Performance assessment of commercial principles in water services provision

As a water scarce country, Jordan started initiatives to reform its water sector to meet the objective of bridging the gap between increasing demands and diminishing renewable water supply, besides implementing technical solutions. Commercialization, as alternative to privatization in its conventional notion, was adopted as a strategy to extend partnership with the private sector and to establish new corporatized water service companies wholly owned by the Government and operated under commercial principles. This paper assesses the utilization of commercial and market principles in managing water services provision, it assesses Amman water utility performances under the management of Jordan water Company (Miyahuna) Corporate and the Management Contractor (LEMA). The assessment covered the period from 1999 through 2013, with 1999 as a base year. It was based on the International Water Association recommended performance indicators and on the customized ones, as used by the Ministry of Water and Irrigation. Financial sustainability Criteria variations and its trends has been analysed, discussed and historically tracked for possible indications and causes. Miyahuna performance was compared to international and regional performance standards using data available on the International Benchmarking Network for Water and Sanitation Utilities database. This inter-utility comparison may trigger enhancement as the water sector direct completion is limited. The paper concludes that application of the corporatize model for the Amman utility was successful. Miyahuna performance in the long term reveals positive trends in most of the evaluated criteria

Selection bias in family reports on end of life with dementia in nursing homes

Background: Selective participation in retrospective studies of families recruited after the patient's death may threaten generalizability of reports on end-of-life experiences. Objectives: To assess possible selection bias in retrospective study of dementia at the end of life using family reports. Methods: Two physician teams covering six nursing home facilities in the Netherlands reported on 117 of 119 consecutive decedents within two weeks after death unaware of after-death family participation in the study. They reported on characteristics; treatment and care; overall patient outcomes such as comfort, nursing care, and outcomes; and their own perspectives on the experience. We compared results between decedents with and without family participation. Results: The family response rate was 55%. There were no significant differences based on participation versus nonparticipation in demographics and other nursing home resident characteristics, treatment and care, or overall resident outcome. However, among participating families, physicians perceived higher-quality aspects of nursing care and outcome, better consensus between staff and family on treatment, and a more peaceful death. Participation was less likely with involvement of a new family member in the last month. Conclusions: Families may be more likely to participate in research with more harmonious teamwork in end-of-life caregiving. Where family participation is an enrollment criterion, comparing demographics alone may not capture possible selection bias, especially in more subjective measures. Selection bias toward more positive experiences, which may include the physician's and probably also the family's experiences, should be considered if representativeness is aimed for. Future work should address selection bias in other palliative settings and countries, and with prospective recruitment

Avaliação da governança da água em bacias hidrográficas do Rio de Janeiro como suporte ao gerenciamento dos recursos hídricos.

A governança da água vem ganhando importância, pois se percebeu que a crise da água está muitas vezes relacionada às deficiências na tomada de decisão. A Lei Nacional da Água permitiu com que o Brasil criasse interessantes instrumentos para a gestão integrada e sustentável da água, incluindo diferentes atores locais na tomada de decisão no âmbito dos comitês de bacias hidrográficas. No Rio de Janeiro há nove comitês de bacias os que abastecem a maior parte da população são: Guandu, Lagos São João e Guapi-Macacu. Este estudo avaliou o seu desempenho em relação à governança da água. Embora a disponibilidade de água não seja um problema, o crescimento demográfico e econômico geram aumento da demanda e, consequentemente, das fontes de poluição da água. Por meio da adaptação do método Barômetro da Governança Local a percepção de diferentes atores locais foi obtida por meio de entrevistas com diferentes atores, quelevaram em conta: efetividade, eficiência, transparência, regras e leis, prestação de contas, resolução de conflitos, conscientização, participação, equidade, mobilização e articulação. Lacunas na estrutura de governança da água foram identificadas em diferentes níveis nas bacias estudadas. Para melhorar o seu nível é importante focar em alguns aspectos tais como: educação ambiental, empoderamento local, diálogo entre os níveis estaduais e municipais, eficiência do uso da água e na transparência do processo decisório

Avaliação da governança da água em bacias hidrográficas do Rio de Janeiro como suporte ao gerenciamento dos recursos hídricos.

A governança da água vem ganhando importância, pois se percebeu que a crise da água está muitas vezes relacionada às deficiências na tomada de decisão. A Lei Nacional da Água permitiu com que o Brasil criasse interessantes instrumentos para a gestão integrada e sustentável da água, incluindo diferentes atores locais na tomada de decisão no âmbito dos comitês de bacias hidrográficas. No Rio de Janeiro há nove comitês de bacias os que abastecem a maior parte da população são: Guandu, Lagos São João e Guapi-Macacu. Este estudo avaliou o seu desempenho em relação à governança da água. Embora a disponibilidade de água não seja um problema, o crescimento demográfico e econômico geram aumento da demanda e, consequentemente, das fontes de poluição da água. Por meio da adaptação do método Barômetro da Governança Local a percepção de diferentes atores locais foi obtida por meio de entrevistas com diferentes atores, que levaram em conta: efetividade, eficiência, transparência, regras e leis, prestação de contas, resolução de conflitos, conscientização, participação, equidade, mobilização e articulação. Lacunas na estrutura de governança da água foram identificadas em diferentes níveis nas bacias estudadas. Para melhorar o seu nível é importante focar em alguns aspectos tais como: educação ambiental, empoderamento local, diálogo entre os níveis estaduais e municipais, eficiência do uso da água e na transparência do processo decisório

Caregivers' understanding of dementia predicts patients' comfort at death: a prospective observational study

Background: Patients with dementia frequently do not receive adequate palliative care which may relate to poor understanding of the natural course of dementia. We hypothesized that understanding that dementia is a progressive and terminal disease is fundamental to a focus on comfort in dementia, and examined how family and professional caregivers' understanding of the nature of the disease was associated with patients' comfort during the dying process. Methods: We enrolled 372 nursing home patients from 28 facilities in The Netherlands in a prospective observational study (2007 to 2010). We studied both the families and the physicians (73) of 161 patients. Understanding referred to families' comprehension of complications, prognosis, having been counseled on these, and perception of dementia as "a disease you can die from" (5-point agreement scale) at baseline. Physicians reported on this perception, prognosis and having counseled on this. Staff-assessed comfort with the End-of-Life in Dementia - Comfort Assessment in Dying (EOLD-CAD) scale. Associations between understanding and comfort were assessed with generalized estimating equations, structural equation modeling, and mediator analyses. Results: A family's perception of dementia as "a disease you can die from" predicted higher patient comfort during the dying process (adjusted coefficient -0.8, 95% confidence interval (CI): -1.5; -0.06 point increment disagreement). Family and physician combined perceptions (-0.9, CI: -1.5; -0.2; 9-point scale) were also predictive, including in less advanced dementia. Forty-three percent of the families perceived dementia as a disease you can die from (agreed completely, partly); 94% of physicians did. The association between combined perception and higher comfort was mediated by the families' reporting of a good relationship with the patient and physicians' perception that good care was provided in the last week. Conclusions: Awareness of the terminal nature of dementia may improve patient comfort at the end of life. Educating families on the nature of dementia may be an important part of advance care planning