Human response to vibration in residential environments.

This paper presents the main findings of a field survey conducted in the United Kingdom into the human response to vibration in residential environments. The main aim of this study was to derive exposure-response relationships for annoyance due to vibration from environmental sources. The sources of vibration considered in this paper are railway and construction activity. Annoyance data were collected using questionnaires conducted face-to-face with residents in their own homes. Questionnaires were completed with residents exposed to railway induced vibration (N = 931) and vibration from the construction of a light rail system (N = 350). Measurements of vibration were conducted at internal and external positions from which estimates of 24-h vibration exposure were derived for 1073 of the case studies. Sixty different vibration exposure descriptors along with 6 different frequency weightings were assessed as potential predictors of annoyance. Of the exposure descriptors considered, none were found to be a better predictor of annoyance than any other. However, use of relevant frequency weightings was found to improve correlation between vibration exposure and annoyance. A unified exposure-response relationship could not be derived due to differences in response to the two sources so separate relationships are presented for each source.

Using computerized clinical decision support for latent tuberculosis infection screening.

BACKGROUND: The Centers for Disease Control and Prevention (CDC) has published guidelines recommending screening high-risk groups for latent tuberculosis infection (LTBI). The goal of this study was to determine the impact of computerized clinical decision support and guided web-based documentation on screening rates for LTBI. DESIGN: Nonrandomized, prospective, intervention study. SETTING AND PARTICIPANTS: Participants were 8463 patients seen at two primary care, outpatient, public community health center clinics in late 2002 and early 2003. INTERVENTION: The CDC's LTBI guidelines were encoded into a computerized clinical decision support system that provided an alert recommending further assessment of LTBI risk if certain guideline criteria were met (birth in a high-risk TB country and aged <40). A guided web-based documentation tool was provided to facilitate appropriate adherence to the LTBI screening guideline and to promote accurate documentation and evaluation. Baseline data were collected for 15 weeks and study-phase data were collected for 12 weeks. MAIN OUTCOME MEASURES: Appropriate LTBI screening according to CDC guidelines based on chart review. RESULTS: Among 4135 patients registering during the post-intervention phase, 73% had at least one CDC-defined risk factor, and 610 met the alert criteria (birth in a high-risk TB country and aged <40 years) for potential screening for LTBI. Adherence with the LTBI screening guideline improved significantly from 8.9% at baseline to 25.2% during the study phase (183% increase, p < 0.001). CONCLUSIONS: This study demonstrated that computerized, clinical decision support using alerts and guided web-based documentation increased screening of high-risk patients for LTBI. This type of technology could lead to an improvement in LTBI screening in the United States and also holds promise for improved care for other preventive and chronic conditions.

Primary care trusts. A room with a view.

Research at an acute hospital, with the aim of providing indicators for hospital developments, found the important factors for patients were privacy, ease of access, provision for relatives and more lavatories and washing facilities. Patients want a sense of connection with the outdoors through windows, courtyards and balconies. Patients prefer single rooms and small bays to wards. Developers should aim for buildings that are aesthetically pleasing and minimise feelings of insecurity.