Broadband in Nebraska: Current Landscape and Recommendations

N ebraska’s broadband vision is that residents, businesses, government entities, commu-nity partners, and visitors have access to affordable broadband service and have the necessary skills to effectively utilize broadband technologies. Objectives To increase economic development opportunities, create good-paying jobs, at-tract and retain population, overcome the barriers of distance, and enhance qual-ity of life in Nebraska by stimulating the continuing deployment of broadband technologies which meet the need for increasing connection speeds. To increase digital literacy and the widespread adoption of broadband technolo-gies in business, agriculture, health care, education, government and by individu-al Nebraskans. Goals The following goals and targets help focus attention on key aspects of the plan and provide a way to assess the state’s progress in addressing broadband development: Increase household adoption of broadband Over 90% of households statewide will subscribe to broadband by 2020. 85% of households in rural Nebraska will subscribe to broadband by 2020. Increase broadband availability Broadband service of 25 Mbps down will be available to 90% of house-holds by 2020. Broadband service of 1 gbps down will be available to 25% of households by 2020. Support broadband-related development by increasing the number and diver-sity of IT workers At least 1,400 degrees in computer and information science, management information systems, computer engineering, and bioinformatics will be awarded annually by Nebraska colleges and universities by 2020. Women receive at least 25% of the degrees in computer and information science, management information systems, computer engineering, and bioinformatics will be awarded by Nebraska colleges and universities by 2020

Broadband in Nebraska: Current Landscape and Recommendations

N ebraska’s broadband vision is that residents, businesses, government entities, commu-nity partners, and visitors have access to affordable broadband service and have the necessary skills to effectively utilize broadband technologies. Objectives To increase economic development opportunities, create good-paying jobs, at-tract and retain population, overcome the barriers of distance, and enhance qual-ity of life in Nebraska by stimulating the continuing deployment of broadband technologies which meet the need for increasing connection speeds. To increase digital literacy and the widespread adoption of broadband technolo-gies in business, agriculture, health care, education, government and by individu-al Nebraskans. Goals The following goals and targets help focus attention on key aspects of the plan and provide a way to assess the state’s progress in addressing broadband development: Increase household adoption of broadband Over 90% of households statewide will subscribe to broadband by 2020. 85% of households in rural Nebraska will subscribe to broadband by 2020. Increase broadband availability Broadband service of 25 Mbps down will be available to 90% of house-holds by 2020. Broadband service of 1 gbps down will be available to 25% of households by 2020. Support broadband-related development by increasing the number and diver-sity of IT workers At least 1,400 degrees in computer and information science, management information systems, computer engineering, and bioinformatics will be awarded annually by Nebraska colleges and universities by 2020. Women receive at least 25% of the degrees in computer and information science, management information systems, computer engineering, and bioinformatics will be awarded by Nebraska colleges and universities by 2020

Evidence for models of diagnostic service provision in the community: literature mapping exercise and focused rapid reviews

Background Current NHS policy favours the expansion of diagnostic testing services in community and primary care settings. Objectives Our objectives were to identify current models of community diagnostic services in the UK and internationally and to assess the evidence for quality, safety and clinical effectiveness of such services. We were also interested in whether or not there is any evidence to support a broader range of diagnostic tests being provided in the community. Review methods We performed an initial broad literature mapping exercise to assess the quantity and nature of the published research evidence. The results were used to inform selection of three areas for investigation in more detail. We chose to perform focused reviews on logistics of diagnostic modalities in primary care (because the relevant issues differ widely between different types of test); diagnostic ultrasound (a key diagnostic technology affected by developments in equipment); and a diagnostic pathway (assessment of breathlessness) typically delivered wholly or partly in primary care/community settings. Databases and other sources searched, and search dates, were decided individually for each review. Quantitative and qualitative systematic reviews and primary studies of any design were eligible for inclusion. Results We identified seven main models of service that are delivered in primary care/community settings and in most cases with the possible involvement of community/primary care staff. Not all of these models are relevant to all types of diagnostic test. Overall, the evidence base for community- and primary care-based diagnostic services was limited, with very few controlled studies comparing different models of service. We found evidence from different settings that these services can reduce referrals to secondary care and allow more patients to be managed in primary care, but the quality of the research was generally poor. Evidence on the quality (including diagnostic accuracy and appropriateness of test ordering) and safety of such services was mixed. Conclusions In the absence of clear evidence of superior clinical effectiveness and cost-effectiveness, the expansion of community-based services appears to be driven by other factors. These include policies to encourage moving services out of hospitals; the promise of reduced waiting times for diagnosis; the availability of a wider range of suitable tests and/or cheaper, more user-friendly equipment; and the ability of commercial providers to bid for NHS contracts. However, service development also faces a number of barriers, including issues related to staffing, training, governance and quality control. Limitations We have not attempted to cover all types of diagnostic technology in equal depth. Time and staff resources constrained our ability to carry out review processes in duplicate. Research in this field is limited by the difficulty of obtaining, from publicly available sources, up-to-date information about what models of service are commissioned, where and from which providers. Future work There is a need for research to compare the outcomes of different service models using robust study designs. Comparisons of ‘true’ community-based services with secondary care-based open-access services and rapid access clinics would be particularly valuable. There are specific needs for economic evaluations and for studies that incorporate effects on the wider health system. There appears to be no easy way of identifying what services are being commissioned from whom and keeping up with local evaluations of new services, suggesting a need to improve the availability of information in this area. Funding The National Institute for Health Research Health Services and Delivery Research programme

Use of information and communication technologies to support effective work practice innovation in the health sector: a multi-site study

<p>Abstract</p> <p>Background</p> <p>Widespread adoption of information and communication technologies (ICT) is a key strategy to meet the challenges facing health systems internationally of increasing demands, rising costs, limited resources and workforce shortages. Despite the rapid increase in ICT investment, uptake and acceptance has been slow and the benefits fewer than expected. Absent from the research literature has been a multi-site investigation of how ICT can support and drive innovative work practice. This Australian-based project will assess the factors that allow health service organisations to harness ICT, and the extent to which such systems drive the creation of new sustainable models of service delivery which increase capacity and provide rapid, safe, effective, affordable and sustainable health care.</p> <p>Design</p> <p>A multi-method approach will measure current ICT impact on workforce practices and develop and test new models of ICT use which support innovations in work practice. The research will focus on three large-scale commercial ICT systems being adopted in Australia and other countries: computerised ordering systems, ambulatory electronic medical record systems, and emergency medicine information systems. We will measure and analyse each system's role in supporting five key attributes of work practice innovation: changes in professionals' roles and responsibilities; integration of best practice into routine care; safe care practices; team-based care delivery; and active involvement of consumers in care.</p> <p>Discussion</p> <p>A socio-technical approach to the use of ICT will be adopted to examine and interpret the workforce and organisational complexities of the health sector. The project will also focus on ICT as a potentially <it>disruptive innovation </it>that challenges the way in which health care is delivered and consequently leads some health professionals to view it as a threat to traditional roles and responsibilities and a risk to existing models of care delivery. Such views have stifled debate as well as wider explorations of ICT's potential benefits, yet firm evidence of the effects of role changes on health service outcomes is limited. This project will provide important evidence about the role of ICT in supporting new models of care delivery across multiple healthcare organizations and about the ways in which innovative work practice change is diffused.</p

Alternative Transportation Energy

Transportation energy issues are moving to the forefront of the public consciousness in the U.S. and particularly California, and gaining increasing attention from legislators and regulators. The three principal concerns motivating interest in transportation energy are urban air quality, oil dependence, and the threat of global warming. Transportation fuels are a principal contributor to each of these. The transportation sector, mostly motor vehicles, contributes roughly half the urban air pollutants, almost one-third of the carbon dioxide, and consumes over 60% of all petroleum