Patterns of hospital utilization among privately insured patients, 1980-1986.

"OM91-0518"--P. [4] of cover.

Patterns of prescribing and utilization of asthma medications in a tertiary hospital in Dubai, United Arab Emirates

Purpose: To assess the prescribing patterns of asthma medications in a hospital in Dubai, United Arab Emirates (UAE) with regard to the demographic pattern of the population. Methods: One hundred fifty four patients, 83 male and 71 female, were randomly selected from the outpatient respiratory diseases clinic of a tertiary hospital in Dubai, UAE over a 3-month period. Patients were asked to complete a structured questionnaire and data were analyzed using STATA 12 software. Results: Most of the patients were within the age range of 0 – 10 years. About 86 % of the patients were overweight. Half of the patients were non-smokers while 51 % of them had a family history of asthma. About 54 % of the patients received multiple drug therapy of which two-drug combinations were widely prescribed (31 %). The most utilized drug classes were short acting β-agonists (42 %), xanthine drugs (16 %), leukotriene modifiers (14 %) and oral and intravenous corticosteroids (13 %). Statistical significant differences among the age groups (F = 2.33, p = 0.0275) were found. Conclusion: Primary prevention to reduce the level of exposure to common risk factors for asthma would be a vital step to control the disease. More resources should be channeled into educating physicians and patients on rational drug utilization to improve the quality of patients’ care.

The Invertebrate Assemblage Associated with Macrocystis pyrifera and its Utilization as a Food Resource by Kelp Forest Fishes

The present study was designed to examine the following: (1) the taxonomic. spatial, and temporal patterns of availability of all invertebrate species associated with Macrocystis (excluding protozoans and nematodes); (2) the utilization of this invertebrate assemblage as food by kelp forest fishes within the Macrocystis "foliage- searching" feeding guild, as well as proximal mechanisms leading to observed patterns of resource partitioning; and (3) the dynamic relationship between availability and utilization of this food resource. The approach was largely descriptive. with observations collected during a 19-month period from June 1975 to December 1976. Chapter I is an investigation of the resource utilization patterns of four species of kelp forest fishes with respect to food-related resource dimensions. and tests aspects of current theory involving inter- and intraspecific competition. Chapter II is a detailed examination of the invertebrate assemblage associated with Macrocystis and presents life histories of the fishes examined during this study. (PDFs contains 387 pages, chapter 1 is 203 pages, chapter 2 is 184 pages)

Fish movement patterns in Virgin Islands National Park, Virgin Islands Coral Reef National Monument and adjacent waters

NOAA’s National Centers for Coastal Ocean Science (NCCOS)-Center for Coastal Monitoring and Assessment’s (CCMA) Biogeography Branch, National Park Service (NPS), US Geological Survey, and the University of Hawaii used acoustic telemetry to quantify spatial patterns and habitat affinities of reef fishes around the island of St. John, US Virgin Islands. The objective of the study was to define the movements of reef fishes among habitats within and between the Virgin Islands Coral Reef National Monument (VICRNM), the Virgin Islands National Park (VIIS), and Territorial waters surrounding St. John. In order to better understand species’ habitat utilization patterns among management regimes, we deployed an array of hydroacoustic receivers and acoustically tagged reef fishes. Thirty six receivers were deployed in shallow near-shore bays and across the shelf to depths of approximately 30 m. One hundred eighty four individual fishes were tagged representing 19 species from 10 different families with VEMCO V9-2L-R64K transmitters. The array provides fish movement information at fine (e.g., day-night and 100s meters within a bay) to broad spatial and temporal scales (multiple years and 1000s meters across the shelf). The long term multi-year tracking project provides direct evidence of connectivity across habitat types in the seascape and among management units. An important finding for management was that a number of individuals moved among management units (VICRNM, VINP, Territorial waters) and several snapper moved from near-shore protected areas to offshore shelf-edge spawning aggregations. However, most individuals spent the majority of their time with VIIS and VICRNM, with only a few wide-ranging species moving outside the management units. Five species of snappers (Lutjanidae) accounted for 31% of all individuals tagged, followed by three species of grunts (Haemulidae) accounting for an additional 23% of the total. No other family had more than a single species represented in the study. Bluestripe grunt (Haemulon sciurus) comprised 22% of all individuals tagged, followed by lane snappers (Lutjanus synagris) at 21%, bar jack (Carangoides ruber) at 11%, and saucereye porgy (Calamus calamus) at 10%. The largest individual tagged was a 70 cm TL nurse shark (Ginglymostoma cirratum), followed by a 65 cm mutton snapper (Lutjanus analis), a 47 cm bar jack, and a 41 cm dog snapper (Lutjanus jocu). The smallest individuals tagged were a 19 cm blue tang (Acanthurus coeruleus) and a 19.2 cm doctorfish (Acanthurus chirurgus). Of the 40 bluestriped grunt acoustically tagged, 73% were detected on the receiver array. The average days at large (DAL) was 249 (just over 8 months), with one individual detected for 930 days (over two and a half years). Lane snapper were the next most abundant species tagged (N = 38) with 89% detected on the array. The average days at large (DAL) was 221 with one individual detected for 351 days. Seventy-one percent of the bar jacks (N = 21) were detected on the array with the average DALs at 47 days. All of the mutton snapper (N = 12) were detected on the array with an average DAL of 273 and the longest at 784. The average maximum distance travelled (MDT) was ca. 2 km with large variations among species. Grunts, snappers, jacks, and porgies showed the greatest movements. Among all individuals across species, there was a positive and significant correlation between size of individuals and MDT and between DAL and MDT.

Effects of tannery sludge application on physiological and fatty acid profiles of the soil microbial community

The impact of tannery sludge application on soil microbial community and diversity is poorly understood. We studied the microbial community in an agricultural soil following two applications (2006 and 2007) of tannery sludge with annual application rates of 0.0,2.3 and 22.6 Mg ha(-1). The soil was sampled 12 and 271 days after the second (2007) application. Community structure was assessed via a phospholipid fatty acid analysis, and the physiological profile of the soil microbial community via the Biolog method. Tannery sludge application changed soil chemical properties, increasing the soil pH and electrical conductivity as well as available P and mineral N concentrations. The higher sludge application rate changed the community structure and the physiological profile of the microbial community at both sampling dates. However, there is no clear link between community structure and carbon substrate utilization. According to the Distance Based Linear Models Analysis, the fatty acids 16:0 and 117:0 together contributed 84% to the observed PLFA patterns, whereas the chemical properties available P, mineral N, and Ca, and pH together contributed 54%. At 12 days, tannery sludge application increased the average well color development from 0.46 to 0.87 after 48 h, and reduced the time elapsed before reaching the midpoint carbon substrate utilization (s) from 71 to 44 h, an effect still apparent nine months after application of the higher sludge application rate. The dominant signature fatty acids and kinetic parameters (r and s) were correlated to the concentrations of available P. Ca, mineral N, pH and EC. (c) 2012 Elsevier B.V. All rights reserved.

MEDICAL CARE UTILIZATION IN TIME AMONG ELDERLY MEDICARE ENROLLEES IN AN HMO

Investigation into the medical care utilization of elderly Medicare enrollees in an HMO (Kaiser - Portland, Oregon): The specific research topics are: (1) The utilization of medical care by selected determinants such as: place of service, type of service, type of appointment, physician status, physician specialty and number of associated morbidities. (2) The attended prevalence of 3 chronic diseases: hypertension, diabetes and arthritis in addition to pneumonias as an example of acute diseases. The selection of these examples was based on their importance in morbidity/or mortality results among the elderly. The share of these diseases in outpatient and inpatient contacts was examined as an example of the relation between morbidity and medical care utilization. (3) The tendency of individual utilization patterns to persist in subsequent time periods. The concept of contagion or proneness was studied in a period of 2 years. Fitting the negative binomial and the Poisson distributions was applied to the utilization in the 2nd year conditional on that in the 1st year as regards outpatient and inpatient contacts.^ The present research is based on a longitudinal study of 20% random sample of elderly Medicare enrollees. The sample size is 1683 individuals during the period from August 1980-December 1982.^ The results of the research were: (1) The distribution of contacts by selected determinants did not reveal a consistent pattern between sexes and age groups. (2) The attended prevalence of hypertension and arthritis showed excess prevalence among females. For diabetes and pneumonias no female excess was noticed. Consistent increased prevalence with increasing age was not detected.^ There were important findings pertaining to the relatively big share of the combined 3 chronic diseases in utilization. They accounted for 20% of male outpatient contacts vs. 25% of female outpatients. For inpatient contacts, they consumed 20% in case of males vs. 24% in case of females. (3) Finding that the negative binomial distribution fit the utilization experience supported the research hypothesis concerning the concept of contagion in utilization. This important finding can be helpful in estimating liability functions needed for forecasting future utilization according to previous experience. Such information has its relevance to organization, administration and planning for medical care in general. (Abstract shortened with permission of author.) ^

Resistance exercise with low glycogen increases p53 phosphorylation and PGC-1α mRNA in skeletal muscle

Purpose We determined the effect of reduced muscle glycogen availability on cellular pathways regulating mitochondrial biogenesis and substrate utilization after a bout of resistance exercise. Methods Eight young, recreationally trained men undertook a glycogen depletion protocol of one-leg cycling to fatigue (LOW), while the contralateral (control) leg rested (CONT). Following an overnight fast, subjects completed 8 sets of 5 unilateral leg press repetitions (REX) at 80 % 1 Repetition Maximum (1RM) on each leg. Subjects consumed 500 mL protein/CHO beverage (20 g whey + 40 g maltodextrin) upon completion of REX and 2 h later. Muscle biopsies were obtained at rest and 1 and 4 h after REX in both legs. Results Resting muscle glycogen was higher in the CONT than LOW leg (~384 ± 114 vs 184 ± 36 mmol kg−1 dry wt; P < 0.05), and 1 h and 4 h post-exercise (P < 0.05). Phosphorylation of p53Ser15 increased 1 h post-exercise in LOW (~115 %, P < 0.05) and was higher than CONT at this time point (~87 %, P < 0.05). p38MAPKThr180/Tyr182 phosphorylation increased 1 h post-exercise in both CONT and LOW (~800–900 %; P < 0.05) but remained above rest at 4 h only in CONT (~585 %, P < 0.05; different between legs P < 0.05). Peroxisome proliferator-activated receptor gamma coactivator-1α (PGC-1α) mRNA was elevated 4 h post-exercise in LOW (~200 %, P < 0.05; different between legs P < 0.05). There were no changes in Fibronectin type III domain-containing protein 5 (FNDC5) mRNA for CONT or LOW legs post-exercise. Conclusion Undertaking resistance exercise with low glycogen availability may enhance mitochondrial-related adaptations through p53 and PGC-1α-mediated signalling.

Nutritional constraints on displacement of Fusarium pseudograminearum from cereal straw by antagonists.

Displacement of the fungus Fusarium pseudograminearum from stubble by antagonists is a potential means of biocontrol of crown rot in cereals. The role of carbon and nitrogen nutrition in interactions between the pathogen and the antagonists Fusarium equiseti, Fusarium nygamai, Trichoderma harzianum and the non-antagonistic straw fungus Alternaria infectoria was investigated. Sole carbon source utilization patterns on Biolog plates were similar among the three Fusarium species, suggesting a possible role for competition. However, carbon niche overlap was unlikely to be important in antagonism by T. harzianum. Straw medium supplemented with sugars generally reduced the inhibitory effect of antagonists on growth of F. pseudograminearum in dual culture, indicating that availability of simple carbon sources does not limit antagonism. Adding nitrogen as urea, nitrate or ammonium to straw medium had little effect on antagonism by F. equiseti and F. nygamai, but ammonium addition removed the inhibitory effect of T. harzianum on growth of F. pseudograminearum. Displacement of F. pseudograminearum from straw by all fungi in a Petri dish assay was greater when urea or nitrate was used as a nitrogen source than with ammonium. All forms of nitrogen significantly increased displacement of F. pseudograminearum from straw under simulated field conditions when straws were either inoculated with T. harzianum or exposed to resident soil microbes. However, in 2 out of 3 experiments urea and nitrate were more effective than ammonium. The results suggest that availability of nitrogen, but not carbon, is limiting the activities of antagonists of F. pseudograminearum in straw, and the way nitrogen is applied can influence the rate of displacement and mortality of the pathogen in host residues.

A Mycobacterial Cyclic AMP Phosphodiesterase That Moonlights as a Modifier of Cell Wall Permeability

Mycobacterium tuberculosis utilizes many mechanisms to establish itself within the macrophage, and bacterially derived cAMP is important in modulating the host cellular response. Although the genome of M. tuberculosis is endowed with a number of mammalian-like adenylyl cyclases, only a single cAMP phosphodiesterase has been identified that can decrease levels of cAMP produced by the bacterium. We present the crystal structure of the full-length and sole cAMP phosphodiesterase, Rv0805, found in M. tuberculosis, whose orthologs are present only in /the genomes of slow growing and pathogenic mycobacteria. The dimeric core catalytic domain of Rv0805 adopts a metallophosphoesterase fold, and the C-terminal region builds the active site and contributes to multiple substrate utilization.Localization of Rv0805 to the cell wall is dependent on its C terminus, and expression of either wild type or mutationally inactivated Rv0805 in M. smegmatis alters cell permeability to hydrophobic cytotoxic compounds. Rv0805 may therefore play a key role in the pathogenicity of mycobacteria, not only by hydrolyzing bacterial cAMP, but also by moonlighting as a protein that can alter cell wall functioning.

Adhesion of Acidithiobacillus ferrooxidans to mineral surfaces

Direct contact mechanism in bioleaching implies prior mineral adhesion of Acidithiobacillus ferrooxidans and subsequent enzymatic attack.Prior bacterial adaptation to sulfide mineral substrates influences bacterial ferrous ion oxidation rates. It is highly beneficial to understand major biooxidation mechanisms with reference to solution- and mineral-grown cells in order to optimize bioleaching reactions. For A. ferrooxidans grown in the presence of solid substrates such as sulfur, pyrite and chalcopyrite, bacterial adhesion is required for its enzymatic machinery to come into close contact for mineral dissolution.But when grown in solution substrate such as ferrous ions and thiosulfate, such an adhesion machinery is not required for substrate utilization. Proteinaceous compounds were observed on the surface of sulfur-grown cells. Such an induction of relatively hydrophobic proteins and down regulation of exposed polysaccharides leads to changes in cell surface chemistry. Sulfur-grown and pyrite- and chalcopyrite-grown bacterial cells were found to be more efficient in the bioleaching of chalcopyrite than those grown in the presence of ferrous ions and thiosulfate. (C) 2010 Elsevier B.V. All rights reserved.

Molecular mechanisms of hypertension-induced heart failure : Experimental studies with special emphasis on local renin-angiotensin system, cardiac metabolism and levosimendan

Hypertension is a major risk factor for stroke, ischaemic heart disease, and the development of heart failure. Hypertension-induced heart failure is usually preceded by the development of left ventricular hypertrophy (LVH), which represents an adaptive and compensatory response to the increased cardiac workload. Biomechanical stress and neurohumoral activation are the most important triggers of pathologic hypertrophy and the transition of cardiac hypertrophy to heart failure. Non-clinical and clinical studies have also revealed derangements of energy metabolism in hypertensive heart failure. The goal of this study was to investigate in experimental models the molecular mechanisms and signalling pathways involved in hypertension-induced heart failure with special emphasis on local renin-angiotensin-aldosterone system (RAAS), cardiac metabolism, and calcium sensitizers, a novel class of inotropic agents used currently in the treatment of acute decompensated heart failure. Two different animal models of hypertensive heart failure were used in the present study, i.e. hypertensive and salt-sensitive Dahl/Rapp rats on a high salt diet (a salt-sensitive model of hypertensive heart failure) and double transgenic rats (dTGR) harboring human renin and human angiotensinogen genes (a transgenic model of hypertensive heart failure with increased local RAAS activity). The influence of angiotensin II (Ang II) on cardiac substrate utilization and cardiac metabolomic profile was investigated by using gas chromatography coupled to time-of-flight mass spectrometry to detect 247 intermediary metabolites. It was found that Ang II could alter cardiac metabolomics both in normotensive and hypertensive rats in an Ang II receptor type 1 (AT1)-dependent manner. A distinct substrate use from fatty acid oxidation towards glycolysis was found in dTGR. Altered cardiac substrate utilization in dTGR was associated with mitochondrial dysfunction. Cardiac expression of the redox-sensitive metabolic sensor sirtuin1 (SIRT1) was increased in dTGR. Resveratrol supplementation prevented cardiovascular mortality and ameliorated Ang II-induced cardiac remodeling in dTGR via blood pressure-dependent pathways and mechanisms linked to increased mitochondrial biogenesis. Resveratrol dose-dependently increased SIRT1 activity in vitro. Oral levosimendan treatment was also found to improve survival and systolic function in dTGR via blood pressure-independent mechanisms, and ameliorate Ang II-induced coronary and cardiomyocyte damage. Finally, using Dahl/Rapp rats it was demonstrated that oral levosimendan as well as the AT1 receptor antagonist valsartan improved survival and prevented cardiac remodeling. The beneficial effects of levosimendan were associated with improved diastolic function without significantly improved systolic changes. These positive effects were potentiated when the drug combination was administered. In conclusion, the present study points to an important role for local RAAS in the pathophysiology of hypertension-induced heart failure as well as its involvement as a regulator of cardiac substrate utilization and mitochondrial function. Our findings suggest a therapeutic role for natural polyphenol resveratrol and calcium sensitizer, levosimendan, and the novel drug combination of valsartan and levosimendan, in prevention of hypertension-induced heart failure. The present study also provides a better understanding of the pathophysiology of hypertension-induced heart failure, and may help identify potential targets for novel therapeutic interventions.

Integrating remote sensing products and GIS tools to support marine spatial management in West Hawai'i

Marine protected areas (MPAs) represent a form of spatial management, and geospatial information on living marine resources and associated habitat is extremely important to support best management practices in a spatially discrete MPA. Benthic habitat maps provide georeferenced information on the geomorphic structure and biological cover types in the marine environment. This information supports an enhanced understanding of ecosystem function and species habitat utilization patterns. Benthic habitat maps are most useful for marine management and spatial planning purposes when they are created at a scale that is relevant to management actions. We sought to improve the resolution of existing benthic habitat maps created during a regional mapping effort in Hawai`i. Our results complemented these existing regional maps and provided more detailed, finer-scale habitat maps for a network of MPAs in West Hawai`i. The map products created during this study allow local planners and managers to extract information at a spatial scale relevant to the discrete management units, and appropriate for local marine management efforts on the Kona Coast. The resultant benthic habitat maps were integrated in a geographic information system (GIS) that also included aerial imagery, underwater video, MPA regulations, summarized ecological data and other relevant and spatially explicit information. The integration of the benthic habitat maps with additional “value added” geospatial information into a dynamic GIS provide a decision support tool with pertinent marine resource information available in one central location and support the application of a spatial approach to the management of marine resources. Further, this work can serve as a case study to demonstrate the integration of remote sensing products and GIS tools at a fine spatial scale relevant to local-level marine spatial planning and management efforts.

The coupling of St. John, US Virgin Islands Marine Protected Areas based on reef fish habitat affinities and movements across management boundaries [Poster]

NOAA's Biogeograpy Branch, the National Park Service (NPS), US Geological Survey, and the University of the Virgin Islands (UVI) are using acoustice telemetry to quantify spatial patterns and habitat affinities of reef fishes in the US Virgin Islands (USVI). The objective of the study is to define the movements of reef fishes among habitats within and between the Virgin Islands Coral Reef Nationla Monument (VICRNM), adjacent to Virgin Islands National Park (VIIS), and USVI Territorial waters. In order to better understand species habitat utilization patterns and movement of fishes among management regimes and areas open to fishing around St. John, we deployed an array of hydroacoutstic receivers and acoustically tagged reef fishes. A total of 150 fishes, representing 18 species and 10 families were acoustically tagged along the south shore of St. John from July 2006 to June 2008. Thirty six receivers with a detection range of approximately 300m each were deployed in shallow nearshore bays and across the shelf to depths of approximately 30m. Receivers were located within reefs and adjacent to reefs in seagrass, algal beds, or sand habitats. Example results include the movement of lane snappers and blue striped grunts that demonstrated diel movement from reef habitats during daytime hours to offshore seagrass beds at night. Fish associated with reefs that did not have adjacent seagrass beds made more extensive movements than those fishes associated with reefs that had adjacent seagrass habitats. The array comprised of both nearshore and cross shelf location of receives provides information on fine to broad scale fish movement patterns across habitats and among management units to examine the strength of ecological connectivity between management areas and habitats. For more information go to: http://ccma.nos.noaa.gov/ecosystems/ coralreef/acoustic_tracking.html

Análise de eficiência energética de transportes rodoviários

Projecto para obtenção do grau de Mestre em Engenharia Informática e de computadores

How enterprise 2,0 firms take advantage of emergent social software platforms to manage knowledge

This research aims to provide a better understanding on how firms stimulate knowledge sharing through the utilization of collaboration tools, in particular Emergent Social Software Platforms (ESSPs). It focuses on the distinctive applications of ESSPs and on the initiatives contributing to maximize its advantages. In the first part of the research, I have itemized all types of existing collaboration tools and classify them in different categories according to their capabilities, objectives and according to their faculty for promoting knowledge sharing. In the second part, and based on an exploratory case study at Cisco Systems, I have identified the main applications of an existing enterprise social software platform named Webex Social. By combining a qualitative and quantitative approach, as well as combining data collected from survey’s results and from the analysis of the company’s documents, I am expecting to maximize the outcome of this investigation and reduce the risk of bias. Although effects cannot be universalized based on one single case study, some utilization patterns have been underlined from the data collected and potential trends in managing knowledge have been observed. The results of the research have also enabled identifying most of the constraints experienced by the users of the firm’s social software platform. Utterly, this research should provide a primary framework for firms planning to create or implement a social software platform and for firms willing to increase adoption levels and to promote the overall participation of users. It highlights the common traps that should be avoided by developers when designing a social software platform and the capabilities that it should inherently carry to support an effective knowledge management strategy.