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Geographic Factors (geographic + factor)
Selected AbstractsSo You Want to Be a Dermasurgeon: How to Get Training or Choose a FellowshipDERMATOLOGIC SURGERY, Issue 9 2006MURAD ALAM MD BACKGROUND There are many routes to obtaining training in dermasurgery. OBJECTIVE The objective is to discuss some considerations that may guide selection of dermasurgery training. METHODS Current training options are reviewed. RESULTS Some considerations that may guide selection of type of dermasurgery training include: (1) individual temperament; (2) the subtype of dermasurgery in which training is desired (Mohs, cosmetic surgery, laser); (3) family and geographic factors; (4) preference for private practice versus academic career; and (5) proportion of future practice to be devoted to dermasurgery. CONCLUSIONS There are a growing number of training choices for budding dermasurgeons, with multiple options available for each set of particular circumstances. [source] Photosensitivity in Relation to Epileptic Syndromes: A Survey from an Epilepsy Center in JapanEPILEPSIA, Issue 3 2001Hideaki Shiraishi Summary: ,Purpose: We examined the incidence and distribution of photosensitivity among the different age groups and different types of epilepsies and epileptic syndromes. Furthermore, we considered the influence of ethnic and geographic factors on the incidence of photoparoxysmal response (PPR) in epilepsy patients. Methods: We analyzed the responses to intermittent photic stimulation (IPS) by using a Grass PS22 or PS33 photic stimulator for in 2,187 unselected patients with epilepsy who were treated in our center. Results: The classic PPR was elicited in 37 (1.7%) patients. The mean age of these 37 patients was 17.0 years. The subpopulation of patients having PPR included 2.0% of all patients with symptomatic generalized epilepsy, 5.6% (p < 0.01) of those with idiopathic generalized epilepsy, 0.7% of those with symptomatic localization-related epilepsy, and 2.9% of those with undetermined epilepsy. PPR accounted for 17.4 % (p < 0.01) of the patients with juvenile myoclonic epilepsy, 7.6% (p < 0.01) of those with grand mal on awakening, and 6.1% (p < 0.01) of those with symptomatic occipital lobe epilepsy. The incidence of PPR increased in patients up to age 15 years, and suddenly decreased after age 20 years. Conclusion: The present study presents the first report from eastern Asia, analyzing the incidence of PPR with a restricted definition comparable to the other studies, and the rate of PPR was relatively low compared with the studies performed in the European countries. We could confirm the clear relation between age and positive PPR. [source] Spatial distribution of cloud coverINTERNATIONAL JOURNAL OF SATELLITE COMMUNICATIONS AND NETWORKING, Issue 2 2008Pedro Garcia Abstract Satellite systems and high-altitude platform systems working in Ka and V bands require the application of adaptive techniques in order to mitigate link degradations caused by atmospheric impairments such as those due to cloud cover. Among these techniques, resource sharing system techniques and site diversity need information on the spatial distribution of impairments caused by cloud cover, including the probability of simultaneous occurrence of adverse conditions in various regions. A study has been performed in Spain, within the framework of COST Action 280, to investigate the large-scale spatial distribution of cloud cover using synoptic meteorological data. Cloud cover distribution for individual sites and the spatial correlation properties for pairs of sites have been investigated. The geographical distributions of the values obtained from the statistical analysis have been represented in maps of contour lines using standard mapping procedures. Correlation parameters are expected to decrease with distance; however, the maps derived taking a given site as reference reveal a significant influence of climatic and geographic factors such as weather fronts, orography or the proximity to the sea. The statistics and maps obtained can be useful to optimize power sharing in multi-beam satellite systems, as suggested in this paper. Copyright © 2008 John Wiley & Sons, Ltd. [source] Factors Associated with Iowa Rural Hospitals' Decision to Convert to Critical Access Hospital StatusTHE JOURNAL OF RURAL HEALTH, Issue 1 2009Pengxiang Li PhD ABSTRACT:,Context: The Balanced Budget Act (BBA) of 1997 allowed some rural hospitals meeting certain requirements to convert to Critical Access Hospitals (CAHs) and changed their Medicare reimbursement from prospective to cost-based. Some subsequent CAH-related laws reduced restrictions and increased payments, and the number of CAHs grew rapidly. Purpose: To examine factors related to hospitals' decisions to convert and time to CAH conversion. Methods: Eighty-nine rural hospitals in Iowa were characterized and observed from 1998 to 2005. Cox proportional hazards models were used to identify the determinants of time to CAH conversion. Findings: T-test and one-covariate Cox regression indicated that, in 1998, Iowa rural hospitals with more staffed beds, discharges, and acute inpatient days, higher operating margin, lower skilled swing bed days relative to acute days, and located in relatively high density counties were more likely to convert later or not convert before 2006. Multiple Cox regression with baseline covariates indicated that lower number of discharges and average length of stay (ALOS) were significant after controlling all other covariates. Conclusion: Iowa rural hospitals' decisions regarding CAH conversion were influenced by hospital size, financial condition, skilled swing bed days relative to acute days, length of stay, proportion of Medicare acute days, and geographic factors. Although financial concerns are often cited in surveys as the main reason for conversion, lower number of discharges and ALOS are the most prominent factors affecting rural hospitals' decision on when to convert. [source] Kidney and Pancreas Transplantation in the United States, 1999,2008: The Changing Face of Living DonationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 4p2 2010D. A. Axelrod The waiting list for kidney transplantation continued to grow between 1999 and 2008, from 41 177 to 76 089 candidates. However, active candidates represented the minority of this increase (36 951,50 624, a 37% change), while inactive candidates increased over 500% (4226,25 465). There were 5966 living donor (LD) and 10 551 deceased donor (DD) kidney transplants performed in 2008. The total number of pancreas transplants peaked at 1484 in 2004 and has declined to 1273. Although the number of LD transplants increased by 26% from 1999 to 2008, the total number peaked in 2004 at 6647 before declining 10% by 2008. The rate of LD transplantation continues to vary significantly as a function of demographic and geographic factors, including waiting time for DD transplant. Posttransplant survival remains excellent, and there appears to be greater use of induction agents and reduced use of corticosteroids in LD recipients. Significant changes occurred in the pediatric population, with a dramatic reduction in the use of LD organs after passage of the Share 35 rule. Many strategies have been adopted to reverse the decline in LD transplant rates for all age groups, including expansion of kidney paired donation, adoption of laparoscopic donor nephrectomy and use of incompatible LD. [source] WHEN IS A SERVICE AN ESSENTIAL PUBLIC SERVICE?ANNALS OF PUBLIC AND COOPERATIVE ECONOMICS, Issue 4 2009Steven Van De Walle ABSTRACT,:,Citizens consider certain public (and private) services as essential services and therefore to be shielded from the full extent of market forces. Little is known about why some services are considered essential public services while other sometimes very similar services are not. In this article, we analyze public opinion using Eurobarometer data to test models exploring what factors determine whether citizens in 15 EU countries consider certain services as essential services and therefore to be provided to all. Despite the variety in public opinion, political orientations and geographic factors do little to explain why citizens have different opinions about the provision of public services. The article ends by outlining a research agenda for the further analysis of this underexplored research topic. [source] Factors associated with surgical options for breast carcinoma,CANCER, Issue 7 2006Anees B. Chagpar M.D., M.Sc. Abstract BACKGROUND Breast conservation surgery (BCS) and mastectomy have equivalent survival outcomes for women with breast carcinoma, but treatment decisions are affected by many factors. The current study evaluated the impact of patient and physician factors on surgical decision-making. METHODS Statistical analyses were performed on a prospective multicenter study of patients with invasive breast carcinoma. Patient, physician, and geographic factors were considered. RESULTS Of 4086 patients, BCS was performed in 2762 (67.6%) and mastectomy was performed in 1324 (32.4%). The median tumor size was 1.5 cm (range, < 0.1,9.0 cm) in patients undergoing BCS and 1.9 cm (range, 0.1,11.0 cm) in patients undergoing mastectomy (P < 0.00001). The median age of patients undergoing BCS was 59 years (range, 27,100 yrs), whereas patients who underwent mastectomy were older (median age of 63 yrs, range, 27,96 yrs [P < 0.00001]). Physicians in academic practices performed more lumpectomies than those who were not in an academic practice (70.9% vs. 65.7%; P = 0.001). More breast conservation procedures were performed by surgeons with a higher percentage of breast practice (P = 0.012). Geographic location was found to be significant, with the Northeast having the highest rate of breast conservation (70.8%) and the Southeast having the lowest (63.2%; P = 0.002). On multivariate analysis, patient age (odds ratio [OR]: 1.455; 95% confidence interval [95% CI], 1.247,1.699 [P < 0.001]), tumor size (P < 0.001), tumor palpability (OR: 0.613; 95% CI, 0.524,0.716 [P < 0.001]), histologic subtype (P = 0.018), tumor location in the breast (P < 0.001), physician academic affiliation (OR: 1.193; 95% CI: 1.021,1.393 [P = 0.026]), and geographic location (P = 0.045) were found to be significant. CONCLUSIONS Treatment decisions were found to be related to patient clinicopathologic features, surgeon academic affiliation, and geographic location. Future studies will elucidate the communication and psychosocial factors that may influence patient decision-making. Cancer 2006. © 2006 American Cancer Society. [source] Declining Antibiotic Prescriptions for Upper Respiratory Infections, 1993,2004ACADEMIC EMERGENCY MEDICINE, Issue 4 2007Stefan G. Vanderweil BA Abstract Objectives: To examine antibiotic prescribing trends for U.S. emergency department (ED) visits with upper respiratory tract infections (URIs) between 1993 and 2004. Methods: Data were compiled from the National Hospital Ambulatory Medical Care Survey (NHAMCS). URI visits were identified by using ICD-9-CM code 465.9, whereas antibiotics were identified using the National Drug Code Directory class Antimicrobials. A multivariate logistic regression model revealed sociodemographic and geographic factors that were independently associated with receipt of an antibiotic prescription for URIs. Results: There were approximately 23.4 million ED visits diagnosed as URIs between 1993 and 2004. Although the proportion of URI diagnoses remained relatively stable (p trend = 0.26), a significant decrease in provision of antibiotic prescriptions for URIs occurred during this 12-year period, from a maximum of 55% in 1993, to a minimum of 35% in 2004. Patients who were prescribed antibiotics were more likely to be white than African American and to have been treated in EDs located in the southern United States. Conclusions: Antibiotic prescribing for URIs continues to decrease, a favorable trend that suggests that national efforts to reduce inappropriate antibiotic usage are having some success. Nevertheless, the frequency of antibiotic treatment for URI in the ED remains high (35%). Future efforts to reduce inappropriate antibiotic prescribing may focus on patients and physicians in southern U.S. EDs. Additional work is needed to address continued evidence of race-related disparities in care. [source] | ||||||||||