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Hip fractures are among the most common orthopedic injuries requiring hospital admission. As the incidence of hip fractures increases, surgeons and administrators are increasingly challenged to provide care for these [...], Background: The increasing incidence of hip fractures in our aging population challenges orthopedic surgeons and hospital administrators to effectively care for these patients. Many patients present to regional hospitals and are transferred to tertiary care centres for surgical management, resulting in long delays to surgery. Providing timely care may improve outcomes, as delay carries an increased risk of morbidity and mortality. Methods: We retrospectively reviewed the cases of all patients with hip fractures treated in a single Level 1 trauma centre in Canada between 2005 and 2012. We compared quality indicators and outcomes between patients transferred from a peripheral hospital and those directly admitted to the trauma centre. Results: Of the 1191 patients retrospectively reviewed, 890 met our inclusion criteria: 175 who were transferred and 715 admitted directly to the trauma centre. Transfer patients&apos; median delay from admission to operation was 93 hours, whereas nontransfer patients waited 44 hours (p < 0.001). The delay predominantly occurred before transfer, as the patients had to wait for a bed to become available at the trauma centre. The median length of stay in hospital was 20 days for transfer patients compared with 13 days for nontransfer patients (p < 0.001). Regional policy changes enacted in 2011 decreased the median transfer delay from regional hospital to tertiary care centre from 47 to 27 hours (p = 0.005). Conclusion: Policy changes can have a significant impact on patient care. Prioritizing patients and expediting transfer will decrease overall mortality, reduce hospital stay and reduce the cost of hip fracture care. Contexte: L&apos;incidence croissante des fractures de la hanche dans notre population vieillissante pose un defi aux chirurgiens orthopedistes et aux administrateurs hospitaliers qui souhaitent offrir des soins efficaces a ces patients. De nombreux patients se presentent dans des hopitaux regionaux avant d&apos;etre transferes dans des centres de soins tertiaires pour y etre operes, ce qui retarde la chirurgie. Fournir les soins requis en temps voulu pourrait ameliorer les resultats etant donne que tout retard s&apos;accompagne d&apos;un risque accru de morbidite et de mortalite. Methodes: Nous avons effectue une revue retrospective de tous les cas de fracture de la hanche traites dans un centre canadien de traumatologie de niveau 1 entre 2005 et 2012. Nous avons compare les indicateurs de qualite et les resultats entre les patients transferes d&apos;un hopital regional et les patients admis directement au centre de traumatologie. Resultats: Parmi les 1191 cas analyses retrospectivement, 890 repondaient a nos criteres d&apos;inclusion: 175 avaient ete transferes et 715 avaient ete admis directement au centre de traumatologie. Le delai median entre l&apos;admission et la chirurgie chez les patients transferes a ete de 93 heures, alors que les patients non transferes ont attendu 44 heures (p < 0,001). Le delai est principalement survenu avant le transfert, car les patients devaient attendre qu&apos;un lit se libere au centre de traumatologie. La duree mediane du sejour hospitalier a ete de 20 jours pour les patients transferes, contre 13 jours pour les patients non transferes (p < 0,001). Les changements apportes a la politique regionale en 2011 ont abrege de 47 a 27 heures (p = 0,005) le delai median avant le transfert des hopitaux regionaux vers le centre de soins tertiaires. Conclusion: Les changements de politiques peuvent avoir un impact significatif sur les soins aux patients. Prioriser les cas et accelerer les transferts reduiront la mortalite globale, abregeront les sejours hospitaliers et reduiront les couts associes au traitement des fractures de la hanche.

To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1365-2966.2007.00446.x Byline: Bruce A. Blonigen (1), Van Kolpin (2) Keywords: H71; L2 Abstract: Abstract. Competition for firms by region has a long-standing history, and the academic literature has debated whether such competition is efficient. We develop a model that explores technology development by firms facing regional competition for their investment and examine the endogenous determination of region policy, firm technology, and agglomeration externalities. We find a new source of inefficiency - regional competition leads firms to inefficiently distort their development and selection of production technology to improve their standing in the regional competition for their investment. We show that these inefficient firm decisions on technology and location can also weaken agglomeration externalities. Abstract (Spanish): Technologie, agglomeration et concurrence regionale pour l'investissement. La concurrence pour les entreprises entre les regions a une longue histoire, et la litterature specialisee a beaucoup debattu pour determiner si une telle concurrence est efficiente. On developpe un modele qui explore le developpement de technologie par des entreprises qui font face a une concurrence interregionale pour leur investissement, et qui examine la determination endogene de la politique regionale, de la technologie de l'entreprise, et des effets externes d'agglomeration. On decouvre une nouvelle source d'inefficacite- la concurrence interregionale entraine les entreprises a modifier leur developpement et leur choix de technologie de production pour ameliorer leur capacitea tirer leur epingle du jeu dans la concurrence interregionale pour leur investissement. On montre que ces decisions inefficaces des entreprises tant pour la technologie que pour la localisation peuvent aussi reduire les effets externes d'agglomeration. Author Affiliation: (1)Department of Economics, University of Oregon (2)Department of Economics, University of Oregon

Regional development policy no longer seems to be accorded the priority it previously received on the Canadian public policy agenda. Five reasons for the demise of regional policy are examined. Future directions for regional policy are discussed in light of the evolving political climate in Canada. The potential for geographers to contribute to policy debates by offering critical perspectives on proposed policies in the context of social science theory and analysis is addressed. La politique de developpement regional ne semble plus avoir la priorite d'autrefois sur la scene publique canadienne. L'auteur examine cinq raisons de ce manque d'interet et presente les orientations futures d'une politique regionale dans le contexte de l'evolution du climat politique canadien. L'article decrit l'opportunite offerte aux geographes de contribuer au debat en critiquant les politiques selon le cadre theorique et analytique de la science sociale.

Laurent Godmer, Des elus regionaux a l'image des electeurs ? L'imperatif representatif en Allemagne, en Espagne et en France, Paris, L'Harmattan, coll. Logiques Politiques, 2009, 238 p. Au fil des [...]

This paper assesses the impact of the European Union's structural funds on the manufacturing sectors of 145 of its regions for the period 1989-2004. Each stage in the EU enlargement [...]

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General 3713 Derman, B. Ferguson, A., Value of water: political ecology and water reform in Southern Africa. Human organization 62 3 2003 277-288 3714 Mcgregor, J., The Victoria Falls 1900-1940: [...]

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