Costs of managing urinary and faecal incontinence in a sub-acute care facility: A "bottom-up" approach

Aims: To measure accurately the direct costs of managing urinary and faecal incontinence in the sub-acute care setting. Materials and Methods: Prospective observational study was undertaken in two sub-acute care units in a metropolitan hospital. A consecutive series of 29 consecutive patients with urinary and/or faecal incontinence, who were in-patients in a geriatric rehabilitation or subacute neurologic unit underwent routine timed voiding protocol, as per usual care. Face-to-face bedside recordings of all incontinence care, with detailed cost analysis, were undertaken. Results: A total of 3,621 occasions of continence care were costed. The median time per 24 hr spent caring for incontinence per patient was 109 min (interquartile range 88-140). Isolated urinary incontinence episodes occurred in 28 patients (96.5%), mixed urinary/faecal incontinence episodes observed in 79.3%, and episodes of pure faecal incontinence were seen in 62%. The median costs of incontinence care in the sub-acute setting was $49AU per 24 hr, the major share ($41) spent on staff wages. The incontinence tasks of toileting assistance, pad changes, bed changes and catheter care were spread evenly across the three 8 hr shifts of duty. Conclusions: As our population demographics include an increasingly greater portion of the elderly, for whom long term institutional care is becoming relatively more scarce, provision of care in the sub-acute unit that may allow rehabilitation and return to home warrants scrutiny. This is the first study that delineates the costs of managing urinary and faecal incontinence in the sub-acute care setting. Such costs are substantial and place a heavy burden upon night-time carets. (C) 2004 Wiley-Liss, Inc.

Community, connection and conservation: Intangible cultural values in natural heritage - the case of Shirakami-sanchi World Heritage area

Intangible cultural heritage, according to a UNESCO definition, is 'the practices, representations, expressions as well as the knowledge and skills that communities, groups and in some cases individuals recognise as part of their cultural heritage'. Using a case study of Shirakami-sanchi World Heritage Area, this paper illustrates how the local community's conservation commitment was formed through their long-term everyday interactions with nature. Such connectivity is vital to maintaining the authentic integrity of a place that does not exclude humans. An examination of the formation of the community's conservation commitment for Shirakami reveals that it is the community's spiritual connection and place-based identity that have supported conservation, leading to the World Heritage nomination, and it is argued that the recognition of such intangible cultural heritage is vital in conservation. The challenge, then, is how to communicate such spiritual heritage today. Forms of community involvement are discussed in an attempt to answer this question.

Water, Communities and Mineral Resource Development: Understanding the Risks and Opportunities

Issues around water – its quality, use, availability and environmental value – can be a major point of tension between mineral projects and local communities. Failure to manage these issues appropriately can jeopardise the obtaining of regulatory approvals for new projects and place at risk the ‘social licence to operate’ of existing operations. Conversely, there may also be significant opportunities for companies to engage constructively with communities over water issues and to make a positive contribution to the sustainable development of these communities. Using case studies, this paper will explore the various types of social risks and opportunities associated with water and mineral resource development and identify key learnings relating to the management of these issues.

Contextual modulation involves suppression and facilitation from the center and the surround

In psychophysics, cross-orientation suppression (XOS) and cross-orientation facilitation (XOF) have been measured by investigating mask configuration on the detection threshold of a centrally placed patch of sine-wave grating. Much of the evidence for XOS and XOF comes from studies using low and high spatial frequencies, respectively, where the interactions are thought to arise from within (XOS) and outside (XOF) the footprint of the classical receptive field. We address the relation between these processes here by measuring the effects of various sizes of superimposed and annular cross-oriented masks on detection thresholds at two spatial scales (1 and 7 c/deg) and on contrast increment thresholds at 7 c/deg. A functional model of our results indicates the following (1) XOS and XOF both occur for superimposed and annular masks. (2) XOS declines with spatial frequency but XOF does not. (3) The spatial extent of the interactions does not scale with spatial frequency, meaning that surround-effects are seen primarily at high spatial frequencies. (4) There are two distinct processes involved in XOS: direct divisive suppression and modulation of self-suppression. (5) Whether XOS or XOF wins out depends upon their relative weights and mask contrast. These results prompt enquiry into the effect of spatial frequency at the single-cell level and place new constraints on image-processing models of early visual processing. © ARVO.

Paediatric 'care closer to home':stake-holder views and barriers to implementation

In this study we explore the views of NHS stakeholders on providing paediatric ‘care closer to home’ (CCTH), in community-based outpatient clinics delivered by consultants. Design: Semi-structured interviews and thematic framework analysis. Setting: UK specialist children's hospital and surrounding primary care trusts. Participants: 37 NHS stakeholders including healthcare professionals, managers, commissioners and executive team members. Results: Participants acknowledged that outreach clinics would involve a change in traditional ways of working and that the physical setting of the clinic would influence aspects of professional practice. Different models of CCTH were discussed, as were alternatives for improving access to specialist care. Participants supported CCTH as a good principle for paediatric outpatient services; however the challenges of setting up and maintaining community clinics meant they questioned how far it could be achieved in practice. Conclusions: The place of service delivery is both an issue of physical location and professional identity. Policy initiatives which ignore assumptions about place, power and identity are likely to meet with limited success.

'Er's from off:the indexicalization and enregisterment of Black Country dialect

This article considers how conscious use of dialect in writing is an intentional act and can be accounted for through the notion of enregisterment. It does this by exploring the value of dialect in social and ideological contexts in relation to a regional dialect of British speech, that of the Black Country in the West Midlands region of England. The article provides a summary of recent directions in sociolinguistic research and an overview of the Black Country speech community, including a summary of its distinctive linguistic variables. This description is then used as an external evaluation of the authenticity of written representations of Black Country speech and the items enregistered in writing. Analysis of three written texts taken from three different genres across a time span of 30 years reveals the extent to which identified linguistic features are drawn upon in each one of the three texts and the extent to which any one is enregisterd across all three. The article discusses the social and linguistic contexts within which the writing occurs by way of accounting for their enregisterment as markers of identity linked to region and place. It also considers the ways in which the texts juxtapose norms and values of those "within" the community with those from "outside" the community in ways that subvert traditional notions of linguistic hierarchy.

The meaning of ‘place’ in families’ lived experiences of paediatric outpatient care in different settings:a descriptive phenomenological study

Health service reforms in the United Kingdom have sought to ensure that children and young people who are ill receive timely, high quality and effective care as close to home as possible. Using phenomenological methods, this study examined the experience and impact of introducing new, community-based paediatric outpatient clinics from the perspective of NHS service-users. Findings reveal that paediatric outpatient ‘care closer to home’ is experienced in ways that go beyond concerns about location and proximity. For families it means care that ‘fits into their lives’ spatially, temporally and emotionally; facilitating a sense of ‘at-homeness’ within the self and within the place, through the creation of a warm and welcoming environment, and by providing timely consultations which attend to aspects of the families’ lifeworld.

Self-esteem and job satisfaction of adults with mild mental retardation in sheltered workshops and supported employment programs

A sample of 200 adults with mild mental retardation were assessed on overall job satisfaction and self-esteem using the Vocational Program Evaluation Profile and the Coopersmith Self-esteem Inventory. The subjects worked either in a sheltered workshop or in a supported employment setting. Results indicated that there was a significant relationship between self-esteem and job satisfaction for both groups of subjects. In addition, subjects who worked in supported employment reported significantly higher levels of job satisfaction also. There was also an interaction between place of residence and place of employment when looking at self-esteem; those who live in a semi-independent home and work in supported employment reported the highest levels of self-esteem. These results are discussed in terms of the social validity of supported-employment for persons with mild mental retardation. ^

An analysis of completeness and historical accuracy in the most commonly used college jazz history texts

Historical accuracy is only one of the components of a scholarly college textbook used to teach the history of jazz music. Textbooks in this field should include accurate ethnic representation of the most important musical figures as jazz is considered the only original American art form. As college and universities celebrate diversity, it is important that jazz history be accurate and complete. ^ The purpose of this study was to examine the content of the most commonly used jazz history textbooks currently used at American colleges and universities. This qualitative study utilized grounded and textual analysis to explore the existence of ethnic representation in these texts. The methods used were modeled after the work of Kane and Selden each of whom conducted a content analysis focused on a limited field of study. This study is focused on key jazz artists and composers whose work was created in the periods of early jazz (1915-1930), swing (1930-1945) and modern jazz (1945-1960). ^ This study considered jazz notables within the texts in terms of ethnic representation, authors' use of language, contributions to the jazz canon, and place in the standard jazz repertoire. Appropriate historical sections of the selected texts were reviewed and coded using predetermined rubrics. Data were then aggregated into categories and then analyzed according to the character assigned to the key jazz personalities noted in the text as well as the comparative standing afforded each personality. ^ The results of this study demonstrate that particular key African-American jazz artists and composers occupy a significant place in these texts while other significant individuals representing other ethnic groups are consistently overlooked. This finding suggests that while America and the world celebrates the quality of the product of American jazz as great musically and significant socially, many ethnic contributors are not mentioned with the result being a less than complete picture of the evolution of this American art form. ^

Life and death in the forest: Landscape agency during the Holocaust

To escape certain death during the Nazi regime, approximately eighty thousand terrorized and persecuted Eastern European Jews sought refuge in the forests surrounding their communities. Most often, their forest deaths were the result of Nazi-sponsored activities such as ghetto deportations and hunts for Jewish escapees. However, anti-Semitic partisans, partisan combat, hostile peasants, and environmental elements were also factors contributing to an estimated ninety percent fatality rate. This dissertation explored the role and meaning of forests to these Jewish fugitives. It investigated the bodily and social practices they developed to enhance their odds of survival in the forest landscape. I develop the concept of landscape agency as a response to my research question: What was it like to live and survive (or die) in the forest during the Holocaust? Moreover, it is an approach to theorizing about the humanity of space. Landscape agency builds upon a phenomenological approach to space and place that links landscape and action through bodily practices. This dissertation analyzed the fugitives' actions as functions of various forms of capital, namely economic, cultural and social. The sample included thirteen individuals who were themselves forest fugitives during the Holocaust. Face-face qualitative interviews were conducted from 2004 to 2006. Primary data from these interviews was used extensively to demonstrate the practices utilized in the fugitives' experiences with life and death in the forest. This study concluded that the odds of survival for forest fugitives were enhanced by use of landscape agency.

Immigrant high school students' in-depth understandings of the value of heritage language and bilingualism

The purpose of this research was to explore perceptions among 9 th through 12th grade students from Brazil, Haiti and Jamaica, with respect to their heritage languages: Portuguese, Haitian Creole, and Jamaican Patois. An additional purpose was to understand in greater detail possible variations of perception with respect to heritage language maintenance (or loss) in relation to one’s gender, first language, and place of birth. The research implemented semi-structured interviews with male and female adolescents with these heritage language backgrounds. Participants’ responses were recorded and transcribed. The transcriptions were analyzed via a categorizing of themes emerging from the data. Data were analyzed using inductive analysis. Three categories emerged from the inductive analysis of the data: (a) heritage language, (b) bilingualism, and (c) English as a second language. The analysis reveals that as participants learn English, they continue to value their heritage language and feel positively toward bilingualism, but differ in their preference regarding use of native language and English in a variety of contexts. There seems to be a mismatch between a positive attitude and an interest in learning their heritage language. Families and teachers, as agents, may not be helping students fully understand the advantages of bilingualism. Students seem to have a lack of understanding of bilingualism’s cognitive and bi-literacy benefits. Instead, employment seems to be perceived as the number one reason for becoming bilingual. Also, the students have a desire to add culture to the heritage language curriculum. The study was conducted at one of the most diverse and largest high schools in Palm Beach, in Palm Beach County, Florida. The results of this study imply that given the positive attitude toward heritage language and bilingualism, students need to be guided in exploring their understanding of heritage language and bilingualism. Implications for teaching and learning, as well as recommendations for further research, are included.

Experiential hospitality environments: The roles of the interior architectural features in affording meanings of place

People’s authentic sense of place is being overshadowed by less authentic experiences referred to as placelessness. Consequently, a demand for experiential interior environments has surfaced. Experiential environmental and place attachment theories suggested that the relationships between self, others, and the environment are what encourage users in creating meaningful authentic experiences. This qualitative study explored the roles of the experiential interior architectural features in affording users of hospitality environments higher-level needs, such as meanings of place. For the case study, ten participants stayed at a hotel for two nights. Participants were given a guided list of ten facets of an experience, which was insidiously structured by both experiential environmental and place attachment theories. The participants used photographs to document each of the facets on the guided list. The photos were then used during the photo elicitation interviews, which evoked additional qualitative information. Participants identified specific interior architectural features and described them using the themes associated to place attachment theories. The findings revealed that the interior architectural features might enrich the meanings a person associates with a given place. Possibly affording users higher-level needs. As a result, if an experiential interior environment allows users to foster relationships between self, others, and the physical environment, they may experience more authentic experiences and give more meanings to a place.

The short reign of Sultan Osman and other stories

A character discovering and testing the limits of his emotional or psychological range most interests me. What will he choose to do? Stay within his old boundaries? Or try and go beyond them? What does he learn about himself in the process? And, finally, what price will be exacted, either for his staying where he is, or for his choosing a new level of self-knowledge? "The Short Reign Of Sultan Osman and Other Stories" is a collection of short stories set in either the United States, Greece, or Brazil, and ranging in time from 1972 to today. Each story presents its protagonist with challenges unique to a specific time and place. In most of these stories, the protagonists are driven by an urge for love or for mastery, and these urges send them across landscapes of delusion or folly before they can arrive at some sense of self-knowledge.

Morbidity and mortality following pelvic rami fractures in an elderly Newfoundland population

Introduction: Pelvic rami fractures in the elderly are associated with significant morbidity and mortality. Despite our rapidly aging population there is a paucity of literature dealing with fractures of the pelvic rami in this age group. The purpose of this study is report mortality rates following these injuries in the Eastern region of Newfoundland. Additionally, we aim to describe and quantify the important resultant morbidity in this vulnerable elderly population . Methods: A retrospective chart review was performed of all the pelvic fractures in individuals over the age of 60 between 2000 and 2005 in the Eastern Health region of Newfoundland and Labrador. From these patients, only those with the radiographic parameters consistent with low energy pattern pelvic ring injuries were included. Excluded from the study were those with concurrent fractures of the femur. Survival data, comorbidities, injury characteristics, hospital stay, ambulatory status, and place of residence were recorded from the chart. A surrogate control group was formulated from Statistics Canada survival data for use as a survival comparison group. Results: There were 80 fractures of the pelvis identified in patients over 60 years old from 2000-2005. Of these, 43 met our inclusion/exclusion criteria and were used in our analysis. The one and five year mortalities of these patients were 16.3% (95% CI; 7.80% to 30.3%) and 58.1% (95% CI; 43.3% to 71.6%), respectively. These were both significantly different from the point estimates from our constructed age and gender matched control group from the Statistics Canada data of 6.58% (one year mortality) and 31.3% (five year mortality). Morbidity was quantified by change in ambulatory status (independent, walker/cane assisted, wheelchair) and change in residential independence (independent, assisted living, nursing home). Post fracture, 36% of patients permanently required increased ambulatory aids and 21% of patients required a permanent increase in everyday level of care. Conclusion: This study suggests that there may be significantly increased mortality and morbidity following low energy pattern pelvic rami fractures in an elderly population compared to age and gender matched controls. In contrast to previous studies describing these injuries, there is greater homogeneity in this population with respect to age and mechanism of injury. This study generates several important hypotheses for future research and in particular highlights the need for larger prospective studies to identify factors predicting the highest risk for poor outcomes in this population.

Data to Decision in a Dynamic Ocean: Robust Species Distribution Models and Spatial Decision Frameworks

Human use of the oceans is increasingly in conflict with conservation of endangered species. Methods for managing the spatial and temporal placement of industries such as military, fishing, transportation and offshore energy, have historically been post hoc; i.e. the time and place of human activity is often already determined before assessment of environmental impacts. In this dissertation, I build robust species distribution models in two case study areas, US Atlantic (Best et al. 2012) and British Columbia (Best et al. 2015), predicting presence and abundance respectively, from scientific surveys. These models are then applied to novel decision frameworks for preemptively suggesting optimal placement of human activities in space and time to minimize ecological impacts: siting for offshore wind energy development, and routing ships to minimize risk of striking whales. Both decision frameworks relate the tradeoff between conservation risk and industry profit with synchronized variable and map views as online spatial decision support systems.

For siting offshore wind energy development (OWED) in the U.S. Atlantic (chapter 4), bird density maps are combined across species with weights of OWED sensitivity to collision and displacement and 10 km2 sites are compared against OWED profitability based on average annual wind speed at 90m hub heights and distance to transmission grid. A spatial decision support system enables toggling between the map and tradeoff plot views by site. A selected site can be inspected for sensitivity to a cetaceans throughout the year, so as to capture months of the year which minimize episodic impacts of pre-operational activities such as seismic airgun surveying and pile driving.

Routing ships to avoid whale strikes (chapter 5) can be similarly viewed as a tradeoff, but is a different problem spatially. A cumulative cost surface is generated from density surface maps and conservation status of cetaceans, before applying as a resistance surface to calculate least-cost routes between start and end locations, i.e. ports and entrance locations to study areas. Varying a multiplier to the cost surface enables calculation of multiple routes with different costs to conservation of cetaceans versus cost to transportation industry, measured as distance. Similar to the siting chapter, a spatial decisions support system enables toggling between the map and tradeoff plot view of proposed routes. The user can also input arbitrary start and end locations to calculate the tradeoff on the fly.

Essential to the input of these decision frameworks are distributions of the species. The two preceding chapters comprise species distribution models from two case study areas, U.S. Atlantic (chapter 2) and British Columbia (chapter 3), predicting presence and density, respectively. Although density is preferred to estimate potential biological removal, per Marine Mammal Protection Act requirements in the U.S., all the necessary parameters, especially distance and angle of observation, are less readily available across publicly mined datasets.

In the case of predicting cetacean presence in the U.S. Atlantic (chapter 2), I extracted datasets from the online OBIS-SEAMAP geo-database, and integrated scientific surveys conducted by ship (n=36) and aircraft (n=16), weighting a Generalized Additive Model by minutes surveyed within space-time grid cells to harmonize effort between the two survey platforms. For each of 16 cetacean species guilds, I predicted the probability of occurrence from static environmental variables (water depth, distance to shore, distance to continental shelf break) and time-varying conditions (monthly sea-surface temperature). To generate maps of presence vs. absence, Receiver Operator Characteristic (ROC) curves were used to define the optimal threshold that minimizes false positive and false negative error rates. I integrated model outputs, including tables (species in guilds, input surveys) and plots (fit of environmental variables, ROC curve), into an online spatial decision support system, allowing for easy navigation of models by taxon, region, season, and data provider.

For predicting cetacean density within the inner waters of British Columbia (chapter 3), I calculated density from systematic, line-transect marine mammal surveys over multiple years and seasons (summer 2004, 2005, 2008, and spring/autumn 2007) conducted by Raincoast Conservation Foundation. Abundance estimates were calculated using two different methods: Conventional Distance Sampling (CDS) and Density Surface Modelling (DSM). CDS generates a single density estimate for each stratum, whereas DSM explicitly models spatial variation and offers potential for greater precision by incorporating environmental predictors. Although DSM yields a more relevant product for the purposes of marine spatial planning, CDS has proven to be useful in cases where there are fewer observations available for seasonal and inter-annual comparison, particularly for the scarcely observed elephant seal. Abundance estimates are provided on a stratum-specific basis. Steller sea lions and harbour seals are further differentiated by ‘hauled out’ and ‘in water’. This analysis updates previous estimates (Williams & Thomas 2007) by including additional years of effort, providing greater spatial precision with the DSM method over CDS, novel reporting for spring and autumn seasons (rather than summer alone), and providing new abundance estimates for Steller sea lion and northern elephant seal. In addition to providing a baseline of marine mammal abundance and distribution, against which future changes can be compared, this information offers the opportunity to assess the risks posed to marine mammals by existing and emerging threats, such as fisheries bycatch, ship strikes, and increased oil spill and ocean noise issues associated with increases of container ship and oil tanker traffic in British Columbia’s continental shelf waters.

Starting with marine animal observations at specific coordinates and times, I combine these data with environmental data, often satellite derived, to produce seascape predictions generalizable in space and time. These habitat-based models enable prediction of encounter rates and, in the case of density surface models, abundance that can then be applied to management scenarios. Specific human activities, OWED and shipping, are then compared within a tradeoff decision support framework, enabling interchangeable map and tradeoff plot views. These products make complex processes transparent for gaming conservation, industry and stakeholders towards optimal marine spatial management, fundamental to the tenets of marine spatial planning, ecosystem-based management and dynamic ocean management.