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BackgroundBetween 2016 and 2020 Scottish Huntington’s Association (SHA) developed a National Care Framework for Huntington’s Disease (HD), followed by localised versions for mainland Health Board areas. SHA presented this work to EHDN 2018, and would like to present an update of the Framework’s achievements.AIMSTo develop an integrated health and social care model that guides staff, empowers HD families and enables SHA and supporters to influence for an expansion of specialist service provision.Methods/TechniquesDeveloped by a national advisory group representing HD families and a full range of health and social care staff, the Framework outlines the gold standard of care and support that families need and should expect to receive. Process repeated by local health board area to ensure tailored regionalised Frameworks.Results/OutcomesThe National Care Framework, and 10 Regionalised Frameworks, are now live. The process resulted in new services being put in place to support HD families including completely new specialist services being established, new HD Clinical Leads being appointed, existing HD Clinical Leads having hours extended, the appointment of new HD Specialists, additional funding for HD Specialist staff and the reversal of planned cuts to services.ConclusionsThe National Care Framework model has been a hugely successful influencing tool that has resulted in a growth of HD specialist services and taken Scotland to being within touching distance of having full nationwide specialist coverage.

BackgroundOver 33 years Scottish Huntington’s Association (SHA) has developed specialist adult clinical services for Huntington’s disease (HD) families within in 9 of Scotland’s 11 mainland health board areas. SHA’s goal is to see full specialist support nationwide.AIMSTo develop a consensus among Members of the Scottish Parliament (MSPs) for an expansion of Specialist HD Services.Methods/TechniquesAn opposition party health spokesperson was approached to table a parliamentary motion calling for an expansion of specialist Huntington’s disease services. On tabling the motion key figures from that party were approached to support. Once achieved equivalents from other opposition parties were lobbied. Once all opposition parties had supported, political representatives of the governing party were approached. Through regular contact and pressure – from SHA staff, families and supporters – we lobbied all politicians to secure maximum cross party support, highlighting this support in the media and to local health care providers.Results/Outcome98% of MSPs supported the motion, making it the most supported in the history of the Scottish Parliament. The motion secured full cross party support. The success of the motion was covered in national media. The Minister for Public Health requested a meeting with SHA to discuss, committing to help close service gaps. Highlighting the motion and associated local media coverage to health providers has resulted in positive service outcomes.ConclusionsPolitical influencing and media coverage has a significant role to play in improving services for Huntington’s disease families.

[Purpose/Significance] Against the backdrop where artificial intelligence generated content (AIGC) is reshaping the paradigm of knowledge production, exploring how to integrate the context-aware capabilities of large models into the knowledge service framework, and on this basis, providing a new interpretation and service expansion of the Five Laws of Library Science, is of great significance for the construction of the AI + knowledge service system. [Method/Process] Starting from the perspective of contextual integration, and with Wilson's Information Behavior Theory and the SECI Model as the theoretical foundation, this study constructs a three-dimensional integrated coupling framework of \"demand-knowledge-context\". By aligning knowledge context with user context, it dynamically perceives users' knowledge needs and provides proactive responsive services. Based on this framework, it further conducts a contextualized interpretation of the Five Laws of Library Science. [Results/Conclusions] With the integratio

Background: Ebola virus emerged in West Africa in December 2013. The ease of mobility, porous borders, and lack of public health infrastructure led to the largest Ebola virus disease (EVD) outbreak to date. Intervention: The 2013 EVD outbreak signalled the need for laboratory diagnostic capabilities in areas without strong public health systems. As part of the United States’ Department of Defense response, MRIGlobal was contracted to design, fabricate, equip, deploy, and operate two mobile diagnostic laboratories (MDLs). The first laboratory analysed blood samples from patients in an adjacent Ebola Treatment Centre (ETC) and buccal swabs from the deceased in the community in Moyamba, Sierra Leone. The second laboratory was deployed to support an ETC in Conakry, Guinea. The Department of Defense provided real-time quantitative reverse transcription polymerase chain reaction assays that were deployed and validated on-site. Lessons Learnt: Prompt and accurate molecular diagnostics reduced sample turn-around times from over 24 h to under 4 h. Experienced laboratory staff tested up to 110 samples per day and on-site engineering proved necessary for MDL setup and operation. As the Ebola response slowed, the sustainment of the MDLs’ operations was prioritised, including staff training and the transition of the MDLs to local governments. Training programmes for local staff were prepared in Sierra Leone and Guinea. Recommendations: The MRIGlobal MDL team significantly contributed to establishing increased laboratory capacity during the EVD outbreak in West Africa. Using the MDLs for molecular diagnosis is highly recommended until more sustainable solutions can be provided.

Metalworking fluids (MWFs) are widely used to cool and lubricate metal workpieces during processing to reduce heat and friction. Extending a MWF’s service life is of importance from both economical and ecological points of view. Knowledge about the effects of processing conditions on the aging behavior and reliable analytical procedures are required to properly characterize the aging phenomena. While so far no quantitative estimations of ageing effects on MWFs have been described in the literature other than univariate ones based on single parameter measurements, in the present study we present a simple spectroscopy-based set-up for the simultaneous monitoring of three quality parameters of MWF and a mathematical model relating them to the most influential process factors relevant during use. For this purpose, the effects of MWF concentration, pH and nitrite concentration on the droplet size during aging were investigated by means of a response surface modelling approach. Systematically varied model MWF fluids were characterized using simultaneous measurements of absorption coefficients µa and effective scattering coefficients µ’s. Droplet size was determined via dynamic light scattering (DLS) measurements. Droplet size showed non-linear dependence on MWF concentration and pH, but the nitrite concentration had no significant effect. pH and MWF concentration showed a strong synergistic effect, which indicates that MWF aging is a rather complex process. The observed effects were similar for the DLS and the µ’s values, which shows the comparability of the methodologies. The correlations of the methods were R2c = 0.928 and R2P = 0.927, as calculated by a partial least squares regression (PLS-R) model. Furthermore, using µa, it was possible to generate a predictive PLS-R model for MWF concentration (R2c = 0.890, R2P = 0.924). Simultaneous determination of the pH based on the µ’s is possible with good accuracy (R²c = 0.803, R²P = 0.732). With prior knowledge of the MWF concentration using the µa-PLS-R model, the predictive capability of the µ’s-PLS-R model for pH was refined (10 wt%: R²c = 0.998, R²p = 0.997). This highlights the relevance of the combined measurement of µa and µ’s. Recognizing the synergistic nature of the effects of MWF concentration and pH on the droplet size is an important prerequisite for extending the service life of an MWF in the metalworking industry. The presented method can be applied as an in-process analytical tool that allows one to compensate for ageing effects during use of the MWF by taking appropriate corrective measures, such as pH correction or adjustment of concentration.

There are relatively few counselors, psychologists, psychiatrists, and social workers who specialize in serving people who are Deaf, Deafblind or hard of hearing in the United States. Professionals that serve minority populations are often an insular group. They tend to network most often with fellow professionals who understand the language and cultural needs of their service population. Such specialized behavioral health providers rarely have the opportunity to interface with “mainstream” program planners, funders and administrators. Consequently, new recovery agendas, best practice models and community reintegration ideas are only slowly integrated into the care of persons who are Deaf, Deafblind or hard of hearing. We describe the development and implementation of a task force comprised of “front line” providers, administrators, county government officials, advocates and consumers that has made strides toward effective change in a local behavioral health care system. Methods employed, successes, barriers and other reflections on the task force’s efforts also are described.

We established a general genetic counseling clinic (GCC) to help reduce long wait times for new patient appointments and to enhance services for a subset of patients. Genetic counselors, who are licensed in Tennessee, were the primary providers and MD geneticists served as medical advisors. This article describes the clinic referral sources, reasons for referral and patient dispositions following their GCC visit(s). We obtained patients by triaging referrals made to our medical genetics division. Over 24 months, our GCC provided timely visits for 321 patients, allowing the MD geneticists to focus on patients needing a clinical exam and/or complex medical management. Following their GCC visit(s), over 80 % of patients did not need additional appointments with an MD geneticist. The GCC allowed the genetic counselor to spend more time with patients than is possible in our traditional medical genetics clinic. Patient satisfaction surveys ( n  = 30) were very positive overall concerning the care provided. Added benefits for the genetic counselors were increased professional responsibility, autonomy and visibility as health care providers. We conclude that genetic counselors are accepted as health care providers by patients and referring providers for a subset of clinical genetics cases. A GCC can expand genetic services, complement more traditional genetic clinic models and utilize the strengths of the genetic counselor health care provider.

Background: The 2014–2016 Ebola outbreak exposed the poor laboratory systems in Sierra Leone. Immense needs were recognised across all areas, from facilities, diagnostic capacity, supplies, trained personnel to quality assurance mechanisms. Objective: We aimed to describe the first year of a comprehensive intervention, which started in 2015, in a public hospital’s general laboratory serving a population of over 500 000 in a rural district. Methods: The intervention focused on (1) supporting local authorities and healthcare workers in policy implementation and developing procedures to enhance access to services, (2) addressing gaps by investing in infrastructure, supplies, and equipment, (3) development of quality assurance mechanisms via mentorship, bench-side training, and the introduction of quality control and information systems. All work was performed alongside counterparts from the Ministry of Health and Sanitation. Results: We observed a strong increase in patient visits and inpatient and outpatient testing volumes. Novel techniques and procedures were taken up well by staff, leading to improved and expanded service and safety, laying foundations for further improvements. Conclusion: This comprehensive approach was successful and the results suggest an increase in trust from patients and healthcare workers.

This study is a product of the Africa Infrastructure Country Diagnostic (AICD), a project designed to expand the world's knowledge of physical infrastructure in Africa. The AICD provides a baseline against which future improvements in infrastructure services can be measured, making it possible to monitor the results achieved from donor support. It also offers a more solid empirical foundation for prioritizing investments and designing policy reforms in the infrastructure sectors in Africa. The book draws upon a number of background papers that were prepared by World Bank staff and consultants, under the auspices of the AICD. The main findings were synthesized in a flagship report titled Africa's infrastructure: A time for transformation, published in November 2009. Meant for policy makers, that report necessarily focused on the high-level conclusions. It attracted widespread media coverage feeding directly into discussions at the 2009 African union commission heads of state summit on infrastructure.

Infrastructure plays a key role in fostering growth and productivity and has been linked to improved earnings, health, and education levels for the poor. Yet Latin America and the Caribbean are currently faced with a dangerous combination of relatively low public and private infrastructure investment. Those investment levels must increase, and it can be done. If Latin American and Caribbean governments are to increase infrastructure investment in politically feasible ways, it is critical that they learn from experience and have an accurate idea of future impacts. This book contributes to this aim by producing what is arguably the most comprehensive privatization impact analysis in the region to date, drawing on an extremely comprehensive dataset.