Trends in the utilisation of emergency departments in California, 2005-2015: a retrospective analysis.

ObjectiveTo examine current trends in the characteristics of patients visiting California emergency departments (EDs) in order to better direct the allocation of acute care resources.DesignA retrospective study.SettingWe analysed ED utilisation trends between 2005 and 2015 in California using non-public patient data from California's Office of Statewide Health Planning and Development.ParticipantsWe included all ED visits in California from 2005 to 2015.Primary and secondary outcome measuresWe analysed ED visits and visit rates by age, sex, race/ethnicity, payer and urban/rural trends. We further examined age, sex, race/ethnicity and urban/rural trends within each payer group for a more granular picture of the patient population. Additionally, we looked at the proportion of patients admitted from the ED and distribution of diagnoses.ResultsBetween 2005 and 2015, the annual number of ED visits increased from 10.2 to 14.2 million in California. ED visit rates increased by 27.8% (p<0.001), with the greatest increases among patients aged 5-19 (37.4%, p<0.001) and 45-64 years (41.1%, p<0.001), non-Hispanic Black and Hispanic patients (56.8% and 48.8%, p<0.001), the uninsured and Medicaid-insured (36.1%, p=0.002; 28.6%, p<0.001) and urban residents (28.3%, p<0.001). The proportion of ED visits resulting in hospitalisation decreased by 18.3%, with decreases across all payer groups.ConclusionsOur findings reveal an increasing demand for emergency care and may reflect current limitations in accessing care in other parts of the healthcare system. Policymakers may need to recognise the increasingly vital role that EDs are playing in the provision of care and consider ways to incorporate this changing reality into the delivery of health services

Advanced Model of Eddy-Current NDE Inverse Problem with Sparse Grid Algorithm

In model-based inverse problem, some unknown parameters need to be estimated. These parameters are used not only to characterize the physical properties of cracks, but also to describe the position of the probes (such as lift off and angles) in the calibration. After considering the effect of the position of the probes in the inverse problem, the accuracy of the inverse result will be improved.With increasing the number of the parameters in the inverse problems, the burden of calculations will increase exponentially in the traditional full grid method. The sparse grid algorithm which introduced by Sergey A. Smolyak was used in our work. With this algorithm, we obtain a powerful interpolation method that requires significantly fewer support nodes than conventional interpolation on a full grid. In this work,we combined sparse grid toolbox TASMANIAN which is produced by Oak Ridge National Laboratory and professional eddy-current NDE software VIC-3D®to solve a specific inverse problem. An advanced model based on our previous one is used to estimate depth and width of the crack, lift off and two angles of the position of probes. Considering the calibration process, pseudorandom noise is considered in the model and statistics behavior is discussed

Recent Developments in Modeling Eddy-Current Probe-Flaw Interactions

A number of industries have been traditional users of eddy-current technology in nondestructive evaluation (NDE). The traditional mode of eddy-current inspection has been ‘monostatic,’ in which a single probe is used as both a ‘transmitter’ and ‘receiver’ Research in these industries now indicates the value of using ‘bistatic,’ or even ‘multistatic’ probe configurations, in which a single probe is used as a transmitter, and one or more probes are used as receivers. The probes may be either air core, or ferrite core, or perhaps a combination. Some examples of bistatic configurations are the split-core differential probe, and remote-field probes. The industry is turning to computer codes that are based on sophisticated computational electromagnetics algorithms in order to design these probes, and to interpret the signals that arise from the interaction of these probes with flaws

Pediatric rheumatology: addressing the transition to adult-orientated health care.

The transition from pediatric to adult health care is often a challenging process due to multiple interwoven complexities, especially for children with chronic medical conditions. Health care transition (HCT) is a process of moving from a pediatric to an adult model of health care with or without a transfer to a new clinician. This paper focuses on what is known about HCT for youth and young adults (Y/YA) with rheumatic diseases within a larger context of HCT recommendations. HCT barriers for youth, families, and providers and current evidence for a structured HCT processes are reviewed. Practical advice is offered on how to approach transition for Y/YA, what tools are available to assist in a successful transition process, and what are the areas of future research that are needed to improve the HCT evidence base

Inversion of Eddy-Current Data via Conjugate Gradients

In a companion paper, [1], we developed a rigorous, nonlinear model for inverting eddy-current data by means of the conjugate gradient algorithm. In this paper we will present some results obtained from the linearized version of the rigorous model. In this version we assume that the electric field within the flaw is simply the incident field that exists in the absence of the flaw

A reusable benchmark of brain-age prediction from M/EEG resting-state signals

Population-level modeling can define quantitative measures of individual aging by applying machine learning to large volumes of brain images. These measures of brain age, obtained from the general population, helped characterize disease severity in neurological populations, improving estimates of diagnosis or prognosis. Magnetoencephalography (MEG) and Electroencephalography (EEG) have the potential to further generalize this approach towards prevention and public health by enabling assessments of brain health at large scales in socioeconomically diverse environments. However, more research is needed to define methods that can handle the complexity and diversity of M/EEG signals across diverse real-world contexts. To catalyse this effort, here we propose reusable benchmarks of competing machine learning approaches for brain age modeling. We benchmarked popular classical machine learning pipelines and deep learning architectures previously used for pathology decoding or brain age estimation in 4 international M/EEG cohorts from diverse countries and cultural contexts, including recordings from more than 2500 participants. Our benchmarks were built on top of the M/EEG adaptations of the BIDS standard, providing tools that can be applied with minimal modification on any M/EEG dataset provided in the BIDS format. Our results suggest that, regardless of whether classical machine learning or deep learning was used, the highest performance was reached by pipelines and architectures involving spatially aware representations of the M/EEG signals, leading to R^2 scores between 0.60-0.71. Hand-crafted features paired with random forest regression provided robust benchmarks even in situations in which other approaches failed. Taken together, this set of benchmarks, accompanied by open-source software and high-level Python scripts, can serve as a starting point and quantitative reference for future efforts at developing M/EEG-based measures of brain aging. The generality of the approach renders this benchmark reusable for other related objectives such as modeling specific cognitive variables or clinical endpoints

Stapling and Section of the Nasogastric Tube during Sleeve Gastrectomy: How to Prevent and Recover?

Bariatric surgery has become an integral part of morbid obesity treatment with well-defined indications. Some complications, specific or not, due to laparoscopic sleeve gastrectomy (LSG) procedure have recently been described. We report a rare complication unpublished to date: a nasogastric section during great gastric curve stapling. A 44-year-old woman suffered of severe obesity (BMI 36.6 kg/m2) with failure of medical treatments for years. According to already published technique, a LSG was performed. Six hours postoperatively, a nurse removed the nasogastric tube according to the local protocol and the nasogastric tube was abnormally short, with staples at its extremity. Surgery was performed with peroperative endoscopy. In conclusion, this is the first publication of a nasogastric section during LSG. Therefore we report this case and propose a solution to prevent its occurrence. To avoid this kind of accident, we now systematically insert the nasogastric tube by mouth through a Guedel cannula. Then, to insert the calibrating bougie, we entirely withdraw the nasogastric tube

The role of the neutral beam fueling profile in the performance of the Tokamak Fusion Test Reactor and other tokamak plasmas

Scalings for the stored energy and neutron yield, determined from experimental data are applied to both deuterium-only and deuterium-tritium plasmas in different neutral beam heated operational domains in Tokamak Fusion Test Reactor. The domain of the data considered includes the Supershot, High poloidal beta, Low-mode, and limiter High-mode operational regimes, as well as discharges with a reversed magnetic shear configuration. The new important parameter in the present scaling is the peakedness of the heating beam fueling profile shape. Ion energy confinement and neutron production are relatively insensitive to other plasma parameters compared to the beam fueling peakedness parameter and the heating beam power when considering plasmas that are stable to magnetohydrodynamic modes. However, the stored energy of the electrons is independent of the beam fueling peakedness. The implication of the scalings based on this parameter is related to theoretical transport models such as radial electric field shear and Ion Temperature Gradient marginality models. Similar physics interpretation is provided for beam heated discharges on other major tokamaks

Experimental studies of the non-adiabatic escape problem

Noise-induced transitions between coexisting stable states of a periodically driven nonlinear oscillator have been investigated by means of analog experiments and numerical simulations in the nonadiabatic limit for a wide range of oscillator parameters. It is shown that, for over-damped motion, the field-induced corrections to the activation energy can be described quantitatively in terms of the logarithmic susceptibility (LS) and that the measured frequency dispersion of the corresponding corrections for a weakly damped nonlinear oscillator is in qualitative agreement with the theoretical prediction. Resonantly directed diffusion is observed in numerical simulations of a weakly damped oscillator. The possibility of extending the LS approach to encompass escape from the basin of attraction of a quasi-attractor is discussed