High-quality Provision Research Articles

The challenge of attaining a sustainable urban morphology for South East Queensland

Click to increase image sizeClick to decrease image size Acknowledgements The author is grateful to the two anonymous referees for their insightful comments on an earlier draft of this article. Notes 1. Self-containment, at least in urban planning terms, relates to the level of travel trips that are internal to the locality. Any locality that has a majority of all its travel trips occurring internally is deemed to be self-contained, though this assertion is not uncontested (Cevero, 1995 Cevero, R. 1995. Planned communities, self-containment and commuting: A cross national perspective. Urban Studies, 32(7): 1135–1161. [Crossref], [Web of Science ®] , [Google Scholar]; Ewing et al., 1996 Ewing, R., DeAnna, M. and Li, S. 1996. Land use impacts on trip generation rates. Transportation Research Record, 1518: 1–6. [Crossref] , [Google Scholar]; Healy & O'Connor, 2001 Healy, E. and O'Connor, K. 2001. Jobs and housing location in Melbourne, 1986 – 1996. The Australian Planner, 38(1): 9–15. [Taylor & Francis Online] , [Google Scholar]). Hence, the colocation of employment, retail, leisure and residential uses to satisfy the majority of local needs are critical to self-containment. Perhaps more important, however, is the mode of transport for these trips and the provision of high quality, high frequency and highly accessible public transport offers greater sustainability gains than car use (Yigitcanlar et al., 2005 Yigitcanlar, T., Dodson, J., Gleeson, B. and Sipe, N. . Sustainable Australia: Containing Travel in Master Planned Estates. Research Monograph 9, Urban Research Program. September, Griffith University, Brisbane. [Google Scholar]). 2. Over the last decade and a half, urban commentators (McLaren, 1992 McLaren, D. 1992. Compact or dispersed: Dilution is no solution. Built Environment, 18(4): 268–284. [Google Scholar]; Cevero, 1995 Cevero, R. 1995. Planned communities, self-containment and commuting: A cross national perspective. Urban Studies, 32(7): 1135–1161. [Crossref], [Web of Science ®] , [Google Scholar]; Jenks et al., 1996 Jenks, M., Burton, E. and Williams, K. 1996. Compact City: A Sustainable Urban Form?, London: Spon. [Google Scholar]; Newman & Kenworthy, 1999 Newman, P. and Kenworthy, J. 1999. Sustainability and Cities: Overcoming Automobile Dependence, Washington, DC: Island Press. [Google Scholar]; Williams et al., 2000 Williams, K., Burton, E. and Jenks, M., eds. 2000. Achieving Sustainable Urban Form, London: Spon. [Google Scholar]; Williams, 2005 Williams, K., ed. 2005. Spatial Planning, Urban Form and Sustainable Transport, London: Ashgate. [Google Scholar]) have generally used the term sustainable urban form to depict the growing debate concerning the economic, social and environmental costs of existing urban morphology. This is a manipulation of the term form and is used to describe both urban structure and the fine grained strategies of implementation, which are more correctly associated with urban form.

Challenging the philosophy of partnership with parents: A grounded theory study

Background Parent participation is viewed as a pivotal concept to the provision of high quality nursing care for children and their families. Since the 1990's, the term ‘partnership with parents’ has increasingly been reported in the literature and adopted as a philosophy of care in most paediatric units in the United Kingdom. Objectives To explore children's, parents’, and nurses’ views on participation in care in the healthcare setting. Design Using grounded theory, data were collected through in-depth interviews, and participant observation. Sample consisted of eleven children, ten parents and twelve nurses from four paediatric wards in two hospitals in England. Results Most nurses assumed that parents would participate in care and viewed their role as facilitators rather than ‘doers’. Nurses reported that the ideology of partnership with parents did not accurately reflect or describe their relationships with parents. Parents could never be partners in care as control of the boundaries of care rested with the nurses. Parents felt compelled to be there and to be responsible for their children's welfare in hospital. Conclusions The pendulum of parent participation has swung from excluding parents in the past to making parents feel total responsibility for their child in hospital. It is argued that the current models or theories on parent participation/partnership are inappropriate or inadequate because they do not address important elements of children's, parents’ and nurses’ experiences in hospital.

Monolithically integrated dye-doped PDMS long-pass filters for disposable on-chip fluorescence detection

We report the fabrication of high quality monolithically integrated optical long-pass filters, for use in disposable diagnostic microchips. The filters were prepared by incorporating dye molecules directly into the microfluidic chip substrate, thereby providing a fully integrated solution that removes the usual need for discrete optical filters. In brief, lysochrome dyes were added to a poly(dimethylsiloxane) (PDMS) monomer prior to moulding of the microchip from a structured SU-8 master. Optimum results were obtained using 1 mm layers of PDMS doped with 1200 microg mL(-1) Sudan II, which resulted in less than 0.01% transmittance below 500 nm (OD 4), >80% above 570 nm, and negligible autofluorescence. These spectral characteristics compare favourably with commercially available Schott-glass long-pass filters, indicating that high quality optical filters can be straightforwardly integrated into the form of PDMS microfluidic chips. The filters were found to be robust in use, showing only slight degradation after extended illumination and negligible dye leaching after prolonged exposure to aqueous solutions. The provision of low cost high quality integrated filters represents a key step towards the development of high-sensitivity disposable microfluidic devices for point-of-care diagnostics.

Nurses’, midwives’ and health visitors’ involvement in cross‐boundary working within child health services

Cross-boundary working is a key policy objective. Cross-boundary working provides the foundation for high quality provision across child health services and is imperative for an effective child protection system and the support of children and young people with health needs. Two participative conferences were attended by 113 stakeholders utilizing the World Café focus group method. Most (87%) of the sample were nurses, midwives or health visitors. Many examples of cross-boundary working were identified across the different areas of practice. Remarkably few transdisciplinary examples were identified in contrast to the number of inter-agency examples. Intra-organizational boundaries across the health service were also noted. Considerable cross-boundary working was reported but transdisciplinary working is not yet well established across all areas of child health provision.

The Impact of Managerial Ownership on the Likelihood of Provision of High Quality Auditing Services

This study investigates the relation between managerial ownership and the audit quality of the firm. In modern corporations, the separation of ownership and control creates incentives for managers to maximize their own wealth at the expense of shareholders (Jensen and Meckling 1976). Manager‐owners thus have an incentive to reduce associated agency costs by providing high quality auditing. High audit quality should thus be increasing as managerial ownership decreases. A related agency problem is that of entrenchment‐ whereby managers, by virtue of their increased voting power, have increasing power to shirk and procure perquisites at shareholders' expense. The associated increasing agency risk implies that, when the risk of entrenchment decreases, the need, and thus provision, of high audit quality should also decrease. Based on these arguments, and following prior empirical research, we posit and find that at low and high levels of managerial ownership (below 5% and above 25%), where entrenchment is not increasing, audit quality is decreasing in managerial ownership. At intermediate levels, where entrenchment arguably does increase, it is unclear which effect (divergence‐of‐interests or entrenchment) dominates. For our sample, we document a negative association in this region, a result consistent with the notion that divergence‐of‐interests is the primary agency‐related determinant of audit quality at all levels.

Institutional and resource constraints that inhibit contractor performance in the small-scale sugarcane industry in KwaZulu-Natal

This study focuses on identifying constraints that inhibit sugarcane contractor performance in the small-scale sugar industry in KwaZulu-Natal (KZN). Information is drawn from a sample survey, conducted with 124 randomly selected contractors from 11 mill group areas of KZN between September 2002 and July 2003 and case studies of contractors, sub-committee members and development officers conducted in eight mill group areas. Results show that contractors face institutional constraints (work allocation limitations, lack of performance incentives and high transaction costs, such as negotiation costs, the risk of a loss in work and contract default risk), cash flow problems, poor physical infrastructure and a lack of labour. It is expected that the promotion of a more competitive small-scale sugarcane contractor sector will alleviate many problems (such as work allocation limitations) faced by small-scale contractors, while providing incentives for their provision of higher quality and cheaper services to small-scale sugarcane growers (SSGs). Government also has a role in strategising the creation of land markets while providing improved rural infrastructure (district roads). Government also needs to ensure unbiased tribal court rulings, review the impacts of minimum wage legislation on contractors sourcing labour, and provide protection for those competing for work. Keywords : institutions; small-scale contractor performance; sugar industry South African Journal of Agricultural Extension Vol. 34(1) 2005: 55-80

Improving induced abortion care in Scotland: enablers and constraints

BackgroundInduced abortion is the most common gynaecological procedure in Scotland. Despite several recent initiatives to improve the quality of abortion care, inappropriate variations in care remain.ObjectiveTo identify and explore factors...

Early Childhood Education and Care Vade Mecum for 2002

This is not an article, but a series of compressed notes which attempt to set down what the writer sees as the principal concerns highlighted in recent studies of early childhood socialisation from birth to about eight years. It draws heavily upon personal and professional experience of education and care systems in some sixteen countries as well as upon current OECD and UNESCO data. It deals with the concerns surrounding a minority of the world's children, however; that is the 10% or less, born into the rich portion of the (largely western) world. It focuses on the context surrounding the growing need for 'institutionalised' provision for children from birth in those OECD countries where divorce is common-place, where the birth rate has fallen dramatically and where, increasingly, most adult women work outside the home. It notes especially the gradual congruence of early childhood care and early education in policy and practice. It emphasises the vital contribution of appropriate early experience and learning to the creation of a humane society, briefly considers the policy preoccupations with literacy, and notes especially that the biggest single factor contributing to high quality provision lies in the quality of the professional staff concerned.

Early years development and childcare partnerships (EYCDPs) in England: Policy and implementation

This paper focuses on UK policy which has established a network of Early Years, Development and Childcare Partnerships (EYDCPs) consisting of providers and local authority representatives, to ensure the availability of pre-school provision within a city, district or local authority which meets the range of needs of parents and reflects quality in standards. Funding for 3 and four year old childcare/education is dependent on meeting government regulations for childcare and successful regular inspection of provision in terms of the government framework for the pre-school curriculum, Desirable Learning Outcomes, now revised as ‘Early Learning Goals’. It examines the role of these partnerships in providing accessible, affordable and high quality provision, and in the development of appropriate professional skills across a wide range of providers. The examination of the implementation of EYDCP partnerships indicates significant achievements, but some tensions between providers and concern that training to support unqualified practitioners, although essential to raise standards, may jeopardize the profession of early years graduate teachers.

A framework for the evaluation of continuing education short courses in dentistry.

The objective of this paper is to propose an evaluation framework for short courses in continuing education for general dental practitioners (GDPs) (so called, Section 63 courses). Existing monitoring and evaluation procedures in the West Midlands deanery were examined and an improved evaluation framework was then devised, piloted and revised. A 5 phase method was used incorporating the examination of existing practice (Phases 1 and 2), development of a new framework (Phase 3), piloting (Phase 4) and revision of the evaluation framework in the light of the pilot. This approach will be implemented in the West Midlands and may be adapted for national use (Phase 5). It was found that existing monitoring and evaluation was inconsistent in prevalence and scope. Those involved in short courses were in favour of a more consistent and visible evaluation, including some assessment of impact-on-practice and cost-effectiveness. In conclusion, meaningful evaluation needs to include four key processes: data gathering; data analysis; dissemination and, action planning (reviewing provision in the light of the data analysis). Thus, this evaluation framework feeds into a quality development cycle designed to ensure high quality and relevant short course provision for general dental practitioners.

A review of third-party reimbursement issues for advanced practice nurses.

1. Dramatic increase in health care costs are attributed to a previously unlimited reimbursement structure for health care organizations and physicians, coupled with a focus on acute, high-technologic, and tertiary care. 2. Advanced practice nurses (APNs) have demonstrated the ability to positively affect patient outcomes through the provision of high quality, accessible, and cost-effective care. 3. The nursing profession has continued to endure a disproportionate struggle to gain third-party reimbursement. APNs must educate the public about their role and continue lobbying for legislation that mandates third-party reimbursement.

The costs of managing advanced colorectal cancer: a broad perspective.

Cancer care is expensive, consuming between 5 and 10% of health-care resources in industrialized countries. Therefore increasing emphasis is being placed on the value of treatment interventions. Colorectal cancer is the second most common cancer in the Western world and nearly two-thirds of patients will require palliative treatment. Only limited data are available on the cost of palliative chemotherapy for patients with advanced disease. The profile of raltitrexed ('Tomudex', formerly ZD1694) suggests that it may reduce costs associated with the administration of chemotherapy. Recent studies demonstrate that the total monthly cost of raltitrexed is lower or about the same as a variety of commonly used 5-fluorouracil-based regimens and offers potential savings for hospitals in terms of demand on specialist facilities, physician, nursing and pharmacy time, and overnight bed occupancy. The personal cost borne by patients and their carers for travelling and time off work is reduced with raltitrexed compared with the widely used Mayo regimen. However, there may be disincentives within certain national health-care systems to the introduction of a more resource-efficient drug such as raltitrexed. Physicians will need information on both the benefits and costs of drug treatments to be able to make informed decisions on the provision of high quality, cost-effective patient care, and it is likely that health economic assessment will be incorporated into increasing numbers of clinical trials.

The transformation of the Russian defence industry

TRADITIONALLY, THE DEFENCE INDUSTRY constituted the most powerful industrial lobby in the USSR, with an administrative structure at all the organisational levels where its interests could be affected. With a hierarchical and pyramidal structure, the different entities of the sector remained isolated from strictly civilian bodies. The strategic part it played within the organisation of the Soviet Union enabled the defence industry to manage a growing and important volume of resources; on the one hand, it had a special supply system which guaranteed regular high-quality provision of the most advanced technology in the country, as well as highly qualified human resources. On the other hand, the sector imposed the production of armaments upon the rest of society as a social necessity justified by the importance of national security. The disintegration of the Soviet Union changed the situation dramatically. Initially, the new reforms were not considered to affect the defence industry but today's reality proves the opposite, and during the three years of transition towards a market economy the face of the defence industry has substantially changed. This article offers a review of the most outstanding events which have taken place in the Russian defence industry during the first years of the transition, with the objective of determining its likely future. The changes can be analysed from different points of view, but two major perspectives clearly stand out: organisational and production changes. As to organisational changes, we focus on the new structures (privatisation, centralisation and decentralisation processes), which are closely related to the current reforms. Regarding the production changes, we shall show the deep shifts in the composition and levels of activity of the industry, concentrating on the conversion process and amplifying this with a description of recent trends in both military and civil production.

Continuing medical education: quality assurance and certification by the EADV

AbstractThe European Academy of Dermatology and Venereology (EADV) prioritises the provision of high quality continuing medical education (CME) to its members.The European Union of Medical Specialists (LJEMS) is currently establishing European Boards of the individual medical specialities to monitor and ensure high professional standards of European medical specialists and harmonisation among member nations. Within the next Few years, national and supra‐national authorities in Europe are expected to request documentation of participation in continuing medical education from physicians in order to maintain their full specialist competence, analogous to the conditions now pertaining in the US. In Belgium, participation in CME is mandatory for standard appointments with the health insurance.The EADV has developed procedures for quality assurance of the CME activities for the 3rd EADV congress in Copenhagen 1993, and the Skin Therapy Update Symposium in Crete 1994, using participant evaluation of the scientific programme. Following these meetings the EADV has issued individual certificates to the participants, documenting their CME activities. The results of the programme evaluation indicate a high standard of CME at the above meetings.The EADV wishes to develop as a competent sponsor of CME activities, to offer extensive membership service in this field, and to administer recognition of EADV‐CME accreditation to other bodies.

Continuing medical education: quality assurance and certification by the EADV

The European Academy of Dermatology and Venereology (EADV) prioritises the provision of high quality continuing medical education (CME) to its members.The European Union of Medical Specialists (UEMS) is currently establishing European Boards of the individual medical specialities to monitor and ensure high professional standards of European medical specialists and harmonisation among member nations. Within the next few years, national and supra-national authorities in Europe are expected to request documentation of participation in continuing medical education from physicians in order to maintain their full specialist competence, analogous to the conditions now pertaining in the US. In Belgium, participation in CME is mandatory for standard appointments with the health insurance.The EADV has developed procedures for quality assurance of the CME activities for the 3rd EADV congress in Copenhagen 1993, and the Skin Therapy Update Symposium in Crete 1994, using participant evaluation of the scientific programme. Following these meetings the EADV has issued individual certificates to the participants, documenting their CME activities. The results of the programme evaluation indicate a high standard of CME at the above meetings.The EADV wishes to develop as a competent sponsor of CME activities, to offer extensive membership service in this field, and to administer recognition of EADV-CME accreditation to other bodies.

Teaching Nursing Students to Assess Older Clients in the Clinical Setting

The process of nursing assessment is complex and occurs throughout all the steps of the nursing process. A nursing assessment that includes both the history-taking process and a screening physical examination. The importance of recognizing and identifying the intricate needs and the physical changes in older clients is critical in the provision of high quality nursing care. Teaching students the skills required to perform this nursing responsibility includes a variety of guided, structured, and non-structured learning opportunities. This article explores one department of nursing's approach to prepare students to perform a nursing assessment on older adult clients.

Hearing impairment in elderly hospital residents.

The provision of high quality nursing care for dependent elderly people is a daunting challenge to the profession. This survey focuses on the frequently neglected area of impaired hearing among elderly hospital residents and evaluates the service provided by one health board.

Radiation or Mastectomy

Women diagnosed with early stage breast cancer are increasingly given the choice of mastectomy or lumpectomy and radiation therapy as primary treatment. This article suggests that high-quality provision of health care must include attention to psychosocial as well as medical issues during this decision-making process. Case examples are used to demonstrate the importance of exploration of feelings during this period to facilitate a decision that may be satisfactory psychologically as well as medically.

A COMMUNITY-WIDE PEDIATRIC PROGRAM: A BEGINNING AND A BLUEPRINT FOR THE FUTURE

IN DECEMBER OF 1963 a communication by Robert M. Sigmond, Director of the Hospital Council of Western Pennsylvania, appeared in Pediatrics. It examined in detail the existing facts concerning the quality of pediatric care and residency training in the community hospitals of Pittsburgh and its environs and came to some definite conclusions. Excerpts of these conclusions follow: "Planning for children's inpatient services should encourage grouping of small segregated pediatric units in which most children receive care today. . . . Small units interfere with provision of high quality, comprehensive care and are wasteful of scarce personnel and dollars. . . . Most general hospitals should affiliate with major general hospitals or children's medical centers at which their pediatric inpatient facilities could be grouped into a few large units. . . . Failure of children's medical centers to develop such affiliations may have dire consequences in the long run." By the time this article appeared Drs. Robert E. Cooke (Professor of Pediatrics), Russell A. Nelson (President of The Johns Hopkins Hospital), Thomas B. Turner (Dean of The Johns Hopkins University School of Medicine), and I were deep in discussions about this very topic. For many years, while I had been heavily engaged in the problems of the pediatric department of the Sinai Hospital and the nursery service of the Hospital for the Women of Maryland, the manifest deficiencies of these services as they were then constituted, and the difficulty of overcoming them had been much on my mind. Chief of these was our inability to develop a training program which would attract the house staff so necessary in modern times to provide ideal patient care.

COMMUNITY-WIDE PLANNING FOR CHILDREN'S HOSPITAL SERVICE IN A METROPOLITAN AREA

Community-wide planning of hospitals and related facilities in a metropolitan area helps to translate the miracles of modern medical science into high quality service for all at reasonable cost. Community-wide planning for children's inpatient services should encourage grouping of small segregated pediatric units in which most children receive care today. These small units interfere with provision of high quality, comprehensive care and are wasteful of scarce personnel and dollars. Experts should agree upon the minimum size unit in which effective care can be provided; this minimum would obviously be much larger than most units in existence today. To achieve this minimum, most general hospitals should affiliate with major general hospitals or children's medical centers at which their pediatric inpatient facilities could be grouped into a few large units. The children's medical centers should take leadership in exploring the feasibility and nature of such affiliations of which the key element is the medical staff relationship. Such affiliations are consistent with and conducive to valid objectives of children's medical centers: leadership in promotion of child health, child care, education and research. Failure of children's medical centers to develop such affiliations may have dire consequences in the long run.