Health risk appraisal in older people 2: the implications for clinicians and commissioners of social isolation risk in older people

BACKGROUND: Social isolation is associated with poorer health, and is seen by the World Health Organisation (WHO) as one of the major issues facing the industrialised world. AIM: To explore the significance of social isolation in the older population for GPs and for service commissioners. DESIGN OF STUDY: Secondary analysis of baseline data from a randomised controlled trial of health risk appraisal. SETTING: A total of 2641 community-dwelling, non-disabled people aged 65 years and over in suburban London. METHOD: Demographic details, social network and risk for social isolation based on the 6-item Lubben Social Network Scale, measures of depressed mood, memory problems, numbers of chronic conditions, medication use, functional ability, self-reported use of medical services. RESULTS: More than 15% of the older age group were at risk of social isolation, and this risk increased with advancing age. In bivariate analyses risk of social isolation was associated with older age, education up to 16 years only, depressed mood and impaired memory, perceived fair or poor health, perceived difficulty with both basic and instrumental activities of daily living, diminishing functional ability, and fear of falling. Despite poorer health status, those at risk of social isolation did not appear to make greater use of medical services, nor were they at greater risk of hospital admission. Half of those who scored as at risk of social isolation lived with others. Multivariate analysis showed significant independent associations between risk of social isolation and depressed mood and living alone, and weak associations with male sex, impaired memory and perceived poor health. CONCLUSION: The risk of social isolation is elevated in older men, older persons who live alone, persons with mood or cognitive problems, but is not associated with greater use of services. These findings would not support population screening for individuals at risk of social isolation with a view to averting service use by timely intervention. Awareness of social isolation should trigger further assessment, and consideration of interventions to alleviate social isolation, treat depression or ameliorate cognitive impairment.

Design of SOA services: experiences from industry

Because of the unknown usage scenarios, designing the elementary services of a service-oriented architecture (SOA), which form the basis for later composition, is rather difficult. Various design guide lines have been proposed by academia, tool vendors and consulting companies, but they differ in the rigor of validation and are often biased toward some technology. For that reason a multiple-case study was conducted in five large organizations that successfully introduced SOA in their daily business. The observed approaches are contrasted with the findings from a literature review to derive some recommendations for SOA service design.

PREPAID MENTAL HEALTH SERVICES: A NATIONAL PERSPECTIVE

The purpose of this 1982 national survey of all operational prepaid health plans, or PHPs (including health maintenance organizations), was to provide information on the current coverage of PHP mental health and substance abuse services, benefits and service provision, general and mental health organization characteristics, mental health service costs, and physical and mental health service utilization.^ Two survey instruments were designed, pretested and distributed to all operational PHPs throughout the United States. A total of 237 PHPs were surveyed, of which 205 (86.50 percent) completed and returned both questionnaires.^ One result of the rapid growth in the PHP field over the past ten years has been the expansion in both the number of PHPs as well as the organizational characteristics of these PHPs. However, little attention in the research literature has been given to the application of empirical results to the PHP arrangements. This project has attempted to contribute to current knowledge regarding prepaid mental health services from a national perspective, and explore, on a preliminary descriptive basis, the variety of potential service delivery arrangements for physical and mental health services (total services) and for mental health services.^ The study emphasized that PHPs must continue to monitor the costs and utilization of mental health services, particularly in light of the apparent elimination of data collection and statistical summary responsibilities within the federal government regarding PHP activities as well as the proposed legislation to eliminate mandated mental health and substance abuse services from basic health plan benefits for federally qualified PHPs. ^

Desarrollo de una aplicación Android para administración y gestión de la información de registro de servicios en una plataforma SOA

Este Proyecto Fin de Grado está enmarcado dentro de las actividades del GRyS (Grupo de Redes y Servicios de Próxima Generación) con las Smart Grids. En la investigación actual sobre Smart Grids se pretenden alcanzar los siguientes objetivos: . Integrar fuentes de energías renovables de manera efectiva. . Aumentar la eficiencia en la gestión de la demanda y suministro de forma dinámica. . Reducir las emisiones de CO2 dando prioridad a fuentes de energía verdes. . Concienciar del consumo de energía mediante la monitorización de dispositivos y servicios. . Estimular el desarrollo de un mercado vanguardista de tecnologías energéticamente eficientes con nuevos modelos de negocio. Dentro del contexto de las Smart Grids, el interés del GRyS se extiende básicamente a la creación de middlewares semánticos y tecnologías afines, como las ontologías de servicios y las bases de datos semánticas. El objetivo de este Proyecto Fin de Grado ha sido diseñar y desarrollar una aplicación para dispositivos con sistema operativo Android, que implementa una interfaz gráfica y los métodos necesarios para obtener y representar información de registro de servicios de una plataforma SOA (Service-Oriented Architecture). La aplicación permite: . Representar información relativa a los servicios y dispositivos registrados en una Smart Grid. . Guardar, cargar y compartir por correo electrónico ficheros HTML con la información anterior. . Representar en un mapa la ubicación de los dispositivos. . Representar medidas (voltaje, temperatura, etc.) en tiempo real. . Aplicar filtros por identificador de dispositivo, modelo o fabricante. . Realizar consultas SPARQL a bases de datos semánticas. . Guardar y cagar consultas SPARQL en ficheros de texto almacenados en la tarjeta SD. La aplicación, desarrollada en Java, es de código libre y hace uso de tecnologías estándar y abiertas como HTML, XML, SPARQL y servicios RESTful. Se ha tenido ocasión de probarla con la infraestructura del proyecto europeo e-Gotham (Sustainable-Smart Grid Open System for the Aggregated Control, Monitoring and Management of Energy), en el que participan 17 socios de 5 países: España, Italia, Estonia, Finlandia y Noruega. En esta memoria se detalla el estudio realizado sobre el Estado del arte y las tecnologías utilizadas en el desarrollo del proyecto, la implementación, diseño y arquitectura de la aplicación, así como las pruebas realizadas y los resultados obtenidos. ABSTRACT. This Final Degree Project is framed within the activities of the GRyS (Grupo de Redes y Servicios de Próxima Generación) with the Smart Grids. Current research on Smart Grids aims to achieve the following objectives: . To effectively integrate renewable energy sources. . To increase management efficiency by dynamically matching demand and supply. . To reduce carbon emissions by giving priority to green energy sources. . To raise energy consumption awareness by monitoring products and services. . To stimulate the development of a leading-edge market for energy-efficient technologies with new business models. Within the context of the Smart Grids, the interest of the GRyS basically extends to the creation of semantic middleware and related technologies, such as service ontologies and semantic data bases. The objective of this Final Degree Project has been to design and develop an application for devices with Android operating system, which implements a graphical interface and methods to obtain and represent services registry information in a Service-Oriented Architecture (SOA) platform. The application allows users to: . Represent information related to services and devices registered in a Smart Grid. . Save, load and share HTML files with the above information by email. . Represent the location of devices on a map. . Represent measures (voltage, temperature, etc.) in real time. . Apply filters by device id, model or manufacturer. . SPARQL query semantic database. . Save and load SPARQL queries in text files stored on the SD card. The application, developed in Java, is open source and uses open standards such as HTML, XML, SPARQL and RESTful services technologies. It has been tested in a real environment using the e-Gotham European project infrastructure (Sustainable-Smart Grid Open System for the Aggregated Control, Monitoring and Management of Energy), which is participated by 17 partners from 5 countries: Spain, Italy, Estonia, Finland and Norway. This report details the study on the State of the art and the technologies used in the development of the project, implementation, design and architecture of the application, as well as the tests performed and the results obtained.

Integración en la plataforma 4mobile de mecanismos de atención en redes sociales

El presente texto se ha desarrollado como Proyecto Fin de Grado en la Escuela Técnica Superior de Ingeniería y Sistemas de Telecomunicación de la Universidad Politécnica de Madrid en colaboración con la Consultora Tecnológica everis. El mismo tiene como objetivo realizar un estudio de los requisitos necesarios para poder desplegar un servicio que permita ofrecer a las Operadoras Móviles Virtuales (OMV) soporte técnico a sus clientes a través de las redes sociales. Este módulo establecerá una nueva vía de comunicación entre el consumidor y el cliente de la OMV con la propia OMV, el cual se caracterizará por una alta accesibilidad y una gran rapidez en el servicio permitiendo de este modo, una mayor satisfacción del cliente con su operador móvil y por tanto de una nueva vía para conseguir la fidelización del mismo y la captación de nuevos clientes. Para ello, este proyecto se lleva a cabo sobre el sistema de información 4mobile el cual es comercializado por la mencionada Consultora Tecnológica. Este sistema consiste en una plataforma web la cual permite cubrir todos los procesos de negocio comunes que un OMV necesita gestionar. Es por ello, que el mencionado estudio se centra en la evaluación de los aspectos necesarios para la integración de un módulo de estas características dentro de la plataforma de 4mobile. Este módulo, estará basado en una herramienta software que permitirá gestionar el ciclo de vida completo del comentario realizado por el cliente a través de una red social, desde que es publicado por el cliente, hasta que se haya respondido al mismo y su solución sea considerada como satisfactoria por el cliente. Por ello, y de cara a definir correctamente esta herramienta, será necesario un detallado análisis el cual recoja diversos aspectos y que a lo largo del texto, será denominado como Plan de Marketing de Medios Sociales (PMMS). Estos aspectos versarán tanto de las necesidades tecnológicas para su mencionada integración, como de la serie de características funcionales que una solución basada en servicio técnico a través de las redes sociales deberá poseer con el objetivo de ofrecer un servicio técnico de calidad. Finalmente, estas funcionalidades y necesidades tecnológicas se expondrán en forma de propuesta a everis para su integración en la plataforma 4mobile junto con un análisis de diseño a alto nivel software de la solución a desarrollar. ABSTRACT. This text has been developed as Final Degree Project in the Escuela Técnica Superior de Ingeniería y Sistemas de Telecomunicación de la Universidad Politécnica de Madrid in collaboration with the Technology Consultant everis, aims to conduct a study of how to provide technical support through social networks and the evaluation of the integration of a social support module within the system platform 4mobile, which cover all business processes that need to manage a Mobile Virtual Network Operator (MVNO), which is marketed by above-mentioned consultant . This module will establish a new communication channel between the consumer and the client with the OMV and itself, which is characterized by high accessibility and great fast service. Thus will allow a higher customer satisfaction with him service and thus a new way to get the same loyalty and attract new customers To this end, this project is performed on the information system 4mobile which is marketed by the consulting part thereof everis. This system is a platform to cover all business processes that need to manage an MVNO. Therefore, the mentioned study focuses on the evaluation of the elements necessary for integrating module these features within the platform 4mobile. This module will be based on a software tool for managing the entire lifecycle of the comment made by the customer via social networking, from the moment it is published, until it has been respond and their solution is considered satisfactory for the customer. So, in order to properly define this tool, a detailed analysis which will be necessary to collect various aspects and throughout the text, it will be referred to as Plan of Social Media Marketing (PMMS). These aspects will be address both: the technological needs for the mentioned integration, and the number of functional characteristics-based service through social networking solution, as this must in order to provide a quality service Finally, these goals and requirements will be discussed as everis offer for integration into the platform 4mobile analysis along with a high level of software design to develop the solution.

Sistema domótico controlado por mensajería instantánea Whatsapp para personas con discapacidad

El presente PFC tiene como objetivo el desarrollo de un gestor domótico basado en el dictado de voz de la red social WhatsApp. Dicho gestor no solo sustituirá el concepto dañino de que la integración de la domótica hoy en día es cara e inservible sino que acercará a aquellas personas con una discapacidad a tener una mejora en la calidad de vida. Estas personas, con un simple comando de voz a su aplicación WhatsApp de su terminal móvil, podrán activar o desactivar todos los elementos domóticos que su vivienda tenga instalados, “activar lámpara”, “encender Horno”, “abrir Puerta”… Todo a un muy bajo precio y utilizando tecnologías OpenSource El objetivo principal de este PFC es ayudar a la gente con una discapacidad a tener mejor calidad de vida, haciéndose independiente en las labores del hogar, ya que será el hogar quien haga las labores. La accesibilidad de este servicio, es por tanto, la mayor de las metas. Para conseguir accesibilidad para todas las personas, se necesita un servicio barato y de fácil aprendizaje. Se elige la red social WhatsApp como interprete, ya que no necesita de formación al ser una aplicación usada mayoritariamente en España y por la capacidad del dictado de voz, y se eligen las tecnologías OpenSource por ser la gran mayoría de ellas gratuitas o de pago solo el hardware. La utilización de la Red social WhatsApp se justifica por sí sola, en septiembre de 2015 se registraron 900 millones de usuarios. Este dato es fruto, también, de la reciente adquisición por parte de Facebook y hace que cumpla el primer requisito de accesibilidad para el servicio domotico que se presenta. Desde hace casi 5 años existe una API liberada de WhatsApp, que la comunidad OpenSource ha utilizado, para crear sus propios clientes o aplicaciones de envío de mensajes, usando la infraestructura de la red social. La empresa no lo aprueba abiertamente, pero la liberación de la API fue legal y su uso también lo es. Por otra parte la empresa se reserva el derecho de bloquear cuentas por el uso fraudulento de su infraestructura. Las tecnologías OpenSource utilizadas han sido, distribuciones Linux (Raspbian) y lenguajes de programación PHP, Python y BASHSCRIPT, todo cubierto por la comunidad, ofreciendo soporte y escalabilidad. Es por ello que se utiliza, como matriz y gestor domotico central, una RaspberryPI. Los servicios que el gestor ofrece en su primera versión incluyen el control domotico de la iluminación eléctrica general o personal, el control de todo tipo de electrodomésticos, el control de accesos para la puerta principal de entrada y el control de medios audiovisuales. ABSTRACT. This final thesis aims to develop a domotic manager based on the speech recognition capacity implemented in the social network, WhatsApp. This Manager not only banish the wrong idea about how expensive and useless is a domotic installation, this manager will give an opportunity to handicapped people to improve their quality of life. These people, with a simple voice command to their own WhatsApp, could enable or disable all the domotics devices installed in their living places. “On Lamp”, “ON Oven”, “Open Door”… This service reduce considerably the budgets because the use of OpenSource Technologies. The main achievement of this thesis is help handicapped people improving their quality of life, making independent from the housework. The house will do the work. The accessibility is, by the way, the goal to achieve. To get accessibility to a width range, we need a cheap, easy to learn and easy to use service. The social Network WhatsApp is one part of the answer, this app does not need explanation because is used all over the world, moreover, integrates the speech recognition capacity. The OpenSource technologies is the other part of the answer due to the low costs or, even, the free costs of their implementations. The use of the social network WhatsApp is explained by itself. In September 2015 were registered around 900 million users, of course, the recent acquisition by Facebook has helped in this astronomic number and match the first law of this service about the accessibility. Since five years exists, in the internet, a free WhatsApp API. The OpenSource community has used this API to develop their own messaging apps or desktop-clients, using the WhatsApp infrastructure. The company does not approve officially, however le API freedom is legal and the use of the API is legal too. On the other hand, the company can block accounts who makes a fraudulent use of his infrastructure. OpenSource technologies used in this thesis are: Linux distributions (Raspbian) and programming languages PHP, Python and BASHCSRIPT, all of these technologies are covered by the community offering support and scalability. Due to that, it is used a RaspberryPI as the Central Domotic Manager. The domotic services that currently this manager achieve are: Domotic lighting control, electronic devices control, access control to the main door and Media Control.

Gerenciamento da qualidade e do custo do transporte de cargas por ônibus interurbano de passageiros

Algumas empresas de transporte intermunicipal e interestadual de transporte rodoviário de passageiros, objetivando maiores lucros, têm se dedicado ao transporte de determinados tipos de cargas e encomendas, aproveitando-se do fato do bagageiro do ônibus ser uma oferta fixa para o transporte. No entanto, percebe-se algumas deficiências de caráter operacional que podem comprometer a qualidade e o custo do serviço prestado. Portanto, essa pesquisa tem por finalidade analisar o transporte de cargas executado por ônibus sob a ótica da qualidade e do custo. Partindo-se da adaptação do modelo clássico de Parasuraman, bem como da adoção de direcionadores de custo, de acordo com o método de custeio baseado em atividades, pretende-se apresentar como as principais atividades que compõem os processos do transporte rodoviário de cargas são afetadas durante a prestação do serviço. Para tanto, é apresentada uma análise crítica qualitativa que estabelece a forma como essas atividades são influenciadas pelos gaps do modelo de qualidade proposto e como as mesmas influenciam o custo operacional. Tal análise é resultado de duas pesquisas realizadas. A primeira pesquisa foi de profundidade numa empresa que atua no segmento. Foram obtidos alguns indicadores de desempenhos que são vitais para que as atividades sejam executadas de acordo com as conformidades previstas. A segunda pesquisa, via questionário, possibilitou identificar as principais expectativas dos clientes. Mesmo com o índice reduzido de respostas do questionário, foram levantados pontos que são extremamente fundamentais para a formação das expectativas dos clientes. Entre esses pontos destacam-se o tempo de atendimento, o treinamento dos funcionários e o cumprimento dos horários preestabelecidos. Dos processos que caracterizam o transporte de cargas, deve-se destacar o processo de entrega que além dos problemas provenientes da operação propriamente dita, sofre ainda a interferência, em algumas atividades, da participação direta do cliente e dos fatores externos da operação (ambiente não controlado).

The Economics of EU Railway Reform. Bruges European Economic Policy (BEEP) Briefing 8/2004

The EU began railway reform in earnest around the turn of the century. Two ‘railway packages’ have meanwhile been adopted amounting to a series of directives and a third package has been proposed. A range of complementary initiatives has been undertaken or is underway. This BEEP Briefing inspects the main economic aspects of EU rail reform. After highlighting the dramatic loss of market share of rail since the 1960s, the case for reform is argued to rest on three arguments: the need for greater competitiveness of rail, promoting the (market driven) diversion of road haulage to rail as a step towards sustainable mobility in Europe, and an end to the disproportional claims on public budgets of Member States. The core of the paper deals respectively with market failures in rail and in the internal market for rail services; the complex economic issues underlying vertical separation (unbundling) and pricing options; and the methods, potential and problems of introducing competition in rail freight and in passenger services. Market failures in the rail sector are several (natural monopoly, economies of density, safety and asymmetries of information), exacerbated by no less than 7 technical and legal barriers precluding the practical operation of an internal rail market. The EU choice to opt for vertical unbundling (with benefits similar in nature as in other network industries e.g. preventing opaque cross-subsidisation and greater cost revelation) risks the emergence of considerable coordination costs. The adoption of marginal cost pricing is problematic on economic grounds (drawbacks include arbitrary cost allocation rules in the presence of large economies of scope and relatively large common costs; a non-optimal incentive system, holding back the growth of freight services; possibly anti-competitive effects of two-part tariffs). Without further detailed harmonisation, it may also lead to many different systems in Member States, causing even greater distortions. Insofar as freight could develop into a competitive market, a combination of Ramsey pricing (given the incentive for service providers to keep market share) and price ceilings based on stand-alone costs might be superior in terms of competition, market growth and regulatory oversight. The incipient cooperative approach for path coordination and allocation is welcome but likely to be seriously insufficient. The arguments to introduce competition, notably in freight, are valuable and many e.g. optimal cross-border services, quality differentiation as well as general quality improvement, larger scale for cost recovery and a decrease of rent seeking. Nevertheless, it is not correct to argue for the introduction of competition in rail tout court. It depends on the size of the market and on removing a host of barriers; it requires careful PSO definition and costing; also, coordination failures ought to be pre-empted. On the other hand, reform and competition cannot and should not be assessed in a static perspective. Conduct and cost structures will change with reform. Infrastructure and investment in technology are known to generate enormous potential for cost savings, especially when coupled with the EU interoperability programme. All this dynamism may well help to induce entry and further enlarge the (net) welfare gains from EU railway reform. The paper ends with a few pointers for the way forward in EU rail reform.

Pioneer Vocational Industrial Services, Inc., Danville, Kentucky.

Mode of access: Internet.

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