Specialist Outreach to Isolated and Disadvantaged Communities: A Population-Based Study

Background Visiting-specialist clinics (specialist outreach) have the potential to overcome some of the substantial access barriers faced by disadvantaged rural, remote, and Indigenous communities, but the effectiveness of outreach clinics has not been assessed outside urban and non-disadvantaged settings. We aimed to assess the effects of outreach clinics on access, referral patterns, and care outcomes in remote communities in Australia. Methods We undertook a population-based observational study of regular surgical, ophthalmological, gynaecological, and ear, nose, and throat outreach visits, compared with hospital clinics alone, on access, referral practices, and outcomes for the populations of three remote Indigenous communities in northern Australia for 11 years. We assessed all new non-emergency potential specialist surgical cases who presented initially between Jan 1, 1990, and Jan 1, 2001. The effects of outreach clinics on the proportion of patients referred, the time from referral to initial specialist consultation, and the rates of community-based and hospital-based procedures were analysed using logic regression and Cox proportional hazard models. Findings 2339 new surgical problems presented in 2368 people between 1990 and 2001. Outreach improved the rate of referral completion (adjusted hazard ratio 1.41, 95% CI 1.07-1.86) and the risk of timely completion according to the urgency of referral (adjusted relative risk 1.30, 1.05-1.53). Outreach had no significant effect on initiation of elective referrals, but there were 156 opportunistic presentations on outreach clinic days. Specialist investigations and procedures in community clinics removed the need for many patients to travel to hospital, and outreach consultations were associated with a reduced rate of procedures that needed hospital admission (adjusted hazard ratio 0.67, 0.43-.03). Interpretation Specialist outreach visits to remote disadvantaged Indigenous communities in Australia improve access to specialist consultations and procedures without increasing elective referrals or demands for hospital inpatient services

Geographic Variation in Informed Consent Law: Two Standards for Disclosure of Treatment Risks

We analyzed 714 jury verdicts in informed consent cases tried in 25 states in 1985–2002 to determine whether the applicable standard of care (“patient” vs. “professional” standard) affected the outcome. Verdicts for plaintiffs were significantly more frequent in states with a patient standard than in states with a professional standard (27 percent vs. 17 percent, P = 0.02). This difference in outcomes did not hold for other types of medical malpractice litigation (36 percent vs. 37 percent, P = 0.8). The multivariate odds of a plaintiff’s verdict were more than twice as high in states with a patient standard than in states with a professional standard (odds ratio = 2.15, 95% confidence interval = 1.32–3.50). The law’s expectations of clinicians with respect to risk disclosure appear to vary geographically

The Role of Perceived Control in Customer Value Cocreation and Service Recovery Evaluation

Treating customers as passive recipients of service recovery does not account for their naturally elevated desire for control following a service failure. Focusing on value cocreation by customers in service recovery, this study conceptualizes three types of customer perceived control in service recovery: process control, decision control, and information control. Using both a field study and a controlled experiment to test the conceptual model, this study reveals various ways service firms can engage customers in service recovery to enhance their service experience. The results show that customers are motivated to exert influence on and regain control over service recovery because they care not only about the economic gains rendered by control but also about their social self-esteem in their relationship with a service firm. An investigation of the interaction effects among the three types of control reveals either complementary or substitution effects between different pairings of the three types of control on customers\u27 justice evaluations of service recovery and repurchase intentions. The findings provide managers with new guidance on developing and implementing successful service recovery programs

Customer Work Practices and the Productive Third Place

Third places – communal or socializing places such as coffee shops – are confronted with a rising customer segment: customers who use them for work. Prior research is divided on this trend: customer-workers are seen either as a source of added value or a major threat to third places. Relying on a multi-method, qualitative study, we investigate the strategic implications of the rise of customer-workers in third places. We extend prior research by considering customer-workers as a new and valuable segment, with its specific motivations and practices. Building on the co-constitution of practices and places, we show that the rise of the customer-worker segment has fostered market differentiation. We identify four types of third places (archetypal, status quo, compromise, and productive) depending on their targeting strategy and their servicescape adaptation. We delineate how customer-workers transform third places’ value proposition and bring challenges to each type. Specifically, we show that status quo third places are most prone to customer conflicts while compromise third places generate managerial struggles. In contrast, productive third places adapt their servicescape to become work accelerators and a source of professional identity for customer-workers. We provide recommendations for managers to overcome conflicts and benefit from this growing customer base

Survival and Home Range Estimates of Pen-Raised Northern Bobwhites in Buffer Strip and Non-Buffer Strip Habitats

We investigated the effect of agricultural buffer strips on survival and home range estimates of pen-raised northern bobwhites (Colinus virginianus) at Tudor Farms on the Eastern Shore of Maryland. In September 2000 we released groups of bobwhites into 9 buffer strip (treatment) areas and 9 non-buffer strip (control) areas among 11 agricultural farms. Each group consisted of 4 radiomarked bobwhites and 26 non-radiomarked bobwhites. To maintain contact with the established coveys, additional radiomarked bobwhites (n = 177) were introduced into the coveys as radiomarked birds died. Survival for bobwhites released in buffer strip areas was lower (P \u3c 0.001) than survival in non-buffer strip areas. None of the radiomarked bobwhites released in the buffer strip areas survived past 27 weeks, whereas 11% of radiomarked bobwhites in non-buffer strip areas survived to 27 weeks and 1 bird survived to 41 weeks. Predation was the primary mortality factor (88%), followed by unknown causes (7%), stress (2%), hunting (2%), and road kill (1%). Mean fall and winter home range (95% minimum convex polygon) for 21 bobwhite coveys was 24.2 +- 3.5 ha, ranging from 1.7 to 65.8 ha. Home range areas of bobwhite coveys in buffer strips (n = 12, x¯ +- 15.0 2.7 ha) was significantly smaller (P = 0.002) than non-buffer strip coveys (n = 9, x¯ = 36.4 +- 4.9 ha). We conclude that the smaller home ranges in buffer strip areas seem to indicate better habitat quality; however, high mortality rates of pen-raised bobwhites limited our ability to confirm this

Dust emission of Comet Halley at large heliocentric distances

Comet Halley is currently approaching the inner solar system. Four spacecrafts (NASA's spacecraft, two Russian Vega probes and the Japanese MS-T5 spacecraft) have already been launched to encounter the comet in March 1986. Two additional Halley probes (the European Giotto spacecraft and another Japanese Planet-A probe) will be launched in mid-85 to join the armada. Observations of dust emissions from Halley's Comet are discussed. The evaporation of cometary ices causes the emission of particulates from the nucleus. These observations will be used to determine the fly-by strategy of the Giotto spacecraft by taking into account the distribution of dust in the vicinity of the nucleus and the associated hazard for the space mission