Multiple Causes for Delay in Arrival at Hospital in Acute Stroke Patients in Aydin, Turkey

This descriptive, hospital-based study, performed in western Turkey, was designed to assess the level of pre-hospital delay and reasons for such delay in acute stroke patients, taking into consideration certain factors such as socioeconomic status, availability of transport options at onset of symptoms. Data were collected from hospital records, and a questionnaire was administered that included questions about socio-demographics, self-reported risk factors and questions related to hospital arrival. The rate of patients arriving at the hospital more than 3 hours after symptom onset was found to be 31.6% for this study. Approximately 1/3 of patients delayed going to the hospital because they were waiting for symptoms to go away while 1/3 of patients were not aware of the importance of seeking immediate medical help. There was a significant relationship between the use of ambulance transportation and length of time before arrival at the hospitals, though there was no statistically significantly relationship between the existence of stroke risk factors and hospital arrival delay. These results will likely be helpful to health care decision makers as they develop a model for stroke health care and community based training

Interactions of Water Quality and Integrated Groundwater Management: Examples from the United States and Europe

Groundwater is available in many parts of the world, but the quality of the water may limit its use. Contaminants can limit the use of groundwater through concerns associated with human health, aquatic health, economic costs, or even societal perception. Given this broad range of concerns, this chapter focuses on examples of how water quality issues influence integrated groundwater management. One example evaluates the importance of a naturally occurring contaminant Arsenic (As) for drinking water supply, one explores issues resulting from agricultural activities on the land surface and factors that influence related groundwater management, and the last examines unique issues that result from human-introduced viral pathogens for groundwater-derived drinking water vulnerability. The examples underscore how integrated groundwater management lies at the intersections of environmental characterization, engineering constraints, societal needs, and human perception of acceptable water quality. As such, water quality factors can be a key driver for societal decision making