73 resultados para Health Care and Public Health


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This paper reports laboratory experiments designed to study the impact of public information about past departure rates on congestion levels and travel costs. Our design is based on a discrete version of Arnott et al.'s (1990) bottleneck model. In all treatments, congestion occurs and the observed travel costs are quite similar to the predicted ones. Subjects' capacity to coordinate is not affected by the availability of public information on past departure rates, by the number of drivers or by the relative cost of delay. This seemingly absence of treatment effects is confirmed by our finding that a parameter-free reinforcement learning model best characterises individual behaviour.

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The Newborn Individualized Developmental Care and Assessment Program (NIDCAP) is widely used in neonatal intensive care units and comprises 85 discrete infant behaviors, some of which may communicate infant distress. The objective of this study was to identify developmentally relevant movements indicative of pain in preterm infants.

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Objectives: (1) To determine informal caregivers perceptions about place of care and place of death; and (2) to identify variables associated with a home death among terminally ill individuals who received in-home support services in a publicly funded home care system. Participants and design: A total of 216 informal caregivers participated in a bereavement interview. Data collection included care recipient and informal caregiver characteristics, the use of and satisfaction with community services, and preferences about place of death. Results: Most caregivers reported that they and the care recipient had a preferred place of death (77 and 68%, respectively) with over 63% reporting home as the preferred place of death. Caregivers had a greater preference for an institutional death (14%) than care recipients (4.7%). While 30% of care recipients did not die in their preferred location, most caregivers (92%) felt, in retrospect, that where the care recipient died was the appropriate place of death. Most caregivers reported being satisfied with the care that was provided. The odds of dying at home were greater when the care recipient stated a preference for place of death (OR: 2.92; 95% CI: 1.25, 6.85), and the family physician made home visits during the care recipients last month of life (Univariate odds ratios (OR): 4.42; 95% CI: 1.46, 13.36). Discussion: The ethic of self-control and choice for the care recipient must be balanced with consideration for the well being of the informal caregiver and responsiveness of the community service system. © 2005 Edward Arnold (Publishers) Ltd.

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Aim This study aimed to develop and evaluate a multi-media educational resource in palliative and end-of-life care for specialist palliative care and intellectual disability services which promoted collaborative working. Methods: A mixed methods design involving three phases was used. Qualitative data were obtained from semi-structured interviews with a purposive sample of professionals (n=30) and family carers (n=5) and from two focus groups with people with intellectual disabilities (n=17). Data were content analysed as outlined y Newell and Burnard (2006). This identified training needs and issues, in end-of-life care for this population which were confirmed through quantitative data from services in a regional scoping study analysed using descriptive statistics. A DVD and manual were developed and evaluated with twelve professionals. Data were collected using a solicited diary, the Readiness for Inter-professional Learning Scale, Likert Scales and an evaluation questionnaire. Thematic analysis and descriptive statistics appropriate to data were used.Results: Findings suggest that this resource demonstrates the need for and benefits of partnership working and transferability of this learning to practice could address issues at end-of-life for people with intellectual disabilities. Conclusions: Findings of this study have importance for partnership working and service provision in end-of-life care for this population.

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Ancient stone monuments (ASMs), such as standing stones and rock art panels, are powerful and iconic expressions of Britain’s rich prehistoric past that have major economic and tourism value. However, ASMs are under pressure due to increasing anthropogenic exposure and changing climatic conditions, which accelerate their rates of disrepair. Although scientific data exists on the integrity of stone monuments, most applies to “built” systems; therefore, additional work specific to ASMs in the countryside is needed to develop better-informed safeguarding strategies. Here, we use Neolithic and Bronze Age rock art panels across Northern England as a case study for delineating ASM management actions required to enhance monument preservation. The state of the rock art is described first, including factors that led to current conditions. Rock art management approaches then are described within the context of future environments, which models suggest to be more dynamic and locally variable. Finally, a Condition Assessment and Risk Evaluation (CARE) scheme is proposed to help prioritise interventions; an example of which is provided based on stone deterioration at Petra in Jordon. We conclude that more focused scientific and behavioural data, specific to deterioration mechanisms, are required for an ASM CARE scheme to be successful.

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Purpose
This article aims to analyze the role of performance management systems (PMS) in supporting public value strategies.

Design/methodology/approach
This article draws on the public value dynamic model by Horner and Hutton (2010). It presents the results of a case study of implementation of a PMS model, the ‘Value Pyramid’ (VP).

Findings
The results stress the need for an improved conceptualization of PMS within public value strategy. Through experimentation using the VP, the case site was able to measure and visualize what it considered public value and reflect on the internal/external causes of both creation and destruction of public value.

Research limitations/implication
This article is limited to just one case study, although in-depth and longitudinal.

Originality/value
This article is one of the first attempting to understand the role of PMS within the public value strategy framework, answering the call of Benington and Moore (2010) to consider public value from an accounting perspective.

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In this paper, I critically assess John Rawls' repeated claim that the duty of civility is only a moral duty and should not be enforced by law. In the first part of the paper, I examine and reject the view that Rawls' position may be due to the practical difficulties that the legal enforcement of the duty of civility might entail. I thus claim that Rawls' position must be driven by deeper normative reasons grounded in a conception of free speech. In the second part of the paper, I therefore examine various arguments for free speech and critically assess whether they are consistent with Rawls' political liberalism. I first focus on the arguments from truth and self-fulfilment. Both arguments, I argue, rely on comprehensive doctrines and therefore cannot provide a freestanding political justification for free speech. Freedom of speech, I claim, can be justified instead on the basis of Rawls' political conception of the person and of the two moral powers. However, Rawls' wide view of public reason already allows scope for the kind of free speech necessary for the exercise of the two moral powers and therefore cannot explain Rawls' opposition to the legal enforcement of the duty of civility. Such opposition, I claim, can only be explained on the basis of a defence of unconstrained freedom of speech grounded in the ideas of democracy and political legitimacy. Yet, I conclude, while public reason and the duty of civility are essential to political liberalism, unconstrained freedom of speech is not. Rawls and political liberals could therefore renounce unconstrained freedom of speech, and endorse the legal enforcement of the duty of civility, while remaining faithful to political liberalism.

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In the large body of literature concerning John Rawls’s Political Liberalism (1993) and his conception of public reason, little attention has been paid to the implications that the constraints of public reason have for partisans, i.e. citizens who participate in politics through political parties. This paper argues that even on the basis of a ‘mild’ understanding of Rawls’s conception of the constraints of public reason, which takes into account the various stipulations Rawls provided throughout his later work, when applied to partisans the constraints of public reason lose none or little of their hindering force. This seriously undermines the contribution that parties and partisans can provide to the change and the varieties of public reason that Rawls himself advocates as a response to social change and, therefore, to political justification and legitimacy. Parties articulate, coordinate and enhance societal demands which, without their support, may remain unheard and fail to change the acceptable terms of public reason and political justification. If the political speech of partisans is restrained, this potential for change (and, therefore, its contribution to political legitimacy) is seriously undermined.

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This paper illustrates how findings from two related studies can enhance nursing and midwifery practice through the evaluation of the effectiveness of a family midwives (FMs) intervention.