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Competing Demands (competing + demand)
Selected AbstractsOvercoming Fears, Frustrations, and Competing Demands: An Effective Integration of Pain Medicine and Primary Care to Treat Complex Pain PatientsPAIN MEDICINE, Issue 7 2007Matthew J. Bair MD No abstract is available for this article. [source] Targeted health insurance in a low income country and its impact on access and equity in access: Egypt's school health insuranceHEALTH ECONOMICS, Issue 3 2001Winnie Yip Abstract Governments are constantly faced with competing demands for public funds, thereby necessitating careful use of scarce resources. In Egypt, the School Health Insurance Programme (SHIP) is a government subsidized health insurance system that targets school children. The primary goals of the SHIP include improving access and equity in access to health care for children while, at the same time, ensuring programme sustainability. Using the Egyptian Household Health Utilization and Expenditure Survey (1995), this paper empirically assesses the extent to which the SHIP achieves its stated goals. Our findings show that the SHIP significantly improved access by increasing visit rates and reducing financial burden of use (out-of-pocket expenditures). With regard to the success of targeting the poor, conditional upon being covered, the SHIP reduced the differentials in visit rates between the highest and lowest income children. However, only the middle-income children benefitted from reduced financial burden (within group equity). Moreover, by targeting the children through school enrollment, the SHIP increased the differentials in the average level of access between school-going children and those not attending school (overall equity). Children not attending school tend to be poor and living in rural areas. Our results also indicate that original calculations may underestimate the SHIP financial outlays, thereby threatening the long run financial sustainability of the programme. Copyright © 2001 John Wiley & Sons, Ltd. [source] A qualitative exploration of communication within the community mental health teamINTERNATIONAL JOURNAL OF MENTAL HEALTH NURSING, Issue 5 2009Jenny Donnison ABSTRACT:, This qualitative study sought to explore conceptual models employed by community mental health team (CMHT) staff in the care of their clients and how CMHT clinicians communicated with one another, particularly in relation to complex clinical work. The qualitative method of interpretive phenomenological analysis was used, and semistructured in-depth interviews with seven UK CMHT clinicians were conducted and analyzed. Four themes were evident in the data and showed that clinicians face complex and competing demands and draw on a range of therapeutic models in their work. It was also clear that much discussion centred primarily on pragmatic issues and lacked conceptual depth. The results underline the complex and challenging nature of CMHT work and suggest that a more systematic approach to interdisciplinary training within teams could be beneficial in increasing clinicians' knowledge, skills, and their understanding of the conceptual models used across different disciplines. [source] A phenomenological exploration of the lived experience of mental health nurses who care for clients with enduring mental health problems who are parentsJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 8 2010S. MADDOCKS mnurssci rn Accessible summary ,,Among people with mental health problems, those who are parents may not have their needs met, especially when receiving inpatient care. ,,There is little research regarding the needs of this group. ,,An integrated model of care is required. Abstract This paper is a report of a study to explore mental health nurses' lived experience of caring for adults with enduring mental health problems who are parents. With the advent of community care, more people with enduring mental health problems have contact with their families and are parents. Ultimately, rehabilitative strategies for parents with mental health problems are focused towards functioning effectively within their own family unit and hopefully enabling them to fulfil their parental role. Mental health nurses working with this client group have competing demands to reconcile. For example, advocating for client rights versus protecting the child and supporting the family. This phenomenological study took place within adult mental health services in the UK. Semi-structured interviews were conducted with six nurses. A thematic analysis was conducted on the data. Five themes were identified from the data: support, remaining impartial, addressing the specific needs of a client who is a parent, models of care and interagency communication. The findings suggest that neither a family-centred nor a person-centred approach to care completely meets the needs of this client group. An integrated model of care is proposed that applies person-centred and family-centred approaches in tandem. [source] The relative effects and equity of inquiry-based and commonplace science teaching on students' knowledge, reasoning, and argumentationJOURNAL OF RESEARCH IN SCIENCE TEACHING, Issue 3 2010Christopher D. Wilson Abstract We conducted a laboratory-based randomized control study to examine the effectiveness of inquiry-based instruction. We also disaggregated the data by student demographic variables to examine if inquiry can provide equitable opportunities to learn. Fifty-eight students aged 14,16 years old were randomly assigned to one of two groups. Both groups of students were taught toward the same learning goals by the same teacher, with one group being taught from inquiry-based materials organized around the BSCS 5E Instructional Model, and the other from materials organized around commonplace teaching strategies as defined by national teacher survey data. Students in the inquiry-based group reached significantly higher levels of achievement than students experiencing commonplace instruction. This effect was consistent across a range of learning goals (knowledge, reasoning, and argumentation) and time frames (immediately following the instruction and 4 weeks later). The commonplace science instruction resulted in a detectable achievement gap by race, whereas the inquiry-based materials instruction did not. We discuss the implications of these findings for the body of evidence on the effectiveness of teaching science as inquiry; the role of instructional models and curriculum materials in science teaching; addressing achievement gaps; and the competing demands of reform and accountability. © 2009 Wiley Periodicals, Inc. J Res Sci Teach 47:276,301, 2010 [source] Sexual segregation in western grey kangaroos: testing alternative evolutionary hypothesesJOURNAL OF ZOOLOGY, Issue 2 2007A. M. MacFarlane Abstract In sexually dimorphic ungulates, sexual segregation is hypothesized to have evolved because of sex-specific differences in body size and/or reproductive strategies. We tested these alternative hypotheses in kangaroos, which are ecological analogues of ungulates. Kangaroos exhibit a wide range of body sizes, particularly among mature males, and so the effects of body size and sex can be distinguished. We tested predictions derived from these hypotheses by comparing the distribution of three sex,sex size classes of western grey kangaroos Macropus fuliginosus, in different habitats, and the composition of groups of kangaroos, across seasons. In accordance with the predation risk-reproductive strategy hypothesis, during the non-breeding season, females, which were more susceptible to predation than larger males, and were accompanied by vulnerable young-at-foot, were over-represented in secure habitats. Large males, which were essentially immune to predation, occurred more often than expected in nutrient-rich habitat, and small males, which faced competing demands of predator avoidance and feeding, were intermediate between females and large males in their distribution across habitats. During the breeding season, females continued to be over-represented in secure habitats when their newly emerged pouch young were most vulnerable to predation. All males occupied these same habitats to maximize their chances of securing mates. Consistent with the social hypotheses, groups composed of individuals of the same sex, irrespective of body size, were over-represented in the population during the non-breeding season, while during the breeding season all males sought females so that mixed-sex groups predominated. These results indicate that body size and reproductive strategies are both important, yet independent, factors influencing segregation in western grey kangaroos. [source] Moral knowledge and responsibilities in evaluation implementation: When critical theory and responsive evaluation collideNEW DIRECTIONS FOR EVALUATION, Issue 127 2010Melissa Freeman An external evaluation documented what occurred in an inaugural summer camp to teach high school students how to preserve religious freedom by learning about and acting on the history and current state of church,state separation and other first amendment issues. Camp designers hoped to promote religious diversity values and civic engagement in youth. An analytic vignette grounded in an inductive analysis of observations, interviews, and document collection represents the competing demands of responsive and critical approaches to evaluation. Balancing obligations to promote the social well-being of society with responsibilities to clients and other stakeholders presents challenges that can be met only by identifying priorities with clients in ongoing dialogue. © Wiley Periodicals, Inc., and the American Evaluation Association. [source] The ecology and evolutionary endocrinology of reproduction in the human femaleAMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY, Issue S49 2009Virginia J. Vitzthum Abstract Human reproductive ecology (HRE) is the study of the mechanisms that link variation in reproductive traits with variation in local habitats. Empirical and theoretical contributions from biological anthropology, physiology, and demography have established the foundation necessary for developing a comprehensive understanding, grounded in life history theory (LHT), of temporal, individual, and populational variation in women's reproductive functioning. LHT posits that natural selection leads to the evolution of mechanisms that tend to allocate resources to the competing demands of growth, reproduction, and survival such that fitness is locally maximized. (That is, among alternative allocation patterns exhibited in a population, those having the highest inclusive fitness will become more common over generational time.) Hence, strategic modulation of reproductive effort is potentially adaptive because investment in a new conception may risk one's own survival, future reproductive opportunities, and/or current offspring survival. The hypothalamic-pituitary-ovarian (HPO) axis is the principal neuroendocrine pathway by which the human female modulates reproductive functioning according to the changing conditions in her habitat. Adjustments of reproductive investment in a potential conception are manifested in temporal and individual variation in ovarian cycle length, ovulation, hormone levels, and the probability of conception. Understanding the extent and causes of adaptive and non-adaptive variation in ovarian functioning is fundamental to ascertaining the proximate and remote determinants of human reproductive patterns. In this review I consider what is known and what still needs to be learned of the ecology of women's reproductive biology, beginning with a discussion of the principal explanatory frameworks in HRE and the biometry of ovarian functioning. Turning next to empirical studies, it is evident that marked variation between cycles, women, and populations is the norm rather than an aberration. Other than woman's age, the determinants of these differences are not well characterized, although developmental conditions, dietary practices, genetic variation, and epigenetic mechanisms have all been hypothesized to play some role. It is also evident that the reproductive functioning of women born and living in arduous conditions is not analogous to that of athletes, dieters, or even the lower end of the "normal range" of HPO functioning in wealthier populations. Contrary to the presumption that humans have low fecundity and an inefficient reproductive system, both theory and present evidence suggest that we may actually have very high fecundity and a reproductive system that has evolved to be flexible, ruthlessly efficient and, most importantly, strategic. Yrbk Phys Anthropol 52:95,136, 2009. © 2009 Wiley-Liss, Inc. [source] THE CROSS-CULTURAL IMPORTANCE OF SATISFYING VITAL NEEDSBIOETHICS, Issue 9 2009ALLEN ANDREW A. ALVAREZ ABSTRACT Ethical beliefs may vary across cultures but there are things that must be valued as preconditions to any cultural practice. Physical and mental abilities vital to believing, valuing and practising a culture are such preconditions and it is always important to protect them. If one is to practise a distinct culture, she must at least have these basic abilities. Access to basic healthcare is one way to ensure that vital abilities are protected. John Rawls argued that access to all-purpose primary goods must be ensured. Amartya Sen and Martha Nussbaum claim that universal capabilities are what resources are meant to enable. Len Doyal and Ian Gough identify physical health and autonomy as basic needs of every person in every culture. When we disagree on what to prioritize, when resources to satisfy competing demands are scarce, our common needs can provide a point of normative convergence. Need-based rationing, however, has been criticized for being too indeterminate to give guidance for deciding which healthcare services to prioritize and for tending to create a bottomless-pit problem. But there is a difference between needing something (first-order need) and needing to have the ability to need (second-order need). Even if we disagree about which first-order need to prioritize, we must accept the importance of satisfying our second-order need to have the ability to value things. We all have a second-order need for basic healthcare as a means to protect our vital abilities even if we differ in what our cultures consider to be particular first-order needs. [source] The challenge of change: Canadian universities in the 21st centuryCANADIAN PUBLIC ADMINISTRATION/ADMINISTRATION PUBLIQUE DU CANADA, Issue 2 2002David M. Cameron It was a crisis of numbers, brought on by a rising participation rate and the postwar Baby Boom. The response, led initially by the federal government, was to enlarge the university system, and later the entire postsecondary sector, very rapidly through the 1950s and 1960s. In the process of rapid growth, universities changed dramatically, becoming much more democratic and laissez-faire in their management. Then came a prolonged period of restraint, as provincial governments regained a measure of control and the public became sceptical of the benefits accruing from rapidly rising expenditures in the face of tight fiscal circumstances and competing demands. University faculty attempted to secure their earlier gains through unionization and collective bargaining. The upshot, as was predicted, was that universities became much more rigid organizations, resistant to managed change, and focused on the self-interest of faculty members. We now confront a new and very different environment and face the challenges and opportunities associated with a knowledge-based economy, with its reliance on research and innovation, and its demand for a highly educated workforce. The federal government is using its new-found surpluses to invest heavily in university-based research and development. The challenge is whether universities, constrained by cumbersome and self-serving decision rules and procedures, now secured in union contracts, can respond appropriately to the new opportunities. Sommaire: Les universités ont connu une crise dans les années qui ont immédiatement suivi la guerre. C'était une crise d'éffectifs, cauée par un taux de fréquentation en hausse et par le baby-boom de l'après-guerre. La réaction initiale du gouvemement fédéral pendant les années 1950 et 1960, a été de développer très rapidement le système universitaire et plus tard tout le secteur post-secondaire. Au cours de cette croissance rapide, les universités ont changé considérablement, devenant plus democratiques et plus souples dans leur administration. Il y a eu ensuite une période de restriction prolongée, où les gouvemements provinciaux ont retrouvé un certain contrôle et le public devint sceptique au sujet des avantages découlant de dépenses croissantes pour faire face à une conjoncture de resserrement budgétaire et à une concurrence acharnée. Le corps professoral universitaire essaya de protéger les gains qu'il avait obtenus précédemment par la syndicalisation et la négotiation collective. Le résultat, comme cela était prévu, c'est que les universités sont devenues des organismes beaucoup plus rigides, résistants aux changements de gestion et axés sur l'intérêt personnel des membres du corps professoral. Nous nous trouvons aujourd'hui dans une conjoncture nouvelle et très différente. Nous devons maintenant relever les défis et tirer parti des possibilités que nous offre une économie axée sur le savoir, qui compte sur la recherche et l'innovation, et sur une main-d'æuvre hautement instruite. Le gouvernement fédéral se sert de ses surplus récents pour investir considérablement dam la recherche et le développement universitaires. Le défi est de savoir si les universités, assujetties à des régles et procédures difficiles à appliquer, intéressés, et protégées par les conventions syndicales, sauront tirer pleinement parti de nouvelles opportunités. [source] Assimilation, control, mediation or advocacy?CHILD & FAMILY SOCIAL WORK, Issue 4 2000Social work dilemmas in providing anti-oppressive services for Traveller children, families This paper explores dilemmas facing social work in England in providing anti-oppressive services for Travellers, particularly those who lack secure sites. A context is provided by outlining the conflict between Travellers and the majority society, and its expression in oppressive legislation, policy and practice. The implications of the corporate local authority role for relationships between Travellers and social services, and the specific history of Travellers and welfare, are also explored. The remainder of the paper draws on findings from a Nuffield-funded study of policy and provision by English social services departments for Traveller children and families. Provision is undermined by mutually difficult relationships between Traveller communities and social services, and competing demands on social services in relation to professional values and support of Travellers' rights, and their simultaneous contribution to local authority control of unauthorized camping. However, newer developments in some social services departments may be able to generate more positive relationships with Travellers, to promote their individual and cultural rights, and build partnerships with voluntary agencies which have a significant role in work with Travellers. The implications for social services departments wishing to develop their policies and practice with Traveller families are outlined. [source] | |||||||||||||||||||