How Best to Serve Seniors on Existing Transit Services, MTI Report 01-04

Increases in the size of the elderly population and changes in travel patterns are expected to create significant new mobility expectations. The research documented here is intended to provide tools for transit providers and public policy makers to make the greatest use of existing transit resources to serve mobility needs of the growing senior population. The research demonstrates how customer satisfaction surveys can be used to set priorities for improving existing fixed route services. The primary analysis technique used is the impact score technique. This method determines the relative impact of various improvements on overall customer satisfaction. It does this by measuring how much customers’ overall satisfaction changes depending on their satisfaction with particular aspects of service. Satisfaction data from rider surveys from three West Coast transit systems were analyzed, comparing the responses of seniors and non-seniors. Many of the results are specific to individual transit systems; however, a number of general patterns were observed: 1) in general, seniors appear to rate service attributes more highly than do non-seniors; 2) while importance scores for non-seniors tended to cluster together, the results for seniors appear to indicate that certain service attributes are significantly more important than others; 3) at the two systems that used a similar method of survey administration and question format, there is broad consistency in importance ratings for seniors. Among the most important attributes at both systems were drivers, reliable equipment, and on-time performance. Direct questioning suggests that the greatest increase in ridership would result from adding service. However, the impact analysis shows that other improvements could have a greater impact on customer satisfaction

Palliative and End of Life Care for Black, Asian, and Minority Ethnic Groups in the UK

This report marks the start of a programme of work by many partners. A better understanding of the nation's changing demographics, of the needs of individual ethnic and cultural groups and of the types of services which will best meet their end of life care needs must be early outputs from the partnership. There are many areas which researchers will investigate further and many opportunities for service providers to work together with local communities to develop care which is sensitive and responsive to their needs as well as on a scale which will be needed for the large numbers of people who could benefi

Resonance Enhanced Tunneling

Time evolution of tunneling in thermal medium is examined using the real-time semiclassical formalism previously developed. Effect of anharmonic terms in the potential well is shown to give a new mechanism of resonance enhanced tunneling. If the friction from environment is small enough, this mechanism may give a very large enhancement for the tunneling rate. The case of the asymmetric wine bottle potential is worked out in detail.Comment: 12 pages, LATEX file with 5 PS figure

Exploring meanings of illness causation among those severely affected by multiple sclerosis: a comparative qualitative study of Black Caribbean and White British people

BACKGROUND: Illness attributions, particularly for those living with life limiting illnesses, are associated with emotional adjustment or psychological distress. Few studies have examined attributions among people severely affected by multiple sclerosis (PwMS), and specifically among from diverse communities. This study aimed to explore and compare the presence and construction of meanings among Black Caribbean and White British PwMS.METHODS: Cross sectional qualitative interviews were conducted among Black Caribbean (BC) and White British (WB) PwMS with an EDSS of ≥6.0 (severe disease). Data were analysed using the framework approach.RESULTS: 15 BC and 15 WB PwMS were interviewed. Attributions were complex with most PwMS reporting multiple explanations. Uncertainty, represents the first theme surrounding the aetiology of MS where participants constantly rehearsed the "why me?" question in relation to their illness, a number expressing considerable frustration. The second theme, 'logical and scientific', was voiced more often by WB PwMS and accounts for a range of genetic/viral influences, stress, environmental and lifestyle factors. Third, the 'supernatural' illness attribution theme departs from a biomedical perspective and was reported often among BC PwMS. This theme included the sub-categories of tests of faith and divine punishment, a view although exclusive to BC participants but was sometimes in conflict with notions of modernity.CONCLUSION: Our findings identify evidence of cross-cultural and intra-group diversity in relation to MS causation. A greater professional awareness of the processes used by PwMS from diverse communities to make sense of their situation will enable health care professionals to facilitate effective support for those in their care and channel relevant psychosocial resources to them. This requires heightened skills in communication and cultural competency.</p

Exploring access to end of life care for ethnic minorities with end stage kidney disease through recruitment in action research

BACKGROUND: Variation in provision of palliative care in kidney services and practitioner concerns to provide equitable access led to the development of this study which focussed on the perspectives of South Asian patients and their care providers. As people with a South Asian background experience a higher risk of Type 2 Diabetes (T2DM) and end stage kidney failure (ESKF) compared to the majority population but wait longer for a transplant, there is a need for end of life care to be accessible for this group of patients. Furthermore because non English speakers and people at end of life are often excluded from research there is a dearth of research evidence with which to inform service improvement. This paper aims to explore issues relating to the process of recruitment of patients for a research project which contribute to our understanding of access to end of life care for ethnic minority patients in the kidney setting. METHODS: The study employed an action research methodology with interviews and focus groups to capture and reflect on the process of engaging with South Asian patients about end of life care. Researchers and kidney care clinicians on four NHS sites in the UK recruited South Asian patients with ESKF who were requiring end of life care to take part in individual interviews; and other clinicians who provided care to South Asian kidney patients at end of life to take part in focus groups exploring end of life care issues. In action research planning, action and evaluation are interlinked and data were analysed with emergent themes fed back to care providers through the research cycle. Reflections on the process of patient recruitment generated focus group discussions about access which were analysed thematically and reported here. RESULTS: Sixteen patients were recruited to interview and 45 different care providers took part in 14 focus groups across the sites. The process of recruiting patients to interview and subsequent focus group data highlighted some of the key issues concerning access to end of life care. These were: the identification of patients approaching end of life; and their awareness of end of life care; language barriers and informal carers' roles in mediating communication; and contrasting cultures in end of life kidney care. CONCLUSIONS: Reflection on the process of recruitment in this action research study provided insight into the complex scenario of end of life in kidney care. Some of the emerging issues such as the difficulty identifying patients are likely to be common across all patient groups, whilst others concerning language barriers and third party communication are more specific to ethnic minorities. A focus on South Asian ethnicity contributes to better understanding of patient perspectives and generic concepts as well as access to end of life kidney care for this group of patients in the UK. Action research was a useful methodology for achieving this and for informing future research to include informal carers and other ethnic groups.Peer reviewedFinal Published versio

Easy in Any Language: Syntax, Semantics, and Pragmatics of Activity-Oriented Adjectives in Six Languages

Words that denote the degree of effort required for some activity, called easy adjectives here, have distinctive behavior. This behavior is explored in six languages to determine how the semantics of these words is reflected in the expressions to which they can apply, the constructions in which they appear, and their use in discourse. For four Indo-European languages, English, Spanish, German, and Russian, the analysis is based on random samples from linguistic corpora. For two non-Indo-European languages, Japanese and Swahili, the analysis is based on consultant elicitations and published examples. The analysis confirms that easy adjectives have distinctive behavior compared to prototypical adjectives that describe properties of things. In every language studied, easy adjectives (such as English easy, difficult, and hard) apply exclusively to: finite and non-finite clauses; Noun Phrases (NPs) that denote activities, including de-verbal nominalizations; NPs that act as metonymies for activities due to frame-semantic associations; NPs that appear in constructions along with an explicitly stated activity; and pro-forms with non-specific antecedents. Details are given of the specific constructions employed in these patterns, showing how a variety of syntactic means are employed in different languages to achieve the same functions. Corpus data for the four Indo-European languages are used to show how the behavior of evaluation adjectives (those that describe the value, cost, or benefit of an activity) differs from that of easy adjectives despite some similarities that have been the focus of prior literature

Evaluating Flexible Transport Solutions

Flexible transport services (FTS) have been of increasing interest in developed countries as a bridge between the use of personal car travel and fixed route transit services. This paper reports on findings from a recent study in Queensland Australia, which identified lessons from an international review and implications for Australia. Potential strategic directions, including a vision, mission, key result areas, strategies, and identified means of measuring performance are described. Evaluation criteria for assessing flexible transport proposals were developed, and approaches to identifying and assessing needs and demands outlined. The use of emerging technologies is also a key element of successful flexible transport services

Migraine Headache associated with Multiple Sclerosis: Results from the Nationwide Inpatient Sample

Background: Multiple Sclerosis (MS) is an immune-mediated disease that targets and injures myelin and axons in the central nervous system. A high prevalence of migraine headache has been reported among MS patients. In this study, we investigated variables affecting migraine headache occurrence in MS patients.Methods: The Health Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) data was utilized. MS hospitalizations (“cases”) were identified by ICD-9-CM code 340. Non-MS Hospitalizations were matched to cases 1:1 by age and gender.  Results: We identified 18955 MS patients between 2010 and 2013. The prevalence of migraine among MS patients (7%) was significantly higher than the control group (2.8%). Unspecified Migraine constituted the highest percentages of migraine subtype in both groups. All subtypes of headache, except migraine without aura, were significantly higher among MS patients compared to the control group. Among MS patients, younger age, white race, female gender, depression, and obesity were significant predictors of migraine.   Conclusions: Our study provides prevalence data for different subtypes of headache and confirms depression and obesity as risk factors for migraine