Factory employee housing; Paul I. Landmann Manufacturing Factory; Mannheim-Neckarau Business Establishments; Factories

"Arbeiter und Mietshaeuser"

Factory employee housing; Paul I. Landmann Manufacturing Factory; Mannheim-Neckarau Business Establishments; Factories

"Arbeiter und Mietshaeuser"

Cost and outcomes of assessing patients with chest pain in an Australian emergency department

Objectives: We sought to characterise the demographics, length of admission, final diagnoses, long-term outcome and costs associated with the population who presented to an Australian emergency department (ED) with symptoms of possible acute coronary syndrome (ACS). Design, setting and participants: Prospectively collected data on ED patients presenting with suspected ACS between November 2008 and February 2011 was used, including data on presentation and at 30 days after presentation. Information on patient disposition, length of stay and costs incurred was extracted from hospital administration records. Main outcome measures: Primary outcomes were mean and median cost and length of hospital stay. Secondary outcomes were diagnosis of ACS, other cardiovascular conditions or non-cardiovascular conditions within 30 days of presentation. Results: An ACS was diagnosed in 103 (11.1%) of the 926 patients recruited. 193 patients (20.8%) were diagnosed with other cardiovascular-related conditions and 622 patients (67.2%) had non-cardiac-related chest pain. ACS events occurred in 0 and 11 (1.9%) of the low-risk and intermediate-risk groups, respectively. Ninety-two (28.0%) of the 329 high-risk patients had an ACS event. Patients with a proven ACS, high-grade atrioventricular block, pulmonary embolism and other respiratory conditions had the longest length of stay. The mean cost was highest in the ACS group ($13 509; 95% CI, $11 794–$15 223) followed by other cardiovascular conditions ($7283; 95% CI, $6152–$8415) and non-cardiovascular conditions ($3331; 95% CI, $2976–$3685). Conclusions: Most ED patients with symptoms of possible ACS do not have a cardiac cause for their presentation. The current guideline-based process of assessment is lengthy, costly and consumes significant resources. Investigation of strategies to shorten this process or reduce the need for objective cardiac testing in patients at intermediate risk according to the National Heart Foundation and Cardiac Society of Australia and New Zealand guideline is required.

Emergency Fund Building

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Emergency Fund Building

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Hospital in the Nursing Home program reduces emergency department presentations and hospital admissions from residential aged care facilities in Queensland, Australia: A quasi-experimental study

Background There has been considerable publicity regarding population ageing and hospital emergency department (ED) overcrowding. Our study aims to investigate impact of one intervention piloted in Queensland Australia, the Hospital in the Nursing Home (HiNH) program, on reducing ED and hospital attendances from residential aged care facilities (RACFs). Methods A quasi-experimental study was conducted at an intervention hospital undertaking the program and a control hospital with normal practice. Routine Queensland health information system data were extracted for analysis. Results Significant reductions in the number of ED presentations per 1000 RACF beds (rate ratio (95 % CI): 0.78 (0.67–0.92); p = 0.002), number of hospital admissions per 1000 RACF beds (0.62 (0.50–0.76); p < 0.0001), and number of hospital admissions per 100 ED presentations (0.61 (0.43–0.85); p = 0.004) were noticed in the experimental hospital after the intervention; while there were no significant differences between intervention and control hospitals before the intervention. Pre-test and post-test comparison in the intervention hospital also presented significant decreases in ED presentation rate (0.75 (0.65–0.86); p < 0.0001) and hospital admission rate per RACF bed (0.66 (0.54–0.79); p < 0.0001), and a non-significant reduction in hospital admission rate per ED presentation (0.82 (0.61–1.11); p = 0.196). Conclusions Hospital in the Nursing Home program could be effective in reducing ED presentations and hospital admissions from RACF residents. Implementation of the program across a variety of settings is preferred to fully assess the ongoing benefits for patients and any possible cost-savings.

Factors influencing sustainability of health service innovation, emergency nurse practitioner service

Escalating health care delivery costs and consumer expectations have led to a range of health service and workforce innovations in the provision of high quality cost effective patient care. This research has operationalised a theoretical framework to examine factors that influence sustainability of health service innovations, in particular, emergency nurse practitioner service. The results of this research will inform health service policy and practice for future implementation of innovative workforce models and add to the understanding of factors that influence sustainability.

What does built environment research have to do with risk mitigation, resilience and disaster recovery?

One could argue that the nature of our housing stock is a key determining factor in the ability of our citizens to manage risk, be resilient to various natural and human events, and to recover from these events. Recent research has been examining current challenges posed by our housing stock and exploring potential solutions from a range of perspectives. The aim of this paper is to discuss key findings from recent built environment research in Australia to initiate cross-sectorial discussion and debate about the implications and opportunities for other sectors such as emergency management and insurance. Three recent building research projects are discussed: - Heat waves The impact of heat waves on houses and occupants, and proposed changes to building regulations, air conditioning standards and building design, to reduce risks associated with heat waves. - Net zero energy homes Exploration of the potential benefits of a strategic optimization of building quality, energy and water efficiency, and household or community level distributed energy and water services for disaster management and recovery. - Building information Mapping of the flow of information about residential buildings, and the potential for national or regional building files (in a similar manner to personal medical records) to assist all parties to make more informed decisions that impact on housing sustainability and community resilience. The paper discusses how sustainability, environmental performance and resilience are inter-related, and can be supported by building files. It concludes with a call for increased cross-sectorial collaboration to explore opportunities for a whole-of-systems approach to our built environment that addresses a range of economic and environmental challenges as well as disaster and emergency management.

Using relationship mapping to understand sustainable housing stakeholders’ actions

The production of sustainable housing requires the cooperation of a variety of participants with different goals, needs, levels of commitment and cultures. To achieve mainstream net zero energy housing objectives, there is arguably a need for a non-linear network of collaboration between all the stakeholders. In order to create and improve such collaborative networks between stakeholders, we first need to map stakeholders’ relationships, processes, and practices. This paper discusses compares and contrasts maps of the sustainable housing production life-cycle in Australia, developed from different perspectives. The paper highlights the strengths and weaknesses of each visualization, clarifying where gaps in connectivity exist within existing industry networks. Understanding these gaps will help researchers and practitioners identify how to improve the collaboration between participants in the housing industry. This in turn may improve decision making across all stakeholder groups, leading to mainstream implementation of sustainability into the housing industry.

Assessing the integrated sustainability of a public rental housing project from the perspective of complex eco-system

Public rental housing (PRH) projects are the mainstream of China's new affordable housing policies, and their integrated sustainability has a far-reaching effect on medium-low income families' well-being and social stability. However, there are few quantitative researches on the integrated sustainability of PRH projects. Our study tries to fill this gap through proposing an assessment model of the integrated sustainability for PRH projects. First, this paper defines what the sustainability of a PRH project is. Second, after constructing the sustainable system of a PRH project from the perspective of complex eco-system, the paper explores the internal operation mechanism and the coupling mechanism among the ecological, economic and social subsystems. Third, it identifies fourteen indices to represent the sustainability system of a PRH project, including six indices of ecological subsystem, five of economic subsystem and three of social subsystem. Fourth, it qualifies the weights of three subsystems and their internal representative indices. In addition, an assessment model is established through expert surveys and analytic network process (ANP). Finally, the paper carries out an empirical research on a PRH project in Nanjing city of China, followed by suggestions to enhance the integrated sustainability. The sustainability system and its evaluation model proposed in this paper are concise and easy to understand and can provide a theoretical foundation and a scientific basis for the evaluation and optimization of PRH projects.

Change to costs and lengths of stay in the emergency department and the Brisbane protocol: An observational study

- Objective To compare health service cost and length of stay between a traditional and an accelerated diagnostic approach to assess acute coronary syndromes (ACS) among patients who presented to the emergency department (ED) of a large tertiary hospital in Australia. - Design, setting and participants This historically controlled study analysed data collected from two independent patient cohorts presenting to the ED with potential ACS. The first cohort of 938 patients was recruited in 2008–2010, and these patients were assessed using the traditional diagnostic approach detailed in the national guideline. The second cohort of 921 patients was recruited in 2011–2013 and was assessed with the accelerated diagnostic approach named the Brisbane protocol. The Brisbane protocol applied early serial troponin testing for patients at 0 and 2 h after presentation to ED, in comparison with 0 and 6 h testing in traditional assessment process. The Brisbane protocol also defined a low-risk group of patients in whom no objective testing was performed. A decision tree model was used to compare the expected cost and length of stay in hospital between two approaches. Probabilistic sensitivity analysis was used to account for model uncertainty. - Results Compared with the traditional diagnostic approach, the Brisbane protocol was associated with reduced expected cost of $1229 (95% CI −$1266 to $5122) and reduced expected length of stay of 26 h (95% CI −14 to 136 h). The Brisbane protocol allowed physicians to discharge a higher proportion of low-risk and intermediate-risk patients from ED within 4 h (72% vs 51%). Results from sensitivity analysis suggested the Brisbane protocol had a high chance of being cost-saving and time-saving. - Conclusions This study provides some evidence of cost savings from a decision to adopt the Brisbane protocol. Benefits would arise for the hospital and for patients and their families.

Studies on the Effects of Property Taxation, Rent Control and Housing Allowances

Tämä väitöskirja koostuu asuntomarkkinoiden taloustieteellistä analyysia esittelevästä johdantoluvusta ja kolmesta tutkimuksesta, joissa analysoidaan asuntomarkkinoihin vaikuttavia politiikkatoimenpiteitä. Luvussa 2 tutkitaan Suomen kiinteistöverojärjestelmän vaikutusta asuntorakentamiseen. Vuonna 2001 tehtiin uudistus, jonka myötä kunnat voivat verottaa rakentamatonta asuintonttia korkeammalla veroasteella kuin rakennettua tonttia. Maanomistajan rakentamispäätöksen teoreettisen mallin mukaan rakentamattoman tontin korotettu kiinteistöveron pitäisi nopeuttaa rakentamista, mutta toisaalta myös rakentamiseen investoitu rahamäärä saattaa muuttua. Asuintonttien kiinteistöverojen yleinen taso ei vaikuta maanomistajan käyttäytymiseen, sillä tontin verotusarvo ei riipu rakentamispäätöksestä. Vain rakentamattoman ja rakennetun tontin veroasteiden erolla on merkitystä. Empiiriset tulokset ovat sopusoinnussa teorian kanssa. Tulosten mukaan prosenttiyksikön nousu rakentamattoman ja rakennetun tontin veroasteiden erossa lisää omakotialoitusten määrää viidellä prosentilla lyhyellä aikavälillä. Luvussa 3 analysoidaan vuokrasääntelystä vuokralaisille aiheutuvia hyötyjä ja haittoja. Vuokrasäännellyissä asunnoissa asuvat kotitaloudet hyötyvät vuokrasääntelystä alhaisen vuokran muodossa. Heille saattaa kuitenkin koitua myös haittaa siitä, että toiveita vastaavan asunnon löytäminen on vuokrasääntelytilanteessa vaikeaa, koska vapaille asunnoille on suuri määrä ottajia. Vapaarahoitteisen vuokra-asuntokannan vuokrien sääntely purettiin Suomessa asteittain vuosina 1992–1995. Tutkimuksen empiiriset tulokset viittaavat siihen, että vuokrasääntelyn aiheuttamista suurista eroista halutun ja todellisen asuntokulutuksen välillä koituvat hyvinvointitappiot kumosivat merkittävän osan matalien vuokrien hyödyistä vuokralaisille. Luvussa 4 tutkitaan Suomen asumistukijärjestelmän kannustinvaikutuksia. Asumistuen määrää rajoittavat asunnon pinta-alalle ja neliövuokralle asetetut ylärajat. Neliövuokrarajoite voidaan tulkita asumisen laatua rajoittavana tekijänä. Tutkimuksen teoreettisessa osassa osoitetaan, että asumistukijärjestelmä luo vahvat kannustimet muuttaa asuntoihin, joissa pinta-ala- ja laaturajoitteet purevat. Empiiristen tulosten mukaan asumistukeen oikeutetut kotitaloudet eivät näytä reagoivan kannusteisiin. Tukeen oikeutettujen kotitalouksien asumisvalinnat suhteessa pinta-ala ja laaturajoitteisiin vastaavat muiden kotitalouksien valintoja ja asunnonvaihdon mahdollistama potentiaalinen asumistuen lisäys ei nosta muuttotodennäköisyyttä. Muuttamiseen liittyvät kustannukset ja vajavaiset tiedot tukijärjestelmästä saattavat selittää heikkoa reagointia asumistuen luomiin kannustimiin. Toinen mahdollinen selitys on asumistuen vajaakäyttö. Tutkimuksen mukaan vain 70–80 prosenttia asumistukeen oikeutetuista kotitalouksista nostaa tukea. Asumistuen hyödyntämisen todennäköisyys riippuu koulutustasosta, tuen määrästä ja tulo-odotuksista.

Sustainable housing development through integrated strata utility and transport infrastructure

A comprehensive study was conducted on potential systems of integrated building utilities and transport power solutions that can simultaneously contain rising electricity, hot water and personal transport costs for apartment residents. The research developed the Commuter Energy and Building Utilities System (CEBUS) and quantified the economic, social and environmental benefits of incorporating such a system in future apartment developments. A decision support tool was produced to assist the exploration of the CEBUS design variants. A set of implementation guidelines for CEBUS was also developed for the property development industry.

Middle-aged and elderly Finnish households considering moving, their preferences, and potential downsizing amidst changing life course and housing careers

We examine the moving and housing preferences of middle-aged and older in Finland, a country where population composition and movement through the life course are changing. A logistic regression reveals that middle-aged, moderate income residents, renters, those who have lived in their houses only a short time, and residents who are generally dissatisfied are most likely to consider moving. Downsizing appeals to residents with lower incomes who live alone, and who have been in their current houses longer. All potential movers agree on the importance of transportation access and a neighborhood grocery store; however, those preferring to downsize are also interested in house and neighborhood design as well as services that will allow aging in place. Income limitations may create affordability problems for some potential movers.