Workforce Issues in the Greater Boston Health Care Industry: Implications for Work and Family

Interviews with more than 40 leaders in the Boston area health care industry have identified a range of broadly-felt critical problems. This document synthesizes these problems and places them in the context of work and family issues implicit in the organization of health care workplaces. It concludes with questions about possible ways to address such issues. The defining circumstance for the health care industry nationally as well as regionally at present is an extraordinary reorganization, not yet fully negotiated, in the provision and financing of health care. Hoped-for controls on increased costs of medical care – specifically the widespread replacement of indemnity insurance by market-based managed care and business models of operation--have fallen far short of their promise. Pressures to limit expenditures have produced dispiriting conditions for the entire healthcare workforce, from technicians and aides to nurses and physicians. Under such strains, relations between managers and workers providing care are uneasy, ranging from determined efforts to maintain respectful cooperation to adversarial negotiation. Taken together, the interviews identify five key issues affecting a broad cross-section of occupational groups, albeit in different ways: Staffing shortages of various kinds throughout the health care workforce create problems for managers and workers and also for the quality of patient care. Long work hours and inflexible schedules place pressure on virtually every part of the healthcare workforce, including physicians. Degraded and unsupportive working conditions, often the result of workplace "deskilling" and "speed up," undercut previous modes of clinical practice. Lack of opportunities for training and advancement exacerbate workforce problems in an industry where occupational categories and terms of work are in a constant state of flux. Professional and employee voices are insufficiently heard in conditions of rapid institutional reorganization and consolidation. Interviewees describe multiple impacts of these issues--on the operation of health care workplaces, on the well being of the health care workforce, and on the quality of patient care. Also apparent in the interviews, but not clearly named and defined, is the impact of these issues on the ability of workers to attend well to the needs of their families--and the reciprocal impact of workers' family tensions on workplace performance. In other words, the same things that affect patient care also affect families, and vice versa. Some workers describe feeling both guilty about raising their own family issues when their patients' needs are at stake, and resentful about the exploitation of these feelings by administrators making workplace policy. The different institutions making up the health care system have responded to their most pressing issues with a variety of specific stratagems but few that address the complexities connecting relations between work and family. The MIT Workplace Center proposes a collaborative exploration of next steps to probe these complications and to identify possible locations within the health care system for workplace experimentation with outcomes benefiting all parties.

Medidas de intervención para promoción de conductas saludables y prevención de riesgos laborales relacionados con accidentalidad y enfermedad laboral en trabajadores de minas de Carbón

Colombia en su legislación normatiza el sector de la minería de carbón, sin embargo se considera que las estrategias no han sido suficientes para la identificación, prevención y control de la accidentalidad y enfermedad laboral. Durante el año 2013 el índice de fatalidad fue de 1,59. Estadísticas del año 2004 evidencian que las neumoconiosis fueron las mayores causas de invalidez de origen profesional. Objetivo: Categorizar actividades de intervención en promoción y prevención de accidentalidad y enfermedad laboral en trabajadores de la minería de carbón. Metodología: Se realizó una revisión de literatura sobre minería de carbón y salud la cual fue obtenida de las bases de datos PUBMED, Sciendirect, VHL, SINAB por literatura publicada sin límites de año, en idioma inglés, español o portugués. Para la búsqueda se utilizaron términos en lenguaje controlado (términos MESH), revisión por pares de títulos y resúmenes. Las publicaciones fueron seleccionadas para revisión de texto completo bajo criterios de inclusión y exclusión. Los códigos contemplados para esta revisión fueron: a) país donde la intervención se llevó a cabo, b) salud ocupacional, c) prevención de accidentalidad, d) programas de promoción, e) tecnologías, f) resultados obtenidos. Resultados: Del total de 2500 artículos seleccionados por los autores principales se realizó la revisión de los primeros 300 artículos, 32 hacen referencia al tema de salud ocupacional y minería de carbón, 10 contienen intervenciones consideradas de relevancia para esta revisión bibliográfica. Se presentan intervenciones estadísticamente significativas (p<0.05) y que han demostrado ser de impacto positivo en la minería de carbón en promoción y prevención de accidentalidad y enfermedad ocupacional. Conclusiones: Se identificaron las siguientes cuatro tipos de intervención: 1) las de carácter educativo que hacen referencia a las capacitaciones participativas, el entrenamiento por medio de “degraded image”, la realización de gestión de autocontrol y retroalimentación para el uso de elementos de protección personal (EPP), la aplicación del Modelo de Proceso Paralelo Extendido; 2) intervenciones preventivas como la medición de alcoholimetría antes del turno, la presencia de personal de enfermería en minas de carbón y el reconocimiento de los predictores de la enfermedad para optimizar la prevención primaria; 3)intervenciones de vigilancia como la promovida en la metodología Estadísticas Europeas de Accidentes de Trabajo (EEAT) para la investigación de los accidentes de trabajo, la aplicación de las recomendaciones de la Organización Mundial de la Salud (OMS) para la detección de la neumoconiosis y 4) De carácter tecnológico consistente en la intervención de tareas a partir de los resultados de la aplicación del software desarrollado por el Instituto Nacional para la Seguridad y Salud Ocupacional (NIOSH). Estas intervenciones han demostrado ser eficaces en la promoción y prevención de accidentalidad y enfermedad ocupacional por lo cual se recomienda su aplicación en Colombia posterior al análisis de costo-efectividad.

Distribution of diatom communities in agricultural and mining watersheds of Southwest Spain

Els sistemes aquàtics continental representen un dels ecosistemes més amenaçats a nivell mundial, com a conseqüència de l'ús intensiu quel'home en fa. La conca del Guadiana no està lliure d'aquestes pressions antròpiques. Les grans infraestructures hidràuliques i l'escorrentia provinent de l'agricultura són només exemples dels greus problemes que pateix la conca. Aquests problemes es fan especialment palesos en la zona alta de la conca, on l'escassetat d'aigua no fa més que agreujar el problema.Tot això ha generat la necessitat urgent d'avaluar l'estat de conservació d'aquests ecosistemes aquàtics continentals, poder determinar la mesura i la magnitud de les pertorbacions que els estan afectant i així proposar mesures de gestió destinades a restaurar-ne la integritat ecològica. El principal objectiu que presenta aquest és determinar els patrons de distribució de les comunitats de algals (amb una menció especial en el grup de les diatomees) i de les seves causes en la conca del Guadiana i associades, amb la finalitat d'establir i proposar eines que permetin avaluar l'estat de conservació de les masses d'aigua d'aquestes conques.

Developing a desertification indicator system for a small Mediterranean catchment: a case study from the Serra de Rodes, Alt Empordà, Catalunya, NE Spain

La desertificació és un problema de degradació de sòls de gran importància en regions àrides, semi-àrides i sub-humides, amb serioses conseqüències ambientals, socials i econòmiques com a resultat de l'impacte d'activitats humanes en combinació amb condicions físiques i medi ambientals desfavorables (UNEP, 1994). L'objectiu principal d'aquesta tesi va ser el desenvolupament d'una metodologia simple per tal de poder avaluar de forma precisa l'estat i l'evolució de la desertificació a escala local, a través de la creació d'un model anomenat sistema d'indicators de desertificació (DIS). En aquest mateix context, un dels dos objectius específics d'aquesta recerca es va centrar en l'estudi dels factors més importants de degradació de sòls a escala de parcel.la, comportant un extens treball de camp, analisi de laboratori i la corresponent interpretació i discussió dels resultats obtinguts. El segon objectiu específic es va basar en el desenvolupament i aplicació del DIS. L'àrea d'estudi seleccionada va ser la conca de la Serra de Rodes, un ambient típic Mediterràni inclòs en el Parc Natural del Cap de Creus, NE Espanya, el qual ha estat progressivament abandonat pels agricultors durant el segle passat. Actualment, els incendis forestals així com el canvi d'ús del sòl i especialment l'abandonament de terres són considerats els problemes ambientals més importants a l'àrea d'estudi (Dunjó et al., 2003). En primer lloc, es va realitzar l'estudi dels processos i causes de la degradació dels sòls a l'àrea d'interés. En base a aquest coneixement, es va dur a terme la identificació i selecció dels indicadors de desertificació més rellevants. Finalment, els indicadors de desertificació seleccionats a escala de conca, incloent l'erosió del sòl i l'escolament superficial, es van integrar en un model espaial de procés. Ja que el sòl és considerat el principal indicador dels processos d'erosió, segons la FAO/UNEP/UNESCO (1979), tant el paisatge original així com els dos escenaris d'ús del sòl desenvolupats, un centrat en el cas hipotétic del pas d'un incendi forestal, i l'altre un paisatge completament cultivat, poden ser ambients classificats sota baixa o moderada degradació. En comparació amb l'escenari original, els dos escenaris creats van revelar uns valors més elevats d'erosió i escolament superficial, i en particular l'escenari cultivat. Per tant, aquests dos hipotètic escenaris no semblen ser una alternativa sostenible vàlida als processos de degradació que es donen a l'àrea d'estudi. No obstant, un ampli ventall d'escenaris alternatius poden ser desenvolupats amb el DIS, tinguent en compte les polítiques d'especial interés per la regió de manera que puguin contribuir a determinar les conseqüències potencials de desertificació derivades d'aquestes polítiques aplicades en aquest escenari tan complexe espaialment. En conclusió, el model desenvolupat sembla ser un sistema força acurat per la identificació de riscs presents i futurs, així com per programar efectivament mesures per combatre la desertificació a escala de conca. No obstant, aquesta primera versió del model presenta varies limitacions i la necessitat de realitzar més recerca en cas de voler desenvolupar una versió futura i millor del DIS.

A Reabilitação face à Sustentabilidade : Casa Burguesa do Porto

Os centros históricos são o resultado de um parque habitacional corrente, com uma grande uniformidade, coerência construtiva e espaços urbanos de modo a proporcionar uma identidade própria. Um dos grandes problemas urbanos são as vastas áreas degradadas do ponto de vista arquitetónico como também social, cultural e económico. Conhecidos os principais problemas dos edifícios de habitação e suas causas, para sua resolução existe necessidade de adaptar o processo de reabilitação tradicional ao conceito de sustentabilidade. Estes dois assuntos conjugados são atualmente emergentes, devido à necessidade de reabilitação do parque habitacional, nomeadamente centros históricos. A casa burguesa do Porto apresenta um elevado grau de degradação, porém apesar de existentes as ações de intervenção que sobre ela reincidem, não são proporcionais à necessidade atual. A cidade do Porto é marcada, maioritariamente, pelas Casas Burguesas, das quais foram executadas segundo padrões de conforto e de utilização da época. É, então, fundamental um estudo pormenorizado da casa burguesa do Porto, avaliando o contexto em que esta se encere (na cidade e na respetiva habitação), os subsistemas construtivos e as praticas de reabilitação.

Reabilitação de edifícios habitacionais com valor patrimonial : o caso do centro histórico de Guimarães

A presente dissertação centra-se no tema “reabilitação de edifícios habitacionais com valor patrimonial – o caso do centro histórico de Guimarães“ Com o passar dos anos tem-se feito, cada vez mais, um esforço para tentar combater as áreas degradadas das cidades e colmatar lacunas referentes às ações tomadas nesse sentido. É necessária a intervenção dos Arquitetos que, através dos seus conhecimentos e poderes, têm a obrigação de manter a história da Arquitetura intacta no tempo. Esta dissertação centra-se em analisar algumas questões inerentes ligadas á reabilitação de edifícios habitacionais, declarando possíveis respostas. As questões vão desde perceber como é que um espaço reabilitado pode ser tão adequado como um espaço pensado de raiz até à questão da utilização de materiais, passando pelo tipo de relacionamento entre o arquiteto e o proprietário, e como os dois protagonistas podem fazer valer as suas ideias em simultâneo. Este trabalho pretende, então, transmitir a importância da reabilitação e preservação dos centros históricos, mostrando que com a reabilitação é possível a sua conservação. Para uma melhor compreensão do tema selecionado, Guimarães apresenta-se como uma cidade que vai ao encontro de todos os pontos referidos até este momento, sendo o seu centro histórico um exemplo de requalificação e conseguindo, com uma metodologia bem determinada, manter todas as origens da cidade, no qual são utilizadas técnicas e materiais tradicionais de construção. A dissertação termina com a análise de cada projeto escolhido para estudo.

Notas sobre la presencia mapuche en la literatura chilena (Crítica)

Mauricio Ostria revisa la manera en que el mapuche es presentado en la literatura chilena. Durante la Colonia, ciertos rasgos de los indios mapuches resaltados por La Araucana, de Alonso de Ercilla (valor, rebeldía, destino épico de resistencia), contribuyeron a configurar la identidad del pueblo chileno. Durante la república, la percepción camina entre la admiración y la conmiseración, y el desprecio por el excluido. En el siglo XX predomina la exclusión, la idea del mapuche como un ser moralmente degradado, sin embargo, poetas como Gabriela Mistral y Pablo Neruda se aproximan con distintos puntos de vista, apartados del desprecio. A fines del siglo XX, la mirada multicultural inicia una literatura que pretende dar voz al mapuche, escritores de esta línea son Violeta Cáceres, Clemente Riedemann, y poetas de origen mapuche, como Jaime Luis Huenún, Leonel Lienlaf, Elicura Chihuailaf («la más reflexiva, la más polémica, la más lúcida de las voces mapuches, la más consciente de la función de resistencia e identidad cultural»), son los que más luchan por una nueva percepción del mapuche que, aun ahora, es visto por la sociedad chilena como héroe, bárbaro o víctima.

Vesper Sparrows and Western Meadowlarks Show a Mixed Response to Cattle Grazing in the Intermountain Region of British Columbia

Livestock grazing in the shortgrass steppe of the Intermountain region of British Columbia is predicted to have significant effects on grassland habitats and their associated ground-nesting bird communities. We tested whether grazed and ungrazed sites could be discriminated on the basis of their vegetation communities, whether the abundance of two ground-nesting bird species, Vesper Sparrow (Pooecetes gramineus) and Western Meadowlark (Sturnella neglecta), differed between grazed and ungrazed sites, and whether vegetation variables found to differ between grazed and ungrazed plots could be used to predict the abundance of the two bird species at a fine scale. Grazed sites were easily distinguishable from a site that had been ungrazed for >30 years based on the structure and composition of their vegetation communities. However, more detailed grazing categories could not be distinguished on the basis of vegetation characteristics. Despite the existence of grazing effects on vegetation structure and composition, we found no consistent differences in abundance of Vesper Sparrows and Western Meadowlarks between the grazed and ungrazed sites. However, there was weak evidence that the abundance of both species was higher at fine-scale plots (100 m radius point count station) with less bare ground and taller vegetation. Bare ground cover was lower on grazed plots, but vegetation was taller on ungrazed plots. Combined, our results suggest that low intensity grazing leads to grassland habitat change with both negative and positive effects on Vesper Sparrows and Western Meadowlarks, resulting in no net change in their broad-scale abundance.

A Demographic Model to Evaluate Population Declines in the Endangered Streaked Horned Lark

The Streaked Horned Lark (Eremophila alpestris strigata) is listed as endangered by the State of Washington, USA and by Canada under the Species at Risk Act and is also classified as a federal candidate for listing under the Endangered Species Act in the USA. A substantial portion of Streaked Horned Lark habitat has been lost or degraded, and range contraction has occurred in Oregon, Washington, and British Columbia. We estimate the vital rates (fecundity, adult and juvenile survival) and population growth rate (λ) for Streaked Horned Larks breeding in Washington, USA and conduct a Life-Stage Simulation Analysis (LSA) to evaluate which vital rate has the greatest influence on λ. We simulated changes in the three vital rates to examine how much they would need to be adjusted either independently or in concert to achieve a stable Streaked Horned Lark population (λ = 1). We also evaluated which fecundity component (the number of fledglings per egg laid or renesting interval) had the greatest impact on λ. The estimate of population growth suggests that Streaked Horned Larks in Washington are declining rapidly (λ = 0.62 ± 0.10) and that local breeding sites are not sustainable without immigration. The LSA results indicate that adult survival had the greatest influence on λ, followed by juvenile survival and fecundity. However, increases in vital rates led to λ = 1 only when adult survival was raised from 0.47 to 0.85, juvenile survival from 0.17 to 0.58, and fecundity from 0.91 to 3.09. Increases in breeding success and decreases in the renesting interval influenced λ similarly; however, λ did not reach 1 even when breeding success was raised to 100% or renesting intervals were reduced to 1 day. Only when all three vital rates were increased simultaneously did λ approach 1 without requiring highly unrealistic increases in each vital rate. We conclude that conservation activities need to target all or multiple vital rates to be successful. The baseline data presented here and subsequent efforts to manage Streaked Horned Larks will provide valuable information for management of other declining Horned Lark subspecies and other grassland songbirds across North America.

Stratospheric communication of El Nino teleconnections to European winter

The stratospheric role in the European winter surface climate response to El Niño–Southern Oscillation sea surface temperature forcing is investigated using an intermediate general circulation model with a well-resolved stratosphere. Under El Niño conditions, both the modeled tropospheric and stratospheric mean-state circulation changes correspond well to the observed “canonical” responses of a late winter negative North Atlantic Oscillation and a strongly weakened polar vortex, respectively. The variability of the polar vortex is modulated by an increase in frequency of stratospheric sudden warming events throughout all winter months. The potential role of this stratospheric response in the tropical Pacific–European teleconnection is investigated by sensitivity experiments in which the mean state and variability of the stratosphere are degraded. As a result, the observed stratospheric response to El Niño is suppressed and the mean sea level pressure response fails to resemble the temporal and spatial evolution of the observations. The results suggest that the stratosphere plays an active role in the European response to El Niño. A saturation mechanism whereby for the strongest El Niño events tropospheric forcing dominates the European response is suggested. This is examined by means of a sensitivity test and it is shown that under large El Niño forcing the European response is insensitive to stratospheric representation.

The four major N- and C-terminal splice variants of the excitatory amino acid transporter GLT-1 form cell surface homomeric and heteromeric assemblies

The L-glutamate transporter GLT-1 is an abundant CNS membrane protein of the excitatory amino acid transporter (EAAT) family which controls extracellular L-glutamate levels and is important in limiting excitotoxic neuronal death. Using RT-PCR, we have determined that four mRNAs encoding GLT-1 exist in mouse brain, with the potential to encode four GLT-1 isoforms that differ in their N- and C-termini. We expressed all four isoforms (termed MAST-KREK, MPK-KREK, MAST-DIETCI and MPK-DIETCI according to amino acid sequence) in a range of cell lines and primary astrocytes and show that each isoform can reach the cell surface. In transfected HEK-293 or COS-7 cells, all four isoforms support high-affinity sodium-dependent L-glutamate uptake with identical pharmacological and kinetic properties. Inserting a viral epitope (V5, HA or FLAG) into the second extracellular domain of each isoform allowed co-immunoprecipitation and tr-FRET studies using transfected HEK-293 cells. Here we show for the first time that each of the four isoforms are able to combine to form homomeric and heteromeric assemblies, each of which are expressed at the cell surface of primary astrocytes. After activation of protein kinase C by phorbol ester, V5-tagged GLT-1 is rapidly removed from the cell surface of HEK-293 cells and degraded. This study provides direct biochemical evidence for oligomeric assembly of GLT-1 and reports the development of novel tools to provide insight into the trafficking of GLT-1.

Simulating SOC changes in 11 land use change chronosequences from the Brazilian Amazon with RothC and Century models

Land use and land cover changes in the Brazilian Amazon have major implications for regional and global carbon (C) cycling. Cattle pasture represents the largest single use (about 70%) of this once-forested land in most of the region. The main objective of this study was to evaluate the accuracy of the RothC and Century models at estimating soil organic C (SOC) changes under forest-to-pasture conditions in the Brazilian Amazon. We used data from 11 site-specific 'forest to pasture' chronosequences with the Century Ecosystem Model (Century 4.0) and the Rothamsted C Model (RothC 26.3). The models predicted that forest clearance and conversion to well managed pasture would cause an initial decline in soil C stocks (0-20 cm depth), followed in the majority of cases by a slow rise to levels exceeding those under native forest. One exception to this pattern was a chronosequence in Suia-Missu, which is under degraded pasture. In three other chronosequences the recovery of soil C under pasture appeared to be only to about the same level as under the previous forest. Statistical tests were applied to determine levels of agreement between simulated SOC stocks and observed stocks for all the sites within the 11 chronosequences. The models also provided reasonable estimates (coefficient of correlation = 0.8) of the microbial biomass C in the 0-10 cm soil layer for three chronosequences, when compared with available measured data. The Century model adequately predicted the magnitude and the overall trend in delta C-13 for the six chronosequences where measured 813 C data were available. This study gave independent tests of model performance, as no adjustments were made to the models to generate outputs. Our results suggest that modelling techniques can be successfully used for monitoring soil C stocks and changes, allowing both the identification of current patterns in the soil and the projection of future conditions. Results were used and discussed not only to evaluate soil C dynamics but also to indicate soil C sequestration opportunities for the Brazilian Amazon region. Moreover, modelling studies in these 'forest to pasture' systems have important applications, for example, the calculation of CO, emissions from land use change in national greenhouse gas inventories. (0 2007 Elsevier B.V. All rights reserved.

Predicted soil organic carbon stocks and changes in the Brazilian Amazon between 2000 and 2030

Currently we have little understanding of the impacts of land use change on soil C stocks in the Brazilian Amazon. Such information is needed to determine impacts'6n the global C cycle and the sustainability of agricultural systems that are replacing native forest. The aim of this study was to predict soil carbon stocks and changes in the Brazilian Amazon during the period between 2000 and 2030, using the GEFSOC soil carbon (C) modelling system. In order to do so, we devised current and future land use scenarios for the Brazilian Amazon, taking into account: (i) deforestation, rates from the past three decades, (ii) census data on land use from 1940 to 2000, including the expansion and intensification of agriculture in the region, (iii) available information on management practices, primarily related to well managed pasture versus degraded pasture and conventional systems versus no-tillage systems for soybean (Glycine max) and (iv) FAO predictions on agricultural land use and land use changes for the years 2015 and 2030. The land use scenarios were integrated with spatially explicit soils data (SOTER database), climate, potential natural vegetation and land management units using the recently developed GEFSOC soil C modelling system. Results are presented in map, table and graph form for the entire Brazilian Amazon for the current situation (1990 and 2000) and the future (2015 and 2030). Results include soil organic C (SOC) stocks and SOC stock change rates estimated by three methods: (i) the Century ecosystem model, (ii) the Rothamsted C model and (iii) the intergovernmental panel on climate change (IPCC) method for assessing soil C at regional scale. In addition, we show estimated values of above and belowground biomass for native vegetation, pasture and soybean. The results on regional SOC stocks compare reasonably well with those based on mapping approaches. The GEFSOC system provided a means of efficiently handling complex interactions among biotic-edapho-climatic conditions (> 363,000 combinations) in a very large area (similar to 500 Mha) such as the Brazilian Amazon. All of the methods used showed a decline in SOC stock for the period studied; Century and RothC simulated values for 2030 being about 7% lower than those in 1990. Values from Century and RothC (30,430 and 25,000 Tg for the 0-20 cm layer for the Brazilian Amazon region were higher than those obtained from the IPCC system (23,400 Tg in the 0-30 cm layer). Finally; our results can help understand the major biogeochemical cycles that influence soil fertility and help devise management strategies that enhance the sustainability of these areas and thus slow further deforestation. (C) 2007 Elsevier B.V. All rights reserved.

Vegetation development and human occupation in the Damascus region of southwestern Syria from the Late Pleistocene to Holocene

Rockshelter Baaz in the Damascus region of Syria provided a variety of botanical remains from the Late Pleistocene and Early Holocene period. These remains provide new information about the vegetation evolution in this region. The earliest occupational levels correspond with a moisture peak during the Late Pleistocene, between ca. 34-32 kyr b.p., when pine expanded. The next occupations took place during extreme arid conditions, ca. 23-21 kyr b.p., and probably during the Last Glacial Maximum when a steppe vegetation was established. The occupation level of the Younger Dryas, represented by Natufian remains, suggests that the area had been covered by almond-pistachio steppe, similar to later periods of the Early Holocene, and was probably located just outside the range of dense wild cereal stands. There is no drastic impact of the Younger Dryas visible on the vegetation in the botanical remains. The lack of fruits and seeds at Baaz indicates that the site was more likely to have been a temporary hunting post rather than a plant processing site for much of its history. It is ideally suited to this purpose because of its location over the Jaba'deen Pass and the associated springs. However, archaeological remains from the Natufian period, suggest that the site was more permanently occupied during this time.