Power Quality Monitoring Integration into Distribution Automation through the Use of AMR

Power-quality events are of increasing concern for the economy because today’s equipment, particularly computers and automated manufacturing devices, is highly sensitive to such imperfections. With volatile energy rates and a need to control costs, regional agencies and utilities are interested in technologies to meter distribution use and manage utility information. Metering technologies and communications systems have advanced to enable the development of Automated Meter Reading (AMR) Systems. Power Quality is one area where the AMR system can be very valuable. This paper investigates the challenges in the development of distributed power-quality monitoring system. The approach of this paper is divided into metering, data collection, archiving, analysis, and presentation. It also discusses system architecture, implementation, and provides general guidelines in the tailoring of PQ indexes. This paper describes the challenges and lessons learned from this work.

Utilización inadecuada de un servicio de urgencias hospitalario. Una evaluación con criterios explícitos

ResumenFundamentoExiste un crecimiento del número de visitas en los servicios de urgencias hospitalarios (SUH) con una elevada proporción de utilización inapropiada. Los métodos empleados para identificar el uso inadecuado basados en criterios implícitos limitan las comparaciones entre hospitales. El objetivo de este estudio es conocer la proporción de visitas inadecuadas en un SUH y sus factores asociados, utilizando un método objetivo.Material y métodoSe utilizó un instrumento basado en criterios explícitos e independientes del diagnóstico para identificar las visitas inapropiadas en una muestra aleatoria de 1.845 pacientes mayores de 14 años que acudieron a los servicios médicos de un SUH, y se analizaron los factores asociados a la demanda inadecuada.ResultadosLa proporción de urgencias inadecuadas fue del 26,8% (495/1.845). En el análisis bivariante la menor edad, la ausencia de patología asociada, las visitas espontáneas y determinados grupos diagnósticos (enfermedades de la piel, músculo-esqueléticas, mentales y sintamos mal definidos) se asociaron a una mayor proporción de uso inadecuado del SUH. Al ajustar las variables mediante regresión logística, la edad, la patología asociada, las consultas espontáneas y los grupos diagnósticos, mantuvieron la asociación con el uso inadecuado, pero otras variables como el ser mujer y la llegada al SUH fuera del turno de noche también se asociaron a una mayor utilización inadecuada.ConclusionesAl menos la cuarta parte de las visitas realizadas en los servicios médicos de los SUH no requieren atención urgente. La inadecuación de las visitas se asocia a características del paciente y el proceso asistido.SummaryBackgroundSeveral studies have shown a growth in the number of visits to accident and emergency (A&E) hospital departments with a high proportion of inappropriate utilization. Methods to identify improper use based on implicit criteria limit the comparisons between hospitals. The aim of this study is to know the proportion of inappropriate attendance's in an A&E department and their associated factors, using a method with objective criteria.MethodsAn instrument based on diagnosis-independent explicit criteria was used to identify inappropriate visits in a random sample of 1845 14-year-old greater patients attended to A&E medical services, and the factors associated with improper demand were analysed.ResultsThe proportion of inappropriate attendance's was of the 26,8% (495/1.845). The unadjusted analysis show that the smaller age, absence of comorbidity, spontaneous visit and some diagnostic groups (diseases of the skin, muscle-skeletal, mental, and bad defined symptoms) were associated to a greater proportion of improper use. Upon adjusting the variables through logistics regression, the age, associated pathology, the spontaneous attendance's and diagnostic groups, maintained the association with improper use, but other variables as woman gender, and night hours were also associated to inappropriate utilization.ConclusionsAt least the fourth part of the attendance's in the A&E medical services do not require urgent attention. Inappropriate utilization is associated to characteristic of the patient and the attended process

Horizontal to vertical spectral ratio measurements in Port-au-Prince (Haiti) area damaged by the 2010 Haiti earthquake

In order to evaluate ground shaking characteristics due to surface soil layers in the urban area of Port-au-Prince, short-period ambient noise observation has been performed approximately in a 500x500m grid. The HVSR method was applied to this set of 36 ambient noise measurement points to determine a distribution map of soil predominant periods. This map reveals a general increasing trend in the period values, from the Miocene conglomerates in the northern and southern parts of the town to the central and western zones formed of Pleistocene and Holocene alluvial deposits respectively, where the shallow geological materials that cover the basement increase in thickness. Shorter predominant periods (less than 0.3 s) were found in mountainous and neighbouring zones, where the thickness of sediments is smaller whereas longer periods (greater than 0.5 s) appear in Holocene alluvial fans, where the thickness of sediments is larger. The shallow shear-wave velocity structure have been estimated by means of inversion of Rayleigh wave dispersion data obtained from vertical-component array records of ambient noise. The measurements were carried out at one open space located in Holocene alluvial deposits, using 3 regular pentagonal arrays with 5, 10 and 20m respectively. Reliable dispersion curves were retrieved for frequencies between 4.0 and 14 Hz, with phase velocity values ranging from 420m/s down to 270 m/s. Finally, the average shear-wave velocity of the upper 30 m (VS30) was inverted for characterization of this geological unit

Mapa preliminar de períodos predominantes del suelo en Puerto Príncipe (Haití) a partir de medidas de ruido ambiental.

The 2010 Haiti earthquake, occurred on January 12th at 16:53:09 local time (21:53:09 UTC) with epicentral distance of 15 km from the capital Port au Prince, MW 7.0 and 13 km hypocenter deep, was the strongest event in the area since happened in 1770. The maximum macroseismic intensity was estimated as X (MMI scale). The aim of this research is to obtain a preliminary zonation of Port-au-Prince in terms of predominant resonance periods of ground. A total of 36 short-period ambient noise records have been carried out on a grid of about 500x500m. H/V spectral ratio method (HVSR) has been applied to determine the predominant period at each point. The lowest values ( 0.45s) correspond to the center and western parts, composed of Pleistocene-Holocene alluvial deposits and anthropogenic land reclaimed from the sea. We have determined the ground VS30 structure inside National Palace garden, using simultaneous ambient noise measurements. An array made up of 6 sensors were used, with 5 of them uniformly distributed along a circumference and a sixth one placed in its centre. The records were analyzed by using the spatial autocorrelation method (SPAC). The VS 30 value obtained was 331m/sec, in good agreement with the average values obtained for this area by other authors, using prospecting techniques

Appropriateness of admission and days of stay in pediatric hospital in Ancona, Italy

Background: In Italy, hospital admission costs account for nearly 42% of total health expenditure; in the Marche region, this share exceeds 50%. High costs of hospitalization, however, can be partly explained by inappropriate use. The aim of this research was to assess the risk factors associated with inappropriate hospital admissions and stay for acute pediatric patients. Methods: Clinical records of children from 30 days to 14 years of age admitted to the wards of orthopedics, pediatrics, pediatric isolation, pediatric surgery and pediatric oncohematology at Salesi Pediatric Hospital of Ancona throughout 2004 were reviewed. The Italian Pediatric Appropriateness Evaluation Protocol (PRUO) was used as a tool for assessing inappropriateness of admission and days of stay. Results: Overall 21.7% (95% CI = 16.1%–22.4%) of hospital admissions and 30.3% (95% CI = 26.0%–34.9%) of days of stay were judged to be inappropriate. Multiple logistic regression analysis indicated that inappropriate admission was significantly associated with type of admission, discharge ward and place of residence. Inappropriateness of stay was significantly higher if admission was to a medical ward and if admission itself was judged inappropriate. Conclusions: In a socioeconomic context in which reducing waste is necessary, ineffective health care interventions are no longer tolerable. As a tool capable of integrating each patient’s specific features with those of the health care process, the pediatric PRUO could be a valid tool in the hands of managers for monitoring the appropriateness of admission and stay

Methylenetetrahydrofolate Reductase Gene Variant (MTHFR C677T) and Migraine: A Case Control Study and Meta-analysis

Extent: 9p.Background: Migraine is a common disorder that often coexists with depression. While a functional polymorphism in methyleneterahydrofolate reductase gene (MTHFR C677T) has been implicated in depression; the evidence to support an association of MTHFR with migraine has been inconclusive. We aim to investigate the effect of this variant on propensity for migraine and to perform a systematic review and meta-analysis of studies of MTHFR and migraine to date. Methods: Individuals with migraine (n = 447) were selected from the Depression Case Control (DeCC) study to investigate the association between migraine and MTHFR C677T single nucleotide polymorphism (SNP) rs1801133 using an additive model compared to non-migraineurs adjusting for depression status. A meta-analysis was performed and included 15 studies of MTHFR and migraine. Results: MTHFR C677T polymorphism was associated with migraine with aura (MA) (OR 1.31, 95% CI 1.01-1.70, p = 0.039) that remained significant after adjusting for age, sex and depression status. A meta-analysis of 15 case-control studies showed that T allele homozygosity is significantly associated with MA (OR = 1.42; 95% CI, 1.10-1.82) and total migraine (OR = 1.37; 95% CI, 1.07-1.76), but not migraine without aura (OR = 1.16; 95% CI, 0.36-3.76). In studies of non-Caucasian population, the TT genotype was associated with total migraine (OR= 3.46; 95% CI, 1.22-9.82), whereas in studies of Caucasians this variant was associated with MA only (OR = 1.28; 95% CI, 1.002-1.63). Conclusions: MTHFR C677T is associated with MA in individuals selected for depression study. A meta-analysis of 15 studies supports this association and demonstrated effects across ethnic groups.Zainab Samaan, Daria Gaysina, Sarah Cohen-Woods, Nick Craddock, Lisa Jones, Ania Korszun, Mike Owen, Andrew Mente, Peter McGuffin and Anne Farme

Long-term adherence to IFN beta-1a treatment when using rebismart1device in patients with relapsing-remitting multiple sclerosis

The effectiveness of disease-modifying drugs in the treatment of multiple sclerosis is associated with adherence. RebiSmart® electronic device provides useful information about adherence to the treatment with subcutaneous (sc) interferon (IFN) ß-1a (Rebif®). The aim of the study was to determine long-term adherence to this treatment in patients with relapsing- remitting multiple sclerosis (RRMS). This retrospective multicentre observational study analysed 258 patients with RRMS who were receiving sc IFN ß-1a (Rebif®) treatment by using RebiSmart® until replacement (36 months maximum lifetime) or treatment discontinuation. Adherence was calculated with data (injection dosage, time, and date) automatically recorded by RebiSmart®. Patients in the study had a mean age of 41 years with a female proportion of 68%. Mean EDSS score at start of treatment was 1.8 (95% CI, 1.6-1.9). Overall adherence was 92.6%(95% CI, 90.6-94.5%). A total of 30.2% of patients achieved an adherence rate of 100%, 80.6% at least 90%, and only 13.2% of patients showed a suboptimal adherence (<80%). A total of 59.9% of subjects were relapse-free after treatment initiation. Among 106 subjects (41.1%) who experienced, on average, 1.4 relapses, the majority were mild (40.6%) or moderate (47.2%). Having experienced relapses from the beginning of the treatment was the only variable significantly related to achieving an adherence of at least 80% (OR = 3.06, 1.28-7.31). Results of this study indicate that sc IFN ß-1a administration facilitated by RebiSmart® could lead to high rates of adherence to a prescribed dose regimen over 36 months

State of emergency medicine in Spain

Spain has universal public health care coverage. Emergency care provisions are offered to patients in different modalities and levels according to the characteristics of the medical complaint: at primary care centers (PCC), in an extrahospital setting by emergency medical services (EMS) and at hospital emergency departments (ED). We have more than 3,000 PCCs, which are run by family doctors (general practitioners) and pediatricians. On average, there is 1 PCC for every 15,000 to 20,000 inhabitants, and every family doctor is in charge of 1,500 to 2,000 citizens, although less populated zones tend to have lower ratios. Doctors spend part of their duty time in providing emergency care to their own patients. While not fully devoted to emergency medicine (EM) practice, they do manage minor emergencies. However, Spanish EMSs contribute hugely to guarantee population coverage in all situations. These EMS are run by EM technicians (EMT), nurses and doctors, who usually work exclusively in the emergency arena. EDs dealt with more than 25 million consultations in 2008, which implies, on average, that one out of two Spaniards visited an ED during this time. They are usually equipped with a wide range of diagnostic tools, most including ultrasonography and computerized tomography scans. The academic and training background of doctors working in the ED varies: nearly half lack any structured specialty residence training, but many have done specific master or postgraduate studies within the EM field. The demand for emergency care has grown at an annual rate of over 4% during the last decade. This percentage, which was greater than the 2% population increase during the same period, has outpaced the growth in ED capacity. Therefore, Spanish EDs become overcrowded when the system exerts minimal stress. Despite the high EM caseload and the potential severity of the conditions, training in EM is still unregulated in Spain. However, in April 2009 the Spanish Minister of Health announced the imminent approval of an EM specialty, allowing the first EM resident to officially start in 2011. Spanish emergency physicians look forward to the final approval, which will complete the modernization of emergency health care provision in Spain

Chronic migraine plus medication overuse headache: two entities or not?

Chronic migraine (CM) represents migraine natural evolution from its episodic form. It is realized through a chronicization phase that may require months or years and varies from patient to patient. The transition to more frequent attacks pattern is influenced by lifestyle, life events, comorbid conditions and personal genetic terrain, and it often leads to acute drugs overuse. Medication overuse headache (MOH) may complicate every type of headache and all the drugs employed for headache treatment can cause MOH. The first step in the management of CM complicated by medication overuse must be the withdrawal of the overused drugs and a detoxification treatment. The goal is not only to detoxify the patient and stop the chronic headache but also to improve responsiveness to acute or prophylactic drugs. Different methods have been suggested: gradual or abrupt withdrawal; home treatment, hospitalization, or a day-hospital setting; re-prophylaxes performed immediately or at the end of the wash-out period. Up to now, only topiramate and local injection of onabotulinumtoxinA have shown efficacy as therapeutic agents for re-prophylaxis after detoxification in patients with CM with and without medication overuse. Although the two treatments showed similar efficacy, onabotulinumtoxinA is associated with a better adverse events profile. Recently, the Phase III Research Evaluating Migraine Prophylaxis Therapy (PREEMPT) clinical program proved that patients with CM, even those with MOH, are the ones most likely to benefit from onabotulinumtoxinA treatment. Furthermore, it provided an injection paradigm that can be used as a guide for a correct administration of onabotulinumtoxinA