A method to determine spatial access to specialized palliative care services using GIS

This is the final version of the article. Available from BioMed Central via the DOI in this record.BACKGROUND: Providing palliative care is a growing priority for health service administrators worldwide as the populations of many nations continue to age rapidly. In many countries, palliative care services are presently inadequate and this problem will be exacerbated in the coming years. The provision of palliative care, moreover, has been piecemeal in many jurisdictions and there is little distinction made at present between levels of service provision. There is a pressing need to determine which populations do not enjoy access to specialized palliative care services in particular. METHODS: Catchments around existing specialized palliative care services in the Canadian province of British Columbia were calculated based on real road travel time. Census block face population counts were linked to postal codes associated with road segments in order to determine the percentage of the total population more than one hour road travel time from specialized palliative care. RESULTS: Whilst 81% of the province's population resides within one hour from at least one specialized palliative care service, spatial access varies greatly by regional health authority. Based on the definition of specialized palliative care adopted for the study, the Northern Health Authority has, for instance, just two such service locations, and well over half of its population do not have reasonable spatial access to such care. CONCLUSION: Strategic location analysis methods must be developed and used to accurately locate future palliative services in order to provide spatial access to the greatest number of people, and to ensure that limited health resources are allocated wisely. Improved spatial access has the potential to reduce travel-times for patients, for palliative care workers making home visits, and for travelling practitioners. These methods are particularly useful for health service planners - and provide a means to rationalize their decision-making. Moreover, they are extendable to a number of health service allocation problems.Funding for this research was provided by the British Columbia Medical Services Foundation and British Columbia Rural and Remote Health Research Network. NS is funded by a Michael Smith Foundation for Health Research Scholar Award and a Canadian Institutes of Health Research New Investigator Award

Editors' introduction to the special issue “Privilege, vulnerability and care: Interspecies dynamics in rural landscapes”

Animals are central actors within rural societies but remain largely invisible within both our empirical and theoretical analyses. Approximately 20 years ago in the pages of this journal, Tovey (2003) pointed to the significance of animals in effectively defining rurality: They are central to the rural economy and society and foster a sense among rural residents that they are organically embedded in an interspecies world. Thus, our shared relations with animals are key to understanding rural social relations and their underlying inequalities and hierarchies. Tovey suggested that it was therefore necessary and appropriate that rural sociology should develop its own approach to including animals in theorising rural society. We believe that such an approach is yet to emerge. The aim of this special issue is to outline what such an approach might look like and to present a diverse range of articles to get it underway. In what follows, then, as editors and contributors, we collectively explore the role and significance of human–animal relations in shaping rural society via a particular focus on relations of privilege, vulnerability and care

Trauma Surveillance in Cape Town, South Africa: An Analysis of 9236 Consecutive Trauma Center Admissions.

PublishedJournal ArticleResearch Support, Non-U.S. Gov'tThis is the final version of the article. Available from American Medical Association via the DOI in this record.IMPORTANCE: Trauma is a leading cause of death and disability worldwide. In many low- and middle-income countries, formal trauma surveillance strategies have not yet been widely implemented. OBJECTIVE: To formalize injury data collection at Groote Schuur Hospital, the chief academic hospital of the University of Cape Town, a level I trauma center, and one of the largest trauma referral hospitals in the world. DESIGN, SETTING, AND PARTICIPANTS: This was a prospective study of all trauma admissions from October 1, 2010, through September 30, 2011, at Groote Schuur Hospital. A standard admission form was developed with multidisciplinary input and was used for both clinical and data abstraction purposes. Analysis of data was performed in 3 parts: demographics of injury, injury risk by location, and access to and maturity of trauma services. Geographic information science was then used to create satellite imaging of injury "hot spots" and to track referral patterns. Finally, the World Health Organization trauma system maturity index was used to evaluate the current breadth of the trauma system in place. MAIN OUTCOMES AND MEASURES: The demographics of trauma patients, the distribution of injury in a large metropolitan catchment, and the patterns of injury referral and patient movement within the trauma system. RESULTS: The minimum 34-point data set captured relevant demographic, geographic, incident, and clinical data for 9236 patients. Data field completion rates were highly variable. An analysis of demographics of injury (age, sex, and mechanism of injury) was performed. Most violence occurred toward males (71.3%) who were younger than 40 years of age (74.6%). We demonstrated high rates of violent interpersonal injury (71.6% of intentional injury) and motor vehicle injury (18.8% of all injuries). There was a strong association between injury and alcohol use, with alcohol implicated in at least 30.1% of trauma admissions. From a systems standpoint, the data suggest a mature pattern of referral consistent with the presence of an inclusive trauma system. CONCLUSIONS AND RELEVANCE: The implementation of injury surveillance at Groote Schuur Hospital improved insights about injury risk based on demographics and neighborhood as well as access to service based on patterns of referral. This information will guide further development of South Africa's already advanced trauma system.This work was supported by the Canadian Institute for Health Research and the Social Sciences and Humanities Research Council

Multilevel Dynamic Twin Modeling

Recent developments in the collection and modeling of intensive longitudinal data have enabled us to fit dynamic twin models, in which within-person processes are separated into genetic and environmental components. A well-known dynamic twin model is the genetic simplex model, which is fitted to a few repeated measures for many twins. A more recently developed model is the iFACE model, which is fitted to many repeated measures for a single pair of twins. In this paper, we introduce a missing link between these two models–a multilevel extension that allows for making both population-level and twin-level inferences. We provide a proof-of-principle simulation study for this model, and apply it to an experience sampling data set on 148 monozygotic and 88 dizygotic twins. We use the multilevel model to examine the overlap and differences between the dynamic genetic twin models and the classic twin models, as well as their interpretation

Background and Preparatory Behaviours of Right-Wing Extremist Lone Actors: A Comparative Study

The threat posed by lone actors ranks high on the list of terrorism-related security concerns. In recent years especially, discussions about these perpetrators have focused primarily on those associated with, or inspired by, Islamic State and other jihadist entities. However, a significant portion of lone actors actually hail from right-wing extremist milieus. This article serves to draw attention to this subcategory of lone-actor terrorists, with a particular focus on their backgrounds and pre-attack behaviours. To that end, two datasets are presented that allow a comparison to be made between right-wing extremist lone actors and other ideologically-motivated lone actors. While several differences are noted, perhaps the most surprising finding is the degree of similarity between right-wing extremist lone actors and those adhering to different ideological currents. The results contribute to a knowledge-base that can inform discussion about whether risk assessment tools and protocols should differentiate between ideological categories of lone actor terrorist

Molecular epidemiology of serogroup a meningitis in Moscow, 1969 to 1997.

Molecular analysis of 103 serogroup A Neisseria meningitidis strains isolated in Moscow from 1969 to 1997 showed that four independent clonal groupings were responsible for successive waves of meningococcal disease. An epidemic from 1969 to the mid-1970s was caused by genocloud 2 of subgroup III, possibly imported from China. Subsequent endemic disease through the early 1990s was caused by subgroup X and then by subgroup VI, which has also caused endemic disease elsewhere in eastern Europe. A 1996 epidemic was part of the pandemic spread from Asia of genocloud 8 of subgroup III. Recent genocloud 8 epidemic disease in Moscow may represent an early warning for spread of these bacteria to other countries in Europe