Flexible Service Delivery Research Articles

Conflict-Related Breakdowns in Routine Medical Care - Longitudinal Outcomes for Civilians with Pre-Existing Cognitive Impairment.

Individuals with dementia face increased vulnerability during crises like armed conflicts. However, little is known about how conflicts affect dementia care delivery and patients' health. We conducted a longitudinal cohort study using medical record data. The study included 23,733 adults aged≥65 years with a diagnosis of dementia and 249,749 matched adults without dementia. Data were collected at baseline (March-October 2023), and two follow-up timepoints (December 2023 and February 2024), bracketing an armed conflict between Israel and Palestinian militant groups that began on October 7, 2023. We compared changes over time in clinical characteristics, medication use, healthcare utilization, costs between groups. Dementia prevalence was stable, but psychotropic medication use declined more sharply in those with dementia. Rates of depression diagnoses fell, and obesity rose in both groups. Healthcare utilization decreased substantially post-conflict, with fewer outpatient visits, hospitalizations, and emergency visits. Cost divergence between groups also increased over time. Machine learning identified shifting clusters of service users from high to mainly low users' post-conflict. The conflict severely disrupted routine dementia care and altered health behaviors. Flexible service delivery and access promotion strategies are needed to support vulnerable populations like people with dementia during crises.

Looking at Tuberculosis Through the Lens of the Vulnerable Population in Parañaque City

This study aimed to support Tuberculosis (TB) advocacy and demand generation initiatives by documenting the experiences of selected population groups in Parañaque City, Philippines. It explored vulnerable populations' perspectives on tuberculosis, health promotion activities, challenges in maintaining health, and access points to health services and information. Through focus group discussions and key informant interviews, 22 elderly individuals, 18 tricycle drivers, 12 barangay health workers, and two public health nurses participated in the study. The findings highlighted various aspects of TB knowledge and awareness, including identification, risk factors, lifestyle, and treatment. The themes that emerged around understanding TB identification included perceived susceptibility, misconceptions, and treatment approaches. Participants' experiences underscored access to information and services, health-seeking behavior, and emotional responses regarding TB. Challenges identified included household situations, perceived stigma, and discrimination, shedding light on community attitudes. Varying perceptions of healthcare services were noted, with some valuing free services at health centers while others found access challenging. The study also underscores the importance of community TB knowledge, tailored healthcare, stigma reduction, and ensuring access to health programs, particularly for vulnerable groups. Advocacy recommendations include maximizing community-based information sharing through training, developing tailored health education approaches, and enhancing health literacy materials. Furthermore, advocating for flexible healthcare service delivery options, stigma reduction activities, and increased community engagement efforts are crucial. These measures are vital for effective TB control and improving overall community wellbeing, particularly in addressing the unique needs of vulnerable populations.

EXPLORING THE EVERYDAY EXPERIENCES OF FAMILY CAREGIVERS OF PEOPLE LIVING WITH DEMENTIA: A LONGITUDINAL DIARY STUDY

Abstract People living with dementia rely largely on the support of unpaid family caregivers to remain living at home in the community. The strain created by this dependence is evidenced by high rates of distress among caregivers of people living with dementia and underscores the importance of access to appropriate formal and informal supports for this group. Providing tailored and meaningful supports and services to families requires a good understanding of the multidimensional and dynamic nature of the caregiving experience. Our study employed longitudinal qualitative methodology to understand how caregivers of people living with dementia were experiencing progression of the disease and shifting support needs over a two year-period. Fourteen family caregivers in British Columbia, Canada, wrote monthly diaries reflecting on their experience of caregiving and navigating supports. Thematic analysis of 137 diary entries shed light on different facets of caregiving experience, including psychological and emotional challenges (e.g., feeling overwhelmed, lacking a sense of control, trouble maintaining sense of self) and difficulties navigating formal care and supports (e.g., lack of access to services and information, lack of flexibility in service delivery). However, accounts also reflected participants’ resilience, through a range of coping strategies adopted to resolve problems encountered in caregiving, drawing on emotional and practical support from family, friends, and community. The diaries offer critical perspectives on gaps and inadequacies in formal supports for family caregivers and opportunities to better support the health and wellness of caregivers and recipients through dementia care policy and practice.

Changes in opioid treatment programs and harm reduction provider services during the COVID-19 pandemic: Findings from 10 states.

Harm reduction and opioid treatment programs (OTPs) modified service delivery based on rapid changes to state and federal regulations during the COVID-19 pandemic. There is little evidence on how these regulations changed the delivery of medication for opioid use disorder and harm reduction services and whether certain regulations should be made permanent. This study explores how harm reduction OTPs across the United States leveraged changes in regulations and responded to impacts of COVID-19 to continue providing services and perspectives on future legislation that regulates their practice and practice sites. The COVID Harm Reduction and Treatment programs Survey study administered a survey that included closed-ended and free-response questions to 22 sites between August 2020 and January 2021. Program demographics and responses to survey items pertaining to site and service modifications were tabulated and proportions reported. A qualitative descriptive method was used to analyze free-response questions. All (100%) surveyed providers reported the need to modify their services. The majority (68%) reported an increase or no change in client volume; 68% reported increases in naloxone services and 77% reported increases in syringe services programs. Qualitative themes included (a) flexibility in reaching clients due to regulatory changes, (b) benefits and drawbacks of telehealth, and (c) increased vulnerabilities of their clients during the pandemic. Despite difficulties during the COVID-19 pandemic, harm reduction and OTP sites found that regulatory changes provided flexibility in service delivery and that they were better able to serve their clients. Future policies should bolster these sites to continue to provide low-barrier and high-quality services. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Team-based continuity of care for patients with hypertension: a retrospective primary care cohort study in Hong Kong.

Continuity of care (COC) is associated with improved health outcomes in patients with hypertension. Team-based COC allows more flexibility in service delivery but there is a lack of research on its effectiveness for patients with hypertension. To investigate the effectiveness of team-based COC on the prevention of cardiovascular disease (CVD) and mortality in patients with hypertension. A retrospective cohort study in a primary care setting in Hong Kong. Eligible patients included those visiting public primary care clinics in Hong Kong from 2008 to 2018. The usual provider continuity index (UPCI) was used to measure the COC provided by the most visited physician team. Cox regression and restricted cubic splines were applied to model the association between the COC and the risk for CVDs and all-cause mortality. This study included 421 640 eligible patients. Compared with participants in the lowest quartile of UPCI, the hazard ratios for overall CVD were 0.94 (95% CI = 0.92 to 0.96), 0.91(95% CI = 0.89 to 0.93), and 0.90 (95% CI = 0.88 to 0.92) in the second, third, and fourth quartiles, respectively. A greater effect size on CVD risk reduction was observed among the patients with unsatisfactory blood pressure control, patients aged <65 years, and those with a Charlson comorbidity index of <4 at baseline (Pinteraction<0.05 in these subgroup analyses), but the effect was insignificant among the participants with an estimated glomerular filtration rate of <60 ml/ min/1.73 m2 at baseline. Team-based COC via a coordinated physician team was associated with reduced risks of CVD and all-cause mortality among patients with hypertension, especially for the patients with unsatisfactory blood pressure control. Early initiation of team-based COC may also achieve extra benefits.

Impact on Teacher Ratings &amp; Perceptions of Efficacy of a 3:1 Model of OT Service Delivery

Abstract Date Presented 04/22/2023 This study evaluated educator perceptions of school-based OT services before and after implementation of a collaborative, flexible service delivery model. Results support contextually embedded school-based OT services. Primary Author and Speaker: Matia Gjellstad

Mobile Payments Affordance as a Driver for End User Entrepreneurship

This explorative study uses the affordance theory to offer an in-depth understanding of how mobile payment affordances are unconventionally facilitating the rise of end-user entrepreneurs, and to explore why these end-user entrepreneurs expand and commercialize their creative ideas. Qualitatively, the researchers interviewed 20 end-user entrepreneurs in eight merchant firms. The data suggest that six significant affordances may serve as motivating factors for the merchant to switch to end-user entrepreneurship. These affordances are the following: i) incorporating informal peer-to-peer business approach; ii) frequent and small transactions settling; iii) greater flexibility in service delivery; iv) new business model development; v) informal finance networks; and vi) financial affordance. Employing a developing economy perspective with a particular focus on Ghana, this paper contributes to both the mobile payment research and end-user entrepreneurial studies, extending the existing knowledge in the area and providing interesting opportunities for future studies.

Trends, barriers and enablers to measles immunisation coverage in Saskatchewan, Canada: A mixed methods study.

Many social, cultural, and systemic challenges affect the uptake of measles immunisation services. Prior studies have looked at the caregivers' perspectives, but little is known about the perspectives of the health care providers on the barriers of measles immunisation services in Canada. This study examined measles immunisation coverage trends across the regional health authorities in Saskatchewan and explored the barriers and enablers to measles immunisation coverage from providers' perspectives. The study adopted an explanatory sequential mixed method. We utilized the entire population of 16,582 children under two years of age available in the Saskatchewan Immunisation Management System (SIMS) registry for 2002 and 2013 in aggregate format and interviewed 18 key informants in pre-determined two-stages in 2016 and 2017. The quantitative analysis was done with Joinpoint regression modelling, while the qualitative interview data was analyzed using hybrid inductive and deductive thematic approaches. There was a 16.89%-point increase in measles immunisation coverage in the province from 56.32% to 73.21% between 2002 and 2013. There was also a persistently higher coverage among the affluent (66.95% - 82.37%) than the most deprived individuals (45.79% - 62.60%) in the study period. The annual rate of coverage change was marginally higher among the most deprived (16.81%; and average annual percentage change (AAPC) 2.0, 95% CI 1.7-2.2) than among the affluent group (15.42% and AAPC 3.0; 95% CI 2.0-4.0). While access-related issues, caregivers' fears, hesitancy, anti-vaccination challenges, and resource limitations were barriers to immunisation, improving community engagement, service delivery flexibility, targeted social responses and increasing media role were found useful to address the uptake of measles and other vaccine-preventable diseases immunisation. There is low coverage and inequity in measles immunisation uptake in Saskatchewan from social and institutional barriers. Even though there is evidence of disparity reduction among the different groups, the barriers to increasing measles immunisation coverage have implications for the health of the socio-economically deprived groups, the healthcare system and other vaccination programs. There is a need to improve policy framework for community engagement, targeted programs, and public health discourse.

The transition of a mental health facility to a COVID-19 isolation ward and unit to deliver remote inpatient mental health care

Throughout the COVID-19 pandemic, mental health services were confronted with significant challenges and mental health staff have not only had to provide a continued service for, often distressed, service users but have had to adapt practice and comply with the ever-changing public guidelines for containing the virus. There is a pressing need, therefore, to learn from the challenges that mental health services have faced and continue to face throughout different stages of the pandemic. While uncertainty is inevitable in pandemics, mental health nurses as a community can learn from individual experiences of adaptation. This article describes the unique and rapid transition of one Irish mental health facility to a COVID-19 isolation ward and unit for delivery of remote admission to a mental health service (home care admission). In order to capture this transitory experience, the areas discussed include preparation of the site, key challenges and the role of nursing staff, mental health service delivery, managing home care packages, the nurse management role and remote ward nursing. This discussion demonstrates how one mental health setting successfully evolved and met the challenges brought by the global pandemic through a combination of adaptability and flexibility in service delivery.

Prioritizing Flexibility, Human Connection, and Representation: Findings from the Qualitative Process Evaluation of the Special Projects of National Significance Black Men Who Have Sex with Men Initiative.

Previous research has identified significant unmet need for behavioral health care services for Black men who have sex with men (Black MSM); this challenge has been linked to poorer overall health and well-being. Health Resources and Services Administration (HRSA) funded a Special Projects of National Significance (SPNS) Initiative, Implementation of Evidence-Informed Behavioral Health Models to Improve HIV Health Outcomes for Black Men who have Sex with Men, with a goal to integrate behavioral health and clinical care services using four different evidence-informed models of care, ultimately improving HIV health outcomes. NORC at the University of Chicago conducted a multisite evaluation to assess the success of this Initiative, including a qualitative process evaluation that examined adaptations, services, integration activities, recruitment methods, and fidelity. The process evaluation described methods and processes used by demonstration sites to achieve their goals. This included challenges or barriers to implementation and the associated adaptations, notably due to the COVID-19 Public Health Emergency. Our study found key themes that indicated successful implementation were flexible service delivery, human connection, and client representation. We recommend future replicators apply these lessons learned in diverse health care and community settings that serve Black MSM. Additional information about the interventions can be found on TargetHIV.

Health service approaches to providing care for people who seek treatment for obesity: identifying challenges and ways forward

This paper aims to identify challenges in current health service approaches to providing optimal care for people who seek treatment for obesity. Type of program or service: Health service management of obesity in Australia Methods: Drawing on lived experience, clinical and academic perspectives, and available evidence, we reflect on the current state of the healthcare system to support people seeking treatment for obesity. We suggest actions to enable effective, acceptable and equitable care for this group of people. Identified challenges include the complexity of care required to adequately manage obesity, existing service capability and capacity, and high out-of-pocket patient costs. To address these challenges, a comprehensive response is required at all levels of the healthcare system. As a starting point, we propose eight areas of action: partner with people living with obesity; eliminate weight stigma; increase healthcare professional education, guidelines and resources; establish clear referral pathways and working partnerships; scale services to meet demand; ensure flexible and accessible service delivery; implement changes to the Medicare Benefits Schedule to increase service provision and pursue opportunities for subsidised medicines.

Speech pathologists’ perspectives when managing adults following traumatic brain injury in community-based rehabilitation settings: A qualitative investigation

Purpose: Across Australia and New Zealand, speech-language pathologists (SLPs) routinely assess and treat adults with cognitive-communication disorders following traumatic brain injury (TBI). Despite their regular involvement, little is known about how clinicians provide management to this client group, particularly in community-based contexts. Therefore the aim of this study is to explore the clinical practices of SLPs who have experience working in community-based rehabilitation services with adults with cognitive-communication disorders following TBI. Method: A qualitative descriptive study using one-on-one semi-structured interviews was conducted as part of an explanatory sequential mixed-methods design. Fourteen SLPs with experience working with individuals with TBI completed an interview with content analysis used to explore the data. Result: The overarching theme identified was that a “Client-centred and inclusive approach to community-based rehabilitation services” is required. The three subthemes to emerge from the data included the importance of utilising a (1) “flexible service delivery approach”, with (2) “meaningful therapy focus”, and (3) “collaboration” with multidisciplinary team members and significant others when managing this client group. Conclusion: SLPs play a crucial role in client-centred inclusive rehabilitation for community-dwelling adults with cognitive-communication disorders following TBI. The complexity of working with this population requires current and future models of care to incorporate an interdisciplinary approach that is flexible in its delivery and meaningful in focus.

Factors influencing the success of telepractice during the COVID-19 pandemic and preferences for post-pandemic services: An interview study with clinicians and parents.

BackgroundThere has been a significant uptake in the use of telepractice during the coronavirus SARS‐CoV‐2 (COVID‐19) pandemic. This study explored the experiences of speech and language therapists (SLTs), assistants (SLTAs) and parents with telepractice during the COVID‐19 pandemic.Aims(1) To identify factors that influenced success of telepractice; and (2) to describe clinicians’ and parents’ preferences for the future mode of service delivery for preschoolers with communication disorders.Methods & ProceduresThe study was conducted in partnership with one publicly funded programme in Ontario, Canada, that offered services to preschoolers with speech, language and communication needs at no cost. SLTs (N = 13), assistants (N = 3) and parents (N = 13) shared their experiences and perspectives during semi‐structured videoconference interviews.Outcomes & ResultsFactors that influenced the success of telepractice were reported in three categories: the setting (i.e., where and how telepractice was being delivered); the nature of telepractice (i.e., the services that were provided via telepractice); and the individuals (i.e., who was involved in telepractice). These factors were reported to interact with each other. As the needs for each child and family are unique, parents and clinicians reported a preference for a hybrid and flexible service delivery model in the future.Conclusions & ImplicationsThe themes identified in this study can be used by clinicians and managers to consider factors that influence the success of telepractice for children and families.WHAT THIS PAPER ADDSWhat is already known on the subject? Studies conducted before the COVID‐19 pandemic showed that telepractice was an effective and acceptable service approach. However, some clinicians and parents reported wanting to resume in‐person visits. The provision of telepractice services to families with children with communication disorders increased significantly during COVID‐19. What this paper adds to existing knowledge? Parents and clinicians shared factors that influenced the success of telepractice during semi‐structured interviews. Factors were identified in three categories: the setting (i.e., where and how telepractice was being delivered); the nature of telepractice (i.e., the services that were provided via telepractice); and the individuals (i.e., who were involved in telepractice). As each child's and family's needs are unique, parents and clinicians reported a preference for a hybrid and flexible service delivery model in the future. What are the potential or actual clinical implications of this work? SLTs and SLT managers can use the factors identified to discuss with parents and decide whether telepractice may be well suited to the needs of each child and family.

Community-based rehabilitation for adults with cognitive-communication disorders following traumatic brain injury: A mixed methods investigation

ABSTRACT Objective To investigate the experiences and perspectives of speech pathologists when delivering cognitive-communication therapy to adults following traumatic brain injury (TBI). Methods An explanatory sequential mixed methods design was used to explore the practices of speech pathologists working in community-based rehabilitation (CBR) settings. The first participant group completed an in-depth online survey, whilst the second group participated in an interview to discuss their processes and recommendations when managing adults following TBI. Results Participants highlighted the need for services to be client-centered and inclusive in their approaches to meet the rehabilitation needs of people following TBI in community-based settings. The key features identified to achieve this included utilizing a flexible service delivery approach, implementation of meaningful therapy, as well as inclusion of significant others. Conclusions These findings provide a snapshot of the current practices employed by a range of speech pathology services across Australia and New Zealand. Health professionals and rehabilitation service providers should consider the key factors highlighted by the participants when designing future CBR models of care for this client group.

Harnessing Organizational Leadership and Cultural Competence to Attract and Retain Quality Teachers: The Case of Inner-City Schools

Strategic investments in organizational leadership within the education sector can reap significant dividends in attracting and retaining quality teachers. These investments include comprehensive cultural competency training for all school administrators, teachers, and staff as well as the inclusion of these groups in creating a collaborative organizational culture. Such investments are particularly important in inner-city schools, where research reveals that cultural incompetence and the absence of a collaboratively developed organizational plan contribute to high levels of teacher attrition and substantial difficulties in attracting new teachers. Because scholarship has already recognized and identified the problem of attracting talented teachers to low-income and urban districts, this article takes the next step to suggest novel evidence-based solutions to the problem. Central to this approach is the school administrator’s responsibility to build an organizational culture that ensures equity, educational rigor, and opportunities for meeting teachers’ and administrators’ work-related needs. Building this culture requires (a) delivery of empirically supported cultural competency training; (b) self-assessments of management style to create an approach designed to enhance employee satisfaction; (c) creation of a shared vision and organizational leadership plan designed to make the work environment more attractive and satisfying to current and prospective teachers; and (d) development of a flexible yet practical service delivery framework that enables employees’ workplace needs to be met. In creating this culture, we argue that inner-city teacher attraction and retention rates can be dramatically improved.

Mental Health Service User and Worker Experiences of Psychosocial Support Via Telehealth Through the COVID-19 Pandemic: Qualitative Study.

BackgroundDuring the COVID-19 pandemic, we saw telehealth rapidly become the primary way to receive mental health care. International research has validated many of the benefits and challenges of telehealth known beforehand for specific population groups. However, if telehealth is to assume prominence in future mental health service delivery, greater understanding of its capacity to be used to provide psychosocial support to people with complex and enduring mental health conditions is needed.ObjectiveWe focused on an Australian community-managed provider of psychosocial intervention and support. We aimed to understand service user and worker experiences of psychosocial support via telehealth throughout the COVID-19 pandemic.MethodsThis study was jointly developed and conducted by people with lived experience of mental ill health or distress, mental health service providers, and university-based researchers. Semistructured interviews were conducted between August and November 2020 and explored participant experiences of receiving or providing psychosocial support via telehealth, including telephone, text, and videoconferencing. Qualitative data were analyzed thematically; quantitative data were collated and analyzed using descriptive statistics.ResultsService users (n=20) and workers (n=8) completed individual interviews via telephone or videoconferencing platform. Service users received psychosocial support services by telephone (12/20, 60%), by videoconferencing (6/20, 30%), and by both telephone and videoconferencing (2/20, 10%). Of note, 55% (11/20) of service user participants stated a future preference for in-person psychosocial support services, 30% (6/20) preferred to receive a mixture of in-person and telehealth, and 15% (3/20) elected telehealth only. Two meta-themes emerged as integral to worker and service user experience of telehealth during the pandemic: (1) creating safety and comfort and (2) a whole new way of working. The first meta-theme comprises subthemes relating to a sense of safety and comfort while using telehealth; including trusting in the relationship and having and exercising choice and control. The second meta-theme contains subthemes reflecting key challenges and opportunities associated with the shift from in-person psychosocial support to telehealth.ConclusionsOverall, our findings highlighted that most service users experienced telehealth positively, but this was dependent on them continuing to get the support they needed in a way that was safe and comfortable. While access difficulties of a subgroup of service users should not be ignored, most service users and workers were able to adapt to telehealth by focusing on maintaining the relationship and using choice and flexibility to maintain service delivery. Although most research participants expressed a preference for a return to in-person psychosocial support or hybrid in-person and telehealth models, there was a general recognition that intentional use of telehealth could contribute to flexible and responsive service delivery. Challenges to telehealth provision of psychosocial support identified in this study are yet to be fully understood.

The impact of COVID-19 on substance use disorder treatment in California: Service providers' perspectives

BackgroundThe COVID-19 pandemic has had a profound impact on the U.S. health care system, including addiction treatment. The objective of this study is to describe the impact of COVID on the delivery of treatment for substance use disorders (SUDs) from the perspectives of service providers. MethodsBetween May and September 2020, 61 service providers from 16 SUD treatment sites in California participated in virtual focus groups that lasted about an hour. We recorded the discussions and transcribed them verbatim. Two qualitative analysts independently conducted content analysis to identify themes from the transcripts. ResultsAt the beginning of the pandemic, service providers observed a slight decrease in patient admissions, followed by an uptick in patient flow due to increased mental health issues, alcohol use, and relapse. Many of the clinics adopted flexible service delivery modes, such as curbside dosing and extended take-home medication, to enable social distancing in clinic settings. Approximately half of the clinic encounters offered telemedicime, and a considerable proportion of patients preferred to use telephone-based services rather than video-based services. Internet instability and technical difficulties limited the use of telemedicine among their patients. ConclusionCOVID has been challenging for SUD treatment, but health care systems rapidly reacted with adjustments that may result in long-term changes in SUD service delivery. Telemedicine-based services have played a major role in ensuring uninterrupted patient care. Providers need organizational, technical, and logistical support to improve and sustain telemedicine services that increase access to quality care for their patients.

Impact of the COVID-19 pandemic on interventional radiology services across the world

AIMTo review data on the impact of the COVID-19 pandemic on interventional radiology (IR) services.MATERIALS AND METHODSA systematic review of the available studies was performed according to the PRISMA guidelines.RESULTSA total of 14 studies met the inclusion criteria. IR caseload reduced between 16.8–80%, with elective activity affected more than emergency work. Trainees also experienced a 11–51.9% reduction in case volumes and many were redeployed to critical care. IR departments re-organised operations and personnel, and many continued to offer 24/7 services and support critical care areas through redeployment of staff. The majority of studies report no significant issues with the availability of personal protective equipment and that local or national governing body or radiology society guidelines were followed.CONCLUSIONThe COVID-19 pandemic reduced case volumes and training opportunities. IR departments showed flexibility in service delivery. The lessons learned offer novel insights into how services and training can be reorganised to ensure that IR continues to thrive.

Productive Aging During COVID-19 - Lessons from WH SeniorLink

<h3>Introduction</h3> According to the National Academies of Science, Medicine, and Engineering, even before the pandemic, 24% of Americans 65+ were considered socially isolated, and 43% of adults 60+ were lonely. Both experiences are associated with serious physical and mental health problems, including increased risks of dementia, stroke, depression, and suicidal ideation. As older adults engage in stricter social distancing to protect themselves from COVID-19, their risk of social isolation and loneliness is heightened. According to research by the Kaiser Family Foundation, 46% of adults 65+ reported that the worry and stress caused by pandemic has had a negative impact on their mental health. In order to combat this unique challenge, we must employ innovative, flexible solutions that adapt to the shifting circumstances and an uncertain future. <h3>Methods</h3> WH SeniorLink has developed an innovative program for integrating friendly visiting, mutual aid, needs assessment and case management, all delivered remotely by trained volunteers. The program was conceived, developed and executed since the beginning of COVID-19 restrictions and has grown to become a fully fledged 501(c)(3) organization, and is a model of flexible service delivery during this unusual time. The program operates through a volunteerism-mutual aid model. Volunteers are trained using online modules and quizzes and supervised by a licensed social worker, including training on needs and risk assessment. Volunteers are then matched with an older adult with similar interests and language preferences to provide friendly weekly phone calls, care packages and letters. Older adults with higher needs are referred to WH SeniorLink's service navigation program which operates using the online platform, Apricot, and is staffed by masters level social work interns and supervised by licensed social workers. Service navigation involves conducting comprehensive assessments and identifying resources and referrals. Older adults who express interest are also paired with each other to provide social support. Barriers to program development have included identifying consistent funding sources and volunteer attrition. <h3>Results</h3> Data shows 169% growth in contacts made with older adults between May and October, with 2.5 times more older adults served in November than in May. Initial responses to the Dejong Gierveld Loneliness Scale and qualitative data collection reflect that older adults continue to feel lonely and isolated in the midst of the pandemic, but that WH SeniorLink is helping. By placing emphasis on empowering older adults to form sustained relationships with volunteers and their peers, WH SeniorLink encourages reciprocal relationships through which older adult participants are valued for their experiences and contributions. <h3>Conclusions</h3> The mission of WH SeniorLink is to strengthen community ties and improve health outcomes among older New Yorkers by providing social-emotional support and connection to essential services. WH SeniorLink was founded during the COVID-19 pandemic, in response to the myriad of new challenges faced by older adults including greater risk of social isolation and increased disconnection from essential services. However, we recognize that the pandemic has only exacerbated a problem that began long before, and older adults are at risk of being left behind in the coming months and beyond. <h3>Funding</h3> WH SeniorLink is funded by a starter grant from Columbia School of Social Work and subsequent crowdfunded donations.

Octans: Optimal Placement of Service Function Chains in Many-Core Systems

Network Function Virtualization (NFV) offers service delivery flexibility and reduces overall costs by running service function chains (SFCs) on commodity servers with many cores. Existing solutions for placing SFCs in one server treat all CPU cores as equal and allocate isolated CPU cores to network functions (NFs). However, advanced servers often adopt Non-Uniform Memory Access (NUMA) architecture to improve the scalability of many-core systems. CPU cores are grouped into nodes, incurring performance degradation due to cross-node memory access and intra-node resource contention. Our evaluation shows that randomly selecting cores to place NFs in an SFC could suffer from 39.2 percent lower throughput comparing to an optimal placement solution. In this article, we propose Octans, an NFV orchestrator to achieve maximum aggregate throughput of all SFCs in many-core systems. Octans first formulates the optimization problem as a Non-Linear Integer Programming (NLIP) Model. Then we identify the key factor for problem solving as evaluating the throughput drop of an NF caused by other NFs in the same SFC or different SFCs, i.e., performance drop index, and propose a formal and accurate prediction model based on system level performance metrics. Finally, we propose two online algorithms to quickly find near-optimal placement solutions for one-time and incremental deployment. Extensive evaluation on a prototype implementation shows that Octans significantly improves the aggregate throughput comparing to two state-of-the-art placement solutions by 27.1 ~ 45.2 percent for one-time deployment and by 20.9 ~ 38.1 percent for incremental deployment, with very low prediction errors. Moreover, Octans could quickly find a near-optimal placement solution with tiny optimality gap.