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Uttaro, Thomas, Allan V. Horwitz, Firoozeh Vali et William F. Henri. « Primary Therapists' Views of Managed Care ». Psychological Reports 82, no 2 (avril 1998) : 459–64. http://dx.doi.org/10.2466/pr0.1998.82.2.459.
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To assess the system's comprehensiveness in provision of public managed mental health care South Beach Psychiatric Center surveyed a sample ( n = 54) of its primary therapists employed in its outpatient departments which have recently been reconligured as key components of the New York State Office of Mental Health Prepaid Mental Health Plan. They are intended to be comprehensive resource and treatment centers which optimize recovery in a deregulated, capitated environment. As key informants, the primary therapists were asked to rate the difficulty they experience in providing or arranging adequate services and support groups in 19 areas. They were also asked to indicate if the fundamental problem was one of access, information, quality, or supply. The five areas with the highest ratings of difficulty were housing or residential services, substance-abuse services, dental care, general health care, and employment or vocational services. The reason for difficulty most endorsed for these areas was supply. It is suggested that capitated managed care contracts can create incentives to increase the supply of such services.
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LACHANCE-McCULLOUGH, MALCOLM L., JAMES M. TESORIERO, MARTIN D. SORIN et ANDREW STERN. « HIV Infection among New York State Female Inmates : Preliminary Results of a Voluntary Counseling and Testing Program ». Prison Journal 74, no 2 (juin 1994) : 198–219. http://dx.doi.org/10.1177/0032855594074002004.
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New York State's prison population has the highest seroprevalence of human immunodeficiency virus (HIV) among incarcerated populations in the United States. Five percent of the State prison inmate population is female. To date there have been few studies of incarcerated females in New York State (NYS). Seroprevalence rates have ranged from 18.9% to as high as 29%. In 1991, counselors from the New York State Department of Health (NYSDOH) AIDS Institute's Criminal Justice Initiative, in collaboration with the State's Department of Correctional Services (NYSDOCS), began to offer educational services and anonymous pretest counseling, HIV antibody testing, and posttest counseling to NYS female prisoners. With preliminary program testing data (N = 216) descriptive and multivariate techniques are used to evaluate the demographic and risk-related behaviors associated with HIV infection among female inmates in this voluntary HIV testing program. Results are discussed in light of previous research findings regarding the correlates of HIV seropositivity among New York State prison inmates and compared to previous blinded epidemiological studies of female inmates in the State. Future research, addressing the limitations of this preliminary study, is proposed.
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Anggara, Ahmad Khabib Dwi, et Ririn Tri Ratnasari. « Pengaruh Store Attribute terhadap Customer Experience dan Brand Loyalty ». Jurnal Ekonomi Syariah Teori dan Terapan 9, no 3 (31 mai 2022) : 379–87. http://dx.doi.org/10.20473/vol9iss20223pp379-387.
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ABSTRAK Industri fashion muslim di Indonesia saat ini sedang mengalami transformasi besar yang didorong oleh beberapa tren. Seiring dengan adanya transformasi teknologi saat ini, media sosial sebagai tempat berekspresi diri mendorong munculnya fast fashion yang mengacu pada praktik industri di mana pelaku industri fashion menawarkan berbagai macam produk baru dengan konsep pergantian mode yang cepat dan paling disukai pasar. Penelitian ini bertujuan untuk mengetahui bagaimana pengaruh store attribute terhadap customer experience, dan brand loyalty pada toko Hijup. Pengumpulan data dilakukan dengan kuesioner yang melibatkan 150 responden yang pernah mengunjungi dan berbelanja di toko Hijup dalam 12 bulan terakhir. Metode Path Analysis dilakukan untuk mengetahui bagaimana store attributes mempengaruhi customer experience dan brand loyalty dalam industri ritel fashion. Hasil penelitian menunjukkan bahwa store attribute memiliki pengaruh positif signifikan terhadap customer experience di dalam toko Hijup. Kemudian, ditemukan juga pengaruh positif signifikan antara customer experience terhadap brand loyalty. Adanya penelitian ini diharapkan dapat membantu toko Hijup sebagai pelaku retail khususnya di industri fashion muslim untuk meningkatkan store attribute mereka sehingga para peretail dapat menciptakan loyalitas bagi konsumen mereka. Kata kunci: Store Attribute, Customer Experience, Brand Loyalty, Toko Hijup. ABSTRACT The Muslim fashion industry in Indonesia is currently undergoing a major transformation shared by several trends. Along with the current technological transformation, social media as a place for self-expression encourages the emergence of fast fashion which refers to industrial practices where fashion industry players offer a variety of new products with the concept of rapid change and are most favored by the market. This study aims to determine how the influence of store attributes on customer experience, and brand loyalty at Hijup stores. Data were collected using questionnaires involving 150 respondents who had visited and purchased at Hijup stores in the last 12 months. The path Analysis method was conducted to find out how store attributes affect customer experience and brand loyalty in the fashion retail industry. The results showed that store attributes had a significant positive effect on customer experience in Hijup stores. Then, it was also found that there was a significant positive effect between customer experience on brand loyalty. This research is expected to help Hijup stores as retail players, especially in the Muslim fashion industry to increase their store attributes so that retailers can create loyalty for their consumers. Keywords: Store Attribute, Customer Experience, Brand Loyalty, Hijup Store. DAFTAR PUSTAKA Bıçakcıoğlu, N., Ilayda, İ., & Bayraktaroğlu, G. (2016). Antecedents and outcomes of brand love: the mediating role of brand loyalty. Journal of Marketing Communications, 24(8), 1–15. https://doi.org/10.1080/13527266.2016.1244108 Bilgihan, A. (2016). Gen Y customer loyalty in online shopping: An integrated model of trust, user experience and branding. Computers in Human Behavior, 61, 103–113. https://doi.org/10.1016/j.chb.2016.03.014 BRP & Windstream E. (2018). Retail’s digital crossroads: The race to meet shopper expectations. Retrieved from https://www.windstreamenterprise.com/wp-content/uploads/2018/07/windstream-retail-pov.pdf Choi, T. (2013). Fast fashion systems: Theories and applications. Florida USA: CRC Press. Finn, A. (2004). A reassessment of the dimensionality of retail performance: a multivariate generalizability theory perspective. Journal of Retailing and Consumer Services, 11(4), 235-245. http://dx.doi.org/10.1016/S0969-6989(03)00050-X Gentile, C., Spiller, N., & Noci, G. (2007). How to sustain the customer experience: an overview of experience components that co-create value with the customer. European Management Journal, 25(5), 395-410. https://doi.org/10.1016/j.emj.2007.08.005 Ghosh, P., Tripathi, V., & Kumar, A. (2010). Customer expectations of store attributes: A study of organized retail outlets in India. Journal of Retail & Leisure Property, 9(1), 75-87. Giddens. (2002). Customer loyalty: Menumbuhkan dan mempertahankan kesetiaan pelanggan. Jakarta: Erlangga. Hartman, K. B., & Spiro, R. L. (2005). Recapturing store image in customer-based store equity: a construct conceptualization. Journal of Business Research, 58(8), 1112-1120. https://doi.org/10.1016/j.jbusres.2004.01.008 Jackson, C. (2006). Driving brand loyalty on the web. DMI Review, 17(1), 62-67. https://doi.org/10.1111/j.1948-7169.2006.tb00031.x Khan, I., Hollebeek, L. D., Fatma, M., Islam, J. U., & Arkonsuo, L. R. (2020). Customer experience and commitment in retailing: Does customer age matter? Journal of Retailing and Consumer Services, 57. https://doi.org/10.1016/j.jretconser.2020.102219 Lemon, K. N., & Verhoef, P. V. (2016). Understanding customer experience throughout the customer journey. Journal of Marketing, 80(6), 69–96. https://doi.org/10.1509%2Fjm.15.0420 Lindquist, J. D. (1974). Meaning of image. Journal of Retailing, 50(4), 29-38. Mohd-Ramly, S., & Omar, N. A. (2017). Exploring the influence of store attributes on customer experience and customer engagement. International Journal of Retail & Distribution Management, 45(11), 1138–1158. https://doi.org/10.1108/IJRDM-04-2016-0049. Jain, R., Aagja, J., & Bagdare, S. (2017). Customer experience–a review and research agenda. Journal of Service Theory and Practice, 27(3), 642–662. https://doi.org/10.1108/JSTP-03-2015-0064. Nikhashemi, S. R., Tarofder, A. K., Gaur, S. S., & Haque, A. (2016). The Effect of customers’ perceived value of retail store on relationship between store attribute and customer brand loyalty: Some insights from Malaysia. Procedia Economics and Finance, 37, 432–438. https://doi.org/10.1016/S2212-5671(16)30148-4 Machtiger, Kate. (2020). What will the retail experience of the future look like?. Harvard Business Review. Retrieved from https://hbr.org/2020/06/what-will-the-retail-experience-of-the-future-look-like Shaw, C., & Ivens, J. (2007). Building great customer experience. New York: Palgrave, Macmillan The Jakarta Post. (2020). Indonesia's e-commerce sales to surpass India's. Retrieved from https://www.thejakartapost.com/news/2020/09/08/indonesias-e-commerce-sales-to-surpass-indias.html Verhoef, P. C., Lemon, K. N., Parasuraman, A., Roggeven, A., Tsiros, M., & Schlesinger, L. A. (2009). Customer experience creation: Determinants, dynamics and management strategies. Journal of Retailing, 85(1), 31–41. https://doi.org/10.1016/j.jretai.2008.11.001. Wang, C. H., & Ha, S. (2011). Store attributes influencing relationship marketing: A study of department stores. Journal of Fashion Marketing and Management: An International Journal, 15(3), 326–344. doi:10.1108/13612021111151923 Williams, L., Buoye, A., Keiningham, T. L., Aksoy, L. (2020). The practitioners’ path to customer loyalty: Memorable experiences or frictionless experiences? Journal of Retailing Consumer Service, 57. https://doi.org/10.1016/j.jretconser.2020.102215
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Anggara, Ahmad Khabib Dwi, et Ririn Tri Ratnasari. « Pengaruh Store Attribute terhadap Customer Experience dan Brand Loyalty ». Jurnal Ekonomi Syariah Teori dan Terapan 9, no 3 (31 mai 2022) : 379–87. http://dx.doi.org/10.20473/vol9iss20223pp379-387.
Texte intégralRésumé :
ABSTRAK Industri fashion muslim di Indonesia saat ini sedang mengalami transformasi besar yang didorong oleh beberapa tren. Seiring dengan adanya transformasi teknologi saat ini, media sosial sebagai tempat berekspresi diri mendorong munculnya fast fashion yang mengacu pada praktik industri di mana pelaku industri fashion menawarkan berbagai macam produk baru dengan konsep pergantian mode yang cepat dan paling disukai pasar. Penelitian ini bertujuan untuk mengetahui bagaimana pengaruh store attribute terhadap customer experience, dan brand loyalty pada toko Hijup. Pengumpulan data dilakukan dengan kuesioner yang melibatkan 150 responden yang pernah mengunjungi dan berbelanja di toko Hijup dalam 12 bulan terakhir. Metode Path Analysis dilakukan untuk mengetahui bagaimana store attributes mempengaruhi customer experience dan brand loyalty dalam industri ritel fashion. Hasil penelitian menunjukkan bahwa store attribute memiliki pengaruh positif signifikan terhadap customer experience di dalam toko Hijup. Kemudian, ditemukan juga pengaruh positif signifikan antara customer experience terhadap brand loyalty. Adanya penelitian ini diharapkan dapat membantu toko Hijup sebagai pelaku retail khususnya di industri fashion muslim untuk meningkatkan store attribute mereka sehingga para peretail dapat menciptakan loyalitas bagi konsumen mereka. Kata kunci: Store Attribute, Customer Experience, Brand Loyalty, Toko Hijup. ABSTRACT The Muslim fashion industry in Indonesia is currently undergoing a major transformation shared by several trends. Along with the current technological transformation, social media as a place for self-expression encourages the emergence of fast fashion which refers to industrial practices where fashion industry players offer a variety of new products with the concept of rapid change and are most favored by the market. This study aims to determine how the influence of store attributes on customer experience, and brand loyalty at Hijup stores. Data were collected using questionnaires involving 150 respondents who had visited and purchased at Hijup stores in the last 12 months. The path Analysis method was conducted to find out how store attributes affect customer experience and brand loyalty in the fashion retail industry. The results showed that store attributes had a significant positive effect on customer experience in Hijup stores. Then, it was also found that there was a significant positive effect between customer experience on brand loyalty. This research is expected to help Hijup stores as retail players, especially in the Muslim fashion industry to increase their store attributes so that retailers can create loyalty for their consumers. Keywords: Store Attribute, Customer Experience, Brand Loyalty, Hijup Store. DAFTAR PUSTAKA Bıçakcıoğlu, N., Ilayda, İ., & Bayraktaroğlu, G. (2016). Antecedents and outcomes of brand love: the mediating role of brand loyalty. Journal of Marketing Communications, 24(8), 1–15. https://doi.org/10.1080/13527266.2016.1244108 Bilgihan, A. (2016). Gen Y customer loyalty in online shopping: An integrated model of trust, user experience and branding. Computers in Human Behavior, 61, 103–113. https://doi.org/10.1016/j.chb.2016.03.014 BRP & Windstream E. (2018). Retail’s digital crossroads: The race to meet shopper expectations. Retrieved from https://www.windstreamenterprise.com/wp-content/uploads/2018/07/windstream-retail-pov.pdf Choi, T. (2013). Fast fashion systems: Theories and applications. Florida USA: CRC Press. Finn, A. (2004). A reassessment of the dimensionality of retail performance: a multivariate generalizability theory perspective. Journal of Retailing and Consumer Services, 11(4), 235-245. http://dx.doi.org/10.1016/S0969-6989(03)00050-X Gentile, C., Spiller, N., & Noci, G. (2007). How to sustain the customer experience: an overview of experience components that co-create value with the customer. European Management Journal, 25(5), 395-410. https://doi.org/10.1016/j.emj.2007.08.005 Ghosh, P., Tripathi, V., & Kumar, A. (2010). Customer expectations of store attributes: A study of organized retail outlets in India. Journal of Retail & Leisure Property, 9(1), 75-87. Giddens. (2002). Customer loyalty: Menumbuhkan dan mempertahankan kesetiaan pelanggan. Jakarta: Erlangga. Hartman, K. B., & Spiro, R. L. (2005). Recapturing store image in customer-based store equity: a construct conceptualization. Journal of Business Research, 58(8), 1112-1120. https://doi.org/10.1016/j.jbusres.2004.01.008 Jackson, C. (2006). Driving brand loyalty on the web. DMI Review, 17(1), 62-67. https://doi.org/10.1111/j.1948-7169.2006.tb00031.x Khan, I., Hollebeek, L. D., Fatma, M., Islam, J. U., & Arkonsuo, L. R. (2020). Customer experience and commitment in retailing: Does customer age matter? Journal of Retailing and Consumer Services, 57. https://doi.org/10.1016/j.jretconser.2020.102219 Lemon, K. N., & Verhoef, P. V. (2016). Understanding customer experience throughout the customer journey. Journal of Marketing, 80(6), 69–96. https://doi.org/10.1509%2Fjm.15.0420 Lindquist, J. D. (1974). Meaning of image. Journal of Retailing, 50(4), 29-38. Mohd-Ramly, S., & Omar, N. A. (2017). Exploring the influence of store attributes on customer experience and customer engagement. International Journal of Retail & Distribution Management, 45(11), 1138–1158. https://doi.org/10.1108/IJRDM-04-2016-0049. Jain, R., Aagja, J., & Bagdare, S. (2017). Customer experience–a review and research agenda. Journal of Service Theory and Practice, 27(3), 642–662. https://doi.org/10.1108/JSTP-03-2015-0064. Nikhashemi, S. R., Tarofder, A. K., Gaur, S. S., & Haque, A. (2016). The Effect of customers’ perceived value of retail store on relationship between store attribute and customer brand loyalty: Some insights from Malaysia. Procedia Economics and Finance, 37, 432–438. https://doi.org/10.1016/S2212-5671(16)30148-4 Machtiger, Kate. (2020). What will the retail experience of the future look like?. Harvard Business Review. Retrieved from https://hbr.org/2020/06/what-will-the-retail-experience-of-the-future-look-like Shaw, C., & Ivens, J. (2007). Building great customer experience. New York: Palgrave, Macmillan The Jakarta Post. (2020). Indonesia's e-commerce sales to surpass India's. Retrieved from https://www.thejakartapost.com/news/2020/09/08/indonesias-e-commerce-sales-to-surpass-indias.html Verhoef, P. C., Lemon, K. N., Parasuraman, A., Roggeven, A., Tsiros, M., & Schlesinger, L. A. (2009). Customer experience creation: Determinants, dynamics and management strategies. Journal of Retailing, 85(1), 31–41. https://doi.org/10.1016/j.jretai.2008.11.001. Wang, C. H., & Ha, S. (2011). Store attributes influencing relationship marketing: A study of department stores. Journal of Fashion Marketing and Management: An International Journal, 15(3), 326–344. doi:10.1108/13612021111151923 Williams, L., Buoye, A., Keiningham, T. L., Aksoy, L. (2020). The practitioners’ path to customer loyalty: Memorable experiences or frictionless experiences? Journal of Retailing Consumer Service, 57. https://doi.org/10.1016/j.jretconser.2020.102215
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Charmatz, Marc. « CUNY case serves as reminder for colleges, universities to ensure accessibility of course content ». Campus Legal Advisor 24, no 2 (11 septembre 2023) : 4–14. http://dx.doi.org/10.1002/cala.41192.
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The U.S. Department of Justice, through the U.S. Attorney for the Southern District of New York, has reached a voluntary compliance agreement with the City University of New York. The agreement requires CUNY to prepare and implement systemwide policies to ensure improved accessibility of educational content, proper training of staff and facility, and effective modifications and auxiliary aids and services (bit.ly/3OD3icq).
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Turner, MD, MSEd, Barbara J., Christine Laine, MD, MPH, Alan Kott et Walter W. Hauck, PhD. « Effect of drug and medical treatment on wide geographic variations in repeated emergency department use by HIV-infected drug users ». Journal of Opioid Management 2, no 2 (1 mars 2006) : 105. http://dx.doi.org/10.5055/jom.2006.0017.
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Repeated (≥ two visits) emergency department (ED) visits by HIV-infected (HIV+) drug users in New York State (NYS) vary widely by region and may reflect regional inequities in receipt of needed drug treatment and medical services. The study’s objective was to evaluate receipt of drug treatment and medical care by HIV+ drug users by region and its effect on ED use. For NYS Medicaid-enrolled HIV+ drug users (N = 11,556) in 1996 and 1997, we identified receipt of long-term (≥ six months) drug treatment, HIV care, and a usual source of medical care from claims files. Regions were classified as New York City , downstate suburban, upstate urban, and rural/small city. We examined adjusted associations of these services with ≥ two ED visits in the entire cohort and separately among patients who do and do not receive these three types of services. Repeated ED visits were greatest in rural/small cities (40.7 percent) and least in New York City (24.1 percent; p < 0.001), and receipt of drug treatment was also poorest (p < 0.001) in rural/small cities, whereas receipt of HIV care and usual source of medical care varied less by region. Adjusted odds of ≥ two ED visits was increased for patients in rural/small cities (1.89 [confidence interval, 1.44 to 2.50]) vs. New York City and reduced for patents with long-term drug treatment (0.76 [confidence interval, 0.69 to 0.84]). Among persons receiving long-term drug treatment, observed regional differences in ED use largely disappeared. Regional variations in receipt of long-term drug treatment by HIV+ drug users in one state appear to contribute to large differences in ED utilization.
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Jose, Anita, et Scott Wetzler. « Implementing a Provider Partnership to Improve Substance Abuse and Child Welfare Outcomes in Urban High-Needs Parents ». Families in Society : The Journal of Contemporary Social Services 100, no 3 (14 mai 2019) : 328–35. http://dx.doi.org/10.1177/1044389419836612.
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This Practice Note describes the implementation of a partnership between child welfare and substance use providers in New York City, with the aim of supporting cross-systems collaboration and improving outcomes for dually involved families. Specifically, this report focuses on improving both coordination and communication between a preventive child welfare service provider (Montefiore Family Treatment & Rehabilitation Program), an outpatient substance abuse treatment provider (Montefiore Division of Substance Abuse), and the local department of social services (New York City Administration for Children’s Services). This article identifies general challenges with collaboration, describes how this collaboration was created and implemented in New York City, and provides guidance for other entities that are attempting to create similar collaborations.
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Arshad, Faizan H., Alan Williams, Glenn Asaeda, Douglas Isaacs, Bradley Kaufman, David Ben-Eli, Dario Gonzalez et al. « A Modified Simple Triage and Rapid Treatment Algorithm from the New York City (USA) Fire Department ». Prehospital and Disaster Medicine 30, no 2 (17 février 2015) : 199–204. http://dx.doi.org/10.1017/s1049023x14001447.
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AbstractIntroductionThe objective of this study was to determine if modification of the Simple Triage and Rapid Treatment (START) system by the addition of an Orange category, intermediate between the most critically injured (Red) and the non-critical, non-ambulatory injured (Yellow), would reduce over- and under-triage rates in a simulated mass-casualty incident (MCI) exercise.MethodsA computer-simulation exercise of identical presentations of an MCI scenario involving a 2-train collision, with 28 case scenarios, was provided for triaging to two groups: the Fire Department of the City of New York (FDNY; n = 1,347) using modified START, and the Emergency Medical Services (EMS) providers from the Eagles 2012 EMS conference (Lafayette, Louisiana USA; n = 110) using unmodified START. Percent correct by triage category was calculated for each group. Performance was then compared between the two EMS groups on the five cases where Orange was the correct answer under the modified START system.ResultsOverall, FDNY-EMS providers correctly triaged 91.2% of cases using FDNY-START whereas non-FDNY-Eagles providers correctly triaged 87.1% of cases using unmodified START. In analysis of the five Orange cases (chest pain or dyspnea without obvious trauma), FDNY-EMS performed significantly better using FDNY-START, correctly triaging 86.3% of cases (over-triage 1.5%; under-triage 12.2%), whereas the non-FDNY-Eagles group using unmodified START correctly triaged 81.5% of cases (over-triage 17.3%; under-triage 1.3%), a difference of 4.9% (95% CI, 1.5-8.2).ConclusionsThe FDNY-START system may allow providers to prioritize casualties using an intermediate category (Orange) more properly aligned to meet patient needs, and as such, may reduce the rates of over-triage compared with START. The FDNY-START system decreases the variability in patient sorting while maintaining high field utility without needing computer assistance or extensive retraining. Comparison of triage algorithms at actual MCIs is needed; however, initial feedback is promising, suggesting that FDNY-START can improve triage with minimal additional training and cost.ArshadFH, WilliamsA, AsaedaG, IsaacsD, KaufmanB, Ben-EliD, GonzalezD, FreeseJP, HillgardnerJ, WeakleyJ, HallCB, WebberMP, PrezantDJ. A modified Simple Triage and Rapid Treatment algorithm from the New York City (USA) Fire Department. Prehosp Disaster Med. 2015;30(2):1-6.
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Zachrison, Kori, Margaret Samuels-Kalow, Krislyn Boggs, Sijia Li, Emily Hayden et Carlos Camargo. « Association of Emergency Department Payer Mix with ED Receipt of Telehealth Services : An Observational Analysis ». Western Journal of Emergency Medicine 23, no 2 (31 janvier 2022) : 141–44. http://dx.doi.org/10.5811/westjem.2021.9.53014.
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Introduction: Telehealth is commonly used to connect emergency department (ED) patients with specialists or resources required for their care. Its infrastructure requires substantial upfront and ongoing investment from an ED or hospital and may be more difficult to implement in lower-resourced settings. Our aim was to examine for an association between ED payer mix and receipt of telehealth services. Methods: Using data from the National Emergency Department Inventory (NEDI)-USA 2016 survey, we categorized EDs based on receipt of telehealth services (yes/no). The NEDI-USA data for EDs in New York state was linked with data from state ED datasets (SEDD) and state inpatient data (SID) to determine EDs’ payer mix (percent self-pay or Medicaid). Other ED characteristics of interest were rural location, academic status, and annual ED visit volume. We compared EDs with and without telehealth receipt, and used a logistic regression model to examine the relationship between ED payer mix and telehealth receipt after accounting for other ED characteristics. Results: Of the 162 New York EDs in the SEDD-SID dataset, 160 (99%) were linked to the NEDI-USA dataset and 133 of those responded (83%) to the survey. Telehealth receipt was reported by 48 EDs (36%, 95% confidence interval [CI], 28-44%). Emergency departments with and without telehealth receipt were similar (all P >0.40) with respect to rurality (6% vs 9%, respectively), academic status (13% vs 8%), and annual volume (median 36,728 vs 43,000). By contrast, median percent of Medicaid or self-pay patients was lower in telehealth EDs (36%) vs non-telehealth EDs (45%, P = 0.02). In adjusted analysis, increasing proportion of Medicaid and self-pay patients was associated with decreased odds of telehealth receipt (odds ratio 0.87 per 5% increase; 95% CI, 0.77-0.99). Rural location, academic status, and ED volume were not significantly associated with odds of ED telehealth receipt in the adjusted model. Conclusion: Among EDs in the state of New York, increasing proportion of self-pay and Medicaid patients was associated with decreased odds of ED telehealth receipt, even after accounting for rural location, academic status, and ED volume. The findings support the need for additional infrastructural investment in EDs serving a greater proportion of disadvantaged patients to ensure equitable access.
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Greenstein, Josh, Jerel Chacko, Brahim Ardolic et Nicole Berwald. « Impact of Hurricane Sandy on the Staten Island University Hospital Emergency Department ». Prehospital and Disaster Medicine 31, no 3 (6 avril 2016) : 335–39. http://dx.doi.org/10.1017/s1049023x16000261.
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AbstractIntroductionOn October 29, 2012, Hurricane Sandy touched down in New York City (NYC; New York USA) causing massive destruction, paralyzing the city, and destroying lives. Research has shown that considerable damage and loss of life can be averted in at-risk areas from advanced preparation in communication procedures, evacuation planning, and resource allocation. However, research is limited in describing how natural disasters of this magnitude affect emergency departments (EDs).Hypothesis/ProblemThe aim of this study was to identify and describe trends in patient volume and demographics, and types of conditions treated, as a result of Hurricane Sandy at Staten Island University Hospital North (SIUH-N; Staten Island, New York USA) site ED.MethodsA retrospective chart review of patients presenting to SIUH-N in the days surrounding the storm, October 26, 2012 through November 2, 2012, was completed. Data were compared to the same week of the year prior, October 28, 2011 through November 4, 2011. Daily census, patient age, gender, admission rates, mode of arrival, and diagnoses in the days surrounding the storm were observed.ResultsA significant decline in patient volume was found in all age ranges on the day of landfall (Day 0) with a census of 114; -55% compared to 2011. The daily volume exhibited a precipitous drop on the days preceding the storm followed by a return to usual volumes shortly after.A notably larger percentage of patients were seen for medication refills in 2012; 5.8% versus 0.4% (P<.05). Lacerations and cold exposure also were increased substantially in 2012 at 7.6% versus 2.8% (P<.05) and 3.8% versus 0.0% (P<.05) of patient visits, respectively.A large decline in admissions was observed in the days prior to the storm, with a nadir on Day +1 at five percent (-22%). Review of admitted patients revealed atypical admissions for home care service such as need for supplemental oxygen or ventilator.In addition, a drop in Emergency Medical Services (EMS) utilization was seen on Days 0 and +1. The SIUH-N typically sees 18% of patients arriving via EMS. On Day +1, only two percent of patients arrived by ambulance.ConclusionThe daily ED census saw a significant decline in the days preceding the storm. In addition, the type of conditions treated varied from baseline, and a considerable drop in hospital admissions was seen. Data such as these presented here can help make predictions for future scenarios.GreensteinJ, ChackoJ, ArdolicB, BerwaldN. Impact of Hurricane Sandy on the Staten Island University Hospital emergency department. Prehosp Disaster Med. 2016;31(3):335–339.
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Milgram, Gail Gleason. « An Analysis of Student Assistance Programs : Connecticut, New Jersey, and New York ». Journal of Drug Education 28, no 2 (juin 1998) : 107–16. http://dx.doi.org/10.2190/h62u-b31y-d8fr-q2m5.
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A questionnaire, designed to determine the process for identifying and providing assistance to students who demonstrate a variety of problem behaviors that interfere with learning or co-curricular performance in school, was mailed to school superintendents ( N = 1526) in Connecticut, New Jersey, and New York. Four hundred and fifty-one responses (29.6%A) were received; the majority (84.7%) indicated that a formal written policy exists for helping students and most (82.5%) also have a formal written procedure. The assistance program, most frequently called student assistance, is predominantly found at high school level. A full-time student assistance counselor paid by the school district (43.2%) or a grant funded position (18.9%) conducts the program. Students in the three states use the services of the program for alcohol problems, drug problems, family problems, school behavior problems, academic problems, etc. The major referral sources to the assistance programs are teachers, guidance counselors, and the students themselves. The survey findings indicate that assistance programs for students in Connecticut, New Jersey, and New York play a significant role in helping students who are experiencing problems and also positively impact on the school and the community.
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Pouliot, Katherine, Carol S. Weisse, David S. Pratt et Philip DiSorbo. « First-Year Analysis of a New, Home-Based Palliative Care Program Offered Jointly by a Community Hospital and Local Visiting Nurse Service ». American Journal of Hospice and Palliative Medicine® 34, no 2 (11 juillet 2016) : 166–72. http://dx.doi.org/10.1177/1049909115617139.
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Background: There is a growing need for home-based palliative care services, especially for seriously ill individuals who want to avoid hospitalizations and remain with their regular outside care providers. Aim: To evaluate the effectiveness of Care Choices, a new in-home palliative care program provided by the Visiting Nurse Services of Northeastern New York and Ellis Medicine’s community hospital serving New York’s Capital District. Methods: This prospective cohort study assessed patient outcomes over the course of 1 year for 123 patients (49 men and 74 women) with serious illnesses who were new enrollees in the program. Quality of life was assessed at baseline and after 1 month on service. Satisfaction with care was measured after 1 and 3 months on service. The number of emergency department visits and inpatient hospitalizations pre- and postenrollment was measured for all enrollees. Results: Patients were highly satisfied (72.7%-100%) with their initial care and reported greater satisfaction ( P < .05) and stable symptom management over time. Fewer emergency department ( P < .001) and inpatient hospital admissions ( P < .001) occurred among enrollees while on the palliative care service. Conclusion: An in-home palliative care program offered jointly through a visiting nurse service and community hospital may be a successful model for providing quality care that satisfies chronically ill patients’ desire to remain at home and avoid hospital admissions.
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Al-Attar, M. « POS1334 RHEUMATOLOGY PATIENT ATTENDANCE TO THE PAEDIATRIC EMERGENCY DEPARTMENT ». Annals of the Rheumatic Diseases 80, Suppl 1 (19 mai 2021) : 949.2–949. http://dx.doi.org/10.1136/annrheumdis-2021-eular.4325.
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Background:A large proportion of patients present to the paediatric emergency department (PED) with non-urgent problems [1]. With growing pressures on services, there is a need to reduce unnecessary attendances. Children with rheumatological conditions may attend PED with flares of their condition or unrelated presentations. These patients may be immunosuppressed due to steroid, disease-modifying or biologic therapy; PED attendance may therefore pose a serious infection risk.Objectives:To evaluate why children with rheumatological conditions attend the PED and whether these attendances are avoidable.Methods:This study was run in Royal Manchester Children’s Hospital, a UK hospital with a PED and tertiary paediatric rheumatology services. Patients under rheumatology who attend PED are usually seen directly. A dataset of all patients referred directly to paediatric rheumatology between 01/01/19 and 31/12/19 was obtained from electronic records (n=59). The age, sex and reason for attendence were collected, as well whether they were admitted/discharged. Further data on management was collected from discharge letters for those with joint pain/swelling.Results:This cohort had 36 females and 23 males, with an average age of 11.9 years (range 1-18). 28 were discharged (47.5%) and 30 were admitted (50.8%). One patient left before being seen. The average waiting time was 3.97 hours.Table 1 summarises reasons for attendance to PED and final outcome. The most common reason for attendance was joint pain/swelling (n=14, 23.7%). Of these, nine were discharged with advice on analgesia or steroid dosing and for early review in clinic. There was no documentation on whether there had been any attempt to access the available rheumatology helpline prior to attending PED.Non-rheumatology-related reasons for attendance are also shown in Table 1, and notably include 20 patients with infections, 75% of whom were admitted to hospital. Chicken pox was the second most common reason for attendance (n=5, 8.5%); all patients attending with chicken pox or shingles (n=6) were admitted.Table 1.Reasons for attendance to PED and final outcomeReason for attendanceNumber admittedNumber dischargedJoint pain/swelling59Chicken pox50Viral URTI14Rash04Pneumonia30SLE flare30Influenza A20GPA flare20Asked to attend due to blood results from clinic20Drug reaction02Minor injury02Shingles10Oral herpes simplex11Orbital inflammation10Urinary tract infection10Dysphagia10Gastroenteritis10Cerebral infarcts10Constipation01Chest pain01Abdominal pain01Enlarged lymph node01Picking up prescription01Unresponsive episode01Conclusion:Our study shows that attendance to PED with joint pain/swelling is usually avoidable in patients known to paediatric rheumatology services. Appropriate alternative services are needed to reduce hospital attendances; nurse-led helplines are beneficial, but still face some challenges in both availability and accessibility [2]. It is also important that patients and parents are given action plans for acute flares, which would ideally involve early clinic review rather than PED attendance. Our data also showed that patients are spending a long time waiting in PED, which needs to be avoided particularly in the context of immunosuppression. This is especially poignant now in light of the Covid-19 pandemic. Direct referral to rheumatology with non-rheumatological problems likely reflects a desire for specialist advice in the context of complex conditions and medications, for example with regards to infections whilst on immunosuppressive medications, or uncertainty about whether new symptoms are related to the underlying condition. Expansion of helpline services and new approaches such as remote consultations should be explored.References:[1]Poku BA et al. Reducing repeat paediatric emergency department attendance for non-urgent care: a systematic review of the effectiveness of interventions. Emerg Med J. 2019 Jul;36(7):435-442.[2]Palmer et al. Rheumatology helpline: challenges in the biologic therapy era. Br. J. Nurs. 2011 20:12, 728-732Disclosure of Interests:None declared
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van der Ven, Els, Stephen Smith, Yasmin Rawlins, Ilana Nossel, Cale Basaraba, Melanie Wall, Jennifer Scodes, Wim Veling, Leslie Marino et Lisa Dixon. « S243. RACIAL AND ETHNIC DIFFERENCES IN PATHWAY TO CARE AND BASELINE CHARACTERISTICS IN EARLY INTERVENTION SERVICES FOR PSYCHOSIS IN NEW YORK STATE ». Schizophrenia Bulletin 46, Supplement_1 (avril 2020) : S131. http://dx.doi.org/10.1093/schbul/sbaa031.309.
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Abstract Background The racial and ethnic background of individuals with psychosis may shape their pathway to early intervention services and clinical presentation at admission. Studies from Europe and Canada demonstrate that black minority patients with first-episode psychosis experience a more adverse and coercive pathway to care. The extent to which these findings can be extrapolated to the US context is unknown. The aims of this study are (1) to compare baseline contextual and clinical characteristics, and (2) to examine care pathways by race and ethnicity among young people with psychosis in early intervention services. Methods This study included individuals with a recent-onset (<2 years) psychosis aged 16 to 30 years enrolled at 19 early intervention programs across New York State. Clinicians collected data on pathway to care, demographic, social and clinical variables at program entry. Level of functioning was assessed using the social, occupational and symptomatic functioning subscales of the MIRECC GAF. Results The sample included 767 individuals with a non-Hispanic white (n=209, 27.2%), non-Hispanic black (277, 36.1%), Hispanic (218, 28.4%), or Asian (63, 8.2%) racial/ethnic background. Compared to non-Hispanic white, minority individuals were more likely to have public or no insurance and, overall, had a lower level of completed education. In terms of pathway to care, a lower proportion of non-Hispanic black (65.7%) and Asian (58.7%) participants had previously used mental health services compared to the non-Hispanic white group (78.0%). In contrast, psychiatric hospital or emergency department admissions in the 90 days prior to program enrollment were more frequent among all minority groups in comparison to the non-Hispanic white group. There were no significant differences by race and ethnicity in the level of symptoms or social functioning at baseline. Discussion Our findings suggest a pattern of mental health service use among minority groups with psychosis characterized by less mental health contacts but more inpatient and emergency care prior to the initiation of early intervention services. This trend could be partly explained by racial and ethnic patterning at the contextual level, including financial barriers to care, less so by racial/ethnic differences in illness severity. Our findings are consistent with evidence demonstrating an overrepresentation of minority individuals, especially African-Americans, in psychiatric emergency services suggesting a gap in unmet mental health need among minority populations in the US.
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Pitt, PhD, Ivan L. « Application of an Ordinal Probit Regression Model in predicting emergency response rates in the Fire Department of New York City ». Journal of Emergency Management 20, no 5 (1 septembre 2022) : 423–42. http://dx.doi.org/10.5055/jem.0537.
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This article introduces the use of an Ordinal Probit Regression Model to predict emergency response rates in the Fire Department of New York City (FDNY) when data are of the count-type variety and ordinal. The main objective of this article is to model the effects of boroughs, emergency incident types, and the volume of emergency incidents (counts) on response rates for the years 2010-2016. The model framework discusses the model selection criteria when the proportional odds assumptions for ordinal models are no longer valid, and a model in which scale effects are allowed to vary among emergency incident types is preferred. This statistical insight can be used by elected officials and city agencies to evaluate FDNY’s emergency response availability, capability, and operational performance in order to improve emergency services in the five boroughs.
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Malik, Romana Fattimah, Carina G. J. M. Hilders et Fedde Scheele. « Do ‘physicians in the lead’ support a holistic healthcare delivery approach ? A qualitative analysis of stakeholders’ perspectives ». BMJ Open 8, no 7 (juillet 2018) : e020739. http://dx.doi.org/10.1136/bmjopen-2017-020739.
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ObjectivesValue-based healthcare implies that healthcare issues are addressed most effectively with the ‘physicians in the lead' (PIL) strategy. This study explores whether PIL also supports a holistic care approach that patients are increasingly demanding.DesignA qualitative research design was used.SettingThis study was conducted in a general hospital in the Netherlands with an integrated PIL strategy.ParticipantsSemistructured interviews were conducted with 14 hospital stakeholders: 13 stakeholders of an Obstetrics and Gynaecology department (the hospital’s Patient Council (n=1), nurses (n=2), midwives (n=2), physicians (n=2), residents (n=2), the non-medical business managers of the Obstetrics and Gynaecology department (n=2) the Board of Directors (n=2)) and a member of the Dutch National Healthcare Institute’s Innovative Healthcare Professions programme.ResultsAccording to diverse stakeholders, PIL does not support a holistic healthcare delivery approach, primarily because of the strong biomedical focus of the physicians. Although physicians can be educated to place more emphasis on the holistic outcome, holistic care delivery requires greater integration and teamwork in the care chain. As different healthcare professions are complementary to each other, a new strategy of a ‘team in the lead' was suggested to meet the holistic healthcare demands. Besides this new strategy, there is a need for an extramural care management coordination centre where patients are able to receive support in managing their own care. This centre should also facilitate services similar to the core function of a church or community centre. These services should help patients to deal with different holistic dimensions that are important for their well-being.ConclusionsThe PIL strategy appears to be insufficient for holistic healthcare delivery. A ‘team in the lead’ approach should be considered to meet the holistic healthcare demands. Further research should focus on observing PIL in different cultures and exploring the effectiveness of the strategy ‘team in the lead’.
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Badner, Victor, et Mana Saraghi. « Using Dental Health Care Personnel During a Crisis ». Public Health Reports 136, no 2 (13 janvier 2021) : 143–47. http://dx.doi.org/10.1177/0033354920976577.
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The first few months of the coronavirus disease 2019 (COVID-19) pandemic challenged health care facilities worldwide in many ways. Inpatient and intensive care unit (ICU) beds were at a premium, and personnel shortages occurred during the initial peak of the pandemic. New York State was the hardest hit of all US states, with a high concentration of cases in New York City and, in particular, Bronx County. The governor of New York and leadership of hospitals in New York City called upon all available personnel to provide support and patient care during this health care crisis. This case study highlights the efforts of Jacobi Medical Center, located in the northeast Bronx, from March 1 through May 31, 2020, and its use of nontraditional health care personnel, including Department of Dentistry/OMFS (Oral and Maxillofacial Surgery) staff members, to provide a wide range of health care services. Dental staff members including ancillary personnel, residents, and attendings were redeployed and functioned throughout the facility. Dental anesthesiology residents provided medical services in support of their colleagues in a step-down COVID-19–dedicated ICU, providing intubation, ventilator management, and critical and palliative care. (Step-down units provide an intermediate level of care between ICUs and the general medical–surgical wards.) Clear communication of an acute need, a well-articulated mission, creative use of personnel, and dedicated staff members were evident during this challenging time. Although not routinely called upon to provide support in the medical and surgical inpatient areas, dental staff members may provide additional health care personnel during times of need.
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Kummer, Benjamin R., Chloe Sweetnam, Barbara G. Vickrey, Georges Naasan, Dayneen Harvey, Kimberly Gallagher et Nathalie Jetté. « Teleneurology Expansion in Response to the COVID-19 Outbreak at a Tertiary Health System in New York City ». Neurology : Clinical Practice 11, no 2 (9 mars 2021) : e102-e111. http://dx.doi.org/10.1212/cpj.0000000000001057.
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ObjectiveTo assess the implementation of teleneurology (TN), including patient and clinician experiences, during the coronavirus respiratory disease 2019 (COVID-19) pandemic.MethodsWe studied synchronous (video visit) and asynchronous (store-and-forward, patient-portal evaluation, remote monitoring) TN utilization in the Mount Sinai Health System Neurology Department in New York, 2 months before and after the start of our department's response to the pandemic in mid-March 2020. Weekly division meetings enabled ongoing assessments and analysis of barriers and facilitators according to the Consolidated Framework for Implementation Research and the Expert Recommendations for Implementing Change models. We used postvisit surveys of clinicians (from April 13 to May 15, 2020) and patients (from May 11 to 15, 2020) to determine technology platforms used, and TN experience and acceptability, using Likert scales (1 = very poor/unlikely to 5 = very good/likely).ResultsOver the 4-month period, 117 TN clinicians (n = 14 subspecialties) conducted 4,225 TN visits with 3,717 patients (52 pre- vs 4,173 post–COVID-19). No asynchronous TN services were delivered. Post–COVID-19, the number of TN clinicians, subspecialties performing TN, and visits increased by 963%, 133%, and 7,925%, respectively. Mean acceptability among patients and clinicians was 4.7 (SD 0.6) and 3.4 (SD 1.6), respectively. Most video visits were completed using Epic MyChart (78.5%) and Zoom (8.1%). TN implementation facilitators included Medicare geographic restriction waivers, development of clinician educational materials, and MyChart outreach programs for patients experiencing technical difficulties.ConclusionsA significant expansion of TN utilization accompanied the COVID-19 response. Patients found TN more acceptable than did clinicians. Proactive application of an implementation framework facilitated rapid and effective TN expansion.
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KARUS, DANIEL, VICTORIA H. RAVEIS, KATHERINE MARCONI, PETER SELWYN, CARLA ALEXANDER, BARBARA HANNA et IRENE J. HIGGINSON. « Mental health status of clients from three HIV/AIDS palliative care projects ». Palliative and Supportive Care 2, no 2 (juin 2004) : 125–38. http://dx.doi.org/10.1017/s1478951504040180.
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Objective:To describe mental health status and its correlates among clients of three palliative care programs targeting underserved populations.Methods:Mental Health Inventory (MHI-5) scores of clients from programs in Alabama (n= 39), Baltimore (n= 57), and New York City (n= 84) were compared.Results:Mean MHI-5 scores did not differ among sites and were indicative of poor mental health. Significant differences were noted among sites with regard to client sociodemographics, physical functioning, and perceptions of interpersonal relations. Results of multivariate regression models estimated for each site suggest variation in the relative importance of potential predictors among sites. Whereas poorer mental health was primarily associated with history of drug dependence at Baltimore and more physical symptomatology at New York, better mental health was most strongly correlated with more positive perceptions of interpersonal relationships at Baltimore and increasing age and more positive perceptions of meaning and purpose in life at New York.Significance of results:The data presented suggest the importance of assessing clients' history of and current need for mental health services. Evidence of a relationship between positive perceptions of meaning and purpose and better psychological function underscores the importance of existential issues for the overall well-being of those who are seriously ill.
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Sah, Pratha, Thomas N. Vilches, Seyed M. Moghadas, Abhishek Pandey, Suhas Gondi, Eric C. Schneider, Jesse Singer, Dave A. Chokshi et Alison P. Galvani. « Return on Investment of the COVID-19 Vaccination Campaign in New York City ». JAMA Network Open 5, no 11 (21 novembre 2022) : e2243127. http://dx.doi.org/10.1001/jamanetworkopen.2022.43127.
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ImportanceNew York City, an early epicenter of the pandemic, invested heavily in its COVID-19 vaccination campaign to mitigate the burden of disease outbreaks. Understanding the return on investment (ROI) of this campaign would provide insights into vaccination programs to curb future COVID-19 outbreaks.ObjectiveTo estimate the ROI of the New York City COVID-19 vaccination campaign by estimating the tangible direct and indirect costs from a societal perspective.Design, Setting, and ParticipantsThis decision analytical model of disease transmission was calibrated to confirmed and probable cases of COVID-19 in New York City between December 14, 2020, and January 31, 2022. This simulation model was validated with observed patterns of reported hospitalizations and deaths during the same period.ExposuresAn agent-based counterfactual scenario without vaccination was simulated using the calibrated model.Main Outcomes and MeasuresCosts of health care and deaths were estimated in the actual pandemic trajectory with vaccination and in the counterfactual scenario without vaccination. The savings achieved by vaccination, which were associated with fewer outpatient visits, emergency department visits, emergency medical services, hospitalizations, and intensive care unit admissions, were also estimated. The value of a statistical life (VSL) lost due to COVID-19 death and the productivity loss from illness were accounted for in calculating the ROI.ResultsDuring the study period, the vaccination campaign averted an estimated $27.96 (95% credible interval [CrI], $26.19-$29.84) billion in health care expenditures and 315 724 (95% CrI, 292 143-340 420) potential years of life lost, averting VSL loss of $26.27 (95% CrI, $24.39-$28.21) billion. The estimated net savings attributable to vaccination were $51.77 (95% CrI, $48.50-$55.85) billion. Every $1 invested in vaccination yielded estimated savings of $10.19 (95% CrI, $9.39-$10.87) in direct and indirect costs of health outcomes that would have been incurred without vaccination.Conclusions and RelevanceResults of this modeling study showed an association of the New York City COVID-19 vaccination campaign with reduction in severe outcomes and avoidance of substantial economic losses. This significant ROI supports continued investment in improving vaccine uptake during the ongoing pandemic.
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Bembenutty, Héfer. « The Teacher of Teachers Talks about Learning to Learn : An Interview with Wilbert (Bill) J. McKeachie ». Teaching of Psychology 35, no 4 (octobre 2008) : 363–72. http://dx.doi.org/10.1080/00986280802390787.
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Wilbert J. McKeachie has been the president of the American Psychological Association (APA), the American Association of Higher Education, the American Psychological Foundation, the Division of Educational and School Psychology of the International Association of Applied Psychology, and APA's Divisions 2 and 15. He received his PhD at the University of Michigan in 1949 and is former Director of the University of Michigan Center for Research on Learning and Teaching. He also served as Chair of the Psychology Department at the University of Michigan from 1961 to 1971. Professor McKeachie has received eight honorary degrees, the American Psychological Foundation Gold Medal for Lifetime Contributions to Psychology, and the American Psychological Association Presidential Citation for exemplary service to the academic and scientific community. His classic book, Teaching Tips, is now in its 12th edition (McKeachie & Svinicki, 2006). Héfer Bembenutty is an Assistant Professor of Educational Psychology at Queens College of The City University of New York in the Department of Secondary and Youth Services. He received his BA in psychology from the University of Michigan, an MS in psychology from Eastern Michigan University, and an MA and PhD in educational psychology from The City University of New York. He maintains an active research agenda in students' and teachers' self-regulation of learning, the effects of test anxiety on learning, homework self-regulation, self-efficacy beliefs, multicultural education, and academic delay of gratification. He teaches undergraduate and graduate courses in educational psychology, cognition, instruction and technology, human development and learning, classroom management, and multicultural education.
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Jouzi, Zeynab, Lauren San Diego, Neil A. Lewis et Tashara M. Leak. « How Can Transitional Housing Be Improved ? Insights from Residents’ Experiences and Perceptions in New York City ». International Journal of Environmental Research and Public Health 21, no 7 (26 juin 2024) : 829. http://dx.doi.org/10.3390/ijerph21070829.
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Homelessness, affecting over half a million Americans, significantly elevates the risks of mental and physical health issues, consequently diminishing life expectancy when compared with the general population. Homelessness is a critical public health issue, and efforts are needed to address lack of housing as a social determinant of health. Transitional housing (TH) programs emerge as vital interventions, offering a place to stay with various support services to facilitate the transition to permanent residency. Nearly half of the unhoused population in the country and over 90% in New York live in TH or shelters. Despite the high utilization rates of TH, engagement with support services and opportunities for improvement remain poorly understood. This study aimed to fill this gap by examining the factors influencing support service usage and opportunities for enhancement through semi-structured interviews with TH residents in New York City to capture their lived experiences and perspectives. Analysis of the interviews (n = 20) revealed five main factors affecting service engagement that aligned with constructs of the socioecological model: intrapersonal (self-efficacy, chronic health conditions, mental health), interpersonal (parenthood and well-being of children with special needs, individual staff interactions, and communication), institutional (bureaucratic challenges, administrative burden, and living facilities), community (social isolation and educational opportunity), and policy (challenge meeting basic needs and undocumented status). Recommendations for bridging service gaps primarily arose at the institutional and community levels, offering critical insights for administrators to tailor services more effectively to TH residents’ needs, thus contributing to the broader goal of advancing health equity among the unhoused.
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Ylvisaker, Mark, Timothy Feeney et Melissa Capo. « Long-Term Community Supports for Individuals With Co-Occurring Disabilities After Traumatic Brain Injury : Cost Effectiveness and Project-Based Intervention ». Brain Impairment 8, no 3 (1 décembre 2007) : 276–92. http://dx.doi.org/10.1375/brim.8.3.276.
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AbstractOutcome studies have established that successful community living is compromised in the population of individuals with traumatic brain injury and chronic behavioural difficulties along with a co-occurring diagnosis of substance abuse and/or mental health disorder. Two studies are presented. The first was aimed at describing long-term outcome of a sample of individuals (N = 51) served by the New York State Department of Health TBI Medicaid Waiver Program. Each of the participants was diagnosed with TBI plus either substance abuse or a mental health disorder, or both. Because of significant behavioural challenges, all of the participants were in a restrictive living setting the year before enrolment in the waiver program (e.g., nursing or correctional facility). Data on community living arrangement, self-reported community integration experiences, and costs are presented. Results indicate that most of the participants (41 of the 46 who were alive and living in state) continued to live in the community 8 to 9 years after commencement of community support services. The participants' community integration responses were generally positive and cost data demonstrate substantial savings to the state for this cohort. Comparing prewaiver costs in residential settings with most recent (2005) costs for community supports, there was an average daily cost savings of US$137 per person for the 1996 cohort and US$144 per person for the 1997 cohort. The second study explored the use of project-oriented interventions and supports in an agency that provides community support services to this dual diagnosis population. Project-oriented services are described as meeting many needs common to this dual-diagnosis population. Clinical staff (N = 11) and a sample of waiver participants (N = 7) were surveyed. Results suggest that the use of personally meaningful projects can become a clinical habit for staff and that projects are generally judged by participants to be a meaningful use of time, and significant in giving them an opportunity to play an expert role and to help others.
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Jiang, Jian, Fanqian Huang et Huiting Li. « Analysis on 1481 case of medical complaints in a Tertiary Hospital in Fujian Province : A 5-year retrospective study ». Medicine 102, no 26 (30 juin 2023) : e34107. http://dx.doi.org/10.1097/md.0000000000034107.
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This study aims to review the 1481 cases of medical complaints from Fujian Provincial Jinshan Hospital in the past 5 years for providing a reference for new hospitals to deal with medical complaints, optimize medical procedures, improve medical quality, and enhance patient experience. The medical complaint information received by the hospital’s medical department and service center accepted and transferred by the health administrative department in the past 5 years was systematically reviewed and statistically analyzed by using hierarchical clustering method. The transfer of the health administration department (61.5%) and the acceptance of the service center (28.9%) were the main sources of medical complaints in hospital. The incidence of medical complaints per 10,000 patients in the hospital was between 3 and 6. The maximum number of complaints was 2017 (5.28 cases/10,000 population), and the least was in 2019 (3.2 cases/10,000 population). The median of complaints was 25, and May to Sep was the period of high incidence of medical complaints each year. In 5 years, the month with the largest number of complaints was May 2020 (41 cases), followed by August 2017(40 cases), and the month with the least number was November 2020 (11 cases). In the past 5 years, the hospital’s medical complaints were mainly in 4 aspects: medical process (n = 329, 22.2%), medical environment (n = 282, 19%), humanistic care (n = 277, 18.7%), and medical management (n = 209, 14.1%). The most frequent complaints were in clinical departments, among which the emergency, outpatient, and pediatric departments accounted for more than 50%. The top 3 complaints were doctors (n = 778, 53%), logistics (n = 284, 19%), and nurses (n = 239, 16%). The main way to resolve complaints was letter and telephone feedback (n = 1372, 92.6%). Our research recommends that new hospitals change their concepts, pay more attention to the services and quality of medical resources and logistical support, follow the best practices of patient-centered, perfect various medical complaint channels, and establish multiple methods. They should also properly accept and dispose medical complaints, improve the timeliness and feedback efficiency of responding to medical complaints, strengthen communication, exchange, and dialogue, and improve patients’ medical experience and sense of gain.
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Glaser, Allison, Emma Kaplan-Lewis, Ana Ventuneac, Wyley Gates, Michael Cruz, Joaquin Aracena, Diane Tider, Bianca Duah, Judith Aberg et Antonio Urbina. « 860. Immediate Access to Post-Exposure Prophylaxis (PEP) Through a 24/7 New York City PEP Hotline ». Open Forum Infectious Diseases 5, suppl_1 (novembre 2018) : S20—S21. http://dx.doi.org/10.1093/ofid/ofy209.045.
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Abstract Background Oral post-exposure prophylaxis (PEP) is effective in preventing HIV transmission. To minimize barriers to PEP for New York City (NYC) residents, the Institute for Advanced Medicine (IAM), Mount Sinai Health System, and the NYC Department of Health and Mental Health established a 24-hour 7-days PEP hotline to provide eligible callers with immediate access to PEP and follow-up clinical care. Methods Data from hotline callers (January to December 2017) was analyzed utilizing multivariable logistic regression to determine whether a call resulted in PEP access within 72 hours of exposure by sociodemographic variables and exposure characteristics. We describe transitions from PEP to PrEP (pre-exposure prophylaxis). Results The PEP hotline cohort (n = 1278) was 83% male, 11% female, 1% transgender; 66% LGBTQ and 20% heterosexual; 35% White, 15% Black, 9% Asian; 41% other/unknown; 25% Hispanic; mean age of 30 years (range 14–72). The majority of callers learned about the hotline by Internet search (59%). Mean exposure time prior to call was 31 hours with 57% within 24 hours. Exposures were 98% sexual; 73% anal sex (43% receptive; 30% insertive), 21% vaginal, and 6% other. 63% reported condomless sex and 29% condom failure. 15% of callers reported a partner with HIV. 35% of callers reported alcohol or recreational substances at the time of the exposure. Prior PEP and PrEP use was 20% and 9%, respectively. 91% of callers were eligible for PEP; 69% called afterhours and received a telephone PEP prescription, and 27% called during business hours and were directed to a clinic. Access to PEP within 72 hours of exposure occurred in 1,081 (93%) of eligible callers and within 36 hours in 68%. 90% of callers had confirmed follow-up clinic appointments. Of the 472 callers linked to care at the IAM, 89 (19%) transitioned to PrEP. Conclusion This unique program demonstrates a timely initiative to facilitate PEP access to a diverse cohort with the purpose of mitigating risk from potential exposure to HIV. Further investigation is needed to explore adherence to PEP, follow-up testing results, transitions to PrEP for prevention planning, and coordination of health care and substance use services. Disclosures E. Kaplan-Lewis, Viiv: Consultant, Consulting fee. J. Aberg, Gilead: Research Contractor, Research support. GSK: Research Contractor, Research support. ViiV: Research Contractor, Research support. A. Urbina, Theratechnologies: Scientific Advisor, Consulting fee. ViiV: Scientific Advisor, Consulting fee. Merck: Scientific Advisor, Consulting fee. Gilead: Scientific Advisor, Consulting fee.
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Rajecki, D. W., et Joan B. Lauer. « Improved Advising Ratings in an Undergraduate Psychology Program ». Psychological Reports 100, no 1 (février 2007) : 171–76. http://dx.doi.org/10.2466/pr0.100.1.171-176.
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During the late 1990s, the psychology department of Indiana University-Purdue University Indianapolis made investments in its undergraduate advising program in terms of additional professional personnel, a new orientation course, an experimental intrusive advising track, innovative peer activities, and expanded physical facilities. Against this backdrop of innovations, from 1995 to 2001 an exit survey of graduating seniors ( N= 311) showed improved evaluations of departmental counseling services. Ratings of the obtainability of advising on courses and the quality of course and career advising all showed significant upward shifts over the seven years of study. Regarding a specific innovation, students who completed a 1-hr. orientation course gave higher mean counseling ratings than those not enrolled.
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Sandhar, G., M. Kruhlak, L. Krebs, L. Gaudet, S. Couperthwaite et B. Rowe. « P035 : Improving emergency department outcomes for Alberta seniors ». CJEM 22, S1 (mai 2020) : S77. http://dx.doi.org/10.1017/cem.2020.242.
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Introduction: In 2010, Alberta Health Services (AHS) introduced Transition Coordinators (TC), a unique nursing role focused on assessment of elderly patients to support safe discharge home. The objective of this study is to describe patient characteristics to predict safe discharge for seniors (≥65 years of age) and identify barriers that can be used to improve ED outcomes for these patients. Methods: Two trained research assistants conducted a chart review of the TC referral form and the ED Information System (EDIS) for patients seen by TCs between April and June 2017. Information on patient characteristics, existing home care and community services, the index ED visit and subsequent revisits were extracted. Data were entered into a purpose-built database in REDCap. A descriptive analysis was conducted; results are reported as mean ± standard deviation (SD), median (interquartile range [IQR]), or proportions, as appropriate. Results: A total of 1411 patients with TC referral forms were included (779 [55%] female). The majority of these patients were ≥65 (1350 [96%]) with a mean age of 82 ± 9.6. The majority of patients were triaged as a CTAS of 3 (835 [59%]) with the most common reasons for presentation including: shortness of breath (128 [9%]), abdominal pain (94 [6.7%]), and general weakness (81 [5.7%]). Nearly one third of patients (391 [30%]) were already receiving home care services; (96 [7%]) received a new home care referral as a result of their ED visit. Of all the patients, 1111 (79%) had comorbidities (median: 3 [IQR: 1 to 5]). Overall, 38% (n = 536) patients had visited the ED in the 12 months prior to the index with a median of 2 [IQR: 1 to 4) visits. On average, patient's length of stay for their index visits was 12 ± 0.35 hours. Admissions occurred for 599 [42%] patients with delays being common; the mean time between the decision to admit and the patient leaving the ED was 6 hrs ± 0.23. Conclusion: Seniors in the ED are complex patients who experience long lengths of stay and frequent delays in decision-making. Upon discharge, few patients receive referrals to community supports, potentially increasing the likelihood of revisits and readmissions. Future studies should assess whether the presence of TCs is associated with better outcomes in the community.
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Yamamoto, Ayae, Lillian Gelberg, Yusuke Tsugawa, Gerald Kominski et Jack Needleman. « 4269 Frequent emergency department use among homeless individuals seen in emergent care : High risks of opioid-related diagnoses and adverse health services utilization outcomes ». Journal of Clinical and Translational Science 4, s1 (juin 2020) : 133. http://dx.doi.org/10.1017/cts.2020.394.
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OBJECTIVES/GOALS: Using multi-state discharge data, to identify predictors of frequent emergency department (ED) use among the homeless patients seen in emergent care, and to compare frequent versus less frequent homeless ED users for their risk of serious health services utilization outcomes. METHODS/STUDY POPULATION: Based on the State Emergency Department Database and the State Inpatient Database, homeless individuals (n = 88,541) who made at least one ED visit in four states (Florida, Maryland, Massachusetts, and New York) in 2014. In this retrospective cross-sectional analysis, patient-level demographic and clinical factors were assessed as predictors for increased ED use. Risks of opioid overdose, opioid-related hospital admission/ED visit, in-hospital mortality, mechanical ventilation, and number of hospitalizations were compared between individuals with 4 or more vs. 2-3 vs. 1 ED visit(s), adjusting for potential confounders including hospital fixed effects (allowing for within hospital comparisons). RESULTS/ANTICIPATED RESULTS: Higher rates of ED use were associated with Medicare coverage <65; primary diagnosis of alcohol abuse, asthma, or abdominal pain; and co-morbidity of alcohol abuse, psychoses, or chronic pulmonary disease. Individuals with ≥4 visits had significantly higher adjusted risk of opioid overdose (3.7% vs. 1.2% vs. 1.0%), opioid-related hospitalizations/ED visits (17.9% vs. 8.5% vs. 6.6%), mechanical ventilation (9.8% vs. 7.0% vs. 4.7%), and greater # of hospitalizations (3.2 vs. 1.3 vs. 0.8) compared to individuals with 2-3 or 1 ED visit. Individuals with ≥4 and 2-3 ED visits had similar but increased risks of in-hospital mortality compared to individuals with 1 ED visit (2.8% vs. 2.8% vs. 2.3%). DISCUSSION/SIGNIFICANCE OF IMPACT: Homeless patients who were high ED users were more likely to be hospitalized and have other adverse outcomes. These findings encourage targeted interventions (i.e. housing) for the high-utilizer homeless population to reduce the burden of serious outcomes and costs for the patient and society.
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Shier, Micheal L., et John R. Graham. « Identifying Social Service Needs of Muslims Living in a Post 9/11 Era : The Role of Community-Based Organizations ». Advances in Social Work 14, no 2 (10 septembre 2013) : 395–415. http://dx.doi.org/10.18060/4180.
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In this qualitative study the investigators sought to better understand the ways in which service provider organizations (n=19) working with Muslim service providers have adapted to the changing social and political contexts in a post-9/11 era in New York City, and how this changing environment has affected the types of services that Muslims need. Service providers described two general ways in which services were adapted: 1) they have sought to address limits in service delivery programs that were a result of emerging sociopolitical dynamics (such as increasing discrimination) through adaptations to existing programs or through the development of new initiatives, programs, and organizations; and 2) they have adapted programs and services to meet the emerging sociocultural demands (such as changing attitudes towards help-seeking, and presenting problems of services users) of the Muslim population. The study illustrated the role of service provider organizations in adapting existing services, or creating new services, in response to a changing sociopolitical context. Social work education must focus attention on how social workers can adapt and create organizations that are responsive to the changing needs of service users. More curriculum content is necessary on the intra- and inter-organizational context of direct social work practice, with particular attention to innovation and adaptation within and between human service organizations.
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Guastaferro, Kate, Nusrat E. Mozid, Jayna Kramsky, Matilda Melkonian, Kashyah Young et Essence Spears. « GRANDPARENTS RAISING GRANDCHILDREN IN NEW YORK STATE : UNDERSTANDING NEEDS OF A VULNERABLE POPULATION ». Innovation in Aging 7, Supplement_1 (1 décembre 2023) : 1050. http://dx.doi.org/10.1093/geroni/igad104.3373.
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Abstract Grandparents raising grandchildren are a rapidly growing population in the US – the 2020 census estimated 5.9million children < 18 were living with a grandparent and in 2023 this estimate exceeded 7.1million. The older adult was likely not anticipating raising a child and is subject to the same stressors as other adults of their age and similar socioeconomic status: financial insecurity, health problems, employment issues, and family conflict. The community-based interventions that exist for ‘grandfamilies’ address a small portion of their needs and there is no universal network of services for this family unit that can sufficiently address the grandparents’ need for support, resources, and training. A total of N = 58 grandparents (56% female; 70% White; 40% urban-dwelling; 63% married) raising grandchildren in New York State participated in the GRAND Study which sought to quantify the needs of grandparents raising grandchildren using mixed methods. Survey results, corroborated by qualitative interview and focus group data, suggest areas of need include: financial needs, legal needs (e.g., acquiring custody), social support and parenting. Additional needs were observed in grandparents’ self-reported level of depressive symptoms – 46% of responses indicated major depressive disorder – and in managing relationships with their adult child (i.e., parent of grandchild). Overwhelmingly, grandparents spoke about the ‘honor’ of raising their grandchildren despite the challenges, specifically how the public health systems with whom they interact are not responsive to their needs. Results can be used to inform a multicomponent behavioral intervention to improve the general health and well-being of grandfamilies.
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Casillo, Stephanie M., Anisha Venkatesh, Nallammai Muthiah, Michael M. McDowell et Nitin Agarwal. « First Female Neurosurgeon in the United States : Dorothy Klenke Nash, MD ». Neurosurgery 89, no 4 (22 juillet 2021) : E223—E228. http://dx.doi.org/10.1093/neuros/nyab246.
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Abstract Dr Dorothy Klenke Nash (1898-1976) became the first female neurosurgeon in the United States in 1928 and maintained her status as the country's only female neurosurgeon until 1960. She graduated with her medical degree from the Columbia College of Physicians and Surgeons in 1927 and then trained at the Neurologic Institute of New York under Dr Byron Stookey. During her training, she contributed to the advancement of neurosurgical practice through academic research. In 1931, she married Charles B. Nash, and together they had 2 children, George (1932) and Dorothy Patricia (1937). Dr Nash became a senior surgeon at St. Margaret's Hospital in Pittsburgh in 1942. Shortly thereafter, she joined the inaugural University of Pittsburgh Department of Neurosurgery led by Dr Stuart N. Rowe and became an instructor of neurosurgery at the University of Pittsburgh School of Medicine. In acknowledgment of her advocacy for public access to services for mental health and cerebral palsy, Dr Nash was recognized as a Distinguished Daughter of Pennsylvania (1953) and honored by Mercy Hospital (1957), Bryn Mawr College (1960), and Columbia University (1968). She retired from neurosurgical practice in 1965, at which time she devoted herself to her grandchildren and her Catholic faith. She died on March 5, 1976 at the age of 77. With unwavering tenacity, Dr Nash paved the way for all women in neurosurgery.
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Cabasal, Maria Celia C., Manolito T. Lusiniara et Amador B. Alumia. « Safety, Security, and Disaster Preparedness Plan of AIMS as Perceived by Internal Stakeholders : Towards the Enhancement of Institutional Safety and Security Plan ». International Journal of Multidisciplinary : Applied Business and Education Research 4, no 12 (23 décembre 2023) : 4430–59. http://dx.doi.org/10.11594/ijmaber.04.12.21.
Texte intégralRésumé :
Employing descriptive-comparative design, the perception towards the safety, security and disaster preparedness of AIMS was taken from 167 employees and 343 students and strategically compared using T-test and analysis of variance (ANOVA). A standardized questionnaire adapted from the School Safety and Security Checklist by the New York State Police and the Virginia State Education Department was used as instrument during the data gathering period held last 1st Trimester of school year 2022-2023. Demographic profile and mean perception were also statistically treated using frequency, percentage and weighted mean. Based on the results, most of the employee respondents are newly-hired, single, not over 30 years old, physically fit and majority are females. They agreed that AIMS management have a safety and security management plan for its internal stakeholders. However, there are significant differences on their perception when grouped by Department, Position, and Years of Service at AIMS. Specifically, employees who are older and more mature seek improvement and enhancement on the services, facilities, and policies pertaining to safety.
On the other hand, majority of the student respondents are male, BSMT first year students and claimed to be physically fit. Their perception towards the safety and security management of AIMS were higher compared to the employees. However, no significant difference was shown on their perception towards the safety and security management plan of AIMS when grouped according to their profile. For the school grounds, both respondents imply the need for parking facility improvement while on the school interior, it is recommended to conduct a psychological capability training and access to conflict resolution under the initiative of the Regiment Department.
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Stoica, Alexandra, Victoriţa Şorodoc, Cătălina Lionte, Irina M. Jaba, Irina Costache, Ecaterina Anisie, Cristina Tuchiluș et al. « Acute cardiac dyspnea in the emergency department : diagnostic value of N-terminal prohormone of brain natriuretic peptide and galectin-3 ». Journal of International Medical Research 47, no 1 (17 septembre 2018) : 159–72. http://dx.doi.org/10.1177/0300060518798257.
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Objective This study was performed to determine whether a dual-biomarker approach using N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and galectin-3 optimizes the diagnosis and risk stratification of acute cardiac dyspnea. Atypical clinical manifestations and overlapping pathologies require objective and effective diagnostic methods to avoid treatment delays. Methods This prospective observational study included 208 patients who presented to the emergency department for acute dyspnea. NT-proBNP and galectin-3 were measured upon admission. The patients were divided into two groups according to the etiology of their clinical manifestations: cardiac and non-cardiac dyspnea. The patients’ New York Heart Association functional class, left ventricular ejection fraction, and discharge status were assessed. Results Diagnostic criteria for acute heart failure were fulfilled in 61.1% of the patients. NT-proBNP and galectin-3 were strongly and significantly correlated. Receiver operating characteristic analysis revealed similar areas under the curve for both markers in the entire group of patients as well as in the high-risk subsets of patients. Conclusions The diagnostic performance of NT-proBNP and galectin-3 is comparable for both the total population and high-risk subsets. Galectin-3 adds diagnostic value to the conventional NT-proBNP in patients with acute cardiac dyspnea, and its utility is of major interest in uncertain clinical situations.
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Balaratnam, Michelle, Ali-Jesus Alim-Marvasti, Charlie Lane, William Bierrum, Isaiah See, Anne Schlattl, Arvind Chandratheva, Timothy Baruah, Robert Simister et Salman Haider. « Delivering acute neurology care via the Same Day Emergency Care (SDEC) model ». Journal of Neurology, Neurosurgery & ; Psychiatry 93, no 9 (12 août 2022) : e2.35. http://dx.doi.org/10.1136/jnnp-2022-abn2.13.
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SDEC is the provision of same day care for emergency patients who would otherwise be admitted to hospital. Embedded within UCLH Emergency Department (ED), the SDEC cases are referred for consultant review. We aimed to determine whether a Neurology SDEC (N-SDEC) service would have a beneficial impact at UCLH.The service has run a weekday consultant neurologist-led service since May 2021. The service is supported by a nurse practitioner. Investigations are arranged via dedicated SDEC slots. The patient then has a nurse-led telephone follow-up. The service sees approximately 100 neurology referrals a month.The major impact of the service is reduced time to diagnosis and treatment and reduced onward referral. Only 5% of referrals to N-SDEC required onward General Neurology out-patient services. For the new diagnoses that require sub-specialist out-patients (9%), N-SDEC has improved the patient pathway (e.g. for neurovascular, multiple sclerosis, brain tumour, and neuro-vestibular presentations). We have also established new acute pathways (e.g. for status migrainosis and acute functional neurological disorders). Feedback on the new service from ED staff shows that the N-SDEC is also popular.Experience so far with the N-SDEC model indicates that it may provide an effective model for Acute Neurology delivery in the ED.
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Lee, Michelle, Mona Fayad, Tarub Mabud, Paulino Tallon de Lara, Adiac Espinosa Hernandez, Gustavo A. Contreras Anez, Christian Olivo Freites, Maanit Kholi, Nikhil Chadha et Raymonde Jean. « 440. Clinical Characteristics of Early Noncritical Hospitalized Patients with Coronavirus Disease 2019 (COVID-19) : A Single-Center Retrospective Study in New York City ». Open Forum Infectious Diseases 7, Supplement_1 (1 octobre 2020) : S287—S288. http://dx.doi.org/10.1093/ofid/ofaa439.633.
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Abstract Background COVID-19 first originated in Wuhan, China, in December 2019. As of April 9, 2020, New York State had become the single largest global epicenter of COVID-19. Methods This is a retrospective chart review of the first 33 patients with RT-PCR-confirmed COVID-19 admitted from the emergency department to a general medicine unit in a single academic hospital in New York City between March 11th to March 27th, 2020. Patient’s demographic, clinical, laboratory, radiographic investigations, treatments and clinical outcomes were retrospectively extracted from the electronic medical record and followed until April 10th, 2020. Patients were divided into severe and nonsevere sub-cohorts. Statistics were descriptive in nature. Results The study cohort (median age 68 yr, 67% male) presented with subjective fevers (82%), cough (88%), and dyspnea (76%). The median incubation period was 3 days. Most cases met SIRS criteria upon admission (76%). Patients had elevated inflammatory markers. Patients were treated with antimicrobials, corticosteroids, hydroxychloroquine, and varying levels of supplemental oxygen. Mortality was 15% and 18% of the cohort required intensive care services. Conclusion Patient age, presenting clinical symptoms, comorbidity profile, laboratory biomarkers, and radiographic features are consistent with findings published from China. Severe patients had peaks in inflammatory biomarkers later in the hospitalization, which may be useful to trend. Further studies are necessary to create guidelines to better risk-stratify COVID-19 patients based on clinical severity. Disclosures All Authors: No reported disclosures
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Villas-Boas, Sofia, Scott Kaplan, Justin S. White et Renee Y. Hsia. « Patterns of US Mental Health–Related Emergency Department Visits During the COVID-19 Pandemic ». JAMA Network Open 6, no 7 (11 juillet 2023) : e2322720. http://dx.doi.org/10.1001/jamanetworkopen.2023.22720.
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ImportanceNumerous studies have shown that the prevalence of mental health (MH) conditions worsened during the COVID-19 pandemic. Further research is needed on this phenomenon over a longer time horizon that considers the increasing trend in MH conditions before the pandemic, after the pandemic onset, and after vaccine availability in 2021.ObjectiveTo track how patients sought help in emergency departments (EDs) for non-MH and MH conditions during the pandemic.Design, Setting, and ParticipantsThis cross-sectional study used administrative data on weekly ED visits and a subset of visits for MH from the National Syndromic Surveillance Program from January 1, 2019, to December 31, 2021. Data were reported from the 10 US Department of Health and Human Services (HHS) regions (Boston, New York, Philadelphia, Atlanta, Chicago, Dallas, Kansas City, Denver, San Francisco, and Seattle) for five 11-week periods. Data analysis was performed in April 2023.Main Outcomes and MeasuresWeekly trends in total ED visits, mean MH-related ED visits, and proportion of ED visits for MH conditions were investigated to determine changes in each measure after the pandemic onset. Prepandemic baseline levels were established from 2019 data, and time trends of these patterns were examined in the corresponding weeks of 2020 and 2021. A fixed-effects estimation approach with weekly ED region data by year was used.ResultsThere were 1570 total observations in this study (52 weeks in 2019, 53 weeks in 2020, and 52 weeks in 2021). Statistically significant changes in non-MH and MH-related ED visits were observed across the 10 HHS regions. The mean total number of ED visits decreased by 45 117 (95% CI, −67 499 to −22 735) visits per region per week (39% decrease; P = .003) in the weeks after the pandemic onset compared with corresponding weeks in 2019. The mean number of ED visits for MH conditions (−1938 [95% CI, −2889 to −987]; P = .003) decreased significantly less (23% decrease) than the mean number of total visits after the onset of the pandemic, increasing the mean (SD) proportion of MH-related ED visits from 8% (1%) in 2019 to 9% (2%) in 2020. In 2021, the mean (SD) proportion decreased to 7% (2%), and the mean number of total ED visits rebounded more than that of mean MH-related ED visits.Conclusions and RelevanceIn this study, MH-related ED visits demonstrated less elasticity than non-MH visits during the pandemic. These findings highlight the importance of addressing the provision of adequate MH services, both in acute and outpatient settings.
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Irvine, Mary K., Bruce Levin, McKaylee M. Robertson, Katherine Penrose, Jennifer Carmona, Graham Harriman, Sarah L. Braunstein et Denis Nash. « PROMISE (Program Refinements to Optimize Model Impact and Scalability based on Evidence) : a cluster-randomised, stepped-wedge trial assessing effectiveness of the revised versus original Ryan White Part A HIV Care Coordination Programme for patients with barriers to treatment in the USA ». BMJ Open 10, no 7 (juillet 2020) : e034624. http://dx.doi.org/10.1136/bmjopen-2019-034624.
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IntroductionGrowing evidence supports combining social, behavioural and biomedical strategies to strengthen the HIV care continuum. However, combination interventions can be resource-intensive and challenging to scale up. Research is needed to identify intervention components and delivery models that maximise uptake, engagement and effectiveness. In New York City (NYC), a multicomponent Ryan White Part A-funded medical case management intervention called the Care Coordination Programme (CCP) was launched at 28 agencies in 2009 in order to address barriers to care and treatment. Effectiveness estimates based on >7000 clients enrolled by April 2013 and their controls indicated modest CCP benefits over ‘usual care’ for short-term and long-term viral suppression, with substantial room for improvement.Methods and analysisIntegrating evaluation findings and CCP service-provider and community-stakeholder input on modifications, the NYC Health Department packaged a Care Coordination Redesign (CCR) in a 2017 request for proposals. Following competitive re-solicitation, 17 of the original CCP-implementing agencies secured contracts. These agencies were randomised within matched pairs to immediate or delayed CCR implementation. Data from three 9-month periods (pre-implementation, partial implementation and full implementation) will be examined to compare CCR versus CCP effects on timely viral suppression (TVS, within 4 months of enrolment) among individuals with unsuppressed HIV viral load newly enrolling in the CCR/CCP. Based on current enrolment (n=933) and the pre-implementation outcome probability (TVS=0.54), the detectable effect size with 80% power is an OR of 2.75 (relative risk: 1.41).Ethics and disseminationThis study was approved by the NYC Department of Health and Mental Hygiene Institutional Review Board (IRB, Protocol 18–009) and the City University of New York Integrated IRB (Protocol 018–0057) with a waiver of informed consent. Findings will be disseminated via publications, conferences, stakeholder meetings, and Advisory Board meetings with implementing agency representatives.Trial registration numberRegistered with ClinicalTrials.gov under identifier: NCT03628287, V.2, 25 September 2019; pre-results.
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Butler, Paul. « Building a Coaching Culture in Irish Schools ; Challenges and Opportunities : A Mixed-Methods Study ». Societies 14, no 1 (15 janvier 2024) : 10. http://dx.doi.org/10.3390/soc14010010.
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Coaching is a relatively new leadership style in Irish schools, but its potential is being supported by the Department of Education and Skills since 2015. This study considers the challenges and obstacles to building a coaching culture within Irish schools, recognising that as a leadership style, it is relatively unknown. It considers school cultures and the challenges as well as the opportunities leaders face in building a coaching culture. A mixed methods study consisting of a quantitative survey (n = 48) followed by semi-structured interviews (n = 12) was the chosen method, using statistical analysis (SPSS) and thematic analysis (Nvivo) to analyse the data. The results indicate that leadership coaching facilitates reflective practice for leaders and those they manage, leading to a distribution of practice that facilitates distributed leadership, therein building leadership capacity and enhancing teacher/leader well-being. However, time, workload and creating a culture of coaching in schools are still challenges, as leadership coaching is still a new and unknown leadership concept. The findings suggest that it is vital that the support services endorse its value, that time is allocated to supporting coaching and that staff need both CPD and further education on what coaching entails in order to build a coaching culture in Irish schools.
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Kagwiza, Jeanne, Kingsley Ekimiri, Chrispinus Mumena, David K. Tumusiime, Gatera Fiston Kitema, Francois Regis Twiringirimana, Marie Josee Uwisunze et al. « Training Needs Assessment for a Bachelor of Science Program in Eye Care at the University of Rwanda ». Rwanda Journal of Medicine and Health Sciences 4, no 3 (30 décembre 2021) : 357–65. http://dx.doi.org/10.4314/rjmhs.v4i3.5.
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BackgroundThe University of Rwanda, established the Ophthalmology Department in 2004 to train Ophthalmic Clinical Officers (OCO). A proposal was developed towards upgrading the qualification level of the OCOs training at the University of Rwanda.AimThis study aimed to assess the need to upgrade the qualification of ophthalmic clinical officers to improve eye health services in Rwanda.MethodologyA descriptive cross-sectional study was conducted among 87 participants comprised of ophthalmic clinical officers, eye health development stakeholders, and employers in Rwanda selected purposively. Data analysis was performed using SPSS version 16.ResultsThe results showed that 77% of participants in the stakeholders group and 51.4% in the OCOs group were males. About 97% (n= 34) of the OCO responded “Yes” to the questions “Do you think some of the weaknesses related to quality practice are related to the level of training?” and “Does your qualification have any effect to your professional development?” Furthermore, 85% had never been promoted at any employment position, 100 % (n=35) alumni and 84 % (n=22) stakeholders agreed that there is a need for bachelor’s degree program.ConclusionThe need for developing new programs in ophthalmology including a Bachelor of Science degree program for OCOs was evident.Rwanda J Med Health Sci 2021;4(3):357-365
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Balogun, O., N. Karamyan, S. Formenti, H. Brereton et M. Botteghi. « Development and Implementation of a Telemedicine Platform for Radiation Oncology Training and Peer Review ». Journal of Global Oncology 4, Supplement 2 (1 octobre 2018) : 91s. http://dx.doi.org/10.1200/jgo.18.61900.
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Background: Telemedicine has been posited as a potential means of bolstering radiation therapy delivery in developing nations. World Aid Exchange (WaidX) is an innovative intercontinental telemedicine platform oriented to oncology specialties. This platform, devoted to reducing the digital divide on health practice, provides telecommunication services between health care facilities in developed and developing countries. It conveys the ability to safely share radiologic images and patient medical records for diagnostic and care purposes. It was successfully piloted in Mwanza, Tanzania in 2015. Since then, it has been implemented in varied settings such as Ethiopia, Djibouti and Brazil. After conducting a site visit and a focused needs assessment, we recognized the need for teleconferencing with the Radiation Department of National Center of Oncology, Yerevan, Armenia, to share expertises in general patient management and contouring and planning for radiotherapy. Aim: To develop a TeleRadiotherapy platform that enables: 1: Conference calling for tumor boards to review radiotherapy plans, discuss disease management and conduct remote quality control 2: Real-time sharing of diagnostic images to guide clinical decision making 3: E-contouring activity performed by parties in Yerevan and New York on radiographic images, with minimization of time lag in contouring 4: Generation of a database for clinical data (i.e., radiation dose, toxicity, disease stage) that serves as a departmental registry and a tool for future research use 5: Access to lectures delivered by physicians, nurses, therapists and physicists both in Yerevan and New York on varied aspects of radiotherapy Methods: The initiative was funded through a competitive grant established within the Department of Radiation Oncology at Cornell. The TeleRadiotherapy system is comprised of 2 physical units, equipped to support networking and telephony integration. An application was used to establish a simplified direct connection between mobile phones in New York and fixed phone extensions in Yerevan. A customized version of Veyon was used for remote connection to a contouring station. Zoom was used to establish the teleconference. Remote operators in Weill Cornell Medicine were trained for using the system. Results: The first teleradiotherapy interaction between Yerevan and New York occurred on February 7th, 2018. Demonstration of contouring on the Oncentra treatment planning system in Yerevan revealed ease of use. The brush tool displayed less drag time than the point-by-point contouring tools. Diagnostic images were easily shared without compromise of the image resolution. Conference call quality was high. This conference has opened a series of biweekly chart rounds, between the two institutions. Conclusion: Teleradiotherapy is feasible with excellent voice quality, image sharing capability and real-time contouring. The database is under construction. We are developing a new model for learning, training and collaboration in radiotherapy using WaidX, to enable rapid knowledge and technology transfer for a more equitable access to high-quality cancer care worldwide.
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عمر, Fatma Abdalla Atitalla, Fathi Saad مصطفى et Randa Mahmoud Gadalla العمروني. « Assessment of Hospitalised Patient Satisfaction with Nursing Care in the Gynaecology and Obstetrics Department of Benghazi Medical Center, Libya ». Journal of medical and pharmaceutical sciences 7, no 2 (30 juin 2023) : 54–62. http://dx.doi.org/10.26389/ajsrp.m060423.
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Satisfaction with nursing care is believed to be an indicator of the quality of the health setting, for this reason, many stakeholders and managers focus on measuring patients’ satisfaction to gather crucial information that could improve nursing service quality. The purpose of this study was to assess patients’ satisfaction with nursing care in the gynaecology and obstetrics department at Benghazi Medical Center (BMC) in Libya. Method: This study utilized a cross-sectional survey design. The survey was conducted from April to May 2022. Participants: - The population of the study consisted of adult patients who agreed to participate in the research and met the inclusion criteria, A convenient sampling method was applied in this study (n=300). Instrument: The data were collected through patient satisfaction with the nursing care quality questionnaire (PSNCQQ). The first section collected general information and demographic data; the second section consisted of a questionnaire related to patient satisfaction with nursing care. The scale included additional questions designed to assess satisfaction with the overall quality of care and treatment received during hospitalization, the overall quality of nursing care, and the likelihood that the patient would recommend the hospital to relatives and friends. The findings: The patients rated their satisfaction with nursing care as being at a low level of satisfaction. Moreover, patients reported less satisfaction with the overall quality of care and services received during their hospital stay and reported that they would not recommend this hospital to their families and friends. Recommendation: Periodic assessments to measure patients’ satisfaction levels with nursing care in different units and locations, and with a larger sample, could help healthcare facilities to guarantee the provision of high-quality patient care. - The results of the evaluation should be used to develop potential new strategies to improve the level of nursing services in the hospital.
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Shalev, Ariel, Veerawat Phongtankuel, Elissa Kozlov, Megan Johnson Shen, Ronald D. Adelman et M. C. Reid. « Awareness and Misperceptions of Hospice and Palliative Care : A Population-Based Survey Study ». American Journal of Hospice and Palliative Medicine® 35, no 3 (20 juin 2017) : 431–39. http://dx.doi.org/10.1177/1049909117715215.
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Background: Despite the documented benefits of palliative and hospice care on improving patients’ quality of life, these services remain underutilized. Multiple factors limit the utilization of these services, including patients’ and caregivers’ lack of knowledge and misperceptions. Objectives: To examine palliative and hospice care awareness, misperceptions, and receptivity among community-dwelling adults. Design: Cross-sectional study. Subjects: New York State residents ≥18 years old who participated in the 2016 Empire State Poll. Outcomes Measured: Palliative and hospice care awareness, misperceptions, and receptivity. Results: Of the 800 participants, 664 (83%) and 216 (27%) provided a definition of hospice care and palliative care, respectively. Of those who defined hospice care, 399 (60%) associated it with end-of-life care, 89 (13.4%) mentioned it was comfort care, and 35 (5.3%) reported hospice care provides care to patients and families. Of those who defined palliative care (n = 216), 57 (26.4%) mentioned it provided symptom management to patients, 47 (21.9%) stated it was comfort care, and 19 (8.8%) reported it was applicable in any course of an illness. Of those who defined hospice or palliative care, 248 (37.3%) had a misperception about hospice care and 115 (53.2%) had a misperception about palliative care. Conclusions: Most community-dwelling adults did not mention the major components of palliative and hospice care in their definitions, implying a low level of awareness of these services, and misinformation is common among community-dwelling adults. Palliative and hospice care education initiatives are needed to both increase awareness of and reduce misperceptions about these services.
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Ruggiero, Amanda Saba, et Luis Michal. « MoMA A&D talks : on curating architecture and design (Second part) ». Risco Revista de Pesquisa em Arquitetura e Urbanismo (Online) 17, no 2 (17 septembre 2019) : 129–30. http://dx.doi.org/10.11606/issn.1984-4506.v17i2p129-130.
Texte intégralRésumé :
During Fall 2016 we had the unique opportunity to participate in the regular internship program of the Museum of Modern Art in New York and assist with ongoing exhibition projects in the Architecture and Design Department (A&D). This Department was established in 1932 as the first curatorial department dedicated to architecture and design and built on an ambitious collection covering major figures and movement of architectural culture from mid-19th century to the present. With looking back on a rich history of influential exhibitions such as Modern Architecture: International Exhibition (1932), Architecture Without Architects (1964/65) or Deconstructivist Architecture (1988) it has been one of the key institutions to push the format of the architecture exhibition and which it keeps doing up to today.
Having this in mind we both came to New York with great respect and honored to gain insights in this institution for a period of three months. The department currently employs around 15 people which made it a really pleasant, intimate place to work with highly passionate and professional individuals full of remarkable expertise and respect for each other. This said and with the department going through some recent (at that moment) personnel changes, most notably the new directorship of Martino Stierli since 2015, as well MoMA reconfiguring and adding gallery spaces set to be open in 2019, we felt it was a very interesting moment for us to talk to our curator colleagues about their personal history and professional ambitions as curators at MoMA as well specific challenges of exhibiting architecture and design.
Being both educated in architecture in different countries (Brazil and Germany) we could gain not only a lot of professional insights but also talk about personal aspects of the curators´ – not always linear – careers. In total we conducted six interviews with all (senior) curators and one curatorial assistant of the Architecture and Design Department, all of whom we asked the same, around ten questions in order to produce a complete “panorama” of the departments staff at that very moment. In the following we would like to share with you the second half with Juliet Kinchin, Martino Stierli and Sean Anderson. The first three interviews with Paola Antonelli, Barry Bergdoll and Michelle Millar Fisher, were published on RISCO v.16 n.1 2018.
From the interviews, Juliet Kinchin had an approach since a student into intellectual debates and design history rather than architectural history, while Martino as a professor, was also engaged doing exhibitions. Sean Anderson struggled being a professor and practicing architect, and curation for him “means also being able to condense ideas and questions”. Since they had different backgrounds before arrive at MoMA, the teaching position and a special love for research is a shared common background for them.
Juliet Kinchin argues that the curator’s activity apart from the responsabilities also means communicate and creating view points and arguments in a spatial and material form, while Martino talk about the work of curating a show as very much about a teamwork. For Sean Anderson also the very strong critical sensibility, is a must have skill for a curator. Sean Anderson’s advice to young curators is to ask questions and to have as many experiences in the world as possible. Juliet Kinchin talks about integrity, that makes the difference in your work, Martino in the same way, reinforce the ideia to love what you do and so you will be successful.
Luis Michal, Amanda Saba Ruggiero
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Kilduff, Caroline LS, Alice AP Thomas, Juliet Dugdill, Edward J. Casswell, Marcin Dabrowski, Claire Lovegrove, Dawn A. Sim, Gordon R. Hay et Peter BM Thomas. « Creating the Moorfields’ virtual eye casualty : video consultations to provide emergency teleophthalmology care during and beyond the COVID-19 pandemic ». BMJ Health & ; Care Informatics 27, no 3 (août 2020) : e100179. http://dx.doi.org/10.1136/bmjhci-2020-100179.
Texte intégralRésumé :
BackgroundThe COVID-19 crisis forced hospitals in the UK dramatically to reduce outpatient activity. To provide continuity of care and to assist patients reluctant or unable to leave their homes, video consultations were rapidly implemented across routine and emergency ophthalmology services.ObjectiveTo describe the deployment and scaling to a large volume of teleophthalmology using a video consultation platform ‘Attend Anywhere’ in Moorfields Eye Hospital’s accident and emergency (A&E) department (London, UK).MethodPatient satisfaction, waiting time, consultation duration, outcome and management were audited following the launch of the new virtual A&E service.ResultsIn the 12 days following the service launch, 331 patients were seen by video consultation. 78.6% of patients (n=260) were determined not to need hospital A&E review and were managed with advice (n=126), remote prescription (n=57), general practitioner referral (n=27), direct referral to hospital subspecialty services (n=26) or diversion to a local eye unit (n=24). Mean patient satisfaction was 4.9 of 5.0 (n=62). The mean consultation duration was 12 min (range 5–31 min) and the wait time was 6 min (range 0–37 min).ConclusionVideo consultations showed greater than expected usefulness in the remote management of eye disease and supported a substantial reduction in the number of people visiting the hospital.
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Franzosa, Emily, Emma K. Tsui et Sherry Baron. « Home Health Aides' Perceptions of Quality Care : Goals, Challenges, and Implications for a Rapidly Changing Industry ». NEW SOLUTIONS : A Journal of Environmental and Occupational Health Policy 27, no 4 (15 novembre 2017) : 629–47. http://dx.doi.org/10.1177/1048291117740818.
Texte intégralRésumé :
Home care payment models, quality measures, and care plans are based on physical tasks workers perform, ignoring relational care that supports clients' cognitive, emotional, and social well-being. As states seek to rein in costs and improve the efficiency and quality of care, they will need to consider how to measure and support relational care. In four focus groups ( n = 27) of unionized, agency-based New York City home health aides, workers reported aide–client relationships were a cornerstone of high-quality care, and building them required communication, respect, and going the extra mile. Since much of this care was invisible outside the worker–client relationship, aides received little supervisory support and felt excluded from the formal care team. Aligning payment models with quality requires understanding the full scope of services aides provide and a quality work environment that offers support and supervision, engages aides in patient care, and gives them a voice in policy decisions.
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Hodo, Laura Nell, Lindsey C. Douglas, Diana S. Lee, Srividya Bhadriraju et Karen M. Wilson. « Deployed : One Pediatric Department’s Experience of Adult Care During COVID-19 ». Hospital Pediatrics 11, no 10 (1 octobre 2021) : e235-e243. http://dx.doi.org/10.1542/hpeds.2020-005799.
Texte intégralRésumé :
OBJECTIVES The number of hospitalized coronavirus disease 2019 patients in March 2020 to April 2020 in our New York City hospital required increased physician staffing, including deployment of pediatricians to adult care. To improve the deployment process, we sought to understand the mindset, preparations for, and experience during deployment of pediatric faculty in our institution. METHODS Faculty members of the Department of Pediatrics completed pre- and postsurveys evaluating perspectives, fears, and preparations relevant to deployment. Demographic characteristics of the faculty members were collected. Survey questions included Likert scale, multiple choice, and free-text responses. Descriptive statistics, Fisher’s exact test, and χ2 test were used to compare groups. Free-text responses were categorized by topic. Survey responses were shared with leadership in real time and adjustments to the deployment process made. RESULTS The predeployment survey was sent to 202 pediatric faculty members, with a 29% (n = 59) completion rate. Of the 36 deployed faculty, 29 (81%) completed all items of the postsurvey. The majority (74%, n = 42) expressed discomfort with care of adults and fear and/or nervousness about deployment (61%, n = 35). Most faculty (88%, n = 52) prepared for deployment and cited local guidelines and published literature as helpful preparation materials (55%, n = 16). Dissemination of details about schedules and role clarification before deployment were areas for improvement. CONCLUSIONS Pediatric faculty facing deployment to adult care have concerns about the process of deployment as well as the work itself. Specific information distributed in advance, along with consistent and frequent communication, may help mitigate these fears.
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El-Bassel, Nabila, Louisa Gilbert, Satya Krishnan, Robert F. Schilling, Theodore Gaeta, Stacey Purpura et Susan S. Witte. « Partner Violence and Sexual HIV-Risk Behaviors Among Women in an Inner-City Emergency Department ». Violence and Victims 13, no 4 (janvier 1998) : 377–93. http://dx.doi.org/10.1891/0886-6708.13.4.377.
Texte intégralRésumé :
This study examines the relationship between partner violence and sexual risk behaviors in a sample of predominantly Latina and African American women who sought medical care from a New York City hospital emergency department. Eligibility criteria selected women between the ages of 18 and 55, who were sexually active in the past 90 days, and were triaged to nonemergency care. The interview addressed demographics, partner violence, childhood abuse, sexual behavior, and drug and alcohol use. Multiple logistic regression analysis was used to assess the association between partner violence and history of having a sexually transmitted disease (STD) and of having sex with a risky partner. Nearly one half of the 143 respondents (46.1 %, n = 66) reported that they had experienced physical, sexual, or life-threatening abuse by a boyfriend or spouse in the past and 17.5% reported that abuse had occurred within the past year. In the univariate analyses, abused women were more likely than nonabused women to report having had an STD; engaging in sex with a risky partner; having more than one sexual partner; and being tested for HIV. After controlling for confounding variables, abused women were almost five times more likely than their counterparts to have reported an STD and four times more likely to engage in sex with a risky sexual partner. The relationship between partner violence and sexual risk behaviors among women seeking treatment in an emergency department suggests the need for the development of HIV-risk reduction strategies that address the needs of women in abusive relationships.
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Kusuma Wijayanti, Puspita Adhi, et Surya Cahyadi. « Antecedents-Consequences Modification to Decrease Hyper-activity and Improve Attention of Child with ADHD ». JPUD - Jurnal Pendidikan Usia Dini 13, no 2 (30 novembre 2019) : 232–48. http://dx.doi.org/10.21009/jpud.132.03.
Texte intégralRésumé :
The prevalence of ADHD children increases every year. Some researchers have shown that psychosocial behavior therapy (antecedents-consequences modification) was effective to decrease hyperactivity and increase attention to ADHD children. This study aims to find out the effectiveness of antecedents-consequences modification by parents and teachers to decrease hyperactivity and increase attention to a 6 years old boy with ADHD. The study was a single case experimental design. Psychosocial behavior therapy has been used with antecedents-consequences modification. The antecedents-consequences modification was applied by teacher at school and parents at home. Data were analyzed using Wilcoxon Signed Rank Test. Results showed that there’s a significant decrease of hyperactivity behavior and significant increase of doing his assignment both at school and also at home. Not only about the content of behavior therapy itself, but how to give the therapy is important. Parents and teacher should do the therapy consistently, immediately, specifically and saliency to reach the target of intervention.
Keywords: ADHD Children, Antecedents, Consequences, Modification
Reference:
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Inviyaeva, Victoria. « Francoist Diplomacy in the United States During the Spanish Civil War 1936–1939 : On the Question of the Status of the Francoist Representative to the United States Juan Francisco de Cardenas ». Novaia i noveishaia istoriia, no 4 (2023) : 98. http://dx.doi.org/10.31857/s013038640025204-2.
Texte intégralRésumé :
Almost two months after the outbreak of the Spanish Civil War, the leader of the insurgents Generalissimo Francisco Franco proclaimed himself the head of Spain on 1 October 1936 and immediately began to deal with its internal structure and with establishing ties with other countries to gain recognition by ideologically close states as Italy and Germany, but also by Western democracies, in particular the United States. To this end, Juan Francisco de Cardenas, an experienced diplomat, went to New York at the end of August 1936. In 1937–1938, he tried to get the government of Francisco Franco recognised and obtain the status of a Francoist agent in the USA. The fact that the United States did not recognise de Cárdenas de jure as Franco's agent in New York, did not name him consul and banned the official seal and the Francoist flag as an attribute of statehood on its territory, indicated that the US did not regard the Franco government as a legitimate one. The Americans maintained formal diplomatic relations with the leadership of Republican Spain until 1 April 1939, viewing it as the only legitimate Spanish government. Nevertheless, with the US State Department's knowledge, de Cardenas was in fact able to provide almost all consular services, which to a certain extent indicated the duality of US policy. In this article the author, for the first time in Russian scholarly literature, studied the materials of the Spanish General Archive of Administration (Alcala de Henares, Spain) where the incoming and outgoing correspondence of Juan Francisco de Cardenas and other Francoist politicians for 1936–1939 is stored.
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Brackbill, Robert M., Amy R. Kahn, Jiehui Li, Rachel Zeig-Owens, David G. Goldfarb, Molly Skerker, Mark R. Farfel et al. « Combining Three Cohorts of World Trade Center Rescue/Recovery Workers for Assessing Cancer Incidence and Mortality ». International Journal of Environmental Research and Public Health 18, no 4 (3 février 2021) : 1386. http://dx.doi.org/10.3390/ijerph18041386.
Texte intégralRésumé :
Three cohorts including the Fire Department of the City of New York (FDNY), the World Trade Center Health Registry (WTCHR), and the General Responder Cohort (GRC), each funded by the World Trade Center Health Program have reported associations between WTC-exposures and cancer. Results have generally been consistent with effect estimates for excess incidence for all cancers ranging from 6 to 14% above background rates. Pooling would increase sample size and de-duplicate cases between the cohorts. However, pooling required time consuming steps: obtaining Institutional Review Board (IRB) approvals and legal agreements from entities involved; establishing an honest broker for managing the data; de-duplicating the pooled cohort files; applying to State Cancer Registries (SCRs) for matched cancer cases; and finalizing analysis data files. Obtaining SCR data use agreements ranged from 6.5 to 114.5 weeks with six states requiring >20 weeks. Records from FDNY (n = 16,221), WTCHR (n = 29,372), and GRC (n = 33,427) were combined de-duplicated resulting in 69,102 unique individuals. Overall, 7894 cancer tumors were matched to the pooled cohort, increasing the number cancers by as much as 58% compared to previous analyses. Pooling resulted in a coherent resource for future research for studies on rare cancers and mortality, with more representative of occupations and WTC- exposure.