Children with special health care needs: Comparison of the effects of home care setting, prescribed pediatric extended care setting, and long-term care setting on child and family health outcomes and health care service use

Technological advances during the past 30 years have dramatically improved survival rates for children with life-threatening conditions (preterm births, congenital anomalies, disease, or injury) resulting in children with special health care needs (CSHCN), children who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who require health and related services beyond that required by children generally. There are approximately 10.2 million of these children in the United States or one in five households with a child with special health care needs. Care for these children is limited to home care, medical day care (Prescribed Pediatric Extended Care; P-PEC) or a long term care (LTC) facility. There is very limited research examining health outcomes of CSHCN and their families. The purpose of this research was to compare the effects of home care settings, P-PEC settings, and LTC settings on child health and functioning, family health and function, and health care service use of families with CSHCN. Eighty four CSHCN ages 2 to 21 years having a medically fragile or complex medical condition that required continual monitoring were enrolled with their parents/guardians. Interviews were conducted monthly for five months using the PedsQL™ Generic Core Module for child health and functioning, PedsQL™ Family Impact Module for family health and functioning, and Access to Care from the NS-CSHCN survey for health care services. Descriptive statistics, chi square, and ANCOVA were conducted to determine differences across care settings. Children in the P-PEC settings had a highest health care quality of life (HRQL) overall including physical and psychosocial functioning. Parents/guardians with CSHCN in LTC had the highest HRQL including having time and energy for a social life and employment. Parents/guardians with CSHCN in home care settings had the poorest HRQL including physical and psychosocial functioning with cognitive difficulties, difficulties with worry, communication, and daily activities. They had the fewest hours of employment and the most hours providing direct care for their children. Overall health care service use was the same across the care settings.

Nursing faculty intention to use service learning as pedagogy in higher education

The purpose of this study was to identify the factors that motivate nursing faculty to use service learning. The study was based on the theory of planned behavior (TPB), which implies that the target behavior of intention to use service learning in higher education is influenced by the predictor variables of behavior beliefs (attitude), normative beliefs (peer influence), and control beliefs (confidence and resources). External variables were also considered (years of teaching experience, tenure status, and the type of curriculum). Group interviews and a pilot test were conducted to create the instrument for the study, and Cronbach alpha were calculated for survey item reliability. The participants were full time undergraduate nursing faculty members (n=-160) in the Southeastern United States who taught in universities with accredited nurse education programs. Demographic data as well as scores on scaled survey responses were used to evaluate the intention of nursing faculty to use service learning in their classes. Pearson product moment correlation coefficient and path analysis were applied to the data. The correlation findings indicated that there were statistically significant relationships between behavior beliefs, normative beliefs, and control beliefs and nursing faculty intention to use service learning. The path analysis also indicated that behavior beliefs and normative beliefs were significant, while control beliefs were not a strong influence on intention to use service learning. Normative beliefs showed the strongest direct influence. The use of a community based curriculum also had a positive influence on intention, and faculty with tenure status were more likely to have positive behavior beliefs (attitude) towards service learning. Finally, as teaching experience increased, positive attitudes towards the intention to use service learning decreased. Seventy-nine percent of the variation in the intention to use service learning was explained by the theory of planned behavior, the type of curriculum, teaching experience, and tenure status. These results will assist nursing administration and faculty to design strategies to facilitate the implementation of service learning pedagogy, as well as a community based curriculum which will help meet the 21st century goals set forth from the American Association of Colleges of Nursing.

Delay-sensitive service request scheduling for cloud computing

Cloud computing realizes the long-held dream of converting computing capability into a type of utility. It has the potential to fundamentally change the landscape of the IT industry and our way of life. However, as cloud computing expanding substantially in both scale and scope, ensuring its sustainable growth is a critical problem. Service providers have long been suffering from high operational costs. Especially the costs associated with the skyrocketing power consumption of large data centers. In the meantime, while efficient power/energy utilization is indispensable for the sustainable growth of cloud computing, service providers must also satisfy a user's quality of service (QoS) requirements. This problem becomes even more challenging considering the increasingly stringent power/energy and QoS constraints, as well as other factors such as the highly dynamic, heterogeneous, and distributed nature of the computing infrastructures, etc. ^ In this dissertation, we study the problem of delay-sensitive cloud service scheduling for the sustainable development of cloud computing. We first focus our research on the development of scheduling methods for delay-sensitive cloud services on a single server with the goal of maximizing a service provider's profit. We then extend our study to scheduling cloud services in distributed environments. In particular, we develop a queue-based model and derive efficient request dispatching and processing decisions in a multi-electricity-market environment to improve the profits for service providers. We next study a problem of multi-tier service scheduling. By carefully assigning sub deadlines to the service tiers, our approach can significantly improve resource usage efficiencies with statistically guaranteed QoS. Finally, we study the power conscious resource provision problem for service requests with different QoS requirements. By properly sharing computing resources among different requests, our method statistically guarantees all QoS requirements with a minimized number of powered-on servers and thus the power consumptions. The significance of our research is that it is one part of the integrated effort from both industry and academia to ensure the sustainable growth of cloud computing as it continues to evolve and change our society profoundly.^

Costs and effects of new professional roles : Evidence from a literature review

“The authors wish to thank the European Commission for funding this research programme ‘Health Care Reform: The iMpact on practice, oUtcomes and cost of New ROles for health profeSsionals (MUNROS), under the European Community’s Seventh Framework Programme (FP7 HEALTH-2012-INNOVATION-1) grant agreement number HEALTH-F3-2012-305467EC. The authors also wish to thank all those who supported and guided this work both within the MUNROS research project team and as external associates. In particular we would like to thank Mathijs Kelder for his valuable contribution in the review process. The authors also wish to thank all the MUNROS research and project partners for their continuing collaboration in this research”.

Costs and effects of new professional roles : Evidence from a literature review

“The authors wish to thank the European Commission for funding this research programme ‘Health Care Reform: The iMpact on practice, oUtcomes and cost of New ROles for health profeSsionals (MUNROS), under the European Community’s Seventh Framework Programme (FP7 HEALTH-2012-INNOVATION-1) grant agreement number HEALTH-F3-2012-305467EC. The authors also wish to thank all those who supported and guided this work both within the MUNROS research project team and as external associates. In particular we would like to thank Mathijs Kelder for his valuable contribution in the review process. The authors also wish to thank all the MUNROS research and project partners for their continuing collaboration in this research”.

Windscapes shape seabird instantaneous energy costs but adult behavior buffers impact on offspring

Acknowledgements K. Ashbrook, M. Barrueto, K. Elner, A. Hargreaves, S. Jacobs, G. Lancton, M. LeVaillant, E. Grosbellet, A. Moody, A. Ronston, J. Provencher, P. Smith, K. Woo and P. Woodward helped in the field. J. Nakoolak kept us safe from bears. N. Sapir and two anonymous reviewers provided very useful comments on an earlier version of our manuscript. R. Armstrong at the Nunavut Research Institute, M. Mallory at the Canadian Wildlife Service Northern Research Division and C. Eberl at National Wildlife Research Centre in Ottawa provided logistical support. F. Crenner, N. Chatelain and M. Brucker customized the GPS at the IPHC-CNRS. KHE received financial support through a NSERC Vanier Canada Graduate Scholarship, ACUNS Garfield Weston Northern Studies scholarship and AINA Jennifer Robinson Scholarship and JFH received NSERC Discovery Grant funding. J. Welcker generously loaned some accelerometers. All procedures were approved under the guidelines of the Canadian Council for Animal Care.

Costs and effects of new professional roles : Evidence from a literature review

“The authors wish to thank the European Commission for funding this research programme ‘Health Care Reform: The iMpact on practice, oUtcomes and cost of New ROles for health profeSsionals (MUNROS), under the European Community’s Seventh Framework Programme (FP7 HEALTH-2012-INNOVATION-1) grant agreement number HEALTH-F3-2012-305467EC. The authors also wish to thank all those who supported and guided this work both within the MUNROS research project team and as external associates. In particular we would like to thank Mathijs Kelder for his valuable contribution in the review process. The authors also wish to thank all the MUNROS research and project partners for their continuing collaboration in this research”.

Conflicting expectations in transforming government service processes: the story of e-payment for social welfare in Ireland

Despite its clear potential and attractiveness as a solution to a broad range of societal problems, E-Government has not been adopted to levels predicted in early 2000 literature. Whilst case studies of punctual development of E-Government initiatives abound, few countries have progressed to high levels of maturity in the systematic use of ICT in the relationship between government and citizens. At the same time, the current period brings challenges in terms of access to public services and costs of delivering these services which make the large scale use of ICT by governments more attractive than ever, if not even a necessity. This paper presents a detailed case study of a specific E-Government initiative in Ireland in the area of E-payments for G2C, in the social welfare area. Locating the current initiative in its historical context, it analyses the varied motivations and conflicting requirements of the numerous stakeholders and discusses the constraints that bear on the potential scenarios that could be followed at this point in time.

Essays in Empirical Operations Management: Bayesian Learning of Service Quality and Structural Estimation of Complementary Product Pricing and Inventory Management

This dissertation contributes to the rapidly growing empirical research area in the field of operations management. It contains two essays, tackling two different sets of operations management questions which are motivated by and built on field data sets from two very different industries --- air cargo logistics and retailing.

The first essay, based on the data set obtained from a world leading third-party logistics company, develops a novel and general Bayesian hierarchical learning framework for estimating customers' spillover learning, that is, customers' learning about the quality of a service (or product) from their previous experiences with similar yet not identical services. We then apply our model to the data set to study how customers' experiences from shipping on a particular route affect their future decisions about shipping not only on that route, but also on other routes serviced by the same logistics company. We find that customers indeed borrow experiences from similar but different services to update their quality beliefs that determine future purchase decisions. Also, service quality beliefs have a significant impact on their future purchasing decisions. Moreover, customers are risk averse; they are averse to not only experience variability but also belief uncertainty (i.e., customer's uncertainty about their beliefs). Finally, belief uncertainty affects customers' utilities more compared to experience variability.

The second essay is based on a data set obtained from a large Chinese supermarket chain, which contains sales as well as both wholesale and retail prices of un-packaged perishable vegetables. Recognizing the special characteristics of this particularly product category, we develop a structural estimation model in a discrete-continuous choice model framework. Building on this framework, we then study an optimization model for joint pricing and inventory management strategies of multiple products, which aims at improving the company's profit from direct sales and at the same time reducing food waste and thus improving social welfare.

Collectively, the studies in this dissertation provide useful modeling ideas, decision tools, insights, and guidance for firms to utilize vast sales and operations data to devise more effective business strategies.

Drug prescribing patterns in the General Medical Services Scheme in Ireland and projected costs to 2026

The primary objective is to investigate the main factors contributing to GMS expenditure on pharmaceutical prescribing and projecting this expenditure to 2026. This study is located in the area of pharmacoeconomic cost containment and projections literature. The thesis has five main aims: 1. To determine the main factors contributing to GMS expenditure on pharmaceutical prescribing. 2. To develop a model to project GMS prescribing expenditure in five year intervals to 2026, using 2006 Central Statistics Office (CSO) Census data and 2007 Health Service Executive{Primary Care Reimbursement Service (HSE{PCRS) sample data. 3. To develop a model to project GMS prescribing expenditure in five year intervals to 2026, using 2012 HSE{PCRS population data, incorporating cost containment measures, and 2011 CSO Census data. 4. To investigate the impact of demographic factors and the pharmacology of drugs (Anatomical Therapeutic Chemical (ATC)) on GMS expenditure. 5. To explore the consequences of GMS policy changes on prescribing expenditure and behaviour between 2008 and 2014. The thesis is centered around three published articles and is located between the end of a booming Irish economy in 2007, a recession from 2008{2013, to the beginning of a recovery in 2014. The literature identified a number of factors influencing pharmaceutical expenditure, including population growth, population aging, changes in drug utilisation and drug therapies, age, gender and location. The literature identified the methods previously used in predictive modelling and consequently, the Monte Carlo Simulation (MCS) model was used to simulate projected expenditures to 2026. Also, the literature guided the use of Ordinary Least Squares (OLS) regression in determining demographic and pharmacology factors influencing prescribing expenditure. The study commences against a backdrop of growing GMS prescribing costs, which has risen from e250 million in 1998 to over e1 billion by 2007. Using a sample 2007 HSE{PCRS prescribing data (n=192,000) and CSO population data from 2008, (Conway et al., 2014) estimated GMS prescribing expenditure could rise to e2 billion by2026. The cogency of these findings was impacted by the global economic crisis of 2008, which resulted in a sharp contraction in the Irish economy, mounting fiscal deficits resulting in Ireland's entry to a bailout programme. The sustainability of funding community drug schemes, such as the GMS, came under the spotlight of the EU, IMF, ECB (Trioka), who set stringent targets for reducing drug costs, as conditions of the bailout programme. Cost containment measures included: the introduction of income eligibility limits for GP visit cards and medical cards for those aged 70 and over, introduction of co{payments for prescription items, reductions in wholesale mark{up and pharmacy dispensing fees. Projections for GMS expenditure were reevaluated using 2012 HSE{PCRS prescribing population data and CSO population data based on Census 2011. Taking into account both cost containment measures and revised population predictions, GMS expenditure is estimated to increase by 64%, from e1.1 billion in 2016 to e1.8 billion by 2026, (ConwayLenihan and Woods, 2015). In the final paper, a cross{sectional study was carried out on HSE{PCRS population prescribing database (n=1.63 million claimants) to investigate the impact of demographic factors, and the pharmacology of the drugs, on GMS prescribing expenditure. Those aged over 75 (ẞ = 1:195) and cardiovascular prescribing (ẞ = 1:193) were the greatest contributors to annual GMS prescribing costs. Respiratory drugs (Montelukast) recorded the highest proportion and expenditure for GMS claimants under the age of 15. Drugs prescribed for the nervous system (Escitalopram, Olanzapine and Pregabalin) were highest for those between 16 and 64 years with cardiovascular drugs (Statins) were highest for those aged over 65. Females are more expensive than males and are prescribed more items across the four ATC groups, except among children under 11, (ConwayLenihan et al., 2016). This research indicates that growth in the proportion of the elderly claimants and associated levels of cardiovascular prescribing, particularly for statins, will present difficulties for Ireland in terms of cost containment. Whilst policies aimed at cost containment (co{payment charges, generic substitution, reference pricing, adjustments to GMS eligibility) can be used to curtail expenditure, health promotional programs and educational interventions should be given equal emphasis. Also policies intended to affect physicians prescribing behaviour include guidelines, information (about price and less expensive alternatives) and feedback, and the use of budgetary restrictions could yield savings.

Delay-Sensitive Service Request Scheduling for Cloud Computing

Cloud computing realizes the long-held dream of converting computing capability into a type of utility. It has the potential to fundamentally change the landscape of the IT industry and our way of life. However, as cloud computing expanding substantially in both scale and scope, ensuring its sustainable growth is a critical problem. Service providers have long been suffering from high operational costs. Especially the costs associated with the skyrocketing power consumption of large data centers. In the meantime, while efficient power/energy utilization is indispensable for the sustainable growth of cloud computing, service providers must also satisfy a user's quality of service (QoS) requirements. This problem becomes even more challenging considering the increasingly stringent power/energy and QoS constraints, as well as other factors such as the highly dynamic, heterogeneous, and distributed nature of the computing infrastructures, etc. In this dissertation, we study the problem of delay-sensitive cloud service scheduling for the sustainable development of cloud computing. We first focus our research on the development of scheduling methods for delay-sensitive cloud services on a single server with the goal of maximizing a service provider's profit. We then extend our study to scheduling cloud services in distributed environments. In particular, we develop a queue-based model and derive efficient request dispatching and processing decisions in a multi-electricity-market environment to improve the profits for service providers. We next study a problem of multi-tier service scheduling. By carefully assigning sub deadlines to the service tiers, our approach can significantly improve resource usage efficiencies with statistically guaranteed QoS. Finally, we study the power conscious resource provision problem for service requests with different QoS requirements. By properly sharing computing resources among different requests, our method statistically guarantees all QoS requirements with a minimized number of powered-on servers and thus the power consumptions. The significance of our research is that it is one part of the integrated effort from both industry and academia to ensure the sustainable growth of cloud computing as it continues to evolve and change our society profoundly.

Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

Knight M, Acosta C, Brocklehurst P, Cheshire A, Fitzpatrick K, Hinton L, Jokinen M, Kemp B, Kurinczuk JJ, Lewis G, Lindquist A, Locock L, Nair M, Patel N, Quigley M, Ridge D, Rivero-Arias O, Sellers S, Shah A on behalf of the UKNeS coapplicant group. Background Studies of maternal mortality have been shown to result in important improvements to women’s health. It is now recognised that in countries such as the UK, where maternal deaths are rare, the study of near-miss severe maternal morbidity provides additional information to aid disease prevention, treatment and service provision. Objectives To (1) estimate the incidence of specific near-miss morbidities; (2) assess the contribution of existing risk factors to incidence; (3) describe different interventions and their impact on outcomes and costs; (4) identify any groups in which outcomes differ; (5) investigate factors associated with maternal death; (6) compare an external confidential enquiry or a local review approach for investigating quality of care for affected women; and (7) assess the longer-term impacts. Methods Mixed quantitative and qualitative methods including primary national observational studies, database analyses, surveys and case studies overseen by a user advisory group. Setting Maternity units in all four countries of the UK. Participants Women with near-miss maternal morbidities, their partners and comparison women without severe morbidity. Main outcome measures The incidence, risk factors, management and outcomes of uterine rupture, placenta accreta, haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, severe sepsis, amniotic fluid embolism and pregnancy at advanced maternal age (≥ 48 years at completion of pregnancy); factors associated with progression from severe morbidity to death; associations between severe maternal morbidity and ethnicity and socioeconomic status; lessons for care identified by local and external review; economic evaluation of interventions for management of postpartum haemorrhage (PPH); women’s experiences of near-miss maternal morbidity; long-term outcomes; and models of maternity care commissioned through experience-led and standard approaches. Results Women and their partners reported long-term impacts of near-miss maternal morbidities on their physical and mental health. Older maternal age and caesarean delivery are associated with severe maternal morbidity in both current and future pregnancies. Antibiotic prescription for pregnant or postpartum women with suspected infection does not necessarily prevent progression to severe sepsis, which may be rapidly progressive. Delay in delivery, of up to 48 hours, may be safely undertaken in women with HELLP syndrome in whom there is no fetal compromise. Uterine compression sutures are a cost-effective second-line therapy for PPH. Medical comorbidities are associated with a fivefold increase in the odds of maternal death from direct pregnancy complications. External reviews identified more specific clinical messages for care than local reviews. Experience-led commissioning may be used as a way to commission maternity services. Limitations This programme used observational studies, some with limited sample size, and the possibility of uncontrolled confounding cannot be excluded. Conclusions Implementation of the findings of this research could prevent both future severe pregnancy complications as well as improving the outcome of pregnancy for women. One of the clearest findings relates to the population of women with other medical and mental health problems in pregnancy and their risk of severe morbidity. Further research into models of pre-pregnancy, pregnancy and postnatal care is clearly needed.

Service Quality in Arts Events: Operations Management Strategies for Effective Delivery

Recent debate on the quality of arts events has concentrated on the requirement to deliver against a complex range of political, social, and cultural criteria with an emphasis on the external partnerships that are forged. Yet those aspects of quality over which event organizers have more direct control have been accorded minor examination. The authors believe that operational effectiveness is key to service quality in the cultural context, and seek to demonstrate that a balanced consideration of both process and product is vital to fully deliver quality arts events. This article identifies areas of emergent research and practice and focuses on issues in the front-of-house environment where the breakdown of service quality is a real concern, using the experience of one UK not-for-profit arts organization as a case study to illustrate potential management responses.

In Service to Iowa : Public Library Standards, 6th edition, August 8, 2016

The Standards and Accreditation Program exists to encourage the ongoing development of high quality public library services in Iowa. In Service to Iowa: Public Library Standards is the manual for the State Library of Iowa’s standards program. It was first published in 1985 and was updated in 1989, 1997, 2004, 2010, and now in 2016. Iowa’s voluntary public library standards program was established to give public libraries a tool to identify strengths and areas for improvement. It is also used to document the condition of public library service in Iowa, to distribute Direct State Aid funding, and to meet statutory requirements. In 2015, the Iowa Commission of Libraries appointed the Public Library Standards Advisory Task Force to revise In Service to Iowa. The Task Force in turn solicited feedback from the State Library Advisory Panel to ensure that proposed standards meet the changing needs of Iowa’s public libraries. All task force members support and stress the importance of the accreditation process and thank the Iowa public library community for its assistance.

THE COSTS OF RAISING EQUITY RATIO FOR BANKS Evidence from publicly listed banks operating in Finland

The solvency rate of banks differs from the other corporations. The equity rate of a bank is lower than it is in corporations of other field of business. However, functional banking industry has huge impact on the whole society. The equity rate of a bank needs to be higher because that makes the banking industry more stable as the probability of the banks going under will decrease. If a bank goes belly up, the government will be compensating the deposits since it has granted the bank’s depositors a deposit insurance. This means that the payment comes from the tax payers in the last resort. Economic conversation has long concentrated on the costs of raising equity ratio. It has been a common belief that raising equity ratio also increases the banks’ funding costs in the same phase and these costs will be redistributed to the banks customers as higher service charges. Regardless of the common belief, the actual reaction of the funding costs to the higher equity ratio has been studied only a little in Europe and no study has been constructed in Finland. Before it can be calculated whether the higher stability of the banking industry that is caused by the raise in equity levels compensates the extra costs in funding costs, it must be calculated how much the actual increase in the funding costs is. Currently the banking industry is controlled by complex and heavy regulation. To maintain such a complex system inflicts major costs in itself. This research leans on the Modigliani and Miller theory, which shows that the finance structure of a firm is irrelevant to their funding costs. In addition, this research follows the calculations of Miller, Yang ja Marcheggianon (2012) and Vale (2011) where they calculate the funding costs after the doubling of specific banks’ equity ratios. The Finnish banks studied in this research are Nordea and Danske Bank because they are the two largest banks operating in Finland and they both also have the right company form to able the calculations. To calculate the costs of halving their leverages this study used the Capital Asset Pricing Model. The halving of the leverage of Danske Bank raised its funding costs for 16—257 basis points depending on the method of assessment. For Nordea the increase in funding costs was 11—186 basis points when its leverage was halved. On the behalf of the results found in this study it can be said that the doubling of an equity ratio does not increase the funding costs of a bank one by one. Actually the increase is quite modest. More solvent banks would increase the stability of the banking industry enormously while the increase in funding costs is low. If the costs of bank regulation exceeds the increase in funding costs after the higher equity ratio, it can be thought that this is the better way of stabilizing the banking industry rather than heavy regulation.