Soil-structure interaction during the San Fernando earthquake

Accelerograms obtained at two sites during the San Fernando earthquake of 1971 were analyzed to investigate the role of soil-structure interaction, using techniques developed by Bielak and others. Analysis of the data from the site of the Hollywood Storage Building, for which data from the Arvin-Tehachapi earthquake of 1952 are also available, showed evidence of soil-structure interaction in the way the transfer functions between parking lot and basement motion decayed with increasing frequency in the two lateral directions. It is concluded also that interaction probably had a small effect on the response near the EW fundamental frequency during the San Fernando earthquake. Although theoretical and experimentally determined transfer functions are broadly similar, they do not agree in detail. The lack of good agreement for reasonable choices of the parameters of the theoretical model indicates a need for some modifications of the theory or its application, and a need for more measurements at the site. A similar analysis showed no clear evidence of soil-structure interaction for the Millikan Library and Athanaeum buildings on the campus of the California Institute of Technology. If soil-structure interaction caused the major differences measured in the base motions of these two buildings, it is of a more complex form than that considered by present theories

Utilization of a mobile medical van for delivering pediatric care in the bateys of the Dominican Republic

Background Bateys are impoverished areas of housing for migrant Haitian sugar cane workers in the Dominican Republic (DR). In these regions, preventative health care is almost non-existent, public service accessibility is limited, and geographic isolation prevents utilization of care even by those families with resources. Consequently, the development of a viable mobile system is vital to the delivery of acute and preventative health care in this region. Aims This study evaluated an existing mobile medical system. The primary goal was to describe the population served, diseases treated, and resources utilized. A secondary goal was to determine qualitatively an optimal infrastructure for sustainable health care delivery within the bateys. Methods Information on basic demographic data, diagnosis, chronicity of disease, and medications dispensed was collected on all pediatric patients seen in conjunction with an existing mobile medical system over a 3-month period in the DR. Health statistics for the region were collected and interviews were conducted with health care workers (HCWs) and community members on existing and optimal health care infrastructure. Results Five hundred eighty-four pediatric patients were evaluated and treated. Median age was 5 years (range 2 weeks to 20 years), and 53.7% of patients seen were 5 years of age or younger. The mean number of complaints per patient was 2.8 (range 0 to 6). Thirty-six percent (373) of all diagnoses were for acute complaints, and 64% (657) were chronic medical problems. The most common pediatric illnesses diagnosed clinically were gastrointestinal parasitic infection (56.6%), skin/fungal infection (46.2%), upper respiratory tract infections (URIs) (22.8%), previously undiagnosed asthma and allergies (8.2%), and symptomatic anemia (7.2%). Thirty HCWs and community members were interviewed, and all cited the need for similar resources: a community clinic and hospital referral site, health promoters within each community, and the initiation of pediatric training for community HCWs. Conclusion A mobile medical system is a sustainable, efficient mechanism for delivering acute and preventive care in the Haitian bateys of the Dominican Republic. The majority of patients served were 8 years of age or younger with multiple presenting symptoms. A pediatric protocol for identifying the most appropriate drugs and supplies for mobile units in the DR can be created based upon diseases evaluated. Qualitative data from HCWs and community members identified the need for an integrative health care delivery infrastructure and community health promoters versed in pediatric care who can aid in education of batey members and monitor chronic and acute illnesses. We are planning follow-up visits to implement these programs

A systematic review of strategies to recruit and retain primary care doctors

Background There is a workforce crisis in primary care. Previous research has looked at the reasons underlying recruitment and retention problems, but little research has looked at what works to improve recruitment and retention. The aim of this systematic review is to evaluate interventions and strategies used to recruit and retain primary care doctors internationally. Methods A systematic review was undertaken. MEDLINE, EMBASE, CENTRAL and grey literature were searched from inception to January 2015.Articles assessing interventions aimed at recruiting or retaining doctors in high income countries, applicable to primary care doctors were included. No restrictions on language or year of publication. The first author screened all titles and abstracts and a second author screened 20%. Data extraction was carried out by one author and checked by a second. Meta-analysis was not possible due to heterogeneity. Results 51 studies assessing 42 interventions were retrieved. Interventions were categorised into thirteen groups: financial incentives (n=11), recruiting rural students (n=6), international recruitment (n=4), rural or primary care focused undergraduate placements (n=3), rural or underserved postgraduate training (n=3), well-being or peer support initiatives (n=3), marketing (n=2), mixed interventions (n=5), support for professional development or research (n=5), retainer schemes (n=4), re-entry schemes (n=1), specialised recruiters or case managers (n=2) and delayed partnerships (n=2). Studies were of low methodological quality with no RCTs and only 15 studies with a comparison group. Weak evidence supported the use of postgraduate placements in underserved areas, undergraduate rural placements and recruiting students to medical school from rural areas. There was mixed evidence about financial incentives. A marketing campaign was associated with lower recruitment. Conclusions This is the first systematic review of interventions to improve recruitment and retention of primary care doctors. Although the evidence base for recruiting and care doctors is weak and more high quality research is needed, this review found evidence to support undergraduate and postgraduate placements in underserved areas, and selective recruitment of medical students. Other initiatives covered may have potential to improve recruitment and retention of primary care practitioners, but their effectiveness has not been established

Social Skills Training of Behavior Disordered Adolescents with Self-Monitoring to Promote Generalization to a Vocational Setting

Four 15–16 yr old emotionally disturbed adolescents in a short-term residential treatment center participated in a vocationally oriented social skills training program. Didactic instruction, provided in a classroom by a special education teacher, resulted in rapid acquisition of appropriate responses to a supervisor\u27s instructions. However, there was no concomitant change in most Ss\u27 interpersonal behavior with their work supervisor in the generalization setting. A subsequent intervention, in which Ss were subjected to role-play training and taught to use a self-monitoring procedure, produced generalized increases in the targeted social skill. In addition to the improvement in Ss\u27 responses to instructions, desirable collateral changes also were noted in their responses to critical feedback and to the conversational initiatives of the work supervisor. The use of a multiple baseline research design across pairs of Ss suggested that the generalized effects were a function of the intervention procedures. It is proposed that the didactic and role-play training might have been responsible for the initial acquisition of the new interpersonal behavior, while the self-monitoring procedure seemed to be implicated in its generalization and maintenance