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Rahman, M. Shafiq-Ur. "Public transport in a small island of a developing country." urbe. Revista Brasileira de Gestão Urbana 4, no. 1 (June 2012): 61–72. http://dx.doi.org/10.1590/s2175-33692012000100005.
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This paper explores the existing forms of public transport system and their services as well as travel pattern of people in Siquijor Province, an island of the Philippines. Household questionnaire survey, interview of the passengers of various public transport modes at their stations, and a detailed participatory observation were conducted for the research. Bus, jeepney, easyride, tricycle, and habalhabal are the available public transport systems in the island. However, these services do not provide travel time, waiting time, availability or frequency, comfort, and safety that is required by passengers. Majority of the people mostly prefer the easyride for comfort and less waiting time whilst the bus for comfort. Considering the travel pattern, socio-economic situation and topographic condition, the research tried to identify which form of public transport system would be appropriate for the island. It was found that bus is appropriate for longer trips while easyride for the inter-municipal trips and habalhabal for the trips in mountain areas.
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Preston, John. "Big buses in a small country: The prospects for bus services in Wales." Research in Transportation Economics 59 (November 2016): 379–87. http://dx.doi.org/10.1016/j.retrec.2016.07.023.
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Ibrahim, Niyan Hussien, Rozhen Kamal Mohammed-Amin, and Alan Faraydoon Ali. "Measuring Service Quality of Bus Services in Sulaimani City." Kurdistan Journal of Applied Research 5, no. 1 (June 30, 2020): 270–86. http://dx.doi.org/10.24017/science.2020.1.19.
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This research paper presents a descriptive model to assess the quality of bus services by measuring passengers’ satisfaction in Sulaimani city. Transportation facilities are enlivening the economic activities of any country. Public transportation services are an important aspect of any urban transportation system, as they provide mobility for a number of passengers to different destinations in different directions at the same time via one transportation facility. Public transportation is considered a sustainable mode of transportation. This study intends to assess the services’ quality and identify the challenges to sustainable development in public transportation in order to achieve sustainable development for the current public transportation system. A passenger survey was conducted in order to assess the level of service quality including 300 participants. The study depends mainly on the passengers’ survey, as well as interviews and personal observations for data collection. SPSS software and GIS are used for Data analysis. The results show the outcomes of the assessment process of the current system based on passenger’s opinions. The results reveal the system’s aspect in detail which is further clarified in the conclusion. The paper recommends several steps to be adopted in order to improve the current public transportation system in Sulaimani and other cities, it also suggests future studies that can integrate with this study and contribute in achieving its goal
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Viggiano, Cecilia, Haris N. Koutsopoulos, Nigel H. M. Wilson, and John Attanucci. "Applying Spatial Aggregation Methods to Identify Opportunities for New Bus Services in London." Transportation Research Record: Journal of the Transportation Research Board 2672, no. 8 (September 20, 2018): 75–85. http://dx.doi.org/10.1177/0361198118797218.
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Kumar, Ravindra, Errampalli Madhu, Amit Dahiya, and Sanjeev Sinha. "Analytical hierarchy process for assessing sustainability." World Journal of Science, Technology and Sustainable Development 12, no. 4 (October 5, 2015): 281–93. http://dx.doi.org/10.1108/wjstsd-05-2015-0027.
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Purpose – The purpose of this paper is to study the analytical hierarchy process (AHP) based on assessment of sustainability indicators for public transportation system including pedestrians and feeder services in developing country. Design/methodology/approach – A hybrid approach based on the AHP is considered for assessment of the sustainability of public transportation system including pedestrians and feeder services. Sustainability related indicators for public transportation system (namely for metro, bus and feeder bus) and pedestrians based on past data were reviewed and subsequently, more important indicators catering needs of developing country have been added to achieve significant sustainability score and a total of 17 indicators were selected for assessment of comprehensive sustainability (seven indicators under economic, six under social and four under environmental categories). Findings – For quantifying the assessment, specific user interview surveys are performed in south Delhi region and accordingly perception of user and transportation-related operational characteristics of the public transport system were also collected. Preliminary result shows air pollution in environmental category, public health in social category and productivity in economic category is most influential parameters in developing country. Originality/value – AHP method is applied for rating the criteria and setting out the priority of designed sustainable indicators. Subsequently sustainable mitigation measures and scenarios for the study area can be evaluated utilizing developed comprehensive sustainability indicator for public transportation system including pedestrian and feeder services available in developing country.
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Hendy, Peter. "New Development: Exemplary Provision of Bus Services-Is London a Model for Other Conurbations?" Public Money and Management 25, no. 3 (June 2005): 195–200. http://dx.doi.org/10.1111/j.1467-9302.2005.00473.x.
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Rosevear, Alan, Dan Bogart, and Leigh Shaw-Taylor. "The spatial patterns of coaching in England and Wales from 1681 to 1836: A geographic information systems approach." Journal of Transport History 40, no. 3 (September 26, 2019): 418–44. http://dx.doi.org/10.1177/0022526619875258.
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Passenger coach services grew enormously in England and Wales between 1681 and 1836. This article documents the spatial patterns using data from trade directories, original maps and geographic information systems. Digital mapping illustrates the development of long-distance services from London to various destinations, including resorts, ports, industrial towns and county towns. Mapping also illustrates the development of Country services between provincial towns, especially major hubs like Manchester and Birmingham, and commuter traffic around large conurbations. Overall the maps and figures point to substantial change in destinations and the structure of the coach network. Country coach services increased after the 1790s to complement the London services. By 1835, an extensive, interlinked network of long-stage coaches grew across the country and a radial network of daily-return services grew on roads leading into London. Beyond coaching, our findings illustrate how traditional primary sources can yield new insights when combined with geographic information systems.
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Morse, Lindsey, Mark Trompet, Alexander Barron, and Daniel J. Graham. "Development of a Key Performance Indicator System to Benchmark Relative Paratransit Performance." Transportation Research Record: Journal of the Transportation Research Board 2650, no. 1 (January 2017): 1–8. http://dx.doi.org/10.3141/2650-01.
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The Americans with Disabilities Act of 1990 prohibits discrimination against people with disabilities. U.S. transit agencies are therefore required to offer eligible customers services that complement the mobility opportunities provided to the general public on fixed-route public transit. Although these paratransit services are necessary and just, they represent a proportionally large cost to agencies: approximately eight times the cost per boarding compared with fixed-route bus service. To be able to identify opportunities for cost efficiencies and to further improve the quality of paratransit services offered, the 20 agencies of the American Bus Benchmarking Group decided to benchmark their relative performance in paratransit management and operations. A key performance indicator system was developed, and associated data items were defined in detail to ensure comparability of agencies’ performance and hence ensure the usefulness of the benchmarking program. The scope of this system went beyond the data already provided to the National Transit Database, both in amount and in granularity of data collected as well as the detail of definitions. The challenges, respective solutions, and other lessons identified during 4 years of paratransit benchmarking development led by Imperial College London, the American Bus Benchmarking Group facilitators, are described. The paper provides transit agencies and authorities as well as benchmarking practitioners and academics an opportunity to apply these lessons for the further benefit of paratransit services and their customers around the United States.
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Horobets, Natalia, and Tatiana Shaban. "Ukrainian Cross-Border Governance since the Beginning of COVID-19." Borders in Globalization Review 2, no. 1 (December 15, 2020): 62–65. http://dx.doi.org/10.18357/bigr21202019895.
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European countries that are normally associated with freedom of movement have temporarily closed their internal (within the European Union) and external borders in response to the outbreak of COVID-19 starting spring 2020. Border closures have heavily impacted the whole European region, including its Eastern European neighbours. As of March, Ukraine stopped all regular passenger services, so that people were not able to leave the country by plane, train or bus. It seriously complicated routine activities of those Ukrainians who were planning to travel out of their country through Europe (and Russia) for various purposes, including work, study, and family visits.
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GREEN, JUDITH, ALASDAIR JONES, and HELEN ROBERTS. "More than A to B: the role of free bus travel for the mobility and wellbeing of older citizens in London." Ageing and Society 34, no. 3 (November 6, 2012): 472–94. http://dx.doi.org/10.1017/s0144686x12001110.
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ABSTRACTThis study contributes to the literature on mobility and wellbeing at older ages through an empirical exploration of the meanings of free bus travel for older citizens, addressing the meanings this holds for older people in urban settings, which have been under-researched. Taking London as a case study, where older citizens have free access to a relatively extensive public transport network through a Freedom Pass, we explore from a public health perspective the mechanisms that link this travel benefit to determinants of wellbeing. In addition to the ways in which the Freedom Pass enabled access to health-related goods and services, it provided less tangible benefits. Travelling by bus provided opportunities for meaningful social interaction; travelling as part of the ‘general public’ provided a sense of belonging and visibility in the public arena – a socially acceptable way of tackling chronic loneliness. The Freedom Pass was described not only as providing access to essential goods and services but also as a widely prized mechanism for participation in life in the city. We argue that the mechanisms linking mobility and wellbeing are culturally, materially and politically specific. Our data suggest that in contexts where good public transport is available as a right, and bus travel not stigmatised, it is experienced as a major contributor to wellbeing, rather than a transport choice of last resort. This has implications for other jurisdictions working on accessible transport for older citizens and, more broadly, improving the sustainability of cities.
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Lloyd, David, David Yates, and Tim Coats. "Preparing the country for another major terrorist event." Bulletin of the Royal College of Surgeons of England 88, no. 1 (January 1, 2006): 10–11. http://dx.doi.org/10.1308/147363506x85840.
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The explosions in London on 7 July 2005 led to scenes of human and structural devastation not experienced since the second world war. The blast injuries that predominated were outside the experience of most contemporary emergency workers. Nevertheless, the general impression is that the response by the various emergency services seems to have been well organised and effective. However, there will no doubt also be lessons to be learned for the future. This successful response can be attributed to the level of disaster preparedness that has been developed in London (as in other parts of the country) following previous terrorist attacks and transport accidents; in addition, in the case of the emergency care of the injured there was the availability of medical expertise and facilities.
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Hibbs, John. "Book Review: Odiham Motor Services: The Nancy Bus, Thank You, Driver, Simpson's of Leaden Roding: A Pioneer Essex Country Busman." Journal of Transport History 13, no. 2 (September 1992): 207. http://dx.doi.org/10.1177/002252669201300228.
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Green, Judith, Rebecca Steinbach, Alasdair Jones, Phil Edwards, Charlotte Kelly, John Nellthorp, Anna Goodman, Helen Roberts, Mark Petticrew, and Paul Wilkinson. "On the buses: a mixed-method evaluation of the impact of free bus travel for young people on the public health." Public Health Research 2, no. 1 (February 2014): 1–206. http://dx.doi.org/10.3310/phr02010.
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BackgroundIn September 2005 London introduced a policy granting young people aged < 17 years access to free bus and tram travel. A year later this policy was extended to people aged < 18 years in education, work or training. This intervention was part of a broader environmental strategy in London to reduce private car use, but its primary aim was to decrease ‘transport exclusion’, and ensure that access to goods, services, education and training opportunities were not denied to some young people because of transport poverty. However, there were also likely to be positive and negative health implications, which were difficult to assess in the absence of a robust evidence base on the impact of transport policies on health and well-being.ObjectivesTo evaluate the impact of free bus travel for young people in London on the public health. Specifically, to provide empirical evidence for the impact of this ‘natural experiment’ on health outcomes and behaviours (e.g. injuries, active travel) for young people; explore the effects on the determinants of health; identify the effects on older citizens of increased access to bus travel for young people and to identify whether or not the intervention represented value for money.DesignQuasi-experimental design, using secondary analysis of routine data, primary qualitative data and literature reviews.SettingLondon, UK.ParticipantsYoung people aged 12–17 years and older citizens aged ≥ 60 years.InterventionThe introduction of free bus travel for those aged < 17 years living in London in 2005, extended to those aged < 18 years in 2006.Main outcome measuresQuantitative: number of journeys to school or work; frequency and distance of active travel (i.e. walking and/or cycling), bus travel, car travel; incidence of road traffic injuries and assaults and socioeconomic gradients in travel patterns. Qualitative: how free bus travel affected young people and older citizens’ travel and well-being.MethodsQuantitative component: change-on-change analysis comparing pre–post change in the target age group (12–17 years) against that seen in ‘non-exposed’ groups [for travel mode, road traffic injury (RTI) and assaults]. Qualitative component: interviews analysed using both deductive and inductive methods. Economic evaluation: cost–benefit analysis (CBA).Data sourcesLondon Area Transport Survey (LATS) and London Travel Demand Survey (LTDS) (travel mode); STATS19 Road Accident data set (RTI); Hospital Episode Statistics (HES) (assaults); interviews with young people and older citizens; and cost data from providers and literature reviews.ResultsThe introduction of free bus travel for young people was associated with higher use of bus travel by adults and young people [31% increase, 95% confidence interval (CI) 19% to 42%; and 26% increase, 95% CI 13% to 41%, respectively], especially for short journeys, and lower car distances relative to adults (relative change 0.73, 95% CI 0.55 to 0.94); no significant overall reduction in ‘active travel’ [reduction in number of walking trips but no evidence of change in distance walked (relative change 0.99, 95% CI 0.92 to 1.07)]; significant reduction in cycling relative to adults (but from a very low base); a reduction in road traffic injuries for car occupants (relative change 0.89, 95% CI 0.84 to 0.95) and cyclists (relative change 0.60, 95% CI 0.55 to 0.66), but not pedestrians; an overall modest increase in journeys to work or school (relative change 1.09, 95% CI 1.06 to 1.14); equivocal evidence of impact on socioeconomic gradients in travel behaviour and no evidence of adverse impact on travel of older people aged > 60 years. An increase in assaults largely preceded the scheme. Qualitative data suggested that the scheme increased opportunities for independent travel, social inclusion, and a sense of belonging and that it ‘normalised’ bus travel. The monetised benefits of the scheme substantially outweighed the costs, providing what the Department for Transport (DfT) considers ‘high’ value for money.ConclusionThe free bus travel scheme for young people appears to have encouraged their greater use of bus transport for short trips without significant impact on their overall active travel. There was qualitative evidence for benefits on social determinants of health, such as normalisation of bus travel, greater social inclusion and opportunities for independent travel. In the context of a good bus service, universal free bus travel for young people appears to be a cost-effective contributor to social inclusion and, potentially, to increasing sustainable transport in the long term. Further research is needed on the effects of both active and other travel modes on the determinants of health; the factors that influence maintenance of travel mode change; travel as ‘social practice’; the impact of driving license changes on injury rates for young adults and the value of a statistical life for young people.FundingThe National Institute for Health Research Public Health Research programme.
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L. Chaudhary, Mahesh. "Commuters’ Perceptions on Service Quality of Bus Rapid Transit Systems: Evidence from the Cities of Ahmedabad, Surat and Rajkot in India." European Transport/Trasporti Europei 79, ET.2020 (September 2020): 1–16. http://dx.doi.org/10.48295/et.2020.79.7.
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Urban public transport is gaining significant importance in today’s world. This is evident from the fact that it has found its place in United Nations Development Programme’s Sustainable Development Goals in the eleventh goal pertaining to ‘Sustainable cities and communities’. The competitiveness of the cities largely depends on the robustness of their transport systems. In India there has been huge spending on the public transport projects in cities across the country. Ahmedabad, Surat and Rajkot from Gujarat, India have been the beneficiaries of these investments. Capturing the demand side quality of services is very important for such projects and hence the attempt has been made to study whether the commuters’ perceptions on quality of services of Bus Rapid Transit systems vary across different demographic cohorts. There are nine demographic cohorts used for the study. SERVPERF model has been adopted to study the performance of Bus Rapid Transit systems in the said citied. The performance is evaluated over the six factors namely; tangibles, empathy, cleanliness, reliability, safety and affordability. It has been found that Surat tops among the three cities followed by Rajkot and Ahmedabad on various service quality factors. Also commuters’ perception towards quality of service dimensions vary across demographic cohorts like gender, time of travel, education, employment status, length of patronization and purpose of trip.
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Parry, Ian W. H., and Kenneth A. Small. "Should Urban Transit Subsidies Be Reduced?" American Economic Review 99, no. 3 (May 1, 2009): 700–724. http://dx.doi.org/10.1257/aer.99.3.700.
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This paper derives empirically tractable formulas for the welfare effects of fare adjustments in passenger peak and off-peak rail and bus transit, and for optimal pricing of those services. The formulas account for congestion, pollution, accident externalities, scale economies, and agency adjustment of transit service offerings. We apply them using parameter values for Washington (DC), Los Angeles, and London. The results support the efficiency of the large current fare subsidies; even starting with fares at 50 percent of operating costs, incremental fare reductions are welfare improving in almost all cases. These findings are robust to alternative assumptions and parameters. (JEL L92, R41, R42, R48)
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Kirk, C. M., and D. M. Bibby. "The Knowledge Economy in New Zealand." Industry and Higher Education 15, no. 1 (February 2001): 55–61. http://dx.doi.org/10.5367/000000001101295498.
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Emanating from its ‘last bus stop on the planet’ remoteness, New Zealand has traditionally faced significant barriers to the development of its export base. In the new knowledge-based economies, many of these barriers no longer apply. In order to take advantage of this new global environment and turn around its declining economic performance, New Zealand must take a number of key steps. The authors propose an approach that will enable the country to develop a knowledge-based advanced technology sector that will: specialize in niche products; be flexible and responsive; have a range of products and services across a number of industrial sectors; and have a global market focus. In proposing this solution, they focus on the respective roles of government, industry, research providers and education providers, and make recommendations accordingly.
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Priebe, S. "Mental health and european big cities: London." European Psychiatry 26, S2 (March 2011): 2118. http://dx.doi.org/10.1016/s0924-9338(11)73821-4.
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Big cities in Europe are characterised by social factors that can influence mental health and impact on the provision of mental health care. These factors include social inequalities, social marginalisation and fragmentation, large scale immigration, and a high proportion of mobile populations. Big cities tend to have higher levels of morbidity and higher costs of service provision than other parts of the same country. This leads to specific challenges, particularly in inner city areas. The paper summarises how mh services in London approach these challenges, how they are organised and how they have changed over the last 10 years. Services are provided by the NHS with an emphasis on care in the community. Whilst there have been large investments in mental health care and the establishment of a range of new teams with specialised functions over the last 10 years, recently funding has come under pressure and service provision may need to be reduced. There has also been a stronger focus on risk issues and the introduction of compulsory treatment in the community.Taking the example of East London as the most deprived area in London, the paper will illustrate how traditional principles of sectorisation, catchment area responsibility and continuity of care have been put into question with potentially new solutions to old problems. The paper will also briefly describe how mental health care for socially marginalised groups is provided and compare the situation in London against that in other European capitals as investigated in the EC funded PROMO Study.
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Mold, Alex, and Virginia Berridge. "Crisis and Opportunity in Drug Policy: Changing the Direction of British Drug Services in the 1980s." Journal of Policy History 19, no. 1 (January 2007): 29–48. http://dx.doi.org/10.1353/jph.2007.0004.
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During the 1980s illegal drug use in Britain appeared to be increasing at an alarming rate and spreading across the country on an unprecedented scale. An apparent growth in the use of heroin caused particular concern: the number of known heroin addicts rose from just over two thousand in 1977 to more than ten thousand by 1987. Moreover, heroin use was being reported in urban areas throughout the country. This was in contrast to previous decades, when it was thought that drug use was largely confined to London. By 1985 the Conservative government was able to assert that “the misuse of drugs is one of the most worrying problems facing our society today.” Growing fears about drug use prompted a flurry of activity from both central and local government, from law enforcement bodies, voluntary organizations, and health professionals.
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Sumartini, Sumartini. "EVALUATION OF OPERATIONAL RISK MANAGEMENT IN TECHNICAL IMPLEMENTATION UNITS OF MOTOR VEHICLES IN SUPPORTING THE CONTINUATION OF LOGISTIC PATHWAYS IN WEST JAVA." Journal of Architectural Research and Education 1, no. 1 (April 11, 2019): 50. http://dx.doi.org/10.17509/jare.v1i1.16502.
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Risk management is important in supporting all objectives of the West Java Province Motor Vehicle Testing Technical Implementation Unit, namely providing technical safety guarantees for the use of motorized vehicles, trailer trains and postage trains on the road, supporting the realization of environmental sustainability from possible pollution caused by motorized vehicle use. trailer and train carts on the road, and provide public services to the community. Vehicles operated on the road include bus cars, goods cars, articulated cars, train carts, special vehicles and public transportation.The application of risk management can be used in all fields of work and even in various activities, including decision making, operations, processes, functions, projects, products, services and assets (ISO 31000, 2009). In Indonesia transportation has an important role in supporting national development. Indonesia is an archipelagic country where the development of the transportation sector is designed to support the movement of the economy, national stability and also reduce development inequality between regions by expanding the reach of the distribution of goods and services throughout the archipelago. With the existence of transportation, the economy of the community is more evenly distributed so that it is expected that people's welfare will increase, because the community is easier to get the goods and services needed. One of the important facilities in the land transportation sector is motorized vehicles.Keywords: Environmental, Sustainability, Pollution, Transportation
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Michael Ngala, Orucho, and Chemutai Patricia. "Differentiation Strategy and Performance of Long-distance Bus Companies in Keny." International Journal of Business and Management 14, no. 10 (September 5, 2019): 146. http://dx.doi.org/10.5539/ijbm.v14n10p146.
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Safe transport is an essential element to the development of an economy of any country. Transport enables
movement of people, services and goods, from one location to another one. In Kenya, majority of the population
who travel beyond three hundred (300) kilometres commonly use long distance bus service. Travelling for a long
distance in a poorly maintained bus can be quite uncomfortable. Some buses are normally over-packed with hard
seats, poor ventilation, overly slow or overly speedy and poor sanitation. Consequently, long distances need the
most comfortable travelling medium to at least not get over exhausted. In product differentiation strategy, a firm
seeks to be unique in its product offing compared to its competitors. This study sought to contribute to
knowledge by assessing the influence of differentiation strategy on performance of long-distance bus companies
in Kenya. Porter’s generic strategies are the main model anchoring the study. Cross-Sectional survey was used as
research design. The population of the study consists of fifty one (51) registered and licensed long distance bus
companies in Kenya. Primary and secondary data were collected by the use of a structured questionnaires and
review of regulatory bodies’ websites and availed documents. Correlation and regression analyses were used to
test hypotheses. Not all organizational performance determinants were included but balanced score card was
appropriately used to reflect non-financial and financial indicators. Results show that safety strategy has the most
significant influence on performance of long-distance bus companies in Kenya. This was followed by comfort
and reliability respectively. The significance of safety measures when it comes to transporting people is quite
critical. The central recommendation that the study offers as impetus to strategic management body of
knowledge, transport companies and policy makers is the need to consider safety measures as the most essential
differentiating features in transport management in order to win the confidence and loyalty of passengers thus
enhance performance. The major limitation of this study is that primary data was gathered from three (3) bus
company managers only per company. However, additional secondary data was used to validate primary data
hence reduce common bias.
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SHYNKARENKO, V., and M. A. MAMEDOV. "FEATURES OF THE COMPETITION IN THE MARKET OF MOTOR TRANSPORT SERVICES." Economics of the transport complex, no. 37 (May 12, 2021): 133. http://dx.doi.org/10.30977/etk.2225-2304.2021.37.133.
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The role of road transport in the transport system of the country and its tasks in solving socio-economic problems facing Ukraine are shown. It is noted that many problems of development of market relations, emergence and development of competitiveness are solved by scientists at the level of the state, the branch, the enterprise. However, some aspects of this problem require further study, especially at the level of certain market types. Particular conditions for the market functioning are given. Definitions of the concept of the market from various positions are offered: sellers and consumers, consumers, the economic theory. Brief characteristics of different types of market are given, allocated according to the factors: territorial, number of subjects, interest of consumers to service, types of consumers, objects of the market. The general features of the market of motor transport services with other branch markets are established, its features are highlighted.
The components of the market of motor transport services are determined: objects, market subjects, subject of competition, criteria of competitiveness. As the main objects of allocation of freight transport segments are marked by the following factors: branches for which transportation is carried out; frequency of provision; territorial boundaries; forms of organization, type of cargo and scale of transportation. As part of passenger traffic, segments are distinguished by the following characteristics: type of rolling stock (bus, car, service, taxi, rolling stock), territorial boundaries; appointments (excursion, tourist, office, school shift, special); forms of organization; scale of traffic (single, mass).
The types of market participants (sellers, buyers, intermediaries) are defined by field of activity, their characteristics are given. Their types, motives of behavior are revealed.
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Koushki, P. A., G. A. Ali, and Y. A. Al-Nuaim. "Calibration of Transit Operations Planning (TOP) Model and Evaluation of Bus Transit Route Performance in Riyadh." Sultan Qaboos University Journal for Science [SQUJS] 2 (December 1, 1997): 5. http://dx.doi.org/10.24200/squjs.vol2iss0pp5-16.
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Public transit systems provide mobility for a large percentage of urban residents very cost-effectively and with minimum negative impact on the environment. ln spite of their vital and indispensable services; however , The majority of transit systems worldwide suffer from financial neglect and are forced to rely heavily on government subsidies for survival. In response to the rapidly shrinking funds and subsidy levels transit managements have to focus attention on ways to improve service operations. The management of public transit systems in Saudi Arabia is no exception to this trend. This study is aimed at evaluating the service performance of a sample of regular (fixed-route, fixed schedule) bus transit routes in Riyadh, Saudi Arabia. Utilizing a microcomputer-based program, the bus transit service operational measures of fare, headway, vehicle size and routing were analyzed. To account for the socio-economic and cultural differences of transit ridership in Riyadh, time/cost elasticities of demand as well as walk time and bus travel time parameters of the model were calibrated. Evaluation of the impact of changes in service operational measures suggested that no change in operational variables could improve the very low productivity of one of the sample study routes. A cost-reduction strategy which includes the use of smaller vehicles and less-frequent service runs should improve the low productivity of this route. Findings also indicated that a small increase in fare would pay for the total operation and maintenance costs of the other routes. The authors, however, do not recommend an increase in fare for a variety of reasons; the low income level of the captive riderships, the enormous financial resources of the country , and the multi-dimentional role of transit systems in providing urban mobility with minimum negative impacts on the environment.
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Halsall, David. "Any More Fares? Delivering Better Bus Services, Tony Grayling (Ed.), Institute for Public Policy Research, London, (2001), ISBN 1 86030 134 7, 226 pp, 14.95 (pbk)." Journal of Transport Geography 10, no. 3 (September 2002): 241–42. http://dx.doi.org/10.1016/s0966-6923(01)00043-6.
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Bunevska Talevska, Jasmina. "Toward Management Of Traffic Culture In Macedonia." Transport and Communications 7, no. 1 (2019): 56–60. http://dx.doi.org/10.26552/tac.c.2019.1.12.
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The World Health Organization in its agenda on sustainable development 2030 sets a goal to reduce the number of traffic-related accidents by 50% [1]. According to the trend of reducing the number of traffic-related accidents and the latest statistics report by SIA Bitola, this is a very high goal for our city and a great challenge which we could try to reach if we start acting right now by trying to rise and advance the traffic culture; to provide infrastructural facilities and elements that are planned and designed according to safety principles that correspond to the projected speed and road function, with access to frontal facilities and protective greenery as well as preserved historical and aesthetic features; to provide a safe infrastructure for pedestrians, the elderly and persons with disabilities, but primarily permanent and visually attractive; to provide a safe and continuous bicycle infrastructure; to introduce traffic calming; to exclude and limit access of freight vehicles for transit and traffic in housing zones; to improve the services of taxis and public bus transport of passengers, namely to improve everything related to safe traffic and transport in our country. The general objective of this article is presentation of the approach to raising traffic safety and improving the traffic culture in our country through field educational workshops on the example of the city of Bitola, Macedonia.
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Kurniawan, V. Reza Bayu, Trisna Yulianti, and Fransiska Hernina Puspitasari. "Fuzzy AHP – DEMATEL Methods To Investigate Passengers’ Decision Factors On Using Public City Bus In An Indonesian Region." OPSI 14, no. 1 (June 24, 2021): 10. http://dx.doi.org/10.31315/opsi.v14i1.4478.
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An advanced public transportation system becomes an indicator for a country. Accordingly, it is essential that the decision-makers (DMs) conduct an initial study based on passengers’ view in order to improve the public transportation services. Since involving multi factors, the problem is often solved using the multi-criteria decision-making (MCDM) approaches. This study aims to examine significant factors on passengers decision making to use public transportation using Fuzzy AHP and DEMATEL. The Fuzzy AHP method is proposed to determine criteria weights so that significant critera are obtained, then the causal relations including the criteria are visualized using DEMATEL. This study demonstrates the integration of the two MCDM methods in a BRT system in the region of Yogyakarta, Indonesia, and invites passengers and the DMs. The result indicated that 21 criteria are identified, while the 11 significant criteria are selected based on the Fuzzy AHP weight – α-cut screening. Besides, the DEMATEL has succeeded in describing the influence relationship for the criteria, where firstly, the significant criteria are classified into cause and effect group and secondly, the two criteria, namely coverage to strategic points and on time arrival, should be put on the top priority list. This study enables the DMs to solve public transportation problems more effectively. However, the follow-up study should be carried out by including other factors such as economic and sustainability to strengthen the decision-making process.
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Dobruszkes, Frédéric. "Air services at risk: The threat of a hard Brexit at the airport level." Environment and Planning A: Economy and Space 51, no. 1 (December 13, 2018): 3–7. http://dx.doi.org/10.1177/0308518x18816693.
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The potential impacts of Brexit on transportation have been discussed to some extent, mostly considering the economic shock as a main factor that would affect the volume of passenger and cargo flows. However, one should also consider the expected impact in terms of regulatory regimes. This specifically concerns aviation, traditionally a tightly regulated market that was extensively liberalised by the European Union. In this note, the worst scenario is tested. Namely, UK airlines would not operate services between or within third countries anymore, and non-UK airlines could only link the UK to their home country. This leads to the concept of ‘vulnerable’ air services, which are mapped at the airport level. The likely consequence is that a myriad of regional airports would be affected, especially in Poland, but also in various tourist areas. In addition, several larger airports and the secondary airports of large cities would be significantly affected, especially London Stansted.
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MARTSENIUK, Olena. "CURRENT TRENDS OF AUTOTRANSPORT INSURANCE IN UKRAINE." "EСONOMY. FINANСES. MANAGEMENT: Topical issues of science and practical activity", no. 2 (56) (June 29, 2021): 94–107. http://dx.doi.org/10.37128/2411-4413-2021-2-7.
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The research of the article is aimed at highlighting the essence and features of the functioning of the car insurance market in Ukraine. The study found that motor insurance is associated with profound economic and social changes in society due to mass motorization, the growth of the car fleet and traffic intensity, as well as huge material losses as a result of road accidents. It should be noted that freight transport is developing quite rapidly both within the country and abroad. At the same time, an increase in the number of intercity bus transportation, excursion and tourist bus services has been established, and as a result, international motor tourism is growing. It is proved that these factors contribute to the growth of accidents, losses in the transportation of goods, increase accidents with passengers and pedestrians on highways and, accordingly, material and social losses of society, population, commercial and government agencies. It is substantiated that insurance in general and civil liability insurance, as its integral part, is an infrastructure that helps to increase the efficiency of all areas of business. This determines the importance of the development of all types of insurance in Ukraine, taking into account the process of integration into the world community. It is established that the development of insurance market in our country should be based on the study and balanced use of experience of industrialized countries with long traditions in the insurance market, legal regulation of insurers and diversification of various types of insurance. However, it should be borne in mind that the world community has invented universal means of compensation, which is the most popular type of liability insurance worldwide – is the insurance of civil liability of owners of land vehicles. It provides for the payment of monetary compensation to the victim in the amount that would be collected from the owner of the vehicle on a civil lawsuit in favor of a third party for damage to life and health, as well as for damage or loss of property due to an accident or other road – transport accident due to the fault of the insured. Given the state and prospects of motorization in our country, as well as foreign experience in insurance market, we can say with confidence that liability insurance is one of the leading areas among other types of insurance. However, in its organization and implementation there are many different problems of legal, social, economic and organizational type. Recommendations on the prospects for the development of civil liability insurance of owners of land vehicles in Ukraine are given.
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Ghodse, Hamid. "Tomlinson on alcohol and drugs." Psychiatric Bulletin 17, no. 10 (October 1993): 579–81. http://dx.doi.org/10.1192/pb.17.10.579.
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Recognition of the problemSir Bernard Tomlinson's Report of the Enquiry into London's Health Service, Medical Education and Research (1992) starts with an excellent analysis of the particular problems associated with providing health care in the capital with its high density and turnover of population and disproportionate burden of severe deprivation. He emphasises the particular problems that arise because of the flow into London of vulnerable people with mental illness, drug addiction problems and alcoholism, many of whom are homeless. The consequent difficulties are compounded by the fact that primary health care and community services are poorly developed in comparison with elsewhere in the country and may not be easily accessible to those who need them most. Inadequacies in comprehensive service provision contribute to the high usage of accident and emergency departments as providers of primary health care, where community nursing services are expensive because of higher staff costs and where the characteristics of the patient population referred to above, make maintaining effective contact very difficult.
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Hohlmeier, Michaela, and Christian Fahrholz. "The Impact of Brexit on Financial Markets—Taking Stock." International Journal of Financial Studies 6, no. 3 (July 16, 2018): 65. http://dx.doi.org/10.3390/ijfs6030065.
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The UK’s withdrawal from the EU will have far-reaching consequences on the European economy. However, the ultimate consequences of Brexit, especially for financial markets, depend on the final agreement, which is still under negotiation. Currently, regulated financial services can be provided across borders under simplified conditions. Without a special agreement, these EU passports cease to apply for business activities between both jurisdictions after Brexit. The EU third-country regimes for non-EEA companies are too few and too unsecure for intensive relations in trade and services. Knowing that London is the leading global financial center, an adequate agreement needs to be found, to ensure affordable and sufficient financial services for business, investors, and consumers. Unfortunately, it appears almost impossible to find solutions for the often contrary interests and various thematic areas in the remaining negotiating period—a no deal scenario becomes more likely. As a result, market participants have started to adapt structures and processes accordingly, by relocating certain functions to the EU27. Nevertheless, it is up to the negotiators to reach an agreement, which achieves the best possible outcome for all affected parties taking into account the opportunity costs of a failure in present Brexit negotiations.
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Salisbury, Chris, Anna Quigley, Nick Hex, and Camille Aznar. "Private Video Consultation Services and the Future of Primary Care." Journal of Medical Internet Research 22, no. 10 (October 1, 2020): e19415. http://dx.doi.org/10.2196/19415.
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In many countries, private companies provide primary care services based predominantly on offering video consultations via smartphones. One example is Babylon GP at Hand (BGPaH), which offers video consultations to National Health Service patients, 24 hours a day, and has grown rapidly in London over the last 3 years. The development of this type of service has been controversial, particularly in the United Kingdom, but there has been little formal published evaluation of these services in any country. This paper outlines the main controversies about the use of privately provided video consultation services for primary care and shows how they are informed by the limited evaluations that have been conducted, particularly the evaluation of BGPaH. This paper describes the advantages of these services in terms of convenience, speed of access, the ability to consult without traveling or face-to-face patient-doctor contact, and the possibility of recruiting doctors who cannot work in conventional settings or do not live near the patients. It also highlights the concerns and uncertainties about quality and safety, demand, fragmentation of care, impact on other health services, efficiency, and equity. There are questions about whether private primary care services based on video consultations have a sustainable business model and whether they will undermine other health care providers. During the recent COVID-19 pandemic, the use of video consulting has become more widespread within conventional primary care services, and this is likely to have lasting consequences for the future delivery of primary care. It is important to understand the extent to which lessons from the evaluation of BGPaH and other private services based on a video-first model are relevant to the use of video consulting within conventional general practices, and to consider the advantages and disadvantages of these developments, before video consultation–based services in primary care become more widely established.
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Gongal, Rajesh, B. Dhungana, S. Regmi, M. Nakarmi, and B. Yadav. "Need of Improvement in Emergency Medical Service in Urban Cities." Journal of Nepal Medical Association 48, no. 174 (April 1, 2009): 139–43. http://dx.doi.org/10.31729/jnma.230.
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Introduction: An effective Emergency Medical Service system does not exist in Nepal. For an effective EMS system to be developed the scale of the problem and the existing facilities need to be studied. Methods: Prospective observational study was carried out on 1964 patients attending Emergency Department at Patan Hospital during one month period of September 2006. The patients were specifically enquired on mode of transport used, place of origin and whether they called for an ambulance or not. Patients triage category at the time of triaging was also noted. Information on ambulance service were collected by direct interview with the service providers and the total number of patients attending Emergency Departments daily were collected from the major hospitals of the urban Lalitpur and Kathmandu. MS Excel and SPSS software were used for data entry, editing and analysis.Results: Total 9.9% patients arrived in ambulance whereas 53.6% came in a Taxi, 11.4% came in private vehicle, 13.5 % came by bus, 5.4% came by bike and the rest 6.2% came by other modes of transportation. Only 13.5% of triage category I patients took the ambulance. There were 31 service providers with 49 ambulances and 720 patients per day attend Emergency Departments in the surveyed area. Conclusions: Very less number of patients use the ambulance service for emergency services. The available ambulances are not properly equipped and do not have trained staff and as such are only a means of transportation to the hospitals of urban Lalitpur and Kathmandu.Key Words: ambulance, emergency medical service, para-medics, triage Need of Improvement in Emergency Medical Service in Urban Cities Gongal R,1Dhungana B,1Regmi S,1Nakarmi M,2Yadav B11Patan Hospital, Lalitpur, Nepal, 2Health Care Foundation, Kathmandu, NepalCorrespondence:Dr. Rajesh GongalDepartment of SurgeryPatan Hospital, Patan, Nepal.Email: rajgongal@yahoo.comORIGINAL ARTICLE J Nepal Med Assoc 2009;48(174):139-43INTRODUCTIONThe sophisticated Emergency Medical Service (EMS) is limited to developed country only. Many developing countries are now slowly developing such system although most services are localized to the urban areas.1-5 Although inadquate ambulance services are available in the capital city of Nepa
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Todkill, Dan, Helen E. Hughes, Alex J. Elliot, Roger A. Morbey, Obaghe Edeghere, Sally Harcourt, Tom Hughes, et al. "An Observational Study Using English Syndromic Surveillance Data Collected During the 2012 London Olympics – What did Syndromic Surveillance Show and What Can We Learn for Future Mass-gathering Events?" Prehospital and Disaster Medicine 31, no. 6 (September 19, 2016): 628–34. http://dx.doi.org/10.1017/s1049023x16000923.
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AbstractIntroductionIn preparation for the London 2012 Olympic Games, existing syndromic surveillance systems operating in England were expanded to include daily general practitioner (GP) out-of-hours (OOH) contacts and emergency department (ED) attendances at sentinel sites (the GP OOH and ED syndromic surveillance systems: GPOOHS and EDSSS).Hypothesis/ProblemThe further development of syndromic surveillance systems in time for the London 2012 Olympic Games provided a unique opportunity to investigate the impact of a large mass-gathering event on public health and health services as monitored in near real-time by syndromic surveillance of GP OOH contacts and ED attendances. This can, in turn, aid the planning of future events.MethodsThe EDSSS and GPOOHS data for London and England from July 13 to August 26, 2012, and a similar period in 2013, were divided into three distinct time periods: pre-Olympic period (July 13-26, 2012); Olympic period (July 27 to August 12); and post-Olympic period (August 13-26, 2012). Time series of selected syndromic indicators in 2012 and 2013 were plotted, compared, and risk assessed by members of the Real-time Syndromic Surveillance Team (ReSST) in Public Health England (PHE). Student’s t test was used to test any identified changes in pattern of attendance.ResultsVery few differences were found between years or between the weeks which preceded and followed the Olympics. One significant exception was noted: a statistically significant increase (P value = .0003) in attendances for “chemicals, poisons, and overdoses, including alcohol” and “acute alcohol intoxication” were observed in London EDs coinciding with the timing of the Olympic opening ceremony (9:00 pm July 27, 2012 to 01:00 am July 28, 2012).ConclusionsSyndromic surveillance was able to provide near to real-time monitoring and could identify hourly changes in patterns of presentation during the London 2012 Olympic Games. Reassurance can be provided to planners of future mass-gathering events that there was no discernible impact in overall attendances to sentinel EDs or GP OOH services in the host country. The increase in attendances for alcohol-related causes during the opening ceremony, however, may provide an opportunity for future public health interventions.TodkillD, HughesHE, ElliotAJ, MorbeyRA, EdeghereO, HarcourtS, HughesT, EndericksT, McCloskeyB, CatchpoleM, IbbotsonS, SmithG. An observational study using English syndromic surveillance data collected during the 2012 London Olympics – what did syndromic surveillance show and what can we learn for future mass-gathering events?Prehosp Disaster Med. 2016;31(6):628–634.
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RYBCHUK, A. V. "PROBLEMS OF THE FORMATION OF THE UNITED EUROPEAN TRANSPORT SPACE." Economic innovations 21, no. 3(72) (September 20, 2019): 117–23. http://dx.doi.org/10.31520/ei.2019.21.3(72).117-123.
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Topicality. The relevance of the study is based on the fact that the transport sector of the European Union is at a crossroads today, as it requires a policy that meets the needs of the 21st century and which will contribute to the growth of jobs in the EU. It must avoid constraining mobility, while at the same time responding to a range of social and economic problems that arise. Aim and tasks. The purpose of the article is to develop theoretical, methodological and practical applications, which should justify the optimization of transport services and changes in the design of vehicles and infrastructure of the European Union. In addition, various factors of historical and geographical nature often affect the political merits of States parties. After decades of EU activity, there is currently not a sufficiently compatible and resource saving network of interconnected, trans border transport infrastructure. Reasearch results. The essence of the formation of a united European transport network is the implementation of direct links between the main nodes and the infrastructure that forms the mobility of passengers. Airports, ports, railways, undergrounds and bus stations must increasingly be transformed into multimodal communication platforms for passengers and cargo. Online information, electronic booking and payment systems that combine all vehicles will contribute to multimodal travel. But today legal, administrative and technical barriers multiply and slow down the process of forming a single European transport space. Despite the intensification of rail freight and international passenger transport, access to the transport services market continues to be a serious problem. This is largely due to lack of independence and lack of financial transparency between infrastructure managers and service providers, which can lead to discrimination and distortion of the market. Conclusion. The transport policy of the European Union provides a powerful lever for economic recovery. A new issue for European transport systems is their intermodality, that is, the opportunity for logistic chains to use different consecutive modes of transport according to their specific needs for optimizing costs and environmental impact. This means the implementation of regular, clear efforts at European level country by country, industry by industry, according to different geographical, economic and historical features. An investment strategy in transport infrastructure will make sense only if it is shared by actors in the world market. By means of joint financing of individual objects by business and states, the possibility of creating a single European transport network will be real.
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Chen, Y. Y. Brandon, and Colleen M. Flood. "Medical Tourism's Impact on Health Care Equity and Access in Low- and Middle-Income Countries: Making the Case for Regulation." Journal of Law, Medicine & Ethics 41, no. 1 (2013): 286–300. http://dx.doi.org/10.1111/jlme.12019.
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Travelling internationally to acquire medical treatments otherwise unavailable or inaccessible in one’s home country is not a novel concept. Conventionally, such medical travel largely entailed patients from developed countries or wealthy patients from the developing world seeking care in Western facilities like the Mayo Clinic in the U.S. and myriad private clinics along Harley Street in London, England. What is different about the topical phenomenon known as “medical tourism” is the growing trend of health services export in the opposite direction. The number of patients travelling from the developed world to low- and middle-income countries (LMICs) for treatments has ballooned in recent years, primarily driven by difficulties with accessing affordable care at home. According to a liberal estimate by the Deloitte Center for Health Solutions, the number of Americans travelling abroad for care rose from 750,000 in 2007 to 1.6 million in 2012. On the flip side, Thailand reportedly treated a total of 1.3 million foreign nationals in 2007, which represented a 16% leap from 2001.
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Stafford, Jamie, Marco Aurelio, and Amar Shah. "Improving access and flow within Child and Adolescent Mental Health Services: a collaborative learning system approach." BMJ Open Quality 9, no. 4 (November 2020): e000832. http://dx.doi.org/10.1136/bmjoq-2019-000832.
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Long waiting times for Child and Adolescent Mental Health Services (CAMHS) have been linked to poorer outcomes for those seeking care. CAMHS teams in England have seen recent increases in referrals, resulting in challenging waiting times nationally. Although recent health policy has brought an increase in funding and staffing, it is believed that only 25% of those needing care receive it. Between trusts, there is considerable variation in waiting times, leaving many waiting longer than others waiting for care. East London Foundation Trust has been seen to have higher waiting times for CAMHS than other organisations across the country between June 2017 and September 2018, seven CAMHS teams were supported to use quality improvement (QI) as part of a collaborative learning system with the aim of improving access and flow. Each team was encouraged to understand their system using basic demand and capacity modelling alongside process mapping. From this teams created project aims, driver diagrams and used Plan Do Study Act cycles to test changes iteratively. Measurement and data were displayed on control charts to help teams learn from changes. Teams were brought together to help learn from each other and accelerate change through a facilitated collaborative learning system. Of the seven teams that began the collaborative learning system, six completed a project. Across the collaborative learning system collectively there were improvements in average waiting times for first, second and third appointments, and an improvement in the number of appointments cancelled. For the individual teams involved, three saw an improvement in their project outcome measures, two just saw improvements in their process measures and one did not see an improvement in any measure. In addition to service improvements, teams used the process to learn more about their pathway, engage with service users and staff, build QI capability and learn together.
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Moch Fajar Suryo Atmojo, Nurfahmiyati, and Meidy Haviz. "Pengaruh Capital Adequacy Ratio , Biaya Operasional Pendapatan Operasional dan Net Operational Margin terhadap Financing to Deposit Ratio pada Bank Umum Syariah di Indonesia Tahun 2016-2018." Jurnal Riset Ilmu Ekonomi dan Bisnis 1, no. 1 (July 6, 2021): 27–33. http://dx.doi.org/10.29313/jrieb.v1i1.69.
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Abstract. Sharia Banking as an economic sub-system certainly will directly or indirectly have an impact on the development and economic growth of a country. Sharia Commercial Bank (BUS) is a bank that conducts business activities based on sharia principles and in its activities provides services in payment traffic as referred to in Act Number 21 of 2008 concerning Sharia Banking. The health of a bank is very important for all parties involved both the owner, manager (management) of the bank, the banking service user community, monetary authorities, and other parties.This study was conducted to examine the effect of CAR, BOPO, and NOM on Financing to Deposit Ratio (FDR) of Sharia Commercial Banks in Indonesia in 2016-2018. This type of research uses quantitative research with a verification approach. The data used are secondary data taken from the FSA using time series data. Data processing uses Eviews version 7.0 with Ordinary Least Square (OLS) method.The results showed that the CAR variable partially had a negative effect and the BOPO and NOM variables had a positive and significant effect on FDR at Islamic Commercial Banks in Indonesia. From the estimation results obtained R-square of 0.733707, which means 73.37 percent variation of changes in Financing to Deposit Ratio (FDR) of Sharia Commercial Banks is explained by variations in changes in CAR, BOPO, and NOM. While the remaining 26.63 percent explained by other variables not included in the equation model.
Abstrak. Perbankan Syariah sebagai suatu sub sistem ekonomi tentunya baik secara langsung maupun tidak langsung akan memberikan dampak terhadap perkembangan dan pertumbuhan ekonomi suatu negara. Bank Umum Syariah (BUS) adalah bank yang menjalankan kegiatan usahanya berdasarkan prinsip syariah dan dalam kegiatannya memberikan jasa dalam lalu lintas pembayaran sebagaimana dimaksud dalam Undang-Undang Nomor 21 Tahun 2008 tentang Perbankan Syariah. Kesehatan suatu bank merupakan hal yang sangat penting bagi seluruh pihak yang terkait baik pemilik, pengelola (manajemen) bank, masyarakat pengguna jasa bank, otoritas moneter, serta pihak lainnya. Penelitian ini dilakukan untuk menguji pengaruh CAR, BOPO, dan NOM terhadap Financing to Deposit Ratio (FDR) Bank Umum Syariah di Indonesia Tahun 2016-2018. Jenis penelitian menggunakan penelitian kuantitatif dengan pendekatan verifikatif. Data yang digunakan adalah data sekunder yang diambil dari OJK menggunakan data runtut waktu (time series). Pengolahan data menggunakan program Eviews versi 7.0 dengan metode Ordinary Least Square (OLS). Hasil penelitian menunjukkan variabel CAR secara parsial berpengaruh negatif dan variabel BOPO dan NOM berpengaruh positif dan signifikan terhadap FDR pada Bank Umum Syariah di Indonesia. Dari hasil estimasi diperoleh R-square sebesar 0.733707, yang berarti 73.37 persen variasi perubahan pada Financing to Deposit Ratio (FDR) Bank Umum Syariah dijelaskan oleh variasi perubahan pada CAR, BOPO, dan NOM. Sementara sisanya 26.63 persen diterangkan oleh variabel lain yang tidak masuk ke dalam model persamaan.
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Palafox, Benjamin, Maureen L. Seguin, Martin McKee, Antonio L. Dans, Khalid Yusoff, Christine J. Candari, Khairuddin Idris, et al. "Responsive and Equitable Health Systems—Partnership on Non-Communicable Diseases (RESPOND) study: a mixed-methods, longitudinal, observational study on treatment seeking for hypertension in Malaysia and the Philippines." BMJ Open 8, no. 7 (July 2018): e024000. http://dx.doi.org/10.1136/bmjopen-2018-024000.
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IntroductionHypertension is a leading contributor to the global burden of disease. While safe and effective treatment exists, blood pressure control is poor in many countries, often reflecting barriers at the levels of health systems and services as well as at the broader level of patients’ sociocultural contexts. This study examines how these interact to facilitate or hinder hypertension control, taking into account characteristics of service provision components and social contexts.Methods and analysisThe study, set in Malaysia and the Philippines, builds on two systematic reviews of barriers to effective hypertension management. People with hypertension (pre-existing and newly diagnosed) will be identified in poor households in 24–30 communities per country. Quantitative and qualitative methods will be used to examine their experiences of and pathways into seeking and obtaining care. These include two waves of household surveys of 20–25 participants per community 12–18 months apart, microcosting exercises to assess the cost of illness (including costs due to health seeking activities and inability to work (5 per community)), preliminary and follow-up in-depth interviews and digital diaries with hypertensive adults over the course of a year (40 per country, employing an innovative mobile phone technology), focus group discussions with study participants and structured assessments of health facilities (including formal and informal providers).Ethics and disseminationEthical approval has been granted by the Observational Research Ethics Committee at the London School of Hygiene and Tropical Medicine and the Research Ethics Boards at the Universiti Putra Malaysia and the University of the Philippines Manila. The project team will disseminate findings and engage with a wide range of stakeholders to promote uptake and impact. Alongside publications in high-impact journals, dissemination activities include a comprehensive stakeholder analysis, engagement with traditional and social media and ‘digital stories’ coproduced with research participants.
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Killaspy, Helen, Stefan Priebe, Michael King, Sandra Eldridge, Paul McCrone, Geoff Shepherd, Maurice Arbuthnott, et al. "Supported accommodation for people with mental health problems: the QuEST research programme with feasibility RCT." Programme Grants for Applied Research 7, no. 7 (September 2019): 1–82. http://dx.doi.org/10.3310/pgfar07070.
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Background Across England, around 60,000 people live in mental health supported accommodation: residential care, supported housing and floating outreach. Residential care and supported housing provide on-site support (residential care provides the highest level), whereas floating outreach staff visit people living in their own tenancies. Despite their abundance, little is known about the quality and outcomes of these services. Objectives The aim was to assess the quality, costs and effectiveness of mental health supported accommodation services in England. The objectives were (1) to adapt the Quality Indicator for Rehabilitative Care (QuIRC) and the Client Assessment of Treatment scale for use in mental health supported accommodation services; (2) to assess the quality and costs of these services in England and the proportion of people who ‘move on’ to less supported accommodation without placement breakdown (e.g. to move from residential care to supported housing or supported housing to floating outreach, or, for those receiving floating outreach, to manage with fewer hours of support); (3) to identify service and service user factors (including costs) associated with greater quality of life, autonomy and successful move-on; and (4) to carry out a feasibility trial to assess the required sample size and appropriate outcomes for a randomised evaluation of two existing models of supported accommodation. Design Objective 1 – focus groups with staff (n = 12) and service users (n = 16); psychometric testing in 52 services, repeated in 87 services (adapted QuIRC) and with 618 service users (adapted Client Assessment of Treatment scale). Objectives 2 and 3 – national survey and prospective cohort study involving 87 services (residential care, n = 22; supported housing, n = 35; floating outreach, n = 30) and 619 service users followed over 30 months; qualitative interviews with 30 staff and 30 service users. Objective 4 – individually randomised, parallel-group feasibility trial in three centres. Setting English mental health supported accommodation services. Participants Staff and users of mental health supported accomodation services. Interventions Feasibility trial involved two existing models of supported accommodation: supported housing and floating outreach. Main outcome measures Cohort study – proportion of participants who successfully moved to less supported accommodation at 30 months’ follow-up without placement breakdown. Feasibility trial – participant recruitment and withdrawal rates. Results The adapted QuIRC [QuIRC: Supported Accomodation (QuIRC-SA)] had excellent inter-rater reliability, and exploratory factor analysis confirmed its structural validity (all items loaded onto the relevant domain at the > ± 0.3 level). The adapted Client Assessment of Treatment for Supported Accommodation had good internal consistency (Cronbach’s alpha 0.89) and convergent validity (r s = 0.369; p < 0.001). Supported housing services scored higher than residential care and floating outreach on six out of seven QuIRC-SA quality domains. Service users had a high prevalence of severe self-neglect (57%) and vulnerability to exploitation (37%). Those in supported housing (25%) and floating outreach (20%) experienced more crime than those in residential care (4%) but had greater autonomy. Residential care was the most expensive service (mean cost per resident per week was £581 for residential care, £261 for supported housing and £66 for floating outreach) but supported users with the greatest needs. After adjusting for clinical differences, quality of life was similar for users of supported housing and residential care (mean difference –0.138, 95% confidence interval –0.402 to 0.126; p = 0.306), whereas autonomy was greater for supported housing users (mean difference 0.145, 95% confidence interval 0.010 to 0.279; p = 0.035). Qualitative interviews showed that staff and service users shared an understanding of service goals and what constituted effective support. After adjusting for clinical differences, those in floating outreach were more likely to move on successfully at 30 months’ follow-up than those in residential care [odds ratio (OR) 7.96; p < 0.001] and supported housing (OR 2.74; p < 0.001), and this was more likely for users of supported housing than residential care (OR 2.90; p = 0.04). Successful move-on was positively associated with scores on two QuIRC-SA domains: the degree to which the service promoted ‘human rights’ (e.g. facilitating access to advocacy) and ‘recovery-based practice’ (e.g. holding therapeutic optimism and providing collaborative, individualised care planning). Service use costs for those who moved on were significantly lower than for those who did not. Recruitment in the feasibility trial was difficult: 1432 people were screened but only eight were randomised. Barriers included concerns about accommodation being decided at random and a perceived lack of equipoise among clinicians who felt that individuals needed to ‘step down’ from supported housing to floating outreach services. Conclusions We did not find clear evidence on the most effective model(s) of mental health supported accommodation. Indeed, our feasibility study suggests that trials comparing effectiveness cannot be conducted in this country. A range of options are required to provide appropriate support to individuals with differing needs. Future work Future research in this field requires alternatives to trials. Service planners should be guided by the mental health needs of the local population and the pros and cons of the different services that our study identified, rather than purely financial drivers. Trial registration Current Controlled Trials ISRCTN19689576. Funding This programme was funded by the National Institute for Heath Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 7, No. 7. See the NIHR Journals Library website for further project information. The fundholders are Camden and Islington NHS Foundation Trust and the research is a collaboration between University College London, Queen Mary University of London, King’s College London, the University of Ulster and Durham University.
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Madan, Siddharth, Nisha Yadav, Maansi Sethi, Gunjan Rana, Akshi Sharma, and Vidhi Bajpai. "Serosurveys for SARS-CoV-2: need of the hour." International Journal Of Community Medicine And Public Health 7, no. 10 (September 25, 2020): 4209. http://dx.doi.org/10.18203/2394-6040.ijcmph20204397.
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This letter is regarding tackling the highly infectious coronavirus disease (COVID-19).Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread across the globe, causing a worldwide pandemic. The total number of cases across the globe is about 11.6 million with over 5 lakh deaths. The number of individuals detected is always less than the actual number of infected, in nearly all respiratory viral pandemics. Rapid Point-of-Care Antigen detection test can detect SARS-CoV-2 early in the field setting. It has moderate sensitivity and high specificity yet limited availability. This test can be employed in the hospitals and containment zones and would aid in contact tracing, isolation of the affected individuals, localized containment and directing quarantine measures. IgG antibodies usually appear after one week of onset of infection and may last for several months. Serosurveys that detect these antibodies using Enzyme-linked immunosorbent assay (ELISA) help in the assessment of asymptomatic infection in close contacts, enhance the current understanding of the spread of disease, individual’s immune status and in identifying potential plasma donors. Case fatality rate is positively associated with SARS-CoV-2 seroprevalence as was demonstrated in the survey conducted in the Spanish population. Immuno-compromised patients, healthcare workers, relatively young working population comprising of bankers, media persons, individuals working at airports, overseas operations and industries, staff in municipal bodies, shopkeepers, vendors, courier services, telecommunication offices, drivers of hospital ambulances, hearse vans, buses, auto-rickshaw, taxies; bus conductors, farmers, electricity workers, migrant labourers who have travelled back from urban and peri-urban areas to rural/tribal; inhabitants of hard to reach areas, prisoners, densely populated regions of the country as well as natives after coming in contact with returned migrant; police and security personnel, those staying in institutional settings and hostels and inhabitants of containment zones should all be tested for the presence of antibodies against the virus.
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Chan, Kelly MY, and Andrew JB Fugard. "Assessing speech, language and communication difficulties in children referred for ADHD: A qualitative evaluation of a UK child and adolescent mental health service." Clinical Child Psychology and Psychiatry 23, no. 3 (March 28, 2018): 442–56. http://dx.doi.org/10.1177/1359104517753510.
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Background: Attention-deficit hyperactivity disorder (ADHD) is one of the most common childhood neuropsychiatric disorders and is highly comorbid with speech, language and communication difficulties (SLCDs). However, it is unclear how often SLCDs are identified in ADHD referrals in routine practice and whether there are unidentified SLCDs within this population. Method: A thematic analysis was conducted on a random sample of case notes from 18 referrals for ADHD made to a child and adolescent mental health service (CAMHS) in London, United Kingdom. Analyses aimed to identify (a) the types of SLCDs detected during assessment, (b) at which point of the episode of care these SLCDs were suspected and (c) whether a referral or consultation was made to a speech and language therapist (SLT) for further evaluation. Results: Out of 18 cases investigated, 15 were found to have possible SLCDs based on case notes and reports provided by external agencies. However, only four were referred by CAMHS for further assessment. It is unclear what, if any, steps other external agencies took. Themes describing types of SLCDs, comorbidities and the process of identification are discussed. Conclusion: The analysis of this service’s case notes revealed a range of different routes to the identification of SLCDs, and it was unclear what steps were taken as a result of assessment. A limitation is that this is just one service and the results may not generalise. However, given the similarity in practitioner training received across the country and that practitioners move from service to service, there are grounds for repeating the study in other services. We recommend a more structured approach to identifying SLCDs and recording assessment and treatment decisions made.
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Hafeez Siddiqui, Sulaman, Muhammad Zafarullah, Muhammad Ijaz Latif, and Ghulam Shabir. "Impact of preferential trade agreements (PTAs) on firms’ degree of internationalization." South Asian Journal of Global Business Research 3, no. 1 (February 25, 2014): 54–78. http://dx.doi.org/10.1108/sajgbr-03-2013-0015.
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Purpose – The purpose of this paper is to postulate the impact of preferential trade agreements (PTAs) on internationalization strategies of member countries’ firms. The study also aims to triangulate the proposed model using empirical data from PTA partner economies. Design/methodology/approach – The mixed methods research design is used for the purpose of inquiry as suggested by Creswell. The inductive reasoning based on critical literature review and grounded theory methodology is used to postulate the model. Explanatory strength of the model is triangulated using empirical longitudinal trade data of Pakistan with her bilateral PTA partners, i.e. Malaysia, Mauritius, Iran, Sri Lanka and China. Internationalization indices are adapted following the Ietto-Gillies and London (2009) and Petri (1994) to measure the intensity and geographical diversification dimensions of internationalization. Country-level trade statistics are used as a proxy of firm-level data to explain the international expansion of home firms resulting from PTAs. Findings – Empirical results confirm a strong and long-term impact of PTAs on the intensity and extensity dimensions of internationalization over post-agreement period in Pakistan and member economies. Gravity index depicts greater concentration of Pakistan's trade in FTA markets and thereby confirms the influence of PTAs on international market selection. Analysis at sectoral level depicts a contraction in services trade whereas expansion in the manufacturing firms’ export growth to member economies. Originality/value – The paper extends the theory of internationalization by identifying PTAs as exogenous variable influencing internationalization strategies of member countries’ firms in a developing South Asian context. Coupled with findings from empirical data, the study identifies PTAs as a new strategic trade policy tool available to policy makers for promoting and influencing the home firms’ internationalization strategies.
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O'Brien, Niki, Ryan Li, Wanrudee Isaranuwatchai, Saudamini Vishwanath Dabak, Amanda Glassman, Anthony J. Culyer, and Kalipso Chalkidou. "How can we make better health decisions a Best Buy for all?" Gates Open Research 3 (September 20, 2019): 1543. http://dx.doi.org/10.12688/gatesopenres.13063.1.
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The World Health Organization (WHO) resolution calling on Member States to work towards achieving universal health coverage (UHC) has increased the need for prioritizing health spending. Such need will soon accelerate as low- and middle-income countries transition from external aid. Countries will have to make difficult decisions on how best to integrate and finance previously donor-funded technologies and health services into their UHC packages in ways that are equitable, and operationally and financially sustainable. The International Decision Support Initiative (iDSI) is a global network of health, policy and economic expertise which supports countries in making better decisions about how best and how much to spend public money on healthcare. iDSI core partners include Center For Global Development, China National Health Development Research Center, Clinton Health Access Initiative, Health Intervention and Technology Assessment Program, Thailand / National Health Foundation, Imperial College London, Kenya Medical Research Institute, and the Norwegian Institute of Public Health. In May 2019, iDSI convened a roundtable entitled Why strengthening health systems to make better decisions is a Best Buy. The event brought together members of iDSI, development partners and other organizations working in the areas of evidence-informed priority-setting, resource allocation and purchasing. The roundtable participants identified key challenges and activities that could be undertaken by the broader health technology assessment (HTA) community to further country-led capacity building, as well to foster deeper collaboration between the community itself. HTA is a tool which can assist governments and development partners with evaluating alternative investment options in a defensible and accountable fashion. The definition and scope of HTA, and what it can achieve and support, can be presented more clearly and cohesively to stakeholders. Organizations engaging in HTA must develop deeper collaboration, and integrate existing collaborations, to ensure progress in developing HTA institutionalization globally is well organized and sustainable.
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Tsekeris, Theodore. "Disaggregate Analysis of Gasoline Consumption Demand of Greek Households." Engineering Economics 23, no. 1 (February 15, 2012): 41–49. http://dx.doi.org/10.5755/j01.ee.23.1.1226.
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The expenditure on private vehicle usage is an important aspect of the budget allocation process of households, which has important implications for the sustainable urban development and transport, energy and environmental policy making. This paper examines the gasoline consumption demand of Greek households using cross-sectional micro-data from a country-wide Household Budget Survey (HBS) during the period 2004/05. The two-step Heckman modeling methodology is adopted to jointly estimate the probability of selecting to use private vehicle and the amount of using it. In this way, it can help to identify and better explain factors for which some private vehicle owners/holders do (not) actually consume that mode. The results offer valuable insight into the existence of feedback relationship between the decision-making mechanisms of selecting to use private vehicle and amount of usage, in terms of the amount of money spent for gasoline consumption. They also indicate the statistically significant impact of region-specific fixed effects, which implies that unobserved or omitted factors associated with each Region have a different impact on the decision to choose and the amount of using private vehicle. The income variable has a statistically significant positive impact on the selection and usage of a private vehicle. The estimated income elasticity suggests that a private vehicle travel is relatively inelastic (normal and necessity good). Its value reflects the increased car dependence and it is within the range of other income elasticities found in the literature. The male gender of household head, the amount of cars owned, the participation of family members in the labour market, the family size (a single-parent or couples with at least one child older than 18 years-old) and the expenditure on communication and tourism increase the probability of private vehicle gasoline consumption. The latter finding verifies that private vehicle constitutes an important means of transport during vacation. The use of communication devices, especially a mobile phone, reinforces the use of private vehicle, as it weakens the need for short-range activity planning in advance and the range and extent of social networking. On the contrary, the high population densities, the connection to the internet and the aging of household head reduce the probability of private vehicle gasoline consumption. The above results signify the role of personal and intra-household constraints, mostly related to size and aging structure, on the selection and use of a private vehicle. The expenditure on most other transport categories, such as an urban public transport, taxi, coach and rail negatively and statistically significantly affect private vehicle gasoline consumption. This outcome stresses the competitive relationship between the private vehicle and other transport modes which are mainly used in urban areas (urban bus, metro, and taxi). The study findings suggest the design of more sustainable leisure travel services, focussed on upgrading the quality of public transport modes servicing tourist resort areas. Policy measures to manage private vehicle use must be spatially targeted, accounting for the local climate, residential densities, infrastructure and accessibility conditions and the service quality of alternative modes in each Region. These measures can be supplemented with the adoption of suitable information and communication technologies to reduce the demand for private vehicle travel and increase the level of public transport services, as well as investments in clean vehicle technologies.DOI: http://dx.doi.org/10.5755/j01.ee.23.1.1226
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Hernandez, Javier. "Local and global organisational dynamics in the field of finance." Qualitative Research in Organizations and Management: An International Journal 13, no. 2 (June 11, 2018): 144–61. http://dx.doi.org/10.1108/qrom-05-2017-1527.
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PurposeWhile financial organisations and systems are becoming global, there still seems to be some country-based differences explained mainly by social dynamics of power and distribution of resources. The purpose of this paper is to analyse practices of a wide variety of financial organisations in two very different social environments, namely, the UK and Chile, with special focus on recruitment and promotion procedures and work under the industry.Design/methodology/approachFrom 41 in-depth interviews with practitioners in London, Edinburgh and Santiago de Chile and participant observation of recruitment practices, it was possible to analyse the practices of financial organisations, emphasising on the way they interact with people in global markets and local fields. Interviews and observation were designed to understand organisational procedures in the life course of a set of people working in financial firms and related institutions.FindingsThe paper argues for a field approach since Chile’s peripheral position in global markets and its elite-concentrated local distribution of resources encourage more traditional organisational practices, especially in terms of recruitment, socialisation and staff allocation, while in the UK, organisational processes are more technically designed and competitive, as part of a different field, the one of the main centres of financial activities.Research limitations/implicationsAlthough organisations are accessed via their workers and not studied directly, the design of the interviews and the findings allow understanding how financial work is structured by organisational procedures.Practical implicationsThe paper contributes to highlight the role played by organisational procedures and how policies oriented to decrease inequality should take them into account.Social implicationsIt contributes to understanding how inequality is based on organisational practices which are, at the same time, grounded in inequal social structures.Originality/valueVery few studies have compared, from an in-depth and qualitative perspective, the way organisational procedures are constituted in two very different countries. It covers a wide variety of organisations types and financial products and services. It also tries to make a contribution bridging the current economic sociology literature and organisational studies. Very few articles have also performed systematic fieldwork in two very different countries.
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Pande, Nivedita. "Growth and development of homeopathy in India: a perception study in and around Kolkata." International Journal of High Dilution Research - ISSN 1982-6206 17, no. 1 (July 22, 2021): 15–16. http://dx.doi.org/10.51910/ijhdr.v17i1.902.
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India is a country of wide diversity in terms of physiography, climate, language, religion andavailable methods or systems of treatment. India also has a rich culture and heritage with ancient beliefs and knowledge; a large number of people use traditional methods of healing.
Homeopathy was first introduced in Kolkata, in 1810, by a German geologist who had come to perform geological investigations. By this time, Mr. Mullence, of the London Missionary Society, was known for treating the local people of southern Kolkata. The Calcutta Medical College was the first homeopathic medical college, established in 1881. This institution played a major role in the spread of homeopathy in India. However, at an earlier time, a homeopathic hospital was set up by the surgeon Samuel Brooking in south India. Many clinics and dispensaries opened at this time.
In 1973, the Government of India passed the Central Act, by which homeopathy is recognized as one of the national systems of medicine in India. This represents a true milestone in the growth and development of homeopathy in the country. The Central Council of Homeopathy (CCH) was established to regulate homeopathy education.
In the present time, there are about 200 homeopathic medical colleges and 38 post-graduate colleges that deliver degree courses; institutions such as like CCH (Central Council of Homoeopathy), NIH (National Institute of Homoeopathy), CCRH (Central Council For Research In Homoeopathy), AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy)promote high-level research. Several hundred thousands of practitioners deliver homeopathic medications all over the country. There are over 200, 000 registered homeopathic doctors, and further 12,000 graduate every year. Government of India introduced the Homeopathic Enquiry Committee in 1948, which recognized homeopathy as a scientific system of medicine. Scientific homeopathic research is performed by investigators from different fields, such as: zoology, physiology, physics, etc. The mechanism of action of homoeopathic potency is actively investigated by them. The experiments are performed on human, animal and plant’s body. The faith in homeopathy increases day by day, as it represents a safe, effective and natural mode of healing.
The aims of the present study were: 1) to analyze the growth and development of homeopathy in India; 2) To establish the degree of acceptance of homeopathy by different socioeconomic groups; and 3) To establish the degree of satisfaction with homeopathic treatment of different socioeconomic groups.
The study was based on primary and secondary data. The primary data were collected in a survey using a questionnaire applied to 100 individuals, randomly selected and with different socioeconomic background in and around Kolkata; the participants were categorized in 3 groups. The secondary data were gathered from the electronic media. The data were subjected to statistical analysis. Variables assessed were: 1) frequency of visits to homeopathic services; 2) type of diseases for which homeopathy is preferred; 3) age range for which homeopathy is preferred; 4) Weather the respondent is the first generation using homeopathic medicine or his/her ancestors used to take it; and 5) level of satisfaction. These variables were compared among the 3 groups.
The result showed that low-income group - family income 8,400 Euro per month (businessmen, college professors etc) prefer homeopathy for their children, visit reputed urban doctors and obtain medicines from reputed manufacturers, but the level of satisfaction is almost equal in 2nd and 3rd groups.
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Jackson, Cath, Lisa Dyson, Helen Bedford, Francine M. Cheater, Louise Condon, Annie Crocker, Carol Emslie, et al. "UNderstanding uptake of Immunisations in TravellIng aNd Gypsy communities (UNITING): a qualitative interview study." Health Technology Assessment 20, no. 72 (September 2016): 1–176. http://dx.doi.org/10.3310/hta20720.
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BackgroundGypsies, Travellers and Roma (referred to as Travellers) are less likely to access health services, including immunisation. To improve immunisation rates, we need to understand what helps and hinders individuals in these communities in taking up immunisations.Aims(1) Investigate the barriers to and facilitators of acceptability and uptake of immunisations among six Traveller communities across four UK cities; and (2) identify possible interventions to increase uptake of immunisations in these Traveller communities that could be tested in a subsequent feasibility study.MethodsThree-phase qualitative study underpinned by the social ecological model. Phase 1: interviews with 174 Travellers from six communities: Romanian Roma (Bristol); English Gypsy/Irish Traveller (Bristol); English Gypsy (York); Romanian/Slovakian Roma (Glasgow); Scottish Showpeople (Glasgow); and Irish Traveller (London). Focus on childhood and adult vaccines. Phase 2: interviews with 39 service providers. Data were analysed using the framework approach. Interventions were identified using a modified intervention mapping approach. Phase 3: 51 Travellers and 25 service providers attended workshops and produced a prioritised list of potentially acceptable and feasible interventions.ResultsThere were many common accounts of barriers and facilitators across communities, particularly across the English-speaking communities. Scottish Showpeople were the most similar to the general population. Roma communities experienced additional barriers of language and being in a new country. Men, women and service providers described similar barriers and facilitators. There was widespread acceptance of childhood and adult immunisation, with current parents perceived as more positive than their elders. A minority of English-speaking Travellers worried about multiple/combined childhood vaccines, adult flu and whooping cough. Cultural concerns about vaccines offered during pregnancy and about human papillomavirus were most evident in the Bristol English Gypsy/Irish Traveller community. Language, literacy, discrimination, poor school attendance, poverty and housing were identified by Travellers and service providers as barriers for some. Trustful relationships with health professionals were important and continuity of care was valued. A few English-speaking Travellers described problems of booking and attending for immunisation. Service providers tailored their approach to Travellers, particularly the Roma. Funding cuts, NHS reforms and poor monitoring challenged their work. Five ‘top-priority’ interventions were agreed across communities and service providers to improve the immunisation among Travellers who are housed or settled on an authorised site: (1) cultural competence training for health professionals and frontline staff; (2) identification of Travellers in health records to tailor support and monitor uptake; (3) provision of a named frontline person in general practitioner practices to provide respectful and supportive service; (4) flexible and diverse systems for booking appointments, recall and reminders; and (5) protected funding for health visitors specialising in Traveller health, including immunisation.LimitationsNo Travellers living on the roadside or on unofficial encampments were interviewed. We should exert caution in generalising to these groups.Future workTo include development, implementation and evaluation of a national policy plan (and practice guidance plan) to promote the uptake of immunisation among Traveller communities.Study registrationCurrent Controlled Trials ISRCTN20019630 and UK Clinical Research Network Portfolio number 15182.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 72. See the NIHR Journals Library website for further project information.
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Inusa, Baba PD, Corrina Macmahon, Laura Sainati, Raffaella Colombatti, Maddalena Casale, Patrizia Rampazzo, Silverio Perrotta, and Soundrie Padayachee. "An Educational Study Promoting the Delivery of TCD Screening in Paediatric Sickle Cell Disease: A European Multi-Centre Perspective." Blood 134, Supplement_1 (November 13, 2019): 2172. http://dx.doi.org/10.1182/blood-2019-130390.
Full textAbstract:
Background: Recent studies on the impact of migration on the geographical distribution of the HbS allele have highlighted sickle cell disease (SCD) as a global public health issue. Although considered a "rare disease" due to its global frequency in the 28 countries of the European Union, SCD is the most common genetic disease in France and the United Kingdom and its frequency is steadily rising in many other countries of central and southern Europe. At present, less than 50% of children with SCD have access to TCD screening in the USA and Europe. Most centers use the non-imaging approach, as described in the STOP trials, which is a "blind technique" where there is no guiding anatomical information and thus relies heavily on operator experience. Some centers now use imaging TCD which provides anatomical information enabling the Circle of Willis to be visualized and so facilitates identification of the basal cerebral arteries and orientation of the Doppler beam when acquiring blood velocities. The primary study objective was to determine the effectiveness of the modular training program in achieving the high level of scanning competency described in the STOP trial, irrespective of practitioner background and when using either non-imaging or imaging TCD. Methodology. The modular TCD training program was developed at the training center in London and delivered to trainees at all three centers (London-UK, Padova-Italy and Dublin, Ireland). The program comprised of a 2-day instructional course covering theory and practical aspects of TCD and incorporated significant hands-on instruction. This was followed by trainees scanning at their own hospital until they had collected a log book of at least 40 scans (within a one year period), after which a scan review and competency evaluation was performed. Results.Modular training program.Nine training courses were held (six in England, one in Ireland and two in Italy); these were attended by a total of 51 trainees (Table 1). Approximately half the trainees (45%) successfully completed the competency evaluation, 20 were still in training, two of whom had failed the assessment and eight withdrew from the program due to problems with local funding for staff or equipment. The ten trainees with an ultrasound background (clinical scientists) were able to acquire TCD skills rapidly as demonstrated by the high pass rate. The findings were more variable in the clinician group (pediatricians and nurses) with five requiring refresher courses and twelve failing to complete the minimum annual scan number (forty) due to small local sickle populations. Comparative analysis of TCD data obtained before and after training.A total of 555 patients were included in this study; 181 patients at Center 1 (52 males, mean age 7.9±3.8 (range 2-15.4 years), genotypes: 134 HbSS, 39 HbSC, 8 HbSβ thalassemia), 194 patients. Center 2 (53 males, mean age 7.4±3·2 (range 2-15.1 years), genotypes: 158 HbSS, 32 HbSC, 4 HbSβ) and 154 patients at Center 3 (50 males, mean age 6.4±3.5 (range 2-15.1 years), genotypes: 154 HbSS, 10HbSC, 16 HbSβ thalassemia). There was no significant difference in gender distribution (Chi-Square=0.313, p=0.85), but more young patients were recruited in Center 3 (ANOVA, F=8.9, p<0.001), more HbSC patients in Centers 1 and 2 and more Sβ thalassemia patients in Center 3 (Chi-Square=21.0, p<0.001).Conclusion: Diagnostic vascular ultrasound is highly operator-dependent; hence training and competency validation are essential in producing skilled TCD operators. The modular training program described here was effective in ensuring standardized TCD technique, irrespective of professional background. In this multi-center study TCD velocity measurements and STOP classification were consistent, irrespective of TCD mode and European country. We believe that this is the first modular training program that has demonstrated efficacy when delivered in different European countries. Delivery of this program in areas where TCD is under-provided will augment the number of trained TCD operators, thus facilitating access to specialist diagnostic services. This will have a significant impact on public health across Europe where SCD patients are increasing due to migration. Competency and quality assurance (QA) are important components of such a screening program; further work is in progress to develop an achievable QA program for ongoing regulation of this screening program. Disclosures Colombatti: AddMedica: Consultancy; Novartis: Consultancy; Global Blood Therapeutics: Consultancy.
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Nur Atika, Aisyah, Khutobah, Misno, Haidor, Lutfi Ariefianto, and Syarifudin. "Early Childhood Learning Quality in Pandalungan Community." JPUD - Jurnal Pendidikan Usia Dini 13, no. 2 (December 5, 2019): 296–309. http://dx.doi.org/10.21009/jpud.132.07.
Full textAbstract:
The challenge for rural communities to provide quality education for early childhood in Indonesia is difficult. National politics, policies, and economic and cultural conditions affect the Early Childhood Education system, and Indonesia is a large multicultural country, so, even the quality of education is difficult. This study aims to look at the quality of children's education in Pandalungan. Using qualitative methods with ethnographic design, data collection techniques using interviews, observation, and documentation. The results showed that educational institutions for children in urban areas can be categorized quite high. However, for early childhood education services in Desa Sukorambi Pandalungan, the quality is quite poor. Research suggestions are the need for follow-up related to social, economic, cultural and environmental factors at the level of Pandalungan community awareness of early childhood education.
Keywords: Early Childhood, Learning Quality, Pandalungan Community
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"Intelligent Framework for Public Transport Bus Services system." International Journal of Recent Technology and Engineering 8, no. 2S4 (August 27, 2019): 12–18. http://dx.doi.org/10.35940/ijrte.b1003.0782s419.
Full textAbstract:
The word “Smart City” has been invented by International Business Machines Corporation’s “Smart Planet” through an application from a new variety of information, with life more refined and dynamic. Smart City is the future of our country with transportation being one of the main features designed to make a city smart. In India, the automotive sector in India is one of the main contributors of the nation’s GDP, thus representing its importance. In this survey paper, we have discussed the actual meaning of a smart city and an important feature of a smart city, which is, smart transportation present in the city. We have discussed about various important smart features which are needed for the transportation sector. We have also compared those features of how they have been implemented in some International cities.
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Yukawa, Sotaro, Mohd Azizul Ladin, and Riza Atiq Abdullah O.K. Rahmat. "Public Transport System in Local City and Rural Area: Comparative Study Between Malaysia and Japan." Jurnal Teknologi 69, no. 6 (July 8, 2014). http://dx.doi.org/10.11113/jt.v69.3243.
Full textAbstract:
Recently, bus companies in Peninsular Malaysia are confronted with a crisis of maintaining its local bus services. Operating unprofitable public transport system in local cities and rural areas is an important issue in a developed country. However, such cases (operating unprofitable public transport) have emerged in developing country like Malaysia. Until recently, researchers focused on this kind of problems for only developed country and there are not enough international comparison about local bus service. To address this gap, we conducted a comparative analysis between Japan and Malaysia in this paper. We’ll focus on the similarities and differences in terms of regulation, policy and some cases of bus substitution in both countries. We also examined the advantages and disadvantages about Japanese case and present some implication about future policy in Malaysia.