Geographical Challenges Research Articles

Access to integrated community case management of childhood illnesses services in rural Ethiopia: a qualitative study of the perspectives and experiences of caregivers.

Background: In 2010, Ethiopia began scaling up the integrated community case management (iCCM) of childhood illness strategy throughout the country allowing health extension workers (HEWs) to treat children in rural health posts. After 2 years of iCCM scale up, utilization of HEWs remains low. Little is known about factors related to the use of health services in this setting. This research aimed to elicit perceptions and experiences of caregivers to better understand reasons for low utilization of iCCM services.Methods: A rapid ethnographic assessment was conducted in eight rural health post catchment areas in two zones: Jimma and West Hararghe. In total, 16 focus group discussions and 78 in-depth interviews were completed with mothers, fathers, HEWs and community health volunteers.Results: In spite of the HEW being a core component of iCCM, we found that the lack of availability of HEWs at the health post was one of the most common barriers to the utilization of iCCM services mentioned by caregivers. Financial and geographic challenges continue to influence caregiver decisions despite extension of free child health services in communities. Acceptability of HEWs was often low due to a perceived lack of sensitivity of HEWs and concerns about medicines given at the health post. Social networks acted both to facilitate and hinder use of HEWs. Many mothers stated a preference for using the health post, but some were unable to do so due to objections or alternative care-seeking preferences of gatekeepers, often mothers-in-law and husbands.Conclusion: Caregivers in Ethiopia face many challenges in using HEWs at the health post, potentially resulting in low demand for iCCM services. Efforts to minimize barriers to care seeking and to improve demand should be incorporated into the iCCM strategy in order to achieve reductions in child mortality and promote equity in access and child health outcomes.

Cultural, geographical and clinical challenges of working with eating disorders in South Auckland

The Eating Disorders Service in South Auckland has been running in its current clinical capacity since January 2014. It is a tertiary referral service offering a service to adults and young people across the CMDHB area. There are multiple challenges in offering a service across a culturally diverse; geographically widespread area as well as the recognised difficulties encountered engaging and treating this clinical group. The challenges specific to NZ such as staff recruitment, training, supervision and support for staff and promoting knowledge of the condition amongst clinicians are also present; alongside the specific nature of the presentations seen in generic services. This talk will aim to present the cultural challenge to offer an appropriate and respectful service to Maori, Pacific as well as other groups (eg Chinese, European, Indian). It will discuss the implications of offering a service to a large catchment area with pockets of high deprivation, rural areas and also those of high socio economic standing. Clinically the service works via multiple interfaces. The specifics of our service will be presented along with details of our clinical population, treatments offered and outcomes. The challenge of workforce recruitment, retention and CPD will also be discussed, along with ideas for further development of this exciting service.

Evaluating Architectural Design Decision Paradigms in Global Software Development

Global software development (GSD) is considered as the coordinated activities of software development that are geographically and temporally distributed. The management of architectural knowledge, specifically, architectural design decisions (ADDs), becomes important in GSD due to the geographical, temporal, and cultural challenges in global environments. Based on our previous work on ADD management in localized software development, we present five ADD paradigms for GSD projects with different organizational structures. We also investigate the benefits and the challenges of these ADD paradigms by conducting an evaluation of the paradigms using extensive archived semi-structured interview data from industrial GSD projects. We aim to provide a fundamental framework for managing ADD documentation and evolution in GSD, as well as offer useful insights into managing architectural knowledge in a global setting.

Geographic Connections: Language, Power Relations, and Relevance

AbstractThe interrogation of language is crucial in all sub‐fields of geography and in related disciplines. This paper interrogates the terms nature, environment, sustainability, and resilience, given their importance in connecting geography with other academic pursuits and with people and organisations that make our discipline relevant. The paper explores how geography may be seen as ‘relevant’ while maintaining a constructively critical approach. It does so through the example of Sydney's metropolitan strategy/plan that was released in December 2014. The concept of resilience as defined and used in this new metropolitan plan fails to address transboundary issues such as climate change, raising concerns about sustainability. As such it serves the needs of political interests aligned with a growth agenda. This is one example highlighting that a challenge for many geographers is to maintain critical thinking while being relevant. It is an important challenge that geographers should relish.

Association Between Orthopaedic Outpatient Satisfaction and Non-Modifiable Patient Factors.

Increasingly, patient satisfaction surveys are being utilized to evaluate hospital and physician performance. Despite this, little is known about factors associated with patient satisfaction. The objective of this study was to determine whether selected non-modifiable patient characteristics are associated with outpatient satisfaction scores. We reviewed patient satisfaction scores from 12,177 outpatient clinical encounters at an academic orthopaedic outpatient clinic between December 2010 and October 2013. Any adult patient who completed at least one patient satisfaction survey at any point during the study period was included in this study. Factors including age, sex, employment status, type of health insurance, zip code, and orthopaedic subspecialty were recorded. Patients were divided into more satisfied and less satisfied groups, and generalized estimating equation logistic regression analysis was performed to identify factors predictive of lower patient satisfaction. Age was found to be strongly associated with patient satisfaction, with younger patients reporting less satisfaction; the adjusted odds ratio for the patient age of eighteen to twenty-nine years compared with the patient age of eighty years or older was 2.78 (95% confidence interval, 1.74 to 3.82) (p < 0.001). This relationship was maintained in a predictive model across all age groups, both sexes, all travel distances, and all orthopaedic subspecialties. Travel distance was also associated with patient satisfaction, with patients who live closer reporting less satisfaction compared with patients who live farther away; the adjusted odds ratio for a distance of less than fifty miles compared with a distance of fifty miles or more was 1.18 (95% confidence interval, 1.03 to 1.33) (p = 0.016). The finding that non-modifiable patient factors such as age and geographic location affect patient satisfaction challenges the utility of comparing patient satisfaction between populations that differ significantly with regard to such characteristics. A more complete knowledge of the factors that influence patient satisfaction may enable better insight into the interpretation of current patient satisfaction metrics and may allow physicians and hospitals to improve their delivery of care.

Providing Rural Care, Remotely: Avera’s eCare Initiative

Providing Rural Care, Remotely: Avera’s eCare Initiative

Evaluating the learning outcomes of an international field trip in postgraduate lighting design courses

Lighting industry professionals work in an international marketplace and encounter a range of social, geographical and cultural challenges associated with this. Education in lighting should introduce students to aspects of these challenges. To achieve this, an international field trip was recently undertaken that sought to provide an authentic learning experience for students. Twelve Masters of Lighting students from two Australian universities took part in a field trip to Shanghai, China and surrounding areas. The goal was to offer students insight into practical issues in the lighting industry at an international level and to do so in a unique and authentic context. To evaluate the outcomes of the trip, each participant was surveyed afterwards. Benefits were identified in terms of: increased knowledge and insight into manufacturing issues in lighting, experiential learning in lighting design practice not available locally (e.g, master planning), increased understanding of cultural influences in design and enhancing professional contacts within the lighting industry. Field trips may also act as an inverted curriculum experience for new students to engage them and promote learning within a professional context.

'Blended’ Learning at the University of the Highlands and Islands: a Case Study in Self-Awareness and Policy Making

The University of the Highlands and Islands (UHI) provides a case study on reflective practices in blended learning at an institution that is overcoming unusual geographic and demographic pedagogical challenges. These practices may be of value to other institutions, from those employing ‘traditional’ delivery, to the latest technologically supported, asynchronous teaching methodology.This paper has developed from the outputs of a project conducted within UHI to collate recent pedagogical research, both external and internal, in order to identify goals for future pedagogical development within the institution. We thus examine the evolution of UHI’s blended learning practice as a case study in the adoption and refinement of blended learning in a higher education institution with a specific geographical context. We will highlight some examples of how UHI has sought to characterise its own delivery, measure success, and translate this into effective strategy and policy across the institution.

The devil in the detail: interpreting livelihood turbulence from a 25‐year panel study from Thailand

Tracking and explaining patterns and trajectories of social and economic change in the global South is a key challenge for geographers. Panel studies, though rare, offer a particularly rich alternative insight to more usual cross‐sectional studies. Drawing on a 25‐year longitudinal panel study of two villages in rural Thailand, this paper reveals the complexities of the processes underway, the shifting terrains of explanation, and the surprises that are easily overlooked in cross‐sectional studies, particularly when it comes to household life chances and courses. The paper makes a case for the value of such approaches and the insights they can provide.

Comparability, diagnostic validity and completeness of Nigerian cancer registries

BackgroundLike many countries in Africa, Nigeria is improving the quality and coverage of its cancer surveillance. This work is essential to address this growing category of chronic diseases, but is made difficult by economic, geographic and other challenges. PurposeTo evaluate the completeness, comparability and diagnostic validity of Nigeria's cancer registries. MethodsCompleteness was measured using children's age-specific incidence (ASI) and an established metric based on a modified Poisson distribution with regional comparisons. We used a registry questionnaire as well as percentages of death-certificate-only cases, morphologically verified cases, and case registration errors to examine comparability and diagnostic validity. ResultsAmong the children's results, we found that over half of all cancers were non-Hodgkin lymphoma. There was also evidence of incompleteness. Considering the regional completeness comparisons, we found potential evidence of cancer-specific general incompleteness as well as what appears to be incompleteness due to inability to diagnose specific cancers. We found that registration was generally comparable, with some exceptions. Since autopsies are not common across Nigeria, coding for both them and death-certificate-only cases was also rare. With one exception, registries in our study had high rates of morphological verification of female breast, cervical and prostate cancers. ConclusionsNigeria's registration procedures were generally comparable to each other and to international standards, and we found high rates of morphological verification, suggesting high diagnostic validity. There was, however, evidence of incompleteness.

Telemedicine: Transforming Community Long-Term Care

Telemedicine: Transforming Community Long-Term Care

Personal Jurisdiction on the Internet: A Global Perspective

Personal jurisdiction refers to a court's authority to bring a defendant to trial, which is traditionally based on the residency of that defendant. However, the Internet has created geographic challenges for defining personal jurisdiction because transactions in cyberspace are not necessarily geographically based. This creates a unique set of global and international legal challenges which must be addressed.

Building Organizational Culture through Social Media: New Understandings

Research supports the importance of co-curricular activities for traditionally aged college students; however, a growing percentage of students who are completing their undergraduate degrees do not fall into the 18-22 year old age-range. They are students, a term used to describe those who are in college over the age of 25. Often they are working adults, many who are raising families and engaged in career and community pursuits. This looks at one university that received a call to action from their nontraditional students, who actively advocated to be part of a campus community, for many of the same reasons that traditional students articulate as valuable. It follows the dialogue between these students and the faculty administrators who sought to meet those needs as the gap between what students felt that they wanted and what they actually used was revealed, with social media a major tool utilized to bridge that gap. The approach to understanding these needs is grounded in participatory inquiry that uses an interpretive approach to reveal new understandings through conversation. Through this process, students and faculty administrators examine their past and imagine new possible ways of being in community both through on-ground and virtual worlds. The results show an increased sense of community, which builds a cohesive organizational culture and a broader common understanding of mission and purpose. This study has implications both for institutions working with nontraditional students and for other organizations that seek to build community when faced with geographical, temporal, or schedule challenges.

Parks in Al Ain, UAE: Geographical Distribution, Opportunities, and Challenges

Parks in Al Ain city, UAE, face two problems: water and spatial distribution. Water consumption is increasing dramatically in the city as a result of increased population and the activities of agriculture and industry. Maintaining parks and saving water in an arid environment is a challenging task. This study examines water consumption by parks and the use of remote sensing to estimate it. Green areas in parks were calculated from remote-sensing images, and the areas were correlated with water consumption. The study also investigates the spatial distribution of parks in Al Ain in relation to population (equity), and demonstrates the use of GIS as an analytical tool and the value of remote sensing in assessing the pattern of relative household income of residents near the parks. Three evaluation indicators were used: number of cars, size of houses, and occurrence of home gardens. The appearance of home gardens on a large scale is considered a new phenomenon in Al Ain and reflects social and economic change...

Delays in Transfer of Elderly Less-injured Trauma Patients Can Have Deadly Consequences

Transfer of severely injured patients to regional trauma centers is often expedited; however, transfer of less-injured, older patients may not evoke the same urgency. We examined referring hospitals' length of stay (LOS) and compared the subsequent outcomes in less-injured transfer patients (TP) with patients presenting directly (DP) to the trauma center. We reviewed the medical records of less-injured (Injury Severity Score [ISS] 9 or less), older (age older than 60 years) patients transferred to a regional Level 1 trauma center to determine the referring facility LOS, demographics, and injury information. Outcomes of the TP were then compared with similarly injured DP using local trauma registry data. In 2011, there were 1657 transfers; the referring facility LOS averaged greater than 3 hours. In the less-injured patients (ISS 9 or less), the average referring facility LOS was 3 hours 20 minutes compared with 2 hours 24 minutes in more severely injured patients (ISS 25 or greater, P < 0.05). The mortality was significantly lower in the DP patients (5.8% TP vs 2.6% DP, P = 0.035). Delays in transfer of less-injured, older trauma patients can result in poor outcomes including increased mortality. Geographic challenges do not allow for every patient to be transported directly to a trauma center. As a result, we propose further outreach efforts to identify potential causes for delay and to promote compliance with regional referral guidelines.

The experience of community first responders in co-producing rural health care: in the liminal gap between citizen and professional.

BackgroundThe involvement of community first responders (CFRs) in medical emergencies in Scotland, and particularly in remote and rural areas, has expanded rapidly in recent years in response to geographical and organisational challenges of emergency medical service access. In 2013 there were over 120 active or developing schemes in a wide variety of settings. Community first responders are volunteers trained in First Person on the Scene (FPOS) first aid, administered prior to the arrival of an ambulance. Although there is limited literature which describes the role of first response, little academic literature has been published about the complexities of their specific role in both the community and organisational contexts.MethodsHere we reflect on data from two mixed-methods studies into the role of CFRs in Scotland.ResultsWe highlight findings that explore the liminal and complex role of the first responder as both ‘practitioner’ and community member, and how this contributes to a sense of communitas within the study areas. The rural context encompasses additional complexity in relation to the role of emergency care volunteer, having the highest levels of volunteering and this paper questions assumptions that rural areas, are more accepting of volunteerism.ConclusionsComplexities arising from the experience of blurred voluntary/practitioner boundaries emerge as a key feature of voluntary participation in medical emergencies in this setting.

Cultural Ecosystem Services and the Challenge for Cultural Geography

AbstractCultural ecosystem services are one of four services identified by the Millennium Ecosystem Assessment as critical to the support of human life on earth and therefore in need of proper valuation and protection. Cultural services seem to embody the objects of enquiry for cultural geographers interested in landscape, identity and place. However, potentially insurmountable epistemological challenges face the participation of cultural geographers in the following: (i) the identification and evaluation of CES; and (ii) the operationalisation of environmental governance. One challenge for cultural geographers is to make the relevance of their theoretical and conceptual insights felt in a field dominated by the natural sciences and scientific epistemologies. Meanwhile, the problems of defining and identifying cultural services in ways that make them compatible with provision, regulating and supporting services, even threaten the continued inclusion of cultural services in the ecosystem services approach. The concept of landscape seems to provide a shared intellectual terrain over which cultural geographers can work with others interested in cultural ecosystem services.

Results of a Stand-Alone PCI Program at Schneider Regional Medical Center

Percutaneous coronary intervention (PCI) is a class I recommended therapy for both ST segment elevation myocardial infarction (STEMI) and unstable angina. Traditionally, PCI has been performed in large tertiary centers with on-site coronary bypass surgery programs. Over the past 10 to 15 years, “stand-alone” PCI programs have become more prevalent, particularly in the United States. Geographic, cultural, and financial challenges prohibit routine transfer to tertiary centers in a timely fashion. This article discusses the PCI program at Schneider Regional Medical Center.

Policy Development and Implementation for Disability Services in Rural New South Wales, Australia

AbstractThroughout their lives, all people, including those who have a disability, use a broad range of community services. Community services are important in assisting people with a range of impairments to participate in their communities. Vast geographic distances and a lack of therapists in rural and remote regions of Australia pose significant barriers for implementing policy aimed at supporting people with a disability. The aim of this study was to investigate the extent to which metropolitan‐formulated policy encompassed the unique geographic, demographic, and sociocultural challenges experienced by rural therapists and people with a disability in New South Wales (NSW). Twenty‐seven policy documents were reviewed and categorized into tier 1 (higher level strategic policies) and tier 2 (specific operational policies). Tier 1 policy documents provided consistent messages about the need to develop strategies and service delivery options to address geographic, cultural, and age‐related barriers facing all people in NSW including those who have a disability. Tier 2 documents revealed a lack of attention to the practical differences between implementing the policy principles in metropolitan compared with rural areas. Study findings identify that the implementation of metropolitan‐formulated policy does not always encompass the unique challenges experienced by therapists providing services to rural people with a disability and their carers. This study highlights the importance of “rural proofing” policy to consider people who live and work in rural areas.

Environmental Governance at the Core of Statecraft: Unresolved Questions and Inbuilt Tensions

AbstractThe state is not only a main environmental player, but its involvement in environmental regulation has major consequences for the dynamics of statecraft. Environmental governance is the expression that better summarises the ongoing transformations of state interventions and the search for more flexible, adaptive approaches. A growing body of scholarly work has tried to establish the connections between the failures of environmental governance and the wider commitments of the state. What is largely missing in those studies is the synergy between environmental governance and the statecraft model put forward by Hegel in the early period of the industrial, liberal capitalism. Recent environmental policies have been particularly influenced by the Hegelian constitutional theory, especially considering the pursuit of legitimacy and flexibility. Consequently, the central challenge for geographers and other scholars of environmental governance is still to identify the changes in the rationale and configuration of the state apparatus and relate them to the wider political ecology of state action.