965 resultados para Rural health services--United States


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The speech is a response by Hon. James H. Hammond as to whether or not the territorial governments established by Congress have the power to define and declare what shall be and what shall not be property within the territorial boundaries. The speech goes on to discuss colonists who went to newly purchased territory and claimed land as their own. He argues whether or not these people have sovereignty of the land over the government.

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This speech is to address the statement that Mr. McLaurin has been excluded from the caucuses of his party and thus that he will be without assignment on any committee. He goes on to explain his exclusion and defend his views that led to his exclusion.

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The speech addresses the question, how can the union be preserved? He goes on to explain the threats to the union and give suggestions for how the threats can be handled.

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This speech was given when the United States Senate was considering a bill to authorize the free coinage of the standard silver dollar and to restore its legal tender character. Mr. Bayard argues against the bill in this speech. He is interrupted during his speech multiple times and questioned about his points.

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The study of knowledge transfer (KT) has been proceeding in parallel but independently in health services and in business, presenting an opportunity for synergy and sharing. This paper uses a survey of 32 empirical KT studies with their 96 uniquely named determinants of KT success to identify ten unique determinants for horizontal knowledge transfer success. These determinants, the outcome measure of Knowledge Use, and separate explicit and tacit transfer flows constitute the KT Framework, extending the work of previous KT framework authors. Our Framework was validated through a case study of the transfer of clinical practice guideline knowledge between the cardiac teams of selected Ontario hospitals, using a survey of senders and receivers developed from the KT literature. The study findings were: 8 of 10 determinants were supported by the Successful Transfer Hospitals; and 4 of 10 determinants were found to a higher degree in the Successful than non-Successful transfer hospitals. Taken together, the results show substantive support for the KT Framework determinants, indicating aggregate support of 9 of these determinants, but not the 10th - Knowledge Complexity. The transfer of tacit knowledge was found to be related to the transfer of the explicit knowledge and expressed as the transfer or recreation of resource profile and internal process tacit knowledge, where this tacit transfer did not require interactions between Sender and Receiver. This study provides managers with the building blocks to assess and improve the success rates of their knowledge transfers.

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To what extent are democratic institutions resilient when nation states mobilise for war? Normative and empirical political theorists have long argued that wars strengthen the executive and threaten constitutional politics. In modern democracies, national assemblies are supposed to hold the executive to account by demanding explanations for events and policies; and by scrutinising, reviewing and, if necessary, revising legislative proposals intended to be binding on the host society or policies that have been implemented already. This article examines the extent to which the British and Australian parliaments and the United States Congress held their wartime executives to account during World War II. The research finds that under conditions approaching those of total war, these democratic institutions not only continued to exist, but also proved to be resilient in representing public concerns and holding their executives to account, however imperfectly and notwithstanding delegating huge powers. In consequence, executives—more so British and Australian ministers than President Roosevelt—were required to be placatory as institutional and political tensions within national assemblies and between assemblies and executives continued, and assemblies often asserted themselves. In short, even under the most onerous wartime conditions, democratic politics mattered and democratic institutions were resilient.

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This paper aims at putting into perspective the recent, post 9/11 debate on the United States‘ alleged exceptionalism and its impact on the definition of American foreign policy. It reminds the readers that the United States was born as a result of a similar debate, at a time when a crucial choice for its future was to be made. Indeed, the Founding Fathers discarded the revolutionary idea that America was altogether different from other (European) nations and, as such, could succeed in saving republicanism and concentrate on domestic affairs. As Gordon Wood and Harvey Mansfield have shown, the 1787 version of republicanism stood as a departure from its earlier version, and such a change was necessary to the creation of a full-fledged federation, therefore paving the way to the current powerful Federal Republic. The early failure of the exceptionalist creed did not cause its disappearance, as the contemporary form of exceptionalism demonstrates, but created conditions that made an enduring and powerful influence very difficult.

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RESUMO: A Nigéria tem uma população estimada em cerca de 170 milhões de pessoas. O número de profissionais de saúde mental é muito diminuto, contando apenas com 150 psiquiatras o que perfaz aproximadamente um rácio de psiquiatra: população de mais de 1:1 milhão de pessoas. O Plano Nacional de Saúde Mental de 1991 reconheceu esta insuficiência e recomendou a integração dos serviços de saúde mental nos cuidados de saúde primários (CSP). Depois de mais de duas décadas, essa política não foi ainda implementada. Este estudo teve como objetivos mapear a estrutura organizacional dos serviços de saúde mental da Nigéria, e explorar os desafios e barreiras que impedem a integração bem-sucedida dos serviços de saúde mental nos cuidados de saúde primários, isto segundo a perspectiva dos profissionais dos cuidados de saúde primários. Com este objetivo, desenvolveu-se um estudo exploratório sequencial e utilizou-se um modelo misto para a recolha de dados. A aplicação em simultâneo de abordagens qualitativas e quantitativas permitiram compreender os problemas relacionados com a integração dos serviços de saúde mental nos CSP na Nigéria. No estudo qualitativo inicial, foram realizadas entrevistas com listagens abertas a 30 profissionais dos CSP, seguidas de dois grupos focais com profissionais dos CSP de duas zonas governamentais do estado de Oyo de forma a obter uma visão global das perspectivas destes profissionais locais sobre os desafios e barreiras que impedem uma integração bem-sucedida dos serviços de saúde mental nos CSP. Subsequentemente, foram realizadas entrevistas com quatro pessoas-chave, especificamente coordenadores e especialistas em saúde mental. Os resultados do estudo qualitativo foram utilizados para desenvolver um questionário para análise quantitativa das opiniões de uma amostra maior e mais representativa dos profissionais dos CSP do Estado de Oyo, bem como de duas zonas governamentais locais do Estado de Osun. As barreiras mais comummente identificadas a partir deste estudo incluem o estigma e os preconceitos sobre a doença mental, a formação inadequada dos profissionais dos CPS sobre saúde mental, a perceção pela equipa dos CSP de baixa prioridade de ação do Governo, o medo da agressão e violência pela equipa dos CSP, bem como a falta de disponibilidade de fármacos. As recomendações para superar estes desafios incluem a melhoria sustentada dos esforços da advocacia à saúde mental que vise uma maior valorização e apoio governamental, a formação e treino organizados dos profissionais dos cuidados primários, a criação de redes de referência e de apoio com instituições terciárias adjacentes, e o engajamento da comunidade para melhorar o acesso aos serviços e à reabilitação, pelas pessoas com doença mental. Estes resultados fornecem indicações úteis sobre a perceção das barreiras para a integração bem sucedida dos serviços de saúde mental nos CSP, enquanto se recomenda uma abordagem holística e abrangente. Esta informação pode orientar as futuras tentativas de implementação da integração dos serviços de saúde mental nos cuidados primários na Nigéria.------------ABSTRACT: Nigeria has an estimated population of about 170 million people but the number of mental health professionals is very small, with about 150 psychiatrists. This roughly translates to a psychiatrist:population ratio of more than 1:1 million people. The National Mental Health Policy of 1991 recognized this deficiency and recommended the integration of mental health into primary health care (PHC) delivery system. After more than two decades, this policy has yet to be implemented. This study aimed to map out the organizational structure of the mental health systems in Nigeria, and to explore the challenges and barriers preventing the successful integration of mental health into primary health care, from the perspective of the primary health care workers. A mixed methods exploratory sequential study design was employed, which entails the use of sequential timing in the combined methods of data collection. A combination of qualitative and uantitative approaches in sequence, were utilized to understand the problems of mental health services integration into PHC in Nigeria. The initial qualitative phase utilized free listing interviews with 30 PHC workers, followed by two focus group discussions with primary care workers from two Local Government Areas (LGA) of Oyo State to gain useful insight into the local perspectives of PHC workers about the challenges and barriers preventing successful integration of mental health care services into PHC. Subsequently, 4 key informant interviews with PHC co-ordinators and mental health experts were carried out. The findings from the qualitative study were utilized to develop a quantitative study questionnaire to understand the opinions of a larger and more representative sample of PHC staff in two more LGAs of Oyo State, as well as 2 LGAs from Osun State. The common barriers identified from this study include stigma and misconceptions about mental illness, inadequate training of PHC staff about mental health, low government priority, fear of aggression and violence by the PHC staff, as well as non-availability of medications. Recommendations for overcoming these challenges include improved and sustained efforts at mental health advocacy to gain governmental attention and support, organized training and retraining for primary care staff, establishment of referral and supportive networks with neighbouring tertiary facilities and community engagement to improve service utilization and rehabilitation of mentally ill persons. These findings provide useful insight into the barriers to the successful integration of mental health into PHC, while recommending a holistic and comprehensive approach. This information can guide future attempts to implement the integration of mental health into primary care in Nigeria.

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ABSTRACT: Background: Childhood is a critical time for social and emotional development, educational progress and mental health prevention. Mental health for children and adolescents is defined by the achievement of expected developmental, cognitive, social and emotional skills. The development of child-adolescent mental health services (CAMHS) is a necessity for each country, not only as a prevention measure for the wellbeing of people, but also as an investment to the future of countries. Qualitative evaluation of services is the only way to ensure whether services function under quality standards and increase the possibility of better outcomes for their patients. This study examines the greek outpatient CAMHS against the British Standards of National Institute of Excellence for community CAMHS. The Standards assessed refer to the areas of Assessment, Care and Intervention. Objectives: The main objectives of the study are 1) to evaluate Greek outpatient CAMHS in the Attica region 2) to promote the evaluation process for mental health services in Greece. Methods: Due to the fact that Greek services are based on the British model, the tool used was the British self-review questionnaire of Quality Network for Community CAMHS(QNCC).The tool was translated, adapted and posted to services. Twelve out of twenty outpatient CAMHS of Attica (including Athens) responded. Data was collected and performed by the Statistical Package for Social Sciences SPSS. Results: The study resulted that the CAMHS examined, meet moderately the British Standards of 1) Referral and Access, 2) Assessment & Care planning, 3) Care & Intervention. Two out of twelve services examined, meet the standards of "Assessment and Care" in a higher percentage between 75% and 100%. Conclusions: The paper describes a satisfactory function of CAMHS in Attica prefecture taking into consideration the extremely difficult political situation of Greece at the time of the research. Strong and weak domains are identified. Also the translation and adaptation of British tools promote the evaluation process and quality assurance of Greek CAMHS.

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We find that leverage behavior both in level and time-series variation is very similar between the United States and Europe throughout the 1990-2013 period. Leverage regimes are simultaneously unstable and persistent for both regions. We define instability as the extent to which firms largely deviate from their long-term leverage mean, while persistence as the extent to which today’s leverage influences its future levels. We then show that this simultaneous evidence imply a mean-reversion behavior of leverage and discuss some of its implications for future research on this field.

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This Work Project clarifies the relationship between liquidity and profitability based on a sample in the Food & Beverage (F&B) industry, and comparing the largest European and United States companies. The research concludes that liquidity, proxied by current ratio or quick ratio, correlates with return on assets taken as the measure of profitability, and so does the cash conversion cycle and its components. Moreover, company size correlates with liquidity, and indirectly affects ROA. This research contributes and addresses to managers in the F&B industry and recommends how they should act in order to improve profitability in the industry.

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Référence bibliographique : Rol, 58592

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The drumlin sediments at Chimney Bluffs, New York appear to represent a block-inmatrix style glacial melange. This melange comprises sand stringers, lenses and intraclasts juxtaposed in an apparently massive diamicton. Thin section examination of these glacigenic deposits has revealed microstructures indicative of autokinetic subglacial defonnation which are consistent with a deformable bed origin for the diamicton. These features include banding and. necking of matrix grains, oriented plasma fabrics and the formation of pressure shadows at the long axis ends of elongate clasts. Preservation of primary stratification within the sand intraclasts appears to suggest that these features were pre-existing up-ice deposits that were frozen, entrained, then deposited as part of a defonning till layer beneath an advancing ice sheet. Multi-directional micro-shearing within the sand blocks is thought to reflect the frozen nature of the sand units in such a high strain environment. It is also contended that dewatering of the sediment pile leading to the eventual immobilisation of the defonning till layer was responsible for opening sub-horizontal fissures within the diamicton. These features were subsequently infilled with mass flow poorly sorted sands and silts which were subjected to ductile defonnation during the waning stages of an actively deforming till layer. Microstructures indicative of the dewatering processes in the sand units include patches of fine-grained particles within a coarser-grained matrix and the presence of concentrated zones of translocated clays. However, these units were probably confined within an impermeable diamicton casing that prevented massive pore water influxes from the deforming till layer~ Hence, these microstructures probably reflect localised dewatering of the sand intraclasts. A layered subglacial shear zone model is proposed for the various features exhibited by the drumlin sediments. The complexity of these structures is explained in terms of ii superposing deformation styles in response to changing pore water pressures. Constructional glaciotectonics, as implied by the occurrence of sub-horizontal fissuring, is suggested as the mechanism for the stacking of the sand intraclast units within the diamicton. The usefulness of micromorphology in complimenting the traditional sedimentology of glacigenic deposits is emphasised by the current study. An otherwise massive diamicton was shown to contain microstructures indicative of the very high strain rates expected in a complexly deforming till layer. . It is quite obvious from this investigation that the classification of diamictons needs to be re-examined for evidence of microstructures that could lead to the re-interpretation of diamicton forming processes. RESUME Le pacquet de sediments drumlinaire de Chimney Bluffs, New York, represent un "bloc-en-matrice" genre de melange glaciale. Des structures microscopique comprennent l'evidence pour la defonnation intrinseque attribuee a l'origine lit non resistant du drumlin. PreselVation des structures primaires au coeur des blocs arenaces suggere que ceux sont des depots preexistant qui furent geles, entraines et par la suite sedimentes au milieu d'une couche de debris sous-glaciaires en voie de deformation. Des failles microscopiques a l'interieur des blocs arenaces appuient aussi l'idee d'un bloc cohesif (c'est-a-dire gele) au centre d'un till non resistant. Des implications significatives s'emergent de cette etude pour les conditions sous-glaciaire et les processus de la formation des drumlin.