A geographical study of health services utilization among elderly in Hong Kong: from spatial variations to health care implications

Introduction: Levels of utilization of health services vary socially and geographically. Differences in the rates of usage are also associated with geographical aspects of health care systems. The purpose of this study was to capture spatial variations in hospital health services utilization in the elderly population in Hong Kong, a Special Administrative Region of China. Materials and Methods: We carried out a secondary analysis of a database from the Hospital Authority (HA) which covers 98% (N = 243,245) of the total registered deaths in Hong Kong during 1999 to 2005. Deaths at age 65y and above (N = 184,671) were included in the analysis. Age-sex weighted mean utilization ratio of hospital services was calculated by dividing the age-sex weighted mean usage of a particular service for each district by that for the whole territory. The variation in utilization by the seniors was analyzed in terms of four types of services: length of stay (LOS) in HA hospitals, number of inpatient admissions, number of visits to specialist outpatient department (SOPD), and attendances at accident and emergency department (AED). Results: Deaths at age 65y and above contributed to 76% of the total registered deaths. Each district contributed 1.0% to 9.1% of the total number of deaths in Hong Kong. Spatial analysis of the age-sex weighted mean utilization ratio showed significant geographic variation in the use of hospital services: the range of difference in the LOS between the lowest and highest district was 44%, while some differences as high as 33%, 35% and 39% in utilization ratios were observed in relation to number of inpatient admissions, visits to SOPD, and attendances at AED respectively. However, the patterns of these variations were not consistent for the four types of service being analyzed. Conclusions: Geographic variation in the utilization of hospital health services across the 18 districts in Hong Kong among the elderly population during the last three years before death was demonstrated. However, the patterns of variation were different for the types of services being examined. Further studies using primary data at an individual level are needed to explain the variations. Detailed analysis examining the relationship between service provision, accessibility and health outcomes are also indicated in order to inform the planning of health service delivery.published_or_final_versio

Ageing and utilisation of hospital services in Hong Kong: a retrospective cohort study.

Key Messages 1. In the 3 years before death, older age-groups do not use inpatient hospital services more than younger age-groups. However, they do use more accident and emergency department services. 2. No compression in morbidity was demonstrated. 3. Data obtained from this retrospective study may be used to project future usage for each type of service as a result of the changing age structure of the population, so as to facilitate health care planning. 4. Health care costs as a result of the changing age structure of populations may also be estimated more accurately, instead of assuming a linear increase in all types of services with age.published_or_final_versio

Aurora-A expressing tumour cells are deficient for homology-directed DNA double strand-break repair and sensitive to PARP inhibition.

The protein kinase Aurora-A is a major regulator of the cell cycle that orchestrates mitotic entry and is required for the assembly of a functional mitotic spindle. Overexpression of Aurora-A has been strongly linked with oncogenesis and this has led to considerable efforts at therapeutic targeting of the kinase activity of this protein. However, the exact mechanism by which Aurora-A promotes oncogenesis remains unclear. Here, we show that Aurora-A modulates the repair of DNA double-strand breaks (DSBs). Aurora-A expression inhibits RAD51 recruitment to DNA DSBs, decreases DSB repair by homologous recombination and sensitizes cancer cells to PARP inhibition. This impairment of RAD51 function requires inhibition of CHK1 by Polo-like kinase 1 (PLK1). These results identify a novel function of Aurora-A in modulating the response to DNA DSB that likely contributes to carcinogenesis and suggest a novel therapeutic approach to the treatment of cancers overexpressing this protein

Collecting 21st-Century Science, Technology and Medicine in Scotland

On 6 June 2017 a group of museum professionals with shared interests in contemporary collecting science, technology and medicine assembled at the National Museum of Scotland to share best practice and lessons learned in this area. After presentations from some of those involved in Scottish collections, different perspectives were provided (UK-wide, from learning, and from another discipline).The workshop concluded with a roundtable discussion during which all participants reflect on the strengths and weaknesses of the sector. This report includes summaries and commentaries of the presentations and a round-up of the discussion

Graduate Program Redesign to Prepare 21st Century Educational Leaders

The content of this article is focused on the theme of curriculum renewal and redesign in three university-based principal preparation programs from diverse sections of the country: Campbell University in North Carolina, the University of Northern Iowa, and the University of Texas at Brownsville.Questions originally posed to representatives of the three principal preparation programs were as follows: • To what state or national standards are the programs aligned?• How did program faculty engage in curriculum redesign and ongoing renewal?• What delivery systems are offered: cohort, online, hybrid, etc.?• How are field experiences and internships conducted?• How do faculty members assess candidates’ mastery of standards-aligned competencies? The redesign processes undertaken by faculty members from the three leadership preparation programs were explored by addressing common components culled from the questions: standards, curriculum renewal and redesign, field experiences and internships, assessment, and lessons learned. Conclusions summarize the common points that have made the processes successful. It is the authors’ hope that the lessons learned from our combined experiences with principal preparation program redesign will be helpful to educational leadership faculty members engaged in similar processes at other colleges or universities

The 3 C’s of Consideration for COVID-19 Workplace Fever Detection Device Selection: Context, Calibration & Cost

COVID-19 screening protocols have become normal practice for employees entering workplaces around the world. However, workplace screening programs that include temperature detection via infrared thermometers or thermal detection cameras often violate many technical specifications for the correct use of these devices. Therefore, this article aims to provide practical guidance for non-thermal imaging specialists responsible for selecting thermal detection devices for workplace screening protocols. Focusing on three critical points of consideration, including the context of use, calibration of equipment, and cost of purchase and maintenance, readers are presented with a framework to guide their decision-making. This framework not only prioritizes the health and wellbeing of employees by ensuring the context of use is appropriate but balances the cost of calibration, purchasing and additional supporting supplies. Further, the presented framework extends beyond the COVID-19 pandemic and can be easily adapted to implement any new workplace technology

Practice Variation in the Immediate Postoperative Care of Pediatric Kidney Transplantation: A National Survey

Introduction Advances in organ allocation, surgical technique, immunosuppression, and long-term follow-up have led to a significant improvement in kidney transplant outcomes. Although there are clear recommendations for several aspects of kidney transplant management, there are no pediatric-specific guidelines for immediate postoperative care. The aim of this survey is to examine practice variations in the immediate postoperative care of pediatric kidney transplant patients. Methods We surveyed medical directors of Pediatric Acute Lung Injury and Sepsis Investigators (PALISI)-affiliated pediatric intensive care units regarding center-specific immediate postoperative management of pediatric kidney transplantation. Results The majority of PALISI centers admit patients to the pediatric intensive care unit postoperatively, and 97% of the centers involve a pediatric nephrologist in immediate postoperative care. Most patients undergo invasive hemodynamic monitoring; 97% of centers monitor invasive arterial blood pressure and 88% monitor central venous pressure. Most centers monitor serum electrolytes every 4 to 6 hours. Wide variation exists regarding blood pressure goal, fluid replacement type, frequency of obtaining kidney ultrasound, and use of prophylactic anticoagulation. Conclusion There is consistent practice across PALISI centers in regards to many aspects of immediate postoperative management of pediatric kidney transplantation. However, variation still exists in some management aspects that warrant further discussions to reach a national consensus

Increased urinary nitrite, a marker of nitric oxide, in active inflammatory bowel disease.

BACKGROUND: Nitric oxide (NO) production is increased in inflammatory bowel disease (IBD), and measurement of NO metabolites may be useful for monitoring disease activity. AIMS AND OBJECTIVES: To characterise urinary nitrite levels, a stable metabolite of NO, in IBD and to evaluate its potential as a marker of disease activity. METHODS: Twelve-hour urinary nitrites were measured by the microplate assay method in 46 patients with IBD (active; n = 32). Urinary samples from 16 healthy individuals served as controls. RESULTS: Increased levels of urinary nitrites were found in patients with active IBD compared with those with inactive IBD. Twenty-eight out of 32 patients (87.5%) with active IBD had detectable levels of nitrite in their urine as compared with 2/14 (14.3%) patients with inactive IBD. None of the 16 healthy controls had detectable urinary nitrite. Twelve-hour urinary nitrite in active compared with inactive IBD: 5 0.7 versus 0.1+/-0.04 micromol (P < 0.05). There was good correlation between urinary nitrite and some markers of disease activity in IBD such as C-reactive protein and microalbuminuria but not with erythrocyte sedimentation rate. Conclusions: Increased levels of nitrite were detected in urine of patients with active IBD, consistent with increased NO synthesis. This simple assay may be exploited as a potential marker of disease activity in IBD