Pre-conception care : current practice and methods of provision

This thesis examines the present provisions for pre-conception care and the views of the providers of services. Pre-conception care is seen by some clinicians and health educators as a means of making any necessary changes in life style, corrections to imbalances in the nutritional status of the prospective mother (and father) and the assessment of any medical problems, thus maximizing the likelihood of the normal development of the baby. Pre-conception care may be described as a service to bridge the gap between the family planning clinic and the first ante-natal booking appointment. There were three separate foci for the empirical research - the Foresight organisation (a charity which has pioneered pre-conception care in Britain); the pre-conception care clinic at the West London Hospital, Hammersmith; and the West Midlands Regional Health Authority. The six main sources of data were: twenty five clinicians operating Foresight pre-conception clinics, couples attending pre-conception clinics, committee members of the Foresight organisation, staff of the West London Hospital pre-conception clinic, Hammersmith, District Health Education Officers working in the West Midlands Regional Health Authority and the members of the Ante-Natal Care Action Group, a sub-group of the Regional Health Advisory Group on Health Promotion and Preventive Medicine. A range of research methods were adopted. These were as follows: questionnaires and report forms used in co-operation with the Foresight clinicians, interviews, participant observation discussions and informal meetings and, finally, literature and official documentation. The research findings illustrated that pre-conception care services provided at the predominantly private Foresight clinics were of a rather `ad hoc' nature. The type of provision varied considerably and clearly reflected the views held by its providers. The protocol which had been developed to assist in the standardization of results was not followed by the clinicians. The pre-conception service provided at the West London Hospital shared some similarities in its approach with the Foresight provision; a major difference was that it did not advocate the use of routine hair trace metal analysis. Interviews with District Health Education Officers and with members of the Ante Natal Care Action Group revealed a tentative and cautious approach to pre-conception care generally and to the Foresight approach in particular. The thesis concludes with a consideration of the future of pre-conception care and the prospects for the establishment of a comprehensive pre-conception care service.

Market-awareness in service-based systems

Service-based systems are applications built by composing pre-existing services. During design time and according to the specifications, a set of services is selected. Both, service providers and consumers exist in a service market that is constantly changing. Service providers continuously change their quality of services (QoS), and service consumers can update their specifications according to what the market is offering. Therefore, during runtime, the services are periodically and manually checked to verify if they still satisfy the specifications. Unfortunately, humans are overwhelmed with the degree of changes exhibited by the service market. Consequently, verification of the compliance specification and execution of the corresponding adaptations when deviations are detected cannot be carried out in a manual fashion. In this work, we propose a framework to enable online awareness of changes in the service market in both consumers and providers by representing them as active software agents. At runtime, consumer agents concretize QoS specifications according to the available market knowledge. Services agents are collectively aware of themselves and of the consumers' requests. Moreover, they can create and maintain virtual organizations to react actively to demands that come from the market. In this paper we show preliminary results that allow us to conclude that the creation and adaptation of service-based systems can be carried out by a self-organized service market system. © 2012 IEEE.

Satisfying requirements for pervasive service compositions

Pervasive environments are characterised by highly heterogeneous services and mobile devices with dynamic availability. Approaches such as that proposed by the Connect project provide means to enable such systems to be discovered and composed, through mediation where necessary. As services appear and disappear, the set of feasible compositions changes. In such a pervasive environment, a designer encounters two related challenges: what goals it is reasonable to pursue in the current context and how to use the services presently available to achieve his goals. This paper proposes an approach to design service compositions, facilitating an interactive process to find the trade-off between the possible and the desirable. Following our approach, the system finds at runtime, where possible, compositions related to the developer's requirements. This process can realise the intent the developer specifies at design time, taking into account the services available at runtime, without a prohibitive level of pre-specification, inappropriate for such dynamic environments. © 2012 ACM.

Service employee clusters in banking:exploring Ind's typology considering behaviour, commitment and attitude about leadership

Purpose: Ind suggests front line employees can be segmented according to their level of brand-supporting performance. His employee typology has not been empirically tested. The paper aims to explore front line employee performance in retail banking, and profile employee types. Design/methodology/approach: Attitudinal and demographic data from a sample of 404 front line service employees in a leading Irish bank informs a typology of service employees. Findings: Champions, Outsiders and Disruptors exist within retail banking. The authors provide an employee profile for each employee type. They found Champions amongst males, and older employees. The highest proportion of female employees surveyed were Outsiders. Disruptors were more likely to complain, and rated their performance lower than any other employee type. Contrary to extant literature, Disruptors were more likely to hold a permanent contract than other employee types. Originality/value: The authors augment the literature by providing insights about the profile of three employee types: Brand Champions, Outsiders and Disruptors. Moreover, the authors postulate the influence of leadership and commitment on each employee type. The cluster profiles raise important questions for hiring, training and rewarding front line banking employees. The authors also provide guidelines for managers to encourage Champions, and curtail Disruptors. © Emerald Group Publishing Limited.

Congenital prosopagnosia in a child:neuropsychological assessment, eye movement recordings and training

Here we report the assessment and treatment of a 6-year-old boy (L.G.) who was referred to us for congenital prosopagnosia (CP). We investigated his performance using a test battery and eye movement recordings pre- and post-training. L.G. showed deficits in recognising relatives and learning new faces, and misrecognition of unfamiliar people. Eye movement recordings showed that L.G. focused on the lower part of stimuli in naming tasks based on familiar or unfamiliar incomplete or complete faces. The training focused on improving his ability to explore internal features of faces, to discriminate specific facial features of familiar and unfamiliar faces, and to provide his family with strategies to use in the future. At the end of the training programme L.G. no longer failed to recognise close and distant relatives and classmates and did not falsely recognise unknown people.

Is there a role for telemedicine in adult allergy services?

Telemedicine refers to the application of telecommunication and information technology (IT) in the delivery of health and clinical care at a distance or remotely and can be broadly considered in two modalities: store-and-forward and real-time interactive services. Preliminary studies have shown promising results in radiology, dermatology, intensive care, diabetes, rheumatology and primary care. However, the evidence is limited and hampered by small sample sizes, paucity of randomised controlled studies and lack of data relating to cost-effectiveness, health related quality of life and patient and clinician satisfaction. This review appraises the evidence from studies that have employed telemedicine tools in other disciplines and makes suggestions for its potential applications in specific clinical scenarios in adult allergy services. Possible examples include: triaging patients to determine the need for allergy tests; pre-assessment for specialised treatments such as allergen immunotherapy; follow up to assess treatment response and side effects; and education in self-management plan including training updates for self-injectable adrenaline and nasal spray use. This approach might improve access for those with limited mobility or living far away from regional centres, as well as bringing convenience and cost savings for the patient and service provider. These potential benefits need to be carefully weighed against evidence of service safety and quality. Keys to success include delineation of appropriate clinical scenarios, patient selection, training, IT support and robust information governance framework. Well-designed prospective studies are needed to evaluate its role. This article is protected by copyright. All rights reserved.

Better queue management in a busy public hospital of a developing country without appointment system::an application using data envelopment analysis

Queuing is a key efficiency criterion in any service industry, including Healthcare. Almost all queue management studies are dedicated to improving an existing Appointment System. In developing countries such as Pakistan, there are no Appointment Systems for outpatients, resulting in excessive wait times. Additionally, excessive overloading, limited resources and cumbersome procedures lead to over-whelming queues. Despite numerous Healthcare applications, Data Envelopment Analysis (DEA) has not been applied for queue assessment. The current study aims to extend DEA modelling and demonstrate its usefulness by evaluating the queue system of a busy public hospital in a developing country, Pakistan, where all outpatients are walk-in; along with construction of a dynamic framework dedicated towards the implementation of the model. The inadequate allocation of doctors/personnel was observed as the most critical issue for long queues. Hence, the Queuing-DEA model has been developed such that it determines the ‘required’ number of doctors/personnel. The results indicated that given extensive wait times or length of queue, or both, led to high target values for doctors/personnel. Hence, this crucial information allows the administrators to ensure optimal staff utilization and controlling the queue pre-emptively, minimizing wait times. The dynamic framework constructed, specifically targets practical implementation of the Queuing-DEA model in resource-poor public hospitals of developing countries such as Pakistan; to continuously monitor rapidly changing queue situation and display latest required personnel. Consequently, the wait times of subsequent patients can be minimized, along with dynamic staff scheduling in the absence of appointments. This dynamic framework has been designed in Excel, requiring minimal training and work for users and automatic update features, with complex technical aspects running in the background. The proposed model and the dynamic framework has the potential to be applied in similar public hospitals, even in other developing countries, where appointment systems for outpatients are non-existent.

Kultúraközi szolgáltatásélmények vizsgálata a megalapozott elmélet módszerével (Examination of the intercultural service experiences with grounded theory method)

A cikk fókuszában az interkulturális szolgáltatással való találkozás áll. A téma jelentősége kétségen kívül áll, hiszen a szolgáltatások egyre növekvő térhódítása, valamint a globalizáció terjedése fontossá teszi annak ismeretét, hogy a különböző nemzeti kultúrából érkező szolgáltató és fogyasztó számára hogyan érhető el a legfőbb cél, az elégedettség. A szerzők jelen kutatásukban annak megértését helyezték a középpontba, hogy melyek azok a tényezők, amelyek befolyásolják a felek erőfeszítéseit a találkozás során fellépő problémák megoldásában. Kutatásuk során mélyinterjúkat folytattak mind a szolgáltatói, mind a fogyasztói oldallal, majd a megalapozott elmélet (grounded theory) konstruktivista irányzatának segítségével elemezték ezen interjúkat, és azonosították azokat a tényezőket, amelyek fontossá válhatnak egy kultúraközi szolgáltatásélmény során. A kutatás eredményei rámutatnak, hogy melyek azok a kommunikációs és kulturális korlátok, amelyek problémát okozhatnak, s hogy az e problémák megoldására tett erőfeszítések visszavezethetők az interakció résztvevőinek személyes jellemzőire, tapasztalataira, kulturális nyitottságára és ismereteire. A kutatás eredményeinek egyik fontos menedzseri következtetése, hogy a szállodákban a probléma jelentősége ellenére nem helyeznek elegendő hangsúlyt a kommunikációs és kulturális korlátok leküzdésére irányuló képzésekre, tréningekre. _____ This paper presents an attempt to analyse the possible solutions to problems that can occur during intercultural service encounters (ICSE). Using grounded theory the authors provide a theoretical framework that identifies the factors that lead to ICSE barriers. Based on in-depth interviews with service providers and clients they have defined the relevant characteristics that influence intercultural competence. Intercultural competence with communication and cultural differences lead to problems during ICSE that can be handled by both parties: the service provider and the client, as well. An important finding is that service companies should provide adequate training that concentrates not only on the cultural knowledge but it should create capability in understanding and adapting to cultural differences.

A New Approach Model in Post Graduate Training of Local Government Officers

In 2013-15 there was a new type of post graduate training elaborated and piloted in Hungary at the Institute of Executive Training and Continuing Education (VTKI) within the National University of Public Service (NKE). Although the pilot financed by the State Administration Reform Operative Program (ÁROP) had not lacked the previously established attempts to include interactivity in the training, it was the first to observe and apply the actual principles of the European Union 2020 expressed in the threefold criteria of economic growth: smartness, sustainability and inclusiveness. All of them are represented by a pillar of the program like e-learning, class training and field training with the inclusion of local society. According to the objectives of the program there were at least 10 thousand attendees from the civil service sphere set as project indicators, so it has been a large scale training program that took place in 2014 in Hungary. The following article shows the innovations included in this new approach model of post graduate training civil servants.

Civil service reform trends in public personnel management: Experiences from the Commonwealth of the Bahamas

This study has explored the potential for implementing a merit-based public personnel system in The Bahamas, a former British colony in The Commonwealth Caribbean. Specifically, the study evaluated the use of merit-based public personnel management practices in areas of recruitment, selection, promotion, training and employee development and performance evaluation. Driving forces and barriers which impact merit system successes and failures as well as strategies for institutionalizing merit system practices are identified. Finally the study attempted to apply the developmental model created by Klingner (1996) to describe the stage of public personnel management in The Bahamas. The data for the study was collected through in-depth interviews with expert observers. ^

The effectiveness of training educators on their ability to identify function of problem behavior

The purpose of this study was to investigate the effectiveness of training educators in the pre-behavioral intervention process of functional behavioral assessment. An original evaluation instrument was developed entitled, The Survey for Students Exhibiting Challenging Behavior. The instrument included measures of participating educators, knowledge of function of problem behavior and their ability to generate recommendations for a behavior intervention plan. The instrument was distributed to schools in a large urban district and completed by special educators. Educators trained and untrained in the functional behavioral assessment process were compared in the study. ^ The study incorporated a post-test only design. All instruments were analyzed using a factorial ANOVA. Those educators who were trained in the district functional behavioral assessment program answered general questions related to function of problem behavior significantly better than those who did not receive training. There is no significant difference between educators on their ability to generate recommendations for behavior intervention plans. It is important that educators receive training in functional behavioral assessment to gain an understanding of the basic notions being function of problem behavior. Current training does not translate into educators' ability to make strong recommendations for behavior intervention plans. ^

Teachers' perceptions of the usefulness of Individual Education Plans (IEP)

Since 1997 federal special education policy mandated that all classroom teachers take part in planning and implementation of Individualized Education Plans (IEP) for students with disabilities. This legislation has given teachers new responsibilities because it requires greater participation in the IEP process. The purpose of this study was to examine teachers' perceptions of the usefulness of Individualized Education Plans (IEP). ^ Eighty seven certified Miami-Dade County Public School teachers, 60 general education teachers and 27 special education teachers were surveyed using an updated version of Rheams' (1989) The Teacher Perceptions of the Usefulness of IEPs. Subjects completed a survey form containing a demographic cover page, 18 Likert-scale statements and 3 open ended questions. This study looked at differences in perceptions by teacher group affiliation (general and special), grade level taught (elementary and secondary), and years of experience (<=5 and >5 years). The dependent variables were teacher preparedness; feasibility of IEP implementation; relevancy of IP to classroom instruction; and legal, professional and personal accountability with regard to the IEP. ^ Results of the Multivariate Analysis of Variance (MANOVA) revealed that (a) special education teachers held a more positive perception of overall IEP usefulness than general education teachers, (b) special educators held more positive perceptions concerning issues of feasibility and preparedness, (c) elementary level teachers viewed the IEP more positively than secondary level teachers, specifically in the areas of preparedness and feasibility. ^ Findings of this study indicate that general and secondary educators have not embraced the legislation and incorporated it into their planning and instruction. These findings provide policymakers, institutions of higher education, and school administrators with insight as to how to better translate policy into classroom instructional practice. Consideration should be given to implementing (a) honest communication and shared decision making with regard to IEP directed curriculum and instruction, (b) updated pre and in-service IEP development and implementation training, and (c) opportunities for collaboration and increased plan time, especially on the secondary level. ^

Best practices in exemplary service delivery: A multiple case study of service quality

The purpose of this study was to explain how exemplary service providers in luxury hotels provide consistently excellent service. Using a case study framework, the study investigated the service provider's strategies and concepts of service delivery, the importance and implementation of organizational and individual controls, and the role of training and learning. The study identified barriers to service provision and characteristics of the exemplary individuals that affect their ability to deliver luxury service. This study sought to better understand how exemplary service providers learn, think about, and do their work. The sample population of three Five-Diamond-Award winning resorts was selected for their potential for learning about the phenomenon of interest. The results demonstrate that exemplary service providers possess individual characteristics that are enhanced by the organizations for which they work. Exemplary service providers are often exemplary communicators who are emotionally generous and genuinely enjoy helping and serving others. Exemplary service organizations treat their employees as they treat their customers, as suggested by the Service-Profit Chain (Heskett, Sasser & Schlesinger, 1997). Further, they have systems and standards to guarantee satisfactory service experiences for every guest. They also encourage their service providers to personalize their service delivery and to seek opportunities to delight their guests, using a combination of controls, traditions and cultural values. Several customer service theories are discussed in relationship to whether they were or were not supported by the data. The study concluded that the delivery of exemplary service is a complex phenomenon that requires successful interactions between guests, service providers and the organization. A Model of Exemplary Service Delivery is presented and discussed that demonstrates the components of service quality as shown in the data. The model can be used by practitioners seeking to create, enhance, or evaluate their service quality, and by researchers seeking insights into the complex concepts in service quality research. Implications for future research are discussed.

Effects of service-learning on student attitudes toward academic engagement and civic responsibility

This empirical study explored the impact of service-learning participation on high school students' attitudes toward academic engagement and civic responsibility. This study focused whether a group of high school students who participated in a service-learning project had more positive attitudes toward academic engagement and civic responsibility than their high school peers who did not participate in a service learning project. ^ Data were collected from 67 volunteer students as participants in grades 9–12. A service-learning treatment group of 34 high school students was examined relative to a comparison group of 33 high school students with similar demographic and academic characteristics. The investigator used questionnaires, an oral history/service-learning project, and interviews with the teacher-coordinators of the project to collect the data. The two surveys, one investigating high school students' attitudes about academic engagement, the other investigating high school students' attitudes toward civic responsibility, were administered in a pre-treatment/post-treatment design. There were 90 days between the pre-treatment and post-treatment administrations. A factor analysis of the civic responsibility instrument and multivariate analysis of gain scores were used to compare the means of the total aggregate scores of the treatment and comparison groups. Factor analysis was performed on the academic engagement instrument but it was determined that only the total scores could be used in subsequent analyses. Results were used to determine the efficacy of service-learning as interpreted in student attitudes toward academic engagement and student attitudes toward civic responsibility. ^ The study found no significant difference between the academic engagement and the civic responsibility attitudes of a high school service-learning project group and a high school comparison group with comparable school and similar demographic characteristics. One of the implications for educational practice and policy from the study results is a need to design and implement more powerful studies, studies implemented at many sites rather than just at two sites that were the basis of this study, and studies that investigate the research questions over longer time periods. Although it was not a focus of the study, the investigator concluded that service learning projects such as this might be more effective if they were better aligned with Dewey's principles. ^