Mark Bickenbach has been hired as Group President of Parts Town Home and Chris Dennison has been hired as Chief Operations Officer of Parts Town Home
today announced the expansion of its Home division leadership team to drive accelerated growth and innovation
who has led the Encompass business for over 15 years
Bickenbach joins Parts Town Home after holding leadership roles with several industry-leading e-commerce and retail organizations
His leadership of omnichannel initiatives ensured a seamless customer experience across all platforms
Bickenbach's deep understanding of the residential space will support the expansion of Parts Town Home's high-tech solutions and value proposition
Bickenbach will play a crucial role in aligning the Parts Town Home division with the company's broader vision for expansion
Dennison brings a wealth of experience to Parts Town Home after previously leading supply chain functions
and inventory management across several companies
He will lead distribution center operations
and oversee the Parts Town Home division's operational growth goals
Dennison will play a pivotal role in leveraging new technologies
including the implementation of a future-ready network and advanced distribution technologies
"We are thrilled to welcome Mark and Chris to the Parts Town Home team," said Steve Snower
"Their extensive experience and passion for innovation will drive our growth in the Home space
we are confident that we will meet our ambitious growth goals and enhance our value proposition in the marketplace
we will be able to bring exceptional products and services to customers in a faster
With the strategic addition of Bickenbach and Dennison
Parts Town Unlimited positions itself for significant growth in the distribution of home appliance parts
and other critical replacement parts used in the home
Their skills in areas such as supply chain optimization
and high-tech product development will be instrumental in realizing Parts Town's vision for supporting residential appliance and equipment needs and continuing to deliver exceptional value to its customers and stakeholders
Encompass Supply Chain Solutions is one of the country's largest suppliers of repair parts and accessories for products throughout the home
Encompass also offers complete parts supply chain management
depot repair and reverse logistics services
Encompass supports an array of B2B customers
In 2022, <a href="https://c212.net/c/link/?t=0&amp;l=en&amp;o=4328346-1&amp;h=1985501539&amp;u=https%3A%2F%2Fsolutions.encompass.com%2Fabout-us%2F&amp;a=Encompass" rel="nofollow" target="_blank">Encompass</a> was acquired by <a href="https://c212.net/c/link/?t=0&amp;l=en&amp;o=4328346-1&amp;h=2608659916&amp;u=https%3A%2F%2Fwww.partstown.com%2Fabout-us&amp;a=Parts+Town" rel="nofollow" target="_blank">Parts Town</a> Unlimited
the global market leader in foodservice equipment parts distribution
Parts Town Unlimited is the parent company of over 45 unique brands worldwide which collectively serve as a global leader in the high-tech distribution of genuine original equipment manufacturer (OEM) parts for foodservice equipment
Parts Town Unlimited is constantly working to create user-friendly parts identification tools
expand its high-tech distribution capabilities and foster forward-thinking innovations
Adam Gasper, Parts Town, 1 9899284462, <a href="/cdn-cgi/l/email-protection#bddcd9dcd093dadccecdd8cffddbd4d3d3cddccfc9d3d8cfce93ded2d0" rel="nofollow" target="_blank">[email&#160;protected]</a>, <a href="https://c212.net/c/link/?t=0&amp;l=en&amp;o=4328346-1&amp;h=1761827773&amp;u=https%3A%2F%2Fwww.partstown.com%2F&amp;a=https%3A%2F%2Fwww.partstown.com%2F" rel="nofollow" target="_blank">https://www.partstown.com/</a>
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We searched Medline and Embase (January 2015 to May 2022) for primary studies published in English describing approaches to provide rehabilitation to older adults. Three authors screened records for eligibility and extracted data independently and in duplicate. Data synthesis included descriptive quantitative analysis of study and rehabilitation provision characteristics, and qualitative analysis to identify rehabilitation delivery models.
Strengthening Rehabilitation in Health Systems
Volume 5 - 2024 | <a class="ArticleLayoutHeader__info__doi" href="https://doi.org/10.3389/fresc.2024.1307536">https://doi.org/10.3389/fresc.2024.1307536</a>
Introduction: Rehabilitation is essential to foster healthy ageing
Older adults have unique rehabilitation needs due to a higher prevalence of non-communicable diseases
higher susceptibility to infectious diseases
there is limited understanding of how rehabilitation is delivered to older adults
we conducted a scoping review to describe rehabilitation delivery models used to optimise older adults&#x0027; functioning/functional ability and foster healthy ageing
Methods: We searched Medline and Embase (January 2015 to May 2022) for primary studies published in English describing approaches to provide rehabilitation to older adults
Three authors screened records for eligibility and extracted data independently and in duplicate
Data synthesis included descriptive quantitative analysis of study and rehabilitation provision characteristics
and qualitative analysis to identify rehabilitation delivery models
585 articles were assessed for eligibility
and 283 studies with 69,257 participants were included
We identified six rehabilitation delivery models: outpatient (24&#x0025;)
These models often involved multidisciplinary teams (31.5&#x0025;) and follow integrated care principles (30.4&#x0025;)
Most studies used a disease-centred approach (59.0&#x0025;)
while studies addressing multimorbidity (6.0&#x0025;) and prevalent health problems of older adults
The most frequently provided interventions were therapeutic exercises (54.1&#x0025;)
and assessment of person-centred goals (40&#x0025;)
such as assistive technology (8.1&#x0025;) and environmental adaptations (7.4&#x0025;) were infrequent
this scoping review provides an overview of rehabilitation delivery models that are used to foster healthy ageing and highlights research gaps that require further attention
including a lack of systematic assessment of functioning/functional ability
a predominance of disease-centred rehabilitation
and a scarcity of programmes addressing prevalent issues like pain
Our research can facilitate evidence-based decision-making and inspire further research and innovation in rehabilitation and healthy ageing
Limitations of our study include reliance on published research to infer practice and not assessing model effectiveness
Future research in the field is needed to expand and validate our findings
strengthening rehabilitation services for older adults should be a key priority for policymakers and stakeholders involved in achieving the Decade&#x0027;s goals
Although rehabilitation&#x0027;s importance for healthy ageing is recognised in the WHO baseline report (<a href="#B22">22</a>) and now in the WHA assembly resolution (<a href="#B5">5</a>)
it has not yet lived up to its potential in the Decade&#x0027;s agenda
A possible reason might be the lack of concrete guidance for health professionals and policymakers
Open questions that represent a gap in current literature include: which rehabilitation services are the most relevant to ageing populations
how should they be delivered or who could benefit from them
Understanding how rehabilitation is offered to older adults is an essential starting point toward more responsive rehabilitation services
The objective of this scoping review was to provide a systematic overview of rehabilitation delivery models used to optimise the intrinsic capacity and functioning/functional ability of older adults
was formulated: What is known from the scientific literature about how rehabilitation is delivered to optimise the intrinsic capacity and functioning/functional ability of older adults
The review will provide rehabilitation stakeholders and policymakers seeking to increase the responsiveness of health systems to ageing populations&#x0027; growing rehabilitation needs with the information needed to (re)design rehabilitation provision to foster healthy ageing
&#x2022; Intervention: We included studies describing or testing approaches to provide rehabilitation
They must have had a sufficiently detailed description of the rehabilitation interventions
We excluded papers focusing on describing needs
on testing the effect of a single intervention (e.g.
and studies without rehabilitation interventions
&#x2022; Outcome: Studies aiming to enhance intrinsic capacity
independence in activities of daily living (ADL)
disease control or intervention adherence were excluded
&#x2022; Publication Type: Reports resulting from primary research
&#x2022; Setting: We did not limit study eligibility to any geographical location or level of care
&#x2022; Language and publication date: We searched for papers published in English after the launch of the WRAH in 2015 (<a href="#B15">15</a>)
MEDLINE and EMBASE were systematically searched. We considered evidence about the optimal database combination for conducting scoping reviews for this selection (<a href="#B37">37</a>)
CS and RB) developed the structured search strategy
which included natural language and Medical Subject Headings
(2) models of care or health care approaches
The final search strategy for both databases
including terms and filters applied can be found in additional file 3
The search results were exported into EndNote
We complemented the search by scanning reference lists of systematic reviews identified during the title and abstract screening process
We anticipated an extensive body of evidence to fulfil our study&#x0027;s objective in indexed databases; consequently
Two researchers (RM, VS) and a student assistant independently screened abstracts using Rayyan; 50&#x0025; of the records were double-screened (<a href="#B38">38</a>)
To ensure consistency in the decision process
we held training sessions and team meetings to clarify eligibility criteria and discuss open issues; three training rounds were required to reach at least 90&#x0025; of agreement
PF and VS) and a student assistant assessed independently and in duplicate the full text of retained records for eligibility
Consensus and discussion with a third team member were used to solve disagreements on study selection and data extraction
We did not appraise methodological quality or risk of bias, in line with scoping reviews&#x0027; methodology (<a href="#B33">33</a>, <a href="#B39">39</a>)
and with our goal of identifying and describing rehabilitation delivery models rather than assessing if the interventions or strategies used were effective
We used four conceptual frameworks (<a href="#B40">40</a>&#x2013;<a href="#B43">43</a>)
described in the data synthesis section below
and input from rehabilitation and health systems research experts to develop the data-charting form
which included information regarding studies&#x0027; characteristics
rehabilitation service delivery and rehabilitation interventions (see additional file 2)
The data extraction process began only after a high agreement (&#x003E;90&#x0025;) was reached during the training sessions
PF and VS) and a student assistant extracted data independently and in duplicate
The synthesis included descriptive quantitative analysis (e.g.
We classified the level of care into primary health care (PHC)
The level of care was classified as PHC if articles self-identified as PHC
if rehabilitation interventions were provided exclusively by PHC workers
including nurses or general practitioners in a traditional PHC setting (home or community)
or if the interventions provided did not require complex equipment or specialised training
studies were classified as specialised care
services starting at a university hospital but continued with a community exercise programme
were classified as a combination of both levels
Co-authors were regularly consulted to validate the categorisation of data
patients or patients&#x0027; representatives in the scoping reviews&#x0027; methodological design
The most frequently reported outcome type was health-related quality of life (HRQOL)
Other outcome types were infrequent and not included in the table; for example
only 6.4&#x0025; of the included studies measured the risk of falls
4.6&#x0025; well-being and 4.2&#x0025; participation
Figure 1. Preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews diagram. (<a href="#B46">46</a>, <a href="#B47">47</a>)
&#x002A;Excluded by random sampling of 65&#x0025;
Most important characteristics of the included studies
Most important characteristics of rehabilitation programmes&#x2019; beneficiaries
Service delivery characteristics and rehabilitation interventions
35.7&#x0025; assessed person-centred goals
We identified 1,361 rehabilitation interventions (<a href="#T5">Table&#x00A0;5</a>)
during the data analysis another category of rehabilitation interventions emerged: &#x201C;coordination and management of the rehabilitation process&#x201D;
This category accounted for 20&#x0025; of all interventions provided and was used in more than half of the studies
Restorative and compensatory approaches were the most frequently used interventions
interventions such as provision and training in the use of AT (8.1&#x0025;)
and pharmacological agents (3.2&#x0025;) were rarely reported
We found that therapeutic exercises (54.1&#x0025;)
education and skills training for self-care and self-management (41&#x0025;)
and assessment of person-centred goals and priorities (40&#x0025;) were the most frequently utilised rehabilitation interventions and were commonly prescribed together
Examples of therapeutic exercises included muscle strengthening and balance training
functional exercises such as training in ADLs
social care and support interventions such as assistance in ADLs and emotional support were provided in 16&#x0025; of the studies in addition to rehabilitation
We also sought to determine whether the rehabilitation programmes included some evaluation of functioning/functional ability or intrinsic capacity
we grouped the following assessments: Assessment of overall functioning/functional ability
independence in activities of daily living and the Comprehensive Geriatric Assessment
36.8&#x0025; of studies used one of these measurements
Models for rehabilitation service delivery
Type of rehabilitation intervention category by delivery model
Percentages represent the proportion of interventions by category over the number of interventions per model
A better match between the rehabilitation needs of older adults and rehabilitation interventions is very much needed and should be defined in specific clinical practice guidelines in line with the Decade&#x0027;s agenda
a PIR for ageing is not being developed yet
although this would considerably foster the access of the ageing population to rehabilitation
Ensuring that rehabilitation remains person-centred is essential for the ageing population
given the prevalence of or age-related impairments
and necessary to contribute to the healthy ageing agenda
A similar in-depth understanding of how rehabilitation is currently delivered through PHC for ageing populations is still needed to guide the efforts required to strengthen PHC to provide rehabilitation
training health workers becomes critical to ensure properly provided interventions and should focus on strengthening the health workforce&#x0027;s rehabilitation competencies
Our detailed description of six rehabilitation delivery models shows that rehabilitation is indeed provided to the ageing population across levels of care
following principles of integrated care and assessing person-centred goals
our work also points out shortcomings like a frequent disease-centred perspective
the rare focus on multimorbidity and age-related impairments
the seldom provision of AT and EAs and the inconsistent assessment of intrinsic capacity and functioning/functional ability
Our findings can be used by policymakers and key stakeholders to improve the responsiveness of health systems to the needs of ageing populations
a more prominent and better-defined role for rehabilitation in the key technical documents and reports of the Decade of Healthy Ageing is needed to provide essential guidance to rehabilitation stakeholders
Greater commitment from policymakers and key stakeholders is needed to unlock the considerable potential of rehabilitation to contribute to the achievement of the goals of the Decade of Healthy Ageing
We believe this is the first review providing an overview of rehabilitation delivery models used to optimise older adults&#x0027; intrinsic capacity and functioning/functional ability
We followed standard methods for designing
and included many papers with different study designs and settings
We used five conceptual frameworks to conduct an innovative synthesise
Our review has limitations. First, results are based only on published primary research. Future research conducted in the field including key rehabilitation stakeholders is needed to expand and confirm the validity of our results. Second, we have excluded papers reporting single interventions because rehabilitation is defined as a &#x201C;set of interventions&#x201D; (<a href="#B19">19</a>) and because we did not focus on the interventions&#x0027; effectiveness
we conducted an extensive search but screened a random sample of 35&#x0025; of hits
This might have left some relevant papers out
we consider that the included 283 studies were sufficient to achieve the goal of the review and that further studies would not have significantly changed the identified models
most studies were conducted in HICs or LMICs
and results cannot be generalised to low-income settings
Our study provides a comprehensive overview of six rehabilitation delivery models that can be used to (re)design rehabilitation services to improve the responsiveness of health systems to the needs of older adults
We also identified key gaps in rehabilitation provision
such as the unsystematic assessment of functioning/functional ability or the lack of provision and training in the use of AT and EA
Rehabilitation can make a meaningful contribution to achieving healthy ageing
but a more prominent and better-defined role for rehabilitation in the key technical documents and reports of the United Nations Decade of Healthy Ageing is urgently needed
The author(s) declare financial support was received for the research
Funding for this review was received from the Velux Foundation
The Velux Foundation had no role in the design of the study or the collection
for her support with records screening and data extraction
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest
The author(s) declared that they were an editorial board member of Frontiers
This had no impact on the peer review process and the final decision
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations
Any product that may be evaluated in this article
or claim that may be made by its manufacturer
is not guaranteed or endorsed by the publisher
The Supplementary Material for this article can be found online at: <a href="https://www.frontiersin.org/articles/10.3389/fresc.2024.1307536/full#supplementary-material">https://www.frontiersin.org/articles/10.3389/fresc.2024.1307536/full&#x0023;supplementary-material</a>
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Volume 1 - 2023 | <a class="ArticleLayoutHeader__info__doi" href="https://doi.org/10.3389/fsci.2023.1118512">https://doi.org/10.3389/fsci.2023.1118512</a>
The World Health Organization (WHO) concept of human functioning represents a new way of thinking about health that has wide-ranging consequences
This article explicates this paradigm shift
and argues that societies can profit by implementing functioning as the third indicator of health
Human functioning integrates biological health (the bodily functions and structures that constitute a person&#x2019;s intrinsic health capacity) and lived health (a person&#x2019;s actual performance of activities in interaction with their environment)
It is key to valuing health both in relation to individual well-being and societal welfare&#x2014;operationalizing the United Nations Sustainable Development Goal (SDG) 3 principle that health is a public good
Implementing functioning as defined and conceptualized in the International Classification of Functioning
Disability and Health (ICF) could profoundly benefit practices
and policy across health systems and health strategies and help integrate health and social systems
It also offers a foundation for reconceptualizing multidisciplinary health sciences and for augmenting epidemiology with information derived from peoples&#x2019; lived experiences of health
A new interdisciplinary science field&#x2014;human functioning sciences&#x2014;itself holds the promise to integrate research inputs and methods from diverse biomedical and social disciplines to provide a more comprehensive understanding of human health
and communication challenges throughout health systems and broader society
This endeavor is vital to orientate health systems toward what matters most to people about health
to unlock the societal economic investment in health that is essential for individual and population-level well-being
and to drive progress toward achieving the SDGs
The wording of SDG3 nonetheless poses a challenge: why should we think that a robust public health and healthcare system that extends life and decreases the incidence of diseases, injuries, and other health conditions will alone significantly improve individual well-being and societal welfare? After all, living a long time is not necessarily living well: data suggest that living longer can mean living in worse health (<a href="#B11">11</a>)
and while the absence of disease and injury may be necessary
it is not sufficient for human flourishing or societal welfare
There is something else that health contributes
while living longer without diseases and injuries is obviously relevant to well-being
a key driver of both individual well-being and societal welfare is being able to do and become what we wish&#x2014;achieving our aspirations
and values and in general acting in ways that make our lives worth living
If we are to take seriously the claim that there is a bridge between health and individual well-being and societal being
we need to fundamentally rethink why health is important to us or
what actually matters to us about our health
These experiences are what matters to us and why we seek out healthcare in the first place
When we find that we cannot climb stairs painlessly
real-life difficulties are the lived experience of health
Complementing the traditional biomedical understanding of health
this essential component of lived health creates a more meaningful operationalization of what health means to us
Figure&#xa0;1 Human functioning is the bridge that links health to individual well-being and societal welfare
Functioning incorporates biological health (the physiological and psychological functions and anatomical structures of the body that constitute the intrinsic health capacity of a person to perform human activities) and lived health (the individual&#x2019;s actual performance of activities in interaction with their actual physical
Functioning&#x2014;both capacity and performance&#x2014;is the bridge between health and individual well-being: objective human flourishing or subjective happiness and cognitive satisfaction
Functioning also drives overall population health and societal welfare
This link to individual well-being and societal welfare constitutes the value of health for individuals and society at large
operationalizing the underlying principle of SDG3 that health is a fundamental public good
constitutes a rethinking of health: a new understanding and conceptualization of health with wide-ranging consequences
Although domains of functioning have been used in health outcome measures for decades
this application does not fully capture the power of the concept of functioning
Functioning is not simply an outcome of health; by capturing the lived experience of health it is conceptually intrinsic to health and accounts for the value of health both for individuals and society at large
operationalizing health as human functioning completes the picture of health envisaged by SDG3 by explaining why health is a driver of individual well-being and
why population health contributes to societal welfare
This article explicates more fully WHO&#x2019;s notion of human functioning
illustrates its potential impact on health and society at large
and argues that societies can profit by implementing functioning systematically as the third indicator of health
we first explain functioning as a rethinking of health
one that more clearly exposes the conceptual and empirical link between health and both individual well-being and societal welfare
we illustrate the implications of this paradigm shift across all components of health systems and other social systems
we outline the broader scientific and social opportunities as well as the formidable methodological
and communication challenges that this new thinking about health entails
The notion of functioning in effect brings health down to earth to the practical
everyday experience in which all of us live with health-related reductions in our capacity to carry out activities and
given the demands and assistance provided by environments in which we live
operationalizing the underlying message of SDG3 that health is a fundamental public good
The novel conceptualization of health in terms of human functioning, operationalized by the ICF classifications, could profoundly change practice, education, research, and policy across health systems and wider social systems. It is difficult to precisely map all these implications since health systems are complex adaptive systems (<a href="#B23">23</a>)
And each of these areas face implementation challenges that are unique to them
and often formidable: there is not enough research
and there can be economic and political obstacles that get in the way
ongoing work provides insight into what we can expect
The implications of functioning across WHO&#x2019;s six building blocks of health systems are shown in <a href="#f2">Figure&#xa0;2</a> (<a href="#B24">24</a>), and an overview of use cases of functioning information across these six functions of the health system is displayed in <a href="#T1">Table&#xa0;1</a>
Rather than discuss the role of functioning in each function
we take a step back and focus on WHO&#x2019;s own interest in formalizing the classification of functioning
Figure&#xa0;2 Highlights for implementing human functioning within health systems
The implementation of functioning has implications across all six of the World Health Organization building blocks of health systems
Table&#xa0;1 Human functioning information in the World Health Organization&#x2019;s six building blocks of the health system
From WHO&#x2019;s perspective, ICF is most relevant to the health information component of health systems, complementing its two other data classifications, ICD and the International Classification of Health Interventions (ICHI) (<a href="#B37">37</a>)
which together allow for the routine collection of data concerning all three indicators of health status&#x2014;mortality
To be useful at all levels of the health system&#x2014;i.e.
and global health agencies&#x2014;health information must not only be reliable but comparable and thus standardized and interoperable
Functioning is relevant across all five of the health strategies (<a href="#B14">14</a>)
Health promotion and disease prevention need information on biological health to create and provide public health interventions
The curative strategy depends on information about biological health for treatment planning and information about lived health for outcomes to assess treatment efficacy
Palliation relies on appraisals of levels of functioning to make sense of quality of life near and at the end of life
But it is the health strategy of rehabilitation that depends most strongly on functioning information; indeed
functioning is at the core of the raison d&#x2019;&#xea;tre of rehabilitation
Although much additional technical and implementation research is required
and many practical challenges have yet to be overcome
enough has been accomplished in the last decade to begin the development of guidelines for applying the ICF as a standard reference language for reporting rehabilitation interventions in the clinic and in research studies
needs to identify and rigorously measure not only survival and recovery but sustainability and optimization of functioning
This suggests that while health system improvements will undoubtedly improve population health
a far greater benefit might be achieved by systematic societal actions in other areas of social policy (education
The political, administrative, and policy bifurcation between &#x201c;health&#x201d; and &#x201c;social&#x201d; hampers policy action to improve population health. Recently, the United Kingdom&#x2019;s Health Foundation has suggested that local National Health Services (NHS) should be empowered as &#x201c;anchor institutions&#x201d; to broker non-healthcare inputs into local communities from social sectors&#x2014;transportation, environment, and social services (<a href="#B73">73</a>)
this approach does not dismantle the entrenched health vs social structural dichotomy; rather
it trades on the fact that the NHS can oversee employment-related health determinants as an employer
and as a land and capital asset holder and environmental advocate
A true resolution would find a path to integrate health and health-related social sectors so that the collaboration between them is fluid and facilitates policy reforms that can only be achieved by means of cross-sectorial cooperation
Rethinking health in terms of human functioning has the potential to
bridge the traditionally separate &#x201c;health&#x201d; and &#x201c;social&#x201d; cultures in order to improve our understanding of the determinants of health to society&#x2019;s considerable benefit
We can envisage many opportunities from rethinking health in terms of human functioning and focus here on two broad areas: health sciences and education and training
the concept of human functioning could be the basis to reconceptualize multidisciplinary health sciences as an integrated and coherent scientific field of study
This reconceptualization opens the door to a broader understanding of epidemiology by moving beyond its traditional focus on mortality and morbidity and incorporating functioning
An emerging &#x201c;functioning epidemiology&#x201d; could pave the way towards the recognition of the need for human functioning sciences as a distinct component of health sciences
although we can only glimpse these potential developments
they clearly signal both the opportunity and the need to expand academic capacity accordingly
It is not an understatement to say that health research has expanded astoundingly over the last century, thanks to the contributions of numerous scientific disciplines, from the biological and natural sciences to social sciences, humanities, and engineering (<a href="#B74">74</a>)
The field of health sciences faces a challenge in encompassing and integrating diverse scientific disciplines to comprehensively understand and respond to individual and population-level health needs within a single field of study
The concept of human functioning&#x2014;particularly the distinction between biological and lived health&#x2014;can help here by identifying the relevant sciences that comprise health research and how they contribute to the societal response to health needs
A scientific description of biological health depends on biological and other natural science tools to account for a person&#x2019;s intrinsic ability to perform activities
involves sciences that explain the interaction between the biological and the environmental
explaining society&#x2019;s response to the individual&#x2019;s health needs depends on scientific understanding of institutions and social processes involved in society&#x2019;s health and health-related systems that respond both to underlying biological needs and environmental determinants of health and lived health
multi-dimensional model of human functioning therefore offers a foundational understanding of health sciences that takes account of biological
and other environmental determinants of health and the societal response to health needs
Figure&#xa0;3 Examples of scientific disciplines rooted in the biological
and socio-humanistic traditions engaging in the new field of study termed human functioning sciences
The recognition and implementation of human functioning as a new way of thinking about health entail communication challenges that need to be addressed
This challenge is at the heart of moving from theory to practice
from a shift in conception to new institutions
and a new cultural understanding of health
for a new paradigm to become effective practice
it is fundamental to agree on the appropriateness
Knowledge translation from evidence to practice must spread at the macro-
and micro-levels of health systems and along the continuum of care
This requires an awareness of the role of functioning from truly interdisciplinary work and
a focus on functioning as a promising language to enhance interdisciplinarity in healthcare
in light of what really matters to patients
All this can be achieved by promoting communication around the notion of functioning and increasing awareness among health professionals using successful implementation cases and scientific evidence gathered during the last two decades
System communication has the important but difficult task of preparing for the global implementation of functioning as a bridge between health and well-being
which is an essential conceptual issue with practical implications
the question of how to inform the public about human functioning (public dissemination) is another challenge
There are benefits to achieving public understanding: knowledge about functioning
and well-being can help the public better understand and accept health investments and resource allocation
especially when other social goods are in competition for limited resources
putting the important distinction between &#x201c;lay&#x201d; people and &#x201c;experts&#x201d; aside
people understand what can influence optimal health policies
Targeting the public is a task embedded in institutional communication and requires strategies for public campaigns centered on functioning
Third, at the level of healthcare provider-patient interaction, there is strong evidence that the use of the functioning framework and the ICF during the interaction facilitates goal-setting and intervention management (<a href="#B81">81</a>, <a href="#B82">82</a>)
ICF provides a common language between health professionals and patients for shared decision-making
knowledge of functioning constitutes an important topic to enrich patients&#x2019; health literacy
Patient education on functioning holds the promise of a &#x201c;language&#x201d; to bridge the gap between the point of view of the health professionals and the lived experience of the patients
The conceptual and evidence base exists to support the implementation of human functioning as the third indicator of health
This requires coordinated action across health systems
including the scaling and extension of use cases
Significant challenges in implementing this new paradigm exist: while the methodological challenges are well on the way to being resolved
true implementation is in its infancy and the communication challenge has yet to be fully comprehended
Addressing these challenges and associated inertia is vital to orientate health systems toward what matters most to people about health based on their lived experience of health
human functioning offers a basis for the societal economic investment in health that is essential both for individual and population-level well-being and for progress toward achieving all of the SDGs to which all countries are committed
The original contributions presented in the study are included in the article/supplementary material
Further inquiries can be directed to the corresponding author
JB and GS conceived the underlying concept and designed the manuscript together with SR and CB
wrote the section on the application of functioning information in the six building blocks of WHO&#x2019;s health system
JB wrote the overall manuscript with support from CB
All authors contributed to the article and approved the submitted version
The authors would like to thank Lee Baker and Susanne Stucki for their support during the preparation of the manuscript
The reviewer WF declared a past collaboration with the authors JB
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Received: 07 December 2022; Accepted: 26 April 2023;Published: 31 May 2023
Copyright &#xa9; 2023 Bickenbach, Rubinelli, Baffone and Stucki. This is an open-access article distributed under the terms of the <a rel="license" href="http://creativecommons.org/licenses/by/4.0/" target="_blank">Creative Commons Attribution License (CC BY)</a>
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The SCHMOLZ + BICKENBACH Group has rebranded and has become the Swiss Steel Group
The proposal for the change of name submitted by the Board of Directors was approved on 21 September 2020
CEO of the Swiss Steel Group said: "The rebranding to the Swiss Steel Group is an important signal for us as we enter a new
exciting and promising era in our company's history
credible and developable brand that our customers can trust with a name that is also easy to remember and pronounce all around the world."
"The change of name is also a turning point after the stressful events of the past few months and years
the coronavirus pandemic have presented us with immense challenges this year
We can now look positively to the future under a new name with a fresh logo"
The legal unit in Lucerne also has a new name – Swiss Steel Holding AG
Steeltec and Swiss Steel business units will all retain their names
but will be referred to as "Companies of the Swiss Steel Group" with immediate effect and will each appear under a new logo
the aim of the rebranding is to transform the Group and be a clear sign of new beginnings
SCHMOLZ + BICKENBACH stood for the steel wholesale trade; however
the group and its business units are regarded worldwide primarily as developers of innovative steel solutions for a wide range of industries and applications
The Group's new website can be found at <a href="http://www.swisssteel-group.com">www.swisssteel-group.com</a>
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takes over the chairmanship of the Transatlantic Business Initiative (TBI) from former BDI President Siegfried Russwurm
Jean-François Fallacher is to become Group CEO of satellite operator Eutelsat
the EU wants to attract more researchers to Europe and safeguard freedom of research
There are also initial initiatives in Germany
the European Commission wants to ban new supply contracts for Russian gas by the end of the year
it will be difficult for importers to invoke force majeure in the case of long-term contracts
Europe.ENBe our guest at Table.Media.Test now for free
The decisive information for the decisive people in politics
think tanks and society from Germany&#x27;s No
Every year between 250 000 and 500 000 people suffer a spinal cord injury
falls and violence as the three leading causes
People with spinal cord injury are two to five times more likely to die prematurely
They also have lower rates of school enrollment and economic participation than people without such injuries
Spinal cord injury has costly consequences for the individual and society
survivable and need not preclude good health and social inclusion
Ensuring an adequate medical and rehabilitation response
followed by supportive services and accessible environments
can help minimize the disruption to people with spinal cord injury and their families
The aims of International perspectives on spinal cord injury are to:
The WHO global disability action plan 2014-2021 is a significant step towards achieving health and well-being and human rights for people with disabilities
The action plan was endorsed by WHO Member States in 2014 and calls for them to remove barriers and improve access to health services and programmes; strengthen and extend rehabilitation
and community-based rehabilitation; and enhance collection of relevant and internationally comparable data on disability
and research on disability and related services
Achieving the objectives of the action plan better enables people with disabilities to fulfil their aspirations in all aspects of life.&nbsp;
HOUSTON, March 29, 2022 /PRNewswire/ -- Britten brings nearly two decades of experience from e-commerce, technology and financial services firms, the company said. He joined <a href="https://c212.net/c/link/?t=0&amp;l=en&amp;o=3486826-1&amp;h=1004707343&amp;u=https%3A%2F%2Fwww.ecommercebrands.com%2F&amp;a=Ecommerce+Brands" rel="nofollow" target="_blank">Ecommerce Brands</a> from Spring Commerce
an Amazon Aggregator that he founded and led as Chief Executive Officer
Britten previously worked at Bluecore where he led strategy and partnerships for the rapidly growing e-commerce SaaS marketing platform
He also worked in private equity at The Blackstone Group and M&amp;A at Lazard
<a href="https://c212.net/c/link/?t=0&amp;l=en&amp;o=3486826-1&amp;h=1004707343&amp;u=https%3A%2F%2Fwww.ecommercebrands.com%2F&amp;a=Ecommerce+Brands" rel="nofollow" target="_blank">Ecommerce Brands</a>&nbsp;is a multichannel aggregator that acquires and optimizes direct-to-consumer brands
Britten is charged with building out Ecommerce Brands' finance and business development team as the company scales for growth and aims to acquire
and scale multiple companies over the next 12 months
"I'm excited to join the exceptional team at Ecommerce Brands and to help execute a differentiated brand aggregation strategy and grow our portfolio by helping brand owners and their talented teams take the next step in their brand's journey," said Britten
Ecommerce Brands has raised more than $40 million and has acquired five brands earning more than $100 million in annual sales
"We are thrilled to have Evan join as a core member of our Ecommerce Brands team
His deep skill set and passion for the space allow us to accelerate both our transformation of the businesses we acquire and the pace at which we scale our model with acquisition-driven growth." said Bickenbach
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With <a href="https://www.housingwire.com/company/polly/" target="_blank" rel="noreferrer noopener">Polly’s</a> pricing at the core
NAF is redefining how loan officers engage with crucial parts of the mortgage process
From intuitive pricing systems to high-touch lock desk support
accuracy and adaptability while staying rooted in its people-first values
This spotlight interview highlights how leading lenders
are scaling their operations without compromising service.&nbsp;&nbsp;
Each episode of Leading Lenders: Risk, Reward, and Reinvention dives into how industry leaders are embracing change, overcoming challenges, and driving innovation in today’s market. <a href="https://www.housingwire.com/articles/leading-lenders-risk-reward-and-reinvention/">Click here to navigate to the series page for videos 1-4. </a>
Episode 1 of Leading Lenders: Risk, Reward, and Reinvention is powered by <a href="https://www.housingwire.com/company/polly/">Polly.</a>
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ONT.&#x2014;Schmolz + Bickenbach Canada Inc.
an international manufacturer and distributor of steel products
has been fined $100,000 after a worker suffered injuries that resulted in amputation
— The International Code Council is celebrating the 45th annive..
— Residential carpentry company Kingsview Carpentry Ltd
TORONTO — The Canadian Mental Health Association says living with a mental healt..
Canadians can now turn to the Liberal housing..
families and others gather at Day of Mou..
Army Corps of Engineers has decided to fast-track permits f..
OTTAWA - The Mechanical Contractors Association of Canada is celebrating CEO Tan..
With the residential construction industry in such dire straits
Google opened its first ground-up mass timber (MTC) commercial office in Sunnyva..
VANCOUVER - A plan is in the works for a new neighbourhood space for those who l..
was diagnosed with a very rare form of cancer
.st1{fill-rule:evenodd;clip-rule:evenodd;fill:#2a2a2a}By <a class="byline__authorLink" href="https://www.nj.com/staff/dgoldberg/posts.html" title="Dan Goldberg at The Star-Ledger">Dan Goldberg | The Star-Ledger</a><a href="http://www.nj.com/essx">NEWARK</a>— Cliff Gordon&#x27;s left foot had been hurting for months
shooting pain - was so bad that he said he could barely walk when he went to Plainfield’s JFK Medical Center Muhlenberg in December 2009
He returned to JFK three months later still suffering intense pain in his second toe
he was told by doctors at University Hospital in Newark he had epithelioid sarcoma
a cancer so rare that Americans have a better chance - a much better chance - of being struck by lightning
A search of medical journals written in English found only seven reported cases of epithelioid sarcoma beginning in the toe
according to the American Journal of Orthopedics
There has never been another reported case like Gordon’s where the primary lesion was found in the toe and then the cancer spread into the bone and muscle
That was the course Gordon’s cancer took and by the time doctors understood what was wrong
the best treatment option was to amputate his leg just above the knee
who said he used to spend his days taking long walks or jogging near his home in Plainfield
now spends his time learning to manipulate his prosthetic leg
The emotional scarring has been even worse
He had to drop out of Drake College in Newark
He used to enjoy mentoring kids in Newark and Elizabeth
He still plays with his neices and nephews but he said he lies to them when they ask
The amputation saved his life but epithelioid sarcoma has a tendency to come back
has a PET Scan every three months to make sure the cancer hasn’t returned
and because this disease is so rare there is really no way to tell whether it will
occur in organs where cells divide frequently
the greater chance there is for a mutation that becomes cancerous
Cliff Gordon suffers from a very rare type of cancer called epithelioid sarcoma
Sarcomas develop in our soft tissue - the stuff in between our skin and bones - an area where there is infrequent cell division
an attending surgeon at the Atlantic Mellanoma Center
affecting only one in every 2.5 million people
do not respond well to chemotherapy or radiation
sections of the soft tissue can be removed but that leaves lasting damage
“Doctors are not aware of it and you can’t diagnose something you don’t know about,” Beebe said
She says she tells students any lump or bump has to be taken seriously
evaluate it and do a biopsy before you have a treatment plan,” she said
Gordon has filed a lawsuit against Solaris Health System
claiming that doctors did not perform the proper tests
said it might be acceptable to misdiagnose the toe the first time doctors saw it
but failing to investigate further after Gordon returned complaining of pain shows the doctors did not exercise the degree of care
knowledge and skill ordinarily possessed and exercised by the average physician
“It should have been diagnosed two or three months earlier than it was,” Preston said
said he could not comment on ongoing legal issues
One of the problems in diagnosing a cancer like this is that lumps and bumps are very common
a surgical oncologist and professor of surgery at Rutgers Cancer Institute of New Jersey
a person has had it for more than a year before they bring it to a doctor,” he said
And then it is often misdiagnosed because it is so rare
Goydos said he has only seen five cases of epithelioid sarcoma in 18 years
There is no environmental or social factors that link these patients
“They don’t have data on whether it is genetic
I just want more information,” Nevels said
“My hope is that if something were to happen like that to another kid they would be more thorough and be aware of what it looks like to keep another kid from losing a limb.”
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Gabor opened a new brand store in Salzburg's Linzer Gasse
The store with a sales area of ​​65 square meters is located in a pedestrian zone
a long-standing Gabor partner opened two Gabor shops in Frankfurt's Hessen Center and in the Hanau Forum
Another Gabor shop is set to open in Bochum in the summer
Several new shop projects are currently being planned or implemented internationally
“We sense a significantly increased willingness to invest in new locations and Gabor shop concepts
The general conditions have improved significantly due to lower rents
“There is also potential for new shoe stores in some locations due to store closures,” says Jens Bickenbach
CEO Achim Gabor would like to encourage his retailers: “We believe that there are many opportunities in stationary retail right now and are happy to provide our retail partners with advice
We also support Gabor shop concepts financially.”
We always keep you up to date: with our free newsletter SHOEZ compact You will regularly receive all information from the shoe industry in a clear form when a new magazine is published
US Managing Director Peter Sachs hands over to Lance Taylor
Alchemy plans to take over almost half of the Austrian shoe retailer
Second best financial year in the company's history
Creditors' meeting decides against P&amp;C's takeover offer
Sanela Krisat becomes International Sales Director
sales representatives and business partners throughout the DACH association
Telephone: +49 (0) 6 41 / 7 95 08 – 0Fax: +49 (0) 6 41 / 7 95 08 – 15Email:&nbsp;<a href="mailto:info@shoez.biz">info@shoez.biz</a>
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The Terex Superlift 3800 lattice boom crawler crane erects a 200 metre Nordex wind turbine close to Bickenbach
Germany-based crane service provider Hofmann Kran-Vermietung &amp; Co KG Autokrane chose a Terex Superlift 3800 lattice boom crawler crane for a job to erect a 200 metre wind turbine
The Nordex turbine was close to Bickenbach
in the Hunsrück mountain range and it was erected on behalf of KS Regenerative Energie
the Hofmann team rigged the crane with full Boom Booster configuration
“We'd already used the Superlift 3800 to carry out several standard lifts for wind turbines with a hub height of up to 144 m
but the project in Bickenbach was the first time we had to take a crack at a total wind turbine height of 227 m,” said crane operator Christoph Bergmaier
The Boom Booster is a welded steel wide-boom structure consisting of up to seven 12 m-long sections
Superlift 3800s can reach a maximum hook height of 174 m and lift loads of up to 80 tonnes
the crane was rigged with a 165 m main boom and 12 m LF jib
“That was the first time we ever used the complete Boom Booster system with all seven sections
which of course meant we were really excited to see how things would pan out
Not just when setting up the crane and with the split tray and Flex Frame options that we were using as well
but also during the actual work later on,” said Bergmaier
The superlift split tray is used when erecting the main boom
the counterweight that was originally removed can be quickly put back in place to lower the main boom
This quick-coupling technology eliminated the work involved in rearranging counterweights for the Hofmann team
and made it possible to work with fewer people
The Flex Frame also proved helpful when setting up the crane
as the team used it to increase the superlift radius to 21 m so that it would be possible to erect the boom
the team had to overcome a different challenge
the relatively steep slope at the tough work site
“A boom with this kind of length needs to be kept at a perfectly horizontal position,” Bergmaier explained
This meant that the technicians first had to set up a support platform of the same length to compensate for the slope
Once all the preparation work was complete and the crane was set up
the team made the necessary arrangements so that the Superlift 3800 would have the required working configuration
was quickly removed without any need for the laborious rearrangement work that would have been required without the split stray option
This left only 25 tonnes of remaining counterweight
which was still more than enough to enable the crane to handle all the upcoming lifts
we used the Flex Frame to move the working counterweight up closer to the crane at a distance of 13 m
which enabled us to comfortably manoeuvre with a minimal counterweight radius so that the tight space conditions at the work site wouldn’t get in the way,” explained Bergmaier
<a href="/articles/10.1186/s12992-018-0410-5/metrics" data-track="click" data-track-action="view metrics" data-track-label="link" rel="nofollow">Metrics details</a>
Rehabilitation is crucial for the realization of the right to health and a proper concern of global health
reliable information to guide rehabilitation service planning is unavailable in many countries in part due to the lack of appropriate indicators
To ensure universal health coverage and meet the central imperative of “leaving no one behind” countries must be able to assess key aspects of rehabilitation policy and provision and monitor how they have discharged their human rights responsibilities towards those most disadvantaged
This article describes the process of developing an expert guided indicator framework to assess governments’ efforts and progress in strengthening rehabilitation in line with the Convention on the Rights of Persons with Disabilities
A systems methodology - concept mapping - was used to capture
aggregate and confirm the knowledge of diverse stakeholders on measures thought to be useful for monitoring the implementation of the Convention with respect to health related rehabilitation
Fifty-six individuals generated a list of 107 indicators through online brainstorming which were subsequently sorted by 37 experts from the original panel into non overlapping categories
Forty-one participants rated the indicators for importance and feasibility
Multivariate statistical techniques where used to explore patterns and themes in the data and create the indicators’ organizing framework which was verified and interpreted by a select number of participants
A concept map of 11 clusters of indicators emerged from the analysis grouped into three broader themes: Governance and Leadership (3 clusters); Service Delivery
Financing and Oversight (6 clusters); and Human Resources (2 clusters)
The indicator framework was comprehensive and well aligned with the Convention
there was a moderately positive correlation between importance and feasibility of the indicators (r = .58) with experts prioritizing the indicators contained in the clusters of the Governance and Leadership domain
Two of the most important indicators arose from the Service Delivery
Financing and Oversight domain and reflect the need to monitor unmet needs and barriers in access to rehabilitation
59 indicators achieved above average score for importance and comprised the two–tiered priority set of indicators
Concept mapping was successful in generating a shared model that enables a system’s view of the most critical legal
policy and programmatic factors that must be addressed when assessing country efforts to reform
upscale and improve rehabilitation services
The Rehabilitation Systems Diagnosis and Dialogue framework provides a data driven basis for the development of standardized data collection tools to facilitate comparative analysis of rehabilitation systems
Despite agreement on the importance and feasibility of 59 indicators
further research is needed to appraise the applicability and utility of the indicators and secure a realistic assessment of rehabilitation systems
Human rights indicators seek to addresses particularly the needs and rights of those made vulnerable by discrimination
lack of policy attention and socio-political power imbalances
rights based indicators would not be only concerned with measuring improvements in functioning and community integration
but seek to provide information about the following important aspects in the process of organizing and delivering rehabilitation services in health systems:
protected and fulfilled in service delivery
Are the key principles of human rights met in policy formulation and implementation– Is the right to access to rehabilitation realized equally for all
with the active participation of service users
effective accountability mechanisms and without discrimination
What barriers do persons with disabilities experience in accessing appropriate rehabilitation
Are efforts being made to progressively remove those barriers
Is there an enabling environment for the implementation of human rights - Is the social
organizational and economic environment conducive to the realization of the right to health and rehabilitation
It is generally agreed that indicators must be embedded in a clear and robust underlying conceptual framework that specifies system domains or target areas for improvement
in the literature there is a gap on indicator frameworks that can help obtain a comprehensive picture of the weaknesses in rehabilitation service delivery and identify systemic failures in policy development and CRPD implementation
Approaches to monitoring rehabilitation systems and services vary considerably and there is very little agreement over the domains and elements of a global indicator framework
Without a strong empirical understanding of what such a framework should comprise of– including its key domains
subdomains and measures – progress with the implementation of the CRPD and other widely agreed recommendations on rehabilitation will be difficult
which indicates the growing need for a health sector specific framework to monitor rehabilitation services
because the organization of rehabilitation services varies significantly across healthcare systems
there is a need for expert consensus regarding standardized approaches to assessing HRR at country level
we conducted a study to develop an expert-informed indicator framework for assessing country efforts to strengthen rehabilitation through implementation of the CRPD
Specifically the objectives of this study were: (a) to elicit and synthesize the knowledge of experts on indicators that would be useful for monitoring the implementation of the HRR aspects of the CRPD; (b) to integrate and confirm this knowledge through feedback to develop a shared conceptual model for rehabilitation sector assessment; and (c) to prioritize a set of important indicators to guide future evaluation and research
we have adopted the following definitions:
meso and macro level with an emphasis on organizational and system characteristics of HRR services
these services consist of scientifically sound and evidence based diagnostic
treatment and therapeutic activities as well as other interventions that are regulated and organized by the health sector
They are typically delivered in an organisational setting by a multidisciplinary team of properly trained and certified professionals (or a single therapist when appropriate)
As with the earlier World Report on Disability
the WHO global action plan directs governments’ attention to the health and rehabilitation needs of people with disabilities asserting that this concrete focus will lead to faster and more sustainable improvements in rehabilitation services and thus bring about larger benefits for all people who may need rehabilitation in the context of UHC
this research and its resulting product will be relevant to all those who are traditionally understood as disabled and face restrictions in everyday participation but also to clinical populations who experience limitations in functioning
This feature makes GCM particularly useful given the objective of the study to develop a consensus understanding of rights based monitoring of rehabilitation policies and programmes
The steps taken to achieve the goals of our study are explained in the text below:
This process resulted in the identification of 221 key stakeholders
Therefore a criterion sampling technique was applied to select experts from the initial stakeholders pool
Individuals were judged as suitable experts if they satisfied one of following additional criteria: (1) relevant science experience/knowledge of monitoring and evaluation as demonstrated by peer reviewed publications; (2) ability to influence monitoring practices and tool application as demonstrated by affiliation with an organization involved in monitoring and evaluation of rehabilitation services
or participation in international standard setting processes
the team expanded the background document to include a set of core principles for the identification of indicators along with a preliminary list of 127 candidate indicators compiled from a focused review of the literature and the authors’ notes from discussions with experts
to facilitate the collection of meaningful input
developed and pilot tested a focus question to which stakeholders responded: “A specific indicator that would help assess progress in the implementation of the health related rehabilitation aspects of the Convention on the Rights of Persons with Disabilities is…”
Participant stakeholders were asked to provide input on specific indicators relevant for monitoring the implementation of the HRR aspects of the CRPD using the above prompt as the focus for the structured responses
Stakeholders were contacted via e-mail and provided with a web address for a project-specific
asynchronous platform through which they could submit their ideas anonymously online
The project specific website contained a link to the background document which participants could access and download
Participants were given 3 weeks to respond
At the conclusion of the brainstorming session the first author (DS) synthesized the responses in preparation for the subsequent phases
doubled barrelled statements were split into their components and the set was reduced by removing duplicate statements or statements containing very similar ideas
Subsequently the statements were reviewed independently by two reviewers (DS
Any disagreements that arose were resolved by consensus or with a third reviewer (JB)
The consolidated brainstormed statements set of ideas was then randomized and uploaded onto the project website for the structuring phase
Structuring of ideas consisted of participants sorting and rating the synthesized set of indicators electronically
Sorting activity consisted of participants individually grouping the indicators into conceptually similar categories or piles and providing labels to each pile they created to reflect the indicators within
The instructions stated that each indicator belonged to only one pile and that participants should not group all indicators into one pile or create a “miscellaneous” pile
Participants were also asked to provide answers to a brief socio-demographic questionnaire
all participants were invited to rate each indicator on a 4 point scale for importance and potential feasibility of obtaining or collecting the data related to the indicator
compared to all other indicators within the set (1 = relatively unimportant/not at all feasible
Agglomerative nesting was used to examine a range of cluster solutions in order to identify a cluster configuration where separation or merger of clusters adequately represented the data as organized by the participants
a measure of the degree to which an indicator was sorted by participants with other indicators in the vicinity
was generated to estimate the internal consistency of each cluster
Bridging values range from 0 to 1 with lower values indicating more conceptually robust clusters
measures of central tendency and measures of dispersion were computed to identify and describe patterns in participants rating data
Pearson product moment correlation (r) was calculated to estimate the degree of the overall agreement between respondents’ average cluster ratings on importance and feasibility as well as the degree of agreement between subgroups of respondents on the same variables (defined by geographic region
level of knowledge of the CRPD and stakeholder group)
All analyses are considered to be exploratory
Interpretation of results involved receiving input from a convenience sample of participants during a half day meeting held in Nottwil
Seven individuals participated in a face to face meeting which was facilitated by a member of the research team
The interpretation group comprised of academic and clinical experts in rehabilitation medicine (n = 3)
experts in disability law and policy (n = 2)
an expert in vocational rehabilitation with lived experience of disability and a health policy scientist
At the interpretation session participants reviewed or modified as allowed the preliminary cluster solution
collectively assigned labels to each cluster and discussed the content of each cluster in light of the rating results
This information provided the basis for researchers and participants to co-finalize and interpret the concept map by identifying regions of thematically related clusters
All group decisions were made by consensus
The Ethics Commission for Northwest and Central Switzerland considered ethical approval not necessary
All participants were assured prior to engaging in this study of data confidentiality
informed of the voluntary nature of their participation
and of their possibility to withdraw at any time
To ensure the reliability of data analysis concept mapping guidelines recommend a number of 10–40 participants to complete the sorting activity [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 50" title="Kane M, Trochim WM. Concept mapping for planning and evaluation. Thousand Oaks: Sage Publications; 2007." href="/articles/10.1186/s12992-018-0410-5#ref-CR50" id="ref-link-section-d9397326e1498">50</a>]
74% of those who agreed to participate in the sorting phase completed the sorting activity (N = 37)
Although 41 participants have originally completed the ratings
importance and feasibility ratings of 4 and 3 individuals respectively were excluded from the final analysis because of extreme response patterns and missing data
of the seven individuals who took part in the group interpretation
four have completed both sorting and rating activities
the point map was considered as sufficiently reliable to proceed with further analyses
Application of hierarchical cluster analysis to the point map resulted in a preliminary framework solution of 11 clusters which was judged by the research team to provide sufficient detail and still yield substantially interpretable content within each cluster
as participants felt it made more sense to be grouped with the indicators that pertain to workforce issues
It is important to note that these changes aimed at improving the overall interpretability of the map and did not alter the underlying data structure (point map) which reflects how participants sorted the indicators
The Legal Commitments and Strategic Priorities cluster contained the most indicators (17)
which reflects the fact that the ideas included in this cluster were most frequently brainstormed by the participants
It was also the most dense construct that emerged from the analysis with high internal coherence as evidenced by a bridging value of .09
This cluster encompassed measures that capture rules
norms and processes at the level of the government that aim to protect human rights (Indicators #20
#103) and promote the right to health and rehabilitation (Indicators #14
It also includes indicators that assess the existence of laws and standards to ensure legal access to comprehensive and effective quality rehabilitation care (Indicators #63
#88) and qualitative measures that examine efforts to mainstream rehabilitation in strategic health care planning (Indicators #17
Evidence informed and Rights based Programming included 13 statements emphasizing the need for operational planning tools (Indicators #70
#104) as means to promote evidence based decision making and as well as critical policy structures and mechanisms (Indicators #40
#100) that States must put in place to strengthen rights based
inclusive rehabilitation policy making and ensure the implementation of the CRPD
This cluster had a bridging value of .25 which indicates the high degree of consensus among experts on the relatedness of the items in the cluster and was internally stable and coherent
The Workforce Development cluster encompassed 5 indicators related to measures taken by governments to ensure the sustainability and awareness of the rehabilitation workforce of the rights of persons with disabilities
suggesting that the items contained within the cluster may be good matches with adjacent clusters
It should be noted however that the space between this cluster and the clusters of the Human Resource domain suggests that participants perceived the items contained in these clusters to be conceptually delineated
The cluster Service Coverage, Utilization and Outcomes was comprised of 14 indicators and had a comparatively low bridging value of .37. This cluster contained the indicator “Unmet needs for medical rehabilitation” (Indicator #65, see Additional file <a data-track="click" data-track-label="link" data-track-action="supplementary material anchor" href="/articles/10.1186/s12992-018-0410-5#MOESM1">1</a>) which was rated second highest for importance across the whole set of indicators
The Service Financing and Quality Control cluster is composed of 14 indicators which
participants perceived as useful to assess the allocation and investment of financial resources to improve access to rehabilitation services (Indicators #11
as well as measures to enhance the coordination (Indicator #77) and quality of rehabilitation care (Indicators #9
including through accreditation (Indicator #93) and inspection of health facilities’ compliance with human rights (Indicators #2
Evidence on the existence and content of a nationally determined set of essential rehabilitative services was the most important indicator in this cluster (Indicator #33)
This cluster occupied the largest area in the concept map which suggests that the indicators contained therein were more loosely related and were highly likely to be sorted with other indicators in the map
The cluster labelled Higher Education was the smallest cluster in the concept map and included 5 indicators addressing issues of academic training of rehabilitation professionals
Although this cluster had a modest bridging value of .66
its small size indicates that participants perceived its content as being conceptually distinct from other clusters
hence its position in the bottom left edge of the map
The adjacent cluster Workforce Planning and Performance is comprised of 12 indicators that reflect the need for
governments and other interested organizations can assess the availability (Indicators #27
It also includes a range of patient reported experience measures (PREM) (Indicators #4
#91) thought to be related to rehabilitation providers and workforce performance
This cluster had the highest bridging value across all clusters (.77) which suggests that the ideas contained within the cluster are thematically more broad and diverse in comparison with indicators contained in other clusters on the map
The relatively small cluster labelled Disability Statistics contained 5 indicators
including prevalence and incidence (Indicator #6
#89) as well as measures thought to be useful for public health (Indicator #23) and disability policy strategies (Indicator #5
The importance of this cluster was relatively low
the standard deviation of 1.06 shows that individual responses
were a little over 1 point away from the mean
which was the highest found across all clusters
suggesting that there was a great deal of variation in individual importance ratings within this cluster
the Social Mobilization and Research cluster contained indicators that address capture efforts to promote empowerment (Indicator #30) a and culture of inclusiveness among health system stakeholders (Indicator #68) as well as efforts to promote rehabilitation research (Indicator #32
The central location of this cluster indicates that the items contained in the cluster were highly likely to be sorted with items in other clusters in the map
</a>Pattern match display comparing importance versus feasibility ratings by cluster
Importance and feasibility rating scales are represented by the two vertical lines
Clusters are positioned on each line in descending order of importance and feasibility respectively
Rating values refer to average cluster ratings derived from average indicator ratings from within each cluster
the correlation between the ratings for importance and feasibility was moderately positive (r = .58)
This indicates that participants perceptions of the importance are well aligned with their perceptions of feasibility
The degree of slope of the lines connecting cluster ratings on the left (Importance) to same ratings on the right (Feasibility) illustrates this alignment
there was a great deal of correspondence between importance and feasibility to implement the indicators contained in the clusters of the Governance and Leadership domain
all participants agreed on the relative low importance and feasibility of the Social Mobilisation and Research cluster
the majority of clusters of Service Delivery
perceived as relatively less important and less feasible to implement with the exception of the cluster Monitoring and Accountability which was ranked second highest for importance
Indicators of barriers to access to rehabilitation were rated almost as important as Service Coverage
Utilization and Outcomes but hardest to implement
Service Financing and Quality Control and Higher Education clusters were perceived equally important
although indicators in the former were thought to be more difficult to implement
Intergroup comparisons of importance and feasibility ratings were conducted to identify patterns of convergence and divergence in the views of participants with differing sociodemographic characteristics
The results showed that there was no significant variation in the responses and most participants followed similar patterns in prioritizing the indicators
the results showed that there was a high degree of consensus between the group of “Rehabilitation professionals and/or academic researchers” and participants belonging to all other groups on both importance (r = .86
Similar patterns were found in additional analyses with intergroup correlations ranging from .69 (p &lt; 0.05) to .98 (p &lt; 0.01)
Figure <a data-track="click" data-track-label="link" data-track-action="figure anchor" href="/articles/10.1186/s12992-018-0410-5#Fig3">3</a> presents a bivariate plot mapping average importance and feasibility ratings for 107 indicators. This plot helped participants during the interpretation session examine the relationship between importance and feasibility at the item level and derive a two-tier set of priority indicators for further field testing.
</a>Bivariate plot mapping importance versus feasibility ratings for 107 indicators. The box plot is divided into quadrants on the basis of the overall mean value for each of the rating variables. Numbered points correspond to the indicators enumerated in the Additional file <a data-track="click" data-track-label="link" data-track-action="supplementary material anchor" href="/articles/10.1186/s12992-018-0410-5#MOESM1">1</a>
Blue and yellow points indicate the 59 indicators that achieved above average score for importance and comprise the priority set of rehabilitation indicators
the indicators in the upper right quadrant (blue shaded area/points) achieved above average score for both importance and feasibility and represent the implementation priority set of indicators (Tier 1) whereas indicators in the lower right quadrant (yellow shaded area/points) received below average score for feasibility and comprise the development priority set (Tier 2)
The 107 indicators of the RESYST framework were mapped onto the CRPD. Table <a data-track="click" data-track-label="link" data-track-action="table anchor" href="/articles/10.1186/s12992-018-0410-5#Tab3">3</a> shows the relevance of the indicators generated from concept mapping for monitoring human rights norms and standards that are implicated in HRR and recognized in the CRPD
All 107 address directly or indirectly fundamental political and social rights in relation to HRR
The majority of the indicators cover the right to health and rehabilitation as expressed in Articles 25 and 26 whereas a large number of indicators capture States efforts to promote the implementation of the CRPD by raising awareness of disability rights among rehabilitation workers and promoting their professional development
The findings of the present study provide the preliminary evidence base for future efforts to assess governments’ response to population rehabilitation needs in line with their international human rights obligations
A similar interpretation can occur across other clusters of indicators allowing an in depth examination of systemic issues pertaining to rehabilitation service delivery
the capacity to collect and process rehabilitation expenditure data through sophisticated accounting infrastructure (Indicator #52
Monitoring and Accountability) is essential for monitoring expenditure trends (Indicator #73
including development aid flows (Indicator #106
and prioritizing investments in assistive technologies (Indicator #90
the RESYST bridges the monitoring and analysis of the human rights implicated in rehabilitation with an assessment of the broader system within which CRPD implementation efforts are being realized which helps formulate well defined and appropriate boundaries for the implementation of the right to access rehabilitation
This dynamic combination offers a powerful means to re-focus stakeholder actions and government priorities from the often paralytic analysis and repetition of policy recommendations to “strengthen rehabilitation” to effective strategies for accountability and system change
the indicators have the potential to inform the development of standardized data collection tools and resources by public health analysts and researchers
surveys and key informant interview guides and thus contribute to the harmonization of data collection practices in rehabilitation services and policy research
Populating the indicators with reliable and comparable data at regular intervals in the future may enable the comparative and longitudinal benchmarking of rehabilitation services and help decision makers draw more meaningful conclusions based on sophisticated country level analyses of the rehabilitation sector
as is the case with all studies that employ non probability sampling techniques
the specific results of this study may have limited sample-to-population generalizability
it is doubtful whether this would be the right choice
it would have resulted in an entirely different set of indicators that would not have been bias free either
including oversampling for specific stakeholder groups (policy makers and consumers) and a combination of web based and face to face data collection is recommended to counterbalance these limitations
Interpretation of the conceptual map took place with a convenience sample of experts who participated in the sorting phase coming mainly from high-income countries
The lack of involvement of participants from low- and middle-income countries in the group interpretation may have introduced a culture bias as it is possible that the results would have evolved differently if their insights on the grouping of clusters into thematically related domains have been incorporated into the final model
Discussion of the cluster map and the indicator set with a larger number of participants - especially policy decision makers and service users –is recommended as part of future local adaptation and/or validation processes
as this may enhance their relevance for implementation as well as the sense of ownership of the results of the monitoring activity
Although the framework incorporates a large number of factors previously found to be important in assessing progress in the implementation of the HRR aspects of the CRPD
it is possible that some indicators that are standardly used in rehabilitation service evaluations and quality assessments may have been missed
This was expected as the emphasis of this research was on human rights indicators intended to complement
rather than replace existing performance measures
including testing and validation of the framework considering local context and stakeholder priorities
additional indicators may be included in the framework
It will be important to test the validity and practical utility of the indicators in different contexts
assess the methodological constraints in data collection as well as the organizational costs and benefits associated with the use of the proposed indicators
This will require the drafting of indicator specification sheets (containing definition
interpretation and limitations for each indicator) and the development of multi-item assessment instruments to facilitate the collection
The use of empirically developed and field tested indicators will provide opportunities to appraise rehabilitation policies and compare service organization across countries and thus move the scientific evidence base on comparative rehabilitation systems research forward
The practical insights offered by this study are both timely and strategically relevant as leading health agencies and professional organizations strive to integrate rehabilitation in health systems through capacity building and assessment initiatives
It is therefore recommended that health agencies
professional organizations and international research consortia use the RESYST framework as an evidence source in future projects aiming to develop service monitoring and capacity assessment tools as well as to stimulate debate on methodological issues pertaining to the construction of system level indicators for rehabilitation
this is the first systematic attempt to conceptualize the constituent domains and elements of a system level framework that details what
beyond traditional clinical outcomes or quality indicators
should be monitored to enable health programme planners implement evidence informed strategies to shape a more inclusive and pragmatic response to population rehabilitation needs as well as introduce and implement disability rights compliant policy reforms
the RESYST framework enables practitioners
researchers and advocates derive a complex understanding of the issues that must be considered in comprehensive rights based analyses and service audits
GCM was used to visualize and simplify the representation of multiple correlated legal
policy and programmatic variables that influence the implementation of the right to access to rehabilitation and helped make the connections between rehabilitation services and health systems more explicit
GCM allowed the collective thinking and priorities of a select group of experts and global scientists to surface which can more meaningfully direct efforts and inform future assessment of rehabilitation systems and policies
The results reported here contribute to expanding the relatively limited evidence base of rehabilitation systems research and thus building stakeholders’ capacity for monitoring and evaluation
Future research should build on the experience of this study aiming at empirically testing the framework and the proposed measures and adapting it to local circumstances
Implementation of the RESYST after proper validation may help governments
strengthen policy surveillance to gain a clearer and more comprehensive picture of the main weaknesses in rehabilitation services and align national strategies with obligations and commitments on disability rights and inclusion
thus leading to better and more equitable outcomes for all
The stress score is a statistic that is standardly reported in MDS analyses and serves as an indicator of the goodness of fit between actual sort data and the point map’s configuration
Stress varies between 0 to 1 with lower scores indicating better fit
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The authors would like to acknowledge those individuals who volunteered to serve as members of the Advisory Committee (Tom Shakespeare
Mary Ann McColl) and the experts who participated in the various stages of this study
Their contributions have been invaluable and this research would not have been completed without their participation
The authors also thank Professors Marcel Post and Jan Reinhardt for providing feedback on earlier drafts of this manuscript as well as Dr
Carolina Fellinghauer for providing statistical analysis guidance
The authors would also like to thank the Swiss Paraplegic Research and Mirjam Brach for providing material and administrative support throughout the implementation of this project
This work was supported by the European Union’s 7th Framework Programme [No 265057] and the Swiss Academy of Medical Sciences
The funding bodies had no role in the design of the study
analysis and interpretation of findings and in the writing the manuscript for publication
All data is stored in locked filing cabinets in the first author’s office as well as a secured server located at Concept Systems Inc.
The datasets generated and/or analysed during the current study are not publicly available due to confidentiality reasons
Department of Health Sciences and Health Policy
Center for Rehabilitation in Global Health Systems
Institute of Social and Preventive Medicine (ISPM)
DS conceived and designed the study with input from JB
DS prepared the manuscript including all tables and Figs
GS and JB critically reviewed the manuscript for intellectual content
All authors have approved the final version of the manuscript for publication
DS had complete access to the original data set and is solely responsible for the accuracy of the data reported in this manuscript
We obtained clearance to conduct this study from the Ethics Commission for Northwest and Central Switzerland
we obtained consent from every participant prior to data collection
The authors declare that they have no competing interests
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations
Rights based indicators for rehabilitation contributed by stakeholder-participants with Bridging Index and rating scores for relative importance and feasibility to implement
arranged by cluster in descending order of importance
Organizational affiliations of participants in the sorting and rating phase
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DOI: https://doi.org/10.1186/s12992-018-0410-5
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<a href="https://www.windpowerengineering.com/">Windpower Engineering &amp; Development</a>
By <a href="https://www.windpowerengineering.com/author/mfroese/" class="entry-author-link" rel="author">Michelle Froese</a> | June 28
This 164-m hybrid tower has been installed in Germany
and is made of a 100-m concrete tower and two tubular steel tower segments
<a href="http://www.nordex-online.com/en/">Nordex</a> has installed the world’s tallest wind turbine to date in Hausbay
which is in the German state of Rhineland-Palatinate
With a hub height of 164 meters (m) and a rotor length of 65.5 m
the N131/3300 wind-power system reaches a total height of just under 230 m
Located roughly 100 kilometers west of Frankfurt/Main
the Hausbay-Bickenbach wind park has been developed by Kreuzberger &amp; Spengler Regenerative Energie from Dunningen-Seedorf
The 164-m hybrid tower is made of a 100-m concrete tower and two tubular steel tower segments
this design has been used for over 500 Nordex N117 and N131 wind-power systems with a total of height of up to 200 m
this enhanced version incorporates considerable practical experience
The N131/3300 will be able to make use of air layers offering a greater yield
it is exposed to less turbulence in hilly and forest-rich terrain
Certified in accordance with Dibt (German Institute for Building Technology) guideline 2012 for wind zone S
the turbine is particularly designed for low-wind regions with wind speeds of an annual average of up to 7.5 m/s
Type testing for the N131/3300 with a hub height of 164 m was completed in January of this year
Noise emission and measurement reports for the 3-MW and the 3.3-MM version of the N131 are also available
The Hasbay-Bickenbach project uses a 100-m concrete tower supplied by long-standing Nordex partner Max Bögl for the first time
As a leading producer of prefabricated parts
the group has been building combined prestressed/steel hybrid towers since 2010
Production of the 3.80-m tall elements with a uniform wall thickness of 30 centimeters at the company’s own facilities ensures consistently high quality and precision of the components
enabling the hybrid tower to be assembled within two weeks
The N131/3300 is a new version of the N131/3000 from the Generation Delta range
With a rotor diameter of 131 m and a nominal output 10% higher than that of the N131/3000
it can boost yields by between four and 6% depending on the location
Nordex is completing the next systematic step towards its own goal of additionally reducing the cost of energy achieved by its turbines
larger hub heights permit additional yield gains: The N131/3300 is available on a hybrid tower with a hub height of 134 m or 164 m
It has a guaranteed noise emission level of a low 104.5 dB(A) – even in yield-optimized operations without the use of any acoustic assistance
<a class="comment-time-link" href="https://www.windpowerengineering.com/nordex-installs-worlds-tallest-wind-turbine/#comment-616146">July 25, 2019 at 6:17 pm</a>
What are the prospects of wind turbine towers
so that the Jet Stream winds are harvested
And what height is the lowest portions of the various Jet Streams
if the height of wind-turbines can be put even higher; then will this end the deaths of birds &amp; bats
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SanctionsShares in Viktor Vekselberg’s Sulzer
Schmolz dropBusinessman is on list of oligarchs targeted by U.S
TreasuryFacebookXLinkedInEmailLinkGiftRussian Stocks Take Worst Hit Since 2014 on U.S
2018 at 10:11 AM EDTBookmarkSaveLock This article is for subscribers only.Russian billionaire Viktor Vekselberg’s constellation of Swiss industrial companies got hammered by investors on Monday after the U.S
imposed sanctions on the oligarch and his Renova Group investment vehicle
Renova owns stakes in three Switzerland-based equipment manufacturers, Sulzer AG, OC Oerlikon Corp. and Schmolz + Bickenbach AG, as well as a holding in <a href="https://www.bloomberg.com/quote/486:HK" target="_blank" rel="noopener" class="media-ui-Link_link-tVkXhPLPofs-" data-component="link">United Co. Rusal</a>
the giant aluminum producer owned by Oleg Deripaska
Shares in the companies tumbled even as Vekselberg
took steps to lower his stake in Sulzer to below a majority in a bid to insulate the company
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