Polasky, Stephen; Lewis, David J; Plantinga, Andrew J; Nelson, Erik
Many ecosystem services are public goods whose provision depends on the spatial pattern of land use. The pattern of land use is often determined by the decisions of multiple private landowners. Increasing the provision of ecosystem services, though beneficial for society as a whole, may be costly to private landowners. A regulator interested in providing incentives to landowners for increased provision of ecosystem services often lacks complete information on landowners' costs. The combination of spatially dependent benefits and asymmetric cost information means that the optimal provision of ecosystem services cannot be achieved using standard regulatory or payment for ecosystem services approaches. Here we show that an auction that sets payments between landowners and the regulator for the increased value of ecosystem services with conservation provides incentives for landowners to truthfully reveal cost information, and allows the regulator to implement the optimal provision of ecosystem services, even in the case with spatially dependent benefits and asymmetric information.
Kreiner, Claus Thustrup; Verdelin, Nicolaj
There currently exist two competing approaches in the literature on the optimal provision of public goods. The standard approach highlights the importance of distortionary taxation and distributional concerns. The new approach neutralizes distributional concerns by adjusting the non-linear income...... for the optimal level of a public good without imposing strong assumptions on preferences. This formula shows that distortionary taxation may have a role to play as in the standard approach. However, the main determinants of optimal provision are completely different and the traditional formula with its emphasis...
Andersen, Lotte Bøgh; Kristensen, Nicolai; Pedersen, Lene Holm
This article extends the framework of Le Grand (2003, 2010) to encompass responsiveness, and the main argument is that the combination of employee motivation, user capacity, and models of public service provision potentially has serious implications for responsiveness across service areas. Although...... research on employee motivation thrives, especially in the public service motivation (PSM) literature, few studies have investigated user capacity empirically, and we know little about the combination of PSM, user capacity and models of service provision. Analyzing four central service areas (day care......, schools, hospitals, and universities), we find variations in both user capacity and PSM. Taking this variation as a point of departure we discuss what implications different combinations of employee motivation, user capacity, and models of public service provision may have for responsiveness....
Camarinha-Matos, L.M.; Afsarmanesh, H.; Oliveira, A.I.; Ferrada, F.; Hammoudi, S.; Maciaszek, L.A.; Cordeiro, J.; Dietz, J.L.G.
The association of services to manufactured products, leading to service-enhanced products, is an important mechanism for value creation and differentiation. This is particularly relevant in the case of complex, highly customized and long-life products. Suitable servicing in this context typically
Kreiner, Claus Thustrup; Verdelin, Nicolaj
The standard approach to the optimal provision of public goods highlights the importance of distortionary taxation and distributional concerns. A new approach neutralizes distributional concerns by adjusting the income tax schedule. We demonstrate that both approaches are derived from the same...... basic formula. We also take the new approach further by deriving an intuitive formula for the optimal level of public goods, without imposing strong assumptions on preferences. This formula shows that distortionary taxation has a role to play, as in the standard approach. However, the main determinants...
Smith, Chris; van Moorsel, Aad
Uncertainty is an inherent property of open, distributed and multiparty systems. The viability of the mutually beneficial relationships which motivate these systems relies on rational decision-making by each constituent party under uncertainty. Service provision in distributed systems is one such relationship. Uncertainty is experienced by the service provider in his ability to deliver a service with selected quality level guarantees due to inherent non-determinism, such as load fluctuations and hardware failures. Statistical estimators utilized to model this non-determinism introduce additional uncertainty through sampling error. Inability of the provider to accurately model and analyze uncertainty in the quality level guarantees can result in the formation of sub-optimal service provision contracts. Emblematic consequences include loss of revenue, inefficient resource utilization and erosion of reputation and consumer trust. We propose a utility model for contract-based service provision to provide a systematic approach to optimal service provision contract formation under uncertainty. Performance prediction methods to enable the derivation of statistical estimators for quality level are introduced, with analysis of their resultant accuracy and cost.
Kreiner, Claus Thustrup; Verdelin, Nicolaj
There currently exist two competing approaches in the literature on the optimal provision of public goods. The standard approach highlights the importance of distortionary taxation and distributional concerns. The new approach neutralizes distributional concerns by adjusting the non-linear income...... tax, and finds that this reinvigorates the simple Samuelson rule when preferences are separable in goods and leisure. We provide a synthesis by demonstrating that both approaches derive from the same basic formula. We further develop the new approach by deriving a general, intuitive formula...
Dynamic Provisioning for Community Services outlines a dynamic provisioning and maintenance mechanism in a running distributed system, e.g. the grid, which can be used to maximize the utilization of computing resources and user demands. The book includes a complete and reliable maintenance system solution for the large-scale distributed system and an interoperation mechanism for the grid middleware deployed in the United States, Europe, and China. The experiments and evaluations have all been practically implemented for ChinaGrid, and the best practices established can help readers to construc
Griffiths, Marc; King, Simon; Stewart, Rob; Dawson, Gary
The developing nature of nuclear medicine practice highlights the need for an evaluation of the fundamental qualities of a Radiographer working within this discipline. Existing guidelines appear to be in place for clinical technologists working within nuclear medicine. However, limited guidance has been provided for Radiographers practicing within this discipline. This article aims to discuss the fundamental qualities that are considered essential for optimal service delivery, following consultation with various stakeholders. Areas such as technical expertise and knowledge, appropriate use of imaging equipment and current models of safe working practice will be discussed. Patient care and ethical considerations will also be evaluated, along with some core recommendations for future advanced practice.
van der Laan, G.; Ruys, P.H.M.; Talman, A.J.J.
This paper deals with the optimal provision of infrastructure by means of public-private partnership contracts.In the economic literature infrastructure is characterized as a large, indivisible and non-rival capital good that produces services for its users.Users can be both consumers and producers.
Forensic mental health services: Current service provision and planning for a prison mental health service in the Eastern Cape. Kiran Sukeri, Orlando A. Betancourt, Robin Emsley, Mohammed Nagdee, Helmut Erlacher ...
Full Text Available This article deals with the methods of services provision in Slovak towns. It addresses decision-making concerning selected services provision, based on a transaction cost economic model. The article looks at five types of services from that point of view. These are core services, i.e., services that are provided in most Slovak towns, thereby allowing outcomes of decision-making to be compared, and services which can be outsourced according to transaction cost theory. Findings partially confirm the hypothesis: Slovak towns do outsource, though “insourcing” moderately prevails. However, a comparison of several research studies in the area indicates a trend towards higher outsourcing of such local services provision. The findings show that public bodies do not always select the most suitable methods of services provision, as suggested by the transaction costs theory (the Brown-Potoski model. This indicates that it is not only economic models that influence decision-making concerning the organization of services provision in the Slovak towns.
Camarinha-Matos, L.M.; Afsarmanesh, H.; Oliveira, A.I.; Ferrada, F.; Hammoudi, S.; Cordeiro, J.; Maciaszek, L.A.; Filipe, J.
The notion of service-enhanced product, representing the association of services to manufactured products, offers an important mechanism for value creation and product differentiation. This is particularly relevant in the case of complex, highly customized and long-life products. Provision of
Bailo, Daniele; Jeffery, Keith G.; Atakan, Kuvvet; Harrison, Matt
EPOS is now in IP (implementation phase) after a successful PP (preparatory phase). EPOS consists of essentially two components, one ICS (Integrated Core Services) representing the integrating ICT (Information and Communication Technology) and many TCS (Thematic Core Services) representing the scientific domains. The architecture developed, demonstrated and agreed within the project during the PP is now being developed utilising co-design with the TCS teams and agile, spiral methods within the ICS team. The 'heart' of EPOS is the metadata catalog. This provides for the ICS a digital representation of the TCS assets (services, data, software, equipment, expertise…) thus facilitating access, interoperation and (re-)use. A major part of the work has been interactions with the TCS. The original intention to harvest information from the TCS required (and still requires) discussions to understand fully the TCS organisational structures linked with rights, security and privacy; their (meta)data syntax (structure) and semantics (meaning); their workflows and methods of working and the services offered. To complicate matters further the TCS are each at varying stages of development and the ICS design has to accommodate pre-existing, developing and expected future standards for metadata, data, software and processes. Through information documents, questionnaires and interviews/meetings the EPOS ICS team has collected DDSS (Data, Data Products, Software and Services) information from the TCS. The ICS team developed a simplified metadata model for presentation to the TCS and the ICS team will perform the mapping and conversion from this model to the internal detailed technical metadata model using (CERIF: a EU recommendation to Member States maintained, developed and promoted by euroCRIS www.eurocris.org ). At the time of writing the final modifications of the EPOS metadata model are being made, and the mappings to CERIF designed, prior to the main phase of (meta
Bennedsen, Morten; Schultz, Christian
We analyze the economic consequences of strategic delegation of the right to decide between public or private provision of governmental service and/or the authority to negotiate and renegotiate with the chosen service provider. Our model encompass both bureaucratic delegation from a government...... contracts. The bargaining effect improves the bargaining position vis a vis a private firm with market power and leads to a lower price for the service...
Karen H. Fung
Conclusion: The majority of the educational institutions teach wheelchair education; however, there is great variability in what and how it is taught and evaluated. The results demonstrate the need for more in-depth investigation regarding the integration process of wheelchair education in educational institutions, with the ultimate goal of improving wheelchair service provision worldwide.
Bingham, Lisa; Straatsma, Menno; Karssenberg, Derek
Attributing monetary value to ecosystem services for decision-making has become more relevant as a basis for decision-making. There are a number of problematic aspects of the calculations, including consistency of economy represented (e.g., purchasing price, production price) and determining which ecosystem subservices to include in a valuation. While several authors have proposed methods for calculating ecosystem services and calculations are presented for global and regional studies, the calculations are mostly broken down into biomes and regions without showing spatially explicit results. The key to decision-making for governments is to be able to make spatial-based decisions because a large spatial variation may exist within a biome or region. Our objective was to compute the spatial distribution of global ecosystem services based on 89 subservices. Initially, only the provisioning ecosystem service category is presented. The provisioning ecosystem service category was calculated using 6 ecosystem services (food, water, raw materials, genetic resources, medical resources, and ornaments) divided into 41 subservices. Global data sets were obtained from a variety of governmental and research agencies for the year 2005 because this is the most data complete and recent year available. All data originated either in tabular or grid formats and were disaggregated to 10 km cell length grids. A lookup table with production values by subservice by country were disaggregated over the economic zone (either marine, land, or combination) based on the spatial existence of the subservice (e.g. forest cover, crop land, non-arable land). Values express the production price in international dollars per hectare. The ecosystem services and the ecosystem service category(ies) maps may be used to show spatial variation of a service within and between countries as well as to specifically show the values within specific regions (e.g. countries, continents), biomes (e.g. coastal, forest
Whitfield, Lindsay; Hirvi, Marja
The politics of public-service delivery continues to be neglected under the supposedly more context-sensitive post-Washington Consensus. Using interviews and documentary evidence from Ghana, this article provides an account of the networks of political interference and informal practices in Ghana......'s public water utility. It argues that, in order to understand why private-sector participation succeeds or fails and why similar arrangements have different outcomes across developing countries, we need to examine the effects of the informal institutional context, particularly the country......-specific political settlement in which public-service provision operates....
Rygg, Knut Helge
The scalability of an information system describes the relationship between system ca-pacity and system size. This report studies the scalability of Microsoft Lync Server 2010 in order to provide guidelines for provisioning hardware resources. Optimal pro-visioning is required to reduce both deployment and operational costs, while keeping an acceptable service quality.All Lync servers in the test setup are virtualizedusingVMware ESXi 5.0 and the system runs on a Cisco Unified Computing System...
McWalter, Kirsty; Hasegawa, Lianne; Au, Sylvia Mann
Guam's geographic isolation and lack of community resources have resulted in unique healthcare needs. In 2006, the Western States Genetic Services Collaborative (WSGSC) conducted a genetics needs assessment and found that professional development is limited, families lack access to genetic services, and improved coverage of genetic testing is needed. With funding from the WSGSC, a Guam genetics outreach clinic was established and staffed by genetic counselors and a medical geneticist from Hawaii. Four clinics have been held to date. Although several challenges have been encountered, including minimal coverage of genetic testing by Guam insurance companies, limited referrals for families with private insurance, and inappropriate referral indications, the outreach clinic has been successful at increasing access to genetic services and improving professional development. With more collaborative work by staff from Guam, Hawaii, and the WSGSC, provision and reimbursement of genetic services and testing will continue to improve.
EU policies for rural development stress the importance of investments rather than subsidies and aim at integrating different sectoral policies in order to improve the coherence and effectiveness of public expenditure. Policies also emphasize a place-based approach for rural development and thereby...... hierarchies and considering local resources and place bound potentials. This paper draws on a study of rural municipalities in Denmark examining how service adjustments e.g. closing of local schools are managed by rural municipalities and local communities. The paper further discusses whether rural...... municipalities can plan strategically, manage service provision and support place bound potential in rural communities in light of a competitive framework for local development....
Full Text Available Service discovery technologies are exploited to enable services to advertise their existence in a dynamic way and can be discovered, configured and used by other devices with minimum of manual efforts. Automatic service discovery plays an important role in future network scenarios. Service discovery in distributed environment is difficult that too if the availability information of the services cannot be in a centralized node. The complexity is increased even further in the case of MANETs in which there will not be central intelligence also, the nodes involved may be on the move. The mobility issue leads to the situation of uncertainty about the service availability of the service provider. In this paper we propose a decentralized discovery mechanism. The basic idea is, distributing service information along with the availability metrics to the nodes. The metrics will give us the information to evaluate the goodness of the service provider. Every node will form multi-layered overlays of service providers sorted based on the metrics. When we send a query, each node will identify the service provider from the overlay with the good metric among the available providers (i.e. the one in the first position in the overlay. We define the message structures and methods needed for this proposal. The simulation result shows that in the high mobile environment too we could have a better convergence. We believe that the architecture presented here is a necessary component of any service provision framework.
Demchenko, Y.; Ngo, C.; de Laat, C.; Lopez, D.R.; Morales, A.; García-Espín, J.A.; Pearson, S.; Yee, G.
This chapter discusses conceptual issues, basic requirements and practical suggestions for designing dynamically configured security infrastructure provisioned on demand as part of the cloud-based infrastructure. This chapter describes general use cases for provisioning cloud infrastructure services
Godard, Béatrice; Kääriäinen, Helena; Kristoffersson, Ulf; Tranebjaerg, Lisbeth; Coviello, Domenico; Aymé, Ségolène
This paper examines the professional and scientific views on the social, ethical and legal issues that impact on the provision of genetic services in Europe. Many aspects have been considered, such as the definition and the aims of genetic services, their organization, the quality assessment, public education, as well as the partnership with patients support groups and the multicultural aspects. The methods was primarily the analysis of professional guidelines, legal frameworks and other documents related to the organization of genetic services, mainly from Europe, but also from USA and international organizations. Then, the method was to examine the background data emerging from an updated report produced by the Concerted Action on Genetic Services in Europe, as well as the issues debated by 43 experts from 17 European countries invited to an international workshop organized by the European Society of Human Genetics Public and Professional Policy Committee in Helsinki, Finland, 8 and 9 September 2000. Some conclusions were identified from the ESHG workshop to arrive at outlines for optimal genetic services. Participants were concerned about equal accessibility and effectiveness of clinical genetic services, quality assessment of services, professional education, multidisciplinarity and division of tasks as well as networking. Within European countries, adherence to the organizational principles of prioritization, regionalization and integration into related health services would maximize equal accessibility and effectiveness of genetic actions. There is a need for harmonization of the rules involved in financial coverage of DNA tests in order to make these available to all Europeans. Clear guidelines for the best practice will ensure that the provision of genetic services develops in a way that is beneficial to its customers, be they health professionals or the public, especially since the coordination of clinical, laboratory and research perspectives within a
Adherence to the policy guidelines and standards is necessary for family planning services. We compared public and private facilities in terms of provision of family planning services. We analyzed data from health facility questionnaire of the 2006 Tanzania Service Provision Assessment survey, based on 529 health ...
This publication is a code of practice for the provision or radiological protection services for establishments in which, or in part of which, work is primarily with radiation sources. It was prepared with the help of an international panel of experts and representatives of international organizations which have an interest in this field and was promulgated by the Director General of the Agency under the authority of the Board of Governors of the Agency as a code of practice in the framework of the Agency's Safety Standards. The Board of Governors also authorized the Director General to recommend to Member States that the code of practice be taken into account in the formulation of national regulations or recommendations. The Appendix to the code contains a number of examples of the organization of radiological protection services that have been provided by the members of the panel of experts. These examples do not form a part of the code of practice, but are intended to illustrate the methods of organization which have been adopted in different countries.
Full Text Available Cloud computing is currently emerging as an ever-changing, growing paradigm that models “everything-as-a-service.” Virtualised physical resources, infrastructure, and applications are supplied by service provisioning in the cloud. The evolution in the adoption of cloud computing is driven by clear and distinct promising features for both cloud users and cloud providers. However, the increasing number of cloud providers and the variety of service offerings have made it difficult for the customers to choose the best services. By employing successful service provisioning, the essential services required by customers, such as agility and availability, pricing, security and trust, and user metrics can be guaranteed by service provisioning. Hence, continuous service provisioning that satisfies the user requirements is a mandatory feature for the cloud user and vitally important in cloud computing service offerings. Therefore, we aim to review the state-of-the-art service provisioning objectives, essential services, topologies, user requirements, necessary metrics, and pricing mechanisms. We synthesize and summarize different provision techniques, approaches, and models through a comprehensive literature review. A thematic taxonomy of cloud service provisioning is presented after the systematic review. Finally, future research directions and open research issues are identified.
Whaiduzzaman, Md; Haque, Mohammad Nazmul; Rejaul Karim Chowdhury, Md; Gani, Abdullah
Cloud computing is currently emerging as an ever-changing, growing paradigm that models "everything-as-a-service." Virtualised physical resources, infrastructure, and applications are supplied by service provisioning in the cloud. The evolution in the adoption of cloud computing is driven by clear and distinct promising features for both cloud users and cloud providers. However, the increasing number of cloud providers and the variety of service offerings have made it difficult for the customers to choose the best services. By employing successful service provisioning, the essential services required by customers, such as agility and availability, pricing, security and trust, and user metrics can be guaranteed by service provisioning. Hence, continuous service provisioning that satisfies the user requirements is a mandatory feature for the cloud user and vitally important in cloud computing service offerings. Therefore, we aim to review the state-of-the-art service provisioning objectives, essential services, topologies, user requirements, necessary metrics, and pricing mechanisms. We synthesize and summarize different provision techniques, approaches, and models through a comprehensive literature review. A thematic taxonomy of cloud service provisioning is presented after the systematic review. Finally, future research directions and open research issues are identified.
The evolution of Cloud Computing brings advantages to both customers and service providers to utilize and manage computing and network resources more efficiently with virtualization, service-oriented architecture technologies, and automated on-demand resource provisioning. However, these advantages
... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Provision of services. 586.406 Section 586.406 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE... & MONTENEGRO) KOSOVO SANCTIONS REGULATIONS Interpretations § 586.406 Provision of services. (a) Except as...
Wen, B.; Luo, Z.; Liang, P.
Software as a service(SaaS), we are moving to the age of service-oriented software engineering(SOSE). But for the goal of services computing, namely on-demand service, it has not been able to achieved by far, especially the active provisioning approach for services resource. In view of these facts
... Against Tax § 1.42-11 Provision of services. (a) General rule. The furnishing to tenants of services other... for purposes of section 42(g). (b) Services that are optional—(1) General rule. A service is optional... low-income building with a common dining facility, the cost of meals is not included in gross rent for...
A narrow technocentric focus on a few favored ecosystem services (generally provisioning services) has led to ecosystem degradation globally, including catchment systems and their capacities to support human well-being. Increasing recognition of the multiple benefits provided by ecosystems is slowly being translated into policy and some areas of practice, although there remains a significant shortfall in the incorporation of a systemic perspective into operation management and decision-making tools. Nevertheless, a range of ecosystem-based solutions to issues as diverse as flooding and green space provision in the urban environment offers hope for improving habitat and optimization of beneficial services. The value of catchment ecosystem processes and their associated services is also being increasingly recognized and internalized by the water industry, improving water quality and quantity through catchment land management rather than at greater expense in the treatment costs of contaminated water abstracted lower in catchments. Parallel recognition of the value of working with natural processes, rather than "defending" built assets when catchment hydrology is adversely affected by unsympathetic upstream development, is being progressively incorporated into flood risk management policy. This focus on wider catchment processes also yields a range of cobenefits for fishery, wildlife, amenity, flood risk, and other interests, which may be optimized if multiple stakeholders and their diverse value systems are included in decision-making processes. Ecosystem services, particularly implemented as a central element of the ecosystem approach, provide an integrated framework for building in these different perspectives and values, many of them formerly excluded, into commercial and resource management decision-making processes, thereby making tractable the integrative aspirations of sustainable development. This can help redress deeply entrenched inherited assumptions
Full Text Available The article highlights the implementation of outsourcing as a mean of service for security provision. Analysis is performed to describe the current issues affecting the management decision in favor of outsourcing. Investigation covers the processes of physical, information and economical security. The main recommendations to use outsourcing for security provision are described in the conclusion.
Pedersen, John Storm; Wilkinson, Adrian
The digital society has been announced and subconsequently, the digital welfare state. The digital society and the digital welfare state changes the provision of welfare services to the citizens as end-users. The article analyses how....
Nunes, João Pedro; Naranjo Quintanilla, Paula; Santos, Juliana Marisa; Serpa, Dalila; Carvalho-Santos, Cláudia; Rocha, João; Keizer, Jan Jacob; Keesstra, Saskia Deborah
Mediterranean landscapes have experienced extensive abandonment and reforestation in recent decades, which should have improved the provision of hydrological services such as flood mitigation, soil erosion protection and water quality regulation. However, these forests are fire-prone, and the
Demchenko, Y.; Ngo, C.; de Laat, C.; Wlodarczyk, T.W.; Rong, C.; Ziegler, W.
Providing consistent security services in on-demand provisioned Cloud infrastructure services is of primary importance due to multi-tenant and potentially multi-provider nature of Clouds Infrastructure as a Service (IaaS) environment. Cloud security infrastructure should address two aspects of the
... 351.511 Customs Duties INTERNATIONAL TRADE ADMINISTRATION, DEPARTMENT OF COMMERCE ANTIDUMPING AND... services. (a) Benefit—(1) In general. In the case where goods or services are provided, a benefit exists to... import duties. (b) Time of receipt of benefit. In the case of the provision of a good or service, the...
Mehmeri, Victor; Wang, Xi; Basu, Shrutarshi
We showcase demonstrations of “program & compile” styled optical networking as well as open platforms & standards based NFV service provisioning using a proof-of-concept implementation of the Software-Programmed Networking Operating System (SPN OS).......We showcase demonstrations of “program & compile” styled optical networking as well as open platforms & standards based NFV service provisioning using a proof-of-concept implementation of the Software-Programmed Networking Operating System (SPN OS)....
Ogunduyile, O.O.; Olugbara, O.O.; Lall, M.
This paper reports on the development of a wearable system using wireless biomedical sensors for ubiquitous healthcare service provisioning. The prototype system is developed to address current healthcare challenges such as increasing cost of services, inability to access diverse services, low quality services and increasing population of elderly as experienced globally. The biomedical sensors proactively collect physiological data of remote patients to recommend diagnostic services. The prot...
van Weert, K.; Dhaene, J.; Goovaerts, M.
In Dhaene et al. (2005), multiperiod portfolio selection problems are discussed, using an analytical approach to find optimal constant mix investment strategies in a provisioning or a savings context. In this paper we extend some of these results, investigating some specific, real-life situations.
van Weert, K.; Dhaene, J.; Goovaerts, M.
In Dhaene et al. (2005), multiperiod portfolio selection problems are discussed, using an analytical approach to find optimal constant mix investment strategies in a provisioning or savings context. In this paper we extend some of these results, investigating some specific, real-life situations. The
In this paper the theory of rank-dependent expected utility (RDEU) is substituted for the theory of expected utility (EU) in a model of optimal provision of public goods. The substitution generalizes the Samuelson rule, previously modified to include deadweight loss and tax evasion loss.
Full Text Available Context: Diagnostic services have a very important role to play in medical decision-making, which have an impact on the nation′s health status. The understanding of Indian diagnostic services provisioning has certain literature gaps. Aims: This study focused on understanding the functioning of provision of diagnostic services by Indian diagnostic laboratories. Materials and Methods: Exploratory field visits and literature review were used as tools to understand the Indian health system. Results: Indian diagnostic laboratory can be classified into various categories based on the type of services provided and governance. The difference in their financing, resources, quality assurance of services and patient access to services was found in these different laboratories. Conclusions: It was concluded from the study that patient′s access to laboratory services is affected by the functioning of laboratories in terms of governance, financing, resources, quality assurance of services and patient services.
This report summarises the findings of a study undertaken to investigate the potential for establishing ancillary service markets at the distribution level in the UK. Existing arrangements for ancillary service markets globally, the design of these markets, regulatory and legislative changes that may be required, different forms of distributed generation (DG), and prospects of increasing the connection to the distributed network are examined along with commercial frameworks and technical procedures, infrastructure requirements, and the effects on different market participants. The scope for new ancillary services at the distribution level, ancillary services from DG, the prospects for DG, commercial and technical aspects, and impact assessments are reviewed.
This report summarises the findings of a study undertaken to investigate the potential for establishing ancillary service markets at the distribution level in the UK. Existing arrangements for ancillary service markets globally, the design of these markets, regulatory and legislative changes that may be required, different forms of distributed generation (DG), and prospects of increasing the connection to the distributed network are examined along with commercial frameworks and technical procedures, infrastructure requirements, and the effects on different market participants. The scope for new ancillary services at the distribution level, ancillary services from DG, the prospects for DG, commercial and technical aspects, and impact assessments are reviewed
Ndyetabula, Daniel; Temu, Andrew E.
The aim of at investigating innovations related to financial services for the agri-bussiness sector, suing examples from Tanzania......The aim of at investigating innovations related to financial services for the agri-bussiness sector, suing examples from Tanzania...
Carlos Arturo Meza Carvajalino
Full Text Available This document studies the theoretical foundations, the different controversies regarding the health service and the conceptions adopted from the hypotheses related to the market efficiency in the provision of a public service and the consequent market failures. The author thinks that when the health public service was delegated to the market in Colombia they originated failures in the competition, externalities, preference goods and services, asymmetry and redistribution, among the most relevant ones.
Caba, Cosmin Marius; Soler, José
One of the applicability areas of SDN is for creating services for dynamic provisioning of network resources with strict QoS requirements. The research available in this field focuses mainly on the service logic implemented over the functionality of the SDN Controller (SDNC). However, there is much...... to be covered regarding the specific mechanisms used by the SDNC to enforce the QoS in the data plane devices. To this end, the current paper proposes a data plane QoS architecture, together with the invariants that have to be maintained by the SDNC in order to ensure predictable QoS for the network services....... More specifically, the paper will look into on demand provisioning of Virtual Circuits (VCs) with specific QoS, based on the SDN paradigm. The aim is to analyze and compare the strategies for network resources management for two cases: a coarse granular and a fine granular VC provisioning service...
This study discussed internet, the services and the uses, it can be put to in the provision of library services, or in an information centre. Literature search was used to elicit information for this study. The results revealed that whenever internet intervenes in library operations, these is bridge in time, space, minimized cost and ...
Ngo, C.; Membrey, P.; Demchenko, Y.; de Laat, C.
Cloud computing is developing as a new wave of ICT technologies, offering a common approach to on-demand provisioning computation, storage and network resources which are generally referred to as infrastructure services. Most of currently available commercial Cloud services are built and organized
You, Shi; Træholt, Chresten; Poulsen, Bjarne
This paper develops a generic optimization model that explores the difficulty met by Electric Energy Storage (EES) systems when economic dispatch for multiple-service provision is requested. Such a model is further used to investigate the economic performance of an EES system which meets the 10...
Rolls, L; Payne, S
The purpose of the study was to identify the location, range and type of childhood bereavement service provision in the UK. A questionnaire was mailed to 127 services who were either solely dedicated to childhood bereavement or who offered a service within the range of work of a host organization and for which there was a supporting organizational structure. Responses were received from 108 services (a response rate of 85%). The findings identified that 85% of childhood bereavement services are located in the voluntary sector; 14% are dedicated childhood bereavement services, while 86% are offered as part of a host organization. Forty-four per cent of host organizations are hospices. The majority of services (73%) relied on both paid and unpaid staff, with 11% relying entirely on paid staff and 14% of services relying entirely on unpaid staff. The interventions offered ranged from individual family work (86%), individual child work (62%), groupwork with families (53%) and groupwork with children (45%). In addition, services offered prebereavement support (64%), a 'drop-in' service (17%), information and advice (95%), training (32%) and the provision of resources (88%). As well as offering a service to children and their families, 74% of childhood bereavement services provided a service to 'secondary users', such as schools (66%), the emergency services (28%) and other professionals (63%). In terms of funding, 12% of services relied solely on external sources of funding, including donations, legacies, revenue from the host organization or grants, while 12% of services relied solely on internal sources of funding, including fundraising and training. The majority of services (73%), however, gained income from a range of sources. The study identifies the diversity of provision that has implications for the evaluation of childhood bereavement services.
Demchenko, Y.; Ngo, C.; de Laat, C.; Smari, W.W.; Fox, G.C.
Cloud technologies are emerging as a new way of provisioning virtualised computing and infrastructure services on-demand for collaborative projects and groups. Security in provisioning virtual infrastructure services should address two general aspects: supporting secure operation of the provisioning
Yanovskaya, O; Yanovsky, M; Kharchenko, V; Kor, A; Pattinson, C
The article is an extension of this paper 1 . It describes methods for dealing with reliability and fault tolerance issues in cloud-based datacenters. These methods mainly focus on the elimination of a single point of failure within any component of the cloud infrastructure, availability of infrastructure and accessibility of cloud services. Methods for providing the availability of hardware, software and network components are also presented. The analysis of the actual accessibility of cloud...
Full Text Available Almost every organization has at its centre a database. The database provides support for conducting different activities, whether it is production, sales and marketing or internal operations. Every day, a database is accessed for help in strategic decisions. The satisfaction therefore of such needs is entailed with a high quality security and availability. Those needs can be realised using a DBMS (Database Management System which is, in fact, software for a database. Technically speaking, it is software which uses a standard method of cataloguing, recovery, and running different data queries. DBMS manages the input data, organizes it, and provides ways of modifying or extracting the data by its users or other programs. Managing the database is an operation that requires periodical updates, optimizing and monitoring.
James L. Chamberlain; Gregory E. Frey; C. Denise Ingram; Michael G. Jacobson; Cara Meghan Starbuck Downes
The purpose of this chapter is to describe approaches to calculate a conservative and defensible estimate of the marginal value of forests for non-timber forest products (NTFPs). 'Provisioning" is one of four categories of benefits, or services that ecosystems provide to humans and was described by the Millennium Ecosystem Assessment as 'products...
Overview of the EU acquis related to the free movement of workers and the posting of workers in the frame of the free service provision. The article identifies how the use of the European Union (EU) mobility rules, as formulated by the EU's Posting Directive, has been linked to the temporary
Risk management forms an integral part of the Library's planning and monitoring process and its internal control framework. It is therefore a vital element of good governance and management. This paper discusses the strategies for managing risks in the provision of information services in University Libraries. The concept ...
... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Provision of services. 544.405 Section 544.405 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE..., provide legal, accounting, financial, brokering, freight forwarding, transportation, public relations, or...
... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Provision of services. 541.405 Section 541.405 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE.... persons may not, except as authorized by or pursuant to this part, provide legal, accounting, financial...
... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Provision of services. 537.405 Section 537.405 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE.... persons may not, except as authorized by or pursuant to this part, provide legal, accounting, financial...
... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Provision of services. 594.406 Section 594.406 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE... to this part, provide legal, accounting, financial, brokering, freight forwarding, transportation...
... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Provision of services. 593.405 Section 593.405 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE.... persons may not, except as authorized by or pursuant to this part, provide legal, accounting, financial...
... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Provision of services. 542.405 Section 542.405 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE.... persons may not, except as authorized by or pursuant to this part, provide legal, accounting, financial...
... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Provision of services. 536.406 Section 536.406 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE... authorized by the Office of Foreign Assets Control by or pursuant to this part, provide legal, accounting...
... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Provision of services. 595.406 Section 595.406 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE... Office of Foreign Assets Control by or pursuant to this part, provide legal, accounting, public relations...
... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Provision of services. 548.405 Section 548.405 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE.... persons may not, except as authorized by or pursuant to this part, provide legal, accounting, financial...
... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Provision of services. 587.405 Section 587.405 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE...) Example: U.S. persons may not, except as authorized by or pursuant to this part, provide legal, accounting...
... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Provision of services. 598.406 Section 598.406 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE... legal, accounting, financial, brokering, freight forwarding, transportation, public relations, or other...
... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Provision of services. 547.405 Section 547.405 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE.... persons may not, except as authorized by or pursuant to this part, provide legal, accounting, financial...
Maibritt Pedersen Zari
Full Text Available This paper presents an ecosystem biomimicry methodology for urban design called ecosystem service analysis. Ecosystem services analysis can provide quantifiable goals for urban ecological regeneration that are determined by site specific ecology and climate of an urban area. This is important given the large negative environmental impact that most cities currently have on ecosystems. If cities can provide some of their own ecosystem services, pressure may be decreased on the surrounding ecosystems. This is crucial because healthier ecosystems enable humans to better adapt to the impacts that climate change is currently having on urban built environments and will continue to have in the future. A case study analyzing two ecosystem services (provision of energy and provision of water for an existing urban environment (Wellington, New Zealand is presented to demonstrate how the ecosystem services analysis concept can be applied to an existing urban context. The provision of energy in Wellington was found to be an example of an ecosystem service where humans could surpass the performance of pre-development ecosystem conditions. When analyzing the provision of water it was found that although total rainfall in the urban area is almost 200% higher than the water used in the city, if rainwater harvested from existing rooftops were to meet just the demands of domestic users, water use would need to be reduced by 20%. The paper concludes that although achieving ecological performance goals derived from ecosystem services analysis in urban areas is likely to be difficult, determining site and climate specific goals enable urban design professionals to know what a specific city should be aiming for if it is to move towards better sustainability outcomes.
Rudman, Seth M; Kreitzman, Maayan; Chan, Kai M A; Schluter, Dolph
Evolution is recognized as the source of all organisms, and hence many ecosystem services. However, the role that contemporary evolution might play in maintaining and enhancing specific ecosystem services has largely been overlooked. Recent advances at the interface of ecology and evolution have demonstrated how contemporary evolution can shape ecological communities and ecosystem functions. We propose a definition and quantitative criteria to study how rapid evolution affects ecosystem services (here termed contemporary evosystem services) and present plausible scenarios where such services might exist. We advocate for the direct measurement of contemporary evosystem services to improve understanding of how changing environments will alter resource availability and human well-being, and highlight the potential utility of managing rapid evolution for future ecosystem services. Copyright © 2017 Elsevier Ltd. All rights reserved.
Tsetis, Dimitrios; Uberoi, Raman; Fanelli, Fabrizio; Roberston, Iain; Krokidis, Miltiadis; Delden, Otto van; Radeleff, Boris; Müller-Hülsbeck, Stefan; Szerbo-Trojanowska, Malgorzata; Lee, Michael; Morgan, Robert; Brountzos, Elias; Belli, Anna Maria
Interventional Radiology (IR) is an essential part of modern medicine, delivering minimally invasive patient-focused care, which has been proven to be safe and effective in both elective and emergency settings. The aim of this document is to outline the core requirements and standards for the provision of Interventional Radiological services, including training, certification, manpower, and accreditation. The ultimate challenge will be the adoption of these recommendations by different countries and health economies around the world, in turn ensuring equal access to IR treatments for all patients, the appropriate distribution of resources for IR service provision as well as the continued development of safe and high-quality IR services in Europe and beyond.
Tsetis, Dimitrios, E-mail: firstname.lastname@example.org [University of Crete, Interventional Radiology Unit, Department of Radiology, University Hospital Heraklion, Faculty of Medicine (Greece); Uberoi, Raman, E-mail: email@example.com [John Radcliff Hospital, Radiology Department (United Kingdom); Fanelli, Fabrizio, E-mail: firstname.lastname@example.org [Sapienza – University of Rome, Interventional Radiology Unit, Department of Radiological Sciences (Italy); Roberston, Iain, E-mail: email@example.com [Gartnavel General Hospital, Interventional Radiology Unit (United Kingdom); Krokidis, Miltiadis, E-mail: firstname.lastname@example.org [Cambridge University Hospitals NHS Foundation Trust, Department of Radiology (United Kingdom); Delden, Otto van, E-mail: email@example.com [Academic Medical Center, Department of Radiology (Netherlands); Radeleff, Boris, E-mail: firstname.lastname@example.org [University Hospital of Heidelberg, Department for Diagnostic and Interventional Radiology (Germany); Müller-Hülsbeck, Stefan, E-mail: email@example.com [Ev.-Luth. Diakonissenanstalt zu Flensburg – Zentrum für Gesundheit und Diakonie, Diagnostische u. Interventionelle Radiologie/Neuroradiologie (Germany); Szerbo-Trojanowska, Malgorzata, E-mail: firstname.lastname@example.org [Medical University of Lublin, Interventional Radiology (Poland); Lee, Michael, E-mail: email@example.com [Beaumont Hospital, Department of Radiology (Ireland); Morgan, Robert, E-mail: firstname.lastname@example.org [St George’s Hospital, Department of Radiology (United Kingdom); Brountzos, Elias, E-mail: email@example.com [National and Kapodistrian University of Athens (Greece); Belli, Anna Maria, E-mail: Anna.firstname.lastname@example.org [St George’s Hospital, Department of Radiology (United Kingdom)
Interventional Radiology (IR) is an essential part of modern medicine, delivering minimally invasive patient-focused care, which has been proven to be safe and effective in both elective and emergency settings. The aim of this document is to outline the core requirements and standards for the provision of Interventional Radiological services, including training, certification, manpower, and accreditation. The ultimate challenge will be the adoption of these recommendations by different countries and health economies around the world, in turn ensuring equal access to IR treatments for all patients, the appropriate distribution of resources for IR service provision as well as the continued development of safe and high-quality IR services in Europe and beyond.
Fazri Nur Yusuf
Full Text Available Studies on potentials of feedback over English language teaching seem not to have not been well-revealed, including studies on the use of feedback to improve English pre-service teachers’ competence. The present study investigates to what extent a multimodal feedback can influence pre-service teachers’ teaching, and which teaching aspects are influenced. Twenty five pre-service teachers taking Microteaching Course served as respondents supervised by a course advisor. The data were collected by teacher observation in a rating-scale form, self-appraisal, and interviews. The data were analyzed by using correlated sample t-test and the eight teaching components proposed by Brown (2001. The results showed that after multimodal feedback provision, pre-service teachers indicated an improvement significantly in seven out of eight teaching aspects. The provision of multimodal feedback could improve their teaching competence on preparation, instructional objective elicitation, mastery of instructional materials, use of media, and classroom management, including classroom language. But, the results do not indicate that they perform well on reflection and follow-up due to some reasons. In addition, the results evince that multimodal feedback provision could improve pre-service teachers’ pedagogical competence when the multimodal feedback is integrated with content, interpersonal relationship, and management.
Radovanovic, I.; Ray, A.; Lukkien, J.J.; Chaudron, M.R.V.; Krämer, B.J.; Lin, K.J.; Narasimhan, P.
This paper presents an extension of the IMS software architecture using a service orientation, which provides flexibility of mobile service provisioning. The suggested extension facilitates composition of new mobile services in run-time based on the existing services and enables the end users to
Brennan, D S; Spencer, A J; Szuster, F S
Service provision patterns may be influenced not only by clinical oral health status leading to a diagnosis and treatment plan, but also by other variables such as patient characteristics. The main aim of this study was to investigate whether associations between services provided and patient factors would persist after controlling for the main presenting diagnosis or condition. A random sample of dentists surveyed in 1993-94 provided a response rate of 74%. Private general practitioners recorded service provision data from logs of 1-2 typical days of practice. Caries (26.5%) was the most prevalent diagnosis, followed by recall/maintenance care (19.0%), pulpal/periapical infection (10.9%), and failed restorations (10.4%). Diagnoses were associated with variation in the percentage of patients receiving services in main areas of service, and also with insurance status, sex and age distributions of patients, and type of visit (chi-square; Pservices indicated statistically significant associations with patient characteristics and diagnosis categories. Controlling for diagnosis, uninsured patients and those visiting for emergencies had less favourable service patterns (e.g., higher odds of extractions, but lower odds of preventive and crown and bridge services) compared to patients who had dental insurance or visited for check-ups or other non-emergency dental problems. The influence of these factors on services provided has implications of public health importance in terms of appropriateness of care and social inequality.
Kazanavicius , Egidijus; Imbrasas , Darius; Razukas , Mantas
Part 3: Digital Goods and Products; International audience; “Development and Management Framework of Smart Home Services (SNAPAS)” is an innovative system, which seeks to fill the market niche of Smart Home services and fully complies with the priorities of scientific development approved by the European Parliament and Council. Framework is characterized by an open component-based pluggable architecture, which provides new forms of interactive services in home environments, including the thir...
Francisco José Villar Rojas
Full Text Available This paper studies the way a Local authority can provide a public service of its competence jointly or cooperatively with other public authorities. Specifically, article 12.4 of Directive 2014/24 /EU, on «contracts for the joint provision of public services», is analyzed. Its basis and the conditions that must be fulfilled for its valid use are studied, as it is an exception to the rules on public works contracts. The conclusion is that European law supports and regulates a traditional way of managing local public services.
Li, Ping; Omani, Nina; Chaubey, Indrajeet; Wei, Xiaomei
Drought is one of the most widespread extreme climate events with a potential to alter freshwater availability and related ecosystem services. Given the interconnectedness between freshwater availability and many ecosystem services, including food provisioning, it is important to evaluate the drought implications on freshwater provisioning and food provisioning services. Studies about drought implications on streamflow, nutrient loads, and crop yields have been increased and these variables are all process-based model outputs that could represent ecosystem functions that contribute to the ecosystem services. However, few studies evaluate drought effects on ecosystem services such as freshwater and food provisioning and quantify these services using an index-based ecosystem service approach. In this study, the drought implications on freshwater and food provisioning services were evaluated for 14 four-digit HUC (Hydrological Unit Codes) subbasins in the Upper Mississippi River Basin (UMRB), using three drought indices: standardized precipitation index ( SPI ), standardized soil water content index ( SSWI ), and standardized streamflow index ( SSI ). The results showed that the seasonal freshwater provisioning was highly affected by the precipitation deficits and/or surpluses in summer and autumn. A greater importance of hydrological drought than meteorological drought implications on freshwater provisioning was evident for the majority of the subbasins, as evidenced by higher correlations between freshwater provisioning and SSI 12 than SPI 12. Food provisioning was substantially affected by the precipitation and soil water deficits during summer and early autumn, with relatively less effect observed in winter. A greater importance of agricultural drought effects on food provisioning was evident for most of the subbasins during crop reproductive stages. Results from this study may provide insights to help make effective land management decisions in responding to
Elsaesser, Linda-Jeanne; Bauer, Stephen M
PURPOSE. This article develops a standardised method for assistive technology service (ATS) provision and a logical basis for research to improve health care quality. The method is 'interoperable' across disabilities, disciplines, assistive technology devices and ATSs. BACKGROUND. Absence of a standardised and interoperable method for ATS provision results in ineffective communication between providers, manufacturers, researchers, policy-makers and individuals with disabilities (IWD), a fragmented service delivery system, inefficient resource allocation and sub-optimal outcomes. OBJECTIVES. Synthesise a standardised, interoperable AT service method (ATSM) fully consistent with key guidelines, systems, models and Federal legislation. Express the ATSM using common and unambiguous language. RESULTS. Guidelines, systems, models and Federal legislation relevant to ATS provision are reviewed. These include the RESNA Guidelines for Knowledge and Skills for Provision of Assistive Technology Products and Services (RESNA Guidelines), IMPACT2 model, international classification of functioning, disability and health (ICF) and AT device classification (ATDC). Federal legislation includes the Assistive Technology Act of 2004, Americans with Disabilities Act of 2008 and Social Security Act. Based on these findings, the ATSM is synthesised and translated into common and accessible language. CONCLUSION. ATSM usage will improve communication between stakeholders, service delivery coherence, resource allocation and intervention outcomes.
Loutas, Nikolaos; Giantsiou, Lemonia; Peristeras, Vassilios; Tarabanis, Konstantinos
During the past years, governments have made significant efforts to improve both their internal processes and the services that they provide to citizens and businesses. These led to several successful e-Government applications (e.g., see www.epractice.eu). One of the most popular tools that was used by governments in order to modernize their services and make them accessible is e-Government portals, e.g., (Drigas et al. 2005), (Fang 2002). The main goals of such portals are: To make available complete, easy to understand, and structured information about public services and public administration's modus operandi, which will assist citizens during the service provision process. To facilitate the electronic execution of public services. Nevertheless, most of such efforts did not succeed. Gartner argues that most e-Government strategies have not achieved their objectives and have failed to trigger sustainable government transformation to greater efficiency and citizen-centricity (DiMaio 2007).
Benkner, S; Berti, G; Engelbrecht, G; Fingberg, J; Kohring, G; Middleton, S E; Schmidt, R
The European GEMSS Project is concerned with the creation of medical Grid service prototypes and their evaluation in a secure service-oriented infrastructure for distributed on demand/supercomputing. Key aspects of the GEMSS Grid middleware include negotiable QoS support for time-critical service provision, flexible support for business models, and security at all levels in order to ensure privacy of patient data as well as compliance to EU law. The GEMSS Grid infrastructure is based on a service-oriented architecture and is being built on top of existing standard Grid and Web technologies. The GEMSS infrastructure offers a generic Grid service provision framework that hides the complexity of transforming existing applications into Grid services. For the development of client-side applications or portals, a pluggable component framework has been developed, providing developers with full control over business processes, service discovery, QoS negotiation, and workflow, while keeping their underlying implementation hidden from view. A first version of the GEMSS Grid infrastructure is operational and has been used for the set-up of a Grid test-bed deploying six medical Grid service prototypes including maxillo-facial surgery simulation, neuro-surgery support, radio-surgery planning, inhaled drug-delivery simulation, cardiovascular simulation and advanced image reconstruction. The GEMSS Grid infrastructure is based on standard Web Services technology with an anticipated future transition path towards the OGSA standard proposed by the Global Grid Forum. GEMSS demonstrates that the Grid can be used to provide medical practitioners and researchers with access to advanced simulation and image processing services for improved preoperative planning and near real-time surgical support.
Valdmanis, Vivian; DeNicola, Arianna; Bernet, Patrick
In this paper, we assess the capacity of Florida's public health departments. We achieve this by using bootstrapped data envelopment analysis (DEA) applied to Johansen's definition of capacity utilization. Our purpose in this paper is to measure if there is, theoretically, enough excess capacity available to handle a possible surge in the demand for primary care services especially after the implementation of the Affordable Care Act that includes provisions for expanded public health services. We measure subunit service availability using a comprehensive data source available for all 67 county health departments in the provision of diagnostic care and primary health care. In this research we aim to address two related research questions. First, we structure our analysis so as to fix budgets. This is based on the assumption that State spending on social and health services could be limited, but patient needs are not. Our second research question is that, given the dearth of primary care providers in Florida if budgets are allowed to vary is there enough medical labor to provide care to clients. Using a non-parametric approach, we also apply bootstrapping to the concept of plant capacity which adds to the productivity research. To preview our findings, we report that there exists excess plant capacity for patient treatment and care, but question whether resources may be better suited for more traditional types of public health services.
Sudlow, C. M.; Rodgers, H.; Kenny, R. A.; Thomson, R. G.
Several large trials have shown that the risk of stroke in patients with non-valvar atrial fibrillation is reduced by treatment with warfarin. Implementing this research evidence requires not only an understanding of the trials' results and of the changes that they imply for clinicians' treatment decisions but also an appreciation of the organisation, quantity, and quality of services required to support these changes. Understanding of these implications is crucial for developing services that allow changes in practice to produce reductions in stroke incidence while minimising the risks of treatment. This article considers the developments in service provision that will probably be required to support the changes in clinical practice suggested by the trials' results. These services will be provided largely by doctors, and their development has implications for doctors in both primary and secondary care. Images FIG 1 PMID:7663216
The National Health Service (NHS) in England provides a comprehensive dental service funded largely from taxation but supplemented by co-payments. This paper provides a historical overview of NHS dental services and some personal reflections on the main challenges over the next five years. A narrative review of the literature and some subjective observations and comments. In 2006 there was a radical change to NHS dental services in England; central budgets were capped and general dental practitioners. Dentists who were previously paid on a fee-for-item basis moved to a new contract that required them to hit activity targets to maintain their historical income. This contract was unpopular with dentists and has been criticized for not improving access or quality. A new dental contract has been promised based on capitation. Against this background significant issues have to be addressed including: a rapidly growing gap in between demand and resources and a need to make substantial cost savings across the whole of the NHS; a significant decline in dental need; inequalities in utilisation of dental services; and provision of treatments of doubtful effectiveness. The NHS dental healthcare system faces significant challenges and consideration needs to be given to the consequences of a focus on need rather than demand. Logically this would require a needs-based resource allocation formula and a needs-based approach to service and workforce planning. A move to a needs-led service is a political decision with associated political risks. © 2012 John Wiley & Sons A/S.
... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Service of legal process under provisions of... AND RELATED SERVICES Quasi-Legal Services § 92.92 Service of legal process under provisions of State law. It may be found that a State statue purporting to regulate the service of process in foreign...
... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Provision of services to migrant and seasonal..., DEPARTMENT OF LABOR SERVICES OF THE EMPLOYMENT SERVICE SYSTEM Services for Migrant and Seasonal Farmworkers (MSFWs) § 653.101 Provision of services to migrant and seasonal farmworkers (MSFWs). (a) Each State...
Wicks, K M
This paper illustrates one model of providing an integrated paediatric speech and language therapy service which attempts to meet the demands of both inclusive education and effective early intervention. A move has been made from location-oriented therapy provision to offering children and their families equal opportunities to have appropriate intervention according to need. The model incorporates the philosophy of inclusive education and supports the development of current specialist educational establishments into resource bases of expertise for children with special needs in mainstream schools.
Mustaffa Kamal, Rahayu; Ward, Elizabeth Celeste; Cornwell, Petrea; Sharma, Shobha
The purpose of the current study was to explore infrastructure issues that may be barriers to the establishment and improvement of dysphagia services in Malaysia compared to settings with established dysphagia management services (i.e. Queensland, Australia). A mixed method design incorporating quantitative and qualitative data was used to increase credibility, validity and comprehensiveness of the results. Thirty-eight hospitals (Malaysia = 21, Queensland = 17) participated in Phase 1 (quantitative component) of the study involving completion of an infrastructure checklist by a speech-language pathologist from each hospital regarding availability of networking and communication, staffing and financial support, facilities and documentation of guidelines for dysphagia management. Subsequently, eight sub-samples from each cohort were then involved in Phase 2 (qualitative component) of the study involving a semi-structured interview on issues related to the impact of infrastructure availability or constraints on service provision. The current study reveals that multiple challenges exist with regard to dysphagia services in Malaysian government hospitals compared to Queensland public hospitals. Overall, it was identified that service improvement in Malaysia requires change at a systems and structures level, but also, more importantly, at the individual/personal level, particularly focusing on the culture, behaviour and attitudes among the staff regarding dysphagia services.
Arifin, Nooranida; Hasbollah, Hasif Rafidee; Hanafi, Muhammad Hafiz; Ibrahim, Al Hafiz; Rahman, Wan Afezah Wan Abdul; Aziz, Roslizawati Che
The incidence of lower limb amputation is high across the globe and continues to be a major threat to morbidity and mortality. Consequently, the provision of high quality and effective prosthetics services have been known as an essential component for a successful rehabilitation outcome. In Malaysia, amputation prevalence has been increasing in which several main components of service delivering aspects (such as service intervention, prosthetic personnel) should be anticipated to accommodate for the increasing demand. This article highlights the hurdles experienced in providing prosthetic services in Malaysia from multiple aspects such as financial burden to acquire the prosthesis and lack of expertise to produce quality prosthesis. This paramount issues consequently justify for the urgency to carry out national level survey on the current statistics of lower limb amputation and to ascertain the available workforce to provide a quality prosthetics services. Only with accurate and current information from the national survey, strategies and policies aimed at enhancing the outcome from prosthetics services can be achieved. PMID:29386978
Full Text Available It is necessary to create new knowledge for the development of the economy. The source of new knowledge are research: basic, applied and industrial, which complement each other to form one whole. Each of these research has other sources of financing and other purposes. Due to the large influx of foreign technology to Poland industrial research is not growing as we would expect. To balance this deficiency the Research Institutes may provide services on the world market. It would be advisable to seek the provision of services on the global research market so that it could became a Polish smart specialization. This specialization would include the sale of intellect, which should never run out of customers.
Yun, Tae Sik; Park, Jong Hyuk; Hwang, Eui Youp; Yoo, Sung Soo; Kim, In Hwan
Spare parts, especially safety related items, being used in Korea Nuclear Power Plants are largely from the United States, Canada, France and the like, meaning the inventory policy, stocking and provision, should be influenced by those countries' nuclear industry situation in a direct or indirect manner. As a result of nuclear industry downturn practices, lots of spare supply corporations have gone broke, which gave immediate signals we have to resolve inventory purchases in need. It is known for that nuclear maintenance spare items are particularly composed of many kinds with small quantities, which makes matters worse to Korea nuclear operation company (KHNP) to purchase them. Hence, Korea nuclear business is trying to change its exinventory purchasing paradigm into innovative schemes it did not have to consider in the past. In order to implement a new stocking policy, it should be kept in mind the factors such as not only how much to stock for a smooth operation but also economic point of view. Even though it has done a lot of studies to optimize the inventory stocking level in an academic curiosity, it is not easy to apply the researches in a real world. Since it is so tough job to anticipate when and how large scale even occurs. Hence, it would be thought that the nuclear inventory should be dealt in a different manner from the general manufacturing industry
Barter, S. [Royal College of Radiologists, London (United Kingdom)], E-mail: email@example.com; Drinkwater, K.; Remedios, D. [Royal College of Radiologists, London (United Kingdom)
In 2003 the Royal College of Radiologists Clinical Radiology Audit Sub-Committee began an audit process evaluating the standards of provision of magnetic resonance imaging (MRI) services. This was prompted by the publication of the 2002 Audit Commission Report, which had identified that lack of MRI provision was responsible for more than half of the total waiting times for diagnostic imaging investigations. The audit found that the time from request to report did not meet the standard for cancer staging examinations, but nationally, was within the target set for routine orthopaedic examinations. However, national mean waiting times were longer than recommended for both cancer and orthopaedic MRI. Since then, there has been massive investment in MRI capacity, both from installation of MRI systems in NHS Trusts, and in England, from outsourcing of routine MRI cases through the Department of Health contract with an independent provider. A re-audit in 2006/7 shows that there has been a significant improvement in waiting times for routine orthopaedic examinations, but the position with cancer staging examinations has deteriorated. Control chart methodology shows that underperformance is due to common cause variation, i.e., improvements need to be made to the overall process from receiving the request for MRI to the issue of the report. Follow-up with participating departments demonstrated there were some common themes for underperformance, and suggestions for improvement are made from departments with best performance.
Barter, S.; Drinkwater, K.; Remedios, D.
In 2003 the Royal College of Radiologists Clinical Radiology Audit Sub-Committee began an audit process evaluating the standards of provision of magnetic resonance imaging (MRI) services. This was prompted by the publication of the 2002 Audit Commission Report, which had identified that lack of MRI provision was responsible for more than half of the total waiting times for diagnostic imaging investigations. The audit found that the time from request to report did not meet the standard for cancer staging examinations, but nationally, was within the target set for routine orthopaedic examinations. However, national mean waiting times were longer than recommended for both cancer and orthopaedic MRI. Since then, there has been massive investment in MRI capacity, both from installation of MRI systems in NHS Trusts, and in England, from outsourcing of routine MRI cases through the Department of Health contract with an independent provider. A re-audit in 2006/7 shows that there has been a significant improvement in waiting times for routine orthopaedic examinations, but the position with cancer staging examinations has deteriorated. Control chart methodology shows that underperformance is due to common cause variation, i.e., improvements need to be made to the overall process from receiving the request for MRI to the issue of the report. Follow-up with participating departments demonstrated there were some common themes for underperformance, and suggestions for improvement are made from departments with best performance
Brewka, Lukasz Jerzy
This thesis addresses selected topics of Quality of Service (QoS) provisioning in heterogeneous data networks that construct the communication environment of today's Internet. In the vast range of protocols available in different domains of network infrastructures, a few chosen ones are discussed......, the general UPnPQoS performance was assessed analytically and confirmed by simulations results. The results validate the usability of UPnP-QoS, but some open issues in the specication were identified. As a result of addressing mentioned shortcomings of UPnP-QoS, a few pre-emption algorithms for home gateway...... and discuss also access Passive Optical Network (PON) technologies, a GMPLS controlled Ten Gigabit Passive Optical Network (XGPON) was proposed. This part of the thesis introduces the possibility of managing the XG-PON by the GMPLS suite, showing again that this protocol suite is a good candidate...
BACKGROUND: In Ireland, specialist paediatric surgery is carried out in paediatric hospitals in Dublin. General surgeons\\/consultants in other surgical specialities provide paediatric surgical care in regional centres. There has been a failure to train general surgeons with paediatric skills to replace these surgeons upon retirement. AIM: To assess paediatric surgical workload in one regional centre to focus the debate regarding the future provision of general paediatric surgery in Ireland. METHODS: Hospital in-patient enquiry (HIPE) system was used to identify total number of paediatric surgical admissions and procedures. Cases assessed requiring hospital transfer. RESULTS: Of 17,478 surgical patients treated, 2,584 (14.8%) were under 14 years. A total of 2,154 procedures were performed. CONCLUSION: Regional centres without dedicated paediatric surgeons deliver care to large numbers of paediatric patients. The demand for care highlights the need for formal paediatric services\\/appropriate surgical training for general surgical trainees.
Full Text Available Cloud Computing is a very fast emerging technology as every enterprise is moving fast towards this system. Cloud Computing is known as a provider of dynamic services. It optimizes a very large, scalable and virtualized resource. So lots of industries have joined this bandwagon nowadays. One of the major research issues is to maintain good Quality of Service (QoS of a Cloud Service Provider (CSP. The QoS encompasses different parameters, like, smart job allocation strategy, efficient load balancing, response time optimization, reduction in wastage of bandwidth, accountability of the overall system, etc. The efficient allocation strategy of the independent computational jobs among different Virtual Machines (VM in a Data center (DC is a distinguishable challenge in the Cloud Computing domain and finding out an optimal job allocation strategy guided by a good scheduling heuristic for such an environment is a mape-k loop problem. So different heuristic approaches may be used for better result and in this result we paper we implement worst fit in mape-k and evaluated the results.
Kreye, Melanie; Nandrup-Bus, Troels
It is becoming a distinctive feature for manufacturing firms to compete strategically through service provision. In relation to reward systems the aim of this thesis is to investigate what motivates employees of servitized manufacturing firms when providing engineering services and why. Through quantitative and qualitative data collection with an international company within the European healthcare sector, the findings show that key motivating factors were to “delight” the customer and being ...
Deslauriers, Simon; Raymond, Marie-Hélène; Laliberté, Maude; Lavoie, Amélie; Desmeules, François; Feldman, Debbie E; Perreault, Kadija
The prevalence of musculoskeletal disorders is high and expected to increase in the next decade. Persons suffering from musculoskeletal disorders benefit from early physiotherapy services. However, access to publicly funded physiotherapy services has been shown to be compromised by long waiting times and limited availability of resources in many countries around the world. Decisions on resource allocation may create geographic disparities in provision and access to services, which may result in inequity in access. This study aimed to assess variations in demand and provision of publicly funded outpatient physiotherapy services across the province of Quebec, Canada, as well as to assess the demand to provision relationship. We conducted a secondary analysis of data retrieved from the 2008 Quebec Health Survey and data obtained from a survey of hospitals in the province of Quebec in 2015. We used geographic information systems analyses and descriptive analyses to assess geographic variations and the relationship between demand and provision. Our results indicate substantial variations in the provision and demand for physiotherapy services in the province of Quebec. The variations in service provision did not follow the variations in demand. Long waiting times and insufficient provision of services were found in many regions. The variations in provision of physiotherapy services between regions reported in our study did not correspond to the variations in demand. Such geographic variations and demand to provision mismatches may create inequity in access to services, especially for those unable to afford private services. © 2017 John Wiley & Sons, Ltd.
Kakoko, D.C.; Ketting, E.; Kamazima, S.R.; Ruben, R.
Adherence to the policy guidelines and standards is necessary for family planning services. We compared public and private facilities in terms of provision of family planning services. We analyzed data from health facility questionnaire of the 2006 Tanzania Service Provision Assessment survey, based
Amorim, Gláucia Maria; Quintão, Eliana Cardoso Vieira; Martelli Júnior, Hercílio; Bonan, Paulo Rogério Ferreti
The scope of this paper was to evaluate the provision of building maintenance services in health units, by means of a descriptive, quantitative and cross-sectional study, considering the five types of facilities (Primary Health, Emergency, Specialty, Hospital and Mental Health Units). The research was approved by the Research Ethics Comittee of FHEMIG with the Terms of Agreement signed with the Unified Health System of Betim. Comparative analysis was conducted by checking the requirements of "Physical-Functional Structure Management" of the "Brazilian Hospital Accreditation Manual" of the National Accreditation Organization. Nonconformities were noted in the physical-functional management of the health centers, especially the primary health units. The assessment was important, considering that compliance with formal, technical and structural requirements, welfare activities, according to the service organization and appropriate to the profile and complexity, can collaborate to minimize the risks of users. To improve the quality of health care establishments, it is essential that managers, backed by "top management," prioritize financial, human and material resources in planning to ensure compliance with security requirements of users in buildings.
Kreye, Melanie; Nandrup-Bus, Troels
It is becoming a distinctive feature for manufacturing firms to compete strategically through service provision. In relation to reward systems the aim of this thesis is to investigate what motivates employees of servitized manufacturing firms when providing engineering services and why. Through...... quantitative and qualitative data collection with an international company within the European healthcare sector, the findings show that key motivating factors were to “delight” the customer and being able to take responsibility and accountability for ones work. Service employees were found to feel proud...
van Weert, K.; Dhaene, J.; Goovaerts, M.
In this paper we discuss multiperiod portfolio selection problems related to a specific provisioning problem. Our results are an extension of Dhaene et al. (2005) , where optimal constant mix investment strategies are obtained in a provisioning and savings context, using an analytical approach
Ikkos, G; Sugarman, Ph; Bouras, N
The commissioning and provision of healthcare, including mental health services, must be consistent with ethical principles - which can be summarised as being "fair", irrespective of the method chosen to deliver care. They must also provide value to both patients and society in general. Value may be defined as the ratio of patient health outcomes to the cost of service across the whole care pathway. Particularly in difficult times, it is essential to keep an open mind as to how this might be best achieved. National and regional policies will necessarily vary as they reflect diverse local histories, cultures, needs and preferences. As systems of commissioning and delivering mental health care vary from country to country, there is the opportunity to learn from others. In the future international comparisons may help identify policies and systems that can work across nations and regions. However a persistent problem is the lack of clear evidence over cost and quality delivered by different local or national models. The best informed economists, when asked about the international evidence do not provide clear answers, stating that it depends how you measure cost and quality, the national governance model and the level of resources. The UK has a centrally managed system funded by general taxation, known as the National Health Service (NHS). Since 2010, the UK's new Coalition* government has responded by further reforming the system of purchasing and providing NHS services - aiming to strengthen choice and competition between providers on the basis of quality and outcomes as well as price. Although the present coalition government's intention is to maintain a tax-funded system, free at the point of delivery, introducing market-style purchasing and provider-side reforms to encompass all of these bring new risks, whilst not pursuing reforms of a system in crisis is also seen to carry risks. Competition might bring efficiency, but may weaken cooperation between providers
Egoh, Benis N
Full Text Available -1 Ecosystem Services December 2012/ Vol. 2 An African account of ecosystem service provision: Use, threats and policy options for sustainable livelihoods Benis N. Egoh a, , , , Patrick J. O'Farrellb, Aymen Charefa, Leigh Josephine Gurney a...
Cocco, Massimo; EPOS Team
EPOS brings together European nations and combines solid Earth science infrastructures and their associated data and services together with the scientific expertise into one integrated delivery system for solid Earth science. By improving and facilitating the integration, access, use, and re-use of solid Earth science data, data products, services and facilities EPOS is developing a holistic, sustainable, multidisciplinary research platform to provide coordinated access to harmonized and quality controlled data from diverse Earth science disciplines, together with tools for their use in analysis and modelling. EPOS has been designed with the vision of creating a single distributed pan-European infrastructure for solid Earth science to support a safe and sustainable society. In accordance with this scientific vision, the EPOS mission is to integrate the diverse and advanced European Research Infrastructures for solid Earth relying on new e-science opportunities to monitor and unravel the dynamic and complex Earth System. EPOS is presently in its implementation phase, which consists of the EPOS IP project and the legal establishment of EPOS-ERIC. The EPOS Implementation Phase builds on the achievements of the successful EPOS Preparatory Phase project. The EPOS implementation phase will last from 2015 to 2019. The key objectives of the project are: implementing Thematic Core Services (TCS), the domain-specific service hubs for coordinating and harmonizing national resources/plans with the European dimension of EPOS; building the Integrated Core Services (ICS) to provide a novel research platform to different stakeholders; designing the access to distributed computational resources (ICS-D); ensuring sustainability and governance of TCS and EPOS-ERIC. Here we present the activities planned for the implementation phase focusing on the TCS, the ICS and on their interoperability. We will present and discuss the data and service provision focusing on the data, data
... 45 Public Welfare 4 2010-10-01 2010-10-01 false Provisions of comprehensive child development... Start Program Options § 1306.30 Provisions of comprehensive child development services. (a) All Head Start grantees must provide comprehensive child development services, as defined in the Head Start...
Waverijn, G.; Groenewegen, P.P.; Klerk, M. de
Differential provision of local services and amenities has been proposed as a mechanism behind the relationship between social capital and health. The aim of this study was to investigate whether social capital and collective efficacy are related to the provision of social support services and
... 47 Telecommunication 3 2010-10-01 2010-10-01 false Policies and procedures for provisioning and restoring certain telecommunications services in emergencies. 64.401 Section 64.401 Telecommunication... procedures for provisioning and restoring certain telecommunications services in emergencies. The...
Browning, Ellen R.; Caro, Patricia; Shastry, Sunita P.
Providing services for children with disabilities has been a part of the culture of India for generations. However service provision has been within the context of family and community rather than in the public sector and thus has been inclusive by its very nature. This article describes current educational provisions and practices in India for…
..., Accumulated provision for depreciation of service company property. 367.1080 Section 367.1080 Conservation of... Account 108, Accumulated provision for depreciation of service company property. (a) This account must be credited with the following: (1) Amounts charged to account 403, Depreciation expense (§ 367.4030), or to...
Nielsen, Anne Sofie Elberg
to the incorporation of spatial factors into cost and benefit evaluation of FES provision. Focus is on assessing where forest ecosystem provision should be undertaken, determinants of private stakeholder provision efforts and welfare consequences of changes in the provision level. Provision of carbon sequestration...... estimates for the U.S. counties of the cost of carbon sequestration from afforestation (conversion of non-forest land to forest), when afforestation is restricted by Holdridge zone climatic conditions. Aside from assessing the overall marginal cost schedule, the spatial distribution of these are examined......, to assess where afforestation should be undertaken for given carbon prices. The second paper investigates the determinants of landowner participation in a Danish voluntary conservation program. Combining contract data of landowners’ actual choices, GIS information on area specific characteristics...
Adams, Robyn; Sheppard, Lorraine; Jones, Anne; Lefmann, Sophie
To obtain stakeholder perspectives on factors influencing rural physiotherapy service provision and insights into decision making about service provision. Purposive sampling, open-ended survey questions and semi-structured interviews were used in this exploratory, qualitative study. A rural centre and its regional referral centre formed the pilot sites. Nine participant perspectives were obtained on rural physiotherapy services. Stakeholder perspectives on factors influencing rural physiotherapy service provision and service level decision making. Workforce capacity and capability, decision maker's knowledge of the role and scope of physiotherapy, consideration of physiotherapy within resource allocation decisions and proof of practice emerged as key issues. The latter three were particularly reflected in public sector participant comments. Business models and market size were identified factors in influencing private practice. Influencing factors described by participants both align and extend our understanding of issues described in the rural physiotherapy literature. Participant insights add depth and meaning to quantitative data by revealing impacts on local service provision. Available funding and facility priorities were key determinants of public sector physiotherapy service provision, with market size and business model appearing more influential in private practice. The level of self direction or choice about which services to provide, emerged as a point of difference between public and private providers. Decisions by public sector physiotherapists about service provision appear constrained by existing capacity and workload. Further research into service level decision making might provide valuable insights into rural health service delivery. © 2014 National Rural Health Alliance Inc.
Kanbur, Ravi; Paukkeri, Tuuli; Pirttilä, Jukka; Tuomala, Matti
The existing literature on optimal taxation typically assumes there exists a capacity to implement complex tax schemes, which is not necessarily the case for many developing countries. We examine the determinants of optimal redistributive policies in the context of a developing country that can only implement linear tax policies due to administrative reasons. Further, the reduction of poverty is typically the expressed goal of such countries, and this feature is also taken into account in our...
Mitchell, Matthew G. E.; Bennett, Elena M.; Gonzalez, Andrew
Human actions, such as converting natural land cover to agricultural or urban land, result in the loss and fragmentation of natural habitat, with important consequences for the provision of ecosystem services. Such habitat loss is especially important for services that are supplied by fragments of natural land cover and that depend on flows of organisms, matter, or people across the landscape to produce benefits, such as pollination, pest regulation, recreation and cultural services. However, our quantitative knowledge about precisely how different patterns of landscape fragmentation might affect the provision of these types of services is limited. We used a simple, spatially explicit model to evaluate the potential impact of natural land cover loss and fragmentation on the provision of hypothetical ecosystem services. Based on current literature, we assumed that fragments of natural land cover provide ecosystem services to the area surrounding them in a distance-dependent manner such that ecosystem service flow depended on proximity to fragments. We modeled seven different patterns of natural land cover loss across landscapes that varied in the overall level of landscape fragmentation. Our model predicts that natural land cover loss will have strong and unimodal effects on ecosystem service provision, with clear thresholds indicating rapid loss of service provision beyond critical levels of natural land cover loss. It also predicts the presence of a tradeoff between maximizing ecosystem service provision and conserving natural land cover, and a mismatch between ecosystem service provision at landscape versus finer spatial scales. Importantly, the pattern of landscape fragmentation mitigated or intensified these tradeoffs and mismatches. Our model suggests that managing patterns of natural land cover loss and fragmentation could help influence the provision of multiple ecosystem services and manage tradeoffs and synergies between services across different human
Gibson, Grant; Newton, Lisa; Pritchard, Gary; Finch, Tracy; Brittain, Katie; Robinson, Louise
In this review we explore the provision of assistive technology products and services currently available for people with dementia within the United Kingdom. A scoping review of assistive technology products and services currently available highlighted 171 products or product types and 331 services. In addition, we assimilated data on the amount and quality of information provided by assistive technology services alongside assistive technology costs. We identify a range of products available across three areas: assistive technology used 'by', 'with' and 'on' people with dementia. Assistive technology provision is dominated by 'telecare' provided by local authorities, with services being subject to major variations in pricing and information provision; few currently used available resources for assistive technology in dementia. We argue that greater attention should be paid to information provision about assistive technology services across an increasingly mixed economy of dementia care providers, including primary care, local authorities, private companies and local/national assistive technology resources. © The Author(s) 2014.
Full Text Available Introduction: Meeting the complex health needs of people often requires interaction among numerous different sectors. No one service can adequately respond to the diverse care needs of consumers. Providers working more effectively together is frequently touted as the solution. Cross-sector service provision is defined as independent, yet interconnected sectors working together to better meet the needs of consumers and improve the quality and effectiveness of service provision. Cross-sector service provision is expected, yet much remains unknown about how it is conceptualised or its impact on health status. This umbrella review aims to clarify the critical attributes that shape cross-sector service provision by presenting the current state of the literature and building on the findings of the 2004 review by Sloper. Methods: Literature related to cross-sector service provision is immense, which poses a challenge for decision makers wishing to make evidence-informed decisions. An umbrella review was conducted to articulate the overall state of cross-sector service provision literature and examine the evidence to allow for the discovery of consistencies and discrepancies across the published knowledge base. Findings: Sixteen reviews met the inclusion criteria. Seven themes emerged: Focusing on the consumer, developing a shared vision of care, leadership involvement, service provision across the boundaries, adequately resourcing the arrangement, developing novel arrangements or aligning with existing relationships, and strengthening connections between sectors. Future research from a cross-organisational, rather than individual provider, perspective is needed to better understand what shapes cross-sector service provision at the boundaries. Conclusion: Findings aligned closely with the work done by Sloper and raise red flags related to reinventing what is already known. Future researchers should look to explore novel areas rather than looking into
Winters, Shannon; Magalhaes, Lilian; Anne Kinsella, Elizabeth; Kothari, Anita
Meeting the complex health needs of people often requires interaction among numerous different sectors. No one service can adequately respond to the diverse care needs of consumers. Providers working more effectively together is frequently touted as the solution. Cross-sector service provision is defined as independent, yet interconnected sectors working together to better meet the needs of consumers and improve the quality and effectiveness of service provision. Cross-sector service provision is expected, yet much remains unknown about how it is conceptualised or its impact on health status. This umbrella review aims to clarify the critical attributes that shape cross-sector service provision by presenting the current state of the literature and building on the findings of the 2004 review by Sloper. Literature related to cross-sector service provision is immense, which poses a challenge for decision makers wishing to make evidence-informed decisions. An umbrella review was conducted to articulate the overall state of cross-sector service provision literature and examine the evidence to allow for the discovery of consistencies and discrepancies across the published knowledge base. Sixteen reviews met the inclusion criteria. Seven themes emerged: Focusing on the consumer, developing a shared vision of care, leadership involvement, service provision across the boundaries, adequately resourcing the arrangement, developing novel arrangements or aligning with existing relationships, and strengthening connections between sectors. Future research from a cross-organisational, rather than individual provider, perspective is needed to better understand what shapes cross-sector service provision at the boundaries. Findings aligned closely with the work done by Sloper and raise red flags related to reinventing what is already known. Future researchers should look to explore novel areas rather than looking into areas that have been explored at length. Evaluations of out
Becker, T.; Hülsmann, S.; Knudsen, H. C.; Martiny, K.; Amaddeo, F.; Herran, A.; Knapp, M.; Schene, A. H.; Tansella, M.; Thornicroft, G.; Vázquez-Barquero, J. L.
Background An increasing diversity of public, voluntary sector and private providers offer services for the mentally ill in the ongoing process of psychiatric reform. Good service description is one important prerequisite for mental health service research. Aims 1) To describe service provision for
for sick children, routine childhood vaccination services (EPI), and routine growth monitoring services) as a package. ... Government facilities mostly provide all three basic child health services. Among all .... All data editing programs were.
Villamagna, Amy M.; Angermeier, Paul L.; Bennett, Elena M.
Ecosystem services provide an instinctive way to understand the trade-offs associated with natural resource management. However, despite their apparent usefulness, several hurdles have prevented ecosystem services from becoming deeply embedded in environmental decision-making. Ecosystem service studies vary widely in focal services, geographic extent, and in methods for defining and measuring services. Dissent among scientists on basic terminology and approaches to evaluating ecosystem services create difficulties for those trying to incorporate ecosystem services into decision-making. To facilitate clearer comparison among recent studies, we provide a synthesis of common terminology and explain a rationale and framework for distinguishing among the components of ecosystem service delivery, including: an ecosystem's capacity to produce services; ecological pressures that interfere with an ecosystem's ability to provide the service; societal demand for the service; and flow of the service to people. We discuss how interpretation and measurement of these four components can differ among provisioning, regulating, and cultural services. Our flexible framework treats service capacity, ecological pressure, demand, and flow as separate but interactive entities to improve our ability to evaluate the sustainability of service provision and to help guide management decisions. We consider ecosystem service provision to be sustainable when demand is met without decreasing capacity for future provision of that service or causing undesirable declines in other services. When ecosystem service demand exceeds ecosystem capacity to provide services, society can choose to enhance natural capacity, decrease demand and/or ecological pressure, or invest in a technological substitute. Because regulating services are frequently overlooked in environmental assessments, we provide a more detailed examination of regulating services and propose a novel method for quantifying the flow of
Full Text Available Objectives: No research data exists on forensic psychiatric service provision in the Eastern Cape, Republic of South Africa. The objective of this research was to assess current forensic psychiatric service provision and utilisation rates at Fort England Hospital. This is important in improving and strengthening the service. A related objective was to develop a model for a provincial prison mental health service. Methodology: This study is a situational analysis of an existing forensic psychiatric service in the Eastern Cape. The design of the study was cross sectional. An audit questionnaire was utilised to collate quantitative data, which was submitted to Fort England Hospital, Grahamstown. A proposed prison mental health service was developed utilising prevalence rates of mental illness among prisoners to calculate bed and staff requirements for an ambulatory and in-patient service. Results: During the study period a total of 403 remand detainees were admitted to the forensic psychiatry division of Fort England Hospital. The average length of stay was 494 days and the bed utilisation rate was determined at 203.54%. We estimate that to provide a provincial prison mental health service to treat psychotic illnesses and major depression the province requires a 52 bedded facility and a total staff complement of approximately 31. Conclusions: Forensic psychiatric services include the assessment, management and treatment of mentally disordered persons in conflict with the law and prisoners requiring psychiatric assessments. The Eastern Cape Province does not have plans or policies to assess and manage mentally ill offenders, resulting in an increased load on available services. We recommend that an inter-departmental task team, which includes Health, Justice and Constitutional Development and Correctional Services, should be established in the province, to develop a strategy to assist in the development of an effective and efficient forensic
Full Text Available This paper deals with the application of High Altitude Platforms for the provision of third generation mobile services in sparsely-populated areas or in developing countries. It focuses on the behavior of large cells provided via a multiple HAP deployment and shows the possibilities of using small cells located inside these large cells to serve hot-spot areas. The impact of the different types of HAP antenna masks and their adjustment on cell capacity and the quality of coverage is presented. The main parameter of the antenna radiation pattern under investigation is the power roll-off at the cell edge. Optimal values of this parameter are presented for different scenarios. Simulations of system level parameters were based on an iteration loops approach.
West, Joyce C; Pingitore, David; Zarin, Deborah A
This study assessed characteristics of psychiatric patients for whom financial considerations affected the provision of "optimal" treatment. Psychiatrists reported that for 33.8 percent of 1,228 patients from a national sample, financial considerations such as managed care limitations, the patient's personal finances, and limitations inherent in the public care system adversely affected the provision of optimal treatment. Patients were more likely to have their treatment adversely affected by financial considerations if they were more severely ill, had more than one behavioral health disorder or a psychosocial problem, or were receiving treatment under managed care arrangements. Patients for whom financial considerations affect the provision of optimal treatment represent a population for whom access to treatment may be particularly important.
Lindley, Lisa C; Held, Mary L; Henley, Kristen M; Miller, Kathryn A; Pedziwol, Katherine E; Rumley, Laurie E
Provision of language services in pediatric hospice enables nurses to communicate effectively with patients who have limited English proficiency. Language barriers contribute to ethnic disparities in health care. While language service use corresponds with improved patient comprehension of illness and care options, we lack an understanding of how the nurse work environment affects the provision of these services. Data were obtained from the 2007 National Home and Hospice Care Survey and included a study sample of 1251 pediatric hospice agencies. Variable selection was guided by structural contingency theory, which posits that organizational effectiveness is dependent upon how well an organization's structure relates to its context. Using multivariate logistic regression, we analyzed the extent to which nursing unit environment predicted provision of translation services and interpreter services. The majority of hospices provided translation services (74.9 %) and interpreter services (87.1 %). Four variables predicted translation services: registered nurse (RN) unit size, RN leadership, RN medical expertise, and for-profit status. RN medical expertise and having a safety climate within the hospice corresponded with provision of interpreter services. Findings indicate that nursing unit environment predicts provision of language services. Hospices with more specialized RNs and a stronger safety climate might include staffs who are dedicated to best care provision, including language services. This study provides valuable data on the nurse work environment as a predictor of language services provision, which can better serve patients with limited English proficiency and ultimately reduce ethnic disparities in end-of-life care for children and their families.
Background: The inverse-care law suggests that fewer healthcare resources are available in deprived areas where health needs are greatest. Aims: To examine the provision of paediatric speech and language services across London boroughs and to relate provision to the level of deprivation of the boroughs. Methods & Procedures: Information on the…
Prisons like other correctional institutions deserve organized information provision centers like a library. This study examined library services provision in the south-western part of Nigeria. It was found out that despite their incarceration, inmates desires variety of information; whereas the library stock is grossly inadequate ...
Improving efficiency and value in health care. Intravenous iron management for anaemia associated with chronic kidney disease: linking treatment to an outpatient clinic, optimizing service provision and patient choice.
Bhandari, Sunil; Naudeer, Sarah
The National Service Framework advocates correction of anaemia in patients with chronic kidney disease (CKD). Oral iron is insufficient, while intravenous (IV) supplementation replenishes and maintains iron stores. In Yorkshire numerous peripheral clinics exist to reduce travel for patients, but patients must travel to the main unit for IV iron therapy. Therefore an outpatient service in tandem with a routine clinic for administration of IV CosmoFer was created. To evaluate the feasibility and benefits of IV iron therapy in the outpatient clinic during active patient review for CKD patients. A cross-sectional study of patients attending for total dose IV iron (n = 57) at a peripheral clinic. Iron was administered and monitored according to protocol by one of the clinic nurses with medical staff available in the adjoining room. Haemoglobin, ferritin and renal function were recorded pre-infusion and after 4-6 months. Results are given as medians/means +/- standard error. A total of 76 IV infusions were carried out with no reported side effects or haemodynamic instability. Haemoglobin (median 10.9 vs. 11.3 g dL(-1), P = NS), creatinine and estimated glomerular filtration rate (eGFR) over the 6-month period remained stable. Serum ferritin rose significantly [80.9 +/- 6.2 vs. 186.4 +/- 18.2 g L(-1) (P Hospital time saved 380 day case bed hours, doctor hours saved 76 hours, and patient hours saved 3 hours/patient. Cost savings for TDI CosmoFer in peripheral clinic versus in centre therapy and versus sucrose, respectively, for 76 treatments was pound 5749.40 and pound 46,320.80 respectively. We have demonstrated, in a resource-limited service, the feasibility and cost-effectiveness of a management care pathway for patients with CKD, in a peripheral clinic, to receive total dose IV CosmoFer without disruption of a functioning renal clinic.
Chatdokmaiprai, Kannikar; Kalampakorn, Surintorn; McCullagh, Marjorie; Lagampan, Sunee; Keeratiwiriyaporn, Sansanee
The purpose of this study was to identify factors predicting occupational health nurses' provision of smoking cessation services. Data were collected via a self-administered questionnaire distributed to 254 occupational health nurses in Thailand. Analysis by structural equation modeling revealed that self-efficacy directly and positively influenced smoking cessation services, and mediated the relationship between workplace factors, nurse factors, and smoking cessation services. The final model had good fit to the data, accounting for 20.4% and 38.0% of the variance in self-efficacy and smoking cessation services, respectively. The findings show that self-efficacy is a mediator that influences provision of smoking cessation services by occupational health nurses. Interventions to enhance nurses' self-efficacy in providing smoking cessation services are expected to promote provision of smoking cessation services to workers.
Deardorff, Alan V.
The author examines the special role that trade liberalization in services industries can play in stimulating trade in both services, and goods. International trade in goods requires inputs from such trade services as transportation, insurance, and finance, for example. Restrictions on services across borders, and within foreign countries add costs, and barriers to international trade. Lib...
South Africa's Choice on Termination of Pregnancy (CTOP) Act of 1996 allows provision of abortion on request up to 12 weeks of gestation and permits midwives who have completed required training to conduct termination of pregnancies. This unique codification of midwives' role in abortion care reflects legislators' ...
Headwater wetlands provide a range of ecosystem services including habitat provisioning and flood retention. Following the River Ecosystem Synthesis framework we identified and assessed not only headwater wetlands, but unconstrained reaches with the potential to support diverse s...
Wiersum, F.; Endalamaw, T.B.
Provisioning services are major environmental services provided by forests. Especially in tropical countries, the livelihoods of local people often partly depend on a range of timber and non-timber forest products. The governance arrangements concerning such locally valued environmental services are
... payment for new medical services and technologies: General provisions. (a) Basis. Sections 412.87 and 412... establish a mechanism to recognize the costs of new medical services and technologies under the hospital... that are new medical services and technologies, if the following conditions are met: (1) A new medical...
Planning is an essential management function which invariably precedes all other activities that yield to effective services in an organization. This paper sought to determine, among other things, how planning affects the provision of library services to children in selected public libraries; determine the services provided and ...
Hansen, Henrik; Hansen, Lars Henrik; Jóhannsson, Hjörtur
This paper addresses a challenge associated with large scale deployment of distributed energy resources (DER) to provide system services in future sustainable power systems; namely how to prioritize conflicting interests in a service provided by a DER. For that purpose, different services utilizing...... the DER in a future system are identified as well as potentially conflicting interests between services. A scheme is suggested for how conflicting interests should be prioritized based on considerations regarding the nature of the service and the system operating state at the time of the service request....... Examples are provided for illustrating the functionality of the scheme....
Full Text Available We consider a two-stage supply chain with one supplier and one retailer. The retailer sells a product to customer and the supplier provides a product in a make-to-order mode. In this case, the supplier’s decisions on service time and service level and the retailer’s decision on retail price have effects on customer demand. We develop optimization models to determine the optimal retail price, the optimal guaranteed service time, the optimal service level, and the optimal capacity to maximize the expected profit of the whole supply chain. The results of numerical experiments show that it is more profitable to determine the optimal price, the optimal guaranteed service time, and the optimal service level simultaneously and the proposed model is more profitable in service level sensitive market.
Bonino da Silva Santos, L.O.
Service-Oriented Computing (SOC) is a paradigm for the design, use and management of distributed system applications in the form of services. The vision of SOC is that services represent distributed pieces of functionality that can be combined (or composed, in SOC terms) to generate new
Smith, Alesha J; Scahill, Shane L; Harrison, Jeff; Carroll, Tilley; Medlicott, Natalie J
Recently, New Zealand has taken a system wide approach providing the biggest reform to New Zealand community pharmacy for 70 years with the aim of providing more clinically orientated patient centred services through a new funding model. The aim of this study was to understand the types of services offered in New Zealand community pharmacies since introduction of the new funding model, what the barriers are to providing these services. A survey of all community pharmacies were undertaken between August, 2014 and February, 2015. Basic descriptive statistics were completed and group comparisons were made using the chi squared test with significance set at p funding attached. Costs and staff availability are the most common barriers to undertake services, more predominantly in patient centred services. This study was the first to provide an evaluation of service provision in response to a new funding model for New Zealand Community Pharmacies. A broad range of services are being undertaken in New Zealand community pharmacies including patient-centred services. A number of barriers to service provision were identified. This study provides a baseline for the current levels of service provision upon which future studies can compare to and evaluate any changes in service provision with differing funding models going forward.
The basic tenet of Service-Oriented Computing (SOC) is the possibility of building distributed applications on the Web by using Web Services as fundamental building blocks. The proliferation of such services is considered the second wave of evolution in the Internet age, moving the Web from...... a collection of pages to a collections of services. Consensus is growing that this Web Service “revolution” won't eventuate until we resolve trust-related issues. Indeed, the intrinsic openness of the SOC vision makes crucial to locate useful services and recognize them as trustworthy. In this paper we review...... the field of trust-based Web Service selection, providing a structured classification of current approaches and highlighting the main limitations of each class and of the overall field. As a result, we claim that a soft notion of trust lies behind such weaknesses and we advocate the need of a new approach...
Full Text Available The current paper inscribes within those approaching the issue of public services from the interdisciplinary perspective. Public service development and imposing standards of efficiency and effectiveness, as well as for citizens’ satisfaction bring in front line the systemic modelling and establishing optimal policies for organisation and functioning of public services. The issue under discussion imposes an interface with powerful determinations of social nature. Consequently, the most adequate modelling might be that with a probabilistic and statistic nature. The fundamental idea of this paper, that obviously can be broadly developed, starts with assimilating the way of organisation and functioning of a public service with a waiting thread, to which some hypotheses are associated concerning the order of provision, performance measurement through costs or waiting time in the system etc. We emphasise the openness and dynamics of the public service system, as well as modelling by turning into account the statistic knowledge and researches, and we do not make detailed remarks on the cybernetic characteristics of this system. The optimal adjustment is achieved through analysis on the feedback and its comparison with the current standards or good practices.
Decker, Michael; Bulander, Rebecca
A middleware platform designed for the provisioning of data services for mobile computers using wireless data communication (e.g. smartphones or PDAs) has to offer a variety of different features. Some of these features have to be provided by external parties, e.g. billing or content syndication. The integration of all these features while considering mobile-specific challenges is a demanding task. In the article at hand we thus describe a middleware platform for mobile services which follows the idea of a so called Enterprise Service Bus (ESB). We explain the concept of ESB and argue why an ESB is an appropriate fundament for a platform for mobile service provisioning.
Full Text Available We propose a cloud service scheduling model that is referred to as the Task Scheduling System (TSS. In the user module, the process time of each task is in accordance with a general distribution. In the task scheduling module, we take a weighted sum of makespan and flowtime as the objective function and use an Ant Colony Optimization (ACO and a Genetic Algorithm (GA to solve the problem of cloud task scheduling. Simulation results show that the convergence speed and output performance of our Genetic Algorithm-Chaos Ant Colony Optimization (GA-CACO are optimal.
Hood, Rick; Goldacre, Allie; Grant, Robert; Jones, Ray
This paper presents the results of an exploratory study linking the national data-sets for all children in need and child protection services in England. The study was informed by an emerging literature on systems thinking in public services, and aimed to examine variations and patterns of response in local authorities to demand for child welfare services in their area. One hundred and fifty-two local authority census returns and other statistical indicators covering up to a thirteen-year per...
Prokofieva, Irina; Mavsar, Robert; Bartczak, Anna
accepted concept in theory, the legitimacy of which nevertheless has not yet been challenged in practice. In our study, we conducted an extensive survey in five European countries – Finland, Denmark, Poland, Italy and Spain – with the aim to explore citizens’ opinions of who should carry the costs...... of ecosystem services provision. The ecosystem services in question were biodiversity, recreation, carbon sequestration, water quality, and scenic beauty. Our results show that the majority of respondents in all studied countries generally think that the costs of enhanced provision of ecosystem services shall......The underlying notion of payments for environmental services is that beneficiaries of environmental services (directly or indirectly) financially support their provision by covering at least part of the costs landowners incur to generate them. This so-called “beneficiary-pay principle” is a widely...
Herbert, Luke Thomas; Sharp, Robin
bounds on resources consumed during execution of business processes. Accurate resource provisioning is often central to ensuring the safe execution of a process. We first introduce a formalised core subset of the Business Process Modelling and Notation (BPMN), which we extend with probabilistic and non......-deterministic branching and reward annotations. We then develop an algorithm for the efficient translation of these models into the guarded command language used by the model checker PRISM, in turn enabling model checking of BPMN processes and allowing for the calculation of a wide range of quantitative properties...
Zarghami, Alireza; Zarifi Eslami, Mohammed; van Sinderen, Marten J.; Wieringa, Roelf J.
Providing IT-based care support for elderly at home is proposed as a highly promising appraoch to address the aging population problem. With the emergence of homecare application service providers, a homecare system can be seen as a linked set of services. Configuring and composing existing homecare
Full Text Available Location Based Services can be considered as one of the most rapidly expanding fields of the mobile communications sector, with an impressively large application range. The proliferation of mobile/wireless Internet and mobile computing, and the constantly increasing use of handheld, mobile devices and position tracking technologies prepared the grounds for the introduction of this new type of services. The combination of position fixing mechanisms with location-dependent, geographical information, can offer truly customized personal communication services through the mobile phone or other type of devices. Prompted by the avalanche of technology advances in the aforementioned areas in this paper we present an integrated platform for delivering Location Based Services (LBS. The platform covers the full life cycle of a LBS starting from the specification of the service, covering issues like the deployment and maintenance of services, the service invocation and the final delivery of the produced results to the invoking user. A prototype implementation of the discussed platform was developed and used to perform a series of trial services, with the purpose of demonstrating the pursued functionality.
Full Text Available Background: The aim of this paper is to argue that there are a number of key drivers for Special Educational Needs (SEN provision that have to be met by Special Educational Needs Coordinators (SENCOs and teaching professionals so as to ensure optimal provision and inclusion for children with SEN in mainstream primary schools. Although the research has been carried out in England, there is a significant European Dimension to the issue, as a similar role to that of SENCOs in respect of SEN management already exists in countries such as Finland and Ireland, and is being considered in Italy. Methods: This paper focuses on the data gathered for the purpose of the author’s doctoral research in England, through questionnaires and interviews with SENCOs, head teachers and teachers. Thematic analysis was used to explore key drivers of SEN provision by practitioners who support children with SEN. Results: Data illustrate that the key drivers of SEN provision include time; teacher openness to change; target setting; evidence of tried interventions; empowerment; decision-making and approachability. The implementation of such drivers depend largely on practitioner skills and competencies. Conclusion: The main conclusion within this paper is to develop points of reference for planning and practice, with illustrations of optimal provision by all practitioners who work with children with SEN.
decoupled and assumed to be fixed during the reactive power dispatch procedures; however, the effect of reactive power on real power is considered in the model by calculating the required reduction in real power output of a generator due to an increase in its reactive power supply. In this case, real power generation is allowed to be rescheduled, within given limits, from the already dispatched levels obtained from the energy market clearing process. The proposed dispatch model achieves the main objective of an ISO in a competitive electricity market, which is to provide the required reactive power support from generators at least cost while ensuring a secure operation of the power system. The proposed reactive power procurement and dispatch models capture both the technical and economic aspects of power system operation in competitive electricity markets; however, from an optimization point of view, these models represent non-convex mixed integer non-linear programming (MINLP) problems due to the presence of binary variables associated with the different regions of reactive power operation in a synchronous generator. Such MINLP optimization problems are difficult to solve, especially for an actual power system. A novel Generator Reactive Power Classification (GRPC) algorithm is proposed in this thesis to address this issue, with the advantage of iteratively solving the optimization models as a series of non-linear programming (NLP) sub-problems. The proposed reactive power procurement and dispatch models are implemented and tested on the CIGRE 32-bus system, with several case studies that represent different practical operating scenarios. The developed models are also compared with other approaches for reactive power provision, and the results demonstrate the robustness and effectiveness of the proposed model. The results clearly reveal the main features of the proposed models for optimal provision of reactive power ancillary service, in order to suit the requirements of
Kuada, Eric; Olesen, Henning
This paper proposes a social network approach to the provisioning and management of cloud computing services termed Opportunistic Cloud Computing Services (OCCS), for enterprises; and presents the research issues that need to be addressed for its implementation. We hypothesise that OCCS...... will facilitate the adoption process of cloud computing services by enterprises. OCCS deals with the concept of enterprises taking advantage of cloud computing services to meet their business needs without having to pay or paying a minimal fee for the services. The OCCS network will be modelled and implemented...... as a social network of enterprises collaborating strategically for the provisioning and consumption of cloud computing services without entering into any business agreements. We conclude that it is possible to configure current cloud service technologies and management tools for OCCS but there is a need...
... 47 Telecommunication 2 2010-10-01 2010-10-01 false Licensing provisions for the Direct Broadcast Satellite Service. 25.148 Section 25.148 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES SATELLITE COMMUNICATIONS Applications and Licenses Space Stations § 25.148...
Ngo, C.; Membrey, P.; Demchenko, Y.; de Laat, C.
Cloud computing is developing as a new wave of ICT technologies, offering a common approach to on-demand provisioning of computation, storage and network resources which are generally referred to as infrastructure services. Most of currently available commercial Cloud services are built and
Faiella, Mariano; Hennig, Tobias; Cutululis, Nicolaos Antonio
This report is the deliverable of the third work package of the REserviceS project and describes the technical options and related costs for the provision of ancillary services specifically from wind energy technologies. It is focused on the set of ancillary services defined in the previous work...
... THE PUBLIC UTILITY HOLDING COMPANY ACT OF 2005, FEDERAL POWER ACT AND NATURAL GAS ACT UNIFORM SYSTEM OF ACCOUNTS FOR CENTRALIZED SERVICE COMPANIES SUBJECT TO THE PROVISIONS OF THE PUBLIC UTILITY HOLDING... (§ 367.4040), for the current amortization of limited-term service company property investments. (2...
Demand response has gained significant attention in recent years as it demonstrates potentials to enhance the power system's operational flexibility in a cost-effective way. Industrial loads such as aluminum smelters, steel manufacturers, and cement plants demonstrate advantages in supporting power system operation through demand response programs, because of their intensive power consumption, already existing advanced monitoring and control infrastructure, and the strong economic incentive due to the high energy costs. In this thesis, we study approaches to efficiently integrate each of these types of manufacturing processes as demand response resources. The aluminum smelting process is able to change its power consumption both accurately and quickly by controlling the pots' DC voltage, without affecting the production quality. Hence, an aluminum smelter has both the motivation and the ability to participate in demand response. First, we focus on determining the optimal regulation capacity that such a manufacturing plant should provide. Next, we focus on determining its optimal bidding strategy in the day-ahead energy and ancillary services markets. Electric arc furnaces (EAFs) in steel manufacturing consume a large amount of electric energy. However, a steel plant can take advantage of time-based electricity prices by optimally arranging energy-consuming activities to avoid peak hours. We first propose scheduling methods that incorporate the EAFs' flexibilities to reduce the electricity cost. We then propose methods to make the computations more tractable. Finally, we extend the scheduling formulations to enable the provision of spinning reserve. Cement plants are able to quickly adjust their power consumption rate by switching on/off the crushers. However, switching on/off the loading units only achieves discrete power changes, which restricts the load from offering valuable ancillary services such as regulation and load following, as continuous power changes
Sellafield Ltd Analytical Services provide an essential view on the environmental, safety, process and high hazard risk reduction performances by analysis of samples. It is the largest and most complex analytical services laboratory in Europe, with 150 laboratories (55 operational) and 350 staff (including 180 analysts). Sellafield Ltd Analytical Services Main Laboratory is in need of replacement. This is due to the age of the facility and changes to work streams. This relocation is an opportunity to -) design and commission bespoke MA (Medium-Active) cells, -) modify HA (High-Active) cell design to facilitate an in-cell laboratory, -) develop non-destructive techniques, -) open light building for better worker morale. The option chosen was to move the activities to the NNL Central laboratory (NNLCL) that is based at Sellafield and is the UK's flagship nuclear research and development facility. This poster gives a time schedule
Amarasena, N; Teusner, D N; Brennan, D S; Satur, J
Dental hygienists (DHs) have been practising in Australia since the early 1970s. This study describes the clinical activity of Australian DHs. A questionnaire was mailed to members of two professional associations representing DHs. Practitioner characteristics, employment characteristics and clinical activity on a self-reported typical practice day were collected. The proportion of each service item of all services provided was estimated. Associations between practice characteristics and service provision were assessed by log-binomial regression models. Adjusted response rate was 60.6%. Of the DHs included in analysis (n=341), 80% were employed in general practice, and nearly all (96%) worked in the private sector. About half (53.7%) of all service provided were preventive services, and one-fourth (23.9%) were diagnostic. Service provision varied by practice and practitioner characteristics, with the largest variations observed by practice type. Unadjusted analysis showed that general practice DHs provided a higher mean number of periodontal instrumentation and coronal polishing (0.92 vs 0.26), fluoride applications (0.64 vs 0.08), oral examinations (0.51 vs 0.22) and intraoral radiographs (0.33 vs 0.07) per patient visit and a lower mean number of impressions (0.05 vs 0.17) and orthodontic services (0.02 vs 0.59) than specialist practice DHs. In adjusted analysis, rates of periodontal services also significantly varied by practice type; other associations persisted. Service provision of DHs varied by practice type. Practice activity was dominated by provision of preventive services while provision of periodontal treatments, fissure sealants and oral examinations was relatively limited indicating areas in which DHs are possibly underutilized. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Harris, Meredith G; Buckingham, William J; Pirkis, Jane; Groves, Aaron; Whiteford, Harvey
To derive planning estimates for the provision of public mental health services in Queensland 2007-2017. We used a five-step approach that involved: (i) estimating the prevalence and severity of mental disorders in Queensland, and the number of people at each level of severity treated by health services; (ii) benchmarking the level and mix of specialised mental health services in Queensland against national data; (iii) examining 5-year trends in Queensland public sector mental health service utilisation; (iv) reviewing Australian and international planning benchmarks; and (v) setting resource targets based on the results of the preceding four steps. Best available evidence was used where possible, supplemented by value judgements as required. Recommended resource targets for inpatient service were: 20 acute beds per 100,000 population, consistent with national average service provision but 13% above Queensland provision in 2005; and 10 non-acute beds per 100,000, 65% below Queensland levels in 2005. Growth in service provision was recommended for all other components. Adult residential rehabilitation service targets were 10 clinical 24-hour staffed beds per 100,000, and 18 non-clinical beds per 100,000. Supported accommodation targets were 35 beds per 100,000 in supervised hostels and 35 places per 100,000 in supported public housing. A direct care clinical workforce of 70 FTE per 100,000 for ambulatory care services was recommended. Fifteen per cent of total mental health funding was recommended for community support services provided by non-government organisations. The recommended targets pointed to specific areas for priority in Queensland, notably the need for additional acute inpatient services for older persons and expansion of clinical ambulatory care, residential rehabilitation and supported accommodation services. The development of nationally agreed planning targets for public mental health services and the mental health community support sector were
This paper focuses on legal service delivery for the indigent by attorneys in private practice acting pro bono in civil rather than criminal matters. In this regard there have been and continue to be considerable gaps between the proper access to civil justice imperatives of constitutional South Africa and the status quo which ...
Braak, ter C.J.F.
The ecosystem services (EcoS) concept is being used increasingly to attach values to natural systems and the multiple benefits they provide to human societies. Ecosystem processes or functions only become EcoS if they are shown to have social and/or economic value. This should assure an explicit
The study also revealed that majority of the University libraries have adequate basic infrastructure for effective electronic information services. ... acquired by the library are put into maximal use by the library clientele, thereby ensuring the achievement of the library's objective which is satisfying the users, information needs.
Vermaat, J.E.; Ellers, J.; Helmus, M.R.; Bouma, J.A.; van Beukering, P.J.H.
Ecosystem services have become a popular concept for policymakers and practioners to explain the societal value of ecosystems and biodiversity to the general public. However, in translating the concept into practice, policymakers are struggling as the measurement, valuation and governance of
Cavin, Edward S.; Stafford, Frank P.
This article develops a production frontier model for the Employment Service and assesses the relative efficiency of the 51 State Employment Security Agencies in attaining program outcomes close to that frontier. This approach stands in contrast to such established practices as comparing programs to their own previous performance. (Author/CT)
The researcher recommended among others that Academic library policy must be redesigned to include disability resources and services in conformity with ALA standard and Library management should create a disability liaison office on the ground floor of their multiple storey buildings and affiliate such offices with any ...
Introduction. Quality management of audit services requires further theoretical research and development in the field of audit activity and quality of audit, continuous improvement of the organization and methodology in providing audit services. Purpose. The article deals with the theoretical and practical questions of assessing the quality of audit services that are different from the audit in order to identify ways to improve the methodological quality assurance in the provision of thes...
In fragile states context of climate change vulnerability, poverty and lack of infrastructure, the ability of ecosystem services to provide for numerous human needs is indispensable. The focus of this paper is describing the prospects for ecosystem services provision in fragile states’ urban areas. This paper presents a distinct approach by analyzing actors with capacity to provide ecosystem services in urban areas: government, international partners and citizens. Using infrastructure investm...
Full Text Available Background: The South African legal and policy framework for sexual and reproductive healthcare provision for teenagers is complex. Objective: The article outlines the dilemmas emanating from the legal and policy framework, summarises issues with implementation of the legal and policy framework in practice, and summarises recent changes to the law. Methods: In-depth analysis of the legal and policy framework. Training workshops with a purposive sample of nurses and other healthcare providers in the Western Cape. Findings: Tensions between consent and confidentiality imposed by the Termination of Pregnancy Act, the Children’s Act, the National Health Act and the Criminal Law (Sexual Offences and Related Matters Amendment Act render conflicting obligations on healthcare providers. Healthcare providers’ experiences with service provision in this context show that the conflicting roles they inhabit render their service provision to teenagers more challenging. Conclusion: Healthcare providers need to learn about their legal obligations surrounding adolescent sexual and reproductive health services.
The purpose of this publication is to provide practical guidance on establishing and maintaining a radiation protection programme for a nuclear power plant that is consistent with the optimization process recommended in the Basic Safety Standards. This publication is written with a view to providing guidance to every person associated with the radiation protection programme for a nuclear power plant and develops the theme that radiation protection requires the commitment of all plant staff, including higher levels of executive management. 12 refs, 2 figs
Lafortezza, Raffaele; Chen, Jiquan
As a consequence of the global increase in economic and societal prosperity, ecosystems and natural resources have been substantially exploited, degraded, or even destroyed in the last century. To prevent further deprivation of the quality of ecosystems, the ecosystem services concept has become a central issue in environmental studies. A growing number of environmental agencies and organizations worldwide are now embracing integrated approaches to plan and manage ecosystems, sharing a goal to maintain the long-term provision of ecosystem services for sustainability. A daunting challenge in this process is to move from general pronouncements about the tremendous benefits that ecosystems provide to society to defensible assessments of their services. In other words, we must move beyond the scientific evidences of the ecosystem services concept to its practical applications. In this work, we discuss the theoretical foundations and applications of ecosystem services with a focus on the assessment of ecosystem service trade-offs and synergies at various spatial and temporal scales. Here, we offer examples of the main factors related to land use management that may affect the provision of ecosystem services and provide direction for future research on ecosystem services and related nature-based solutions. We also provide a briefing on the major topics covered in this Special Issue, which focuses on the provision of ecosystem services in the context of global change. Copyright © 2016 Elsevier Inc. All rights reserved.
Hornet, P.; Venturini, V.; Persoz, M.; Debost-Eymard, I.; Meister, E.
In order to justify its power plants safety which conditions their service life, EDF uses a deterministic approach until now. A probabilistic approach also exists which has a decisive advantage because it quantifies risk and makes it possible to optimize maintenance volume. The application of this approach is illustrated on the case of a reactor vessel; a coupling between the Code Aster tool and a probabilistic analysis software is necessary. (authors)
Full Text Available Literature about the psychological consequences of stroke in those under 65 is reviewed focussing on services and work. Despite similarities, young and old survivors have different experiences and needs. These are attributable to the effects of stroke on age-normative roles and activities, self-image, and the young person's stage in the life-cycle, especially family and work. “Hidden” cognitive impairments, a disrupted sense of self, and the incongruity of suffering an “older person's” disease are salient. Young survivors benefit from services, but experience lack of congruence between their needs and service philosophy, methods, and aims, and consequently have unmet needs. Employment is psychologically salient, and the evidence about return rates, factors that affect return, and the adequacy of employment-related service provision is reviewed. Specific and general recommendations are made for increasing congruence between young survivors' needs and service provision and also for facilitating their return to work.
Kathleen C. Stosch
Full Text Available Ensuring water, food and energy security for a growing world population represents a 21st century catchment management challenge. Failure to recognise the complexity of interactions across ecosystem service provision can risk the loss of other key environmental and socioeconomic benefits from the natural capital of catchment systems. In particular, the ability of soil and water to meet human needs is undermined by uncertainties around climate change effects, ecosystem service interactions and conflicting stakeholder interests across catchments. This critical review draws from an extensive literature to discuss the benefits and challenges of utilising an ecosystem service approach for integrated catchment management (ICM. State-of-the-art research on ecosystem service assessment, mapping and participatory approaches is evaluated and a roadmap of the key short- and longer-term research needs for maximising landscape-scale ecosystem service provision from catchments is proposed.
Full Text Available SUMMARY Objective: To describe the clinical and sociodemographic profile of cancer patients admitted to the Emergency Center for High Complexity Oncologic Assistance, observing the coverage of palliative and home care. Method: Cross sectional study including adult cancer patients admitted to the emergency service (September-December/2011 with a minimum length of hospital stay of two hours. Student’s t-test and Pearson chi-square test were used to compare the means. Results: 191 patients were enrolled, 47.6% elderly, 64.4% women, 75.4% from the city of Recife and greater area. The symptom prevalent at admission was pain (46.6%. 4.2% of patients were linked to palliative care and 2.1% to home care. The most prevalent cancers: cervix (18.3%, breast (13.6% and prostate (10.5%; 70.7% were in advanced stages (IV, 47.1%; 39.4% without any cancer therapy. Conclusion: Patients sought the emergency service on account of pain, probably due to the incipient coverage of palliative and home care. These actions should be included to oncologic therapy as soon as possible to minimize the suffering of the patient/family and integrate the skills of oncologists and emergency professionals.
Full Text Available The article analyses the aspects of provision of social services, reducing social exclusion, in the view of rational choice theory. This approach was selected due to the fact that provision of social services often leads to discussions explaining the appropriate and rational choice of assistance for the socially excluded members of society. The authors discuss the key aspects of provision of social services, considering the dimensions and factors of social exclusion in the context of rational choice theory.
Jaruseviciene, L.; Valius, L.; Lazarus, J.V.
collaboration with mental health teams were a lack of GPs'confidence in their communication skills and ability to diagnose the most frequent mental disorders, prompt referral to mental health team specialists, low estimation of the prevalence of non-managed mental disorders, and location of mental health team......Background. General practitioners (GPs) often become the first point of care for mental health issues. Improved collaboration between GPs and mental health teams can make a GP's mental health services more efficient. Objective. The aim of this study was to assess the collaboration between GPs...... and mental health team members and determine predictors for better collaboration. Methods. In this cross-sectional study, a 41- item questionnaire was distributed to a random sample of 797 Lithuanian GPs. The purpose of this questionnaire was to obtain knowledge about current practices of GPs in providing...
Clastres, C.; Ha Pham, T.T.; Wurtz, F.; Bacha, S.
This article presents a project designed to increase the monetary value of photovoltaic (PV) solar production for residential applications. To contribute to developing new functionalities for this type of PV system and an efficient control system for optimising its operation, this article explains how the proposed system could contract to provide ancillary services, particularly the supply of active power services. This provision of service by a PV-based system for domestic applications, not currently available, has prompted a market design proposal related to the distribution system. The mathematical model for calculating the system's optimal operation (sources, load and exchanges of power with the grid) results in a linear mix integer optimisation problem in which the objective is to maximise the profits achieved by taking part in the electricity market. Our approach is illustrated in a case study. PV producers could gain by taking part in the markets for balancing power or ancillary services despite the negative impact on profit of several types of uncertainty, notably the intermittent nature of the PV source.
Illing, R.O., E-mail: firstname.lastname@example.org [University College London Hospitals NHS Foundation Trust, 235 Euston Road, London NW1 2BU (United Kingdom); Ingham Clark, C.L.; Allum, C. [Whittington Hospital NHS Trust, London (United Kingdom)
Aim: To review the provision of out-of-hours interventional radiology (IR) services in the London Strategic Health Authority (SHA). Materials and methods: All 29 acute hospitals in the London SHA were contacted between November 2008 and January 2009. A questionnaire based on the Royal College of Radiologists (RCR) guidelines assessed the provision of out-of-hours IR services. An 'ad-hoc' service was defined as on-call provision where not all the radiologists could perform intervention: If IR was required out of hours, an interventionalist came in when off-duty or the patient was transferred. Results: Seventeen out of the 29 (59%) hospitals provided ad-hoc out-of-hours services, eight (28%) provided a 24-hour rota, and four (14%) provide no out-of-hours cover. No ad-hoc service had formal transfer arrangements to a centre providing a 24 h service. Only two hospitals providing a 24 h service had six radiologists on the rota. Conclusion: Strategic planning for out-of-hours IR across London is recommended. This is likely to be welcomed by the hospitals involved, allowing informal arrangements to be formalized, and collaboration to provide comprehensive regional networks, provided appropriate funding is made available. A national audit is recommended; it is unlikely these findings are unique to London.
Illing, R.O.; Ingham Clark, C.L.; Allum, C.
Aim: To review the provision of out-of-hours interventional radiology (IR) services in the London Strategic Health Authority (SHA). Materials and methods: All 29 acute hospitals in the London SHA were contacted between November 2008 and January 2009. A questionnaire based on the Royal College of Radiologists (RCR) guidelines assessed the provision of out-of-hours IR services. An 'ad-hoc' service was defined as on-call provision where not all the radiologists could perform intervention: If IR was required out of hours, an interventionalist came in when off-duty or the patient was transferred. Results: Seventeen out of the 29 (59%) hospitals provided ad-hoc out-of-hours services, eight (28%) provided a 24-hour rota, and four (14%) provide no out-of-hours cover. No ad-hoc service had formal transfer arrangements to a centre providing a 24 h service. Only two hospitals providing a 24 h service had six radiologists on the rota. Conclusion: Strategic planning for out-of-hours IR across London is recommended. This is likely to be welcomed by the hospitals involved, allowing informal arrangements to be formalized, and collaboration to provide comprehensive regional networks, provided appropriate funding is made available. A national audit is recommended; it is unlikely these findings are unique to London.
Full Text Available Recently positioning services are getting more attention not only within research community but also from service providers. From the service providers point of view positioning service that will be able to work seamlessly in all environments, for example, indoor, dense urban, and rural, has a huge potential to open new markets. However, such system does not only need to provide accurate position estimates but have to be scalable and resistant to fake positioning requests. In the previous works we have proposed a modular system, which is able to provide seamless positioning in various environments. The system automatically selects optimal positioning module based on available radio signals. The system currently consists of three positioning modules—GPS, GSM based positioning, and Wi-Fi based positioning. In this paper we will propose algorithm which will reduce time needed for position estimation and thus allow higher scalability of the modular system and thus allow providing positioning services to higher amount of users. Such improvement is extremely important, for real world application where large number of users will require position estimates, since positioning error is affected by response time of the positioning server.
Following the largely unimpressive performance of the public sector in the provision of solid waste services in many cities of African countries, the search for alternative strategies for addressing this challenge became inevitable. One of the strategies is the involvement of the private sector
Katusiimeh, M.W.; Mol, A.P.J.; Burger, C.P.J.
This paper compares the operations and discusses the effectiveness of public and private sector provision of solid waste collection in Kampala, Uganda. Household data suggest that the private sector is more effective than the public sector. Private sector companies provide services like container
Full Text Available Peninsula University of Technology, 10 September 2013 Selection and provisioning of services in a cloud using recommender systems approach for SMME S. Manqele1, N.Dlodlo2, P.Mvelase3, M. Dlodlo4 , S.S. Xulu5, M. Adigun6 1, 2, 3 CSIR – Meraka...
Gadkari, Abhijit S.; Mott, David A.; Kreling, David H.; Bonnarens, Joseph K.
Context: Higher prevalence of chronic diseases and reduced access to other health professionals in rural areas suggest that rural Medicare enrollees will benefit from pharmacist-provided drug therapy services (DTS). Purpose: The purpose of this study was to describe non-metropolitan community pharmacy sites in Wisconsin, the provision of DTS at…
Ramirez-Gomez, Sara O I; Torres-Vitolas, Carlos A.; Schreckenberg, Kate; Honzák, Miroslav; Cruz-Garcia, Gisella S.; Willcock, Simon; Palacios, Erwin; Pérez-Miñana, Elena; Verweij, Pita A.; Poppy, Guy M.
Over the last two decades indigenous peoples in the lower Caquetá River basin in Colombia have experienced detrimental changes in the provision of important ecosystem services in ways that have significant implications for the maintenance of their traditional livelihoods. To assess these changes we
... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Provision of certain legal services authorized. 545.513 Section 545.513 Money and Finance: Treasury Regulations Relating to Money and Finance... issued on a case-by-case basis authorizing receipt from unblocked sources of payment of professional fees...
... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Provision of certain legal services authorized. 586.509 Section 586.509 Money and Finance: Treasury Regulations Relating to Money and Finance..., authorizing receipt, from unblocked sources, of payment of professional fees and reimbursement of incurred...
... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Provision of certain legal services authorized. 598.507 Section 598.507 Money and Finance: Treasury Regulations Relating to Money and Finance... case-by-case basis authorizing receipt from unblocked sources of payment of professional fees and...
... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Provision of certain legal services authorized. 587.507 Section 587.507 Money and Finance: Treasury Regulations Relating to Money and Finance...-case basis authorizing receipt from unblocked sources of payment of professional fees and reimbursement...
Evaluating the opinions of staff and health care service provision of an std/Hiv clinic in Africa – Indications for recovery. RG Cooper ... Data were analysed according to gender, using a two-sample t-test and chi-square tests. Yates' correction was made for continuity of smaller samples. A value of p<0.05 was taken a ...
... DEPARTMENT OF TRANSPORTATION Federal Aviation Administration 14 CFR Parts 91, 121, 125, 129, and 135 Proposed Provision of Navigation Services for the Next Generation Air Transportation System (Next...) navigation infrastructure to enable performance-based navigation (PBN) as part of the Next Generation Air...
Wairimu, Winnie Wangari; Christoplos, Ian; Hilhorst, D.J.M.
This paper critically evaluates the transition from crisis to development in northern Uganda from the perspective of agricultural service provision. It contributes to debates on how efforts to link relief to rehabilitation and development may bypass the underlying challenges in linking humanitarian
Priebe, S; Badesconyi, A; Fioritti, A; Hansson, L; Kilian, RT; Torres-Gonzales, F; Turner, T; Wiersma, D
Objective To establish whether reinstitutionalisation is occurring in mental health care mid, if so, with What variations between Western European countries. Design Comparison of data on changes in service provision. Setting Six European countries with different traditions of mental health care that
Full Text Available ABSTRACT In recently world creating opportunities under appropriate circumstances for people to manipulate decisions that affect them will increase the sense of ownership and care that is why participation has become a question of concern for any public and private project development and sustainability. The purpose of this study was to assessing the challenges affecting participation in provision of public services in Arusha city council. The specific objective of this study was to find out the challenges affecting public consultations and involvement in provision of public services at Arusha city council. The researcher use survey design technique in studying 150 samples from 416442 which included public citizens mayor councilors and employees at the Arusha city council office. The sample was selected through non- probability sampling techniques which was purposive and convenience. The data was collected through questionnaire and structured interview schedule and data was qualitatively analyzed where the factual and logical interpretation was explained through using of table and percentages. From the findings of the study provision of effective public services in Arusha city council is less effective and unsatisfactory because of insufficient number of staff poor technology conservatism bureaucracy culture relationship politics and poor communication. In order to address the issues the researcher recommends that the governance is weak and it needed to be reviewed in order to enhance the effectiveness of the entire process in provision of effective public services.
As cloud computing is increasingly transforming the information technology landscape, organizations and businesses are exhibiting strong interest in Software-as-a-Service (SaaS) offerings that can help them increase business agility and reduce their operational costs. They increasingly demand services that can meet their functional and non-functional requirements. Given the plethora and the variety of SaaS offerings, we propose, in this paper, a framework for SaaS provisioning, which relies o...
Hauptfleisch, J.; Meagher, T.M.; King, D.; López de Heredia, L.; Hughes, R.J.
Aim: To examine current out-of-hours magnetic resonance imaging (MRI) provision through a snapshot survey of National Health Service (NHS) trusts and to assay how radiographer staffing cover was provided for out-of-hours services. Materials and methods: A snapshot postal survey was mailed to heads of service of all 234 trusts in England and Wales. A literature search on the models of service delivery and correlation with the authors' internal MRI rota, which has provided a full on-call service for 20 years was undertaken. Results: The response rate was 45.7% (107 of 234); 14% of responders provided full access to MRI 24 h a day; 63% provided extended weekday service, typically to 20.00 h; and 81% provided a weekend daytime service. The radiographers running the service were typically from the core MRI team. Approximately one-third (29.9%) of trusts provided training in basic brain and spine MRI to non-core MRI team members, but they typically did not participate in out-of-hours provision. Conclusion: There is currently a paucity of information on the provision of out-of-hours MRI in the NHS. However, there is increasing pressure to provide complex imaging out of hours, and in the future, trauma centres may be required to provide MRI to assess spinal injury. The authors describe a system to provide access to MRI at no additional cost to the organization based on 20 years of experience. A minority of surveyed acute NHS trusts have full out-of-hours access to MRI. Demand for MRI provision out of core hours is likely to increase
The continuous increase in the complexity and the heterogeneity of corporate and healthcare telecommunications infrastructures will require new assessment methods of quality of service (QoS) provision that are capable of addressing all engineering and social issues with much faster speeds. Speed and accessibility to any information at any time from anywhere will create global communications infrastructures with great performance bottlenecks that may put in danger human lives, power supplies, national economy and security. Regardless of the technology supporting the information flows, the final verdict on the QoS is made by the end user. The users' perception of telecommunications' network infrastructure QoS provision is critical to the successful business management operation of any organization. As a result, it is essential to assess the QoS Provision in the light of user's perception. This article presents a cost effective methodology to assess the user's perception of quality of service provision utilizing the existing Staffordshire University Network (SUN) by adding a component of measurement to the existing model presented by Walker. This paper presents the real examples of CISCO Networking Solutions for Health Care givers and offers a cost effective approach to assess the QoS provision within the campus network, which could be easily adapted to any health care organization or campus network in the world.
Full Text Available Introduction. Quality management of audit services requires further theoretical research and development in the field of audit activity and quality of audit, continuous improvement of the organization and methodology in providing audit services. Purpose. The article deals with the theoretical and practical questions of assessing the quality of audit services that are different from the audit in order to identify ways to improve the methodological quality assurance in the provision of these services. Results. It is proved that factors (economic, methodological, organizational and conditions have an impact on the quality of audit services. This, in general, affects the content of audit services regulation and their social and economic significance. The terms of quality assurance, which are considered in the article, have a decisive influence on the implementation of those specific factors that directly change the properties of the audit services and create the services of the required quality. Assurance of the quality of audit services is considered as the creation of the necessary conditions for the implementation of all factors that affect the quality of audit services, maintanence of the given level of quality of audit services in accordance with the requirements of legal acts and market needs. Conclusions. The issue of identifying criteria, factors and indicators for assessing the quality in audit services is raised. In the generalized form, the matrix of quality assurance of audit services is presented, which indicates the interconnection of various conditions, factors, quality indicators in audit services.
Full Text Available The article highlights the implementation of outsourcing as a mean of service for security provision. Analysis is performed to describe the current issues affecting the management decision in favor of outsourcing. Investigation covers the processes of physical, information and economical security. The main recommendations to use outsourcing for security provision are described in the conclusion. With the development of mobile technology protecting of user data becomes more and more important. The article is dedicated to the vulnerability of devices running on the iOS platform, potentially allowing an attacker to obtain information about the movements of their owners, and suggests ways to protect against these attacks.
Vedel, Suzanne Elizabeth; Jacobsen, Jette Bredahl; Thorsen, Bo Jellesmark
A key prerequisite to ensure that payment for ecosystem services is effective is that the management measures landowners are paid to undertake are in fact additional to the status quo and hence bring about a change in provision. We investigated Danish forest owners' preferences for conditional...... owners may already provide some of these, e.g., if they derive private benefits from them, in which case additionality becomes an issue. This study investigates the link between forest owners' current management and their willingness to accept (WTA) payments for providing specific ecosystem services...... contracts for the provision of ecosystem services in Natura 2000 policies in a sample covering 12.5% of the total private forest area. This involves allowing old trees to decay naturally, setting aside forest areas, accepting a fixed percentage of broadleaves and increasing access for the public. Forest...
This rule reissues the current regulations and: Establishes policy, assigns responsibilities, and implements the non-funding and non-reporting provisions in DoD for: Provision of early intervention services (EIS) to infants and toddlers with disabilities and their families, as well as special education and related services to children with disabilities entitled under this part to receive education services from the DoD; implementation of a comprehensive, multidisciplinary program of EIS for infants and toddlers with disabilities and their families who, but for age, are eligible to be enrolled in DoD schools; provision of a free appropriate public education (FAPE), including special education and related services, for children with disabilities, as specified in their individualized education programs (IEP), who are eligible to enroll in DoD schools; and monitoring of DoD programs providing EIS, and special education and related services for compliance with this part. This rule also establishes a DoD Coordinating Committee to recommend policies and provide compliance oversight for early intervention and special education.
... 32 CFR Part 57 Provision of Early Intervention and Special Education Services to Eligible DoD...-2011-OS-0095] RIN 0790-AI77 Provision of Early Intervention and Special Education Services to Eligible... (EIS) to infants and toddlers with disabilities and their families, as well as special education and...
...-Party Provision of Ancillary Services; Accounting and Financial Reporting for New Electric Storage... Financial Reporting for New Electric Storage Technologies, Notice of Proposed Rulemaking, FERC Stats. & Regs... Commission 18 CFR Parts 35 and 101 Third-Party Provision of Ancillary Services; Accounting and Financial...
Horwitz, Jill R; Nichols, Austin
To test whether nonprofit, for-profit, or government hospital ownership affects medical service provision in rural hospital markets, either directly or through the spillover effects of ownership mix. Data are from the American Hospital Association, U.S. Census, CMS Healthcare Cost Report Information System and Prospective Payment System Minimum Data File, and primary data collection for geographic coordinates. The sample includes all nonfederal, general medical, and surgical hospitals located outside of metropolitan statistical areas and within the continental United States from 1988 to 2005. We estimate multivariate regression models to examine the effects of (1) hospital ownership and (2) hospital ownership mix within rural hospital markets on profitable versus unprofitable medical service offerings. Rural nonprofit hospitals are more likely than for-profit hospitals to offer unprofitable services, many of which are underprovided services. Nonprofits respond less than for-profits to changes in service profitability. Nonprofits with more for-profit competitors offer more profitable services and fewer unprofitable services than those with fewer for-profit competitors. Rural hospital ownership affects medical service provision at the hospital and market levels. Nonprofit hospital regulation should reflect both the direct and spillover effects of ownership. © Health Research and Educational Trust.
Passalent, Laura; Borsy, Emily; Landry, Michel D; Cott, Cheryl
To illustrate the application of geographic information systems (GIS) as a tool to assess rehabilitation service delivery by presenting results from research recently conducted to assess demand and provision for community rehabilitation service delivery in Ontario, Canada. Secondary analysis of data obtained from existing sources was used to establish demand and provision profiles for community rehabilitation services. These data were integrated using GIS software. A number of descriptive maps were produced that show the geographical distribution of service provision variables (location of individual rehabilitation health care providers and location of private and publicly funded community rehabilitation clinics) in relation to the distribution of demand variables (location of the general population; location of specific populations (i.e., residents age 65 and older) and distribution of household income). GIS provides a set of tools for describing and understanding the spatial organization of the health of populations and the distribution of health services that can aid the development of health policy and answer key research questions with respect to rehabilitation health services delivery. Implications for Rehabilitation It is important to seek out alternative and innovative methods to examine rehabilitation service delivery. GIS is a computer-based program that takes any data linked to a geographically referenced location and processes it through a software system that manages, analyses and displays the data in the form of a map, allowing for an alternative level of analysis. GIS provides a set of tools for describing and understanding the spatial organization of population health and health services that can aid the development of health policy and answer key research questions with respect to rehabilitation health services delivery.
Margaria, Tiziana; Kubczak, Christian; Steffen, Bernhard
With Bio-jETI, we introduce a service platform for interdisciplinary work on biological application domains and illustrate its use in a concrete application concerning statistical data processing in R and xcms for an LC/MS analysis of FAAH gene knockout. Bio-jETI uses the jABC environment for service-oriented modeling and design as a graphical process modeling tool and the jETI service integration technology for remote tool execution. As a service definition and provisioning platform, Bio-jETI has the potential to become a core technology in interdisciplinary service orchestration and technology transfer. Domain experts, like biologists not trained in computer science, directly define complex service orchestrations as process models and use efficient and complex bioinformatics tools in a simple and intuitive way.
Davies, Helen J; Doick, Kieron J; Hudson, Malcolm D; Schreckenberg, Kate
Urbanisation and a changing climate are leading to more frequent and severe flood, heat and air pollution episodes in Britain's cities. Interest in nature-based solutions to these urban problems is growing, with urban forests potentially able to provide a range of regulating ecosystem services such as stormwater attenuation, heat amelioration and air purification. The extent to which these benefits are realized is largely dependent on urban forest management objectives, the availability of funding, and the understanding of ecosystem service concepts within local governments, the primary delivery agents of urban forests. This study aims to establish the extent to which British local authorities actively manage their urban forests for regulating ecosystem services, and identify which resources local authorities most need in order to enhance provision of ecosystem services by Britain's urban forests. Interviews were carried out with staff responsible for tree management decisions in fifteen major local authorities from across Britain, selected on the basis of their urban nature and high population density. Local authorities have a reactive approach to urban forest management, driven by human health and safety concerns and complaints about tree disservices. There is relatively little focus on ensuring provision of regulating ecosystem services, despite awareness by tree officers of the key role that urban forests can play in alleviating chronic air pollution, flood risk and urban heat anomalies. However, this is expected to become a greater focus in future provided that existing constraints - lack of understanding of ecosystem services amongst key stakeholders, limited political support, funding constraints - can be overcome. Our findings suggest that the adoption of a proactive urban forest strategy, underpinned by quantified and valued urban forest-based ecosystem services provision data, and innovative private sector funding mechanisms, can facilitate a change to a
Full Text Available Abstract Background UK NHS Stop Smoking Services provide cost effective smoking cessation interventions but, as yet, there has been no assessment of their provision of relapse prevention interventions. Methods Electronic questionnaire survey of 185 UK Stop Smoking Services Managers. Results Ninety six Stop Smoking Service managers returned completed questionnaires (52% response rate. Of these, 58.3% (n = 56 ran NHS Stop Smoking Services which provided relapse prevention interventions for clients with the most commonly provided interventions being behavioural support: telephone (77%, group (73%, and individual (54%. Just under half (48%, n = 27 offered nicotine replacement therapy (NRT, 21.4% (n = 12 bupropion; 19.6% (n = 11 varenicline. Over 80% of those providing relapse prevention interventions do so for over six months. Nearly two thirds of all respondents thought it was likely that they would either continue to provide or commence provision of relapse prevention interventions in their services. Of the remaining respondents, 66.7% (n = 22 believed that the government focus on four-week quit rates, and 42.9% (14 services believed that inadequate funding for provision of relapse prevention interventions, were major barriers to introducing these interventions into routine care. Conclusions Just over half of UK managers of NHS Stop Smoking Services who responded to the questionnaire reported that, in their services, relapse prevention interventions were currently provided for clients, despite, at that time, there being a weak evidence base for their effectiveness. The most commonly provided relapse prevention interventions were those for which there was least evidence. If these interventions are found to be effective, barriers would need to be removed before they would become part of routine care.
Meagen M. Rosenthal
Full Text Available The integration of advanced pharmacy services into community pharmacy practice is not complete. According to implementation research understanding professional culture, as a part of context, may provide insights for accelerating this process. There are three objectives in this study. The first objective of this study was to validate an adapted version of an organizational culture measure in a sample of United States’ (US community pharmacists. The second objective was to examine potential relationships between the cultural factors identified using the validated instrument and a number of socialization and education variables. The third objective was to examine any relationships between the scores on the identified cultural factors and the provision of MTM services. This study was a cross-sectional online survey for community pharmacists in the southeastern US. The survey contained questions on socialization/education, respondents’ self-reported provision of medication therapy management (MTM services, and the organizational culture profile (OCP. Analyses included descriptive statistics, a principle components analysis (PCA, independent samples t-test, and multivariate ordinal regression. A total of 303 surveys were completed. The PCA revealed a six-factor structure: social responsibility, innovation, people orientation, competitiveness, attention to detail, and reward orientation. Further analysis revealed significant relationships between social responsibility and years in practice, and people orientation and attention to detail and pharmacists’ training and practice setting. Significant positive relationships were observed between social responsibility, innovation, and competitiveness and the increased provision of MTM services. The significant relationships identified between the OCP factors and community pharmacist respondents’ provision of MTM services provides an important starting point for developing interventions to improve the
Rosenthal, Meagen M; Holmes, Erin R
The integration of advanced pharmacy services into community pharmacy practice is not complete. According to implementation research understanding professional culture, as a part of context, may provide insights for accelerating this process. There are three objectives in this study. The first objective of this study was to validate an adapted version of an organizational culture measure in a sample of United States' (US) community pharmacists. The second objective was to examine potential relationships between the cultural factors identified using the validated instrument and a number of socialization and education variables. The third objective was to examine any relationships between the scores on the identified cultural factors and the provision of MTM services. This study was a cross-sectional online survey for community pharmacists in the southeastern US. The survey contained questions on socialization/education, respondents' self-reported provision of medication therapy management (MTM) services, and the organizational culture profile (OCP). Analyses included descriptive statistics, a principle components analysis (PCA), independent samples t-test, and multivariate ordinal regression. A total of 303 surveys were completed. The PCA revealed a six-factor structure: social responsibility, innovation, people orientation, competitiveness, attention to detail, and reward orientation. Further analysis revealed significant relationships between social responsibility and years in practice, and people orientation and attention to detail and pharmacists' training and practice setting. Significant positive relationships were observed between social responsibility, innovation, and competitiveness and the increased provision of MTM services. The significant relationships identified between the OCP factors and community pharmacist respondents' provision of MTM services provides an important starting point for developing interventions to improve the uptake of practice
Tumwesigye Nazarius M
Full Text Available Abstract Background Unintended pregnancies lead to unsafe abortions, which are a leading cause of preventable maternal mortality among young women in Uganda. There is a discrepancy between the desire to prevent pregnancy and actual contraceptive use. Health care providers' perspectives on factors influencing contraceptive use and service provision to young people aged 15-24 in two rural districts in Uganda were explored. Methods Semi-structured questionnaires were used for face- to-face interviews with 102 providers of contraceptive service at public, private not-for-profit, and private for-profit health facilities in two rural districts in Uganda. Descriptive and inferential statistics were used in the analysis of data. Results Providers identified service delivery, provider-focused, structural, and client-specific factors that influence contraceptive use among young people. Contraceptive use and provision to young people were constrained by sporadic contraceptive stocks, poor service organization, and the limited number of trained personnel, high costs, and unfriendly service. Most providers were not competent enough to provide long-acting methods. There were significant differences in providers' self-rated competence by facility type; private for-profit providers' competence was limited for most contraceptives. Providers had misconceptions about contraceptives, they had negative attitudes towards the provision of contraceptives to young people, and they imposed non-evidence-based age restrictions and consent requirements. Thus, most providers were not prepared or were hesitant to give young people contraceptives. Short-acting methods were, however, considered acceptable for young married women and those with children. Conclusion Provider, client, and health system factors restricted contraceptive provision and use for young people. Their contraceptive use prospects are dependent on provider behavior and health system improvements.
Knezovic, Katarina; Marinelli, Mattia; Codani, Paul
Due to the increasing penetration of distributed generation and new high-power consumption loads – such as electric vehicles (EVs) – distribution system operators (DSO) are facing new grid security challenges. DSOs have historically dealt with such issues by making investments in grid reinforcement...... on current grid conditions. In return, flexibility provision should be remunerated accordingly. In this paper, the authors are interested in making an accurate description of the flexibility services at the distribution level which could be provided by EVs as well as their requirements, e.g. location......, activation time and duration. Market design recommendations for enhancing the provision of DSO grid services by EVs are derived from the conducted analysis....
Wang Chen; Sun Haitao; Gao Chen; Deng Dong
In-service inspection (ISI) is an important method to ensure the safety of the mechanical equipment in nuclear power stations. According to the in-service inspection experience feedback from the domestic nuclear power stations, the reasonableness of some provisions in the RSE-M code are discussed and the applications of risk-informed in-service inspection (RI-ISI) are introduced, and the advices for the optimization of the ISI of the domestic M310 nuclear power stations are proposed. (authors)
Iliffe, Steve; Davies, Susan L; Gordon, Adam L; Schneider, Justine; Dening, Tom; Bowman, Clive; Gage, Heather; Martin, Finbarr C; Gladman, John R F; Victor, Christina; Meyer, Julienne; Goodman, Claire
The number of beds in care homes (with and without nurses) in the United Kingdom is three times greater than the number of beds in National Health Service (NHS) hospitals. Care homes are predominantly owned by a range of commercial, not-for-profit or charitable providers and their residents have high levels of disability, frailty and co-morbidity. NHS support for care home residents is very variable, and it is unclear what models of clinical support work and are cost-effective. To critically evaluate how the NHS works with care homes. A review of surveys of NHS services provided to care homes that had been completed since 2008. It included published national surveys, local surveys commissioned by Primary Care organisations, studies from charities and academic centres, grey literature identified across the nine government regions, and information from care home, primary care and other research networks. Data extraction captured forms of NHS service provision for care homes in England in terms of frequency, location, focus and purpose. Five surveys focused primarily on general practitioner services, and 10 on specialist services to care home. Working relationships between the NHS and care homes lack structure and purpose and have generally evolved locally. There are wide variations in provision of both generalist and specialist healthcare services to care homes. Larger care home chains may take a systematic approach to both organising access to NHS generalist and specialist services, and to supplementing gaps with in-house provision. Access to dental care for care home residents appears to be particularly deficient. Historical differences in innovation and provision of NHS services, the complexities of collaborating across different sectors (private and public, health and social care, general and mental health), and variable levels of organisation of care homes, all lead to persistent and embedded inequity in the distribution of NHS resources to this population
Funmilayo Moyinola Araloyin; OJO Olatoye
Real estate firms attempting to increase and retain their customers need to know the factors contributing to customers¡¯ satisfaction and retention. This study investigate into real estate agency market with the purposes of identifying factors that affect quality in service provision and possible factors contributing to customers¡¯ satisfaction and retention in real estate agency. This study uses survey questionnaires to obtain information from real estate consumers. This sample size consiste...
de Sosa, Laura L; Glanville, Helen C; Marshall, Miles R; Prysor Williams, A; Jones, Davey L
Riparian areas, the interface between land and freshwater ecosystems, are considered to play a pivotal role in the supply of regulating, provisioning, cultural and supporting services. Most previous studies, however, have tended to focus on intensive agricultural systems and only on a single ecosystem function. Here, we present the first study which attempts to assess a wide range of ecological processes involved in the provision of the ecosystem service of water quality regulation across a diverse range of riparian typologies. Specifically, we focus on 1) evaluating the spatial variation in riparian soils properties with respect to distance with the river and soil depth in contrasting habitat types; 2) gaining further insights into the underlying mechanisms of pollutant removal (i.e. pesticide sorption/degradation, denitrification, etc.) by riparian soils; and 3) quantify and evaluate how riparian vegetation across different habitat types contribute to the provision of watercourse shading. All the habitats were present within a single large catchment and included: (i) improved grassland, (ii) unimproved (semi-natural) grassland, (iii) broadleaf woodland, (iv) coniferous woodland, and (iv) mountain, heath and bog. Taking all the data together, the riparian soils could be statistically separated by habitat type, providing evidence that they deliver ecosystem services to differing extents. Overall, however, our findings seem to contradict the general assumption that soils in riparian area are different from neighbouring (non-riparian) areas and that they possess extra functionality in terms of ecosystem service provision. Watercourse shading was highly habitat specific and was maximal in forests (ca. 52% shade cover) in comparison to the other habitat types (7-17%). Our data suggest that the functioning of riparian areas in less intensive agricultural areas, such as those studied here, may be broadly predicted from the surrounding land use, however, further research
Chauhan, Aufeef; Babar, Muhammad Ali
Organizations involve in Global Software Development (GSD) face challenges in terms of having access to appropriate set of tools for performing distributed engineering and development activities, integration between heterogeneous desktop and web-based tools, management of artifacts developed...... distributed environment. In this paper, we argue the need to have a cloud-enabled platform for supporting GSD and propose reference architecture of a cloud based Platform for providing support to provision ecosystem of the Tools as a Service (PTaaS)....
Cartwright, J Daniel
Children and adolescents with chronic diseases and disabling conditions often need educationally related services. As medical home providers, physicians and other health care professionals can assist children, adolescents, and their families with the complex federal, state, and local laws, regulations, and systems associated with these services. Expanded roles for physicians and other health care professionals in individualized family service plan, individualized education plan, and Section 504 plan development and implementation are recommended. Recent updates to the Individuals With Disabilities Education Act will also affect these services. Funding for these services by private and nonprivate sources also continue to affect the availability of these educationally related services. The complex range of federal, state, and local laws, regulations, and systems for special education and related services for children and adolescents in public schools is beyond the scope of this statement. Readers are referred to the American Academy of Pediatrics policy statement "The Pediatrician's Role in Development and Implementation of an Individual Education Plan (IEP) and/or an Individual Family Service Plan (IFSP)" for additional background materials. The focus of this statement is the role that health care professionals have in determining and managing educationally related services in the school setting. This policy statement is a revision of a previous statement, "Provision of Educationally Related Services for Children and Adolescents With Chronic Diseases and Disabling Conditions," published in February 2000 by the Committee on Children With Disabilities (http://aappolicy.aappublications.org/cgi/content/full/pediatrics;105/2/448).
Stadler, Michael; Marnay, Christ; Lai, Judy; Siddiqui, Afzal; Limpaitoon, Tanachai; Phan, Trucy; Megel, Olivier; Chang, Jessica; DeForest, Nicholas
Non-residential sectors offer many promising applications for electrical storage (batteries) and photovoltaics (PVs). However, choosing and operating storage under complex tariff structures poses a daunting technical and economic problem that may discourage potential customers and result in lost carbon and economic savings. Equipment vendors are unlikely to provide adequate environmental analysis or unbiased economic results to potential clients, and are even less likely to completely describe the robustness of choices in the face of changing fuel prices and tariffs. Given these considerations, researchers at Lawrence Berkeley National Laboratory (LBNL) have designed the Storage Viability and Optimization Web Service (SVOW): a tool that helps building owners, operators and managers to decide if storage technologies and PVs merit deeper analysis. SVOW is an open access, web-based energy storage and PV analysis calculator, accessible by secure remote login. Upon first login, the user sees an overview of the parameters: load profile, tariff, technologies, and solar radiation location. Each parameter has a pull-down list of possible predefined inputs and users may upload their own as necessary. Since the non-residential sectors encompass a broad range of facilities with fundamentally different characteristics, the tool starts by asking the users to select a load profile from a limited cohort group of example facilities. The example facilities are categorized according to their North American Industry Classification System (NAICS) code. After the load profile selection, users select a predefined tariff or use the widget to create their own. The technologies and solar radiation menus operate in a similar fashion. After these four parameters have been inputted, the users have to select an optimization setting as well as an optimization objective. The analytic engine of SVOW is LBNL?s Distributed Energy Resources Customer Adoption Model (DER-CAM), which is a mixed
Tolstrup Christensen, Lene
This doctoral thesis (PhD) explores from a public governance perspective the role of stateowned enterprises (SOEs) in an era of marketization of public service provision and thus contributes to the renewed academic interest in contemporary SOEs. It builds on an explorative comparative case study...... of DSB SOV and SJ AB in the marketization of passenger rail in Denmark and Sweden respectively from the 1990s to 2015. In the period both cases kept full state ownership and Sweden gradually exposed all services to competition whereas in Denmark with time competition was put on hold. The case study...... as an institutional market actor (IMA)....
AbstractBackgroundMental health problems are disproportionately higher amongst homeless people. Many barriers exist for homeless people with mental health problems in accessing treatment yet little research has been done on service provision and quality of care for this group. The aim of this paper is to assess current service provision and identify barriers to care for homeless people with mental health problems in 14 European capital cities.MethodTwo methods of data collection were employed; (i) In two highly deprived areas in each of the 14 European capital cities, homeless-specific services providing mental health, social care or general health services were assessed. Data were obtained on service characteristics, staff and programmes provided. (ii) Semi-structured interviews were conducted in each area with experts in mental health care provision for homeless people in order to determine the barriers to care and ways to overcome them.ResultsAcross the 14 capital cities, 111 homeless-specific services were assessed. Input from professionally qualified mental health staff was reported as low, as were levels of active outreach and case finding. Out-of-hours service provision appears inadequate and high levels of service exclusion criteria were evident. Prejudice in the services towards homeless people, a lack of co-ordination amongst services, and the difficulties homeless people face in obtaining health insurance were identified as major barriers to service provision.ConclusionsWhile there is variability in service provision across European capital cities, the reported barriers to service accessibility are common. Homeless-specific services are more responsive to the initial needs of homeless people with mental health problems, while generic services tend to be more conducive to long term care. Further research is needed to determine the effectiveness of different service delivery models, including the most effective coordination of homeless specific and generic
Full Text Available Abstract Background Mental health problems are disproportionately higher amongst homeless people. Many barriers exist for homeless people with mental health problems in accessing treatment yet little research has been done on service provision and quality of care for this group. The aim of this paper is to assess current service provision and identify barriers to care for homeless people with mental health problems in 14 European capital cities. Method Two methods of data collection were employed; (i In two highly deprived areas in each of the 14 European capital cities, homeless-specific services providing mental health, social care or general health services were assessed. Data were obtained on service characteristics, staff and programmes provided. (ii Semi-structured interviews were conducted in each area with experts in mental health care provision for homeless people in order to determine the barriers to care and ways to overcome them. Results Across the 14 capital cities, 111 homeless-specific services were assessed. Input from professionally qualified mental health staff was reported as low, as were levels of active outreach and case finding. Out-of-hours service provision appears inadequate and high levels of service exclusion criteria were evident. Prejudice in the services towards homeless people, a lack of co-ordination amongst services, and the difficulties homeless people face in obtaining health insurance were identified as major barriers to service provision. Conclusions While there is variability in service provision across European capital cities, the reported barriers to service accessibility are common. Homeless-specific services are more responsive to the initial needs of homeless people with mental health problems, while generic services tend to be more conducive to long term care. Further research is needed to determine the effectiveness of different service delivery models, including the most effective coordination of
Quality and the Academic Library: Reviewing, Assessing and Enhancing Service Provision provides an in-depth review and analysis of quality management and service quality in academic libraries. All aspects of quality are considered in the book, including quality assessment, quality review, and quality enhancement. An overview of quality management and service quality concepts, principles, and methods leads to a detailed consideration of how they have been applied in universities and their libraries. A case study approach is used with different perspectives provided from the different stakeholders involved in the quality processes. All contributors adopt a critical reflection approach, reflecting on the implications, impact, and significance of the activities undertaken and the conclusions that can be drawn for future developments. The book concludes with an overall reflection on quality management and service quality in academic libraries with a final analysis of priorities for the future.
Prokofieva, Irina; Górriz, Elena; Boon, Tove Enggrob
Incentive schemes and payments for ecosystem services attract increasing attention as a means for aligning the interests of landowners and society by remunerating forest owners for the goods and services their forests produce. As incentive schemes expand around the world, questions related...... and Italy. The analysed schemes are predominantly aimed at enhancing biodiversity and improving recreation. One of the schemes is also related to preserving a variety of forest ecosystem services from forest fires. The incentive schemes are studied following a framework for the institutional analysis of PES...... developed by Prokofieva and Gorriz (Prokofieva, I. and Gorriz, E. 2013: Institutional analysis of incentives for the provision of forest goods and services: an assessment of incentive schemes in Catalonia (North-East Spain), Forest Policy and Economics, 37, 104-114.). We focus on actor and institutional...
Schneider, P J
Biotechnology products offer both problems and opportunities for pharmacists. On one hand, they are expensive to purchase and keep on inventory. Typical compensation for outpatient prescriptions does not offset the cost of maintaining the inventory, or providing the education and training that patients often need to use biotechnology products properly. On the other hand, there are issues related to proper storage, preparation, and administration for which pharmacists are well prepared to address. Pharmacists are also convenient, trusted, and provide service at relatively low cost. Examples of special services that pharmacists can provide to improve the use of biotechnology products include patient education, injection clinics, provision of medical supplies, and predrawing syringes for patients. Patients are often sent to many providers for these services, resulting in inconvenience and fragmentation of care. If new compensation methods can be established to support more comprehensive pharmacy services, the use of biotechnology products by patients will improve.
Tamburini, Giovanni; De Simone, Serena; Sigura, Maurizia; Boscutti, Francesco; Marini, Lorenzo
Agroecosystems are principally managed to maximize food provisioning even if they receive a large array of supporting and regulating ecosystem services (ESs). Hence, comprehensive studies investigating the effects of local management and landscape composition on the provision of and trade-offs between multiple ESs are urgently needed. We explored the effects of conservation tillage, nitrogen fertilization and landscape composition on six ESs (crop production, disease control, soil fertility, water quality regulation, weed and pest control) in winter cereals. Conservation tillage enhanced soil fertility and pest control, decreased water quality regulation and weed control, without affecting crop production and disease control. Fertilization only influenced crop production by increasing grain yield. Landscape intensification reduced the provision of disease and pest control. We also found tillage and landscape composition to interactively affect water quality regulation and weed control. Under N fertilization, conventional tillage resulted in more trade-offs between ESs than conservation tillage. Our results demonstrate that soil management and landscape composition affect the provision of several ESs and that soil management potentially shapes the trade-offs between them. © 2016 The Author(s).
Smith, S M; Campbell, N C
There is a paucity of research into rural health care services. In particular little is known about the provision of specialist cancer services for patients who live in remote rural areas of the UK. This study set out to investigate current models of medical and clinical oncology care in Scotland. A national survey with key health professionals was conducted to identify rural oncology schemes currently in operation. Detailed quantitative data about the schemes together with qualitative data on how health professionals view current models of care were collected by a computer-assisted telephone survey. Schemes that currently provide outpatient and chemotherapy oncology services for remote rural patients fell into three categories: central clinics (5); shared care outreach clinics with chemotherapy provision (11); and shared care outreach clinics without chemotherapy provision (7). All radiotherapy was conducted at central clinics (5). Widely varying practices in delivery of cancer care were found across the country. The main issues for professionals about current models of care involved expertise, travelling and accessibility (for patients), communication and expansion of the rural service. Nation-wide consistency in cancer care has still to be achieved. Travelling for treatment was seen to take its toll on all patients but particularly for the very remote, elderly and poor. Most professionals believe that an expansion of rural services would be of benefit to these patients. It is clear, however, that the proper infrastructure needs to be in place in terms of local expertise, ensured quality of care, and good communication links with cancer centres before this could happen.
Muntadas, Alba; de Juan, Silvia; Demestre, Montserrat
The species interaction and their biological traits (BT) determine the function of benthic communities and, hence, the delivery of ecosystem services. Therefore, disturbance of benthic communities by trawling may compromise ecosystem service delivery, including fisheries' catches. In this work, we explore 1) the impact of trawling activities on benthic functional components (after the BTA approach) and 2) how trawling impact may affect the ecosystem services delivered by benthic communities. To this aim, we assessed the provision of ecosystem services by adopting the concept of Ecosystem Service Providers (ESP), i.e. ecological units that perform ecosystem functions that will ultimately deliver ecosystem services. We studied thirteen sites subjected to different levels of fishing effort in the Mediterranean. From a range of environmental variables included in the study, we found ESPs to be mainly affected by fishing effort and grain size. Our results suggested that habitat type has significant effects on the distribution of ESPs and this natural variability influences ESP response to trawling at a specific site. In order to summarize the complex relationships between human uses, ecosystem components and the demand for ecosystem services in trawling grounds, we adapted a DPSIR (Drivers-Pressures-State Change-Impact-Response) framework to the study area, emphasizing the role of society as Drivers of change and actors demanding management Responses. This integrative framework aims to inform managers about the interactions between all the elements involved in the management of trawling grounds, highlighting the need for an integrated approach in order to ensure ecosystem service provision. Copyright © 2014 Elsevier B.V. All rights reserved.
Goran Z. MarkoviÄ‡
division multiplexing (WDM and wavelength routing techniques are being considered as a candidate solution for future backbone infrastructures 1. Such networks are able to provide practically unlimited bandwidths required for a variety of advanced and upcoming telecommunication services and applications. With the purpose to offer high data rates and guaranteed quality of service to end users network operators (NOs have to provide a number of connections over optical network infrastructure. All-optical connections established between two wavelength routing nodes are called the lightpaths. While establishing the lightpaths a NO tries to maximize its own revenue by charging the occupation of network resources. To achieve this goal NO has to be addressed how to solve the call admission control jointly with the lightpaths routing and wavelength assignment (RWA problem1. Various services over future backbone optical networks, like lambda grids or optical virtual private networks (oVPNs could be characterized as off-line (or static traffic demands. In such case, the traffic demands are specified in advance before the connections have to be established. By knowing the complete set of demands, a more efficient network resource usage (and consequently more revenues could be achieved compared to on-line (dynamic traffic case in which future demands are not known a priori. So far, various approaches to solve the revenue (profit maximization problem in optical WDM networks have been proposed in literature 2-6. In Ref. 2, the problem of maximizing profits is mathematically formulated as an integer linear programming (ILP problem. Since the optimal provisioning of lightpaths is NP-hard combinatorial problem, several heuristic algorithms are proposed to solve the problem assuming both an off-line and an on-line traffic model. The authors of Ref. 3 proposed an efficient near-optimal algorithm based on Lagrangean relaxation (LGR approach to solve the lightpath provisioning problem in which
... 12 Banks and Banking 4 2010-01-01 2010-01-01 false Financial education programs that include the provision of bank products and services. 303.46 Section 303.46 Banks and Banking FEDERAL DEPOSIT INSURANCE... Branches and Offices § 303.46 Financial education programs that include the provision of bank products and...
Bangash, Rubab F; Passuello, Ana; Sanchez-Canales, María; Terrado, Marta; López, Alfredo; Elorza, F Javier; Ziv, Guy; Acuña, Vicenç; Schuhmacher, Marta
The Mediterranean basin is considered one of the most vulnerable regions of the world to climate change and such changes impact the capacity of ecosystems to provide goods and services to human society. The predicted future scenarios for this region present an increased frequency of floods and extended droughts, especially at the Iberian Peninsula. This paper evaluates the impacts of climate change on the water provisioning and erosion control services in the densely populated Mediterranean Llobregat river basin of. The assessment of ecosystem services and their mapping at the basin scale identify the current pressures on the river basin including the source area in the Pyrenees Mountains. Drinking water provisioning is expected to decrease between 3 and 49%, while total hydropower production will decrease between 5 and 43%. Erosion control will be reduced by up to 23%, indicating that costs for dredging the reservoirs as well as for treating drinking water will also increase. Based on these data, the concept for an appropriate quantification and related spatial visualization of ecosystem service is elaborated and discussed. Copyright © 2013 Elsevier B.V. All rights reserved.
Beyrer, Chris; Makofane, Keletso; Orazulike, Ifeanyi; Diouf, Daouda; Baral, Stefan D
Chris Beyrer and colleagues reflect on an underappreciated trend in multiple African, Asian, and Caribbean settings, in which the provision of HIV and other essential health services for sexual and gender minorities is expanding despite challenging legal and social environments.
Full Text Available State legitimacy – particularly its alleged potential to counter state fragility – has received increasing attention in academic and policy literature concerned with African development. Service provision can substantially influence such state legitimacy. Services, however, are mostly provided by a multiplicity of (state and non-state providers. This article therefore specifically explores how joint service delivery by multiple providers shapes the attribution of state legitimacy in Burundi by means of two qualitative case studies. Empirically, the article demonstrates, first, that the process of stakeholder interaction, rather than the output of this process, most distinctly shapes state legitimacy and, second, that there are substantial variations in legitimacy attribution by different stakeholders and for different state institutions. Epistemologically, the article suggests three specific challenges that merit attention in further empirical investigation of state legitimacy in fragile settings: the diversity of people’s expectations; the artificiality of state/non-state distinctions; and the personification and politicization of state institutions.
... Ancillary Services; Accounting and Financial Reporting for New Electric Storage Technologies AGENCY: Federal... Ancillary Services; Accounting and Financial Reporting for New Electric Storage Technologies, 135 FERC ] 61... Commission 18 CFR Parts 35, 37, and 101 Third-Party Provision of Ancillary Services; Accounting and Financial...
Zealley, I.A.; Gordon, T.J.; Robertson, I.; Moss, J.G.; Gillespie, I.N.
Aim: To evaluate the availability of out-of-hours (OOH) interventional radiology (IR) services in Scotland and discuss implications for service redesign. Materials and methods: Data were gathered via a survey conducted by telephone/e-mail interview. The setting was hospitals in Scotland with acute medical and/or surgical beds. The interviewees were consultant interventional radiologists representing each of the 14 geographical Health Boards in Scotland. Results: Three of the 14 geographical Health Boards provided a formal, prospectively planned OOH IR service in at least one hospital. Fourteen of the 34 acute hospitals provided an in-hours IR service, which includes endovascular haemorrhage control. Eight of the 34 acute hospitals had formal, prospectively planned on-call IR arrangements, 12 had an ad-hoc service, and 20 transferred patients to other facilities. Thirty-eight of the 223 consultant radiologists in Scotland were able to perform endovascular haemorrhage control procedures: only 18 of these 38 (47%) were included in on-call rotas. A further 42 radiologists were able to perform nephrostomy and a further 61 were able to perform abscess drainage. Eighty-two radiologists did not perform any interventional procedures. Conclusions: The provision of OOH IR services in Scotland is limited and available resources, both skills and equipment, are being underutilized. These data will be used to inform a process of OOH IR service redesign in Scotland.
Smaill, Simeon J; Bayne, Karen M; Coker, Graham W R; Paul, Thomas S H; Clinton, Peter W
Stakeholders in plantation forestry are increasingly aware of the importance of the ecosystem services and non-market values associated with forests. In New Zealand, there is significant interest in establishing species other than Pinus radiata D. Don (the dominant plantation species) in the belief that alternative species are better suited to deliver these services. Significant risk is associated with this position as there is little objective data to support these views. To identify which species were likely to be planted to deliver ecosystem services, a survey was distributed to examine stakeholder perceptions. Stakeholders were asked which of 15 tree attributes contributed to the provision of five ecosystem services (amenity value, bioenergy production, carbon capture, the diversity of native habitat, and erosion control/water quality) and to identify which of 22 candidate tree species possessed those attributes. These data were combined to identify the species perceived most suitable for the delivery of each ecosystem service. Sequoia sempervirens (D.Don) Endl. closely matched the stakeholder derived ideotypes associated with all five ecosystem services. Comparisons to data from growth, physiological and ecological studies demonstrated that many of the opinions held by stakeholders were inaccurate, leading to erroneous assumptions regarding the suitability of most candidate species. Stakeholder perceptions substantially influence tree species selection, and plantations established on the basis of inaccurate opinions are unlikely to deliver the desired outcomes. Attitudinal surveys associated with engagement campaigns are essential to improve stakeholder knowledge, advancing the development of fit-for-purpose forest management that provides the required ecosystem services.
Lwin, Kristen; Fluke, John; Trocmé, Nico; Fallon, Barbara; Mishna, Faye
Ongoing child welfare services are put in place after completion of the initial maltreatment investigation when there is a perceived need to mitigate the risk of future harm. The knowledge of how clinical, worker, and organizational characteristics interact with this decision to provide ongoing child welfare services is not well integrated in the research literature. Using secondary data from the Canadian Incidence Study of Reported Child Abuse and Neglect-2008, this study's primary objective is to understand the relationship of clinical, worker, and organizational characteristics to the decision to transfer a case to ongoing child welfare services and their relative contribution to the transfer decision in Canada. Findings indicate that several clinical level variables are associated with families receiving ongoing services. Additionally, organizational factors, such as type of services offered by the organization and the number of employee support programs available to workers, significantly predicted the decision to transfer a case to ongoing services. While no worker factors, such as education, amount of training, experience, or caseload, were associated with ongoing service receipt, the intraclass correlation coefficient of the final three-level parsimonious model indicated substantial clustering at the worker level. Results indicate that Canadian child welfare workers make decisions differently based on factors not available in the current study and that what would be deemed as important worker characteristics do not necessarily predict this outcome. Findings and implications for future research are discussed. Copyright © 2018 Elsevier Ltd. All rights reserved.
Full Text Available More and more Web services raise the demands of personalized service recommendation; there exist some recommendation technologies, which improve the qualities of service recommendation by using service ranking and collaborative filtering. However, privacy and security are also important issues in service scheduling process; social relationships have been the key factors of interpersonal communication; service selection based on user preferences has become an inevitable trend. Starting from user demand preferences, this paper analyzes social topology and service demand information and obtains trusted social relationships; then we construct the fusion model of service historical preferences and potential ones; according to social service recommendation demands, TSRSR algorithm has completed designing. Through experiments, TSRSR algorithm is much better than the others, which can effectively improve potential preferences’ learning. Furthermore, the research results of this paper have more significance to study the security and privacy of service recommendation.
Kane, Debra J; Kasehagen, Laurin; Punyko, Judy; Carle, Adam C; Penziner, Andy; Thorson, Sarah
To examine whether individual, condition-related, and system-related characteristics are associated with state performance (high, medium, low) on the provision of transition services to children with special health care needs (CSHCN). We conducted descriptive, bivariate, and multivariable analyses of 16876 children aged 12 to 17 years by using data from the 2005-2006 National Survey of Children With Special Health Care Needs. Polytomous logistic regression was used to compare the characteristics of CSHCN residing within high-, medium-, and low-performance states, with low-performance states serving as the reference group. Compared with non-Hispanic white CSHCN, Hispanic (adjusted odds ratio [aOR]: 0.25 [95% confidence interval (CI): 0.17-0.37]) and non-Hispanic black (aOR: 0.44 [95% CI: 0.30-0.62]) CSHCN were less likely to reside in a high-performance than in a low-performance state. Compared with CSHCN who had a medical home or adequate insurance coverage, CSHCN who did not have a medical home or adequate insurance coverage were less likely to reside in a high-performance than in a low-performance state (aOR: 0.73 [95% CI: 0.57-0.95]; aOR: 0.73 [95% CI: 0.58-0.93], respectively). Key factors found to be important in a state's performance on provision of transition services to CSHCN were race/ethnicity and having a medical home and adequate insurance coverage. Efforts to support the Maternal and Child Health Bureau's integration of system-level factors in quality-improvement activities, particularly establishing a medical home and attaining and maintaining adequate insurance, are likely to help states improve their performance on provision of transition services.
Mitev, Miroslav; Mihovska, Albena Dimitrova; Poulkov, Vladimir
Indoor localization is very critical for the provision of Ambient Assisted Living (AAL) services, such as e-Health, smart home, etc. The success of deploying a real-time localization system depends on selecting the right performance characteristics. Bluetooth Low Energy (BLE) is a technology, which...
Full Text Available Context of case: In Portugal, the integration of care services is still in its infancy. Nevertheless, a home support service called SAD (Serviço de Apoio Domiciliário—Domiciliary Support Service, provided by non-profit institutions to the elderly population is believed to be a first approach to integrated care. Purpose: The aim of this work is to describe and discuss the services provided by the institutions that participate in SAD and understand if this service is the first step in a change towards integrated care. Data sources: The main data sources were documents provided by institutions like INE (Instituto Nacional de Estatística—National Institute of Statistics and a questionnaire that was submitted to 75 institutions in order to capture: (a demographic and structural data; (b the type of information that the professionals need to fulfil their jobs and (c the kind of relationship and constraints, if they exist, to better integration, between the institutions that provide SAD and the patients, the social and health systems, and other entities. Conclusion and discussion: SAD seems to have been promoting a formal collaboration between several entities in the social and health systems. The information shared between these institutions has increased, but where cooperation in care service provision is concerned this seldom surpasses the social bounds because health care is still difficult to integrate.
Bowes, Alison; Avan, Ghizala; Macintosh, Sherry Bien
Previous research on mistreatment of older people in black and minority ethnic communities has identified limited service responses and the need to consider mistreatment as an issue not only for individuals but also for families, communities, and institutions. The impact of cultural factors on understandings, experiences, and remedies for mistreatment has been debated. Drawing on empirical research in the United Kingdom involving service providers and ethnically-diverse community members, the article explores implications of cultural variation for service provision. Clear gaps exist between service provision and people experiencing mistreatment due to structural and contextual factors; cultural factors have a relatively minor impact.
Xiong , Kaiqi
This book includes a study of trustworthiness, percentile response time, service availability, and authentication in the networks between users and cloud service providers, and at service stations or sites that may be owned by different service providers. The first part of the book contains an analysis of percentile response time, which is one of the most important SLA (service level agreements) metrics. Effective and accurate numerical solutions for the calculation of the percentile response time in single-class and multi-class queueing networks are obtained. Then, the numerical solution is
Thatte, Nandita; Choi, Yoonjoung
Human resource (HR) management is a priority for health systems strengthening in developing countries, yet few studies have empirically examined associations with service quality. The purpose of this study was to assess the relationship between HR management and family planning (FP) service quality. Data came from the 2010 Kenya Service Provision Assessment, a nationally representative health facility assessment. In total, 912 FP consultations from 301 facilities were analysed. Four indices were created to measure quality on reproductive history taking, physical examination, sexually transmitted infections prevention and pill/injectable specific counselling. HR management variables included training in the past year, any and supportive (i.e. with feedback, technical updates and discussion) in-person supervision in the past 6 months and having a written job description. Multivariate linear regression analyses were conducted to estimate coefficients of HR management variables on each of the four quality indices, adjusting for background characteristics of clients, provider and facilities. The level of service quality ranged from 16 to 53 out of a maximum score of 100 across the indices. Fifty-two per cent of consultations were done by providers who received supportive in-person supervision in the previous 6 months. In 23% and 38% of consultations, the provider was trained in the past year and had a written job description, respectively. Multivariate analyses indicated that having a written job description was associated with higher service quality in history taking, physical examination and the pill/injectable specific counselling. Other HR management variables were not significantly associated with service quality. Having a written job description was significantly associated with higher service quality and may be a useful tool for strengthening management practices. The details of such job descriptions and the quality of other management indicators should be
IT .................................................................................................... Information Technology KPI ...the service delivery be measured? 3. Key Performance Indicators ( KPIs ): Describe the KPIs and the responsible party for producing the KPIs . 4...level objectives (SLOs) that are evaluated according to measurable Key Performance Indicators ( KPIs ). Automatic SLA protection enables further
Lazarus, Jeffrey V; Safreed-Harmon, Kelly; Nicholson, Joey
OBJECTIVES: In response to the lack of evidence-based guidance for how to continue scaling up antiretroviral therapy (ART) in ways that make optimal use of limited resources, to assess comparative studies of ART service delivery models implemented in sub-Saharan Africa. METHODS: A systematic lite...
Full Text Available A number of studies have established that service quality has a direct impact on a restaurant’s profitability. This study made an empirical assessment of customers’ perceptions and expectations of service to measure service quality in three restaurants in a casino complex in Gauteng Province in South Africa. The research helped to assess the levels of customer satisfaction with service provision in three restaurants and identified factors that contribute to customer satisfaction and dissatisfaction; It also determined the current status of service and compared and ranked three restaurants service provision. Another importance was the aiding in the establishment of customer service standards for the restaurants concerned. The tipping of waitrons was also used as an indicator of customer satisfaction with service provision in general. A three-column SERVQUAL instrument was used together with part of the Fishbein model. The study was able to firstly determine and analyze service gaps that exist in the service delivery procedure to measure service quality as well as general customer satisfaction and secondly, to evaluate customers’ attitudes towards the service measure attributes of similar restaurants in the same location. The findings offer implications to improve service quality in restaurant business in general.
Dunford, Robert W; Smith, Alison C; Harrison, Paula A; Hanganu, Diana
Future patterns of European ecosystem services provision are likely to vary significantly as a result of climatic and socio-economic change and the implementation of adaptation strategies. However, there is little research in mapping future ecosystem services and no integrated assessment approach to map the combined impacts of these drivers. Map changing patterns in ecosystem services for different European futures and (a) identify the role of driving forces; (b) explore the potential influence of different adaptation options. The CLIMSAVE integrated assessment platform is used to map spatial patterns in services (food, water and timber provision, atmospheric regulation, biodiversity existence/bequest, landscape experience and land use diversity) for a number of combined climatic and socio-economic scenarios. Eight adaptation strategies are explored within each scenario. Future service provision (particularly water provision) will be significantly impacted by climate change. Socio-economic changes shift patterns of service provision: more dystopian societies focus on food provision at the expense of other services. Adaptation options offer significant opportunities, but may necessitate trade-offs between services, particularly between agriculture- and forestry-related services. Unavoidable trade-offs between regions (particularly South-North) are also identified in some scenarios. Coordinating adaptation across regions and sectors will be essential to ensure that all needs are met: a factor that will become increasingly pressing under dystopian futures where inter-regional cooperation breaks down. Integrated assessment enables exploration of interactions and trade-offs between ecosystem services, highlighting the importance of taking account of complex cross-sectoral interactions under different future scenarios of planning adaptation responses.
Benito-López, Bernardino; Moreno-Enguix, María del Rocio; Solana-Ibañez, José
Effective waste management systems can make critical contributions to public health, environmental sustainability and economic development. The challenge affects every person and institution in society, and measures cannot be undertaken without data collection and a quantitative analysis approach. In this paper, the two-stage double bootstrap procedure of Simar and Wilson (2007) is used to estimate the efficiency determinants of Spanish local entities in the provision of public street-cleaning and refuse collection services. The purpose is to identify factors that influence efficiency. The final sample comprised 1072 municipalities. In the first stage, robust efficiency estimates are obtained with Data Envelopment Analysis (DEA). We apply the second stage, based on a truncated-regression, to estimate the effect of a group of environmental factors on DEA estimates. The results show the existence of a significant relation between efficiency and all the variables analysed (per capita income, urban population density, the comparative index of the importance of tourism and that of the whole economic activity). We have also considered the influence of a dummy categorical variable - the political sign of the governing party - on the efficient provision of the services under study. The results from the methodology proposed show that municipalities governed by progressive parties are more efficient. Copyright © 2011 Elsevier Ltd. All rights reserved.
Kalsi, A S; Kochhar, S; Lewis, N J; Hemmings, K W
Objective To assess new UK graduates' knowledge of training and service provision within restorative dentistry.Design A national descriptive cross-sectional survey.Subjects and methods An online survey assessing clinicians' knowledge of restorative dentistry, who had graduated within the last four years in the UK, was distributed across the UK via postgraduate dental deaneries. One-hundred responses were accepted as a sample of a potential population of 4,000.Main outcome measure How well respondents understood the service provision and training aspects of the specialty of restorative dentistry.Results The responses were received from graduates from a variety of dental schools across the UK. Of those respondents, 41 reported receiving career guidance within restorative dentistry. 45 new graduates were confident in their understanding of the specialty, while 53 were confident in the differences between restorative dentistry and monospecialty training. The respondents appeared unaware regarding treatment priorities within restorative dentistry departments. Most respondents felt that receiving teaching on restorative dentistry as a specialty and career pathway would be beneficial.Conclusion The results suggest that new graduates may benefit from clarification regarding the specialty of restorative dentistry, however, caution must be taken due to the limitations of the study.
Cecile Gerwel Proches
Full Text Available South Africa faces difficulties related to the provision of services, which stem from common challenges related to globalisation, urbanisation, and the divide between the rich and poor. The country also has to take account of other factors which impact negatively on economic development. Various stakeholders in the public and private sector, Non-Governmental Organisations (NGOs and even communities engage in Local Economic Development (LED initiatives. Such efforts include job creation and economic stimulation, the creation and support of enterprise establishment and development, infrastructure investment, and attempts to increase the competitiveness in a local area, through the use of the available physical and intellectual resources. The aim of this theoretical paper is to focus on the role of LED in addressing the local and global challenges that impact on service provision and economic development in South Africa. The specific challenges will be outlined, and LED in South Africa will be discussed in some detail, along with recommendations to address areas of concern.
Benito-Lopez, Bernardino; Rocio Moreno-Enguix, Maria del; Solana-Ibanez, Jose
Effective waste management systems can make critical contributions to public health, environmental sustainability and economic development. The challenge affects every person and institution in society, and measures cannot be undertaken without data collection and a quantitative analysis approach. In this paper, the two-stage double bootstrap procedure of is used to estimate the efficiency determinants of Spanish local entities in the provision of public street-cleaning and refuse collection services. The purpose is to identify factors that influence efficiency. The final sample comprised 1072 municipalities. In the first stage, robust efficiency estimates are obtained with Data Envelopment Analysis (DEA). We apply the second stage, based on a truncated-regression, to estimate the effect of a group of environmental factors on DEA estimates. The results show the existence of a significant relation between efficiency and all the variables analysed (per capita income, urban population density, the comparative index of the importance of tourism and that of the whole economic activity). We have also considered the influence of a dummy categorical variable - the political sign of the governing party - on the efficient provision of the services under study. The results from the methodology proposed show that municipalities governed by progressive parties are more efficient.
Full Text Available This study aims to clarify some issues concerning the rules applicable to posted workers within the framework of the transnational provision of services and obligations incumbent upon employers, both of those the post and the provision of services to beneficiaries , issues raises a number of practical problems with regard to the distinction in regulating the notion of posting, relative to the internal regulation of the Labour Code (Act 53/2003 - republished on the one hand and the European legislation by the other hand. Thus, the contractual relationships between the employer post their workers to perform work for the benefit of its contractual partner, must be very defined very clearly the relationships between employees and employer posted in Romania and that to which they are posted abroad and the obligations each of them. In preparing this paper were used qualitative and quantitative research methods specific depth research of legal sciences, the sociological method, deductive method on regulations, concepts and theories, comparative method. Expected results of the study consist of a summary of the main regulations, solutions and doctrinal views on the development of an suggestions of law, clarification of the regulations with significance implications for business, citizens in their capacity as workers and also for legal practitioners.
Marshal, Sarah L; Oades, Lindsay G; Growe, Trevor P
One key component of recovery-oriented mental health services, typically overlooked, involves genuine collaboration between researchers and consumers to evaluate and improve services delivered within a recovery framework. Eighteen mental health consumers working with staff who had received training in the Collaborative Recovery Model (CRM) took part in in-depth focus group meetings, of approximately 2.5 hours each, to generate feedback to guide improvement of the CRM and its use in mental health services. Consumers identified clear avenues for improvement for the CRM both specific to the model and broadly applicable to recovery-oriented service provision. Findings suggest consumers want to be more engaged and empowered in the use of the CRM from the outset. Improved sampling procedures may have led to the identification of additional dissatisfied consumers. Collaboration with mental health consumers in the evaluation and improvement of recovery-oriented practice is crucial with an emphasis on rebuilding mental health services that are genuinely oriented to support recovery.
McCabe, Karen E; Ling, Jonathan; Wilson, Graeme B; Crosland, Ann; Kaner, Eileen F S; Haighton, Catherine A
UK society is ageing. Older people who drink alcohol, drink more than those from previous generations, drink more frequently than other age groups and are more likely to drink at home and alone. Alcohol problems in later life however are often under-detected and under-reported meaning older people experiencing alcohol problems have high levels of unmet need. This study sought to identify existing services within South of Tyne, North East England to capture the extent of service provision for older drinkers and identify any gaps. The Age UK definition of 'older people' (aged 50 and over) was used. Services were contacted by telephone, managers or their deputy took part in semi-structured interviews. Forty six service providers were identified. Only one provided a specific intervention for older drinkers. Others typically provided services for age 18+. Among providers, there was no definitive definition of an older person. Data collection procedures within many organisations did not enable them to confirm whether older people were accessing services. Where alcohol was used alongside other drugs, alcohol use could remain unrecorded. To enable alcohol services to meet the needs of older people, greater understanding is needed of the patterns of drinking in later life, the experiences of older people, the scale and scope of the issue and guidance as to the most appropriate action to take. An awareness of the issues related to alcohol use in later life also needs to be integrated into commissioning of other services that impact upon older people. © Royal Society for Public Health 2015.
Ng, Wai Hoe; Wang, Ernest; Ng, Ivan
Neurosurgical emergencies constitute a significant proportion of workload of a tertiary neurosurgical service. Prompt diagnosis and emergent institution of definitive treatment are critical to reduce neurological mortality and morbidity. Diagnosis is highly dependent on accurate interpretation of scans by experienced clinicians. This expertise may not be readily available especially after office hours because many neurosurgical units are manned by middle-level neurosurgical staff with varying levels of experience in scan interpretation. Multimedia Messaging Service mobile phone technology offers a simple, cheap, quick, and effective solution to the problem of scan interpretation. An MMS takes only a few minutes to send and receive and allows senior doctors to view important images and make important clinical decisions to enhance patient management in an emergency situation. A mobile phone (with VGA camera and MMS capabilities) was provided to the neurosurgery registrar on call. The on-call mobile phone is passed on to the corresponding registrar on-call the next day. All consultants had personal mobile phones that are MMS-enabled. Relevant representative CT/MRI images can be taken directly from the mobile phone from the PACS off the computer screen. When only hard copies are available, the images can be taken off the light box. After a 12-month trial period, a questionnaire was given to all staff involved in the project to ascertain the usefulness of the MMS teleradiology service. The survey on the use of the MMS service in a tertiary neurosurgical service demonstrated that the technology significantly improved the level of confidence of the senior-level staff in emergent clinical decision making. Significantly, the MMS images were of sufficient quality and resolution to obviate the need to view the actual scans. The impact of MMS is less pronounced in the middle-level staff, but there was a trend that most of the junior staff found the service more useful. The MMS
Schwarz, Corinne; Unruh, Erik; Cronin, Katie; Evans-Simpson, Sarah; Britton, Hannah; Ramaswamy, Megha
The medical sector presents a unique opportunity for identification and service to victims of human trafficking. In this article, we describe local and site-specific efforts to develop an intervention tool to be used in an urban hospital's emergency department in the midwestern United States. In the development of our tool, we focused on both identification and intervention to assist trafficked persons, through a largely collaborative process in which we engaged local stakeholders for developing site-specific points of intervention. In the process of developing our intervention, we highlight the importance of using existing resources and services in a specific community to address critical gaps in coverage for trafficked persons. For example, we focus on those who are victims of labor trafficking, in addition to those who are victims of sex trafficking. We offer a framework informed by rights-based approaches to anti-trafficking efforts that addresses the practical challenges of human trafficking victim identification while simultaneously working to provide resources and disseminate services to those victims.
Waverijn, Geeke; Groenewegen, Peter P; de Klerk, Mirjam
Differential provision of local services and amenities has been proposed as a mechanism behind the relationship between social capital and health. The aim of this study was to investigate whether social capital and collective efficacy are related to the provision of social support services and amenities in Dutch municipalities, against a background of decentralisation of long-term care to municipalities. We used data on neighbourhood social capital, collective efficacy (the extent to which people are willing to work for the common good), and the provision of services and amenities in 2012. We included the services municipalities provide to support informal caregivers (e.g. respite care), individual services and support (e.g. domiciliary help), and general and collective services and amenities (e.g. lending point for wheelchairs). Data for social capital were collected between May 2011 and September 2012. Social capital was measured by focusing on contacts between neighbours. A social capital measure was estimated for 414 municipalities with ecometric measurements. A measure of collective efficacy was constructed based on information about the experienced responsibility for the liveability of the neighbourhood by residents in 2012, average charity collection returns in municipalities in 2012, voter turnout at the municipal elections in 2010 and the percentage of blood donors in 2012. We conducted Poisson regression and negative binomial regression to test our hypotheses. We found no relationship between social capital and the provision of services and amenities in municipalities. We found an interaction effect (coefficient = 3.11, 95% CI = 0.72-5.51, P = 0.011) of social capital and collective efficacy on the provision of support services for informal caregivers in rural municipalities. To gain more insight in the relationship between social capital and health, it will be important to study the relationship between social capital and differential provision of
Benetoli, Arcelio; Chen, Timothy F; Spagnardi, Sarah; Beer, Troy; Aslani, Parisa
Social networking sites (SNSs) have changed the way people communicate. They may also change the way people seek health advice. This study describes the provision of a medicines information service on Facebook to individual consumers. It aimed to discuss the pros and cons, and inform health and pharmacy stakeholders and researchers about the opportunities and challenges of providing such a service. We adopted an exploratory approach using a case study method. NPS MedicineWise, an independent, not-for-profit Australian organization, runs a public question-and-answer service on Facebook, dubbed Pharmacist Hour. Consumers following the organization's Facebook page are invited to post medication-related questions often with a suggested health topic. A wide range of questions and comments are posted related to medication usage. The pharmacist answers the queries, providing evidence-based medicines information and using consumer-friendly language, during the specific 1-hour period. The most popular questions in the past 12 months were related to adverse effects, treatment options for conditions, and drug interactions. The service had a mean number of engagements (defined as a like or share of the Pharmacy Hour post) of 38 (SD 19) people and a mean 5 (SD 3) questions per session. The Pharmacist Hour Facebook service addresses the medicines information needs of consumers and indirectly promotes other appropriate and relevant NPS MedicineWise products and services to further assist consumers. The service offers a new medium for a quality use of medicines organization committed to promoting awareness about the correct and safe use of medicines in Australia.
Chauhan, Muhammad Aufeef; Babar, Muhammad Ali; Sheng, Quan Z.
Software Architecture (SA) plays a critical role in designing, developing and evolving cloud-based platforms that can be used to provision different types of services to consumers on demand. In this paper, we present a Reference Architecture (RA) for designing cloud-based Tools as a service SPACE...... (TSPACE) for provisioning a bundled suite of tools by following the Software as a Service (SaaS) model. The reference architecture has been designed by leveraging information structuring approaches and by using well-known architecture design principles and patterns. The RA has been documented using view...
... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Can the Administrator of General Services waive the postpayment auditing provisions of this subpart? 102-118.420 Section 102-118... Transportation Audits § 102-118.420 Can the Administrator of General Services waive the postpayment auditing...
... 47 Telecommunication 2 2010-10-01 2010-10-01 false Licensing provisions for the 2.3 GHz satellite digital audio radio service. 25.144 Section 25.144 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES SATELLITE COMMUNICATIONS Applications and Licenses Space Stations § 25...
... 47 Telecommunication 2 2010-10-01 2010-10-01 false Licensing provisions for the non-voice, non-geostationary mobile-satellite service. 25.142 Section 25.142 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES SATELLITE COMMUNICATIONS Applications and Licenses Space...
... developmental areas: (i) Cognitive development. (ii) Physical development, including vision and hearing. (iii... Intervention Services for Infants and Toddlers With Disabilities and Their Families A Appendix A to Part 57... Appendix A to Part 57—Procedures for the Provision of Early Intervention Services for Infants and Toddlers...
Koponen, Anne M; Laamanen, Ritva; Simonsen-Rehn, Nina; Sundell, Jari; Brommels, Mats; Suominen, Sakari
To investigate whether the development of job involvement of primary healthcare (PHC) employees in Southern Municipality (SM), where PHC services were outsourced to an independent non-profit organisation, differed from that in the three comparison municipalities (M1, M2, M3) with municipal service providers. Also, the associations of job involvement with factors describing the psychosocial work environment were investigated. A panel mail survey 2000-02 in Finland (n=369, response rates 73% and 60%). The data were analysed by descriptive statistics and multivariate linear regression analysis. Despite the favourable development in the psychosocial work environment, job involvement decreased most in SM, which faced the biggest organisational changes. Job involvement decreased also in M3, where the psychosocial work environment deteriorated most. Job involvement in 2002 was best predicted by high baseline level of interactional justice and work control, positive change in interactional justice, and higher age. Also other factors, such as organisational stability, seemed to play a role; after controlling for the effect of the psychosocial work characteristics, job involvement was higher in M3 than in SM. Outsourcing of PHC services may decrease job involvement at least during the first years. A particular service provision model is better than the others only if it is superior in providing a favourable and stable psychosocial work environment.
Radford, Kathryn; Grant, Mary; Terry, Jane
Purpose: This study aimed to clarify the existing service provision of stroke-specific vocational rehabilitation (VR) in one English county, in order to facilitate future service development. Method: Using soft systems methodology, services in Health, Social Care, Department of Work and Pensions, the voluntary and private sectors, which were identified as supporting return to work after stroke, were mapped using a mixed-methodology approach. Results: A lack of a sanctioned VR pathway meant access to support relied on brokered provision and tacit knowledge. The timing of an intervention was complex and there was a substantial degree of unmet need for mild stroke patients. VR was seen as “non-essential” due to competing commissioning priorities. Service providers from all sectors lacked training and cross-sector partnerships were tenuous and provider roles unclear. Conclusions: Stroke-specific VR should be delivered by an integrated, cross-sector multi-disciplinary team and integrated commissioning between health and other sectors is necessary. Although early intervention is important, support later on in the recovery process is also necessary. Service providers need adequate training to meet the needs of stroke survivors wishing to return to work and better awareness of best practice guidelines. Business cases which demonstrate the efficacy and cost-effectiveness of VR are vital. Implications for Rehabilitation The timeliness of a vocational rehabilitation (VR) intervention is complex; services need to be responsive to the changing needs of the stroke survivor throughout their recovery process and have better mechanisms to ensure re-entry into the stroke pathway is possible. Return to work is a recognised health outcome; health services need to develop better mechanisms for interagency/cross sector working and liaison with employers and not assume that VR is beyond their remit. Therapists and non-health service providers should receive sufficient training to
Sinclair, Emma; Radford, Kathryn; Grant, Mary; Terry, Jane
This study aimed to clarify the existing service provision of stroke-specific vocational rehabilitation (VR) in one English county, in order to facilitate future service development. Using soft systems methodology, services in Health, Social Care, Department of Work and Pensions, the voluntary and private sectors, which were identified as supporting return to work after stroke, were mapped using a mixed-methodology approach. A lack of a sanctioned VR pathway meant access to support relied on brokered provision and tacit knowledge. The timing of an intervention was complex and there was a substantial degree of unmet need for mild stroke patients. VR was seen as "non-essential" due to competing commissioning priorities. Service providers from all sectors lacked training and cross-sector partnerships were tenuous and provider roles unclear. Stroke-specific VR should be delivered by an integrated, cross-sector multi-disciplinary team and integrated commissioning between health and other sectors is necessary. Although early intervention is important, support later on in the recovery process is also necessary. Service providers need adequate training to meet the needs of stroke survivors wishing to return to work and better awareness of best practice guidelines. Business cases which demonstrate the efficacy and cost-effectiveness of VR are vital. Implications for Rehabilitation The timeliness of a vocational rehabilitation (VR) intervention is complex; services need to be responsive to the changing needs of the stroke survivor throughout their recovery process and have better mechanisms to ensure re-entry into the stroke pathway is possible. Return to work is a recognised health outcome; health services need to develop better mechanisms for interagency/cross sector working and liaison with employers and not assume that VR is beyond their remit. Therapists and non-health service providers should receive sufficient training to meet the needs of stroke survivors wishing to
Wendpanga , Francis; Biennier , Frédérique; Merle , Philippe
International audience; Enterprises are more and more involved in collabo-rative business. This leads to open and outsourcing all or part of their information system (IS) to create collaborative processes by composing business services picked in each partner IS and to take advantage of Cloud computing. Business services outsourcing and their dynamic collaboration context can bring lost of control on IS and new security risks can occur. This leads to inconsistent protec-tion allowing competito...
Sriram, Veena M; Naseer, Rizwan; Hyder, Adnan A
The availability and quality of emergency medical services in low- and middle-income countries, including Pakistan, are extremely limited. New models for prehospital emergency medical services provision have recently emerged across multiple sectors, and research on these models is urgently needed to inform current and future emergency medical services systems in low-resource settings. The objective of this case study was to provide a comprehensive description of the organizational structure and service delivery model of a public sector provider in the Punjab Province of Pakistan, Rescue 1122, with a focus on operations in Lahore. We used case study methodology to systematically describe the organizational model of Rescue 1122. Qualitative data were collected during an in-person site visit to Lahore in June 2013. Three sources were utilized-semi-structured in-depth interviews, document review, and nonparticipant observation. Data were analyzed according to the health system "building blocks" proposed by the World Health Organization. Rescue 1122 is based on a legal framework that provides public financing for EMS, resulting in financial stability for the service. The organization has also reportedly taken positive steps in engaging with communities, and in coordinating across EMS, fire and rescue. We noted benefits and challenges in scaling up the service to all districts in Punjab. Finally, some areas of improvement include supply chain management and expanded data utilization. Our case study highlights key components of the model, areas for strengthening, and opportunities for further research. Rescue 1122 provides an example of a government-financed and operated emergency medical system in a low-resource setting. Copyright © 2017. Published by Elsevier Inc.
Dutton, Adam; Edwards-Jones, Gareth; Macdonald, David W
The unit of trade in ecosystem services is usually the use of a proportion of the parcels of land associated with a given service. Valuing small changes in the provision of an ecosystem service presents obstacles, particularly when the service provides non-use benefits, as is the case with conservation of most plants and animals. Quantifying non-use values requires stated-preference valuations. Stated-preference valuations can provide estimates of the public's willingness to pay for a broad conservation goal. Nevertheless, stated-preference valuations can be expensive and do not produce consistent measures for varying levels of provision of a service. Additionally, the unit of trade, land use, is not always linearly related to the level of ecosystem services the land might provide. To overcome these obstacles, we developed a method to estimate the value of a marginal change in the provision of a non-use ecosystem service--in this case conservation of plants or animals associated with a given land-cover type. Our method serves as a tool for calculating transferable valuations of small changes in the provision of ecosystem services relative to the existing provision. Valuation is achieved through stated-preference investigations, calculation of a unit value for a parcel of land, and the weighting of this parcel by its ability to provide the desired ecosystem service and its effect on the ability of the surrounding land parcels to provide the desired service. We used the water vole (Arvicola terrestris) as a case study to illustrate the method. The average present value of a meter of water vole habitat was estimated at UK £ 12, but the marginal value of a meter (based on our methods) could range between £ 0 and £ 40 or more. © 2010 Society for Conservation Biology.
els Bank Teller scheduling system for optimizing a Banks customer service. The model takes into account real time .... tinuous observation by management personnel and thus results in .... relationships in a mathematical model. A mathematical ...
Full Text Available Services are the key of success in operation management. Designing the effective strategies by optimization techniques is the fundamental and important condition for performance increase in service operations (SOs management. In this paper, we mainly focus on investigating SOs optimization in the areas of supply chain management, which create the greatest business values. Specifically, we study the recent development of SOs optimization associated with supply chain by categorizing them into four different industries (i.e., e-commerce industry, consumer service industry, public sector, and fashion industry and four various SOs features (i.e., advertising, channel coordination, pricing, and inventory. Moreover, we conduct the technical review on the stylish industries/topics and typical optimization models. The classical optimization approaches for SOs management in supply chain are presented. The managerial implications of SOs in supply chain are discussed.
Modernel, P.; Rossing, W. A. H.; Corbeels, M.; Dogliotti, S.; Picasso, V.; Tittonell, P.
New livestock production models need to simultaneously meet the increasing global demand for meat and preserve biodiversity and ecosystem services. Since the 16th century beef cattle has been produced on the Pampas and Campos native grasslands in southern South America, with only small amounts of external inputs. We synthesised 242 references from peer-reviewed and grey literature published between 1945 and mid-2015 and analysed secondary data to examine the evidence on the ecosystem services provided by this grassland biodiversity hotspot and the way they are affected by land use changes and their drivers. The analysis followed the requirements of systematic review from the PRISMA statement (Moher et al 2009 Acad. Clin. Ann. Intern. Med. 151 264-9). The Pampas and Campos provide feed for 43 million heads of cattle and 14 million sheep. The biome is habitat of 4000 native plant species, 300 species of birds, 29 species of mammals, 49 species of reptiles and 35 species of amphibians. The soils of the region stock 5% of the soil organic carbon of Latin America on 3% of its area. Driven by high prices of soybean, the soybean area increased by 210% between 2000 and 2010, at the expense of 2 million ha (5%) of native grassland, mostly in the Pampas. Intensification of livestock production was apparent in two spatially distinct forms. In subregions where cropping increased, intensification of livestock production was reflected in an increased use of grains for feed as part of feedlots. In subregions dominated by native grasslands, stocking rates increased. The review showed that land use change and grazing regimes with low forage allowances were predominantly associated with negative effects on ecosystem service provision by reducing soil organic carbon stocks and the diversity of plants, birds and mammals, and by increasing soil erosion. We found little quantitative information on changes in the ecosystem services water provision, nutrient cycling and erosion control
Falcó, Jorge L; Vaquerizo, Esteban; Lain, Luis; Artigas, Jose Ignacio; Ibarz, Alejandro
The MonAMI project aims to investigate the feasibility of the deployment of open platforms for Ambient Assisted Living (AAL) services provision based on Ambient Intelligence (AmI) and to test user acceptance and the usability of the services. Services were designed to provide support in the areas of environmental control, security, well-being and leisure. These services were installed and evaluated in a Spanish geriatric residence. The participants included elderly persons with disabilities, nursing home care givers and informal carers. The concept of the open platform proved to be satisfactory for the provision of the services in a context aware framework. Furthermore, the usability of the technology was viewed positively and the overall results indicate that this system has the potential to prolong independent living at home for elderly people with disabilities. Deployment was proven successful and awareness of open-platform AAL service delivery was raised in local communities throughout Europe.
Full Text Available The MonAMI project aims to investigate the feasibility of the deployment of open platforms for Ambient Assisted Living (AAL services provision based on Ambient Intelligence (AmI and to test user acceptance and the usability of the services. Services were designed to provide support in the areas of environmental control, security, well-being and leisure. These services were installed and evaluated in a Spanish geriatric residence. The participants included elderly persons with disabilities, nursing home care givers and informal carers. The concept of the open platform proved to be satisfactory for the provision of the services in a context aware framework. Furthermore, the usability of the technology was viewed positively and the overall results indicate that this system has the potential to prolong independent living at home for elderly people with disabilities. Deployment was proven successful and awareness of open-platform AAL service delivery was raised in local communities throughout Europe.
Sarah E. Kelling
Full Text Available As pharmacists move toward more patient-centered care through medication therapy management (MTM, important issues and conflicts may arise within the therapeutic relationship, requiring pharmacists to use ethical knowledge and skills toward conflict-resolution. The purpose of this paper is to explore practical strategies that pharmacists and other champions of MTM may utilize to support the ethical principles of autonomy, veracity, nonmaleficence, beneficence, and justice, along with an ethic of care during the provision of MTM services. With a deeper understanding of ethical principles and the Code of Ethics for Pharmacists, pharmacists may be more prepared to make difficult ethical decisions, and ultimately, guide better patient care. Type: Idea Paper
Martinsen, Dorte Sindbjerg
Welfare regulation in the European Union continues to crawl forward despite salient conflicts of interests. This article addresses the fundamental puzzle of how regulatory competences may expand into the core of the welfare state and how conflicts are, eventually, managed in such processes....... It analyses the EU cross-border provision of healthcare services and argues that the interplay between the Commission and the Court constitutes a powerful dynamic in generating new regulatory activities and in finding ways to set conflicts aside. The Commission draws on formulations offered by the Court...... in finding ways to manage conflict, for example, by requiring ‘proportionate’ national policies which establish that national obstacles to free movement principles are ‘objectively necessary’. The article concludes that law and evidence-based policy-making serve as powerful resources for the Commission...
Paulo F. Azevedo
Full Text Available This paper aims to compare the performance of two modes of provision of prison services: public, and with the participation of private companies. There are few empirical studies concerning the alternative modes of governance in this sector, which differs from other public utilities in that there is an absence of network externalities and scale economies. In addition, an understanding of informal institutions is crucial for the performance of the service provider, either public or private. In this paper, we build a comparative analysis of two case studies of similar correctional facilities, one public and the other outsourced to a private company under the supervision of civil servants (hybrid governance structure, both located in the same region of Brazil. We found that the privately operated facility has achieved better performance indicators (in terms of number of escapes, riots, deaths, assistance to inmates etc. than the public facility, which in part refutes the arguments of Hart, Shleifer and Vishny (1997 against private participation in prison services. We conclude that the reasons for these differences are related to lower levels of administrative controls; to the presence of civil servants within the privately operated prison, which contributes to reducing information asymmetries; to greater incentives for the private operator: to monitor employees, to bypass local judiciary constraints and to fulfill contractual obligations.
Brett M. McDermott
Full Text Available Background: From a global perspective, natural disasters are common events. Published research highlights that a significant minority of exposed children and adolescents develop disaster-related mental health syndromes and associated functional impairment. Consistent with the considerable unmet need of children and adolescents with regard to psychopathology, there is strong evidence that many children and adolescents with post-disaster mental health presentations are not receiving adequate interventions. Objective: To critique existing child and adolescent mental health services (CAMHS models of care and the capacity of such models to deal with any post-disaster surge in clinical demand. Further, to detail an innovative service response; a child and adolescent stepped-care service provision model. Method: A narrative review of traditional CAMHS is presented. Important elements of a disaster response – individual versus community recovery, public health approaches, capacity for promotion and prevention and service reach are discussed and compared with the CAMHS approach. Results: Difficulties with traditional models of care are highlighted across all levels of intervention; from the ability to provide preventative initiatives to the capacity to provide intense specialised posttraumatic stress disorder interventions. In response, our over-arching stepped-care model is advocated. The general response is discussed and details of the three tiers of the model are provided: Tier 1 communication strategy, Tier 2 parent effectiveness and teacher training, and Tier 3 screening linked to trauma-focused cognitive behavioural therapy. Conclusion: In this paper, we argue that traditional CAMHS are not an appropriate model of care to meet the clinical needs of this group in the post-disaster setting. We conclude with suggestions how improved post-disaster child and adolescent mental health outcomes can be achieved by applying an innovative service approach.
McDermott, Brett M; Cobham, Vanessa E
From a global perspective, natural disasters are common events. Published research highlights that a significant minority of exposed children and adolescents develop disaster-related mental health syndromes and associated functional impairment. Consistent with the considerable unmet need of children and adolescents with regard to psychopathology, there is strong evidence that many children and adolescents with post-disaster mental health presentations are not receiving adequate interventions. To critique existing child and adolescent mental health services (CAMHS) models of care and the capacity of such models to deal with any post-disaster surge in clinical demand. Further, to detail an innovative service response; a child and adolescent stepped-care service provision model. A narrative review of traditional CAMHS is presented. Important elements of a disaster response - individual versus community recovery, public health approaches, capacity for promotion and prevention and service reach are discussed and compared with the CAMHS approach. Difficulties with traditional models of care are highlighted across all levels of intervention; from the ability to provide preventative initiatives to the capacity to provide intense specialised posttraumatic stress disorder interventions. In response, our over-arching stepped-care model is advocated. The general response is discussed and details of the three tiers of the model are provided: Tier 1 communication strategy, Tier 2 parent effectiveness and teacher training, and Tier 3 screening linked to trauma-focused cognitive behavioural therapy. In this paper, we argue that traditional CAMHS are not an appropriate model of care to meet the clinical needs of this group in the post-disaster setting. We conclude with suggestions how improved post-disaster child and adolescent mental health outcomes can be achieved by applying an innovative service approach.
Gettel, G. M.; van Dam, A. A.; Hes, E.; Irvine, K.
East Africa is rapidly losing wetlands as the region intensifies agricultural development in rice, sugarcane, and aquaculture production. However, these wetlands are critically important to the livelihoods of region's most vulnerable smallholders, who depend on them for fisheries, water abstraction, and dry-season subsistence agriculture, including livestock grazing. At the same time, wetlands are used for their regulating services, including for water purification of waste-water in some of the region's largest capital cities (e.g. Kampala and Kigali). They also store an enormous, but poorly quantified amount of below-ground carbon and prevent excess nitrogen inputs to sensitive downstream ecosystems. Our research in papyrus wetlands in the Lake Victoria Basin aims to quantify trade-offs in provisioning and regulating services and link these services to socio-economic conditions of the smallholders. We present a framework for evaluating these trade-offs, which can ultimately be used for more informed management decisions for sustainable wetland management and for evaluating impacts on livelihoods. Specifically, we have found that papyrus wetlands can maintain many of their regulating functions, including high plant productivity and denitrification rates when native vegetation is allowed to grow back during wet-seasons, while during dry seasons they can be developed for economically important agricultural activities, including livestock grazing and crop production. This shows the possibility to include wetlands in management plans aimed to increase agricultural production without jeopardizing their ability to maintain other important regulating services. These patterns highlight the need to evaluate the regional importance of these wetlands for both food production and regulating services.
Full Text Available Prospective customers of financial and insurance products can be targeted based on the profit the provider expects to earn from them. We present a model for individual expected profit and two alternatives for calculating optimal personalized prices that maximize the expected profit. For one of these alternatives, we obtain a closed-form expression for the price offered to each prospective customer; for the other, we need to use a numerical approximation. In both approaches, the profits generated by prospective customers are not immediately observed, given that the products sold by these companies have a risk component. We assume that willingness to pay is heterogeneous and apply our methodology using real data from a European insurance company. Our study indicates that a substantial boost in profits can be expected when applying the simplest optimal pricing method proposed.
Mullins, L.E.; Harrison, J.M.
The phenomenon of intergranular stress corrosion cracking (IGSCC) in nuclear power plant piping systems has been the single biggest factor in an evolution that has changed and continues to change in-service inspection practices and philosophy throughout the industry. In-service inspection has been found to deal with several distinct phases of the problem. At the onset, existing technology was demonstrated to be unable to detect IGSCC adequately. This inability to detect IGSCC was soon overcome. However, it immediately pointed out the difficulties associated with the discrimination between IGSCC and other harmless metallurgical conditions. On the heels of detection and discrimination came problems associated with determining crack size and the monitoring of overlayed flaws. A wealth of information has been written on all phases of IGSCC; however, one particular aspect has as of yet seen little attention. With an increasing number of plants choosing to replace flawed pipe, the pre-service inspection of the replaced piping demands increased attention. The lessons learned through inspection for IGSCC need again to be applied to the replacement piping. Through increased attention at installation, many of the difficulties associated with proper inservice inspection may be reduced or eliminated, thereby realizing an economy in outage scheduling, personnel exposure, and, overall, a more reliable in-service examination
Full Text Available The crucial role of networking in Cloud computing calls for a holistic vision of both networking and computing systems that leads to composite network–compute service provisioning. Software-Defined Network (SDN is a fundamental advancement in networking that enables network programmability. SDN and software-defined compute/storage systems form a Software-Defined Cloud Environment (SDCE that may greatly facilitate composite network–compute service provisioning to Cloud users. Therefore, networking and computing systems need to be modeled and analyzed as composite service provisioning systems in order to obtain thorough understanding about service performance in SDCEs. In this paper, a novel approach for modeling composite network–compute service capabilities and a technique for evaluating composite network–compute service performance are developed. The analytic method proposed in this paper is general and agnostic to service implementation technologies; thus is applicable to a wide variety of network–compute services in SDCEs. The results obtained in this paper provide useful guidelines for federated control and management of networking and computing resources to achieve Cloud service performance guarantees.
Zhao, Yongli; Li, Shikun; Song, Yinan; Sun, Ji; Zhang, Jie
Hierarchical control architecture is designed for software-defined multidomain optical networks (SD-MDONs), and a unified service logic processing model (USLPM) is first proposed for various applications. USLPM-based virtual optical network (VON) provisioning process is designed, and two VON mapping algorithms are proposed: random node selection and per controller computation (RNS&PCC) and balanced node selection and hierarchical controller computation (BNS&HCC). Then an SD-MDON testbed is built with OpenFlow extension in order to support optical transport equipment. Finally, VON provisioning service is experimentally demonstrated on the testbed along with performance verification.
Gregório, João; Pizarro, Ângela; Cavaco, Afonso; Wipfli, Rolf; Lovis, Christian; Mira da Silva, Miguel; Lapão, Luís Velez
Chronic diseases are pressing health systems to introduce reforms, focused on primary care and multidisciplinary models. Community pharmacists have developed a new role, addressing pharmaceutical care and services. Information systems and technologies (IST) will have an important role in shaping future healthcare provision. However, the best way to design and implement an IST for pharmaceutical service provision is still an open research question. In this paper, we present a possible strategy based on the use of Design Science Research Methodology (DSRM). The application of the DSRM six stages is described, from the definition and characterization of the problem to the evaluation of the artefact.
Full Text Available SUMMARYThis paper focuses on legal service delivery for the indigent by attorneys in private practice acting pro bono in civil rather than criminal matters. In this regard there have been and continue to be considerable gaps between the proper access to civil justice imperatives of constitutional South Africa and the status quo which has existed from the advent of a democratic South Africa until the present. Law as a vehicle for necessary positive change in the daily lives of South African residents is pertinently considered within the country’s woefully unequal socio-economic climate. This paper considers the role which pro bono work by private attorneys is playing and should play in promoting a more just and equitable society through proper access to justice. It explores the current position in South Africa as well as the position in selected foreign jurisdictions regarding pro bono services by attorneys in private practice in civil matters. Part of the discussion focuses on the question of whether pro bono work should be voluntary or mandatory. The merits of introducing a pro bono obligation are critically analysed by looking at the effect on both legal practitioners as well as those receiving the pro bono services. Having defined pro bono work, the practical need for pro bono work by lawyers in private practice is highlighted due to the dearth of legal aid in civil matters for indigent South Africans. Possible constitutional imperatives for the provision of free legal services in civil matters are highlighted. An important part of the paper is a reflection on some of the pro bono work being conducted by private firms of attorneys. The paper concludes with suggestions on means for establishing a more effective pro bono system in South Africa.
Habtamu, Esmael; Eshete, Zebiba; Burton, Matthew J
Cataract is the leading cause of blindness worldwide, with the greatest burden found in low-income countries. Cataract surgery is a curative and cost-effective intervention. Despite major non-governmental organization (NGO) support, the cataract surgery performed in Southern Region, Ethiopia is currently insufficient to address the need. We analyzed the distribution, productivity, cost and determinants of cataract surgery services. Confidential interviews were conducted with all eye surgeons (Ophthalmologists & Non-Physician Cataract Surgeons [NPCS]) in Southern Region using semi-structured questionnaires. Eye care project managers were interviewed using open-ended qualitative questionnaires. All eye units were visited. Information on resources, costs, and the rates and determinants of surgical output were collected. Cataract surgery provision is uneven across Southern Region: 66% of the units are within 200 km of the regional capital. Surgeon to population ratios varied widely from 1:70,000 in the capital to no service provision in areas containing 7 million people. The Cataract Surgical Rate (CSR) in 2010 was 406 operations/million/year with zonal CSRs ranging between 204 and 1349. Average number of surgeries performed was 374 operations/surgeon/year. Ophthalmologists and NPCS performed a mean of 682 and 280 cataract operations/surgeon/year, respectively (p = 0.03). Resources are underutilized, at 56% of capacity. Community awareness programs were associated with increased activity (p = 0.009). Several factors were associated with increased surgeon productivity (p 2 years, working in a NGO/private clinic, working in an urban unit, having a unit manger, conducting outreach programs and a satisfactory work environment. The average cost of cataract surgery in 2010 was US$141.6 (Range: US$37.6-312.6). Units received >70% of their consumables from NGOs. Mangers identified poor staff motivation, community awareness and limited government support as major
Optical transport networks based on wavelength division multiplexing (WDM) are considered to be the most appropriate choice for future Internet backbone. On the other hand, future DOE networks are expected to have the ability to dynamically provision on-demand survivable services to suit the needs of various high performance scientific applications and remote collaboration. Since a failure in aWDMnetwork such as a cable cut may result in a tremendous amount of data loss, efficient protection of data transport in WDM networks is therefore essential. As the backbone network is moving towards GMPLS/WDM optical networks, the unique requirement to support DOE’s science mission results in challenging issues that are not directly addressed by existing networking techniques and methodologies. The objectives of this project were to develop cost effective protection and restoration mechanisms based on dedicated path, shared path, preconfigured cycle (p-cycle), and so on, to deal with single failure, dual failure, and shared risk link group (SRLG) failure, under different traffic and resource requirement models; to devise efficient service provisioning algorithms that deal with application specific network resource requirements for both unicast and multicast; to study various aspects of traffic grooming in WDM ring and mesh networks to derive cost effective solutions while meeting application resource and QoS requirements; to design various diverse routing and multi-constrained routing algorithms, considering different traffic models and failure models, for protection and restoration, as well as for service provisioning; to propose and study new optical burst switched architectures and mechanisms for effectively supporting dynamic services; and to integrate research with graduate and undergraduate education. All objectives have been successfully met. This report summarizes the major accomplishments of this project. The impact of the project manifests in many aspects: First
Montserrat Pallares Barbera
Full Text Available This paper examines Ildefons Cerdà’s 1860 Plan for the Urban Expansion of Barcelona; specifically, how and why it was conceived in a unique way, in which the provision of services to the population was an important part. Cerdà based his expansion proposal on an in depth socio statistical study of old Barcelona’s population conditions. The high mortality rates of the working class population and poor health and education conditions pushed Cerdà to design a new type of urban planning, which he defined as “urbanism”. In his proposal for the new city, he planned the location of services such as marketplaces, schools and hospitals. The first part of this paper introduces the urban and political preconditions of Barcelona and the statistics on which Cerdà based his contribution. The second part uses location theory and a geographic information system (GIS to analyse the pattern of location and the population served by markets and hospitals. In addition, topographic maps from 1926 and 1975 are used to study the development of the expansion up to when it was fully developed. The evolution of the city differed from Cerdà’s proposal, partly due to unexpected increases in population density, the built environment, and higher amounts of building occupation. Nevertheless, Cerdà’s layout of streets and avenues has prevailed.
Edworthy, Rachel; Sampson, Stephanie; Völlm, Birgit
Laws governing the detention and treatment of mentally disordered offenders (MDOs) vary widely across Europe, yet little information is available about the features of these laws and their comparative advantages and disadvantages. The purpose of this article is to compare the legal framework governing detention in forensic psychiatric care in three European countries with long-established services for MDOs, England, Germany and the Netherlands. A literature review was conducted alongside consultation with experts from each country. We found that the three countries differ in several areas, including criteria for admission, review of detention, discharge process, the concept of criminal responsibility, service provision and treatment philosophy. Our findings suggest a profound difference in how each country relates to MDOs, with each approach contributing to different pathways and potentially different outcomes for the individual. Hopefully making these comparisons will stimulate debate and knowledge exchange on an international level to aid future research and the development of best practice in managing this population. Copyright © 2016 Elsevier Ltd. All rights reserved.
Davis, Jullet A; Whitman, Marilyn V
Like several states in the Southeast, Alabama is in the nascent stages of an increase in the population of foreign-born individuals for whom English is a second language. These individuals are also culturally different from the traditional southern population. Given the impact of culture and language on a person's service utilization, the introduction of new cultures may pose significant challenges for Alabama's health care providers if they are not prepared. The purpose of this project is to examine the organizational characteristics associated with the provision of culturally and linguistically appropriate services by Alabama hospitals. The data for the project come from a survey of all medical/surgical hospitals (N = 101). Fifty-nine surveys were returned, giving us a 58% response rate. The data were analyzed using correlations, analysis of variance, and logistic regression. Approximately 47% of the sample hospitals reported having a staff interpreter. Furthermore, hospitals that had staff interpreters did seem to be more aware of their community, which was reflected in their mission statements. In addition, directors who viewed their role as fulfilling the strategic plan accepted the task of providing staff interpreters. Thus, several hospitals in Alabama seemed to be ready to meet the cultural and language needs of their markets.
Inclusion of ecosystem services (ES) information into national-scale development and climate adaptation planning has yet to become common practice, despite demand from decision makers. Identifying where ES originate and to whom the benefits flowunder current and future climate conditionsis especially critical in rapidly developing countries, where the risk of ES loss is high. Here, using Myanmar as a case study, we assess where and how ecosystems provide key benefits to the countrys people and infrastructure. We model the supply of and demand for sediment retention, dry-season baseflows, flood risk reduction and coastal storm protection from multiple beneficiaries. We find that locations currently providing the greatest amount of services are likely to remain important under the range of climate conditions considered, demonstrating their importance in planning for climate resilience. Overlap between priority areas for ES provision and biodiversity conservation is higher than expected by chance overall, but the areas important for multiple ES are underrepresented in currently designated protected areas and Key Biodiversity Areas. Our results are contributing to development planning in Myanmar, and our approach could be extended to other contexts where there is demand for national-scale natural capital information to shape development plans and policies
Jones, Stephen G
Clinical audit is a tool that may be used to improve the quality of care and outcomes for patients in a health care setting as well as a mechanism for clinicians to reflect on their performance. The audit described in this short report involved the collection and analysis of data related to the administration of 1,756 conscious sedations, categorised as standard techniques, by clinicians employed by an NHS Trust-based dental service during the year 2014. Data collected included gender, age and medical status of subject, the type of care delivered, the dose of drug administered and the quality of the achieved sedation and any sedation-related complications. This was the first time that a service-wide clinical audit had been undertaken with the objective of determining the safety and effectiveness of this aspect of care provision. Evaluation of the analysed data supported the perceived view that such care was being delivered satisfactorily. This on-going audit will collect data during year 2016 on the abandonment of clinical sessions, in which successful sedation had been achieved, due to the failure to obtain adequate local anaesthesia.
Anogianakis, G; Maglavera, S
MERMAID is an EU financed telemedicine project with global reach and 24-hour, multilingual capability. It aspires to provide a model for the provision of health care services based on the electronic transmission of medical information, via ISDN based videoconferencing. This model will not be limited to medical diagnostics but it will encompass all cases where the actual delivery of health care services involves a patient who is not located where the provider is. Its implementation requires the commissioning of an expensive telecommunications infrastructure and the exploration of a number of solutions. In fact, all categories of telemedical applications (audio and video conferencing, multimedia communications, flat file and image transfer with low, medium and high bandwidth data requirements) are considered while the full range of network choices (Digital land lines, Cellular/Wireless, Satellite and Broadband) are being tested in terms of cost/performance tradeoffs that are inherent to them and the developmental state each of these options occupies in their in its life cycle. Finally, out that MERMAID utilises advanced land based line transmission technologies to aid the remote patient by making available the specialist care that is best suited in the particular case.
Walker, Kathleen; Allen, Jennifer; Andrews, Richard
With dramatic increases in health care costs and growing concerns about the quality of health care services, nurse executives are seeking ways to transform their organizations to improve operational and financial performance while enhancing quality care and patient safety. Nurse leaders are challenged to meet new cost, quality and service imperatives, and change cannot be achieved by traditional approaches, it must occur through innovation. Imagine an organization that can mitigate a $56 million loss in revenue and claim the following successes: Increase admissions by a 8 day and a $5.5 million annualized increase by repurposing existing space. Decrease emergency department holding hours by an average of 174 hours a day, with a labor savings of $502,000 annually. Reduce overall inpatient length of stay by 0.5 day with total compensation running $4.2 million less than the budget for first quarter of 2010. Grow emergency department volume 272 visits greater than budgeted for first quarter of 2010. Complete admission assessments and diagnostics in 90 minutes. This article will address how these outcomes were achieved by transforming care delivery, creating a patient transition center, enhancing outreach referrals, and revising admission processes through collaboration and innovation.
de Haan, C
In the future, animal health services in developing countries will need to operate in a continuously changing policy, institutional and commercial environment. Firstly, the changing policies and priorities of national policy-makers regarding public and private sector roles, reinforced in Africa by the donors, have reduced funding and support for the large number of tasks that animal health services have traditionally performed, and there is continuing pressure from policy-makers to focus on what the public sector can do best. Secondly, poverty reduction has become one of the main criteria guiding the allocation of official development assistance, which has major implications for the main target clientele of veterinary services. Thirdly, population growth, increasing income and urbanisation are causing a marked increase in demand for livestock products in the developing world. As a result, the entire livestock commodity chain is undergoing major structural changes, which has significant implications for the definition and control of food safety standards. Fourthly, globalisation, and increasing trade and travel have greatly increased the risk of disease transmission between different countries and continents. Veterinary institutions in the developing world need to adapt to these challenges. They will have to be able to focus on the essential public sector roles. At the same time they must deliver those essential services to the poor, and provide the policy framework to ensure that the inevitable structural changes in the commodity chain take place in an equitable and sustainable fashion, with an acceptable level of health risk for the consumer. According to the weight given to these different objectives, changes in the institutional set-up need to be considered. This issue of the Scientific and Technical Review addresses these challenges. It begins by reviewing the basic economic characteristics underlying the provision of animal health services, and then examines
Makadon, Harvey J; Bharucha, Farzan; Gavin, Michael; Oliveira, Jason; Wietecha, Mark
Hospitals have wrestled with balancing quality, service, and cost for years--and the visibility and urgency around measuring and communicating real metrics has grown exponentially in the last decade. However, even today, most hospital leaders cannot articulate or demonstrate the "value" they provide to patients and payers. Instead of developing a strategic direction that is based around a core value proposition, they focus their strategic efforts on tactical decisions like physician recruitment, facility expansion, and physician alignment. In the healthcare paradigm of the next decade, alignment of various tactical initiatives will require a more coherent understanding of the hospital's core value positioning. The authors draw on their experience in a variety of healthcare settings to suggest that for most hospitals, quality (i.e., clinical outcomes and patient safety) will become the most visible indicator of value, and introduce a framework to help healthcare providers influence their value positioning based on this variable.
We consider n M/M/1 queues in series. At queue one the arrival and service rates are chosen in pair from a finite set whenever there are arrivals or service completions at any queue. Customers arriving to queue L (L=1,2,...,n-1) must go on to queue L+1 after finishing service at server L. Customers arriving to queue n leave the system after finishing service at the last server. At queues 2 to n arrival and service rates are fixed. The objective is to minimize the expected discounted cost of the system over finite and infinite horizons. We show that the optimal policy is of threshold type. In order to establish the result, we formulate the optimal control problem as a Linear Programming. (author). 9 refs
Full Text Available It is widely acknowledged that land use changes (LUC associated with climate variations are affecting the human wellbeing. This paper conducted a revisit to relevant researches on the impacts of LUC on human wellbeing via specifically altering the ecosystem provisioning services. First, the explorations on the influences of LUC on ecosystem provisioning services were reviewed, including the researches on the influences of LUC on agroecosystem services and forest and/or grassland ecosystem services. Then the quantitative identification of the impacts of LUC on ecosystem provisioning services was commented on. In the light of enhanced observation and valuation methods, several approaches to ecosystem services and improved models for assessing those ecosystem services were assessed. The major indicators used to uncover the influences of LUC on human wellbeing were summarized including the increase of inputs and the reduction of outputs in production and the augmented health risk induced by the irrational land uses. Finally, this paper uncovered the research gaps and proposed several research directions to address these gaps.
Amiel Castro, Rita T; Schroeder, Katrin; Pinard, Claudia; Blöchlinger, Patricia; Künzli, Hansjörg; Riecher-Rössler, Anita; Kammerer, Martin
The epidemiology of maternal perinatal-psychiatric disorders as well as their effect on the baby is well recognised. Increasingly well researched specialised treatment methods can reduce maternal morbidity, positively affect mother-baby bonding and empower women's confidence as a mother. Here, we aimed to compare guidelines and the structure of perinatal-psychiatric service delivery in the United Kingdom and in Switzerland from the government's perspective. Swiss cantons provided information regarding guidelines and structure of service delivery in 2000. A subsequent survey using the same questionnaire was carried out in 2007. In the UK, similar information was accessed through published reports from 2000-2012. Guidelines for perinatal psychiatry exist in the UK, whereas in Switzerland in 2000 none of the 26 cantons had guidelines, and in 2007 only one canton did. Joint mother-baby admissions on general psychiatric wards were offered by 92% of the Swiss cantons. In the UK, pregnant women and joint mother-baby admissions are only advised onto specialised perinatal-psychiatric units. In Switzerland, in 2007, three specialised units (max. 24 beds) were in place corresponding to 1 unit per 2.5 million people, while in the UK there were 22 mother-baby units (168 beds) in 2012 (1 unit per 2.8 million). In the UK, less than 50% of trusts provided specialised perinatal-psychiatric health care. The main difference between the UK and Switzerland was the absence of guidelines, regular assessment and plans for future development of perinatal psychiatry in Switzerland. There are still geographical differences in the provision of perinatal-psychiatric services in the UK.
Edward Ivor Broughton
Full Text Available ObjectiveHIV in Nicaragua is concentrated among key populations (KPs – men who have sex with men, female sex workers and female transgender – in whom prevalence is 600-4 000 times higher than the general population. The USAID PrevenSida Project is aimed at increasing healthy behavior among KPs and people with HIV and improving testing, counseling, and continuity of prevention and treatment by building capacity and improving performance of non-governmental organizations (NGOs providing services to KPs. We evaluated the cost-effectiveness of PrevenSida’s activities. MethodsThis retrospective observational evaluation used individuals in KPs covered by NGOs receiving assistance from PrevenSida from 2012 to 2014. Cost-effectiveness analysis compared PrevenSida’s intervention with business-as-usual. Model inputs were generated from epidemiological modeling and PrevenSida’s records.ResultsBy 2014, 24 NGOs received grants and technical assistance from PrevenSida with 72 955 people in KPs served at $11.32/person ($9.39 to $16.55/person depending on region. The estimated incremental cost-effectiveness ratio was $50 700/HIV case averted or $2 600/Disability-adjusted Life Year (DALY averted (95% CI: $1 000-$99 000 and $50-$5 100, respectively.ConclusionPrevenSida distributed about $600 000 in grants and used $230 000 to support 24 NGOs in 2014. Cost-effectiveness from the program perspective compared to no program was slightly over half of GDP per capita per DALY averted, considered highly cost-effective by WHO criteria. Cost and efficiency varied by region, reflecting the number of people in KPs receiving services. Cost-sharing by NGOs improved cost-effectiveness from the program perspective and likely promotes sustainability. Focused interventions for KP service provision organizations can be acceptably efficient in this setting.
Hugo Consciência Silvestre
Full Text Available Abstract Co-production includes all actions where citizens assist, as volunteers, in the provision of services by public agencies in order to increase the efficiency and efficacy of the public services provided. This practice, known as co-production, is being adopted by governments in the resolution of conflicts, particularly those regarding administrative and fiscal matters. However, is co-production a more efficient and effective way of settling disputes in administrative and tax areas than the traditional administrative model? And why? In Portugal, the Administrative Arbitration Centre was created in 2009 with the aim of resolving disputes between public administration and taxpayers/service users by means of co-production. The available data support the thesis that efficiency and efficacy are higher under the co-production model. Nevertheless, users are not totally satisfied since the costs associated with the use of this service provision model are also higher.
... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Provision of certain legal services... Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL... receipt, from unblocked sources, of payment of professional fees and reimbursement of incurred expenses...
Holland, Deirdre M
Medication reconciliation is a basic principle of good medicines management. With the establishment of the National Acute Medicines Programme in Ireland, medication reconciliation has been mandated for all patients at all transitions of care. The clinical pharmacist is widely credited as the healthcare professional that plays the most critical role in the provision of medication reconciliation services.
Kaplan, Sigal; de Abreu e Silva, João; Di Ciommo, Floridea
This study investigates the effect of price and travel mode fairness and spatial equity in transit provision on the perceived transit service quality, willingness to pay, and habitual frequency of use. Based on the theory of planned behavior, we developed a web-based questionnaire for revealed...
Ogbah, Enovwor Laura
This study is an assessment of Information Provision Services of Libraries in the 21st century in some selected academic libraries in Delta State. A descriptive survey was adopted in carrying out the research. The questionnaire was the instrument for data collection of which 62 were retrieved. Based on the findings of the study, it was recommended…
...-000 and AD10-13-000] Third-Party Provision of Ancillary Services; Accounting and Financial Reporting... Commission's accounting and financial reporting requirements currently do not contain specific accounting \\12... financial reporting requirements \\41\\ for public utilities \\42\\ are designed to provide information about a...
Suphanchaimat, Rapeepong; Kantamaturapoj, Kanang; Putthasri, Weerasak; Prakongsai, Phusit
, attitudes and practices of practitioners in the provision of healthcare services for migrants were mainly influenced by: (1) diverse cultural beliefs and language differences, (2) limited institutional capacity, in terms of time and/or resource constraints, (3) the contradiction between professional ethics and laws that limited migrants' right to health care. Nevertheless, healthcare providers addressedsuch problems by partially ignoring the immigrants'precarious legal status, and using numerous tactics, including seeking help from civil society groups, to support their clinical practice. It was evident that healthcare providers faced several challenges in managing care for migrants, which included not only language and cultural barriers, but also resource constraints within their workplaces, and disharmony between the law and their professional norms. Further studies, which explore health care management for migrants in countries with different health insurance models, are recommended.
Nakari, Pentti J. E.
Aging of the population is an increasing problem in many countries, including Finland, and it poses a challenge to public services such as home care. Vehicle routing optimization (VRP) type optimization solutions are one possible way to decrease the time required for planning home visits and driving to customer addresses, as well as decreasing transportation costs. Although VRP optimization is widely and succesfully applied to commercial and industrial logistics, the home care ...
Bodnaruk, E.; Kroll, C. N.; Endreny, T. A.; Hirabayashi, S.; Yang, Y.
Urban land area and the proportion of humanity living in cities is growing, leading to increased urban air pollution, temperature, and stormwater runoff. These changes can exacerbate respiratory and heat-related illnesses and affect ecosystem functioning. Urban trees can help mitigate these threats by removing air pollutants, mitigating urban heat island effects, and infiltrating and filtering stormwater. The urban environment is highly heterogeneous, and there is no tool to determine optimal locations to plant or protect trees. Using spatially explicit land cover, weather, and demographic data within biophysical ecosystem service models, this research expands upon the iTree urban forest tools to produce a new decision support tool (iTree-DST) that will explore the development and impacts of optimal tree planting. It will also heighten awareness of environmental justice by incorporating the Atkinson Index to quantify disparities in health risks and ecosystem services across vulnerable and susceptible populations. The study area is Baltimore City, a location whose urban forest and environmental justice concerns have been studied extensively. The iTree-DST is run at the US Census block group level and utilizes a local gradient approach to calculate the change in ecosystem services with changing tree cover across the study area. Empirical fits provide ecosystem service gradients for possible tree cover scenarios, greatly increasing the speed and efficiency of the optimization procedure. Initial results include an evaluation of the performance of the gradient method, optimal planting schemes for individual ecosystem services, and an analysis of tradeoffs and synergies between competing objectives.
Ouellet Dallaire, C.; Bennett, E.; Lehner, B.
Canadian rivers are under threat from climate and other anthropogenic changes, which will have important repercussion on the provision of water. Ensuring the long-term provision of this ecosystem services (ES) necessitates integrative and sustainable management of river systems. Because of rivers' highly connected nature, freshwater management must consider the spatial configuration of river systems to account for the upstream/downstream connections of the beneficiaries. To answer this need, we developed a spatial and hydrological approach to measure capacity for, demand for and pressure from ES linked to river systems. We applied this method to all Canadian rivers for the provision of water and analyzed the intensity of interactions among four beneficiaries: agriculture, municipalities, industries and hydropower. As such this is a first-ever cartography of capacity for, demand for and pressure from water provision and their interactions at large scale. In Canada, rivers under high interactions are located in three main regions: the Prairies where demand for and pressure from water provision for agriculture is high, southern Ontario and Québec where demand for and pressure from water provision for municipalities and industries is high, and in Northern large rivers, especially in Québec, where pressures from water provision for hydropower production is high. The distribution of capacity, demand and pressure shows an intense but concentrated reliance on small rivers to provide water for downstream users. For Canadian large rivers, interactions among capacity, demand and pressure are moderate but constant. This cartography can inform freshwater management by identifying rivers where water provisioning is at risk, for example, where capacity cannot meet the demand or where water use has negative consequences on downstream ES.
Sándor, János; Kósa, Karolina; Papp, Magor; Fürjes, Gergő; Kőrösi, László; Jakovljevic, Mihajlo; Ádány, Róza
Mortality caused by non-communicable diseases has been extremely high in Hungary, which can largely be attributed to not performed preventive examinations (PEs) at the level of primary health care (PHC). Both structures and financial incentives are lacking, which could support the provision of legally defined PEs. A Model Programme was launched in Hungary in 2012 to adapt the recommendations for PHC of the World Health Organization. A baseline survey was carried out to describe the occurrence of not performed PEs. A sample of 4320 adults representative for Hungary by age and gender was surveyed. Twelve PEs to be performed in PHC as specified by a governmental decree were investigated and quantified. Not performed PEs per person per year with 95% confidence intervals were computed for age, gender, and education strata. The number of not performed PEs for the entire adult population of Hungary was estimated and converted into expenses according to the official reimbursement costs of the National Health Insurance Fund. The rate of service use varied between 16.7 and 70.2%. There was no correlation between the unit price of examinations and service use (r = 0.356; p = 0.267). The rate of not performed PEs was not related to gender, but older age and lower education proved to be risk factors. The total number of not performed PEs was over 17 million in the country. Of the 31 million euros saved by not paying for PEs, the largest share was not spent on those in the lowest educational category. New preventive services offered in the reoriented PHC model program include systematic and scheduled health examination health promotion programs at community settings, risk assessment followed by individual or group care, and/or referral and chronic care. The Model Programme has created a pressure for collaborative work, consultation, and engagement at each level, from the GPs and health mediators up to the decision-making level. It channeled the population into preventive
Duncan, Catharine; Hudson, Megan; Heck, Carol
At the hospital studied, weekend physiotherapy (WEPT) is routinely provided and in 2013 WEPT was increased from one (PRE) to three (POST) physiotherapists (PTs) to cover intensive care and ward patients. (1) To evaluate the impact of increased WEPT on patient volumes, treatments provided and conditions treated in critical care and wards; and (2) to understand the PTs' perspectives on the new coverage model. A mixed methods design was utilized. The quantitative component consisted of retrospective document reviews of all weekend patients treated January 1-May 5 (PRE) and May 11-December 31 (POST). The qualitative component used a questionnaire to collect staff feedback. PRE-POST comparisons were conducted using χ(2) or Mann-Whitney U tests. Significant (p = 0.00) increases POST were seen in number of patients treated, number of mobility treatments provided and number of post-surgical patients seen in both clinical areas. The majority of survey respondents reported feeling adequately trained, but had concerns regarding the impact of increased WEPT on work-life balance. PTs perceived enhanced service was beneficial for continuity of weekday care and improved patient function. Future studies need to focus on measuring the effect of increased weekend provision on outcomes, preventing complications and length of stay.
Recklitis, Christopher J; Syrjala, Karen L
Meeting the psychosocial needs of patients with cancer has been recognised as a priority within oncology care for several decades. Many approaches that address these needs have been developed and described; however, until recently much of this work had focused on patients during treatment and end-of-life care. With continued improvement in therapies, the population of cancer survivors who can expect to live for 5 or more years after cancer diagnosis has increased dramatically, as have associated concerns about how to meet their medical, psychosocial, and health behaviour needs after treatment. Guidelines and models for general survivorship care routinely address psychosocial needs, and similar guidelines for psychosocial care of patients with cancer are being extended to address the needs of survivors. In this Series paper, we summarise the existing recommendations for the provision of routine psychosocial care to survivors, as well as the challenges present in providing this care. We make specific recommendations for the integration of psychosocial services into survivorship care. PMID:28049576
Fan, Hong; Li, Huan
Location-related data are playing an increasingly irreplaceable role in business, government and scientific research. At the same time, the amount and types of data are rapidly increasing. It is a challenge how to quickly find required information from this rapidly growing volume of data, as well as how to efficiently provide different levels of geospatial data to users. This paper puts forward a data-oriented access model for geographic information science data. First, we analyze the features of GIS data including traditional types such as vector and raster data and new types such as Volunteered Geographic Information (VGI). Taking into account these analyses, a classification scheme for geographic data is proposed and TRAFIE is introduced to describe the establishment of a multi-level model for geographic data. Based on this model, a multi-level, scalable access system for geospatial information is put forward. Users can select different levels of data according to their concrete application needs. Pull-based and push-based data access mechanisms based on this model are presented. A Service Oriented Architecture (SOA) was chosen for the data processing. The model of this study has been described by providing decision-making process of government departments with a simulation of fire disaster data collection. The use case shows this data model and the data provision system is flexible and has good adaptability.
Beguería, S.; Campos, P.
Hydro-economic models that allow integrating the ecological, hydrological, infrastructure, economic and social aspects into a coherent, scientifically- informed framework constitute preferred tools for supporting decision making in the context of integrated water resources management. We present a case study of water regulation and provision services of forests in the Andalusia region of Spain. Our model computes the physical water flows and conducts an economic environmental income and asset valuation of forest surface and underground water yield. Based on available hydrologic and economic data, we develop a comprehensive water account for all the forest lands at the regional scale. This forest water environmental valuation is integrated within a much larger project aiming at providing a robust and easily replicable accounting tool to evaluate yearly the total income and capital of forests, encompassing all measurable sources of private and public incomes (timber and cork production, auto-consumption, recreational activities, biodiversity conservation, carbon sequestration, water production, etc.). We also force our simulation with future socio-economic scenarios to quantify the physical and economic efects of expected trends or simulated public and private policies on future water resources. Only a comprehensive integrated tool may serve as a basis for the development of integrated policies, such as those internationally agreed and recommended for the management of water resources.
Do efforts to standardize, assess and improve the quality of health service provision to adolescents by government-run health services in low and middle income countries, lead to improvements in service-quality and service-utilization by adolescents?
Chandra-Mouli, Venkatraman; Chatterjee, Subidita; Bose, Krishna
Researchers and implementers working in adolescent health, and adolescents themselves question whether government-run health services in conservative and resource-constrained settings can be made adolescent friendly. This paper aims to find out what selected low and middle income country (LMIC) governments have set out to do to improve the quality of health service provision to adolescents; whether their efforts led to measurable improvements in quality and to increased health service-utilization by adolescents. We gathered normative guidance and reports from eight LMICs in Asia, Africa, Central and Eastern Europe and the Western Pacific. We analysed national quality standards for adolescent friendly health services, findings from the assessments of the quality of health service provision, and findings on the utilization of health services. Governments of LMICs have set out to improve the accessibility, acceptability, equity, appropriateness and effectiveness of health service provision to adolescents by defining standards and actions to achieve them. Their actions have led to measurable improvements in quality and to increases in health service utilisation by adolescents. With support, government-run health facilities in LMICs can improve the quality of health services and their utilization by adolescents.
Teunter, R.H.; Klein Haneveld, W.K.
When an expensive piece of equipment is bought, spare parts can often be bought at a reduced price. A decision must be made about the initial provisioning of spare parts. Furthermore, if at a certain time the stock drops to zero, because a number of failures have occurred, a decision must be made
Administrative Circular No. 25 (Rev. 3) entitled “Special provisions for the Fire and Rescue Service governing working and rest time”, approved by the Director-General following discussion at the Standing Concertation Committee meeting of 28 September 2012 and entering into force in October 2012, is available on the intranet site of the Human Resources Department: http://cern.ch/hr-docs/admincirc/admincirc.asp This Circular is applicable to staff members of the Fire and Rescue Service It cancels and replaces Administrative Circular No. 25 (Rev. 2) entitled “Shift work – Special provisions for the Fire and Rescue Service” of April 2003. This new version takes into account the new organisation of the Fire and Rescue Service, members of which will henceforth not exclusively perform their functions in the context of shift work, but also during reference working hours and during stand-by duty. Additionally, applicable limits regarding working and rest times an...
O'Reilly, Claire L; Bell, J Simon; Kelly, Patrick J; Chen, Timothy F
Pharmacists' provision of medication counseling and medication review has been shown to improve adherence and resolve drug-related problems. Lack of knowledge of mental health conditions and negative beliefs may act as a barrier to the provision of pharmacy services. It is unclear how pharmacists' knowledge and attitudes impact their provision of pharmacy services. To explore the relationship between pharmacists' level of mental health stigma, mental health literacy and behavioral intentions in relation to providing pharmacy services for consumers with schizophrenia. A survey instrument containing a measure of mental health literacy, the 7-item social distance scale, and 16 items relating to the provision of pharmacy services for consumers with schizophrenia compared to cardiovascular disease, was mailed to a random sample of 1000 pharmacists registered with the Pharmacy Board of New South Wales in November 2009. Multiple linear regression models were used to assess the relationship between stigma, knowledge and behavior. Responses were received from 188 pharmacists. Pharmacists were significantly more confident and comfortable to provide services to consumers with a cardiovascular illness than a mental illness. Social distance, β = -0.11 (95% CI: -0.22, -0.01, P = 0.03), and schizophrenia literacy scores, β = 1.02, (95% CI: 0.54, 1.50, P mental health stigma and high levels of schizophrenia literacy were associated with pharmacists being more willing to provide medication counseling and identify drug-related problems for consumers with schizophrenia. This demonstrates the importance of improving knowledge and stigma surrounding schizophrenia to improve service delivery for consumers taking medications for schizophrenia. Copyright © 2015 Elsevier Inc. All rights reserved.
This monograph presents a tactical planning approach for service network design in metropolitan areas. Designing the service network requires the suitable aggregation of demand data as well as the anticipation of operational relocation decisions. To this end, an integrated approach of data analysis and mathematical optimization is introduced. The book also includes a case study based on real-world data to demonstrate the benefit of the proposed service network design approach. The target audience comprises primarily research experts in the field of traffic engineering, but the book may also be beneficial for graduate students.
Carrizales, L.; Gamez, L.; Reggio, F.; Gamboa, M.; Quintero, A.; Almeida, J.
Most of the radio diagnosis institutions (public and private) in Venezuela have a lack quality control applied to radiological equipment, as well as capable staff to implement it. It is intended to implant training programs and corrective policies to optimize their services [es
Podesta, Marion; Poudou, Jean-Christophe
In this paper, we propose to analyze optimal nonlinear pricing when a firm offers in a bundle a commodity and a contingent service. The paper studies a mechanism design where all private information can be captured in a single scalar variable in a monopoly context. We show that to propose the package for commodity and service is less costly for the consumer, the firm has lower consumers' rent than the situation where it sells their good and contingent service under an independent pricing strategy. In fact, the possibility to use price discrimination via the supply of package is dominated by the fact that it is costly for the consumer to sign two contracts. Bundling energy and a contingent service is a profitable strategy for a energetician monopoly practising optimal nonlinear tariff. We show that the rates of the energy and the contingent service depend to the optional character of the contingent service and depend to the degree of complementarity between commodities and services. (authors)
Full Text Available This paper develops a crowdfunding platform model incorporating quality and a matching service from the perspective of a two-sided market. It aims to explore the impact of different factors on the optimal quality threshold and matching service in a context of crowdfunding from the perspective of a two-sided market. We discuss the impact of different factors on the optimal quality threshold and matching service. Two important influential factors are under consideration, simultaneously. One is the quality threshold of admission and the other is the matching efficiency on crowdfunding platforms. This paper develops a two-sided market model incorporating quality, a matching service, and the characters of crowdfunding campaigns. After attempting to solve the model by derivative method, this paper identifies the mechanism of how the parameters influence the optimal quality threshold and matching service. Additionally, it compares the platform profits in scenarios with and without an exclusion policy. The results demonstrate that excluding low-quality projects is profitable when funder preference for project quality is substantial enough. Crowdfunding platform managers would be unwise to admit the quality threshold of the crowdfunding project and charge entrance fees when the parameter of funder preference for project quality is small.
Díaz de León-Castañeda, Christian; Gutiérrez-Godínez, Jéssica; Colado-Velázquez, Juventino Iii; Toledano-Jaimes, Cairo
In Mexico, the Modelo Nacional de Farmacia Hospitalaria (MNFH, or National Hospital Pharmacy Model), published in 2009, mainly aims to promote the provision of clinical pharmacy services in private and public hospitals. However, there is little scientific documentation about the quality of these services. To explore healthcare professionals' perceptions related to the quality of clinical pharmacy services provision. A case-study based on a qualitative approach was performed at the pharmaceutical services unit at a public hospital located in Mexico City, which operates under the administrative control of the Ministry of Health. Donabedian's conceptual model was adapted to explore health care professionals' perceptions of the quality of clinical pharmacy services provision. Semi-structured interviews were carried out with pharmacists, physicians and nurses and then transcribed and analyzed via discourse analysis and codification techniques, using the software package Atlas. ti. Limitations in pharmaceutical human resources were identified as the main factor affecting coverage and quality in clinical pharmacy services provision. However, the development in pharmacy staff of technical competences and skills for clinical pharmacy service provision were recognized. Significant improvements in the rational use of medicines were associated with clinical pharmacy services provision. The perception analysis performed in this study suggested that it is necessary to increase pharmacy staff in order to improve interprofessional relationships and the quality of clinical pharmacy services provision. Copyright © 2018 Elsevier Inc. All rights reserved.
Zinn, Jacqueline S; Mor, Vincent; Intrator, Orna; Feng, Zhanlian; Angelelli, Joseph; Davis, Jullet A
To examine skilled nursing facilities (SNFs) "make-or-buy" decisions with respect to rehabilitation therapy service provision in the 1990s, both before and after implementation of Medicare's Prospective Payment System (PPS) for SNFs. Longitudinal On-line Survey Certification and Reporting (OSCAR) data (1992-2001) on a sample of 10,241 freestanding urban SNFs. We estimated a longitudinal multinomial logistic regression model derived from transaction cost economic theory to predict the probability of the outcome in each of four service provision categories (all employed staff, all contract, mixed, and no services provided). Transaction frequency, uncertainty, and complexity result in greater control over therapy services through employment as opposed to outside contracting. For-profit status and chain affiliation were associated with greater control over therapy services. Following PPS, nursing homes acted to limit transaction costs by either exiting the rehabilitation market or exerting greater control over therapy services by managing rehabilitation services in-house. The financial incentives associated with changes in reimbursement methodology have implications that extend beyond the boundaries of the health care industry segment directly affected. Unintended quality and access consequences need to be carefully monitored by the Medicare program.
The EPOS-IP WP10 - "GNSS Data & Products" is the Working Package of the EPOS-IP project in charge of implementing the necessary services in order that the geo-sciences community can access the existing Pan-European Geodetic Infrastructures. The WP10 is formed by representatives of the participating institutions (10) but it is also open to the entire geodetic community. In fact, WP10 also includes members from other institutions/countries that formally are not participating in the EPOS-IP. During the EPOS-IP project, the geodetic component of EPOS (WP10) is dealing essentially with Research Infrastructures focused on continuous operating GNSS (cGNSS). The option of concentrating the efforts on the presently most generalized geodetic tool supporting research on Solid Earth was decided in order to optimize the existing resources. Furthermore, although the focus is on Solid Earth applications, other research and technical applications (e.g., reference frames, meteorology, space weather) can also benefit from the efforts of WP10 towards the optimization of the geodetic resources in Europe. We will present and discuss the plans for the implementation of the thematic and core services (TCS) for GNSS data within EPOS and the related business plan. We will focus on strategies towards the implementation of the best solutions that will permit to the end-users, and in particular geo-scientists, to access the geodetic data, derived solutions, and associated metadata using transparent and uniform processes. The collaboration with EUREF is also an essential component of the implementation plan.
Gregório, João; Cavaco, Afonso Miguel; Lapão, Luís Velez
, depending on the condition presented. Workload results are very similar to findings from studies in other countries, which may be an indication of uniformity of community pharmacy practice across countries. The amount of time a pharmacist has at the counter to interact with a patient during a year renders disease management or therapeutic management non-viable. Also, the perception of "lack of time," many times reported as a barrier for service provision, must be called into question, since substantial available time was found. However, to turn this available time into usable time, redesign of work processes and new role definition are necessary. Both better management and new communication channels should be developed to address this gap and increase patient follow-up services. Copyright Â© 2016 Elsevier Inc. All rights reserved.
Luana Alves Figueiredo
Full Text Available Objective To analyse the provision of health care actions and services for people living with AIDS and receiving specialised care in Ribeirão Preto, SP. Method A descriptive, exploratory, survey-type study that consisted of interviews with structured questionnaires and data analysis using descriptive statistics. Results The provision of health care actions and services is perceived as fair. For the 301 subjects, routine care provided by the reference team, laboratory tests and the availability of antiretroviral drugs, vaccines and condoms obtained satisfactory evaluations. The provision of tests for the prevention and diagnosis of comorbidities was assessed as fair, whereas the provisions of specialised care by other professionals, psychosocial support groups and medicines for the prevention of antiretroviral side effects were assessed as unsatisfactory. Conclusion Shortcomings were observed in follow-up and care management along with a predominantly biological, doctor-centred focus in which clinical control and access to antiretroviral therapy comprise the essential focus of the care provided.
Laing, G L; Skinner, D L; Bruce, J L; Aldous, C; Govindasamy, V; Thomson, S R; Clarke, D L
The optimal management of resources within South African state hospitals has been hampered by a paucity of data due to a lack of robust auditing information systems. This study reviews the use of a Hybrid Electronic Medical Record (HEMR) system to capture and aggregate data pertaining to the inpatient service demands on a South African tertiary surgical service. This dataset was used to analyse the appropriateness of tertiary surgical resource utilisation. The HEMR system was implemented at Greys Hospital, in the city of Pietermaritzburg, Kwa-Zulu Natal, South Africa on 1 January 2013. Inpatient data pertaining to surgical admissions and operative interventions were captured prospectively. Following an 18-month study period, the data were extracted, aggregated and analysed. The district referral hospitals were mapped, and district surgical procedures performed within the tertiary center were identified and quantified. Results: 7314 patients were admitted and managed by the tertiary surgical service during the study period. The median patient age was 33 years (IQR 6.5-42.4 years). 59.7% were male and 40.3% were female. General, trauma and paediatric surgical admissions constituted 54.8%, 28.6% and 16.6% respectively. Emergency admissions constituted 62.4% and elective admissions 37.6%. Referral sources were captured for 6653 (91%) of the cohort. 4338 (65.2%) patients were referred from district hospitals. The district hospital (Northdale) closest to Greys Hospital was responsible for 1675 (25.2%) of surgical referrals. 4174 operative procedures were performed during the study period, 54.7% performed as an emergency, 34.1% electively and 11.2% semi-electively. The median waiting time for emergency operative intervention was 535 minutes (IQR 130-663). A total of 1272 (30.5%) operative procedures performed were assessed as district-level operations. The time intervals of 07:00-07:59 and 17:00-17:59 were identified as the time periods during which the least number of
Reddy, Anusha; Watson, Margaret; Hannaford, Philip; Lefevre, Karen; Ayansina, Dolapo
In the UK, a large proportion of contraceptive services are provided from general practice. However, little is known about which contraceptive services are provided and to whom. Descriptive serial cross-sectional study of women aged 12-55 years, registered with 191 general practices in Scotland, UK between 2004 and 2009. Annual incidence of provision of hormonal and long-acting reversible contraceptives (LARCs) increased from 27.7% in 2004 to 30.1% in 2009. Amongst those women registered with a general practice for the full 5-year period the provision of LARCs increased from 8.8% to 12.5% (pemergency hormonal contraception (EHC) decreased from 5.2% to 2.6% (pcontraceptives and LARCs from general practices. It is important that a full range of contraceptive options remains easily available to women.
Ursula Loret de Mola
Full Text Available Latin American (LA megacities are facing enormous challenges to provide welfare to millions of people who live in them. High rates of urbanization and limited administrative capacity of LA cities to plan and control urban growth have led to a critical deficit of urban green space, and therefore, to sub-optimal outcomes in terms of urban sustainability. This study seeks to assess the possibility of using real estate prices to provide an estimate of the monetary value of the ecosystem services provided by urban green space across five Latin American megacities: Bogota, Buenos Aires, Lima, Mexico City and Santiago de Chile. Using Google Earth images to quantify urban green space and multiple regression analysis, we evaluated the impact of urban green space, crime rates, business density and population density on real estate prices across the five mentioned megacities. In addition, for a subset of the data (Lima and Buenos Aires we analyzed the effects of landscape ecology variables (green space patch size, connectivity, etc. on real estate prices to provide a first insight into how the ecological attributes of urban green space can determine the level of ecosystem service provision in different urban contexts in Latin America. The results show a strong positive relationship between the presence of urban green space and real estate prices. Green space explains 52% of the variability in real estate prices across the five studied megacities. Population density, business density and crime had only minor impacts on real estate prices. Our analysis of the landscape ecology variables in Lima and Buenos Aires also show that the relationship between green space and price is context-specific, which indicates that further research is needed to better understand when and where ecological attributes of green space affect real estate prices so that managers of urban green space in LA cities can optimize ecological configuration to maximize ecosystem service
Full Text Available The informative society is seen as the central element of rural development at the beginning of the third millennium and the development of information technology and communication in villages has always been considered in current summits across the world. Nowadays, information and communication technology service offices are the basis of electronic government. Therefore, recognition of these offices is necessary for sustainable rural development. The purpose of this research was a comparative analysis between the current situation and the desirable situation of e-government services in the rural districts of the Hamedan province as perceived by their directors (Hamedan, Bahar and Famenin Counties. The study population consists of 91 respondents who were chosen and studied through the census method. The findings of this research study consist of two sections. The items related to satisfaction with the activities in information and communication technology service offices were prioritized in the first section. Moreover, the current and the desirable conditions for electronic service provision were identified. The gap between these two were analyzed in the second section. The results indicate that there is a significant difference between these two conditions of electronic service provisions in rural areas. This significant difference was recognized through the paired T test at the 0.05 level with 6.33 value that illustrates the existence of a gap between these two situations. Electronic government, information technology and communication, information and communication technology service offices
Brad R. Fulton
Full Text Available When congregations seek to address social needs, they often pursue this goal through acts of service and political engagement. Over the past three decades, a tremendous amount of research has been dedicated to analyzing congregation-based service provision and political participation. However, little is known about how congregations’ involvement in these arenas has changed during this period. To help fill this gap, this study analyzes three waves of data from a national survey of congregations to assess how congregations’ participation patterns in service-related and political activities have been changing since the 1990s. It also examines trends among subpopulations of congregations grouped by their religious tradition, ethnoracial composition, and ideological orientation. Overall, this study finds that among most types of congregations, the percentage participating in service-related activities is substantial and increasing, while the percentage participating in political activities is less substantial and decreasing. This decline in political participation has implications for the role congregations play in addressing social needs. Relieving immediate needs through service provision without also pursuing long-term solutions through political participation can limit congregations’ ability to comprehensively address social needs. Among the few types of congregations that have high and/or increasing participation rates in both service-related and political activities are Catholic, predominantly Hispanic, and politically liberal congregations.
The study revealed that the ICT-based services provided are: bar coded circulation services; bibliographic database services; electronic-mail services; online selective dissemination of information resources; e-library services; and full text journal articles. Users are not satisfied with the available ICT-based services provided ...
Peykov, Pavel; Cameron, Ron; Westmacott, Chad
In June 2011, the OECD Nuclear Energy Agency's (NEA) High-level Group on the Security of Supply of Medical Radioisotopes (HLG-MR) released its policy approach for ensuring a long-term secure supply of molybdenum-99 ( 99 Mo) and its decay product technetium-99m (' 99m Tc). This policy approach was developed after two years of extensive examination and analysis of the challenges facing the supply chain, and the provision of a reliable, secure supply of these important medical isotopes. The full policy approach can be found in the OECD/NEA report, The Supply of Medical Radioisotopes: The Path to Reliability (NEA, 2011). One of the key principles in the policy approach relates to the provision of outage reserve capacity (ORC) in the 99 Mo/' 99m Tc supply chain, as defined on page 7: 'Principle 2: Reserve capacity should be sourced and paid for by the supply chain. A common approach should be used to determine the amount of reserve capacity required'. This Principle follows the findings of the OECD/NEA report, The Supply of Medical Radioisotopes: An Economic Study of the Molybdenum-99 Supply Chain (NEA, 2010), which clearly demonstrated the need for excess 99 Mo production capacity, relative to demand, as some reactors may have to be shutdown unexpectedly or for extended periods. The Study also demonstrated that the pricing structure from reactors for 99 Mo irradiation services prior to the 2009-10 supply shortage was not economically sustainable, including the pricing of ORC, with the cost being subsidised by host nations. These nations have indicated a move away from subsidising production, which often benefits foreign nations or foreign companies, and therefore pricing for irradiation services must recover the full cost of production to ensure economic sustainability and a long-term secure supply. Appropriate pricing would also encourage more efficient use of the product, reducing inefficient use of 99 Mo/' 99m Tc would reduce excess production and the associated
Full Text Available Abstract Background The extent of stroke-related disability typically becomes most apparent after patient discharge to the community. As part of the Irish National Audit of Stroke Care (INASC, a national survey of community-based allied health professionals and public health nurses was conducted. The aim was to document the challenges to service availability for patients with stroke in the community and to identify priorities for service improvement. Methods The study was a cross-sectional tailored interview survey with key managerial and service delivery staff. As comprehensive listings of community-based health professionals involved in stroke care were not available, a cascade approach to information gathering was adopted. Representative regional managers for services incorporating stroke care (N = 7 and disciplinary allied health professional and public health nurse managers (N = 25 were interviewed (94% response rate. Results Results indicated a lack of formal, structured community-based services for stroke, with no designated clinical posts for stroke care across disciplines nationally. There was significant regional variation in availability of allied health professionals. Considerable inequity was identified in patient access to stroke services, with greater access, where available, for older patients (≥ 65 years. The absence of a stroke strategy and stroke prevalence statistics were identified as significant impediments to service planning, alongside organisational barriers limiting the recruitment of additional allied health professional staff, and lack of sharing of discipline-specific information on patients. Conclusions This study highlighted major gaps in the provision of inter-disciplinary team community-based services for people with stroke in one country. Where services existed, they were generic in nature, rarely inter-disciplinary in function and deficient in input from salient disciplines. Challenges to optimal care
Background The extent of stroke-related disability typically becomes most apparent after patient discharge to the community. As part of the Irish National Audit of Stroke Care (INASC), a national survey of community-based allied health professionals and public health nurses was conducted. The aim was to document the challenges to service availability for patients with stroke in the community and to identify priorities for service improvement. Methods The study was a cross-sectional tailored interview survey with key managerial and service delivery staff. As comprehensive listings of community-based health professionals involved in stroke care were not available, a cascade approach to information gathering was adopted. Representative regional managers for services incorporating stroke care (N = 7) and disciplinary allied health professional and public health nurse managers (N = 25) were interviewed (94% response rate). Results Results indicated a lack of formal, structured community-based services for stroke, with no designated clinical posts for stroke care across disciplines nationally. There was significant regional variation in availability of allied health professionals. Considerable inequity was identified in patient access to stroke services, with greater access, where available, for older patients (≥ 65 years). The absence of a stroke strategy and stroke prevalence statistics were identified as significant impediments to service planning, alongside organisational barriers limiting the recruitment of additional allied health professional staff, and lack of sharing of discipline-specific information on patients. Conclusions This study highlighted major gaps in the provision of inter-disciplinary team community-based services for people with stroke in one country. Where services existed, they were generic in nature, rarely inter-disciplinary in function and deficient in input from salient disciplines. Challenges to optimal care included the need for
Bimo Abraham Nkhata
Full Text Available This paper proposes a property rights perspective to interpret institutional regime shifts in the provision of freshwater ecosystem services. Institutional regime shifts are conceived as persistent changes in the structure and function of a system. Property rights are viewed as an important component of institutional regimes. The paper draws on a case study of flow regulation on the Pongolo Floodplain in South Africa to illustrate the central role of property rights in mediating institutional regime shifts. The case study illustrates that there are many combinations of property rights that underpin institutional regime shifts in the provision of freshwater ecosystem services. It provides useful insights into the consequences of failing to recognize, establish and enforce bundles of rights. A major thrust of the case study is that the nature and context of property rights are important in determining the long-term provision of these services. By examining the configurations of property rights that have governed the Pongola River floodplain over the years, the paper demonstrates the importance of explicitly defining and categorizing the range of rights.
Wu, Zhao; Xiong, Naixue; Huang, Yannong; Gu, Qiong
Services composition technology provides a flexible approach to building Wireless Sensor Network (WSN) Service Applications (WSA) in a service oriented tasking system for WSN. Maintaining the data security of WSA is one of the most important goals in sensor network research. In this paper, we consider a WSN service oriented tasking system in which the WSN Services Broker (WSB), as the resource management center, can map the service request from user into a set of atom-services (AS) and send them to some independent sensor nodes (SN) for parallel execution. The distribution of ASs among these SNs affects the data security as well as the reliability and performance of WSA because these SNs can be of different and independent specifications. By the optimal service partition into the ASs and their distribution among SNs, the WSB can provide the maximum possible service reliability and/or expected performance subject to data security constraints. This paper proposes an algorithm of optimal service partition and distribution based on the universal generating function (UGF) and the genetic algorithm (GA) approach. The experimental analysis is presented to demonstrate the feasibility of the suggested algorithm. PMID:25093346
Silumbwe, Adam; Nkole, Theresa; Munakampe, Margarate Nzala; Milford, Cecilia; Cordero, Joanna Paula; Kriel, Yolandie; Zulu, Joseph Mumba; Steyn, Petrus S
Unmet need for contraception results in several health challenges such as unintended pregnancies, unwanted births and unsafe abortions. Most interventions have been unable to successfully address this unmet need due to various community and health system level factors. Identifying these inhibiting and enabling factors prior to implementation of interventions forms the basis for planning efforts to increase met needs. This qualitative study was part of the formative phase of a larger research project that aimed to develop an intervention to increase met needs for contraception through community and health system participation. The specific study component reported here explores barriers and enablers to family planning and contraceptive services provision and utilisation at community and health systems levels. Twelve focus group discussions were conducted with community members (n = 114) and two with healthcare providers (n = 19). Ten in-depth interviews were held with key stakeholders. The study was conducted in Kabwe district, Zambia. Interviews/discussions were translated and transcribed verbatim. Data were coded and organised using NVivo 10 (QSR international), and were analysed using thematic analysis. Health systems barriers include long distances to healthcare facilities, stock-outs of preferred methods, lack of policies facilitating contraceptive provision in schools, and undesirable provider attitudes. Community level barriers comprise women's experience with contraceptive side effects, myths, rumours and misconceptions, societal stigma, and negative traditional and religious beliefs. On the other hand, health systems enablers consist of political will from government to expand contraceptive services access, integration of contraceptive services, provision of couples counselling, and availability of personnel to offer basic methods mix. Functional community health system structures, community desire to delay pregnancy, and knowledge of contraceptive
Green, Cheri A
Full Text Available for two or more facilities to create an integrated plan for development Step 6 Costing of development plan Case Study Access norms and thresholds guidelines in accessibility analysis Appropriate norms/provision guidelines facilitate both service... access norms and threshold standards ?Test the relationship between service demand and the supply (service capacity) of the facility provision points within a defined catchment area ?Promote the ?right?sizing? of facilities relative to the demand...
Full Text Available This paper deals with designing a fair public service system. To achieve fairness, various schemes are be applied. The strongest criterion in the process is minimization of disutility of the worst situated users and then optimization of disutility of the better situated users under the condition that disutility of the worst situated users does not worsen, otherwise called lexicographical minimization. Focusing on the first step, this paper endeavours to find an effective solution to the weighted p-median problem based on radial formulation. Attempts at solving real instances when using a location-allocation model often fail due to enormous computational time or huge memory demands. Radial formulation can be implemented using commercial optimisation software. The main goal of this study is to show that the suitability solving of the min-max optimal public service system design can save computational time.
Morinec, Allen G.
As the electric power industry transitions to a deregulated market, power transactions are made upon price rather than cost. Generator companies are interested in maximizing their profits rather than overall system efficiency. A method to equitably compensate generation providers for real power, and ancillary services such as reactive power and spinning reserve, will ensure a competitive market with an adequate number of suppliers. Optimizing the generation product mix during bidding is necessary to maximize a generator company's profits. The objective of this research work is to determine and formulate appropriate optimal bidding strategies for a generation company in both the energy and ancillary services markets. These strategies should incorporate the capability curves of their generators as constraints to define the optimal product mix and price offered in the day-ahead and real time spot markets. In order to achieve such a goal, a two-player model was composed to simulate market auctions for power generation. A dynamic game methodology was developed to identify Nash Equilibria and Mixed-Strategy Nash Equilibria solutions as optimal generation bidding strategies for two-player non-cooperative variable-sum matrix games with incomplete information. These games integrated the generation product mix of real power, reactive power, and spinning reserve with the generators's capability curves as constraints. The research includes simulations of market auctions, where strategies were tested for generators with different unit constraints, costs, types of competitors, strategies, and demand levels. Studies on the capability of large hydrogen cooled synchronous generators were utilized to derive useful equations that define the exact shape of the capability curve from the intersections of the arcs defined by the centers and radial vectors of the rotor, stator, and steady-state stability limits. The available reactive reserve and spinning reserve were calculated given a
Farmer, E.D.; Cory, B.J.; Perera, B.L.P.P.
A new strategy for the separate pricing of transmission and distribution services in electricity supply is formulated and evaluated. The proposed methodology is a multivariate transmission generalisation of the method of peak load pricing previously applied to the optimal time-of-use pricing of generation on a power system with diverse generation technologies and with elastic demand. The method allocates both capacity and operational costs on a time-of-use basis, in an optimal manner, that avoids cross-subsidisation both between differing supply system participants and differing times of usage. The method is shown to promote the optimal development of the transmission, distribution or interconnecting systems, rewarding justified investments in transmission capacity and discouraging overinvestment. It also leads to appropriate returns on invested capital without significant 'revenue reconciliation'. This contrasts with SRMC pricing as is shown by a comparative revenue evaluation. It is concluded that the method has wide potential application in electricity supply. (author)
Costa, A.L.; Costa, A. Simoes
This paper presents an approach based on dynamic optimal power flow (DOPF) to clear both energy and spinning reserve day-ahead markets. A competitive environment is assumed, where agents can offer active power for both demand supply and ancillary services. The DOPF jointly determines the optimal solutions for both energy dispatch and reserve allocation. A non-linear representation for the electrical network is employed, which is able to take transmission losses and power flow limits into account. An attractive feature of the proposed approach is that the final optimal solution will automatically meet physical constraints such as generating limits and ramp rate restrictions. In addition, the proposed framework allows the definition of multiple zones in the network for each time interval, in order to ensure a more adequate distribution of reserves throughout the power system. (author)
Steigen, Anne Mari; Bergh, Daniel
This article analyses the psychometric properties of the Social Provisions Scale 10-items version. The Social Provisions Scale was analysed by means of the polytomous Rasch model, applied to data on 93 young adults (16-30 years) out of school or work, participating in different nature-based services, due to mental or drug-related problems. The psychometric analysis concludes that the original scale has difficulties related to targeting and construct validity. In order to improve the psychometric properties, the scale was modified to include eight items measuring functional support. The modification was based on theoretical and statistical considerations. After modifications the scale showed not only satisfying psychometric properties, but it also clarified uncertainties regarding construct validity of the measure. However, further analysis on larger samples are required. Implications for Rehabilitation Social support is important for a variety of rehabilitation outcomes and for different patient groups in the rehabilitation context, including people with mental health or drug-related problems. Social Provisions Scale may be used as a screening tool to assess social support of participants in rehabilitation, and the scale may also be an important instrument in rehabilitation research. There might be issues measuring structural support using a 10-items version of the Social Provisions Scale but it seemed to work well as an 8-item scale measuring functional support.
Vieira, Joana; Matos, Paula; Mexia, Teresa; Silva, Patrícia; Lopes, Nuno; Freitas, Catarina; Correia, Otília; Santos-Reis, Margarida; Branquinho, Cristina; Pinho, Pedro
The growing human population concentrated in urban areas lead to the increase of road traffic and artificial areas, consequently enhancing air pollution and urban heat island effects, among others. These environmental changes affect citizen's health, causing a high number of premature deaths, with considerable social and economic costs. Nature-based solutions are essential to ameliorate those impacts in urban areas. While the mere presence of urban green spaces is pointed as an overarching solution, the relative importance of specific vegetation structure, composition and management to improve the ecosystem services of air purification and climate regulation are overlooked. This avoids the establishment of optimized planning and management procedures for urban green spaces with high spatial resolution and detail. Our aim was to understand the relative contribution of vegetation structure, composition and management for the provision of ecosystem services of air purification and climate regulation in urban green spaces, in particular the case of urban parks. This work was done in a large urban park with different types of vegetation surrounded by urban areas. As indicators of microclimatic effects and of air pollution levels we selected different metrics: lichen diversity and pollutants accumulation in lichens. Among lichen diversity, functional traits related to nutrient and water requirements were used as surrogates of the capacity of vegetation to filter air pollution and to regulate climate, and provide air purification and climate regulation ecosystem services, respectively. This was also obtained with very high spatial resolution which allows detailed spatial planning for optimization of ecosystem services. We found that vegetation type characterized by a more complex structure (trees, shrubs and herbaceous layers) and by the absence of management (pruning, irrigation and fertilization) had a higher capacity to provide the ecosystems services of air
Today, billing is a big challenge for service providers. With a growing number of rich services such as music, mobile TV, Video-on-Demand and eHealth delivered to the mass market, service providers are missing business opportunities because current billing solutions are not fully capable. In particular, the delivery of on-the-fly composite services, composed of many service components provided by different service providers causes many complexities. This book proposes a billing system that de...
Engelhardt, J.; Martini, E.
Recent epidemiological studies are implying that the radio sensitivity of the eye lens is much higher than supposed in the past. International recommendations and standards demand to lower down the annual limit of the eye lens organ dose to 20 mSv. Since about 10 years German monitoring services offer partial-body dosimeters fixed on the head or on glasses for monitoring the eye lens dose. These dosimeters are optimized to measure the (surface) personal dose equivalent H p (0,07) from 0,5 mSv up to 10 Sv, which clearly overestimate the organ dose of the eye lens. With special features like different calibrations partial-body dosimeters should be applicable for legal dosimetry to avoid the development of special H p (3) dosimeters. Accepting the right way for wearing these dosimeters it is important to get the right results. Practical experiences are shown with measuring results and the difficulties of rounding the exact measuring values to discrete dose steps. Closing this article we point to still missing legal basis and open questions regarding to type testing procedures. (orig.)
Zazovskiy, F Ya; Soltysyak, T I
The operational efficiency of drilling services operations management are examined. The structure of time expenditure is analyzed for repair operations according to equipment type employed by the Ivano-Frankovsk Drilling Management under the Ukrneft' enterprise during 1977. The results of this analysis are weighed against a series of service operations carried out at industrial enterprises and connected with technical disruptions. Some of the cases examined include service competion operations outside of the industrial units when technical processes are disrupted only for the change of equipment which has outlived its usefulness and is no longer in series production. First of all, time expended for repair work can be reduced to zero during the drilling of shallow wells which do not require extensive drilling time. The actual savings, both in time and money, as far as repair work is concerned, hinges on the actual time factor for total oil depetion. An equation is provided for optimal time expenditure necessary for repair work and equipment replacement. An actual example is given from the Dolinsk UBR (Drillin Management) under the Ukrneft' enterprise where time spent on actual service operations has appeared to be less than the optimal figure cited in the above material. This is possible because of increased capital expenditures.
The efficient organisation of social insurance is an important problem for modern societies. The paper discusses evidence that shocks in labour income have largely persistent effects and analyses the implications of this observation for the optimal design of institutions for wage contracting, social
Peijnenburg, J.M.J.; Nijman, T.E.; Werker, B.J.M.
We analyze the effect of health cost risk on optimal annuity demand and consumption/savings decisions. Many retirees are exposed to sizeable out-of-pocket medical expenses, while annuities potentially impair the ability to get liquidity to cover these costs and smooth consumption. We find that if
Upshur, Ross E G; Moineddin, Rahim; Crighton, Eric J; Mamdani, Muhammad
The question of how best to reduce waiting times for health care, particularly surgical procedures such as hip and knee replacements is among the most pressing concern of the Canadian health care system. The objective of this study was to test the hypothesis that significant seasonal variation exists in the performance of hip and knee replacement surgery in the province of Ontario. We performed a retrospective, cross-sectional time series analysis examining all hip and knee replacement surgeries in people over the age of 65 in the province of Ontario, Canada between 1992 and 2002. The main outcome measure was monthly hospitalization rates per 100,000 population for all hip and knee replacements. There was a marked increase in the rate of hip and knee replacement surgery over the 10-year period as well as an increasing seasonal variation in surgeries. Highly significant (Fisher Kappa = 16.05, p Holidays and utilization caps appear to exert a significant influence on the rate of service provision. It is expected that waiting times for hip and knee replacement could be reduced by reducing seasonal fluctuations in service provision and benchmarking services to peak delivery. The results highlight the importance of system behaviour in seasonal fluctuation of service delivery.
Upshur Ross EG
Full Text Available Abstract Background The question of how best to reduce waiting times for health care, particularly surgical procedures such as hip and knee replacements is among the most pressing concern of the Canadian health care system. The objective of this study was to test the hypothesis that significant seasonal variation exists in the performance of hip and knee replacement surgery in the province of Ontario. Methods We performed a retrospective, cross-sectional time series analysis examining all hip and knee replacement surgeries in people over the age of 65 in the province of Ontario, Canada between 1992 and 2002. The main outcome measure was monthly hospitalization rates per 100 000 population for all hip and knee replacements. Results There was a marked increase in the rate of hip and knee replacement surgery over the 10-year period as well as an increasing seasonal variation in surgeries. Highly significant (Fisher Kappa = 16.05, p 2Autoreg = 0.85 seasonality was identified in the data. Conclusion Holidays and utilization caps appear to exert a significant influence on the rate of service provision. It is expected that waiting times for hip and knee replacement could be reduced by reducing seasonal fluctuations in service provision and benchmarking services to peak delivery. The results highlight the importance of system behaviour in seasonal fluctuation of service delivery.
Lira, Renata F. de; Filho, Joao A.; Santos, Luiz A.P.; Lima, Fernando Roberto de Andrade; Vieira, Jose W.
Nuclear medicine (NM) is a medical specialty which uses small amounts of radioactive material combined with drugs, to make either therapeutic treatments or form diagnostic images of the organ and tissue. Follow the nuclear regulations any activity involving ionizing radiation should be justified and it must have their procedures of work to be optimized. Thus, the aim of the study is to determine the need and the importance of optimization of radiation protection in NM services and reduce occupationally exposed individuals (OEI) doses in order to avoid possible contamination or accidents and reduce the costs of protection. Optimization for a NM service that makes use of ionizing radiation can be performed using different techniques such as the expanded cost-benefit analysis. Such technique introduces one or two attributes associated to the detriment cost, Y, and the protection costs, X. This work was conducted in the year 2011, where it was analyzed data of 56 employees from 2002 to 2010. The value of the cost of protection was R$ 147.645,95, including accessories, courses, training and maintenance costs. On the other hand, the cost of the expense ranged from R$ 1.065.750, 00 up to R$ 28.890.351, 00 and the parameter responsible for this variation is the collective dose. The increasing of these dose values causes the increasing of the total costs, and one can conclude that there really is an importance of applying the optimization technique to improve the safety of OEI at the nuclear medicine service and reducing costs of protection. (author)
Zhou, T.; Koomen, E.; Ke, X.
People benefit from cropland through food production and a variety of environmental and recreational benefits. However, the provision of the different functions offered by agricultural landscape deteriorates as a consequence of ongoing urban development, especially in urban fringe. To help define
Galduf Tel, Enrique
Galduf Tel, E. (2010). Provision of an air traffic control services in an airport environment : design and development of a Java application through the Hibernate persistence framework. http://hdl.handle.net/10251/10161. Archivo delegado
La Peyre, Megan K.; Schwarting, Lindsay; Miller, Shea
Understanding the time frame in which ecosystem services (that is, water quality maintenance, shoreline protection, habitat provision) are expected to be provided is important when restoration projects are being designed and implemented. Restoration of three-dimensional shell habitats in coastal Louisiana and elsewhere presents a valuable and potentially self-sustaining approach to providing shoreline protection, enhancing nekton habitat, and providing water quality maintenance. As with most restoration projects, the development of expected different ecosystem services often occurs over varying time frames, with some services provided immediately and others taking longer to develop. This project was designed initially to compare the provision and development of ecosystem services by created fringing shoreline reefs in subtidal and intertidal environments in Vermilion Bay, Louisiana. Specifically, the goal was to test the null hypothesis that over time, the oyster recruitment and development of a sustainable oyster reef community would be similar at both intertidal and subtidal reef bases, and these sustainable reefs would in time provide similar shoreline stabilization, nekton habitat, and water quality services over similar time frames. Because the ecosystem services hypothesized to be provided by oyster reefs reflect long-term processes, fully testing the above-stated null hypothesis requires a longer-time frame than this project allowed. As such, this project was designed to provide the initial data on reef development and provision of ecosystem services, to identify services that may develop immediately, and to provide baseline data to allow for longer-term follow up studies tracking reef development over time. Unfortunately, these initially created reef bases (subtidal, intertidal) were not constructed as planned because of the Deepwater Horizon oil spill in April 2010, which resulted in reef duplicates being created 6 months apart. Further confounding the
... 47 Telecommunication 2 2010-10-01 2010-10-01 false Licensing provisions for the 1.6/2.4 GHz mobile-satellite service and 2 GHz mobile-satellite service. 25.143 Section 25.143 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES SATELLITE COMMUNICATIONS Applications and Licenses...
Rosenthal, Meagen; Tsao, Nicole W; Tsuyuki, Ross T; Marra, Carlo A
Legislative changes are affording pharmacists the opportunity to provide more advanced pharmacy services. However, many pharmacists have not yet been able to provide these services sustainably. Research from implementation science suggests that before sustained change in pharmacy can be achieved an improved understanding of pharmacy context, through the professional culture of pharmacy and pharmacists' personality traits, is required. The primary objective of this study was to investigate possible relationships between cultural factors, and personality traits, and the uptake of advanced practice opportunities by pharmacists in British Columbia, Canada. The study design was a cross-sectional survey of registered, and practicing, pharmacists from one Canadian province. The survey gauged respondents' characteristics, practice setting, and the provision of advanced pharmacy services, and contained the Organizational Culture Profile (OCP), a measure of professional culture, as well as the Big Five Inventory (BFI), a measure of personality traits. A total of 945 completed survey instruments were returned. The majority of respondents were female (61%), the average age of respondents was 42 years (SD: 12), and the average number of years in practice was 19 (SD: 12). A significant positive relationship was identified for respondents perceiving greater value in the OCP factors competitiveness and innovation and providing a higher number of all advanced services. A positive relationship was observed for respondents scoring higher on the BFI traits extraversion and the immunizations provided, and agreeableness and openness and medication reviews completed. This is the first work to identify statistically significant relationships between the OCP and BFI, and the provision of advanced pharmacy services. As such, this work serves as a starting place from which to develop more detailed insight into how the professional culture of pharmacy and pharmacists personality traits may
Levin, Ann; Kaddar, Miloud
The authors conducted a literature review on the role of the private sector in low- and middle-income countries. The review indicated that relatively few studies have researched the role of the private sector in immunization service delivery in these countries. The studies suggest that the private sector is playing different roles and functions according to economic development levels, the governance structure and the general presence of the private sector in the health sector. In some countries, generally low-income countries, the private for-profit sector is contributing to immunization service delivery and helping to improve access to traditional EPI vaccines. In other countries, particularly middle-income countries, the private for-profit sector often acts to facilitate early adoption of new vaccines and technologies before introduction and generalization by the public sector. The not-for-profit sector plays an important role in extending access to traditional EPI vaccines, particularly in low-income countries. Not-for-profit facilities are situated in rural as well as urban areas and are more likely to be coordinated with public services than the private for-profit sector. Although numerous studies on non-governmental organizations (NGOs) suggest that the extent of NGO provision of immunization services in low- and middle-income countries is substantial, the contribution of this sector is poorly documented, leading to a lack of recognition of its role at national and global levels. Studies on quality of immunization service provision at private health facilities suggest that it is sometimes inadequate and needs to be monitored. Although some articles on public-private collaboration exist, little was found on the extent to which governments are effectively interacting with and regulating the private sector. The review revealed many geographical and thematic gaps in the literature on the role and regulation of the private sector in the delivery of immunization
Filimonau, Viachaslau; Lemmer, Christian; Marshall, D.; Bejjani, G.
The sector of food service provision generates substantial environmental and societal impacts. Environmental impacts are particularly pronounced in terms of carbon footprint build-up while societal impacts are reflected in often unhealthy food choice. These impacts should be minimised to facilitate progress of the sector towards sustainability. A significant share of the negative impacts from food service provision is attributed to irresponsible consumer choice which needs to be architected a...
Taylor, M. D.; Mackay, A. D.; Dominati, E.; Hill, R. B.
This paper presents the process used to review soil quality monitoring in New Zealand to better align indicators and indicator target ranges with critical values of change in soil function. Since its inception in New Zealand 15 year ago, soil quality monitoring has become an important state of the environment reporting tool for Regional Councils. This tool assists councils to track the condition of soils resources, assess the impact of different land management practices, and provide timely warning of emerging issues to allow early intervention and avoid irreversible loss of natural capital stocks. Critical to the effectiveness of soil quality monitoring is setting relevant, validated thresholds or target ranges. Provisional Target Ranges were set in 2003 using expert knowledge available and data on production responses. Little information was available at that time for setting targets for soil natural capital stocks other than those for food production. The intention was to revise these provisional ranges as further information became available and extend target ranges to cover the regulating and cultural services provided by soils. A recently developed ecosystems service framework was used to explore the feasibility of linking soil natural capital stocks measured by the current suite of soil quality indicators to the provision of ecosystem services by soils. Importantly the new approach builds on and utilises the time series data sets collected by current suite of soil quality indicators, adding value to the current effort, and has the potential to set targets ranges based on the economic and environmental outcomes required for a given farm, catchment or region. It is now timely to develop a further group of environmental indicators for measuring specific soil issues. As with the soil quality indicators, these environmental indicators would be aligned with the provision of ecosystem services. The toolbox envisaged is a set of indicators for specific soil issues
van der Eem, Lisette; Nyanza, Elias C.; van Pelt, Sandra; Ndaki, Pendo; Basinda, Namanya; Sundby, Johanne
Antenatal care is essential to improve maternal and newborn health and wellbeing. The majority of pregnant women in Tanzania attend at least one visit. Since implementation of the focused antenatal care model, quality of care assessments have mostly focused on utilization and coverage of routine interventions for antenatal care. This study aims to assess the quality of antenatal care provision from a holistic perspective in a rural district in Tanzania. Structure, process and outcome components of quality are explored. This paper reports on data collected over several periods from 2012 to 2015 through facility audits of supplies and services, ANC observations and exit interviews with pregnant women. Additional qualitative methods were used such as interviews, focus group observations and participant observations. Findings indicate variable performance of routine ANC services, partly explained by insufficient resources. Poor performance was also observed for appropriate history taking, attention for client’s wellbeing, basic physical examination and adequate counseling and education. Achieving quality improvement for ANC requires increased attention for the process of care provision beyond coverage, including attention for response-based services, which should be assessed based on locally determined criteria. PMID:29236699
Today, billing is a big challenge for service providers. With a growing number of rich services such as music, mobile TV, Video-on-Demand and eHealth delivered to the mass market, service providers are missing business opportunities because current billing solutions are not fully capable. In
Shawn T. Flanigan
Full Text Available Research demonstrates that service provision by violent organizations can be an effective strategy for coercing the local community to accept and conceal a group’s violent activities, and for creating loyalty to these groups. This has been most frequently explored among political organizations such as terrorist groups, with organizations like Hezbollah and Hamas very visibly engaged in providing social welfare in addition to their violent activities. Recent reports indicate that criminal organizations in Mexico also are involved in instances of public service provision in local communities. This article explores the extent to which drug cartels operating in Mexico are involved in public service provision to members of communities where they operate, and considers possible motivations and implications for public service provision by these criminal organizations, with specific attention to the organization La Familia Michoacána/ Knights Templar. The article also gives attention to the consequences to citizenship and government of service provision by violent nonstate actors, and the ways such service provision may disrupt the social contract between the citizen and the state.
This article reviews key arguments around evidence-based practice and outlines the methodological demands for effective adoption of recovery model principles. The recovery model is outlined and demonstrated as compatible with current needs in substance misuse service provision. However, the concepts of evidence-based practice and the recovery model are currently incompatible unless the current value system of evidence-based practice changes to accommodate the methodologies demanded by the recovery model. It is suggested that critical health psychology has an important role to play in widening the scope of evidence-based practice to better accommodate complex social health needs.
Weinke, Elisabeth; Hölbling, Daniel; Albrecht, Florian; Friedl, Barbara
Geo-hazards and their effects are distributed geographically over wide regions. The effective mapping and monitoring is essential for hazard assessment and mitigation. It is often best achieved using satellite imagery and new object-based image analysis approaches to identify and delineate geo-hazard objects (landslides, floods, forest fires, storm damages, etc.). At the moment, several local/national databases and platforms provide and publish data of different types of geo-hazards as well as web-based risk maps and decision support systems. Also, the European commission implemented the Copernicus Emergency Management Service (EMS) in 2015 that publishes information about natural and man-made disasters and risks. Currently, no platform for landslides or geo-hazards as such exists that enables the integration of the user in the mapping and monitoring process. In this study we introduce the concept of a spatial data infrastructure for object delineation, web-processing and service provision of landslide information with the focus on user interaction in all processes. A first prototype for the processing and mapping of landslides in Austria and Italy has been developed within the project Land@Slide, funded by the Austrian Research Promotion Agency FFG in the Austrian Space Applications Program ASAP. The spatial data infrastructure and its services for the mapping, processing and analysis of landslides can be extended to other regions and to all types of geo-hazards for analysis and delineation based on Earth Observation (EO) data. The architecture of the first prototypical spatial data infrastructure includes four main areas of technical components. The data tier consists of a file storage system and the spatial data catalogue for the management of EO-data, other geospatial data on geo-hazards, as well as descriptions and protocols for the data processing and analysis. An interface to extend the data integration from external sources (e.g. Sentinel-2 data) is planned
Hotchkiss, David R; Godha, Deepali; Do, Mai
Wealth-related inequity in the use of maternal healthcare services continues to be a substantial problem in most low- and middle-income countries. One strategic approach to increase the use of appropriate maternal healthcare services is to encourage the expansion of the role of the private sector. However, critics of such an approach argue that increasing the role of the private sector will lead to increased inequity in the use of maternal healthcare services. This article explores this issue in two South Asian countries that have traditionally had high rates of maternal mortality-Nepal and Bangladesh. The study is based on multiple rounds of nationally representative household survey data collected in Nepal and Bangladesh from 1996 to 2011. The methodology involves estimating a concentration index for each survey to assess changes in wealth-related inequity in the use of institutional delivery assistance over time. The results of the study suggest that the expansion of private sector supply of institutional-based delivery services in Nepal and Bangladesh has not led to increased horizontal inequity. In fact, in both countries, inequity was shown to have decreased over the study period. The study findings also suggest that the provision of government delivery services to the poor protects against increased wealth-related inequity in service use. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.
The goal is to optimize the allowed levels of 137 Cs contamination of food products according to the ALARA principle. The model creates a virtual market of contaminated daily portions of various products, their contamination being distributed log normally with the same parameters as in real products. The consumer requests portions and wasters contaminated until one obtains 365 acceptable portions of every product per year. The cost of wastering is high at a low allowed level. The floating price of irradiation depends on the yearly consumption of 137 Cs and is stated very high when the last value approaches the dose limit (risk aversive function). Varying allowed levels, it is possible to minimize the cost of wastering and total cost of wastering and irradiation. The iterative algorithm is proposed
Background Through this paper, we present the initial steps for the creation of an integrated platform for the provision of a series of eHealth tools and services to both citizens and travelers in isolated areas of thesoutheast Mediterranean, and on board ships travelling across it. The platform was created through an INTERREG IIIB ARCHIMED project called INTERMED. Methods The support of primary healthcare, home care and the continuous education of physicians are the three major issues that the proposed platform is trying to facilitate. The proposed system is based on state-of-the-art telemedicine systems and is able to provide the following healthcare services: i) Telecollaboration and teleconsultation services between remotely located healthcare providers, ii) telemedicine services in emergencies, iii) home telecare services for "at risk" citizens such as the elderly and patients with chronic diseases, and iv) eLearning services for the continuous training through seminars of both healthcare personnel (physicians, nurses etc) and persons supporting "at risk" citizens. These systems support data transmission over simple phone lines, internet connections, integrated services digital network/digital subscriber lines, satellite links, mobile networks (GPRS/3G), and wireless local area networks. The data corresponds, among others, to voice, vital biosignals, still medical images, video, and data used by eLearning applications. The proposed platform comprises several systems, each supporting different services. These were integrated using a common data storage and exchange scheme in order to achieve system interoperability in terms of software, language and national characteristics. Results The platform has been installed and evaluated in different rural and urban sites in Greece, Cyprus and Italy. The evaluation was mainly related to technical issues and user satisfaction. The selected sites are, among others, rural health centers, ambulances, homes of "at
Full Text Available Abstract Background Through this paper, we present the initial steps for the creation of an integrated platform for the provision of a series of eHealth tools and services to both citizens and travelers in isolated areas of thesoutheast Mediterranean, and on board ships travelling across it. The platform was created through an INTERREG IIIB ARCHIMED project called INTERMED. Methods The support of primary healthcare, home care and the continuous education of physicians are the three major issues that the proposed platform is trying to facilitate. The proposed system is based on state-of-the-art telemedicine systems and is able to provide the following healthcare services: i Telecollaboration and teleconsultation services between remotely located healthcare providers, ii telemedicine services in emergencies, iii home telecare services for "at risk" citizens such as the elderly and patients with chronic diseases, and iv eLearning services for the continuous training through seminars of both healthcare personnel (physicians, nurses etc and persons supporting "at risk" citizens. These systems support data transmission over simple phone lines, internet connections, integrated services digital network/digital subscriber lines, satellite links, mobile networks (GPRS/3G, and wireless local area networks. The data corresponds, among others, to voice, vital biosignals, still medical images, video, and data used by eLearning applications. The proposed platform comprises several systems, each supporting different services. These were integrated using a common data storage and exchange scheme in order to achieve system interoperability in terms of software, language and national characteristics. Results The platform has been installed and evaluated in different rural and urban sites in Greece, Cyprus and Italy. The evaluation was mainly related to technical issues and user satisfaction. The selected sites are, among others, rural health centers, ambulances
Full Text Available Background: Duty service of gyecology and obstetrics in Slovenia is organized on the regional basis and consists of ten regional hospitals, two hospitals for gynecology and obstetrics and two university clinical centres. Methods: Heads of hospitals where duty service is performed, have answered the questionnaires about the doctors who perform duty service. Results: Specialists and trainees in gynecology and obstetrics perform duty service on 21 posts and on 6 on-call posts. In Slovenia there are 287 active specialists in gynecology and obstetrics. 139 (48.4% among them are active on the primary level (outpatient clinics and 148 (51.6% in the hospitals and both clinical centres. Among hospital gynecologists and obstetricians 54 (36.5% of them are older than 55 years. Conclusions: Duty service of gyecology and obstetrics in Slovenia does not meet legislation criteria regard- ing doctors’ work time. Adequate changes for increasing the number of available doctors for duty service are proposed.
This paper presents an overview of the markets for ancillary services, which are regulated and traded differently within and across borders in the Nordic countries. We describe the services provided and their characteristics in terms of definition, participation, contracting approach and duration, selection of offers, and dispatch criteria. Further, we assess the costs, specify the payments, and discuss cost allocation, and we conclude with a policy discussion of ancillary services in the Nordic countries. (author)
Ayoib Che Ahmad; Nava Subramaniam
Although internal auditing (IA) services have been traditionally performed in-house, organizations are increasingly outsourcing such services. Using a Transaction Cost Economics (TCE) perspective, this study examined the influence of several organizational-level variables on the decision to outsource or in-house their internal audit function. The study also identified the type of IA services that were likely to be out-sourced rather than in-housed, the extent to which incumbent external finan...
Podobnik, Vedran; Matijasevic, Maja; Lovrek, Ignac; Skorin-Kapov, Lea; Desic, Sasa
In a global multi-service and multi-provider market, the Internet Service Providers will increasingly need to differentiate in the service quality they offer and base their operation on new, consumer-centric business models. In this paper, we propose an agent-based framework for the Business-to-Consumer (B2C) electronic market, comprising the Consumer Agents, Broker Agents and Content Agents, which enable Internet consumers to select a content provider in an automated manner. We also discuss how to dynamically allocate network resources to provide end-to-end Quality of Service (QoS) for a given consumer and content provider.
Wac, K.E.; Delgado Kloos, C.; Larrabeiti, D.; van Halteren, Aart; Bults, Richard G.A.; Lopez, A.M.; Broens, T.H.F.
Inevitably, healthcare goes mobile. Recently developed mobile healthcare (i.e., m-health) services allow healthcare professionals to monitor mobile patient’s vital signs and provide feedback to this patient anywhere at any time. Due to the nature of current supporting mobile service platforms, m-health services are delivered with a best-effort, i.e., there are no guarantees on the delivered Quality of Service (QoS). In this paper, we argue that the use of context information in an m-health se...
Gert van der Westhuizen
Full Text Available The South African local government sector has undergone changes in the post-apartheid era as policy makers have sought to improve basic services provided to disadvantaged local communities. While scholars have considered various dimensions of the reform program, little effort has been directed at evaluating the effectiveness and efficiency dimensions of the changes in service provision, with some notable exceptions (van der Westhuizen and Dollery, 2009; Krugell, et al., 2010. This article seeks to contribute to this literature by evaluating the efficiency with which municipalities have provided (Reconstruction and Development Program RDP water, RDP sanitation RDP electricity and RDP refuse removal, using Data Envelopment Analysis techniques (DEA applied to panel data from 2006/2007 to 2008/2009 for 231 local municipalities and 46 district municipalities. Keywords: Data warehousing, Systems thinking, Prescriptive theory, Descriptive theory, Interpretative research. Disciplines: Information technology, systems theory, data warehousing, hermeneutics
Langerwisch, Fanny; Václavík, Tomáš; von Bloh, Werner; Vetter, Tobias; Thonicke, Kirsten
Irrigated rice croplands are among the world’s most important agro-ecosystems. They provide food for more than 3.5 billion people and a range of other ecosystem services (ESS). However, the sustainability of rice agro-ecosystems is threatened by continuing climate and land-use changes. To estimate their combined effects on a bundle of ESS, we applied the vegetation and hydrology model LPJmL to seven study areas in the Philippines and Vietnam. We quantified future changes in the provision of four essential ESS (carbon storage, carbon sequestration, provision of irrigation water and rice production) under two climate scenarios (until 2100) and three site-specific land-use scenarios (until 2030), and examined the synergies and trade-offs in ESS responses to these drivers. Our results show that not all services can be provided in the same amounts in the future. In the Philippines and Vietnam the projections estimated a decrease in rice yields (by approximately 30%) and in carbon storage (by 15%) and sequestration (by 12%) towards the end of the century under the current land-use pattern. In contrast, the amount of available irrigation water was projected to increase in all scenarios by 10%-20%. However, the results also indicate that land-use change may partially offset the negative climate impacts in regions where cropland expansion is possible, although only at the expense of natural vegetation. When analysing the interactions between ESS, we found consistent synergies between rice production and carbon storage and trade-offs between carbon storage and provision of irrigation water under most scenarios. Our results show that not only the effects of climate and land-use change alone but also the interaction between ESS have to be considered to allow sustainable management of rice agro-ecosystems under global change.
Full Text Available Customization degree is a very important field of mass customization. Its improvement could enhance customer satisfaction and further increase customer demand while correspondingly it will increase service price and decrease customer satisfaction and demand. Therefore this paper discusses how to deal with such issues in logistics service supply chain (LSSC with a logistics service integrator (LSI and a customer. With the establishment of customer demand function for logistics services and profit functions of the LSI and the customer, three different decision modes are proposed (i.e., customization degree dominated by LSI, customization degree dominated by customer, and customization degree decided by concentrated supply chain; many interesting findings are achieved. Firstly, to achieve customization cooperation between LSI and customer, measures should be taken to make the unit increase cost of the customized logistics services lower than a certain value. Secondly, there are differences between the optimal customization degree dominated by LSI and that dominated by customer. And in both cases, the dominator could realize more profit than the follower. Thirdly, with the profit secondary distribution strategy, the modified decentralized decision mode could accomplish the maximum profit achieved in centralized decision mode and meanwhile get the optimal customization degree.
Hatt, Laurel E; Makinen, Marty; Madhavan, Supriya; Conlon, Claudia M
User fee removal has been put forward as an approach to increasing priority health service utilization, reducing impoverishment, and ultimately reducing maternal and neonatal mortality. However, user fees are a source of facility revenue in many low-income countries, often used for purchasing drugs and supplies and paying incentives to health workers. This paper reviews evidence on the effects of user fee exemptions on maternal health service utilization, service provision, and outcomes, including both supply-side and demand-side effects. We reviewed 19 peer-reviewed research articles addressing user fee exemptions and maternal health services or outcomes published since 1990. Studies were identified through a USAID-commissioned call for evidence, key word search, and screening process. Teams of reviewers assigned criteria-based quality scores to each paper and prepared structured narrative reviews. The grade of the evidence was found to be relatively weak, mainly from short-term, non-controlled studies. The introduction of user fee exemptions appears to have resulted in increased rates of facility-based deliveries and caesarean sections in some contexts. Impacts on maternal and neonatal mortality have not been conclusively demonstrated; exemptions for delivery care may contribute to modest reductions in institutional maternal mortality but the evidence is very weak. User fee exemptions were found to have negative, neutral, or inconclusive effects on availability of inputs, provider motivation, and quality of services. The extent to which user fee revenue lost by facilities is replaced can directly affect service provision and may have unintended consequences for provider motivation. Few studies have looked at the equity effects of fee removal, despite clear evidence that fees disproportionately burden the poor. This review highlights potential and documented benefits (increased use of maternity services) as well as risks (decreased provider motivation and quality
This document concerns the award of a contract for the provision of mechanical design and draughting services off the CERN site. Following a market survey carried out among 62 firms in fifteen Member States, a call for tenders (IT-3213/EST) was sent on 19 January 2004 to eight firms, in seven Member States. By the closing date, CERN had received eight tenders from eight firms in seven Member States. The Finance Committee is invited to agree to the negotiation of a contract with ACROTECNA (FR), the lowest bidder, for the provision of mechanical design and draughting services off the CERN site for an amount of 489 373 euros (771 882 Swiss francs) for an initial period of three years starting on 1 July 2004, subject to revision for inflation from 1 July 2007. The rate of exchange used is that stipulated in the tender. The contract will include options for two one-year extensions beyond the initial three-year period. The firm has indicated the following distribution by country of the contract value covered by thi...
Armstrong, Joshua J; Zhu, Mu; Hirdes, John P; Stolee, Paul
To examine regional variation in service provision and identify the client characteristics associated with occupational therapy (OT) and physiotherapy (PT) services for older adults in the Ontario Home Care System. Secondary analyses of a provincial database containing comprehensive assessments (RAI-HC) linked with service utilization data from every older long-stay home care client in the system between 2005 and 2010 (n = 299 262). Hierarchical logistic regression models were used to model the dependent variables of OT and PT service use within 90 d of the initial assessment. Regional differences accounted for 9% of the variation in PT service provision and 20% of OT service provision. After controlling for the differences across regions, the most powerful predictors of service provision were identified for both OT and PT. The most highly associated client characteristics related to PT service provision were hip fracture, impairments in activities of daily living/instrumental activities of daily living, cerebrovascular accidents, and cognitive impairment. For OT, hazards in the home environment was the most powerful predictor of future service provision. Where a client lived was an important determinant of service provision in Ontario, raising the possibility of inequities in access to rehabilitation services. Health care planners and policy makers should review current practices and make adjustments to meet the increasing and changing needs for rehabilitation therapies of the aging population. Implications for Rehabilitation For older adults in home care, the goal of rehabilitation therapy services is to allow individuals to maintain or improve physical functioning, quality of life and overall independence while living within their community. Previous research has demonstrated that a large proportion of home care clients specifically identified as having rehabilitation potential do not receive it. This article used clinical assessment data to identify the
Wac, K.E.; Delgado Kloos, C.; Larrabeiti, D.; van Halteren, Aart; Bults, Richard G.A.; Lopez, A.M.; Broens, T.H.F.
Inevitably, healthcare goes mobile. Recently developed mobile healthcare (i.e., m-health) services allow healthcare professionals to monitor mobile patient’s vital signs and provide feedback to this patient anywhere at any time. Due to the nature of current supporting mobile service platforms,
... contain data for reporting categories that are still active, such as business and Centrex-based services....S. Providers of International Telecommunications Services, Amendment of Part 43 of the Commission's... information in the context of an individual complaint proceeding under section 208 of the Act than through...
... EDUCATION VOCATIONAL REHABILITATION SERVICE PROJECTS What Conditions Must Be Met by a Grantee? § 369.42 What... rehabilitation services provided in projects assisted under these programs must be provided in the same manner as... under its project, or as appropriate, the parents, family members, guardians, advocates, or authorized...
de Blok, C.; Meijboom, B.R.; Luijkx, K.G.; Schols, J.M.G.A.; Schroeder, R.G.
We conduct case research in a particular service context, i.e. the sector for elderly care, in order to explore characteristics of interfaces and the role they play in service customization. Even though the study of modularity in areas other than goods production is increasing, little is known about
Whynes, D K; Reed, G
As a result of the 1990 National Health Services Act, hospitals now compete with one another to win service contracts. A high level of service quality represents an important ingredient of a successful competitive strategy, yet, in general, hospitals have little external information on which to base quality decisions. Specifically, in their efforts to win contracts from fundholding general practitioners, hospitals require information on that which these purchasers deem important with respect to quality, and on how these purchasers assess the quality of their current service performance. The problem is complicated by the fact that hospital service quality, in itself, is multi-dimensional. In other areas of economic activity, the information problem has been resolved by importance-performance analysis and this paper reports the findings of such an analysis conducted for hosptials in the Trent region. The importance and performance service quality ratings of fundholders were obtained from a questionnaire survey and used in a particular variant of importance-performance analysis, which possesses certain advantages over more conventional approaches. In addition to providing empirical data on the determinants of service quality, as perceived by the purchasers of hospital services, this paper demonstrates how such information can be successfully employed in a quality enhancement strategy.
... comparably efficient interconnection (CEI) and open network architecture (ONA) services; proposes eliminating... Further Notice of Proposed Rulemaking, is available for public inspection during regular business hours in... BOCs use for their own enhanced services offerings. The BOCs' ONA plans, based on the architecture of...
..., unless the company maintains costs and related reserves for specific units or types of property. (c... depreciation and amortization of service company property. 256.108 Section 256.108 Commodity and Securities... COMPANIES AND SUBSIDIARY SERVICE COMPANIES, PUBLIC UTILITY HOLDING COMPANY ACT OF 1935 Balance Sheet...
Full Text Available This article analyzes the process of forest fragmentation of a floodplain landscape of the Lower Amazon over a 30-year period and its implications for the biodiversity and the provision of ecosystem services to the riverine population. To this end, we created a multi-temporal forest cover map based on Landsat images, and then analyzed the fragmentation dynamics through landscape metrics. From the analyses of the landscape and bibliographic information, we made inferences regarding the potential impacts of fragmentation on the biodiversity of trees, birds, mammals and insects. Subsequently, we used data on the local populations’ environmental perception to assess whether the inferred impacts on biodiversity are perceived by these populations and whether the ecosystem services related to the biodiversity of the addressed groups are compromised. The results show a 70% reduction of the forest habitat as well as important changes in the landscape structure that constitute a high degree of forest fragmentation. The perceived landscape alterations indicate that there is great potential for compromise of the biodiversity of trees, birds, mammals and insects. The field interviews corroborate the inferred impacts on biodiversity and indicate that the ecosystem services of the local communities have been compromised. More than 95% of the communities report a decreased variety and/or abundance of animal and plant species, 46% report a decrease in agricultural productivity, and 19% confirm a higher incidence of pests during the last 30 years. The present study provides evidence of an accelerated process of degradation of the floodplain forests of the Lower Amazon and indicate substantial compromise of the ecosystem services provision to the riverine population in recent decades, including reductions of food resources (animals and plants, fire wood, raw material and medicine, as well as lower agricultural productivity due to probable lack of pollination
Nik, Jah; Lai, Pauline Siew Mei; Ng, Chirk Jenn; Emmerton, Lynne
Osteoporosis has significant impact on healthcare costs and quality of life. Amongst the models for collaborative disease state management services published internationally, there is sparse evidence regarding the role of community pharmacists in the provision of osteoporosis care. Hence, the aim of our study was to explore community pharmacists' opinions (including the barriers and facilitators) and scope of osteoporosis disease state management services by community pharmacists in Malaysia, informing a vision for developing these services. Semi-structured individual interviews and focus groups discussions were conducted with community pharmacists from October 2013 to July 2014. Three trained researchers interviewed the participants. Interviews were recorded and transcribed verbatim. Data were analyzed thematically using an interpretative description approach. Nineteen community pharmacists with 1-23 years of experience were recruited (in depth interviews: n = 9; focus group discussions: n = 10). These participants reflected on their experience with osteoporosis-related enquiries, which included medication counseling, bone density screening and referral of at-risk patients. Key barriers were the lack of numerous factors: public awareness of osteoporosis, accurate osteoporosis screening tools for community pharmacists, pharmacists' knowledge on osteoporosis disease and medications, time to counsel patients about bone health, collaboration between pharmacists and doctors, and support from the government and professional body. The pharmacists wanted more continuing education on osteoporosis, osteoporosis awareness campaigns, a simple, unbiased osteoporosis education material, and inter-professional collaboration practices with doctors, and pharmacists' reimbursement for osteoporosis care. The involvement of community pharmacists in the provision of osteoporosis disease state management was minimal. Only ad-hoc counseling on osteoporosis prevention was
The number of women in the United States choosing to give birth at home has risen substantially in the past decade, creating an increased need for understanding of the evidence regarding the provision of midwifery care to women and families considering this option. The safety of home birth has been evaluated in observational studies in several industrialized nations, including the United States. Most studies find that women who are essentially healthy at term with a singleton fetus and give birth at home have positive outcomes and a lower rate of interventions during labor. Although some studies have found increased neonatal morbidity and mortality in newborns born at home when compared to newborns born in a hospital, the absolute numbers reported in both birth sites are very low. The purpose of this clinical bulletin is to review the evidence on provision of care to women and families who plan to give birth at home, including roles and responsibilities, shared decision making, informed consent, and ongoing assessment for birth site selection. © 2015 by the American College of Nurse-Midwives.
Martinenas, Sergejus; Marinelli, Mattia; Andersen, Peter Bach
Replacement of conventional generation by more stochastic renewable generation sources leads to reduction of inertia and controllability in the power system. This introduces the need for more dynamic regulation services. These faster services could potentially be provided by the growing number...... of electric vehicles. EVs are a fast responding energy resource with high availability. This work evaluates and experimentally shows the limits of EV charging controllability with the focus on its suitability for providing ancillary grid services. Three different series produced EVs are tested....... The experimental testing is done by using charging current controllability of built-in AC charger to provide a primary frequency regulation service with very dynamic input frequency. The results show that most the controllability of most EVs is more than suitable for providing time critical grid services...
Porto, Miguel; Correia, Otília; Beja, Pedro
Landscapes are often patchworks of private properties, where composition and configuration patterns result from cumulative effects of the actions of multiple landowners. Securing the delivery of services in such multi-ownership landscapes is challenging, because it is difficult to assure tight compliance to spatially explicit management rules at the level of individual properties, which may hinder the conservation of critical landscape features. To deal with these constraints, a multi-objective simulation-optimization procedure was developed to select non-spatial management regimes that best meet landscape-level objectives, while accounting for uncoordinated and uncertain response of individual landowners to management rules. Optimization approximates the non-dominated Pareto frontier, combining a multi-objective genetic algorithm and a simulator that forecasts trends in landscape pattern as a function of management rules implemented annually by individual landowners. The procedure was demonstrated with a case study for the optimum scheduling of fuel treatments in cork oak forest landscapes, involving six objectives related to reducing management costs (1), reducing fire risk (3), and protecting biodiversity associated with mid- and late-successional understories (2). There was a trade-off between cost, fire risk and biodiversity objectives, that could be minimized by selecting management regimes involving ca. 60% of landowners clearing the understory at short intervals (around 5 years), and the remaining managing at long intervals (ca. 75 years) or not managing. The optimal management regimes produces a mosaic landscape dominated by stands with herbaceous and low shrub understories, but also with a satisfactory representation of old understories, that was favorable in terms of both fire risk and biodiversity. The simulation-optimization procedure presented can be extended to incorporate a wide range of landscape dynamic processes, management rules and quantifiable
Full Text Available Landscapes are often patchworks of private properties, where composition and configuration patterns result from cumulative effects of the actions of multiple landowners. Securing the delivery of services in such multi-ownership landscapes is challenging, because it is difficult to assure tight compliance to spatially explicit management rules at the level of individual properties, which may hinder the conservation of critical landscape features. To deal with these constraints, a multi-objective simulation-optimization procedure was developed to select non-spatial management regimes that best meet landscape-level objectives, while accounting for uncoordinated and uncertain response of individual landowners to management rules. Optimization approximates the non-dominated Pareto frontier, combining a multi-objective genetic algorithm and a simulator that forecasts trends in landscape pattern as a function of management rules implemented annually by individual landowners. The procedure was demonstrated with a case study for the optimum scheduling of fuel treatments in cork oak forest landscapes, involving six objectives related to reducing management costs (1, reducing fire risk (3, and protecting biodiversity associated with mid- and late-successional understories (2. There was a trade-off between cost, fire risk and biodiversity objectives, that could be minimized by selecting management regimes involving ca. 60% of landowners clearing the understory at short intervals (around 5 years, and the remaining managing at long intervals (ca. 75 years or not managing. The optimal management regimes produces a mosaic landscape dominated by stands with herbaceous and low shrub understories, but also with a satisfactory representation of old understories, that was favorable in terms of both fire risk and biodiversity. The simulation-optimization procedure presented can be extended to incorporate a wide range of landscape dynamic processes, management rules
Bintabara, Deogratius; Nakamura, Keiko; Seino, Kaoruko
Global policy reports, national frameworks, and programmatic tools and guidance emphasize the integration of family planning and HIV testing and counseling services to ensure universal access to reproductive health care and HIV prevention. However, the status of integration between these two services in Tanzanian health facilities is unclear. This study examined determinants of facility readiness for integration of family planning with HIV testing and counseling services in Tanzania. Data from the 2014-2015 Tanzania Service Provision Assessment Survey were analyzed. Facilities were considered ready for integration of family planning with HIV testing and counseling services if they scored ≥ 50% on both family planning and HIV testing and counseling service readiness indices as identified by the World Health Organization. All analyses were adjusted for clustering effects, and estimates were weighted to correct for non-responses and disproportionate sampling. Descriptive, bivariate, and multivariate logistic regression analyses were performed. A total of 1188 health facilities were included in the study. Of all of the health facilities, 915 (77%) reported offering both family planning and HIV testing and counseling services, while only 536 (45%) were considered ready to integrate these two services. Significant determinants of facility readiness for integrating these two services were being government owned [AOR = 3.2; 95%CI, 1.9-5.6], having routine management meetings [AOR = 1.9; 95%CI, 1.1-3.3], availability of guidelines [AOR = 3.8; 95%CI, 2.4-5.8], in-service training of staff [AOR = 2.6; 95%CI, 1.3-5.2], and availability of laboratories for HIV testing [AOR = 17.1; 95%CI, 8.2-35.6]. The proportion of facility readiness for the integration of family planning with HIV testing and counseling in Tanzania is unsatisfactory. The Ministry of Health should distribute and ensure constant availability of guidelines, availability of rapid diagnostic
Ulfbeck, Vibe Garf; Andrecka, Marta
The article discusses liability issues related to the contracting out of welfare services. It focuses on the possible liability of the private actor and of the public entity towards the individual (the citizen) for non- performance or malperformance of the welfare service. It is argued that since...... of vicarious liability on the public entity. Four different models are identified. The reasoning behind these models varies but they all have in common that the public law nature of the service that has been outsourced somehow plays a role....
Gelayee, Dessalegn Asmelashe; Mekonnen, Gashaw Binega
Globally, undergraduate pharmacy education comprises practice programs aimed to address different competencies. This study was intended to investigate pharmacy students' provision of health promotion (HP) counseling services during a community pharmacy clerkship in Northwest Ethiopia. A prospective cross-sectional study was conducted on fifty one fifth-year pharmacy students immediately after completion of a 2-week community pharmacy clerkship. Data were collected through a self-administered questionnaire. Relationship between variables was examined using Pearson's Chi-square test of independence, Mann-Whitney U test, and Spearman's rank correlation coefficient. The mean number of HP counseling service types delivered during the clerkship was 6.3 ± 2.8 out of 12. It is positively correlated with the number of HP counseling service types delivered in students' previous training (rho =0.437, p = 0.001). Nearly half (n = 25, 49%) of the students were actively-involved (i.e delivered ≥ 7 types of HP counseling service types) in the service and those who were well involved in previous training are more likely to do the same during the clerkship (X 2 = 4.581, p = 0.032). The main barriers perceived to hinder health promotion service were clients' lack of time and interest as well as absence of a guideline for health promotion service. Community pharmacy clerkship is a good opportunity for pharmacy students to develop health promotion counseling skill. Clerkship performance can best be improved through successful exposures to similar activities in previous courses and students shall be encouraged to carry out self-assessments of their health promotion counseling practice against standards set for the clerkship.
Ulfbeck, Vibe Garf; Andrecka, Marta
there is no contract between the individual and the private service provider there may be several obstacles to a claim against the private service provider based on contract. At the same time it is a general tort law principle that there is no vicarious liability for independent contractors, making it difficult also......The article discusses liability issues related to the contracting out of welfare services. It focuses on the possible liability of the private actor and of the public entity towards the individual (the citizen) for non- performance or malperformance of the welfare service. It is argued that since...... to succeed with a claim against the public entity based on tort law. Thus, a liability gap seems to exist. However, the article demonstrates that there are signs in different jurisdictions that solutions are being found in case law to this problem allowing to some extent for the imposition of some kind...
Urban, K.; Wester, P.
Through irrigation management transfer inMexico poorly functioning governancemechanisms for maintenance were replaced.New actors, new roles, and newresponsibilities in the maintenance ofMexican irrigation systems wereestablished. This article analyzes themaintenance service delivery mechanisms inthe
.... Historically, programs designed to assist at-risk youth to attain employment and self-sufficiency were a patchwork of short-term, stand alone services delivered by a loosely coordinated network...
It is now widely recognised that a potential recruitment crisis is looming in the provision of primary care physicians for remote rural areas of the United Kingdom. Anecdotal evidence suggests that rural registrar, associate and principal vacancies are becoming increasingly difficult to fill and for many rural GPs locums are an impossible dream. Many practitioners are no longer prepared to work in areas where out-of-hours cooperatives are not available. We are now faced with the very real possibility that in some remote areas of the Scottish Highlands and Islands the recruitment of suitable GPs may no longer be possible. So what are the alternatives? In October 1999 I visited a community in the mountains of northern New Mexico which has had to deal with this very problem.
Green, Cheri A
Full Text Available .0 – smart, sustainable, integrative. Strategies, concepts and technologies for planning the urban future The South African constitution requires that every citizen be granted access to basic services. It is therefore a legal requirement that all... eradication 8 REAL CORP 2009: Cities 3.0 – smart, sustainable, integrative. Strategies, concepts and technologies for planning the urban future 6 EVALUATION OF THE SERVICE ACCESS PLANNING APPLICATION 6.1 Usefulness of the results...
Full Text Available The article presents a case study whereby the service performance of a single-choice information technology service provider in the parastatal industry of South Africa is measured against multi-choice private service providers without any provisional agreements. The outcome of the case study reveals that single-choice service provision options with provisional agreements have a limited chance of success if they are not supported by strong service user inputs. In fact, provisional strategies that disallow sound competition among service providers are bound to impact negatively on user preferences as well as information technology skills development opportunities that are required to improve service provision generally and long-term survival in particular.
Cocco, Massimo; Freda, Carmela; Haslinger, Florian; Consortium, Epos
Addressing Ethics issues is nowadays a relevant challenge for any initiative, program or project dealing with scientific data and products provision, access to services for scientific purposes and communication with different stakeholders, including society. This is corroborated by the evidence that Ethics has very high priority in EU funded research. Indeed, all the activities carried out under Horizon 2020 must comply with ethical principles and national, Union and international legislation. This implies that "For all activities funded by the European Union, Ethics is an integral part of research from beginning to end, and ethical compliance is seen as pivotal to achieve real research excellence." Here, we present the experience of EPOS, a public pan-European research infrastructure. EPOS aims at integrating data, data products, services and software (DDSS) for solid Earth science generated and provided by monitoring networks, observing systems and facilities belonging to European countries. EPOS fosters the integrated use of multidisciplinary solid Earth data to improve the understanding of physical and chemical processes controlling earthquakes, volcanic eruptions, tsunamis as well as those driving tectonics and surface dynamics. The EPOS integration plan will make significant contributions to understanding and mitigating geo-hazards, yielding data for hazard assessment, data products for engaging different stakeholders, and services for training, education and communication to society. Numerous national research infrastructures engaged in EPOS are deployed for the monitoring of areas prone to geo-hazards and for the surveillance of the national territory including areas used for exploiting geo-resources. The EPOS community is therefore already trained to provide services to public (civil defence agencies, local and national authorities) and private (petroleum industry, mining industry, geothermal companies, aviation security) stakeholders. Our ability to
Florentina Ratih Wulandari
Full Text Available The development of information technology and public administration paradigms that emphasize services for the benefit of society has affected the strategic efforts of e-Gov in Indonesia. For that, there is a need to create qualified, competitive, effective and efficient of the public services. Indonesia’s E-Gov Policy has been applying principles of good governance and information technology to serve and interact with the community. Some local governments, including South Jakarta Municipality has been implementing e-Gov to optimize public service. e-Gov in South Jakarta Municipality is reflected on the implementation of a management information technology to improve services to the community by creating a web site, namely http://selatan.jakarta.go.id/. The information presented in South Jakarta Municipality website includes tourism, local regulations, and other information of Municipality of South Jakarta.
Lin, Jin-Ding; Hsu, Shang-Wei; Yen, Chia-Feng; Chou, Ying-Ting; Wu, Chia-Ling; Chu, Cordia M.; Loh, Ching-Hui
Aims: The aims of the present study were to explore the perceptions of general practitioners (GPs) in the provision of health care services for people with intellectual disabilities and to analyse GPs' priorities in the delivery of health care services to this group of people in Taiwan. Methods: The study employed a cross-sectional design and was…
Evaluating the effectiveness of a clinical practice change intervention in increasing clinician provision of preventive care in a network of community-based mental health services: a study protocol of a non-randomized, multiple baseline trial.
Bartlem, Kate; Bowman, Jennifer; Freund, Megan; Wye, Paula; McElwaine, Kathleen; Knight, Jenny; McElduff, Patrick; Gillham, Karen; Wiggers, John
People with a mental illness experience substantial disparities in health, including increased rates of morbidity and mortality caused by potentially preventable chronic diseases. One contributing factor to such disparity is a higher prevalence of modifiable health risk behaviors, such as smoking, inadequate fruit and vegetable intake, harmful alcohol consumption, and inadequate physical activity. Evidence supports the effectiveness of preventive care in reducing such risks, and guidelines recommend that preventive care addressing such risks be incorporated into routine clinical care. Although community-based mental health services represent an important potential setting for ensuring that people with a mental illness receive such care, research suggests its delivery is currently sub-optimal. A study will be undertaken to evaluate the effectiveness of a clinical practice change intervention in increasing the routine provision of preventive care by clinicians in community mental health settings. A two-group multiple baseline design will be utilized to assess the effectiveness of a multi-strategic intervention implemented over 12 months in increasing clinician provision of preventive care. The intervention will be implemented sequentially across the two groups of community mental health services to increase provision of client assessment, brief advice, and referral for four health risk behaviors (smoking, inadequate fruit and vegetable consumption, harmful alcohol consumption, and inadequate physical activity). Outcome measures of interest will be collected via repeated cross-sectional computer-assisted telephone interviews undertaken on a weekly basis for 36 months with community mental health clients. This study is the first to assess the effectiveness of a multi-strategic clinical practice change intervention in increasing routine clinician provision of preventive care for chronic disease behavioral risk factors within a network of community mental health services
Full Text Available Terrestrial carbon resources are major drivers of development in West Africa. The distribution of these resources co-varies with ecosystem type and rainfall along a strong Northeast-Southwest climatic gradient. Soil organic carbon, a strong indicator of soil quality, has been severely depleted in some areas by human activities, which leads to issues of soil erosion and desertification, but this trend can be altered with appropriate management. There is significant potential to enhance existing soil carbon stores in West Africa, with benefits at the global and local scale, for atmospheric CO2 mitigation as well as supporting and provisioning ecosystem services. Three key factors impacting carbon stocks are addressed in this review: climate, biotic factors, and human activities. Climate risks must be considered in a framework of global change, especially in West Africa, where landscape managers have few resources available to adapt to climatic perturbations. Among biotic factors, biodiversity conservation paired with carbon conservation may provide a pathway to sustainable development, and biodiversity conservation is also a global priority with local benefits for ecosystem resilience, biomass productivity, and provisioning services such as foodstuffs. Finally, human management has largely been responsible for reduced carbon stocks, but this trend can be reversed through the implementation of appropriate carbon conservation strategies in the agricultural sector, as shown by multiple studies. Owing to the strong regional climatic gradient, country-level initiatives will need to consider carbon sequestration approaches for multiple ecosystem types. Given the diversity of environments, global policies must be adapted and strategies developed at the national or sub-national levels to improve carbon storage above and belowground. Initiatives of this sort must act locally at farmer scale, and focus on ecosystem services rather than on carbon
Nunes, João Pedro; Naranjo Quintanilla, Paula; Santos, Juliana; Serpa, Dalila; Carvalho-Santos, Cláudia; Rocha, João; Keizer, Jan Jacob; Keesstra, Saskia
Mediterranean landscapes have experienced extensive abandonment and reforestation in recent decades, which should have improved the provision of hydrological services, such as flood mitigation, soil erosion protection and water quality regulation. However, these forests are fire-prone, and the post-fire increase in runoff, erosion and sediment exports could negatively affect service provision. This issue was assessed using the SWAT model for a small mountain agroforestry catchment, which was monitored between 2010 and 2014 and where some eucalypt stands burned in 2011 and were subsequently plowed for replanting. The model was calibrated and validated for streamflow, sediment yield and erosion in agricultural fields and the burnt hillslopes, showing that it can be adapted for post-fire simulation. It was then used to perform a decadal assessment of surface runoff, erosion, and sediment exports between 2004 and 2014. Results show that the fire did not noticeably affect flood mitigation but that it increased erosion by 3 orders of magnitude, which subsequently increased sediment yield. Erosion in the burnt forest during this decade was one order of magnitude above that in agricultural fields. SWAT was also used to assess different fire and land-use scenarios during the same period. Results indicate that the impacts of fire were lower without post-fire soil management, and when the fire occurred in pine forests (i.e. before the 1990s) or in shrublands (i.e. before afforestation in the 1930s). These impacts were robust to changes in post-fire weather conditions and to a lower fire frequency (20-year intervals). The results suggest that, in the long term, fire-prone forests might not provide the anticipated soil protection and water quality regulation services in wet Mediterranean regions.
BenDor, Todd K; Guo, Tianshu; Yates, Andrew J
Ecosystem service markets are popular policy tools for ecosystem protection. Advanced credit releases are an important factor affecting the supply side of ecosystem markets. Under an advanced credit release policy, regulators give ecosystem suppliers a fraction of the total ecosystem credits generated by a restoration project before it is verified that the project actually achieves the required ecological thresholds. In spite of their prominent role in ecosystem markets, there is virtually no regulatory or research literature on the proper design of advanced credit release policies. Using U.S. aquatic ecosystem markets as an example, we develop a principal-agent model of the behavior of regulators and wetland/stream mitigation bankers to determine and explore the optimal degree of advance credit release. The model highlights the tension between regulators' desire to induce market participation, while at the same time ensuring that bankers successfully complete ecological restoration. Our findings suggest several simple guidelines for strengthening advanced credit release policy.
Zagaria, Cecilia; de Vente, Joris; Perez-Cutillas, Pedro
Topical research investigating climate, land-use and management scenarios in the Segura catchment (SE Spain), depicts a landscape at high-risk of, quite literally, deserting agriculture. Land degradation in the semi-arid region of SE Spain is characterized by water shortage, high erosion rates and salinization, increasingly exacerbated by climatic changes, scarce vegetation cover and detrimental farming practices. Future climate scenarios predict increases in aridity, variability and intensity of rainfall events, leading to increasing pressure on scarce soil and water resources. This study conceptualized the impending crisis of agro-ecological systems of the Segura basin (18800 km2) as a crisis of ecosystem service deterioration. In light of existing land degradation drivers and future climate scenarios, the potential of Sustainable Land Management (SLM) strategies was evaluated to target three priority ecosystem services (water provision, sediment retention and carbon sequestration) as a means to achieve climate change adaptation and mitigation. A preceding thorough process of stakeholder engagement (as part of the EU funded DESIRE project) indicated five SLM technologies for potential implementation, all with a focus upon reducing soil erosion, increasing soil water holding capacity and soil organic matter content. These technologies have been tested for over four years in local experimental field plots, and have provided results on the local effects upon individual environmental parameters. Despite the growing emphasis witnessed in literature upon the context-specificity which characterizes adaptation solutions, the frequent analysis at the field scale is limited in both scope and utility. There is a need to investigate the effects of adaptive SLM solutions at wider, regional scales. Thus, this study modeled the cumulative effect of each of the five selected SLM technologies with InVEST, a spatial analyst tool designed for ecosystem service quantification and
Milne, Nikki; Choy, Nancy Low; Leong, Gary M; Hughes, Roger; Hing, Wayne
This study explored current physiotherapy practice trends for management of children who are overweight or obese. The professional needs of physiotherapists working with this population were also assessed, including the perceived need for physiotherapy clinical guidelines for prevention and management of children with obesity. A cross-sectional survey design was used, with questionnaires purposefully distributed through 13 key physiotherapy services throughout Australia. Snowball sampling resulted in completed questionnaires from 64 physiotherapists who provided services to children. Half (n=33, 52%) of respondents provided services specifically to overweight or obese children. Of those providing services, one-quarter had prior training specific to working with this population. Most used multi-disciplinary models (n=16, 76%) and provided under 5h of obesity-related services each week (n=29, 88%). Half (n=16, 49%) used body mass index as an outcome measure but more (n=25, 76%) used bodyweight. Only 14 (42%) assessed motor skills. The majority of respondents (n=57, 89%) indicated a need for physiotherapy guidelines to best manage overweight and obese children. Professional development priorities included: 'Educating children and families', 'Assessment methods' and 'Exercise prescription' for overweight and obese children. This data provides workforce intelligence to guide future professional training and inform development of clinical guidelines for physiotherapists in prevention and management of children with obesity and related chronic disease.
Macy, Rebecca J; Graham, Laurie M
Children, youth, and adults of both genders are sex trafficked into and throughout the United States every day. Regrettably, little attention has been given to how human service providers might identify the sex-trafficking victims they are likely to encounter. To address this knowledge gap, the authors review 20 documents with the aim of detecting and synthesizing service identification recommendations in the scientific literature, government reports, and documents produced by organizations working with sex-trafficking victims. The review shows consensus regarding identification recommendations, including (a) trafficking indicators, (b) victim interaction strategies, (c) immediate response strategies, and (d) child-specific information. The review also shows consensus regarding screening questions that are important for service providers to use in identifying sex-trafficking victims. These questions relate to the victims' safety, employment, living environment, and travel and immigration status in addition to specific questions used with children and youth. The review results offer human service providers a preliminary set of screening strategies and questions that can be used to identify sex-trafficking victims in the context of human services. Building on the review findings, the authors offer policy and research recommendations.
Operational research (OR) analysis provides information and systems to support decision making. In health care there are examples of OR being used to support decisions surrounding both the organization of health services and the treatment of individual patients. However, its uptake is currently low in spite of the increase in potential areas of application. In practice there is a lack of awareness amongst health service staff about what OR is and how it can help. This paper addresses this issue by exposing the contribution that OR made to a programme of research relating to DNA technology. Examples are given of the way it was used to provide information on the costs and outcomes of services and the ways these evolve over time. These examples demonstrate the way OR methods increase the understanding of both analysts and service providers about a problem area. This helps ensure that appropriate and valid approaches to tackling problem areas are developed. When developing these approaches, the problem orientated philosophy of OR means analysts are willing to use a range of methodologies, some originating in OR and some in other disciplines. The broad focus of OR also means that its findings enhance those provided by other disciplines which might seem to be competitors. The conclusion of the paper is that OR has a crucial role to play in the improvement of health services.
Salanova Grau, J.M.; Estrada Romeu, M.
This paper presents a mathematical model for supporting the decision and policy making related to the optimal determination of shifts and fares of taxi services in a major city. The model is based on the system’s generalized cost function and uses continuous approximations and geometric probabilities for estimating the key performance indicators of the taxi market, which are waiting and access time for the customers (in-vehicle travel time does not depend on the offer side) and benefits for the drivers. The model is based on an econometric model with the inclusion of an elastic demand, which allows the estimation of the optimal values for the two decision variables of the problem: fare structure and the taxi fleet size. The model also accounts for a full-day time period instead of the one-hour time frame models used in most of the taxi models, which allows for providing insights on the daily duration and distribution of the shifts that should be defined by the policy makers. (Author)
Vogdrup-Schmidt, Mathias; Strange, Niels; Olsen, Søren Bøye
We propose a spatial multi-criteria decision analysis approach as a value-focused decision support tool for evaluating land use change decisions affecting multiple ecosystem services. In an empirical case study concerned with creating a robust and interconnected network of natural areas in a Danish...... municipality, we first conduct a biophysical and economic baseline mapping of ecosystem services. We then construct a spatially explicit multi-criteria decision analysis model which is utilized to identify candidate areas for inclusion in the network. We define a base scenario for future land use in the area......, where all criteria have equal weight, and assess the outcome in terms of welfare economic benefits of ecosystem services and opportunity cost of reducing forest and agricultural production. As weights in multi-criteria analysis is innately a subjective task, we conduct a sensitivity analysis using four...
Guijarro, Luis; Pla, Vicent; Vidal, Jose R; Naldi, Maurizio; Mahmoodi, Toktam
This paper proposes a business model for providing services based on the Internet of Things through a platform that intermediates between human users and Wireless Sensor Networks (WSNs). The platform seeks to maximize its profit through posting both the price charged to each user and the price paid to each WSN. A complete analysis of the profit maximization problem is performed in this paper. We show that the service provider maximizes its profit by incentivizing all users and all Wireless Sensor Infrastructure Providers (WSIPs) to join the platform. This is true not only when the number of users is high, but also when it is moderate, provided that the costs that the users bear do not trespass a cost ceiling. This cost ceiling depends on the number of WSIPs, on the value of the intrinsic value of the service and on the externality that the WSIP has on the user utility.
Do Manh, Thai; Williams, Idongesit
are very important in formulating and implementing universal service policy. Originality/value - There have been a few studies applying actor network theory in analysing the formulation of policy, especially in universal service. The paper wants to close this gap.......Purpose - The paper looks at the formulation of the BMGF-VN project to examine which actors participated in the formulation of this project, how their interests were translated into this project, and what lessons may be drawn for the formulation and implementation of universal service policy...... in Vietnam in general. Design/methodology/approach - The paper recruits the actor network theory and qualitative analysis to analyse the BMGF-VN project. Findings - the involvement of non-government actors in formulating and implementing the project, the focus not only on the supply side but also demand side...
been extremely difficult in the past; but with the advent of cloud computing, this problem should be less difficult to solve. Opportunistic Cloud Services (OCS) is about enterprises leveraging cloud computing technologies to contribute spare IT resources to a platform so that others on the platform can...... utilize them as and when needed. The OCS network is modelled as a social network of enterprises collaborating strategically in contributing and utilizing cloud services without entering into any business agreements. Such a platform faces several problems. One of such problems is the free riding problem...... challenges that were discovered during this study, the obtained results demonstrate both the technical feasibility and the existence of enabling conditions for the implementation of opportunistic cloud services for enterprises....
Full Text Available Nature, ecosystems and biodiversity provide human society with many benefits known as ecosystem services. Functional diversity is an important aspect of biodiversity. In this paper, we applied inductive approach to the identification, mapping and evaluation of ecosystem services of the Aegopodio-Alnetum glutinosae community in Tribeč Mts. The results from 2015 show that the alder floodplain forest represents one of the most productive forest ecosystems with seasonal maximum production of 59.03 g m−2, species diversity of N0 = 40 and functional diversity of FD = 10. The forage potential of this community is medium, the melliferous potential is high and the therapeutic potential was estimated as extremely rich in medicinal plants. From the functional groups for providing ecosystem services, woody plants and hemicryptophytes play the most significant role.
Full Text Available Abstract Background Crisis resolution and home treatment (CRHT is an emerging mode of delivering acute mental health care in the community. There is a paucity of knowledge regarding the workings of CRHT in the literature. This is the second paper in a series of three from the longitudinal survey of patients of a CRHT team in Norway, which was aimed at describing the characteristics of patients served, professional services provided, and clinical outcomes. This report focuses on the provision of professional services by the team. Methods The project was a descriptive, quantitative study based on the patient data from a longitudinal survey of one CRHT team in Norway. The participants of the survey, a total of 363 patients, constituted the complete registration of patients of this team in the period from February 2008 to July 2009. Results The average length of service by the team was about 15 days, and those with depression as the major symptom had the longest mean length of stay on the team. The team was engaged in providing a variety of services including individual treatments involving multiple professionals, group treatment meetings, and coordination activities involving external service sectors. While the type of professionals providing individual treatment was not associated with the severity level of clinical problems, those receiving various group treatment meetings had more serious level of clinical symptoms than those not receiving group treatment meetings. In addition coordination activities involving healthcare professionals and social services in the community were in line with the patients' clinical and social needs. The results of the study show that the team functioned effectively in addressing the general guidelines for the functioning of CRHT teams.
Bell, Andrew; Zhang, Wei
The contribution of synthetic pesticides to closing yield gaps around the world is undeniable; however, their use is also a classic double-edged sword. Beyond the well-recognized social costs (e.g., pollution to soil and water, and health effects both on consumers and other species) there are also private costs on farmers beyond the direct costs of inputs, associated with elevated risks of both acute and chronic damage to farmers’ health, and with the destruction of populations of beneficial organisms. Managing agricultural land use to enhance natural pest control services (also called mobile agent-based ecosystem services or MABES) holds promise to reduce this growing reliance on pesticides, though it too carries costs. In particular, uncertainty in crop yield due to pest damages, as well as the need to coordinate pesticide use with neighboring farms, can be important obstacles to establishing the longer-term public good of natural pest regulation. Current thinking on promoting ecosystem services suggests that payments or other economic incentives are a good fit for the promotion of public good ecosystem services such as MABES. We undertook a framed field experiment to examine the role of subsidies for non-crop habitat in improving insect-based ecosystem services in two separate samples in Southeast Asia—Cambodia and Vietnam. Our central finding is that these two contexts are not poised equally to benefit from incentives promoting MABES, and in fact may be left worse off by payments schemes. As the study and practice of payments for ecosystem services programs grows, this finding provides an important qualifier on recent theory supporting the use of payments to promote public good ecosystem services—where the nature of the coordination problem is complex and nonlinear, farm systems can be made worse off by being encouraged to attempt it.
Horrocks, Claire Alice
Intensive agriculture has led to an increase in production; however this has often coincided with a decline in the provision of other Ecosystem Services (ES). ES affected include those regulated by soil chemical, physical and biological properties such as biodiversity provision and the regulation of nutrient cycling, water quality and rates of greenhouse gas emissions. A growing awareness of the value of nonproduction ES to human health and wellbeing has encouraged the funding ...
Nicole, Madelyn; Fairbrother, Michele; Nagarajan, Srivalli Vilapakkam; Blackford, Julia; Sheepway, Lyndal; Penman, Merrolee; McAllister, Lindy
Through a collaborative university-hospital partnership, a student-led service model (SLS-model) was implemented to increase student placement capacity within a physiotherapy department of a 150 bed Sydney hospital. This study investigates the perceived barriers and enablers to increasing student placement capacity through student-led services…
Juhl, Jacqueline A; Stedman, Lynn
Educational preparation of dental hygiene students for hospital-based practice, and advocacy efforts promote inclusion of dental hygienists within hospital-based interdisciplinary health care teams. Although the value of attending to the oral care needs of patients in critical care units has been recognized, the potential impact of optimal oral health care for the general hospital population is now gaining attention. This article describes a hospital-based educational experience for dental hygiene students and provides advocacy strategies for inclusion of dental hygienists within the hospital interdisciplinary team. The dental hygienist authors, both educators committed to evidence-based oral health care and the profession of dental hygiene, studied hospital health care and recognized a critical void in oral health care provision within that setting. They collaboratively developed and implemented a hospital-based rotation within the curriculum of a dental hygiene educational program and used advocacy skills to encourage hospital administrators to include a dental hygiene presence within hospital-based care teams. Hospital-based dental hygiene practice, as part of interprofessional health care delivery, has the potential to improve patient well-being, shorten hospital stays, and provide fiscal savings for patients, institutions, and third party payers. Advocacy efforts can promote dental hygienists as members of hospital-based health care teams. Further research is needed to document: (1) patient outcomes resulting from optimal oral care provision in hospitals; (2) best ways to prepare dental hygienists for career opportunities within hospitals and other similar health care settings; and (3) most effective advocacy strategies to promote inclusion of dental hygienists within care teams. Copyright © 2016 Elsevier Inc. All rights reserved.
Full Text Available This paper discusses the experiences of twelve social workers as providers of family preservation services. The sample was selected through purposive and snowball sampling. Data were collected through face-to-face semi-structured interviews, which yielded rich information on a host of challenges experienced by social workers. Some of the challenges entail the parents’ reluctance to participate in family preservation services, their unwillingness to care for their children, non-adherence to intervention plans, protection of perpetrators of child abuse by family members, traditional practices, lack of resources and low salaries. These challenges have an adverse effect on the morale and wellbeing of social workers
Cass, Tony; CERN. Geneva. IT Department
Much effort (and money) has been invested in recent years to ensure that academic and research sites are well interconnected with high-capacity networks that, in most cases, span national and continental boundaries. However, these dedicated research and education networks, whether national (NRENs) or trans-continental (RENs), frequently have Acceptable Use Policies (AUPs) that restrict their use by commercial entities, notably Cloud Service Providers (CSPs). After a brief summary of the issues involved, we describe three approaches to removing the network connectivity barrier that threatens to limit the ability of academic and research institutions to profit effectively from services offered by CSPs.
Afifi, Ladan; Shinkai, Kanade
A consultative dermatology service plays an important role in patient care and education in the hospital setting. Optimizing education in balance with high-quality dermatology consultative services is both a challenge and an opportunity for dermatology consultation teams. There is an emergence of new information about how dermatology can best be taught in the hospital, much of which relies on principles of workplace learning as well as the science of how learning and teaching best happen in work settings. These best practices are summarized in this narrative review with integrated discussion of concepts from outpatient dermatology education and lessons learned from other inpatient teaching models. In addition, consultative dermatology curricula should utilize a blended curriculum model comprised of patient care and active learning and self-study modalities. Specific educational methods will discuss 2 strategies: (1) direct patient-care activities (ie, bedside teaching rounds) and (2) nonpatient care activities (ie, case presentations, didactic sessions, online modules, and reading lists). ©2017 Frontline Medical Communications.
N. Awortwi (Nicholas); A.H.J. Helmsing (Bert)
textabstractDuring 1970 to mid 1980s, governments’ policies on basic services in sub-Saharan Africa (SSA) had an almost exclusive focus on directly provided, publicly-funded. This approach coupled with disintegration of the economic structures resulted in steep decline in people’s access to basic
Yee, S; Buckett, W; Campbell, S; Yanofsky, R A; Barr, R D
The purpose of this study was to survey the current state of oncology sperm banking services provided by fertility clinics across Canada. A total of 78 Canadian fertility facilities were invited to complete a questionnaire related to the availability, accessibility, affordability and utilisation of sperm banking services for cancer patients. The total response rate was 59%, with 20 (69%) in vitro fertilisation clinics and 26 (53%) other fertility centres returning the survey. A total of 24 responding facilities accepted oncology sperm banking referrals. The time frame to book the first banking appointment for 19 (79%) facilities was within 2 days. Inconsistent practice was found regarding the consent process for cancer patients who are of minority age. Eight (33%) facilities did not provide any subsidy and charged a standard banking fee regardless of patients' financial situations. Overall, the utilisation of oncology sperm banking services was low despite its availability and established efficacy, suggesting that Canadian cancer patients are notably underserved. The study has highlighted some important issues for further consideration in improving access to sperm banking services for cancer patients, especially for adolescents. Better collaboration between oncology and reproductive medicine to target healthcare providers would help to improve sperm banking rates. © 2013 John Wiley & Sons Ltd.
Timur A. Tultaev
Full Text Available In the modern world innovation is one of the key factors determining the economic prospects of enterprises development, commodity markets, sectors of the economy and the state generally. The complete implementation of innovative technologies in marketing communicative policy of intangible enterprises contributes to the effective promotion of their services on the market and building a loyal consumer audience.
... more doctors of medicine or osteopathy and one or more physician assistants, nurse practitioners, or... patients, including— (i) Inpatient hospital care; (ii) Services of doctors of medicine or osteopathy; and... supervision of a registered nurse, a doctor of medicine or osteopathy, or, where permitted by State law, a...
Objectives. To assess the extent of inequalities in availability and utilisation of HIV services across South Africa. Design. Cross-sectional descriptive study. Setting. Three districts reflecting different socio-economic conditions, but with similar levels of HIV infection, were purposively sampled. Outcome measures. Availability ...
Eklund, Katie; Meyer, Lauren; Way, Samara; Mclean, Deija
As one out of five children in the United States demonstrate some type of mental or behavioral health concern warranting additional intervention, federal policies have emphasized the need for school-based mental health (SBMH) services and an expansion of Medicaid reimbursement for eligible children and families. Most youth access mental health…
Caniëls, M.C.J.; Romijn, H.A.
Programmes providing services for small and medium enterprises are important in developed and developing countries alike. Yet, the quality and impact of many of these programmes continues to be relatively disappointing. In this paper we analyse the performance and functioning of the Small Business
Beck, Tanja; Diaz del Castillo, Patricia; Fovet, Frederic; Mole, Heather; Noga, Brodie
This article presents out an outcome analysis of a Universal Design (UD) audit to the various professional facets of a disability service (DS) provider's office on a large North American campus. The context of the audit is a broad campus-wide drive to implement Universal Design for Learning (UDL) in teaching practices. In an effort for consistency…
Imbody, Bethany; Vandsburger, Etty
With our communities rapidly aging, there is always a clear need for greater knowledge on how to serve elders. Professionals must be able to recognize cases of abuse and neglect and provide appropriate follow up services. Through reviewing recent literature, this paper surveys existing assessment tools and interventions, describes characteristics…
Jorritsma, P.Y.; Wilderom, Celeste P.M.
Purpose – Headquarters managers of a medium-sized manufacturing company initiated a culture change in five of their dispersed wholesale units. The aim was for more external service quality. This paper aims to report the results of a test of three hypotheses, shedding light on the behavior of the
... be performed on the basis of the sample as submitted. (b) Reinspection, and appeal inspection... requested. In performing these services, a sample obtained with an approved diverter-type mechanical sampler... criteria, and a sample obtained with a probe at the time of the reinspection or appeal, generally, shall be...
Modernel Hristoff, Pablo; Rossing, W.A.H.; Corbeels, M.; Dogliotti, S.; Picasso, V.; Tittonell, P.
New livestock production models need to simultaneously meet the increasing global demand for meat and preserve biodiversity and ecosystem services. Since the 16th century beef cattle has been produced on the Pampas and Campos native grasslands in southern South America, with only small amounts of
Frost, Mareka; Casey, Leanne; Rando, Natalie
Although increasing numbers of young people are seeking help online for self-injury, relatively little is known about their online help-seeking preferences. To investigate the perspectives of young people who self-injure regarding online services, with the aim of informing online service delivery. A mixed-methods exploratory analysis regarding the perspectives of a subsample of young people who reported a history of self-injury and responded to questions regarding preferences for future online help-seeking (N = 457). The sample was identified as part of a larger study (N = 1,463) exploring self-injury and help-seeking. Seven themes emerged in relation to preferences for future online help-seeking: information, guidance, reduced isolation, online culture, facilitation of help-seeking, access, and privacy. Direct contact with a professional via instant messaging was the most highly endorsed form of online support. Young people expressed clear preferences regarding online services for self-injury, supporting the importance of consumer consultation in development of online services.
Pirkis, Jane; Burgess, Philip; Kohn, Fay; Morley, Belinda; Blashki, Grant; Naccarella, Lucio
The Access to Allied Psychological Services component of Australia's Better Outcomes in Mental Health Care program enables eligible general practitioners to refer consumers to allied health professionals for affordable, evidence-based mental health care, via 108 projects conducted by Divisions of General Practice. The current study profiled the models of service delivery across these projects, and examined whether particular models were associated with differential levels of access to services. We found: 76% of projects were retaining their allied health professionals under contract, 28% via direct employment, and 7% some other way; Allied health professionals were providing services from GPs' rooms in 63% of projects, from their own rooms in 63%, from a third location in 42%; and The referral mechanism of choice was direct referral in 51% of projects, a voucher system in 27%, a brokerage system in 24%, and a register system in 25%. Many of these models were being used in combination. No model was predictive of differential levels of access, suggesting that the approach of adapting models to the local context is proving successful.
Daly Justine B
Full Text Available Abstract Background Despite the need for a reduction in levels of childhood exposure to environmental tobacco smoke (ETS being a recognised public health goal, the delivery of ETS preventive care in child health service settings remains a largely unstudied area. The purpose of this study was to determine the prevalence of ETS preventive care in child health services; differences in the provision of care by type of service; the prevalence of strategies to support such care; and the association between care support strategies and care provision. Method One-hundred and fifty-one (83% child health service managers within New South Wales, Australia completed a questionnaire in 2002 regarding the: assessment of parental smoking and child ETS exposure; the provision of parental smoking cessation and ETS-exposure reduction advice; and strategies used to support the provision of such care. Child health services were categorised based on their size and case-mix, and a chi-square analysis was performed to compare the prevalence of ETS risk assessment and ETS prevention advice between service types. Logistic regression analysis was used to examine associations between the existence of care support strategies and the provision of ETS risk assessment and ETS exposure prevention advice. Results A significant proportion of services reported that they did not assess parental smoking status (26%, and reported that they did not assess the ETS exposure (78% of any child. Forty four percent of services reported that they did not provide smoking cessation advice and 20% reported they did not provide ETS exposure prevention advice. Community based child and family health services reported a greater prevalence of ETS preventive care compared to other hospital based units. Less than half of the services reported having strategies to support the provision of ETS preventive care. The existence of such support strategies was associated with greater odds of care provision
Sanchis-Cano, Angel; Romero, Julián; Sacoto-Cabrera, Erwin J; Guijarro, Luis
We analyze the feasibility of providing Wireless Sensor Network-data-based services in an Internet of Things scenario from an economical point of view. The scenario has two competing service providers with their own private sensor networks, a network operator and final users. The scenario is analyzed as two games using game theory. In the first game, sensors decide to subscribe or not to the network operator to upload the collected sensing-data, based on a utility function related to the mean service time and the price charged by the operator. In the second game, users decide to subscribe or not to the sensor-data-based service of the service providers based on a Logit discrete choice model related to the quality of the data collected and the subscription price. The sinks and users subscription stages are analyzed using population games and discrete choice models, while network operator and service providers pricing stages are analyzed using optimization and Nash equilibrium concepts respectively. The model is shown feasible from an economic point of view for all the actors if there are enough interested final users and opens the possibility of developing more efficient models with different types of services.
Full Text Available Abstract The decline in dairy herd fertility internationally has highlighted the limited impact of traditional veterinary approaches to bovine fertility management. Three questionnaire surveys were conducted at buiatrics conferences attended by veterinary practitioners on veterinary dairy herd fertility services (HFS in countries with a seasonal (Ireland, 47 respondents and non-seasonal breeding model (The Netherlands, 44 respondents and Portugal, 31 respondents. Of the 122 respondents, 73 (60% provided a HFS and 49 (40% did not. The majority (76% of all practitioners who responded stated that bovine fertility had declined in their practice clients' herds with inadequate cow management, inadequate nutrition and increased milk yield as the most important putative causes. The type of clients who adopted a herd fertility service were deemed more educated than average (70% of respondents, and/or had fertility problems (58% and/or large herds (53%. The main components of this service were routine postpartum examinations (95% of respondents, fertility records analysis (75% and ultrasound pregnancy examinations (69%. The number of planned visits per annum varied between an average of four in Ireland, where breeding is seasonal, and 23 in Portugal, where breeding is year-round. The benefits to both the practitioner and their clients from running a HFS were cited as better fertility, financial rewards and job satisfaction. For practitioners who did not run a HFS the main reasons given were no client demand (55% and lack of fertility records (33%. Better economic evidence to convince clients of the cost-benefit of such a service was seen as a major constraint to adoption of this service by 67% of practitioners.
Korosec, D.; Vojvodic Tuma, J.
In the present paper, the aspects of optimizing In-Service Inspection (ISI) is discussed. Slovenian Nuclear Safety Administration (SNSA) and its authorized organization for the ISI activities, Institute of Metals and Technologies, are actually permanently involved in the ISI processes of the nuclear power plant (NPP) Krsko. Based on the previous experience on the ISI activities, evaluation of the results and review of the new ISI program, the decision was made to improve recent regulatory and professional practice. That means, the conclusion was made to optimize the evaluation process of the ISI as a process. Traditional criteria, standards and practice gives good fundament for the improvements implementation. Improvements can be done on the way that the more broad knowledge about safety important components of the systems shall bee added to the basic practice. It is necessary to identify conditions of the safety important components, such as realistic stress and fatigue conditions, material properties changes due aging processes, the temperature cycling effects, existing flaws characterization in the light of the previous detection and equipment technique used, assessment of the measurement accuracy on the results etc. In addition to the above mentioned, risk assessment and evaluation of the whole ISI shall be done. To do this it is necessary to made risk evaluation, based on previous structural element probability assessment. Probabilistic risk assessment is important and one of the most powerful tools in the ISI optimization. Some basic work on the filed of the risk informed methods related to the nuclear safety components has been already done. Based on reference documentation, the most important steps in risk informed ISI are discussed: scope definition, consequence evaluation, failure probability estimation, risk evaluation, non-destructive examination method selection and possibilities of implementation, monitoring and feedback. Recent experience on the ISI
Lu, Yikun; Käkölä, Timo
ICT-enabled international sourcing of software-intensive systems and services (eSourcing) is a powerful strategy for managing businesses more effectively. China is becoming a superpower for eSourcing service provisioning, but most Chinese providers are small or medium-sized and leverage the mediated eSourcing model, delivering services to foreign ICT clients that interface with end-clients onshore. This model restricts the providers to low-value projects. This paper probes eSourci...
Higgs, Elizabeth S; Stammer, Emily; Roth, Rebecca; Balster, Robert L
Recognizing the need for evidence to inform US Government and governments of the low- and middle-income countries on efficient, effective maternal health policies, strategies, and programmes, the US Government convened the Evidence Summit on Enhancing Provision and Use of Maternal Health Services through Financial Incentives in April 2012 in Washington, DC, USA. This paper summarizes the background and methods for the acquisition and evaluation of the evidence used for achieving the goals of the Summit. The goal of the Summit was to obtain multidisciplinary expert review of literature to inform both US Government and governments of the low- and middle-income countries on evidence-informed practice, policies, and strategies for financial incentives. Several steps were undertaken to define the tasks for the Summit and identify the appropriate evidence for review. The process began by identifying focal questions intended to inform governments of the low-and middle-income countries and the US Government about the efficacy of supply- and demand-side financial incentives for enhanced provision and use of quality maternal health services. Experts were selected representing the research and programme communities, academia, relevant non-governmental organizations, and government agencies and were assembled into Evidence Review Teams. This was followed by a systematic process to gather relevant peer-reviewed literature that would inform the focal questions. Members of the Evidence Review Teams were invited to add relevant papers not identified in the initial literature review to complete the bibliography. The Evidence Review Teams were asked to comply with a specific evaluation framework for recommendations on practice and policy based on both expert opinion and the quality of the data. Details of the search processes and methods used for screening and quality reviews are described.
Søvig, Karl Harald
All European countries are now facing a situation where a part of the population consists of migrants without a permit to stay or reside. These persons may have health problems, and the question then rises regarding health services to irregular migrants. Normally, welfare benefits are offered those with a relationship to the country concerned, as citizen, asylum seeker, tourist, etc. Irregular migrants are outside the society, and it could be suggested that they therefore should be denied health services. On the other hand, common European standards of humanity lay obligations on the States, for example, where situations are life-threatening. This contribution gives an overview of relevant legal instruments, both from the UN, Council of Europe and the European Union. Although there are many similarities, the instruments have their differences, and there may even be some tensions regarding the underlying values.
Hansen, Anca Daniela; Altin, Müfit; Iov, Florin
Emphasis in this article is on the power system impact of wind power plants capability to provide enhanced ancillary services, i.e. temporary frequency response (TFR) and power oscillation damping (POD). The main objective of the article is to analyze and justify the challenges in the use of TFR...... and POD from wind power plants (WPPs). The study is conducted with an aggregated wind power plant model which is integrated into a generic power system model, specifically designed to assess the targeted ancillary services in a relatively simple, but still relevant environment. Various case studies...... with different wind power penetration levels are considered. The study shows that WPPs can provide additional control features such as TFR and POD to enhance the stability of power systems with large share of wind power. Nevertheless, the results illustrate that the power system stability can be potentially...
Layman, Craig A; Jud, Zachary R; Archer, Stephanie K; Riera, David
Water filtration is one of the most important ecosystem services provided by sessile organisms in coastal ecosystems. As a consequence of increased coastal development, human-made shoreline structures (e.g., docks and bulkheads) are now common, providing extensive surface area for colonization by filter feeders. We estimate that in a highly urbanized sub-tropical estuary, water filtration capacity supported by filter feeding assemblages on dock pilings accounts for 11.7 million liters of water h −1 , or ∼30% of the filtration provided by all natural oyster reef throughout the estuary. Assemblage composition, and thus filtration capacity, varied as a function of piling type, suggesting that the choice of building material has critical implications for ecosystem function. A more thorough depiction of the function of coastal ecosystems necessitates quantification of the extensive ecosystem services associated with human-made structures. (paper)
Kjær, Anne Mette; Joughin, James
This article examines how political incentives shape the implementation of agricultural advisory service reforms. Using the Uganda experience as a typical case we find that elections incentivised the government to add a subsidised input component to the existing service. Growing pressures from...... local politicians, the Ministry of Agriculture, and, increasingly, disgruntled army factions then constituted a strong, interlocking set of further incentives to revert to a recentralised, top-down model dominated by the new, subsidised input, component. Our findings point to how well designed...... implementation processes can be disrupted by the changing incentive structure, an insight which calls for more patient and much more pragmatic approaches to adopting ‘trial and error’ models rather than more ambitious but perhaps unrealistic ones....
Fertility programs may withhold services from prospective patients on the basis of well-grounded reasons that those patients will be unable to provide minimally adequate or safe care for offspring. This document was reviewed and updated; this version replaces the previous version of this document, last published July 2013 (Fertil Steril 2013;100:50-53). Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
Watila, Musa M; Keezer, Mark R; Angwafor, Samuel A; Winkler, Andrea S; Sander, Josemir W
Epilepsy is a public health issue in sub-Saharan Africa (SSA) where many people with the condition receive no treatment. Health-care services for epilepsy in this region have not been comprehensively assessed. We examined key features of epilepsy health services provided in SSA. This was a scoping review conducted using pre-specified protocols. We implemented an electronic search strategy to identify relevant citations using PUBMED, EMBASE, Web of Science, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), African Index Medicus (AIM), Open Grey, Cochrane database, and Google Scholar. Articles eligible for full-text review were screened and data of interest were reported. The search identified 81 eligible articles, forty-nine from East Africa, 19 from West Africa, 8 from South Africa, and 5 from Central Africa. A variety of care services were identified, with reporting of rural epilepsy care in 75% of retrieved articles mainly from East and South African countries. The majority of the rural epilepsy clinics were health worker- or nurse-led, reporting good seizure control in about two-thirds of patients using phenobarbital as the most commonly prescribed antiepileptic drug. Funding for rural epilepsy care came mainly from external donor agencies. We attempted to provide a 'snapshot' of epilepsy care services in SSA. The successes achieved in some of the centers are due to the use of existing primary health-care systems and employing non-physician health-care personnel. The true picture of epilepsy care coverage is not apparent due to the lack of data and proper health system structure in most parts of SSA. As more individuals begin to receive care, the long-term funding for epilepsy care in African countries will depend on the commitment of their respective governments. Copyright © 2017 Elsevier Inc. All rights reserved.
Diffey, J.L.; Cartwright, L.E.; Collins, L.T.; Grewal, R.K.
Full text: Breast Screen NSW is a fully digital screening programme with 70 mammographic units from eight vendors. We present the challenges and learning experiences associated with providing the physics service to this extensive screening programme. The EPA requires an annual check of Mean Glandular Dose and registration renewal every 2 years. Additionally, BreastScreen NSW requires annual compliance testing to RANZCR standards. To ensure that testing is carried out to a consistently high level, the contract specifies that only five physicists in the state are eligible to test the equipment. An equipment database has been developed to enable us to meet these deadlines. We have also created a radiog rapher QC manual. Two physicists take responsibility for the overall co-ordination of the service, reviewing reports and test methodology of other physics providers. The database has greatly improved the system for meeting deadlines; visits to all sites revealed that many were overdue. The radiographer QC manual has been accompanied by practical tutorials and has been successful in improving understanding of digital mam mography and ensuring consistency in testing. This has been a particular challenge because equipment has been supplied by a number of vendors, with a range of detector technology. The number of mammography units, combined with the range of vendor technology and frequency of testing has presented a challenge to both physicists and radiographers. It has been extremely beneficial to have two dedicated physicists in place to co-ordinate the service and ensure that the demands of the contract are met.
Syrogiannis, Andreas; Rotchford, Alan P; Agarwal, Pankaj Kumar; Kumarasamy, Manjula; Montgomery, Donald; Burr, Jennifer; Sanders, Roshini
To describe the pattern of glaucoma-service delivery in Scotland and identify areas for improvement, taking into account Scottish General Ophthalmic Services (GOS) arrangements and the Eye Care Integration project, and to design Scottish Intercollegiate Guidelines Network (SIGN) guidelines to refine the primary and secondary interface of glaucoma care. A glaucoma-survey questionnaire was sent to all consultant glaucomatologists in Scotland. The design of SIGN guidelines was based on the results of the questionnaire using SIGN methodology. Over 90% of Scottish glaucoma care is triaged and delivered within hospital services. Despite GOS referral, information is variable. There are no consistent discharge practices to the community. These results led to defined research questions that were answered, thus formulating the content of the SIGN guidelines. The guideline covers the assessment of patients in primary care, referral criteria to hospital, discharge criteria from hospital to community, and monitoring of patients at risk of glaucoma. With increasing age and limitations to hospital resources, refining glaucoma pathways between primary and secondary care has become a necessity. Scotland has unique eye care arrangements with both the GOS and Eye Care Integration project. It is hoped that implementation of SIGN guidelines will identify glaucoma at the earliest opportunity and reduce the rate of false-positive referrals to hospital.
Full Text Available Abstract Background Mulago National Referral Hospital (MNRH, Uganda’s primary tertiary and teaching hospital, and Makerere University College of Health Sciences (MakCHS have a close collaborative relationship. MakCHS students complete clinical rotations at MNRH, and MakCHS faculty partner with Mulago staff in clinical care and research. In 2009, as part of a strategic planning process, MakCHS undertook a qualitative study to examine care and service provision at MNRH, identify challenges, gaps, and solutions, and explore how MakCHS could contribute to improving care and service delivery at MNRH. Methods Key informant interviews (n=23 and focus group discussions (n=7 were conducted with nurses, doctors, administrators, clinical officers and other key stakeholders. Interviews and focus groups were tape recorded and transcribed verbatim, and findings were analyzed through collaborative thematic analysis. Results Challenges to care and service delivery at MNRH included resource constraints (staff, space, equipment, and supplies, staff inadequacies (knowledge, motivation, and professionalism, overcrowding, a poorly functioning referral system, limited quality assurance, and a cumbersome procurement system. There were also insufficiencies in the teaching of professionalism and communication skills to students, and patient care challenges that included lack of access to specialized services, risk of infections, and inappropriate medications. Suggestions for how MakCHS could contribute to addressing these challenges included strengthening referral systems and peripheral health center capacity, and establishing quality assurance mechanisms. The College could also strengthen the teaching of professionalism, communication and leadership skills to students, and monitor student training and develop courses that contribute to continuous professional development. Additionally, the College could provide in-service education for providers on professionalism
Andreas C. Soteriou; Richard B. Chase
Delivering high quality service during the service encounter is central to competitive advantage in service organizations. However, achieving such high quality while controlling for costs is a major challenge for service managers. The purpose of this paper is to present an approach for addressing this challenge. The approach entails developing a model linking service process operational variables to service quality metrics to provide guidelines for service resource allocation. The approach en...
Pereira, Paulo; Depellegrin, Daniel; Misiune, Ieva; Cerda, Artemi
Maps are fundamental to understand the spatial pattern of natural and human impacts on the landscape (Brevik et al., 2016; Lavado Contador et al., 2009; Pereira et al., 2010a,b). Urban areas are subjected to an intense human pressure (Beniston et al., 2015), contributing to the degradation of the ecosystems, reducing their capacity to provide services in quality and quantity (Requier-Desjardins et al., 2011; Zhang et al., 2011). Environments that can provide a high number and quality of ecosystem services (ES) must be identified and managed correctly, since are spaces that can mitigate the impacts of human settlements and improve their quality. thus is of major importance have identify the areas that can provide better ES (Deppelegrin and Pereira, 2015). The aim of this work is to identify areas with high ES potential in Vilnius city. Here, we identified a total of 4 different land uses, agricultural areas (32.48%), water bodies (1.46%), forest and semi-natural (31.91%) areas and artificial surfaces (34.16%). CORINE land cover 2006 was used as base information to classify ES potential. The assessment of each land cover potential was carried out using expert assessment. Each land use type was ranked from 0 (no potential) to 5 (High potential). In this work the sum of total regulating, providing and cultural ES were assessed. The areas with optimal ES were the ones with the sum of all ranks equal or higher than the 3rd Quartil of each distribution. After identifying these areas, data was mapped using ArcGIS software. The results showed that on average Vilnius city has a higher potential for regulating services (20.35±15.92), followed by cultural (14.43±8.81) and providing (14.26±8.87). There was a significant correlation among the different type of services. Regulating vs cultural (0.92, p<0.001), regulating vs providing (0.72, p<0.001) and providing vs cultural (0.65, p<0.001). The results of Morans I autocorrelation index showed that regulating (Z-score: 10
Thingvad, Andreas; Ziras, Charalampos; Hu, Junjie
The purpose of this paper is to quantify the effect of biased system frequency deviations and charger losses in order for an aggregation of electric vehicles (EVs) to provide reliable primary frequency control (PFC). A data set consisting of one year of frequency measurements of the Nordic....... Additionally, a method for calculating the expected energy loss caused by continuous charging and discharging is presented together with efficiency measurements of a commercial bidirectional EV charger. It is found that during a year, the energy balance of the service provider, relative to the grid, is within...
Many studies have attributed the disproportionately high rate of domestic violence in Asian communities to Asian patriarchal "cultural norms" and the psychological and behavioral traits that these norms produce in individuals. This article seeks to expand the scope of domestic violence analysis beyond these individual and cultural frameworks, arguing that Asian domestic violence is also a product of larger scale, social systems of inequality. By examining the funding criteria of the Family Violence Prevention Services Administration (FVPSA) and the Quality-Adjusted Life Year (QALY) standard used by Robin Hood, my research shows how state and private organizations systematically devalue and underfund minority-targeted programs.
Full Text Available The process of semantic service discovery using an ontology reasoner such as Pellet is time consuming. This restricts the usage of web services in real time applications having dynamic composition requirements. As performance of semantic service discovery is crucial in service composition, it should be optimized. Various optimization methods are being proposed to improve the performance of semantic discovery. In this work, we investigate the existing optimization methods and broadly classify optimization mechanisms into two categories, namely optimization by efficient reasoning and optimization by efficient matching. Optimization by efficient matching is further classified into subcategories such as optimization by clustering, optimization by inverted indexing, optimization by caching, optimization by hybrid methods, optimization by efficient data structures and optimization by efficient matching algorithms. With a detailed study of different methods, an integrated optimization infrastructure along with matching method has been proposed to improve the performance of semantic matching component. To achieve better optimization the proposed method integrates the effects of caching, clustering and indexing. Theoretical aspects of performance evaluation of the proposed method are discussed.
Whitman, Marilyn V; Davis, Jullet A; Terry, Allison J
The number of English-as-as second-language (ESL) students in public schools across the country is rising creating unique challenges for school health services with the introduction of new cultures and languages. This study describes the perceptions of school nurses in Alabama schools regarding the challenges they face when communicating with ESL students and their parents. The population consists of school nurses in Alabama public schools. The obtained sample of 1,429 responses is presented and discussed. Urban school nurses were more likely to have access to an interpreter, yet they were more likely to rely on an ESL student to act as a translator when speaking to his/her parents. Kindergarten through elementary school nurses were more likely to witness an increase in ESL students and encounter difficulty communicating with these students and their parents. School nurses have a unique opportunity to engage parents of ESL students in the health of their child, thus it is vital that they be provided with cultural facts and encouraged to use interpreter services to lessen language barriers.
Kuek, K; Liow, T S
The Chinese traditional medical system and pharmacology have a 1000-year history, and practitioners of Chinese traditional medicine play an important role in providing health care and family planning services in China. Vast numbers of patients from all walks of life and of all races benefit from Chinese traditional medicine. Although there are no official government records on the activities of practitioners of traditional medicine, the Chinese charitable medical organizations have some data on the nature of available services and their use. In China, in the context of significant government investment in health care facilities throughout the country and the proliferation of private hospitals, specialist centers, and general practitioners providing modern health care, the number of Chinese traditional charity medical aid departments, instead of falling by the wayside, has increased. The Chinese Traditional Medicine and Physician and Medicine Dealers Association of Malaysia was established 27 years ago. There are now officially 719 Chinese physicians and 1869 medical halls and Chinese physician infirmaries in Malaysia. The authors describe the status of Chinese physicians and medical halls in Malaysia, charitable organizations, and applications of Chinese traditional medicine.
Sollom, T; Donovan, P
65 laws relating to fertility were enacted by the 49 state legislatures that held sessions in 1985. This was the largest enacted since 1973, and the 2nd largest total since. Some of the 1985 abortion laws are designed to protect abortion rights. Several states in the US took action to severely punish the perpetrators of violence against abortion clinics. Lesislation dealing with the delivery of family planning services was subjected to public funding restrictions in 1985. Attempts have been made recently on the federal level to prevent Title X recipients from being provided with information on abortion in their pregnancy counseling sessions. These actions are similar to some of the state laws attempting to reach the same end. Many states included funds for family planning in general appropriations bills. Differences among legislators regarding the right of minors to consent to reproductive health care have led to 2 patterns of response: 1) affirmation of the right of minors to receive family planning services on their own consent; or 2) laws mandating parental involvement in a minor's abortion decision. The most troubling aspect of the fertility related legislation endated in 1985 is the effort by a number of legislatures to attach restrictions on abortion counseling and referral to family planning appropriations bills. In 1985, state laws were enacted to regulate the disposal of fetal remains, to prohibit the use of fetal remains for commercial purposes and to impose criminal sanctions for causing the miscarriage of a fetus during a felony.
Allott, Kelly; Lloyd, Susan
Despite rapid growth of the discipline of clinical neuropsychology during recent times, there is limited information regarding the identification and management of professional and ethical issues associated with the practice of neuropsychology within rural settings. The aim of this article is to outline the characteristics unique to practicing neuropsychology in rural communities and to describe the potential professional and ethical dilemmas that might arise. Issues are illustrated using examples from neuropsychological practice in a rural/regional setting in Victoria, Australia. Relative to urban regions, there is an inequality in the distribution of psychologists, including neuropsychologists, in rural areas. The unique characteristics of rural and regional communities that impact on neuropsychological practice are: 1) limited resources in expertise, technology, and community services, 2) greater travel distances and costs, 3) professional isolation, and 4) beliefs about psychological services. These characteristics lower the threshold for particular ethical issues. The ethical issues that require anticipation and careful management include: 1) professional competence, 2) multiple relationships, and 3) confidentiality. Through increased awareness and management of rural-specific professional and ethical issues, rural neuropsychologists can experience their work as rewarding and enjoyable. Specific guidelines for identifying, managing, and resolving ethically and professionally challenging situations that may arise during rural practice are provided.
Chan, Y T; Ho, H K; Lai, Christopher K W; Lau, C S; Lau, Y L; Lee, T H; Leung, T F; Wong, Gary W K; Wu, Y Y
Many children in Hong Kong have allergic diseases and epidemiological data support a rising trend. Only a minority of children will grow out of their allergic diseases, so the heavy clinical burden will persist into adulthood. In an otherwise high-quality health care landscape in Hong Kong, allergy services and training are a seriously unmet need. There is one allergy specialist for 1.5 million people, which is low not only compared with international figures, but also compared with most other specialties in Hong Kong. The ratio of paediatric and adult allergists per person is around 1:460 000 and 1:2.8 million, respectively, so there is a severe lack of adult allergists, while the paediatric allergists only spend a fraction of their time working with allergy. There are no allergists and no dedicated allergy services in adult medicine in public hospitals. Laboratory support for allergy and immunology is not comprehensive and there is only one laboratory in the public sector supervised by accredited immunologists. These findings clearly have profound implications for the profession and the community of Hong Kong and should be remedied without delay. Key recommendations are proposed that could help bridge the gaps, including the creation of two new pilot allergy centres in a hub-and-spoke model in the public sector. This could require recruitment of specialists from overseas to develop the process if there are no accredited allergy specialists in Hong Kong who could fulfil this role.
Svirydzenka, Nadzeya; Ronzoni, Pablo; Dogra, Nisha
Defining quality in health presents many challenges. The Institute of Medicine (IOM) defined quality clinical care as care that is equitable, timely, safe, efficient, effective and patient centred. However, it is not clear how different stakeholders within a child and adolescent mental health service (CAMHS) understand and/or apply this framework. This project aims to identify key stakeholders" understanding of the meaning of quality in the context of CAMHS. The study sample comprised of three groups: (i) patients and carers, (ii) CAMHS clinical staff, and (iii) commissioners (Total N = 24). Semi-structured interviews were used to collect data and thematic analysis was applied to explore participant's views on the meaning and measurement of quality and how these might reflect the IOM indicators and their relevance in CAMHS. An initial barrier to implementing quality care in CAMHS was the difficulty and limited agreement in defining the meaning of quality care, its measurement and implementation for all participants. Clinical staff defined quality as personal values, a set of practical rules, or clinical discharge rates; while patients suggested being more involved in the decision-making process. Commissioners, while supportive of adequate safeguarding and patient satisfaction procedures, did not explicitly link their view on quality to commissioning guidelines. Identifying practical barriers to implementing quality care was easier for all interviewees and common themes included: lack of meaningful measures, recourses, accountability, and training. All interviewees considered the IOM six markers as comprehensive and relevant to CAMHS. No respondent individually or within one stakeholder group identified more than a few of the indicators or barriers of a quality CAMHS service. However, the composite responses of the respondents enable us to develop a more complete picture of how to improve quality care in practice and guide future research in the area.
Full Text Available As Internet usage grows exponentially, network security issues become increasingly important. Network security measures are needed to protect data during transmission. Various security controls are used to prevent the access of hackers in networks. They are firewall, virtual private networks and encryption algorithms. Out of these, the virtual private network plays a vital role in preventing hackers from accessing the networks. A Virtual Private Network (VPN provides end users with a way to privately access information on their network over a public network infrastructure such as the internet. Using a technique called “Tunneling”, data packets are transmitted across a public routed network, such as the internet that simulates a point-to-point connection. Virtual private networks provide customers with a secure and low-cost communication environment. The basic structure of the virtual circuit is to create a logical path from the source port to the destination port. This path may incorporate many hops between routers for the formation of the circuit. The final, logical path or virtual circuit acts in the same way as a direct connection between the two ports. The K-Cost Optimized Delay Satisfied Virtual Private Networks Tree Provisioning Algorithm connects VPN nodes using a tree structure and attempts to optimize the total bandwidth reserved on the edges of the VPN tree that satisfies the delay requirement. It also allows sharing the bandwidth on the links to improve the performance. The proposed KCDVT algorithm computes the optimal VPN Tree. The performance analysis of the proposed algorithm is carried out in terms of cost, the number of nodes, and the number of VPN nodes, delay, asymmetric ratio and delay with constraints with Breadth First Search Algorithm. The KCDVT performs better than the Breadth First Search Algorithm.
Full Text Available With the widespread use of Internet, the scale of mobile data traffic grows explosively, which makes 5G networks in cellular networks become a growing concern. Recently, the ideas related to future network, for example, Software Defined Networking (SDN, Content-Centric Networking (CCN, and Big Data, have drawn more and more attention. In this paper, we propose a service-customized 5G network architecture by introducing the ideas of separation between control plane and data plane, in-network caching, and Big Data processing and analysis to resolve the problems traditional cellular radio networks face. Moreover, we design an optimal routing algorithm for this architecture, which can minimize average response hops in the network. Simulation results reveal that, by introducing the cache, the network performance can be obviously improved in different network conditions compared to the scenario without a cache. In addition, we explore the change of cache hit rate and average response hops under different cache replacement policies, cache sizes, content popularity, and network topologies, respectively.
Clark, Phillipa; Macarthur, Jude
To describe the reported experiences of the estimated 14 500 New Zealand children with a physical disability and those of their families and whanau (extended families). We have used data from the Household Disability Survey conducted in 2002 to obtain this information. These children and their carers reported a number of perceived unmet needs in all areas covered in the survey: service and assistance, transport, accommodation and education. Thus an estimated 24% reported an unmet need for equipment, and 10% an unmet need for home modification. Around 9% reported having to fund respite care themselves. Of particular note was the proportion of children who had difficulties joining in games and sport at school (59%), going on school outings or camps (28%), playing at school (47%), and or making friends (35%). In all, an estimated 67% of children had one or more problems taking part at school. More could be done to help such families and to facilitate the full participation of these children.
Shahid, Kamal; Olsen, Rasmus Løvenstein; Petersen, Lennart
The penetration of renewable energy into the electricity supply mix necessitates the traditional power grid to become more resilient, reliable and efficient. One way of ensuring this is to require renewable power plants to have similar regulating properties as conventional power plants...... applications – in terms of data payloads, sampling rates, latency and reliability. Therefore, this paper presents a brief survey on the control and communication architectures for controlling renewable power plants in the future power grid, including the communication network technologies, requirements...... and to coordinate their grid support services (GSS) as well. Among other requirements, the coordination of GSS will highly depend on the communication between renewable plants and system operators’ control rooms, thereby imposing high responsibility on the under lying communication infrastructure. Despite...
Purpose: The individual EU Member States have options on how they implement the new statutory audit framework in Europe. They may introduce stricter rules or apply certain exemptions where deemed appropriate. Denmark exemplifies Member States with a traditionally high level of non-audit services...... provided by its auditors. The aim of this study is to contrast the minimum implementation rationale observed in the Danish implementation process with an ex ante examination of fee dependency. Design/methodology/approach: The audit reform introduces a cap on non-audit fees which implies a regulator......-determined condition of non-independence. The cap is applied as a treatment effect on the ex ante relationship between audit fees and non-audit fees. In a sample with 3,238 observations, Denmark is compared with Finland, Germany, Sweden and the UK in order to determine whether the new measure will have different...
Full Text Available Many patients and health care professionals in the developed world are uncomfortable about doing nothing in the face of the glaring inequities in health care between their own environment and that of Africa. In an effort to 'think global, act local' a Scottish GP practice used personal contacts to build a twinning link with a clinic serving a township in Malawi. This article describes the experience of establishing e-mail and internet services for Malawian health care staff to afford them the same level of access as developed world staff enjoy in accessing educational materials and professional supports. Using our twin link as an exemplar we are now matching other Scottish General Practices to Malawian Clinics around a common theme of modern communication media.
Cavalari, Rachel N S; Gillis, Jennifer M; Kruser, Nathan; Romanczyk, Raymond G
While the use of computer-based communication, video recordings, and other "electronic" records is commonplace in clinical service settings and research, management of digital records can become a great burden from both practical and regulatory perspectives. Three types of challenges commonly present themselves: regulatory requirements; storage, transmission, and access; and analysis for clinical and research decision-making. Unfortunately, few practitioners and organizations are well enough informed to set necessary policies and procedures in an effective, comprehensive manner. The three challenges are addressed using a demonstrative example of policies and procedural guidelines from an applied perspective, maintaining the unique emphasis behavior analysts place upon quantitative analysis. Specifically, we provide a brief review of federal requirements relevant to the use of video and electronic records in the USA; non-jargon pragmatic solutions to managing and storing video and electronic records; and last, specific methodologies to facilitate extraction of quantitative information in a cost-effective manner.
An economic model by DeAngelo shows that the existence of client-specific quasi-rents impairs auditor independence. The provison of non-audit advisory services (NAS) increases quasi-rents, and thus it is a threat to independence. Recently, a number of changes have been made not only to the relevent...... international and US regulations, but also to the German regulations related to NAS. A large number of empirical studies have investigated the influence of NAS on the perceived auditor independence. Most of these studies were performed in Anglo-Saxon countries, particularly in the US, and a majority found...... a negative impact. Six studies are based on data from Germany. Most of them failed to find a significant negative impact on auditor's independence. German investors have not been surveyed so far. Thus an empirical investigation of the impact of NAS on investors' perceptions of auditor independence in Germany...
Full Text Available Epidemiological surveys over the last 20 years show a steady increase in the amount of alcohol consumed by older age groups. Physiological changes and an increased likelihood of health problems and medication use make older people more likely than younger age groups to suffer negative consequences of alcohol consumption, often at lower levels. However, health services targeting excessive drinking tend to be aimed at younger age groups. The aim of this study was to gain an in-depth understanding of experiences of, and attitudes towards, support for alcohol related health issues in people aged 50 and over.Qualitative interviews (n = 24, 12 male/12 female, ages 51-90 years and focus groups (n = 27, 6 male/21 female, ages 50-95 years were carried out with a purposive sample of participants who consumed alcohol or had been dependent.Participants' alcohol misuse was often covert, isolated and carefully regulated. Participants tended to look first to their General Practitioner for help with alcohol. Detoxification courses had been found effective for dependent participants but only in the short term; rehabilitation facilities were appreciated but seen as difficult to access. Activities, informal groups and drop-in centres were endorsed. It was seen as difficult to secure treatment for alcohol and mental health problems together. Barriers to seeking help included functioning at a high level, concern about losing positive aspects of drinking, perceived stigma, service orientation to younger people, and fatalistic attitudes to help-seeking. Facilitators included concern about risk of fatal illness or pressure from significant people.Primary care professionals need training on improving the detection and treatment of alcohol problems among older people. There is also a compelling need to ensure that aftercare is in place to prevent relapse. Strong preferences were expressed for support to be provided by those who had experienced alcohol problems themselves.
Everaars, Babette; Jerković-Ćosić, Katarina; van der Putten, Gert-Jan; Pretty, Ian A; Brocklehurst, Paul
Retaining natural teeth for longer, together with increasing care dependency in the elderly, has the potential to hamper adequate oral self-care and service provision. The aim of this qualitative study was to compare and contrast views from a multi-stakeholder perspective on the future priorities for oral health care services of older people in the United Kingdom and the Netherlands. A participatory setting partnership was undertaken with 4 key stakeholder groups in the United Kingdom and the Netherlands. A final consensus group considered collective responses. The views of the different groups were recorded, transcribed verbatim, and analyzed thematically. Two main themes derived: "individual well-being" and "underlying principles of service provision." Codes relating to principles of service provision focused on the importance of developing quality criteria, improving access, prevention and screening, awareness raising, education and training, together with multidisciplinary care. In both countries, oral health was seen as an important element of "individual well-being," and a number of "principles of service provision" were suggested. This contrasts with the current lack of evidence-based treatments and quality criteria that are available for dependent older people.
Kapur, Navneet; House, Allan; May, Chris; Creed, Francis
The aim of the study was to compare the hospital management and direct costs of self-poisoning in six United Kingdom hospitals and to investigate whether hospital management influences outcome. This was a prospective descriptive study carried out at three teaching hospitals and three district general hospitals in North West England on adults (aged 16 or over) presenting to the study centres with deliberate self-poisoning over a 5-month period. Data were based on demographic and clinical characteristics, management of the current episode, direct costs and repetition of self-poisoning within 12 weeks of index episode. There were 1778 episodes of self-poisoning during the study period. There were marked differences in management between centres. There was a fivefold difference in the rate of admission to a medical bed (16.5%-81.3%), and a twofold difference in the rate of psychosocial assessment (28.5%-57.7%). These differences remained after adjustment for demographic and clinical factors. Hospital costs per episode varied from pound 228 to pound 422 and repetition rate ranged from 10% to 16%. Psychosocial assessment was associated with a twofold reduction in the risk of repetition. The marked variability of services for self-poisoning continue. It seems likely that this is having a detrimental effect on patient outcomes. Large scale intervention studies are required to inform both clinical practice and service provision.
David Perez-Diaz de Cerio
Full Text Available It is very common to rule out Bluetooth as a suitable technology for vehicular communications. The reasons behind this decision usually result from misconceptions such as accepting that Bluetooth has a short application range, or assuming its connection setup is not fast enough to allow communication which involves high speed moving nodes. This paper refutes those assertions and proposes the use of Bluetooth not only for Infrastructure-to-Vehicle (I2V or Road-to-Vehicle (R2V communications, but also for Vehicle-to-Vehicle (V2V or Vehicle-to-Infrastructure (V2I communications. This novel proposal is based on using the remote name request procedure of the standard, combined with an adjustment and optimization of the parameters present in the inquiry and page procedures. The proposed modifications reduce the information exchange delay, thus making Bluetooth a suitable technology for high-speed vehicle communications. The feasibility of the proposed scheme has been validated through experimental tests conducted in different scenarios: laboratory, a real highway and a racing test circuit. There, the communication system was installed in a vehicle circulating at speeds of up to 250 km/h, whereas autonomous devices were disseminated throughout the road path to communicate with the on board devices obtaining satisfying results.
Ishengoma, Deus S; Kamugisha, Mathias L; Rutta, Acleus S M; Kagaruki, Gibson B; Kilale, Andrew M; Kahwa, Amos; Kamugisha, Erasmus; Baraka, Vito; Mandara, Celine I; Materu, Godlisten S; Massaga, Julius J; Magesa, Stephen M; Lemnge, Martha M; Mboera, Leonard E G
Roll-out and implementation of antiretroviral therapy (ART) necessitated many countries in Sub-Saharan Africa to strengthen their national health laboratory systems (NHLSs) to provide high quality HIV diagnostic and supportive services. This study was conducted to assess the performance of health laboratories in provision of HIV diagnostic and supportive services in eight districts (from four regions of Iringa, Mtwara, Tabora and Tanga), after nine years of implementation of HIV/AIDS care and treatment plan in Tanzania. In this cross-sectional study, checklists and observations were utilized to collect information from health facilities (HFs) with care and treatment centres (CTCs) for HIV/AIDS patients; on availability of laboratories, CTCs, laboratory personnel, equipment and reagents. A checklist was also used to collect information on implementation of quality assurance (QA) systems at all levels of the NHLS in the study areas. The four regions had 354 HFs (13 hospitals, 41 Health Centres (HCs) and 300 dispensaries); whereby all hospitals had laboratories and 11 had CTCs while 97.5 and 61.0% of HCs had both laboratories and CTCs, respectively. Of the dispensaries, 36.0 and 15.0% had laboratories and CTCs (mainly in urban areas). Thirty nine HFs (12 hospitals, 21 HCs and six dispensaries) were assessed and 56.4% were located in urban areas. The assessed HFs had 199 laboratory staff of different cadres (laboratory assistants = 35.7%; technicians =32.7%; attendants = 22.6%; and others = 9.1%); with >61% of the staff and 72.3% of the technicians working in urban areas. All laboratories were using rapid diagnostic tests for HIV testing. Over 74% of the laboratories were performing internal quality control and 51.4% were participating in external QA programmes. Regional and district laboratories had all key equipment and harmonization was maintained for Fluorescence-Activated Cell Sorting (FACS) machines. Most of the biochemical (58.0%) and haematological
Strauch, Ayron M; Rurai, Masegeri T; Almedom, Astier M
Social, religious and economic facets of rural livelihoods in Sub-Saharan Africa are heavily dependent on natural resources, but improper resource management, drought, and social instability frequently lead to their unsustainable exploitation. In rural Tanzania, natural resources are often governed locally by informal systems of traditional resource management (TRM), defined as cultural practices developed within the context of social and religious institutions over hundreds of years. However, following independence from colonial rule, centralized governments began to exercise jurisdictional control over natural resources. Following decades of mismanagement that resulted in lost ecosystem services, communities demanded change. To improve resource protection and participation in management among stakeholders, the Tanzanian government began to decentralize management programs in the early 2000s. We investigated these two differing management approaches (traditional and decentralized government) in Sonjo communities, to examine local perceptions of resource governance, management influences on forest use, and their consequences for forest and water resources. While 97% of households understood the regulations governing traditionally-managed forests, this was true for only 39% of households for government-managed forests, leading to differences in forest use. Traditional management practices resulted in improved forest condition and surface water quality. This research provides an essential case study demonstrating the importance of TRM in shaping decision frameworks for natural resource planning and management. Copyright © 2016 Elsevier Ltd. All rights reserved.
Standiford, Connie J; Nolan, Elizabeth; Harris, Michelle; Bernstein, Steven J
To evaluate and improve the provision of language services at an academic medicine center caring for a diverse population including many limited-English-proficient (LEP) patients. The authors performed a prospective observational study between November 2006 and December 2008 evaluating the provision of language services at the University of Michigan Health System. The primary performance measures were (1) screening patients for their preferred language for health care, (2) assessing the proportion of LEP patients receiving language services from a qualified language services provider, and (3) assessing whether there were any disparities in diabetes care for LEP patients compared with English-speaking patients. The proportion of patients screened for preferred language increased from 59% to 96% with targeted inventions, such as training staff to capture preferred language for health care and correcting prior inaccurate primary language data entry. The proportion of LEP outpatients with a qualified language services provider increased from 19% to 83% through the use of staff and contract interpreters, over-the-phone interpreting and bilingual providers. There were no systematic differences in diabetes quality performance measures between LEP and English-proficient patients. Academic medical centers should measure their provision of language services and compare quality and safety data (e.g., performance measures and adverse events) between LEP and English-speaking patients to identify disparities in care. Leadership support and ongoing training are needed to ensure language-specific services are embedded into clinical care to meet the needs of our diverse patient populations.
Larsen, Hogne Nersund
This thesis describes the development and application of a tool to assess and document the life cycle greenhouse gas emissions of municipalities and other public-service providers. The model is linked to the financial accounting system of municipalities and counties to calculate the Carbon Footprint (CF) of all purchases/activities made. In particular indirect emissions (Scope 3 according to the greenhouse gas (GHG) protocol) will effectively be accounted for with this system. One of the main findings of the thesis is indeed the importance of Scope 3 emissions to the total CF of the cases investigated. Within the local climate action framework, this thesis focuses on the CF resulting from the activities of the municipal/county administration. This will largely be the provision of services. Insights in the structure of the CF of services will therefore be provided in the papers presented in the thesis. Results show that direct GHG emissions from the burning of fossil fuels are not very significant. At the same time, indirect GHG emissions embodied in the purchase of products and services from sub-suppliers are very significant. Furthermore, when time series are investigated, we identify a shift from direct emissions (e.g. the combustion of diesel in municipal vehicles) to indirect Scope 3 emissions (e.g. the purchase of transportation services from a private company). This outsourcing of activities indicates a necessary shift to complete consumption-based inventories that include all direct and indirect GHG emissions in developing comparable indicators of sustainability. The comparability of municipal CFs is the focus of one of the papers in the thesis. In the paper, we investigate how the CF of all Norwegian municipalities compares to a set of key characteristics. The main finding here is that the CF is highly dependent on both municipal wealth and municipal size. Small and wealthy municipalities tend to have a significantly higher CF per capita relating to the
Larsen, Hogne Nersund
This thesis describes the development and application of a tool to assess and document the life cycle greenhouse gas emissions of municipalities and other public-service providers. The model is linked to the financial accounting system of municipalities and counties to calculate the Carbon Footprint (CF) of all purchases/activities made. In particular indirect emissions (Scope 3 according to the greenhouse gas (GHG) protocol) will effectively be accounted for with this system. One of the main findings of the thesis is indeed the importance of Scope 3 emissions to the total CF of the cases investigated. Within the local climate action framework, this thesis focuses on the CF resulting from the activities of the municipal/county administration. This will largely be the provision of services. Insights in the structure of the CF of services will therefore be provided in the papers presented in the thesis. Results show that direct GHG emissions from the burning of fossil fuels are not very significant. At the same time, indirect GHG emissions embodied in the purchase of products and services from sub-suppliers are very significant. Furthermore, when time series are investigated, we identify a shift from direct emissions (e.g. the combustion of diesel in municipal vehicles) to indirect Scope 3 emissions (e.g. the purchase of transportation services from a private company). This outsourcing of activities indicates a necessary shift to complete consumption-based inventories that include all direct and indirect GHG emissions in developing comparable indicators of sustainability. The comparability of municipal CFs is the focus of one of the papers in the thesis. In the paper, we investigate how the CF of all Norwegian municipalities compares to a set of key characteristics. The main finding here is that the CF is highly dependent on both municipal wealth and municipal size. Small and wealthy municipalities tend to have a significantly higher CF per capita relating to the
Ombelet, Willem; Cooke, Ian; Dyer, Silke; Serour, Gamal; Devroey, Paul
BACKGROUND Worldwide more than 70 million couples suffer from infertility, the majority being residents of developing countries. Negative consequences of childlessness are experienced to a greater degree in developing countries when compared with Western societies. Bilateral tubal occlusion due to sexually transmitted diseases and pregnancy-related infections is the most common cause of infertility in developing countries, a condition that is potentially treatable with assisted reproductive technologies (ART). New reproductive technologies are either unavailable or very costly in developing countries. This review provides a comprehensive survey of all important papers on the issue of infertility in developing countries. METHODS Medline, PubMed, Excerpta Medica and EMBASE searches identified relevant papers published between 1978 and 2007 and the keywords used were the combinations of ‘affordable, assisted reproduction, ART, developing countries, health services, infertility, IVF, simplified methods, traditional health care'. RESULTS The exact prevalence of infertility in developing countries is unknown due to a lack of registration and well-performed studies. On the other hand, the implementation of appropriate infertility treatment is currently not a main goal for most international non-profit organizations. Keystones in the successful implementation of infertility care in low-resource settings include simplification of diagnostic and ART procedures, minimizing the complication rate of interventions, providing training-courses for health-care workers and incorporating infertility treatment into sexual and reproductive health-care programmes. CONCLUSIONS Although recognizing the importance of education and prevention, we believe that for the reasons of social justice, infertility treatment in developing countries requires greater attention at National and International levels. PMID:18820005
Ponnusamy, Vellapandian; Grove, J Robert
Factors relevant to the working alliance between athletes and sport psychology consultants were investigated in a sample of elite Malaysian athletes (n = 217). The athletes represented a variety of team and individual sports, and they provided information about the perceived importance of seven consultant characteristics/behaviors as well as seven program delivery options. At a full-sample level, general preferences were expressed for consultants to lead a physically active lifestyle, regularly attend training sessions and competitions, and have prior experience as an athlete or coach. General preferences were also expressed for program content to be determined by the coach or consultant, and for regular, small doses of mental skills training to be delivered in a face-to-face context throughout the year. At a sub-group level, team sport athletes had stronger preferences than individual sport athletes for program delivery on a group/team basis, while individual sport athletes had stronger preferences than team sport athletes for having a role in determining program content. Findings are discussed in relation to dominant value themes within Malaysian society and the reinforcement of these themes within specific sport subcultures. Key pointsConsultant characteristics and program delivery methods have an impact on the effectiveness of sport psychology services.Preferred consultant characteristics and preferred methods of delivery may be affected by cultural and subcultural values.Elite Malaysian athletes prefer consultants to lead a physically active lifestyle; to regularly attend training/competition; and to have prior experience as an athlete or coach.Elite Malaysian athletes also prefer that the coach or consultant determine program content, and that mental skills training take place in a face-to-face context throughout the year.
Ponnusamy, Vellapandian; Grove, J. Robert
Factors relevant to the working alliance between athletes and sport psychology consultants were investigated in a sample of elite Malaysian athletes (n = 217). The athletes represented a variety of team and individual sports, and they provided information about the perceived importance of seven consultant characteristics/behaviors as well as seven program delivery options. At a full-sample level, general preferences were expressed for consultants to lead a physically active lifestyle, regularly attend training sessions and competitions, and have prior experience as an athlete or coach. General preferences were also expressed for program content to be determined by the coach or consultant, and for regular, small doses of mental skills training to be delivered in a face-to-face context throughout the year. At a sub-group level, team sport athletes had stronger preferences than individual sport athletes for program delivery on a group/team basis, while individual sport athletes had stronger preferences than team sport athletes for having a role in determining program content. Findings are discussed in relation to dominant value themes within Malaysian society and the reinforcement of these themes within specific sport subcultures. Key points Consultant characteristics and program delivery methods have an impact on the effectiveness of sport psychology services. Preferred consultant characteristics and preferred methods of delivery may be affected by cultural and subcultural values. Elite Malaysian athletes prefer consultants to lead a physically active lifestyle; to regularly attend training/competition; and to have prior experience as an athlete or coach. Elite Malaysian athletes also prefer that the coach or consultant determine program content, and that mental skills training take place in a face-to-face context throughout the year. PMID:25177193
Makropoulos, C; Rozos, E; Tsoukalas, I; Plevri, A; Karakatsanis, G; Karagiannidis, L; Makri, E; Lioumis, C; Noutsopoulos, C; Mamais, D; Rippis, C; Lytras, E
Water scarcity, either due to increased urbanisation or climatic variability, has motivated societies to reduce pressure on water resources mainly by reducing water demand. However, this practice alone is not sufficient to guarantee the quality of life that high quality water services underpin, especially within a context of increased urbanisation. As such, the idea of water reuse has been gaining momentum for some time and has recently found a more general context within the idea of the Circular Economy. This paper is set within the context of an ongoing discussion between centralized and decentralized water reuse techniques and the investigation of trade-offs between efficiency and economic viability of reuse at different scales. Specifically, we argue for an intermediate scale of a water reuse option termed 'sewer-mining', which could be considered a reuse scheme at the neighbourhood scale. We suggest that sewer mining (a) provides a feasible alternative reuse option when the geography of the wastewater treatment plant is problematic, (b) relies on mature treatment technologies and (c) presents an opportunity for Small Medium Enterprises (SME) to be involved in the water market, securing environmental, social and economic benefits. To support this argument, we report on a pilot sewer-mining application in Athens, Greece. The pilot, integrates two subsystems: a packaged treatment unit and an information and communications technology (ICT) infrastructure. The paper reports on the pilot's overall performance and critically evaluates the potential of the sewer-mining idea to become a significant piece of the circular economy puzzle for water. Copyright © 2017 Elsevier Ltd. All rights reserved.
Akingbade, A.O.; Navarra, D.D.; Georgiadou, P.Y.; Zevenbergen, J.A.
This paper examines the role of the Abuja geographic information systems as an e-government policy initiative for promoting the reduction in corruption in the provision of e-land administration services and good governance in general. The paper explores the contribution of e-land administration with
Aantjes, Carolien J; Gilmoor, Andrew; Syurina, Elena V; Crankshaw, Tamaryn L
OBJECTIVE: To conduct a systematic review of the status of post-abortion care (PAC) provision in Eastern and Southern Africa with particular reference to reach, quality and costs of these services. STUDY DESIGN: We searched Pubmed, EMBASE, Science Direct, POPLINE and Web of Science for articles
Terefe, T.; Lee, van der J.
This study was conducted in the Dale and Shebedino districts of southern Ethiopia during the period October 2014 to January 2015. It investigates dairy-related input and service provision in mixed crop-livestock production systems. Data were collected from 120 dairy producers, six focus group
de Blok, Carolien; Meijboom, Bert; Luijkx, Katrien; Schols, Jos
Practical implementation of notions such as patient-orientation, client-centredness, and demand-driven care is far from straightforward in care and service supply to elderly clients living independently. This paper aims to provide preliminary insights into how it is possible to bridge the gap between policy intent, which reflects an increasing client orientation, and actual practice of care and service provision. Differences in personal objectives and characteristics generate different sets of needs among elderly clients that must have an appropriate response in the daily routines of care and service providers. From a study of the available literature and by conceptual reasoning, we identify several important operational implications of client-oriented care and service provision. To deal with these implications the authors turn to the field of operations management. This field has deepened the understanding of translating an organisation's policy into daily activities and working methods. More specifically, we elaborate on the concept of modularity, which stems from the field of operations management. With respect to elderly people who live independently, this concept, among others, seems to be particularly useful in providing options and variation in individual care and service packages. Based on our line of reasoning, we propose that modularity provides possibilities to enhance the provision of demand-based care and services. Furthermore, our findings offer direction on how organisations in housing, welfare and care can be guided in translating demand-based care to their operational processes.
Full Text Available The paper stresses on understanding citizens’ trust to local government authorities in the provision of social services, the case of education service in Maswa district. The paper discloses that majority of respondents of 82.2% of total respondents were not involved in full council meetings, although the meetings are supposed to be open to the public and all information that is presented there is public information which includes proposed plans and budgets as well as quarterly progress reports. This shows that there are problems in primary education. Moreover, due to various problems that still exist in primary education in the area under study, they created a sense of distrust between citizens to local government and local leaders to be specific including Village Executive Officers, Ward Executive Officers and councilors since majority of the respondents revealed that they are lazy harass people. This makes people to be reluctant to participate in development activities include refusing to contribute financially in various development initiatives since they do not see importance of their local leaders so they decide to take their own decisions.