Auswahl der wissenschaftlichen Literatur zum Thema „15 months conscript service“

United Kingdom guidelines recommend screening for and treatment of latent tuberculosis infection (LTBI) in HIV-positive patients at high risk of active tuberculosis (TB) disease, but implementation is suboptimal. We investigated potential missed opportunities to identify and treat LTBI among HIV-positive patients accessing a large HIV outpatient service in London. Case records of all adult patients attending our service for HIV care diagnosed with active TB between 2011 and 2015 were reviewed to determine whether they met criteria for LTBI screening and whether screening was undertaken. Twenty-five patients were treated for TB. Of 15 (60%) patients who started TB treatment ≥6 months after HIV diagnosis, 14 (93%) met UK guideline-recommended criteria for LTBI screening and treatment; only one (7%) had been screened for LTBI. Eight of these 15 (53%) patients had additional risk factors for TB which are not reflected in current UK guidelines. Of 15 patients treated for TB ≥6 months after diagnosis of HIV, 14 (93%) had not been screened for LTBI, suggesting missed opportunities for TB prevention. People living with HIV may benefit from a broader approach to LTBI screening which takes into account additional recognised TB risk factors and ongoing TB exposure.

SummaryThis study describes service utilisation under routine clinical activity and the costs of providing mental health care for 24 months for the whole population of 330 subjects who had first contact with the Magenta Community Mental Health Centre during one year. The mean age of patients was 42.5 years, and 61% were females. According to ICD 10 criteria, 7% were diagnosed as having schizophrenia, 22% mood disorders, 37% neurotic disorders, 15% personality disorders and 19% other diagnoses. The clinical routine activity was monitored for 24 months from the first contact for each patient. The mean cost for a schizophrenic patient is more than double that of other patients. In-patient activity and community services accounted, respectively, for 49.7% and 50.3% of the total costs. Total health care costs per patient differ widely according to whether patients had been hospitalised during the observation period. Patients with a previous psychiatric contact and a longer duration of illness were more costly than the other patients. Multiple regression analysis was used to assess the association between all the individual variables and costs. For the whole population, the model explains 50% of the cost variation. Higher treatment costs were positively associated with the presence of previous psychiatric contacts and referral to the CPS by other sources than a general practitioner, and negatively associated with age.

New targeted social service – social rehabilitation program for young people with behavioural problems is implemented in Riga since 2016. The program beneficiaries are young people from social risk families with multiple social problems – learning difficulties, delinquency, low communication skills, difficulties in problem and conflict resolution, addictions, social isolation, etc. The program is provided by two organizations – “The Samaritan Association of Latvia” and the “Social Services Agency”. The duration of the programs is 6 months and 8 months respectively, each Program provides services for 15 young people aged 13 to 18 years. The study analyses results of the Program implemented by the “Social Service Agency” for 15 young people. The main objective was to determine if the implementation of the Program improves the social functioning of young people having behavioural problems.

The emergence of e-services benefited the stakeholders due to ease of access to data, information and knowledge sources. Service-based applications have evolved into flexible and adaptable systems capable of coping with changes in user requirements and business processes. The shift from monolithic application silos towards service-oriented approaches is evident in the literature today. The benefits of service-oriented approaches include cost effectiveness, improved inter-operability, reusability, and flexibility. The benefits are not enjoyed without the threat of cognitively overloading managers in their decision making activities. Tools for effective management of information are necessary. Effective and efficient service-oriented applications need to operate within their situational boundaries. As such, decision support type tools require tight integration with the service-based approach. This study proposes an integrated Situated Service-Oriented Model and demonstrates its value via a case study of an e-learning service-based application used over a period of 15 months. Two designs were used; component-based and service-oriented. The significance of this study is in the tangible value of the model proposed and demonstrated by the e-learning case study.

Aims and methodThe Maintaining Adherence Programme (MAP) is a new model of care for patients with schizophrenia, schizoaffective disorder and bipolar affective disorder which aims to encourage adherence and prevent relapse. This evaluation, conducted by retrospective and prospective data collection (including patient questionnaires and staff interviews), aimed to describe MAP's impact on healthcare resource use, clinical measures and patient and staff satisfaction, following its implementation in a university National Health Service (NHS) foundation trust in England. We included 143 consenting patients who entered MAP before 31 March 2012.ResultsIn-patient bed days and non-MAP NHS costs reduced significantly in the 18 months post-MAP entry. At 15–18 months post-MAP, Medication Adherence Rating Scale scores had improved significantly from baseline and there was a shift towards less severe clinician-rated disease categories. Based on patient surveys, 96% would recommend MAP to friends, and staff were also overwhelmingly positive about the service.Clinical implicationsMAP was associated with reduced cost of treatment, improvements in clinical outcomes and very high patient and staff satisfaction.

Objective: One objective of chiropractic education is to cultivate clinical confidence in novice practitioners. The purpose of this qualitative study was to describe how participation in a short-term international service learning experience changed perceptions of clinical confidence in senior chiropractic students. Methods: Seventeen senior chiropractic students participated in 4 moderated focus group sessions within 4 months after a clinical educational opportunity held in international settings. Participants answered standard questions on how this educational experience may have changed their clinical confidence. Two investigators performed qualitative thematic analysis of the verbatim transcripts to identify core concepts and supporting themes. Results: The core concept was transformation from an unsure student to a confident doctor. The service learning experience allowed students to deliver chiropractic treatment to patients in a real-world setting, engage in frequent repetitions of technical skills, perform clinical decision-making and care coordination, and communicate with patients and other health professionals. Students described increased clinical confidence in 9 competency areas organized within 3 domains: (1) chiropractic competencies including observation, palpation, and manipulation; (2) clinical competencies including problem solving, clinic flow, and decision-making; and (3) communication competencies, including patient communication, interprofessional communication, and doctor–patient relationship. Students recommended that future service learning programs include debriefing sessions similar to the experience offered by these focus groups to enhance student learning. Conclusion: Senior chiropractic students who participated in an international service learning program gained confidence and valuable practical experience in integrating their chiropractic, clinical, and communication skills for their future practices.

Care coordination (CC) has shown positive outcomes among children with special health care needs (CSHCN); however, the association between CC and well-child care (WCC) visits is unknown. We hypothesize that CSHCN who receive CC are more likely to attend the recommended WCC visits. A retrospective cohort analysis was conducted of patients aged 15 months attending the Arizona Children’s Center clinic. Logistic regression models explored the association between children receiving CC and attending the recommended minimum WCC visits before 15 months of age. CC was associated with higher odds of proper WCC attendance (any CC service, adjusted odds ratio = 2.14, 95% confidence interval = 1.75-2.62; high level of CC, adjusted odds ratio = 2.61, 95% confidence interval = 1.73-3.94). Pediatric CC is associated with greater up-to-date status of the WCC schedule among CSHCN 15 months of age, and higher odds among children who receive higher levels of CC. Further research is needed to validate findings.

This paper describes HealthConnect, an after-hours telephone triage and advice service which operated for 15 months in 2000 and 2001. We describe the service, discuss utilisation and implementation issues, and conclude with a description of the key lessons learned from the trial. The service received over of 12000 calls, of which over half were for information rather than immediately seeking care.Continuing marketing appears to be required in order to ensure ongoing demand for services of this kind. Qualityassurance is essential to ensure that an optimal service is provided, and staff recruitment and training are critical tothis. A national standardised approach to services of this kind is desirable to provide a consistent service to consumers and realise economies of scale.

Objectives: The first aim of this study was to examine the rate, pattern and correlates of inpatient admission during the first 3 months of treatment for first-episode psychosis (FEP). The second aim was to determine whether the pattern of inpatient admission during this period was associated with remission of psychotic symptoms or inpatient service use at 15-month follow-up. Method: One hundred and four consecutive patients with FEP at a specialist treatment service were approached to participate in a follow-up study. Patients were grouped on the basis of the pattern of inpatient admission (none, one, or multiple) during the first 3 months of treatment. Clinical ratings at baseline and 3-month follow-up, and ratings of remission of psychotic symptoms at 3 and 15-month follow-up, were available for two-thirds of the patients. Inpatient data for the 15-month follow-up period were derived from an electronic database for most patients (n = 98). Results: Eighty (76.9%) of the 104 patients were admitted to an inpatient unit during the first 3 months of treatment. Fifty-nine (56.7%) patients had a single admission and 21 (20.2%) had multiple admissions. At baseline, inpatient admission was associated with a diagnosis of affective psychosis and more severe behavioural and functional disturbance but not positive psychotic symptoms. Multiple admissions were associated with risks to self or others at baseline and 3-month follow-up, and lack of remission of positive symptoms at 3 and 15-month follow-up. There was no association between the pattern of inpatient admission during the initial 3-month period and inpatient service use during the following 12-month period. Conclusions: The substantial proportion of young patients with FEP admitted to hospital emphasizes the need for youth-friendly treatment environments and practices. Although patients with multiple admissions during the initial treatment period are less likely to achieve remission, these patients are no more likely to establish a pattern of revolvingdoor hospitalizations compared with other patients.

Sedan början av 2000-talet har Försvarsmakten genomfört en mängd förändringar med sin organisation och personal. Nedskärningarna av förband tillsammans med ett ökat fokus på internationella insatser i början av 00-talet har under slutet av 10-talet förändrats till en tillväxt av förband samt en återgång till ett nationellt fokus. Yrkesofficerarnas profession har förändrats genom införandet av ett tvåbefälssystem under slutet av 00-talet från ett enbefälssystem, likväl som att värnplikten lades vilande 2010 och anställda soldater introducerades i organisationen. Sedan 2018 är värnplikten återinförd med utbildning av soldater och gruppbefäl, 9 respektive 11 månader. Från och med sommaren 2021 återinförs 15 månaders värnpliktiga, som övertar befattningar i krigsorganisationen som tidigare bemannats av yrkesofficerare. Studien utforskar vad detta införande innebär för yrkesofficersprofessionen, vilka konsekvenser som uppstår likväl som hur införandet bör implementeras. Genom intervjuer av åtta respondenter från Trängregementet i Skövde utforskas införandet ur yrkesofficerarnas perspektiv. Studien tar hjälp av Bolman och Deal’s fyra perspektiv på organisation och ledarskap samt Runsten och Werr’s modell för kunskapsintegration för att förstå och tolka organisationsförändringen. Införandet av 15 månaders värnpliktiga omfattar yrkesofficerarnas förväntningar på förändringen, som baseras från tidigare erfarenheter men innehåller även farhågor och positiva förväntningar. Erfarenheten att utbilda dessa värnpliktiga saknas idag på grundutbildningskompanierna, denna kunskap återfinns hos äldre yrkesofficerare i högre nivåer - varvid ett utbyte av gamla erfarenheter i dagens kontext är en framgångsfaktor. Införandet påverkar även utbildning och övningar för förbanden, då värnplikten sker under en längre tid samt att de värnpliktiga ställer ett ökat ansvarstagande hos plutonchefer. Professionen för främst specialistofficerare förändras, genom att värnpliktiga innehar samma grad som specialistofficerare likväl som att expertisen för specialistofficerare kommer ta längre tid att uppnå. En maktförskjutning sker från yrkesofficerare till värnpliktiga, vilket främst påverkar unga specialistofficerare. Studien rekommenderar Försvarsmakten att överse nuvarande styrdokument och uppdatera dessa, samt vidare utveckla yrkesofficersprofessionen. Studien rekommenderar Försvarsmakten att med nuvarande indelning i trebefälssystemet att sergeantsgraden är lämplig för de värnpliktiga och att en förstegsutbildning är bäst lämpad för att utbilda och öva sig till ställföreträdande plutonchef. Om Försvarsmakten inför värnpliktiga plutonchefer i framtiden bör detta föregås av en analys utifrån den militära professionen och trebefälssystemet.
Since the early 2000’s the Swedish Armed Forces has conducted several changes concerning its organization and personnel. The downsizings of units as well as an increased focus on international operations in the early 2000’s have changed to a growth of units and a return to a national focus. The professions of professional officers have changed with the transformation from a single-command system to a two-officer system in the late 00s, as well as the pause of national conscript service in 2010 and introduction of professional soldiers within the organization. The national conscript service was reintroduced in 2018, for soldiers and squad leaders between 9 and 11 months. During the summer of 2021, 15 months conscript service will be reintroduced. These new conscripts will take over the positions previously manned by professional officers in the wartime organization. The study explores the reintroduction’s affects for professional officers, what consequences that occur as well as how the reintroduction should be implemented. Through interviews with eight respondents from the Logistics regiment in Skövde the reintroduction is explored through the professional officers’ view. The study seeks guidance from Bolman and Deal’s four perspectives on organization and leadership and also Runsten and Werr’s model for integration of knowledge, to be able to understand and interpret the organizational change. The reintroduction of 15 months conscripts includes professional officers’ expectations of the change, which is based from earlier experiences but also includes concerns and hopes. There is a lack of experience to train this new category of conscripts today at company level, the ability to do so is found in older officers in higher echelons – therefore an exchange of old experiences in the context of today is a criterion for success. The reintroduction also affects the training and the field exercises, because the conscript service is prolonged and the conscripts require an increased responsibility from the platoon leader. The profession for non-commissioned officers (NCO) changes - through the use of the same rank by conscripts and NCO’s. It will also take longer time for NCO’s to achieve expertise within their profession. A shift of power occurs from professional officers to conscripts, which mostly affects junior NCO’s. The study recommends the Swedish Armed Forces to overlook its current steering documents and to update these, and also to further develop its military profession for all officers. The study recommends the Armed Forces that with the current officer system, the rank of sergeant is well suited for these conscripts and the conscripts service should be based upon a pre-training concept to be able to succeed as deputy platoon leader. If the Armed Forces introduce conscripts as platoon leaders in the future, an analysis should be conducted prior to the change, concerning the military profession and the three-officer system.

The emergence of e-services benefited the stakeholders due to ease of access to data, information and knowledge sources. Service-based applications have evolved into flexible and adaptable systems capable of coping with changes in user requirements and business processes. The shift from monolithic application silos towards service-oriented approaches is evident in the literature today. The benefits of service-oriented approaches include cost effectiveness, improved inter-operability, reusability, and flexibility. The benefits are not enjoyed without the threat of cognitively overloading managers in their decision making activities. Tools for effective management of information are necessary. Effective and efficient service-oriented applications need to operate within their situational boundaries. As such, decision support type tools require tight integration with the service-based approach. This study proposes an integrated Situated Service-Oriented Model and demonstrates its value via a case study of an e-learning service-based application used over a period of 15 months. Two designs were used; component-based and service-oriented. The significance of this study is in the tangible value of the model proposed and demonstrated by the e-learning case study.

Postnatal depression (PND) in Japan, despite a traditional support system for perinatal women and cultural differences, is no less common than in western countries. Our previous two studies, which began in the 1990s, found that PND was experienced by about 15% of Japanese women. First, 98 Japanese women living in England (Yoshida et al. 1997) and then 88 Japanese women living in Japan (Yamashita et al. 2000) were recruited into two prospective studies of PND from late pregnancy to 3 postnatal months. Using the same research protocol and diagnostic method, (Schedule for Affective Disorders and Schizophrenia, Research Diagnostic Criteria), the incidence of PND was 12% and 17% respectively. We have a traditional support system for perinatal women called Satogaeri Bunben. Satogaeri means returning to their home towns where their families of origin live and Bunben means delivery. Pregnant women return to their home towns several weeks prior to their delivery and remain there, with their babies, after delivery for a couple of months. It seems to be a very supportive system. However, Satogaeri Bunben itself did not lower the incidence of PND in either of the groups mentioned above. A disadvantage of Satogaeri Bunben is that a woman cannot be monitored by the same midwife or obstetrician and her husband has to work and live separately until their reunion in their marital home (Yoshida et al. 2001). Most mothers with PND are unlikely to access psychiatric care, even though their depressive symptoms are serious (Mclntosh 1993). Therefore neonatal home visits by health visitors were seen as a potentially useful opportunity for detecting mothers with PND. Luckily, a home visit system by community health visitors has been well organized throughout Japan since the late 1940’s. In the past, the focus was on reducing infant death and promoting infant growth and development. In our city, the neonatal home visit service is provided for mother–baby dyads where (a) a baby’s birth weight is less than 2500 g, (b) first-born babies with a birth weight of less than 2800 g, (c) babies with perinatal or pediatric physical health problems.

An ambitious project in propulsion was introduced as part of the final-year integrator project offerings of the mechanical and aerospace engineering programs at École Polytechnique de Montréal in 2011–2012. It has been running successfully for the past three academic years. The project consists in the design, fabrication and placement into service of a functional instrumented multi-stage compressor test rig, including the compressor, for research in compressor aerodynamics. A team of 15–17 senior-year undergraduate engineering students are given set of design and performance specifications and measurement requirements, an electric motor and drive, a data acquisition system and some measurement probes. They must complete the project in two semesters with a budget on the order of Can$15,000. The compressor is made from rapid prototyping to keep production cost and time reasonable. However, its required rotation speed of 7200 rpm stretches the limits of the plastic material and presents the same structural challenges as industrial compressors running at higher speeds. The students are split into sub-teams according to the required disciplines, namely compressor aerodynamics, general aerodynamics, structures, dynamics, mechanical design and integration, instrumentation and project management. For the initial phase, which covers the first two months, the students receive short seminars from experts in academia and industry in each discipline and use the knowledge from fundamental engineering courses to analytically model the different components to come up with a preliminary design. In the second phase, covering months three through six, the students are trained at commercial simulation tools and use them for detailed analysis to refine and finalize the design. In each of the first two phases, the students present their work in design reviews with a jury made up of engineers from industry and supervising professors. During the final phase, the compressor is built and tested with data acquisition and motor control programs written by the students. Finally, the students present their results with comparison of measured performance with numerical and analytical predictions from the first two phases and hand over their compressor rig with design and test reports as well as a user manual and an assembly/maintenance manual. This complete project allows the students to put into practice virtually all the courses of their undergraduate engineering curriculum while giving them an extensive taste of the rich and intellectually challenging environment of gas turbine and turbomachinery engineering.

Abstract Chains are extensively used in the Oil and Gas industry for mooring vessels or floating platforms, both for temporary and long-term moorings. Moreover, recently they found a new application in the mooring of floating wind turbines. The integrity of mooring systems is of great importance for both industries. Failure Records [1]–[2] indicate that fatigue of mooring chains is one of the main causes of failure, and therefore their lifetime prediction represents an important challenge for industry. Chains are intended to work under Tension Loading, however, anomalous loading modes such as Out-of-Plane Bending (OPB) or Twisting can appear. For example, OPB caught the attention of engineers after the Girassol incident; where it was identified as the main cause of failure of several chain links eight months after the installation [3]. Since this failure, OPB has attracted the attention of several research programs and multiple publications can be found in the literature (For example, [4]–[5]). Twist may occur during the installation of a chain or during service due to torque generated in the near-by elements of the mooring (for example wire cables). This paper presents a computational fatigue assessment of mooring chains working in twisted conditions. It is based on a two steps analysis: a mechanical and a fatigue analysis. The mechanical analysis accounts for the initial residual stress state of the chain after manufacturing and subsequent proof loading. The result is the stabilized cycle of the multiaxial stress field, which is obtained through an elastic-plastic three-dimensional Finite Element Analysis (FEA). Then, the fatigue analysis is performed to predict the failure location and determine the lifetime. The predicted failure location has shown good agreement with fatigue cracks found in recovered chain links in the North Sea after more than 15 years of service.

United States (US) Freight and Passenger railroads and transit entities are preparing for the deployment of Positive Train Control (PTC) systems as soon as the end of 2012, and by Federal mandate, by the end of 2015. PTC depends on a reliable and robust wireless data link between train and wayside equipment, train and network access points, and waysides and network access points. While, for the wireless component, some spectrum has been acquired and initial functionality defined, there will be lessons learned and new expectations as systems are rolled out over this period and beyond. Since the average service life of radio equipment in rail and transit applications is in excess of 10–15 years, and a system design may remain in place for 20–25 years, the challenge is to ensure that wireless systems are flexible enough to adapt to technology changes that may occur during the radio system’s long service life. Software-Defined Radio (SDR) is the appropriate approach to deal with this future uncertainty. The worldwide cellular communications standards are a great example: 3GPP established its first 3G specification, Release-99, in the year 2000; there have been 7 full specification releases since then, demonstrating the challenges of predicting future use based on current expectation. Deployment and long-term maintenance account for the majority of system cost: when system deployment is expensive and time-consuming, the needs for flexible design are crucial. The maintenance cost should be added and weighted higher in the calculation for total cost of ownership. One can argue that fixed design is cheaper; however, the total cost of ownership may end up much higher when changes are needed before the end of the product’s expected service life. In Information Technology, the system performance doubles approximately every 18–24 months. Thoughtful radio design can leverage this generational improvement. To address the issue of broad interoperability and a forward-looking specification, radio experts, including transit systems integrators, Federal agencies, end device and chipset manufacturers, and researchers, from around the world have teamed up under the aegis of the Institute of Electrical and Electronic Engineers (IEEE) to establish a Positive Train Control group for the RF/PHY/MAC based upon the well adopted IEEE 802.15.4 standard. The outcome of this effort will ensure the maturity of a PTC specification and long term maintenance of this mission-critical PTC wireless interface protocol. With any new specification development, continuous vetting, modification and upgrade will occur over coming years to improve the functionality and stability. SDR architectures allow the radio system to follow the standard. SDR allows railroads to start system validation and hardware qualification now, in order to meet the required Federal deadline. Since SDR provides a continuous path for interoperability as radios can reprogram and reconfigure on the fly, the hardware can remain unchanged while interoperability and advances in standards can be met through software upgrade.