Scope Of Services Research Articles

Alzheimer's Disease Services, Staffing, and Outcomes in Adult Day Health Centers.

Increasing rates of Alzheimer disease and related dementia (ADRD) has resulted in greater reliance on adult day health centers (ADHCs) and their skilled workforce. Little is known about staffing in ADHCs that provide ADRD services compared with ADHCs that do not. This study examines whether there are differences in staffing between ADHCs that offer ADRD services versus those that do not, and whether the percentage of ADHC participants with ADRD is associated with staffing levels. It also examines whether staffing levels and provision of ADRD services are associated with participant outcomes. Cross-sectional analysis of secondary survey data. We used facility-level data from the 2014 National Post-acute and Long-term Care Study Adult Day Services Center module. This survey is completed by administrators of ADHCs, who provide information about their ADHC's organization, services, participants, sources of payment, staffing, and participant outcomes. Bivariate comparisons and multivariate regressions were used to compare scope of services, staffing, and participant outcomes for ADHCs that offered ADRD programs compared with those that did not. ADHCs with ADRD programs had similar average daily attendance, less revenue from Medicaid and self-payment, and greater proportions of Black and female participants. ADHCs with ADRD programs had similar staff hours per participant day for all staff categories; licensed nurse staffing increased and social worker staffing decreased with the proportion of participants with ADRD. Staffing had significant associations with participant outcomes. ADHCs that have more participants with ADRD have greater staffing of licensed nurses but fewer social workers. Participant outcomes are associated with staffing, but the results suggest that there are unmeasured dimensions of participant risk that confound the relationship.

RAYLEIGH FADING CHANNEL ESTIMATION BASED ON GENERALIZED REGRESSION NEURAL NETWORK

With the rapid development of wireless communication, 5G is gradually growing into a large-scale basic Internet that supports various industries in the whole society. The substantial expansion of its service scope poses many challenges for the underlying technology, especially for the crucial component of the physical Layer-Orthogonal Frequency Division Multiplexing (OFDM). Recently, Neural Networks (NNs) have attracted extensive attention due to their excellent performance in computing vision and natural language processing. Its strong universality also provides new development space for traditional communications. This manuscript conducts an in-depth study on channel estimation for OFDM systems and explores the possible application of a Generalized Regression Neural Network (GRNN) to estimate the Channel Impulse Response (CIR) attenuated by AWGN and Rayleigh fading system. Moreover, three traditional channel estimation algorithms, i.e., LS, MMSE, and LMMSE, are derived by mathematics. In addition, this thesis illustrates several typical neural networks in detail, including their internal structure, parameter updating process, and related optimization algorithms.

Survey of Auditory Training Awareness for Hearing Professionals and Elderly Individuals Using Hearing Aids

Purpose: The purpose of this study was to identify the demand for auditory training provision and survey beneficiary experience.Methods: A total of 161 participants (80 hearing professionals and 81 elderly hearing aid users) were surveyed online or in-person. Both groups completed 26 questions related to their experience of providing or receiving auditory training, awareness of need, and preference.Results: The hearing professional group was strongly aware of the need to provide auditory training to improve communication problems in elderly individuals using hearing aids, and the absence of a systematic auditory training program was the biggest factor in not providing auditory training. The elderly hearing aid user group also recognized the need for auditory training to improve communication problems, but they responded that the hassle of visiting a clinic for training and lack of training time were factors that made participation in auditory training difficult.Conclusion: Hearing professionals should expand the scope of aural rehabilitation services to provide effective auditory training programs that fit the concept of rehabilitation, rather than simply providing hearing aid fitting management services to improve communication skills. Therefore, hearing professionals should conduct an intervention program after hearing aid fitting for elderly hearing aid users so that hearing rehabilitation can be comprehensively performed according to auditory and cognitive perceptual changes. In addition, efforts are required to solve limitations that make it difficult for elderly individuals who use hearing aids to participate in auditory training, such as the development of a web-based auditory training program.

Brazilians technology transfer offices: processes’ performance and effectiveness

Considering relations between universities and the productive sector, the Technology Transfer Offices (TTOs) fundamentally foster innovation. In the technology process, transfer TT) since they are responsible for studies of prospecting and competitive intelligence and their protection in intellectual property (IP). The present study aims to identify the effectiveness of TT processes as a measure of the performance of Brazilians Science and Technology Institutions (STIs) TTOs considering their technology, innovation promotion policies and intellectual property protection. It regards qualitative, exploratory-descriptive research with a multiple-study method. The data was collected through documentary research and semi-structured interviews with three groups of actors already participating in TT processes: researchers, TTO managers, and company managers. Through the triangulation of data, data triangulation these institutions still need to have adequate adherence to the models of business innovation management used by the local productive sector and need more bidirectional planning. Despite the advancement of the scope and quality of services offered by TTOs and the amounts of technology contracts, there has been an extensive effort to improve the communication channels and promote innovation by identifying factors that contribute to and hamper the promotion of change in the Ceará' scenario, the characteristics that group STIs in different stages of maturation were detected.

Task Shifting and Task Sharing Implementation in Africa: A Scoping Review on Rationale and Scope.

Numerous studies have reported task shifting and task sharing due to various reasons and with varied scopes of health services, either task-shifted or -shared. However, very few studies have mapped the evidence on task shifting and task sharing. We conducted a scoping review to synthesize evidence on the rationale and scope of task shifting and task sharing in Africa. We identified peer-reviewed papers from PubMed, Scopus, and CINAHL bibliographic databases. Studies that met the eligibility criteria were charted to document data on the rationale for task shifting and task sharing, and the scope of tasks shifted or shared in Africa. The charted data were thematically analyzed. Sixty-one studies met the eligibility criteria, with fifty-three providing insights on the rationale and scope of task shifting and task sharing, and seven on the scope and one on rationale, respectively. The rationales for task shifting and task sharing were health worker shortages, to optimally utilize existing health workers, and to expand access to health services. The scope of health services shifted or shared in 23 countries were HIV/AIDS, tuberculosis, hypertension, diabetes, mental health, eyecare, maternal and child health, sexual and reproductive health, surgical care, medicines' management, and emergency care. Task shifting and task sharing are widely implemented in Africa across various health services contexts towards ensuring access to health services.

MANAGEMENT OF CUSTOMER WITH DYSFUNCTION OF SOCIAL IN HEALTH ORGANIZATIONS

Any of health organization must be create a good relation not only inside of organization but mostly with all of them from outside of organization. One of them is a patient, by author is named “customer” because for every person for health organization is going money that affects the proper functioning of the hospital. Decision makers within the system are constantly required to make choices, as well as seek alternative ways to measure the unit costs of illness. One of the factors that makes it difficult to optimize the scope of health services is the phenomenon of social exclusion, which is increasingly affecting society. The author intends to demonstrate the links between social exclusion and the higher costs of treating customers belonging to this social sector, unlike other customers who are neither unemployed nor live in poverty.

Effects of hydrogen bonding on photo-responsive behavior of healable azobenzene-containing polyurea elastomers

Photo-responsive polymers, obtained by incorporation of photochromic azobenzene groups into polymer, can display reversible photoactuation behavior. However, the damage can cause a reduction in their service scope or service lifetime. It remains a challenge to design healable and reprocessable azobenzene-containing polymers. The polyaddition of isophorone diisocyanate (IPDI) with p-diaminoazobenzene (DAAB) and amino-terminated poly(propylene glycol) (D2000) was performed to prepare the main-chain polyurea elastomer. The hydrogen bonding between urea groups can enhance self-healing of polyurea elastomer, but its influence on photo-responsive behavior of polyurea elastomer is not clear. The proportion of ordered hydrogen bonds was regulated by changing azobenzene content and the ratio of hard/soft segments. The ordered hydrogen bonds played a fundamental role in the maximum peak intensity of polyurea, while they had no direct effect on the photo-responsive efficiency of polyurea. This study provides a feasible way to obtain healable and reprocessable azobenzene-containing polymers.

Resource Allocations for Common Radiation Oncology Procedures

Radiation Oncology is a complex, resource-intensive discipline. The complexity of the radiation oncology treatment process has increased significantly in recent years with the introduction of more advanced imaging, planning, and treatment delivery technology and enhanced use of multidisciplinary care paths. We conducted a multi-institutional study to estimate the average time by functional unit for a wide range of modern radiation oncology treatment regimens. Structured process mapping was performed for 24 treatment categories, and average time estimates for 6 functional groups were obtained for each process step through consultation with the full clinical team at each institution. Six geographically dispersed institutions participated in the study. Significant effort was invested in aggregate data analysis and clarification of assumptions. The findings show significant variability in the resources expended for many treatment categories as well as the distribution of workload between functional units. Major factors in the variability include the rate of adoption of hypofractionation in external beam therapy, adoption of automation tools and standardization, and the transition to multimodality image-based planning in brachytherapy. The data obtained from this study may be useful in designing institution-specific staffing models appropriate to the scope of radiation therapy services provided at each institution.

Efficient scale and scope of business models used in municipal solid waste management

PurposeThe paper aims to compare the efficiency of alternative municipal solid waste (MSW) management business models: a single provider against multiple providers.Design/methodology/approachIn this paper the drivers of MSW management costs are analysed to test the impact of the scale and scope of MSW management services on the average cost. While the business-as-usual scenario foresees a single provider, the alternative scenario foresees multiple providers.FindingsBased on the empirical data on municipal waste management costs, on average, the size and the average cost of the service are inversely related. This trend is supported using sub-sets defined by the quantity of waste managed. Multiple factors aid in explaining this result, and among others, due to scale and scope, factors such as transition costs increase with the number of players running different services.Practical implicationsThe provision of public services of economic interest should favour the participation of more companies wherever possible to the extent that social surplus is produced. However, pursuing this principle to the detriment of efficient service delivery is not ideal. This paper demonstrated that a single-provider waste management business model is efficient under specific conditions, as in this article.Originality/valueThis paper presents an original research methodology for comparatively analysing waste management service efficiency in urban areas and provides adequate evidence using alternative measures of costs according to the phase of the waste management chain, the scale and ultimately the scope of MSW management services.

World Health Organization survey on the level of integration of traditional Chinese medicine in Chinese health system rehabilitation services

BackgroundTo meet the growing global demand for rehabilitation services, the World Health Organization (WHO) launched Rehabilitation 2030. This study was commissioned by the WHO to investigate the integration degree of traditional Chinese medicine (TCM) in Chinese health system rehabilitation services and the demand for TCM rehabilitation in China. MethodsTwenty TCM rehabilitation experts and relevant government administrators were invited to complete the questionnaire between September 2019 and January 2022. The development of traditional, complementary, and integrative medicine (TCI) rehabilitation in China was assessed primarily based on six different health system components. Results26 policies, regulations, and national strategic plans related to TCI rehabilitation were issued by relevant government departments since 2002; notably, 14 policies related to TCI rehabilitation development were intensively introduced from 2016 to 2021. These policies cover the three main areas of financing, infrastructure development, and service delivery. The National Administration of Traditional Chinese Medicine's investment in TCM clinical capacity infrastructure and scientific research in 2019–2021 increased by 66% compared to 2010–2012, and the average number of TCM hospitals with rehabilitation departments in 2020 increased by 6.5% compared to 2018. The proportion of community health service centers providing TCM services in primary medical and health institutions has increased by 30.8% over the past 10 years. ConclusionLong-term continuous policies, substantial financial investment, and expansion of the scope of TCI rehabilitation services in primary care institutions have effectively contributed to the rapid development of TCI rehabilitation. However, human resources and financing mechanisms for TCI rehabilitation need further improvement.

Improving type 2 diabetes mellitus management in Ministry of Defense Hospitals in the Kingdom of Saudi Arabia 2018–2021

Diabetes mellitus is a metabolic disease characterised by elevated levels of blood glucose and is a leading cause of disability and mortality. Uncontrolled type 2 diabetes leads to complications such...

International Aspects of IT Business Development in Ukraine

Results of a study of macroeconomic effects from foreign economic activities of IT business in Ukraine and its revealed development patterns are presented in the article. It was found that the domestic IT business gained the increasingly more features of the international business, which is very important in addressing the issues related with securing the advantages of doing IT business in Ukraine and building up the institutional framework required for it.
 The study revealed that the increased scopes of services in creating software design, data processing and databases, techniques, provided by the IT sector in Ukraine, had a considerable positive effect for the exports of external services and the overall trade balance of services in Ukraine. It could be achieved due to the adaptation of the Ukrainian IT sector, in particular its organizational forms, to the specifics of foreign economic activities. 
 The analysis laid the basis for elaborating recommendations for securing the advantages of doing IT business in Ukraine and building up the relevant institutional framework that would allow for effective utilization of the potentials available with the domestic IT business.

Leveraging Community Resources and Local Expertise to Build a Safe Learning Environment for K-12 Students During COVID-19: A Field Experience.

To share the experiences of stakeholders in a school district's response to the COVID-19 pandemic, especially related to supporting the district in the reopening process and sharing key decision points, challenges, facilitators, and overall lessons learned that may be applied to future emergencies. A descriptive study of participants' experience that included (1) a content analysis of policy documents and recommendations that were developed and published by key stakeholders and (2) interviews with stakeholders in the school system that were coded to identify patterns and themes. Remote interviews conducted over Zoom. Participants live or work in Brookline, Massachusetts. Fifteen qualitative interviews were conducted with school committee members, principals, members of school leadership, school nurses, school staff, parents, advisory panel members, and physicians collaborating with the school district. Whether patterns and themes related to challenges, solutions, and recommendations for future management of public health emergencies in the district could be identified. Challenges experienced during a school district's response included staffing burdens, changing scopes of services, the difficulty of successfully enforcing social distancing, addressing staff and family fears, meeting informational needs, and limited resources. Multiple interviewees shared that they felt there should have been a greater emphasis on mental health in the district's response. Successes of the response included the creation and implementation of a consistent communications system, recruiting volunteers and mobilizing the community to address critical needs, and effective technology expansion and usage in schools. Leadership and community collaboration were essential to the response to the COVID-19 pandemic in addition to strategies used to enhance coordination and communication and relay information across the community.

Impact of Telehealth and Process Virtualization on Healthcare Utilization

Telehealth has emerged as a tool to improve patient access by virtualizing healthcare services, particularly during the COVID-19 pandemic. However, concerns have been raised that telehealth may actually increase healthcare spending by leading to new types of utilization. Our research provides empirical evidence that this concern is unfounded based on a state-wide study of patient visit-level data of telehealth use in 58 hospitals in Maryland from 2012 to 2021. On average, telehealth use can reduce future outpatient visits by 13.6% within 30 days after a telehealth visit, leading to a cost reduction of $239. The benefits of telehealth are most apparent for diseases with high potential for process virtualization, such as mental health, skin disorders, metabolic, and musculoskeletal diseases. Although telehealth has a substitution effect on future healthcare utilization, this effect is not observed among rural patients who use telehealth as a gateway to utilize more primary care and specialist services. Our findings suggest that policymakers should promote the use of telehealth in a value-based healthcare environment by providing monetary incentives to expand telehealth use among patients and providers, and expand the scope of telehealth services to include consultation with specialists especially among rural patients.

A case study of HIV/AIDS services from community-based organizations during COVID-19 lockdown in China

IntroductionPeople living with HIV (PLHIV) relied on community-based organizations (CBOs) in accessing HIV care and support during the COVID-19 pandemic in China. However, little is known about the impact of, and challenges faced by Chinese CBOs supporting PLHIV during lockdowns.MethodsA survey and interview study was conducted among 29 CBOs serving PLHIV in China between November 10 and November 23, 2020. Participants were asked to complete a 20-minute online survey on their routine operations, organizational capacity building, service provided, and challenges during the pandemic. A focus group interview was conducted with CBOs after the survey to gather CBOs’ policy recommendations. Survey data analysis was conducted using STATA 17.0 while qualitative data was examined using thematic analysis.ResultsHIV-focused CBOs in China serve diverse clients including PLHIV, HIV high-risk groups, and the public. The scope of services provided is broad, ranging from HIV testing to peer support. All CBOs surveyed maintained their services during the pandemic, many by switching to online or hybrid mode. Many CBOs reported adding new clients and services, such as mailing medications. The top challenges faced by CBOs included service reduction due to staff shortage, lack of PPE for staff, and lack of operational funding during COVID-19 lockdowns in 2020. CBOs considered the ability to better network with other CBOs and other sectors (e.g., clinics, governments), a standard emergency response guideline, and ready strategies to help PLHIV build resilience to be critical for future emergency preparation.ConclusionChinese CBOs serving vulnerable populations affected by HIV/AIDS are instrumental in building resilience in their communities during the COVID-19 pandemic, and they can play significant roles in providing uninterrupted services during emergencies by mobilizing resources, creating new services and operation methods, and utilizing existing networks. Chinese CBOs’ experiences, challenges, and their policy recommendations can inform policy makers on how to support future CBO capacity building to bridge service gaps during crises and reduce health inequalities in China and globally.

ORthopaedic trauma hospital outcomes - Patient operative delays (ORTHOPOD) Study: The management of day-case orthopaedic trauma in the United Kingdom

IntroductionORTHOPOD: Day Case Trauma is a multicentre prospective service evaluation of day-case trauma surgery across four countries. It is an epidemiological assessment of injury burden, patient pathways, theatre capacity, time to surgery and cancellation. It is the first evaluation of day-case trauma processes and system performance at nationwide scale. MethodsData was prospectively recorded through a collaborative approach. Arm one captured weekly caseload burden and operating theatre capacity. Arm two detailed patient and injury demographics, and time to surgery for specific injury groups. Patients scheduled for surgery between 22/08/22 and 16/10/22 and operated on before 31/10/22, were included. For this analysis, hand and spine injuries were excluded. ResultsData was obtained from 86 Data Access Groups (70 in England, 2 in Wales, 10 in Scotland and 4 in Northern Ireland). After exclusions, 709 weeks worth of data representing 23,138 operative cases were analysed. Day-case trauma patients (DCTP) accounted for 29.1% of overall trauma burden and utilised 25.7% of general trauma list capacity. They were predominantly adults aged 18 to 59 (56.7%) with upper limb Injuries (65.7%). Across the four nations, the median number of day-case trauma lists (DCTL) available per week was 0 (IQR 1). 6 of 84 (7.1%) hospitals had at least five DCTLs per week. Rates of cancellation (13.2% day-case; 11.9% inpatient) and escalation to elective operating lists (9.1% day-case; 3.4% inpatient) were higher in DCTPs. For equivalent injuries, DCTPs waited longer for surgery. Distal radius and ankle fractures had median times to surgery within national recommendations: 3 days and 6 days respectively. Outpatient route to surgery was varied. Dominant pathways (>50% patients listed at that episode) in England and Wales were uncommon but the most frequently seen was listing patients in the emergency department, 16 of 80 hospitals (20%). ConclusionThere is significant mismatch in DCTP management and resource availability. There is also considerable variation in DCTP route to surgery. Suitable DCTL patients are often managed as inpatients. Improving day-case trauma services reduces the burden on general trauma lists and this study demonstrates there is considerable scope for service and pathway development and improved patient experience.

The Flow of Green Exercise, Its Characteristics, Mechanism, and Pattern in Urban Green Space Networks: A Case Study of Nangchang, China

An urban green space network provides safe and green exercise routes for residents. This study selected Nanchang as the study area. Using fitness application data, we explored the mobility of people exercising in the network, i.e., the flow of green exercise. Spatial analysis based on social networks, GIS, and the gravity model was used to analyze the nodes, network characteristics, and mechanism of the flow of green exercise. The results show that there were differences in the hierarchy and attractiveness of nodes. Distance had an important influence on green exercise. It was found that walkers moved between adjacent parks, runners visited more parks and corridors, while cyclists covered longer distances and preferred to explore suburban green spaces. The length of the exercise route in green spaces had a positive effect on mobility. Because of the many combinations of patches and corridors, three flow subnetworks were formed. In addition, the green space network expanded the scope of exercise services in the central node. The management of green spaces should pay attention to the social value of urban green space networks and create a hierarchical and interconnected green space for exercisers.

Digital Inclusive Finance and Regional Innovation Output

This paper systematically sorts out the internal mechanism of the development of digital inclusive finance affecting regional innovation output, and uses the panel data of 31 provinces in mainland China from 2011 to 2020. From the provincial level, the individual fixed effect model and channel test are used to test the promotion effect of digital inclusive finance on the improvement of regional innovation output. The study found that the development of digital inclusive finance, its coverage, depth and degree of digitalization help to improve regional innovation capacity. The empirical results show that the development of digital inclusive finance is conducive to alleviating financing constraints and directly promoting regional innovation output; The analysis of intermediary mechanism shows that digital inclusive finance can increase external demand by promoting industrial upgrading, and then indirectly promote regional innovation output. This provides policy inspiration for relevant government departments to evaluate regional development conditions, expand the scope of financial services, and improve regional innovation systems and mechanisms.

Impact of the COVID-19 Pandemic on Interventional Radiology inGermany.

To investigate the effect of the ongoing COVID-19 pandemic on interventional radiology (IR) in Germany in 2020 and 2021. This retrospective study is based on the nationwide interventional radiology procedures documented in the quality register of the German Society for Interventional Radiology and Minimally Invasive Therapy (DeGIR-QS-Register). The nationwide volume of interventions in the pandemic years 2020 and 2021 was compared with the pre-pandemic period (Poisson-test, Mann-Whitney test). The aggregated data were additionally evaluated by intervention type with differentiated consideration of the temporal epidemiological infection occurrence. During the two pandemic years 2020 and 2021, thenumber of interventional procedures increased by appr. 4 % compared to the same period of the previous year (n = 190 454 and 189 447 vs. n = 183 123, respectively, p < 0.001). Only the first pandemic wave in spring 2020 (weeks 12-16) showed a significant temporary drop in the number of interventional procedures by 26 % (n = 4799, p < 0.05). This primarily involved interventions that were not immediately medically urgent, such as pain treatments or elective arterial revascularization. In contrast, interventions in the field of interventional oncology, such as port catheter implantations and local tumor ablations, remained unaffected. The decline of the first wave of infection was accompanied by a rapid recovery and a significant, partly compensatory, 14 % increase in procedure numbers in the second half of 2020 compared to the same period of the previous year (n = 77 151 vs. 67 852, p < 0.001). Subsequent pandemic waves had no effect on intervention numbers. The COVID-19 pandemic in Germany led to a significant short-term decrease in interventional radiology procedures in the initial phase. A compensatory increase in the number of procedures was observed in the subsequent period. This reflects the adaptability and robustness of IR and the high demand for minimally invasive radiological procedures in medical care. · The study shows the nationwide pandemic-related effects on interventional radiology in Germany.. · In quantitative terms, the ongoing pandemic caused a significant, temporary decline in intervention cases only in the initial phase.. · Subsequent waves of infections had no effect on the scope of services provided by interventional radiology.. · Short-term deficits, especially in elective interventions, could be partially compensated.. · Schmidbauer M, Busjahn A, Paprottka P et al. Impact of the COVID-19 Pandemic on Interventional Radiology in Germany. Fortschr Röntgenstr 2023; 195: 597 - 604.

Contributions of Green Infrastructure-Oriented Planning and Designing in Residential Gardens to the City’s Ecosystem: Case of Trabzon City, Turkey

The ratio of green areas belonging to residential areas and their location in the city is too important to ignore. However, when we look at urban planning, it is seen that green areas belonging to common public areas are generally evaluated within the scope of ecosystem services, while residential gardens that are within the scope of private property are ignored. In this context, the main purpose of the study is to examine the contribution of the residential gardens, in which the landscape value is kept to the forefront, to the ecosystem services. Within the scope of this main purpose, this study analyzes how the green areas of the residential gardens in Trabzon can be designed through a focus on green infrastructure (GI) within the axis of landscape value and how these designs will serve the ecosystem services in this perspective. Following the study, it has been determined that both spatial needs and ecosystem benefits can be met with the same GI elements, while, on the other hand, it has been conferred that the landscape value, as a significant factor in the design of residential gardens, is supported by several GI elements of an edible garden, pollinator garden, rain garden, biological pond, and green roof. It has been determined that GI elements, where vegetation and water landscape elements are used together, have a higher potential for ecosystem services. In addition, it has been concluded that the green areas of the residential gardens should not be planned and designed solely within their own areas. Based on these analyses, it has been determined that the benefits are considerably increased when the green areas of the residential gardens are planned and designed through a holistic GI-oriented design approach based on the total building parcel. Thus, it is very important to consider GI systems with a holistic approach in residential gardens throughout the city. This holistic approach will allow the benefits of GI to be spread throughout the city and will ensure that the benefits are homogenized within the city.