Metropolitan Public Research Articles

Adherence to clinical practice guidelines for South Australian pregnant women with cardiac conditions between 2003 and 2013

For pregnant women with a known cardiac condition or those who develop cardiac disease during pregnancy, there is an increased risk of complications during pregnancy, to both mother and foetus. To reduce this risk, best practice guidelines have been developed and available in South Australia for several years. Measuring clinical practice against the guideline recommendations verifies real-life practice and an essential part of any clinical practice quality improvement project by identifying gaps. This study is the first report on adherence to statewide perinatal guidelines for these women in South Australia. To evaluate adherence to evidence-based clinical practice perinatal guidelinesTo identify predictors of adherence.Make comparisons across three practice settings examined. A retrospective cross-sectional observational design that analysed data from medical records. Three SA Health public metropolitan, university-affiliated teaching hospitals with an obstetric service within a ten-year timeframe (2003-2013). 271 admissions of women who were categorised as 'pre-existent' or 'newly acquired' cardiac condition during their pregnancy. Adherence to guidelines was measured using a purposefully designed scoring system across the three sites. The researcher chose a minimum acceptable score of 17 applicable to the 'newly acquired' group and 35 for the 'pre-existent' group. Overall adherence to the perinatal guidelines for the combined groups (n = 271) reported a mean score of 16.3, SD ± 6.7, with a median score of 17. Women in the 'newly acquired' group scored less compared to women in the 'pre-existent' group (Estimate -2.3, CI -3.9,-0.7). Variance in adherence was observed across the three hospitals (P value <0.0001). The most significant predictor of adherence to guidelines was pre-pregnancy cardiac consultation which increased the likelihood of preconception care by Odds ratio 18.5 (95%, CI 2, 168). Similarly, compliance with mental health screening was associated with improved adherence to antenatal assessments (OR: 11.3(95% CI 4.7, 27.3). There was overall suboptimal adherence to the statewide guidelines for women with cardiac conditions in pregnancy. The variance in the level of adherence across the three hospitals correlated with the exposure to higher acuity cases, and that appropriate up- referral to a higher acuity hospital was intrinsically linked to better adherence. Recommendations include preconception counselling, and to ensure that all health practitioners have the skills, sufficient training and time to complete a comprehensive initial antenatal assessment. ACTRN12617000417381.

Factors associated with adverse outcomes during influenza outbreaks in aged care facilities

ObjectiveTo explore factors associated with adverse outcomes during influenza outbreaks in residential aged care facilities. MethodsA retrospective cohort study of all outbreaks reported to three Sydney metropolitan Public Health Units during 2017. ResultsA total of 123 outbreaks affected 1,787 residents and 543 staff. Early notification to a Public Health Unit was associated with shorter outbreak duration (p<0.001; B=0.674). Resident attack rates and resident mortality rates were lower in outbreaks notified early, on univariate analysis (p=0.034 and p=0.048 respectively) but not on an adjusted model. Staff attack rates were significantly associated with resident attack rates (p=0.001; B=0.736). Data on staff vaccination rates was incomplete and reported coverage rates were low (median 39%). Resident vaccination coverage ≥95% was associated with shorter outbreak duration in univariate testing but not on an adjusted model. ConclusionsEarly public health notification is associated with improved outbreak parameters; sick staff may pose a risk to residents, yet vaccination rates are low. Resident vaccination may also be valuable. Implications for public healthMeasures that facilitate early PHU involvement in influenza outbreaks should be implemented, such as compulsory reporting requirements and processes that permit easier notification through technology. Actions that enhance staff and resident vaccination coverage should also be undertaken.

The Governance of Metropolitan Public Transport in Mexico City

The Governance of Metropolitan Public Transport in Mexico City

Il MSNA, tra diritti consolidati e nascenti esigenze di tutela. Il punto di vista di un ufficio Tutele Metropolitano

The Italian Juvenile Law guarantees protection to unaccompanied foreign minors, which is a child coming from non-EU countries without parents. This phenomenon, in recent years, concerns the migratory flows of refugees, who arrive from Turkey or Libya to the coasts of Italy; the journey is often dramatic and sometimes it requires to pass through other European countries. The EU Regulation - Dublin III, which entered into force on 1 January 2014, points at the competence of the EU State in which the minors arrived at first; further transfers, except the need to be reunited with family members in other EU States, are not significant for the European law. The current system of granting refugee or other forms of international protection is based on this fundamental principle. The protection of unaccompanied foreign minors in Italy is achieved through a form of "multidisciplinary" support; the legal data is only one component. In addition, there are social and educational projects as well as protection for health; the need of an effective integration is perceived. Together with the social intervention, a legal public representative, the Guardian, is appointed for unaccompanied minor. The competence belongs to the Municipality in which the minor is found or where, following a first reception, will be transferred on the basis of a regional territorial assignment, within the national system of Italian reception for refugee minors, called "SIPROIMI". The legal Guardian’s role is to guarantee children’s rights and an adequate assistance. It’s a very thorny topic in the Metropolitan Area of Bologna, which has more than a million inhabitants; all the local offices created a "Public Metropolitan Protection Office" with the aims to manage these aspects. Promoting the function of these public offices confers the role of a “third party” in the protection of the children with the assistance of social and health services.

Assessing the Seamlessness of Bangkok Metropolitan Public Transport by using Modified Quantitative Gap Analysis

A sustainable transportation system requires a larger contribution to public transport share in comparison to private transport. Bangkok Metropolitan, the study area, exhibits a significant transport modal alteration trend towards public transport, in line with the expansion of Bangkok Transit System (BTS) and Mass Rapid Transit (MRT) for more coverage within the metropolis along main roads along with expansion of public bus routes, which increases the seamlessness and reduces transit time. This study is important as we believe that the higher seamlessness the more urban travelers would shift to using public transport modes. This matter is considered as a pertinent urban transport problem. This study aims at understanding the level of transit seamlessness of the Bangkok public transport system. The study was carried out by firstly measuring six factors of the regular transit process, on formal and informal transport modes used by Bangkokians. These six factors were observed along the origin and the destination of the travelers with respect to travel time, number of transit points, average transit time, comfort, and transit facilities including facilities for disables, and walking distance. A total number of 300 public transport users were selected as respondents, 50 respondents for each selected transit hub. The selection was based on convenient random sampling considering the variability of destinations and purpose of travel. Despite a different destination, the residence was set as the origin. By using Modified Quantitative Gap Analysis, based on six selected transit hubs, the study found that the seamlessness of the inter-modal transits in Bangkok exhibits a characteristics of hard transit process, particularly for disabled people, notwithstanding the continuous efforts to make the seamless transit are in place, particularly with respect to infrastructure facilities.

Student Success, Research Preeminence, and Unintended Consequences at Public Metropolitan Research Universities

This article extends a line of research on intentional change at public metropolitan research universities that aims to improve undergraduate student success (as measured by graduation and retention rates) while improving access (as measured by Pell and minority rates). Some of the issues that have emerged from this line of research involve the dynamics of various competing goals, such as (a) student success and student access and (b) student success with access and research preeminence. This article uses performance data to examine the challenges of improving success with access and research preeminence, simultaneously, at public metropolitan research universities. A case study offers an illustration of the challenges and clarifies the unintended consequences.

The Combined SIRS + qSOFA (qSIRS) Score is More Accurate Than qSOFA Alone in Predicting Mortality in Patients with Surgical Sepsis in an LMIC Emergency Department.

qSOFA has been proposed as a prognostic tool in patients with sepsis. This study set out to assess the sensitivity of several scores, namely: the pre-ICU qSOFA, the qSOFA with lactate (qSOFA L), SIRS score, qSOFA + SIRS score (qSIRS) and qSIRS with lactate (qSIRS L) in predicting in-hospital mortality in patients with surgical sepsis as well as the sensitivity of these scores in predicting high-grade sepsis. The secondary aim was to determine which of these scores is best suited to predict high-grade surgical sepsis. This was a retrospective cohort study that was conducted between December 2012 and August 2017 in a public metropolitan surgical service. Data from patients aged >13 years, who were admitted to the hospital and who had an emergency surgical procedure for source control were retrieved from a prospectively maintained hybrid electronic database. The qSOFA, qSOFA plus lactate (qSOFA L), SIRS and qSOFA + SIRS (qSIRS), as well as the qSIRS plus lactate (qSIRS L), were calculated for each patient. A lactate level that was greater than 2mmol/L was deemed to be a positive finding. Any score ≥2 was deemed to be a positive score. The outcome measure was in-hospital mortality. The prognostic value of qSOFA, qSOFA L, SIRS, qSIRS and qSIRS L was studied. Receiver operating characteristic analyses were performed to determine the area under the curve (AUC), sensitivity, specificity and positive and negative likelihood ratios for positive qSOFA, qSOFA L, SIRS, qSIRS, and qSIRS L. Contingency tables were used to calculate the sensitivity, specificity, PPV and NPV for predicting severe or high-grade surgical sepsis. There were a total number of 1884 patients in the sample group of whom 855 were female (45.4%). The median patient age was 36 years (IQR 23-56). A total of 1489 patients (79%) were deemed to have high-grade sepsis based on an advanced EGS AAST grading, whilst 395 patients (21%) had low-grade sepsis. A total of 71 patients died (3.8%). Of these patients who died, 67 (94.4%) had high-grade sepsis and 4 (5.6%) had low-grade sepsis. The mortality rate in the high-grade sepsis group was 4.5%, whilst the mortality rate in the low-grade sepsis group was 1%. The scores with the greatest accuracy in predicting mortality were qSIRS (AUROC 0.731, 95% CI 0.68-0.78), followed by SIRS (AUROC 0.70, 95% CI 0.65-0.75). The qSOFA and qSOFA L were the least accurate in predicting mortality (AUROC 0.684, 95% CI 0.63-0.74 for both). The addition of lactate had no significant effect on the accuracy of the five scores in predicting mortality. Patients with a qSOFA ≥ 2 have an increased risk of dying (OR 5.8), as do patients with a SIRS score ≥2 (OR 2.7). qSIRS L had the highest sensitivity (69%) in predicting the presence of high-grade surgical sepsis, followed by qSIRS (65.5% sensitivity). qSOFA showed a very low sensitivity of only 4.5% and a high specificity of 99.2%. The addition of lactate to the score marginally improved the sensitivity. Lactate of 2mmol/L or more was also an independent predictor of high-grade sepsis. The qSIRS score is most accurate in predicting mortality in surgical sepsis. The qSOFA score is inferior to both the SIRS and the qSIRS scores in predicting mortality. The qSIRS score with the addition of lactate to the qSIRS score made it the most sensitive score in predicting high-grade surgical sepsis.

Economic and non-economic effects of the mismatch between one's job and field of study: evidence from the implementation of an institutional follow-up survey of graduates

Misalignment between a worker's field of study and job has received much attention in the literature (Robst, 2007). Research shows that workers employed in areas unrelated to their fields of study earn lower salaries than those with the same level of education yet employed in positions related to their education. This paper estimates the educational mismatch's effect on wages and analyses its implications on job satisfaction, through analyzing data gleamed from a survey of a public metropolitan university's graduates, applied over the period of 2014-2017. The study seeks to answer the following: How does working outside of one's degree field affect earnings and job satisfaction? Which characteristics of educational and work pathways explain the misalignment between the field of study and type of employment? This study shows that those who are employed in positions unrelated to their areas of study earn less and enjoy less job satisfaction than those whose work is aligned with their field of study. Likewise, effects on job satisfaction are more pronounced three years after graduation, particularly for men with business and administration degrees compared to technology graduates, given lower expectations for professional development in their current positions.

Alignment through Community

The University of Central Oklahoma (UCO) is a public metropolitan university that has developed a highly collaborative relationship with the Greater Oklahoma City Hispanic Chamber of Commerce (HC). This partnership unites several UCO divisions and the HC in support of a set of shared goals, articulated in UCO’s “Vision 2020” strategic planning document and in the HC’s seven community development priorities, which include business development, cultural and environmental stewardship, workforce development, and education. To facilitate these partnerships, UCO’s Division of Academic Affairs has reorganized its administrative structure to create an Office of Global and Cultural Competencies, which includes a Director of Cultural Outreach and Diversity Strategies, who serves as on-site liaison to the HC; the Division of Academic Affairs also has representation on the HC Board of Directors. These shared efforts provide a means for securing extramural funding, internships, and new leadership programs that will sustain the partnership and affect a growing demographic and economic segment of Oklahoma City. Within the university, this partnership complements the diversity and inclusion initiatives of UCO’s Division of Student Affairs and promotes the legislative and economic initiatives led by UCO’s Division of Public Affairs. This article addresses the often-unrecognized role that a university’s academic mission plays in anchoring community partnerships, and it contributes to best practices in fulfilling an institutional commitment to serve diverse, metropolitan populations.

Trends in Conservative Management for Low-risk Prostate Cancer in a Population-based Cohort of Australian Men Diagnosed Between 2009 and 2016

Conservative management, specifically with active surveillance (AS), has emerged as the preferred approach for low-risk prostate cancer (LRPC). We evaluated the trend for conservative management (ie, no active treatment within 12mo of diagnosis) for LRPC in an Australian population-based cohort of men captured in the Prostate Cancer Outcomes Registry Victoria (PCOR-Vic). Of the 3201 men diagnosed with LRPC between January 2009 and December 2016, 60% (1928/3201) had conservative management, and 52% (1664/3201) were documented to be on AS. There was an increase in conservative management from 52% in 2009 to 73% in 2016 (p<0.001), largely attributable to an increase in AS from 33% in 2009 to 67% in 2016 (p<0.001). When stratified by age group, the increase in conservative management was more pronounced among younger patients: from 37% to 66% for men aged <60yr versus from 72% to 86% for men aged ≥70yr. In multivariable analyses, increasing age, lower prostate-specific antigen and clinical category, lower socioeconomic status, and being diagnosed in public metropolitan institutions were all independently associated with a greater likelihood of conservative management. Identification of sociodemographic and institutional variations in practice allows for targeted strategies to improve management for men with LRPC. Patient summaryWe looked at the uptake of conservative management (no active treatment within 12 mo of diagnosis) over time in an Australian population-based cohort of men with low-risk prostate cancer. The proportion of men with low-risk prostate cancer managed conservatively increased from 52% in 2009 to 73% in 2016. The increase in the uptake of conservative management for low-risk prostate cancer in Australia is concordant with international guidelines and other international population-based studies.

LGBTQIA-R: Creating a Diverse and Inclusive Medical Collection at a Public Metropolitan University

Information about the LGBTQIA population is difficult to collect because of the sensitive nature of the topic of sexual preference and gender identity. This paper examines our weeding project and collection development efforts to provide health care information for the LGBTQIA community at a Midwestern metropolitan university. The findings conclude that our collection was not providing sufficient, up-to-date health information for the personal and professional information needs of our patrons in the R-RZ Library of Congress range. The weeding process, strategies for working with department faculty, and the implications for an intersectional medical collection are discussed.

Is There a Change in Electroconvulsive Therapy Practice Following the New Mental Health Act 2014 in Victoria?: A Study at a Metropolitan Mental Health Service.

The main objective of our study was to examine whether there has been any change to electroconvulsive therapy (ECT) practice since the new Mental Health Act 2014 (MHA) in a public metropolitan mental health service in Victoria. This retrospective study examined any change in ECT rate following the new MHA. We compared sociodemographic, clinical, and ECT-related variables for patients treated before (July 1, 2013, and June 30, 2014) and after (1st July 2014 and the 30th June 2015) the new MHA. A reduction of 11.15% in ECT use per 1000 admissions and 16.4% in ECT use per 100,000 persons was observed subsequent to the new MHA. Hospital legal status at admission positively predicted the chance of starting ECT treatment under involuntary consent. Hospital legal status at admission and discharge, history of involuntary ECT, and final Clinical Global Impression-Severity scores positively predicted, but the year of treatment negatively predicted the chance of completing ECT treatment under involuntary consent. The new MHA appeared to have been associated with reduced ECT use and lower rate of completing ECT under involuntary consent.

Evolving and Enduring Patterns Surrounding Student Usage and Perceptions of Academic Library Reference Services

This descriptive study analyzes results from an 18-item survey which assessed students’ usage and perceptions of library reference services at a comprehensive public metropolitan university. Among 235 surveys completed between November 2016 and January 2017, the majority of respondents represented the “Generation Z” population of college students, 18 to 24 years of age. Quantitative and qualitative findings revealed patterns of reference service usage, perceptions of librarians, and barriers and facilitators to seeking help from a librarian. These findings can inform decision-making to improve marketing and outreach to students regarding general reference services, reference models, and liaison roles.

Performance Perspectives on Undergraduate Student Success at Public Metropolitan Research Universities

This study is part of a line of research that focuses on intentional, large-scale, and effective change in complex, dynamical, organizational systems. This research utilizes the behavior analytic perspective of organizational behavior management and connects multiple levels of analysis ranging from individual learning to cultural evolution. This study examined a national sample of public metropolitan research universities (N = 35) regarding their performance in sustained improvement in undergraduate student success with simultaneous improvement in access. The specific objective of the study was to examine university performance from a variety of perspectives, such as Excellence (variable sum) and Improvement (variable change). Data from the Integrated Postsecondary Educational Data System were analyzed over a nine year period, 2008–2016. This study built on an earlier case study of Florida International University, a public metropolitan research university. The objective of the study reported here was to select candidates for future case studies within this same line of research.

Changes of Time-Distance Accessibility by Year and Day in the Integrated Seoul Metropolitan Public Transportation Network

Changes of Time-Distance Accessibility by Year and Day in the Integrated Seoul Metropolitan Public Transportation Network

The urgency of new quantitative public open space standards in London

The new National Planning Policies Framework (NPPF 2012) in England, requires local authorities to carry out a detailed assessment regarding open space (OS) and to propose new quantitative and qualitative OS standards, based on the new needs of local communities. In particular, the paper examines if and how the new quantitative OS standard (Ha/1.000 pop.) is researched in the 32+1 London Boroughs Open Space Strategies (OSS) and Local Plans (Local Development Frameworks, LDF) (2002–2018). The experimentation with the new quantitative OS standard at local level faces a number of challenges, problems and contradictions. A non-compulsory quantitative standard, in several cases, justifies the reduction in quantity of the Public Green Belt and Metropolitan Open Land. This makes urgent the need to reaffirm the importance of the quantitative component in order to ensure the POS endowment. Based on content analysis of local plans and interviews, this study identifies and discusses local concerns and proposals. Some local authorities propose a minimum reduced quantitative POS standard, equal for all, that could be integrated at the local level by a quota of POS variable in relation to the diverse qualitative requests of the local communities. On this specific topic, London Boroughs’ experience in the current phase of implementation, can offer interesting solutions and remark of general interest.

How soon do allied health professionals lose confidence to perform EBP activities? A cross-sectional study.

To explore if there is a relationship between allied health professionals' confidence to perform a range of evidence-based practice (EBP) activities and the time since they graduated from their entry-level degree and the presence of postgraduate qualifications. Cross-sectional survey. Allied health professionals from two Australian public metropolitan health services, including acute, subacute, and community settings. Sample of 288 (n=288) allied health professionals from the disciplines of physiotherapy, occupational therapy, speech pathology, social work, dietetics/nutrition, and other. Cross-sectional survey including 12 questions measuring respondents' confidence to conduct a range of EBP activities. Allied health professionals begin to lose confidence related to EBP activities within the first 5years of clinical practice, particularly for those activities involving critical analysis of published studies. Respondents with postgraduate qualifications were more likely to report greater confidence with EBP activities, suggesting that higher level qualifications protect against the effect of degradation of EBP skills and confidence over time. Allied health professionals' confidence to perform EBP activities degrades over time, particularly for those individuals with no postgraduate qualifications. Registration and accreditation bodies along with allied health professional employers should explore potential strategies to preserve and enhance EBP skills, confidence, and behaviours.

Evaluation and Implementation of a Telepsychiatry Trial in the Emergency Department of a Metropolitan Public Hospital

ABSTRACTTelepsychiatry via video conferencing is not new to mental health but has been expanding at a rapid rate over recent years. Initially it was introduced for treatment in remote and rural communities, but it is now being utilized in larger health settings due to increasing patient demand and cost-effectiveness. Emergency departments are becoming increasingly burdened, as the workforce cannot keep pace with the rising demand of patient mental health needs. While telepsychiatry has been shown to have treatment efficacy, research is still relatively new, especially within the emergency department context.

Implementation and evaluation of a community-based interprofessional learning activity

ABSTRACTImplementation of large-scale, meaningful interprofessional learning activities for pre-licensure students has significant barriers and requires novel approaches to ensure success. To accomplish this goal, faculty at Case Western Reserve University, Ohio, USA, used the Ottawa Model of Research Use (OMRU) framework to create, improve, and sustain a community-based interprofessional learning activity for large numbers of medical students (N = 177) and nursing students (N = 154). The model guided the process and included identification of context-specific barriers and facilitators, continual monitoring and improvement using data, and evaluation of student learning outcomes as well as programme outcomes. First year Case Western Reserve University medical students and undergraduate nursing students participated in team-structured prevention screening clinics in the Cleveland Metropolitan Public School District. Identification of barriers and facilitators assisted with overcoming logistic and scheduling issues, large class size, differing ages and skill levels of students and creating sustainability. Continual monitoring led to three distinct phases of improvement and resulted in the creation of an authentic team structure, role clarification, and relevance for students. Evaluation of student learning included both qualitative and quantitative methods, resulting in statistically significant findings and qualitative themes of learner outcomes. The OMRU implementation model provided a useful framework for successful implementation resulting in a sustainable interprofessional learning activity.

문화예술기관 법인화에 따른 전속 예술단체의 구조 및 운영체제 연구

전속 예술단체는 수준 높은 공연예술을 경제적 부담의 최소화로 국민에 대한 문화예술 보급과 진흥을 목적으 로 창단되었고, 우리나라의 문화예술 기반 구축에(활성화･대중화) 주도적 역할을 하고 있다. 그러나 최근 문화예 술기관 법인화에 따른 전속 예술단체 운영에 대한 다양한 방법적 논의가 사회문제로 확대되고 있다. 이는 재정지 원 대비 성과 측면의 실효성 부진을 이유로 정부와 지자체가 시장경제논리의 경쟁력 제고를 위한 문화예술에 경 영합리화(법인화)를 강요하면서부터이다. 문제는 시설과 전속 예술단체의 조직 및 운영체제에 대한 명확한 대처 와 방안 없이 법인화의 향방에 따라 이들의 존폐 여부가 결정되고 있어 논란이 확대되고 있는 것이다. 특히 실질 적 공연예술 활성화 및 대중화 주체인 전속단체에 대한 논의가 부각되지 못하고 있어, 각 지역을 대표하는 전속 예술단체의 기능과 역할, 나아가 생존에 대한 위기감으로 문제의 심각성이 더해지고 있다. 따라서 본 연구에서는 공연예술기관 법인화에 있어 그간 공연예술기반 구축과 정착에 기여한 전속 예술단체를 지속적인 지역 문화 보 호와 창의적 공연 제작 및 보급 주체로서의 활용 방안을 제시는 데 목적을 두고자 하며, 또한 문제 발생의 원인 규명으로는 법과 제도, 규정에 대한 요인 분석과 각각의 광역권 공연예술기관의 운영체제와 종속적 관계의 전속 예술단체 운영 등에 대한 현황 분석으로 결과를 도출하여 공연예술기관과 전속 예술단체에 대한 ‘법인 체제의(시 설 전담) 전속 예술단체(운영주체) 병합 운영 체제’와 ‘전속 예술단체 중심의 사무국 체제’를 문제해결 및 발전방 안으로 제안하였다.