Historical Ecology: A Robust Bridge between Archaeology and Ecology

How can the disintegration of ecosystems, the foundation of life on Earth, be halted and these critical systems be rehabilitated? For scholars, the action list is long: increase the pool of expertise by engaging all relevant knowledge communities, collect rapidly disappearing data, analyze with both familiar and new methods, and apply the results of actionable science to policy and practice. This enormously complex and urgent activity requires an integrated research framework with the flexibility to accommodate the global diversity of places, peoples, and processes and to examine future options. Based on evidence of environmental change and human activity, the framework termed historical ecology assembles tools to construct an evidence-validated, open-ended narrative of the evolution and transformation of specific ecosystems and landscapes. Welcoming knowledge from scholars and communities of both heritage and practice, this comprehensive and systemic understanding offers insights, models, and ideas for the durable future of contemporary landscapes. The article evaluates how practitioners could adjust aspects of practice and improve access to policy makers, and the discussion applies to regions and localities everywhere.

Development of parametric garment pattern design system

PurposeThe development of a parametric garment pattern design system that utilizes anthropometric data for consumer-oriented garment pattern design.Design/methodology/approachAction list and interactive user interface were developed to design flat garment patterns. Three-dimensional drape simulation was also implemented to verify the fit of patterns.FindingsPatterns generated by the parametric design system developed in this study could be modified easily by providing appropriate anthropometric data regardless of their complexities.Practical implicationsParametric pattern design system can reduce considerable amount of time and cost by replacing the trial-and-error based grading processes.Social implicationsParametric pattern design system can generate customized garment patterns quickly and easily. Therefore, it is expected to contribute to the production of sustainable fashion and textile by reducing the loss of time and resource.Originality/valueA versatile and comprehensive action list structure was implemented to manage the drawing actions of the user. Various numerical analysis methods were also used to maintain the geometrical validity of patterns.

Analisis Postur Kerja pada Pengangkutan Buah Kelapa Sawit menggunakan Metode RULA dan REBA

Aktivitas pengangkatan dan penurunan buah kelapa sawit merupakan aktivitas yang memiliki risiko cidera yang tinggi dengan berat beban tertentu, secara terus menerus dapat menyebabkan penyakit ataupun cedera tulang bagian belakang, terlebih jika pekerjaan tersebut dilakukan dengan tidak benar. Aktivitas ini merupakan pekerjaan yang sangat berbahaya, sehingga kemungkinan pekerja mengalami keluhan muskuloskeletal. Penelitian ini bertujuan untuk mengukur serta mengetahui postur kerja pekerja. Pengukuran dilakukan pada tubuh bagian atas dan tubuh bagian bawah. Metode yang digunakan dalam penelitian ini yaitu Rapid Uper Limb Assessment (RULA) dan Rapid Entire Body Assessment (REBA). Hasil pengukuran didapat skor rata-rata Rapid Uper Limb Assessment (RULA) yaitu 5 termasuk kedalam Action List 3 dengan risiko sedang dan menunjukkan bahwa penyelidikan dan perubahan dibutuhkan segera. Hasil pengukuran Rapid Entire Body Assessment (REBA) didapat skor rata-rata yaitu 11 termasuk kedalam Action List 4 dengan level risiko sangat tinggi dan tindakan perbaikan perlu saat ini juga. Usulan perbaikan yang efektif yaitu berupa rekomendasi alat bantu katrol.

Impact of a Certified Asthma Educator Pharmacist on Medication Adherence in Patients with Persistent Asthma in an Inner-City Hospital

Background: The medication management for people with asthma (MMA) Healthcare Effectiveness Data and Information Set (HEDIS) measure assesses adherence to controller therapy >75% of the calendar year. A new “Action List” feature recently incorporated into Allscripts, the hospital electronic health record (EHR), is used by a certified asthma educator (AE-C) pharmacist to track both the progress of and to improve patients’ MMA measures.Objective: To evaluate the impact of an AE-C pharmacist using an EHR Action List on improving the number of patients with a MMA >75% compared to a pre-intervention group. Methods: This was a retrospective, pre-post cohort study assessing the impact of an AE-C pharmacist on 2017 versus 2016 calendar year MMA measures. During the intervention period, the AE-C pharmacist conducted patient follow-up calls, as per the Action List, for refill reminders and identification/resolution of nonadherence. Providers were contacted for prescription renewals and insurance formulary changes. This data was compared with historical data from 2016.Results: One-hundred and fifty-five patients were identified, 100 in the 2017 pharmacyintervention group and 55 in the pre-intervention (pre Action List) group. There was no significant increase in the MMA >75% measure in the Action List group when compared with the pre-intervention group (46% vs. 34.6%, p=0.1667). More patients who met the MMA measure were seen by a pulmonologist versus a primary care provider in both groups.Conclusions: The AE-C pharmacist intervention was associated with a non-significant 11.4% increase in patients with a MMA >75%. This small preliminary study suggests promising results for the use of pharmacists to improve HEDIS measures, especially in PCP clinics.

EMR-based handoff tool improves completeness of internal medicine residents’ handoffs

BackgroundThe majority of adverse events in healthcare involve communication breakdown. Physician-to-physician handoffs are particularly prone to communication errors, yet have been shown to be more complete when systematised according to a standardised bundle. Interventions that improve thoroughness of handoffs have not been widely studied.AimTo measure the effect of an electronic medical record (EMR)-based handoff tool on handoff completeness.InterventionThis EMR-based handoff tool included a radio button prompting users to classify patients as stable, a ‘watcher’ or unstable. It automatically pulled in EMR data on the patient’s 24-hour vitals, common lab tests and code status. Finally, it provided text boxes labelled ‘Active Issues’, ‘Action List (To-Dos)’ and ‘If/Then’ to fill in.Implementation and evaluationWritten handoffs from general and specialty (haematology, oncology, cardiology) Internal Medicine resident-run inpatient wards were evaluated on a randomly chosen representative sample of days in April and May 2015 at Stanford University Medical Center, focusing on a predefined set of content elements. The intervention was then implemented in June 2015 with postintervention data collected in an identical fashion in August to September 2016.ResultsHandoff completeness improved significantly (p<0.0001). Improvement in inclusion of illness severity was notable for its magnitude and its importance in establishing a consistent mental model of a patient. Elements that automatically pulled in data and those prompting users to actively fill in data both improved.ConclusionA simple EMR-based handoff tool providing a mix of frameworks for completion and automatic pull-in of objective data improved handoff completeness. This suggests that EMR-based interventions may be effective at improving handoffs, possibly leading to fewer medical errors and better patient care.