Healthcare use in patients with multimorbidity

Background: The existence of multiple chronic conditions in the same patient is a public health problem increasingly recognized as relevant to health systems. Individuals with multimorbidity have additional health needs, which imply a heavy burden in healthcare use. It is estimated that between 70% and 80% of the total health expenditure is used with chronic conditions. Patients with multimorbidity are responsible for up to 75% of primary care appointments. These patients are also high hospital users, with up to 14.6 times more risk of hospitalization. Methods: This study analyses the association between healthcare use and multimorbidity in the Portuguese population aged 25-74 years old. The association between socioeconomic variables and healthcare use was studied, based on data from the first Portuguese Health Examination Survey using a logistic regression model, stratified by sex and adjusted for socioeconomic confounding variables. Results: In patients with multimorbidity, there was a greater use of primary healthcare consultations, medical or surgical specialist consultations and hospitalizations. An association was established between female, older age groups and lower educational levels, and increased healthcare use. When adjusted to socioeconomic variables, the likelihood of using healthcare services can be as high as 3.5 times, when compared to patients without chronic conditions. Conclusion: Our results show a greater healthcare use in multimorbidity patients, both in primary and hospital care. The availability of scientific evidence regarding the use of healthcare services by multimorbidity patients may support health policy changes, which could allow a more efficient management of these patients.publishersversionpublishe

A cost-effective heuristic to schedule local and remote memory in cluster computers

Cluster computers represent a cost-effective alternative solution to supercomputers. In these systems, it is common to constrain the memory address space of a given processor to the local motherboard. Constraining the system in this way is much cheaper than using a full-fledged shared memory implementation among motherboards. However, memory usage among motherboards can be unfairly balanced. On the other hand, remote memory access (RMA) hardware provides fast interconnects among the motherboards of a cluster. RMA devices can be used to access remote RAM memory from a local motherboard. This work focuses on this capability in order to achieve a better global use of the total RAM memory in the system. More precisely, the address space of local applications is extended to remote motherboards and is used to access remote RAM memory. This paper presents an ideal memory scheduling algorithm and proposes a cost-effective heuristic to allocate local and remote memory among local applications. Compared to the devised ideal algorithm, the heuristic obtains the same (or closely resembling) results while largely reducing the computational cost. In addition, we analyze the impact on the performance of stand alone applications varying the memory distribution among regions (local, local to board, and remote). Then, this study is extended to any number of concurrent applications. Experimental results show that a QoS parameter is needed in order to avoid unacceptable performance degradation. © 2011 Springer Science+Business Media, LLC.This work was supported by Spanish CICYT under Grant TIN2009-14475-C04-01 and by Consolider-Ingenio under Grant CSD2006-00046.Serrano Gómez, M.; Sahuquillo Borrás, J.; Petit Martí, SV.; Hassan Mohamed, H.; Duato Marín, JF. (2012). A cost-effective heuristic to schedule local and remote memory in cluster computers. Journal of Supercomputing. 59(3):1533-1551. https://doi.org/10.1007/s11227-011-0566-8S15331551593IBM journal of Research and Development staff (2008) Overview of the IBM blue gene/P project. IBM J Res Dev 52(1/2):199–220Blocksome M, Archer C, Inglett T, McCarthy P, Mundy M, Ratterman J, Sidelnik A, Smith B, Almási G, Castaños J, Lieber D, Moreira J, Krishnamoorthy S, Tipparaju V, Nieplocha J (2006) Design and implementation of a one-sided communication interface for the IBM eServer Blue Gene® supercomputer. In: Proceedings of the 2006 ACM/IEEE conference on supercomputing, SC ’06, Tampa, FL, USA, November 2006, pp 54–54Kumar S, Dózsa G, Almasi G, Heidelberger P, Chen D, Giampapa M, Blocksome M, Faraj A, Parker J, Ratterman J, Smith BE, Archer C (2008) The deep computing messaging framework: generalized scalable message passing on the blue gene/P supercomputer. In: Proceedings of the 22nd annual international conference on supercomputing, Island of Kos, Greece, June 2008, pp 94–103Tipparaju V, Kot A, Nieplocha J, Bruggencate MT, Chrisochoides N (2007) Evaluation of remote memory access communication on the cray XT3. In: Proceedings of the 21th international parallel and distributed processing symposium, Long Beach, California, USA, March 2007, pp 1–7Nussle M, Scherer M, Bruning U (2009) A resource optimized remote-memory-access architecture for low-latency communication. In: International conference on parallel processing, Sept 2009, pp 220–227http://www.hypertransport.org/Serrano M, Sahuquillo J, Hassan H, Petit S, Duato J (2010) A scheduling heuristic to handle local and remote memory in cluster computers. In: Proceedings of the 12th IEEE international conference on high performance computing, Melbourne, Australia, Sept 2010, pp 35–42Keltcher CN, McGrath KJ, Ahmed A, Conway P (2003) The AMD opteron processor for multiprocessor servers. IEEE MICRO 23(2):66–76Duato J, Silla F, Yalamanchili S (2009) Extending hypertransport protocol for improved scalability. In: First international workshop on hypertransport research and applications.Litz H, Fröening H, Nuessle M, Brüening U (2007) A hypertransport network interface controller for ultra-low latency message transfers. HyperTransport Consortium White Paperhttps://www.simics.net/http://www.cs.wisc.edu/gems/http://www.cs.virginia.edu/stream/Woo SC, Ohara M, Torrie E, Singh JP, Gupta A (1995) The SPLASH-2 programs: Characterization and methodological considerations. In: Proceedings of the 22nd annual international symposium on computer architecture, New York, NY, USA, 1995, pp 24–36Levitin A (2003) Introduction to the design and analysis of algorithms. Addison Wesley, ReadingOleszkiewicz J, Xiao L, Liu Y (2004) Parallel network RAM: Effectively utilizing global cluster memory for large data-intensive parallel programs. In: Proceedings of 33rd international conference on parallel processing, Montreal, Quebec, Canada, pp 353–360Liang S, Noronha R, Panda DK (2005) Swapping to remote memory over infiniband: An approach using a high performance network block device. In: Proceedings of the 2005 IEEE international conference on cluster computing, Boston, Massachusetts, USA, pp 1–10Oguchi M, Kitsuregawa M (2000) Using available remote memory dynamically for parallel data mining application on ATM-connected PC cluster. In: Proceedings of the 14th international parallel & distributed processing symposium, Cancun, Mexico, pp 411–420Werstein P, Jia X, Huang Z (2007) A remote memory swapping system for cluster computers. In: Proceedings of the eighth international conference on parallel and distributed computing, applications and technologies, Adelaide, Australia, pp 75–81Midorikawa H, Kurokawa M, Himeno R, Sato M (2008) DLM: A distributed large memory system using remote memory swapping over cluster nodes. In: Proceedings of the 2008 IEEE international conference on cluster computing, Tsukuba, Japan, October 2008, pp 268–27

Evaluation of a range of mammalian and mosquito cell lines for use in Chikungunya virus research

Chikungunya virus (CHIKV) is becoming an increasing global health issue which has spread across the globe and as far north as southern Europe. There is currently no vaccine or anti-viral treatment available. Although there has been a recent increase in CHIKV research, many of these in vitro studies have used a wide range of cell lines which are not physiologically relevant to CHIKV infection in vivo. In this study, we aimed to evaluate a panel of cell lines to identify a subset that would be both representative of the infectious cycle of CHIKV in vivo, and amenable to in vitro applications such as transfection, luciferase assays, immunofluorescence, western blotting and virus infection. Based on these parameters we selected four mammalian and two mosquito cell lines, and further characterised these as potential tools in CHIKV research

Heritability of Attractiveness to Mosquitoes

Female mosquitoes display preferences for certain individuals over others, which is determined by differences in volatile chemicals produced by the human body and detected by mosquitoes. Body odour can be controlled genetically but the existence of a genetic basis for differential attraction to insects has never been formally demonstrated. This study investigated heritability of attractiveness to mosquitoes by evaluating the response of Aedes aegypti (=Stegomyia aegypti) mosquitoes to odours from the hands of identical and non-identical twins in a dual-choice assay. Volatiles from individuals in an identical twin pair showed a high correlation in attractiveness to mosquitoes, while non-identical twin pairs showed a significantly lower correlation. Overall, there was a strong narrow-sense heritability of 0.62 (SE 0.124) for relative attraction and 0.67 (0.354) for flight activity based on the average of ten measurements. The results demonstrate an underlying genetic component detectable by mosquitoes through olfaction. Understanding the genetic basis for attractiveness could create a more informed approach to repellent development

Epidemiology of traumatic spinal cord injury in Galicia, Spain: trends over a 20-year period

[Abstract] Study design: Observational study with prospective and retrospective monitoring. Objective: To describe the epidemiological and demographic characteristics of traumatic spinal cord injury (TSCI), and to analyze its epidemiological changes. Setting: Unidad de Lesionados Medulares, Complejo Hospitalario Universitario A Coruña, in Galicia (Spain). Methods: The study included patients with TSCI who had been hospitalized between January 1995 and December 2014. Relevant data were extracted from the admissions registry and electronic health record. Results: A total of 1195 patients with TSCI were admitted over the specified period of time; 76.4% male and 23.6% female. Mean patient age at injury was 50.20 years. Causes of injury were falls (54.2%), traffic accidents (37%), sports/leisure-related accidents (3.5%) and other traumatic causes (5.3%). Mean patient age increased significantly over time (from 46.40 to 56.54 years), and the number of cases of TSCI related to traffic accidents decreased (from 44.5% to 23.7%), whereas those linked to falls increased (from 46.9% to 65.6%). The most commonly affected neurological level was the cervical level (54.9%), increasing in the case of levels C1–C4 over time, and the most frequent ASIA (American Spinal Injury Association) grade was A (44.3%). The crude annual incidence rate was 2.17/100 000 inhabitants, decreasing significantly over time at an annual percentage rate change of −1.4%. Conclusions: The incidence rate of TSCI tends to decline progressively. Mean patient age has increased over time and cervical levels C1–C4 are currently the most commonly affected ones. These epidemiological changes will eventually result in adjustments in the standard model of care for TSCI

Assessing the Influence of Different ROI Selection Strategies on Functional Connectivity Analyses of fMRI Data Acquired During Steady-State Conditions

In blood oxygen level dependent (BOLD) functional magnetic resonance imaging (fMRI), assessing functional connectivity between and within brain networks from datasets acquired during steady-state conditions has become increasingly common. However, in contrast to connectivity analyses based on task-evoked signal changes, selecting the optimal spatial location of the regions of interest (ROIs) whose timecourses will be extracted and used in subsequent analyses is not straightforward. Moreover, it is also unknown how different choices of the precise anatomical locations within given brain regions influence the estimates of functional connectivity under steady-state conditions. The objective of the present study was to assess the variability in estimates of functional connectivity induced by different anatomical choices of ROI locations for a given brain network. We here targeted the default mode network (DMN) sampled during both resting-state and a continuous verbal 2-back working memory task to compare four different methods to extract ROIs in terms of ROI features (spatial overlap, spatial functional heterogeneity), signal features (signal distribution, mean, variance, correlation) as well as strength of functional connectivity as a function of condition. We show that, while different ROI selection methods produced quantitatively different results, all tested ROI selection methods agreed on the final conclusion that functional connectivity within the DMN decreased during the continuous working memory task compared to rest