Department of Human Rights Division of Central Administration Performance Plan, FY2005

This report provides valuable information about Central Administration’s coordination and provision of quality administrative, personnel, and financial services for all DHR divisions. Information is being provided in accordance with the Accountable Government Act to improve decision-making and increase accountability to stakeholders and citizens of Iowa. This report includes performance information for the division’s core function - resource management. The two services, products, and activities provided by the division – financial services and human resources services - also are reviewed. The division is comprised of seven full-time employees. The division’s FY2005 operating budget was $ 604,888 of which $292,660 was from the State General Fund. The additional $ 312,228 was received via intra-state transfers from the non-state funded programs administered by the Department of Human Rights. Central Administration oversaw expenditures of $ 66,868,806 for the entire department, and coordinated the personnel and payroll transactions of 56 FTEs. As we review the results from this year’s report we will continue to refine how we measure our successes and modify plans to improve results.

Construction and Maintenance Practices to Minimize the Potential Liability of Counties for Roads in Rural Subdivisions, HR-221, 1981

In an earlier research project, HR-204, the magnitude and nature of highway related tort claims against counties in Iowa were investigated. However, virtually all of the claims identified in that research resulted from incidents that occurred in areas with predominantly agricultural land use. With recent increases in the rural non-farm population, many traditionally urban problems are also appearing in built-up areas under county jurisdiction. This trend is expected to continue so that counties must anticipate a change in the nature of the tort claims they will encounter. Problems that heretofore have been unique to cities may become commonplace in areas for which counties are responsible. The research reported here has been directed toward an investigation of those problems in rural subdivisions that lead to claims growing out of the provision of highway services by counties. Lacking a sufficient database among counties for the types of tort claims of interest in this research, a survey was sent to 259 cities in Iowa in order to identify highway related problems leading to those claims. The survey covered claims during a five year period from 1975 to 1980. Over one-third of the claims reported were based on alleged street defects. Another 34 percent of the claims contained allegations of damages due to backup of sanitary sewers or defects in sidewalks. By expanding the sample from the 164 cities that responded to the survey, it was estimated that a total of $49,000,000 in claims had been submitted to all 259 cities. Over 34% of this amount resulted from alleged defects in the use of traffic signs, signals, and markings. Another 42% arose from claims of defects in streets and sidewalks. Payments in settlement of claims were about 13.4% of the amount asked for those claims closed during the period covered by the survey. About $9,000,000 in claims was pending on June 30, 1980 according to the information furnished. Officials from 23 cities were interviewed to provide information on measures to overcome the problems leading to tort claims. On the basis of this information, actions have been proposed that can be undertaken by counties to reduce the potential for highway-related claims resulting from their responsibilities in rural subdivisions and unincorporated communities. Suggested actions include the eight recommendations contained in the final report for the previous research under HR-204. In addition, six recommendations resulted from this research, as follows: 1. Counties should adopt county subdivision ordinances. 2. A reasonable policy concerning sidewalks should be adopted. 3. Counties should establish and implement a system for setting road maintenance priorities. 4. Counties should establish and implement a procedure for controlling construction or maintenance activities within the highway right of way. 5. Counties should establish and implement a system to record complaints that are received relating to highway maintenance and to assure timely correction of defective conditions leading to such complaints. 6. Counties should establish and implement a procedure to ensure timely advice of highway defects for which notice is not otherwise received.

Cost-effectiveness of surgery in low- and middle-income countries: a systematic review.

BACKGROUND: There is increasing interest in provision of essential surgical care as part of public health policy in low- and middle-income countries (LMIC). Relatively simple interventions have been shown to prevent death and disability. We reviewed the published literature to examine the cost-effectiveness of simple surgical interventions which could be made available at any district hospital, and compared these to standard public health interventions. METHODS: PubMed and EMBASE were searched using single and combinations of the search terms "disability adjusted life year" (DALY), "quality adjusted life year," "cost-effectiveness," and "surgery." Articles were included if they detailed the cost-effectiveness of a surgical intervention of relevance to a LMIC, which could be made available at any district hospital. Suitable articles with both cost and effectiveness data were identified and, where possible, data were extrapolated to enable comparison across studies. RESULTS: Twenty-seven articles met our inclusion criteria, representing 64 LMIC over 16 years of study. Interventions that were found to be cost-effective included cataract surgery (cost/DALY averted range US$5.06-$106.00), elective inguinal hernia repair (cost/DALY averted range US$12.88-$78.18), male circumcision (cost/DALY averted range US$7.38-$319.29), emergency cesarean section (cost/DALY averted range US$18-$3,462.00), and cleft lip and palate repair (cost/DALY averted range US$15.44-$96.04). A small district hospital with basic surgical services was also found to be highly cost-effective (cost/DALY averted 1 US$0.93), as were larger hospitals offering emergency and trauma surgery (cost/DALY averted US$32.78-$223.00). This compares favorably with other standard public health interventions, such as oral rehydration therapy (US$1,062.00), vitamin A supplementation (US$6.00-$12.00), breast feeding promotion (US$930.00), and highly active anti-retroviral therapy for HIV (US$922.00). CONCLUSIONS: Simple surgical interventions that are life-saving and disability-preventing should be considered as part of public health policy in LMIC. We recommend an investment in surgical care and its integration with other public health measures at the district hospital level, rather than investment in single disease strategies.

Issue review : Federal Budget Control Act of 2011.

This issue review provides an overview and update on the sequester provision of the Federal Budget Control Act of 2011.

Effectiveness of pharmacist care in the improvement of adherence to antidepressants: a systematic review and meta-analysis

BACKGROUND: Pharmacists can play a decisive role in the management of ambulatory patients with depression who have poor adherence to antidepressant drugs. OBJECTIVE: To systematically evaluate the effectiveness of pharmacist care in improving adherence of depressed outpatients to antidepressants. METHODS: A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted. RCTs were identified through electronic databases (MEDLINE, Cochrane Central Register of Controlled Trials, Institute for Scientific Information Web of Knowledge, and Spanish National Research Council) from inception to April 2010, reference lists were checked, and experts were consulted. RCTs that evaluated the impact of pharmacist interventions on improving adherence to antidepressants in depressed patients in an outpatient setting (community pharmacy or pharmacy service) were included. Methodologic quality was assessed and methodologic details and outcomes were extracted in duplicate. RESULTS: Six RCTs were identified. A total of 887 patients with an established diagnosis of depression who were initiating or maintaining pharmacologic treatment with antidepressant drugs and who received pharmacist care (459 patients) or usual care (428 patients) were included in the review. The most commonly reported interventions were patient education and monitoring, monitoring and management of toxicity and adverse effects, adherence promotion, provision of written or visual information, and recommendation or implementation of changes or adjustments in medication. Overall, no statistical heterogeneity or publication bias was detected. The pooled odds ratio, using a random effects model, was 1.64 (95% CI 1.24 to 2.17). Subgroup analysis showed no statistically significant differences in results by type of pharmacist involved, adherence measure, diagnostic tool, or analysis strategy. CONCLUSIONS: These results suggest that pharmacist intervention is effective in the improvement of patient adherence to antidepressants. However, data are still limited and we would recommend more research in this area, specifically outside of the US.

BUSINESS CONCEPTS OF MOBILE VALUE-ADDED SERVICES FROM OPERATOR’S POINT OF VIEW

Tämä diplomityö on tehty Lappeenrannassa Telecom Business Research Centerin 5T-projektiin liittyen. Työssä tutkitaan matkaviestinnän lisäarvopalveluiden liiketoimintakonsepteja operaattoreiden näkökulmasta. Lisäarvopalvelut laajentavat operaattoreiden palveluvalikoimaa. Niiden osuuden telekommunikaatioalan yritysten ja erityisesti operaattoreiden tuotoista on ennustettu kasvavan huomattavasti. Työn tärkeimpänä tavoitteena on tuoda uusia näkökulmia ja lisätä ymmärrystä lisäarvopalveluiden liiketoimintakonseptin rakentamisprosessista. Tätä tietämystä käytetään edesauttamaan työn empiirisessä osuudessa tutkitun Content Gateway -tuotteen liiketoimintaa. Tarjoamalla nopean liitynnän ja laskutuskanavan ulkopuolisten palveluntarjoajien ja operaattorin välille tämä tuote mahdollistaa operaattorille ja palveluntarjoajille lisäarvopalveluiden liiketoiminnan käynnistämisen. Lisäarvopalveluiden arvonluontiprosessi vaatii lukuisia yhteistyötä tekeviä osapuolia, joiden yhteistoiminta on dynaamista ja tiedonvälitys avointa, interaktiivista ja nopeaa. Arvonluontiin liittyy myös monia konvergoituvia kehityssuuntia. Perinteinen arvoketjuajattelu on riittämätön uuteen, verkottuneeseen toimintaympäristöön ja sen tilalle on tullut modernimpi arvoverkostomalli. Arvoverkosto luo kilpailuetunsa muita verkostoja vastaan jakamalla resurssit ja kompetenssit optimaalisesti ja liittämällä strategisen ja operationaalisen johtamisen kulttuurit toisiinsa. Tässä työssä verrataan arvoverkoston teoreettisia tavoitteita kahteen lisäarvopalveluiden liiketoimintakonseptiin. Näistä ensimmäinen, i-mode –niminen konsepti on valittu vertailuun edistyksellisyytensä ja tulevaa kehitystä ennakoivien ominaispiirteidensä vuoksi. Toinen esimerkkikonsepti on rakennettu edellä mainitun Content Gateway -tuotteen ympärille. Tutkimus sisältää mm. liikekumppaneiden hankinnan, ansaintalogiikoiden ja verkostojen johtamisen analysoinnin. Työn tuloksena on saatu ohjeita siihen, miten operaattori voi rakentaa tällaista konseptia ja mitä seikkoja tulee ottaa huomioon erityisesti sanomapalveluihin liittyvässä liiketoiminnassa.

Air services on thin routes : Regional versus low-cost airlines

An examination of the impact in the US and EU markets of two major innovations in the provision of air services on thin routes - regional jet technology and the low-cost business model - reveals significant differences. In the US, regional airlines monopolize a high proportion of thin routes, whereas low-cost carriers are dominant on these routes in Europe. Our results have different implications for business and leisure travelers, given that regional services provide a higher frequency of flights (at the expense of higher fares), while low-cost services offer lower fares (at the expense of lower flight frequencies).

Paediatric end-of-life care needs in Switzerland: current practices, and perspectives from parents and professionals. A study protocol.

AIM: To present a protocol for a multi-phase study about the current practice of end-of-life care in paediatric settings in Switzerland. BACKGROUND: In Switzerland, paediatric palliative care is usually provided by teams, who may not necessarily have specific training. There is a lack of systematic data about specific aspects of care at the end of a child's life, such as symptom management, involvement of parents in decision-making and family-centred care and experiences and needs of parents, and perspectives of healthcare professionals. DESIGN: This retrospective nationwide multicentre study, Paediatric End-of-LIfe CAre Needs in Switzerland (PELICAN), combines quantitative and qualitative methods of enquiry. METHODS: The PELICAN study consists of three observational parts, PELICAN I describes practices of end-of-life care (defined as the last 4 weeks of life) in the hospital and home care setting of children (0-18 years) who died in the years 2011-2012 due to a cardiac, neurological or oncological disease, or who died in the neonatal period. PELICAN II assesses the experiences and needs of parents during the end-of-life phase of their child. PELICAN III focuses on healthcare professionals and explores their perspectives concerning the provision of end-of-life care. CONCLUSION: This first study across Switzerland will provide comprehensive insight into the current end-of-life care in children with distinct diagnoses and the perspectives of affected parents and health professionals. The results may facilitate the development and implementation of programmes for end-of-life care in children across Switzerland, building on real experiences and needs. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01983852.

Cultural Planning and community sustainability: The case of the Cultural Facilities Plan of Catalonia (PECCAT 2010-20)

The government of Catalonia has developed a planning framework that seeks to establish the provision of cultural facilities throughout the country. The Cultural Facilities Plan of Catalonia (PECCAT) is based on an analysis of historical gaps and establishes a minimum spatial scheme. The plan responds to problems associated with the absence of a former similar instrument, which has led to an inconsistent and inappropriate cultural infrastructure that fails to fulfill its fundamental mission of securing the cultural rights of the population. The paper sets forth the aims of this policy and describes the objectives and basic characteristics of the plan and the expected outcomes. With the plan, the government of Catalonia seeks to rebalance the infrastructure within the territory and to ensure universal access to basic cultural services, while avoiding a logic of standardization and taking local communities into account. With the development of local plans in the municipalities, local governments encourage community participation processes to adapt and decide on priorities for action based on needs assessments and cultural opportunities for local sustainable development. The local plans focus on local cultural strengths, take advantage of opportunities, and aim to realize the cultural dynamics of a place through establishing an infrastructure that can best respond to the needs and cultural demands of the local communities, taking into account economic, social, and environmental sustainability.

ESTRO-HERO survey: Guidelines for equipment and staffing of radiotherapy facilities in the European countries: Final results of the ESTRO-HERO survey

Background and purpose: In planning to meet evidence based needs for radiotherapy, guidelines for the provision of capital and human resources are central if access, quality and safety are not to be compromised. A component of the ESTRO-HERO (Health Economics in Radiation Oncology) project is to document the current availability and content of guidelines for radiotherapy in Europe. Materials and methods: An 84 part questionnaire was distributed to the European countries through their national scientific and professional radiotherapy societies with 30 items relating to the availability of guidelines for equipment and staffing and selected operational issues. Twenty-nine countries provided full or partial evaluable responses. Results: The availability of guidelines across Europe is far from uniform. The metrics used for capital and human resources are variable. There seem to have been no major changes in the availability or specifics of guidelines over the ten-year period since the QUARTS study with the exception of the recent expansion of RTT staffing models. Where comparison is possible it appears that staffing for radiation oncologists, medical physicists and particularly RTTs tend to exceed guidelines suggesting developments in clinical radiotherapy are moving faster than guideline updating. Conclusion: The efficient provision of safe, high quality radiotherapy services would benefit from the availability of well-structured guidelines for capital and human resources, based on agreed upon metrics, which could be linked to detailed estimates of need

The Role of Firm Size in Training Provision Decisions: evidence from Spain

The level of training provided by small firms to their employees is below that provided by their larger counterparts. The provision of firm-related training is believed to be associated to certain characteristics of the firm. In this paper we argue that small firms provide fewer training opportunities as they are less likely to be associated with these characteristics than large firms. The suitability of estimating training decisions as a double-decision process is examined here: first, a firm has to decide whether to provide training or not and, second, having decided to do so, the amount of training to provide. The differences in training provision between small and large firms are decomposed in order to analyse the individual contribution of these characteristics to explaining the gap. The results show that small firms face greater obstacles in accessing training and that the main reasons for that are related to their technological activity and the geographical scope of the market in which they operate.

Marketing of Lappeenranta University of Technology energy auditing services

The objective of this study was to find out how LUT Energy should start marketing its energy audit services, what would be the optimal pricing policy for its services and how LUT Energy could manage customer expectations towards quality of its auditing services. In order to answer these questions, a quantitative survey questionnaire was sent by e-mail to 56 companies from the regions of South Karelia and Kymenlaakso. The empirical data of the study was the answers and opinions of the companies, previous researches about energy efficiency and articles and presentations about the current situation in the energy efficiency market. The results of the study were that there is a great potential for energy audit services and also the legislation requires companies to improve their energy efficiency. To start marketing its services, LUT Energy should first clarify its service concept and divide its service offering into two offers. It should also clarify the marketing message it wants to send its customers and then do the marketing with the help of three-way-model. The best pricing policy for the service would be that the price is proportioned to the future savings. In order to ensure the quality of its services, LUT Energy has to make sure that both dimensions of the quality are managed properly and to fade out customer expectations towards the quality the auditing work has to be monitored.

Understanding space, place and leisure of women over 85 living in the community

There is an increase in the number of older adults 85 and over, who are choosing to live alone within the community. Moreover, older adults who live alone are reportedly spending an extensive amount of time alone within the home environment. In an effort to provide additional support and resources to older adults living in the community, a compliment of services are being offered through public and private organizations. These in-home supports focus on the instrumental or functional tasks of daily living, such as personal and rehabilitative care, nourishment, maintenance and upkeep of the home, as well as volunteer social visitation. However leisure resources and programs are not included among these services. Consequently, this creates a gap in leisure provision among this segment of the population. Throughout the life course, an individual's identity, role and purpose are developed and sustained through instrumental work roles in the formal and informal sector, as well as through personally meaningful leisure pastimes and experiences. Although roles shift post retirement, participation in instrumental and expressive activities can provide opportunities through which older adults are able to fulfill their need for agency (individuality and autonomy) and affiliation (social relatedness). Therefore barriers that inhibit instrumental or leisure experiences can negatively impact older adults' quality of life. This study explored the leisure lifestyles of four older adults, all of whom were over 85, lived alone within the community and were oriented to person, time and place. It became apparent that participants ordered their lives around a routine that consisted of instrumental, expressive and socially integrated tasks and activities. Moreover participants purposely chose to remain at home because their home environment facilitated freedom, choice and independence. As a result all four participants viewed their independence within the home as a critical determinant to their overall quality of life. Challenges associated with the home environment, participants' personal capacities and relationships were negotiated on a daily basis. Failure to positively adapt to these challenges inhibited meaningful engagement and personal fulfillment. Traditionally, leisure service delivery has been offered within institutions and through various community based venues. As a result leisure provision has been focused on the needs of the frail elderly who reside in institutions or the well elderly who are able to access leisure amenities within the community. However the growing number of older adults electing to live alone is on the rise. As individuals age the home becomes the preferred context for leisure experiences. If older adults are choosing to live alone, then both their instrumental and leisure needs must be addressed. As a result, it is imperative that leisure professionals extend the scope of service delivery to include home centered older adults.

Advocating recognition and redistribution in poverty alleviation programs in Ghana : an examination of state and NGO programs and policies

Abstract This thesis argues that poverty alleviation strategies and programs carried out by the government and Non Governmental Organizations in Ghana provide affirmative solutions to poverty. This is because, these intervention strategies have been influenced by conventional discourses on poverty that fail to adequately address non-economic issues of poverty such as powerlessness, marginalization and tmder-representation. The study is carried out in a two-pronged manner; first, it analyses state policies and strategies, particularly the Ghana Poverty Reduction Strategy (GPRS), on poverty alleviation and compares these to NGO programs, implemented with funds and support from external donor organizations. Specifically, I focus on how NGOs and the governnlent of Ghana negotiate autonomy and financial dependency with their funding donor-partners and how these affect their policies and programs. Findings from this study reveal that while external influences dominate poverty alleviation policies and strategies, NGOs and the government of Ghana exercise varying degrees of agency in navigating these issues. In particular, NGOs have been able to adapt their programs to the changing needs of donor markets, and are also actively engaged in re-orienting poverty back to the political domain through advocacy campaigns. Overall, rural communities in Ghana depend on charitable NGOs for the provision of essential social services, while the Ghanaian government depends on international donor assistance for its development projects.

Being a bereaved parent : early bereavement experiences and perspectives on paediatric palliative care and bereavement services

La mort d'un enfant est considérée comme l'une des expériences les plus difficiles à laquelle une personne puisse faire face. Les cliniciens, les hôpitaux et plusieurs organismes ont pour objectif d’aider les parents endeuillés, mais leurs efforts sont compliqués par un manque de recherche dans le domaine du deuil parental. Cette thèse est composée de trois articles, soit deux revues de littérature et une étude empirique, qui tentent de combler cette lacune et d’informer les services en soins palliatifs pédiatriques et les services de soutien au deuil en particulier. Le premier article porte sur les besoins des patients recevant des soins palliatifs pédiatriques et de leurs familles. Par le biais d’un méta-résumé de la recherche descriptive et qualitative récente, 10 domaines de besoins ont été identifiés qui correspondent aux lignes directrices actuelles en soins palliatifs pédiatriques et de fin de vie. Ces besoins sont présentés de manière à être facilement applicables à la pratique. Cependant, les résultats mettent aussi en évidence plusieurs aspects des soins identifiés comme déficitaires ou problématiques qui mériteraient une attention particulière dans le cadre de politiques futures. Dans le deuxième article, l'objectif était de résumer une vaste littérature d'une manière utile aux cliniciens. À cette fin, une synthèse narrative a permis d’intégrer la recherche quantitative et qualitative dans le domaine du deuil parental. Les résultats mettent en évidence les éléments susceptibles de favoriser l’adaptation des parents au deuil, éléments qui suggèrent par le fait même des avenues possibles de soutien et d'intervention. Cette synthèse a cependant cerné dans la littérature certaines failles méthodologiques qui rendent l'applicabilité clinique des résultats difficile. L'objectif du troisième article était d'informer les services de suivi et de soutien au deuil auprès des parents en se renseignant directement auprès de parents endeuillés. À cette fin, 21 parents (dont 8 couples) et 7 membres du personnel impliqués dans des activités de suivi de deuil de 2 hôpitaux pédiatriques ont été interrogés dans le cadre d’une description interprétative, et l'application clinique des résultats a été vérifiée par le biais de réunions avec des collaborateurs de recherche et les décideurs des centres hospitaliers. Les résultats décrivent comment les parents ont fait face à leur détresse dans la phase précoce de leur deuil, ainsi que leurs points de vue sur la façon dont les divers services de suivi de deuil ont été aidants. Les résultats suggèrent que les parents gèrent leurs sentiments intenses de douleur par une alternance de stratégies axées soit sur leur deuil ou sur leur quotidien et que dans plusieurs cas leurs relations avec autrui les ont aidé. Cette étude a également permis d'élucider la façon dont divers services de soutien aide les parents à aborder leur deuil. Les implications cliniques de ces résultats sont discutées ainsi que des recommandations à l’intention de ceux qui sont impliqués dans la provision des services en deuil.