Frequent users of the emergency department in a universal health coverage system : a randomized controlled trial of a case-management intervention

BACKGROUND: Frequent emergency department users represent a small number of patients but account for a large number of emergency department visits. They should be a focus because they are often vulnerable patients with many risk factors affecting their quality of life (QoL). Case management interventions have resulted in a significant decrease in emergency department visits, but association with QoL has not been assessed. One aim of our study was to examine to what extent an interdisciplinary case management intervention, compared to standard emergency care, improved frequent emergency department users' QoL. METHODS: Data are part of a randomized, controlled trial designed to improve frequent emergency department users' QoL and use of health-care resources at the Lausanne University Hospital, Switzerland. In total, 250 frequent emergency department users (≥5 attendances during the previous 12 months; ≥ 18 years of age) were interviewed between May 2012 and July 2013. Following an assessment focused on social characteristics; social, mental, and somatic determinants of health; risk behaviors; health care use; and QoL, participants were randomly assigned to the control or the intervention group (n=125 in each group). The final sample included 194 participants (20 deaths, 36 dropouts, n=96 in the intervention group, n=99 in the control group). Participants in the intervention group received a case management intervention by an interdisciplinary, mobile team in addition to standard emergency care. The case management intervention involved four nurses and a physician who provided counseling and assistance concerning social determinants of health, substance-use disorders, and access to the health-care system. The participants' QoL was evaluated by a study nurse using the WHOQOL-BREF five times during the study (at baseline, and at 2, 5.5, 9, and 12 months). Four of the six WHOQOL dimensions of QoL were retained here: physical health, psychological health, social relationship, and environment, with scores ranging from 0 (low QoL) to 100 (high QoL). A linear, mixed-effects model with participants as a random effect was run to analyze the change in QoL over time. The effects of time, participants' group, and the interaction between time and group were tested. These effects were controlled for sociodemographic characteristics and health-related variables (i.e., age, gender, education, citizenship, marital status, type of financial resources, proficiency in French, somatic and mental health problems, and behaviors at risk).

Plant diversity across five vegetation belts in the Pyrenees (Catalonia, Spain)

In this paper we analyze the size and habitat partitioning of the vascular floras of five areas of the NE Iberian Peninsula, representing five distinct vegetation belts and three floristic regions: Mediterranean (basal belt), medio-European (submontane and montane belts) and Boreo-Alpine (subalpine and alpine belts). Each area covered over 1000 ha, and was fairly uniform in terms of potential vegetation, bedrock and bioclimate. They excluded large villages and field areas, the landscape being mainly natural or moderately anthropized.

When Langmuir is too simple: H2 dissociation on Pd(111) at high coverage

Recent experiments of H2 adsorption on Pd(111) [T. Mitsui et al., Nature (London) 422, 705 (2003)] have questioned the classical Langmuir picture of second order adsorption kinetics at high surface coverage requiring pairs of empty sites for the dissociative chemisorption. Experiments find that at least three empty sites are needed. Through density functional theory, we find that H2 dissociation is favored on ensembles of sites that involve a Pd atom with no direct interaction with adsorbed hydrogen. Such active sites are formed by aggregation of at least 3 H-free sites revealing the complex structure of the "active sites."

Emergent geomorphic-vegetation interactions on a subalpine alluvial fan

Following perturbation, an ecosystem (flora, fauna, soil) should evolve as a function of time at a rate conditioned by external variables (relief, climate, geology). More recently, biogeomorphologists have focused upon the notion of co-development of geomorphic processes with ecosystems over very short through to very long (evolutionary) timescales. Alpine environments have been a particular focus of this co-development. However, work in this field has tended to adopt a simplified view of the relationship between perturbation and succession, including: how the landform and ecosystem itself conditions the impact of a perturbation to create a complex spatial response impact; and how perturbations are not simply ecosystem destroyers but can be a significant source of ecosystem resources. What this means is that at the within landform scale, there may well be a complex and dynamic topographic and sedimentological template that co-develops with soil, flora and fauna. Here, we present and test a conceptual model of this template for a subalpine alluvial fan. We combine detailed floristic inventory with soil inventory, determination of edaphic variables and analysis of historical aerial imagery. Spatial variation in the probability of perturbation of sites on the fan surface was associated with down fan variability in the across-fan distribution of fan ages, fan surface channel characteristics and fan surface sedimentology. Floristic survey confirmed that these edaphic factors distinguished site floristic richness and plant communities up until the point that the soil-vegetation system was sufficiently developed to sustain plant communities regardless of edaphic conditions. Thus, the primary explanatory variable was the estimated age of each site, which could be tied back into perturbation history and its spatial expression due to the geometry of the fan: distinct plant communities were emergent both across fan and down fan, a distribution maintained by the way in which the fan dissipates potentially perturbing events.

Who's fault is it ? : An analysis of the press coverage of football betting scandals in France and the United Kingdom

Sport betting is a lucrative business for bookmakers, for the lucky (or wise) punters, but also for governments and for sport. While not new or even recent, the deviances linked to sport betting, primarily match-fixing, have gained increased media exposure in the past decade. This exploratory study is a qualitative content analysis of the press coverage of sport betting-related deviances in football in two countries (UK and France), using in each case two leading national publications over a period of five years. Data analysis indicates a mounting coverage of sport betting scandals, with teams, players and criminals increasingly framed as culprits, while authorities and federations primarily assume a positive role. As for the origin of sport betting deviances, French newspapers tend to blame the system (in an abstract way); British newspapers, in contrast, focus more on individual weaknesses, notably greed. This article contributed to the growing body of literature on the importance of these deviances and on the way they are perceived by sport organizations, legislators and the public at large.

A survey on coverage path planning for robotics

Coverage Path Planning (CPP) is the task of determining a path that passes over all points of an area or volume of interest while avoiding obstacles. This task is integral to many robotic applications, such as vacuum cleaning robots, painter robots, autonomous underwater vehicles creating image mosaics, demining robots, lawn mowers, automated harvesters, window cleaners and inspection of complex structures, just to name a few. A considerable body of research has addressed the CPP problem. However, no updated surveys on CPP reflecting recent advances in the field have been presented in the past ten years. In this paper, we present a review of the most successful CPP methods, focusing on the achievements made in the past decade. Furthermore, we discuss reported field applications of the described CPP methods. This work aims to become a starting point for researchers who are initiating their endeavors in CPP. Likewise, this work aims to present a comprehensive review of the recent breakthroughs in the field, providing links to the most interesting and successful works

Calculation of radio electrical coverage in Medium-Wave Frequencies

The aim of this project is to accomplish an application software based on Matlab to calculate the radioelectrical coverage by surface wave of broadcast radiostations in the band of Medium Wave (WM) all around the world. Also, given the location of a transmitting and a receiving station, the software should be able to calculate the electric field that the receiver should receive at that specific site. In case of several transmitters, the program should search for the existence of Inter-Symbol Interference, and calculate the field strenght accordingly. The application should ask for the configuration parameters of the transmitter radiostation within a Graphical User Interface (GUI), and bring back the resulting coverage above a map of the area under study. For the development of this project, it has been used several conductivity databases of different countries, and a high-resolution elevation database (GLOBE). Also, to calculate the field strenght due to groundwave propagation, it has been used ITU GRWAVE program, which must be integrated into a Matlab interface to be used by the application developed.

Riparian vegetation affected by bank erosion in the Lower São Francisco River, Northeastern Brazil

Changes in the hydrological regime of the Lower São Francisco River, located in Northeastern Brazil have brought negative environmental impacts, jeopardizing the flora and fauna of a global biodiversity hotspot, due to implementation of hydroelectric power dams and surface water withdrawal for irrigation in public and private perimeters. Remnants of the riparian stratum associated to the riverbank destabilization in six fragments were studied by surveying trees, shrubs, herbs, and aquatic species. The calculation of the Factor of Safety (FS) was performed in order to understand the riverbank's stability related to soil texture and vegetation cover. An overall number of 51 botanic families distributed in 71 genera and 79 species were recorded, predominantly from the families Mimosaceae, Myrtaceae, and Fabaceae. The fragmented riparian vegetation is mostly covered by secondary species under a strong anthropogenic impact such as deforestation, mining and irrigation, with an advanced erosion process in the river margins. Strong species that withstand the waves present in the river flow are needed to reduce the constant landslides that are mainly responsible for the river sedimentation and loss of productive lands. A lack of preservation attitude among the local landholders was identified, and constitutes a continuing threat to the riparian ecosystem biodiversity.

Secondary seed dispersal of Ricinus communis Linnaeus (Euphorbiaceae) by ants in secondary growth vegetation in Minas Gerais

In this study, I tested the efficacy of ants as secondary seed dispersers of Ricinus communis in southeastern Brazil. In a natural population of 143 individuals, I determined the ballistic dispersal distance for 62 seeds and 100 additional seeds were experimentally offered to ants in groups of ten seeds along a transect of 50 m. Fifty-three seeds were removed by ants, mainly by the leafcutter Atta sexdens (90.4%). The dispersal distance by ants was high, compared to the global average (4.38 m ± 0.74 m vs. 0.96 m), but was lower than the ballistic distance (7.27 m ± 0.13 m). Ants increased the total dispersal distance (8.66 m ± 0.60 m), but the main benefit for the plant was the directed dispersal, with seed deposition on the enriched soil of ant nests.

Enhanced Vegetation Index (EVI) na análise da dinâmica da vegetação da reserva biológica de Sooretama, ES

Técnicas de análises de séries temporais são utilizadas para caracterizar o comportamento de fenômenos naturais no domínio do tempo. Neste artigo, segundo a metodologia proposta por Box et al. (1994), 125 observações do Enhanced Vegetation Index (EVI) foram analisadas. Os valores modelados correspondem às variações temporais ocorridas no dossel florestal da reserva biológica de Sooretama, localizada ao Norte do Estado do Espírito Santo, no Município de Linhares. Os resultados indicaram que a metodologia foi adequada. Os resíduos do modelo ajustado são não correlacionados com distribuição normal, média zero e variância s². Com o menor valor do Critério de Informação de Akaike (AIC) -570,51, o modelo ajustado foi o Sazonal Auto-Regressivo Integrado de Médias Móveis (1,0,1)(1,0,1)12.

Accuracy and efficiency evaluation of point-centered quarter method variations for vegetation sampling in an araucaria forest

In order to verify Point-Centered Quarter Method (PCQM) accuracy and efficiency, using different numbers of individuals by per sampled area, in 28 quarter points in an Araucaria forest, southern Paraná, Brazil. Three variations of the PCQM were used for comparison associated to the number of sampled individual trees: standard PCQM (SD-PCQM), with four sampled individuals by point (one in each quarter), second measured (VAR1-PCQM), with eight sampled individuals by point (two in each quarter), and third measuring (VAR2-PCQM), with 16 sampled individuals by points (four in each quarter). Thirty-one species of trees were recorded by the SD-PCQM method, 48 by VAR1-PCQM and 60 by VAR2-PCQM. The level of exhaustiveness of the vegetation census and diversity index showed an increasing number of individuals considered by quadrant, indicating that VAR2-PCQM was the most accurate and efficient method when compared with VAR1-PCQM and SD-PCQM.

DYNAMICS OF LEAF FALL FROM RIPARIAN VEGETATION AND THE ACCUMULATION IN BENTHIC STOCK IN NEOTROPICAL STREAMS1

ABSTRACT Considering the importance of the riparian vegetation leaves as an energetic source to first order streams, the aim of the present study was to evaluate the leaf biomass contribution to the system and its temporal dynamics. With this purpose, monthly samples from July 2008 to June 2009 were collected using four sampling devices installed in three streams, in order to collect the vertical, lateral and terrestrial loads, and the benthic stock. We tested the following hypothesis: (1) leaf biomass input is higher after hydric stress periods; and (2) benthic stock biomass increase with higher loads from vertical and lateral entrances. Leaves represented 71.9% (on average) of all sampled allochthonous matter, with seasonal significant variation along the studied year. Peaks of leaf input were registered in September-October, after an increase in rainfall, and also in January, after a decrease in rainfall. Leaf input was higher in the lateral load.