A longstanding debate on health systems organization relates to benefits of integrating health programmes that emphasize specific interventions into mainstream health systems to increase access and ...improve health outcomes. This debate has long been characterized by polarization of views and ideologies, with protagonists for and against integration arguing the relative merits of each approach. However, all too frequently these arguments have not been based on hard evidence. The presence of both integrated and non-integrated programmes in many countries suggests there may be benefits to either approach, but the relative merits of integration in various contexts and for different interventions have not been systematically analysed and documented. In this paper we present findings of a systematic review that explores a broad range of evidence on: (i) the extent and nature of the integration of targeted health programmes that emphasize specific interventions into critical health systems functions, (ii) how the integration or non-integration of health programmes into critical health systems functions in different contexts has influenced programme success, (iii) how contextual factors have affected the extent to which these programmes were integrated into critical health systems functions. Our analysis shows few instances where there is full integration of a health intervention or where an intervention is completely non-integrated. Instead, there exists a highly heterogeneous picture both for the nature and also for the extent of integration. Health systems combine both non-integrated and integrated interventions, but the balance of these interventions varies considerably.
ABSTRACT
Aims To show the utility of analysing time trends of need and coverage of needle‐exchange programmes (NEPs) and opioid substitution treatment (OST) to assess harm reduction policies ...targeting drug injectors or heroin users.
Design Multiple methods applied to secondary data.
Setting Spain.
Participants Thousands of drug injectors or heroin users included in administrative registers, surveys and published studies during 1987–2010.
Measurements Coverage for the general population was calculated as the ratio between interventions provided (obtained directly from the sources) and interventions needed (estimated by multiple methods), and as the difference between the two. Timeliness was estimated by time elapsed between year of highest need and year in which coverage reached a reference level.
Findings In 2010 NEPs provided 138 syringes per drug injector 95% confidence interval (CI) 100–223, covering 25.7% (95% CI 18.3–43.3) of their need. OST coverage was 60.3% (95% CI 44.3–94.2). Syringe and OST provision increased between 1991 and 2001 and then declined. Syringe and OST coverage also increased substantially during this period and then stabilized, due mainly to decreases in drug injection or heroin use. Medium‐level coverage for both syringes and OST was not achieved until 2000, 8 years after the peak in need (1992).
Conclusions In Spain, the expansion of harm reduction interventions was greatly delayed, although the concomitant decrease in heroin and injecting drug use led to reasonable coverage after 2000. A longitudinal measurement of need and coverage provides insight into the timeliness and potential population impact of interventions, enabling better assessment of their adequacy.
Busy elementary librarians need help applying the new AASL Standards Framework, especially in collaboration with social studies teachers seeking to apply the social studies standards framework. This ...book shows a path forward for both.This book will be a tremendous help to the busy elementary school librarian who is working with the busy elementary social studies teachers in the school. As they are designing and co-teaching library-based lessons based on the Social Studies Standards Framework, the English Literacy Common Core Standards, and the new American Association of School Librarians Standards (AASL) Learners Framework, these reproducible applicable lessons will enhance planning and implementation.You'll get ready-to-use lessons as well as model lessons to adapt to the needs of your own curriculum and students. All standards are applied in - with needed handouts - other tools and current lists of recommended resources provided. Lessons are coordinated to common elementary social studies curricula at indicated grade levels, but can be adapted as template lessons as needed. Current resource lists aid librarians in collection development to support new and current standards.Applies the new AASL Standards Learner Framework to easily used lessons Applies the new Social Studies Standards Framework to library-based lessons and resources Applies Common Core Language Arts Literacy Standards to library-based lessons Provides easy-to-use reproducible elementary school lessons Provides recommended current resources for all elementary library lessons
ABSTRACT
Aims To investigate whether opiate substitution therapy (OST) and needle and syringe programmes (NSP) can reduce hepatitis C virus (HCV) transmission among injecting drug users (IDUs).
...Design Meta‐analysis and pooled analysis, with logistic regression allowing adjustment for gender, injecting duration, crack injecting and homelessness.
Setting Six UK sites (Birmingham, Bristol, Glasgow, Leeds, London and Wales), community recruitment.
Participants A total of 2986 IDUs surveyed during 2001–09.
Measurement Questionnaire responses were used to define intervention categories for OST (on OST or not) and high NSP coverage (≥100% versus <100% needles per injection). The primary outcome was new HCV infection, measured as antibody seroconversion at follow‐up or HCV antibody‐negative/RNA‐positive result in cross‐sectional surveys.
Findings Preliminary meta‐analysis showed little evidence of heterogeneity between the studies on the effects of OST (I2 = 48%, P = 0.09) and NSP (I2 = 0%, P = 0.75), allowing data pooling. The analysis of both interventions included 919 subjects with 40 new HCV infections. Both receiving OST and high NSP coverage were associated with a reduction in new HCV infection adjusted odds ratios (AORs) = 0.41, 95% confidence interval (CI): 0.21–0.82 and 0.48, 95% CI: 0.25–0.93, respectively. Full harm reduction (on OST plus high NSP coverage) reduced the odds of new HCV infection by nearly 80% (AOR = 0.21, 95% CI: 0.08–0.52). Full harm reduction was associated with a reduction in self‐reported needle sharing by 48% (AOR 0.52, 95% CI: 0.32–0.83) and mean injecting frequency by 20.8 injections per month (95% CI: −27.3 to −14.4).
Conclusions There is good evidence that uptake of opiate substitution therapy and high coverage of needle and syringe programmes can substantially reduce the risk of hepatitis C virus transmission among injecting drug users. Research is now required on whether the scaling‐up of intervention exposure can reduce and limit hepatitis C virus prevalence in this population.
Purpose
The purpose of this paper is to provide a decision support model for optimizing the composition of portfolios of market-driven academic programs, primarily in schools offering market-driven ...academic programs. This model seeks to maximize financial performance during a desired planning time period while also achieving targets for other non-financial dimensions of the portfolio (e.g. mission alignment, student demographics and faculty characteristics) by deciding the types of programs to be added, redesigned and/or removed for each year of the planning period.
Design/methodology/approach
This paper introduces an integer linear program (i.e. mathematical optimization) to describe the portfolio optimization problem. Integer linear programs are widely used for optimizing portfolios of financial and non-financial products and services in non-educational settings. Additionally, in order to use an integer linear program for the model, qualitative data must be incorporated into the quantitative model. To do so, this paper first discusses two methods of quantifying qualitative information related to market-driven program dimensions in the following section.
Findings
The paper provides empirical insights related to the impact of this model through an illustrative case from a school offering market-driven academic programs at a prestigious private university in the USA. The results of the case highlight the potential positive impact of utilizing a similar model for planning purposes. Financially, the model results in almost double financial surplus than without the model while also achieving higher scores for all non-financial dimensions measured for the portfolio analyzed.
Originality/value
This paper provides a unique and impactful model for decision support in strategic planning for market-driven academic programs, an area of intense discussion and focus in higher education today.
Pendant les deux décennies qui suivirent la Seconde Guerre mondiale, des hommes de radio, évangéliques conservateurs américains, conçurent plusieurs grands projets pour porter la bonne parole en ...Europe, qu'ils voyaient comme le couronnement de leur projet de radio missionnaire mondiale. Lancer une «Voix de l'Europe» protestante émettant sur ondes moyennes leur posa une série de défis qu'ils n'avaient pas eu à relever en Amérique du Nord ou dans les pays du Sud. Le succès arriva par des voies inattendues, grâce au mouvement d'évangélisation de la jeunesse Youth for Christ et au baptiste et homme de radio débutant Paul Freed. En émettant depuis plusieurs sites commerciaux situés à la périphérie de l'Europe continentale, à Tanger, Monaco et aux Antilles néerlandaises, Freed développa une formule efficace associant la diffusion sous licence d'émissions religieuses américaines en ondes longues et courtes et des partenariats avec des évangélisateurs locaux. Une vision périphérique de la radiodiffusion européenne d'après-guerre nuance l'identification de la radio au territoire national, au service public et à l'entreprise d'État. Elle donne une place singulière à ces deux décennies d'après-guerre au sein du continuum de l'histoire de la radiodiffusion en Europe et d'une histoire globale de la radio. In the two decades after the Second World War, conservative American radio evangelists devised several large-scale projects to preach the gospel in Europe, which they viewed as the crowning piece of their plans for a global missionary project over the airwaves. Launching a Protestant "Voice of Europe" via medium-wave radio raised a series of unique challenges that they had not faced in North America or in southern countries. Success finally came from an unexpected source: the Youth for Christ evangelisation movement and beginning radio evangelist Paul Freed, a Baptist. By broadcasting from a series of commercial sites on the outskirts of Continental Europe (in Tankers, Monaco and the Dutch West Indies), Freed developed a powerful formula that combined the syndicated broadcasting of American religious shows on both long and short-wave frequencies, and partnerships with local evangelicals. By looking at post-war European radio broadcasting from an atypical perspective, this paper gives a nuanced view of radio broadcasting being defined by national territorial boundaries, public service and state-owned broadcasters. It places the two-decade period back into the broader continuum of the history of radio broadcasting in Europe and the more general context of global radio activities.
L'extension du domaine de la musique (classique et contemporaine), des salles, du disque, de la radio à la télévision, pose des questions de programmation, de compétences musicales, d'orchestres, de ...moyens techniques et de production, ainsi que de rapports avec les différents milieux de la musique, dont bien entendu les créateurs, et avec les publics. Un mariage de raison s'établit progressivement. C'est du reste le cas pour d'autres genres musicaux. Des hommes et des femmes se distinguent peu à peu par leur capacité à plaider la cause de la musique à l'intérieur des chaînes comme devant les téléspectateurs. La place accrue des critères d'audience tend à renvoyer les captations de concerts comme les créations à des heures tardives sur la majorité des chaînes, tandis que se développent les marchés des cassettes, de la vidéo, puis des DVD. Mais cette même musique retrouve une partie de la place perdue sur le petit écran grâce au streaming et à la constitution de chaînes en ligne. On s'interroge enfin - par rapport à des expériences étrangères - sur la place de la télévision dans la culture musicale et sur la transformation de la mission de culture à laquelle l'État fait souscrire les chaînes. The extension of music (both classical and contemporary) from concert halls, records and the radio to television raised questions about programming, musical competencies, orchestras, technical resources and production, as well as questions about ties with different musical milieus (including composers and musicians) and with audiences. A marriage of reason gradually took shape. Moreover, this was also the case for other musical genres. Little by little, certain individuals stood out due to their ability to plead the cause of music within television channels and to audiences. Then, as audience figures became more important, concert performances and new musical creative works were relegated to late time slots on most channels, whereas the markets for cassettes, videos and DVDs grew. However, this music has recovered some of its previous standing on television thanks to streaming and online channels. Lastly, by comparing France with other countries, we will examine televisions place in musical culture and the changing cultural responsibilities that the French government ascribes to television channels.
Wraparound programmes, wherein multiple services are offered at one location, are effective in engaging pregnant or parenting women experiencing substance use and other complex challenges while also ...addressing gaps in services between the health, child welfare and addictions fields. Evaluations of these programmes have demonstrated positive outcomes; nevertheless, few studies have focused on how programmes' cross‐sectoral partnerships are structured and the difference these partnerships make. Drawing on the Co‐Creating Evidence study, a three‐year Canadian evaluation of eight multi‐service programmes in six provinces, this article examines the partnerships that make wraparound service delivery possible. The study used a mixed‐methods design involving interviews, questionnaires, output and de‐identified client data; this article reports on qualitative findings only. Sixty service partners and 108 programme staff were interviewed in 2018 and 2019. Qualitative data analysis techniques were applied; NVivo12 software (QRS International, Melbourne, Australia) was utilised to facilitate the analyses. In terms of the programmes' partnership characteristics, overall, programmes more commonly formed partnerships with child welfare, health services (e.g. primary care, public health and perinatal care) and specialised health services such as mental health services, maternal addictions and Opioid Agonist Therapy. The programmes had fewer partnerships with housing, income assistance, Indigenous cultural programming, infant development and legal services. Key benefits of partnerships included: clients' improved access to health and social care, addressing social determinants of health; partners' increased knowledge about the significance of trauma in relation to women's substance use; improved child welfare outcomes and strengthened cultural safety and (re)connection. Key challenges included: tensions between partners regarding differing perceptions, mandates and responsibilities; personal differences and systemic barriers. Lastly, by means of steady dialogue and collaboration, partners increased their appreciation and use of the trauma‐informed, harm reduction approaches that are central to wraparound programmes.
Provides a practical, up-to-date treatment of evaluability assessment (EA) focused on application, and capturing the multidisciplinary appeal of EA with case studies from different disciplines.
Using the trauma-informed approach outlined in this book, libraries can ensure they are empathetic community hubs where everyone feels welcomed, respected, and safe.
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