Ambulatory care, insurance, and avoidable emergency department utilization in North Carolina

Objective: To examine whether and how avoidable emergency department (ED) utilization is associated with ambulatory or primary care (APC) utilization, insurance, and interaction effects. Design and sample: A cross-sectional analysis of electronic health records from 70,870 adults residing in Mecklenburg County, North Carolina, who visited an ED within a large integrated healthcare system in 2017. Methods: APC utilization was measured as total visits, categorized as: 0, 1, and > 1. Insurance was defined as the method of payment for the ED visit as: Medicaid, Medicare, private, or uninsured. Avoidable ED utilization was quantified as a score (aED), calculated as the sum of New York University Algorithm probabilities multiplied by 100. Quantile regression models were used to predict the 25th, 50th, 75th, 95th, and 99th percentiles of avoidable ED scores with APC visits and insurance as predictors (Model 1) and with an interaction term (Model 2). Results: Having >1 APC visit was negatively associated with aED at the lower percentiles and positively associated at higher percentiles. A higher aED was associated with having Medicaid insurance and a lower aED was associated with having private insurance, compared to being uninsured. In stratified models, having >1 APC visit was negatively associated with aED at the 25th percentile for the uninsured and privately insured, but positively associated with aED at higher percentiles among the uninsured, Medicaid-insured, and privately insured. Conclusions: The association between APC utilization and avoidable ED utilization varied based on segments of the distribution of ED score and differed significantly by insurance type

Towards an improved seismic risk scenario for Bishkek, Kyrgyz Republic

A risk scenario for Bishkek, capital of the Kyrgyz Republic, is evaluated by considering a magnitude 7.5 earthquake occurring over the Issyk-Ata fault.The intensity values predicted through the application of an attenuation relationship and a recently compiled vulnerability composition model are used as inputs for seismic risk assessment, carried out using the CREST (Cedim Risk Estimation Tool) code. Although the results of this study show a reduction by as much as a factor of two with respect to the results of earlier studies, the risk scenario evaluated in this paper confirms the large number of expected injuries and fatalities in Bishkek, as well as the severe level of building damage. Furthermore, the intensity map has also been evaluated by performing stochastic simulations. The spectral levels of the ground shaking are converted into intensity values by applying a previously derived conversion technique. The local site effects are empirically estimated considering the spectral ratios between the earthquakes recorded by a temporary network deployed in Bishkek and the recordings at two reference sites. Although the intensities computed via stochastic simulations are lower than those estimated with the attenuation relationship, the simulations showed that site effects, which can contribute to intensity increments as large as 2 units in the north part of the town, are playing an important role in altering the risk estimates for different parts of the town

Sorting Permutations: Games, Genomes, and Cycles

Permutation sorting, one of the fundamental steps in pre-processing data for the efficient application of other algorithms, has a long history in mathematical research literature and has numerous applications. Two special-purpose sorting operations are considered in this paper: context directed swap, abbreviated cds, and context directed reversal, abbreviated cdr. These are special cases of sorting operations that were studied in prior work on permutation sorting. Moreover, cds and cdr have been postulated to model molecular sorting events that occur in the genome maintenance program of certain species of single-celled organisms called ciliates. This paper investigates mathematical aspects of these two sorting operations. The main result of this paper is a generalization of previously discovered characterizations of cds-sortability of a permutation. The combinatorial structure underlying this generalization suggests natural combinatorial two-player games. These games are the main mathematical innovation of this paper.Comment: to appear in Discrete Mathematics, Algorithms and Application

Identifying "Useful" Fitness Models: Balancing the Benefits of Added Complexity with Realistic Data Requirements in Models of Individual Plant Fitness

Direct species interactions are commonly included in individual fitness models used for coexistence and local diversity modeling. Though widely considered important for such models, direct interactions alone are often insufficient for accurately predicting fitness, coexistence, or diversity outcomes. Incorporating higher-order interactions (HOIs) can lead to more accurate individual fitness models but also adds many model terms, which can quickly result in model overfitting. We explore approaches for balancing the trade-off between tractability and model accuracy that occurs when HOIs are added to individual fitness models. To do this, we compare models parameterized with data from annual plant communities in Australia and Spain, varying in the extent of information included about the focal and neighbor species. The best-performing models for both data sets were those that grouped neighbors based on origin status and life form, a grouping approach that reduced the number of model parameters substantially while retaining important ecological information about direct interactions and HOIs. Results suggest that the specific identity of focal or neighbor species is not necessary for building well-performing fitness models that include HOIs. In fact, grouping neighbors by even basic functional information seems sufficient to maximize model accuracy, an important outcome for the practical use of HOI-inclusive fitness models

Progressing for Intelligent to Smart Buildings

This paper addresses the issue of the misunderstandings surrounding the terms intelligent and smart when applied to modern buildings. The terms have increasingly been used interchangeably which has led to confusion for designers, researchers and clients. The authors propose that utilising the increasingly available information as a tool to forewarn the building control systems, rather than reacting to stimuli, can allow adaptability and a distinction between Intelligent and Smart Buildings. A case study building in Sheffield is used as a simple example of using enterprise systems to manipulate zoning of a building at predicted occupancy levels. The results suggest that this example of information utilisation enables efficient energy and resource distribution whilst maintaining the functional value of the building and the ability for occupants to have a choice of their own environment

Reduced elastogenesis: a clue to the arteriosclerosis and emphysematous changes in Schimke immuno-osseous dysplasia?

BACKGROUND: Arteriosclerosis and emphysema develop in individuals with Schimke immuno-osseous dysplasia (SIOD), a multisystem disorder caused by biallelic mutations in SMARCAL1 (SWI/SNF-related, matrix-associated, actin-dependent regulator of chromatin, subfamily a-like 1). However, the mechanism by which the vascular and pulmonary disease arises in SIOD remains unknown. METHODS: We reviewed the records of 65 patients with SMARCAL1 mutations. Molecular and immunohistochemical analyses were conducted on autopsy tissue from 4 SIOD patients. RESULTS: Thirty-two of 63 patients had signs of arteriosclerosis and 3 of 51 had signs of emphysema. The arteriosclerosis was characterized by intimal and medial hyperplasia, smooth muscle cell hyperplasia and fragmented and disorganized elastin fibers, and the pulmonary disease was characterized by panlobular enlargement of air spaces. Consistent with a cell autonomous disorder, SMARCAL1 was expressed in arterial and lung tissue, and both the aorta and lung of SIOD patients had reduced expression of elastin and alterations in the expression of regulators of elastin gene expression. CONCLUSIONS: This first comprehensive study of the vascular and pulmonary complications of SIOD shows that these commonly cause morbidity and mortality and might arise from impaired elastogenesis. Additionally, the effect of SMARCAL1 deficiency on elastin expression provides a model for understanding other features of SIOD

ERGR: An ethanol-related gene resource

Over the last decade rapid progress has been made in the study of ethanol-related traits including alcohol abuse and dependence, and behavioral responses to ethanol in both humans and animal models. To collect, curate, integrate these results so as to make them easily accessible and interpretable for researchers, we developed ERGR, a comprehensive ethanol-related gene resource. We collected and curated more than 30 large-scale data sets including linkage, association and microarray gene expression from the literature and 21 mouse QTLs from public databases. At present, the ERGR deposits ethanol-related information of ∼7000 genes from five organisms: human (3311), mouse (2129), rat (679), fly (614) and worm (228). ERGR provides gene annotations and orthologs, detailed gene study information (e.g. fold changes of gene expression, P-values), and both the text and BLAST searches. Moreover, ERGR has data integration tools such as for data union and intersection, and candidate gene selection based on evidence in multiple datasets or organisms. The ERGR database is evolving with new data releases. More functions will also be added. ERGR has a user-friendly web interface with browse and search functions at multiple levels. It is freely available at http://bioinfo.vipbg.vcu.edu/ERGR/

Gender and Videogames: The political valency of Lara Croft

The Face: Is Lara a feminist icon or a sexist fantasy? Toby Gard: Neither and a bit of both. Lara was designed to be a tough, self-reliant, intelligent woman. She confounds all the sexist cliches apart from the fact that she’s got an unbelievable figure. Strong, independent women are the perfect fantasy girls—the untouchable is always the most desirable (Interview with Lara’s creator Toby Gard in The Face magazine, June 1997)