Planning for the opioid crisis: how four cities approach zoning of healthcare related facilities

Master of Regional and Community PlanningDepartment of Landscape Architecture/Regional and Community PlanningHuston GibsonAs the opioid epidemic continues to ravage the United States, there are a variety of structural and societal causes of the epidemic that must be explored in order to produce a sustainable solution to the problem. According to the Centers for Disease Control (CDC), "a multifaceted, collaborative public health and law enforcement approach is urgently needed" (Rudd, 2016). The intersection of community social dynamics, public health, and planning is a critical area to study and can uncover the role that planners have to play in ending the crisis. This study seeks to answer the question "How do zoning and land use regulations affect the accessibility of substance abuse treatment facilities?" The purpose of this study is to determine an effective land use regulation and policy regime for the city of Springfield, Missouri, USA to employ in order to improve access to substance abuse treatment facilities (SATF). This topic is important to understand because knowing where there are gaps in accessibility to treatment will inform where to develop new treatment centers to treat a larger swath of the population. Improving access to treatment facilities improves the health and wellbeing of communities and reduces the time and financial cost of seeking treatment (Pearce, Witten, & Bartie, 2006). This study relies on zoning analysis and qualitative methods, plus a site suitability analysis to assess how Springfield, Missouri can update their zoning codes to provide increased accessibility to SATF facilities. The framework for this study is based on the methods used by Nemeth and Ross (2014). The analytic strategy for this project can be divided into three basic components: a zoning analysis, a socioeconomic disadvantage (SED) index, and site suitability analysis. ArcMap was used to map city zoning and socioeconomically disadvantaged census tracts, and also for land area calculations that contribute to a site suitability analysis. The maps produced demonstrate the accessibility of treatment centers via the permissiveness of zoning for potential locations of treatment centers using land area calculations. This study also demonstrates the availability of treatment according to an overlay of the zoning permissions and location of various population demographics via a socioeconomic disadvantage index. The study utilized Springfield, Missouri as the main study site. Regulation suites included in the analyses were Seattle, Washington, USA; Denver, Colorado, USA; and San Francisco, California, USA. Research findings suggest that Denver, CO provides the most equitable model for siting SATFs in Springfield despite the fact that the model is the least permissive. There are four key takeaways from this study: 1.) Syntax matters. SATF are human health services and can be retail service uses; 2.) Normalizing seeking treatment can start with co-locating facilities in established retail developments; 3.) Quality of permitted zones should be considered over quantity of permitted use zones; 4.) Utilize additional zoning tools such as districts and conditional use zones. This limited sample indicates that cities must carefully consider zoning regulations in order to promote both high equity and high permissiveness in siting SATFs. This could be an area for further study in providing high quality treatment to all segments of the population

What are the experiences of adults returning to work following recovery from Guillain-Barré syndrome? An interpretative phenomenological analysis

This is the author's accepted manuscript. The final published article is available from the link below. Copyright @ 2009 Informa UK Ltd.Purpose. Guillain-Barré syndrome (GBS) is a transient inflammatory disorder affecting peripheral nerves, characterised by weakness and numbness in limbs, upper body and face. Residual problems affect a large minority, and complicate return to work. This qualitative study explored the experiences of people who returned to work following their diagnosis of GBS and recovery, to gain insight into factors that facilitated or inhibited this process. Method. Five people participated in in-depth interviews. Individual and common experiences were explored through interpretative phenomenological analysis. Findings. Three recurring themes are presented: the perceived value of work; losing and recovering a familiar identity at work; and dilemmas around using support and adaptations at work. Certain individual issues also emerged but are beyond the scope of this article. Participants tended to measure their recovery in terms of returning to work yet continued to experience certain physical and psychosocial difficulties at work related to GBS, which required active coping strategies. Limited public awareness of GBS was perceived as a hindrance when returning to work. Conclusion. This study provides a rich account of the experiences that people encounter returning to work following GBS. Rehabilitation specialists may offer more effective preparation for this process, drawing upon the issues identified

Hip and knee replacements: Should we follow them up? A survey of orthopaedic health professionals

The aim of this study was to collect evidence on the current view of orthopaedic health professionals on follow-up services after hip or knee replacement. It consisted of a short survey that was distributed, following ethical approval, at the British Association for Surgery of the Knee (BASK) and the British Hip Society 2018 annual meetings with the agreement of their executive committees.One hundred and seventy-two delegates completed the surveys with a high response rate. The majority of respondents were orthopaedic consultants (mean years since qualification = 18), with 13% of the participants from an allied health professional or research background. Results showed that 87% (hips) and 78% (knees) of healthcare professionals (HCPs) supported long-term follow-up by the orthopaedic community with 33% stating that changes are needed in the intervals for review and age limits as recommended in the current NICE guidelines. Freehand comments noted concerns about skilled assessment and cost; some included suggestions for alternative models of care. Seventy-four percent of HCPs were in favour of using arthroplasty practitioner services with the majority preferring a virtual arthroplasty practitioner service. Forty-six percent of HCPs were aware of their local National Health Service plans for sustainability and transformation (STP). Of these, 61% reported that their responses were not consistent with their local STP. In conclusion, there continues to be widespread support for arthroplasty follow-up services. However, with the current pressure on healthcare resources, a re-evaluation of recommended follow-up services and their method of delivery is required

Gratitude mediates consumer responses to marketing communications

Purpose: From Adam Smith onwards, gratitude has been held as invaluable to societal functioning in view of its role in helping individuals maintain their reciprocal obligations to one another. The purpose of the current research was to use current conceptions of gratitude derived from work in social psychology to test whether simple descriptions of hypothetical organisations could systematically differ in the extent to which they elicit gratitude, and subsequently whether gratitude would mediate behavioural intentions towards these organisations.  Methodology: In two studies, participants read vignettes describing hypothetical organisations that systematically differed in the extent to which the services they provided were costly to the organisation, of high value, and provided out of a genuine desire to help. Perceptions of these dimensions, feelings of gratitude, and behavioural intentions towards each organisation were subsequently measured.  Findings: The appraisal group manipulation significantly impacted consumers’ behavioural intentions towards these businesses, and the majority of this relationship was mediated by feelings of gratitude towards the organisations.  Research limitations/implications: These data indicate that gratitude not only mediates customer responses to relationship marketing investments, but may also be integral in marketing communications’ role in converting non-customers to customers. They also indicate that marketing communications should stress that an organisations services are of high value, of cost to the organisation and provided out of a genuine desire to help.  Originality/value: This paper shows for the first time that the same cognitive appraisals that underpin feelings of interpersonal gratitude mediate responses to global evaluations of organisations. This considerably broadens the situations under which gratitude had previously been considered to operate and argues for the inclusion of gratitude in understanding how marketing communications and relationship management are used to influence consumer responses

Exploration of potential triggers for self-directed behaviours and regurgitation and reingestion in zoo-housed chimpanzees

The unique challenges faced by animals living in zoos can lead to the production of anxiety-related behaviours. In this study we aimed to understand what specific factors may cause chimpanzees to display these behaviours. In non-human primates, displacement behaviours, such as self-scratching and yawning, are considered markers of anxiety and stress, and Regurgitation and Reingestion (R/R) is considered an abnormal behaviour with negative consequences for physical health. We examined the possible triggers of R/R, scratching, and yawning in a group of zoo-housed chimpanzees and followed this up with an analysis of long-term data to examine further aspects of R/R behaviour. In the first study we conducted focal observations on 18 adult chimpanzees at Edinburgh Zoo, UK, in addition to all occurrence sampling of visitors using flash photography, screaming and banging on the glass in the exhibit. 158 h of data were analysed and Generalised Linear Mixed Models revealed that yawning was significantly more likely if there was a long period of time since the last feed and when there were moderate numbers of visitors in the zoo. There were trends that yawning was more likely to occur if children screamed and that scratching was more likely to occur if visitors used flash photography. R/R occurred most often within 40 min of a feed, but was not affected by the inter-feed interval preceding that feed, positive or negative social interactions, or visitor numbers or behaviour. As there was no obvious daily trigger for R/R, an analysis of long-term data (2009 to 2015) was conducted to investigate if social or dietary factors affected rates of R/R over a larger timescale. It was found that R/R rates in the months before a significant diet change were not different from R/R rates in the months after, but it was found that R/R rates decreased over the five-year period. Lastly, we found no evidence that the introduction of individuals engaging in R/R lead to resident chimpanzees habitually adopting the behaviour, despite considerable opportunities to observe it. These findings have implications for welfare interventions aimed to reduce R/R and/or anxiety behaviours in captive populations and for the translocation of individuals that are known to engage in R/R between groups.Peer reviewe

Pilot study: Is a long‐term follow‐up service beneficial for patients undergoing revision hip replacement surgery?

PurposeTotal hip arthroplasty (THA) is highly successful but some patients will require later revision surgery. This pilot study evaluates the effects of long‐term follow‐up for patients undergoing revision hip replacement.MethodsConsecutive patients undergoing aseptic revision of THA were recruited from a large orthopaedic unit to a single centre, observational study. Primary outcomes were changes in patient‐reported scores from pre‐revision to 12 months post‐surgery. Secondary outcomes were costs during hospital stay up to 6 months post‐revision. Participants were retrospectively allocated to two groups—those with regular orthopaedic review prior to revision (Planned revision) or those without (Unplanned revision).Resultspatients were recruited, 7 were unrevised, one incomplete baseline questionnaires. There were 25 planned and 19 unplanned revisions with no significant differences between groups at baseline. At 12 months, 34 complete data sets were available for analysis, 17 in each group. Change scores were analysed with Mann–Whitney U test; none reached statistical significance. There was a significant difference for length of stay: Planned group 5 days (2–22), Unplanned 11 days (3–86) (Mann–Whitney U test, p = 0.023). No significant differences found for theatre time or component costs. Resource costs post‐revision surgery are presented.ConclusionThis pilot study indicates that some change in methods would be required for future work. The results show that there may be some financial benefit from providing long‐term follow‐up of THA but a larger study is needed to explore these findings and to discuss the impact on recommended guidelines

Studies Needed to Address Public Health Challenges of the 2009 H1N1 Influenza Pandemic: Insights from Modeling

In light of the 2009 influenza pandemic and potential future pandemics, Maria Van Kerkhove and colleagues anticipate six public health challenges and the data needed to support sound public health decision making.The authors acknowledge support from the Bill & Melinda Gates Foundation (MDVK, CF, NMF); Royal Society (CF); Medical Research Council (MDVK, CF, PJW, NMF); EU FP7 programme (NMF); UK Health Protection Agency (PJW); US National Institutes of Health Models of Infectious Disease Agent Study program through cooperative agreement 1U54GM088588 (ML); NIH Director's Pioneer Award, DP1-OD000490-01 (DS); EU FP7 grant EMPERIE 223498 (DS); the Wellcome Trust (DS); 3R01TW008246-01S1 from Fogerty International Center and RAPIDD program from Fogerty International Center with the Science & Technology Directorate, Department of Homeland Security (SR); and the Institut de Veille Sanitaire Sanitaire funded by the French Ministry of Health (J-CD). The funders played no role in the decision to submit the article or in its preparation

Past Tense Formation in Williams Syndrome

It has been claimed that in the language systems of people with Williams syndrome (WS), syntax is intact but lexical memory is impaired. Evidence has come from past tense elicitation tasks with a small number of participants where individuals with WS are said to have a specific deficit in forming irregular past tenses. However, typically developing children also show poorer performance on irregulars than regulars in these tasks, and one of the central features of WS language development is that it is delayed. We compared the performance of 21 participants with WS on two past tense elicitation tasks with that of four typically developing control groups, at ages 6, 8, 10, and adult. When verbal mental age was controlled for, participants in the WS group displayed no selective deficit in irregular past tense performance. However, there was evidence for lower levels of generalisation to novel strings. This is consistent with the hypothesis that the WS language system is delayed because it has developed under different constraints, constraints that perhaps include atypical phonological representations. The results are discussed in relation to dual-mechanism and connectionist computational models of language development, and to the possible differential weight given to phonology versus semantics in WS development

NASA's High-Resolution GEOS Forecasting and Reanalysis Products: Support for TOLNet

Stratospheric intrusions (SIs) the introduction of ozone-rich stratospheric air into the troposphere have been the interest of decades of research for their link with surface ozone air quality exceedances, especially at the high elevations in the western USA in springtime; however, the impact of SIs in the remaining seasons and over the rest of the USA is less clear. We can expect MERRA-2 to realistically represent both atmospheric dynamics and composition. The operational GEOS weather forecasting system, GEOS-FP, has a similar ozone observing system to MERRA-2, while NASA's new global high-resolution air quality forecast system, GEOS-CF, combines the operational GEOS weather forecasting model with the state-of-the-science GEOS-Chem chemistry module (version 12), simulating a wide range of additional air pollutants and tracers which strengthens this detailed analysis of the intrusions and the sources for the high ozone concentrations. Using a multitude of observational datasets, including lidar, air craft, ozonesondes and air quality monitoring surface sites, in combination with the GEOS forecast and reanalysis products, we aim to provide the public with tools which are available in near-real time to enhance their capability to identify the impact of stratospheric air on surface ozone concentrations separate from anthropogenic sources. In particular, improved understanding of the connections between large-scale climate variability and local-scale dynamically-driven air quality events may support improved seasonal prediction of SI events

Genetic contributions to visuospatial cognition in Williams syndrome: insights from two contrasting partial deletion patients

Background Williams syndrome (WS) is a rare neurodevelopmental disorder arising from a hemizygotic deletion of approximately 27 genes on chromosome 7, at locus 7q11.23. WS is characterised by an uneven cognitive profile, with serious deficits in visuospatial tasks in comparison to relatively proficient performance in some other cognitive domains such as language and face processing. Individuals with partial genetic deletions within the WS critical region (WSCR) have provided insights into the contribution of specific genes to this complex phenotype. However, the combinatorial effects of different genes remain elusive. Methods We report on visuospatial cognition in two individuals with contrasting partial deletions in the WSCR: one female (HR), aged 11 years 9 months, with haploinsufficiency for 24 of the WS genes (up to GTF2IRD1), and one male (JB), aged 14 years 2 months, with the three most telomeric genes within the WSCR deleted, or partially deleted. Results Our in-depth phenotyping of the visuospatial domain from table-top psychometric, and small- and large-scale experimental tasks reveal a profile in HR in line with typically developing controls, albeit with some atypical features. These data are contrasted with patient JB’s atypical profile of strengths and weaknesses across the visuospatial domain, as well as with more substantial visuospatial deficits in individuals with the full WS deletion. Conclusions Our findings point to the contribution of specific genes to spatial processing difficulties associated with WS, highlighting the multifaceted nature of spatial cognition and the divergent effects of genetic deletions within the WSCR on different components of visuospatial ability. The importance of general transcription factors at the telomeric end of the WSCR, and their combinatorial effects on the WS visuospatial phenotype are also discussed