Elevator availability and its impact on stair use in a workplace

Consistent success in encouraging stair climbing on public access staircases contrasts with equivocal evidence for effectiveness in worksites. This paper tests whether contextual factors may affect stair/elevator choice. The study investigated the impact of elevator availability, pedestrian traffic (number using the elevator and stairs per minute), building occupancy (total individuals in the building) and time of day on stair ascent and descent in a workplace. Stair and elevator choices were monitored by automatic counters every weekday during two phases. In a natural experiment, days with four available elevators were compared with days when three elevators were available. Stair use increased for three elevators compared to four. Increasing building occupancy was associated with increased stair use, whilst increasing pedestrian traffic and time of day was associated with reduced stair use. A follow-up study revealed complimentary effects of building occupancy and time of day on elevator waiting times, indicating that increased stair use by contextual factors reflects increased elevator waiting times. In contrast, shorter waiting times are likely when momentary pedestrian traffic is high and later in the day. Crucially, the magnitude of the effects of these contextual factors was ten times larger than previously reported effects of stair climbing interventions

Patients Emotions during Meal Experience: Understanding through Critical Incident Technique

Background and Objectives: It was established that eating experience may affect patients emotionally. Acknowledging the role and understanding the basis of patients’ emotions in their food consumption may assist in identifying their nutritional status as well as their satisfaction with foodservice. To date, there are limited studies focusing on patients’ food-related emotional experiences. Hence the present study sought to explore the issue using a qualitative approach. Methods: The study was conducted in three Malaysian public hospitals, two of which from rural and one from urban areas. Information about aspects of the hospital food experience was gathered using semi-structured interview method. A total of 29 patients who felt well enough to provide information about the hospital food were identified with the help of the head nurses. Patients were recruited based on the concept of data saturation. The interview was implemented based on Critical Incident Technique (CIT), which enables systematic extraction of information from the wealth of data in the stories told by the interviewees about things which have happened to them. Data were analysed using content analysis method. Findings: Patients were found toexperience emotions including frustration, interest, enjoyment, hostility, shame, boredom, sadness, anger, surprise and satisfaction in relation to food provision. The frequency of incidents eliciting negative emotions (56.7%) was higher than that of positive incidents (43.3%). Frustration, interest, and enjoyment were the most frequently reported emotions. Conclusions: Our study highlights emotion as an important aspect of patients’ food consumption, and lays a ground for incorporation of food-related emotion into hospital services and patient management research. Our study also indicated the CIT to be effective and credible in elucidating hidden patients’ emotions, which encourages its application in future relevant studies

Understanding Patients’ Meal Experiences through Staff’s Role: Study on Malaysian Public Hospitals

Background: One way to improve hospital food provision is certainly by understanding the management of hospital foodservices, but there is limited detailed information about staff roles in food provision in many hospitals around the world. Objective: The hospital meal experience of patients, a part of the services provided by hospitals, is becoming important. Therefore, the role of various hospital staff members was studied through their behavior, attitudes, and practices so as to understand how the foodservice system works to address patients’ food consumption. Methods: This qualitative research used the convenient sampling method. Data was collected by interviewing twenty hospital employees with different job scopes (nurses, doctors, dietitians, foodservice managers, and directors of hospital foodservices) in 6 public hospitals. Results: Themes such as providing familiar food, food as the motivational factor for consumption, empathy shown by staff, and influences of the eating environment were identified using content analysis. Conclusion: The viewpoints and experiences of key stakeholders facilitated the understanding of various factors involved in the provision of hospital food which affect patients’ decisions to accept and consume food

Promoting stair climbing: Stair-riser banners are better than posters... sometimes

Objective: Stair-riser banners are twice as effective as posters in encouraging stair climbing in shopping centres. This study tested the effectiveness of stair-riser banners in an English train station in 2006-2007. Method: The train station had a 39-step staircase and an adjacent escalator. Baseline observations (3.5 weeks) were followed by 10.5 weeks of a banner intervention supplemented with 3 weeks of a poster intervention. Both poster and banner featured the message ‘Stair climbing burns more calories per minute than jogging. Take the stairs’. Ascending escalator and stair users (N=36,239) were coded for gender. Results: Analyses, controlling for effects of gender and pedestrian traffic volume, revealed no significant change in stair climbing between baseline (40.6%) and the banner intervention (40.9%; p=0.98). Addition of the poster increased stair climbing (44.3%; OR= 1.36, 95% CIs 1.16-1.60, p< 0.001), with the effect reduced at higher pedestrian traffic volumes. Conclusion: While stair-riser banners had no effect, the poster intervention increased stair climbing. The high pedestrian volumes as the wave of disembarking passengers seek to leave the station would have obscured the visibility of the banner for many commuters. Thus stair-riser banners appear unsuitable point-of-choice prompts in stations where pedestrian traffic volume is high

Increasing stair climbing in a train station: effects of contextual variables and visibility

Accumulation of physical activity during daily living is a current public health target that is influenced by the layout of the built environment. This study reports how the layout of the environment may influence responsiveness to an intervention. Pedestrian choices (n = 41 717) between stairs and the adjacent escalators were monitored for seven weeks in a train station (Birmingham, UK). After a 3.5 week baseline period, a stair riser banner intervention to increase stair climbing was installed on two staircases adjacent to escalators and monitoring continued for a further 3.5 weeks. Logistic regression analyses revealed that the visibility of the intervention, defined as the area of visibility in the horizontal plane opposite to the direction of travel (termed the isovist) had a major effect on success of the intervention. Only the largest isovist produced an increase in stair climbing (isovist=77.6 m2, OR = 1.10, CIs 1.02-1.19; isovist=40.7 m2, OR = 0.98, CIs 0.91-1.06; isovist=53.2 m2, OR = 1.00, CIs 0.95-1.06). Additionally, stair climbing was more common during the morning rush hour (OR = 1.56, CIs 1.80-2.59) and at higher levels of pedestrian traffic volume (OR = 1.92, CIs 1.68-2.21). The layout of the intervention site can influence responsiveness to point-of-choice interventions. Changes to the design of train stations may maximize the choice of the stairs at the expense of the escalator by pedestrians leaving the station

Precision public health – A critical review of the opportunities and obstacles

The term ‘precision public health’ (PPH) refers to a new approach in public health which involves the use of novel data sources and/or computer science-driven methods of data analysis to predict risk or outcomes, in order to improve how interventions are targeted or tailored, with the aim of making them more individualised and therefore more effective and cost-effective than methods currently in use. These data may include, for example, information from social media or devices, genomic or clinical data, and information from healthcare services. In this critical review, which was conducted between March and October 2019, we outline key assumptions underpinning the PPH approach and identify potential challenges in its application. We adopted a pragmatic, non-systematic review methodology to examine: (i) the general principles underlying PPH; (ii) the validity of claims made about PPH in empirical studies and commentaries; and (iii) the potential opportunities and challenges of adopting a PPH approach through examining two case studies: health checks and community-based interventions. Non-empirical studies (commentaries and think-pieces) were included in this review because PPH represents an emerging approach and many of the ideas around the potential of PPH are only described in such studies Commentary studies emphasise that precision can be achieved in targeting interventions towards narrow social profiles of people through the incorporation of data reflecting micro-level day-to-day insights into the lives of individuals. Structured analysis of commentary studies shows that (i) the PPH field may be highly influenced by commentary and non-systematic review pieces that lack transparent methods but make claims about the potential of PPH; (ii) commentators on PPH often attempt to provide evidence for claims but the link between the evidence and the claim is often unsubstantiated when critically examined; and (iii) many of the assumptions underlying PPH are not supported by empirical evidence suggesting that there needs to be a measured approach to adopting PPH approaches. Claims around the effectiveness of PPH and around PPH being an advance on current public health approaches tended not to be supported by empirical evidence. As a relatively new concept therefore, there is limited direct empirical evidence showing PPH to be effective, and the theoretical arguments in its favour are often not well supported by evidence. The more ambitious claims made for PPH in the literature often rest on questionable readings of the evidence – for example, citing the possibility of identifying subgroups of the population through better targeting as though this automatically promises greater effectiveness among interventions targeting those subgroups. In practice, it seems that PPH is less a radically new paradigm and more a range of incremental improvements to public health interventions. Hypothetical case studies outlining the potential of a PPH approach applied to health checks and community-based interventions indicate several ways in which new data or tools could be productively used to inform the design and implementation of public health interventions. Current evidence suggests the impact of these is likely to be fairly modest, although further focused research (e.g. exploring the utility of strategies for targeting or involving communities using PPH) may merit further exploration and evaluation. Defining PPH is contentious and our findings reflect the difficulty in assessing and operationalising the broad ambition of using emerging data and technologies to better understand profiles, predict risk and outcomes, and act upon this evidence. Future work in this area should seek to introduce more focus around the concept of PPH, including being clearer about the goals and breaking down the concept into a series of components that can each be evaluated. The bulk of the work presented here took place between March and October 2019. There is scope for further analysis to understand the potential of PPH in the future, as the number of studies adopting a PPH approach grows. This larger pool of studies may also lend itself to more systematic approaches to reviewing the evidence, particularly if there is an interest in evaluating a particular component or principle of PPH. In addition, the evidence examined in this report predates the COVID-19 global pandemic, and many of the measures taken to mitigate the spread of the pandemic may provide a further source of evidence and data to understand the potential role of PPH in public health decision-making

Infinitesimals without Logic

We introduce the ring of Fermat reals, an extension of the real field containing nilpotent infinitesimals. The construction takes inspiration from Smooth Infinitesimal Analysis (SIA), but provides a powerful theory of actual infinitesimals without any need of a background in mathematical logic. In particular, on the contrary with respect to SIA, which admits models only in intuitionistic logic, the theory of Fermat reals is consistent with classical logic. We face the problem to decide if the product of powers of nilpotent infinitesimals is zero or not, the identity principle for polynomials, the definition and properties of the total order relation. The construction is highly constructive, and every Fermat real admits a clear and order preserving geometrical representation. Using nilpotent infinitesimals, every smooth functions becomes a polynomial because in Taylor's formulas the rest is now zero. Finally, we present several applications to informal classical calculations used in Physics: now all these calculations become rigorous and, at the same time, formally equal to the informal ones. In particular, an interesting rigorous deduction of the wave equation is given, that clarifies how to formalize the approximations tied with Hook's law using this language of nilpotent infinitesimals.Comment: The first part of the preprint is taken directly form arXiv:0907.1872 The second part is new and contains a list of example

Correlated X-ray and Optical Variability in V404 Cyg in Quiescence

We report simultaneous X-ray and optical observations of V404 Cyg in quiescence. The X-ray flux varied dramatically by a factor of >20 during a 60ks observation. X-ray variations were well correlated with those in Halpha, although the latter include an approximately constant component as well. Correlations can also be seen with the optical continuum, although these are less clear. We see no large lag between X-ray and optical line variations; this implies they are causally connected on short timescales. As in previous observations, Halpha flares exhibit a double-peaked profile suggesting emission distributed across the accretion disk. The peak separation is consistent with material extending outwards to at least the circularization radius. The prompt response in the entire Halpha line confirms that the variability is powered by X-ray (and/or EUV) irradiation.Comment: 5 pages; Accepted for publication in the Astrophysical Journal Letter