Disaster E-Health Framework for Community Resilience

Disaster management and the health sector ought to be natural allies, but there are few examples of the collaborative planning and application of disaster healthcare involving emergency managers and care practitioners. The different origins, culture, and priorities of the various agencies tasked with disaster healthcare mean that communication and coordination between them is often lacking, leading to delayed, sub-standard, or inappropriate care for disaster victims. The potential of the new e-health technologies, such as the electronic health record, telehealth and mobile health, that are revolutionizing non-disaster healthcare, is also not being realised. These circumstances have led to an international project to develop a disaster e-health framework that can inform national disaster and health strategies. This paper describes this project and its extension to embrace community resilience that strengthens preparedness, safeguards life during the disaster phase, and assists long-term recovery to preserve the health and basic values of citizens

Progress towards attainment of Education for All (EFA) among Nomadic Pastoralist: Do Home-based Variables make a Difference in Kenya

The purpose of this study was to analyze home-based factors inhibiting access and participation in basic education among vulnerable groups in Garissa County, Kenya. The study was framed by a household production function approach that typically assumes that postulates that household schooling decisions are explained by the interaction of social, cultural, and economic factors working through power relations within the household.  The study used a sample of 45 students selected by convenience sampling from undergraduate and postgraduate students undertaking their school-based studies at Kenyatta and Mount Kenya universities residing or teaching in Carissa County, Kenya during the 2012/203 academic year. The   study used mixed methods to collect and analyze the data.  It was found that despite the gains in access and equity since the launch of FPE and FDSE in Kenya at the national level, there still remain pockets within Kenyan communities, especially Carissa County which has remained unreached for a host of reason including home-based factors. The major reasons were the low educational level of the heads of households, household poverty, retrogressive cultural practices, and low premium attached to education. It is concluded that home-based factors make a significant difference in efforts to achieve EFA among nomadic pastoralists .It is recommended  that :all other user charges that have been sneaked into the current FPE and FDSE should be removed; enhance the school security by  advocating for  peaceful conflict resolution; create  a conducive learning environment through peace education and education in emergency; reverse most of the retrogressive socio-cultural practices through civic education as well as mass advocacy and appropriate legal measures as stipulated in the Basic Education Act 2013;  amongst others. Key words:  Home-based factors, Access, Participation, equity, and quality of Basic Education, Nomadic pastoralists, multiple approaches; Education for All

The Formation of Interorganizational Networks in Extreme Events: A Comparative Study of the 1999 ChiChi Earthquake and the 2009 Typhoon Morakot

After catastrophic events, public, private and non-profit actors must find the means to act collectively to solve problems that do not stay within institutional and jurisdictional boundaries. Traditional hierarchical relationships do not provide governmental organizations with the means to solve such problems. Nor do traditional governmental structures enable organizations to work in collaborative networks. This study proposes a conceptual framework that argues that the formation of interorganizational networks is driven by formal structures and informal processes. The purpose of this research is to explore the dynamics of collective action in a disaster response system. The conceptual framework used in this research is a synthesis of the literatures on network governance, complex adaptive system theory, institutional analysis and development, decision making, and policy change (Koppenjan and Klijn 2004; Kooiman 2003; Axelrod and Cohen 2000; Birkland 1997, 2006; Comfort 1999, 2007; Kettl 1993; Klein 1993; Ostrom 1999, 2005; Simon 1996, 1997). This conceptual framework was employed using a mixed-method case study design that investigated two disaster events that occurred in Taiwan: ChiChi Earthquake in 1999 and Typhoon Morakot in 2009. Data were collected through a content analysis of newspaper articles published in the United Daily, network analysis techniques, and semi-structured interviews with key informants that participated in the disaster response systems. These data were used to address four research objectives. First, to identify the organizations involved in the disaster response systems. Second, to identify structure and evolution of the interactions exchanged among these organizations. Third, to identify the structure and process factors that encouraged organizations to interact within the response system. Finally, to identify the extent to which Taiwan's disaster response system learned after these two events. The findings indicate that the response operations that followed the ChiChi Earthquake and Typhoon Morakot were influenced by the tension between the need for administrative control and the need for adaptation and self-organization. The findings also indicate that disaster resilient response systems not only depend on shared cognition and the capacity to adapt during emergency situations, they also depend on striking the appropriate balance between structure and process

The nursing contribution to chronic disease management: a whole systems approach: Report for the National Institute for Health Research Service Delivery and Organisation programme

Background Transforming the delivery of care for people with Long Term Conditions (LTCs) requires understanding about how health care policies in England and historical patterns of service delivery have led to different models of chronic disease management (CDM). It is also essential in this transformation to analyse and critique the models that have emerged to provide a more detailed evidence base for future decision making and better patient care. Nurses have made, and continue to make, a particular contribution to the management of chronic diseases. In the context of this study, there is a particular focus on the origins of each CDM model examined, the processes by which nursing care is developed, sustained and mainstreamed, and the outcomes of each case study as experienced by service users and carers. Aims To explore, identify and characterise the origins, processes and outcomes of effective CDM models and the nursing contribution to such models using a whole systems approach Methods The study was divided into three phases: Phase 1: Systematic mapping of published and web-based literature. Phase 2: A consensus conference of nurses working within CDM. Sampling criteria were derived from the conference and selected nurses attended a follow up workshop where case study sites were identified. Phase 3: Multiple case study evaluation Sample: 7 case studies representing 4 CDM models. These were: i) public health nursing model; ii) primary care nursing model; iii) condition specific nurse specialist model; iv) community matron model. Methods: Evaluative case study design with the unit of analysis the CDM model (Yin, 2003): • semi-structured interviews with practitioners, patients, their carers, managers and commissioners • documentary analysis • psycho-social and clinical outcome data from specific conditions • children and young people: focus groups, age-specific survey tools. Benchmarking outcomes: Adults benchmarked against the Health Outcomes Data Repository (HODaR) dataset (Currie et al, 2005). Young people were benchmarked against the Health Behaviour of School aged Children Survey (Currie et al, 2008). Cost analysis: Due to limitations in the available data, a simple costing exercise was undertaken to ascertain the per patient cost of the nurse contribution to CDM in each of the models, and to explore patterns of health and social care utilisation. Analysis: A whole system methodology was used to establish the principles of CDM. i) The causal system is a “network of causal relationships” and focuses on long term trends and processes. ii) The data system recognises that for many important areas there is very little data. Where a particular explanatory factor is important but precise data are lacking, a range of methods should be employed to illuminate each factor as much as possible. iii) The organisational whole system emphasises how various parts of the health and social care system function together as a single system rather than as parallel systems. iv) The patient experience recognises that the whole system comes together and is embodied in the experience of each patient. Key findings While all the models strove to be patient centred in their implementation, all were linked at a causal level to disease centric principles of care which dominated the patient experience. Public Health Model • The users (both parents and children) experienced a well organised and coordinated service that is crossing health and education sectors. • The lead school nurse has provided a vision for asthma management in school-aged children. This has led to the implementation of the school asthma strategy, and the ensuing impacts including growing awareness, prevention of hospital admissions, confidence in schools about asthma management and healthier children. Primary Care Model • GP practices are providing planned and routine management of chronic disease, tending to focus on single diseases treated in isolation. Care is geared to the needs of the uncomplicated stable patient. • More complex cases tend to be escalated to secondary care where they may remain even after the patient has stabilised. • Patients with multiple diagnoses continue to experience difficulty in accessing services or practice that is designed to provide a coherent response to the idiosyncratic range of diseases with which they present. This is as true for secondary care as for primary care. • While the QOF system has clearly been instrumental in developing and sustaining a primary care nursing model of CDM, it has also limited the scope of the model to single diseases recordable on a register, rather than focus on patient centred care needs. Nurse Specialist Model • The model works under a disease focused system underpinned by evidence based medicine exemplified by NICE guidelines and NSF’s. • The model follows a template drawn from medicine and sustainability is significantly dependent on the championship and protectionism offered by senior medical clinicians. • A focus on self-management in LTCs gives particular impetus to nurse-led enablement of self-management. • The shift of LTC services from secondary care to primary care has often not been accompanied by a shift in expertise. Community Matron Model • The community matron model was distinctive in that it had been implemented as a top down initiative. • The model has been championed by the community matrons themselves, and the pressure to deliver observable results such as hospital admission reductions has been significant. • This model was the only one that consistently resulted in open access (albeit not 24 hours) and first point of contact for patients for the management of their ongoing condition. Survey Findings Compared to patients from our case studies those within HODaR visited the GP, practice nurse or NHS walk-in centres more, but had less home visits from nurses or social services within the six weeks prior to survey. HODaR patients also took significantly more time off work and away from normal activities, and needed more care from friends/ relatives than patients from our study within the last six weeks. The differences between the HODaR and case study patients in service use cannot easily be explained but it could be speculated when referring to the qualitative data that the case study patients are benefiting from nurse-led care. Cost analysis – The nurse costs per patient are at least ten times higher for community matrons conducting CDM than for nurses working in other CDM models. The pattern of service utilisation is consistent with the focus of the community matron role to provide intensive input to vulnerable patients. Conclusions Nurses are spearheading the kind of approaches at the heart of current health policies (Department of Health, 2008a). However, tensions in health policy and inherent contradictions in the context of health care delivery are hampering the implementation of CDM models and limiting the contribution nurses are able to make to CDM. These include: ? data systems that were incompatible and recorded patients as a disease entity ? QOF reinforced a disease centric approach ? practice based commissioning was resulting in increasing difficulties in cross health sector working in some sites ? the value of the public health model may not be captured in evaluation tools which focus on the individual patient experience. Recommendations Commissioners and providers 1. Disseminate new roles and innovations and articulate how the role or service fits and enhances existing provision. 2. Promote the role of the nurses in LTC management to patients and the wider community. 3. Actively engage with service users in shaping LTC services to meet patients’ needs. 4. Improve the support and supervision for nurses working within new roles. 5. Develop training and skills of nurses working in the community to enable them to take a more central role in LTC management. 6. Develop organisations that are enabling of innovation and actively seek funding for initiatives that provide an environment where nurses can reach their potential in improving LTC services. 7. Work towards data systems that are compatible between sectors and groups of professionals. Explore ways of enabling patients to access data and information systems for test results and latest information. 8. Promote horizontal as well as vertical integration of LTC services. Practitioners 1. Increase awareness of patient identified needs through active engagement with the service user. 2. Work to develop appropriate measures of nursing outcomes in LTC management including not only bureaucratic and physiological outcomes, but patient-identified outcomes. Implications of research findings 1. Investment should be made into changing patient perceptions about the traditional division of labour, the nurses’ role and skills, and the expertise available in primary care for CDM. 2. Development and evaluation of patient accessible websites where patients can access a range of information, their latest test results and ways of interpreting these. 3. Long-term funding of prospective evaluations to enable identification of CDM outcomes. 4. Mapping of patient experience and patient satisfaction so that the conceptual differences between these two related ideas can be demonstrated. 5. Development of appropriate measures of patient experience that can be used as part of the quality outcome measures. 6. Cost evaluation/effectiveness studies carried out over time that includes national quality outcome indicators and valid measures of patient experience. 7. The importance of whole system working needs to be identified in the planning of services. 8. Research into the role of the health visitor in chronic disease management within a public health model

The devil's in the detail: Final report of the independent evaluation of the Summary Care Record and HealthSpace programmes

professionals, NHS staff, service users, citizens, academics and evaluation scholars. It should be read in conjunction with our Year 1 reports on the SCR programme (May 2008) 1 and data quality (May 2008). 2 2. The SCR is an electronic summary of key health data, currently drawn from a patient’s GP-held electronic record and accessible over a secure Internet connection by authorised healthcare staff. It is one of a suite of innovations being introduced as part of the National Programme for IT in the English National Health Service (NHS) and delivered via a central ‘Spine’. Policy documents published in 2005-8 anticipated a number of benefits of the SCR, including: 3-6 a. Better care (i.e. the SCR would improve clinical decision-making); b. Safer care (i.e. the SCR would reduce risk of harm, especially medication errors); c. More efficient care (e.g. the SCR would make consultations quicker); d. More equitable care (i.e. the SCR would be particularly useful in patients unable to communicate or advocate for themselves); e. Reduction in onward referral (e.g. the SCR would avoid unnecessary ambulanc

Management of major accidents - Communication challenges and solutions in the preparedness and response phases for both authorities and companies

siirretty Doriast

Sustainable interaction with digital technologies : fostering pro-environmental behavior and maintaining mental health

One of the most essential challenges of the twenty-first century is to realize sustainability in everyday behavior. Daily, partly unconscious decisions influence environmental sustainability. Such everyday choices are increasingly shifted toward digital environments, as digital technologies are ubiquitous in a wide variety of everyday contexts. This yields the great potential to positively influence the users behavior toward more environmental sustainability when interacting with digital technologies, for example, through the use of digital nudging. But besides these benefits, research indicates that interacting with digital technologies can lead to a specific form of stress, also known as technostress, that can cause adverse health outcomes. Individuals increasingly suffer from or are at risk of mental health issues like depression or burnout. This demonstrates that it is essential to ensure a sustainable interaction with digital technologies that is both environmentally friendly and healthy, especially for the mind. Addressing individuals interaction with digital technologies requires a broad understanding from all perspectives. The Human-Computer-Interaction (HCI) framework represents a guiding structure for studying the interaction of humans with digital technologies. Along with the guiding structure of the HCI framework, the seven research articles included in this dissertation aim to contribute to sustainable interaction with digital technologies. The focus is on two outcomes resulting from the interaction: First, fostering pro-environmental behavior and, second, maintaining mental health. After an introductory first chapter, Chapter 2 focuses on the outcome of fostering pro-environmental behavior when interacting with digital technologies using digital nudging. Chapter 2.1 contributes to a deeper understanding of the effectiveness of DNEs in different behavioral contexts (HCI perspective context) that influence the individuals pro-environmental behavior (e.g., e-commerce shopping behavior). Chapters 2.2 and 2.3 zoom in on two of the behavioral contexts described in Chapter 2.1 to investigate and test the design and effectiveness of specific DNEs in an e-commerce shop and a smart home app (HCI perspective technology) through online experiments. While prior research concentrated on the effectiveness of different feedback nudge features (FNFs) (e.g., different update frequencies), Chapter 2.4 investigates the influence of 25 identified FNFs on user satisfaction in a smart home app through a card sorting approach followed by an online survey based on the Kano model (HCI perspective human). Chapter 3 puts focuses on the outcome of maintaining mental health when interacting with digital technologies, thus avoiding technostress. Chapter 3.1 concentrates on the role of the organization in preventing technostress among their employees (HCI perspective context). It introduces and characterizes 24 primary and secondary technostress prevention measures and determines the relevance of primary prevention measures in reducing different sources of technostress (technostress creators). Out of the 24 technostress prevention measures, two specific measures (adopt a stress-sensitive digital workplace design and use gamification) are addressed in Chapters 3.2 and 3.3. Through a large-scale online survey, Chapter 3.2 derives an understanding of the characteristic profiles of technologies used at the digital workplace, their interplay, and how they influence technostress (HCI perspective technology). Chapter 3.3 focuses on the individuals appraisal (HCI perspective human) of a demanding situation when interacting with digital technologies. After conducting an online experiment, Chapter 3.3 finds that the integration of gamification elements (e.g., points or levels) in digital technologies can reduce the individuals threat appraisal. Lastly, Chapter 4 discusses the results of the seven included research articles and provides an outlook for future research. In summary, this dissertation aims to provide research and practice with new insights into creating a sustainable interaction with digital technologies to foster pro-environmental behavior and maintain mental health.Die nachhaltige Gestaltung des Lebens eine der zentralen Herausforderung des einundzwanzigsten Jahrhunderts. Alltägliche, teils unterbewusste Entscheidungen haben Einfluss auf die ökologische Nachhaltigkeit. Diese Entscheidungen werden durch die Allgegenwärtigkeit digitaler Technologien zunehmend in digitalen Umgebungen getroffen. Dies birgt das Potenzial, die Entscheidungen und somit das Verhalten der Nutzer:innen bei der Interaktion mit digitalen Technologien, beispielsweise durch Digital Nudging, positiv in Richtung ökologischer Nachhaltigkeit zu beeinflussen. Doch neben diesen Vorteilen zeigt die Forschung, dass die Interaktion mit digitalen Technologien eine spezifische Form von Stress, bekannt unter dem Begriff Technostress, auslösen kann, die zu negativen gesundheitlichen Folgen führen kann. Immer mehr Menschen leiden unter psychischen Krankheiten wie Depressionen oder Burnout oder sind akut gefährdet, diese zu entwickeln. Das zeigt, dass eine nachhaltige Interaktion mit digitalen Technologien sowohl umweltfreundlich als auch gesund, insbesondere für die Psyche, sein sollte. Das erfordert zunächst ein umfassendes Verständnis für die Problematik und muss deshalb aus allen relevanten Perspektiven betrachtet werden. Das Human-Computer-Interaction (HCI) Framework stellt eine Struktur für die Untersuchung der Interaktion von Menschen mit digitalen Technologien bereit. Das Framework stellt einen ganzheitlichen Ansatz zur Strukturierung und Klassifizierung der Forschung entlang der drei verschiedenen Perspektiven dar. Orientiert an dieser Struktur zielen die sieben Forschungsartikel dieser Dissertation darauf ab, einen Beitrag zur nachhaltigen Interaktion mit digitalen Technologien zu leisten. Dabei liegt der Fokus auf den beiden Ergebnissen der Förderung des umweltfreundlichen Verhaltens und der Aufrechterhaltung der psychischen Gesundheit. Nach dem einleitenden ersten Kapitel fokussiert Kapitel 2 die Förderung eines umweltfreundlichen Verhaltens bei der Interaktion mit digitalen Technologien durch die Verwendung von Digital Nudging. Durch eine strukturierte Literaturanalyse und der anschließenden Entwicklung eines Frameworks trägt Kapitel 2.1 zu einem tieferen Verständnis und einem Überblick der Effektivität von DNEs in verschiedenen Verhaltenskontexten (HCI Perspektive Kontext), die umweltfreundliches Verhalten bestimmen (z.B. Einkaufsverhalten), bei. In den Kapiteln 2.2 und 2.3 werden zwei der in Kapitel 2.1 betrachteten Kontexte vertieft und sowohl das Design als auch die Effektivität spezifischer DNEs in einem E-Commerce-Shop (Kapitel 2.2) und einer Smart Home App (Kapitel 2.3) in Online-Experimenten untersucht (HCI Perspektive Technologie). Kapitel 2.4 konzentriert sich das gut erforschte und wirksame DNE Feedback zur Förderung von energiesparendem Verhalten. Während sich bisherige Forschung auf die Effektivität verschiedener Feedback Nudge Features (FNFs) konzentriert (z.B. unterschiedliche Aktualisierungsfrequenzen), wird in Kapitel 2.4 der Einfluss von 25 identifizierten FNFs auf die Nutzerzufriedenheit mit Hilfe eines Card Sortings und einer Online-Befragung basierend auf dem Kano Modell untersucht (HCI Perspektive Mensch). In Kapitel 3 liegt der Schwerpunkt auf dem Ziel der Aufrechterhaltung der psychischen Gesundheit und somit der Vermeidung von Technostress. Kapitel 3.1 konzentriert sich auf die Rolle der Organisation bei der Prävention von Technostress bei Mitarbeiter:innen (HCI Perspektive Kontext). Basierend auf einer Delphi-Studie werden 24 primäre und sekundäre Technostress-Präventionsmaßnahmen vorgestellt und charakterisiert, sowie deren Relevanz zur Vermeidung von Technostress eingeschätzt. Von den 24 Maßnahmen werden zwei spezifische Maßnahmen (Gestaltung eines stresssensiblen digitalen Arbeitsplatzes" und Einsatz von Gamification) in Kapitel 3.2 und 3.3 behandelt. Kapitel 3.2 trägt durch eine groß angelegte Umfrage zu einem Verständnis für die Charakteristika der am digitalen Arbeitsplatz eingesetzten Technologien und deren Einfluss auf Technostress bei (HCI Perspektive Technologie). Kapitel 3.3 konzentriert sich auf das Individuum und dessen Wahrnehmung einer potenziellen Technostress-Situation bei der Interaktion mit digitalen Technologien (HCI Perspektive Mensch). Durch ein Online-Experiment zeigt sich, dass die Integration von Gamification-Elementen in digitalen Technologien die bedrohende Wahrnehmung der gegebenen Situation des Einzelnen reduzieren kann. Zusammenfassend zielt diese Dissertation darauf ab, Forschung und Praxis mit neuen Erkenntnissen zu einer nachhaltigen Interaktion von Menschen mit digitalen Technologien zu bereichern, die sowohl umweltfreundliches Verhalten fördert als auch die psychische Gesundheit aufrechterhält und somit zu den aktuellen Nachhaltigkeitsbemühungen beiträgt

Strategies and practices to reduce the ecological impact of product returns: An environmental sustainability framework for multichannel retail

Product returns in retail are inherently wasteful and have considerable negative environmental impacts. Besides the monetary costs, they lead to increased transportation, packaging and processing, and the returned items are often discarded. We present strategies and practices retailers can adopt to manage their product returns in a way that reduces environmental impacts. With eCommerce flourishing, product returns have increased significantly. Whilst highest for online sales, they are a challenge across all channels. The importance of developing sustainability management in operations and supply chains is evident from the growing body of literature, but there is a gap regarding the management of product returns in a more environmentally sustainable manner. To address this gap, we interviewed multichannel retailers, retail experts and return service providers operating in the UK and North America. The findings reveal that although retailers have started paying attention to the financial impact of returns, there is little awareness of the scale of environmental impacts. In addition, retailers lack a comprehensive approach to addressing the environmental impact of product returns. Based on our findings, we (1) unpack the barriers inhibiting retailers from developing environmental sustainability plans in returns management, (2) present a set of strategies for retailers to reduce the environmental impact of returns and (3) develop a framework for environmental sustainability in returns management. Our findings and proposed framework have implications for research and practice on addressing the environmental impact of product returns

Gender in Agriculture Sourcebook

The purpose of the Sourcebook is to act as a guide for practitioners and technical staff in addressing gender issues and integrating gender-responsive actions in the design and implementation of agricultural projects and programs. It speaks not with gender specialists on how to improve their skills but rather reaches out to technical experts to guide them in thinking through how to integrate gender dimensions into their operations. The Sourcebook aims to deliver practical advice, guidelines, principles, and descriptions and illustrations of approaches that have worked so far to achieve the goal of effective gender mainstreaming in the agricultural operations of development agencies. It captures and expands the main messages of the World Development Report 2008: Agriculture for Development and is considered an important tool to facilitate the operationalization and implementation of the report's key principles on gender equality and women's empowerment