The multiple location time weighted index: Using patient activity spaces to calculate primary care service areas

Geographic health planning analyses, such as service area calculations, are hampered by a lack of patient-specific geographic data. Using the limited patient address information in patient management systems, planners analyze patient origin based on home address. But activity space research done sparingly in public health and extensively in non-health related arenas uses multiple addresses per person when analyzing accessibility. Also, health care access research has shown that there are many non-geographic factors that influence choice of provider. Most planning methods, however, overlook non-geographic factors influencing choice of provider, and the limited data mean the analyses can only be related to home address. This research attempted to determine to what extent geography plays a part in patient choice of provider and to determine if activity space data can be used to calculate service areas for primary care providers. ^ During Spring 2008, a convenience sample of 384 patients of a locally-funded Community Health Center in Houston, Texas, completed a survey that asked about what factors are important when he or she selects a health care provider. A subset of this group (336) also completed an activity space log that captured location and time data on the places where the patient regularly goes. ^ Survey results indicate that for this patient population, geography plays a role in their choice of health care provider, but it is not the most important reason for choosing a provider. Other factors for choosing a health care provider such as the provider offering "free or low cost visits", meeting "all of the patient's health care needs", and seeing "the patient quickly" were all ranked higher than geographic reasons. ^ Analysis of the patient activity locations shows that activity spaces can be used to create service areas for a single primary care provider. Weighted activity-space-based service areas have the potential to include more patients in the service area since more than one location per patient is used. Further analysis of the logs shows that a reduced set of locations by time and type could be used for this methodology, facilitating ongoing data collection for activity-space-based planning efforts. ^

Kawasaki syndrome: Cluster analysis of incident cases presenting to a pediatric tertiary care hospital in Texas from January 1, 2005 to December 31, 2009

Background: Despite almost 40 years of research into the etiology of Kawasaki Syndrome (KS), there is little research published on spatial and temporal clustering of KS cases. Previous analysis has found significant spatial and temporal clustering of cases, therefore cluster analyses were performed to substantiate these findings and provide insight into incident KS cases discharged from a pediatric tertiary care hospital. Identifying clusters from a single institution would allow for prospective analysis of risk factors and potential exposures for further insight into KS etiology. ^ Methods: A retrospective study was carried out to examine the epidemiology and distribution of patients presenting to Texas Children’s Hospital in Houston, Texas, with a diagnosis of Acute Febrile Mucocutaneous Lymph Node Syndrome (MCLS) upon discharge from January 1, 2005 to December 31, 2009. Spatial, temporal, and space-time cluster analyses were performed using the Bernoulli model with case and control event data. ^ Results: 397 of 102,761 total patients admitted to Texas Children’s Hospital had a principal or secondary diagnosis of Acute Febrile MCLS upon over the 5 year period. Demographic data for KS cases remained consistent with known disease epidemiology. Spatial, temporal, and space-time analyses of clustering using the Bernoulli model demonstrated no statistically significant clusters. ^ Discussion: Despite previous findings of spatial-temporal clustering of KS cases, there were no significant clusters of KS cases discharged from a single institution. This implicates the need for an expanded approach to conducting spatial-temporal cluster analysis and KS surveillance given the limitations of evaluating data from a single institution.^

Use of a modified delphi process for establishing occupational exposure limits in support of health surveillance for space travelers

On-orbit exposures can come from numerous factors related to the space environment as evidenced by almost 50 years of environmental samples collected for water analysis, air analysis, radiation analysis, and physiologic parameters. For astronauts and spaceflight participants the occupational exposures can be very different from those experienced by workers performing similar tasks in workplaces on Earth, because the duration of the exposure could be continuous for very long orbital, and eventually interplanetary, missions. The establishment of long-term exposure standards is vital to controlling the quality of the spacecraft environment over long periods. NASA often needs to update and revise its prior exposure standards (Spacecrafts Maximum Allowable Concentrations (SMACs)). Traditional standards-setting processes are often lengthy, so a more rapid method to review and establish standards would be a substantial advancement in this area. This project investigates use of the Delphi method for this purpose. ^ In order to achieve the objectives of this study a modified Delphi methodology was tested in three trials executed by doctoral students and a panel of experts in disciplines related to occupational safety and health. During each test/trial modifications were made to the methodology. Prior to submission of the Delphi Questionnaire to the panel of experts a pilot study/trial was conducted using five doctoral students with the goals of testing and adjusting the Delphi questionnaire to improve comprehension, work out any procedural issues and evaluate the effectiveness of the questionnaire in drawing the desired responses. The remainder of the study consisted of two trials of the Modified Delphi process using 6 chemicals that currently have the potential of causing occupational exposures to NASA astronauts or spaceflight participants. To assist in setting Occupational Exposure Limits (OEL), the expert panel was established consisting of experts from academia, government and industry. Evidence was collected and used to create close-ended questionnaires which were submitted to the Delphi panel of experts for the establishment of OEL values for three chemicals from the list of six originally selected (trial 1). Once the first Delphi trial was completed, adjustments were made to the Delphi questionnaires and the process above was repeated with the remaining 3 chemicals (trial 2). ^ Results indicate that experience in occupational safety and health and with OEL methodologies can have a positive effect in minimizing the time experts take in completing this process. Based on the results of the questionnaires and comparison of the results with the SMAC already established by NASA, we conclude that use of the Delphi methodology is appropriate for use in the decision-making process for the selection of OELs.^

Healthy aging : Free time of adults

El trabajo que aquí se presenta surge de la necesidad de conceptualizar y profundizar sobre el uso productivo del tiempo libre de las personas adultas mayores. Se llevará a cabo una aproximación teórica sobre las diferentes concepciones de tiempo libre y ocio como dimensiones interdisciplinarias que involucran elementos referidos al entorno en donde personas y comunidades buscan integrarse en un tiempo y espacio determinado

Healthy aging : Free time of adults

El trabajo que aquí se presenta surge de la necesidad de conceptualizar y profundizar sobre el uso productivo del tiempo libre de las personas adultas mayores. Se llevará a cabo una aproximación teórica sobre las diferentes concepciones de tiempo libre y ocio como dimensiones interdisciplinarias que involucran elementos referidos al entorno en donde personas y comunidades buscan integrarse en un tiempo y espacio determinado

Healthy aging : Free time of adults

El trabajo que aquí se presenta surge de la necesidad de conceptualizar y profundizar sobre el uso productivo del tiempo libre de las personas adultas mayores. Se llevará a cabo una aproximación teórica sobre las diferentes concepciones de tiempo libre y ocio como dimensiones interdisciplinarias que involucran elementos referidos al entorno en donde personas y comunidades buscan integrarse en un tiempo y espacio determinado

Travel time and speed of gray whales and amphipod abundance along Chukotka Peninsula in 2006

The purpose of this study was to evaluate summer and fall residency and habitat selection by gray whales, Eschrichtius robustus, together with the biomass of benthic amphipod prey on the coastal feeding grounds along the Chukotka Peninsula. Thirteen gray whales were instrumented with satellite transmitters in September 2006 near the Chukotka Peninsula, Russia. Nine transmitters provided positions from whales for up to 81 days. The whales travelled within 5 km of the Chukotka coast for most of the period they were tracked with only occasional movements offshore. The average daily travel speeds were 23 km/day (range 9-53 km/day). Four of the whales had daily average travel speeds <1 km/day suggesting strong fidelity to the study area. The area containing 95% of the locations for individual whales during biweekly periods was on average 13,027 km**2 (range 7,097-15,896 km**2). More than 65% of all locations were in water <30 m, and between 45 and 70% of biweekly kernel home ranges were located in depths between 31 and 50 m. Benthic density of amphipods within the Bering Strait at depths <50 m was on average ~54 g wet wt/m**2 in 2006. It is likely that the abundant benthic biomass is more than sufficient forage to support the current gray whale population. The use of satellite telemetry in this study quantifies space use and movement patterns of gray whales along the Chukotka coast and identifies key feeding areas.

Atmospheric, oceanic and hydrological polar motion excitation mechanisms based on a combination of geometric and gravimetric space observations

The goal of our study is to determine accurate time series of geophysical Earth rotation excitations to learn more about global dynamic processes in the Earth system. For this purpose, we developed an adjustment model which allows to combine precise observations from space geodetic observation systems, such as Satellite Laser Ranging (SLR), Global Navigation Satellite Systems (GNSS), Very Long Baseline Interferometry (VLBI), Doppler Orbit determination and Radiopositioning Integrated on Satellite (DORIS), satellite altimetry and satellite gravimetry in order to separate geophysical excitation mechanisms of Earth rotation. Three polar motion time series are applied to derive the polar motion excitation functions (integral effect). Furthermore we use five time variable gravity field solutions from Gravity Recovery and Climate Experiment (GRACE) to determine not only the integral mass effect but also the oceanic and hydrological mass effects by applying suitable filter techniques and a land-ocean mask. For comparison the integral mass effect is also derived from degree 2 potential coefficients that are estimated from SLR observations. The oceanic mass effect is also determined from sea level anomalies observed by satellite altimetry by reducing the steric sea level anomalies derived from temperature and salinity fields of the oceans. Due to the combination of all geodetic estimated excitations the weaknesses of the individual processing strategies can be reduced and the technique-specific strengths can be accounted for. The formal errors of the adjusted geodetic solutions are smaller than the RMS differences of the geophysical model solutions. The improved excitation time series can be used to improve the geophysical modeling.

(Tables 1,2) Tracking records and space use statistics of polar bears (Ursus maritimus) in Storfjorden, Svalbard

Arctic sea ice is declining rapidly, making it vital to understand the importance of different types of sea ice for ice-dependent species such as polar bears Ursus maritimus. In this study we used GPS telemetry (25 polar bear tracks obtained in Svalbard, Norway, during spring) and high-resolution synthetic aperture radar (SAR) sea-ice data to investigate fine-scale space use by female polar bears. Space use patterns differed according to reproductive state; females with cubs of the year (COYs) had smaller home ranges and used fast-ice areas more frequently than lone females. First-passage time (FPT) analysis revealed that females with COYs displayed significantly longer FPTs near (<10 km) glacier fronts than in other fast-ice areas; lone females also increased their FPTs in such areas, but they also frequently used drifting pack ice. These results clearly demonstrate the importance of fast-ice areas, in particular close to glacier fronts, especially for females with COYs. Access to abundant and predictable prey (ringed seal pups), energy conservation and reluctance to cross large open water areas are possible reasons for the observed patterns. However, glacier fronts are retracting in Svalbard, and declines in land-fast ice have been notable over the past decade. The eventual disappearance of these important habitats might become critical for the survival of polar bear cubs in Svalbard and other regions with similar habitat characteristics. Given the relatively small size of many fast-ice areas in Svalbard, the results observed in this study would not have been revealed using less accurate location data or lower-resolution sea-ice data.

Dissolved aluminium measured on water bottle samples during POLARSTERN cruise ARK-XXII/2 (SPACE)

Concentrations of dissolved (0.2 µm filtered) aluminium (Al) have been determined for the first time in the Eurasian part of the Arctic Ocean over the entire water column during expedition ARK XXII/2 aboard R.V. Polarstern (2007). An unprecedented number of 666 samples was analysed for 44 stations along 5 ocean transects. Dissolved Al in surface layer water (SLW) was very low, close to 1 nM, with lowest SLW concentrations towards the Canadian part of the Arctic Ocean and higher values adjacent to and in the shelf seas. The low SLW concentrations indicate no or little influence from aeolian dust input. Dissolved Al showed a nutrient-type increase with depth up to 28 nM, but large differences existed between the different deep Arctic basins. The differences in concentrations of Al between water masses and basins could largely be related to the different origins of the water masses. In the SLW and intermediate water layers, Atlantic and Pacific inflows were of importance. Deep shelf convection appeared to influence the Al distribution in the deep Eurasian Basin. The Al distribution of the deep Makarov Basin provides evidence for Eurasian Basin water inflow into the deep Makarov Basin. A strong correlation between Al and Silicon (Si) was observed in all basins. This correlation and the nutrient-like profile indicate a strong biological influence on the cycling and distribution of Al. The biological influence can be direct by the incorporation of Al in biogenic silica, indirect by preferential scavenging of Al onto biogenic siliceous particles, or by a combination of both processes. From the slope of the overall Al-Si relationship in the intermediate water layer (AIDW; ~ 200-2000 m depth), an Al/Si ratio of 2.2 atoms Al per 1000 atoms Si was derived. This ratio is consistent with the range of previously reported Al/Si uptake ratio in biogenic opal frustules of diatoms. In the deepest waters (>2000 m depth) a steeper slope of the Al-Si relationship of 7.4 to 13 atoms Al per 1000 atoms Si likely results from entrainment of cold shelf water into the deep basins, carrying the signal of dissolution of terrigenous particles with a much higher Al:Si ratio of crustal abundance. Only a small enrichment with such crustal Al and Si component may readily account for the higher Al:Si slope in the deepest waters.

Barium measured on water bottle samples during POLARSTERN cruise ARK-XXII/2 (SPACE)

Dissolved barium has been shown to have the potential to distinguish Eurasian from North American (NA) river runoff. As part of the ARK-XXII/2 Polarstern expedition in summer 2007, Ba was analyzed in the Barents, Kara, Laptev seas, and the Eurasian Basins as well as the Makarov Basin up to the Alpha and Mendeleyev Ridges. By combining salinity, d18O and initial phosphate corrected for mineralization with oxygen (PO4*) or N/P ratios we identified the water mass fractions of meteoric water, sea ice meltwater, and marine waters of Atlantic as well as Pacific origin in the upper water column. In all basins inside the lower halocline layer and the Arctic intermediate waters we find Ba concentrations close to those of the Fram Strait branch of the lower halocline (41-45 nM), reflecting the composition of the incoming Atlantic water. A layer of upper halocline water (UHW) with higher Ba concentrations (45-55 nM) is identified in the Makarov Basin. Atop of the UHW, the Surface Mixed Layer (SML), including the summer and winter mixed layers, has high concentrations of Ba (58-67 nM). In the SML of the investigated area of the central Arctic the meteoric fraction can be identified by assuming a conservative behavior of Ba to be primarily of Eurasian river origin. However, in productive coastal regions biological removal compromises the use of Ba to distinguish between Eurasian and NA rivers. As a consequence, the NA river water fraction is underestimated in productive surface waters or waters that have passed a productive region, whereas this fraction is overestimated in subsurface waters containing remineralised Ba, particularly when these waters have passed productive shelf regions. Especially in the Laptev Sea and small regions in the Barents Sea, Ba concentrations are low in surface waters. In the Laptev Sea exceptionally high Ba concentrations in shelf bottom waters indicate that Ba is removed from surface waters to deep waters by biological activity enhanced by increasing ice-free conditions as well as by scavenging by organic matter of terrestrial origin. We interpret high Ba concentrations in the UHW of the Makarov Basin to result from enrichment by remineralisation in bottom waters on the shelf of the Chukchi Sea and therefore the calculated NA runoff is an artefact. We conclude that no NA runoff can be demonstrated unequivocally anywhere during our expedition with the set of tracers considered here. Small contributions of NA runoff may have been masked by Ba depletion and could only be resolved by supportive tracers on the uptake history. We thus suggest that Ba has to be used with care as it can put limits but not yield quantitative water mass distributions. Only if the extra Ba inputs exceed the cumulative biological uptake the signal can be unequivocally attributed to NA runoff.