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Where to Enhance Rural Palliative Care? Developing a Spatial Model to Identify Suitable Communities Most in Need of Service Enhancement

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2020-03-04
Abstract: 

Background  In Canada, access to palliative care is a growing concern, particularly in rural communities. These communities have constrained health care services and accessing local palliative care can be challenging. The Site Suitability Model (SSM) was developed to identify rural “candidate” communities with need for palliative care services and existing health service capacity that could be enhanced to support a secondary palliative care hub. The purpose of this study was to test the feasibility of implementing the SSM in Ontario by generating a ranked summary of rural “candidate” communities as potential secondary palliative care hubs.

Methods  Using Census data combined with community-level data, the SSM was applied to assess the suitability of 12 communities as rural secondary palliative care hubs. Scores from 0 to 1 were generated for four equally-weighted components: (1) population as the total population living within a 1-h drive of a candidate community; (2) isolation as travel time from that community to the nearest community with palliative care services; (3) vulnerability as community need based on a palliative care index score; and (4) community readiness as five dimensions of fit between a candidate community and a secondary palliative care hub. Component scores were summed for the SSM score and adjusted to range from 0 to 1.

Results  Population scores for the 12 communities ranged widely (0.19–1.00), as did isolation scores (0.16–0.94). Vulnerability scores ranged more narrowly (0.27–0.35), while community readiness scores ranged from 0.4–1.0. These component scores revealed information about each community’s particular strengths and weaknesses. Final SSM scores ranged from a low of 0.33 to a high of 0.76.

Conclusions  The SSM was readily implemented in Ontario. Final scores generated a ranked list based on the relative suitability of candidate communities to become secondary palliative care hubs. This list provides information for policy makers to make allocation decisions regarding rural palliative services. The calculation of each community’s scores also generates information for local policy makers about how best to provide these services within their communities. The multi-factorial structure of the model enables decision makers to adapt the relative weights of its components.

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Article
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Multi-decadal Reduction in Glacier Velocities and Mechanisms Driving Deceleration at Polythermal White Glacier, Arctic Canada

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2017-02-27
Abstract: 

Annual and seasonal surface velocities measured continuously from 1960 to 1970 at White Glacier, a 14 km long polythermal valley glacier spanning ~100–1800 m a.s.l., provide the most comprehensive early record of ice dynamics in the Canadian Arctic. Through comparison with differential GPS-derived velocity data spanning 2012–16, we find reductions in mean annual velocity by 31 and 38% at lower elevations (600 and 400 m a.s.l.). These are associated with decreased internal ice deformation due to ice thinning and reduced basal motion likely due to increased hydraulic efficiency in recent years. At higher elevation (~850 m a.s.l.) there is no detectable change in annual velocity and the expected decrease in internal deformation rates due to ice thinning is offset by increased basal motion in both summer and winter, likely attributable to supraglacial melt accessing a still inefficient subglacial drainage system. Decreases in mass flux at lower elevations since the 1960s cannot explain the observed elevation loss of ~20 m, meaning that ice thinning along the glacier trunk is primarily a function of downwasting rather than changing ice dynamics. The current response of the glacier exemplifies steady thinning, velocity slowdown and upstream retreat of the ELA but, because the glacier has an unstable geometry with considerable mass in the 1300–1500 m elevation range, a retreat of the ELA to >1300 plausible within 25–40 years, could trigger runaway wastage.

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Article
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What Determines the Warming Commitment after Cessation of CO2 Emissions?

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2017-01-23
Abstract: 

Previous studies have shown that global mean surface air temperature remains elevated after cessation of CO2 emissions. However, studies differ in whether the temperature continues to increase, slowly decreases, or remains constant after cessation of emissions. An understanding of this committed warming is of importance because it has implication for the estimation of carbon budgets compatible with temperature targets. Here, we investigate the effect of the state of thermal and bio-geochemical equilibration at the time emissions are set to zero on the committed warming as the latter is determined by the balance of these two equilibration processes. We find that the effect of thermal equilibration, expressed as fraction of realized warming, dominates over the bio-geochemical equilibration, expressed as ratio of the airborne fraction to the equilibrium airborne fraction. This leads to a positive warming commitment, and a commitment that declines the later emissions are zeroed along a trajectory of constant atmospheric CO2 concentration. We furthermore show that the scenario prior to zeroed emissions has the strongest effect on the warming commitment, compared to the time of zeroed emissions and the time horizon over which the commitment is calculated.

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Article
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Are Perceived Barriers to Accessing Health Care Associated with Inadequate Antenatal Care Visits among Women of Reproductive Age in Rwanda?

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2020-02-10
Abstract: 

Background  Maternal and child mortality remain a global health concern despite different interventions that have been implemented to address this issue. Adequate antenatal care (ANC) is crucial in reducing maternal and neonatal morbidity and mortality. However, in Rwanda, there is still suboptimal utilization of ANC services. This study aims to assess the relationship between perceived barriers to accessing health care and inadequate ANC visits among women of reproductive age in Rwanda.

Methods  This study is cross-sectional using secondary data from the 2014–15 Rwanda demographic and health survey (RDHS). The study included 5876 women aged 15–49 years, and the primary outcome of the investigation was inadequate ANC visits defined as delayed first ANC visit and non-completion of at least four recommended visits during the pregnancy period. The primary exposure was perceived barriers to accessing health care, operationalized using the following 4 variables: distance to the health facility, getting money for treatment, not wanting to go alone and getting permission to go for treatment. A survey-weighted multivariable logistic regression analysis and backward elimination method based on Akaike information criterion (AIC) was used to select the final model. We conducted a number of sensitivity analyses using stratified and weighting propensity score methods and investigated the relationship between the outcome and each barrier to care separately.

Results  Of 5, 876 women included in the analysis, 53% (3132) aged 20 to 34 years, and 44% (2640) were in the lowest wealth index. Overall, 64% (2375) of women who perceived to have barriers to health care had inadequate ANC visits. In multivariable analysis, women who perceived to have barriers to health care had higher odds of having inadequate ANC visits (OR: 1.14; 95% CI: 0.99, 1.31). However, the association was borderline statistically significant. The findings from sensitivity analyses were consistent with the main analysis results.

Conclusion  The study suggests a positive association between perceived barriers to health care access and inadequate ANC visits. The findings speak to a need for interventions that focus on improving access to health care in Rwanda to increase uptake of ANC services.

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Article
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Lithostratigraphic and Magnetostratigraphic Data From Late Cenozoic Glacial and Proglacial Sequences Underlying the Altiplano at La Paz, Bolivia

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2018-05-19
Abstract: 

We provide lithostratigraphic and magnetostratigraphic data derived from a Plio-Pleistocene continental sediment sequence underlying the Altiplano plateau at La Paz, Bolivia. The record comprises six sections along the upper Río La Paz valley, totaling over one kilometre of exposure and forming a ~20-km transect oblique to the adjacent Cordillera Real. Lithostratigraphic characterization includes lithologic and stratigraphic descriptions of units and their contacts. We targeted gravel and diamicton units for paleomagnetic sampling to address gaps in the only previous magnetostratigraphic study from this area. Paleomagnetic data – magnetic susceptibility and primary remanent magnetization revealed by progressive alternating field demagnetization – are derived from 808 individually oriented samples of flat-lying, fine-grained sediments. The datasets enable characterization of paleo-surfaces within the sequence, correlation between stratigraphic sections, and differentiation of asynchronous, but lithologically similar units. Correlation of the composite polarity sequence to the geomagnetic polarity time scale supports a range of late Cenozoic paleoenvironmental topics of regional to global importance: the number and ages of early glaciations in the tropical Andes; interhemispheric comparison of paleoclimate during the Plio-Pleistocene climatic transition; timing of and controls on inter-American faunal exchange; and the variability of Earth's paleomagnetic field.

Document type: 
Article
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Community Readiness and Momentum: Identifying and Including Community-driven Variables in a Mixed-method Rural Palliative Care Service Siting Model

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2018-04-06
Abstract: 

Background: Health service administrators make decisions regarding how to best use limited resources to have the most significant impact. Service siting models are tools that can help in this capacity. Here we build on our own mixed-method service siting model focused on identifying rural Canadian communities most in need of and ready for palliative care service enhancement through incorporating new community-driven insights.

Methods: We conducted 40 semi-structured interviews with formal and informal palliative care providers from four purposefully selected rural communities across Canada. Communities were selected by running our siting model, which incorporated GIS methods, and then identifying locations suitable as qualitative case studies. Participants were identified using multiple recruitment methods. Interviews were transcribed verbatim and the transcripts were reviewed to identify emerging themes and were coded accordingly. Thematic analysis then ensued.

Results: We previously introduced the inclusion of a ‘community readiness’ arm in the siting model. This arm is based on five community-driven indicators of palliative care service enhancement readiness and need. The findings from the current analysis underscore the importance of this arm of the model. However, the data also revealed the need to subjectively assess the presence or absence of community awareness and momentum indicators. The interviews point to factors such as educational tools, volunteers, and local acknowledgement of palliative care priorities as reflecting the presence of community awareness and factors such as new employment and volunteer positions, new care spaces, and new projects and programs as reflecting momentum. The diversity of factors found to illustrate these indicators between our pilot study and current national study demonstrate the need for those using our service siting model to look for contextually-relevant signs of their presence.

Conclusion: Although the science behind siting model development is established, few researchers have developed such models in an open way (e.g., documenting every stage of model development, engaging with community members). This mixed-method study has addressed this notable knowledge gap. While we have focused on rural palliative care in Canada, the process by which we have developed and refined our siting model is transferrable and can be applied to address other siting problems.

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Article
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Irreversible Ocean Thermal Expansion under Carbon Dioxide Removal

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2018-03-05
Abstract: 

In the Paris Agreement in 2015 countries agreed on holding global mean surface air warming to “well below 2 ◦C above pre-industrial” levels, but the emission reduction pledges under that agreement are not ambitious enough to meet this target. Therefore, the question arises of whether restoring global warming to this target after exceeding it by artificially removing CO2 from the atmosphere is possible. One important aspect is the reversibility of ocean heat uptake and associated sea level rise, which have very long (centennial to millennial) response timescales. In this study the response of sea level rise due to thermal expansion to a 1 % yearly increase of atmospheric CO2 up to a quadrupling of the pre-industrial concentration followed by a 1 % yearly decline back to the pre-industrial CO2 concentration is examined using the University of Victoria Earth System Climate Model (UVic ESCM). We find that global mean thermosteric sea level (GMTSL) continues to rise for several decades after atmospheric CO2 starts to decline and does not return to pre-industrial levels for over 1000 years after atmospheric CO2 is restored to the pre-industrial concentration. This finding is independent of the strength of vertical sub-grid-scale ocean mixing implemented in the model. Furthermore, GMTSL rises faster than it declines in response to a symmetric rise and decline in atmospheric CO2 concentration partly because the deep ocean continues to warm for centuries after atmospheric CO2 returns to the pre-industrial concentration. Both GMTSL rise and decline rates increase with increasing vertical ocean mixing. Exceptions from this behaviour arise if the overturning circulations in the North Atlantic and Southern Ocean intensify beyond pre-industrial levels in model versions with lower vertical mixing, which leads to rapid cooling of the deep ocean.

Document type: 
Article

A Challenging Entanglement: Health Care Providers’ Perspectives on Caring for Ill and Injured Tourists on Cozumel Island, Mexico

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2018-06-05
Abstract: 

Purpose: Despite established knowledge that tourists often fall ill or are injured abroad, little is known about their treatment. The intent of this study was to explore health care professionals’ treatment provision experiences on Cozumel Island, Mexico. Methods: 13 semi-structured interviews were undertaken with professionals across a number of health care vocations on Cozumel Island. Interviews were transcribed and thematically analysed to determine common challenges faced in the provision of treatment for transnational tourists. Results: Three thematic challenges emerged from the data: human and physical resource deficiencies, medical (mis)perceptions held by patients and complexities surrounding remuneration of care. Health care providers employ unique strategies to mitigate these challenges. Conclusion: Although many of these challenges exist within other touristic and peripheral spaces, we suggest that the challenges experienced by Cozumel Island’s health care professionals, and their mitigation strategies, exist as part of a complex entanglement between the island’s health care sector and its dominant tourism landscape. We call on tangential tourism services to take a larger role in ensuring the ease of access to, and provision of quality health care services for tourists on Cozumel Island.

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Article
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Palaeogeographical reconstruction and hydrology of glacial Lake Purcell during MIS 2 and its potential impact on the Channeled Scabland, USA

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2020-01-13
Abstract: 

Large, ice-marginal lakes that were impounded by the maximally-extended Cordilleran Ice Sheet (CIS) provided source waters for the extraordinarily large floods that formed the Channeled Scabland of Washington and Idaho, USA.  However, flood flows that drained CIS meltwater and contributed to landscape evolution during later stages of deglaciation have hitherto been poorly investigated.  This paper provides the first evidence for such a late deglacial floodwater source: glacial Lake Purcell (gLP). Sedimentary evidence records the northward extension of gLP from Idaho, USA into British Columbia, Canada and establishes its minimum palaeogeographical extent.  Sedimentary evidence suggests that the deglacial Purcell Lobe was a capable ice dam that impounded large volumes of gLP water.  A review of glacioisostatically affected lakes during CIS deglaciation suggests that gLP could have been subjected to tilts ranging from 0 – >1.25 m km-1. Sedimentary evidence suggests high lake plane tilts (⪆1.25 m km-1) are the most likely to have affected gLP.  Using this, the palaeogeography and volume of gLP are modelled, revealing that ~116 km3 of water was susceptible to sudden drainage into the Channeled Scabland via the Columbia River system. This calculation is supported by sedimentary and geomorphic evidence compatible with energetic flood flows along the gLP drainage route and suggests gLP drained suddenly, causing significant landscape change.

Document type: 
Article
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Facilitating Equitable Community-Level Access to Maternal Health Services: Exploring the Experiences of Rwanda’s Community Health Workers

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2019-11-26
Abstract: 

Background

In Rwanda, community health workers (CHWs) are an integral part of the health system. For maternal health, CHWs are involved in linking members of the communities in which they live to the formal health care system to address preventative, routine, and acute maternal care needs. Drawing on the findings from in-depth interviews with maternal health CHWs and observational insights in ten Rwandan districts, we identify specific strategies CHWs employ to provide equitable maternal care while operating in a low resource setting.

Methods

Using case study methodology approach, we conducted interviews with 22 maternal health CHWs to understand the nature of their roles in facilitating equitable access to maternal care in Rwanda at the community level. Interviews were conducted in five Rwandan districts. Participants shared their experiences of and perceptions on promoting equitable access to maternal health service in their communities.

Results

Four key themes emerged during the analytic process that characterize the contexts and strategic ways in which maternal health CHWs facilitate equitable access to maternal care in an environment of resource scarcity. They are: 1) community building; 2) physical landscapes, which serve as barriers or facilitators both to women’s care access and CHWs’ equitable service provision; 3) the post-crisis socio-political environment in Rwanda, which highlights resilience and the need to promote maternal health subsequent to the genocide of 1994; and, 4) the strategies used by CHWs to circumvent the constraints of a resource-poor setting and provide equitable maternal health services at the community level.

Conclusion

Rwanda’s maternal CHWs are heavily responsible for promoting equitable access to maternal health services. Consequently, they may be required to use their own resources for their practice, which could jeopardize their own socio-economic welfare and capacity to meet the demands of their families. Considering the unpaid and untrained nature of this position, we highlight the factors that threaten the sustainability of CHWs’ role to facilitate equitable access to maternal care. These threats introduce turbulence into what is a relatively successful community-level health care initiative.

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