Designing prenatal care for low-income, black patients in urban settings using human centered design

Objective: Black and low-income pregnant patients face significant inequities in health care access and outcomes in the United States. Yet, these patients’ voices have been largely absent from designing improved prenatal care models. Our objective was to use Human Centered Design to examine patients’ and health care workers’ experiences with prenatal care delivery in a largely low-income, Black population, to inform future care innovations to improve access, quality, and outcomes. Study Design: Using snowball sampling, we conducted Human Centered Design-informed interviews with low-income, Black patients and health care workers in a large, urban setting. Interview questions addressed the first two Human Centered Design phases: 1) observation: understanding the problem from the end-user’s perspective, and 2) ideation: generating novel potential solutions. We assessed these questions for the three key components of prenatal care: medical care, anticipatory guidance, and psychosocial support. Results: Nineteen patients and 19 health care workers were interviewed. All patients were Black, and the majority had public insurance (17/19, 89.5%). Health care workers included doctors, midwives, breastfeeding counselors, doulas, and social workers. Participants affirmed the three goals of prenatal care. Participants reported failures of current prenatal care delivery and potential solutions for each of the three goals (medical care, anticipatory guidance, and psychosocial support) and two overarching categories: maternity care professionals and care structure. Participants reported in an ideal model, patients would have strong relationships with their maternity care professional who would be at the center of all prenatal care services. Additionally, care would be tailored to individual patients and use care navigators, flexible models, and colocation of services, to reduce barriers. Conclusion: Current prenatal care delivery fails to meet low-income, Black patients’ needs. Ideal prenatal care delivery includes more comprehensive, integrated services tailored to patients’ medical needs and preferences

Experiences With Prenatal Care Delivery Reported by Black Patients With Low Income and by Health Care Workers in the US: A Qualitative Study

IMPORTANCE: Black pregnant people with low income face inequities in health care access and outcomes in the US, yet their voices have been largely absent from redesigning prenatal care. OBJECTIVE: To examine patients\u27 and health care workers\u27 experiences with prenatal care delivery in a largely low-income Black population to inform care innovations to improve care coordination, access, quality, and outcomes. DESIGN, SETTING, AND PARTICIPANTS: For this qualitative study, human-centered design-informed interviews were conducted at prenatal care clinics with 19 low-income Black patients who were currently pregnant or up to 1 year post partum and 19 health care workers (eg, physicians, nurses, and community health workers) in Detroit, Michigan, between October 14, 2019, and February 7, 2020. Questions focused on 2 human-centered design phases: observation (understanding problems from the end user\u27s perspective) and ideation (generating novel potential solutions). Questions targeted participants\u27 experiences with the 3 goals of prenatal care: medical care, anticipatory guidance, and social support. An eclectic analytic strategy, including inductive thematic analysis and matrix coding, was used to identify promising strategies for prenatal care redesign. MAIN OUTCOMES AND MEASURES: Preferences for prenatal care redesign. RESULTS: Nineteen Black patients (mean [SD] age, 28.4 [5.9] years; 19 [100%] female; and 17 [89.5%] with public insurance) and 17 of 19 health care workers (mean [SD] age, 47.9 [15.7] years; 15 female [88.2%]; and 13 [76.5%] Black) completed the surveys. A range of health care workers were included (eg, physicians, doulas, and social workers). Although all affirmed the 3 prenatal care goals, participants reported failures and potential solutions for each area of prenatal care delivery. Themes also emerged in 2 cross-cutting areas: practitioners and care infrastructure. Participants reported that, ideally, care structure would enable strong ongoing relationships between patients and practitioners. Practitioners would coordinate all prenatal services, not just medical care. Finally, care would be tailored to individual patients by using care navigators, flexible models, and colocation of services to reduce barriers. CONCLUSIONS AND RELEVANCE: In this qualitative study of low-income, Black pregnant people in Detroit, Michigan, and the health care workers who care for them, prenatal care delivery failed to meet many patients\u27 needs. Participants reported that an ideal care delivery model would include comprehensive, integrated services across the health care system, expanding beyond medical care to also include patients\u27 social needs and preferences

Mapping and Assessment of Ecosystems and their Services: An EU ecosystem assessment

This report presents an ecosystem assessment covering the total land area of the EU as well as the EU marine regions. The assessment is carried out by Joint Research Centre, European Environment Agency, DG Environment, and the European Topic Centres on Biological Diversity and on Urban, Land and Soil Systems. This report constitutes a knowledge base which can support the evaluation of the 2020 biodiversity targets. It also provides a data foundation for future assessments and policy developments, in particular with respect to the ecosystem restoration agenda for the next decade (2020-2030). The report presents an analysis of the pressures and condition of terrestrial, freshwater and marine ecosystems using a single, comparable methodology based on European data on trends of pressures and condition relative to the policy baseline 2010. The following main conclusions are drawn: - Pressures on ecosystems exhibit different trends. - Land take, atmospheric emissions of air pollutants and critical loads of nitrogen are decreasing but the absolute values of all these pressures remain too high. - Impacts from climate change on ecosystems are increasing. - Invasive alien species of union concern are observed in all ecosystems, but their impact is particularly high in urban ecosystems and grasslands. - Pressures from overfishing activities and marine pollution are still high. - In the long term, air and freshwater quality is improving. - In forests and agroecosystems, which represent over 80% of the EU territory, there are improvements in structural condition indicators (biomass, deadwood, area under organic farming) relative to the baseline year 2010 but some key bio-indicators such as tree-crown defoliation continue to increase. This indicates that ecosystem condition is not improving. - Species-related indicators show no progress or further declines, particularly in agroecosystems. The analysis of trends in ecosystem services concluded that the current potential of ecosystems to deliver timber, protection against floods, crop pollination, and nature-based recreation is equal to or lower than the baseline value for 2010. At the same time, the demand for these services has significantly increased. A lowered potential in combination with a higher demand risks to further decrease the condition of ecosystems and their contribution to human well-being. Despite the wide coverage of environmental legislation in the EU, there are still large gaps in the legal protection of ecosystems. On land, 76% of the area of terrestrial ecosystems, mainly forests, agroecosystems and urban ecosystems, are excluded from a legal designation under the Bird and Habitat Directives. Freshwater and marine ecosystems are subject to specific protection measures under the Water Framework and Marine Strategy Framework Directives. The condition of ecosystems that are under legal designation is unfavourable. More efforts are needed to bend the curve of biodiversity loss and ecosystem degradation and to put ecosystems on a path to recovery. The progress that is made in certain areas such as pollution reduction, increasing air and water quality, increasing share of organic farming, the expansion of forests, and the efforts to maintain marine fish stocks at sustainable levels show that a persistent implementation of policies can be effective. These successes should encourage us to act now and to put forward an ambitious plan for the restoration of Europe’s ecosystems.JRC.D.3-Land Resource

Reflections on the challenges of EU Policy-Making with view to Flood Risk Management: Actors, processes and the acquis communautaire

Europe has a long history of devastation caused by floods. Each flood event triggers dynamic spatial and temporal mechanisms, which include the mobilisation of many multi-disciplinary actors, setting up and/or revision of many administrative and operational processes, and entry into force and/or update of legal frameworks. Depending on geographical extent of the flooding coupled with national modus operandi of countries, the above-mentioned mechanisms may take place at local, regional and national levels. However, as floods can also be a transboundary phenomenon, and as events in one country are no longer isolated but are strictly related to progress towards increased social cohesion and competitiveness within the European Union (EU), European initiatives dealing with floods and other major hazards have gained momentum and are considered a strategic objective in the EU. This is evidenced by the establishment of the EU Solidarity Fund that was set up in the aftermath of the Central European flooding in August 2002 ¿providing financial assistance to contribute to a rapid return to normal living conditions in the disaster-stricken regions¿. The decision-making process prescribed in the Treaty establishing the European Community(TEC) would govern the legal basis for any potential flood risk management initiative at EU level and would mainly be based on Article 174, comma 2 of the TEC. This paper introduces the reader to the EU decision-making mechanism by briefly describing the actors of the EU inter-institutional decision-making process with view to flood risk management. It also gives an overview of the existing European Commission (CEC) efforts in the field and portrays the challenges the EU has to face given the state-of-the-art of flood risk management at EU level. Finally, a glimpse of a strategy to provide added-value through EU policy endeavours to complement national initiatives are proposed strategic objective in the EU.JRC.DDG.F.7-Energy systems evaluatio

Escritura en educación inicial y su transición al 1er grado de educación básica

The investigation is framed under a methodology of a descriptive study, of field under the quantitative approach. The population and sample is constituted by the teachers of Initial Education of the School U.E.E. "Algeria Laya" Santiago Mariño Municipality of Aragua State. For data collection, the survey was applied as an instrument consisting of 4 questions with several alternative answers determining its content validity through the Expert Judgment technique and the reliability was obtained using Combrach's Alpha, resulting in 0.87. This allowed knowing the willingness of teachers to apply the proposed strategy. The results obtained showed that even when teachers possess knowledge about the constructive process of teaching writing, they continue to ignore this learning process in the initial stageLa investigación está enmarcada bajo una metodología de un estudio descriptivo, de campo bajo el enfoque cuantitativo. La población y muestra está constituida por las docentes de Educación Inicial de la Escuela U.E.E. “Argelia Laya” Municipio Santiago Mariño del estado Aragua. Para la recolección de datos se aplicó como instrumento la encuesta que consta de 4 preguntas con varias alternativas de repuestas determinando su validez de contenido a través de la técnica de Juicio de Expertos y la confiabilidad se obtuvo mediante Alpha de Combrach resultando 0,87. Esto permitió conocer la disposición que tienen los docentes de aplicar la estrategia propuesta. Los resultados obtenidos demostraron que aun cuando los docentes poseen los conocimientos sobre el proceso constructivo de la enseñanza de la escritura, estos continúan dejando de lado dicho proceso de aprendizaje en la etapa inicial

Querying and reasoning over large scale building data sets:an outline of a performance benchmark

The architectural design and construction domains work on a daily basis with massive amounts of data. Properly managing, exchanging and exploiting these data is an ever ongoing challenge in this domain. This has resulted in large semantic RDF graphs that are to be combined with a significant number of other data sets (building product catalogues, regulation data, geometric point cloud data, simulation data, sensor data), thus making an already huge dataset even larger. Making these big data available at high performance rates and speeds and into the correct (intuitive) formats is therefore an incredibly high challenge in this domain. Yet, hardly any benchmark is available for this industry that (1) gives an overview of the kind of data typically handled in this domain; and (2) that lists the query and reasoning performance results in handling these data. In this article, we therefore present a set of available sample data that explicates the scale of the situation, and we additionally perform a query and reasoning performance benchmark. This results not only in an initial set of quantitative performance results, but also in recommendations in implementing a web-based system relying heavily on large semantic data. As such, we propose an initial benchmark through which new upcoming data management proposals in the architectural design and construction domains can be measured