Polls on the Environment and Global Warming

This report is a meta-analysis of twenty years of public opinion polls about Americans views on environmental quality, environmental policy, and environmental science

Businessman\u27s information guide

https://egrove.olemiss.edu/aicpa_guides/2187/thumbnail.jp

Evidence for models of diagnostic service provision in the community: literature mapping exercise and focused rapid reviews

Background Current NHS policy favours the expansion of diagnostic testing services in community and primary care settings. Objectives Our objectives were to identify current models of community diagnostic services in the UK and internationally and to assess the evidence for quality, safety and clinical effectiveness of such services. We were also interested in whether or not there is any evidence to support a broader range of diagnostic tests being provided in the community. Review methods We performed an initial broad literature mapping exercise to assess the quantity and nature of the published research evidence. The results were used to inform selection of three areas for investigation in more detail. We chose to perform focused reviews on logistics of diagnostic modalities in primary care (because the relevant issues differ widely between different types of test); diagnostic ultrasound (a key diagnostic technology affected by developments in equipment); and a diagnostic pathway (assessment of breathlessness) typically delivered wholly or partly in primary care/community settings. Databases and other sources searched, and search dates, were decided individually for each review. Quantitative and qualitative systematic reviews and primary studies of any design were eligible for inclusion. Results We identified seven main models of service that are delivered in primary care/community settings and in most cases with the possible involvement of community/primary care staff. Not all of these models are relevant to all types of diagnostic test. Overall, the evidence base for community- and primary care-based diagnostic services was limited, with very few controlled studies comparing different models of service. We found evidence from different settings that these services can reduce referrals to secondary care and allow more patients to be managed in primary care, but the quality of the research was generally poor. Evidence on the quality (including diagnostic accuracy and appropriateness of test ordering) and safety of such services was mixed. Conclusions In the absence of clear evidence of superior clinical effectiveness and cost-effectiveness, the expansion of community-based services appears to be driven by other factors. These include policies to encourage moving services out of hospitals; the promise of reduced waiting times for diagnosis; the availability of a wider range of suitable tests and/or cheaper, more user-friendly equipment; and the ability of commercial providers to bid for NHS contracts. However, service development also faces a number of barriers, including issues related to staffing, training, governance and quality control. Limitations We have not attempted to cover all types of diagnostic technology in equal depth. Time and staff resources constrained our ability to carry out review processes in duplicate. Research in this field is limited by the difficulty of obtaining, from publicly available sources, up-to-date information about what models of service are commissioned, where and from which providers. Future work There is a need for research to compare the outcomes of different service models using robust study designs. Comparisons of ‘true’ community-based services with secondary care-based open-access services and rapid access clinics would be particularly valuable. There are specific needs for economic evaluations and for studies that incorporate effects on the wider health system. There appears to be no easy way of identifying what services are being commissioned from whom and keeping up with local evaluations of new services, suggesting a need to improve the availability of information in this area. Funding The National Institute for Health Research Health Services and Delivery Research programme

Preserving our Institutions: The Continuity of the Presidency (Second Report)

The report addresses Presidential succession after a terrorist attack

From Intervention to Empowerment: A New Approach to Assisting SMEs in Latin America: Regulation, Procurement, and Dispute Resolution

This paper outlines some of the issues that affect small and medium sized enterprises (SMEs) in three areas: regulation, procurement, and dispute resolution. The work presented herein is part of the Bank's most recent efforts to develop new approaches and instruments to strengthen its role as a major development partner of this important engine of growth in the Latin American and Caribbean region. It focuses on nonfinancial issues which have seldom been addressed systematically in the debate on the constraints hindering SMEs.SME, Fiscal Policy, Transparency & Anticorruption, Finance, Microenterprise, Publications, Small and Medium Enterprise

The creative partnership: government and the professional services; proceedings.

Sponsored by the Technical Analysis Division, Institute for Applied Technology, National Bureau of Standards, in cooperation with the Center for the Study of Private Enterprise, the American University.Mode of access: Internet