Death by Suicide: A Report Based on the Northern Ireland Coroner’s Database

Funded by HSC R&D Division, Public Health Agency Why did we start? Potentially new information, especially relating to the characteristics of those who had died by suicide was made available through the Coroner’s Office.  The information made available to us covered deaths that occurred in the years 2005 to the end of 2011. What did we do? First we addressed the descriptive characteristics associated with this group of individuals. These descriptive characteristics included information relating to (1) means by which the death occurred (2) gender, age and employment status of the person (3) prior attempts (4)  alcohol and prescription use around time of death (5) adverse events (6) use of health services and (7) mental and physical health problems. Second we examined area level residential location in terms of Local Government Districts, and Wards within Northern Ireland. To address this area level of analysis, standardised mortality ratios (SMRs) were used.      

Audit report on the County Rural Offices of Social Services Mental Health Region (CROSS) for the year ended June 30, 2015

Audit report on the County Rural Offices of Social Services Mental Health Region (CROSS) for the year ended June 30, 2015

Audit report on County Social Services for the year ended June 30, 2015

Audit report on County Social Services for the year ended June 30, 2015

Audit report on Mental Health Disability Services of the East Central Region (MHDS-ECR) for the year ended June 30, 2015

Audit report on Mental Health Disability Services of the East Central Region (MHDS-ECR) for the year ended June 30, 2015

Report on the Iowa Department of Administrative Services for the year ended June 30, 2014

Report on the Iowa Department of Administrative Services for the year ended June 30, 2014

Report on the Iowa Department of Administrative Services for the year ended June 30, 2015

Report on the Iowa Department of Administrative Services for the year ended June 30, 2015

Agreed-upon procedures reports on twelve agreements between the Bureau of Nutrition and Health Services of the Iowa Department of Education and child care centers for the period October 1, 2014 through September 30, 2015

Agreed-upon procedures reports on twelve agreements between the Bureau of Nutrition and Health Services of the Iowa Department of Education and child care centers for the period October 1, 2014 through September 30, 2015

The Effect of Non-Audit Services on Auditor Independence : A study on 11 food retail- and wholesale companies in the United Kingdom

Purpose – The purpose of this study is to investigate the effect of non-audit services on auditor independence, and the importance of non-audit services as a source of income for audit firms in the United Kingdom. Design/method/approach – This study will examine 11 companies in the food retail- and wholesale industry during 2007 - 2014. Five indicators have been used; (1) Appointed auditor and provision of non-audit services to audit clients; (2) Auditor tenure; (3) Non-audit services in relation to total services; (4) Tax-services in relation to non-audit services, (5) Big Four’s revenue. Information has been collected using the quantitative approach through annual- and transparency reports. The threshold used to measure possible independence threats (self-review-, self-interest- and familiarity threat) has been set at 18,5 %. Findings – This study concludes that the jointly provision of audit- and nonaudit services possibly causes impairment of auditor independence, and that non-audit services is an important source of income for audit firms. The findings showed that in 99 %, companies purchased non-audit services from their statutory auditor. Non-audit services in relation to total services surpassed the threshold in 78 % of all financial years. Likewise, tax-services in comparison to non-audit services exceeded the threshold in 65 % of all financial years. The Big Four’s revenue from non-audit services to audit clients in relation to total revenue is almost constantly below the threshold. However, in all financial years except from one, total revenue from non-audit services surpassed revenue from audit services by far. Contribution – The study contributes to the ongoing discussion about nonaudit services effect on auditor independence. Originality/value – This study is one of few that provide detailed information about non-audit services in the food retail- and wholesale industry. It highlights social and ethical issues with regard to agency relationships.  

Combined report on the eight Judicial District Departments of Correctional Services for the year ended June 30, 2015

Combined report on the eight Judicial District Departments of Correctional Services for the year ended June 30, 2015

CATEGORIZATION OF BRAZILIAN INTERNET USERS AND ITS IMPACTS ON THE USE OF ELECTRONIC GOVERNMENT SERVICES

This paper aims to categorize Brazilian Internet users according to the diversity of their online activities and to assess the propensity of these Internet users´ groups to use electronic government (e-gov) services. The Amartya Sen’s Capability Approach was adopted as the theoretical framework for its consideration of people’s freedom to decide on their use of available resources and their competencies for these decisions, leading to the use of e-gov services. Multivariate statistical techniques were used to perform data analysis from the 2007, 2009 and 2011 editions of ICT Household Survey. The results showed that Internet users belonging to the advanced and intermediate use groups were more likely to use e-gov services than those who belong to the sporadic use group. Moreover, the results also demonstrated that the Internet user group of intermediate use presented a higher tendency to use e-gov services than the Internet user group of advanced use. This tendency is possibly related to the extensive use of interactive and collaborative activities of leisure and entertainment performed by this type of user. The findings of this research may be useful in guiding public policies for the dissemination and provision of electronic government services in Brazil.

On the way to universal coverage of maternal services in Iringa rural District in Tanzania. Who is yet to be reached?

Background: Strategies to tackle maternal mortality in sub-Saharan Africa include expanding coverage of reproductive services.Even where high, more vulnerable women may not access services. No data is available on high coverage determinants. We investigated this in Tanzania in a predicted high utilization area. Methods: Data was collected through a household survey of 464 women with a recent delivery. Primary outcomes were facility delivery and ≥4 ANC visits. Determinants were analysed using multivariate regression. Results: Almost all women had attended ANC, though only 58.3% had ≥4 visits. ≥4 visits were more likely in the youngest age group (OR 2.7 95% CI 1.32–5.49, p=0.008), and in early ANC attenders (OR 3.2 95% CI 2.04–4.90, p<0.001). Facility delivery was greater than expected (87.7%), more likely in more educated women (OR 2.7 95% CI 1.50–4.75, p=0.002), in those within 5 kilometers of a facility (OR 3.2 95% CI 1.59–6.48, p=0.002), and for early ANC attenders (OR 2.4 95% CI 1.20–4.91, p=0.02). Conclusion: Rural contexts can achieve high facility delivery coverage. Based on our findings, strategies to reach women yet unserved should include promotion of early ANC start particularly for the less educated, and improvement of distant communities' access to facilities.

VOX POPULI: THREE ESSAYS ON THE USE OF SOCIAL MEDIA FOR VALUE CREATION IN SERVICES

Prior research shows that electronic word of mouth (eWOM) wields considerable influence over consumer behavior. However, as the volume and variety of eWOM grows, firms are faced with challenges in analyzing and responding to this information. In this dissertation, I argue that to meet the new challenges and opportunities posed by the expansion of eWOM and to more accurately measure its impacts on firms and consumers, we need to revisit our methodologies for extracting insights from eWOM. This dissertation consists of three essays that further our understanding of the value of social media analytics, especially with respect to eWOM. In the first essay, I use machine learning techniques to extract semantic structure from online reviews. These semantic dimensions describe the experiences of consumers in the service industry more accurately than traditional numerical variables. To demonstrate the value of these dimensions, I show that they can be used to substantially improve the accuracy of econometric models of firm survival. In the second essay, I explore the effects on eWOM of online deals, such as those offered by Groupon, the value of which to both consumers and merchants is controversial. Through a combination of Bayesian econometric models and controlled lab experiments, I examine the conditions under which online deals affect online reviews and provide strategies to mitigate the potential negative eWOM effects resulting from online deals. In the third essay, I focus on how eWOM can be incorporated into efforts to reduce foodborne illness, a major public health concern. I demonstrate how machine learning techniques can be used to monitor hygiene in restaurants through crowd-sourced online reviews. I am able to identify instances of moral hazard within the hygiene inspection scheme used in New York City by leveraging a dictionary specifically crafted for this purpose. To the extent that online reviews provide some visibility into the hygiene practices of restaurants, I show how losses from information asymmetry may be partially mitigated in this context. Taken together, this dissertation contributes by revisiting and refining the use of eWOM in the service sector through a combination of machine learning and econometric methodologies.

Reflections on the Preferential Liberalization of Services Trade

This paper takes stock of the forces that lie behind the recent rise of preferential agreements in services trade. Its focuses first on a number of distinguishing features of services trade that sets it apart from trade in goods and shapes trade liberalization and rule-making approaches in the services field. The paper then documents the nature, modal and sectoral incidence of the trade and investment preferences spawned by preferential trade agreements (PTAs) in services. It does so with a view to addressing the question: how “preferential” is the preferential treatment of services trade? Finally, the paper addresses a number of considerations arising from attempts to multilateralize preferential access and rule-making in services trade.

Economic evaluations of clinical pharmacy services in Ireland, 2007-2015

Introduction The concept of this thesis was driven by stagnation within the Irish healthcare system. Multiple reports from pharmacy organisations had outlined possible future directions for the profession but progress was minimal, especially in comparison with other countries. The author’s directive was to evaluate the economic impact of a series of clinical pharmacy services (CPS) in hospital and community settings. Methods A systematic review of economic evaluations of clinical pharmacy services in hospital patients was undertaken to gain insight into recent research in the field. Eligible studies were evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS), to establish the quality, consistency and transparency of relevant research. A retrospective analysis of an internal hospital pharmacy interventions database was conducted. A method first described by Nesbit et al. was implemented to estimate the level of cost avoidance achieved. A cost-effectiveness analysis based on data from a randomised controlled trial of a pharmacist-supervised patient self-testing (PST) of warfarin therapy is presented. Outcome measure was the incremental cost associated with six months of intervention management. A similar cost-effectiveness analysis based on previously published RCT data was used to evaluate a novel structured pharmacist review of medication in older hospitalised patients. Cost-effectiveness analysis was presented in the form of an incremental cost-effectiveness ratio (ICER). An ICER is an additional cost per unit effect, in the case of this study, the cost of preventing an additional non-trivial ADR in hospital. A method described by Preaud et al. was adapted to estimate the clinical and economic benefit gained from vaccination of patients by a community pharmacist in Ireland in 2013/14. Sample demographic data was obtained from a national chain of community pharmacies and applied to overall national vaccination data. Results Systematic review identified twenty studies which were eligible for inclusion. Overall, pharmacist interventions had a positive impact on hospital budgets. Only three studies (15%) were deemed to be “good-quality” studies. No ‘novel’ clinical pharmacist intervention was identified during the course of this review. Analysis of internal hospital database identified 4,257 interventions documented on 2,147 individual patients over a 12 month period. Substantial cost avoidance of €710,000 was generated over a 1 year period from the perspective of the health care provider. Mean cost avoidance of €166 per intervention was generated. The cost of providing these interventions was €82,000. Substantial net cost-benefits of €626,279 and a cost-benefit ratio of 8.64 : 1 were generated based on this evaluation of pharmacist interventions. Results from an evaluation of a novel pharmacist-led form of warfarin management indicated indicated that on a per patient basis, PST was slightly more expensive than established anticoagulant management. On a per patient basis over a six month period, PST resulted in an incremental cost of €59.08 in comparison with routine care. Overall cost of managing a patient through pharmacist-supervised PST for a six month period is €226.45. However, for this increase in cost a clinically significant improvement in care was provided. Patients achieved a significantly higher time in therapeutic range during the PST arm in comparison with routine care, (72 ± 19.7% vs 59 ± 13.5%). Difference in overall cost was minimal and PST was the dominant strategy in some scenarios examined during sensitivity analysis. Structured pharmacist review of medication was determined to be dominant in comparison to usual pharmaceutical care. Even if the healthcare payer was unwilling to pay any money for the prevention of an ADR, the intervention strategy is still likely to be cost-effective (probability of being determined cost-effective = 0.707). Implementation of pharmacist-led influenza vaccination has resulted in substantial clinical and economic benefits to the healthcare system. The majority of patients (64.9%) who availed of this service had identifiable influenza-related risk factors. Of patients with influenza-related risk factors, age ≥65 year was the most commonly cited risk factor. Pharmacist vaccination services averted a total of 848 influenza cases across all age groups during the 2013/2014 influenza season. Due to receipt of vaccination in a pharmacy setting, 444 influenza-related GP visits were prevented. In terms of more serious influenza-associated events, 11 hospitalisations and five influenza-related deaths were averted. Costs averted were approximately €305,000. These were principally wider societal-related costs associated with lost productivity. Conclusion Overall, clinical pharmacy services are adding value to the Irish healthcare system in both hospital and community settings, but provision of additional funding for new services would enable them to offer a great deal more.

Report on the Iowa Department of Human Services for the year ended June 30, 2015

Report on the Iowa Department of Human Services for the year ended June 30, 2015