Individual Residents Research Articles

New York State Climate Impacts Assessment Chapter 01: Introduction.

New York State's climate is changing. Temperatures are rising, precipitation is increasing, sea levels are rising, and extreme weather events are becoming more frequent and severe. Over time, these changes are projected to worsen. The New York State Climate Impacts Assessment provides a science-based analysis of what to expect from climate change in New York. Working with partners across the state, the team assembled to produce this assessment reviewed the latest science and modeling to project and characterize what New York State's climate is likely to look like in the future and how this will affect natural systems, society, and various sectors of the economy. The assessment will enable decision-makers at all levels-from individual residents, businesses, and landowners to municipal and state government agencies-to better understand and make informed choices about how to plan and prepare for climate change.

Comparison of Income Tax and Tax Reliefs According to Income Tax Laws and Regulations for Individual Residents in Indonesia and Singapore

This study focuses on a comparative analysis of income tax laws and regulations and tax reliefs in Indonesia and Singapore, employing a normative legal approach. It reveals that Singapore's tax reliefs, reflecting the government’s shared values, address diverse family needs, including elderly care, child development, health, and housing. Conversely, Indonesia provides tax reliefs through non-taxable income to support families. Despite Indonesia’s well-structured tax system, the government should address challenges, including inflation and external constraints, impacting public purchasing power and contributing to a high-cost economy.

Beyond the requirement: A novel patient follow‐up report

AbstractBackgroundResidents are required to participate in practice‐based learning and improvement. Most commonly, a resident‐initiated patient follow‐up log is used to meet the requirement. We sought to provide residents with follow‐up information in an efficient, value‐added manner via a patient follow‐up report (PFUR).MethodsThe PFUR is an automated monthly report sent to individual residents via email. It was generated from the electronic medical record and included five categories of cases: patients who were discharged and returned for admission within 72 h, diagnosis‐based criteria, patients who expired during the hospital stay, patients who were admitted to or upgraded to the intensive care unit (ICU) within 24 h of admission, and patients independently flagged by the care team for follow‐up. The PFURs were analyzed for 6 months after implementation for number and categorization of cases included as well as via survey of the residents.ResultsIn 6 months, 1078 patients, generating 1155 follow‐ups, were included on the PFUR. ICU upgrades were the most represented category (41%), followed by diagnosis‐based criteria (30%). Patients who were discharged and admitted within 72 h were least commonly represented on the PFUR (2%). Seventy‐eight percent of residents felt that patient follow‐ups were valuable to their education and 82% felt that the PFUR impacted the clinical care they provided. The PFUR was preferred by 90% of resident respondents and had an average value rating of 4.38 out of 5.ConclusionsOverall numbers of patient follow‐ups significantly increased after implementation of the PFUR. Certain categories were more represented overall and within each class, which has implications for future educational initiatives. After a pilot period, the novel PFUR appears to be more efficient, accessible, and highly valued than the log used previously. Programs looking to maximize the educational benefits of patient follow‐ups may consider a similar initiative.

Digitalisation, neighbourhood change and urban social processes: Conceptual framework and introduction to the Special Issue

Neighbourhoods are salient for many dimensions of individuals’ social and economic well-being, yet the impacts of rapidly emerging digital information and communication technologies (DICTs) on neighbourhoods and the social processes within them are understudied. This gap motivates this Special Issue, the themes of which we introduce here. We provide an overarching conceptual framework within which the topics, conceptualisations and empirical results of the 11 constituent research papers can be placed. Our framework posits multiple, mutually causal interrelationships between each element in the triad of neighbourhoods, individual residents’ characteristics and individual residents’ actions. In each element we focus on the role(s) of DICTs and their interplay with social processes. These technologies alter traditional housing search patterns, sometimes reinforcing existing segregation, but they also present opportunities for greater access to information and potential social integration. The issue’s 11 research papers, contributed by scholars from various global contexts, explore diverse aspects of these themes. They examine how DICTs mediate neighbourhood change by influencing local housing choices, amplifying or mitigating neighbourhood stigma and transforming social cohesion. By offering a rich empirical and conceptual exploration, this special issue aims to deepen our understanding of the transformative role that DICTs play in neighbourhoods, urging further research into their implications for neighbourhood change and urban social processes.

Sistem Pendukung Keputusan Pemilihan Kayu Dalam Konstruksi Atas Rumah Dengan Aspek Kualitas Dan Keberlanjutan Menggunakan Metode Weighted Sum Model Studi Kasus Pada CV Persada Sejahtera Kabupaten Ponorogo

House constuction is one of the main aspects of infrastructure development in various parts of the world. A house is not only a residence for individuals and families, but also reflects environmental sustainability and the cultural values of the local community. Therefore, selecting the right construction materials is crucial in ensuring the success of an efficient and sustainable home building project. The aim of this research is to design and build a decision support system for wood selection in the construction of house structures with quality and sustainability aspects using the Weighted Sum Model method. The decision support system using the Weighted Sum Model method was chosen because in its solution the ranking results of the WSM method are objective, so that it can provide fairness in decision making and can provide better results than conventional methods. The results of testing the DSS application using Black Box Testing, based on this test, the results obtained were as expected and valid. In this research, the user role is only for admin, for future researchers it can be developed by adding roles for users such as roles for company owners.

Taxation of foreign trusts in Greece /Tax incentives for the transfer of residence of individuals to Greece

Abstract The present overview provides a summary of the Greek tax regime applicable to foreign trusts. Up until 2017, the taxation of foreign trusts was largely left unregulated in the Greek tax system, which can be attributed to the fact that trusts, being a common-law concept, are not recognized by Greek legislation. Despite the uncertainties, foreign trusts were often used as structures for wealth management or estate planning. The guidelines provided in 2017 were thus eagerly awaited to provide clarity on a matter that was left unregulated for decades and can therefore only be considered as a very positive development. Nevertheless, certain aspects raise concern. This overview also summarizes the Greek Tax Incentive Regimes, which have been met with great demand from foreign residents seeking to transfer their (tax) residence to Greece.

The use and usefulness of the Peninsula Health Falls Risk Assessment Tool (PHFRAT) process in residential aged care: a mixed methods study across 25 aged care facilities

BackgroundFalls remain a persistent problem in residential aged care (RAC) facilities. Fall screening and assessment tools such as the Peninsula Health Falls Risk Assessment Tool (PHFRAT) are widely used to inform falls risk and guide fall prevention interventions. However, it is unclear how it is used in practice and whether clinicians believe it supports resident care. This study aimed to measure the extent of use of PHFRAT to understand clinicians’ perceptions of its value and usefulness.MethodsThis mixed method study involved an analysis of PHFRAT assessment from 25 RAC facilities in New South Wales, Australia, and interviews with seven RAC staff about how PHFRAT information is used in practice. In the quantitative component, descriptive statistics were applied to PHFRAT data to summarise how RAC staff use the PHFRAT including the completeness and content of the three parts. In the qualitative component, thematic analysis techniques were applied to interview data.ResultsThe sample included 215 RAC residents with 703 PHFRATs, of which 617 documented fall prevention interventions. Among these 617 PHFRATs, 593 (96.1%) included strategies related to staff assistance and 283 (45.9%) recorded strategies related to device provision. While nearly all residents (96.74%) received at least one PHFRAT assessment over the study period, many PHFRAT assessments were incomplete (part 1: 11.5% of information missing; part 2: 10.8%; part 3: 17.1%). There were few variations in fall interventions prescribed to individual residents by their fall risk level. Interviews with RAC staff indicated that PHFRAT assessments are the responsibility of registered nurses with limited input from other staff or residents. While the structured process was viewed positively in guiding risk assessment and intervention assessment, a lack of input from others prevented strategies from being tailored to residents’ specific needs and preferences. A shortage of resources, lack of communication, and limited staff education were identified as the main barriers to PHFRAT guideline implementation.ConclusionThe PHFRAT provides a useful structure for clinicians to assess falls risk factors and plan falls prevention strategies. In the future, increased multidisciplinary input into fall prevention strategy development may improve the comprehensiveness of fall prevention plans.

Association Between Modifiable Structural and Process Factors and the Quality Indicator Pain in Nursing Home Residents: A MultiCentre Cross-Sectional Survey.

The aim of this study is to examine the association between modifiable structural and process factors and self-reported as well as observed pain in Swiss residential long-term care residents. Sub-study of a multicentre cross-sectional survey. Institution, unit, and staff data were collected from September 2018 to October 2019 in 118 residential long-term care institutions in Switzerland's German- and French-speaking regions using paper questionnaires. Resident data were exported during the same period from routine data sets. In this study, 6213 residents from 86 residential long-term care institutions were included. Modifiable structural factors such as institutions having access to geriatricians, nursing experts and a palliative care team, the presence of a pain guideline on the unit and good teamwork among care workers were associated to less pain in residents. It is possible for residential long-term care institutions to improve pain in residents and to optimise the quality of care by providing access to geriatricians, nursing experts and a palliative care team, working with a pain guideline and fostering teamwork. Residential long-term care institutions can modify and implement modifiable structural factors which can reduce pain in residents to optimise residents' quality of life and quality of care. Improved pain management in residential long-term care institutions can lead to optimised quality of care and quality of life for individual residents. STROBE checklist. No patient or public contribution.

To Achieve Carbon Neutrality, What Do Individual Residents Say? A Case Study of Yunnan Province of China Based on Spatial Analysis

This study aims to explore factors that affect individual residents’ behaviors contributing to reducing carbon emissions (low-carbon behaviors), based on the empirical analysis of the choice of adoption and the extent of adoption of low-carbon practices, such as using low-carbon transportation and energy-saving, in Kunming, China. We use spatial econometric regression models to consider positive spillover of low-carbon behaviors amongst residents as people tend to obtain knowledge and learn good actions from those located nearby. The results show the existence of positive spillover effects of low-carbon behaviors across several types of low-carbon practices. We find that location effects, such as access to parks, residents’ knowledge of carbon neutrality, and science communications in the local community are the most important determinants of residents’ low-carbon behaviors. The findings may provide insights into designing supporting policies to incentivize residents’ low-carbon behaviors and contribute to the pathway toward carbon neutrality from the micro-perspective.

Clinical characteristics, treatment, and outcomes for elderly patients in a dedicated Covid-19 ward at a primary health care facility in western Norway: a retrospective observational study

BackgroundThe coronavirus pandemic has hit the oldest and frailest individuals hard, particularly patients and residents in nursing homes. In March 2020, we established a Covid-19 ward at a nursing home in Bergen, western Norway for elderly patients with Sars-CoV-2 infection and in the need of treatment and care in a primary health care facility. The aims of this study were to describe the organization of the ward, the clinical outcomes of infection, treatment, mortality rates in the population, the level of advanced care planning, and end-of-life care for those who died.MethodsWe present patient characteristics, outcomes, vaccination status, treatment, decisions regarding treatment intensity upon clinical deterioration, and mortality for the patients in the ward. Clinical factors possibly related to a fatal outcome were analysed with chi square test (categorical variables) or t-test (continuous variables).Results257 patients were included from March 2020 to April 2022. Fifty-nine patients (23.0%) developed respiratory failure. Ten patients (3.9%) were admitted to hospital. Advance care planning was undertaken for 245 (95.3%) of the patients. 30-day mortality rate decreased from 42 to 4% during the study period. Of the 29 (11.3%) patients who died, all were well alleviated in the terminal phase, and 26 (89.7%) of them had a Clinical Frailty Scale (CFS) value ≥ 7. A high score for CFS, respiratory failure and respiratory co-infection were significantly associated with Covid-19 related death within 30 days.ConclusionsCovid-19-related mortality markedly decreased during the study period, and a high score for CFS was related to a fatal outcome. Thorough planning of treatment intensity upon deterioration, low hospitalization rates, and good relief for those who died suggest that dedicated Covid-19 wards in nursing homes can provide good treatment for the patients and relieve other nursing homes and specialist health care services.

Interannual homing to reproductive sites and transboundary migration in black seabream Spondyliosoma cantharus, with implications for management

Abstract Fish spawning aggregations are vulnerable to overexploitation, which can have severe ecological, social, and economic consequences. Knowledge on the spatial ecology of aggregating species is often lacking, but is crucial for their effective conservation. This study explores the spawning site residency, interannual fidelity, and migration of black seabream Spondyliosoma cantharus using acoustic (n = 55) and conventional (n = 2397) tagging within and outside Marine Conservation Zones in the southern UK. Detections and recaptures of tagged fish indicated that black seabream display significant interannual fidelity to nesting areas, but that residency of individuals at nesting areas was short relative to current temporal management of these areas. Locations of detection and recapture during autumn/winter indicated migration by black seabream into deeper waters of the English Channel and coastal waters of France and the Channel Islands. The results indicate spatial structuring of black seabream populations maintained by homing of adults to previously occupied sites. However, short residency periods within protected reproductive sites, and evidence of transboundary migrations emphasize the importance of effective fisheries management, i.e. collaborative between European nations. These findings highlight the importance of international-scale telemetry studies and networks for informing ecosystem-based fisheries management of sensitive migratory species.

Understanding herpes zoster vaccine hesitancy and information asymmetry: a qualitative study in China.

Herpes zoster is more prevalent among the older adult due to the age-related immune decline, leading to significant pain and complications. Although vaccination effectively prevents viral infections, vaccine hesitancy remains a major barrier to achieving high vaccination rates.To address this, we conducted a qualitative survey using Vaccine Hesitancy Determinants Matrix and 5C model to understand and improve vaccination rates in this group. Descriptive qualitative research design based on the philosophical underpinnings of naturalistic inquiry and purposive sampling methodology was conducted on adults aged 50 and above, as well as community health workers. Data were collected through semi-structured, in-depth personal interviews. The interview outline was constructed following a comprehensive review of the literature and consideration of the theoretical framework. Seventeen adults over 50 years and four community healthcare workers were included in this study. The study found that information asymmetry in immunization planning was evident at all stages of vaccine supply, dissemination and demand. The main manifestations included limited access to authoritative information, insufficient community awareness of herpes zoster as a route of vaccination, insufficient vocational training, significant gaps in vaccine knowledge, and high levels of complacency among individual residents. Herpes zoster vaccine hesitancy is prevalent among middle-aged and older adults in China due to information asymmetry, vaccine complacency, inadequate community services, and other multiple layers of factors. Public health strategies should aim to reduce cognitive biases and information gaps by disseminating diverse and credible vaccine information through social media, medical institutions, and offline channels to promote higher vaccination rates.

Modeling the relationship between living in informal dwellings and fear of crime in Gauteng Province, South Africa

ABSTRACT Information from the fifth wave of the Quality-of-Life Survey conducted by the Gauteng City-Region Observatory was used in this paper to investigate the relationship between living in informal dwellings and fear of crime. This examination is based on existing theories, including victimization/vulnerability, neighborhood disorder, and diffuse anxiety theories. Given the prominence of informal dwellings in most urban areas in South Africa, including Gauteng Province, this study examines whether living in informal dwellings determines fear of crime or feelings of unsafety. Multilevel cumulative logistic models were therefore estimated to account for similarities between individuals in the same wards while at the same time modeling for differences between wards. The results indicate that an individual residing in an informal dwelling is less likely to feel safe than one who resides in a formal dwelling in Gauteng Province. By focusing on informal dwellings as the predictor of interest, the present paper attempts to extend the panoply of predictors that can be used in empirical research when testing the above-mentioned theories.

Toward precision medical education: Characterizing individual residents' clinical experiences throughout training.

Despite the central role of experiential learning in residency training, the actual clinical experiences residents participate in are not well characterized. A better understanding of the type, volume, and variation in residents' clinical experiences is essential to support precision medical education strategies. We sought to characterize the entirety of the clinical experiences had by individual internal medicine residents throughout their time in training. We evaluated the clinical experiences of medicine residents (n = 51) who completed training at NYU Grossman School of Medicine's Brooklyn campus between 2020 and 2023. Residents' inpatient and outpatient experiences were identified using notes written, orders placed, and care team sign-ins; principal ICD-10 codes for each encounter were converted into medical content categories using a previously described crosswalk tool. Of 152,426 clinical encounters with available ICD-10 codes, 132,284 were mapped to medical content categories (94.5% capture). Residents' clinical experiences were particularly enriched in infectious and cardiovascular disease; most had very little exposure to allergy, dermatology, oncology, or rheumatology. Some trainees saw twice as many cases in a given content area as did others. There was little concordance between actual frequency of clinical experience and expected content frequency on the ABIM certification exam. Individual residents' clinical experiences in training vary widely, both in number and in type. Characterizing these experiences paves the way for exploration of the relationships between clinical exposure and educational outcomes, and for the implementation of precision education strategies that could fill residents' experiential gaps and complement strengths with targeted educational interventions.

“What Is Your Primary Language?”: Spatial Considerations of Primary Language Identification in a Multilingual Rural Region

In small-scale multilingual societies, an individual uses a large number of languages and usually identifies one of them as the primary language. Although empirically observable, primary language has been significantly underexplored, particularly the spatiality of its identification. It is not clear whether and how place is related to why one language might be seen as being more significant than other languages. This study predicts the primary language used by multilingual individuals in an indigenous rural region of Cameroon based on two types of place: the residence of multilingual individuals and the birthplace of their family members. The research goals are supported by a random forest model using spatial-sociolinguistic data of the region. Results show that primary language can be predicted at a high accuracy. The residence of multilingual individuals and the birthplace of their family members capture the spatiality behind primary language identification. This work adds to the current discussion of the space–language connection and is valuable for maintaining the endangered languages in small-scale rural societies.

Two Novel Antibiotic Use Metrics for Facilities and Individual Prescribers in Post-Acute and Long-Term Care Settings

Background: Measuring and reporting antibiotic use are essential to antimicrobial stewardship activities. The most common metric to assess facility-level use is days of antibiotic therapy per 1000 days of care (DOT/1000 DOC). This metric may be difficult to calculate, not be readily comparable, or not provide actionable data to individual prescribers, particularly those that work in post-acute and long-term care (PALTC) settings. Here we use data from a centralized dispensing pharmacy to develop antibiotic use metrics suitable for offering individualized feedback to prescribers working in PALTC settings. Methods: We obtained medication dispensing data and resident census data for 13 PALTC settings within the same network. After omitting non-pharmacologic items and limiting the data to medications dispensed from 1/2020 – 12/2022, we determined the following metrics by month: days of antibiotic therapy (DOT), number of medications prescribed, number of antibiotic courses prescribed (antibiotic starts), and the number of individual residents issued a prescription for any medication (unique residents). These metrics were assessed for each facility (2020 – 2022) and for prescribers responsible for > 1% of prescriptions within that facility (2022 only). Prescriber-level unique residents was the number of residents issued a prescription by the given provider. We obtained facility-level census data to calculate antibiotic DOT/1000 resident days of care (DOC) as a standard to which we compared novel metrics. Results: During the 3-year study period, 1718 prescribers at 13 PALTC settings wrote for 672256 medications, including 31087 antibiotic courses. At the facility level, the correlation between monthly antibiotic starts (courses)/unique residents and antibiotic DOT/1000 DOC was 0.83 (p < 0 .0001). The correlation between monthly antibiotic DOT/unique residents and antibiotic DOT/1000 DOC was 0.98 (p < 0 .0001). Trends in monthly values of both novel metrics and DOT/1000 DOC were consistent across the examined period (Figure 1). For individual prescribers, both novel metrics permit assessment and comparison of antibiotic prescription rates over time (Figure 2). Conclusions: Pharmacy dispensing data can be used to determine antibiotic DOT/unique residents and antibiotic starts/unique residents at the facility level and for individual providers. The novel metric antibiotic DOT/unique residents demonstrated strong correlation with antibiotic DOT/1000 DOC at the facility level. In addition to supporting tracking and reporting of antibiotic use among PALTC settings, these new metrics permit visualization of the antibiotic prescribing rates of individuals prescribers, as well as peer comparison, which in turn can lead to actionable feedback that helps improve antibiotic use in the care of PALTC.

Longitudinal look at individual resident preferences to prevent burnout: Which matter the most?

ABSTRACT A longitudinal look at individual resident preferences to prevent burnout: Which matter the most? Background and Objectives Burnout among residents-in-training is being reported more frequently. Previous studies have shown that lower measures of emotional intelligence, mindfulness, emotional regulation, and gratitude earlier in residency were associated with higher burnout scores later. Many studies have reported interventions intended to lessen burnout but not chosen by the residents with variable results on subsequent burnout measures. This paper reports an individually paired longitudinal analysis of strategies ranked by the resident as important with a subsequent burnout measure. Methods From 2017 through 2021, 32 residents completed a survey ranking their preference of ten approaches to preventing burnout at the beginning of the academic year. Then they later completed a burnout survey at the end of each year. Results With a usable response rate of 94% and calculating Spearman’s Correlation, residents completing their first year of training after medical school (PG-1) who gave a higher rank to a workplace supporting their personal values (p=.016), self-care (p=.031), and administrative support (p=.046) showed less burnout at the end of the year. PG-3s (those completing their third year of training after medical school) who gave a higher rank to spending time with family and friends (p=.002) showed less burnout. For all three years, the most powerful correlation was with adopting a healthy philosophical outlook (p=.014, .008, <.001). Conclusions In this group of residents, the correlations of preferred strategies for lessening burnout differed by training level. Rather than faculty choosing an intervention, we propose these ten strategies as a potential menu, allowing the individual resident to focus on their preferences working with a mentor. Group discussion of methods used by individual residents to adopt a healthy philosophical outlook would also be helpful.

Evaluating the uncertainty in mean residual times: Estimators based on residence times from discrete time processes

In this work, we propose estimators for the variance of mean residual times, which rely on individual residence times. The latter are assumed to be described by independent and identically distributed random variables, generated by a discrete-time stochastic process. We examine their performance through numerical experiments involving well-known probability distributions, and an application example using molecular dynamics simulation results, from an aqueous NaCl solution, is provided. These computationally inexpensive estimators, capable of achieving very accurate outcomes, serve as useful tools for assessing and reporting uncertainties in mean residual times across a wide range of simulations.

Contextual Action Theory in Nursing Home Settings: A Conceptual Framework for Considering the Active Role of Residents

AbstractNursing home (NH) residents are often considered passive recipients of care with a limited role in shaping their experience. This perspective is often reproduced in NH research, which restricts resident participation, thereby upholding ageist views that cause discrimination of older adults living in NH settings. In this article, we propose using Contextual Action Theory (CAT) as a conceptual framework for exploring NH experiences in a way that incorporates the active role of residents. CAT supports the active role of NH residents by emphasizing the capabilities of human beings to form preferences and act on those preferences, without assumptions of rationality. The emphasis on human action allows researchers to consider NH experiences as co-constructed between residents, care providers, and family members, which means placing an emphasis on the actions and goals of NH residents, no matter their cognitive or physical impairments. CAT also supports personhood and social citizenship concerns in NH research, by acknowledging the differing preferences and thereby differing experiences of NH care by individual residents. We argue that CAT should be considered a useful framework for putting residents in the center of NH research.

Screening for Conscientiousness at Start of Residency: Early Detection of Professionalism Concerns.

Early identification of residents who may require remediation could help prevent problems for both individual residents and their programs. Our aim in this project was to identify whether residents prone to challenges with professionalism could be identified early. For 3 years we tracked onboarding tasks completed by residents between official match and the first day of residency to develop a tool that would help identify residents who may be at risk for problems with timely chart completion and subsequent remediation. We compared residents' "at risk" scores with in-training exam (ITE) scores to differentiate between professionalism (task completion issues) and medical knowledge. Our at-risk tool successfully predicted timely chart completion rates and need for remediation within our residency program (Fischer's exact P<.001), but was not predictive of ITE scores. Using readily accessible information, we can identify residents at risk for poor task completion performance, who may benefit from extra support and development in the area of organizational skill. Early identification may increase opportunities for early intervention.