Specialist versus generic models of psychiatry training and service provision for people with intellectual disabilities

Background  Models of service provision and professional training differ between countries. This study aims to investigate a specialist intellectual disabilities model and a generic mental health model, specifically comparing psychiatrists’ knowledge and competencies, and service quality and accessibility in meeting the mental health needs of people with intellectual disabilities. Method  Data were collected from consultant and trainee psychiatrists within a specialist intellectual disabilities model (UK) and a generic mental health model (Australia). Results  The sample sizes were 294 (UK) and 205 (Australia). Statistically significant differences were found, with UK participants having positive views about the specialist intellectual disabilities service model they worked within, demonstrating flexible and accessible working practices and service provision, responsive to the range of mental health needs of the population with intellectual disabilities, and providing a wide range of treatments and supports. The UK participants were knowledgeable, well trained and confident in their work. They wanted to work with people with intellectual disabilities. In all of these areas, the converse was found from the Australian generic mental health service model. Conclusions  The specialist intellectual disabilities model of service provision and training has advantages over the generic mental health model.

Análise do investimento direto estrangeiro em Portugal utilizando a metodologia de box-jenkins

Dissertação para obtenção do Grau de Mestre em Contabilidade e Finanças Orientadora: Professora Doutora Patrícia Ramos

Previsão estocástica de nível fluviométrico para cidade de Marabá-PA: método de Box-Jenkins

O Município de Marabá- PA, situado na região Amazônica, sudeste do Estado do Pará, sofre anualmente com eventos de enchentes, ocasionados pelo aumento periódico do rio Tocantins e pela situação de vulnerabilidade da população que reside em áreas de risco. A defesa civil estadual e municipal anualmente planeja e prepara equipes para ações de defesa no município. Nesta fase o monitoramento e previsão de eventos de enchentes são importantes. Portanto, com o objetivo de diminuir erros nas previsões hidrológicas para o Município de Marabá, desenvolveu-se um modelo estocástico para previsão de nível do rio Tocantins, baseado na metodologia de Box e Jenkins. Utilizou os dados de níveis diários observados nas estações hidrológicas de Marabá e Carolina e Conceição do Araguaia da Agência Nacional de Águas (ANA), do período de 01/12/ 2008 a 31/03/2011. Efetuou-se o ajustamento de três modelos (M_t, N_t e Y_t), através de diferentes aplicativos estatísticos: o SAS e o Gretl, usando diferentes interpretações do comportamento das séries para gerar as equações dos modelos. A principal diferença entre os aplicativos é que no SAS usa o modelo de função de transferência na modelagem. Realizou-se uma classificação da variabilidade do nível do rio, através da técnica dos Quantis para o período de 1972 a 2011, examinando-se apenas as categorizações de níveis ACIMA e MUITO ACIMA do normal. Para análise de impactos socioeconômicos foram usados os dados das ações da Defesa Civil Estado do Pará nas cheias de 2009 e 2011. Os resultados mostraram que o número de eventos de cheias com níveis MUITO ACIMA do normal, geralmente, podem estar associados a eventos de La Niña. Outro resultado importante: os modelos gerados simularam muito bem o nível do rio para o período de sete dias (01/04/2011 a 07/04/2011). O modelo multivariado N_t (com pequenos erros) representou o comportamento da série original, subestimando os valores reais nos dias 3, 4 e 5 de abril de 2011, com erro máximo de 0,28 no dia 4. O modelo univariado (Y_t) teve bons resultados nas simulações com erros absolutos em torno de 0,12 m. O modelo com menor erro absoluto (0,08m) para o mesmo período foi o modelo M_t, desenvolvido pelo aplicativo SAS, que interpreta a série original como sendo não linear e não estacionária. A análise quantitativa dos impactos fluviométricos, ocorridos nas enchentes de 2009 e 2011 na cidade de Marabá, revelou em média que mais de 4 mil famílias sofrem com estes eventos, implicado em gastos financeiros elevados. Logo, conclui-se que os modelos de previsão de níveis são importantes ferramentas que a Defesa Civil, utiliza no planejamento e preparo de ações preventivas para o município de Marabá.

Previsão da velocidade dos ventos por redes neurais artificiais e arima de box & jenkins

Pós-graduação em Engenharia Elétrica - FEIS

Palliative Medicine:Scoping the level and extent of service provision to people with intellectual disability at end of life Poster Presentation

Background: Concerns exist about the end of life care
that people with intellectual disabilities receive. This population
are seldom referred to palliative care services and
inadequate data sets exist about their place of death.
Aim: To scope the extent of service provision to people
with intellectual disabilities at the end of life by specialist
palliative care and intellectual disability services in one
region of the United Kingdom.
Methods: As part of a larger doctoral study a regional survey
took place of a total sample (n=66) of specialist palliative
care and intellectual disability services using a postal
questionnaire containing forty items. The questionnaire
was informed by the literature and consultation with an
expert reference group. Data were analysed using SPSS to
obtain descriptive statistics.
Results: A total response rate from services of 71.2%
(n=47) was generated. Findings showed a range of experience
among services in providing end of life care to people
with intellectual disabilities in the previous five years, but
general hospitals were reported the most common place of
death. A lack of accessible information on end of life care
for people with learning disabilities was apparent. A few
services (n=14) had a policy to support this population to
make decisions about their care or had used adapted Breaking
Bad News guidelines (n=5) to meet their additional
needs. Both services recognised the value of partnership
working in assessing and meeting the holistic needs of
people with intellectual disabilities at end of life.
Conclusions: A range of experience in caring for people
with intellectual disabilities was present across services,
but more emphasis is required on adapting communication
for this population to facilitate them to participate in their
care. These findings could have international significance
given that studies in other countries have highlighted a
need to widen access to palliative care for this group of
people.

Facilitated advocacy: supporting farmers to have a voice in policy making and the development of service provision

Listening to people, especially those who are poor, and involving them in policy making and decisions about service delivery processes are logical steps in building better services and improving policies aimed at poverty alleviation. This case describes a facilitated advocacy that helped to negotiate and support a role for poor people who farm and fish, to contribute recommendations for changes in services and policies that impact on their lives. The national Government of India’s Department of Animal Husbandry and Dairying and the Indian Council for Agricultural Research, both in the capital Delhi, have been linking with farmers and fishers and state government officials in the eastern states of Jharkhand, Orissa and West Bengal, in partnership with the STREAM Initiative of the intergovernmental Network of Aquaculture Centers in Asia Pacific and with the support of the UK Government Department for International Development, Natural resources Systems Program supporting farmers to have a voice(13 p.)

Resource utilization and cost analyses of home-based palliative care service provision:The Niagara West End-of-Life Shared-Care Project

Background: Increasing emphasis is being placed on the economics of health care service delivery - including home-based palliative care. Aim: This paper analyzes resource utilization and costs of a shared-care demonstration project in rural Ontario (Canada) from the public health care system's perspective. Design: To provide enhanced end-of-life care, the shared-care approach ensured exchange of expertise and knowledge and coordination of services in line with the understood goals of care. Resource utilization and costs were tracked over the 15 month study period from January 2005 to March 2006. Results: Of the 95 study participants (average age 71 years), 83 had a cancer diagnosis (87%); the non-cancer diagnoses (12 patients, 13%) included mainly advanced heart diseases and COPD. Community Care Access Centre and Enhanced Palliative Care Team-based homemaking and specialized nursing services were the most frequented offerings, followed by equipment/transportation services and palliative care consults for pain and symptom management. Total costs for all patient-related services (in 2007 CAN) were 1,625,658.07 - or 17,112.19 per patient/117.95 per patient day. Conclusion: While higher than expenditures previously reported for a cancer-only population in an urban Ontario setting, the costs were still within the parameters of the US Medicare Hospice Benefits, on a par with the per diem funding assigned for long-term care homes and lower than both average alternate level of care and hospital costs within the Province of Ontario. The study results may assist service planners in the appropriate allocation of resources and service packaging to meet the complex needs of palliative care populations. © 2012 The Author(s).

Modelling requirements of supplier selection for benchmarking service provision

Supplier selection has a great impact on supply chain management. The quality of supplier selection also affects profitability of organisations which work in the supply chain. As suppliers can provide variety of services and customers demand higher quality of service provision, the organisation is facing challenges for making the right choice of supplier for the right needs. The existing methods for supplier selection, such as data envelopment analysis (DEA) and analytical hierarchy process (AHP) can automatically perform selection of competitive suppliers and further decide winning supplier(s). However, these methods are not capable of determining the right selection criteria which should be derived from the business strategy. An ontology model described in this paper integrates the strengths of DEA and AHP with new mechanisms which ensure the right supplier to be selected by the right criteria for the right customer's needs.

Determining spatial resolution in spatial load forecasting using a grid-based model

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Models of psychological service provision under Australia's better outcomes in mental health care program

The Access to Allied Psychological Services component of Australia's Better Outcomes in Mental Health Care program enables eligible general practitioners to refer consumers to allied health professionals for affordable, evidence-based mental health care, via 108 projects conducted by Divisions of General Practice. The current study profiled the models of service delivery across these projects, and examined whether particular models were associated with differential levels of access to services. We found: 76% of projects were retaining their allied health professionals under contract, 28% via direct employment, and 7% some other way; Allied health professionals were providing services from GPs' rooms in 63% of projects, from their own rooms in 63%, from a third location in 42%; and The referral mechanism of choice was direct referral in 51% of projects, a voucher system in 27%, a brokerage system in 24%, and a register system in 25%. Many of these models were being used in combination. No model was predictive of differential levels of access, suggesting that the approach of adapting models to the local context is proving successful.

"Fair" government contracts for community service provision : time to curb unfettered executive freedom?

All Australian governments are significantly increasing the use of contracted community service provision through not for profit (NFP) organisations. These transactions occur through grant arrangements which take the form of standard contracts or deeds rather than drawing on statutory authority. Government inquiries bodies have consistently reported and raised concerns about the fairness of such standard grant contract terms, but failed to provide any mechanism whereby fairness can be assured. The Productivity Commission has suggested that the resulting poor relationship results in inappropriate risk transfer, micro-management, disincentives to innovate and poor service provision. This paper develops and tests a fairness measure based on the principles of the Australian Consumer Law which legislates fairness protections for standard consumer contracts.  

Changes to commercial service provision among sex workers from Queensland, Australia

Introduction: The role of commercial sex in facilitating infection transmission is a subject of ongoing empirical enquiry, with little attention to the variety and extent of ‘non-traditional’ commercial services that pose a lesser risk of infection. This study sought to examine the supply and demand of a wide range of traditional and non-traditional commercial sexual services among sex workers and their clients from Queensland, Australia. Methods: Cross-sectional convenience sampling was used to compare female sex workers in 1991 (n=200, aged 16-46 years) and 2003 (n=247, aged 18-57 years) and from male clients in 2003. The client sample comprised 160 male clients aged between 19 and 72 years. Results: Over the comparison period there was a significant increase in the provision of ‘exotic’ or non-traditional sexual services. In 2003, the availability of bondage and discipline, submission, fantasy, use of sex toys, golden showers, fisting and lesbian double acts had increased dramatically, while ‘traditional’ services had mostly remained at similar levels. Moreover, the proportion of sex workers in some industry sectors providing ‘exotic’ commercial services seem to have risen over time. Conclusion: Undoubtedly, the sex industry has professionalised and now includes more sophisticated and specialized suppliers. As with any commercial business, the diversification of services is largely driven with client demand, with the ‘menu’ being generally broader than the majority of client preferences. However, although clients demands for particular commercial sexual services seems to have been met, with regard to anal sex and anal play, supply has failed to meet client demand. Disclosure of Interest Statement: Funding for the 2003 study was provided by the Prostitution Licensing Authority. Acknowledgement and sincere thanks to the men and women who participated in this study.

Domestic violence (DV) service provision and the architecture of rural life: An Australian case study

This article uses the concept of the architecture of rural life to analyse domestic violence service provision in rural Australia. What is distinctive about this architecture is that it polices the privacy of the rural family. A tight cloak of silence is carved around instances of domestic violence. Imagined threats to rural safety are seen as coming from outsiders (i.e. urban influences or Indigenous), not insiders within rural families. This article draws on key findings from a study conducted in rural New South Wales, Australia. The study interviewed 49 rural service providers working in human services and the criminal justice system. The application of architecture of rural life as a conceptual tool demonstrates challenges with service provision in a rural setting. The main results of this study found that this architecture operates as a silencing form of social control in three distinctive ways. Firstly, shame about being a victim of domestic violence encourages rural women's complicity in remaining silent. Secondly, family privacy maintains a veil of silence that accentuates rural women's social and economic dependency on men. Thirdly, community sanctions act as a deterrent to women seeking help.