Intermediate Services Research Articles

Valuation of Ecosystem Services & Benefits of Son Beel Wetland in Assam, India: A Case Study of Natural Solutions to Climate Change & Water

Valuation of Ecosystem Services & Benefits of Son Beel Wetland in Assam, India: A Case Study of Natural Solutions to Climate Change & Water

Service-oriented manufacturing: assessing the role of intermediate services in industrial transformation in China

Service-oriented manufacturing: assessing the role of intermediate services in industrial transformation in China

QoS3: Secure Caching in HTTPS Based on Fine-Grained Trust Delegation

With the ever-increasing concern in network security and privacy, a major portion of Internet traffic is encrypted now. Recent research shows that more than 70% of Internet content is transmitted using HyperText Transfer Protocol Secure (HTTPS). However, HTTPS encryption eliminates the advantages of many intermediate services like the caching proxy, which can significantly degrade the performance of web content delivery. We argue that these restrictions lead to the need for other mechanisms to access sites quickly and safely. In this paper, we introduce QoS3, which is a protocol that can overcome such limitations by allowing clients to explicitly and securely re-introduce in-network caching proxies using fine-grained trust delegation without compromising the integrity of the HTTPS content and modifying the format of Transport Layer Security (TLS). In QoS3, we classify web page contents into two types: (1) public contents that are common for all users, which can be stored in the caching proxies, and (2) private contents that are specific for each user. Correspondingly, QoS3 establishes two separate TLS connections between the client and the web server for them. Specifically, for private contents, QoS3 just leverages the original HTTPS protocol to deliver them, without involving any middlebox. For public contents, QoS3 allows clients to delegate trust to specific caching proxy along the path, thereby allowing the clients to use the cached contents in the caching proxy via a delegated HTTPS connection. Meanwhile, to prevent Man-in-the-Middle (MitM) attacks on public contents, QoS3 validates the public contents by employing Document object Model (DoM) object-level checksums, which are delivered through the original HTTPS connection. We implement a prototype of QoS3 and evaluate its performance in our testbed. Experimental results show that QoS3 provides acceleration on page load time ranging between 30% and 64% over traditional HTTPS with negligible overhead. Moreover, QoS3 is deployable since it requires just minor software modifications to the server, client, and the middlebox.

The Framework of Ecosystem Services for Economic Valuation Purposes: A Review

Although humans need ecosystems and ecosystem services for their survival and well-being, most of the global ecosystems and the services that they provide have declined and/or degraded rapidly over the past few decades. In order to find the ways to sustainably use natural resources, substantial efforts have been made to measure and value the ecosystem services. The term ‘ecosystem service’ was interpreted in different ways in the literature. For making correct decisions in natural resource management, a consistent way of defining and classifying ecosystem services is needed for valuation purposes. This paper argued for the need to divide ecosystem services into intermediate and final services.

The Framework of Ecosystem Services for Economic Valuation Purposes: A Review

Although humans need ecosystems and ecosystem services for their survival and well-being, most of the global ecosystems and the services that they provide have declined and/or degraded rapidly over the past few decades. In order to find the ways to sustainably use natural resources, substantial efforts have been made to measure and value the ecosystem services. The term ‘ecosystem service’ was interpreted in different ways in the literature. For making correct decisions in natural resource management, a consistent way of defining and classifying ecosystem services is needed for valuation purposes. This paper argued for the need to divide ecosystem services into intermediate and final services.

Discounting in the presence of scarce ecosystem services

The discount rate for cost-benefit analysis has to take account of future scarcity of ecosystem services in consumption and production. Previous literature focuses on the first aspect and shows the importance of the relative price effect, for given growth rates of consumption and ecosystem services. This paper focuses on intermediate ecosystem services in production and shows that for limited substitutability and a low growth rate of these ecosystem services, the growth rate of consumption, and thus the discount rate, declines towards a low value. Using a Ramsey growth model, the paper distinguishes three cases. If ecosystem services can be easily substituted, the discount rate converges to the usual value in the long term. Secondly, if ecosystem services can be easily substituted in production but not in consumption, the relative price effect is important. Finally, and most interestingly, if ecosystem services cannot be easily substituted in production, the discount rate declines towards a low value and the relative price effect is less important. Another part of the previous literature has shown that a declining discount rate is the result of introducing several forms of uncertainty, but this paper reaches that conclusion from an endogenous effect on the growth rate of the economy.

BRICS Countries in Global Value Chains

The picture of the post-crisis world is shaped by the paradigm shifts about the sustainability of national development as a globally integrated co-development and as a necessary condition for national security and defence. Each state faces the steep task of developing new effective foreign economic policy, replacing the former export-oriented and protectionist import-substituting strategies. Such policy changes primarily concern the BRICS countries, including Russia and its place/role in expanding international trade in intermediate goods and services. Simultaneously, Russia and the BRICS must develop new mechanisms of economic cooperation between themselves in the form of global value chains (GVCs).

Implications of measuring value added in exports with a regional input-output table. A case of study in South America

Global value chains (GVC) describe the functioning of international trade today. A widely used way to measure GVC is the input-output analysis. However, many developing countries are not covered in the main multi-regional input-output (MRIO) databases, hindering the measurement of GVC in regions like South America. The purpose of this paper is to analyse the role of South America in GVC using a novel regional input-output table (RIOT). To this end, a novel adaptation of Koopman, Wang and Wei gross exports decomposition scheme, suitable for any RIOT, is created. The implications of using a RIOT are assessed. Besides, the results are complemented with those obtained using a MRIO table. It is confirmed the low insertion of South America in GVC and its upstream position as a provider of intermediate goods and services. Imported content in South American exports comes mostly from outside the region and only Uruguay is vertically integrated.

Admiral Nursing: supporting families affected by dementia within a holistic intermediate care team

There are increasing pressures on the health and social care system, particularly within acute hospital care. This has led to significant changes being implemented throughout the NHS England Long Term Plan (2019) , such as moving services closer to home and improving ‘out of hospital’ care. Intermediate care services are being developed to improve timely discharge from hospital and prevent unnecessary hospital admissions and premature transfer to residential care. An innovative intermediate care model, inclusive of Admiral Nursing, has been developed within Olympus Care Services to support families living with dementia, implementing an intensive 8-week intervention model. It is essential that intermediate services are accessible for people with dementia, inclusive of the needs of the family, and that they work within the context of integrated and collaborative models of care across traditional organisational boundaries. The aim is not only to improve resilience and quality of life, but also to offer opportunities to promote the narrative of living well with dementia. This service model illustrates how this can be achieved with inclusion of Admiral Nursing working within reablement services.

Public perception and valuation of long‐term ecological monitoring

AbstractOrganizations tasked with implementing long‐term ecological monitoring programs often struggle to stay funded. Government agencies are typically the only entities with sufficient capacity and motivation to support long‐term scientific programs that generate data for environmental management and conservation. Taxpayers bear this funding burden, yet we know of no studies assessing public perception of government‐led long‐term monitoring. We present the results of a survey designed to assess willingness to pay (WTP) for the benefits resulting from long‐term ecological monitoring in Southeast Alaska for residents and visitors. We hypothesized that four factors have the potential to influence preferences for long‐term ecological monitoring: (1) type of ecosystem service monitored (intermediate vs. final); (2) place of residence; (3) prior knowledge of monitoring; and (4) sociodemographic characteristics. We defined final ecosystem services as ecosystem attributes that have clear relevance to human well‐being and intermediate ecosystem services as those required to produce final services. We found a greater WTP for programs monitoring intermediate ecosystem services, longer‐running programs, and programs covering a larger spatial extent. Respondents with higher income and conservative political preferences were more likely to choose no monitoring program at all (status quo), whereas respondents with previous knowledge of monitoring were generally more supportive of long‐term monitoring programs.

The Dramaturgical Act of Positioning Within Family Meetings: Negotiation of Patients' Participation in Intermediate Care Services.

Family meetings are a cornerstone in intermediate care (IC) and a powerful tool in achieving patient participation. Staff in IC are nevertheless uncertain about how to run these meetings. This study explores the negotiation of patient participation in 14 family meetings by observing the interactions between patients, relatives, and staff. Using Goffman's dramaturgical theory, supplemented by positioning theory, we illustrate, through four cases, how the participants negotiate their opinions by enacting positions like performer, director, audience, and nonperson. Patient participation takes place when the family meetings are characterized by respect and empathy, when the staff restore and elicit patients' and relatives' preferences, and there exist real alternative outcomes of the meetings. The emphasis should be on meeting structure, group composition, and preparation of the patient team. The findings are valuable for staff, patient organizations, and policy makers responsible for program development and tools to optimize patient participation within family meetings.

The role of non-commercial intermediate services in the valuations of ecosystem services: Application to cork oak farms in Andalusia, Spain

This research applies and compares the Agroforestry Accounting System (AAS) and the lightly revised System of National Accounts (SNA) in five cork oak farms in Andalusia, Spain, in 2010. We value eighteen economic activities, eleven of which are managed by individual farmers and seven of which are overseen by government. Our objectives are to measure and compare ecosystem services (ES), gross value added (GVA) and environmental income (EI). The comparison takes into account the valuation of products at producer, basic and social prices. Our most noteworthy novelty is that the AAS proposal incorporates the environmental income as a variable which serves as a reference value for the condition of economic sustainability of ecosystem service consumption. Our results show that ES and GVA estimates vary depending on the omission/measurement of auto-consumed/donated non-commercial intermediate services and nature based activity with zero ES value represents nature’s free physical service contribution to the farms net value added. Farms AAS ecosystem services at social prices contribute to 64% of final product consumption, and ES at basic prices represent 1.2 times the ES at social prices. Farm revised SNA ecosystem services at basic prices are 0.5 times the AAS ecosystem services at social prices.

Understanding variation in unplanned admissions of people aged 85 and over: a systems-based approach

AimTo examine system characteristics associated with variations in unplanned admission rates in those aged 85+.DesignMixed methods.SettingPrimary care trusts in England were ranked according to changes in admission rates for people...

A Systematic Review of Relationships Between Mountain Wildfire and Ecosystem Services

Consideration of human–environment dimensions of wildfire make ecosystem services (ES) a useful framework for understanding wildfire challenges and devising viable management strategies. Scientific literature on wildfire and ES is growing rapidly, but connections are disparate and evolving. We review relationships between mountain wildfire and a comprehensive list of 50 relevant ES informed by the Millennium Ecosystem Assessment. Our conceptual framework is used to evaluate underlying mechanisms and the direction and scale of wildfire impacts on ES. We focus the review on the Colorado Front Range of the Rocky Mountains, one of the best-studied landscapes in the world for understanding fire-ES relationships and evaluating how regional differences contribute to broader understanding of ES globally. We begin our review by considering key relationships, followed by a structured literature search of wildfire impacts with tabulated trends and findings. Key findings from the review: (1) current fire regimes mostly have negative impacts on ES, with some positive effects on cultural services, (2) changes to vegetation composition and structure are the most common mechanism, (3) mechanisms acting at local and landscape scales impact ES at broader scales, (4) intermediate services warrant attention and management resources, and (5) regional differences may provide opportunities for stronger global synthesis. Familiarity with landscape legacies, current land use practices, and stakeholder values uniquely positions landscape ecologists to contribute to future studies of wildfire-ES connections. A framework that considers the complete suite of ES can guide researchers to seek collaborations that more completely characterize their regions.

Reablement services for people at risk of needing social care: the MoRe mixed-methods evaluation

Background Reablement is an intensive, time-limited intervention for people at risk of needing social care or an increased intensity of care. Differing from home care, it seeks to restore functioning and self-care skills. In England, it is a core element of intermediate care. The existing evidence base is limited. Objectives To describe reablement services in England and develop a service model typology; to conduct a mixed-methods comparative evaluation of service models investigating outcomes, factors that have an impact on outcomes, costs and cost-effectiveness, and user and practitioner experiences; and to investigate specialist reablement services/practices for people with dementia. Methods Work package (WP) 1, which took place in 2015, surveyed reablement services in England. Data were collected on organisational characteristics, service delivery and practice, and service costs and caseload. WP2 was an observational study of three reablement services, each representing a different service model. Data were collected on health (EuroQol-5 Dimensions, five-level version) and social care related (Adult Social Care Outcomes Toolkit – self-completed) quality of life, practitioner (Barthel Index of Activities of Daily Living) and self-reported (Nottingham Extended Activities of Daily Living scale) functioning, individual and service characteristics, and resource use. They were collected on entry into reablement (n = 186), at discharge (n = 128) and, for those reaching the point on the study timeline, at 6 months post discharge (n = 64). Interviews with staff and service users explored experiences of delivering or receiving reablement and its perceived impacts. In WP3, staff in eight reablement services were interviewed to investigate their experiences of reabling people with dementia. Results A total of 201 services in 139 local authorities took part in the survey. Services varied in their organisational base, their relationship with other intermediate care services, their use of outsourced providers, their skill mix and the scope of their reablement input. These characteristics influenced aspects of service delivery and practice. The average cost per case was £1728. Lower than expected sample sizes meant that a comparison of service models in WP2 was not possible. The findings are preliminary. At discharge (T1), significant improvements in mean score on outcome measures, except self-reported functioning, were observed. Further improvements were observed at 6 months post discharge (T2), but these were significant for self-reported functioning only. There was some evidence that individual (e.g. engagement, mental health) and service (e.g. service structure) characteristics were associated with outcomes and resource use at T1. Staff’s views on factors affecting outcomes typically aligned with, or offered possible explanations for, these associations. However, it was not possible to establish the significance of these findings in terms of practice or commissioning decisions. Service users expressed satisfaction with reablement and identified two core impacts: regained independence and, during reablement, companionship. Staff participating in WP3 believed that people with dementia can benefit from reablement, but objectives may differ and expectations for regained independence may be inappropriate. Furthermore, staff believed that flexibility in practice (e.g. duration of home visits) should be incorporated into delivery models and adequate provision made for specialist training of staff. Conclusions The study contributes to our understanding of reablement, and what the impacts are on outcomes and costs. Staff believe that reablement can be appropriate for people with dementia. Findings will be of interest to commissioners and service managers. Future research should further investigate the factors that have an impact on outcomes, and reabling people with dementia. Funding The National Institute for Health Research Health Services and Delivery Research programme.

Energy Consumption and Performance of Sectoral Outputs: Results from an Energy-Impoverished Economy

This paper is directed at exploring the relationship among energy consumption, disaggregated sectoral output (GDP) and economic growth in Nigeria using time series data. The study applied a plethora of estimation techniques (multivariate unit root, Johansen cointegration and Granger causality tests). The study found that energy consumption has enhanced the performance of agriculture, health, manufacturing, utilities, finance and transport sectors in Nigeria during the period under consideration. Long-run energy consumption was found to be detrimental to the performance of administration output (GDP). The study recommends that energy consumption should be encouraged essentially for sectoral and industrial purposes (the production of intermediate goods and services) and not only for household consumption.

Tier 2: A Warm welcome or a Cold Reality?

Since the introduction of the 2006 NHS dental contract, various waiting list initiatives and the subsequent release of NHS commissioning guidance for dental services, there has been a remarkable and rapid shift towards the provision of intermediate services within the profession. the complexity surrounding those non-specialist providers working within these services has lead to much confusion and the further development of competencies required to work within these settings. this paper focuses on explaining and exploring the topics that arise from an area that has attracted much discussion and debate.

Make-or-buy configurational approaches in product-service ecosystems and performance

This research examines firm boundary configurations for manufacturers' product-service offerings. We argue that the building of a product-service ecosystem through collaboration with service providers in certain types of business services can increase performance as a result of the superior knowledge-based resources coming from specialized partners. By using fuzzy set qualitative analysis on a sample of 370 multinational manufacturing enterprises (MMNEs), the results reveal that effective servitization is heterogeneous across manufacturing industries and across business service offerings. The findings indicate that most industries achieve their highest performance through collaborations with value-added service providers in two out of three of the service continuum stages (Base and Intermediate services); while keeping the development of Advanced services in-house. The results help to contextualize the best practices for implementing service business models in MMNEs by detailing which service capabilities should be retained in-house and which should be outsourced to specialized partners in various industrial contexts.

Costs of clinical trials with anticancer biological agents in an Oncologic Italian Cancer Center using the activity-based costing methodology.

AimThe aim of the present study was to assess the estimated “per patient” total cost for a single Oncologic Italian Cancer Center participating in a multicenter clinical trial with new anticancer biological agents using the activity-based costing (ABC) methodology.MethodologyNine randomized phase 3 clinical trials employing biological agents at the National Cancer Institute of Napoli, Italy, were analyzed to indentify “per patient” costs of each trial, according to the ABC methodology. The average consumption of resources for a patient completing the entire planned treatment was estimated for each trial. Through interviews of the personnel (doctors, nurses and technicians) and by analyses of the clinical trials protocols, the main activities of the 9 clinical trials were identified and, for each trial, the complete health care pathway of the patients and the treatment programmes were minutely reconstructed. Drug costs were not included because provided by Sponsors.Principal findingsThe average costs of the pre-study, treatment, monitoring, follow-up, audit, and administrative activities accounted for 2.357, 4.783, 700, 372, 1.263, and 9 Euro, respectively. The average total cost estimated for all “per patient” activities, including overhead costs, was 11.379 Euro. Staff costs accounted for € 5.988, while costs of diagnostic test accounted for 3.494 Euro. Clinical trials with immunotherapeutic drugs accounted for higher costs (+601 Euro as oncological staff costs, +1.318 Euro as intermediate services cost and +384 Euro as overheads).ConclusionsThe average total cost estimated for all “per patient” activities of a clinical trial with new anticancer biological agents was 11.379 Euro using the ABC methodology.

Analysis of the profile, characteristics, patient experience and community value of community hospitals: a multimethod study

BackgroundCommunity hospitals have been part of England’s health-care landscape since the mid-nineteenth century. Evidence on them has not kept pace with their development.AimTo provide a comprehensive analysis of the profile, characteristics, patient experience and community value of community hospitals.DesignA multimethod study with three phases. Phase 1 involved national mapping and the construction of a new database of community hospitals through data set reconciliation and verification. Phase 2 involved nine case studies, including interviews and focus groups with patients (n = 60), carers (n = 28), staff (n = 132), volunteers (n = 68), community stakeholders (n = 74) and managers and commissioners (n = 9). Phase 3 involved analysis of Charity Commission data on voluntary support.SettingCommunity hospitals in England.ResultsThe study identified 296 community hospitals with beds in England. Typically, the hospitals were small (< 30 beds), in rural communities, led by doctors/general practitioners (GPs) and nurses, without 24/7 on-site medical cover and provided step-down and step-up inpatient care, with an average length of stay of < 30 days and a variable range of intermediate care services. Key to patients’ and carers’ experiences of community hospitals was their closeness to ‘home’ through their physical location, environment and atmosphere and the relationships that they support; their provision of personalised, holistic care; and their role in supporting patients through difficult psychological transitions. Communities engage with and support their hospitals through giving time (average 24 volunteers), raising money (median voluntary income £15,632), providing services (voluntary and community groups) and giving voice (e.g. taking part in communication and consultation). This can contribute to hospital utilisation and sustainability, patient experience, staff morale and volunteer well-being. Engagement varies between and within communities and over time. Community hospitals are important community assets, representing direct and indirect value: instrumental (e.g. health care), economic (e.g. employment), human (e.g. skills development), social (e.g. networks), cultural (e.g. identity and belonging) and symbolic (e.g. vitality and security). Value varies depending on place and time.LimitationsThere were limitations to the secondary data available for mapping community hospitals and tracking charitable funds and to the sample of case study respondents, which concentrated on people with a connection to the hospitals.ConclusionsCommunity hospitals are diverse but are united by a set of common characteristics. Patients and carers experience community hospitals as qualitatively different from other settings. Their accounts highlight the importance of considering the functional, interpersonal, social and psychological dimensions of experience. Community hospitals are highly valued by their local communities, as demonstrated through their active involvement as volunteers and donors. Community hospitals enable the provision of local intermediate care services, delivered through an embedded, relational model of care, which generates deep feelings of reassurance. However, current developments may undermine this, including the withdrawal of GPs, shifts towards step-down care for non-local patients and changing configurations of services, providers and ownership.Future workComparative studies of patient experience in different settings; longitudinal studies of community support and value; studies into the implications of changes in community hospital function, GP involvement, provider-mix and ownership; and international comparative studies could all be undertaken.FundingThe National Institute for Health Research Health Services and Delivery Research programme.