Challenges to care coordination posed by the use of multiple health IT applications

Coordinating care for hospitalized patients requires the use of multiple sources of information. Using a macroergonomic framework (i.e. the work system model), we conducted interviews and observations of care managers involved in care coordination across transitions of care. When information is distributed across multiple health IT applications, care managers experience a range of challenges, including organizational barriers, technology design problems, skills and knowledge issues, and task performance demands (i.e. issues related to individual information processing and management and sharing of information). These challenges can be used as a checklist to evaluate the proposed IT infrastructure that will allow the integration of multiple health IT applications and, therefore, support coordination across transitions of care.     

Prevention of MSD by means of ergonomic risk assessment (tools) in all phases of the vehicle development process

In industrialized countries musculoskeletal disorders (MSD) play an import role and are often responsible for almost one third of the total sick leave. The changes in the demographic profiles, i.e. aging work forces might even worsen this situation in the future. For a highly productive and sustainable use of human resources in production systems, ergonomics offers high potentials. In the recent years the authors have developed several ergonomic risk assessment tools, especially for the use in automotive industries. These methods may be used during the planning phases in the Tech Centers as well as during the production phase at shop floor level. The tools might also be used for a standardized communication in between the Tech Center and the plants to improve the effects of "lessons learned" for the design and layout of workstations and processes and the optimization of vehicle components. This paper describes suitable risk assessment tools as well as the integration of these tools into the vehicle development process. It introduces a comprehensive management approach for the integration of ergonomics into the management of production systems.     

Influence of substrate depth and vegetation type on temperature and water runoff mitigation by extensive green roofs: shrubs versus herbaceous plants

The relative contribution of substrate depth and vegetation type on temperature mitigation and stormwater runoff reduction was studied in an experimental green roof in North eastern Italy. Two substrate depths (120 and 200?mm) and two vegetation types (herbaceous plants and shrubs, respectively) were used, and compared to control modules with similar substrate depths but left bare of vegetation. Experimental observations showed that: a) green roofs substantially reduce thermal load over the rooftop, with significant effects of substrate depth and no apparent impact of vegetation type; b) thermal effects are strongly influenced by substrate water content; c) green roofs strongly reduce water runoff with significant substrate x vegetation effects. Our data suggest that green roof design addressed to optimization of the thermal functions should take into account adequate planning of substrate depth. Moreover, our data show that vegetated modules out-competed medium-only ones in terms of runoff reduction capacity, in accordance with some previous studies. Both shrub-vegetated and herbaceous modules intercepted and stored more than 90% rainfall during intense precipitation events, with no significant difference between the two vegetation types despite different substrate depths.     

Pathophysiology of premenstrual syndrome and premenstrual dysphoric disorder

Premenstrual syndrome (PMS) and premenstrual dysphoric disorder are triggered by hormonal events ensuing after ovulation. The symptoms can begin in the early, mid or late luteal phase and are not associated with defined concentrations of any specific gonadal or non-gonadal hormone. Although evidence for a hormonal abnormality has not been established, the symptoms of the premenstrual disorders are related to the production of progesterone by the ovary. The two best-studied and relevant neurotransmitter systems implicated in the genesis of the symptoms are the GABArgic and the serotonergic systems. Metabolites of progesterone formed by the corpus luteum of the ovary and in the brain bind to a neurosteroid-binding site on the membrane of the gamma-aminobutyric acid (GABA) receptor, changing its configuration, rendering it resistant to further activation and finally decreasing central GABA-mediated inhibition. By a similar mechanism, the progestogens in some hormonal contraceptives are also thought to adversely affect the GABAergic system. The lowering of serotonin can give rise to PMS-like symptoms and serotonergic functioning seems to be deficient by some methods of estimating serotonergic activity in the brain; agents that augment serotonin are efficacious and are as effective even if administered only in the luteal phase. However, similar to the affective disorders, PMS is ultimately not likely to be related to the dysregulation of individual neurotransmitters. Brain imaging studies have begun to shed light on the complex brain circuitry underlying affect and behaviour and may help to explicate the intricate neurophysiological foundation of the syndrome.     

The role of dispersal and local environment in urban land snail assemblages: an example of three cities in Central Italy

Ecologists increasingly appreciate the central role that urban biodiversity plays in ecosystems, however much urban biodiversity is neglected, especially some very diverse groups of invertebrates. For the first time in southern Europe, land snail communities are analysed in four urban habitats along a geographical gradient of three cities, using quantitative methods and assessing the relative roles of local environmental conditions (“distance from sea”, “distance from city centre”, “vegetation cover”) and spatial effects by principal coordinate analysis of neighbour matrices, redundancy analysis and variation partitioning. A total of 53 species was recorded, a richness similar to that of natural areas. At habitat level, species richness did not show a clear increasing trend from more to less urbanized habitats, but rather a homogeneous pattern. At city level, study areas hosted rather heterogeneous species assemblages and biotic homogenization did not seem to have any impact; indeed, only three species could be considered alien. Variation partitioning showed that land snail communities were mostly structured by environmental factors, even when spatial structures independent of measured environmental variables were included: “vegetation cover” and “distance from city centre” were the environmental variables that explained most of the variation in species composition. The lack of strong spatial structure also unexpectedly suggested that transport by humans aids dispersal of organisms with low mobility, which are usually limited by spatial constraints in natural environments. These results provide ecological and conservation implications for other invertebrate groups, suggesting to set priorities in management strategies that include habitat conservation at local scale.     

Assessing social vulnerability and identifying spatial hotspots of flood risk to inform socially just flood management policy

This study presents the first nationwide spatial assessment of flood risk to identify social vulnerability and flood exposure hotspots that support policies aimed at protecting high-risk populations and geographical regions of Canada. The study used a national-scale flood hazard dataset (pluvial, fluvial, and coastal) to estimate a 1-in-100-year flood exposure of all residential properties across 5721 census tracts. Residential flood exposure data were spatially integrated with a census-based multidimensional social vulnerability index (SoVI) that included demographic, racial/ethnic, and socioeconomic indicators influencing vulnerability. Using Bivariate Local Indicators of Spatial Association (BiLISA) cluster maps, the study identified geographic concentration of flood risk hotspots where high vulnerability coincided with high flood exposure. The results revealed considerable spatial variations in tract-level social vulnerability and flood exposure. Flood risk hotspots belonged to 410 census tracts, 21 census metropolitan areas, and eight provinces comprising about 1.7 million of the total population and 51% of half-a-million residential properties in Canada. Results identify populations and the geographic regions near the core and dense urban areas predominantly occupying those hotspots. Recognizing priority locations is critically important for government interventions and risk mitigation initiatives considering socio-physical aspects of vulnerability to flooding. Findings reinforce a better understanding of geographic flood-disadvantaged neighborhoods across Canada, where interventions are required to target preparedness, response, and recovery resources that foster socially just flood management strategies.     

New Measures of Economic Insecurity Reveal its Expansion Into EU Middle Classes and Welfare States

Economic instability, social changes, and new social policies place economic insecurity high on the scholarly and political agenda. We contribute to these debates by proposing a new multidimensional, intertemporal measure of economic insecurity that accounts for both its multiplicity and its dynamism. First, we develop three theory-driven, multidimensional measures of economic insecurity. Principal Components Analysis validates the measure. Second, we develop a dynamic approach to insecurity, using longitudinal data and a newly revised headcount method. Third, we then use our new measures to analyze the distribution of insecurity in Europe. Our analysis shows that insecurity is widespread across Europe, even in low-inequality, encompassing welfare states. Moreover, it extends across income groups and occupational classes, reaching into the middle classes.

     

Implementation of the Family Violence Option 20 Years Later: A Review of State Welfare Rules for Domestic Violence Survivors

The Family Violence Option (FVO) was included in the 1996 welfare reform legislation to ensure that domestic violence survivors are not subject to unfair penalties resulting from compliance with the new requirements. This study presents a comprehensive review of the states’ different approaches to address domestic violence. Our findings identified variation in implementation and practice, from the decision to adopt the FVO to the process of granting waivers. Although not contradictory to the federal legislation, the variation is indicative of the limited research on best practices and lack of national discussions on how state FVO processes relate to one another.