75 FR 78709 - Public Comment on the Draft Tribal Consultation Policy

Science.gov (United States)

2010-12-16

... future. ACF solicited membership for an ACF Tribal/Federal Workgroup to develop the initial draft policy... disparities of American Indians and Alaska Natives (AI/AN) and ensuring that access to critical health and... consult with American Indians and Alaska Natives (AI/ ANs). 3. Background Since the formation of the Union...

Political consultation and large-scale research

International Nuclear Information System (INIS)

Bechmann, G.; Folkers, H.

1977-01-01

Large-scale research and policy consulting have an intermediary position between sociological sub-systems. While large-scale research coordinates science, policy, and production, policy consulting coordinates science, policy and political spheres. In this very position, large-scale research and policy consulting lack of institutional guarantees and rational back-ground guarantee which are characteristic for their sociological environment. This large-scale research can neither deal with the production of innovative goods under consideration of rentability, nor can it hope for full recognition by the basis-oriented scientific community. Policy consulting knows neither the competence assignment of the political system to make decisions nor can it judge succesfully by the critical standards of the established social science, at least as far as the present situation is concerned. This intermediary position of large-scale research and policy consulting has, in three points, a consequence supporting the thesis which states that this is a new form of institutionalization of science: These are: 1) external control, 2) the organization form, 3) the theoretical conception of large-scale research and policy consulting. (orig.) [de

Can Knowledge Management Become Global? - Consulting Engineering Companies in the Knowledge Economy

DEFF Research Database (Denmark)

Koch, Christian

2004-01-01

The paper presents different strategies for consulting engineering companies in the emergent global economy. It is a common assumption that players can obtain market gain through cross border mergers, acquisitions, or strategic alliances in synchronisation with internal organisation. Many big...

Business-as-Unusual: Existing policies in energy model baselines

International Nuclear Information System (INIS)

Strachan, Neil

2011-01-01

Baselines are generally accepted as a key input assumption in long-term energy modelling, but energy models have traditionally been poor on identifying baselines assumptions. Notably, transparency on the current policy content of model baselines is now especially critical as long-term climate mitigation policies have been underway for a number of years. This paper argues that the range of existing energy and emissions policies are an integral part of any long-term baseline, and hence already represent a 'with-policy' baseline, termed here a Business-as-Unusual (BAuU). Crucially, existing energy policies are not a sunk effort; as impacts of existing policy initiatives are targeted at future years, they may be revised through iterative policy making, and their quantitative effectiveness requires ex-post verification. To assess the long-term role of existing policies in energy modelling, currently identified UK policies are explicitly stripped out of the UK MARKAL Elastic Demand (MED) optimisation energy system model, to generate a BAuU (with-policy) and a REF (without policy) baseline. In terms of long-term mitigation costs, policy-baseline assumptions are comparable to another key exogenous modelling assumption - that of global fossil fuel prices. Therefore, best practice in energy modelling would be to have both a no-policy reference baseline, and a current policy reference baseline (BAuU). At a minimum, energy modelling studies should have a transparent assessment of the current policy contained within the baseline. Clearly identifying and comparing policy-baseline assumptions are required for cost effective and objective policy making, otherwise energy models will underestimate the true cost of long-term emissions reductions.

An IMP interaction approach to modelling business-to-business professional service quality: the case of Hong Kong consulting engineering service

OpenAIRE

Woo, Ka-shing

2001-01-01

In the domain of services marketing, the most researched area is in service quality. Since the pioneering stage of service quality research in the early 1980s, most of the studies have been conducted in the context of consumer services and consumer professional services. The purpose of this study is to bridge the gap in the existing literature to measure service quality of a particular business-to-business professional service industry (i.e., Hong Kong consulting engineering industry). I...

EXPOsOMICS: final policy workshop and stakeholder consultation.

Science.gov (United States)

Turner, Michelle C; Vineis, Paolo; Seleiro, Eduardo; Dijmarescu, Michaela; Balshaw, David; Bertollini, Roberto; Chadeau-Hyam, Marc; Gant, Timothy; Gulliver, John; Jeong, Ayoung; Kyrtopoulos, Soterios; Martuzzi, Marco; Miller, Gary W; Nawrot, Timothy; Nieuwenhuijsen, Mark; Phillips, David H; Probst-Hensch, Nicole; Samet, Jonathan; Vermeulen, Roel; Vlaanderen, Jelle; Vrijheid, Martine; Wild, Christopher; Kogevinas, Manolis

2018-02-15

The final meeting of the EXPOsOMICS project "Final Policy Workshop and Stakeholder Consultation" took place 28-29 March 2017 to present the main results of the project and discuss their implications both for future research and for regulatory and policy activities. This paper summarizes presentations and discussions at the meeting related with the main results and advances in exposome research achieved through the EXPOsOMICS project; on other parallel research initiatives on the study of the exposome in Europe and in the United States and their complementarity to EXPOsOMICS; lessons learned from these early studies on the exposome and how they may shape the future of research on environmental exposure assessment; and finally the broader implications of exposome research for risk assessment and policy development on environmental exposures. The main results of EXPOsOMICS in relation to studies of the external exposome and internal exposome in relation to both air pollution and water contaminants were presented as well as new technologies for environmental health research (adductomics) and advances in statistical methods. Although exposome research strengthens the scientific basis for policy development, there is a need in terms of showing added value for public health to: improve communication of research results to non-scientific audiences; target research to the broader landscape of societal challenges; and draw applicable conclusions. Priorities for future work include the development and standardization of methodologies and technologies for assessing the external and internal exposome, improved data sharing and integration, and the demonstration of the added value of exposome science over conventional approaches in answering priority policy questions.

Biomedical engineering and society: policy and ethics.

Science.gov (United States)

Flexman, J A; Lazareck, L

2007-01-01

Biomedical engineering impacts health care and contributes to fundamental knowledge in medicine and biology. Policy, such as through regulation and research funding, has the potential to dramatically affect biomedical engineering research and commercialization. New developments, in turn, may affect society in new ways. The intersection of biomedical engineering and society and related policy issues must be discussed between scientists and engineers, policy-makers and the public. As a student, there are many ways to become engaged in the issues surrounding science and technology policy. At the University of Washington in Seattle, the Forum on Science Ethics and Policy (FOSEP, www.fosep.org) was started by graduate students and post-doctoral fellows interested in improving the dialogue between scientists, policymakers and the public and has received support from upper-level administration. This is just one example of how students can start thinking about science policy and ethics early in their careers.

Consultant management estimating tool.

Science.gov (United States)

2012-04-01

The New York State Department of Transportation (NYSDOT) Consultant Management Bureaus primary responsibilities are to negotiate staffing hours/resources with : engineering design consultants, and to monitor the consultant's costs. Currently the C...

75 FR 78198 - Proposed Final Policy on Consultation and Coordination With Indian Tribes

Science.gov (United States)

2010-12-15

... ENVIRONMENTAL PROTECTION AGENCY 40 CFR Chapter I [EPA-HQ-OA-2010-0992 FRL-9239-4] Proposed Final Policy on Consultation and Coordination With Indian Tribes AGENCY: Environmental Protection Agency (EPA). ACTION: Notice of document for public comment. SUMMARY: The Environmental Protection Agency (EPA) is...

The Impact of Ict on Business Models for Delivery Of ConsultancyServices - The Case Of Technical Engineering

DEFF Research Database (Denmark)

Falch, Morten; Nicolajsen, Hanne Westh

2009-01-01

This paper analyses the impact of the use of ICT in production and delivery of technical engineering consultancy services on business structures with regard to industry convergence and transaction costs. The paper takes an empirical study on the introduction of 3D-modelling tools in the building...... section in a Scandinavian engineering consultancy firm as its point of departure. The discussion identifies three different structural aspects, which all are affected by the use of ICT: Internationalisation vs. Local markets, Outsourcing vs. Structural integration, and Division of work between actors...

The impact of ICT on market organisation – A case of 3D-models in engineering consultancy

DEFF Research Database (Denmark)

Falch, Morten

2014-01-01

This paper analyses the impact of the use of ICT in production and delivery of technical engineering consultancy services on business structures with regard to industry convergence and transaction costs. The paper takes an empirical study on the introduction of 3D-modelling tools in the building...... section in a Scandinavian engineering consultancy firm as its point of departure. The discussion identifies three different structural aspects, which all are affected by the use of ICT: Internationalisation vs. Local markets, Outsourcing vs. Structural integration, and Division of work between actors...

Integrating ergonomics in design processes: a case study within an engineering consultancy firm.

Science.gov (United States)

Sørensen, Lene Bjerg; Broberg, Ole

2012-01-01

This paper reports on a case study within an engineering consultancy firm, where engineering designers and ergonomists were working together on the design of a new hospital sterile processing plant. The objective of the paper is to gain a better understanding of the premises for integrating ergonomics into engineering design processes and how different factors either promote or limit the integration. Based on a grounded theory approach a model illustrating these factors is developed and different hypotheses about how these factors either promote and/or limit the integration of ergonomics into design processes is presented along with the model.

76 FR 55678 - Tribal Consultation Policy

Science.gov (United States)

2011-09-08

... types of agency actions that will require tribal consultation in the future. ACF's response was that due... disparities of American Indians and Alaska Natives (AI/AN) and ensuring that access to critical health and... within ACF, many of which already consult with AI/ANs. 3. Background Since the formation of the Union...

78 FR 33331 - Tribal Consultation and Coordination Policy for the U.S. Department of Commerce

Science.gov (United States)

2013-06-04

.... Comment 4: Clarify the Department's role in coordinating with other federal agencies, and increase....'' Comments to Section 5: Roles and Responsibilities Comment 24: The tribal consultation official should.... Additionally, the policy should acknowledge that Tribes are more familiar with their local environment and...

Improving Indonesian Construction Consulting Services

Directory of Open Access Journals (Sweden)

Rizal Z. Tamin

2015-05-01

Full Text Available Indonesian construction consulting services are facing a complex problem in fulfilling the nation’s expectations regarding high quality infrastructure development and the construction industry’s competitiveness. A study of this problem and a formulation of solutions to improve the situation are presented in this paper. A survey was carried out in Jakarta, West Java, East Java, and North Sumatra provinces to collect data related to this problem. A focus group discussion and a workshop with all stakeholders were conducted to formulate improvement actions that need to be taken. It was revealed that the problems faced include, among others, the limited number of professional engineers compared to the number of national consultancy companies, the uneven distribution of engineers in Indonesian regions, an imperfect procurement system, and low-quality work output in general. Recommended actions include improvement of the government’s role in consulting services nurturing and facilitation, development of partnerships, and amelioration of the professional engineer and consultant certification system.

Experiences of using email for general practice consultations: a qualitative study.

Science.gov (United States)

Atherton, Helen; Pappas, Yannis; Heneghan, Carl; Murray, Elizabeth

2013-11-01

Reports suggest approximately 21-23% of GPs in the UK have consulted with patients using email, but little is known about the nature of this use and what it means for clinicians and patients in general practice. To understand the use of email consultation in general practice by investigating the experiences of existing users and views of experts. A qualitative study conducted in 2010 using purposive sampling and semi-structured interviews in general practice and community settings in some London boroughs. A maximum variation sample of GPs and patients who had used email for consultation in general practice were recruited, as were policy and/or implementation experts. Interviews continued until saturation was achieved. In total 10 GPs, 14 patients, and six experts were interviewed. Consultation by email was often triggered by logistic or practical issues; motivators for ongoing use were the benefits, such as convenience, for GPs and patients. Both GPs and patients reported concerns about safety and lack of guidance about the 'rules of engagement' in email consultations, with GPs also concerned about workload. In response, both groups attempted to introduce their own rules, although this only went some way to addressing uncertainty. Long term, participants felt there was a need for regulation and guidance. Consultations by email in general practice occur in an unregulated and unstructured way. Current UK policy is to promote consultations by email, making it crucial to consider the responsibility and workload faced by clinicians, and the changes required to ensure safe use; not doing so may risk safety breaches and result in suboptimal care for patients.

Global Journal of Engineering Research: Editorial Policies

African Journals Online (AJOL)

Focus and Scope. The Global Journal of Engineering Research is aimed at promoting research in all areas of Engineering Research including Mechanical, Civil, Electrical, Chemical, Electronics, Geological etc. Section Policies. Articles. Checked Open Submissions, Checked Indexed, Checked Peer Reviewed. Publication ...

Existence and Policy Effectiveness in Feedback Nash LQ-Games

Directory of Open Access Journals (Sweden)

Nicola Acocella

2008-12-01

Full Text Available This paper illustrates how the classical theory of economic policy can profitably be used to verify some properties of the Linear Nash Feedback Equilibrium in difference LQ-games. In particular, we find that both a necessary condition for the equilibrium existence and a sufficient condition for policy ineffectiveness can be defined in the terms of the simple Tinbergen counting rule.

Integrating ergonomics knowledge into business-driven design projects: The shaping of resource constraints in engineering consultancy.

Science.gov (United States)

Hall-Andersen, Lene Bjerg; Neumann, Patrick; Broberg, Ole

2016-10-17

The integration of ergonomics knowledge into engineering projects leads to both healthier and more efficient workplaces. There is a lack of knowledge about integrating ergonomic knowledge into the design practice in engineering consultancies. This study explores how organizational resources can pose constraints for the integration of ergonomics knowledge into engineering design projects in a business-driven setting, and how ergonomists cope with these resource constraints. An exploratory case study in an engineering consultancy was conducted. A total of 27 participants were interviewed. Data were collected applying semi-structured interviews, observations, and documentary studies. Interviews were transcribed, coded, and categorized into themes. From the analysis five overall themes emerged as major constituents of resource constraints: 1) maximizing project revenue, 2) payment for ergonomics services, 3) value of ergonomic services, 4) role of the client, and 5) coping strategies to overcome resource constraints. We hypothesize that resource constraints were shaped due to sub-optimization of costs in design projects. The economical contribution of ergonomics measures was not evaluated in the entire life cycle of a designed workplace. Coping strategies included teaming up with engineering designers in the sales process or creating an alliance with ergonomists in the client organization.

Consultation with First Nations stakeholders : an Alberta perspective

Energy Technology Data Exchange (ETDEWEB)

Rutwind, S. [Alberta Justice, Edmonton, AB (Canada). Aboriginal Law

2005-07-01

Aboriginal issues present risks and challenges to resource development in Alberta. This paper provided an overview of significant precedents and acts which may impact on oil and gas activities. The Constitution Act of 1982 acknowledged that existing Aboriginal and treaty rights of the Aboriginal peoples of Canada were recognized and confirmed. In the case of R v. Sparrow, justification was established where there was a valid legislative objective, such as conservation and resource management, and a precedent was set regarding the interpretation of disputes of section 35 subsection 1 concerning legal restriction of the exercise of treaty rights, such as hunting and fishing. In R v. Badger, the Supreme Court of Canada (SCC) advised that the framework applied to treaty rights as well as Aboriginal rights. The Natural Resources Transfer Agreement transferred powers over natural resources from Canada to Alberta in relation to hunting rights. Proof of rights issues were discussed in Taku River Tlingit First Nation v. Tulesequa Chief Mine Project, as well as in Haida Nation v. British Columbia, where it was concluded that an Aboriginal right need not be proven before a duty to consult arises. A review of Alberta's consultation practices was presented, as well as the Aboriginal issues and resource development initiative, which recognizes the importance of consultation with affected Aboriginal people and communities when regulatory and development activities infringe their existing treaty and other constitutional rights, such as the rights to hunt, fish and trap for food. Details of the Consultation Coordination Group were presented. A draft of the Government of Alberta's First Nations Consultation Policy on Land Management and Resource Development was also presented. tabs, figs.

The Impact of Ict on Business Models for Delivery Of ConsultancyServices - The Case Of Technical Engineering

DEFF Research Database (Denmark)

Falch, Morten; Nicolajsen, Hanne Westh

2009-01-01

section in a Scandinavian engineering consultancy firm as its point of departure. The discussion identifies three different structural aspects, which all are affected by the use of ICT: Internationalisation vs. Local markets, Outsourcing vs. Structural integration, and Division of work between actors...

The existence of policies, practices and perceptions regarding ...

African Journals Online (AJOL)

Interviews were conducted with 7 nursing managers regarding the existence and content of a hospital visitors' policy, 12 operational managers (OMs) to describe ward practices regarding child visitors, and 12 professional nurses and 11 doctors to determine their attitudes towards children as visitors in all four general state ...

77 FR 23283 - Tribal Consultation Policy

Science.gov (United States)

2012-04-18

... and Waivers VII. Consultation Process Guidelines VIII. Performance and Accountability IX. Designated..., improving working conditions, and assuring work-related benefits and rights of workers and retirees in the... services. The Department's Women's Bureau (WB) has an ongoing relationship with the United Indians of All...

76 FR 28446 - Policy on Consultation With Indian Tribes

Science.gov (United States)

2011-05-17

.... Consultation promotes an enhanced form of communication that emphasizes trust, respect, and shared... consultation process, ensure continuity, and demonstrate commitment to the process. Communication will be open... access to traditional areas of cultural or religious importance on Federally managed lands; 2. The...

Professional Service innovations at Consulting Engineering - how change stay flat in project Organisations

DEFF Research Database (Denmark)

Koch, Christian; Bendixen, Mads

understood through a practicebased theory approach using predominantly Actor Network Theory (Latour 2005). The paper focus on attempts to innovate service products, within projects and the remaining organisation. A seven-year cooperation with a consulting engineering, now employing the one of the authors has...... production. One relates to the formation of a building envelope group and a design of a building with a double glass facade, the other to client counselling on realising a public private partnership, a 30 year contract of a public service, where the initial programming was followed. The analysis follows...

40 CFR Appendix D to Subpart E of... - EPA Transition Policy-Existing Consulting Engineering Agreements

Science.gov (United States)

2010-07-01

... access to Category A records. Also, where there is an indication that fraud, gross abuse, or corrupt... historical and advisory guidelines in general use and acceptable locally. These guidelines include those in ASCE manual 45 or other analyses or data which the contracting parties relied on or used in negotiation...

Ideas of holistic engineering meet engineering work practices

DEFF Research Database (Denmark)

Buch, Anders

2016-01-01

This article critically reflects on the viability of the idea that reforming engineering education will result in more holistic engineering work practices. Drawing on an empirical study, the article aims to demonstrate that in order to change existing engineering work practices, it might...... be necessary to change engineers’ knowledge and skills; however, such changes are far from sufficient. Conditions and circumstances external to practitioners’ knowledge and skills are crucial if engineering work is to become more holistic. To illustrate this point, the article outlines an empirical study...... of a small team of professionals who engage in holistic engineering work practices in an engineering consultancy company. The work practices are investigated using a philosophical empirical method that inquires into the doings, sayings, and relatings of the practitioners. The study describes the practice...

User illusion: ideological construction of ‘user-generated content’ in the EC consultation on copyright

Directory of Open Access Journals (Sweden)

Kristofer Erickson

2014-10-01

Full Text Available Recent policy consultations by the UK Intellectual Property Office, the US Patent and Trademark Office and the European Commission (EC have highlighted the importance of user-generated content in debates to reform copyright. User-generated content (UGC – often combining existing copyright material with transformative creativity – remains a contested terrain, with no clear or widely accepted definition. This paper examines how various stakeholders in the 2014 EC consultation on copyright attempted to shape the definition of UGC in order to suit their interests, sometimes aligning or conflicting with other stakeholder groups. Data from 203 written responses by registered stakeholders (authors, platform intermediaries and users were subjected to a discourse analysis methodology. Key arguments and policy preferences from each stakeholder group are identified and discussed.

Environmental engineering of navigation infrastructure: a survey of existing practices, challenges, and potential opportunities.

Science.gov (United States)

Fredette, Thomas J; Foran, Christy M; Brasfield, Sandra M; Suedel, Burton C

2012-01-01

Navigation infrastructure such as channels, jetties, river training structures, and lock-and-dam facilities are primary components of a safe and efficient water transportation system. Planning for such infrastructure has until recently involved efforts to minimize impacts on the environment through a standardized environmental assessment process. More recently, consistent with environmental sustainability concepts, planners have begun to consider how such projects can also be constructed with environmental enhancements. This study examined the existing institutional conditions within the US Army Corps of Engineers and cooperating federal agencies relative to incorporating environmental enhancements into navigation infrastructure projects. The study sought to (1) investigate institutional attitudes towards the environmental enhancement of navigation infrastructure (EENI) concept, (2) identify potential impediments to implementation and solutions to such impediments, (3) identify existing navigation projects designed with the express intent of enhancing environmental benefit in addition to the primary project purpose, (4) identify innovative ideas for increasing environmental benefits for navigation projects, (5) identify needs for additional technical information or research, and (6) identify laws, regulations, and policies that both support and hinder such design features. The principal investigation tool was an Internet-based survey with 53 questions. The survey captured a wide range of perspectives on the EENI concept including ideas, concerns, research needs, and relevant laws and policies. Study recommendations included further promotion of the concept of EENI to planners and designers, documentation of existing projects, initiation of pilot studies on some of the innovative ideas provided through the survey, and development of national goals and interagency agreements to facilitate implementation. Copyright © 2011 SETAC.

Breaking out of the biomed box: an audit assessment and recommendations for an in-house biomedical engineering program.

Science.gov (United States)

Dickey, David M; Jagiela, Steven; Fetters, Dennis

2003-01-01

In order to assess the current performance and to identify future growth opportunities of an in-house biomedical engineering (BME) program, senior management of Lehigh Valley Hospital (Allentown, Penn) engaged (in July 2001) the services of a clinical engineering consultant. Although the current in-house program was both functionally and financially sound, an independent audit had not been performed in over 4 years, and there were growing concerns by the BME staff related to the department's future leadership and long-term support from senior management. After an initial 2-month audit of the existing program, the consultant presented 41 separate recommendations for management's consideration. In order to refine and implement these recommendations, 5 separate committees were established to further evaluate a consolidated version of them, with the consultant acting as the facilitator for each group. Outcomes from each of the committees were used in the development of a formal business plan, which, upon full implementation, would not only strengthen and refine the current in-house service model but could also result in a substantial 3-year cost savings for the organization ($1,100,000 from existing operations, $500,000 in cost avoidance by in-sourcing postwarranty support of future capital equipment acquisitions). Another key outcome of the project was related to the development of a new master policy, titled the "Medical Equipment Management Program," complete with a newly defined state-of-the-art equipment scheduled inspection frequency model.

Implementation of partnership management model of SMK (Vocational High School) with existing industries in mechanical engineering expertise in Central Java

Science.gov (United States)

Sumbodo, Wirawan; Pardjono, Samsudi, Rahadjo, Winarno Dwi

2018-03-01

This study aims to determine the existing conditions of implementation of partnership management model of SMK with the industry on the mechanical engineering expertise in Central Java. The method used is descriptive analysis. The research result shows that the implementation of partnership management model of SMK based on new existing industry produces ready graduates of 62.5% which belongs to low category, although the partnership program of SMK with the industry is done well with the average score of 3.17. As many as 37.5% of SMK graduates of Mechanical Engineering Expertise Program choose to continue their studies or to be an entrepreneur. It is expected that the partnership model of SMK with the industry can be developed into a reference for government policy in developing SMK that is able to produce graduates who are ready to work according to the needs of partner industry.

Making consultations run smoothly

DEFF Research Database (Denmark)

Jespersen, Astrid Pernille; Elgaard Jensen, Torben

2012-01-01

This article investigates the skilful use of time in general practice consultations. It argues that consultation work involves social and material interactions, which are only partially conceptualized in existing medical practice literatures. As an alternative, this article employs ideas from the......-inspired analysis opens up a wider discussion of time as a complex resource and problem in general practice....

Population Consultation: A Powerful Means to Ensure that Health Strategies are Oriented Towards Universal Health Coverage.

Science.gov (United States)

Rohrer, Katja; Rajan, Dheepa; Schmets, Gerard

2017-01-01

We seek to highlight why population consultations need to be promoted more strongly as a powerful means to move health reforms towards Universal Health Coverage (UHC). However, despite this increasing recognition that the "population" is the key factor of successful health planning and high-quality service delivery, there has been very little systematic reflection and only limited (international) attention brought to the idea of specifically consulting the population to improve the quality and soundness of health policies and strategies and to strengthen the national health planning process and implementation. So far, research has done little to assess the significance of population consultations for the health sector and its importance for strategic planning and implementation processes; in addition, there has been insufficient evaluation of population consultations in the health sector or health-related areas. We drew on ongoing programmatic work of World Health Organization (WHO) offices worldwide, as most population consultations are not well-documented. In addition, we analyzed any existing documentation available on population consultations in health. We then elaborate on the potential benefits of bringing the population's voice into national health planning. We briefly mention the key methods used for population consultations, and we put forward recent country examples showing that population consultation is an effective way of assessing the population's needs and expectations, and should be more widely used in strategizing health. Giving the voice to the population is a means to strengthen accountability, to reinforce the commitment of policy makers, decision-makers and influencers (media, political parties, academics, etc.) to the health policy objectives of UHC, and, in the specific case of donor-dependent countries, to sensitize donors' engagement and alignment with national health strategies. The consequence of the current low international interest for

Stakeholder consultations in the energy directorate : can they help integrate climate change?

NARCIS (Netherlands)

Vasileiadou, E.; Tuinstra, W.

2013-01-01

Investigation of the conditions under which formal stakeholder consultations of the Directorate General Energy of the European Commission can help integrate climate change policy in energy policy in the European Union suggests that stakeholder consultations that aim at producing soft law and binding

Computer Supported Argument Visualisation: Modelling in Consultative Democracy Around Wicked Problems

Science.gov (United States)

Ohl, Ricky

In this case study, computer supported argument visualisation has been applied to the analysis and representation of the draft South East Queensland Regional Plan Consultation discourse, demonstrating how argument mapping can help deliver the transparency and accountability required in participatory democracy. Consultative democracy for regional planning falls into a category of problems known as “wicked problems”. Inherent in this environment is heterogeneous viewpoints, agendas and voices, built on disparate and often contradictory logic. An argument ontology and notation that was designed specifically to deal with consultative urban planning around wicked problems is the Issue Based Information System (IBIS) and IBIS notation (Rittel & Webber, 1984). The software used for argument visualisation in this case was Compendium, a derivative of IBIS. The high volume of stakeholders and discourse heterogeneity in this environment calls for a unique approach to argument mapping. The map design model developed from this research has been titled a “Consultation Map”. The design incorporates the IBIS ontology within a hybrid of mapping approaches, amalgamating elements from concept, dialogue, argument, debate, thematic and tree-mapping. The consultation maps developed from the draft South East Queensland Regional Plan Consultation provide a transparent visual record to give evidence of the themes of citizen issues within the consultation discourse. The consultation maps also link the elicited discourse themes to related policies from the SEQ Regional Plan providing explicit evidence of SEQ Regional Plan policy-decisions matching citizen concerns. The final consultation map in the series provides explicit links between SEQ Regional Plan policy items and monitoring activities reporting on the ongoing implementation of the SEQ Regional Plan. This map provides updatable evidence of and accountability for SEQ Regional Plan policy implementation and developments.

Mental Health Consultation Among Ontario's Immigrant Populations.

Science.gov (United States)

Islam, Farah; Khanlou, Nazilla; Macpherson, Alison; Tamim, Hala

2017-11-16

To determine the prevalence rates and characteristics of past-year mental health consultation for Ontario's adult (18 + years old) immigrant populations. The Canadian Community Health Survey (CCHS) 2012 was used to calculate the prevalence rates of past-year mental health consultation by service provider type. Characteristics associated with mental health consultation were determined by carrying out multivariable logistic regression analysis on merged CCHS 2008-2012 data. Adult immigrant populations in Ontario (n = 3995) had lower estimated prevalence rates of past-year mental health consultation across all service provider types compared to Canadian-born populations (n = 14,644). Amongst those who reported past-year mental health consultation, 57.89% of Ontario immigrants contacted their primary care physician, which was significantly higher than the proportion who consulted their family doctor from Canadian-born populations (45.31%). The factors of gender, age, racial/ethnic background, education level, working status, food insecurity status, self-perceived health status, smoking status, alcohol drinking status, years since immigration, and age at time of immigration were significantly associated with past-year mental health consultation for immigrant populations. Ontario's adult immigrant populations most commonly consult their family doctor for mental health care. Potential exists for expanding the mental health care role of primary care physicians as well as efforts to increase accessibility of specialized mental health services. Integrated, coordinated care where primary care physicians, specialized mental health professionals, social workers, and community educators, etc. working together in a sort of "one-stop-shop" may be the most effective way to mitigate gaps in the mental health care system. In order to effectively tailor mental health policy, programming, and promotion to suit the needs of immigrant populations initiatives that focus on

Consultancy in the development of coal deposits all over the world

Energy Technology Data Exchange (ETDEWEB)

Gold, R.; Schiebel, W.

1977-04-01

Dr. Otto Gold, Consulting Engineers, Cologne, are working as consultants in the area of prospecting, exploration and development of lignite deposits. Some projects successfully carried out are reported on, being an example for other consulting projects on the coal sector.

Mental health consultations in the perinatal period: a cost-analysis of Medicare services provided to women during a period of intense mental health reform in Australia.

Science.gov (United States)

Chambers, Georgina M; Randall, Sean; Mihalopoulos, Cathrine; Reilly, Nicole; Sullivan, Elizabeth A; Highet, Nicole; Morgan, Vera A; Croft, Maxine L; Chatterton, Mary Lou; Austin, Marie-Paule

2017-12-05

Objective To quantify total provider fees, benefits paid by the Australian Government and out-of-pocket patients' costs of mental health Medicare Benefits Schedule (MBS) consultations provided to women in the perinatal period (pregnancy to end of the first postnatal year). Method A retrospective study of MBS utilisation and costs (in 2011-12 A$) for women giving birth between 2006 and 2010 by state, provider-type, and geographic remoteness was undertaken. Results The cost of mental health consultations during the perinatal period was A$17.5million for women giving birth in 2007, rising to A$29million in 2010. Almost 9% of women giving birth in 2007 had a mental health consultation compared with more than 14% in 2010. An increase in women accessing consultations, along with an increase in the average number of consultations received, were the main drivers of the increased cost, with costs per service remaining stable. There was a shift to non-specialist care and bulk billing rates increased from 44% to 52% over the study period. In 2010, the average total cost (provider fees) per woman accessing mental health consultations during the perinatal period was A$689, and the average cost per service was A$133. Compared with women residing in regional and remote areas, women residing in major cities where more likely to access consultations, and these were more likely to be with a psychiatrist rather than an allied health professional or general practitioner. Conclusion Increased access to mental health consultations has coincided with the introduction of recent mental health initiatives, however disparities exist based on geographic location. This detailed cost analysis identifies inequities of access to perinatal mental health services in regional and remote areas and provides important data for economic and policy analysis of future mental health initiatives. What is known about the topic? The mental healthcare landscape in Australia has changed significantly over the

From Solution Shop to Boutique Consulting? Capturing Recent Developments on the German Consulting Marke

Directory of Open Access Journals (Sweden)

Jörg Jasper DÖTSCH

2016-12-01

Full Text Available Digitalization, globalization, new technologies and shorter product life cycles are only a few keywords underlining the fact that companies are under increasing pressure for faster adaptation, innovation and hence applying a higher knowledge intensity. We assume that these conditions require an increasingly important role of consulting companies, because they seem to be the intermediaries needed to bridge the faster growing gaps between existing business models, organizational structures and accelerating market change. Market pressure is growing on the market for consultant companies as well. New technologies and digitalization should influence both the structure of the consultancy market and the business models of consultancies. Christensen suggested a trend from Dzsolution shop” to Dzboutique consulting.” To track current developments, we concentrate on the German consulting market as one of the most important consultant markets worldwide and explore changes of the last two years based on various studies. Processes of change seem to be both substantially driven by digitalization and to reflect change on the non-consultancy markets. A high willingness to switch among providers documents a high pressure on performance. The impact of digitalisation seem• to be observable in structural and qualitative change. With regard to the German consulting market and the latest available data we cannot validate a tendency from a dominance of “solution shop” consultancies to “boutique” consultancy services.

Consultation on the implementation of Engineering Recommendation ER G77. Volume 2: Subgroup report

Energy Technology Data Exchange (ETDEWEB)

Thornycroft, J.; Cotterell, M.; Crabtree, J.

2002-07-01

A Sub-Group report of a project whose main objective is to develop Engineering Recommendation ER G77/1 'Connection of Single-Phase Inverter Connected Photovoltaic (PV) Generating Equipment of up to 5kVA in Parallel with a Distribution Network Operators (DNOs) Distribution System' is presented. The paper specifically addresses the testing of inverters, including small integrated systems called 'AC Modules'. The report is linked to Volume 1 of report ETSU/P2/00400 'Research into Aspects of PV Inverters and Engineering Recommendation ER G77'. The sub-group's objectives were: (i) to develop a safety assessment and accreditation strategy for PV inverter topologies incorporating solid-state switched protection systems; (ii) develop strategies for safe and cost-effective installation of PV systems utilising AC Modules; (iii) consult with the main ER G77 Group on what to include in ER G77/1 and (iv) obtain independent views.

Social acceptability of climate change policies; will energy efficiency always fail to win its case through the consultation process? Volume 1

International Nuclear Information System (INIS)

Pett, Jacky

2007-01-01

Which segments of society 'win' as a result of climate change policies? Actors generally support the principle of reduced emissions through decarbonising fuels, and many are convinced that reducing overall energy consumption is an essential strategy to prevent further damaging climate change. However, proposed strategies for ensuring that sufficient action is taken to reduce emissions suffer from complexity, uncertainty and dissent, especially from vested interests. The policy maker has to choose between many options, and many conflicting consultation responses, to select the most politically feasible and socially acceptable pathway. An FP6 funded project into Adaptation and Mitigation Strategies for climate change is developing an innovative tool to support policy choice based on a mix of methods, using case studies to test the outputs. Resources include stakeholder deliberation on criteria necessary to evaluate pathway options. The first stage maps energy actors' perspectives of climate change, identifying key issues for socially acceptable policies for the 2012 - 2050 period that would either limit climate change to only 2 deg C increase, or provide a 'soft landing' to a world 5 degrees above present.This paper describes this mapping exercise and indicates the issues of most debate, on which rest the criteria for social acceptability. It describes how deliberative methods can involve stakeholders more effectively in policy formation, contrasts the roles of deliberation and consultation, and discusses the engagement of powerful vested interests with this approach. While there are considerable overlaps in perspectives of different actors, leading to specific points of contention, importantly, decisions on selection and engagement of stakeholders with the process become critical if the criteria for policy decisions are to be accepted by society

Influencing school health policy: the role of state school nurse consultants.

Science.gov (United States)

Broussard, Lisa; Howat, Holly; Stokes, Billy; Street, Tanya

2011-01-01

The role of the State School Nurse Consultant has been well defined by the National Association of School Nurses. State School Nurse Consultants serve as a resource to school nurses on issues related to their practice, as well as a liaison between top-level educators and school nurses. The purpose of this article is to describe the role of the State School Nurse Consultant, and to present results of a survey of Louisiana school nurses related to their practice needs. A survey was administered via Survey Monkey to determine the perceived needs of Louisiana school nurses related to their professional practice. Eighty-eight members of the Louisiana School Nurse Organization participated in the online survey. Louisiana is 1 of 6 states that do not have a State School Nurse Consultant. Respondents to the survey indicated an overwhelming need to have a school nurse representative at the state level. Twenty-two of the respondents specifically stated that they would like to have a State School Nurse Consultant within the Department of Education. Budgetary constraints have resulted in a lack of funding for a State School Nurse Consultant in Louisiana. Partnerships with federally qualified health centers (FQHC) and billing of Medicaid for school nursing services are 2 examples of revenue sources for school nurses that Louisiana is investigating. Revenue from these sources may serve to supplement state funds so that this important resource for Louisiana school nurses can be put into place.

Assessment of current Dutch energy transition policy instruments for the existing housing stock

International Nuclear Information System (INIS)

Tambach, Milly; Hasselaar, Evert; Itard, Laure

2010-01-01

This research assesses to what extent current Dutch energy transition policy instruments for the existing housing stock can fulfil local executive actors' needs and instigate adoption of energy efficiency measures by them. This is done by studying energy policy instruments for the existing housing stock in the Netherlands and in other European countries, and by an empirical research, which analyses barriers and needs of local executive actors. We found that, despite current Dutch energy transition policy instruments for the existing housing stock seem to fulfil local executive actors' needs to a large extent, complementary policy instruments are needed to stimulate and pressure the incumbent renovation regime. A long-term oriented financial rewarding system is needed to build up a structural market for the deployment of renewables, to increase the number of specialist jobs in the building sector, and to stimulate the development of integrated, standardized, building components. Furthermore, a long-term oriented financial rewarding system for energy efficiency investments in housing renovation projects, and a low VAT rate applied to energy efficient renovation measures, are needed. Finally, enforcement possibilities and sanctions (fines) should become an integrative part of Dutch energy certification regulation to make the certificate become part of a value chain.

Starting a nursing consultation practice.

Science.gov (United States)

Schulmeister, L

1999-03-01

Because the clinical nurse specialist (CNS) role has been changed or eliminated in many hospital organizations, many CNSs in career transition are considering establishing collaborative or independent nursing consultation practices. Opportunities for consultants exist in diverse practice settings and specialties. Before starting a consultation practice, the CNS should carefully examine goals, identify resources, and begin contacting potential referral sources. He or she must also decide what form of business organization to establish and write a business plan to solidify ideas and prepare for the unexpected. Most CNS consultants rely on personal savings to cover initial business and personal expenses, and many continue working as a CNS until the consultation practice is established. Fees can be set based on community standards, what the market will bear, desired projected income, or a third-party payor's fee schedule. The consultation practice can be marketed by word of mouth, inexpensive advertising techniques such as distributing flyers and business cards, direct mall, and media advertising. In today's healthcare marketplace, opportunities abound for the CNS risk-taker interested in starting a nursing consultation practice.

Consultations to formulate a UK perspective for planning of the Sixth Framework Nuclear (Fission) Energy Programme. Policy issues

International Nuclear Information System (INIS)

Dutton, L.; Moscrop, R.; Smedley, C.

2000-01-01

This report provides advice to the DETR and the Health and Safety Executive on the policy aspects of the Sixth European Framework Programme (FP6) for research and technological development. This advice is based on a consultation within the UK and other Member States and covers the areas of reactor safety, decommissioning and radioactive waste management. It is concluded that there is general support for FP6 across the UK nuclear industry. The specific benefits are seen to be improvements in the competitiveness of the UK nuclear industry through research on plant life extension, improvements to the safety of existing plants and research on radioactive waste management. The broad structure of FP5 does not appear to require fundamental change for FP6 to meet the requirements of the UK, with funding staying at roughly the same level. There is agreement on the need to improve on programme organisation and management to ensure better quality of output and value for money. There is also scope for improving the organisation of UK participation to maximise the UK benefit. Further work has been undertaken under a parallel phase of this project to identify the technical requirements for FP6. (author)

Investigating the Effect of New Communication and Information Technologies on Organizational Structure and Firm Performance in Service Industry: a Survey of Consultant Engineering Firms

Directory of Open Access Journals (Sweden)

ali akbar Farghangi

2013-10-01

Full Text Available This study aims to investigate the current and desired situation of information and communication technologies (ICT, organizational structure and firm performance in Consultant Engineering Firms. To do so, a descriptive-exploratory study was performed among 252 managers and experts of consultant engineering firms in Tehran. A cluster sampling approach was used bya self-administrated questionnaire. Reliability was confirmed by Cronbach’s coefficient. Using one sample t-test, paired sample t-test and regression analysis, results indicated that 1 current and desired situation of ICT, organizational structure and firm performance are acceptable, 2 there is significant difference between current and desired situation of ICT, organizational structure and firm performance, 3 ICT has a positive and significant effect on organizational structure and firm performance

Structural analysis consultation using artificial intelligence

Science.gov (United States)

Melosh, R. J.; Marcal, P. V.; Berke, L.

1978-01-01

The primary goal of consultation is definition of the best strategy to deal with a structural engineering analysis objective. The knowledge base to meet the need is designed to identify the type of numerical analysis, the needed modeling detail, and specific analysis data required. Decisions are constructed on the basis of the data in the knowledge base - material behavior, relations between geometry and structural behavior, measures of the importance of time and temperature changes - and user supplied specifics characteristics of the spectrum of analysis types, the relation between accuracy and model detail on the structure, its mechanical loadings, and its temperature states. Existing software demonstrated the feasibility of the approach, encompassing the 36 analysis classes spanning nonlinear, temperature affected, incremental analyses which track the behavior of structural systems.

A TOTAL QUALITY MANAGEMENT APPROACH TO CIVIL ENGINEERING CONSULTING

Directory of Open Access Journals (Sweden)

G.A.L. Ambrose

2012-01-01

Full Text Available

ENGLISH ABSTRACT: The article describes the development of a framework for the implementation of a Total Quality Management (TQM approach in the civil consulting industry through the five phases of the typical civil engineering project. For any project to be successful the project team members must take collective and individual responsibility for their role in the project implementation. The organisational goal is “to make money now and in the future”. To achieve this goal the organization must provide value to its clientele. The clients are searching for the silver bullet; double the performance at half the price. TQM provides a means to achieve this goal.

AFRIKAANSE OPSOMMING: Die artikel beskryf die ontwikkeling van 'n raamwerk vir die implementering van 'n gehaltebestuurstelsel vir die siviele raadgewende bedryf soos dit deelneem aan die vyf fases van 'n tipiese siviele ingenieursprojek. Vir die suksesvolle afhandeling van 'n projek is dit noodsaaklik dat alle projekspanlede gesamentlik en afsonderlik verantwoordelikheid moet aanvaar vir hulle eie betrokkenheid by die projekimplementering. Die organisasie se oogmerk is om “nou en in die toekoms geld te maak”. Ten einde hierdie oogmerk te bereik moet die organisasie waarde vir sy kliënte bied. 'n Gehaltebestuurstelsel voorsien die gereedskap om hierdie doelwit te bereik.

BNFL Sellafield further public consultation

International Nuclear Information System (INIS)

1994-01-01

The main issues raised during the further public consultation on the draft Sellafield authorisations for the discharge of radioactive wastes from the British Nuclear Fuel (BNFL) Sellafield site are outlined. An analysis of the categories and numbers of the 42,500 responses is made. The public consultation was based on five documents; a letter to consultees from the Department of the Environment and the Ministry of Agriculture, Fisheries and Food (MAFF); the report by Her Majesty's Inspectorate of Pollution and the Inspectorate of MAFF on their earlier consultation exercise; a paper by BNFL on the economic and commercial justification of the Thermal Oxide Reprocessing Plant (THORP); a statement of the Government's policy on reprocessing and THORP and a document prepared by BNFL on the environmental implication of THORP. (UK)

Tapping into past design experiences : Knowledge sharing and creation during novice-expert design consultations

NARCIS (Netherlands)

Deken, F.; Kleinsmann, M.S.; Aurisicchio, M.; Lauche, K.; Bracewell, R.

2011-01-01

Designing is a knowledge-intensive activity. For novice design engineers, an important means of acquiring knowledge is to consult experienced colleagues. We observed novice–expert consultations as part of three engineering projects in a large aerospace company. Seven meetings were analysed in detail

Interest group satisfaction with the European Commission's consultation agendas

DEFF Research Database (Denmark)

Hermansson, Henrik Alf Jonas

2016-01-01

Interest groups exist largely to raise awareness of particular problems or to avoid regulation by keeping items off the political agenda, it is a major component of their raison d'être. At the earliest stages of the European policy process, the European Commission presents an agenda in the form...... of a "call for consultation" which interest groups attempt to influence. Groups that have had a role in setting the Commission's agenda will likely show most satisfaction with the agenda, used here as a way to examine their agenda-setting power. Based on a novel dataset covering 190 policy issues and 469...... interest groups, unique issue-level data on the expertise held by interest groups, their privileged access and their resources, this paper evaluates whether it is the technical information provided by groups, their insider status or their ability to put pressure on the European institutions that form...

Decommissioning Trawsfynydd - How public consultation shaped the strategy

Energy Technology Data Exchange (ETDEWEB)

Kay, Martin J [Nuclear Electric plc. (United Kingdom)

1995-07-01

This case study discusses the ned of consulting the public when decommissioning a nuclear power plants. When Trawsfynydd power station in North Wales shutdown in July 1993, Nuclear Electric's strategy for decommissioning its stations was not clearly defined. The company had altered its corporate policy on decommissioning fro he strategy referred to as the 'Reference Case' which had been approved by the Government, to the preferred 'Deferred Safestore' strategy, which was waiting Government approval. Deferred Safestore is preferred as it simplifies the engineering work involved by capitalising an the basic strength and integrity of the reactor building. It minimises thd radiation exposure to workers and radioactivity released to the environment, reduces the amount of radioactive waste produced and significantly cuts the total decommissioning cost. The closure and the decommissioning of Trawsfynydd power station was a sensitive issue as: The station lies within a National Park of outstanding beauty. The economic circumstances in the area are such that employment opportunities are very limited. At a crucial time when the company was approaching a Government review which would decide its future, Nuclear Electric could not afford to lose any credibility. A public consultation programme was launched in the vicinity of the power station To gauge the reactions of the public and elected local government bodies to a series of decommissioning options. Nuclear Electric presented three main options with details on the employment opportunities, the costs, and the lorry loads of material involved with each. The people were identified on whom decommissioning Trawsfynydd power station is likely to have an environmental or socioeconomic impact. As a result of the polls the Nuclear Electric received feedback in two ways. Formal feedback from the local councils Independent analysis of the completed questionnaires. The company was wholly committed to a meaningful consultation. Before

Decommissioning Trawsfynydd - How public consultation shaped the strategy

International Nuclear Information System (INIS)

Kay, Martin J.

1995-01-01

This case study discusses the ned of consulting the public when decommissioning a nuclear power plants. When Trawsfynydd power station in North Wales shutdown in July 1993, Nuclear Electric's strategy for decommissioning its stations was not clearly defined. The company had altered its corporate policy on decommissioning fro he strategy referred to as the 'Reference Case' which had been approved by the Government, to the preferred 'Deferred Safestore' strategy, which was waiting Government approval. Deferred Safestore is preferred as it simplifies the engineering work involved by capitalising an the basic strength and integrity of the reactor building. It minimises thd radiation exposure to workers and radioactivity released to the environment, reduces the amount of radioactive waste produced and significantly cuts the total decommissioning cost. The closure and the decommissioning of Trawsfynydd power station was a sensitive issue as: The station lies within a National Park of outstanding beauty. The economic circumstances in the area are such that employment opportunities are very limited. At a crucial time when the company was approaching a Government review which would decide its future, Nuclear Electric could not afford to lose any credibility. A public consultation programme was launched in the vicinity of the power station To gauge the reactions of the public and elected local government bodies to a series of decommissioning options. Nuclear Electric presented three main options with details on the employment opportunities, the costs, and the lorry loads of material involved with each. The people were identified on whom decommissioning Trawsfynydd power station is likely to have an environmental or socioeconomic impact. As a result of the polls the Nuclear Electric received feedback in two ways. Formal feedback from the local councils Independent analysis of the completed questionnaires. The company was wholly committed to a meaningful consultation. Before

Le rapprochement Chercheur-Consultant en aménagement du territoire : un apport à haute valeur ajoutée ?

Directory of Open Access Journals (Sweden)

Christine Chemin

2010-02-01

Full Text Available En aménagement du territoire, de nouvelles pratiques partenariales semblent émerger lors de la réalisation d'expertises (études, ingénierie de projets, audits, etc.. Si le recours aux cabinets-conseils – au Consultant – et aux laboratoires scientifiques – au Chercheur – par les services de l'Etat ou les collectivités territoriales existe depuis de nombreuses années, le rapprochement et le partenariat entre les consultants et les chercheurs est récent. Certes, cette pratique n’est pas encore systématique en aménagement du territoire mais elle constitue, selon les commanditaires publics, un apport à haute valeur ajoutée dans les prestations de services.In urban planning new partnership practices seem to appear through the realization of expertises (studies, projects engineering, audits…. Although the appeal to consulting firms – to consultants – and in the scientific laboratories – to researchers – by the State services or local government, exists for a long time now, the partnership between consultants and researchers is recent. Even though this partnership is not systematic in urban planning, it brings a contribution with a high added value in the services, according to the public partners.

Public consultation in public policy information: a state-of-the-art report

International Nuclear Information System (INIS)

Bishop, A.B.; McKee, M.; Hansen, R.D.

1977-01-01

The purpose of the National Waste Terminal Storage (NWTS) Program is to site, construct and operate nuclear waste repositories at several locations. Recent experience indicates that the public is aware of the problems of nuclear waste disposal, and correspondingly there is public concern about how and where to dispose of nuclear wastes. The selection of sites involves a wide range of considerations including geological, technical and environmental feasibility. In addition to these, it is important that societal acceptance of repository options also be taken into account in moving foward with the NWTS Program. Such an incorporation of social considerations and preferences correspondingly implies the need for public consultation in the site selection process. In exploring the concept and state-or-the-art of public involvement in public policy decision, a number of important questions are relevant: (1) What are the basic objectives of public participation in policy formation and program decisions. (2) Who are the ''publics'' that should be involved and how can they be identified. (3) What information should be communicated between the agency and the publics. (4) What techniques are available to elicit public participation and involvement and what are their capabilities. At the outset, it should be noted that the purpose of this paper in addressing these questions is not to design public participation procedures for the NWTS program. Rather, the above are questions that provide a broad framework for developing an understanding of citizen participation in public policy decisions, such as nuclear waste disposal. In this sense, the following discussion is to provide a context and guidance for approaching the problem of organizing and structuring involvement in the NWTS program. Annotated bibliography of 95 references is included

Public consultation in public policy information: a state-of-the-art report

Energy Technology Data Exchange (ETDEWEB)

Bishop, A.B.; McKee, M.; Hansen, R.D.

1977-01-01

The purpose of the National Waste Terminal Storage (NWTS) Program is to site, construct and operate nuclear waste repositories at several locations. Recent experience indicates that the public is aware of the problems of nuclear waste disposal, and correspondingly there is public concern about how and where to dispose of nuclear wastes. The selection of sites involves a wide range of considerations including geological, technical and environmental feasibility. In addition to these, it is important that societal acceptance of repository options also be taken into account in moving foward with the NWTS Program. Such an incorporation of social considerations and preferences correspondingly implies the need for public consultation in the site selection process. In exploring the concept and state-or-the-art of public involvement in public policy decision, a number of important questions are relevant: (1) What are the basic objectives of public participation in policy formation and program decisions. (2) Who are the ''publics'' that should be involved and how can they be identified. (3) What information should be communicated between the agency and the publics. (4) What techniques are available to elicit public participation and involvement and what are their capabilities. At the outset, it should be noted that the purpose of this paper in addressing these questions is not to design public participation procedures for the NWTS program. Rather, the above are questions that provide a broad framework for developing an understanding of citizen participation in public policy decisions, such as nuclear waste disposal. In this sense, the following discussion is to provide a context and guidance for approaching the problem of organizing and structuring involvement in the NWTS program. Annotated bibliography of 95 references is included.

An analytical comparison of the patient-to-doctor policy and the doctor-to-patient policy in the outpatient clinic

NARCIS (Netherlands)

Hulshof, P.J.H.; Vanberkel, P.T.; Boucherie, Richardus J.; Hans, Elias W.; van Houdenhoven, Mark; van Ommeren, Jan C.W.

Outpatient clinics traditionally organize processes such that the doctor remains in a consultation room, while patients visit for consultation, we call this the Patient-to-Doctor policy. A different approach is the Doctor-to-Patient policy, whereby the doctor travels between multiple consultation

Radiology consultation in the era of precision oncology: A review of consultation models and services in the tertiary setting

Energy Technology Data Exchange (ETDEWEB)

DiPiro, Pamela J.; Krajewski, Katherine M.; Giardino, Angela A.; Braschi-Amirfarzan, Marta; Ramaiya, Nikhil H. [Dept. of Radiology, Brigham and Women' s Hospital, Harvard Medical School, Boston (United States)

2017-01-15

The purpose of the article is to describe the various radiology consultation models in the Era of Precision Medicine. Since the inception of our specialty, radiologists have served as consultants to physicians of various disciplines. A variety of radiology consultation services have been described in the literature, including clinical decision support, patient-centric, subspecialty interpretation, and/or some combination of these. In oncology care in particular, case complexity often merits open dialogue with clinical providers. To explore the utility and impact of radiology consultation services in the academic setting, this article will further describe existing consultation models and the circumstances that precipitated their development. The hybrid model successful at our tertiary cancer center is discussed. In addition, the contributions of a consultant radiologist in breast cancer care are reviewed as the archetype of radiology consultation services provided to oncology practitioners.

Radiology Consultation in the Era of Precision Oncology: A Review of Consultation Models and Services in the Tertiary Setting.

Science.gov (United States)

DiPiro, Pamela J; Krajewski, Katherine M; Giardino, Angela A; Braschi-Amirfarzan, Marta; Ramaiya, Nikhil H

2017-01-01

The purpose of the article is to describe the various radiology consultation models in the Era of Precision Medicine. Since the inception of our specialty, radiologists have served as consultants to physicians of various disciplines. A variety of radiology consultation services have been described in the literature, including clinical decision support, patient-centric, subspecialty interpretation, and/or some combination of these. In oncology care in particular, case complexity often merits open dialogue with clinical providers. To explore the utility and impact of radiology consultation services in the academic setting, this article will further describe existing consultation models and the circumstances that precipitated their development. The hybrid model successful at our tertiary cancer center is discussed. In addition, the contributions of a consultant radiologist in breast cancer care are reviewed as the archetype of radiology consultation services provided to oncology practitioners.

Science Outside the Lab: Helping Graduate Students in Science and Engineering Understand the Complexities of Science Policy.

Science.gov (United States)

Bernstein, Michael J; Reifschneider, Kiera; Bennett, Ira; Wetmore, Jameson M

2017-06-01

Helping scientists and engineers challenge received assumptions about how science, engineering, and society relate is a critical cornerstone for macroethics education. Scientific and engineering research are frequently framed as first steps of a value-free linear model that inexorably leads to societal benefit. Social studies of science and assessments of scientific and engineering research speak to the need for a more critical approach to the noble intentions underlying these assumptions. "Science Outside the Lab" is a program designed to help early-career scientists and engineers understand the complexities of science and engineering policy. Assessment of the program entailed a pre-, post-, and 1 year follow up survey to gauge student perspectives on relationships between science and society, as well as a pre-post concept map exercise to elicit student conceptualizations of science policy. Students leave Science Outside the Lab with greater humility about the role of scientific expertise in science and engineering policy; greater skepticism toward linear notions of scientific advances benefiting society; a deeper, more nuanced understanding of the actors involved in shaping science policy; and a continued appreciation of the contributions of science and engineering to society. The study presents an efficacious program that helps scientists and engineers make inroads into macroethical debates, reframe the ways in which they think about values of science and engineering in society, and more thoughtfully engage with critical mediators of science and society relationships: policy makers and policy processes.

43 CFR 46.155 - Consultation, coordination, and cooperation with other agencies.

Science.gov (United States)

2010-10-01

... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false Consultation, coordination, and... Interior IMPLEMENTATION OF THE NATIONAL ENVIRONMENTAL POLICY ACT OF 1969 Protection and Enhancement of Environmental Quality § 46.155 Consultation, coordination, and cooperation with other agencies. The Responsible...

Bridging Water Resources Policy and Environmental Engineering in the Classroom at Cornell University

Science.gov (United States)

Walter, M. T.; Shaw, S. B.; Seifert, S.; Schwarz, T.

2006-12-01

Current university undergraduate students in environmental sciences and engineering are the next generation of environmental protection practitioners. Recognizing this, Cornell's Biological and Environmental Engineering department has developed a popular class, Watershed Engineering (BEE 473), specifically designed to bridge the too-common gap between water resources policy and state-of-art science and technology. Weekly homework assignments are to design real-life solutions to actual water resources problems, often with the objective of applying storm water policies to local situations. Where appropriate, usually in conjunction with recent amendments to the Federal Clean Water Act, this course introduces water resource protection tools and concepts developed in the Cornell Soil and Water Lab. Here we present several examples of how we build bridges between university classrooms and the complex world of water resources policy.

Design Factors Influencing Quality of Building Projects in Nigeria: Consultants' Perception

Directory of Open Access Journals (Sweden)

Lukumon Oyedele

2012-11-01

Full Text Available Various factors identified from the literature that caninfluence quality of building projects in Nigeria have beenstudied by means of questionnaire survey sent to architects,engineers and quantity surveyors in the industry. From atotal response of 107 consultants, the importance of eachfactor was obtained via severity and frequency responsesof the factors. Data analysis includes comparisons ofranking among consultants using severity, frequency andimportance indexes, correlation analysis, and percentagerank agreement factor (PRAF to measure the agreement inthe importance ranking among the consultants.Correlation results between the professionals are architects/quantity surveyors (0.75, architects/engineers (0.21 ,and engineers/quantity surveyors (0.24. The percentagerank agreement factor (PRAF shows that the five mostimportant factors affecting quality are 'design changes'(78.9%; 'inadequate involvement of other professionalsduring the design stage' (78.9%; 'insufficient andunrealistic constraints of project cost' (71.1 %; 'poor levelof commitment to quality improvement among designprofessionals' (63.2%; and 'making design decisions oncost and not value of work' (55.3%. The results of this studywould provide feedback for the clients, project and qualitymangers and all the consultants in the industry, so thateffective management of quality can be ensured from theconceptual-design stage of the project.

Stakeholder consultations on community-based rehabilitation guidelines in Ghana and Uganda

Directory of Open Access Journals (Sweden)

Mary Wickenden

2012-10-01

Objectives: To consult with key stakeholders in the disability arena in Uganda and Ghana, in order to gain their opinions and suggestions for improvements to the then draft CBR guidelines, as part of a wider global participatory process of consultation on the document. Methods: The INGO Sightsavers gathered qualitative data through focus group discussions and questionnaires in both countries. Results: The participants’ critiques of the draft guidelines carried out in multiagency participatory processes were analysed thematically and fed back to the CBR guidelines editorial team. Conclusion: The paper concludes that stakeholders in diverse communities can actively contribute to shaping policy and practice through participatory consultations. Local and national government and non-government organisations and other key informants can inform the development of national and international guidelines and policies. This participatory approach can be successfully facilitated by INGOs. In turn, these processes have prompted organisations to adapt their own policies and programmes in order to be more responsive to the local needs and concerns of PWDs.

Being an effective nurse consultant in the English National Health Service: what does it take? A study of consultants specializing in safeguarding.

Science.gov (United States)

Franks, Helen; Howarth, Michelle

2012-10-01

This study established key attributes and perceived strengths, weaknesses, opportunities and threats (SWOT) of nurse consultants specializing in safeguarding children. The nurse consultant role in England spans four domains--clinical, leadership, education and research--and was intended to enable senior nurses to remain in clinical practice. ata identifying the time spent by the nurse consultants in the four domains was collated and a thematic content analysis of the SWOT of the role was ascertained from semi-structured interviews with nurse consultants (n = 4) and stakeholders (n = 6). Strengths and opportunities in clinical (consultancy), leadership and educational functions were identified but some weaknesses and threats in terms of nurse consultant's contributions to research were also identified. The role was neither wholly strategic nor clinical. Role ambiguity meant that they were not always valued by managers, making the role potentially expendable. Nurse consultants are pivotal within health-care organizations because they span clinical practice and leadership enabling them to support managers in strategic planning, commissioning and implementation of policy. Nurse consultants can support strategic practice development and influence quality and effectiveness service-wide. To succeed they must be understood, supported and nurtured by managers. © 2012 Blackwell Publishing Ltd.

Characterisation of organisational issues in paediatric clinical ethics consultation: a qualitative study.

Science.gov (United States)

Opel, D J; Wilfond, B S; Brownstein, D; Diekema, D S; Pearlman, R A

2009-08-01

The traditional approach to resolving ethics concerns may not address underlying organisational issues involved in the evolution of these concerns. This represents a missed opportunity to improve quality of care "upstream". The purpose of this study was to understand better which organisational issues may contribute to ethics concerns. Directed content analysis was used to review ethics consultation notes from an academic children's hospital from 1996 to 2006 (N = 71). The analysis utilised 18 categories of organisational issues derived and modified from published quality improvement protocols. Organisational issues were identified in 68 of the 71 (96%) ethics consult notes across a range of patient settings and reasons for consultation. Thirteen of the 18 categories of organisational issues were identified and there was a median of two organisational issues per consult note. The most frequently identified organisational issues were informal organisational culture (eg, collective practices and approaches to situations with ethical dimensions that are not guided by policy), policies and procedures (eg, staff knows policy and/or procedural guidelines for an ethical concern but do not follow it) and communication (eg, communication about critical information, orders, or hand-offs repeatedly does not occur among services). Organisational issues contribute to ethical concerns that result in clinical ethics consults. Identifying and addressing organisational issues such as informal culture and communication may help decrease the recurrence of future similar ethics concerns.

SOME REFLECTIONS UPON MANAGEMENT CONSULTING AS PROFESSIONAL SERVICES

OpenAIRE

Tomescu Ada; Botezat Elena

2008-01-01

Management consulting helping organizations improve their performance, primarily through the thorough analysis of existing business problems and development of plans for improvement. There is probably no activity about which the opinions are so divided as management consulting. The purpose of this paper is to make some reflections upon what role play the consulting management services as professional service to the firms and how offering these services affects the offering and delivery of oth...

Promoting a Culture of Tailoring for Systems Engineering Policy Expectations

Science.gov (United States)

Blankenship, Van A.

2016-01-01

NASA's Marshall Space Flight Center (MSFC) has developed an integrated systems engineering approach to promote a culture of tailoring for program and project policy requirements. MSFC's culture encourages and supports tailoring, with an emphasis on risk-based decision making, for enhanced affordability and efficiency. MSFC's policy structure integrates the various Agency requirements into a single, streamlined implementation approach which serves as a "one-stop-shop" for our programs and projects to follow. The engineers gain an enhanced understanding of policy and technical expectations, as well as lesson's learned from MSFC's history of spaceflight and science missions, to enable them to make appropriate, risk-based tailoring recommendations. The tailoring approach utilizes a standard methodology to classify projects into predefined levels using selected mission and programmatic scaling factors related to risk tolerance. Policy requirements are then selectively applied and tailored, with appropriate rationale, and approved by the governing authorities, to support risk-informed decisions to achieve the desired cost and schedule efficiencies. The policy is further augmented by implementation tools and lifecycle planning aids which help promote and support the cultural shift toward more tailoring. The MSFC Customization Tool is an integrated spreadsheet that ties together everything that projects need to understand, navigate, and tailor the policy. It helps them classify their project, understand the intent of the requirements, determine their tailoring approach, and document the necessary governance approvals. It also helps them plan for and conduct technical reviews throughout the lifecycle. Policy tailoring is thus established as a normal part of project execution, with the tools provided to facilitate and enable the tailoring process. MSFC's approach to changing the culture emphasizes risk-based tailoring of policy to achieve increased flexibility, efficiency

School Neuropsychology Consultation in Neurodevelopmental Disorders

Science.gov (United States)

Decker, Scott L.

2008-01-01

The role of school psychologists with training in neuropsychology is examined within the context of multitiered models of service delivery and educational reform policies. An expanded role is suggested that builds on expertise in the assessment of neurodevelopmental disorders and extends to broader tiers through consultation practice. Changes in…

A Low Cost Implementation of an Existing Hands-on Laboratory Experiment in Electronic Engineering

Directory of Open Access Journals (Sweden)

Clement Onime

2014-10-01

Full Text Available In engineering the pedagogical content of most formative programmes includes a significant amount of practical laboratory hands-on activity designed to deliver knowledge acquisition from actual experience alongside traditional face-to-face classroom based lectures and tutorials; this hands-on aspect is not always adequately addressed by current e-learning platforms. An innovative approach to e-learning in engineering, named computer aided engineering education (CAEE is about the use of computer aids for the enhanced, interactive delivery of educational materials in different fields of engineering through two separate but related components; one for classroom and another for practical hands-on laboratory work. The component for hands-on laboratory practical work focuses on the use of mixed reality (video-based augmented reality tools on mobile devices/platforms. This paper presents the computer aided engineering education (CAEE implementation of a laboratory experiment in micro-electronics that highlights some features such as the ability to closely implement an existing laboratory based hands-on experiment with lower associated costs and the ability to conduct the experiment off-line while maintaining existing pedagogical contents and standards.

Status of nuclear data needed for radiation therapy and existing data development activities in Member States. Summary report of a consultants' meeting

International Nuclear Information System (INIS)

Kocherov, N.P.

1997-01-01

The present report contains the summary of the IAEA Consultants' Meeting on the ''Status of nuclear data needed for radiation therapy and existing data development activities in Member States'' held at the IAEA Headquarters, Vienna, 9-11 December 1996. The present activities on nuclear data for radiotherapy are summarized in Member States, the present status of nuclear data for photon, neutron and proton therapy is reviewed and topics which are not presently covered by other institutions are identified. (author). 4 refs, 2 figs

Investigation of existing financial incentive policies for solar photovoltaic systems in U.S. regions

Directory of Open Access Journals (Sweden)

Jian Zhang

2017-12-01

Full Text Available This paper analyzes some of the existing incentives for solar photovoltaic (PV energy generation in the U.S. Four types of buildings (e.g., hospitals, large offices, large hotels, and secondary schools located in five different U.S. states, each having their own incentives, are selected and analyzed for the PV incentive policies. The payback period of the PV system is chosen as an indicator to analyze and critique the effectiveness of each incentive by comparing the payback periods before and after taking the incentive into consideration. Then a parametric analysis is conducted to determine the influence of the variation in key parameters, such as PV system capacity, capital cost of PV, sell back ratio and the performance-based incentive rate, on the performance of the PV system. The results show how the existing incentives can be effectively used to promote the PV systems in the U.S. and how variations of the parameters can impact the payback period of the PV systems. Through the evaluation of the existing incentive policies and the parametric study, this paper demonstrates that the type and level of incentives should be carefully determined in policy-making processes to effectively promote the PV systems.

Windows® Group Policy Administrators Pocket Consultant

CERN Document Server

Stanek, William

2009-01-01

Portable and precise, this pocket-sized guide delivers ready answers for the day-to-day administration of Group Policy. Zero in on core support and maintenance tasks using quick-reference tables, instructions, and lists. You'll get the focused information you need to solve problems and get the job done-whether at your desk or in the field! Get fast facts to: Configure Local GPOs and Active Directory®-based GPOsManage policy preferences and settingsModel policy changes through the consoleMigrate and maintain the SYSVOLDiagnose and troubleshoot replication issuesKnow when to enforce, block,

Services performed by an engineering consultant

International Nuclear Information System (INIS)

Seyffert, L.

1984-01-01

In the near future, services for the nuclear power plants in operation will become particularly important. Already at the present stage, engineering firms contribute to the planning of revisions and repair work, to the design, procurement and project management of new components and subsystems, respectively; they delegate supporting engineering personnel for the execution of in-plant measures, create special EDP software, develop quality assurance systems and work on quality control. This enumeration presents a rough outline of the field of activities, although it is far from complete. Also, the lines are drawn rather artibrarily, leaving out, for instance, the extensive activities in the fields of waste management and fuel management. These are main activities of specialized engineering firms which will be the subject of a future report. (orig.) [de

Bladder Pain Syndrome International Consultation on Incontinence

DEFF Research Database (Denmark)

Hanno, P.; Lin, A.; Nordling, J.

2010-01-01

Aims of Study: The Bladder Pain Syndrome Committee of the International Consultation on Incontinence was assigned the task by the consultation of reviewing the syndrome, formerly known as interstitial cystitis, in a comprehensive fashion. This included the topics of definition, nomenclature......, taxonomy, epidemiology, etiology, pathology, diagnosis, symptom scales, outcome assessment, principles of management, specific therapies, and future directions in research. Study Design, Materials, Methods: The emphasis was on new information developed since the last consultation 4 years previously. Where...... possible, existing evidence was assessed and a level of recommendation was developed according to the Oxford system of classification. Results: The consultation decided to refer to the condition as "bladder pain syndrome" (BPS) because the designation is more descriptive of the clinical condition...

Learning to consult with computers.

Science.gov (United States)

Liaw, S T; Marty, J J

2001-07-01

To develop and evaluate a strategy to teach skills and issues associated with computers in the consultation. An overview lecture plus a workshop before and a workshop after practice placements, during the 10-week general practice (GP) term in the 5th year of the University of Melbourne medical course. Pre- and post-intervention study using a mix of qualitative and quantitative methods within a strategic evaluation framework. Self-reported attitudes and skills with clinical applications before, during and after the intervention. Most students had significant general computer experience but little in the medical area. They found the workshops relevant, interesting and easy to follow. The role-play approach facilitated students' learning of relevant communication and consulting skills and an appreciation of issues associated with using the information technology tools in simulated clinical situations to augment and complement their consulting skills. The workshops and exposure to GP systems were associated with an increase in the use of clinical software, more realistic expectations of existing clinical and medical record software and an understanding of the barriers to the use of computers in the consultation. The educational intervention assisted students to develop and express an understanding of the importance of consulting and communication skills in teaching and learning about medical informatics tools, hardware and software design, workplace issues and the impact of clinical computer systems on the consultation and patient care.

Focusing on relationships, not information, respects autonomy during antenatal consultations.

Science.gov (United States)

Gaucher, Nathalie; Payot, Antoine

2017-01-01

Policy statements regarding antenatal consultations for preterm labour are guided by physicians' concerns for upholding the legal doctrine of informed consent, through the provision of standardised homogeneous medical information. This approach, led by classical in-control conceptions of patient autonomy, conceives moral agents as rational, independent, self-sufficient decision-makers. Recent studies on these antenatal consultations have explored patients' perspectives, and these differ from guidelines' suggestions. Relational autonomy - which understands moral agents as rational, emotional, creative and interdependent - resonates impressively with these new data. A model for antenatal consultations is proposed. This approach encourages clinicians to explore individual patients' lived experiences and engage in trusting empowering relationships. Moreover, it calls on physicians to enhance patients' relational autonomy by becoming advocates for their patients within healthcare institutions and professional organisations, while calling for broadscale policy changes to encourage further funding and support in investigations of the patient's voice. ©2016 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Letting the people speak: the public consultation process for nuclear power in Alberta and Saskatchewan

International Nuclear Information System (INIS)

Bratt, D.

2010-01-01

This paper compares the Alberta and Saskatchewan governments' public consultation process for the introduction of nuclear power in their provinces. While the goal was the same - to gauge public reaction on a continuous policy issue - the design of their respective consultation process was quite different. The paper analyzes the techniques of public consultation in the nuclear sector, especially the use of public hearings and multiple consultative tools. Finally, it assesses the impact that public consultation has on government decision-making. (author)

Past/Forward Policy-Making: Transforming Chinese Engineering Education since the Reform and Opening-Up

Science.gov (United States)

Zhu, Qin; Jesiek, Brent K.; Gong, Yu

2015-01-01

Although engineering education has played important roles in China's growing power and influence on the world stage, engineering education policy since the Reform and Opening-up in the late 1970s has not been well documented in current English-language scholarship. Informed by historical and sociological studies of education, engineering and…

Analyzing the Existing Undergraduate Engineering Leadership Skills

OpenAIRE

Hamed M. Almalki; Luis Rabelo; Charles Davis; Hammad Usmani; Debra Hollister; Alfonso Sarmiento

2016-01-01

Purpose: Studying and analyzing the undergraduate engineering students' leadership skills to discover their potential leadership strengths and weaknesses. This study will unveil potential ways to enhance the ways we teach engineering leadership. The research has great insights that might assist engineering programs to improve curricula for the purpose of better engineering preparation to meet industry's demands. Methodology and Findings: 441 undergraduate engineering students have been s...

The Organizational Communication Consulting Spectrum.

Science.gov (United States)

Tubbs, Stewart L.

Surveys of businesses and business managers indicate that developing communication skills within organizations is a priority. Communication consulting exists over a wide spectrum of activities that include guest speaking, conducting workshops, and conducting management training programs. These three processes can include a "canned program" that…

Optimal Pricing Strategy in Marketing Research Consulting.

OpenAIRE

Chang, Chun-Hao; Lee, Chi-Wen Jevons

1994-01-01

This paper studies the optimal pricing scheme for a monopolistic marketing research consultant who sells high-cost proprietary marketing information to her oligopolistic clients in the manufacturing industry. In designing an optimal pricing strategy, the consultant needs to fully consider the behavior of her clients, the behavior of the existing and potential competitors to her clients, and the behavior of her clients' customers. The authors show how the environment uncertainty, the capabilit...

THE ROLE OF ACCOUNTING ENGINEERING IN SHAPING THE BALANCE POLICY OF A COMPANY

Directory of Open Access Journals (Sweden)

Leszek Michalczyk

2013-02-01

Full Text Available The issue discussed in the present paper is associated with a theoretical view of accounting engineering in which it is perceived as covering activities based on the use of variant solutions permitted by Polish balance sheet law. These possibilities are defined as the accounting policy of a given company. Keeping the accounts of a business enterprise in accordance with the accounting engineering paradigm requires a full use of codified variant accounting. The accounting policy of a company should, in these respects, be characterized by entries which are the least precise and the most facultative. The view of accounting assumed in the present article sees it as an auxiliary science for management and organizational studies. In this respect, it is also synonymous with recognizing accounting engineering as a paradigm of company management.

Relation between a career and family life for English hospital consultants: qualitative, semistructured interview study.

Science.gov (United States)

Dumelow, C; Littlejohns, P; Griffiths, S

2000-05-27

To explore the relation between work and family life among hospital consultants and their attitude towards the choices and constraints that influence this relation. Qualitative study of consultants' experiences and views based on tape recorded semistructured interviews. Former South Thames health region in southeast England. 202 male and female NHS hospital consultants aged between 40 to 50 years representing all hospital medical specialties. Three types of relation between work and family life (career dominant, segregated, and accommodating) were identified among hospital consultants. Most consultants had a segregated relation, although female consultants were more likely than male consultants to have a career dominant or an accommodating relation. Many male consultants and some female consultants expressed considerable dissatisfaction with the balance between their career and family life. A factor influencing this dissatisfaction was the perceived lack of choice to spend time on their personal or family life, because of the working practices and attitudes within hospital culture, if they wanted a successful career. Consultants are currently fitting in with the profession rather than the profession adapting to enable doctors to have fulfilling professional and personal lives. Current government policies to increase the medical workforce and promote family friendly policies in the NHS ought to take account of the need for a fundamental change in hospital culture to enable doctors to be more involved in their personal or family life without detriment to their career progress.

Information and communication technology (ICT) and eHealth policy in Latin America and the Caribbean: a review of national policies and assessment of socioeconomic context.

Science.gov (United States)

Jimenez-Marroquin, Maria Carolina; Deber, Raisa; Jadad, Alejandro R

2014-01-01

To examine the availability of national information and communication technology (ICT) or eHealth policies produced by countries in Latin America and the Caribbean (LAC), and to determine the influence of a country's socioeconomic context on the existence of these policies. Documents describing a national ICT or eHealth policy in any of the 33 countries belonging to the LAC region as listed by the United Nations were identified from three data sources: academic databases; the Google search engine; and government agencies and representatives. The relationship between the existence of a policy and national socioeconomic indicators was also investigated. There has been some progress in the establishment of ICT and eHealth policies in the LAC region. The most useful methods for identifying the policies were 1) use of the Google search engine and 2) contact with Pan American Health Organization (PAHO) country representatives. The countries that have developed a national ICT policy seem to be more likely to have a national eHealth policy in place. There was no statistical significant association between the existence of a policy and a country's socioeconomic context. Governments need to make stronger efforts to raise awareness about existing and planned ICT and eHealth policies, not only to facilitate ease of use and communication with their stakeholders, but also to promote collaborative international efforts. In addition, a better understanding of the effect of economic variables on the role that ICTs play in health sector reform efforts will help shape the vision of what can be achieved.

Coevolution in management fashion: an agent-based model of consultant-driven innovation.

Science.gov (United States)

Strang, David; David, Robert J; Akhlaghpour, Saeed

2014-07-01

The rise of management consultancy has been accompanied by increasingly marked faddish cycles in management techniques, but the mechanisms that underlie this relationship are not well understood. The authors develop a simple agent-based framework that models innovation adoption and abandonment on both the supply and demand sides. In opposition to conceptions of consultants as rhetorical wizards who engineer waves of management fashion, firms and consultants are treated as boundedly rational actors who chase the secrets of success by mimicking their highest-performing peers. Computational experiments demonstrate that consultant-driven versions of this dynamic in which the outcomes of firms are strongly conditioned by their choice of consultant are robustly faddish. The invasion of boom markets by low-quality consultants undercuts popular innovations while simultaneously restarting the fashion cycle by prompting the flight of high-quality consultants into less densely occupied niches. Computational experiments also indicate conditions involving consultant mobility, aspiration levels, mimic probabilities, and client-provider matching that attenuate faddishness.

A Critical Review of Videoconferencing Software to Support School Consultation

Science.gov (United States)

Fischer, Aaron J.; Schultz, Brandon K.; Collier-Meek, Melissa A.; Zoder-Martell, Kimberly A.; Erchul, William P.

2018-01-01

With recent advances in technology, several viable options now exist for school consultants to communicate with teachers via synchronous online videoconferencing (VC) without the need for specialized equipment. Unfortunately, few studies have evaluated the effectiveness of school consultation through VC, so practitioners are provided little…

A qualitative evaluation of policy instruments used to improve energy performance of existing private dwellings in the Netherlands

International Nuclear Information System (INIS)

Murphy, Lorraine; Meijer, Frits; Visscher, Henk

2012-01-01

Climate change policies in the Netherlands recognise the importance of existing dwellings. Efforts to gain these energy savings are led at national level by policy instruments such as the Energy Performance Certificate, covenants, economic and information tools. These instruments reflect a policy style described as consensus based and incentivising. However, this approach has been subject to criticism with suggestions that alternatives are required. As a first step towards conceptualising alternatives previous evaluations and stakeholder interviews are used to assess instruments. Elements from the theory based evaluation method combined with concepts from policy instrument and energy policy literature form an evaluation framework. Results demonstrate weak impact of some key instruments. Underlying theories associated with instruments are often lost during implementation or remain unsubstantiated. Policy instrument and energy policy concepts are evident but are far from pervasive. Results show that current instruments are poorly equipped to forge a long-term energy saving strategy for existing dwellings. It is further demonstrated that complexity with existing dwellings is not only limited to frequently cited barriers but to the intricacies of designing and operating a well-orchestrated instrument mix. - Highlights: ► Instruments are evaluated using the theory based method and normative concepts. ► Lack of monitoring and evaluation data affects impact assessment. ► Impact and normative concepts are reflected in part in individual instruments. ► A coherent strategy that demonstrates impact and reflects concepts is absent. ► Results form a first step from which to conceptualise alternatives.

Consulting Basics for the Teacher-Turned-Technology Consultant.

Science.gov (United States)

Stager, Sue; Green, Kathy

1988-01-01

Discusses the role of educational technology consultants who may be classroom teachers with no formal training in consulting. Consulting models are described, including content-oriented and process-oriented approaches; Schein's process facilitator model is examined; and Kurpius' consulting model is explained and expanded. (LRW)

State transformation and policy networks: The challenging implementation of new water policy paradigms in post-apartheid South Africa

Directory of Open Access Journals (Sweden)

Magalie Bourblanc

2017-06-01

Full Text Available For many years, South Africa had represented a typical example of a hydrocracy. Following the democratic transition in South Africa, however, new policy paradigms emerged, supported by new political elites from the ANC. A reform of the water policy was one of the priorities of the new Government, but with little experience in water management, they largely relied on 'international best practices' in the water sector, although some of these international principles did not perfectly fit the South African water sector landscape. In parallel, a reform called 'transformation' took place across all public organisations with the aim of allowing public administrations to better reflect the racial components in South African society. As a result, civil engineers lost most of their power within the Department of Water Affairs and Sanitation (DWS. However, despite these changes, demand-side management has had difficulties in materializing on the ground. The paper aims at discussing the resilience of supply-side management within the Ministry, despite its new policy orientation. Using a policy network concept, the paper shows that the supply-side approach still prevails today, due to the outsourcing of most DWS tasks to consulting firms with whom DWS engineers have nourished a privileged relationship since the 1980s. The article uses the decision-making process around the Lesotho Highlands Water Project (LHWP Phase 2 as an emblematic case study to illustrate such developments. This policy network, which has enjoyed so much influence over DWS policies and daily activities, is now being contested. As a consequence, we argue that the fate of the LHWP Phase 2 is ultimately linked to a competition between this policy network and a political one.

Determinants of Management Innovation in the Ghanaian Construction Consulting Sector

Directory of Open Access Journals (Sweden)

De-Graft Owusu-Manu

2015-03-01

Full Text Available Determinants of management innovation (MI within the Ghanaian construction consulting sector are examined. A sample of 70 consulting firms is surveyed using self-administered questionnaires. Data are analysed using descriptive statistics and factor analysis. Findings indicate that determinants of MI were interwoven among seven principal factors viz: community and market demands; financial and business management practices; human resource policies; creativity and organizational strategies; corporate social responsibility; prevailing conditions; and competitive leverage. The study adds to the discourse on evolution of innovation within the global consulting sector generally, while providing reference for practitioners and academics in the field with respect to MI determinants more specifically. It is envisaged that practitioners who adopt these findings in the construction consultancy sector would enhance their ability to provide innovative services to clients. Study recommendations include that future research should explore how innovation is diffused within consulting enterprises’ value chains. Paper Type: Research article

Electronic medical records in diabetes consultations: participants' gaze as an interactional resource.

Science.gov (United States)

Rhodes, Penny; Small, Neil; Rowley, Emma; Langdon, Mark; Ariss, Steven; Wright, John

2008-09-01

Two routine consultations in primary care diabetes clinics are compared using extracts from video recordings of interactions between nurses and patients. The consultations were chosen to present different styles of interaction, in which the nurse's gaze was either primarily toward the computer screen or directed more toward the patient. Using conversation analysis, the ways in which nurses shift both gaze and body orientation between the computer screen and patient to influence the style, pace, content, and structure of the consultation were investigated. By examining the effects of different levels of engagement between the electronic medical record and the embodied patient in the consultation room, we argue for the need to consider the contingent nature of the interface of technology and the person in the consultation. Policy initiatives designed to deliver what is considered best-evidenced practice are modified in the micro context of the interactions of the consultation.

Challenges in Australian policy processes for disinvestment from existing, ineffective health care practices.

Science.gov (United States)

Elshaug, Adam G; Hiller, Janet E; Tunis, Sean R; Moss, John R

2007-10-31

Internationally, many health care interventions were diffused prior to the standard use of assessments of safety, effectiveness and cost-effectiveness. Disinvestment from ineffective or inappropriately applied practices is a growing priority for health care systems for reasons of improved quality of care and sustainability of resource allocation. In this paper we examine key challenges for disinvestment from these interventions and explore potential policy-related avenues to advance a disinvestment agenda. We examine five key challenges in the area of policy driven disinvestment: 1) lack of resources to support disinvestment policy mechanisms; 2) lack of reliable administrative mechanisms to identify and prioritise technologies and/or practices with uncertain clinical and cost-effectiveness; 3) political, clinical and social challenges to removing an established technology or practice; 4) lack of published studies with evidence demonstrating that existing technologies/practices provide little or no benefit (highlighting complexity of design) and; 5) inadequate resources to support a research agenda to advance disinvestment methods. Partnerships are required to involve government, professional colleges and relevant stakeholder groups to put disinvestment on the agenda. Such partnerships could foster awareness raising, collaboration and improved health outcome data generation and reporting. Dedicated funds and distinct processes could be established within the Medical Services Advisory Committee and Pharmaceutical Benefits Advisory Committee to, a) identify technologies and practices for which there is relative uncertainty that could be the basis for disinvestment analysis, and b) conduct disinvestment assessments of selected item(s) to address existing practices in an analogous manner to the current focus on new and emerging technology. Finally, dedicated funding and cross-disciplinary collaboration is necessary to build health services and policy research capacity

Analyzing the Existing Undergraduate Engineering Leadership Skills

Directory of Open Access Journals (Sweden)

Hamed M. Almalki

2016-12-01

Full Text Available Purpose: Studying and analyzing the undergraduate engineering students' leadership skills to discover their potential leadership strengths and weaknesses. This study will unveil potential ways to enhance the ways we teach engineering leadership. The research has great insights that might assist engineering programs to improve curricula for the purpose of better engineering preparation to meet industry's demands. Methodology and Findings: 441 undergraduate engineering students have been surveyed in two undergraduate engineering programs to discover their leadership skills. The results in both programs were revealing that undergraduate engineering students are lacking behind in the visionary leadership skills compared to directing, including and cultivating leadership styles. Recommendation: A practical framework has been proposed to enhance the lacking leadership skills by utilizing the Matrix of Change (MOC, and the Balanced Scorecard BSC to capture the best leadership scenarios to design virtual simulation environment as per the lacking leadership skills which is the visionary leadership skills in this case. After that, the virtual simulation will be used to provide an experiential learning by replacing human beings with avatars that can be managed or dramatized by real people to enable the creation of live, practical, measurable, and customizable leadership development programs.

Wind power projects and Aboriginal consultation

Energy Technology Data Exchange (ETDEWEB)

Isaac, T. [McCarthy Tetrault LLP, Vancouver, BC (Canada)

2006-07-01

This presentation outlined some of the legal aspects related to Aboriginal involvement in wind power development consultation processes and disputes. Aboriginal rights are rights held by Aboriginal people that are an element of a practice, custom, or tradition integral to the culture of groups claiming such rights. Wind power developers should understand that Aboriginal rights claims may include fishing; whaling; transportation; and cultural and spiritual activities. Aboriginal title is a subcategory of Aboriginal rights, and is a right to land itself, and an encumbrance on the Crown's underlying title to land. Weak Aboriginal claims where potential infringement by energy developers is minor may only require notice and information. Strong prima facie cases for Aboriginal rights and title where the potential for infringement is of high significance may result in more extensive consultation involving interim solutions; formal Aboriginal participation in decision-making processes; and written responses demonstrating how Aboriginal concerns have been considered. There are a number of circumstances requiring a case-by-case approach, and the Crown may make decisions in the face of Aboriginal disagreement. However, energy developers should ensure that consultation processes are fair and reasonable. Conflicting interests can often be successfully resolved through consultation, and accommodation to Aboriginal rights may include mitigation, avoiding interference, and agreeing to as little infringement as possible. Aboriginal title may attach to private land but only to the Crown's underlying title. The Crown has no duty to consult respecting Aboriginal title on private land because title has already been infringed. In these cases, duty to consult and accommodate may be discharged through other regulatory processes such as environmental impact assessments. It was concluded that wind power project proponents should build a relationship with the Crown, as avoiding

Engineering - a key aspect of the UK nuclear policy review

International Nuclear Information System (INIS)

Bindon, J.L.; Butcher, Sally

1993-01-01

In anticipation of the forthcoming nuclear review, a forum on issues relevant to the industry was held at the Institution of Electrical Engineers HQ in London, in association with the Institute of Energy and the Watt Committee on Energy. The forum was divided into five sections, dealing with energy policy, the environment, industry, economics and safety. (author)

"It's More Flexible": Persistence of Women Engineers in the Academy

Science.gov (United States)

Mlambo, Yeukai Angela; Mabokela, Reitumetse Obakeng

2017-01-01

The under-representation of women in engineering is an issue of concern for policy-makers. While much of the existing literature has focussed on understanding reasons for women's under-representation in engineering and related technical fields, there is a paucity of research that examines why women who are already in engineering persist. This…

Access to essential medicines in Pakistan: policy and health systems research concerns.

Directory of Open Access Journals (Sweden)

Shehla Zaidi

Full Text Available INTRODUCTION: Inadequate access to essential medicines is a common issue within developing countries. Policy response is constrained, amongst other factors, by a dearth of in-depth country level evidence. We share here i gaps related to access to essential medicine in Pakistan; and ii prioritization of emerging policy and research concerns. METHODS: An exploratory research was carried out using a health systems perspective and applying the WHO Framework for Equitable Access to Essential Medicine. Methods involved key informant interviews with policy makers, providers, industry, NGOs, experts and development partners, review of published and grey literature, and consultative prioritization in stakeholder's Roundtable. FINDINGS: A synthesis of evidence found major gaps in essential medicine access in Pakistan driven by weaknesses in the health care system as well as weak pharmaceutical regulation. 7 major policy concerns and 11 emerging research concerns were identified through consultative Roundtable. These related to weaknesses in medicine registration and quality assurance systems, unclear and counterproductive pricing policies, irrational prescribing and sub-optimal drug availability. Available research, both locally and globally, fails to target most of the identified policy concerns, tending to concentrate on irrational prescriptions. It overlooks trans-disciplinary areas of policy effectiveness surveillance, consumer behavior, operational pilots and pricing interventions review. CONCLUSION: Experience from Pakistan shows that policy concerns related to essential medicine access need integrated responses across various components of the health systems, are poorly addressed by existing evidence, and require an expanded health systems research agenda.

Governmentality and Social Capital in Tribal/Federal Relations Regarding Heritage Consultation

Science.gov (United States)

2016-04-08

for improved tribal/federal heritage consultation; this will be accomplished by working collaboratively with tribal heritage specialists toward...during this period and will receive scholarships or fellowships for further studies in science, mathematics , engineering or technology fields...graduated during this period with a degree in science, mathematics , engineering, or technology fields: The number of undergraduates funded by your

[Clinical ethics consultation - an integrative model for practice and reflection].

Science.gov (United States)

Reiter-Theil, Stella

2008-07-01

Broad evidence exists that health care professionals are facing ethical difficulties in patient care demanding a spectrum of useful ethics support services. Clinical ethics consultation is one of these forms of ethics support being effective in the acute setting. An authentic case is presented as an illustration. We introduce an integrative model covering the activities being characteristic for ethics consultation and going beyond "school"-specific approaches. Finally, we formulate some do's and don'ts of ethics consultation that are considered to be key issues for successful practice.

Energy-saving construction. A practice book for architects, engineers and energy consultants; Energiesparendes Bauen. Ein Praxisbuch fuer Architekten, Ingenieure und Energieberater

Energy Technology Data Exchange (ETDEWEB)

Marquardt, Helmut

2011-07-01

Due to a rapid amendment of the Energy Saving Ordinance in 2007 and 2009, the opportunities for energy conservation in buildings come more clearly into the public consciousness. The energy consultancy increasingly is in demand. Under this aspect, the author of te book under consideration reports on the fundamentals of thermal protection, on designs for compliance with the Energy Saving Ordinance, on the appropriate plant engineering as well as on the calculation of residential buildings according to the Energy Saving Ordinance and Act on Power Generation from Renewable Energy Sources.

Engineering in the energy sector. The single market and the engineering sector

International Nuclear Information System (INIS)

Garcia Rodrigues, A.

1993-01-01

Projects with large infrastructures, particularly those in the field of energy, provide a strong boost to certain industrial sectors in the country. In the case of Spain, the policy of direct management 'by components' of these projects - hydroelectric power plants, petrochemical plants, thermoelectric plants and nuclear power plants - adopted by the electric utility owners has furthered not only the local equipment manufacturing industry but also the engineering sector. At present, with full implementation of the Single Market in sight, it is particularly interesting for Spain to continue building up a powerful engineering sector, increasing its size and usefulness, and extending its traditional areas of action to other technologies, more on the lines of engineering and consulting firms in the USA than in the rest of Europe. The intention is to endow our equipment and construction companies with the skills necessary to enable them to compete with large European conglomerates in their respective sectors. The structure of these conglomerates usually contains engineering capabilities which are not habitual in our industry. Examples are given, showing how this model has been used to compete and win awards for important international projects. A specific analysis has been made of the position of Spanish engineering and industry in nuclear power generation projects in the former Soviet Union and East European countries, in which large investments are expected to be made. (author)

Fiscal Policy as an Engine of Economic Growth in Nigeria | Zhattau ...

African Journals Online (AJOL)

Economic growth is a powerful engine for generating long-term standard of living. There are many strategies through which a country may attain self-reliance. Fiscal policy has been identified as a means of generating growth. Taxation, major source of government revenue as well government expenditure are important ...

What Chemistry To Teach Engineers?

Science.gov (United States)

Hawkes, Stephen J.

2000-01-01

Examines possible general chemistry topics that would be most relevant and practical for engineering majors. Consults the Accreditation Board for Engineering and Technology (ABET), engineering textbooks, texts from other required subjects, and practicing engineers for recommendations. (Contains 24 references.) (WRM)

Integrated assessment and consultation for the preoperative patient.

Science.gov (United States)

Silverman, David G; Rosenbaum, Stanley H

2009-12-01

Assessment of the presurgical patient requires interdisciplinary cooperation over the continuum of documentation and optimization of existing disorders, determination of patient resilience and reserve, and planning for subsequent interventions and care. For many patients, evident or suspected morbidities or anticipated surgical disturbance warrant specialty consultation. There may be uncertainty as to the optimal processes for a given patient, a limitation attributable to myriad factors, not the least of which is that there is often a paucity of evidence that is directly relevant to a given patient in a given setting. The present article discusses these limitations and describes a framework for documentation, optimization, risk assessment, and planning, as well as a uniform grading of existing morbidities and anticipated perioperative disturbances for patients requiring integrated assessment and consultation.

Roles of isotopic techniques in human nutrition evaluations. Report of an IAEA consultants' meeting

International Nuclear Information System (INIS)

1996-01-01

A nutrition consultants' meeting was convened by the IAEA for an advice on technical and programmatic issues related to isotope based nutritional evaluations. The salient recommendation from the consultants was for the IAEA to try to inaugurate a multi-national programme for using isotopes in evaluations that would have substantial practical relevance to public health policy. 6 refs

Roles of isotopic techniques in human nutrition evaluations. Report of an IAEA consultants` meeting

Energy Technology Data Exchange (ETDEWEB)

NONE

1996-11-01

A nutrition consultants` meeting was convened by the IAEA for an advice on technical and programmatic issues related to isotope based nutritional evaluations. The salient recommendation from the consultants was for the IAEA to try to inaugurate a multi-national programme for using isotopes in evaluations that would have substantial practical relevance to public health policy. 6 refs.

Patient education about cough: effect on the consulting behaviour of general practice patients.

Science.gov (United States)

Rutten, G; Van Eijk, J; Beek, M; Van der Velden, H

1991-07-01

The aim of this general practice study was to examine how the consulting behaviour of patients with a cough was affected when the tasks and responsibilities of patients, practice nurses and general practitioners were reorganized. In four 'average' single-handed general practices the effects on the consulting behaviour of patients of a rational practice policy on cough and the provision of systematic patient education on cough were compared with patient behaviour in four matched control practices. Changes of behaviour were measured in 548 patients who consulted for cough at least twice, in two successive autumn-winter periods. Significantly more patients in the experimental practice changed their behaviour to follow the practice guidelines than did patients in the control practices (56% versus 30%, P less than 0.001). The proportion of patients who continued to consult in the approved manner was greater among patients receiving intervention (66% versus 29%, P less than 0.001). This was equally true for patients who had suffered less than four episodes of cough or more than four episodes. The more often the patients received the education, the more effective it was. All patients who consulted the general practitioner for cough during the first autumn-winter period filled in a cough diary during the second period. From this it appeared that the intervention did not result in patients delaying consultation when they had a cough lasting longer than three weeks or one with 'serious' symptoms. It would appear that a rational practice policy and the provision of patient education can stimulate patients to modify their consulting behaviour. This could result in a reduction in the costs of health care.

A report on the green plan consultations

International Nuclear Information System (INIS)

1990-08-01

This document is a summary of what Canadians who participated in the consultations had to say about environmental issues and concerns; the solutions, roles and responsibilities, and priorities for action. It is based on detailed reports from 41 information sessions and 17 consultation workshops held across Canada. It is based on some 3,000 pages of comments and suggestions, an analysis of 4,500 question response forms, and written submissions from more than 1,000 individuals and organizations. The report is organized into two sections: improving decision making; and, action on environmental issues. The first section deals with science, education, enforcement, decision-making processes and partnerships. The second section deals with specific environmental issues identified in the consultation document, such as global warming and toxic substances, and other publicly identified issues, including energy and land use. Suggestions for further consideration represent possible policy, program and legislative elements of 'The Green Plan'. They are intended as a basis for a more focused debate which will help in the establishment of priorities

33 CFR 385.10 - Implementation responsibilities, consultation, and coordination.

Science.gov (United States)

2010-07-01

... a de facto veto power. This part authorizes the Corps of Engineers and the non-Federal sponsor to... agencies and tribes may consider relevant considerations such as sequencing of projects, planning, contracting and funding, and any factor listed for setting time limits for consulting under the National...

The Contemporary Consultant

DEFF Research Database (Denmark)

Olson, Thomas; Poulfelt, Flemming; Greiner, Larry

This book complements The handbook of Management Consulting: The Contemporary Consultant: Insights from Leading Experts, 1e but can also be studied separately. The book consists of 20 cases including Harvard and Stanford cases. The cases present the broad range of topics that are pertinent to cur...... current management issues facing consulting firms. These cases, together with the handbook, will prepare consultants and other business managers for a successful future in a highly competitive consulting environment.......This book complements The handbook of Management Consulting: The Contemporary Consultant: Insights from Leading Experts, 1e but can also be studied separately. The book consists of 20 cases including Harvard and Stanford cases. The cases present the broad range of topics that are pertinent...... to current management consulting. Each of the four parts of the text presents a cogent introduction by the editors, delineating topics that are critical for today's consultants to understand. The cases represent major practice areas of consulting and afford new insights into change processes and other...

What should be given a priority - costly medications for relatively few people or inexpensive ones for many? The Health Parliament public consultation initiative in Israel.

Science.gov (United States)

Guttman, Nurit; Shalev, Carmel; Kaplan, Giora; Abulafia, Ahuva; Bin-Nun, Gabi; Goffer, Ronen; Ben-Moshe, Roei; Tal, Orna; Shani, Mordechai; Lev, Boaz

2008-06-01

In the past two decades, government and civic organizations have been implementing a wide range of deliberative public consultations on health care-related policy. Drawing on these experiences, a public consultation initiative in Israel called the Health Parliament was established. To implement a public consultation initiative that will engage members of the public in the discussion of four healthcare policy questions associated with equity in health services and on priorities for determining which medications and treatments should be included in the basket of national health services. One hundred thirty-two participants from the general population recruited through a random sample were provided with background materials and met over several months in six regional sites. Dilemma activities were used and consultants were available for questions and clarifications. Participants presented their recommendations in a national assembly to the Minister of Health. Across the regional groups the recommendations were mostly compatible, in particular regarding considering the healthcare system's monetary state, even at the expense of equity, but for each policy question minority views were also expressed. A strong emphasis in the recommendations was pragmatism. Participants felt the experience was worthwhile; though the actual impact of their recommendations on policy making was indirect, they were willing to participate in future consultations. However, despite enthusiasm the initiative was not continued. Issues raised are whether consultation initiatives must have a direct impact on healthcare policy decisions or can be mainly a venue to involve citizens in the deliberation of healthcare policy issues.

Bedfordshire County Structure Plan. Proposed alterations. Results of public consultation. Policy 97: Nuclear waste

International Nuclear Information System (INIS)

1984-01-01

The document refers to Alterations to the County Structure Plan, proposed by Bedfordshire County Council and submitted to the Secretary of State for the Environment. An additional Alteration initiated at the County Council's meeting, dealing with nuclear waste, had not been the subject of prior public consultation. Consultation had since been arranged, and the present document summarises the responses that have been received, and describes the next action to be taken. (U.K.)

Video-conferencing Telehealth Linkage attempts to Schools to Facilitate Mental Health Consultation.

Science.gov (United States)

McLennan, John D

2018-04-01

Telehealth to schools may be a strategic approach to expand child mental health service delivery, however, there are only a few published examples. This report describes video-conferencing telehealth linkage attempts to schools to facilitate mental health consultation. A series of synchronous video-conferencing linkage strategies were attempted to connect a mental health consultation service to multiple schools in a Canadian setting. Consultation to support the implementation of the Daily Report Card, for students with attentional and behavioural problems, was the core content of this pilot linkage attempt. Synchronous video conference consultations were successfully delivered to six elementary schools across three school districts. Two of three linkage strategies were functional. One used existing health centre-based telehealth units to connect to school-based dedicated tablets with a video collaboration app and reliance on existing school Wi-Fi. A second used existing laptops in both the health and school system linked through a communication platform. A third connection, using 3G/4G hotspots to obviate the need to access school Wi-Fi, was deemed too expensive in this setting. The potential to use existing computer hardware to connect mental health providers and schools could facilitate scale-up. However, it is unknown whether mental health systems and school sectors will invest in such linkages and reorganize core mental health services to be delivered in this way.

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

Science.gov (United States)

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

2015-05-01

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

22 CFR 181.4 - Consultations with the Secretary of State.

Science.gov (United States)

2010-04-01

... international agreements of the United States are fully consistent with United States foreign policy objectives... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Consultations with the Secretary of State. 181.4 Section 181.4 Foreign Relations DEPARTMENT OF STATE INTERNATIONAL AGREEMENTS COORDINATION...

A retrospective analysis of medical record use in e-consultations.

Science.gov (United States)

Pecina, Jennifer L; North, Frederick

2017-06-01

Introduction Under certain circumstances, e-consultations can substitute for a face-to-face consultation. A basic requirement for a successful e-consultation is that the e-consultant has access to important medical history and exam findings along with laboratory and imaging results. Knowing just what information the specialist needs to complete an e-consultation is a major challenge. This paper examines differences between specialties in their need for past information from laboratory, imaging and clinical notes. Methods This is a retrospective study of patients who had an internal e-consultation performed at an academic medical centre. We reviewed a random sample of e-consultations that occurred in the first half of 2013 for the indication for the e-consultation and whether the e-consultant reviewed data in the medical record that was older than one year to perform the e-consultation. Results Out of 3008 total e-consultations we reviewed 360 (12%) randomly selected e-consultations from 12 specialties. Questions on management (35.8%), image results (27.2%) and laboratory results (25%) were the three most common indications for e-consultation. E-consultants reviewed medical records in existence more than one year prior to the e-consultation 146 (40.6%) of the time with e-consultants in the specialties of endocrinology, haematology and rheumatology, reviewing records older than one year more than half the time. Labs (20.3%), office notes (20%) and imaging (17.8%) were the types of medical data older than one year that were reviewed the most frequently overall. Discussion Management questions appear to be the most common reason for e-consultation. E-consultants frequently reviewed historical medical data that is older than one year at the time of the e-consultation, especially in endocrinology, haematology and rheumatology specialties. Practices engaging in e-consultations that require transfer of data may want to include longer time frames of historical information

Increasing public support for food-industry related, obesity prevention policies: The role of a taste-engineering frame and contextualized values.

Science.gov (United States)

Ortiz, Selena E; Zimmerman, Frederick J; Adler, Gary J

2016-05-01

Support for policies to combat obesity is often undermined by a public sense that obesity is largely a matter of personal responsibility. Industry rhetoric is a major contributor to this perception, as the soda/fast food/big food companies emphasize choice and individual agency in their efforts to neutralize policies that are burdensome. Yet obesity experts recognize that environmental forces play a major role in obesity. We investigate whether exposure to a taste-engineering frame increases support for food and beverage policies that address obesity. A taste-engineering frame details strategies used by the food industry to engineer preferences and increase the over-consumption of processed foods and sugary beverages. We also examine the effects of exposure to two contextualized values that have recently been promoted in expert discourse-consumer knowledge and consumer safety - on public support of policies. Our research shows how causal frames and contextualized values may effectively produce support for new obesity policies. We use an online survey experiment to test the effects of exposure to a taste-engineering frame (TEF), the value of consumer knowledge (CK), or the value of consumer safety (CS), on level of support for a range of policies. A random sample of adults, age 18 + living in the United States was included in the study (N = 2580). Ordered logistic regression was used to measure the effects of treatment exposure. The primary outcome was level-of-support for four (4) food-industry related, obesity prevention policies (aka food and beverage policies): 1) require food-manufacturers to disclose the amount of additives in food products on food packaging; 2) require food-manufacturers to advertise food products in accordance with their actual nutritional value; 3) prohibit all high-fat, high-sugar food advertising on television programming watched primarily by children; and 4) increase healthy food availability in work sites, schools, and hospitals

Improving teaching on the basis of student evaluation: integrative teaching consultation.

Science.gov (United States)

Wibbecke, Gerald; Kahmann, Janine; Pignotti, Tanja; Altenberger, Leander; Kadmon, Martina

2015-01-01

Due to the development of medical education in the past decade the role of teachers has changed and requires higher didactic competence. Student evaluation of teaching alone does not lead to considerable improvement of teaching quality. We present the concept of "Integrative Teaching Consultation", which comprises both the teacher's reflection and own objectives to improve their teaching as well as data from students ratings. Teachers in collaboration with a teaching consultant reflect on their teaching ability and set themselves improvement goals. Then the consultant himself observes a teaching session and subsequently analyses the respective student evaluation in order to give meaningful feedback to the teacher. The combination of student feedback with professional consultation elements can initiate and maintain improvements in teaching. Teaching consultation complements existing faculty development programs and increases the benefit of student evaluations.

Alternatives to the face-to-face consultation in general practice: focused ethnographic case study.

Science.gov (United States)

Atherton, Helen; Brant, Heather; Ziebland, Sue; Bikker, Annemieke; Campbell, John; Gibson, Andy; McKinstry, Brian; Porqueddu, Tania; Salisbury, Chris

2018-04-01

NHS policy encourages general practices to introduce alternatives to the face-to-face consultation, such as telephone, email, e-consultation systems, or internet video. Most have been slow to adopt these, citing concerns about workload. This project builds on previous research by focusing on the experiences of patients and practitioners who have used one or more of these alternatives. To understand how, under what conditions, for which patients, and in what ways, alternatives to face-to-face consultations present benefits and challenges to patients and practitioners in general practice. Focused ethnographic case studies took place in eight UK general practices between June 2015 and March 2016. Non-participant observation, informal conversations with staff, and semi-structured interviews with staff and patients were conducted. Practice documents and protocols were reviewed. Data were analysed through charting and the 'one sheet of paper' mind-map method to identify the line of argument in each thematic report. Case study practices had different rationales for offering alternatives to the face-to-face consultation. Beliefs varied about which patients and health issues were suitable. Co-workers were often unaware of each other's practice; for example, practice policies for use of e-consultations systems with patients were not known about or followed. Patients reported benefits including convenience and access. Staff and some patients regarded the face-to-face consultation as the ideal. Experience of implementing alternatives to the face-to-face consultation suggests that changes in patient access and staff workload may be both modest and gradual. Practices planning to implement them should consider carefully their reasons for doing so and involve the whole practice team. © British Journal of General Practice 2018.

Engineering judgement and bridging the fire safety gap in existing nuclear facilities

Energy Technology Data Exchange (ETDEWEB)

Qamheiah, G.; Wu, Y., E-mail: gqamheiah@plcfire.com, E-mail: dwu@plcfire.com [PLC Fire Safety Solutions, Mississauga, ON (Canada)

2014-07-01

Canadian nuclear power plants were constructed in the 1960's through the 1980's. Fire safety considerations were largely based on guidance from general building and fire codes in effect at the time. Since then, nuclear specific fire safety standards have been developed and adopted by the Regulator, increasing the expected level of fire safety in the process. Application of the standards to existing plants was largely limited to operational requirements viewed as retroactive. However, as existing facilities undergo modifications or refurbishment for the purpose of life extension, the expectation is that the design requirements of these fire safety standards also be satisfied. This creates considerable challenges for existing nuclear power plants as fire safety requirements such as those intended to assure means for safe egress, prevention of fire spread and protection of redundancy rely upon fire protection features that are inherent in the physical infrastructural design. This paper focuses on the methodology for conducting fire safety gap analyses on existing plants, and the integral role that engineering judgement plays in the development of viable and cost effective solutions to achieve the objectives of the current fire safety standards. (author)

A health app developer's guide to law and policy: a multi-sector policy analysis.

Science.gov (United States)

Parker, Lisa; Karliychuk, Tanya; Gillies, Donna; Mintzes, Barbara; Raven, Melissa; Grundy, Quinn

2017-10-02

Apps targeted at health and wellbeing sit in a rapidly growing industry associated with widespread optimism about their potential to deliver accessible and cost-effective healthcare. App developers might not be aware of all the regulatory requirements and best practice principles are emergent. Health apps are regulated in order to minimise their potential for harm due to, for example, loss of personal health privacy, financial costs, and health harms from delayed or unnecessary diagnosis, monitoring and treatment. We aimed to produce a comprehensive guide to assist app developers in producing health apps that are legally compliant and in keeping with high professional standards of user protection. We conducted a case study analysis of the Australian and related international policy environment for mental health apps to identify relevant sectors, policy actors, and policy solutions. We identified 29 policies produced by governments and non-government organisations that provide oversight of health apps. In consultation with stakeholders, we developed an interactive tool targeted at app developers, summarising key features of the policy environment and highlighting legislative, industry and professional standards around seven relevant domains: privacy, security, content, promotion and advertising, consumer finances, medical device efficacy and safety, and professional ethics. We annotated this developer guidance tool with information about: the relevance of each domain; existing legislative and non-legislative guidance; critiques of existing policy; recommendations for developers; and suggestions for other key stakeholders. We anticipate that mental health apps developed in accordance with this tool will be more likely to conform to regulatory requirements, protect consumer privacy, protect consumer finances, and deliver health benefit; and less likely to attract regulatory penalties, offend consumers and communities, mislead consumers, or deliver health harms. We

Starting a business as a nurse consultant: practical considerations.

Science.gov (United States)

Papp, E M

2000-03-01

Nursing experience translates well to self employment in the occupational and environmental health field. However, nurses must conduct a self assessment to determine whether owning a business is a good fit for their personality and work style. Exploring which services to offer is the next step in starting a business and consists of determining not only which service to offer (e.g., writing policies or protocols, providing clinical services) but also which type of consultation model to use (i.e., purchase of expertise, doctor/client, process consultation). Every business must have a plan. A business plan is essential to starting a business. It solidifies the entrepreneur's focus, lays the foundation for the business, provides a tool for evaluating success, and is a strong tool for soliciting financial support. The name of the business is an important consideration because it is often the first contact the customers have with the occupational health nurse consultant. The name must be descriptive, appropriate, and memorable.

Improving teaching on the basis of student evaluation: Integrative teaching consultation

Directory of Open Access Journals (Sweden)

Wibbecke, Gerald

2015-02-01

Full Text Available Objective: Due to the development of medical education in the past decade the role of teachers has changed and requires higher didactic competence. Student evaluation of teaching alone does not lead to considerable improvement of teaching quality. We present the concept of "Integrative Teaching Consultation", which comprises both the teacher’s reflection and own objectives to improve their teaching as well as data from students ratings.Methods: Teachers in collaboration with a teaching consultant reflect on their teaching ability and set themselves improvement goals. Then the consultant himself observes a teaching session and subsequently analyses the respective student evaluation in order to give meaningful feedback to the teacher.Results: The combination of student feedback with professional consultation elements can initiate and maintain improvements in teaching. Conclusion: Teaching consultation complements existing faculty development programs and increases the benefit of student evaluations.

Internet-based remote consultations - general practitioner experience and attitudes in Norway and Germany.

Science.gov (United States)

Kampik, Timotheus; Larsen, Frank; Bellika, Johan Gustav

2015-01-01

The objective of the study was to identify experiences and attitudes of German and Norwegian general practitioners (GPs) towards Internet-based remote consultation solutions supporting communication between GPs and patients in the context of the German and Norwegian healthcare systems. Interviews with four German and five Norwegian GPs were conducted. The results were qualitatively analyzed. All interviewed GPs stated they would like to make use of Internet-based remote consultations in the future. Current experiences with remote consultations are existent to a limited degree. No GP reported to use a comprehensive remote consultation solution. The main features GPs would like to see in a remote consultation solution include asynchronous exchange of text messages, video conferencing with text chat, scheduling of remote consultation appointments, secure login and data transfer and the integration of the remote consultation solution into the GP's EHR system.

What should be given a priority – costly medications for relatively few people or inexpensive ones for many? The Health Parliament public consultation initiative in Israel

Science.gov (United States)

Guttman, Nurit; Shalev, Carmel; Kaplan, Giora; Abulafia, Ahuva; Bin‐Nun, Gabi; Goffer, Ronen; Ben‐Moshe, Roei; Tal, Orna; Shani, Mordechai; Lev, Boaz

2008-01-01

Abstract Background  In the past two decades, government and civic organizations have been implementing a wide range of deliberative public consultations on health care‐related policy. Drawing on these experiences, a public consultation initiative in Israel called the Health Parliament was established. Goals  To implement a public consultation initiative that will engage members of the public in the discussion of four healthcare policy questions associated with equity in health services and on priorities for determining which medications and treatments should be included in the basket of national health services. Method  One hundred thirty‐two participants from the general population recruited through a random sample were provided with background materials and met over several months in six regional sites. Dilemma activities were used and consultants were available for questions and clarifications. Participants presented their recommendations in a national assembly to the Minister of Health. Outcomes  Across the regional groups the recommendations were mostly compatible, in particular regarding considering the healthcare system’s monetary state, even at the expense of equity, but for each policy question minority views were also expressed. A strong emphasis in the recommendations was pragmatism. Conclusion  Participants felt the experience was worthwhile; though the actual impact of their recommendations on policy making was indirect, they were willing to participate in future consultations. However, despite enthusiasm the initiative was not continued. Issues raised are whether consultation initiatives must have a direct impact on healthcare policy decisions or can be mainly a venue to involve citizens in the deliberation of healthcare policy issues. PMID:18429997

Reko and the accounting consultant : A quantitative study of the effects of Reko

OpenAIRE

Johansson, Julia; Österman, Olof

2014-01-01

The demand for consultants have increased during the last decades, and not the least within the service industry. There are two major accounting occupations related to the service industry existing in Sweden nowadays: the auditor and the accounting consultants. These professions are commonly being mistaken as being the same thing. However, while the accounting consultant used to be mainly occupied with bookkeeping, the profession is currently evolving into becoming more of an advisory role pr...

Patients' reports of barriers to expressing concerns during cancer consultations.

Science.gov (United States)

Brandes, Kim; Linn, Annemiek J; Smit, Edith G; van Weert, Julia C M

2015-03-01

To identify cancer patients' most influential barriers to expressing concerns during cancer consultations in a new manner by examining patients' reports of perceived barriers and perceived occurrence of barriers in consultations. Two online focus groups (N=16) and an online survey (N=236) were conducted among cancer patients and cancer survivors. The online focus groups and survey were used to examine two elements of patients' barriers, i.e., patients' reports of perceived barriers and perceived occurrence of barriers in consultations. Composite scores of these two elements were calculated to determine influential barriers. Results showed that the most influential barriers were related to providers' behavior (e.g., providers do not explicitly invite patients to express concerns) and the environment where the consultation takes place (e.g., perceived lack of time). The results of this study indicate that influential barriers to expressing concerns are barriers that patients cannot overcome themselves (i.e., they are related to providers' behavior or the environment of the consultation). A collaborative approach between researchers, providers and policy makers is needed to overcome these barriers. The results of this study can be used to develop strategies to overcome barriers to patients expressing concerns. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Research Ethics Consultation: Ethical and Professional Practice Challenges and Recommendations

Science.gov (United States)

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

2015-01-01

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

Small Business & Consultancy: Exploration of an Experiment with Student Consultants

NARCIS (Netherlands)

I. Hollaender

2007-01-01

In this paper I’ll discuss the first outcomes of an explorative research concerning the consultancy projects of a consultancy-based learning programme (Minor Consultancy 2006 - 2007, half-year bachelor programme University of Applied Sciences, Hogeschool Utrecht, The Netherlands). In order to

United Arab Emirates; 2013 Article IV Consultation

OpenAIRE

International Monetary Fund

2013-01-01

This staff report on United Arab Emirates 2013 Article IV Consultation highlights economic policies and development. Against a backdrop of political stability, confidence has further increased, tourism has been firm, demand from expatriates from the broader region has increased, and capital inflows have strengthened amid high global liquidity. The real estate sector, which had been impaired since the 2009 crisis, has stabilized in Abu Dhabi and has started to recover in Dubai. Dubai aims to b...

75 FR 54064 - Consultation Agreements: Proposed Changes to Consultation Procedures

Science.gov (United States)

2010-09-03

... State consultants performing worksite visits. Following the successful completion of an on-site... all types of complaints in a similar fashion. As a result, OSHA does not need to distinguish between...) * * * (2) The Consultant shall terminate an onsite consultative visit already in progress where one of the...

Policy Instruments to Improve Energy Performance of Existing Owner Occupied Dwellings

Directory of Open Access Journals (Sweden)

Lorraine Colette Murphy

2016-11-01

Full Text Available The aim of this thesis is to add knowledge to the role and impact of policy instruments in meeting energy performance ambition in the existing owner occupied housing stock. The focus was instruments available in the Netherlands in 2011 and 2012. These instruments represented the ‘on the ground’ efforts to meet climate change targets and many continue to do so today in the same or slightly altered forms. At international level there is a recognized need to keep global temperatures within the range of 1.5 - 2°C above pre-industrial levels (Carrington, 2016. At European level, the 2020 package contains a series of binding legislation to help the EU meet its more immediate climate and energy targets. 2020 targets include 20% reduction in greenhouse gas emission, 20% of EU energy obtained from renewable sources and 20% improvement in energy efficiency. 2020 targets for the Netherlands are a 20% reduction in greenhouse gas emissions and a 14% increase in energy generation from renewable sources (Vringer et al., 2014. A raft of policies has been produced over the last number of decades from international to local level to orientate action towards targets. At European level the Energy Performance of Buildings Directive (EPBD drives efforts at reducing energy among one of the biggest players, the building sector. By requiring a mandatory certificate at the point of sale and rent of buildings and making regulatory demands on existing buildings the EPBD upped the ante of what could be expected from the building sector, but especially the existing dwelling stock. National governments have already been tackling existing dwellings for decades propelled by the energy crisis and later by climate change policy. Information campaigns, subsidies, energy taxes, energy loans and tailored advice are among the instruments that have been available to homeowners to carry out works on their dwellings to reduce energy consumption. In recent years, the pace of efforts

Team- and project work in engineering practices

DEFF Research Database (Denmark)

Buch, Anders; Andersen, Vibeke

2015-01-01

in teamwork practices, and, thirdly, how team- and project work affect engineering professionalism and collaborative work practices. A practice theoretical framework informs the analysis. Teamwork is investigated as a phenomenon enacted through the sayings, doings and relatings of practitioners in landscapes......In this paper we investigate teamwork amongst professionals in engineering consultancy companies in order to discern how teamwork affects the collaboration and work practices of the professionals. The paper investigates how professional engineering practices are enacted in two engineering...... consultancy companies in Denmark where teamwork has been or is an ideal for organizing work. Through a practice-based lens the article sets out to investigate, firstly, how discourses about teamand project work affect engineering work practices, secondly, how technology-mediated management is reconciled...

Doctor-patient communication: a comparison between telemedicine consultation and face-to-face consultation.

Science.gov (United States)

Liu, Xiao; Sawada, Yoshie; Takizawa, Takako; Sato, Hiroko; Sato, Mahito; Sakamoto, Hironosuke; Utsugi, Toshihiro; Sato, Kunio; Sumino, Hiroyuki; Okamura, Shinichi; Sakamaki, Tetsuo

2007-01-01

The objective of this study was to compare doctor-patient communications in clinical consultations via telemedicine technology to doctor-patient communications in face-to-face clinical consultations. Five doctors who had been practicing internal medicine for 8 to 18 years, and twenty patients were enrolled in this study; neither doctors nor patients had previous experience of telemedicine. The patients received both a telemedicine consultation and a face-to-face consultation. Three measures--video observation, medical record volume, and participants' satisfaction--were used for the assessment. It was found that the time spent on the telemedicine consultation was substantially longer than the time spent on the face-to-face consultation. No statistically significant differences were found in the number of either closed or open-ended questions asked by doctors between both types of consultation. Empathy-utterances, praise-utterances, and facilitation-utterances were, however, seen less in the telemedicine consultations than in the face-to-face consultations. The volume of the medical records was statistically smaller in the telemedicine consultations than in the face-to-face consultations. Patients were satisfied with the telemedicine consultation, but doctors were dissatisfied with it and felt hampered by the communication barriers. This study suggests that new training programs are needed for doctors to develop improved communication skills and the ability to express empathy in telemedicine consultations.

Fiscal and tax policy support for energy efficiency retrofit for existing residential buildings in China's northern heating region

International Nuclear Information System (INIS)

Li Dongyan

2009-01-01

Energy efficiency retrofit for existing residential buildings (EERERB) in China's northern heating region is an important component of the national energy strategy. The main content and related subject in EERERB performance is the basis of understanding and developing targeted policies. So, this paper designed the content system of EERERB. And then, provided a cost-benefit analysis on related subjects, assessed the government's function in EERERB, and come to the conclusion that the Chinese government should increase fiscal fund investment and implement more fiscal and tax incentive policies. Moreover, in view of China's current policy, which lacks long-term mechanism and flexibility, this paper proposed specific policy recommendations, including clarifying the government's corresponding responsibilities at all levels and increasing the intensity of the central government's transfer payments. It further proposed targeted financial and tax policies for supporting and encouraging heating enterprises and owners, as well as policies to cultivate energy-saving service markets and to support the ESCO.

Evolution of External Consultant Involvement in Human Resource Management in Eastern Europe (1990-2007

Directory of Open Access Journals (Sweden)

József Poór

2015-03-01

Full Text Available This paper aims to analyze the evolution of Human Resources (HR consulting in transitional economies of Eastern Europe (EE from the political changes till the economic crisis (2008. This article provides insights into the specific socio-economic environment and HR practice of the region.  Following Markham's model (1999 we analyze specific characteristics of four typical ways of external consultant involvement: informative-becnhmarking, design, change and organizational learning consulting.  in this region. In general, before the political changes at the end of the 1980's, in most EE countries , consulting service was redendered by sector  research institutes, controlled by the state or by the different minsitries. Consulting approach in EE countries  were predominant similar to the school of scientific management. HR consulting hardly existed that time. Since changes in the regime's consulting linked to privatization, firm restructuring, and development has been developing significantly in all countries of the region. HR consulting underwent a significant development in the region.

Systematic Heuristic Evaluation of Computerized Consultation Order Templates: Clinicians' and Human Factors Engineers' Perspectives.

Science.gov (United States)

Savoy, April; Patel, Himalaya; Flanagan, Mindy E; Weiner, Michael; Russ, Alissa L

2017-08-01

We assessed the usability of consultation order templates and identified problems to prioritize in design efforts for improving referral communication. With a sample of 26 consultation order templates, three evaluators performed a usability heuristic evaluation. The evaluation used 14 domain-independent heuristics and the following three supplemental references: 1 new domain-specific heuristic, 6 usability goals, and coded clinicians' statements regarding ease of use for 10 sampled templates. Evaluators found 201 violations, a mean of 7.7 violations per template. Minor violations outnumbered major violations almost twofold, 115 (57%) to 62 (31%). Approximately 68% of violations were linked to 5 heuristics: aesthetic and minimalist design (17%), error prevention (16%), consistency and standards (14%), recognition rather than recall (11%), and meet referrers' information needs (10%). Severe violations were attributed mostly to meet referrers' information needs and recognition rather than recall. Recorded violations yielded potential negative consequences for efficiency, effectiveness, safety, learnability, and utility. Evaluators and clinicians demonstrated 80% agreement in usability assessment. Based on frequency and severity of usability heuristic violations, the consultation order templates reviewed may impede clinical efficiency and risk patient safety. Results support the following design considerations: communicate consultants' requirements, facilitate information seeking, and support communication. While the most frequent heuristic violations involved interaction design and presentation, the most severe violations lacked information desired by referring clinicians. Violations related to templates' inability to support referring clinicians' information needs had the greatest potential negative impact on efficiency and safety usability goals. Heuristics should be prioritized in future design efforts.

Realistic nurse-led policy implementation, optimization and evaluation: novel methodological exemplar.

Science.gov (United States)

Noyes, Jane; Lewis, Mary; Bennett, Virginia; Widdas, David; Brombley, Karen

2014-01-01

To report the first large-scale realistic nurse-led implementation, optimization and evaluation of a complex children's continuing-care policy. Health policies are increasingly complex, involve multiple Government departments and frequently fail to translate into better patient outcomes. Realist methods have not yet been adapted for policy implementation. Research methodology - Evaluation using theory-based realist methods for policy implementation. An expert group developed the policy and supporting tools. Implementation and evaluation design integrated diffusion of innovation theory with multiple case study and adapted realist principles. Practitioners in 12 English sites worked with Consultant Nurse implementers to manipulate the programme theory and logic of new decision-support tools and care pathway to optimize local implementation. Methods included key-stakeholder interviews, developing practical diffusion of innovation processes using key-opinion leaders and active facilitation strategies and a mini-community of practice. New and existing processes and outcomes were compared for 137 children during 2007-2008. Realist principles were successfully adapted to a shorter policy implementation and evaluation time frame. Important new implementation success factors included facilitated implementation that enabled 'real-time' manipulation of programme logic and local context to best-fit evolving theories of what worked; using local experiential opinion to change supporting tools to more realistically align with local context and what worked; and having sufficient existing local infrastructure to support implementation. Ten mechanisms explained implementation success and differences in outcomes between new and existing processes. Realistic policy implementation methods have advantages over top-down approaches, especially where clinical expertise is low and unlikely to diffuse innovations 'naturally' without facilitated implementation and local optimization. © 2013

A Scalable Policy and SNMP Based Network Management Framework

Institute of Scientific and Technical Information of China (English)

LIU Su-ping; DING Yong-sheng

2009-01-01

Traditional SNMP-based network management can not deal with the task of managing large-scaled distributed network,while policy-based management is one of the effective solutions in network and distributed systems management. However,cross-vendor hardware compatibility is one of the limitations in policy-based management. Devices existing in current network mostly support SNMP rather than Common Open Policy Service (COPS) protocol. By analyzing traditional network management and policy-based network management, a scalable network management framework is proposed. It is combined with Internet Engineering Task Force (IETF) framework for policybased management and SNMP-based network management. By interpreting and translating policy decision to SNMP message,policy can be executed in traditional SNMP-based device.

Overview of hypertext and hypermedia systems and tools appropriate for structural and materials engineering

International Nuclear Information System (INIS)

Arents, H.C.; Bogaerts, W.F.L.

1991-01-01

After a concise description of the operational characteristics and the information consultation potential of hypertext and hypermedia systems, we discuss in detail the key system characteristics one has to look at when selecting commercially available hypertext and hypermedia products which are appropriate for structural and materials engineering. We then compare a number of PC-based, Macintosh-based and workstation-based hypertext and hypermedia systems and tools, highlighting the key features of each product. Finally, we briefly point to an existing materials engineering hypermedia application and discuss how hypermedia systems might be combined with expert systems to achieve added functionality and reliability. (orig./DG)

Geoethics: what can we learn from existing bio-, ecological, and engineering ethics codes?

Science.gov (United States)

Kieffer, Susan W.; Palka, John

2014-05-01

Many scientific disciplines are concerned about ethics, and codes of ethics for these professions exist, generally through the professional scientific societies such as the American Geophysical Union (AGU), American Geological Institute (AGI), American Association of Petroleum Engineers (AAPE), National Society of Professional Engineers (NSPE), Ecological Society of America (ESA), and many others worldwide. These vary considerably in depth and specificity. In this poster, we review existing codes with the goal of extracting fundamentals that should/can be broadly applied to all geo-disciplines. Most of these codes elucidate a set of principles that cover practical issues such as avoiding conflict of interest, avoiding plagiarism, not permitting illegitimate use of intellectual products, enhancing the prestige of the profession, acknowledging an obligation to perform services only in areas of competence, issuing public statements only in an objective manner, holding paramount the welfare of the public, and in general conducting oneself honorably, responsibly, and lawfully. It is striking that, given that the work of these societies and their members is relevant to the future of the earth, few discuss in any detail ethical obligations regarding our relation to the planet itself. The AGU code, for example, only states that "Members have an ethical obligation to weigh the societal benefits of their research against the costs and risks to human and animal welfare and impacts on the environment and society." The NSPE and AGI codes go somewhat further: "Engineers are encouraged to adhere to the principles of sustainable development in order to protect the environment for future generations," and "Geoscientists should strive to protect our natural environment. They should understand and anticipate the environmental consequences of their work and should disclose the consequences of recommended actions. They should acknowledge that resource extraction and use are necessary

The role of a consultant breast radiographer: A description and a reflection

International Nuclear Information System (INIS)

Kelly, Judith; Hogg, Peter; Henwood, Suzanne

2008-01-01

Consultant radiographers are a relatively new concept within the British healthcare system, with them being first established in 2003. Consultant radiographer job roles are broad and include advanced clinical activities (often being similar in nature to those delivered by medical practitioners, e.g. radiologists), professional leadership, teaching and education and service improvement. Given their relative novelty almost no literature exists to describe in detail specific roles of consultant breast radiographers. Consequently, in this article we use a case study approach to describe and reflect critically upon the role of one consultant breast radiographer. The article commences with a general introduction about consultant radiographers; it then progresses to outline the context in which the case study of the breast consultant radiographer sits. Through description and reflective commentary we take the reader through the role of the consultant breast radiographer to highlight where the role has had perceived value and also to highlight where the role has been particularly challenging for the post holder. As a consequence of the case study approach taken, the article is written partly in the first person (taken from interview comments made by the consultant breast radiographer) and partly in the third person. The final element of the article is a reflective commentary given by the consultant radiographer regarding her feelings about her first few years as a consultant breast radiographer

Data Security and Privacy in Apps for Dementia: An Analysis of Existing Privacy Policies.

Science.gov (United States)

Rosenfeld, Lisa; Torous, John; Vahia, Ipsit V

2017-08-01

Despite tremendous growth in the number of health applications (apps), little is known about how well these apps protect their users' health-related data. This gap in knowledge is of particular concern for apps targeting people with dementia, whose cognitive impairment puts them at increased risk of privacy breaches. In this article, we determine how many dementia apps have privacy policies and how well they protect user data. Our analysis included all iPhone apps that matched the search terms "medical + dementia" or "health & fitness + dementia" and collected user-generated content. We evaluated all available privacy policies for these apps based on criteria that systematically measure how individual user data is handled. Seventy-two apps met the above search teams and collected user data. Of these, only 33 (46%) had an available privacy policy. Nineteen of the 33 with policies (58%) were specific to the app in question, and 25 (76%) specified how individual-user as opposed to aggregate data would be handled. Among these, there was a preponderance of missing information, the majority acknowledged collecting individual data for internal purposes, and most admitted to instances in which they would share user data with outside parties. At present, the majority of health apps focused on dementia lack a privacy policy, and those that do exist lack clarity. Bolstering safeguards and improving communication about privacy protections will help facilitate consumer trust in apps, thereby enabling more widespread and meaningful use by people with dementia and those involved in their care. Copyright © 2017. Published by Elsevier Inc.

Consultation Models Revisited

International Nuclear Information System (INIS)

Fawaz, S.; Khan, Zulfiquar A.; Mossa, Samir Y.

2006-01-01

A new definition is proposed for analyzing the consultation in the primary health care, integrating other models of consultation and provides a framework by which general practitioners can apply the principles of consultation using communication skills to reconcile the respective agenda and autonomy of both doctor and patient into a negotiated agreed plan, which includes both management of health problems and health promotion. Achieving success of consultations depends on time and mutual cooperation between patient and doctor showed by doctor-patient relationship. (author)

Consultancy driven Business Process Re-engineering in Denmark and its impact on Organizations and Working Environment

DEFF Research Database (Denmark)

Manske, Fred; Koch, Christian; Vogelius, Peter

1998-01-01

The articel present some interim results from a Danish research project on social constitution of BPR in Denmark and the consequences for working environment. The consultants play a key role in developing and promoting management concepts internationally. Also in the development and diffusion...... of BPR in Denmark consultants are central but they are in interaction with enterprises, professional associations, publishers, the press, a/o. Whether this interaction leads to a special national (e.g. Danish) variant of BPR. is an central question in the discussion, On the basis of it interviews...... with consultants it concluded that we can't identify any special Danish version of BPR informed by a sort of "Scandinavian tradition"....

7 CFR 1753.17 - Engineering services.

Science.gov (United States)

2010-01-01

... form. (B) The contract will not accomplish loan purposes. (C) The engineering service fees are unreasonable. (D) The contract presents unacceptable loan security risk to RUS. (E) The consulting engineering... loan shall be rendered by a qualified engineer selected by the borrower or by qualified employees on...

On becoming a consultant: A study exploring the journey to consultant practice

International Nuclear Information System (INIS)

Henwood, S.; Booth, L.

2016-01-01

Background: This paper reports a qualitative study exploring the establishment of non-medical consultant roles in Radiography. Given the difficulties reported in recruiting and retaining staff in these posts, we hope this paper offers a historical documentation of those consultants who were some of the first in post, sharing their stories of how they obtained and transitioned into their roles. Methods: This paper is part of a two year case study exploring the leadership domain of consultant practice. The focus of this paper is a reflection, by the consultants, of their journey to becoming a consultant; a documentation of some of the practical issues in establishing the roles; and the transition to higher levels of practice. Eight consultant radiographers participated in the initial interviews (two consultants withdrew from the study subsequent to this). In-depth iterative interviewing was used to explore and record individual stories and experiences. Findings: The consultants shared their perceptions of being in post, including their own motivation to progress to a new role, how prepared they felt initially, the lack of role models, the lack of clarity surrounding the role and a perception of ‘being on display’. Conclusions: The paper offers insight into the journey of these consultants and some of the common characteristics they share. These characteristics give some indication of what motivated them to step into higher level roles, in particular the need to drive change and improvement. The paper also offers suggestions for how the transition into the role could be more effectively supported. - Highlights: • Identifies characteristics thought to contribute to effective consultant practice. • A desire to change practice is a major motivator in applying for a consultant post. • The consultant role was a natural evolution for some, not a desired career pathway. • There is recognition that the initial consultants were pioneers for the profession. �

Brief Report: Healing Touch Consults at a Tertiary Care Children's Hospital.

Science.gov (United States)

Schlefman, Amanda; Rappaport, David I; Adams-Gerdts, Walle; Stubblefield, Samuel C

2016-02-01

Components of complementary and alternative medicine are increasingly being implemented at academic medical centers. These approaches include therapeutic touch or healing touch (HT), an energy-based therapy using light touch on or near the body. Limited data exist regarding complementary and alternative medicine use at children's hospitals. The aim of this study was to evaluate patterns and clinical characteristics of HT consultations among children hospitalized at Nemours/A.I. duPont Hospital for Children. We conducted a retrospective chart review of all patients hospitalized from January 2012 through December 2013, comparing patients who received HT consultations with those who did not. There were 25,396 admissions during the study period; 882 (4%) of these, representing 593 individual patients, received an HT consultation. As compared with those without an HT consultation, patients receiving HT were older (median 12 years vs 5 years, P<.001), female (58% vs 46%, P<.001), and more likely to be admitted to the hematology/oncology or blood/bone marrow transplant units (P<.001). Patients with HT consultations had longer hospitalizations (median 121 hours vs 38 hours, P<.001) and more medical problems (median 12 vs 4, P<.001). Six attending physicians were responsible for placing the majority of HT consultations. Of the 593 patients receiving an HT consultation, 21% received ≥2 consultations during the study period. Certain patients, such as those with longer hospitalizations and more medical problems, were more likely to receive HT consultations. Many patients received multiple consultations, suggesting that HT may be an important aspect of ongoing care for hospitalized children.

CERN's IT Consultancy Team: a new IT project support service

CERN Multimedia

Ignacio Reguero, IT Department

2016-01-01

Newly created IT Consultancy Team provides advice on IT matters to communities at CERN starting new projects or reviewing computing activities of old.   The members of CERN's IT Consultancy Team. The consultants share their knowledge and experience to improve awareness of the IT landscape at CERN and to advise on system architecture and design to ensure best usage of existing IT services and solutions that favour, and are compatible with, the infrastructure already in place. They also help to formalise requirements and assess impact on security, software licenses and cost, especially where contacts among different services are needed and questions go beyond the current computing service offerings. For instance, the IT consultants may help answering questions like the ones below: We are starting with project X – how could we make its computing aspects compatible with the CERN IT infrastructure? E.g. if you need a web content management system favour Drupal instead of Wor...

Using Markov Decision Processes with Heterogeneous Queueing Systems to Examine Military MEDEVAC Dispatching Policies

Science.gov (United States)

2017-03-23

POLICIES THESIS Presented to the Faculty Department of Operational Sciences Graduate School of Engineering and Management Air Force Institute of Technology...dispatching policy and three practitioner-friendly myopic baseline policies. Two computational experiments, a two-level, five-factor screening design and a...over, an open question exists concerning the best exact solution approach for solving Markov decision problems due to recent advances in performance by

The Effect of the Strictness of Consultation Requirements on Fraud Consultation

NARCIS (Netherlands)

Gold, A.H.; Knechel, W.R.; Wallage, P.

2012-01-01

We investigate how the strictness of a requirement to consult on potential client fraud affects auditors' propensity to consult with firm experts. We consider two specific forms of guidance about fraud consultations: (1) strict, i.e., mandatory and binding; and (2) lenient, i.e., advisory and

Effects of workplace, family and cultural influences on low back pain: what opportunities exist to address social factors in general consultations?

Science.gov (United States)

Shaw, William S; Campbell, Paul; Nelson, Candace C; Main, Chris J; Linton, Steven J

2013-10-01

Social factors are widely acknowledged in behavioural models of pain and pain management, but incorporating these factors into general medical consultations for low back pain (LBP) can be challenging. While there is no compelling evidence that social factors contribute to LBP onset, these factors have been shown to influence functional limitation and disability, especially the effects of organisational support in the workplace, spousal support, family conflict and social disadvantage. A number of barriers exist to address such social factors in routine medical encounters for LBP, but there is emerging evidence that improving social and organisational support may be an effective strategy to reduce the negative lifestyle consequences of LBP. For clinicians to address these factors in LBP treatment requires a clearer psychosocial framework in assessment and screening, more individualised problem-solving efforts, more patient-centred interventions involving family, peers and workplace supports and a less biomechanical and diagnostic approach. Copyright © 2013 Elsevier Ltd. All rights reserved.

Inpatient Consultative Dermatology.

Science.gov (United States)

Biesbroeck, Lauren K; Shinohara, Michi M

2015-11-01

Dermatology consultation can improve diagnostic accuracy in the hospitalized patient with cutaneous disease. Dermatology consultation can streamline and improve treatment plans, and potentially lead to cost savings. Dermatology consultants can be a valuable resource for education for trainees, patients, and families. Inpatient consultative dermatology spans a breadth of conditions, including inflammatory dermatoses,infectious processes, adverse medication reactions, and neoplastic disorders, many of which can be diagnosed based on dermatologic examination alone, but when necessary, bedside skin biopsies can contribute important diagnostic information. Copyright © 2015 Elsevier Inc. All rights reserved.

Quality of Work and Team- and Project Based Work Practices in Engineering

DEFF Research Database (Denmark)

Buch, Anders; Andersen, Vibeke

2015-01-01

It is the aim of this paper to investigate teamwork amongst professionals in engineering consultancy companies in order to discern how teamwork affects the collaboration and work practices of the professionals and eventually their quality of work. The paper investigates how professional engineering...... ractices are enacted in two engineering consultancy companies in Denmark where ‘teamwork’ has been or is an ideal for organizing work....

A tax policy to liberate environmental engineering

International Nuclear Information System (INIS)

Kendall, R.C.

1997-01-01

Examples are provided of the great gulf between what the design professions are capable of doing and what they are actually doing. Principles of resolutionary design are applied to the problem. The result: changes in tax policy with substantial economic gain in the best interest of all the people. It is recommended that taxation of what one wants to conserve--energy resource use--be substituted over the long term for taxation of what one does not want to minimize--income. It is time for lenders, in the case of dwelling construction, to accept appraisals based on present worth, in turn based on competent life-cycle costing and certified by engineering economic analysis. It is time for the professional societies and the publicly regulated utilities to join forces with the lenders and the appraisers in a matter which is in the best interest of all the people

Evaluation of the AECB's process of consultation with employees of its licensees

International Nuclear Information System (INIS)

Hart, D.; Eedy, W.; Hostovsky, C.; Burt, A.J.; Maghy, R.

1986-03-01

The study involved a review of public consultation methods used by various Federal Government agencies. These were then compared to the existing AECB programs to evaluate potential improvements. These were also referred to in later surveys of employees at licensed facilities to determine their perceived appropriateness. The majority of employees were both aware of AECB and correctly understood its function. Both of these aspects increased as a function of union membership, age, income, male sex and ARW status. However, the use of AECB consultative documents declined with union membership and increased with membership in professional associations. Satisfaction with the AECB consultative process was fairly low. Workers tended to be more satisfied with other agencies or safety associations. Feelings of job safety were greatest among those who received consultative documents or read AECB press releases. Feelings of safety also increased with age, education, income and professional association membership, but declined with union membership. Unionized employees expressed a desire for more consultation with AECB. Recommendations to improve the process of consultation are included

AGE assessment of interactions between climate change policy instruments and pre-existing taxes: the case of Ireland

NARCIS (Netherlands)

Wissema, W.W.; Dellink, R.B.

2010-01-01

We introduce a computable general equilibrium model for Ireland to investigate the impact of climate policy on the Irish economy, taking special notice of interactions with the existing tax structure. To this end, we extend the model with a detailed representation of the tax system using separate

The politics of nuclear consultation in NATO, 1965-1980

International Nuclear Information System (INIS)

Buteux, P.

1983-01-01

One of the least known but most effective Western institutions is the Nuclear Planning Group (NPG) of NATO. Conceived in 1965 as a result of the debacle of the multilateral nuclear force, it has been a forum for consultation on the Alliance's strategic policy, especially regarding tactical atomic weapons and the control of nuclear arms. This is an account of about as much as can be discussed about NPG deliberations

Consulting communities: a renewable energy toolkit

Energy Technology Data Exchange (ETDEWEB)

Hinshelwood, E.; McCallum, D.

2001-07-01

Renewable Energy (RE) projects in the UK have always involved a degree of consultation. In many cases, however, it is limited to statutory consultees and key individuals in the locality of a proposed site. But as sustainable development moves up the agenda, and as the UK generation of RE is falling behind its European counterparts, the views of communities are becoming more of an issues. If priority is to be placed on sensitive and successful RE development, then it is vital to recognise local people as key stakeholders. They need to be acknowledged as potential catalysts for change, rather than as obstacles or sources of resistance to new technologies. A greater emphasis on community involvement (at all levels in RE development) represents a strategic move. It is both ethically important, and cost-effective in the long run. While there are a variety of aspects of community involvement, this guide deals specifically with community consultation, and acts as a support to organisations and companies planning the development of a Renewable Energy project. The guide is not intended as a 'tactic to get around' communities or to somehow 'win them over'. The premise behind consultation is to ensure that local people have access to relevant information and that the channels of communication exist whereby local people can contribute to project development. In a successful consultation, residents are seen as partners in the overall process of sustainable development. Local people are vital if we are to move forward. (Author)

Carbon mitigation with biomass: An engineering, economic and policy assessment of opportunities and implications

Science.gov (United States)

Rhodes, James S., III

2007-12-01

Industrial bio-energy systems provide diverse opportunities for abating anthropogenic greenhouse gas ("GHG") emissions and for advancing other important policy objectives. The confluence of potential contributions to important social, economic, and environmental policy objectives with very real challenges to deployment creates rich opportunities for study. In particular, the analyses developed in this thesis aim to increase understanding of how industrial bio-energy may be applied to abate GHG emissions in prospective energy markets, the relative merits of alternate bio-energy systems, the extent to which public support for developing such systems is justified, and the public policy instruments that may be capable of providing such support. This objective is advanced through analysis of specific industrial bio-energy technologies, in the form of bottom-up engineering-economic analyses, to determine their economic performance relative to other mitigation options. These bottom-up analyses are used to inform parameter definitions in two higher-level stochastic models that explicitly account for uncertainty in key model parameters, including capital costs, operating and maintenance costs, and fuel costs. One of these models is used to develop supply curves for electricity generation and carbon mitigation from biomass-coal cofire in the U.S. The other is used to characterize the performance of multiple bio-energy systems in the context of a competitive market for low-carbon energy products. The results indicate that industrial bio-energy systems are capable of making a variety of potentially important contributions under scenarios that value anthropogenic GHG emissions. In the near term, cofire of available biomass in existing coal fired power plants has the potential to provide substantial emissions reductions at reasonable costs. Carbon prices between 30 and 70 per ton carbon could induce reductions in U.S. carbon emissions by 100 to 225 megatons carbon ("Mt

Exploring the research domain of consultant practice: Experiences of consultant radiographers

International Nuclear Information System (INIS)

Harris, R.; Paterson, A.

2016-01-01

Aim: This paper reports on one part of a larger study. The aim of the overall study was to explore what the core domain of research means to consultant radiographers in clinical practice and to identify the key factors that facilitate or hinder research activity by this staff group. Design and method: Grounded theory research methodology was employed. This second part of the study involved telephone interviews with twenty five consultant radiographers. Results: Results indicate there are variations across clinical specialties as to the amount and level of research undertaken by consultant radiographers. The principal barriers revealed were: lack of time; excessive clinical workload; lack of skills and confidence to undertake research; poor research culture; and lack of support. The main facilitators noted were: dedicated time, research training and up-skilling; mutually beneficial collaborations; managerial understanding of the research domain of the role; and research focussed on clinical demand. Conclusion: Fulfilling the clinical role is imperative and integral to the profession at consultant level; however, if it is undertaken to the detriment of the other domains then these practitioners may not be operating at ‘consultant’ level. Overall improvements must be made to ensure that the consultant radiographer role is delivering on current expectations and is safeguarded for the future of the next generation of radiographers. - Highlights: • Consultant radiographers undertake research but have concerns about their research skills. • Research aims to improve practice and patients' experiences. • Relatively few consultant radiographers publish their work regularly. • Consultant radiographers allocate little protected time for research due to clinical demands.

Architectural Engineers

DEFF Research Database (Denmark)

Petersen, Rikke Premer

engineering is addresses from two perspectives – as an educational response and an occupational constellation. Architecture and engineering are two of the traditional design professions and they frequently meet in the occupational setting, but at educational institutions they remain largely estranged....... The paper builds on a multi-sited study of an architectural engineering program at the Technical University of Denmark and an architectural engineering team within an international engineering consultancy based on Denmark. They are both responding to new tendencies within the building industry where...... the role of engineers and architects increasingly overlap during the design process, but their approaches reflect different perceptions of the consequences. The paper discusses some of the challenges that design education, not only within engineering, is facing today: young designers must be equipped...

Exploring the research domain of consultant practice: Perceptions and opinions of consultant radiographers

International Nuclear Information System (INIS)

Harris, R.; Paterson, A.

2016-01-01

Aim: This paper reports on one part of a larger study. The aim was to explore what the core domain of research means to consultant radiographers in clinical practice and to identify the key factors that facilitate or hinder research activity by this staff group. Design and method: Grounded theory research methodology was employed. This first part of the study involved electronic questionnaires being sent to all those known in consultant radiographer posts in the United Kingdom. Results: Results indicate there are variations across clinical specialties as to the amount and level of research undertaken by consultant radiographers, and not all agreed that research should be a core domain of consultant practice. Main facilitators to research were noted as: time; skills and knowledge of the researcher; a well defined research question. Main barriers to research were noted as: lack of allocated time; lack of skills/experience; clinical workload. Conclusion: Research is one of the four core domains of consultant allied health professional and nursing roles but, as yet, it is not fully embedded into those of all consultant radiographers. Many consultant radiographers appear to spend more of their time on the ‘clinical expert’ element of their role at the expense of the research domain. This study concludes that there is an urgent need for consultant radiographers to understand that research is one of the four core domains and to recognise the need to embed research into their clinical practice. - Highlights: • Consultant radiographers undertake research but have concerns about their research skills. • Research aims to improve practice and patients' experiences. • Relatively few consultant radiographers publish their work routinely. • Consultant radiographers allocate little protected time for research due to clinical demands. • Almost half of the consultant radiographers feel research should not be a core part of their roles.

Accompanied consultations in occupational health.

Science.gov (United States)

Hobson, J; Hobson, H; Sharp, R

2016-04-01

Accompanied consultations are often reported as difficult by occupational physicians but have not been studied in the occupational health setting. To collect information about accompanied consultations and the impact of the companion on the consultation. We collected data on all accompanied consultations by two occupational physicians working in a private sector occupational health service over the course of 16 months. Accompanied consultations were matched to non-accompanied consultations for comparison. We collected data on 108 accompanied consultations. Accompanied consultations were more likely to be connected with ill health retirement (P Occupational health practitioners may benefit from better understanding of accompanied consultations and guidance on their management. © The Author 2015. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Biomedical scientists' perceptions of ethical and social implications: is there a role for research ethics consultation?

Directory of Open Access Journals (Sweden)

Jennifer B McCormick

Full Text Available Research ethics consultation programs are being established with a goal of addressing the ethical, societal, and policy considerations associated with biomedical research. A number of these programs are modelled after clinical ethics consultation services that began to be institutionalized in the 1980s. Our objective was to determine biomedical science researchers' perceived need for and utility of research ethics consultation, through examination of their perceptions of whether they and their institutions faced ethical, social or policy issues (outside those mandated by regulation and examination of willingness to seek advice in addressing these issues. We conducted telephone interviews and focus groups in 2006 with researchers from Stanford University and a mailed survey in December 2006 to 7 research universities in the U.S.A total of 16 researchers were interviewed (75% response rate, 29 participated in focus groups, and 856 responded to the survey (50% response rate. Approximately half of researchers surveyed (51% reported that they would find a research ethics consultation service at their institution moderately, very or extremely useful, while over a third (36% reported that such a service would be useful to them personally. Respondents conducting human subjects research were more likely to find such a service very to extremely useful to them personally than respondents not conducting human subjects research (20% vs 10%; chi(2 p<0.001.Our findings indicate that biomedical researchers do encounter and anticipate encountering ethical and societal questions and concerns and a substantial proportion, especially clinical researchers, would likely use a consultation service if they were aware of it. These findings provide data to inform the development of such consultation programs in general.

On the Compliance of Women Engineers with a Gendered Scientific System.

Directory of Open Access Journals (Sweden)

Gita Ghiasi

Full Text Available There has been considerable effort in the last decade to increase the participation of women in engineering through various policies. However, there has been little empirical research on gender disparities in engineering which help underpin the effective preparation, co-ordination, and implementation of the science and technology (S&T policies. This article aims to present a comprehensive gendered analysis of engineering publications across different specialties and provide a cross-gender analysis of research output and scientific impact of engineering researchers in academic, governmental, and industrial sectors. For this purpose, 679,338 engineering articles published from 2008 to 2013 are extracted from the Web of Science database and 974,837 authorships are analyzed. The structures of co-authorship collaboration networks in different engineering disciplines are examined, highlighting the role of female scientists in the diffusion of knowledge. The findings reveal that men dominate 80% of all the scientific production in engineering. Women engineers publish their papers in journals with higher Impact Factors than their male peers, but their work receives lower recognition (fewer citations from the scientific community. Engineers-regardless of their gender-contribute to the reproduction of the male-dominated scientific structures through forming and repeating their collaborations predominantly with men. The results of this study call for integration of data driven gender-related policies in existing S&T discourse.

On the Compliance of Women Engineers with a Gendered Scientific System.

Science.gov (United States)

Ghiasi, Gita; Larivière, Vincent; Sugimoto, Cassidy R

2015-01-01

There has been considerable effort in the last decade to increase the participation of women in engineering through various policies. However, there has been little empirical research on gender disparities in engineering which help underpin the effective preparation, co-ordination, and implementation of the science and technology (S&T) policies. This article aims to present a comprehensive gendered analysis of engineering publications across different specialties and provide a cross-gender analysis of research output and scientific impact of engineering researchers in academic, governmental, and industrial sectors. For this purpose, 679,338 engineering articles published from 2008 to 2013 are extracted from the Web of Science database and 974,837 authorships are analyzed. The structures of co-authorship collaboration networks in different engineering disciplines are examined, highlighting the role of female scientists in the diffusion of knowledge. The findings reveal that men dominate 80% of all the scientific production in engineering. Women engineers publish their papers in journals with higher Impact Factors than their male peers, but their work receives lower recognition (fewer citations) from the scientific community. Engineers-regardless of their gender-contribute to the reproduction of the male-dominated scientific structures through forming and repeating their collaborations predominantly with men. The results of this study call for integration of data driven gender-related policies in existing S&T discourse.

The role of a consultant radiologist - are patients still in the dark?

Energy Technology Data Exchange (ETDEWEB)

Grant, L.; Griffin, N.; McDonald, S.; Vargas, H.; Hampson, F.; Sinnatamby, R. [Cambridge University Teaching Hospitals, NHS Foundation Trust, Department of Radiology, Cambridge (United Kingdom); Vasconcelos, J.C. [University of Cambridge, Centre for Applied Medical Statistics, Department of Public Health and Primary Care, Cambridge (United Kingdom)

2009-10-15

Little is known regarding public awareness of the roles and responsibilities of a consultant radiologist. Between 1 April and 20 May 2008, 916 outpatients attending our radiology department completed a questionnaire addressing this issue. We found public perception variable. Thirty-six percent of respondents thought we were responsible for choosing appropriate imaging; only 65% perceived that we reported studies. Another 38% felt that we did not play an important role in their treatment, and 38% considered that we were not part of their medical team. Thirty-two percent of respondents preferred their hospital consultant to give them their imaging results, with 17% preferring this to come from the radiologist. There is significant under-appreciation of the roles and responsibilities of a consultant radiologist. It is important that we educate the public to ensure that future health policy reflects the increasingly central role imaging plays in health-care delivery. (orig.)

Team and Project Work in Engineering Practices

Directory of Open Access Journals (Sweden)

Anders Buch

2015-11-01

Full Text Available In this article, we investigate teamwork amongst professionals in engineering consultancy companies in order to discern how teamwork affects the collaboration and work practices of the professionals. The article investigates how professional engineering practices are enacted in two engineering consultancy companies in Denmark where teamwork has been or is an ideal for organizing work. Through a practice-based lens, the article sets out to investigate, firstly, how discourses about team and project work affect engineering work practices; secondly, how technologymediated management is reconciled in teamwork practices; and thirdly, how team and project work affect engineering professionalism and collaborative work practices. A practice theoretical framework informs the analysis. Teamwork is investigated as a phenomenon enacted through the sayings, doings and relatings of practitioners in landscapes of practices and the interconnectedness of the practices is traced through the setup of specific ecologies in the sites.

Ongkharak Nuclear Research Center-the role of the consultant

International Nuclear Information System (INIS)

Jacobi, A.; De Haller, L.

1998-01-01

The Ongkharak Nuclear Research Center Project is known to have started on 26 June 1997. At that date the Contract for the turnkey delivery of the three nuclear facilities, the Reactor Island [RI] , Isotope Production Facility [IPF] and the Waste Processing and Storage Facilities [WPSF], was signed by the Office of the Atomic Energy for Peace [OAEP] with General Atomics [GA]. The involvement of Atomic Consultant - Electrowatt Engineering Ltd. (EWE) - already started more than 2 years earlier than the official start of this ambitious project. Since mid 1995 EWE has been serving in a variety of functions and has been requested to perform numerous tasks in support of OAEP. By acting in the function of the Consultant, EWE was aiming firstly to help the project to proceed as quickly as possible. Secondly EWE was overseeing constantly that the quality of the Center, once finished, will meet the present state of the art, will be licensable in Thailand (or elsewhere) and will be internationally recognised as a safe, reliable and modern research and production installation. The role of EWE covers a multitude of engineering disciplines, such as architecture; civil, mechanical, nuclear, I and C and electrical engineering; nuclear and reactor physics; chemistry and radiopharmacy; economy and price estimation. Besides, EWE has to use its skills in conducting and/or supervising large projects, e.g., by appropriate scheduling, QA surveys, licensing support, document control, etc. Furthermore, EWE is actively involved in know-how transfer to Thai engineers and scientists by working in close co-operation with OAEP's project personnel and - if required - by giving special training courses. This paper presents some highlights as well as routine activities performed by EWE so far in the Project

Child consultation patterns in general practice comparing "high" and "low" consulting families.

OpenAIRE

Campion, P D; Gabriel, J

1984-01-01

All children's consultations with their general practitioner over a 12 month period in a small urban practice were analysed. Overall consultation rates ranged from 2.2 per child a year for 8 to 11 year olds, to 6.8 for those under 2. Families were grouped according to their average rate of new consultation for children, standardised for age. Families with higher consulting rates scored higher on an index of economic disadvantage, with mothers who scored higher on a test of "tendency to consul...

Informing the Australian government on AT policies: ARATA's experiences.

Science.gov (United States)

Friesen, Emma L; Walker, Lloyd; Layton, Natasha; Astbrink, Gunela; Summers, Michael; De Jonge, Desleigh

2015-05-01

This article describes the development and dissemination of an evidence-based Policy Statement and Background Papers by the Australian Rehabilitation and Assistive Technology Association (ARATA). An experienced project team was engaged to conduct literature reviews and member consultations, develop resources and implement a targeted advocacy strategy that included a policy launch and meetings with government officials. The Policy Statement and Background Papers have enabled ARATA to represent the views of Assistive Technology (AT) Practitioners in consultations around the National Disability Insurance Scheme and other AT-related inquiries. In ARATA's experience, developing a policy statement and disseminating it through a targeted advocacy strategy is an effective way for a not-for-profit professional organisation to influence government policy. AT practitioners must consider political factors in working towards effective policies to support their practice. To be effective at a systemic level, AT practitioners must develop political awareness and an understanding of the drivers of policy. This case study provides a blueprint for AT practitioners and organisations in tackling policy change.

Skills for Effective Consultation.

Science.gov (United States)

Dustin, Dick; Ehly, Stewart

1984-01-01

Discusses counselor skills that promote effective consultation. Reviews research on effective school consultation and presents a five-stage model which involves phasing in, problem identification, implementation, evaluation, and termination. Provides recommendations for the process and products of consultation. (JAC)

US and territory telemedicine policies: identifying gaps in perinatal care

Science.gov (United States)

Okoroh, Ekwutosi M.; Kroelinger, Charlan D.; Smith, Alexander M.; Goodman, David A.; Barfield, Wanda D.

2016-01-01

BACKGROUND Perinatal regionalization is a system of maternal and neonatal risk-appropriate health care delivery in which resources are ideally allocated for mothers and newborns during pregnancy, labor and delivery, and postpartum, in order to deliver appropriate care. Typically, perinatal risk-appropriate care is provided in-person, but with the advancement of technologies, the opportunity to provide care remotely has emerged. Telemedicine provides distance-based care to patients by consultation, diagnosis, and treatment in rural or remote US jurisdictions (states and territories). OBJECTIVE We sought to summarize the telemedicine policies of states and territories and assess if maternal and neonatal risk-appropriate care is specified. STUDY DESIGN We conducted a 2014 systematic World Wide Web–based review of publicly available rules, statutes, regulations, laws, planning documents, and program descriptions among US jurisdictions (N=59) on telemedicine care. Policies including language on the topics of consultation, diagnosis, or treatment, and those specific to maternal and neonatal risk-appropriate care were categorized for analysis. RESULTS Overall, 36 jurisdictions (32 states; 3 territories; and District of Columbia) (61%) had telemedicine policies with language referencing consultation, diagnosis, or treatment; 29 (49%) referenced consultation, 30 (51%) referenced diagnosis, and 35 (59%) referenced treatment. In all, 26 jurisdictions (22 states; 3 territories; and District of Columbia) (44%), referenced all topics. Only 3 jurisdictions (3 states; 0 territories) (5%), had policy language specifically addressing perinatal care. CONCLUSION The majority of states have published telemedicine policies, but few specify policy language for perinatal risk-appropriate care. By ensuring that language specific to the perinatal population is included in telemedicine policies, access to maternal and neonatal care can be increased in rural, remote, and resource

State of Data Guidance in Journal Policies: A Case Study in Oncology

Directory of Open Access Journals (Sweden)

Deborah H. Charbonneau

2015-06-01

Full Text Available This article reports the results of a study examining the state of data guidance provided to authors by 50 oncology journals. The purpose of the study was the identification of data practices addressed in the journals’ policies. While a number of studies have examined data sharing practices among researchers, little is known about how journals address data sharing. Thus, what was discovered through this study has practical implications for journal publishers, editors, and researchers. The findings indicate that journal publishers should provide more meaningful and comprehensive data guidance to prospective authors. More specifically, journal policies requiring data sharing, should direct researchers to relevant data repositories, and offer better metadata consultation to strengthen existing journal policies. By providing adequate guidance for authors, and helping investigators to meet data sharing mandates, scholarly journal publishers can play a vital role in advancing access to research data.

Wipro Consulting Services: Building an Effective Global Configuration in Business and IT Consulting Industry

OpenAIRE

Joseph Lampel; Ajay Bhalla; Kaivalya Vishnu

2010-01-01

The Wipro Consulting Services (WCS) case charts the evolution of the consulting initiative within Wipro Technologies; the strategic choices the management made during this evolution and the challenges facing the firm once it consolidated the various consulting initiatives to set up Wipro Consulting Services in 2008. The case deals with several questions facing the leadership team, such as the competencies to develop to move up the value chain in delivering consulting services and the extent t...

European Consulting Survey 2012 : The Future of European Management Consulting Firms' Business Models

OpenAIRE

Kreutzer, Markus; Menz, Markus

2012-01-01

This study report provides European management consulting firms' assessment of trends and currently prevailing business models in the industry. It depicts the different threats and opportunities that consulting firms with different business models, consulting foci, sizes, leverage ratios, international orientations, and geographical footprints face; it also reveals these firms' adaptation strategies. Based on an analysis of a survey of 311 consulting firms from 26 European countries, the repo...

Nurse consultants 10 years on: an insight to the role for nurse managers.

Science.gov (United States)

Mullen, Chris; Gavin-Daley, Ann; Kilgannon, Helen; Swift, Juliette

2011-09-01

To evaluate the Non-Medical Consultant role in the North West of England. The objective was to identify the current number of Non-Medical Consultants, what they do and the impact of the role in practice. The Non-Medical Consultant role for nursing and midwifery was introduced in the UK in 2000 to provide better outcomes for patients by improving service and quality; strengthening clinical leadership; and providing a new career opportunity to help retain experienced and expert professionals in practice. A combined qualitative and quantitative design was adopted. This included desktop review of previous studies, a survey questionnaire to current consultants, focus group meetings with Non-Medical Consultants, sponsors and champions. The role is effective, flexible, responsive and outward facing both internal to the organization and externally on a local, regional and national basis. A key challenge for the Non-Medical Consultants was organizational understanding of the role. The small size of the Non-Medical Consultant workforce can limit individual organizations experience of establishing and supporting the role. Effective Non-Medical Consultants lead, drive and support quality improvement, increased productivity and service effectiveness. Other impacts include sharing and promoting best practice with colleagues, income generation and financial savings through service redesign and/or staff skill mix changes. Managerial issues identified may assist Nurse Managers seeking to introduce new consultant roles and/or support, and retain existing consultants to reach their full potential. 2011 Blackwell Publishing Ltd.

Scientific political consulting and university education in Germany: demand and supply patterns in the context of the Bologna process

NARCIS (Netherlands)

Niemann, A.; Heister, S.

2010-01-01

This article examines the competences required for a career in scientific policy consultancy (especially in the field of foreign policy) in Germany and the extent to which university education in the field of political science can and does prepare for this occupation. Our analysis indicates that

Bioethics Consultations and Resources

OpenAIRE

Thomas, Jennie

2011-01-01

Making difficult healthcare decisions is often helped by consultation with a bioethics committee. This article reviews the main bioethics principles, when it is appropriate and how to call a bioethics consult, ethical concerns, and members of the consult team. Bioethics resources are included.

Hydro-Quebec's environmental policy

International Nuclear Information System (INIS)

1996-10-01

Hydro-Quebec established a new environmental policy on August 1, 1996. A summary of the policy was presented. According to this policy statement the utility undertakes to recognize the environmental implications of its activities and assumes responsibilities for these implications by integrating them into its corporate decision-making processes. The following general principles and means of implementation have been highlighted: (1) sustainable development, (2) strict, responsible environmental management, (3) environmental research, (4) enhancement of activities and facilities, (5) information, consultation and dialogue, and (6) environmental responsibility of Hydro-Quebec personnel, subsidiaries and business partners

Community Consultation and Public Disclosure: Preliminary Results From A New Model

Science.gov (United States)

Ramsey, Cornelia A.; Quearry, Bonnie; Ripley, Elizabeth

2011-01-01

Emergency medicine research conducted under the exception from informed consent (EFIC) regulation enables critical scientific advancements. When EFIC is proposed, there is a requirement for broad community consultation and public disclosure regarding the risks and benefits of the study. At the present time, no clear guidelines or standards exist for conducting and evaluating the community consultation and public disclosure. This preliminary study tested the feasibility and acceptability of a new approach to community consultation and public disclosure for a large-scale EFIC trial by engaging community members in designing and conducting the strategies. The authors enrolled key community members (called Community Advocates for Research, or CARs) to use community-based participatory methods to design and implement community consultation and public disclosure. By partnering with community members who represent target populations for the research study, this new approach has demonstrated a feasible community consultation and public disclosure plan with greater community participation and less cost than previous studies. In a community survey, the percentage of community members reporting having heard about the EFIC trial more than doubled after employing the new approach. This article discusses initial implementation and results. PMID:21729187

Job competencies for the malaysian consultant project managers

Directory of Open Access Journals (Sweden)

Dr. Ilias Said

2009-12-01

Full Text Available Architects, engineers and quantity surveyors are among the main players in construction.Coming from different background and professional background, these professionals bring in their own respective styles and methods of project management practices. There is now a body of opinion among industry people and academics alike that the industry needs to establish competency standard especially for project managers. Irrespective of their professional background, competent project managers should hypothetically deliver high quality services to the clients. A study was conducted at the School of Housing, Building and Planning, University of Science Malaysia (USM, to develop a job competence model for Consultant Project Managers (CPMs. It attempts to determine a set of minimum standards of skills and competencies for CPMs. This paper reports the findings of the study. It provides an insight into the type of competencies needed by CPMs based on the “Job Competence Model for Consultant Project Managers” developed from the study.

Thermodynamic Modeling of a Solid Oxide Fuel Cell to Couple with an Existing Gas Turbine Engine Model

Science.gov (United States)

Brinson, Thomas E.; Kopasakis, George

2004-01-01

The Controls and Dynamics Technology Branch at NASA Glenn Research Center are interested in combining a solid oxide fuel cell (SOFC) to operate in conjunction with a gas turbine engine. A detailed engine model currently exists in the Matlab/Simulink environment. The idea is to incorporate a SOFC model within the turbine engine simulation and observe the hybrid system's performance. The fuel cell will be heated to its appropriate operating condition by the engine s combustor. Once the fuel cell is operating at its steady-state temperature, the gas burner will back down slowly until the engine is fully operating on the hot gases exhausted from the SOFC. The SOFC code is based on a steady-state model developed by The U.S. Department of Energy (DOE). In its current form, the DOE SOFC model exists in Microsoft Excel and uses Visual Basics to create an I-V (current-voltage) profile. For the project's application, the main issue with this model is that the gas path flow and fuel flow temperatures are used as input parameters instead of outputs. The objective is to create a SOFC model based on the DOE model that inputs the fuel cells flow rates and outputs temperature of the flow streams; therefore, creating a temperature profile as a function of fuel flow rate. This will be done by applying the First Law of Thermodynamics for a flow system to the fuel cell. Validation of this model will be done in two procedures. First, for a given flow rate the exit stream temperature will be calculated and compared to DOE SOFC temperature as a point comparison. Next, an I-V curve and temperature curve will be generated where the I-V curve will be compared with the DOE SOFC I-V curve. Matching I-V curves will suggest validation of the temperature curve because voltage is a function of temperature. Once the temperature profile is created and validated, the model will then be placed into the turbine engine simulation for system analysis.

[Psychiatric consultations for nursing-home residents: aspects and course of such consultations].

Science.gov (United States)

Steenbeek, M; van Baarsen, C; Koekkoek, B

2012-01-01

Psychiatric symptoms occur frequently in nursing-home residents. The psychiatric expertise and support available to residents vary from one nursing home to another. International studies show that psychiatric consultations can be effective, but in the Netherlands very little research has been done on this topic. To list the types of psychiatric problems and symptoms for which consultations are requested and to determine whether a psychiatric consultation can have positive results for nursing-home residents and staff. The psychiatric consultations requested were tabulated and were analysed. Details of 71 psychiatric consultations were recorded. The percentage of women (average age 74 years) was slightly higher than the percentage of men. More than 75% of the patients suffered from agitation/aggression or irritability, 65% suffered from depression, 63% from anxiety and 56% from dysinhibition. A post-intervention assessment was performed in 54 patients (76%). In this group psychiatric symptoms were found to be greatly reduced, with regard to both frequency and severity. In addition, nursing staff seemed to suffer less of the stress and strain in their work. The patients for whom a consultation was requested seemed to suffer from serious psychiatric symptoms and were often aggressive. It was possible to achieve substantial progress as a result of a simple intervention. A possible explanation for this effect is probably the nature of the psychiatric consultation used; it was structured, multi-disciplinary and time-consuming. However, since no control group was involved, it is impossible to say with certainty that the reduction in symptoms can be attributed solely to the consultation.

Symptom validity issues in the psychological consultative examination for social security disability.

Science.gov (United States)

Chafetz, Michael D

2010-08-01

This article is about Social Security Administration (SSA) policy with regard to the Psychological Consultative Examination (PCE) for Social Security Disability, particularly with respect to validation of the responses and findings. First, the nature of the consultation and the importance of understanding the boundaries and ethics of the psychologist's role are described. Issues particular to working with low-functioning claimants usually form a large part of these examinations. The psychologist must understand various forms of non-credible behavior during the PCE, and how malingering might be considered among other non-credible presentations. Issues pertaining to symptom validity testing in low-functioning claimants are further explored. SSA policy with respect to symptom validity testing is carefully examined, with an attempt to answer specific concerns and show how psychological science can be of assistance, particularly with evidence-based practice. Additionally, the nature and importance of techniques to avoid the mislabeling of claimants as malingerers are examined. SSA requires the use of accepted diagnostic techniques with which to establish impairment, and this article describes the implementation of that requirement, particularly with respect to validating the findings.

Consultation paper : Nova Scotia's renewed energy strategy and climate change action plan

International Nuclear Information System (INIS)

2007-10-01

The Nova Scotia Department of Energy is seeking to create a sustainable and prosperous Nova Scotia that is responsive to climate change. The purpose of this report was to inform public discussion around two upcoming documents, namely the renewed energy strategy focusing on broad energy policy and a climate change action plan for Nova Scotia to reduce greenhouse gas emissions. The report discussed mitigation measures, as it is closely tied with energy use. The consultation process to inform the two documents was to include public forums and direct stakeholder consultation. The report discussed Nova Scotia's strategy for dealing with climate change and the world of energy. Recent changes in energy prices, exploration, awareness, and emerging but uncertain technologies were presented. Long term planning and a review of policy changes were also addressed. The report also presented options for a renewed energy strategy and discussed air quality; energy conservation and efficiency; electricity; natural gas; energy opportunities; government action; and government intervention. Submissions were also sought as input to the discussion paper. refs., tabs., figs., appendices

78 FR 48342 - Consultation Agreements: Proposed Changes to Consultation Procedures

Science.gov (United States)

2013-08-08

... clarify the high priority enforcement cases when OSHA may initiate a non-programmed inspection at those.... OSHA-2010-0010] RIN 1218-AC32 Consultation Agreements: Proposed Changes to Consultation Procedures AGENCY: Occupational Safety and Health Administration (OSHA), Labor. ACTION: Withdrawal of proposed rule...

3 CFR - Tribal Consultation

Science.gov (United States)

2010-01-01

.... Recommendations for improving the plans and making the tribal consultation process more effective, if any, should... 3 The President 1 2010-01-01 2010-01-01 false Tribal Consultation Presidential Documents Other Presidential Documents Memorandum of November 5, 2009 Tribal Consultation Memorandum for the Heads of Executive...

Optimal Replacement Policy of Jet Engine Modules from the Aircarrier's Point of View

Directory of Open Access Journals (Sweden)

Anita Domitrović

2008-01-01

Full Text Available A mathematical model for optimising preventive maintenanceof aircraft jet engine was developed by dynamic programming.Replacement planning for jet engine modules is regardedas a multistage decision process, while optimum modulereplacement is considered as a problem of equipment replacement.The goal of the optimal replacement policy of jet enginemodules is a defined series of decisions resulting in minimummaintenance costs. The model was programmed inC++ programming language and tested by using CFM56 jetengine data. The optimum maintenance strategy costs werecompared to costs of simpler experience-based maintenancestrategies. The results of the comparison j usti.JY further developmentand usage of the model in order to achieve significant costreduction for airline carriers.

A Unique Civil Engineering Capstone Design Course

Directory of Open Access Journals (Sweden)

G Padmanabhan

2018-02-01

Full Text Available The North Dakota State University, USA, capstone course was developed as a unique model in response to the effort of the Accreditation Board of Engineering and Technology, USA, to streamline and improve design instruction in the curriculum and has steadily evolved to keep pace with the ever-changing technology and the expectations of the profession and the society we serve. A capstone design course by definition should be a design experience for students in the final year before graduation integrating all major design concepts they have learned up until then in the program. Carefully chosen real world projects with design content in all sub-disciplines of civil engineering are assigned in this team-taught course. Faculty and practicing professionals make presentations on design process; project management; leadership in an engineering environment; and public policy; global perspectives in engineering; and professional career and licensure. Practicing professionals also critique the final student presentations. Students work in teams with number of faculty serving as technical consultants, and a faculty mentor for each team to provide non-technical guidance and direction. The course requires students to demonstrate mastery of the curriculum and to work with others in a team environment. Course assessment includes evaluation of the final design, presentations, written technical reports, project design schedule, a project design journal, and reaction papers.

Life cycle assessment of engineered nanomaterials: state of the art and strategies to overcome existing gaps.

Science.gov (United States)

Hischier, Roland; Walser, Tobias

2012-05-15

The use of engineered nanomaterials offers advantages as well as disadvantages from a sustainability perspective. It is important to identify such points as early as possible in order to be able to build on existing strengths, while counteracting disadvantages. Life Cycle Assessment (LCA) is a suitable method to assess the environmental performance of a product or process. But so far studies applying LCA to the area of nanotechnology have been scarce. One reason might be that the LCA framework has a whole list of issues that need further precision in order to be applicable to nanotechnologies: system boundaries and a functional unit have to be chosen in a way that allows one to do a comparison of equal functionalities; adequate and comprehensive life cycle inventory data for engineered nanomaterials are the key on the level of inventory analysis; and the impact assessment step requires a clear definition of the degree of detail on the level of nanoparticle emissions. The LCA studies existing thus far in the area of nanotechnology have barely begun to cover all these aspects. Thus, in order to improve the current situation, the authors propose to go ahead in each of the LCA stages as far as scientific advances allow. For the inventory modelling this means e.g. that comprehensive, transparently documented and quality ensured data of the most important engineered nanomaterials should be collected and made available in a widely-accepted format. Concerning nanoparticle emissions, as many parameters as possible have to be collected pertaining to the production, use, and the disposal phase of these engineered nanomaterials. Furthermore, on the level of impact assessment, relevant physical characteristics have to be identified for a toxicity assessment of nanoparticles and a consensus has to be found for a limited but sufficient number of independent parameters influencing toxicity to be collected. Copyright © 2012 Elsevier B.V. All rights reserved.

Policy priority objectives: comparative assessment in four European cities

Energy Technology Data Exchange (ETDEWEB)

Alonso Ramos, A.

2016-07-01

Sustainability must be an urban issue. Cities should be managed so as to minimize their impacts on environment, but providing an appropriate framework for economic and social development. However, European cities are facing some trends that threaten sustainable development. The aim of the EC research project INSIGHT-7FP (2013/16) is to develop appropriate management tools that can help to achieve sustainability in the context of European cities. In the project, a set of policy objectives have been designed for the management of urban areas, in order to face the main threats existing over cities. The paper presents a methodology based on indicators for analysing the progress towards these ten policy objectives in the four EU cities participating in the project: London (12.3 mill. inhab.), Madrid (6.4 mill. inhab.), Barcelona (5.4 mill. inhab.) and Rotterdam (1.4 mill. inhab.). All the indicators used in the analysis have been validated by ten policy makers of European cities. These policy makers participated on the stakeholders consultation carried out in the project, where the importance of the policy objectives proposed was also assessed. The paper concludes determining the policy priority objectives in each city, in order to contain the main threats existing over them: London should especially address the threats of social exclusion and transport inefficiency; Madrid the threats of economic decline and urban sprawl; Barcelona the economic decline and Rotterdam the contribution to climate change and the urban sprawl. Finally, the role played by the land use and transport system in these policy objectives is analysed. To this end, the assessment allows for the comparability of the results in a horizontal manner, in the basis of common indicators. Nearly half of these indicators are related to the land use and transport system of the cities. (Author)

18 CFR 2.1c - Policy statement on consultation with Indian tribes in Commission proceedings.

Science.gov (United States)

2010-04-01

... relationship between the United States and Indian tribes as defined by treaties, statutes, and judicial... between these agencies and tribes. In essence, this means that consultation should involve direct contact...

Introducing a new operational policy : the PIS operational policy

CSIR Research Space (South Africa)

Pattinson, T

2009-01-01

Full Text Available ; No. of Pages 14 Computers and Chemical Engineering xxx (2009) xxx–xxx Contents lists available at ScienceDirect Computers and Chemical Engineering journa l homepage: www.e lsev ier .com/ locate /compchemeng Introducing a new operational policy...), • Finite Intermediate Storage (FIS), • Unlimited Intermediate Storage (UIS), ARTICLE IN PRESSG ModelCACE-3875; No. of Pages 14 2 T. Pattinson, T. Majozi / Computers and Chemical Engineering xxx (2009) xxx–xxx W situatio ationa polic u CI policie...

Tax Policy Assessment in Slovenia – Case of Interest Tax Shield

Directory of Open Access Journals (Sweden)

Jovanovic Tatjana

2017-03-01

Full Text Available The tax policy assessment is an indispensable strategy within any modern country’s system of governance. There are several types of “impact assessments”, with RIA as one of the most commonly used. This tool is used to measure and analyse the benefits, costs and effects of a new or existing legal regime, which can be carried out by collecting and analysing empirical data in the context of a broader decision-making framework. The main objective of the paper is to analyse which stage the Slovenian regulatory impact assessment is in, and whether this stage is sophisticated enough to provide for the essential verification of tax policy and specific instruments, focusing mainly on the case of interest tax shield issues. Methodologically, the paper is based on a systematic literature review, a survey for public consultations and statistical tools for calculating the differences in internal indebtedness in different observed periods. The results show that the Slovenian RIA is not sophisticated enough to evaluate complex tax instruments and policy. Nevertheless, tax policy decision-makers should reconsider the implementation of a thin capitalization rule (but also future tax policy instruments focusing also on other, non-tax revenue, factors.

Collaborative-Large scale Engineering Assessment Networks for Environmental Research: The Overview

Science.gov (United States)

Moo-Young, H.

2004-05-01

A networked infrastructure for engineering solutions and policy alternatives is necessary to assess, manage, and protect complex, anthropogenic ally stressed environmental resources effectively. Reductionist and discrete disciplinary methodologies are no longer adequate to evaluate and model complex environmental systems and anthropogenic stresses. While the reductonist approach provides important information regarding individual mechanisms, it cannot provide complete information about how multiple processes are related. Therefore, it is not possible to make accurate predictions about system responses to engineering interventions and the effectiveness of policy options. For example, experts cannot agree on best management strategies for contaminated sediments in riverine and estuarine systems. This is due, in part to the fact that existing models do not accurately capture integrated system dynamics. In addition, infrastructure is not available for investigators to exchange and archive data, to collaborate on new investigative methods, and to synthesize these results to develop engineering solutions and policy alternatives. Our vision for the future is to create a network comprising field facilities and a collaboration of engineers, scientists, policy makers, and community groups. This will allow integration across disciplines, across different temporal and spatial scales, surface and subsurface geographies, and air sheds and watersheds. Benefits include fast response to changes in system health, real-time decision making, and continuous data collection that can be used to anticipate future problems, and to develop sound engineering solutions and management decisions. CLEANER encompasses four general aspects: 1) A Network of environmental field facilities instrumented for the acquisition and analysis of environmental data; 2) A Virtual Repository of Data and information technology for engineering modeling, analysis and visualization of data, i.e. an environmental

77 FR 13137 - Draft Policy on Consultation with Alaska Native Claims Settlement Act Corporations

Science.gov (United States)

2012-03-05

... availability and request for comments. SUMMARY: The Department of the Interior is requesting comments on its... limited to: 1. ANCSA Corporation land, water areas and resources; 2. The ability of an ANCSA Corporation... the Department's discretion to engage in consultation. ANCSA Corporation--Any Alaska Native village...

Radioisotope power system based on derivative of existing Stirling engine

International Nuclear Information System (INIS)

Schock, A.; Or, C.T.; Kumar, V.

1995-01-01

In a recent paper, the authors presented the results of a system design study of a 75-watt(c) RSG (Radioisotope Stirling Generator) for possible application to the Pluto Fast Flyby mission. That study was based on a Stirling engine design generated by MTI (Mechanical Technology, Inc.). The MTI design was a derivative of a much larger (13 kwe) engine that they had developed and tested for NASA's LERC. Clearly, such a derivative would be a major extrapolation (downsizing) from what has actually been built and tested. To avoid that, the present paper describes a design for a 75-watt RSG system based on derivatives of a small (11-watt) engine and linear alternator system that has been under development by STC (Stirling Technology Company) for over three years and that has operated successfully for over 15,000 hours as of March 1995. Thus, the STC engines would require much less extrapolation from proven designs. The design employs a heat source consisting of two standard General Purpose Heat Source (GPHS) modules, coupled to four Stirling engines with linear alternators, any three of which could deliver the desired 75-watt(e) output if the fourth should fail. The four engines are coupled to four common radiators with redundant heatpipes for rejecting the engines' waste heat to space. The above engine and radiator redundancies promote system reliability. The paper describes detailed analyses to determine the effect of radiator geometry on system mass and performance, before and after an engine or heatpipe failure

Validity aspects of the patient feedback questionnaire on consultation skills (PFC), a promising learning instrument in medical education

NARCIS (Netherlands)

Reinders, M.E.; Blankenstein, A.H.; Knol, D.L.; Vet, de H.C.W.; Marwijk, van H.W.J.

2009-01-01

OBJECTIVE: A focus on the communicator competency is considered to be an important requirement to help physicians to acquire consultation skills. A feedback questionnaire, in which patients assess consultation skills might be a useful learning tool. An existing questionnaire on patient perception of

Longer-term impact of cardiology e-consults.

Science.gov (United States)

Wasfy, Jason H; Rao, Sandhya K; Kalwani, Neil; Chittle, Melissa D; Richardson, Calvin A; Gallen, Kathleen M; Isselbacher, Eric M; Kimball, Alexandra B; Ferris, Timothy G

2016-03-01

Cardiac e-consults may be an effective way to deliver value-oriented outpatient cardiology care in an accountable care organization. Initial results of cardiac e-consults have demonstrated high satisfaction among both patients and referring providers, no known adverse events, and low rates of diagnostic testing. Nevertheless, differences between e-consults and traditional consults, effects of e-consults on traditional consult volume, and whether patients seek traditional consults after e-consults are unknown. We established a cardiac e-consult program on January 13, 2014. We then conducted detailed medical record reviews of all patients with e-consults to detect any adverse clinical events and detect subsequent traditional visits to cardiologists. We also performed 2 comparisons. First, we compared age, gender, and referral reason for e-consults vs traditional consults. Second, we compared changes in volume of referrals to cardiology vs other medical specialties that did not have e-consults. From January 13 to December 31, 2014, 1,642 traditional referrals and 165 e-consults were requested. The proportion of e-consults of all evaluations requested over that period was 9.1%. Gender balance was similar among traditional consults and e-consults (44.8% male for e-consults vs 45.0% for traditional consults, P = .981). E-consult patients were younger than traditional consult patients (55.3 vs 60.4 years, P cardiology visit during the follow-up period. E-consults are an effective and safe mechanism to enhance value in outpatient cardiology care, with low rates of bounceback to traditional consults. E-consults can account for nearly one-tenth of total outpatient consultation volume at 1 year within an accountable care organization and are associated with a reduction in traditional referrals to cardiologists. Copyright © 2015 Elsevier Inc. All rights reserved.

External Tank Liquid Hydrogen (LH2) Prepress Regression Analysis Independent Review Technical Consultation Report

Science.gov (United States)

Parsons, Vickie s.

2009-01-01

The request to conduct an independent review of regression models, developed for determining the expected Launch Commit Criteria (LCC) External Tank (ET)-04 cycle count for the Space Shuttle ET tanking process, was submitted to the NASA Engineering and Safety Center NESC on September 20, 2005. The NESC team performed an independent review of regression models documented in Prepress Regression Analysis, Tom Clark and Angela Krenn, 10/27/05. This consultation consisted of a peer review by statistical experts of the proposed regression models provided in the Prepress Regression Analysis. This document is the consultation's final report.

Danish energy-sector exports. Products and consulting services

International Nuclear Information System (INIS)

Wolter, H.C.

2000-06-01

Danish Energy Agency has previously carried out studies of Danish energy-sector exports. The latest results were published in the report, Energisektorens eksport. Produkter og raadgivning. Danish Energy Agency, September 1998. The present survey is an update of the earlier studies, and includes 1998 exports. As previously, the study, carried out in cooperation with the Confederation of Danish Industries and the Danish Council of Consulting Architects and Engineers, is based on questionnaires sent to relevant companies. In addition, information has been obtained from companies that do not belong to these organisations. On the basis of the answers received, 58 Danish companies exported products to a value of approximately DKK 16,000 million, and 22 consulting firms exported consulting services to a value of approximately DKK 370 million. These exports of approximately DKK 16.5 billion accounted for 5% of all Danish exports in 1998. In comparison with 1996, energy-sector exports have risen by more than 40% in a period in which Danish exports in general have risen by an average of 8%. Energy sector exports provide employment for more than 18,000 persons in Denmark - approximately 17,500 employees in companies that export products, and approximately 600 persons in consulting firms. To this must be added a presumably significantly larger number of persons employed by sub-suppliers to the above companies computed by value, 80% of the exports come from relatively few companies, i.e. 13 companies with products, and five offering consulting services. Energy-sector exports fall within the following product areas: 1) Wind turbines (25%). 2) District heating and combined heat and power (CHP) (21%). 3) Energy savings and control (20%). 4) Oil and natural gas (13%). 5) Electricity plants and power supply (13%). 6) Other (8%). 67% of the exports go to Western Europe, 18% to Asia, 7% to Eastern and Central Europe, and 8% to other parts of the world. (EHS)

Mental health policy process: a comparative study of Ghana, South Africa, Uganda and Zambia

Directory of Open Access Journals (Sweden)

Kigozi Fred

2010-08-01

Full Text Available Abstract Background Mental illnesses are increasingly recognised as a leading cause of disability worldwide, yet many countries lack a mental health policy or have an outdated, inappropriate policy. This paper explores the development of appropriate mental health policies and their effective implementation. It reports comparative findings on the processes for developing and implementing mental health policies in Ghana, South Africa, Uganda and Zambia as part of the Mental Health and Poverty Project. Methods The study countries and respondents were purposively selected to represent different levels of mental health policy and system development to allow comparative analysis of the factors underlying the different forms of mental health policy development and implementation. Data were collected using semi-structured interviews and document analysis. Data analysis was guided by conceptual framework that was developed for this purpose. A framework approach to analysis was used, incorporating themes that emerged from the data and from the conceptual framework. Results Mental health policies in Ghana, South Africa, Uganda and Zambia are weak, in draft form or non-existent. Mental health remained low on the policy agenda due to stigma and a lack of information, as well as low prioritisation by donors, low political priority and grassroots demand. Progress with mental health policy development varied and respondents noted a lack of consultation and insufficient evidence to inform policy development. Furthermore, policies were poorly implemented, due to factors including insufficient dissemination and operationalisation of policies and a lack of resources. Conclusions Mental health policy processes in all four countries were inadequate, leading to either weak or non-existent policies, with an impact on mental health services. Recommendations are provided to strengthen mental health policy processes in these and other African countries.

Management Consultancy As Practice: A Study Of The Duality Of The Management Consultants' Role

OpenAIRE

Hartley, Jeanette

2017-01-01

The central question addressed in this research is: “How do practicing management consultants cope with the duality of their role?” Management consultants are often responsible for internal business leadership roles as well as developing business, people and knowledge alongside client delivery (Richter et al., 2008). The research sought to understand the nature of the potentially conflicting demands of their client-facing and consultancy-facing roles on management consultants, how conflicts a...

Reflections on the role of consultant radiographers in the UK: What is a consultant radiographer?

International Nuclear Information System (INIS)

Booth, L.; Henwood, S.; Miller, P.

2016-01-01

Context: This paper is the second paper from a two year in depth case study, exploring the role of consultant radiographers in the UK. Methods: A longitudinal case study approach was used to determine the role of consultant radiographers. Interviews were used to explore experiences of being a consultant, which were analysed using thematic analysis. Eight consultant radiographers participated (Note, two of the consultants withdrew after the first interview due to workload). Therefore two consultants were interviewed only once. The remaining six consultants were interviewed twice over a 12 month period. Findings: The data presented in this paper explores the nature of the role, differences between roles, the four domains of practice, and how the role fits into local organisational structures. The study shows wide variation in the types of roles undertaken, reflecting that the creation of these roles were in response to local clinical need and often related to an individual practitioner's skills. The broad scope of the role was shown across all the consultants, with evidence of roles developing into new areas of service delivery. Conclusions: The paper offers insight into the role(s) of consultant radiographers in the UK. The range and scope of their practice is extensive, with much variation. It is evident that the clinical aspect of the role dominates, with research being the least supported domain of practice. There remains a lack of clarity around the role, with concerns about remuneration and other limitations that may restrict the role developing further. - Highlights: • This paper shows the variation in roles between consultant radiographers. • The commonality with medical roles is highlighted. • Problem solving is identified as a core skill in consultant radiography. • Consultants offered evidence of the roles developing service provision. • While all four domains of practice are covered, research is the least well supported.

Selling Academies: Local Democracy and the Management of "Consultation"

Science.gov (United States)

Hatcher, Richard

2008-01-01

Academies (state schools owned and run by private sponsors on a non-profit basis) are a key element in Labour's education agenda. Proposals to set up Academies, in most cases by taking over existing schools, have provoked local campaigns of opposition in many areas. Replacing a Local Authority with an Academy entails a process of consultation.…

National environmental radiation monitoring program: towards formulating policy on radioactive waste management

International Nuclear Information System (INIS)

Sukiman Sarmani

2002-01-01

Though Malaysia has no nuclear power station, but the management of its low level radioactive waste generated from industrial activities involves most of the same issues that must be considered in countries with nuclear power. These include public consultation at all stages, an open approach, high level scientific and engineering input and political decision by the Government. A carefully planned approach, which involves the public and gives time to build trust and confidence, is necessary for success. It is also pertinent to establish accurate and reliable data on environmental radiation to accurately assess possible risk. This is where a national monitoring program on environmental radiation is very important. While accurate data will help formulate sound policy on radioactive waste management, it should also be readily available to the public to gain support and acceptance. This paper presents arguments on the importance of a national monitoring program for environmental radiation as an input for formulating a policy on radioactive waste management in Malaysia. (Author)

The Dream Consultant

DEFF Research Database (Denmark)

Muhr, Sara Louise; Kirkegaard, Line

2013-01-01

Consultants are known to work extreme hours. We show empirically how consultants fantasize about off-work activities, which are impossible to realize with their work schedule. These fantasies are, however, not obstructing their work, but important to justify the extreme hours and sustain desire f...

Scientific decision-making and stakeholder consultations: the case of salt recommendations.

Science.gov (United States)

Timotijevic, Lada; Barnett, Julie; Brown, Kerry; Raats, Monique M; Shepherd, Richard

2013-05-01

Scientific advisory committees (SACs) are seen as "boundary organisations" working at the interface between science, policy and society. Although their narrowly defined remit of risk assessment is anchored in notions of rationality, objectivity, and reason, in reality, their sources for developing recommendations are not limited to scientific evidence. There is a growing expectation to involve non-scientific sources of information in the formation of knowledge, including the expectation of stakeholder consultation in forming recommendations. Such a move towards "democratisation" of scientific processes of decision-making within SACs has been described and often studied as "post-normal science" (PNS) (Funtowicz & Ravetz, 1993). In the current paper we examine the application of PNS in practice through a study of stakeholder consultations within the workings of the UK Scientific Advisory Committee for Nutrition (SACN). We use the theoretical insights from PNS-related studies to structure the analysis and examine the way in which PNS tenets resonate with the practices of SACN. We have selected a particular case of the SACN UK recommendations for salt as it is characterized by scientific controversy, uncertainty, vested interests and value conflict. We apply the tenets of PNS through documentary analysis of the SACN Salt Subgroup (SSG) consultation documents published in 2002/2003: the minutes of the 5 SACN SSG's meetings which included summary of the SACN SSG's stakeholder consultation and the SSG's responses to the consultation. The analysis suggests that the SACN consultation can be construed as a process of managing sources of risk to its organisation. Thus, rather than being an evidence of post-normal scientific practice, engagement became a mechanism for confirming the specific framing of science that is resonant with technocratic models of science holding authority over the facts. The implications for PNS theory are discussed. Copyright © 2013 Elsevier Ltd. All

Observations of sexually transmitted disease consultations in India.

Science.gov (United States)

Mertens, T E; Smith, G D; Kantharaj, K; Mugrditchian, D; Radhakrishnan, K M

1998-03-01

To assess the quality of sexually transmitted disease (STD) case management provided in public and private health facilities in selected areas of Madras, Tamil Nadu, India, in order to make recommendations for improving the quality of care and promote the syndromic approach to STD treatment. Structured observations of consultations for STDs in health care facilities. Scoring of the observations according to standards for history taking, examination, treatment and provision of basic health promotion advice allows evaluation of STD case management. With STD treatment adequacy scored against Indian national guidelines (which recommend aetiologic treatment), history taking, examination and treatment were satisfactory in 76 out of 108 (70%) of observed consultations. However, if STD treatment adequacy is scored with respect to the syndrome approach towards selected STD (male urethritis and non herpetic genital ulcer for both sexes), only 8 out of 81 (10%) of the patients were satisfactory managed. During 32 out of 108 (30%) of the consultations, advice on the use of condoms in order to prevent STD or HIV/AIDS was given. Instructions regarding how to use condoms were offered to seven (6%) patients and condoms were only provided to one patient (1%). Patients were urged to refer their partner(s) for treatment during 29 (27%) of consultations. A criterion of adequate use of the STD consultation for health promotion, requiring both promotion of condoms and encouragement to refer partner(s) for treatment, was met during 13 (12%) of consultations. Monitoring and improving the standards of care at facilities at which STDs are treated have become key roles of STD/HIV/AIDS programmes. The present report suggests that in Madras the activities of medical practitioners who treat STD patients are far from ideal at present. Improvements would involve simplifying existing treatment guidelines by promoting the syndromic approach to STD management, continuing education programmes for

Looking beyond the forest: Using harvest plots, gap analysis, and expert consultations to assess effectiveness, engage stakeholders, and inform policy.

Science.gov (United States)

Burns, J; Polus, S; Brereton, L; Chilcott, J; Ward, S E; Pfadenhauer, L M; Rehfuess, E A

2018-03-01

We describe a combination of methods for assessing the effectiveness of complex interventions, especially where substantial heterogeneity with regard to the population, intervention, comparison, outcomes, and study design of interest is expected. We applied these methods in a recent systematic review of the effectiveness of reinforced home-based palliative care (rHBPC) interventions, which included home-based care with an additional and explicit component of lay caregiver support. We first summarized the identified evidence, deemed inappropriate for statistical pooling, graphically by creating harvest plots. Although very useful as a tool for summary and presentation of overall effectiveness, such graphical summary approaches may obscure relevant differences between studies. Thus, we then used a gap analysis and conducted expert consultations to look beyond the aggregate level at how the identified evidence of effectiveness may be explained. The goal of these supplemental methods was to step outside of the conventional systematic review and explore this heterogeneity from a broader perspective, based on the experience of palliative care researchers and practitioners. The gap analysis and expert consultations provided valuable input into possible underlying explanations in the evidence, which could be helpful in the further adaptation and testing of existing rHBPC interventions or the development and evaluation of new ones. We feel that such a combination of methods could prove accessible, understandable, and useful in informing decisions and could thus help increase the relevance of systematic reviews to the decision-making process. Copyright © 2017 John Wiley & Sons, Ltd.

Classroom Collaboration: Implementing Consultation-Based Intervention in Five Multidisciplinary Teams.

Science.gov (United States)

Kuralt, Sally K.

This study attempted system-wide institutionalization of a consultation-based ancillary service delivery model into the norms and work behaviors of the elementary school organization, through modifying the role and function of members of existent school-based multidisciplinary Child Study Teams (CSTs) and the demonstration of the potential of the…

Participation in European water policy

NARCIS (Netherlands)

J.A. van Ast (Jacko); S.P. Boot (Sander Paul)

2003-01-01

textabstractThis paper considers the possibilities for interactive policy-making in European water management. In the new European Water Framework Directive, public information and consultation are major elements in the procedure (process) that leads to River Basin Management Plans. In general,

Quality Management in Project Management Consulting. A Case Study in an International Consulting Company

Directory of Open Access Journals (Sweden)

Eduard-Gabriel Ceptureanu

2017-02-01

Full Text Available The present paper addresses quality management from the specific perspective of project management consulting service providers, in the framework of large infrastructure projects. Because of their supposed superiority in knowledge and experience, project management consultants have an ultimate responsibility for the proper implementing of the project. Therefore, quality management in consulting organizations should focus on critical success factors. As there is no consensus yet regarding the most important aspects of the consulting activity on which depend the achievement of the project aims, there is scope for further investigating this subject. Here, the case of a project management consulting organization involved in large infrastructure projects in Romania, Bulgaria, Moldova, Ukraine and Serbia is analyzed. Data collected through a questionnaire-based survey among international consultants and support personnel suggest that factors related to leadership style and communication skills are more closely tied to the success of the project than more technical aspects. The results constitute an empirical evidence of main success factors for specialized consulting services in project management and can be useful in improving business and project performance and achieving business excellence.

Experiences with online consultation systems in primary care: case study of one early adopter site.

Science.gov (United States)

Casey, Michael; Shaw, Sara; Swinglehurst, Deborah

2017-11-01

There is a strong policy drive towards implementing alternatives to face-to-face consultations in general practice to improve access, efficiency, and cost-effectiveness. These alternatives embrace novel technologies that are assumed to offer potential to improve care. To explore the introduction of one online consultation system (Tele-Doc) and how it shapes working practices. Mixed methods case study in an inner-city general practice. The study was conducted through interviews with IT developers, clinicians, and administrative staff, and scrutiny of documents, websites, and demonstrator versions of Tele-Doc, followed by thematic analysis and discourse analysis. Three interrelated themes were identified: online consultation systems as innovation, managing the 'messiness' of general practice consultations, and redistribution of the work of general practice. These themes raise timely questions about what it means to consult in contemporary general practice. Uptake of Tele-Doc by patients was low. Much of the work of the consultation was redistributed to patients and administrators, sometimes causing misunderstandings. The 'messiness' of consultations was hard to eliminate. In-house training focused on the technical application rather than associated transformations to practice work that were not anticipated. GPs welcomed varied modes of consulting, but the aspiration of improved efficiency was not realised in practice. Tele-Doc offers a new kind of consultation that is still being worked out in practice. It may offer convenience for patients with discrete, single problems, and a welcome variation to GPs' workload. Tele-Doc's potential for addressing more complex problems and achieving efficiency is less clear, and its adoption may involve unforeseeable consequences. © British Journal of General Practice 2017.

Does a Link Exist Between Examination Performance and Lecture Attendance for First Year Engineering Students ?

OpenAIRE

O'Dwyer, Aidan

2011-01-01

The objective of this study is to examine if a link exists between lecture attendance and examination performance of Level 7, Year 1, Electrical Engineering students at Dublin Institute of Technology in the Electrical Systems subject. Lecture attendance was monitored and analysed over four academic years (2007-8, 2008-9, 2009-10 and 2010-11). The average lecture attendance for students in the three academic years from 2007-10 was 55%, increasing noticeably in the 2009-10 academic year. A stat...

Trends and Issues in California's Low Carbon Fuel Standard - Learning from Response to Existing Climate Policy

Science.gov (United States)

Witcover, J.

2015-12-01

Debate over lower greenhouse gas (GHG) emissions from transportation has included heated discussion about appropriate policies and their cost and feasibility. One prominent policy mechanism, a carbon intensity standard, rates transport fuels based on analysis of lifecycle GHG emissions, and targets lower fuel pool carbon intensity through a market mechanism that uses a system of tradable, bankable credits and deficits. California instituted such a policy -- the Low Carbon Fuel Standard (LCFS) - in 2010, which targets a 10% carbon intensity (CI) reduction by 2020. The program rolled out amid concerns over slow development of new fuels expected to be very low carbon (such as cellulosic) and has faced court challenges that added considerable policy uncertainty. Since the program's start, state transport energy mix has shifted modestly but noticeably. Looking ahead, emerging issues for the program include amendments and re-adoption in response to a court ruling, potential interaction with California's multi-sector cap on carbon emissions (which started covering transport fuels in 2015), and impacts from similar CI standards in other jurisdictions. This study provides an analysis of fuel mix changes since the LCFS was implemented in 2011, and a discussion of emerging issues focusing on policy interaction. Descriptive statistics on alternative fuel use, available fuel pathways, and CI ratings are presented based on data from the California Air Resources Board (which runs the program). They document a shift towards more alternative fuels in a more diverse mix, with lower average CI ratings for most alternative fuel types. Financial incentives for various fuels are compared under the LCFS and the US federal Renewable Fuel Standard; disincentives from conceptually different carbon pricing schemes under the LCFS and the Cap-and-Trade are also outlined. The results provide important information on response to an existing market-based policy mechanism for addressing GHG

Requirements for guidelines systems: implementation challenges and lessons from existing software-engineering efforts.

Science.gov (United States)

Shah, Hemant; Allard, Raymond D; Enberg, Robert; Krishnan, Ganesh; Williams, Patricia; Nadkarni, Prakash M

2012-03-09

A large body of work in the clinical guidelines field has identified requirements for guideline systems, but there are formidable challenges in translating such requirements into production-quality systems that can be used in routine patient care. Detailed analysis of requirements from an implementation perspective can be useful in helping define sub-requirements to the point where they are implementable. Further, additional requirements emerge as a result of such analysis. During such an analysis, study of examples of existing, software-engineering efforts in non-biomedical fields can provide useful signposts to the implementer of a clinical guideline system. In addition to requirements described by guideline-system authors, comparative reviews of such systems, and publications discussing information needs for guideline systems and clinical decision support systems in general, we have incorporated additional requirements related to production-system robustness and functionality from publications in the business workflow domain, in addition to drawing on our own experience in the development of the Proteus guideline system (http://proteme.org). The sub-requirements are discussed by conveniently grouping them into the categories used by the review of Isern and Moreno 2008. We cite previous work under each category and then provide sub-requirements under each category, and provide example of similar work in software-engineering efforts that have addressed a similar problem in a non-biomedical context. When analyzing requirements from the implementation viewpoint, knowledge of successes and failures in related software-engineering efforts can guide implementers in the choice of effective design and development strategies.

Shared consultant physician posts.

LENUS (Irish Health Repository)

Cooke, J

2012-01-31

Our aim was to assess the acceptability and cost-efficiency of shared consultancy posts. Two consultant physicians worked alternate fortnights for a period of twelve months. Questionnaires were distributed to general practitioners, nurses, consultants and junior doctors affected by the arrangement. Patients or their next of kin were contacted by telephone. 1\\/17 of consultants described the experience as negative. 14\\/19 junior doctors reported a positive experience. 11 felt that training had been improved while 2 felt that it had been adversely affected. 17\\/17 GPs were satisfied with the arrangement. 1\\/86 nurses surveyed reported a negative experience. 1\\/48 patients were unhappy with the arrangement. An extra 2.2 (p<0.001) patients were seen per clinic. Length of stay was shortened by 2.49 days (p<0.001). A saving of 69,212 was made due to decreased locum requirements. We present data suggesting structured shared consultancy posts can be broadly acceptable and cost efficient in Ireland.

Advanced training of tax consultants

Directory of Open Access Journals (Sweden)

Adigamova Farida F.

2016-01-01

Full Text Available The purpose of the research is to review and analyze the data on the necessity to provide an educational environment for training and advanced training of tax consultants in Russia. The article considers the types of tax consulting, the historical background of training financiers in Russia, as well as identifies conditions determining the significance of tax consulting. The research establishes the connection between the negative attitude to tax payment and tax evasion. The advanced training of tax consultants should be a continuous process as they need to take into account both external and internal taxpayers risks associated with the development of law and law-enforcement practice. Obviously, the training of tax consultants should take into account the experience of developed foreign countries, such as Germany, Austria, Czech Republic, Slovakia and other European countries as well. In Russia, it is necessary to open educational institutions, which will not only be involved in the certification of tax consultants, but also provide training courses. These courses should contribute to constant increase of tax consultants knowledge, consider the tax treatment of economic activities, as well changes in the legislation, economics, finance, accounting, manufacturing processes, which will improve the quality of services provided by tax consultants.

Testing a tri-partite contingent model of engineering cultures: A pilot study

International Nuclear Information System (INIS)

Murphy, Glen D.

2010-01-01

For some time there has been a growing awareness of organizational culture and its impact on the functioning of engineering and maintenance departments. Those wishing to implement contemporary maintenance regimes (e.g. condition based maintenance) are often encouraged to develop 'appropriate cultures' to support a new method's introduction. Unfortunately these same publications often fail to specifically articulate the cultural values required to support those efforts. In the broader literature, only a limited number of case examples document the cultural values held by engineering asset intensive firms and how they contribute to their success (or failure). Consequently a gap exists in our knowledge of what engineering cultures currently might look like, or what might constitute a best practice engineering asset culture. The findings of a pilot study investigating the perceived ideal characteristics of engineering asset cultures are reported. Engineering managers, consultants and academics (n=47), were surveyed as to what they saw were essential attributes of both engineering cultures and engineering asset personnel. Valued cultural elements included those orientated around continuous improvement, safety and quality. Valued individual attributes included openness to change, interpersonal skills and conscientiousness. The paper concludes with a discussion regarding the development of a best practice cultural framework for practitioners and engineering managers.

Conducting Participatory Culture-Specific Consultation: A Global Perspective on Multicultural Consultation.

Science.gov (United States)

Nastasi, Bonnie K.; Varjas, Kristen; Bernstein, Rachel; Iavasena, Asoka

2000-01-01

Describes a participatory approach to consultation that builds upon contemporary models of research and practice and is designed to address the culture-specific needs of individuals and systems. The Participatory Culture-Specific Consultation (PCSC) model embodies a participatory interpersonal process and relies on ethnographic and action research…

Sickness certification in the general practice consultation: the patients' perspective, a qualitative study.

Science.gov (United States)

O'Brien, Kathryn; Cadbury, Naomi; Rollnick, Stephen; Wood, Fiona

2008-02-01

Up to a third of general practice consultations involve issuing sickness certificates. Recent research has looked at the GPs' perspective of sickness certification but there has been no in-depth research exploring patients' views of these consultations. To explore patients' views of sickness certification within general practice consultations, and how these could be improved. A qualitative study was carried out with 12 general practices in South Wales; interview study of 19 patients who had recently received a sick note from a GP. Patients rarely attended just for a sick note, more often wanting advice or an opportunity to ask questions. Patients valued continuity of care, a good doctor-patient relationship, adequate consultation time and discussion about their illness, social situation and work-related issues when consulting with their GP for a sick note. Many patients felt doctors did not have enough time or knowledge of the patient to the able to address this issue adequately and this increased feelings of anxiety. Patients did not feel that being questioned by their GP or discussing return to work threatened the doctor-patient relationship. GPs who simply give out sick notes without question or discussion are not necessarily giving the patient what they want. More time should be spent discussing work and illness-related issues. Policy makers should recognize that continuity of care a good doctor-patient relationship and adequate consultation time are important to patients and any initiatives aimed at GPs to improve return to work rates should take these into consideration.

Disruptive Innovation: Implementation of Electronic Consultations in a Veterans Affairs Health Care System.

Science.gov (United States)

Gupte, Gouri; Vimalananda, Varsha; Simon, Steven R; DeVito, Katerina; Clark, Justice; Orlander, Jay D

2016-02-12

reflected a request for specialist input to a generalist's question in diagnosis or management in the ambulatory setting, we identified creative uses of e-consults, including requests for face-to-face appointments and documentation of pre-operative chart reviews; moreover, 7.00% (360/5141) of the e-consults originated from our sub-acute and chronic care inpatient units. In interviews, requesting providers reported high utility and usability. Specialists recognized the value of e-consults but expressed concerns about additional workload. The e-consult mechanism is frequently utilized for its initial intended purpose. It has also been adopted for unexpected clinical and administrative uses, developing into a "disruptive innovation" and highlighting existing gaps in mechanisms for provider communication. Further investigation is needed to characterize optimal utilization of e-consults within specialty and the medical center, and what features of the e-consult program, other than volume, represent valid measures of access and quality care.

Efficiency principles of consulting entrepreneurship

OpenAIRE

Moroz Yustina S.; Drozdov Igor N.

2015-01-01

The article reviews the primary goals and problems of consulting entrepreneurship. The principles defining efficiency of entrepreneurship in the field of consulting are generalized. The special attention is given to the importance of ethical principles of conducting consulting entrepreneurship activity.

Engineering in the energy sector. The single market and the engineering sector; Ingenieria en el sector energetico. El mercado unico y el sector de ingenieria

Energy Technology Data Exchange (ETDEWEB)

Garcia Rodrigues, A [Empresarios Agrupados, A.I.E., Madrid (Spain)

1993-12-15

Projects with large infrastructures, particularly those in the field of energy, provide a strong boost to certain industrial sectors in the country. In the case of Spain, the policy of direct management 'by components' of these projects - hydroelectric power plants, petrochemical plants, thermoelectric plants and nuclear power plants - adopted by the electric utility owners has furthered not only the local equipment manufacturing industry but also the engineering sector. At present, with full implementation of the Single Market in sight, it is particularly interesting for Spain to continue building up a powerful engineering sector, increasing its size and usefulness, and extending its traditional areas of action to other technologies, more on the lines of engineering and consulting firms in the USA than in the rest of Europe. The intention is to endow our equipment and construction companies with the skills necessary to enable them to compete with large European conglomerates in their respective sectors. The structure of these conglomerates usually contains engineering capabilities which are not habitual in our industry. Examples are given, showing how this model has been used to compete and win awards for important international projects. A specific analysis has been made of the position of Spanish engineering and industry in nuclear power generation projects in the former Soviet Union and East European countries, in which large investments are expected to be made. (author)

The art of consultation.

Science.gov (United States)

Bhangoo, Kulwant S

2014-05-01

Sophisticated marketing and practice-enhancing strategies can help bring patients to a surgeon's practice. However, the ability to retain these patients and also convert the consultations into surgical procedures depends on the art of consultation. This very important aspect of clinical practice is seldom taught in the medical school. In this paper, the author discusses many aspects of the art of consultation, which he has learned in his practice over the years.

Revitalising Evidence-based Policy for the Sendai Framework for Disaster Risk Reduction 2015-2030: Lessons from Existing International Science Partnerships.

Science.gov (United States)

Carabine, Elizabeth

2015-04-23

The convergence of agreements on disaster risk reduction (DRR), development finance, sustainable development and climate change in 2015 presents a unique opportunity for coherence across these inter-related policy areas. At the same time, demand is growing for a more prominent and effective role for science and technology in providing evidence for policy, with the international community recognising that successful disaster risk reduction (DRR) depends on it. Reflecting this ambition, science is included as a core aspect of the Sendai Framework for Disaster Risk Reduction 2015-2030, although the ways in which this will be implemented in practice is still unclear. This paper aims to inform the implementation of international science coordination for DRR by examining a number of existing international science partnerships used across other relevant areas of policy to understand best practice, options for coordination and lessons identified. In the field of DRR, the science-policy interface needs to be strengthened in line with the best practice described in this review. An enhanced UNISDR Scientific and Technical Advisory Group will be given the mandate for to enhance the evidence base for DRR and mobilise science and technical work in coordination with a broad range of stakeholders. The structure and function of an enhanced STAG must be as open, as inclusive and as participatory as possible in order to build trust in new and existing institutions at local, national, regional and global levels. The challenge for the international community is to facilitate evidence-based policy making by formally recognising the links between DRR, development finance, sustainable development and climate change in the upcoming post-2015 agreements.

Ethics policy review: a case study in quality improvement.

Science.gov (United States)

Frolic, Andrea Nadine; Drolet, Katherine

2013-02-01

Policy work is often cited as one of the primary functions of Hospital Ethics Committees (HECs), along with consultation and education. Hospital policies can have far reaching effects on a wide array of stakeholders including, care providers, patients, families, the culture of the organisation and the community at large. In comparison with the wealth of information available about the emerging practice of ethics consultation, relatively little attention has been paid to the policy work of HECs. In this paper, we hope to advance the development of best practices in HEC policy work by describing the quality improvement process that we undertook at Hamilton Health Sciences, Hamilton, Ontario, Canada. In the first section of the paper we describe the context of our HEC policy work, and the shortcomings of our historical review process. In subsequent sections, we detail the quality improvement project we undertook in 2010, the results of the project and the specific tools we developed to enhance the quality of HEC policy work. Our goal in sharing this organisational case study is to prompt other HECs to publish qualitative descriptions of their policy work, in order to generate a body of knowledge that can inform the development of best practices for ethics policy review.

Energy efficiency consultants as change agents? Examining the reasons for EECs’ limited success

International Nuclear Information System (INIS)

Feser, Daniel; Runst, Petrik

2016-01-01

Residential energy consumption has been increasingly singled out by public policies as a key area for potential emission reduction. The public implementation of energy efficiency consultants (EECs) as change agents aims at the diffusion of innovation in residential building efficiency and overcoming information asymmetries in the construction sector. However, the success of these measures has been described as low. We conducted a case study involving 17 in-depth expert interviews to examine the causes of this failure in the case of Germany. In Germany, EECs are organized in a certification scheme which is prerequisite to participate in the publicly funded subsidy system. This analysis has important implications for EECs in general and hence other European countries pursuing such policies. We show that information asymmetries (ex-ante/ex-post) in the ECC market lead to a low willingness to pay. Certification of EECs does not suffice to overcome information asymmetries. We also identify a mismatch between EECs and customer incentives. As top-down policies have failed to facilitate a viable EEC market, we recommend a greater role for private and private-public networks, the cutting of EEC subsidies and a closer alignment between climate policy goals and home owners’ economic efficiency considerations. - Highlights: • Energy Efficiency Consultants have not increased the rate of energetic retrofits of residential buildings in Germany. • We show that information asymmetries (ex-ante/ex-post) in the ECC market led to a low willingness to pay. • Certification of EECs does not suffice to overcome information asymmetries.

Managing Interactions Between Carbon Pricing and Existing Energy Policies. Guidance for Policymakers

Energy Technology Data Exchange (ETDEWEB)

Hood, Christina

2013-07-01

Carbon pricing can be a key policy tool to help countries move their energy sectors onto a cleaner development path. One important issue to consider when introducing carbon pricing is how it will integrate with other energy policies that also reduce greenhouse gas emissions, including policies to support low-carbon technologies (such as renewable energy) and energy efficiency programmes. Poor policy integration can undermine energy security and affordability, and affect the performance of renewable energy policies and energy markets. Climate objectives can also be undermined, through low and uncertain carbon prices and the risk of stop-start policy. Understanding how to manage policy interactions can improve the climate and energy policy package, reducing the trade-offs and advancing the synergies between energy and climate objectives. This will benefit the country in terms of a more effective and lower-cost low-carbon development path, as well as supporting a more energy-secure future.

Tribal Consultation Tracking System

Data.gov (United States)

U.S. Environmental Protection Agency — The consultation-related information the AIEO Consultation Team working with our Tribal Portal contractors has developed a Lotus Notes Database that is capable of...

Addressing Palliative Sedation during Expert Consultation: A Descriptive Analysis of the Practice of Dutch Palliative Care Consultation Teams.

Science.gov (United States)

Hoek, Patrick; Grandjean, Ilse; Verhagen, Constans A H H V M; Jansen-Landheer, Marlies L E A; Schers, Henk J; Galesloot, Cilia; Vissers, Kris C P; Engels, Yvonne; Hasselaar, Jeroen G J

2015-01-01

Since palliative sedation is considered a complex intervention, consultation teams are increasingly established to support general practice. This study aims to offer insight into the frequency and characteristics of expert consultations regarding palliative sedation. We performed a retrospective analysis of a longitudinal database. This database contained all patient-related consultations by Dutch Palliative Care Consultation teams, that were requested between 2004 and 2011. We described the frequency and characteristics of these consultations, in particular of the subgroup of consultations in which palliative sedation was addressed (i.e. PSa consultations). We used multivariate regression analysis to explore consultation characteristics associated with a higher likelihood of PSa consultations. Of the 44,443 initial consultations, most were requested by general practitioners (73%) and most concerned patients with cancer (86%). Palliative sedation was addressed in 18.1% of all consultations. Palliative sedation was relatively more often discussed during consultations for patients with a neurologic disease (OR 1.79; 95% CI: 1.51-2.12) or COPD (OR 1.39; 95% CI: 1.15-1.69) than for patients with cancer. We observed a higher likelihood of PSa consultations if the following topics were also addressed during consultation: dyspnoea (OR 1.30; 95% CI: 1.22-1.40), agitation/delirium (OR 1.57; 95% CI: 1.47-1.68), exhaustion (OR 2.89; 95% CI: 2.61-3.20), euthanasia-related questions (OR 2.65; 95% CI: 2.37-2.96) or existential issues (OR 1.55; 95% CI: 1.31-1.83). In conclusion, PSa consultations accounted for almost one-fifth of all expert consultations and were associated with several case-related characteristics. These characteristics may help clinicians in identifying patients at risk for a more complex disease trajectory at the end of life.

Addressing Palliative Sedation during Expert Consultation: A Descriptive Analysis of the Practice of Dutch Palliative Care Consultation Teams.

Directory of Open Access Journals (Sweden)

Patrick Hoek

Full Text Available Since palliative sedation is considered a complex intervention, consultation teams are increasingly established to support general practice. This study aims to offer insight into the frequency and characteristics of expert consultations regarding palliative sedation.We performed a retrospective analysis of a longitudinal database. This database contained all patient-related consultations by Dutch Palliative Care Consultation teams, that were requested between 2004 and 2011. We described the frequency and characteristics of these consultations, in particular of the subgroup of consultations in which palliative sedation was addressed (i.e. PSa consultations. We used multivariate regression analysis to explore consultation characteristics associated with a higher likelihood of PSa consultations.Of the 44,443 initial consultations, most were requested by general practitioners (73% and most concerned patients with cancer (86%. Palliative sedation was addressed in 18.1% of all consultations. Palliative sedation was relatively more often discussed during consultations for patients with a neurologic disease (OR 1.79; 95% CI: 1.51-2.12 or COPD (OR 1.39; 95% CI: 1.15-1.69 than for patients with cancer. We observed a higher likelihood of PSa consultations if the following topics were also addressed during consultation: dyspnoea (OR 1.30; 95% CI: 1.22-1.40, agitation/delirium (OR 1.57; 95% CI: 1.47-1.68, exhaustion (OR 2.89; 95% CI: 2.61-3.20, euthanasia-related questions (OR 2.65; 95% CI: 2.37-2.96 or existential issues (OR 1.55; 95% CI: 1.31-1.83.In conclusion, PSa consultations accounted for almost one-fifth of all expert consultations and were associated with several case-related characteristics. These characteristics may help clinicians in identifying patients at risk for a more complex disease trajectory at the end of life.

Translating vaccine policy into action: a report from the Bill & Melinda Gates Foundation Consultation on the prevention of maternal and early infant influenza in resource-limited settings.

Science.gov (United States)

Ortiz, Justin R; Neuzil, Kathleen M; Ahonkhai, Vincent I; Gellin, Bruce G; Salisbury, David M; Read, Jennifer S; Adegbola, Richard A; Abramson, Jon S

2012-11-26

Immunization of pregnant women against influenza is a promising strategy to protect the mother, fetus, and young infant from influenza-related diseases. The burden of influenza during pregnancy, the vaccine immunogenicity during this period, and the robust influenza vaccine safety database underpin recommendations that all pregnant women receive the vaccine to decrease complications of influenza disease during their pregnancies. Recent data also support maternal immunization for the additional purpose of preventing disease in the infant during the first six months of life. In April 2012, the WHO Strategic Advisory Group of Experts (SAGE) on Immunization recommended revisions to the WHO position paper on influenza vaccines. For the first time, SAGE recommended pregnant women should be made the highest priority for inactivated seasonal influenza vaccination. However, the variable maternal influenza vaccination coverage in countries with pre-existing maternal influenza vaccine recommendations underscores the need to understand and to address the discrepancy between recommendations and implementation success. We present the outcome of a multi-stakeholder expert consultation on inactivated influenza vaccination in pregnancy. The creation and implementation of vaccine policies and regulations require substantial resources and capacity. As with all public health interventions, the existence of perceived and real risks of vaccination will necessitate effective and transparent risk communication. Potential risk allocation and sharing mechanisms should be addressed by governments, vaccine manufacturers, and other stakeholders. In resource-limited settings, vaccine-related issues concerning supply, formulation, regulation, evidence evaluation, distribution, cost-utility, and post-marketing safety surveillance need to be addressed. Lessons can be learned from the Maternal and Neonatal Tetanus Elimination Initiative as well as efforts to increase vaccine coverage among pregnant

The art of consultation

Directory of Open Access Journals (Sweden)

Kulwant S Bhangoo

2014-01-01

Full Text Available Sophisticated marketing and practice-enhancing strategies can help bring patients to a surgeon′s practice. However, the ability to retain these patients and also convert the consultations into surgical procedures depends on the art of consultation. This very important aspect of clinical practice is seldom taught in the medical school. In this paper, the author discusses many aspects of the art of consultation, which he has learned in his practice over the years.

Ethics in Management Consulting

OpenAIRE

Carlo Vallini

2007-01-01

Ethics is a relevant value in business and management consulting. The presence of recognized ethics tends to reduce the need for informative or legal-contractual precautions in the formalization of relationships, for both of the parts involved in a negotiation. Management Consulting on ethics will develop more and more. Law will consider more and more ethics in business and management consulting. The ethics of corporations influences their workers and behaviour with the customers. It is an e...

Why do people consult the doctor?

Science.gov (United States)

Campbell, S M; Roland, M O

1996-02-01

Symptoms are an everyday part of most peoples' lives and many people with illness do not consult their doctor. The decision to consult is not based simply on the presence or absence of medical problems. Rather it is based on a complex mix of social and psychological factors. This literature review seeks to explore some of the pathways to care and those factors associated with low and high rates of consultation. The paper examines the impact of socioeconomic and demographic factors on consultation rates and, using a revised version of the Health Belief Model, it highlights the psychological factors which influence decisions to seek medical care. Barriers which can inhibit consultation are discussed, as the decision to seek care will only result in a consultation if there is adequate access to care. Whilst poor health status and social disadvantage increase both "objective" medical need and in turn, consultation rates, a range of other social and psychological factors have been shown to influence consulting behaviour.

Implementation of a nationwide health economic consultation service to assist substance use researchers: Lessons learned.

Science.gov (United States)

Murphy, Sean M; Leff, Jared A; Linas, Benjamin P; Morgan, Jake R; McCollister, Kathryn; Schackman, Bruce R

2018-03-20

Health economic evaluation findings assist stakeholders in improving the quality, availability, scalability, and sustainability of evidence-based services, and in maximizing the efficiency of service delivery. The Center for Health Economics of Treatment Interventions for Substance Use Disorders, HCV, and HIV (CHERISH) is a NIDA-funded multi-institutional center of excellence whose mission is to develop and disseminate health-economic research on healthcare utilization, health outcomes, and health-related behaviors that informs substance use disorder treatment policy, and HCV and HIV care of people who use substances. We designed a consultation service that is free to researchers whose work aligns with CHERISH's mission. The service includes up to six hours of consulting time. After prospective consultees submit their request online, they receive a screening call from the consultation service director, who connects them with a consultant with relevant expertise. Consultees and consultants complete web-based evaluations following the consultation; consultees also complete a six-month follow-up. We report on the status of the service from its inception in July 2015 through June 2017. We have received 28 consultation requests (54% Early Stage Investigators, 57% MD or equivalent, 28% PhD, 61% women) on projects typically related to planning a study or grant application (93%); 71% were HIV/AIDS-related. Leading topics included cost-effectiveness (43%), statistical-analysis/econometrics (36%), cost (32%), cost-benefit (21%), and quality-of-life (18%). All consultees were satisfied with their overall experience, and felt that consultation expectations and objectives were clearly defined and the consultant's expertise was matched appropriately with their needs. Results were similar for consultants, who spent a median of 3 hours on consultations. There is a need for health-economic methodological guidance among substance use, HCV, and HIV researchers. Lessons learned

Vickers Attenuator. Volume 3C(VA) - Technical appraisal. Consultants' 1983 report

Energy Technology Data Exchange (ETDEWEB)

1986-01-01

A report is given by a team of Consultants on the estimated cost of converting wave energy to electrical energy by a 2 GW array of Vickers Attenuator wave energy devices and delivering this to a sub-station on the west coast of Skye. Comparisons of the estimates made by the team developing the concept are presented and discrepancies discussed. A detailed engineering assessment is given.

Integrating Environmental Sustainability Considerations into Food and Nutrition Policies: Insights from Australia's National Food Plan.

Science.gov (United States)

Ridgway, Ella Megan; Lawrence, Mark Andrew; Woods, Julie

2015-01-01

The environmental sustainability (ES) of food systems is a critical challenge for policy makers. This is a highly contested policy area with differing views among stakeholders. The aim of the study was to develop a better understanding of how ES considerations are addressed in Australian food and nutrition policies and the way that consultation processes affect final policy outcomes. A mixed-methods study design combined a detailed chronology of key policy developments (2009-2015), a content analysis of written submissions obtained during the NFP's consultation period (2011-2013) and a frame analysis of the sustainability perspectives - efficiency, demand restraint, and system transformation - in the NFP's Issues, Green, and White Papers. There were 555 written submissions responding to two consultation papers. Stakeholders represented all sectors of Australia's food system including government, non-government organizations, the food supply chain, research and academic institutions, and members of the general public. Around 74% of submissions referred to ES considerations and ~65% supported their inclusion into the final policy. Efficiency frames were most dominant; emphasizing a production-oriented approach that regards the environment as a natural resource base for food production but overlooks consumption and equity concerns. Despite strong support for the inclusion of ES considerations in the NFP, the influence of Australia's socio-political context, powerful, industry-dominated stakeholders, and a reliance on traditional production-oriented perspectives delivered a business-as-usual approach to food policy making. It has since been replaced by an agricultural strategy that provides only cursory attention to ES. Our findings indicate that Australia's political environment is not sufficiently mature for ES considerations to be integrated into food and nutrition policies. We propose reforms to the current consultation process in Australia to better support this

Psychiatric Consultation in Community Clinics: A Decade of Experience in the Community Clinics in Jerusalem.

Science.gov (United States)

Avny, Ohad; Teitelbaum, Tatiana; Simon, Moshe; Michnick, Tatiana; Siman-Tov, Maya

2016-01-01

A consultation model between primary care physicians and psychiatrists that has been in operation for 12 years in the Jerusalem district of the Clalit Health Services in Israel is evaluated. In this model psychiatrists provide consultations twice a month at the primary care clinic. All patients are referred by their family physicians. Communication between the psychiatric consultant and the referring physician is carried out by telephone, correspondence and staff meetings. Evaluation of the psychiatric care consultation model in which a psychiatrist consults at the primary care clinic. A questionnaire-based survey distributed to 17 primary care physicians in primary care clinics in Jerusalem in which a psychiatric consultant is present. Almost all of the doctors (93%) responded that the consultation model was superior to the existing model of referral to a secondary psychiatric clinic alone and reduced the workload in caring for the referred patients. The quality of psychiatric care was correlated with the depression prevalence among patients referred for consultation at their clinic (r=0.530, p=0.035). In addition, correlation was demonstrated between primary care physicians impression of alleviation of care of patients and their impression of extent of the patients' cooperation with the consulting psychiatrist (r=0.679, p = 0.015) Conclusions: Very limited conclusions may be drawn from this questionnaire distributed to primary care physicians who were asked to assess psychiatric consultation in their clinic. Our conclusion could be influenced by the design and the actual distribution of the questionnaires by the consulting psychiatrist. Nevertheless answers to the questionnaire might imply that the consultation model of care between a psychiatric consultant and the primary care physician, where the patient's primary care physician takes a leading role in his psychiatric care, is perceived by family physicians as a good alternative to referral to a psychiatric

Global Consultation Processes: Lessons Learned from Refugee Teacher Consultation Research in Malaysia

Science.gov (United States)

O'Neal, Colleen R.; Gosnell, Nicole M.; Ng, Wai Sheng; Clement, Jennifer; Ong, Edward

2018-01-01

The process of global consultation has received little attention despite its potential for promoting international mutual understanding with marginalized communities. This article details theory, entry, implementation, and evaluation processes for global consultation research, including lessons learned from our refugee teacher intervention. The…

Factors influencing the current practice of self-medication consultations in Eastern Indonesian community pharmacies: a qualitative study.

Science.gov (United States)

Brata, Cecilia; Fisher, Colleen; Marjadi, Brahmaputra; Schneider, Carl R; Clifford, Rhonda M

2016-05-13

Research has shown that the current practice of pharmacy staff when providing self-medication consultations in Indonesia is suboptimal. To improve the performance of pharmacy staff when providing self-medication consultations in community pharmacies, the factors that influence current practice need to be understood. The aim of this study is to identify the factors that influence current practice of pharmacy staff when handling self-medication consultations in Eastern Indonesian community pharmacies. Fifteen in-depth interviews were conducted with pharmacists, pharmacy technicians, pharmacy owners, and counter attendants. Thematic analysis was used to generate findings. The current practice of pharmacy staff when handling self-medication consultations is directly influenced by the professionalism of pharmacy staff and patient responses to the consultations. These factors are in turn affected by the organisational context of the pharmacy and the external pharmacy environment. The organisational context of the pharmacy includes staffing, staff affordability, and the availability of time and facilities in which to provide consultations. The external pharmacy environment includes the number of trained pharmacy staff in the research setting, the relevance of pharmacy education to the needs of pharmacy practice, the support offered by the Indonesian Pharmacists Association, a competitive business environment, and the policy environment. Complex and inter-related factors influence the current practice of pharmacy staff when providing self-medication consultations in community pharmacies in this research setting. Multiple strategies will be required to improve consultation practices.

Consultant's Playbook: A Survey of Pharmacy Consultant Experiences Among Hospitals In the University HealthSystem Consortium.

Science.gov (United States)

Hicks, Dave; McCarthy, Bryan; Fanikos, John; Emamifar, Amir; Nedved, Andrea; Thompson, Bruce; Bender, Fred; McMahon, Patrick

2013-10-01

Our team surveyed a group of pharmacy directors to learn about their experiences with pharmacy consultants so that the directors might be able to use their consulting resources in a more effective manner. In May 2012, the University HealthSystem Consortium (UHC) Pharmacy Council Financial Performance Committee developed an electronic survey that collectively measured the characteristics, goals, and methodology of historical pharmacy consultant engagements and level of satisfaction. After e-mailing the initial electronic survey, we conducted follow-up telephone interviews with respondents from July through November 2012. These interviews were designed to include questions about expected outcomes, recommendations for evaluation processes, timelines for implementing the recommendations, consultants' expenses, and insights gained. A total of 23 pharmacy directors responded to the initial electronic survey; their organizations had engaged at least one consultant within the previous 5 years. Data were collected for 28 consultant engagements. Subsequent telephone interviews were conducted with 20 of the 23 pharmacy directors (87%) who completed the initial electronic survey, accounting for 25 of the 28 consultant engagements (89%). Cost reduction along with revenue enhancement was most often the focus of these engagements. These engagements were also mainly within the scope of an organization-wide effort initiated by the executive board or executive team. Consultant experiences varied greatly in terms of (1) the degree to which assistance was provided to the organization, (2) benchmarking methodologies and resources, and (3) timelines for implementing the consultants' recommendations. In general, most respondents rated their consultant experience as positive and were able to provide "pearls of wisdom" or lessons learned.

Ethics consultation on demand: concepts, practical experiences and a case study.

Science.gov (United States)

Reiter-Theil, S

2000-06-01

Despite the increasing interest in clinical ethics, ethics consultation as a professional service is still rare in Europe. In this paper I refer to examples in the United States. In Germany, university hospitals and medical faculties are still hesitant about establishing yet another "committee". One of the reasons for this hesitation lies in the ignorance that exists here about how to provide medical ethics services; another reason is that medical ethics itself is not yet institutionalised at many German universities. The most important obstacle, however, may be that medical ethics has not yet demonstrated its relevance to the needs of those caring for patients. The Centre for Ethics and Law, Freiburg, has therefore taken a different approach from that offered elsewhere: clinical ethics consultation is offered on demand, the consultation being available to clinician(s) in different forms. This paper describes our experiences with this approach; practical issues are illustrated by a case study.

Guidelines for Education and Training at the Doctoral and Postdoctoral Levels in Consulting Psychology/Organizational Consulting Psychology

Science.gov (United States)

American Psychologist, 2007

2007-01-01

The purpose of these "Guidelines for Education and Training at the Doctoral and Postdoctoral Levels in Consulting Psychology/Organizational Consulting Psychology" is to provide a common framework for use in the development, evaluation, and review of education and training in consulting psychology/organizational consulting psychology (CP/OCP). The…

77 FR 34073 - Value Engineering

Science.gov (United States)

2012-06-08

... OFFICE OF MANAGEMENT AND BUDGET Office of Federal Procurement Policy Value Engineering AGENCY... Office of Management and Budget Circular No. A-131, ``Value Engineering''. SUMMARY: The Office of Federal...- 131, Value Engineering, to update and reinforce policies associated with the consideration and use of...

78 FR 78399 - Value Engineering

Science.gov (United States)

2013-12-26

... OFFICE OF MANAGEMENT AND BUDGET Office of Federal Procurement Policy Value Engineering AGENCY... to Office of Management and Budget Circular No. A-131, ``Value Engineering''. SUMMARY: The Office of... revisions to OMB Circular A-131, Value Engineering, to update and reinforce policies associated with the...

The existence of policies, practices and perceptions regarding ...

African Journals Online (AJOL)

parent or sibling and only if supervised by an accompanying adult. ... Objective. To identify policies, describe current practices and determine the perceptions of healthcare workers to child visitors. Methods. .... were developed within the hospital and .... the category of the patient to be visited, his/her relationship to the visitor ...

Gender and Race in the Timing of Requests for Ethics Consultations: A Single-Center Study.

Science.gov (United States)

Spielman, Bethany; Gorka, Christine; Miller, Keith; Pointer, Carolyn A; Hinze, Barbara

2016-01-01

Clinical ethics consultants are expected to "reduce disparities, discrimination, and inequities when providing consultations," but few studies about inequities in ethics consultation exist.1 The objectives of this study were (1) to determine if there were racial or gender differences in the timing of requests for ethics consultations related to limiting treatment, and (2) if such differences were found, to identify factors associated with that difference and the role, if any, of ethics consultants in mitigating them. The study was a mixed methods retrospective study of consultation summaries and hospital and ethics center data on 56 age-and gender-matched Caucasian and African American Medicare patients who received ethics consultations related to issues around limiting medical treatment in the period 2011 to 2014. The average age of patients was 70.9. Consultation requests for females were made significantly earlier in their stays in the hospital (6.57 days) than were consultation requests made for males (16.07 days). For African American patients, the differences in admission-to-request intervals for female patients (5.93 days) and male patients (18.64 days) were greater than for Caucasian male and female patients. Differences in the timing of a consultation were not significantly correlated with the presence of an advance directive, the specialty of the attending physician, or the reasons for the consult request. Ethics consultants may have mitigated problems that developed during the lag in request times for African American males by spending more time, on average, on those consultations (316 minutes), especially more time, on average, than on consultations with Caucasian females (195 minutes). Most consultations (40 of 56) did result in movement toward limiting treatment, but no statistically significant differences were found among the groups studied in the movement toward limiting treatment. The average number of days from consult to discharge or death were

Quality Management in Project Management Consulting. A Case Study in an International Consulting Company

OpenAIRE

Ceptureanu, Eduard-Gabriel; Ceptureanu, Sebastian-Ion; Luchian, Cristian-Eugen; Luchian, Iuliana

2017-01-01

The present paper addresses quality management from the specific perspective of project management consulting service providers, in the framework of large infrastructure projects. Because of their supposed superiority in knowledge and experience, project management consultants have an ultimate responsibility for the proper implementing of the project. Therefore, quality management in consulting organizations should focus on critical success factors. As there is no consensus yet regarding the ...

Psychiatric Consultation at Your Fingertips: Descriptive Analysis of Electronic Consultation From Primary Care to Psychiatry.

Science.gov (United States)

Lowenstein, Margaret; Bamgbose, Olusinmi; Gleason, Nathaniel; Feldman, Mitchell D

2017-08-04

Mental health problems are commonly encountered in primary care, with primary care providers (PCPs) experiencing challenges referring patients to specialty mental health care. Electronic consultation (eConsult) is one model that has been shown to improve timely access to subspecialty care in a number of medical subspecialties. eConsults generally involve a PCP-initiated referral for specialty consultation for a clinical question that is outside their expertise but may not require an in-person evaluation. Our aim was to describe the implementation of eConsults for psychiatry in a large academic health system. We performed a content analysis of the first 50 eConsults to psychiatry after program implementation. For each question and response, we coded consults as pertaining to diagnosis and/or management as well as categories of medication choice, drug side effects or interactions, and queries about referrals and navigating the health care system. We also performed a chart review to evaluate the timeliness of psychiatrist responses and PCP implementation of recommendations. Depression was the most common consult template selected by PCPs (20/50, 40%), followed by the generic template (12/50, 24%) and anxiety (8/50, 16%). Most questions (49/50, 98%) pertained primarily to management, particularly for medications. Psychiatrists commented on both diagnosis (28/50, 56%) and management (50/50, 100%), responded in an average of 1.4 days, and recommended in-person consultation for 26% (13/50) of patients. PCPs implemented psychiatrist recommendations 76% (38/50) of the time. For the majority of patients, psychiatrists provided strategies for ongoing management in primary care without an in-person evaluation, and PCPs implemented most psychiatrist recommendations. eConsults show promise as one means of supporting PCPs to deliver mental health care to patients with common psychiatric disorders. ©Margaret Lowenstein, Olusinmi Bamgbose, Nathaniel Gleason, Mitchell D Feldman

Lancaster Flexible Bag. Volume 3B - Technical appraisal. Consultants' 1983 report

Energy Technology Data Exchange (ETDEWEB)

1986-01-01

A report is given by a team of Consultants on the estimated cost of converting wave energy to electrical energy by a 2 GW array of Lancaster Flexible Bag Devices and transmitting this to a sub-station on the west coast of Skye. Comparisons with the estimates made by the team developing the concept are made and discussed when not in agreement. A detailed engineering assessment is presented.

Engineers win award for Swiss tunnel

CERN Multimedia

2003-01-01

A Derby engineering consultancy has won the Tunnelling Industry Award 2003 for Excellence in Tunnel Design, offered by the British Tunnelling Society, for its work on the LHC in Geneva, Switzerland (1/2 page).

The ALFA (Activity Log Files Aggregation) Toolkit: A Method for Precise Observation of the Consultation

OpenAIRE

de Lusignan, Simon; Kumarapeli, Pushpa; Chan, Tom; Pflug, Bernhard; van Vlymen, Jeremy; Jones, Beryl; Freeman, George K

2008-01-01

Background There is a lack of tools to evaluate and compare Electronic patient record (EPR) systems to inform a rational choice or development agenda. Objective To develop a tool kit to measure the impact of different EPR system features on the consultation. Methods We first developed a specification to overcome the limitations of existing methods. We divided this into work packages: (1) developing a method to display multichannel video of the consultation; (2) code and measure activities, in...

The duty to consult and legal obligations

Energy Technology Data Exchange (ETDEWEB)

Carpenter, A.W. [Lawson Lundell Lawson and MacIntosh, Calgary, AB (Canada)

2002-07-01

Aboriginal law in Canada has been evolving and industry is beginning to engage in the change. This presentation describes the legal aspects regarding Aboriginal rights and the duty to consult First Nations regarding treaty rights. The implications for First Nations and industry are described. Aboriginal peoples of Canada include the Indian, Inuit and Metis populations. Aboriginal titles exist, therefore they are constitutionally protected. The paper describes recent decisions regarding the Mikisew Cree First Nation versus Canada, the Taku River Tlinget versus Ringstad, and the Haida Nation versus British Columbia and Weyerhaeuser.

The Import-Substitution Adaptation of Power Engineering Programs

Directory of Open Access Journals (Sweden)

Aleksandr N. Kuzminov

2017-03-01

Full Text Available The realization problem of the import substitution policy in the context of existing programs for the individual branches development is considered in the paper on the example of power engineering. There is a contradiction to the objective of programs reflected in the process of alignment, which consists in stabilizing on the one hand and on the development of innovative on the other hand. In addition, the analysis of the implementation of power engineering of the Russian Federation for 2010-2020 and up to 2030 revealed significant shortcomings and deficiencies that reinforce the negative trends of this pairing. Classification of problems and purpose allowed choosing the most significant conceptual directions, methodologically based on the ideas of self-organization and balance, which can get instrumentality software by adapting programs for the development of power engineering in the system of the European model of Industry 4.0. As a fundamental position addresses the need for such a project, which would ensure the greatest impact with limited resources, including public funding, which lags far behind foreign. It is proposed to transform the efforts to implement the existing strategies of industry development in view of the policy of import substitution based on the implementation of the program of production of a balanced range of innovative products and providing replacement of imported equipment and the formation of the technological basis for the development of the industry

Sites of institutional racism in public health policy making in New Zealand.

Science.gov (United States)

Came, Heather

2014-04-01

Although New Zealanders have historically prided ourselves on being a country where everyone has a 'fair go', the systemic and longstanding existence of health inequities between Māori and non-Māori suggests something isn't working. This paper informed by critical race theory, asks the reader to consider the counter narrative viewpoints of Māori health leaders; that suggest institutional racism has permeated public health policy making in New Zealand and is a contributor to health inequities alongside colonisation and uneven access to the determinants of health. Using a mixed methods approach and critical anti-racism scholarship this paper identifies five specific sites of institutional racism. These sites are: majoritarian decision making, the misuse of evidence, deficiencies in both cultural competencies and consultation processes and the impact of Crown filters. These findings suggest the failure of quality assurance systems, existing anti-racism initiatives and health sector leadership to detect and eliminate racism. The author calls for institutional racism to be urgently addressed within New Zealand and this paper serves as a reminder to policy makers operating within other colonial contexts to be vigilant for such racism. Copyright © 2014 Elsevier Ltd. All rights reserved.

The establishment of research ethics consultation services (RECS): an emerging research resource.

Science.gov (United States)

McCormick, Jennifer B; Sharp, Richard R; Ottenberg, Abigale L; Reider, Carson R; Taylor, Holly A; Wilfond, Benjamin S

2013-02-01

Emphasis on translational research to facilitate progression from the laboratory into the community also creates a dynamic in which ethics and social policy questions and solutions are ever pressing. In response, academic institutions are creating Research Ethics Consultation Services (RECS). All Clinical Translational Science Award institutions were surveyed in early 2010 to determine which institutions have a RECS in operation and what is their composition and function. Of the 46 institutions surveyed, 33 (70%) have a RECS. Only 15 RECS have received any consult requests in the last year. Issues that are common among these relatively nascent services include relationships with institutional oversight committees, balancing requestor concerns about confidentiality with research integrity and human subjects protection priorities, tracking consult data and outcomes, and developing systems for internal evaluation. There is variability in how these issues are approached. It will be important to be attentive to the institutional context to develop an appropriate approach. Further data about the issues raised by requestors and the recommendations provided are necessary to build a community of scholars who can navigate and resolve ethical issues encountered along the translational research pathway. © 2012 Wiley Periodicals, Inc.

Product Recall Policies and Their Improvement in Korea

Directory of Open Access Journals (Sweden)

Huh Kyungok

2016-12-01

Full Text Available This article aims to investigate recall policies for product safety in Korea and make suggestions for future improvements. Problematic issues in current recall policies are reviewed and analyzed. Based on survey results and previous studies, this article discusses the consumer perception of a recall. Consumers tend to regard a recall as a signal of poor quality. Furthermore, regulatory differences and weak penalties remain as obstacles to improving the recall system. Suggestions for the betterment of recall policies are derived from consultations with an expert panel and the application of other appropriate methods. At first, despite an increasing number of recall cases in Korea, it turns out that consumers are not highly sensitive to recalls, although their perceptions are mostly negative. Secondly, regulatory inconsistencies and difference problems are primarily attributable to the existence of many separate rules and regulations by product category. Thirdly, the information concerning recalls is limited, which creates an inefficient environment in which manufacturers are reluctant to voluntarily recall a defective product and consumer participation rates are too low. Therefore, the government should induce consumers to have more positive perceptions of recalls whilst concurrently reinforcing the related rules and regulations in accordance with international standards.

Public interest in the private sphere: how far into the home can local policy-making reach?

Energy Technology Data Exchange (ETDEWEB)

Palm, Jenny (Linkoeping Univ., Dept. of Technology and Social Change, Linkoeping (Sweden))

2009-07-01

Environmental problems in the energy system largely originate from everyday activities and choices. The home is a 'node' of daily life and is often seen as our private sphere. However, the privacy of the home can be contested in relation to local policies in general and energy and environmental policies in particular. This paper discusses the private/public divide in energy policies and how this divide appears to Swedish municipal energy consultants. By analyzing the actions of several energy consultants and their efforts to influence households as well as how households perceive this guidance, we can gauge how far policy instruments have penetrated the private sphere. Municipal energy consultants are careful in providing advice to the households: they preserve a rather large 'no-trespassing' area to avoid interfering in peoples' private sphere. Households can accept information, even individually tailored information, but will not accept requests to do certain things. Authorities can inform but not tell people how to act: the decision is still the householders'. Looking at exactly how both households and consultants reason about energy efficiency and the public/private divide, we can discern tendencies for what were earlier considered private concerns to be increasingly perceived as common or public concerns. Energy consultants are trying to find ways to influence family lifestyle while householders are requesting individual inspections and want the consultants to keep individual records of family energy use, not regarding this information as too private. Swedish regulations, however, are hampering this development and delaying the urgent need for changes in both technologies used and energy-related behaviours.

Consultant breast radiographers: Where are we now?

International Nuclear Information System (INIS)

Rees, Zebby

2014-01-01

Introduction: The aim of this study is to: • Evaluate the current role of the consultant breast radiographer. • Compare current practice with the four key components for consultant practice. • Gauge the support of radiologist colleagues. • Determine the other professional commitments involved with the role. This study could be the precursor for a macro study of all consultant radiographer practice in other specialities. Methodology: Methodology used was a comparative ethnographic study. Questionnaires to the 24 consultant breast radiographers currently in post, and consultant breast radiologists, who work with them, were conducted. Data collection was a qualitative thematic approach. Conclusion: Consultant breast radiographers provide high quality care to patients through excellent clinical practice, leadership and good communication. However, this study shows hospital Trusts emphasis for non medical consultants is for clinical practice first. Some radiologists are still a barrier to progression for consultant breast radiographers, and radiologists have a big influence in recruitment decisions. Consultant breast radiographer posts are well established, their numbers are increasing through recognition of the role and of their abilities and performance. Consultant breast radiographers state that becoming a consultant is the major achievement of their career, proving the Society of Radiographers' vision of the four-tier career structure has been well received by the radiography profession

Can't see the woods for the trees: exploring the range and connection of tobacco industry argumentation in the 2012 UK standardised packaging consultation.

Science.gov (United States)

Lie, Jessamina Lih Yan; Fooks, Gary; de Vries, Nanne K; Heijndijk, Suzanne M; Willemsen, Marc C

2017-07-25

Transnational tobacco company (TTC) submissions to the 2012 UK standardised packaging consultation are studied to examine TTC argumentation in the context of Better Regulation practices. A content analysis was conducted of Philip Morris International and British American Tobacco submissions to the 2012 UK consultation. Industry arguments concerning expected costs and (contested) benefits of the policy were categorised into themes and frames. The inter-relationship between frames through linked arguments was mapped to analyse central arguments using an argumentation network. 173 arguments were identified. Arguments fell into one of five frames: ineffectiveness, negative economic consequences, harm to public health, increased crime or legal ramifications. Arguments highlighted high costs to a wide range of groups, including government, general public and other businesses. Arguments also questioned the public health benefits of standardised packaging and highlighted the potential benefits to undeserving groups. An increase in illicit trade was the most central argument and linked to the greatest variety of arguments. In policy-making systems characterised by mandatory impact assessments and public consultations, the wide range of cost (and contested benefits) based arguments highlights the risk of TTCs overloading policy actors and causing delays in policy adoption. Illicit trade related arguments are central to providing a rationale for these arguments, which include the claim that standardised packaging will increase health risks. The strategic importance of illicit trade arguments to industry argumentation in public consultations underlines the risks of relying on industry data relating to the scale of the illicit trade. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Development of a National Aboriginal and Torres Strait Islander Cancer Framework: A Shared Process to Guide Effective Policy and Practice

Directory of Open Access Journals (Sweden)

Jenny Brands

2018-05-01

Full Text Available Indigenous Australians experience a substantially higher cancer mortality rate than non-Indigenous Australians. While cancer outcomes are improving for non-Indigenous Australians, they are worsening for Indigenous Australians. Reducing this disparity requires evidence-based and culturally-appropriate guidance. The purpose of this paper is to describe an initiative by Cancer Australia and Menzies School of Health Research (Menzies to develop Australia’s first National Aboriginal and Torres Strait Islander Cancer Framework using a process of co-design with relevant stakeholders. The initiative was guided by three core principles: achieving policy-relevant evidence-based outcomes; engaging and maintaining trust with Indigenous Australians at every phase; and employing best-practice and appropriate research methods. Four components of research comprised the Framework development: evidence review; multifaceted stakeholder consultation and input; triangulation of findings; and direct stakeholder input in drafting and refining the Framework. The evidence review confirmed the increasing burden of cancer on Indigenous Australians, while stakeholder consultations facilitated comprehensive input from those with lived experience. The consultations revealed issues not identified in existing literature, and gave different emphases of priority, thus reinforcing the value of including stakeholder perspectives. This paper focuses primarily on documenting the methods used; findings are presented only in order to illustrate the results of the process. The published Framework is available at www.canceraustralia.gov.au; further description and analyses of findings from the consultations will be published elsewhere. The logistics inherent in large-scale consultation are considerable. However, the quality of data and the foundation for sustained partnership with stakeholders and knowledge translation vastly outweighed the challenges. The process of wide

resolution of the first national conference of engin·eers and architects

African Journals Online (AJOL)

including Codes or Practices for the construction trades; .... The Ethiopian Cement Corporation. The Research Department ... Authority. SAUTJ - Consulting Engineers (Rome). The 1971 graduating class of Electrical and Civil. Engineers at the ...

Consultation on the implementation of Engineering Recommendation ER G77. Volume 1: Summary report

Energy Technology Data Exchange (ETDEWEB)

Thornycroft, J; Cotterell, M; Collinson, A

2002-07-01

The paper is a summary report on consultation inside the Electricity and PV Industry leading to publication of ER G77/1: 'Connection of Single-Phase Inverter Connected Photovoltaic (PV) Generating Equipment of up to 5kVA in Parallel with a Distribution Network Operators (DNOs) Distribution System'. Technical work on ETSU/S/P2/0040 is also reported. The project is a continuation of ETSU/S/P2/00215 which set-up the 'ER G77 Working Group' in order to (i) continue consultation with DNOs and the PV industry; (ii) monitor and make use of experience resulting from implementation of ER G77; (iii) act as a forum for discussion of improvements to ER G77; (iv) assist projects like the DTI supported Domestic Field Trial; (v) provide a link to BSI Standards Work in the field; (vi) provide a link with sub-projects investigating questions related to ER G77. Overall, the goal is to develop a final version of ER G77/1 acceptable to both the electricity supply industry and the PV industry. A revised version of ER G/771 is included.

Financial and Temporal Advantages of Virtual Consultation in Veterans Requiring Specialty Care.

Science.gov (United States)

Abbott, Daniel E; Macke, Ryan A; Kurtz, Jodi; Safdar, Nasia; Greenberg, Caprice C; Weber, Sharon M; Voils, Corrine I; Fisher, Deborah A; Maloney, James D

2018-01-01

Access to specialty health care in the Veterans Affairs (VA) system continues to be problematic. Given the potential temporal and fiscal benefits of telehealth, the Madison VA developed a virtual consultation (VC) mechanism to expedite diagnostic and therapeutic interventions for Veterans with incidentally discovered pulmonary nodules. Materials and. VC, a remote encounter between referring provider and thoracic surgeon for incidentally discovered pulmonary nodules, was implemented at the Madison VA between 2009 and 2011. Time from request to completion of consultation, hospital cost, and travel costs were determined for 157 veterans. These endpoints were then compared with in-person consultations over a concurrent 6-mo period. For the entire study cohort, the mean time to completion of VC was 3.2 d (SD ± 4.4 d). For the 6-mo period of first VC availability, the mean time to VC completion versus in-person consultation was 2.8 d (SD ± 2.8 d) and 20.5 d (SD ± 15.6 d), respectively (p < 0.05). Following initial VC, 84 (53%) veterans were scheduled for virtual follow-up alone; no veteran required an additional office visit before further diagnostic or therapeutic intervention. VA hospital cost was $228 per in-person consultation versus $120 per episode for VC - a 47.4% decrease. The average distance form veteran home to center was 86 miles, with an average travel reimbursement of $112 per in-person consultation, versus no travel cost associated with VC. VC for incidentally discovered pulmonary nodules significantly decreases time to consultation completion, hospital cost, and veteran travel cost. These data suggest that a significant opportunity exists for expansion of telehealth into additional practice settings within the VA system. © Association of Military Surgeons of the United States 2017. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Lay Consultations in Heart Failure Symptom Evaluation.

Science.gov (United States)

Reeder, Katherine M; Sims, Jessica L; Ercole, Patrick M; Shetty, Shivan S; Wallendorf, Michael

2017-01-01

Lay consultations can facilitate or impede healthcare. However, little is known about how lay consultations for symptom evaluation affect treatment decision-making. The purpose of this study was to explore the role of lay consultations in symptom evaluation prior to hospitalization among patients with heart failure. Semi-structured interviews were conducted with 60 patients hospitalized for acute decompensated heart failure. Chi-square and Fisher's exact tests, along with logistic regression were used to characterize lay consultations in this sample. A large proportion of patients engaged in lay consultations for symptom evaluation and decision-making before hospitalization. Lay consultants provided attributions and advice and helped make the decision to seek medical care. Men consulted more often with their spouse than women, while women more often consulted with adult children. Findings have implications for optimizing heart failure self-management interventions, improving outcomes, and reducing hospital readmissions.

Reflections on New Search Engine 新型搜索引擎畅想

OpenAIRE

Huang, Jiannian

2007-01-01

English abstract]Quick increment of need on internet information resources leads to a rush of search engines. This article introduces some new type of search engines which is appearing and will appear. These search engines includes as follows: grey document search engine, invisible web search engine, knowledge discovery search engine, clustering meta search engine, academic clustering search engine, conception comparison and conception analogy search engine, consultation search engine, teachi...

Exploratory Analysis of the Effect of Consultants on the Use of World Wide Web Sites in SMEs

Directory of Open Access Journals (Sweden)

Sigi Goode

2002-11-01

Full Text Available There is little published research on the role of consultants in technology adoption. Given the increasing popularity of the World Wide Web in commercial environments and the number of consultants now offering web development services, some analysis into the effects of their engagement would be of benefit. In an extension of an ongoing study, an existing sample of 113 World Wide Web adopters was used to examine the nature of World Wide Web site use with respect to consultant and Internet Service Provider (ISP engagement. Analysis was also conducted into the use of consultants and ISPs as developers and maintainers of these sites. This preliminary research finds a number of interesting outcomes. No significant relationship is found between consultant or ISP engagement and World Wide Web site use, regardless of whether the consultant was engaged as site developer or site maintainer. The study raises a number of additional findings that are of interest but are not directly related to this study. These findings merit further research.

Engineering co-operation

Energy Technology Data Exchange (ETDEWEB)

Hryniszak, W

1981-06-01

A purposeful employment policy for human energy is basic to solving the energy dilemma, but a lack of understanding about human behavior has allowed man's exploitive characteristics to dominate during the Inductrial Revolution. England is dependent on trade to survive, but the importance of size in world competition is seen in the trend toward multinational and partnership enterprises. Reflecting this increasing competition, the engineering industries see a need for government policies that acknowledge the importance of technology and the effects of those policies on productivity. Engineering progress requires the creativity of optimistic idealism and the realism of implementing new ideas. The training and nurturing of human resources should begin by broadening the education of engineers to emphasize the concepts of quality and cooperation between government and industry. Engineers and scientists, who work within society, need to understand national demands and to operate in accordance with the highest moral standards. (DCK)

The impact of the improvement in internal medicine consultation process on ED length of stay.

Science.gov (United States)

Shin, Sangheon; Lee, Soo Hoon; Kim, Dong Hoon; Kim, Seong Chun; Kim, Tae Yun; Kang, Changwoo; Jeong, Jin Hee; Lim, Daesung; Park, Yong Joo; Lee, Sang Bong

2018-04-01

Although consultations are essential for delivering safe, high-quality care to patients in emergency departments, they contribute to emergency department patient flow problems and overcrowding which is associated with several adverse outcomes, such as increases in patient mortality and poor quality care. This study aimed to investigate how time flow metrics including emergency department length of stay is influenced by changes to the internal medicine consultation policy. This study is a pre- and post-controlled interventional study. We attempted to improve the internal medicine consultation process to be more concise. After the intervention, only attending emergency physicians consult internal medicine chief residents, clinical fellows, or junior staff of each internal medicine subspecialty who were on duty when patients required special care or an admission to internal medicine. Emergency department length of stay of patients admitted to the department of internal medicine prior to and after the intervention decreased from 996.94min to 706.62min. The times from consultation order to admission order and admission order to emergency department departure prior to and after the intervention were decreased from 359.59min to 180.38min and from 481.89min to 362.37min, respectively. The inpatient mortality rates and Inpatient bed occupancy rates prior to and after the intervention were similar. The improvements in the internal medicine consultation process affected the flow time metrics. Therefore, more comprehensive and cooperative strategies need to be developed to reduce the time cycle metrics and overcrowding of all patients in the emergency department. Copyright © 2017 Elsevier Inc. All rights reserved.

`It's more flexible': persistence of women engineers in the academy

Science.gov (United States)

Mlambo, Yeukai Angela; Mabokela, Reitumetse Obakeng

2017-05-01

The under-representation of women in engineering is an issue of concern for policy-makers. While much of the existing literature has focussed on understanding reasons for women's under-representation in engineering and related technical fields, there is a paucity of research that examines why women who are already in engineering persist. This study aims to answer the question, why do women engineers in academe persist in a discipline that is generally perceived to be inhospitable to women. Three main challenges, namely gender discrimination, lack of institutional and disciplinary support, and the rigid nature of the workplace, emerged as key impediments to women engineers in the private sector. In contrast, women engineers in the academy identified the flexibility offered by academic environments, the presence of personal support networks, and a passion for teaching and students as critical factors that influenced their decision to remain in academia.

Resources and the Quality of Life

Science.gov (United States)

Jemian, Wartan A.

1975-01-01

Describes the speakers involved and presents the issues addressed at the Plenary Session of the American Society of Engineering Education in 1974. Speakers included a historian, a representative of the Army Corps of Engineers, a practicing engineer, and a consultant on national materials policy. (GS)

Applications of Statistics and Probability in Civil Engineering

DEFF Research Database (Denmark)

Faber, Michael Havbro

contains the proceedings of the 11th International Conference on Applications of Statistics and Probability in Civil Engineering (ICASP11, Zürich, Switzerland, 1-4 August 2011). The book focuses not only on the more traditional technical issues, but also emphasizes the societal context...... and reliability in engineering; to professionals and engineers, including insurance and consulting companies working with natural hazards, design, operation and maintenance of civil engineering and industrial facilities; and to decision makers and professionals in the public sector, including nongovernmental...

The biometric imaginary: (Dis)trust in a policy vacuum.

Science.gov (United States)

Gunnarsdóttir, Kristrún; Rommetveit, Kjetil

2017-02-01

The decision in Europe to implement biometric passports, visas and residence permits was made at the highest levels without much consultation, checks and balances. Council regulation came into force relatively unnoticed in January 2005, as part of wider securitization policies urging systems interoperability and data sharing across borders. This article examines the biometric imaginary that characterizes this European Union decision, dictated by executive powers in the policy vacuum after 9/11 - a depiction of mobility governance, technological necessity and whom/what to trust or distrust, calling upon phantom publics to justify decisions rather than test their grounding. We consult an online blog we operated in 2010 to unravel this imaginary years on. Drawing on Dewey's problem of the public, we discuss this temporary opening of a public space in which the imaginary could be reframed and contested, and how such activities may shape, if at all, relations between politics, publics, policy intervention and societal development.

34 CFR 75.191 - Consultation costs.

Science.gov (United States)

2010-07-01

... 34 Education 1 2010-07-01 2010-07-01 false Consultation costs. 75.191 Section 75.191 Education... Development of Curricula Or Instructional Materials § 75.191 Consultation costs. An applicant may budget reasonable consultation fees or planning costs in connection with the development of curricula or...

Academic Development for Careers in Management Consulting

Science.gov (United States)

Adams, Susan M.; Zanzi, Alberto

2004-01-01

Explores the extent to which academic offerings are serving the consulting industry and identifies ways that academia can help. The numbers of management consulting courses, field experiences in consulting and consulting concentrations by graduate business schools were tracked over a three-year period to assess the current state of offerings. A…

Owners and Veterinary Surgeons in the United Kingdom Disagree about What Should Happen during a Small Animal Vaccination Consultation.

Science.gov (United States)

Belshaw, Zoe; Robinson, Natalie J; Dean, Rachel S; Brennan, Marnie L

2018-01-18

Dog and cat vaccination consultations are a common part of small animal practice in the United Kingdom. Few data are available describing what happens during those consultations or what participants think about their content. The aim of this novel study was to investigate the attitudes of dog and cat owners and veterinary surgeons towards the content of small animal vaccination consultations. Telephone interviews with veterinary surgeons and pet owners captured rich qualitative data. Thematic analysis was performed to identify key themes. This study reports the theme describing attitudes towards the content of the consultation. Diverse preferences exist for what should be prioritised during vaccination consultations, and mismatched expectations may lead to negative experiences. Vaccination consultations for puppies and kittens were described to have a relatively standardised structure with an educational and preventative healthcare focus. In contrast, adult pet vaccination consultations were described to focus on current physical health problems with only limited discussion of preventative healthcare topics. This first qualitative exploration of UK vaccination consultation expectations suggests that the content and consistency of adult pet vaccination consultations may not meet the needs or expectations of all participants. Redefining preventative healthcare to include all preventable conditions may benefit owners, pets and veterinary surgeons, and may help to provide a clearer structure for adult pet vaccination consultations. This study represents a significant advance our understanding of this consultation type.

Owners and Veterinary Surgeons in the United Kingdom Disagree about What Should Happen during a Small Animal Vaccination Consultation

Directory of Open Access Journals (Sweden)

Zoe Belshaw

2018-01-01

Full Text Available Dog and cat vaccination consultations are a common part of small animal practice in the United Kingdom. Few data are available describing what happens during those consultations or what participants think about their content. The aim of this novel study was to investigate the attitudes of dog and cat owners and veterinary surgeons towards the content of small animal vaccination consultations. Telephone interviews with veterinary surgeons and pet owners captured rich qualitative data. Thematic analysis was performed to identify key themes. This study reports the theme describing attitudes towards the content of the consultation. Diverse preferences exist for what should be prioritised during vaccination consultations, and mismatched expectations may lead to negative experiences. Vaccination consultations for puppies and kittens were described to have a relatively standardised structure with an educational and preventative healthcare focus. In contrast, adult pet vaccination consultations were described to focus on current physical health problems with only limited discussion of preventative healthcare topics. This first qualitative exploration of UK vaccination consultation expectations suggests that the content and consistency of adult pet vaccination consultations may not meet the needs or expectations of all participants. Redefining preventative healthcare to include all preventable conditions may benefit owners, pets and veterinary surgeons, and may help to provide a clearer structure for adult pet vaccination consultations. This study represents a significant advance our understanding of this consultation type.

Owners and Veterinary Surgeons in the United Kingdom Disagree about What Should Happen during a Small Animal Vaccination Consultation

Science.gov (United States)

Robinson, Natalie J.; Dean, Rachel S.

2018-01-01

Dog and cat vaccination consultations are a common part of small animal practice in the United Kingdom. Few data are available describing what happens during those consultations or what participants think about their content. The aim of this novel study was to investigate the attitudes of dog and cat owners and veterinary surgeons towards the content of small animal vaccination consultations. Telephone interviews with veterinary surgeons and pet owners captured rich qualitative data. Thematic analysis was performed to identify key themes. This study reports the theme describing attitudes towards the content of the consultation. Diverse preferences exist for what should be prioritised during vaccination consultations, and mismatched expectations may lead to negative experiences. Vaccination consultations for puppies and kittens were described to have a relatively standardised structure with an educational and preventative healthcare focus. In contrast, adult pet vaccination consultations were described to focus on current physical health problems with only limited discussion of preventative healthcare topics. This first qualitative exploration of UK vaccination consultation expectations suggests that the content and consistency of adult pet vaccination consultations may not meet the needs or expectations of all participants. Redefining preventative healthcare to include all preventable conditions may benefit owners, pets and veterinary surgeons, and may help to provide a clearer structure for adult pet vaccination consultations. This study represents a significant advance our understanding of this consultation type. PMID:29346332

Consultations

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

IDRC CRDI

Qu'arrive-t-il si j'engage des dépenses avant d'avoir signé mon contrat? Combien de ... Facture-type de consultant. Cette fiche ... Le représentant du CRDI dont le nom figure dans votre contrat est votre source d'information la plus fiable.

Consultation on AIDS and the workplace.

Science.gov (United States)

1988-12-01

The 1988 Consultation on Acquired Immunodeficiency Syndrome (AIDS) and the Workplace, organized by the World Health Organization (WHO), addressed 3 issues: 1) risk factors associated with human immunodeficiency virus (HIV) infection in the workplace, 2) the response of businesses and workers to the AIDS epidemic, and 3) use of the workplace for AIDS education. There is no evidence to suggest that HIV can be transmitted by casual, person-to-person contact in the workplace. The central policy issue for businesses concerns protection of the human rights of workers with HIV infection. Most workers with HIV/AIDS want to continue working as long as they are able to, and they should be enabled to contribute their creativity and productivity in a supportive occupational setting. Consistent policies and procedures should be developed at national and enterprise levels before HIV-related questions arise in the workplace. Such policies should be communicated to all concerned, continually reviewed in the light of scientific and epidemiologic evidence, monitored for their successful implementation, and evaluated for their effectiveness. Pre-employment HIV/AIDS screening, whether for assessment of fitness to work or for insurance purposes, should not be required and raises serious concerns about discrimination. Moreover, there should be no obligation on the worker's part to inform his or her employer if HIV infection develops. Information and educational activities at the workplace are essential to create the climate of collective responsibility and mutual understanding required to protect individuals with HIV or AIDS from stigmatization and discrimination by co-workers, employers or clients, and unions.

Random maintenance policies

CERN Document Server

Nakagawa, Toshio

2014-01-01

Exploring random maintenance models, this book provides an introduction to the implementation of random maintenance, and it is one of the first books to be written on this subject.  It aims to help readers learn new techniques for applying random policies to actual reliability models, and it provides new theoretical analyses of various models including classical replacement, preventive maintenance and inspection policies. These policies are applied to scheduling problems, backup policies of database systems, maintenance policies of cumulative damage models, and reliability of random redundant systems. Reliability theory is a major concern for engineers and managers, and in light of Japan’s recent earthquake, the reliability of large-scale systems has increased in importance. This also highlights the need for a new notion of maintenance and reliability theory, and how this can practically be applied to systems. Providing an essential guide for engineers and managers specializing in reliability maintenance a...

Long-term land use future scenarios for the Idaho National Engineering Laboratory

International Nuclear Information System (INIS)

1995-08-01

In order to facilitate decision regarding environmental restoration activities at the Idaho National Engineering Laboratory (INEL), the United States Department of Energy, Idaho Operations Office (DOE-ID) conducted analyses to project reasonable future land use scenarios at the INEL for the next 100 years. The methodology for generating these scenarios included: review of existing DOE plans, policy statements, and mission statements pertaining to the INEL; review of surrounding land use characteristics and county developments policies; solicitation of input from local, county, state and federal planners, policy specialists, environmental professionals, and elected officials; and review of environmental and development constraints at the INEL site that could influence future land use

15 CFR 923.57 - Continuing consultation.

Science.gov (United States)

2010-01-01

... § 923.57 Continuing consultation. (a) As required by subsection 306(d)(3)(B) of the Act, a State must establish an effective mechanism for continuing consultation and coordination between the management agency... 15 Commerce and Foreign Trade 3 2010-01-01 2010-01-01 false Continuing consultation. 923.57...

The feasibility of using UML to compare the impact of different brands of computer system on the clinical consultation.

Science.gov (United States)

Kumarapeli, Pushpa; de Lusignan, Simon; Koczan, Phil; Jones, Beryl; Sheeler, Ian

2007-01-01

UK general practice is universally computerised, with computers used in the consulting room at the point of care. Practices use a range of different brands of computer system, which have developed organically to meet the needs of general practitioners and health service managers. Unified Modelling Language (UML) is a standard modelling and specification notation widely used in software engineering. To examine the feasibility of UML notation to compare the impact of different brands of general practice computer system on the clinical consultation. Multi-channel video recordings of simulated consultation sessions were recorded on three different clinical computer systems in common use (EMIS, iSOFT Synergy and IPS Vision). User action recorder software recorded time logs of keyboard and mouse use, and pattern recognition software captured non-verbal communication. The outputs of these were used to create UML class and sequence diagrams for each consultation. We compared 'definition of the presenting problem' and 'prescribing', as these tasks were present in all the consultations analysed. Class diagrams identified the entities involved in the clinical consultation. Sequence diagrams identified common elements of the consultation (such as prescribing) and enabled comparisons to be made between the different brands of computer system. The clinician and computer system interaction varied greatly between the different brands. UML sequence diagrams are useful in identifying common tasks in the clinical consultation, and for contrasting the impact of the different brands of computer system on the clinical consultation. Further research is needed to see if patterns demonstrated in this pilot study are consistently displayed.

Patient assessment: effective consultation and history taking.

Science.gov (United States)

Kaufman, Gerri

This article explores patient consultation with specific reference to the Calgary-Cambridge consultation guide. It provides an overview of history taking and explores the patient's perspective during the consultation. The article also discusses the skills required to provide information effectively. In addition, the article addresses 'safety netting' and emphasises the interdependence of communication and consultation skills.

Mandatory food labeling of trans fat acids: qualitative analysis of the public consultation

Directory of Open Access Journals (Sweden)

Vanessa Fernandes Davies

Full Text Available The objective of this paper is to identify the stakeholders and their contributions to the public consultation carried out with regard to the mandatory trans fat acids food labeling proposal in Brazil. Methodology thematic analysis of the documents. Results 25 stakeholders made suggestions regarding the proposed law, and the majority belonged to the food industry sector. The following issues were raised: lack of knowledge among the consumers about trans fat acids; lack of information about trans fat acids in food composition tables and infrastructure to analyse the trans fat content of foods; voluntary trans fat labelling. Conclusions The stakeholders addressed important issues, such as improving nutritional knowledge among the population. However, few stakeholders linked to consumers took part in the public consultation, which might lead to disproportionate influence of the food industry on the development of future food policies.

Towards increased policy relevance in energy modeling

Energy Technology Data Exchange (ETDEWEB)

Worrell, Ernst; Ramesohl, Stephan; Boyd, Gale

2003-07-29

Historically, most energy models were reasonably equipped to assess the impact of a subsidy or change in taxation, but are often insufficient to assess the impact of more innovative policy instruments. We evaluate the models used to assess future energy use, focusing on industrial energy use. We explore approaches to engineering-economic analysis that could help improve the realism and policy relevance of engineering-economic modeling frameworks. We also explore solutions to strengthen the policy usefulness of engineering-economic analysis that can be built from a framework of multi-disciplinary cooperation. We focus on the so-called ''engineering-economic'' (or ''bottom-up'') models, as they include the amount of detail that is commonly needed to model policy scenarios. We identify research priorities for the modeling framework, technology representation in models, policy evaluation and modeling of decision-making behavior.

Consultation document Energy Market Concentrations

International Nuclear Information System (INIS)

De Maa, J.; Van Gemert, M.; Karel, A.; La Bastide, G.; Giesbertz, P.; Buijs, F.; Vermeulen, M.; Beusmans, P.

2006-06-01

This the second consultation document of the Netherlands Competition Authority (NMa) on the title subject (the first was in 2002). The purpose of the consultation is to involve all the relevant and interested parties in the development of the energy market in the Netherlands and to consult those parties on studies that have been carried out by the NMa so far: (1) defining (possible) relevant markets in the electricity sector, and (2) the vision and opinion of the NMa with respect to mergers and take-overs. Also, the consultation document is a contribution to the response of the letter from the Dutch Minister of Economic Affairs of May 2005 in which the NMa was requested to give an overview of the preconditions with regard to competition and it's legal aspects [nl

“Nudge” in the clinical consultation – an acceptable form of medical paternalism?

OpenAIRE

Aggarwal, Ajay; Davies, Joanna; Sullivan, Richard

2014-01-01

Background Libertarian paternalism is a concept derived from cognitive psychology and behavioural science. It is behind policies that frame information in such a way as to encourage individuals to make choices which are in their best interests, while maintaining their freedom of choice. Clinicians may view their clinical consultations as far removed from the realms of cognitive psychology but on closer examination there are a number of striking similarities. Discussion Evidence has shown that...

Postpartum consultation: Occurrence, requirements and expectations

Directory of Open Access Journals (Sweden)

Carlgren Ingrid

2008-07-01

Full Text Available Abstract Background As a matter of routine, midwives in Sweden have spoken with women about their experiences of labour in a so-called 'postpartum consultation'. However, the possibility of offering women this kind of consultation today is reduced due to shortage of both time and resources. The aim of this study was to explore the occurrence, women's requirements of, and experiences of a postpartum consultation, and to identify expectations from women who wanted but did not have a consultation with the midwife assisting during labour. Methods All Swedish speaking women who gave birth to a live born child at a University Hospital in western Sweden were consecutively included for a phone interview over a three-week period. An additional phone interview was conducted with the women who did not have a postpartum consultation, but who wanted to talk with the midwife assisting during labour. Data from the interviews were analysed using qualitative content analysis. Results Of the 150 interviewed women, 56% (n = 84 had a postpartum consultation of which 61.9% (n = 52 had this with the midwife assisting during labour. Twenty of the 28 women who did not have a consultation with anyone still desired to talk with the midwife assisting during labour. Of these, 19 were interviewed. The content the women wanted to talk about was summarized in four categories: to understand the course of events during labour; to put into words, feelings about undignified management; to describe own behaviour and feelings, and to describe own fear. Conclusion The survey shows that the frequency of postpartum consultation is decreasing, that the majority of women who give birth today still require it, but only about half of them receive it. It is crucial to develop a plan for these consultations that meets both the women's needs and the organization within current maternity care.

Integrating Environmental Sustainability Considerations into Food and Nutrition Policies: Insights from Australia’s National Food Plan

Science.gov (United States)

Ridgway, Ella Megan; Lawrence, Mark Andrew; Woods, Julie

2015-01-01

The environmental sustainability (ES) of food systems is a critical challenge for policy makers. This is a highly contested policy area with differing views among stakeholders. The aim of the study was to develop a better understanding of how ES considerations are addressed in Australian food and nutrition policies and the way that consultation processes affect final policy outcomes. A mixed-methods study design combined a detailed chronology of key policy developments (2009–2015), a content analysis of written submissions obtained during the NFP’s consultation period (2011–2013) and a frame analysis of the sustainability perspectives – efficiency, demand restraint, and system transformation – in the NFP’s Issues, Green, and White Papers. There were 555 written submissions responding to two consultation papers. Stakeholders represented all sectors of Australia’s food system including government, non-government organizations, the food supply chain, research and academic institutions, and members of the general public. Around 74% of submissions referred to ES considerations and ~65% supported their inclusion into the final policy. Efficiency frames were most dominant; emphasizing a production-oriented approach that regards the environment as a natural resource base for food production but overlooks consumption and equity concerns. Despite strong support for the inclusion of ES considerations in the NFP, the influence of Australia’s socio-political context, powerful, industry-dominated stakeholders, and a reliance on traditional production-oriented perspectives delivered a business-as-usual approach to food policy making. It has since been replaced by an agricultural strategy that provides only cursory attention to ES. Our findings indicate that Australia’s political environment is not sufficiently mature for ES considerations to be integrated into food and nutrition policies. We propose reforms to the current consultation process in Australia to

Integrating environmental sustainability considerations into food and nutrition policies: insights from Australia’s National Food Plan

Directory of Open Access Journals (Sweden)

Ella Megan Ridgway

2015-09-01

Full Text Available The environmental sustainability (ES of food systems is a critical challenge for policy-makers. This is a highly contested policy area with differing views among stakeholders. The aim of the study was to develop a better understanding of how ES considerations are addressed in Australian food and nutrition policies and the way that consultation processes affect final policy outcomes. A mixed-methods study design combined a detailed chronology of key policy developments (2009 – 2015, a content analysis of written submissions obtained during the NFP’s consultation period (2011 – 2013 and a framing analysis of the sustainability perspectives - efficiency, demand restraint and system transformation – in the NFP’s Issues, Green and White Papers. There were 555 written submissions responding to two consultation papers. Stakeholders represented all sectors of Australia’s food system including government, non-government organizations, the food supply chain, research and academic institutions and members of the general public. Around 74% of submissions referred to ES considerations and approximately 65% supported their inclusion into the final policy. Efficiency frames were most dominant; emphasizing a production-oriented approach that regards the environment as a natural resource base for food production but overlooks consumption and equity concerns. Despite strong support for the inclusion of ES considerations in the NFP the influence of Australia’s sociopolitical context, powerful, industry-dominated stakeholders and a reliance on traditional production-oriented perspectives delivered a business-as-usual approach to food policy-making. It has since been replaced by an agricultural strategy that provides only cursory attention to ES. Our findings indicate that Australia’s political environment is not sufficiently mature for ES considerations to be integrated into food and nutrition policies. We propose reforms to the current consultation

Knowledge Sharing in IT Consultant and SME Interactions

Directory of Open Access Journals (Sweden)

Adrian Bradshaw

2015-10-01

Full Text Available Many small and medium enterprises (SMEs depend on consultants to overcome knowledge barriers, especially for IT projects. This paper aims to determine how IT consultants affect the IT knowledge of SMEs when IT consultants and SMEs interact. Data were collected using face-to-face interviews with both IT consultants and SME managers. The study is the first to identify what and how SMEs learn from consultants during an IT implementation project. Consultants help SMEs gain different types of knowledge, employing a broad range of knowledge sharing mechanisms. As consultants are an important part of the knowledge creation processes of SMEs, SMEs should strive to form long-term relationships with consultants and use these interactions to develop IT knowledge within the SME.

Market of dwelling improvement. The policies of energy mastery in existing dwellings in the European Union countries; Marche de l'amelioration de l'habitat. Les politiques de maitrise de l'energie dans l'habitat existant dans les pays de l'Union Europeenne

Energy Technology Data Exchange (ETDEWEB)

Le Fur, B.

2003-09-01

This document is an extended abstract of the study carried out by B. Le Fur about the energy mastery policies implemented by European Union countries for existing buildings: 1 - identification of the key factors of success; 2 - the two-steps methodology followed: identification of innovating policies and deeper investigation of these policies; 3 - common European policy of energy mastery in accommodations (improvement of the energy efficiency of buildings); 4 - measures already implemented in member countries (regulatory tools and financial incentives, public information, eco-taxes); 5 - precursor measures: programs of aid to renewable energies in Germany, energy certification in Denmark, regulations for existing buildings (UK and Germany), mobilization of professionals in Germany, marketing strategies of local authorities in the UK; 6 - locating of key factors of success. (J.S.)

Cost allocation policy review: options and preferred alternatives

Energy Technology Data Exchange (ETDEWEB)

NONE

2010-10-15

This policy review of the consultation process on the electricity cost allocation issue is presented with specific cost allocation policy issues addressed herein, such as: the new microFIT rate, accounting changes and the transition to IFRS, and review of allocating costs to load displacement generation. This report gave the current situation for all these issues, previous work, issues, viable options for dealing with these issues and the preferred alternatives.

Factors influencing common diagnoses made during first-opinion small-animal consultations in the United Kingdom.

Science.gov (United States)

Robinson, N J; Dean, R S; Cobb, M; Brennan, M L

2016-09-01

It is currently unclear how frequently a diagnosis is made during small-animal consultations or how much of a role making a diagnosis plays in veterinary decision-making. Understanding more about the diagnostic process will help direct future research towards areas relevant to practicing veterinary surgeons. The aim of this study was to determine the frequency with which a diagnosis was made, classify the types of diagnosis made (and the factors influencing these) and determine which specific diagnoses were made for health problems discussed during small-animal consultations. Data were gathered during real-time direct observation of small-animal consultations in eight practices in the United Kingdom. Data collected included characteristics of the consultation (e.g. consultation type), patient (e.g. breed), and each problem discussed (e.g. new or pre-existing problem). Each problem discussed was classified into one of the following diagnosis types: definitive; working; presumed; open; previous. A three-level multivariable logistic-regression model was developed, with problem (Level 1) nested within patient (Level 2) nested within consulting veterinary surgeon (Level 3). Problems without a previous diagnosis, in cats and dogs only, were included in the model, which had a binary outcome variable of definitive diagnosis versus no definitive diagnosis. Data were recorded for 1901 animals presented, and data on diagnosis were gathered for 3192 health problems. Previous diagnoses were the most common diagnosis type (n=1116/3192; 35.0%), followed by open (n=868/3192; 27.2%) then definitive (n=660/3192; 20.7%). The variables remaining in the final model were patient age, problem history, consultation type, who raised the problem, and body system affected. New problems, problems in younger animals, and problems raised by the veterinary surgeon were more likely to result in a definitive diagnosis than pre-existing problems, problems in older animals, and problems raised by

Inpatient Consults and Complications During Primary Total Joint Arthroplasty in a Bundled Care Model.

Science.gov (United States)

Baumgartner, Billy T; Karas, Vasili; Kildow, Beau J; Cunningham, Daniel J; Klement, Mitchell R; Green, Cindy L; Attarian, David E; Seyler, Thorsten M

2018-04-01

The Centers for Medicare and Medicaid Services (CMS) are implementing changes in hospital reimbursement models for total joint arthroplasty (TJA), moving to value-based bundled payments from the fee-for-service model. The purpose of this study is to identify consults and complications during the perioperative period that increase financial burden. We combined CMS payment data for inpatient, professional, and postoperative with retrospective review of patients undergoing primary TJA and developed profiles of patients included in the Comprehensive Care for Joint Replacement bundle undergoing TJA. Statistical comparison of episode inpatient events and payments was conducted. Multiple regression analysis was adjusted for length of stay, disposition, and Charlson-Deyo comorbidity profile. Median total payment was $21,577.36, which exceeded the median bundle target payment of $20,625.00. Adjusted analyses showed that psychiatry consults (increase of $73,123.32; P care unit admission ($14,078.37; P care unit admission, and medical/psychiatric consultation exceeded the CMS target. Although study results showed typical complication rates, acute inpatient consultation significantly increased utilization beyond the CMS target even when adjusted for length of stay, patient comorbidities, and discharge. Needed medical care should continue to be a priority for inpatients, and allowance for individual outliers should be considered in policy discussions. Copyright © 2017 Elsevier Inc. All rights reserved.

Understanding the consultation processes

International Nuclear Information System (INIS)

Laing, A.C.

1998-01-01

This presentation focuses on the consultation processes between industry, government and First Nations communities regarding resource development. The expectations of the Crown are to facilitate capacity building within First Nations, to promote traditional use studies and to participate with industry proponents on certain consultation issues. The role of industry is to encourage partnerships between established contractors and First Nations contracting firms to allow First Nations firms to grow and experience success under the guidance of a mentor company. It is important to realize that solid First Nations relations are the key to shorter time lines and lower costs in developing projects. However, consultation and involvement must be 'real' with benefits and participation that fall within the First Nations Communities' definition of success

System Reliability Engineering

International Nuclear Information System (INIS)

Lim, Tae Jin

2005-02-01

This book tells of reliability engineering, which includes quality and reliability, reliability data, importance of reliability engineering, reliability and measure, the poisson process like goodness of fit test and the poisson arrival model, reliability estimation like exponential distribution, reliability of systems, availability, preventive maintenance such as replacement policies, minimal repair policy, shock models, spares, group maintenance and periodic inspection, analysis of common cause failure, and analysis model of repair effect.

Site systems engineering: Systems engineering management plan

Energy Technology Data Exchange (ETDEWEB)

Grygiel, M.L. [Westinghouse Hanford Co., Richland, WA (United States)

1996-05-03

The Site Systems Engineering Management Plan (SEMP) is the Westinghouse Hanford Company (WHC) implementation document for the Hanford Site Systems Engineering Policy, (RLPD 430.1) and Systems Engineering Criteria Document and Implementing Directive, (RLID 430.1). These documents define the US Department of Energy (DOE), Richland Operations Office (RL) processes and products to be used at Hanford to implement the systems engineering process at the site level. This SEMP describes the products being provided by the site systems engineering activity in fiscal year (FY) 1996 and the associated schedule. It also includes the procedural approach being taken by the site level systems engineering activity in the development of these products and the intended uses for the products in the integrated planning process in response to the DOE policy and implementing directives. The scope of the systems engineering process is to define a set of activities and products to be used at the site level during FY 1996 or until the successful Project Hanford Management Contractor (PHMC) is onsite as a result of contract award from Request For Proposal DE-RP06-96RL13200. Following installation of the new contractor, a long-term set of systems engineering procedures and products will be defined for management of the Hanford Project. The extent to which each project applies the systems engineering process and the specific tools used are determined by the project`s management.

B 150 civil engineering futures

DEFF Research Database (Denmark)

Foreword B150 –Civil Engineering Futures consists of interviews made, articles written, and projects presented in connection with the 150th anniversary celebrations of the study of civil engineering in Denmark. Instead of a historical retrospect, it was decided to look into the future. What...... challenges will the next 150 years bring civil engineers? Researchers and lecturers at DTU’s Department of Civil Engineering (known as DTU Byg) suggested possible events, and we also consulted civil engineers and their business partners in the building industry. In this way, a programme was put together...... theme in twentieth century architecture. Together, civil engineer Peter Rice and architect Ian Ritchie created a paradigm shift with their revolutionary ideas for glass facades supported by cables. Glued and bolted constructions made entirely of glass are now a reality in small-scale projects, yet...

Nuclear consultant - a new profession

International Nuclear Information System (INIS)

Hardung von Hardung, H.

1976-01-01

The nuclear field is an area fraugh with particular difficulties for industries, banks, public authorities etc. in acquiring the precise knowledge needed for decision making. This gap can be filled by the activities of nuclear consultants; in view of the size of the market which, in Europe, probably involves a capital investment by far exceeding DM 100 billion, chances are promising. These consultant activities include technological problems as well as economics, organization, strategy, and training in nuclear technology. Of course, the consultant staff must have broad and specialized knowledge. (orig.) [de

Nuclear consultant: a new profession

Energy Technology Data Exchange (ETDEWEB)

Hardung von Hardung, H

1976-02-01

The nuclear field is an area fraught with particular difficulties for industries, banks, and public authorities etc. in acquiring the precise knowledge needed for decision making. This gap can be filled by the activities of nuclear consultants; in view of the size of the market which, in Europe, probably involves a capital investment by far exceeding DM 100 billion, chances are promising. These consultant activities include technological problems as well as economics, organization, strategy, and training in nuclear technology. Of course, the consultant staff must have broad and specialized knowledge.

Energy policy, economic and engineering issues of the extension of Paks Nuclear Power Plant

International Nuclear Information System (INIS)

Aszodi, Attila; Boros, Ildiko; Kovacs, Arnold

2014-01-01

The four operating blocks of the Paks Nuclear Power Plant are of Russian design. They entered into operation three decades ago, between 1982 and 1987. In 2013 they produced 15 TWh out of the 42 TWh energy consumption of Hungary, that is they produced 36% of the energy demand. In the beginning of 2014 the Hungarian and the Russian governments signed the agreement on the extension of Paks site with building two new blocks, producing 1200 MW each. The paper summarizes the energy policy, engineering, safety and economic aspects of the extension. (TRA)

Science Policy Research Unit annual report 1984/1985

Energy Technology Data Exchange (ETDEWEB)

1984-01-01

The report covers the principal research programmes of the Unit, and also describes its graduate and undergraduate teaching, (listing subjects of postgraduate research) and library services. A list of 1984 published papers and staff is presented. The principle research programmes include: the setting up of the Designated Research Centre on Science, Technology and Energy Policy in British Economic Development; policy for technology and industrial innovation in industrialised countries; energy economics, technology and policy (with a sub-section on coal); European science and industrial policy; science policy and research evaluation; technical change and employment opportunities in the UK economy; new technology, manpower and skills; technology and social change; science and technology policy in developing countries; military technology and arms limitation. Short-term projects and consultancy are also covered.

Vickers Terminator. Volume 3C(VT) - Technical appraisal. Consultants' 1983 report

Energy Technology Data Exchange (ETDEWEB)

1986-01-01

A report is given by a team of consultants on the estimated cost of converting wave energy to electrical energy by a 2 GW array of Vickers Terminator wave energy devices and delivering the electricity to a sub-station on the west coast of Skye. Comparisons with the estimates made by the team developing the concept are presented and are largely in agreement, except for the capital cost per device and the power chain efficiency. A detailed engineering assessment is given.

Dermatology consultations significantly contribute quality to care of hospitalized patients: a prospective study of dermatology inpatient consults at a tertiary care center.

Science.gov (United States)

Galimberti, Fabrizio; Guren, Lauren; Fernandez, Anthony P; Sood, Apra

2016-10-01

Cutaneous abnormalities are common in hospitalized patients but are frequently missed or misdiagnosed by admitting teams. Inpatient dermatology consultations provide important information to help diagnose and manage these patients. However, few studies have analyzed dermatology inpatient consultations and their effect. We prospectively collected information for 691 consecutive dermatology consultations from November 2013 to November 2014. Patients ranged in age from newborns to 97 years old. The internal medicine service requested the most consultations (45%). Only 6.5% of consultations were requested within 24 hours of appearance of cutaneous findings. Before consultation, 70.3% of patients did not receive treatment for or based on their cutaneous findings. Dermatology consultation resulted in treatment change in 81.9% of patients. The most common diagnoses were drug rash and contact dermatitis. Biopsies confirmed 71.7% of the initial bedside diagnoses by the dermatology consultation team. Common skin diseases were responsible for the majority of dermatology consultations. Most patients were not treated for their cutaneous conditions before the dermatology consultation. Dermatology consultations resulted in treatment changes in the majority of cases. © 2016 The International Society of Dermatology.

Health Reform Requires Policy Capacity

Directory of Open Access Journals (Sweden)

Pierre-Gerlier Forest

2015-05-01

Full Text Available Among the many reasons that may limit the adoption of promising reform ideas, policy capacity is the least recognized. The concept itself is not widely understood. Although policy capacity is concerned with the gathering of information and the formulation of options for public action in the initial phases of policy consultation and development, it also touches on all stages of the policy process, from the strategic identification of a problem to the actual development of the policy, its formal adoption, its implementation, and even further, its evaluation and continuation or modification. Expertise in the form of policy advice is already widely available in and to public administrations, to well-established professional organizations like medical societies and, of course, to large private-sector organizations with commercial or financial interests in the health sector. We need more health actors to join the fray and move from their traditional position of advocacy to a fuller commitment to the development of policy capacity, with all that it entails in terms of leadership and social responsibility

SOME INDICATORS OF CONSULTATIVE SERVICES DEVELOPMENT IN SERBIA

Directory of Open Access Journals (Sweden)

Vesna PARAUSIC

2012-01-01

Full Text Available Transition process and Serbia's entering into the European Union is possible to hasten by adequate and timely consultative services, before all during the programs and methodologies creation for conducting the enterprises' restructuring processes. In such conditions, the consultative organizations help the enterprises in accomplishing their goals, solving problems in business and management, identifying and using new possibilities, increasing their knowledge and applying suggested changes in the practice. Consulting is a result of manager need for integrated and complex business information. To obtain the transfer of consultant knowledge and manager skills development, a certain conditions must be fulfilled. First of all, business integrity and consultant competence are the most important. Business integrity, i.e. consultant ethics contributes image and reputation and is important competitiveness factor on consultant services market. Regarding actual consulting trends in countries within our region, as well as developmental level of consulting in EU countries, the market of consultative services in Serbia has not significantly changed in previous period (as we saw, the acknowledgement of it was got also by empirical research. The owners and managers of enterprises still do not feel a need for external services, in order to solve business problems. Having in mind a level and quality of demand, neither a supply of consultative services had not reached satisfactory level.

Workplace health and safety regulations: Impact of enforcement and consultation on workers' compensation claims rates in Washington State.

Science.gov (United States)

Baggs, James; Silverstein, Barbara; Foley, Michael

2003-05-01

There has been considerable debate in the public policy arena about the appropriate mix of regulatory enforcement and consultation in achieving desired health and safety behavior across industries. Recently there has been a shift in federal policy toward voluntary approaches and constraining the scope of enforcement programs, although there is little evidence that this might improve health and safety outcomes. To address this, we examined changes in lost time workers compensation claims rates for Washington State employers who had (1) no OSHA State Plan (WISHA) activity, (2) enforcement, (3) consultation, and (4) both types of visits. Compensable claims rates, hours, and WISHA activity were determined for each employer account with a single business location that had payroll hours reported for every quarter from 1997-2000 and more than 10 employees. We used a generalized estimating equations (GEE) approach to Poisson regression to model the association between WISHA activity and claims rate controlling for other external factors. Controlling for previous claims rate and average size, claims rates for employers with WISHA enforcement activity declined 22.5% in fixed site industry SIC codes compared to 7% among employers with no WISHA activity (P 0.10). WISHA consultation activity was not associated with a greater decline in compensable claims rates (-2.3% for fixed sites and +3.5% for non-fixed sites). WISHA activity did not adversely affect worksite survivability through the study period. Enforcement inspections are significantly associated with decreasing compensable workers compensation claims rates especially for fixed site employers. We were unable to identify an association between consultation activities and decreasing claims rates. Copyright 2003 Wiley-Liss, Inc.

Strangers at the Benchside: Research Ethics Consultation

Science.gov (United States)

Cho, Mildred K.; Tobin, Sara L.; Greely, Henry T.; McCormick, Jennifer; Boyce, Angie; Magnus, David

2008-01-01

Institutional ethics consultation services for biomedical scientists have begun to proliferate, especially for clinical researchers. We discuss several models of ethics consultation and describe a team-based approach used at Stanford University in the context of these models. As research ethics consultation services expand, there are many unresolved questions that need to be addressed, including what the scope, composition, and purpose of such services should be, whether core competencies for consultants can and should be defined, and how conflicts of interest should be mitigated. We make preliminary recommendations for the structure and process of research ethics consultation, based on our initial experiences in a pilot program. PMID:18570086

TECHNOLOGIES TO ENHANCE THE OPERATION OF EXISTING NATURAL GAS COMPRESSION INFRASTRUCTURE - MANIFOLD DESIGN FOR CONTROLLING ENGINE AIR BALANCE

Energy Technology Data Exchange (ETDEWEB)

Gary D. Bourn; Ford A. Phillips; Ralph E. Harris

2005-12-01

This document provides results and conclusions for Task 15.0--Detailed Analysis of Air Balance & Conceptual Design of Improved Air Manifolds in the ''Technologies to Enhance the Operation of Existing Natural Gas Compression Infrastructure'' project. SwRI{reg_sign} is conducting this project for DOE in conjunction with Pipeline Research Council International, Gas Machinery Research Council, El Paso Pipeline, Cooper Compression, and Southern Star, under DOE contract number DE-FC26-02NT41646. The objective of Task 15.0 was to investigate the perceived imbalance in airflow between power cylinders in two-stroke integral compressor engines and develop solutions via manifold redesign. The overall project objective is to develop and substantiate methods for operating integral engine/compressors in gas pipeline service, which reduce fuel consumption, increase capacity, and enhance mechanical integrity.

Should consultation recording use be a practice standard? A systematic review of the effectiveness and implementation of consultation recordings.

Science.gov (United States)

Rieger, Kendra L; Hack, Thomas F; Beaver, Kinta; Schofield, Penelope

2018-04-01

To conduct a systematic review of the effectiveness of consultation recordings and identify factors contributing to their successful implementation in health-care settings. A systematic review was conducted for quantitative studies examining the effectiveness of consultation recordings in health care. Two independent reviewers assessed the relevance and quality of retrieved quantitative studies by using standardized criteria. Study findings were examined to determine consultation recording effectiveness and to identify barriers and facilitators to implementation. A supplementary review of qualitative evidence was performed to further explicate implementation factors. Of the 3373 articles retrieved in the quantitative search, 26 satisfied the standardized inclusion criteria (12 randomized controlled trials, 1 quasi-experiment, and 13 cross-sectional studies). Most patients found consultation recordings beneficial. Statistically significant evidentiary support was found for the beneficial impact of consultation recordings on the following patient reported outcomes: knowledge, perception of being informed, information recall, decision-making factors, anxiety, and depression. Implementation barriers included strength of evidence concerns, patient distress, impact of the recording on consultation quality, clinic procedures, medico-legal issues, and resource costs. Facilitators included comfort with being recorded, clinical champions, legal strategies, efficient recording procedures, and a positive consultation recording experience. Consultation recordings are valuable to patients and positively associated with patient-reported outcomes. Successful integration of consultation recording use into clinical practice requires an administratively supported, systematic approach to addressing implementation factors. Copyright © 2017 John Wiley & Sons, Ltd.

The guideline "consultation psychiatry" of the Netherlands Psychiatric Association.

Science.gov (United States)

Leentjens, Albert F G; Boenink, Annette D; Sno, Herman N; Strack van Schijndel, Rob J M; van Croonenborg, Joyce J; van Everdingen, Jannes J E; van der Feltz-Cornelis, Christina M; van der Laan, Niels C; van Marwijk, Harm; van Os, Titus W D P

2009-06-01

In 2008, the Netherlands Psychiatric Association authorized a guideline "consultation psychiatry." To set a standard for psychiatric consultations in nonpsychiatric settings. The main objective of the guideline is to answer three questions: Is psychiatric consultation effective and, if so, which forms are most effective? How should a psychiatric consultations be performed? What increases adherence to recommendations given by the consulting psychiatrist? Systematic literature review. Both in general practice and in hospital settings psychiatric consultation is effective. In primary care, the effectiveness of psychiatric consultation is almost exclusively studied in the setting of "collaborative care." Procedural guidance is given on how to perform a psychiatric consultation. In this guidance, psychiatric consultation is explicitly looked upon as a complex activity that requires a broad frame of reference and adequate medical and pharmacological expertise and experience and one that should be performed by doctors. Investing in a good relation with the general practitioner, and the use of a "consultation letter" increased efficacy in general practice. In the hospital setting, investing in liaison activities and an active psychiatric follow-up of consultations increased adherence to advice. Psychiatric consultations are effective and constitute a useful contribution to the patients' treatment. With setting a standard consultations will become more transparent and checkable. It is hoped that this will increase the quality of consultation psychiatry.

National consultation leads to agrivita research to practice plan for Canada.

Science.gov (United States)

Asselin, Johanne; MacLeod, Martha L P; Dosman, James A

2009-01-01

A gap exists between research development and its implementation in agricultural health and safety. In order to fill this gap, the goal of this project was to consult agricultural stakeholders across Canada in order to identify the health and safety priorities in research and knowledge translation, and then to propose an approach to bridge the gap. Between April and August 2007, "A National Stakeholder Consultation on Health and Safety Research and its Effective Translation to the Agricultural Sector" was initiated by the Canadian Centre for Heath and Safety in Agriculture. The experiences and opinions of stakeholders across Canada were gathered through focus groups with over 150 participants in seven Canadian provinces and a survey of 289 individuals across Canada. Stakeholders identified a range of health and safety research priorities. Chemical exposure, stress, and farm safety issues were immediate concerns and issues surrounding labor and trained workers, whereas health problems and environmental issues were long-term concerns. Results identified research and knowledge translation priorities, which provided elements for a proposed program aiming at bridging the gap existing between research development and its translation into practice. A request for a knowledge translation/transfer mechanism, where all agricultural stakeholders from researchers to end users are involved in the process, was identified. Findings from the national consultation were used to develop a business plan entitled "Agrivita Research to Practice Program: A Partnership Plan for Health and Safety and its Effective Transfer to the Agricultural Sector in Canada." The plan provides for a coordinated and integrated approach in Canada, conceptually drawing on the American experience established by The National Institute for Occupational Safety and Health.

Services of strategic consulting: special features and types

Directory of Open Access Journals (Sweden)

Klenin Oleh Volodymyrovych

2016-09-01

Full Text Available In the article essence of terms “consulting” and “strategic consulting” was studied. It was proved that strategic consulting must be analyzed as professional activity in the system of enterprise strategic management. Specific features of consultative services and its composition was added from the point of view of strategic management and innovative development were studied. In the process of providing consulting services it was suggested to take into account the strategic orientation of human capital of consulting company that was accepted to determine as professional actions of consultants. It was found out main problems that could prevent stable activity of industrial enterprises. It was proved necessity of researches concerning authentication factors of industrial enterprises innovative development and the role of consulting company in its decision making. It was made review of the most widespread classifications of consulting services. Was shown author`s view concerning forming more demanded services of strategic consulting by subject basis.

Policy interventions related to medicines: Survey of measures taken in European countries during 2010-2015.

Science.gov (United States)

Vogler, Sabine; Zimmermann, Nina; de Joncheere, Kees

2016-12-01

Policy-makers can use a menu of pharmaceutical policy options. This study aimed to survey these measures that were implemented in European countries between 2010 and 2015. We did bi-annual surveys with competent authorities of the Pharmaceutical Pricing and Reimbursement Information network. Additionally, we consulted posters produced by members of this network as well as further published literature. Information on 32 European countries (all European Union Member States excluding Luxembourg; Iceland, Norway, Serbia, Switzerland, Turkey) was included. 557 measures were reported between January 2010 and December 2015. The most frequently mentioned measure was price reductions and price freezes, followed by changes in patient co-payments, modifications related to the reimbursement lists and changes in distribution remuneration. Most policy measures were identified in Portugal, Greece, Belgium, France, the Czech Republic, Iceland, Spain and Germany. 22% of the measures surveyed could be classified as austerity. Countries that were strongly hit by the financial crisis implemented most policy changes, usually aiming to generate savings and briefly after the emergence of the crisis. Improvements in the economic situation tended to lead to an easing of austerity measures. Countries also implemented policies that aimed to enhance enforcement of existing measures and increase efficiency. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Summary report of the consultants' meeting on nuclear data for production of therapeutic radioisotopes

International Nuclear Information System (INIS)

Haight, R.C.; Paviotti-Corcuera, R.

2002-04-01

This report summarizes the presentations, recommendations and conclusions of the Consultants' Meeting on Nuclear Data for Production of Therapeutic Radioisotopes. The purpose of this meeting was to discuss scientific and technical matters related to the subject and to advise the IAEA Nuclear Data Section (NDS) on the need and possible formation of a Coordinated Research Programme (CRP). Accurate and complete knowledge of nuclear data are essential for the production of radionuclides for therapy to achieve the specific activity and purity required for efficient and safe clinical application. The Consultants recommended updating and completing the data for production of radionuclides that are recognized to be important in therapy. In addition, the consultants recommend investigating other radionuclides that have a potential interest and for which there exists a medical rationale for therapeutic use. To date no serious effort has been devoted to evaluation of nuclear data for the reactor and accelerator production of therapeutic radionuclides. The IAEA is in the unique and privileged position to address this important public health related problem. Therefore, the consultants highly recommend the formation of a CRP with the title: 'Nuclear Data for Production of Therapeutic Radionuclides.' (author)

ARL/OMS Consultant Training Program.

Science.gov (United States)

Euster, Joanne R.

1982-01-01

Describes Academic Library Consultant Training Program begun in 1979, sponsored by Office of Management Studies (OMS) and designed to provide 80 consultants to aid academic libraries in improving performance. Viewpoints are included from OMS Director and participants concerning program objectives, trainee selection, workshops, internships, and the…

B 150 civil engineering futures

DEFF Research Database (Denmark)

specific climatic challenge or clean the air. With nanotechnology, the artificial and the natural move closer together; this is the perspective for civil engineer Chris McCarthy’s work all over the world. And what is new is not just the way the construction materials are put together; they also require......Foreword B150 –Civil Engineering Futures consists of interviews made, articles written, and projects presented in connection with the 150th anniversary celebrations of the study of civil engineering in Denmark. Instead of a historical retrospect, it was decided to look into the future. What...... challenges will the next 150 years bring civil engineers? Researchers and lecturers at DTU’s Department of Civil Engineering (known as DTU Byg) suggested possible events, and we also consulted civil engineers and their business partners in the building industry. In this way, a programme was put together...

Evaluating employee assistance policy in an HMO-based alcoholism project.

Science.gov (United States)

Putnam, S L; Stout, R L

1985-01-01

One aspect of successful employee assistance program (EAP) implementation is the adoption of a formal, written policy, reflecting company commitment to EAP guidelines and goals. This study of criteria predictive of such policy adoption was conducted at the occupational alcoholism project of a New England health maintenance organization (HMO). Data on nearly 400 organizations contacted by occupational program consultants (OPCs) over a 20-month period were collected by questionnaire and interview. One third of these organizations adopted employee assistance policies and set about establishing formal programs. Stepwise multiple regression is the principal method used to pinpoint the correlates of policy adoption. Two of the most important of these are the attitudes of contact persons within the organization toward alcoholism and employee assistance programs, particularly their admission of alcohol problems within their social networks; and the consultants' persistence and marketing skills. The adopting organizations also had reputations for being progressive, and actively concerned about employee welfare; they tended to be large, their executives autonomous, and their union membership rates high. Inhibiting policy acceptance were fears that a written policy would jeopardize the reputation and image of the organization, and that an employee assistance program would remove internal control of personal procedures. The adequacy of the evaluative data and methods are discussed, and recommendations are offered in the interests of streamlining the efforts of OPCs and of achieving greater penetration of targeted organizations.

The rose of Sharon: what is the ideal timing for palliative care consultation versus ethics consultation?

Science.gov (United States)

La Via, Jennifer; Schiedermayer, David

2012-01-01

Ethics committees and palliative care consultants can function in a complementary fashion, seamlessly and effectively. Ethics committees can "air" and help resolves issues, and palliative care consultants can use a low-key, longitudinal approach.

Maternity leave: existing policies in obstetrics and gynecology residency programs.

Science.gov (United States)

Davis, J L; Baillie, S; Hodgson, C S; Vontver, L; Platt, L D

2001-12-01

To survey program directors in obstetrics and gynecology regarding maternity leave and to determine how programs are dealing with maternity leave coverage. Questionnaires regarding impact and policy on maternity leave were mailed to accredited obstetrics and gynecology residency programs. A total of 188 of 274 (69%) questionnaires were returned completed. Respectively, 80% and 69% of respondents indicated that they have a formal maternity (maximum mean 8.7 weeks) and paternity (mean 5.27 days) leave policy. Approximately 75% of programs require residents to make up time if their leave exceeds 8 weeks during the first 3 years. Eighty-five percent of programs require residents to make up time if their leave exceeds 6 weeks during the fourth year. Ninety-three percent of programs require residents to make up time if their leave exceeds 20 weeks over the 4 years. Seventy-seven percent of respondents have other residents in their program cover for the absent resident. Thirty-seven percent of programs have schedules flexible enough to allow rearrangement so that some rotations go uncovered. Eighty-three percent of programs surveyed stated that maternity leave has a somewhat to very significant impact on the residents' schedules. Most residency programs have written maternity/paternity leave policies. A more flexible curriculum may help to accommodate the residents on leave without overburdening the residents who are left to cover.

Hospitalist Perspective of Interactions with Medicine Subspecialty Consult Services.

Science.gov (United States)

Adams, Traci N; Bonsall, Joanna; Hunt, Daniel; Puig, Alberto; Richards, Jeremy B; Yu, Liyang; McSparron, Jakob I; Shah, Nainesh; Weissler, Jonathan; Miloslavsky, Eli M

2018-05-01

Medicine subspecialty consultation is becoming increasingly important in inpatient medicine. We conducted a survey study in which we examined hospitalist practices and attitudes regarding medicine subspecialty consultation. The survey instrument was developed by the authors based on prior literature and administered online anonymously to hospitalists at 4 academic medical centers in the United States. The survey evaluated 4 domains: (1) current consultation practices, (2) preferences regarding consultation, (3) barriers to and facilitating factors of effective consultation, and (4) a comparison between hospitalist-fellow and hospitalist-subspecialty attending interactions. One hundred twenty-two of 261 hospitalists (46.7%) responded. The majority of hospitalists interacted with fellows during consultation. Of those, 90.9% reported that in-person communication occurred during less than half of consultations, and 64.4% perceived pushback at least "sometimes " in their consult interactions. Participants viewed consultation as an important learning experience, preferred direct communication with the consulting service, and were interested in more teaching during consultation. The survey identified a number of barriers to and facilitating factors of an effective hospitalist-consultant interaction, which impacted both hospitalist learning and patient care. Hospitalists reported more positive experiences when interacting with subspecialty attendings compared to fellows with regard to multiple aspects of the consultation. The hospitalist-consultant interaction is viewed as important for both hospitalist learning and patient care. Multiple barriers and facilitating factors impact the interaction, many of which are amenable to intervention.

Compensation Consultants and CEO Pay

NARCIS (Netherlands)

Kabir, Mohammed Rezaul; Minhat, Marizah

2014-01-01

The study examines the practice of employing multiple compensation consultants. Examining data of a sample of UK companies over the period 2003–2006 we find that CEOs receive higher equity-based pay when firms employ more than one compensation consultant. An increase in the number of compensation

The Lawyer-Therapist Consultation Team.

Science.gov (United States)

Korelitz, Ann; Schulder, Diane

1982-01-01

Discusses a pilot study in which joint consultations with a family therapist and a matrimonial attorney were offered to 10 couples and one woman contemplating divorce. Videotaped sessions. Suggests joint consultations can be useful in helping couples understand the psychological and legal implications of conflicts expressed during separation.…

Discussing patient's lifestyle choices in the consulting room: analysis of GP-patient consultations between 1975 and 2008

Directory of Open Access Journals (Sweden)

van Dulmen Sandra

2010-11-01

Full Text Available Abstract Background The increasing prevalence of chronic diseases and the growing understanding that lifestyle behaviour plays an essential role in improving overall health suggest a need for increased attention to lifestyle choices in the consulting room. This study aims to examine whether or not healthy and unhealthy lifestyle choices of patients are currently being discussed more often in primary care consultations than in former decades. Furthermore, we are interested in GPs' approach to lifestyle behaviour during consultations. Lastly, we examine whether lifestyle behaviour is discussed more with certain patients during consultations, depending on gender, age and educational background. Method We analysed video-recordings of medical consultations, collected between 1975 and 2008 in Dutch GP practices. Data were analysed using logistic regression. Results This study shows that discussion of smoking behaviour and physical activity has increased somewhat over time. A change in discussion of nutrition and alcohol is, however, less clear. Overall, alcohol use is the least discussed and physical activity the most discussed during consultations. GPs mainly refer to lifestyle when it is relevant to the patient's complaints (symptom approach. GPs' approach to lifestyle behaviour did not change over time. In general, lifestyle behaviour is discussed more with older, male patients (except for nutrition. GPs talk about lifestyle behaviour with patients from different educational backgrounds equally (except for physical activity. Conclusion In recent years there is greater awareness of a healthy lifestyle, which is reflected to a limited extent in this study. Still, lifestyle behaviour is discussed in only a minority of consultations. GPs do not refer to lifestyle behaviour as a routine procedure, i.e. do not include it in primary prevention. This highlights the importance of the introduction of prevention consultations, where GPs can discuss lifestyle

Exploring gender differences in the working lives of UK hospital consultants.

Science.gov (United States)

Jefferson, Laura; Bloor, Karen; Spilsbury, Karen

2015-05-01

Internationally, increasing numbers of women are practising medicine. Gender differences in doctors' working hours, specialty choices and communication styles are well documented, but studies often neglect contextual factors such as the role of socialised gender expectations on behaviours in the workplace and the medical profession. These may be important as recent studies have reported gender differences in doctors' activity rates that cannot be explained by specialty or contracted hours, suggesting other sources of variation. This study sought to explore the working lives of hospital doctors and how their work is negotiated according to gender and context. Gender differences in the day-to-day work of hospital specialists (consultants) in the NHS were investigated using a qualitative approach, including observation and interview methods. Data were analysed inductively using qualitative observation and interview methods. Two NHS hospital trusts in England. Data were collected from 13 participants working in a variety of specialties and in a range of clinical and non-clinical settings. Various behaviours, attitudes and experiences were explored, such as doctor-patient communication, interactions with colleagues and workload. Influences at both individual and situational levels, appear to affect differentially the work of male and female doctors. Female consultants described awareness of the impact of behaviours on relationships with colleagues, and their interactions appeared to be more carefully performed. Nurses and other colleagues tend to demonstrate less cooperation with female consultants. Gender differences also exist in patient communication, feelings of work-family conflict and barriers to career progression. These variations in hospital consultants' work may have implications for both the quantity and quality of care provided by male and female consultants. This is timely and of importance to the medical workforce as the gender composition approaches

Comparative Analysis of Institutional Policy Definitions of Plagiarism: A Pan-Canadian University Study

Science.gov (United States)

Eaton, Sarah Elaine

2017-01-01

This article shares the findings of a study investigating institutional policy definitions of plagiarism at twenty English-speaking Canadian universities. The types of primary sources consulted for this study included: (1) university academic calendars for 2016-2017, (2) institutional policies on academic misconduct, and (3) student academic codes…

How Can Air Force Civil Engineers Use Expert Systems?

Science.gov (United States)

1988-09-01

Acknowledgements On this academic path called "thesis", many individuals have befriended me along the way. I would like to express my thanks to Maj James R...that provided their insight into civil engineering throughout the interviews: Col James G. Zody, Col Thomas E. Lollis, Col Joe L. Hicks, Col Nicholas A...training role" ( Basden , 1984: 63-64). Consultant. Using an expert system as a consultant, the non- specialist can obtain counsel, guidance, or information

Core Competencies for Training Effective School Consultants

Science.gov (United States)

Burkhouse, Katie Lynn Sutton

2012-01-01

The purpose of this research was to develop and validate a set of core competencies of effective school-based consultants for preservice school psychology consultation training. With recent changes in service delivery models, psychologists are challenged to engage in more indirect, preventative practices (Reschly, 2008). Consultation emerges as…

Edgar Schein's Process versus Content Consultation Models.

Science.gov (United States)

Rockwood, Gary F.

1993-01-01

Describes Schein's three models of consultation based on assumptions inherent in different helping styles: purchase of expertise and doctor-patient models, which focus on content of organization problems; and process consultation model, which focuses on how organizational problems are solved. Notes that Schein has suggested that consultants begin…

Investigating preventive-medicine consultations in first-opinion small-animal practice in the United Kingdom using direct observation.

Science.gov (United States)

Robinson, N J; Brennan, M L; Cobb, M; Dean, R S

2016-02-01

Preventive-medicine consultations account for a large proportion of the veterinary caseload and previous research has suggested these consultations are fundamentally different from those in which the animal is presented for a specific health problem. There has been recent controversy around some aspects of preventive medicine for cats and dogs, and the full health benefits of the preventive-medicine consultation remain unclear. The aim of this study was to compare characteristics of the consultation and the problems discussed during the consultation between preventive-medicine consultations and other types of consultations. Data were gathered during direct observation of small-animal consultations in seven first-opinion practices in the United Kingdom. Data collected included type of clinical examination performed, patient signalment, and details of all problems discussed (including whether the problem was presenting or non-presenting, new or pre-existing, who had raised the problem, body system affected and whether an action was taken). A two-level multivariable logistic-regression model was developed, with canine and feline patients at Level 1 nested within consulting veterinary surgeons at Level 2, and a binary outcome variable of preventive-medicine consultation versus specific health-problem consultation. A total of 1807 patients were presented, of which 690 (38.2%) presented for a preventive-medicine consultation. Dogs were the most frequently presented species (n=1168; 64.6%) followed by cats (n=510; 28.2%), rabbits (n=86; 4.8%) and patients of other species (n=43; 2.4%). The five variables remaining in the multi-level model were whether multiple patients were presented, patient age, clinical examination type, weighing and number of problems discussed. Species, breed, sex, neutering status and practice did not remain in the final model. Many non-presenting problems, including both preventive-medicine problems and specific-health problems, were discussed and

Language Policy and Communication Policy - Same Same but Different?

DEFF Research Database (Denmark)

Bergenholtz, Henning; Johnsen, Mia

2006-01-01

Surprisingly, no attempts have yet been made to relate language policy and communication policy. This is the case in theoretical contributions on language policy and theoretical contributions on communication policy alike, none of which mentions the other concept. It is also the case in existing...... language policies where the term communication policy is not mentioned at all. Likewise, the term language policy is not found in communication policies, even where a particular company or organisation has a language policy as well as a communication policy. This contribution aims to define both terms...

Inconsistency of residents' communication performance in challenging consultations.

Science.gov (United States)

Wouda, Jan C; van de Wiel, Harry B M

2013-12-01

Communication performance inconsistency between consultations is usually regarded as a measurement error that jeopardizes the reliability of assessments. However, inconsistency is an important phenomenon, since it indicates that physicians' communication may be below standard in some consultations. Fifty residents performed two challenging consultations. Residents' communication competency was assessed with the CELI instrument. Residents' background in communication skills training (CST) was also established. We used multilevel analysis to explore communication performance inconsistency between the two consultations. We also established the relationships between inconsistency and average performance quality, the type of consultation, and CST background. Inconsistency accounted for 45.5% of variance in residents' communication performance. Inconsistency was dependent on the type of consultation. The effect of CST background training on performance quality was case specific. Inconsistency and average performance quality were related for those consultation combinations dissimilar in goals, structure, and required skills. CST background had no effect on inconsistency. Physician communication performance should be of high quality, but also consistent regardless of the type and complexity of the consultation. In order to improve performance quality and reduce performance inconsistency, communication education should offer ample opportunities to practice a wide variety of challenging consultations. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

The Problem of Citizens: E-Democracy for Actually Existing Democracy

Directory of Open Access Journals (Sweden)

Daniel Kreiss

2015-11-01

Full Text Available This article argues that many contemporary e-democracy projects, particularly in the United States, have at their heart a model of atomistic, independent, rational, and general-interest citizens. As such, these projects, variously grouped under the labels of e-governance, online deliberation, open government, and civic technology, often assume a broad shared consensus about collective definitions of “public problems” that both does not exist and sidesteps debates over what these problems are and what potential solutions can and should be. Drawing on recent theories of political parties, social identity, and cultural cognition, this article argues that e-democracy efforts need to account for the fact that the citizens practitioners appeal to see themselves by default as members of social groups, and that this has implications for politics and what Jasanoff calls “civic epistemology.” Presenting the case of attempting to change Republican opinions about climate change, I argue that e-democracy initiatives should seek to foster collaboration and deliberation within , not between, parties and among partisans. To do so, e-democratic reformers need to explicitly structure the collaborative and deliberative environment so there is a range of intra-party opinions and beliefs as part of the consultative and policy-making process.

Does professional-centred training improve consultation outcomes?

DEFF Research Database (Denmark)

Parkin, Tracey; Barnard, K.; Cradock, S.

2006-01-01

discussed and decisions made. Patients also completed the Health Care Climate Questionnaire (HCCQ). Pre-training results were fed back to the professionals to provide an objective measure of current practice. Training day one comprised 10 minutes' observation of videoed consultations of each professional......This study aimed to examine whether professional-centred training improves consultation outcomes. Using a pre- and post-data collection design. Immediately after consultations, professionals and patients completed a consultation review sheet which was coded for the level of agreement on issues...... in order to identify strengths and training needs. Each professional identified key areas of their consultation that they felt needed further development. Training day two centred on goal setting and negotiating agendas as these were identified as priority areas requiring more skills. Data from 110...

Policy-Based Negotiation Engine for Cross-Domain Interoperability

Science.gov (United States)

Vatan, Farrokh; Chow, Edward T.

2012-01-01

A successful policy negotiation scheme for Policy-Based Management (PBM) has been implemented. Policy negotiation is the process of determining the "best" communication policy that all of the parties involved can agree on. Specifically, the problem is how to reconcile the various (and possibly conflicting) communication protocols used by different divisions. The solution must use protocols available to all parties involved, and should attempt to do so in the best way possible. Which protocols are commonly available, and what the definition of "best" is will be dependent on the parties involved and their individual communications priorities.

Using information and communication technologies to consult with patients in Victorian primary care: the views of general practitioners.

Science.gov (United States)

Hanna, Lisa; Fairhurst, Karen

2013-01-01

Information and communication technologies such as email, text messaging and video messaging are commonly used by the general population. However, international research has shown that they are not used routinely by GPs to communicate or consult with patients. Investigating Victorian GPs' perceptions of doing so is timely given Australia's new National Broadband Network, which may facilitate web-based modes of doctor-patient interaction. This study therefore aimed to explore Victorian GPs' experiences of, and attitudes toward, using information and communication technologies to consult with patients. Qualitative telephone interviews were carried out with a maximum variation sample of 36GPs from across Victoria. GPs reported a range of perspectives on using new consultation technologies within their practice. Common concerns included medico-legal and remuneration issues and perceived patient information technology literacy. Policy makers should incorporate GPs' perspectives into primary care service delivery planning to promote the effective use of information and communication technologies in improving accessibility and quality of general practice care.

Telephone Consultation as a Substitute for Routine Out-patient Face-to-face Consultation for Children With Inflammatory Bowel Disease: Randomised Controlled Trial and Economic Evaluation.

Science.gov (United States)

Akobeng, Anthony K; O'Leary, Neil; Vail, Andy; Brown, Nailah; Widiatmoko, Dono; Fagbemi, Andrew; Thomas, Adrian G

2015-09-01

Evidence for the use of telephone consultation in childhood inflammatory bowel disease (IBD) is lacking. We aimed to assess the effectiveness and cost consequences of telephone consultation compared with the usual out-patient face-to-face consultation for young people with IBD. We conducted a randomised-controlled trial in Manchester, UK, between July 12, 2010 and June 30, 2013. Young people (aged 8-16 years) with IBD were randomized to receive telephone consultation or face-to-face consultation for 24 months. The primary outcome measure was the paediatric IBD-specific IMPACT quality of life (QOL) score at 12 months. Secondary outcome measures included patient satisfaction with consultations, disease course, anthropometric measures, proportion of consultations attended, duration of consultations, and costs to the UK National Health Service (NHS). Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT02319798. Eighty six patients were randomised to receive either telephone consultation (n = 44) or face-to-face consultation (n = 42). Baseline characteristics of the two groups were well balanced. At 12 months, there was no evidence of difference in QOL scores (estimated treatment effect in favour of the telephone consultation group was 5.7 points, 95% CI - 2.9 to 14.3; p = 0.19). Mean consultation times were 9.8 min (IQR 8 to 12.3) for telephone consultation, and 14.3 min (11.6 to 17.0) for face-to-face consultation with an estimated reduction (95% CI) of 4.3 (2.8 to 5.7) min in consultation times (p consultation had a mean cost of UK£35.41 per patient consultation compared with £51.12 for face-face consultation, difference £15.71 (95% CI 11.8-19.6; P consultation compared with face-to-face consultation with regard to improvements in QOL scores, and telephone consultation reduced consultation time and NHS costs. Telephone consultation is a cost-effective alternative to face-to-face consultation for the

IT Consultants in Acquisition IT Integration

DEFF Research Database (Denmark)

Henningsson, Stefan; Øhrgaard, Christian

2016-01-01

strategic IT initiatives and how companies can draw effectively on their services. The paper investigates the use of consultants in relation to one type of major strategic IT initiative: acquisition IT integration. Acquisition IT integration, which is the integration of the acquirer’s and target......’s IT following a corporate acquisition, presents a difficult but crucial IT challenge for the many acquiring organizations. Through a comparative case study of four acquirers, theoretically grounded in the resource-based view of the firm, it is analyzed how acquirers draw on external consultants to realize...... acquisition IT integration. Two complementary and two supplementary roles consultants assume in these projects are identified. Additionally, three characteristics of the acquisition IT integration strategy are identified that influence how the acquirers assign different roles to IT consultants. The resulting...

The economic and clinical impact of an inpatient palliative care consultation service: a multifaceted approach.

Science.gov (United States)

Ciemins, Elizabeth L; Blum, Linda; Nunley, Marsha; Lasher, Andrew; Newman, Jeffrey M

2007-12-01

While there has been a rapid increase of inpatient palliative care (PC) programs, the financial and clinical benefits have not been well established. Determine the effect of an inpatient PC consultation service on costs and clinical outcomes. Multifaceted study included: (1) interrupted time-series design utilizing mean daily costs preintervention and postintervention; (2) matched cohort analysis comparing PC to usual care patients; and (3) analysis of symptom control after consultation. Large private, not-for-profit, academic medical center in San Francisco, California, 2004-2006. Time series analysis included 282 PC patients; matched cohorts included 27 PC with 128 usual care patients; clinical outcome analysis of 48 PC patients. Mean daily patient costs and length of stay (LOS); pain, dyspnea, and secretions assessment scores. Mean daily costs were reduced 33% (p reduction in mean daily costs and LOS resulted in an estimated annual savings of $2.2 million in the study hospital. Our results extend the evidence base of financial and clinical benefits associated with inpatient PC programs. We recommend additional study of best practices for identifying patients and providing consultation services, in addition to progressive management support and reimbursement policy.

Determinants of Dividend Payout Policy: A Case of Pakistan Engineering Sector

Directory of Open Access Journals (Sweden)

Kashif Imran

2011-09-01

Full Text Available The return on investment can be divided in capital gain and dividend payouts. It is a difficult task for management to allocate a sufficient amount in both segments, especially to prevent from agency problems. The firms pay dividends only when enough amounts have after meeting their requirements and short term needs. The purpose of the present study is to empirically investigate the factors determine the dividend payout decisions in the case of Pakistan’s engineeringsector by using the data of thirty-six firms listed on Karachi Stock Exchange from the period 1996 to 2008. By employing various panel data techniques like fixed and random effects, the results suggest that the previous dividend per share, earnings per share, profitability, cash flow, sales growth, and size of the firm are the most critical factors determining dividend policy in the engineering sector of Pakistan.

Game mechanics engine

OpenAIRE

Magnusson, Lars V

2011-01-01

Game logic and game rules exists in all computer games, but they are created di erently for all game engines. This game engine dependency exists because of how the internal object model is implemented in the engine, as a place where game logic data is intermingled with the data needed by the low- level subsystems. This thesis propose a game object model design, based on existing theory, that removes this dependency and establish a general game logic framework. The thesis the...

The Application of Standards and Recommendations to Clinical Ethics Consultation in Practice: An Evaluation at German Hospitals.

Science.gov (United States)

Schochow, Maximilian; Rubeis, Giovanni; Steger, Florian

2017-06-01

The executive board of the Academy for Ethics in Medicine (AEM) and two AEM working groups formulated standards and recommendations for clinical ethics consultation in 2010, 2011, and 2013. These guidelines comply with the international standards like those set by the American Society for Bioethics and Humanities. There is no empirical data available yet that could indicate whether these standards and recommendations have been implemented in German hospitals. This desideratum is addressed in the present study. We contacted 1.858 German hospitals between September 2013 and January 2014. A follow-up survey was conducted between October 2014 and January 2015. The data of the initial survey and the follow-up survey were merged and evaluated. The statements of the participants were compared with the standards and recommendations. The standards of the AEM concerning the tasks of clinical ethics consultation (including ethics consultation, ethics training and the establishment of policy guidelines) are employed by a majority of participants of the study. Almost all of these participants document their consultation activities by means of protocols or entries in the patient file. There are deviations from the recommendations of the AEM working groups regarding the drafting of statutes, activity reports, and financial support. The activities of clinical ethics consultation predominantly comply with the standards of the AEM and recommendations for the documentation. The recommendations for evaluation should be improved in practice. This applies particularly for activity reports in order to evaluate the activities. Internal evaluation could take place accordingly.

Risk-based analysis and policy implications for renewable energy investments in Greece

International Nuclear Information System (INIS)

Angelopoulos, Dimitrios; Doukas, Haris; Psarras, John; Stamtsis, Giorgos

2017-01-01

Significant renewable energy (RE) investments have to be implemented in order to achieve the ambitious RE targets set in the EU for 2020 and beyond. Moreover, a great amount of capital has to be leveraged, as these projects are followed by high investment and financing costs. Main aim of this paper is the provision of a comprehensive assessment of the existing risk elements of RE investments in relation to the respective policies and the evaluation of their impact on the weighted average cost of capital (WACC) in Greece. A consultation procedure with key national energy stakeholders took also place, including policy makers, project developers, investors, equity providers, bankers and energy analysts in the Greek RE market, in order to provide a validation of the respective results. It has been concluded that the policy design risk represents the risk element with the greatest impact on the cost of capital and, thus, the level of RE investments’ deployment. Βased on the cost of capital valuation process followed, the WACC was estimated to reach approximately 12% for onshore wind and little lower values for solar PV projects in Greece. - Highlights: • Policy design risk constitutes the main influential parameter of the WACC. • Social acceptance is more critical for large-scale, mainly onshore wind, projects. • A stable policy framework may lead to less risk and, thus, cost of RE projects. • The WACC is around 12% for onshore wind and little lower for solar PV projects.

"Systematizing" ethics consultation services.

Science.gov (United States)

Bruce, Courtenay R; Eves, Margot M; Allen, Nathan G; Smith, Martin L; Peña, Adam M; Cheney, John R; Majumder, Mary A

2015-03-01

While valuable work has been done addressing clinical ethics within established healthcare systems, we anticipate that the projected growth in acquisitions of community hospitals and facilities by large tertiary hospitals will impact the field of clinical ethics and the day-to-day responsibilities of clinical ethicists in ways that have yet to be explored. Toward the goal of providing clinical ethicists guidance on a range of issues that they may encounter in the systematization process, we discuss key considerations and potential challenges in implementing system-wide ethics consultation services. Specifically, we identify four models for organizing, developing, and enhancing ethics consultation activities within a system created through acquisitions: (1) train-the-trainer, (2) local capacity-building, (3) circuit-riding, and (4) consolidated accountability. We note each model's benefits and challenges. To our knowledge, this is the first paper to consider the broader landscape of issues affected by consolidation. We anticipate that clinical ethicists, volunteer consultants, and hospital administrators will benefit from our recommendations.

The impact of the strategic factor in knowledge management projects in the consulting industry

Directory of Open Access Journals (Sweden)

Marta Mas-Machuca

2008-10-01

Full Text Available The projects of Knowledge Management in the consulting industry have become a necessity to obtain sustainable competitive advantages. Between all the factors that influence in the success of a Knowledge Management project, the strategic ones have a decisive weight according to existing literature. Although many studies raise the issue of strategy’s influence on Knowledge Management success, few have measured them. This paper aims to identify the elements that configure the strategic dimension and measure its contribution in order to maximize the profit. The research methodology is based on a Structural Equation Model to validate the hypothesis. The findings highlight the huge influence of strategy in Knowledge Management project’s success in the consultancy industry.

Feeling lucky? Using search engines to assess perceptions of urban sustainability

International Nuclear Information System (INIS)

Keirstead, James

2009-01-01

The sustainability of urban environments is an important issue at both local and international scales. Indicators are frequently used by decision-makers seeking to improve urban performance but these metrics can be dependent on sparse quantitative data. This paper explores the potential of an alternative approach, using an internet search engine to quickly gather qualitative data on the key attributes of cities. The method is applied to 21 world cities and the results indicate that, while the technique does shed light on direct and indirect aspects of sustainability, the validity of derived metrics as objective indicators of long-term sustainability is questionable. However the method's ability to provide subjective short-term assessments is more promising and it could therefore play an important role in participatory policy exercises such as public consultations. A number of promising technical improvements to the method's performance are also highlighted

Consultant radiographers: Profile of the first generation

International Nuclear Information System (INIS)

Forsyth, Lesley J.; Maehle, Valerie

2010-01-01

Aim: The aim of this research is to examine the profile of first generation consultant radiographers: their demographics, educational backgrounds, qualifications and training, career experience and progression, teaching, lecturing and research activities. Method: Participant recruitment was drawn from the Society and College of Radiographers consultant radiographer group. Data collection involved a self-administered paper based and web based questionnaire. Results: Participant response rate of 55% (n = 11). Conclusions: The profile of the first consultant radiographer cohort reflects a diverse and eclectic mix. While some aspects of their development such as educational background, clinical training and skills enhancement are comparable to nurse consultants, clinical experience and employment history show some differences. Commitment to development of expert clinical skills is evident within the profile of the first generation cohort of consultant radiographers however research and leadership training are not strong features.

Consultant radiographers: Profile of the first generation

Energy Technology Data Exchange (ETDEWEB)

Forsyth, Lesley J., E-mail: l.forsyth@rgu.ac.u [School of Health Sciences, Robert Gordon University, Aberdeen, AB10 7QG (United Kingdom); Maehle, Valerie [Faculty of Health and Social Care, Robert Gordon University, Aberdeen, AB10 7QG (United Kingdom)

2010-11-15

Aim: The aim of this research is to examine the profile of first generation consultant radiographers: their demographics, educational backgrounds, qualifications and training, career experience and progression, teaching, lecturing and research activities. Method: Participant recruitment was drawn from the Society and College of Radiographers consultant radiographer group. Data collection involved a self-administered paper based and web based questionnaire. Results: Participant response rate of 55% (n = 11). Conclusions: The profile of the first consultant radiographer cohort reflects a diverse and eclectic mix. While some aspects of their development such as educational background, clinical training and skills enhancement are comparable to nurse consultants, clinical experience and employment history show some differences. Commitment to development of expert clinical skills is evident within the profile of the first generation cohort of consultant radiographers however research and leadership training are not strong features.

The effectiveness of policy on consumer choices for private road passenger transport emissions reductions in six major economies

Science.gov (United States)

Mercure, J.-F.; Lam, A.

2015-06-01

The effectiveness of fiscal policy to influence vehicle purchases for emissions reductions in private passenger road transport depends on its ability to incentivise consumers to make choices oriented towards lower emissions vehicles. However, car purchase choices are known to be strongly socially determined, and this sector is highly diverse due to significant socio-economic differences between consumer groups. Here, we present a comprehensive dataset and analysis of the structure of the 2012 private passenger vehicle fleet-years in six major economies across the World (UK, USA, China, India, Japan and Brazil) in terms of price, engine size and emissions distributions. We argue that choices and aggregate elasticities of substitution can be predicted using this data, enabling us to evaluate the effectiveness of potential fiscal and technological change policies on fleet-year emissions reductions. We provide tools to do so based on the distributive structure of prices and emissions in segments of a diverse market, both for conventional as well as unconventional engine technologies. We find that markets differ significantly between nations, and that correlations between engine sizes, emissions and prices exist strongly in some markets and not strongly in others. We furthermore find that markets for unconventional engine technologies have patchy coverages of varying levels. These findings are interpreted in terms of policy strategy.

Energy futures project : backgrounder for consultation sessions

International Nuclear Information System (INIS)

Bhargava, A.

2006-05-01

The National Energy Board periodically publishes a long-term energy and demand report as part of an ongoing monitoring program. The next report is planned for release in 2007. This background document provided background information to ensure that consultation participants have a common understanding of key issues to be addressed during the cross-country consultations that have been planned before the release of the final version of the report. An outline of the proposed analytical approach was presented, as well as details of major assumptions and scenario storylines. Scenario themes included: economic, energy and environmental sustainability; a security-focused world shaped by war and civil strife; and strong global economic growth fueled by the rapid growth of the Chinese and Indian economies. A methodology overview was provided as well as a reference case. Issues related to energy supply included oil; natural gas liquids; natural gas; and electricity. Issues related to energy demand included the residential sector; the commercial sector; the industrial sector; and the transportation sector. Historical trends and forecasts were outlined using the macroeconomic variable of interest. Supply, demand, and supporting infrastructure across all energy forms within a North American and global context were considered. The impact of environmental management strategies were reviewed, as well as the role of the government in shaping policies. It was concluded that the purpose of the final report is to serve as a standard of references for parties interested in Canadian energy issues and trends as well as to inform decision makers of key risks and uncertainties facing the energy future.9 tabs., 1 fig

Climate Engineering: A Nexus of Ethics, Science and Governance

Science.gov (United States)

Ackerman, T. P.

2015-12-01

Climate engineering (or geoengineering) has emerged as a possible component of a strategy to mitigate global warming. This emergence has produced a novel intersection of atmospheric science, environmental ethics and global governance. The scientific questions of climate engineering, while difficult to answer in their own right, are compounded by ethical considerations regarding whether these questions should be addressed and governance questions of how research and deployment could be managed. In an effort to address this intersection of ideas and provide our students with a rich interdisciplinary experience, we (T. Ackerman and S. Gardiner, both senior professors at the University of Washington) taught a cross-listed course in the Atmospheric Sciences and Philosophy departments. The course attracted 12 students (mostly graduate students but with two upper level undergraduates), with roughly equal representation from environmental sciences, ethics, and public policy disciplines, as well as two post-docs. Our primary goal for the course was to develop a functioning research community to address the core issues at the intersection of science and ethics. In this presentation, we discuss the course structure, identify strategies that were successful (or less so), and describe outcomes. We consider this course to be primarily pedagogical in nature, but we also recognize that many of the students in the class, perhaps even a majority, are intending to pursue careers outside academia in areas of public policy, environmental consulting, etc., which added an extra dimension to our class. Here, we also discuss the possibility of developing and teaching such courses in an academic environment that is stressed financially and increasingly dependent on metrics related to class size and student credit hours.

The transition to hospital consultant

DEFF Research Database (Denmark)

Westerman, Michiel; Teunissen, Pim W.; Jorgensen, Rasmus Lundhus

2013-01-01

Danish and Dutch new consultants' perceptions regarding the transition to consultant were compared to gain insight into this period, particularly the influence of contextual factors concerning the organisation of specialty training and health care therein. Preparation for medical and generic comp...... competencies, perceived intensity and burnout were compared. Additionally, effects of differences in working conditions and cultural dimensions were explored....

The mining engineer as an international consultant; El ingeniero de minas como consultor internacional

Energy Technology Data Exchange (ETDEWEB)

Arias, A. M.

2009-07-01

These notes are a summary of the lecture I had the honor of giving on 5 May 2009, invited by the Higher Council of Mining Engineers of Spain, in the Engineering Institute of Spain. Interventions that, next to mine, were held that day, were integrated into the framework of an organized cycle, in which the different branches of engineering were encouraged to provide an overview of its current occupation. (Author)

Experience of a year of adult hospital dermatology consultations.

Science.gov (United States)

Storan, Eoin R; McEvoy, Marian T; Wetter, David A; El-Azhary, Rokea A; Camilleri, Michael J; Bridges, Alina G; Davis, Mark D P

2015-10-01

Dermatology consultations are frequently requested by inpatient hospital services. As inpatient dermatology services in the USA decline, dermatology hospital consultations are becoming increasingly important. We aim to describe the spectrum of skin diseases encountered and the health care subspecialties requesting dermatology hospital consultations. We performed a retrospective chart review of adult patient (age: ≥18 years) dermatology hospital consultations from January 1 to December 31, 2010. We examined patient demographic characteristics, consultation requesting services, and consultation diagnoses. Among dermatology services, 614 patients had 674 separate inpatient dermatology consultations during 2010. Of these patients, 55.9% were male (mean age: 59 years). In total, 205 consultations (30.4%) were requested by the internal medicine subspecialty, 137 (20.3%) by the hematology and oncology subspecialty, and 93 (13.8%) by the surgical subspecialty. The most common conditions seen by the hospital dermatology consulting service were skin infections (n = 125, 18.5%), dermatitis (n = 120, 17.8%), drug eruptions (n = 87, 12.9%), chronic wounds and ulcers (n = 55, 8.1%), cutaneous neoplasms (n = 39, 5.8%), graft-versus-host disease (n = 37, 5.5%), ecchymosis, purpura simplex or petechia (n = 26, 3.8%), intertrigo (n = 21, 3.1%), and urticaria (n = 20, 3.0%). The majority of consultations conducted by the dermatology hospital consulting service were for the management of common skin diseases, such as cutaneous infections, dermatitis, and drug eruptions. Most consultations were requested by the departments of internal medicine, hematology and oncology, and surgical services. © 2014 The International Society of Dermatology.

Factors influencing the development and implementation of advanced and consultant radiographer practice - A review of the literature

International Nuclear Information System (INIS)

Kelly, Judith; Piper, Keith; Nightingale, Julie

2008-01-01

United Kingdom (UK) government policy, which has focused on modernising the NHS and making it more responsive to patients' needs, has, in fact, created significant service demand. The Department of Health (DoH) committed itself to changing and improving the organisation and delivery of health care through professional role development and blurring of traditional professional boundaries. In 2000, the DoH announced an intention to create consultant allied health professional posts to facilitate career development opportunities for expert and experienced staff. There are currently 31 consultant radiographers in the UK who have been appointed to new posts, and 2 trainees. Such posts are created subject to a formal approval panel process as laid down by the DoH. This paper will begin by outlining the current scope of radiographic consultant practice and advanced clinical roles in the UK. Key factors that have facilitated the development and implementation of such roles will then be explored and discussed. It will also consider what specific factors can inhibit innovative change and whether there appears to be any perceived threats to the current momentum of change

The Environmental Compliance Office at the Idaho National Engineering Laboratory

International Nuclear Information System (INIS)

Cooper, S.C.

1990-01-01

The Idaho Operations Office of the U.S. Department of Energy (DOE-ID) has established an Environmental Compliance Office (ECO) at the Idaho National Engineering Laboratory (INEL). This office has been formed to ensure that INEL operations and activities are in compliance with all applicable environmental state and federal regulations. The ECO is headed by a DOE-ID manager and consists of several teams, each of which is led by a DOE-ID employee with members from DOE-ID, from INEL government contractors, and from DOE-ID consultants. The teams are (a) the negotiated compliance team, (b) the compliance implementation team (CIT), (c) the permits team, (d) the interagency agreement (IAG) team, (e) the consent order and compliance agreement (COCA) oversight team, and (f) the National Environmental Policy Act (NEPA) team. The last two teams were short term and have already completed their respective assignments. The functions of the teams and the results obtained by each are discussed

Canadian National Consultation on Access to Scientific Research Data

Directory of Open Access Journals (Sweden)

Michel Sabourin

2007-06-01

Full Text Available In June 2004, an expert Task Force, appointed by the National Research Council Canada and chaired by Dr. David Strong, came together in Ottawa to plan a National Forum as the focus of the National Consultation on Access to Scientific Research Data. The Forum, which was held in November 2004, brought together more than seventy Canadian leaders in scientific research, data management, research administration, intellectual property and other pertinent areas. This article presents a comprehensive review of the issues, and the opportunities and the challenges identified during the Forum. Complex and rich arrays of scientific databases are changing how research is conducted, speeding the discovery and creation of new concepts. Increased access will accelerate such changes even more, creating other new opportunities. With the combination of databases within and among disciplines and countries, fundamental leaps in knowledge will occur that will transform our understanding of life, the world and the universe. The Canadian research community is concerned by the need to take swift action to adapt to the substantial changes required by the scientific enterprise. Because no national data preservation organization exists, may experts believe that a national strategy on data access or policies needs to be developed, and that a "Data Task Force" be created to prepare a full national implementation strategy. Once such a national strategy is broadly supported, it is proposed that a dedicated national infrastructure, tentatively called "Data Canada", be established, to assume overall leadership in the development and execution of a strategic plan.

Nurse and allied health professional consultants: perceptions and experiences of the role.

Science.gov (United States)

Stevenson, Kay; Ryan, Sarah; Masterson, Abigail

2011-02-01

To explore the perceptions and experiences of nurse and allied health professional consultants and key stakeholders. Nurse and allied health professional consultants' roles were introduced in the United Kingdom in 1999 with defined role criteria and a remit to improve patient outcomes. Although these roles have now existed for over a decade, there is a lack of research as to whether these roles have achieved their intended impact on clinical care. Through an exploration of the experiences of consultant nurses and allied health professionals and key stakeholders who work with these practitioners, a greater understanding of the consultant role can be achieved. Qualitative. A purposive sample of seven non-medical consultants (five nurses, one physiotherapist and a pharmacist) and eight stakeholders took part in focus group interviews. Each focus group was audio-taped and lasted between 1.5-2 hours. Content analysis was used to interpret the data. Four main themes were identified: (1) Role interpretation--core features include clinical practice, leadership, education and research. Debate surrounded the need to incorporate managerial responsibilities into the role. (2) Role implementation required political skills and emotional intelligence. (3) Role impact especially on clinical practice was a major priority for both groups. (4) Challenges included lack of organisational and administrative support. There was consensus amongst the two groups regarding the value of the role, key role functions and skills and the emerging impact on clinical practice. Both groups were able to identify the clinical impact of the role including helping patients manage chronic pain, reducing the need for follow-up appointments and managing emergency admissions. To capture the clinical diversity of the roles, a variety of evaluation strategies should be implemented. © 2011 Blackwell Publishing Ltd.

Introducing the Institute of Physics in Engineering and Medicine (IPEM)

Science.gov (United States)

Keevil, Stephen F.

2014-04-01

profile of the medical physics and bioengineering sectors. We seek to influence science and healthcare policy-makers through responses to consultations, high-level committee representation and policy statements. By providing expert spokespeople, we help to ensure accurate media coverage of IPEM-related issues. For example, in 2012 we contributed to the development of new European Commission regulations on medical implants and diagnostic devices. We also worked with the Science Media Centre to provide a press briefing on the subject that led to informed coverage by national media outlets, including BBC Radio 4's Today programme, The Times and the British Medical Journal. Enhancing science and technology in healthcare IPEM works to uphold the quality, safety and effectiveness of science and technology in healthcare. We do this by influencing healthcare policy and practice, helping to set international standards and guidelines and conducting surveys and audits. Our special interest groups (SIGs) provide specialized expertise on a range of topics (see table 1). For example, the Radiotherapy SIG was recently consulted on the distribution of the UK Department of Health's #23m Radiotherapy Innovation Fund. Table 1. IPEM special interest groups (SIGs). Clinical engineering Diagnostic radiology Informatics and computing Nuclear medicine Radiotherapy Magnetic resonance Radiation protection Physiological measurement Rehabilitation and biomechanics Ultrasound and non-ionizing radiation High-quality education and training We aim to maintain high standards of professional development for healthcare scientists, engineers and technicians. In the UK, we are an important source of accreditation for training centres. We also offer training and other support for trainees, such as the trainee network which enables early career healthcare scientists and engineers to collaborate and support each other. Through IPEM, members can seek professional registration on the Science Council and

Certification ISO 9001 in clinical ethics consultation for improving quality and safety in healthcare.

Science.gov (United States)

Tozzo, Pamela; Mazzi, Anna; Aprile, Anna; Rodriguez, Daniele; Caenazzo, Luciana

2018-03-24

This paper refers to the quality management process of the Laboratory of Clinical Bioethics (LCB) of the University of Padua (Italy), which has obtained the quality certification to ISO 9001:2008, as a Clinical Ethics Support Service. Its activities consist mainly in clinical ethics consultations and training services, addressed to those who are called to decisions with ethical implications in the clinical setting, proposing a structured approach to identify and analyze the ethical issues that may loom in the relationships between health professionals and patients, and participating in their solution. The expected benefits of the application of ISO 9001 were mainly the following: to formalize the procedure adopted for clinical ethics consultation and training, to obtain a controlled management of documents, information and data, to ensure and demonstrate the quality of the provided activities and to make methods and organization publicly available. The main results which have been achieved with the 'quality management project' are summarized as follows: the enunciation of LCB Mission and Quality Policy; the drafting of the procedure by which clinical ethics consultation is provided; the formalization of members' skills and the adoption of relevant process and outcome indicators. Our experience may be useful in promoting accountability for the quality of ethics consultation services. We consider the certification process as a tool for transparent and reliable management of one of the most critical tasks in the current context of healthcare, motivating similar facilities to undertake similar pathways, with the aim to provide quality control on their activities.

Influence of behavioral concerns and early childhood expulsions on the development of early childhood mental health consultation in Colorado.

Science.gov (United States)

Hoover, Sarah D; Kubicek, Lorraine F; Rosenberg, Cordelia Robinson; Zundel, Claudia; Rosenberg, Steven A

2012-05-01

This article examines how the Colorado study Children With Social, Emotional and Behavioral Concerns and the Providers Who Support Them (S.D. Hoover, 2006) was used to advance a statewide agenda for early childhood mental health consultation in Colorado. The study involved a survey of licensed childcare providers throughout the state asking about the behavior of children in their care and their responses to that behavior. Exclusion of children from early care and education settings due to challenging behavior was found to be a significant problem taking a toll on families, children, and early care and education providers. Importantly, results from the survey indicated that the rate of exclusion of children from care due to challenging behavior was lower for family childcare providers who had access to mental health consultation. Recommendations are offered regarding the infrastructure needed to sustain mental health consultation capacity in early care and education settings, and related policies and practices. Copyright © 2012 Michigan Association for Infant Mental Health.

Ethics consultation on demand: concepts, practical experiences and a case study

OpenAIRE

Reiter-Theil, S.

2000-01-01

Despite the increasing interest in clinical ethics, ethics consultation as a professional service is still rare in Europe. In this paper I refer to examples in the United States. In Germany, university hospitals and medical faculties are still hesitant about establishing yet another "committee". One of the reasons for this hesitation lies in the ignorance that exists here about how to provide medical ethics services; another reason is that medical ethics itself is not yet institutionalised at...

42 CFR 493.1419 - Standard; Clinical consultant responsibilities.

Science.gov (United States)

2010-10-01

... Testing Laboratories Performing Moderate Complexity Testing § 493.1419 Standard; Clinical consultant... clinical consultation to the laboratory's clients; (b) Be available to assist the laboratory's clients in... 42 Public Health 5 2010-10-01 2010-10-01 false Standard; Clinical consultant responsibilities. 493...

A qualitative study of caregivers' expectations and communication desires during medical consultation for sick children in Uganda.

NARCIS (Netherlands)

Kiguli, S.; Mafigiri, D.; Nakigudde, J.; Dalen, J. Van; Vleuten, C.P.M. van der

2011-01-01

OBJECTIVE: Little data exist on patients' expectations and communication desires during medical consultation in Non-Western settings. We conducted a qualitative study to compare expectations and communication desires of sick children's caregivers at Mulago Hospital, Uganda, to those of patients in

CSchema: A Downgrading Policy Language for XML Access Control

Institute of Scientific and Technical Information of China (English)

Dong-Xi Liu

2007-01-01

The problem of regulating access to XML documents has attracted much attention from both academic and industry communities.In existing approaches, the XML elements specified by access policies are either accessible or inac-cessible according to their sensitivity.However, in some cases, the original XML elements are sensitive and inaccessible, but after being processed in some appropriate ways, the results become insensitive and thus accessible.This paper proposes a policy language to accommodate such cases, which can express the downgrading operations on sensitive data in XML documents through explicit calculations on them.The proposed policy language is called calculation-embedded schema (CSchema), which extends the ordinary schema languages with protection type for protecting sensitive data and specifying downgrading operations.CSchema language has a type system to guarantee the type correctness of the embedded calcula-tion expressions and moreover this type system also generates a security view after type checking a CSchema policy.Access policies specified by CSchema are enforced by a validation procedure, which produces the released documents containing only the accessible data by validating the protected documents against CSchema policies.These released documents are then ready tobe accessed by, for instance, XML query engines.By incorporating this validation procedure, other XML processing technologies can use CSchema as the access control module.

40 CFR 725.17 - Consultation with EPA.

Science.gov (United States)

2010-07-01

... ACT REPORTING REQUIREMENTS AND REVIEW PROCESSES FOR MICROORGANISMS General Provisions and..., ATTN: Biotechnology Notice Consultation. Persons wishing to consult with EPA by telephone should call...

Managing outpatient consultations: from referral to discharge.

Science.gov (United States)

Mitchell, Rachael; Jacob, Hannah; Morrissey, Benita; Macaulay, Chloe; Gomez, Kumudini; Fertleman, Caroline

2017-08-01

Although a great deal of paediatric consultations are not urgent, doctors in training spend so much time providing service for acute conditions that they spend little time focusing on outpatient work before they become a consultant. Engaging clinicians in the managerial aspects of providing clinical care is a key to improving outcomes, and this article addresses these aspects of the outpatient consultation from referral to discharge. We aim to provide doctors in training with a tool to use during their training and their first few years as a consultant, to think about how outpatient work is organised and how it can be improved to maximise patient experience. The non-urgent consultation varies across the world; this article is aimed to be relevant to an international audience. 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/.

Teacher consultation and coaching within mental health practice: classroom and child effects in urban elementary schools.

Science.gov (United States)

Cappella, Elise; Hamre, Bridget K; Kim, Ha Yeon; Henry, David B; Frazier, Stacy L; Atkins, Marc S; Schoenwald, Sonja K

2012-08-01

To examine effects of a teacher consultation and coaching program delivered by school and community mental health professionals on change in observed classroom interactions and child functioning across one school year. Thirty-six classrooms within 5 urban elementary schools (87% Latino, 11% Black) were randomly assigned to intervention (training + consultation/coaching) and control (training only) conditions. Classroom and child outcomes (n = 364; 43% girls) were assessed in the fall and spring. Random effects regression models showed main effects of intervention on teacher-student relationship closeness, academic self-concept, and peer victimization. Results of multiple regression models showed levels of observed teacher emotional support in the fall moderated intervention impact on emotional support at the end of the school year. Results suggest teacher consultation and coaching can be integrated within existing mental health activities in urban schools and impact classroom effectiveness and child adaptation across multiple domains. © 2012 American Psychological Association

The International Consultant: Substance and Culture.

Science.gov (United States)

Fest, Thorrel B.

To function effectively in crosscultural settings, international consultants, development specialists, and trainers should be prepared to examine objectively a number of personal qualities. Problems arise in crosscultural relationships when either the client or the consultant fails to identify objectives, fails to accommodate different views of…

Consulting by Business College Academics: Lessons for Business Communication Courses

Science.gov (United States)

Dave, Anish

2009-01-01

Business communication (BC) is a crucial aspect of management consulting. BC scholars have widely studied the relationship between BC and management consulting, including consulting by BC academics. A limited review of the studies of management consulting, including consulting done by business college academics, hereafter referred to simply as…

A Collaborative Approach to Implement Positive Behavior Support Plans for Children with Problem Behaviors: A Comparison of Consultation versus Consultation and Feedback Approach

Science.gov (United States)

Erbas, Dilek

2010-01-01

The purpose of this study is to compare the effectiveness of consultation alone and consultation plus feedback on the proper use of positive behavior support strategies (PBS) on behaviors of three mothers with children with developmental disabilities. Results indicated that consultation plus feedback was more effective than consultation alone…

[Differences between patients in consultation psychiatry and psychiatric inpatients].

Science.gov (United States)

Unterecker, Stefan; Maloney, Julia; Pfuhlmann, Bruno; Deckert, Jürgen; Warrings, Bodo

2014-05-01

To optimize psychiatric consultation service epidemiological information is needed. We compared data on gender, age and diagnoses of patients in the consultation service to psychiatric inpatients. In psychiatric consultation service patients are older (56.6 vs. 44.9 years, p psychiatric consultation service is contacted more often in cases of organic disorders, for females in adjustment disorders (p psychiatric consultation service is different for males and females with relevance for diagnostic and therapeutic procedures. © Georg Thieme Verlag KG Stuttgart · New York.

20 CFR 404.1616 - Medical or psychological consultants.

Science.gov (United States)

2010-04-01

..., psychological experts employed by or under contract with the State agencies must meet the qualification... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Medical or psychological consultants. 404... Determination Function § 404.1616 Medical or psychological consultants. (a) What is a medical consultant? A...

Improving the utility and effectiveness of the standing consultative commission

International Nuclear Information System (INIS)

Graybeal, S.N.; Krepon, M.

1988-01-01

The Standing Consultative Commission has been an indispensable channel of communication between the superpowers over SALT implementation and compliance. Other channels could have been used for these purposes, but none would have been as ideally suited, or specifically authorized to do so. If something like the SCC did not exist, it would have to be created. In recent years, the SCC has not been a forum of productive exchanges, its jurisdiction has been narrowed, and its reputation tarnished. Nevertheless, new bilateral arms reduction agreements will require effective consultation if they are to be implemented properly and with a minimum of compliance problems. Important lessons can be learned from the experience of the SCC, whether this body is strenghened or new mechanisms are created to perform similar functions for new agreements. The guidelines presented here can help minimize treaty implementation and compliance problems. No suggestions will be of much value, however, if the United States and Soviet Union are ambivalent about affirming the objectives and purposes of past agreements. During periods of strained political relations, negotiations over new agreements rarely proceed smoothly. While the SCC has been somewhat more insulated from the ups and downs of superpower relations, it clearly has not been immune from them. But when political relations between negotiating partners deteriorate to the point where intentions toward existing treaty obligations are called into question, no bilateral compliance mechanism can serve as an effective, problem-solving forum

Options for change in the NHS consultant contract.

Science.gov (United States)

Clarke, R W; Gray, C

The lead negotiators for the management and consultant sides in an NHS trust in northern England responded to debate in their trust about consultant contracts by offering to research the attitudes of their peers towards a variety of contract options. The options tested included the current contract; models already examined in the trust and elsewhere, such as time sensitive and mild performance related contracts; and some more radical and speculative possibilities, including consultants franchising their services to the trust. Beyond the predictable conclusion that consultants would prefer no change while managers desired it, a time sensitive contract emerged as having potential for successful negotiation. On the other hand, neither consultants nor managers favoured a strict performance related contract or a fee for service contract. There was a strong similarity of opinion between the two groups on the relative salary values of the options, though the consultants consistently priced these higher than the managers.

Multiple Compensation Consultants and CEO Pay

NARCIS (Netherlands)

Kabir, Mohammed Rezaul; Minhat, Marizah

The study examines the practice of employing multiple compensation consultants. Data for a sample of UK companies over the period 2003-2006 are analyzed using a variety of econometric methods. We find that CEOs receive higher equity-based pay when firms employ more than one compensation consultant.

Consultants' Corner: System Performance. A Forum.

Science.gov (United States)

Drabenstott, John, Ed.

1986-01-01

Five library consultants address issues that affect online system performance: options in system design that relate to diverse library requirements; criteria that most affect performance; benchmark tests and sizing criteria; minimalizing the risks of miscalculation; and the roles and responsibilities of vendors, libraries, and consultants.…

Web-based E-commerce information consultation system

International Nuclear Information System (INIS)

Zhao Yanping; Xu Rongsheng

2003-01-01

This paper discusses an on-line e-Commerce information consultation system. It uses NLP and Robot techniques, to provide information retrieval more easily for users, and find required content answers not large amount of documents from variety of e-Commerce markets and products information from Internet. It can supplies more convenient, quicker and exact queried results. On the design of the our system framework, we integrate FAQ database with Internet as a knowledge base, which makes user be able to not only query existing EC products information, but also just-in-time information. An intelligent web crawler is integrated to help users to gather specific information from EC sites. We briefly introduce the function and realization of each part of the system and test the system. (authors)

Therapists perspectives on the effective elements of consultation following training.

Science.gov (United States)

Beidas, Rinad S; Edmunds, Julie M; Cannuscio, Carolyn C; Gallagher, Mark; Downey, Margaret Mary; Kendall, Philip C

2013-11-01

Consultation is an effective implementation strategy to improve uptake of evidence-based practices for youth. However, little is known about what makes consultation effective. The present study used qualitative methods to explore therapists perspectives about consultation. We interviewed 50 therapists who had been trained 2 years prior in cognitive-behavioral therapy for child anxiety. Three themes emerged regarding effective elements of consultation: (1) connectedness with other therapists and the consultant, (2) authentic interactions around actual cases, and (3) the responsiveness of the consultant to the needs of individual therapists. Recommendations for the design of future consultation endeavors are offered.

Therapists’ Perspectives on the Effective Elements of Consultation Following Training

Science.gov (United States)

Beidas, Rinad S.; Edmunds, Julie M.; Cannuscio, Carolyn C.; Gallagher, Mark; Downey, Margaret Mary; Kendall, Philip C.

2013-01-01

Consultation is an effective implementation strategy to improve uptake of evidence-based practices for youth. However, little is known about what makes consultation effective. The present study used qualitative methods to explore therapists’ perspectives about consultation. We interviewed 50 therapists who had been trained 2 years prior in cognitive-behavioral therapy for child anxiety. Three themes emerged regarding effective elements of consultation: (1) connectedness with other therapists and the consultant, (2) authentic interactions around actual cases, and (3) the responsiveness of the consultant to the needs of individual therapists. Recommendations for the design of future consultation endeavors are offered. PMID:23435832

77 FR 31348 - Boott Hydropower, Inc.; Notice of Consulting Parties and Agenda for Section 106 Consultation Meeting

Science.gov (United States)

2012-05-25

... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Project No. 2790-055] Boott Hydropower, Inc.; Notice of Consulting Parties and Agenda for Section 106 Consultation Meeting On May 4, 2012, the... Hydropower, Inc. and the Eldred L. Field Hydroelectric Facility Trust (co-licensees for the Lowell...

Psychiatric Consultation and Substance Use Disorders

Directory of Open Access Journals (Sweden)

Sheila Specker

2009-01-01

Full Text Available Background A substantial number of patients in general hospitals will evince substance abuse problems but a majority is unlikely to be adequately identified in the referral-consultation process. This failure may preclude patients from receiving effective interventions for substance use disorders. Objectives 1. To evaluate all referred patients for possible substance use disorders. 2. To ascertain the degree of convergence between patients referred for chemical problems and the corresponding DSM diagnosis. 3. To compare demographic data for substance abusing patients and referrals not so classified. 4. To evaluate conditions concomitant with substance use disorders. Method Consecutive one-year referrals (524 to consultation-liaison psychiatric services were scrutinized for chemically-related problems by psychiatric consultants. Results Of the referrals, 176 met criteria for substance use disorders (SUD (57% alcohol; 25% other drugs; 18% both alcohol and other drugs. Persons diagnosed with SUD tended to be younger, male, non-Caucasian, unmarried, and unemployed. They were more likely to be depressed, have liver and other gastrointestinal problems, and to have experienced traumatic events; they also tended to have current financial difficulties. Most were referred for SUD evaluation by personnel in general medicine and family practice. Following psychiatric consultation, SUD designated patients were referred mainly to substance abuse treatment programs. The only variable related to recommended inpatient versus outpatient services for individuals with SUD was the Global Assessment of Functioning Axis (GAF with persons having lower estimated functioning more likely to be referred for inpatient interventions. Conclusions These data are similar to the results of past studies in this area. Unlike previous investigations in the domain of consultative-liaison psychiatry, financial stressors and specific consultant recommendations were included in data

Psychiatric Consultation and Substance Use Disorders

Directory of Open Access Journals (Sweden)

Sheila Specker

2009-11-01

Full Text Available Background: A substantial number of patients in general hospitals will evince substance abuse problems but a majority is unlikely to be adequately identified in the referral-consultation process. This failure may preclude patients from receiving effective interventions for substance use disorders. Objectives: 1. To evaluate all referred patients for possible substance use disorders. 2. To ascertain the degree of convergence between patients referred for chemical problems and the corresponding DSM diagnosis. 3. To compare demographic data for substance abusing patients and referrals not so classified. 4. To evaluate conditions concomitant with substance use disorders. Method: Consecutive one-year referrals (524 to consultation-liaison psychiatric services were scrutinized for chemically-related problems by psychiatric consultants. Results: Of the referrals, 176 met criteria for substance use disorders (SUD (57% alcohol; 25% other drugs; 18% both alcohol and other drugs. Persons diagnosed with SUD tended to be younger, male, non-Caucasian, unmarried, and unemployed. They were more likely to be depressed, have liver and other gastrointestinal problems, and to have experienced traumatic events; they also tended to have current financial difficulties. Most were referred for SUD evaluation by personnel in general medicine and family practice. Following psychiatric consultation, SUD designated patients were referred mainly to substance abuse treatment programs. The only variable related to recommended inpatient versus outpatient services for individuals with SUD was the Global Assessment of Functioning Axis (GAF with persons having lower estimated functioning more likely to be referred for inpatient interventions. Conclusions: These data are similar to the results of past studies in this area. Unlike previous investigations in the domain of consultative-liaison psychiatry, financial stressors and specific consultant recommendations were included in

Incongruous consultation behaviour: results from a UK-wide population survey

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Elliott Alison M

2012-03-01

Full Text Available Abstract Background Symptom characteristics are strong drivers of care seeking. Despite this, incongruous consultation behaviour occurs and has implications for both individuals and health-care services. The aim of this study was to determine how frequently incongruous consultation behaviour occurs, to examine whether it is more common for certain types of symptoms and to identify the factors associated with being an incongruous consulter. Methods An age and sex stratified random sample of 8,000 adults was drawn from twenty UK general practices. A postal questionnaire was used to collect detailed information on the presence and characteristics of 25 physical and psychological symptoms, actions taken to manage the symptoms, general health, attitudes to symptom management and demographic/socio-economic details. Two types of incongruous consultation behaviour were examined: i consultation with a GP for symptoms self-rated as low impact and ii no consultation with a GP for symptoms self-rated as high impact. Results A fifth of all symptoms experienced resulted in consultation behaviour which was incongruous based on respondents' own rating of the symptoms' impact. Low impact consultations were not common, although symptoms indicative of a potentially serious condition resulted in a higher proportion of low impact consultations. High impact non-consultations were more common, although there was no clear pattern in the type of associated symptoms. Just under half of those experiencing symptoms in the previous two weeks were categorised as an incongruous consulter (low impact consulter: 8.3%, high impact non-consulter: 37.1%. Employment status, having a chronic condition, poor health, and feeling that reassurance or advice from a health professional is important were associated with being a low impact consulter. Younger age, employment status, being an ex-smoker, poor health and feeling that not wasting the GPs time is important were associated with

Telephone consultations on exposure to nuclear disaster radiation

International Nuclear Information System (INIS)

Yashima, Sachiko; Chida, Koichi

2014-01-01

The Fukushima nuclear disaster occurred on March 11, 2011. For about six weeks, I worked as a counselor for phone consultations regarding radiation risk. I analyzed the number of consultations, consultations by telephone, and their changing patterns with elapse of time, to assist with consultations about risk in the future. There were a large number of questions regarding the effects of radiation, particularly with regard to children. We believe that counseling and risk communication are the key to effectively informing the public about radiation risks. (author)

A Bibliometric Analysis of Climate Engineering Research

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Belter, C. W.; Seidel, D. J.

2013-12-01

The past five years have seen a dramatic increase in the number of media and scientific publications on the topic of climate engineering, or geoengineering, and some scientists are increasingly calling for more research on climate engineering as a possible supplement to climate change mitigation and adaptation strategies. In this context, understanding the current state of climate engineering research can help inform policy discussions and guide future research directions. Bibliometric analysis - the quantitative analysis of publications - is particularly applicable to fields with large bodies of literature that are difficult to summarize by traditional review methods. The multidisciplinary nature of the published literature on climate engineering makes it an ideal candidate for bibliometric analysis. Publications on climate engineering are found to be relatively recent (more than half of all articles during 1988-2011 were published since 2008), include a higher than average percentage of non-research articles (30% compared with 8-15% in related scientific disciplines), and be predominately produced by countries located in the Northern Hemisphere and speaking English. The majority of this literature focuses on land-based methods of carbon sequestration, ocean iron fertilization, and solar radiation management and is produced with little collaboration among research groups. This study provides a summary of existing publications on climate engineering, a perspective on the scientific underpinnings of the global dialogue on climate engineering, and a baseline for quantitatively monitoring the development of climate engineering research in the future.

Information giving and receiving in hematological malignancy consultations.

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Alexander, Stewart C; Sullivan, Amy M; Back, Anthony L; Tulsky, James A; Goldman, Roberta E; Block, Susan D; Stewart, Susan K; Wilson-Genderson, Maureen; Lee, Stephanie J

2012-03-01

Little is known about communication with patients suffering from hematologic malignancies, many of whom are seen by subspecialists in consultation at tertiary-care centers. These subspecialized consultations might provide the best examples of optimal physician-patient communication behaviors, given that these consultations tend to be lengthy, to occur between individuals who have not met before and may have no intention of an ongoing relationship, and which have a goal of providing treatment recommendations. The aim of this paper is to describe and quantify the content of the subspecialty consultation in regards to exchanging information and identify patient and provider characteristics associated with discussion elements. Audio-recorded consultations between 236 patients and 40 hematologists were coded for recommended communication practices. Multilevel models for dichotomous outcomes were created to test associations between patient, physician and consultation characteristics and key discussion elements. Discussions about the purpose of the visit and patient's knowledge about their disease were common. Other elements such as patient's preference for his/her role in decision-making, preferences for information, or understanding of presented information were less common. Treatment recommendations were provided in 97% of the consultations and unambiguous presentations of prognosis occurred in 81% of the consultations. Unambiguous presentations of prognosis were associated with non-White patient race, lower educational status, greater number of questions asked, and specific physician provider. Although some communication behaviors occur in most consultations, others are much less common and could help tailor the amount and type of information discussed. Approximately half of the patients are told unambiguous prognostic estimates for mortality or cure. Copyright © 2011 John Wiley & Sons, Ltd.

Construction of a questionnaire measuring outpatients' opinion of quality of hospital consultation departments

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Durieux Pierre

2004-08-01

Full Text Available Abstract Background Few questionnaires on outpatients' satisfaction with hospital exist. All have been constructed without giving enough room for the patient's point of view in the validation procedure. The main objective was to develop, according to psychometric standards, a self-administered generic outpatient questionnaire exploring opinion on quality of hospital care. Method First, a qualitative phase was conducted to generate items and identify domains using critical analysis incident technique and literature review. A list of easily comprehensible non-redundant items was defined using Delphi technique and a pilot study on outpatients. This phase involved outpatients, patient association representatives and experts. The second step was a quantitative validation phase comprised a multicenter study in 3 hospitals, 10 departments and 1007 outpatients. It was designed to select items, identify dimensions, measure reliability, internal and concurrent validity. Patients were randomized according to the place of questionnaire completion (hospital v. home (participation rate = 65%. Third, a mail-back study on 2 departments and 248 outpatients was conducted to replicate the validation (participation rate = 57%. Results A 27-item questionnaire comprising 4 subscales (appointment making, reception facilities, waiting time and consultation with the doctor. The factorial structure was satisfactory (loading >0.50 on each subscale for all items, except one item. Interscale correlations ranged from 0.42 to 0.59, Cronbach α coefficients ranged from 0.79 to 0.94. All Item-scale correlations were higher than 0.40. Test-retest intraclass coefficients ranged from 0.69 to 0.85. A unidimensional 9-item version was produced by selection of one third of the items within each subscale with the strongest loading on the principal component and the best item-scale correlation corrected for overlap. Factors related to satisfaction level independent from departments

The effect of patient satisfaction with pharmacist consultation on medication adherence: an instrumental variable approach

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Gu NY

2008-12-01

Full Text Available There are limited studies on quantifying the impact of patient satisfaction with pharmacist consultation on patient medication adherence. Objectives: The objective of this study is to evaluate the effect of patient satisfaction with pharmacist consultation services on medication adherence in a large managed care organization. Methods: We analyzed data from a patient satisfaction survey of 6,916 patients who had used pharmacist consultation services in Kaiser Permanente Southern California from 1993 to 1996. We compared treating patient satisfaction as exogenous, in a single-equation probit model, with a bivariate probit model where patient satisfaction was treated as endogenous. Different sets of instrumental variables were employed, including measures of patients' emotional well-being and patients' propensity to fill their prescriptions at a non-Kaiser Permanente (KP pharmacy. The Smith-Blundell test was used to test whether patient satisfaction was endogenous. Over-identification tests were used to test the validity of the instrumental variables. The Staiger-Stock weak instrument test was used to evaluate the explanatory power of the instrumental variables. Results: All tests indicated that the instrumental variables method was valid and the instrumental variables used have significant explanatory power. The single equation probit model indicated that the effect of patient satisfaction with pharmacist consultation was significant (p<0.010. However, the bivariate probit models revealed that the marginal effect of pharmacist consultation on medication adherence was significantly greater than the single equation probit. The effect increased from 7% to 30% (p<0.010 after controlling for endogeneity bias. Conclusion: After appropriate adjustment for endogeneity bias, patients satisfied with their pharmacy services are substantially more likely to adhere to their medication. The results have important policy implications given the increasing focus

Sustainability of a Primary Care-Driven eConsult Service.

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Liddy, Clare; Moroz, Isabella; Afkham, Amir; Keely, Erin

2018-03-01

Excessive wait times for specialist appointments pose a serious barrier to patient care. To improve access to specialist care and reduce wait times, we launched the Champlain BASE (Building Access to Specialists through eConsultation) eConsult service in April 2011. The objective of this study is to report on the impact of our multiple specialty eConsult service during the first 5 years of use after implementation, with a focus on growth and sustainability. We conducted a cross-sectional study of all eConsult cases submitted between April 1, 2011 and April 30, 2016, and measured impact with system utilization data and mandatory close-out surveys completed at the end of each eConsult. Impact indicators included time interval to obtain specialist advice, effect of specialist advice on the primary care clinician's course of action, and rate of avoidance of face-to-face visits. A total of 14,105 eConsult cases were directed to 56 different medical specialty groups, completed with a median response time of 21 hours, and 65% of all eConsults were resolved without a specialist visit. We observed rapid growth in the use of eConsult during the study period: 5 years after implementation the system was in use by 1,020 primary care clinicians, with more than 700 consultations taking place per month. This study presents the first in-depth look at the growth and sustainability of the multispecialty eConsult service. The results show the positive impact of an eConsult service and can inform other regions interested in implementing similar systems. © 2018 Annals of Family Medicine, Inc.

Consultation Barriers between Teachers and External Consultants: A Grounded Theory of Change Resistance in School Consultation

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Thornberg, Robert

2014-01-01

The aim of this study, conducted in Sweden, was to investigate the cultural barriers between school personnel (teachers and principals) and nonschool personnel (a resource team), who were external to the school system, regarding consultation about challenging or difficult-to-teach students. Focus groups with teachers, principals, and the resource…

Earthquake engineering development before and after the March 4, 1977, Vrancea, Romania earthquake

International Nuclear Information System (INIS)

Georgescu, E.-S.

2002-01-01

At 25 years since the of the Vrancea earthquake of March, 4th 1977, we can analyze in an open and critical way its impact on the evolution of earthquake engineering codes and protection policies in Romania. The earthquake (M G-R = 7.2; M w = 7.5), produced 1,570 casualties and more than 11,300 injured persons (90% of the victims in Bucharest), seismic losses were estimated at more then USD 2 billions. The 1977 earthquake represented a significant episode of XXth century in seismic zones of Romania and neighboring countries. The INCERC seismic record of March 4, 1977 put, for the first time, in evidence the spectral content of long period seismic motions of Vrancea earthquakes, the duration, the number of cycles and values of actual accelerations, with important effects of overloading upon flexible structures. The seismic coefficients k s , the spectral curve (the dynamic coefficient β r ) and the seismic zonation map, the requirements in the antiseismic design norms were drastically, changed while the microzonation maps of the time ceased to be used, and the specific Vrancea earthquake recurrence was reconsidered based on hazard studies Thus, the paper emphasises: - the existing engineering knowledge, earthquake code and zoning maps requirements until 1977 as well as seismology and structural lessons since 1977; - recent aspects of implementing of the Earthquake Code P.100/1992 and harmonization with Eurocodes, in conjunction with the specific of urban and rural seismic risk and enforcing policies on strengthening of existing buildings; - a strategic view of disaster prevention, using earthquake scenarios and loss assessments, insurance, earthquake education and training; - the need of a closer transfer of knowledge between seismologists, engineers and officials in charge with disaster prevention public policies. (author)

Qualification of contractor/consultant instructors

International Nuclear Information System (INIS)

Hanson, H.D.

1985-01-01

Following a brief discussion of the role of consultant instructors in Public Service Electric and Gas Company's training organization, the qualification process is presented. Consultant instructors are provided with information regarding supervision of the trainees and the instructional process and procedures required. Each individual must have his or her instructional capability, supervisory skills and technical competence verified and documented prior to conducting training independently. Concluding comments describe the overall satisfactory experience with this program

Women Entrepreneurship in the Western Romania. Research Results and Policy Recommendations

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Anca DODESCU

2011-01-01

Full Text Available Starting from the results of the empirical, quantitative, and qualitative research performed in the AntrES project, between 5.01.2009 - 4.01.2011, in the Western Romania, referring to the existence of obvious gender gaps regarding the start up of new businesses and the ownership of the businesses; the characteristics, the motivations, and the difficulties of the women entrepreneurs and potentially enterprising women; the successful women entrepreneurs' perceptions on the sex equality in the field of entrepreneurship - this paper presents arguments and recommendations of specific policies meant to support the potential women entrepreneurship in Romania, as an engine to overcome the economic crisis and to reconnect to the regional development mechanism facilitated by the European Union's regional policy.

Informed decision-making in elective major vascular surgery: analysis of 145 surgeon-patient consultations.

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Etchells, Edward; Ferrari, Michel; Kiss, Alex; Martyn, Nikki; Zinman, Deborah; Levinson, Wendy

2011-06-01

Prior studies show significant gaps in the informed decision-making process, a central goal of surgical care. These studies have been limited by their focus on low-risk decisions, single visits rather than entire consultations, or both. Our objectives were, first, to rate informed decision-making for major elective vascular surgery based on audiotapes of actual physician-patient conversations and, second, to compare ratings of informed decision-making for first visits to ratings for multiple visits by the same patient over time. We prospectively enrolled patients for whom vascular surgical treatment was a potential option at a tertiary care outpatient vascular surgery clinic. We audio-taped all surgeon-patient conversations, including multiple visits when necessary, until a decision was made. Using an existing method, we evaluated the transcripts for elements of decision-making, including basic elements (e.g., an explanation of the clinical condition), intermediate elements (e.g., risks and benefits) and complex elements (e.g., uncertainty around the decision). We analyzed 145 surgeon-patient consultations. Overall, 45% of consultations contained complex elements, whereas 23% did not contain the basic elements of decision-making. For the 67 consultations that involved multiple visits, ratings were significantly higher when evaluating all visits (50% complex elements) compared with evaluating only the first visit (33% complex elements, p decision-making over multiple visits yielded different results than analyzing decision-making for single visits.

Policies and strategies for radioactive waste management

International Nuclear Information System (INIS)

2009-01-01

A policy for spent fuel and radioactive waste management should include a set of goals or requirements to ensure the safe and efficient management of spent fuel and radioactive waste in the country. Policy is mainly established by the national government and may become codified in the national legislative system. The spent fuel and radioactive waste management strategy sets out the means for achieving the goals and requirements set out in the national policy. It is normally established by the relevant waste owner or nuclear facility operator, or by government (institutional waste). Thus, the national policy may be elaborated in several different strategy components. To ensure the safe, technically optimal and cost effective management of radioactive waste, countries are advised to formulate appropriate policies and strategies. A typical policy should include the following elements: defined safety and security objectives, arrangements for providing resources for spent fuel and radioactive waste management, identification of the main approaches for the management of the national spent fuel and radioactive waste categories, policy on export/import of radioactive waste, and provisions for public information and participation. In addition, the policy should define national roles and responsibilities for spent fuel and radioactive waste management. In order to formulate a meaningful policy, it is necessary to have sufficient information on the national situation, for example, on the existing national legal framework, institutional structures, relevant international obligations, other relevant national policies and strategies, indicative waste and spent fuel inventories, the availability of resources, the situation in other countries and the preferences of the major interested parties. The strategy reflects and elaborates the goals and requirements set out in the policy statement. For its formulation, detailed information is needed on the current situation in the country

Factors associated with the number of consultations per dietetic treatment: an observational study

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Tol Jacqueline

2012-09-01

Full Text Available Abstract Background Greater understanding of the variance in the number of consultations per dietetic treatment will increase the transparency of dietetic healthcare. Substantial inter-practitioner variation may suggest a potential to increase efficiency and improve quality. It is not known whether inter-practitioner variation also exists in the field of dietetics. Therefore, the aims of this study are to examine inter-practitioner variation in the number of consultations per treatment and the case-mix factors that explain this variation. Methods For this observational study, data were used from the National Information Service for Allied Health Care (LiPZ. LiPZ is a Dutch registration network of allied health care professionals, including dietitians working in primary healthcare. Data were used from 6,496 patients who underwent dietetic treatment between 2006 and 2009, treated by 27 dietitians working in solo practices located throughout the Netherlands. Data collection was based on the long-term computerized registration of healthcare-related information on patients, reimbursement, treatment and health problems, using a regular software program for reimbursement. Poisson multilevel regression analyses were used to model the number of consultations and to account for the clustered structure of the data. Results After adjusting for case-mix, seven percent of the total variation in consultation sessions was due to dietitians. The mean number of consultations per treatment was 4.9 and ranged from 2.3–10.1 between dietitians. Demographic characteristics, patients’ initiative and patients’ health problems explained 28% of the inter-practitioner variation. Certain groups of patients used significantly more dietetic healthcare compared to others, i.e. older patients, females, the native Dutch, patients with a history of dietetic healthcare, patients who started the treatment on their own initiative, patients with multiple diagnoses, overweight

Why Hire a Consultant if You Already Know What's Best?

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Kaufman, Roger

1996-01-01

Discusses the client-consultant relationship from both sides. Argues that a consulting breakdown can be a chance for both the client and the consultant to grow through negotiation. Lists some basic guidelines for successful consulting relationships. (PEN)

Group Work in Schools: A Process Consultation Approach

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Farouk, Shaalan

2004-01-01

This paper provides a description of how an educational psychologist can consult with groups of teachers mostly in relation to their work with pupils who display emotional behavioural difficulties. The paper includes a review of the work on group consultation in schools, followed by a description of process consultation (Schein, 1988 ) and how the…

Adapting services to the needs of children and families with complex migration experiences: The Toulouse University Hospital's intercultural consultation.

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Sturm, Gesine; Guerraoui, Zohra; Bonnet, Sylvie; Gouzvinski, Françoise; Raynaud, Jean-Philippe

2017-08-01

This article presents the recently created intercultural consultation at the Medical and Psychological Health Care Service (CMP) of the University Hospital la Grave at Toulouse. The approach of the intercultural consultation was elaborated in response to the increasing diversity of children and families using the service in Toulouse. It is also based on local research that indicates the difficulties service providers encounter when trying to establish a solid therapeutic alliance with families with complex migration backgrounds who accumulate different disadvantaging factors. The intercultural consultation adapts existing models of culture-sensitive consultations in child mental health care in France and Canada to the local context in Toulouse. We describe the underlying principles of the intercultural consultation work, the therapeutic and mediation techniques used, and the way the work is integrated into the global service provision of the CMP. The process is illustrated with a case study followed by a discussion of the innovations.

THE IMPORTANCE OF CONSULTING IN CONTEMPORARY BUSINESS MANAGEMENT

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Svetlana Vukotić

2017-07-01

Full Text Available Modern business is characterized by risk and uncertainty, and such an environment is reflected in the decisions taken by managers. On the other hand, management consulting is one of the most important management techniques developed over the last fifty years. The secondary effect of this invention is the rapid development of new frameworks, tools, and techniques improving the operations in a number of companies. Exposure of consulting organizations to varying combinations of business circumstances and experiences of different companies have allowed for the accumulation of valuable knowledge and business experience. From this coupling, or interaction of knowledge and experience of consulting companies, on the one hand and the needs of management companies to recognize their role and hire consultants, on the other hand, developed the importance of financial consulting and auditing. Rational management processes cannot be imagined without reliable information provided by the audit, especially as the strategic management includes the control phase. The importance and relationship between consulting and management in companies that do business according to modern principles is a central topic of consideration in this paper.

Improving access to urologists through an electronic consultation service

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Witherspoon, Luke; Liddy, Clare; Afkham, Amir; Keely, Erin; Mahoney, John

2017-01-01

Introduction Access to specialist services is limited by wait times and geographic availability. Champlain Building Access to Specialist Advice (BASE) has been implemented in our service region to facilitate access to specialists by primary care providers (PCPs). Through a secure web-based system, PCPs are able to send eConsults instead of requesting a formal in-office consultation. Methods Urology eConsults completed through the Champlain BASE service from March 2013 to January 2015 were analyzed. Each consult was characterized in regard to the type of question asked by the referring physician and the clinical content of the referral. Using the mandatory close-out surveys, we analyzed rates of referral avoidance, physician satisfaction, and overall impact on patient care. Results Of 190 eConsultations, 70% were completed in less than 10 minutes. The most common clinical questions related to the interpretation of imaging reports (16%) and tests to choose for investigating a condition (15%). The most common diagnoses were hematuria (13%) and renal mass (8%). In 35% of cases, referral to a urologist had originally been contemplated and was avoided. In 8% of cases, a PCP did not believe a consultation was initially needed, but a referral was ultimately initiated after the eConsultation. Conclusions Our study shows that although certain clinical presentations still require a formal in-person urological consultation, eConsultations can potentially reduce unnecessary clinic visits while identifying patients who may benefit from early urological consultation. Through both these mechanisms, we may improve timely access to urologists. PMID:28798830

Teacher Consultation and Coaching within Mental Health Practice: Classroom and Child Effects in Urban Elementary Schools

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Cappella, Elise; Hamre, Bridget K.; Kim, Ha Yeon; Henry, David B.; Frazier, Stacy L.; Atkins, Marc S.; Schoenwald, Sonja K.

2012-01-01

Objective To examine effects of a teacher consultation and coaching program delivered by school and community mental health professionals on change in observed classroom interactions and child functioning across one school year. Method Thirty-six classrooms within five urban elementary schools (87% Latino, 11% Black) were randomly assigned to intervention (training + consultation/coaching) and control (training only) conditions. Classroom and child outcomes (n = 364; 43% girls) were assessed in the fall and spring. Results Random effects regression models showed main effects of intervention on teacher-student relationship closeness, academic self-concept, and peer victimization. Results of multiple regression models showed levels of observed teacher emotional support in the fall moderated intervention impact on emotional support at the end of the school year. Conclusions Results suggest teacher consultation and coaching can be integrated within existing mental health activities in urban schools and impact classroom effectiveness and child adaptation across multiple domains. PMID:22428941

Opportunities and challenges in developing a whole-of-government national food and nutrition policy: lessons from Australia's National Food Plan.

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Carey, Rachel; Caraher, Martin; Lawrence, Mark; Friel, Sharon

2016-01-01

The present article tracks the development of the Australian National Food Plan as a 'whole of government' food policy that aimed to integrate elements of nutrition and sustainability alongside economic objectives. The article uses policy analysis to explore the processes of consultation and stakeholder involvement in the development of the National Food Plan, focusing on actors from the sectors of industry, civil society and government. Existing documentation and submissions to the Plan were used as data sources. Models of health policy analysis and policy streams were employed to analyse policy development processes. Australia. Australian food policy stakeholders. The development of the Plan was influenced by powerful industry groups and stakeholder engagement by the lead ministry favoured the involvement of actors representing the food and agriculture industries. Public health nutrition and civil society relied on traditional methods of policy influence, and the public health nutrition movement failed to develop a unified cross-sector alliance, while the private sector engaged in different ways and presented a united front. The National Food Plan failed to deliver an integrated food policy for Australia. Nutrition and sustainability were effectively sidelined due to the focus on global food production and positioning Australia as a food 'superpower' that could take advantage of the anticipated 'dining boom' as incomes rose in the Asia-Pacific region. New forms of industry influence are emerging in the food policy arena and public health nutrition will need to adopt new approaches to influencing public policy.

Simulated consultations: a sociolinguistic perspective.

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Atkins, Sarah; Roberts, Celia; Hawthorne, Kamila; Greenhalgh, Trisha

2016-01-15

Assessment of consulting skills using simulated patients is widespread in medical education. Most research into such assessment is sited in a statistical paradigm that focuses on psychometric properties or replicability of such tests. Equally important, but less researched, is the question of how far consultations with simulated patients reflect real clinical encounters--for which sociolinguistics, defined as the study of language in its socio-cultural context, provides a helpful analytic lens. In this debate article, we draw on a detailed empirical study of assessed role-plays, involving sociolinguistic analysis of talk in OSCE interactions. We consider critically the evidence for the simulated consultation (a) as a proxy for the real; (b) as performance; (c) as a context for assessing talk; and (d) as potentially disadvantaging candidates trained overseas. Talk is always a performance in context, especially in professional situations (such as the consultation) and institutional ones (the assessment of professional skills and competence). Candidates who can handle the social and linguistic complexities of the artificial context of assessed role-plays score highly--yet what is being assessed is not real professional communication, but the ability to voice a credible appearance of such communication. Fidelity may not be the primary objective of simulation for medical training, where it enables the practising of skills. However the linguistic problems and differences that arise from interacting in artificial settings are of considerable importance in assessment, where we must be sure that the exam construct adequately embodies the skills expected for real-life practice. The reproducibility of assessed simulations should not be confused with their validity. Sociolinguistic analysis of simulations in various professional contexts has identified evidence for the gap between real interactions and assessed role-plays. The contextual conditions of the simulated

"Nudge" in the clinical consultation--an acceptable form of medical paternalism?

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Aggarwal, Ajay; Davies, Joanna; Sullivan, Richard

2014-04-17

Libertarian paternalism is a concept derived from cognitive psychology and behavioural science. It is behind policies that frame information in such a way as to encourage individuals to make choices which are in their best interests, while maintaining their freedom of choice. Clinicians may view their clinical consultations as far removed from the realms of cognitive psychology but on closer examination there are a number of striking similarities. Evidence has shown that decision making is prone to bias and not necessarily rational or logical, particularly during ill health. Clinicians will usually have an opinion about what course of action represents the patient's best interests and thus may "frame" information in a way which "nudges" patients into making choices which are considered likely to maximise their welfare. This may be viewed as interfering with patient autonomy and constitute medical paternalism and appear in direct opposition to the tenets of modern practice. However, we argue that clinicians have a responsibility to try and correct "reasoning failure" in patients. Some compromise between patient autonomy and medical paternalism is justified on these grounds and transparency of how these techniques may be used should be promoted. Overall the extremes of autonomy and paternalism are not compatible in a responsive, responsible and moral health care environment, and thus some compromise of these values is unavoidable. Nudge techniques are widely used in policy making and we demonstrate how they can be applied in shared medical decision making. Whether or not this is ethically sound is a matter of continued debate but health care professionals cannot avoid the fact they are likely to be using nudge within clinical consultations. Acknowledgment of this will lead to greater self-awareness, reflection and provide further avenues for debate on the art and science of clinical communication.

Policies | College of Engineering & Applied Science

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Transportation Studies Milwaukee Engineer℠ Office of Research Support Strategic Planning Workshops College-Wide systems without prior approval of the CEAS Lab Manager. No food or beverage is allowed under any

Institutional capacity for designing and implementing agricultural and rural development policies and strategies in Nigeria:

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Adebayo, Kolawole; Babu, Suresh Chandra; Rhoe, Valerie

2009-01-01

This study assessed the capacity for designing and implementing agricultural and rural development policies, strategies, and programs in Nigeria. Data for this study were derived from initial consultations at the Federal Ministry of Agriculture and Water Resources (FMAWR), Federal Ministry of Women affairs and Social Development (FMWASD), and the Federal Ministry of Environment (FMEnv) early in 2008. Two consultation workshops were also held, one for relevant staff in the ministries, parastat...

Does bioethics exist?