Suburban Centers Research Articles

Thinking outside the Box to Expand Metropolitan Travel Choices

The multimodal expressway system is a concept of introducing travel choices for suburban commuters in major metropolitan areas relatively quickly and inexpensively. The entire existing limited-access highway system would provide for free flow of carpool vehicles and buses by temporarily slowing (or stopping) and releasing excess traffic at freeway entrance ramps and on the freeway main line at a series of concentric cordon locations around the core of the metropolitan area. At these locations, travel lanes would be created on the shoulder and restricted to use by buses and high-occupancy vehicles with three or more persons and would allow them to bypass the slower moving metered general-purpose traffic. A multicentered bus rapid transit system would serve commute trips between suburban residential areas and major employment centers. The transit system would be supplemented with a flexible carpooling system. An enhanced version of the concept would introduce variable peak period tolls to encourage further mode shifts, reduce traffic demand, and help pay for system costs. Sketch planning estimates of costs for freeway, transit, and flexible carpooling investments suggested that the capital costs could be self-financed through road-pricing revenues.

Predictors of Sustaining Burn Injury: Does the Use of Common Prevention Strategies Matter?

The incidence of burn injury has decreased over the past several decades. Although this has been largely attributed to increased prevention awareness, few studies evaluate the effectiveness of implementing standard burn prevention strategies in preventing burn injury. The authors hypothesized that patients who sustain burns use burn prevention strategies less frequently than those who do not. This was a case-control study composed of a prospective survey questionnaire and retrospective burn registry query, which was performed in a suburban academic medical center with a burn unit. All burn patients seen by the burn service in the year 2008 and a nonrandom sample of nonburned emergency department patients and visitors during the same time period were enrolled. Demographics included age, gender, income, education, house type, insurance status, and prevention strategy usage including smoke alarms, carbon monoxide detectors, fire extinguishers, and escape plans. The primary outcome of interest in this study was burn injury. Chi-square tests were used to compare rates, Student's t-tests were used to compare mean values of continuous variables between burn patients and others, and multivariate logistic regression was used to determine the strongest predictors of sustaining burn injury. One hundred ninety-four burn patients and 348 nonburned emergency department patients and visitors were surveyed. Burn patients reported the same rates of smoke alarm usage (96.9 vs 96.3%, P = .692), carbon monoxide detectors (75.3 vs 67.2%, P = .05), and higher rates of fire extinguisher ownership (80.4 vs 72.7%, P = .045) when compared with others. In multivariable analysis, the strongest predictor of sustaining burn injury was less than high school education (odds ratio [OR] 3.61, 95% confidence interval [CI] 1.27-10.27), whereas English as a primary language (OR 0.48, 95% CI 0.26-0.89), a graduate degree (OR 0.10, 95% CI 0.02-0.42), income >$50,000 (OR 0.46, 95% CI 0.29-0.72), and keeping flammable liquids in a locked place (OR 0.59, 95% CI 0.44-0.80) were protective against burn injury. Smoke alarms (OR 0.75, 95% CI 0.22-2.61), fire extinguishers (OR 1.34, 95% CI 0.80-2.32), and having an escape plan (OR 0.85, 95% CI 0.56-1.29) were not protective. Patients who sustain burn injury use burn prevention strategies at similar rates when compared with those who do not. When holding demographic characteristics constant, utilization of most burn prevention strategies is not protective of sustaining burn injury. Those with lower levels of education and income remain more susceptible to burn injury.

What Makes TOD Success?: Analysis of Japanese Suburban Center TOD by Comparison of Tachikawa Station and Machida Station

What Makes TOD Success?: Analysis of Japanese Suburban Center TOD by Comparison of Tachikawa Station and Machida Station

Evaluating the Impact of Transit Service on Parking Demand and Requirements

Many jurisdictions in the United States typically set minimum parking requirements for residential multifamily developments based on old data that were collected in suburban settings with little transit availability. Such parking requirements applied to urban settings with adequate transit service often result in an oversupply of parking, which in turn creates a barrier to smart growth. Not only does the oversupply of parking encourage automobile use and reduce housing affordability, but it also increases development costs, consumes land and natural resources, and increases associated air and water pollution. This research examines the relationship of parking demand and transit service in First Hill– Capitol Hill (FHCH) and Redmond, two urban centers in King County, Washington. An alternative method to collect parking demand data is explored. The results show a strong relationship between transit service and parking demand. The FHCH urban center, which abuts downtown Seattle, exhibited higher levels of transit service and lower parking demand. Parking demand in FHCH was observed to be 0.52 parking space per dwelling unit, which was about 50% less than parking demand observed in Redmond, a growing mixed-use suburban center, and 50% less than data reported by the Institute of Transportation Engineers. After a review of the parking policies of each urban center, opportunities to improve regulations—including adjusting minimum parking requirements and allowing for reductions in required parking when developers implement solutions to reduce demand for parking—were identified.

US Metropolitan Spatial Structure and Labour Accessibility

Metropolitan areas vary widely in employment distribution and labour accessibility. Comparing four US metropolitan areas–Atlanta, Boston, Phoenix and Washington, DC—it is found that Atlanta and Washington, DC suffer from low labour accessibility compared with Boston and Phoenix. Moreover, large suburban employment centres in Atlanta and Washington, DC suffer from even lower accessibility than other employment centres within the same metropolitan areas or their counterparts in Boston and Phoenix. Their low labour accessibility is mainly explained by slower commuting speeds. Even though their residential and employment densities are modest, congestion in these employment centres is severe enough to undermine accessibility. The results raise questions about the effectiveness of creating large sub-centres in metropolitan areas, particularly creating auto-oriented edge-city-style employment centres at highway nodes.

The Changing Location of Trade and Services in Guadalajara, Mexico, 1994–2004*

The location of trade and services in Guadalajara, Mexico, is in flux as suburban commercial centers compete with the traditional downtown for new businesses and employment. Since the mid‐1990s a factor driving the change has been the introduction of American‐style big‐box retailers, corporate franchise supermarkets, and large suburban shopping malls. In this article I analyze the changing patterns of commercial and service businesses and employment from 1994 to 2004 in order to compare suburban and urban growth. My analysis includes comparative measures of change in neighborhoods immediately surrounding Walmart stores and by disaggregated types of commercial districts. Results indicate that a complementary relationship has developed: Suburbs are increasingly strong in the services, but the downtown remains a commercial hub. Moreover, some traditional small vendors in close proximity to Walmart may suffer, but growth in employment and in the service sector near Walmarts is high.

Columbia University College of Physicians and Surgeons

Columbia University College of Physicians and Surgeons

Land subsidence in Tianjin, China

Land subsidence has been affecting Tianjin for the past 50 years. It leads to comprehensive detrimental effects on society, the economy and natural environment. Overpumping of groundwater is the main cause. In 2008, the maximum cumulative subsidence reached 3.22 m and the total affected area nearly 8,000 km2. The subsidence reached its most critical state in the early 1980s when it occurred at a rate as high as 110 mm/year. At the same time, groundwater extraction had also reached a maximum of 1,200 million m3. By importing the Luan River to Tianjin and restricting exploitation of groundwater, hydraulic heads gradually recovered after 1986 in all aquifers, and this has continued to the present in the second aquifer. The subsidence rate in urban areas dropped to 10–15 mm/year. The area of groundwater extraction expanded to the suburban area with economic growth in the 1990s, and it was shifted to the third and fourth aquifers. At present, with a subsidence rate of 30–40 mm/year, four new suburban subsidence centers have been formed. Several measures were adopted to mitigate and prevent land subsidence disasters. These included restricting groundwater exploitation, groundwater injection, prohibiting use in the specific zone, a pricing policy for water resources, advocating water-saving technology, and strict enforcement of groundwater laws. Although the subsidence area is still increasing slowly, the subsidence rate is being controlled.

The persistence of suburban centres in Greater London: combining Conzenian and space syntax approaches

The relationship between settlement form and the historical persistence of concentrations of diverse socio-economic activity in Greater London’s suburban centres through successive phases of rapid urban transformation is examined. Particular consideration is given to the development of three suburbs in Greater London: Barnet, South Norwood and Surbiton. Conzenian and space syntax approaches are combined within an integrated GIS environment. Both these approaches identify the historical grain of settlement forms as the key to understanding how socio-economic activity becomes organized in the built environment. Using Surbiton as a case study the analysis demonstrates firstly, how the configuration of Greater London’s historical road network relates to the persistence of socio-economic activity in the built environment over time, and secondly, how diverse, localized patterns of such activity are accessible at a range of morphological scales. It is concluded that the relationship between suburban built form and socioeconomic activity is both configurational and historical in nature.

Spontaneous Intracerebral Hemorrhage Following a Blood Pressure Surge During Emergency Department Evaluation

Chronic hypertension and anticoagulation are important risk factors for the development of intracerebral hemorrhage (ICH). Spontaneous ICH occurring in the Emergency Department (ED) following a normal unenhanced computed tomography (CT) scan of the brain and an acute blood pressure (BP) surge is exceedingly rare and has, to our knowledge, never been reported in the literature. Single case observation in a suburban tertiary care medical center. A neurologically intact 72-year-old man whose BP and neurologic status were monitored during an ED evaluation suddenly became unresponsive following an acute BP surge. A CT of the brain shortly before the episode was normal; following the episode, a repeat CT demonstrated a large right ganglionic ICH. We present a rare case of an elderly man on warfarin who developed a spontaneous ICH during an ED evaluation following an acute BP surge. We propose that the ICH occurred as a result of the BP surge and was contributed to by warfarin anticoagulation.

Introduction to the Featured Collection on Riparian Ecosystems & Buffers1

Mayer, Paul M., Albert H. Todd, Judith A. Okay, and Kathleen A. Dwire, 2010. Introduction to the FeaturedCollection on Riparian Ecosystems & Buffers. Journal of the American Water Resources Association (JAWRA)46(2):207-210. DOI: 10.1111/j.1752-1688.2010.00425.xRiparian ecosystems, located at the interface of ter-restrial and aquatic systems, are often given specialattention by scientists for their high biodiversity andbiological activity (Naiman et al., 1993; Naiman andDecamps, 1997) and significant role in nutrient andenergy flux (McClain et al., 2003). Riparian ecosys-tems are known to buffer environmental impacts andcontribute to the maintenance of water quality (Low-rance et al., 1997). For example, riparian zones canintercept, filter, and process anthropogenic nitrogeninputs (Lowrance et al., 1984; Peterjohn and Correll,1984; Mayer et al., 2007), attenuate phosphorus(Hoffmann et al., 2009), capture sediments (Liu et al.,2008), reduce urban noise (Harris, 1985), and moder-ate stream temperature (Wilkerson et al., 2006), func-tions that are especially important in the face ofglobal climate change and continued land use devel-opment. Their position in the landscape and linearpathways create critical corridors for animal migra-tion and movement (Hagar, 1999). Thus, riparianareas provide critical ecosystem services that supportsociety and economies (Millennium Ecosystem Assess-ment, 2005) and are, therefore, essential to humanhealth and well-being. In many regions such as urbanand suburban centers, riparian areas remain the lastintact ecosystems to provide parks and green space(Groffman et al., 2003). Ultimately, riparian ecosys-tems are immeasurably valuable. The continual lossof riparian zones represents a loss of ecosystem ser-vices (Sweeney et al., 2004). The proliferation of man-agement initiatives for riparian buffers demonstratesa need for sound, quantitative science on riparianecosystem function and the results of conservationand restoration actions. The contents of this specialissue are intended to help inform management deci-sions that support the values and services riparianecosystems provide.The 10 papers in this collection were solicited fromresearch scientists and others who participated in theAmerican Water Resources Association summer spe-cialty conference titled ‘‘Riparian Ecosystems & Buf-fers: Working at the Water’s Edge,’’ held in VirginiaBeach, Virginia, June 30-July 2, 2008. The approxi-mately 330 conference attendees participated in aninterdisciplinary forum with over 120 speakers in 36technical sessions. Keynote speakers included BrianRichter of the Nature Conservancy, James Karr ofthe University of Washington, Bernard Sweeneyof the Stroud Water Research Center, and EmilyBernhardt of Duke University who spoke on issues

Rates of Compliance With First Aid Recommendations in Burn Patients

Several techniques (such as cooling and covering) are recommended in the first aid management of burn injured patients, both for lay persons and for EMS. Few studies have examined the rates of compliance with these recommendations. This study is a burn registry query performed in a suburban academic medical center with a regional burn unit. Patients seen by the burn service between January 2008 and February 2009 were included. Demographics, injury characteristics, rates of implementation of first aid, and method of transport to medical care (self vs ambulance) were recorded. Rates of implementation are reported as proportions with confidence intervals (CIs) and rates of implementation in those transported by self vs ambulance and work-related vs nonwork-related burns are compared using chi tests. Two hundred eleven burn patients were entered in the registry during the study period. Mean age was 27.0 (SD, 22.1) years, 44.3% were female, 95.2% were thermal burns, and 29.9% were transported by ambulance; 72.7% (95% CI, 66-78%) reported cooling their burn before presentation for medical care. Of those, 39.9% reported using tap water to cool their burn (95% CI, 33.4-46.8%), whereas 25.2% used ice (95% CI, 18.4-33.5%), and 8.9% used a cooling blanket (95% CI, 5-15%). Only 22.2% reported having applied a dressing before arrival in the hospital (95% CI, 16.9-28.5%). There were no significant differences between the groups who transported themselves to care in comparison with those who were brought in by ambulance in terms of cooling with water (P = .516), cooling with ice (P = .063), or application of dressing (P = .506). Further, no differences existed between those reporting cooling of the burn and those who did not in terms of patient characteristics. Rates of first aid administered for burn injury by lay persons before arrival at a burn center are high. A substantial percentage of people continue to use ice to cool their burns despite evidence of its potential detrimental nature. There is no difference in the rates of first aid implementation in those who did and did not contact EMS. The initial call to EMS might be used to instruct lay persons in appropriate burn first aid while awaiting the ambulance.

Office Endometrial Ablation with Local Anesthesia Using the HydroThermAblator System: Comparison of Outcomes in Patients with Submucous Myomas with Those with Normal Cavities in 246 Cases Performed Over 5½ Years

Study Objective To estimate the safety and efficacy of the HydroThermAblator (HTA) system for performance of endometrial ablation in the medical office setting using local anesthesia and minimal oral sedation and to compare results obtained in patients with submucous myomas with those in patients with normal endometrial cavities. Design Retrospective cohort analysis of 246 HTA procedures (Canadian Task Force classification II-2). Setting Medical offices of a suburban community medical center that is part of a large health maintenance organization. Patients Two hundred forty-six women aged 28 to 63 years (mean [SD], 45.1 [6.0] years) with abnormal uterine bleeding unresponsive to conservative management, including 104 patients (42.3%) with submucous myomas. Type 0 or type I myomas were present in at least 86 patients with submucous myomas (82.7%) and ranged from 1 to 4 cm in greatest diameter. In the other 18 patients, submucous myomas were not classified by type. Patients were evaluated at 2 to 70 months after the procedure (median follow-up, 31.0 months). Three patients were lost to follow-up, and 12 patients underwent hysterectomy for indications other than abnormal bleeding and were excluded from the analysis. Thus, 231 patients were included in the analysis. Interventions Endometrial ablation was performed using the HTA system with paracervical or intracervical block after oral premedication with ibuprophen, diazepam, and acetominophen or hydrocodone and intramuscular ketorolac. No intravenous or intramuscular narcotics were used. The anesthesia regimen was the same in patients with submucous myomas as in those with normal cavities, and the procedure was performed in exactly the same manner. All procedures were performed in the medical office procedure room by 7 board-certified gynecologists; most procedures were performed by the authors. Measurements and Main Results Of the 231 patients included in the analysis, 121 (53.4%) reported postablation amenorrhea, 62 (26.8%) reported light menses or spotting, 21 (9.1%) reported normal menses, 15 (6.5%) reported menorrhagia, and 12 (5.2%) underwent hysterectomy because of bleeding. In the 136 patients with normal cavities, amenorrhea was achieved in 84 patients (61.8%), oligomenorrhea in 35 (25.7%), and eumenorrhea in 12 (8.8%). Four patients (2.9%) continued to have menorrhagia requiring medical treatment. In the 95 patients with submucous myomas, amenorrhea was reported by 37 patients (38.9%), oligomenorrhea by 27 (28.4%), eumenorrhea by 9 (9.5%), and menorrhagia by 11 (11.6%). In 11 patients (11.6%), hysterectomy was performed because of menorrhagia. All patients who underwent hysterectomy had multiple myomas, and 9 (81.8%) also had adenomyosis. The failure rate, defined as patients with menorrhagia or undergoing hysterectomy because of bleeding, was 11.7% overall. The failure rate in patients with submucous myomas and normal cavities was 23.2% and 3.7%, respectively (relative risk, 6.3; 95% confidence interval, 2.5–16.0). While the failure rate in the group with myomas was statistically significantly higher than in the group without myomas, the failure rate in the myoma group was still comparable to that achieved using electrosurgical resection and ablation of similar types of myomas as reported in the literature. The amenorrhea rate achieved in the myoma group (38.9%) was also comparable to that achieved in US Food and Drug Administration pivotal trials in patients with normal cavities treated using all of the nonhysteroscopic global ablation devices as well those treated using rollerball endometrial ablation. The rate of hysterectomy because of bleeding was 5.2% overall. The hysterectomy rate in patients with submucous myomas and normal cavities was 11.6% and 0.7%, respectively. Only 1 procedure was discontinued (at 8 minutes) because of pain. Four patients had postoperative endometritis, with 2 requiring hospitalization for intravenous antibiotic therapy. Two false passages were created while dilating the cervix, with subsequent inability to perform the procedure. Conclusions Hydrothermablation performed in the medical office using local anesthesia seems to be a safe, effective, and cost-saving procedure for treatment of abnormal uterine bleeding in women with both normal and myomatous uteri. Although the success rate in patients with normal cavities was higher than that achieved in patients with submucous myomas, hysterectomy because of abnormal bleeding related to myomas was avoided in 88.4% of the group with myomas.

Analyzing intra-metropolitan poverty differentiation: causes and consequences of poverty expansion to suburbs in the metropolitan Atlanta region

Although metropolitan areas have traditionally been viewed as dichotomous structures with a central city and surrounding suburbs, the development patterns of such areas have taken on a multi-ring sectoral and polycentric structure in the context of intra-metropolitan spatial differentiation. Using the longitudinal census database (1970–2000) for the Atlanta metropolitan region, this study showed not only substantial increases in poverty and its concentration in suburban areas such as inner- and middle-ring suburbs and some suburban employment centers, but also causal factors for changes in poverty by race and subarea. The results suggest that unemployment and rental housing burden were the strongest determinants of levels of poverty and its change across race and subareas, indicating the importance of jobs and affordable rental housing to alleviating poverty and its concentration.

Use of urban marine habitats by foraging wading birds

Wading birds (i.e, Ardeidae: herons, egrets, and bitterns) are a guild of waterbirds that forage in coastal habitats which in the US and Europe are often located in close proximity to urban centers. However, the use of urban marine habitats may have consequences for bird populations, as birds can be subject to stress from increased levels of passive and active human disturbance. We examined the effects of human disturbance, available foraging habitat, and prey abundance on wading bird density and species richness at 17 urban coastal sites in Narragansett Bay, Rhode Island USA. The sites represented a gradient of immediately adjacent residential and commercial land use (e.g., 0.0–67.7% urban land use within a 30.5 m buffer of the sites) within an urban matrix (i.e., all sites were located within a suburban center with a population of about 85,000 people). Wading bird density (0.62 ± 0.12 birds ha−1) and species richness (average 4.49 ± 0.37 species across all sites) were not influenced by passive human disturbance as measured by the extent of urban land surrounding a site. However, wading bird density and species richness both decreased significantly as active disturbance (i.e., number of boats moored or docked upstream of the site) increased (r = −0.56, F = 6.85, p = 0.019 and r = −0.73, F = 16.6, p = 0.001, respectively). In addition, both density (r = 0.72, F = 16.2, p = 0.001) and species richness (r = 0.72, F = 16.2, p = 0.001) increased concomitantly with a prey index that combines the density of fish and invertebrates on which the birds feed with the amount of available shallow water foraging habitat at a site. Our results suggest that wading birds i) may not be negatively affected by urban land surrounding estuarine foraging areas in and of itself; and ii) may be utilizing urban areas in the absence of high levels of active disturbance to take advantage of potentially enhanced prey resources. In the case where the benefits of foraging at a site outweigh the costs related to human disturbance, urban marine habitats may need to be considered for restoration or protection from further increases in active human disturbance.

Hormonal Therapy Use for Prostate Cancer and Mortality in Men With Coronary Artery Disease–Induced Congestive Heart Failure or Myocardial Infarction

Hormonal therapy (HT) when added to radiation therapy (RT) for treating unfavorable-risk prostate cancer leads to an increase in survival except possibly in men with moderate to severe comorbidity. However, it is unknown which comorbid conditions eliminate this survival benefit. To assess whether neoadjuvant HT use affects the risk of all-cause mortality in men with prostate cancer and coronary artery disease (CAD)-induced congestive heart failure (CHF) or myocardial infarction (MI), CAD risk factors, or no comorbidity. A total of 5077 men (median age, 69.5 years) with localized or locally advanced prostate cancer were consecutively treated with or without a median of 4 months of neoadjuvant HT followed by RT at a suburban cancer center between 1997 and 2006 and were followed up until July 1, 2008. Cox regression multivariable analyses were performed assessing whether neoadjuvant HT use affected the risk of all-cause mortality, adjusting for age, year and type of RT, treatment propensity score, and known prostate cancer prognostic factors in each comorbidity group. Risk of all-cause mortality. Neoadjuvant HT use was not associated with an increased risk of all-cause mortality in men with no comorbidity (9.6% vs 6.7%, adjusted hazard ratio [HR], 0.97; 95% confidence interval [CI], 0.72-1.32; P = .86) or a single CAD risk factor (10.7% vs 7.0%, adjusted HR, 1.04; 95% CI, 0.75-1.43; P = .82) after median follow-ups of 5.0 and 4.4 years, respectively. However, for men with CAD-induced CHF or MI, after a median follow-up of 5.1 years, neoadjuvant HT use was significantly associated with an increased risk of all-cause mortality (26.3% vs 11.2%, adjusted HR, 1.96; 95% CI, 1.04-3.71; P = .04). Neoadjuvant HT use is significantly associated with an increased risk of all-cause mortality among men with a history of CAD-induced CHF or MI but not among men with no comorbidity or a single CAD risk factor.

Community-Acquired Methicillin-Resistant Staphylococcus Aureus in the Suburban Hand Surgery Patient Population

Methicillin-resistant Staphylococcus aureus (MRSA) is a frequent cause for patients to present to a physician's office or emergency department. We observed increasing numbers of community-acquired MRSA infections in patients admitted to the hand surgery service at our suburban academic center. It is an important issue as unsuspected community-acquired MRSA hand infections can be admitted to the hospital, inadequately treated, and allowed for nosocomial spread. This study was performed to examine the trend in the incidence of community-acquired MRSA infections in patients admitted to the hand surgery service in order to sensitize practitioners to have a high index of suspicion for this entity and promote early recognition and treatment of this organism. A multihospital retrospective chart review was undertaken to compare the total number of community-acquired MRSA infections in our hospital as well as the number in patients admitted to the hand surgery service with community-acquired MRSA from 2000 through 2008. Statistical analysis was provided by linear regression. Two community-acquired hand MRSA infections were treated in 2000, as compared to three in 2001 and 2002, four in 2003, five in 2004, six in 2005, 14 in 2006, 13 in 2007, and ten in 2008. This increase was statistically significant (p = 0.038). This retrospective review documents a rapidly rising number of community-acquired MRSA hand infections in the suburban environment. The hand surgeon must be aware of the increased prevalence of this entity to adequately combat this organism and prevent prolonged hospital stays, expanded morbidity, and inflated treatment costs.

Geographic-Time Distribution of Ambulance Calls in Singapore: Utility of Geographic Information System in Ambulance Deployment (CARE 3)

Pre-hospital ambulance calls are not random events, but occur in patterns and trends that are related to movement patterns of people, as well as the geographical epidemiology of the population. This study describes the geographic-time epidemiology of ambulance calls in a large urban city and conducts a time demand analysis. This will facilitate a Systems Status Plan for the deployment of ambulances based on the most cost effective deployment strategy. An observational prospective study looking at the geographic-time epidemiology of all ambulance calls in Singapore. Locations of ambulance calls were spot mapped using Geographic Information Systems (GIS) technology. Ambulance response times were mapped and a demand analysis conducted by postal districts. Between 1 January 2006 and 31 May 2006, 31,896 patients were enrolled into the study. Mean age of patients was 51.6 years (S.D. 23.0) with 60.0% male. Race distribution was 62.5% Chinese, 19.4% Malay, 12.9% Indian and 5.2% others. Trauma consisted 31.2% of calls and medical 68.8%. 9.7% of cases were priority 1 (most severe) and 70.1% priority 2 (moderate severity). Mean call receipt to arrival at scene was 8.0 min (S.D. 4.8). Call volumes in the day were almost twice those at night, with the most calls on Mondays. We found a definite geographical distribution pattern with heavier call volumes in the suburban town centres in the Eastern and Southern part of the country. We characterised the top 35 districts with the highest call volumes by time periods, which will form the basis for ambulance deployment plans. We found a definite geographical distribution pattern of ambulance calls. This study demonstrates the utility of GIS with despatch demand analysis and has implications for maximising the effectiveness of ambulance deployment.

Self-Care Strategies to Cope With Taste Changes After Chemotherapy

To describe factors related to taste changes, to examine patients' use of a self-care suggestion sheet to manage taste changes associated with chemotherapy, and to identify potentially useful strategies for managing specific taste changes after chemotherapy. Quasi-experimental, pre/post design. Four outpatient urban and suburban oncology centers in Illinois. 42 patients who had received at least two cycles of chemotherapy previously identified to be associated with taste changes. Pre- and postintervention survey of taste changes; patient education regarding self-care for taste changes. Taste changes, taste change strategies, and self-care. Most patients that reported taste changes had affected their ability to eat. Taste changes and strategies varied somewhat according to chemotherapy regimen. Avoiding strong-smelling or -tasting foods, eating blander foods, drinking more water with foods, oral care before eating, and eating smaller, more frequent meals were reported to help. Taste changes are common in patients receiving cisplatin, carboplatin, or cyclophosphamide. At-risk patients may benefit from prechemotherapy teaching regarding specific taste change management suggestions. Use of a taste change suggestion sheet encouraged self-care, and counseling patients regarding strategies to deal with taste changes may help them during chemotherapy. Nurses should incorporate patient education tools that promote self-care regarding the management of taste changes in patients with known factors that could affect taste early in their chemotherapy.

Metrorail Trends and Markets

The Washington Metropolitan Area Transit Authority operates the second-busiest heavy rail transit system in the country, serving 3.5 million people over a 1,500-mi2 service area. Ridership on Metrorail has continued to rise steadily since service started in 1976 and has been driven by system expansion and regional growth. This paper presents the emerging trends and travel markets of Metrorail transit in the Washington, D.C., metropolitan region, with the purpose of providing better planning for and serving a growing and changing transit market. The paper also examines the connections between Metrorail system growth and urban development at the regional, local, and station-area levels. The analysis is based on 2002 and 2007 Metrorail passenger surveys and the most recent ridership growth study. The paper concludes that although system expansion and regional development remain significant contributors to the growth in ridership on the system, sporting events and downtown activities have emerged as new factors that have driven the recent growth. The growth in ridership is particularly noticeable in the non-work-related, off-peak, and weekend travel markets and at stations in the downtown area and is revitalizing communities and suburban activity centers. The paper also highlights the significant modal shift in access to the Metro-rail system, with increasing walking, bicycling, and bus trips occurring. In conclusion, Metrorail is meeting the increasingly diverse transportation needs of the region, supporting emerging urban trends, and enhancing local development initiatives.