Intermediate Services Research Articles

Implementation of the four habits model in intermediate care services in Norway: a process evaluation

BackgroundIntermediate care (IC) services bridge the transition for older patients from the hospital to the home. Despite the goal of involving individuals in their recovery process, these services often become standardised, leading to communication breakdowns. While evidence-based practices, such as the Four Habits Model (4HM), for effective communication are crucial for enhancing high-quality healthcare, research suggests their integration into routine practice remains limited. In this study, we aimed to investigate the implementation process of the 4HM through a two-day course that engaged healthcare professionals and managers in IC.MethodsWe conducted a process evaluation employing qualitative and quantitative methods: (i) individual interviews with three managers and two course participants pre-course, (ii) two focus group interviews with course participants (N = 11) and individual interviews with the same three managers post-course, and (iii) the NoMAD questionnaire (Normalisation MeAsure Development) administered four months later to assess the short- and long-term impact on course participants (N = 14). Reflexive thematic analyses were guided by Normalisation Process Theory (NPT), which offers insight into how new interventions become routine practices. The analysis of the NoMAD involved descriptive statistics.ResultsWe identified four themes in the qualitative data: (i) Decoding Interactions: Making Sense of the 4HM in IC services, (ii) Fostering Change: Legitimising 4HM Through Staff Engagement, (iii) Harmonising Practice: Integrating 4HM into Complex Situations, and (iv) Embedding Value: Normalising the 4HM into Everyday Work. These themes illustrate the normalisation process of the 4HM course within IC, establishing standard practices. Healthcare professionals and managers highlighted the urgent need to integrate communication skills based on the 4HM into daily care. They noted positive changes in their communication habits following the course. The consistent findings from the NoMAD questionnaire underscore the sustainability of implementing the 4HM programme, as participants continue to utilise it in their clinical practice beyond the initial four-month period.ConclusionThe 4HM course programme was deemed feasible for expansion within IC services. Both managers and staff found its focus on addressing communication breakdowns and readiness for change sensible. The study findings may benefit the stakeholders involved in IC service routines, potentially improving services for older patients and relatives.

Does the digital economy really help reduce industrial carbon intensity? Empirical evidence from intermediate inputs of digital products in China.

The booming digital economy is promoting industrial upgrading and transformation, providing an opportunity for the industrial low-carbon development. Based on input-output analysis and panel data regression, the impact of the input of intermediate digital products on Chinese industrial carbon intensity from 1997 to 2017 has been evaluated. The results reveal that the input of China's intermediate digital products can significantly reduce industrial carbon intensity, and significantly reduce the carbon intensity of non-energy-intensive industries. It has also been discovered that the input of intermediate digital product manufacturing can significantly reduce the carbon intensity of different types of industries, while the input of the intermediate digital products services industry has no significant effect on the reduction of industrial carbon intensity. Channel analysis shows that the input of the intermediate digital products can reduce industrial carbon intensity by improving productive efficiency and promoting innovative technology. In the current climate, it is especially necessary to increase the input of the intermediate digital product manufacturing industry in industrial development.

The Networked Data Lab: using linked data to understand intermediate care services in the United Kingdom

Intermediate care (IC) is short-term care aimed at maximising patients’ independence. Across the UK, scaling up IC is included in post-pandemic recovery plans. This could reduce pressures on acute services through timely discharge or preventing admissions. The issues IC seeks to address are common across high-income countries. The Networked Data Lab is a network of analytical teams embedded in the UK health and care system. Each year, we support five local partners with acquisition, linkage and analysis of health and social care datasets. Our 2023-24 project is focused on IC. Patients and the public (PP) played an integral role in throughout our project. We established a panel of individuals with lived experience of IC to assist with the research questions, interpretation, and communication of results. Our partners all consult PP in their areas to inform their analyses. Our partners’ analyses of linked patient-level data on IC will provide information about who is receiving IC, changes over time and outcomes for patients. We are also analysing national linked data for England on intermediate care following hospital discharge. Preliminary results include: The age and health needs of people receiving bed-based intermediate care has increased over time (Grampian, Scotland) Intermediate care following a hospital admission is more common for emergency admissions than elective admissions (Leeds, England) Large variation in intermediate care delivery between neighbouring boroughs (North West London, England) Full results are expected in April 2024. Our work highlights the importance of linking data to answer important health and care questions.

How important is the blue economy for regional development? – The case of Poland

Since 2012, the European Union has actively promoted the growth of its maritime economy, driven by factors such as climate change and energy shortages. Despite this, research on the blue economy's impact on subnational development remains limited, often focusing solely on coastal regions. This paper aims to explore the broader spatial effects of the maritime economy in Poland, a country with a diverse and rapidly growing blue economy. Our study employs an estimated interregional version of Leontief's input-output (I-O) model, focusing on Poland's 16 regions, including three coastal regions. We address two key methodological challenges: compiling maritime sectors within the I-O table and extending the national I-O table to an interregional dimension using a spatial econometric approach.Our research demonstrates the extensive reach of the blue economy across Poland, offering a comprehensive view of its direct and indirect impacts. The results reveal significant intersectoral and interregional linkages driven by maritime economic activities. These linkages extend beyond coastal regions, highlighting the blue economy's wider influence on regional development. By examining the demand for intermediate goods and services by maritime sectors across regions, we identify the spill-over effects that transcend regional boundaries. This knowledge is crucial for crafting policies that support both maritime industries and the regions supplying these industries, ensuring balanced and inclusive economic growth. Our findings provide specific insights for policymaking, suggesting targeted spatial policy interventions to enhance the effectiveness of maritime policy and its integration with regional development strategies.

Hospital in the Home: Nurse-Led Models of Care and Pathways.

Hospital in the Home (HITH) model of care was developed to support the COVID-19 response and the need to deliver care in new ways to ensure secondary care services were free to deliver care to the sickest patients and not be overwhelmed by the COVID-19 patients needing hospital-level care. Intermediate Care Services, led by nursing and allied health stepped up to the challenge and collaborated on the development of the HITH model of care with defined pathways. This provided hospital-level acute health services in the home that was a clinically safe alternative option to inpatient care. The establishment of HITH released bed capacity and resources and therefore prevented the need for expanding hospital inpatient capacity at a time where resources and staff were constrained. Care delivery was achieved by utilising both in-person visits and telehealth. Technology supported the care delivery which allowed patients, whanau (family) and clinicians to be connected.

An Investigation of the Effect of Entrepreneurial Ecosystem on Startups Success through the Mediating Effect of Self Efficacy, Entrepreneurial Attitude and Entrepreneurial Intention

Developing an effective entrepreneurial ecosystem is viewed as a regional economic development approach that focuses on developing supportive circumstances that encourage the startup’s success. This study aims to investigate the impact of the entrepreneurial ecosystem on startups’ success and the variables that could play a mediating role in the relationship between entrepreneurial ecosystem and startups’ success. The research is based on face-to-face and online semi-structured interviews (the interview guide consisted of 9 open-ended questions) from second quarter of 2023 until the end of the third quarter of 2023 (the data collection phase was closed after meeting the criteria of data saturation). The participants were selected via purposeful sampling technique (20 owners or managers of startup companies including IT, customer service, food, transportation, etc. in Egypt). Thematic and content analysis is done by using NVivo software. From the analysis of the interviews, four themes are developed, and each theme consists of several codes. The first theme is the entrepreneurial ecosystem, with codes: competence development, education and training, enterprising culture and leadership, financial support, government policies and regulations, market openness, and intermediary services. The second theme is entrepreneurial characteristics, with codes: self-efficacy, entrepreneurial attitude, entrepreneurial intention, and entrepreneurial innovation. The third theme is entrepreneurial challenges, with codes: fierce competition, failure to plan and unrealistic expectations, knowledge and skills gaps, and ineffective marketing. The fourth theme is startup success, with codes: productivity, financial performance, and competitive advantage. This study found, that some elements are unimportant for startup’s ecosystem: government programs and support, commercial and professional infrastructure for entrepreneurs, and access to physical infrastructure for entrepreneurship. At the same time, the study confirmed that education and training, enterprising culture and leadership, financial support, government policies and regulations, and market openness are unimportant for startup’s ecosystem. Moreover, it is found that such elements as competence development and intermediate services should be additionally included in the ecosystem. From this study, the model that investigates the relationship between the entrepreneurial ecosystem and startup success was developed. Finally, some recommendations provided to decision-makers and current and future research.

Improved assessments of subsurface projects: Systematic mapping of geosystem services and a review of their economic values

Awareness of the subsurface and its multitude of resources is generally low and decisions on access to subsurface resources are often guided by a ‘first come, first served principle’. Although not yet fully developed, the concept of geosystem services has been put forward to make subsurface resources more visible and acknowledged in decision-making. This study (1) illustrates a systematic mapping of effects on geosystem services using a process-oriented perspective in two conceptual case studies; (2) translates the mapped effects into costs and benefits items in a qualitative cost-benefit analysis (CBA) context; and (3) presents a systematic review of economic valuation studies of geosystem services to investigate the available support for a quantitative CBA. The findings suggest that systematic mapping of effects on multiple geosystem services can inform different types of assessment methods and decision-makers on trade-offs and provide a basis for well-informed and responsible decisions on subsurface use. Combining such mapping with a CBA can further strengthen decision support through indications of the net effects on human well-being. However, although economic valuation of non-market geosystem services is possible using established valuation methods, such studies are scarce in scientific literature. Thus, although a CBA can provide a basis for supporting decisions on subsurface use from a consequentialist perspective, full quantification of all effects may require great efforts, and it needs to be complemented with other methods to capture the full range of values the subsurface can provide. This study also highlights that depending on the context, supporting and regulating geosystem services can be either intermediate or final services. Therefore, if geosystem services are to be included in the abiotic extension of CICES, in which supporting services by definition are excluded, reclassification of the supporting geosystem services should be considered not to risk being overlooked in economic valuation and CBA.

Determinants of the growing material footprints along the Belt and Road

AbstractThe Belt and Road Initiative (BRI) has induced immense material consumption and environmental threats while fostering economic development along participating countries. Quantifying recent trends of the material footprint of BRI economies and identifying potential drivers are vital to inform sustainable resource use. However, an assessment on the determinants of BRI material consumption from an economic system viewpoint is lacking in the literature. To fill this gap, this study proposes a multi‐region structural decomposition analysis model to assess the drivers of material footprints in BRI economies. To scrutinize the effects of transitioning economic structures, the effects of domestic and cross‐border production activities are separated. The latter is further characterized by production technology and sourcing structure. Using global multi‐region input–output tables of 2005–2015, this study reveals that shifting international sourcing patterns boosted BRI material footprint, with rising intermediate goods and services sourced from BRI regions substituting those from North America and the European Union. Capital formation in the construction sector took the primary role in driving BRI material footprint growth, followed by manufacturing sectors, especially since 2013. Disparities in the key drivers of material footprints have been identified among developed, emerging, and least developed economies. The results have relevant policy implications regarding alleviating BRI material pressure, including fostering material‐efficient demand patterns, facilitating environmental technology improvements in local countries, and establishing stringent governance on material usage.

Validation and Clinical Application of the Japanese Version of the Patient-Reported Experience Measures for Intermediate Care Services: A Cross-Sectional Study.

Older adult patients account for 70% of all hospitalized patients in Japan, and intermediate care based on patient-centered care (PCC) that ensures continuity and quality of care at the interface between home services and acute care services and restores patient's independence and confidence is necessary for them to continue living independently. At present, no concept of intermediate care is established in Japan, and the implementation of PCC has been delayed. Thus, in this study, a Japanese version of the intermediate care evaluation index (patient-reported experience measure (PREM)) was created on the basis of the original PREM developed in the UK, and data in wards with intermediate care functions in Japan were collected to confirm internal consistency and validity from 2020 to 2022. The Japanese version of PREM was found to have a factor structure with two potential factors. Given the clear correlation with the shared decision-making evaluation index, which is the pinnacle of PCC, the theoretical validity of the Japanese version of PREM, which is based on PCC as a theoretical basis, was confirmed.

Deregulation as an Effort to Improve Public Services in Indonesia

This article aims to understand various efforts to improve public services through deregulation. For example, the Mayor of Pekalongan shared complaints from fishermen who felt that the existence of the state and government made it difficult because to take care of sea permits alone had to deal with 17 different agencies. The problem centers on the obstacles to improving public services through deregulation and the factors that cause overregulation in Indonesia. This study determined the obstacles to public services and over-regulation. The data used are secondary data collected through literature studies and analyzed qualitatively. This study concludes that the Government has made various efforts to improve intermediate public services through deregulation by enacting several laws and regulations that unify the material of previous laws and regulations. Overregulation occurs in Indonesia due to the unclear development of authority between various institutions. There are still many overlapping laws and regulations in regulating various affairs so the applicable regulations can be said to have been too many. Therefore, there needs to be a firm policy in the division of authority of regulators so that there is no more over-regulation because there are no more overlapping regulations.

Groundwater Ecosystem Services: Redefining and Operationalizing the Concept

In the last decade, the publication of research studies in the field of groundwater ecosystem services and their classification has increased dramatically. Several academic and other institutions have developed ecosystem service classification systems for use in environmental policy research. However, the existing classification systems need to be optimized in the following areas: (a) the weak correlation between concepts and the definitions assigned, which creates double counting in economic valuation, (b) the absence of correlation of the concept of use value with the ecosystem service, (c) the non-categorization of final and intermediate services, and (d) the overlapping of wetland, soil, and groundwater regulating ecosystem services. Our research aims, through the results of a literature analysis and the synthesis of the results of an expert consultation process, to develop a unified categorization system for groundwater ecosystem services. In the context of the conceptualization of groundwater ecosystem services, this research implemented an expert judging elicitation process where subject discussions and targeted interviews were performed, combined with a literature review analysis. Through the completion of a specific questionnaire and expert interviews, a new groundwater ecosystem services classification system, namely GROUNDWES, was established.

The Linkages of the Manufacturing Sector with Other Sectors of Nigerian Economy

This paper examines the linkage between the manufacturing sector and other sectors of the Nigerian economy using Rasmussen method with the help of the Leontief inverse matrix. The National Bureau of Statistics (NBS) and the CBN Statistical Bulletin for 2011 provided the input-output transaction table of all sectors, which served as the source of data for the study. The constructed input-output (I-O) table gives a simple and logical arrangement of all economic activity within an economy. The result of this study shows that the manufacturing sector has a strong forward and backward linkage with other sectors of the Nigerian economy.The findings suggest that the Nigerian government should prioritize policies that promote growth in the manufacturing sector, as it will improve better living standard for all individuals in the sector and all others connected to the manufacturing sector. This can be done by providing tax breaks and other incentives to manufacturing firms, and by investing in infrastructure and education. The government should also focus on developing policies that promote the development of industries that produce intermediate goods and services, as these industries are important for the growth of the manufacturing sector as a whole also the manufacturing enterprises should be encouraged to employ domestic inputs.

The sectoral trade losses from financial crises

Abstract The “Great Trade Collapse” triggered by the 2008-2009 crisis calls for a careful assessment of the trade losses from financial crises. We adopt a more detailed perspective by looking at the response of different types of trade (i.e. consumption, intermediate, capital goods, and business services) following various types of financial crises (i.e. debt, banking, and currency crises) in 41 emerging markets. Estimations performed in the 1980-2019 period using a combination of impact assessment and local projections to capture a causal dynamic effect running from financial crises to the trade activity show that the collapse of total trade is long-lasting and mainly driven by the fall of intermediate goods and to some extent capital goods, while trade in consumption goods and business services is more resilient to crises. Therefore, financial crises could lead to considerable disruption of global value chains, as observed during the Global Financial Crisis (GFC), and easily spill over from one country to another through trade linkages. The examination of heterogeneity reveals that total and sectoral trade is more severely impacted in countries with a lower share of manufacturing exports, less diversified exported products, and trading partners, with lower demand from trading partners and when associated with a deterioration of the domestic and external financial conditions and sudden stops. By contributing to the understanding of the trade effects of financial crises, our analysis provides insightful support for the design and implementation of policies aimed at coping with these effects.

Effects of trade and financial openness on inflationary pressure in Nigeria

The continuous rapid upsurge in inflationary pressure in Nigeria amidst the gradual liberalisation of the country’s trade and financial market calls for questioning of the role of trade and financial openness in the inflationary trend in Nigeria, which makes the research on this issue relevant. The purpose of this study was to determine the effects of trade and financial openness on inflation in Nigeria. In the estimation of the model built to capture the objective of the study, the fully modified ordinary least squares was employed based on the data collected from the World Development Indicators covering the period of 1981 to 2023. The results showed that trade openness and exchange rate exerted a significant negative effect on inflation in Nigeria while exchange rate showed a significant positive effect. The study concluded that financial openness had a positive significant effect on inflation while trade openness and exchange rate exerted a significant negative effect. The need for government to review their foreign trade policies in such a way that the importation of both finished and intermediate goods and services from the rest of the world can be significantly reduced by boosting local production was recommended. The study offers two-folds contributions. It provides new information on the factors that determine inflation and it specifically shows the nexus among trade and financial openness. The findings therefore revealed that higher trade and financial openness raises inflation implying openness-induced inflation. The findings from the study will be of practical value to policy makers such as those in the fiscal authorities and the Central Bank of Nigeria in devising policies to tame the current inflationary pressure in Nigeria

MICROBIOTA<b> </b>AMBIENTAL DEL DEPARTAMENTO DE NEONATOLOGIA EN EL INSTITUTO NACIONAL MATERNO PERINATAL, LIMA<b>, PERÚ</b>

Introduction. Healthcare-associated infections (IAAS) increase neonatal morbidity and mortality. Identifying the microbiological profile and sensitivity of the microbiota allows us to reduce infection rates, rationalize the use of antibiotics and improve neonatal survival. Objectives. To know the environmental microbiota and antimicrobial sensitivity in the Department of Neonatology (DN). Methods. Observational, descriptive, cross-sectional study, carried out between April and May 2021, in the Intensive Care, Intermediate and Immediate Care services of the DN of the Instituto Nacional Materno Perinatal, a reference center for maternal and neonatal care. 144 surfaces were selected from the hospitalized patient environment. Using swabbing technique, samples were obtained and then seeded in common and selective culture media. Sensitivity was determined using Kirby-Bauer diffusion disks, the analysis of variables was performed with SPSS version 22.0 Results. Of 147 samples, 67% gave positive cultures with pathogenic bacteria. In immediate care 50% tested positive, in intermediate care 46.5% and in NICU 39.7%. The 100% contaminated surfaces were fan screens, electroencephalogram monitor, chart holders and scales. Of 41 hands of health personnel, 29.3% were contaminated: 54.5% nursing technicians, 30% doctors and 23% nursing graduates. The isolated germs were SCN (67%) sensitive to vancomycin, Enterococcus (16.5%) sensitive to ampicillin and vancomycin, Pseudomonas (8.2%) to meropenem, Escherichia coli (2.4%) to gentamicin and amikacin, Klebsiella (1.2%). Conclusion. Pathogens causing IAAS were isolated on surfaces in the environment of our patients. The bacterial agents found have high antimicrobial resistance and virulence.

Artificial neural network for safety information dissemination in vehicle‐to‐internet networks

AbstractIn vehicular networks, diverse safety information can be shared among vehicles through internet connections. In vehicle‐to‐internet communications, vehicles on the road are wirelessly connected to different cloud networks, thereby accelerating safety information exchange. Onboard sensors acquire traffic‐related information, and reliable intermediate nodes and network services, such as navigational facilities, allow to transmit safety information to distant target vehicles and stations. Using vehicle‐to‐network communications, we minimize delays and achieve high accuracy through consistent connectivity links. Our proposed approach uses intermediate nodes with two‐hop separation to forward information. Target vehicle detection and routing of safety information are performed using machine learning algorithms. Compared with existing vehicle‐to‐internet solutions, our approach provides substantial improvements by reducing latency, packet drop, and overhead.

Deconstructing Deglobalization: The Future of Trade is in Intermediate Services

AbstractThis article contests the idea that the world has entered a post‐globalization era. It argues that rapid globalization has evolved rather than ended. Even though the global goods trade‐to‐GDP ratio reached its zenith 15 years ago, the rapid rise of services trade has persisted and now accounts for one‐fifth of international commerce. The paper makes a statistical and logical case that the future of trade lies in services trade—especially trade in intermediate services.

The moderating effect of supply chain collaboration on servitization

PurposeSupply chain collaboration (SCC) is an important element that contributes to enhanced performance. Nonetheless, there is still a need to understand its role in servitization implementation and outcomes. This study aims to address this gap by looking at the impact of SCC on servitization and performance when considering service levels (base, intermediate and advanced).Design/methodology/approachFollowing a quantitative research design, data were collected from firms in pharmaceutical sector.FindingsModeration effects were tested. Results suggest that SCC is a crucial moderator when it comes to the influence of service levels on servitization consequences and performance, particularly to advanced and intermediate services.Originality/valueThis study contributes to the literature by providing further empirical evidence of the impact of intermediate and advanced services shedding light into the moderating role of SCC.

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