms for response to NCDs in Tanzania: a narrative review.

Science.gov (United States)

Metta, Emmy; Msambichaka, Beverly; Mwangome, Mary; Nyato, Daniel J; Dieleman, Marjolein; Haisma, Hinke; Klatser, Paul; Geubbels, Eveline

2014-01-01

Most low- and middle- income countries are facing a rise of the burden of non-communicable diseases (NCDs) alongside the persistent burden of infectious diseases. This narrative review aims to provide an inventory of how the existing policy environment, health system, and communities are addressing the NCDs situation in Tanzania and identify gaps for advancing the NCD research and policy agenda. A literature search was performed on PubMed and Google scholar with full text retrieval from HINARI of English language articles published between 2000 and 2012. Documents were read to extract information on what Tanzanian actors were doing that contributed to NCDs prevention, treatment, and control, and a narration was written out of these. Reference lists of all retrieved articles were searched for additional relevant articles. Websites of organizations active in the field of NCDs including the Government of Tanzania and WHO were searched for reports and grey literature. Lack of a specific and overarching NCD policy has slowed and fragmented the implementation of existing strategies to prevent and control NCDs and their determinants. The health system is not prepared to deal with the rising NCD burden although there are random initiatives to improve this situation. How the community is responding to these emerging conditions is still unknown, and the current health-seeking behavior and perceptions on the risk factors may not favor control of NCDs and their risk factors. There is limited information on the burden and determinants of NCDs to inform the design of an integrative and multisectorial policy. Evidence on effective interventions for NCD services in primary care levels and on community perceptions on NCDs and their care seeking is virtually absent. Research and public health interventions must be anchored in the policy, health system, and community platforms for a holistic response.

Influence of plume rise on the consequences of radioactive material releases

International Nuclear Information System (INIS)

Russo, A.J.; Wayland, J.R.; Ritchie, L.T.

1977-01-01

Estimates of health consequences resulting from a postulated nuclear reactor accident can be strongly dependent on the buoyant rise of the plume of released radioactive material. The sensitivity of the consequences of a postulated accident to two different plume rise models has been investigated. The results of these investigations are the subject of this report. One of the models includes the effects of emission angle, momentum, and radioactive heating of the released material. The difference in the consequence estimates from the two models can exceed an order of magnitude under some conditions, but in general the results are similar

[Health services research for the public health service (PHS) and the public health system].

Science.gov (United States)

Hollederer, A; Wildner, M

2015-03-01

There is a great need for health services research in the public health system and in the German public health service. However, the public health service is underrepresented in health services research in Germany. This has several structural, historical and disciplinary-related reasons. The public health service is characterised by a broad range of activities, high qualification requirements and changing framework conditions. The concept of health services research is similar to that of the public health service and public health system, because it includes the principles of multidisciplinarity, multiprofessionalism and daily routine orientation. This article focuses on a specified system theory based model of health services research for the public health system and public health service. The model is based on established models of the health services research and health system research, which are further developed according to specific requirements of the public health service. It provides a theoretical foundation for health services research on the macro-, meso- and microlevels in public health service and the public health system. Prospects for public health service are seen in the development from "old public health" to "new public health" as well as in the integration of health services research and health system research. There is a significant potential for development in a better linkage between university research and public health service as is the case for the "Pettenkofer School of Public Health Munich". © Georg Thieme Verlag KG Stuttgart · New York.

Calcium supplementation and cardiovascular risk: A rising concern.

Science.gov (United States)

Tankeu, Aurel T; Ndip Agbor, Valirie; Noubiap, Jean Jacques

2017-06-01

Over the past decade, the number of individuals taking calcium supplementation worldwide has been on the rise, especially with the emergence of new pharmaceutical companies specialized in the marketing of dietary supplements; with calcium supplementation being their main business axis. This is mostly because of the established role of calcium in the prevention and treatment of osteoporosis and, to a lesser extent, its role in the prevention of fractures. Recently, a rising body of evidence on the adverse effect of calcium supplementation on nonskeletal, especially cardiovascular, health has been a cause for concern. In fact, a significant number of studies have reported an association between calcium supplementation and adverse cardiovascular events, even though high dietary calcium intake was shown to have a protective effect. The mechanism by which calcium supplementation could cause a cardiovascular event was still unclear until a recent study published in the Journal of the American Heart Association. Combining this recent finding with available data associating calcium supplementation with cardiovascular mortality and all-cause mortality, we call on the need for an evidence-based approach to calcium supplementation, while stressing on the safety of dietary calcium intake over the former on cardiovascular health. ©2017 Wiley Periodicals, Inc.

Combining urbanization and hydrodynamics data to evaluate sea level rise impacts on coastal water resources

Science.gov (United States)

Young, C. R.; Martin, J. B.

2016-02-01

Assessments of the potential for salt water intrusion due to sea level rise require consideration of both coastal hydrodynamic and human activity thresholds. In siliciclastic systems, sea level rise may cause salt intrusion to coastal aquifers at annual or decadal scales, whereas in karst systems salt intrudes at the tidal scalse. In both cases, human activity impacts the freshwater portion of the system by altering the water demand on the aquifer. We combine physicochemical and human activity data to evaluate impact of sea level rise on salt intrusion to siliclastic (Indian River Lagoon, Fl, USA) and karst (Puerto Morelos, Yucatan, Mexico) systems under different sea level rise rate scenarios. Two hydrodynamic modeling scenarios are considered; flux controlled and head controlled. Under a flux controlled system hydraulic head gradients remain constant during sea level rise while under a head controlled system hydraulic graidents diminish, allowing saltwater intrusion. Our model contains three key terms; aquifer recharge, groundwater discharge and hydraulic conductivity. Groundwater discharge and hydraulic conductivity were calculated based on high frequency (karst system) and decadal (siliciclastic system) field measurements. Aquifer recharge is defined as precipitation less evapotranspiration and water demand was evaluated based on urban planning data that provided the regional water demand. Water demand includes agricultural area, toursim, traffic patterns, garbage collection and total population. Water demand was initially estimated using a partial leaset squares regression based on these variables. Our model indicates that water demand depends most on agricultural area, which has changed significantly over the last 30 years. In both systems, additional water demand creates a head controlled scenario, thus increaseing the protential fo salt intrusion with projected sea level rise.

The Canadian health care system: a model for American to emulate?

Science.gov (United States)

Naylor, C D

1992-04-01

The American health care system has the world's highest per capita costs and over 30 million citizens uninsured. The neighbouring Canadian system provides coverage for all basic medical and hospital services, at costs per capita that are about US$700 lower. Single-agency public funding allows tighter control of Canadian expenditures, and reduces administrative overheads. Hospitals are run as non-profit private corporations, funded primarily by a fixed annual allocation for operating costs. Most physicians are in private fee-for-service practice, but cannot charge more than the insured tariff negotiated between their provincial government and medical association. This approach, while attractive in its decentralization, tends to separate the funding and management of clinical services. Thus, hospital information systems lag a decade behind the USA, managed care initiatives are few, health maintenance organisations do not exist, and experimentation with alternative funding or delivery systems has been sporadic. Strengths of the system compared to the USA include: higher patient satisfaction, universal coverage, slightly better cost containment, higher hospital occupancy rates, and reduction in income-related rationing with more equitable distribution of services. Weaknesses in common with the United States are: cost escalation consistently outstripping the consumer price index with costs per capita second highest in the world, ever rising consumption of services per capita, inadequate manpower planning and physician maldistribution, poor regional co-ordination of services, inadequate quality assurance and provider frustration. Additional weaknesses include: an emerging funding crisis caused by the massive federal deficit, less innovation in management and delivery of care as compared to the USA, implicit rationing with long waiting lists for some services, and recurrent provider-government conflicts that have reduced goodwill among stakeholders. Thus, while the

Managing health care costs: strategies available to small businesses.

Science.gov (United States)

Higgins, C W; Finley, L; Kinard, J

1990-07-01

Although health care costs continue to rise at an alarming rate, small businesses can take steps to help moderate these costs. First, business firms must restructure benefits so that needless surgery is eliminated and inpatient hospital care is minimized. Next, small firms should investigate the feasibility of partial self-insurance options such as risk pooling and purchasing preferred premium plans. Finally, small firms should investigate the cost savings that can be realized through the use of alternative health care delivery systems such as HMOs and PPOs. Today, competition is reshaping the health care industry by creating more options and rewarding efficiency. The prospect of steadily rising prices and more choices makes it essential that small employers become prudent purchasers of employee health benefits. For American businesses, the issue is crucial. Unless firms can control health care costs, they will have to keep boosting the prices of their goods and services and thus become less competitive in the global marketplace. In that event, many workers will face a prospect even more grim than rising medical premiums: losing their jobs.

Thinking shift on health systems: from blueprint health programmes towards resilience of health systems Comment on "Constraints to applying systems thinking concepts in health systems: A regional perspective from surveying stakeholders in Eastern Mediterranean countries".

Science.gov (United States)

Blanchet, Karl

2015-03-03

International health is still highly dominated by equilibrium approaches. The emergence of systems thinking in international health provides a great avenue to develop innovative health interventions adapted to changing contexts. The public health community, nevertheless, has the responsibility to translate concepts related to systems thinking and complexity into concrete research methods and interventions. One possibility is to consider the properties of systems such as resilience and adaptability as entry points to better understand how health systems react to shocks. © 2015 by Kerman University of Medical Sciences.

Health policy, health systems research and analysis capacity ...

African Journals Online (AJOL)

Introduction: Health Policy and Systems Research and Analysis (HPSR&A) is an applied science that deals with complexity as it tries to provide lessons, tools and methods to understand and improve health systems and health policy. It is defined by the kinds of questions asked rather than a particular methodology.

Are there differences in health information exchange by health system type?

Science.gov (United States)

Opoku-Agyeman, William; Menachemi, Nir

2016-01-01

Despite the potential of health information exchange (HIE) to improve safety and reduce cost, hospitals have been slow to adopt HIE with only 30% of U.S. hospitals doing so in 2012. The aim of this study was to explore the relationship between different health system types and how they engage in HIE. Data on health system types and engagement in HIE activity were combined with secondary hospital characteristics. Ordinal logistic regression analyses were used to examine the relationship between a scale measuring the level of HIE engagement and health system type controlling for hospital and market characteristics. Data from 1552 hospitals were available for analyses. Overall, hospital in a health system of any kind exchanged more patient data elements (e.g., patient demographics, clinical summaries, laboratory results, medication history, and radiology report) compared with stand-alone hospitals (3.82 vs. 1.80, p centralized health systems, 75 (4.8%) were in centralized physician/insurance health system, 284 (18.3%) were in moderately centralized health system, 391 (25.2%) were in decentralized health system, and 91 (5.9%) were in independent health system. In regression analyses, hospitals belonging to a health system were more likely to exchange patient health data with other hospitals in the same system (OR = 3.94, p < .001) but not with hospitals outside their system (OR = 1.89, p = .445). Across health system types, there was no significant difference in the exchange of patient health data. Hospital engagement in HIE is associated with health system membership. These findings will assist hospital leaders and managers to better understand how the structure and nature of their system may influence what their individual hospital can and cannot do in their decision to engage in HIE and other decisions that support the overall system objectives.

Development of high-rise buildings: digitalization of life cycle management

Directory of Open Access Journals (Sweden)

Gusakova Elena

2018-01-01

Full Text Available The analysis of the accumulated long-term experience in the construction and operation of high-rise buildings reveals not only the engineering specificity of such projects, but also systemic problems in the field of project management. Most of the project decisions are made by the developer and the investor in the early stages of the life cycle - from the acquisition of the site to the start of operation, so most of the participants in the construction and operation of the high-rise building are far from the strategic life-cycle management of the project. The solution of these tasks due to the informatization of management has largely exhausted its efficiency resource. This is due to the fact that the applied IT-systems automated traditional "inherited" processes and management structures, and, in addition, they were focused on informatization of the activities of the construction company, rather than the construction project. Therefore, in the development of high-rise buildings, the tasks of researching approaches and methods for managing the full life cycle of projects that will improve their competitiveness become topical. For this purpose, the article substantiates the most promising approaches and methods of informational modeling of high-rise construction as a basis for managing the full life cycle of this project. Reengineering of information interaction schemes for project participants is considered; formation of a unified digital environment for the life cycle of the project; the development of systems for integrating data management and project management.

Development of high-rise buildings: digitalization of life cycle management

Science.gov (United States)

Gusakova, Elena

2018-03-01

The analysis of the accumulated long-term experience in the construction and operation of high-rise buildings reveals not only the engineering specificity of such projects, but also systemic problems in the field of project management. Most of the project decisions are made by the developer and the investor in the early stages of the life cycle - from the acquisition of the site to the start of operation, so most of the participants in the construction and operation of the high-rise building are far from the strategic life-cycle management of the project. The solution of these tasks due to the informatization of management has largely exhausted its efficiency resource. This is due to the fact that the applied IT-systems automated traditional "inherited" processes and management structures, and, in addition, they were focused on informatization of the activities of the construction company, rather than the construction project. Therefore, in the development of high-rise buildings, the tasks of researching approaches and methods for managing the full life cycle of projects that will improve their competitiveness become topical. For this purpose, the article substantiates the most promising approaches and methods of informational modeling of high-rise construction as a basis for managing the full life cycle of this project. Reengineering of information interaction schemes for project participants is considered; formation of a unified digital environment for the life cycle of the project; the development of systems for integrating data management and project management.

Possible impacts of sea level rise on disease transmission and potential adaptation strategies, a review.

Science.gov (United States)

Dvorak, Ana C; Solo-Gabriele, Helena M; Galletti, Andrea; Benzecry, Bernardo; Malone, Hannah; Boguszewski, Vicki; Bird, Jason

2018-04-18

Sea levels are projected to rise in response to climate change, causing the intrusion of sea water into land. In flat coastal regions, this would generate an increase in shallow water covered areas with limited circulation. This scenario raises a concern about the consequences it could have on human health, specifically the possible impacts on disease transmission. In this review paper we identified three categories of diseases which are associated with water and whose transmission can be affected by sea level rise. These categories include: mosquitoborne diseases, naturalized organisms (Vibrio spp. and toxic algae), and fecal-oral diseases. For each disease category, we propose comprehensive adaptation strategies that would help minimize possible health risks. Finally, the City of Key West, Florida is analyzed as a case study, due to its inherent vulnerability to sea level rise. Current and projected adaptation techniques are discussed as well as the integration of additional recommendations, focused on disease transmission control. Given that sea level rise will likely continue into the future, the promotion and implementation of positive adaptation strategies is necessary to ensure community resilience. Copyright © 2018 Elsevier Ltd. All rights reserved.

Plume rise from multiple sources

International Nuclear Information System (INIS)

Briggs, G.A.

1975-01-01

A simple enhancement factor for plume rise from multiple sources is proposed and tested against plume-rise observations. For bent-over buoyant plumes, this results in the recommendation that multiple-source rise be calculated as [(N + S)/(1 + S)]/sup 1/3/ times the single-source rise, Δh 1 , where N is the number of sources and S = 6 (total width of source configuration/N/sup 1/3/ Δh 1 )/sup 3/2/. For calm conditions a crude but simple method is suggested for predicting the height of plume merger and subsequent behavior which is based on the geometry and velocity variations of a single buoyant plume. Finally, it is suggested that large clusters of buoyant sources might occasionally give rise to concentrated vortices either within the source configuration or just downwind of it

Four centuries on from Bacon: progress in building health research systems to improve health systems?

Science.gov (United States)

Hanney, Stephen R; González-Block, Miguel A

2014-09-23

In 1627, Francis Bacon's New Atlantis described a utopian society in which an embryonic research system contributed to meeting the needs of the society. In this editorial, we use some of the aspirations described in New Atlantis to provide a context within which to consider recent progress in building health research systems to improve health systems and population health. In particular, we reflect on efforts to build research capacity, link research to policy, identify the wider impacts made by the science, and generally build fully functioning research systems to address the needs identified. In 2014, Health Research Policy and Systems has continued to publish one-off papers and article collections covering a range of these issues in both high income countries and low- and middle-income countries. Analysis of these contributions, in the context of some earlier ones, is brought together to identify achievements, challenges and possible ways forward. We show how 2014 is likely to be a pivotal year in the development of ways to assess the impact of health research on policies, practice, health systems, population health, and economic benefits.We demonstrate how the increasing focus on health research systems will contribute to realising the hopes expressed in the World Health Report, 2013, namely that all nations would take a systematic approach to evaluating the outputs and applications resulting from their research investment.

Henry Ford Health Systems

Science.gov (United States)

Henry Ford Health Systems evolved from a hospital into a system delivering care to 2.5 million patients and includes the Cancer Epidemiology, Prevention and Control Program, which focuses on epidemiologic and public health aspects of cancer.

Health system functionality in a low-income country in the midst of conflict: the case of Yemen.

Science.gov (United States)

Qirbi, Naseeb; Ismail, Sharif A

2017-07-01

 Although the literature on effects of armed conflict on population health is extensive, detailed assessments of effects on public health 'systems' are few. This article aims to help address this deficit through the medium of a case study on Yemen, describing health system and health outcome performance prior to the internationalisation of the conflict there in March 2015, before assessing the impact of war on health system functionality since that time. Review of peer- and non-peer reviewed literature from 2005 to 2016 from academic sources, multilateral organizations, donors and governmental and non-governmental organizations, augmented by secondary data analysis. Despite significant health system weaknesses and structural vulnerabilities pre-conflict, there were important improvements in selected health outcome measures in Yemen up to early 2015 (life expectancy, and infant and maternal mortality, e.g.), partly driven by a fragile health sector that was heavily reliant on out-of-pocket expenditure, and hampered by weak service penetration especially in rural areas. High intensity conflict has resulted in rising mortality and injury rates since March 2015, the first decline in life expectancy and increase in child and maternal mortality in Yemen for some years, and worsening levels of malnutrition. Service delivery has become increasingly challenging in the context of a funding crisis, destruction of health facilities, widespread shortages of essential medicines and equipment across the country, and governance fragmentation. Conflict in Yemen has resulted in humanitarian disaster on a wide scale in a short period of time, and crippled an already weak health system. Important areas of uncertainty remain, however, including the scale of health worker flight, and the extent to which alternative providers have stepped in to fill widening service gaps as the conflict has unfolded. Planning for longer-term health system reconstruction should begin as soon as possible

The Far Right Challenge Comment on "The Rise of Post-truth Populism in Pluralist Liberal Democracies: Challenges for Health Policy".

Science.gov (United States)

Halikiopoulou, Daphne

2017-07-11

Speed and Mannion make a good case that the rise of populism poses significant challenges for health policy. This commentary suggests that the link between populism and health policy should be further nuanced in four ways. First, a deconstruction of the term populism itself and a focus on the far right dimension of populist politics; second, a focus on the supply side and more specifically the question of nationalism and the 'national preference'; third, the dynamics of party competition during economic crisis; and fourth the question of policy, and more specifically the extent to which certain labour market policies are able to mediate demand for the far right. © 2018 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Thermal environmental case study of an existing underfloor air distribution (UFAD) system in a high-rise building in the tropics

Science.gov (United States)

Ya, Y. H.; Poh, K. S.

2015-09-01

The performance of an existing underfloor air distribution (UFAD) system in a renowned high-rise office tower in Malaysia was studied to identify the root cause issues behind the poor indoor air quality. Occupants are the best thermal sensor. The building was detected with the sick building syndrome (SBS) that causes runny noses, flu-like symptoms, irritated skin, and etc. Long period of exposure to indoor air pollutants may increase the occupant's health risk. The parameters such as the space temperature, relative humidity, air movement, air change, fresh air flow rate, chilled water supply and return are evaluated at three stories that consist of five open offices. A full traverse study was carried out at one of the fresh air duct. A simplified duct flow measurement method using pitot-tubes was developed. The results showed that the diffusers were not effective in creating the swirl effect to the space. Internal heat gain from human and office electrical equipment were not drawn out effectively. Besides, relative humidity has exceeded the recommended level. These issues were caused by the poor maintenance of the building. The energy efficiency strategy of the UFAD system comes from the higher supply air temperature. It may leads to insufficient cooling load for the latent heat gained under improper system performance. Special care and considerations in design, construction and maintenance are needed to ensure the indoor air quality to be maintained. Several improvements were recommended to tackle the existing indoor air quality issues. Solar system was studied as one of the innovative method for retrofitting.

Decision-making Processes among Prostate Cancer Survivors with Rising PSA Levels: Results from a Qualitative Analysis.

Science.gov (United States)

Shen, Megan Johnson; Nelson, Christian J; Peters, Ellen; Slovin, Susan F; Hall, Simon J; Hall, Matt; Herrera, Phapichaya Chaoprang; Leventhal, Elaine A; Leventhal, Howard; Diefenbach, Michael A

2015-05-01

Prostate cancer survivors with a rising prostate-specific antigen (PSA) level have few treatment options, experience a heightened state of uncertainty about their disease trajectory that might include the possibility of cancer metastasis and death, and often experience elevated levels of distress as they have to deal with a disease they thought they had conquered. Guided by self-regulation theory, the present study examined the cognitive and affective processes involved in shared decision making between physicians and patients who experience a rising PSA after definitive treatment for prostate cancer. In-depth interviews were conducted with 34 prostate cancer survivors who had been diagnosed with a rising PSA (i.e., biochemical failure) within the past 12 months. Survivors were asked about their experiences and affective responses after being diagnosed with a rising PSA and while weighing potential treatment options. In addition, patients were asked about their decision-making process for the initial prostate cancer treatment. Compared with the initial diagnosis, survivors with a rising PSA reported increased negative affect following their diagnosis, concern about the treatability of their disease, increased planning and health behavior change, heightened levels of worry preceding doctor appointments (especially prior to the discussion of PSA testing results), and a strong reliance on physicians' treatment recommendations. Prostate cancer survivors' decision-making processes for the treatment of a rising PSA are markedly different from those of the initial diagnosis of prostate cancer. Because patients experience heightened distress and rely more heavily on their physicians' recommendations with a rising PSA, interactions with the health care provider provide an excellent opportunity to address and assist patients with managing the uncertainty and distress inherent with rising PSA levels. © The Author(s) 2014.

Observed rise of visible plumes from hyperbolic natural draft cooling towers

Energy Technology Data Exchange (ETDEWEB)

Brennan, P T [Smith-Singer Meteorologists, Inc., Amityville, NY; Seymour, D E; Butler, M J; Kramer, M L; Smith, M E; Frankenberg, T T

1976-01-01

The behavior of natural draft cooling tower plumes and related meteorological variables have been measured from aircraft near three major plants of the American Electric Power System. The rise of those plumes which persisted long enough to reach a stabilized height depended primarily upon the height of the capping inversion aloft. All such plumes rose to elevations of 425 m or more above grade. No significant relationships between plume rise and wind speed, plant load, or ambient temperature were found. We conclude that simple temperature humidity soundings in the vicinity of the towers would serve as effective predictors of plume rise and persistence.

Modelling of energy consumption at construction of high-rise buildings

Directory of Open Access Journals (Sweden)

Korol Elena

2018-01-01

Full Text Available High-rise building structures in the course of its erection suppose primary use of methods provided for erection, concrete and external finishing works. Erection works do not differ significantly from usual ones: traditional equipment, accessories and techniques are used which are based on erection of structures in project position using a crane. Structures to be assembled in building frame include steel columns and beams, wall panels, form elements of columns, walls and floor structures. We can note heightened attention to operational control for quality of erection, but it is attributable to all works in the course of high-rise construction. During high-rise erection by means of cast in-situ reinforced concrete all formworks to be used do not have any special differences except systems specially designed for high-rise erection using sliding formwork or vertical traveling forms. In these systems special attention is paid to safety of elevated works. Working methods of placement and curing of concrete and structures as a whole remain traditional – the requirements for controlling such operations become toughened. The most evident differences in high-rise erection with regard to equipment, machinery and accessories used are in means provided for load transportation and safety of works at heights. Particularity of internal finishing works which are also obligatory during construction of skyscrapers allows not considering them in as technological differences from usual construction as far as the «height» of its execution is limited by height of particular floor and determined by price and building class.

Modelling of energy consumption at construction of high-rise buildings

Science.gov (United States)

Korol, Elena; Korol, Oleg

2018-03-01

High-rise building structures in the course of its erection suppose primary use of methods provided for erection, concrete and external finishing works. Erection works do not differ significantly from usual ones: traditional equipment, accessories and techniques are used which are based on erection of structures in project position using a crane. Structures to be assembled in building frame include steel columns and beams, wall panels, form elements of columns, walls and floor structures. We can note heightened attention to operational control for quality of erection, but it is attributable to all works in the course of high-rise construction. During high-rise erection by means of cast in-situ reinforced concrete all formworks to be used do not have any special differences except systems specially designed for high-rise erection using sliding formwork or vertical traveling forms. In these systems special attention is paid to safety of elevated works. Working methods of placement and curing of concrete and structures as a whole remain traditional - the requirements for controlling such operations become toughened. The most evident differences in high-rise erection with regard to equipment, machinery and accessories used are in means provided for load transportation and safety of works at heights. Particularity of internal finishing works which are also obligatory during construction of skyscrapers allows not considering them in as technological differences from usual construction as far as the «height» of its execution is limited by height of particular floor and determined by price and building class.

Wetland Responses to Sea Level Rise in the Northern Gulf of Mexico

Science.gov (United States)

Alizad, K.; Bilskie, M. V.; Hagen, S. C.; Medeiros, S. C.; Morris, J. T.

2016-12-01

Coastal regions are vulnerable to flood risk due to climate change, sea level rise, and wetland losses. The Northern Gulf of Mexico (NGOM) is a region in which extreme events are projected to be more intense under climate change and sea level rise scenarios [Wang et al., 2013; Bilskie et al., 2014]. Considering increased frequency and intensity of coastal flooding, wetlands are valuable natural resources that protect shorelines by dissipating waves and storm surges [Costanza et al., 2008]. Therefore, it is critical to investigate the response of salt marsh systems in different estuaries to sea level rise in the NGOM and their effects on storm surges to inform coastal managers to choose effective restoration plans. This research applies the coupled Hydro-MEM model [Alizad et al., 2016] to study three different estuarine systems in the NGOM. The model incorporates both sea level rise rate and feedbacks between physics and biology by coupling a hydrodynamic (ADCIRC) and salt marsh (MEM) model. The results of the model provide tidal hydrodynamics and biomass density change under four sea level rise projections during a 100-year period. The results are used to investigate marsh migration path in the estuarine systems. In addition, this study shows how marsh migration and biomass density change can impact storm surge modeling. The results imply the broader impacts of sea level rise on the estuarine systems in the NGOM. ReferencesAlizad, K., S. C. Hagen, J. T. Morris, P. Bacopoulos, M. V. Bilskie, J. Weishampel, and S. C. Medeiros (2016), A coupled, two-dimensional hydrodynamic-marsh model with biological feedback, Ecological Modeling, 327, 29-43. Bilskie, M. V., S. C. Hagen, S. C. Medeiros, and D. L. Passeri (2014), Dynamics of sea level rise and coastal flooding on a changing landscape, Geophysical Research Letters, 41(3), 927-934. Costanza, R., O. Pérez-Maqueo, M. L. Martinez, P. Sutton, S. J. Anderson, and K. Mulder (2008), The Value of Coastal Wetlands for Hurricane

Integrated Systems Health Management for Intelligent Systems

Science.gov (United States)

Figueroa, Fernando; Melcher, Kevin

2011-01-01

The implementation of an integrated system health management (ISHM) capability is fundamentally linked to the management of data, information, and knowledge (DIaK) with the purposeful objective of determining the health of a system. It is akin to having a team of experts who are all individually and collectively observing and analyzing a complex system, and communicating effectively with each other in order to arrive at an accurate and reliable assessment of its health. In this paper, concepts, procedures, and approaches are presented as a foundation for implementing an intelligent systems ]relevant ISHM capability. The capability stresses integration of DIaK from all elements of a system. Both ground-based (remote) and on-board ISHM capabilities are compared and contrasted. The information presented is the result of many years of research, development, and maturation of technologies, and of prototype implementations in operational systems.

Dynamic analysis of interhospital collaboration and competition: empirical evidence from an Italian regional health system.

Science.gov (United States)

Mascia, Daniele; Di Vincenzo, Fausto; Cicchetti, Americo

2012-05-01

Policymakers stimulate competition in universalistic health-care systems while encouraging the formation of service provision networks among hospital organizations. This article addresses a gap in the extant literature by empirically analyzing simultaneous collaboration and competition between hospitals within the Italian National Health Service, where important procompetition reforms have been implemented. To explore how rising competition between hospitals relates to their propensity to collaborate with other local providers. Longitudinal data on interhospital collaboration and competition collected in an Italian region from 2003 to 2007 are analyzed. Social network analysis techniques are applied to study the structure and dynamics of interhospital collaboration. Negative binomial regressions are employed to explore how interhospital competition relates to the collaborative network over time. Competition among providers does not hinder interhospital collaboration. Collaboration is primarily local, with resource complementarity and differentials in the volume of activity and hospital performance explaining the propensity to collaborate. Formation of collaborative networks among hospitals is not hampered by reforms aimed at fostering market forces. Because procompetition reforms elicit peculiar forms of managed competition in universalistic health systems, studies are needed to clarify whether the positive association between interhospital competition and collaboration can be generalized to other health-care settings. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Strengthening Rehabilitation in Health Systems Worldwide by Integrating Information on Functioning in National Health Information Systems.

Science.gov (United States)

Stucki, Gerold; Bickenbach, Jerome; Melvin, John

2017-09-01

A complete understanding of the experience of health requires information relevant not merely to the health indicators of mortality and morbidity but also to functioning-that is, information about what it means to live in a health state, "the lived experience of health." Not only is functioning information relevant to healthcare and the overall objectives of person-centered healthcare but to the successful operation of all components of health systems.In light of population aging and major epidemiological trends, the health strategy of rehabilitation, whose aim has always been to optimize functioning and minimize disability, will become a key health strategy. The increasing prominence of the rehabilitative strategy within the health system drives the argument for the integration of functioning information as an essential component in national health information systems.Rehabilitation professionals and researchers have long recognized in WHO's International Classification of Functioning, Disability and Health the best prospect for an internationally recognized, sufficiently complete and powerful information reference for the documentation of functioning information. This paper opens the discussion of the promise of integrating the ICF as an essential component in national health systems to secure access to functioning information for rehabilitation, across health systems and countries.

The Rise of Mobile Technology on the Financial Sector in Zimbabwe

Directory of Open Access Journals (Sweden)

Paul Mupfiga

2017-07-01

Full Text Available The emergence of technology has revolted the way that the financial industry operates and the increasing use of mobile gadgets has changed the banking system from the traditional brick and mortar building to a virtual system. The sudden rise in use and innovation of smart mobile phones, mobile personal computers, tablets and various other mobile electronic gadgets has resulted in the rise of mobile financial products. Rapid quickening innovative headways are making completely new business suggestions, for example, crowd financing, shared loaning, advanced monetary forms, versatile managing an account, online speculation and new instalment frameworks. Zimbabwe's mobile technology use is currently on the rise too as mobile service providers like Econet are enabling the connection between consumers and financial related products. Despite the fact that innovation without a doubt brings benefits, prominent specialized disappointments in the money related part lately are disturbing and several negative factors are to some extent affecting production. Drawbacks like cybercrime, resistance to change, and compatibility of mobile gadgets are affecting the information technology environment. This paper highlights the rise of mobile technology in the financial sector in Zimbabwe.

Interrogating resilience in health systems development.

Science.gov (United States)

van de Pas, Remco; Ashour, Majdi; Kapilashrami, Anuj; Fustukian, Suzanne

2017-11-01

The Fourth Global Symposium on Health Systems Research was themed around 'Resilient and responsive health systems for a changing world.' This commentary is the outcome of a panel discussion at the symposium in which the resilience discourse and its use in health systems development was critically interrogated. The 2014-15 Ebola outbreak in West-Africa added momentum for the wider adoption of resilient health systems as a crucial element to prepare for and effectively respond to crisis. The growing salience of resilience in development and health systems debates can be attributed in part to development actors and philanthropies such as the Rockefeller Foundation. Three concerns regarding the application of resilience to health systems development are discussed: (1) the resilience narrative overrules certain democratic procedures and priority setting in public health agendas by 'claiming' an exceptional policy space; (2) resilience compels accepting and maintaining the status quo and excludes alternative imaginations of just and equitable health systems including the socio-political struggles required to attain those; and (3) an empirical case study from Gaza makes the case that resilience and vulnerability are symbiotic with each other rather than providing a solution for developing a strong health system. In conclusion, if the normative aim of health policies is to build sustainable, universally accessible, health systems then resilience is not the answer. The current threats that health systems face demand us to imagine beyond and explore possibilities for global solidarity and justice in health. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Is the swiss health care system a model for the United States?

Science.gov (United States)

Chaufan, Claudia

2014-01-01

Both supporters and critics of the Patient Protection and Affordable Care Act (ACA) have argued that it is similar to Switzerland's Federal Law on Health Insurance (LAMal), which currently governs Swiss health care, and have either praised or condemned the ACA on the basis of this alleged similarity. I challenge these observers on the grounds that they overlook critical problems with the Swiss model, such as its inequities in access, and critical differences between it and the ACA, such as the roots in, and continuing commitment to, social insurance of the Swiss model. Indeed, the daunting challenge of attempting to impose the tightly regulated model of operation of the Swiss model on mega-corporations like UnitedHealth, WellPoint, or Aetna is likely to trigger no less ferocious resistance than a fully public, single-payer system would. I also conclude that the ACA might unravel in ways unintended or even opposed by its designers and supporters, as employers, confronted with ever-rising costs, retreat from sponsoring insurance, and workers react in outrage as they confront the unaffordable underinsurance mandated by the ACA. A new political and ideological landscape may then ensue that finally ushers in a truly national health program.

Methodology for determining the investment attractiveness of construction of high-rise buildings

Science.gov (United States)

Nezhnikova, Ekaterina; Kashirin, Valentin; Davydova, Yana; Kazakova, Svetlana

2018-03-01

The article presents the analysis of the existing methods for assessing the investment attractiveness of high-rise construction. The authors determined and justified the primary choice of objects and territories that are the most attractive for the development of high-rise construction. A system of risk indicators has been developed that allow making a quantitative adjustment for a particular project in the evaluation of the efficiency of investment projects. The study is aimed at developing basic methodological concepts for a comparative evaluation of the prospects of construction of high-rise facilities that allow to take into consideration the features of investment in construction and to enable quantitative evaluation of the investment effectiveness in high-rise construction.

On the merging rates of envelope-deprived components of binary systems which can give rise to supernova events

Science.gov (United States)

Tornambe, Amedeo

1989-08-01

Theoretical rates of mergings of envelope-deprived components of binary systems, which can give rise to supernova events are described. The effects of the various assumptions on the physical properties of the progenitor system and of its evolutionary behavior through common envelope phases are discussed. Four cases have been analyzed: CO-CO, He-CO, He-He double degenerate mergings and He star-CO dwarf merging. It is found that, above a critical efficiency of the common envelope action in system shrinkage, the rate of CO-CO mergings is not strongly sensitive to the efficiency. Below this critical value, no CO-CO systems will survive for times larger than a few Gyr. In contrast, He-CO dwarf systems will continue to merge at a reasonable rate up to 20 Gyr, and more, also under extreme conditions.

Public health systems under attack in Canada: Evidence on public health system performance challenges arbitrary reform.

Science.gov (United States)

Guyon, Ak'ingabe; Perreault, Robert

2016-10-20

Public health is currently being weakened in several Canadian jurisdictions. Unprecedented and arbitrary cuts to the public health budget in Quebec in 2015 were a striking example of this. In order to support public health leaders and citizens in their capacity to advocate for evidence-informed public health reforms, we propose a knowledge synthesis of elements of public health systems that are significantly associated with improved performance. Research consistently and significantly associates four elements of public health systems with improved productivity: 1) increased financial resources, 2) increased staffing per capita, 3) population size between 50,000 and 500,000, and 4) specific evidence-based organizational and administrative features. Furthermore, increased financial resources and increased staffing per capita are significantly associated with improved population health outcomes. We contend that any effort at optimization of public health systems should at least be guided by these four evidence-informed factors. Canada already has existing capacity in carrying out public health systems and services research. Further advancement of our academic and professional expertise on public health systems will allow Canadian public health jurisdictions to be inspired by the best public health models and become stronger advocates for public health's resources, interventions and outcomes when they need to be celebrated or defended.

System health monitoring

International Nuclear Information System (INIS)

Reneke, J.A.; Fryer, M.O.

1995-01-01

Well designed large systems include many instrument taking data. These data are used in a variety of ways. They are used to control the system and its components, to monitor system and component health, and often for historical or financial purposes. This paper discusses a new method of using data from low level instrumentation to monitor system and component health. The method uses the covariance of instrument outputs to calculate a measure of system change. The method involves no complicated modeling since it is not a parameter estimation algorithm. The method is iterative and can be implemented on a computer in real time. Examples are presented for a metal lathe and a high efficiency particulate air (HEPA) filter. It is shown that the proposed method is quite sensitive to system changes such as wear out and failure. The method is useful for low level system diagnostics and fault detection

Regional approaches in high-rise construction

Science.gov (United States)

Iconopisceva, O. G.; Proskurin, G. A.

2018-03-01

The evolutionary process of high-rise construction is in the article focus. The aim of the study was to create a retrospective matrix reflecting the tasks of the study such as: structuring the most iconic high-rise objects within historic boundaries. The study is based on contemporary experience of high-rise construction in different countries. The main directions and regional specifics in the field of high-rise construction as well as factors influencing the further evolution process are analyzed. The main changes in architectural stylistics, form-building, constructive solutions that focus on the principles of energy efficiency and bio positivity of "sustainable buildings", as well as the search for a new typology are noted. The most universal constructive methods and solutions that turned out to be particularly popular are generalized. The new typology of high-rises and individual approach to urban context are noted. The results of the study as a graphical scheme made it possible to represent the whole high-rise evolution. The new spatial forms of high-rises lead them to new role within the urban environments. Futuristic hyperscalable concepts take the autonomous urban space functions itself and demonstrate us how high-rises can replace multifunctional urban fabric, developing it inside their shells.

Factors associated with high-rise evacuation: qualitative results from the World Trade Center Evacuation Study.

Science.gov (United States)

Gershon, Robyn R M; Qureshi, Kristine A; Rubin, Marcie S; Raveis, Victoria H

2007-01-01

Due to the fact that most high-rise structures (i.e., >75 feet high, or eight to ten stories) are constructed with extensive and redundant fire safety features, current fire safety procedures typically only involve limited evacuation during minor to moderate fire emergencies. Therefore, full-scale evacuation of high-rise buildings is highly unusual and consequently, little is known about how readily and rapidly high-rise structures can be evacuated fully. Factors that either facilitate or inhibit the evacuation process remain under-studied. This paper presents results from the qualitative phase of the World Trade Center Evacuation Study, a three-year, five-phase study designed to improve our understanding of the individual, organizational, and environmental factors that helped or hindered evacuation from the World Trade Center (WTC) Towers 1 and 2, on 11 September 2001. Qualitative data from semi-structured, in-depth interviews and focus groups involving WTC evacuees were collected and analyzed. On the individual level, factors that affected evacuation included perception of risk (formed largely by sensory cues), preparedness training, degree of familiarity with the building, physical condition, health status, and footwear. Individual behavior also was affected by group behavior and leadership. At the organizational level, evacuation was affected by worksite preparedness planning, including the training and education of building occupants, and risk communication. The environmental conditions affecting evacuation included smoke, flames, debris, general condition and degree of crowdedness on staircases, and communication infrastructure systems (e.g., public address, landline, cellular and fire warden's telephones). Various factors at the individual, organizational, and environmental levels were identified that affected evacuation. Interventions that address the barriers to evacuation may improve the full-scale evacuation of other high-rise buildings under extreme

Soil Structure Interaction Effect on High Rise and Low Rise Buildings

OpenAIRE

Divya Pathak; PAresh H. SHAH

2000-01-01

Effect of supporting soil on the response of structure has been analyzed in the present study. A low rise (G+ 5 storey) and a high rise (G+12 storey) building has been taken for the analysis. For both type of buildings, the response of building with and without consideration of soil structure interaction effect has been compared.Without interaction case is the case in which ends of the structure are assumed to be fixed while in interaction case, structure is assumed to be...

Health care quality, access, cost, workforce, and surgical education: the ultimate perfect storm.

Science.gov (United States)

Schwartz, Marshall Z

2012-01-01

The discussions on health care reform over the past two years have focused on cost containment while trying to maintain quality of care. Focusing on just cost and quality unfortunately does not address other very important factors that impact on our health care delivery system. Availability of a well-trained workforce, maintaining the sophisticated medical/surgical education system, and ultimately access to quality care by the public are critical to maintaining and enhancing our health care delivery system. Unfortunately, all five of these components are under at risk. Thus, we have evolving the ultimate perfect storm affecting our health care delivery system. Although not ideal and given the uniqueness of our population and their expectations, our current delivery system is excellent compared to other countries. However, the cost of our current system is rising at an alarming rate. Currently, health care consumes 17% of our gross domestic product. If our system is not revised this will continue to rise and by 2025 it will consume 48%. The dilemma, given the current state of our overall economy and rising debt, is how to address this major problem. Unfortunately, the Affordable Care Act, which is now law, does not address most of the issues and the cost was initially grossly under estimated. Furthermore, the law does not address the issues of workforce, maintaining our medical education system or ultimately, access. A major revision of our system will be necessary to truly create a system that protects and enhances all five of the components of our health care delivery system. To effectively accomplish this will require addressing those issues that lead to wasteful spending and diversion of our health care dollars to profit instead of care. Improved and efficient delivery systems that reduce complications, reduction of duplication of tertiary and quaternary programs or services within the same markets (i.e. regionalization of care), health insurance reform, and

Military Health System Transformation Implications on Health Information Technology Modernization.

Science.gov (United States)

Khan, Saad

2018-03-01

With the recent passage of the National Defense Authorization Act for Fiscal Year 2017, Congress has triggered groundbreaking Military Health System organizational restructuring with the Defense Health Agency assuming responsibility for managing all hospitals and clinics owned by the Army, Navy, and Air Force. This is a major shift toward a modern value-based managed care system, which will require much greater military-civilian health care delivery integration to be in place by October 2018. Just before the National Defense Authorization Act for Fiscal Year 2017 passage, the Department of Defense had already begun a seismic shift and awarded a contract for the new Military Health System-wide electronic health record system. In this perspective, we discuss the implications of the intersection of two large-scope and large-scale initiatives, health system transformation, and information technology modernization, being rolled out in the largest and most complex federal agency and potential risk mitigating steps. The Military Health System will require an expanded unified clinical leadership to spearhead short-term transformation; furthermore, developing, organizing, and growing a cadre of informatics expertise to expand the use and diffusion of novel solutions such as health information exchanges, data analytics, and others to transcend organizational barriers are still needed to achieve the long-term aim of health system reform as envisioned by the National Defense Authorization Act for Fiscal Year 2017.

Construction of high-rise building with underground parking in Moscow

Directory of Open Access Journals (Sweden)

Ilyichev Vyacheslav

2018-01-01

Full Text Available Paper presents results of scientific support to construction of unique residential building 108 m high with one storey underground part under high-rise section and 3-storey underground parking connected by underground passage. On-site soils included anthropogenic soil, clayey soils soft-stiff, saturated sands of varied grain coarseness. Design of retaining structure and support system for high-rise part excavation was developed. It suggested installation of steel pipes and struts. Construction of adjacent 3-storey underground parking by “Moscow method” is described in the paper. This method involves implementation of retaining wall consisted of prefabricated panels, truss structures (used as struts and reinforced concrete slabs. Also design and construction technology is provided for foundations consisted of bored piles 800 MM in diameter joined by slab with base widening diameter of 1500 MM. Experiment results of static and dynamic load testing (ELDY method are considered. Geotechnical monitoring data of adjacent building and utility systems settlement caused by construction of presented high-rise building were compared to numerical modelling results, predicted and permissible values.

Construction of high-rise building with underground parking in Moscow

Science.gov (United States)

Ilyichev, Vyacheslav; Nikiforova, Nadezhda; Konnov, Artem

2018-03-01

Paper presents results of scientific support to construction of unique residential building 108 m high with one storey underground part under high-rise section and 3-storey underground parking connected by underground passage. On-site soils included anthropogenic soil, clayey soils soft-stiff, saturated sands of varied grain coarseness. Design of retaining structure and support system for high-rise part excavation was developed. It suggested installation of steel pipes and struts. Construction of adjacent 3-storey underground parking by "Moscow method" is described in the paper. This method involves implementation of retaining wall consisted of prefabricated panels, truss structures (used as struts) and reinforced concrete slabs. Also design and construction technology is provided for foundations consisted of bored piles 800 MM in diameter joined by slab with base widening diameter of 1500 MM. Experiment results of static and dynamic load testing (ELDY method) are considered. Geotechnical monitoring data of adjacent building and utility systems settlement caused by construction of presented high-rise building were compared to numerical modelling results, predicted and permissible values.

Applications of network analysis for adaptive management of artificial drainage systems in landscapes vulnerable to sea level rise

Science.gov (United States)

Poulter, Benjamin; Goodall, Jonathan L.; Halpin, Patrick N.

2008-08-01

SummaryThe vulnerability of coastal landscapes to sea level rise is compounded by the existence of extensive artificial drainage networks initially built to lower water tables for agriculture, forestry, and human settlements. These drainage networks are found in landscapes with little topographic relief where channel flow is characterized by bi-directional movement across multiple time-scales and related to precipitation, wind, and tidal patterns. The current configuration of many artificial drainage networks exacerbates impacts associated with sea level rise such as salt-intrusion and increased flooding. This suggests that in the short-term, drainage networks might be managed to mitigate sea level rise related impacts. The challenge, however, is that hydrologic processes in regions where channel flow direction is weakly related to slope and topography require extensive parameterization for numerical models which is limited where network size is on the order of a hundred or more kilometers in total length. Here we present an application of graph theoretic algorithms to efficiently investigate network properties relevant to the management of a large artificial drainage system in coastal North Carolina, USA. We created a digital network model representing the observation network topology and four types of drainage features (canal, collector and field ditches, and streams). We applied betweenness-centrality concepts (using Dijkstra's shortest path algorithm) to determine major hydrologic flowpaths based off of hydraulic resistance. Following this, we identified sub-networks that could be managed independently using a community structure and modularity approach. Lastly, a betweenness-centrality algorithm was applied to identify major shoreline entry points to the network that disproportionately control water movement in and out of the network. We demonstrate that graph theory can be applied to solving management and monitoring problems associated with sea level rise

Health-system reform and universal health coverage in Latin America.

Science.gov (United States)

Atun, Rifat; de Andrade, Luiz Odorico Monteiro; Almeida, Gisele; Cotlear, Daniel; Dmytraczenko, T; Frenz, Patricia; Garcia, Patrícia; Gómez-Dantés, Octavio; Knaul, Felicia M; Muntaner, Carles; de Paula, Juliana Braga; Rígoli, Felix; Serrate, Pastor Castell-Florit; Wagstaff, Adam

2015-03-28

Starting in the late 1980s, many Latin American countries began social sector reforms to alleviate poverty, reduce socioeconomic inequalities, improve health outcomes, and provide financial risk protection. In particular, starting in the 1990s, reforms aimed at strengthening health systems to reduce inequalities in health access and outcomes focused on expansion of universal health coverage, especially for poor citizens. In Latin America, health-system reforms have produced a distinct approach to universal health coverage, underpinned by the principles of equity, solidarity, and collective action to overcome social inequalities. In most of the countries studied, government financing enabled the introduction of supply-side interventions to expand insurance coverage for uninsured citizens--with defined and enlarged benefits packages--and to scale up delivery of health services. Countries such as Brazil and Cuba introduced tax-financed universal health systems. These changes were combined with demand-side interventions aimed at alleviating poverty (targeting many social determinants of health) and improving access of the most disadvantaged populations. Hence, the distinguishing features of health-system strengthening for universal health coverage and lessons from the Latin American experience are relevant for countries advancing universal health coverage. Copyright © 2015 Elsevier Ltd. All rights reserved.

Health Care Spending: Changes in the Perceptions of the Australian Public.

Directory of Open Access Journals (Sweden)

Jane Robertson

Full Text Available Increasing demand for services and rising health care costs create pressures within the Australian health care system and result in higher health insurance premiums and out-of-pocket costs for consumers.To measure changes in consumer views on the quality of the Australian health care system, contributors to rising costs and attitudes towards managing these costs.Two computer-assisted telephone interviews were conducted in 2006 (533 respondents and 2015 (1318 respondents and results compared.More respondents in 2015 rated the Australian health care system 'very adequate' than in 2006 (22.3% vs 8.3%; Odds Ratio OR 3.2, 99% CI 2.1, 5.1 with fewer 'concerned' or 'fairly concerned' about the health care costs (69.0% vs 85.7%; OR 0.37, 99% CI 0.25, 0.53. The 2015 respondents were more likely to identify new treatments for cancer (77% vs 65.7%; OR 1.75, 99% CI 1.30, 2.35 and community expectations for access to the latest technologies (73.8% vs 67%; OR 1.39, 99% CI 1.04, 1.86 as contributors to rising health care costs. While more 2015 respondents agreed that patients should pay a greater part of the health care costs, this remained a minority view (37.9% vs 31.7%; OR 1.32, 99% CI 0.99, 1.76. They were less likely to agree that doctors should offer medical treatments regardless of the cost and chance of benefit (63.6% vs 82.9%; OR 0.36, 99% CI 0.25, 0.50.Satisfaction with the Australian health care system has increased over time. Consumers recognise the cost pressures and have lower expectations that all services should be provided regardless of their costs and potential benefit. Public consultation on the allocation of health care resources and involvement in health care decision-making remains important. There should be community consultation about the principles and values that should guide resource allocation decisions.

Health Care Spending: Changes in the Perceptions of the Australian Public.

Science.gov (United States)

Robertson, Jane; Newby, David A; Walkom, Emily J

2016-01-01

Increasing demand for services and rising health care costs create pressures within the Australian health care system and result in higher health insurance premiums and out-of-pocket costs for consumers. To measure changes in consumer views on the quality of the Australian health care system, contributors to rising costs and attitudes towards managing these costs. Two computer-assisted telephone interviews were conducted in 2006 (533 respondents) and 2015 (1318 respondents) and results compared. More respondents in 2015 rated the Australian health care system 'very adequate' than in 2006 (22.3% vs 8.3%; Odds Ratio OR 3.2, 99% CI 2.1, 5.1) with fewer 'concerned' or 'fairly concerned' about the health care costs (69.0% vs 85.7%; OR 0.37, 99% CI 0.25, 0.53). The 2015 respondents were more likely to identify new treatments for cancer (77% vs 65.7%; OR 1.75, 99% CI 1.30, 2.35) and community expectations for access to the latest technologies (73.8% vs 67%; OR 1.39, 99% CI 1.04, 1.86) as contributors to rising health care costs. While more 2015 respondents agreed that patients should pay a greater part of the health care costs, this remained a minority view (37.9% vs 31.7%; OR 1.32, 99% CI 0.99, 1.76). They were less likely to agree that doctors should offer medical treatments regardless of the cost and chance of benefit (63.6% vs 82.9%; OR 0.36, 99% CI 0.25, 0.50). Satisfaction with the Australian health care system has increased over time. Consumers recognise the cost pressures and have lower expectations that all services should be provided regardless of their costs and potential benefit. Public consultation on the allocation of health care resources and involvement in health care decision-making remains important. There should be community consultation about the principles and values that should guide resource allocation decisions.

The Netherlands: health system review

NARCIS (Netherlands)

Schäfer, W.; Kroneman, M.; Boerma, W.; van den Berg, M.; Westert, G.; Devillé, W.; van Ginneken, E.

2010-01-01

The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of health systems and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of

Introduction on health recommender systems.

Science.gov (United States)

Sanchez-Bocanegra, C L; Sanchez-Laguna, F; Sevillano, J L

2015-01-01

People are looking for appropriate health information which they are concerned about. The Internet is a great resource of this kind of information, but we have to be careful if we don't want to get harmful info. Health recommender systems are becoming a new wave for apt health information as systems suggest the best data according to the patients' needs.The main goals of health recommender systems are to retrieve trusted health information from the Internet, to analyse which is suitable for the user profile and select the best that can be recommended, to adapt their selection methods according to the knowledge domain and to learn from the best recommendations.A brief definition of recommender systems will be given and an explanation of how are they incorporated in the health sector. A description of the main elementary recommender methods as well as their most important problems will also be made. And, to finish, the state of the art will be described.

Medical dominance in Canada in historical perspective: the rise and fall of medicine?

Science.gov (United States)

Coburn, D; Torrance, G M; Kaufert, J M

1983-01-01

Freidson's concept of medical dominance is compared to the alternative conceptions of neo-Marxist writers. Dominance is then examined in historical perspective, using medicine in Canada (mainly Ontario) as a case study. Medicine emerged as the dominant health occupation in Canada in the late 19th and early 20th centuries, consolidating its power between World War I and the Saskatchewan doctors' strike of 1962. The authors argue that medical dominance has declined since that time due to such factors as the involvement of the state in health insurance, the rise of other health occupations, increasing public or at least elite skepticism, and possible internal fragmentation. The underlying social explanation for this historical process is sought in changes in the Canadian class structure, specifically the spread of the capitalist mode of production, the decline of the petite bourgeoisie, and the rise of the state. It is suggested that Freidson's specific accounts of the history of medicine must be incorporated for explanatory purposes within the broader neo-Marxist view of medicine as an intermediary rather than an ultimately determining institution.

Analysis of uncertainties in CRAC2 calculations: wet deposition and plume rise

International Nuclear Information System (INIS)

Ward, R.C.; Kocher, D.C.; Hicks, B.B.; Hosker, R.P. Jr.; Ku, J.Y.; Rao, K.S.

1984-01-01

We have studied the sensitivity of results from the CRAC2 computer code, which predicts health impacts from a reactor-accident scenario, to uncertainties in selected meteorological models and parameters. The sources of uncertainty examined include the models for plume rise and wet deposition and the meteorological bin-sampling procedure. An alternative plume-rise model usually had little effect on predicted health impacts. In an alternative wet-deposition model, the scavenging rate depends only on storm type, rather than on rainfall rate and atmospheric stability class as in the CRAC2 model. Use of the alternative wet-deposition model in meteorological bin-sampling runs decreased predicted mean early injuries by as much as a factor of 2 to 3 and, for large release heights and sensible heat rates, decreased mean early fatalities by nearly an order of magnitude. The bin-sampling procedure in CRAC2 was expanded by dividing each rain bin into four bins that depend on rainfall rate. Use of the modified bin structure in conjunction with the CRAC2 wet-deposition model changed all predicted health impacts by less than a factor of 2. 9 references

eHealth Policy

CERN Document Server

Capello, Fabio

2014-01-01

The rising of a new technological era has brought within it opportunities and threats the health systems worldwide have to deal with. In such a changed scenario the role of decision-makers is crucial to identify the real and perceived needs of the population and those areas on intervention in which eHealth can help to improve the quality and efficacy of care. Therefore, in-depth analysis of the state of the art both in industrialized and in developing countries is paramount. Many in fact are constraints that mine the designing and implementation of electronic systems for health. Only if policymakers understand the real implication of eHealth and the complexities of the human being, working model could be introduced. Otherwise the systems proposed will follow the same schemes that have produced failures so far. It implies also that the mutated role of the patient had to be known, together with his expectations and needs. Nevertheless, in a globalize world, a policy for eHealth have to consider also those facto...

Near Surface Geophysical Methods Applied to the Rising Star Cave System

Science.gov (United States)

Webb, S. J.; Naidoo, M.; Elliott, M. C.; Kruger, A.; Roberts, E.; Dirks, P.

2017-12-01

The Rising Star Cave system is located approximately 40 km northwest of Johannesburg in the Malmani dolomites (Chuniespoort group,Transvaal Supergroup). The cave system is extensive with 4 km of mapped passages and chambers. The Dinaledi chamber, host to the Homo Naledi fossils, is reached by following a tortuous route with squeezes as small as 20 cm. The chamber is located 30 m below surface and 80 m from the entrance. The enigmatic find of fossils from at least 15 individual hominins, without the presence of other species, led to the idea of deliberate burial. The present access route is difficult and it is unclear how early hominins were able to navigate it, prompting the suggestion of an undiscovered entrance. We are using near surface geophysical methods to investigate possible connections between the surface and the caves. Using a Geometrics Cs-vapor Walkmag, we collected preliminary ground magnetic intensity measurements over a region 300 m x 200 m, using 1 m station spacing and 10 m line spacing. The average magnetic variation along line is 200 nT. We also collected over 100 susceptibility measurements on outcropping lithologies, surface soil and cave sediments using a SM-30 susceptibility meter. The surface soil was one to two orders of magnitude higher than surrounding lithologies (average = 1.5 x 10-3 SI) and the cave sediment samples were slightly higher (average = 3.07 x 10-3 SI). We were able to collect GPR data (GSSI SIR-3000, 400 MHz) in selected spots on the cave floor with the goal of locating the cave floor beneath the sediments. Dolomites usually have low magnetic susceptibilities, but erosion products of the nearby magnetic Hospital Hill or Rooihoogte shales may have been transported into or onto the cave system. This is a likely cause of the magnetic anomalies and larger amplitude anomalies may indicate an accumulation of sediments, extending to depth. These anomalies will be further investigated using gravity to determine if there are

State strategies of governance in biomedical innovation: aligning conceptual approaches for understanding 'Rising Powers' in the global context

Directory of Open Access Journals (Sweden)

Faulkner Alex

2011-02-01

Full Text Available Abstract Background 'Innovation' has become a policy focus in its own right in many states as they compete to position themselves in the emerging knowledge economies. Innovation in biomedicine is a global enterprise in which 'Rising Power' states figure prominently, and which undoubtedly will re-shape health systems and health economies globally. Scientific and technological innovation processes and policies raise difficult issues in the domains of science/technology, civil society, and the economic and healthcare marketplace. The production of knowledge in these fields is complex, uncertain, inter-disciplinary and inter-institutional, and subject to a continuing political struggle for advantage. As part of this struggle, a wide variety of issues - regulation, intellectual property, ethics, scientific boundaries, healthcare market formation - are raised and policy agendas negotiated. Methods A range of social science disciplines and approaches have conceptualised such innovation processes. Against a background of concepts such as the competition state and the developmental state, and national innovation systems, we give an overview of a range of approaches that have potential for advancing understanding of governance of global life science and biomedical innovation, with special reference to the 'Rising Powers', in order to examine convergences and divergences between them. Conceptual approaches that we focus on include those drawn from political science/political economy, sociology of technology; Innovation Studies and Science & Technology Studies. The paper is part of a project supported by the UK ESRC's Rising Powers programme. Results We show convergences and complementarities between the approaches discussed, and argue that the role of the national state itself has become relatively neglected in much of the relevant theorising. Conclusions We conclude that an approach is required that enables innovation and governance to be seen as 'co

State strategies of governance in biomedical innovation: aligning conceptual approaches for understanding 'Rising Powers' in the global context

Science.gov (United States)

2011-01-01

Background 'Innovation' has become a policy focus in its own right in many states as they compete to position themselves in the emerging knowledge economies. Innovation in biomedicine is a global enterprise in which 'Rising Power' states figure prominently, and which undoubtedly will re-shape health systems and health economies globally. Scientific and technological innovation processes and policies raise difficult issues in the domains of science/technology, civil society, and the economic and healthcare marketplace. The production of knowledge in these fields is complex, uncertain, inter-disciplinary and inter-institutional, and subject to a continuing political struggle for advantage. As part of this struggle, a wide variety of issues - regulation, intellectual property, ethics, scientific boundaries, healthcare market formation - are raised and policy agendas negotiated. Methods A range of social science disciplines and approaches have conceptualised such innovation processes. Against a background of concepts such as the competition state and the developmental state, and national innovation systems, we give an overview of a range of approaches that have potential for advancing understanding of governance of global life science and biomedical innovation, with special reference to the 'Rising Powers', in order to examine convergences and divergences between them. Conceptual approaches that we focus on include those drawn from political science/political economy, sociology of technology; Innovation Studies and Science & Technology Studies. The paper is part of a project supported by the UK ESRC's Rising Powers programme. Results We show convergences and complementarities between the approaches discussed, and argue that the role of the national state itself has become relatively neglected in much of the relevant theorising. Conclusions We conclude that an approach is required that enables innovation and governance to be seen as 'co-producing' each other in a multi

Health information systems to improve health care: A telemedicine case study

Directory of Open Access Journals (Sweden)

Liezel Cilliers

2013-03-01

Full Text Available Background: E-health has been identified as an integral part of the future of South African public healthcare. Telemedicine was first introduced in South Africa in 1997 and since then the cost of running the Telemedicine projects has increased substantially. Despite these efforts to introduce the system, only 34% of the Telemedicine sites in South Africa are functional at present. Objectives: Literature has suggested that one of the barriers to the successful implementation of health information systems is the user acceptance by health care workers of systems such as Telemedicine. This study investigated the user acceptance of Telemedicine in the public health care system in the Eastern Cape Province, making use of the Unified Theory of the Use and Acceptance of Technology. Method: The study employed a quantitative survey approach. A questionnaire was developed making use of existing literature and was distributed to various clinics around the province where Telemedicine has been implemented. Statistics were produced making use of Statistical Package for the Social Sciences (SPSS. Results: In general, the health care workers did understand the value and benefit of health information systems to improve the effectiveness and efficiency of the health care system. The barriers to the effective implementation of a health information system include the lack of knowledge and the lack of awareness regarding the Telemedicine system. This in turn means that the user is apprehensive when making use of the system thus contributing to less frequent usage. Conclusion: Health care workers do acknowledge that information systems can help to increase the effectiveness of the health care system. In general, the acceptance of Telemedicine in the Eastern Cape Department of Health is positive, but in order to integrate it into standard work practices, more must be done with regards to the promotion and education of telemedicine.

Effects of sea-level rise on barrier island groundwater system dynamics: ecohydrological implications

Science.gov (United States)

Masterson, John P.; Fienen, Michael N.; Thieler, E. Robert; Gesch, Dean B.; Gutierrez, Benjamin T.; Plant, Nathaniel G.

2014-01-01

We used a numerical model to investigate how a barrier island groundwater system responds to increases of up to 60 cm in sea level. We found that a sea-level rise of 20 cm leads to substantial changes in the depth of the water table and the extent and depth of saltwater intrusion, which are key determinants in the establishment, distribution and succession of vegetation assemblages and habitat suitability in barrier islands ecosystems. In our simulations, increases in water-table height in areas with a shallow depth to water (or thin vadose zone) resulted in extensive groundwater inundation of land surface and a thinning of the underlying freshwater lens. We demonstrated the interdependence of the groundwater response to island morphology by evaluating changes at three sites. This interdependence can have a profound effect on ecosystem composition in these fragile coastal landscapes under long-term changing climatic conditions.

The role of health system governance in strengthening the rural health insurance system in China.

Science.gov (United States)

Yuan, Beibei; Jian, Weiyan; He, Li; Wang, Bingyu; Balabanova, Dina

2017-05-23

Systems of governance play a key role in the operation and performance of health systems. In the past six decades, China has made great advances in strengthening its health system, most notably in establishing a health insurance system that enables residents of rural areas to achieve access to essential services. Although there have been several studies of rural health insurance schemes, these have focused on coverage and service utilization, while much less attention has been given to the role of governance in designing and implementing these schemes. Information from publications and policy documents relevant to the development of two rural health insurance policies in China was obtained, analysed, and synthesise. 92 documents on CMS (Cooperative Medical Scheme) or NCMS (New Rural Cooperative Medical Scheme) from four databases searched were included. Data extraction and synthesis of the information were guided by a framework that drew on that developed by the WHO to describe health system governance and leadership. We identified a series of governance practices that were supportive of progress, including the prioritisation by the central government of health system development and certain health policies within overall national development; strong government commitment combined with a hierarchal administrative system; clear policy goals coupled with the ability for local government to adopt policy measures that take account of local conditions; and the accumulation and use of the evidence generated from local practices. However these good practices were not seen in all governance domains. For example, poor collaboration between different government departments was shown to be a considerable challenge that undermined the operation of the insurance schemes. China's success in achieving scale up of CMS and NCMS has attracted considerable interest in many low and middle income countries (LMICs), especially with regard to the schemes' designs, coverage, and funding

Global Health Governance Challenges 2016 - Are We Ready?

Science.gov (United States)

Kickbusch, Ilona

2016-02-29

The year 2016 could turn out to be a turning point for global health, new political realities and global insecurities will test governance and financing mechanisms in relation to both people and planet. But most importantly political factors such as the global power shift and "the rise of the rest" will define the future of global health. A new mix of health inequity and security challenges has emerged and the 2015 humanitarian and health crises have shown the limits of existing systems. The global health as well as the humanitarian system will have to prove their capacity to respond and reform. The challenge ahead is deeply political, especially for the rising political actors. They are confronted with the consequences of a model of development that has neglected sustainability and equity, and was built on their exploitation. Some direction has been given by the path breaking international conferences in 2015. Especially the agreement on the Sustainable Development Goals (SDGs) and the Paris agreement on climate change will shape action. Conceptually, we will need a different understanding of global health and its ultimate goals - the health of people can no longer be seen separate from the health of the planet and wealth measured by parameters of growth will no longer ensure health. © 2016 by Kerman University of Medical Sciences.

77 FR 26280 - Patient Safety Organizations: Voluntary Relinquishment From CareRise LLC

Science.gov (United States)

2012-05-03

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety... relinquishment from CareRise LLC of its status as a Patient Safety Organization (PSO). The Patient Safety and Quality Improvement Act of 2005 (Patient Safety Act) authorizes the listing of PSOs, which are entities or...

E-health, health systems and social innovation

DEFF Research Database (Denmark)

Brem, Alexander; Sliwa, Sophie Isabel; Agarwal, Nivedita

2017-01-01

This paper explores telecare as one of the practical applications in the field of e-health. Using 11 expert interviews the study evaluates development of cross-national analogies between the different institutional contexts of health systems in Germany, Austria, and Denmark. Telecare is treated a...... to be driving socially innovative solutions. Implications for research and practice, as well as future research directions, are elaborated....... as a set of ideas regarding future processes in health and home care services, involving technological solutions, starting to change stakeholders' behaviour, work practices, and social roles. A system-centric framework is proposed to evaluate the interdependencies between telecare, the changing...

Distribution of flexural deflection in the worldwide outer rise area

Science.gov (United States)

Lin, Zi-Jun; Lin, Jing-Yi; Lin, Yi-Chin; Chin, Shao-Jinn; Chen, Yen-Fu

2015-04-01

The outer rise on the fringe of a subduction system is caused by an accreted load on the flexed oceanic lithosphere. The magnitude of the deflection is usually linked to the stress state beard by the oceanic plate. In a coupled subduction zone, the stress is abundantly accumulated across the plate boundary which should affect the flexural properties of the subducted plate. Thus, the variation of the outer rise in shape may reflect the seismogenic characteristics of the subduction system. In this study, we intent to find the correlation between the flexure deflection (Wb) of the outer rise and the subduction zone properties by comparing several slab parameters and the Wb distribution. The estimation of Wb is performed based on the available bathymetry data and the statistic analysis of earthquakes is from the global ISC earthquake catalog for the period of 1900-2015. Our result shows a progressive change of Wb in space, suggesting a robust calculation. The average Wb of worldwise subduction system spreads from 348 to 682 m. No visible distinction in the ranging of Wb was observed for different subduction zones. However, in a weak coupling subduction system, the standard variation of Wb has generally larger value. Relatively large Wb generally occurs in the center of the trench system, whereas small Wb for the two ends of trench. The comparison of Wb and several slab parameters shows that the Wb may be correlated with the maximal magnitude and the number of earthquakes. Otherwise, no clear relationship with other parameters can be obtained.

High-rise architecture in Ufa, Russia, based on crystallography canons

Science.gov (United States)

Narimanovich Sabitov, Ildar; Radikovna Kudasheva, Dilara; Yaroslavovich Vdovin, Denis

2018-03-01

The article considers fundamental steps of high-rise architecture forming stylistic tendencies, based on C. Willis and M. A. Korotich's studies. Crystallographic shaping as a direction is assigned on basis of classification by M. A. Korotich's. This direction is particularly examined and the main high-rise architecture forming aspects on basis of natural polycrystals forming principles are assigned. The article describes crystal forms transformation into an architectural composition, analyzes constructive systems within the framework of CTBUH (Council on Tall Buildings and Urban Habitat) classification, and picks out one of its types as the most optimal for using in buildings-crystals. The last stage of our research is the theoretical principles approbation into an experimental project of high-rise building in Ufa with the description of its contextual dislocation aspects.

Embedded Sensor Systems for Health - A Step Towards Personalized Health.

Science.gov (United States)

Lindén, Maria; Björkman, Mats

2018-01-01

The demography is changing towards older people, and the challenge to provide an appropriate care is well known. Sensor systems, combined with IT solutions are recognized as one of the major tools to handle this situation. Embedded Sensor Systems for Health (ESS-H) is a research profile at Mälardalen University in Sweden, focusing on embedded sensor systems for health technology applications. The research addresses several important issues: to provide sensor systems for health monitoring at home, to provide sensor systems for health monitoring at work, to provide safe and secure infrastructure and software testing methods for physiological data management. The user perspective is important in order to solve real problems and to develop systems that are easy and intuitive to use. One of the overall aims is to enable health trend monitoring in home environments, thus being able to detect early deterioration of a patient. Sensor systems, signal processing algorithms, and decision support algorithms have been developed. Work on development of safe and secure infrastructure and software testing methods are important for an embedded sensor system aimed for health monitoring, both in home and in work applications. Patient data must be sent and received in a safe and secure manner, also fulfilling the integrity criteria.

Systemic antioxidants and skin health.

Science.gov (United States)

Nguyen, Gloria; Torres, Abel

2012-09-01

Most dermatologists agree that antioxidants help fight free radical damage and can help maintain healthy skin. They do so by affecting intracellular signaling pathways involved in skin damage and protecting against photodamage, as well as preventing wrinkles and inflammation. In today's modern world of the rising nutraceutical industry, many people, in addition to applying topical skin care products, turn to supplementation of the nutrients missing in their diets by taking multivitamins or isolated, man-made nutraceuticals, in what is known as the Inside-Out approach to skin care. However, ingestion of large quantities of isolated, fragmented nutrients can be harmful and is a poor representation of the kind of nutrition that can be obtained from whole food sources. In this comprehensive review, it was found that few studies on oral antioxidants benefiting the skin have been done using whole foods, and that the vast majority of current research is focused on the study of compounds in isolation. However, the public stands to benefit greatly if more research were to be devoted toward the impact that physiologic doses of antioxidants (obtained from fruits, vegetables, and whole grains) can have on skin health, and on health in general.

Environmental health surveillance system; Kankyo hoken surveillance system

Energy Technology Data Exchange (ETDEWEB)

Ono, M. [National Inst. for Environmental Studies, Tsukuba (Japan)

1998-02-01

The Central Environmental Pollution Prevention Council pointed out the necessity to establish an environmental health surveillance system (hereinafter referred to as System) in its report `on the first type district specified by the Environmental Pollution Caused Health Damages Compensation Act,` issued in 1986. A study team, established in Environment Agency, has been discussing to establish System since 1986. This paper outlines System, and some of the pilot surveillance results. It is not aimed at elucidation of the cause-effect relationships between health and air pollution but at discovery of problems, in which the above relationships in a district population are monitored periodically and continuously from long-term and prospective viewpoints, in order to help take necessary measures in the early stage. System is now collecting the data of the chronic obstructive lung diseases on a nation-wide scale through health examinations of 3-year-old and preschool children and daily air pollution monitoring. 6 refs., 3 figs., 1 tab.

Governance of Health Systems Comment on “A Network Based Theory of Health Systems and Cycles of Well-Being”

OpenAIRE

Blanchet, Karl

2013-01-01

Health systems research aims to understand the governance of health systems (i.e. how health systems function and perform and how their actors interact with each other). This can be achieved by applying innovative methodologies and concepts that are going to capture the complexity and dynamics of health systems when they are affected by shocks. The capacity of health systems to adapt to shocks (i.e. the resilience of health systems) is a new area of investigation. Social network analysis is a...

The right to health, health systems development and public health policy challenges in Chad.

Science.gov (United States)

Azétsop, Jacquineau; Ochieng, Michael

2015-02-15

There is increasing consensus that the right to health can provide ethical, policy and practical groundings for health systems development. The goals of the right to health are congruent with those of health systems development, which are about strengthening health promotion organizations and actions so as to improve public health. The poor shape and performance of health systems in Chad question the extent of realization of the right to health. Due to its comprehensiveness and inclusiveness, the right to health has the potential of being an organizational and a normative backbone for public health policy and practice. It can then be understood and studied as an integral component of health systems development. This paper uses a secondary data analysis of existing documents by the Ministry of Public Health, Institut National de la Statistique, des Etudes Economiques et Démographiques (INSEED), the Ministry of Economy and Agence Française de Cooperation to analyze critically the shape and performance of health systems in Chad based on key concepts and components of the right to health contained in article 12 of the International Covenant on Economic, Social and Cultural Rights, and on General Comment 14. The non-realization of the right to health, even in a consistently progressive manner, raises concerns about the political commitment of state officials to public health, about the justice of social institutions in ensuring social well-being and about individual and public values that shape decision-making processes. Social justice, democratic rule, transparency, accountability and subsidiarity are important groundings for ensuring community participation in public affairs and for monitoring the performance of public institutions. The normative ideals of health systems development are essentially democratic in nature and are rooted in human rights and in ethical principles of human dignity, equality, non-discrimination and social justice. These ideals are grounded

Modeling vegetation community responses to sea-level rise on Barrier Island systems: A case study on the Cape Canaveral Barrier Island complex, Florida, USA.

Directory of Open Access Journals (Sweden)

Tammy E Foster

Full Text Available Society needs information about how vegetation communities in coastal regions will be impacted by hydrologic changes associated with climate change, particularly sea level rise. Due to anthropogenic influences which have significantly decreased natural coastal vegetation communities, it is important for us to understand how remaining natural communities will respond to sea level rise. The Cape Canaveral Barrier Island complex (CCBIC on the east central coast of Florida is within one of the most biologically diverse estuarine systems in North America and has the largest number of threatened and endangered species on federal property in the contiguous United States. The high level of biodiversity is susceptible to sea level rise. Our objective was to model how vegetation communities along a gradient ranging from hydric to upland xeric on CCBIC will respond to three sea level rise scenarios (0.2 m, 0.4 m, and 1.2 m. We used a probabilistic model of the current relationship between elevation and vegetation community to determine the impact sea level rise would have on these communities. Our model correctly predicted the current proportions of vegetation communities on CCBIC based on elevation. Under all sea level rise scenarios the model predicted decreases in mesic and xeric communities, with the greatest losses occurring in the most xeric communities. Increases in total area of salt marsh were predicted with a 0.2 and 0.4 m rise in sea level. With a 1.2 m rise in sea level approximately half of CCBIC's land area was predicted to transition to open water. On the remaining land, the proportions of most of the vegetation communities were predicted to remain similar to that of current proportions, but there was a decrease in proportion of the most xeric community (oak scrub and an increase in the most hydric community (salt marsh. Our approach provides a first approximation of the impacts of sea level rise on terrestrial vegetation communities

Modeling vegetation community responses to sea-level rise on Barrier Island systems: A case study on the Cape Canaveral Barrier Island complex, Florida, USA.

Science.gov (United States)

Foster, Tammy E; Stolen, Eric D; Hall, Carlton R; Schaub, Ronald; Duncan, Brean W; Hunt, Danny K; Drese, John H

2017-01-01

Society needs information about how vegetation communities in coastal regions will be impacted by hydrologic changes associated with climate change, particularly sea level rise. Due to anthropogenic influences which have significantly decreased natural coastal vegetation communities, it is important for us to understand how remaining natural communities will respond to sea level rise. The Cape Canaveral Barrier Island complex (CCBIC) on the east central coast of Florida is within one of the most biologically diverse estuarine systems in North America and has the largest number of threatened and endangered species on federal property in the contiguous United States. The high level of biodiversity is susceptible to sea level rise. Our objective was to model how vegetation communities along a gradient ranging from hydric to upland xeric on CCBIC will respond to three sea level rise scenarios (0.2 m, 0.4 m, and 1.2 m). We used a probabilistic model of the current relationship between elevation and vegetation community to determine the impact sea level rise would have on these communities. Our model correctly predicted the current proportions of vegetation communities on CCBIC based on elevation. Under all sea level rise scenarios the model predicted decreases in mesic and xeric communities, with the greatest losses occurring in the most xeric communities. Increases in total area of salt marsh were predicted with a 0.2 and 0.4 m rise in sea level. With a 1.2 m rise in sea level approximately half of CCBIC's land area was predicted to transition to open water. On the remaining land, the proportions of most of the vegetation communities were predicted to remain similar to that of current proportions, but there was a decrease in proportion of the most xeric community (oak scrub) and an increase in the most hydric community (salt marsh). Our approach provides a first approximation of the impacts of sea level rise on terrestrial vegetation communities, including important

Hawaii's public mental health system.

Science.gov (United States)

VanderVoort, Debra J

2005-03-01

The following article addresses the nature of and problems with the public mental health system in Hawaii. It includes a brief history of Hawaii's public mental health system, a description and analysis of this system, economic factors affecting mental health, as well as a needs assessment of the elderly, individuals with severe mental illness, children and adolescents, and ethnically diverse individuals. In addition to having the potential to increase suicide rates and unnecessarily prolong personal suffering, problems in the public mental health system such as inadequate services contribute to an increase in social problems including, but not limited to, an increase in crime rates (e.g., domestic violence, child abuse), divorce rates, school failure, and behavioral problems in children. The population in need of mental health services in Hawaii is under served, with this inadequacy of services due to economic limitations and a variety of other factors.

[eHealth in Peru: implementation of policies to strengthen health information systems].

Science.gov (United States)

Curioso, Walter H

2014-01-01

Health information systems play a key role in enabling high quality, complete health information to be available in a timely fashion for operational and strategic decision-making that makes it possible to save lives and improve the health and quality of life of the population. In many countries, health information systems are weak, incomplete, and fragmented. However, there is broad consensus in the literature of the need to strengthen health information systems in countries around the world. The objective of this paper is to present the essential components of the conceptual framework to strengthen health information systems in Peru. It describes the principal actions and strategies of the Ministry of Health of Peru during the process of strengthening health information systems. These systems make it possible to orient policies for appropriate decision-making in public health.

Measuring health indicators and allocating health resources: a DEA-based approach.

Science.gov (United States)

Yang, Chih-Ching

2016-02-03

This paper suggests new empirical DEA models for the measurement of health indicators and the allocation of health resources. The proposed models were developed by first suggesting a population-based health indicator. By introducing the suggested indicator into DEA models, a new approach that solves the problem of health resource allocation has been developed. The proposed models are applied to an empirical study of Taiwan's health system. Empirical findings show that the suggested indicator can successfully accommodate the differences in health resource demands between populations, providing more reliable performance information than traditional indicators such as physician density. Using our models and a commonly used allocation mechanism, capitation, to allocate medical expenditures, it is found that the proposed model always obtains higher performance than those derived from capitation, and the superiority increases as allocated expenditures rise.

Development of a fast rise-time, high-voltage pulse generator

International Nuclear Information System (INIS)

Zhang Yanxia; Zhu Jie; Li Xianyou

2006-01-01

In order to test the attenuation of the system, a fast rise-time, high-voltage pulse generator is required for the fast pulse signal measurement. The paper presents the development of the generator. More emphasis is paid on the discussion of the difficulties occurring in the circuit debugging and their resolutions. The output rise-time of the generator is 700 ps, the amplitude is adjustable in the range of 0 to 500 V, the pulse-width is adjustable in the range of 4ns to 1μs. (authors)

[The national health system in Peru].

Science.gov (United States)

Sánchez-Moreno, Francisco

2014-01-01

In 1975, a group of professionals in Peru who were experts on national health systems began a process that led the country to be the first in South America to initiate a modern organization of the health system. This pioneering development meant that the creation of the National Health Services System [in Peru] in 1978 occurred before the health system reforms in Chile (1980), Brazil (1990), Colombia (1993), and Ecuador (2008). This encouraging start has had permanent reformist fluctuations since then, with negative development because of the lack of a State policy. Current features of the Peruvian system are inefficient performance, discontinuity, and lack of assessment, which creates a major setback in comparison with other health systems in America. In the 21st century, significant technical efforts have been missed to modernize the system and its functions. The future is worrying and the role of new generations will be decisive.

Evaluation of Stiffness Changes in a High-Rise Building by Measurements of Lateral Displacements Using GPS Technology

Science.gov (United States)

Choi, Se Woon; Kim, Ill Soo; Park, Jae Hwan; Kim, Yousok; Sohn, Hong Gyoo; Park, Hyo Seon

2013-01-01

The outrigger truss system is one of the most frequently used lateral load resisting structural systems. However, little research has been reported on the effect of installation of outrigger trusses on improvement of lateral stiffness of a high-rise building through full-scale measurements. In this paper, stiffness changes of a high-rise building due to installation of outrigger trusses have been evaluated by measuring lateral displacements using a global positioning system (GPS). To confirm the error range of the GPS measurement system used in the full-scale measurement tests, the GPS displacement monitoring system is investigated through a free vibration test of the experimental model. Then, for the evaluation of lateral stiffness of a high-rise building under construction, the GPS displacement monitoring system is applied to measurements of lateral displacements of a 66-story high-rise building before and after installation of outrigger truss. The stiffness improvement of the building before and after the installation is confirmed through the changes of the natural frequencies and the ratios of the base shear forces to the roof displacements. PMID:24233025

Evaluation of Stiffness Changes in a High-Rise Building by Measurements of Lateral Displacements Using GPS Technology

Directory of Open Access Journals (Sweden)

Se Woon Choi

2013-11-01

Full Text Available The outrigger truss system is one of the most frequently used lateral load resisting structural systems. However, little research has been reported on the effect of installation of outrigger trusses on improvement of lateral stiffness of a high-rise building through full-scale measurements. In this paper, stiffness changes of a high-rise building due to installation of outrigger trusses have been evaluated by measuring lateral displacements using a global positioning system (GPS. To confirm the error range of the GPS measurement system used in the full-scale measurement tests, the GPS displacement monitoring system is investigated through a free vibration test of the experimental model. Then, for the evaluation of lateral stiffness of a high-rise building under construction, the GPS displacement monitoring system is applied to measurements of lateral displacements of a 66-story high-rise building before and after installation of outrigger truss. The stiffness improvement of the building before and after the installation is confirmed through the changes of the natural frequencies and the ratios of the base shear forces to the roof displacements.

Changes in health expenditures in China in 2000s: has the health system reform improved affordability.

Science.gov (United States)

Long, Qian; Xu, Ling; Bekedam, Henk; Tang, Shenglan

2013-06-13

China's health system reform launched in early 2000s has achieved better coverage of health insurance and significantly increased the use of healthcare for vast majority of Chinese population. This study was to examine changes in the structure of total health expenditures in China in 2000-2011, and to investigate the financial burden of healthcare placed on its population, particularly between urban and rural areas and across different socio-economic development regions. Health expenditures data came from the China National Health Accounts study in 1990-2011, and other data used to calculate the financial burden of healthcare were from China Statistical Yearbook and China Population Statistical Yearbook. Total health expenditures were divided into government and social expenditure, and out-of-pocket payment. The financial burden of healthcare was estimated as out-of-pocket payment per capita as a percentage of annual household living consumption expenditure per capita. Between 2000 and 2011, total health expenditures in China increased from Chinese yuan 319 to 1888 (United States dollars 51 to 305), with average annual increase of 17.4%. Government and social health expenditure increased rapidly being 22.9% and 18.8% of average annual growth rate, respectively. The share of out-of-pocket payment in total health expenditure for the urban population declined from 53% in 2005 to 36% in 2011, but had only a slight decrease for the rural population from 53% to 50%. Out-of-pocket payment, as a percentage of annual household living consumption, has continued to rise, particularly in the rural population from the less developed region (6.1% in 2000 to 8.8% in 2011). The rapid increase of public funding to subsidize health insurance in China, as part of the reform strategy, did not mitigate the out-of-pocket payment for healthcare over the past decade. Financial burden of healthcare on the rural population increased. Affordability among the rural households with sick

Page | 131 RISING CASES OF RAPE OFFENCES IN NIGERIA: NEW ...

African Journals Online (AJOL)

Fr. Ikenga

Key words: Rape, Rising Cases, New Measures, Penetration, Criminal Justice System, Tripod. 1. Introduction ... International Law and Jurisprudence, Faculty of Law, Nnamdi Azikiwe University, Awka. .... 10 Sexual Offences Act 2003 of the UK.

Very low temperature rise laser annealing of radiation-damaged solar cells in orbit

International Nuclear Information System (INIS)

Poulek, V.

1988-01-01

Solar cells of all space objects are damaged by radiation in orbit. This damage, however, can be removed by laser annealing. A new in-orbit laser regeneration system for both body- and spin-stabilized space objects is proposed. For successful annealing of solar cells damaged by 10 years' radiation dose in orbit it is necessary for the temperature rise in the incidence point of the laser beam to reach about 400 0 C. By continuous regeneration, however, between two annealing cycles the solar cells are hit by about two orders of magnitude lower radiation dose. This makes it possible to carry out the regeneration at a temperature rise well under 1 0 C! If an optimal laser regeneration system is used, such low temperature rise laser annealing of radiation-damaged solar cells is possible. A semiconductor GaAlAs diode laser with output power up to 10 mW CW was used for annealing. Some results of the very low temperature rise annealing experiment are given in this paper. (author)

Health Systems Sustainability and Rare Diseases.

Science.gov (United States)

Ferrelli, Rita Maria; De Santis, Marta; Egle Gentile, Amalia; Taruscio, Domenica

2017-01-01

The paper is addressing aspects of health system sustainability for rare diseases in relation to the current economic crisis and equity concerns. It takes into account the results of the narrative review carried out in the framework of the Joint Action for Rare Diseases (Joint RD-Action) "Promoting Implementation of Recommendations on Policy, Information and Data for Rare Diseases", that identified networks as key factors for health systems sustainability for rare diseases. The legal framework of European Reference Networks and their added value is also presented. Networks play a relevant role for health systems sustainability, since they are based upon, pay special attention to and can intervene on health systems knowledge development, partnership, organizational structure, resources, leadership and governance. Moreover, sustainability of health systems can not be separated from the analysis of the context and the action on it, including fiscal equity. As a result of the financial crisis of 2008, cuts of public health-care budgets jeopardized health equity, since the least wealthy suffered from the greatest health effects. Moreover, austerity policies affected economic growth much more adversely than previously believed. Therefore, reducing public health expenditure not only is going to jeopardise citizens' health, but also to hamper fair and sustainable development.

A network of Pediatric Environmental Health Specialty Units (PEHSUs: Filling a critical gap in the health care system

Directory of Open Access Journals (Sweden)

Christine M. Zachek

2012-09-01

Full Text Available A network of pediatric environmental health specialty units (PEHSUs in the United States was formed in 1998 out of a recognized need for clinical expertise in children’s environmental health. Documented trends in a rise of pediatric diseases caused or exacerbated by environmental conditions, coupled with the failure of medical schools and residency programs to cover these issues in a significant way, leaves health care providers, parents, communities, and governments at a loss for this specialized knowledge. The PEHSUs fill this gap by providing: 1 medical education, 2 general outreach and communications, and 3 consultative services to communities and health care professionals. This paper presents examples of key situations where PEHSU involvement was instrumental in improved patient outcomes or advancing clinical expertise in children’s environmental health. Challenges and opportunities for future directions for the program are also discussed.

Czechoslovakia's changing health care system.

Science.gov (United States)

Raffel, M W; Raffel, N K

1992-01-01

Before World War II, Czechoslovakia was among the most developed European countries with an excellent health care system. After the Communist coup d'etat in 1948, the country was forced to adapt its existing health care system to the Soviet model. It was planned and managed by the government, financed by general tax money, operated in a highly centralized, bureaucratic fashion, and provided service at no direct charge at the time of service. In recent years, the health care system had been deteriorating as the health of the people had also been declining. Life expectancy, infant mortality rates, and diseases of the circulatory system are higher than in Western European countries. In 1989, political changes occurred in Czechoslovakia that made health care reform possible. Now health services are being decentralized, and the ownership of hospitals is expected to be transferred to communities, municipalities, churches, charitable groups, or private entities. Almost all health leaders, including hospital directors and hospital department heads, have been replaced. Physicians will be paid according to the type and amount of work performed. Perhaps the most important reform is the establishment of an independent General Health Care Insurance Office financed directly by compulsory contributions from workers, employers, and government that will be able to negotiate with hospitals and physicians to determine payment for services.

Human Factors in Green Office Building Design: The Impact of Workplace Green Features on Health Perceptions in High-Rise High-Density Asian Cities

Directory of Open Access Journals (Sweden)

Fei Xue

2016-10-01

Full Text Available There is a growing concern about human factors in green building, which is imperative in high-rise high-density urban environments. This paper describes our attempts to explore the influence of workplace green features (such as green certification, ventilation mode, and building morphology on health perceptions (personal sensation, sensorial assumptions, healing performance based on a survey in Hong Kong and Singapore. The results validated the relationship between green features and health perceptions in the workplace environment. Remarkably, participants from the air-conditioned offices revealed significant higher concerns about health issues than those participants from the mixed-ventilated offices. The mixed-ventilation design performs as a bridge to connect the indoor environment and outdoor space, which enables people to have contact with nature. Additionally, the preferred building morphology of the workplace is the pattern of a building complex instead of a single building. The complex form integrates the configuration of courtyards, podium gardens, green terrace, public plaza, and other types of open spaces with the building clusters, which contributes to better health perceptions. This research contributes to the rationalization and optimization of passive climate-adaptive design strategies for green buildings in high-density tropical or subtropical cities.

[A Maternal Health Care System Based on Mobile Health Care].

Science.gov (United States)

Du, Xin; Zeng, Weijie; Li, Chengwei; Xue, Junwei; Wu, Xiuyong; Liu, Yinjia; Wan, Yuxin; Zhang, Yiru; Ji, Yurong; Wu, Lei; Yang, Yongzhe; Zhang, Yue; Zhu, Bin; Huang, Yueshan; Wu, Kai

2016-02-01

Wearable devices are used in the new design of the maternal health care system to detect electrocardiogram and oxygen saturation signal while smart terminals are used to achieve assessments and input maternal clinical information. All the results combined with biochemical analysis from hospital are uploaded to cloud server by mobile Internet. Machine learning algorithms are used for data mining of all information of subjects. This system can achieve the assessment and care of maternal physical health as well as mental health. Moreover, the system can send the results and health guidance to smart terminals.

The rise of global health diplomacy: An interdisciplinary concept linking health and international relations.

Science.gov (United States)

Chattu, Vijay Kumar

2017-01-01

Global health diplomacy (GHD) is relatively a very new field that has yet to be clearly defined and developed though there are various definitions given by different experts from foreign policy, global health, diplomacy, international relations, governance, and law. With the intensification of globalization and increasing gaps between countries, new and reemerging health threats such as HIV/AIDS, tuberculosis, influenza, severe acute respiratory syndrome, Ebola, and Zika and a gradual rethinking on security concepts framed a new political context. The health problems addressed diplomatically have also become diverse ranging from neglected tropical diseases, infectious diseases, sale of unsafe, counterfeit drugs to brain drain crisis. We see that global health has become more diverse as the actors widened and also the interests appealing not only to the traditional humanitarian ideals associated with health but also to the principles grounded in national and global security. Recently, we are witnessing the increased priority given to the GHD because the issue of health is discussed by various actors outside the WHO to shape the global policy for health determinants. In fact, the area of health has become the part of UN Summit Diplomacy involving the G8, G20, BRICS, and the EU. The recent WHO Pandemic Influenza Framework, UN High Level Framework on Prevention and Control of Noncommunicable Diseases, and the WHO Framework Convention on Tobacco Control are some of the examples of long-term negotiation processes for agreements that took place.

Lack of Critical Slowing Down Suggests that Financial Meltdowns Are Not Critical Transitions, yet Rising Variability Could Signal Systemic Risk

Science.gov (United States)

Hoarau, Quentin

2016-01-01

Complex systems inspired analysis suggests a hypothesis that financial meltdowns are abrupt critical transitions that occur when the system reaches a tipping point. Theoretical and empirical studies on climatic and ecological dynamical systems have shown that approach to tipping points is preceded by a generic phenomenon called critical slowing down, i.e. an increasingly slow response of the system to perturbations. Therefore, it has been suggested that critical slowing down may be used as an early warning signal of imminent critical transitions. Whether financial markets exhibit critical slowing down prior to meltdowns remains unclear. Here, our analysis reveals that three major US (Dow Jones Index, S&P 500 and NASDAQ) and two European markets (DAX and FTSE) did not exhibit critical slowing down prior to major financial crashes over the last century. However, all markets showed strong trends of rising variability, quantified by time series variance and spectral function at low frequencies, prior to crashes. These results suggest that financial crashes are not critical transitions that occur in the vicinity of a tipping point. Using a simple model, we argue that financial crashes are likely to be stochastic transitions which can occur even when the system is far away from the tipping point. Specifically, we show that a gradually increasing strength of stochastic perturbations may have caused to abrupt transitions in the financial markets. Broadly, our results highlight the importance of stochastically driven abrupt transitions in real world scenarios. Our study offers rising variability as a precursor of financial meltdowns albeit with a limitation that they may signal false alarms. PMID:26761792

Health care delivery systems.

NARCIS (Netherlands)

Stevens, F.; Zee, J. van der

2007-01-01

A health care delivery system is the organized response of a society to the health problems of its inhabitants. Societies choose from alternative health care delivery models and, in doing so, they organize and set goals and priorities in such a way that the actions of different actors are effective,

Study on rapid evacuation in high-rise buildings

Directory of Open Access Journals (Sweden)

Xin Zhang

2017-06-01

Full Text Available More and more high rising buildings emerged in modern cities, but emergency evacuation of tall buildings has been a worldwide difficult problem. In this paper, a new evacuation device for high rising buildings in fire accident was proposed and studied. This device mainly consisted of special spiral slideway and shunt valve. People in this device could fast slide down to the first floor under gravity without any electric power and physical strength, which is suitable for various emergency evacuation including mobility-impaired persons. The plane simulation test has shown that human being in alternative clockwise and counterclockwise movement will not become dizzy. The evacuated people should wear protection pad, which can prevent slider from being injured by surface friction with the slide, and eliminate the friction coefficient difference caused by different clothes and slide surface. The calculation results show that the evacuation speed of the new device is much faster than traditional staircases. Moreover, such new evacuation device can also be used as a means of vertical transportation in high-rise buildings partly. People can take it from any floor to ground floor directly, which not only save time for waiting for the lifts but also save the power. The new evacuation system is of simple structure, easy to use, and suitable for evacuation and partly used as vertical downwards traffic, which shows light on solving world-wide difficulties on fast evacuation in high-rise buildings.

Measuring health systems strength and its impact: experiences from the African Health Initiative.

Science.gov (United States)

Sherr, Kenneth; Fernandes, Quinhas; Kanté, Almamy M; Bawah, Ayaga; Condo, Jeanine; Mutale, Wilbroad

2017-12-21

Health systems are essential platforms for accessible, quality health services, and population health improvements. Global health initiatives have dramatically increased health resources; however, funding to strengthen health systems has not increased commensurately, partially due to concerns about health system complexity and evidence gaps demonstrating health outcome improvements. In 2009, the African Health Initiative of the Doris Duke Charitable Foundation began supporting Population Health Implementation and Training Partnership projects in five sub-Saharan African countries (Ghana, Mozambique, Rwanda, Tanzania, and Zambia) to catalyze significant advances in strengthening health systems. This manuscript reflects on the experience of establishing an evaluation framework to measure health systems strength, and associate measures with health outcomes, as part of this Initiative. Using the World Health Organization's health systems building block framework, the Partnerships present novel approaches to measure health systems building blocks and summarize data across and within building blocks to facilitate analytic procedures. Three Partnerships developed summary measures spanning the building blocks using principal component analysis (Ghana and Tanzania) or the balanced scorecard (Zambia). Other Partnerships developed summary measures to simplify multiple indicators within individual building blocks, including health information systems (Mozambique), and service delivery (Rwanda). At the end of the project intervention period, one to two key informants from each Partnership's leadership team were asked to list - in rank order - the importance of the six building blocks in relation to their intervention. Though there were differences across Partnerships, service delivery and information systems were reported to be the most common focus of interventions, followed by health workforce and leadership and governance. Medical products, vaccines and technologies, and

RISING ATMOSPHERIC CO2 AND CARBON SEQUESTRATION IN FORESTS

Science.gov (United States)

Rising CO2 concentrations in the Earth's atmosphere could alter Earth's climate system, but it is thought that higher concentrations may improve plant growth by way of the fertilization effect. Forests, an important part of the Earth's carbon cycle, are postulated to sequester a...

Structural response of steel high rise buildings to fire

DEFF Research Database (Denmark)

Gentili, Filippo; Giuliani, Luisa; Bontempi, Franco

2013-01-01

Due to the significant vertical elevation and complexity of the structural system, high rise buildings may suffer from the effects of fire more than other structures. For this reason, in addition to evacuation strategies and active fire protection, a careful consideration of structural response t...

Sun Radio Interferometer Space Experiment (SunRISE)

Science.gov (United States)

Kasper, Justin C.; SunRISE Team

2018-06-01

The Sun Radio Interferometer Space Experiment (SunRISE) is a NASA Heliophysics Explorer Mission of Opportunity currently in Phase A. SunRISE is a constellation of spacecraft flying in a 10-km diameter formation and operating as the first imaging radio interferometer in space. The purpose of SunRISE is to reveal critical aspects of solar energetic particle (SEP) acceleration at coronal mass ejections (CMEs) and transport into space by making the first spatially resolved observations of coherent Type II and III radio bursts produced by electrons accelerated at CMEs or released from flares. SunRISE will focus on solar Decametric-Hectometric (DH, 0.1 space before major SEP events, but cannot be seen on Earth due to ionospheric absorption. This talk will describe SunRISE objectives and implementation. Presented on behalf of the entire SunRISE team.

PHYSICAL CULTURE AND HEALTH CULTURE – INNOVATIONAL CULTUROLOGICAL APPROACH

Directory of Open Access Journals (Sweden)

Grujo Bjeković

2008-08-01

Full Text Available Inaugural discusses of metatheoretical innovatinal forming of upgrading the cultural health and pedagogical technology of children’s and youth’s health progress and protection systems in the system of generally educational and health-school organizations. Establishment of a dynamical cumulative knowledge exchange and cooperative harmonization of the pedagogues of teaching obligations in the constitution of knowledge management educational space on rising health culture, physicality, and enriching sport and recreative lifestyle. Working out of con ceptual structural-functional scheme of health management measures in school and of evaluation of psychophysical and functional potentials, from the aspect of personalorientation. Establishment of complex system monitoring for physical development and physical capabilities and achieved results in domain of self-organized sport and sport-recreative selected activities.

Strengthening global health security by embedding the International Health Regulations requirements into national health systems.

Science.gov (United States)

Kluge, Hans; Martín-Moreno, Jose Maria; Emiroglu, Nedret; Rodier, Guenael; Kelley, Edward; Vujnovic, Melitta; Permanand, Govin

2018-01-01

The International Health Regulations (IHR) 2005, as the overarching instrument for global health security, are designed to prevent and cope with major international public health threats. But poor implementation in countries hampers their effectiveness. In the wake of a number of major international health crises, such as the 2014 Ebola and 2016 Zika outbreaks, and the findings of a number of high-level assessments of the global response to these crises, it has become clear that there is a need for more joined-up thinking between health system strengthening activities and health security efforts for prevention, alert and response. WHO is working directly with its Member States to promote this approach, more specifically around how to better embed the IHR (2005) core capacities into the main health system functions. This paper looks at how and where the intersections between the IHR and the health system can be best leveraged towards developing greater health system resilience. This merging of approaches is a key component in pursuit of Universal Health Coverage and strengthened global health security as two mutually reinforcing agendas.

Rise of a cold plume

International Nuclear Information System (INIS)

Kakuta, Michio

1977-06-01

The rise of smoke from the stacks of two research reactors in normal operation was measured by photogrametric method. The temperature of effluent gas is less than 20 0 C higher than that of the ambient air (heat emission of the order 10 4 cal s -1 ), and the efflux velocity divided by the wind speed is between 0.5 and 2.8 in all 16 smoke runs. The field data obtained within downwind distance of 150m are compared with those by plume rise formulas presently available. Considering the shape of bending-over plume, the Briggs' formula for 'jet' gives a reasonable explanation of the observed plume rise. (auth.)

Institutional analysis of health system governance.

Science.gov (United States)

Abimbola, Seye; Negin, Joel; Martiniuk, Alexandra L; Jan, Stephen

2017-11-01

It is important that researchers who study health system governance have a set of collective understandings of the meanings of governance, which can then inform the methods used in research. We present an institutional framing and definition of health system governance; that is, governance refers to making, changing, monitoring and enforcing the rules that govern the demand and supply of health services. This pervasive, relational view of governance is to be preferred to approaches that focus primarily on structures of governments and health care organizations, because health system governance involves communities and service users, and because governments in many low- and middle-income countries tend to under-govern. Therefore, the study of health system governance requires institutional analysis; an approach that focuses not only on structures, but also on the rules (both formal and informal) governing demand and supply relations. Using this 'structure-relations' lens, and based on our field experience, we discuss how this focus could be applied to the three approaches to framing and studying health system governance that we identified in the literature. In order of decreasing focus on structures ('hardware') and increasing focus on relations ('software'), they are: (1) the government-centred approach, which focuses on the role of governments, above or to the exclusion of non-government health system actors; (2) the building-block approach, which focuses on the internal workings of health care organizations, and treats governance as one of the several building blocks of organizations; and (3) the institutional approach, which focuses on how the rules governing social and economic interactions are made, changed, monitored and enforced. Notably, either or both qualitative and quantitative methods may be used by researchers in efforts to incorporate the analysis of how rules determine relations among health system actors into these three approaches to health system

The State Public Health Laboratory System.

Science.gov (United States)

Inhorn, Stanley L; Astles, J Rex; Gradus, Stephen; Malmberg, Veronica; Snippes, Paula M; Wilcke, Burton W; White, Vanessa A

2010-01-01

This article describes the development since 2000 of the State Public Health Laboratory System in the United States. These state systems collectively are related to several other recent public health laboratory (PHL) initiatives. The first is the Core Functions and Capabilities of State Public Health Laboratories, a white paper that defined the basic responsibilities of the state PHL. Another is the Centers for Disease Control and Prevention National Laboratory System (NLS) initiative, the goal of which is to promote public-private collaboration to assure quality laboratory services and public health surveillance. To enhance the realization of the NLS, the Association of Public Health Laboratories (APHL) launched in 2004 a State Public Health Laboratory System Improvement Program. In the same year, APHL developed a Comprehensive Laboratory Services Survey, a tool to measure improvement through the decade to assure that essential PHL services are provided.

High-rise construction in the Saint Petersburg agglomeration in 1703-1950s

Science.gov (United States)

Sementsov, Sergey; Akulova, Nadezhda; Kurakina, Severina

2018-03-01

Regularities of high-rise construction (implemented projects and developments) in Saint Petersburg and the Saint Petersburg agglomeration since the foundation of the city in 1703 till the 1950s are considered. Based on these regularities, a single spatially developed system of vertical dominants is formed. High-rise construction in the city and its suburbs started in the 1710s and continues up to the present time. In the considered decades (1703-1950s), high-rise construction mostly performed urban-planning functions (with vertical and symbolic dominants), relying on patterns of the visual perception of man-made landscapes under development. Since the 1710s, the construction of vertical dominants (mainly temples, spires of towers, lighthouses, etc.) of five ranks (depending on the altitude range and in relation to the background development) was conducted in territories of the entire agglomeration. These dominants were arranged in landscapes of the city and suburbs with almost mathematically precise accuracy and according to special regulations. Such dominants obtained particular descriptive and silhouette characteristics in accordance with the conditions of spatial perception. In some periods of city development, attempts were made to create monuments (symbolic dominants) of specific height and include those in the spatial system of high-rise dominants as significant elements of the city silhouette.

Private sector in public health care systems

OpenAIRE

Matějusová, Lenka

2008-01-01

This master thesis is trying to describe the situation of private sector in public health care systems. As a private sector we understand patients, private health insurance companies and private health care providers. The focus is placed on private health care providers, especially in ambulatory treatment. At first there is a definition of health as a main determinant of a health care systems, definition of public and private sectors in health care systems and the difficulties at the market o...

Organic and inorganic carbon dynamics in a karst aquifer: Santa Fe River Sink-Rise system, north Florida, USA

Science.gov (United States)

Jin, Jin; Zimmerman, Andrew R.; Moore, Paul J.; Martin, Jonathan B.

2014-03-01

Spatiotemporal variations in dissolved organic carbon (DOC), dissolved inorganic carbon (DIC), major ions concentrations and other geochemical parameters including stable carbon isotopes of DIC (δ13CDIC), were measured in surface water and deep and shallow well water samples of the Santa Fe River Sink-Rise eogenetic karst system, north Florida, USA. Three end-member water sources were identified: one DOC-rich/DIC-poor/δ13CDIC-depleted, one DOC-poor/DIC-rich/δ13CDIC-enriched, and one enriched in major ions. Given their spatiotemporal distributions, they were presumed to represent soil water, upper aquifer groundwater, and deep aquifer water sources, respectively. Using assumed ratios of Na+, Cl, and SO42- for each end-member, a mixing model calculated the contribution of each water source to each sample. Then, chemical effects of biogeochemical reactions were calculated as the difference between those predicted by the mixing model and measured species concentrations. In general, carbonate mineral dissolution occurred throughout the Sink-Rise system, surface waters were net autotrophic and the subsurface was in metabolic balance, i.e., no net DOC or DIC production or consumption. However, there was evidence for chemolithoautotrophy, perhaps by hydrogen oxidizing microbes, at some deep aquifer sites. Mineralization of this autochthonous natural dissolved organic matter (NDOM) led to localized carbonate dissolution as did surface water-derived NDOM supplied to shallow well sites during the highest flow periods. This study demonstrates linkages between hydrology, abiotic and microbial processes and carbon dynamics and has important implications for groundwater quality, karst morphologic evolution, and hydrogeologic projects such as aquifer storage and recovery in karst systems.

[Efficiency of medical and economic activities of a sanatorium-and-spa facility in the active phase of the public health system reform under macroeconomic instability].

Science.gov (United States)

Poliakov, B A; Kizeev, M V

2010-01-01

Results of a comprehensive study have demonstrated that the reform of the public health system currently underway in this country provides conditions for the extension of medical care based at sanatorium-and-spa facilities with simultaneous rise in relevant expenses. Bearing in mind the unstable macroeconomic situation, this requires thorough monitoring medical and economic activities of health resorts for the purpose of enhancing cost efficiency. The goal of optimization can be achieved by increasing competitive capacity based on strict control of expenditures and income redistribution for financing the most promising projects.

On Capillary Rise and Nucleation

Science.gov (United States)

Prasad, R.

2008-01-01

A comparison of capillary rise and nucleation is presented. It is shown that both phenomena result from a balance between two competing energy factors: a volume energy and a surface energy. Such a comparison may help to introduce nucleation with a topic familiar to the students, capillary rise. (Contains 1 table and 3 figures.)

Health for All - Italia, an informative health system

Directory of Open Access Journals (Sweden)

Marzia Loghi

2008-06-01

Full Text Available

Background: On ISTAT website the informative system Health for All – Italia is available. It collects indicators on health coming from various sources to make up a basis for constructing an organic and joint framework on the country’s health reality. The system includes more than 4000 indicators about: demographic and socioeconomic context; causes of death; life styles; disease prevention; chronic and infectious diseases; disability; health status and life expectancy; health facilities; hospital discharges by diagnosis; health care resources. The database-related software was developed by the World Health Organization to make it easier for any user to access the information available either as tables, graphs and territorial maps.

Methods: The system has been built considering data coming from different sources and using, if possible, the same definitions, classifications and desegregations. Time series goes from 1980 to the last year available (which can differ among the different sources. Indicators are calculated by provinces (if possible, regions, big areas and Italy. In order to compare indicators over time and space, standardised rates are calculated, using the same population reference. For each indicator metadata are available to give users additional notes necessary to correctly read and use the data, and publications or internet websites to examine more in-depth the argument.

Results: Different kind of users find Health for All – Italia very useful for their aims: students, researchers, doctors, socio-sanitary operators, policy makers. Some examples of official reports from public institutions are briefly described in the paper.

Conclusions: The increasing number of users of Health for All – Italia make necessary the online version and an English version for international comparisons.

The Rise of Global Science and the Emerging Political Economy of International Research Collaborations

Science.gov (United States)

Peters, Michael A.

2006-01-01

This article charts the rise of global science and a global science infrastructure as part of the emerging international knowledge system exemplifying a geography of knowledge and the importance of new info-communications networks. The article theorises the rise of global science, which still strongly reflects a Western bias and is highly…

42 CFR 438.242 - Health information systems.

Science.gov (United States)

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Health information systems. 438.242 Section 438.242... Measurement and Improvement Standards § 438.242 Health information systems. (a) General rule. The State must ensure, through its contracts, that each MCO and PIHP maintains a health information system that collects...

A Case for Open Network Health Systems: Systems as Networks in Public Mental Health.

Science.gov (United States)

Rhodes, Michael Grant; de Vries, Marten W

2017-01-08

Increases in incidents involving so-called confused persons have brought attention to the potential costs of recent changes to public mental health (PMH) services in the Netherlands. Decentralized under the (Community) Participation Act (2014), local governments must find resources to compensate for reduced central funding to such services or "innovate." But innovation, even when pressure for change is intense, is difficult. This perspective paper describes experience during and after an investigation into a particularly violent incident and murder. The aim was to provide recommendations to improve the functioning of local PMH services. The investigation concluded that no specific failure by an individual professional or service provider facility led to the murder. Instead, also as a result of the Participation Act that severed communication lines between individuals and organizations, information sharing failures were likely to have reduced system level capacity to identify risks. The methods and analytical frameworks employed to reach this conclusion, also lead to discussion as to the plausibility of an unconventional solution. If improving communication is the primary problem, non-hierarchical information, and organizational networks arise as possible and innovative system solutions. The proposal for debate is that traditional "health system" definitions, literature and narratives, and operating assumptions in public (mental) health are 'locked in' constraining technical and organization innovations. If we view a "health system" as an adaptive system of economic and social "networks," it becomes clear that the current orthodox solution, the so-called integrated health system, typically results in a "centralized hierarchical" or "tree" network. An overlooked alternative that breaks out of the established policy narratives is the view of a 'health systems' as a non-hierarchical organizational structure or 'Open Network.' In turn, this opens new technological and

Rising synchrony controls western North American ecosystems

Science.gov (United States)

Black, Bryan A.; van der Sleen, Peter; Di Lorenzo, Emanuele; Griffin, Daniel; Sydeman, William J.; Dunham, Jason B.; Rykaczewski, Ryan R.; Garcia-Reyes, Marisol; Safeeq, Mohammad; Arismendi, Ivan; Bograd, Steven J.

2018-01-01

Along the western margin of North America, the winter expression of the North Pacific High (NPH) strongly influences interannual variability in coastal upwelling, storm track position, precipitation, and river discharge. Coherence among these factors induces covariance among physical and biological processes across adjacent marine and terrestrial ecosystems. Here, we show that over the past century the degree and spatial extent of this covariance (synchrony) has substantially increased, and is coincident with rising variance in the winter NPH. Furthermore, centuries‐long blue oak (Quercus douglasii) growth chronologies sensitive to the winter NPH provide robust evidence that modern levels of synchrony are among the highest observed in the context of the last 250 years. These trends may ultimately be linked to changing impacts of the El Niño Southern Oscillation on mid‐latitude ecosystems of North America. Such a rise in synchrony may destabilize ecosystems, expose populations to higher risks of extinction, and is thus a concern given the broad biological relevance of winter climate to biological systems.

Rise of oil prices and energy policy

International Nuclear Information System (INIS)

2005-01-01

This document reprints the talk of the press conference given by D. de Villepin, French prime minister, on August 16, 2005 about the alarming rise of oil prices. In his talk, the prime minister explains the reasons of the crisis (increase of worldwide consumption, political tensions in the Middle East..) and presents the strategy and main trends of the French energy policy: re-launching of energy investments in petroleum refining capacities and in the nuclear domain (new generation of power plants), development of renewable energy sources and in particular biofuels, re-launching of the energy saving policy thanks to financial incentives and to the development of clean vehicles and mass transportation systems. In a second part, the prime minister presents his policy of retro-cession of petroleum tax profits to low income workers, and of charge abatement to professionals having an occupation strongly penalized by the rise of oil prices (truckers, farmers, fishermen, taxi drivers). (J.S.)

Mobile health information system: a mobile app. to aid health ...

African Journals Online (AJOL)

Mobile health information system: a mobile app. to aid health workers relate health information. ... Global Journal of Mathematical Sciences ... phones in delivering vital health information and effective fieldwork reporting is of significance.

Strategic advantages of high-rise construction

Directory of Open Access Journals (Sweden)

Yaskova Natalya

2018-01-01

Full Text Available Traditional methods to assess the competitiveness of different types of real estate in the context of huge changes of new technological way of life don’t provide building solutions that would be correct from a strategic perspective. There are many challenges due to changes in the consumers’ behavior in the housing area. A multiplicity of life models, a variety of opportunities and priorities, traditions and new trends in construction should be assessed in terms of prospective benefits in the environment of the emerging new world order. At the same time, the mane discourse of high-rise construction mainly relates to its design features, technical innovations, and architectural accents. We need to clarify the criteria for economic evaluation of high-rise construction in order to provide decisions with clear and quantifiable contexts. The suggested approach to assessing the strategic advantage of high-rise construction and the prospects for capitalization of high-rise buildings poses new challenges for the economy to identify adequate quantitative assessment methods of the high-rise buildings economic efficiency, taking into account all stages of their life cycle.

Strategic advantages of high-rise construction

Science.gov (United States)

Yaskova, Natalya

2018-03-01

Traditional methods to assess the competitiveness of different types of real estate in the context of huge changes of new technological way of life don't provide building solutions that would be correct from a strategic perspective. There are many challenges due to changes in the consumers' behavior in the housing area. A multiplicity of life models, a variety of opportunities and priorities, traditions and new trends in construction should be assessed in terms of prospective benefits in the environment of the emerging new world order. At the same time, the mane discourse of high-rise construction mainly relates to its design features, technical innovations, and architectural accents. We need to clarify the criteria for economic evaluation of high-rise construction in order to provide decisions with clear and quantifiable contexts. The suggested approach to assessing the strategic advantage of high-rise construction and the prospects for capitalization of high-rise buildings poses new challenges for the economy to identify adequate quantitative assessment methods of the high-rise buildings economic efficiency, taking into account all stages of their life cycle.

Mind the Gap: Social Media Engagement by Public Health Researchers

OpenAIRE

Keller, Brett; Labrique, Alain; Jain, Kriti M; Pekosz, Andrew; Levine, Orin

2014-01-01

Background The traditional vertical system of sharing information from sources of scientific authority passed down to the public through local health authorities and clinicians risks being made obsolete by emerging technologies that facilitate rapid horizontal information sharing. The rise of Public Health 2.0 requires professional acknowledgment that a new and substantive forum of public discourse about public health exists on social media, such as forums, blogs, Facebook, and Twitter. Objec...

Implications of sea-level rise in a modern carbonate ramp setting

Science.gov (United States)

Lokier, Stephen W.; Court, Wesley M.; Onuma, Takumi; Paul, Andreas

2018-03-01

This study addresses a gap in our understanding of the effects of sea-level rise on the sedimentary systems and morphological development of recent and ancient carbonate ramp settings. Many ancient carbonate sequences are interpreted as having been deposited in carbonate ramp settings. These settings are poorly-represented in the Recent. The study documents the present-day transgressive flooding of the Abu Dhabi coastline at the southern shoreline of the Arabian/Persian Gulf, a carbonate ramp depositional system that is widely employed as a Recent analogue for numerous ancient carbonate systems. Fourteen years of field-based observations are integrated with historical and recent high-resolution satellite imagery in order to document and assess the onset of flooding. Predicted rates of transgression (i.e. landward movement of the shoreline) of 2.5 m yr- 1 (± 0.2 m yr- 1) based on global sea-level rise alone were far exceeded by the flooding rate calculated from the back-stepping of coastal features (10-29 m yr- 1). This discrepancy results from the dynamic nature of the flooding with increased water depth exposing the coastline to increased erosion and, thereby, enhancing back-stepping. A non-accretionary transgressive shoreline trajectory results from relatively rapid sea-level rise coupled with a low-angle ramp geometry and a paucity of sediments. The flooding is represented by the landward migration of facies belts, a range of erosive features and the onset of bioturbation. Employing Intergovernmental Panel on Climate Change (Church et al., 2013) predictions for 21st century sea-level rise, and allowing for the post-flooding lag time that is typical for the start-up of carbonate factories, it is calculated that the coastline will continue to retrograde for the foreseeable future. Total passive flooding (without considering feedback in the modification of the shoreline) by the year 2100 is calculated to likely be between 340 and 571 m with a flooding rate of 3

Intelligent Integrated System Health Management

Science.gov (United States)

Figueroa, Fernando

2012-01-01

Intelligent Integrated System Health Management (ISHM) is the management of data, information, and knowledge (DIaK) with the purposeful objective of determining the health of a system (Management: storage, distribution, sharing, maintenance, processing, reasoning, and presentation). Presentation discusses: (1) ISHM Capability Development. (1a) ISHM Knowledge Model. (1b) Standards for ISHM Implementation. (1c) ISHM Domain Models (ISHM-DM's). (1d) Intelligent Sensors and Components. (2) ISHM in Systems Design, Engineering, and Integration. (3) Intelligent Control for ISHM-Enabled Systems

The problems and perspectives for the introduction of high-rise construction in Russian cities

Science.gov (United States)

Pershina, Anna; Radzhabov, Mehman; Dormidontova, Tatyana

2018-03-01

The propose of academic affairs is discovery the principal areas of concern high-rise construction in Russia. Examples of modern Russian and foreign high-rise construction are considered in the work. The most important problems and their solutions for Russia are identified on their basis. The everyone area of concern is considered separately. Ecology problems and influence of high-rise construction for the healthy and psychological effect of people are considered special. High-rise constructions influence negative and positive for urban environment in Moscow and Samara cities. The experience lack, defects in requirements document, which don't include all high-rise constructions specific, system problem of construction and often non-availability of proper control at the existing requirements document result for complexity of designing, construction and operation. At this moment, high-rise constructions temp is increasing in Moscow. Feasibility of high-rise buildings come up in regions of Russia. The reasons include high material inputs, irregularities of requirements network and utility lines and maintenance problems. The researching follow up of conclusions and recommendations for high-rise constructions development in Russia. The reasons of high-rise buildings are urbanization of people and necessary of concentration labor supply. The important tasks for organization are creating compact urban environment, decrease urban area for development, using an innovative technology for construction and properly maintenance. The balance between the preference of high-rise construction, inputs for construction and influence for ecology are resolve for this task.

Veneto Region, Italy. Health system review.

Science.gov (United States)

Toniolo, Franco; Mantoan, Domenico; Maresso, Anna

2012-01-01

The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. This HiT is one of the first to be written on a subnational level of government and focuses on the Veneto Region of northern Italy. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. The Veneto Region is one of Italy's richest regions and the health of its resident population compares favourably with other regions in Italy. Life expectancy for both men and women, now at 79.1 and 85.2 years, respectively, is slightly higher than the national average, while mortality rates are comparable to national ones. The major causes of death are tumours and cardiovascular diseases. Under Italy's National Health Service, the organization and provision of health care is a regional responsibility and regions must provide a nationally defined (with regional input) basic health benefit package to all of their citizens; extra services may be provided if budgets allow. Health care is mainly financed by earmarked central and regional taxes, with regions receiving their allocated share of resources from the National Health Fund. Historically, health budget deficits have been a major problem in most Italian regions, but since the early 2000s the introduction of efficiency measures and tighter procedures on financial management have contributed to a significant decrease in the Veneto Regions health budget deficit.The health system is governed by the Veneto Region government (Giunta) via the Departments of Health and Social Services, which receive technical support from a single General Management Secretariat. Health care is

Procurement performance measurement system in the health care industry.

Science.gov (United States)

Kumar, Arun; Ozdamar, Linet; Ng, Chai Peng

2005-01-01

The rising operating cost of providing healthcare is of concern to health care providers. As such, measurement of procurement performance will enable competitive advantage and provide a framework for continuous improvement. The objective of this paper is to develop a procurement performance measurement system. The paper reviews the existing literature in procurement performance measurement to identify the key areas of purchasing performance. By studying the three components in the supply chain collectively with the resources, procedures and output, a model is been developed. Additionally, a balanced scorecard is proposed by establishing a set of generic measures and six perspectives. A case study conducted at the Singapore Hospital applies the conceptual model to describe the purchasing department and the activities within and outside the department. The results indicate that the material management department has already made a good start in measuring the procurement process through the implementation of the balanced scorecard. There are many data that are collected but not properly collated and utilized. Areas lacking measurement include cycle time of delivery, order processing time, effectiveness, efficiency and reliability. Though a lot of hard work was involved, the advantages of establishing a measurement system outweigh the costs and efforts involved in its implementation. Results of balanced scorecard measurements provide decision-makers with critical information on efficiency and effectiveness of the purchasing department's work. The measurement model developed could be used for any hospital procurement system.

Modeling the Effects of Sea-Level Rise on Groundwater Levels in Coastal New Hampshire

Science.gov (United States)

Jacobs, J. M.; Knott, J. F.; Daniel, J.; Kirshen, P. H.

2017-12-01

Coastal communities with high population density and low topography are vulnerable from sea-level rise (SLR) caused by climate change. Groundwater in coastal communities will rise with sea level impacting water quality, the structural integrity of infrastructure, and natural ecosystem health. SLR-induced groundwater rise has been studied in areas of high aquifer transmissivity and in low-lying areas immediately along the coast. In this regional study, we investigate SLR-induced groundwater rise in a coastal area characterized by shallow unconsolidated deposits overlying fractured bedrock, typical of the glaciated northeast United States. MODFLOW, a numerical groundwater-flow model, is used with groundwater observations, lidar topography, surface-water hydrology, and groundwater withdrawals to investigate SLR-induced changes in groundwater levels and vadose-zone thickness in New Hampshire's Seacoast. The SLR groundwater signal is detected up to 5 km from the coast, more than 3 times farther inland than projected surface-water flooding associated with SLR. Relative groundwater rise ranges from 38 to 98% of SLR within 1 km of the shoreline and drops below 4% between 4 and 5 km from the coast. The largest magnitude of SLR-induced groundwater rise occurs in the marine and estuarine deposits and land areas with tidal water bodies on three sides. In contrast, groundwater rise is dampened near streams. Groundwater inundation caused by 2 m of SLR is projected to contribute 48% of the total land inundation area in the City of Portsmouth with consequences for built and natural resources. Freshwater wetlands are projected to expand 3% by year 2030 increasing to 25% by year 2100 coupled with water-depth increases. These results imply that underground infrastructure and natural resources in coastal communities will be impacted by rising groundwater much farther inland than previously thought when considering only surface-water flooding from SLR.

Rising statin use and effect on ischemic stroke outcome

Directory of Open Access Journals (Sweden)

Haymore Joseph

2004-03-01

Full Text Available Abstract Background Statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors have neuroprotective effects in experimental stroke models and are commonly prescribed in clinical practice. The aim of this study was to determine if patients taking statins before hospital admission for stroke had an improved clinical outcome. Methods This was an observational study of 436 patients admitted to the National Institutes of Health Suburban Hospital Stroke Program between July 2000 and December 2002. Self-reported risk factors for stroke were obtained on admission. Stroke severity was determined by the admission National Institutes of Health Stroke Scale score. Good outcome was defined as a Rankin score Results There were 436 patients with a final diagnosis of ischemic stroke; statin data were available for 433 of them. A total of 95/433 (22% of patients were taking a statin when they were admitted, rising from 16% in 2000 to 26% in 2002. Fifty-one percent of patients taking statins had a good outcome compared to 38% of patients not taking statins (p = 0.03. After adjustment for confounding factors, statin pretreatment was associated with a 2.9 odds (95% CI: 1.2–6.7 of a good outcome at the time of hospital discharge. Conclusions The proportion of patients taking statins when they are admitted with stroke is rising rapidly. Statin pretreatment was significantly associated with an improved functional outcome at discharge. This finding could support the early initiation of statin therapy after stroke.

Intensive Care Nurses’ Belief Systems Regarding the Health Economics: A Focused Ethnography

Science.gov (United States)

Heydari, Abbas; Vafaee-Najar, Ali; Bakhshi, Mahmoud

2016-01-01

Background: Health care beliefs can have an effect on the efficiency and effectiveness of nursing practices. Nevertheless, how belief systems impact on the economic performance of intensive care unit (ICU) nurses is not known. This study aimed to explore the ICU nurses’ beliefs and their effect on nurse’s: practices and behavior patterns regarding the health economics. Methods: In this study, a focused ethnography method was used. Twenty-four informants from ICU nurses and other professional individuals were purposively selected and interviewed. As well, 400 hours of ethnographic observations were used for data collection. Data analysis was performed using the methods described by Miles and Huberman (1994). Findings: Eight beliefs were found that gave meaning to ICU nurse’s practices regarding the health economics. 1. The registration of medications and supplies disrupt the nursing care; 2. Monitoring and auditing improve consumption; 3. There is a fear of possible shortage in the future; 4. Supply and replacement of equipment is difficult; 5. Higher prices lead to more accurate consumption; 6. The quality of care precedes the costs; 7. Clinical Guidelines are abundant but useful; and 8. Patient economy has priority over hospital economy. Maintaining the quality of patient care with least attention to hospital costs was the main focus of the beliefs formed up in the ICU regarding the health economics. Conclusions: ICU nurses’ belief systems have significantly shaped in relation to providing a high-quality care. Although high quality of care can lead to a rise in the effectiveness of nursing care, cost control perspective should also be considered in planning for improve the quality of care. Therefore, it is necessary to involve the ICU nurses in decision-making about unit cost management. They must become familiar with the principles of heath care economics and productivity by applying an effective cost management program. It may be optimal to implement the

Intensive Care Nurses' Belief Systems Regarding the Health Economics: A Focused Ethnography.

Science.gov (United States)

Heydari, Abbas; Vafaee-Najar, Ali; Bakhshi, Mahmoud

2016-09-01

Health care beliefs can have an effect on the efficiency and effectiveness of nursing practices. Nevertheless, how belief systems impact on the economic performance of intensive care unit (ICU) nurses is not known. This study aimed to explore the ICU nurses' beliefs and their effect on nurse's practices and behavior patterns regarding the health economics. In this study, a focused ethnography method was used. Twenty-four informants from ICU nurses and other professional individuals were purposively selected and interviewed. As well, 400 hours of ethnographic observations were used for data collection. Data analysis was performed using the methods described by Miles and Huberman (1994). Eight beliefs were found that gave meaning to ICU nurse's practices regarding the health economics. 1. The registration of medications and supplies disrupt the nursing care; 2.Monitoring and auditing improve consumption; 3.There is a fear of possible shortage in the future; 4.Supply and replacement of equipment is difficult; 5.Higher prices lead to more accurate consumption; 6.The quality of care precedes the costs; 7. Clinical Guidelines are abundant but useful; and 8.Patient economy has priority over hospital economy. Maintaining the quality of patient care with least attention to hospital costs was the main focus of the beliefs formed up in the ICU regarding the health economics. ICU nurses' belief systems have significantly shaped in relation to providing a high-quality care. Although high quality of care can lead to a rise in the effectiveness of nursing care, cost control perspective should also be considered in planning for improve the quality of care. Therefore, it is necessary to involve the ICU nurses in decision-making about unit cost management. They must become familiar with the principles of heath care economics and productivity by applying an effective cost management program. It may be optimal to implement the reforms in various aspects, such as the hospital

Mapping Health Needs to Support Health System Management in Poland

Science.gov (United States)

Holecki, Tomasz; Romaniuk, Piotr; Woźniak-Holecka, Joanna; Szromek, Adam R.; Syrkiewicz-Świtała, Magdalena

2018-01-01

In Poland, following the example of other EU countries, the first maps of health needs prepared by the Ministry of Health were presented in 2016. The maps constitute a foundation for rational decision-making in the management of health care resources, being potentially useful for all actors in health system. This refers in particular to the institutions responsible for distribution of funds and contracting health service, but also for decision-makers, who determine the scope of funds to be utilized in the health system, or the structure of benefits provided to patients. Service providers are also addressees of the maps, to give them a basis for planning future activities. The article presents a structured assessment of the current state of affairs, based on recent experience and sets out likely directions for the development of health needs in mapping in Poland in the future. We discuss the criticism addressed toward maps by representatives of various groups acting in health care. It includes the lack of recognition of some of the key health needs, or wrong emphases, where much more attention is paid to the recognition of current resources in the health system, instead of making prognoses regarding the future developments of health needs. Nonetheless, we find that this instrument is potentially of high usability, in case of elimination of the existing weaknesses. PMID:29662876

Strengthening Governance in Health Systems for Reproductive ...

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

Home · What we do ... As a result, Pakistan's health system has suffered and health service delivery has worsened. ... This four-year project aims to strengthen health systems governance for reproductive health and rights in Pakistan.

Health-system strengthening and tuberculosis control.

Science.gov (United States)

Atun, Rifat; Weil, Diana E C; Eang, Mao Tan; Mwakyusa, David

2010-06-19

Weak health systems are hindering global efforts for tuberculosis care and control, but little evidence is available on effective interventions to address system bottlenecks. This report examines published evidence, programme reviews, and case studies to identify innovations in system design and tuberculosis control to resolve these bottlenecks. We outline system bottlenecks in relation to governance, financing, supply chain management, human resources, health-information systems, and service delivery; and adverse effects from rapid introduction of suboptimum system designs. This report also documents innovative solutions for disease control and system design. Solutions pursued in individual countries are specific to the nature of the tuberculosis epidemic, the underlying national health system, and the contributors engaged: no one size fits all. Findings from countries, including Bangladesh, Cambodia, India, Tanzania, Thailand, and Vietnam, suggest that advances in disease control and system strengthening are complementary. Tuberculosis care and control are essential elements of health systems, and simultaneous efforts to innovate systems and disease response are mutually reinforcing. Highly varied and context-specific responses to tuberculosis show that solutions need to be documented and compared to develop evidence-based policies and practice. Copyright 2010 Elsevier Ltd. All rights reserved.

Towards 5G communication systems: Are there health implications?

Science.gov (United States)

Di Ciaula, Agostino

2018-04-01

The spread of radiofrequency electromagnetic fields (RF-EMF) is rising and health effects are still under investigation. RF-EMF promote oxidative stress, a condition involved in cancer onset, in several acute and chronic diseases and in vascular homeostasis. Although some evidences are still controversial, the WHO IARC classified RF-EMF as "possible carcinogenic to humans", and more recent studies suggested reproductive, metabolic and neurologic effects of RF-EMF, which are also able to alter bacterial antibiotic resistance. In this evolving scenario, although the biological effects of 5G communication systems are very scarcely investigated, an international action plan for the development of 5G networks has started, with a forthcoming increment in devices and density of small cells, and with the future use of millimeter waves (MMW). Preliminary observations showed that MMW increase skin temperature, alter gene expression, promote cellular proliferation and synthesis of proteins linked with oxidative stress, inflammatory and metabolic processes, could generate ocular damages, affect neuro-muscular dynamics. Further studies are needed to better and independently explore the health effects of RF-EMF in general and of MMW in particular. However, available findings seem sufficient to demonstrate the existence of biomedical effects, to invoke the precautionary principle, to define exposed subjects as potentially vulnerable and to revise existing limits. An adequate knowledge of pathophysiological mechanisms linking RF-EMF exposure to health risk should also be useful in the current clinical practice, in particular in consideration of evidences pointing to extrinsic factors as heavy contributors to cancer risk and to the progressive epidemiological growth of noncommunicable diseases. Copyright © 2018 Elsevier GmbH. All rights reserved.

US spending on complementary and alternative medicine during 2002-08 plateaued, suggesting role in reformed health system.

Science.gov (United States)

Davis, Matthew A; Martin, Brook I; Coulter, Ian D; Weeks, William B

2013-01-01

Complementary and alternative medicine services in the United States are an approximately $9 billion market each year, equal to 3 percent of national ambulatory health care expenditures. Unlike conventional allopathic health care, complementary and alternative medicine is primarily paid for out of pocket, although some services are covered by most health insurance. Examining trends in demand for complementary and alternative medicine services in the United States reported in the Medical Expenditure Panel Survey during 2002-08, we found that use of and spending on these services, previously on the rise, have largely plateaued. The higher proportion of out-of-pocket responsibility for payment for services may explain the lack of growth. Our findings suggest that any attempt to reduce national health care spending by eliminating coverage for complementary and alternative medicine would have little impact at best. Should some forms of complementary and alternative medicine-for example, chiropractic care for back pain-be proven more efficient than allopathic and specialty medicine, the inclusion of complementary and alternative medicine providers in new delivery systems such as accountable care organizations could help slow growth in national health care spending.

The public health system in England

National Research Council Canada - National Science Library

Hunter, David J; Marks, Linda; Smith, Katherine E

2010-01-01

.... The Public Health System in England offers a wide-ranging, provocative and accessible assessment of challenges confronting a public health system, exploring how its parameters have shifted over time...

Groundwater table rise in northwest Nile Delta:Problems and Recommendations

International Nuclear Information System (INIS)

El-Sayed, S. A.; Atta, E. R.; Al-Ashri, K. M.

2012-01-01

The present research work is devoted to evaluate the surrounding zones of a site which could be selected for construction of radiation facility. It is a model study to investigate the factors that protect sites from the risks of groundwater rising. The study area (village 17 and the related cultivated lands) lies in Bangar El Sukar area, south Alexandria Governorate. The area is suffering from the groundwater table rise phenomenon and its relevant problems (water logging, soil salinization and degradation of buildings). This water table rise is investigated using the hydrogeological, hydrogeochemical and isotopic approaches. The groundwater table of the Pleistocene-Holocene aquifer rises due to uncontrolled irrigation and drainage systems and the lack of municipal sewage system as well as soil and aquifer characteristics. The aquifer is being shallow and exists under semi-confined conditions. It consists of heterogeneous deposits (very fine to coarse grained sand, clay and calcareous rock fragments). Depths to water vary between 0.85 m and 1.44 m from ground surface. The groundwater (TDS 3331 mg/l, averagely) is a mixture of both the fresh water of the irrigation canals (TDS = 544.2 mg/l) and the more saline water (TDS = 5505 mg/l, averagely) of the drains used in irrigation. Nile water is considered the main recharge source to these types of waters. The recharge to the aquifer occurs by seepage from the canals and/or by the infiltration of the return flow after irrigation. The infiltration rate is moderately rapid (ranging from 1.8 mm/min to 2.6 mm/min). The groundwater moves from south to north with an average hydraulic gradient reaching about 1.7 x 10-3. The average rate of groundwater flow through the aquifer varies between 1799 m2/day and 543.65 m2/day. In order to avoid the risks related to the problem and its environmental impacts, proper recommendations are presented. Suggested design for a constructed net of drainage system and pumped well is presented in

Health system vision of iran in 2025.

Science.gov (United States)

Rostamigooran, N; Esmailzadeh, H; Rajabi, F; Majdzadeh, R; Larijani, B; Dastgerdi, M Vahid

2013-01-01

Vast changes in disease features and risk factors and influence of demographic, economical, and social trends on health system, makes formulating a long term evolutionary plan, unavoidable. In this regard, to determine health system vision in a long term horizon is a primary stage. After narrative and purposeful review of documentaries, major themes of vision statement were determined and its context was organized in a work group consist of selected managers and experts of health system. Final content of the statement was prepared after several sessions of group discussions and receiving ideas of policy makers and experts of health system. Vision statement in evolutionary plan of health system is considered to be :"a progressive community in the course of human prosperity which has attained to a developed level of health standards in the light of the most efficient and equitable health system in visionary region(1) and with the regarding to health in all policies, accountability and innovation". An explanatory context was compiled either to create a complete image of the vision. Social values and leaders' strategic goals, and also main orientations are generally mentioned in vision statement. In this statement prosperity and justice are considered as major values and ideals in society of Iran; development and excellence in the region as leaders' strategic goals; and also considering efficiency and equality, health in all policies, and accountability and innovation as main orientations of health system.

Improving the health of people with multimorbidity: the need for prospective cohort studies

Directory of Open Access Journals (Sweden)

Stewart W. Mercer

2011-12-01

Full Text Available The many challenges of multimorbidity The dramatic rise in long-term conditions (LTCs represents a major challenge for individuals, families, and health care systems worldwide [1]. Due to the scale of this rise, the management of patients with LTCs largely falls within the domain of primary rather than secondary care, at least in countries with well-developed primary care systems. For example, in the UK, which has a comprehensive primary care system based around general practice (trained family physicians working in multidisciplinary teams and funded by the National Health Service (NHS, primary care contacts account for around 90% of the total activity of the NHS, and patients with LTCs account for 80% of general practice consultations [2]. Effective primary care and community-based management of people with LTCs is thus a top priority [2–6].

Local health systems in 21st century: who cares?-An exploratory study on health system governance in Amsterdam.

Science.gov (United States)

Plochg, T; Delnoij, D M J; Hogervorst, W V G; van Dijk, P; Belleman, S; Klazinga, N S

2006-10-01

There is a growing awareness that there should be a public health perspective to health system governance. Its intrinsic population health orientation provides the ultimate ground for determining the health needs and governing collaborative care arrangements within which these needs can be met. Notwithstanding differences across countries, population health concerns are not central to European health reforms. Governments currently withdraw leaving governance roles to care providers and/or financiers. Thereby, incentives that trigger the uptake of a public health perspective are often ignored. In this study we addressed this issue in the city of Amsterdam. Using a qualitative study design, we explored whether there is a public health perspective to the governance practices of the municipality and the major sickness fund in Amsterdam. And if so, what the scope of this perspective is. And if not, why not. Findings indicate that the municipality has a public health perspective to local health system governance, but its scope is limited. The municipality facilitates rather than governs health care provision in Amsterdam. Furthermore, the sickness fund runs major financial risks when adapting a public health perspective. It covers an insured population that partly overlaps the Amsterdam population. Returns on investments in population health are therefore uncertain, as competitors would also profit from the sickness fund's investments. The local health system in Amsterdam is not consistently aligned to the health needs of the Amsterdam population. The Amsterdam case is not unique and general consequences for local health system governance are discussed.

Spatial Hedonic Models for Measuring the Impact of Sea-Level Rise on Coastal Real Estate

OpenAIRE

Okmyung Bin; Ben Poulter; Christopher F. Dumas; John C. Whitehead

2009-01-01

This study uses a unique integration of geospatial and hedonic property data to estimate the impact of sea-level rise on coastal real estate in North Carolina. North Carolina’s coastal plain is one of several large terrestrial systems around the world threatened by rising sea-levels. High-resolution topographic LIDAR (Light Detection and Ranging) data are used to provide accurate inundation maps for all properties that will be at risk under six different sea-level rise scenarios. A simulation...

Oral and General Health Promotion for Children: A Holistic Approach

DEFF Research Database (Denmark)

Cinar, Ayse Basak

Inequalities in oral and general health have been rising globally; WHO calls for adoption of an integrated approach to their promotion as both share common risk factors. However, research about this issue among children is scarce. Based on the associations of such a research found in common for a...... to adopt healthy lifestyles, both in economically developing and developed countries. This book should be especially useful to researchers, professionals in dentistry and medicine, policy makers, and anyone else involved in provision of better health to community....... Turkish and Finnish children, this book underlies that oral health is turning out to be part of the global health culture, regardless of cultural differences and different oral health care systems. The book, further, by most recent literature, provides a review of 'Significance of Oral Health, Concept......Inequalities in oral and general health have been rising globally; WHO calls for adoption of an integrated approach to their promotion as both share common risk factors. However, research about this issue among children is scarce. Based on the associations of such a research found in common for all...

Mobile health monitoring system for community health workers

CSIR Research Space (South Africa)

Sibiya, G

2014-09-01

Full Text Available of hypertension as it provides real time information and eliminates the need to visit a healthcare facility to take blood pressure readings. Our proposed mobile health monitoring system enables faster computerization of data that has been recorded... pressure, heart rate and glucose readings. These reading closely related to most common NCDs. D. Feedback to health worker and the subject of care Community health workers are often not professionally trained on health. As a result they are not expected...

Integrated System Health Management Development Toolkit

Science.gov (United States)

Figueroa, Jorge; Smith, Harvey; Morris, Jon

2009-01-01

This software toolkit is designed to model complex systems for the implementation of embedded Integrated System Health Management (ISHM) capability, which focuses on determining the condition (health) of every element in a complex system (detect anomalies, diagnose causes, and predict future anomalies), and to provide data, information, and knowledge (DIaK) to control systems for safe and effective operation.

Populism, Exclusion, Post-truth. Some Conceptual Caveats Comment on "The Rise of Post-truth Populism in Pluralist Liberal Democracies: Challenges for Health Policy".

Science.gov (United States)

De Cleen, Benjamin

2017-07-15

In their editorial, Speed and Mannion identify two main challenges "the rise of post-truth populism" poses for health policy: the populist threat to inclusive healthcare policies, and the populist threat to well-designed health policies that draw on professional expertise and research evidence. This short comment suggests some conceptual clarifications that might help in thinking through more profoundly these two important issues. It argues that we should approach right-wing populism as a combination of a populist down/up (people/elite) axis with an exclusionary nationalist in/out (member/non-member) axis. And it raises some questions regarding the equation between populism, demagogy and the rejection of expertise and scientific knowledge. © 2018 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Advancing Health Literacy Measurement: A Pathway to Better Health and Health System Performance

Science.gov (United States)

Pleasant, Andrew

2014-01-01

The concept of health literacy initially emerged and continues to gain strength as an approach to improving health status and the performance of health systems. Numerous studies clearly link low levels of education, literacy, and health literacy with poor health, poor health care utilization, increased barriers to care, and early death. However, theoretical understandings and methods of measuring the complex social construct of health literacy have experienced a continual evolution that remains incomplete. As a result, the seemingly most-cited definition of health literacy proposed in the now-decade-old Institute of Medicine report on health literacy is long overdue for updating. Such an effort should engage a broad and diverse set of health literacy researchers, practitioners, and members of the public in creating a definition that can earn broad consensus through validation testing in a rigorous scientific approach. That effort also could produce the basis for a new universally applicable measure of health literacy. Funders, health systems, and policymakers should reconsider their timid approach to health literacy. Although the field and corresponding evidence base are not perfect, health literacy—especially when combined with a focus on prevention and integrative health—is one of the most promising approaches to advancing public health. PMID:25491583

Software for Intelligent System Health Management

Science.gov (United States)

Trevino, Luis C.

2004-01-01

This viewgraph presentation describes the characteristics and advantages of autonomy and artificial intelligence in systems health monitoring. The presentation lists technologies relevant to Intelligent System Health Management (ISHM), and some potential applications.

Dual-Use Aspects of System Health Management

Science.gov (United States)

Owens, P. R.; Jambor, B. J.; Eger, G. W.; Clark, W. A.

1994-01-01

System Health Management functionality is an essential part of any space launch system. Health management functionality is an integral part of mission reliability, since it is needed to verify the reliability before the mission starts. Health Management is also a key factor in life cycle cost reduction and in increasing system availability. The degree of coverage needed by the system and the degree of coverage made available at a reasonable cost are critical parameters of a successful design. These problems are not unique to the launch vehicle world. In particular, the Intelligent Vehicle Highway System, commercial aircraft systems, train systems, and many types of industrial production facilities require various degrees of system health management. In all of these applications, too, the designers must balance the benefits and costs of health management in order to optimize costs. The importance of an integrated system is emphasized. That is, we present the case for considering health management as an integral part of system design, rather than functionality to be added on at the end of the design process. The importance of maintaining the system viewpoint is discussed in making hardware and software tradeoffs and in arriving at design decisions. We describe an approach to determine the parameters to be monitored in any system health management application. This approach is based on Design of Experiments (DOE), prototyping, failure modes and effects analyses, cost modeling and discrete event simulation. The various computer-based tools that facilitate the approach are discussed. The approach described originally was used to develop a fault tolerant avionics architecture for launch vehicles that incorporated health management as an integral part of the system. Finally, we discuss generalizing the technique to apply it to other domains. Several illustrations are presented.

Some think of all rises on efficiency and performance for antisubmarine weapon

International Nuclear Information System (INIS)

Wan Qian

2003-01-01

The integrated antisubmarine weapon system is new antisubmarine weapon system studied by our country. The efficiency and performance of the system was not put into fullplay in the trying on. The reason for thus is much, such as: personnel, training, management, use, arm system and son on. The author presented some think of all rises on efficiency and performance for integrated antisubmarine weapon

Management Matters: A Leverage Point for Health Systems Strengthening in Global Health

Directory of Open Access Journals (Sweden)

Elizabeth H. Bradley

2015-07-01

Full Text Available Despite a renewed focus in the field of global health on strengthening health systems, inadequate attention has been directed to a key ingredient of high-performing health systems: management. We aimed to develop the argument that management – defined here as the process of achieving predetermined objectives through human, financial, and technical resources – is a cross-cutting function necessary for success in all World Health Organization (WHO building blocks of health systems strengthening. Management within health systems is particularly critical in low-income settings where the efficient use of scarce resources is paramount to attaining health goals. More generally, investments in management capacity may be viewed as a key leverage point in grand strategy, as strong management enables the achievement of large ends with limited means. We also sought to delineate a set of core competencies and identify key roles to be targeted for management capacity building efforts. Several effective examples of management interventions have been described in the research literature. Together, the existing evidence underscores the importance of country ownership of management capacity building efforts, which often challenge the status quo and thus need country leadership to sustain despite inevitable friction. The literature also recognizes that management capacity efforts, as a key ingredient of effective systems change, take time to embed, as new protocols and ways of working become habitual and integrated as standard operating procedures. Despite these challenges, the field of health management as part of global health system strengthening efforts holds promise as a fundamental leverage point for achieving health system performance goals with existing human, technical, and financial resources. The evidence base consistently supports the role of management in performance improvement but would benefit from additional research with improved

COMMUNITY HEALTH & PRIMARY HEALTH CARE

African Journals Online (AJOL)

adedamla

enrol in an insurance scheme feeling that they need more information on health insurance and the willingness to enrol in a ... and utilize the benefits of different types of health insurance services. Conclusion: The findings ..... improvements in access and quality of care, and the ... the 'rising tide' of and information technology.

An assessment of interactions between global health initiatives and country health systems.

Science.gov (United States)

Samb, Badara; Evans, Tim; Dybul, Mark; Atun, Rifat; Moatti, Jean-Paul; Nishtar, Sania; Wright, Anna; Celletti, Francesca; Hsu, Justine; Kim, Jim Yong; Brugha, Ruairi; Russell, Asia; Etienne, Carissa

2009-06-20

Since 2000, the emergence of several large disease-specific global health initiatives (GHIs) has changed the way in which international donors provide assistance for public health. Some critics have claimed that these initiatives burden health systems that are already fragile in countries with few resources, whereas others have asserted that weak health systems prevent progress in meeting disease-specific targets. So far, most of the evidence for this debate has been provided by speculation and anecdotes. We use a review and analysis of existing data, and 15 new studies that were submitted to WHO for the purpose of writing this Report to describe the complex nature of the interplay between country health systems and GHIs. We suggest that this Report provides the most detailed compilation of published and emerging evidence so far, and provides a basis for identification of the ways in which GHIs and health systems can interact to mutually reinforce their effects. On the basis of the findings, we make some general recommendations and identify a series of action points for international partners, governments, and other stakeholders that will help ensure that investments in GHIs and country health systems can fulfil their potential to produce comprehensive and lasting results in disease-specific work, and advance the general public health agenda. The target date for achievement of the health-related Millennium Development Goals is drawing close, and the economic downturn threatens to undermine the improvements in health outcomes that have been achieved in the past few years. If adjustments to the interactions between GHIs and country health systems will improve efficiency, equity, value for money, and outcomes in global public health, then these opportunities should not be missed.

Health record systems that meet clinical needs

Directory of Open Access Journals (Sweden)

Gabriella Negrini

2012-10-01

Full Text Available Introduction Increased attention has recently been focused on health record systems as a result of accreditation programs, a growing emphasis on patient safety, and the increase in lawsuits involving allegations of malpractice. Health-care professionals frequently express dissatisfaction with the health record systems and complain that the data included are neither informative nor useful for clinical decision making. This article reviews the main objectives of a hospital health record system, with emphasis on its roles in communication and exchange among clinicians, patient safety, and continuity of care, and asks whether current systems have responded to the recent changes in the Italian health-care system.Discussion If health records are to meet the expectations of all health professionals, the overall information need must be carefully analyzed, a common data set must be created, and essential specialist contributions must be defined. Working with health-care professionals, the hospital management should define how clinical information is to be displayed and organized, identify a functionally optimal layout, define the characteristics of ongoing patient assessment in terms of who will be responsible for these activities and how often they will be performed. Internet technology can facilitate data retrieval and meet the general requirements of a paper-based health record system, but it must also ensure focus on clinical information, business continuity, integrity, security, and privacy.Conclusions The current health records system needs to be thoroughly revised to increase its accessibility, streamline the work of health-care professionals who consult it, and render it more useful for clinical decision making—a challenging task that will require the active involvement of the many professional classes involved.

Health Care Payments in Vietnam: Patients’ Quagmire of Caring for Health versus Economic Destitution

Directory of Open Access Journals (Sweden)

Andre Pekerti

2017-09-01

Full Text Available In the last three decades many developing and middle-income nations’ health care systems have been financed via out-of-pocket payments by individuals. User fees charges, however, may not be the best approach or thenmost equitable approach to finance and/or reform health services in developing nations. This study investigates the status of Vietnam’s current health system as a result of implementing user fees policies. A recent mandate by the government to increase the universal cover to 100% attempts to tackle inadequate insurance cover, one of the four major factors contributing to the high and increasing probability of destitution for Vietnamese patients (the other three being: non-residency, long stay in hospital, and high cost of treatment. Empirical results however suggest that this may be catastrophic for low-income earners: if insurance cover reimbursement decreases below 50% of actual health expenditures, the probability of Vietnamese falling into destitution will rise further. Our findings provide policy implications and directions to improve Vietnam’s health care system, in particular by ensuring the utilization of health services and financial protection for the people.

High-rise construction in the Saint Petersburg agglomeration in 1703–1950s

Directory of Open Access Journals (Sweden)

Sementsov Sergey

2018-01-01

Full Text Available Regularities of high-rise construction (implemented projects and developments in Saint Petersburg and the Saint Petersburg agglomeration since the foundation of the city in 1703 till the 1950s are considered. Based on these regularities, a single spatially developed system of vertical dominants is formed. High-rise construction in the city and its suburbs started in the 1710s and continues up to the present time. In the considered decades (1703–1950s, high-rise construction mostly performed urban-planning functions (with vertical and symbolic dominants, relying on patterns of the visual perception of man-made landscapes under development. Since the 1710s, the construction of vertical dominants (mainly temples, spires of towers, lighthouses, etc. of five ranks (depending on the altitude range and in relation to the background development was conducted in territories of the entire agglomeration. These dominants were arranged in landscapes of the city and suburbs with almost mathematically precise accuracy and according to special regulations. Such dominants obtained particular descriptive and silhouette characteristics in accordance with the conditions of spatial perception. In some periods of city development, attempts were made to create monuments (symbolic dominants of specific height and include those in the spatial system of high-rise dominants as significant elements of the city silhouette.

X-33/RLV System Health Management/Vehicle Health Management

Science.gov (United States)

Mouyos, William; Wangu, Srimal

1998-01-01

To reduce operations costs, Reusable Launch Vehicles (RLVS) must include highly reliable robust subsystems which are designed for simple repair access with a simplified servicing infrastructure, and which incorporate expedited decision-making about faults and anomalies. A key component for the Single Stage To Orbit (SSTO) RLV system used to meet these objectives is System Health Management (SHM). SHM incorporates Vehicle Health Management (VHM), ground processing associated with the vehicle fleet (GVHM), and Ground Infrastructure Health Management (GIHM). The primary objective of SHM is to provide an automated and paperless health decision, maintenance, and logistics system. Sanders, a Lockheed Martin Company, is leading the design, development, and integration of the SHM system for RLV and for X-33 (a sub-scale, sub-orbit Advanced Technology Demonstrator). Many critical technologies are necessary to make SHM (and more specifically VHM) practical, reliable, and cost effective. This paper will present the X-33 SHM design which forms the baseline for the RLV SHM, and it will discuss applications of advanced technologies to future RLVs. In addition, this paper will describe a Virtual Design Environment (VDE) which is being developed for RLV. This VDE will allow for system design engineering, as well as program management teams, to accurately and efficiently evaluate system designs, analyze the behavior of current systems, and predict the feasibility of making smooth and cost-efficient transitions from older technologies to newer ones. The RLV SHM design methodology will reduce program costs, decrease total program life-cycle time, and ultimately increase mission success.

The rise and fall of democratic universalism: health care reform in Italy, 1978-1994.

Science.gov (United States)

Ferrera, M

1995-01-01

In 1978, a sweeping reform created the first national health service of continental Europe: Italy's Servizio Sanitario Nazionale. This new scheme was based on the principle of "full democratic universalism": The state would provide free and equal benefits to every citizen and the organization of public health would subject to popular control, essentially through political parties. However, the severe problems encountered in implementing the reform design and rapidly increasing health expenditures soon eroded any consensus on this principle. Thus the 1980s and early 1990s witnessed a gradual shift to "conditional and well managed universalism." These latter principles stress the need to differentiate access to care according to some criterion to regulate demand and the need for efficient use of scarce resources through adequate valorization of managerial skills and the use of "market-type" incentives. An elaborated system of user copayments was introduced gradually, and in 1992 a "reform of the reform" profoundly changed the organizational framework of the Servizio Sanitario Nazionale. The new government elected in the spring of 1994 announced ambitious plans to partially dismantle public universal insurance. Although these plans may prove difficult, the potential to form an anti-universalistic coalition seems strong in the contemporary Italian health care arena.

Health Information Systems

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

the technology and expertise to process and share ... services. GEHS supports efforts that reach beyond healthcare institutions to capture evidence ... Health information systems are a foundation for quality care, and can increase accountability ...

African Health Systems Initiative (AHSI) | IDRC - International ...

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

The African Health Systems Initiative (AHSI) is a 10-year Canadian International ... for strengthening African-led health systems and human resources for health. ... IDRC congratulates first cohort of Women in Climate Change Science Fellows.

New forms of contractual relationships and the implications for occupational safety and health

NARCIS (Netherlands)

Goudswaard, A.; André, J.C.; Ekstedt, E.

2002-01-01

Changes in the world of work can give rise to new risk areas or change the way that occupational safety and health needs to be managed. This has implications for workplaces themselves and also for the occupational safety and health system. For this reason the 'changing world of work' has been a

Croatia: health system review.

Science.gov (United States)

Džakula, Aleksandar; Sagan, Anna; Pavić, Nika; Lonćčarek, Karmen; Sekelj-Kauzlarić, Katarina

2014-01-01

Croatia is a small central European country on the Balkan peninsula, with a population of approximately 4.3 million and a gross domestic product (GDP) of 62% of the European Union (EU) average (expressed in purchasing power parity; PPP) in 2012. On 1 July 2013, Croatia became the 28th Member State of the EU. Life expectancy at birth has been increasing steadily in Croatia (with a small decline in the years following the 1991 to 1995 War of Independence) but is still lower than the EU average. Prevalence of overweight and obesity in the population has increased during recent years and trends in physical inactivity are alarming. The Croatian Health Insurance Fund (CHIF), established in 1993, is the sole insurer in the mandatory health insurance (MHI) system that provides universal health coverage to the whole population. The ownership of secondary health care facilities is distributed between the State and the counties. The financial position of public hospitals is weak and recent reforms were aimed at improving this. The introduction of concessions in 2009 (public private partnerships whereby county governments organize tenders for the provision of specific primary health care services) allowed the counties to play a more active role in the organization, coordination and management of primary health care; most primary care practices have been privatized. The proportion of GDP spent on health by the Croatian government remains relatively low compared to western Europe, as does the per capita health expenditure. Although the share of public expenditure as a proportion of total health expenditure (THE) has been decreasing, at around 82% it is still relatively high, even by European standards. The main source of the CHIFs revenue is compulsory health insurance contributions, accounting for 76% of the total revenues of the CHIF, although only about a third of the population (active workers) is liable to pay full health care contributions. Although the breadth and scope

Rising Long-term Interest Rates

DEFF Research Database (Denmark)

Hallett, Andrew Hughes

Rather than chronicle recent developments in European long-term interest rates as such, this paper assesses the impact of increases in those interest rates on economic performance and inflation. That puts us in a position to evaluate the economic pressures for further rises in those rates......, the first question posed in this assignment, and the scope for overshooting (the second question), and then make some illustrative predictions of future interest rates in the euro area. We find a wide range of effects from rising interest rates, mostly small and mostly negative, focused on investment...... till the emerging European recovery is on a firmer basis and capable of overcoming increases in the cost of borrowing and shrinking fiscal space. There is also an implication that worries about rising/overshooting interest rates often reflect the fact that inflation risks are unequally distributed...

Efficiency performance of China's health care delivery system.

Science.gov (United States)

Zhang, Luyu; Cheng, Gang; Song, Suhang; Yuan, Beibei; Zhu, Weiming; He, Li; Ma, Xiaochen; Meng, Qingyue

2017-07-01

Improving efficiency performance of the health care delivery system has been on the agenda for the health system reform that China initiated in 2009. This study examines the changes in efficiency performance and determinants of efficiency after the reform to provide evidence to assess the progress of the reform from the perspective of efficiency. Descriptive analysis, Data Envelopment Analysis, the Malmquist Index, and multilevel regressions are used with data from multiple sources, including the World Bank, the China Health Statistical Yearbook, and routine reports. The results indicate that over the last decade, health outcomes compared with health investment were relatively higher in China than in most other countries worldwide, and the trend was stable. The overall efficiency and total factor productivity increased after the reform, indicating that the reform was likely to have had a positive impact on the efficiency performance of the health care delivery system. However, the health care delivery structure showed low system efficiency, mainly attributed to the weakened primary health care system. Strengthening the primary health care system is central to enhancing the future performance of China's health care delivery system. Copyright © 2017 John Wiley & Sons, Ltd.

Understanding and valuing the broader health system benefits of Uganda's national Human Resources for Health Information System investment.

Science.gov (United States)

Driessen, Julia; Settle, Dykki; Potenziani, David; Tulenko, Kate; Kabocho, Twaha; Wadembere, Ismail

2015-08-31

To address the need for timely and comprehensive human resources for health (HRH) information, governments and organizations have been actively investing in electronic health information interventions, including in low-resource settings. The economics of human resources information systems (HRISs) in low-resource settings are not well understood, however, and warrant investigation and validation. This case study describes Uganda's Human Resources for Health Information System (HRHIS), implemented with support from the US Agency for International Development, and documents perceptions of its impact on the health labour market against the backdrop of the costs of implementation. Through interviews with end users and implementers in six different settings, we document pre-implementation data challenges and consider how the HRHIS has been perceived to affect human resources decision-making and the healthcare employment environment. This multisite case study documented a range of perceived benefits of Uganda's HRHIS through interviews with end users that sought to capture the baseline (or pre-implementation) state of affairs, the perceived impact of the HRHIS and the monetary value associated with each benefit. In general, the system appears to be strengthening both demand for health workers (through improved awareness of staffing patterns) and supply (by improving licensing, recruitment and competency of the health workforce). This heightened ability to identify high-value employees makes the health sector more competitive for high-quality workers, and this elevation of the health workforce also has broader implications for health system performance and population health. Overall, it is clear that HRHIS end users in Uganda perceived the system to have significantly improved day-to-day operations as well as longer term institutional mandates. A more efficient and responsive approach to HRH allows the health sector to recruit the best candidates, train employees in

Improvement of the bubble rise velocity model in the pressurizer using ALMOD 3 computer code to calculate evaporation

International Nuclear Information System (INIS)

Madeira, A.A.

1985-01-01

It's studied the improvement for the calculation of bubble rise velocity, by adding two different ways to estimate this velocity, one of which more adequate to pressures normally found in the Reactor Cooling System. Additionally, a limitation in bubble rise velocity growth was imposed, to account for the actual behavior of bubble rise in two-phase mixtures. (Author) [pt

Techno-economic analysis of a wind-solar hybrid renewable energy system with rainwater collection feature for urban high-rise application

International Nuclear Information System (INIS)

Chong, W.T.; Naghavi, M.S.; Poh, S.C.; Mahlia, T.M.I.; Pan, K.C.

2011-01-01

Graphical abstract: This wind-solar hybrid renewable energy system is a new concept of the utilization, integration and optimization of existing renewable energy and rain water harvesting technologies. It is compact and can be built on the top of high rise buildings to provide on-site green power to that building or feed into the grid line. This system utilizes the advantages of Malaysian climate, i.e. high solar radiation and rainfall for green energy generation and free water supply. It also overcomes the inferior aspect on the low wind speed by guiding and increasing the speed of the high altitude free-stream wind from all directions radially through power-augmentation-guide-vane (PAGV) before entering the wind turbine at center portion. The PAGV is an innovative design used to guide and create venturi effect to increase the wind speed before the wind-stream enters wind turbine. The system must also be designed to provide optimum surface area for solar panel (solar thermal or photovoltaic or solar PV/T)) installation and battery compartment for power storage. In addition; rain water collection feature must be built-into the system design. The system is recommended to be sited on the top of high rise buildings or structures with its appearance or outer design can be blended into the building architecture without negative visual impact. With this system, the size of wind turbine can be reduced for a given power output and the noise is also reduced since it is contained in the PAGV. The design is also safer and suitable to be used in populated area. Mesh can be mounted at the entrance of the PAGV to prevent the bird-strike. This system can eliminate or minimize the current problems concerning public acceptance of wind energy, i.e. poor starting behavior in low wind speed, noise, visual impact, electromagnetic interference, safety and environmental factors. Highlights: → This wind, solar and rain harvester integrates existing renewable energy and rain water

HealthStyles: a new psychographic segmentation system for health care marketers.

Science.gov (United States)

Endresen, K W; Wintz, J C

1988-01-01

HealthStyles is a new psychographic segmentation system specifically designed for the health care industry. This segmentation system goes beyond traditional geographic and demographic analysis and examines health-related consumer attitudes and behaviors. Four statistically distinct "styles" of consumer health care preferences have been identified. The profiles of the four groups have substantial marketing implications in terms of design and promotion of products and services. Each segment of consumers also has differing expectations of physician behavior.

China's rise as a major contributor to science and technology.

Science.gov (United States)

Xie, Yu; Zhang, Chunni; Lai, Qing

2014-07-01

In the past three decades, China has become a major contributor to science and technology. China now employs an increasingly large labor force of scientists and engineers at relatively high earnings and produces more science and engineering degrees than the United States at all levels, particularly bachelor's. China's research and development expenditure has been rising. Research output in China has been sharply increasing since 2002, making China the second largest producer of scientific papers after the United States. The quality of research by Chinese scientists has also been improving steadily. However, China's rise in science also faces serious difficulties, partly attributable to its rigid, top-down administrative system, with allegations of scientific misconduct trending upward.

Fellowship Program in Health System Improvement: A novel approach integrating leadership development and patient-centred health system transformation.

Science.gov (United States)

Philippon, Donald J; Montesanti, Stephanie; Stafinski, Tania

2018-03-01

This article highlights a novel approach to professional development, integrating leadership, development and patient-centred health system transformation in the new Fellowship Program in Health System Improvement offered by the School of Public Health at the University of Alberta. Early assessment of the program is also provided.

US Spending On Complementary And Alternative Medicine During 2002–08 Plateaued, Suggesting Role In Reformed Health System

Science.gov (United States)

Davis, Matthew A.; Martin, Brook I.; Coulter, Ian D.; Weeks, William B.

2013-01-01

Complementary and alternative medicine services in the United States are an approximately $9 billion market each year, equal to 3 percent of national ambulatory health care expenditures. Unlike conventional allopathic health care, complementary and alternative medicine is primarily paid for out of pocket, although some services are covered by most health insurance. Examining trends in demand for complementary and alternative medicine services in the United States reported in the Medical Expenditure Panel Survey during 2002–08, we found that use of and spending on these services, previously on the rise, have largely plateaued. The higher proportion of out-of-pocket responsibility for payment for services may explain the lack of growth. Our findings suggest that any attempt to reduce national health care spending by eliminating coverage for complementary and alternative medicine would have little impact at best. Should some forms of complementary and alternative medicine—for example, chiropractic care for back pain—be proven more efficient than allopathic and specialty medicine, the inclusion of complementary and alternative medicine providers in new delivery systems such as accountable care organizations could help slow growth in national health care spending. PMID:23297270

New Reforms to the Health System

OpenAIRE

Tran Dai, Candice; Duchâtel, Mathieu

2012-01-01

Based on:– Li Ling, “Successful reform of the health system hangs on two key elements,” Zhongguo jingyingbao (China Management News), 18 April 2009.– Li Hongmei, Li Xiaohong, Wang Junping, “Ten experts comment on the new reform of the health system: Providing better and cheaper access to medical care,” Renmin ribao (People’s Daily), 15 April 2009.– Yao Qi, “The new reform of the health system must first and foremost compensate for the shortcomings in the local hospitals,” Yangcheng wanbao (Ya...

United States of America: health system review.

Science.gov (United States)

Rice, Thomas; Rosenau, Pauline; Unruh, Lynn Y; Barnes, Andrew J; Saltman, Richard B; van Ginneken, Ewout

2013-01-01

This analysis of the United States health system reviews the developments in organization and governance, health financing, health-care provision, health reforms and health system performance. The US health system has both considerable strengths and notable weaknesses. It has a large and well-trained health workforce, a wide range of high-quality medical specialists as well as secondary and tertiary institutions, a robust health sector research program and, for selected services, among the best medical outcomes in the world. But it also suffers from incomplete coverage of its citizenry, health expenditure levels per person far exceeding all other countries, poor measures on many objective and subjective measures of quality and outcomes, an unequal distribution of resources and outcomes across the country and among different population groups, and lagging efforts to introduce health information technology. It is difficult to determine the extent to which deficiencies are health-system related, though it seems that at least some of the problems are a result of poor access to care. Because of the adoption of the Affordable Care Act in 2010, the United States is facing a period of enormous potential change. Improving coverage is a central aim, envisaged through subsidies for the uninsured to purchase private insurance, expanded eligibility for Medicaid (in some states) and greater protection for insured persons. Furthermore, primary care and public health receive increased funding, and quality and expenditures are addressed through a range of measures. Whether the ACA will indeed be effective in addressing the challenges identified above can only be determined over time. World Health Organization 2013 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).

Developing a dementia-specific health state classification system for a new preference-based instrument AD-5D.

Science.gov (United States)

Nguyen, Kim-Huong; Mulhern, Brendan; Kularatna, Sanjeewa; Byrnes, Joshua; Moyle, Wendy; Comans, Tracy

2017-01-25

With an ageing population, the number of people with dementia is rising. The economic impact on the health care system is considerable and new treatment methods and approaches to dementia care must be cost effective. Economic evaluation requires valid patient reported outcome measures, and this study aims to develop a dementia-specific health state classification system based on the Quality of Life for Alzheimer's disease (QOL-AD) instrument (nursing home version). This classification system will subsequently be valued to generate a preference-based measure for use in the economic evaluation of interventions for people with dementia. We assessed the dimensionality of the QOL-AD to develop a new classification system. This was done using exploratory and confirmatory factor analysis and further assessment of the structure of the measure to ensure coverage of the key areas of quality of life. Secondly, we used Rasch analysis to test the psychometric performance of the items, and select item(s) to describe each dimension. This was done on 13 items of the QOL-AD (excluding two general health items) using a sample of 284 residents living in long-term care facilities in Australia who had a diagnosis of dementia. A five dimension classification system is proposed resulting from the three factor structure (defined as 'interpersonal environment', 'physical health' and 'self-functioning') derived from the factor analysis and two factors ('memory' and 'mood') from the accompanying review. For the first three dimensions, Rasch analysis selected three questions of the QOL-AD ('living situation', 'physical health', and 'do fun things') with memory and mood questions representing their own dimensions. The resulting classification system (AD-5D) includes many of the health-related quality of life dimensions considered important to people with dementia, including mood, global function and skill in daily living. The development of the AD-5D classification system is an important step

Big things come in bundled packages: implications of bundled payment systems in health care reimbursement reform.

Science.gov (United States)

Delisle, Dennis R

2013-01-01

With passage of the Affordable Care Act, the ever-evolving landscape of health care braces for another shift in the reimbursement paradigm. As health care costs continue to rise, providers are pressed to deliver efficient, high-quality care at flat to minimally increasing rates. Inherent systemwide inefficiencies between payers and providers at various clinical settings pose a daunting task for enhancing collaboration and care coordination. A change from Medicare's fee-for-service reimbursement model to bundled payments offers one avenue for resolution. Pilots using such payment models have realized varying degrees of success, leading to the development and upcoming implementation of a bundled payment initiative led by the Center for Medicare and Medicaid Innovation. Delivery integration is critical to ensure high-quality care at affordable costs across the system. Providers and payers able to adapt to the newly proposed models of payment will benefit from achieving cost reductions and improved patient outcomes and realize a competitive advantage.

The health and health system of South Africa: historical roots of current public health challenges.

Science.gov (United States)

Coovadia, Hoosen; Jewkes, Rachel; Barron, Peter; Sanders, David; McIntyre, Diane

2009-09-05

The roots of a dysfunctional health system and the collision of the epidemics of communicable and non-communicable diseases in South Africa can be found in policies from periods of the country's history, from colonial subjugation, apartheid dispossession, to the post-apartheid period. Racial and gender discrimination, the migrant labour system, the destruction of family life, vast income inequalities, and extreme violence have all formed part of South Africa's troubled past, and all have inexorably affected health and health services. In 1994, when apartheid ended, the health system faced massive challenges, many of which still persist. Macroeconomic policies, fostering growth rather than redistribution, contributed to the persistence of economic disparities between races despite a large expansion in social grants. The public health system has been transformed into an integrated, comprehensive national service, but failures in leadership and stewardship and weak management have led to inadequate implementation of what are often good policies. Pivotal facets of primary health care are not in place and there is a substantial human resources crisis facing the health sector. The HIV epidemic has contributed to and accelerated these challenges. All of these factors need to be addressed by the new government if health is to be improved and the Millennium Development Goals achieved in South Africa.

Embedding health literacy into health systems: a case study of a regional health service.

Science.gov (United States)

Vellar, Lucia; Mastroianni, Fiorina; Lambert, Kelly

2017-12-01

Objective The aim of the present study was to describe how one regional health service the Illawarra Shoalhaven Local Health District embedded health literacy principles into health systems over a 3-year period. Methods Using a case study approach, this article describes the development of key programs and the manner in which clinical incidents were used to create a health environment that allows consumers the right to equitably access quality health services and to participate in their own health care. Results The key outcomes demonstrating successful embedding of health literacy into health systems in this regional health service include the creation of a governance structure and web-based platform for developing and testing plain English consumer health information, a clearly defined process to engage with consumers, development of the health literacy ambassador training program and integrating health literacy into clinical quality improvement processes via a formal program with consumers to guide processes such as improvements to access and navigation around hospital sites. Conclusions The Illawarra Shoalhaven Local Health District has developed an evidence-based health literacy framework, guided by the core principles of universal precaution and organisational responsibility. Health literacy was also viewed as both an outcome and a process. The approach taken by the Illawarra Shoalhaven Local Health District to address poor health literacy in a coordinated way has been recognised by the Australian Commission on Safety and Quality in Health Care as an exemplar of a coordinated approach to embed health literacy into health systems. What is known about the topic? Poor health literacy is a significant national concern in Australia. The leadership, governance and consumer partnership culture of a health organisation can have considerable effects on an individual's ability to access, understand and apply the health-related information and services available to them

Socioeconomic differences in health expectancy in Denmark

DEFF Research Database (Denmark)

Brønnum-Hansen, Henrik

2000-01-01

Social differences in mortality rates reported in Denmark gave rise to the present study of health expectancy in different socioeconomic groups.......Social differences in mortality rates reported in Denmark gave rise to the present study of health expectancy in different socioeconomic groups....

National evaluation of Chinese coastal erosion to sea level rise using a Bayesian approach

International Nuclear Information System (INIS)

Zhan, Q; Fan, X; Du, X; Zhu, J

2014-01-01

In this paper a Causal Bayesian network is developed to predict decadal-scale shoreline evolution of China to sea-level rise. The Bayesian model defines relationships between 6 factors of Chinese coastal system such as coastal geomorphology, mean tide range, mean wave height, coastal slope, relative sea-level rise rate and shoreline erosion rate. Using the Bayesian probabilistic model, we make quantitative assessment of china's shoreline evolution in response to different future sea level rise rates. Results indicate that the probability of coastal erosion with high and very high rates increases from 28% to 32.3% when relative sea-level rise rates is 4∼6mm/a, and to 44.9% when relative sea-level rise rates is more than 6mm/a. A hindcast evaluation of the Bayesian model shows that the model correctly predicts 79.3% of the cases. Model test indicates that the Bayesian model shows higher predictive capabilities for stable coasts and very highly eroding coasts than moderately and highly eroding coasts. This study demonstrates that the Bayesian model is adapted to predicting decadal-scale Chinese coastal erosion associated with sea-level rise

The impact of mHealth interventions on health systems: a systematic review protocol.

Science.gov (United States)

Fortuin, Jill; Salie, Faatiema; Abdullahi, Leila H; Douglas, Tania S

2016-11-25

Mobile health (mHealth) has been described as a health enabling tool that impacts positively on the health system in terms of improved access, quality and cost of health care. The proposed systematic review will examine the impact of mHealth on health systems by assessing access, quality and cost of health care as indicators. The systematic review will include literature from various sources including published and unpublished/grey literature. The databases to be searched include: PubMed, Cochrane Library, Google Scholar, NHS Health Technology Assessment Database and Web of Science. The reference lists of studies will be screened and conference proceedings searched for additional eligible reports. Literature to be included will have mHealth as the primary intervention. Two authors will independently screen the search output, select studies and extract data; discrepancies will be resolved by consensus and discussion with the assistance of the third author. The systematic review will inform policy makers, investors, health professionals, technologists and engineers about the impact of mHealth in strengthening the health system. In particular, it will focus on three metrics to determine whether mHealth strengthens the health system, namely quality of, access to and cost of health care services. Systematic review registration: PROSPERO CRD42015026070.

Budget-makers and health care systems.

Science.gov (United States)

White, Joseph

2013-10-01

Health programs are shaped by the decisions made in budget processes, so how budget-makers view health programs is an important part of making health policy. Budgeting in any country involves its own policy community, with key players including budgeting professionals and political authorities. This article reviews the typical pressures on and attitudes of these actors when they address health policy choices. The worldview of budget professionals includes attitudes that are congenial to particular policy perspectives, such as the desire to select packages of programs that maximize population health. The pressures on political authorities, however, are very different: most importantly, public demand for health care services is stronger than for virtually any other government activity. The norms and procedures of budgeting also tend to discourage adoption of some of the more enthusiastically promoted health policy reforms. Therefore talk about rationalizing systems is not matched by action; and action is better explained by the need to minimize blame. The budget-maker's perspective provides insight about key controversies in healthcare policy such as decentralization, competition, health service systems as opposed to health insurance systems, and dedicated vs. general revenue finance. It also explains the frequency of various "gaming" behaviors. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Advancing the application of systems thinking in health: managing rural China health system development in complex and dynamic contexts.

Science.gov (United States)

Zhang, Xiulan; Bloom, Gerald; Xu, Xiaoxin; Chen, Lin; Liang, Xiaoyun; Wolcott, Sara J

2014-08-26

This paper explores the evolution of schemes for rural finance in China as a case study of the long and complex process of health system development. It argues that the evolution of these schemes has been the outcome of the response of a large number of agents to a rapidly changing context and of efforts by the government to influence this adaptation process and achieve public health goals. The study draws on several sources of data including a review of official policy documents and academic papers and in-depth interviews with key policy actors at national level and at a sample of localities. The study identifies three major transition points associated with changes in broad development strategy and demonstrates how the adaptation of large numbers of actors to these contextual changes had a major impact on the performance of the health system. Further, it documents how the Ministry of Health viewed its role as both an advocate for the interests of health facilities and health workers and as the agency responsible for ensuring that government health system objectives were met. It is argued that a major reason for the resilience of the health system and its ability to adapt to rapid economic and institutional change was the ability of the Ministry to provide overall strategy leadership. Additionally, it postulates that a number of interest groups have emerged, which now also seek to influence the pathway of health system development. This history illustrates the complex and political nature of the management of health system development and reform. The paper concludes that governments will need to increase their capacity to analyze the health sector as a complex system and to manage change processes.

[The Health Plan for Catalonia: an instrument to transform the health system].

Science.gov (United States)

Constante i Beitia, Carles

2015-11-01

The Department of Health of the Generalitat in Catalonia periodically draws up the Health Plan, which is the strategic document that brings together the reference framework for initiatives concerning public health in terms of the Catalan health administration. The 2011-2015 version of the Health Plan incorporates key care and system governance-related elements, which, in conjunction with health goals, make up the complete picture of what the health system in Catalonia should look like until 2015. The Plan was drawn up at a time when the environmental conditions were extremely particular, given the major economic crisis that began in 2007. This has meant that the system has been forced to address public health problems using a significant reduction in the economic resources available, while aiming to maintain the level of care provided, both quantitatively and qualitatively, and preserve the sustainability of the system whose defining traits are its universality, equity and the wide range of services on offer. The Health Plan focuses on three areas of action, 9 major courses of action and 32 strategic projects designed to respond to new social needs: addressing the most common health issues, comprehensive care for chronic patients and organizational modernization. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

THE E-HEALTH SYSTEMS IN POLAND

Directory of Open Access Journals (Sweden)

Zdzisław PÓLKOWSKI

2013-11-01

Full Text Available Information Technologies are disruptive technologies that have caused major changes in health system in Poland. Current digital economy is driven by modern information and new IT tools, which offer hospitals, doctors and patient access to any type of information, regardless of its form of existence, storage type or geographical location. These tools encourage the development of new activities, health services. The purpose of this article is to analyze the the current state of development of e-services in Poland in the context of nowadays health system. In the first part of the paper, the authors present various programmes, which enable the access to the medical services and patients’ data online. The next part of the paper is devoted to examining the technical aspects of the said programmes and presenting their advantages as well as the areas which might be improved.The last part of the work will be focused on the websites of the selected health institutions. According to the authors, WWW services provide much information on how the process of computer systems are being implemented, what data the services include and the capacity of the equipment as well as the software, human resources and the knowledge in this sphere. Moreover this section highlights the latest trends in e-health with particular emphasis on aspects such as the use of private and public cloud computer and t heir integration with web sites of health institutions. This study brings its contribution to the understanding of the change of health system in Poland behavior by using a new perspective e-health systems and IT tools above by doctors, officers and patients.

Possible impacts of sea-level rise on the Diep river/Rietvlei system, Cape-Town

CSIR Research Space (South Africa)

Hughes, P

1993-10-01

Full Text Available Many of the Cape Province's estuaries and tidal inlets have sandy connections to the sea and are often intensively developed for industrial or residential purposes. The possible impacts of sea-level rise are of considerable interest...

Health care prices, the federal budget, and economic growth.

Science.gov (United States)

Monaco, R M; Phelps, J H

1995-01-01

Rising health care spending, led by rising prices, has had an enormous impact on the economy, especially on the federal budget. Our work shows that if rapid growth in health care prices continues, under current institutional arrangements, real economic growth and employment will be lower during the next two decades than if health price inflation were somehow reduced. How big the losses are and which sectors bear the brunt of the costs vary depending on how society chooses to fund the federal budget deficit that stems from the rising cost of federal health care programs.

A Case for Open Network Health Systems: Systems as Networks in Public Mental Health

Directory of Open Access Journals (Sweden)

Michael Grant Rhodes

2017-03-01

Full Text Available Increases in incidents involving so-called confused persons have brought attention to the potential costs of recent changes to public mental health (PMH services in the Netherlands. Decentralized under the (Community Participation Act (2014, local governments must find resources to compensate for reduced central funding to such services or “innovate.” But innovation, even when pressure for change is intense, is difficult. This perspective paper describes experience during and after an investigation into a particularly violent incident and murder. The aim was to provide recommendations to improve the functioning of local PMH services. The investigation concluded that no specific failure by an individual professional or service provider facility led to the murder. Instead, also as a result of the Participation Act that severed communication lines between individuals and organizations, information sharing failures were likely to have reduced system level capacity to identify risks. The methods and analytical frameworks employed to reach this conclusion, also lead to discussion as to the plausibility of an unconventional solution. If improving communication is the primary problem, non-hierarchical information, and organizational networks arise as possible and innovative system solutions. The proposal for debate is that traditional “health system” definitions, literature and narratives, and operating assumptions in public (mental health are ‘locked in’ constraining technical and organization innovations. If we view a “health system” as an adaptive system of economic and social “networks,” it becomes clear that the current orthodox solution, the so-called integrated health system, typically results in a “centralized hierarchical” or “tree” network. An overlooked alternative that breaks out of the established policy narratives is the view of a ‘health systems’ as a non-hierarchical organizational structure or �

Integrating ICTs within health systems | IDRC - International ...

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

2016-06-10

Jun 10, 2016 ... But for too long, ICT and health system researchers have worked in isolation ... be used to enable the governance and functioning of health systems in ... most African countries adopted direct payment for health services as the ...

Health at the center of health systems reform: how philosophy can inform policy.

Science.gov (United States)

Sturmberg, Joachim P; Martin, Carmel M; Moes, Mark M

2010-01-01

Contemporary views hold that health and disease can be defined as objective states and thus should determine the design and delivery of health services. Yet health concepts are elusive and contestable. Health is neither an individual construction, a reflection of societal expectations, nor only the absence of pathologies. Based on philosophical and sociological theory, empirical evidence, and clinical experience, we argue that health has simultaneously objective and subjective features that converge into a dynamic complex-adaptive health model. Health (or its dysfunction, illness) is a dynamic state representing complex patterns of adaptation to body, mind, social, and environmental challenges, resulting in bodily homeostasis and personal internal coherence. The "balance of health" model-emergent, self-organizing, dynamic, and adaptive-underpins the very essence of medicine. This model should be the foundation for health systems design and also should inform therapeutic approaches, policy decision-making, and the development of emerging health service models. A complex adaptive health system focused on achieving the best possible "personal" health outcomes must provide the broad policy frameworks and resources required to implement people-centered health care. People-centered health systems are emergent in nature, resulting in locally different but mutually compatible solutions across the whole health system.

Exposure to rising inequality shapes Americans' opportunity beliefs and policy support.

Science.gov (United States)

McCall, Leslie; Burk, Derek; Laperrière, Marie; Richeson, Jennifer A

2017-09-05

Economic inequality has been on the rise in the United States since the 1980s and by some measures stands at levels not seen since before the Great Depression. Although the strikingly high and rising level of economic inequality in the nation has alarmed scholars, pundits, and elected officials alike, research across the social sciences repeatedly concludes that Americans are largely unconcerned about it. Considerable research has documented, for instance, the important role of psychological processes, such as system justification and American Dream ideology, in engendering Americans' relative insensitivity to economic inequality. The present work offers, and reports experimental tests of, a different perspective-the opportunity model of beliefs about economic inequality. Specifically, two convenience samples (study 1, n = 480; and study 2, n = 1,305) and one representative sample (study 3, n = 1,501) of American adults were exposed to information about rising economic inequality in the United States (or control information) and then asked about their beliefs regarding the roles of structural (e.g., being born wealthy) and individual (e.g., hard work) factors in getting ahead in society (i.e., opportunity beliefs). They then responded to policy questions regarding the roles of business and government actors in reducing economic inequality. Rather than revealing insensitivity to rising inequality, the results suggest that rising economic inequality in contemporary society can spark skepticism about the existence of economic opportunity in society that, in turn, may motivate support for policies designed to redress economic inequality.

Exposure to rising inequality shapes Americans’ opportunity beliefs and policy support

Science.gov (United States)

McCall, Leslie; Burk, Derek; Laperrière, Marie; Richeson, Jennifer A.

2017-01-01

Economic inequality has been on the rise in the United States since the 1980s and by some measures stands at levels not seen since before the Great Depression. Although the strikingly high and rising level of economic inequality in the nation has alarmed scholars, pundits, and elected officials alike, research across the social sciences repeatedly concludes that Americans are largely unconcerned about it. Considerable research has documented, for instance, the important role of psychological processes, such as system justification and American Dream ideology, in engendering Americans’ relative insensitivity to economic inequality. The present work offers, and reports experimental tests of, a different perspective—the opportunity model of beliefs about economic inequality. Specifically, two convenience samples (study 1, n = 480; and study 2, n = 1,305) and one representative sample (study 3, n = 1,501) of American adults were exposed to information about rising economic inequality in the United States (or control information) and then asked about their beliefs regarding the roles of structural (e.g., being born wealthy) and individual (e.g., hard work) factors in getting ahead in society (i.e., opportunity beliefs). They then responded to policy questions regarding the roles of business and government actors in reducing economic inequality. Rather than revealing insensitivity to rising inequality, the results suggest that rising economic inequality in contemporary society can spark skepticism about the existence of economic opportunity in society that, in turn, may motivate support for policies designed to redress economic inequality. PMID:28831007

Environmental health risk assessment: Energy systems

International Nuclear Information System (INIS)

Krewski, D.; Somers, E.; Winthrop, S.O.

1984-01-01

Most industrialized nations have come to rely on a variety of systems for energy production, both of a conventional and non-conventional nature. In the paper, the spectrum of energy systems currently in use in Canada is outlined along with their potential health risks. Several examples of environmental health studies involving both outdoor and indoor air pollution related to energy production in Canada are reported. The limitations of current technologies for assessing health risks are discussed and possible approaches to managing energy related health risks are indicated. (author)