Demand for emergency health service: factors associated with inappropriate use

<p>Abstract</p> <p>Background</p> <p>The inappropriate use of emergency room (ER) service by patients with non-urgent health problems is a worldwide problem. Inappropriate ER use makes it difficult to guarantee access for real emergency cases, decreases readiness for care, produces negative spillover effects on the quality of emergency services, and raises overall costs.</p> <p>Methods</p> <p>We conducted a cross-sectional study in a medium-sized city in southern Brazil. The urgency of the presenting complaint was defined according to the Hospital Urgencies Appropriateness Protocol (HUAP). Multivariable Poisson regression was carried out to examine factors associated with inappropriate ER use.</p> <p>Results</p> <p>The study interviewed 1,647 patients over a consecutive 13-day sampling period. The prevalence of inappropriate ER use was 24.2% (95% CI 22.1–26.3). Inappropriate ER use was inversely associated with age (P = 0.001), longer stay in the waiting room, longer duration of symptoms and morning shift. However, the determinants of inappropriate ER use differed according age groups (P value for interaction = 0.04). Within the younger age-group (15–49 years), inappropriate ER use was higher among females, patients who reported visiting the ER because there was no other place to go, patients reporting that the doctor at the regular place of care refused to attend to them without a prior appointment, and individuals who reported that the PHC clinic which they use is open for shorter periods during the day. Among older patients (50+ years), those with highest level of education, absence of self-reported chronic diseases and lack of social support were more likely to engage in higher inappropriate ER use.</p> <p>Conclusion</p> <p>Efforts should be made to redirect inappropriate ER demand. Besides expanding access to, and improving the quality of primary and secondary care, it is important to mobilize social support for older patients, to enhance the relationship between different levels of care, as well as to develop campaigns to educate the public about the appropriate use of medical services.</p

Access to recreational physical activities by car and bus : an assessment of socio-spatial inequalities in mainland Scotland

Obesity and other chronic conditions linked with low levels of physical activity (PA) are associated with deprivation. One reason for this could be that it is more difficult for low-income groups to access recreational PA facilities such as swimming pools and sports centres than high-income groups. In this paper, we explore the distribution of access to PA facilities by car and bus across mainland Scotland by income deprivation at datazone level. GIS car and bus networks were created to determine the number of PA facilities accessible within travel times of 10, 20 and 30 minutes. Multilevel negative binomial regression models were then used to investigate the distribution of the number of accessible facilities, adjusting for datazone population size and local authority. Access to PA facilities by car was significantly (p<0.01) higher for the most affluent quintile of area-based income deprivation than for most other quintiles in small towns and all other quintiles in rural areas. Accessibility by bus was significantly lower for the most affluent quintile than for other quintiles in urban areas and small towns, but not in rural areas. Overall, we found that the most disadvantaged groups were those without access to a car and living in the most affluent areas or in rural areas

Production of Oxidants by Ion Bombardment of Icy Moons in the Outer Solar System

Our groups in Brazil, France and Italy have been active, among others in the world, in performing experiments on physical-chemical effects induced by fast ions colliding with solids (frozen gases, carbonaceous and organic materials, silicates, etc.) of astrophysical interest. The used ions span a very large range of energies, from a few keV to hundreds MeV. Here we present a summary of the results obtained so far on the formation of oxidants (hydrogen peroxide and ozone) after ion irradiation of frozen water, carbon dioxide and their mixtures. Irradiation of pure water ice produces hydrogen peroxide whatever is the used ion and at different temperatures. Irradiation of carbon dioxide and water frozen mixtures result in the production of molecules among which hydrogen peroxide and ozone. The experimental results are discussed in the light of the relevance they have to support the presence of an energy source for biosphere on Europa and other icy moons in the outer Solar System.This research has been supported by the European COST Action CM0805: The Chemical Cosmos.Boduch, P.; Da Silveira, EF.; Domaracka, A.; Gomis Hilario, O.; Lv, XY.; Palumbo, ME.; Pilling, S.... (2011). Production of Oxidants by Ion Bombardment of Icy Moons in the Outer Solar System. Advances in Astronomy. 1-10. doi:10.1155/2011/327641S11

Correlated fragile site expression allows the identification of candidate fragile genes involved in immunity and associated with carcinogenesis

Common fragile sites (cfs) are specific regions in the human genome that are particularly prone to genomic instability under conditions of replicative stress. Several investigations support the view that common fragile sites play a role in carcinogenesis. We discuss a genome-wide approach based on graph theory and Gene Ontology vocabulary for the functional characterization of common fragile sites and for the identification of genes that contribute to tumour cell biology. CFS were assembled in a network based on a simple measure of correlation among common fragile site patterns of expression. By applying robust measurements to capture in quantitative terms the non triviality of the network, we identified several topological features clearly indicating departure from the Erdos-Renyi random graph model. The most important outcome was the presence of an unexpected large connected component far below the percolation threshold. Most of the best characterized common fragile sites belonged to this connected component. By filtering this connected component with Gene Ontology, statistically significant shared functional features were detected. Common fragile sites were found to be enriched for genes associated to the immune response and to mechanisms involved in tumour progression such as extracellular space remodeling and angiogenesis. Our results support the hypothesis that fragile sites serve a function; we propose that fragility is linked to a coordinated regulation of fragile genes expression.Comment: 18 pages, accepted for publication in BMC Bioinformatic

On a weaker notion of ring stability for mixed traffic with human-driven and autonomous vehicles

International audienc

Aurora kinase A drives the evolution of resistance to third-generation EGFR inhibitors in lung cancer.

Although targeted therapies often elicit profound initial patient responses, these effects are transient due to residual disease leading to acquired resistance. How tumors transition between drug responsiveness, tolerance and resistance, especially in the absence of preexisting subclones, remains unclear. In epidermal growth factor receptor (EGFR)-mutant lung adenocarcinoma cells, we demonstrate that residual disease and acquired resistance in response to EGFR inhibitors requires Aurora kinase A (AURKA) activity. Nongenetic resistance through the activation of AURKA by its coactivator TPX2 emerges in response to chronic EGFR inhibition where it mitigates drug-induced apoptosis. Aurora kinase inhibitors suppress this adaptive survival program, increasing the magnitude and duration of EGFR inhibitor response in preclinical models. Treatment-induced activation of AURKA is associated with resistance to EGFR inhibitors in vitro, in vivo and in most individuals with EGFR-mutant lung adenocarcinoma. These findings delineate a molecular path whereby drug resistance emerges from drug-tolerant cells and unveils a synthetic lethal strategy for enhancing responses to EGFR inhibitors by suppressing AURKA-driven residual disease and acquired resistance

Geo-environmental mapping using physiographic analysis: constraints on the evaluation of land instability and groundwater pollution hazards in the Metropolitan District of Campinas, Brazil

Geo-environmental terrain assessments and territorial zoning are useful tools for the formulation and implementation of environmental management instruments (including policy-making, planning, and enforcement of statutory regulations). They usually involve a set of procedures and techniques for delimitation, characterisation and classification of terrain units. However, terrain assessments and zoning exercises are often costly and time-consuming, particularly when encompassing large areas, which in many cases prevent local agencies in developing countries from properly benefiting from such assessments. In the present paper, a low-cost technique based on the analysis of texture of satellite imagery was used for delimitation of terrain units. The delimited units were further analysed in two test areas situated in Southeast Brazil to provide estimates of land instability and the vulnerability of groundwater to pollution hazards. The implementation incorporated procedures for inferring the influences and potential implications of tectonic fractures and other discontinuities on ground behaviour and local groundwater flow. Terrain attributes such as degree of fracturing, bedrock lithology and weathered materials were explored as indicators of ground properties. The paper also discusses constraints on- and limitations of- the approaches taken

Increased Adiposity, Dysregulated Glucose Metabolism and Systemic Inflammation in Galectin-3 KO Mice

PMCID: PMC3579848This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Roles of GSK-3 and microRNAs on epithelial mesenchymal transition and cancer stem cells

Various signaling pathways exert critical roles in the epithelial to mesenchymal transition (EMT) and cancer stem cells (CSCs). The Wnt/beta-catenin, PI3K/PTEN/ Akt/mTORC, Ras/Raf/MEK/ERK, hedgehog (Hh), Notch and TP53 pathways elicit essential regulatory influences on cancer initiation, EMT and progression. A common kinase involved in all these pathways is moon-lighting kinase glycogen synthase kinase-3 (GSK-3). These pathways are also regulated by micro-RNAs (miRs). TP53 and components of these pathways can regulate the expression of miRs. Targeting members of these pathways may improve cancer therapy in those malignancies that display their abnormal regulation. This review will discuss the interactions of the multi-functional GSK-3 enzyme in the Wnt/beta-catenin, PI3K/PTEN/Akt/mTORC, Ras/Raf/MEK/ERK, Hh, Notch and TP53 pathways. The regulation of these pathways by miRs and their effects on CSC generation, EMT, invasion and metastasis will be discussed

All-Fiber DBR-Based Sensor Interrogation System for Measuring Acoustic Waves

We investigate the use of all-fiber distributed Bragg reflector (DBR) lasers for fiber optic sensing. We measure the steady-state strain response and show that it is very similar to that for a simple fiber Bragg grating (FBG). The lasers can be wavelength multiplexed and support multisensor operation without crosstalk. We also verify the principle of wavelength-to-power mapping, which can simplify sensor interrogation. Finally, we demonstrate that all-fiber DBR lasers can be used to detect acoustic waves