Study of citizen satisfaction and loyalty in the urban area of Guayaquil: Perspective of the quality of public services applying structural equations.

This study investigates the satisfaction and adequacy of citizens through the expected quality and perceived quality in the areas of planning and territorial viability, experience in the provision of municipal services and citizen experience in environmental issues, in order to provide tools for territorial decision making for the citizens' well-being. In our research PLS software is used for the analysis of hypotheses. A questionnaire was delivered to a sample of 521 citizens, representing the spectrum of the population, and the statistical study of the responses yielded results on citizen satisfaction and loyalty. Our research includes the study of moderating effects on the causal ratio of perceived value and satisfaction in territorial planning and viability, the perceived quality in the provision of municipal services and the perceived quality in the citizen experience in the environmental management of the territory on the value relationship perceived by the citizen and general satisfaction. A second objective of the study is to see if there are significant differences in the hypotheses raised by gender by performing a multigroup analysis. This difference has been appreciated in two of the hypotheses. The study shows that the policies exercised by the territorial managers of the different areas have a significant influence on the value perceived by citizens, satisfaction and loyalty, which shape their general well-being. Areas for improvement in territorial policies and municipal services such as citizen security, air quality, public lighting and sports services have been identified. Knowing these shortcomings allows politicians to focus their efforts on improving the quality of life in cities.

A Scoping Review of Bikeability Assessment Methods.

Bicycling holds promise as a healthy and sustainable means of transportation and physical activity. Despite the growing interest in community-based environmental approaches to promoting physical activity, bikeability has received relatively little attention. This paper provides a scoping review of the instruments developed to measure bikeability along with practice-based analyses of the tools related to user expertise, estimated cost, and required time to implement. The review summarizes the literature, identifies research gaps, and informs stakeholders with articles from EBSCO and transportation databases published after 2003 when the previous bikeability instrument review paper was published. Data extraction included the tool name, data collection method, study location, data collection scale, type of measure, and description. Two reviewers independently reviewed articles included in the full text review, and the inter-rater agreement exceeded 90%. The database search yielded 388 unique articles, and 17 met the inclusion/exclusion criteria. Most of the studies, 11 of 17, were applied to settings outside of the U.S. Five studies employed a self-report survey, and five studies examined bikeability using geospatial data, like GIS. Seven studies used a direct observation audit tool-one specifically using a mobile app and another using virtual observation techniques with Google Street View. Bikeability tools are useful for assessing communities and their supports for bicycling. Our primary finding is that advances in technology over the past two decades have driven innovative and useful methodologies, in a variety of disciplines, for assessing the environment, but more consensus is needed to provide a universal definition of bikeability.

Inclusive Parks across Ages: Multifunction and Urban Open Space Management for Children, Adolescents, and the Elderly.

In urban areas where increased density has caused loss of urban open space (UOS), there is a need for high-quality parks that are inclusive and fit for multiple user groups. To make parks more inclusive, UOS management may need to consider multifunction and the perspectives of various age groups in future development and maintenance activities. Walking interviews were conducted in a park in central Landskrona, Sweden, with children, adolescents, and elderly users, and also with the head park manager of the city. The results revealed different perspectives among the three age groups of users concerning affordances and UOS management. The manager described user-oriented management to support multifunction and inclusion, including user participation. All user groups studied showed an appreciation of liveliness, contact with nature, social places for their own age group, clean and safe parks, and a variety of different atmospheres and activities in the park. Social multifunction can be developed in programmed or non-programmed ways, but some functions interfere with each other. UOS managers can develop parks to suit different age groups, promote user participation within management, and develop social multifunction to create inclusive parks for various age groups.

A project to identify the best practices and health performance objectives for building construction and renovation.

The 2014-2018 National Prevention Plan (NPP), in order to promote a correct relationship between health and the environment, indicated, among the central objectives, the definition of guidelines to promote the building hygiene codes in an eco-compatible way, but also to develop specific skills on the subject of confined environments and residential construction in the operators of the Regional Health Services. The CCM2015 Project has therefore set itself the goal of taking stock of the best health practices available today in terms of sustainability and eco-compatibility in the buildings' construction and renovation actions. All this in order to define updated health performance targets to be made available to the competent Authorities, to adapt the current legislation at national, regional and local level, and finally to define the contents of a continuing education (training courses) capable to support operators in risk assessment related to the built environment and in the definition of effective preventive measures.

Reliability of T-WSI to Evaluate Neighborhoods Walkability and Its Changes over Time.

More walkable neighborhoods are linked to increased physical activity. The Walking Suitability Index of the territory (T-WSI) is an easy method to evaluate walkability on the basis of direct observation. T-WSI provides 12 indicators divided into 4 categories (practicability, safety, urbanity, pleasantness); the weighted analysis of these indicators gives an overall score of the actual usability of the neighborhood. The aim of the study is to evaluate the ability of T-WSI' indicators to measure, in a reliable way, any street's walkability variations occurred over time. The investigation was performed in 2018 in nine urban neighborhoods of Rieti city. Cronbach's α is used to evaluate internal consistency of T-WSI; Intraclass Correlation Coefficient (ICC) is used to evaluate the reproducibility of measurements (or ratings) made by different investigators. Cronbach's α is 0.89 (± 0.02); ICC is also good (ICC = 0.89; 95% CI: 0.84-0.92). The results of the 2018 investigation are also compared with those collected in 2016 in the same districts. The results show that T-WSI is a reliable and easy to use tool, useful to measure the effectiveness of the interventions already realized at local level, but it could also contribute to making decisions to develop regeneration projects.

Modeling of a novel risk index for evaluating the geometric designs of roundabouts.

In the geometric design of roundabouts, safety-oriented approaches are required rather than specification design ones that simply determine the dimensions of the geometric structural elements. We herein propose a risk index (RI) that combines the invisibility probability and the crash impact as a performance measure for evaluating the safety of the geometric designs of roundabouts, and we also describe a method for calculating this index. Invisibility probability represents the probability that an entering vehicle cannot view a vehicle coming from the upstream in a circulatory roadway and crash impact represents the amount of lost kinetic energy at the time of collision corresponds to the impact of the crash. A numerical simulation to model this RI on the basis of various geometric conditions is further presented. It is demonstrated that the invisibility probability is large when the entry angle is small and that the crash impact increases when the deviation angle decreases. The proposed approach is expected to help resolve issues with currently existing roundabouts and improve the design of future roundabouts to enhance their safety performance.

The Appropriateness of Adapting the Australian Environmental Assessment Tool-High Care (EAT-HC) for Persons With Dementia in Singapore.

OBJECTIVES: This study investigated the level of acceptance in Singapore of the eight principles of design underpinning the Environmental Assessment Tool-High Care (EAT-HC), which is commonly used in Australia to evaluate environments for the care of people living with dementia. A secondary goal was to identify topics particularly relevant to the Singaporean context, which are not included in the Australian EAT-HC. BACKGROUND: This study was undertaken in preparation for the development of a Singaporean version of the Australian EAT-HC. METHODS: Discussions from 23 focus groups involving 150 family caregivers, aged care staff, administrators, and architects were recorded and thematically analyzed to identify the characteristics of the principles underpinning the EAT-HC that are unlikely to be relevant in a Singaporean version and to identify additional topics required to tailor it to reflect the Singaporean culture. The thematic analysis was supplemented with quantitative data obtained through the use of simple Likert-type scales measuring the appropriateness of each principle in the Singaporean context. RESULTS: The principles of design that underpin the EAT-HC were highly accepted by participants and provided a framework for a systematic exploration of Singaporean residential care for people with dementia. Some topics of particular relevance to Singapore were identified. These can be subsumed by the principles without the need for the principles to be changed. CONCLUSION: The results support the use of the design principles underpinning the EAT-HC as the foundation of a tool for the evaluation of Singaporean dementia facilities.

Investigating safety effects of wider longitudinal pavement markings.

Many road authorities in Canada have been contemplating the use of wider longitudinal pavement markings (LPMs) to enhance road safety and driver comfort. However, conclusive evidence on the safety impacts of wider LPMs has not been available. To address this gap in the literature, this study was conducted to investigate the safety impacts of wider LPMs. The study adopted the Full Bayes approach to conduct a before and after safety evaluation, using data collected from 38 treatment sites (highway segments) from three Canadian jurisdictions (i.e., British Columbia, Alberta, and Quebec). Collision and traffic data were obtained from the 38 sites over a period of eight years (2008-2015). The widths of LPMs at all sites were increased between 2012 and 2013, which enables a before and after safety evaluation to investigate the impact of the wider markings on the collision frequency. The results showed an overall significant reduction in both total collisions and target collisions (i.e., run-off-the-road collisions) by 12.3 % and 19.0 %, respectively, after implementing the wider LPMs. Total collisions were reduced by 11.1 %, 27.5 %, and 1.1 % in Alberta, British Columbia, and Quebec, respectively. Similarly, a reduction in the run-off-the-road collisions that ranged between 22.7 % and 28.9 % were observed in the three jurisdictions. The results suggest that wider longitudinal pavement markings can reduce collisions and improve safety on Canadian highways. As such, road authorities should consider using this intervention to enhance road safety, particularly, at locations that experience a high frequency of run-off-the-road collisions.

Documentary analysis in the study of architectural designs of a hospital in the city of São Paulo.

OBJECTIVES: to report the experience of using architectural designs of a hospital for a historical documentary research. METHODS: report of the experience of the methodological route of using architectural designs of a model hospital from 1974 to 2002. RESULTS: after being spread on a worksheet, the projects of interest were selected, enabling the data arrangement, where the analytical chart was applied, containing: context; authorship; authenticity/ reliability; nature of the text and preliminary analysis. The findings were grouped by pertinence and similarity, resulting in the construction of categories of analysis. FINAL CONSIDERATIONS: architectural design is a challenging source, both for its pursuit, since it took two and a half years until it was legally licensed, as well as for involving specific terminologies and symbology of its own. A special attention should be given to the selection criteria, organization and analysis of the document, and sharing the access of unusual sources with the health area, like this one, so as to stimulate the development of research.

Increasing translation of research evidence for optimal park design: a qualitative study with stakeholders.

BACKGROUND: The design of parks is critical to ensure they are appealing, meet the needs of the community and optimise opportunities for physical activity, relaxation, exposure to nature and social interaction. There is currently a lack of understanding on how research evidence is informing park design and how to reduce the many challenges associated with research-practice-policy translation. Understanding how organisations use evidence for decision-making regarding park design is critical for reducing the research-practice-policy gap and ensuring evidence based strategies inform park design to support healthy active living. This study explored stakeholder perceptions regarding factors that influence the use of research evidence to inform park planning and design, and potential strategies to enhance effective translation of research evidence for optimal park design into policy and practice. METHODS: One-on-one in-depth interviews were conducted with 23 stakeholders within the park design, planning and management sector. Participants shared experiences regarding: influences on park development and design; current park development policies; ways to facilitate use of evidence; and priorities for future research. Interviews were recorded and transcribed verbatim and content analysis performed using NVivo 12. RESULTS: Research evidence is used and considered important for park planning; however, several barriers were highlighted: time and cost constraints; difficulties accessing research; and limited research relevant to specific needs. Developing partnerships between researchers and park developers and providing evidence in a more accessible format such as short summaries/reports, infographics, presentations, research updates and dedicated research databases emerged as key enablers. The main research gaps identified included research into park features to encourage visitation and cost-benefit analyses studies. CONCLUSIONS: This research is a first step to better understand strategies to promote more effective uptake and use of evidence to inform park planning. Researchers must develop multi-sectoral collaborations and generate policy-relevant research in a readily accessible, timely and user-friendly format to ensure evidence is used to enhance park design and ultimately public health.

Relocating to a New OR Suite: Practical Observations.

Operating room renovation projects usually involve updated technology and processes that can create challenges for administrative leaders (eg, maintaining a surgery schedule during a move) and require staff member adjustments. The perioperative team of a large tertiary care and trauma center relocated from a 35-year-old suite to a new suite, which required years of planning, months of training, and weeks of organizing. This article discusses the processes and observations that helped ensure a smooth transition to the new space. Early planning allowed time for leaders to make equipment decisions, develop and test new processes, and train staff members. The actual move required detailed planning, thorough execution, patience, and flexibility to ensure a safe transition. Perioperative leaders balanced operational needs with relocation plans to maintain patient and staff member safety. Open, multidisciplinary communication combined with staff member participation and buy-in contributed to an efficient, safe move at this facility.

Examining the Impact of Knowledge Mobilization Strategies to Inform Urban Stakeholders on Accessibility: A Mixed-Methods study.

Urban areas offer many opportunities for people with disabilities, but limited accessibility may prevent their full engagement in society. It has been recommended that the experience-based perspective of people with disabilities should be an integral part of the discussion on urban accessibility, complementing other stakeholder expertise to facilitate the design of more inclusive environments. The goals of this mixed-method study were to develop knowledge mobilization (KM) strategies to share experience-based findings on accessibility and evaluate their impact for various urban stakeholders. Using a participatory approach, various KM strategies were developed including videos, a photo exhibit and an interactive game. These strategies were evaluated based on various impact indicators such as reach, usefulness, partnerships and practice changes, using quantitative and qualitative methods. The findings suggested that the KM strategies were effective in raising the awareness of various urban stakeholders and providing information and guidance to urban planning practices related to accessibility.

Perspectives on "Novel" Techniques for Designing Age-Friendly Homes and Neighborhoods with Older Adults.

Worldwide, growth in the older population creates a pressing need to develop supportive environments that enhance quality of life as people age. Too often, built environments present barriers and challenges to older adults that compromise independent living and adversely affect health and life outcomes. Designing homes, buildings, and neighborhoods with older adults, through exercises in participatory or co-design, could help ensure that environments are better able to facilitate healthy aging. However, while it is potentially advantageous to involve this age group in environmental design decisions, doing so can be difficult. Analysis of and guidance on effective ways to involve older adults in these activities could make the challenge easier. With this aim in mind, this article provides critical perspectives on eight "less traditional" engagement techniques-walking interviews, photovoice, photo-elicitation, Talking Mats®, participatory mapping, drawing, model-making, and the "Design Fair". Insights into the strengths and limitations of these techniques, gained from observation of their use in participatory design activities, as well as feedback collected from older co-design participants, are presented. The article concludes by offering a number of practical recommendations for those interested in designing age-friendly homes and neighborhoods with older people.

Evaluation of an Exclusive Spur Dike U-Turn Design with Radar-Collected Data and Simulation.

Traditional U-turn designs can improve operational features obviously, while U-turn diversions and merge segments still cause traffic congestion, conflicts, and delays. An exclusive spur dike U-turn lane design (ESUL) is proposed here to solve the disadvantages of traditional U-turn designs. To evaluate the operation performance of ESUL, a traffic simulation protocol is needed. The whole simulation process includes five steps: data collection, data analysis, simulation model build, simulation calibration, and sensitive analysis. Data collection and simulation model build are two critical steps and are described later in greater detail. Three indexes (travel time, delay, and number of stops) are commonly used in the evaluation, and other parameters can be measured from the simulation according to experimental needs. The results show that the ESUL significantly diminishes the disadvantages of traditional U-turn designs. The simulation can be applied to solve microscopic traffic problems, such as in single or several adjacent intersections or short segments. This method is not suitable for larger scale road networks or evaluations without data collection.

Cross-National Comparison of Environmental Factors Important to Facility-Based Senior Living.

OBJECTIVE: Focusing on environmental factors important to facility-based senior living, this research intends to identify cross-national similarities and differences in perspective on elderly care between senior-living professionals in the United States and China. BACKGROUND: American models of senior-living facility design have been introduced in China. In social and cultural context, environmental factors important to facility-based senior living are expected to be different by nation and need to be clarified. METHOD: Questionnaire data were collected from 188 staff members working in senior-living facilities in the United States and China. Seven factors summarized through literature review were investigated. The frequencies of each factor selected by the participants as one of the three most important factors were ranked. The influence of personal and social factors on environmental perception was analyzed using analysis of variance tests. RESULTS: Common area and cross-facility home-like decoration were similarly valued by both groups as two of the three most important factors. Residential room was valued more in the United States whereas natural lighting was valued more in China. Chinese participants with more work experience valued building layout more. Amenities were valued less than expected in both countries. CONCLUSION: Environmental factors important to facility-based senior living are different between countries. American models of senior-living facility design should be adjusted for use in China. There is much to be gained from investigating the similarities and differences in perspective on elderly care.

Developing, validating and testing a ward environment assessment tool.

AIMS: To develop, validate and test a ward environment assessment tool (WEAT) for post-occupancy evaluation of hospital wards from the perspectives of ward nurses, using Person-Environment fit theory. BACKGROUND: It is argued that as the needs and expectations of various user groups of healthcare facilities would vary, so would the tools to measure the suitability of the architectural design features of these healing environments for different groups of users. However, a review of relevant literature revealed that there is a dearth of assessment tools to appraise the adequacy of healthcare facilities for nursing staff. METHODS: Extant literature was reviewed to construct WEAT. Twenty ward nurses were interviewed to obtain user perspectives on the ward environment. Post-occupancy evaluation of three hospital wards was undertaken to validate and test WEAT. RESULTS: WEAT: A new post-occupancy evaluation tool was created. CONCLUSIONS: WEAT measures the impacts of ward environment on nurses in four personal constructs; namely physical, cognitive, sensory and universal. IMPLICATIONS FOR NURSING MANAGEMENT: WEAT is an innovative management decision-making tool for ward managers, who may use its results to argue for workspace redesign with facilities managers, explore job readjustments with occupational health nurses and review job description with human resource managers.

Cognitive Aids in Obstetric Units: Design, Implementation, and Use.

Obstetrics has unique considerations for high stakes and dynamic clinical care of ≥2 patients. Obstetric crisis situations require efficient and coordinated responses from the entire multidisciplinary team. Actions that teams perform, or omit, can strongly impact peripartum and perinatal outcomes. Cognitive aids are tools that aim to improve patient safety, efficiency in health care management, and patient outcomes. However, they are intended to be combined with clinician judgment and training, not as absolute or exhaustive standards of care for patient management. There is simulation-based evidence showing efficacy of cognitive aids for enhancing appropriate team management during crises, especially with a reader role, with growing literature supporting use in obstetric and nonobstetric clinical settings when combined with local customization and implementation efforts. The purpose of this article is to summarize current understanding and available resources for cognitive aid design, implementation, and use in obstetrics and to highlight existing gaps that can stimulate further enhancement in this field.

An alternative perspective on assistive technology: The person-environment-tool (PET) model.

The medical and social models of disability categorize people as ablebodied or disabled. In contrast, the biopsychosocial model, which forms the basis for the International Classification of Functioning, Disability and Health (ICF), suggests a universalistic perspective on human functioning, encompassing all human beings. In this article, we argue that the artificial separation of function-enhancing technology into assistive technology (AT) and mainstream technology (MST) might be one of the barriers to a universalistic view of human functioning. Thus, an alternative view of AT is needed. The aim of this article was to construct a conceptual model to demonstrate how all human activities and participation depend on factors related to the person, environment, and tools, emphasizing a universalistic perspective on human functioning. In the person-environment-tool (PET) model, a person's activity and participation are described as a function of factors related to the person, environment, and tool, drawing on various ICF components. Importantly, the PET model makes no distinction between people of different ability levels, between environmental modifications intended for people of different ability levels, or between different function-enhancing technologies (AT and MST). The PET model supports a universalistic view of technology use, environmental adapMcNeill tations, and variations in human functioning.

Speech Perception in Classroom Acoustics by Children With Hearing Loss and Wearing Hearing Aids.

Purpose The classroom acoustic standard ANSI/ASA S12.60-2010/Part 1 requires a reverberation time (RT) for children with hearing impairment of 0.3 s, shorter than its requirement of 0.6 s for children with typical hearing. While preliminary data from conference proceedings support this new RT requirement of 0.3 s, peer-reviewed data that support 0.3-s RT are not available on those wearing hearing aids. To help address this, this article compares speech perception performance by children with hearing aids in RTs, including those specified in the ANSI/ASA-2010 standard. A related clinical issue is whether assessments of speech perception conducted in near-anechoic sound booths, which may overestimate performance in reverberant classrooms, may now provide a more reliable estimate when the child is in a classroom with a short RT of 0.3 s. To address this, this study compared speech perception by children with hearing aids in a sound booth to listening in 0.3-s RT. Method Participants listened in classroom RTs of 0.3, 0.6, and 0.9 s and in a near-anechoic sound booth. All conditions also included a 21-dB range of speech-to-noise ratios (SNRs) to further represent classroom listening environments. Performance measures using the Bamford-Kowal-Bench Speech-in-Noise (BKB-SIN) test were 50% correct word recognition across these acoustic conditions, with supplementary analyses of percent correct. Results Each reduction in RT from 0.9 to 0.6 to 0.3 s significantly benefited the children's perception of speech. Scores obtained in a sound booth were significantly better than those measured in 0.3-s RT. Conclusion These results support the acoustic standard of 0.3-s RT for children with hearing impairment in learning spaces ≤ 283 m3, as specified in ANSI/ASA S12.60-2010/Part 1. Additionally, speech perception testing in a sound booth did not predict accurately listening ability in a classroom with 0.3-s RT. Supplemental Material https://doi.org/10.23641/asha.11356487.

Documentary analysis in the study of architectural designs of a hospital in the city of São Paulo / El análisis documental en el estudio de proyectos arquitectónicos de un hospital de la ciudad de São Paulo / A análise documental no estudo de projetos arquitetônicos de um hospital paulistano

ABSTRACT Objectives: to report the experience of using architectural designs of a hospital for a historical documentary research. Methods: report of the experience of the methodological route of using architectural designs of a model hospital from 1974 to 2002. Results: after being spread on a worksheet, the projects of interest were selected, enabling the data arrangement, where the analytical chart was applied, containing: context; authorship; authenticity/ reliability; nature of the text and preliminary analysis. The findings were grouped by pertinence and similarity, resulting in the construction of categories of analysis. Final Considerations: architectural design is a challenging source, both for its pursuit, since it took two and a half years until it was legally licensed, as well as for involving specific terminologies and symbology of its own. A special attention should be given to the selection criteria, organization and analysis of the document, and sharing the access of unusual sources with the health area, like this one, so as to stimulate the development of research.

RESUMEN Objetivos: informar la experiencia del uso de proyectos arquitectónicos de un hospital, en una investigación histórica y documental. Métodos: reporte de experiencia del recorrido metodológico del uso de proyectos arquitectónicos de 1974 a 2002 de un hospital modelar. Resultados: después de insertar los proyectos en planillas, se seleccionaron los proyectos de interés, creando un arreglo de datos en que se aplicó la ficha analítica que contenía: contexto; autoría; autenticidad/fiabilidad; naturaleza del texto y análisis preliminar. Los hallazgos fueron agrupados por pertinencia y semejanza, resultando en la construcción de categorías de análisis. Consideraciones Finales: el proyecto arquitectónico es una fuente desafiante, tanto para su búsqueda, ya que fueron necesarios dos años y medio hasta que recibieron la licencia legal, como por involucrar terminologías específicas y simbologías propias. Se debe prestar atención a los criterios de selección, organización y análisis del documento y compartir el manejo de fuentes inusuales en el área de la salud, como ésta, a fin de favorecer el desarrollo de la investigación.

RESUMO Objetivos: relatar a experiência do uso de projetos arquitetônicos de um hospital para uma pesquisa histórico-documental. Métodos: relato de experiência do percurso metodológico do uso de projetos arquitetônicos de 1974 a 2002 de um hospital modelar. Resultados: após planilhados, os projetos de interesse foram selecionados, criando um arranjo de dados em que foi aplicada a ficha analítica contendo: contexto; autoria; autenticidade/confiabilidade; natureza do texto e análise preliminar. Os achados foram agrupados por pertinência e similaridade, resultando na construção de categorias de análise. Considerações Finais: o projeto arquitetônico é uma fonte desafiadora, tanto em sua busca, visto que foram necessários dois anos e meio até que fossem licenciados legalmente, como por envolver terminologias específicas e simbologias próprias. Deve-se ter atenção aos critérios de seleção, à organização e à análise do documento, e compartilhar o manejo de fontes incomuns na área da saúde, como esta, a fim de favorecer o desenvolvimento da pesquisa.