RAMOS: A Model Validation and Sensitivity Analysis

This paper focuses on the predictive capabilities of the model RAMOS (Resource Allocation Model Over Space). This model, which is being jointly developed by IIASA and the Operational Research Services of the UK Department of Health and Social Security (DHSS), is designed to predict the impact on hospitalization rates when population and resource availability are changing simultaneously in time and space. The performance of the model is critically examined using validation techniques and sensitivity analysis. The validation part is based on an experiment that tries to simulate the outputs of a regional health care system at a point earlier time. This "back-prediction" is then compared for accuracy with what actually occurred. It is shown that the model functions very well in achieving the purposes for which it was designed. Different model specifications are then tested in order to seek further improvements that remove some small but consistent biases in the outputs. Following this, a detailed sensitivity analysis is carried out on the main input variables and parameter, in order to check the internal consistency of the model when it is exposed to unrealistic extremes of change. The paper concludes by noting the mostly satisfactory performance of the model in both the validation tests and the sensitivity analysis but with some caveats and recommendations for further research

RAMOS: A Model of Health Care Resource Allocation in Space

This paper sets out the background and initial results of a resource allocation model called RAMOS. It was developed to explore the consequences on hospitalization rates resulting from one or more of the following: hospital building programs, treatment trends in in-patient care, population changes, or transport developments affecting the accessibility of the population to health care supply. For decision makers the control variables in the model are principally the resource levels in each geographical area of in-patient treatment. A typical question as asked of the model might be: what rearrangement of health care facilities would redress the regional imbalance in health care provision? RAMOS takes as inputs the current or projected morbidity in each area of the region (based on the sex and age structure of the population), a 'test' configuration of health care facilities, and data on patient accessibility. It then outputs the anticipated hospitalization rates by area of residence (admissions per 1000), and other information, so enabling the evaluation of many different allocation plans by the decision maker. RAMOS is a behavioral model based on extensive data relating to southeast England, an area containing 13.5 million people. It represents a continuation of the work begun in the Department of Health and Social Security in 1979. RAMOS is especially suited to applications in rapidly changing regions, crowded urban settlements, and wherever the locations of health care facilities or of other types of service provision is an important issue

Receiving care for intimate partner violence in primary care: barriers and enablers for women participating in the weave randomised controlled trial

BACKGROUND: Interventions in health settings for intimate partner violence (IPV) are being increasingly recognised as part of a response to addressing this global public health problem. However, interventions targeting this sensitive social phenomenon are complex and highly susceptible to context. This study aimed to elucidate factors involved in women\u27s uptake of a counselling intervention delivered by family doctors in the weave primary care trial (Victoria, Australia). METHODS: We analysed associations between women\u27s and doctors\u27 baseline characteristics and uptake of the intervention. We interviewed a random selection of 20 women from an intervention group women to explore cognitions relating to intervention uptake. Interviews were audio-recorded, transcribed, coded in NVivo 10 and analysed using the theory of planned behaviour (TPB). RESULTS: Abuse severity and socio-demographic characteristics (apart from current relationship status) were unrelated to uptake of counselling (67/137 attended sessions). Favourable doctor communication was strongly associated with attendance. Eight themes emerged, including four sets of beliefs that influenced attitudes to uptake: (i) awareness of the abuse and readiness for help; (ii) weave as an avenue to help; (iii) doctor\u27s communication; and (iv) role in providing care for IPV; and four sets of beliefs regarding women\u27s control over uptake: (v) emotional health, (vi) doctors\u27 time, (vii) managing the disclosure process and (viii) viewing primary care as a safe option. CONCLUSIONS: This study has identified factors that can promote the implementation and evaluation of primary care-based IPV interventions, which are relevant across health research settings, for example, ensuring fit between implementation strategies and characteristics of the target group (such as range in readiness for intervention). On practice implications, providers\u27 communication remains a key issue for engaging women. A key message arising from this work concerns the critical role of primary care and health services more broadly in reaching victims of domestic violence, and providing immediate and ongoing support (depending on the healthcare context)

PANDA (Participatory Appraisal of Needs and Development of Action): A Multi Methodological Framework

This is the final version. Available on open access from Cabrera Research Lab via the DOI in this recordData availability: All data generated or analysed during this study are included in this published article (and its supplementary information files)

Why so serious? Theorising playful model-driven group decision support with situated affectivity

This is the author accepted manuscript. The final version is available from Springer via the DOI in this record.An integrative approach to theorising behavioural, affective and cognitive processes in modeldriven group decision support (GDS) interventions is needed to gain insight into the (micro-)processes by which outcomes are accomplished. This paper proposes that the theoretical lens of situated affectivity, grounded in recent extensions of scaffolded mind models, is suitable to understand the performativity of affective micro-processes in model-driven GDS interventions. An illustrative vignette of a humorous micro-moment in a group decision workshop is presented to reveal the performativity of extended affective scaffolding processes for group decision development. The lens of situated affectivity constitutes a novel approach for the study of interventionist practice in the context of group decision making (and negotiation). An outlook with opportunities for future research is offered to facilitate an integrated approach to the study of cognitive-affective and behavioural micro-processes in model-driven GDS interventions.This work was supported in part by the EU FP7-ENERGY- SMARTCITIES-2012 (314277) project STEEP (Systems Thinking for Comprehensive City Efficient Energy Planning

An agenda for rethinking mid-career master programs in public administration

The pace of societal change and the development of societal challenges have speeded up considerably during the last couple of decades, with substantial impact on different levels, i.e. ranging from global to local, or from business to government. When focusing on the public domain, these changes and challenges have had a major impact on public professionals, who face different and frequently changing questions. Mid-career programs in Public Administration (MPA) have the mission to support enrolled professionals in dealing with these changes and challenges. This article is about the development of such MPAs. Both substantive and didactic development is needed. To counter institutional inertia it seems vital to institutionalize a regular rethinking and adaptation of curricula and didactic strategies. This article identified some important points of attention and some options to deal with these in order to continuously improve the contribution of MPA programs to relevant and effective professional development and ongoing professional learning

Domestic Violence and Health Care: Opening Pandora¿s Box ¿ Challenges and Dilemmas

In this article we take a critical stance toward the rational progressive narrative surrounding the integration of domestic violence within health care. Whilst changes in recent UK policy and practice have resulted in several tangible benefits, it is argued that there may be hidden dilemmas and challenges. We suggest that the medical model of care and its discursive practices position women as individually accountable for domestic violence-related symptoms and injuries. This may not only be ineffective in terms of service provision but could also have the potential to reduce the political significance of domestic violence as an issue of concern for all women. Furthermore, it is argued that the use of specific metaphors enables practitioners to distance themselves from interactions that may prove to be less comfortable and provide less than certain outcomes. Our analysis explores the possibilities for change that might currently be available. This would appear to involve a consideration of alternative discourses and the reformulation of power relations and subject positions in health care