90 resultados para Medically Undeserved Areas


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A GIS-based computer modelling methodology was developed and applied to identify climate change adaptation issues arising in regional agricultural production systems (including forestry). Agricultural production in Australia is very susceptible to the adverse impacts of climate change due to projected shifts in rainfall and temperature. The methodology integrates land suitability analysis with uncertainty analysis and spatial (regional) optimisation to determine optimal agricultural land use at a regional scale for current and possible future climatic conditions. The approach can be used to recognise regions under threat of productivity decline, identify alternative cropping systems that may be better adapted to likely future conditions, and investigate implementation actions to improve the sub-optimal situations created by climate change. An example of how the methodology may be used is outlined through a case study involving the South West Region of Victoria, Australia. The case study provides information on the tools available to support the formulation of a regional adaptation strategy.

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Due to irrational use of natural resources, human society is facing unprecedented threats. Remote sensing is one of the essential tools to determine changes in various forms of biological diversity over time. There are many methods to determine changes in protected areas, using satellite images. In this paper after introducing different change detection methods and their advantages and disadvantages, a hybrid method is used to analyse changes in forests and protected areas in a national park. Two Landsat images of Golestan National Park in Iran (taken in 1998 and 2010) were used. This hybrid approach combines Change Vector Analysis (CVA) for flagging the occurrence of changes, followed by signature extension to assign labels to changedpixels. The main objective of this paper is to propose a method for discovering and assessing environmental threats to natural treasures.

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The literature on how to improve Indigenous access to early childhood services consists mainly of program descriptions and documented practice experience, with a limited number of formal program evaluations. Accessible early childhood services fulfil four overlapping dimensions. They are physically accessible; economically accessible (affordable); appropriate (comprehensive and non-discriminatory); and acceptable (respect and acknowledge culture).The literature suggests that there are five types of barriers to accessible early childhood services: individual; program; provider; social and neighbourhood; and cultural.It is not sufficient to just improve access—engagement strategies are also necessary to get families involved in the services that may benefit them.

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The establishment of protected corridors linking the breeding and foraging grounds of many migratory species remains deficient, particularly in the world's oceans. For example, Australia has recently established a network of Commonwealth Marine Reserves, supplementing existing State reserves, to protect a wide range of resident and migratory marine species; however, the routes used by mobile species to access these sites are often unknown. The flatback marine turtle (Natator depressus) is endemic to the continental shelf of Australia, yet information is not available about how this species uses the marine area. We used a geospatial approach to delineate a coastal corridor from 73 adult female flatback postnesting migratory tracks from four rookeries along the north-west coast of Australia. A core corridor of 1,150 km length and 30,800 km2 area was defined, of which 52 % fell within 11 reserves, leaving 48 % (of equivalent size to several Commonwealth Reserves) of the corridor outside of the reserve network. Despite limited data being available for other marine wildlife in this region, humpback whale migratory tracks overlapped with 96 % of the core corridor, while the tracks of three other species overlapped by 5-10 % (blue whales, olive ridley turtles, whale sharks). The overlap in the distribution ranges of at least 20 other marine vertebrates (dugong, cetaceans, marine turtles, sea snakes, crocodiles, sharks) with the corridor also imply potential use. In conclusion, this study provides valuable information towards proposing new locations requiring protection, as well as identifying high-priority network linkages between existing marine protected areas. © 2014 Springer-Verlag Berlin Heidelberg.

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In order to alleviate the traffic congestion and reduce the complexity of traffic control and management, it is necessary to exploit traffic sub-areas division which should be effective in planing traffic. Some researchers applied the K-Means algorithm to divide traffic sub-areas on the taxi trajectories. However, the traditional K-Means algorithms faced difficulties in processing large-scale Global Position System(GPS) trajectories of taxicabs with the restrictions of memory, I/O, computing performance. This paper proposes a Parallel Traffic Sub-Areas Division(PTSD) method which consists of two stages, on the basis of the Parallel K-Means(PKM) algorithm. During the first stage, we develop a process to cluster traffic sub-areas based on the PKM algorithm. Then, the second stage, we identify boundary of traffic sub-areas on the base of cluster result. According to this method, we divide traffic sub-areas of Beijing on the real-word (GPS) trajectories of taxicabs. The experiment and discussion show that the method is effective in dividing traffic sub-areas.

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Networks of marine protected areas (MPAs) are being adopted globally to protect ecosystems and supplement fisheries management. The state of California recently implemented a coast-wide network of MPAs, a statewide seafloor mapping program, and ecological characterizations of species and ecosystems targeted for protection by the network. The main goals of this study were to use these data to evaluate how well seafloor features, as proxies for habitats, are represented and replicated across an MPA network and how well ecological surveys representatively sampled fish habitats inside MPAs and adjacent reference sites. Seafloor data were classified into broad substrate categories (rock and sediment) and finer scale geomorphic classifications standard to marine classification schemes using surface analyses (slope, ruggedness, etc.) done on the digital elevation model derived from multibeam bathymetry data. These classifications were then used to evaluate the representation and replication of seafloor structure within the MPAs and across the ecological surveys. Both the broad substrate categories and the finer scale geomorphic features were proportionately represented for many of the classes with deviations of 1-6% and 0-7%, respectively. Within MPAs, however, representation of seafloor features differed markedly from original estimates, with differences ranging up to 28%. Seafloor structure in the biological monitoring design had mismatches between sampling in the MPAs and their corresponding reference sites and some seafloor structure classes were missed entirely. The geomorphic variables derived from multibeam bathymetry data for these analyses are known determinants of the distribution and abundance of marine species and for coastal marine biodiversity. Thus, analyses like those performed in this study can be a valuable initial method of evaluating and predicting the conservation value of MPAs across a regional network.

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OBJECTIVE: To assess the prevalence of overweight, obesity and underweight among Vietnamese adults living in urban areas of Ho Chi Minh City (HCMC), Vietnam. DESIGN: This cross-sectional survey was conducted in the local health stations of 30 randomly selected wards, which represent all 13 urban districts of HCMC, over a period of 2 months from March to April 2004. SUBJECTS: A total of 1488 participants aged 20-60 years completed the interview, physical examination and venous blood collection. MEASUREMENTS: Anthropometric measurements of body weight, height, waist and hip circumference were taken to construct indicators of adiposity including body mass index (BMI), waist circumference, and waist-to-height and waist-to-hip ratios. Both systolic and diastolic blood pressure and biochemical indicators of cardiovascular disease and type II diabetes risk (lipid profile and fasting blood glucose) were also measured. RESULTS: The age and sex standardized prevalence of overweight and obesity using Asian specific BMI cutoffs of 23.0 and 27.5 kg/m2 was 26.2 and 6.4%, respectively. The prevalence of overweight and obesity was slightly higher in females (33.6%) than males (31.6%), and progressively increased with age. The age and sex-standardized prevalence of underweight (BMI <18.5 kg/m2) among Vietnamese adults living in HCMC was 20.4%. The prevalence was slightly higher in males (22.0%) than in females (18.9%), and there was a much higher prevalence in all underweight categories in younger women than in men but this was reversed for older men. CONCLUSION: The adult population in HCMC Vietnam is in an early 'nutrition transition' with approximately equal prevalence of low and high BMI. The prevalence of overweight and obesity of Vietnamese urban adults was lower than that reported for other east and southeast Asian countries.

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Background
Much of a General Practitioner’s (GP) workload consists of managing patients with medically unexplained symptoms (MUS). GP trainees are often taking responsibility for looking after people with MUS for the first time and so are well placed to reflect on this and the preparation they have had for it; their views have not been documented in detail in the literature. This study aimed to explore GP trainees’ clinical and educational experiences of managing people presenting with MUS.
Method
A mixed methods approach was adopted. All trainees from four London GP vocational training schemes were invited to take part in a questionnaire and in-depth semi-structured interviews. The questionnaire explored educational and clinical experiences and attitudes towards MUS using Likert scales and free text responses. The interviews explored the origins of these views and experiences in more detail and documented ideas about optimising training about MUS. Interviews were analysed using the framework analysis approach.


Results

Eighty questionnaires out of 120 (67 %) were returned and a purposive sample of 15 trainees interviewed. Results suggested most trainees struggled to manage the uncertainty inherent in MUS consultations, feeling they often over-investigated or referred for their own reassurance. They described difficulty in broaching possible psychological aspects and/or providing appropriate explanations to patients for their symptoms. They thought that more preparation was needed throughout their training. Some had more positive experiences and found such consultations rewarding, usually after several consultations and developing a relationship with the patient.
Conclusion
Managing MUS is a common problem for GP trainees and results in a disproportionate amount of anxiety, frustration and uncertainty. Their training needs to better reflect their clinical experience to prepare them for managing such scenarios, which should also improve patient care.