850 resultados para outcomes assessment


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Over the past two decades there has been a remarkable expansion in the use of executive coaching as an executive development technique. The increasing prominence of executive coaching has been attributed to the emergence of new organisational cultures and the subtler competencies needed by executives in these faster moving organisations. The widespread popularity of executive coaching has been based largely on anecdotal feedback regarding its effectiveness. The small body of empirical research has been growing but conclusive outcomes are rare. The prominent question for those with the business imperative to implement executive coaching has been what are the ingredients of the process that engender an effective outcome? This investigation has focused on the factors of executive coaching that contribute to effectiveness. A qualitative methodology facilitated an in-depth study of the experiences of the participants of executive coaching with the perceptions of both executives and coaches being sought. Semi-structured interviews and a focus group provided rich, thick descriptions and together with a process of inductive analysis produced findings that confidently identify the key factors that contribute to coaching effectiveness. Six major themes were identified, each comprising a collection of meanings. These themes have been labelled Executive Engagement, Preliminary Assessment and Feedback, Coaching Process, Coach.s Contribution, Trusting Relationship and Support from the Organisation. One theme, Coaching Process, comprises three significant sub-themes, namely, Encouragement and Emotional Support, Challenge and Reflection and Enhancing Executive Performance. The findings of this study add value to the field by identifying factors contributing to coaching effectiveness, and providing for the coaching practitioner a basis for enhancing their practice of executive coaching to better meet the needs of executives and their organisations.

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Background: In response to the need for more comprehensive quality assessment within Australian residential aged care facilities, the Clinical Care Indicator (CCI) Tool was developed to collect outcome data as a means of making inferences about quality. A national trial of its effectiveness and a Brisbane-based trial of its use within the quality improvement context determined the CCI Tool represented a potentially valuable addition to the Australian aged care system. This document describes the next phase in the CCI Tool.s development; the aims of which were to establish validity and reliability of the CCI Tool, and to develop quality indicator thresholds (benchmarks) for use in Australia. The CCI Tool is now known as the ResCareQA (Residential Care Quality Assessment). Methods: The study aims were achieved through a combination of quantitative data analysis, and expert panel consultations using modified Delphi process. The expert panel consisted of experienced aged care clinicians, managers, and academics; they were initially consulted to determine face and content validity of the ResCareQA, and later to develop thresholds of quality. To analyse its psychometric properties, ResCareQA forms were completed for all residents (N=498) of nine aged care facilities throughout Queensland. Kappa statistics were used to assess inter-rater and test-retest reliability, and Cronbach.s alpha coefficient calculated to determine internal consistency. For concurrent validity, equivalent items on the ResCareQA and the Resident Classification Scales (RCS) were compared using Spearman.s rank order correlations, while discriminative validity was assessed using known-groups technique, comparing ResCareQA results between groups with differing care needs, as well as between male and female residents. Rank-ordered facility results for each clinical care indicator (CCI) were circulated to the panel; upper and lower thresholds for each CCI were nominated by panel members and refined through a Delphi process. These thresholds indicate excellent care at one extreme and questionable care at the other. Results: Minor modifications were made to the assessment, and it was renamed the ResCareQA. Agreement on its content was reached after two Delphi rounds; the final version contains 24 questions across four domains, enabling generation of 36 CCIs. Both test-retest and inter-rater reliability were sound with median kappa values of 0.74 (test-retest) and 0.91 (inter-rater); internal consistency was not as strong, with a Chronbach.s alpha of 0.46. Because the ResCareQA does not provide a single combined score, comparisons for concurrent validity were made with the RCS on an item by item basis, with most resultant correlations being quite low. Discriminative validity analyses, however, revealed highly significant differences in total number of CCIs between high care and low care groups (t199=10.77, p=0.000), while the differences between male and female residents were not significant (t414=0.56, p=0.58). Clinical outcomes varied both within and between facilities; agreed upper and lower thresholds were finalised after three Delphi rounds. Conclusions: The ResCareQA provides a comprehensive, easily administered means of monitoring quality in residential aged care facilities that can be reliably used on multiple occasions. The relatively modest internal consistency score was likely due to the multi-factorial nature of quality, and the absence of an aggregate result for the assessment. Measurement of concurrent validity proved difficult in the absence of a gold standard, but the sound discriminative validity results suggest that the ResCareQA has acceptable validity and could be confidently used as an indication of care quality within Australian residential aged care facilities. The thresholds, while preliminary due to small sample size, enable users to make judgements about quality within and between facilities. Thus it is recommended the ResCareQA be adopted for wider use.

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As a result of a broad invitation extended by Professor Martin Betts, Executive Dean of the Faculty of Built Environment and Engineering, to the community of interest at QUT, a cross-disciplinary collaborative workshop was conducted to contribute ideas about responding to the Government of India’s urgent requirement to implement a program to re-house slum dwellers. This is a complex problem facing the Indian Ministry of Housing. Not only does the government aspire to eradicate existing slum conditions and to achieve tangible results within five years, but it must also ensure that slums do not form in the future. The workshop focused on technological innovation in construction to deliver transformation from the current unsanitary and overcrowded informal urban settlements to places that provide the economically weaker sections of Indian society with healthy, environmentally sustainable, economically viable mass housing that supports successful urban living. The workshop was conducted in two part process as follows: Initially, QUT academics from diverse fields shared current research and provided technical background to contextualise the challenge at a pre-workshop briefing session. This was followed by a one-day workshop during which participants worked intensively in multi-disciplinary groups through a series of exercises to develop innovative approaches to the complex problem of slum redevelopment. Dynamic, compressed work sessions, interspersed with cross-functional review and feedback by the whole group took place throughout the day. Reviews emphasised testing the concepts for their level of complexity, and likelihood of success. The two-stage workshop process achieved several objectives:  Inspired a sense of shared purpose amongst a diverse group of academics  Built participants’ knowledge of each other’s capacity  Engaged multi disciplinary team in an innovative design research process  Built participants’ confidence in the collaborative process  Demonstrated that collaborative problem solving can create solutions that represent transformative change.  Developed a framework of how workable solutions might be developed for the program through follow up workshops and charrettes of a similar nature involving stakeholders drawn from the context of the slum housing program management.

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The paper provides an assessment of the performance of commercial Real Time Kinematic (RTK) systems over longer than recommended inter-station distances. The experiments were set up to test and analyse solutions from the i-MAX, MAX and VRS systems being operated with three triangle shaped network cells, each having an average inter-station distance of 69km, 118km and 166km. The performance characteristics appraised included initialization success rate, initialization time, RTK position accuracy and availability, ambiguity resolution risk and RTK integrity risk in order to provide a wider perspective of the performance of the testing systems. ----- ----- The results showed that the performances of all network RTK solutions assessed were affected by the increase in the inter-station distances to similar degrees. The MAX solution achieved the highest initialization success rate of 96.6% on average, albeit with a longer initialisation time. Two VRS approaches achieved lower initialization success rate of 80% over the large triangle. In terms of RTK positioning accuracy after successful initialisation, the results indicated a good agreement between the actual error growth in both horizontal and vertical components and the accuracy specified in the RMS and part per million (ppm) values by the manufacturers. ----- ----- Additionally, the VRS approaches performed better than the MAX and i-MAX when being tested under the standard triangle network with a mean inter-station distance of 69km. However as the inter-station distance increases, the network RTK software may fail to generate VRS correction and then may turn to operate in the nearest single-base RTK (or RAW) mode. The position uncertainty reached beyond 2 meters occasionally, showing that the RTK rover software was using an incorrect ambiguity fixed solution to estimate the rover position rather than automatically dropping back to using an ambiguity float solution. Results identified that the risk of incorrectly resolving ambiguities reached 18%, 20%, 13% and 25% for i-MAX, MAX, Leica VRS and Trimble VRS respectively when operating over the large triangle network. Additionally, the Coordinate Quality indicator values given by the Leica GX1230 GG rover receiver tended to be over-optimistic and not functioning well with the identification of incorrectly fixed integer ambiguity solutions. In summary, this independent assessment has identified some problems and failures that can occur in all of the systems tested, especially when being pushed beyond the recommended limits. While such failures are expected, they can offer useful insights into where users should be wary and how manufacturers might improve their products. The results also demonstrate that integrity monitoring of RTK solutions is indeed necessary for precision applications, thus deserving serious attention from researchers and system providers.

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Large mysticete whales represent a unique challenge for chemical risk assessment. Few epidemiological investigations are possible due to the low incidence of adult stranding events. Similarly their often extreme life-history adaptations of prolonged migration and fasting challenge exposure assumptions. Molecular biomarkers offer the potential to complement information yielded through tissue chemical analysis, as well as providing evidence of a molecular response to chemical exposure. In this study we confirm the presence of cytochrome P450 reductase (CPR) and cytochrome P450 isoenzyme 1A1 (CYP1A1) in epidermal tissue of southern hemisphere humpback whales (Megaptera novaeangliae). The detection of CYP1A1 in the integument of the humpback whale affords the opportunity for further quantitative non-destructive investigations of enzyme activity as a function of chemical stress.

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Modern statistical models and computational methods can now incorporate uncertainty of the parameters used in Quantitative Microbial Risk Assessments (QMRA). Many QMRAs use Monte Carlo methods, but work from fixed estimates for means, variances and other parameters. We illustrate the ease of estimating all parameters contemporaneously with the risk assessment, incorporating all the parameter uncertainty arising from the experiments from which these parameters are estimated. A Bayesian approach is adopted, using Markov Chain Monte Carlo Gibbs sampling (MCMC) via the freely available software, WinBUGS. The method and its ease of implementation are illustrated by a case study that involves incorporating three disparate datasets into an MCMC framework. The probabilities of infection when the uncertainty associated with parameter estimation is incorporated into a QMRA are shown to be considerably more variable over various dose ranges than the analogous probabilities obtained when constants from the literature are simply ‘plugged’ in as is done in most QMRAs. Neglecting these sources of uncertainty may lead to erroneous decisions for public health and risk management.

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Aim: Maternal substance use has been associated with a range of child risk factors. The study investigated the relationship between engagement with child health services and child protection outcomes for children of substance using mothers. ----- ----- Methods: A sample of 119 children of mothers who disclosed opiate, amphetamine or methadone use during a maternity admission between 2000 and 2003, as included in a previous matched co-hort study1, were included in the current study. Statutory child protection agency and child health engagement information for the first two years of life, was obtained. The relationship between type of maternal substance use, child health engagement and child protection outcomes was examined. ----- ----- Results: Seventy two percent of study group infants were engaged with child health services during the first two years of life. Chi square analysis showed no significant relationship between child health engagement and child protection reports. Child health engagement was associated with decreased substantiated child protection notifications for children of methadone using mothers, but not for children of illicit substance users. ----- ----- Conclusions: Almost a quarter of identified children of substance using mothers are not accessing standard child health services in their first two years of life. This study provides support for increased attention to the provision of child health services for children of methadone using mothers. Further research into effective intervention strategies for children of illicit substance using mothers is indicated.

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After the primary researches on constructability issue which were implemented in United States, United Kingdom and Australia, more explorations were applied on that in order to assess this unique scientific fact in East Asian country of Malaysia. Based on the latest researches done on constructability concept in Malaysia, the most Critical Constructability Activities (CCAs) are defined according to amount of contractors’ participation in each activity and amount of gap between actual and potential effects of each of them on achieving the overall objectives of the construction projects with more cost and time savings and better quality which is the whole aim of a beneficial constructability activity. The present research aims to assess the current findings on CCAs in order to identify the types of contractors and projects which these CCAs are getting performed in and also the types of contracts is used in these CCAs. Finally it was found that there are some significant differences in amount of contractors’ involvement in CCAs among various considered independent variables. This study uses the former researches to help Malaysian construction stakeholders to find out the barriers of constructability implementation in building projects via giving more details on application of CCAs among different IVs.

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Evidence based practice (EBP) has been accepted as a process to assist health professionals in clinical decision making to improve patient outcomes. It requires applying skills in a prescribed sequence to critique existing practices. Many countries, including Australia, require nurses to demonstrate competencies in EBP skills to be registered. In the last ten years, this has lead to universities incorporating EBP in undergraduate nursing degree courses. The literature reports many challenges including students’ difficulties in critically appraising research evidence, and their need for both simplification of the process and extensive support. The purpose of our study was to investigate the effectiveness of a standalone introductory EBP subject for a diverse group of third-year undergraduates, based on a novel but challenging approach to assessment. Despite many changes made in the second iteration of the subject, most students’ perceptions of the subject’s difficulty remained unchanged. This research aligns with the issues identified in the literature and has wider applicability to the teaching of rapidly changing disciplines, where evidence-driven consumers have easy access to information and expect up-to-date practices.

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In recent years there has been a rapid growth in the International Baccalaureate Diploma(IBD), a secondary curriculum administered by the International Baccalaureate Organisation(IBO), as an alternative to the local curriculum in Australian schools in some schools. This growth is indicative of an increasing demand from Australian families for new educational structures, practices and processes. With more curriculum options and pathways such as the IBD available in the secondary education system, parents are faced with a more complex high stakes decision when it comes to choosing the optimal education path for their offspring, one which requires a careful assessment of potential outcomes and risks. This paper reports on the responses of 184 parents to an online survey conducted in 26 Australian schools that offer the IBD as a curricular alternative. It examines which parents either chose, or chose not to, enrol their children in the program, why, and what risks they perceived to be associated with that choice. The paper will compare the choice behaviour of the two groups of parents from a sociological perspective, framing the enquiry with reference to globalisation and neo-liberal education policy and its effect on parental choice of schooling. This paper will make evident how parental choice of educational alternatives has become a more complicated process for Australian families.

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Automobiles have deeply impacted the way in which we travel but they have also contributed to many deaths and injury due to crashes. A number of reasons for these crashes have been pointed out by researchers. Inexperience has been identified as a contributing factor to road crashes. Driver’s driving abilities also play a vital role in judging the road environment and reacting in-time to avoid any possible collision. Therefore driver’s perceptual and motor skills remain the key factors impacting on road safety. Our failure to understand what is really important for learners, in terms of competent driving, is one of the many challenges for building better training programs. Driver training is one of the interventions aimed at decreasing the number of crashes that involve young drivers. Currently, there is a need to develop comprehensive driver evaluation system that benefits from the advances in Driver Assistance Systems. A multidisciplinary approach is necessary to explain how driving abilities evolves with on-road driving experience. To our knowledge, driver assistance systems have never been comprehensively used in a driver training context to assess the safety aspect of driving. The aim and novelty of this thesis is to develop and evaluate an Intelligent Driver Training System (IDTS) as an automated assessment tool that will help drivers and their trainers to comprehensively view complex driving manoeuvres and potentially provide effective feedback by post processing the data recorded during driving. This system is designed to help driver trainers to accurately evaluate driver performance and has the potential to provide valuable feedback to the drivers. Since driving is dependent on fuzzy inputs from the driver (i.e. approximate distance calculation from the other vehicles, approximate assumption of the other vehicle speed), it is necessary that the evaluation system is based on criteria and rules that handles uncertain and fuzzy characteristics of the driving tasks. Therefore, the proposed IDTS utilizes fuzzy set theory for the assessment of driver performance. The proposed research program focuses on integrating the multi-sensory information acquired from the vehicle, driver and environment to assess driving competencies. After information acquisition, the current research focuses on automated segmentation of the selected manoeuvres from the driving scenario. This leads to the creation of a model that determines a “competency” criterion through the driving performance protocol used by driver trainers (i.e. expert knowledge) to assess drivers. This is achieved by comprehensively evaluating and assessing the data stream acquired from multiple in-vehicle sensors using fuzzy rules and classifying the driving manoeuvres (i.e. overtake, lane change, T-crossing and turn) between low and high competency. The fuzzy rules use parameters such as following distance, gaze depth and scan area, distance with respect to lanes and excessive acceleration or braking during the manoeuvres to assess competency. These rules that identify driving competency were initially designed with the help of expert’s knowledge (i.e. driver trainers). In-order to fine tune these rules and the parameters that define these rules, a driving experiment was conducted to identify the empirical differences between novice and experienced drivers. The results from the driving experiment indicated that significant differences existed between novice and experienced driver, in terms of their gaze pattern and duration, speed, stop time at the T-crossing, lane keeping and the time spent in lanes while performing the selected manoeuvres. These differences were used to refine the fuzzy membership functions and rules that govern the assessments of the driving tasks. Next, this research focused on providing an integrated visual assessment interface to both driver trainers and their trainees. By providing a rich set of interactive graphical interfaces, displaying information about the driving tasks, Intelligent Driver Training System (IDTS) visualisation module has the potential to give empirical feedback to its users. Lastly, the validation of the IDTS system’s assessment was conducted by comparing IDTS objective assessments, for the driving experiment, with the subjective assessments of the driver trainers for particular manoeuvres. Results show that not only IDTS was able to match the subjective assessments made by driver trainers during the driving experiment but also identified some additional driving manoeuvres performed in low competency that were not identified by the driver trainers due to increased mental workload of trainers when assessing multiple variables that constitute driving. The validation of IDTS emphasized the need for an automated assessment tool that can segment the manoeuvres from the driving scenario, further investigate the variables within that manoeuvre to determine the manoeuvre’s competency and provide integrated visualisation regarding the manoeuvre to its users (i.e. trainers and trainees). Through analysis and validation it was shown that IDTS is a useful assistance tool for driver trainers to empirically assess and potentially provide feedback regarding the manoeuvres undertaken by the drivers.

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The emergence of ePortfolios is relatively recent in the university sector as a way to engage students in their learning and assessment, and to produce records of their accomplishments. An ePortfolio is an online tool that students can utilise to record, catalogue, retrieve and present reflections and artefacts that support and demonstrate the development of graduate students’ capabilities and professional standards across university courses. The ePortfolio is therefore considered as both process and product. Although ePortfolios show promise as a useful tool and their uptake has grown, they are not yet a mainstream higher education technology. To date, the emphasis has been on investigating their potential to support the multiple purposes of learning, assessment and employability, but less is known about whether and how students engage with ePortfolios in the university setting. This thesis investigates student engagement with an ePortfolio in one university. As the educational designer for the ePortfolio project at the University, I was uniquely positioned as a researching professional to undertake an inquiry into whether students were engaging with the ePortfolio. The participants in this study were a cohort (defined by enrolment in a unit of study) of second and third year education students (n=105) enrolled in a four year Bachelor of Education degree. The students were introduced to the ePortfolio in an introductory lecture and a hands-on workshop in a computer laboratory. They were subsequently required to complete a compulsory assessment task – a critical reflection - using the ePortfolio. Following that, engagement with the ePortfolio was voluntary. A single case study approach arising from an interpretivist paradigm directed the methodological approach and research design for this study. The study investigated the participants’ own accounts of their experiences with the ePortfolio, including how and when they engaged with the ePortfolio and the factors that impacted on their engagement. Data collection methods consisted of an attitude survey, student interviews, document collection, a researcher reflective journal and researcher observations. The findings of the study show that, while the students were encouraged to use the ePortfolio as a learning and employability tool, most students ultimately chose to disengage after completing the assessment task. Only six of the forty-five students (13%) who completed the research survey had used the ePortfolio in a sustained manner. The data obtained from the students during this research has provided insight into reasons why they disengaged from the ePortfolio. The findings add to the understandings and descriptions of student engagement with technology, and more broadly, advance the understanding of ePortfolios. These findings also contribute to the interdisciplinary field of technology implementation. There are three key outcomes from this study, a model of student engagement with technology, a set of criteria for the design of an ePortfolio, and a set of recommendations for effective practice for those implementing ePortfolios. The first, the Model of Student Engagement with Technology (MSET) (Version 2) explored student engagement with technology by highlighting key engagement decision points for students The model was initially conceptualised by building on work of previous research (Version 1), however, following data analysis a new model emerged, MSET (Version 2). The engagement decision points were identified as: • Prior Knowledge and Experience, leading to imagined usefulness and imagined ease of use; • Initial Supported Engagement, leading to supported experience of usefulness and supported ease of use; • Initial Independent Engagement, leading to actual experience of independent usefulness and actual ease of use; and • Ongoing Independent Engagement, leading to ongoing experience of usefulness and ongoing ease of use. The Model of Student Engagement with Technology (MSET) goes beyond numerical figures of usage to demonstrate student engagement with an ePortfolio. The explanatory power of the model is based on the identification of the types of decisions that students make and when they make them during the engagement process. This model presents a greater depth of understanding student engagement than was previously available and has implications for the direction and timing of future implementation, and academic and student development activities. The second key outcome from this study is a set of criteria for the re-conceptualisation of the University ePortfolio. The knowledge gained from this research has resulted in a new set of design criteria that focus on the student actions of writing reflections and adding artefacts. The process of using the ePortfolio is reconceptualised in terms of privileging student learning over administrative compliance. The focus of the ePortfolio is that the writing of critical reflections is the key function, not the selection of capabilities. The third key outcome from this research consists of five recommendations for university practice that have arisen from this study. They are that, sustainable implementation is more often achieved through small steps building on one another; that a clear definition of the purpose of an ePortfolio is crucial for students and staff; that ePortfolio pedagogy should be the driving force not the technology; that the merit of the ePortfolio is fostered in students and staff; and finally, that supporting delayed task performance is crucial. Students do not adopt an ePortfolio just because it is provided. While students must accept responsibility for their own engagement with the ePortfolio, the institution has to accept responsibility for providing the environment, and technical and pedagogical support to foster engagement. Ultimately, an ePortfolio should be considered as a joint venture between student and institution where strong returns on investment can be realised by both. It is acknowledged that the current implementation strategies for the ePortfolio are just the beginning of a much longer process. The real rewards for students, academics and the university lie in the future.

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Developments in school education in Australia over the past decade have witnessed the rise of national efforts to reform curriculum, assessment and reporting. Constitutionally the power to decide on curriculum matters still resides with the States. Higher stakes in assessment, brought about by national testing and international comparative analyses of student achievement data, have challenged State efforts to maintain the emphasis on assessment to promote learning while fulfilling accountability demands. In this article lessons from the Queensland experience indicate that it is important to build teachers' assessment capacity and their assessment literacy for the promotion of student learning. It is argued that teacher assessment can be a source of dependable results through moderation practice. The Queensland Studies Authority has recognised and supported the development of teacher assessment and moderation practice in the context of standards-driven, national reform. Recent research findings explain how the focus on learning can be maintained by avoiding an over-interpretation of test results in terms of innate ability and limitations and by encouraging teachers to adopt more tailored diagnosis of assessment data to address equity through focus on achievement for all. Such efforts are challenged as political pressures related to the Australian government’s implementation of national testing and national partnership funding arrangements tied to the performance of students at or below minimum standards become increasingly apparent.

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Attending potentially dangerous and traumatic incidents is inherent in the role of emergency workers, yet there is a paucity of literature aimed at examining variables that impact on the outcomes of such exposure. Coping has been implicated in adjusting to trauma in other contexts, and this study explored the effectiveness of coping strategies in relation to positive and negative posttrauma outcomes in the emergency services environment. One hundred twenty-five paramedics completed a survey battery including the Posttraumatic Growth Inventory (PTGI; Tedeschi & Calhoun, 1996), the Impact of Events Scale–Revised (IES-R; Weiss & Marmar, 1997), and the Revised-COPE (Zuckerman & Gagne, 2003). Results from the regression analysis demonstrated that specific coping strategies were differentially associated with positive and negative posttrauma outcomes. The research contributes to a more comprehensive understanding regarding the effectiveness of coping strategies employed by paramedics in managing trauma, with implications for their psychological well-being as well as the training and support services available.

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Purpose: To examine the relationship between visual impairment and functional status in a community-dwelling sample of older adults with glaucoma. Methods: This study included 74 community-dwelling older adults with open-angle glaucoma (aged 74 ± 6 years). Assessment of central vision included high-contrast visual acuity and Pelli-Robson contrast sensitivity. Binocular integrated visual fields were derived from merged monocular Humphrey Field Analyser visual field plots. Functional status outcome measures included physical performance tests (6-min walk test, timed up and go test and lower limb strength), a physical activity questionnaire (Physical Activity Scale for the Elderly) and an overall functional status score. Correlation and linear regression analyses, adjusting for age and gender, examined the association between visual impairment and functional status outcomes. Results: Greater levels of visual impairment were significantly associated with lower levels of functional status among community-dwelling older adults with glaucoma, independent of age and gender. Specifically, lower levels of visual function were associated with slower timed up and go performance, weaker lower limb strength, lower self-reported physical activity, and lower overall functional status scores. Of the components of vision examined, the inferior visual field and contrast factors were the strongest predictors of these functional outcomes, whereas the superior visual field factor was not related to functional status. Conclusions: Greater visual impairment, particularly in the inferior visual field and loss of contrast sensitivity, was associated with poorer functional status among older adults with glaucoma. The findings of this study highlight the potential links between visual impairment and the onset of functional decline. Interventions which promote physical activity among older adults with glaucoma may assist in preventing functional decline, frailty and falls, and improve overall health and well-being.