Exarh of the Bulgarian Church metropolitan Stephen and the Moscow Patriarchy

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Kostriukov Andrei

2013-02-01

Full Text Available The article covers the last period of church-administrative activity of the Sofia’s metropolitan Stephаn (Shokov. The author describes the testimonies of contemporaries about the character and personal qualities of this ambiguous hierarch. In 1945–1948 metropolitan Stephan was the exarch of the Bulgarian Orthodox Church and participated in the Meeting of heads and representatives of Autocephalous Orthodox Churches in 1948. The author considers the circumstances of the dismissal of metropolitan Stephаn and his exile as especially important and interesting ones. The meeting of 1948 became the critical event in the exarch’s destiny. Being the supporter of ecumenism, metropolitan Stephen tried unsuccessfully to convince Patriarch Alexis of his rightness in order not to allow the condemnation of ecumenical contacts by the Moscow meeting. However Moscow looked on ecumenism differently in those days. In Moscow the Soviet management aspired to establishment of the centre of World Orthodoxy and tried to cite the Moscow Patriarchy against Constantinople that was under the influence of the USA and the Great Britain. As the Constantinople Patriarchy approved the ecumenical movement, the Moscow Patriarchy has been forced to take of an opposite position. Therefore, the participation of the Russian Church and Churches of the socialist countries in the ecumenical movement was impossible. Metropolitan Stephan, supporting the superiority of the Moscow Patriarchy in the World Orthodoxy, supported the active participation of all Local Churches in the ecumenical movement. The communistic management applied the maximum force to the exarch in order he has not made undesirable statements at the meeting. The fate of metropolitan Stephan has been decided after this meeting. In 1948 he was fired and exiled. The Moscow Patriarchy did not exclude the possibility of moving of metropolitan Stephаn to Russia and his location in any monastery. However metropolitan

Barriers to participation in a hospital-based falls assessment clinicprogramme

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Evron, Lotte; Schultz-Larsen, Kirsten; Fristrup, Tine

2009-01-01

Aims: To gain new knowledge about barriers to participation in hospital-based falls assessment. Methods: Semi-structured interviews with 20 older people referred to falls assessment at a hospital-based clinic were conducted. A convenience sample of 10 refusers and 10 accepters was collected. Those...... of knowledge were expected, owing to accepters' participation in the programme. Interview transcriptions were thematically analysed. The analysis was directed towards identification of barriers to falls assessment. Results: Barriers to participation were categorized as being either within or outside the falls...

Pediatric disaster preparedness of a hospital network in a large metropolitan region.

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Ferrer, Rizaldy R; Balasuriya, Darshi; Iverson, Ellen; Upperman, Jeffrey S

2010-01-01

We describe pediatric-related emergency experiences and responses, disaster preparation and planning, emergency plan execution and evaluation, and hospital pediatric capabilities and vulnerabilities among a disaster response network in a large urban county in the West Coast of the United States. Using semistructured key informant interviews, the authors conducted qualitative research between March and April 2008. Eleven hospitals and a representative from the community clinic association agreed to participate (86 percent response rate) and a total of 22 key informant interviews were completed. Data were analyzed using ATLAS.ti.v.5.0, a qualitative analytical software program. Although hospitals have infrastructure to respond in the event of a large-scale disaster, well-established disaster preparedness plans have not fully accounted for the needs of children. The general hospitals do not anticipate a surge of pediatric victims in the event of a disaster, and they expect that children will be transported to a children's hospital as their conditions become stable. Even hospitals with well-established disaster preparedness plans have not fully accounted for the needs of children during a disaster. Improved communication between disaster network hospitals is necessary as incorrect information still persists.

An audit of the pharmacological management of ischaemic stroke patients in a metropolitan Australian hospital.

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Khalil, Viviane; Li, Matthew; Hua, Qiantong Amanda

2015-02-01

According to the Australian Bureau of Statistics, stroke is the second leading cause of death in Australia. The clinical Guidelines for stroke management published by the National Stroke Foundation provide a series of evidence based recommendations to assist clinicians in the management of stroke patients. Appropriate management of patients admitted to stroke units reduces death and disability by 20 %. Moreover, a multidisciplinary team approach also improves patient outcomes. To retrospectively review the pharmacological management of ischaemic stroke patients in a metropolitan Australian hospital, and to compare adherence with the guidelines for stroke management with the national stroke foundation data with and without pharmacist intervention. A retrospective audit of medical records was undertaken of all patients admitted to a large teaching hospital with the diagnosis of stroke or cerebral infarction from January 2013 to May 2013. A total of 124 patients were included in the study. Most patients were discharged on appropriate pharmacological intervention for the prevention of secondary stroke: antihypertensive agents (71 %), lipid lowering agents (67 %) and antithrombotic (85 %) medications. The majority of the cohort was discharged on the appropriate evidence based medications for the management of secondary stroke. Further improvement may be achieved by pharmacist intervening as part of a multidisciplinary team.

Patient participation in medication safety during an acute care admission.

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McTier, Lauren; Botti, Mari; Duke, Maxine

2015-10-01

Patient participation in medication management during hospitalization is thought to reduce medication errors and, following discharge, improve adherence and therapeutic use of medications. There is, however, limited understanding of how patients participate in their medication management while hospitalized. To explore patient participation in the context of medication management during a hospital admission for a cardiac surgical intervention of patients with cardiovascular disease. Single institution, case study design. The unit of analysis was a cardiothoracic ward of a major metropolitan, tertiary referral hospital in Melbourne, Australia. Multiple methods of data collection were used including pre-admission and pre-discharge patient interviews (n = 98), naturalistic observations (n = 48) and focus group interviews (n = 2). All patients had changes made to their pre-operative cardiovascular medications as a consequence of surgery. More patients were able to list and state the purpose and side-effects of their cardiovascular medications at pre-admission than prior to discharge from hospital. There was very little evidence that nurses used opportunities such as medication administration times to engage patients in medication management during hospital admission. Failure to engage patients in medication management and provide opportunities for patients to learn about changes to their medications has implications for the quality and safety of care patients receive in hospital and when managing their medications once discharged. To increase the opportunity for patients to participate in medication management, a fundamental shift in the way nurses currently provide care is required. © 2013 John Wiley & Sons Ltd.

Epidemiology of Hospital-Treated Injuries Sustained by Fitness Participants

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Gray, Shannon E.; Finch, Caroline F.

2015-01-01

Purpose: The purpose of this study was to provide an epidemiological profile of injuries sustained by participants in fitness activities in Victoria, Australia, based on hospital admissions and emergency department (ED) presentations and to identify the most common types, causes, and sites of these injuries. Method: Hospital-treated fitness…

Understanding hospital meal experiences by means of participant-driven-photo-elicitation.

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Justesen, Lise; Mikkelsen, Bent E; Gyimóthy, Szilvia

2014-04-01

A patients' hospital meal experiences can be complex and often difficult to capture using traditional methods. This study investigated patients' hospital meal experiences using participant-driven-photo-elicitation (PDPE). PDPE invites respondents to photograph their daily lives and combines this with interviews, which can provide deeper insight into multisensory experiences beyond verbal or written discourse. The sample consisted of eight hospitalised patients. Patients completed a photo-essay of their hospital meal experience during a single day at a Danish hospital and afterwards participated in an open-ended interview. Two inductive analytical approaches were selected to assess the patients' reflections on their hospital meal experiences. First, the interview transcripts were analysed using the Semiotic Analysis approach using qualitative data analysis software NVivo 9. Second, the 91 produced photographs and the participants' engagement with the photographs were analysed by means of a Reflexive Content Analysis. The study found that PDPE is a research method that can be used for expanding the conceptualisation of hospital meal experiences, revealing the significance of the meal context, materiality and memories beyond food per se. Copyright © 2013 Elsevier Ltd. All rights reserved.

Perceptions by medical students of their educational environment for obstetrics and gynaecology in metropolitan and rural teaching sites.

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Carmody, Dianne F; Jacques, Angela; Denz-Penhey, Harriet; Puddey, Ian; Newnham, John P

2009-12-01

Medical student education in Western Australia is expanding to secondary level metropolitan hospitals and rural sites to accommodate workforce demands and increasing medical student numbers. To determine if students' perceptions of the teaching environment for obstetrics and gynaecology differ between tertiary, secondary level metropolitan hospitals and rural sites, and to determine if students' perceptions of their learning environment are associated with improved academic performance. An evaluation was conducted of medical students' perceptions of their learning environment during an obstetrics and gynaecology program at a variety of sites across metropolitan and rural Western Australia. The evaluation was based on the Dundee Ready Education Environmental Measure (DREEM) questionnaire. There were no significant differences in students' perceptions of their learning environment between the tertiary hospital, combined programs involving a tertiary and secondary metropolitan hospital, rural sites with a population of more than 25,000 and rural sites with a population less than 25,000 people. Perceptions were similar in male and female students. The overall mean score for all perceptions of the learning environment in obstetrics and gynaecology were in the range considered to be favorable. Higher scores of perceptions of the learning environment were associated positively with the measures of academic achievement in the clinical, but not written, examination. Medical students' perceptions of their learning environment in obstetrics and gynaecology were not influenced by the geographical site of delivery or their gender but were positively related to higher academic achievement. Providing appropriate academic and clinical support systems have been put in place the education of medical students can be extended outside major hospitals and into outer metropolitan and rural communities without any apparent reduction in perceptions of the quality of their learning

Hospital staffing and hospital costs.

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Andrew, R R

1976-08-07

A comparative study of costs per bed per day in teaching hospitals affiliated with Monash University compared with large non-teaching metropolitan hospitals (1964 to 1974) shows they are much higher in teaching hospitals. There is no evidence that this is due to the additional costs arising from the clinical schools. Research in the teaching hospitals and the accompanying high professional standards and demands on services are major factors accounting for the difference. Over the decade studied, the resident staff have increased by 77% and other salaried staff by 24%. The index of expenditure for the three teaching hospitals in the decade has increased by 386%.

Patient participation in quality pain management during an acute care admission.

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McTier, Lauren J; Botti, Mari; Duke, Maxine

2014-04-01

The objective of the study was to explore patient participation in the context of pain management during a hospital admission for a cardiac surgical intervention of patients with cardiovascular disease. This is a single-institution study, with a case-study design. The unit of analysis was a cardiothoracic ward of a major metropolitan, tertiary referral hospital in Melbourne, Australia. Multiple methods of data collection were used including preadmission and predischarge patient interviews (n=98), naturalistic observations (n=48), and focus group interviews (n=2). Patients' preference for participation in pain management was not always commensurate with their involvement in pain management. Patients displayed a greater understanding of their role in pain management in terms of reporting pain and the use of multimodal analgesics after surgery. The majority of patients, however, did not understand the importance of reporting pain to avoid complications. Patients had limited opportunity to participate in their pain management. On occasions in which clinicians did involve patients, the involvement appeared to be focused on reporting pain rather than treatment of pain. Patient participation in pain management during hospitalization is not optimal. This has implications for the quality of pain management patients receive. Higher engagement of patients in their pain management during hospitalization is required to ensure comfort, reduce potential for complications, and adequately prepare the patients to manage their pain following discharge from hospital.

Examination of the relative importance of hospital employment in non-metropolitan counties using location quotients.

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Smith, Jon L

2013-01-01

The US Health Care and Social Services sector (North American Industrial Classification System 'sector 62') has become an extremely important component of the nation's economy, employing approximately 18 million workers and generating almost $753 billion in annual payrolls. At the county level, the health care and social services sector is typically the largest or second largest employer. Hospital employment is often the largest component of the sector's total employment. Hospital employment is particularly important to non-metropolitan or rural communities. A high quality healthcare sector serves to promote economic development and attract new businesses and to provide stability in economic downturns. The purpose of this study was to examine the intensity of hospital employment in rural counties relative to the nation as a whole using location quotients and to draw conclusions regarding how potential changes in Medicare and Medicaid might affect rural populations. Estimates for county-level hospital employment are not commonly available. Estimates of county-level hospital employment were therefore generated for all counties in the USA the Census Bureau's County Business Pattern Data for 2010. These estimates were used to generate location quotients for each county which were combined with demographic data to generate a profile of factors that are related to the magnitude of location quotients. The results were then used to draw inferences regarding the possible impact of the Patient Protection and Affordable Care Act 2010 (ACA) and the possible imposition of aspects of the Budget Control Act 2011 (BCA). Although a very high percentage of rural counties contain medically underserved areas, an examination of location quotients indicates that the percentage of the county workforce employed by hospitals in the most rural counties tends to be higher than for the nation as a whole, a counterintuitive finding. Further, when location quotients are regressed upon data

Googling Service Boundaries for Endovascular Clot Retrieval Hub Hospitals in a Metropolitan Setting: Proof-of-Concept Study.

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Phan, Thanh G; Beare, Richard; Chen, Jian; Clissold, Benjamin; Ly, John; Singhal, Shaloo; Ma, Henry; Srikanth, Velandai

2017-05-01

There is great interest in how endovascular clot retrieval hubs provide services to a population. We applied a computational method to objectively generate service boundaries for such endovascular clot retrieval hubs, defined by traveling time to hub. Stroke incidence data merged with population census to estimate numbers of stroke in metropolitan Melbourne, Australia. Traveling time from randomly generated addresses to 4 endovascular clot retrieval-capable hubs (Royal Melbourne Hospital [RMH], Monash Medical Center [MMC], Alfred Hospital [ALF], and Austin Hospital [AUS]) estimated using Google Map application program interface. Boundary maps generated based on traveling time at various times of day for combinations of hubs. In a 2-hub model, catchment was best distributed when RMH was paired with MMC (model 1a, RMH 1765 km 2 and MMC 1164 km 2 ) or with AUS (model 1c, RMH 1244 km 2 and AUS 1685 km 2 ), with no statistical difference between models ( P =0.20). Catchment was poorly distributed when RMH was paired with ALF (model 1b, RMH 2252 km 2 and ALF 676 km 2 ), significantly different from both models 1a and 1c (both P AUS was superior to that of RMH, MMC, and ALF in catchment distribution and travel time. The method was also successfully applied to the city of Adelaide demonstrating wider applicability. We provide proof of concept for a novel computational method to objectively designate service boundaries for endovascular clot retrieval hubs. © 2017 American Heart Association, Inc.

The relationship between hospital and ehr vendor market dynamics on health information organization presence and participation.

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Lin, Sunny C; Adler-Milstein, Julia

2018-05-08

Health Information Organizations (HIOs) are third party organizations that facilitate electronic health information exchange (HIE) between providers in a geographic area. Despite benefits from HIE, HIOs have struggled to form and subsequently gain broad provider participation. We sought to assess whether market-level hospital and EHR vendor dynamics are associated with presence and level of hospital participation in HIOs. 2014 data on 4523 hospitals and their EHR vendors were aggregated to the market level. We used multivariate OLS regression to analyze the relationship between hospital and vendor dynamics and (1) probability of HIO presence and (2) percent of hospitals participating in an HIO. 298 of 469 markets (64%) had HIO presence, and in those markets, 47% of hospitals participated in an HIO on average. In multivariate analysis, four characteristics were associated with HIO presence. Markets with more hospitals, markets with more EHR vendors, and markets with an EHR vendor-led HIE approach were more likely to have an HIO. Compared to markets with low hospital competition, markets with high hospital competition had a 25 percentage point lower probability of HIO presence. Two characteristics were associated with level of hospital HIO participation. Markets with more hospitals as well as markets with high vendor competition (compared to low competition) had lower participation. Both hospital and EHR vendor dynamics are associated with whether a market has an HIO as well as the level of hospital participation in HIOs.

Understanding hospital meal experiences by means of Participant-Driven-Photo-Elicitation

DEFF Research Database (Denmark)

Justesen, Lise; Mikkelsen, Bent Egberg; Gyimóthy, Szilvia

2014-01-01

A patients’ hospital meal experiences can be complex and often difficult to capture using traditional methods. This study investigated patients’ hospital meal experiences using participant-driven-photo-elicitation (PDPE). PDPE invites respondents to photograph their daily lives and combines this ...

MRSA Causing Infections in Hospitals in Greater Metropolitan New York: Major Shift in the Dominant Clonal Type between 1996 and 2014.

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Maria Pardos de la Gandara

Full Text Available A surveillance study in 1996 identified the USA100 clone (ST5/SCCmecII-also known as the "New York/Japan" clone-as the most prevalent MRSA causing infections in 12 New York City hospitals. Here we update the epidemiology of MRSA in seven of the same hospitals eighteen years later in 2013/14. Most of the current MRSA isolates (78 of 121 belonged to the MRSA clone USA300 (CC8/SCCmecIV but the USA100 clone-dominant in the 1996 survey-still remained the second most frequent MRSA (25 of the 121 isolates causing 32% of blood stream infections. The USA300 clone was most common in skin and soft tissue infections (SSTIs and was associated with 84.5% of SSTIs compared to 5% caused by the USA100 clone. Our data indicate that by 2013/14, the USA300 clone replaced the New York/Japan clone as the most frequent cause of MRSA infections in hospitals in Metropolitan New York. In parallel with this shift in the clonal type of MRSA, there was also a striking change in the types of MRSA infections from 1996 to 2014.

MPLS for metropolitan area networks

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Tan, Nam-Kee

2004-01-01

METROPOLITAN AREA NETWORKS AND MPLSRequirements of Metropolitan Area Network ServicesMetropolitan Area Network OverviewThe Bandwidth DemandThe Metro Service Provider's Business ApproachesThe Emerging Metro Customer Expectations and NeedsSome Prevailing Metro Service OpportunitiesService Aspects and RequirementsRoles of MPLS in Metropolitan Area NetworksMPLS PrimerMPLS ApplicationsTRAFFIC ENGINEERING ASPECTS OF METROPOLITAN AREA NETWORKSTraffic Engineering ConceptsNetwork CongestionHyper Aggregation ProblemEasing CongestionNetwork ControlTactical versus Strategic Traffic EngineeringIP/ATM Overl

Spatial variations in US poverty: beyond metropolitan and non-metropolitan.

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Wang, Man; Kleit, Rachel Garshick; Cover, Jane; Fowler, Christopher S

2012-01-01

Because poverty in rural and urban areas of the US often has different causes, correlates and solutions, effective anti-poverty policies depend on a thorough understanding of the ruralness or urbanness of specific places. This paper compares several widely used classification schemes and the varying magnitudes of poverty that they reveal in the US. The commonly used ‘metropolitan/non-metropolitan’ distinction obscures important socioeconomic differences among metropolitan areas, making our understanding of the geography of poverty imprecise. Given the number and concentration of poor people living in mixed-rural and rural counties in metropolitan regions, researchers and policy-makers need to pay more nuanced attention to the opportunities and constraints such individuals face. A cross-classification of the Office of Management and Budget’s metro system with a nuanced RUDC scheme is the most effective for revealing the geographical complexities of poverty within metropolitan areas.

Development of hospital information systems: user participation and factors affecting it.

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Rahimi, Bahlol; Safdari, Reza; Jebraeily, Mohamad

2014-12-01

Given the large volume of data generated in hospitals, in order to efficiently management them; using hospital information system (HIS) is critical. User participation is one of the major factors in the success of HIS that in turn leads Information needs and processes to be correctly predicted and also their commitment to the development of HIS to be augmented. The purpose of this study is to investigate the participation rate of users in different stages of HIS development as well as to identify the factors affecting it. This is a descriptive-cross sectional study which was inducted in 2014. The study population consists of 140 HIS users (from different types of job including physicians, nurses, laboratory, radiology and HIM staffs) from Teaching Hospitals Affiliated to Urmia University of Medical Sciences. Data were collected using a self-structured questionnaire which was estimated as both reliable and valid. The data were analyzed by SPSS software descriptive statistics and analytical statistics (t-test and chi-square). The highest participation rate of users in the four-stage development of the HIS was related to the implementation phase (2.88) and the lowest participation rate was related to analysis (1.23). The test results showed that the rate of user participation was not satisfactory in none of the stages of development (Psystem, and in this way, the success of the system will be assured.

High hospital research participation and improved colorectal cancer survival outcomes: a population-based study.

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Downing, Amy; Morris, Eva Ja; Corrigan, Neil; Sebag-Montefiore, David; Finan, Paul J; Thomas, James D; Chapman, Michael; Hamilton, Russell; Campbell, Helen; Cameron, David; Kaplan, Richard; Parmar, Mahesh; Stephens, Richard; Seymour, Matt; Gregory, Walter; Selby, Peter

2017-01-01

In 2001, the National Institute for Health Research Cancer Research Network (NCRN) was established, leading to a rapid increase in clinical research activity across the English NHS. Using colorectal cancer (CRC) as an example, we test the hypothesis that high, sustained hospital-level participation in interventional clinical trials improves outcomes for all patients with CRC managed in those research-intensive hospitals. Data for patients diagnosed with CRC in England in 2001-2008 (n=209 968) were linked with data on accrual to NCRN CRC studies (n=30 998). Hospital Trusts were categorised by the proportion of patients accrued to interventional studies annually. Multivariable models investigated the relationship between 30-day postoperative mortality and 5-year survival and the level and duration of study participation. Most of the Trusts achieving high participation were district general hospitals and the effects were not limited to cancer 'centres of excellence', although such centres do make substantial contributions. Patients treated in Trusts with high research participation (≥16%) in their year of diagnosis had lower postoperative mortality (presearch participation, with a reduction in postoperative mortality of 1.5% (6.5%-5%, pstudies for all patients with CRC treated in the hospital study participants. Improvement precedes and increases with the level and years of sustained participation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Retaining nurses in metropolitan areas: insights from senior nurse and human resource managers.

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Drennan, Vari M; Halter, Mary; Gale, Julia; Harris, Ruth

2016-11-01

To investigate the views of senior nurse and human resource managers of strategies to retain hospital nurses in a metropolitan area. Against a global shortage, retaining nurses is a management imperative for the quality of hospital services. Semi-structured interviews, thematically analysed. Metropolitan areas have many health organisations in geographical proximity, offering nurses choices in employer and employment. Senior nurse and human resource managers recognised the complexity of factors influencing nurse turnover, including those that 'pulled' nurses out of their jobs to other posts and factors that 'pushed' nurses to leave. Four themes emerged in retaining nurses: strategy and leadership, including analysis of workforce and leavers' data, remuneration, the type of nursing work and career development and the immediate work environment. In contexts where multiple organisations compete for nurses, addressing retention through strategic leadership is likely to be important in paying due attention and apportioning resources to effective strategies. Aside from good human resource management practices for all, strategies tailored to different segments of the nursing workforce are likely to be important. This metropolitan study suggests attention should be paid to strategies that address remuneration, progressing nursing careers and the immediate work environment. © 2016 The Authors Journal of Nursing Management Published by John Wiley & Sons Ltd.

Is There a Global Role for Metropolitan City Libraries?

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Mason, Marilyn Gell

1994-01-01

Discusses the potential for linking large metropolitan public libraries to international interlibrary loan networks. Issues involved in international networking, including funding, standards, network connectivity, and protectionism, are discussed. Examples of libraries capable of participating and brief descriptions of their collections are given.…

Planning for strategic change? A participative planning approach for community hospitals.

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MacDonald, S K; Beange, J E; Blachford, P C

1992-01-01

Strategic planning is becoming to hospitals what business case analysis is to private corporations. In fact, this type of planning is becoming essential for the professional management of Ontario hospitals. The participative strategic planning process at Toronto East General Hospital (TEGH) is an example of how a professionally structured and implemented strategic planning process can be successfully developed and implemented in a community hospital. In this article, the environmental factors driving planning are reviewed and the critical success factors for the development and implementation of a strategic plan are examined in the context of TEGH's experience.

Syndromic surveillance: hospital emergency department participation during the Kentucky Derby Festival.

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Carrico, Ruth; Goss, Linda

2005-01-01

Electronic syndromic surveillance may have value in detecting emerging pathogens or a biological weapons release. Hospitals that have an agile process to evaluate chief complaints of patients seeking emergency care may be able to more quickly identify subtle changes in the community's health. An easily adaptable prototype system was developed to monitor emergency department patient visits during the Kentucky Derby Festival in Louisville, Kentucky, from April 16-May 14, 2002. Use of the system was continued during the same festival periods in 2003 and 2004. Twelve area hospitals in Louisville, Kentucky, participated in a prospective analysis of the chief symptoms of patients who sought care in the emergency department during the Kentucky Derby Festival during 2002. Six hospitals were classified as computer record groups (CRG) and used their existing computerized record capabilities. The other 6 hospitals used a personal digital assistant (PDA) with customized software (PDA group). Data were evaluated by the health department epidemiologist using SaTScan, a modified version of a cancer cluster detection program, to look for clusters of cases above baseline over time and by Zip code. All 12 hospitals were able to collect and provide data elements during the study period. The 6 CRG hospitals were able to perform daily data transmission; however, 3 CRG hospitals were unable to interpret their data because it was transmitted in pure text format. In contrast, data from all 6 PDA group hospitals were interpretable. Real-time data analysis was compared with post-event data, and it was found that the real-time evaluation correctly identified no unusual disease activity during the study period. The 12 hospitals participating in this study demonstrated that community-wide surveillance using computerized data was possible and that the 6 study hospitals using a PDA could quickly interpret emergency department patients' chief complaints. The emergency department chief complaints

Impact and management of dual relationships in metropolitan, regional and rural mental health practice.

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Endacott, Ruth; Wood, Anita; Judd, Fiona; Hulbert, Carol; Thomas, Ben; Grigg, Margaret

2006-01-01

To explore the extent and impact of professional boundary crossings in metropolitan, regional and rural mental health practice in Victoria and identify strategies mental health clinicians use to manage dual relationships. Nine geographically located focus groups consisting of mental health clinicians: four focus groups in rural settings; three in a regional city and two in a metropolitan mental health service. A total of 52 participants were interviewed. Data revealed that professional boundaries were frequently breached in regional and rural settings and on occasions these breaches had a significantly negative impact. Factors influencing the impact were: longevity of the clinician's relationship with the community, expectations of the community, exposure to community 'gossip' and size of the community. Participants reported greater stress when the boundary crossing affected their partner and/or children. Clinicians used a range of proactive and reactive strategies, such as private telephone number, avoidance of social community activities, when faced with a potential boundary crossing. The feasibility of reactive strategies depended on the service configuration: availability of an alternative case manager, requirement for either patient or clinician to travel. The greater challenges faced by rural and regional clinicians were validated by metropolitan participants with rural experience and rural participants with metropolitan experience. No single strategy is used or appropriate for managing dual relationships in rural settings. Employers and professional bodies should provide clearer guidance for clinicians both in the management of dual relationships and the distinction between boundary crossings and boundary violation. Clinicians are clearly seeking to represent and protect the patients' interests; consideration should be given by consumer groups to steps that can be taken by patients to reciprocate.

Urine Creatinine Concentrations in Drug Monitoring Participants and Hospitalized Patients.

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Love, Sara A; Seegmiller, Jesse C; Kloss, Julie; Apple, Fred S

2016-10-01

Urine drug testing is commonly performed in both clinical and forensic arenas for screening, monitoring and compliance purposes. We sought to determine if urine creatinine concentrations in monitoring program participants were significantly different from hospital in-patients and out-patients undergoing urine drug testing. We retrospectively reviewed urine creatinine submitted in June through December 2015 for all specimens undergoing urine drug testing. The 20,479 creatinine results were categorized as hospitalized patients (H) and monitoring/compliance groups for pain management (P), legal (L) or recovery (R). Median creatinine concentrations (interquartile range, mg/dL) were significantly different (P creatinine concentrations were significantly lower in the R vs. L group (Pcreatinine concentration and may indicate participants' attempts to tamper with their drug test results through dilution means. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

NURSES’ VIEWS ABOUT PARENT PARTICIPATION IN THE CARE OF HOSPITALIZED CHILDREN

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Sevil Ozkan

2017-12-01

Full Text Available Aim: To determine views of nurses’, who worked at pediatric clinics, about parent participation in the care of hospitalized children. Methods: This descriptive research was performed with 155 nurses who worked at pediatric clinics of four hospitals located in the city center of Konya, in March-May, 2014. Data were collected using a questionaire which was developed according to literature. Data were evaluated in terms of number, percentage, mean, standard deviation via SPSS 20 programme. Results: In study, 81.9% of nurses agreed to views about parent participation can result “reduce fear and anxiety of child" and "facilitation child's coping with painful practices". It was found that most of nurses agreed “it provides that parents know everything about child's care and treatment” (74.8% and “professional communication between nurses and families can return social communication style" (81.3. Gender of parents, comunication style, education levels, knowing caring process of children, children's disease process, age and doctor's order about parent participation were determined effective factors in parent participation. Conclusion: It was found that nurses’ views about effect of parent participation on children were mostly positive but they also had negative views about its effects on parents and nursing. [J Contemp Med 2017; 7(4.000: 355-364

Hospitalization of abused and neglected children.

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Marshall, W N

1997-03-01

To describe the use of inpatient hospitalization for abused and neglected children living in a metropolitan area. Retrospective record review of abused and neglected children admitted in 1992 and 1993 to hospitals with 87% of metropolitan area pediatric admissions; comparison of these data with population, crisis nursery, and child protective services data. Thirty-four abused and neglected children were admitted to hospital, representing 0.3% (34/11,066; 95% confidence interval, 0%-1.2%) of pediatric admissions and 0.2% (34/19,950; 95% confidence interval, 0%-0.6%) of child protective services reports. This represents a rate of hospitalization for child abuse of 10 children (95% confidence interval, 0-46) per 100,000 child population per year. Seven hundred fifteen children were admitted to the crisis nursery by child protective services. Of those admitted to the hospital, 12 needed intensive care, 5 of whom died. Only 3 of 34 hospital-admitted children had private health insurance; 19 of 34 were younger than 1 year. Inpatient hospitalization for abuse represented a small fraction of total pediatric admissions and of child protective services reports. Comprehensive medical care for most abused children and medical education about child abuse must occur in outpatient settings.

Prevalence of CMV infection among staff in a metropolitan children’s hospital – occupational health screening findings

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Stranzinger, Johanna

2016-09-01

Full Text Available Background: Staff in children’s hospitals may run an increased risk of cytomegalovirus (CMV contact infection leading to a congenital CMV fetopathy during pregnancy. The main risk factor is close contact with inapparent carriers of CMV among infants (<3 years. We therefore examined CMV seroprevalence (SP and possible risk factors for CMV infection among staff at a children’s hospital.Method: In 2014, staff at a metropolitan children’s hospital were offered a CMV antibody test in the context of occupational health screening. Besides of anti-CMV immunoglobulin G (anti-CMV IgG gender, age, profession, number of children and migration background were assessed and used as independent variables in multiple logistic regression. Women without a migration background (MIG were considered as a separate group.Results: The study included 219 employees. Women showed a significant higher risk than men of being CMV-positive (adjusted odds ratio [aOR] 3.0; 95% CI 1.1–7.8. The risk among age groups of 30 and over was double that of the under-30s (aOR 2.0; 95% CI 1.0–3.9; among those aged 40-plus it was aOR 2.3 (95% CI 1.1–4.7. Staff with an MIG tested more often positive than those without an MIG (95.5% versus 45.7%. CMV SP was 47.7% among women without an MIG. In this subgroup the probability of CMV infection increased with age (p=0.08 as well. Conclusion: In the staff group as a whole there was a significant correlation between CMV SP, country of origin and age. We found no significant differences between occupational groups; perhaps our random sample was too small. Given the low CMV SP particularly in those without MIG, women who want to have children in particular must be protected from CMV infection. Follow-up studies should be undertaken to test whether good workplace hygiene offers sufficient protection for pregnant women and could be an alternative to prohibiting certain activities.

Participation of informal caregivers in the hospital care of elderly patients and their evaluations of the care given: pilot study in three different hospitals.

Science.gov (United States)

Laitinen, P

1992-10-01

This action research is an ongoing study which will last from 1991 to 1993. The main purpose of the study is to increase the participation of informal caregivers in the hospital care of elderly patients without decreasing the quality of care. The data reported here are from a pilot study. This study had three aims: (a) to test reliability and validity of the measure used, (b) to investigate the current participation of informal caregivers in the hospital care of elderly patients (aged over 75), and (c) to evaluate and compare the quality of care from both the patients' and the informal caregivers' point of view in three different hospitals. The measure of quality of care was developed on the basis of need theories, mainly those of Maslow and Alderfer. Patients and caregivers were also asked to rate the participation of the caregivers in the hospital care of elderly patients. Participation consisted of 18 activities of daily living. The pilot test with 18 elderly hospital patients and seven family members or significant others showed differences between the two groups in perception of care received. Statistically significant differences (P needs, psychic and spiritual needs and totals. The results supported earlier findings that elderly patients are satisfied with and do not criticize their care. The younger generation (i.e. their children) is more demanding and has precise perceptions about the care given. Relatives could be used more in planning, evaluation and even implementation of care; however, their current participation in patient hospital care is minimal.

HMO penetration: has it hurt public hospitals?

Science.gov (United States)

Clement, J P; Grazier, K L

2001-01-01

The purpose of this study is to determine the extent to which health maintenance organization (HMO) penetration within the public hospitals' market area affects the financial performance and viability of these institutions, relative to private hospitals. Hospital- and market-specific measures are examined in a fully interacted model of over 2,300 hospitals in 321 metropolitan statistical areas (MSAs) in 1995. Although hospitals located in markets with higher HMO penetration have lower financial performance as reflected in revenues, expenses and operating margin, public hospitals are not more disadvantaged than other hospitals by managed care.

[Morbidity and mortality associated to influenza A (H1N1) 2009 admissions in two hospitals of the Metropolitan area and analysis of its economic impact].

Science.gov (United States)

Armstrong, Macarena; Fica, Alberto; Dabanch, Jeannette; Olivares, Felipe; Fasce, Rodrigo; Triantafilo, Vjera

2012-12-01

Influenza A (H1N1) 2009 infection was an important cause of morbidity and mortality in Chile. To characterize the clinical pattern of hospitalized patients, identify risk factors associated with ICU admission or death, and evaluate its economic impact. Twenty five adult patients admitted to 2 hospitals in the Metropolitan Area from May 2009 to December 2010 with PCR confirmed H1N1 infection were analyzed. Total hospital charges were obtained and, using data of registered cases, expenses for the whole country during the first epidemic wave were estimated. Aill cases presented a risk factor: age over 60 years old (n = 13, 52%), co-morbid conditions (n = 24, 96%) or pregnancy (n = 1, 4%). Pneumonia was present in 64% (n = 16) and 16% (n = 4) had hypotension. Only 6 patients (24%) had a CURB-65 score ≥ 2 and 36% (n = 9) requiring ICU admission. Case fatality rate was 16% (n = 4). By multivariate analysis, diabetes mellitus type 2 was independently associated with ICU admission or death (OR 8.12; IC95 1.11-59.2, p Chile during the first wave. The CURB-65 score was inappropriate to recognize patients at risk of hospitalization or ICU admission.

Premises for Shaping Metropolitan Areas in Romania

Directory of Open Access Journals (Sweden)

RAULARIAN RUSU

2012-01-01

Full Text Available The setting up of metropolitan areas is a process which is still in progress in Romania. The legislative framework for the creation of these areas has been built up only since 2001, and there are still a number of juridical inconsistencies concerning the association of administrative units to form metropolitan areas. On the other hand, political reasons and the fear of losing a certain degree of authority and to become subordinates of the large cities (in the case of rural municipalities also hindered the development of metropolitan areas in Romania. Nevertheless, the metropolitan areas already in existence are running a number of projects that are beneficial for most members of the association. Such positive examples may trigger the creation of the other metropolitan areas. Although the existing metropolitan areas did not yield spectacular results, the time passed since their foundation is yet too short to correctly assess their usefulness and territorial meaning. For the moment, the following metropolitan areas exist in Romania: Iaşi, Oradea, Braşov, Constanţa, Bacău, Cluj-Napoca, Târgu Mureş and Craiova. Bucharest, Timişoara, Ploieşti and Galaţi-Brăila metropolitan areas are still in process of setting up.

42 CFR 489.34 - Allowable charges: Hospitals participating in State reimbursement control systems or...

Science.gov (United States)

2010-10-01

... reimbursement control systems or demonstration projects. 489.34 Section 489.34 Public Health CENTERS FOR... CERTIFICATION PROVIDER AGREEMENTS AND SUPPLIER APPROVAL Allowable Charges § 489.34 Allowable charges: Hospitals participating in State reimbursement control systems or demonstration projects. A hospital receiving payment for...

[Avoidable perinatal deaths and the environment outside the health care system: a case study in a city in Greater Metropolitan Rio de Janeiro].

Science.gov (United States)

Rosa, Maria L G; Hortale, Virginia Alonso

2002-01-01

This paper focuses on the role of environmental factors external to the health care system in the occurrence of perinatal deaths in maternity hospitals belonging to the local health system in a city in Greater Metropolitan Rio de Janeiro in 1994. Elements from the political and administrative context that contribute to an understanding of the relationship between failures in health care and structural deficiencies in these maternity hospitals were divided into four groups of variables: distribution of resources, spatial and temporal factors, organizational and managerial features, and action by interest groups. Semi-structured interviews were conducted. The study concluded that poor performance in four groups of variables may have contributed to perinatal mortality: distribution of resources was insufficient to provide quality in health care, especially in private maternity hospitals; there was no formal or informal regional or hierarchical organization of obstetric care in the city; Ministry of Health guidelines were ignored in all four maternity hospitals, while in three of the hospitals there were no admissions procedures and delivery and fetal follow-up listed in their own rules; and the level of actual participation was low.

Radiation therapy for Kaposi's sarcoma associated with acquired immunodeficiency syndrome. Tokyo Metropolitan Komagome Hospital experience

International Nuclear Information System (INIS)

Ebara, Takeshi; Karasawa, Katsuyuki; Maebayashi, Katsuya; Kurosaki, Hiromasa; Ishikawa, Hitoshi; Kaizu, Toshihide; Tanaka, Yoshiaki; Akagi, Kumiko; Masuda, Gota

2000-01-01

Kaposi's sarcoma is frequently found in association with acquired immunodeficiency syndrome (AIDS). We report on radiotherapy for patients with AIDS-related Kaposi's sarcoma at Tokyo Metropolitan Komagome Hospital. Between April 1991 and May 1997, radiotherapy was given to 11 lesions in eight men with AIDS-related Kaposi's sarcoma to relieve their symptoms. The lesions involved the head and neck region, the legs, and the gastrointestinal tract. Radiotherapy was carried out with 4-MV photon through parallel opposed field or high energy electrons. Total doses ranged from 20 to 38 Gy, with a median of 30 Gy, delivered in 2- to 3-Gy fractions. Four patients were given other treatments prior to the radiotherapy. Acute reaction was evaluated according to the modified acute radiation morbidity scoring criteria of the Radiation Therapy Oncology Group (RTOG). Radiotherapy had relieved the symptoms in all patients at completion of this therapy. Lesions that involved the hard palate and vocal cords had completely disappeared. The lesions that received radiotherapy were controlled without symptoms until the patients died. Patients who had the head and neck region treated exhibited severe acute mucosal reaction (at a dose of 30 Gy, there was grade 2 morbidity by modified RTOG criteria, in two patients, and grade 3 in three patients) although the radiation therapy was completed for these patients. Radiotherapy promises a favorable outcome for symptom relief in AIDS-related Kaposi's sarcoma. (author)

Relative Food Prices and Obesity in U.S. Metropolitan Areas: 1976-2001

Science.gov (United States)

Xu, Xin; Variyam, Jayachandran N.; Zhao, Zhenxiang; Chaloupka, Frank J.

2014-01-01

This study investigates the impact of food price on obesity, by exploring the co-occurrence of obesity growth with relative food price reduction between 1976 and 2001. Analyses control for female labor participation and metropolitan outlet densities that might affect body weight. Both the first-difference and fixed effects approaches provide consistent evidence suggesting that relative food prices have substantial impacts on obesity and such impacts were more pronounced among the low-educated. These findings imply that relative food price reductions during the time period could plausibly explain about 18% of the increase in obesity among the U.S. adults in metropolitan areas. PMID:25502888

The burden of healthcare-associated Clostridium difficile infection in a non-metropolitan setting.

Science.gov (United States)

Bond, S E; Boutlis, C S; Yeo, W W; Pratt, W A B; Orr, M E; Miyakis, S

2017-04-01

Healthcare-associated Clostridium difficile infection (HCA-CDI) remains a major cause of morbidity and mortality in industrialized countries. However, few data exist on the burden of HCA-CDI in multi-site non-metropolitan settings. This study examined the introduction of an antimicrobial stewardship programme (ASP) in relation to HCA-CDI rates, and the effect of HCA-CDI on length of stay (LOS) and hospital costs. A comparative before-and-after intervention study of patients aged ≥16 years with HCA-CDI from December 2010 to April 2016 across the nine hospitals of a non-metropolitan health district in New South Wales, Australia was undertaken. The intervention comprised a multi-site ASP supported by a clinical decision support system, with subsequent introduction of email feedback of HCA-CDI cases to admitting medical officers. HCA-CDI rates, comparative LOS and hospital costs, prior use of antimicrobials and proton pump inhibitors, and appropriateness of CDI treatment. HCA-CDI rates rose from 3.07 to 4.60 cases per 10,000 occupied bed-days pre-intervention, and remained stable at 4 cases per 10,000 occupied bed-days post-intervention (P=0.24). Median LOS (17 vs six days; P<0.01) and hospital costs (AU$19,222 vs $7861; P<0.01) were significantly greater for HCA-CDI cases (N=91) than for matched controls (N=172). Half of the patients with severe HCA-CDI (4/8) did not receive initial appropriate treatment (oral vancomycin). HCA-CDI placed a significant burden on the regional and rural health service through increased LOS and hospital costs. Interventions targeting HCA-CDI could be employed to consolidate the effects of ASPs. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

Influence of Intimate Partner Violence on Domestic Relocation in Metropolitan and Non-Metropolitan Young Australian Women

NARCIS (Netherlands)

Dillon, Gina; Hussain, Rafat; Kibele, Eva; Rahman, Saifur; Loxton, Deborah

2016-01-01

Data from a national, population-based longitudinal study of Australian women (26-34 years) were analyzed to investigate the association between domestic relocation and multiple explanatory factors, namely intimate partner violence (IPV), metropolitan versus non-metropolitan residence, education,

Participation in sports clubs is a strong predictor of injury hospitalization: a prospective cohort study.

Science.gov (United States)

Mattila, V M; Parkkari, J; Koivusilta, L; Kannus, P; Rimpelä, A

2009-04-01

The aim of this prospective cohort study was to investigate the nature and risk factors of injuries leading to hospitalization. A cohort of 57 407 Finns aged 14-18 years was followed in the Hospital Discharge Register for an average of 10.6 years, totaling 608 990 person-years. We identified 5889 respondents (10.3%) with injury hospitalization. The most common anatomical location was the knee and shin (23.9%), followed by the head and neck (17.8%), and the ankle and foot (16.7%). Fractures (30.4%) and distortions (25.4%) were the most common injury types. The strongest risk factor for injury hospitalization was frequent participation in sports clubs [hazard ratio (HR) in males 1.8; 95% confidence interval (CI): 1.7-2.0 and in females 2.3; 95% CI: 1.9-2.7], followed by recurring drunkenness (HR 1.6; 95% CI: 1.4-2.7 in males and 1.4; 95% CI: 1.2-1.6 in females) and daily smoking (HR 1.4; 95% CI: 1.3-1.5 in males and 1.43 95% CI: 1.2-1.5 in females). The association between injuries and sports clubs participation remained after adjusting for sociodemographic background, health, and health behaviors. Health behavior in adolescence, particularly sports club activity, predicted injury hospitalization. Preventive interventions directed toward adolescents who participate in sports clubs may decrease injury occurrence.

Barriers to participation in a hospital-based falls assessment clinic programme: an interview study with older people

DEFF Research Database (Denmark)

Evron, L.; Schultz-Larsen, K.; Fristrup, T.

2009-01-01

Aims: To gain new knowledge about barriers to participation in hospital-based falls assessment. Methods: Semi-structured interviews with 20 older people referred to falls assessment at a hospital-based clinic were conducted. A convenience sample of 10 refusers and 10 accepters was collected. Thos...... the findings of this study to a public health message, we have to consider moving the focus of falls prevention strategies from disease control to the domain of health promotion in order to engage older adults in preventive healthcare Udgivelsesdato: 2009/9......Aims: To gain new knowledge about barriers to participation in hospital-based falls assessment. Methods: Semi-structured interviews with 20 older people referred to falls assessment at a hospital-based clinic were conducted. A convenience sample of 10 refusers and 10 accepters was collected. Those...... system taking over their life. Conclusions: This study indicates that older at-risk patients acknowledge their falls problem, but refuse to participate in hospital-based assessment programmes because they expect to lose their authority and to be caught up in the healthcare system. In order to transform...

Barriers to participation in a hospital-based falls assessment clinic programme: an interview study with older people

DEFF Research Database (Denmark)

Evron, Lotte; Schultz-Larsen, Kirsten; Fristrup, Tine

2009-01-01

Aims: To gain new knowledge about barriers to participation in hospital-based falls assessment. Methods: Semi-structured interviews with 20 older people referred to falls assessment at a hospital-based clinic were conducted. A convenience sample of 10 refusers and 10 accepters was collected. Thos...... the findings of this study to a public health message, we have to consider moving the focus of falls prevention strategies from disease control to the domain of health promotion in order to engage older adults in preventive healthcare.......Aims: To gain new knowledge about barriers to participation in hospital-based falls assessment. Methods: Semi-structured interviews with 20 older people referred to falls assessment at a hospital-based clinic were conducted. A convenience sample of 10 refusers and 10 accepters was collected. Those...... system taking over their life. Conclusions: This study indicates that older at-risk patients acknowledge their falls problem, but refuse to participate in hospital-based assessment programmes because they expect to lose their authority and to be caught up in the healthcare system. In order to transform...

Population levels of sport participation: implications for sport policy

Directory of Open Access Journals (Sweden)

R. M. Eime

2016-08-01

Full Text Available Abstract Background Participation in sport can contribute to health-enhancing levels of leisure-time physical activity. There are recent reports that participation in sport in Australia is decreasing. However, these studies are limited to ages 15 years and over. Methods This study integrates sports club membership data from five popular team sports and investigates sport participation across the lifespan (4–100 years by sex and region (metropolitan/non-metropolitan. Results Overall participant numbers per annum increased from 414,167 in 2010 to 465,403 in 2012 corresponding to a rise in the proportion of Victorian’s participating in these sports from 7.5 % in 2010 to 8.3 % in 2012. The highest proportion of participants was in the 10–14 year age range, with participation rates of 36 % in 2010 and 40 % in 2012. There was a considerably lower participation rate in the 15–19 year age group compared to the 10–14 age group, in all three years studied, and the decline continued progressively with increasing age. Male and female age profiles of participation were generally similar in shape, but the female peak at age 10–14 was sharper than for the males, and conversely there were very few 4 year old female participants. Participation rates were generally higher in non-metropolitan than metropolitan areas; the difference increased with increasing age from 4 to 34 years, then steadily declined, reaching parity at around 60 years of age. Conclusions It is a positive sign that participation in these popular sports increased by over 50,000 participants from 2010 to 2012. Large proportions of the population aged 5–14 participate in club based sport. Participation rates decline sharply in late adolescence, particularly for females, and while this may not be a concern from a broad health perspective so long as they transition into other forms of physical activity, it is certainly a matter of concern for the sport sector. It is recommended

Private Sector Participation in Urban Water and Sanitation Provision in Ghana: Experiences from the Tamale Metropolitan Area (TMA)

Science.gov (United States)

Osumanu, Issaka Kanton

2008-07-01

African governments, like most countries in the developing world, face daunting tasks in their attempts to provide effective and equitable water and sanitation services for their ever increasing urban populations. Consequently, the past few years have witnessed increased private sector participation in urban water and sanitation provision, as many African governments strive to improve access to water and sanitation services for their citizens in line with Millennium Development Goal 7 (MDG7). Since the early 1990s, the government of Ghana and many local authorities have entered into various forms of public-private partnerships in urban water and sanitation provision. This article examines the outcome of such partnerships using the Tamale Metropolitan Area (TMA) as a case study with the aim of providing policy guidelines for the way forward. The article argues that the public-private arrangement for water supply and sanitation infrastructure management in the Tamale Metropolis has done nothing that an invigorated public sector could not have possibly achieved. It concludes that there can be no sustainable improvement in water and sanitation provision without political commitment, stakeholder ownership, and strong support for community driven initiatives.

Agency problems in hospitals participating in self-management project under global budget system in Taiwan.

Science.gov (United States)

Yan, Yu-Hua; Hsu, Shuofen; Yang, Chen-Wei; Fang, Shih-Chieh

2010-02-01

The main purposes of this study are to clarify the agency problems in the hospitals participating in self-management project within the context of Global Budgeting Payment System regulated by Taiwan government, and also to provide some suggestions for hospital administrator and health policy maker in reducing the waste of healthcare resources resulting from agency problems. For the purposes above, this study examines the relationships between two agency problems (ex ante moral hazard and ex post moral hazard) aroused among the hospitals and Bureau of National Health Insurance in Taiwan's health care sector. This study empirically tested the theoretical model at organization level. The findings suggest that the hospital's ex ante moral hazards before participating the self-management project do have some influence on its ex post moral hazards after participating the self-management project. This study concludes that the goal conflict between the agents and the principal certainly exist. The principal tries hard to control the expenditure escalation and keep the financial balance, but the agents have to subsist within limited healthcare resources. Therefore, the agency cost would definitely occur due to the conflicts between both parties. According to the results of the research, some suggestions and related management concepts were proposed at the end of the paper.

Rural hospital wages

Science.gov (United States)

Hendricks, Ann M.

1989-01-01

Average fiscal year 1982 wages from 2,302 rural American hospitals were used to test for a gradient descending from hospitals in counties adjacent to metropolitan areas to those not adjacent. Considerable variation in the ratios of adjacent to nonadjacent averages existed. No statistically significant difference was found, however. Of greater importance in explaining relative wages within States were occupational mix, mix of part-time and full-time workers, case mix, presence of medical residencies, and location in a high-rent county within the State. Medicare already adjusts payments for only two of these variables. PMID:10313454

Consensus on the leadership of hospital CEOs and its impact on the participation of physicians in improvement projects.

Science.gov (United States)

Dückers, Michel L A; Stegeman, Inge; Spreeuwenberg, Peter; Wagner, Cordula; Sanders, Karin; Groenewegen, Peter P

2009-08-01

The success of a Dutch program to disseminate quality improvement projects depends on the participation of physicians working in program hospitals. The leadership of hospital executives (CEOs) is considered an important explanation. This study aims to determine whether the relation, between the extent to which physicians notice their CEOs stimulate improvement initiatives and the number of projects joined by physicians, is moderated by the consensus among physicians working in the same hospital. Multilevel analyses are applied on data of 286 physicians from eight hospitals to: (1) estimate whether participation depends on noticing if CEOs stimulate improvement, (2) test if an individual's participation differs when more colleagues have the same opinion (effect modification). Significant moderator effects are found. The participation of physicians, noticing that CEOs stimulate improvement is higher when more colleagues share this opinion. For physicians not knowing whether improvement is encouraged, higher consensus coincides with lower participation. Project involvement of physicians depends on their consensus about encouragement by CEOs. This confirms the importance of strategic leaders in dissemination programs. Further research is recommended into causes of CEO leadership visibility and methods to strengthen leadership climate.

Psychiatric hospital nursing staff's experiences of participating in group-based clinical supervision:

DEFF Research Database (Denmark)

Buus, Niels; Angel, Sanne; Traynor, Michael

2010-01-01

Group-based clinical supervision is commonly offered as a stress-reducing intervention in psychiatric settings, but nurses often feel ambivalent about participating. This study aimed at exploring psychiatric nurses' experiences of participating in groupbased supervision and identifying psychosocial...... reasons for their ambivalence. Semi-structured interviews were conducted with 22 psychiatric nurses at a Danish university hospital. The results indicated that participation in clinical supervision was difficult for the nurses because of an uncomfortable exposure to the professional community. The sense...... of exposure was caused by the particular interactional organisation during the sessions, which brought to light pre-existing but covert conflicts among the nurses....

Metropolitan migration and population growth in selected developing countries.

Science.gov (United States)

1983-01-01

The purpose of this article is to estimate the components of metropolitan population growth in selected developing countries during 1960-1970 period. The study examines population growth in 26 cities: 5 are in Africa, 8 in Asia, and 13 in Latin America, using data from national census publications. These cities in general are the political capitals of their countries, but some additional large cities were selected in Brazil, Mexico, and South Africa. All cities, at the beginning of the 1960-1970 decade had over 500,000 population; Accra, the only exception, reached this population level during the 1960s. Some cities had over 4 million residents in 1970. Net migration contributed about 37% to total metropolitan population growth; the remainder of the growth is attributable to natural increase. Migration has a much stronger impact on metropolitan growth than suggested by the above figure: 1) Several metropolitan areas, for various reasons, are unlikely to receive many migrants; without those cities, the share of metropolitan growth from net migration is 44%. 2) Estimates of the natural increase of migrants after their arrival in the metropolitan areas, when added to migration itself, changes the total contribution of migration to 49% in some metropolitan areas. 3) Even where net migration contributes a smaller proportion to metropolitan growth than natural increase, the rates of net migration are generally high and should be viewed in the context of rapid metropolitan population growth from natural increase alone. Finally, the paper also compares the components of metropolitan growth with the components of growth in the remaining urban areas. The results show that the metropolitan areas, in general, grow faster than the remaining urban areas, and that this more rapid growth is mostly due to a higher rate of net migration. Given the significance of migration for metropolitan growth, further investigations of the effects of these migration streams, particularly with

FINANCING FARMLAND PRESERVATION: THE TWIN CITIES METROPOLITAN AREA EXPERIENCE

OpenAIRE

Greden, Leah R.; Taff, Steven J.

1994-01-01

Two farmland protection programs in the Twin Cities (Minnesota) Metropolitan Area--Green Acres and Agricultural Preserves-- together enrolled 608,331 acres in 1992. The principal financing tool was a provision common to both programs under which participating landowners paid reduced property taxes in exchange for certain non- development assurances. The resulting shift in property tax obligations to other taxpayers amounted to $7.6 million for the 1993 tax year, an average shift of $12.50 per...

Early-career registered nurses' participation in hospital quality improvement activities.

Science.gov (United States)

Djukic, Maja; Kovner, Christine T; Brewer, Carol S; Fatehi, Farida K; Bernstein, Ilya

2013-01-01

We surveyed 2 cohorts of early-career registered nurses from 15 states in the US, 2 years apart, to compare their reported participation in hospital quality improvement (QI) activities. We anticipated differences between the 2 cohorts because of the growth of several initiatives for engaging nurses in QI. There were no differences between the 2 cohorts across 14 measured activities, except for their reported use of appropriate strategies to improve hand-washing compliance to reduce nosocomial infection rates.

Radiation protection in an interventional laboratory: a comparative study of Australian and Saudi Arabian hospitals

International Nuclear Information System (INIS)

Alahmari, Mohammed Ali S.; Sun, Zhonghua; Bartlett, Andrew

2016-01-01

This study aimed to investigate whether the use of protection devices and attitudes of interventional professionals (including radiologists, cardiologists, vascular surgeons, medical imaging technicians and nurses) towards radiation protection will differ between Saudi Arabian and Australian hospitals. Hard copies of an anonymous survey were distributed to 10 and 6 clinical departments in the Eastern province of Saudi Arabia and metropolitan hospitals in Western Australia, respectively. The overall response rate was 43 % comprising 110 Australian participants and 63 % comprising 147 Saudi participants. Analysis showed that Australian respondents differed significantly from Saudi respondents with respect to their usages of leaded glasses (p < 0.001), ceiling-suspended lead screen (p < 0.001) and lead drape suspended from the table (p < 0.001). This study indicates that the trained interventional professionals in Australia tend to adhere to benefit from having an array of tools for personal radiation protection than the corresponding group in Saudi Arabia. (authors)

The Influence of Nurses' Demographics on Patient Participation in Hospitals: A Cross-Sectional Study.

Science.gov (United States)

Malfait, Simon; Eeckloo, Kristof; Van Hecke, Ann

2017-12-01

Patient participation is an important issue in contemporary healthcare as it improves quality of care and enhances positive health outcomes. The participation of patients is mainly initiated by the nurses' willingness to share their power and responsibility, but knowledge on nurses' demographic characteristics influencing this behavior is nonexistent. This knowledge is essential to understand and improve patient participation. To determine if nurses' demographic characteristics influence their willingness to engage in patient participation. A cross-sectional multicenter study in 22 general and three university hospitals with 997 nurses was performed. The Patient Participation Culture Tool for healthcare workers, which measures patient participation behavior, was used. Multilevel analysis, taking into account the difference in wards and hospitals, was used to identify the influence of demographic characteristics. A position as supervisor (range: p nurses seem to be more reluctant in accepting a collaborative patient role (p = .002) and coping with more active patient behavior (p nurses on geriatric wards (p = .013), who also showed less sharing of information with their patients (p nurses' willingness to share power and responsibility with their patients, perhaps indicating that patient participation behavior is an advanced nursing skill and multifaceted interventions, are needed for optimal implementation. Moreover, supervising nurses have different perceptions on patient participation and possibly regard patient participation as an easier task than their team members. This could lead to misunderstandings about the expectations toward patient participation in daily practice, leading to struggles with their nursing staff. Both findings implicate that implementing patient participation on a wide scale is more difficult than expected, which is conflicting with the widespread societal demand for more participation. © 2017 Sigma Theta Tau International.

Analysis of Solid Waste Management and Strategies for Bangkok Metropolitan

Directory of Open Access Journals (Sweden)

Palika Wannawilai

2017-04-01

Full Text Available This study aimed to examine and analyze strategic gaps and the environment of waste management of Bangkok Metropolitan Administration (BMA in order to suggest suitable waste management strategies for Bangkok Metropolitan. The study was conducted by interviewing BMA and districts’ administrators and officers, local leaders and people, and private sectors, conducting a focus group, as well as reviewing relevant documents. The data was analyzed by applying Gap analysis and SWOT analysis. The proposed five strategies are: 1 enhancement of efficiency in solid waste and hazardous waste management; 2 discipline, participation and responsibility of citizens and all sectors related to waste management; 3 appropriate and integrated waste management; 4 capacity building for BMA’s staff and improvement of solid waste management system; and 5 research and development of knowledge and technology in waste management. The study also suggested driving approaches for effective implementation of the strategies.

Understanding organisational development, sustainability, and diffusion of innovations within hospitals participating in a multilevel quality collaborative.

NARCIS (Netherlands)

Dückers, M.L.A.; Wagner, C.; Vos, L.; Groenewegen, P.P.

2011-01-01

BACKGROUND: Between 2004 and 2008, 24 Dutch hospitals participated in a two-year multilevel quality collaborative (MQC) comprised of (a) a leadership programme for hospital executives, (b) six quality-improvement collaboratives (QICs) for healthcare professionals and other staff, and (c) an internal

Self-reported oral health of a metropolitan homeless population in Australia: comparisons with population-level data.

Science.gov (United States)

Parker, E J; Jamieson, L M; Steffens, M A; Cathro, P; Logan, R M

2011-09-01

There is limited information on self-perceived oral health of homeless populations. This study quantified self-reported oral health among a metropolitan homeless adult population and compared against a representative sample of the metropolitan adult population obtained from the National Survey of Adult Oral Health. A total of 248 homeless participants (age range 17-78 years, 79% male) completed a self-report questionnaire. Data for an age-matched, representative sample of metropolitan-dwelling adults were obtained from Australia's second National Survey of Adult Oral Health. Percentage responses and 95% confidence intervals were calculated, with non-overlapping 95% confidence intervals used to identify statistically significant differences between the two groups. Homeless adults reported poorer oral health than their age-matched general population counterparts. Twice as many homeless adults reported visiting a dentist more than a year ago and that their usual reason for dental attendance was for a dental problem. The proportion of homeless adults with a perceived need for fillings or extractions was also twice that of their age-matched general population counterparts. Three times as many homeless adults rated their oral health as 'fair' or 'poor'. A significantly greater proportion of homeless adults in an Australian metropolitan location reported poorer oral health compared with the general metropolitan adult population. © 2011 Australian Dental Association.

The impact of non-IPA HMOs on the number of hospitals and hospital capacity.

Science.gov (United States)

Chernew, M

1995-01-01

Concentration in the hospital market could limit the success of health care reform strategies that rely on managed care to constrain costs. Hospital market capacity also is important because capacity affects both costs and the degree of price competition. Because managed care plans, particularly non-individual practice association (non-IPA) model HMOs, practice a less hospital-intensive style of care, consolidation and downsizing in the hospital market potentially will accompany managed care growth, influencing the long-run effectiveness of managed care cost-containment strategies. Using Standard Metropolitan Statistical Area (SMSA) data from 1982 and 1987, a 10-percentage point increase in non-IPA HMO market share is estimated to reduce the number of hospitals by about 4%, causing an approximate 5% reduction in the number of hospital beds. No statistically significant relationship is found between non-IPA HMO penetration rates and hospital occupancy rates.

Metropolitan water management

National Research Council Canada - National Science Library

Milliken, J. Gordon; Taylor, Graham C

1981-01-01

This monograph is intended to inform interested and capable pesons, who happen not to be specialists in water resources planning, of the issues and alternative strategies related to metropolitan water supply...

Occupational Therapy and Physiotherapy in Acute Stroke: Do Rural Patients Receive Less Therapy?

Directory of Open Access Journals (Sweden)

Josie Merchant

2016-01-01

Full Text Available Objective. To assess whether acute stroke patients in rural hospitals receive less occupational therapy and physiotherapy than those in metropolitan hospitals. Design. Retrospective case-control study of health data in patients ≤10 days after stroke. Setting. Occupational therapy and physiotherapy services in four rural hospitals and one metropolitan hospital. Participants. Acute stroke patients admitted in one health district. Main Outcome Measures. Frequency and duration of face-to-face and indirect therapy sessions. Results. Rural hospitals admitted 363 patients and metropolitan hospital admitted 378 patients. Mean age was 73 years. Those in rural hospitals received more face-to-face (p>0.0014 and indirect (p=0.001 occupational therapy when compared to those in the metropolitan hospital. Face-to-face sessions lasted longer (p=0.001. Patients admitted to the metropolitan hospital received more face-to-face (p>0.000 and indirect (p>0.000 physiotherapy when compared to those admitted to rural hospitals. Face-to-face sessions were shorter (p>0.000. Almost all were seen within 24 hours of referral. Conclusions. Acute stroke patients in Australian rural hospital may receive more occupational therapy and less physiotherapy than those in metropolitan hospitals. The dose of therapy was lower than recommended, and the referral process may unnecessarily delay the time from admission to a patient’s first therapy session.

‘New urbanism' or metropolitan-level centralization?

DEFF Research Database (Denmark)

Næss, Petter

2011-01-01

Based on a study in Copenhagen Metropolitan Area, this paper compares the influences of macro-level and micro-level urban form characteristics on the respondents' traveling distance by car on weekdays. The Copenhagen study shows that metropolitan-scale urban structural variables generally exert...... stronger influences than neighborhood-scale built environment characteristics on the amount of car travel. In particular, the location of the residence relative to the main city center of the metropolitan region shows a strong effect. Some local scale variables often mentioned in the literature...

Understanding organisational development, sustainability, and diffusion of innovations within hospitals participating in a multilevel quality collaborative.

Science.gov (United States)

Dückers, Michel La; Wagner, Cordula; Vos, Leti; Groenewegen, Peter P

2011-03-09

Between 2004 and 2008, 24 Dutch hospitals participated in a two-year multilevel quality collaborative (MQC) comprised of (a) a leadership programme for hospital executives, (b) six quality-improvement collaboratives (QICs) for healthcare professionals and other staff, and (c) an internal programme organisation to help senior management monitor and coordinate team progress. The MQC aimed to stimulate the development of quality-management systems and the spread of methods to improve patient safety and logistics. The objective of this study is to describe how the first group of eight MQC hospitals sustained and disseminated improvements made and the quality methods used. The approach followed by the hospitals was described using interview and questionnaire data gathered from eight programme coordinators. MQC hospitals followed a systematic strategy of diffusion and sustainability. Hospital quality-management systems are further developed according to a model linking plan-do-study-act cycles at the unit and hospital level. The model involves quality norms based on realised successes, performance agreements with unit heads, organisational support, monitoring, and quarterly accountability reports. It is concluded from this study that the MQC contributed to organisational development and dissemination within participating hospitals. Organisational learning effects were demonstrated. System changes affect the context factors in the theory of organisational readiness: organisational culture, policies and procedures, past experience, organisational resources, and organisational structure. Programme coordinator responses indicate that these factors are utilised to manage spread and sustainability. Further research is needed to assess long-term effects.

Radiation therapy for Kaposi's sarcoma associated with acquired immunodeficiency syndrome. Tokyo Metropolitan Komagome Hospital experience

Energy Technology Data Exchange (ETDEWEB)

Ebara, Takeshi [Municipal Kanbara General Hospital, Fujikawa, Shizuoka (Japan); Karasawa, Katsuyuki; Maebayashi, Katsuya; Kurosaki, Hiromasa; Ishikawa, Hitoshi; Kaizu, Toshihide; Tanaka, Yoshiaki; Akagi, Kumiko; Masuda, Gota

2000-12-01

Kaposi's sarcoma is frequently found in association with acquired immunodeficiency syndrome (AIDS). We report on radiotherapy for patients with AIDS-related Kaposi's sarcoma at Tokyo Metropolitan Komagome Hospital. Between April 1991 and May 1997, radiotherapy was given to 11 lesions in eight men with AIDS-related Kaposi's sarcoma to relieve their symptoms. The lesions involved the head and neck region, the legs, and the gastrointestinal tract. Radiotherapy was carried out with 4-MV photon through parallel opposed field or high energy electrons. Total doses ranged from 20 to 38 Gy, with a median of 30 Gy, delivered in 2- to 3-Gy fractions. Four patients were given other treatments prior to the radiotherapy. Acute reaction was evaluated according to the modified acute radiation morbidity scoring criteria of the Radiation Therapy Oncology Group (RTOG). Radiotherapy had relieved the symptoms in all patients at completion of this therapy. Lesions that involved the hard palate and vocal cords had completely disappeared. The lesions that received radiotherapy were controlled without symptoms until the patients died. Patients who had the head and neck region treated exhibited severe acute mucosal reaction (at a dose of 30 Gy, there was grade 2 morbidity by modified RTOG criteria, in two patients, and grade 3 in three patients) although the radiation therapy was completed for these patients. Radiotherapy promises a favorable outcome for symptom relief in AIDS-related Kaposi's sarcoma. (author)

Participation of the nurse manager in the process of hospital accreditation

Directory of Open Access Journals (Sweden)

Andréia Guerra Siman

Full Text Available This study's aim was to understand the role of nurse managers in the process of hospital accreditation. This qualitative case study was conducted in a large private hospital in Belo Horizonte, MG, Brazil. Five nurse managers were interviewed using a semi-structured script from April to May, 2011 and content analysis was used to interpret the data. Results show the strategic position of this professional, his/her managerial skills and participation in the implementation and maintenance of accreditation, and the importance of care management. Nurses have played managerial roles with greater autonomy, connecting inter-sector care, which contrasts with the curative model, and have established partnerships with different social and institutional segments, adopting standards for teamwork. Managerial, healthcare, and educational work is performed from a procedural and indivisible perspective.

Understanding organisational development, sustainability, and diffusion of innovations within the hospitals participating in a multilevel quality collaborative.

NARCIS (Netherlands)

Duckers, M.L.A.; Wagner, C.; Groenewegen, P.P.

2011-01-01

Background: Between 2004 and 2008, 24 Dutch hospitals participated in a two-year multilevel quality collaborative (MQC) comprised of (a) a leadership programme for hospital executives, (b) six quality-improvement collaboratives (QICs) for healthcare professionals and other staff, and (c) an

Australian Hospital-Based Nurse Educators' Perceptions of Their Role.

Science.gov (United States)

Thornton, Karleen

2018-06-01

This article presents the findings from a phenomenological study that explored the understandings of Australian hospital-based nurse educators' experiences of their role. Purposive sampling resulted in 11 nurse educators from four large metropolitan hospitals within an Australian jurisdiction. The participants were asked how they understand their role and translate that understanding into practice. Thematic analysis identified four themes representative of nurse educators' understanding of their role: Becoming an Educator, Capability Building, Panacea, and Tension. A coherent picture emerged from subthemes highlighting that nurse educators were undervalued and value is added. Being undervalued and value adding are translated into nurse educator practice as resilience, being educationally literate, investing, and having a presence. This article identifies a gap in knowledge related to understanding the nurse educator role and informs recruitment and subsequent retention of nurses into nurse educator roles at a time when the nursing workforce in Australia and internationally is about to experience a major shortfall. Findings are specific to the Australian context and are not necessarily generalizable to other hospital jurisdictions. J Contin Educ Nurs. 2018;49(6):274-281. Copyright 2018, SLACK Incorporated.

The perils of healthcare workforce forecasting: a case study of the Philadelphia metropolitan area.

Science.gov (United States)

Smith, David Barton; Aaronson, William

2003-01-01

In 1996, a widely circulated and influential forecast for the Philadelphia Metropolitan Area stated that a decline in hospital and healthcare employment in the region would occur over the next five years. It also suggested that this decline would exacerbate the problem of an oversupply of nurses seeking hospital employment. The forecast reflected a regional leadership and expert consensus on the impact of the managed care transformation on workforce needs and was supported by short-term statistical trends in regional utilization and employment. Confounding these predictions was the fact that hospital and healthcare employment actually grew. By the end of 2001, hospitals in the region were experiencing problems in recruiting sufficient numbers of nurses, pharmacists, and technicians. The forecast failed to anticipate the impact of a strong regional economy on supply and underestimated the resilience of underlying forces that have driven the long-term growth in healthcare workforce demand. More effective ongoing monitoring can help moderate the fluctuation of workforce shortages and surpluses.

Using database reports to reduce workplace violence: Perceptions of hospital stakeholders.

Science.gov (United States)

Arnetz, Judith E; Hamblin, Lydia; Ager, Joel; Aranyos, Deanna; Essenmacher, Lynnette; Upfal, Mark J; Luborsky, Mark

2015-01-01

Documented incidents of violence provide the foundation for any workplace violence prevention program. However, no published research to date has examined stakeholders' preferences for workplace violence data reports in healthcare settings. If relevant data are not readily available and effectively summarized and presented, the likelihood is low that they will be utilized by stakeholders in targeted efforts to reduce violence. To discover and describe hospital system stakeholders' perceptions of database-generated workplace violence data reports. Eight hospital system stakeholders representing Human Resources, Security, Occupational Health Services, Quality and Safety, and Labor in a large, metropolitan hospital system. The hospital system utilizes a central database for reporting adverse workplace events, including incidents of violence. A focus group was conducted to identify stakeholders' preferences and specifications for standardized, computerized reports of workplace violence data to be generated by the central database. The discussion was audio-taped, transcribed verbatim, processed as text, and analyzed using stepwise content analysis. Five distinct themes emerged from participant responses: Concerns, Etiology, Customization, Use, and Outcomes. In general, stakeholders wanted data reports to provide ``the big picture,'' i.e., rates of occurrence; reasons for and details regarding incident occurrence; consequences for the individual employee and/or the workplace; and organizational efforts that were employed to deal with the incident. Exploring stakeholder views regarding workplace violence summary reports provided concrete information on the preferred content, format, and use of workplace violence data. Participants desired both epidemiological and incident-specific data in order to better understand and work to prevent the workplace violence occurring in their hospital system.

Metropolitan Lima: area profile.

Science.gov (United States)

Hakkert, R

1986-11-01

-help construction. Only 2.7% of the metropolitan population over age 15 is illiterate, down from 5.4% in 1972 and 7.7% in 1961. In 1981 Lima had 93 hospitals with a total of 12,640 beds. In addition there were 102 health centers and 10 sanitary posts. Lima's economically active population totaled 1.53 million in 1981, 71% of whom were men. On average, each household has 1.8 income earners, and only 17% have more than 2. A 1978 survey revealed that the families of Lima spend an average of 45.2% of their incomes on food, 15.6% on housing and utilities, 9.8% on transport and communication, 7.4% on education, sports, and cultural activities, 7.3% on clothing, and 7.0% on furniture and housing maintenance.

Understanding organisational development, sustainability, and diffusion of innovations within hospitals participating in a multilevel quality collaborative

Directory of Open Access Journals (Sweden)

Wagner Cordula

2011-03-01

Full Text Available Abstract Background Between 2004 and 2008, 24 Dutch hospitals participated in a two-year multilevel quality collaborative (MQC comprised of (a a leadership programme for hospital executives, (b six quality-improvement collaboratives (QICs for healthcare professionals and other staff, and (c an internal programme organisation to help senior management monitor and coordinate team progress. The MQC aimed to stimulate the development of quality-management systems and the spread of methods to improve patient safety and logistics. The objective of this study is to describe how the first group of eight MQC hospitals sustained and disseminated improvements made and the quality methods used. Methods The approach followed by the hospitals was described using interview and questionnaire data gathered from eight programme coordinators. Results MQC hospitals followed a systematic strategy of diffusion and sustainability. Hospital quality-management systems are further developed according to a model linking plan-do-study-act cycles at the unit and hospital level. The model involves quality norms based on realised successes, performance agreements with unit heads, organisational support, monitoring, and quarterly accountability reports. Conclusions It is concluded from this study that the MQC contributed to organisational development and dissemination within participating hospitals. Organisational learning effects were demonstrated. System changes affect the context factors in the theory of organisational readiness: organisational culture, policies and procedures, past experience, organisational resources, and organisational structure. Programme coordinator responses indicate that these factors are utilised to manage spread and sustainability. Further research is needed to assess long-term effects.

Understanding organisational development, sustainability, and diffusion of innovations within hospitals participating in a multilevel quality collaborative

Science.gov (United States)

2011-01-01

Background Between 2004 and 2008, 24 Dutch hospitals participated in a two-year multilevel quality collaborative (MQC) comprised of (a) a leadership programme for hospital executives, (b) six quality-improvement collaboratives (QICs) for healthcare professionals and other staff, and (c) an internal programme organisation to help senior management monitor and coordinate team progress. The MQC aimed to stimulate the development of quality-management systems and the spread of methods to improve patient safety and logistics. The objective of this study is to describe how the first group of eight MQC hospitals sustained and disseminated improvements made and the quality methods used. Methods The approach followed by the hospitals was described using interview and questionnaire data gathered from eight programme coordinators. Results MQC hospitals followed a systematic strategy of diffusion and sustainability. Hospital quality-management systems are further developed according to a model linking plan-do-study-act cycles at the unit and hospital level. The model involves quality norms based on realised successes, performance agreements with unit heads, organisational support, monitoring, and quarterly accountability reports. Conclusions It is concluded from this study that the MQC contributed to organisational development and dissemination within participating hospitals. Organisational learning effects were demonstrated. System changes affect the context factors in the theory of organisational readiness: organisational culture, policies and procedures, past experience, organisational resources, and organisational structure. Programme coordinator responses indicate that these factors are utilised to manage spread and sustainability. Further research is needed to assess long-term effects. PMID:21385467

Reconceptualization Sexuality and Rethinking Homophobia in Metropolitan Campus Spaces

Science.gov (United States)

Deniz, Caglar

2017-01-01

The Metropolitan city gives non-metropolitan students an opportunity to meet new social groups. In this article, the perceptions of sexuality of those students who come from provincial areas to a metropolitan city for university education are examined within a framework of semi-structured interviews. The study on which this article is based used a…

Barriers to participation in a hospital-based falls assessment clinic programme: an interview study with older people

DEFF Research Database (Denmark)

Evron, Lotte

2009-01-01

Aims: To gain new knowledge about barriers to participation in hospital-based falls assessment. Methods: Semi-structured interviews with 20 older people referred to falls assessment at a hospital-based clinic were conducted. A convenience sample of 10 refusers and 10 accepters was collected. Those...

Spatiotemporal patterns of childhood asthma hospitalization and utilization in Memphis Metropolitan Area from 2005 to 2015.

Science.gov (United States)

Oyana, Tonny J; Podila, Pradeep; Wesley, Jagila Minso; Lomnicki, Slawo; Cormier, Stephania

2017-10-01

To identify the key risk factors and explain the spatiotemporal patterns of childhood asthma in the Memphis metropolitan area (MMA) over an 11-year period (2005-2015). We hypothesize that in the MMA region this burden is more prevalent among urban children living south, downtown, and north of Memphis than in other areas. We used a large-scale longitudinal electronic health record database from an integrated healthcare system, Geographic information systems (GIS), and statistical and space-time models to study the spatiotemporal distributions of childhood asthma at census tract level. We found statistically significant spatiotemporal clusters of childhood asthma in the south, west, and north of Memphis city after adjusting for key covariates. The results further show a significant increase in temporal gradient in frequency of emergency department (ED) visits and inpatient hospitalizations from 2009 to 2013, and an upward trajectory from 4 per 1,000 children in 2005 to 16 per 1,000 children in 2015. The multivariate logistic regression identified age, race, insurance, admit source, encounter type, and frequency of visits as significant risk factors for childhood asthma (p asthma burden and healthcare utilization for African American (AA) patients living in a high-risk area than those living in a low-risk area in comparison to the white patients: AA vs. white [odds ratio (OR) = 3.03, 95% confidence interval (CI): 2.75-3.34]; and Hispanic vs. white (OR = 1.62, 95% CI: 1.21-2.17). These findings provide a strong basis for developing geographically tailored population health strategies at the neighborhood level for young children with chronic respiratory conditions.

Metropolitan City: the Italian experience

Directory of Open Access Journals (Sweden)

Giuseppe Franco Ferrari

2013-12-01

Full Text Available Due to the fact that the definitions of territorial organization are no longer adequate, the concept of “metropolitan areas” arises as a solution to resolve such deficit. This study shows the beginnings of this figure in Italy and the problems of identification and delimitation caused by the abstraction of the norms, therefore entailing a difficult implementation of the concept of metropolitan cities. By identifying these obstacles, this paper presents an analysis where it is possible to ensure compliance with this new reality in the near future.

Metropolitan Optical Networks 1995 Annual Report

DEFF Research Database (Denmark)

Kristensen, Martin; Jouanno, Jean-Marc; Malone, Kevin

1996-01-01

The annual report describes the research carried out in the ACTS-project METON (Metropolitan Optical Networks) in 1995. L.M. Ericsson is prime contractor and 12 partners including DTU is involved in the project.......The annual report describes the research carried out in the ACTS-project METON (Metropolitan Optical Networks) in 1995. L.M. Ericsson is prime contractor and 12 partners including DTU is involved in the project....

Initiatives towards Carbon Neutrality in the Helsinki Metropolitan Area

Directory of Open Access Journals (Sweden)

Karna Dahal

2016-07-01

Full Text Available Carbon neutrality represents one climate strategy adopted by many cities, including the city of Helsinki and the Helsinki metropolitan area in Finland. This study examines initiatives adopted by the Helsinki metropolitan area aimed at reducing energy-related carbon emissions and achieving carbon neutrality through future actions. Various sectorial energy consumption rates per year and carbon emissions from various sectors within the city of Helsinki and the metropolitan area were extracted from an online database and re-calculated (in GWh, MWh/inhabitant and MtCO2e, KtCO2e/inhabitant. We employed a backcasting scenario method to explore the various carbon reduction measures in the Helsinki metropolitan area. About 96% of the emissions produced in the Helsinki metropolitan area are energy-based. District heating represents the primary source of emissions, followed by transportation and electricity consumption, respectively. We also found that accomplishing the carbon reduction strategies of the Helsinki metropolitan area by 2050 remains challenging. Technological advancement for clean and renewable energy sources, smart policies and raising awareness resulting in behavioral changes greatly affect carbon reduction actions. Thus, strong political commitments are also required to formulate and implement stringent climate actions.

African urbanization in metropolitan South Africa--differential urbanization perspectives.

Science.gov (United States)

Geyer, H S

1993-07-01

"As a potentially important urban development policy consideration, attention is focused in this paper on differential urbanization trends in South Africa at the metropolitan level. Recent informal urban settlement patterns of the African population within the major metropolitan areas are contrasted against these differential urbanization trends to determine the implications of both for residential development in the metropolitan areas during the post-apartheid era." excerpt

Consensus on the leadership of hospital CEOs and its impact on the participation of physicians in improvement projects

NARCIS (Netherlands)

Dückers, Michel L.A.; Stegeman, Inge; Spreeuwenberg, Peter; Wagner, Cordula; Sanders, Karin; Groenewegen, Peter P.

2009-01-01

Objectives: The success of a Dutch program to disseminate quality improvement projects depends on the participation of physicians working in program hospitals. The leadership of hospital executives (CEOs) is considered an important explanation. This study aims to determine whether the relation,

Consensus on the leadership of hospital CEOs and its impact on the participation of clinicians in improvement projects.

NARCIS (Netherlands)

Dückers, M.L.A.; Stegeman, I.; Spreeuwenberg, P.; Wagner, C.; Sanders, K.; Groenewegen, P.P.

2009-01-01

Objectives: The success of a Dutch program to disseminate quality improvement projects depends on the participation of physicians working in program hospitals. The leadership of hospital executives (CEOs) is considered an important explanation. This study aims to determine whether the relation,

Consensus on the leadership of hospital CEOs and its impact on the participation of physicians in improvement projects

NARCIS (Netherlands)

Duckers, M.L.A.; Stegeman, I.; Spreeuwenberg, P.; Wagner, C.; Sanders, K.; Groenewegen, P.P.

2009-01-01

OBJECTIVES: The success of a Dutch program to disseminate quality improvement projects depends on the participation of physicians working in program hospitals. The leadership of hospital executives (CEOs) is considered an important explanation. This study aims to determine whether the relation,

Consensus on the leadership of hospital CEO's and its impact on the participation of physicians in improvement projects

NARCIS (Netherlands)

Dückers, M.L.A.; Stegeman, I.; Spreeuwenberg, P.; Wagner, C.; Sanders, K.; Groenewegen, P.P.

2009-01-01

Objectives: The success of a Dutch program to disseminate quality improvement projects depends on the participation of physicians working in program hospitals. The leadership of hospital executives (CEOs) is considered an important explanation. This study aims to determine whether the relation,

Deprivation and mortality in non-metropolitan areas of England and Wales.

Science.gov (United States)

Jessop, E G

1996-10-01

To test the hypothesis that the relationship between deprivation and mortality is weaker among residents of non-metropolitan areas of England and Wales than among residents of metropolitan areas. This study compared mortality, expressed as standardised mortality ratios (SMRs), in residents of metropolitan and non-metropolitan districts at three levels of deprivation classified by an electoral ward deprivation score and by home and car ownership. SMRs were computed for all causes of death, for bronchitis and asthma (ICD9 codes 490-493), and for accident, violence, and poisoning (ICD9 codes 800-999). England and Wales. Members of the longitudinal study of the Office of Population Censuses and Surveys, a quasi-random 1% sample of the population of England and Wales. There was an association between deprivation and mortality which was clear for all cause mortality, more noticeable for respiratory disease, and less clear for deaths from accident, violence, and poison. In general, the results showed a remarkable similarity between metropolitan and non-metropolitan areas. This study does not support the hypothesis that the relationship between mortality and deprivation differs between residents of metropolitan and non-metropolitan areas of England and Wales.

Analysis of hospital logistics and costs of the Clinical Engineering Sector in a Philanthropic Hospital

Directory of Open Access Journals (Sweden)

Antônio Artur de Souza

2014-12-01

Full Text Available Hospitals are considered complex organizations mainly due to the high cost of the health care structure employed for care. Reducing operating costs is a challenge for hospital managers. Particularly in the clinical engineering sector, adequate hospital logistics can reduce costs. In this context, the aim of the research was to analyze the activities of hospital logistics of the Clinical Engineering department at a charity hospital, focusing on cost reduction. The paper presents a case study in a large charity hospital located in the metropolitan region of Belo Horizonte, MG. The analysis focuses on the activities of hospital logistics at this hospital clinical engineering sector. The work in this sector is concentrated in the realization and implementation of equipment maintenance, to the detriment of efforts to reduce costs and increase safety for all streams managed by the sector. It was also found that there are risks of increased costs with inadequate routines: (i acquisition of new and large equipment; (ii maintenance and release schedule for use; and (iii the theft of equipment.

Metropolitan Optical Networks 1996 Annual Report

DEFF Research Database (Denmark)

Kristensen, Martin; Jouanno, Jean-Marc; Malone, Kevin

1997-01-01

The report desribes the reasearch carried out in the ACTS-project METON (Metropolitan Optical Networks) in 1996. L.M. Ericsson is prime contractor and 12 partners are involved in the project including DTU, i.e. EMI and MIC.......The report desribes the reasearch carried out in the ACTS-project METON (Metropolitan Optical Networks) in 1996. L.M. Ericsson is prime contractor and 12 partners are involved in the project including DTU, i.e. EMI and MIC....

The influence of population on the economic efficiency of the metropolitan governance

Directory of Open Access Journals (Sweden)

Yuriy V. Pavlov

2017-01-01

Full Text Available Research purpose. In order to implement the optimal metropolitan governance model, it is important to understand the conditions under which this or that model is economically effective. There is a need to develop a quantitatively justified methodology for choosing the optimal metropolitan governance model for different types of metropolitan areas. It has been emphasized in some federal documents of Russia, for example, in the “Recommendations for the selection of pilot projects for approbation and improvement of mechanisms for managing the development of metropolitan areas in the Russian Federation”.Materials and methods. Domestic researchers (N. Zubarevich, K. Gonchar, etc. and foreign researchers (Glaeser Edward L., Nakamura, Ciccone A., Hall R., etc. carried out the study of quantitative relationships between the economic growth of cities and the characteristics of cities.However, for metropolitan areas, the analysis of the relationship has not yet been implemented between the outpacing economic growth of the metropolitan area relative to the average country values (labor productivity and GDP per capita, the institutional factor (the type of metropolitan governance model, andthe non-institutional factor (population size. To identify the dependencies we are interested in, we used the OECD statistical database and OECD researches to identify the metropolitan governance model in the sample of metropolitan areas in the world. The sample in this research was 87 metropolitan areas in Europe and was divided into groups, depending on the population and the introduced metropolitan governance model. For each group, a correlation-regression analysis was performed and a weighted average was calculated from the indexes of the economic growth. As the leading index of the economic growth, labor productivity was used, as the final - GDP per capita. Then a comparison was made between the real value of economic growth in each surveyed metropolitan area and

Workplace violence injury in 106 US hospitals participating in the Occupational Health Safety Network (OHSN), 2012-2015.

Science.gov (United States)

Groenewold, Matthew R; Sarmiento, Raymond F R; Vanoli, Kelly; Raudabaugh, William; Nowlin, Susan; Gomaa, Ahmed

2018-02-01

Workplace violence is a substantial occupational hazard for healthcare workers in the United States. We analyzed workplace violence injury surveillance data submitted by hospitals participating in the Occupational Health Safety Network (OHSN) from 2012 to 2015. Data were frequently missing for several important variables. Nursing assistants (14.89, 95%CI 10.12-21.91) and nurses (8.05, 95%CI 6.14-10.55) had the highest crude workplace violence injury rates per 1000 full-time equivalent (FTE) workers. Nursing assistants' (IRR 2.82, 95%CI 2.36-3.36) and nurses' (IRR 1.70, 95%CI 1.45-1.99) adjusted workplace violence injury rates were significantly higher than those of non-patient care personnel. On average, the overall rate of workplace violence injury among OHSN-participating hospitals increased by 23% annually during the study period. Improved data collection is needed for OHSN to realize its full potential. Workplace violence is a serious, increasingly common problem in OHSN-participating hospitals. Nursing assistants and nurses have the highest injury risk. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

Balanced performance measurement in research hospitals: the participative case study of a haematology department.

Science.gov (United States)

Catuogno, Simona; Arena, Claudia; Saggese, Sara; Sarto, Fabrizia

2017-08-03

The paper aims to review, design and implement a multidimensional performance measurement system for a public research hospital in order to address the complexity of its multifaceted stakeholder requirements and its double institutional aim of care and research. The methodology relies on a participative case study performed by external researchers in close collaboration with the staff of an Italian research hospital. The paper develops and applies a customized version of balanced scorecard based on a new set of performance measures. Our findings suggest that it can be considered an effective framework for measuring the research hospital performance, thanks to a combination of generalizable and context-specific factors. By showing how the balanced scorecard framework can be customized to research hospitals, the paper is especially of interest for complex healthcare organizations that are implementing management accounting practices. The paper contributes to the body of literature on the application of the balanced scorecard in healthcare through an examination of the challenges in designing and implementing this multidimensional performance tool. This is one of the first papers that show how the balanced scorecard model can be adapted to fit the specific requirements of public research hospitals.

Hospitals Participating In ACOs Tend To Be Large And Urban, Allowing Access To Capital And Data.

Science.gov (United States)

Colla, Carrie H; Lewis, Valerie A; Tierney, Emily; Muhlestein, David B

2016-03-01

Relationships between physicians and hospitals have changed considerably over the past decade, as hospitals and physician groups have integrated and new public and private payment policies have created financial interdependence. The extent to which accountable care organizations (ACOs) involve hospitals in their operations may prove to be vitally important, because managing hospital care is a key part of improving health care quality and lowering cost growth. Using primary data on ACO composition and capabilities paired with hospital characteristics, we found that 20 percent of US hospitals were part of an ACO in 2014. Hospitals that were in urban areas, were nonprofit, or had a smaller share of Medicare patients were more likely to participate in ACOs, compared to hospitals that were in more rural areas, were for-profit or government owned, or had a larger share of Medicare patients, respectively. Qualitative data identified the following advantages of including a hospital in an ACO: the availability of start-up capital, advanced data sharing, and engagement of providers across the care continuum. Although the 63 percent of ACOs that included hospitals offered more comprehensive services compared to ACOs without hospitals, we found no differences between the two groups in their ability to manage hospital-related aspects of patient care. Project HOPE—The People-to-People Health Foundation, Inc.

Metropolitan planning from an international comparative perspective

DEFF Research Database (Denmark)

Galland, Daniel; Grønning, Marius

2016-01-01

policies, and thus also to the instrumental orientation within planning. A challenge stemming from this comparison is to understand how similar policies are implemented at a strategic and metropolitan level. Within the institutional framework of Copenhagen, the problem with the Finger Plan directive might...... (Faludi & van der Valk, 1994), thus integrating the archetypal land-use character of municipal plans and the strategic and growth-oriented pursuit of regional plans. A number of questions may be deduced: How explicit is the metropolitan scale? How local and how regional is the knowledge basis? Within......Over the last few years new practices of spatial strategy making at different planning scales have emerged. At the metropolitan level, such spatial strategies are reminiscent of national and supranational competitive strategies (e.g. EU policies) as well as ratifications of international...

A tale of two hospitals: assessing cultural landscapes and compositions.

Science.gov (United States)

Braithwaite, Jeffrey; Westbrook, Mary T; Iedema, Rick; Mallock, Nadine A; Forsyth, Rowena; Zhang, Kai

2005-03-01

Clinical directorate service structures (CDs) have been widely implemented in acute settings in the belief that they will enhance efficiency and patient care by bringing teams together and involving clinicians in management. We argue that the achievement of such goals depends not only on changing its formalized structural arrangements but also the culture of the organisation concerned. We conducted comparative observational studies and questionnaire surveys of two large Australian teaching hospitals similar in size, role and CD structure. Martin's conceptualization of culture in terms of integration, differentiation and fragmentation was applied in the analysis of the data. The ethnographic work revealed that compared to Metropolitan Hospital, Royal Hospital was better supported and more favourably viewed by its staff across six categories identified in both settings: leadership, structure, communication, change, finance and human resource management. Royal staff were more optimistic about their organisation's ability to meet future challenges. The surveys revealed that both staff groups preferred CD to traditional structures and shared some favourable and critical views of them. However Royal staff were significantly more positive, reporting many more benefits from CDs e.g. improved working relations, greater accountability and efficiency, better cost management, more devolvement of management to clinicians and a hospital more strategically placed and patient focused. Metropolitan staff were more likely to claim that CDs failed to solve problems and created a range of others including disunity and poor working relationships. There was greater consensus of views among Royal staff and more fragmentation at Metropolitan where both intensely held and uncertain attitudes were more common. The outcomes of implementing CDs in these two similar organisations differed considerably indicating the need to address cultural issues when introducing structural change. Martin

40 CFR 81.17 - Metropolitan Los Angeles Air Quality Control Region.

Science.gov (United States)

2010-07-01

... Quality Control Regions § 81.17 Metropolitan Los Angeles Air Quality Control Region. The Metropolitan Los Angeles Air Quality Control Region consists of the following territorial area (including the territorial... 40 Protection of Environment 17 2010-07-01 2010-07-01 false Metropolitan Los Angeles Air Quality...

[Survey of methicillin-resistant Staphylococcus aureus control measures in hospitals participating in the VINCat program].

Science.gov (United States)

Sopena-Galindo, Nieves; Hornero-Lopez, Anna; Freixas-Sala, Núria; Bella-Cueto, Feliu; Pérez-Jové, Josefa; Limon-Cáceres, Enric; Gudiol-Munté, Francesc

2016-01-01

VINCat is a nosocomial infection surveillance program in hospitals in Catalonia. The aim of the study was to determine the surveillance and control measures of methicillin-resistant Staphylococcus aureus (MRSA) in these centres. An e-mail survey was carried out from January to March 2013 with questions related to the characteristics of the hospitals and their control measures for MRSA. A response was received from 53 hospitals (>500 beds: 7; 200-500 beds: 14;prevent MRSA in hospitals participating in the VINCat program. Most of the centres have an MRSA protocol, however compliance with it should be improved, especially in areas such as active detection on admission in patients at risk, hand hygiene adherence, cleaning frequency and optimising the use of antibiotics. Copyright © 2015 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Modeling Metropolitan Detroit transit.

Science.gov (United States)

2010-10-01

"The seven-county Southeast Michigan region, that encompasses the Detroit Metropolitan Area, : ranks fifth in population among top 25 regions in the nation. It also ranks among bottom five in : the transit service provided, measured in miles or hours...

The Last Case and Death of «Moscow Metropolitan» Boris (Rukin: to the Issue of His Suicide

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A. MAZYRIN

2014-02-01

Full Text Available The author investigates circumstances of the last arrest and the death of bishop (in schism — «the Moscow metropolitan» Boris (Rukin in detention in 1931 on the basis of his Case from the documents of the Central archive of FSB of the Russian Federation. The author studies the arrest’s reason (the attempt to bribe a soviet clerk, assorts in details the course of investigation and analyzes its result — death of bishop Boris in the hospital of the Butyrsky insulator. In the article the basic attention was occupied with checking of the official version of church-historical literature about suicide of the bishop. The author considers the death of the prisoner, «the metropolitan Moscow», has followed soon after accusing him of a counterrevolutionary propaganda. It was his words to «churchmen» about the possibility to bribe the Soviet power. Materials of the investigatory case do not contain any data to support the version of suicide. At the same time, they allow to assume the interest of the OGPU bodies in the distribution of this version with the purpose to justify the refusal to give out the body of late «metropolitan» Boris for his church burial. The materials have also indirectly testified to the interest in elimination of «the Moscow metropolitan» of some «churchmen» connecting with him. First of all, it was «metropolitan» Bessarion (Zorin who headed the Gregorian split. He obtained a Boris’s apartment under the decision of VCIK. The article can be useful at drawing up of biographic directories, at writing of historical monographies about the Gregorian split, the Moscow diocese and the Russian Orthodox Church as a whole.

Violence against metropolitan bus drivers and fare collectors in Brazil

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Ada Ávila Assunção

2015-01-01

Full Text Available OBJECTIVE To analyze the correlation between sociodemographic factors and working conditions of bus workers in a metropolitan area and violence against them. METHODS This cross-sectional study used a nonprobabilistic sample estimated according to the number of workers employed in bus companies located in three cities in the Belo Horizonte metropolitan region in 2012 (N = 17,470. Face-to-face interviews were conducted using a digital questionnaire. The factors associated with violence were analyzed in two stages using Poisson regression, according to each level. The magnitude of the association was evaluated using prevalence ratios with robust variance and a statistical significance of 5%, and 95% confidence intervals were obtained. RESULTS The study sample comprised 782 drivers and 691 fare collectors; 45.0% participants reported at least one act of violence in the workplace in the last 12 months, with passengers being predominantly responsible. The age of the bus workers was inversely associated with violence. Chronic diseases, sickness absenteeism, and working conditions were also associated with violence. CONCLUSIONS The findings on the correlation between violence and working conditions are essential for implementing prevention strategies by transportation service managers.

A systematic review of professional supervision experiences and effects for allied health practitioners working in non-metropolitan health care settings

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Ducat WH

2015-08-01

Full Text Available Wendy H Ducat,1,3 Saravana Kumar2 1Cunningham Centre, Darling Downs Hospital and Health Service, Australia; 2School of Health Sciences, International Centre for Allied Health Evidence, Sansom Institute, University of South Australia, Adelaide, SA, Australia; 3Rural Clinical School, School of Medicine, University of Queensland, Brisbane, QLD, Australia Introduction: In regional, rural, and remote settings, allied health professional supervision is one organizational mechanism designed to support and retain the workforce, provide clinical governance, and enhance service delivery. A systematic approach to evaluating the evidence of the experience and effects of professional supervision for non-metropolitan allied health practitioners and their service delivery is needed. Methods: Studies investigating the experience and effects of professional supervision across 17 allied health disciplines in non-metropolitan health services were systematically searched for using standardized keywords across seven databases. The initial search identified 1,574 references. Of these studies, five met inclusion criteria and were subject to full methodological appraisal by both reviewers. Two studies were primarily qualitative with three studies primarily quantitative in their approach. Studies were appraised using McMaster critical appraisal tools and data were extracted and synthesized. Results: Studies reported the context specific benefits and challenges of supervision in non-metropolitan areas and the importance of supervision in enhancing satisfaction and support in these areas. Comparison of findings between metropolitan and non-metropolitan settings within one study suggested that allied health in non-metropolitan settings were more satisfied with supervision though less likely to access it and preferred supervision with other non-metropolitan practitioners over access to more experienced supervisors. One study in a regional health service identified the lack

Hygiene behaviour and hospitalized severe childhood diarrhoea: a case-control study.

OpenAIRE

Baltazar, J. C.; Tiglao, T. V.; Tempongko, S. B.

1993-01-01

The relationship between personal and domestic hygiene behaviour and hospitalized childhood diarrhoea was examined in a case-control study of 356 cases and 357 controls from low-income families in metropolitan Manila. Indices of hygiene behaviour were defined for overall cleanliness, kitchen hygiene, and living conditions. Only the indices for overall cleanliness and kitchen hygiene were significantly associated with diarrhoea. An increasing excess risk of hospitalization with severe diarrhoe...

Smoking status and associated factors among male Chinese restaurant workers in metropolitan Sydney.

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Jiang, Wei; Leung, Brenda; Tam, Nancy; Xu, Huilan; Gleeson, Suzanne; Wen, Li Ming

2017-03-01

Issue addressed The smoking rate among male Chinese migrants in Australia is higher than among the general population. This study investigated the smoking rate of male Chinese restaurant workers in metropolitan Sydney, and explored factors associated with smoking and quitting. Methods A self-administered questionnaire survey was completed by Chinese workers in selected Chinese restaurants in metropolitan Sydney from October-December 2012. Eighty-nine Chinese restaurants were approached and 54 (61%) took part in the study. The questionnaire asked participants about their smoking status, knowledge of and attitudes to smoking and quitting as well as socio-demographic information. Multivariable logistic regression was built to assess the associated factors. Results Of the 382 participants who completed the survey, 171 (45%) were current smokers and 50% of current smokers wanted to quit smoking. Participants who spoke Mandarin, had lower English proficiency, did not realise environmental smoke harms children, did not prefer a smoke-free environment or had more than 50% of relatives or friends who smoked were more likely to be current smokers. Participants who were aged 18-29 years, did not understand the benefits of quitting smoking or did not prefer a smoke-free environment were less likely to want to quit. Conclusions Nearly 50% of male Chinese restaurant workers surveyed in this study were current smokers. Key factors associated with the participants' smoking or quitting status are: aged 18-29 years; speaking Mandarin; lower English literacy; and not knowing the dangers of smoking. So what? Tobacco control programs targetted at male Chinese restaurant workers that raise awareness of the harm caused by smoking and the benefits of quitting smoking are required to enhance intention to quit smoking within this population.

Effects of long-range transported air pollution from vegetation fires on daily mortality and hospital admissions in the Helsinki metropolitan area, Finland.

Science.gov (United States)

Kollanus, Virpi; Tiittanen, Pekka; Niemi, Jarkko V; Lanki, Timo

2016-11-01

Fine particulate matter (PM 2.5 ) emissions from vegetation fires can be transported over long distances and may cause significant air pollution episodes far from the fires. However, epidemiological evidence on health effects of vegetation-fire originated air pollution is limited, particularly for mortality and cardiovascular outcomes. We examined association between short-term exposure to long-range transported PM 2.5 from vegetation fires and daily mortality due to non-accidental, cardiovascular, and respiratory causes and daily hospital admissions due to cardiovascular and respiratory causes in the Helsinki metropolitan area, Finland. Days significantly affected by smoke from vegetation fires between 2001 and 2010 were identified using air quality measurements at an urban background and a regional background monitoring station, and modelled data on surface concentrations of vegetation-fire smoke. Associations between daily PM 2.5 concentration and health outcomes on i) smoke-affected days and ii) all other days (i.e. non-smoke days) were analysed using Poisson time series regression. All statistical models were adjusted for daily temperature and relative humidity, influenza, pollen, and public holidays. On smoke-affected days, 10µg/m 3 increase in PM 2.5 was associated with a borderline statistically significant increase in cardiovascular mortality among total population at a lag of three days (12.4%, 95% CI -0.2% to 26.5%), and among the elderly (≥65 years) following same-day exposure (13.8%, 95% CI -0.6% to 30.4%) and at a lag of three days (11.8%, 95% CI -2.2% to 27.7%). Smoke day PM 2.5 was not associated with non-accidental mortality or hospital admissions due to cardiovascular causes. However, there was an indication of a positive association with hospital admissions due to respiratory causes among the elderly, and admissions due to chronic obstructive pulmonary disease or asthma among the total population. In contrast, on non-smoke days PM 2.5 was

49 CFR 613.100 - Metropolitan transportation planning and programming.

Science.gov (United States)

2010-10-01

... programming. 613.100 Section 613.100 Transportation Other Regulations Relating to Transportation (Continued... Metropolitan Transportation Planning and Programming § 613.100 Metropolitan transportation planning and programming. The regulations in 23 CFR 450, subpart C, shall be followed in complying with the requirements of...

Participant observation of time allocation, direct patient contact and simultaneous activities in hospital physicians

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Zupanc Andrea

2009-06-01

Full Text Available Abstract Background Hospital physicians' time is a critical resource in medical care. Two aspects are of interest. First, the time spent in direct patient contact – a key principle of effective medical care. Second, simultaneous task performance ('multitasking' which may contribute to medical error, impaired safety behaviour, and stress. There is a call for instruments to assess these aspects. A preliminary study to gain insight into activity patterns, time allocation and simultaneous activities of hospital physicians was carried out. Therefore an observation instrument for time-motion-studies in hospital settings was developed and tested. Methods 35 participant observations of internists and surgeons of a German municipal 300-bed hospital were conducted. Complete day shifts of hospital physicians on wards, emergency ward, intensive care unit, and operating room were continuously observed. Assessed variables of interest were time allocation, share of direct patient contact, and simultaneous activities. Inter-rater agreement of Kappa = .71 points to good reliability of the instrument. Results Hospital physicians spent 25.5% of their time at work in direct contact with patients. Most time was allocated to documentation and conversation with colleagues and nursing staff. Physicians performed parallel simultaneous activities for 17–20% of their work time. Communication with patients, documentation, and conversation with colleagues and nursing staff were the most frequently observed simultaneous activities. Applying logit-linear analyses, specific primary activities increase the probability of particular simultaneous activities. Conclusion Patient-related working time in hospitals is limited. The potential detrimental effects of frequently observed simultaneous activities on performance outcomes need further consideration.

Planning Assignments of the Italian Metropolitan Cities. Early Trends

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Giuseppe Mazzeo

2017-04-01

Full Text Available The last stage of the process of establishment of the Italian Metropolitan Cities, which took place in 2014, follows of a few decades the start of this institutional reform. In 1990, in fact, the Act 142 (Local Autonomies Reform had planned metropolitan areas as the administrative organization more suitable to provide these territories of structures for the management and the strategic development alike the best international models. The paper proposes to analyse the first activities taken by the Italian Metropolitan Cities in the sector of territorial government, three years after the enactment in 2014 of Act nr. 56.  Focal point of the analysis is the jurisdiction in the formation of two plans (the Strategic Plan and the Metropolitan Territorial Plan and the following relationships among them, in the logical assumption that between them a necessary and strict consistency there should be. In the first part, the paper analyses some factors characterizing the metropolitan areas and the functions that the law assigns to the new institution in the territorial government sector. The second part outlines the updated situation with regard to the formation of the sectoral tools (Strategic Plan, Territorial Plan and homogeneous zones. The third part analyses the progresses in three Metropolitan Cities taken as sample (Milan, Genoa and Bologna and, in general, to those of Southern Italy. In the last part, the paper exposes some considerations regarding the issues raised in the article, particularly about the innovativeness of the tools and the timeline for the implementation of the act.

[Compatibility of Work and Family Life: Survey of Physicians in the Munich Metropolitan Area].

Science.gov (United States)

Lauchart, Meike; Ascher, Philipp; Kesel, Karin; Weber, Sabine; Grabein, Beatrice; Schneeweiss, Bertram; Fischer-Truestedt, Cordula; Schoenberg, Michael; Rogler, Gudrun; Borelli, Claudia

2017-05-15

Aim Investigation of the compatibility of work and family life for physicians in the Munich metropolitan area. Methods Survey of a representative sample of 1,800 physicians using a questionnaire. Results Men were less satisfied (7% very satisfied vs. 21%) with compatibility between work and family life than women. The group least satisfied overall was hospital-based physicians (p=0.000, chi-square=122.75). Women rather than men cut back their career due to children, perceived their professional advancement as impaired, desisted from establishing private practice or quit hospital employment altogether. Respondents strove for flexible childcare and makeshift solution if the established service failed. Most did not have that at their disposal. Hospital-based physicians wished for predictable working hours, and would like to have a say in the structure of their schedule. For the majority this was not the case. While for 80% it would be important to participate in the definition of their working hours, this was only possible in 17%. 86% found the opportunity to work part-time important, but many doctors (more than 30%) did not have that option. The biggest help for office-based physicians would be an expedited procedure by the Bavarian Association of Statutory Health Insurance Physicians (KVB) when applying for a proxy. The second most important would be the ability to hand over on-call duties. 36% of respondents felt that compatibility of work and family life was best achieved outside of patient care, during residency 42% believed this to be the case. Only 6% of physicians felt the best compatibility to be achieved in a hospital. Among the physician owners of practices, 34% considered their model to be the best way to reconcile both aspects of life. Conclusion More flexible options for childcare and more influence on the definition of working hours are necessary in order to better reconcile work and family life. For office-based physicians it must be made easier to

The impact of heat on mortality and morbidity in the Greater Metropolitan Sydney Region: a case crossover analysis

OpenAIRE

Wilson, Leigh Ann; Gerard Morgan, Geoffrey; Hanigan, Ivan Charles; Johnston, Fay H; Abu-Rayya, Hisham; Broome, Richard; Gaskin, Clive; Jalaludin, Bin

2013-01-01

Background This study examined the association between unusually high temperature and daily mortality (1997?2007) and hospital admissions (1997?2010) in the Sydney Greater Metropolitan Region (GMR) to assist in the development of targeted health programs designed to minimise the public health impact of extreme heat. Methods Sydney GMR was categorized into five climate zones. Heat-events were defined as severe or extreme. Using a time-stratified case-crossover design with a conditional logisti...

40 CFR 81.38 - Metropolitan Houston-Galveston Intrastate Air Quality Control Region.

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 17 2010-07-01 2010-07-01 false Metropolitan Houston-Galveston... Designation of Air Quality Control Regions § 81.38 Metropolitan Houston-Galveston Intrastate Air Quality Control Region. The Metropolitan Houston-Galveston Intrastate Air Quality Control Region (Texas) has been...

Impact of the 2001 Tohoku-oki earthquake to Tokyo Metropolitan area observed by the Metropolitan Seismic Observation network (MeSO-net)

Science.gov (United States)

Hirata, N.; Hayashi, H.; Nakagawa, S.; Sakai, S.; Honda, R.; Kasahara, K.; Obara, K.; Aketagawa, T.; Kimura, H.; Sato, H.; Okaya, D. A.

2011-12-01

The March 11, 2011 Tohoku-oki earthquake brought a great impact to the Tokyo metropolitan area in both seismological aspect and seismic risk management although Tokyo is located 340 km from the epicenter. The event generated very strong ground motion even in the metropolitan area and resulted severe requifaction in many places of Kanto district. National and local governments have started to discuss counter measurement for possible seismic risks in the area taking account for what they learned from the Tohoku-oki event which is much larger than ever experienced in Japan Risk mitigation strategy for the next greater earthquake caused by the Philippine Sea plate (PSP) subducting beneath the Tokyo metropolitan area is of major concern because it caused past mega-thrust earthquakes, such as the 1703 Genroku earthquake (M8.0) and the 1923 Kanto earthquake (M7.9). An M7 or greater (M7+) earthquake in this area at present has high potential to produce devastating loss of life and property with even greater global economic repercussions. The Central Disaster Management Council of Japan estimates that an M7+ earthquake will cause 11,000 fatalities and 112 trillion yen (about 1 trillion US$) economic loss. In order to mitigate disaster for greater Tokyo, the Special Project for Earthquake Disaster Mitigation in the Tokyo Metropolitan Area was launched in collaboration with scientists, engineers, and social-scientists in nationwide institutions. We will discuss the main results that are obtained in the respective fields which have been integrated to improve information on the strategy assessment for seismic risk mitigation in the Tokyo metropolitan area; the project has been much improved after the Tohoku event. In order to image seismic structure beneath the Metropolitan Tokyo area we have developed Metropolitan Seismic Observation network (MeSO-net; Hirata et al., 2009). We have installed 296 seismic stations every few km (Kasahara et al., 2011). We conducted seismic

non-metropolitan stars

Directory of Open Access Journals (Sweden)

Elena Grigoryeva

2017-06-01

Full Text Available Capitals gather constellations of bright and creative people, attracting them from the peripheries. Tchekhov’s sisters were anxious to get to Moscow, d’Artagnan – to Paris. Evtushenko, Shukshin and Gaidai ascended to the climax of their glory, having moved to the capital. Vampilov, Rasputin and Astafiev became internationally famous without leaving their home grounds, but having joined in the metropolitan whirl. In this regard, the architectural profession differs greatly from the literary and cinematographic ones. The destinies of the masters who fulfilled themselves far from the capital are different but equally bright and unique. The Irkutsk “Varangians”of the sixtieth – Voronezhsky, Bukh and Pavlov – built up their relations with geography in a different way:someone came from the capitals just for a few years that became the brightest, the most fruitful and the most interesting years of his creative life. But someone stayed in the non-metropolitan city for a long time and even forever. This subsection contains certain examples of self-fulfillment in the cities distant from the capitals: Khabarovsk, Irkutsk, Bratsk, Krasnoyarsk, Kemerovo and Anzhero-Sudzhensk.

Spousal caregivers and persons with dementia: Increasing participation in shared leisure activities among hospital-based dementia support program participants.

Science.gov (United States)

DiLauro, Michelle; Pereira, Amanda; Carr, Jennifer; Chiu, Mary; Wesson, Virginia

2015-02-20

Spousal caregivers of persons with dementia often have difficulty engaging persons with dementia in leisure activities. This qualitative descriptive study identifies how caregivers perceive their spouses' participation in leisure activities since dementia onset and the professional guidance caregivers require to increase persons with dementia participation in shared leisure activities. Nine spousal caregivers from a hospital-based caregiver intervention attended one of three focus groups. Using symbolic interactionism and selective optimization with compensation theory as guiding frameworks, thematic content analysis was performed. Three major themes were identified: Recognizing and acknowledging changes, Making sense of changes and conflicts, and Embracing changes and forging ahead. Findings can be used by healthcare providers to better understand caregivers' needs for engaging persons with dementia in shared leisure activities, and inform development of feedback protocols to enhance caregiver interventions. © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Smart City, Metropolitan Areas and Competitiveness: the Case Study of Florence

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Carmela Gargiulo

2015-07-01

Full Text Available In several urban contexts, the definition of a new development process is arising and it is focused on the use and the application of new technologies in different areas of the urban system. Such new development process is aimed at increasing life quality and local communities wellness and at promoting the creation of a more efficient and more sustainable urban system, as well as at making it more competitive. The issue of the reorganization of metropolitan areas is combined with such process, following the recent approval of the Delrio Law that establishes the Metropolitan City in Italy, as government authority of the metropolitan areas. Smart City, Metropolitan Areas and Competitiveness are the three topics of this paper, which aim is the description of the most innovative politics and initiatives adopted in the Metropolitan City of Florence that is proposed as a case study where such topics are combined.

Burnout syndrome in dental surgeons from Lima Metropolitan hospitals

OpenAIRE

Robles Velásquez, Ronald; Cáceres Gutiérrez, Lita

2014-01-01

This research was carried out in a probabilistic randomized sample of 117 dental surgeons who work in hospitals from the Armed Forces, Social Security and the Ministry of Health (MINSA) from Lima and El Callao, during the months of March and April 2008. Its objective was to determine the levels of the Burnout Syndrome in this population and its association with some socio-demographic, labor and general health variables. The Maslash Burnout Inventory questionnaire, as well as a personal data s...

40 CFR 81.63 - Metropolitan Fort Smith Interstate Air Quality Control Region.

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 17 2010-07-01 2010-07-01 false Metropolitan Fort Smith Interstate Air... Air Quality Control Regions § 81.63 Metropolitan Fort Smith Interstate Air Quality Control Region. The Metropolitan Fort Smith Interstate Air Quality Control Region (Arkansas-Oklahoma) has been revised to consist...

Audit of appendicectomies at Frere Hospital | Rogers | South African ...

African Journals Online (AJOL)

Objective. We sought to evaluate the surgical service in the central part of the Eastern Cape Province by reviewing the practice of appendicectomy at Frere Hospital. Specifically, it was our aim to compare the service to those patients who reside in and outside the East London metropolitan area and the outcomes of patients ...

Participation of the family in hospital-based palliative cancer care: perspective of nurses

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Marcelle Miranda da Silva

Full Text Available The objective was to understand the perspective of nurses about the participation of the family in palliative cancer care and to analyze the nursing care strategies to meet their needs. Descriptive and qualitative research, conducted at the National Cancer Institute between January and March 2013, with 17 nurses. Elements of the Roy Adaptation Model were used for the interpretation of the data. Two categoriesemergedfrom the thematic analysis: perspective of nurses about the presence and valuation of family in the hospital; and appointing strategies to encourage family participation in care and meet their needs. This participation is essentialand represents a training opportunity for the purpose of homecare. Nurses create strategies to encourage it and seek to meet the needs. The results contribute to promote the family adaptation and integrity, in order to balance the dependent and independent behaviors, aimingfor quality of life and comfort. Further studies are neededdue to the challenges of the specialty.

[Communication, participation and leadership in the perception of the emotional climate in a university hospital in Andalusia, Spain].

Science.gov (United States)

Danet, Alina; March, Joan Carles; Romera, Inmaculada García

2014-03-01

The aim of this study was to identify and analyze perceptions and opinions among health professionals in a university hospital in Andalusia, Spain, regarding the emotional climate, leadership style, quality of information, and internal communication. The study also aimed to collect health professionals' suggestions for improving these workplace characteristics. The study included 730 participants and used a quantitative and qualitative methodology. The results reflect a medium-to-low level of emotional climate, correlated with the leadership style and information and internal communication. Statistically significant differences appeared when comparing professional categories and hospital units. The health professionals provided a positive assessment of the administrators' work, although requiring more task-oriented, participative, and affiliative leadership skills.

23 CFR 450.336 - Applicability of NEPA to metropolitan transportation plans and programs.

Science.gov (United States)

2010-04-01

... the Secretary concerning a metropolitan transportation plan or TIP developed through the processes... 23 Highways 1 2010-04-01 2010-04-01 false Applicability of NEPA to metropolitan transportation... TRANSPORTATION PLANNING AND RESEARCH PLANNING ASSISTANCE AND STANDARDS Metropolitan Transportation Planning and...

Weaknesses and capacities affecting the Prehospital emergency care for victims of road traffic incidents in the greater Kampala metropolitan area: a cross-sectional study.

Science.gov (United States)

Balikuddembe, Joseph Kimuli; Ardalan, Ali; Khorasani-Zavareh, Davoud; Nejati, Amir; Raza, Owais

2017-10-03

Pre-hospital emergency care is a vital and integral component of health systems particularly in the resource constrained countries like Uganda. It can help to minimize deaths, injuries, morbidities, disabilities and trauma caused by the road traffic incidents (RTIs). This study identifies the weaknesses and capacities affecting the pre-hospital emergency care for the victims of RTIs in the Greater Kampala Metropolitan Area (GKMA). A cross-sectional study was conducted in the GKMA using a three-part structured questionnaire. Data related to the demographics, nature of RTIs and victims' pre-hospital experience and existing Emergency Medical Services (EMS) were collected from victims and EMS specialists in 3 hospitals and 5 EMS institutions respectively. Data was descriptively analyzed, and after the principal component analysis was employed to identify the most influential weaknesses and capacities affecting the pre-hospital emergency care for the victims of RTI in the GKMA. From 459 RTI victims (74.7% males and 25.3% females) and 23 EMS specialists (91.3% males and 8.7% females) who participated in the study between May and June 2016, 4 and 5 key weaknesses and capacities respectively were identified to affect the pre-hospital emergency care for RTI victims in the GKMA. Although some strengths exist like ambulance facilitation, EMS structuring, coordination and others), the key weaknesses affecting the pre-hospital care for victims were noted to relate to absence of predefined EMS systems particularly in the GKMA and Uganda as a whole. They were identified to involve poor quality first aid treatment; insufficient skills/training of the first responders; inadequate EMS resources; and avoidable delays to respond and transport RTI victims to medical facilities. Though some strengths exist, the weaknesses affecting prehospital care for RTI victims primarily emanate from the absence of predefined and well-organized EMS systems in the GKMA and Uganda as a whole.

The food environment and adult obesity in US metropolitan areas.

Science.gov (United States)

Michimi, Akihiko; Wimberly, Michael C

2015-11-26

This research examines the larger-scale associations between obesity and food environments in metropolitan areas in the United States (US). The US Census County Business Patterns dataset for 2011 was used to construct various indices of food environments for selected metropolitan areas. The numbers of employees engaged in supermarkets, convenience stores, full service restaurants, fast food restaurants, and snack/coffee shops were standardised using the location quotients, and factor analysis was used to produce two uncorrelated factors measuring food environments. Data on obesity were obtained from the 2011 Behavioral Risk Factor Surveillance System. Individual level obesity measures were linked to the metropolitan area level food environment factors. Models were fitted using generalised estimating equations to control for metropolitan area level intra-correlation and individual level sociodemographic characteristics. It was found that adults residing in cities with a large share of supermarket and full-service restaurant workers were less likely to be obese, while adults residing in cities with a large share of convenience store and fast food restaurant workers were more likely to be obese. Supermarkets and full-service restaurant workers are concentrated in the Northeast and West of the US, where obesity prevalence is relatively lower, while convenience stores and fast-food restaurant workers are concentrated in the South and Midwest, where obesity prevalence is relatively higher. The food environment landscapes measured at the metropolitan area level explain the continental-scale patterns of obesity prevalence. The types of food that are readily available and widely served may translate into obesity disparities across metropolitan areas.

Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and Fiscal Year 2014 rates; quality reporting requirements for specific providers; hospital conditions of participation; payment policies related to patient status. Final rules.

Science.gov (United States)

2013-08-19

We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems. Some of the changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and other legislation. These changes will be applicable to discharges occurring on or after October 1, 2013, unless otherwise specified in this final rule. We also are updating the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. The updated rate-of-increase limits will be effective for cost reporting periods beginning on or after October 1, 2013. We also are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and implementing certain statutory changes that were applied to the LTCH PPS by the Affordable Care Act. Generally, these updates and statutory changes will be applicable to discharges occurring on or after October 1, 2013, unless otherwise specified in this final rule. In addition, we are making a number of changes relating to direct graduate medical education (GME) and indirect medical education (IME) payments. We are establishing new requirements or have revised requirements for quality reporting by specific providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities (IPFs)) that are participating in Medicare. We are updating policies relating to the Hospital Value-Based Purchasing (VBP) Program and the Hospital Readmissions Reduction Program. In addition, we are revising the conditions of participation (CoPs) for hospitals relating to the

Metropolitan vision making - using backcasting as a strategic learning process to shape metropolitan futures

NARCIS (Netherlands)

Neuvonen, A.; Ache, P.M.

2014-01-01

Abstract: The need for new forward looking tools in urban planning is immense: The new functional relations and structures are stretching beyond our capacity to 'rationally' capture modern metropolitan spaces Neuman & Hull 2009). At the same time cities struggle to find tools to help manage a

[Prenatal patient cards and quality of prenatal care in public health services in Greater Metropolitan Vitória, Espírito Santo State, Brazil].

Science.gov (United States)

Santos Neto, Edson Theodoro dos; Oliveira, Adauto Emmerich; Zandonade, Eliana; Gama, Silvana Granado Nogueira da; Leal, Maria do Carmo

2012-09-01

This study aimed to assess the completeness of prenatal care information on the patients' prenatal care cards, according to coverage by various public health services: Family Health Strategy (FHS), Community-Based Health Workers' Program (CBHWP), and traditional Primary Care Units (PCU) in Greater Metropolitan Vitória, Espírito Santo State, Brazil. In a cross-sectional study, 1,006 prenatal cards were randomly selected from postpartum women at maternity hospitals in the metropolitan area. Completeness of the cards was assessed according to the criteria proposed by Romero & Cunha, which measure the quality on a scale from excellent ( 50% incomplete cards). In general, completion of information on the cards was bad (> 20% incomplete), but cards were filled out better in the FHS than in the CBHWP and PCU, especially for tetanus vaccination (p = 0.016) and gestational weight (p = 0.039). In conclusion, the quality of prenatal care in the public health system in Greater Metropolitan Vitória fails to meet the Brazilian national guidelines for maternal and child health.

Pent-up demand for surgery in the Manaus metropolitan region: A population-based cross-sectional study.

Science.gov (United States)

Ferreira, Priscila Gusmão da Silva; Galvao, Tais Freire; Silva, Marcus Tolentino

2017-08-01

Waiting lines in healthcare reflect an imbalance between the availability and the demand for medical services. This study aimed to analyze the prevalence and factors associated with the pent-up demand for surgical procedures in the Manaus metropolitan region.We performed a population-based cross-sectional study in 2015. Pent-up demand was based on self-report by the participants; those who reported waiting were contacted by phone to clarify the nature and reasons for the experienced delay.We interviewed 4001 adults in their households. The pent-up demand for surgical procedures in the Manaus metropolitan region was 14% (95% confidence interval: 13-15%). The surgical specialties with the highest demand included orthopedics (18.1%), gynecology (17.0%), ophthalmology (12.4%), neurosurgery (10.8%), and general surgery (10.2%). The main reason for not accessing services was their lack of availability in the public health system, leading some patients to pay for procedures in private facilities. The populations most affected by pent-up demand included elderly individuals, women, and housewives.Pent-up demand for surgical procedures is a common problem in the Manaus metropolitan region and thus requires coordinated actions to optimize access to and capacity of the healthcare system.

Nurses' perceptions of and participation in continuing nursing education: results from a study of psychiatric hospital nurses in Bahrain.

Science.gov (United States)

Al-Majid, Sadeeka; Al-Majed, Hashmiya; Rakovski, Cyril S; Otten, Rebecca A

2012-05-01

Although many psychiatric hospital nurses in Bahrain attend at least one continuing nursing education (CNE) activity per year, many others do not. This study explored these nurses' perceptions of CNE and factors that promote or hinder participation in CNE activities. A descriptive design was used to gather data from a convenience sample of 200 nurses working at the psychiatric hospital in Bahrain. Nurses believed that CNE improved the quality of patient care and patient outcomes, increased nurses' knowledge and skills, and kept them current with advances in nursing. Participation in CNE was hindered by unavailability of CNE activities related to psychiatric nursing. The majority of nurses had positive perceptions of CNE. Their participation was hindered by unavailability of CNE activities related to psychiatric nursing. Those responsible for planning continuing education in Bahrain should consider these findings when planning future CNE activities. Copyright 2012, SLACK Incorporated.

78 FR 53270 - Revision of Air Quality Implementation Plan; California; Sacramento Metropolitan Air Quality...

Science.gov (United States)

2013-08-29

... Quality Implementation Plan; California; Sacramento Metropolitan Air Quality Management District... to the Sacramento Metropolitan Air Quality Management District (SMAQMD or District) portion of the..., Sacramento Metropolitan Air Quality Management District, Rule 214 (Federal New Source Review), Rule 203...

Legislation and water management of water source areas of São Paulo Metropolitan Region, Brazil

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Luis Eduardo Gregolin Grisotto

2010-12-01

Full Text Available This paper presents the history of occupation in the water source areas in São Paulo Metropolitan Region (hereinafter SPMR and the evolution of the legislation related to this issue, from the point of view of the environmental and water management. A descriptive methodology was used, with searches into bibliographical and documental materials, in order to present the main laws for the protection of the water supply areas of SPMR and environmental and water management. It was possible to observe some progress in the premises of the both legislation and the format proposed for the management of the water source areas. However, such progress is limited due to the lack of a more effective mechanism for metropolitan management. The construction of the metropolitan management in SPMR would enlarge the capacity of integration between municipalities and sectors. The integration between the management of water and the land use management showed to be fundamental for the protection of the water sources. The new law for protection of the water sources, State Law nº 9.866/97, is decentralized and participative, focusing on non-structural actions and integrated management. However, the effective implementation of the law still depends on the harmonization of sectoral public policies, extensive coordination and cooperation among municipalities and the progress in the degree of the commitment of the governments.

Small-town migration to metropolitan centres: a case in Peninsular Malaysia.

Science.gov (United States)

Lee Boon Thong

1979-12-01

In Malaysia small towns are an important source of population gowth in metropolitan areas. To provide empirical evidence of the magnitude and roles of small urban centers as complementary sources of population growth in metropolitan areas, a small survey was conducted in 10 small towns in the State of Selangor. Criteria for the selection of these towns include a fair geographical spread over the State, and each area must characteristically possess a dominant urban center. The questionnaires were directed to the heads of 300 households with the intention of investigating the socioeconomic background of the households and the magnitude and characteristics of those members of the households who have migrated elsewhere. The total number of outmigrants from each area varied from 27-57, giving an overall average figure of 1.53 outmigrants/household. About 77% of the outmigrants had moved to the metropolitan centers. As the majority of the metropolitan migrants were more attracted to Kuala Lumpur, Klang, and Petaling Jaya, it may be assumed that the total outmigrants from small towns as derived would have consitituted about 39% of the population in the Klang Valley region. Based on this estimate, the role of small towns in metropolitan population growth is important. In the survey conducted, 2 broad categories of movements were involved: "economic movers," i.e., those who migrated to work or to establish businesses in the metropolitan areas; and "noneconomic movers," i.e., those who moved to continue their studies or to follow their spouses, and so forth. The economic mover stream made up 71% of the total metropolitan migrants. 2 variables--marital status and sex--were significantly related to the economic or noneconomic nature of the metropolitan migrants. The movement of males tended to be associated with economic motives whereas noneconomic reasons for movement tended to be the case among females migrants. The most important occupational group of the economically

Human milk use in Australian hospitals, 1949-1985.

Science.gov (United States)

Thorley, Virginia

2012-07-01

This paper will draw mainly on the experiences of fourteen women to explore the use of expressed human milk by hospitals in Australia from the postwar period through to 1985. The purpose is to provide a snapshot of common practices before the decline of human milk banking and other uses of expressed breastmilk in Australian hospitals, thus providing a source for future comparison against the more rigorous, uniform practices being instituted in the new milk banks of the early-21st century. The ten mothers included were a convenience sample drawn from the author's networks, with recruitment continuing till a range of hospital types and a majority of states were included. Three of the mothers also had experience as trainee midwives and midwives, and four midwives contributed their experiences as staff members, only. The hospitals ranged from large teaching hospitals to small private hospitals and were in metropolitan, regional and country locations. The practices included routine expression and expression for specific purposes, whether for the mother's own baby or to donate. Some hospitals pooled the donor milk for premature or sick babies.

Air pollution holiday effect in metropolitan Kaohsiung

Science.gov (United States)

Tan, P.; Chen, P. Y.

2014-12-01

Different from Taipei, the metropolitan Kaohsiung which is a coastal and industrial city has the major pollution sources from stationary sources such as coal-fired power plants, petrochemical facilities and steel plants, rather than mobile sources. This study was an attempt to conduct a comprehensive and systematical examination of the holiday effect, defined as the difference in air pollutant concentrations between holiday and non-holiday periods, over the Kaohsiung metropolitan area. We documented evidence of a "holiday effect", where concentrations of NOx, CO, NMHC, SO2 and PM10 were significantly different between holidays and non-holidays, in the Kaohsiung metropolitan area from daily surface measurements of seven air quality monitoring stations of the Taiwan Environmental Protection Administration during the Chinese New Year (CNY) and non-Chinese New Year (NCNY) periods of 1994-2010. Concentrations of the five pollutants were lower in the CNY than in the NCNY period, however, that of O3 was higher in the CNY than in the NCNY period and had no holiday effect. The exclusion of the bad air quality day (PSI > 100) and the Lantern Festival Day showed no significant effects on the holiday effects of air pollutants. Ship transportation data of Kaohsiung Harbor Bureau showed a statistically significant difference in the CNY and NCNY period. This difference was consistent with those found in air pollutant concentrations of some industrial and general stations in coastal areas, implying the possible impact of traffic activity on the air quality of coastal areas. Holiday effects of air pollutants over the Taipei metropolitan area by Tan et al. (2009) are also compared.

Printing activity of the Metropolitan Gavriil Banulescu Bodoni

Directory of Open Access Journals (Sweden)

Nicolae Fustei

2013-07-01

Full Text Available The present study is dedicated to the printing activity of the Metropolitan Gavriil Bănulescu-Bodoni’s activity. The religious and secular prints made from Chisinau’s Diocesan typography by Metropolitan Gavriil promote the idea of national unity of people from Moldavia, Wallachia and Transylvania. Due to the new documents from archives, more evidences and „more light” are being spread over the activity of famous hierarch, whose life is linked with the history of culture of three nations – Romanians, Ukrainians and Russians.

Polycentric Structures in Latin American Metropolitan Areas : Identifying Employment Sub-centres

NARCIS (Netherlands)

Fernández-Maldonado, Ana María; Romein, Arie; Verkoren, Otto|info:eu-repo/dai/nl/073181773; Parente Paula Pessoa, Renata

2014-01-01

Fernández-Maldonado A. M., Romein A., Verkoren O. and Parente Paula Pessoa R. Polycentric structures in Latin American metropolitan areas: identifying employment sub-centres, Regional Studies. The significant spatial transformations that have occurred within Latin American metropolitan areas since

Assessment of flood risk in Tokyo metropolitan area

Science.gov (United States)

Hirano, J.; Dairaku, K.

2013-12-01

Flood is one of the most significant natural hazards in Japan. The Tokyo metropolitan area has been affected by several large flood disasters. Therefore, investigating potential flood risk in Tokyo metropolitan area is important for development of adaptation strategy for future climate change. We aim to develop a method for evaluating flood risk in Tokyo Metropolitan area by considering effect of historical land use and land cover change, socio-economic change, and climatic change. Ministry of land, infrastructure, transport and tourism in Japan published 'Statistics of flood', which contains data for flood causes, number of damaged houses, area of wetted surface, and total amount of damage for each flood at small municipal level. By using these flood data, we estimated damage by inundation inside a levee for each prefecture based on a statistical method. On the basis of estimated damage, we developed flood risk curves in the Tokyo metropolitan area, representing relationship between damage and exceedance probability of flood for the period 1976-2008 for each prefecture. Based on the flood risk curve, we attempted evaluate potential flood risk in the Tokyo metropolitan area and clarify the cause for regional difference of flood risk. By analyzing flood risk curves, we found out regional differences of flood risk. We identified high flood risk in Tokyo and Saitama prefecture. On the other hand, flood risk was relatively low in Ibaraki and Chiba prefecture. We found that these regional differences of flood risk can be attributed to spatial distribution of entire property value and ratio of damaged housing units in each prefecture.We also attempted to evaluate influence of climate change on potential flood risk by considering variation of precipitation amount and precipitation intensity in the Tokyo metropolitan area. Results shows that we can evaluate potential impact of precipitation change on flood risk with high accuracy by using our methodology. Acknowledgments

Metropolization Process for enhancing local and regional planning : an experience of cirebon metropolitan, West Java

Science.gov (United States)

Supriyadi Rustidja, E.

2018-03-01

Metropolitan develops in line with resource utilization, investment, and transactions of regional activities. Metropolization of an area gives emerge urban economy that changes the situation, form, and pattern of urban space interactions. On the other hand, metropolism concerns the strategy of changing variation of urban space, so that metropolitan invasion not only form of urban space but also the process of interaction among stakeholders in developing metropolitan area. Based on participatory research, this article explores metropolitan invasion process for enhancing local and regional planning, both indigenous and intrusive cataclysmic. The study find that the primeval, rural, and urban as elemental environment must be considered in developing metropolitan, not merely form the structure and pattern of urban space. The metropolization process also requires the strategic of rural urban linkage, context setting and local assessment, strategic community investment, and interculturalist approach. The other findings of the study show that metropolization in Cirebon Metropolitan, West Java emphasizing on promotion of competitiveness strategy, value chain urban activities, and networking of urban areas. Cirebon Metropolitan must promote the realization of growth centers and connect the interregional activities of metropolitan area for providing sustainable economic growth.

40 CFR 81.43 - Metropolitan Toledo Interstate Air Quality Control Region.

Science.gov (United States)

2010-07-01

... Quality Control Region. 81.43 Section 81.43 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Air Quality Control Regions § 81.43 Metropolitan Toledo Interstate Air Quality Control Region. The Metropolitan Toledo Interstate Air Quality Control Region (Ohio-Michigan) consists of the territorial area...

40 CFR 81.31 - Metropolitan Providence Interstate Air Quality Control Region.

Science.gov (United States)

2010-07-01

... Quality Control Region. 81.31 Section 81.31 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Air Quality Control Regions § 81.31 Metropolitan Providence Interstate Air Quality Control Region. The Metropolitan Providence Interstate Air Quality Control Region (Rhode Island-Massachusetts) consists of the...

40 CFR 81.78 - Metropolitan Portland Intrastate Air Quality Control Region.

Science.gov (United States)

2010-07-01

... Quality Control Region. 81.78 Section 81.78 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Air Quality Control Regions § 81.78 Metropolitan Portland Intrastate Air Quality Control Region. The Metropolitan Portland Intrastate Air Quality Control Region (Maine) consists of the territorial area...

40 CFR 81.16 - Metropolitan Denver Intrastate Air Quality Control Region.

Science.gov (United States)

2010-07-01

... Quality Control Region. 81.16 Section 81.16 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Air Quality Control Regions § 81.16 Metropolitan Denver Intrastate Air Quality Control Region. The Metropolitan Denver Intrastate Air Quality Control Region (Colorado) consists of the territorial area...

40 CFR 81.29 - Metropolitan Indianapolis Intrastate Air Quality Control Region.

Science.gov (United States)

2010-07-01

... Air Quality Control Region. 81.29 Section 81.29 Protection of Environment ENVIRONMENTAL PROTECTION... Designation of Air Quality Control Regions § 81.29 Metropolitan Indianapolis Intrastate Air Quality Control Region. The Metropolitan Indianapolis Intrastate Air Quality Control Region consists of the territorial...

40 CFR 81.101 - Metropolitan Dubuque Interstate Air Quality Control Region.

Science.gov (United States)

2010-07-01

... Quality Control Region. 81.101 Section 81.101 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Air Quality Control Regions § 81.101 Metropolitan Dubuque Interstate Air Quality Control Region. The Metropolitan Dubuque Interstate Air Quality Control Region (Illinois-Iowa-Wisconsin) consists of the...

40 CFR 81.44 - Metropolitan Memphis Interstate Air Quality Control Region.

Science.gov (United States)

2010-07-01

... Quality Control Region. 81.44 Section 81.44 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Air Quality Control Regions § 81.44 Metropolitan Memphis Interstate Air Quality Control Region. The Metropolitan Memphis Interstate Air Quality Control Region (Arkansas-Mississippi-Tennessee) consists of the...

40 CFR 81.19 - Metropolitan Boston Intrastate Air Quality Control Region.

Science.gov (United States)

2010-07-01

... Quality Control Region. 81.19 Section 81.19 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Air Quality Control Regions § 81.19 Metropolitan Boston Intrastate Air Quality Control Region. The Metropolitan Boston Intrastate Air Quality Control Region (Massachusetts) consists of the territorial area...

40 CFR 81.28 - Metropolitan Baltimore Intrastate Air Quality Control Region.

Science.gov (United States)

2010-07-01

... Quality Control Region. 81.28 Section 81.28 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Air Quality Control Regions § 81.28 Metropolitan Baltimore Intrastate Air Quality Control Region. The Metropolitan Baltimore Intrastate Air Quality Control Region (Maryland) consists of the territorial area...

40 CFR 81.89 - Metropolitan Cheyenne Intrastate Air Quality Control Region.

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2010-07-01

... Quality Control Region. 81.89 Section 81.89 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Air Quality Control Regions § 81.89 Metropolitan Cheyenne Intrastate Air Quality Control Region. The Metropolitan Cheyenne Intrastate Air Quality Control Region (Wyoming) consists of the territorial area...

40 CFR 81.87 - Metropolitan Boise Intrastate Air Quality Control Region.

Science.gov (United States)

2010-07-01

... Quality Control Region. 81.87 Section 81.87 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Air Quality Control Regions § 81.87 Metropolitan Boise Intrastate Air Quality Control Region. The Metropolitan Boise Intrastate Air Quality Control Region (Idaho) consists of the territorial area encompassed...

40 CFR 81.75 - Metropolitan Charlotte Interstate Air Quality Control Region.

Science.gov (United States)

2010-07-01

... Quality Control Region. 81.75 Section 81.75 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Air Quality Control Regions § 81.75 Metropolitan Charlotte Interstate Air Quality Control Region. The Metropolitan Charlotte Interstate Air Quality Control Region (North Carolina-South Carolina) has been revised...

40 CFR 81.45 - Metropolitan Atlanta Intrastate Air Quality Control Region.

Science.gov (United States)

2010-07-01

... Quality Control Region. 81.45 Section 81.45 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Air Quality Control Regions § 81.45 Metropolitan Atlanta Intrastate Air Quality Control Region. The Metropolitan Atlanta Intrastate Air Quality Control Region (Georgia) has been revised to consist of the...

40 CFR 81.20 - Metropolitan Cincinnati Interstate Air Quality Control Region.

Science.gov (United States)

2010-07-01

... Quality Control Region. 81.20 Section 81.20 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Air Quality Control Regions § 81.20 Metropolitan Cincinnati Interstate Air Quality Control Region. The Metropolitan Cincinnati Interstate Air Quality Control Region (Ohio-Kentucky-Indiana) is revised to consist of...

40 CFR 81.34 - Metropolitan Dayton Intrastate Air Quality Control Region.

Science.gov (United States)

2010-07-01

... Quality Control Region. 81.34 Section 81.34 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Air Quality Control Regions § 81.34 Metropolitan Dayton Intrastate Air Quality Control Region. The Metropolitan Dayton Intrastate Air Quality Control Region consists of the territorial area encompassed by the...

40 CFR 81.41 - Metropolitan Birmingham Intrastate Air Quality Control Region.

Science.gov (United States)

2010-07-01

... Quality Control Region. 81.41 Section 81.41 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Air Quality Control Regions § 81.41 Metropolitan Birmingham Intrastate Air Quality Control Region. The Metropolitan Birmingham Intrastate Air Quality Control Region (Alabama) has been revised to consist of the...

40 CFR 81.14 - Metropolitan Chicago Interstate Air Quality Control Region.

Science.gov (United States)

2010-07-01

... Quality Control Region. 81.14 Section 81.14 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Air Quality Control Regions § 81.14 Metropolitan Chicago Interstate Air Quality Control Region. The Metropolitan Chicago Interstate Air Quality Control Region (Illinois-Indiana) is revised to consist of the...

Telehealth-based model of care redesign to facilitate local fitting and management of patients with a spinal fracture requiring a thoracic lumbar sacral orthosis in rural hospitals in New South Wales.

Science.gov (United States)

Gallagher, Ryan; Giles, Michelle; Morison, Jane; Henderson, Judith

2018-03-23

To develop and implement a telehealth-based model of care for spinal fractures requiring management with thoracic lumbar sacral orthoses that eliminates the need for transfer to a metropolitan tertiary referral hospital. Pre-post design observational study evaluating model of care implementation. Rural referral hospitals in a large NSW region covering metropolitan, rural and remote hospitals. Patients presenting with a thoracic or lumbar spine fracture requiring thoracic lumbar sacral orthoses management and rural clinicians caring for them. Number of patients managed in rural hospitals without transfer to a metropolitan tertiary referral hospital; length of stay and related cost efficiencies; clinicians' perceived skills, knowledge and confidence levels. Model of care was implemented with clinical and system governance processes; and educational workshops across eight rural hospitals. A total of 81 patients managed in rural hospitals under this model between July 2013 and June 2016 without transfer were included in this study. Mean length of stay reduced from nine to four days. Hospital transfers were eliminated from the patient journey, totalling 24 324 km. Workshops were attended by 71 clinicians from nine rural hospitals and survey findings indicated a significant increase in staff knowledge, skill and confidence post education. Cost efficiencies were gained by eliminating 162 inter-hospital transfers and 405 patient bed days. This model has streamlined patient journeys and reduced transfers and travel, enabling rural clinicians to provide specialised services in local communities and facilitating timely evidence-based care in local communities without any adverse events. © 2018 National Rural Health Alliance Ltd.

Spatial clustering of knowledge-based industries in the Helsinki Metropolitan Area

Directory of Open Access Journals (Sweden)

Juan Eduardo Chica

2016-01-01

Full Text Available The central locations of metropolitan areas have some specific attributes, leading to an accumulation of large knowledge exchanges and extensive knowledge externalities, which encourage the concentration of various economic activities, especially knowledge-based industries (KBI. Other agglomeration economies found in metropolitan areas – such as telecommunications and transport infrastructures connected to global productive circuits and complementary labour markets – are key factors for KBI employment growth. This paper explores the Helsinki Metropolitan Area’s (HMA spatial clustering of KBI at the sub-district level, and the role played by agglomeration economies (both specialization and diversity economies in fostering this process. The results reveal that KBI employment shows patterns of concentration in the core and adjacent areas. The specialization and diversity economies found in the metropolitan core and the specialization economies found in others areas lead to KBI spatial clustering in the HMA. Public policies regarding the promotion of science parks have also played a decisive role.

URBANIZATION AND SPATIAL CHANGES IN DEMOGRAPHIC CHARACTERISTICS IN MONTERREY METROPOLITAN REGION

Directory of Open Access Journals (Sweden)

Arun Kumar Acharya

2011-10-01

Full Text Available This paper tries to explore the process of urbanization and spatial changes in demographic features in the Monterrey Metropolitan Region (MMR, Mexico. This city is the third largest urban sector in Mexico which has around 4 million population. It is also the industrial and economic capital of the country. The present study found that rapid urbanization in the metropolitan region has a close association with process of industrialization. In population distribution and composition, study found that the metropolitan region had its “demographic transition” during the years seventies and currently the region is taking advantages of demographic bonus cohort, i.e. a higher concentration of population in economic active groups compare to children and old age population. However, this paper indentified a higher imbalance in metropolitan demographic scenario. On the one hand, there is di-populization in the city center region and in other there is a steady increment of population in peri-urban region.

[External workplace violence against doctors in hospital services in Lima Metropolitana, Peru 2014].

Science.gov (United States)

Tuya-Figueroa, Ximena; Mezones-Holguin, Edward; Monge, Eduardo; Arones, Ricardo; Mier, Milagros; Saravia, Mercedes; Torres, Jose; Mayta-Tristán, Percy

2016-01-01

. To calculate the frequency and factors associated with external workplace violence (EWV) against doctors in health inpatient services in the metropolitan area of Lima (Spanish: Lima Metropolitana), Peru. . A cross-sectional analytic study, which included doctors from the Ministry of Health (MINSA), Social Security (EsSalud), and the private subsector, was carried out. The frequency of EWV was measured throughout the entire professional practice during the previous 12 months and during the last month. Variables related to the doctor, assailant, and health service were measured. Raw and adjusted prevalence ratios (PR) were calculated by means of a Poisson-family generalized linear model with non-parametric bootstrapping. . A total of 406 doctors participated; 31.5% were victims of EWV at least once during their professional practice, with 19.9% over the past 12 months and 7.6% during the last month. The chances of being threatened in the last 12 months increased if the doctor was male (adjusted PR [aPR]: 1.7; 95% confidence interval [CI] = 1.1- 2.8), had graduated from a Peruvian university outside of the metropolitan area of Lima (aPR: 1.5; 95% CI = 1.1-2.4), worked at MINSA (aPR: 7.9; 95% CI = 2.24-50.73) or EsSalud (RR: 8.68; 95% CI = 2.26-56.17), and worked in the emergency (aPR: 1.9; 95% CI = 1.2-3.6) or operating room (aPR: 1.6; 95% CI = 1.1-2.3). Age, years of professional practice, or being a medical resident were not associated with EWV. . In the hospitals studied, a large number of doctors have been victims of EWV. Working in public services increases the possibility of violence. Implementation of support, identification, and primary prevention strategies in hospitals is recommended.

The Prevalence of HIV Risk Behaviors among Felony Drug Court Participants.

Science.gov (United States)

Festinger, David S; Dugosh, Karen L; Metzger, David S; Marlowe, Douglas B

2012-01-01

A small percentage of participants in a large metropolitan felony Drug Court engaged in high-risk injection drug use, but a large percentage engaged in high-risk sexual behaviors. HIV risk behaviors were associated with being male, African-American, and younger. A large proportion of Drug Court participants resided in areas of the city with a high prevalence of persons living with HIV/AIDS, thus heightening the probability of exposure to the virus.

Acute adverse effects of radiation therapy on HIV-positive patients in Japan. Study of 31 cases at Tokyo Metropolitan Komagome Hospital

International Nuclear Information System (INIS)

Kaminuma, Takuya; Karasawa, Katsuyuki; Hanyu, Nahoko

2010-01-01

Recently, the number of human immunodeficiency virus (HIV)-positive patients has increased in Japan. HIV-positive patients are at a higher risk of cancer than the general population. This paper retrospectively reports the acute adverse effects of radiation therapy on HIV-positive patients who were treated at Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital (TMCICK). Thirty-one cases involving 24 HIV-positive cancer patients who were treated at TMCICK from January 1997 to March 2009 were included in this study. All acute adverse effects of radiation therapy were examined during, and one month after, the last radiation therapy session. Acute adverse effects were classified according to the site of radiation therapy treatment and analyzed using the Common Terminology Criteria for Adverse Events (CTCAE) version 3.0. Grade 3 acute adverse effects were seen in 17% of cases, and Grade 2 toxicities were found in 23% of patients. Damage to the skin and mucosa, including stomatitis or diarrhea, tended to occur after low-dose radiation therapy; however, no severe acute adverse effects were seen in other organs, such as the brain, lung, and bone. Acute adverse effects tended to occur earlier in HIV-positive patients and became severe more frequently than in the general population. In particular, disorders of the mucosa, such as those of the oral cavity, pharynx, and intestine, tended to occur rapidly. It was shown that radiation therapy is safe when treatment is performed carefully and that it is a very useful treatment for cancer in HIV-positive patients. (author)

Implications of urban structure on carbon consumption in metropolitan areas

International Nuclear Information System (INIS)

Heinonen, Jukka; Junnila, Seppo

2011-01-01

Urban structure influences directly or indirectly the majority of all green house gas (GHG) emissions in cities. The prevailing belief is that dense metropolitan areas produce less carbon emissions on a per capita basis than less dense surrounding rural areas. Consequently, density targets have a major role in low-carbon urban developments. However, based on the results of this study, the connection seems unclear or even nonexistent when comprehensive evaluation is made. In this letter, we propose a hybrid life cycle assessment (LCA) method for calculating the consumption-based carbon footprints in metropolitan areas, i.e. carbon consumption, with the emphasis on urban structures. The method is input-output-based hybrid LCA, which operates with the existing data from the region. The study is conducted by performing an analysis of the carbon consumption in two metropolitan areas in Finland, including 11 cities. Both areas consist of a dense city core and a less dense surrounding suburban area. The paper will illustrate that the influence of urban density on carbon emissions is insignificant in the selected metropolitan areas. In addition, the utilized consumption-based method links the climate effects of city-level development to the global production of emissions.

Towards a Metropolitan Fundamental Diagram Using Travel Survey Data

Science.gov (United States)

2016-01-01

Using travel diary data from 2000–2001 and 2010–2012 this research examines fundamental traffic relationships at the metropolitan level. The results of this paper can help to explain the causes of some traffic phenomena. Network average speed by time of day can be explained by trip length and cumulative number of vehicles on the road. A clockwise hysteresis loop is found in the Metropolitan Fundamental Diagram in the morning period and a reverse process happens in the afternoon. PMID:26866913

Outpatient admissions and hospital costs of Syrian refugees in a Turkish university hospital.

Science.gov (United States)

Tahirbegolli, Bernard; Çavdar, Sabanur; Çetinkaya Sümer, Esin; Akdeniz, Sıdıka I; Vehid, Suphi

2016-07-01

To examine the most frequent admitted polyclinics, diagnoses, and the costs of Syrian refugee patient in a Turkish university hospital in the metropolitan city of Istanbul, Western part of Turkey.  Research methodology consist of analyzing outpatient admissions to the Hospital Polyclinics of Faculty of Medicine, Istanbul University, Cerrahpasa, Istanbul, Turkey from January-June 2014. We carried out diagnosis groups as classified in the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification, and analyzed the hospital cost of first admission through records based in the hospital information system.  Median age of 251 Syrian refugee patients is 19 years, inter quartile rate 7-34 years. Patients aged 65 and older compared with those until 18 years and 19 to 64 years aged groups have made statistically significant (p less than 0.001) less hospital admissions. The Most frequented clinic was the emergency clinic. On June there have been significantly (p less than 0.001) more admissions compared with other months. The most common diagnoses were diseases of the respiratory system. The costs of per admission was estimated nearly 48 US Dollar/per patient and the total amount of hospital admissions was 12,031.93 US Dollar.  On the specified dates, the clinics were mostly frequented from Syrian refugees until 18 years group. The most common presenting symptoms are respiratory diseases and most frequented clinic is emergency.

Metropolitan Quantum Key Distribution with Silicon Photonics

Science.gov (United States)

Bunandar, Darius; Lentine, Anthony; Lee, Catherine; Cai, Hong; Long, Christopher M.; Boynton, Nicholas; Martinez, Nicholas; DeRose, Christopher; Chen, Changchen; Grein, Matthew; Trotter, Douglas; Starbuck, Andrew; Pomerene, Andrew; Hamilton, Scott; Wong, Franco N. C.; Camacho, Ryan; Davids, Paul; Urayama, Junji; Englund, Dirk

2018-04-01

Photonic integrated circuits provide a compact and stable platform for quantum photonics. Here we demonstrate a silicon photonics quantum key distribution (QKD) encoder in the first high-speed polarization-based QKD field tests. The systems reach composable secret key rates of 1.039 Mbps in a local test (on a 103.6-m fiber with a total emulated loss of 9.2 dB) and 157 kbps in an intercity metropolitan test (on a 43-km fiber with 16.4 dB loss). Our results represent the highest secret key generation rate for polarization-based QKD experiments at a standard telecom wavelength and demonstrate photonic integrated circuits as a promising, scalable resource for future formation of metropolitan quantum-secure communications networks.

Metropolitan siting: a historical perspective

International Nuclear Information System (INIS)

Bunch, D.F.

1978-09-01

The paper discusses the development and implementation of the Reactor Site Criteria and particularly the evolving posture of the agency on the subject of metropolitan siting. The review actions on nine sites are described to illustrate the various issues and positions and to clarify at least some of the bases for current practices of the NRC staff

Disparities experienced by Aboriginal compared to non-Aboriginal metropolitan Western Australians in receiving coronary angiography following acute ischaemic heart disease: the impact of age and comorbidities.

Science.gov (United States)

Lopez, Derrick; Katzenellenbogen, Judith M; Sanfilippo, Frank M; Woods, John A; Hobbs, Michael S T; Knuiman, Matthew W; Briffa, Tom G; Thompson, Peter L; Thompson, Sandra C

2014-10-21

Aboriginal Australians have a substantially higher frequency of ischaemic heart disease (IHD) events than their non-Aboriginal counterparts, together with a higher prevalence of comorbidities. The pattern of health service provision for IHD suggests inequitable delivery of important diagnostic procedures. Published data on disparities in IHD management among Aboriginal Australians are conflicting, and the role of comorbidities has not been adequately delineated. We compared the profiles of Aboriginal and non-Aboriginal patients in the metropolitan area undergoing emergency IHD admissions at Western Australian metropolitan hospitals, and investigated the determinants of receiving coronary angiography. Person-linked administrative hospital and mortality records were used to identify 28-day survivors of IHD emergency admission events (n =20,816) commencing at metropolitan hospitals in 2005-09. The outcome measure was receipt of angiography. The Aboriginal to non-Aboriginal risk ratio (RR) was estimated from a multivariable Poisson log-linear regression model with allowance for multiple IHD events in individuals. The subgroup of myocardial infarction (MI) events was modelled separately. Compared with their non-Aboriginal counterparts, Aboriginal IHD patients were younger and more likely to have comorbidities. In the age- and sex-adjusted model, Aboriginal patients were less likely than others to receive angiography (RRIHD 0.77, 95% CI 0.72-0.83; RRMI 0.81, 95% CI 0.75-0.87) but in the full multivariable model this disparity was accounted for by comorbidities as well as IHD category and MI subtype, and private health insurance (RRIHD 0.95, 95% CI 0.89-1.01; RRMI 0.94, 95% CI 0.88-1.01). When stratified by age groups, this disparity was not significant in the 25-54 year age group (RRMI 0.95, 95% CI 0.88-1.02) but was significant in the 55-84 year age group (RRMI 0.88, 95% CI 0.77-0.99). The disproportionate under-management of older Aboriginal IHD patients is of

Non-metropolitan residential gated developments in the Western Cape Province, South Africa

CSIR Research Space (South Africa)

Spocter, M

2011-07-01

Full Text Available -metropolitan locale and the topic is also unexplored in the South African context. This research attempts to address this research gap by investigating the locations of gated developments in non-metropolitan towns of varying sizes in the Western Cape...

The diffusion of Magnet hospital recognition.

Science.gov (United States)

Abraham, Jean; Jerome-D'Emilia, Bonnie; Begun, James W

2011-01-01

Magnet recognition is promoted by many in the practice community as the gold standard of nursing care quality. The Magnet hospital population has exploded in recent years, with about 8% of U.S. general hospitals now recognized. The purpose of this study was to identify the characteristics that distinguish Magnet-recognized hospitals from other hospitals within the framework of diffusion theory. We conceptualize Magnet recognition as an organizational innovation and Magnet-recognized hospitals as adopters of the innovation. We hypothesize that adoption is associated with selected characteristics of hospitals and their markets. The study population consists of the 3,657 general hospitals in the United States in 2008 located in metropolitan or micropolitan areas. We used logistic regression analysis to estimate the association of Magnet recognition with organizational and market characteristics. Empirical results support hypotheses that adoption is positively associated with hospital complexity and specialization, as measured by teaching affiliation, and with hospital size, slack resources, and not-for-profit or public ownership (vs. for-profit). Adopters also are more likely to be located in markets that are experiencing population growth and are more likely to have competitor hospitals within the market that also have adopted Magnet status. A positive association of adoption with baccalaureate nursing school supply is contrary to the hypothesized relationship. Because of its rapid recent growth, consideration of Magnet program recognition should be on the strategic planning agenda of hospitals and hospital systems. Hospital administrators, particularly in smaller, for-profit hospitals, may expect more of their larger not-for-profit competitors, particularly teaching hospitals, to adopt Magnet recognition, increasing competition for baccalaureate-prepared registered nurses in the labor market.

Comparison of daytime and night-time populations adjacent to interstate highways in metropolitan areas

International Nuclear Information System (INIS)

Mills, G.S.; Neuhauser, K.S.

1999-01-01

Daytime and night-time population densities bordering Interstate highway routes in metropolitan areas are compared at the traffic analysis zone level. In three of the metropolitan areas studied, histograms of daytime to night-time population density ratios are peaked at 1.0. In a smaller metropolitan area, the peak of the histogram moves to values greater than 1.0 but less than 2.0. In view of the typical uncertainties in calculating radiological transport effects (∼2), this study indicates that a distinction between daytime and night-time transport is not warranted, especially since a typical route includes extensive transport outside metropolitan areas. (author)

Attitudes of pregnant women towards personally controlled electronic, hospital-held, and patient-held medical record systems: a survey study.

Science.gov (United States)

Quinlivan, Julie A; Lyons, Sarah; Petersen, Rodney W

2014-09-01

On July 1, 2012 the Australian Government launched the personally controlled electronic health record (PCEHR). This article surveys obstetric patients about their medical record preferences and identifies barriers to adoption of the PCEHR. A survey study was conducted of antenatal patients attending a large Australian metropolitan hospital. Consecutive patients completed questionnaires during the launch phase of the PCEHR system. Quantitative and qualitative data were collected on demographics, computer access and familiarity, preference for medical record system, and perceived benefits and concerns. Of 528 women eligible to participate, 474 completed the survey (89.8%). Respondents had high levels of home access to a computer (90.5%) and the Internet (87.1%) and were familiar with using computers in daily life (median Likert scale of 9 out of 10). Despite this, respondents preferred hospital-held paper records, and only one-third preferred a PCEHR; the remainder preferred patient-held records. Compared with hospital-held paper records, respondents felt a PCEHR would reduce the risk of lost records (padvantages and disadvantages with the PCEHR, although the majority still prefer existing record systems. To increase uptake, confidentiality, privacy, and control concerns need to be addressed.

Green Infrastructure Concept for JABODETABEKJUR Metropolitan Area

Science.gov (United States)

Tanuwidjaja, Gunawan; Gates Chang, Bill

2017-07-01

Sixty “Mega Cities” would emerge by 2015 catering of 600 million populations, and were threatened by the climate change, because of cyclones, flooding, etc. Jakarta became a metro region covering Jakarta, Bogor, Tangerang, Bekasi, Depok and Cianjur. Jakarta metropolitan faced the very high population growth, urban sprawling, traffic jams, flooding, green open space reduction, environmental degradation, urban slums and illegal street hawkers. Flooding and traffic congestions were the two most important issues to solve. SWOT analysis and urban design solutions were produced to create a sustainable solution. Related to transportation issues, Singapore Mass Rapid Transport (MRT) concept was evaluated. Meanwhile the Netherlands’ polder concept as well as Singapore’s Integrated Water Management were also analyzed. The development of above ground MRT as well as Busway could be developed to connect Jakarta Metropolitan Region. The networks were developed on the main toll road networks. The MRT and Busway would eventually replace the need of automobile use in the future. The Transit - Oriented - Development (TOD) with high density can be suggested to be concentrated nearby the MRT and Busway interchange stations. The Netherlands’ polder and were adopted for urban’ low-lying lands in Jakarta Metropolitan Region, A polder system was defined as the Integrated Man-made Drainage System consisting Dikes, Drains, Retention Ponds, Outfall Structures or Pumping Stations. The polder system was proposed to be extended to Tangerang and Bekasi area.

Factors Influencing Patronage Of Medical Tourism In Metropolitan Lagos Nigeria

Directory of Open Access Journals (Sweden)

Omisore

2015-08-01

Full Text Available Since medical tourism attract patient from various origin to seek medical services at different destinations it is paramount to consider the factors that motivate patrons decision on medical tourism. Hence this study assesses the factors influencing patronage of medical tourism in Lagos metropolis Nigeria. Lagos State is situated in the southwestern corner of Nigeria it lies within Latitudes 62N to 64N of the Equator and Longitudes 245E to 420E of the Greenwich meridian. Metropolitan Lagos is a statistical division and not an administrative unit it extends over 16 of the 20 LGAs of Lagos State it contains 88 of the population of Lagos State and includes semi-rural areas. Data were collected from primary source. Primary data collection was carried out through the use of structured questionnaire. Systematic sampling technique was employed to select 15 specialized private hospitals and 14 Public hospitals in the study area resulting to a sample size of 29 hospitals. Ten 10 patrons were contacted in each of the selected hospitals consequently 290 patrons were sampled. The study revealed three factors influencing patronage of medical tourism in the study area to be service related economic and facilities. These were further established by factor analysis result which combine service related economic factor as factor one with 29.5 variance explained and Eigen value of 5.605 Facility factor as factor two with 28.6 variance explained and Eigen value of 5.435 Service related factor as factor three with 14.7 variance explained and Eigen value of 2.788 and Economic factor as factor four with 9.2 variance explained and Eigen value of 1.754. The relevant authority in charge of health facilities in the study area would have to employ adequate manpower in-terms of doctors and other healthcare personnel across the public hospital while also regulating the scale of charges of the registered private hospitals in the study area. There is need to improve upon the

The metropolitan VoD system based on ethernet/SCM PON

Science.gov (United States)

Ji, Wei; Yang, Hongliang; Feng, Dejun; Liu, Yang; Sun, Jande

2008-11-01

VoD is a very attractive service which used for entertainment, education and other purposes. In this paper, we present an evolution method that integrates the EPON and SCM-PON by WDM technology to provide high dedicated bandwidth for the metropolitan VoD services. Using DVB, IPTV protocol, unicasting and broadcasting method to maximize the system throughput and by numerical analysis, the hybrid PON system can implement the metropolitan VoD services.

Polycentric Metropolitan Form: Application of a ‘Northern’ Concept in Latin America

Directory of Open Access Journals (Sweden)

Arie Romein

2014-07-01

Full Text Available Since the mid 20th century, large urban areas in advanced economies have experienced a fundamental transformation from relatively compact monocentric cities towards more extended polycentric metropolitan areas. By now, it is being commented repeatedly, but not investigated systematically that the concept of polycentricity is also adequate to characterise recent metropolitan dynamics in Latin-America.This paper aims to present a few key-issues for a future research agenda into polycentricity in Latin-American metropolitan areas. These elements are identified from a review of existing literature. Since no clear-cut definition and operationalisation of polycentricity exist yet, we distinguish some key-elements of this phenomenon in North America as a frame of reference for this review. It reveals that ‘polycentricity U.S. style’ is at best dawning in Latin-America. In order to achieve a more appropriate picture of polycentricity of Latin American metropolitan areas, our ideas for a research agenda take into account these areas typical economic, social and spatial conditions.

[Participation of one children hospital residents in scientific and training activities of Sociedad Argentina de Pediatría].

Science.gov (United States)

Davenport, María Carolina; Domínguez, Paula Alejandra; Martins, Andrea Elizabeth

2012-04-01

The Sociedad Argentina de Pediatría, SAP (Argentine Society of Pediatrics) offers courses and scientific activities for pediatricians and residents. We evaluated the participation of Pedro de Elizalde Hospital residents in the scientific and training activities of SAP and assessed the trend of participation throughout the residency; 107 residents were surveyed; 48% were members, and the participation increased significantly throughout the residence (p <0.01). None of the surveyed residents were part of any association; 84% did not know the "Pediatricians in Training Group"; 49% participated in continued training programs, with a growing tendency to participation through-out the residency (p <0.01); 80% considered that the SAP is a friendly entity. We concluded that participation of residents in the SAP is scarce during the first two years of training, and that it shows a growth in the senior residents' group. Encouraging the interest of first and second year residents in the activities is necessary.

Metropolitan Quantum Key Distribution with Silicon Photonics

Directory of Open Access Journals (Sweden)

Darius Bunandar

2018-04-01

Full Text Available Photonic integrated circuits provide a compact and stable platform for quantum photonics. Here we demonstrate a silicon photonics quantum key distribution (QKD encoder in the first high-speed polarization-based QKD field tests. The systems reach composable secret key rates of 1.039 Mbps in a local test (on a 103.6-m fiber with a total emulated loss of 9.2 dB and 157 kbps in an intercity metropolitan test (on a 43-km fiber with 16.4 dB loss. Our results represent the highest secret key generation rate for polarization-based QKD experiments at a standard telecom wavelength and demonstrate photonic integrated circuits as a promising, scalable resource for future formation of metropolitan quantum-secure communications networks.

Rural hospital ownership: medical service provision, market mix, and spillover effects.

Science.gov (United States)

Horwitz, Jill R; Nichols, Austin

2011-10-01

To test whether nonprofit, for-profit, or government hospital ownership affects medical service provision in rural hospital markets, either directly or through the spillover effects of ownership mix. Data are from the American Hospital Association, U.S. Census, CMS Healthcare Cost Report Information System and Prospective Payment System Minimum Data File, and primary data collection for geographic coordinates. The sample includes all nonfederal, general medical, and surgical hospitals located outside of metropolitan statistical areas and within the continental United States from 1988 to 2005. We estimate multivariate regression models to examine the effects of (1) hospital ownership and (2) hospital ownership mix within rural hospital markets on profitable versus unprofitable medical service offerings. Rural nonprofit hospitals are more likely than for-profit hospitals to offer unprofitable services, many of which are underprovided services. Nonprofits respond less than for-profits to changes in service profitability. Nonprofits with more for-profit competitors offer more profitable services and fewer unprofitable services than those with fewer for-profit competitors. Rural hospital ownership affects medical service provision at the hospital and market levels. Nonprofit hospital regulation should reflect both the direct and spillover effects of ownership. © Health Research and Educational Trust.

The relationship of sport participation to provision of sports facilities and socioeconomic status: a geographical analysis.

Science.gov (United States)

Eime, Rochelle M; Harvey, Jack; Charity, Melanie J; Casey, Meghan; Westerbeek, Hans; Payne, Warren R

2017-06-01

Ecological models have been applied to investigate multiple domains influencing physical activity behaviour, including individual, social, organisational, community, environmental and policy factors. With regard to the built environment, research to date has been limited to small geographical areas and/or small samples of participants. This study examined the geographical association between provision of sport facilities and participation in sport across an entire Australian state, using objective total enumerations of both, for a group of sports, with adjustment for the effect of socioeconomic status (SES). De-identified membership registration data were obtained from state sport governing bodies of four popular team sports. Associations between participation rate, facility provision rate and SES were investigated using correlation and regression methods. Participation rate was positively associated with provision of facilities, although this was complicated by SES and region effects. The non-metropolitan region generally had higher participation rates and better provision of facilities than the metropolitan region. Better provision of sports facilities is generally associated with increased sport participation, but SES and region are also contributing factors. Implications for public health: Community-level analysis of the population, sport participation and provision of facilities should be used to inform decisions of investments in sports facilities. © 2017 The Authors.

Hospital emergency on-call coverage: is there a doctor in the house?

Science.gov (United States)

O'Malley, Ann S; Draper, Debra A; Felland, Laurie E

2007-11-01

The nation's community hospitals face increasing problems obtaining emergency on-call coverage from specialist physicians, according to findings from the Center for Studying Health System Change's (HSC) 2007 site visits to 12 nationally representative metropolitan communities. The diminished willingness of specialist physicians to provide on-call coverage is occurring as hospital emergency departments confront an ever-increasing demand for services. Factors influencing physician reluctance to provide on-call coverage include decreased dependence on hospital admitting privileges as more services shift to non-hospital settings; payment for emergency care, especially for uninsured patients; and medical liability concerns. Hospital strategies to secure on-call coverage include enforcing hospital medical staff bylaws that require physicians to take call, contracting with physicians to provide coverage, paying physicians stipends, and employing physicians. Nonetheless, many hospitals continue to struggle with inadequate on-call coverage, which threatens patients' timely access to high-quality emergency care and may raise health care costs.

High participation rate among 25 721 patients with broad age range in a hospital-based research project involving whole-genome sequencing - the Lausanne Institutional Biobank.

Science.gov (United States)

Bochud, Murielle; Currat, Christine; Chapatte, Laurence; Roth, Cindy; Mooser, Vincent

2017-10-24

We aimed to evaluate the interest of adult inpatients and selected outpatients in engaging in a large, real-life, hospital-based, genomic medicine research project and in receiving clinically actionable incidental findings. Within the framework of the cross-sectional Institutional Biobank of Lausanne, Switzerland, a total of 25721 patients of the CHUV University Hospital were systematically invited to grant researchers access to their biomedical data and to donate blood for future analyses, including whole-genome sequencing. Multivariable logistic regression analysis was used to identify personal factors, including age, gender, religion, ethnicity, citizenship, education level and mode of admission, associated with willingness to participate in this genomic research project and with interest in receiving clinically actionable incidental findings. The overall participation rate was 79% (20343/25721). Participation rate declined progressively with age, averaging 83%, 75%, 67% and 62% in patients aged rate, but not with higher willingness to receive incidental findings within the population who had agreed to participate. A large proportion of adult patients, even among the elderly, are willing to actively participate and receive incidental findings in this systematic hospital-based precision and genomic medicine research program with broad consent.

Sources of funding for adult and paediatric CT procedures at a metropolitan tertiary hospital: How much do Medicare statistics really cover?

Science.gov (United States)

Hayton, Anna; Wallace, Anthony; Johnston, Peter

2015-12-01

The radiation dose to the Australian paediatric population as a result of medical imaging is of growing concern, in particular the dose from CT. Estimates of the Australian population dose have largely relied on Medicare Australia statistics, which capture only a fraction of those imaging procedures actually performed. The fraction not captured has been estimated using a value obtained for a survey of the adult population in the mid-1990s. To better quantify the fraction of procedures that are not captured by Medicare Australia, procedure frequency and funding data for adult and paediatric patients were obtained from a metropolitan tertiary teaching and research hospital. Five calendar years of data were obtained with a financial class specified for each individual procedure. The financial classes were grouped to give the percentage of Medicare Australia billable procedures for both adult and paediatric patients. The data were also grouped to align with the Medicare Australia age cohorts. The percentage of CT procedures billable to Medicare Australia increased from 16% to 28% between 2008 and 2012. In 2012, the percentage billable for adult and paediatric patients was 28% and 33%, respectively; however, many adult CT procedures are performed at stand-alone clinics, which bulk bill. Using Medicare Australia statistics alone, the frequency of paediatric CT procedures performed on the Australian paediatric population will be grossly under estimated. A correction factor of 4.5 is suggested for paediatric procedures and 1.5 for adult procedures. The fraction of actual procedures performed that are captured by Medicare Australia will vary with time. © 2015 The Royal Australian and New Zealand College of Radiologists.

Hospital emergency preparedness and response during Superstorm Sandy.

Science.gov (United States)

2015-01-01

This article presents the findings of a report by the HHS Office of Inspector General (OIG) on the performance of 172 Medicare-certified hospitals in the New York Metropolitan Area before, during, and after Sandy. It makes recommendations on how to close gaps that were found in emergency planning and execution for a disaster of this magnitude. To download the complete 40-page report and a Podcast based on it, go to http://oig.hhs.gov/oei/ reports/oei-06-13-00260. asp.

Area Median Income and Metropolitan Versus Nonmetropolitan Location of Care for Acute Coronary Syndromes: A Complex Interaction of Social Determinants.

Science.gov (United States)

Fabreau, Gabriel E; Leung, Alexander A; Southern, Danielle A; James, Matthew T; Knudtson, Merrill L; Ghali, William A; Ayanian, John Z

2016-02-23

Metropolitan versus nonmetropolitan status and area median income may independently affect care for and outcomes of acute coronary syndromes. We sought to determine whether location of care modifies the association among area income, receipt of cardiac catheterization, and mortality following an acute coronary syndrome in a universal health care system. We studied a cohort of 14 012 acute coronary syndrome patients admitted to cardiology services between April 18, 2004, and December 31, 2011, in southern Alberta, Canada. We used multivariable logistic regression to determine the odds of cardiac catheterization within 1 day and 7 days of admission and the odds of 30-day and 1-year mortality according to area median household income quintile for patients presenting at metropolitan and nonmetropolitan hospitals. In models adjusting for area income, patients who presented at nonmetropolitan facilities had lower adjusted odds of receiving cardiac catheterization within 1 day of admission (odds ratio 0.22, 95% CI 0.11-0.46, Pcommunities. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Regional differences in commuting activities of inhabitants in the Tokyo metropolitan suburb

Directory of Open Access Journals (Sweden)

Masaki Kawase

2004-12-01

Full Text Available The purpose of this study is to elucidate gender differences and regional differences of co-mmuting activities by inhabitants in Japanese metropolitan suburbs. I found the different parts by districts in the metropolitan suburb. Regional factors cause gender differences in commuting activities and result in regional differences: In residential areas, inhabitants who work in metropolitan centers occupy much of the population. In older built-up areas, there are many “local” persons. In rural areas, motorization is progressing because access to rail-roads has been inconvenient. These regional factors influence the behavioral characteristics of commuting by married men, married women, never married men and never married women.

20 CFR 655.1111 - Element I-What hospitals are eligible to participate in the H-1C program?

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Element I-What hospitals are eligible to participate in the H-1C program? 655.1111 Section 655.1111 Employees' Benefits EMPLOYMENT AND TRAINING... Internet website at http://www.access.gpo.gov. (d) To make a determination about information in the settled...

Barriers to Participation in an Online Nursing Journal Club at a Community Teaching Hospital.

Science.gov (United States)

Rodriguez, Christopher; Victor, Carol; Leonardi, Nathaniel; Sulo, Suela; Littlejohn, Gina

2016-12-01

HOW TO OBTAIN CONTACT HOURS BY READING THIS ISSUE Instructions: 1.2 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded after you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. In order to obtain contact hours you must: 1. Read the article, "Barriers to Participation in an Online Nursing Journal Club at a Community Teaching Hospital," found on pages 536-542, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website to register for contact hour credit. You will be asked to provide your name, contact information, and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until November 30, 2019. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. OBJECTIVES Describe the benefits and barriers to participating in an online nursing journal club (ONJC) over a

An indoor radon survey of the X-ray rooms of Mexico City hospitals

Energy Technology Data Exchange (ETDEWEB)

Juarez, Faustino [Facultad de Ciencias, Universidad Autonoma del Estado de Mexico, Instituto Literario No. 100. Estado de Mexico, 50000, Mexico. Instituto de Geofisica, Universidad Nacional Autonoma de Mexico, Circuito (Mexico); Reyes, Pedro G. [Facultad de Ciencias, Universidad Autonoma del Estado de Mexico, Instituto Literario No. 100. Estado de Mexico, 50000 (Mexico); Espinosa, Guillermo [Instituto de Fisica, Universidad Nacional Autonoma de Mexico, Circuito Exterior Ciudad Universitaria, Mexico D.F. Cp.04510 (Mexico)

2013-07-03

This paper presents the results of measurements of indoor radon concentrations in the X-ray rooms of a selection of hospitals in the metropolitan area of Mexico City. The metropolitan area of Mexico City is Mexico's largest metropolitan area by population; the number of patients requiring the use of X-rays is also the highest. An understanding of indoor radon concentrations in X-ray rooms is necessary for the estimation of the radiological risk to which patients, radiologists and medical technicians are exposed. The indoor radon concentrations were monitored for a period of six months using nuclear track detectors (NTD) consisting of a closed-end cup system with CR-39 (Lantrack Registered-Sign ) polycarbonate as detector material. The indoor radon concentrations were found to be between 75 and 170 Bq m{sup -3}, below the USEPA-recommended indoor radon action level for working places of 400 Bq m{sup -3}. It is hoped that the results of this study will contribute to the establishment of recommended action levels by the Mexican regulatory authorities responsible for nuclear safety.

Emergency response planning in hospitals, United States: 2003-2004.

Science.gov (United States)

Niska, Richard W; Burt, Catharine W

2007-08-20

This study presents baseline data to determine which hospital characteristics are associated with preparedness for terrorism and natural disaster in the areas of emergency response planning and availability of equipment and specialized care units. Information from the Bioterrorism and Mass Casualty Preparedness Supplements to the 2003 and 2004 National Hospital Ambulatory Medical Care Surveys was used to provide national estimates of variations in hospital emergency response plans and resources by residency and medical school affiliation, hospital size, ownership, metropolitan statistical area status, and Joint Commission accreditation. Of 874 sampled hospitals with emergency or outpatient departments, 739 responded for an 84.6 percent response rate. Estimates are presented with 95 percent confidence intervals. About 92 percent of hospitals had revised their emergency response plans since September 11, 2001, but only about 63 percent had addressed natural disasters and biological, chemical, radiological, and explosive terrorism in those plans. Only about 9 percent of hospitals had provided for all 10 of the response plan components studied. Hospitals had a mean of about 14 personal protective suits, 21 critical care beds, 12 mechanical ventilators, 7 negative pressure isolation rooms, and 2 decontamination showers each. Hospital bed capacity was the factor most consistently associated with emergency response planning and availability of resources.

Changing Housing Patterns in Metropolitan Washington

Science.gov (United States)

Grier, George; Grier, Eunice

1975-01-01

This testimony, before a public hearing of the New York City Commission on Human Rights in May 1974, summarizes extensive studies of changing minority residential patterns in metropolitan Washington and less extensive studies of other groups; the prospects for future desegregation and for using the growing economic potential of minority families…

[The use of seatbelts and child seats in drivers and passengers of motor vehicles in four metropolitan areas in Mexico].

Science.gov (United States)

Cervantes-Trejo, Arturo; Leenen, Iwin

2015-01-01

To estimate the rate of seatbelt and child seat use in drivers and passengers of motor vehicles in four metropolitan areas in Mexico (Guadalajara, León, Monterrey and Mexico City). To evaluate the impact of the Mexican Initiative for Road Safety (IMESEVI) in this respect. Data were collected at the start of IMESEVI (June 2008) and one year after the program's implementation (October 2009) in the four participating metropolitan areas. In particular, the use of seatbelts and child seats was observed in occupants of automobiles, station wagons, and light trucks. The sample included 28,412 (pre) and 52,274 (post) individuals, of which 1,454 (pre) and 1,679 (post) were younger than five years old. The data analysis was based on a hierarchical logistic model. Globally, the probability of using either safety device is 46% (95% CI: 43-49%) at baseline and 52% (95% CI: 48-55%) at the post measurement, with large differences, though, among the four participating metropolitan areas. Factors that significantly affect their use include the individual's position in the vehicle, the type and age of the vehicle, and the individual's sex. Child seat use is very limited. At baseline, about 17% (95% CI: 11-25%) of children below five years old travelled in a special seat, with this number increasing to 26% (95% CI: 19-34%) after the implementation of IMESEVI. Child seat use for children above four years is virtually nonexistent. Continued efforts are required to raise the public awareness of the importance of using safety devices, especially for passengers in the back of the car as well as with respect to the use of adapted seats for small children.

Tokyo Metropolitan Earthquake Preparedness Project - A Progress Report

Science.gov (United States)

Hayashi, H.

2010-12-01

Munich Re once ranked that Tokyo metropolitan region, the capital of Japan, is the most vulnerable area for earthquake disasters, followed by San Francisco Bay Area, US and Osaka, Japan. Seismologists also predict that Tokyo metropolitan region may have at least one near-field earthquake with a probability of 70% for the next 30 years. Given this prediction, Japanese Government took it seriously to conduct damage estimations and revealed that, as the worst case scenario, if a7.3 magnitude earthquake under heavy winds as shown in the fig. 1, it would kill a total of 11,000 people and a total of direct and indirect losses would amount to 112,000,000,000,000 yen(1,300,000,000,000, 1=85yen) . In addition to mortality and financial losses, a total of 25 million people would be severely impacted by this earthquake in four prefectures. If this earthquake occurs, 300,000 elevators will be stopped suddenly, and 12,500 persons would be confined in them for a long time. Seven million people will come to use over 20,000 public shelters spread over the impacted area. Over one millions temporary housing units should be built to accommodate 4.6 million people who lost their dwellings. 2.5 million people will relocate to outside of the damaged area. In short, an unprecedented scale of earthquake disaster is expected and we must prepare for it. Even though disaster mitigation is undoubtedly the best solution, it is more realistic that the expected earthquake would hit before we complete this business. In other words, we must take into account another solution to make the people and the assets in this region more resilient for the Tokyo metropolitan earthquake. This is the question we have been tackling with for the last four years. To increase societal resilience for Tokyo metropolitan earthquake, we adopted a holistic approach to integrate both emergency response and long-term recovery. There are three goals for long-term recovery, which consists of Physical recovery, Economic

Earthquake Risk Mitigation in the Tokyo Metropolitan area

Science.gov (United States)

Hirata, N.; Sakai, S.; Kasahara, K.; Nakagawa, S.; Nanjo, K.; Panayotopoulos, Y.; Tsuruoka, H.

2010-12-01

Seismic disaster risk mitigation in urban areas constitutes a challenge through collaboration of scientific, engineering, and social-science fields. Examples of collaborative efforts include research on detailed plate structure with identification of all significant faults, developing dense seismic networks; strong ground motion prediction, which uses information on near-surface seismic site effects and fault models; earthquake resistant and proof structures; and cross-discipline infrastructure for effective risk mitigation just after catastrophic events. Risk mitigation strategy for the next greater earthquake caused by the Philippine Sea plate (PSP) subducting beneath the Tokyo metropolitan area is of major concern because it caused past mega-thrust earthquakes, such as the 1703 Genroku earthquake (magnitude M8.0) and the 1923 Kanto earthquake (M7.9) which had 105,000 fatalities. A M7 or greater (M7+) earthquake in this area at present has high potential to produce devastating loss of life and property with even greater global economic repercussions. The Central Disaster Management Council of Japan estimates that the M7+ earthquake will cause 11,000 fatalities and 112 trillion yen (about 1 trillion US$) economic loss. This earthquake is evaluated to occur with a probability of 70% in 30 years by the Earthquake Research Committee of Japan. In order to mitigate disaster for greater Tokyo, the Special Project for Earthquake Disaster Mitigation in the Tokyo Metropolitan Area (2007-2011) was launched in collaboration with scientists, engineers, and social-scientists in nationwide institutions. The results that are obtained in the respective fields will be integrated until project termination to improve information on the strategy assessment for seismic risk mitigation in the Tokyo metropolitan area. In this talk, we give an outline of our project as an example of collaborative research on earthquake risk mitigation. Discussion is extended to our effort in progress and

Spatio-temporal aspects of gated residential security estates in non-metropolitan Western Cape

CSIR Research Space (South Africa)

Spocter, M

2011-04-01

Full Text Available . This research attempts to address this research gap by focusing on the spatio-temporal aspects of non-metropolitan gated residential security estates in the Western Cape Province. It was found that most non-metropolitan gated residential security estates were...

Daily Mobility and Residential Migrations in the Montréal Metropolitan Region

Directory of Open Access Journals (Sweden)

Gilles Sénécal

2013-06-01

Full Text Available The purpose of this article is to simultaneously examine two types of mobility by developing a model of metropolitan organization that emphasizes the axis structure of mobility. The model is based on the realities of daily mobility and long-term residential mobility. Origin−Destination study results validated the axis representation of the metropolitan structure. Furthermore, building on data from a telephone survey, we considered the interactions between the two types of mobility along the Center-North axis of Montréal’s Census Metropolitan Area (CMA. The ensuing discussion on various models of metropolitan structure and their relevance today is framed in terms of the axes of mobility defined as territorial practices that are established within the patterns of daily life and are a significant factor in residential location decisions. The study raises broader issues concerning the relevance of drawing on standard models such as Burgess’s concentric zone model, Hoyt’s sector theory, Adam’s directional bias, or recent findings from the literature to understand urban form dynamics in the CMA.

Movement Technologies, Scale Structure and Metropolitan Life – an Empirical Research on the Effects of the Transportation System on the Metropolitan Process in Beijing

Directory of Open Access Journals (Sweden)

Qiang Sheng

2014-07-01

Full Text Available This paper is a morphological study on Beijing’s metropolitanisation process based on the development of its transportation networks. By extracting the ‘scale structure’ embedded in them, we construct a movement network model for Beijing and use it to analyse changing metropolitan centralities as shopping areas and market places in 1924, 1987 and 2006. Following Taylor’s proposal of Central Flow as a complementary model to Central Place, our study focuses on how the spatial distribution of metropolitan centralities has been affected by the rapid modernisation of transportation networks.

Helsinki Metropolitan Area Climate Change Adaptation Strategy

Energy Technology Data Exchange (ETDEWEB)

NONE

2012-07-01

The Helsinki Metropolitan Area Climate Change Adaptation Strategy has been prepared in close cooperation with the four cities of the metropolitan area (Helsinki, Espoo, Vantaa and Kauniainen), the Helsinki Region Environmental Services Authority HSY and other municipal, regional and state level organisations. In the strategy, strategic starting points and policies with which the metropolitan area prepares for the consequences of climate change, are compiled. The Helsinki Metropolitan Area adaptation strategy concentrates on the adaptation of the built and urban environment to the changing climate. The vision of the strategy is climate proof city - the future is built now. The strategy aims to (1) assess the impacts of climate change in the area, (2) prepare for the impacts of climate change and to extreme weather events and (3) to reduce the vulnerabilities of the area to climate variability and change. The target is to secure the well-being of the citizens and the functioning of the cities also in the changing climate conditions. The preparation of the adaptation strategy started in 2009 by producing the background studies. They include the regional climate and sea level scenarios, modelling of river floods in climate change conditions and a survey of climate change impacts in the region. Also, existing programmes, legislation, research and studies concerning adaptation were collected. The background studies are published in a report titled 'The Helsinki metropolitan area climate is changing - Adaptation strategy background studies' (in Finnish) (HSY 2010). HSY coordinated the strategy preparation. The work was carried out is close cooperation with the experts of the metropolitan area cities, regional emergency services, Ministry of the Environment, Helsinki Region Transport Authority and other regional organisations. The strategy work has had a steering group that consists of representatives of the cities and other central cooperation partners. The

Prescribing Patterns in Outpatient Clinics of Township Hospitals in China: A Comparative Study before and after the 2009 Health System Reform.

Science.gov (United States)

Ding, Ding; Pan, Qingxia; Shan, Linghan; Liu, Chaojie; Gao, Lijun; Hao, Yanhua; Song, Jian; Ning, Ning; Cui, Yu; Li, Ye; Qi, Xinye; Liang, Chao; Wu, Qunhong; Liu, Guoxiang

2016-07-05

China introduced a series of health reforms in 2009, including a national essential medicines policy and a medical insurance system for primary care institutions. This study aimed to determine the changing prescribing patterns associated with those reforms in township hospitals. A multi-stage stratified random cluster sampling method was adopted to identify 29 township hospitals from six counties in three provinces. A total of 2899 prescriptions were collected from the participating township hospitals using a systematic random sampling strategy. Seven prescribing indicators were calculated and compared between 2008 and 2013, assessing use of medicines (antibiotics and adrenal corticosteroids) and polypharmacy, administration route of medicines (injections), and affordability of medicines. Significant changes in prescribing patterns were found. The average number of medicines and costs per-prescription dropped by about 50%. The percentage of prescriptions requiring antibiotics declined from 54% to 38%. The percentage of prescriptions requiring adrenal corticosteroid declined from 14% to 4%. The percentage of prescriptions requiring injections declined from 54% to 25%. Despite similar changing patterns, significant regional differences were observed. Significant changes in prescribing patterns are evident in township hospitals in China. Overprescription of antibiotics, injections and adrenal corticosteroids has been reduced. However, salient regional disparities still exist. Further studies are needed to determine potential shifts in the risk of the inappropriate use of medicines from primary care settings to metropolitan hospitals.

Giving birth, going home: influences on when low-income women leave hospital.

Science.gov (United States)

Lichtenstein, Bronwen; Brumfield, Cynthia; Cliver, Suzanne; Chapman, Victoria; Lenze, Deanna; Davis, Valisia

2004-01-01

The US Newborns' and Mothers' Health Protection Act of 1996 ('The Two-Day Law') mandates insurance coverage for women who have just given birth to remain in hospital for two days post-partum. However, many women are being discharged from hospital after 24 hours. To assess why early discharge is still occurring, a study of 406 new mothers was conducted at an urban metropolitan hospital in the USA. The women were aware of the new law (95%) but decision making was often relinquished to hospital authorities. Patients who stayed longer tended to be more assertive in decision making, and used the Two-Day Law as leverage in discussions about going home. The study concluded that the nurses were authoritative and often influential agents in the decision-making process, and that patients were likely to interpret specific interactions with hospital staff as a signal to leave.

Findings from non-participant observational data concerning health promoting nursing practice in the acute hospital setting focusing on generalist nurses.

Science.gov (United States)

Casey, Dympna

2007-03-01

This paper reports on the non-participant observational findings from a study, which examined hospital-based nurses' health promoting nursing practice in an acute setting. Nurses are considered to have a key role in health promotion. However, the development of the role of the generalist hospital-based nurse in health promotion has been slow and is not well-understood. The conceptual framework used was based on the Ottawa Charter (WHO 1986). A single qualitative embedded case study, employing data source and methodological triangulation was used. A framework for identifying nurse's use of health promotion methods was developed and used to collect non-participant observations on a purposive sample of eight nurses working on an acute hospital ward. Following the observations a semi structured one-to-one interview was conducted with each observed nurse. One randomly selected patient that the observed nurse had cared for during the observations was also interviewed. Qualitative data analysis based on the work of Miles and Huberman was employed. Two categories were identified 'health promotion strategies and content' and 'patient participation'. The findings indicated that, overall, the strategies used by nurses to promote health were prescriptive and individualistic. The main strategy observed was information giving and the content was 'preparatory information'. Predominantly, nurses practised traditional health education. Overall, patient participation was limited to minor personal aspects of care as nurses focused on the routine and getting the tasks completed. There was no evidence of a ward culture which valued health promotion. Ward managers are key in creating a culture for health promotion. A review of the methods of organizing nursing care is warranted. Nursing programmes must highlight health promotion as integral to practice and emphasis the socio-political dimensions of health promotion.

The Hydro-Economic Interdependency of Cities: Virtual Water Connections of the Phoenix, Arizona Metropolitan Area

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Richard R. Rushforth

2015-06-01

Full Text Available Water footprinting has revealed hydro-economic interdependencies between distant global geographies via trade, especially of agricultural and manufactured goods. However, for metropolitan areas, trade not only entails commodity flows at many scales from intra-municipal to global, but also substantial intra-metropolitan flows of the skilled labor that is essential to a city’s high-value economy. Virtual water flows between municipalities are directly relevant for municipal water supply policy and infrastructure investment because they quantify the hydro-economic dependency between neighboring municipalities. These municipalities share a physical water supply and also place demands on their neighbors’ water supplies by outsourcing labor and commodity production outside the municipal and water supply system boundary to the metropolitan area. Metropolitan area communities span dense urban cores to fringe agricultural towns, spanning a wide range of the US hydro-economy. This study quantifies water footprints and virtual water flows of the complete economy of the Phoenix Metropolitan Area’s municipalities. A novel approach utilized journey to work data to estimate virtual water flows embedded in labor. Commodities dominate virtual water flows at all scales of analysis, however labor is shown to be important for intra-metropolitan virtual water flows. This is the first detailed water footprint analysis of Phoenix, an important city in a water-scarce region. This study establishes a hydro-economic typology for communities to define several niche roles and decision making points of view. This study’s findings can be used to classify communities with respect to their relative roles, and to benchmark future improvements in water sustainability for all types of communities. More importantly, these findings motivate cooperative approaches to intra-metropolitan water supply policy that recognize the hydro-economic interdependence of these

Hygiene behaviour and hospitalized severe childhood diarrhoea: a case-control study.

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Baltazar, J C; Tiglao, T V; Tempongko, S B

1993-01-01

The relationship between personal and domestic hygiene behaviour and hospitalized childhood diarrhoea was examined in a case-control study of 356 cases and 357 controls from low-income families in metropolitan Manila. Indices of hygiene behaviour were defined for overall cleanliness, kitchen hygiene, and living conditions. Only the indices for overall cleanliness and kitchen hygiene were significantly associated with diarrhoea. An increasing excess risk of hospitalization with severe diarrhoea was noted as the ratings for standards of hygiene became lower, and this excess risk persisted even after controlling for confounding variables. The implications of our findings for the control of diarrhoeal disease are discussed.

Urban food security at the crossroads between metropolitan food planning and global trade

NARCIS (Netherlands)

Wascher, Dirk Michael; Jeurissen, Leonne

2017-01-01

Making use of Life Cycle Thinking, the Metropolitan Foodscape Planner (MFP) tool provides ecological footprint maps and supply/demand data showing a large potential for metropolitan food supplies. In the discussion, we examine these results in the light of recent research on the impacts of the

[Urban and population development of the city of Puebla and its metropolitan area].

Science.gov (United States)

Barbosa Prieto, A

1991-12-01

Metropolitanization has been considered an important problem of regional development in developing countries. Attitudes toward the metropolis have been ambivalent in Latin America. On the 1 hand the metropolis is viewed as an obstacle to development that absorbs resources from the zone of influence and incurs high social costs of urbanization, but on the hand it is also viewed as a form of achieving levels of economic efficiency comparable to those of developed countries. Metropolitan areas should not be viewed as isolated, but rather as important points of demographic and manpower attraction, poles of economic growth and technological and cultural innovation. "Urban areas" and "metropolitan zones" are distinct ways of defining and delimiting urban phenomena. Although there is no consensus as to the exact definitions of these 2 urban units, it is generally accepted that the urban area is the city itself as well as the contiguous built up area reaching in all directions to the onset of nonurban land uses such as forests territorial extension that includes the politico-administrative units with urban characteristics such as work places and residences for nonagricultural workers, and that maintain constant and intense socioeconomic interrelations with the central city. The process of urban planning in the metropolitan zone of Puebla, Mexico, began in institutional form in 1980 with master plans for the population centers of Puebla, Amozoc, San Andres and San Pedro Cholula, and Zacatelco in the state of Tlaxcala. In 1987., an attempt was made by the governments of the states of Puebla and Tlaxcala to develop a plan for the metropolitan zone as a single unit. Population growth was greater within the city of Puebla than in the metropolitan zone from 1960-80, but after 1980 growth in the outlying areas exceeded that in the center city. The population density of the city of Puebla declined from 160/hectare in 1950 to 76/hectare in 1990, the result of progressive dispersion

Uber and Metropolitan Traffic Fatalities in the United States.

Science.gov (United States)

Brazil, Noli; Kirk, David S

2016-08-01

Uber and similar rideshare services are rapidly dispersing in cities across the United States and beyond. Given the convenience and low cost, Uber has been characterized as a potential countermeasure for reducing the estimated 121 million episodes of drunk driving and the 10,000 resulting traffic fatalities that occur annually in the United States. We exploited differences in the timing of the deployment of Uber in US metropolitan counties from 2005 to 2014 to test the association between the availability of Uber's rideshare services and total, drunk driving-related, and weekend- and holiday-specific traffic fatalities in the 100 most populated metropolitan areas in the United States using negative binomial and Poisson regression models. We found that the deployment of Uber services in a given metropolitan county had no association with the number of subsequent traffic fatalities, whether measured in aggregate or specific to drunk-driving fatalities or fatalities during weekends and holidays. © The Author 2016. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Twelve metropolitan carbon footprints. A preliminary comparative global assessment

International Nuclear Information System (INIS)

Sovacool, Benjamin K.; Brown, Marilyn A.

2010-01-01

A dearth of available data on carbon emissions and comparative analysis between metropolitan areas make it difficult to confirm or refute best practices and policies. To help provide benchmarks and expand our understanding of urban centers and climate change, this article offers a preliminary comparison of the carbon footprints of 12 metropolitan areas. It does this by examining emissions related to vehicles, energy used in buildings, industry, agriculture, and waste. The carbon emissions from these sources - discussed here as the metro area's partial carbon footprint - provide a foundation for identifying the pricing, land use, help metropolitan areas throughout the world respond to climate change. The article begins by exploring a sample of the existing literature on urban morphology and climate change and explaining the methodology used to calculate each area's carbon footprint. The article then depicts the specific carbon footprints for Beijing, Jakarta, London, Los Angeles, Manila, Mexico City, New Delhi, New York, Sao Paulo, Seoul, Singapore, and Tokyo and compares these to respective national averages. It concludes by offering suggestions for how city planners and policymakers can reduce the carbon footprint of these and possibly other large urban areas. (author)

Assessing the Impact of Chlorinated-Solvent Sites on Metropolitan Groundwater Resources

OpenAIRE

Brusseau, Mark L.; Narter, Matthew

2013-01-01

Chlorinated-solvent compounds are among the most common groundwater contaminants in the U.S.A. The majority of the many sites contaminated by chlorinated-solvent compounds are located in metropolitan areas, and most such areas have one or more chlorinated-solvent contaminated sites. Thus, contamination of groundwater by chlorinated-solvent compounds may pose a potential risk to the sustainability of potable water supplies for many metropolitan areas. The impact of chlorinated-solvent sites on...

Tracking the deployment of the integrated metropolitan ITS infrastructure in Orlando : FY99 results

Science.gov (United States)

2000-01-01

In January 1996, Secretary Pea set a goal of deploying the integrated metropolitan Intelligent Transportation System (ITS) infrastructure in 75 of the nations largest metropolitan areas by 2006. In 1997, the U.S. Department of Transportation ini...

New Metropolitan Spaces and Metropolitan Strategies in the Face of Modernisation

Directory of Open Access Journals (Sweden)

Willem Salet

2007-10-01

Full Text Available Au début du xxie siècle, les espaces urbains traversent une période de croissance et de transformation radicale. Les villes s’étendent de plus en plus. Leur configuration spatiale devient de plus en plus décentralisée et fragmentée. La dichotomie traditionnelle entre hiérarchie urbaine et périphérie est en train de disparaître. Les nouveaux espaces métropolitains sont caractérisés par des processus de segmentation et de spécialisation à distance ainsi que par des polarisations sociales qui structurent l’espace. Les tentatives de planification des villes-régions essaient de rééquilibrer ces processus qui font éclater la ville. Cet article explore brièvement les transformations métropolitaines actuelles en utilisant une approche générique. Il se focalise également sur les stratégies des métropoles pour affronter ces défis dans le cadre de situations institutionnelles variées, un peu partout en Europe. En troisième lieu, cet article interroge les effets potentiels des projets urbains sur un rééquilibrage des transformations urbaines. Comment les grands projets urbains sont-ils conceptuellement élaborés ? Comment les alliances d’acteurs qui les soutiennent se forgent-elles ? Comment les citoyens et les groupes sociaux sont-ils impliqués de manière à produire de nouveaux espaces plus intégrés ?At the beginning of the 21st century, urban spaces can be said to be in a stage of growth and radical transformation. Cities are highly expansive, both in scale and scope. The spatial configuration of urban spaces is, however, becoming more and more decentralised and fragmentary. The traditional dichotomy between urban hierarchy and periphery is disappearing. New metropolitan spaces are characterised by distance related processes of social and economic specialisation and segmentation, and often also by splitting social polarisation. The planning agendas in city regions are trying to make add more balance to the

The effect of chain membership on hospital costs.

Science.gov (United States)

Menke, T J

1997-06-01

To compare the cost structures of hospitals in multihospital systems and independently owned hospitals. The American Hospital Association's Annual Survey from 1990 for data on hospital costs and attributes. Area characteristics came from the Area Resource File, and the Medicare case-mix index came from the Health Care Financing Administration. Data on wages are from the Bureau of the Census' State and Metropolitan Area Data Book. The Guide to Hospital Performance from HCIA, Inc. provided data on quality of care. Separate cost functions were estimated for chain and independent hospitals. Hybrid translog cost functions included measures of outputs, input prices, and hospital and area characteristics. The estimation method accounted for the simultaneous determination of costs and chain membership, and for any nonrandom selection of hospitals into chains. Several economic cost measures were calculated to compare the cost structures of the two types of hospitals. Data from all sources were merged at the hospital level to form the study sample. Hospitals in multihospital systems were less costly than independently owned hospitals. Among independent hospitals, for-profits had the highest costs. There were no statistically significant differences in costs by ownership among chain members. Economies of scale were enjoyed in both types of hospitals only at high volumes of output, while economies of scope occurred at all volumes for chain hospitals, but only at low and medium volumes for independent hospitals. This study provides support for the idea that growth of the multihospital system sector can provide a market solution to the problem of constraining costs. It does not, however, support the property rights theory that proprietary hospitals are more efficient than nonprofit hospitals.

Validation of walk score for estimating neighborhood walkability: an analysis of four US metropolitan areas.

Science.gov (United States)

Duncan, Dustin T; Aldstadt, Jared; Whalen, John; Melly, Steven J; Gortmaker, Steven L

2011-11-01

Neighborhood walkability can influence physical activity. We evaluated the validity of Walk Score(®) for assessing neighborhood walkability based on GIS (objective) indicators of neighborhood walkability with addresses from four US metropolitan areas with several street network buffer distances (i.e., 400-, 800-, and 1,600-meters). Address data come from the YMCA-Harvard After School Food and Fitness Project, an obesity prevention intervention involving children aged 5-11 years and their families participating in YMCA-administered, after-school programs located in four geographically diverse metropolitan areas in the US (n = 733). GIS data were used to measure multiple objective indicators of neighborhood walkability. Walk Scores were also obtained for the participant's residential addresses. Spearman correlations between Walk Scores and the GIS neighborhood walkability indicators were calculated as well as Spearman correlations accounting for spatial autocorrelation. There were many significant moderate correlations between Walk Scores and the GIS neighborhood walkability indicators such as density of retail destinations and intersection density (p walkability. Correlations generally became stronger with a larger spatial scale, and there were some geographic differences. Walk Score(®) is free and publicly available for public health researchers and practitioners. Results from our study suggest that Walk Score(®) is a valid measure of estimating certain aspects of neighborhood walkability, particularly at the 1600-meter buffer. As such, our study confirms and extends the generalizability of previous findings demonstrating that Walk Score is a valid measure of estimating neighborhood walkability in multiple geographic locations and at multiple spatial scales.

Nurses' health promoting lifestyle behaviors in a community hospital.

Science.gov (United States)

Kurnat-Thoma, Emma; El-Banna, Majeda; Oakcrum, Monica; Tyroler, Jill

2017-06-01

To examine nurses' health-promoting lifestyle behaviors, describe their self-reported engagement in employee wellness program benefit options, and explore relationships between nurse demographic factors, health characteristics and lifestyle behaviors. Nurses adopting unhealthy lifestyle behaviors are at significantly higher risk for developing a number of chronic diseases and are at increased susceptibility to exhaustion, job dissatisfaction and turnover. Strengthening professional nurses' abilities to engage in healthy lifestyle behaviors could serve as a valuable tool in combating negative workplace stress, promote improved work-life balance and personal well-being, and help retain qualified health-care providers. In a 187-bed community hospital in the Washington D.C. metropolitan area, we conducted an IRB-approved exploratory descriptive study. We examined 127 nurses' demographic characteristics, self-reported employer wellness program use, and measured their healthy lifestyle behaviors using the 52-item Health-Promoting Lifestyle Profile-II (HPLP-II) survey instrument. Nurse demographic and HPLP-II scores were analyzed in SPSS v20.0. Inferential univariate statistical testing examined relationships between nurse demographic factors, health and job characteristics, and HPLP-II score outcomes. Nurses over 40years old were more likely to report participation in hospital wellness program options. Statistically significant age differences were identified in total HPLP-II score (p=0.005), and two subscale scores-spiritual growth (p=0.002) and interpersonal relations (p=0.000). Post-hoc testing identified nurse participants 40-49years old and ≥50years old experienced slightly lower total HPLP-II score, subscale scores in comparison to younger colleagues. Nurses ≥40years old may benefit from additional employer support and guidance to promote and maintain healthy lifestyles, personal well-being, and positive interpersonal relationships. Copyright © 2017 Elsevier

75 FR 40726 - Revisions to the California State Implementation Plan, Sacramento Metropolitan Air Quality...

Science.gov (United States)

2010-07-14

... the California State Implementation Plan, Sacramento Metropolitan Air Quality Management District and South Coast Air Quality Management District AGENCY: Environmental Protection Agency (EPA). ACTION... Metropolitan Air Quality Management District (SMAQMD) and South Coast Air Quality Management District (SCAQMD...

Usage of Social Media in City Marketing: A Research on 30 Metropolitan Municipalities in Turkey

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Niyazi Gümüş

2017-01-01

Full Text Available Rapid changes in information and communication technologies cause serious developments in marketing field similar to every sector. In parallel with these developments, the social media channels which appear as Web 2.0 applications have a number of advantages in comparison with traditional media channels. Social media gained a place in marketing activities because of its advantages. Social media is added on instruments in line with these developments that countries benefit in marketing activities for attracting more tourists, investment and becoming prominent against the other cities. Cities intensively benefit from social media because of social media’s properties like reaching the large masses, low marketing cost, interaction, receiving feedbacks rapidly, etc. Within this context, the purpose of this research is to determine the use statuses of social media by metropolitan municipalities as part of city marketing. In accordance with this purpose, official social media accounts of 30 metropolitan municipalities are investigated between the dates of 01/09/2016 and 30/09/2016, then their shares in social media channels are investigated in the context of city marketing.It is observed that two metropolitan municipalities do not have official Facebook accounts, four metropolitan municipalities do not have an official Twitter account as well. Again, it is found that 19 metropolitan municipalities do not have an official Instagram account and 17 metropolitan municipalities do not have official YouTube account. In consequence, it is observed that, our metropolitan municipalities do not benefit from social media effectively for city marketing activities.

75 FR 40762 - Revisions to the California State Implementation Plan, Sacramento Metropolitan Air Quality...

Science.gov (United States)

2010-07-14

... the California State Implementation Plan, Sacramento Metropolitan Air Quality Management District and South Coast Air Quality Management District AGENCY: Environmental Protection Agency (EPA). ACTION: Proposed rule. SUMMARY: EPA is proposing to approve revisions to the Sacramento Metropolitan Air Quality...

Mammography screening among Arab American women in metropolitan Detroit.

Science.gov (United States)

Schwartz, Kendra; Fakhouri, Monty; Bartoces, Monina; Monsur, Joseph; Younis, Amani

2008-12-01

Mammography screening behavior has not been well studied among Middle Eastern immigrant women. We conducted a telephone survey of 365 Arab American women residing in metropolitan Detroit, home to one of the largest populations of Middle Eastern immigrants in the US, to determine prevalence of factors associated with mammography, and attitudes and beliefs regarding mammography screening. Of 365 participants, only five were born in the US. Mean age was 53.2 years (SD 10.8). Two hundred twelve (58.1%) reported having mammogram every 1-2 years; 70% ever had mammogram. Age 50-64 years, having health insurance, married status, being in the US over 10 years, and being Lebanese were associated with mammography every 1-2 years. After adjusting for demographic factors, perceived seriousness of disease, general health motivation, and having fewer barriers were associated with more frequent screening. Appropriate mammography screening is decreased in this group. Targeted outreach regarding screening is appropriate for this population; however, lack of insurance may prevent adequate follow-up.

ELECTRICITY DEMAND IN A NORTHERN MEXICO METROPOLITAN ECONOMY

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Thomas M. Fullerton

2014-10-01

Full Text Available Using an error correction framework, this study analyzes the long- and short-run dynamics of electricity demand in Ciudad Juarez, a large metropolitan economy on Mexico’s northern border. Demand is decomposed into the total number of electricity accounts and electricity usage per customer, each of which is modeled separately. A two-stage least squares approach is used to estimate the per customer electricity demand equations due to the endogeneity of the average price variable. The results indicate sustained growth in population, employment, and income can be expected to exert substantial upward pressure on regional electric power demand. Furthermore, demand is found to be price-inelastic in this metropolitan area, suggesting that rate increases can help raise the revenues necessary to fund expansion of the electrical grid.

Addressing hospital-acquired pressure ulcers: patient care managers enhancing outcomes at the point of service.

Science.gov (United States)

Frumenti, Jeanine M; Kurtz, Abby

2014-01-01

An innovative leadership training program for patient care managers (PCMs) aimed at improving the management of operational failures was conducted at a large metropolitan hospital center. The program focused on developing and enhancing the transformational leadership skills of PCMs by improving their ability to manage operational failures in general and, in this case, hospital-acquired pressure ulcers. The PCMs received 8 weeks of intense training using the Toyota Production System process improvement approach, along with executive coaching. Compared with the control group, the gains made by the intervention group were statistically significant.

78 FR 10589 - Revision of Air Quality Implementation Plan; California; Sacramento Metropolitan Air Quality...

Science.gov (United States)

2013-02-14

... Quality Implementation Plan; California; Sacramento Metropolitan Air Quality Management District... Sacramento Metropolitan Air Quality Management District (SMAQMD or District) portion of the California State... sources within the areas covered by the plan as necessary to assure that the National Ambient Air Quality...

Recognition of management structure and spatial planning in Tehran metropolitan area

Directory of Open Access Journals (Sweden)

Manijeh Lalehpour

2016-06-01

Full Text Available Metropolitan areas are concentrated and dense areas filled settlements and include a central urban region with its surrounding residences. Severity and complexity of issues in metropolitan areas along with intricacy and quantity of influential factors in these areas necessitate novel approaches and innovative solutions for comprehensive strategies and management coordination of land use in these regions. The present study has taken this approach to investigate management structure and spatial planning in Tehran metropolitan area. The study takes parameters like political and management decentralization, elements affecting urban management based on the sources of power and province and finally spatial domain of urban management into account. Findings revealed that decentralization in national management and political structure has limited tasks and authority of urban management. In this regard, a closer look at management structure and spatial planning of Tehran metropolitan are demonstrates that the government and its element dominate policy making, planning and spatial management of the city and inherent position of municipality and city council suffer weaknesses in their role as urban management. Results from investigating official tasks in urban management elements and their spatial domain reveals lack of coordination and Fragmentation in management structure and spatial planning in the region. The paper attempts to discuss these Fragmentation in the fields of management, function, politics and domains.

Revenues for Education in Metropolitan Areas. Chapter VI, Metropolitanism: Its Challenge to Education, 1968. Sixty-seventh Yearbook, Part I.

Science.gov (United States)

Alkin, Marvin C.

For local school districts to provide equal educational opportunities throughout a metropolitan area, a school organization plan should distribute populations among districts in such a manner as to maximize the aggregate expressed demand for educational services and to provide relatively equal financial support. Consolidation of contiguous…

Evaluation of the external costs of energy production in the Helsinki metropolitan area

International Nuclear Information System (INIS)

Otterstroem, T.

1995-01-01

The aim of the research is to evaluate the external costs of energy production at Helsinki metropolitan area (Helsinki, Espoo, Vantaa). The previously developed valorization method for effects on population centres is adjusted. All the main health, material and environmental effects will be taken into account in the research. The effects of emissions of the energy production of the Helsinki metropolitan area on concentrations of the impurities in the air and through them on human and environment will be evaluated. The estimates will be based on the relativistic fuels consumption and the emission data of Helsinki metropolitan area. Life-cycle reasoning will be applied so that the emissions of the main components of the fuels used in the metropolitan area will be included in the estimation. The cost-effectiveness of the investments will be estimated by comparing the environmental investments of energy boards with the external costs. The methods of this work can be applied to estimation of the profitability of energy production plants from the point of view of national economy also elsewhere in the country

A REGIONAL APPROACH TO THE METROPOLITAN ECONOMIC GROWTH: EVIDENCE FROM THE EUROPEAN UNION

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Florin Teodor Boldeanu

2016-09-01

Full Text Available The main goal of this study is to contribute to metropolitan economic growth literature by carrying out an analysis for 271 areas located in the EU between 2000 and 2013. For this objective the study uses several panel data estimation techniques, namely the GMM, System GMM and the QML estimation. To check the robustness of the results, the time period is divided in two (post and ante economic crisis and by splitting the sample of metropolitan regions in two components, the Western more developed regions and the Central and South-Eastern (the formal communist states, except for Cyprus areas. The results indicate that the industrial, construction and wholesale and retail trade sectors are positively linked with metropolitan growth. The agricultural, fishery and forestry sector is negatively influencing growth. The manufacturing and ITC sectors and migration are not statistically significant. Furthermore population density and size is more important than population growth and European enlargement did not have a substantial positive impact on metropolitan growth for the Central and South-Eastern regions.

Kansas City Metropolitan Community Colleges. Audit Report.

Science.gov (United States)

Missouri Office of the State Auditor, Jefferson City.

This audit report reviews the employment contracts, related compensation, and other benefits provided for the chancellor and other officers of the Kansas City Metropolitan Community Colleges (KCMCC) in Missouri. The chancellor is allowed to either solicit bids or negotiate for contracted services such as architects, construction managers,…

Radiological protection study at the 'Hospital Edgardo Rebagliati Martins'/Peru

International Nuclear Information System (INIS)

Luna Q, R.

1996-01-01

Edgardo Rebagliati Martins Hospital of the Peruvian Institute of Social Security started its activities in 1957, as the largest metropolitan general hospital for the insured workers of the I.P.S.S. At present, it has 1350 hospital beds, attends 36,600 external consults per month, about 10,700 x-rays examinations, as well as 16,800 radiotherapy treatments monthly. 200 brachytherapies with Cesium or Radium are performed annually, besides many other (examinations) imaging exams that use ionizing radiation are carried out by our radiology staff with diagnosis or therapeutic purposes. This is the reason why the hospital directory sent some staff physicians abroad to learn all about radiation protection in a hospital setting, so that they will be able to organize a Radiation Protection Committee to advise and to set up rules and regulations to protect exposed personnel, as well as public in general, improving quality and, consequently, saving costs to the institution. The Constitution of the Radiation Protection Committee, its importance in a medical institution, is informed, and finally its experiences of the every day work and how to act in hospital accidents where ionizing radiation is involved, are transmitted. (author). 1 fig

42 CFR 482.30 - Condition of participation: Utilization review.

Science.gov (United States)

2010-10-01

... circumstances: (1) A Utilization and Quality Control Quality Improvement Organization (QIO) has assumed binding... HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CONDITIONS OF PARTICIPATION FOR HOSPITALS Basic Hospital Functions § 482.30 Condition of participation: Utilization review. The hospital must have in...

23 CFR 420.109 - What are the requirements for distribution of metropolitan planning funds?

Science.gov (United States)

2010-04-01

... and Research Funds § 420.109 What are the requirements for distribution of metropolitan planning funds... 23 Highways 1 2010-04-01 2010-04-01 false What are the requirements for distribution of metropolitan planning funds? 420.109 Section 420.109 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF...

Heterogeneous Structure and Seismicity beneath the Tokyo Metropolitan Area

Science.gov (United States)

Nakagawa, S.; Kato, A.; Sakai, S.; Nanjo, K.; Panayotopoulos, Y.; Kurashimo, E.; Obara, K.; Kasahara, K.; Aketagawa, T.; Kimura, H.; Hirata, N.

2010-12-01

Beneath the Tokyo metropolitan area, the Philippine Sea Plate (PSP) subducts and causes damaged mega-thrust earthquakes. Sato et al. (2005) revealed the geometry of upper surface of PSP, and Hagiwara et al. (2006) estimated the velocity structure beneath Boso peninsula. However, these results are not sufficient for the assessment of the entire picture of the seismic hazards beneath the Tokyo metropolitan area including those due to an intra-slab M7+ earthquake. So, we launched the Special Project for Earthquake Disaster Mitigation in the Tokyo Metropolitan area (Hirata et al., 2009). Proving the more detailed geometry and physical properties (e.g. velocities, densities, attenuation) and stress field within PSP is very important to attain this issue. The core item of this project is a dense seismic array called Metropolitan Seismic Observation network (MeSO-net) for making observations in the metropolitan area (Sakai and Hirata, 2009; Kasahara et al., 2009). We deployed the 249 seismic stations with a spacing of 5 km. Some parts of stations construct 5 linear arrays at interval of 2 km such as Tsukuba-Fujisawa (TF) array, etc. The TF array runs from northeast to southwest through the center of Tokyo. In this study, we applied the tomography method to image the heterogeneous structure under the Tokyo metropolitan area. We selected events from the Japan Meteorological Agency (JMA) unified earthquake list. All data of MeSO-net were edited into event data by the selected JMA unified earthquake list. We picked the P and S wave arrival times. The total number of stations and events are 421 and 1,256, respectively. Then, we applied the double-difference tomography method (Zhang and Thurber, 2003) to this dataset and estimated the fine-scale velocity structure. The grid nodes locate 10 km interval in parallel with the array, 20 km interval in perpendicular to the array; and on depth direction, 5 km interval to a depth of less than 50 km and 10 km interval at a depth of more

The effect of nursing participation in the design of a critical care information system: a case study in a Chinese hospital.

Science.gov (United States)

Qin, Yanhong; Zhou, Ranyun; Wu, Qiong; Huang, Xiaodi; Chen, Xinli; Wang, Weiwei; Wang, Xun; Xu, Hua; Zheng, Jing; Qian, Siyu; Bai, Changqing; Yu, Ping

2017-12-06

Intensive care information systems (ICIS) are continuously evolving to meet the ever changing information needs of intensive care units (ICUs), providing the backbone for a safe, intelligent and efficient patient care environment. Although beneficial for the international advancement in building smart environments to transform ICU services, knowledge about the contemporary development of ICIS worldwide, their usage and impacts is limited. This study aimed to fill this knowledge gap by researching the development and implementation of an ICIS in a Chinese hospital, nurses' use of the system, and the impact of system use on critical care nursing processes and outcomes. This descriptive case study was conducted in a 14-bed Respiratory ICU in a tertiary hospital in Beijing. Participative design was the method used for ICU nurses, hospital IT department and a software company to collaboratively research and develop the ICIS. Focus group discussions were conducted to understand the subjective perceptions of the nurses toward the ICIS. Nursing documentation time and quality were compared before and after system implementation. ICU nursing performance was extracted from the annual nursing performance data collected by the hospital. A participative design process was followed by the nurses in the ICU, the hospital IT staff and the software engineers in the company to develop and implement a highly useful ICIS. Nursing documentation was fully digitized and was significantly improved in quality and efficiency. The wrong data, missing data items and calculation errors were significantly reduced. Nurses spent more time on direct patient care after the introduction of the ICIS. The accuracy and efficiency of medication administration was also improved. The outcome was improvement in ward nursing performance as measured by ward management, routine nursing practices, disinfection and isolation, infection rate and mortality rate. Nurses in this ICU unit in China actively

Information Systems Evaluation: A Study in Hospital Organizations

Directory of Open Access Journals (Sweden)

Laís Coelho Ayala

2012-06-01

Full Text Available Given increasing demand for timely and accurate information to support decision making, hospitals, a particularly complex type of service organization, have increasingly resorted to a wide range of tools such as the Clinical Information Systems (CIS. However, research has shown that such systems do not always meet hospital managers’ needs, and assessment processes are necessary both before and after CIS implementation. Aiming to identify whether the CIS do meet hospital managers’ information needs and do fit in the specificities of such organizations, this paper reports on the assessment of four CIS based on the perspective of their users in four hospitals in the Metropolitan Region of Belo Horizonte, State of Minas Gerais, Brazil. The data was collected by means of semi-structured interviews and non-obtrusive observation. On the one hand, the result shows that the four organizations have difficulties in using their systems, such as accessibility problems, inadequate training and system underutilization. On the other hand, they also benefit from such systems, as they make processes faster and enable information control. One can say that the results from this research contribute to a better understanding of evaluating information systems in hospitals. Managers of such organizations can benefit from these results when seeking to evaluate and improve their information systens.

Engaging with sustainability issues in metropolitan Chennai

NARCIS (Netherlands)

Kennedy, L.; Varrel, A.; Denis, E.; Dupont, V.; Dhanalakshmi, R.; Roumeau, S.; Baud, I.; Pfeffer, K.; Sridharan, N.; Vijayabaskar, M.; Suresh Babu, M.; Seifelislam, A.; Rouanet, H.; Saharan, T.

2014-01-01

Chennai is the largest metropolitan city in South India (8.7 million in 2011) and the provincial capital of the large state of Tamil Nadu (population 72 million in 2011). Before that, under British rule, the city was the capital of the Madras Presidency, and was known as Madras until 1996, when the

Explaining turnover intention in Korean public community hospitals: occupational differences.

Science.gov (United States)

Hwang, Jee-In; Chang, Hyejung

2008-01-01

Personnel in public hospitals had relatively low job satisfaction despite of tenure employment. High turnover rates degrade hospital image and incur additional costs related to recruitment and training. The purposes of this study were to describe the occupational differences and to identify factors affecting turnover intention among public hospital personnel. A questionnaire survey was conducted as part of Administrative Services Quality Evaluation Program by Seoul metropolitan municipality from 1 November to 1 December in 2003. The subjects were 1251 entire hospital personnel in four hospitals. The questionnaire was designed to measure job satisfaction, organizational commitment, turnover intention, and demographic characteristics. Logistic regression analysis was performed to determine factors influencing turnover intention. There were significant differences in job satisfaction, organizational commitment, and turnover intention according to the occupations. The turnover intention rates were highest among physicians, followed by paramedicals and nursing staffs and then administrators. The significant factors affecting turnover intention were involvement and loyalty among physicians, hospital type, satisfaction with systems and loyalty among nursing staffs, satisfaction with relationship and loyalty among administrators, and loyalty among paramedicals. There were different moderators that influence turnover intentions of hospital personnel. Loyalty had the most important effect upon turnover intention in all occupations. 2007 John Wiley & Sons, Ltd

Atmospheric pollution biomonitoring of the Sao Paulo metropolitan region using epiphytic lichens

International Nuclear Information System (INIS)

Fuga, Alessandra

2006-01-01

Due to the increasing problems of atmospheric pollution in the Sao Paulo metropolitan region that affect the environment and human health the application of biomonitoring methodologies using cosmopolite organisms has now become relevant. Biomonitoring is a method to evaluate the response of live organisms to pollution. This method offers advantages such as reduced costs, efficient monitoring of large geographic areas and accumulated pollutants over a large period in which low concentrations of chemicals elements in the environment can be evaluated. In the present study, neutron activation analysis method was applied to determine elements accumulated in Canoparmelia texana lichenized fungi. Samples were collected in two distinct areas: Carlos Botelho (PECB) and Intervales (PEI) State Parks that are considered as non-polluted areas and that belong to the Atlantic Forest - SP ecosystem; and Sao Paulo city metropolitan region in sites near automatic monitoring stations of the Environmental Protection Agency of the State of Sao Paulo (CETESB). The lichens collected from the bark of the trees were properly treated, and irradiated with neutrons from IEA-R1 nuclear reactor along with synthetic standards of elements. The precision and the accuracy of the results were evaluated by the analyses of IAEA-336 LICHEN and Mixed Polish Herbs (INCT -MPH-2) certified reference materials. The results obtained for these materials were in accordance with the certified values and presented good precision with variation coefficients ranging from 0.9 to 14.6%. Results obtained for lichens showed that elements As, Co, Cr, Cs, La, Mo, Sb, Sc, Se and U are present at ng g -1 levels, Ba, Br, Cl, Fe, K, Mn, Na, Rb and Zn at μg g -1 and Ca at mg g -1 . By applying cluster and discriminant analyses to the results for the lichen samples from areas with different levels of pollution, the sampling sites were grouped according to their chemical similarities and their elemental composition. It was

Diarrheal diseases and hospitalization of children under five years of age according to population-based surveys in the State of Pernambuco, Brazil, in the years 1997 and 2006.

Science.gov (United States)

Vasconcelos, Maria Josemere Oliveira Borba; Rissin, Anete; Figueiroa, José Natal; Lira, Pedro Israel Cabral de; Batista Filho, Malaquias

2018-03-01

The scope of this paper was to assess the temporal and geographical trends of diarrhea and its implications on the demands of hospitalizations of children under five years of age in the state of Pernambuco in 1997 and 2006. Databases of two population-based surveys were assessed with probabilistic samples of 2078 children (1997) and 1650 children (2006) evaluated in 18 municipalities of Pernambuco, including the Metropolitan Region of Recife, Urban Interior and Rural Interior. Prevalence was considered to involve the occurrence of cases on the day or in the two weeks prior to the interview and as admissions, service cases with minimal hospital stay of 24 hours in the period, covering up to one year before the interview. The prevalence of diarrhea in Pernambuco had a statistically non-significant decline (19.8% to 18.1%; p = 0.192). However, a statistically-significant reduction was observed (16.9% to 10.5%; p = 0.003) in the Metropolitan Region of Recife. The number of admissions increased by more than double (2.7% to 5.5% in the State and from 1.6% to 3.8% within the Metropolitan Region of Recife), in contrast with national trends. Therefore, diarrhea in the State appears as the main component of the demands of pediatric hospitalizations during the period under scrutiny.

The Rural Inpatient Mortality Study: Does Urban-Rural County Classification Predict Hospital Mortality in California?

Science.gov (United States)

Linnen, Daniel T; Kornak, John; Stephens, Caroline

2018-03-28

Evidence suggests an association between rurality and decreased life expectancy. To determine whether rural hospitals have higher hospital mortality, given that very sick patients may be transferred to regional hospitals. In this ecologic study, we combined Medicare hospital mortality ratings (N = 1267) with US census data, critical access hospital classification, and National Center for Health Statistics urban-rural county classifications. Ratings included mortality for coronary artery bypass grafting, stroke, chronic obstructive pulmonary disease, heart attack, heart failure, and pneumonia across 277 California hospitals between July 2011 and June 2014. We used generalized estimating equations to evaluate the association of urban-rural county classifications on mortality ratings. Unfavorable Medicare hospital mortality rating "worse than the national rate" compared with "better" or "same." Compared with large central "metro" (metropolitan) counties, hospitals in medium-sized metro counties had 6.4 times the odds of rating "worse than the national rate" for hospital mortality (95% confidence interval = 2.8-14.8, p centers may contribute to these results, a potential factor that future research should examine.

Governing metropolitan green infrastructure in the United States

Science.gov (United States)

Robert F. Young; E. Gregory McPherson

2013-01-01

In this paper we explore whether the enhancement of urban ecosystem services through largescale metropolitan treeplanting initiatives is being planned and executed as a component of traditional municipal government or represents new transdisciplinary strategies in environmental governance Drawing on qualitative interviews with...

Spatial analysis of the Rio de Janeiro metropolitan area and social and environmental management issues

DEFF Research Database (Denmark)

Ribeiro, Gustavo

2005-01-01

and infrastructural data. Through these three levels of spatial analysis it is possible to develop and to support a more comprehensible study of urban development of the Rio de Janeiro Metropolitan Area. The aim of this study is (a) to develop an alternative spatial analysis leading to a more comprehensive...... understanding of the urban development process and its correlation not just with political-administrative borders but also to ecological systems: (b) to identify the correlations between infrastructure and socio-economical data in the Rio de Janeiro Metropolitan Area (c) to evaluate urban development dynamics...... in the period between 1990 and 2000, based on the application of the above-mentioned data to the three spatial levels in question. This paper highlights the role of the hydrographical systems of the Rio de Janeiro Metropolitan Area as an important spatial unit of analysis to understand the metropolitan urban...

Green Urbanism for the Greener Future of Metropolitan Areas

Science.gov (United States)

Zaręba, Anna; Krzemińska, Alicja; Widawski, Krzysztof

2016-10-01

Intensive urbanization is swallowing municipal green areas which causes intensification of erosion, decrease in biodiversity and permanent fragmentation of habitats. In the face of these changes, a risk of irreversible damages to urban ecosystems is growing. That is why planning of solutions within the framework of Green Urbanism in metropolitan areas inhabited by over 55% of the global population is of extraordinary importance. The task of the paper is to present patterns of the Green Urbanism using selected examples of metropolitan areas as case studies. The main goal of the research is to make comparison between GU practices in different countries, in various spatial settings. The principles of triple zero framework: zero fossil-fuel energy use, zero waste, zero emissions (from low-to-no-carbon emissions) introduce not only the contemporary trends in theoretical urban planning but are dictated by practical considerations to create a healthy environment for a healthy society with a minimized environmental footprint. The research results help to identify Green Urbanism techniques used for multiple functions, including ecological, recreational, cultural, aesthetic and other uses and present opportunities for implementation of Green Urbanism solutions in metropolitan areas. To achieve healthier society and environment, highly congested and polluted cities have to be recreated through working with the existing landscape, topography and natural resources particular to the site.

Iron, Oil, and Emeryville: Resource Industrialization and Metropolitan Expansion in the San Francisco Bay Area, 1850-1900

OpenAIRE

Lunine, Seth

2013-01-01

Scholars have largely overlooked the formative role of industry in both California's economic development and the San Francisco Bay Area's metropolitan expansion during the late nineteenth century. Beginning in the early 1880s, leading firms in San Francisco's specialized industries, such as the iron and chemicals sectors, dispersed to the metropolitan periphery. This process of industrial suburbanization created an integrative metropolitan economy, as well as individual suburbs. In this di...

Innovation and change in a rehabilitation unit for the elderly : Through action research

NARCIS (Netherlands)

Hoogwerf, Lucienne Josepha Rosalia

2002-01-01

This report describes an eighteen-month action research project in an assessment, treatment and rehabilitation ward for older people in a large metropolitan hospital in New Zealand. The study aimed at developing participative care and the clinical nurse consultant role, and advancing nursing

Design and Scale Isses in the New Metropolitan City: a study of the south-east homogeneous zone

Directory of Open Access Journals (Sweden)

Elena Mussinelli

2015-11-01

Full Text Available The establishment of the new Metropolitan City and recent anti-sprawl legislations form part of a new urban regeneration initiative. In this context, the goal of the current research is to provide spatial forecasts, guidelines for governance, and economic feasibility scenarios for revitalisation work. The research is centred on the Milan Metropolitan area. In addition to exploring certain theories of regeneration and resilience, this paper reinstates the practice of spatial analysis of abandoned industrial areas at a metropolitan scale and identifies boundaries, environments, and issues for meta-design testing based on public initiatives aimed at increasing socio-economic resilience for the south-east sector of the Milanese metropolitan area. 

Business profile of metropolitan Las Vegas

International Nuclear Information System (INIS)

Boyle, M.R.

1988-06-01

This first report describes the present makeup of the Las Vegas metropolitan statistical area (MSA) economy and analyzes the climate for business expansion. The second report contains an assessment of the competitiveness of the area as a location for new or expanded facilities investment by companies in approximately 600 business groups. The third report projects Las Vegas' competitiveness at the start of the next century in the absence of a nuclear waste storage facility and then evaluates the potential impacts of siting that facility near Las Vegas on its ability to attract and retain business investment. The primary purpose of these reports is to contribute to the overall assessment of the environmental impact of the US Department of Energy's proposed action to build and operate an underground nuclear waste storage facility at Yucca Mountain. The first two reports also serve a second purpose -- they can be used by economic development organizations in the Las Vegas metropolitan area in their ongoing efforts to attract new business investment. Information contained in the business climate analysis found in this first report can be incorporated into marketing materials. The competitiveness assessment contained in the second report can be used by these organizations in identifying targets they wish to pursue

Use of renewable energy in the greater metropolitan area

International Nuclear Information System (INIS)

Arias Garcia, Rocio; Castro Gomez, Gustavo; Fallas Cordero, Kenneth; Grant Chaves, Samuel; Mendez Parrales, Tony; Parajeles Fernandez, Ivan

2012-01-01

A study is conducted on different renewable energy within the larger metropolitan area, selecting the most suitable for the area and the implementation for distributed generation. A research methodology is practiced type pretending gather the necessary information to make proposals selected of different type of energy. The geography of the greater metropolitan area is studied along with the different existing renewable energy: distributed generation, remote measurement of energy which is one of the elements of the concept of intelligent networks (Smart Grid) in the electricity sector, legislation of Costa Rica regarding the generation of renewable energy and environmental impact. An analysis of economic feasibility is covered for each of the proposals estimating current rates for leading distributors of a future value, concluding with the viability of projects for possible execution of the same. (author) [es

The Metropolitan Area of the Municipality of Bucharest. Present-Day Features Relating to Some Environmental Issues in an International Context

Directory of Open Access Journals (Sweden)

INES GRIGORESCU

2005-01-01

Full Text Available The development of metropolitan areas represents the main characteristic of today’s urban evolution trends. The first initiatives to delimitate and define metropolitan areas have been in the United States since 1910. In Europe, this concept was adopted at the beginning of the1990s when the United States had already had 250 metropolitan areas. Romania adopted the concept of metropolitan area in the late 1990s, namely in 1997 when a study on the Directions, Ways, and Intensities of Development in the Municipality of Bucharest and its Metropolitan Zone. Environmental protection politics appeared. This made public a point of view about the Bucharest metropolitan area, which was legally defined by Law no. 351 of July 6th 2001 regarding the National Territory Management Plan, Section IV – Settlements. But many other limits of this area were also taken into account. The uncontrolled evolution of the Bucharest Metropolitan Area as well as of many other European capital cities can be stopped or stabilized by developing green belts or green areas.

Satisfaction with physical and social surroundings and the habit of smoking cigarettes in the metropolitan area of Belo Horizonte, Brazil.

Science.gov (United States)

Souza, Ricardo Alexandre de; Oliveira, Cláudia Di Lorenzo; Lima-Costa, Maria Fernanda; Proietti, Fernando Augusto

2014-01-01

The objective of this study was to examine the association between individual satisfaction with social and physical surroundings and the habit of smoking cigarettes. Data from the Health Survey of Adults from the metropolitan area of Belo Horizonte, Minas Gerais, Brazil, were used. Based on a probability sample, participants (n = 12,299) were selected among residents aged 20 years old or more. The response variable was the smoking habit and the explanatory variable of interest was the neighborhood perception. Potential confounding variables included demographic characteristics, health behaviors and other indicators of socioeconomic position. The prevalence of current smokers, former smokers and never smokers were 20.8, 14.1 and 65.1%, respectively; 74.4 and 25.5% of the participants were categorized as being more satisfied and less satisfied with the neighborhood, respectively. Compared to those who never smoked, former smokers (adjusted odds ratio = 1.40, 95% confidence interval 1.20 - 1.62) and current smokers (adjusted odds ratio = 1.17, 95% confidence interval 1.03 - 1.34) were less satisfied with the neighborhood compared to those who never smoked. The results of this study indicate there is an independent association between the smoking habit and a less satisfying neighborhood perception in the metropolitan region of Belo Horizonte, which does not depend on individual characteristics, traditionally reported as being associated with smoking.

Inpatient satisfaction at different public sector hospitals of a metropolitan city in Pakistan: a comparative cross-sectional study.

Science.gov (United States)

Hussain, Mehwish; Rehman, Rehana; Ikramuddin, Zia; Asad, Nava; Farooq, Ayesha

2018-04-01

To observe inpatient satisfaction at different public sector hospitals of Karachi, Pakistan. A cross sectional study was carried out during 2010-2012 in four major public sector hospitals of Karachi. A total of 710 patients completed the study. Responses were gathered in a self-structured questionnaire that comprised of four dimensions of satisfaction with doctor, staff, administration and treatment. Average Score of each dimension was taken and compared using one way analysis of variance. Satisfaction with doctors, staff and administration of provincial and federal hospitals were comparatively similar (P > 0.05). However, satisfaction with treatment significantly differed in all four hospitals (P public sector hospitals showed satisfaction with healthcare personnel and related administration. However, treatment dimension needs to be improved to get more satisfaction.

Intestinal Parasites among Waste-Handlers in Jos Metropolitan Area ...

African Journals Online (AJOL)

Intestinal Parasites among Waste-Handlers in Jos Metropolitan Area of Plateau State, Nigeria. ... Solid waste management is associated with health hazards. ... Waste disposal workers are at high risk of infection with different species of ...

[Characterization of assistance among philanthropic hospitals in Brazil].

Science.gov (United States)

Portela, Margareth C; Lima, Sheyla M L; Barbosa, Pedro R; Vasconcellos, Miguel M; Ugá, Maria Alícia D; Gerschman, Silvia

2004-12-01

To characterize the Brazilian philanthropic hospital network and its relation to the public and private sectors of the Sistema Unico de Saude (SUS) [Brazilian Unified Health System]. This is a descriptive study that took into consideration the geographic distribution, number of beds, available biomedical equipment, health care complexity as well as the productive and consumer profiles of philanthropic hospitals. It is based on a sample of 175 hospitals, within a universe of 1,917, involving 102 distinct institutions. Among these, there were 66 Brazilian Unified Health System (SUS) inpatient care providers with less than 599 beds randomly included in this study. Twenty-six of the twenty-seven SUS inpatient care providers with at least 599 beds, as well as ten institutions which do not provide their services to SUS, were also included. This is a cross-sectional study and the data was obtained in 2001. Data collection was conducted by trained researchers, who applied a questionnaire in interviews with the hospital's managers. Within the random sample, 81.2% of the hospitals are located in cities outside of metropolitan areas, and 53.6% of these are the only hospitals within their municipalities. Basic clinical hospitals, without ICUs, predominate within the random sample (44.9%). Among the individual hospitals of the large philanthropic institutions and the special hospitals, the majority -- 53% and 60% respectively -- are level II general hospitals, a category of greater complexity. It was verified that complexity of care was associated to hospital size, being that hospitals with the greatest complexity are situated predominantly in the capitals. Given the importance of the philanthropic hospital sector within the SUS [Unified Health System] in Brazil, this paper identifies some ways of formulating appropriate health policies adjusted to the specificities of its different segments.

Agricultural land cover changes in metropolitan areas of Poland for the period 1990–2012

Directory of Open Access Journals (Sweden)

Nalej Marta

2016-06-01

Full Text Available Agricultural land covers more than half the area of metropolitan areas in Poland, and is therefore particularly prone to the influences of the processes associated with their development. The aim of the study was to analyse changes in agricultural land cover within the metropolitan areas of Poland for the years 1990–2012; and to capture their dynamics, types and directions. The percentage share of the total study area, for each of the forms of agricultural land cover and their changes were traced, with the spatial distribution of the changes also being determined. The results of the study show that in metropolitan areas, agricultural land cover is undergoing transformations that do not result in the loss of agricultural lands, or that involve a decrease in surface area due to their change into anthropogenic forms of land cover. The greatest transitions occurred between 2000 and 2006 and were observed in the outer zones of metropolitan areas.

Enhancing field GP engagement in hospital-based studies. Rationale, design, main results and participation in the diagest 3-GP motivation study

Directory of Open Access Journals (Sweden)

Berkhout Christophe

2012-06-01

Full Text Available Abstract Background Diagest 3 was a study aimed at lowering the risk of developing type 2 diabetes within 3 years after childbirth. Women with gestational diabetes were enrolled in the study. After childbirth, the subjects showed little interest in the structured education programme and did not attend workshops. Their general practitioners (GPs were approached to help motivate the subjects to participate in Diagest 3, but the GPs were reluctant. The present study aimed to understand field GPs’ attitudes towards hospital-based studies, and to develop strategies to enhance their involvement and reduce subject drop-out rates. Methods We used a three-step process: step one used a phenomenological approach exploring the beliefs, attitudes, motivations and environmental factors contributing to the GPs’ level of interest in the study. Data were collected in face-to-face interviews and coded by hand and with hermeneutic software to develop distinct GP profiles. Step two was a cross-sectional survey by questionnaire to determine the distribution of the profiles in the GP study population and whether completion of an attached case report form (CRF was associated with a particular GP profile. In step three, we assessed the impact of the motivation study on participation rates in the main study. Results Fifteen interviews were conducted to achieve data saturation. Theorisation led to the definition of 4 distinct GP profiles. The response rate to the questionnaire was 73%, but dropped to 52% when a CRF was attached. The link between GP profiles and the rate of CRF completion remains to be verified. The GPs provided data on the CRF that was of comparable quality to those collected in the main trial. Our analysis showed that the motivation study increased overall participation in the main study by 23%, accounting for 16% (24/152 of all final visits for 536 patients who were initially enrolled in the Diagest 3 study. Conclusions When a hospital-led study

Enhancing field GP engagement in hospital-based studies. Rationale, design, main results and participation in the Diagest 3-GP motivation study.

Science.gov (United States)

Berkhout, Christophe; Vandaele-Bétancourt, Marie; Robert, Stéphane; Lespinasse, Solène; Mitha, Gamil; Bradier, Quentin; Vambergue, Anne; Fontaine, Pierre

2012-06-21

Diagest 3 was a study aimed at lowering the risk of developing type 2 diabetes within 3 years after childbirth. Women with gestational diabetes were enrolled in the study. After childbirth, the subjects showed little interest in the structured education programme and did not attend workshops. Their general practitioners (GPs) were approached to help motivate the subjects to participate in Diagest 3, but the GPs were reluctant. The present study aimed to understand field GPs' attitudes towards hospital-based studies, and to develop strategies to enhance their involvement and reduce subject drop-out rates. We used a three-step process: step one used a phenomenological approach exploring the beliefs, attitudes, motivations and environmental factors contributing to the GPs' level of interest in the study. Data were collected in face-to-face interviews and coded by hand and with hermeneutic software to develop distinct GP profiles. Step two was a cross-sectional survey by questionnaire to determine the distribution of the profiles in the GP study population and whether completion of an attached case report form (CRF) was associated with a particular GP profile. In step three, we assessed the impact of the motivation study on participation rates in the main study. Fifteen interviews were conducted to achieve data saturation. Theorisation led to the definition of 4 distinct GP profiles. The response rate to the questionnaire was 73%, but dropped to 52% when a CRF was attached. The link between GP profiles and the rate of CRF completion remains to be verified. The GPs provided data on the CRF that was of comparable quality to those collected in the main trial. Our analysis showed that the motivation study increased overall participation in the main study by 23%, accounting for 16% (24/152) of all final visits for 536 patients who were initially enrolled in the Diagest 3 study. When a hospital-led study explores issues in primary care, its design must anticipate GP

Transfer of residents to hospital prior to cardiac death: the influence of nursing home quality and ownership type.

Science.gov (United States)

Anic, Gabriella M; Pathak, Elizabeth Barnett; Tanner, Jean Paul; Casper, Michele L; Branch, Laurence G

2014-01-01

We hypothesised that among nursing home decedents, nursing home for-profit status and poor quality-of-care ratings, as well as patient characteristics, would lower the likelihood of transfer to hospital prior to heart disease death. Using death certificates from a large metropolitan area (Tampa Florida Metropolitan Statistical Area) for 1998-2002, we geocoded residential street addresses of heart disease decedents to identify 2172 persons who resided in nursing homes (n=131) at the time of death. We analysed decedent place of death as an indicator of transfer prior to death. Multilevel logistic regression modelling was used for analysis. Cause of death and decedent characteristics were obtained from death certificates. Nursing home characteristics, including state inspector ratings for multiple time points, were obtained from Florida's Agency for Healthcare Administration. Nursing home for-profit status, level of nursing care and quality-of-care ratings were not associated with the likelihood of transfer to hospital prior to heart disease death. Nursing homes >5 miles from a hospital were more likely to transfer decedents, compared with facilities located close to a hospital. Significant predictors of no transfer for nursing home residents were being white, female, older, less educated and widowed/unmarried. In this study population, contrary to our hypotheses, sociodemographic characteristics of nursing home decedents were more important predictors of no transfer prior to cardiac death than quality rankings or for-profit status of nursing homes.

The Tshwane metropolitan municipality and strategic partnerships in ...

African Journals Online (AJOL)

... Tshwane Metropolitan Municipality commissioned research to investigate the potential of strategic partnerships for the optimal facilitation and co-operative governance of sport and recreation. The aim of this project was to identify the possible structure and nature of partnerships in order to facilitate effective management, ...

The relationship between burnout and mobbing among hospital managers.

Science.gov (United States)

Karsavuran, Seda; Kaya, Sıdıka

2017-05-01

Mobbing and burnout can cause serious consequences, especially for health workers and managers. Level of burnout and exposure to mobbing may trigger each other. There is a need to conduct additional and specific studies on the topic to develop some strategies. The purpose of this study is to determine the relationship between level of burnout and exposure to mobbing of the managers (head physician, assistant head physician, head nurse, assistant head nurse, administrator, assistant administrator) at the Ministry of Health hospitals. The "Leymann Inventory of Psychological Terrorization" scale was used to measure the level of exposure to mobbing and the "Maslach Burnout Inventory" scale was used to measure the level of burnout of hospital managers. The relationship between level of burnout and exposure to mobbing was analyzed by Pearson's Correlation Analysis. Participants and research context: The population of this study included managers (454 managers) at the Ministry of Health hospitals in the metropolitan area of Ankara between September 2010 and May 2011. All the managers were tried to conduct, but some managers did not want to reply to the questionnaire and some managers were not found at their workplace. Consequently, using a convenience sampling, 54% of the managers replied to the questionnaire (244 managers). Ethical consideration: The approval of the study was granted by the Ministry of Health in Turkey. Furthermore, the study was evaluated and accepted by the Education, Planning and Coordination Council of one of the education and research hospitals in the study. Positive relationships were found among each subdimension of the mobbing and emotional exhaustion and depersonalization. A negative relationship was found between each subdimension of the mobbing and personal accomplishment. In hospitals, by detecting mobbing actions, burnout may be prevented. Exposure to mobbing and burnout could be a serious problem for head nurses who are responsible for both

Cohort profile: the Italian Network of Longitudinal Metropolitan Studies (IN-LiMeS), a multicentre cohort for socioeconomic inequalities in health monitoring.

Science.gov (United States)

Caranci, Nicola; Di Girolamo, Chiara; Giorgi Rossi, Paolo; Spadea, Teresa; Pacelli, Barbara; Broccoli, Serena; Ballotari, Paola; Costa, Giuseppe; Zengarini, Nicolás; Agabiti, Nera; Bargagli, Anna Maria; Cacciani, Laura; Canova, Cristina; Cestari, Laura; Biggeri, Annibale; Grisotto, Laura; Terni, Gianna; Costanzo, Gianfranco; Mirisola, Concetta; Petrelli, Alessio

2018-04-20

The Italian Network of Longitudinal Metropolitan Studies (IN-LiMeS) is a system of integrated data on health outcomes, demographic and socioeconomic information, and represents a powerful tool to study health inequalities. IN-LiMeS is a multicentre and multipurpose pool of metropolitan population cohorts enrolled in nine Italian cities: Turin, Venice, Reggio Emilia, Modena, Bologna, Florence, Leghorn, Prato and Rome. Data come from record linkage of municipal population registries, the 2001 population census, mortality registers and hospital discharge archives. Depending on the source of enrolment, cohorts can be closed or open. The census-based closed cohort design includes subjects resident in any of the nine cities at the 2001 census day; 4 466 655 individuals were enrolled in 2001 in the nine closed cohorts. The open cohort design includes subjects resident in 2001 or subsequently registered by birth or immigration until the latest available follow-up (currently 31 December 2013). The open cohort design is available for Turin, Venice, Reggio Emilia, Modena, Bologna, Prato and Rome. Detailed socioeconomic data are available for subjects enrolled in the census-based cohorts; information on demographic characteristics, education and citizenship is available from population registries. The first IN-LiMeS application was the study of differentials in mortality between immigrants and Italians. Either using a closed cohort design (nine cities) or an open one (Turin and Reggio Emilia), individuals from high migration pressure countries generally showed a lower mortality risk. However, a certain heterogeneity between the nine cities was noted, especially among men, and an excess mortality risk was reported for some macroareas of origin and specific causes of death. We are currently working on the linkage of the 2011 population census data, the expansion of geographical coverage and the implementation of the open design in all the participating cohorts. © Article author

Effect of photochemical smog associated with synoptic weather patterns on cardiovascular and respiratory hospital admissions in metropolitan Taipei.

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Lai, Li-Wei

2012-01-01

This study focuses on the relationship between photochemical smog (PS) (hourly ozone conc. >100 ppb), PS-related diseases, and the synoptic weather patterns during 2005-2009 in metropolitan Taipei. The results show that compared to respiratory ailments (ICD code 460-519) and asthma (ICD code 493), cardiovascular ailments (ICD code 390-459) were more clearly influenced by PS events. On the PS event day, the number of admissions of babies, children, and adults increased by 0.04 [95% CI 0.01-0.06], 0.03 [95% CI 0.00-0.07], and 1.12 [95% CI 0.36-1.89] (P < 0.05), respectively. The investigation showed that more than 70% of the PS events were associated primarily with the peripheral circulation of typhoons, Pacific pressure, and discrete Pacific pressure. PS events are a threat to public health. To avoid the ill effects of air pollution, residents should be informed about the daily weather patterns and air quality.

What is the job satisfaction and active participation of medical staff in public hospital reform: a study in Hubei province of China.

Science.gov (United States)

Fang, Pengqian; Luo, Zhenni; Fang, Zi

2015-05-16

In China, public hospital reform has been underway for almost 5 years, and 311 pilot county hospitals are the current focus. This study aimed to assess the job satisfaction and active participation of medical staff in the reform. A total of 2268 medical staff members in pilot and non-pilot county hospitals in Hubei, China, were surveyed. Questionnaires were used to collect data. The Pearson chi-square statistical method was used to assess the differences between pilot and non-pilot county hospitals and identify the factors related to job satisfaction as well as the understanding and perception of the reform. Binary logistic regression was performed to determine the significant factors that influence the job satisfaction of medical staff in pilot county hospitals. Medical staff members in pilot county hospitals expressed higher satisfaction on current working situation, performance appraisal system, concern showed by leaders, hospital management, and compensation packages (P job and they have evidently less satisfaction on compensation packages and learning and training opportunities. The working hours and work stress were negatively related to the job satisfaction (P Satisfaction on the performance appraisal system, hospital management, compensation packages, and learning and training opportunities were positively related to job satisfaction (P pay attention to influencing factors of job satisfaction and focus on the reasonable demands of medical staff. In addition, the medical staff in pilot county hospitals exhibited a better understanding of the public hospital reform programme and showed more firm confidence, but there still were some medical staff members who hold negative attitude. The publicity and education of the public hospital reform still need improvement.

Perceived stigmatization and discrimination of people with mental illness: A survey-based study of the general population in five metropolitan cities in India.

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Böge, Kerem; Zieger, Aron; Mungee, Aditya; Tandon, Abhinav; Fuchs, Lukas Marian; Schomerus, Georg; Tam Ta, Thi Minh; Dettling, Michael; Bajbouj, Malek; Angermeyer, Matthias; Hahn, Eric

2018-01-01

India faces a significant gap between the prevalence of mental illness among the population and the availability and effectiveness of mental health care in providing adequate treatment. This discrepancy results in structural stigma toward mental illness which in turn is one of the main reasons for a persistence of the treatment gap, whereas societal factors such as religion, education, and family structures play critical roles. This survey-based study investigates perceived stigma toward mental illness in five metropolitan cities in India and explores the roles of relevant sociodemographic factors. Samples were collected in five metropolitan cities in India including Chennai ( n = 166), Kolkata ( n = 158), Hyderabad ( n = 139), Lucknow ( n = 183), and Mumbai ( n = 278). Stratified quota sampling was used to match the general population concerning age, gender, and religion. Further, sociodemographic variables such as educational attainment and strength of religious beliefs were included in the statistical analysis. Participants displayed overall high levels of perceived stigma. Multiple linear regression analysis found a significant effect of gender ( P Gender differences in cultural and societal roles and expectations could account for higher levels of perceived stigma among female participants. A higher level of perceived stigma among female participants is attributed to cultural norms and female roles within a family or broader social system. This study underlines that while India as a country in transition, societal and gender rules still impact perceived stigma and discrimination of people with mental illness.

Study on waste waters of metal finishing industries around Lahore metropolitan area

International Nuclear Information System (INIS)

Khan, Izhar-ul-Haq; Mahmood, F.; Tufail, S.; Naeem, M.

2002-01-01

Study was undertaken on the waste water samples from metal finishing industries of Lahore metropolitan area for the evaluation of metallic impurities. The metal finishing industry was classified into three categories i. e. medium scale, small scale and cottage scale industry. About 93 wastewater samples were collected from various metal finishing industries around Lahore metropolitan area. In addition to toxic elements like cadmium, nickel and zinc the other parameters such as hydrogen ion concentration (pH), Electrical conductivity (EC) and Total Dissolved Salts (TDS) were also determined. (author)

Shifting balances in U.S. metropolitan and nonmetropolitan area growth.

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Garnick, D H

1984-12-01

"This paper assesses some of the recent attempts to explain the perceived growth reversal between metropolitan and nonmetropolitan areas in the United States during the 1970s. The paper argues that the reversal in population trends was not a one-time, radical shift in settlement trends, but rather the result of more continuous underlying industrial trends. Indeed, since 1979, population growth has again become faster in metropolitan than nonmetropolitan areas." The paper includes three sections. Regional and area population and industrial earnings growth patterns are first summarized for the 1960s, 1970s, and 1980s. Theories of polarization and polar reversal are then evaluated and found to be inadequate. Finally, a reconstruction of the neoclassical model is proposed. excerpt

The Role of Great Cities in Romania for the Metropolitan Development

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Ruxandra Irina POPESCU

2008-02-01

Full Text Available According to the legislation in force, in Romania there are 11 first rank cities that given their size, their importance, the level of services and the economic activity, represent attractions and are subjected to the development pressures. Still, according to the European tendencies, the urban agglomerations tend to approach this type of cooperation regardless the number of the inhabitants. Currently in Romania there are 11 great cities that have developed processes of organizing the metropolitan areas corresponding to them. Among them, two have already created metropolitan areas: Oradea (2001 and Iaşi (2004, both with the assistance of programs financed by USAID.

Intra-metropolitan inequalities in Rio de Janeiro and the Guanabara Bay cleaning programme

DEFF Research Database (Denmark)

Ribeiro, Gustavo; Silva, Victor

2005-01-01

This paper investigates the impacts of the Guanabara Bay Cleaning Programme (GBCP) on the Rio de Janeiro urban development process. Based on the magnitude of the budget of the programme (HOW MUCH?) and its relevance to the improvement of the life quality of urban dwellers, the main discussion...... of this paper focuses on the role of GBCP in the context of the Rio de Janeiro urban trends and intra-metropolitan inequality dynamics. In studying the impact of the GBCP, we present: (a) a description of the GBCP intervention process and its goals, (b) a spatial analysis of the Rio de Janeiro Metropolitan Area...... the role of the GBCP implementation in the spatial distribution of these patterns throughout these 10 years. The conclusion builds on an analysis of the GBCP role in the current urban development process of the Rio de Janeiro Metropolitan Area, identifying its influences on the dynamics of intra...

Radiographer commenting of trauma radiographs: a survey of the benefits, barriers and enablers to participation in an Australian healthcare setting

International Nuclear Information System (INIS)

Neep, Michael J.; Steffens, Tom; Owen, Rebecca; McPhail, Steven M.

2014-01-01

Radiographer abnormality detection systems that highlight abnormalities on trauma radiographs ('red dot' system) have been operating for more than 30 years. Recently, a number of pitfalls have been identified. These limitations initiated the evolution of a radiographer commenting system, whereby a radiographer provides a brief description of abnormalities identified in emergency healthcare settings. This study investigated radiographers' participation in abnormality detection systems, their perceptions of benefits, barriers and enablers to radiographer commenting, and perceptions of potential radiographer image interpretation services for emergency settings. A cross-sectional survey was implemented. Participants included radiographers from four metropolitan hospitals in Queensland, Australia. Conventional descriptive statistics, histograms and thematic analysis were undertaken. Seventy-three surveys were completed and included in the analysis (68% response rate); 30 (41%) of respondents reported participating in abnormality detection in 20% or less of examinations, and 26(36%) reported participating in 80% or more of examinations. Five overarching perceived benefits of radiographer commenting were identified: assisting multidisciplinary teams, patient care, radiographer ability, professional benefits and quality of imaging. Frequently reported perceived barriers included 'difficulty accessing image interpretation education', 'lack of time' and 'low confidence in interpreting radiographs'. Perceived enablers included 'access to image interpretation education' and 'support from radiologist colleagues'. A range of factors are likely to contribute to the successful implementation of radiographer commenting in addition to abnormality detection in emergency settings. Effective image interpretation education amenable to completion by radiographers would likely prove valuable in preparing radiographers for participation in abnormality detection and commenting systems in

42 CFR 482.62 - Condition of participation: Special staff requirements for psychiatric hospitals.

Science.gov (United States)

2010-10-01

... requirements for psychiatric hospitals. 482.62 Section 482.62 Public Health CENTERS FOR MEDICARE & MEDICAID... staff requirements for psychiatric hospitals. The hospital must have adequate numbers of qualified...) Standard: Director of inpatient psychiatric services; medical staff. Inpatient psychiatric services must be...

Epitaphios of Jovan, the Metropolitan of Skopje, in the treasury of the Hilandar monastery

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Radovanović Janko

2006-01-01

Full Text Available The epitaphios of Jovan, the Metropolitan of Skopje, was created between 1346 and 1348. It is unique for its beauty and iconographic program and, at the same time, it is the oldest of the epitaphia preserved in our country. The epitaphios was worn in the course of Holy Liturgy, during the Great Entrance in the cathedral churches and the major monasteries. Metropolitan Jovan presented the epitaphios as a gift to Christ 'my life-giver.' Depicted on its central field is the Epitaphios Threnos (Lamentation at the Tomb. Added around it, at a later time it seems, are bands representing the fourteen scenes of Great Feasts and the officiating Church Fathers, in embroidery. Holy Liturgy is served by the greatest fathers and teachers of the Church and Metropolitan Jovan.

Statewide and Metropolitan Transportation Planning Processes : a TPCB Peer Exchange

Science.gov (United States)

2016-04-20

This report highlights key recommendations and noteworthy practices identified at Statewide and Metropolitan Transportation Planning Processes Peer Exchange held on September 9-10, 2015 in Shepherdstown, West Virginia. This event was sponsored ...

Moving Upstream in U.S. Hospital Care Toward Investments in Population Health.

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Begun, James W; Potthoff, Sandra

The root causes for most health outcomes are often collectively referred to as the social determinants of health. Hospitals and health systems now must decide how much to "move upstream," or invest in programs that directly affect the social determinants of health. Moving upstream in healthcare delivery requires an acceptance of responsibility for the health of populations. We examine responses of 950 nonfederal, general hospitals in the United States to the 2015 American Hospital Association Population Health Survey to identify characteristics that distinguish those hospitals that are most aligned with population health and most engaged in addressing social determinants of health. Those "upstream" hospitals are significantly more likely to be large, not-for-profit, metropolitan, teaching-affiliated, and members of systems. Internally, the more upstream hospitals are more likely to organize their population health activities with strong executive-level involvement, full-time-equivalent support, and coordination at the system level.The characteristics differentiating hospitals strongly involved in population health and upstream activity are not unlike those characteristics associated with diffusion of many innovations in hospitals. These hospitals may be the early adopters in a diffusion process that will eventually include most hospitals or, at least, most not-for-profit hospitals. Alternatively, the population health and social determinants movements could be transient or could be limited to a small portion of hospitals such as those identified here, with distinctive patient populations, missions, and resources.

Comparative Analysis of User-Generated Online Yelp Reviews for Periodontal Practices in Multiple Metropolitan Markets.

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Holtzclaw, Dan J

2017-02-01

Previously published research for a single metropolitan market (Austin, Texas) found that periodontists fare poorly on the Yelp website for nearly all measured metrics, including average star ratings, number of reviews, review removal rate, and evaluations by "elite" Yelp users. The purpose of the current study is to confirm or refute these findings by expanding datasets to additional metropolitan markets of various sizes and geographic locations. A total of 6,559 Yelp reviews were examined for general dentists, endodontists, pediatric dentists, oral surgeons, orthodontists, and periodontists in small (Austin, Texas), medium (Seattle, Washington), and large (New York City, New York) metropolitan markets. Numerous review characteristics were evaluated, including: 1) total number of reviews; 2) average star rating; 3) review filtering rate; and 4) number of reviews by Yelp members with elite status. Results were compared in multiple ways to determine whether statistically significant differences existed. In all metropolitan markets, periodontists were outperformed by all other dental specialties for all measured Yelp metrics in this study. Intermetropolitan comparisons of periodontal practices showed no statistically significant differences. Periodontists were outperformed consistently by all other dental specialties in every measured metric on the Yelp website. These results were consistent and repeated in all three metropolitan markets evaluated in this study. Poor performance of periodontists on Yelp may be related to the age profile of patients in the typical periodontal practice. This may result in inadvertently biased filtering of periodontal reviews and subsequently poor performance in multiple other categories.

Hospital boards and hospital strategic focus: the impact of board involvement in strategic decision making.

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Ford-Eickhoff, Karen; Plowman, Donde Ashmos; McDaniel, Reuben R

2011-01-01

Despite pressures to change the role of hospital boards, hospitals have made few changes in board composition or director selection criteria. Hospital boards have often continued to operate in their traditional roles as either "monitors" or "advisors." More attention to the direct involvement of hospital boards in the strategic decision-making process of the organizations they serve, the timing and circumstances under which board involvement occurs, and the board composition that enhances their abilities to participate fully is needed. We investigated the relationship between broader expertise among hospital board members, board involvement in the stages of strategic decision making, and the hospital's strategic focus. We surveyed top management team members of 72 nonacademic hospitals to explore the participation of critical stakeholder groups such as the board of directors in the strategic decision-making process. We used hierarchical regression analysis to explore our hypotheses that there is a relationship between both the nature and involvement of the board and the hospital's strategic orientation. Hospitals with broader expertise on their boards reported an external focus. For some of their externally-oriented goals, hospitals also reported that their boards were involved earlier in the stages of decision making. In light of the complex and dynamic environment of hospitals today, those charged with developing hospital boards should match the variety in the external issues that the hospital faces with more variety in board makeup. By developing a board with greater breadth of expertise, the hospital responds to its complex environment by absorbing that complexity, enabling a greater potential for sensemaking and learning. Rather than acting only as monitors and advisors, boards impact their hospitals' strategic focus through their participation in the strategic decision-making process.

Knowledge Worker Perceptions of Telework Policy in the New York Metropolitan Area: A Qualitative Descriptive Study

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Slaughter, Sandra Lorraine Hawks

2013-01-01

This qualitative descriptive case study, "Knowledge Worker Perceptions of Telework in the New York Metropolitan Area," was conducted to explore the perceptions of knowledge workers who commute to a physical workplace in the New York Metropolitan area (NYMA). In-depth interviews were conducted with fourteen NYMA commuters who are…

Hospital board effectiveness: relationships between board training and hospital financial viability.

Science.gov (United States)

Molinari, C; Morlock, L; Alexander, J; Lyles, C A

1992-01-01

This study examined whether hospital governing boards that invest in board education and training are more informed and effective decision-making bodies. Measures of hospital financial viability (i.e., selected financial ratios and outcomes) are used as indicators of hospital board effectiveness. Board participation in educational programs was significantly associated with improved profitability, liquidity, and occupancy levels, suggesting that investment in the education of directors is likely to enhance hospital viability and thus increase board effectiveness.

Outsourcing and "dismantling" of steady jobs at hospitals

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Helton Saragor de Souza

2016-04-01

Full Text Available Abstract OBJECTIVE To relate hospitals' organizational structure as the core of a web of outsourced services and flexible employment bonds among healthcare professionals in the context of finance capitalism, analyzing work arrangements based mainly on the type of employment bond. METHOD Qualitative research through ethnography, interviews, data analysis, and case studies. The case studies were concentrated in 3 hospitals located in the São Paulo metropolitan region under different management types: public administration; outsourced administration via a healthcare social organization (HSO; and private administration. RESULTS This study highlights a trend in outsourcing, dismantling of steady jobs, and shaping working relations asymmetrically in terms of healthcare professions. CONCLUSION These aspects are characteristic of contemporary capitalism and post-Fordist work organization. In this context, the state under sponsorship cripples the very existence of an effective human resources policy, creating a favorable environment for outsourcing and flexibility of employment bonds among healthcare workers.

The metropolitan area as a knee-jerk response to the multilevel governance and its derived national public decisions

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Cătălin Daniel DUMITRICĂ

2013-06-01

Full Text Available The paper objectifies the first part of a larger projects aiming at establishing a public decision-making map pertaining to the negative externalities in the framework of the economic approach of subsidiarity in the multilevel governance (the case of Romania. The first part of the larger research project refers to testing whether the economic theory of the European Union multilevel governance, with its core consisting in the subsidiarity principle, puts more pressure on the national public decisions (more specifically those related to specific market failures, though it interferes with all state’s functions and their specific decisions.Our research thesis begins by establishing whether the relationship between the local political elites and public governance at the level of towns and communes is considered a very straight forward, even obvious relationship. The political parties, by means of the publicly and democratically-elected officials (mayors and local council-members, make the most important decisions concerning public affairs (i.e. pertaining to a market failure examined by a second stage of the project.In an attempt to modernize the Romanian administrative system, to make public administration more dynamic, flexible and pro-active, the local political leaders decided the development of a new type of structure, the metropolitan area. The metropolitan areas, due to the constraints of the law, were established as associative organizations, composed of several administrative-territorial units.The paper at hand presents the establishment of the metropolitan areas in Romania as a political decision to associate towns and communes, in view of gaining access to better-performance instruments for local economic development. The emergence of the metropolitan areas in our country is strongly connected with the local political elites, the local political actors representing, in fact, the engine of the metropolitan structures and regional

Benchmarking of Percutaneous Injuries at the Ministry of Health Hospitals of Saudi Arabia in Comparison with the United States Hospitals Participating in Exposure Prevention Information Network (EPINet™

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ZA Memish

2015-01-01

Full Text Available Background: Exposure to blood-borne pathogens from needle-stick and sharp injuries continues to pose a significant risk to health care workers. These events are of concern because of the risk to transmit blood-borne diseases such as hepatitis B virus, hepatitis C virus, and the human immunodeficiency virus. Objective: To benchmark different risk factors associated with needle-stick incidents among health care workers in the Ministry of Health hospitals in the Kingdom of Saudi Arabia compared to the US hospitals participating in Exposure Prevention Information Network (EPINet ™. Methods: Prospective surveillance of needle-stick and sharp incidents carried out during the year 2012 using EPINet™ ver 1.5 that provides uniform needle stick and sharp injury report form. Results: The annual percutaneous incidents (PIs rate per 100 occupied beds was 3.2 at the studied MOH hospitals. Nurses were the most affected job category by PIs (59.4%. Most PIs happened in patients' wards in the Ministry of Health hospitals (34.6%. Disposable syringes were the most common cause of PIs (47.20%. Most PIs occurred during use of the syringes (36.4%. Conclusion: Among health care workers, nurses and physicians appear especially at risk of exposure to PIs. Important risk factors of injuries include working in patient room, using disposable syringes, devices without safety features. Preventive strategies such as continuous training of health care workers with special emphasis on nurses and physicians, encouragement of reporting of such incidents, observation of sharp handling, their use and implementation of safety devices are warranted.

Health Impacts and Economic Costs of Air Pollution in the Metropolitan Area of Skopje.

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Martinez, Gerardo Sanchez; Spadaro, Joseph V; Chapizanis, Dimitris; Kendrovski, Vladimir; Kochubovski, Mihail; Mudu, Pierpaolo

2018-03-29

Urban outdoor air pollution, especially particulate matter, remains a major environmental health problem in Skopje, the capital of the former Yugoslav Republic of Macedonia. Despite the documented high levels of pollution in the city, the published evidence on its health impacts is as yet scarce. we obtained, cleaned, and validated Particulate Matter (PM) concentration data from five air quality monitoring stations in the Skopje metropolitan area, applied relevant concentration-response functions, and evaluated health impacts against two theoretical policy scenarios. We then calculated the burden of disease attributable to PM and calculated the societal cost due to attributable mortality. In 2012, long-term exposure to PM 2.5 (49.2 μg/m³) caused an estimated 1199 premature deaths (CI95% 821-1519). The social cost of the predicted premature mortality in 2012 due to air pollution was estimated at between 570 and 1470 million euros. Moreover, PM 2.5 was also estimated to be responsible for 547 hospital admissions (CI95% 104-977) from cardiovascular diseases, and 937 admissions (CI95% 937-1869) for respiratory disease that year. Reducing PM 2.5 levels to the EU limit (25 μg/m³) could have averted an estimated 45% of PM-attributable mortality, while achieving the WHO Air Quality Guidelines (10 μg/m³) could have averted an estimated 77% of PM-attributable mortality. Both scenarios would also attain significant reductions in attributable respiratory and cardiovascular hospital admissions. Besides its health impacts in terms of increased premature mortality and hospitalizations, air pollution entails significant economic costs to the population of Skopje. Reductions in PM 2.5 concentrations could provide substantial health and economic gains to the city.

Elders and patient participation revisited - a discourse analytic approach to older persons' reflections on patient participation.

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Foss, Christina

2011-07-01

This study focuses on how older persons' accounts of participation might be framed and constructed based on their social and historical situatedness. The picture emerging from contemporary research tends to portray older people as a group who prefer to leave decisions to the professionals during a hospital stay. Through an approach that sought to contextualise the respondents' accounts of participation, different features of patient participation became visible. The study is based on a postmodern framework using a discursive approach, informed by the works of Foucault and on works that have been developed in line with his main ideas. Eighteen individual in-depth interviews with older people (age 80+) were conducted between one to two weeks after discharge from hospital. Findings indicate that older people actively position themselves in relation to various discourses at play in the hospital, and display a wide variety of strategies aimed at gaining influence. To the older persons in this study, participation was practised in a subtle and discreet way, as a matter of choosing a good strategy to interact with the personnel. Participation was also seen as a matter of balancing their own needs against the needs of others and as a behaviour that required self-confidence. The accounts of patient participation given by the older persons differed from the dominant and taken-for-granted discourse of patient participation as a right. As the older persons' understanding and practice of patient participation do not 'fit' the contemporary idea of participation, it is in danger of being ignored or overlooked by care-givers as well as by researchers. To identify older patients' wish to participate, one must actively search for it. © 2011 Blackwell Publishing Ltd.

Costs of day hospital and community residential chemical dependency treatment.

Science.gov (United States)

Kaskutas, Lee Ann; Zavala, Silvana K; Parthasarathy, Sujaya; Witbrodt, Jane

2008-03-01

Patient placement criteria developed by the American Society of Addiction Medicine (ASAM) have identified a need for low-intensity residential treatment as an alternative to day hospital for patients with higher levels of severity. A recent clinical trial found similar outcomes at social model residential treatment and clinically-oriented day hospital programs, but did not report on costs. This paper addresses whether the similar outcomes in the recent trial were delivered with comparable costs, overall and within gender and ethnicity stratum. This paper reports on clients not at environmental risk who participated in a randomized trial conducted in three metropolitan areas served by a large pre-paid health plan. Cost data were collected using the Drug Abuse Treatment Cost Analysis Program (DATCAP). Costs per episode were calculated by multiplying DATCAP-derived program-specific costs by each client's length of stay. Differences in length of stay, and in per-episode costs, were compared between residential and day hospital subjects. Lengths of stay at residential treatment were significantly longer than at day hospital, in the sample overall and in disaggregated analyses. This difference was especially marked among non-Whites. The average cost per week was USD 575 per week at day hospital, versus USD 370 per week at the residential programs. However, because of the longer stays in residential, per-episode costs were significantly higher in the sample overall and among non-Whites (and marginally higher for men). These cost results must be considered in light of the null findings comparing outcomes between subjects randomized to residential versus day hospital programs. The longer stays in the sample overall and for non-White clients at residential programs came at higher costs but did not lead to better rates of abstinence. The short stays in day hospital among non-Whites call into question the attractiveness of day hospital for minority clients. Outcomes and costs

Illicit Drug Use, Illicit Drug Use Disorders, and Drug Overdose Deaths in Metropolitan and Nonmetropolitan Areas - United States.

Science.gov (United States)

Mack, Karin A; Jones, Christopher M; Ballesteros, Michael F

2017-10-20

Drug overdoses are a leading cause of injury death in the United States, resulting in approximately 52,000 deaths in 2015. Understanding differences in illicit drug use, illicit drug use disorders, and overall drug overdose deaths in metropolitan and nonmetropolitan areas is important for informing public health programs, interventions, and policies. Illicit drug use and drug use disorders during 2003-2014, and drug overdose deaths during 1999-2015. The National Survey of Drug Use and Health (NSDUH) collects information through face-to-face household interviews about the use of illicit drugs, alcohol, and tobacco among the U.S. noninstitutionalized civilian population aged ≥12 years. Respondents include residents of households and noninstitutional group quarters (e.g., shelters, rooming houses, dormitories, migratory workers' camps, and halfway houses) and civilians living on military bases. NSDUH variables include sex, age, race/ethnicity, residence (metropolitan/nonmetropolitan), annual household income, self-reported drug use, and drug use disorders. National Vital Statistics System Mortality (NVSS-M) data for U.S. residents include information from death certificates filed in the 50 states and the District of Columbia. Cases were selected with an underlying cause of death based on the ICD-10 codes for drug overdoses (X40-X44, X60-X64, X85, and Y10-Y14). NVSS-M variables include decedent characteristics (sex, age, and race/ethnicity) and information on intent (unintentional, suicide, homicide, or undetermined), location of death (medical facility, in a home, or other [including nursing homes, hospices, unknown, and other locations]) and county of residence (metropolitan/nonmetropolitan). Metropolitan/nonmetropolitan status is assigned independently in each data system. NSDUH uses a three-category system: Core Based Statistical Area (CBSA) of ≥1 million persons; CBSA of illicit drugs, the prevalence was highest for the large metropolitan areas compared with

Quality of life of head and neck cancer patients in urban and regional areas: An Australian perspective.

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Pateman, Kelsey A; Cockburn, Nicole L; Batstone, Martin D; Ford, Pauline J

2018-06-01

Head and neck cancer treatment affects quality of life. There are differences in quality of life outcomes and perceived supportive care needs between cancer patients living in metropolitan and regional-remote areas. This study investigated quality of life over the first 6 months following head and neck cancer diagnosis and observed differences in quality of life by geographical location. Prospective observational study. Tertiary hospital in Brisbane, Australia. Newly diagnosed patients who were referred for the diagnosis, and/or treatment of head and neck cancer. Quality of life was measured by the University of Washington Quality of Life Survey, version 4 (UW-QoL). Participants completed the UW-QoL questionnaire prior to starting treatment, 1 month and 6 months post treatment. Metropolitan and regional or remote status was classified according to the Australian Standard Geographic Classification-Remoteness Area system. Ninety-five participants were included at baseline; 49 and 41 participants completed the 1-month and 6-month follow-ups, respectively. Scores in most UW-QoL domains decreased between baseline and 1 month post treatment and increased towards pre-treatment scores at the 6-month follow-up (except for anxiety and saliva). Pain at baseline was significantly worse in the regional-remote participants compared with metropolitan participants. No other statistically significant differences in UW-QoL score by geographical location were observed. The findings generally did not support significant differences in quality of life outcome between metropolitan and regional-remote head and neck cancer patients. The difference in pain experience between metropolitan and regional-remote groups requires further investigation. © 2018 National Rural Health Alliance Ltd.

42 CFR 482.42 - Condition of participation: Infection control.

Science.gov (United States)

2010-10-01

... Hospital Functions § 482.42 Condition of participation: Infection control. The hospital must provide a... be an active program for the prevention, control, and investigation of infections and communicable... 42 Public Health 5 2010-10-01 2010-10-01 false Condition of participation: Infection control. 482...

Factors Affecting the Decision to Quit Smoking of the Participants of a Hospital-Based Smoking Cessation Program in Greece

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Charikleia Georgiadou

2015-03-01

Full Text Available Introduction: The purpose of this study was to investigate the factors that affect people who are in the process of quitting smoking. Methods: A randomly selected sample of 110 participants in a smoking cessation program (SCP of a hospital in Thessaloniki Greece. Instruments of data collection were: i the Demographic Data Lifestyle Questionnaire and ii the Fragerstrom Tolerance Questionnaire. ANOVA tests between the Demographic Data Lifestyle Questionnaire and the Fagerstrom Tolerance Questionnaire relating to the smokers’ determination to quit smoking applied. Results: Work satisfaction was related to whether the participants had difficulty to smoke in places that prohibited smoking and to how many cigarettes they smoked per day. If a non-smoker partner was urging the participant to quit smoking, it affected the hours of the day when the respondents smoked more cigarettes. Pressure from a non-smoking spouse was a deterrent from smoking many cigarettes during morning hours. Those participants who consumed alcohol smoked cigarettes containing higher levels of nicotine. Conclusion: Smoking cessation is a difficult process which is influenced by many factors such as educational level, work satisfaction and the presence of a partner.

Accessibility, activity participation and location of activities

DEFF Research Database (Denmark)

Næss, Petter

2006-01-01

By investigating relationships between residential location and the availability of facilities, location of activities, trip distances, activity participation and trip frequencies, this paper seeks to contribute to a more detailed and nuanced understanding of the relationships between residential...... location and the amount of daily-life travel in an urban region. The empirical data are from a comprehensive study of residential location and travel in Copenhagen Metropolitan Area. Differences between inner- and outer-area residents in activity frequencies and trip frequencies are modest and partly...... outweigh each other. However, differences in trip distances due to the location of the dwelling relative to concentrations of facilities translate into substantially longer total travelling distances among suburbanites than among inner-city residents....

Online identity: constructing interpersonal trust and openness through participating in hospitality social networks

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Alexander Ronzhyn

2013-06-01

Full Text Available The present article describes the results of research on online identity construction during the participation in the hospitality social networks. Specifically the user references are analysed to understand patterns that form the image of a member. CouchSurfing service (couchsurfing.org allows users to leave short texts where the experience of hosting/being hosted by a CS member is described, is an evaluation of the CS members of each other’s personal traits, skills and common experience. Therefore references can become a good instrument for portraying a CouchSurfing member and understanding his or her particular traits. References form an important part of a user’s virtual identity in the network. Using a sample of references of Spanish CouchSurfing users, the research established main characteristics of the references, which are the openness, readiness to share ideas and experiences and trustworthiness. These concepts illustrate the typical traits associated with a user of the network and also shed light on the activities common during offl ine CS meetings

Using the Hospital Nutrition Environment Scan to Evaluate Health Initiative in Hospital Cafeterias.

Science.gov (United States)

Derrick, Jennifer Willahan; Bellini, Sarah Gunnell; Spelman, Julie

2015-11-01

Health-promoting environments advance health and prevent chronic disease. Hospitals have been charged to promote health and wellness to patients, communities, and 5.3 million adults employed in United States health care environments. In this cross-sectional observational study, the Hospital Nutrition Environment Scan (HNES) was used to measure the nutrition environment of hospital cafeterias and evaluate the influence of the LiVe Well Plate health initiative. Twenty-one hospitals in the Intermountain West region were surveyed between October 2013 and May 2014. Six hospitals participated in the LiVe Well Plate health initiative and were compared with 15 hospitals not participating. The LiVe Well Plate health initiative identified and promoted a healthy meal defined as health initiative branding were also posted at point of purchase. Hospital cafeterias were scored on four subcategories: facilitators and barriers, grab-and-go items, menu offerings, and selection options at point of purchase. Overall, hospitals scored 35.3±13.7 (range=7 to 63) points of 86 total possible points. Cafeterias in health initiative hospitals had significantly higher mean nutrition composite scores compared with non-health initiative hospitals (49.2 vs 29.7; Penvironment of hospital cafeterias. Additional research is needed to quantify and strategize ways to improve nutrition environments within hospital cafeterias and assess the influence on healthy lifestyle behaviors. Copyright © 2015 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Is Urban Planning in Australia Hindered by Poor Metropolitan Governance?

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Paul Burton

2017-11-01

Full Text Available There are many calls for urban planning in Australia to be reformed, although often in contradictory ways. For example, some argue it should be capable of delivering greater certainty to developers while others call for more flexibility in processes of urban development regulation; some would like to roll back its regulatory impact while others argue for a renewal of planning’s commitment to promoting social and spatial justice. The Australian planning system is also held to be hindered by a comparative lack of planning at and for the metropolitan scale. This is connected to the absence of well-developed structures of metropolitan governance in what is a three-tier federal system, with most power over planning concentrated at the State and Territory government scale. The paper explores this putative hindrance by considering three important issues in Australian urban policy debates about the efficacy of contemporary multi-level governance arrangements: spatial scale; identity and legitimacy; and efficiency and effectiveness. It includes some analysis of the case made for a more explicit and rigorous national urban policy and how this might relate to lower level planning regimes. The paper focuses on recent urban policy and planning initiatives in South East Queensland, one of Australia’s fastest growing metropolitan regions, and concludes that while incremental but nonetheless significant improvements in planning policy and practice are possible, these are unlikely to satisfy those calling for more radical changes to improve the Australian planning system.

Estimating the health and economic benefits associated with reducing air pollution in the Barcelona metropolitan area (Spain).

Science.gov (United States)

Pérez, Laura; Sunyer, Jordi; Künzli, Nino

2009-01-01

To estimate the health and economic benefits that would result from two scenarios of improved air quality in 57 municipalities of the metropolitan area of Barcelona. We used attributable fractions and life tables to quantify the benefits for selected health outcomes, based on published concentration-response functions and economic unit values. The mean weighted concentration of PM(10) for the study population was estimated through concentration surface maps developed by the local government. The annual mean health benefits of reducing the mean PM(10) exposure estimated for the population in the study area (50microg/m(3)) to the annual mean value recommended by the World Health Organization (20microg/m(3)) were estimated to be 3,500 fewer deaths (representing an average increase in life expectancy of 14 months), 1,800 fewer hospitalizations for cardio-respiratory diseases, 5,100 fewer cases of chronic bronchitis among adults, 31,100 fewer cases of acute bronchitis among children, and 54,000 fewer asthma attacks among children and adults. The mean total monetary benefits were estimated to be 6,400 million euros per year. Reducing PM(10) to comply with the current European Union regulatory annual mean level (40microg/m(3)) would yield approximately one third of these benefits. This study shows that reducing air pollution in the metropolitan area of Barcelona would result in substantial health and economic benefits. The benefits are probably underestimated due to the assumptions made in this study. Assessment of the health impact of local air pollution is a useful tool in public health.

The polycentric structure of local labour markets in Mexico City's Metropolitan Area

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José María Casado Izquierdo

2012-11-01

Full Text Available Commuting data at a district level and an algorithm designed to delineate self–contained areas show that Mexico City Metropolitan Area (MCMA was organized in 2007 in twelve local labour market areas. Although six exployment subcenters were identified, the MCMA is still clearly dominated by its Central Business District (CBD, being located the remaining five subcenters close to the CBD. Assessment of this spatial structure is not a positive one: diminishing co–location, decrease in speed and increase in commuting time and distance. Nevertheless, the rising percentage of intra–district commuting is a positive sign, even if this trend is not uniform throughout the metropolitan area.

Local Authorities Participation in the Tourism Planning Process

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Ali SELCUK CAN

2014-02-01

Full Text Available The aim of this article is to explore the weaknesses and strengths of local authorities in terms of their participation in the tourism planning process in Turkey. A two-page questionnaire was applied, along with structured interviews with 71 administrators of metropolitan, provincial, and district authorities, between January 1 and September 31, 2011. The findings of the survey suggest that tourism planning responsibilities should be devolved to local authorities. Local authorities do not extensively participate in tourism planning at present because of inadequate budgeting and tourism allocation facilities, insufficient cooperation among stakeholders, and a domination of central administration traditions. Causes of insufficient participation in tourism planning statistically differ among local authorities, in terms of insufficient realizations of the importance of tourism planning by stakeholders, and public land allocation for the purpose of tourism. On the other hand, there is a statistically significant difference between local authorities that have a tourism master plan and those who do not, in terms of a lack of educational opportunities for planners.

Point prevalence of suboptimal footwear features among ambulant older hospital patients: implications for fall prevention.

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Chari, Satyan R; McRae, Prue; Stewart, Matthew J; Webster, Joan; Fenn, Mary; Haines, Terry P

2016-09-01

Objective The aim of the present study was to establish the point prevalence of 'suboptimal' features in footwear reported to have been used by older hospital patients when ambulating, and to explore underpinning factors for their choice of footwear. Method A cross-sectional investigation was undertaken on 95 of 149 eligible in-patients across 22 high fall-risk wards in a large metropolitan hospital in Brisbane, Australia. Results Over 70% of participants experienced an unplanned admission. Although most participants had access to some form of footwear in hospital (92%), nearly all reported ambulating in footwear with 'suboptimal' features (99%). Examples included slippers (27%), backless slippers (16%) or bare feet (27%). For patients who ambulated in bare feet, only one-third reported 'lack of access to footwear' as the primary cause, with others citing foot wounds, pain, oedema and personal choice as the main reason for bare foot ambulation. Conclusions Admitted patients frequently use footwear with 'suboptimal' features for ambulation in hospital. While some footwear options (for example well-fitting slippers) could be suited for limited in-hospital ambulation, others are clearly hazardous and might cause falls. Since footwear choices are influenced by multiple factors in this population, footwear education strategies alone may be insufficient to address the problem of hazardous footwear in at-risk patients. Footwear requirements may be more effectively addressed within a multidisciplinary team approach encompassing foot health, mobility and safety. What is known about the topic? Accidental falls while ambulating are an important health and safety concern for older people. Because certain footwear characteristics have been negatively linked to posture and balance, and specific footwear types linked to falls among seniors, the use of footwear with fewer suboptimal characteristics is generally recommended as a means of reducing the risk of falling. While footwear

Assessment of the Impact of Metropolitan-Scale Urban Planning Scenarios on the Moist Thermal Environment under Global Warming: A Study of the Tokyo Metropolitan Area Using Regional Climate Modeling

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Asuka Suzuki-Parker

2015-01-01

Full Text Available Using a high-resolution regional climate model coupled with urban canopy model, the present study provides the first attempt in quantifying the impact of metropolitan-scale urban planning scenarios on moist thermal environment under global warming. Tokyo metropolitan area is selected as a test case. Three urban planning scenarios are considered: status quo, dispersed city, and compact city. Their impact on the moist thermal environment is assessed using wet-bulb globe temperature (WBGT. Future projections for the 2070s show a 2–4°C increase in daytime mean WBGT relative to the current climate. The urban scenario impacts are shown to be small, with a −0.4 to +0.4°C range. Relative changes in temperature and humidity as the result of a given urban scenario are shown to be critical in determining the sign of the WBGT changes; however, such changes are not necessarily determined by local changes in urban land surface parameters. These findings indicate that urban land surface changes may improve or worsen the local moist thermal environment and that metropolitan-scale urban planning is inefficient in mitigating heat-related health risks for mature cities like Tokyo.

Peer-support suicide prevention in a non-metropolitan U.S. community.

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Walker, Rheeda L; Ashby, Judy; Hoskins, Olivia D; Greene, Farrah N

2009-01-01

Though suicide is a leading cause of death for high school age youth, the overall base rates for suicide deaths are relatively low. Consequently, very few evidence-based suicide prevention programs that address suicide death have emerged. Relative to urban areas, non-metropolitan and rural communities in particular tend to report higher suicide rates that are compounded by poor access to mental health care. In the current study, 63 high school youth participated in the three-day, LifeSavers peer-support suicide prevention training program. The goals of the program are to teach youth to engage in teamwork and listen to others without judgment in addition to recognizing the signs for youth who may be at risk for suicide. The overall aim of LifeSavers is to create a culture whereby primary prevention is active and crisis situations are preempted. Each participant in the current study completed pre-test and posttraining measures of suicide attitudes and knowledge, self-esteem, and also self-acceptance. Findings demonstrated a significant increase in knowledge and positive attitudes toward suicide prevention and also self-esteem, but not self-acceptance. Though more work is needed, these preliminary data reveal that youth in rural communities may benefit from programming such as LifeSavers that commit to advancing peer support and peer-gatekeeping efforts.

The New England Drought Study: Water Resources Planning Metropolitan Boston, Massachusetts

National Research Council Canada - National Science Library

Joyce, Charles

1994-01-01

.... The drought of the 1960s precipitated a debate between the operators of the metropolitan Boston water system and interested citizens and citizens' groups, who were opposed to a structural solution...

Disparities in Salaries: Metropolitan versus Nonmetropolitan Community College Faculty

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Glover, Louis C.; Simpson, Lynn A.; Waller, Lee Rusty

2009-01-01

This article explores disparities in faculty salaries between metropolitan and nonmetropolitan Texas community colleges. The analysis reveals a significant difference in faculty salaries for the 2000 and 2005 academic years respectively. The study found no significant difference in the rate of change in faculty salaries from 2000 to 2005.…

Six sigma: program characteristics in eleven companies located in the metropolitan region of Porto Alegre

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Jaqueline Terezinha Martins Correa Rodrigues

2012-01-01

Full Text Available Six Sigma combines managerial factors with statistical tools and is deployed in many enterprises today. Rio Grande do Sul is a Brazilian state that has a great industrialization, especially in the metropolitan area of Porto Alegre. Some of these industries have deployed the Six Sigma program. The aim of this paper is to present characteristics of the Six Sigma program in companies located in this region, through an exploratory study. A literature review subsidized the development of the questionnaire. Eleven companies participated of research in July and August 2008. It used statistical tools and qualitative analysis to analyze the results. Most of the companies that participated is classified as large and uses the DMAIC method to implement Six Sigma. The principal cause of program implementation was process improvement. In only one company the Six Sigma is implemented in all sectors, including administrative areas. Another result is the lack of clearly criteria for defining the career of Belts and the discrepancy of academic formation of these specialists.

Leadership styles of hospital pharmacy directors.

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Parrett, E E; Hurd, P D; Northcraft, G; McGhan, W F; Bootman, J L

1985-05-01

The leadership styles of hospital pharmacy directors and the association between leadership style, participative management, and innovative pharmaceutical services were studied using a mail questionnaire. The questionnaire was sent to 570 randomly selected hospital pharmacy directors. Included were a validated instrument that measures task-oriented versus relationship-oriented leadership behavior and other questions about participation of staff members, innovative services, and respondents' personal characteristics. The response rate was 69%. The majority of respondents perceived their leadership as highly relationship-oriented as well as highly task-oriented. Respondents with the "high relationship-high task" leadership style had the highest scores for subordinate participation. There were no significant differences in scores for innovative services by leadership style. A positive correlation between scores for subordinate participation and scores for innovative services was demonstrated. Most hospital pharmacy directors used a management style in which relationships and staff participation were important.

Leaching Functions from the Outer Metropolitan Zones (Trade, Services - Increasing Peripherality of Small Towns and Rural Areas

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Krystian Heffner

2015-01-01

Full Text Available Intensive spatial processes taking place around metropolitan areas leads to many economic, structural and social changes in their surroundings. The small towns and rural areas located in the outer zone of metropolitan areas are most affected by this functional changes. In the outer zone of a big urban canters appears a lot of new competing possibilities on the labor market and a comprehensive commercial, service and cultural offer to smaller centres. One of the most competitive advantage of the metropolitan zones becomes modern shopping centres being established in the most accessible places, providing a comprehensive shopping-services and even cultural-recreational offer.

Characterizing Spatial and Temporal Patterns of Thermal Environment and Air Quality in Taipei Metropolitan Area

Science.gov (United States)

Juang, J. Y.; Sun, C. H.; Jiang, J. A.; Wen, T. H.

2017-12-01

The urban heat island effect (UHI) caused by the regional-to-global environmental changes, dramatic urbanization, and shifting in land-use compositions has becoming an important environmental issue in recent years. In the past century, the coverage of urban area in Taipei Basin has dramatically increasing by ten folds. The strengthen of UHI effect significantly enhances the frequency of warm-night effect, and strongly influences the thermal environment of the residents in the Greater Taipei Metropolitan. In addition, the urban expansions due to dramatic increasing in urban populations and traffic loading significantly impacts the air quality and causes health issue in Taipei. In this study, the main objective is to quantify and characterize the temporal and spatial distributions of thermal environmental and air quality in the Greater Taipei Metropolitan Area by using monitoring data from Central Weather Bureau, Environmental Protection Administration. In addition, in this study, we conduct the analysis on the distribution of physiological equivalent temperature in the micro scale in the metropolitan area by using the observation data and quantitative simulation to investigate how the thermal environment is influenced under different conditions. Furthermore, we establish a real-time mobile monitoring system by using wireless sensor network to investigate the correlation between the thermal environment, air quality and other environmental factors, and propose to develop the early warning system for heat stress and air quality in the metropolitan area. The results from this study can be integrated into the management and planning system, and provide sufficient and important background information for the development of smart city in the metropolitan area in the future.

Metropolitan Blueprints of Colonial Taxation? Lessons from Fiscal Capacity Building in British and French Africa, c. 1880-1940

NARCIS (Netherlands)

Frankema, E.H.P.; Waijenburg, van M.F.M.

2014-01-01

The historical and social science literature is divided about the importance of metropolitan blueprints of colonial rule for the development of colonial states. We exploit historical records of colonial state finances to explore the importance of metropolitan identity on the comparative development

Analysing contemporary metropolitan spatial plans in Europe through their institutional context, instrumental content and planning process

DEFF Research Database (Denmark)

Elinbaum, Pablo; Galland, Daniel

2016-01-01

This article sets out to propose and apply a qualitative framework for thinking about how to analyze and compare metropolitan spatial plans in a milieu of divergent spatial planning traditions and discretionary planning practices. In doing so, the article reviews and develops an understanding...... concerning the institutional context, instrumental content and planning processes associated with four contemporary metropolitan spatial plans in Europe, namely London, Copenhagen, Paris and Barcelona. Through the results of a multiple case study and a subsequent cross comparative analysis, the article...... stresses that contemporary metropolitan spatial plans tend to merge characteristics associated with project-based and strategy-based spatial plans, thus contrasting with the typical land-use character of municipal plans and the often strategic, growth-oriented pursuit of regional plans in Europe...

Urban heat island effect on cicada densities in metropolitan Seoul

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Hoa Q. Nguyen

2018-01-01

Full Text Available Background Urban heat island (UHI effect, the ubiquitous consequence of urbanization, is considered to play a major role in population expansion of numerous insects. Cryptotympana atrata and Hyalessa fuscata are the most abundant cicada species in the Korean Peninsula, where their population densities are higher in urban than in rural areas. We predicted a positive relationship between the UHI intensities and population densities of these two cicada species in metropolitan Seoul. Methods To test this prediction, enumeration surveys of cicada exuviae densities were conducted in 36 localities located within and in the vicinity of metropolitan Seoul. Samples were collected in two consecutive periods from July to August 2015. The abundance of each species was estimated by two resource-weighted densities, one based on the total geographic area, and the other on the total number of trees. Multiple linear regression analyses were performed to identify factors critical for the prevalence of cicada species in the urban habitat. Results C. atrata and H. fuscata were major constituents of cicada species composition collected across all localities. Minimum temperature and sampling period were significant factors contributing to the variation in densities of both species, whereas other environmental factors related to urbanization were not significant. More cicada exuviae were collected in the second rather than in the first samplings, which matched the phenological pattern of cicadas in metropolitan Seoul. Cicada population densities increased measurably with the increase in temperature. Age of residential complex also exhibited a significantly positive correlation to H. fuscata densities, but not to C. atrata densities. Discussion Effects of temperature on cicada densities have been discerned from other environmental factors, as cicada densities increased measurably in tandem with elevated temperature. Several mechanisms may contribute to the abundance of

Impact of participation in the California Healthcare-Associated Infection Prevention Initiative on adoption and implementation of evidence-based practices for patient safety and health care-associated infection rates in a cohort of acute care general hospitals.

Science.gov (United States)

Halpin, Helen Ann; McMenamin, Sara B; Simon, Lisa Payne; Jacobsen, Diane; Vanneman, Megan; Shortell, Stephen; Milstein, Arnold

2013-04-01

In 2008, hospitals were selected to participate in the California Healthcare-Associated Infection Prevention Initiative (CHAIPI). This research evaluates the impact of CHAIPI on hospital adoption and implementation of evidence-based patient safety practices and reduction of health care-associated infection (HAI) rates. Statewide computer-assisted telephone surveys of California's general acute care hospitals were conducted in 2008 and 2010 (response rates, 80% and 76%, respectively). Difference-in-difference analyses were used to compare changes in process and HAI rate outcomes in CHAIPI hospitals (n = 34) and non-CHAIPI hospitals (n = 149) that responded to both waves of the survey. Compared with non-CHAIPI hospitals, CHAIPI hospitals demonstrated greater improvements between 2008 and 2010 in adoption (P = .021) and implementation (P = .012) of written evidence-based practices for overall patient safety and prevention of HAIs and in assessing their compliance (P = .033) with these practices. However, there were no significant differences in the changes in HAI rates between CHAIPI and non-CHAIPI hospitals over this time period. Participation in the CHAIPI collaborative was associated with significant improvements in evidence-based patient safety practices in hospitals. However, determining how evidence-based practices translate into changes in HAI rates may take more time. Our results suggest that all hospitals be offered the opportunity to participate in an active learning collaborative to improve patient safety. Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

The New England Drought Study: Water Resources Planning Metropolitan Boston, Massachusetts

National Research Council Canada - National Science Library

Joyce, Charles

1994-01-01

The study has traced the water resources planning experience for the metropolitan Boston area from the 17th century to the present in order to investigate how current planning has evolved from seeking...

Health Impacts and Economic Costs of Air Pollution in the Metropolitan Area of Skopje

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Gerardo Sanchez Martinez

2018-03-01

Full Text Available Background: Urban outdoor air pollution, especially particulate matter, remains a major environmental health problem in Skopje, the capital of the former Yugoslav Republic of Macedonia. Despite the documented high levels of pollution in the city, the published evidence on its health impacts is as yet scarce. Methods: we obtained, cleaned, and validated Particulate Matter (PM concentration data from five air quality monitoring stations in the Skopje metropolitan area, applied relevant concentration-response functions, and evaluated health impacts against two theoretical policy scenarios. We then calculated the burden of disease attributable to PM and calculated the societal cost due to attributable mortality. Results: In 2012, long-term exposure to PM2.5 (49.2 μg/m3 caused an estimated 1199 premature deaths (CI95% 821–1519. The social cost of the predicted premature mortality in 2012 due to air pollution was estimated at between 570 and 1470 million euros. Moreover, PM2.5 was also estimated to be responsible for 547 hospital admissions (CI95% 104–977 from cardiovascular diseases, and 937 admissions (CI95% 937–1869 for respiratory disease that year. Reducing PM2.5 levels to the EU limit (25 μg/m3 could have averted an estimated 45% of PM-attributable mortality, while achieving the WHO Air Quality Guidelines (10 μg/m3 could have averted an estimated 77% of PM-attributable mortality. Both scenarios would also attain significant reductions in attributable respiratory and cardiovascular hospital admissions. Conclusions: Besides its health impacts in terms of increased premature mortality and hospitalizations, air pollution entails significant economic costs to the population of Skopje. Reductions in PM2.5 concentrations could provide substantial health and economic gains to the city.

Designing metropolitan landscapes for biodiversity: deriving guidelines from metapopulation ecology

NARCIS (Netherlands)

Opdam, P.F.M.; Steingröver, E.G.

2008-01-01

The decentralization of planning is giving local planning groups more power in decision making on the spatial development of metropolitan landscapes. However, because scientific knowledge is rarely used in these decision-making processes, there is a risk of discrepancies between the conservation

A Measure of the Potential Impact of Hospital Community Health Activities on Population Health and Equity.

Science.gov (United States)

Begun, James W; Kahn, Linda M; Cunningham, Brooke A; Malcolm, Jan K; Potthoff, Sandra

2017-12-13

Many hospitals in the United States are exploring greater investment in community health activities that address upstream causes of poor health. Develop and apply a measure to categorize and estimate the potential impact of hospitals' community health activities on population health and equity. We propose a scale of potential impact on population health and equity, based on the cliff analogy developed by Jones and colleagues. The scale is applied to the 317 activities reported in the community health needs assessment implementation plan reports of 23 health care organizations in the Minneapolis-St Paul, Minnesota metropolitan area in 2015. Using a 5-point ordinal scale, we assigned a score of potential impact on population health and equity to each community health activity. A majority (50.2%) of health care organizations' community health activities are classified as addressing social determinants of health (level 4 on the 5-point scale), though very few (5.4%) address structural causes of health equity (level 5 on the 5-point scale). Activities that score highest on potential impact fall into the topic categories of "community health and connectedness" and "healthy lifestyles and wellness." Lower-scoring activities focus on sick or at-risk individuals, such as the topic category of "chronic disease prevention, management, and screening." Health care organizations in the Minneapolis-St Paul metropolitan area vary substantially in the potential impact of their aggregated community health activities. Hospitals can be significant contributors to investment in upstream community health programs. This article provides a scale that can be used not only by hospitals but by other health care and public health organizations to better align their community health strategies, investments, and partnerships with programming and policies that address the foundational causes of population health and equity within the communities they serve.

Broadband availability in metropolitan and non-metropolitan Pennsylvania

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Lawrence E. Wood

2016-09-01

Full Text Available Over the past few years having a broadband connection has become essential for many Internet activities. As broadband increases in importance, it becomes imperative to assess how its use and availability may vary, especially in relation to issues such as geographic location. For rural areas in particular, the availability of broadband service is especially important. This research assesses broadband service availability in rural areas of Pennsylvania, USA. In particular, it examines the extent to which Digital Subscriber Line (DSL and broadband cable modem services are being deployed throughout rural Pennsylvania. It compares this deployment with the availability of such services in the state’s urban and metropolitan areas. The results of this research suggest that there is a “digital divide” in terms of broadband availability between rural and urban areas of Pennsylvania. However, this “divide” is perhaps not as wide as might be expected. Thus, as broadband is becoming increasingly available in rural areas of the U.S. and throughout much of the rest of the world, this research concludes that while research must remain vigilant in terms of assessing advanced telecommunications availability in rural areas, future research should also be sure to focus on how such technologies can be used to promote economic and social concerns, including in relation to building online networks and diminishing social and professional isolation in rural areas.

Urbanisation, urban growth and planning in the Copenhagen Metropolitan Region

DEFF Research Database (Denmark)

Fertner, Christian

pressure. Growth management strategies are necessary to secure future balanced and sustainable development throughout the whole urban region. The analysis of urbanisation and urban growth in peri-urban areas is at the core of this study, including socio-demographic and functional dynamics, land use impacts...... and options for spatial planning. The main case was the metropolitan region of Copenhagen, Denmark. Other cases from Europe and the USA were used as reference studies. The methods included quantitative analyses of register and land use data as well as general case study work to investigate options for spatial...... planning. The study shows that, while the most visible impacts of land use changes can be found at the close urban fringe, many other dynamics have a much longer reach into the rural-urban region. In the Copenhagen metropolitan region, we can observe migration to peri-urban areas and to the urban core...

Creation of inpatient capacity during a major hospital relocation: lessons for disaster planning.

Science.gov (United States)

Jen, Howard C; Shew, Stephen B; Atkinson, James B; Rosenthal, J Thomas; Hiatt, Jonathan R

2009-09-01

To identify tools to aid the creation of disaster surge capacity using a model of planned inpatient census reduction prior to relocation of a university hospital. Prospective analysis of hospital operations for 1-week periods beginning 2 weeks (baseline) and 1 week (transition) prior to move day; analysis of regional hospital and emergency department capacity. Large metropolitan university teaching hospital. Hospital census figures and patient outcomes. Census was reduced by 36% from 537 at baseline to 345 on move day, a rate of 18 patients/d (P emergency operations was unchanged. Hospital admissions were decreased by 42%, and the adjusted discharges per occupied bed were increased by 8% (both P capacity to absorb new patients was limited. During a period in which southern California population grew by 8.5%, acute care beds fell by 3.3%, while Los Angeles County emergency departments experienced a 13% diversion rate due to overcrowding. Local or regional disasters of any size can overwhelm the system's ability to respond. Our strategy produced a surge capacity of 36% without interruption of emergency department and trauma services but required 3 to 4 days for implementation, making it applicable to disasters and mass casualty events with longer lead times. These principles may aid in disaster preparedness and planning.

Derivation of Nationally Consistent Indices Representing Urban Intensity Within and Across Nine Metropolitan Areas of the Conterminous United States

Science.gov (United States)

Cuffney, Thomas F.; Falcone, James A.

2009-01-01

Two nationally consistent multimetric indices of urban intensity were developed to support studies of the effects of urbanization on streams in nine metropolitan areas of the conterminous United States: Atlanta, Georgia; Birmingham, Alabama; Boston, Massachusetts; Dallas-Fort Worth, Texas; Denver, Colorado; Milwaukee-Green Bay, Wisconsin; Portland, Oregon; Raleigh, North Carolina; and Salt Lake City, Utah. These studies were conducted as a part of the U.S. Geological Survey's National Water-Quality Assessment Program. These urban intensity indices were used to define gradients of urbanization and to interpret biological, physical, and chemical changes along these gradients. Ninety census, land-cover, and infrastructure variables obtained from nationally available databases were evaluated. Only variables that exhibited a strong and consistent linear relation with 2000 population density were considered for use in the indices. Housing-unit density (HUDEN), percentage of basin area in developed land (P_NLCD1_2), and road density (ROADDEN) were selected as the best representatives of census, land-cover, and infrastructure variables. The metropolitan area national urban intensity index (MA-NUII) was scaled to represent urban intensity within each metropolitan area and ranged from 0 (little or no urban) to 100 (maximum urban) for sites within each metropolitan area. The national urban intensity index (NUII) was scaled to represent urban intensity across all nine metropolitan areas and ranged from 0 to 100 for all sites. The rates at which HUDEN, P_NLCD1_2, and ROADDEN changed with changes in population density varied among metropolitan areas. Therefore, these variables were adjusted to obtain a more uniform rate of response across metropolitan areas in the derivation of the NUII. The NUII indicated that maximum levels of urban intensity occurred in the West and Midwest rather than in the East primarily because small inner-city streams in eastern metropolitan areas are

An exploratory study of healthcare strategic planning in two metropolitan areas.

Science.gov (United States)

Begun, James W; Kaissi, Amer A

2005-01-01

Little is known about empirical variation in the extent to which healthcare organizations conduct formal strategic planning or the extent to which strategic planning affects performance. Structural contingency and complexity science theory offer differing interpretations of the value of strategic planning. Structural contingency theory emphasizes adaptation to achieve organizational fit with a changing environment and views strategic planning as a way to chart the organization's path. Complexity science argues that planning is largely futile in changing environments. Interviews of leaders in 20 healthcare organizations in the metropolitan areas of Minneapolis/St. Paul, Minnesota, and San Antonio, Texas, reveal that strategic planning is a common and valued function in healthcare organizations. Respondents emphasized the need to continuously update strategic plans, involve physicians and the governing board, and integrate strategic plans with other organizational plans. Most leaders expressed that strategic planning contributes to organizational focus, fosters stakeholder participation and commitment, and leads to achievement of strategic goals. Because the widespread belief in strategic planning is based largely on experience, intuition, and faith, we present recommendations for developing an evidence base for healthcare strategic planning.

[Cleaning and disinfection of surfaces in hospitals: Data on structure, process and result in the Frankfurt/Main Metropolitan Area].

Science.gov (United States)

Hausemann, A; Hofmann, H; Otto, U; Heudorf, Ursel

2015-06-01

In addition to hand hygiene and reprocessing of medical products, cleaning and disinfection of surfaces is also an important issue in the prevention of germ transmission and by implication infections. Therefore, in 2014, the quality of the structure, process and result of surface preparation of all hospitals in Frankfurt am Main, Germany, was monitored. All 17 hospitals transferred information on the quality of structure. Process quality was obtained through direct observation during cleaning and disinfection of rooms and their plumbing units. Result quality was gained using the fluorescent method, i.e. marking surfaces with a fluorescent liquid and testing if this mark has been sufficiently removed by cleaning. Structure quality: in all hospitals the employees were trained regularly. In 12 of them, the foremen had the required qualifications, in 6 hospitals unclarity as to the intersection of the cleaning and care services remained. In 14 hospitals only visible contamination was cleaned on the weekends, whereas complete cleaning was reported to take place in 12 hospitals on Saturdays and in 2 hospitals on Sundays. The contractually stipulated cleaning (observations specified in brackets) averaged 178 m(2)/h (148 m(2)/h) per patient room and 69 m(2)/h (33 m(2)/h) for bathrooms. Process quality: during process monitoring, various hand contact surfaces were prepared insufficiently. Result quality: 63 % of fluorescent markings were appropriately removed. The need for improvement is given especially in the area of the qualification of the foremen and a in a clear definition of the intersection between cleaning and care services, as well as in the regulations for weekends and public holidays.

OXYGEN TRANSFER STUDIES AT THE MADISON METROPOLITAN SEWERAGE DISTRICT FACILITIES

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Field studies at the Madison Metropolitan Sewerage District facilities were conducted over a 3-year period to obtain long-term data on the performance of fine pore aeration equipment in municipal wastewater. The studies were conducted on several basins in the East Plant containi...

Uranium in underground water public supply of the metropolitan region of Recife

International Nuclear Information System (INIS)

Silva, C.M.; Sousa, G.H.; Vasconcelos, W.E.; Hazin, C.A.; Amaral, R.S.

2001-01-01

The geologic formation of the metropolitan region of Recife is of sedimentary origin. In the coast area, where the phosphate deposits are located, it is sufficiently rich in underground hydric features. In the superposed layers of the sedimentary basin exists three underground aquifers and 80% of the underground hydric features of public supplying of the metropolitan region of Recife are located in the phosphate deposits, which are rich in uranium. Physiologically the uranian are in the steady state (6+) with bivalent cations U 2+ 2 . The ingestion of uranium by man occurs through foods and water ingestion. The places of the human body where it has greater clamping of this radionuclides are the bones. The uranium is deposited slowly from surface of the bone, redistributing itself in route to the marrow. An important competition between Ca 2+ 2 and the UO 2+ 2 exists in the kidneys, where the Ca 2+ 2 efficiently is absorbed. This work was carried through aiming to determine the concentrations of uranium in waters of the wells of public supplying of the metropolitan region of Recife, collating them with the limits established for the Health Department, that establishes the level of 0.1 Bq/L referring to the total alpha radioactivity in drinking waters

Perceived stigmatization and discrimination of people with mental illness: A survey-based study of the general population in five metropolitan cities in India

Science.gov (United States)

Böge, Kerem; Zieger, Aron; Mungee, Aditya; Tandon, Abhinav; Fuchs, Lukas Marian; Schomerus, Georg; Tam Ta, Thi Minh; Dettling, Michael; Bajbouj, Malek; Angermeyer, Matthias; Hahn, Eric

2018-01-01

Background: India faces a significant gap between the prevalence of mental illness among the population and the availability and effectiveness of mental health care in providing adequate treatment. This discrepancy results in structural stigma toward mental illness which in turn is one of the main reasons for a persistence of the treatment gap, whereas societal factors such as religion, education, and family structures play critical roles. This survey-based study investigates perceived stigma toward mental illness in five metropolitan cities in India and explores the roles of relevant sociodemographic factors. Materials and Methods: Samples were collected in five metropolitan cities in India including Chennai (n = 166), Kolkata (n = 158), Hyderabad (n = 139), Lucknow (n = 183), and Mumbai (n = 278). Stratified quota sampling was used to match the general population concerning age, gender, and religion. Further, sociodemographic variables such as educational attainment and strength of religious beliefs were included in the statistical analysis. Results: Participants displayed overall high levels of perceived stigma. Multiple linear regression analysis found a significant effect of gender (P mental illness. PMID:29736059

Potential for air quality improvement in the Tokyo metropolitan area from use of hydrogen fuel

International Nuclear Information System (INIS)

Kruger, Paul; Murdock, Mork

1998-01-01

A revised estimation has been made of the local air quality improvement that can be achieved in Tokyo as a byproduct of a word-wide hydrogen energy economy based on global reduction of CO2 emission from fossil fuels. The study for the WE-NET Project in Japan examined the potential for reduction in nitrogen oxide emission with hydrogen fuel in the Tokyo metropolitan area where sufficient data exist on trends in population, vehicle registrations, traffic activity, and exhaust emissions. A dynamic model was developed to extrapolate the trends in these data to estimate future NOx emission rates in comparison to regulatory scenarios based on policy and technical decisions of the Tokyo Metropolitan Government for improvement of air quality in the metropolitan area. The results of the model show significant potential for reduction of NOx emission by the year 2020 with a concomitant reduction in mean roadside NOx concentration. (author)

Infection after open heart surgery in Golestan teaching hospital of Ahvaz, Iran.

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Nashibi, Roohangiz; Mohammadi, Mohammad Javad; Alavi, Seyed Mohammad; Yousefi, Farid; Salmanzadeh, Shokrolah; Ahmadi, Fatemeh; Varnaseri, Mehran; Ramazani, Asghar; Moogahi, Sasan

2018-02-01

The present study surveyed demographic and infection data which were obtained after open heart surgery (OHS) through patient's admission in Golestan teaching hospital, Ahvaz metropolitan city of Iran, taking into account the confirmed location of the infection, microorganism and antibiotic susceptibility. The occurrence of infection among patients during 48 to 72 h after surgery and hospital admission is the definition of Nosocomial infections (NIs) (Salmanzadeh et al., 2015) [1]. All of them after OHS were chosen for this study. In this paper, type of catheter, fever, type of microorganism, antibiotic susceptibility, location of the infection and outcome (live or death) were studied (Juhl et al., 2017; Salsano et al., 2017) [2], [3]. After the completion of the observations and recording patients' medical records, the coded data were fed into EXCELL. Data analysis was performed using SPSS 16.

The 'unnecessary' use of emergency departments by older people: findings from hospital data, hospital staff and older people.

Science.gov (United States)

Faulkner, Debbie; Law, Julia

2015-11-01

Increasing demands are being placed on emergency departments in Australia and there is a view that older Australians are more likely than other age groups to attend for non-urgent conditions. The objective of this paper is to compare and contrast administrative data with the views of hospital staff and older people with regard to their presentation at two emergency departments in metropolitan Adelaide and how this aligns with the Australian Institute of Health and Welfare definition of 'potentially avoidable general practitioner-type presentations'. The study used three sources of data from two emergency departments: hospital data for the financial year 2010-11 for patients aged 65 years and over and identified as triage category four or five; three focus groups with medical, nursing and allied staff from these two hospitals; and interviews with 58 older people who presented at the two emergency departments over a two-week period. The hospital administrative data provided a very limited insight into why older people attended the emergency department, other than the medical diagnosis. Professional staff identified individual determinants, societal determinants and the health services system as explanations. Older people attended the emergency department for a range of reasons that may not necessarily reflect the opinions of health professionals. For many older people the emergency department was an appropriate place to attend considering their condition, though some presentations could be circumvented with appropriate and increased services in the community. However, as many older people suffer comorbidities, careful consideration needs to be given as to the best possible practices to achieve this.

Risk factors for recurrent hospital-acquired Clostridium difficile infection in a Japanese university hospital

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Hikone M

2015-07-01

Full Text Available Mayu Hikone,1 Yusuke Ainoda,1,2 Sayaka Tago,2 Takahiro Fujita,2 Yuji Hirai,2 Kaori Takeuchi,2 Kyoichi Totsuka31Department of Infectious Diseases, Tokyo Metropolitan Bokutoh General Hospital, 2Department of Infectious Diseases, Tokyo Women's Medical University, 3Department of Internal Medicine, Kitatama Hospital, Tokyo, JapanBackground: Clostridium difficile infection (CDI is a highly prevalent hospital-associated infection. Although most patients respond well to discontinuation of antibiotics, 20%–30% of patients relapse. To initiate early therapeutic measures, the risk factors for recurrent CDI must be identified, although very few Japanese studies have used standard surveillance definitions to identify these risk factors.Methods: We retrospectively reviewed the medical records of patients with health care facility-onset CDI between August 2011 and September 2013. Patients with diarrhea who were positive for Clostridium difficile (via an enzyme immunoassay were defined as having CDI. Clinical data (eg, demographics, comorbidities, medication, laboratory results, and clinical outcomes were evaluated, and multivariate analysis was used to identify risk factors that were associated with recurrent CDI.Results: Seventy-six health care facility-onset CDI cases were identified, with an incidence rate of 0.8 cases per 10,000 patient-days. Fourteen cases (18.4% were recurrent, with 13 patients having experienced a single recurrent episode and one patient having experienced three recurrent episodes. The 30-day and 90-day mortality rates were 7.9% and 14.5%, respectively. Multivariate analysis revealed that recurrent patients were more likely to have underlying malignant disease (odds ratio: 7.98; 95% confidence interval: 1.22–52.2; P=0.03 and a history of intensive care unit hospitalization (odds ratio: 49.9; 95% confidence interval: 1.01–2,470; P=0.049.Conclusion: Intensive care unit hospitalization and malignancy are risk factors for recurrent

Comparative Analysis of Health Care Needs among Children with Special Health Care Needs in Ohio's Metropolitan and Appalachian Counties.

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Earley, Elizabeth; Asti, Lindsey; Chisolm, Deena

2015-08-01

The study assessed whether children with special health care needs (CSHCN) living in Appalachian Ohio have differential health care utilization, unmet needs, and health outcomes compared with CSHCN in Ohio's metropolitan counties using a statewide Ohio survey. Based on this survey, an estimated 28% of children in Appalachian Ohio counties have special health care needs compared with 25% of children in metropolitan counties. In Appalachia, CSHCN are poorer and more likely to have Medicaid than their metropolitan counterparts, but had no reported significant differences in health outcomes or unmet needs. Data suggested a trend toward higher use of emergency department care and inpatient services and lower use of well-child visits but these differences did not reach significance. We conclude that CSHCN in Appalachian and metropolitan areas face similar levels of health status and unmet needs but results suggest a need for additional research on access to primary care services.

The Challenge of Forecasting Metropolitan Growth: Urban Characteristics Based Models versus Regional Dummy Based Models

OpenAIRE

NA

2005-01-01

This paper presents a study of errors in forecasting the population of Metropolitan Statistical Areas and the Primary MSAs of Consolidated Metropolitan Statistical Areas and New England MAs. The forecasts are for the year 2000 and are based on a semi-structural model estimated by Mills and Lubelle using 1970 to 1990 census data on population, employment and relative real wages. This model allows the testing of regional effects on population and employment growth. The year 2000 forecasts are f...

Organizational and market factors associated with leadership development programs in hospitals: a national study.

Science.gov (United States)

Kim, Tae Hyun; Thompson, Jon M

2012-01-01

Effective leadership in hospitals is widely recognized as the key to organizational performance. Clinical, financial, and operational performance is increasingly being linked to the leadership practices of hospital managers. Moreover, effective leadership has been described as a means to achieve competitive advantage. Recent environmental forces, including reimbursement changes and increased competition, have prompted many hospitals to focus on building leadership competencies to successfully address these challenges. Using the resource dependence theory as our conceptual framework, we present results from a national study of hospitals examining the association of organizational and market factors with the provision of leadership development program activities, including the presence of a leadership development program, a diversity plan, a program for succession planning, and career development resources. The data are taken from the American Hospital Association's (AHA) 2008 Survey of Hospitals, the Area Resource File, and the Centers for Medicare & Medicaid Services. The results of multilevel logistic regressions of each leadership development program activity on organizational and market factors indicate that hospital size, system and network affiliation, and accreditation are significantly and positively associated with all leadership development program activities. The market factors significantly associated with all leadership development activities include a positive odds ratio for metropolitan statistical area location and a negative odds ratio for the percentage of the hospital's service area population that is female and minority. For-profit hospitals are less likely to provide leadership development program activities. Additional findings are presented, and the implications for hospital management are discussed.

Youthification in the Metropolitan Area of Cluj

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Vlad Cocheci

2018-06-01

Full Text Available This research exercise aims to identify all areas affected by what is now known as ‘youthification’ in the Metropolitan Area of Cluj. Broadly speaking, an area touched by youthification witnesses a massive arrival of young adults, who invest in housing, but only remain there until they age. Youthification is usually the second phase within an encompassing process of gentrification. To gain a clearer picture of this phenomenon, we employed a snapshot of the situation recorded by the Population and Housing Census of 2011. Using this image as a starting point, we then applied statistical thresholds aimed at measuring the presence and intensity of youthification within different areas. Thereafter, we looked at areas exhibiting the same level of youthification, in order to find those common traits of their young adult inhabitants that might prove relevant for their choices in matters of housing. Once completed, our efforts resulted in the first map showing the areas affected by youthification within the Metropolitan Area of Cluj. In addition, we reached the following conclusion: Young adults who live in the city are more likely to still be enrolled in a form of education and less likely to be married or to have children than those who live in the suburbs or in rural areas. This observation implies that there might be some hidden dependency relations, which are at work in shaping the choice of housing.

The one million volt X-ray therapy equipment at St Bartholomew's Hospital, 1936-1960

International Nuclear Information System (INIS)

Innes, G.S.

1988-01-01

St Bartholomew's Hospital in 1934 placed a contract with Messrs Metropolitan Vickers, of Manchester, for an X-ray therapy equipment to operate at 600 kV, 2mA d.c., but with the proviso that every effort would be made to attain an operating condition of 1000 kV, 4mA. The X-ray tube and rectifiers were to be continuously evacuated and demountable. This meant that components such as filaments, anodes and the target could be easily replaced, so providing cheap maintenance and continuous availability of the plant. No specification exists today, but one was assembled from the minutes of the Cancer Committee of the hospital and the contract pricing. A brief outline historical review is also presented, particularly of the personalities involved, and the War years 1939-1945. (author)

Top Soils Geochemical and Radioactivity Survey of Naples (Italy) Metropolitan.

Science.gov (United States)

Somma, R.; De Vivo, B.; Cicchella, D.

2001-05-01

The metropolitan area of Naples due to intense human activities is an emblematic area affected by various environmental pollution of soils and waters in addition to hydrogeological volcanic, seismic and bradyseismic hazards. The geology of the area is prevailing represented by volcanics erupted, from the Upper Pleistocene to Recent by Mt. Somma-Vesuvius on the east and the Campi Flegrei fields on the west. The morphology of the metropolitan area of Naples city can be subdivided in flat areas, constituted by reworked pyroclastic terrains, and by hills originated by the overlapping of different welded pyroclastic flows (i.e.: Campanian Ignimbrite and Neapoletan Yellow Tuff) intercalated with pyroclastic deposits of different origins (i.e.: Campi Flegrei, Mt. Somma-Vesuvius, Ischia) and ages. In order to compile a multi-element baseline geochemical and radioactivity mapping of the metropolitan area of the Napoli we have sampled for this study, in situ top soil and imported filling material (mainly soil, volcanic ash, pumice and scoriae). The sampling and radioactivity survey has been carried out on about 200 sampling sites covering an area of about 150 Km2, with a grid of 0.5 x 0.5 km in the urbanised downtown and 1 km x 1 km in the sub urban areas. In each site has been determined a radioactivity by a Scintrex GRS-500 at different emission spectra as total radioactivity (> 0.08 MeV and > 0.40 MeV), 238U (at 1.76 MeV mostly from 214Bi), 232Th (at 2.6 MeV mostly from 208Tl) and 40K (at 1.46 MeV mostly for 40K). The range of values of in situ soils are as follow for the in situ soils (Total radioactivity: 1327- 360 and 114- 47; 238U: 2.6- 1.3; 40K: 8.1- 3.1; 232U: 0.5- 0.1). Analyses of major, metallic elements and pH of each soil sample are in progress, while Pb isotopes compositions, for a selected number of samples, will be determined to discriminate the natural (geogenic) from the anthropogenic components in the soils by versus the anthropogenetic origin. The data

Attitudes and expectations regarding exercise in the hospital of hospitalized older adults: a qualitative study.

Science.gov (United States)

So, Cynthia; Pierluissi, Edgar

2012-04-01

To describe expectations of, and perceived motivators and barriers to, in-hospital exercise of hospitalized older adults. Qualitative study using the framework theory. Public hospital general medical wards. Twenty-eight English- or Spanish-speaking inpatients aged 65 to 103. Semistructured interviews were conducted at the bedside. Questions explored attitudes and expectations regarding in-hospital exercise. Interviews were tape recorded and transcribed, and content analysis was performed to identify major themes. For most participants (71%), exercise in the hospital meant walking. Only 29% of participants expected to be exercising in the hospital, although three-quarters perceived it to be appropriate. Major themes included motivating factors and barriers to in-hospital exercise. Motivating factors included avoiding the negative effects of prolonged bed rest, promoting a sense of well-being, promoting functional recovery, and being asked to exercise. Barriers included symptoms related to one's illness, institutional barriers, and fear of injury. Most respondents (85%) felt that if the physician suggested exercise, it would influence their decision to do so, yet few (27%) reported that they had spoken to their physician about exercise. Hospitalized older adults have positive perceptions about in-hospital exercise, although they must overcome significant barriers to do so. Medical professionals have a strong influence over the exercise behavior of elderly adults in the hospital yet infrequently address the issue. Incorporating motivating factors and removing barriers may increase the effectiveness of in-hospital exercise programs. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

The perception of corporate services directorate in a metropolitan municipality on King III good governance compliance in business and projects

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Sly Newton Mutiro

2015-03-01

Full Text Available Good governance has been and is a growing phenomenon for many business organisations regardless of size, profit margins and purpose for existence. The South African Metropolitan municipality Metropolitan Municipality is one such organisation that has adopted good governance models to business practices. The challenge was how to effectively and efficiently implement governance issues around projects and business organisations. A number of people, committees and institutions have developed different governance frameworks that can be adopted by organisations as a guide to good governance. This research is based on King III guide to good governance. The objective was to establish the perceptions of the corporate services directorate in the South African Metropolitan municipality municipality on King III good governance compliance by interviewing some employees orally and through a questionnaire. The responses were captured and analysed using IMB SPSS software. Problems were identified in governance training and understanding in general. Another major finding was poor communication internally and externally. To overcome these shortfall recommendations were made. Communication models, communication plan, governance models and training were recommended. The major challenges facing the South African Metropolitan municipality Metropolitan Municipality are poor effective governance communication and lack of governance training.

Model LPA Terpadu untuk Wilayah Surabaya Metropolitan

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Mimien Bt. M. Al Muhdhar a Henie Irawati

2009-02-01

Full Text Available The purpose of this research is to establish the integrated LPA model for Surabaya Metropolitan Area. The methods used are literature overviews, comparative studies to well-established areas, and expert assistantships through national seminars. The result shows that the integrated LPA has opportunity to combine some activities such as sorting and classifying, producing, wrapping and containing, selling the compost and decayed materials, and filling residual waste by landfill system. In 25 Ha land area, 14.10 Ha is allocated for waste management, and 10.90 Ha for sanitary landfill.

Acceptability of the 6-PACK falls prevention program: A pre-implementation study in hospitals participating in a cluster randomized controlled trial.

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Anna L Barker

Full Text Available There is limited evidence to support the effectiveness of falls prevention interventions in the acute hospital setting. The 6-PACK falls prevention program includes a fall-risk tool; 'falls alert' signs; supervision of patients in the bathroom; ensuring patients' walking aids are within reach; toileting regimes; low-low beds; and bed/chair alarms. This study explored the acceptability of the 6-PACK program from the perspective of nurses and senior staff prior to its implementation in a randomised controlled trial. A mixed-methods approach was applied involving 24 acute wards from six Australian hospitals. Participants were nurses working on participating wards and senior hospital staff including: Nurse Unit Managers; senior physicians; Directors of Nursing; and senior personnel involved in quality and safety or falls prevention. Information on program acceptability (suitability, practicality and benefits was obtained by surveys, focus groups and interviews. Survey data were analysed descriptively, and focus group and interview data thematically. The survey response rate was 60%. Twelve focus groups (n = 96 nurses and 24 interviews with senior staff were conducted. Falls were identified as a priority patient safety issue and nurses as key players in falls prevention. The 6-PACK program was perceived to offer practical benefits compared to current practice. Nurses agreed fall-risk tools, low-low beds and alert signs were useful for preventing falls (>70%. Views were mixed regarding positioning patients' walking aid within reach. Practical issues raised included access to equipment; and risk of staff injury with low-low bed use. Bathroom supervision was seen to be beneficial, however not always practical. Views on the program appropriateness and benefits were consistent across nurses and senior staff. Staff perceived the 6-PACK program as suitable, practical and beneficial, and were open to adopting the program. Some practical concerns were raised

Association of Admission to Veterans Affairs Hospitals vs Non-Veterans Affairs Hospitals With Mortality and Readmission Rates Among Older Men Hospitalized With Acute Myocardial Infarction, Heart Failure, or Pneumonia.

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Nuti, Sudhakar V; Qin, Li; Rumsfeld, John S; Ross, Joseph S; Masoudi, Frederick A; Normand, Sharon-Lise T; Murugiah, Karthik; Bernheim, Susannah M; Suter, Lisa G; Krumholz, Harlan M

2016-02-09

Little contemporary information is available about comparative performance between Veterans Affairs (VA) and non-VA hospitals, particularly related to mortality and readmission rates, 2 important outcomes of care. To assess and compare mortality and readmission rates among men in VA and non-VA hospitals. Cross-sectional analysis involving male Medicare fee-for-service beneficiaries aged 65 years or older hospitalized between 2010 and 2013 in VA and non-VA acute care hospitals for acute myocardial infarction (AMI), heart failure (HF), or pneumonia using the Medicare Standard Analytic Files and Enrollment Database together with VA administrative claims data. To avoid confounding geographic effects with health care system effects, we studied VA and non-VA hospitals within the same metropolitan statistical area (MSA). Hospitalization in a VA or non-VA hospital in MSAs that contained at least 1 VA and non-VA hospital. For each condition, 30-day risk-standardized mortality rates and risk-standardized readmission rates for VA and non-VA hospitals. Mean aggregated within-MSA differences in mortality and readmission rates were also assessed. We studied 104 VA and 1513 non-VA hospitals, with each condition-outcome analysis cohort for VA and non-VA hospitals containing at least 7900 patients (men; ≥65 years), in 92 MSAs. Mortality rates were lower in VA hospitals than non-VA hospitals for AMI (13.5% vs 13.7%, P = .02; -0.2 percentage-point difference) and HF (11.4% vs 11.9%, P = .008; -0.5 percentage-point difference), but higher for pneumonia (12.6% vs 12.2%, P = .045; 0.4 percentage-point difference). In contrast, readmission rates were higher in VA hospitals for all 3 conditions (AMI, 17.8% vs 17.2%, 0.6 percentage-point difference; HF, 24.7% vs 23.5%, 1.2 percentage-point difference; pneumonia, 19.4% vs 18.7%, 0.7 percentage-point difference, all P percentage-point difference, -0.22; 95% CI, -0.40 to -0.04) and HF (-0.63; 95% CI, -0.95 to -0.31), and

Subsurface information for risk-sensitive urban spatial planning in Dhaka Metropolitan City, Bangladesh

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Günther, Andreas; Aziz Patwary, Mohammad Abdul; Bahls, Rebecca; Asaduzzaman, Atm; Ludwig, Rüdiger; Ashraful Kamal, Mohammad; Nahar Faruqa, Nurun; Jabeen, Sarwat

2016-04-01

Dhaka Metropolitan City (including Dhaka and five adjacent municipal areas) is one of the fastest developing urban regions in the world. Densely build-up areas in the developed metropolitan area of Dhaka City are subject to extensive restructuring as common six- or lower storied buildings are replaced by higher and heavier constructions. Additional stories are built on existing houses, frequently exceeding the allowable bearing pressure on the subsoil as supported by the foundations. In turn, newly developing city areas are projected in marshy terrains modified by extensive, largely unengineered landfills. In most areas, these terrains bear unfavorable building ground conditions within 30 meters. Within a collaborative technical cooperation project between Bangladesh and Germany, BGR supports GSB in the provision of geo-information for the Capital Development Authority (RAJUK). For general urban planning, RAJUK successively develops a detailed area plan (DAP) at scale 1 : 50000 for the whole Dhaka Metropolitan City area (approx. 1700 km2). Geo-information have not been considered in the present DAP. Within the project, geospatial information in form of a geomorphic map, a digital terrain model and a 3-D subsurface model covering the whole city area have been generated at a scale of 1 : 50000. An extensive engineering geological data base consisting of more than 2200 borehole data with associated Standard Penetration Testing (SPT) and lab data has been compiled. With the field testing (SPT) and engineering geological lab data, the 3-D subsurface model can be parameterized to derive important spatial subsurface information for urban planning like bearing capacity evaluations for different foundation designs or soil liquefaction potential assessments for specific earthquake scenarios. In conjunction with inundation potential evaluations for different flooding scenarios, comprehensive building ground suitability information can be derived to support risk

[Increasing participation of primary care in the management of people with human immunodeficiency virus: hospital care professionals express their views].

Science.gov (United States)

Ortega López, Angela; Morales Asencio, José Miguel; Rengel Díaz, Cristóbal; Peñas Cárdenas, Eloísa María; González Rodríguez, María José; Prado de la Sierra, Rut

2014-04-01

To determine the opinions of infectious diseases professionals on the possibilities of monitoring patients with HIV in Primary Care. Qualitative study using in-depth interviews. Infectious Diseases Unit in the University Hospital "Virgen de la Victoria" in Málaga. Health professionals with more than one year experience working in infectious diseases. A total of 25 respondents: 5 doctors, 15 nurses and 5 nursing assistants. Convenience sample. Semi-structured interviews were used that were later transcribed verbatim. Content analysis was performed according to the Taylor and Bogdan approach with computer support. Validation of information was made through additional analysis, expert participation, and feedback of part of the results to the participants. Hospital care professionals considered the disease-related complexity of HIV, treatment and social aspects that may have an effect on the organizational level of care. Professionals highlighted the benefits of specialized care, although opinions differed between doctors and nurses as regards follow up in Primary Care. Some concerns emerged about the level of training, confidentiality and workload in Primary Care, although they mentioned potential advantages related to accessibility of patients. Physicians perceive difficulties in following up HIV patients in Primary Care, even for those patients with a good control of their disease. Nurses and nursing assistants are more open to this possibility due to the proximity to home and health promotion in Primary Care. Copyright © 2013 Elsevier España, S.L. All rights reserved.

Antifungal therapy in European hospitals

DEFF Research Database (Denmark)

Zarb, P; Amadeo, B; Muller, A

2012-01-01

The study aimed to identify targets for quality improvement in antifungal use in European hospitals and determine the variability of such prescribing. Hospitals that participated in the European Surveillance of Antimicrobial Consumption Point Prevalence Surveys (ESAC-PPS) were included. The WHO...

Regional Disparities and Social Cohesion Policies. The Case of the Metropolitan Area of Bari (Italy

Directory of Open Access Journals (Sweden)

ROSALINA GRUMO

2015-06-01

Full Text Available The role of Regions appears reconfigured by the "reshaping" of national States. Besides, under a sub-regional scale, forms of governance have been launched, redefining a new territoriality. In Italy, the role of the Regions and Cities is more and more important in the decision-making processes of the territories and it is also characterized by the recent establishment of the metropolitan cities, but still not geo-politically defined. There is, in fact, a constitutional reform process through the region's reorganization legislative autonomy and strengthening of local governments. In this context, some areas are characterized by social unrest that includes new forms of poverty, urban malaise and marginalization, due also to the financial and economic crisis whose signs of recovery are still very weak. In the European Union, the programming decisions considered the policy of development and cohesion also at the local scale. The 2014-2020 EU programming cycle, in fact, has defined the main role of metropolitan cities, but also of cities and internal areas. The contribution will analyze Puglia, region of southern Italy, and the metropolitan area of Bari, the regional capital, in order to verify policies concerning the social field, both through "strategic planning" and launching the so-called "smart city" experience. In the metropolitan city, indeed, there is already an orientation towards the "social innovation" to address the issues of social cohesion and inclusion, consistent to sustainable development.

Prevalence and risk factors of childhood allergic diseases in eight metropolitan cities in China: a multicenter study.

Science.gov (United States)

Li, Fei; Zhou, Yingchun; Li, Shenghui; Jiang, Fan; Jin, Xingming; Yan, Chonghuai; Tian, Ying; Zhang, Yiwen; Tong, Shilu; Shen, Xiaoming

2011-06-06

Several studies conducted during the past two decades suggested increasing trend of childhood allergic diseases in China. However, few studies have provided detailed description of geographic variation and explored risk factors of these diseases. This study investigated the pattern and risk factors of asthma, allergic rhinitis and eczema in eight metropolitan cities in China. We conducted a cross-sectional survey during November-December 2005 in eight metropolitan cities in China. A total of 23791 children aged 6-13 years participated in this survey. Questions from the standard questionnaire of the International Study of Asthma and Allergies in Children (ISAAC) were used to examine the pattern of current asthma, allergic rhinitis and eczema. Logistic regression analyses were performed to assess the risk factors for childhood allergies. The average prevalence of childhood asthma, allergic rhinitis and eczema across the eight cities was 3.3% (95% Confidence interval (CI): 3.1%, 3.6%), 9.8% (95% CI: 9.4%, 10.2%) and 5.5% (95% CI: 5.2%, 5.8%), respectively. Factors related to lifestyle, mental health and socio-economic status were found to be associated with the prevalence of childhood allergies. These risk factors were unevenly distributed across cities and disproportionately affected the local prevalence. There was apparent geographic variation of childhood allergies in China. Socio-environmental factors had strong impacts on the prevalence of childhood allergies; but these impacts differed across regions. Thus public health policies should specifically target at the local risk factors for each individual area.

Los Angeles County Metropolitan Transportation Authority climate change adaptation pilot project report.

Science.gov (United States)

2013-08-01

This Climate Change Adaptation Pilot Project Report details the project background of the recently-completed Los Angeles County : Metropolitan Transportation Authority (Metro) Transit Climate Change Adaptation Pilot Project as well as the various wor...

The design of gated communities in São Paulo metropolitan area

Directory of Open Access Journals (Sweden)

João Rett Lemos

2007-06-01

Full Text Available This paper has as study object the formation of a kind of residential urban landscape spread in a large number of Brazilian cities, in special those around the Sao Paulo metropolitan area: the gated communities destined to a population with average and high income. The premise that it deals with a type of appropriation of urban ground related since the middle of the 1970‘s when internal adjustments in real estate market were implemented, and to the standards of growth of the São Paulo metropolitan area, specifically its process of dispersion, excites the necessity of identify the characteristics and specially the effects to the rest of the urban space that are been spread in terms never seen. Twenty eight enterprises launched between 1994 and 2005 in the metropolitan area are analyzed. The set of case studies involves from communities settled in the rural zones to the urban areas; in common is the fact that are enterprises created by a private entrepreneur to subdivide an only one private property, and the management of the internal space by proper codes. The analysis was developed in two scales: at a first moment, it was restricted in the internal spaces, appointing the planning methods and the distribution standards of the open areas, the volumetric occupations, and the leisure equipments; in the following one, were analyzed the neighbor landscape, identifying the main characteristics of the fabric urban and the not constructed natural environment.

Athletic participation in children with symptomatic spondylolysis in the New York area.

Science.gov (United States)

Ladenhauf, Hannah N; Fabricant, Peter D; Grossman, Eric; Widmann, Roger F; Green, Daniel W

2013-10-01

The purpose of this study was to assess athletic activities associated with spondylolysis in children and adolescents in a New York metropolitan tertiary referral center. We retrospectively evaluated 137 consecutive cases of symptomatic spondylolysis presenting to one of two pediatric orthopedic spine surgeons. Ten patients who did not participate in any organized athletics were excluded, leaving 127 children for analysis. Data regarding spondylolysis and athletic participation were gathered for analysis. One hundred and twenty-seven patients were analyzed (mean age, 13.9 ± 2.2 yr). All patients had initial x-rays, with nearly all obtaining further advanced level imaging to confirm the diagnosis of spondylolysis. Magnetic resonance imaging was obtained in 42.5% of cases, limited computed tomography scan in 29.1% of cases, and single-photon emission computed tomography scan in 23.6% of cases. The most common location of spondylolysis was at the L5 level (74%), of which 43.6% were bilateral. Of the overall cohort, 2.4% had spondylolysis at multiple levels. The most common athletic activities associated with spondylolysis in this cohort were soccer (19.3%), basketball (17.2%), and lacrosse (9.4%). Although previous reports have implicated participation in various sports in the development of symptomatic spondylolysis in children, lacrosse and baseball have rarely been associated with spondylolysis. We found that in the New York metropolitan area, soccer, basketball, lacrosse, baseball, tennis, and football were most commonly associated with spondylolysis. Therefore, we emphasize consideration of spondylolysis in these children if they present with low back pain. These results may be used to counsel parents and young athletes about the possibility of spondylolysis as an etiology of lumbar back pain and in educating coaches, teachers, school nurses, and primary care providers.

Can Maine metropolitan planning organizations (MPOs) finance transportation projects through bond financing?

Science.gov (United States)

2008-12-01

In January 2008 the Maine metropolitan planning organizations (MPOs) requested the Transportation : Research Division of the Maine Department of Transportation to conduct research to determine if it is : possible for MPOs to finance projects through ...

Demographic Transformation in a Policy Vacuum: The Changing Face of U.S. Metropolitan Society and Challenges for Public Schools

Science.gov (United States)

Mordechay, Kfir; Orfield, Gary

2017-01-01

Educators and policy makers must confront the race and class disparities in learning opportunities across American society. Nowhere are these disparities more acute than in the country's great metropolitan areas. As the demographic landscape continues to shift, metropolitan areas are fueling the transition to a majority-minority country. This…

Prevalence and risk factors of childhood allergic diseases in eight metropolitan cities in China: A multicenter study

OpenAIRE

Jin Xingming; Jiang Fan; Zhou Yingchun; Li Shenghui; Li Fei; Yan Chonghuai; Tian Ying; Zhang Yiwen; Tong Shilu; Shen Xiaoming

2011-01-01

Abstract Background Several studies conducted during the past two decades suggested increasing trend of childhood allergic diseases in China. However, few studies have provided detailed description of geographic variation and explored risk factors of these diseases. This study investigated the pattern and risk factors of asthma, allergic rhinitis and eczema in eight metropolitan cities in China. Methods We conducted a cross-sectional survey during November-December 2005 in eight metropolitan ...

A Political-Ecological Analysis of Income Inequality in the Metropolitan Area.

Science.gov (United States)

Bollens, Scott A.

1986-01-01

Metropolitan development is not simply a result of ecological factors. Governmental organization affects the incentives of localities and helps determine patterns of growth. This study updates previous studies on factors influencing residential area income inequality. Modification of the variables in the ecological explanation will increase…

The Spatial Changes of Land Use in the Bucharest Metropolitan Area 1970s – 2000s

Directory of Open Access Journals (Sweden)

Gabriel Simion

2010-11-01

Full Text Available The article explore the dimension of spatial changes of land use in the Bucharest Metropolitan Area (BMA over the past forty years. Using GIS-based land use data sets of the years 1970, 1990 and 2000, combining with statistical data, we attempted to quantify the spatial pattern of land use changes in the BMA. Our findings indicate that most significantly changes occurred with arable lands that have been reduced from 77% of total metropolitan area in 1970 to 71.3% in 2000 and in same time the built up area increase from 6.2% in 1970 to 10.4% in 2000. Vineyards and orchards suffered a reduced of their spread. In the case of vineyards the percentage of total area decrease from 2.7% in 1970 to 0.8% and regarding orchards from 1.1% in 1970 to 0.6% in 2000. The growth of built up indicate the urban influence of Bucharest city on it the large metropolitan area. The decrease of vineyards and orchards can be correlated with agrarian reform passed after the fall of socialist economic system that generated many problems for the farmers that cannot continue to cultivate the land with these kinds of cultures. These findings have implication with the futures strategies on urban and metropolitan planning in this area.

Validation of Walk Score® for Estimating Neighborhood Walkability: An Analysis of Four US Metropolitan Areas

Science.gov (United States)

Duncan, Dustin T.; Aldstadt, Jared; Whalen, John; Melly, Steven J.; Gortmaker, Steven L.

2011-01-01

Neighborhood walkability can influence physical activity. We evaluated the validity of Walk Score® for assessing neighborhood walkability based on GIS (objective) indicators of neighborhood walkability with addresses from four US metropolitan areas with several street network buffer distances (i.e., 400-, 800-, and 1,600-meters). Address data come from the YMCA-Harvard After School Food and Fitness Project, an obesity prevention intervention involving children aged 5–11 years and their families participating in YMCA-administered, after-school programs located in four geographically diverse metropolitan areas in the US (n = 733). GIS data were used to measure multiple objective indicators of neighborhood walkability. Walk Scores were also obtained for the participant’s residential addresses. Spearman correlations between Walk Scores and the GIS neighborhood walkability indicators were calculated as well as Spearman correlations accounting for spatial autocorrelation. There were many significant moderate correlations between Walk Scores and the GIS neighborhood walkability indicators such as density of retail destinations and intersection density (p walkability. Correlations generally became stronger with a larger spatial scale, and there were some geographic differences. Walk Score® is free and publicly available for public health researchers and practitioners. Results from our study suggest that Walk Score® is a valid measure of estimating certain aspects of neighborhood walkability, particularly at the 1600-meter buffer. As such, our study confirms and extends the generalizability of previous findings demonstrating that Walk Score is a valid measure of estimating neighborhood walkability in multiple geographic locations and at multiple spatial scales. PMID:22163200

Addressing the Clinical Burden of Child Physical Abuse and Neglect in a Large Metropolitan Region: Improving the Evidence-Base

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Shanti Raman

2014-10-01

Full Text Available Children at risk of abuse are more likely to be hospitalized and utilize health services according to international research. In a large metropolitan health region in New South Wales, Australia, there was little known of the clinical burden of child physical abuse and/or neglect (PAN, or of systems for clinical assessment of children presenting with abuse/neglect. We aimed to identify the number of children presenting with suspected PAN to emergency departments (EDs and paediatric services in this region, to determine enablers and barriers to assessment for children with PAN presenting to frontline services, and to identify best practices to address gaps. We collated available data on children presenting to EDs and paediatric services with suspected PAN in 2007. We interviewed 36 health professionals from nine hospitals and 12 statutory child protection professionals, across the region before undertaking relevant document analysis. Of 64,700 paediatric ED presentations, a quarter were due to injury; 2%–5% of these were due to maltreatment. Clinician estimates and assessments of PAN varied widely; health and welfare workers identified major practice gaps, as well as good local practice. We identified feasible minimum standards for improving clinical assessment and follow-up for children presenting with PAN, given the right organizational support.

Learning to participate while shifting location in a hospital ward

DEFF Research Database (Denmark)

Kjær, Malene

2015-01-01

of the development of a professional identity for the students as they learn to become competent practitioners or members (Sacks, 1989; Schegloff, 2007) in the field of nursing. The present study shows how students and their clinical supervisors move through different locations when students are introduced to new...... practices and interactions with patients: Instruction before interaction with patient takes place in the guardroom, the interaction with the patient takes place in the patient’s room and the assessment of the performed task takes place in the guard room again. Thus different kinds of routinized...... participation and interaction emerge that are connected to the different locations. Participation is thus understood in two ways: 1) Learning to participate as a competent practitioner with a patient is learned not just in situ by the patient’s side but also by 2) participating in interaction with the clinical...

Exploitation of geospatial techniques for monitoring metropolitan population growth and classification of landcover features

International Nuclear Information System (INIS)

Almas, A.S.; Rahim, C.A.

2006-01-01

The present research relates to the exploitation of Remote Sensing and GIS techniques for studying the metropolitan expansion and land use/ landcover classification of Lahore, the second largest city of Pakistan where urbanization is taking place at a striking rate with inadequate development of the requisite infrastructure. Such sprawl gives rise to the congestion, pollution and commuting time issues. The metropolitan expansion, based on growth direction and distance from the city centre, was observed for a period of about thirty years. The classification of the complex spatial assemblage of urban environment and its expanding precincts was done using the temporally spaced satellite images geo-referenced to a common coordinate system and census data. Spatial categorization of urban landscape involving densely populated residential areas, sparsely inhibited regions, bare soil patches, water bodies, vegetation, Parks, and mixed features was done with the help of satellite images. Resultantly, remote sensing and GIS techniques were found very efficient and effective for studying the metropolitan growth patterns along with the classification of urban features into prominent categories. In addition, census data augments the usefulness of spatial techniques for carrying out such studies. (author)

[Food and health risks: views on healthy food and food consumption practices among middle-class women and men in the Metropolitan Area of Buenos Aires].

Science.gov (United States)

Freidin, Betina

2016-01-01

In this article we analyze notions about healthy food and the perceptions of risks related to industrialized foodstuffs within a group of young and middle-aged females and males who belong to the middle class and live in the Metropolitan Area of Buenos Aires. Data come from eight focus groups that were carried out in 2013. The study shows that the participants of the focus group have incorporated scientific-nutritional knowledge into their conceptions of healthy food. However, few discuss the risks of industrialized food beyond the growing public attention regarding trans fats and salt content. Although organic foods are positively valued, participants object to their high cost and the location of their commercialization. We show how in their food practices, the participants of the focus groups weigh their concern about health against other priorities such as costs, convenience, aesthetics, pleasure and sociability.

Comparative Analysis of Recruitment Strategies in a Study of Men Who Have Sex with Men (MSM) in Metropolitan Detroit.

Science.gov (United States)

Iott, Bradley E; Veinot, Tiffany C; Loveluck, Jimena; Kahle, Erin; Golson, Leon; Benton, Akilah

2018-02-22

HIV/AIDS-related research requires recruitment of representative samples of MSM; yet, we know little about the comparative yield, diversity and cost-benefit tradeoffs between different recruitment venues. We compared 11 recruitment venues used for nine HIV prevention-related focus groups with MSM in Metropolitan Detroit. Of the 64 participants, 24 were clients recruited via an HIV/AIDS-focused nonprofit, 20 from Grindr advertisements, 6 from university-student email lists, and 5 from flyers/palmcards. Significantly more African-American, low-income and HIV-positive participants were recruited via the nonprofit. The best cost-benefit tradeoffs were for organizational Facebook posts, email groups, personal networking, and nonprofit recruitment. Grindr increased the size of the sample, though at greater expense. Facebook and Scruff advertisements and gay bar outreach represented greater costs than benefits. Only 11.6% of Grindr respondents attended the focus groups. A mix of online and offline recruitment venues can generate a large and diverse sample of MSM, but venue performance is uneven.

The Age of Environmental Impasse? Globalization and Environmental Transformation of Metropolitan Cities

NARCIS (Netherlands)

Melchert Saguas Presas, L.

2005-01-01

Metropolitan cities are undergoing a major spatial and environmental transformation. The proliferation of business districts, corporate headquarters and international hotels is prompting a massive verticalization and densification of land use, which is affecting the urban environment and

Coronary heart disease prevalence and occupational structure in U.S. metropolitan areas: a multilevel analysis.

Science.gov (United States)

Michimi, Akihiko; Ellis-Griffith, Gregory; Nagy, Christine; Peterson, Tina

2013-05-01

This research explored the link between coronary heart disease (CHD) prevalence and metropolitan-area level occupational structure among 137 metropolitan/micropolitan statistical areas (MMSA) in the United States. Using data from the 2006-2008 Behavioral Risk Factor Surveillance System and 2007 County Business Patterns, logistic mixed models were developed to estimate CHD prevalence between MMSAs controlling for individual-level socioeconomic characteristics and various types of occupational structure. Results showed that CHD prevalence was lower in MMSAs where their economy was dominated by 'tourism and resort' and 'the quaternary sector' and higher in MMSAs dominated by 'manufacturing', 'transportation and warehousing', and 'mining'. MMSA-level effects on CHD were found in 'tourism and resort' and 'the quaternary sector' having lower risk and 'mining' having higher risk of CHD. Although these effects prevailed in many MMSAs, some MMSAs did not fit into these effects. Additional analysis indicated a possible link between metropolitan population loss and higher CHD prevalence especially in the coal mining region of the Appalachian Mountains. Copyright © 2013 Elsevier Ltd. All rights reserved.

CITTÀ METROPOLITANE E PROVINCE IN ITALIA: ORGANI, FUNZIONI FONDAMENTALI ED ESIGENZE DI RIDUZIONE DELLA SPESA

Directory of Open Access Journals (Sweden)

Giovanni Cocozza

2014-04-01

Full Text Available This paper analyses the problems derived from the metropolitan cities entities in Italy and the simultaneous reform of the provinces. These two issues are part of a broader and current Italian political debate related to targets for reduction of public spending and have to do with the achievement of a new order of local government different from that established in the Title V of the Italian Constitution after its 2001 reform. After an examination of previous attempts to regulate metropolitan cities entities, the article examines the aspects contained in decree law on spending review (d.l. n. 95/2012. In this way, the article aims to highlight both the difficulties and incoherencies of the identification of administrative functions and of the general structure to be assigned to the new level of government (the metropolitan city, provided in the Italian Constitution in 2001 but not yet established. Consequently, the article considers the effects that this new model has upon the other and already existing levels of government (such as municipalities, as provinces and as regions.

Hypersomnolence and Sleep-related Complaints in Metropolitan, Urban, and Rural Georgia

Science.gov (United States)

Decker, Michael J.; Lin, Jin-Mann S.; Tabassum, Humyra

2009-01-01

Persistent daytime hypersomnolence is associated with significant morbidity and mortality, but its prevalence in the population has been poorly documented. This study sought to characterize the prevalence of persistent daytime hypersomnolence, difficulties initiating and maintaining sleep, unrefreshing sleep, snoring, and the presence of physician-diagnosed sleep disorders in metropolitan, urban, and rural US Georgia populations. Between September 2004 and July 2005, a total of 6,530 randomly selected well and unwell adults, identified by screening interviews of 10,837 households (contacted by random digit dialing), completed a detailed phone interview. Sixteen percent reported persistent problems staying awake during the day; 26% reported persistent problems falling asleep at night; 31% experienced problems sleeping through the night; 34% were bothered by unrefreshing sleep; and 33% reported that they snored. In spite of the high occurrence of reported persistent sleep problems, only 10% of the survey participants reported having been diagnosed with a sleep disorder. These study findings highlight the need for increased public and clinician awareness with respect to proactively indentifying signs and symptoms of sleep disorders, a better understanding of their adverse impact upon morbidity and mortality, and their negative impact upon socioeconomic and academic potential. PMID:19066308

Uudised : Õhtu Metropolitan Operas. Järvi Michigani ülikooli audoktoriks / Priit Kuusk

Index Scriptorium Estoniae

Kuusk, Priit, 1938-

1999-01-01

"Klassikaraadio" vahendab 25. dets. otseülekande New Yorgist Metropolitan Operast, kus tuleb ettekandele W.A. Mozarti ooper "Figaro pulm". 19. dets. nimetati N. Järvi Michigani ülikooli audoktoriks

Health professionals' perspectives on children's and young people's participation in health care: a qualitative multihospital study.

Science.gov (United States)

Schalkers, Inge; Parsons, Cathleen S; Bunders, Joske F G; Dedding, Christine

2016-04-01

To investigate healthcare professionals' perspectives on child participation in paediatric hospital care and their opinions on improving participation practices. Some scholars argue that the decision-making capacities of children largely depend on the attitudes of healthcare professionals rather than on the children's own competences. Healthcare professionals' perspectives on children's participation in hospital care remain largely unexplored. Qualitative descriptive design. Healthcare professionals (n = 32) from 10 paediatric wards in the Netherlands participated in semi-structured interviews. Shier's Pathways to Participation model (2001) was used to guide the interviews. Participation is not a term that is frequently used by professionals; however, they feel familiar with the ideas underlying the term, and it is perceived as being at the core of their work. Professionals believe that high levels of participation are possible in basic care for children. Participation in medical decision-making is considered to be more complex and subject to a number of reservations and restrictions. The participants expressed a strong need to enhance child participation in service evaluation and to increase the respect for and understanding of the rights of children to participate outside of the paediatric unit, including in the surgery and emergency departments. Children do not currently participate in the assessment of hospital services. Creative methods that support the role of children in evaluating and improving the quality of paediatric hospital care and services should be developed. Hospital-wide policies could help to promote understanding of child participation among all professionals caring for children in hospitals. Based on international agreements that the Netherlands has ratified, professionals have the duty to facilitate child participation in hospital care. Concrete opportunities and ideas on how to accomplish this goal in practice are provided, and areas for

Hospital ownership, decisions on supervisory board characteristics, and financial performance.

Science.gov (United States)

Kuntz, Ludwig; Pulm, Jannis; Wittland, Michael

2016-01-01

Dynamic and complex transformations in the hospital market increase the relevance of good corporate governance. However, hospital performance and the characteristics of supervisory boards differ depending on ownership. The question therefore arises whether hospital owners can influence performance by addressing supervisory board characteristics. The objective of this study is to explain differences in the financial performance of hospitals with regard to ownership by studying the size and composition of supervisory boards. The AMADEUS database was used to collect information on hospital financial performance in 2009 and 2010. Business and quality reports, hospital websites, and data from health insurer were used to obtain information on hospital and board characteristics. The resulting sample consisted of 175 German hospital corporations. We utilized ANOVA and regression analysis to test a mediation hypothesis that investigated whether decisions regarding board size and composition were associated with financial performance and could explain performance differences. Financial performance and board size and composition depend on ownership. An increase in board size and greater politician participation were negatively associated with all five tested measures of financial performance. Furthermore, an increase in physician participation was positively associated with one dimension of financial performance, whereas one negative relationship was identified for nurse and economist participation. For clerics, no associations were found. Decisions concerning board size and composition are important as they relate to hospital financial performance. We contribute to existing research by showing that, in addition to board size and physician participation, the participation of other professionals can also influence financial performance.

Suicide among young rural Australians 1964-1993: a comparison with metropolitan trends.

Science.gov (United States)

Dudley, M; Kelk, N; Florio, T; Howard, J; Waters, B; Haski, C; Alcock, M

1997-07-01

The study tested hypotheses that from 1964 to 1993: (1) suicide rates among Australian 15- to 24-year-old males rose more sharply in rural than metropolitan areas; (2) firearm suicide rates among 15- to 24-year-old males, declining throughout Australia recently, rose continuously in rural areas; (3) suicide rates among 15- to 24-year-old females did not change significantly in either metropolitan or rural areas. Suicides of those aged 10-24 years recorded by the Australian Bureau of Statistics (ABS) were classified according to the subject's residential grouping. Rates were calculated using ABS population data corresponding to these groupings. Results were analysed using log-linear analysis and chi-square statistics. The results supported the first two hypotheses, but not the third. Suicide rates for 15- to 24-year-old males rose by a factor of 2.2 in metropolitan areas, by 4-fold in towns with populations between 4,000 and 25,000, and by 12-fold in towns with populations less than 4,000. Male firearm suicide rates continued to rise in rural areas, and the greatest proportion of deaths in those locations were by firearms, though male hanging rates increased most in recent years in all locations. Female youth suicide rates did not change overall, but in towns with populations less than 4,000, they increased 4.5-fold. Possible explanations for this epidemic, which are mostly speculative and require confirmation, are discussed.

Partners In Motion And Customer Satisfaction In The Washington Dc Metropolitan Area

Science.gov (United States)

1999-06-01

PARTNERS IN MOTION IS A PROGRAM AIMED AT IMPROVING THE QUALITY, QUANTITY, AND AVAILABILITY OF TRAVEL INFORMATION TO TRANSPORTATION AGENCIES, THE MEDIA, AND, ULTIMATELY, TO THE TRAVELER IN THE WASHINGTON, D.C. METROPOLITAN AREA. THE PROGRAM WAS INITIA...

Access to destinations : annual accessibility measure for the Twin Cities Metropolitan Region.

Science.gov (United States)

2012-11-01

This report summarizes previous phases of the Access to Destinations project and applies the techniques developed : over the course of the project to conduct an evaluation of accessibility in the Twin Cities metropolitan region for : 2010. It describ...

State of malnutrition in Cuban hospitals.

Science.gov (United States)

Barreto Penié, Jesús

2005-04-01

We assessed the current state of undernutrition as observed in 1905 patients hospitalized in 12 Cuban health care institutions, as part of a Latin American, multinational survey similar in design and goals. We surveyed 1905 randomly selected patients from 12 Cuban hospitals in a two-phase study. Patients' clinical charts were audited in phase 1, the Subjective Global Assessment was used to assess patients' nutritional status in phase 2. The study was locally conducted by a properly trained team. The frequency of undernutrition in Cuban hospitals was 41.2% (95% confidence interval = 38.9 to 43.4), and 11.1% of patients were considered severely undernourished. Statistically significant (P hospital services/specialties were identified: geriatrics (56.3%), critical care (54.8%), nephrology (54.3%), internal medicine (48.6%), gastroenterology (46.5%), and cardiovascular surgery (44.8%). Malnutrition rates increased progressively with prolonged length of stay. A high malnutrition rate was observed among participating hospitals. The design and inception of policies that foster intervention programs focusing on early identification of hospital malnutrition and its timely management is suggested to decrease its deleterious effects on outcomes of health care in the participating hospitals.

Morte neonatal precoce segundo complexidade hospitalar e rede SUS e não-SUS na Região Metropolitana de São Paulo, Brasil Early neonatal mortality according to level of hospital complexity in Greater Metropolitan São Paulo, Brazil

Directory of Open Access Journals (Sweden)

Zilda Pereira da Silva

2010-01-01

Full Text Available O objetivo foi analisar o perfil dos recém-nascidos, mães e mortalidade neonatal precoce, segundo complexidade do hospital e vínculo com o Sistema Único de Saúde (SUS, na Região Metropolitana de São Paulo, Brasil. Estudo baseado em dados de nascidos vivos, óbitos e cadastro de hospitais. Para obter a tipologia de complexidade e o perfil da clientela, empregaram-se análise fatorial e de clusters. O SUS atende mais recém-nascidos de risco e mães com baixa escolaridade, pré-natal insuficiente e adolescentes. A probabilidade de morte neonatal precoce foi 5,6‰ nascidos vivos (65% maior no SUS, sem diferenças por nível de complexidade do hospital, exceto nos de altíssima (SUS e média (não-SUS complexidade. O diferencial de mortalidade neonatal precoce entre as duas redes é menor no grupo de recém-nascidos 2.500g. Há uma concentração de nascimentos de alto risco na rede SUS, contudo a diferença de mortalidade neonatal precoce entre a rede SUS e não-SUS é menor nesse grupo de recém-nascidos. Novos estudos são necessários para compreender melhor a elevada mortalidade de recém-nascidos > 2.500g no SUS.The aim of this study was to analyze the profile of newborns, mothers, and early neonatal mortality according to the hospital's complexity and affiliation (or lack thereof with the Unified National Health System (SUS in Greater Metropolitan São Paulo, Brazil. The study was based on data for live births, deaths, and hospital registries. Factor and cluster analysis were used to obtain the typology of hospital complexity and user profile. The SUS treats more high-risk newborns and mothers with low schooling, insufficient prenatal care, and teenage mothers. The probability of early neonatal death was 5.6‰ live births (65% higher in the SUS, with no significant differences by level of hospital complexity, except those with extremely high (SUS and medium (non-SUS complexity. The difference in early neonatal mortality between the

FINE PORE DIFFUSER SYSTEM EVALUATION FOR THE GREEN BAY METROPOLITAN SEWERAGE DISTRICT

Science.gov (United States)

The Green Bay Metropolitan Sewerage District retrofitted two quadrants of their activated sludge aeration system with ceramic and membrane fine pore diffusers to provide savings in energy usage compared to the sparged turbine aerators originally installed. Because significant di...

The Spatial Changes of Land Use in the Bucharest Metropolitan Area 1970s – 2000s

OpenAIRE

Gabriel Simion

2010-01-01

The article explore the dimension of spatial changes of land use in the Bucharest Metropolitan Area (BMA) over the past forty years. Using GIS-based land use data sets of the years 1970, 1990 and 2000, combining with statistical data, we attempted to quantify the spatial pattern of land use changes in the BMA. Our findings indicate that most significantly changes occurred with arable lands that have been reduced from 77% of total metropolitan area in 1970 to 71.3% in 2000 and in same time th...

Seroprevalence of poliovirus antibodies in the Kansas City metropolitan area, 2012-2013.

Science.gov (United States)

Wallace, Gregory S; Pahud, Barbara A; Weldon, William C; Curns, Aaron T; Oberste, M Steven; Harrison, Christopher J

2017-04-03

No indigenous cases of poliomyelitis have occurred in the US since 1979; however the risk of importation persists until global eradication is achieved. The seropositivity rate for different age cohorts with exposures to different poliovirus vaccine types and wild virus in the US are not presently known. A convenience sample was conducted in the Kansas City metropolitan area during 2012-2103 with approximately 100 participants enrolled for each of 5 age cohorts categorized based on vaccine policy changes over time in the US. Immunization records for poliovirus vaccination were required for participants poliovirus serotypes. Seroprevalence was evaluated by demographics as well as between polio serotypes. The overall seroprevalence to poliovirus was 90.7%, 94.4%, and 83.3%, for types 1, 2, and 3, respectively. Seroprevalence was high (88.6%-96.2%) for all 3 types of poliovirus for the 6-10 y old age group that was likely to have received a complete schedule of IPV-only vaccination. Children 2-3 y of age, who have not yet completed their full IPV series, had lower seroprevalence compared with all older age groups for types 1 and 2 (p-value poliovirus in the population surveyed. Seroprevalence for subjects aged 2-3 y was lower than all other age groups for serotypes 1 and 2 highlighting the importance of completing the recommended poliovirus vaccine series with a booster dose at age 4-6 y.

When rendering hospitality becomes collateral damage: Psycho-organisational variables and job burnout amongst hotel workers in metropolitan Nigeria

Directory of Open Access Journals (Sweden)

Oluyinka Ojedokun

2013-10-01

Research purpose: The study investigated the influence of psycho-organisational variables (i.e. perceived organisational support, self-efficacy and age on job burnout amongst hotel workers. Motivation for the study: Investigating the independent and joint influence of psychoorganisational variables on burnout will assist in pulling together psycho-organisational factors influencing burnout and its dimensions cohesively in systematic theory building and intervention plans. Research design, approach and method: This is a cross-sectional survey designed to investigate perceived organisational support, self-efficacy and age as predictors of job burnout amongst 268 hotel workers from 10 registered hotels in some metropolitan cities in Ondo State, south-western Nigeria. Structural equation modelling techniques were conducted to test the proposed hypotheses. Main findings: Structural equation modelling revealed that perceived organisational support and self-efficacy have inverse relationships with burnout syndrome and its dimensions. Practical/managerial implications: These findings imply that it is possible for different stakeholders in the hotel industry in Nigeria to reduce the incidence of high burnout amongst hotel workers by providing adequate organisational support to cope with difficult job demands and organising self-efficacy training to improve individuals’ confidence in their abilities to deal with job burnout. Such intervention can be individual-oriented, organisation-oriented or a combination. Contribution/value-add: This study contributes to literature by confirming that organisational support and self-efficacy are relevant in coping with burnout.

The impact of heat on mortality and morbidity in the Greater Metropolitan Sydney Region: a case crossover analysis.

Science.gov (United States)

Wilson, Leigh Ann; Morgan, Geoffrey Gerard; Hanigan, Ivan Charles; Johnston, Fay H; Abu-Rayya, Hisham; Broome, Richard; Gaskin, Clive; Jalaludin, Bin

2013-11-15

This study examined the association between unusually high temperature and daily mortality (1997-2007) and hospital admissions (1997-2010) in the Sydney Greater Metropolitan Region (GMR) to assist in the development of targeted health programs designed to minimise the public health impact of extreme heat. Sydney GMR was categorized into five climate zones. Heat-events were defined as severe or extreme. Using a time-stratified case-crossover design with a conditional logistic regression model we adjusted for influenza epidemics, public holidays, and climate zone. Odds ratios (OR) and 95% confidence intervals were estimated for associations between daily mortality and hospital admissions with heat-event days compared to non-heat event days for single and three day heat-events. All-cause mortality overall had similar magnitude associations with single day and three day extreme and severe events as did all cardiovascular mortality. Respiratory mortality was associated with single day and three day severe events (95th percentile, lag0: OR = 1.14; 95%CI: 1.04 to 1.24). Diabetes mortality had similar magnitude associations with single day and three day severe events (95th percentile, lag0: OR = 1.22; 95%CI: 1.03 to 1.46) but was not associated with extreme events. Hospital admissions for heat related injuries, dehydration, and other fluid disorders were associated with single day and three day extreme and severe events. Contrary to our findings for mortality, we found inconsistent and sometimes inverse associations for extreme and severe events with cardiovascular disease and respiratory disease hospital admissions. Controlling for air pollutants did not influence the mortality associations but reduced the magnitude of the associations with hospital admissions particularly for ozone and respiratory disease. Single and three day events of unusually high temperatures in Sydney are associated with similar magnitude increases in mortality and hospital admissions. The trend

High School Graduate Participation Rates: Proportions of Sacramento Area High School Graduates Enrolled in Los Rios Community College District, Fall 1998-Fall 1994.

Science.gov (United States)

Los Rios Community Coll. District, Sacramento, CA. Office of Planning and Research.

This report profiles the enrollment patterns of recent high school graduates of the Greater Sacramento Metropolitan Area who attend Los Rios colleges (California). This summary and the full data report provide the District and its colleges with research information on rates of participation by students who graduated from Los Rios Community College…

Survey of intestinal parasitism in dogs in the Phoenix metropolitan area.

Science.gov (United States)

Cornell, Heather N; O'Neal, Peter R; Wong, Valerie M; Noah, Donald L

2017-09-01

OBJECTIVE To determine the prevalence of selected intestinal parasites in pet dogs and recently apprehended free-roaming (AFR) shelter dogs in the Phoenix metropolitan area and compare those prevalences between the 2 groups. DESIGN Cross-sectional study. SAMPLE Convenience samples of fecal specimens from owned pet dogs from the Phoenix metropolitan area (n = 175) and free-roaming dogs apprehended and admitted to Maricopa County Animal Care and Control and Arizona Humane Society facilities from November 2014 through March 2015 (188). PROCEDURES Fresh fecal specimens were collected from all dogs; for AFR shelter dogs, specimens were collected within 72 hours after facility admission. Standard centrifugal flotation tests and an ELISA were performed to detect 5 common intestinal parasites (roundworms, hookworms, whipworms, Giardia spp, and Cystoisospora spp). Group comparisons were performed by means of the χ 2 test and Rogan-Gladen prevalence estimate. RESULTS At least 1 of the 5 evaluated parasites was detected in 85 (45.2%) fecal specimens from AFR shelter dogs and 24 (13.7%) specimens from owned pet dogs. This prevalence differed significantly between the groups. Notably, the prevalence of Giardia spp in AFR shelter dogs (n = 76 [40.4%]) was higher than previously reported in the United States. CONCLUSIONS AND CLINICAL RELEVANCE The prevalence of the evaluated intestinal parasites, particularly of Giardia spp, in AFR shelter dogs was higher than expected. This information is important for veterinarians, animal shelter personnel, pet owners, human health-care providers, and public health officials to consider when devising effective interventions and risk communication efforts against potential zoonotic threats, particularly those relevant to the Phoenix metropolitan area.

Psychiatric nursing menbers' reflections on participating in group-based clinical supervision

DEFF Research Database (Denmark)

Buus, Niels; Angel, Sanne; Traynor, Michael

2011-01-01

This paper is a report of an interview study exploring psychiatric hospital nursing staff members' reflections on participating in supervision. Clinical supervision is a pedagogical process designed to direct, develop, and support clinical nurses. Participation rates in clinical supervision...... they influence participation rates. Twenty-two psychiatric hospital nursing staff members were interviewed with a semistructured interview guide. Interview transcripts were interpreted by means of Ricoeur's hermeneutic method. The respondents understood clinical supervision to be beneficial, but with very...

Satisfaction among early and mid-career dentists in a metropolitan dental hospital in China

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Cui X

2017-06-01

Full Text Available Xiaoxi Cui,1 David G Dunning,2 Na An3 1College of Dentistry, University of Nebraska Medical Center, Lincoln, NE, USA; 2Department of Oral Biology, College of Dentistry, University of Nebraska Medical Center, Lincoln, NE, USA; 3School of Stomatology, Department of General Dentistry II, Peking University School and Hospital of Stomatology, Beijing, People’s Republic of China Abstract: A growing body of research has examined career satisfaction among dentists using a standardized instrument, dentist satisfaction survey (DSS. This project examined career satisfaction of early to mid-career dentists in China, a population whose career satisfaction, heretofore, has not been studied. This is an especially critical time to examine career satisfaction because of health care reform measures being implemented in China. A culturally sensitive Chinese-language version of the DSS (CDSS was developed and electronically administered to 367 early and mid-career dentists in a tertiary dental hospital in Beijing, China. One hundred and seventy respondents completed the survey. The average total career score was 123, with a range of 82–157. Data analysis showed some significant differences in total career score and several subscales based on gender, working hours per week, and years in practice. A stepwise regression model revealed that two variables predicted total career score: working hours per week and gender. Stepwise regression also demonstrated that four subscales significantly predicted the overall professional satisfaction subscale score: respect, delivery of care, income and patient relations. Implications of these results are discussed in light of the health care delivery system and dentist career paths in China. Keywords: job satisfaction, career satisfaction, early and mid-career dentists, Chinese health care reform

Sudden Cardiac Arrest during Participation in Competitive Sports.

Science.gov (United States)

Landry, Cameron H; Allan, Katherine S; Connelly, Kim A; Cunningham, Kris; Morrison, Laurie J; Dorian, Paul

2017-11-16

The incidence of sudden cardiac arrest during participation in sports activities remains unknown. Preparticipation screening programs aimed at preventing sudden cardiac arrest during sports activities are thought to be able to identify at-risk athletes; however, the efficacy of these programs remains controversial. We sought to identify all sudden cardiac arrests that occurred during participation in sports activities within a specific region of Canada and to determine their causes. In this retrospective study, we used the Rescu Epistry cardiac arrest database (which contains records of every cardiac arrest attended by paramedics in the network region) to identify all out-of-hospital cardiac arrests that occurred from 2009 through 2014 in persons 12 to 45 years of age during participation in a sport. Cases were adjudicated as sudden cardiac arrest (i.e., having a cardiac cause) or as an event resulting from a noncardiac cause, on the basis of records from multiple sources, including ambulance call reports, autopsy reports, in-hospital data, and records of direct interviews with patients or family members. Over the course of 18.5 million person-years of observation, 74 sudden cardiac arrests occurred during participation in a sport; of these, 16 occurred during competitive sports and 58 occurred during noncompetitive sports. The incidence of sudden cardiac arrest during competitive sports was 0.76 cases per 100,000 athlete-years, with 43.8% of the athletes surviving until they were discharged from the hospital. Among the competitive athletes, two deaths were attributed to hypertrophic cardiomyopathy and none to arrhythmogenic right ventricular cardiomyopathy. Three cases of sudden cardiac arrest that occurred during participation in competitive sports were determined to have been potentially identifiable if the athletes had undergone preparticipation screening. In our study involving persons who had out-of-hospital cardiac arrest, the incidence of sudden cardiac

The freight landscape : using secondary data sources to describe metropolitan freight flows.

Science.gov (United States)

2015-12-01

Metropolitan areas around the world are seeking to better manage freight flows and reduce negative impacts on local populations. A major challenge to better urban freight management is the lack of data; little is known about freight movements at the ...

Actual Condition of Quality Control of X-ray Imaging System in Primary Care Institution: focused on Gwangju Metropolitan City

International Nuclear Information System (INIS)

Dong, Kyung Rae; Lee, Seun Joo; Lee, Kyu Su; Kweon, Dae Cheol; Goo, Eun Hoe; Jung, Jae Eun; Lee, Kyu Su

2010-01-01

With the expanded use of radiation in modern medical practices, the most important issue in regards to efforts to reduce individual exposure dose is quality assurance. Therefore in order to study the present condition of quality assurance, the Gwangju Metropolitan City area was divided into five districts each containing ten hospitals. Four experiments were conducted: a reproducibility experiment for kVp, mA, and examination time (sec) intensity of illumination; half-value layer (HVL) measurement; and beam perpendicularity test matching experiment. The tube voltage reproducibility experiment for all fifty hospitals resulted in a 95.33% passing rate and mA and examination time both resulted in a 77.0% passing rate. The passing rate for intensity of illumination was 86.0% and 52.0% for HVL, which was the lowest passing rate of all four factors. For the beam perpendicularity test matching experiment, generally the central flux is matched to within 1.5 . deg. . Of all fifty hospitals 30.0% were beyond 3 . deg. . The results of the survey showed that 58% responded that they knew about quality assurance cycle. All fifty respondents stated that they have not received any training in regards to quality assurance at their current place of employment. Although quality assurance is making relative progress, the most urgent issue is awareness of the importance of quality assurance. Therefore, the implementation of professional training focusing on safety management and accurate quality assurance of radiation will reduce the exposure to radiation for radiologists and patients and higher quality imaging using less dosage will also be possible

Understanding hospital meal experiences by means of participant-driven-photo-elicitation

DEFF Research Database (Denmark)

Justesen, Lise; Mikkelsen, Bent Egberg; Gyimóthy, Szilvia

2013-01-01

in an open-ended interview. Two inductive analytical approaches were selected to assess the patients’ reflections on their hospital meal experiences. First, the interview transcripts were analysed using the Semiotic Analysis approach using qualitative data analysis software NVivo 9. Second, the 91 produced...

Metropolitan governance and infrastructure in São Paulo: the challenge of mediating regional interests and local impact

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Marcelo Sacenco Asquino

2010-12-01

Full Text Available The formation of the São Paulo metropolis is related to the historical process of building regional infrastructure as of the late 19th century, in connection with economic motivation and territorial influences. Since that time, São Paulo has played a key role in the network of cities that has been fundamental to its economic development and to its recognition as the most important city in Brazil. This article examines the importance of understanding the regional scale in relation to São Paulo's plans and projects, from Plano de Avenidas (Avenue Plan in the 1930s to the Rodoanel (ring road in the 1990s; the experience of planning and management of the metropolitan system in the 1970s and, in contrast, the environmental licensing process of these large projects after the 1990s. Discussing São Paulo's plans and projects is a complex task, because a project's local impact as well as regional interests must be considered. From different perspectives, the author reviewed the results of environmental licensing of Ampliação da Calha do Rio Tietê (deepening the bed of the Tietê river and Rodoanel Trecho Sul (south section of the ring road projects, and their actual role in the future arrangement and development of the São Paulo metropolis. Based on (a the results of the metropolitan planning experience in the 1970s, (b the updating of the metropolitan discussion in the 1990s from an economic globalization perspective, and (c the current experience of metropolitan systems in the state of São Paulo, it seems necessary to re-establish an effective metropolitan planning and management system in order to guarantee its legitimacy, commitment and governance.

Washington DC Metropolitan Area Drug Study Homeless and Transient Population (DC-MADST-1991)

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U.S. Department of Health & Human Services — The DC Metropolitan Area Drug Study (DCMADS) was conducted in 1991, and included special analyses of homeless and transient populations and of women delivering live...

Analysis of sexual activity without obstetric risk pregnant women attending public hospitals in Lima, Peru

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Alex Guibovich Mesinas

2015-09-01

Full Text Available Objective: to know the characteristics of sexual activity in pregnant women without obstetric risk who attend public hospitals in Lima. Material and Methods: exploratory, multicenter, descriptive and cross-sectional study, conducted during the first half of 2014 in 9 public hospitals in Lima. The sample was made up of pregnant women without obstetric risk who attended the outpatient clinic of obstetric departments. A non-probabilistic model is used for convenience. An expert validated survey was conducted on patients who voluntarily agreed to participate and signed the informed consent. The information was analyzed using STATA 21 software. Results: 1991 pregnant women answered the survey, 924 (46.4% were between 15 and 25 years, most were married, and Catholic (81.8% and 1380 (69.3% were born in Lima. Most had several previous pregnancies (46.3%, with term pregnancy and 86.3% informed they had no pre-term infants. 1347 (67.6% had vaginal delivery. The frequency of sexual acts, sexual desire, the response pattern and the fear of exercising sexual intercourse decreased at higher gestational age. Fear of sex acts increased from 12.6% to 76.2% in the third quarter. Most informed of a lack of orgasm during intercourse (42.8%. The position for intercourse went from "him on her" in the first quarter to "sideways" during the third quarter, with statistical significance. Conclusion: sexual activity in pregnant women of Metropolitan Lima tend to decrease in frequency, desire, and response cycle. The "sideways" position was the most often used in the third trimester.

Residential fencing in a metropolitan area and three small towns.

Science.gov (United States)

Edwin Kallio; Jerry A. Sesco

1967-01-01

Many types of fences were found on residential lots in the metropolitan-suburban area of St. Louis County, Missouri, and three small towns in southern Illinois. Wire fences predominated. More wooden fences were found on village lots than on city lots. In general, the more expensive homes had the most wooden fencing. Homes over 5 years old had more fencing of all...

Are hospitals also for relatives?

DEFF Research Database (Denmark)

Nissen, Nina Konstantin; Madsen, Mette; Kjøller, Mette

2008-01-01

at relatives of patients with cardiac diseases is sparse. This study aimed to survey the prevalence of health services for relatives of cardiac patients in Denmark. METHODS: We surveyed activities offered by Danish hospitals to the relatives of cardiac patients. Data were obtained from an Internet-based survey...... and 50 of 55 invited hospital departments participated. RESULTS: Almost all departments offer activities to relatives of cardiac patients, but only one-quarter have activities specifically aimed at supporting relatives. Large departments offer activities for relatives more often than smaller departments....... Participation rates for relatives are generally low, and the departments experience numerous barriers in providing activities for relatives of heart patients. CONCLUSIONS: Danish hospitals focus very little on relatives of cardiac patients, and this seems to be due to several factors, including lack...

On scaling of scientific knowledge production in U.S. metropolitan areas

NARCIS (Netherlands)

Nomaler, Önder; Frenken, Koen; Heimeriks, Gaston

2014-01-01

Using data on all scientific publications from the Scopus database, we find a superlinear scaling effect for U.S. metropolitan areas as indicated by the increase of per capita publication output with city size. We also find that the variance of residuals is much higher for mid-sized cities (100,000

[Family participation in premature care in neonatal ICU].

Science.gov (United States)

Gaíva, Maria Aparecida Munhoz; Scochi, Carmen Gracinda Silvan

2005-01-01

This study aimed at analyzing the family participation in the premature assistance in a university hospital neonatal ICU. Data were collected from the participant observation. Results showed that despite of the mother's presence in the daily life of their premature children placed in a hospital, family isn't inserted in the work process and mothers are the only ones who take part of the cares. This participation basically happens in the execution of maternity care, especially at the medium risk unity, the mother and premature family are less welcomed and there isn't any partnership between the care team and the family, there aren't team interventions in order to turn premature family in autonomous subject to promote health and life quality to baby's life.

Radon survey in Metropolitan Toronto schools

International Nuclear Information System (INIS)

Becker, E.; Moridi, R.

1992-01-01

The radon testing survey in Metropolitan Toronto public schools was the most intensive project of its kind ever undertaken in Canadian schools. It also included an extensive public education program on radiation and radon-in-schools. The radon levels at 632 schools were measured using the CAIRS Radon Monitors. Ninety percent of the locations measured were found to have a radon level equal to or less than 2 mWL. Two locations in two different schools were found to have a radon level at or above the Action Level (20 mWL). The remaining results were between the two extremes. Follow-up testing in those schools where more than 10 mWL of radon was found is in progress. (author)

Diabetes diagnosis and management among insured adults across metropolitan areas in the U.S.

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Wenya Yang

2018-06-01

Full Text Available This study provides diabetes-related metrics for the 50 largest metropolitan areas in the U.S. in 2012—including prevalence of diagnosed and undiagnosed diabetes, insurance status of the population with diabetes, diabetes medication use, and prevalence of poorly controlled diabetes.Diabetes prevalence estimates were calculated using cross-sectional data combining the Behavioral Risk Factor Surveillance System, American Community Survey, National Nursing Home Survey, Census population files, and National Health and Nutrition Examination Survey. Analysis of medical claims files (2012 de-identified Normative Health Information database, 2011 Medicare Standard Analytical Files, and 2008 Medicaid Analytic eXtract produced information on treatment and poorly controlled diabetes by geographic location, insurance type, sex, and age group.Among insured adults with diagnosed type 2 diabetes in 2012, the proportion receiving diabetes medications ranged from 83% in Oklahoma City, Oklahoma, to 65% in West Palm Beach, Florida. The proportion of treated patients with medical claims indicating poorly controlled diabetes was lowest in Minneapolis, Minnesota (36% and highest in Texas metropolitan areas of Austin (51%, San Antonio (51%, and Houston (50%.Estimates of diabetes detection and management across metropolitan areas often differ from state and national estimates. Local metrics of diabetes management can be helpful for tracking improvements in communities over time. Keywords: Diabetes, Management

Going Up? Canada's metropolitan areas and their role as escalators or elevators

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Bruce Newbold

2015-10-01

Full Text Available Canada’s major metropolitan areas offer multiple opportunities for economic and social advancement for in-migrants. As such, young adults may be attracted to these locations. In-migrants to Toronto have been observed to receive a substantial income benefit associated with migration into Toronto that is consistent with a productivity effect. This income effect is greater than the income benefit received by migrants elsewhere in the system or those who did not migrate. However, migration into Toronto did not lead to an acceleration in income gains consistent with the more rapid career progression expected to result from the migration into an escalator region.Consequently, this paper explores the income benefits for young adult migrants by considering the role of other major metropolitan areas within Canada, and whether they function similar to Toronto as escalators, or serve other roles that are unique to employment sector and type.

Collaboration between Hospital and Community Pharmacists to Improve Medication Management from Hospital to Home

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Judith Kristeller

2017-05-01

Full Text Available Objective: The objective of this study is to determine if a model for patient-centered care that integrates medication management between hospital and community pharmacists is feasible and can improve medication adherence. Design: This was a randomized, non-blinded, interventional study of 69 patients discharged from a hospital to home. Process measures include the number and type of medication-related discrepancies or problems identified, patient willingness to participate, the quality and quantity of interactions with community pharmacists, hospital readmissions, and medication adherence. Setting: A 214-bed acute care hospital in Northeastern Pennsylvania and seventeen regional community pharmacies. Patients: Enrolled patients were hospitalized with a primary or secondary diagnosis of heart failure or COPD, had a planned discharge to home, and agreed to speak to one of seventeen community pharmacists within the study network (i.e., a network community pharmacist following hospital discharge. Intervention: Information about a comprehensive medication review completed by the hospital pharmacist was communicated with the network community pharmacist to assist with providing medication therapy management following hospital discharge. Results: Of 180 patients eligible for the study, 111 declined to participate. Many patients were reluctant to talk to an additional pharmacist, however if the patient’s pharmacist was already within the network of 17 pharmacies, they usually agreed to participate. The study enrolled 35 patients in the intervention group and 34 in the control group. An average of 6 medication-related problems per patient were communicated to the patient’s network community pharmacist after discharge. In the treatment group, 44% of patients had at least one conversation with the network community pharmacist following hospital discharge. There was no difference in post-discharge adherence between the groups (Proportion of Days

The 13-year experience of performing pancreaticoduodenectomy in a mid-volume municipal hospital.

Science.gov (United States)

Kim, Hongbeom; Chung, Jung Kee; Ahn, Young Joon; Lee, Hae Won; Jung, In Mok

2017-02-01

Pancreaticoduodenectomy (PD) is a complex surgery associated with high morbidity, mortality, and cost. Municipal hospitals have their important role in the public health and welfare system. The purpose of this study was to identify the feasibility as well as the cost-effectiveness of performing PD in a mid-volume municipal hospital based on 13 years of experience with PD. From March 2003 to November 2015, 183 patients underwent PD at Seoul Metropolitan Government - Seoul National University Boramae Medical Center.. Retrospectively collected data were analyzed, with a particular focus on complications. Hospital costs were analyzed and compared with a national database, with patients divided into 2 groups on the basis of medical insurance status. The percentage of medical aid was significantly higher than the average in Korean hospitals. (19.1% vs. 5.8%, P = 0.002). Complications occurred in 88 patients (44.3%). Postoperative pancreatic fistula (POPF) occurred in 113 cases (61.7%), but the clinically relevant POPF was 24.6% (grade B: 23.5% and grade C: 1.1%). The median hospital stay after surgery was 20 days (range, 6-137 days). In-hospital mortality was 3.8% (n = 7), with pulmonary complications being the leading cause. During the study period, improvements were observed in POPF rate, operation time, and hospital stay. The mean total hospital cost was 13,819 United States dollar (USD) per patient, and the mean reimbursement from the National Health Insurance Service (NHIS) to health care providers was 10,341 USD (74.8%). The patient copayment portion of the NHIS payment was 5%. Performing PD in a mid-volume municipal hospital is feasible, with comparable results and cost-effectiveness.

Metropolitan natural area protection to maximize public access and species representation

Science.gov (United States)

Jane A. Ruliffson; Robert G. Haight; Paul H. Gobster; Frances R. Homans

2003-01-01

In response to widespread urban development, local governments in metropolitan areas in the United States acquire and protect privately-owned open space. We addressed the planner's problem of allocating a fixed budget for open space protection among eligible natural areas with the twin objectives of maximizing public access and species representation. Both...

Internal audit disclosures in annual reports of metropolitan municipalities in South Africa

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Christo Ackermann

2016-03-01

Full Text Available The role of internal audit in governance contributes significantly to accountability. However, its work is limited to internal use, and as such, it does not provide external stakeholders with information about the accountability contributions made by the internal audit function (IAF. The assurance provided by internal audit is equally important as the assurance provided by external auditors. Arguments exist that the inclusion of internal audit disclosure in public annual reports could contribute significantly to transparency and accountability in respect of municipalities. Literature suggest that the advantages of internal audit disclosure outweigh its disadvantages. This paper reports on the extent of internal audit disclosure in the eight metropolitan municipalities in South Africa for the 2012/2013 financial year. To achieve the objective set out in this paper, a mixed method approach was followed. A qualitative content analysis (deductive and inductive was performed. Qualitative text was displayed showing evidence of the disclosure item (visual presentation of quotes. To complement the qualitative text, Atlas.Ti was further utilised to quantify the codes which showed the differences in the disclosure practices of IAFs across metropolitan municipalities in South Africa. The results of this study show evidence of internal audit disclosure in annual reports despite the fact that no legislative requirements exist for internal audit to report in annual reports of municipalities. The extent and the nature of disclosure varied across metropolitan municipalities in South Africa. The results of this paper could be used to assist with establishing policy guidelines for internal audit disclosure.

Spatial mismatch, wages and unemployment in metropolitan areas in Brazil

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Ana Maria Bonomi Barufi

2017-12-01

Full Text Available The spatial mismatch hypothesis states that a lack of connection to job opportunities may affect an individual’s prospects in the labour market, especially for low-skilled workers. This phenomenon is especially observed in large urban areas, in which low-skilled minorities tend to live far away from jobs and face geographical barriers to finding and keeping jobs. This paper aims to investigate whether this negative relationship between spatial mismatch and labour market outcomes is valid in Brazil after controlling for individual characteristics. Our conclusions indicate that there is no clear relation between different measures of accessibility to jobs and the probability of being unemployed. However, for wages there is a clear correlation, which is stronger in larger metropolitan areas in the country. Given the exploratory nature of this work, our results still rely on strong identification hypotheses to avoid potential bias related to simultaneous location decisions of workers and firms within the city. Even if these conditions do not hold, the results are still meaningful as they provide a better understanding of the conditional distribution of wages and the unemployment rate in the biggest metropolitan areas of Brazil.

Association between air pollution and coronary artery calcification within six metropolitan areas in the USA (the Multi-Ethnic Study of Atherosclerosis and Air Pollution): a longitudinal cohort study.

Science.gov (United States)

Kaufman, Joel D; Adar, Sara D; Barr, R Graham; Budoff, Matthew; Burke, Gregory L; Curl, Cynthia L; Daviglus, Martha L; Diez Roux, Ana V; Gassett, Amanda J; Jacobs, David R; Kronmal, Richard; Larson, Timothy V; Navas-Acien, Ana; Olives, Casey; Sampson, Paul D; Sheppard, Lianne; Siscovick, David S; Stein, James H; Szpiro, Adam A; Watson, Karol E

2016-08-13

Long-term exposure to fine particulate matter less than 2.5 μm in diameter (PM2.5) and traffic-related air pollutant concentrations are associated with cardiovascular risk. The disease process underlying these associations remains uncertain. We aim to assess association between long-term exposure to ambient air pollution and progression of coronary artery calcium and common carotid artery intima-media thickness. In this prospective 10-year cohort study, we repeatedly measured coronary artery calcium by CT in 6795 participants aged 45-84 years enrolled in the Multi-Ethnic Study of Atherosclerosis and Air Pollution (MESA Air) in six metropolitan areas in the USA. Repeated scans were done for nearly all participants between 2002 and 2005, for a subset of participants between 2005 and 2007, and for half of all participants between 2010 and 2012. Common carotid artery intima-media thickness was measured by ultrasound in all participants at baseline and in 2010-12 for 3459 participants. Residence-specific spatio-temporal pollution concentration models, incorporating community-specific measurements, agency monitoring data, and geographical predictors, estimated concentrations of PM2.5 and nitrogen oxides (NOX) between 1999 and 2012. The primary aim was to examine the association between both progression of coronary artery calcium and mean carotid artery intima-media thickness and long-term exposure to ambient air pollutant concentrations (PM2.5, NOX, and black carbon) between examinations and within the six metropolitan areas, adjusting for baseline age, sex, ethnicity, socioeconomic characteristics, cardiovascular risk factors, site, and CT scanner technology. In this population, coronary calcium increased on average by 24 Agatston units per year (SD 58), and intima-media thickness by 12 μm per year (10), before adjusting for risk factors or air pollutant exposures. Participant-specific pollutant concentrations averaged over the years 2000-10 ranged from 9.2-22.6 �

The role of a bus network in access to primary health care in Metropolitan Auckland, New Zealand.

Science.gov (United States)

Rocha, C M; McGuire, S; Whyman, R; Kruger, E; Tennant, M

2015-09-01

Background: This study examined the spatial accessibility of the population of metropolitan Auckland, New Zealand to the bus network, to connect them to primary health providers, in this case doctors (GP) and dentists. Analysis of accessibility by ethnic identity and socio-economic status were also carried out, because of existing health inequalities along these dimensions. The underlying hypothesis was that most people would live within easy reach of primary health providers, or easy bus transport to such providers. An integrated geographic model of bus transport routes and stops, with population and primary health providers (medical. and dental practices) was developed and analysed. Although the network of buses in metropolitan Auckland is substantial and robust it was evident that many people live more than 150 metres from a stop. Improving the access to bus stops, particularly in areas of high primary health care need (doctors and dentists), would certainly be an opportunity to enhance spatial access in a growing metropolitan area.

Implementing the Green City Policy in Municipal Spatial Planning: The Case of Buffalo City Metropolitan Municipality

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Abongile Dlani

2015-06-01

Full Text Available The term “eco-city,” and similar concepts such as “green” and “sustainable” cities, has evolved overtime concurrent to the development of the understanding of social change and mankind’s impact on environmental and economic health. With the advent of climate change impacts, modern economies developed the green city policy to create sustainable urban development, low emission, and environmentally friendly cities. In South Africa municipalities, including Buffalo City Metropolitan Municipality (BCMM have been tasked to and implement the green city policy. However, BCMM is yet to develop the green city policy that clearly articulate how the municipality will combat climate change and reduce its Green House Gases (GHG emissions in its spatial planning designs. Against this background, this article reviews and analyses green policy landscape in Metropolitan Municipalities. It is envisaged that the research will provide the basis for the development of a comprehensive green policy strategies and programmes for the local transition to action in Buffalo City Metropolitan Municipality, in the Eastern Cape Province.

Conhecimento da disponibilidade e sobre o uso da ventilação não invasiva em unidades de terapia intensiva de hospitais públicos, privados e de ensino da região metropolitana de São Paulo Availability and use of noninvasive ventilation in the intensive care units of public, private and teaching hospitals in the greater metropolitan area of São Paulo, Brazil

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Lara Maris Nápolis

2006-02-01

physiotherapists with noninvasive positive-pressure ventilation in the intensive care units of public, private and teaching hospitals in the greater metropolitan area of São Paulo, Brazil. METHODS: On-site administration of questionnaires. RESULTS: Noninvasive positive-pressure ventilation equipment was widely available and was more commonly found in private hospitals than in teaching hospitals. Such equipment was least available in public hospitals, in which the predominant method was the use of mechanical ventilators designed for invasive ventilation and adapted to noninvasive positive-pressure ventilation. In private hospitals, continuous flow ventilators were more common, whereas, in teaching hospitals, ventilators specifically designed for noninvasive ventilation were typically employed. All physiotherapists felt themselves capable of initiating noninvasive positive pressure ventilation, compared with 72.6% of physicians and 33.3% of nurses. Physicians and physiotherapists presented high percentages of correct answers when asked about the indications and contraindications for the use of noninvasive positive-pressure ventilation. Over a one year period, more physiotherapists read articles about noninvasive positive-pressure ventilation and participated in related classes than did physicians, who in turn did so more than did nurses. CONCLUSION: Noninvasive positive-pressure ventilation equipment is widely available in the greater metropolitan area of São Paulo, although differences exist among public, private and teaching hospitals in terms of the type of equipment used. Physicians and physiotherapists exhibited considerable knowledge regarding the indications and contraindications for the use of noninvasive positive-pressure ventilation. More physiotherapists felt themselves able to initiate noninvasive positive-pressure ventilation, and their knowledge of the subject was more current than was that of physicians or nurses.

Assessing and comparing information security in swiss hospitals.

Science.gov (United States)

Landolt, Sarah; Hirschel, Jürg; Schlienger, Thomas; Businger, Walter; Zbinden, Alex M

2012-11-07

Availability of information in hospitals is an important prerequisite for good service. Significant resources have been invested to improve the availability of information, but it is also vital that the security of this information can be guaranteed. The goal of this study was to assess information security in hospitals through a questionnaire based on the International Organization for Standardization (ISO) and the International Electrotechnical Commission (IEC) standard ISO/IEC 27002, evaluating Information technology - Security techniques - Code of practice for information-security management, with a special focus on the effect of the hospitals' size and type. The survey, set up as a cross-sectional study, was conducted in January 2011. The chief information officers (CIOs) of 112 hospitals in German-speaking Switzerland were invited to participate. The online questionnaire was designed to be fast and easy to complete to maximize participation. To group the analyzed controls of the ISO/IEC standard 27002 in a meaningful way, a factor analysis was performed. A linear score from 0 (not implemented) to 3 (fully implemented) was introduced. The scores of the hospitals were then analyzed for significant differences in any of the factors with respect to size and type of hospital. The participating hospitals were offered a benchmark report about their status. The 51 participating hospitals had an average score of 51.1% (range 30.6% - 81.9%) out of a possible 100% where all items in the questionnaire were fully implemented. Room for improvement could be identified, especially for the factors covering "process and quality management" (average score 1.3 ± 0.8 out of a maximum of 3) and "organization and risk management" (average score 1.3 ± 0.7 out of a maximum of 3). Private hospitals scored significantly higher than university hospitals in the implementation of "security zones" and "backup" (P = .008). Half (50.00%, 8588/17,177) of all assessed hospital beds

Quantitative valuation placed by children and teenagers on participation in two hypothetical research scenarios.

Science.gov (United States)

Funnell, Dan; Fertleman, Caroline; Carrey, Liz; Brierley, Joe

2012-11-01

For paediatric medicine to advance, research must be conducted specifically with children. Concern about poor recruitment has led to debate about payments to child research participants. Although concerns about undue influence by such 'compensation' have been expressed, it is useful to determine whether children can relate the time and inconvenience associated with participation to the value of payment offered. This study explores children's ability to determine fair remuneration for research participation, and reviews payments to children participating in research. Forty children were interviewed before outpatient visits at two London Hospitals: Great Ormond Street Children's Hospital and the Whittington Hospital District General Hospital. Children were asked to value their involvement in two hypothetical research scenarios - the first an 'additional blood sample', the second also involving daily oral oil capsules taken for a fortnight before further venesection. Background knowledge about familiarity with money, and experience with hospitalisation was assessed. The mean valuation of involvement in the second scenario (£13.18) was higher than in the first (£2.84) (pfair valuation for participation in medical research. The monetary sums are influenced by the time and inconvenience involved in the research, and by the extent of recent experience with hospital procedures. The authors review current ethical thinking regarding payments to child research participants and suggest that a fair wage model might be an ethically acceptable way to increase participation of children in research.

Assessing Anxiety, Depression and Psychological Wellbeing Status of Urban Elderly Under Represent of Tehran Metropolitan City

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Mahtab Alizadeh

2012-10-01

Full Text Available Objectives: the present study describes assessing mental health status (anxiety, depression, and psychological wellbeing of old people in different age groups in tehran metropolitan city. The outcomes of this study could help to health policy makers to develop of better health policy in gerontology field by determine of priorities of mental care in different age groups of old people. Methods & Materials: this was a cross sectional study in 2010. The participants were (n=402 aged 60 years old and over which have underrepresented from Shahid Beheshti University. The survey methods were via face-to-face interviews, and just in a few cases as telephone interviews. The instrument to data collection included demographic questionnaire, k6 and yeild tools. Data analyzed by Stata and SPSS ver.15 through t-test, one-way anova. Regression models applied as well. Results: based on results in the past 4 weeks,10.9% of elderly had sever anxiety or depression symptoms and about half of them (46.5% had moderate psychological distress. The rate of psychological distress increased with age growing, specifically in 60- 79 years old however, this rate declined from age of 80 years and over. Psychological distress levels among elderly women were more than old men in all age groups, except of 60-69 years old people. Regarding psychological wellbeing, feeling of tireless, lone less, and depression are the most common complain of house dowelling old people in tehran metropolitan area. As the results show 43.1% elderly participants were in moderate level and 17% of them were in the bad level of psychological wellbeing. Based on regression model, sex (P=0.012, housing (P=0.004, and retirement salary (P=0.048 were significant variables that effect on psychological distress. The income rate was only important component that effect on psychological wellbeing of elderly participants. There was no significant different between aged groups 60-64 and 65-69 in psychological

The provision and utilisation of casemix and demographic data by nursing managers in seven hospitals.

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Blay, Nicole; Donoghue, Judith

2003-01-01

The role of the nursing manager has evolved from clinician and bed manager to one with greater accountability for evidence based practice, benchmarking and more recently, budget liability. Casemix data are widely believed to be a means of providing essential information for effective decision making and financial management but have not been widely utilised by nursing managers (Diers & Bozzo, 1999). This paper will report the results of a survey of nursing managers in seven hospitals within a metropolitan area health service. The hospitals include tertiary referral hospitals, specialist public hospitals and an affiliated public hospital for aged care and rehabilitation services. The survey sought to establish what casemix and related data were provided to nurse managers, who provided these data and how supplied data were utilised by the nurse managers. Results demonstrated that the majority of nursing managers surveyed received minimal (if any) casemix and/or demographic data on a routine basis. Some were provided with data in response to specific requests. The information that was provided varied both within and across hospitals, and no consistent methods of data distribution were available. Few nursing managers believed that the information provided aided their decision-making processes partly due to the minimalist nature of provided data while some nursing managers demonstrated a lack of understanding of the potential benefit of casemix data as a resource to support management decision making.

The determinants of part-time work in Metropolitan Lima

OpenAIRE

Manuel Enrique Saavedra Martinez

2011-01-01

The following paper examines the part-time work in Metropolitan Lima in 2008. The overall objective is to identify the determinants of the incidence of part-time work in Lima. We worked with one Probit econometric model, measured by the National Survey of Households (NSH), which explores the job characteristics of people. This will determine the presence of part-time workers in the areas of trade, health, education and communication; also realized that this group has completed university stud...

The determinants of part-time work in Metropolitan Lima

OpenAIRE

Saavedra Martinez, Manuel Enrique

2012-01-01

The following paper examines the part-time work in Metropolitan Lima in 2008. The overall objective is to identify the determinants of the incidence of part-time work in Lima. We worked with one Probit econometric model, measured by the National Survey of Households (NSH), which explores the job characteristics of people. This will determine the presence of part-time workers in the areas of trade, health, education and communication; also realized that this group has completed university stud...

The 1987 Whittier Narrows, California, earthquake: A Metropolitan shock

OpenAIRE

Hauksson, Egill; Stein, Ross S.

1989-01-01

Just 3 hours after the Whittier Narrows earthquake struck, it became clear that a heretofore unseen geological structure was seismically active beneath metropolitan Los Angeles. Contrary to initial expectations of strike-slip or oblique-slip motion on the Whittier fault, whose north end abuts the aftershock zone, the focal mechanism of the mainshock showed pure thrust faulting on a deep gently inclined surface [Hauksson et al., 1988]. This collection of nine research reports spans the spectru...

Forecasting drug utilization and expenditure in a metropolitan health region

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Korkmaz Seher

2010-05-01

Full Text Available Abstract Background New pharmacological therapies are challenging the healthcare systems, and there is an increasing need to assess their therapeutic value in relation to existing alternatives as well as their potential budget impact. Consequently, new models to introduce drugs in healthcare are urgently needed. In the metropolitan health region of Stockholm, Sweden, a model has been developed including early warning (horizon scanning, forecasting of drug utilization and expenditure, critical drug evaluation as well as structured programs for the introduction and follow-up of new drugs. The aim of this paper is to present the forecasting model and the predicted growth in all therapeutic areas in 2010 and 2011. Methods Linear regression analysis was applied to aggregate sales data on hospital sales and dispensed drugs in ambulatory care, including both reimbursed expenditure and patient co-payment. The linear regression was applied on each pharmacological group based on four observations 2006-2009, and the crude predictions estimated for the coming two years 2010-2011. The crude predictions were then adjusted for factors likely to increase or decrease future utilization and expenditure, such as patent expiries, new drugs to be launched or new guidelines from national bodies or the regional Drug and Therapeutics Committee. The assessment included a close collaboration with clinical, clinical pharmacological and pharmaceutical experts from the regional Drug and Therapeutics Committee. Results The annual increase in total expenditure for prescription and hospital drugs was predicted to be 2.0% in 2010 and 4.0% in 2011. Expenditures will increase in most therapeutic areas, but most predominantly for antineoplastic and immune modulating agents as well as drugs for the nervous system, infectious diseases, and blood and blood-forming organs. Conclusions The utilisation and expenditure of drugs is difficult to forecast due to uncertainties about the rate

Chieti-Pescara Metropolitan Area: International Migrations, Residential Choices and Economic Deconcentration

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Armando Montanari

2006-06-01

Full Text Available The subject of human mobility – with reference to the migratory component – has taken on specific significance during the last decade, particularly with regard to the concept of place. This paper considers the subject in relation to residential and economic deconcentration. The specific point of reference is the metropolitan area of Chieti-Pescara, in the central part of Italy’s Adriatic coast. The research was carried out through quantitative analysis of official data from population censuses and register offices. The results highlight the links between movements of residents and those of firms, in which foreign residents show distinctive behaviour. The residential choices made by foreigners in the area are based on economic reasons and are primarily linked to housing and transport costs. Their communities tend to be concentrated in specific zones of the metropolitan area and in specific districts of the cities, as a consequence of a feeling of belonging and solidarity. Although there are no clear signs of segregation phenomena, the native population tends to avoid mingling with foreigners from marginal countries.

Provider-related barriers to rapid HIV testing in U.S. urban non-profit community clinics, community-based organizations (CBOs) and hospitals.

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Bogart, Laura M; Howerton, Devery; Lange, James; Setodji, Claude Messan; Becker, Kirsten; Klein, David J; Asch, Steven M

2010-06-01

We examined provider-reported barriers to rapid HIV testing in U.S. urban non-profit community clinics, community-based organizations (CBOs), and hospitals. 12 primary metropolitan statistical areas (PMSAs; three per region) were sampled randomly, with sampling weights proportional to AIDS case reports. Across PMSAs, all 671 hospitals and a random sample of 738 clinics/CBOs were telephoned for a survey on rapid HIV test availability. Of the 671 hospitals, 172 hospitals were randomly selected for barriers questions, for which 158 laboratory and 136 department staff were eligible and interviewed in 2005. Of the 738 clinics/CBOs, 276 were randomly selected for barriers questions, 206 were reached, and 118 were eligible and interviewed in 2005-2006. In multivariate models, barriers regarding translation of administrative/quality assurance policies into practice were significantly associated with rapid HIV testing availability. For greater rapid testing diffusion, policies are needed to reduce administrative barriers and provide quality assurance training to non-laboratory staff.

The MeSO-net (Metropolitan Seismic Observation network) confronts the Pacific Coast of Tohoku Earthquake, Japan (Mw 9.0)

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Kasahara, K.; Nakagawa, S.; Sakai, S.; Nanjo, K.; Panayotopoulos, Y.; Morita, Y.; Tsuruoka, H.; Kurashimo, E.; Obara, K.; Hirata, N.; Aketagawa, T.; Kimura, H.

2011-12-01

On April 2007, we have launched the special project for earthquake disaster mitigation in the Tokyo Metropolitan area (Fiscal 2007-2011). As a part of this project, construction of the MeSO-net (Metropolitan Seismic Observation network) has been completed, with about 300 stations deployed at mainly elementary and junior-high schools with an interval of about 5 km in space. This results in a highly dense network that covers the metropolitan area. To achieve stable seismic observation with lower surface ground noise, relative to a measurement on the surface, sensors of all stations were installed in boreholes at a depth of about 20m. The sensors have a wide dynamic range (135dB) and a wide frequency band (DC to 80Hz). Data are digitized with 200Hz sampling and telemetered to the Earthquake Research Institute, University of Tokyo. The MeSO-net that can detect and locate most earthquakes with magnitudes above 2.5 provides a unique baseline in scientific and engineering researches on the Tokyo metropolitan area, as follows. One of the main contributions is to greatly improve the image of the Philippine Sea plate (PSP) (Nakagawa et al., 2010) and provides an accurate estimation of the plate boundaries between the PSP and the Pacific plate, allowing us to possibly discuss clear understanding of the relation between the PSP deformation and M7+ intra-slab earthquake generation. Also, the latest version of the plate model in the metropolitan area, proposed by our project, attracts various researchers, comparing with highly-accurate solutions of fault mechanism, repeating earthquakes, etc. Moreover, long-periods ground motions generated by the 2011 earthquake off the Pacific coast of Tohoku earthquake (Mw 9.0) were observed by the MeSO-net and analyzed to obtain the Array Back-Projection Imaging of this event (Honda et al., 2011). As a result, the overall pattern of the imaged asperities coincides well with the slip distribution determined based on other waveform inversion

Building motivation to participate in a quality improvement collaborative in NHS hospital trusts in Southeast England: a qualitative participatory evaluation.

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Lalani, Mirza; Hall, Kate; Skrypak, Mirek; Laing, Chris; Welch, John; Toohey, Peter; Seaholme, Sarah; Weijburg, Thomas; Eyre, Laura; Marshall, Martin

2018-04-07

This study explores the barriers and facilitators that impact on the motivation of practitioners to participate in a quality improvement collaborative. A qualitative and formative evaluation using a participatory approach, the researcher-in-residence model which embraces the concept of 'coproducing' knowledge between researchers and practitioners using a range of research methods such as participant observation, interviews and documentary analysis. The design, creation and application of newly generated evidence are facilitated by the researcher through negotiation and compromise with team members. Senior and middle managers, doctors and nurses. Two hospitals in Southeast England participating in a Patient Safety Improvement Collaborative and the facilitator (host) of the collaborative, based in Central London. The evaluation has revealed facilitators and barriers to motivation categorised under two main themes: (1) inherent motivation and (2) factors that influence motivation, interorganisational and intraorganisational features as well as external factors. Facilitators included collaborative 'champions,' individuals who drove the quality improvement agenda at a local level, raising awareness and inspiring colleagues. The collaborative itself acted as a facilitator, promoting shared learning as well as building motivation for participation. A key barrier was the lack of board engagement in the participating National Health Service organisations which may have affected motivation among front-line staff. Collaboratives maybe an important way of engaging practitioners in quality improvement initiatives. This study highlights that despite a challenging healthcare environment in the UK, there remains motivation among individuals to participate in quality improvement programmes as they recognise that improvement approaches may facilitate positive change in local clinical processes and systems. Collaboratives can harness this individual motivation to facilitate spread

Food insecurity, a determinant of obesity? - an analysis from a population-based survey in the Paris metropolitan area, 2010.

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Martin-Fernandez, Judith; Caillavet, France; Lhuissier, Anne; Chauvin, Pierre

2014-01-01

The relationship between food insecurity and obesity is discussed in the literature. The objective of this study was to determine whether food insecurity and obesity were associated in the Paris metropolitan area. We used data from third wave of the Health, Inequalities and Social Ruptures (SIRS) cohort study, a longitudinal population-based, representative health and socioepidemiological survey of the general population in the Paris metropolitan area. The participants' BMI (calculated using self-reported height and weight) was analyzed as a continuous variable, and a dichotomous variable (BMI Food insecurity was estimated using the Household Food Security Scale Module (HFSSM) and was treated as a trichotomous variable (food security / low food security / very low food security). Multilevel models were estimated for men and women separately. Obesity (BMI ≥ 30 kg/m(2)) prevalence was 10.2%. The determinant of obesity differs according to gender. After adjustment for age, income and the sociooccupational group, very low food security was associated with obesity in women (OR = 2.01, 95%CI 1.05-3.82), and women with very low food security had a higher BMI (Coef. = 1.78, 95% CI 0.24-3.31). This association, however, was not significant for men (OR = 1.84, 95%CI 0.64-5.30). In times of economic crisis, it is increasingly essential to explore and understand the pathway through which very low food security is linked to obesity.

Overweight according to geographical origin and time spent in France: a cross sectional study in the Paris metropolitan area

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Martin-Fernandez Judith

2012-10-01

Full Text Available Abstract Background For the first time in France in a population-based survey, this study sought to investigate the potential impact of migration origin and the proportion of lifetime spent in mainland France on body mass index (BMI and overweight in adults living in the Paris metropolitan area. Methods A representative, population-based, random sample of the adult, French speaking population of the Paris metropolitan area was interviewed in 2005. Self-reported BMI (BMI = weight/height2 and overweight (BMI ≥ 25 were our 2 outcomes of interest. Two variables were constructed to estimate individuals’ migration origin: parental nationality and the proportion of lifetime spent in mainland France, as declared by the participants. We performed multilevel regression models among different gender and age groups, adjusted for demographics and socioeconomic status. Results In women, a parental origin in the Middle East or North Africa (MENA was associated with a higher risk of being overweight (especially before the age of 55 and a higher BMI (between 35 and 54 years of age, and so were women of Sub-Sahara African parental origin in the middle age category. Only in the youngest men ( Conclusions Our results plea for potential cultural determinants of overweight in the migrant and migrants-born populations in the French context of the capital region. Taking into account the people’ family and personal migration histories may be an important issue in public health research and policies on overweight and obesity prevention.

A metropolitan optical network with support for multicasting in the optical domain

NARCIS (Netherlands)

Dey, D.; Koonen, A.M.J.; Bochove, van A.C.; Geuzebroek, D.; Salvador, M.R.; Berghmans, F.; Thienpont, H.; Danckaert, J.; Desmet, L.

2001-01-01

We present the FLAMINGO1 network architecture, an all-optical wavelength-and-timeslotted Metropolitan Optical Network based on a multiple-ring topology. A couple of important aspects of this architecture include all-optical packet switching at intermediate nodes on a ring and the ability to put IP

A Metropolitan Optical Network with support for multicasting in the optical domain

NARCIS (Netherlands)

Dey, D.; Koonen, A.M.J.; van Bochove, A.C.; Geuzebroek, D.H.; Salvador, M.R.; Thienpont, H.; Berghmans, F.; Danckaert, J.; Desmet, L.

2001-01-01

We present the FLAMINGO1 network architecture, an all-optical wavelength-and-timeslotted Metropolitan Optical Network based on a multiple-ring topology. A couple of important aspects of this architecture include all-optical packet switching at intermediate nodes on a ring and the ability to put IP

Interprofessional simulation to improve patient participation in transitional care.

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Dyrstad, Dagrunn Nåden; Storm, Marianne

2017-06-01

Educating and training healthcare professionals is known to improve the quality of transitional care for older adults. Arranging interprofessional meetings for healthcare professionals might be useful to improve patient participation skills in transitional care. To describe the learning activities used in The Meeting Point programme, focusing on patient participation in transitional care, and assess whether they increase healthcare professionals' awareness of and competencies relating to patient participation in the transitional care of older patients. Data were collected as part of an educational intervention programme, The Meeting Point, including three seminars on 'Patient participation in the transitional care of older patients' and four follow-up meetings. Participants were nurses, care assistants, doctors, physiotherapists, patient coordinators and administrative personnel from hospital, nursing homes and home-based care services. The Meeting Point was organised around four pillars: introduction, teaching session, group work activity and plenary discussion. Qualitative data included log reports, summaries of meetings, notes from group work activities, and reports from participants and from follow-up meetings. Feedback from participants shows that they were satisfied with meeting healthcare professionals from other units of care. A film scenario was perceived relevant for group work activity and useful in focusing participants' attention to patient participation. Follow-up meetings show that some nursing home wards, the emergency department and one medical ward at the hospital continued with ongoing work to improve quality of care. Efforts included implementation of an observational waiting room with comfortable chairs, planning for discharge in hospital admission, a daily patient flow registration system and motivational interviewing during admission to nursing home. The description of the learning activities used at The Meeting Point seminars shows that they

Seroprevalence of Toxoplasma gondii in domestic pets from metropolitan regions of Panama

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Rengifo-Herrera Claudia

2017-01-01

Full Text Available Toxoplasmosis is a worldwide zoonotic disease but information regarding domestic animals in Central America is scarce and fragmented. The aim of this study was to determine the seroprevalence of Toxoplasma gondii in domestic cats and dogs in different metropolitan regions of Panama. A total of 576 samples were collected; sera from 120 cats and 456 dogs were tested using a commercial indirect enzyme-linked immunosorbent assay (ELISA. The overall seroprevalence of IgG antibodies was 30.73%. There is high seroprevalence of T. gondii in cats and dogs in the metropolitan regions around the Panama Canal; however, differences between these species were not significant. Statistical analysis indicated that there are relevant variables, such as the age of animals, with a direct positive relationship with seroprevalence. None of the variables related to animal welfare (veterinary attention provided, type of dwelling, and access to green areas and drinking water were associated with seropositivity.

Health professionals' experience of teamwork education in acute hospital settings: a systematic review of qualitative literature.

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Eddy, Kylie; Jordan, Zoe; Stephenson, Matthew

2016-04-01

Teamwork is seen as an important element of patient care in acute hospital settings. The complexity of the journey of care for patients highlights the need for health professionals to collaborate and communicate clearly with each other. Health organizations in western countries are committed to improving patient safety through education of staff and teamwork education programs have been integral to this focus. There are no current systematic reviews of the experience of health professionals who participate in teamwork education in acute hospital settings. The objective of this systematic review was to search for the best available evidence on the experiences of health professionals who participate in teamwork education in acute hospital settings. This review considered studies reporting on experiences of registered health professionals who work in acute hospitals. This included medical, nursing and midwifery and allied health professionals. The focus of the meta-synthesis was the experiences and reflections of health professionals who were involved in teamwork education in acute hospital settings. The geographical context for this review was acute hospitals in rural or metropolitan settings in Australia and overseas countries. The review focused on the experiences of health professionals who work in acute hospitals and participated in teamwork education programs. This review considered studies that focused on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research.In the absence of research studies, other text such as opinion papers, discussion papers and reports were considered. Studies published in English and from 1990 to 2013 were included in this review. The literature search for relevant papers occurred between 13 September and 26 October 2013. A three-step search strategy was utilized in this review. The databases searched were PubMed, CINAHL, Embase and Scopus. The

Vaccine-preventable, hospitalizations among American Indian/Alaska Native children using the 2012 Kid's Inpatient Database.

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Nickel, Amanda J; Puumala, Susan E; Kharbanda, Anupam B

2018-02-08

Our aim was to assess the odds of hospitalization for a vaccine-preventable, infectious disease (VP-ID) in American Indian/Alaska Native (AI/AN) children compared to other racial and ethnic groups using the 2012 Kid's Inpatient Database (KID) The KID is a nationally representative sample, which allows for evaluation of VP-ID in a non-federal, non-Indian Health Service setting. In a cross-sectional analysis, we evaluated the association of race/ethnicity and a composite outcome of hospitalization due to vaccine-preventable infection using multivariate logistic regression. AI/AN children were more likely (OR=1.81, 95% CI=1.34, 2.45) to be admitted to the hospital in 2012 for a VP-ID compared to Non-Hispanic white children after adjusting for age, sex, chronic disease status, metropolitan location, and median household income. This disparity highlights the necessity for a more comprehensive understanding of immunization and infectious disease exposure among American Indian children, especially those not covered or evaluated by Indian Health Service. Copyright © 2017 Elsevier Ltd. All rights reserved.

Suburbanization and sustainability in metropolitan Moscow.

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Mason, Robert J; Nigmatullina, Liliya

2011-01-01

Although Soviet-era urban-growth controls produced relatively sustainable metropolitan development patterns, low-density suburban sprawl has accelerated markedly in modern Russia. Distinctive features of Moscow's development history are its greenbelt, which dates from 1935 and is becoming increasingly fragmented, proliferation of satellite cities at the urban fringe, conversion of seasonal dachas into full-time residences, the very exclusive Rublevo Uspenskoe Highway development, and today's crippling traffic congestion. The recent economic crisis has slowed development and actually increased the supply of “economy-class” single-family homes, for which there is much pent-up desire but insufficient credit availability to meet the demand. A renewed commitment to sustainability's triple bottom line—environmental quality, equity, and economic prosperity—will require greater government transparency and fairness, stronger planning controls, and an expanded public transportation system.

Seroprevalence of poliovirus antibodies in the Kansas City metropolitan area, 2012–2013

Science.gov (United States)

Wallace, Gregory S.; Pahud, Barbara A.; Weldon, William C.; Curns, Aaron T.; Oberste, M. Steven; Harrison, Christopher J.

2017-01-01

ABSTRACT No indigenous cases of poliomyelitis have occurred in the US since 1979; however the risk of importation persists until global eradication is achieved. The seropositivity rate for different age cohorts with exposures to different poliovirus vaccine types and wild virus in the US are not presently known. A convenience sample was conducted in the Kansas City metropolitan area during 2012–2103 with approximately 100 participants enrolled for each of 5 age cohorts categorized based on vaccine policy changes over time in the US. Immunization records for poliovirus vaccination were required for participants poliovirus serotypes. Seroprevalence was evaluated by demographics as well as between polio serotypes. The overall seroprevalence to poliovirus was 90.7%, 94.4%, and 83.3%, for types 1, 2, and 3, respectively. Seroprevalence was high (88.6%–96.2%) for all 3 types of poliovirus for the 6–10 y old age group that was likely to have received a complete schedule of IPV-only vaccination. Children 2–3 y of age, who have not yet completed their full IPV series, had lower seroprevalence compared with all older age groups for types 1 and 2 (p-value poliovirus in the population surveyed. Seroprevalence for subjects aged 2–3 y was lower than all other age groups for serotypes 1 and 2 highlighting the importance of completing the recommended poliovirus vaccine series with a booster dose at age 4–6 y. PMID:28059613

Racial/Ethnic Pay Disparities among Registered Nurses (RNs) in U.S. Hospitals: An Econometric Regression Decomposition.

Science.gov (United States)

Moore, Jean; Continelli, Tracey

2016-04-01

To detect the presence of racial and ethnic pay disparities between minority and white hospital RNs using a national sample. The National Sample Survey of Registered Nurses, 2008, which is representative at both the state and national level. Cross-sectional data were analyzed using multivariate regression and regression decomposition. Differences between groups were decomposed into differences in the possession of characteristics and differences in the value of the same characteristic between different groups, the latter being a commonly used measure of wage discrimination. As the majority of minority hospital RNs are employed within the most densely populated (central) counties of metropolitan statistical areas (MSAs), only hospital RNs employed in the central counties of MSAs were selected. Regression decomposition found that black and Hispanic RNs earned less than whites and Asians, while Asian RNs earned more than white RNs. The majority of pay variation between white RNs, versus Asian, black, or Hispanic RNs was due to unexplained differences in the value of the same characteristic between groups. Differences in earnings between underrepresented and overrepresented hospital RNs is suggestive of discrimination. © Health Research and Educational Trust.

SPATIAL SEGMENTATION WITHIN METROPOLITAN LABOUR MARKET: MAPPING THE GENDER DIMENSION

OpenAIRE

DEBNATH, TANIA

2017-01-01

Spatial segmentation of the labour market of informal workers within the metropolitan is observed globally. InIndia it is not only compartmentalised on gender, caste, ethnic lines but also geographically segmented by thecreation of spatially disjoined markets. The differential impact of this limited mobility on female and malelabour remains largely unexplored. The present paper argues that the labour market for informal workers issegmented into smaller labour markets separated by commuting (h...

Budaya Konsumsi Remaja-Pelajar di Tiga Kota Metropolitan Pantai Indonesia

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Andi Mappiare

2016-02-01

Full Text Available This research aimed to obtain a narrative description of students' thought patterns on their consumptive behaviors and the work ethos in self-management relating to their consumptive motives. The research was conducted using  focused ethnography on senior high school students in three Indonesian coastal metropolitan cities. Following, this research, a self-help book was constructed  increase students awareness of their"budgeting intelligence and their local wisdom.

CHANGES IN BACTERIAL COMPOSITION OF BIOFILM IN A METROPOLITAN DRINKING WATER DISTRIBUTION SYSTEM

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This study examined the development of bacterial biofilms within a metropolitan distribution system. The distribution system is fed with different source water (i.e., groundwater, GW and surface water, SW) and undergoes different treatment processes in separate facilities. The b...

Spirometry and impulse oscillometry (IOS) for detection of respiratory abnormalities in metropolitan firefighters.

NARCIS (Netherlands)

Schermer, T.R.J.; Malbon, W.; Newbury, W.; Holton, C.; Smith, M.; Morgan, M.; Crockett, A.

2010-01-01

BACKGROUND AND OBJECTIVE: As firefighters are at increased risk of adverse health effects, periodic examination of their respiratory health is important. The objective of this study was to establish whether the use of impulse oscillometry (IOS) reveals respiratory abnormalities in metropolitan

78 FR 40146 - Patient Safety Organizations: Voluntary Relinquishment From Northern Metropolitan Patient Safety...

Science.gov (United States)

2013-07-03

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations: Voluntary Relinquishment From Northern Metropolitan Patient Safety Institute AGENCY: Agency for Healthcare Research and Quality (AHRQ), HHS. ACTION: Notice of Delisting. SUMMARY: The Patient Safety and...

Regeneration as an approach for the development of informal settlements in Cairo metropolitan

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Ghada Farouk Hassan

2012-09-01

Finally the paper ends by discussing the capability of the application of this approach in dealing with the informal settlements in Cairo metropolitan as proper approach to cope with the need of dealing effectively with those shadows in the urban context.

Geographically varying associations between personality and life satisfaction in the London metropolitan area

NARCIS (Netherlands)

Jokela, M.; Bleidorn, W.; Lamb, M.E.; Gosling, S.D.; Rentfrow, P.J.

2015-01-01

Residential location is thought to influence people’s well-being, but different individuals may value residential areas differently. We examined how life satisfaction and personality traits are geographically distributed within the UK London metropolitan area, and how the strength of associations

Local macroeconomic trends and hospital admissions for child abuse, 2000-2009.

Science.gov (United States)

Wood, Joanne N; Medina, Sheyla P; Feudtner, Chris; Luan, Xianqun; Localio, Russell; Fieldston, Evan S; Rubin, David M

2012-08-01

To examine the relationship between local macroeconomic indicators and physical abuse admission rates to pediatric hospitals over time. Retrospective study of children admitted to 38 hospitals in the Pediatric Hospital Information System database. Hospital data were linked to unemployment, mortgage delinquency, and foreclosure data for the associated metropolitan statistical areas. Primary outcomes were admission rates for (1) physical abuse in children <6 years old, (2) non-birth, non-motor vehicle crash-related traumatic brain injury (TBI) in infants <1 year old (which carry high risk for abuse), and (3) all-cause injuries. Poisson fixed-effects regression estimated trends in admission rates and associations between those rates and trends in unemployment, mortgage delinquency, and foreclosure. Between 2000 and 2009, rates of physical abuse and high-risk TBI admissions increased by 0.79% and 3.1% per year, respectively (P ≤ .02), whereas all-cause injury rates declined by 0.80% per year (P < .001). Abuse and high-risk TBI admission rates were associated with the current mortgage delinquency rate and with the change in delinquency and foreclosure rates from the previous year (P ≤ .03). Neither abuse nor high-risk TBI rates were associated with the current unemployment rate. The all-cause injury rate was negatively associated with unemployment, delinquency, and foreclosure rates (P ≤ .007). Multicenter hospital data show an increase in pediatric admissions for physical abuse and high-risk TBI during a time of declining all-cause injury rate. Abuse and high-risk TBI admission rates increased in relationship to local mortgage delinquency and foreclosure trends.

Land suitability for waste disposal in metropolitan areas.

Science.gov (United States)

Baiocchi, Valerio; Lelo, Keti; Polettini, Alessandra; Pomi, Raffaella

2014-08-01

Site selection for waste disposal is a complex task that should meet the requirements of communities and stakeholders. In this article, three decision support methods (Boolean logic, index overlay and fuzzy gamma) are used to perform land suitability analysis for landfill siting. The study was carried out in one of the biggest metropolitan regions of Italy, with the objective of locating suitable areas for waste disposal. Physical and socio-economic information criteria for site selection were decided by a multidisciplinary group of experts, according to state-of-the-art guidelines, national legislation and local normative on waste management. The geographic information systems (GIS) based models used in this study are easy to apply but require adequate selection of criteria and weights and a careful evaluation of the results. The methodology is arranged in three steps, reflecting the criteria defined by national legislation on waste management: definition of factors that exclude location of landfills or waste treatment plants; classification of the remaining areas in terms of suitability for landfilling; and evaluation of suitable sites in relation to preferential siting factors (such as the presence of quarries or dismissed plants). The results showed that more than 80% of the provincial territory falls within constraint areas and the remaining territory is suitable for waste disposal for 0.72% or 1.93%, according to the model. The larger and most suitable sites are located in peripheral areas of the metropolitan system. The proposed approach represents a low-cost and expeditious alternative to support the spatial decision-making process. © The Author(s) 2014.

South Platte Watershed from the Headwaters to the Denver Metropolitan Area (Colorado) Systems Thinking

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South Platte Watershed from the Headwaters to the Denver Metropolitan Area (Colorado) of the Urban Waters Federal Partnership (UWFP) reconnects urban communities with their waterways by improving coordination among federal agencies and collaborating

Washington DC Metropolitan Area Drug Study Household and Non-Household Populations (DC-MADSH-1991)

Data.gov (United States)

U.S. Department of Health & Human Services — The DC Metropolitan Area Drug Study (DCMADS) was conducted in 1991, and included special analyses of homeless and transient populations and of women delivering live...

Uudised : ERSO menu Rootsis. Õhtu Metropolitan Operas. NYYD Ensemble'i kontserdid / Madis Kolk

Index Scriptorium Estoniae

Kolk, Madis, 1953-

2001-01-01

ERSO kontserdireisist Rootsis. "Klassikaraadio" teeb 17. veebr. otseülekande New Yorgi Metropolitan Operast, kus tuleb ettekandele Rossini ooepr "Itaallanna Alzhiiris". NYYD Ensemble'i kontsertidest Pärnus ja Tallinnas kontserdisarjas "I Got Rhythm"

Relationships between golf range users’ participation motivation, satisfaction, and exercise adherence intention

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Kyoung-Ran Shim

2017-05-01

Full Text Available Purpose - This paper aims to identify the relationship between participation motivation, satisfaction and exercise adherence intention of golf range users on the basis of self-determination theory. Design/methodology/approach - For this purpose, the authors proposed research questions and a conceptual research model as well. Then, the authors surveyed users of golf ranges located in Seoul Metropolitan City and Gyeonggi-do province. Findings - By applying convenience sampling, the authors received a total of 313 questionnaires. Results were as follows. First, among the participation motivation sub-factors, health-oriented motivation, achievement motivation, pleasure-oriented motivation and self-displayed motivation had a significant effect on emotional satisfaction, while achievement motivation and pleasure-orientation motivation had a significant effect on performance satisfaction. Second, the following participation motivation factors had a significant effect on exercise adherence intention: health-orientation motivation, achievement motivation and pleasure-orientation motivation. Third, among the satisfaction factors, emotional satisfaction and performance satisfaction both had a significant effect on exercise adherence intention. Originality/value - This is one of the first papers to examine the relationships that exist between golf range users’ participation motivation, satisfaction and exercise adherence intention.

Premier Hospital Historical Data

Data.gov (United States)

U.S. Department of Health & Human Services — To provide a historical overview of the participating hospitals, before the first project report, Premier Healthcare Informatics has used data already available for...

A Partial Proportional Odds Model for Pedestrian Crashes at Mid-Blocks in Melbourne Metropolitan Area

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Toran Pour Alireza

2016-01-01

Full Text Available Pedestrian crashes account for 11% of all reported traffic crashes in Melbourne metropolitan area between 2004 and 2013. There are very limited studies on pedestrian accidents at mid-blocks. Mid-block crashes account for about 46% of the total pedestrian crashes in Melbourne metropolitan area. Meanwhile, about 50% of all pedestrian fatalities occur at mid-blocks. In this research, Partial Proportional Odds (PPO model is applied to examine vehicle-pedestrian crash severity at mid-blocks in Melbourne metropolitan area. The PPO model is a logistic regression model that allows the covariates that meet the proportional odds assumption to affect different crash severity levels with the same magnitude; whereas the covariates that do not meet the proportional odds assumption can have different effects on different severity levels. In this research vehicle-pedestrian crashes at mid-blocks are analysed for first time. In addition, some factors such as distance of crashes to public transport stops, average road slope and some social characteristics are considered to develop the model in this research for first time. Results of PPO model show that speed limit, light condition, pedestrian age and gender, and vehicle type are the most significant factors that influence vehicle-pedestrian crash severity at mid-blocks.

Appropriate Urban Livability Indicators for Metropolitan Johor, Malaysia via Expert-Stakeholder Approach: a Delphi technique

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Dario Gallares Pampanga

2015-11-01

Full Text Available Metro Johor is one of the fast emerging metropolitan urban centers where its current progress and spatial transformation have made it a key player in the economic growth of Malaysia. The recent creation of the Iskandar Malaysia, an economic strategy which aims to be a global player as potential destination for high-value investments, has certainly added social, environmental and economic stress to its urban citizens. This paper intends to develop urban livability indicators for Metropolitan Johor anchored on the changing urban complexion in the face of climate change, economic, governance, social and cultural dynamics, among others. The urban livability conundrum of Metro Johor illustrates that indicators are imperative, especially policy-based indicators, which would aid to scale-up the desired progress according to urban livability metrics. The study involves iterative 3-rounds of Delphi blind survey with Likert scale’s degree of agreement, and finally assigning weightings to each sub-indicator. Thus, with the expert-stakeholders involvement, constituting broad-sectoral community representation, a robust and appropriate urban livability index for Metro Johor was generated - a comprehensive framework yet prospective benchmark in appropriating timely policy decisions that would redound to the benefit of urban citizens ensuring a livable Metropolitan Johor.

Strauss, R.: Symphony in F minor, Op. 12... Tokyo Metropolitan Symphony Orchestra / David Nice

Index Scriptorium Estoniae

Nice, David

1994-01-01

Uuest heliplaadist "Strauss, R.: Symphony in F minor, Op. 12... Tokyo Metropolitan Symphony Orchestra / Hiroshi Wakasugi. Denon CD CO-75 860 (54 minutes); Symphony - comparative version: SNO, Järvi" (8/93)(CHAN) CHAN 9166

Legitimacy of hospital reconfiguration: the controversial downsizing of Kidderminster hospital.

Science.gov (United States)

Oborn, Eivor

2008-04-01

This paper examines the contested organizational legitimacy of hospital reconfiguration, which continues to be a central issue in health care management. A qualitative study which focuses on the controversial downsizing of Kidderminster Hospital, a highly publicized landmark case of district general hospital closure. Rhetorical strategies are analysed to examine how legitimacy was constructed by stakeholder groups and how these strategies were used to support or resist change. Stakeholders promoting change legitimized re-organization pragmatically and morally arguing the need for centralization as a rational necessity. Stakeholders resisting change argued for cognitive and moral legitimacy in current service arrangements, contrasting local versus regionalized aspects of safety and provision. Groups managed to talk past each other, failing to establish a dialogue, which led to significant conflict and political upheaval. Stakeholders value hospitals in different ways and argue for diverse accounts of legitimacy. Broader discourses of medical science and democratic participation were drawn into rhetorical texts concerning regionalization to render them more powerful.

Dynamics of Metropolitan Landscapes and Daily Mobility Flows in the Italian Context. An Analysis Based on the Theory of Graphs

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Amedeo Ganciu

2018-02-01

Full Text Available The distribution of services across a territory generates daily commuting flows, which have a significant influence on the development of the territory and often causes congestion in large areas. This negatively affects the environmental, economic and social components of the metropolitan landscape. Using the graph theory, we constructed and analyzed various (in typologies of transportation and moving time flow networks in the two main Italian metropolitan areas: Rome (MCR and Milan (MCM. The analysis of these networks provided us with strategic information on the dynamics of the two urban macro-systems. In particular, the aim of our study was to: (i identify the characteristics, distribution and direction of the main attractive forces within the regional systems under study; (ii identify the main differences in size and structure of commuter networks between the two metropolitan areas and between the two regional systems that include the two mother cities; and, (iii identify the main differences in the size and structure of the two commuting networks by transport modes (private, public, non-motorized mobility and the travel time. The results highlighted significant differences between the two case studies regarding volume flows, complexity and structure networks, and the spatial extension of the territories that are governed by the two metropolitan areas. MCR is a strongly monocentric urban system with a regional influence centred on the mother city of Rome, while MCM is a diffused polycentric regional metropolitan system centred on multiple mother cities. The findings many have a role in urban planning choices and in the evaluation of policies aimed to favor sustainable mobility.

PAD TECHNIQUE ON DEFORESTATION SITUATION ON PETROPOLIS’ METROPOLITAN AREA - RJ

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Amanda Santos de Alencar

2015-12-01

Full Text Available With the rising and intensification of production’s activities, as industries, the deforestation taxes show to be on an alarming level. It is wide spread known the consequences that deforestation might cause in metropolitan areas. In order to evalue the consequences of this growing phenomenon, is possible to use a role of ambiental impacts evaluations techniques. One of them is the Preliminary Analysis of Danger (PAD, which is based on qualitative and statistics analysis and might be used in association with other ambiental impacts evaluations techniques. It’s goal is to analyze dangers in potential, it’s causes and consequences, in which is also done an associated risk analysis, which the last is the association between the classifications of frequency and severity, and, in the end, it gives suggestions of measures to avoid these dangers (undesired events. In this study, six dangers have been identified, in which none of them present despicable or low risk (0%, 16% present medium or high risk and 66% present critic risk. These datas point out that the deforestation situation might cause dangers with great consequences to Petropolis’ metropolitan area, just as floodings and earth slidings, which higthlights the urgency of management of the area. DOI: http://dx.doi.org/10.12957/sustinere.2015.20003

Prevalence and risk factors of childhood allergic diseases in eight metropolitan cities in China: A multicenter study

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Jin Xingming

2011-06-01

Full Text Available Abstract Background Several studies conducted during the past two decades suggested increasing trend of childhood allergic diseases in China. However, few studies have provided detailed description of geographic variation and explored risk factors of these diseases. This study investigated the pattern and risk factors of asthma, allergic rhinitis and eczema in eight metropolitan cities in China. Methods We conducted a cross-sectional survey during November-December 2005 in eight metropolitan cities in China. A total of 23791 children aged 6-13 years participated in this survey. Questions from the standard questionnaire of the International Study of Asthma and Allergies in Children (ISAAC were used to examine the pattern of current asthma, allergic rhinitis and eczema. Logistic regression analyses were performed to assess the risk factors for childhood allergies. Results The average prevalence of childhood asthma, allergic rhinitis and eczema across the eight cities was 3∙3% (95% Confidence interval (CI: 3∙1%, 3∙6%, 9∙8% (95% CI: 9∙4%, 10∙2% and 5∙5% (95% CI: 5∙2%, 5∙8%, respectively. Factors related to lifestyle, mental health and socio-economic status were found to be associated with the prevalence of childhood allergies. These risk factors were unevenly distributed across cities and disproportionately affected the local prevalence. Conclusions There was apparent geographic variation of childhood allergies in China. Socio-environmental factors had strong impacts on the prevalence of childhood allergies; but these impacts differed across regions. Thus public health policies should specifically target at the local risk factors for each individual area.

Working paper : national costs of the metropolitan ITS infrastructure : updated with 2004 deployment data

Science.gov (United States)

The purpose of this report, "Working Paper National Costs of the Metropolitan ITS infrastructure: Updated with 2004 Deployment Data," is to update the estimates of the costs remaining to deploy Intelligent Transportation Systems (ITS) infrastructure ...

Diabetes and risk of hospitalized fall injury among older adults.

Science.gov (United States)

Yau, Rebecca K; Strotmeyer, Elsa S; Resnick, Helaine E; Sellmeyer, Deborah E; Feingold, Kenneth R; Cauley, Jane A; Vittinghoff, Eric; De Rekeneire, Nathalie; Harris, Tamara B; Nevitt, Michael C; Cummings, Steven R; Shorr, Ronald I; Schwartz, Ann V

2013-12-01

To determine whether older adults with diabetes are at increased risk of an injurious fall requiring hospitalization. The longitudinal Health, Aging, and Body Composition Study included 3,075 adults aged 70-79 years at baseline. Hospitalizations that included ICD-9-Clinical Modification codes for a fall and an injury were identified. The effect of diabetes with and without insulin use on the rate of first fall-related injury hospitalization was assessed using proportional hazards models. At baseline, 719 participants had diabetes, and 117 of them were using insulin. Of the 293 participants who were hospitalized for a fall-related injury, 71 had diabetes, and 16 were using insulin. Diabetes was associated with a higher rate of injurious fall requiring hospitalization (hazard ratio [HR] 1.48 [95% CI 1.12-1.95]) in models adjusted for age, race, sex, BMI, and education. In those participants using insulin, compared with participants without diabetes, the HR was 3.00 (1.78-5.07). Additional adjustment for potential intermediaries, such as fainting in the past year, standing balance score, cystatin C level, and number of prescription medications, accounted for some of the increased risk associated with diabetes (1.41 [1.05-1.88]) and insulin-treated diabetes (2.24 [1.24-4.03]). Among participants with diabetes, a history of falling, poor standing balance score, and A1C level ≥8% were risk factors for an injurious fall requiring hospitalization. Older adults with diabetes, in particular those using insulin, are at greater risk of an injurious fall requiring hospitalization than those without diabetes. Among those with diabetes, poor glycemic control may increase the risk of an injurious fall.

Dreptul la oraș – generația a IV-a de drepturi ale omului metropolitan (The Right to city – the IVth generation of rights for the metropolitan man

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Mădălina Virginia ANTONESCU

2016-03-01

Full Text Available The right to city begins to be recently consecrated by academic research, presenting several links with the “sustainable development” paradigm. UN documents see our contemporary world as an “urban global world”, confronted with issues as chronic poverty, lack of access to basic urban services, insufficient democratic participation to main decisions regarding the urban management. This new right can be regarded as derived from solidarity rights as the right to a healthy, clean, durable environment, as well as the right to continuous improvement of life quality, but also, it can be seen as a special, distinct kind of human right. Right to have clean, sustainable cities can be recognized, at national, regional, international levels, to individuals, to local groups (as the metropolitan inhabitants of one city or to nations (having at their disposal a collective new right to own prosperous, sustainable cities, as effect of their right to economic development. We consider the right to city as being a dynamic right, in full process of exploration and consecration within academic research, more than necessary for understanding an urban globalized world characterized by proliferation of metropolises, towns, cities, megalopolises that demand new juridical approaches.

First epidemiological report of feline heartworm infection in the Barcelona metropolitan area (Spain).

Science.gov (United States)

Montoya-Alonso, José Alberto; Carretón, Elena; García-Guasch, Laín; Expósito, Jordi; Armario, Belén; Morchón, Rodrigo; Simón, Fernando

2014-11-12

The metropolitan area of Barcelona is the most densely populated metropolitan area on the Mediterranean coast. Several studies have reported the presence of canine heartworm disease in this region; however, there are no published epidemiological data regarding feline heartworm in this region and the prevalence in this species remains unknown. Serum samples from 758 cats living in the metropolitan area of Barcelona (Spain) were collected between 2012 and 2013. To establish the seroprevalence of heartworm infection in cats, serological techniques for anti-D.immitis and anti-Wolbachia antibody detection were used while a commercial ELISA test kit was used to detect circulating D.immitis antigens. Of these samples, 11.47% were positive to D.immitis and Wolbachia surface protein antibodies and 0.26% were positive to D.immitis antigens. The higher antibody seroprevalences were found in the areas that follow the courses of the rivers Llobregat and Anoia (Baix Llobregat 11.5%, Vallés Occidental 13.2%; Barcelonés 11.7%) where humidity and vegetation favour the development of the mosquito vectors. High antibody seroprevalences were also found in the urban areas (Barcelona city 13.1%; Sabadell 15.5%), which demonstrates that city cats are also at risk from D.immitis infection. Generally, in Spain cats do not receive prophylactic treatment and therefore the risk of infection is higher in this species than in dogs. Adequate prophylactic plans should be implemented in the feline population. This is the first epidemiologic study on feline heartworm infection to be carried out in continental Spain.

Comparison of burnout pattern between hospital physicians and family physicians working in Suez Canal University Hospitals.

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Kotb, Amany Ali; Mohamed, Khalid Abd-Elmoez; Kamel, Mohammed Hbany; Ismail, Mosleh Abdul Rahman; Abdulmajeed, Abdulmajeed Ahmed

2014-01-01

The burnout syndrome is characterized by emotional exhaustion, depersonalization, and low personal accomplishment. It is associated with impaired job performance. This descriptive study examined 171 physicians for the presence of burnout and its related risk factors. The evaluation of burnout was through Maslach Burnout Inventory (MBI). The participant was considered to meet the study criteria for burnout if he or she got a "high" score on at least 2 of the three dimensions of MBI. In the current study, the prevalence of burnout in hospital physicians (53.9%) was significantly higher than family physicians (41.94%) with (p=0.001). Participants who work in the internal medicine department scored the highest prevalence (69.64%) followed by Surgeons (56.50%) and Emergency doctors (39.39%). On the other hand, Pediatricians got the lowest prevalence (18.75%). Working in the teaching hospital and being married are strong predictors for occurrence of burnout. There is a significant difference of burnout between hospital physicians and family physicians among the study subjects. Working in the teaching hospital and being married are strong predictors for occurrence of burnout.

Hospital culture--why create one?

Science.gov (United States)

Sovie, M D

1993-01-01

Hospitals, to survive, must be transformed into responsive, participative organizations capable of new practices that produce improved results in both quality of care and service at reduced costs. Creating, managing, and changing the culture are critical leadership functions that will enable the hospital to succeed. Strategic planning and effective implementation of planned change will produce the desired culture. Work restructuring, a focus on quality management along with changes in clinical practices, as well as the care and support processes, are all a part of the necessary hospital cultural revolution.

The Audiometric Findings among Curitiba and Metropolitan Area Students

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Klas, Regina

2014-02-01

Full Text Available Introduction Hearing loss can compromise the language, learning process, and socialization of students. Objective Study the audiometric findings among Curitiba and Metropolitan Area students. Methods Analysis of data collected at the hearing health service of Paraná State special education and inclusion department. Results The sample consisted of 646 students, children and teenagers of both genders (38.2% female and 61.8% male, with average age of 8.12 years (range 2 to 15; all were students of public or private schools of Curitiba and Metropolitan Area. The justifications to refer the students to audiometric evaluation were: otolaryngologists diagnosis (73.1%, school difficulties (39.6%, and midlevel hearing problems (32%. Audiometric results showed that 29.5% of the students had hearing loss. Conductive hearing losses showed the greatest occurrence among preschool students (right ear 38.6%, left ear 39.8%. The predominant hearing loss degree was mild (RE 20.5%, LE 19.3% to slight (RE 17%, LE 19.3%, as was the horizontal configuration (RE 81.5%, LE 78.4%. A significant relationship (p = 0.0000 between hearing loss and poor school performance was noted. Conclusion Considering the available data, especially the high number of findings of conductive losses, it is necessary to highlight prevention and diagnosis of early hearing alteration. Nevertheless, Brazil, as an emerging country, has been pursuing improvement in health and life quality of all citizens.

Knowledge and Attitude of Hospital Personnel Regarding Medical Waste Management

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Amouei A.1 PhD,

2015-06-01

Full Text Available Aims Considering the importance of medical waste recognition by health centers staffs and its role on maintenance and improvement of social and environmental health, this study aimed to evaluate the knowledge, attitude and practices of hospital staffs regarding to medical waste management. Instrument & Methods The current descriptive, analytical and cross-sectional research was carried out on the staffs of the Ayatollah Rohani Hospital of Babol City, Iran, in 2013. 130 employees were selected by stratified sampling method. A researcher-made questionnaire (accessible as an attachment containing 4 parts of demographic information, knowledge (15 questions, attitude (6 questions and practices (6 questions was used for data gathering. The data was analyzed by SPSS 17 software using Kruskal Wallis and Mann-Whitney tests. Findings The participants mean scores of knowledge, attitude, and practice were 10.7±1.6 (out of 15, 5.5±0.8 (out of 6, and 4.5±1.5 (out of 6, respectively. 12% (16 people of the participants had low, 72% (93 people of the participants had medium, and 16% (21 people of them had high knowledge toward hospital waste management. 16% (21 people of the participants had medium and 84% (109 people of them had high attitude toward hospital waste management. 4% (5 people, 46% (60 people and 50% (65 people of the participants had low, medium and high practice, respectively. Conclusion The level of knowledge, attitude and practice of the Ayatollah Rohani Hospital of Babol City, Iran, regarding hospital waste management is acceptable.

Municipal Revenue Generation and Development in the Calgary and Edmonton Metropolitan Regions

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Brian W. Conger

2016-12-01

Full Text Available Municipal reliance on property taxes and the competing priorities of municipalities—in terms of where they plan and approve land development within their boundaries—in order to capture new property taxes, has led to political conflict between adjacent municipalities.1 Nowhere in Alberta is this more evident than in the Edmonton and Calgary metropolitan regions, where sustained high-levels of growth has led to the expansion of the core-cities, rapid residential development rates in peripheral urban centres and the rise urban-scale development in the rural municipal districts – spurring intrametropolitan competition, harsh words and hurt feelings amongst municipalities.2 In response to this ongoing conflict, the province and at times the municipalities themselves have developed successive regional planning frameworks over the past 60 years3 to guide development and encourage—and at times enforce—intermunicipal collaboration. In an exploration of the contemporary relationship between municipal finance and development patterns in the Calgary and Edmonton metropolitan regions, we use municipal property tax and building-permit data for new residential, commercial and industrial development to track the incidence of development since 1983 and the property tax rates for municipalities in both regions from 2001 to 2015. In looking at the tax data there is evidence of increasing competition among municipalities, in particular for non-residential development; however, the trends could also be consistent with collusion. In looking at the building permit data, although there has been a lot of development in the peripheral urban and rural municipalities, proportionately, growth and development has occurred overwhelmingly in the core-cities. Our findings point to a system where local development considerations in both metropolitan regions, and the municipal prerogative to set municipal tax rates to attract development, take precedence over the

Vital prognosis after hospitalization for COPD

DEFF Research Database (Denmark)

Vestbo, J; Prescott, E; Lange, P

1998-01-01

STUDY AIM: To examine survival after admission due to chronic obstructive pulmonary disease (COPD) in a population sample over a time span of 15 years. DESIGN: Linkage between a prospective population cohort and register information on hospitalization and mortality. SETTING: The Copenhagen City...... Heart Study (CCHS). PARTICIPANTS: A total of 267 men and 220 women who had participated in the CCHS and who were hospitalized with a discharge diagnosis of COPD (ICD-8 491-2). MAIN RESULTS: The crude 5-yr survival rate after a COPD admission was 45% (37% for men and 52% for women). Mortality risk...... associated with prognosis. Survival after admission due to COPD did not change significantly over time. CONCLUSION: Compared to previous studies of COPD patients, the present study indicates that prognosis after hospital admission remains virtually unchanged over the last decades. FEV1 is still the strongest...

Dietary intake, nutritional status and rehabilitation outcomes of stroke patients in hospital.

Science.gov (United States)

Nip, W F R; Perry, L; McLaren, S; Mackenzie, A

2011-10-01

Nutrition affects rehabilitation through its influence on physical and mental functioning, although little attention has been paid to effects on rehabilitation outcomes. The present study aimed to describe nutritional status and food consumption in stroke patients within 2 weeks of hospital admission and before discharge, as well as to investigate the effects of nutritional and dietary factors on rehabilitation outcomes. One hundred patients from a consecutive cohort admitted to a metropolitan hospital with acute stroke were recruited and assessed by a single researcher, with 38 reassessed at discharge. Nutritional status was assessed using Mini-Nutritional Assessment and anthropometric indices and dietary intake was assessed by 1-day weighed dietary records. Rehabilitation outcomes were changes in Barthel index scores and the rehabilitation efficiency index. Few (n = 9; 10%) consumed ≥100% of the estimated average requirement (EAR) for energy within 2 weeks of admission and 13 (33%) had energy intakes stroke patients to improve rehabilitation outcomes. © 2011 The Authors. Journal of Human Nutrition and Dietetics © 2011 The British Dietetic Association Ltd.

Population deconcentration in metropolitan Manila in the twentieth century.

Science.gov (United States)

Stinner, W F; Bacol-montilla, M

1981-10-01

"The present analysis is intended to delineate the extent of population deconcentration through an examination of changes in core-periphery growth and density patterns within the Metropolitan Manila complex. Specifically, [the authors] examine changes in absolute and relative population growth and density levels in the central city of Manila, the inner suburban ring, and the outer suburban ring from 1903 to 1975. [The authors] also present a preliminary assessment of the demographic processes underlying the post-World War II trends." Data are from the 1975 Philippine census. excerpt

Spatiotemporal Analysis of Human Mobility in Manila Metropolitan Area with Person-Trip Data

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Kai Liu

2018-01-01

Full Text Available The metropolitan area can be regarded as a multi-functional structure consisting of plural coordinated urban nucleuses. This study aims to clarify the characteristics of urban nucleuses and a spatiotemporal pattern of human mobility in the Manila metropolitan area. Hourly density of human mobility from 00:00 to 24:00 in the whole study area is quantitatively studied. Urban nucleuses with six types: central city, business city, commuter town, south suburb, north suburb, and subcenter city, are identified. Differences of human mobility owing to different human behaviors or properties are also analyzed in 10 typical areas with different urban functions. Results prove that pattern of human mobility in each area depends on its human social division, population composition, infrastructure condition, and functional structure. This study provides an effective thinking on handling geo-tagged big data supported by MATLAB programming and GIS technology. Moreover, spatiotemporal analysis of human mobility also possesses a meaningful academic value for transport geography.

Working Together to Connect Care: a metropolitan tertiary emergency department and community care program.

Science.gov (United States)

Harcourt, Debra; McDonald, Clancy; Cartlidge-Gann, Leonie; Burke, John

2017-03-02

small compared with non-frequent users, the presentations are high. People in the frequent attendee group will often seek care from multiple EDs for, in the main, mental health issues and substance abuse. Furthermore, frequent ED users are vulnerable and experience higher mortality, hospital admissions and out-patient visits than non-frequent users. Aggressive and assertive outreach, intense coordination of services by integrated care teams, and the need for non-medical resources, such as supportive housing, have positive outcomes for this group of people. What does this paper add? This study uses international research findings in an Australian setting to provide a testing of the generalisability of an assertive and collaborative ED and community case management approach for supporting people who frequent a metropolitan ED. What are the implications for practitioners? The chronicling of a process undertaken to affect change in a health care setting supports practitioners when developing processes for this cohort across different ED contexts.

Behavioral Risk Factors: Selected Metropolitan Area Risk Trends (SMART) County Prevalence Data (2010 and prior)

Data.gov (United States)

U.S. Department of Health & Human Services — 2002-2010. BRFSS SMART County Prevalence land line only data. The Selected Metropolitan Area Risk Trends (SMART) project uses the Behavioral Risk Factor Surveillance...

Behavioral Risk Factors: Selected Metropolitan Area Risk Trends (SMART) MMSA Prevalence Data (2010 and Prior)

Data.gov (United States)

U.S. Department of Health & Human Services — 2002-2010. BRFSS SMART MMSA Prevalence land line only data. The Selected Metropolitan Area Risk Trends (SMART) project uses the Behavioral Risk Factor Surveillance...

More care out of hospital? A qualitative exploration of the factors influencing the development of the district nursing workforce in England.

Science.gov (United States)

Drennan, Vari M

2018-01-01

Objectives Many countries seek to improve care for people with chronic conditions and increase delivery of care outside of hospitals, including in the home. Despite these policy objectives in the United Kingdom, the home visiting nursing service workforce, known as district nursing, is declining. This study aimed to investigate the factors influencing the development of district nursing workforces in a metropolitan area of England. Methods A qualitative study in a metropolitan area of three million residents in diverse socio-economic communities using semi-structured interviews with a purposive sample of senior nurses in provider and commissioning organizations. Thematic analysis was framed by theories of workforce development. All participants reported that the context for the district nursing service was one of major reorganizations in the face of wider National Health Service changes and financial pressures. The analysis identified five themes that can be seen to impact the ways in which the district nursing workforce was developed. These were: the challenge of recruitment and retention, a changing case-mix of patients and the requirement for different clinical skills, the growth of specialist home visiting nursing services and its impact on generalist nursing, the capacity of the district nursing service to meet growing demand, and the influence of the short-term service commissioning process on the need for long-term workforce development. Conclusion There is an apparent paradox between health policies which promote more care within and closer to home and the reported decline in district nursing services. Using the lens of workforce development theory, an explanatory framework was offered with factors such as the nature of the nursing labour market, human resource practices, career advancement opportunities as well as the contractual context and the economic environment.

42 CFR 482.98 - Condition of participation: Human resources.

Science.gov (United States)

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Condition of participation: Human resources. 482.98 Section 482.98 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Specialty Hospitals Transplant Center Process Requirements § 482.98 Condition of participation: Human...

Clinical audit on documentation of anticipatory "Not for Resuscitation" orders in a tertiary australian teaching hospital

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Naveen Sulakshan Salins

2011-01-01

Full Text Available Aim: The purpose of this clinical audit was to determine how accurately documentation of anticipatory Not for Resuscitation (NFR orders takes place in a major metropolitan teaching hospital of Australia. Materials and Methods: Retrospective hospital-based study. Independent case reviewers using a questionnaire designed to study NFR documentation reviewed documentation of NFR in 88 case records. Results: Prognosis was documented in only 40% of cases and palliative care was offered to two-third of patients with documented NFR. There was no documentation of the cardiopulmonary resuscitation (CPR process or outcomes of CPR in most of the cases. Only in less than 50% of cases studied there was documented evidence to suggest that the reason for NFR documentation was consistent with patient′s choices. Conclusion: Good discussion, unambiguous documentation and clinical supervision of NFR order ensure dignified and quality care to the dying.

Trends in hospital cost and revenue, 1994-2005: how are they related to HMO penetration, concentration, and for-profit ownership?

Science.gov (United States)

Shen, Yu-Chu; Wu, Vivian Y; Melnick, Glenn

2010-02-01

Analyze trends in hospital cost and revenue, as well as price and quantity (1994-2005) as a function of health maintenance organization (HMO) penetration, HMO concentration, and for-profit (FP) HMO market share. Medicare hospital cost reports, AHA Annual Surveys, HMO data from Interstudy, and other supplemental data. A retrospective study of all short-term, general, nonfederal hospitals in metropolitan statistical areas (MSAs) in the United States from 1994 to 2005, using hospital/MSA fixed-effects translog regression models. A 10 percentage point increase in HMO enrollment is associated with 4.1-4.2 percent reduction in costs and revenues in the pre-2000 period but only a 2.1-2.5 percent reduction in the post-2000 period. Hospital revenue in HMO-dominant markets (highly concentrated HMO market and competitive hospital market) is 19-27 percent lower than other types of markets, and the difference is most likely due mainly to lower prices and to a lesser extent lower utilization. The historical difference of lower spending in high HMO penetration markets compared with low HMO markets narrowed after 2000 and the relative concentration between HMO and hospital markets can substantially influence hospital spending. Additional research is needed to understand how different aspects of these two markets have changed and interacted and how they are causally linked to spending trends.

Brucellosis among Hospitalized Febrile Patients in Northern Tanzania

Science.gov (United States)

Bouley, Andrew J.; Biggs, Holly M.; Stoddard, Robyn A.; Morrissey, Anne B.; Bartlett, John A.; Afwamba, Isaac A.; Maro, Venance P.; Kinabo, Grace D.; Saganda, Wilbrod; Cleaveland, Sarah; Crump, John A.

2012-01-01

Acute and convalescent serum samples were collected from febrile inpatients identified at two hospitals in Moshi, Tanzania. Confirmed brucellosis was defined as a positive blood culture or a ≥ 4-fold increase in microagglutination test titer, and probable brucellosis was defined as a single reciprocal titer ≥ 160. Among 870 participants enrolled in the study, 455 (52.3%) had paired sera available. Of these, 16 (3.5%) met criteria for confirmed brucellosis. Of 830 participants with ≥ 1 serum sample, 4 (0.5%) met criteria for probable brucellosis. Brucellosis was associated with increased median age (P = 0.024), leukopenia (odds ratio [OR] 7.8, P = 0.005), thrombocytopenia (OR 3.9, P = 0.018), and evidence of other zoonoses (OR 3.2, P = 0.026). Brucellosis was never diagnosed clinically, and although all participants with brucellosis received antibacterials or antimalarials in the hospital, no participant received standard brucellosis treatment. Brucellosis is an underdiagnosed and untreated cause of febrile disease among hospitalized adult and pediatric patients in northern Tanzania. PMID:23091197

Implementation challenges in delivering team-based care ('TEAMcare') for patients with chronic obstructive pulmonary disease in a public hospital setting: a mixed methods approach.

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Cochrane, Belinda; Foster, Jann; Boyd, Robert; Atlantis, Evan

2016-08-03

Chronic obstructive pulmonary disease (COPD) is considered a multisystem disease, in which comorbidities feature prominently. COPD guidelines recommend holistic assessment and management of relevant comorbid diseases but there is limited information as to how this is best achieved. This pilot study aimed to explore the views of stakeholders, including patients and the healthcare team, on the feasibility, acceptability and barriers to a collaborative, multidisciplinary team-based care intervention ('TEAMcare') to improve health outcomes in COPD patients, within the context of a local hospital outpatient clinic. A mixed methods study design was used. A COPD care algorithm was developed based on the Australasian guidelines, COPDX. COPD participants were consecutively recruited from an outer metropolitan hospital's respiratory clinic. Participants attended for follow up visits at 5 and 10 months to ascertain clinical status, algorithm compliance and to review and revise management recommendations. The intervention was conducted using existing resources, involving collaboration with general practice and the publicly-funded local chronic disease management programme (Medicare Local). Stakeholders provided qualitative feedback about the intervention in terms of feasibility, acceptability and barriers via structured and semi-structured interviews. All interviews were recorded, transcribed verbatim and analysed using qualitative thematic analysis to identify key concepts and themes. The study protocol was abandoned prematurely due to clear lack of feasibility. Of 12 participants, 4 withdrew and none completed pulmonary rehabilitation (PR). The main reasons for non-participation or study withdrawal related to reluctance to attend PR (6 of 16) and the burden of increased appointments (4 of 16). PR conflicted with employment hours, which presented problems for some participants. Similarly, themes that emerged from qualitative data indicate healthcare provider perception of

Pediatric Neglected Tropical Diseases in a Major Metropolitan Children's Hospital in the United States, 2004-2013.

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Sweet, Leigh R; Palazzi, Debra L

2016-12-01

We conducted a retrospective study of neglected tropical diseases (NTDs) diagnosed at Texas Children's Hospital between 2004 and 2013. Forty-three patients with an NTD were identified; 47% had never traveled outside of the United States. The results of this study highlight the importance of physician awareness of NTDs in children in the United States. © The Author 2015. Published by Oxford University Press on behalf of the Pediatric Infectious Diseases Society. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Behavioral Risk Factors: Selected Metropolitan Area Risk Trends (SMART) County Prevalence Data (2011 to 2012)

Data.gov (United States)

U.S. Department of Health & Human Services — 2011 to 2012. BRFSS SMART County Prevalence combined land line and cell phone data. The Selected Metropolitan Area Risk Trends (SMART) project uses the Behavioral...

Behavioral Risk Factors: Selected Metropolitan Area Risk Trends (SMART) MMSA Prevalence Data (2011 to Present)

Data.gov (United States)