WorldWideScience

Sample records for metropolitan hospital participants

  1. Skinner boxes for psychotics: Operant conditioning at Metropolitan state hospital

    OpenAIRE

    Rutherford, Alexandra

    2003-01-01

    Between 1953 and 1965, Ogden Lindsley and his associates conducted free-operant research with psychiatric inpatients and normal volunteers at Metropolitan State Hospital in Waltham, Massachusetts. Their project, originally named “Studies in Behavior Therapy,” was renamed “Harvard Medical School Behavior Research Laboratory” in 1955. This name change and its implications were significant. The role of the laboratory in the history of the relationship between the experimental analysis of behavio...

  2. Skinner boxes for psychotics: operant conditioning at Metropolitan State Hospital.

    Science.gov (United States)

    Rutherford, Alexandra

    2003-01-01

    Between 1953 and 1965, Ogden Lindsley and his associates conducted free-operant research with psychiatric inpatients and normal volunteers at Metropolitan State Hospital in Waltham, Massachusetts. Their project, originally named "Studies in Behavior Therapy," was renamed "Harvard Medical School Behavior Research Laboratory" in 1955. This name change and its implications were significant. The role of the laboratory in the history of the relationship between the experimental analysis of behavior and applied behavior analysis is discussed. A case is made for viewing Lindsley's early work as foundational for the subfield of the experimental analysis of human behavior that formally coalesced in the early 1980s. The laboratory's work is also contextualized with reference to the psychopharmacological revolution of the 1950s. Finally, a four-stage framework for studying the historical and conceptual development of behavior analysis is proposed.

  3. Prevention of hospital-onset Clostridium difficile infection in the New York metropolitan region using a collaborative intervention model.

    Science.gov (United States)

    Koll, Brian S; Ruiz, Rafael E; Calfee, David P; Jalon, Hillary S; Stricof, Rachel L; Adams, Audrey; Smith, Barbara A; Shin, Gina; Gase, Kathleen; Woods, Maria K; Sirtalan, Ismail

    2014-01-01

    The incidence, severity, and associated costs of Clostridium difficile (C. difficile) infection (CDI) have dramatically increased in hospitals over the past decade, indicating an urgent need for strategies to prevent transmission of C. difficile. This article describes a multifaceted collaborative approach to reduce hospital-onset CDI rates in 35 acute care hospitals in the New York metropolitan region. Hospitals participated in a comprehensive CDI reduction intervention and formed interdisciplinary teams to coordinate their efforts. Standardized clinical infection prevention and environmental cleaning protocols were implemented and monitored using checklists. Monthly data reports were provided to hospitals for facility-specific performance evaluation and comparison to aggregate data from all participants. Hospitals also participated in monthly teleconferences to review data and highlight successes, challenges, and strategies to reduce CDI. Incidence of hospital-onset CDI per 10,000 patient days was the primary outcome measure. Additionally, the incidence of nonhospital-associated, community-onset, hospital-associated, and recurrent CDIs were measured. The use of a collaborative model to implement a multifaceted infection prevention strategy was temporally associated with a significant reduction in hospital-onset CDI rates in participating New York metropolitan regional hospitals. © 2013 National Association for Healthcare Quality.

  4. Night shift fatigue among anaesthesia trainees at a major metropolitan teaching hospital.

    Science.gov (United States)

    Lancman, B M

    2016-05-01

    Night shifts expose anaesthesia trainees to the risk of fatigue and, potentially, fatigue-related performance impairment. This study examined the workload, fatigue and coping strategies of anaesthesia trainees during night shifts. A blinded survey-based study was undertaken at a major single centre metropolitan teaching hospital in Australia. All ten anaesthesia trainees who worked night shifts participated. The survey collected data on duration of night shifts, workload, and sleep patterns. Fatigue was assessed using the Karolinska Sleepiness Scale (KSS). There were 93 night shifts generating data out of a potential 165. Trainees tended to sleep an increasing amount before their shift as the nights progressed from 1 to 5. Night 1 was identified as an 'at risk' night due to the amount of time spent awake before arriving at work (32% awake for U+003E8 hours); on all other nights trainees were most likely to have slept 6-8 hours. The KSS demonstrated an increase in sleepiness of 3 to 4 points on the scale from commencement to conclusion of a night shift. The Night 1 conclusion sleepiness was markedly worse than any other night with 42% falling into an 'at-risk' category. The findings demonstrate fatigue and inadequate sleep in anaesthesia trainees during night shifts in a major metropolitan teaching hospital. The data obtained may help administrators prepare safer rosters, and junior staff develop improved strategies to reduce the likelihood of fatigue.

  5. Thoracic and Cardiovascular Surgeons’ Perception of the Concentration of Cardiovascular Operations in Seoul Metropolitan Area’s Hospitals

    Directory of Open Access Journals (Sweden)

    Hyo Seon Jeong

    2016-12-01

    Full Text Available Background: The purpose of this study is to evaluate the concentration of cardiovascular surgical procedures in a metropolitan area and investigate the perception of specialists regarding governmental policies to resolve this imbalance. Methods: From March to May 2015, surveys were distributed to members of the Thoracic and Cardiovascular Surgery Association. The final pool of research subjects consisted of 75 respondents. Subjects were queried regarding the concentration of cardiovascular operations in metropolitan areas, alternatives to the imbalance, and governmental policies to resolve the inequalities. Results: Survey participants responded that South Korea needs governmental policies to alleviate the concentration of cardiovascular surgery patients in large metropolitan hospitals. Participants agreed that the freedom to choose medical institutions and improved accessibility to metropolitan hospitals due to advanced transportation systems were some of the causes for the concentration. A majority (98.7% of respondents thought establishing thoracic and cardiovascular surgery centers in provinces was an appropriate solution to alleviate the concentration. Thoracic and cardiovascular surgery specialists were ranked as the number one group on which to focus development. Conclusion: Developing and carrying out policies to establish thoracic and cardiovascular surgery centers in provinces will alleviate the regional imbalance in available heart surgery services and an overall improvement in cardiovascular disease treatment in South Korea.

  6. Hospital workplace experiences of registered nurses that have contributed to their resignation in the Durban metropolitan area.

    Science.gov (United States)

    King, L A; McInerney, P A

    2006-11-01

    Hospital workplace experiences of registered nurses that have contributed to their resignation in the Durban Metropolitan Area. The purpose of this research was to explore and describe the hospital workplace experiences that had contributed to the resignations of Registered Nurses in the Durban Metropolitan Area. The broad perspective governing this research is qualitative in nature. The researcher employed a phenomenological approach specifically because the researcher was interested in identifying, describing and understanding the subjective experiences of individual nurses at the two Private and two Provincial health care institutions selected to participate in the study - in respect of their decision (s) to resign from their employment, and/or to leave the nursing profession. Two semistructured interviews were conducted with each participant by the researcher. The researcher applied the principle of theoretical saturation and a total of fifteen participants were interviewed and thirty interviews were conducted. Experiential themes and subthemes in the data were identified by a process of meaning condensation, and the data were managed by means of a qualitative software package - NVIVO (QSR - NUD*IST). The resignations of registered nurses in the Durban Metropolitan Area were found to be linked to their respective hospital workplace experiences. These experiences related to their physical working conditions and environment and included the following: unsupportive management structures, autocratic and dehumanizing management styles, negative stereotypy of nurses and the nursing profession, lack of autonomy in the workplace, professional jealousies and fractures within the profession, sub-optimal physical working conditions and shortage of staff, equipment and lack of appropriate surgical supplies, concerns regarding occupational safety e.g. the increasing exposure of health care personnel to HIV and AIDS; lack of opportunities for promotion or continuing one

  7. Surgical education and training in an outer metropolitan hospital: a qualitative study of surgical trainers and trainees.

    Science.gov (United States)

    Nestel, Debra; Harlim, Jennifer; Bryant, Melanie; Rampersad, Rajay; Hunter-Smith, David; Spychal, Bob

    2017-08-01

    The landscape of surgical training is changing. The anticipated increase in the numbers of surgical trainees and the shift to competency-based surgical training places pressures on an already stretched health service. With these pressures in mind, we explored trainers' and trainees' experiences of surgical training in a less traditional rotation, an outer metropolitan hospital. We considered practice-based learning theories to make meaning of surgical training in this setting, in particular Actor-network theory. We adopted a qualitative approach and purposively sampled surgical trainers and trainees to participate in individual interviews and focus groups respectively. Transcripts were made and thematically analysed. Institutional human research ethics approval was obtained. Four surgical trainers and fourteen trainees participated. Almost without exception, participants' report training needs to be well met. Emergent inter-related themes were: learning as social activity; learning and programmatic factors; learning and physical infrastructure; and, learning and organizational structure. This outer metropolitan hospital is suited to the provision of surgical training with the current rotational system for trainees. The setting offers experiences that enable consolidation of learning providing a rich and varied overall surgical training program. Although relational elements of learning were paramount they occurred within a complex environment. Actor-network theory was used to give meaning to emergent themes acknowledging that actors (both people and objects) and their interactions combine to influence training quality, shifting the focus of responsibility for learning away from individuals to the complex interactions in which they work and learn.

  8. 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...

  9. The Child Opportunity Index and Disparities in Pediatric Asthma Hospitalizations Across One Ohio Metropolitan Area, 2011-2013.

    Science.gov (United States)

    Beck, Andrew F; Huang, Bin; Wheeler, Kathryn; Lawson, Nikki R; Kahn, Robert S; Riley, Carley L

    2017-11-01

    To determine whether the Child Opportunity Index (COI), a nationally available measure of relative educational, health/environmental, and social/economic opportunity across census tracts within metropolitan areas, is associated with population- and patient-level asthma morbidity. This population-based retrospective cohort study was conducted between 2011 and 2013 in a southwest Ohio county. Participants included all children aged 1-16 years with hospitalizations or emergency department visits for asthma or wheezing at a major pediatric hospital. Patients were identified using discharge diagnosis codes and geocoded to their home census tract. The primary population-level outcome was census tract asthma hospitalization rate. The primary patient-level outcome was rehospitalization within 12 months of the index hospitalization. Census tract opportunity was characterized using the COI and its educational, health/environmental, and social/economic domains. Across 222 in-county census tracts, there were 2539 geocoded hospitalizations. The median asthma-related hospitalization rate was 5.0 per 1000 children per year (IQR, 1.9-8.9). Median hospitalization rates in very low, low, moderate, high, and very high opportunity tracts were 9.1, 7.6, 4.6, 2.1, and 1.8 per 1000, respectively (P asthma morbidity. The details provided by the COI may inform interventions aimed at increasing opportunity and reducing morbidity across regions. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Smoking behavior among patients and staff: a snapshot from a major metropolitan hospital in Melbourne, Australia

    Directory of Open Access Journals (Sweden)

    Rahman MA

    2014-01-01

    Full Text Available Muhammad Aziz Rahman,1,2 Andrew M Wilson,2–4 Rhonda Sanders,3 David Castle,2–4 Karen Daws,3 David R Thompson,2 Chantal F Ski,2 Sarah Matthews,3 Christine Wright,2 Linda Worrall-Carter1–31St Vincent's Centre for Nursing Research (SVCNR, Australian Catholic University, Melbourne, VIC, Australia; 2The Cardiovascular Research Centre (CvRC, Australian Catholic University, Melbourne, VIC, Australia; 3St Vincent's Hospital, Melbourne, VIC, Australia; 4The University of Melbourne, Melbourne, VIC, AustraliaBackground: A cross-sectional study was conducted to provide a snapshot of smoking behavior among staff and patients at a major metropolitan hospital in Melbourne.Methods: Patients and staff were surveyed using a questionnaire exploring demographics, nicotine dependence (Fagerstrom test, readiness to quit, and preference for smoking cessation options.Results: A total of 1496 people were screened within 2 hours; 1,301 participated (1,100 staff, 199 patients. Mean age was 42 years, 68% were female. There were 113 (9% current smokers and 326 (25% ex-smokers. Seven percent of the staff were current smokers compared with 19% of the patients. The Fagerstrom test showed that 47% of patients who smoked were moderately nicotine dependent compared with 21% of staff. A third of the staff who smoked did not anticipate health problems related to smoking. Most patients (79% who smoked disagreed that their current health problems were related to smoking. Although more than half of the current smokers preferred pharmacotherapy, one in two of them did not prefer behavior counseling; with consistent results among staff and patients. Multivariate analyses showed that patients were three times more likely (odds ratio 3.0, 95% confidence interval 1.9–4.7 to smoke than staff.Conclusion: This study reports lower prevalence of smoking among hospital staff compared with national data. It also indicates an under-appreciation of health effects of smoking, and a

  11. Renewed growth in hospital inpatient cost since 1998: variation across metropolitan areas and leading clinical conditions.

    Science.gov (United States)

    Friedman, Bernard S; Wong, Herbert S; Steiner, Claudia A

    2006-03-01

    To use disaggregated data about metropolitan statistical areas (MSAs) and clinical conditions to better describe the variation in cost increases and explore some of the hypothesized influences. The study uses the state inpatient databases from the Healthcare Cost and Utilization Project, containing all discharges from hospitals in 172 MSAs in 1998 and 2001. The discharge summary information was combined with standardized hospital accounting files, surveys of managed care plans, MSA demographics, and state data pertaining to caps on medical malpractice awards. The analysis used descriptive comparisons and multivariate regressions of admission rate and cost per case in 9 leading disease categories across the MSAs. The increase in hospital input prices and changes in severity of illness were controlled. Metropolitan statistical areas with higher HMO market penetration continued to show lower admission rates, no less so in 2001 than in 1998. A cap on malpractice awards appeared to restrain admissions, but the net effect on hospital cost per adult eroded for those states with the most experience with award caps. Higher admission rates and increase in cost were found in several disease categories.

  12. Hospital distribution in a metropolitan city: assessment by a geographical information system grid modelling approach

    Directory of Open Access Journals (Sweden)

    Kwang-Soo Lee

    2014-05-01

    Full Text Available Grid models were used to assess urban hospital distribution in Seoul, the capital of South Korea. A geographical information system (GIS based analytical model was developed and applied to assess the situation in a metropolitan area with a population exceeding 10 million. Secondary data for this analysis were obtained from multiple sources: the Korean Statistical Information Service, the Korean Hospital Association and the Statistical Geographical Information System. A grid of cells measuring 1 × 1 km was superimposed on the city map and a set of variables related to population, economy, mobility and housing were identified and measured for each cell. Socio-demographic variables were included to reflect the characteristics of each area. Analytical models were then developed using GIS software with the number of hospitals as the dependent variable. Applying multiple linear regression and geographically weighted regression models, three factors (highway and major arterial road areas; number of subway entrances; and row house areas were statistically significant in explaining the variance of hospital distribution for each cell. The overall results show that GIS is a useful tool for analysing and understanding location strategies. This approach appears a useful source of information for decision-makers concerned with the distribution of hospitals and other health care centres in a city.

  13. Spread of Staphylococcus aureus between medical staff and high-frequency contact surfaces in a large metropolitan hospital

    Directory of Open Access Journals (Sweden)

    Li-sha Shi

    2015-12-01

    Conclusion: Cross-contamination of S. aureus or MRSA on medical workers' hands and contact surfaces was demonstrated within and between departments of a large metropolitan hospital. Improvements are needed in medical staff hygiene habits and in the cleaning of high-frequency contact surfaces to help prevent and control nosocomial infections.

  14. Factors that affect job satisfaction and intention to leave of allied health professionals in a metropolitan hospital.

    Science.gov (United States)

    Wilson, Natalie A

    2015-06-01

    The purpose of the present study was to determine the aspects of the allied health professional's job that contribute most to job satisfaction and intention to leave in a metropolitan hospital. Data were collected via a questionnaire that was emailed to all clinical allied health staff at Campbelltown and Camden Hospitals in New South Wales, Australia. The participants then rated their level of satisfaction with various job.aspects. A significant correlation was found between several job satisfaction factors and intention to leave in this study group, including quality of supervision, level of competency to do the job, recognition for doing the job, advancement opportunities, autonomy, feelings of worthwhile accomplishment, communication and support from the manager. In relation to Herzberg's job satisfaction theory, both intrinsic and extrinsic work factors have been shown to have a significant correlation with intention to leave in this study group. This information can assist workforce planners to implement strategies to improve retention levels of allied health professionals in the work place.

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

    Science.gov (United States)

    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

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

    Science.gov (United States)

    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.

  17. 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)

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

    Science.gov (United States)

    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.

  19. 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.

  20. Epidemiology of Hospital-Treated Injuries Sustained by Fitness Participants

    Science.gov (United States)

    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…

  1. Transfers to metropolitan hospitals and coronary angiography for rural Aboriginal and non-Aboriginal patients with acute ischaemic heart disease in Western Australia.

    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

    2014-05-01

    Aboriginal people have a disproportionately higher incidence rate of ischaemic heart disease (IHD) than non-Aboriginal people. The findings on Aboriginal disparity in receiving coronary artery procedures are inconclusive. We describe the profile and transfers of IHD patients admitted to rural hospitals as emergency admissions and investigate determinants of transfers and coronary angiography. Person-linked hospital and mortality records were used to identify 28-day survivors of IHD events commencing at rural hospitals in Western Australia. Outcome measures were receipt of coronary angiography, transfer to a metropolitan hospital, and coronary angiography if transferred to a metropolitan hospital. Compared to non-Aboriginal patients, Aboriginal patients with IHD were more likely to be younger, have more co-morbidities, reside remotely, but less likely to have private insurance. After adjusting for demographic characteristics, Aboriginal people with MI were less likely to be transferred to a metropolitan hospital, and if transferred were less likely to receive coronary angiography. These disparities were not significant after adjusting for comorbidities and private insurance. In the full multivariate model age, comorbidities and private insurance were adversely associated with transfer to a metropolitan hospital and coronary angiography. Disparity in receiving coronary angiography following emergency admission for IHD to rural hospitals is mediated through the lower likelihood of being transferred to metropolitan hospitals where this procedure is performed. The likelihood of a transfer is increased if the patient has private insurance, however, rural Aboriginal people have a lower rate of private insurance than their non-Aboriginal counterparts. Health practitioners and policy makers can continue to claim that they treat Aboriginal and non-Aboriginal people alike based upon clinical indications, as private insurance is acting as a filter to reduce rural residents

  2. 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.

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

    Science.gov (United States)

    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.

  4. Urine Creatinine Concentrations in Drug Monitoring Participants and Hospitalized Patients.

    Science.gov (United States)

    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.

  5. 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)

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

    Directory of Open Access Journals (Sweden)

    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

  7. Ethical issues that confront nurses in private hospitals in the Western Cape Metropolitan area

    Directory of Open Access Journals (Sweden)

    Ethelwynn L. Stellenberg

    2014-06-01

    Full Text Available Background: Nurses are faced daily with a variety of ethical issues which could be as a result of budget cuts, target setting, the shortage of nurses and expertise. Objectives: The objectives of the study were to identify ethical issues related to patient care, to describe ethical issues related to patient diversity, rights and human dignity. To describe ethical issues related to caring in nursing and to the workplace environment. Method: A quantitative explorative descriptive research design was applied. A stratified sample of (n = 142/5% was drawn from all nurses and caregivers (N = 2990 working in a selected group of eight private hospitals. Self-administered questionnaires were used to collect the data. Statistical tests were applied to determine statistical relationships between variables. Results: Results included (95% of respondents provided safe and committed care to their patients, (99% loved to care for their patients and (93% believed in the Nurses’ Pledge of Service. Fifty percent (50% of the respondents indicated verbal abuse from patients and only (59% experienced openness and transparency in the work environment. Analysis further identified that the caregivers did not respect the noble tradition of the profession and experienced the most verbal abuse. Conclusion: This study has identified ethical issues which may give rise to conflict within the workplace environment if not adequately addressed by management. The study further showed that the use of caregivers not regulated in nursing practice may pose as a threat to the safety of the patient.

  8. Ethical issues that confront nurses in private hospitals in the Western Cape Metropolitan area

    Directory of Open Access Journals (Sweden)

    Ethelwynn L. Stellenberg

    2014-02-01

    Full Text Available Background: Nurses are faced daily with a variety of ethical issues which could be as a result of budget cuts, target setting, the shortage of nurses and expertise.Objectives: The objectives of the study were to identify ethical issues related to patient care, to describe ethical issues related to patient diversity, rights and human dignity. To describe ethical issues related to caring in nursing and to the workplace environment.Method: A quantitative explorative descriptive research design was applied. A stratified sample of (n = 142/5% was drawn from all nurses and caregivers (N = 2990 working in a selected group of eight private hospitals. Self-administered questionnaires were used to collect the data. Statistical tests were applied to determine statistical relationships between variables.Results: Results included (95% of respondents provided safe and committed care to their patients, (99% loved to care for their patients and (93% believed in the Nurses’ Pledge of Service. Fifty percent (50% of the respondents indicated verbal abuse from patients and only (59% experienced openness and transparency in the work environment. Analysis further identified that the caregivers did not respect the noble tradition of the profession and experienced the most verbal abuse.Conclusion: This study has identified ethical issues which may give rise to conflict within the workplace environment if not adequately addressed by management. The study further showed that the use of caregivers not regulated in nursing practice may pose as a threat to the safety of the patient.

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

    Directory of Open Access Journals (Sweden)

    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.

  10. Using participant or non-participant observation to explain information behaviour. Participant observation, Non-participant observation, Information behaviour, Hospital pharmacists, Older people

    Directory of Open Access Journals (Sweden)

    Janet Cooper

    2004-01-01

    Full Text Available The aim of the paper is to provide guidance on conducting participant and non-participant observation studies of information behaviour. Examines lessons learned during non-participant observation of hospital pharmacists, and participant observation with dependent older people living in their own homes. Describes the methods used in both studies, and discusses the ethical issues involved in gaining access to the subjects. In the hospital setting, professional affiliation between the researcher and the subjects (six pharmacists made access easier to obtain. In the home care setting, access to subjects (seven clients for participant observation (as a care worker was more difficult, as was withdrawal from the field study. In both studies, the observation element was triangulated with survey data. Both studies indicated the fundamental need for trust between the observer and the research subjects. In some situations, professional relations offer instant access and trust, whereas in closed and sensitive situations such as social care, time is required to build up trust. With participant observation, that trust should not be damaged by withdrawal of the researcher from the research setting.

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

    Science.gov (United States)

    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.

  12. 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...

  13. [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.

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

    Directory of Open Access Journals (Sweden)

    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.

  15. Efficient Metropolitan Resource Allocation

    Directory of Open Access Journals (Sweden)

    Richard Arnott

    2016-05-01

    Full Text Available Over the past 30 years Calgary has doubled in size, from a population of 640,645 in 1985 to 1,230,915 in 2015. During that time the City has had five different mayors, hosted the Winter Olympics, and expanded the C-Train from 25 platforms to 45. Calgary’s Metropolitan Area has grown too, with Airdrie, Chestermere, Okotoks and Cochrane growing into full-fledged cities, ripe with inter-urban commuters.* And with changes to provincial legislation in the mid-’90s, rural Rocky View County and the Municipal District of Foothills are now real competitors for residential, commercial and industrial development that in the past would have been considered urban. In this metropolitan system, where people live, their household structure, and their place of work informs the services they need to conduct their daily lives, and directly impacts the spatial character of the City and the broader region. In sum, Metropolitan Calgary is increasingly complex. Calgary and the broader metropolitan area will continue to grow, even with the current economic slowdown. Frictions within Calgary, between the various municipalities in the metropolitan area, and the priorities of other local authorities (such as the School Boards and Alberta Health Services will continue to impact the agendas of local politicians and their ability to answer to the needs of their residents. How resources – whether it is hard infrastructure, affordable housing, classrooms, or hospital beds – are allocated over space and how these resources are funded, directly impacts these relationships. This technical paper provides my perspective as an urban economist on the efficient allocation of resources within a metropolitan system in general, with reference to Calgary where appropriate, and serves as a companion to the previously released “Reflections on Calgary’s Spatial Structure: An Urban Economists Critique of Municipal Planning in Calgary.” It is hoped that the concepts reviewed

  16. 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.

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

    Science.gov (United States)

    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.

  18. 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.

  19. 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 ...

  20. 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...

  1. 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

  2. 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.

  3. [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.

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

    Science.gov (United States)

    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/.

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

    Science.gov (United States)

    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.

  6. Barriers to participation in a hospital-based falls assessment clinicprogramme

    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. 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...

  7. 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.

  8. 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.

  9. 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

  10. Pediatric Neglected Tropical Diseases in a Major Metropolitan Children's Hospital in the United States, 2004-2013.

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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.

  12. 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.

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

    Science.gov (United States)

    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

  14. Labor Force Activity of Women in Metropolitan and Nonmetropolitan America. Rural Development Research Report No. 15.

    Science.gov (United States)

    Brown, David L.; O'Leary, Jeanne M.

    Between 1960 and 1970 economic opportunity and progress for women in American non-metropolitan areas was mixed. While women in metropolitan areas were more likely to be labor force members than were non-metropolitan women, the difference in metropolitan and non-metropolitan labor force participation rates narrowed during the period. For women…

  15. Assessing the accuracy of self-reported height and weight in an elective surgical population in a Melbourne metropolitan hospital.

    Science.gov (United States)

    Bowden, C; Loughnan, T

    2006-10-01

    A Health Questionnaire serves as a screening form as part of our Hospital Preadmission process and is completed by all patients scheduled for elective surgery. We reviewed the completed Health Questionaires of 444 patients. Completion of the Health Questionnaire requires patients to record their height and weight. At the time of admission their actual height and weight was measured and recorded by nursing staff as part of the preoperative assessment. We compared their estimated body mass index (BMI) from self-reported height and weight, with their actual BMI calculated from height and weight measured upon admission. The measured BMI accorded well with that calculated from reported values and showed no systematic over- or under-reporting. Of 70 patients with a BMI greater than 35, only ten estimated their BMI less than 35 and only five of these had more than a two unit difference. Perioperative patients appear to be more accurate at providing height and weight than previously analysed non-patient groups. However there is not complete accuracy and some patients still provide unreliable information. Whether or not individual practitioners utilize BMI from self-reported height and weight will depend on the accuracy that they require for their purposes. Of note there was greater accuracy in prediction of height and weight than in the derived variable of BMI due to the calculations required.

  16. 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.

  17. [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.

  18. 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.

  19. 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....

  20. 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)

  1. 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.

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

    Science.gov (United States)

    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.

  3. 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

  4. 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.

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

    Directory of Open Access Journals (Sweden)

    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

  6. 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.

  7. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  10. 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.

  11. 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.

  12. 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,

  13. 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,

  14. 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,

  15. 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,

  16. 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...

  17. 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

  18. 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

  19. 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...

  20. 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.

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

    Directory of Open Access Journals (Sweden)

    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

  2. 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.

  3. 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...

  4. 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...

  5. 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...

  6. 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...

  7. 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...

  8. [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.

  9. 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.

  10. 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...

  11. [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.

  12. 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.

  13. MPLS for metropolitan area networks

    CERN Document Server

    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

  14. Review of medical discharge summaries and medical documentation in a metropolitan hospital: impact on diagnostic-related groups and Weighted Inlier Equivalent Separation.

    Science.gov (United States)

    Chin, N; Perera, P; Roberts, A; Nagappan, R

    2013-07-01

    Accurate and comprehensive clinical documentation is crucial for effective ongoing patient care, follow up and to optimise case mix-based funding. Each Diagnostic Related Group (DRG) is assigned a 'weight', leading to Weighted Inlier Equivalent Separation (WIES), a system many public and private hospitals in Australia subscribe to. To identify the top DRG in a general medical inpatient service, the completeness of medical discharge documentation, commonly missed comorbidities and system-related issues and subsequent impact on DRG and WIES allocation. One hundred and fifty completed discharge summaries were randomly selected from the top 10 medical DRG in our health service. From a detailed review of the clinical documentation, principal diagnoses, associated comorbidities and complications, where appropriate, the DRG and WIES were modified. Seventy-two (48%) of the 150 reviewed admissions resulted in a revision of DRG and WIES equivalent to an increase of AUD 142,000. Respiratory-based DRG generated the largest revision of DRG and WIES, while 'Cellulitis' DRG had the largest relative change. Twenty-seven per cent of summaries reviewed necessitated a change in coding with no subsequent change in DRG allocation or WIES. Acute renal failure, anaemia and electrolyte disturbances were the most commonly underrepresented entities in clinical discharge documentation. Seven patients had their WIES downgraded. Comprehensive documentation of principal diagnosis/diagnoses, comorbidities and their complications is imperative to optimal DRG and WIES allocation. Regular meetings between clinical and coding staff improve the quality and timeliness of medical documentation, ensure adequate communication with general practitioners and lead to appropriate funding. © 2013 The Authors; Internal Medicine Journal © 2013 Royal Australasian College of Physicians.

  15. [Assessment of antibiotic use and impact of an intervention intended to modify the prescribing behavior in surgical prophylaxis in 6hospitals in the metropolitan area of Monterrey, Mexico].

    Science.gov (United States)

    Palacios-Saucedo, Gerardo Del Carmen; de la Garza-Camargo, Mauricio; Briones-Lara, Evangelina; Carmona-González, Sandra; García-Cabello, Ricardo; Islas-Esparza, Luis Arturo; Saldaña-Flores, Gustavo; González-Cano, Juan Roberto; González-Ruvalcaba, Román; Valadez-Botello, Francisco Javier; Muñoz-Maldonado, Gerardo Enrique; Montero-Cantú, Carlos Alberto; Díaz-Ramos, Rita Delia; Solórzano-Santos, Fortino

    Improper use of antibiotics increases antimicrobial resistance. Evaluate the use of antibiotics and the impact of an intervention designed to improve antibiotic prescription for surgical prophylaxis in 6 hospitals of Monterrey, Mexico. Design: A prospective multicenter survey and a pretest-postest experimental study. Phase 1: Survey to evaluate the use of antibiotics through an especially designed guide. Phase 2: Intervention designed to improve antibiotic prescription for surgical prophylaxis by the medical staff by using printed, audiovisual and electronic messages. Phase 3: Survey to evaluate the impact of the intervention. Frequencies, percentages, medians, ranges and X 2 test. Phase 1: We evaluated 358 surgical patients, 274 prophylactic antibiotic regimens. A total of 96% of antibiotics regimens began with inappropriate timing (290/302), 82.8% were inappropriate regimens (274/331), 77.7% were in inappropriate dosage (230/296), 86% of inadequate length (241/280), and in 17.4% restricted antibiotics were used (52/299). Phase 2: 9 sessions including 189 physicians (14 department chairs, 58 general practitioners and 117 residents). Phase 3: We evaluated 303 surgical patients, 218 prophylactic antibiotics regimens. Inappropriate treatment commencement was reduced to 84.1% (180/214) (P<0.001), inappropriate regimens to 75.3% (162/215) (P=0.03), inappropriate dosages to 51.2% (110/215) (P<0.001), and use of restricted antibiotics to 8.3% (18/215) (P=0.003). Inappropriate use of prophylactic antibiotics in surgery is a frequent problem in Monterrey. The intervention improved the antibiotic prescription for surgical prophylaxis by reducing inappropriate treatment commencement, regimens, dosages, and overuse of restricted antibiotics. It is necessary to strengthen strategies to improve the prescription of antibiotics in surgical prophylaxis. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  16. [The medico-psychological rehabilitation of participants in combat actions in a general hospital].

    Science.gov (United States)

    Belinskiĭ, A V; Liamin, M V

    2000-01-01

    There were investigated 453 servicemen--participants of fighting actions in Chechnya [correction of Chechenskaya] Republic in whom the incidence of psychologic stress reactions nearly twice exceeded disorders of other types of psychic dysfunction. 5 groups of combatants were selected and severity of psychic disorders depending on duration of participation in fighting actions was determined. Posttraumatic stress disorders were revealed in 14.5% of servicemen, no signs of psychologic desadaptation were detected in 16.6%, 16.9% had pathologic psychogenic reactions, 18.6% showed pathologic level of psychic disorders, and psychologic stress reactions were noted in 33.4%. The developed individual programs of medico-psychologic rehabilitation depending on type and severity of psychic disorders will allow to reduce the period of restorative treatment and significantly decrease servicemen discharge from the Armed Forces because of psychic disorders.

  17. 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™

    Directory of Open Access Journals (Sweden)

    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.

  18. A Descriptive Survey of Weight Control Participants at a U.S. Army Community Hospital.

    Science.gov (United States)

    1983-08-01

    participation in the survey was strictly voluntary; 3. only active duty Army personnel who were on the Army’s weight control program could volunteer ...A.R. 600-9 limit 2 I was singled out because I looked overweight 3 I volunteered for the program 4 Other, specify 18. Where was your initial weight...33. Wing, Rena R., and Epstein, Leonard H. "Prescribed Level of Caloric Restriction in Bahavioral Weight Loss Programs. Addictive Behaviors 6

  19. The participative method of subject definition as used in the quantitative modelling of hospital laundry services.

    Science.gov (United States)

    Hammer, K A; Janes, F R

    1995-01-01

    The objectives for developing the participative method of subject definition were to gain all the relevant information to a high level of fidelity in the earliest stages of the work and so be able to build a realistic model at reduced labour cost. In order to better integrate the two activities--information acquisition and mathematical modelling--a procedure was devised using the methods of interactive management to facilitate teamwork. This procedure provided the techniques to create suitable working relationships between the two groups, the informants and the modellers, so as to maximize their free and accurate intercommunication, both during the initial definition of the linen service and during the monitoring of the accuracy and reality of the draft models. The objectives of this project were met in that the final model was quickly validated and approved, at a low labour cost.

  20. [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.

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

    Directory of Open Access Journals (Sweden)

    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.

  2. Building motivation to participate in a quality improvement collaborative in NHS hospital trusts in Southeast England: a qualitative participatory evaluation.

    Science.gov (United States)

    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

  3. Challenges and Resources for Nurses Participating in a Hurricane Sandy Hospital Evacuation.

    Science.gov (United States)

    VanDevanter, Nancy; Raveis, Victoria H; Kovner, Christine T; McCollum, Meriel; Keller, Ronald

    2017-11-01

    Weather-related disasters have increased dramatically in recent years. In 2012, severe flooding as a result of Hurricane Sandy necessitated the mid-storm patient evacuation of New York University Langone Medical Center. The purpose of this study was to explore, from the nurses' perspective, what the challenges and resources were to carrying out their responsibilities, and what the implications are for nursing education and preparation for disaster. This mixed-methods study included qualitative interviews with a purposive sample of nurses and an online survey of nurses who participated in the evacuation. The interviews explored prior disaster experience and training, communication, personal experience during the evacuation, and lessons learned. The cross-sectional survey assessed social demographic factors, nursing education and experience, as well as potential challenges and resources in carrying out their disaster roles. Qualitative interviews provided important contextual information about the specific challenges nurses experienced and their ability to respond effectively. Survey data identified important resources that helped nurses to carry out their roles, including support from coworkers, providing support to others, personal resourcefulness, and leadership. Nurses experienced considerable challenges in responding to this disaster due to limited prior disaster experience, training, and education, but drew on their personal resourcefulness, support from colleagues, and leadership to adapt to those challenges. Disaster preparedness education in schools of nursing and practice settings should include more hands-on disaster preparation exercises, more "low-tech" options to address power loss, and specific policies on nurses' disaster roles. Nurses play a critical role in responding to disasters. Learning from their disaster experience can inform approaches to nursing education and preparation. © 2017 Sigma Theta Tau International.

  4. Hospitals

    Data.gov (United States)

    Department of Homeland Security — This database contains locations of Hospitals for 50 states and Washington D.C. , Puerto Rico and US territories. The dataset only includes hospital facilities and...

  5. 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.

  6. Hospital staffing and hospital costs.

    Science.gov (United States)

    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%.

  7. Hospitals

    DEFF Research Database (Denmark)

    Mullins, Michael

    2013-01-01

    The challenge could be briefly seen in these terms: hospitals as places for treatment where there’s a technology focus and hospitals for healing where there’s a human focus. In the 60s - 70s wave of new hospital building, an emphasis on technology can be seen. It’s time to move from the technology...... focus. It is not enough to consider only the factors of function within architecture, hygiene, economy and logistics. We also need to look at aspects of aesthetics, bringing nature into the building, art, color, acoustics, volume and space as we perceive them. Contemporary methods and advances...... placed, accessible, provided with plenty of greenery, and maximize sensory impressions, providing sounds, smells, sight and the possibility to be touched. This is a very well documented area I can say. Hygiene, in terms of architecture can give attention to hand wash facilities and their positioning...

  8. 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.

  9. Is There a Global Role for Metropolitan City Libraries?

    Science.gov (United States)

    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.…

  10. 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.

  11. 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.

  12. Patient participation in medication safety during an acute care admission.

    Science.gov (United States)

    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.

  13. Political apathy amongst students: A case study of Nelson Mandela Metropolitan University

    Directory of Open Access Journals (Sweden)

    Ntsikelelo B. Breakfast

    2017-09-01

    Full Text Available The primary motivation for this research, in which a qualitative method was employed, was to examine political apathy amongst students at Nelson Mandela Metropolitan University. The secondary motivation was to question whether youth political apathy threatens the consolidation of democracy. The researchers arranged four focus groups at Nelson Mandela Metropolitan University. A purposive sampling technique was utilised. All 50 participants in the study were Nelson Mandela Metropolitan University undergraduate and postgraduate black students, with ages ranging from 21 to 35 years. The researchers encouraged participants to have maximum participation in the focus group deliberations. The researchers also made use of elite interviews in the study. The findings of this study suggest that political apathy does exist amongst students at Nelson Mandela Metropolitan University. Most of the participants in the focus groups indicated that young people in post-apartheid South Africa have no interest in politics.

  14. 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

  15. Medicare: Reviews of Quality of Care at Participating Hospitals. Report to the Administrator, Health Care Financing Administration.

    Science.gov (United States)

    General Accounting Office, Washington, DC. Div. of Human Resources.

    This report concerns the Health Care Financing Administration's (HCFA) contracting with Utilization and Quality Control Peer Review Organizations (PROs) as a means of monitoring the medical necessity and quality of in-hospital care provided to Medicare beneficiaries. Findings from a HCFA survey of PROs in California, Florida, and Georgia are used…

  16. 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

  17. Injuries to Aboriginal populations living on- and off-reserve in metropolitan and non-metropolitan areas in British Columbia, Canada: Incidence and trends, 1986-2010

    Directory of Open Access Journals (Sweden)

    Mariana Brussoni

    2016-05-01

    Full Text Available Abstract Background Disparities in injury rates between Aboriginal and non-Aboriginal populations in British Columbia (BC are well established. Information regarding the influence of residence on disparities is scarce. We sought to fill these gaps by examining hospitalization rates for all injuries, unintentional injuries and intentional injuries across 24 years among i Aboriginal and total populations; ii populations living in metropolitan and non-metropolitan areas; and iii Aboriginal populations living on- and off-reserve. Methods We used data spanning 1986 through 2010 from BC’s universal health care insurance plan, linked to vital statistics databases. Aboriginal people were identified by insurance premium group and birth and death record notations, and their residence was determined by postal code. “On-reserve” residence was established by postal code areas associated with an Indian reserve or settlement. Health Service Delivery Areas (HSDAs were classified as “metropolitan” if they contained a population of at least 100,000 with a density of 400 or more people per square kilometre. We calculated the crude hospitalization incidence rate and the Standardized Relative Risk (SRR of hospitalization due to injury standardizing by gender, 5-year age group, and HSDA. We assessed cumulative change in SRR over time as the relative change between the first and last years of the observation period. Results Aboriginal metropolitan populations living off-reserve had the lowest SRR of injury (2.0, but this was 2.3 times greater than the general British Columbia metropolitan population (0.86. For intentional injuries, Aboriginal populations living on-reserve in non-metropolitan areas were at 5.9 times greater risk than the total BC population. In general, the largest injury disparities were evident for Aboriginal non-metropolitan populations living on-reserve (SRR 3.0; 2.5 times greater than the general BC non-metropolitan population (1

  18. Limited activity and social participation after hospital discharge from leprosy treatment in a hyperendemic area in north Brazil

    Directory of Open Access Journals (Sweden)

    Lorena Dias Monteiro

    2014-03-01

    Full Text Available INTRODUCTION: Neural damages are among the main factors that contribute to physical disability in leprosy. Systematic monitoring using a broad physical, psychological and social approach is necessary. OBJECTIVE: The objective of this study was to characterize the limitation of activity and social participation and its correlation with disabilities and/or impairment in individuals after being discharged from a multidrug leprosy therapy. METHOD: A cross-sectional study conducted in Araguaína, state of Tocantins, which is a leprosy hyperendemic municipality. We included cases of patients who were discharged from treatment considered as cured from January 2004 to December 2009. We performed dermatological examination and applied the Screening Activity Limitation and Safety Awareness (SALSA and social participation scales. RESULTS: We included 282 individuals (mean age: 45.8 years old. The paucibacillary operational classification was more common (170; 60.3%. The eye-hand-foot score ranged from 0 to 12 (mean: 0.7. A total of 84 (29.8% individuals presented limited activity. A slight restriction in social participation occurred in 18 (6.3% cases. There was a statistically significant correlation between activity limitation, age (r = 0.40; p < 0.0001 and degree of functional limitation (r = 0.54; p < 0.0001, as well as of restricted social participation, activity limitation (r = 0.56, p < 0.0001 and functional limitations (r = 0.54, p < 0.0001. CONCLUSION: Functional limitation due to leprosy had an impact on the conduct of activities and social participation after the discharge from a leprosy treatment. The association between Screening of Activity Limitation and Safety Awareness and participation scales will assist in designing evidence-based assistance measures.

  19. 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.

  20. Patient empowerment, patient participation and patient-centeredness in hospital care : A concept analysis based on a literature review

    NARCIS (Netherlands)

    Castro, E.M.; van Regenmortel, T.; Vanhaecht, K.; Sermeus, W.; van Hecke, A.

    2016-01-01

    Objectives The concepts of patient empowerment, patient participation and patient-centeredness have been introduced as part of the trend towards a more participatory health care and have largely been used interchangeably. Although these concepts have been discussed for a number of years, their exact

  1. Gender Differences in Posttraumatic Stress Symptoms Among Participants of a Violence Intervention Program at a Pediatric Hospital: A Pilot Study.

    Science.gov (United States)

    Purtle, Jonathan; Adams-Harris, Erica; Frisby, Bianca; Rich, John A; Corbin, Theodore J

    2016-01-01

    Hospital-based violence intervention programs (HVIPs) have emerged as a strategy to address posttraumatic stress (PTS) symptoms among violently injured patients and their families. HVIP research, however, has focused on males and little guidance exists about how HVIPs could be tailored to meet gender-specific needs. We analyzed pediatric HVIP data to assess gender differences in prevalence and type of PTS symptoms. Girls reported more PTS symptoms than boys (6.96 vs 5.21, P = .027), particularly hyperarousal symptoms (4.00 vs 2.82, P = .002) such as feeling upset by reminders of the event (88.9% vs 48.3%, P = .005). Gender-focused research represents a priority area for HVIPs.

  2. 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

    Directory of Open Access Journals (Sweden)

    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.

  3. 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

  4. 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...

  5. 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

  6. 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

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

    Directory of Open Access Journals (Sweden)

    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

  8. 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.

  9. 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.

  10. 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.

  11. The Blood Stocks Management Scheme, a partnership venture between the National Blood Service of England and North Wales and participating hospitals for maximizing blood supply chain management.

    Science.gov (United States)

    Chapman, J F; Cook, R

    2002-10-01

    The Blood Stocks Management Scheme (BSMS) has been established as a joint venture between the National Blood Service (NBS) in England and North Wales and participating hospitals to monitor the blood supply chain. Stock and wastage data are submitted to a web-based data-management system, facilitating continuous and complete red cell data collection and 'real time' data extraction. The data-management system enables peer review of performance in respect of stock holding levels and red cell wastage. The BSMS has developed an innovative web-based data-management system that enables data collection and benchmarking of practice, which should drive changes in stock management practice, therefore optimizing the use of donated blood.

  12. Hospital capacity and management preparedness for pandemic influenza in Victoria.

    Science.gov (United States)

    Dewar, Ben; Barr, Ian; Robinson, Priscilla

    2014-04-01

    This study was designed to investigate acute hospital pandemic influenza preparedness in Victoria, Australia, particularly focussing on planning and management efforts. A prospective study was conducted by questionnaire and semi-structured interview of health managers across the Victorian hospital system from July to October 2011. Participants with responsibility for emergency management, planning and operations were selected from every hospital in Victoria with an emergency department to complete a questionnaire (response rate 22/43 = 51%). Each respondent was invited to participate in a phone-based semi-structured interview (response rate 11/22 = 50%). Rural/regional hospitals demonstrated higher levels of clinical (86%) and non-clinical (86%) staff contingency planning than metropolitan hospitals (60% and 40% respectively). Pandemic plans were not being sufficiently tested in exercises or drills, which is likely to undermine their effectiveness. All respondents reported hand hygiene and standard precautions programs in place, although only one-third (33%) of metropolitan respondents and no rural/regional respondents reported being able to meet patient needs with high levels of staff absenteeism. Almost half Victoria's healthcare workers were unvaccinated against influenza. Hospitals across Victoria demonstrated different levels of influenza pandemic preparedness and planning. If a more severe influenza pandemic than that of 2009 arose, Victorian hospitals would struggle with workforce and infrastructure problems, particularly in rural/regional areas. Staff absenteeism threatens to undermine hospital pandemic responses. Various strategies, including education and communication, should be included with in-service training to provide staff with confidence in their ability to work safely during a future pandemic. © 2014 The Authors. ANZJPH © 2014 Public Health Association of Australia.

  13. 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

  14. Human albumin use at hospitals in the Metropolitan Region of Rio de Janeiro, Brazil Uso de albumina humana nos hospitais da Região Metropolitana do Estado do Rio de Janeiro, Brasil

    Directory of Open Access Journals (Sweden)

    Guacira Corrêa de Matos

    2010-05-01

    Full Text Available The study analyzes the use of human albumin in hospitals in Rio de Janeiro, Brazil, using inpatient data from the information system of Brazil's health system between 1999 and 2001. Death was the main outcome as patients died in 32% of admissions in which human albumin was used as compared with 4% of all admissions in the same period and region. The Charlson Comorbidity Index was included for risk adjustment. Human albumin was used in 10,111 in-patients more than 1 year old. 87,774 50-ml bottles of 20% human albumin were consumed at a cost of US$ 1,755. The main diagnoses were neoplasms (29.1%, diseases of the digestive system (17.5% and circulatory system (16%. Death rate increased with age, public ownership of the hospital, clinical services (as opposed to surgical services, length of stay and use of intensive care. Death was associated with use of more than four bottles of human albumin (PR: 1.30; 99%CI: 1.23-1.37, adjusted for severity and speciality. The results are cause for concern as they may be related to poor compliance with guidelines, excess of risk to patients and unnecessary expenses for the public health system.O estudo analisou o uso da albumina humana em hospitais do Rio de Janeiro, Brasil, utilizando os registros do Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH/SUS, 1999 e 2001. Como 32% das internações resultaram em óbito, em comparação com 4% de óbito para todas as internações no mesmo período e região, este foi o desfecho principal do estudo. A albumina humana foi usada em 10.111 internações de maiores de um ano, que consumiram 87.774 frascos - 50mL a 20%, com gasto de US$ 1.755,00. Os principais diagnósticos foram neoplasias (29,1%, doenças do aparelho digestivo (17,5% e do aparelho circulatório (16%. Houve maior proporção de óbitos de pacientes mais idosos, que receberam mais doses de albumina humana, internados por mais tempo, em especialidades clínicas, em UTI, em hospitais p

  15. Broadband availability in metropolitan and non-metropolitan Pennsylvania

    Directory of Open Access Journals (Sweden)

    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.

  16. 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....

  17. 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....

  18. [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.

  19. 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...

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

    Science.gov (United States)

    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.

  1. 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

  2. The effect of an active on-ward participation of hospital pharmacists in Internal Medicine teams on preventable Adverse Drug Events in elderly inpatients: protocol of the WINGS study (Ward-oriented pharmacy in newly admitted geriatric seniors)

    NARCIS (Netherlands)

    Klopotowska, J.E.; Wierenga, P.C.; de Rooij, S.E.; Stuijt, C.C.; Arisz, L.; Kuks, P.F.; Dijkgraaf, M.G.; Lie-A-Huen, L.; Smorenburg, S.M.

    2011-01-01

    The potential of clinical interventions, aiming at reduction of preventable Adverse Drug Events (preventable ADEs) during hospital stay, have been studied extensively. Clinical Pharmacy is a well-established and effective service, usually consisting of full-time on-ward participation of clinical

  3. Exarh of the Bulgarian Church metropolitan Stephen and the Moscow Patriarchy

    Directory of Open Access Journals (Sweden)

    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

  4. 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…

  5. 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

  6. 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,…

  7. 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…

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

    Science.gov (United States)

    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.

  9. [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

  10. Organizational learning in the implementation and adoption of national electronic health records: case studies of two hospitals participating in the National Programme for Information Technology in England.

    Science.gov (United States)

    Takian, Amirhossein; Sheikh, Aziz; Barber, Nicholas

    2014-09-01

    To explore the role of organizational learning in enabling implementation and supporting adoption of electronic health record systems into two English hospitals. In the course of conducting our prospective and sociotechnical evaluation of the implementation and adoption of electronic health record into 12 "early adopter" hospitals across England, we identified two hospitals implementing virtually identical versions of the same "off-the-shelf" software (Millennium) within a comparable timeframe. We undertook a longitudinal qualitative case study-based analysis of these two hospitals (referred to hereafter as Alpha and Omega) and their implementation experiences. Data included the following: 63 in-depth interviews with various groups of internal and external stakeholders; 41-h on-site observation; and content analysis of 218 documents of various types. Analysis was both inductive and deductive, the latter being informed by the "sociotechnical changing" theoretical perspective. Although Alpha and Omega shared a number of contextual similarities, our evaluation revealed fundamental differences in visions of electronic health record and the implementation strategy between the hospitals, which resulted in distinct local consequences of electronic health record implementation and impacted adoption. Both hospitals did not, during our evaluation, see the hoped-for benefits to the organization as a result of the introduction of electronic health record, such as speeding-up tasks. Nonetheless, the Millennium software worked out to be easier to use at Omega. Interorganizational learning was at the heart of this difference. Despite the turbulent overall national "roll out" of electronic health record systems into the English hospitals, considerable opportunities for organizational learning were offered by sequential delivery of the electronic health record software into "early adopter" hospitals. We argue that understanding the process of organizational learning and its

  11. Violence against metropolitan bus drivers and fare collectors in Brazil

    Directory of Open Access Journals (Sweden)

    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.

  12. 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.

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

    Science.gov (United States)

    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

  14. 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

  15. 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.

  16. 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.

  17. 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.

  18. Sports members' participation in assessment of incidence rate of injuries in five sports from records of hospital-based clinical treatment

    NARCIS (Netherlands)

    Kingma, J; ten Duis, HJ

    This study is about the incidence rate of sports injuries in five different types of sports, gymnastics, soccer, volleyball, hockey, and basketball, for which 5,154 patients were admitted to the Emergency Unit of the Groningen University Hospital during the period 1990 through 1994. Incidence rate

  19. 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.

  20. 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.

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

    Science.gov (United States)

    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.

  2. Urinary protein as a marker for systolic blood pressure reduction in patients with type 2 diabetes mellitus participating in an in-hospital diabetes education program.

    Science.gov (United States)

    Okada, Kenta; Miyamoto, Michiaki; Kotani, Kazuhiko; Yagyu, Hiroaki; Osuga, Junichi; Nagasaka, Shoichiro; Ishibashi, Shun

    2011-10-01

    Increased blood pressure (BP) and urinary protein (UP)/microalbuminuria are risk factors for cardiovascular disease in patients with diabetes. Although the management of BP in patients with diabetes should involve a multidisciplinary therapy, there are no reports in which modulators have been identified in an in-hospital diabetes education program. The aim of the present study was to investigate the change in BP levels in patients with type 2 diabetes mellitus (T2DM) during a short-term (2-week) in-hospital education program on lifestyle modifications. A total of 167 patients with T2DM (101 men, 66 women; mean age, 61.1 years; glycated hemoglobin, 9.2%) were divided into 2 groups on the basis of their urinary albumin levels: 1 group without UP (urinary albumin level patients with T2DM.

  3. 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

  4. Does participation in preventive child health care at the general practitioner minimise social differences in the use of specialist care outside the hospital system?

    DEFF Research Database (Denmark)

    Mårtensson, Solvej; Hansen, KH; Olsen, KR

    2012-01-01

    INTRODUCTION: The primary purposes of preventive child health care in Denmark are to help ensure a healthy childhood and to create preconditions for a healthy adult life. The aim of this study is to examine whether participation in age-appropriate preventative child health care affects...... the number of contacts with a specialist in 2006 was related to participation in preventive child health care between 2002 and 2005. To control for the potential effect of difference in GP behaviour the data were analysed using a multilevel Poisson model linking each child to the GP with whom he or she...... was listed. RESULTS: If the children attended any preventive child health care visits, they had the same probability of contact with a specialist regardless of the parents' income. However, children from low-income families not participating in any preventive care had a lower probability of contact...

  5. 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

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

    Science.gov (United States)

    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.

  7. 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)

  8. 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

  9. Participation of architect-engineering companies in management of hospital and research centre wastes-management optimization and application of exemption

    International Nuclear Information System (INIS)

    Andaluz Trujillano, F.

    1994-01-01

    The exemption of very-low-level rad waste from regulatory control for conventional removal and treatment is a management possibility admitted by the international radiological protection authorities ICRP and IAEA, and taken into a account in the regulations of the EC and its member countries. This form of management facilities the removal of very-low-level waste from the facilities generating it and resolves the problems of its interim storage. The paper explains, in the first place, how architect-engineering companies which known the study methodologies contribute to the exemption of wastes, and gives a panoramic view of these methodologies. Next, a description is given of EMPRESARIOS AGRUPADOS (EA's) experience in declassification of wastes and the work it has carried out in Spain for ENRESA and the SEPR, and internationally, for the EC. The following aspects are highlighted: - Preparation of a work method - Characterization and quantification at national level of rad waste from hospitals and laboratories - Feasibility study on exemption at national level of various rad waste streams and other disposal radioactive materials originated by NPPs and small producers - Study for the EC on the feasibility of exemption by incineration of two waste stream from hospitals and laboratories; determination of reference values Finally, two practical cases of declassification of small producer's wastes are studied, showing results and practical reference values calculated for exemption (derived values). (Author)

  10. On-ward participation of a hospital pharmacist in a Dutch intensive care unit reduces prescribing errors and related patient harm: an intervention study

    NARCIS (Netherlands)

    Klopotowska, J.E.; Kuiper, R.; van Kan, H.J.; de Pont, A.C.; Dijkgraaf, M.G.; Lie-A-Huen, L.; Vroom, M.B.; Smorenburg, S.M.

    2010-01-01

    Introduction: Patients admitted to an intensive care unit (ICU) are at high risk for prescribing errors and related adverse drug events (ADEs). An effective intervention to decrease this risk, based on studies conducted mainly in North America, is on-ward participation of a clinical pharmacist in an

  11. On-ward participation of a hospital pharmacist in a Dutch intensive care unit reduces prescribing errors and related patient harm: an intervention study

    NARCIS (Netherlands)

    Klopotowska, Joanna E.; Kuiper, Rob; van Kan, Hendrikus J.; de Pont, Anne-Cornelie; Dijkgraaf, Marcel G.; Lie-A-Huen, Loraine; Vroom, Margreeth B.; Smorenburg, Susanne M.

    2010-01-01

    Patients admitted to an intensive care unit (ICU) are at high risk for prescribing errors and related adverse drug events (ADEs). An effective intervention to decrease this risk, based on studies conducted mainly in North America, is on-ward participation of a clinical pharmacist in an ICU team. As

  12. Model LPA Terpadu untuk Wilayah Surabaya Metropolitan

    Directory of Open Access Journals (Sweden)

    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.

  13. 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

  14. Patient safety climate (PSC) perceptions of frontline staff in acute care hospitals: examining the role of ease of reporting, unit norms of openness, and participative leadership.

    Science.gov (United States)

    Zaheer, Shahram; Ginsburg, Liane; Chuang, You-Ta; Grace, Sherry L

    2015-01-01

    Increased awareness regarding the importance of patient safety issues has led to the proliferation of theoretical conceptualizations, frameworks, and articles that apply safety experiences from high-reliability industries to medical settings. However, empirical research on patient safety and patient safety climate in medical settings still lags far behind the theoretical literature on these topics. The broader organizational literature suggests that ease of reporting, unit norms of openness, and participative leadership might be important variables for improving patient safety. The aim of this empirical study is to examine in detail how these three variables influence frontline staff perceptions of patient safety climate within health care organizations. A cross-sectional study design was used. Data were collected using a questionnaire composed of previously validated scales. The results of the study show that ease of reporting, unit norms of openness, and participative leadership are positively related to staff perceptions of patient safety climate. Health care management needs to involve frontline staff during the development and implementation stages of an error reporting system to ensure staff perceive error reporting to be easy and efficient. Senior and supervisory leaders at health care organizations must be provided with learning opportunities to improve their participative leadership skills so they can better integrate frontline staff ideas and concerns while making safety-related decisions. Finally, health care management must ensure that frontline staff are able to freely communicate safety concerns without fear of being punished or ridiculed by others.

  15. 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

  16. Youthification in the Metropolitan Area of Cluj

    Directory of Open Access Journals (Sweden)

    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.

  17. 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...

  18. 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.

  19. 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...

  20. Knowledge level estimation of medical workers participating in rendering of emergency medical aid to children at a pre-hospital stage

    Directory of Open Access Journals (Sweden)

    V.M. Popkov

    2010-06-01

    Full Text Available Purpose: Estimation of qualifying preparation of the doctors participating in rendering of emergency medical aid to children. Material: On the basis of the developed test cards the analysis of doctors' knowledge level of the first help on the basic questions of emergency medicine is carried out. 120 doctors are interrogated. Results compared depending on age, work experience and presence of a qualifying professional category. Results: As a whole answers of respondents were distributed as follows: unsatisfactorily - 2,6 %; satisfactorily - 7,9 %; well - 18,4 %; perfectly - 71,1 %. Distinctions in a dale of right answers on separate sections of knowledge depending on the experience and a qualifying professional category are established. The conclusion: The weakest places in preparation of experts of the first help on which it is necessary to pay special attention in courses of postdegree preparation are revealed

  1. 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,

  2. 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...

  3. 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)

  4. Suburbanization and sustainability in metropolitan Moscow.

    Science.gov (United States)

    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.

  5. Ambivalent participation

    DEFF Research Database (Denmark)

    Groes-Green, Christian

    2012-01-01

    Participation in young peoples' sexual cultures in Maputo, Mozambique led to reflections about the field dynamics of power, participation, desire, and discomfort. Structural inequalities of race, gender, and educational status resulted in informants seeing me as a morally righteous person to whom......' continued participation. I show how negotiating the risks of participation may simultaneously satisfy the desire for knowledge and curb erotic desires....

  6. 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

  7. ‘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...

  8. 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.

  9. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  11. 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 ...

  12. 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 ...

  13. Unfolding Participation

    DEFF Research Database (Denmark)

    Saad-Sulonen, Joanna; Halskov, Kim; Eriksson, Eva

    2015-01-01

    The aim of the Unfolding Participation workshop is to outline an agenda for the next 10 years of participatory design (PD) and participatory human computer interaction (HCI) research. We will do that through a double strategy: 1) by critically interrogating the concept of participation (unfolding...... the concept itself), while at the same time, 2) reflecting on the way that participation unfolds across different participatory configurations. We invite researchers and practitioners from PD and HCI and fields in which information technology mediated participation is embedded (e.g. in political studies......, urban planning, participatory arts, business, science and technology studies) to bring a plurality of perspectives and expertise related to participation....

  14. 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

  15. Understanding metropolitan patterns of daily encounters.

    Science.gov (United States)

    Sun, Lijun; Axhausen, Kay W; Lee, Der-Horng; Huang, Xianfeng

    2013-08-20

    Understanding of the mechanisms driving our daily face-to-face encounters is still limited; the field lacks large-scale datasets describing both individual behaviors and their collective interactions. However, here, with the help of travel smart card data, we uncover such encounter mechanisms and structures by constructing a time-resolved in-vehicle social encounter network on public buses in a city (about 5 million residents). Using a population scale dataset, we find physical encounters display reproducible temporal patterns, indicating that repeated encounters are regular and identical. On an individual scale, we find that collective regularities dominate distinct encounters' bounded nature. An individual's encounter capability is rooted in his/her daily behavioral regularity, explaining the emergence of "familiar strangers" in daily life. Strikingly, we find individuals with repeated encounters are not grouped into small communities, but become strongly connected over time, resulting in a large, but imperceptible, small-world contact network or "structure of co-presence" across the whole metropolitan area. Revealing the encounter pattern and identifying this large-scale contact network are crucial to understanding the dynamics in patterns of social acquaintances, collective human behaviors, and--particularly--disclosing the impact of human behavior on various diffusion/spreading processes.

  16. Planning Assignments of the Italian Metropolitan Cities. Early Trends

    Directory of Open Access Journals (Sweden)

    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.

  17. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  19. Explaining the effects of a multifaceted intervention to improve inpatient care in rural Kenyan hospitals -- interpretation based on retrospective examination of data from participant observation, quantitative and qualitative studies

    Directory of Open Access Journals (Sweden)

    English Mike

    2011-12-01

    Full Text Available Abstract Background We have reported the results of a cluster randomized trial of rural Kenyan hospitals evaluating the effects of an intervention to introduce care based on best-practice guidelines. In parallel work we described the context of the study, explored the process and perceptions of the intervention, and undertook a discrete study on health worker motivation because this was felt likely to be an important contributor to poor performance in Kenyan public sector hospitals. Here, we use data from these multiple studies and insights gained from being participants in and observers of the intervention process to provide our explanation of how intervention effects were achieved as part of an effort to better understand implementation in low-income hospital settings. Methods Initial hypotheses were generated to explain the variation in intervention effects across place, time, and effect measure (indicator based on our understanding of theory and informed by our implementation experience and participant observations. All data sources available for hospitals considered as cases for study were then examined to determine if hypotheses were supported, rejected, or required modification. Data included transcriptions of interviews and group discussions, field notes and that from the detailed longitudinal quantitative investigation. Potentially useful explanatory themes were identified, discussed by the implementing and research team, revised, and merged as part of an iterative process aimed at building more generic explanatory theory. At the end of this process, findings were mapped against a recently reported comprehensive framework for implementation research. Results A normative re-educative intervention approach evolved that sought to reset norms and values concerning good practice and promote 'grass-roots' participation to improve delivery of correct care. Maximal effects were achieved when this strategy and external support supervision helped

  20. Explaining the effects of a multifaceted intervention to improve inpatient care in rural Kenyan hospitals--interpretation based on retrospective examination of data from participant observation, quantitative and qualitative studies.

    Science.gov (United States)

    English, Mike; Nzinga, Jacinta; Mbindyo, Patrick; Ayieko, Philip; Irimu, Grace; Mbaabu, Lairumbi

    2011-12-02

    We have reported the results of a cluster randomized trial of rural Kenyan hospitals evaluating the effects of an intervention to introduce care based on best-practice guidelines. In parallel work we described the context of the study, explored the process and perceptions of the intervention, and undertook a discrete study on health worker motivation because this was felt likely to be an important contributor to poor performance in Kenyan public sector hospitals. Here, we use data from these multiple studies and insights gained from being participants in and observers of the intervention process to provide our explanation of how intervention effects were achieved as part of an effort to better understand implementation in low-income hospital settings. Initial hypotheses were generated to explain the variation in intervention effects across place, time, and effect measure (indicator) based on our understanding of theory and informed by our implementation experience and participant observations. All data sources available for hospitals considered as cases for study were then examined to determine if hypotheses were supported, rejected, or required modification. Data included transcriptions of interviews and group discussions, field notes and that from the detailed longitudinal quantitative investigation. Potentially useful explanatory themes were identified, discussed by the implementing and research team, revised, and merged as part of an iterative process aimed at building more generic explanatory theory. At the end of this process, findings were mapped against a recently reported comprehensive framework for implementation research. A normative re-educative intervention approach evolved that sought to reset norms and values concerning good practice and promote 'grass-roots' participation to improve delivery of correct care. Maximal effects were achieved when this strategy and external support supervision helped create a soft-contract with senior managers clarifying

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

    Directory of Open Access Journals (Sweden)

    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

  2. Forecasting drug utilization and expenditure in a metropolitan health region

    Directory of Open Access Journals (Sweden)

    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

  3. Internal audit risk management in metropolitan municipalities

    Directory of Open Access Journals (Sweden)

    Christo Ackermann

    2016-07-01

    Full Text Available Internal audit functions (IAFs of organisations are regarded as crucial components of the combined assurance model, alongside the audit committee, management and external auditors. The combined assurance model aims at having integrated and aligned assurance in organisations with the overall aim of maximising risk and governance oversight and control efficiencies. In this regard, internal audit plays a crucial role, insofar as it consists of experts in risk, governance and control consultancy who provide assurance to senior management and the audit committee. Audit committees are dependent on internal audit for information and their effectiveness revolves around a strong and well-resourced internal audit function which is able to aid audit committees to meet their oversight responsibilities. There is thus a growing demand for managing risk through the process of risk management and internal audit is in a perfect position to assist with the improvement of such processes. If internal auditors wish to continue being an important aspect of the combined assurance model, they need to address the critical area, amongst others, of risk management as part of their work. If not, it follows that the board, audit committees and other levels of management will remain uninformed on the status of these matters which, in turn, will negatively impact the ability of these stakeholders to discharge their responsibilities. This study therefore focuses on analysing the functioning of IAFs, with specific reference to their risk management mandate. The study followed a mixed method approach to describe internal audits risk management functioning in the big eight metropolitan municipalities in South Africa. The results show that internal audit provide a broad scope of risk management work which assist senior management in the discharge of their responsibilities. However, in the public eye, internal audits risk management functioning is scant

  4. Authoring Participation

    DEFF Research Database (Denmark)

    Papazu, Irina

    2016-01-01

    participation so central to the Renewable Energy Island project can be better understood as instances of material participation motivated first and foremost by a concern for the future of the island as a 'liveable' community; a community in which jobs and institutions are not constantly threatening to disappear...

  5. Determinants of blood-lead levels in children in Callao and Lima metropolitan area

    Directory of Open Access Journals (Sweden)

    Espinoza Rocío

    2003-01-01

    Full Text Available OBJECTIVES: To determine blood lead levels in urban populations of children (n=2 510 and women (n=874 in the early postpartum in certain districts of Lima and Callao, and to correlate those levels with particular exposures. MATERIAL AND METHODS: Between July 1998 and January 1999 cross sectional study was conducted. The study population was selected using three sampling strategies in the government operated school system and from public pediatric and maternity hospitals at Lima and Callao, Peru. Study personnel were trained to collect finger stick blood samples with a protocol that minimizes external lead contamination. Lead determinations in blood and environmental samples were performed at the study site using portable anodic striping voltamenters. To determine the simultaneous effects of different predictors on blood lead levels, multivariate regression models were used to estimate adjusted mean differences. RESULTS: The mean blood lead level in the children studied was 9.9 µg/dl ranging from I µg/dl to 64 µg/dl with 29% of the children displaying values greater than 10 µg/dl and 9.4% at levels greater than 20 µg/dl. Among the women, the mean was 3.5 µg/dl (SD=2.4 µg/dl, and 2.4% (n=21 displayed levels greater than 10 µg/dl. Important differences were observed between the sample locations, and the highest levels were documented in the port region near Callao. The mean level of blood lead in this group was 25.6 µg/dl (SD=4.6 µg/dl, while among the rest of the sample it was 7.1 µg/dl (SD=5.1 µg/dl. The presence of a mineral storage area signified a difference in exposure in excess of 13 µg/dl for children living near the port area in contrast to the other children who were not as close to such fixed sources of lead exposure. For the participants in Lima, the risk of showing levels above 10 µg/dl was associated with exposure to high vehicular traffic. CONCLUSIONS: In metropolitan Lima, we conclude that the mean blood lead levels of

  6. 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.

  7. 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.

  8. 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.

  9. 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.

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

    Science.gov (United States)

    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.

  11. Opinión de los pacientes sobre su participación en la enseñanza práctica de medicina en un hospital universitario de Brasil Opinion of patients on their participation in the practice of teaching medicine in hospital university of Brazil

    Directory of Open Access Journals (Sweden)

    R.L. Sousa-Muñoz

    2011-03-01

    Full Text Available Objetivo: Evaluar la percepción del paciente como participante de lecciones prácticas de medicina del hospital de la Universidad Federal de Paraíba (UFPB, Brasil. Pacientes y métodos: Estudio observacional de abordaje cuantitativo con realización de entrevistas de pacientes por estudiantes de la Escuela de Medicina de la UFPB. Resultados: La edad de los 54 pacientes osciló entre 20 y 77 años, 57,1% hombres, con 5,0 ± 3,6 años de escolaridad. El 87,9% dijeron que no se sentían incómodos en participar en las clases. El 43,9% indicaron que aceptarían participar incluso si presentaran un breve malestar. El 50% contestó que no se les había solicitado su consentimiento por parte de los estudiantes. Conclusiones: La percepción de los pacientes fue positiva, pero parecieron ambivalentes en algunos aspectos. Se precisan directrices para orientar la participación del paciente en la enseñanza práctica con el fin de preservar su función didáctica sin dañar al paciente.Aim: To evaluate the patient's perception as a participant of practical lessons of Medicine Hospital of the Universidade Federal da Paraíba (UFPB, Brazil. Patients and methods: An observational and qualitative study with interviews of patients by students from the School of Medicine at the UFPB. Results: The age of the 54 patients ranged from 20 to 77, 57,1% men and 5.0 ± 3.6 years of schooling, 85,7% said they were not uncomfortable in participating in classes, 51,8% indicated they would accept to participate even if you submit a brief discomfort, 50% have replied that they did not request consent by students. Conclusions: The perception of the patients was positive, but they seemed ambivalent in some ways. Guidelines for direct patient participation in teaching practice are necessary to preserve its training function, without harming the patient.

  12. 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.

  13. Hospitalization of abused and neglected children.

    Science.gov (United States)

    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.

  14. 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...

  15. 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...

  16. 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...

  17. 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

  18. Hospitals; hospitals13

    Data.gov (United States)

    University of Rhode Island Geospatial Extension Program — Hospital Facilities information was compiled from several various sources. Main source was the RI Department of Health Facilities Regulation database, License 2000....

  19. Politicising participation

    OpenAIRE

    Calderon, Camilo

    2013-01-01

    The involvement of local communities in public space planning and design processes is widely promoted as an essential element of landscape architecture and urban design practice. Despite this, there has been little theorisation of this topic within these fields. Furthermore, the implementation of ideals and principles commonly found in theory are far from becoming mainstream practice, indicating a significant gap between the theory and practice of participation. This thesis aims to contri...

  20. 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.

  1. 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...

  2. 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.

  3. 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...

  4. Disparities in Salaries: Metropolitan versus Nonmetropolitan Community College Faculty

    Science.gov (United States)

    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.…

  5. 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

  6. 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, ...

  7. 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...

  8. OXYGEN TRANSFER STUDIES AT THE MADISON METROPOLITAN SEWERAGE DISTRICT FACILITIES

    Science.gov (United States)

    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...

  9. 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...

  10. 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...

  11. 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...

  12. 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...

  13. 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 ...

  14. Claiming Participation

    DEFF Research Database (Denmark)

    Fabian, Louise; Samson, Kristine

    2015-01-01

    The article discuss the conflicts, potentials and possible alliances of do-it-yourself (DIY) urbanism when it takes the form of spontaneous place appropriations, when it is performed as participatory urban design and when it is integrated strategically in planning. DIY urbanism and experimentation...... with participation are currently strong influential factors in Danish planning. The article explores the use of participatory DIY urban design in two cases: the relocation of beer drinkers in Enghave Square and the Carlsberg City development in Copenhagen, Denmark. Carlsberg City is the most thorough Danish example...

  15. 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…

  16. Elaboração multidisciplinar e participativa de jogos de papéis: uma experiência de modelagem de acompanhamento em torno da gestão dos mananciais da Região Metropolitana de São Paulo Multidisciplinary elaboration of and participation in role-playing games: an experiment in companion modeling about catchment management in the metropolitan region of São Paulo

    Directory of Open Access Journals (Sweden)

    Raphaèle Ducrot

    2008-01-01

    Full Text Available O desenvolvimento de ferramentas de simulação, como os jogos de papéis, pressupõe a integração das várias representações e conhecimentos, o que garante a sua legitimidade e a possibilidade de os utilizar como plataforma de mediação na discussão dos conflitos socioambientais. Este artigo discute a utilização da abordagem de modelagem de acompanhamento no desenvolvimento de dois jogos de papéis sobre a gestão da água e do solo em mananciais periurbanos da Região Metropolitana de São Paulo (RMSP.The development of simulation tools like role-playing games require the integration of some knowledge and several representations which guarantee its legitimacy and the possibility to be used as a mediation platform in collective discussions about environmental conflicts. The paper presents and discusses the use of the companion modeling approach in the development of two role-playing games dealing with water and land management in the periurban catchment of the metropolitan region of São Paulo.

  17. 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

  18. 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

  19. 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.

  20. Hospital Compare

    Data.gov (United States)

    U.S. Department of Health & Human Services — Hospital Compare has information about the quality of care at over 4,000 Medicare-certified hospitals across the country. You can use Hospital Compare to find...

  1. HCAHPS - Hospital

    Data.gov (United States)

    U.S. Department of Health & Human Services — A list of hospital ratings for the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). HCAHPS is a national, standardized survey of hospital...

  2. 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

  3. 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

  4. ELECTRICITY DEMAND IN A NORTHERN MEXICO METROPOLITAN ECONOMY

    Directory of Open Access Journals (Sweden)

    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.

  5. 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

  6. 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...

  7. 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...

  8. Factors Influencing Patronage Of Medical Tourism In Metropolitan Lagos Nigeria

    OpenAIRE

    Omisore; E.O.; Agbabiaka; H. I.

    2015-01-01

    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...

  9. 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...

  10. 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...

  11. 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...

  12. 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.

  13. 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.

  14. 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)

  15. Is Urban Planning in Australia Hindered by Poor Metropolitan Governance?

    Directory of Open Access Journals (Sweden)

    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.

  16. 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.

  17. 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

  18. 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

  19. 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

  20. 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.

  1. Themes and time use by participants in general team meetings at a psychiatric day hospital Temas y utilización del tiempo por los participantes de reuniones del equipo general en un hospital día psiquiátrico Temas e utilização do tempo pelos participantes de reuniões de equipe geral em um hospital-dia psiquiátrico

    Directory of Open Access Journals (Sweden)

    Edson Arthur Scherer

    2007-10-01

    Full Text Available This naturalistic study was realized through observation and aimed to characterize general staff meetings held at a day hospital regarding theme and the professionals' participation in the use of time. We observed 21 meetings, during which 144 announcements were made and 46 issues were discussed, with greater participation in discussions by fixed team members. In 18 of these meetings, the discussed themes corresponded to daily situations registered during the weeks preceding the meetings. Our findings reveal that these meetings are inserted in the service on a regular basis. Power relations and differences in experience and technical knowledge between the different professionals seem to contribute to the higher or lower number of announcements and issues presented. As this space favors exchanges, we suggest these meetings to be used in other health services working with assistance teams.La finalidad de este estudio, configurado como una investigación naturalística conducida mediante observación, fue la de caracterizar las reuniones del equipo general de un hospital día respecto a la temática y la participación de los profesionales en la utilización del tiempo. Fueron comunicados 144 avisos y discutidos 46 asuntos en 21 reuniones observadas, con mayor participación del equipo fijo en las discusiones. En 18 de las reuniones estudiadas, los temas discutidos correspondieron a las situaciones diarias registradas durante las semanas antecedentes a las mismas. Los hallazgos muestran que estas reuniones están insertadas regularmente en el servicio. Las relaciones de poder y las diferencias de experiencia y conocimientos técnicos entre los diversos profesionales parecieron contribuir para la mayor o menor colocación de avisos y asuntos. Como son un espacio que favorece cambios, sugerimos la utilización de estas reuniones en otros servicios de salud que trabajen con equipos de atención.O presente estudo, configurado como pesquisa natural

  2. 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.

  3. [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.

  4. 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

  5. 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)

  6. [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.

  7. 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

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

    Science.gov (United States)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  10. 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...

  11. Assessing Anxiety, Depression and Psychological Wellbeing Status of Urban Elderly Under Represent of Tehran Metropolitan City

    Directory of Open Access Journals (Sweden)

    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

  12. 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

  13. Urban heat island effect on cicada densities in metropolitan Seoul

    Directory of Open Access Journals (Sweden)

    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

  14. 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

  15. Travel Models for Corridors of Metropolitan Areas Served by Railways

    Directory of Open Access Journals (Sweden)

    Brzeziński A.

    2016-12-01

    Full Text Available In recent years adverse processes of suburbanization have been observed in cities. It has become a serious challenge for urban and transport planners, as it influences largely the quality of space, the quality of life, and the cost of running the city. This paper is dedicated to travel models in areas serviced by a railway system, and is based on a real-life survey example of the Błonie community, a district belonging to the Warsaw metropolitan area. Research carried out in 2014 focused on combined travels behaviors recorded using GPS locators as well as quantitative research (volumes of users across various transport systems.

  16. The determinants of part-time work in Metropolitan Lima

    Directory of Open Access Journals (Sweden)

    Manuel Enrique Saavedra Martinez

    2011-12-01

    Full Text Available 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 studies and incomplete, and the woman has a probability of 83,11397% more than men of working part time.

  17. An audit of pregnancy outcomes in solid organ transplant recipients at a metropolitan hospital.

    Science.gov (United States)

    Fang, Yunjing E; Nayyar, Roshini; Diplock, Hayley

    2018-04-22

    Pregnancies in patients with solid organ transplants have higher rates of complications and caesarean sections (CS). To perform an audit of the pregnancy outcomes in transplant recipients, to determine the rate of CS in our cohort, the appropriate skin incision for CS in these patients and to formulate recommendations for preoperative planning. This is a retrospective cohort study. All patients who had a solid organ transplant were identified from the obstetrics database. The operation records of the transplant recipients who delivered by CS were reviewed and the de-identified data were evaluated for pregnancy outcomes. This cohort consisted of 22 women: six had simultaneous pancreas and kidney (SPK) transplants and 16 had kidney transplants. Over a ten-year period, four women had two pregnancies and one had a twin pregnancy, thus 27 babies were born. The rate of CS was 58% (n = 15) and the surgical approach in 13 of these patients was by Pfannenstiel incision. One patient had an elective midline incision at the first CS, which was repeated in the next pregnancy. Two CS were complicated by bladder injury, both occurring in SPK recipients. Patients with solid organ transplants have a higher rate of CS and SPK patients may be at a higher risk of bladder injuries during CS. Our data suggest that Pfannenstiel skin incision is still suitable for these patients. We recommend reviewing the operative details of the transplant operation and a pelvic magnetic resonance imaging for pre-operative planning. © 2018 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  18. 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.

  19. 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.

  20. 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.

  1. Spatial mismatch, wages and unemployment in metropolitan areas in Brazil

    Directory of Open Access Journals (Sweden)

    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.

  2. The Audiometric Findings among Curitiba and Metropolitan Area Students

    Directory of Open Access Journals (Sweden)

    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.

  3. PAD TECHNIQUE ON DEFORESTATION SITUATION ON PETROPOLIS’ METROPOLITAN AREA - RJ

    Directory of Open Access Journals (Sweden)

    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

  4. 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

  5. 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...

  6. 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...

  7. 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...

  8. 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...

  9. 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...

  10. 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...

  11. 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...

  12. 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...

  13. 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...

  14. 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...

  15. 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...

  16. 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...

  17. 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...

  18. 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...

  19. 40 CFR 81.89 - Metropolitan Cheyenne Intrastate Air Quality Control Region.

    Science.gov (United States)

    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...

  20. 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...

  1. 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...

  2. 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.

  3. 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.

  4. 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...

  5. 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...

  6. 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

  7. 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

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

    Science.gov (United States)

    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…

  9. 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...

  10. 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...

  11. [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.

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

    Science.gov (United States)

    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.

  13. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  16. A Study of the Utility of a Participative Approach to Employee Attitude Surveys as a Management Tool at the Audie L. Murphy Memorial VA Hospital in San Antonio, Texas

    Science.gov (United States)

    1979-05-01

    Classification) A Study of the Utility of a Participative Approach to Employee Attitude Surveys as a Management Tool at the Audie L. Murphy Memoria VA...Engineering-49, Medical-38, Laboratory-32, Social Work-23, and RMS-19.) The responses of employees in all other services would be collectively identified...Laboratory 47 Social Work 78 All Others 50 TABLE 3 Positive Responses to Question Thirteen By Service Comparing responses by salary level the average positive

  17. 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

  18. 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...

  19. Causes of informal settlements in Ekurhuleni Metropolitan Municipality: An exploration

    Directory of Open Access Journals (Sweden)

    Noah K. Marutlulle

    2017-08-01

    Full Text Available This article aims to explore the causes of informal settlements in Ekurhuleni Metropolitan Municipality (EMM. The article strongly challenges the view that the cause of informal settlements in EMM and other parts of South Africa is predominantly the apartheid government and agrees with literature which provides evidence that to a larger extent, the present government, not the apartheid government, is one of the dominant causes of informal settlements. The article further establishes a common and fertile ground for the convergence of the different views and perspectives into variables which, in addition to the present government, include population growth, government economic policies, economic variables, housing shortage, unavailability of land and unaffordability as the real causes of informal settlements in EMM.

  20. Massage Therapy in Outpatient Cancer Care: A Metropolitan Area Analysis

    Science.gov (United States)

    Miccio, Robin Streit; Parikh, Bijal

    2017-01-01

    Massage offers cancer patients general quality of life benefits as well as alleviation of cancer-related symptoms/cancer-treatment–related symptoms including pain, anxiety, and fatigue. Little is known about whether massage is accessible to cancer patients who receive treatment in the outpatient setting and how massage is incorporated into the overall cancer treatment plan. Outpatient cancer centers (n = 78) in a single metropolitan area were included this mixed-methods project that included a systematic analysis of website information and a telephone survey. Massage was offered at only 40 centers (51.3% of total). A range of massage modalities were represented, with energy-based therapies (Reiki and Therapeutic Touch) most frequently provided. Although massage therapists are licensed health care providers in the states included in this analysis, massage was also provided by nurses, physical therapists, and other health care professionals. PMID:28845677

  1. Urban mobility regulation in metropolitan area of Mendoza

    Directory of Open Access Journals (Sweden)

    Lía Martínez

    2016-11-01

    Full Text Available Achieving the paradigm of sustainable urban mobility requires institutional capacities, appropriate policies and a regulatory framework that contains them. This work aims to contribute to the knowledge of the regulation of urban mobility in the metropolitan area of Mendoza. To this end, the current mobility regulations are assessed through indicators that are classified into three key areas: institutional and political organization, urban system and financial setup. The purpose is to account for the existence, or not, of regulatory capacities contained in the paradigm of sustainable mobility. Among the results, the absence of a policy of sustainable urban mobility is noteworthy, as well as the lack of sectorial coordination. Also of note is the absence of coordination between the urban planning system and the public transport provision. Lastly, in the financial sector, the results point to a promotion of sustainable transport modes but without such an explicit purpose.

  2. Atmospheric aerosol layers over Bangkok Metropolitan Region from CALIPSO observations

    Science.gov (United States)

    Bridhikitti, Arika

    2013-06-01

    Previous studies suggested that aerosol optical depth (AOD) from the Earth Observing System satellite retrievals could be used for inference of ground-level air quality in various locations. This application may be appropriate if pollution in elevated atmospheric layers is insignificant. This study investigated the significance of elevated air pollution layers over the Bangkok Metropolitan Region (BMR) from all available aerosol layer scenes taken from Cloud-Aerosol Lidar and Infrared Pathfinder Satellite Observations (CALIPSO) for years 2007 to 2011. The results show that biomass burning smoke layers alone were the most frequently observed. The smoke layers accounted for high AOD variations and increased AOD levels. In the dry seasons, the smoke layers alone with high AOD levels were likely brought to the BMR via northeasterly to easterly prevailing winds and found at altitudes above the typical BMR mixing heights of approximately 0.7 to 1.5 km. The smoke should be attributed to biomass burning emissions outside the BMR.

  3. Comparative Risk Analysis for Metropolitan Solid Waste Management Systems

    Science.gov (United States)

    Chang, Ni-Bin; Wang, S. F.

    1996-01-01

    Conventional solid waste management planning usually focuses on economic optimization, in which the related environmental impacts or risks are rarely considered. The purpose of this paper is to illustrate the methodology of how optimization concepts and techniques can be applied to structure and solve risk management problems such that the impacts of air pollution, leachate, traffic congestion, and noise increments can be regulated in the iong-term planning of metropolitan solid waste management systems. Management alternatives are sequentially evaluated by adding several environmental risk control constraints stepwise in an attempt to improve the management strategies and reduce the risk impacts in the long run. Statistics associated with those risk control mechanisms are presented as well. Siting, routing, and financial decision making in such solid waste management systems can also be achieved with respect to various resource limitations and disposal requirements.

  4. Quantum metropolitan optical network based on wavelength division multiplexing.

    Science.gov (United States)

    Ciurana, A; Martínez-Mateo, J; Peev, M; Poppe, A; Walenta, N; Zbinden, H; Martín, V

    2014-01-27

    Quantum Key Distribution (QKD) is maturing quickly. However, the current approaches to its application in optical networks make it an expensive technology. QKD networks deployed to date are designed as a collection of point-to-point, dedicated QKD links where non-neighboring nodes communicate using the trusted repeater paradigm. We propose a novel optical network model in which QKD systems share the communication infrastructure by wavelength multiplexing their quantum and classical signals. The routing is done using optical components within a metropolitan area which allows for a dynamically any-to-any communication scheme. Moreover, it resembles a commercial telecom network, takes advantage of existing infrastructure and utilizes commercial components, allowing for an easy, cost-effective and reliable deployment.

  5. Massage Therapy in Outpatient Cancer Care: A Metropolitan Area Analysis.

    Science.gov (United States)

    Cowen, Virginia S; Miccio, Robin Streit; Parikh, Bijal

    2017-10-01

    Massage offers cancer patients general quality of life benefits as well as alleviation of cancer-related symptoms/cancer-treatment-related symptoms including pain, anxiety, and fatigue. Little is known about whether massage is accessible to cancer patients who receive treatment in the outpatient setting and how massage is incorporated into the overall cancer treatment plan. Outpatient cancer centers (n = 78) in a single metropolitan area were included this mixed-methods project that included a systematic analysis of website information and a telephone survey. Massage was offered at only 40 centers (51.3% of total). A range of massage modalities were represented, with energy-based therapies (Reiki and Therapeutic Touch) most frequently provided. Although massage therapists are licensed health care providers in the states included in this analysis, massage was also provided by nurses, physical therapists, and other health care professionals.

  6. 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.

  7. Seismic Microzonation of Islamabad-Rawalpindi Metropolitan Area, Pakistan

    Science.gov (United States)

    Khan, Sarfraz; Khan, M. Asif

    2018-01-01

    Microzonation deals with classifying seismic hazards in terms of ground motions resulting from amplification of seismic waves by nature of soil profiles underlying a site, town or city. This paper presents the results of microzonation study for Islamabad metropolitan, the capital of Pakistan. Cumulative SPT- N values from geophysical borehole and microtremor (Tromino Engy Plus) data were used to classify the soils into classes C (very dense soil profile and soft rock) and D (stiff soil profile) as devised by the National Earthquake Hazard Reduction Program (NEHRP). Soil response analyses were carried out based on scaled time histories of Kashmir earthquake (2005, 0.02 g), Mangla earthquake (2006, 0.031 g) and Haripur earthquake (2010, 0.13 g) corresponding to return periods of 150, 475, 975 and 2475 years. Spectral accelerations on the ground surface are calculated by two different approaches (1) soil response analysis performed using one dimensional shear wave propagation method (equivalent linear approach); and (2) NEHRP and Borcherdt amplification factors. Microzonation maps are produced with respect to ground shaking intensity for the return periods of 150, 475, 975 and 2475 years taking into account the variation of the spectral accelerations calculated based on these two procedures. The results show that the accelerations at the ground surface in the Islamabad-Rawalpindi metropolitan are in the range of 0.40-0.48 g (for 150 years), 0.59-0.65 g (for 475 years), 0.71-0.77 g (for 975 years), and 0.92-0.94 g (for 2475 years). The amplification factors for these four hazard levels range from 0.96 to 1.38 (150 years), 0.90-1.14 (475 years), 0.85-1.04 (975 years) and 0.84-1.00 (2475 years).

  8. 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....

  9. Overweight according to geographical origin and time spent in France: a cross sectional study in the Paris metropolitan area

    Directory of Open Access Journals (Sweden)

    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.

  10. Food insecurity, a determinant of obesity? - an analysis from a population-based survey in the Paris metropolitan area, 2010.

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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

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

    Directory of Open Access Journals (Sweden)

    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.

  13. Cancer incidence in Bucaramanga Metropolitan Area, 2000-2004. First five years report from population based cancer registry of Metropolitan Area of Bucaramanga.

    Directory of Open Access Journals (Sweden)

    Erika Eliana Meza Durán

    2007-11-01

    Full Text Available Cancer is one of the most common chronic diseases that cause high morbidity and mortality. In the evaluation of all illnessand its impact on the community, a surveillance system becomes necessary to allows us to know its incidence. Cancersurveillance is achieved by the population-based cancer registry. Methodology: The Population Based Cancer Registry ofMetropolitan Area of Bucaramanga (RPC-AMB collected information from the years 2000 to 2004, in patients with anymalignant cancer the which include both invasive and in situ behavior in addition to reside within this geographical area . TheCancer Registry also collects data on brain and nervous system tumors classified as benign or those that have uncertainbehavior. Basal cell cancers of the skin were included during the two first years as well as all the intraepithelial neoplasm ofthe cervix. Active collections of information at all sources by registry staff were made (Hospitals, Health care institutions,especially oncology centers and Pathology and Hematology Laboratories and some specialist in oncology attention. Theinclusion approaches are verified and collects data on specific sociodemographic information (age, gender, residence, placeof birth, etc. and on the anatomic site of the tumor, the cell type of the cancer, behavior and extension on each individualdiagnosed with cancer. Each case was coded using the International Classification of Diseases Oncology Third Edition (ICDO-3, for topographical and morphological code. The data was entered into a computer with CanReg-4 software that is aconfigurable computer program designed for cancer registration in population-based registries and was provided as aservice by the Descriptive Epidemiology Unit to members of the International Association of Cancer Registries. This softwareprovides the number of cancer cases (frequency and the incidence rates. The quality control included exhaustiveness of thecases and information, verification of the

  14. 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.

  15. 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...

  16. 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

  17. 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.

  18. 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.

  19. 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.

  20. 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

  1. Prediction of cardiovascular disease risk among low-income urban dwellers in metropolitan Kuala Lumpur, Malaysia.

    Science.gov (United States)

    Su, Tin Tin; Amiri, Mohammadreza; Mohd Hairi, Farizah; Thangiah, Nithiah; Bulgiba, Awang; Majid, Hazreen Abdul

    2015-01-01

    We aimed to predict the ten-year cardiovascular disease (CVD) risk among low-income urban dwellers of metropolitan Malaysia. Participants were selected from a cross-sectional survey conducted in Kuala Lumpur. To assess the 10-year CVD risk, we employed the Framingham risk scoring (FRS) models. Significant determinants of the ten-year CVD risk were identified using General Linear Model (GLM). Altogether 882 adults (≥30 years old with no CVD history) were randomly selected. The classic FRS model (figures in parentheses are from the modified model) revealed that 20.5% (21.8%) and 38.46% (38.9%) of respondents were at high and moderate risk of CVD. The GLM models identified the importance of education, occupation, and marital status in predicting the future CVD risk. Our study indicated that one out of five low-income urban dwellers has high chance of having CVD within ten years. Health care expenditure, other illness related costs and loss of productivity due to CVD would worsen the current situation of low-income urban population. As such, the public health professionals and policy makers should establish substantial effort to formulate the public health policy and community-based intervention to minimize the upcoming possible high mortality and morbidity due to CVD among the low-income urban dwellers.

  2. Prediction of Cardiovascular Disease Risk among Low-Income Urban Dwellers in Metropolitan Kuala Lumpur, Malaysia

    Directory of Open Access Journals (Sweden)

    Tin Tin Su

    2015-01-01

    Full Text Available We aimed to predict the ten-year cardiovascular disease (CVD risk among low-income urban dwellers of metropolitan Malaysia. Participants were selected from a cross-sectional survey conducted in Kuala Lumpur. To assess the 10-year CVD risk, we employed the Framingham risk scoring (FRS models. Significant determinants of the ten-year CVD risk were identified using General Linear Model (GLM. Altogether 882 adults (≥30 years old with no CVD history were randomly selected. The classic FRS model (figures in parentheses are from the modified model revealed that 20.5% (21.8% and 38.46% (38.9% of respondents were at high and moderate risk of CVD. The GLM models identified the importance of education, occupation, and marital status in predicting the future CVD risk. Our study indicated that one out of five low-income urban dwellers has high chance of having CVD within ten years. Health care expenditure, other illness related costs and loss of productivity due to CVD would worsen the current situation of low-income urban population. As such, the public health professionals and policy makers should establish substantial effort to formulate the public health policy and community-based intervention to minimize the upcoming possible high mortality and morbidity due to CVD among the low-income urban dwellers.

  3. High-capacity transport, floor area ratio and its relationship with urbanization of metropolitan areas

    Energy Technology Data Exchange (ETDEWEB)

    Carvalho da Costa, B.L. de; Carvalho da Costa, F.B. de

    2016-07-01

    Most of the world’s population lives in urban areas (54%). Near 42% of the global urban population live in cities with more than 1 million inhabitants, where problems associated with urban sprawl such as informal settlement, social-economic changes, environmental degradation and deficient high-capacity transport (HCT) systems are common. Meanwhile, urbanization and its associated transportation infrastructure define the relationship between city and countryside, between the city’s inner core and the periphery, between the citizen and his right to move. This article discusses and presents an overview about the relationship between the planning and extension of HCT systems and urban planning, (in the figure of the floor-area ratio - FAR- prescribed in regulations). The methodological approach consists of drawing a conceptual framework and studying 33 different cities of metropolitan areas on five continents. It’s noticed that areas in cities with a high construction potential but with an insufficient HCT negatively influence in urban mobility and hence the right to the city. We consider right to the city the various social and fundamental rights that, among others, includes the right to public transportation. Therefore there’s a real need of an integrated approach of community participation, FAR distribution, urban planning and transportation planning and so that urbanization, inevitable these days, takes place in a fair and harmonious way. (Author)

  4. Environmental non-governmental organizations – The actions of civil society in Curitiba and Metropolitan Area

    Directory of Open Access Journals (Sweden)

    Cleusa Mara WOLSKY CARNEIRO

    2010-04-01

    Full Text Available The present article aims at achieving a diagnosis of the major actions of the environmental non-governmental organizations (NGOs that actuate in Curitiba and Metropolitan Area. It also studies the relations established by these organizations to build a place socially fair and environmental sustainable. In order to do that the main activities of these organizations in the last decades were raised through interviews with their representatives, visitations to the central office and verification of the institutional documents available. The paper explains that the NGOs search to make actions that raise a sustainable model of development, since they understand that the State reduced the participation in this sector and that the people gave them power for it. To achieve so, they need to create a net of relationships between the community, the private and public agents and the NGOs, with the objective of learn the problems, point at the solutions and to develop environmental interventions models to legitimize their actions. That way, the territoriality that these organizations seek to create depend of integrated decisions and of a continuous search of people, information and mobilization, to set up news socials actors and to ensure the development of the activities of these organizations.

  5. Hospital Inspections

    Data.gov (United States)

    U.S. Department of Health & Human Services — Welcome to hospitalinspections.org, a website run by the Association of Health Care Journalists (AHCJ) that aims to make federal hospital inspection reports easier...

  6. Education for Earthquake Disaster Prevention in the Tokyo Metropolitan Area

    Science.gov (United States)

    Oki, S.; Tsuji, H.; Koketsu, K.; Yazaki, Y.

    2008-12-01

    Japan frequently suffers from all types of disasters such as earthquakes, typhoons, floods, volcanic eruptions, and landslides. In the first half of this year, we already had three big earthquakes and heavy rainfall, which killed more than 30 people. This is not just for Japan but Asia is the most disaster-afflicted region in the world, accounting for about 90% of all those affected by disasters, and more than 50% of the total fatalities and economic losses. One of the most essential ways to reduce the damage of natural disasters is to educate the general public to let them understand what is going on during those desasters. This leads individual to make the sound decision on what to do to prevent or reduce the damage. The Ministry of Education, Culture, Sports, Science and Technology (MEXT), therefore, offered for public subscription to choose several model areas to adopt scientific education to the local elementary schools, and ERI, the Earthquake Research Institute, is qualified to develop education for earthquake disaster prevention in the Tokyo metropolitan area. The tectonic setting of this area is very complicated; there are the Pacific and Philippine Sea plates subducting beneath the North America and the Eurasia plates. The subduction of the Philippine Sea plate causes mega-thrust earthquakes such as the 1703 Genroku earthquake (M 8.0) and the 1923 Kanto earthquake (M 7.9) which had 105,000 fatalities. A magnitude 7 or greater earthquake beneath this area is recently evaluated to occur with a probability of 70 % in 30 years. This is of immediate concern for the devastating loss of life and property because the Tokyo urban region now has a population of 42 million and is the center of approximately 40 % of the nation's activities, which may cause great global economic repercussion. To better understand earthquakes in this region, "Special Project for Earthquake Disaster Mitigation in Tokyo Metropolitan Area" has been conducted mainly by ERI. It is a 4-year

  7. Radon and lung cancer in Bangalore Metropolitan, India

    International Nuclear Information System (INIS)

    Sathish, L.A.; Nethravathi, K.S.; Ramachandran, T.V.

    2012-01-01

    Radon is a radioactive gas released from the normal decay of 238 U in rocks and soil. It is an invisible, odorless, tasteless gas that seeps up through the ground and diffuses into the air. In a few areas, depending on local geology, radon dissolves into ground water and can be released into the air when the water is used. Radon gas usually exists at very low levels outdoors. However, in areas without adequate ventilation, such as underground mines, radon can accumulate to levels that substantially increase the risk of lung cancer. Radon decays quickly, giving off tiny radioactive particles. When inhaled, these radioactive particles can damage the cells that line the lung. Long-term exposure to radon can lead to lung cancer, the only cancer proven to be associated with inhaling radon. Public interest in radon has been occasionally piqued by articles in the general press. Considerable attention has been given to the high radon levels that were uncovered in the Reading Prong region of Pennsylvania, following the discovery in late 1984 of extremely high levels in one home. Several epidemiological study programmes in different countries are in progress to estimate the population exposures due to natural radiation with a view to obtain the radiation risk coefficients at low dose rate levels. In this regard, radiation surveys in high background areas (HBRAs) can provide excellent settings for epidemiological studies relating to the effects of low doses of radiation. In view of these, a comprehensive estimate of the natural inhalation dose requires both 222 Rn and 220 Rn levels in the indoor atmosphere. In this outlook an attempt is made to investigate the 222 Rn and 220 Rn levels in dwellings of Bangalore Metropolitan, India. Three year results shows that the activity concentrations of 226 Ra, 232 Th, radon in ground water, the concentrations 222 Rn and 220 Rn and the dose rate (mSvy -1 ) are at alarming levels for the environment of Bangalore Metropolitan, India. The

  8. Hospital marketing.

    Science.gov (United States)

    Carter, Tony

    2003-01-01

    This article looks at a prescribed academic framework for various criteria that serve as a checklist for marketing performance that can be applied to hospital marketing organizations. These guidelines are drawn from some of Dr. Noel Capon of Columbia University's book Marketing Management in the 21st Century and applied to actual practices of hospital marketing organizations. In many ways this checklist can act as a "marketing" balanced scorecard to verify performance effectiveness and develop opportunities for innovation.

  9. 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.

  10. Regional transportation and land use decision making in metropolitan regions : findings from four case studies.

    Science.gov (United States)

    2012-02-01

    "Throughout the United States, metropolitan regions face increasingly complex issues related to transportation and : land use. The diffuse nature of decision making creates a need to better coordinate land use and transportation to : address issues s...

  11. 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

  12. 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.

  13. 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...

  14. 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...

  15. Behavioral Risk Factors: Selected Metropolitan Area Risk Trends (SMART) MMSA Prevalence Data (2011 to Present)

    Data.gov (United States)

    U.S. Department of Health & Human Services — 2011 to present. BRFSS SMART MMSA Prevalence combined land line and cell phone data. The Selected Metropolitan Area Risk Trends (SMART) project uses the Behavioral...

  16. 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...

  17. 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...

  18. South Platte Watershed from the Headwaters to the Denver Metropolitan Area (Colorado) Systems Thinking

    Science.gov (United States)

    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

  19. 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 ...

  20. 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

  1. 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 ...

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

    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 ...

  3. 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...

  4. 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...

  5. Washington DC Metropolitan Area Drug Study Homeless and Transient Population (DC-MADST-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...

  6. 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...

  7. 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

  8. 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"

  9. 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...

  10. 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...

  11. 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...

  12. 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.

  13. 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 ...

  14. 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...

  15. 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.

  16. Benefícios da permanência de participação da mãe no cuidado ao filho hospitalizado Beneficios de la permanencia de participación de la madre en el cuidado al hijo hospitalizado Benefits of mothers' permanence and participation in the care for their hospitalized child

    Directory of Open Access Journals (Sweden)

    Rosemeire Cristina Moretto Molina

    2009-12-01

    ón por el poder cuidar del hijo. Es preciso que los enfermeros repiensen su comportamiento en lo que se refiere a la madre acompañante y adopten actitudes que favorezcan su participación en el cuidado del hijo hospitalizado.The purpose of the present study was to identify, according to the mothers' perspective, the benefits related to her permanence and participation in the care for her child hospitalized at a Pediatric Intensive Care Unit (PICU. The theoretical framework was Cross-cultural Nursing Theory, and the methodological framework was the assistant convergent research approach. Data was collected from six mothers of children hospitalized at a PICU of a University Hospital, in the period from January to May 2007, through interviews and active observation. Analysis was conducted following four generic processes: collection, synthesis, theorization and application. The results evidenced that the mothers' presence and care increased the attachment between mother and child, increased mothers' confidence, and made the child calmer. This produced positive feelings such as joy and satisfaction for being able to care for their child. Nurses should review their behavior toward the mothers accompanying their child at the hospital, and adopt attitudes that support her participation in the care for her hospitalized child.

  17. A participação do cirurgião-dentista em equipe de saúde multidisciplinar na atenção à saúde da criança no contexto hospitalar The participation of the dental surgeon in the multidisciplinary health team for child care in the hospital context

    Directory of Open Access Journals (Sweden)

    Gianina Salton Mattevi

    2011-10-01

    Full Text Available Pesquisa de abordagem qualitativa que teve como objetivo analisar as percepções da equipe de saúde e de usuários da Unidade de Internação Pediátrica do Hospital Universitário da Universidade Federal de Santa Catarina quanto à participação do cirurgião-dentista na atenção à saúde da criança hospitalizada. Os dados foram coletados em entrevistas com base em formulário composto por questões semi-estruturadas e analisados pela técnica de análise de conteúdo e pelo processo de análise-reflexão-síntese. Participaram: oito profissionais da equipe de saúde, sete acompanhantes e cinco crianças internadas. A atenção odontológica prestada a essas crianças foi desenvolvida por alunos do Curso de Graduação e do Programa de Pós-Graduação em Odontologia, através de um projeto de extensão de caráter educativo preventivo. Os resultados evidenciam a ampla aceitação e a importância da participação do cirurgião-dentista no contexto da Unidade como: membro da equipe para concretização do conceito de saúde integral; profissional de apoio à equipe nos cuidados e na dinamização e otimização do trabalho interdisciplinar. Os participantes percebem como muito importante e até fundamental a participação efetiva do cirurgião-dentista na atenção à saúde da criança hospitalizada.This is research of a qualitative nature that sought to analyze the perceptions of both the health team and users of the Pediatric Unit of the University Hospital of Santa Catarina Federal University with respect to the participation of dental surgeons in the healthcare of hospitalized children. Data were collected through interviews based on a form with semi-structured questions and analyzed by the content analysis technique and the analysis-reflection-synthesis process. Eight professionals from the health team, as well as seven caregivers and five hospitalized children took part in the interviews. The dental care provided to these

  18. 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.

  19. 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...

  20. 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...

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

    Directory of Open Access Journals (Sweden)

    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

  2. Cooling effect of rivers on metropolitan Taipei using remote sensing.

    Science.gov (United States)

    Chen, Yen-Chang; Tan, Chih-Hung; Wei, Chiang; Su, Zi-Wen

    2014-01-23

    This study applied remote sensing technology to analyze how rivers in the urban environment affect the surface temperature of their ambient areas. While surface meteorological stations can supply accurate data points in the city, remote sensing can provide such data in a two-dimensional (2-D) manner. The goal of this paper is to apply the remote sensing technique to further our understanding of the relationship between the surface temperature and rivers in urban areas. The 2-D surface temperature data was retrieved from Landsat-7 thermal infrared images, while data collected by Formosat-2 was used to categorize the land uses in the urban area. The land surface temperature distribution is simulated by a sigmoid function with nonlinear regression analysis. Combining the aforementioned data, the range of effect on the surface temperature from rivers can be derived. With the remote sensing data collected for the Taipei Metropolitan area, factors affecting the surface temperature were explored. It indicated that the effect on the developed area was less significant than on the ambient nature zone; moreover, the size of the buffer zone between the river and city, such as the wetlands or flood plain, was found to correlate with the affected distance of the river surface temperature.

  3. Water management for a megacity: Mexico City Metropolitan Area.

    Science.gov (United States)

    Tortajada, Cecilia; Castelán, Enrique

    2003-03-01

    The paper presents an overview of the present situation of the Mexico City Metropolitan Area (MCMA). The analysis indicates an urgent need to radically improve the current water supply and wastewater management practices, to become sustainable. The MCMA is one of the most rapidly growing urban centers of the world, with a population of about 21 million people, a very high rate of immigration and numerous illegal settlements. In order to meet the increasing water demand, successive governments have focused almost exclusively on supply management and engineering solutions, which have resulted in investments of hundreds of millions of USD and the construction of major infrastructure projects for interbasin water transfer. Environmental, economic and social policies associated with water management are mostly inadequate and insufficient, which is resulting in increasing deterioration in the environment, health and socioeconomic conditions of a population living in one of the largest urban agglomerations of the world. Surprisingly, however, no long-term strategies on demand-management, reuse, conservation, and improved water-management practices have been developed so far.

  4. Secular variations of radon in metropolitan Vancouver, British Columbia, Canada

    International Nuclear Information System (INIS)

    Ghomshei, M.M.; Slawson, W.F.

    1990-01-01

    In this paper sampling of radon within the soil from three sites in metropolitan Vancouver is reported. Alpha trace bi-weekly measurements during a period of 4 years show secular variations with a period of 8-15 months. There are low-radon and high-radon episodes enduring several months to a year. Average radon level during the high-radon episodes reaches 5-10 times that of the low-radon periods. During high-radon episodes the high-frequency variations show very high amplitudes. After filtering of the high-frequency fluctuations, the data from different sites demonstrate remarkably similar trends. It is suggested that along with hydrogeological events, stress relaxation in rocks, earthquake, and magma emplacement may contribute to the sources of secular variations of radon. Because of long-term variations, radon level in urban areas should be monitored on a continuous basis. Single measurements, even those integrating radiation over a period of few months, may sample a low-radon episode, and provide a false assurance, or occur during a high-radon episode and give a false alarm

  5. EVALUATION OF PRIVATE SCHOOL LOCATION IN THE ISTANBUL METROPOLITAN AREA

    Directory of Open Access Journals (Sweden)

    Mehmet TOPÇU

    2014-01-01

    Full Text Available Investment in education is considered important for economic growth and poverty alleviation. In many developed and developing countries families contribute privately to the education of their children as a result of continuously shrinking public budgets. Also, in Istanbul private primary schools were supported by the government in order to answer to increasing demand due to continuous rural migration and to create a competitive educational market to improve the quality of primary education. This paper, first, analyzes the spatial distribution of private primary schools according to the concentric rings and illustrates the gap between the center and the periphery and among the districts. Then, the relationships between the number of private primary schools and demand and the characteristics of the districts are investigated by a regression analysis. According to the results, the number of public primary schools is the most important factor and GDP per capita is the second factor to affect the number of private primary schools in the districts. Currently, the cluster of private primary schools mainly in high-income districts does not allow developing a competitive educational market at the metropolitan level. It is expected that a more balanced market will be develop as the urban structure of Istanbul adjusted to the neo-liberal economies in the future. The results are useful for urban planners, investors and policy makers. Further research is suggested to investigate the impact of private primary schools on the quality of public primary school education in Istanbul.

  6. Aspects of Land Take in the Metropolitan Area of Naples

    Directory of Open Access Journals (Sweden)

    Giuseppe Mazzeo

    2016-03-01

    Full Text Available Land take is a phenomenon of great concern nowadays because of the large number of its negative impacts regarding biological, economic and social balance. In Italy, the development of urban and other artificial land has been irreversibly transforming a non-renewable resource such as soil, regardless the almost constant population rate, with different speed depending of the region considered. The aim of this paper is to analyze the phenomenon in the metropolitan area of Naples, which is an area highly affected by territorial aggression of human matrix. The data used are both by the Institute for Environmental Protection and Research (ISPRA Report 2015 on the usage of the land and by ISTAT relating to the resident population up to the 1st of January 2015 and the extension of land for agricultural use (Census 2010. The mathematical combination of this data creates a new indicator that can be referred to as “residual land”; this residual area is of great extension with many different characteristics and it could represent the area where the phenomenon of land take most occurs. The identification, measurement and analysis of “residual land” provide new insights on the evolution of land take and this new indicator can represent a critical element to work on to prevent future land transformation and protect natural and agricultural areas within the Italian context.

  7. Marketing paediatric influenza vaccination: results of a major metropolitan trial

    Science.gov (United States)

    Van Buynder, Paul G.; Carcione, Dale; Rettura, Vince; Daly, Alison; Woods, Emily

    2010-01-01

    Please cite this paper as: Van Buynder et al. (2010) Marketing paediatric influenza vaccination: results of a major metropolitan trial. Influenza and Other Respiratory Viruses 5(1), 33–38. Objectives  After a cluster of rapidly fulminant influenza related toddler deaths in a Western Australian metropolis, children aged six to 59 months were offered influenza vaccination in subsequent winters. Some parental resistance was expected and previous poor uptake of paediatric influenza vaccination overseas was noted. A marketing campaign addressing barriers to immunization was developed to maximise uptake. Design  Advertising occurred in major statewide newspapers, via public poster displays and static ‘eye‐lite’ displays, via press releases, via a series of rolling radio advertisements, via direct marketing to child care centres, and via a linked series of web‐sites. Parents were subsequently surveyed to assess reasons for vaccination. Main Outcome Results  The campaign produced influenza vaccination coverage above that previously described elsewhere and led to a proportionate reduction in influenza notifications in this age group compared to previous seasons. Conclusions  Influenza in children comes with significant morbidity and some mortality. Paediatric influenza vaccination is safe, well tolerated and effective if two doses are given. A targeted media campaign can increase vaccine uptake if it reinforces the seriousness of influenza and addresses community ‘myths’ about influenza and influenza vaccine. The lessons learned enabling enhancements of similar programs elsewhere. PMID:21138538

  8. Characterization of aerosols in the Metropolitan Area of San Jose

    International Nuclear Information System (INIS)

    Mejias Perez, J.A.

    1997-07-01

    The objective of the present study, was to elaborate a profile of the contamination by private matter and to characterize the aerosols collected in the Metropolitan Area of San Jose (Costa Rica). For that, a campaign of sampling was carried out in three points of the city of San Jose, differentiated by there degree of activity: Center of San Jose (Central Station of Firemen), San Isidro of Coronado -Canton of Vasquez of Coronado- (Municipality) and Escazu (Municipality). Such campaign was carried out from April 4 to July 4, 1996 (transition summer-winter), and in two periods of time of 8 hours: 8 a.m. to 4 p.m. and of 8 p.m. to 4 a.m. The aerosols were collected utilizing Gent Pm-10 samplers, in filters of polycarbonate of 0,4 μm and 8 μm in cascade, with a flow average of 15 L/min., and it determined the composition average of the present aerosols. The concentration of the majority of the anions were obtained by means of ionic chromatography of high resolution, and the main cations by spectrophotometry of atomic absorption with electro thermic atomization. The space-temporary variations of the concentrations were evaluated and their correlation with the meteorologic variable. (S. Grainger) [es

  9. Emissions inventory for the Mexico City Metropolitan Area

    Energy Technology Data Exchange (ETDEWEB)

    Figueroa, V.H.P.; Renteria, J.S. [Secretaria de Medio Ambiente, Col. Tiacopac San Angel (Mexico); Hernandez, C.G. [Departamento del Distrito Federal, Col. Centro (Mexico)] [and others

    1996-12-31

    The emissions inventory bears a broad relationship to the energy balance, reflecting the dependence of the emissions with reference to the use of energy. Actually the consumption of gasoline and diesel fuel in the transport sector represents collectively, the greatest comparative expense of energy and the major contributor of the ozone precursor pollutants HC, NO{sub x} and CO, relative to the total volume of emissions in the Mexico City Metropolitan Area (MCMA). Also, the industrial sector introduces significant emissions of SO{sub 2} and NO{sub x} due to its energy consumption of fuel oils and natural gas. In contrast, the great majority of suspended particulate in the MCMA emanate from degradation processes of surface soil along the periphery of the urban zone. To the federal and local authorities charged with the design of strategies for prevention and control of atmospheric pollution, the emissions inventory is a strategic tool that reflects the relative intensity of the various emitters to the load capacity of the atmosphere. A comprehensive inventory was compiled for 1995, categorizing the emissions generated by four sectors: industry, services, transport and surface soils and vegetation, considering the following pollutants: TSP, SO{sub 2}, NO{sub x}, HC and CO. The combined pollutant emissions are 4,009,628 tons/year of which 3% are generated by the industry, 10% by the services sector, 75% by the transport sector, and 12% by surface soils and vegetation.

  10. E-book Collections in Academic Libraries of Metropolitan Tehran

    Directory of Open Access Journals (Sweden)

    Sepideh Fahimifar

    2008-04-01

    Full Text Available In the present age users not only need to have access information, but they need to have access as fast and as easy as possible. This is one of the reasons that has intensified the current ICT applications and the growing need for it. Today not only countless journals are published in electronic format side by side with their printed versions, but numerous books on diverse subjects are published elecrtronically. To better serve their patrons, academic libraries should also collect electronic books along with printed resources. Managers of academic libraries must consider acquisition of various types of electronic books and provision of facilities for accessing. The present paper initially offers the definitions offered with respect to e-books as well as the workshops held globally, researches carried out in academic libraries as well as the categories of information contained in e-books. It would then investigates the various types of e-books held in the academic libraries within metropolitan Tehran and describes the access method for students and patrons. A survey , using questionnaire as a data collection instrument, was conducted .

  11. Evaluation of sludge management alternatives in Istanbul metropolitan area.

    Science.gov (United States)

    Cakmakci, M; Erdim, E; Kinaci, C; Akca, L

    2005-01-01

    The main concern of this paper was to predict the sludge quantities generated from 18 wastewater treatment plants, which were stated to be established in the "Istanbul Water Supply, Sewerage and Drainage, Sewage Treatment and Disposal Master Plan", 10 of which are in operation at present. Besides this, obtaining the required data to compare various treatment schemes was another goal of the study. Especially, the estimation of the sludge quantity in the case of enhanced primary sedimentation was of importance. Wastewater sludge management strategies were discussed in order to develop suggestions for Istanbul Metropolitan city. Within this context, the wastewater treatment facilities, mentioned in the Master Plan that had been completed by 2000, were evaluated in terms of sludge production rates, locations and technical and management aspects. Disposal alternatives of the wastewater treatment sludge were also evaluated in this study. Using of the dewatered sludge as a landfill cover material seems the best alternative usage. Up to the year of 2040, the requirement of cover material for landfills in Istanbul will be met by the dewatered sludge originated from wastewater treatment plants in the region.

  12. Perspectives and limitations of QKD integration in metropolitan area networks.

    Science.gov (United States)

    Aleksic, Slavisa; Hipp, Florian; Winkler, Dominic; Poppe, Andreas; Schrenk, Bernhard; Franzl, Gerald

    2015-04-20

    Quantum key distribution (QKD) systems have already reached a reasonable level of maturity. However, a smooth integration and a wide adoption of commercial QKD systems in metropolitan area networks has still remained challenging because of technical and economical obstacles. Mainly the need for dedicated fibers and the strong dependence of the secret key rate on both loss budget and background noise in the quantum channel hinder a practical, flexible and robust implementation of QKD in current and next-generation optical metro networks. In this paper, we discuss these obstacles and present approaches to share existing fiber infrastructures among quantum and classical channels. Particularly, a proposal for a smooth integration of QKD in optical metro networks, which implies removing spurious background photons caused by optical transmitters, amplifiers and nonlinear effects in fibers, is presented and discussed. We determine and characterize impairments on quantum channels caused by many classical telecom channels at practically used power levels coexisting within the same fiber. Extensive experimental results are presented and indicate that a practical integration of QKD in conventional optical metro networks is possible.

  13. Metropolitan area networks: a corner stone in the broadband era

    Science.gov (United States)

    Ghanem, Adel

    1991-02-01

    Deployment of Broadband ISDN is being influenced by both a market pull and a technology push. New broadband service opportunities exist in the business and residential sectors of the market place. It is envisioned that some customers will need connections directly to broadband switches because of the high bandwidth needed for their applications. At the same time Metropolitan Area Network (MAN) systems will serve those customers with bandwidth requirements less than or equal to 150 Mbps. A given MAN will have a geographical domain to serve where it will carry out the switching tasks within this domain. While MANs couldbe designed using differentarchitecturalconcepts the setofservices expected tobeprovidedby MANs could be equivalent to thelist ofservices thatwillbe supported by the targetbroadband network. This paperpositions MANs as a major building block for Broadband networks. It also examines the evolution process ofMANs as a needed step to assure the successful deployment of these new broadband services. 2. BISDN - OVERVIEW Broadband ISDN (BISDN) is being driven into existence by both a market pull as well as a technology push. Opportunities for new valueadded services are the prime market pull for future broadband networks. These services opportunities extend beyond simple voice and low speed data applications and cover both the residential and the business sectors of the market. It is noted for instance that business customers have growing needs for sophisticated telecommunication vehicles to support their

  14. Assessment of rain water chemistry in the Lucknow metropolitan city

    Science.gov (United States)

    Sharma, Purnima; Rai, Vibhuti

    2018-05-01

    Lucknow metropolitan city is one of the most populated cities of India, which have been facing many problems such as chaotic urbanization, overpopulation, water scarcity, waterlogging, etc., among these water scarcity is one of the important problem. Rain water harvesting is a futuristic tool for mitigation of water scarcity problem through conservation and storage of rain water. This rain water can be used for all purposes by human beings, thus it is necessary to check the chemistry of rain water. The rain water samples were collected from the five zones of Lucknow city. For the comparative study, water samples have been collected from two different dates first from first rainfall and second after 3 days of interval in the second rainfall. The heavy metal concentrations were found in both first and second rainfall water samples in all zones of Lucknow city. The concentration of chromium, cadmium and lead were found to be sufficiently high in several samples. These heavy metals show the concentration above the permissible limit as set by WHO, which can cause various adverse health impacts.

  15. Water crisis: the metropolitan Atlanta, Georgia, regional water supply conflict

    KAUST Repository

    Missimer, Thomas M.

    2014-07-01

    Many large population centres are currently facing considerable difficulties with planning issues to secure future water supplies, as a result of water allocation and environmental issues, litigation, and political dogma. A classic case occurs in the metropolitan Atlanta area, which is a rapidly growing, large population centre that relies solely on surface water for supply. Lake Lanier currently supplies about 70% of the water demand and has been involved in a protracted legal dispute for more than two decades. Drought and environmental management of the reservoir combined to create a water shortage which nearly caused a disaster to the region in 2007 (only about 35 days of water supply was in reserve). While the region has made progress in controlling water demand by implementing a conservation plan, per capita use projections are still very high (at 511 L/day in 2035). Both non-potable reuse and indirect reuse of treated wastewater are contained in the most current water supply plan with up to 380,000 m3/day of wastewater treated using advanced wastewater treatment (nutrient removal) to be discharged into Lake Lanier. The water supply plan, however, includes no additional or new supply sources and has deleted any reference to the use of seawater desalination or other potential water sources which would provide diversification, thereby relying solely on the Coosa and Chattahoochee river reservoirs for the future. © 2014 IWA Publishing.

  16. Truck transport of RAM: Risk effects of avoiding metropolitan areas

    International Nuclear Information System (INIS)

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

    1997-11-01

    In the transport of radioactive material (RAM), e.g., spent nuclear fuel (SNF), stakeholders are generally most concerned about risks in high population density areas along transportation routes because of the perceived high consequences of potential accidents. The most significant portions of a transcontinental route and an alternative examined previously were evaluated again using population density data derived from US Census Block data. This method of characterizing population that adjoins route segments offers improved resolution of population density variations, especially in high population density areas along typical transport routes. Calculated incident free doses and accident dose risks for these routes, and the rural, suburban and urban segments are presented for comparison of their relative magnitudes. The results indicate that modification of this route to avoid major metropolitan areas through use of non-Interstate highways increases total risk yet does not eliminate a relatively small urban component of the accident dose risk. This conclusion is not altered by improved resolution of route segments adjoining high density populations

  17. Face Recognition by Metropolitan Police Super-Recognisers.

    Science.gov (United States)

    Robertson, David J; Noyes, Eilidh; Dowsett, Andrew J; Jenkins, Rob; Burton, A Mike

    2016-01-01

    Face recognition is used to prove identity across a wide variety of settings. Despite this, research consistently shows that people are typically rather poor at matching faces to photos. Some professional groups, such as police and passport officers, have been shown to perform just as poorly as the general public on standard tests of face recognition. However, face recognition skills are subject to wide individual variation, with some people showing exceptional ability-a group that has come to be known as 'super-recognisers'. The Metropolitan Police Force (London) recruits 'super-recognisers' from within its ranks, for deployment on various identification tasks. Here we test four working super-recognisers from within this police force, and ask whether they are really able to perform at levels above control groups. We consistently find that the police 'super-recognisers' perform at well above normal levels on tests of unfamiliar and familiar face matching, with degraded as well as high quality images. Recruiting employees with high levels of skill in these areas, and allocating them to relevant tasks, is an efficient way to overcome some of the known difficulties associated with unfamiliar face recognition.

  18. A slotted access control protocol for metropolitan WDM ring networks

    Science.gov (United States)

    Baziana, P. A.; Pountourakis, I. E.

    2009-03-01

    In this study we focus on the serious scalability problems that many access protocols for WDM ring networks introduce due to the use of a dedicated wavelength per access node for either transmission or reception. We propose an efficient slotted MAC protocol suitable for WDM ring metropolitan area networks. The proposed network architecture employs a separate wavelength for control information exchange prior to the data packet transmission. Each access node is equipped with a pair of tunable transceivers for data communication and a pair of fixed tuned transceivers for control information exchange. Also, each access node includes a set of fixed delay lines for synchronization reasons; to keep the data packets, while the control information is processed. An efficient access algorithm is applied to avoid both the data wavelengths and the receiver collisions. In our protocol, each access node is capable of transmitting and receiving over any of the data wavelengths, facing the scalability issues. Two different slot reuse schemes are assumed: the source and the destination stripping schemes. For both schemes, performance measures evaluation is provided via an analytic model. The analytical results are validated by a discrete event simulation model that uses Poisson traffic sources. Simulation results show that the proposed protocol manages efficient bandwidth utilization, especially under high load. Also, comparative simulation results prove that our protocol achieves significant performance improvement as compared with other WDMA protocols which restrict transmission over a dedicated data wavelength. Finally, performance measures evaluation is explored for diverse numbers of buffer size, access nodes and data wavelengths.

  19. 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...

  20. Observing participating observation

    DEFF Research Database (Denmark)

    Keiding, Tina Bering

    2011-01-01

    Current methodology concerning participating observation in general leaves the act of observation unobserved. Approaching participating observation from systems theory offers fundamental new insights into the topic. Observation is always participation. There is no way to escape becoming...

  1. Observing participating observation

    DEFF Research Database (Denmark)

    Keiding, Tina Bering

    2010-01-01

    Current methodology concerning participating observation in general leaves the act of observation unobserved. Approaching participating observation from systems theory offers fundamental new insights into the topic. Observation is always participation. There is no way to escape becoming...

  2. 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.

  3. 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

  4. Worker participation - the Netherlands

    OpenAIRE

    Kwantes, J.H.

    2014-01-01

    Worker participation relates to the involvement of workers in the management decision-making processes. In this article attention is focused on worker participation related to occupational safety and health in the Netherlands. Worker participation can refer either to direct or indirect participation by the worker. Indirect participation involves employee representation, while direct participation relates to individual involvement in management’s decision-making processes. In the Framework Dir...

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

    Directory of Open Access Journals (Sweden)

    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.

  6. Worker participation - the Netherlands

    NARCIS (Netherlands)

    Kwantes, J.H.

    2014-01-01

    Worker participation relates to the involvement of workers in the management decision-making processes. In this article attention is focused on worker participation related to occupational safety and health in the Netherlands. Worker participation can refer either to direct or indirect participation

  7. User Participation in Pilot Implementation

    DEFF Research Database (Denmark)

    Torkilsheyggi, Arnvør Martinsdóttir á; Hertzum, Morten

    2014-01-01

    Pilot implementations provide users with real-work experiences of how a system will affect their daily work before the design of the system is finalized. On the basis of a pilot implementation of a system for coordinating the transport of patients by hospital porters, we investigate pilot...... implementation as a method for participatory design. We find that to foster participation and learning about user needs a pilot implementation must create a space for reflecting on use, in addition to the space for using the pilot system. The space for reflection must also exist during the activities preparing...... the use of the pilot system because the porters and nurses learned about their needs throughout the pilot implementation, not just during use. Finally, we discuss how the scope and duration of a pilot implementation influence the conditions for participation....

  8. Diurnal variations of indoor radon progeny for Bangalore metropolitan, India

    International Nuclear Information System (INIS)

    Nagesh, V.; Sathish, L.A.; Nagaraja, K.; Sundareshan, S.

    2010-01-01

    Radon progenies are identified as major causes of the lung cancer if the activity is above its normal. It has not been clear whether radon poses a similar risk of causing lung cancer in humans exposed at generally lower levels found in homes, but a number of indoor radon survey have been carried out in recent years around the world. In view of this an attempt has been made for the measurement of diurnal variation of indoor radon levels for the environment of Bangalore metropolitan, India. The Radon progeny concentrations in terms of working level were measured using Kusnetz's method. The patterns of daily and annual changes in indoor Radon concentration have been observed in a general way for many years. However, understanding of the physical basis for these changes had to await the development of continuous monitors and a more complete knowledge of transport processes in the atmosphere. Over a continent, heating of the ground surface by the Sun during the day and cooling by radiation during the night causes a marked diurnal change in temperature near the surface. As a result cool air near the ground will accumulate radon isotopes from surface flux during the night; while during the day the warm air will be transported upward carrying radon with it. Many buildings show diurnal radon variations. Concentrations are relatively higher during night than daytime. This is influenced by the outdoor-indoor temperature contrast. This effect can be enhanced in buildings with strong diurnal use patterns. Buildings that have high average radon concentrations, but are only occupied for part of the day, may need to be measured during occupied periods to determine if there is significant diurnal radon variation. The results are discussed in detail. (author)

  9. Designing Freshwater Resilience for the Mexico City Metropolitan Area

    Science.gov (United States)

    Freeman, S.; Wi, S.; Brown, C.

    2017-12-01

    There are few places in the world where the water management challenges associated with global urbanization are as fully visible as in the Greater Mexico City Metropolitan Area (MCMA). MCMA has a population of 22 million of which only 82% have daily water provision and this figure is projected by local agencies to decrease drastically in the next decade due to population growth, infrastructure degradation and climate change. The city is served by a massive water delivery system, consisting of complex network of infrastructure in the surrounding basins that provides about 40% of the supply for MCMA and is characterized by increasing land use change and competition for water. The remaining 60% of MCMA's water is sourced internally from already depleted groundwater resources whose exploitation also results in significant subsidence throughout the city, further damaging already degraded infrastructure. Consequently, there is interest and need for investments that improve the performance of the freshwater delivery system, including local resources and connected basins, in the face of change and shocks that can be only partially anticipated. The quest for such resilience is a common theme in urban infrastructure design yet practical approaches for achieving it remain nascent. In this study, we use MCMA and the Cutzamala Water supply system to demonstrate a quantitative framework to evaluate investment strategies which seek resilience for the water supply system of MCMA. Multiobjective optimization and decisions under deep uncertainty approaches are used to evaluate the best performing investment portfolios across different resilience performance metrics which encompass social equity, environmental and economic objectives. This analysis shows dynamic system responses that result from different investment portfolios, elucidating difficult planning and management decisions around tradeoffs between allocations as well as performance metrics (e.g short period of total failure

  10. Household dust metal levels in The Sao Paulo metropolitan area

    International Nuclear Information System (INIS)

    Scapin, Valdirene O.; Scapin, Marcos A.; Sato, Ivone M.

    2007-01-01

    A study about household dust is being conducted to determine the level of metal contamination in the Sao Paulo Metropolitan Area (SPMA). The SPMA, with 18 million inhabitants, is one of the largest urban areas of the world, with serious environmental problems, due to the great amount of industries, heavy traffic and the disordered growth of population. The pollutants originate from a multiplicity of indoor and outdoor sources. Indoor sources are originated from residual (hair, skin scales), pets, human activities, construction materials, and furnishings as well as biological material (pollen, insect parts).and outdoor pollution, usually from the urban traffic. The pollutant mixture involved in numerous physical and chemical processes and changes its characteristics with time. Its composition and concentration depend on the strengths of indoor sources, the concentration of pollutants outside and the properties of ventilation and air-conditioning systems. It is well recognized that many metals have chronic effects on humans, in particular toddlers, who are at an higher risk compared to adults because they engage in greater hand to-mouth activity and their neurological systems are still developing. The household dust samples were collected from different localities, using vacuum cleaner, and sieved up to particle size -1 ; Mn, 119-369 μg g -1 ; Fe, 372-1464 μg g -1 ; Ni, 33-85 μg g -1 ; Cu, 42-303 μg g -1 ; Zn, 156-1369 μg g -1 and Pb, 26-160 μg g -1 . (author)

  11. Indoor radon distribution in metropolitan region of Belo Horizonte, Brazil

    International Nuclear Information System (INIS)

    Santos, Talita O.; Oliveira, Arno H. de

    2009-01-01

    Human beings are exposed to ionizing radiation from many natural sources. Radon and its progeny have been recognized as the most important contributors to the natural radioactivity dose, accounting for about half of all human exposure to ionizing radiation. Radon ( 222 Rn) is a α-radioactive noble gas derived from the natural series of uranium (2 38 U), which occurs in a wide concentration range in all geological materials, especially, in rocks, soils and waters. By diffusion and convection, radon migrates from the rocks and soils to atmosphere and through fissures, pipes and holes it may enter the dwellings and other buildings. Another important radon source in dwellings is its emanation from the construction material. The radon progeny concentration in dwellings has been receiving considerable global attention due to its potential effect in causing lung cancer if it deposited in upper respiratory tract when inhaled. This paper presents radon concentration distribution in dwellings in Metropolitan Region of Belo Horizonte - RMBH. The effective dose estimate is also presented for the RMBH inhabitants. The geological settings of the area are Archean rocks of Granitic Gnaissic Complex and of metasediments sequences of the great Precambrian unit of the Iron Quadrangle of Minas Gerais, Brazil. Radon concentration measurements were carried out with continuous detector AlphaGUARD PQ200PRO (Genitron), in passive mode and with passive detectors E-PERM R Eletret Ion Chamber-EIC. The radon progeny concentration was carried out with a solid state alpha spectroscope, the DOSEman PRO (Sarad). It was found an indoor radon concentration varying in a large range from 18.5 to 2671.4 Bq/m -3 , with an average value of 148.0 Bqm -3 and geometric mean equal to 128.2 Bqm -3 . The variable results are due mainly to region geological factors and building material composition of dwellings. The equilibrium factor between radon and its progeny were determined in dwellings, as 0.3 in

  12. 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

    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.

  13. Academic Hospitality

    Science.gov (United States)

    Phipps, Alison; Barnett, Ronald

    2007-01-01

    Academic hospitality is a feature of academic life. It takes many forms. It takes material form in the hosting of academics giving papers. It takes epistemological form in the welcome of new ideas. It takes linguistic form in the translation of academic work into other languages, and it takes touristic form through the welcome and generosity with…

  14. Hospitality and hostility in hospitals

    DEFF Research Database (Denmark)

    Jensen, Tina Blegind; Aanestad, Margunn

    2007-01-01

    The purpose of this paper is to discuss the adoption of healthcare information systems (HIS) from a user perspective. Our case study concerns how a group of orthopaedic surgeons experienced and reacted to the adoption and mandatory use of an Electronic Patient Record system in a Danish hospital. We...... propose to use the concepts of hospitality and hostility to turn our attention to the interaction between the host (the surgeons) and the guest (the information system) and consider how the boundaries between them evolved in the everyday work practices. As an alternative to previous studies on technology...

  15. 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.

  16. 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...

  17. 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.

  18. 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

  19. Biological risk among hospital housekeepers.

    Science.gov (United States)

    Ream, Priscilla Santos Ferreira; Tipple, Anaclara Ferreira Veiga; Barros, Dayane Xavier; Souza, Adenícia Custódia Silva; Pereira, Milca Severino

    2016-01-01

    Although not directly responsible for patient care, hospital housekeepers are still susceptible to accidents with biological material. The objectives of this study were to establish profile and frequency of accidents among hospital housekeepers, describe behaviors pre- and postaccident, and risk factors. This was a cross-sectional study with hospital housekeepers in Goiania, Brazil. Data were obtained from interviews and vaccination records. The observations were as follows: (1) participating workers: 94.3%; (2) incomplete hepatitis B vaccination: 1 in 3; and (3) accident rate: 26.5%, mostly percutaneous with hypodermic needles, and involved blood from an unknown source; roughly half occurred during waste management. Upon review, length of service less than 5 years, completed hepatitis B vaccination, and had been tested for anti-HBs (hepatitis B surface antigen) influenced frequency of accidents. These findings suggest that improper disposal of waste appears to enhance the risk to hospital housekeepers. All hospital workers should receive continued training with regard to waste management.

  20. Connecting Participant Observation Positions

    DEFF Research Database (Denmark)

    McCurdy, Patrick; Uldam, Julie

    2014-01-01

    In this article, we argue for the importance of considering participant observation roles in relation to both insider/outsider and overt/covert roles. Through combining key academic debates on participant observation, which have separately considered insider/outsider and overt/covert participant...... observation, we develop a reflexive framework to assist researchers in (1) locating the type of participant observation research; (2) identifying implications of participant observation for both the research and the subjects under study; and (3) reflecting on how one’s role as participant observer shifts over...

  1. 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.

  2. Understanding participation in a hospital-based HIV support group ...

    African Journals Online (AJOL)

    2009-10-04

    Oct 4, 2009 ... Access to disability grants was ... People living with HIV/AIDS (PLWHA) face significant physical ... HIV/AIDS, coping skills, women's health issues, safe sex, sleep ... emotion-regulation strategies,22 to enhance perceptions.

  3. 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.

  4. [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.

  5. 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

  6. 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

  7. 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

  8. Demand of radiopharmaceutical Fluoride 18-FDG (fluorodeoxyglucose) in the Sao Paulo State metropolitan area

    International Nuclear Information System (INIS)

    Sato, Renato C.; Zouain, Desiree M.

    2005-01-01

    This research presents partial results from the development of a Masters Dissertation for the Post-Graduation in Nuclear Technology Program - IPEN/USP, aiming to study the demand of radiopharmaceutical Fluoride 18-FDG (fluorodeoxyglucose) in the Sao Paulo State metropolitan area, as a subsidiary for the establishment of distribution strategy within the State. This study presented the results of a bibliographic review as well as the market evolution for FDG in Sao Paulo. Studies pointed to a tendency of an increase in the international and national nuclear medicine market; while the United States of America participate in 47% of the world profit, South America shares only 2.5% of the global market. This market will tend to grow in 2006 to 2020 up to 776% for diagnosis and 760% for therapy. Partial results are presented in this study from researching medical centers that use PET in the city of Sao Paulo, as well as companies that commercialize the equipment and the manufacturer center. There is an increase of sales for IPEN's Fluoride 18-FDG and its representation on the total radiopharmaceutical profit surpassed 5.3% in 2003 to 8.2% in 2004. The dissemination of this technology in Brazil is lately being discussed especially due to the acquisition price of the equipment as well as the viability of the resources (Fluoride 18- FDG; implementation strategies of regional cyclotron accelerators) and the question of remuneration of the PET produced exams for health care plans and national health care system (SUS). IPEN is developing yet another study to grasp possible demand for this product in the Southern and Southeastern regions, allowing better view of the necessity of the supplement, and in study the implementation of a new cyclotron in the institute dedicated for the production of Fluoride 18-FDG. (author)

  9. Association between body weight, physical activity and food choices among metropolitan transit workers

    Directory of Open Access Journals (Sweden)

    Hannan Peter J

    2007-11-01

    Full Text Available Abstract Background Associations between body weight, physical activity and dietary intake among a population of metropolitan transit workers are described. Methods Data were collected during October through December, 2005, as part of the baseline measures for a worksite weight gain prevention intervention in four metro transit bus garages. All garage employees were invited to complete behavioral surveys that assessed food choices and physical activity, and weight and height were directly measured. Seventy-eight percent (N = 1092 of all employees participated. Results The prevalence of obesity (BMI >= 30 kg/m2 was 56%. Over half of the transit workers reported consuming fruit (55% and vegetables (59% ≥ 3/week. Reported fast food restaurant frequency was low (13% visited ≥ 3/week. Drivers reported high levels of physical activity (eg. walking 93 minutes/day. However, an objective measure of physical activity measured only 16 minutes moderate/vigorous per day. Compared to other drivers, obese drivers reported significantly less vigorous physical activity, more time sitting, and more time watching television. Healthy eating, physical activity and weight management were perceived to be difficult at the worksite, particularly among obese transit workers, and perceived social support for these behaviors was modest. However, most workers perceived weight management and increased physical activity to be personally important for their health. Conclusion Although transit workers' self-report of fruit and vegetable intake, and physical activity was high, perceived access to physical activity and healthful eating opportunities at the worksite was low. Obese workers were significantly less physically active and were more likely to report work environmental barriers to physical activity.

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

    Science.gov (United States)

    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.

  11. 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

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

    Directory of Open Access Journals (Sweden)

    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.

  13. 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.

  14. Labor Force Participation Rate

    Data.gov (United States)

    City and County of Durham, North Carolina — This thematic map presents the labor force participation rate of working-age people in the United States in 2010. The 2010 Labor Force Participation Rate shows the...

  15. 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

  16. Hospital Malnutrition

    OpenAIRE

    Asumadu-Sarkodie, Samuel

    2012-01-01

    Malnutrition seen in hospitals usually occurs as some form of protein-energy malnutrition (PEM). Primary PEM results from an acute or chronic deficiency of both protein and calories. Secondary PEM, or cachexia, results from a disease or medical condition such as cancer or gastrointestinal disease that alters requirements or impairs utilization of nutrients. This record was migrated from the OpenDepot repository service in June, 2017 before shutting down.

  17. A highly attennuative zone beneath the Tokyo Metropolitan area.

    Science.gov (United States)

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

    2014-12-01

    The intensities of seismic waves observed at the dense seismic array of the Tokyo Metropolitan Seismic Observation network (MeSO-net) inside the Kanto basin, display unusual distribution patterns. In several occasions, the highest intensities are not observed in the area above an earthquakes hypocenter but appear sifted more than 20 km away. In order to understand the source of this unusual intensity distribution pattern, it is crucial to understand how the waves attenuate before they reach the surface. The attenuation of seismic waves along their path is represented by the t∗ attenuation operator that can be obtained by fitting the observed seismic wave spectrum to a theoretical spectrum using an ω2 model. In order to create a high quality dataset, only 1449 earthquakes that are recorded with intensity greater than 0 in the Japan Meteorological Agency (JMA) intensity scale are selected from the JMA unified earthquake list from April 1st 2008 to October 2nd 2013. A grid search method is applied to determine the t∗ values by matching the observed and theoretical spectra. The t∗ data where then inverted to estimate a 3D Q structure with grid points set at a 10 km spacing. We implemented the 3D velocity model estimated by Nakagawa et al., 2012 and in addition we set the initial Q values at 100 for the 0 km grids and to 400 for the grids below them. The obtained model suggests average Q values of 50˜100 inside the Kanto basin. Furthermore, a low Q zone is observed in the area where the Philippine Sea plate meets the upper part of the Pacific sea plate. This area is located at approximately 40 km depth, beneath the north-east Tokyo and west Chiba prefectures and is represented by Q values Earthquakes occurring on the Pacific plate pass through this low Q area inside the Philippine sea plate and are attenuated significantly. The estimated attenuation distribution at the MeSO-net station for these earthquakes implementing our 3D Q model greatly coincides with the

  18. Participation in adult learning

    DEFF Research Database (Denmark)

    Desjardins, Richard

    2010-01-01

    This entry presents an internationally comparative overview of adult learning patterns. Emphasis is placed on who is participating in adult learning and the observed unequal chances to participate. The entry covers three overarching questions that are central to participation research: a) What...

  19. User participation in implementation

    DEFF Research Database (Denmark)

    Fleron, Benedicte; Rasmussen, Rasmus; Simonsen, Jesper

    2012-01-01

    Systems development has been claimed to benefit from user participation, yet user participation in implementation activities may be more common and is a growing focus of participatory-design work. We investigate the effect of the extensive user participation in the implementation of a clinical...... experienced more uncertainty and frustration than management and non-participating staff, especially concerning how to run an implementation process and how to understand and utilize the configuration possibilities of the system. This suggests that user participation in implementation introduces a need...

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

    Directory of Open Access Journals (Sweden)

    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.

  1. 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...

  2. 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)

  3. 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.

  4. 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...

  5. 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.

  6. [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.

  7. Health professionals' experience of teamwork education in acute hospital settings: a systematic review of qualitative literature.

    Science.gov (United States)

    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

  8. 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...

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

    Directory of Open Access Journals (Sweden)

    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.

  10. The Role of Great Cities in Romania for the Metropolitan Development

    Directory of Open Access Journals (Sweden)

    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.

  11. 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)

  12. Paramedic identification of acute pulmonary edema in a metropolitan ambulance service.

    Science.gov (United States)

    Williams, Teresa A; Finn, Judith; Celenza, Antonio; Teng, Tiew-Hwa; Jacobs, Ian G

    2013-01-01

    Acute pulmonary edema (APE) is a common cause of acute dyspnea. In the prehospital setting, it is often difficult to differentiate APE from other causes of shortness of breath (SOB). Radiography and echocardiography aid in the identification of APE but are often not available. There is little information on how accurately ambulance paramedics identify patients with APE. Objectives. This study aimed to 1) describe the prehospital clinical presentation and management of patients with a clinical diagnosis of APE and 2) compare the accuracy of coding of APE by paramedics against the emergency department (ED) medical discharge diagnosis. This study included a retrospective cohort of all patients who had episodes identified as APE by ambulance paramedics and were transported to a metropolitan hospital ED in 2011. Two databases were used: an ambulance database and the Emergency Department Information System. The ED medical discharge diagnosis (using International Statistical Classification of Diseases and Related Problems, 10th Revision, Australian Modification [ICD-10-AM] codes) was used as the comparator with paramedic-assigned problem codes for APE. The outcomes for the study were the positive predictive value, i.e., the proportion of patients identified as having APE in the ambulance database who also had an ED discharge diagnosis of APE, and the sensitivity of paramedic identification of APE, i.e., the proportion of patients with an ED discharge diagnosis of APE that were correctly identified as APE by the ambulance paramedics. Four hundred ninety-five patients were transported to an ED with APE identified by the paramedics as the primary problem code. Shortness of breath, crepitations, high systolic blood pressure, and chest pain were the most common presenting signs and symptoms. Pink frothy sputum was rare (3% of patient episodes of APE). One hundred eighty-six patients received an ED discharge diagnosis of APE, i.e., a positive predictive value of 41%. Of 631 ED

  13. Hospital Value-Based Purchasing (HVBP) – Total Performance Score

    Data.gov (United States)

    U.S. Department of Health & Human Services — A list of hospitals participating in the Hospital VBP Program and their Clinical Process of Care domain scores, Patient Experience of Care dimension scores, and...

  14. Hospital Value-Based Purchasing (HVBP) – Heart Failure Scores

    Data.gov (United States)

    U.S. Department of Health & Human Services — A list of hospitals participating in the Hospital VBP Program and their performance rates and scores for the Clinical Process of Care Heart Failure measures.

  15. 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

  16. 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…

  17. New aerosol particles formation in the Sao Paulo Metropolitan Area

    Science.gov (United States)

    Vela, Angel; Andrade, Maria de Fatima; Ynoue, Rita

    2016-04-01

    The Sao Paulo Metropolitan Area (SPMA), in the southeast region of Brazil, is considered a megalopolis comprised of Sao Paulo city and more 38 municipalities. The air pollutant emissions in the SPMA are related to the burning of the fuels: etanol, gasohol (gasoline with 25% ethanol) and diesel. According to CETESB (2013), the road vehicles contributed up to about 97, 87, and 80% of CO, VOCs and NOx emissions in 2012, respectively, being most of NOx associated to diesel combustion and most of CO and VOCs from gasohol and ethanol combustion. Studies conducted on ambient air pollution in the SPMA have shown that black carbon (BC) explains 21% of mass concentration of PM2.5 compared with 40% of organic carbon (OC), 20% of sulfates, and 12% of soil dust (Andrade et al., 2012). Most of the observed ambient PM2.5 mass concentration usually originates from precursors gases such as sulphur dioxide (SO2), ammonia (NH3), nitrogen oxides (NOx) and VOCs as well as through the physico-chemical processes such as the oxidation of low volatile hydrocarbons transferring to the condensed phase (McMurry et al., 2004). The Weather Research and Forecasting with Chemistry model (WRF-Chem; Grell et al. 2005), configured with three nested grid cells: 75, 15, and 3 km, is used as photochemical modeling to describe the physico-chemical processes leading to evolution of particles number and mass size distribution from a vehicular emission model developed by the IAG-USP laboratory of Atmospheric Processes and based on statistical information of vehicular activity. The spatial and temporal distributions of emissions in the finest grid cell are based on road density products compiled by the OpenStreetMap project and measurements performed inside tunnels in the SPMA, respectively. WRF-Chem simulation with coupled primary aerosol (dust and sea-salt) and biogenic emission modules and aerosol radiative effects turned on is conducted as the baseline simulation (Case_0) to evaluate the model

  18. 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.

  19. Public Participation Plan

    International Nuclear Information System (INIS)

    1993-07-01

    The purpose of this Public Participation Plan is to describe the US Department of Energy's (DOE) plan for involving the public in the decision-making process for the Uranium Mill Tailings Remedial Action (UMTRA) Project. The plan describes how the DOE will meet the public participation requirements of the Uranium Mill Tailings Radiation Control Act (UMTRCA) of 1978, as amended, and of the National Environmental Policy Act (NEPA) of 1969. It includes the UMTRA Project Office plans for complying with DOE Order 5440.1D and for implementing the DOE's Public Participation Policy for Environmental Restoration and Waste Management (1992) and Public Participation Guidance for Environmental Restoration and Waste Management (1993)

  20. Implementation of nutrition risk screening using the Malnutrition Universal Screening Tool across a large metropolitan health service.

    Science.gov (United States)

    Cooper, P L; Raja, R; Golder, J; Stewart, A J; Shaikh, R F; Apostolides, M; Savva, J; Sequeira, J L; Silvers, M A

    2016-12-01

    A standardised nutrition risk screening (NRS) programme with ongoing education is recommended for the successful implementation of NRS. This project aimed to develop and implement a standardised NRS and education process across the adult bed-based services of a large metropolitan health service and to achieve a 75% NRS compliance at 12 months post-implementation. A working party of Monash Health (MH) dietitians and a nutrition technician revised an existing NRS medical record form consisting of the Malnutrition Universal Screening Tool and nutrition management guidelines. Nursing staff across six MH hospital sites were educated in the use of this revised form and there was a formalised implementation process. Support from Executive Management, nurse educators and the Nutrition Risk Committee ensured the incorporation of NRS into nursing practice. Compliance audits were conducted pre- and post-implementation. At 12 months post-implementation, organisation-wide NRS compliance reached 34.3%. For those wards that had pre-implementation NRS performed by nursing staff, compliance increased from 7.1% to 37.9% at 12 months (P Audit', which is reported 6-monthly to the Nutrition Risk Committee and site Quality and Safety Committees. NRS compliance improved at MH with strong governance support and formalised implementation; however, the overall compliance achieved appears to have been affected by the complexity and diversity of multiple healthcare sites. Ongoing education, regular auditing and establishment of NRS routines and ward practices is recommended to further improve compliance. © 2016 The British Dietetic Association Ltd.

  1. 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.

  2. Impact of the mobile phone on junior high-school students' friendships in the Tokyo metropolitan area.

    Science.gov (United States)

    Kamibeppu, Kiyoko; Sugiura, Hitomi

    2005-04-01

    The proportion of having keitai (Japanese mobile phone) has increased rapidly in young children. To research how junior high school students use their own keitai and to examine the impact of using it on their psychology, especially on their friendship, we recruited 651 students, grade 8, from five public junior high schools in the Tokyo metropolitan area. Each student participant completed a questionnaire that we had created. The response rates were 88.8% (n = 578) for participants. The proportion of having their own keitai was 49.3% (n = 285) and that of not having it was 50.7% (n = 293). We found that they used it much more frequently for e-mail than as a phone. Most of them exchanged e-mails between schoolmates, and more than a half of them exchanged e-mails more than 10 times a day. Sociable students estimated that their own keitai was useful for their friendship. But they experienced some insecurity or started staying up late at night engaged in e-mail exchanges, and they thought that they could not live without their own keitai. Our findings suggest that keitai having an e-mail function play a big part in the junior high-school students' daily life, and its impact on students' friendships, psychology, or health should be discussed among students to prevent keitai addiction.

  3. An exploration of the role and scope of the clinical nurse consultant (CNC) in a metropolitan health service.

    Science.gov (United States)

    Bloomer, Melissa J; Cross, Wendy M

    2011-01-01

    Clinical nurse consultants have been a part of the nursing workforce for some time however a lack of clarity regarding this role has led to significant variations in health service expectations, workloads and scope for the Clinical nurse consultants working within this metropolitan health service. The aim of this study was to explore the role of the CNC as it is perceived by them, in the context of this health service. A qualitative approach was used for this study. Following ethics approval a single audio-taped focus group was undertaken to gather data. Guiding questions were used to elicit responses from the group, moderated by the co-investigators. The focus group was transcribed verbatim. Each researcher independently analysed the narrative data, using coding and clustering the data to develop primary and sub-themes. Whilst each participant experiences their role individually, there were four themes derived from comments expressed by the participants: 'Diversity and conflict', 'Leaders but powerless', 'Support systems' and 'The portfolio holder role'. The role of the Clinical nurse consultant is complex and diverse. The variability in the role suggests that organisational consensus of the role, scope and purpose of the CNC position has not been actualised, resulting in a lack of support systems, and an underutilisation of the Clinical nurse consultants as leaders, where they can challenge existing practice and guide future directions in care delivery.

  4. 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...

  5. 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.

  6. The Day Hospitals Organisation

    African Journals Online (AJOL)

    1974-05-25

    May 25, 1974 ... costs and the long period taken in planning before con- struction (which in itself takes ... in the Peninsula and near metropolitan Cape Town, where the old 'Free ..... At the invitation of the Red Cross War Memorial. Children's ...

  7. Student teacher training: participant motivation.

    Science.gov (United States)

    Burgess, Annette; van Diggele, Christie; Mellis, Craig

    2016-08-01

    Teaching, assessment and feedback skills are documented globally as required graduate attributes for medical students. By integrating teacher training into curricula, the importance of teaching and educational scholarship is highlighted. In this study, we used self-determination theory (SDT) to consider medical students' motivation to voluntarily participate in a short teacher training programme. Thirty-eight senior medical students were invited to attend a teacher training programme at a major tertiary teaching hospital. Participating students were asked to respond to one question: 'Why did you volunteer to take part in the teacher training course?' Self-determination theory was used as a conceptual framework to identify and code recurrent themes in the data. In total, 23/38 (61%) of invited students chose to participate in the programme, and 21/23 (91%) of the students responded to the survey. Students' motivation to participate in the teacher training programme were related to: (1) autonomy - their enjoyment of their current voluntary involvement in teaching; (2) competence - a recognition of the need for formal training and certification in teaching, and as an essential part of their future career in medicine; (3) relatedness - the joint recognition of the importance of quality in teaching, as emphasised by their own learning experiences in the medical programme. Students reported being motivated to take part in teacher training because of their enjoyment of teaching, their desire to increase the quality of teaching within medical education, their desire for formal recognition of teaching as a learned skill, plus their recognition of teaching as a requirement within the medical profession. By integrating teacher training into curricula, the importance of teaching and educational scholarship is highlighted. © 2015 John Wiley & Sons Ltd.

  8. Extent of local participation

    International Nuclear Information System (INIS)

    Albisu, F.

    1977-01-01

    After a brief historical comment on national participation on past nuclear projects, a description is made of the desirable situation to be achieved as regards local content. The reasons, the procedures and the areas for that participation (i.e., the why, how and where) are suggested, as well as the means to promote it. (orig.) [de

  9. Characterizing eParticipation

    DEFF Research Database (Denmark)

    Sanford, Clive Carlton; Rose, Jeremy

    2007-01-01

    that are considered to be highly relevant to eParticipation. We develop a definitional schema that suggests different ways of understanding an emerging research area, and use this schema to identify key academic articles that help to define eParticipation. We adapt Deetz's [(1996). Describing differences...

  10. Children's participation in research

    DEFF Research Database (Denmark)

    Broström professor m.so., Stig

    2012-01-01

    In (post) modern society children are seen as active subjects and participants who have a legitimate basis in the United Nations Convention of the Rights of the Child. As a consequence of this, children are able to play an active role in the 10 planning of/and participation in both education...

  11. Contact Quality in Participation

    DEFF Research Database (Denmark)

    Simonsen, Jesper; Jensen, Olav Storm

    2016-01-01

    We investigate the concept of participation from the perspective of quality of the contact in the communicative interactions between participants. We argue for the need for an academic-personal competence that qualifies the human contact central in all Participatory Design (PD) activities as a way...

  12. Mapping eParticipation

    DEFF Research Database (Denmark)

    Rose, Jeremy; Sanford, Clive Carlton

    2007-01-01

    The emerging research area of eParticipation can be characterized as the study of technology-facilitated citizen participation in (democratic) deliberation and decision-making. Using conventional literature study techniques, we identify 105 articles that are considered to be highly relevant to e......Participation. We develop a definitional schema that suggests different ways of understanding an emerging socio-technical research area and use this schema to map the research contributions identified. This allows us make an initial sketch of the scientific character of the area and its central concerns, theories......, and methods. We extend the analysis to define four central research challenges for the field: understanding technology and participation; the strategic challenge; the design challenge; and the evaluation challenge. This article thus contributes to a developing account of eParticipation, which will help future...

  13. 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.

  14. Hybrid Wavelength Routed and Optical Packet Switched Ring Networks for the Metropolitan Area Network

    DEFF Research Database (Denmark)

    Nord, Martin

    2005-01-01

    Increased data traffic in the metropolitan area network calls for new network architectures. This paper evaluates optical ring architectures based on optical packet switching, wavelength routing, and hybrid combinations of the two concepts. The evaluation includes overall throughput and fairness...... attractive when traffic is unbalanced....

  15. 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

  16. CHANGES IN BACTERIAL COMPOSITION OF BIOFILM IN A METROPOLITAN DRINKING WATER DISTRIBUTION SYSTEM

    Science.gov (United States)

    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...

  17. 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

  18. 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...

  19. The Metropolitan Studies Institute at USC Upstate: Translational Research that Drives Community Decision-Making

    Science.gov (United States)

    Brady, Kathleen

    2012-01-01

    The Metropolitan Studies Institute (MSI) at the University of South Carolina Upstate (USC Upstate) demonstrates a robust and unique record of community impact through community indicators research and other translational research. The MSI's work drives programmatic priorities and funding decisions, generates revenue, and increases the community's…

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

    Directory of Open Access Journals (Sweden)

    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.

  1. A Comprehensive Survey on Student Perceptions of Cyberbullying at a Major Metropolitan University

    Science.gov (United States)

    Lawler, James P.; Molluzzo, John C.

    2015-01-01

    Cyberbullying is a concern for any college or university. Digital harassment incidents are featured daily in the news. The authors of this study examine the perceptions of students on cyberbullying at a major metropolitan university. From the findings of a student survey, the authors learn of high levels of perceptions on incidents as an issue but…

  2. 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.

  3. A computerized model for integrating the physical environmental factors into metropolitan landscape planning

    Science.gov (United States)

    Julius Gy Fabos; Kimball H. Ferris

    1977-01-01

    This paper justifies and illustrates (in simplified form) a landscape planning approach to the environmental management of the metropolitan landscape. The model utilizes a computerized assessment and mapping system, which exhibits a recent advancement in computer technology that allows for greater accuracy and the weighting of different values when mapping at the...

  4. Analysis of Acculturative Stress and Sociocultural Adaptation among International Students at a Non-Metropolitan University

    Science.gov (United States)

    Mahmood, Hajara; Burke, Monica Galloway

    2018-01-01

    This quantitative descriptive study analyzed levels of acculturative stress and sociocultural adaptation among international students at a non-metropolitan university in the United States related to certain demographic characteristics. Surveys were used to measure international students' levels of acculturative stress and sociocultural adaptation,…

  5. The Evolution of a Multi-Instructional Teaching Center (MITC) in a Metropolitan University System.

    Science.gov (United States)

    Bell, David P.; Hayes, Edward J.; Hugetz, Edward T.; Ivancevich, John M.; Smith, Don N.; Woods, Molly R.

    1998-01-01

    The University of Houston (Texas) and its four campuses have adopted a "co-opetition" approach to create a multi-instructional teaching center to deliver educational programs and courses in the Houston metropolitan area. It has been found that citizens, legislators, administrators, faculty, and students all benefit, without sacrificing…

  6. Regeneration as an approach for the development of informal settlements in Cairo metropolitan

    Directory of Open Access Journals (Sweden)

    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.

  7. Teaching Language Minority Students in Los Angeles and Oslo--A Metropolitan Perspective nr 1

    Science.gov (United States)

    Kerchner, Charles Taylor; Özerk, Kamil

    2014-01-01

    Receiving, accommodation and education of children with immigrant background is one of the challenging issues in almost all the metropolitan areas in many countries. In our study we are exploring the impact of demographic changes on political agendas, legal frames, educational approaches, research findings and student achievement in the field of…

  8. Diversity and Educational Challenges in Oslo and Los Angeles--A Metropolitan Perspective nr 2

    Science.gov (United States)

    Özerk, Kamil; Kerchner, Charles Taylor

    2014-01-01

    Receiving, accommodation and education of children with immigrant background is one of the challenging issues in almost all the metropolitan areas in many countries. In our study we are exploring the impact of demographic changes on political agendas, legal frames, educational approaches, research findings and student achievement in the field of…

  9. 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.

  10. Metropolitan Foodsheds as Spatial References for a Landscape-Based Assessment of Regional Food Supply

    NARCIS (Netherlands)

    Wascher, D.M.; Eupen, van M.; Corsi, S.; Sali, G.; Zasada, I.

    2016-01-01

    The Food Planning and Innovation for Sustainable Metropolitan Regions (FOODMETRES) project strives to assess the environmental and socioeconomic impacts of food chains, with regard to the spatial, logistical, and resource dimensions of growing food as well as the questions of food safety and quality

  11. The Changing Influence of Educational Policy and Race on Metropolitan Inequality, 1970-2010

    Science.gov (United States)

    Johnson, Odis, Jr.

    2017-01-01

    Schools do not receive much recognition within urban sociological research for the role they perform in shaping the demographic, structural, and social features of neighborhoods, cities, and metropolitan areas. In contrast, this article links schools, and the racial avoidance that operates through educational policy, to the extreme economic…

  12. 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.

  13. The metropolitan park: searching for a new typology for intermediate green areas in urban fields

    NARCIS (Netherlands)

    Brinkhuijsen, M.; Velde, van der R.; Graaf, de E.; Kruit, E.; Lodder, A.

    2011-01-01

    Ongoing urbanization in metropolitan regions creates a wish for large green areas in the urban peripheries for recreational purposes. Agricultural landscapes are being replaced with woods, nature and water to provide citizens with space for outdoor recreation and other activities. Park-like settings

  14. Do Metropolitan and Nonmetropolitan Chicano Youth Differ: A Study of South Texas Teen-Agers - 1973.

    Science.gov (United States)

    Venegas, Moises; Kuvlesky, William

    Based on comparative data from two 1973 studies, this study examined whether or not the occupational and educational status projections and language usage patterns of Mexican American teenagers living in a large metropolitan area differed from those of teenagers living in isolated, relatively small nonmetropolitan places. The two separate, but…

  15. 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

  16. 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...

  17. 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

  18. 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

  19. The Neighborhood Unit: Schools, Segregation, and the Shaping of the Modern Metropolitan Landscape

    Science.gov (United States)

    Erickson, Ansley T.; Highsmith, Andrew R.

    2018-01-01

    Background/Context: In the first half of the 20th century, American policy makers at all levels of government, alongside housing and real estate industry figures, crafted mechanisms of racial exclusion that helped to segregate metropolitan residential landscapes. Although educators and historians have recognized the long-term consequences of these…

  20. Climate change impacts on extreme temperature mortality in select metropolitan areas of the United States

    Science.gov (United States)

    Projected mortality from climate change-driven impacts on extremely hot and cold days increases significantly over the 21st century in a large group of United States Metropolitan Statistical Areas. Increases in projected mortality from more hot days are greater than decreases in ...