Distribution by Scientific Domains

Kinds of Service

  • adolescent mental health service
  • advisory service
  • agricultural research service
  • ambulance service
  • and adolescent mental health service
  • area health service
  • assessment service
  • awareness service
  • care service
  • child and adolescent mental health service
  • civil service
  • clinical service
  • community service
  • consultation service
  • continence service
  • counselling service
  • current awareness service
  • customer service
  • day service
  • delivery service
  • dental service
  • diabetes service
  • disorders service
  • eating disorders service
  • ecosystem service
  • emergency medical service
  • emergency service
  • end-to-end quality of service
  • english national health service
  • field service
  • general packet radio service
  • genetics service
  • health service
  • healthcare service
  • hospital service
  • indian health service
  • information service
  • management service
  • medical service
  • medicine service
  • mental health service
  • messaging service
  • military service
  • national health service
  • national service
  • national weather service
  • new service
  • nurse practitioner service
  • nursing service
  • of service
  • outreach service
  • packet radio service
  • pain service
  • pharmacy service
  • police service
  • pollination service
  • practitioner service
  • probation service
  • psychiatric service
  • psychiatry service
  • psychosis service
  • public health service
  • public service
  • quality of service
  • quality service
  • radio service
  • rehabilitation service
  • research service
  • screening service
  • social service
  • specialist service
  • states public health service
  • support service
  • surgical service
  • telephone service
  • transplantation service
  • treatment service
  • uk national health service
  • united states public health service
  • universal service
  • weather service
  • wildlife service

  • Terms modified by Service

  • service access
  • service activity
  • service agencies
  • service agency
  • service announcement
  • service architecture
  • service area
  • service attendance
  • service attribute
  • service availability
  • service award
  • service businesses
  • service capacity
  • service centre
  • service channel
  • service class
  • service committee
  • service company
  • service component
  • service condition
  • service contact
  • service context
  • service contract
  • service control
  • service cost
  • service delivery
  • service delivery models
  • service delivery system
  • service department
  • service design
  • service development
  • service differentiation
  • service district
  • service economy
  • service effort
  • service element
  • service employee
  • service encounter
  • service environment
  • service evaluation
  • service facility
  • service failure
  • service firm
  • service framework
  • service frameworks
  • service function
  • service hospital
  • service implication
  • service improvement
  • service industry
  • service infrastructure
  • service innovation
  • service integration
  • service interruption
  • service issues
  • service learning
  • service level
  • service level agreement
  • service life
  • service management
  • service managers
  • service market
  • service member
  • service model
  • service models
  • service motivation
  • service need
  • service network
  • service obligation
  • service occupation
  • service offering
  • service organisation
  • service organization
  • service outcome
  • service performance
  • service personnel
  • service perspective
  • service planning
  • service policy
  • service process
  • service professional
  • service program
  • service project
  • service provider
  • service provision
  • service quality
  • service rate
  • service record
  • service recovery strategy
  • service region
  • service reliability
  • service representative
  • service requirement
  • service research
  • service response
  • service satisfaction
  • service sector
  • service selection
  • service setting
  • service site
  • service staff
  • service strategy
  • service structure
  • service system
  • service time
  • service time distribution
  • service trust
  • service type
  • service use
  • service user
  • service user involvement
  • service user participation
  • service utilisation
  • service utilization
  • service utilization pattern
  • service work
  • service worker

  • Selected Abstracts


    ECONOMIC INQUIRY, Issue 4 2010
    Montgomery GI Bill (MGIB) educational benefits are a prime recruiting tool in today's all-volunteer military. This paper studies the effects of changes in education benefits using data of the period 1990,2005. Higher benefits lead to higher separation due to both pure incentive effects and by attracting more college-oriented youth into military service. We deal with potential selection issues by distinguishing between anticipated and unanticipated benefit changes. Higher education benefits are associated with higher separation from the Army and Air Force, but not the other services. A $10,000 increase in MGIB benefits is estimated to increase usage by about 5 percentage points, but the duration of usage is estimated to be insensitive to benefit levels. (JEL H52, I21, J24) [source]


    Ryan Chiang MBChB
    No abstract is available for this article. [source]


    Terry Donovan DDS


    JOURNAL OF RENAL CARE, Issue 3 2009
    Vicki Hartig RN
    SUMMARY The buttonhole, or constant-site, cannulation technique, although used elsewhere, had not been used in North Queensland, Australia, prior to 2005. This paper reports the results from a survey of patients' and nurses' initial experiences with the buttonhole cannulation technique 20 months after its introduction into a renal service in North Queensland. The use of the buttonhole technique increased the ease and decreased the discomfort associated with access cannulation for both patients and nurses; both groups reported less anxiety associated with this technique. The patients were especially pleased with the improved cosmetic appearance and indicated that they would be more likely to become involved in self-care, including self-cannulation. The nursing service has implemented strategies to ensure that buttonhole cannulation continues to be used as one means of arteriovenous fistula access across the region. A current study is examining longer-term outcomes of using the buttonhole technique within this regional service. [source]


    This descriptive paper tells the story of the daily difficulties that members of the Public Order Police (POP) unit in South Africa experienced in their attempts to create a more diverse (in terms of race and gender) and representative police organization. This story is told through recordings of observations and conversations that span a 4-year ethnographic journal. The paper demonstrates that despite affirmative action and equity legislation and programmes, Durban POP by the year 2001, six years after the transformation process within the unit began, was still plagued by deep racial and gender divisions. These divisions were reinforced by the structural make-up of the unit and the inability of middle management to challenge entrenched practices, as well as deep-seated assumptions, schemas and values associated with race, ethnicity and gender. By means of a ethnographic journal I was able to discover some of the daily dilemmas of the police in their change efforts and also the difficulties of getting police practice to meet new policy agendas. [source]


    In December 1999, the UK Civil Service Management Board agreed an internal reform programme, complementing the more externally-oriented ,modernizing government' programme, to bring about major changes in the functioning of the civil service ,,step change' rather than continuous improvement. This paper suggests that the aims of the reform programme were only partially achieved. While some step changes did indeed occur, even such central elements of reform as ,joined-up' working with other public organizations were still only at an initial stage some three years later and others , for example, business planning and performance management systems , have taken 20 years to achieve acceptance within the civil service. It appears that examples of meteoric change are rare in the civil service , the reality of the changes are better characterized as ,evolution' and ,continuous improvement' than ,revolution' and ,step change'. [source]


    Steven Van De Walle
    ABSTRACT,:,Citizens consider certain public (and private) services as essential services and therefore to be shielded from the full extent of market forces. Little is known about why some services are considered essential public services while other sometimes very similar services are not. In this article, we analyze public opinion using Eurobarometer data to test models exploring what factors determine whether citizens in 15 EU countries consider certain services as essential services and therefore to be provided to all. Despite the variety in public opinion, political orientations and geographic factors do little to explain why citizens have different opinions about the provision of public services. The article ends by outlining a research agenda for the further analysis of this underexplored research topic. [source]


    ANZ JOURNAL OF SURGERY, Issue 5 2007
    Cassandra Clayforth BHlth Sc(Hons)
    No abstract is available for this article. [source]


    Wai Lam
    We investigate the unique requirements of the adaptive textual document filtering problem and propose a new high-dimensional on-line learning framework, known as the REPGER (relevant feature pool with good training example retrieval rule) algorithm to tackle this problem. Our algorithm possesses three characteristics. First, it maintains a pool of selective features with potentially high predictive power to predict document relevance. Second, besides retrieving documents according to their predicted relevance, it also retrieves incoming documents that are considered good training examples. Third, it can dynamically adjust the dissemination threshold throughout the filtering process so as to maintain a good filtering performance in a fully interactive environment. We have conducted experiments on three document corpora, namely, Associated Press, Foreign Broadcast Information Service, and Wall Street Journal to compare the performance of our REPGER algorithm with two existing on-line learning algorithms. The results demonstrate that our REPGER algorithm gives better performance most of the time. Comparison with the TREC (Text Retrieval Conference) adaptive text filtering track participants was also made. The result shows that our REPGER algorithm is comparable to them. [source]

    A pedagogical Web service-based interactive learning environment for a digital filter design course: An evolutionary approach

    Wen-Hsiung Wu
    Abstract The course of digital filter design in electronic/electrical engineering involves complicated mathematical equations and dynamic waveform variations. It is a consensus among educators that using simulation tools assist in improving students' learning experiences. Previous studies on system simulation seemed to lack an appropriate approach to design such a course. Few emphasized the design of an interactive learning environment by using an evolutionary approach. This study integrated the design concept of an evolutionary approach and Web service-based technology into a simulation system entitled Pedagogical Web Service-Based Interactive Learning Environment (PEWSILE) was introduced. The PEWSILE system contained two interactive learning environments,a simple system and an advanced system. It offered a total of six pedagogical Web services. The simple interactive learning environment included text/color-based services, and text/color/diagram-based services. The advanced interactive learning environment included batch-based, interval change-based, comparison-based, and scroll bar-based services. The study also assessed the students' performance in six pedagogical Web services covering interaction and overall use, usefulness, and intention to use through a questionnaire survey and subsequent interviews. Three significant findings were reported. For example, in the advanced interactive learning environment, the designs of interval change-based and comparison-based services make it easier to observe differences in the outcome of parameter change, while batch-based services lacks the element of waveform comparison. In sum, the findings in this study provide helpful implications in designing engineering educational software. © 2010 Wiley Periodicals, Inc. Comput Appl Eng Educ 18: 423,433, 2010; View this article online at; DOI 10.1002/cae.20163 [source]

    Towards an integrated GIS-based coastal forecast workflow

    Gabrielle Allen
    Abstract The SURA Coastal Ocean Observing and Prediction (SCOOP) program is using geographical information system (GIS) technologies to visualize and integrate distributed data sources from across the United States and Canada. Hydrodynamic models are run at different sites on a developing multi-institutional computational Grid. Some of these predictive simulations of storm surge and wind waves are triggered by tropical and subtropical cyclones in the Atlantic and the Gulf of Mexico. Model predictions and observational data need to be merged and visualized in a geospatial context for a variety of analyses and applications. A data archive at LSU aggregates the model outputs from multiple sources, and a data-driven workflow triggers remotely performed conversion of a subset of model predictions to georeferenced data sets, which are then delivered to a Web Map Service located at Texas A&M University. Other nodes in the distributed system aggregate the observational data. This paper describes the use of GIS within the SCOOP program for the 2005 hurricane season, along with details of the data-driven distributed dataflow and workflow, which results in geospatial products. We also focus on future plans related to the complimentary use of GIS and Grid technologies in the SCOOP program, through which we hope to provide a wider range of tools that can enhance the tools and capabilities of earth science research and hazard planning. Copyright © 2008 John Wiley & Sons, Ltd. [source]

    Specification, planning, and execution of QoS-aware Grid workflows within the Amadeus environment

    Ivona Brandic
    Abstract Commonly, at a high level of abstraction Grid applications are specified based on the workflow paradigm. However, majority of Grid workflow systems either do not support Quality of Service (QoS), or provide only partial QoS support for certain phases of the workflow lifecycle. In this paper we present Amadeus, which is a holistic service-oriented environment for QoS-aware Grid workflows. Amadeus considers user requirements, in terms of QoS constraints, during workflow specification, planning, and execution. Within the Amadeus environment workflows and the associated QoS constraints are specified at a high level using an intuitive graphical notation. A distinguishing feature of our system is the support of a comprehensive set of QoS requirements, which considers in addition to performance and economical aspects also legal and security aspects. A set of QoS-aware service-oriented components is provided for workflow planning to support automatic constraint-based service negotiation and workflow optimization. For improving the efficiency of workflow planning we introduce a QoS-aware workflow reduction technique. Furthermore, we present our static and dynamic planning strategies for workflow execution in accordance with user-specified requirements. For each phase of the workflow lifecycle we experimentally evaluate the corresponding Amadeus components. Copyright © 2007 John Wiley & Sons, Ltd. [source]

    CCLRC Portal infrastructure to support research facilities

    Asif Akram
    Abstract The emergence of portal technology is providing benefits in developing portlet interfaces to applications to meet the current and future requirements of CCLRC facilities support. Portlets can be reused by different projects, e.g. the high-profile Integrative Biology project (with the University of Oxford), and in different Java Specification Request 168 Portlet Specification (JSR 168) compliant portal frameworks. Deployment and maintenance of applications developed as portlets becomes easier and manageable. A community process is already beginning and many portal frameworks come with free-to-use useful portlets. As rendering is carried out in the framework, applications can be easily accessible and internationalized. Portlets are compatible with J2EE, thus providing additional capabilities required in the service-oriented architecture (SOA). We also describe how Web service gateways can be used to provide many of the functionalities encapsulated in a portal server in a way to support Grid applications. Portals used as a rich client can allow users to customize or personalize their user interfaces and even their workflow and application access. CCLRC facilities will be able to leverage the work so far carried out on the National Grid Service (NGS) and e-HTPX portals, as they are fully functional and have received detailed user feedback. This demonstrates the usefulness of providing advanced capabilities for e-Research and having the associated business logic in a SOA loosely coupled from the presentation layer for an Integrated e-Science Environment. Copyright © 2006 John Wiley & Sons, Ltd. [source]

    Science gateways made easy: the In-VIGO approach

    Andréa M. Matsunaga
    Abstract Science gateways require the easy enabling of legacy scientific applications on computing Grids and the generation of user-friendly interfaces that hide the complexity of the Grid from the user. This paper presents the In-VIGO approach to the creation and management of science gateways. First, we discuss the virtualization of machines, networks and data to facilitate the dynamic creation of secure execution environments that meet application requirements. Then we discuss the virtualization of applications, i.e. the execution on shared resources of multiple isolated application instances with customized behavior, in the context of In-VIGO. A Virtual Application Service (VAS) architecture for automatically generating, customizing, deploying, and using virtual applications as Grid services is then described. Starting with a grammar-based description of the command-line syntax, the automated process generates the VAS description and the VAS implementation (code for application encapsulation and data binding) that is deployed and made available through a Web interface. A VAS can be customized on a per-user basis by restricting the capabilities of the original application or by adding to it features such as parameter sweeping. This is a scalable approach to the integration of scientific applications as services into Grids and can be applied to any tool with an arbitrarily complex command-line syntax. Copyright © 2006 John Wiley & Sons, Ltd. [source]

    Threshold-based admission control for a multimedia Grid: analysis and performance evaluation

    Yang Zhang
    Abstract In a Grid-based services system facing a large number of requests with different services and profits significance, there is always a trade-off between the system profits and the Quality of Service (QoS). In such systems, admission control plays an important role: the system has to employ a proper strategy to make admission control decisions and reserve resources for the coming requests thus to achieve greater profits without violating the QoS of the requests already admitted. In this paper, we introduce three essential admission control strategies with threshold on resource reservation and a newly proposed strategy with layered threshold. Through comprehensive theoretical analyses and extensive simulations, we demonstrate that the strategy with layered threshold is more efficient and flexible than the existing strategies for Grid-based multimedia services systems. Copyright © 2006 John Wiley & Sons, Ltd. [source]

    HLA real-time extension

    Hui Zhao
    Abstract The IEEE 1516 Standard ,High Level Architecture (HLA)' and its implementation ,Run-Time Infra-structure (RTI)' defines a general-purpose network communication mechanism for Distributed Interactive Simulation (DIS). However, it does not address real-time requirements of DIS. Current operating system technologies can provide real-time processing through some real-time operating systems (RTOSs) and the Internet is also moving to an age of Quality of Service (QoS), providing delay and jitter bounded services. With the availability of RTOSs and IP QoS, it is possible for HLA to be extended to take advantage of these technologies in order to construct an architecture for Real-Time DIS (RT-DIS). This extension will be a critical aspect of applications in virtual medicine, distributed virtual environments, weapon simulation, aerospace simulation and others. This paper outlines the current real-time technology with respect to operating systems and at the network infrastructure level. After summarizing the requirements and our experiences with RT-DIS, we present a proposal for HLA real-time extension and architecture for real-time RTI. Similar to the growth of real-time CORBA (Common Object Request Broker) after the mature based CORBA standard suite, Real-Time HLA is a natural extension following the standardization of HLA into IEEE 1516 in September 2000. Copyright © 2004 John Wiley & Sons, Ltd. [source]

    Severe personality disorder emerging in childhood: a proposal for a new developmental disorder

    Eileen Vizard
    Background The concept of ,severe personality disorder' is currently applied to adults with a history of serious antisocial and offending behaviour. There is, however, no similar classification that can be applied to the sub-group of children and adolescents who display persistent and serious offending from an early age. This omission from diagnostic nomenclature prevents the appropriate early identification, assessment and management of these young people. Method This paper therefore proposes a new developmental disorder: ,severe personality disorder emerging in childhood'. The existing evidence base strongly supports the presence of a developmental trajectory from childhood to adult life for the small number of children who show early signs of severe personality disorder (SPD). Based on a review of the literature and the experience of working in a specialist, forensic Child and Adolescent Mental Health Service (CAMHS), a multi-factorial model is proposed that outlines the developmental trajectory of SPD. This model includes neurobiological, psychosocial, environmental and systemic factors, within a developmental framework, and contributes to a more developmentally appropriate understanding of the genesis of severe personality disorder. Copyright © 2004 Whurr Publishers Ltd. [source]


    Research Summary: This article examines a chain of policy directives concerning self-injury inside federal correctional facilities in Canada. Specific attention is paid to the impact of these policies on federally sentenced women. I argue that the Correctional Service of Canada's focus on risk assessment fails to address the needs of the women they confine. Instead, women's needs are reconceptualized as institutional risk factors. Policy Implications: Women who self-injure are still routinely disciplined for their behaviour in Federal Canadian prisons through admittance to administrative segregation. This policy challenges two sections of the Charter of Rights and Freedoms (s. 7 and s. 15) and must be changed. In this article, I will recommend a new women-centered approach to replace current practice. [source]

    Two-year follow-up of fractured anterior teeth restored with direct composite resin: report of three cases

    Emre Ozel
    Fractures of maxillar central incisors including enamel and dentin were diagnosed. Beveling with diamond bur was performed in all four cases. Dentin was cleaned with tungsten carbid bur. The teeth were etched with 37% phosphoric acid, restored with an adhesive system and microhybrid composite. Finishing and polishing procedures were performed by discs (Sof-Lex) and burs. Restorations were found successful according to modified United States Public Health Service (USPHS) criteria after 2 years in terms of retention, color match, marginal discoloration, secondary caries, marginal adaptation, and surface texture. [source]

    A systematic review of the diagnostic classifications of traumatic dental injuries

    Karla Maria Pugliesi da Costa Feliciano
    Abstract,,, A systematic review of the literature was undertaken to evaluate the criteria used for the diagnostic classification of traumatic dental injuries from an epidemiological standpoint. The methodology used was that suggested by the Cochrane Collaboration and the National Health Service. A total of 12 electronic bibliographical databases (BBO, BioMed Central, Blackwell Synergy, Cochrane, DARE, EMBASE, HighWire, LILACS, MEDLINE, PubMed Central, SciELO, SciSearch) and the World Wide Web were searched. There was no attempt to specify the strategy in relation to date, study design, or language. The last search was performed in May 2003. Two reviewers screened each record independently for eligibility by examining titles, abstracts, keywords and using a standardized reference form. Disagreements were resolved through consensus. The final study collection consisted of 164 articles, from 1936 to 2003, and the population sample ranged from 38 to 210 500 patients. 54 distinct classification systems were identified. According to the literature, the most frequently used classification system was that of Andreasen (32%); as regards the type of injury, the uncomplicated crown fracture was the most mentioned lesion (88.5%). Evidence supports the fact that there is no suitable system for establishing the diagnosis of the studied injuries that could be applied to epidemiological surveys. [source]

    Outcomes for 236 patients from a 2-year early intervention in psychosis service

    M. A. Turner
    Objective:, To examine: i) changes in key outcome measures over time in treatment in a representative first-episode psychosis treatment cohort and ii) baseline predictors of service disengagement. Method:, Baseline characteristics of 236 patients were examined for associations with outcomes over time using generalized estimating equation models. The data on disengagement were analysed using logistic regression. Results:, After controlling for admission scores, patients showed consistently improved outcomes while in treatment on functional recovery (unemployment, P < 0.01; HoNOS, P < 0.001; the Quality of Life Scale, P < 0.001; GAF, P < 0.05) but not symptomatology (as assessed by the PANSS and substance abuse). The 64 (33%) who disengaged were more likely to be unemployed (P < 0.01) and have higher HoNOS (P < 0.01) and GAF (P < 0.05) scores at baseline. Conclusion:, This evaluation has shown significant improvements in psychosocial functioning but not psychopathology during treatment at an Early Intervention for Psychosis Service. Despite attempts to retain patients, there is a high rate of treatment discontinuation. [source]

    Evaluation of a Pediatric-sedation Service for Common Diagnostic Procedures

    Wendalyn K. King MD
    Abstract Background: Pediatric patients often require sedation for diagnostic procedures such as magnetic resonance imaging and computed tomography scanning. In October 2002, a dedicated sedation service was started at a tertiary care pediatric facility as a joint venture between pediatric emergency medicine and pediatric critical care medicine. Before this service, sedation was provided by the department of radiology by using a standard protocol, with high-risk patients and failed sedations referred for general anesthesia. Objectives: To describe the initial experience with a dedicated pediatric-sedation service. Methods: This was a retrospective analysis of quality-assurance data collected on all sedations in the radiology department for 23-month periods before and after sedation-service implementation. Study variables were number and reasons for canceled or incomplete procedures, rates of referral for general anesthesia, rates of hypoxia, prolonged sedation, need for assisted ventilation, apnea, emesis, and paradoxical reaction to medication. Results are reported in odds ratios (OR) with 95% confidence intervals (95% CI). Results: Data from 5,444 sedations were analyzed; 2,148 before and 3,296 after sedation-service activation. Incomplete studies secondary to inadequate sedation decreased, from 2.7% before the service was created to 0.8% in the post,sedation-service period (OR, 0.29; 95% CI = 0.18 to 0.47). There also were decreases in cancellations caused by patient illness (3.8% vs. 0.6%; OR, 0.16; 95% CI = 0.10 to 0.27) and rates of hypoxia (8.8% vs. 4.6%; OR, 0.50; 95% CI = 0.40 to 0.63). There were no significant differences between the groups in rates of apnea, need for assisted ventilation, emesis, or prolonged sedation. The implementation of the sedation service also was associated with a decrease in both the number of patients referred to general anesthesia without a trial of sedation (from 2.1% to 0.1%; OR, 0.33; 95% CI = 0.06 to 1.46) and the total number of general anesthesia cases in the radiology department (from 7.5% to 4.4% of all patients requiring either sedation or anesthesia; OR, 0.56; 95% CI = 0.45 to 0.71). Conclusions: The implementation of a dedicated pediatric-sedation service resulted in fewer incomplete studies related to inadequate sedation, in fewer canceled studies secondary to patient illness, in fewer referrals for general anesthesia, and in fewer recorded instances of sedation-associated hypoxia. These findings have important implications in terms of patient safety and resource utilization. [source]

    Typological thinking and the conservation of subspecies: the case of the San Clemente Island loggerhead shrike

    Michael A. Patten
    Abstract. ,Hybridization with closely related taxa poses a significant threat to endangered subspecies (e.g. outbreeding depression, inbreeding) and confounds efforts to manage and conserve these taxa through a loss of taxonomic identity, in part because of the practical necessity of defining subspecies in a typological manner. We examined nine morphological characters in 167 post-juvenile museum specimens to determine if loggerhead shrikes Lanius ludovicianus Linnaeus 1766 on San Clemente Island (off the coast of California) remain diagnosable as L. l. mearnsi Ridgway (1903); an island endemic listed as endangered by the United States Fish and Wildlife Service. Four recent shrike specimens from the island were compared to historical specimens using a bivariate scatter plot and a discriminant function (the latter was used to classify recent specimens post hoc). The few recent specimens were not diagnosable as L. l. mearnsi, but instead appear to be intergrades between L. l. mearnsi and L. l. anthonyi Mearns 1898 (the subspecies endemic to Santa Cruz, Santa Catalina, Santa Rosa and Anacapa islands), and are perhaps closer to pure anthonyi. Our data and the species' natural history and distribution suggest that shrikes currently on San Clemente Island are the result of genetic ,swamping' of mearnsi by anthonyi. Under a necessarily typological definition of a subspecies, it is evident that mearnsi is probably no longer diagnosable. However, we conclude that protection of the entire Channel Islands population of the loggerhead shrike would be the best management strategy, as the species has declined drastically throughout the islands. [source]

    Client satisfaction and risk behaviours of the users of syringe dispensing machines: a pilot study

    Abstract Introduction and Aims. The study examines risk behaviours of the users of syringe dispensing machines (SDMs) and evaluates the usefulness of these machines in providing injecting drug users (IDUs) with sterile injecting equipment. Design and Methods. Self-administered questionnaires were used among users of SDMs in an Area Health Service of Sydney. Results. The majority of the 167 participants reported being happy with the quality of the SDM services. Problems identified with machines were that they were often broken or jammed (32.8% respondents), not in the right place (21.9%) or require money (16.7%). Just over half (50.9%) of the IDUs use SDMs only from 5 p.m. to 9 a.m., the time when almost all other outlets for accessing sterile injecting equipment remain closed. Relatively young IDUs (age , 30 years) were more likely to prefer SDMs over staffed needle syringe programmes (NSPs) compared with older users (age > 30) and to identify stigma (a desire to hide their identity or not liking the way people treat them at staffed NSPs or chemists) as a main reason for using these machines. Primary users of SDMs do not differ from primary users of NSP/chemists in terms of sharing of needles. Those users who had shared in the last month were nearly four times as likely to have never used condoms in sexual encounters over that period (95% confidence interval: 1.2,14.5). Discussion and Conclusion. SDMs appear to complement other outlets of NSPs. Providing free-of-cost equipment from SDMs should be considered carefully, as needing money to buy equipment was a reason given for sharing of needles by 35% of those who shared. [source]

    Process evaluation of an out-patient detoxification service

    Abstract This paper describes the process evaluation of an out-patient detoxification service (ODS) established by Drug Health Services (DHS) to increase the supervised withdrawal options for substance users in a Sydney metropolitan Area Health Service. The ODS aimed to provide a safe and effective supervised withdrawal to substance users who were at low risk of severe withdrawal, engage those with severe dependence in further treatment and increase the involvement of general practitioners (GPs) in the medical care of ODS clients. During its first 10 months of operation, the ODS received 199 inquiries, assessed 82 individuals and admitted 76 clients for detoxification. Withdrawal treatment proceeded without complications and within the expected time frames. Fifty-four clients completed withdrawal, 10 ceased treatment, 10 remained in treatment without completing withdrawal and two were transferred elsewhere. Clients who injected substances (mainly heroin) daily at admission, compared to others, were less likely to complete withdrawal and more likely to use a range of non-prescribed substances during withdrawal. One-fifth of clients went on to further treatment with DHS, attending at least once. Overall, the ODS met its goals, providing a safe and effective supervised withdrawal to local residents, especially women, young people and those withdrawing from benzodiazepines who had significant substance dependence, impairment and previous alcohol and other drug (AOD) treatment. Non-injecting substance users benefited most from the ODS in terms of withdrawal completion and ongoing treatment. The level of GP involvement in the conjoint care of ODS clients remained constant over time. The development and expansion of the ODS are discussed. [source]

    The development of the Recovery and Prevention of Psychosis Service in Melbourne, Australia

    Brendan P. Murphy
    Abstract Aim: To describe the establishment of a multicomponent, phase-specific, early intervention service for young people experiencing psychosis. Methods: The Recovery and Prevention of Psychosis Service commenced streamed clinical service delivery in November 2004, providing comprehensive case management for up to 3 years within Victoria's largest metropolitan health service. It delivers phase-oriented treatment focusing on early detection, recovery and relapse prevention, and minimizing disability and secondary comorbidity. The combined programme covers training and professional development, data collection and evaluation, specialist intervention services, group programme work and community development. Results: Of the first 151 clients, 70.2% were male, the average age at first presentation was 20.9 years, 15% were under 18 at first contact and 67% required inpatient admission at least once. Mean age at first contact was 20.84 years for those requiring inpatient services and 70% admitted were male. The average length of stay was 25.69 days and 23% were secluded, with an average of 2.1 seclusions. A large percentage of Recovery and Prevention of Psychosis Service clients (81%) required involuntary treatment, a significantly greater proportion of admitted patients were on Community Treatment Orders compared to those never admitted (22.5% cf. 4.1%; P = 0.04) and 92% of those admitted subsequently relapsed compared to 8% of those not admitted (P = 0.02). Conclusions: Recovery and Prevention of Psychosis Service is successfully developing a fully integrated first episode service. Recent developments include expanding the period of care up to 5 years for selected patients, the recruitment of a health promotions officer and planning for the development of a youth inpatient unit. [source]

    Early intervention with difficult to engage, ,high-risk' youth: evaluating an intensive outreach approach in youth mental health

    Carsten Schley
    Abstract Background: Although intensive outreach (IO) models such as assertive community treatment and intensive case management have a strong evidence base in adult psychiatry, their effectiveness in the early intervention sector is unknown. Aim: To explore client characteristics and treatment effects in a group of difficult to engage, ,high-risk' young people, seen by the Intensive Mobile Youth Outreach Service (IMYOS, ORYGEN Youth Heath) in Western Metropolitan Melbourne. Methods: The clinical files of 47 clients were audited, targeting demographic and treatment outcome data prior to and during IMYOS involvement. Results: Clients typically presented with traumatic childhoods, disrupted education, repeated treatment dropout, poor mental health and ,high-risk' behaviours. Results showed a significant reduction in risk to self and others between referral and discharge, and significantly lower admissions rates and inpatient days compared with the 9 months prior to referral. Conclusions: IO might be an effective early intervention strategy to minimize risk of harm and decrease hospitalization in young people. However, conclusions are provisional as there was no control group included in this study. Further study is required, perhaps with a waiting list control. [source]

    One-year outcome of an early intervention in psychosis service: a naturalistic evaluation

    Swaran P. Singh
    Abstract Aim: We conducted a 1-year prospective evaluation of an early intervention in psychosis service (Early Treatment and Home-based Outreach Service (ETHOS)) during its first 3 years of operation in South-west London, UK. Methods: All patients referred to ETHOS underwent structured assessments at baseline and at 1-year follow-up. In addition, hospitalization rates of ETHOS patients (intervention group) were compared with a non-randomized parallel cohort (comparison group) of first-episode patients treated by community mental health teams. Results: The Early Treatment and Home-based Outreach Servicepatients experienced significant improvements in symptomatic and functional outcomes, especially vocational recovery. The service received only a quarter of eligible patients from referring teams. ETHOS patients did not differ from the comparison group in number of admissions, inpatient days or detention rates. Although number of referrals increased over time, there was no evidence that patients were being referred earlier. Conclusions: There is now robust evidence for the effectiveness of specialist early intervention services. However, such services must be adequate resourced, including an early detection team and provision of their own inpatient unit. [source]

    Effects of a community intervention to reduce the serving of alcohol to intoxicated patrons

    ADDICTION, Issue 6 2010
    Katariina Warpenius
    ABSTRACT Aims To assess the effects of an alcohol prevention programme to reduce the serving of alcoholic beverages to intoxicated clients on licensed premises. Research design A controlled pre- (2004) and post-intervention study (2006) design. Intervention A community-based programme combining law enforcement, responsible beverage service training, information campaigns and policy initiatives in one Finnish town (Jyväskylä). Participants and measurements A male actor pretended to be clearly under the influence of alcohol and tried to buy a pint of beer at licensed premises. For the baseline measurement, every bar and nightclub was visited in the intervention and the control areas (94 licensed premises in total). Post-intervention data were gathered with the same principles (100 licensed premises in total). A researcher observed every visit and documented the results. Results In the post-intervention study there was a statistically significant increase in refusals to serve denials alcohol to the actor in the intervention area (from 23% to 42% of the licensed premises) compared to refusals in the control area (from 36% to 27% of the licensed premises). Conclusion Previous research has documented that multi-component community-based interventions can have a significant impact on over-serving of alcohol when training and house policies are combined with effective law enforcement. The present findings also demonstrate that comprehensive Responsible Beverage Service (RBS) interventions applied at a local community level can be effective in decreasing service to intoxicated clients in a Nordic context. [source]

    Measurements in the Addictions for Triage and Evaluation (MATE): an instrument based on the World Health Organization family of international classifications

    ADDICTION, Issue 5 2010
    Gerard M. Schippers
    ABSTRACT Aims To present and evaluate a measurement tool for assessing characteristics of people with drug and/or alcohol problems for triage and evaluation in treatment. Measurements in the Addictions for Triage and Evaluation (MATE) is composed of 10 modules, selected on the basis of a detailed set of specifications. Conceptually, the MATE was constructed according to the ICD and International Classification of Functioning (ICF) in the World Health Organization (WHO) classification system. Two of the ICF-related modules were newly designed. Design Monitoring feasibility and field-testing in a treatment-seeking population with researcher and clinician-administered test,retest interviews, construct validation with related instruments and evaluation of the dimensional structure of the ICF-related modules. Setting The research was conducted in a large, regional substance abuse treatment centre in the Netherlands and at the Municipal Health Service of Amsterdam. Participants A total of 945 treatment-seeking patients were recruited during routine intakes, 159 of whom were interviewed twice; 32 problem drug users were also recruited from the Amsterdam cohort studies among problem drug users. Findings Completion time was reasonably short, and there were relatively few missing data. The factor structure of the ICF-related modules revealed a three-factor model with an acceptable fit. Inter-rater reliability ranged between 0.75 and 0.92 and was satisfactory, but interviewer reliability ranged between 0.34 and 0.73, indicating that some of subscales need to be improved. Concurrent validity was indicated by significant correlations (>0.50) between the ICF-related modules and the WHO Disability Assessment Schedule II (WHODAS II) and WHO Quality of Life brief version (WHOQOL-BREF). Conclusions The MATE can be used to allocate patients to substance abuse treatment. Because it is a comprehensive but flexible measurement tool that is also practical to use, the MATE is well suited for use in a heterogeneous population. [source]