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Journal articles on the topic 'Client deterioration'
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Shields, Richard K., and Shauna Dudley-Javoroski. "Musculoskeletal Deterioration and Hemicorporectomy After Spinal Cord Injury." Physical Therapy 83, no. 3 (March 1, 2003): 263–75. http://dx.doi.org/10.1093/ptj/83.3.263.
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Abstract Background and Purpose. The long-term management following an hemicorporectomy (HCP) is not well documented in the scientific literature. The purpose of this case report is to describe the 25-year history of a man with a spinal cord injury who experienced severe musculoskeletal deterioration and hemicorporectomy. Case Description. The client sustained T10 complete paraplegia at age 18 years, developed severe decubitus ulcers, and required an HCP as a life-saving measure 13 years later. The authors describe the chronology of several rehabilitation and prosthetic strategies and speculate on factors that may have contributed to their successes and failures. Outcomes. The client survived 12 years after the HCP and returned to independent mobility, self-care, and schooling despite complications with continued skin breakdown. Over the 12 years following discharge from the hospital after the spinal cord injury, he spent 749 days in the hospital. During the 12 years he lived after discharge from the hospital following the HCP, he was hospitalized 190 days. Discussion. The authors discuss factors contributing to the client's musculoskeletal deterioration including chronic wounds, postural deviations, and incomplete adherence to pressure-relief recommendations and raise considerations for physical therapists who treat patients after HCP.
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Walfish, Steven, Brian McAlister, Paul O'Donnell, and Michael J. Lambert. "An Investigation of Self-Assessment Bias in Mental Health Providers." Psychological Reports 110, no. 2 (April 2012): 639–44. http://dx.doi.org/10.2466/02.07.17.pr0.110.2.639-644.
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Previous research has consistently found self-assessment bias (an overly positive assessment of personal performance) to be present in a wide variety of work situations. The present investigation extended this area of research with a multi-disciplinary sample of mental health professionals. Respondents were asked to: (a) compare their own overall clinical skills and performance to others in their profession, and (b) indicate the percentage of their clients who improved, remained the same, or deteriorated as a result of treatment with them. Results indicated that 25% of mental health professionals viewed their skill to be at the 90th percentile when compared to their peers, and none viewed themselves as below average. Further, when compared to the published literature, clinicians tended to overestimate their rates of client improvement and underestimate their rates of client deterioration. The implications of this self-assessment bias for improvement of psychotherapy outcomes are discussed.
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Her, Young-Won, Jennifer Howard, and Myungsoo Son. "Timing of auditor terminations and client firm risk." Managerial Auditing Journal 34, no. 6 (June 13, 2019): 650–72. http://dx.doi.org/10.1108/maj-03-2018-1831.
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Purpose The purpose of this study is to examine whether the timing of auditor terminations signals the riskiness of client firms. Design/methodology/approach This empirical study uses a sample of auditor switches during 2003-2014 to conduct univariate tests and multivariate regression analyses. Auditor switches occurring after the audit report date but before the shareholders’ meeting are classified as “planned” terminations and auditor switches that occur outside of this window are classified as “abrupt” terminations. Findings First, abrupt terminations are more strongly related to client risk factors than planned terminations. Second, relative to planned terminations, abrupt terminations are more likely to result from an auditor resignation rather than a client dismissal. Third, abrupt termination firms are more likely to have internal control weaknesses and experience delistings in the following year. Future operating performance is also worse after an abrupt termination. Finally, auditors and investors view abrupt terminations as riskier than planned terminations. Practical implications As the timing of the auditor termination is publicly available information, it can provide an important signal of deteriorating financial performance to shareholders and potential investors. Abrupt terminations could be costly to shareholders because those firms likely have lower quality financial reporting (due to internal control weakness) and deterioration of future operating performance. Originality/value While concurrent studies investigate the relation between the timing of new auditor appointment and audit quality, this is the first study to document the relation between the timing of auditor termination and the riskiness of client firms.
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Angral, Akash. "Architect–client relationship and value addition in private residential projects." Archnet-IJAR: International Journal of Architectural Research 13, no. 1 (March 18, 2019): 58–71. http://dx.doi.org/10.1108/arch-12-2018-0026.
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Purpose The purpose of this paper is to contextualise the architect–client relationship and evaluate the factors responsible for its deterioration, and then define the impact of these factors on the future needs of architects and clients, including how such knowledge can help emerging architects to develop an understanding of the profession at an early stage. It will attempt to reveal new insights and build consensus around issues, such as functionality and aesthetics, per cent-based fee structure, conflict of interest amongst architects, contractors and clients. Design/methodology/approach A combination of qualitative online survey, semi-structured interviews and online focus group discussions under the comprehensive umbrella of the case study method has been used to construct a pragmatic framework. The data collection was focused on revealed preferences rather than stated preferences, in terms of likes and dislikes, in a standard survey. Findings Overall, this paper strengthens the idea that the predicament of the profession and the marginalisation of architects is due to their detachment from clients. The findings suggest that the fee structure might be a major source of discontent and there is an urgent need for alternative routes of procurement, particularly for private residential clients. While most clients prefer functionality over aesthetics and want architects to be affordable, they are more willing to invest their trust in architects who can deliver from concept to completion. Research limitations/implications The arguments contested in this paper attempt to demystify the dynamics that are at play during the construction stage. It looks at power sharing, responsibilities and silent hierarchies that transpire between architects, clients and contractors, particularly in private residential projects. Originality/value The main recommendation of this paper is that to secure the future of the architecture profession emerging architects need to be trained more in client-centric skills than design-centric aptitude.
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Tengku Sharif, Tengku Intan Suzila, Mohd Yusri Mohamad Noor, and Siti Rohana Omar. "POLITENESS IN ONLINE COMMUNICATION: RETAILER-CLIENT INTERACTION." Humanities & Social Sciences Reviews 7, no. 2 (March 19, 2019): 233–39. http://dx.doi.org/10.18510/hssr.2019.7226.
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Purpose of the study: The paper aims to unfold politeness in online communication among retailers and clients and debates some ways where cultural values of communication can be taught and thus re-learned.
Methodology: The qualitative approach was adopted where discourse analysis method used to review and analyse the updates and comments from Facebook and WhatsApp of conveniently collected data for this study.
Main Findings: The study suggest a deterioration of cultural values in communication is at an alarming level among retailers and clients in online communication.
Applications of this study: The study will benefit online businesses. Area of studies include business management and communication. Other sub- areas include culture and ethic relations.
Novelty/Originality of this study: The study is new to Malaysian business context where multi-racial and multilingual environment play significant roles.
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Hart, Christina, Inga Boellinghaus, Sue Holttum, Melanie Shepherd, Clare O’Brien, and Daniel Salter. "A Grounded Theory Analysis of the Experience of Therapy in the Context of Negative Change." SAGE Open 11, no. 2 (April 2021): 215824402110231. http://dx.doi.org/10.1177/21582440211023198.
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Negative change occurring during psychotherapy is relatively underresearched and current theories take little account of social context. Eight clients and four therapists were interviewed about their therapy experience when reliable score deterioration on an outcome measure was observed, with the aim of generating a Grounded Theory model of negative change. The emerging model identified three major themes: a context of adversity, the therapeutic experience, and help withdrawn (within the context of positive outcomes). Difficulties included wanting therapy to provide more advice, talking about distressing issues, relationship difficulties, ambivalence, and a wish for support instead of change. Client context merits increased attention. Changes in outcome measures used, more diverse supervision models, training to use outcome measures constructively, and sensitive, routine analysis of negative change are indicated. Increased availability of therapies able to address clients’ interpersonal and social context and a wider choice of therapy type would allow interventions to better fit the individual in context.
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Malmgren Fänge, Agneta, Carlos Chiatti, and Anna Axmon. "One-Year Changes in Activities of Daily Living, Usability, Falls and Concerns about Falling, and Self-Rated Health for Different Housing Adaptation Client Profiles." International Journal of Environmental Research and Public Health 18, no. 18 (September 15, 2021): 9704. http://dx.doi.org/10.3390/ijerph18189704.
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The purpose of this study was to investigate one-year changes and differences in changes in activities of daily living (ADL), usability, a history of falls, concerns about falling, and self-rated health across five housing adaptation (HA) client profiles identified previously using a cluster analysis approach: older adults with low level of disability (n = 59); older adults with medium/high level of disability (n = 26); adults with low level of disability (n = 10); adults with high level of disability (n = 8); and older adults with medium level of disability including at least moderate cognitive impairment (n = 5). Comparisons between the five profiles include secondary analyses aggregating those with low level of disability and those with medium/high level of disability. Changes within the client profiles demonstrate a complex pattern of improvements and declines, depending on outcome, with no profile showing consistent improvement or decline across all outcomes. The risks of deterioration over one year were the highest among those with cognitive impairments at baseline, but no recommendation of prioritization decisions based on baseline profiles can be made. Instead, it seems that all HA clients, independently of baseline profile, are at risk of increasing disability over time and require follow-up evaluations regularly.
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Brown, Kevin F., and Li Dang. "Consequences of auditor reputation loss for client firms: deterioration of financial reporting quality after the Andersen collapse." International Journal of Business Innovation and Research 5, no. 3 (2011): 318. http://dx.doi.org/10.1504/ijbir.2011.040101.
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Patricia, Helena, Khatijah Lim Abdullah, and Ira Erwina. "Quality of life on caregiver of schizophrenia client in outpatient installation of Tampan psychiatric hospital." International Journal Of Community Medicine And Public Health 6, no. 9 (August 27, 2019): 3723. http://dx.doi.org/10.18203/2394-6040.ijcmph20193959.
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Background: The process of caring for a schizophrenic client creates a stressful situation; caregiver's unpreparedness in dealing with this problem has an impact on the deterioration of the quality of life. The decline in quality of life of caregiver is influenced by several factors such as caregiver’s burden and characteristic of caregiver include age, gender, sex, marital status, education, income, and relationship with client. This study aimed to determine the relationship of burden and characteristic with the quality of life on the caregiver.Methods: The design of this study was descriptive analytic with cross sectional study approach on 186 caregiver with convenient technique sampling. Data were collected by the Zarit Burden Interview questionnaire and the World Health Organization Quality of Life (WHOQOL-BREF).Results: The results showed 99 (53.2%) caregivers had a low quality of life, 92 (49.5%) caregivers felt heavy burden. Chi-square statistical test proved a significant relationship between burden (0.001) and all characteristics caregiver include age (0.033), gender (0.033), sex (0.000) marital status (0.001), education (0.001), income (0.002), and relationship with client (0.000) with quality of life.Conclusions: The result showed that test proved a significant relationship between burden and characteristics caregiver with quality of life of multivariate analysis showed that marital status was the most correlated with quality of life of caregiver. Suggestions for Tampan Psychiatric Hospital Pekanbaru are to improve mental nursing service comprehensively to client and family like health education program about how to improve quality of life.
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Akinrata, Ebunoluwa Bimbola, Deji Rufus Ogunsemi, and Olusola Festus Akinradewo. "OUTCOMES OF UNETHICAL PRACTICES BY QUANTITY SURVEYORS IN NIGERIAN CONSTRUCTION INDUSTRY." International Journal of Applied Research in Social Sciences 1, no. 3 (June 21, 2020): 84–94. http://dx.doi.org/10.51594/ijarss.v1i3.23.
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Ethics have a verifiable effect on the validity and economic supportability of quantity studying practices and additionally influencing the individual security of the profession. There is a developing consent inside and outside the construction industry that unscrupulous practices are endemic in the construction industry especially quantity surveying practice in Nigeria. This paper thusly, x-rayed the outcomes of unethical practices by Quantity Surveyors in the construction industry in Nigeria, and likewise displays more scholarly and practical approach in dealing with moral appraisal of Quantity Surveyors in the construction industry and ways to improve moral standard among them. Very much organized polls (questionnaire) were self-administered to stakeholders and professionals in construction organizations. Literature review also revealed that unethical practices result to dissatisfied clients, late compensation due to delays, low productivity/efficiency of project team, deterioration in professionalism, poor workmanship, high maintenance, upward review of contract cost, poor project coordination, poor quality infrastructure development, stunted growth of the industry, reduction in the life span of building, loss of public trust, conflicts between client and construction team, poor quality of infrastructural development and loss of public trust. Data were collected and analyzed using Mean Item Score (MIS) and Standard Deviation (SD). The results shows that dissatisfaction of clients, High maintenance cost and Poor workmanship were perceived to be the major ethical misconduct by Quantity Surveyors in the construction industry. The study recommended that Quantity Surveyors should not always make financial benefits, other advantages as their real concern and gain cash unethically by all means. Others professionals in the industry ought to dependably be caution and endeavor not to keep any untrustworthy conduct among themselves. Major client in Nigeria construction industry, which is the government need to be fair to the Quantity Surveyors and other professionals in the construction industry.
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Dobud, Will W., Daniel L. Cavanaugh, and Nevin J. Harper. "Adventure Therapy and Routine Outcome Monitoring of Treatment: The Time Is Now." Journal of Experiential Education 43, no. 3 (March 20, 2020): 262–76. http://dx.doi.org/10.1177/1053825920911958.
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Background: Routine outcome monitoring (ROM) was popularized in the mid-1990s to improve client outcomes in psychotherapy, though implementation in clinical practice has been slow. Although increased outcome research in adventure therapy (AT) in the last decade has demonstrated AT as a viable treatment option, recent reviews have found worrying trends regarding research methodology and poorly substantiated claims of superiority. Purpose: The purpose of this article is to explore the potential for ROM in AT. Methodology/Approach: We conducted a brief review of the literature on ROM and offered a discussion that positions principles of ROM with the nascent knowledge base of AT. Findings/Conclusions: We propose ROM is a viable next step in AT research and practice. ROM can explore when change is likely to occur during an AT program and provide a platform for improving client engagement and outcomes. Implications: We recommend implementation of ROM in AT and that future AT research explore therapist effects and important therapeutic factors, such as the therapeutic alliance and deterioration.
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Alvarez, Jennifer, Craig Rosen, Kim Davis, Greg Smith, and Malachy Corrigan. "“Stay Connected”: Psychological Services for Retired Firefighters after 11 September 2001." Prehospital and Disaster Medicine 22, no. 1 (February 2007): 49–54. http://dx.doi.org/10.1017/s1049023x00004337.
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AbstractIntroduction:A large number of firefighters retired after 11 September 2001. These retirees were confronted with multiple challenges, including grief, trauma- related physical injuries and psychological distress, difficulties related to the transition of their roles, and deterioration of social support.Objective:The Fire Department of NewYork (FDNY) Counseling Service Unit's “Stay Connected” Program designed and implemented after 11 September 2001 is described in this report. This unique program was designed to usea combination of peer outreach and professional counseling to address the mental health needs of retiring firefighters and their families.Methods:Descriptive information about the intervention program was gathered through semi-structured interviews with Counseling Service Unit staff. Client satisfaction surveys were collected during three six-week periods.Results:Quantitative data indicate that clients rated their overall satisfaction with the clerical and counseling staff a perfect 4 out of 4. The report of their overall satisfaction with the services also was nearly at ceiling (3.99 out 4).The perceived helpfulness of the services in resolving the problems experienced by the clients increased significantly over time.Qualitative data indicate that peer involvement and intensive community outreach, i.e., social events, wellness activities, and classes, were integral to the success of the intervention.Conclusions:This project provided valuable lessons about how to develop and implement a “culturally competent”intervention program for public safety workers retiring after a disaster. Creative, proactive, non-traditional outreach efforts and leveraging peers for credibility and support were particularly important.
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Grau Rebollo, Jorge, Paula Escribano Castaño, Hugo Valenzuela-Garcia, and Miranda Jessica Lubbers. "Charities as symbolic families: ethnographic evidence from Spain." Journal of Organizational Ethnography 8, no. 1 (April 1, 2019): 25–41. http://dx.doi.org/10.1108/joe-03-2018-0012.
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PurposeThe purpose of this paper is to explore the care provision of charity organizations that assist people in situations of economic vulnerability. After analyzing central theoretical elements of kinning, the authors contend that charity organizations function as symbolic families for people in need.Design/methodology/approachEthnographic fieldwork was performed in two sites of a large catholic charity organization in the outskirts of Barcelona. Ethnographic fieldwork included participant observations and informal interviews with individuals located under the official poverty threshold.FindingsSymbolic family bonds among different individuals are created through the entwining of interconnectedness, obligation and commitment, sense of belonging, interdependence and the projection of symbolic spaces of hearth. The authors propose the term of “disposable families” (akin to that of Desmond’s, 2013 for dyadic relationships) because a remarkable feature of these bonds is its short-term nature.Social implicationsThe consideration of charities as symbolic families offers new insights into their social role and may contribute to reshaping the social function within emergency situations.Originality/valueThis research opens new ground for the understanding of charities as something else than care providers, as the relational dimension with clients extends beyond the conventional patron/client relationship. This fact has particular relevance in an economic context of post-crisis, with the Welfare State withdrawal and a deterioration of the traditional sources of informal support.
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Gong, Qihui, Oliver Zhen Li, Yupeng Lin, and Liansheng Wu. "On the Benefits of Audit Market Consolidation: Evidence from Merged Audit Firms." Accounting Review 91, no. 2 (July 1, 2015): 463–88. http://dx.doi.org/10.2308/accr-51236.
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ABSTRACT We examine efficiency improvement associated with audit firm mergers. Our analysis is made possible by a unique dataset of audit hours in China. We find a significant reduction in audit hours, unaccompanied by a deterioration in audit quality, of merged audit firms. Further, we find a larger reduction in audit hours when acquirers are Chinese domestic Big 10 audit firms and when client firms are more complex. These results are consistent with the notion of economies of scale arising from horizontal mergers. However, enhanced efficiency does not necessarily reduce audit fees. Instead, we find an increase in audit fees when acquirers are international Big 4 audit firms even when we control for possible changes in market power. This premium is at least partially due to the certification effect of international Big 4 audit firms.
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Gamil, Mohammed, and Taher El-Bitar. "Design and Manufacturing of a Non-Standard Chain Parts for a Scraper Chain Conveyor: A Case Study." Key Engineering Materials 786 (October 2018): 335–41. http://dx.doi.org/10.4028/www.scientific.net/kem.786.335.
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This paper presents a complete case study for designing and manufacturing chain parts for scraper chain conveyor (SCC) for a real client (chicken’s dietary supplements company). The chain of the SCC is dilapidated due to joints and pins deterioration. The Productivity was reduced as a result of operating at low capacity load and repeated maintenance. The condition of chain was too worse and not able to be repaired. Furthermore, the chain was non-standardized. Therefore, a complete design is required to replace the damage parts of the chain. The design procedures are: (1) calculation of the expected loads that exert on the chain during operation, (2) selection of materials, (3) designing the different parts of the chain taking into account safety, assembly process and economic considerations. The final design was justified and validated. The SCC is working properly and safety under various load capacities.
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Pinkney, Lesley. "A Comparison of the Snoezelen Environment and a Music Relaxation Group on the Mood and Behaviour of Patients with Senile Dementia." British Journal of Occupational Therapy 60, no. 5 (May 1997): 209–12. http://dx.doi.org/10.1177/030802269706000506.
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Relaxation for elderly people is one of the more complicated activities to achieve with a client group who have limited cognitive abilities, particularly those with senile dementia. The deterioration in cognitive function and orientation may lead to agitation and frustration with their perceived situation. Consequently, this makes directed relaxation a difficult activity to facilitate. Following research of Snoezelen carried out at the King's Park Community Hospital, Bournemouth, the need to test the effectiveness of Snoezelen in manipulating mood had been identified. It was further identified that comparisons should be made between more conventional relaxation groups and Snoezelen. Three moderately demented female subjects were studied during a 9-week period. Observations were made on their behaviour and affect. The results indicated that the principles of Snoezelen could be used in many settings, making it a versatile medium. However, its effectiveness was dependent on the patient's cognitive skill level.
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Kitamura, Satomi, Ayumi Igarashi, Asa Inagaki, Manami Takaoka, Maiko Noguchi-Watanabe, Mariko Sakka, Takashi Naruse, and Noriko Yamamoto-Mitani. "HEALTH PROMOTION A NEW APPROACH TO DEVELOP GERONTOLOGICAL NURSING CARE QUALITY INDICATORS." Innovation in Aging 3, Supplement_1 (November 2019): S145. http://dx.doi.org/10.1093/geroni/igz038.523.
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Abstract While the inter-RAI, a comprehensive geriatric assessment tool, contains standardized system for assessing quality of care, there are limitations for its everyday use. Limitations include large number of items, lack of apparent process indicators, and limited symptoms and disease-related information. A new approach was introduced to develop gerontological nursing quality indicators that were targeted at long-term care. We plan to develop staff-friendly indicators, which can be extracted from regular routine client records. A group of nurse researchers discussed essential domains of elderly persons’ life quality, based on nursing theory literature, that nurses strive to maintain. Several outcome indicators were derived out of the domains, and process quality indicators were developed based on literature review. We identified nine domains based on Gordon’s functional health patterns: 1) minimizing symptoms and disease deterioration, 2) maintaining nutritional status, 3) controlling bowel movements, 4) encouraging physical activities, 5) promoting sound sleep, 6) minimizing dementia symptoms, 7) maintaining dignity, and 8) reducing family stress. We then developed 17 outcome indicators; each domain included one to four outcome indicators (e.g., maintaining nutritional status has three indicators: no aspiration, no weight loss by 3% or more, and no dehydration). Process indicators that covered regular assessment (e.g., swallowing evaluation), preventive interventions (e.g., adjusting body positions during a meal), and interventions for the problems (e.g., food texture modification) were determined. These indicators may be useful to assess gerontological nursing quality. We are planning to conduct expert panel and individual client surveys to assess its usability.
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Lee, Hwunjae, and Junhaeng Lee. "Peak Signal-to-Noise Ratio Evaluation of Server Display Monitors and Client Display Monitors in a Digital Subtraction Angiography Devices." ScholarGen Publishers 3, no. 1 (December 28, 2020): 33–41. http://dx.doi.org/10.31916/sjmi2020-01-04.
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This study evaluated PSNR of server display monitor and client display monitor of DSA system. The signal is acquired and imaged during the surgery and stored in the PACS server. After that, distortion of the original signal is an important problem in the process of observation on the client monitor. There are many problems such as noise generated during compression and image storage/transmission in PACS, information loss during image storage and transmission, and deterioration in image quality when outputting medical images from a monitor. The equipment used for the experiment in this study was P's DSA. We used two types of monitors in our experiment, one is P’s company resolution 1280×1024 pixel monitor, and the other is W’s company resolution 1536×2048 pixel monitor. The PACS Program used MARO-view, and for the experiment, a PSNR measurement program using Visual C++ was implemented and used for the experiment. As a result of the experiment, the PSNR value of the kidney angiography image was 26.958dB, the PSNR value of the lung angiography image was 28.9174 dB, the PSNR value of the heart angiography image was 22.8315dB, and the PSNR value of the neck angiography image was 37.0319 dB, and the knee blood vessels image showed a PSNR value of 43.2052 dB, respectively. In conclusion, it can be seen that there is almost no signal distortion in the process of acquiring, storing, and transmitting images in PACS. However, it suggests that the image signal may be distorted depending on the resolution and performance of each monitor. Therefore, it will be necessary to evaluate the performance of the monitor and to maintain the performance.
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Krasovsky, Tal, Tamar Silberg, Sharon Barak, Etzyona Eisenstein, Neta Erez, Irit Feldman, Dafna Guttman, et al. "Transition to Multidisciplinary Pediatric Telerehabilitation during the COVID-19 Pandemic: Strategy Development and Implementation." International Journal of Environmental Research and Public Health 18, no. 4 (February 4, 2021): 1484. http://dx.doi.org/10.3390/ijerph18041484.
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Telerehabilitation offers a unique solution for continuity of care in pediatric rehabilitation under physical distancing. The major aims of this study were to: (1) describe the development of telerehabilitation usage guidelines in a large hospital in Israel, and to (2) evaluate the implementation of telerehabilitation from the perspectives of healthcare practitioners and families. An expert focus group developed guidelines which were disseminated to multidisciplinary clinicians. Following sessions, clinicians filled The Clinician Evaluation of Telerehabilitation Service (CETS), a custom-built feedback questionnaire on telerehabilitation, and parents completed the client version of the Therapist Presence Inventory (TPI-C) and were asked to rate the effectiveness of sessions on an ordinal scale. Four goals of telerehabilitation sessions were defined: (1) maintenance of therapeutic alliance, (2) provision of parental coping strategies, (3) assistance in maintaining routine, and (4) preventing functional deterioration. Principal Components Analysis was used for the CETS questionnaire and the relationships of CETS and TPI-C with child’s age and the type of session were evaluated using Spearman’s correlations and the Kruskal–Wallis H test. In total, sixty-seven telerehabilitation sessions, with clients aged 11.31 ± 4.8 years, were documented by clinicians. Three components (child, session, parent) explained 71.3% of the variance in CETS. According to therapists, their ability to maintain the therapeutic alliance was generally higher than their ability to achieve other predefined goals (p < 0.01). With younger children, the ability to provide feedback to the child, grade treatment difficulty and provide coping strategies to the parents were diminished. Families perceived the therapist as being highly present in therapy regardless of treatment type. These results demonstrate a potential framework for the dissemination of telerehabilitation services in pediatric rehabilitation.
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Tellegen, Anna, Martijn Beukers, Imke Rudnik-Jansen, Nicolien van Klaveren, Kan Loi How, Nina Woike, George Mihov, et al. "Intra-Articular Slow-Release Triamcinolone Acetonide from Polyesteramide Microspheres as a Treatment for Osteoarthritis." Pharmaceutics 13, no. 3 (March 11, 2021): 372. http://dx.doi.org/10.3390/pharmaceutics13030372.
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Osteoarthritis (OA) is a common cause of pain and disability. Local corticosteroid injections are effective in treating OA pain and inflammation but are short-acting. Prolonged intra-articular (IA) corticosteroid exposure may even lead to cartilage deterioration. The aim of this prospective study was to assess safety and provide proof-of-concept of IA-applied biodegradable polyesteramide-based microspheres (PEAMs) gradually releasing triamcinolone acetonide (TA). Mimicking continuous exposure associated with local drug delivery in canine articular chondrocytes cultured in the continuous presence of TA tissue regeneration was not affected, whereas intermittent exposure reduced proteoglycan production. In this respect, TA-PEAMs administered IA in a proof-of-concept study in 12 client-owned dogs with established OA also showed safety by radiographic examination, without changes in OA severity and in glycosaminoglycan synovial fluid levels. Treatment also resulted in clinical improvement in 10 out of 11 dogs during the two-month follow-up period, which persisted in 6 out of 10 dogs after 6 months, based on objective gait analysis and owner questionnaires. Synovial prostaglandin E2, a pro-inflammatory marker, was decreased two months after treatment. This study showed safety and proof-of-concept of IA-administered TA-PEAMs in dogs with OA, as a first step towards translation into the veterinary and human clinic.
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Momková, Erika, and Kinga Izsóf Jurásová. "Výkon bilingválnych jednotlivcov pri psychodiagnostickom vyšetrení kognitívnych funkcií v ich prvom a druhom jazyku." TESTFÓRUM 5, no. 7 (March 29, 2016): 64–84. http://dx.doi.org/10.5817/tf2016-7-93.
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Cieľom práce bolo porovnať výkon bilingválnych jednotlivcov pri testovaní pozornosti, pamäti a inteligencie v ich prvom a druhom jazyku. Mienili sme tým preveriť implicitné predpoklady o zhoršení výkonu bilingválnych jednotlivcov pri psychodiagnostickom vyšetrení, ak to neprebieha v ich prvom jazyku. Výskumný súbor tvorilo 126 bilingválnych respondentov s priemerným vekom 17.87 (SD = 7.77), 66 žien a 60 mužov. Súbor bol rozdelený na štyri vekové skupiny – mladší školský vek, obdobie pubescencie, adolescencie a dospelosti. Vybrané kognitívne funkcie boli merané slovenskými a maďarskými jazykovými formami nasledovných psychologických testov: Číselný štvorec, Pamäťový test učenia, Wechslerov inteligenčný test pre dospelých a Wechslerova inteligenčná škála pre deti. Z výsledkov vyplýva zhoršenie výkonu pri psychodiagnostickom vyšetrení pozornosti, pamäti a inteligencie v druhom jazyku bilingvistov a to bez ohľadu na ich vek. Závery práce poukazujú na dôležitosť voľby primeraného jazyka psychologického testovania bilingválneho klienta kvôli eliminácii znevýhodňujúcich podmienok oproti monolingvistom. The aim of the study was to compare the performance of bilingual individuals in testing attention, memory and intelligence in their first (L1) and second (L2) languages. Our intention was to test the implicit assumptions about the deterioration of the performance of bilingual individuals by psychodiagnostic examination, if it does not proceed in their L1. The sample included 126 bilingual respondents with an average age of 17.87 (SD = 7.77), 66 women and 60 men. This work was divided into four age groups - younger school age, pubescence period, adolescence and adulthood. The selected cognitive functions were measured by Slovak and Hungarian language forms of the following psychological tests: Numeric Square, Memory test of learning, WAIS-R and WISC-III. The results indicate a deterioration of performance at psychodiagnostic test of attention, memory and intelligence in the L2 of bilinguals regardless of their age. The conclusions of the work show the importance of choosing the appropriate language of psychological testing of a bilingual client in order to eliminate disadvantageous conditions compared to a monolingual.
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Reyes Chirino, Raymari, Isabel Cristina Ramos Nieves, Claudia Jimenez Heredia, Marcos Pedro Ramos Rodríguez, and Alfredo Jimenez González. "APLICACIÓN WEB PARA LA GESTIÓN DE LA INFORMACIÓN EN LA ESCUELA DE CAPACITACIÓN DE LA CONSTRUCCIÓN DE PINAR DEL RÍO, CUBA." UNESUM-Ciencias. Revista Científica Multidisciplinaria. ISSN 2602-8166 2, no. 3 (January 26, 2019): 101–16. http://dx.doi.org/10.47230/unesum-ciencias.v2.n3.2018.107.
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Desde la década de los años 60 el Ministerio de la Construcción en Cuba se ha preocupado por la capacitación de su fuerza laboral, desarrollando una importante labor tanto en la formación vocacional como en la orientación profesional. En la actualidad la Escuela de Capacitación de dicho Ministerio en Pinar del Río, dirige su trabajo hacia la capacitación en aulas anexas y de reclusos, generándose grandes volúmenes de información a partir de una gestión que se hace de forma manual. Esta situación ocasiona una búsqueda engorrosa, pérdida y deterioro de la información, y demora en la entrega de reportes mensuales, incurriendo en ocasiones, en errores humanos. En atención a lo anterior y considerando que las Tecnologías de la Información y las Comunicaciones constituyen una herramienta inmejorable para el manejo de la información, el presente trabajo se desarrolló con el objetivo de diseñar una aplicación web para la gestión de la información en las aulas anexas y de reclusos de la Escuela de Capacitación de la Construcción en Pinar del Río, Cuba. Se analizaron sistemas informáticos relacionados con la investigación, así como tecnologías del lado del cliente y del servidor y herramientas de desarrollo. Se construyó una base de datos para almacenar la información de las aulas anexas y los reclusos y se diseñó una aplicación web que mejora el proceso de gestión de dicha información.PALABRAS CLAVE: Base de datos; Tecnologías de la Información y las Comunicaciones; informática; servidor; clienteSUSTAINABLE FOREST MANAGEMENT AT LOT 121 IN THE BASIC UNIT OF FOREST PRODUCTION RÍO MANTUA, MACURIJE FOREST ENTERPRISE, PINAR DEL RÍO, CUBAABSTRACTSince the 1960s, the Ministry of Construction in Cuba has been concerned with the training of its workforce, developing an important task in both vocational training and career guidance. Currently the Training School of the Ministry in Pinar del Rio, directs its work towards training in adjoining classrooms and convicts, generating large volumes of information from a management that is done manually. This situation causes a cumbersome search, loss and deterioration of the information, and delay in the delivery of monthly reports, sometimes incurring in human errors. In view of the above and considering that Information and Communication Technologies are an excellent tool for managing information, this work was developed with the aim of designing a web application for information management in the adjoining classrooms and of convicts of the Construction Training School in Pinar del Río, Cuba. We analyzed computer systems related to research, as well as client-side and server-side technologies and development tools. A database was built to store the information of the adjoining classrooms and the inmates and a web application was designed that improves the management process of said information.KEYWORDS: Database; Information Technology and Communications; computing; server; client
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Muhammad, K. Rahman, Al Omran Zaki, Ibrahim Mohammed, Al Nahdi Fahad, and S. Barry Mohammed. "Performance Based Specifications for Durability of Mass Concrete Blocks Subjected to Harsh Arabian Gulf Marine Environment." Key Engineering Materials 711 (September 2016): 444–52. http://dx.doi.org/10.4028/www.scientific.net/kem.711.444.
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Concrete structures in the Eastern region of Saudi Arabia are exposed to the harsh Arabian Gulf environment, and they suffer from deterioration due to accelerated corrosion of the reinforcing steel resulting in reduced service life. The service life of reinforced concrete structures in this environment is strongly affected by the quality of concrete. The resistances of concrete to chloride penetration, the chloride threshold for corrosion initiation and corrosion rate of the reinforcing steel are critical in ensuring long-term durability of concrete structures. In order to ensure that the concrete functions in the harsh environment for which it is expected to meet the service life requirement, the concrete must be designed for durability performance. A prescriptive concrete specification emphasizing on limits on mix parameters is generally ineffective for durability issues. A performance based specification based on concrete quality represented by durability indices and compliance criteria measured on cast-in-place concrete provides a framework for the contractor and ready-mix concrete supplier to produce a structure meeting the stipulated service life by the client. This paper presents the results of experimental investigations conducted for mass-concrete blocks used in the quay walls off the coastline on a reclaimed land. For long-term durability, a concrete mix in which 50% and 70% of cement was replaced by ground blast furnace slag was used to cater for the durability performance requirements.
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Neupane, Nira, and M. Vijaya lakshmi. "Effectiveness of Self Instructional Module (Sim) on Knowledge Regarding Alzheimer's Disease." Journal of Universal College of Medical Sciences 4, no. 2 (January 25, 2018): 25–29. http://dx.doi.org/10.3126/jucms.v4i2.19088.
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INTRODUCTION: Alzheimer's disease is a progressive neurodegenerative disease that causes severe deterioration of functional and cognitive abilities. As the leading cause of dementia in adults, it affects one in every 10 people who are more than 65 years of age. There is a vital need for student nurses with knowledge of Alzheimer's disease to provide high quality care for the growing number of patients. The use of effective nursing interventions for the management of Alzheimer's disease can help student nurses promote independence and quality of life for Alzheimer's disease patients. Thus this study is under taken to assess the effectiveness of the self instructional module (SIM) on nursing management of client with Alzheimer's disease among 4th year B. Sc. (N) students.MATERIALS AND METHODS: A quantitative evaluative research approach with pre experimental one group pre test and post test research design & non probability purposive sampling technique was used to select the 60 samples of B.Sc. (N) 4th year students. Self administered structured knowledge questionnaire were used to collect the information from the study samples. The prepared tool was validated by the experts and the reliability was established. The study was conducted in R.V. College of Nursing and Vidyakirana Institute of Nursing Sciences, Bangalore. The data was analyzed by descriptive and inferential statistics using SPSS version 19.RESULTS: Findings of the study shown that, the overall mean percentage pre test level of knowledge of B.Sc. Nursing 4th year studentswas 62.08%, and the pre test knowledge score was 35(58.33%) respondents were having moderately adequate knowledge, 13(21.67%) had inadequate knowledge and 12(20%) were having adequate knowledge regarding nursing management of clients with Alzheimer's disease. In the post test overall mean percentage post test level of knowledge was 84.37%. The post test knowledge score was 54(90%) respondents were having adequate knowledge and 06(10%) had moderately adequate knowledge after the administration of SIM. The overall obtained ''t'' value of knowledge 15.6 is highly significant at P< 0.01 level. The obtained chi-square value showed significant association between the pre test level of knowledge and certain socio demographical variables; gender (χ2 =5.12, df =1, p<0.05) and sources of information (χ2 =4.82, df=1, p<0.05). However, it did not show any significant association with other demographic variables of 4th Year B. Sc. (N) students.CONCLUSION: Findings of the study showed that majority of the student nurses were moderately adequate knowledge before administering the SIM. The SIM facilitated them to gain more knowledge regarding nursing management of client's with Alzheimer's disease which was evident in post test knowledge scores. Hence SIM was an effective strategy for providing information and to improve knowledge of students' nurses.Journal of Universal College of Medical Sciences (2016)Vol.04 No.02 Issue 14, page: 25-29
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Roy, STR, and J. A. Morrison. "Experience with alkali-aggregate reaction in the Canadian prairie region." Canadian Journal of Civil Engineering 27, no. 2 (April 1, 2000): 261–76. http://dx.doi.org/10.1139/l99-068.
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This paper summarizes alkali-aggregate reaction (AAR) experience in the prairie region to date. Information is presented on reactive rock types and their geological significance, laboratory test data, field evidence of affected structures, and industry practices for preventive measures and management of affected structures. The frequency and severity of documented AAR-affected structures in Manitoba, Saskatchewan, and Alberta is low, Alberta having the highest incidence. A significant number of aggregate sources in the region show potential for excessive expansion when subjected to laboratory testing. The lack of field evidence is generally attributed to the lower alkali contents of cements that have historically been produced and used in the region. Limited number and extent of searches for affected structures, inadequate diagnosis of the phenomenon, and client confidentiality are also factors. It is imperative that specifiers, owners, researchers, suppliers, and producers be aware of the potential reactivity of local aggregates. The occurrences of AAR-related deterioration in the field demonstrates that the phenomenon is not limited to the laboratory. The effectiveness of low to moderate alkali contents of concrete mixtures in controlling the AAR phenomenon demonstrates the need to specify low-alkali cement and the importance of measuring the effectiveness of supplementary cementing materials in preventing AAR. There is a need to conduct extensive field searches for affected structures and it is important that suspected cases of AAR be properly diagnosed.Key words: alkali-aggregate reaction, concrete, Manitoba, Saskatchewan, Alberta, laboratory testing, field evidence, pattern cracking, prisms, mortar bars, prevention, management.
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Zackova, Marketa, Tereza Lopotova, Sylvie Nadvornikova, Hana Klamova, and Jana Moravcova. "HSP90 Chaperone – An Important Player in CML: Study At RNA and Protein Level." Blood 118, no. 21 (November 18, 2011): 4878. http://dx.doi.org/10.1182/blood.v118.21.4878.4878.
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Abstract Abstract 4878 Chronic myeloid leukemia (CML) is the myeloproliferative disease characterised by presence of BCR-ABL tyrosine kinase, which has been proved to play the basic role in CML ontogenesis. BCR-ABL as well as other kinases active during disease progression (e.g. Src kinase) belong to HSP90 client proteins. It is known, that HSP90 protein is overexpressed in cancer cells and leukemias and is related to therapy resistance in CML cells (Gorre et.al. Blood 2002;100:3041-3044). HSP90 exists in two isoforms: alpha - inducible and beta – constitutively expressed. Taherian et.al. (Biochemistry and Cell Biology, 2008, 86:(1) 37–45) demonstrated that Hsp90α and Hsp90β exhibit similar interactions with cochaperones, but significantly different substrate specificity under stress conditions. Those results reveal both functional similarities and key functional differences between the individual members of this protein family. In our previous study we found high protein expression of total HSP90 in leukocytes of CML patients in advanced disease states and in patients with poor responses (Zackova et.al. EHA 2011). The HSP90 seems to be an indicator of disease deterioration in patients with chronic myeloid leukemia. In the current study, we extended our field of interest on HSP90 isoforms alpha and beta on mRNA level. We aimed to find out possible correlation between protein and mRNA expression levels, as well as between mRNA levels and response to the therapy. We wondered to know whether the monitoring of total HSP90 or its isoforms in CML can early predict the disease deterioration. We tested HSP90 alpha and HSP90 beta mRNA expression levels in patients with various response of CML by real-time RT-PCR method. The mRNA profiles showed high similarity with the data obtained from previous western blot analyses. The analyses showed that high HSP90 levels are associated with poor response to therapy and in advanced disease phases. These levels are probably represented by HSP90-beta isoform (constitutively expressed), which is expressed in higher levels comparing to HSP90 alpha in all samples tested. Expression of HSP90 alpha isoform is much lower while its mRNA expression level highly increases only in blast crisis. Studying both isoformes separately could distinguish various mechanisms in disease progression. The results of this and previous studies suggest HSP90 (on protein and mRNA levels) is an important molecule for studying of prognosis in CML patients. Thus HSP90 appears to be a candidate for novel marker of CML progression. Disclosures: No relevant conflicts of interest to declare.
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Fikre, Seyfe. "The Role and Challenge of Ethiopian Commodity Exchange (ECX) on Coffee Supplies and Marketing in Ethiopia." Business and Management Studies 6, no. 3 (September 8, 2020): 1. http://dx.doi.org/10.11114/bms.v6i3.4976.
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The objective of the study was to examine the role and challenge of ECX in coffee supply by measuring the core function ECX. The study used primary data collected from 120 respondents and analyzed through descriptive statistics and multiple linear regression. The study used six core function of ECX i.e. market information, enabling competition, market development, price discovery, and storage and grading and facilitation of physical commodity to measure the role and challenge of ECX. The results of the descriptive statistics showed that among ECX‘s core function, facilitation of physical commodity trade service was given the highest score while the storage and grading service was given the least score by the respondents. The multiple linear regression result indicate that three independent variable (Market information, market development and facilitation of physical commodity trade) were found to be significantly and positively influence the coffee supply and performance. Facilitation of physical commodity trade was significant at 1% while market information and market development were significant at 10%. Even though ECX have contributed to coffee supply and marketing performance, it is not free from a problem. The challenge are associated with service delivery system like grading system to test the quality of coffee was not uniform and biasedness one client from the other and wastage of time to test and low quality grading widely observed. ECX experts also indicate that absence of skilled man power, low government attention and capital shortage also another challenge in coffee marketing and supply. ECX should improve the service of storage and grading by introducing new technology and by maintaining transparent service. ECX should also build better warehouse management system in order to avoid wastage and quality deterioration.
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Rossmeisl, John H., Paulo A. Garcia, Theresa E. Pancotto, John L. Robertson, Natalia Henao-Guerrero, Robert E. Neal, Thomas L. Ellis, and Rafael V. Davalos. "Safety and feasibility of the NanoKnife system for irreversible electroporation ablative treatment of canine spontaneous intracranial gliomas." Journal of Neurosurgery 123, no. 4 (October 2015): 1008–25. http://dx.doi.org/10.3171/2014.12.jns141768.
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OBJECT Irreversible electroporation (IRE) is a novel nonthermal ablation technique that has been used for the treatment of solid cancers. However, it has not been evaluated for use in brain tumors. Here, the authors report on the safety and feasibility of using the NanoKnife IRE system for the treatment of spontaneous intracranial gliomas in dogs. METHODS Client-owned dogs with a telencephalic glioma shown on MRI were eligible. Dog-specific treatment plans were generated by using MRI-based tissue segmentation, volumetric meshing, and finite element modeling. After biopsy confirmation of glioma, IRE treatment was delivered stereotactically with the NanoKnife system using pulse parameters and electrode configurations derived from therapeutic plans. The primary end point was an evaluation of safety over the 14 days immediately after treatment. Follow-up was continued for 12 months or until death with serial physical, neurological, laboratory, and MRI examinations. RESULTS Seven dogs with glioma were treated. The mean age of the dogs was 9.3 ± 1.6 years, and the mean pretreatment tumor volume was 1.9 ± 1.4 cm3. The median preoperative Karnofsky Performance Scale score was 70 (range 30–75). Severe posttreatment toxicity was observed in 2 of the 7 dogs; one developed fatal (Grade 5) aspiration pneumonia, and the other developed treatment-associated cerebral edema, which resulted in transient neurological deterioration. Results of posttreatment diagnostic imaging, tumor biopsies, and neurological examinations indicated that tumor ablation was achieved without significant direct neurotoxicity in 6 of the 7 dogs. The median 14-day post-IRE Karnofsky Performance Scale score of the 6 dogs that survived to discharge was 80 (range 60–90), and this score was improved over the pretreatment value in every case. Objective tumor responses were seen in 4 (80%) of 5 dogs with quantifiable target lesions. The median survival was 119 days (range 1 to > 940 days). CONCLUSION With the incorporation of additional therapeutic planning procedures, the NanoKnife system is a novel technology capable of controlled IRE ablation of telencephalic gliomas.
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Jain, Shilpa, Jill Kings, and E. Diane Playford. "Occupational Therapy for People with Progressive Neurological Disorders: Unpacking the Black Box." British Journal of Occupational Therapy 68, no. 3 (March 2005): 125–30. http://dx.doi.org/10.1177/030802260506800305.
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Progressive neurological disorders often present a challenge to occupational therapists owing to their variable presentation and relentlessly deteriorating course. The literature available to guide therapists either is process driven or describes key roles without detail of the specific therapeutic intervention used. This report describes an occupational therapy programme provided for eight people with multiple system atrophy as part of a randomised controlled trial. The framework given illustrates the three stages of the client-centred programme and provides a comprehensive account of the therapeutic interventions used to change occupational performance. The treatment included techniques to enhance skills, increase knowledge and change attitude. Upon completion of the 8-week programme, the clients reported benefit. Although it cannot be asserted that all these techniques are effective, the occupational therapy programme described constitutes a ‘black box’ and may be useful in formulating further research questions.
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Burstein, Beth. "Involuntary Aged Clients: Ethical and Treatment Issues." Social Casework 69, no. 8 (October 1988): 518–24. http://dx.doi.org/10.1177/104438948806900807.
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Elderly people often reject help despite their apparent suffering. Family members may react to a client's pain or deterioration by imposing change on the elderly person. The author discusses the causes for these phenomena and suggests treatment techniques.
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Williams, Nicole, Dawn M. Guthrie, Jacob G. S. Davidson, Kathryn Fisher, and Lauren E. Griffith. "A Deterioration in Hearing Is Associated With Functional and Cognitive Impairments, Difficulty With Communication, and Greater Health Instability." Journal of Applied Gerontology 39, no. 2 (February 5, 2018): 159–71. http://dx.doi.org/10.1177/0733464818755312.
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Objectives: To examine the relationship between hearing deterioration and several health-related outcomes among home care clients in Ontario. Design: Longitudinal analysis was completed for clients with at least two comprehensive assessments. Hearing status, based on a single item, ranged from zero (no impairment) to three (highly impaired). Hearing deterioration was defined as at least a 1-point decline between subsequent assessments. Results: Seven percent experienced a 1-point deterioration in hearing and roughly 1% had a 2/3-point decline. After adjusting for other covariates, increasing age (odds ratio = 1.94; 95% confidence intervals [CIs] = [1.45, 2.61]) and a diagnosis of Alzheimer’s disease (1.37; CI = [1.04, 1.80]) and other dementias (1.32; CI = [1.07, 1.63]) increased the risk of a 2/3-point deterioration. Conclusion: These findings can assist home care professionals and policy makers in creating and refining interventions to meet the needs of older adults with hearing difficulties.
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Du, Lijing, Adi Masli, and Felix Meschke. "Credit Default Swaps on Corporate Debt and the Pricing of Audit Services." AUDITING: A Journal of Practice & Theory 37, no. 3 (July 1, 2017): 117–44. http://dx.doi.org/10.2308/ajpt-51858.
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SUMMARY Previous studies document that lenders lack incentives to monitor borrowing firms or to make concessions during bankruptcy if these lenders insure against corporate default with credit default swaps (CDS). This article investigates whether external auditors increase their audit fees for those client firms that have their debt referenced by CDS. In a comprehensive sample of U.S. companies from 2001–2015, we find that CDS-referenced companies incur larger audit fees compared to companies without CDS. The economic magnitude of the audit fee increase ranges from 5.4 percent to 11 percent, depending on the econometric specification employed. Deteriorating corporate conditions or other observable characteristics do not explain the positive association between CDS trading and audit fees, or the increase in audit fees following CDS initiations. The findings suggest that auditors increase their professional skepticism and monitoring efforts of CDS-referenced clients; they might also expect higher liability losses. JEL Classifications: G10; G30; G33; G34.
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Thomas, D., and N. Kendig. "Tension Pneumocephalus: Acute Neurological Deterioration Associated with Pleocytosis of the CSF." Clinical Infectious Diseases 16, no. 5 (May 1, 1993): 703–5. http://dx.doi.org/10.1093/clind/16.5.703.
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Лычева, Irina Lycheva, Молчанова, and Vera Molchanova. "IMPROVING CONSUMER LENDING MODEL CLIENTS." Bulletin of Belgorod State Technological University named after. V. G. Shukhov 2, no. 1 (December 8, 2016): 245–49. http://dx.doi.org/10.12737/23353.
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The dynamism of the ongoing reforms in the domestic banking sector, one way or another, concerns the relationship of banks with their clients. The customer base responds differently to the reform of the banking system: there is a category of clients who do not take the action of the Central Bank of the Russian Federation, they argue that the monopoly of state-owned banks will lead to a deterioration of service, reduction in quality of banking products and riskiness of banking operations. But there is another category of customers who are positive about the changes and consider increasing the state presence in the banking market of the natural course of development. They link these changes with the possibility of increasing the funding the most important sectors of the real sector of the economy: construction, metallurgy, mechanical engineering. The problem of the banking sector today and in previous periods is similar in many respects: banks still continue to search for the elusive Holy Grail - lasting relationships with customers. Despite the high technology, graphical user interfaces and marketing strategy for the implementation of the task is still unclear in many respects.
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Sturm, Annelies, Anneke Menger, Vivienne de Vogel, and Marcus J. H. Huibers. "Predictors of Change of Working Alliance Over the Course of Probation Supervision: A Prospective Cohort Study." International Journal of Offender Therapy and Comparative Criminology 64, no. 8 (October 3, 2019): 753–73. http://dx.doi.org/10.1177/0306624x19878554.
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The body of evidence that the working alliance is associated with positive outcomes for mandated clients is growing. The aim of this research was to investigate the influence of several characteristics of probation officers (POs) and offenders on the course of the working alliance during probation supervision. This study examined the patterns on the four alliance subscales: Trust, Bond, Goals-Restrictions, and Reactance of the Working Alliance With Mandated Clients Inventory (WAMCI) in 201 offenders and their 137 POs. Three patterns on each alliance subscale were found: deteriorating, improving, and stable. Multinomial logistic analysis revealed that change of POs and the preference of the PO to maintain rules were associated with a deteriorating Trust pattern. From the perspective of the offenders, being motivated to take part in supervision was associated with a stable pattern on every alliance subscale, but having problems with substance use increased the likelihood of a deteriorating pattern on every alliance subscale.
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Rooney, Siobhan, Aideen Freyne, Gabrielle Kelly, and John O'Connor. "Differences in the quality of life of two groups of drug users." Irish Journal of Psychological Medicine 19, no. 2 (June 2002): 55–59. http://dx.doi.org/10.1017/s0790966700006960.
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AbstractObjectives: The aim of this study was to compare aspects of the quality of life of drug users on a methadone maintenance programme to drug users on a harm minimisation programme.Method: Thirty-six clients attending the harm minimisation programme in the National Drug Treatment Centre, Dublin, were matched for age and sex to 36 clients on the methadone maintenance programme. All were interviewed with the SF-36 Health Survey Questionnaire to measure health related quality of life and with the Hospital Anxiety and Depression Scale (HADs) to measure psychological morbidity.Results: More clients from the harm minimisation programme had previous psychiatric problems than clients on the methadone maintenance programme, with an odds ratio of 4.3 CI(1.2,15.2). On the HADs, clients on the methadone maintenance programme had significantly lower depression scores than clients on the harm minimisation programme. In addition more clients on the harm minimisation programme were severely depressed than clients on the methadone maintenance programme. On the UK SF-36 Scale, clients on the harm minimisation programme perceived a significantly greater deterioration in ‘change in health’ over the previous year than clients on the methadone maintenance programme.Conclusions: Although clients on a methadone maintenance programme had an improved perception of their quality of life in relation to psychological and overall health function from the previous year, compared to clients on a harm minimisation programme, there still existed varying degrees of psychopathology in both groups which need to be considered when providing future services for drug users.
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Wang, Bin, Mian Li, Zhiyun Zhao, Shuangyuan Wang, Jieli Lu, Yuhong Chen, Min Xu, et al. "Glycemic Measures and Development and Resolution of Nonalcoholic Fatty Liver Disease in Nondiabetic Individuals." Journal of Clinical Endocrinology & Metabolism 105, no. 5 (March 7, 2020): 1416–26. http://dx.doi.org/10.1210/clinem/dgaa112.
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Abstract Context Type 2 diabetes (T2D) is closely associated with nonalcoholic fatty liver disease (NAFLD); however, evidence regarding the link between blood glucose, especially below the threshold for T2D, and NAFLD is scarce. Objective The objective of this work is to examine the associations of fasting glucose, oral glucose tolerance test (OGTT) 2-hour glucose, and hemoglobin A1c (HbA1c), and changes in these measures with development and resolution of NAFLD in nondiabetic individuals. Methods This longitudinal cohort study comprised 4273 Chinese adults age 40 years or older and free of baseline T2D from 2010 to 2015. Blood sampling was performed during the OGTT test. NAFLD was ascertained by hepatic ultrasonography. Risk ratios (RRs) were calculated using modified Poisson regression models. Results During a mean 4.4 years of follow-up, NAFLD occurred in 573 (17.9%) of the 3209 participants without baseline NAFLD and resolved in 304 (28.6%) of the 1064 participants with baseline NAFLD. OGTT 2-h glucose was positively associated with NAFLD incidence (RR per 1-SD increase: 1.16, 95% CI: 1.08-1.25), whereas fasting (RR: 0.86, 95% CI: 0.78-0.94) and 2-hour glucose (RR: 0.85, 95% CI: 0.77-0.93) were inversely associated with resolution of NAFLD. Glycemic deterioration conferred increased risk of developing NAFLD and decreased likelihood of resolution of NAFLD than maintaining normal glycemic regulation (NGR). The strongest associations were observed for individuals who developed T2D. Meanwhile, baseline or incident NAFLD significantly increased the risk of deterioration in glucose metabolism. Conclusions Increased glycemic levels within the nondiabetic range, as well as progression from NGR to T2D or prediabetes, were adversely associated with development and improvement of NAFLD.
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Wykes, Til, Emese Csipke, Diana Rose, Thomas Craig, Paul McCrone, Paul Williams, Leonardo Koeser, and Stephen Nash. "Patient involvement in improving the evidence base on mental health inpatient care: the PERCEIVE programme." Programme Grants for Applied Research 6, no. 7 (December 2018): 1–182. http://dx.doi.org/10.3310/pgfar06070.
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BackgroundDespite the movement towards care in the community, 40% of the NHS budget on mental health care is still attributed to inpatient services. However, long before the Francis Report highlighted grave shortcomings in inpatient care, there were reports by service user groups on the poor quality of these services in mental health. The programme provides a particular focus on the inclusion of the patient’s perspective in the development and evaluation of evidence.ObjectivesTo understand how changes to inpatient care affect the perceptions of the ward by service users and staff by using stakeholder participatory methods.DesignThe programme consisted of four work packages (WPs). (1) Lasting Improvements for Acute Inpatient SEttings (LIAISE): using participatory methods we developed two new scales [Views On Therapeutic Environment (VOTE) for staff and Views On Inpatient CarE (VOICE) for service users]. (2) Client Services Receipt Inventory – Inpatient (CITRINE): working with nurses and service users we developed a health economic measure of the amount of contact service users have with staff. The self-report measure records interactions with staff as well as the number of therapeutic activities attended. (3) Delivering Opportunities for Recovery (DOORWAYS): a stepped-wedge randomised controlled trial to test if training ward nurses to deliver therapeutic group activities would improve the perception of the ward by service users and staff. A total of 16 wards were progressively randomised and we compared the VOICE, VOTE and CITRINE measures before and after the intervention. A total of 1108 service users and 539 staff participated in this trial. (4) Bringing Emergency TreatmenT to Early Resolution (BETTER PATHWAYS) was an observational study comparing two service systems. The first was a ‘triage’ system in which service users were admitted to the triage ward and then either transferred to their locality wards or discharged back into the community within 7 days. The second system was routine care. We collected data from 454 service users and 284 nurses on their perceptions of the wards.Main outcome measuresThe main outcomes for the DOORWAYS and BETTER project were service user and staff perceptions of the ward (VOICE and VOTE, respectively) and the health economic measure was CITRINE. All were developed in WPs 1 and 2.ResultsWe developed reliable and valid measures of (1) the perceptions of inpatient care from the perspectives of service users and nurses (VOICE and VOTE) and (2) costs of interactions that were valued by service users (CITRINE). In the DOORWAYS project, after adjusting for legal status, we found weak evidence for benefit (standardised effect of –0.18, 95% CI 0.38 improvement to 0.01 deterioration;p = 0.062). There was only a significant benefit for involuntary patients following the staff training (N582, standardised effect of –0.35, 95% CI –0.57 to –0.12;p = 0.002; interactionp-value 0.006). VOTE scores did not change over time (standardised effect size of 0.04, 95% CI –0.09 to 0.18;p = 0.54). We found no evidence of an improvement in cost-effectiveness (estimated effect of £33, 95% CI –£91 to £146;p = 0.602), but resource allocation did change towards patient-perceived meaningful contacts by an average of £12 (95% CI –£76 to £98;p = 0·774). There were no significant differences between the triage and routine models of admission in terms of better perceptions by service users (estimated effect 0.77-point improvement in VOICE score on the triage ward;p = 0.68) or nurses (estimated effect of 1.68-point deterioration in VOTE on the triage ward;p = 0.38) or in terms of the cost of the length of care provided (£391 higher on triage;p = 0.77).Strengths and limitationsWe have developed measures using methods involving both service users and staff from mental health services. The measures were developed specifically for acute inpatient services and, therefore, cannot be assumed to be useful for other services. For instance, extensions of the measures are under construction for use in mother and baby units. The strength of the BETTER PATHWAYS and DOORWAYS projects is the large-scale data collection. However, we were testing specific services based in inner city areas and stretching to inner urban areas. It may be that different effects would be found in more rural communities or in different types of inpatient care.Future workOur database will be used to develop an understanding of the mediating and moderating factors for improving care quality.Trial registrationCurrent Controlled Trials ISRCTN06545047.FundingThis project was funded by the NIHR Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 6, No. 7. See the NIHR Journals Library website for further project information.
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Khalaf Mahran, Ghada Shalaby, Amal Ismael Abd El-Hafez, and Mostafa Samy Abbas. "Deterioration of mechanically ventilated patients in the presence of intra-abdominal hypertension." Journal of Nursing Education and Practice 8, no. 8 (April 8, 2018): 105. http://dx.doi.org/10.5430/jnep.v8n8p105.
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Background and objective: Elevated pressure within the cavity of the abdomen is a serious complication that can threat the life of critically ill patients. Thus, there is an intense need to highlight the outcomes of intra-abdominal hypertension (IAH) that can face critical care nurses. This work aimed to explore the deterioration of mechanical ventilated patients in the presence of IAH.Methods: Design: A non-randomized prospective study. Procedures: This trial was implemented in trauma and general intensive care in the period between December 2015 and August 2016. The pressure within the abdomen was measured for each patient, three times with 8-hr interval, at the third day of mechanical ventilator (MV). Sepsis-related organ failure assessment score was measured for all patients at first day of admission. All patients who had normal intra-abdominal pressure (IAP) or developed IAH were observed, monitored and evaluated for the clinical outcomes until discharged. Results: Of the 60 MV patients, 83.3% developed IAH. Higher mean of MV and stay period among patients with increased pressure within the abdomen (14.04 ± 10.30 and 16.30 ± 9.36) than normotensive patients (6.90 ± 2.80 and 11.000 ± 3.77) with significant difference (p = .001). Non-survivor had a significantly higher mean IAP than survivor (23.266 ± 2.37 vs. 7.91 ± 3.17) (p value < .001).Conclusions: The occurrence of IAH complicated 83.3% of mechanical ventilated clients in the study period: like longer stay and use of ventilator, and high mortality rate.
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Altmaier, Elizabeth. "Best Practices in Counseling Grief and Loss: Finding Benefit from Trauma." Journal of Mental Health Counseling 33, no. 1 (January 1, 2011): 33–45. http://dx.doi.org/10.17744/mehc.33.1.tu9wx5w3t2145122.
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Grief may be a primary presenting concern of clients or may form a background to another presenting concern. In either case, use of best practices in assessing and treating grief is essential. In this article I review what best practices are in general and in assessment and treatment. I also evaluate ways to measure grief and describe domains of the grief experience. The article also discusses controversies within the literature on grief counseling, including the potential for deterioration after treatment. It concludes with a view of counseling grief that promotes finding benefit from trauma.
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Vidal, David, Hervé Fenneteau, and Gilles Paché. "Should I stay or should I go? Customers’ reactions faced with the deterioration of a business relationship." Journal of Business & Industrial Marketing 31, no. 1 (February 1, 2016): 47–58. http://dx.doi.org/10.1108/jbim-06-2014-0124.
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Purpose – This paper aims to develop a framework helping managers to understand reactions, adopting the supplier perspective, and starting from the idea that the outcome of the degradation process is mainly determined by customers’ reactions. Inter-organisational relationships are sometimes subject to degradation. When incidents arise, and relationship attractiveness decreases, its evolution becomes uncertain. Design/methodology/approach – A case study carried out with a large French industrial company (FabIndus) specialised in the production of supplies destined to a large variety of business sectors. In all, 26 semi-structured interviews were conducted with staff members of FabIndus and clients’ representatives identified as having recently been confronted with deterioration in their relationship. Findings – The paper finds that customers’ reactions vary according to the nature of the business relationship and the customer commitment when degradation begins. Using two types of commitment and the exit–voice–loyalty–neglect model, it is possible to identify four types of reactions in the situation of the deterioration of a relationship. For each one of the reactions, the paper defines the response strategy that suppliers may take on. Originality/value – The paper underlines the importance of a segmented view of business behaviours faced with the deterioration of a relationship. This can be helpful to elaborate differentiated response strategies, to avoid mutual misunderstandings.
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Min, Jie, Tianshu Zeng, Margaretha Roux, David Lazar, Lulu Chen, and Slavica Tudzarova. "The Role of HIF1α-PFKFB3 Pathway in Diabetic Retinopathy." Journal of Clinical Endocrinology & Metabolism 106, no. 9 (May 21, 2021): 2505–19. http://dx.doi.org/10.1210/clinem/dgab362.
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Abstract Diabetic retinopathy (DR) is the leading cause of blindness for adults in developed countries. Both microvasculopathy and neurodegeneration are implicated in mechanisms of DR development, with neuronal impairment preceding microvascular abnormalities, which is often underappreciated in the clinic. Most current therapeutic strategies, including anti-vascular endothelial growth factor (anti-VEGF)-antibodies, aim at treating the advanced stages (diabetic macular edema and proliferative diabetic retinopathy) and fail to target the neuronal deterioration. Hence, new therapeutic approach(es) intended to address both vascular and neuronal impairment are urgently needed. The hypoxia-inducible factor 1α (HIF1α)–6-phosphofructo-2-kinase/fructose-2,6-bisphosphatase 3 (PFKFB3) pathway is critically implicated in the islet pathology of diabetes. Recent evidence highlighted the pathway relevance for pathologic angiogenesis and neurodegeneration, two key aspects in DR. PFKFB3 is key to the sprouting angiogenesis, along with VEGF, by determining the endothelial tip-cell competition. Also, PFKFB3-driven glycolysis compromises the antioxidative capacity of neurons leading to neuronal loss and reactive gliosis. Therefore, the HIF1α-PFKFB3 signaling pathway is unique as being a pervasive pathological component across multiple cell types in the retina in the early as well as late stages of DR. A metabolic point-of-intervention based on HIF1α-PFKFB3 targeting thus deserves further consideration in DR.
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Treloar, Carla, and Martin Holt. "Drug treatment clients' readiness for hepatitis C treatment: implications for expanding treatment services in drug and alcohol settings." Australian Health Review 32, no. 3 (2008): 570. http://dx.doi.org/10.1071/ah080570.
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This study explores the perception of and readiness for hepatitis C treatment within a sample of 77 clients already participating in drug treatment, with a view to identifying likely barriers and incentives to hepatitis C treatment within a drug treatment population. Participants with hepatitis C did not demonstrate a consistent, indepth knowledge of the infection, lacked confidence in symptom recognition, and had little awareness of treatment options. Those without obvious symptoms or liver deterioration did not have a pressing interest in treatment, and many had heard concerning stories about the side effects of hepatitis C treatment. For those coping with anxiety or depression, the increased risk of a depressive episode under interferon treatment was a major barrier to treatment.
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Pelsma, Iris C. M., Nienke R. Biermasz, Wouter R. van Furth, Alberto M. Pereira, Herman M. Kroon, Margreet Kloppenburg, and Kim M. J. A. Claessen. "Progression of acromegalic arthropathy in long-term controlled acromegaly patients: 9 years of longitudinal follow-up." Journal of Clinical Endocrinology & Metabolism 106, no. 1 (October 25, 2020): 188–200. http://dx.doi.org/10.1210/clinem/dgaa747.
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Abstract Context Joint complaints in patients with acromegaly are common, although the long-term disease course is largely unknown. Objective This study aims to evaluate the long-term course of acromegalic arthropathy. Design and Setting A prospective longitudinal cohort study was conducted in controlled acromegaly patients followed at a tertial referral center, with 3 study visits: at baseline and after a median of 2.6 and 9.1 years. Patients We included 31 patients with biochemically controlled acromegaly for 2 or more years (49% female; median age, 60 years) at baseline. Main Outcome Measures Radiographic arthropathy of the knee, hip, hand, and cervical and lumbar spine were evaluated using Kellgren and Lawrence (KL) scores, developed for assessment of primary osteoarthritis (OA). Radiographic progression was defined as a KL increase above the smallest detectable change. Joint symptoms were assessed using self-reported questionnaires. Progression was defined using existing clinically important cutoff values. Risk factors for progression were investigated using a multivariable model. Results All patients had definite radiographic OA at 1 or more joints at baseline. Radiographic progression was observed in 29%, 48%, 84%, and 94% of patients in the knees, hips, hands, and axial joints, respectively. Deterioration in hand-related pain and function was observed in 10 (32.3%) and 11 patients (35.5%), respectively. Solely baseline KL scores of the hip were associated with hip OA progression (OR 1.88; 95% CI, 1.09-3.16). Conclusions Acromegalic arthropathy showed significant radiographic progression over 9.1 years of follow-up in patients in remission, whereas clinical progression was observed less frequently. Future studies should focus on adequate prevention and treatment strategies of acromegalic arthropathy.
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Martel-Duguech, Luciana, Alicia Alonso-Jiménez, Helena Bascuñana, Jordi Díaz-Manera, Jaume Llauger, Claudia Nuñez-Peralta, Betina Biagetti, Paula Montesinos, Susan M. Webb, and Elena Valassi. "Thigh Muscle Fat Infiltration Is Associated With Impaired Physical Performance Despite Remission in Cushing’s Syndrome." Journal of Clinical Endocrinology & Metabolism 105, no. 5 (January 8, 2020): e2039-e2049. http://dx.doi.org/10.1210/clinem/dgz329.
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Abstract Context Muscle weakness is common in patients with Cushing’s syndrome (CS) and may persist after the resolution of hypercortisolism. Intramuscular fatty infiltration has been associated with the deterioration of muscle performance in several conditions. Objectives To quantify the degree of fatty infiltration in the thigh muscles of “cured” CS patients and evaluate the relationship between intramuscular fatty infiltration and physical performance. Design This was a cross-sectional study. Setting Tertiary referral center. Patients Thirty-six women with CS in remission, and 36 controls matched for age, BMI, menopausal status, and level of physical activity. Main Outcome Measures We analyzed the percentage fat fraction (FF) of the thigh muscles in the anterior, posterior, and combined anterior and posterior compartments using MRI and 2-point Dixon sequence. We assessed muscle function and strength using the following tests: gait speed (GS), timed up and go (TUG), 30-second chair stand, and hand grip strength. Results Fat fraction in all the compartments analyzed was increased in patients as compared with controls. The performance on TUG, 30-second chair stand, and GS was more impaired in CS patients versus controls. In patients, greater FF was negatively associated with performance on functional tests. Fat fraction in the combined anterior and posterior compartments predicted performance on TUG (ß 0.626, P < 0.000) and GS (ß -0.461, P = 0.007), after adjusting for age, BMI, menopausal status, and muscle mass. Conclusions Thigh muscle fatty infiltration is increased in “cured” CS patients and is associated with poorer muscle performance. Future studies are needed to establish therapeutic strategies to improve muscle weakness in these patients.
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Athimulam, Shobana, Danae Delivanis, Melinda Thomas, William F. Young, Sundeep Khosla, Matthew T. Drake, and Irina Bancos. "The Impact of Mild Autonomous Cortisol Secretion on Bone Turnover Markers." Journal of Clinical Endocrinology & Metabolism 105, no. 5 (March 10, 2020): 1469–77. http://dx.doi.org/10.1210/clinem/dgaa120.
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Abstract Context Several studies have reported increased risk of fragility fractures in patients with mild autonomous cortisol secretion (MACS), discordant to the degree of bone density deterioration. Objective To evaluate the effect of MACS on bone metabolism in patients with adrenal adenomas. Design Cross-sectional study with prospective enrollment, 2014-2019 Setting Referral center. Patients 213 patients with adrenal adenomas: 22 Cushing syndrome (CS), 92 MACS and 99 nonfunctioning adrenal tumors (NFAT). Main Outcome Measures Osteocalcin, procollagen I intact N-terminal (PINP), C-terminal telopeptide (CTX), sclerostin. Results Patients with CS demonstrated lower markers of bone formation compared with patients with MACS and NFAT (CS vs MACS vs NFAT: mean osteocalcin 14.8 vs 20.1 vs 21.3 ng/mL [P < 0.0001]; mean PINP 34.8 vs 48.7 vs 48.5 µg/L [P = 0.003]). Severity of cortisol excess was inversely associated with sclerostin (CS vs MACS vs NFAT: mean sclerostin 419 vs 538 vs 624 ng/L, [P < 0.0001]). In a multivariable model of age, sex, body mass index, cortisol, and bone turnover markers, sclerostin was a significant predictor of low bone mass in patients with MACS (OR 0.63 [CI 95%, 0.40–0.98] for each 100 ng/L of sclerostin increase). After adrenalectomy, osteocalcin, CTX, and sclerostin increased by a mean difference of 6.3 ng/mL, 0.12 ng/mL, and 171 pg/mL (P = 0.02 for all), respectively. Conclusions Lower sclerostin level in patients with MACS reflects a reduction in osteocyte function or number associated with exposure to chronic cortisol excess. Increase in bone turnover markers after adrenalectomy suggests restoration of favorable bone metabolism.
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Kazemi, Maryam, Brittany Y. Jarrett, Stephen A. Parry, Anna E. Thalacker-Mercer, Kathleen M. Hoeger, Steven D. Spandorfer, and Marla E. Lujan. "Osteosarcopenia in Reproductive-Aged Women with Polycystic Ovary Syndrome: A Multicenter Case-Control Study." Journal of Clinical Endocrinology & Metabolism 105, no. 9 (July 2, 2020): e3400-e3414. http://dx.doi.org/10.1210/clinem/dgaa426.
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Abstract Context Osteosarcopenia (loss of skeletal muscle and bone mass and/or function usually associated with aging) shares pathophysiological mechanisms with polycystic ovary syndrome (PCOS). However, the relationship between osteosarcopenia and PCOS remains unclear. Objective We evaluated skeletal muscle index% (SMI% = [appendicular muscle mass/weight (kg)] × 100) and bone mineral density (BMD) in PCOS (hyperandrogenism + oligoamenorrhea), and contrasted these musculoskeletal markers against 3 reproductive phenotypes (i): HA (hyperandrogenism + eumenorrhea) (ii); OA (normoandrogenic + oligoamenorrhea) and (iii), controls (normoandrogenic + eumenorrhea). Endocrine predictors of SMI% and BMD were evaluated across the groups. Design, Setting, and Participants Multicenter case-control study of 203 women (18-48 years old) in New York State. Results PCOS group exhibited reduced SMI% (mean [95% confidence interval (CI)]; 26.2% [25.1,27.3] vs 28.8% [27.7,29.8]), lower-extremity SMI% (57.6% [56.7,60.0] vs 62.5% [60.3,64.6]), and BMD (1.11 [1.08,1.14] vs 1.17 [1.14,1.20] g/cm2) compared to controls. PCOS group also had decreased upper (0.72 [0.70,0.74] vs 0.77 [0.75,0.79] g/cm2) and lower (1.13 [1.10,1.16] vs 1.19 [1.16,1.22] g/cm2) limb BMD compared to HA. Matsuda index was lower in PCOS vs controls and positively associated with SMI% in all groups (all Ps ≤ 0.05). Only controls showed associations between insulin-like growth factor (IGF) 1 and upper (r = 0.84) and lower (r = 0.72) limb BMD (all Ps < 0.01). Unlike in PCOS, IGF-binding protein 2 was associated with SMI% in controls (r = 0.45) and HA (r = 0.67), and with upper limb BMD (r = 0.98) in HA (all Ps < 0.05). Conclusions Women with PCOS exhibit early signs of osteosarcopenia when compared to controls likely attributed to disrupted insulin function. Understanding the degree of musculoskeletal deterioration in PCOS is critical for implementing targeted interventions that prevent and delay osteosarcopenia in this clinical population.
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M. W., Muthoga,. "Client Satisfaction with Public Housing Maintenance Contractors: A Case Study of Nairobi City County." International Journal of Scientific Research and Management 8, `10 (October 15, 2020): 29–38. http://dx.doi.org/10.18535/ijsrm/v8i10.cs01.
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Coupled with the challenge of housing shortage in view of the growing urban population in Nairobi City County currently at 4.4 Million, the public housing sector is faced with deteriorating quality housing particularly for the low income residents and Public residential units, characterized by a poor state of maintenance. The foregoing points to an infringement of the right of access to adequate and decent housing as a basic right for every Kenyan as entrenched in the bill of rights in the constitution of Kenya, 2010. In an effort to transform the foregoing scenario, the County Government of Nairobi, through its Urban Renewal, Housing and Projects Management sector procures maintenance and other technical services from private sector contractors for renovation of old NCCG housing units and public housing amenities including water and sanitation, among other services. It however remains unexplored in the Kenyan body of knowledge, the extent to which NCCG is satisfied with the maintenance services by private contractors. Against this backdrop, the study set out to assess client satisfaction with public housing maintenance contractors with reference to Nairobi City County. The study adopted the descriptive study design, sampling 43 staff from NCCG’s, Urban Renewal, Housing and Projects Management sector. data was collected by use of structured questionnaires and analyzed by descriptive and inferential statistics. Findings indicate that the maintenance strategy adopted has a significant effect (β=.332, P value=.050=.05) on client satisfaction with service delivery by public housing maintenance contractors. The study however found that the procurement method adopted does not have a significant effect (β=.078, P value=.639>.05) on client satisfaction with service delivery by public housing maintenance contractors. The study recommends a combination of preventive, predictive and condition-based maintenance as they assure the longevity of public houses and avoidance of longer term costly and frequent renovations.
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Radek, Radek, Helena Hanusova, and Zuzana Lipovska. "The Importance of Marketing Strategy for Creating and Maintaining Goodwill for Construction Companies." Journal of International Business Research and Marketing 6, no. 2 (2021): 21–26. http://dx.doi.org/10.18775/jibrm.1849-8558.2015.62.3004.
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If a company wants to have a long-term presence on the market, it must have a long-term marketing strategy. It should respect the expected technical, technological and socio-economic development. All these factors are clearly manifested in the construction industry. Construction activities are specific in that their products are for long-term use and financially demanding for the investor. The underestimation of trends, technological changes and investor requirements leads to loss of clients and a significant deterioration in the economic situation. Creating a marketing strategy to keep it on the market can prevent these problems. In construction it means estimating trends and shaping a marketing strategy. This activity is very demanding and costly. It leads to the creation of Goodwill and its focus and is an integral part of the company’s assets. If is the marketing strategy insufficient or wrong, it will result in the loss of Goodwill and therefore clients in the market. Construction companies needs to build Goodwill and record it as part of the company’s property. Goodwill is also part of internal accounting. This is where the cost of marketing will take place, not only in terms of costs. There is a need for companies to deliberately choose the methods through which they will express the value of Goodwill.
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Semenova, Maria, and Victoria Kulikova. "Informal Loans in Russia: Why Not to Borrow from a Bank?" Review of Pacific Basin Financial Markets and Policies 19, no. 03 (September 2016): 1650016. http://dx.doi.org/10.1142/s0219091516500168.
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After the 2008 crisis, the Russian consumer loan market shows high growth rates, accompanied by the quality deteriorating even faster. At the same time, a great proportion of households are not attracted by the banks and borrow informally. In this paper, we aim to learn why households refuse to become bank clients, using the data from a 2009–2010 national survey of Russian households. Our results suggest that household's choice of the informal credit market is based not only on credit rationing, but also on a lack of financial literacy, credit discipline and trust in the banking sector as a whole.