THE MULTIPLE LOCATION TIME WEIGHTED INDEX: USING PATIENT ACTIVITY SPACES TO CALCULATE PRIMARY CARE SERVICE AREAS

Geographic health planning analyses, such as service area calculations, are hampered by a lack of patient-specific geographic data. Using the limited patient address information in patient management systems, planners analyze patient origin based on home address. But activity space research done sparingly in public health and extensively in non-health related arenas uses multiple addresses per person when analyzing accessibility. Also, health care access research has shown that there are many non-geographic factors that influence choice of provider. Most planning methods, however, overlook non-geographic factors influencing choice of provider, and the limited data mean the analyses can only be related to home address. This research attempted to determine to what extent geography plays a part in patient choice of provider and to determine if activity space data can be used to calculate service areas for primary care providers. During Spring 2008, a convenience sample of 384 patients of a locally-funded Community Health Center in Houston, Texas, completed a survey that asked about what factors are important when he or she selects a health care provider. A subset of this group (336) also completed an activity space log that captured location and time data on the places where the patient regularly goes. Survey results indicate that for this patient population, geography plays a role in their choice of health care provider, but it is not the most important reason for choosing a provider. Other factors for choosing a health care provider such as the provider offering “free or low cost visits”, meeting “all of the patient’s health care needs”, and seeing “the patient quickly” were all ranked higher than geographic reasons. Analysis of the patient activity locations shows that activity spaces can be used to create service areas for a single primary care provider. Weighted activity-space-based service areas have the potential to include more patients in the service area since more than one location per patient is used. Further analysis of the logs shows that a reduced set of locations by time and type could be used for this methodology, facilitating ongoing data collection for activity-space-based planning efforts.

Human Trafficking: What is the Role of the Health Care Provider?

The article will address the global and local issue of human trafficking. An estimated 20,000 people are trafficked within the U.S. each year. Trafficked people are forced, defrauded and coerced into labor and sexual service for profit of others. Traffickers use individual vulnerabilities and immigration status, language ability and poor understanding of U.S. laws to identify future victims. One case in 2005 in Texas resulted in 100 victims being identified, none of whom revealed themselves to health care professionals. Health care professionals need contemporary and updated information and resources about health risks, screening methods, and identification of trafficked persons. Readers will learn about common medical problems experienced by individuals who are leaving trafficking situations. Legal and health care intersections will be explored. Implementation of a response protocol to assist those who may currently be enslaved will be introduced. Real case examples from trafficking survivors will be presented and discussed. Participants will learn how to reach out, look beneath the surface, provide assistance, and access resources to help victims, and gain a better understanding of the health challenges faced by trafficked victims.

Race and discourse analysis: Building a dialogue in health service research and health care settings

Using a framework for discourse analysis developed by Van Dijk, the investigator will pinpoint the pathological forms of discourse on race, defined as 'race talk' in three professional domains: health services research, public health provider organizations, and literature on multiculturalism. Attention will then turn to developing an analytical strategy for building more meaningful dialogue on race. The retrieval of potential resources for dialogue will be drawn from the third domain. Analysis will focus on enhancing the prospects of converting 'race talk' into dialogue. This will be accomplished by characterizing the normative preconditions as formal procedural requirements for dialogue and then supplementing these conditions with others related specifically to race. From here, the practical implications of combining procedural requirements and resources in each of the domains will be considered. Finally, the author will attempt to determine how these selected resources might be employed to transform 'race talk' in practice and lay the groundwork for a dialogue of understanding. ^

The multiple location time weighted index: Using patient activity spaces to calculate primary care service areas

Geographic health planning analyses, such as service area calculations, are hampered by a lack of patient-specific geographic data. Using the limited patient address information in patient management systems, planners analyze patient origin based on home address. But activity space research done sparingly in public health and extensively in non-health related arenas uses multiple addresses per person when analyzing accessibility. Also, health care access research has shown that there are many non-geographic factors that influence choice of provider. Most planning methods, however, overlook non-geographic factors influencing choice of provider, and the limited data mean the analyses can only be related to home address. This research attempted to determine to what extent geography plays a part in patient choice of provider and to determine if activity space data can be used to calculate service areas for primary care providers. ^ During Spring 2008, a convenience sample of 384 patients of a locally-funded Community Health Center in Houston, Texas, completed a survey that asked about what factors are important when he or she selects a health care provider. A subset of this group (336) also completed an activity space log that captured location and time data on the places where the patient regularly goes. ^ Survey results indicate that for this patient population, geography plays a role in their choice of health care provider, but it is not the most important reason for choosing a provider. Other factors for choosing a health care provider such as the provider offering "free or low cost visits", meeting "all of the patient's health care needs", and seeing "the patient quickly" were all ranked higher than geographic reasons. ^ Analysis of the patient activity locations shows that activity spaces can be used to create service areas for a single primary care provider. Weighted activity-space-based service areas have the potential to include more patients in the service area since more than one location per patient is used. Further analysis of the logs shows that a reduced set of locations by time and type could be used for this methodology, facilitating ongoing data collection for activity-space-based planning efforts. ^

Testing a Cloud Provider Network for Hybrid P2P and Cloud Streaming Architectures

The number of online real-time streaming services deployed over network topologies like P2P or centralized ones has remarkably increased in the recent years. This has revealed the lack of networks that are well prepared to respond to this kind of traffic. A hybrid distribution network can be an efficient solution for real-time streaming services. This paper contains the experimental results of streaming distribution in a hybrid architecture that consist of mixed connections among P2P and Cloud nodes that can interoperate together. We have chosen to represent the P2P nodes as Planet Lab machines over the world and the cloud nodes using a Cloud provider's network. First we present an experimental validation of the Cloud infrastructure's ability to distribute streaming sessions with respect to some key streaming QoS parameters: jitter, throughput and packet losses. Next we show the results obtained from different test scenarios, when a hybrid distribution network is used. The scenarios measure the improvement of the multimedia QoS parameters, when nodes in the streaming distribution network (located in different continents) are gradually moved into the Cloud provider infrastructure. The overall conclusion is that the QoS of a streaming service can be efficiently improved, unlike in traditional P2P systems and CDN, by deploying a hybrid streaming architecture. This enhancement can be obtained by strategic placing of certain distribution network nodes into the Cloud provider infrastructure, taking advantage of the reduced packet loss and low latency that exists among its datacenters.

Will the construction of a nuclear power plant in Belarus exacerbate the country's energy dependence on Russia? OSW Commentary No. 87, 2012-07-23

During Russian PM Dmitry Medvedev’s working visit to Minsk on 18 July, Russia and Belarus signed a general contract for the construction of a nuclear power plant in Belarus. The signature brought to an end the complex negotiations which had been underway since January 2009 involving the leadership in Minsk, the Russian government and Atomstroyexport, the Russian company that will be the main contractor of the investment. However, the power plant’s future ownership structure, management arrangements and terms and conditions of profit sharing remain unclear. The Belarusian leadership hopes that with the launch of the nuclear power plant, it will be able to reduce gas imports from Russia, gas being the main resource used in producing heat and electricity in Belarus. This should in turn reduce the costs of energy generation. In addition, Minsk expects that the new investment will allow it to export electricity surpluses to the European Union, including Poland. Agreements concerning the power plant have been concluded over the last year or so and, according to these, Russia has acquired partial control of the Belarusian electricity grid, especially with regard to the transmission of energy to foreign markets. Russia is also the sole creditor and contractor for the investment, and the sole future provider of nuclear fuel. Therefore, implementation of the project will exacerbate Minsk’s already significant dependence on Moscow in energy and political terms.

Treating tobacco use and dependence /

"This guideline is an updated version of the 1996 Smoking Cessation Clinical Practice Guideline No. 18."--P. ii.

Wavelength dependence of ultraviolet-enhanced reactivation and induction of mammalian viruses /

Mode of access: Internet.

Behavioral pharmacology of human drug dependence /

Mode of access: Internet.

Testing drugs for physical dependence potential and abuse liability /

Mode of access: Internet.

Mechanisms of tolerance and dependence /

Mode of access: Internet.

A family response to the drug problem : a family program for the prevention of chemical dependence.

Mode of access: Internet.

Understanding service experience in non-profit performing arts: Implications for operations and service management

Recent research in the non-profit performing arts has shown that marketing efforts designed to increase revenue from ticket sales are not achieving the results required to sustain the performing arts. This paper applies operations management analytical techniques to the non-profit performing arts to increase understanding of operational issues and inform service management strategy. The paper takes a two-study idiographic approach. Implementing a modified version of service transaction analysis (STA), Study One describes a performing arts service from provider and customer perspectives, identifies service gaps and develops an elaborated service description incorporating both perspectives. In Study Two, building on the elaborated service description and extant research, in-depth interviews are conducted to gather thick descriptions of predictors of satisfaction, value and service quality as they relate to repurchase intention (RI). Technical, functional and critical factors required to improve organizational performance are identified. Implications for operational strategy, service design and service management theory for this context are discussed. (c) 2005 Published by Elsevier B.V.

A cost-effectiveness analysis of heroin detoxification methods in the Australian National Evaluation of Pharmacotherapies for Opioid Dependence (NEPOD)

This economic evaluation was part of the Australian National Evaluation of Pharmacotherapies for Opioid Dependence (NEPOD) project. Data from four trials of heroin detoxification methods, involving 365 participants, were pooled to enable a comprehensive comparison of the cost-effectiveness of five inpatient and outpatient detoxification methods. This study took the perspective of the treatment provider in assessing resource use and costs. Two short-term outcome measures were used-achievement of an initial 7-day period of abstinence, and entry into ongoing post-detoxification treatment. The mean costs of the various detoxification methods ranged widely, from AUD $491 (buprenorphine-based outpatient); to AUD $605 for conventional outpatient; AUD $1404 for conventional inpatient; AUD $1990 for rapid detoxification under sedation; and to AUD $2689 for anaesthesia per episode. An incremental cost-effectiveness analysis was carried out using conventional outpatient detoxification as the base comparator. The buprenorphine-based outpatient detoxification method was found to be the most cost-effective method overall, and rapid opioid detoxification under sedation was the most costeffective inpatient method.

Does naltrexone treatment lead to depression? Findings from a randomized controlled trial in subjects with opioid dependence

Objective: Dysphoria and depression have been cited as side effects of the opioid antagonist naltrexone. We aimed to assess whether depressive symptoms are a clinically relevant side effect in a population receiving naltrexone as a treatment for opioid dependence. Methods: We carried out a randomized controlled, open-label trial comparing rapid opiate detoxification under anesthesia and naltrexone treatment with continued methadone maintenance at the Alcohol and Drug Service, Royal Brisbane and Women's Hospital, Brisbane, Australia. The study subjects were patients stabilized on methadone maintenance treatment for heroin dependence who wished to transfer to naltrexone treatment. The Beck Depression Inventory, State-Trait Anxiety Inventory and Opiate Treatment Index subscales for heroin use and social functioning were used at baseline and follow-up assessments at 1, 2, 3 and 6 months. Results: Forty-two participants were allocated to receive naltrexone treatment, whereas 38 continued methadone maintenance as the control condition. Participants who received naltrexone did not exhibit worsening of depressive symptoms. In participants attending all follow-up assessments, there was a trend for those receiving naltrexone to exhibit an improvement in depression over time compared with the control group. Participants who were adherent to naltrexone treatment exhibited fewer depressive symptoms than those who were nonadherent. Conclusions: These results suggest that depression need not be considered a common adverse effect of naltrexone treatment or a treatment contraindication and that engaging with or adhering to naltrexone treatment may be associated with fewer depressive symptoms.