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PubMed1997

Making our offices universally accessible: guidelines for physicians.

OBJECTIVE: To develop recommendations for office-based physicians who wish to make their offices accessible to all patients. OPTIONS: Include taking steps to make offices more accessible, or not; offices may be accessible to varying degrees. OUTCOMES: Outcomes of accessibility involve patient-care, economic, ethical and legal issues. Stakeholders in these outcomes include patients, physicians, government and society. EVIDENCE: Data were obtained from a series of searches of MEDLINE, CINAHL and Healthstar (previously Health) databases for articles on disability and family medicine, primary (health) care and family practice, and on access and offices, and health services accessibility, and from a telephone survey of 50 stakeholders. VALUES: A high value was placed on services to persons with disabilities and on stakeholder input. Universal accessibility was valued as an overall goal; improved accessibility was also highly valued. BENEFITS, HARMS AND COSTS: Benefits to patients include improved access to care as guaranteed by the Canada Health Act and in keeping with provincial Human Rights Codes. Benefits to physicians include contact with a broader patient population and freedom from fear of litigation. Costs of improved accessibility vary depending on individual circumstances and on whether an office is being built or renovated; some improvement costs are minimal. RECOMMENDATIONS: All physicians should take measures to improve practice accessibility. Improved access should be considered in each of the following areas: transportation and entrance to the facility, entrance to the office, waiting rooms, rest rooms, examination rooms, general building features and other features. VALIDATION: No similar guidelines exist. To assess the content validity of these guidelines, the authors had a draft document reviewed by 18 stakeholders. All specific recommendations met the minimum criterion of adherence to current legislation, including national and provincial building codes. The specific recommendations are endorsed by the Canadian Paraplegic Association (national and Ontario offices), the DisAbled Women's Network (Ontario) and the Centre for Independent Living (Toronto). SPONSORS: Development of these guidelines was supported in part by the Department of Family and Community Medicine, Toronto Hospital, Toronto, Ont.

Adult↗

PubMed1975

Legal dimensions of the psychiatric halfway house.

This paper addresses itself to the solutions developed in Massachusetts to three key legal problem areas with regard to the psychiatric halfway house. The areas are (1) the assurance of the overall quality of the programs through rigorous implementation of regulatory statutes; (2) the determination of beneficial location and equitable geographical distribution of these facilities as enabled through local zoning ordinances--preventing at the same time arbitrary community exclusion; and (3) the establishment of standards for safe, suitable, and feasible structures to house the community residence as determined by building codes.

Community Mental Health Services↗

PubMed1985

Limitation of exposure to natural radioactivity in Canada.

The jurisdictional responsibility for natural radioactivity in Canada is divided between the federal and provincial governments. The desire for uniform standards has resulted in the formation of a scientific group to advise governments concerning the desirability of standards for exposure to natural radioactivity. The various types of exposure are reviewed with emphasis on naturally occurring radon in homes. The scientific Committee could not agree either philosophically or practically on the control level for radon in homes. To resolve this impasse, it undertook a calculation designed to illustrate for Canada, the potential cancers saved each year compared to the actual lung cancer rate, with an estimate of the cost for each limit derived. A second calculation reviewed the cost of modifying the building code and estimated the long term effect by comparing avoided cancers and cost. The calculations are based on cross-Canada surveys, intensive long term investigation of smaller groups of homes and national housing statistics. The results are discussed and serve to illustrate development of the proposed policy.

Canada↗

PubMed2006

Assessing slope stability in unplanned settlements in developing countries.

Unplanned housing in developing countries is often located on steep slopes. Frequently no building code is enforced for such housing and mains water is provided with no drainage provision. Both of these factors can be particularly significant in terms of landslide risk if, as is so often the case, such slopes lack any planned drainage provision. There is thus a need to develop a model that facilitates the assessment of slope stability in an holistic context, incorporating a wide range of factors (including surface cover, soil water topographic convergence, slope loading and point source water leakage) in order that appropriate advice can be given as to the general controls on slope stability in such circumstances. This paper outlines a model configured for this specific purpose and describes an application to a site in St. Lucia, West Indies, where there is active slope movement in an unplanned housing development on relatively steep topography. The model findings are in accord with the nature of the current failure at the site, provide guidance as to the significance of slope drainage and correspond to inferences drawn from an application of resistance envelope methods to the site. In being able to scenario test a uniquely wide range of combinations of factors, the model structure is shown to be highly valuable in assessing dominant slope stability process controls in such complex environments.

Developing Countries↗

PubMed2001

Radiation performance index for Dutch dwellings: consequences for some typical situations.

This paper describes the new approach to control radiation exposure from natural sources to inhabitants of dwellings that is presently being considered in the Netherlands. The goal of this approach is to uphold the current rather favorable situation (average annual effective dose due to indoor radon and external radiation in dwellings is approx. 1 mSv). To achieve this goal a model is foreseen to predict the potential effective dose an inhabitant may receive from a dwelling on basis of its building plan. A scheme to calculate this dose is proposed in this paper. In future, such a scheme will be included in the Dutch Building Codes and houses to be built will be evaluated by using this scheme and comparing the results with, yet to be posed, limits to the potential effective dose.

Air Pollutants, Radioactive↗

PubMedDate not supplied

Disasters and development: Part 2: Understanding and exploiting disaster-development linkages.

This lesson is a continuation of Disasters and Development: Part 2: Understanding and Exploiting Disaster-Development Linkages published in Prehospital and Disaster Medicine in Volume 17, Number 3. It identifies the goals of a specific damage mitigation project that can be incorporated into a regular development project and the mechanisms for obtaining the mitigation component of such a project. Mechanisms for assessing the success of such a project are discussed. It stresses the importance of the application of building codes, associated training programs, and more extensive use of zoning regulations in urban development that decrease the population at risk and the likelihood of damage to industrial facilities. Disasters can elevate the development potential of a society at risk for damage from a hazard. The political impact of damage and disruption can be a catalyst for change. Development opportunities often are compromised because of an excessive focus on relief assistance. Interventions designed to mitigate the damage from a given hazard are particularly effective when they focus on areas at particularly high risk for actualization of the hazard. Support from the private sector, including the non-formal sector, is a key element of successful reconstruction management. The period of recovery is an opportunity for general assistance to government with administrative procedures, including enhanced management training programs.

Disaster Planning↗

PubMed1996

Initiation process of earthquakes and its implications for seismic hazard reduction strategy.

For the average citizen and the public, "earthquake prediction" means "short-term prediction," a prediction of a specific earthquake on a relatively short time scale. Such prediction must specify the time, place, and magnitude of the earthquake in question with sufficiently high reliability. For this type of prediction, one must rely on some short-term precursors. Examinations of strain changes just before large earthquakes suggest that consistent detection of such precursory strain changes cannot be expected. Other precursory phenomena such as foreshocks and nonseismological anomalies do not occur consistently either. Thus, reliable short-term prediction would be very difficult. Although short-term predictions with large uncertainties could be useful for some areas if their social and economic environments can tolerate false alarms, such predictions would be impractical for most modern industrialized cities. A strategy for effective seismic hazard reduction is to take full advantage of the recent technical advancements in seismology, computers, and communication. In highly industrialized communities, rapid earthquake information is critically important for emergency services agencies, utilities, communications, financial companies, and media to make quick reports and damage estimates and to determine where emergency response is most needed. Long-term forecast, or prognosis, of earthquakes is important for development of realistic building codes, retrofitting existing structures, and land-use planning, but the distinction between short-term and long-term predictions needs to be clearly communicated to the public to avoid misunderstanding.

Journal Article↗

PubMed2001

Demonstrating effectiveness of passive radon-resistant new construction.

Fifty percent of homes tested for radon in Rock Island County, IL, have radon levels above the U.S. Environmental Protection Agency (EPA) action guideline of 4 picoCuries per liter (pCi/L) of air. Therefore, the county is classified by the EPA as Zone 1 on the EPA's Map of Radon Potential. Radon-resistant new construction (RRNC) strategies for new homes are recommended by the EPA in Zone 1 areas. One city in the county, East Moline, reduced the cost of building permits for contractors volunteering to build new homes incorporating modified passive RRNC. Forty-six of 124 new homes built with passive RRNC in the city were tested during this study. Only 27 of the homes tested were below 4-pCi/L, justifying the importance of testing the system to ensure levels are below the action guideline. To provide additional support to an argument in favor of changing city building codes to the required RRNC, 23 of the homes were also tested with the systems deactivated. After systems were deactivated, 73% of the homes had radon levels above the action guideline. Four homes were sampled for bioaerosols to evaluate if passive RRNC might impact other indicators of poor indoor air quality (IAQ). The results of the research will be discussed here.

Air Pollutants, Radioactive↗

PubMed1991

Pediatric falls from heights.

Injuries resulting from falls from heights still constitute a significant portion of urban trauma. At this pediatric trauma center, 70 children were admitted from 1985 to 1988 after sustaining a fall of 10 feet or greater or at least one story. The mean patient age was 5 years and 68% of the patients were boys. Seventy-eight percent of falls occurred from 2 stories or less and usually took place at or near the home. Most patients sustained a single major injury and all survived. The majority of injuries involved the head or skeleton and residual functional deficits were uncommon. The incidence of falls from heights has remained high in urban areas despite public education and building codes that require window guards and safety rails.

Accidental Falls↗

PubMedDate not supplied

Planning for burn disasters: lessons learned from one hundred years of history.

The terrorist attacks of September 11th have prompted interest in developing plans to manage thousands of burn casualties. There is little actual experience in the United States in managing disasters of this magnitude. As an alternative, lessons may be learned from the historical experiences of previous civilian burn or fire disasters occurring in this country. A review of relevant medical, fire service, and popular literature pertaining to civilian burn or fire disasters occurring in the United States between the years 1900 and 2000 was performed. In the 20th century, 73 major U.S. fire or burn disasters have occurred. With each disaster prompting a strengthening of fire regulations or building codes, the number of fatalities per incident has steadily decreased. Detailed examination of several landmark fires demonstrated that casualty counts were great but that most victims had fatal injuries and died on the scene or within 24 hours. A second large cohort comprised the walking wounded, who required minimal outpatient treatment. Patients requiring inpatient burn care comprise a small percentage of the total casualty figure but consume enormous resources during hospitalization. Burn mass casualty incidents are uncommon. The number of casualties per incident decreased over time. In most fire disasters, the majority of victims either rapidly die or have minimal injuries and can be treated and released. As a result, most disasters produce fewer than 25 to 50 patients requiring inpatient burn care. This would be a rational point to begin burn center preparations for mass casualty incidents. A robust outpatient capability to manage the walking wounded is also desirable.

Burns↗

PubMed2002

Finding and fixing systems weaknesses: probabilistic methods and applications of engineering risk analysis.

Methods of engineering risk analysis are based on a functional analysis of systems and on the probabilities (generally Bayesian) of the events and random variables that affect their performances. These methods allow identification of a system's failure modes, computation of its probability of failure or performance deterioration per time unit or operation, and of the contribution of each component to the probabilities and consequences of failures. The model has been extended to include the human decisions and actions that affect components' performances, and the management factors that affect behaviors and can thus be root causes of system failures. By computing the risk with and without proposed measures, one can then set priorities among different risk management options under resource constraints. In this article, I present briefly the engineering risk analysis method, then several illustrations of risk computations that can be used to identify a system's weaknesses and the most cost-effective way to fix them. The first example concerns the heat shield of the space shuttle orbiter and shows the relative risk contribution of the tiles in different areas of the orbiter's surface. The second application is to patient risk in anesthesia and demonstrates how the engineering risk analysis method can be used in the medical domain to rank the benefits of risk mitigation measures, in that case, mostly organizational. The third application is a model of seismic risk analysis and mitigation, with application to the San Francisco Bay area for the assessment of the costs and benefits of different seismic provisions of building codes. In all three cases, some aspects of the results were not intuitively obvious. The probabilistic risk analysis (PRA) method allowed identifying system weaknesses and the most cost-effective way to fix them.

Journal Article↗

PubMed2002

Risk and uncertainty analysis in government safety decisions.

Probabilistic risk analysis (PRA) can be an effective tool to assess risks and uncertainties and to set priorities among safety policy options. Based on systems analysis and Bayesian probability, PRA has been applied to a wide range of cases, three of which are briefly presented here: the maintenance of the tiles of the space shuttle, the management of patient risk in anesthesia, and the choice of seismic provisions of building codes for the San Francisco Bay Area. In the quantification of a risk, a number of problems arise in the public sector where multiple stakeholders are involved. In this article, I describe different approaches to the treatments of uncertainties in risk analysis, their implications for risk ranking, and the role of risk analysis results in the context of a safety decision process. I also discuss the implications of adopting conservative hypotheses before proceeding to what is, in essence, a conditional uncertainty analysis, and I explore some implications of different levels of "conservatism" for the ranking of risk mitigation measures.

Journal Article↗

PubMed2005

Reduction potential of urban PM2.5 mortality risk using modern ventilation systems in buildings.

UNLABELLED: Urban PM2.5 (particulate matter with aerodynamic diameter smaller than 2.5 microm) is associated with excess mortality and other health effects. Stationary sources are regulated and considerable effort is being put into developing low-pollution vehicles and environment-friendly transportation systems. While waiting for technological breakthroughs in emission controls, the current work assesses the exposure reductions achievable by a complementary means: efficient filtration of supply air in buildings. For this purpose infiltration factors for buildings of different ages are quantified using Exposures of Adult Urban Populations in Europe Study (EXPOLIS) measurements of indoor and outdoor concentrations in a population-based probability sample of residential and occupational buildings in Helsinki, Finland. These are entered as inputs into an evaluated simulation model to compare exposures in the current scenario with an alternative scenario, where the distribution of ambient PM2.5 infiltration factors in all residential and occupational buildings are assumed to be similar to the subset of existing occupational buildings using supply air filters. In the alternative scenario exposures to ambient PM2.5 were reduced by 27%. Compared with source controls, a significant additional benefit is that infiltration affects particles from all outdoor sources. The large fraction of time spent indoors makes the reduction larger than what probably can be achieved by local transport policies or other emission controls in the near future. PRACTICAL IMPLICATIONS: It has been suggested that indoor concentrations of ambient particles and the associated health risks can be reduced by using mechanical ventilation systems with supply air filtering in buildings. The current work quantifies the effects of these concentration reductions on population exposures using population-based data from Helsinki and an exposure model. The estimated exposure reductions suggest that correctly defined building codes may reduce annual premature mortality by hundreds in Finland and by tens of thousands in the developed world altogether.

Adult↗

PubMed2005

Association between ventilation rates in 390 Swedish homes and allergic symptoms in children.

UNLABELLED: The aim of the study was to test the hypothesis that a low-ventilation rate in homes is associated with an increased prevalence of asthma and allergic symptoms among children. A total of 198 cases (with at least two of three symptoms: wheezing, rhinitis, eczema) and 202 healthy controls, living in 390 homes, were examined by physicians. Ventilation rates were measured by a passive tracer gas method, and inspections were carried out in the homes. About 60% of the multi-family houses and about 80% of the single-family houses did not fulfill the minimum requirement regarding ventilation rate in the Swedish building code (0.5 air changes per hour, ach). Cases had significantly lower ventilation rates than controls and a dose-response relationship was indicated. PRACTICAL IMPLICATIONS: A low-ventilation rate of homes may be a risk factor for allergies among children. Families with allergic children should be given the advice to have good ventilation in the home. In investigations, of associations between environmental factors and allergies, the air change rate in homes has to be considered.

Asthma↗

PubMed2000

Disaster management. U.S. policies pertaining to weather and climate extremes.

Climate and weather extremes--floods, drought, storms, severe weather--now have an impact on all levels of government and on the insurance industry. U.S. national policy has moved from structural approaches (building dams, levees, and irrigation ditches) to societal approaches: moving people out of hazardous areas, seeking improvements in building codes, and encouraging the use of crop and flood insurance. Federal relief assistance policies have been called into question, and renewed emphasis on personal responsibility is part of future policy.

Climate↗

PubMed1979

The architectural design of a psychotherapeutic milieu.

The physical environment of a treatment program affects patient outcome, but how and to what degree is not known. However, decisions about the design of the environment must be made, and they must be made in the face of cost and building-code constraints and widely varying patient characteristics and treatment models. The authors describe the design principles and philosophies they followed in the remodeling of an in-patient treatment and research service in a university psychiatric hospital and indicate where cost and code constraints resulted in a less than ideal solution. They point out that many apparent amenities, such as a ward kitchen, are significant milieu therapy resources, and they advocate the involvement of all levels of staff in the planning process.

Adolescent↗

PubMed2001

The potential impacts of climate variability and change on health impacts of extreme weather events in the United States.

Extreme weather events such as precipitation extremes and severe storms cause hundreds of deaths and injuries annually in the United States. Climate change may alter the frequency, timing, intensity, and duration of these events. Increases in heavy precipitation have occurred over the past century. Future climate scenarios show likely increases in the frequency of extreme precipitation events, including precipitation during hurricanes, raising the risk of floods. Frequencies of tornadoes and hurricanes cannot reliably be projected. Injury and death are the direct health impacts most often associated with natural disasters. Secondary effects, mediated by changes in ecologic systems and public health infrastructure, also occur. The health impacts of extreme weather events hinge on the vulnerabilities and recovery capacities of the natural environment and the local population. Relevant variables include building codes, warning systems, disaster policies, evacuation plans, and relief efforts. There are many federal, state, and local government agencies and nongovernmental organizations involved in planning for and responding to natural disasters in the United States. Future research on health impacts of extreme weather events should focus on improving climate models to project any trends in regional extreme events and as a result improve public health preparedness and mitigation. Epidemiologic studies of health effects beyond the direct impacts of disaster will provide a more accurate measure of the full health impacts and will assist in planning and resource allocation.

Climate↗

PubMed2003

Tools and approaches for the construction of knowledge models from the neuroscientific literature.

Within this paper, we describe a neuroinformatics project (called "NeuroScholar," http://www.neuroscholar.org/) that enables researchers to examine, manage, manipulate, and use the information contained within the published neuroscientific literature. The project is built within a multi-level, multi-component framework constructed with the use of software engineering methods that themselves provide code-building functionality for neuroinformaticians. We describe the different software layers of the system. First, we present a hypothetical usage scenario illustrating how NeuroScholar permits users to address large-scale questions in a way that would otherwise be impossible. We do this by applying NeuroScholar to a "real-world" neuroscience question: How is stress-related information processed in the brain? We then explain how the overall design of NeuroScholar enables the system to work and illustrate different components of the user interface. We then describe the knowledge management strategy we use to store interpretations. Finally, we describe the software engineering framework we have devised (called the "View-Primitive-Data Model framework," [VPDMf]) to provide an open-source, accelerated software development environment for the project. We believe that NeuroScholar will be useful to experimental neuroscientists by helping them interact with the primary neuroscientific literature in a meaningful way, and to neuroinformaticians by providing them with useful, affordable software engineering tools.

Artificial Intelligence↗