Design review : alternative models of administration.

Thesis (M.C.P.)--Massachusetts Institute of Technology, Dept. of Urban Studies and Planning; and, (M. Arch. in Advanced Studies)--Massachusetts Institute of Technology, Dept. of Architecture, 1977.MICROFICHE COPY AVAILABLE IN ARCHIVES AND ROTCH.Bibliography : leaves 347-352.M.C.P.M.Arch.A.S

The Transportation Dividend: Transit Investments and the Massachusetts Economy

As home to America's first subway, Boston has been a transit-oriented city for more than a century. In fact, much of our regional economic success is due to the connectivity that a transit system provides. It is no coincidence that the area served by the MBTA houses almost 70 percent of the state's population, offers 74 percent of the jobs, and generates 84 percent of Massachusetts's gross domestic product. The MBTA is the backbone of our economy and any successful strategy for continued growth and prosperity for the region must begin with smart investment in this system.Luckily, the calculus is straightforward as the benefits from our transit system far outweigh the costs we dedicate to support it. A new report from A Better City, made possible through support from both the Barr Foundation and The Boston Foundation, measured the MBTA's performance and economic impact. It found that through travel time and cost savings, vehicular crashes avoided and reduced auto emissions, the MBTA provides an estimated $11.4 billion in value to Greater Boston each year for both transit users and non-users alike. Boston residents experience all of these benefits from the T's annual operating budget of approximately$2 billion.The report also considered the alternative, examining what would it cost if our transit system did not exist. Our economy would require the capital cost of nearly 2,300 additional lane miles of roads and 400,000 more parking spaces. If we needed to build that today, the cost for this vehicular infrastructure would be over $15 billion. The MBTA is a bargain today and for the future

Access to non-violent pornography in a secure forensic hospital

The current research explores non-violent pornography within secure hospital settings. It includes a systematic review (n = 40 papers), followed by a qualitative study comprising semi-structured interviews (n = 24, six patients and 18 staff) and staff focus groups (n = 22 staff). The systematic review identified six themes; (1) pornography is inconsistently defined, (2) pornography exposure can increase general aggression, (3) pornography exposure may increase the risk for sexual aggression, (4) pornography exposure can increase aggression supportive beliefs, (5) pornography exposure impacts negatively on those with a violent predisposition, and (6) pornography is educational for men not identifying as heterosexual. The semi-structured interviews and focus groups revealed four themes; (1) staff members hold diverse beliefs about pornographic material, (2) pornography is difficult to obtain and use for patients who do not identify as heterosexual, (3) pornography is used for specific functions, and (4) frequent exposure to pornography can have negative effects for staff members. Implementation of individualised and multi-disciplinary decision-making, continual monitoring of access and consideration of the functions of pornography are argued as beneficial, with suggestions for future research outlined

Impacting on factors promoting intra-group aggression in secure psychiatric settings

Three preliminary and linked studies investigate the impact of making alterations to factors considered relevant to engaging in and experiencing intra-group aggression (bullying) among adult male patients detained in a single secure forensic hospital. Study one (n = 44) outlines the institutional factors, attitudes towards bullying and environmental factors that increase the likelihood of engaging in bullying and or being victimised. Study two (n = 56 patients and 113 staff) assesses the effect of three variations of intervention that aimed to reduce intra-group aggression through direct alteration of the physical and psychosocial environment, using data from both patients and staff. Study three (n = 414) looks at the effects of two variations of the intervention used in study two, which offered patients’ participation in individual and communal activities. It was predicted that changes to the physical and social environment would produce a reduction in the factors shown to predict intra-group aggression. Attitudes supportive of bullying and the presence of social hierarchies each increased the likelihood of engaging in bullying. Indirect changes to the social environment on the wards had more positive effects than those incorporating direct alterations to the physical and social environment. The differences in effectiveness of the two approaches are discussed in relation to the established predictors of intra-group aggression. The research concludes by noting the preliminary nature of the research and outlining potential directions for future research and interventions

Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

Background A reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets. Methods Patient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendall’s tau for dichotomous variables, or Jonckheere–Terpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis. Results A higher operative difficulty grade was consistently associated with worse outcomes for the patients in both the reference and CholeS cohorts. The median length of stay increased from 0 to 4 days, and the 30-day complication rate from 7.6 to 24.4% as the difficulty grade increased from 1 to 4/5 (both p < 0.001). In the CholeS cohort, a higher difficulty grade was found to be most strongly associated with conversion to open and 30-day mortality (AUROC = 0.903, 0.822, respectively). On multivariable analysis, the Nassar operative difficultly scale was found to be a significant independent predictor of operative duration, conversion to open surgery, 30-day complications and 30-day reintervention (all p < 0.001). Conclusion We have shown that an operative difficulty scale can standardise the description of operative findings by multiple grades of surgeons to facilitate audit, training assessment and research. It provides a tool for reporting operative findings, disease severity and technical difficulty and can be utilised in future research to reliably compare outcomes according to case mix and intra-operative difficulty

Mongooses (\u3ci\u3eUrva auropunctata\u3c/i\u3e) as reservoir hosts of leptospira species in the United States Virgin Islands, 2019–2020

During 2019–2020, the Virgin Islands Department of Health investigated potential animal reservoirs of Leptospira spp., the bacteria that cause leptospirosis. In this cross-sectional study, we investigated Leptospira spp. exposure and carriage in the small Indian mongoose (Urva auropunctata, syn: Herpestes auropunctatus), an invasive animal species. This study was conducted across the three main islands of the U.S. Virgin Islands (USVI), which are St. Croix, St. Thomas, and St. John. We used the microscopic agglutination test (MAT), fluorescent antibody test (FAT), real-time polymerase chain reaction (lipl32 rt-PCR), and bacterial culture to evaluate serum and kidney specimens and compared the sensitivity, specificity, positive predictive value, and negative predictive value of these laboratory meth-ods. Mongooses (n = 274) were live-trapped at 31 field sites in ten regions across USVI and humanely euthanized for Leptospira spp. testing. Bacterial isolates were sequenced and evaluated for species and phylogenetic analysis using the ppk gene. Anti-Leptospira spp. antibodies were detected in 34% (87/256) of mongooses. Reactions were observed with the following serogroups: Sejroe, Icterohaemorrhagiae, Pyrogenes, Mini, Cynopteri, Australis, Hebdomadis, Autumnalis, Mankarso, Pomona, and Ballum. Of the kidney specimens exam-ined, 5.8% (16/270) were FAT-positive, 10% (27/274) were culture-positive, and 12.4% (34/ 274) were positive by rt-PCR. Of the Leptospira spp. isolated from mongooses, 25 were L. borgpetersenii, one was L. interrogans, and one was L. kirschneri. Positive predictive values of FAT and rt-PCR testing for predicting successful isolation of Leptospira by culture were 88% and 65%, respectively. The isolation and identification of Leptospira spp. in mongooses highlights the potential role of mongooses as a wildlife reservoir of leptospirosis; mongooses could be a source of Leptospira spp. infections for other wildlife, domestic animals, and humans

Disentangling the Relative Importance of Changes in Climate and Land-Use Intensity in Driving Recent Bird Population Trends

Threats to biodiversity resulting from habitat destruction and deterioration have been documented for many species, whilst climate change is regarded as increasingly impacting upon species' distribution and abundance. However, few studies have disentangled the relative importance of these two drivers in causing recent population declines. We quantify the relative importance of both processes by modelling annual variation in population growth of 18 farmland bird species in the UK as a function of measures of land-use intensity and weather. Modelled together, both had similar explanatory power in accounting for annual fluctuations in population growth. When these models were used to retrodict population trends for each species as a function of annual variation in land-use intensity and weather combined, and separately, retrodictions incorporating land-use intensity were more closely linked to observed population trends than retrodictions based only on weather, and closely matched the UK farmland bird index from 1970 onwards. Despite more stable land-use intensity in recent years, climate change (inferred from weather trends) has not overtaken land-use intensity as the dominant driver of bird populations

A function-based typology for Earth’s ecosystems

As the United Nations develops a post-2020 global biodiversity framework for the Convention on Biological Diversity, attention is focusing on how new goals and targets for ecosystem conservation might serve its vision of ‘living in harmony with nature’(1,2). Advancing dual imperatives to conserve biodiversity and sustain ecosystem services requires reliable and resilient generalizations and predictions about ecosystem responses to environmental change and management(3). Ecosystems vary in their biota(4), service provision(5) and relative exposure to risks(6), yet there is no globally consistent classification of ecosystems that reflects functional responses to change and management. This hampers progress on developing conservation targets and sustainability goals. Here we present the International Union for Conservation of Nature (IUCN) Global Ecosystem Typology, a conceptually robust, scalable, spatially explicit approach for generalizations and predictions about functions, biota, risks and management remedies across the entire biosphere. The outcome of a major cross-disciplinary collaboration, this novel framework places all of Earth’s ecosystems into a unifying theoretical context to guide the transformation of ecosystem policy and management from global to local scales. This new information infrastructure will support knowledge transfer for ecosystem-specific management and restoration, globally standardized ecosystem risk assessments, natural capital accounting and progress on the post-2020 global biodiversity framework