Characteristics of patients presenting to the vascular emergency department of a tertiary care hospital: a 2-year study

<p>Abstract</p> <p>Background</p> <p>The structure of health care in Greece is receiving increased attention to improve its cost-effectiveness. We sought to examine the epidemiological characteristics of patients presenting to the vascular emergency department of a Greek tertiary care hospital during a 2-year period. We studied all patients presenting to the emergency department of vascular surgery at Red Cross Hospital, Athens, Greece between 1^stJanuary 2009 and 31st December 2010.</p> <p>Results</p> <p>Overall, 2452 (49.4%) out of 4961 patients suffered from pathologies that should have been treated in primary health care. Only 2509 (50.6%) needed vascular surgical intervention.</p> <p>Conclusions</p> <p>The emergency department of vascular surgery in a Greek tertiary care hospital has to treat a remarkably high percentage of patients suitable for the primary health care level. These results suggest that an improvement in the structure of health care is needed in Greece.</p

Using Administrative Data to Count and Classify Households with Local Applications

Households rather than individuals are being increasingly used for research and to target and evaluate public policy. As a result accurate and timely household level statistics have become an increasing necessity especially at local level. However, official sources of information on households are fragmented with significant gaps and inaccuracies that limit their usefulness. This paper reviews present statistical arrangements and then describes a new approach to data collection and household classification which combine various local administrative sources. An intermediate step is the creation of local population counts which are converted into household types and these methods are described in two companion papers previously published in this journal. The utility and advantages of the approach are demonstrated using the example of the six Olympic London Boroughs for whom the data collection was undertaken in 2011 and the analysis subsequently

The Peculiar SN 2005hk: Do Some Type Ia Supernovae Explode as Deflagrations?

We present extensive u'g'r'i'BVRIYJHKs photometry and optical spectroscopy of SN 2005hk. These data reveal that SN 2005hk was nearly identical in its observed properties to SN 2002cx, which has been called ``the most peculiar known type Ia supernova.'' Both supernovae exhibited high ionization SN 1991T-like pre-maximum spectra, yet low peak luminosities like SN 1991bg. The spectra reveal that SN 2005hk, like SN 2002cx, exhibited expansion velocities that were roughly half those of typical type Ia supernovae. The R and I light curves of both supernovae were also peculiar in not displaying the secondary maximum observed for normal type Ia supernovae. Our YJH photometry of SN 2005hk reveals the same peculiarity in the near-infrared. By combining our optical and near-infrared photometry of SN 2005hk with published ultraviolet light curves obtained with the Swift satellite, we are able to construct a bolometric light curve from ~10 days before to ~60 days after B maximum. The shape and unusually low peak luminosity of this light curve, plus the low expansion velocities and absence of a secondary maximum at red and near-infrared wavelengths, are all in reasonable agreement with model calculations of a 3D deflagration which produces ~0.25 M_sun of 56Ni.Comment: Accepted by PASP, to appear in April 2007 issue, 63 pages, 16 figures, 11 table

Assessment of health care needs and utilization in a mixed public-private system: the case of the Athens area

BACKGROUND: Given the public-private mix of the Greek health system, the purpose of this study was to assess whether variations in the utilisation of health services, both primary and inpatient care, were associated with underlying health care needs and/or various socio-economic factors. METHODS: Data was obtained from a representative sample (N = 1426) residing in the broader Athens area (response rate 70.6%). Perceived health-related quality of life (HRQOL), as measured by the physical and mental summary component scores of the SF-36 Health Survey, was used as a proxy of health care need. Health care utilization was measured by a) last-month visits to public sector physicians, b) last-month visits to private sector physicians, c) last-year visits to hospital emergency departments and d) last-year hospital admissions. Statistical analysis involved the implementation of logistic regression models. RESULTS: Health care need was the factor most strongly associated with all measures of health care utilization, except for visits to public physicians. Women, elderly, less wealthy and individuals of lower physical health status visited physicians contracted to their insurance fund (public sector). Women, well educated and those once again of lower physical health status were more likely to visit private providers. Visits to hospital emergency departments and hospital admissions were related to need and no socio-economic factor was related to the use of those types of care. CONCLUSION: This study has demonstrated a positive relationship between health care need and utilisation of health services within a mixed public-private health care system. Concurrently, interesting differences are evident in the utilization of various types of services. The results have potential implications in health policy-making and particularly in the proper allocation of scarce health resources

First-year Sloan Digital Sky Survey-II (SDSS-II) Supernova Results: Hubble Diagram and Cosmological Parameters

We present measurements of the Hubble diagram for 103 Type Ia supernovae (SNe) with redshifts 0.04 < z < 0.42, discovered during the first season (Fall 2005) of the Sloan Digital Sky Survey-II (SDSS-II) Supernova Survey. These data fill in the redshift "desert" between low- and high-redshift SN Ia surveys. We combine the SDSS-II measurements with new distance estimates for published SN data from the ESSENCE survey, the Supernova Legacy Survey, the Hubble Space Telescope, and a compilation of nearby SN Ia measurements. Combining the SN Hubble diagram with measurements of Baryon Acoustic Oscillations from the SDSS Luminous Red Galaxy sample and with CMB temperature anisotropy measurements from WMAP, we estimate the cosmological parameters w and Omega_M, assuming a spatially flat cosmological model (FwCDM) with constant dark energy equation of state parameter, w. For the FwCDM model and the combined sample of 288 SNe Ia, we find w = -0.76 +- 0.07(stat) +- 0.11(syst), Omega_M = 0.306 +- 0.019(stat) +- 0.023(syst) using MLCS2k2 and w = -0.96 +- 0.06(stat) +- 0.12(syst), Omega_M = 0.265 +- 0.016(stat) +- 0.025(syst) using the SALT-II fitter. We trace the discrepancy between these results to a difference in the rest-frame UV model combined with a different luminosity correction from color variations; these differences mostly affect the distance estimates for the SNLS and HST supernovae. We present detailed discussions of systematic errors for both light-curve methods and find that they both show data-model discrepancies in rest-frame $U$-band. For the SALT-II approach, we also see strong evidence for redshift-dependence of the color-luminosity parameter (beta). Restricting the analysis to the 136 SNe Ia in the Nearby+SDSS-II samples, we find much better agreement between the two analysis methods but with larger uncertainties.Comment: Accepted for publication by ApJ

First-year Sloan Digital Sky Survey-II (SDSS-II) supernova results: consistency and constraints with other intermediate-redshift datasets

We present an analysis of the luminosity distances of Type Ia Supernovae from the Sloan Digital Sky Survey-II (SDSS-II) Supernova Survey in conjunction with other intermediate redshift (z<0.4) cosmological measurements including redshift-space distortions from the Two-degree Field Galaxy Redshift Survey (2dFGRS), the Integrated Sachs-Wolfe (ISW) effect seen by the SDSS, and the latest Baryon Acoustic Oscillation (BAO) distance scale from both the SDSS and 2dFGRS. We have analysed the SDSS-II SN data alone using a variety of "model-independent" methods and find evidence for an accelerating universe at >97% level from this single dataset. We find good agreement between the supernova and BAO distance measurements, both consistent with a Lambda-dominated CDM cosmology, as demonstrated through an analysis of the distance duality relationship between the luminosity (d_L) and angular diameter (d_A) distance measures. We then use these data to estimate w within this restricted redshift range (z<0.4). Our most stringent result comes from the combination of all our intermediate-redshift data (SDSS-II SNe, BAO, ISW and redshift-space distortions), giving w = -0.81 +0.16 -0.18(stat) +/- 0.15(sys) and Omega_M=0.22 +0.09 -0.08 assuming a flat universe. This value of w, and associated errors, only change slightly if curvature is allowed to vary, consistent with constraints from the Cosmic Microwave Background. We also consider more limited combinations of the geometrical (SN, BAO) and dynamical (ISW, redshift-space distortions) probes.Comment: 13 pages, 7 figures, accepted for publication in MNRA

First-Year Spectroscopy for the SDSS-II Supernova Survey

This paper presents spectroscopy of supernovae discovered in the first season of the Sloan Digital Sky Survey-II Supernova Survey. This program searches for and measures multi-band light curves of supernovae in the redshift range z = 0.05 - 0.4, complementing existing surveys at lower and higher redshifts. Our goal is to better characterize the supernova population, with a particular focus on SNe Ia, improving their utility as cosmological distance indicators and as probes of dark energy. Our supernova spectroscopy program features rapid-response observations using telescopes of a range of apertures, and provides confirmation of the supernova and host-galaxy types as well as precise redshifts. We describe here the target identification and prioritization, data reduction, redshift measurement, and classification of 129 SNe Ia, 16 spectroscopically probable SNe Ia, 7 SNe Ib/c, and 11 SNe II from the first season. We also describe our efforts to measure and remove the substantial host galaxy contamination existing in the majority of our SN spectra.Comment: Accepted for publication in The Astronomical Journal(47pages, 9 figures

Assessing socioeconomic health care utilization inequity in Israel: impact of alternative approaches to morbidity adjustment

<p/> <p>Background</p> <p>The ability to accurately detect differential resource use between persons of different socioeconomic status relies on the accuracy of health-needs adjustment measures. This study tests different approaches to morbidity adjustment in explanation of health care utilization inequity.</p> <p>Methods</p> <p>A representative sample was selected of 10 percent (~270,000) adult enrolees of Clalit Health Services, Israel's largest health care organization. The Johns-Hopkins University Adjusted Clinical Groups^®were used to assess each person's overall morbidity burden based on one year's (2009) diagnostic information. The odds of above average health care resource use (primary care visits, specialty visits, diagnostic tests, or hospitalizations) were tested using multivariate logistic regression models, separately adjusting for levels of health-need using data on age and gender, comorbidity (using the Charlson Comorbidity Index), or morbidity burden (using the Adjusted Clinical Groups). Model fit was assessed using tests of the Area Under the Receiver Operating Characteristics Curve and the Akaike Information Criteria.</p> <p>Results</p> <p>Low socioeconomic status was associated with higher morbidity burden (1.5-fold difference). Adjusting for health needs using age and gender or the Charlson index, persons of low socioeconomic status had greater odds of above average resource use for all types of services examined (primary care and specialist visits, diagnostic tests, or hospitalizations). In contrast, after adjustment for overall morbidity burden (using Adjusted Clinical Groups), low socioeconomic status was no longer associated with greater odds of specialty care or diagnostic tests (OR: 0.95, CI: 0.94-0.99; and OR: 0.91, CI: 0.86-0.96, for specialty visits and diagnostic respectively). Tests of model fit showed that adjustment using the comprehensive morbidity burden measure provided a better fit than age and gender or the Charlson Index.</p> <p>Conclusions</p> <p>Identification of socioeconomic differences in health care utilization is an important step in disparity reduction efforts. Adjustment for health-needs using a comprehensive morbidity burden diagnoses-based measure, this study showed relative underutilization in use of specialist and diagnostic services, and thus allowed for identification of inequity in health resources use, which could not be detected with less comprehensive forms of health-needs adjustments.</p

The Sloan Digital Sky Survey-II Supernova Survey: Search Algorithm and Follow-up Observations

The Sloan Digital Sky Survey-II Supernova Survey has identified a large number of new transient sources in a 300 sq. deg. region along the celestial equator during its first two seasons of a three-season campaign. Multi-band (ugriz) light curves were measured for most of the sources, which include solar system objects, Galactic variable stars, active galactic nuclei, supernovae (SNe), and other astronomical transients. The imaging survey is augmented by an extensive spectroscopic follow-up program to identify SNe, measure their redshifts, and study the physical conditions of the explosions and their environment through spectroscopic diagnostics. During the survey, light curves are rapidly evaluated to provide an initial photometric type of the SNe, and a selected sample of sources are targeted for spectroscopic observations. In the first two seasons, 476 sources were selected for spectroscopic observations, of which 403 were identified as SNe. For the Type Ia SNe, the main driver for the Survey, our photometric typing and targeting efficiency is 90%. Only 6% of the photometric SN Ia candidates were spectroscopically classified as non-SN Ia instead, and the remaining 4% resulted in low signal-to-noise, unclassified spectra. This paper describes the search algorithm and the software, and the real-time processing of the SDSS imaging data. We also present the details of the supernova candidate selection procedures and strategies for follow-up spectroscopic and imaging observations of the discovered sources.Comment: Accepted for publication in The Astronomical Journal (66 pages, 13 figures); typos correcte