Service Affiliation Research Articles

Early Childhood Development Awareness and Practices of Family Physicians According to Healthcare Service Affiliation: Primary versus Secondary and Tertiary

Early Childhood Development Awareness and Practices of Family Physicians According to Healthcare Service Affiliation: Primary versus Secondary and Tertiary

The Paradox of Choice in Palliative Care Decision-Making in Managed Long-Term Care: A Qualitative Study

Palliative care offers undeniable advantages to elderly patients with multiple chronic illnesses in managed long-term care. However, only approximately 14% of those who require palliative care actually receive it. To investigate factors influencing decision-making regarding palliative care acceptance, and healthcare providers’ communication strategies, which patients or family caregivers perceive during managed long-term care. Qualitative thematic content analysis study. Two data sources from home and community-based health care organization in a metropolitical city in the Northeastern United States were used: (a) retrospectively collected 79 phone call audio recordings between patients and/or family caregivers with healthcare providers when initiate palliative care option, and (b) prospectively collected 10 exploratory qualitative interviews with patients and/or family caregivers for this study purpose. From a total of 89 conversations, 7 themes emerged during palliative care decision-making: (a) capability for self-management; (b) symptom severity; (c) perceptions of chronic disease; (d) satisfaction with current health services; (e) code status; (f) caregiver burden and (g) other reasons, including financial considerations and service affiliations. In addition, from 10 qualitative interviews, 4 key themes in healthcare providers’ communication that optimize palliative care conversations were indicated: (i) trust and relationship dynamics; (ii) positive reinforcement and personal connection; (iii) conversation setting and initiator; and (iv) collaborative approach to care coordination. Enhancing decision-making around palliative care and improving acceptance of palliative care services may be improved through the integration of personalized care plans, empathetic communication, use of symptom-inclusive assessments for timely care, and proactively addressing caregiver burden.

Determining influence of service quality on user identification, belongingness, and satisfaction on mobile social media: Insight from emotional attachment perspective

WeChat has burgeoned into a predominant mobile communication platform that facilitates instantaneous text and voice-mediated dialogues. Currently, it stands out as a quintessential mobile social media platform in mainland China. The primary objective of this study is to meticulously dissect the ramifications of entire service quality on user assessments of WeChat, encompassing facets such as user satisfaction, identification, belongingness, and perceived benefit, whilst unraveling the correlation between user assessments and their proclivity towards emotional and service attachment. This scholarly endeavor is amongst the scant researches that empirically scrutinize the intricate interplay between entire service quality, user evaluations, emotional attachment specific to WeChat, and overarching service attachment within the mobile social media milieu. The research paradigm was rigorously evaluated through the harnessing of data collected from the Sojump database, which contains 598 valid observational data points. Employing the robust methodology of structural equation modeling, the research model was subsequently corroborated and authenticated. Obtained results validate the path effects, demonstrating that entire service quality exerts a positive influence on WeChat users’ identification, belongingness, satisfaction and benefit. Furthermore, emotional attachment significantly contributes to service attachment. Based on attachment theory, the revelations from this study shed light on the profound mechanisms through which entire service quality in mobile social media can invigorate and solidify user evaluations, fortifying their predisposition towards sustained product and service affiliations.

Review Essay: “Free Radical: Music, Violence and Radicalism”

Review Essay: “Free Radical: Music, Violence and Radicalism”

A Prospective Assessment of a Novel, Disposable Video Laryngoscope With Physician Assistant Trainees Using a Synthetic Cadaver Model.

Airway obstruction is the second leading cause of preventable death on the battlefield. Video laryngoscopy has improved airway management in the emergency setting for several decades, and technology continues to improve. Current technology in the supply chain is cost-prohibitive to incorporate at Role 1 facilities, which is where many intubations occur by novice intubators. The i-view is a novel video laryngoscopy device that is handheld, inexpensive, and disposable. The aim of this study was to determine if the i-view is suitable based on performance assessments by physician assistant trainees and survey feedback. We prospectively enrolled physician assistant students at the Interservice Physician Assistant Program at Joint Base San Antonio-Fort Sam Houston. We provided them structured training on how to use the device, and then, a board-certified emergency medicine physician or certified registered nurse anesthetist assessed their intubations performed on a SynDaver mannequin model. We surveyed the participants afterward. We enrolled 60 Interservice Physician Assistant Program students. Most participants were male (75%) with a median age of 32 years. Service affiliations included Army (50%), Navy (23%), Air Force (18%), and Coast Guard (8%). Most (70%) had previous deployment experience. All the participants successfully cannulated the mannequins and 98% achieved first-attempt success. Most participants (78%) reported a grade 1 view. On postprocedure survey, 91% strongly agreed with using this device in the deployed setting and 89% strongly agreed with finding it easy to use. All physician assistant trainees successfully and rapidly performed endotracheal intubation using the disposable i-view video laryngoscope. Study participants rated the device as easy to use and desirable for deployment. Further research is necessary to validate this novel device in the clinical setting before recommending dissemination to the deployed military medical force sets, kits, and outfits.

Coronal restoration of the root filled tooth - a qualitative analysis of the dentists' decision-making process.

AimTo describe the decision‐making process of the general dental practitioner (GDP) underlying the choice of coronal restoration of a root filled tooth.MethodologyGDPs were strategically selected with respect to gender, age, undergraduate dental school, service affiliation and duration of professional experience. Semistructured in‐depth interviews were conducted, focusing on the informant’s personal experience of the process which leads to a decision as to how to restore a root filled tooth. The informants were invited to describe in their own words the latest two cases involving decisions of direct or full crown restorations respectively. The interviews were digitally recorded and transcribed verbatim. Interviews from 14 informants, aged 27–64 (mean age 46 years), were included and analysed according to Qualitative Content Analysis.ResultsA theme (latent content) was identified: Clinical factors were considered important but were overruled by context and patient opinions, if in conflict. Three main categories, including seven subcategories (manifest content), were identified. The categories were clinical factors, contextual factors and patient's views. Clinical factors underlying the GDPs' decision included the current dental status and the estimated longevity of the intended restoration. In certain cases, contextual factors were also of importance, either supporting the GDPs' decision or modifying it. However, the patient's views played a decisive role in the final choice of coronal restoration, leading to either mutual acceptance or a compromise, taking into account the patient's economic status and opinions.ConclusionsWith respect to coronal restoration of a root filled tooth, the GDPs’ decision‐making process was based not only on clinical factors, but also on decisive contextual factors and consideration of the patients’ views.

The Mexican National Health and Nutrition Survey as a Basis for Public Policy Planning: Overweight and Obesity.

Mexico has one of the highest overweight and obesity rates in the world. Our objective is to describe the tendency of overweight and obesity by sex, health service affiliation, and socioeconomic tertile (T1,2,3), and to give examples of public policies derived from the results of the Mexican National Health and Nutrition Surveys (ENSANUT). Data come from the 2006, 2012, and 2016 ENSANUTs, which are probabilistic surveys that allow us to make inferences at the national level, on urban and rural strata and regions; their coverage includes all the population age groups. We assessed overweight and obesity (OW + O) in all population groups. The prevalence of OW + O in preschool children was lower in T1 in all the surveys, and shows an increase by year of survey, according to the health service affiliation. In school-age women, prevalence increased over the 10 years of evaluation, in spite of the high prevalence in both genders in T3. Adolescent behavior is similar and, in adults, the prevalence of OW + O shows an increase by year of survey, gender, and affiliation, with the differences not explained by socioeconomic tertile. In conclusion, the ENSANUT series represents a surveillance system that allow us to observe the changes in overweight and obesity prevalence over the time, showing a high prevalence of OW + O in the population, and has contributed to public policy enhancement.

'Seeing is believing': a qualitative approach to studying the use of cone beam computed tomography in endodontics in Sweden.

To gain insight into the decision processes of dentists when requesting a cone beam computed tomography (CBCT) examination in endodontic settings. Fourteen dentists (eight female) 33-58years of age (mean=44) practising in Sweden were interviewed. Ten of the dentists were specialists in Endodontics. The absolute inclusion criterion was experience of referring patients for CBCT for endodontic reasons. The included dentists comprised a strategically selected diverse sample in terms of gender, age, work experience, educational background, location of practice, service affiliation and accessibility to CBCT. Data were obtained through semistructured interviews exposing the context of their last three self-reported referrals. Dentists were encouraged to describe their experiences of the circumstances in their own words, aided by the interviewer's open-ended questions. The interviews were audio-recorded and transcribed verbatim. The text was analysed by qualitative content analysis. The manifest content was organized into three categories that were defined as visualization as a desire, facilitating tough decisions and allocating responsibility. An overall theme (covering the latent content) was identified: A balance between clinical common sense and a 'better safe than sorry'attitude guides the use of CBCT in endodontic settings. Informants had high clinical standards, knowledge concerning radiation risks and good sense, which could compensate for their lack of knowledge of guidelines. The national radiation regulatory system was perceived to work as a slightly porous gatekeeper for over-usage.

Assessing and addressing domestic abuse by Ex-armed service personnel

In the context that separate peer-led services are increasingly being developed to meet the needs of Ex-armed service personnel (Ex-asp) in the criminal justice system, we explore whether such services should also be developed to address any tendencies towards domestic abuse. Based on interviews with 12 imprisoned Ex-asp and 10 service-affiliated informants working with them, we found domestic abuse is not always recognized as a potential problem for Ex-asp. Nonetheless, respondents suggested that interventions to address the potential for domestic abuse by some Ex-asp would be useful and legitimate if they are provided by those with service affiliations. Considering our findings, however, we strike a note of caution about separate and peer-led approaches becoming the default option for working with Ex-asp in the criminal justice system. We suggest the gendered nature of military culture may be associated with concerns about the implications of re-engaging Ex-asp with their military identities. Moreover, being steeped in military culture, we suggest that without training some service-affiliated staff may be unsighted on important aspects of the role gender expectancies play in domestic abuse and poorly placed to respond appropriately to this type of offending.

The dentist's care-taking perspective of dental fear patients - a continuous and changing challenge.

The aim was to analyse the care taking of dental fear patients from the perspective of the dentist, using a qualitative methodology. In total, 11 dentists from both the private and public dental service were selected through a purposive sampling according to their experience of treating dental fear patients, their gender, age, service affiliation and location of undergraduate education. Data were obtained using one semi-structured interview with each informant. The interviews were taped and verbatim transcribed. The text was analysed using qualitative content analysis. The theme, 'The transforming autodidactic process of care taking', covering the interpretative level of data content was identified. The first main category covering the descriptive level of data was 'The continuous and changing challenge', with the subcategories 'The emotional demand' and 'The financial stress'. The second main category identified was 'The repeated collection of experience', with the subcategories 'The development of resources' and 'The emotional change'. The dentists' experience of treating dental fear patients was considered a challenging self-taught process under continuous transformation. The competence and routine platform expanded over time, parallel to a change of connected emotions from frustration towards safety, although challenges remained.

The regional distribution of foreign investment in Russia

AbstractThis article conducts a plant‐level study of the factors affecting foreign direct investment (FDI) inflow to a large opening economy endowed with specific factor advantages. We conclude that the distribution of FDI in Russian regions depends on market access and can be most notably described by the knowledge‐capital framework. Factor endowments built by natural resources are more successful in explaining the location decisions of export–platform affiliates. The impact of natural resources depends on how the availability of these resources is measured. The results reject the crowding out effects of resource FDI and prove co‐location mode, when service investments are attracted to resource‐rich regions. Labour cost advantages better explain the preferences of non‐trading service affiliates.

Forking Paths: War After Afghanistan

Abstract: For defense departments and professional militaries of advanced liberal democracies, judgments concerning future armed conflict are necessary guide force preparation, personnel readiness, and equipment procurement. When such judgments are made in times of economic austerity and geopolitical uncertainty, need for clarity of thought on future of war becomes imperative in determining priorities. ********** It is not primarily in present, nor in past that we live. Our life is an activity directed towards what is come. The significance of present and past only becomes clear afterwards in relation future. Jose Ortega y Gassett While all advanced military establishments engage in intellectual examinations about future of armed conflict, it is often unclear which intellectual methods actually represent best futures practice. In any Western officer corps one can find contending advocates for best interpret future of war. Some argue that lens of human experience--filtered through a Clausewitzian-style of military history as Kritik--is most sensible way forward; others prefer geometrical tradition of Jomini and seek gain better understanding through science in form of operations research and technical experimentation; still others prefer look interdisciplinary subject of strategic studies as a means of revealing holistic insights on armed conflict. Further diversity in professional outlook is often imposed by imperatives of service affiliation and specialized training for separate domains of land, sea, and aerospace warfare. Speculation on future of war may also be affected by demands of hierarchical military culture ranging from idiosyncratic command preferences imposition of short-term strategic and operational goals. Not surprisingly, ad hoc intellectual endeavors can easily dominate military institutions--driven as much by interaction of budgets, personalities, and internal compromises--as by objective mental rigor. Such pressures led American philosopher Lewis Mumford conclude that military establishments represent the refuge of third-rate minds in which institutional thinking can be conformist, sometimes dogmatic, and frequently anti-intellectual. (1) This article probes generic intellectual requirements involved in preparing consider problems of future war. Two caveats are immediately required. First, author makes no claims having uncovered any magic formulae for predictive accuracy about future conflicts. Second, this essay is not a meditation on full sweep of potential future military operations from computers through cyberwarfare climate change. Rather, it is a reflection on conceptual demands of dealing with future armed conflict--what Peter Paret calls cognitive challenge of war--the how think dimension which is most serious problem facing any military organization. (2) The author believes that, for armed forces establishments, futures studies, if properly conceived and conducted, are likely be particularly valuable over next decade. When militaries are faced with an end a long period of hostilities--as is case with United States and its allies in 2014--they must embark on rigorous contemplation of shape of future war. The task is to look ahead, not into distant future, but beyond vision of operating officers caught in smoke and crises of current battle; far enough ahead see emerging form of things come and outline what should be done meet or anticipate them. (3) With these issues in mind, three areas are analyzed. First, provide philosophical and methodological context, development of modern futures studies is explored and its intellectual connections field of strategic studies are highlighted. In second section, role history can play in military futures studies is explored. …

Complete process of implantation of a nutritional risk screening system in the University Hospital La Paz, Madrid

Disease-Related Malnutrition (DRM) is present in a high percentage of patients admitted to hospital and their impact is diverse and of great importance. Nutrition Department of University Hospital La Paz, in collaboration with all members of the Nutrition Committee, we decided to implement some method of screening in our centre which allowed us to detect as many patients with malnutrition risk as possible. Due to the large size of our centre, with about 1,500 beds and the few human resources in our unit, we chose to use the CONUT system (Nutritional Control), a 100% automatic method based on analytical parameters, very easy to use, low cost and whose validity is confirmed, characteristics that fulfilled our needs. The method collects information from databases of Admission Service (affiliation, age, date) and Laboratory (albumin, cholesterol, total lymphocytes) and generates, in the report of analytical results, "alert" information about each patient''s nutritional risk and also nutritional recommendations based on the risk identified. Prior to its implantation several evaluations were performed in order to allow us to better know the extra workload, as it was the main factor that could limit our ability to assume that screening method and also many training activities for doctors and hospital health professionals who were increasingly assuming responsibilities in the nutritional treatment of their patients. This screening system has been working from June of 2010 and it has detected risk of malnutrition in 32% of the evaluated patients. In general, only in those cases where the alert corresponded to a high-risk nutritional situation, which represents approximately 10% of the total, specialized intervention by the Clinical Nutrition Unit was required. Later, as we have detected some possible causes that justify the system does not work properly; the screening system has undergone several changes . In this sense, we have made a retrospective evaluation of 233 patients admitted to the General Surgery plants and documented that those entering for scheduled surgery, having a alarm of malnutrition (50% of cases), its presence increases significantly the hospital stay and mortality. The implementation of this nutritional screening method has led to a change in the "nutritional" culture of our centre respect to DRM in most of our professionals: doctors and nurses and even in the management team, so all of them understand the importance of the process and know about the available tools and knowledge to indicate an adequate and early nutritional support.

The utilitarian and social dual presence in Web 2.0 services

A unidimentional construct of utilitarianism in exploring the adoption of Web 2.0 services is not enough to capture the complexity of user experience. There is a need to pursue a broader conceptualisation that goes beyond the utilitarian presence that has dominated studies in innovation adoption, and incorporates social presence as well. The results suggest that the utilitarian and social dual presence provide a richer insight into the nature of user experience in the Web 2.0 services. Further, this study discovers the users' continuance intention beyond utilitarian benefit sought but more social-oriented. Users are preferential to the social superior option when the minimum utilitarian benefits are met. Users are more interested in the social links that come from service affiliations than the service itself. The differences in magnitudes of effects of utilitarian and social presence provide insights for designers and managers to prioritise resources and to personalise the service's interface design.

Interpreting comparative died of wounds rates as a quality benchmark of combat casualty care

The died of wounds (DOW) rate is cited as a measure of combat casualty care effectiveness without the context of injury severity or insight into lethality of the battlefield. The objective of this study was to characterize injury severity and other factors related to variations in the DOW rate. The highest monthly DOW (HDOW) and lowest monthly DOW (LDOW) rates from 2004 to 2008 were identified from analysis and casualty report databases and used to direct a search of the Joint Theater Trauma Registry. Casualties from the HDOW and LDOW were combined into cohorts, and injury data were analyzed and compared. The HDOW rates were 13.4%, 11.6%, and 12.8% (mean, 12.6%), and the LDOW rates were 1.3%, 2.0%, and 2.7% (mean, 2.0%) (p < 0.0001). The HDOW (n = 541) and LDOW (n = 349) groups sustained a total of 1,154 wounds. Injury Severity Score was greater in the HDOW than the LDOW group (mean [SD], 11.1 [0.53] vs. 9.4 [0.58]; p = 0.03) as was the percentage of patients with Injury Severity Score of more than 25 (HDOW, 12% vs. LDOW, 7.7%; p = 0.04). Excluding minor injuries (Abbreviated Injury Scale score of 1), there was a greater percentage of chest injuries in the HDOW compared with the LDOW group (16.5% vs. 11.2%, p = 0.03). Explosive mechanisms were more commonly the cause of injury in the HDOW group (58.7% vs. 49.7%; p = 0.007), which also had a higher percentage of Marine Corps personnel (p = 0.02). This study provides novel data demonstrating that the died of wounds rate ranges significantly throughout the course of combat. Discernible differences in injury severity, wounding patterns, and even service affiliation exist within this variation. For accuracy, the died of wounds rate should be cited only in the context of associated injury patterns, injury severity, and mechanisms of injury. Without this context, DOW should not be used as a comparative medical metric.

Respiratory Symptoms Necessitating Spirometry Among Soldiers With Iraq/Afghanistan War Lung Injury

Respiratory Symptoms Necessitating Spirometry Among Soldiers With Iraq/Afghanistan War Lung Injury

Edad de la gestante adolescente como factor de riesgo para complicaciones en el embarazo. Cartagena (Colombia) 2009. Estudio de corte transversal

Objetivo: estimar las diferencias entre los subgrupos de adolescentes embarazadas de 13 a 15 años; y 16 a 18 años, con respecto a las complicaciones presentes durante el embarazo en la ciudad de Cartagena (Colombia).Materiales y métodos: estudio de corte transversal en 100 adolescentes embarazadas, vinculadas a una fundación durante el año 2008. Se indagaron variables sociodemográficas, estado nutricional, afiliación al servicio de salud, ocupación, prácticas de salud sexual y reproductiva, control prenatal, anemia, infección urinaria y vaginal, preeclampsia, eclampsia, diabetes gestacional, hipertensión, semanas de embarazo y vía del parto. Los resultados se presentan mediante medidas de tendencia central y dispersión o proporciones según el tipo de variable. Las características basales de los grupos se compararon mediante la prueba de chi cuadrado. Se estimó la asociación entre los dos grupos de edad y las complicaciones del embarazo por medio del odds ratio (OR).Resultados: las adolescentes de 13 a 15 años tienen más riesgo que las adolescentes de 16 a 18 años de presentar parto pretérmino [OR 5,0 (IC 95%: 1,86 -13,7)] y parto vía cesárea [OR 3,57 (IC 95%: 1,25 – 10,5)].Conclusiones: se concluye que el embarazo a edad temprana conlleva a complicaciones durante la gestación en el grupo de adolescentes de 13 a 18 años.

Neck Pain During Combat Operations

STUDY DESIGN. Prospective observational study among soldiers medically evacuated out of theaters of combat operations for neck pain, with retrospective analysis of variables associated with return-to-duty. To provide an epidemiological overview of the burden of neck pain in deployed soldiers involved in combat operations and to identify factors associated with return-to-duty. Neck pain represents one of the leading causes of medical evacuation out of theaters of combat operations. Yet when compared to other diagnostic categories, treatment outcomes, militarily defined as returning a soldier to duty, remain appallingly low. Demographic, military-specific, and outcome data were prospectively collected over a 2-week period at the Deployed Warrior Medical Management Center in Germany on 374 consecutive soldiers medically evacuated out of theaters of combat operations for a primary diagnosis pertaining to neck pain between 2004 and 2007. The 2-week period represents the maximal allowable time an evacuated soldier can spend in treatment before disposition (i.e., return to theater or evacuate to United States) is rendered. Electronic medical records were reviewed to examine the effect the following variables had on the categorical outcome measure, return-to-unit: age, gender, service-affiliation, rank and seniority, smoking history, coexisting psychiatric diagnosis, prior neck pain, mechanism of injury, whether or not the injury was combat-related, presence of headache, quality of symptoms, correlation with radiologic imaging, and referral to pain specialist. Only 14% of service members returned to their units. Significant correlations were found between female gender and non-army service affiliation, and a service member returning to their unit. Weak trends toward returning to duty were noted for nonsmokers, absence of prior neck pain, concomitant psychiatric diagnosis, corresponding complaints of headache, and referral to a pain specialist. The treatment of service members medically evacuated for neck pain at the main receiving center, the level IV military treatment facility in Landstuhl, Germany, is associated with a low return-to-unit rate. Future studies should consider whether treating personnel predisposed towards a positive outcome with the limited resources available can improve return-to-duty rates.

Network and border effects: Where do foreign multinationals locate in Germany?

This study assesses the determinants of location choices of foreign multinational firms at the level of German federal states. Adjacency and existing firm networks are assumed to influence the investors' profits in a given location by overcoming informational disadvantages when entering the new market. A nested logit model resembles the structure of the location choice process well, since it allows foreign investors to have differing perceptions about the substitutability among East and West German federal states. By using affiliate-level data between 1997 and 2005, the results confirm that firms react positively to local demand, a common border and existing firm networks, while unit labor costs exhibit the expected negative impact. In the sectoral estimations, it is shown that these effects vary in their relevance across manufacturing and service affiliates, and between upstream and downstream activities and that intersectoral linkages play an important role.

Firm Productivity and Foreign Direct Investment into Non‐core Activities*

As foreign direct investment (FDI) often originates from multinational enterprises (MNEs) with non‐core activities and not single‐product firms, as MNE theory typically suggests, we hypothesize that such firms are more productive than MNEs without non‐core activities as well as non‐MNE firms. We test this hypothesis using Kolmogorov–Smirnov stochastic dominance Tests and Japanese firm‐level productivity and FDI data for the period 1985–2001. We find that both manufacturing and service multinational firms with non‐core foreign investments stochastically dominate firms without non‐core activities. We also find cost‐complementarities between certain core and non‐core FDI activities that span both manufacturing and service affiliates.