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).

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."

Gleevec, an Abl family inhibitor, produces a profound change in cell shape and migration (in press)

The issue of how contractility and adhesion are related to cell shape and migration pattern remains largely unresolved. In this paper we report that Gleevec (Imatinib), an Abl family kinase inhibitor, produces a profound change in the shape and migration of rat bladder tumor cells (NBTII) plated on collagen-coated substrates. Cells treated with Gleevec adopt a highly spread D-shape and migrate more rapidly with greater persistence. Accompanying this more spread state is an increase in integrin-mediated adhesion coupled with increases in the size and number of discrete adhesions. In addition, both total internal reflection fluorescence microscopy (TIRFM) and interference reflection microscopy (IRM) revealed a band of small punctate adhesions with rapid turnover near the cell leading margin. These changes led to an increase in global cell-substrate adhesion strength, as assessed by laminar flow experiments. Gleevec-treated cells have greater RhoA activity which, via myosin activation, led to an increase in the magnitude of total traction force applied to the substrate. These chemical and physical alterations upon Gleevec treatment produce the dramatic change in morphology and migration that is observed.

Internet press releases : informative or manipulative?

Una anàlisi de la difusió voluntària de dades o la seva gestió discreta en els Comunicats de Premsa i la importància de la presentació de resultats anuals. L¿exemple del context espanyol: cost de regulació i litigi.

Newspaper attention and policy activities in Spain

Spain"s newspapers are characterised by strong partisan identities. We demonstrate that the two leading newspapers nonetheless show powerful similarities in the topics of their coverage over time. The media system is strongly related to the policy process and it shows similar levels of skew (attention focuses on just a few topics) and friction (attention lurches rapidly from topic to topic) as others have shown for policy processes more generally. Further, media attention is significantly related to parliamentary activities. Oral questions in parliament track closely with media attention over time. Our assessment is based on a comprehensive database of all front-page stories (over 95,000 stories) in El Paı´s and El Mundo, Spain"s largest daily newspapers, and all 7,446 oral questions from 1996 to 2009. The paper shows that explanations of friction and skew in governmental activities should incorporate media dynamics as well. Political leaders are clearly sensitive to media salience.

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

The modular forming press for paperboard packages

In this master’s thesis the structural and functional features of a forming tool are developed to meet the needs of modern packaging production for paperboard packaging are studied. The goal of the study is to develop a new type of machine for the manufacture of the paperboard package by pressing. In the structure of the developed forming press the possibility to modify the packaging as well as the requirements of industrial production, food hygiene and other operational matters are accounted for. The press has been sized based on the main dimensions of a single food-grade paperboard tray. In the LUT Packaging Laboratory the forming press is designed suitable for on-line operation. In addition, suggestions for further development of packaging line and equipment have been made based on the information gathered during this thesis study.

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.

Simulando catástrofes : recursos para la enseñanza de los riesgos naturales

Los riesgos naturales son abordados por distintas asignaturas de ciencias naturalesa lo largo de la ESO y el bachillerato. Su tratamiento en el aula es una evidencia del interés y el carácter aplicado de muchos aspectos de las ciencias de la tierra. Para facilitar su enfoque didáctico se proponen algunas actividades prácticas