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. ^

Use of light intensity, temperature, and humidity to verify exposure location

Research studies on the association between exposures to air contaminants and disease frequently use worn dosimeters to measure the concentration of the contaminant of interest. But investigation of exposure determinants requires additional knowledge beyond concentration, i.e., knowledge about personal activity such as whether the exposure occurred in a building or outdoors. Current studies frequently depend upon manual activity logging to record location. This study's purpose was to evaluate the use of a worn data logger recording three environmental parameters—temperature, humidity, and light intensity—as well as time of day, to determine indoor or outdoor location, with an ultimate aim of eliminating the need to manually log location or at least providing a method to verify such logs. For this study, data collection was limited to a single geographical area (Houston, Texas metropolitan area) during a single season (winter) using a HOBO H8 four-channel data logger. Data for development of a Location Model were collected using the logger for deliberate sampling of programmed activities in outdoor, building, and vehicle locations at various times of day. The Model was developed by analyzing the distributions of environmental parameters by location and time to establish a prioritized set of cut points for assessing locations. The final Model consisted of four "processors" that varied these priorities and cut points. Data to evaluate the Model were collected by wearing the logger during "typical days" while maintaining a location log. The Model was tested by feeding the typical day data into each processor and generating assessed locations for each record. These assessed locations were then compared with true locations recorded in the manual log to determine accurate versus erroneous assessments. The utility of each processor was evaluated by calculating overall error rates across all times of day, and calculating individual error rates by time of day. Unfortunately, the error rates were large, such that there would be no benefit in using the Model. Another analysis in which assessed locations were classified as either indoor (including both building and vehicle) or outdoor yielded slightly lower error rates that still precluded any benefit of the Model's use.^

(Table 1) Iceberg characteristics and start and end date and location of iceberg buoys in the Weddell Sea

The drift of 52 icebergs tagged with GPS buoys in the Weddell Sea since 1999 has been investigated with respect to prevalent drift tracks, sea ice/iceberg interaction, and freshwater fluxes. Buoys were deployed on small- to medium-sized icebergs (edge lengths ? 5 km) in the southwestern and eastern Weddell Sea. The basin-scale iceberg drift of this size class was established. In the western Weddell Sea, icebergs followed a northward course with little deviation and mean daily drift rates up to 9.5 ± 7.3 km/d. To the west of 40°W the drift of iceberg and sea ice was coherent. In the highly consolidated perennial sea ice cover of 95% the sea ice exerted a steering influence on the icebergs and was thus responsible for the coherence of the drift tracks. The northward drift of buoys to the east of 40°W was interrupted by large deviations due to the passage of low-pressure systems. Mean daily drift rates in this area were 11.5 ± 7.2 km/d. A lower threshold of 86% sea ice concentration for coherent sea ice/iceberg movement was determined by examining the sea ice concentration derived from Special Sensor Microwave Imager (SSM/I) and Advanced Microwave Scanning Radiometer for EOS (AMSR-E) satellite data. The length scale of coherent movement was estimated to be at least 200 km, about half the value found for the Arctic Ocean but twice as large as previously suggested. The freshwater fluxes estimated from three iceberg export scenarios deduced from the iceberg drift pattern were highly variable. Assuming a transit time in the Weddell Sea of 1 year, the iceberg meltwater input of 31 Gt which is about a third of the basal meltwater input from the Filchner Ronne Ice Shelf but spreads across the entire Weddell Sea. Iceberg meltwater export of 14.2 × 103 m3 s?1, if all icebergs are exported, is in the lower range of freshwater export by sea ice.

Criterios de selección de terrenos para viviendas de interés social : indicadores actualmente en desarrollo para la Provincia de Mendoza, Argentina

El objetivo de la presente investigación en desarrollo es integrar criterios vinculados al hábitat en una herramienta de gestión que permita una mejor toma de decisión en cuanto a la selección de terrenos para viviendas de interés social; logrando así en un mediano y largo plazo una intervención más sostenible en el territorio. El tema de estudio presenta un alto grado de complejidad para abordar su análisis debido a los diferentes actores y fuerzas que intervienen en la decisión de localización de los conjuntos habitacionales, esta multidimensionalidad está dada por lo social, lo económico – financiero, lo político – administrativo, lo legal – notarial y lo territorial - ambiental. La metodología utilizada es a través de un enfoque sistémico que permite contemplar las relaciones que se establecen entre los distintos elementos que conforman el sistema territorial. Esta herramienta se encuentra actualmente (2007-2008) en desarrollo como Tesis de la “Maestría en Ordenamiento Territorial con orientación en Planificación Estratégica" (Departamento de Geografía, Facultad de Filosofía y Letras, UNCuyo, Mendoza) y está siendo aplicada desde el año 2007 en el Instituto Provincial de la Vivienda de Mendoza (aprobada por Resolución Nº 732/07).