Budgetary inplications of cross boundary flows in East Anglia: a report to the Regional Health Authority

The East Anglian Regional Health Authority is concerned to base its budgetary decisions on accurate information about the costs of cross-boundary flows in the Region. A patient counts as a cross boundary flow when a resident in one district completes a spell as an in-patient in a hospital in another district. Patients can flow across regional boundaries as well as district boundaries within the same region. The first question at issue is whether such patients present distinctively different treatment problems from those presented by resident patients. Such treatment problems might register in terms of greater length of stay and/or greater severity of condition requiring more intensive treatment during the stay. Severity could have several aspects to it. At admission it could involve the expectation of greater difficulty in diagnosis or in treatment. During treatment, it could present in terms of the need for more medical and nursing time for some patients or for more complex or more frequent treatment. Severity would lead to greater caution about discharge and to greater length of stay. The second issue is whether such differences (if they exist) lead to higher cost. The third issue is whether such differences in cost justify budgetary compensation. To justify compensation in terms of budgetary targets the costs would have to be consistent and likely to continue over a long period of time. There could also be compensation in arrears which would be related to measured differences from plan. At present districts are compensated for cross boundary flows on the bases if overage costs per case by specialty. The East Anglian RHA has asked the Centre for Health Economics at York University to carry out an independent study of the whole issue. This request followed the Report of the Regional Working Party on Resource Allocation published in September 1983. We set out the two relevant paragraphs in Appendix 1 as they reflect the state of information and the questions in the minds of policy-makers when we began our enquiry. The terms of reference set to us by the RHA originally cover all types of hospital care. IN subsequent discussion it was agreed that the study should cover in-patients only and exclude out-patients, day cases and the costs of laboratory tests. The information required to make estimates on these points is not available routinely in sufficient detail for individual cases. The aim is: “To show whether there is a significant variation among Districts in the severity of illness of patients crossing boundaries for treatment and, if so, whether this results in a significant difference in attributable costs.”EARHA, HAA, district boundaries

Monitoring Ground Cover and Associated Erosion Risks Using Satellite Remote Sensing in the Agricultural Region of Western Australia

National satellite-derived fractional ground cover products (percentage of green vegetation, dry vegetation, bare soil) are now routinely produced by Geoscience Australia and other groups, and are available for interpretation. The extensive coverage, frequent repeated observations and large archive of historical imagery supports more objective and reproducible methods than previous degradation monitoring efforts that were based on intermittent field surveys of land condition and anecdotal reporting. Landsat (30-m pixel resolution) seasonal composite images will be used to estimate total ground cover throughout the year, and assess the proportion of cropland in the grainbelt below recommended cover thresholds of 50% for wind erosion, and 70% for water erosion

Battle : cambio desde adentro (2014)

"Curriculum de la guia de observacion.""Este documental es sobre el educador Eliot Battle y el papel fundamental que jugo en la desegregacion de las escuelas, barrios residenciales y en la comunidad en general de Columbia, Missouri. Battle promovio estos cambios a traves de la via pacifica, pese a que tuvo que enfrentarse en muchas ocasiones a la resistencia a sus ideas, tanto en las comunidades negras y blancas. Se caracterizo por su comportamiento calmado y su trabajo dedicado dentro de las instituciones y sistemas locales, en los que tendio puentes de entendimiento y tolerancia entre ambas razas, lo cual conllevo a impulsar cambios para que Columbia fuera mejor."New 7/14/Web only

Battle : change from within, curriculum viewing guide - community (2012)

"Community.""Curriculum viewing guide.""This documentary is about educator Eliot Battle and the pivotal role he played in desegregating schools, housing and the Columbia community. As Battle facilitated changes with quiet resolve, he faced resistance from both the black and white communities. His calm demeanor and dedicated work within existing institutions and systems allowed him to bridge the gap between the two races and change Columbia for the better.

Battle : change from within, curriculum viewing guide - schools (2012)

"Schools.""Curriculum viewing guide.""This documentary is about educator Eliot Battle and the pivotal role he played in desegregating schools, housing and the Columbia community. As Battle facilitated changes with quiet resolve, he faced resistance from both the black and white communities. His calm demeanor and dedicated work within existing institutions and systems allowed him to bridge the gap between the two races and change Columbia for the better.

Battle : change from within, curriculum viewing guide (2014)

"Curriculum viewing guide.""This documentary is about educator Eliot Battle and the pivotal role he played in desegregating schools, housing and the Columbia community. As Battle facilitated changes with quiet resolve, he faced resistance from both the black and white communities. His calm demeanor and dedicated work within existing institutions and systems allowed him to bridge the gap between the two races and change Columbia for the better."New 6/14/150

Battle : change from within, curriculum viewing guide - 4-H (2012)

"4-H.""Curriculum viewing guide.""This documentary is about educator Eliot Battle and the pivotal role he played in desegregating schools, housing and the Columbia community. As Battle facilitated changes with quiet resolve, he faced resistance from both the black and white communities. His calm demeanor and dedicated work within existing institutions and systems allowed him to bridge the gap between the two races and change Columbia for the better.

The influence of urban design on neighbourhood walking following residential relocation : longitudinal results from the RESIDE study

The design of urban environments has the potential to enhance the health and well-being of residents by impacting social determinants of health including access to public transport, green space and local amenities. Commencing in 2003, RESIDE is a longitudinal natural experiment examining the impact of urban planning on active living in metropolitan Perth, Western Australia. Participants building homes in new housing developments were surveyed before relocation (n = 1813; 34·6% recruitment rate); and approximately 12 months later (n = 1437). Changes in perceived and objective neighbourhood characteristics associated with walking following relocation were examined, adjusted for changes in demographic, intrapersonal, interpersonal and baseline reasons for residential location choice. Self-reported walking was measured using the Neighbourhood Physical Activity Questionnaire. Following relocation, transport-related walking declined overall (p < 0.001) and recreational walking increased (p < 0.001): access to transport- and recreational destinations changed in similar directions. However, in those with increased access to destinations, transport-related walking increased by 5.8 min/week for each type of transport-related destination that increased (p = 0.045); and recreational walking by 17.6 min/week for each type of recreational destination that increased (p = 0.070). The association between the built environment and recreational walking was partially mediated by changes in perceived neighbourhood attractiveness: when changes in ‘enjoyment’ and ‘attitude’ towards local walking were removed from the multivariate model, recreational walking returned to 20.1 min/week (p = 0.040) for each type of recreational destination that increased. This study provides longitudinal evidence that both transport and recreational-walking behaviours respond to changes in the availability and diversity of local transport- and recreational destinations, and demonstrates the potential of local infrastructure to support health-enhancing behaviours. As neighbourhoods evolve, longer-term follow-up is required to fully capture changes that occur, and the impact on residents. The potential for using policies, incentives and infrastructure levies to enable the early introduction of recreational and transport-related facilities into new housing developments warrants further investigation

A Synoptic- and Remote Sensing-based Analysis of a Severe Dust Storm Event over Central Asia

Published by [Verlag nicht ermittelbar], Taina

Combining exercise with cognitive training and vitamin D

Changes in functional brain connectivity (FBC) may indicate how lifestyle modifications can prevent the progression to dementia; FBC identifies areas that are spatially separate but temporally synchronized in their activation and is altered in those with mild cognitive impairment (MCI), a prodromal state between healthy cognitive aging and dementia. Participants with MCI were randomly assigned to one of five study arms. Three times per week for 20-weeks, participants performed 30-min of (control) cognitive training, followed by 60-min of (control) physical exercise. Additionally, a vitamin