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Background Substantial health disparities have been reported between Black and White Americans diagnosed with schizophrenia. The nature and extent of these disparities among individuals receiving services in an equal-access health care system remains understudied. Purpose and aims The purpose of this study was to examine disparities in enrollment characteristics, service delivery and clinical outcomes between Black and White veterans diagnosed with schizophrenia who received care in the Veterans Health Administration (VHA), an equal-access health care system. Methods National program evaluation data from the VHA Intensive Community Mental Health Recovery (ICMHR) program were used to evaluate disparities between 2436 Black and 3565 White veterans who enrolled between 1999 and 2013. Veterans and case managers completed measures of sociodemographic factors, clinical history, clinical characteristics, and justice system involvement at enrollment and six months. Chi square and ANOVAs were used to evaluate enrollment and service delivery differences. Six-month changes were evaluated using multiple regression controlling for potentially confounding baseline characteristics. Effect sizes were evaluated with Cohen's d. Results Results indicated differences between Black and White veterans in clinical history, justice system involvement, and clinical characteristics at enrollment. Minimal differences in service delivery were noted and longitudinal analyses revealed no significant differences between Black and White veterans on the majority of outcomes. Conclusion Fewer racial disparities in service use and outcomes were observed in ICMHR than in standard non-VA clinic settings. This study demonstrates that disparities may emerge more strongly from systemic rather than individual-level differences.

Innovating service delivery in higher education by leveraging technology is central to supporting goals of transforming higher education to center on the needs of today's students. Aligned with these goals, this article identifies key determinants of student information technology adoption. Using a mixed-methods and empirical approach based on the Unified Theory of Acceptance and Use of Technology (UTAUT), a web-based survey was administered to undergraduate students at a public university in the Western United States to learn about their experiences with a web-based digital services platform (native mobile app and website), that aids students in accessing services and resources critical to maintaining their enrollment. Structural Equation Modeling, including Principal Components Analysis, was used to analyze 1841 valid survey responses and derive statistical results. The findings suggest that effort expectancy and social influence stand out as critical influences on behavioral intention to adopt the software for accessing university services, and new to UTAUT, that social influence and a students’ basic technology skills are significant determinants of effort expectancy. This article makes unique contributions to the research literature. It applies UTAUT to a higher education context to help explain the critical determinants of the adoption of software for accessing university services. It also provides insights for how UTAUT can be applied in the university setting and offers suggestions for enhancing UTAUT.

Implementation science is a useful tool to consider ways in which we can introduce improvements to burn services in low-and-middle income countries (LMICs), where the majority of the burden of burn injury is now experienced. This paper outlines the development of the Delivery Assessment Tool (DAT), a method for facilitating quality improvement in burn services in LMICs. We used a participatory approach that ensured that local clinicians and experts were fully involved in piloting the tool. The DAT is based on internationally agreed operational standards for burn care service delivery and has undergone an iterative process of improvement and refinement through an initial three-year project in Nepal and Bangladesh. The DAT, a 50-item tool organised into 10 subsections, is used to assess a service through a participatory focus group discussion (FGD) with a mixed, multidisciplinary team of staff working at the burn service, typically 6-10 participants. This usually lasts 2 to 3hours. The staff in the unit then select priority areas for quality improvement programmes that are within their control to achieve, which starts a cycle of audit and review. The final version of the tool was used in a further three-year project to evaluate 11 hospitals in Nepal and Bangladesh. Education and training are key components of this work; both were provided by Interburns as part of on-going support for the clinical teams. At the end of the project a >19% improvement in scores was demonstrated using the final version of the DAT in both Nepal and Bangladesh; this achievement is remarkable given the continued difficulties in service provision where patient numbers far outstrip the resources available to care for them. As a result of this work, we have made a digital version of the tool available free of charge.

Given the ongoing dilemma for college counseling centers to meet steady increases in demand for services, this study outlines the implementation of an adapted stepped care model in a university counseling center. Our adapted model focused, as do other stepped care models, on treatment planning and lower-intensity interventions, with the addition of the intensive therapy option being provided on a weekly basis. We adopted our stepped care model across a large center and hypothesized that after implementation we would be able to serve a similar number of clients as our previous model and that treatment outcomes for these clients would improve. Descriptive data and regression analyses demonstrated support for our hypotheses, including an increased likelihood of clinically significant improvement for clients postimplementation. Implications for adapting service delivery models using practice-based evidence are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Background Across the globe, many women including economic and humanitarian migrants receive inadequate antenatal care. Understanding the difficulties that migrant women encounter when accessing maternity care, including the approach of health professionals, is necessary because inadequate care is associated with increasing rates of morbidity and mortality. There are very few studies of migrant women’s access to and experience of maternity services when they have migrated from a low- to a middle-income country. Aim To examine the perceptions and practices of Thai health professionals providing maternity care for migrant Burmese women, and to describe women’s experiences of their encounters with health professionals providing maternity care in Ranong Province in southern Thailand. Methods Ethnography informed the study design. Individual interviews were conducted with 13 healthcare professionals and 10 Burmese women before and after birth. Observations of interactions (130 h) between health care providers and Burmese women were also conducted. Data were analysed using thematic analysis. Findings The healthcare professionals’ practices differed between the antenatal clinics and the postnatal ward. Numerous barriers to accessing culturally appropriate antenatal care were evident. In contrast, the care provided in the postnatal ward was woman and family centered and culturally sensitive. One overarching theme, “The system is in control’ was identified, and comprised three sub-themes (1) ‘Being processed’ (2) ‘Insensitivity to cultural practices’ and, (3) ‘The space to care’. Discussion and conclusions The health system and healthcare professionals controlled the way antenatal care was provided to Burmese migrant women. This bureaucratic and culturally insensitive approach to antenatal care impacted on some women’s decision to engage in antenatal care. Conversely, the more positive examples of woman-centered care evident after birth in the postnatal ward, can inform service delivery.

Efforts to improve mental health treatment delivery come at a time of rising inequality and cuts or insufficient increases to mental health funding. Public mental health clinicians face increased demands, experience economic stress, and treat underresourced patients disproportionately burdened by trauma. The authors sought to understand clinicians' current economic and psychological conditions and the relationship of these conditions to the delivery of an evidence-based intervention (EBI) designed to treat posttraumatic stress disorder among youths.In July 2020, 49 public mental health clinicians from 16 Philadelphia clinics who were trained in an EBI, trauma-focused cognitive-behavioral therapy (TF-CBT), were surveyed by e-mail. Respondents reported on their economic precarity, financial strain, burnout, secondary traumatic stress (i.e., the stress response associated with caring for people exposed to trauma), and TF-CBT use. Associations between clinicians' job-related stressors and their use of TF-CBT were examined with mixed models. Content coding was used to organize clinicians' open-ended responses to questions regarding financial strain related to the COVID-19 pandemic.Clinicians' economic precarity, financial strain, and job-related stress were high; 37% of clinicians were independent contractors, 44% of whom wanted a salaried position. Of 37 clinicians with education debt, 38% reported owing ≥$100,000. In the past year, 29% of clinicians reported lack of personal mental health care because of cost, and 22% met the cutoff for experiencing secondary traumatic stress symptoms. Education debt was negatively associated with use of TF-CBT (p0.001).The stress of providing care in underresourced clinical settings may interfere with efforts to integrate scientific evidence into mental health care.

This professional perspective provides background knowledge and evidence to support reflection on disability outcomes internationally and in Aotearoa New Zealand Over one billion people live with disability worldwide Approximately 4 5% of the world’s population live with significant difficulties in function, activity, and participation In Aotearoa New Zealand, approximately 1 1 million (24%) people have a disability, making disability the largest minority group Yet disabled people face extreme health inequities These are exacerbated when response planning and service delivery during times of humanitarian emergency, such as COVID-19, fail to include and consider the impact decisions will have for disabled people Disabled people are more “at risk” of contracting COVID-19, and some disabled people are “at risk” of poorer health outcomes from COVID-19 However, “vulnerability” arises from the continuation and exacerbation of discriminatory policies, including health professionals’ conscious and unconscious biases, in times of crisis but also within conventional health service delivery As part of the health system, it is perhaps timely for physiotherapists to reflect upon their knowledge of the health inequities disabled people experience, and to consider personal and collective bias There are strategies physiotherapists might adopt to challenge interpersonal, internalised, and institutional bias These steps will help affirm disability inclusiveness at all levels of the health system and support a human rights expectation that all New Zealanders should have equitable health outcomes © 2020, Physiotherapy New Zealand All rights reserved

Conditions created by the COVID-19 pandemic have impacted many aspects of medical practice. Responding to this crisis has required health systems to rapidly address a multitude of concerns, including workforce safety, staff redeployment, supply shortages and physical space restructuring. The pace of change created by new information and evolving conditions has proven challenging for traditionally-structured academic departments in medicine. Pandemic medicine requires a nimbleness in decision-making, clarity of communication and comprehensiveness of services that may demand a temporary rearrangement of leadership structure and clinical service delivery. Furthermore, the uncertain nature of a pandemic may require reinstitution and dissolution of services as demand sporadically either rises or falls. As the global medical community continues to respond to what may be multiple COVID-19 peaks stretching over months or years, it is important that approaches to preparation and management of the pandemic are shared to enable the identification of best practices and an effective response. With the availability of open access and free communication technologies, these strategies can be easily shared among the global anaesthesia community. The approach outlined here represents one way to organise leadership and streamline communication in order to reinvent an academic department to match the dynamic requirements of crisis conditions. We describe our experience in offering new services such as an airway team, COVID-19 simulation training and personal protective equipment testing, as well as our approach to evaluating the rapid flow of research findings related to SARS-CoV-2 and COVID-19. We summarise lessons learnt and our adaptation to what may be a “new normal” in anaesthesiology practice.

With astonishing speed, bandwidth, and scale, Mobile Edge Computing (MEC) has played an increasingly important role in the next generation of connectivity and service delivery. Yet, along with the massive deployment of MEC servers, the ensuing energy issue is now on an increasingly urgent agenda. In the current context, the large-scale deployment of renewable-energy-supplied MEC servers is perhaps the most promising solution for the incoming energy issue. Nonetheless, as a result of the intermittent nature of their power sources, these special design MEC servers must be more cautious about their energy usage, in a bid to maintain their service sustainability as well as service standard. Targeting optimization on a single-server MEC scenario, we in this paper propose NAFA, an adaptive processor frequency adjustment solution, to enable an effective plan of the server’s energy usage. By learning from the historical data revealing request arrival and energy harvest pattern, the deep reinforcement learning-based solution is capable of making intelligent schedules on the server’s processor frequency, so as to strike a good balance between service sustainability and service quality. The superior performance of NAFA is substantiated by real-data-based experiments, wherein NAFA demonstrates up to 20% increase in average request acceptance ratio and up to 50% reduction in average request processing time.

Respondent-driven sampling (RDS) is commonly used to sample from key populations without a sampling frame since traditional methods are unable to efficiently survey them. Surveying these populations is often desirable to inform service delivery, assess effectiveness of programs, and determine prevalence of diseases. However, there are concerns about how RDS works in practice due to its many assumptions. To assess some of these assumptions, we develop diagnostics using geographical data and demonstrate their utility by identifying lack of convergence and characterizing RDS reach in surveys conducted among female sex workers and men who have sex with men in Kampala, Uganda.

Chatbots are being used in an increasingly wide range of public services. Chatbots present several benefits for public service delivery (e.g. cost efficiency for public organizations and better service accessibility for service applicants). However, obtaining effective service outcomes from a chatbot-mediated service delivery requires designing a suitable type of chatbot for specific types of public services. We (a) classify different types of public services in terms of complexity of their delivery process; (b) classify chatbots based on their technical properties and capabilities; and (c) propose a typology that supports public organizations with deciding what type of chatbot is suitable for what type of public services. Our typology contributes to effective chatbot-mediated service delivery in the public service context.

The COVID-19 pandemic triggered abrupt challenges for health care providers, requiring them to simultaneously plan for and manage a rise of COVID-19 cases while maintaining essential health services. Since March 2020, the COVID-19 Health System Response Monitor, a joint initiative of the European Observatory on Health Systems and Policies, the WHO Regional Office for Europe, and the European Commission, has documented country responses to COVID-19 using a structured template which includes a section on provision of care. Using the information available on the platform, this paper analyzes how countries planned services for potential surge capacity, designed patient flows ensuring separation between COVID-19 and non-COVID-19 patients, and maintained routine services in both hospital and ambulatory settings. Despite very real differences in the organization of health and care services, there were many similarities in country responses. These include transitioning the management of COVID-19 mild cases from hospitals to outpatient settings, increasing the use of remote consultations, and cancelling or postponing non-urgent services during the height of the first wave. In the immediate future, countries will have to continue balancing care for COVID-19 and non-COVID-19 patients to minimize adverse health outcomes, ideally with supporting guidelines and COVID-19-specific care zones. Looking forward, policymakers will have to consider whether strategies adopted during the COVID-19 pandemic will become permanent features of care provision.

Maternal and perinatal death surveillance and response (MPDSR) is a health systems process entailing the continuous cycle of identification, notification, and review of maternal and perinatal deaths (Surveillance), followed by actions to improve service delivery and quality of care and Response. Prior to the COVID-19 pandemic, there were an estimated 4.6 million maternal and newborn deaths and stillbirths each year. During the pandemic, maternal and perinatal health outcomes have worsened, especially in low- and middle-income countries, highlighting the urgent need to galvanize MPDSR to end preventable mortality and strengthen health systems.

The integration of the space-air-ground integrated network and the Internet of Vehicles (IoV) enables the IoV to achieve full network coverage and better network performance. However, the large scale of the network and the complex cooperation mechanism make the credibility of the nodes in the network, and the service delivery questioned. In this paper, the hardware trusted module is used as the root of trust to build the trust chain and the trusted running environment and provide protection and trusted state attestation for services. In order to overcome the large-scale and high-concurrency performance bottlenecks in the remote verification of trusted states in the IoV, a novel batch remote approach for trusted states is proposed. The simulation results show that the proposed approach can effectively attest to the trusted state of each network node and virtual service in the IoV and enhance the trustworthiness of the network.

The COVID-19 pandemic forced clinics to quickly shift service provision and supervision of students to remote operations Mental health services for people facing barriers, including those who live in extreme poverty, remain a critical need, especially when considering the direct and indirect consequences of a global health crisis The focus of this paper was to examine the effectiveness of psychotherapy treatment and clinical supervision, via telephone delivery (i e , audio-only calls), from March to July of 2020 in a university training clinic, which primarily serves a low-income, community population Participants (n = 33) were ethnically diverse, adult, outpatient psychotherapy clients from a large, urban setting and the university community Primary diagnoses included major depressive, anxiety, and posttraumatic stress disorder Student clinicians (n = 14) were novice psychotherapy providers, mostly in their second or third year of training Qualitative data indicated that 1-third of clients met treatment goals and successfully terminated during this period, while another third made significant progress toward these goals (operationalized as objective observations by the clinician and supervisor, self-reported changes by the client, and observations by the clinician and supervisor of in-session skill use) Smaller proportions of the sample were referred out for relocation or rotation changes, dropped out of care prematurely, or were transferred to a higher level of care Clinician report of supervision alliance (SWAI-T), satisfaction, and other supervisory variables during remote supervision were comparable to in-person supervision and reflected good alliance and satisfaction for both modalities These data suggest that use of audio-only calls for supervision and treatment provision can be effective for training and care, especially when clients have established therapeutic relationships with their clinicians As telehealth services and remote training are likely to expand into the future, these findings provide preliminary support for the use of this modality as an option for clients with significant barriers to access and sufficient supervisory support to novice clinicians (PsycInfo Database Record (c) 2021 APA, all rights reserved) Impact Statement Mental health services for people facing barriers, including those who live in extreme poverty, remain a critical need during the COVID-19 pandemic, especially when considering the direct and indirect consequences of a global health crisis Ensuring that a vulnerable population has access to high-quality mental health is crucial during the pandemic, as many individuals in this group do not have simultaneous access to all of the resources needed to migrate to a video telehealth platform for therapy sessions Therefore, the aim of this paper is to contribute to the literature on the effectiveness of telephone-only telehealth service delivery by novice clinicians to provide an evidence-based approach for increasing access to needed care among community-based clients, often living in poverty (PsycInfo Database Record (c) 2021 APA, all rights reserved)

The NHS is facing an unprecedented backlog in both patient care and building maintenance, with severe implications for service delivery, finance and population wellbeing. This article is the first in a series discussing modular healthcare facilities as a potential solution to these issues, providing flexible and cost-effective spaces to allow services to increase capacity without sacrificing care quality. The first of three instalments, this paper will outline the problems facing the NHS estate, many of which have been exacerbated to critical levels by the COVID-19 pandemic, and what this means for service delivery. It will then make the case for modular infrastructure, outlining the potential benefits for healthcare services, staff and patients alike. Using modern methods of construction, this approach to creating physical space in healthcare can provide greater flexibility and a reduced impact on the environment. The next two articles in this series will go on to provide detailed case studies of successful modular implementation in NHS trusts, an analysis of the cost implications and guidance on the commissioning process and building a business case.

The Army New Parent Support Program (Army NPSP) provides home visitation services that promote positive parenting strategies and aims to prevent family violence for expectant military parents and military families with children from birth to age 3. Since the onset of the novel coronavirus (COVID-19), Army NPSP services have rapidly adapted to a telehealth model to fit with the suggested practices of physical distancing. Employing a grounded theory approach, nine virtual focus groups with 30 Army NPSP home visitors across eight installations were conducted to examine how this rapid shift has impacted their services, practice, and professional role. The present study identified two overarching themes: (1) working with families (e.g., continued engagement with families, increased communication, shifting family needs) and (2) adjusting to telework (e.g., technology, professional collaboration and communication, professional growth). Findings from these focus groups indicated that home visitors were actively engaged with their clients and experienced both challenges and benefits of telehealth. While the rapid transition was a big change, and home visitors missed the face-to-face interactions, they expressed that they were adapting and improving their virtual service delivery with time. Increased concerns regarding families' well-being due to social and physical isolation, increased symptoms of anxiety and depression, and grief for losses due to COVID-19, along with the ability to continue connections with these highly mobile families, points to the importance of telehealth as a means to implement parenting programs vital to military family well-being. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

In recent years driving violations have increased in big and crowded cities specially in developing countries. This has resulted in escalation of traffic congestions and number of accidents, making them difficult to handle by a central managing authority. New technologies can be used in order to mitigate this problem. Hence, in this paper, we propose a novel concept, called self-fining vehicle, using Blockchain infrastructure on top of the Vehicular Edge Computing, VEC. Self-fining vehicle is a vehicle that detects and records driving violations, issues tickets and pays fines without the need for centralized management system. Violations can be coded into OBU and detected by vehicular communications. The conceptual architecture of secure self-fining vehicle is proposed and discussed in this paper. The proposed architecture improves violation data security, processing speed and communication delay using encryption, authentication, Blockchain and edge computing, enhancing quality of service and consumers‘ quality of experience. The performance analysis of the proposed architecture proves its efficiency in terms of latency in service delivery.

A WHO global strategy launched in November 2020 sets out an ambitious pathway towards the worldwide elimination of cervical cancer as a public health problem within the next 100 years. Achieving this goal will require investment in innovative approaches. This review aims to describe integrated approaches that combine human papillomavirus (HPV) vaccination and cervical cancer screening in low- and middle-income countries (LMIC), and their efficacy in increasing uptake of services. A systematic review was conducted analyzing relevant papers from Embase, Medline, CINAHL and CAB Global Health databases, as well as grey literature. Narrative synthesis was performed on the included studies. Meta-analysis was not appropriate due to the heterogeneity and nature of included studies. From 5,278 titles screened, 11 uncontrolled intervention studies from four countries (from Africa and east Asia) were included, all from the past 12 years. Four distinct typologies of integration emerged that either increased awareness of HPV and/or cervical cancer screening, and/or coupled the delivery of HPV vaccination and cervical cancer screening programs. The synthesis of findings suggests that existing HPV vaccination programs can be a useful pathway for educating mothers and other female caregivers about cervical cancer screening; through in person conversations with care providers (preferred) or take-home communications products. Integrated service delivery through outreach and mobile clinics may overcome geographic and economic barriers to access for both HPV vaccination and cervical cancer screening, however these require significant program and system resources. One study promoted HPV vaccination as part of integrated service delivery, but there were no other examples found that examined use of cervical cancer screening platforms to promote or educate on HPV vaccination. This review has demonstrated gaps in published literature on attempts to integrate HPV vaccination and cervical cancer screening. The most promising practices to date seem to relate to integrated health communications for cervical cancer prevention. Future research should further explore the opportunities for integrated health communications to support the efforts towards the new global cervical cancer elimination agenda, and costs and feasibility of integrated service delivery for underserved populations.

Following successful school-based demonstration programs in 2014-2016, the human papillomavirus (HPV) vaccine was introduced nationwide in Senegal for 9-year-old girls in 2018, using a routine service delivery strategy at health facilities, schools, and other outreach sites. We reviewed the HPV vaccine introduction in Senegal to understand the successes, challenges, and lessons learned. Focusing on three key domains (program decision-making, planning, and implementation), we conducted ten semi-structured interviews during 2019-2020 with purposively selected national-level stakeholders (government, expert advisory committee, key technical and implementation partners) and comprehensive desk reviews of country documents on HPV vaccine introduction. Due to the global HPV vaccine shortage, the introduction was limited to a single-age cohort; therefore, 9-year-old girls were chosen. This strategy enabled Senegal to potentially reach more girls in primary education because school enrolment rates decline thereafter. Vaccination through routine delivery platforms (i.e., health facility, school-based, and community outreach) was perceived to be more cost-effective than a campaign approach. High-level political commitment and collaborations between immunization and education partners were frequently cited by key informants as reasons for a successful vaccine introduction. All key informants reported that the health care worker (HCW) strike, rumors, and vaccine hesitancy negatively impacted the introduction. Other challenges noted included insufficient information on attitudes towards HPV vaccination among HCWs, teachers, and community members. Senegal successfully introduced HPV vaccine into the national immunization schedule, using a routine delivery strategy. Strong leadership and a multi-sectoral approach likely contributed to this success. To build sustainability of the HPV vaccination program in the future, it is important to improve the understanding and engagement among all stakeholders, including HCWs and community members, and to strengthen and innovate communication and crisis management strategies. To better understand the efficiency and effectiveness of Senegal's vaccination strategy, additional assessments of the operational costs and coverage achieved are needed.

The introduction of the Human papillomavirus (HPV) vaccine has shown potential to not only prevent cervical cancer but also drive adolescents’ access to other health care services, even in low-income countries. Few studies have been conducted to date to identify best practices and estimate the acceptance, operational challenges and benefits of including broader adolescent health interventions into immunization efforts, knowledge which is essential to supporting widespread integration. In this paper we review the efforts undertaken by the government of Togo to integrate adolescent health programming with the HPV vaccination roll out. With the support of partners (GAVI, WHO, UNFPA and UNICEF), the country successfully completed, in 2017, two years of an HPV vaccine demonstration project, which entailed vaccinating 10-year-old girls against HPV in two selected districts of the country and integrating a health education component focused on puberty education / menstrual hygiene and hand washing practice. Our study is a post-implementation program evaluation, using mixed methods to assess key questions of feasibility and acceptability of an integrated adolescent package of care. It showed that the HPV vaccination in conjunction with the health education sessions was well received by the majority of health care providers, teachers and parents. Our study confirmed that in Togo it proved feasible to combine education and HPV vaccination in school-based service delivery. However, more operational research is neded to understand how to increase the impact and sustainability of the co-delivery of interventions. We did not analyze the health impact and cost implications of the intervention, which will be an important consideration for scaling up such integration efforts alongside routine immunization.

To address gaps in coverage and quality of nutrition services, AliveThrive (AT) strengthened the delivery of maternal nutrition interventions through government antenatal care (ANC) services in Uttar Pradesh, India. The impact evaluation of the AT interventions compared intensive ANC (I-ANC) with standard ANC (S-ANC) areas and found modest impacts on micronutrient supplementation, dietary diversity, and weight-gain monitoring.This study examined intervention-specific program impact pathways (PIPs) and identified reasons for limited impacts of the AT maternal nutrition intervention package.We used mixed methods: frontline worker (FLW) surveys (n = ∼500), counseling observations (n = 407), and qualitative in-depth interviews with FLWs, supervisors, and block-level staff (n = 59). We assessed 7 PIP domains: training and materials, knowledge, supportive supervision, supply chains, data use, service delivery, and counseling.Exposure to training improved in both I-ANC and S-ANC areas with more job aids used in I-ANC compared with S-ANC (90% compared with 70%), but gaps remained for training content and refresher trainings. FLWs' knowledge improvement was higher in I-ANC than S-ANC (22-36 percentage points), but knowledge of micronutrient supplement benefits and recommended foods was insufficient (50%). Most FLWs received supervision (90%), but supportive supervision was limited by staff vacancies and competing work priorities. Supplies of iron-folic acid and calcium supplements were low in both areas (30-50% stock-outs). Use of monitoring data during review meetings was higher in I-ANC than S-ANC (52% compared with 36%) but was constrained by time, understanding, and data quality. Service provision improved in both I-ANC and S-ANC areas, but counseling on supplement benefits and weight-gain monitoring was low (30-40%).Systems-strengthening efforts improved maternal nutrition interventions in ANC, but gaps remained. Taking an intervention-specific perspective to the PIP analysis in this package of services was critical to understand how common and specific barriers influenced overall program impact.

Every health care system requires an adequate health care workforce, service delivery, financial support, and information technology. During the COVID-19 pandemic, global health systems were ill prepared to address the rising prevalence of mental health problems, especially in low- and middle-income countries (LMICs), thereby increasing treatment gaps. To close these gaps globally, task shifting and telepsychiatry should be made available and maximized, particularly in LMICs. Task shifting to nonspecialist health workers to improve essential mental health coverage and encourage efficient use of the available resources and technology has become the most viable strategy.

Peer-to-peer (P2P) federated cloud system has emerged as a promising service delivery model wherein multiple cloud service providers (CSPs) collaborate and share resources and services among themselves to fulfill the spikes in demand from their cloud service consumers (CSCs). It facilitates CSPs to accomplish the committed service level agreements (SLAs) to their CSCs. However, the lack of preexisting trust relationships and unawareness about the cloud infrastructure and service delivery performance among CSPs in a distributed environment poses a risk to the quality of service (QoS) being delivered. We address this challenge by proposing a trust model, PRTrust, for a peer-to-peer federated cloud system that capitalizes the triangular relationship of performance, risk, and trust for the participating CSPs. The main contributions of this work are: (1) providing a logical design and architecture for trust and performance management in a peer-to-peer federated cloud system; (2) providing a two-tier weighted performance evaluation mechanism for CSPs; (3) providing a risk evaluation mechanism for CSPs based on their current performance level; (4) providing an improvised mechanism to evaluate and manage personalized reputation-based trust for the participating CSPs; (5) providing a CSP selection mechanism from a trusted list of CSPs, using the evaluated performance-based risk, for sharing the resources and services in a peer-to-peer federated cloud system. The proposed PRTrust model has shown better threat resilient behavior in dealing with malicious peer CSPs when compared with the reference EigenTrust model.

More than 25 years after Moore’s first introduction of the public value concept in 1995, the concept is now widely used, but its operationalization is still considered difficult. This paper presents the empirical results of a study analyzing the application of the public value concept in Higher Education Institutions, thereby focusing on how to account for public value. The paper shows how Dutch universities of applied sciences operationalize the concept ‘public value’, and how they report on the outcome achievements. The official strategy plans and annual reports for FY2016 through FY2018 of the ten largest institutions were used. While we find that all the institutions selected aim to deliver public value, they still use performance indicators that have a more narrow orientation, and are primarily focused on processes, outputs, and service delivery quality. However, we also observe that they use narratives to show the public value they created. In this way this paper contributes to the literature on public value accounting.

Medication errors are closely associated with patient safety, as they affect quality of health care. Pharmacists play a key role in preventing such errors to ensure patient safety and enhance pharmacy service quality. Quality improvement has been suggested to be incorporated into daily practice, providing practitioners an opportunity to identify service delivery gaps and configure solutions fitting the context. This paradigm is similar to the concept of action research (AR); therefore, this research approach is deemed appropriate for improving the quality of pharmacy practice. AR is context-specific, dynamic, and systematic and is driven by a spiral process to identify problems, design solutions, and evaluate the impacts of the solution. Since AR uses multiple methods, including a spiral process, confusion may arise among practicing pharmacists and novice researchers interested in using it. This paper aims to describe key information regarding AR, including its brief history and definition, spiral process, and research methods used for data collection, key characteristics, and common limitations to help readers understand the AR protocol.

Abstract. Background: Australia's first short message service (SMS) crisis support service was launched by Lifeline Australia in July 2018. The pilot program was independently evaluated over a 240-day period. Aims: We aimed to examine the experiences of key staff employed in the Lifeline Text pilot and identify the skills and types of support required to deliver a high-quality SMS-based crisis support service. Method: In total, 22 interviews were conducted with 14 Lifeline Text crisis supporters and in-shift supervisors (supervisors) at two time points in September 2018 and March 2019. A modified framework approach was adopted to undertake qualitative data analyses. Results: Delivering crisis support via text was initially challenging as a result of the need to translate skills from telephone crisis support to the SMS platform. This was compounded by the high degree of suicidality of help-seekers and volatility in demand for the service. Limitations: The independent evaluators were not involved in the design of the pilot. Conclusion: Lifeline text is providing an important and necessary service, using a novel mode of delivery in Australia. Maintaining service quality at peak demand, with many distressed and suicidal help-seekers, requires specialized training, experience, and exceptional skills.

This paper will incorporate a survey of Unmanned Aerial Vehicle (UAV) and associated problems and present important challenges. Drones have attracted a lot of attention because of their innumerable applications as they are highly movable and provide applications such as service delivery, farming, pollution mitigation, rescue operations. Drones or Unmanned Aerial Vehicles (UAVs) which is one of the components of Unmanned Aerial System (UAS) are equipped with different IoT devices such as sensors, cameras, and actuators. They have a potential market because of their ubiquitous usability. They can be remotely controllable and regulating them in a well organized manner is a challenging task. Different communication technologies can be used such as Wi-Fi, WiMax, and Satellite Communication (SATCOM).

Untreated mental illness as a result of trauma is a significant health concern leading to increased morbidity and mortality. Individuals in post-conflict countries, like Uganda, are at risk for poor mental health outcomes because of trauma as a result of decades of violent conflict coupled with a lack of access to quality psychological care. Community-based psychological service delivery programs, like Mental Health First Aid (MHFA), have been found to be effective in helping individuals with mental and emotional problems access care. However, little is known about the cultural adaptations needed and implementation considerations of these kinds of community programs for under-resourced nations. This case study describes key considerations for the implementation of the MHFA curriculum in various regions throughout the country of Uganda. Specifically, this case study gathered observations while implementing MHFA and highlights challenges, such as cultural adaptability and country infrastructure, that must be addressed when attempting to implement Western mental health curricula in non-Western nations, like Uganda. Recommendations for the use of psychological service delivery programs in developing countries are presented. If incorporated, these recommendations will serve to increase access to mental health services in the regions of the world that need them most. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Sustainable Development Goal (SDG) target for access to safe sanitation and hygiene represents a marked improvement over the target used during the Millennium Development Goal (MDG) period. The SDG target attempts to: explicitly address hygiene; eliminate inequalities within populations; evaluate sanitation services beyond the household; account for the accessibility, safety, acceptability, and affordability of service delivery; and improve the sustainability of services (WHO/UNICEF, 2015). However, the proposed indicators for monitoring progress in sanitation and hygiene still rely primarily on infrequent household surveys and census data. This paper provides a critical review of the sanitation and hygiene target and explores the potential gaps between the expanded understanding of access, the proposed monitoring strategies, and the desired impacts. A variety of innovative methodologies and technologies are reviewed, with specific attention given to their suitability for measuring and monitoring progress towards the sanitation and hygiene target.

Background: South Africa faces the highest burden of HIV infection globally. The National Strategic Plan on HIV recommends provider-initiated HIV counselling and testing (HCT) in all healthcare facilities. However, HIV continues to overwhelm the healthcare system. Emergency department (ED)-based HCT could address unmet testing needs. Objectives: This study examines the reasons for accepting or declining HCT in South African EDs to inform the development of HCT implementation strategies. Method: We conducted a prospective observational study in two rural EDs, from June to September 2017. Patients presenting to the ED were systematically approached and offered a point-of-care test in accordance with national guidelines. Patients demographics, presenting compaint, medical history and reasons for accepting/declining testing, were recorded. A pooled analysis is presented. Results: Across sites, 2074 adult, non-critical patients in the ED were approached; 1880 were enrolled in the study. Of those enrolled, 19.7% had a previously known positive diagnosis, and 80.3% were unaware of their HIV status. Of those unaware, 90% patients accepted and 10% declined testing. The primary reasons for declining testing were ‘does not want to know status’ (37.6%), ‘in too much pain’ (34%) and ‘does not believe they are at risk’ (19.9%). Conclusions: Despite national guidelines, a high proportion of individuals remain undiagnosed, of which a majority are young men. Our study demonstrated high patient acceptance of ED-based HCT. There is a need for investment and innovation regarding effective pain management and confidential service delivery to address patient barriers. Findings support a routine, non-targeted HCT strategy in EDs.

Background: Since 1994, the South African healthcare system has undergone several changes to meet the needs of contemporary South Africa. Yet the state of mental healthcare, especially in low-resource areas, remains in a precarious state. Aim: This study aimed to explore how persons diagnosed with a mental disorder experience and perceive mental health services in a low-resource community in the Eastern Cape, South Africa. Setting: The study was conducted at a primary care clinic in a low resource community setting in the Eastern Cape, South Africa. Method: Semi-structured interviews were conducted with eight participants diagnosed with mental illness who had been accessing treatment for at least the past 6 months from a primary health clinic. Thematic analysis was used to analyse and identify pertinent themes. Results: The following themes emerged from the data: (1) perceptions of mental disorders – role of culture, (2) experiences of having mental disorders – loss of employment, (3) problem of stigma – social rejection and labelling, (4) experience of distress – sadness and frustration and (5) challenges in accessing treatment – transport fee and shortage of staff. Conclusion: This study yielded several lived experiences and perceptions in relation to participants’ feelings, opinions and interpretations of persons living with mental disorders and accessing mental health treatment in their local context. Future interventions should consider provision of more extensive professional help in the form of counsellors and social workers at the clinics, more efficient service delivery and future interventions regarding stigma should incorporate community members into the learning process.

This paper reports the results from a qualitative study aimed at identifying the factors influencing the rehabilitation experience of people living with an amputation in a rural setting. Following the conduct of an initial focus group, 24 rural-based individuals responded to an invitation to participate in the study's in-depth interviews. Fourteen of those interviewed lived in a ‘regional’ setting (the regional group) and the other ten lived in more remote locations (the ‘distant’ group). Consistent with this population's demography, the sample was comprised mainly of older people (mean age of 66.8 years) who had suffered their amputation as a result of vascular disease. While the groups differed with respect to two aspects of their rehabilitation experience (with the distant group reporting more problems with accommodation and access to health services), many common themes emerged from the interviews, including an overall positive acceptance of the surgical intervention, the call for increased post-operative counselling services, and an endorsement of the usefulness of peer-support (and more generally of social support) services. Results are discussed in terms of their implications for service delivery and endorsement is made of the suggestion that rural health planning be more community-focussed.

Purpose: The purpose of this study was to examine changes in speech-language pathology service provision in Iceland during the first wave of the COVID-19 pandemic. Method: Data were analyzed for 53 Icelandic speech-language pathologists (SLPs) who completed an online questionnaire between September and October 2020. Participants represented 54.1% of all SLPs practicing in Iceland. The questionnaire examined SLP employment status, populations served, and use of telepractice pre-COVID-19, during COVID-19, and after the first wave of COVID-19. Results: During COVID-19, speech-language pathology services in Iceland were reduced, but many SLPs were able to continue working in some capacity. Services to children and those with lifelong communication difficulties were most affected. There was an increase in the use of telepractice during the first wave of COVID-19, and the most frequently reported platform used was Kara Connect. Qualitative analysis of participants' free-text responses revealed that SLPs saw a range of advantages (themes: SLP service delivery and client accessibility) and disadvantages (themes: technology, personal, interpersonal, and clinical context) of telepractice. Conclusions: Telepractice provided a viable solution for maintaining clinical services in Iceland in response to restrictions on traditional in-person services. This survey provides a unique window into the practices of SLPs in a context that is underrepresented in the literature.

Objective: Hospital-in-the-home (HITH) is a service model widely adopted in medical specialties to help alleviate pressure on the availability of inpatient beds and allow patients to receive acute ...

Background Trauma places a burden on healthcare services accounting for a large proportion of Emergency Department presentations. COVID-19 spread rapidly affecting over 30 million worldwide. To manage trauma presentations the Department of Trauma & Orthopaedic Surgery reorganised service delivery. Aim To assess the impact of service reorganisation and Virtual Clinics on patients in a Regional Unit in Ireland. Methods A retrospective review of trauma activity following introduction of Virtual Fracture Clinics and Theatre COVID Pathways for a 10 week period in comparison with the same 2019 period. All patients underwent both nasopharyngeal and oropharyngeal swabs PCR testing prior to operations. Theatre and outpatient activity were evaluated. Clinic data were accumulated using the Integrated Patient Management System. Results Theatre Activity: 242 patients underwent surgery in our trauma unit (mean 2.98 per list) during the COVID- 19 period. 29 cases were performed in repurposed elective hospital giving a total of 271 during the 2020 study period. 371 cases were performed in the same 2019 period (mean 4.58 per list). Outpatient Activity: We noted a 25.86% fracture clinic referral reduction during the COVID 19 period compared to 2019. There was a 150.77% increase in patients managed through Trauma Assessment Clinic. 639 patients were managed through the Virtual Fracture Clinic Pathway during COVID 19 period. Conclusions Over one in four fracture clinic patients can be managed virtually. A new dedicated Acute Fracture Unit within our institution permitted streamlining of care and social distancing. The “Non-COVID” pathway for ambulatory trauma was essential in managing the growing presentations of these injuries.

Statement of problem Facial prosthesis research uses a wide variety of outcome measures, which results in challenges when comparing the effectiveness of interventions among studies. Consensus is lacking regarding the most appropriate and meaningful outcome measures to use in facial prosthesis research to capture important perspectives. Purpose The purpose of the systematic review was to identify and synthesize outcome measures used in facial prosthesis research. Material and methods Electronic searches were performed in 11 databases (including nonpeer-reviewed literature). The citations were searched, and expert societies were contacted to identify additional studies. Inclusion criteria comprised studies of participants with facial defects who required or had received prosthetic rehabilitation with an external facial prosthesis. Exclusion criteria comprised participants with ocular prostheses, case reports, case series with fewer than 5 participants, laboratory-based studies, and studies published before 1980. Study selection was performed independently by 2 reviewers. Discrepancies were resolved through discussion or by a third reviewer. Outcome measures were synthesized with a categorization approach based on the perspective, theme, and subtheme of the outcome measures. Quality assessment was performed with an appraisal tool that enabled evaluation of studies with diverse designs. Results Database searching identified 13 058 records, and 7406 remained after duplications were removed. After initial screening, 189 potentially relevant records remained, and 186 full texts were located (98% retrieval rate). After full-text screening, 124 records were excluded. Citation searches and contact with expert societies identified 4 further records. In total, 69 articles (grouped into 65 studies) were included. Studies were categorized as per the perspective of their outcome measures, with the following findings: patient-reported (74% of studies), clinical indicators (34%), clinician-reported (8%), multiple viewpoints (6%), and independent observer-reported (3%). Patient-reported outcome measures included tools to assess satisfaction, quality of life, and psychologic health. Variability in the choice of outcome measures was evident among the studies, with many self-designed, unvalidated, condition-specific questionnaires reported. A greater number of outcome measure themes emerged over time; themes such as service delivery and health state utility have recently been evaluated. Conclusions Over the past 40 years, facial prosthesis research has focused on patient-reported outcome measures. Outcome measures relating to other perspectives have been used less frequently, although new themes appear to be emerging in the literature. Future research should use outcome measures with appropriate measurement properties for use with facial prosthetics.

Palliative care is an important component of pediatric cancer treatment that provides holistic support for children and their families. In low- and middle-income countries, where 98% of the children needing palliative care reside, access to palliative care services is often very limited. Training opportunities for healthcare professionals are essential to improve access to palliative care in these settings. Virtual learning, which brings training and mentorship directly to learners, can improve access to educational opportunities for staff in resource-limited settings. In this report, we describe a novel and evolving model of building pediatric palliative care (PPC) capacity in South Asia. We describe the design, implementation, challenges, and subsequent modifications of our program, as well as the impact of the program for participants and for PPC service delivery in South Asia. Our teleteaching and mentoring program (Project ECHO) [Extension for Community Healthcare Outcomes] consisted of biweekly videoconference sessions with didactic teaching and case-based discussions. The program focused on engaging participants in meaningful learning by focusing on opportunities for participant interaction through teachings and case discussions. Participants identified the program as particularly beneficial for improving their knowledge and confidence in managing seriously ill children. Project ECHO is a novel model of building PPC capacity that is suitable for resource-limited settings. Key modifications to the Project ECHO model include a course-specific leadership team, developing learning plans to address the specific learning needs of participants, focusing on ensuring learner participation during sessions, and using social media and electronic resources to create opportunities for further learning outside of ECHO sessions. These adaptations may improve the efficacy of Project ECHO and others using virtual learning programs in resource-limited settings.

The ongoing balance of service delivery and training offset with the European Working Time Directive has resulted in a requirement to review the surgical workforce and new ways of working. The extended surgical team can be utilized to support the delivery of surgical services. Surgical care practitioners are trained to care for surgical patients across the whole patient pathway: in clinics, theatre and on the ward. They are continual members of the surgical team and can support both the service and training due to the flexible nature of the role. This article gives an overview of the role of the surgical care practitioner (SCP) and how the role impacts surgical training.

Over its first year Public Health Scotland (PHS) played a key role in the national vaccination programme by providing professional leadership and expertise. We expedited the reporting of all aspects of the pandemic, and accelerated rapid evidence reviews. We contributed to rigorous research showing that: vaccination reduced hospitalisation by 90%, and the transmission of COVID-19 within households by 55%; hence vaccination works. Lessons for the future included strengthening whole genome sequencing to manage COVID-19 and to prepare for future pathogens. COVID-19 also stimulated the redesign of many health and social care services: by exploiting digital media; by implementing evidence on reducing barriers to service delivery; and by greater integration - of projects rather than organisations - enabling groups who had not worked together to address common issues. PHS and partners soon recognised the need to mitigate the adverse impact of the pandemic on existing inequalities. So we aim to ‘build back fairer’ as the pandemic recedes, by pursuing PHS's four priorities: poverty; children and young people; place and community; and mental health and well-being.

Background Ghana has a generalized HIV epidemic and efforts have been made to curb the spread and reverse its effects on the general population. In the wake of COVID-19 pandemic, the health system was unsettled and antiretroviral therapy (ART) care has been impacted in diverse ways. The study sought to explore the effects of COVID-19 on ART service provision in Ghana from the perspectives of the healthcare workers. Methods An exploratory-descriptive qualitative approach was employed in this study. Using maximum variation sampling method, fifteen healthcare workers; nurses, data managers and pharmacists were recruited from an ART clinic in a Teaching Hospital in Ghana. In-depth interviews were conducted and analysed using Braun and Clarke thematic approach. Results Three themes emerged from the data; “… And the pandemic struck”, “Impact of the pandemic on ART service delivery”; “Effecting the needed change”. The healthcare workers’ initial reactions to the pandemic and their show of commitment in ensuring continued ART service was evident. COVID-19 impacted service delivery in three main ways; (1) clients’ clinic attendance was erratic at various stages of the pandemic, (2) irregular resource availability as shortage was reported due to affected last mile delivery as a result of the lockdown in Accra, and (3) the health worker-patient interaction became less engaging because of established COVID-19 protocols. The healthcare workers however instituted strategies such as adjusting the patient appointment schedule, health professionals’ work schedule, establishing several work stations, task-shifting, and ensuring the implementation of all the COVID-19 protocols within the ART unit to ensure consistent service delivery as well as patient and staff safety. The study also found a decline in the implementation of several strategies established in the ART clinic during the initial phases of the pandemic such as a decline in the supply of Personal Protective Equipment (PPEs) by hospital management. Conclusions Although several strategies were implemented to manage the effects of the pandemic on ART care, there is a need to establish pathways of support for healthcare workers within the ART clinic and to consolidate as well as institutionalise the changes that ensured continuous but safe service delivery.

Preconception care (PCC) entails counselling and interventions to optimise health before pregnancy. Barriers to this service delivery include access and time. Primary healthcare nurses (PHCNs) are uniquely placed to deliver PCC. The aim of this study was to understand PHCNs’ knowledge, practice and attitudes to PCC. A cross-sectional study was performed of a convenience sample of PHCNs in Australia who were seeing people of reproductive age. Recruitment was via the Australian Primary Health Care Nurses Association (APNA) electronic communication platforms. The 18-item, online, anonymous survey captured demographics, as well as PCC knowledge, practices and attitudes. Descriptive statistics were used to describe our findings. In all, 152 completed surveys were received. Of all respondents, 74% stated they discuss PCC in their practice, although only 13% do so routinely. Of these, more preconception discussions are held with women than with men. In total, 95% of respondents identified at least one barrier to delivery of PCC, with lack of time and knowledge being the most common. The findings of this study can inform targeted strategies, including education programs and resources, and consideration of incentives to support PHCNs deliver PCC. This study identifies areas for improvement at the individual, organisational and health system levels to enhance the role of PHCNs in PCC

The delivery of care in the inpatient rehabilitation setting was disrupted during the coronavirus disease 2019 (COVID-19) pandemic. As a 150-bed freestanding inpatient rehabilitation facility in the epicenter of the pandemic, Burke Rehabilitation Hospital was required to increase overall bed capacity for regional overflow needs and still maintain our mission to provide inpatient rehabilitation for patients with and without COVID-19. During the period between March and September 2020, Burke Rehabilitation Hospital treated over 300 rehabilitation patients who were COVID-19 positive and at one point had a census that was >50% COVID-19 positive. A model grounded in 5 priorities—communication, personal protective equipment, clinical service delivery, discharge planning, and patient/staff support—was implemented to reprioritize daily operations and ensure patient and staff safety while providing valuable rehabilitation services. The delivery of physical, occupational, speech, and recreational therapy services transformed, and a number of innovative clinical practices were developed. During the study period, 100% of our patients continued to be scheduled to receive therapy services. Patient length of stay values did increase during the pandemic (from 16.38d to 19.93d), and slightly more patients were discharged to home (68.7% compared with 68.3%). Despite modifications to rehabilitation care delivery, patients continued to make functional gains in the areas of self-care, mobility, and walking. Flexible leadership was pivotal in the development and implementation of new processes and procedures to meet the evolving needs of patients, staff, and the organization as a whole.

Objective: Examine the changes in service delivery Australian public sexual health clinics made to remain open during lockdown. Methods: A cross‐sectional survey designed and delivered on Qualtrics was emailed to 21 directors of public sexual health clinics across Australia from July‐August 2020 and asked about a variety of changes to service delivery. Descriptive statistics were calculated. Results: Twenty clinics participated, all remained open and reported service changes, including suspension of walk‐in services in eight clinics. Some clinics stopped offering asymptomatic screening for varying patient populations. Most clinics transitioned to a mix of telehealth and face‐to‐face consultations. Nineteen clinics reported delays in testing and 13 reported limitations in testing. Most clinics changed to phone consultations for HIV medication refills (n=15) and eleven clinics prescribed longer repeat prescriptions. Fourteen clinics had staff redeployed to assist the COVID‐19 response. Conclusion: Public sexual health clinics pivoted service delivery to reduce risk of COVID‐19 transmission in clinical settings, managed staffing reductions and delays in molecular testing, and maintained a focus on urgent and symptomatic STI presentations and those at higher risk of HIV/STI acquisition. Implications for public health: Further research is warranted to understand what impact reduced asymptomatic screening may have had on community STI transmission.

Objective Method Results Conclusions Due to the COVID pandemic psychologists have been required to rapidly adapt to a different type of service delivery to ensure safety of the public and maintain the provision of essential psychological services within schools. In response, telehealth or online counselling became the norm across much of Australia. Psychologists in school settings were required to move many traditional face-to-face psychological services online to continue to support the needs of school communities. This project aimed to identify changes made to the practice of school psychology during COVID, the efficacy of these changes and potential applications within the field post COVID.Registered psychologists working in school settings across Australia were invited to participate in an online survey. Fifty-six participants completed questions related to their school psychological practice during COVID, they also completed the Counsellor’s Crisis Self Efficacy Scale, rating their level of confidence to respond in a crisis.Results identified a range of technology-informed changes to practice during COVID including greater use of telehealth in provision of service to clients, parents and schools. Respondents reported moderate to high levels of self-efficacy overall in their ability to respond during the crisis, and significant differences according to level of experience were identified.Respondents identified potential post COVID changes to practice that represented greater flexibility in modes of service delivery. Key Points What is already known about this topic: (1) Impact of COVID-19 on school psychological practice. (2) Benefits of telehealth. (3) Influences on crisis intervention self-efficacy. (1) Impact of COVID-19 on school psychological practice.(2) Benefits of telehealth.(3) Influences on crisis intervention self-efficacy. What this study adds: (1)Technology enabling factors to school psychological practice. (2)Relationship between crisis intervention self-efficacy and experience. (3)Opportunities to change model of service delivery. (1)Technology enabling factors to school psychological practice.(2)Relationship between crisis intervention self-efficacy and experience.(3)Opportunities to change model of service delivery. [ FROM AUTHOR] Copyright of Australian Psychologist is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

The attainment of excellence in institutions is maintained through the institutions’ adherence to its core values and efficient service delivery. These factors are very important in facilitating global development of a country and determining the world ranking of an institution. To this effect, this study presents an effective approach for evaluating and ranking quality of services in a higher institution, taking four higher institutions in Nigeria as case studies. Service quality consists of different attributes and many of them are intangible and difficult to measure, which means that using the previously known measurement approach will be insufficient. Therefore, a fuzzy method was proposed to resolve the ambiguity of the concepts and intra-uncertainty, which are associated with human judgments in decision-making. This study adopted a contextualized service quality model for educational domain called HiEdQUAL with some extended criteria in order to evaluate the perception of service quality by respondents from the selected higher institutions: two private universities and two public universities from the south-west region of Nigeria. Four Multi-Criteria Decision-Making (MCDM) methods: TOPSIS, Yager’s min-max, Compensatory AND, and Ordered Weighted Averaging are applied to comparatively evaluate the quality of services in the four higher institutions. The MCDM methods are engaged independently to validate the reliability of the ranking results. The importance weight of each performance criterion is found with Fuzzy Analytical Hierarchy Process (FAHP) algorithm. This study has been able to practically establish Ext-HiEdQUAL as a new service quality model for higher education with six concepts and 33 criteria. The output of the Fuzzy MCDM ranking recommends institution B as the best institution to students based on the Ext-HiEdQUAL measures. Also, findings from the sensitivity analysis showed that Yager’s min-max outperform the other investigated methods in this study by being consistent and exceptionally tolerant in most instances when there is significant deviation in criteria weights.

Purpose This paper aims to focus on the trends and projection for future use of artificial intelligence (AI) in libraries. AI technologies is the latest among the technologies being used in libraries. The technology has systems that have natural language processing, machine learning and pattern recognition capabilities that make service provision easier for libraries. Design/methodology/approach Systematic literature review is done, exploring blogs and wikis, to collect information on the ways in which AI is used and can be futuristically used in libraries. Findings This paper found that uses of AI in libraries entailed enhanced services such as content indexing, document matching, content mapping content summarization and many others. AI possibilities were also found to include improving the technology of gripping, localizing and human–robot interaction and also having artificial superintelligence, the hypothetical AI that surpasses human intelligence and abilities. Originality/value It is concluded that advanced technologies that AI are, will help librarians to open up new horizons and solve challenges that crop up in library service delivery.