A Dynamic Model of Post-Traumatic Stress Disorder for Military Personnel and Veterans

Post-traumatic stress disorder (PTSD) stands out as a major mental illness; however, little is known about effective policies for mitigating the problem. The importance and complexity of PTSD raise critical questions: What are the trends in the population of PTSD patients among military personnel and veterans in the postwar era? What policies can help mitigate PTSD? To address these questions, we developed a system dynamics simulation model of the population of military personnel and veterans affected by PTSD. The model includes both military personnel and veterans in a “system of systems.” This is a novel aspect of our model, since many policies implemented at the military level will potentially influence (and may have side effects on) veterans and the Department of Veterans Affairs. The model is first validated by replicating the historical data on PTSD prevalence among military personnel and veterans from 2000 to 2014 (datasets from the Department of Defense, the Institute of Medicine, the Department of Veterans Affairs, and other sources). The model is then used for health policy analysis. Our results show that, in an optimistic scenario based on the status quo of deployment to intense/combat zones, estimated PTSD prevalence among veterans will be at least 10% during the next decade. The model postulates that during wars, resiliency-related policies are the most effective for decreasing PTSD. In a postwar period, current health policy interventions (e.g., screening and treatment) have marginal effects on mitigating the problem of PTSD, that is, the current screening and treatment policies must be revolutionized to have any noticeable effect. Furthermore, the simulation results show that it takes a long time, on the order of 40 years, to mitigate the psychiatric consequences of a war. Policy and financial implications of the findings are discussed.United States. Dept. of Defense. Office of the Assistant Secretary of Defense for Health Affairs (W81XWH-12-0016

Independent Impact Evaluation for the Strengthening Protections of Internationally Recognized Labor Rights in Colombia Project

[Excerpt]This report presents the end-of-project impact evaluation for the project Strengthening Protections of Internationally Recognized Labor Rights in Colombia. The project is designed to address Colombian workers’ lack of access to safe mechanisms through which they can address workers’ rights violations. The main purpose of this evaluation was to estimate the impact of CAL services on workers’ labor-related complaints and their resolution and on CAL clients’ knowledge of their labor rights. Although the specificity of the population targeted by the program and by the evaluation means that the results of this study may not be readily applicable to other contexts, the issues raised are potentially relevant in many contexts

Sweatfree Independent Monitoring Contract

This document is part of a digital collection provided by the Martin P. Catherwood Library, ILR School, Cornell University, pertaining to the effects of globalization on the workplace worldwide. Special emphasis is placed on labor rights, working conditions, labor market changes, and union organizing.ilrf_sweatfree_independent_monitoring_contract.pdf: 210 downloads, before Oct. 1, 2020

National Adolescent Sexual and Reproductive Health Programme: Mid-Term Evaluation Report

EXECUTIVE SUMMARY Background and rationale Th e Ministry of Health and Population (MoHP) Nepal has endorsed the Nepal Health Sector Programme (NHSP) II (2010–2015), which aims to introduce 1,000 adolescent-friendly services (AFSs) in Nepal by 2015. Towards this, the Government of Nepal is implementing the National Adolescent Sexual and Reproductive Health (ASRH) Programme, which, by November 2012 had covered 516 health facilities in 36 districts. To assess the implementation of the National ASRH Programme, a mid-term evaluation was conducted by the Health Research and Social Development Forum (HERD) in collaboration with GIZ/GFA in selected health facilities in Doti and Banke. Th e mid-term evaluation is part of an operational research to determine the eff ectiveness of the National ASRH Programme and explored the understanding, perceptions and experiences of service providers and adolescents related to the implementation of the National ASRH Programme. Th e main aims of the mid-term evaluation were to: • understand the implementation processes and the wider context as it aff ects the National ASRH Programme in order to provide detailed explanations for the results of the fi nal evaluation; and • identify improvements that can be made to the intervention to increase access by adolescents to SRH services in the remaining period of the programme and ways of improving the likelihood of scaling up the intervention across Nepal. Data was collected for the evaluation in March 2013 in semi-structured interviews and focus groups discussions, mainly with health workers and adolescents, supplemented by peer ethnography interviews and observation by the researchers. As the study was conducted in selected health facilities in only two districts, the fi ndings may not be generalised to other GIZ-supported districts or to the many other intervention districts of the ASRH Programme that are supported by the Family Health Division or other donors. Th is report presents the fi ndings of this research. Implementation of the ASRH Programme Th e evaluation looked at the understanding of health workers about the National ASRH Programme and the extent of conforming with the programme guidelines. Th e National ARSH Health Programme was introduced in 2011 in 14 health facilities in Doti and 13 health facilities in Banke districts. Under the programme, health workers from selected facilities were provided with a two-day orientation about the programme; a display board with the AFS logo; information, education and communication (IEC) materials; and a small fl exible amount of fi nancial support for benches, curtains, and shelves to make the facility more adolescent friendly. Health workers in both of the study districts had attended orientations and understood that the programme is for young people (aged 10–19) undergoing changes associated with adolescence. Th ey said that the programme aims to create an environment that is conducive for adolescents to visit health facilities and receive services including by providing adolescent-friendly services and maintaining privacy. Th ey also understood that the programme is about providing counselling and services to adolescents related to SRH. Although most of the health workers understood that the programme is designed to address the specifi c needs of adolescents, some said that the programme is only about delivering family planning services and safe motherhood services. Although the School Health Programme and the training of peer educators do not form part of the ASRH Programme, health workers mentioned these activities as part of it. Th ey said that these activities have created awareness about ASRH services, which suggests that there should be more coordination between the ASRH Programme and programmes at the school level to create demand for ASRH services among adolescents. Key fi nding 1: All health workers are aware of the National ASRH Programme and its components, except for a few who said that the programme is only about delivering family planning and maternal health services. While the School Health Programme and the training of peer educators are not part of the National ASRH Programme, health workers stressed that these are effective ways to share about the ASRH services available at health facilities. Health workers were asked what activities have been undertaken to implement the ASRH Programme in their health facilities. In all facilities, health workers reported attending orientations, distributing IEC materials and making physical changes to the facilities, such as erecting curtains for privacy. Facilities had also organised orientations for the members of the health facility operation and management committee (HFOMC), female community health volunteers (FCHVs), students, teachers and members of the village development committee. Researchers observed that all of the health facilities had AFS boards displayed in visible places, except for Doti Hospital. Most HFOMCs did not have any adolescent members although some health workers remembered that adolescents had been members on previous committees. Some health workers mentioned schools, the community and peer educators as important in reaching out to adolescents and imparting SRH messages. Key fi nding 2: Health facilities have oriented selected FCHVs, teachers and other people in the village development committee about the National ASRH programme and health workers perceive community awareness to be a key factor in facilitating adolescents’ access to SRH services. Th e study also looked at how health workers are recording and reporting data on the ASRH Programme and what diffi culties they face in doing so. Health workers stated that they complete the monthly reporting form for the ASRH Programme by referring to diff erent registers and send the data along with the HMIS 32 form. Some health workers said that it is diffi cult for them to keep records because they have to look through several registers and suggested a separate recording format for the ASRH Programme. Irregular reporting appeared to be an issue, as was lack of follow-up or refresher training. In relation to monitoring, health workers reported that GIZ/GFA staff visited the facilities along with the focal person from the District (Public) Health Offi ce. Th e issue of limited resources was raised in the interviews – there is no budget to visit health facilities under the programme. An annual review at the district level was suggested by health workers to enable them to address the diffi culties and challenges in implementing the ASRH Programme. Key fi nding 3: The recording and reporting of the ASRH Programme has not been regular and consistent. Health workers mentioned not having a separate recording register for the programme and suggested that the programme be included in the HMIS 32 (monthly reporting format). Interaction between health workers and adolescent users Th e study examined adolescents’ access to health services and the behaviour of health workers in delivering AFSs. In relation to access to health services, health workers said that adolescents visit health facilities mostly for contraceptives, as well as for other SRH problems. Th ey also mentioned that a few adolescents presented with concerns about physical changes and their appearance. Health workers agreed that unmarried adolescents visit health facilities more than married adolescents and adolescent boys more than girls. However, the demand side of the programme is weak, with only a few adolescents reporting that they had visited a health facility for SRH services. Among the focus group discussion participants who had visited a health facility, most said that they visited the facility to take condoms; a few had gone with friends who had sought services for erection problems and rashes around the sexual organs. Other participants said they buy condoms from the nearby medical store instead of visiting the health facility. Most adolescent girls in Doti had not visited a health facility, but in Banke adolescent girls had been to a facility, either for themselves or accompanying their friends or sisters-in-law. Adolescent girls visited health facilities for menstrual problems, the oral contraceptive pill and condoms; some had friends who had been to a health facility for an abortion. Married adolescents reported visiting health facilities for antenatal checkups and vaccinations. Health workers said that sometimes adolescent girls come to ask about pimples or for a remedy for pain during sexual intercourse. In relation to the behaviour of health workers towards adolescents, all health workers interviewed emphasised that there have been signifi cant | X | | XI | changes in their behaviour since the introduction of the ASRH Programme. Th ey said that they used to think that giving young people access to contraceptives would ‘spoil’ or corrupt them and that adolescents should not be talking about SRH or using contraceptives. Now, some even stated that adolescents have the right to know about and use modern family planning methods. All health workers stressed that they do not ask the marital status of adolescents seeking family planning services. Th e study found an increased realisation of the importance of SRH among health workers and of the need to deal with SRH issues in privacy. Th ere is an evident awareness among health workers of how they need to respond to adolescents’ SRH needs. Some of the health workers mentioned that high patient fl ows mean that they cannot give as much time to adolescents as they should. Some health workers pointed to a knowledge gap regarding specifi c aspects of ASRH (e.g. emergency contraception, sexually transmitted infections) and suggested that a training would be helpful on technical aspects of the programme as well as refresher training on other aspects. Th ese comments and the concerns of the focal person at the central level indicate that health workers require better skills to deal with adolescents and further training could be of use to them. Adolescents were asked how health workers responded when they visited the health facility for SRH services. Adolescent boys had mixed experiences, but most gave positive feedback and said that the health workers counselled them well and answered their queries. Th ey also shared that they could take condoms easily from health facilities. Many participants shared that the health workers taught them how to use condoms properly and advised them not to have unprotected sex with multiple partners. Adolescents said that the health workers assured them that they would maintain confi dentiality and privacy. Th e fi ndings of peer ethnography also suggest that confi dentiality is maintained. While most adolescents were pleased with the health workers’ behaviour and said that they would happily go back to the health facility again, some did not have good experiences. Some adolescents shared that the health workers asked whether or not they were married when they went to take condoms. Some of the adolescent boys mentioned that the health workers asked the question in a teasing way or made ‘fun’ of them. Similarly, adolescent girls, with few exceptions, said that they found the behaviour of health workers good and that the health workers talk to them in a friendly manner. Th ese girls also shared that there are separate toilets for males and females. Th ey mentioned that the ‘sisters’ maintain privacy by taking them into a separate room. However, some adolescent girls in Doti were discouraged by health workers’ behaviour. In some cases, health workers were judgmental. Such behaviour from health workers creates a sense of mistrust among adolescents and discourages them from visiting health facilities and discussing problems with health workers. Key fi nding 4: All health workers stated that there have been signifi cant changes in their behaviour as a result of the programme. They shared their previous reluctance to provide contraceptives to adolescents as they thought it would ‘spoil’ them and their previous belief that adolescents should not talk about SRH or use contraceptives. Now, when asked about changes in their behaviour towards adolescents seeking SRH services, almost all health workers expressed adolescentfriendly attitudes. However, one health worker mentioned a gap in the training of health workers, which was also stressed by the focal person at the central level, namely, that, in addition to managerial aspects, such training should also cover more technical knowledge and skills on SRH topics and on the counselling of adolescents in SRH. Key fi nding 5: Health workers were aware of the importance of maintaining privacy and ensuring confi dentiality while providing services to adolescents. They mentioned using curtains or meeting adolescents in ANC clinics, but that high patient fl ow sometimes does not allow them to give much separate time to adolescents. Key fi nding 6: Few adolescents stated that they had visited health facilities for SRH services. Most of those who had visited related positive experiences, while a few had bad experiences regarding the attitude of health workers. According to health workers, unmarried adolescents visit health facilities to access services related to the ASRH Programme more than married adolescents. Furthermore, adolescent boys visited health facilities more than adolescent girls. At the same time, adolescent girls tended to have detailed knowledge about the specifi c health services offered, e.g., for STIs, menstrual problems, acne, pain during sexual intercourse and even abortions. Most adolescents who visited health facilities shared that they were happy with the health workers’ behaviour and that health workers treated them in a friendly and helpful way, did not ask for their marital status and maintained confi dentiality while providing information and services. Adolescents who said that they had never visited a health facility for SRH services were asked their reasons for not visiting. They said that they feared that their issues would be talked about and that they would feel embarrassed. These adolescents were often not aware that health facilities offer confi dential services in private. Boys in particular said that they feel uncomfortable because the health workers are senior to them. Adolescents also shared that in some cases the health workers are relatives, which adds to their discomfort as they feel shy and fear that the health worker might tell their parents. They also said that they fear running into neighbours or people they know at the health facility. Some adolescents said that they could not fi nd the time to visit a health facility because of the long distance to school and the need to do household chores. Instead they shared their problems with friends or their mother and, hence, did not feel the need to visit a health facility. Key fi nding 7: Those adolescents who had not used SRH services were concerned about confi dentiality, which seems to be one of the main reasons for adolescents not visiting health facilities for SRH services, in addition to feeling embarrassed to talk to health workers who are older than them or acquaintances. A set of eight adolescent-friendly IEC booklets on issues related to adolescents’ SRH and rights have been produced and distributed to all public health facilities that provide AFSs and to schools in the catchment area of these facilities as part of the National ASRH Programme. Both the health workers and adolescents who have read the booklets found these materials to be very helpful. Health workers have said that adolescents visit health facilities to read these booklets. Th e health workers maintain that the materials are adequate in quantity for adolescents to come and read, but not for wider distribution, except for in Baijapur where the health workers said that they have been distributing the booklets. Health workers also said that they had distributed the booklets to school libraries and community libraries. In addition to the booklets, health facilities that provide AFSs are provided with ASRH posters, an ASRH fl ipchart and comic book. Key fi nding 8: Most boys interviewed were aware of the IEC materials available in the health facilities, but only a few boys and girls said that they ha

U.S. Election Assistance Commission Urban-Rural Study: Final Report

In May, the U.S. Election Assistance Commission released a report comparing election administration in urban and rural jurisdictions. The survey uncovered more similarities than differences, in part because many small, urban jurisdictions have more in common with rural offices than with very large metropolitan ones. The size of the registered voter population seemed to influence administration more than did the degree of urbanization.The report was based on a national survey of local election administrators that focused on voter-outreach efforts and office personnel -- topics identified by a working group of election officials and researchers as likely to vary based on a jurisdiction's urbanization

National Security Pedagogy: The Role of Simulations

This article challenges the dominant pedagogical assumptions in the legal academy. It begins by briefly considering the state of the field of national security, noting the rapid expansion in employment and the breadth of related positions that have been created post-9/11. It considers, in the process, how the legal academy has, as an institutional matter, responded to the demand. Part III examines traditional legal pedagogy, grounding the discussion in studies initiated by the American Bar Association, the Carnegie Foundation, and others. It suggests that using the law-writ-large as a starting point for those interested in national security law is a mistake. Instead, it makes more sense to work backwards from the skills most essential in this area of the law. The article then proposes six pedagogical goals that serve to distinguish national security law: (1) understanding the law as applied, (2) dealing with factual chaos and uncertainty, (3) obtaining critical distance—including, inter alia, when not to give legal advice, (4) developing nontraditional written and oral communication skills, (5) exhibiting leadership, integrity, and good judgment in a high-stakes, highly-charged environment, and (6) creating continued opportunities for self-learning. Equally important to the exercise of each of these skills is the ability to integrate them in the course of performance. These goals, and the subsidiary points they cover, are neither conclusive nor exclusive. Many of them incorporate skills that all lawyers should have—such as the ability to handle pressure, knowing how to modulate the mode and content of communications depending upon the circumstances, and managing ego, personality, and subordination. To the extent that they are overlooked by mainstream legal education, however, and present in a unique manner in national security law, they underscore the importance of more careful consideration of the skills required in this particular field. Having proposed a pedagogical approach, the article turns in Part IV to the question of how effective traditional law school teaching is in helping to students reach these goals. Doctrinal and experiential courses both prove important. The problem is that in national security law, the way in which these have become manifest often falls short of accomplishing the six pedagogical aims. Gaps left in doctrinal course are not adequately covered by devices typically adopted in the experiential realm, even as clinics, externships, and moot court competitions are in many ways ill-suited to national security. The article thus proposes in Part V a new model for national security legal education, based on innovations currently underway at Georgetown Law. NSL Sim 2.0 adapts a doctrinal course to the special needs of national security. Course design is preceded by careful regulatory, statutory, and Constitutional analysis, paired with policy considerations. The course takes advantage of new and emerging technologies to immerse students in a multi-day, real-world exercise, which forces students to deal with an information-rich environment, rapidly changing facts, and abbreviated timelines. It points to a new model of legal education that advances students in the pedagogical goals identified above, while complementing, rather than supplanting, the critical intellectual discourse that underlies the value of higher legal education

Service-learning @ Lingnan : facts & figures

This booklet summarizes the results and findings from the ongoing research and evaluation studies of Service-Learning. It provides supporting evidence that Service-Learning enhances students’ development in seven learning outcomes: Subject-Related Knowledge, Communication Skills, Social Competence, Problem- Solving Skills, Research Skills, Organization Skills and Civic Orientation.https://commons.ln.edu.hk/osl_book/1011/thumbnail.jp

When will we learn: key factors and potential barriers

The overall aim of this research was to improve the dissemination of Lessons Learned in construction projects so that contractors’ project teams have access to the most relevant lessons at the most appropriate time, in the most appropriate format. The outcome of the research aimed to provide (1) an understanding of the different systems and tools used for recording Lessons Learned amongst major construction contractors; (2) an understanding of the needs in terms of what sort of lessons are required, the level of detail required and how best these should be made available; and (3) an approach on how best to disseminate Lessons Learned. The key objectives of the research were to: 1. Investigate current practice for recording and disseminating Lessons Learned; 2. Identify potential barriers for successfully disseminating Lessons Learned; and 3. Identify key factors affecting company processes to encourage a more systematic dissemination of Lessons Learned. The study was conducted in three phases. The first investigated contractors’ current practices for recording and disseminating Lessons Learned through a questionnaire survey. The second phase identified key factors that would encourage the institutionalisation of Lessons Learned and also the factors that inhibit their use. The third phase examined how current processes could be adapted to develop a process that would embed the systematic dissemination of Lessons Learned within an organisation’s existing practices. This report focuses on the second stage of the project that identified from the end users those factors that would encourage the institutionalisation of Lessons Learned and also the factors that inhibit their use of Lessons Learned

Improving (Software) Patent Quality Through the Administrative Process

The available evidence indicates that patent quality, particularly in the area of software, needs improvement. This Article argues that even an agency as institutionally constrained as the U.S. Patent and Trademark Office (“PTO”) could implement a portfolio of pragmatic, cost-effective quality improvement strategies. The argument in favor of these strategies draws upon not only legal theory and doctrine but also new data from a PTO software examination unit with relatively strict practices. Strategies that resolve around Section 112 of the patent statute could usefully be deployed at the initial examination stage. Other strategies could be deployed within the new post-issuance procedures available to the agency under the America Invents Act. Notably, although the strategies the Article discusses have the virtue of being neutral as to technology, they are likely to have a very significant practical impact in the area of software