Curtailment Of Services Research Articles

Life under lockdown and social restrictions - the experiences of people living with dementia and their carers during the COVID-19 pandemic in England

BackgroundThe impact of COVID-19 restrictions on people living with dementia and their carers is an emerging focus of recent research determining how we can best support this population. People living with dementia have faced service curtailment, increased risk for COVID-19, as well as potential heightened deterioration. This study reports the experiences of people living with dementia and their family carers during the early months of the COVID-19 pandemic in England and the impact on them.MethodsWe recruited and remotely interviewed 30 people living with dementia in their own homes and 31 family carers, via video or telephone call in mid-2020. Data were transcribed and analysed using thematic analysis.ResultsPeople living with dementia often had a basic understanding of COVID-19 restrictions but could have difficulty translating this into personalised risk-appraisal of their own actions. Managing COVID-19 risks facing people living with dementia at home was largely done by family carers, exemplified by changes to living arrangements, which could strain or sustain caring relationships. Well-established familial caring relationships contributed to the wellbeing of the person living with dementia and their carer, as well as keeping to simple routines that included leaving the home for exercise and stimulation. People living with dementia reported some negative psychological and cognitive effects due to the imposed restrictions, such as increased apathy, irritability, or anxiety, which were fuelled by lack of social engagement.ConclusionsStructuring routine (remote) social interactions where possible could increase social engagement and improve wellbeing for people living with dementia, especially those with limited familial support in a post-COVID-19 context. As some care relationships had been restructured to manage COVID-19 risks, additional carer strain may emerge as a result of the impact on the independence of the person living with dementia and come to the attention of professionals in health and care services. People living with dementia and their carers highlighted the importance of maintaining or adapting routines which may be useful learning for professionals, although additional support may be necessary for those who are impacted by more severe or worsening symptoms of dementia.

Policy Implications for the COVID-19 Pandemic in Light of Most Patients (≥72%) Spending at Most One Night at the Hospital After Elective, Major Therapeutic Procedures.

A large number of inpatients with Coronavirus disease 2019 (COVID-19) in some regions of the United States may interfere with the ability of hospitals to take care of patients requiring treatment for other conditions. Nonetheless, many patients need surgery to improve their quality of life and to prevent deterioration in health. Curtailment of services also negatively affects the financial health of hospitals and health systems. Broad policies to prohibit all “elective” surgical procedures to ensure that there is sufficient hospital capacity for pandemic patients may be unnecessarily restrictive because, for many such procedures, patients are rarely admitted following surgery or only stay overnight. We studied all elective inpatient and ambulatory cases involving major therapeutic procedures performed in the state of Florida in 2018. We mapped the primary procedure to the corresponding Clinical Classification Software (CCS) category. We determined the distributions of lengths of stay overall and as stratified by CCS category, then calculated the percentage of cases that had a hospital length of stay of ≤1 night (i.e., 0 or 1 day). A threshold of one night was selected because patients discharged home on the day of surgery have no effect on the inpatient census, and those staying overnight would either have a transient effect or no effect if observed overnight in the postoperative care unit. Among the 1,852,391 elective cases with one or more major therapeutic procedures, 65.2% (95% lower confidence limit [LCL] = 65.1%) of cases had a length of stay of 0 days and 72.9% (95% LCL = 72.8%) had stay ≤1 day. There were 38 different CCS categories for which at least 95% of patients had a length of stay of ≤1 day. There were 28 CCS codes that identified 80% of the patients who were discharged with a length of stay ≤1 day, showing representation of multiple surgical specialties. Our results show that even in the face of constraints imposed by a high hospital census, many categories of major therapeutic elective procedures could be performed without necessarily compromising hospital capacity. Most patients will be discharged on the day of surgery. If overnight admission is required, there would be an option to care for them in the postanesthesia care unit, thus not affecting the census. Thus, policies can reasonably be based on allowing cases with a substantial probability of at most an overnight stay rather than a blanket ban on “elective” surgery or creating a carve-out for specified surgical subspecialties. Such policies would apply to at least 72% of elective, major therapeutic surgical procedures.

Operational reliability of multi-energy customers considering service-based self-scheduling

The developments of energy storage and substitution techniques have made it possible for customers to self-schedule their energy consumption behaviors, to better satisfy their demands in response to uncertain supply conditions. The interdependency of multiple energies, the chronological characteristics, and uncertainties in the self-scheduling context bring about additional complexities to secure the reliable energy requirements of multi-energy customers. As a necessary and challenging task, the operational reliability of multi-energy customers is tackled in this paper. Considering that the consumed energies eventually come down to the energy-related services, the self-scheduling of multi-energy customers is implemented from the perspective of specific energy-related services rather than energy carriers. Firstly, an optimal self-scheduling model for multi-energy customers is developed with the consideration of chronological service curtailment, service shifting and possible failures during service shifting. In the optimal self-scheduling model, the costs of service curtailment and shifting are formulated based on the proposed evaluation method. The time-sequential Monte Carlo simulation approach is applied to model the chronological volatilities of multi-energy demands over the entire study period, embedded with a scenario reduction technique to reduce the computational efforts. Taking full account of the possible scenarios, the quantitative reliability indices of the multi-energy customers can be obtained. The results in test cases demonstrate that the expected energy not supplied of the multi-energy customer drops significantly by 56.32% with the self-scheduling strategy. It can be also concluded that, the self-scheduling and its inherent uncertainties do have significant impacts on the operational reliability of the multi-energy customer.

Testing the accuracy of low-cost data streams for determining single-person office occupancy and their use for energy reduction of building services

We explored methods of detecting occupancy in single-person offices using data already collected by the occupant’s PC, or data from relatively cheap sensors added to the PC. We collected data at 15-s intervals for up to 31 days in each of 28 offices. A combination of low/no cost sensors (webcam-based motion detection, and keyboard and mouse activity) was much more accurate at detecting occupancy than a commercial ceiling-based passive infrared (PIR) sensor, and provided overall daytime accuracy >90%, with very low false negative rates. This enhanced detection performance would enable a reduction in the timeout periods for building service curtailment on space vacancy. For example, lighting switch-off timeout could be reduced from the current energy code standard of 20min to less than 5min, increasing energy savings potential by 25–45%. We then deployed this system in a proof-of-concept demonstration, using it to control lighting, heating, ventilation, and air conditioning (HVAC), and plug loads in a mock-up office environment. Tests were run over nine occupied days (six in cooling season, three in heating season). The system delivered energy savings of 15–68%, with no reported false negative errors.

‘The children not counted’: reports on the deaths of children in the Republic of Ireland

In 2010 it became apparent that no reliable data were available on the deaths of children in contact with social workers in the Republic of Ireland. As a result of this lacuna, in 2011–12, the Independent Child Death Review Group (ICDRG) and the National Review Panel (NRP) published official reports tabulating and partly describing these deaths. A close reading of the reports indicates that practitioner involvement is frequently enmeshed in factors associated with neoliberal imperatives connected to unfilled vacancies, related staffing problems and the rationing and curtailment of services. Following the appearance of the reports, an emerging ‘change agenda’, partly influenced by New Labour in the UK, has sought to chart a way forward. Nevertheless, given that the state remains committed to a more embracing programme of intensive neoliberalisation, efforts seeking ‘reform’ are likely to fail.

P64 Financial planning for uncertainty

Introduction In common with other independent hospices, Weldmar Hospicecare Trust faces considerable uncertainty over the size and nature of future income. This paper describes the financial modelling which allows us...

An integrative approach to threat assessment and management: Security and mental health response to a threatening client

Workplace violence threat assessment and management practices represent an interdisciplinary approach to the diversion of potentially dangerous employees and clients. This case study illustrates such an intervention in a complex situation involving a social service agency and its client. Following a curtailment of services and an arrest, the client developed an escalating homicidal anger toward the agency administrator. Once a Tarasoff warning was received, the agency contacted a security company who organized a threat assessment and management plan involving interdisciplinary collaboration. Information developed in the course of the assessment was presented to prosecutors, who facilitated the client's arrest and involuntary psychiatric commitment until he was judged to be no longer dangerous. This case ultimately involved an integration of the services of security, law enforcement, mental health professionals, prosecutors, the courts and the state mental health system in leading to a successful diversion of the client from a path of intended violence.

Multiple Perspectives in Power Transmission Expansion Planning under Environmental Awareness

Over the past 20 years, most countries have made revolutionary changes in critical infrastructure. One of them is the massive deregulation of infrastructure industries such as the airline, natural gas, trucking, telecommunications, and most recently, the electric power sectors. Traditionally, these infrastructure industries were publicly owned and/or run by vertically integrated, regulated monopolies. Deregulation of these infrastructure industries has brought about decentralization of decision making and has created markets that enable and incentivize customer choices. By empowering consumers to make informed choices, the deregulation movement has fundamentally changed the concepts of pricing and reliability. For example, in an infrastructure industry that is governed by an “obligation to serve,” service curtailment e.g., being bumped off a flight due to overbooking is considered a failure in terms of reliability. By contrast, a deregulated environment is governed by “obligation to serve at a price,” in which service curtailment is no longer counted as a failure but a voluntary action of the customer in exchange for compensation or a cheaper fare . In the electric power industry, the vertical separation of the generation, transmission, and distribution sectors has resulted in new operations and planning paradigms. Planning and investment in the privately owned generation sector is now driven by economic considerations in response to market prices and incentives. The transmission system, on the other hand, is operated by independent transmission organizations that may or may not own the transmission assets. Whether the transmission system is owned by the system operator or by separate owners, the transmission system operator plays a key role in assessing the needs for transmission investments from reliability and economic perspectives, and in evaluating proposed transmission investments. Restructuring has resulted in increased use of transmission infrastructure to support electricity trade. It is sometimes argued that this growing stress has reduced reliability as systems are operated closer to maximum capacity. Meanwhile, investment in the transmission infrastructure has lagged behind power demand growth, which has been mounting around the world. There is a clear need for better methodologies to manage, plan, and incentivize investment in transmission to allow the existing infrastructure to operate more efficiently and securely. In addition to that, the transmission network should be able to accommodate a greater volume of trades and provide transparent transmission prices to support other markets. Furthermore, with aging power plants and old technologies still being used to cope with the rising

Community Activism in the USA: Catholic Hospital Mergers and Reproductive Access

This article analyzes how grassroots organizing diminishes the potential loss of reproductive services in communities affected by Catholic hospital mergers. The empirical contribution of this study is to highlight changing patterns of pro-choice social movement mobilization and approaches to conflict resolution in the reproductive rights arena. To discover how Catholic hospital mergers threaten access to reproductive services, five case studies based in diverse regional and demographic areas throughout the USA are developed. From the case studies, we analyze which organizational factors most strongly influence the preservation of services. Among the variables which may affect outcomes are: characteristics of the acquiring institution, the type of coalition created to terminate the merger, the failure of pro-life activists to counter-mobilize, incentives for compromise on both sides, and regulatory intervention by government or state action. The study concludes that this new phase of the abortion struggle represents renewed vigor among local pro-choice activists and demonstrates that grassroots coalitions who oppose the curtailment of services often preserve reproductive healthcare options in their communities by creating alliances with professionals and other coalition partners.

Gazing into the Crystal Ball: Health Care, Health Policy, and Rehabilitation for Spinal Cord Injury

The US Congress faces a host of health issues that demand immediate attention. Many of these issues are of considerable importance to those persons with spinal cord injury (SCI), including the rising cost of health care and health insurance, the current budget shortfalls facing state governments, and the need for a Medicare prescription drug program. Persons with disabilities are becoming increasingly dependent on public forms of insurance, like Medicare and Medicaid, and are bearing a disproportionate share of service curtailment. Other issues relevant to persons with disabilities and health care providers are prospective payment reimbursement implementation for rehabilitation, the reauthorization of the Rehabilitation Act, and the New Freedom Initiative. Considering the political climate and the importance of such issues, the need for advocacy among professionals and consumers is greater than ever.

Third‐Party Contract Constituted Curtailment of Service under Federal Law

A municipality's contract to provide water service to another municipality encroached on a water district's services and was thus in violation of federal law, according to the US Court of Appeals for the Sixth Circuit.

The Future of Health Care: Military Model? Canadian Cost Cutting?

<h3>To the Editor.—</h3> Dr Bronow¹and the National Organization of Physicians Who Care are properly concerned about the looming changes in physician payment and practice patterns. Many of their fears, though, may not be wholly justified. We need not go as far as Saskatchewan to find an example of a universal-enrollment, managed care system that has served physicians and patients admirably well. The US military medical system provides comprehensive, cradle-to-grave medical care, with no out-of-pocket cost to the patient, to over 9 million people. At a cost of about $1444 per beneficiary,²the system is also more cost-efficient by 28% than the US per capita health care cost and is nearly as cost-efficient as the Canadian and German systems.³Poor, elderly, and chronically ill patients are all cared for. While staffing fluctuations occasionally lead to temporary curtailment of services in military hospitals, the Department of Defence—sponsored insurance

Efficient electricity pricing with self-rationing

Random rationing of generation capacity is inefficient because of the externality caused by an unpriced shortage. We eliminate the inefficiency by introducing a market for capacity via a self-rationing scheme that reflects a consumer's willingness-to-pay for electricity service. This scheme defines the notion of service reliability. We derive the optimal pricing and capacity planning rules under asymmetric information and demand uncertainty. The major findings are: (1) marginal cost pricing is ex ante efficient; (2) an electric utility's installed capacity should equal the total subscription for capacity; (3) the electric utility breaks even with certainty; and (4) partial service curtailment is ex post efficient if consumer preference is weakly separable.

Optimum Load-Shedding Policy for Power Systems

The now classical problem of optimlum dispatching miimizes the cost of production and transmission of electrical power to meet a specified demand under normal operating conditions. It appears logical and desirable to utilize and extend the methodology of optimum dispatching to problems encountered during abnormal operating conditions. This paper, as a first step in that direction, discusses a systematic approach toward minimizing the curtailment of service in a power system after a severe fault. The problem of minimizing load curtailment under a given set of emergency conditions is formulated as a problem of static optimization, subject to operational and equipment constraints. First, a feasible steady-state solution is obtained for the postfault network configuration. Starting from this initial feasible solution, the optinum (minimum curtailment) is approached by a gradient technique. An efficient computational procedure is based on the Newton-Raphson technique for solving the power flow equations, and the Kuhn-Tucker theorem for the optimization. The analytical results are verified on a 26-node example problem. Two typical emergency situations are considered: the loss of generation and the loss of an interconnection tie line. The same optimization procedure and the computed dual (Lagrangian) variables can be utilized for computer programs involving optimum service restoration, generation reserve scheduling, and system expansion studies.

Clarification of Transportation - Policy Goals

The basic principle of transportation policy should be adequate, efficient transportation at reasonable, non-discriminatory cost to users. Early railway growth in the age of great territorial expansion led to a chaos of rates and services, discriminatory treatment of users, and unfair wage and labor practices by the railroads. The original objective in the regulation of railway rates and services was to prevent monopoly and to assure fair competition among the railways themselves and among the communities and industries affected. This has been implemented, but with the constant effort to fix rates which yield "cost plus fair return" to the railways while still maintaining their public-utility function. The uneven railway rate structure thus produced has coupled with vast technological change and diversification in the transportation field to encourage an array of alternative means of transportation to flourish and compete with the railways for business. Certain governmental attitudes underlying regulation have placed railways at a disadvantage in the competition. Furthermore, railway corporations themselves have followed policies of curtailment of services and merger with competing lines. The time has come for a new look, with national scope, at transport conditions with a view to returning to the original objective of regulation to provide adequate service at fair rates and with maximum preservation of competition.

Public Ownership and Tax Replacement by the T.V.A.

The state and county governments in the Tennessee Valley area, particularly in Tennessee, completed 1940 with one of their most pressing financial problems solved or well on the way to solution. The threatened loss of taxes to governmental units, resulting from the program of public ownership of power and the purchase by the Tennessee Valley Authority and the municipalities of the properties of private electrical power companies, had been serious to many counties facing bankruptcy, curtailment of services, or exorbitant taxes. Besides the financial effects, the situation strikingly demonstrated the need for reforms in local government, mainly the consolidation of counties and the introduction of better budgeting and accounting practices. Moreover, the problem has also been significant because of certain issues resulting from the venture into public ownership. Should proprietary agencies of the national government engaged in competition with private business and acquiring existing taxable facilities be responsible for the taxes thereby displaced and replace them as a matter of policy? Are proprietary functions of the national government subject to state and local taxing authority? These issues have demanded widespread consideration not only in the Tennessee Valley area but also in other sections where public power programs are being tried on a large scale. A bill was introduced into Congress on September 30, 1940, to provide for payments to governmental units affected by displacement of taxes arising from the Bonneville Power Project, and a more recent bill applies to the proposed Arkansas Valley Authority Project. The passage of the Norris-Sparkman amendment by Congress in June, 1940, whereby payments in lieu of taxes are being made by the T.V.A., has answered these questions and relieved the pressing financial aspects of the situation. The tax replacement provision has now been in operation more than six months, and an analysis of the period affords an interesting insight into its effects on the various governments concerned.

Transactions preprint of technical papers comprising pages 563–602 of the 1940 volume: Restoration of service on a metropolitan power system

THE purpose of this paper is to outline procedures and discuss pertinent problems that arise when restoring service to a metropolitan system following a major shutdown. In the discussion, consideration is given to the fundamental plan of the system, pointing out the inherent features in the design which prevent such failures. Several cases of trouble which have been the cause of service curtailment have been discussed and the service restoration procedure outlined. A brief outline of the essential procedure is given for two types of service restoration.

Philadelphia's Earned Income Tax

The city of Philadelphia is tapping a new source of revenue for $18,000,000 in 1940. Events leading to its adoption have their basis in the past ten years of financial distress. These events were not peculiar to Philadelphia. They may be found in one form or another as budgetary problems in many leading municipalities of the nation. Outstanding among the factors causing distress in Philadelphia was a 25 per cent decline in the assessed valuation of real property since the peak year 1931. This represented over a billion dollars of valuation and a loss of $20,000,000 in current real estate tax levy. Since current real estate has been the chief source of the city's annual income, the decline resulted in curtailment of essential city services and reduction of personnel.For some years, curtailment of services, reduction in personnel, and the fortunate receipt of large annual sums from delinquent taxes enabled the city to survive the difficulties of the depression. However, the point was reached when these factors no longer sufficed to balance the budget. They were followed by more doubtful financial expedients, namely, overestimating of yearly receipts, floating of current deficits by means of temporary loans, and short-changing of sinking funds through excessive valuation of sinking-fund assets.