Study objectives and significance Generally, patients go to hospitals or clinical offices for seeking health care service. However, some studies reveal that old patient or those who have disability would get hurt and expose in some dangerous situation, such as falls and infection. As the reasons, the rehabilitation delivery model, which sends the service to patients¡¦ community, is needed. The community delivering-rehabilitation model that this study focuses on integrates hospital center and retirement home. This study is to compare the community delivering-rehabilitation model and general delivery model that patients go to hospital for rehabilitation service. Data and methods In one-year study duration from Nov. 1, 2002 to Oct. 31, 2003, the Barthel Index score from two delivery models were collected every 3 months. On the other hand, patients¡¦ rehabilitation costs were collected once 3 months, too. The study unit is individual unit. Cost-effectiveness analysis (CEA) was used here to be a standard comparing tool. CEA was computed by dividing the cost that patient spent in 3 months into the Barthel Index score which patient improved his functional status. Independent variables include environmental factors and structural factors The Environment factors include rehabilitation delivery model and the patient-therapist ratio. Structural factors include chain-affiliation status, instrumental volume and status. The General Estimating Equation was used here for comparing longitudinal dependent data. Results The study reveals that environmental factors and structural factors affect the performance of rehabilitation units. Environmental factors positively affect the rehabilitation effect. Structural factors negatively affect the rehabilitation effect. On the other hand, Environmental factors positively affect the rehabilitation efficiency. Structural factors negatively affect the rehabilitation efficiency. Conclusion and the project¡¦s relevance to public health The community delivering-rehabilitation model has better rehabilitation effect, but on the aspect of efficiency, is not as good as general delivery model. However, the community delivering-rehabilitation model has good accessibility to patient. It also concerns patient safety. If the model can improve its efficiency, the promotion of health can be further implied in community delivering-rehabilitation model.

There are over 3,700 active and decommissioned municipal solid waste (MSW) landfill sites located in Ontario (MOE, 1991). Under current legislation, these landfill sites must be rehabilitated to a defined end use when decommissioned. In Ontario, the primary prescribed end use of closed landfills is typically agriculture, and that end use can lead to food-consumer concerns, due to the perceived risk of potential contamination from legacy materials found in landfills. Converting these sites to produce biomass-energy crops instead of food crops could mitigate that concern and also help to avoid the current controversy with bioenergy-crop production on high-capability agricultural land. In this study, a 3.5-year field program with subsequent verification and analysis investigated and developed rehabilitation prescriptions using locally obtained topsoil and soil-forming materials (subsoil) to develop anthropogenic soil profiles on top of a sealed landfill cover (clay cap). These prescriptions provided crop productivity at least as good as, and generally better than, local agricultural soils. Mixed forages and biomass-specific crops (warm season grasses) were grown on these soils in replicated plot trials to evaluate the efficacy of a range of soil treatments. Following establishment of technical feasibility for site rehabilitation, economic modeling was conducted to determine the feasibility of using these anthropogenic soils for the production of forage crops, biofuel feedstock, and simple energy products at a scale consistent with typical landfill sites in Ontario. An economic model was developed to aid proponents in selecting appropriate rehabilitation methods and to assess potential bioenergy-crop outputs for their site. This study demonstrated that while it is technically feasible to rehabilitate these waste sites to produce agricultural crops and/or biofuel feedstock, the scale of typical landfill sites makes it very difficult to compete, from an economic perspective, with conventional energy sources. However, the diverted incoming materials, such as leaf and yard waste, compostable biosolids, and paper mill waste, can be used in the development of manufactured soil profiles for rehabilitation, significantly reducing rehabilitation costs and facilitating more cost-competitive production of agricultural and biomass feedstock crops. / Niagara Waste Systems Limited, a division of Walker Industries Holdings Limited, MITACS