923 resultados para customer needs assessment
Resumo:
Belize is currently faced with several critical challenges associated with the production, distribution and use of energy. Despite an abundance of renewable energy resources, the country remains disproportionately dependent on imported fossil fuels, which exposes it to volatile and rising oil prices, limits economic development, and retards its ability to make the investments that are necessary for adapting to climate change, which pose a particularly acute threat to the small island states and low-lying coastal nations of the Caribbean. This transition from energy consumption and supply patterns that are based on imported fossil fuels and electricity towards a more sustainable energy economy that is based on environmentally benign, indigenous renewable energy technologies and more efficient use of energy requires concerted action as the country is already challenged by limited fiscal space which reduces its ability to provide some fiscal incentives, which have been proven to be effective tools for the promotion of sustainable energy markets in a number of countries. This report identifies the fiscal and regulatory barriers to implementation of energy efficiency measures and renewable energy technologies in Belize. Data and information were derived from stakeholder consultations conducted within the country. The major result of the assessment is that the transition of policies and plans into tangible action needs to be increased. In this regard, it is necessary to articulate sub-policies of the National Energy Policy to amend the Public Utilities Commission Act, to develop a grid interconnection policy, to establish minimum energy performance standards for buildings and equipment and to develop a public procurement policy. Finally, decisions on renewable energy and energy efficiency-related incentives from the Government formally requires decision-makers to solve what may be extremely complex optimization problems in order to obtain the lowest-cost provision of energy services to society, thereby weighing the cost of revenue losses with the benefits of fuel and infrastructure expansion savings. The establishment of a management system that is efficient, flexible, and transparent, which will facilitate the implementation of the strategic objectives and outputs in the time available, with the financial resources allocated is recommended. Support is required for additional institutional and capacity strengthening.
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This report analyses the agriculture, energy, and health sectors in Trinidad and Tobago to assess the potential economic impacts of climate change on the sectors. The fundamental aim of this report is to assist with the development of strategies to deal with the potential impact of climate change on Trinidad and Tobago. It also has the potential to provide essential input for identifying and preparing policies and strategies to help advance the Caribbean subregion closer to solving problems associated with climate change and attaining individual and regional sustainable development goals. Some of the key anticipated impacts of climate change for the Caribbean include elevated air and sea-surface temperatures, sea-level rise, possible changes in extreme events and a reduction in freshwater resources. The economic impact of climate change on the three sectors was estimated for the A2 and B2 IPCC scenarios until 2050. An exploration of various adaptation strategies was also undertaken for each sector using standard evaluation techniques. The study of the impact of climate change on the agriculture sector focused on root crops, green vegetables and fisheries. For these sectors combined, the cumulative loss under the A2 scenario is calculated as approximately B$2.24 and approximately B$1.72 under the B2 scenario by 2050. This is equivalent to 1.37% and 1.05% of the 2008 GDP under the A2 and B2 scenarios, respectively. Given the potential for significant damage to the agriculture sector a large number of potential adaptation measures were considered. Out of these a short-list of 10 potential options were selected by applying 10 evaluation criteria. All of the adaptation strategies showed positive benefits. The analysis indicate that the options with the highest net benefits are: (1) Building on-farm water storage, (2) Mainstreaming climate change issues into agricultural management and (3) Using drip irrigation. Other attractive options include water harvesting. The policy decisions by governments should include these assessments, the omitted intangible benefits, as well as the provision of other social goals such as employment. The analysis of the energy sector has shown that the economic impact of climate change during 2011-2050 is similar under the A2 (US$142.88 million) and B2 (US$134.83 million) scenarios with A2 scenario having a slightly higher cost (0.737% of 2009 GDP) than the B2 scenario (0.695% of 2009 GDP) for the period. On the supply side, analyses indicate that Trinidad and Tobago’s energy sector will be susceptible to the climate change policies of major energy-importing countries (the United States of America and China), and especially to their renewable energy strategies. Implementation of foreign oil substitution policy by the United States of America will result in a decline in Trinidad and Tobago’s Liquefied Natural Gas (LNG) export (equivalent to 2.2% reduction in 2009 GDP) unless an alternative market is secured for the lost United States of America market. China, with its rapid economic growth and the highest population in the world, offers a potential replacement market for Trinidad and Tobago’s LNG export. In this context the A2 scenario will offer the best option for Trinidad and Tobago’s energy sector. The cost-benefit analysis undertaken on selected adaptation strategies reveal that the benefit-cost ratio of replacing electric water heaters with solar water heaters is the most cost-effective. It was also found that the introduction of Compact Fluorescent Light (CFL) and Variable Refrigerant Volume (VRV) air conditioners surpasses the projected cost of increased electricity consumption due to climate change, and provides an economic rationale for the adoption of these adaptation options even in a situation of increased electricity consumption occasioned by climate change. Finally, the conversion of motor fleets to Compressed Natural Gas (CNG) is a cost-effective adaptation option for the transport sector, although it has a high initial cost of implementation and the highest per capita among the four adaptation options evaluated. To investigate the effect of climate change on the health sector dengue fever, leptospirosis, food borne illnesses, and gastroenteritis were examined. The total number of new dengue cases for the period 2008 to 2050 was 204,786 for BAU, 153,725 for A2 and 131,890 for the B2 scenario. With regard to the results for leptospirosis, A2 and B2 seem to be following a similar path with total number of new cases in the A2 scenario being 9,727 and 9,218 cases under the B2 scenario. Although incidence levels in the BAU scenario coincided with those of A2 and B2 prior to 2020, they are somewhat lower post 2020. A similar picture emerges for the scenarios as they relate to food-borne illnesses and to gastroenteritis. Specifically for food-borne illnesses, the BAU scenario recorded 27,537 cases, the A2 recorded 28,568 cases and the B2 recorded 28,679 cases. The focus on the selected sources of morbidity in the health sector has highlighted the fact that the vulnerability of the country’s health sector to climate change does not depend solely on exogenously derived impacts, but also on the behaviour and practices among the population. It is clear that the vulnerability which became evident in the analysis of the impacts on dengue fever, leptospirosis and food-borne illnesses is not restricted solely to climate or other external factors. The most important adaptation strategy being recommended targets lifestyle, behaviour and attitude changes. The population needs to be encouraged to alter their behaviours and practices so as to minimise their exposure to harmful outcomes as it relates to the incidence of these diseases.
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Changing precipitation patterns and temperature relate directly to water resources and water security. This report presents the findings of an assessment of the water sector in Grenada with respect to the projected impact of climate change. Grenada‘s water resources comprise primarily surface water, with an estimated groundwater potential to satisfy about 10%-15% of the present potable requirement. On the smaller islands Carriacou and Petite Martinique, domestic water is derived exclusively from rainwater catchments. Rainfall seasonality is marked and the available surface water during the dry season declines dramatically. Changing land use patterns, increase in population, expansion in tourism and future implementation of proposed irrigation schemes are projected to increase future water requirements. Economic modeling approaches were implemented to estimate sectoral demand and supply between 2011 and 2050. Residential, tourism and domestic demand were analysed for the A2, B2 and BAU scenarios as illustrated. The results suggest that water supply will exceed forecasted water demand under B2 and BAU during all four decades. However under the A2 scenario, water demand will exceed water supply by the year 2025. It is important to note that the model has been constrained by the omission of several key parameters, and time series for climate indicators, data for which are unavailable. Some of these include time series for discharge data, rainfall-runoff data, groundwater recharge rates, and evapotranspiration. Further, the findings which seem to indicate adequacy of water are also masked by seasonality in a given year, variation from year to year, and spatial variation within the nation state. It is imperative that some emphasis be placed on data generation in order to better project for the management of Grenada‘s water security. This analysis indicates the need for additional water catchment, storage and distribution infrastructure, as well as institutional strengthening, in order to meet the future needs of the Grenadian population. Strategic priorities should be adopted to increase water production, increase efficiency, strengthen the institutional framework, and decrease wastage. Grenada has embarked on several initiatives that can be considered strategies toward adaptation to the variabilities associated with climate change. The Government should ensure that these programs be carried out to the optimal levels for reasons described above. The ―no-regrets approach‖ which intimates that measures will be beneficial with or without climate change should be adopted. A study on the Costs of Inaction for the Caribbean in the face of climate change listed Grenada among the countries which would experience significant impacts on GDP between now and 2100 without adaptation interventions. Investment in the water sector is germane to building Grenada‘s capacity to cope with the multivariate impact of changes in the parameters of climate.
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Climate change is a naturally occurring phenomenon in which the earth‘s climate goes through cycles of warming and cooling; these changes usually take place incrementally over millennia. Over the past century, there has been an anomalous increase in global temperature, giving rise to accelerated climate change. It is widely accepted that greenhouse gas emissions from human activities such as industries have contributed significantly to the increase in global temperatures. The existence and survival of all living organisms is predicated on the ability of the environment in which they live not only to provide conditions for their basic needs but also conditions suitable for growth and reproduction. Unabated climate change threatens the existence of biophysical and ecological systems on a planetary scale. The present study aims to examine the economic impact of climate change on health in Jamaica over the period 2011-2050. To this end, three disease conditions with known climate sensitivity and importance to Jamaican public health were modelled. These were: dengue fever, leptospirosis and gastroenteritis in children under age 5. Historical prevalence data on these diseases were obtained from the Ministry of Health Jamaica, the Caribbean Epidemiology Centre, the Climate Studies Group Mona, University of the West Indies Mona campus, and the Meteorological Service of Jamaica. Data obtained spanned a twelve-year period of 1995-2007. Monthly data were obtained for dengue and gastroenteritis, while for leptospirosis, the annual number of cases for 1995-2005 was utilized. The two SRES emission scenarios chosen were A2 and B2 using the European Centre Hamburg Model (ECHAM) global climate model to predict climate variables for these scenarios. A business as usual (BAU) scenario was developed using historical disease data for the period 2000-2009 (dengue fever and gastroenteritis) and 1995-2005 (leptospirosis) as the reference decades for the respective diseases. The BAU scenario examined the occurrence of the diseases in the absence of climate change. It assumed that the disease trend would remain unchanged over the projected period and the number of cases of disease for each decade would be the same as the reference decade. The model used in the present study utilized predictive empirical statistical modelling to extrapolate the climate/disease relationship in time, to estimate the number of climate change-related cases under future climate change scenarios. The study used a Poisson regression model that considered seasonality and lag effects to determine the best-fit model in relation to the diseases under consideration. Zhang and others (2008), in their review of climate change and the transmission of vector-borne diseases, found that: ―Besides climatic variables, few of them have included other factors that can affect the transmission of vector-borne disease….‖ (Zhang 2008) Water, sanitation and health expenditure are key determinants of health. In the draft of the second communication to IPCC, Jamaica noted the vulnerability of public health to climate change, including sanitation and access to water (MSJ/UNDP, 2009). Sanitation, which in its broadest context includes the removal of waste (excreta, solid, or other hazardous waste), is a predictor of vector-borne diseases (e.g. dengue fever), diarrhoeal diseases (such as gastroenteritis) and zoonoses (such as leptospirosis). In conceptualizing the model, an attempt was made to include non-climate predictors of these climate-sensitive diseases. The importance of sanitation and water access to the control of dengue, gastroenteritis and leptospirosis were included in the Poisson regression model. The Poisson regression model obtained was then used to predict the number of disease cases into the future (2011-2050) for each emission scenario. After projecting the number of cases, the cost associated with each scenario was calculated using four cost components. 1. Treatment cost morbidity estimate. The treatment cost for the number of cases was calculated using reference values found in the literature for each condition. The figures were derived from studies of the cost of treatment and represent ambulatory and non-fatal hospitalized care for dengue fever and gastroenteritis. Due to the paucity of published literature on the health care cost associated with leptospirosis, only the cost of diagnosis and antibiotic therapy were included in the calculation. 2. Mortality estimates. Mortality estimates are recorded as case fatality rates. Where local data were available, these were utilized. Where these were unavailable, appropriate reference values from the literature were used. 3. Productivity loss. Productivity loss was calculated using a human capital approach, by multiplying the expected number of productive days lost by the caregiver and/or the infected person, by GDP per capita per day (US$ 14) at 2008 GDP using 2008 US$ exchange rates. 4. No-option cost. The no-option cost refers to adaptation strategies for the control of dengue fever which are ongoing and already a part of the core functions of the Vector Control Division of the Ministry of Health, Jamaica. An estimated US$ 2.1 million is utilized each year in conducting activities to prevent the post-hurricane spread of vector borne diseases and diarrhoea. The cost includes public education, fogging, laboratory support, larvicidal activities and surveillance. This no-option cost was converted to per capita estimates, using population estimates for Jamaica up to 2050 obtained from the Statistical Institute of Jamaica (STATIN, 2006) and the assumption of one expected major hurricane per decade. During the decade 2000-2009, Jamaica had an average inflation of 10.4% (CIA Fact book, last updated May 2011). This average decadal inflation rate was applied to the no-option cost, which was inflated by 10% for each successive decade to adjust for changes in inflation over time.
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With external conditions sluggish and highly uncertain as the global economy still struggles to shake off the effects of the economic crisis of 2008-2009, the Latin American and Caribbean region is not isolated from these effects and is projected to record a small drop in gross domestic product (GDP) in 2015, followed by a weak recovery in 2016. Against this backdrop, 2015 will be the third consecutive year of increasing declines in regional export values; a state of affairs not seen since the Great Depression of the 1930s. This poor performance reflects the end of the commodity price boom, the slowdown of the Chinese economy, the weak recovery of the eurozone and the lacklustre economic activity in the region, particularly in South America.
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The fierce competitiveness of the current market and the sophistication of customer requirements made the commitment to quality a need within organizations. The search for quality has been carried out by the adoption of quality management systems, a formal organization that should be present throughout the organization, from the initial identification of market needs to the satisfaction of customer requirements. The methodology most commonly used for this purpose is based on the requirements of ISO 9001, latest version of 2008. Considering this scenario, was developed a case study in a small company of the industrial sector with the development of a plan for the implementation of ISO 9001. The proposed methodology involved the construction of a theoretical framework on the subject and the development of a case study with a qualitative approach. Initially, was applied a questionnaire to the representative of the organization about the company's operating procedures, activity logs held, current documentation, planning and resource management for the construction of an assessment about the adequacy of the company needs to ISO 9001. Were obtained as results the characterization of production processes and organizational structure of the company and examples of policy and objectives of quality, performance indicators, document control, system for visualization of non-compliances, among others. Finally, the benefits of adopting a quality management system based on ISO 9001 requirements for the company and its environmental issues such as increased process efficiency, less waste and greater profitability, were pointed out, and the conditions for effective certification in the future
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In this action research study of my eighth grade differentiated Algebra students, I investigated the effects of students using self-assessment on their homework. Students in my class were unmotivated and failed test objectives consistently. I wanted students to see that they controlled their learning and could be motivated to succeed. Formative assessment tells students how they need to improve. Learning needs to happen before they can be assessed. Self-assessment is one tool that helps students know if they are learning. A rubric scoring guide, daily documentation sheet and feedback on homework and test correlations were used to help students monitor their learning. Students needed time to develop the skill to self-assess. Students began to understand the relationship between homework and performing well on tests by the end of the action research period. Early in the period, most students encountered difficulty understanding that they controlled their learning and did not think homework was important. By the end of the year, all students said homework was important and that it helped them on quizzes and tests. Motivating students to complete homework is difficult. Teaching them to self-assess and to keep track of their learning helps them stay motivated.
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Objective: To compare the agreement of multiplanar and rendering modes in the assessment fetal atrioventricular valves (mitral and tricuspid) areas by three-dimensional (3D) ultrasonography using the software spatio-temporal image correlation (STIC). Methods: We conducted a prospective cross-sectional study with normal pregnant women, with single fetuses, between 18-33 weeks. To measure the areas, we used the plan of four-chamber view. In the case of multiplanar, the plane was rotated on the axis "Z" form the heart to position at 9h. For rendering, the green line (region of interest - ROI) was placed from the atria of the heart perpendicular to the crux. The agreement was assessed by a Bland-Altman (limits of agreement) using the relative difference between the measures: ((rendering mode) - (multiplanar mode)) / (average). Results: 328 fetuses were evaluated. We have not identified the occurrence of systematic error between methods: the average relative difference was 1.62% (-2.07% to 5.32%, confidence interval 95%) in the mitral and 1.77% (- 1.08% to 4.62%) in the tricuspid valve. The limits of agreement between methods were -65.26% to 68.51% for the mitral and -49.91% to 53.45% for the tricuspid. Conclusions: There was no systematic error between modes and thus the observed values for the area of fetal atrioventricular valves can be used for comparisons needs to be corrected. However, relatively large variations may be observed when repeating the measurement area by different modes.
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Abstract Background Despite evidence that health and disease occur in social contexts, the vast majority of studies addressing dental pain exclusively assessed information gathered at individual level. Objectives To assess the association between dental pain and contextual and individual characteristics in Brazilian adolescents. In addition, we aimed to test whether contextual Human Development Index is independently associated with dental pain after adjusting for individual level variables of socio-demographics and dental characteristics. Methods The study used data from an oral health survey carried out in São Paulo, Brazil, which included dental pain, dental exams, individual socioeconomic and demographic conditions, and Human Development Index at area level of 4,249 12-year-old and 1,566 15-year-old schoolchildren. The Poisson multilevel analysis was performed. Results Dental pain was found among 25.6% (95%CI = 24.5-26.7) of the adolescents and was 33% less prevalent among those living in more developed areas of the city than among those living in less developed areas. Girls, blacks, those whose parents earn low income and have low schooling, those studying at public schools, and those with dental treatment needs presented higher dental-pain prevalence than their counterparts. Area HDI remained associated with dental pain after adjusting for individual level variables of socio demographic and dental characteristics. Conclusions Girls, students whose parents have low schooling, those with low per capita income, those classified as having black skin color and those with dental treatment needs had higher dental pain prevalence than their counterparts. Students from areas with low Human Development Index had higher prevalence of dental pain than those from the more developed areas regardless of individual characteristics.
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Modern food systems are characterized by a high energy intensity as well as by the production of large amounts of waste, residuals and food losses. This inefficiency presents major consequences, in terms of GHG emissions, waste disposal, and natural resource depletion. The research hypothesis is that residual biomass material could contribute to the energetic needs of food systems, if recovered as an integrated renewable energy source (RES), leading to a sensitive reduction of the impacts of food systems, primarily in terms of fossil fuel consumption and GHG emissions. In order to assess these effects, a comparative life cycle assessment (LCA) has been conducted to compare two different food systems: a fossil fuel-based system and an integrated system with the use of residual as RES for self-consumption. The food product under analysis has been the peach nectar, from cultivation to end-of-life. The aim of this LCA is twofold. On one hand, it allows an evaluation of the energy inefficiencies related to agro-food waste. On the other hand, it illustrates how the integration of bioenergy into food systems could effectively contribute to reduce this inefficiency. Data about inputs and waste generated has been collected mainly through literature review and databases. Energy balance, GHG emissions (Global Warming Potential) and waste generation have been analyzed in order to identify the relative requirements and contribution of the different segments. An evaluation of the energy “loss” through the different categories of waste allowed to provide details about the consequences associated with its management and/or disposal. Results should provide an insight of the impacts associated with inefficiencies within food systems. The comparison provides a measure of the potential reuse of wasted biomass and the amount of energy recoverable, that could represent a first step for the formulation of specific policies on the integration of bioenergies for self-consumption.
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Obbiettivo: Valutazione delle eventuali differenze nel trattamento ortodontico di un gruppo di bambini con particolari necessità sanitarie (SHCN) rispetto ad un gruppo di bambini non diagnosticati con SHCN. Materiali e Metodi: Il gruppo campione (SHCN) è costituito da 50 bambini con SHCN. Il gruppo di controllo (NO SHCN) è costituito da 50 bambini non diagnosticati con SHCN pienamente corrispondenti per età, genere e tipo di apparecchio ortodontico utilizzato con i pazienti del gruppo di studio. I dati riguardanti i gruppi SHCN e NO SHCN sono stati analizzati in modo retrospettivo, valutando: - il punteggio pre- e post-trattamento e la riduzione finale dei valori dell'indice PAR (Peer Assessment Rating), della componente DHC (Dental Health Component) e della componente AC (Aesthetic Component) dell'indice IOTN (Orthodontic Treatment Need Index), - il numero di appuntamenti, - il numero di sedute semplici e complesse, - la durata complessiva del trattamento, - l'età all’inizio ed alla fine della terapia. Risultati: Non sono state rilevate differenze statisticamente significative tra i due gruppi per quanto concerne il numero di appuntamenti, la durata complessiva del trattamento, l'età all’inizio ed alla fine della terapia ortodontica (valori del p-value:0.682, 0.458, 0.535, 0.675). Sono state rilevate differenze statisticamente significative tra i due gruppi per quanto riguarda i punteggi dell’indice PAR, delle componenti DHC e AC dello IOTN pre- e post-trattamento, il numero di sedute semplici e complesse (valori del p-value:0.030, 0.000, 0.020, 0.023, 0.000, 0.000, 0.043, 0.037). Per quanto concerne la riduzione finale del valore dell’indice PAR, della componente DHC e di quella AC dello IOTN non sono state riscontrate differenze statisticamente significative tra i due gruppi (valori del p-value:0.060, 0.765, 0.825). Conclusioni: Lo studio incoraggia gli ortodontisti a trattare i bambini con SHCN nell'obiettivo di migliorarne la qualità di vita, pur evidenziando la necessità di un maggior numero di sedute complesse.
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The so called cascading events, which lead to high-impact low-frequency scenarios are rising concern worldwide. A chain of events result in a major industrial accident with dreadful (and often unpredicted) consequences. Cascading events can be the result of the realization of an external threat, like a terrorist attack a natural disaster or of “domino effect”. During domino events the escalation of a primary accident is driven by the propagation of the primary event to nearby units, causing an overall increment of the accident severity and an increment of the risk associated to an industrial installation. Also natural disasters, like intense flooding, hurricanes, earthquake and lightning are found capable to enhance the risk of an industrial area, triggering loss of containment of hazardous materials and in major accidents. The scientific community usually refers to those accidents as “NaTechs”: natural events triggering industrial accidents. In this document, a state of the art of available approaches to the modelling, assessment, prevention and management of domino and NaTech events is described. On the other hand, the relevant work carried out during past studies still needs to be consolidated and completed, in order to be applicable in a real industrial framework. New methodologies, developed during my research activity, aimed at the quantitative assessment of domino and NaTech accidents are presented. The tools and methods provided within this very study had the aim to assist the progress toward a consolidated and universal methodology for the assessment and prevention of cascading events, contributing to enhance safety and sustainability of the chemical and process industry.
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Nowadays the environmental issues and the climatic change play fundamental roles in the design of urban spaces. Our cities are growing in size, many times only following immediate needs without a long-term vision. Consequently, the sustainable development has become not only an ethical but also a strategic need: we can no longer afford an uncontrolled urban expansion. One serious effect of the territory industrialisation process is the increase of urban air and surfaces temperatures compared to the outlying rural surroundings. This difference in temperature is what constitutes an urban heat island (UHI). The purpose of this study is to provide a clarification on the role of urban surfacing materials in the thermal dynamics of an urban space, resulting in useful indications and advices in mitigating UHI. With this aim, 4 coloured concrete bricks were tested, measuring their emissivity and building up their heat release curves using infrared thermography. Two emissivity evaluation procedures were carried out and subsequently put in comparison. Samples performances were assessed, and the influence of the colour on the thermal behaviour was investigated. In addition, some external pavements were analysed. Albedo and emissivity parameters were evaluated in order to understand their thermal behaviour in different conditions. Surfaces temperatures were recorded in a one-day measurements campaign. ENVI-met software was used to simulate how the tested materials would behave in two typical urban scenarios: a urban canyon and a urban heat basin. Improvements they can carry to the urban microclimate were investigated. Emissivities obtained for the bricks ranged between 0.92 and 0.97, suggesting a limited influence of the colour on this parameter. Nonetheless, white concrete brick showed the best thermal performance, whilst the black one the worst; red and yellow ones performed pretty identical intermediate trends. De facto, colours affected the overall thermal behaviour. Emissivity parameter was measured in the outdoor work, getting (as expected) high values for the asphalts. Albedo measurements, conducted with a sunshine pyranometer, proved the improving effect given by the yellow paint in terms of solar reflection, and the bad influence of haze on the measurement accuracy. ENVI-met simulations gave a demonstration on the effectiveness in thermal improving of some tested materials. In particular, results showed good performances for white bricks and granite in the heat basin scenario, and painted concrete and macadam in the urban canyon scenario. These materials can be considered valuable solutions in UHI mitigation.
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For survivors of aneurysmal subarachnoid hemorrhage (SAH), somatic and cognitive deficits can affect long-term outcomes. We were interested in comparing the deficits identified in SAH patients, including cognitive deficits, at discharge by neurosurgeons and deficits identified by neurologists upon admission to the rehabilitation unit on the same day. The assessment of deficits might have an impact on referring patients to rehabilitation. This retrospective study included 494 SAH patients treated between 2005 and 2010. Of these, 50 patients were discharged to an affiliated rehabilitation unit. Deficits were grouped into 18 categories and summarized into three groups: major somatic, minor somatic, and cognitive deficits. Major somatic deficits were identified in 16 and 20 patients (p = 0.53), minor somatic deficits in 16 and 44 (p < 0.0001) patients, and cognitive deficits in 36 and 45 (p < 0.04) patients by neurosurgeons and neurologists, respectively. The absolute number of deficits in daily activities identified by the neurosurgeon and neurologist were 21 and 31 major somatic deficits (p = 0.2), 18 and 97 minor somatic deficits (p < 0.0001), and 61 and 147 cognitive deficits (p < 0.0001), respectively. Significant differences in assessment of cognitive and minor somatic deficits between neurosurgeons and neurologists exist. Based on these findings, it is evident that for the neurosurgeon, there needs to be an increased awareness of the assessment of cognitive deficits and a more routine interdisciplinary approach, including the use of neuropsychological evaluations, to ensure a better triage of patients to rehabilitation or for discharge home.
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The conference on Global Change and the World’s Mountains held in Perth, Scotland, in 2010 offered a unique opportunity to analyze the state and progress of mountain research and its contribution to sustainable mountain development, as well as to reflect on required reorientations of research agendas. In this paper we provide the results of a three-step assessment of the research presented by 450 researchers from around the world. First, we determined the state of the art of mountain research and categorized it based on the analytical structure of the Global Land Project (GLP 2005). Second, we identified emerging themes for future research. Finally, we assessed the contribution of mountain research to sustainable development along the lines of the Grand Challenges in Global Sustainability Research (International Council for Science 2010). Analysis revealed that despite the growing recognition of the importance of more integrative research (inter- and transdisciplinary), the research community gathered in Perth still focuses on environmental drivers of change and on interactions within ecological systems. Only a small percentage of current research seeks to enhance understanding of social systems and of interactions between social and ecological systems. From the ecological systems perspective, a greater effort is needed to disentangle and assess different drivers of change and to investigate impacts on the rendering of ecosystem services. From the social systems perspective, significant shortcomings remain in understanding the characteristics, trends, and impacts of human movements to, within, and out of mountain areas as a form of global change. Likewise, sociocultural drivers affecting collective behavior as well as incentive systems devised by policy and decision makers are little understood and require more in-depth investigation. Both the complexity of coupled social– ecological systems and incomplete data sets hinder integrated systems research. Increased understanding of linkages and feedbacks between social and ecological systems will help to identify nonlinearities and thresholds (tipping points) in both system types. This presupposes effective collaboration between ecological and social sciences. Reflections on the Grand Challenges in Sustainability Research put forth by the International Council for Science (2010) reveal the need to intensify research on effective responses and innovations. This will help to achieve sustainable development in mountain regions while maintaining the core competence of mountain research in forecasting and observation.