A household's vulnerability to energy poverty is socially and spatially variable. Efforts to measure energy poverty, however, have focused on narrow, expenditure-based metrics or area-based ...targeting. These metrics are not spatial per se, because the relative importance of drivers does not vary between neighborhoods to reflect localized challenges. Despite recent advancements in geographically weighted methodologies that have the potential to yield important information about the sociospatial distribution of vulnerability to energy poverty, the phenomenon has not been approached from this perspective. For a case study of England, global principal component analysis (PCA) and local geographically weighted PCA (GWPCA) are applied to a suite of neighborhood-scale vulnerability indicators. The explicit spatiality of this methodological approach addresses a common criticism of vulnerability assessments. The global PCA reaffirms the importance of well-established vulnerabilities, including older age, disability, and energy efficiency. It also demonstrates striking new evidence of vulnerabilities among precarious and transient households that are less well understood and have become starker during austerity. In contrast, rather than providing a single estimate of propensity to energy poverty for neighborhoods based on a national understanding of what drives the condition, the GWPCA identifies a diverse array of vulnerability factors of greatest importance in different locales. These local results destabilize the geographical configurations of an urban-rural and north-south divide that typify understandings of deprivation in this context. The geographically weighted approach therefore draws attention to vulnerabilities often hidden in policymaking, allowing for reflection on the applicability of spatially constituted methodologies to wider social vulnerability assessments. Key Words: energy poverty, geographically weighted PCA, GIS, spatial analysis, vulnerability.
•We investigate the geographical features of fuel poverty using different indicators.•We compare the spatial distribution of fuel poverty using a 10% and LIHC indicator.•The shift to a LIHC indicator ...has disproportionately affected regions with lower housing costs.•Using a LIHC indicator there is a higher prevalence of fuel poverty in urban areas.•Using a LIHC indicator there are fewer fuel poverty ‘hot-spots’ and ‘cold-spots’.•The results have implications for targeting of fuel poverty alleviation resources.
Recognition of the negative impacts of fuel poverty, a lack of sufficient energy services in the home, has generated considerable interest in how the phenomenon can best be measured. Subsequently, the most well-known indicators deployed in policy-making, the established 10% indicator and the recent Low Income High Cost (LIHC) indicator, have generated considerable discussion and critique. One facet of the debate that remains unexplored is the effect of a change in indicator upon the spatial distribution of fuel poverty. Using spatial analyses we interrogate sub-regional estimates of the two indicators in England, where the LIHC indicator was first conceived. Three principle findings are discussed, enhancing understanding of the geographic features of fuel poverty as understood by each indicator. Firstly, the reduction in fuel poor households has disproportionately affected areas with lower housing costs. Secondly, there is a higher prevalence of fuel poverty in urban areas. Finally, the condition is more spatially heterogeneous with fewer ‘hot-spots’ and ‘cold-spots’. As a result, each indicator captures different notions of what it means to be fuel poor, representing particular vulnerabilities, losses of wellbeing and injustices. This has implications for the targeting of limited alleviation resources and for alternative national contexts where the LIHC indicator might be deployed.
Cities in China have undergone considerable transformation in recent decades with unprecedented economic growth, rural to urban migration and a rapidly emerging middle class all contributing to ...increased energy consumption. In this context, we investigate the inability of urban households in the cold climate zone in northern China to access sufficient domestic energy services, and thus their vulnerability to energy poverty, focusing upon heating provision. Results of a questionnaire survey of households in the urban area of Beijing (n = 880) are analysed using Latent Class Analysis, a methodologically novel approach to developing a typology of energy poverty. The analysis highlights vulnerabilities that increase the likelihood of a household being unable to access adequate heating in the home in this context. Despite provision of state-subsidies for heating in cities in northern China, a mechanism that might be anticipated to buffer households from energy poverty, these do not shield from the cold those households that lack access to efficient and flexible networked infrastructures, or a high quality, built environment. Our findings represent the first detailed study of energy poverty in relation to heating in this geographical context and have significant implications for domestic policy-making concerned with energy poverty, residential energy efficiency and energy consumption.
•Vulnerability frameworks can challenge assumption that gender inequality is synonymous with energy poverty.•We need to move beyond a focus upon the household to consider energy vulnerability of ...individuals.•Evidence spatialities of gendered energy vulnerability related to health and economic activity.
A growing research agenda has sought to understand the substantial inequalities that exist in domestic energy provision. One way in which these inequalities are shaped is through socio-spatially contingent gender relations, an area underexplored with regards to energy poverty. This paper aims to uncover the spatialities of gender and energy poverty. It argues that established energy vulnerability frameworks can challenge the assumption that gender inequality is synonymous with energy poverty, but to do so these framings must move beyond a focus upon the household to recognise the vulnerability of individuals. Gendered vulnerabilities likely to enhance energy poverty are delineated for a case study of England, underpinned by socio-spatial analyses of gender-sensitive indicators. Five dimensions of gendered, socio-spatial energy vulnerability are evidenced in this context: exclusion from the economy; time-consuming and unpaid reproductive, caring or domestic roles; exposure to physiological and mental health impacts; a lack of social protection during a life course; and coping and helping others to cope. The findings demonstrate that whilst it is possible to draw initial conclusions about the spatialities of gendered energy vulnerability associated with health and economic activity, this is more complex concerning gendered aspects of energy vulnerability related to infrastructure that tend to be measured at the scale of the household, or those aspects of vulnerability that are relatively private or personal.
In-house calls contribute to loss of sleep and surgeon burnout. Although acknowledged to have an opportunity cost, home call is often considered less onerous, with minimal effects on sleep and ...burnout. We hypothesized home call would result in impaired sleep and increased burnout in acute care surgeons.
Data from 224 acute care surgeons were collected for 6 months. Participants wore a physiological tracking device and responded to daily surveys. The Maslach Burnout Inventory was administered at the beginning and end of the study. Within-participant analyses were conducted to compare sleep, feelings of restedness, and burnout as a function of home call.
One hundred seventy-one surgeons took 3,313 home calls, 52.5% were associated with getting called and 38.5% resulted in a return to the hospital. Home call without calls was associated with 3 minutes of sleep loss (p < 0.01), home call with 1 or more call resulted in a further 14 minutes of sleep loss (p < 0.0001), and home call with a return to the hospital led to an additional 70 minutes of sleep loss (p < 0.0001). All variations of home call resulted in decreased feelings of restedness (p < 0.0001) and increased feelings of daily burnout (p < 0.0001, Fig. 1).
Home call is deleterious to sleep and burnout. Even home call without calls or returns to the hospital is associated with burnout. Internal assessments locally should incorporate frequency of calls and returns to the hospital when creating call schedules. Repeated nights of home call can result in cumulative sleep debt, with adverse effects on health and well-being.
Acute and chronic sleep deprivation are significantly associated with depressive symptoms and are thought to be contributors to the development of burnout. In-house call inherently includes frequent ...periods of disrupted sleep and is common among acute care surgeons. The relationship between in-house call and sleep deprivation among acute care surgeons has not been previously studied. The goal of this study was to determine prevalence and patterns of sleep deprivation in acute care surgeons.
A prospective study of acute care surgeons with in-house call responsibilities from 2 level I trauma centers was performed. Participants wore a sleep-tracking device continuously over a 3-month period. Data collected included age, sex, schedule of in-house call, hours and pattern of each sleep stage (light, slow wave, and rapid eye movement REM), and total hours of sleep. Sleep patterns were analyzed for each night, excluding in-house call, and categorized as normal, acute sleep deprivation, or chronic sleep deprivation.
There were 1,421 nights recorded among 17 acute care surgeons (35.3% female; ages 37 to 65 years, mean 45.5 years). Excluding in-house call, the average amount of sleep was 6.54 hours, with 64.8% of sleep patterns categorized as acute sleep deprivation or chronic sleep deprivation. Average amount of sleep was significantly higher on post-call day 1 (6.96 hours, p = 0.0016), but decreased significantly on post-call day 2 (6.33 hours, p = 0.0006). Sleep patterns with acute and chronic sleep deprivation peaked on post-call day 2, and returned to baseline on post-call day 3 (p = 0.046).
Sleep patterns consistent with acute and chronic sleep deprivation are common among acute care surgeons and worsen on post-call day 2. Baseline sleep patterns were not recovered until post-call day 3. Future study is needed to identify factors that affect physiologic recovery after in-house call and further elucidate the relationship between sleep deprivation and burnout.
The following paper proposes a novel machine learning approach to the segmentation of urban housing markets. We extract features from globally available satellite imagery using an unsupervised ...machine learning model called MOSAIKS, and apply a k-means clustering algorithm to the extracted features to identify sub-markets at multiple intra-urban scales within a case study of Madrid (Spain). To systematically explore scale effects on the resulting clusters, the analysis is repeated with varying sizes of satellite image patches. We assess the resulting clusters across scales using several internal cluster-evaluation metrics. Additionally, we use data from online listings portal Idealista to measure the homogeneity of housing prices within the clusters, to understand how well sub-markets can be differentiated by the image features. This paper evaluates the strengths and weakness of the method to identify urban housing sub-markets, a task which is important for planners and policy makers and is often limited by a lack of data. We conclude that the approach seems useful to divide large urban housing markets according to different attributes and scales.
Myofascial pelvic pain Spitznagle, Theresa Monaco; Robinson, Caitlin McCurdy
Obstetrics and gynecology clinics of North America,
09/2014, Letnik:
41, Številka:
3
Journal Article
Recenzirano
Individuals with pelvic pain commonly present with complaints of pain located anywhere below the umbilicus radiating to the top of their thighs or genital region. The somatovisceral convergence that ...occurs within the pelvic region exemplifies why examination of not only the organs but also the muscles, connective tissues (fascia), and neurologic input to the region should be performed for women with pelvic pain. The susceptibility of the pelvic floor musculature to the development of myofascial pain has been attributed to unique functional demands of this muscle. Conservative interventions should be considered to address the impairments found on physical examination.
We sought to identify opportunities for interventions to mitigate complications of tube thoracostomy (TT).
Retrospective review of all trauma patients undergoing TT from 6/30/2016–6/30/2019. ...Multivariable logistic regression identified independent predictors of complications.
Out of 451 patients, 171 (37.9%) had at least one TT malpositioning or complication. Placement in the emergency department, placement by emergency medicine physicians, and body mass index >30 kg/m2 were independent predictors of complication. Malpositioning increased the likelihood of early complication (6.5%–53.5%), and early complication increased the likelihood of late complication (4.3%–13.6%). Patients with a late complication had, on average, a 7.56 day longer hospital stay than patients without a late complication.
TT complications were associated with placement in the emergency department, placement by emergency medicine physicians, and BMI>30 kg/m2. We identified associations between malpositioning, early complications, and late complications, and demonstrated that TT complications impact patient outcomes.
•Increased TT complication rates are independently associated with placement in the ED.•Urgency, i.e. time to placement, is not associated with increased complication rates.•EM Physician TT placement is associated with increased complication rates.•Malpositioning and early complications are associated with subsequent complications.•TT complications impact hospital length of stay and patient outcomes.
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