Service Tier Research Articles

Discrepancy model to RtI: Gauging teacher preparedness for this shift in specific learning disability classification

AbstractThe Individuals with Disabilities Education Improvement Act (2004) allows alternate pathways for school districts to identify and classify students with a specific learning disability (SLD). Response to Intervention (RtI) is one of the frameworks schools can use when eliminating the use of the discrepancy model. The premise of RtI posits that tiered instruction can assist all students who are struggling through utilizing research‐based interventions. When these tiers of intervention services are exhausted with limited to no response to the intervention, a child can be classified under the SLD category. There are documented concerns with effective implementation of RtI frameworks. This qualitative exploratory study examined the perceptions of teachers in a graduate education program regarding the knowledge, usage and implementation of RtI to classify students with a SLD. Through thematic analysis, findings indicate a need for more training in districts, better preparation at the university level and more support in applying RtI in the classroom. Implications for practice and future research are discussed.

Improving influenza vaccine uptake in clinical risk groups: patient, provider and commissioner perspectives on the acceptability and feasibility of expanding delivery pathways in England

BackgroundPeople under the age of 65 in clinical risk groups are at increased risk of severe complications and death from influenza. In England, influenza vaccine coverage rates in this cohort...

Webcraft AI

WebCraft AI is a user-friendly website builder that allows users to create an online presence with minimal effort and creative freedom. It offers features like online storage, e-commerce tools, video backgrounds, title animations, mobile apps, and a free service tier. The platform offers hundreds of template choices, many of which are free, and includes options for text, media, social media widgets, buttons, and shapes. Users can edit template designs with ease, using right-click context menus to change images or edit text. The platform also allows users to customize page design, add new pages, and change the site's navigation hierarchy. WebCraft AI offers nearly 20 top-level site types, each with subcategories, and a free service tier. Users can choose to use a site template or have WebCraft AI automatically create a site using Artificial Design Intelligence (ADI). Keywords: Free website templates, Easy web design, Customizable page design, User-friendly website builder

74 Trial-CARE: Centralized Support Services for Investigator-Initiated Multi-Site Clinical Trials

OBJECTIVES/GOALS: To describe the impact of Trial-CARE (Coordination, Acceleration, and Recruitment Enhancement), a centralized service core at Washington University (WU), aimed at enhancing the capability of investigator-initiated multi-site clinical trials at WU and partner CTSA institutions. METHODS/STUDY POPULATION: Through review of our marketing materials and service tracking system we defined the following Trial-CARE offerings: Infrastructure: Trial-CARE is a centralized service core at WU. Whereby, a team member is sourced to an investigator-initiated multi-site clinical trial (II-MCT) to ensure the achievement of study milestones across any phase of the clinical trial life cycle. Team: Our team consists of research professionals with expertise in II-MCT project management, data management, and administrative/regulatory management. Services: * One free 60-minute case consultation * Tiers of Service * Academic Research Organization (ARO) support * Clinical Coordinating Center * Data Coordinating Center * II-MCT project management support * Time-limited targeted support RESULTS/ANTICIPATED RESULTS: Trial-CARE has completed 94 consultations in support of WU and partner CTSA institutions enabling the streamlining of study start-up; guidance for study recruitment, implementation, and operations; and offering resources to foster career development. Consultations can be completed at any phase in the clinical trial lifecycle, with Trial-CARE completing: * 12% in the idea phase * 45% in the grant development and submission stage * 28% after funding has been awarded Top reasons researchers connect with Trial-CARE about II-MCTs: * regulatory guidance (40%) * general information about Trial-CARE Services and II-MCTs (35%) * protocol development (21%) * data management (20%) * study budgeting (20%) DISCUSSION/SIGNIFICANCE: In response to a WU wide survey, Trial-CARE plans to generate informational webinars and is creating a clinical trial tracking dashboard, to pro-actively offer support services to researchers prior to grant funding. The goal is also to increase the percentage of consultations completed in the idea phase and the grant development and submission stage.

Education and training of prehospital first responders in low- and middle-income countries

Prehospital emergency medical services play a vital role in providing essential emergency medical and trauma care. However, in many low- and middle-income countries, there is a significant lack of adequate emergency medical services coverage, a problem compounded by a profound deficit of first responder training programs. The African Federation of Emergency Medicine classifies prehospital emergency care into 2 categories: tier-1, which includes laypersons, and tier-2, consisting of professionals equipped with dispatch capabilities. Both tier-1 and tier-2 first responders require protocolized training, integration, and coordination to varying degrees, with tier-1 programs focusing primarily on immediate stabilization and hospital transportation and tier-2 programs dedicating increased focus toward formal dispatch and advanced life support interventions. Training for both tiers of emergency medical services typically involves in-person didactic lectures with practical skills sessions. However, the content of these courses is highly context-dependent, and there is no international consensus regarding pedagogical methods or curriculum content for first responder training in low- and middle-income countries.Similarly, there is a lack of consensus in monitoring and evaluating training programs, including assessment methods, passing scores, and certification requirements. Although many programs use knowledge or skills acquisition testing, the content and depth of these examinations vary greatly, and long-term follow-up reporting is limited. As such, the educational landscape of both tier-1 and tier-2 emergency medical services in low- and middle-income countries remains highly varied and often faces a dual challenge of lacking clear international guidelines while still maintaining local appropriateness. Modular curricula developed in conjunction with standardized needs assessments, accompanied by the adoption of the training of trainers model, may present a pathway for local adaptability by leveraging local community members to inform and proliferate training. Although there have been notable improvements in prehospital training programs in resource-limited settings during the past 3 decades, challenges related to maintaining fidelity in monitoring and evaluation, expanding programs within resource constraints, and adapting to specific contexts continue to offer opportunities for further development in the future.

Contraceptive services for women in the UK

Journal of Prescribing PracticeVol. 5, No. 5 EditorialContraceptive services for women in the UKPolly MoffatPolly MoffatEditorSearch for more papers by this authorPolly MoffatPublished Online:17 May 2023https://doi.org/10.12968/jprp.2023.5.5.181AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View article References Lederman S, Ottery F, Cano A. Fezolinetant for treatment of moderate-to-severe vasomotor symptoms associated with menopause (SKYLIGHT 1): a phase 3 randomised controlled study. Lancet. 2023 Apr 1;401(10382):1091–1102 Google ScholarNHS England. NHS Pharmacy Contraception Service Tier 1 – Ongoing supply of oral contraception. 2023. https://www.england.nhs.uk/long-read/nhs-pharmacy-contraception-service-tier-1-ongoing-supply-of-oral-contraception (accessed 4 May 2023) Google Scholar FiguresReferencesRelatedDetails 2 May 2023Volume 5Issue 5ISSN (print): 2631-8385ISSN (online): 2631-8393 Metrics History Published online 17 May 2023 Published in print 2 May 2023 Information© MA Healthcare LimitedPDF download

Using FOCUS-PDSA Quality Improvement Methodology Model in Healthcare: Process and Outcomes.

Using FOCUS-PDSA Quality Improvement Methodology Model in Healthcare: Process and Outcomes.

Cost Optimization Strategies for Cloud Infrastructure

Cloud computing has been increasingly growing as it offers various benefits with the way organizations deploy, manage and scale their IT resources. Nevertheless, cost management in cloud environments is still a major challenge due to the complexity of pricing models and dynamically changing cloud services. This paper discusses, inter alia, effective strategies for optimizing cloud costs: right-sizing resources, leveraging reserved and spot instances, autoscaling, and optimum service tiers. Additionally reviews various tools for management and monitoring, including AWS Cost Explorer and Google Cloud Cost Management tools, and the role of automation in reducing operational cost. Also features case studies from various sectors and highlight successful implementations and lessons learned. Further, the challenges and considerations with respect to security, performance trade-offs, and compliance are addressed. Conclusions are drawn with action points for organizations and future directions for research that focus on emerging technologies and their impact on cloud cost optimization

Analysis of a Personalized Provision of Service Level Agreement (SLA) Algorithm

The existence of restricted Service Level Agreement (SLA) choices, which typically correspond with a couple of service tiers, can result in a customer accepting a service that may not effectively respond to their needs. From a service provider perspective, it is also a less than optimum business model, with capacity being reserved for customers who will not use it and subsequently being unavailable for customers who would. We, therefore, advocate the use of personalized SLAs to avoid such situations, which can ideally be set up without the assistance of a human operator. We suggest classifying customers according to their distinguishing features, one of which includes a customer’s propensity to have online devices in their home. Through the results presented in this paper, we are confident about the accuracy of our classification results; however, we recognize that there are opportunities for latency improvements in the efficiency of the process.

AI-Optimized Cost-Aware Design Strategies for Resource-Efficient Applications

In the context of modern computing landscapes marked by escalating resource demands and cost considerations, this paper introduces a novel framework that integrates artificial intelligence (AI) for the creation of resource-efficient applications while maintaining a keen awareness of costs. The imperative to strike a harmonious equilibrium between application performance and expenses has never been more pressing, especially with the proliferation of cloud-based services. In response, our approach capitalizes on AI methodologies to dynamically analyze real-time application requisites, workload trends, and the availability of resources. Central to our methodology is the elevation of cost to a principal design determinant. We devise strategies that dynamically apportion resources, opt for suitable service tiers, and make necessary adjustments to application configurations. This duality of optimizing performance while curtailing expenditure underscores the essence of our approach. Rigorous simulations and empirical evaluations underscore the efficacy of our strategies across diverse scenarios, underscoring substantial cost reductions without compromising the quality of applications.

The Hidden Tier of Social Services. Frontline Workers' Provision of Informal Resources in the Public, Nonprofit and Private Sectors By EinatLavee, Cambridge: Cambridge University Press. 2021. pp. 74. (including index), $22 (paperback). ISBN: 9781009101370

Public Administration ReviewVolume 83, Issue 2 p. 442-443 BOOK REVIEWS The Hidden Tier of Social Services. Frontline Workers' Provision of Informal Resources in the Public, Nonprofit and Private Sectors By Einat Lavee, Cambridge: Cambridge University Press. 2021. pp. 74. (including index), $22 (paperback). ISBN: 9781009101370 Jos Raadschelders, Corresponding Author Jos Raadschelders raadschelders.1@osu.edu Correspondence Jos Raadschelders Email: raadschelders.1@osu.eduSearch for more papers by this author Jos Raadschelders, Corresponding Author Jos Raadschelders raadschelders.1@osu.edu Correspondence Jos Raadschelders Email: raadschelders.1@osu.eduSearch for more papers by this author First published: 02 February 2023 https://doi.org/10.1111/puar.13604Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume83, Issue2March/April 2023Pages 442-443 RelatedInformation

Alternatives to in vitro fertilization

There have been concerns on the potential overuse of invitro fertilization (IVF) in view of the lack of evidence on effectiveness in certain populations, potential short and long-term safety risks, and economic considerations. On the other hand, the use of alternatives to IVF seems to be underappreciated in clinical practice as well as research. In this review, we summarized the up-to-date evidence on the effectiveness, safety as well as cost-effectiveness of different alternatives to IVF, including expectant management, intrauterine insemination, tubal flushing, invitro maturation as well as intravaginal culture. We also discussed the trend of IVF use over the last decade and the available tiers of service because of intravaginal culture, and revisited the roles of different alternatives to IVF in modern reproductive medicine from both clinical and research perspectives.

Off-grid households’ preferences for electricity services: Policy implications for mini-grid deployment in rural Tanzania

Mini-grids play a critical role in providing electricity to remote, off-grid communities in Sub-Saharan Africa. However, success of mini-grid projects can be hindered by poor cash flows and limited revenue returns. A clear understanding of off-grid households’ preferences for electricity services is a prerequisite for mini-grid stakeholders to set tariff structures and stimulate income-generating power demand to scale up mini-grid deployment. This study conducted a choice experiment survey in two off-grid villages targeted by new mini-grid projects in Tanzania to reveal heterogeneity in households’ preferences for multiple electricity service attributes. We found that households’ heterogeneous preferences were significantly associated with demographic (e.g. gender), socioeconomic (e.g. ownership of TV), and energy-related behavioural characteristics (e.g. charging devices away from home). We suggest that service-based, tiered tariffs and business models can be designed to cater for the heterogenous demands and preferences of different segments of customers. Successful deployment of mini-grids needs to consider the competition from the existing solar home systems and focus on the provision of higher tiers of electricity services. Gender equality issues should be addressed in rural electrification efforts given the significantly greater vulnerability of female-led households to higher electricity fees.

How Smart Should a Service Robot Be?

Service robots are taking over the frontline. They can possess three types of artificial intelligence (AI): mechanical, thinking, and feeling AI. Although these intelligences determine how service robots can help customers, not much is known about how customers respond to robots of different intelligence. This paper addresses this gap, builds on the appraisal theory of emotions, and employs three online experiments and one field study to demonstrate that customers have different emotional responses to the three types of AI. Particularly, the influence of AI on positive emotions becomes stronger as the AI type becomes more sophisticated. That is, feeling AI relates more strongly to positive emotions than mechanical AI. Also, feeling AI and thinking AI increase spending and loyalty intention through customers’ positive emotions. We also identify important contingency effects of service tiers: mechanical AI is more suitable for low-cost firms, whereas feeling AI mainly benefits full-service providers. Remarkably, none of the three intelligences are directly related to negative emotions; perceived robot autonomy is an important mediator in these relationships. The findings yield concrete managerial guidance as to how smart a service robot should be by pinpointing the right type of AI given the market segment of the service provider.

Primary Cesarean Deliveries of Term Singletons Prior to or in Labour and Risks of Severe Maternal Morbidity: A Comparison of Canadian Tiers of Obstetric Services

To estimate the rates of severe maternal morbidity/mortality associated with primary cesarean sections (PCS) in different tiers of obstetrics services (ToS) in Canada.

Examining equity in accessibility to multi-tier healthcare services across different income households using estimated travel time

Accessibility equity is a critical factor in developing equitable and sustainable communities. Although numerous studies have analyzed accessibility inequity, few of them examined inter-group and intra-group inequity and made comparisons between private cars and public transit. In this paper, a Gaussian-based Two-step Floating Catchment Area method was applied to evaluate the spatial accessibility of multitier healthcare services among different income groups in Shanghai, China. The results show that high-income households have better access to healthcare services than low-income households. The gap between low- and high-income groups increases as the level of healthcare services rises. The Theil index was used to assess inequity between groups and within groups, as well as overall inequity. The inter-group inequity for public transit is greater than that for private cars, suggesting that accessibility by public transit is more unequally distributed across groups of people compared with private cars. Inter-group inequity increases with the tier of healthcare services. The bivariate local Moran index shows that underserved areas are found primarily in low-income neighborhoods. Overall, the research findings indicate the quality of public transit services might have a more significant impact on accessibility inequity than the spatial distribution of health services. This study provides valuable information for designing targeted policy provisions to improve equity and efficiency in healthcare access.

800 The Impact of the COVID-19 Pandemic on The Management of Patients with Vascular Conditions: The Vascular and Endovascular Research Network (VERN) COVID-19 Vascular Service (COVER) Tier 3 Study

IntroductionThe COVID-19 pandemic has had significant impact on healthcare delivery internationally. The aim of this study was to evaluate the changes in the management of vascular conditions during the COVID-19 pandemic compared to pre-pandemic standards.MethodAn international multicentre prospective cohort study was conducted over a 4-week period from March 2020. All patients referred to vascular services with acute vascular conditions were eligible to participate. Data on patient demographics, diagnosis and treatment delivered during the pandemic were collected. If there was a deviation from the pre-pandemic management plan, this ‘ideal’ plan was recorded, and the severity of modification scored on a 5-point scale.ResultsA total of 1801 patients from 52 centres in 19 countries were included in the study, most commonly referred with lower limb conditions (54.4%). Only 2.3% of patients had a confirmed diagnosis of COVID-19. A deviation from the pre-pandemic treatment standard occurred in 35% of unruptured ≥5.5cm diameter abdominal aortic aneurysms, 24.7% of patients with carotid disease, 17% with acute or chronic limb-threatening ischaemia and 12.7% with diabetic foot conditions. Of these modifications, 40.7% were significant, such as endovascular instead of open aneurysm repair or treatment delays, 38.1% major, such as non-operative management of carotid and lower limb disease, and 4.9% life-changing/ending including major amputation or palliation.ConclusionsThe COVID-19 pandemic has significantly impacted upon the management decisions for vascular conditions, independent of COVID status, with 17% of all-referred patients receiving suboptimal care due to limited resources and difficulty accessing services.

O5 Outcomes of vascular and endovascular interventions performed during the COVID-19 pandemic: The Vascular and Endovascular Research Network (VERN) COvid-19 Vascular sERvice (COVER) Tier 2 study

IntroductionThe COVID-19 pandemic forced rapid adaptations to healthcare provision. The COvid-19 Vascular sERvice (COVER) Study aimed to contemporaneously report outcomes for patients undergoing vascular interventions worldwide during the pandemic.MethodsCOVER is an international multi-centre observational cohort study of outcomes following vascular interventions during the pandemic. The primary outcome was to capture procedural information on all open and endovascular interventions undertaken. Secondary outcomes included in-hospital mortality and changes in management resulting from the pandemic.Results1103 patients from 57 institutions in 19 countries were enrolled. Mean age was 66.9±13.9 (75·6% male). The rate of suspected/confirmed COVID-19 infection was 4·0%. Overall, in-hospital mortality was 11.0%. Aortic interventions had a mortality of 15·2% (23/151), amputations 12·1% (28/232), carotid interventions 10·7% (11/103) and lower limb revascularisation 9·8% (51/521). Increased risk of in-hospital mortality was noted for patients with chronic obstructive pulmonary disease, lower respiratory tract infection, Caucasian ethnicity and those undergoing urgent/immediate surgery. Choice of procedure deviated from standard management in 7·1% cases. Adjusting for confounders, antiplatelet (OR 0·503 (0·273-0·928) and oral anticoagulant (OR 0·411 (0·205-0·824) reduced risk of in-hospital mortality.ConclusionsPatients undergoing vascular intervention during the pandemic had substantially higher overall and condition-specific mortality compared to pre-pandemic cohort reports, despite low COVID-19 infection rates.

P33 Changes to acute vascular care management during the COVID-19 pandemic: The Vascular and Endovascular Research Network (VERN) COvid-19 Vascular sERvice (COVER) Tier 3 study

IntroductionThe COVID-19 pandemic forced rapid adaptations to healthcare provision. The COvid-19 Vascular sERvice (COVER) Study aimed to contemporaneously report changes to practice and subsequent outcomes of vascular patients managed during the pandemic.MethodsCOVER is a three-tiered international multi-centre observational cohort study aiming to quantify the specific impact of the pandemic on the provision of vascular and endovascular surgery and the adjustments made to standard vascular practice during this time. The primary outcome of Tier 3 was to identify how the management of all referred urgent vascular cases changed throughout the COVID-19 pandemic. Secondary outcomes included longitudinal data to identify condition-specific outcomes for these patients at 3, 6 months and 1 year. Over a minimum four-week period, contributing vascular centers contemporaneously collected prospective data on the management of all urgent referrals received during this time.ResultsData from over 1693 patients worldwide has been obtained and is currently undergoing analysis. Provisional results suggest that approximately 18% of patients had significant changes to their care during the pandemic. Full descriptive results of management changes during the pandemic itself will be reported at the NRCM meeting.ConclusionsIt is anticipated that this work will highlight significant deviation in the management of urgent vascular referrals when compared to pre-pandemic best practice guidelines. It will be crucial to identify and monitor the ongoing impact this has on patient care.

“It’s changed my life!” Evaluation and improvement of a pilot Tier 2 weight management course, “Balance”

Purpose This paper aims to describe a service evaluation study of “Balance” – a National Health Service Tier 2 pilot weight management course delivered in a primary care mental health service. The 12 weekly sessions included dietetic, psychological and behavioural elements underpinned by cognitive behavioural theory and “third-wave” approaches, including acceptance and commitment therapy, compassion-focused therapy and mindfulness. Design/methodology/approach A mixed-methods design was used in this service evaluation study that included analysis of outcome measures (weight, eating choices, weight-related self-efficacy and mental health) and focus group data (n = 6) analysed using thematic analysis. Eleven clients with a body mass index of 25–40 kg/m2 enrolled, and nine clients completed the course. Outcome data were collected weekly with follow-up at three and six months. Findings Quantitative data analysis using non-parametric Wilcoxon signed-rank tests showed that the group mean weight decreased significantly (p = 0.030) by the end of Balance, but the group mean weight loss was not statistically significant at the three-month (p = 0.345) or six-month (p = 0.086) follow-up. The qualitative results showed that participants valued the course ethos of choice and also welcomed learning new tools and techniques. Balance was very well-received by participants who reported benefitting from improved well-being, group support and developing new weight management skills. Research limitations/implications Only one client attended all sessions of the group, and it is possible that missed sessions impacted effectiveness. Some of the weight change data collected at the six-month follow-up was self-reported (n = 4), which could reduce data reliability. Focus group participants were aware that Balance was a pilot with a risk that the group would not be continued. As the group wanted the pilot to be extended, the feedback may have been positively skewed. A small sample size limits interpretation of the results. A group weight management intervention, including dietetic, psychological and behavioural elements, underpinned by cognitive behavioural theory was well-received by service users and effective for some. Commissioners and service users may have different definitions of successful outcomes in weight management interventions. Practical implications Longer-term support and follow-up after Tier 2 weight management interventions may benefit service users and improve outcomes. Originality/value The paper contributes to a small but growing evidence base concerned with the design and delivery of weight management interventions. Areas of particular interest include: a gap analysis between the course content and National Institute for Health and Care Excellence clinical guidelines, participants’ views on the most impactful course features and recommendations for course development. The results also show a disconnect between evidence-based guidelines (mandatory weight monitoring), participants’ preferences and clinicians' experience. The difference between client and commissioner priorities is also discussed.