Estimates of hospital and physician costs of epilepsy in the United States for 1995 comparing the provider -based survey method and a patient -based medical charts and billing method

This investigation compares two different methodologies for calculating the national cost of epilepsy: provider-based survey method (PBSM) and the patient-based medical charts and billing method (PBMC&BM). The PBSM uses the National Hospital Discharge Survey (NHDS), the National Hospital Ambulatory Medical Care Survey (NHAMCS) and the National Ambulatory Medical Care Survey (NAMCS) as the sources of utilization. The PBMC&BM uses patient data, charts and billings, to determine utilization rates for specific components of hospital, physician and drug prescriptions. ^ The 1995 hospital and physician cost of epilepsy is estimated to be $722 million using the PBSM and $1,058 million using the PBMC&BM. The difference of $336 million results from $136 million difference in utilization and $200 million difference in unit cost. ^ Utilization. The utilization difference of $136 million is composed of an inpatient variation of $129 million, $100 million hospital and $29 million physician, and an ambulatory variation of $7 million. The $100 million hospital variance is attributed to inclusion of febrile seizures in the PBSM, $−79 million, and the exclusion of admissions attributed to epilepsy, $179 million. The former suggests that the diagnostic codes used in the NHDS may not properly match the current definition of epilepsy as used in the PBMC&BM. The latter suggests NHDS errors in the attribution of an admission to the principal diagnosis. ^ The $29 million variance in inpatient physician utilization is the result of different per-day-of-care physician visit rates, 1.3 for the PBMC&BM versus 1.0 for the PBSM. The absence of visit frequency measures in the NHDS affects the internal validity of the PBSM estimate and requires the investigator to make conservative assumptions. ^ The remaining ambulatory resource utilization variance is $7 million. Of this amount, $22 million is the result of an underestimate of ancillaries in the NHAMCS and NAMCS extrapolations using the patient visit weight. ^ Unit cost. The resource cost variation is $200 million, inpatient is $22 million and ambulatory is $178 million. The inpatient variation of $22 million is composed of $19 million in hospital per day rates, due to a higher cost per day in the PBMC&BM, and $3 million in physician visit rates, due to a higher cost per visit in the PBMC&BM. ^ The ambulatory cost variance is $178 million, composed of higher per-physician-visit costs of $97 million and higher per-ancillary costs of $81 million. Both are attributed to the PBMC&BM's precise identification of resource utilization that permits accurate valuation. ^ Conclusion. Both methods have specific limitations. The PBSM strengths are its sample designs that lead to nationally representative estimates and permit statistical point and confidence interval estimation for the nation for certain variables under investigation. However, the findings of this investigation suggest the internal validity of the estimates derived is questionable and important additional information required to precisely estimate the cost of an illness is absent. ^ The PBMC&BM is a superior method in identifying resources utilized in the physician encounter with the patient permitting more accurate valuation. However, the PBMC&BM does not have the statistical reliability of the PBSM; it relies on synthesized national prevalence estimates to extrapolate a national cost estimate. While precision is important, the ability to generalize to the nation may be limited due to the small number of patients that are followed. ^

Chlorophyll a content, protist biomass and experimental plankton growth and mortality in West Greenland water samples

We evaluated the role of microzooplankton (sensu latto, grazers <500 µm) in determining the fate of phytoplankton production (PP) along a glacier-to-open sea transect in the Greenland subarctic fjord, Godthabfjord. Based on the distribution of size fractionated chlorophyll a (chl a) concentrations we established 4 zones: (1) Fyllas Bank, characterized by deep chl a maxima (ca. 30 to 40 m) consisting of large cells, (2) the mouth and main branch of the fjord, where phytoplankton was relatively homogeneously distributed in the upper 30 m layer, (3) inner waters influenced by glacial melt water and upwelling, with high chl a concentrations (up to 12 µg/l) in the >10 µm fraction within a narrow (2 m) subsurface layer, and (4) the Kapisigdlit branch of the fjord, ice-free, and characterized with a thick and deep chl a maximum layer. Overall, microzooplankton grazing impact on primary production was variable and seldom significant in the Fyllas Bank and mouth of the fjord, quite intensive (up to >100% potential PP consumed daily) in the middle part of the main and Kapisigdlit branches of the fjord, and rather low and unable to control the fast growing phytoplankton population inhabiting the nutrient rich waters in the upwelling area in the vicinity of the glacier. Most of the grazing impact was on the <10 µm phytoplankton fraction, and the major grazers of the system seem to be >20 µm microzooplankton, as deducted from additional dilution experiments removing this size fraction. Overall, little or no export of phytoplankton out of the fjord to the Fyllas Bank can be determined from our data.

Isotope ratios, trace elements and ultrastructure results of Mytilus galloprovincialis shells and experimental site data off Ischia (Italy)

Bivalve shells can provide excellent archives of past environmental change but have not been used to interpret ocean acidification events. We investigated carbon, oxygen and trace element records from different shell layers in the mussels Mytilus galloprovincialis combined with detailed investigations of the shell ultrastructure. Mussels from the harbour of Ischia (Mediterranean, Italy) were transplanted and grown in water with mean pHT 7.3 and mean pHT 8.1 near CO2 vents on the east coast of the island. Most prominently, the shells recorded the shock of transplantation, both in their shell ultrastructure, textural and geochemical record. Shell calcite, precipitated subsequently under acidified seawater responded to the pH gradient by an in part disturbed ultrastructure. Geochemical data from all test sites show a strong metabolic effect that exceeds the influence of the low-pH environment. These field experiments showed that care is needed when interpreting potential ocean acidification signals because various parameters affect shell chemistry and ultrastructure. Besides metabolic processes, seawater pH, factors such as salinity, water temperature, food availability and population density all affect the biogenic carbonate shell archive.

Species occurrence and richness of lichen, bryophytes and vascular plants near Abisko, Sweden and Toolik lake, Alaska

Little is known about the impact of changing temperature regimes on composition and diversity of cryptogam communities in the Arctic and Subarctic, despite the well-known importance of lichens and bryophytes to the functioning and climate feedbacks of northern ecosystems. We investigated changes in diversity and abundance of lichens and bryophytes within long-term (9-16 years) warming experiments and along natural climatic gradients, ranging from Swedish subarctic birch forest and subarctic/subalpine tundra to Alaskan arctic tussock tundra. In both Sweden and Alaska, lichen diversity responded negatively to experimental warming (with the exception of a birch forest) and to higher temperatures along climatic gradients. Bryophytes were less sensitive to experimental warming than lichens, but depending on the length of the gradient, bryophyte diversity decreased both with increasing temperatures and at extremely low temperatures. Among bryophytes, Sphagnum mosses were particularly resistant to experimental warming in terms of both abundance and diversity. Temperature, on both continents, was the main driver of species composition within experiments and along gradients, with the exception of the Swedish subarctic birch forest where amount of litter constituted the best explanatory variable. In a warming experiment in moist acidic tussock tundra in Alaska, temperature together with soil ammonium availability were the most important factors influencing species composition. Overall, dwarf shrub abundance (deciduous and evergreen) was positively related to warming but so were the bryophytes Sphagnum girgensohnii, Hylocomium splendens and Pleurozium schreberi; the majority of other cryptogams showed a negative relationship to warming. This unique combination of intercontinental comparison, natural gradient studies and experimental studies shows that cryptogam diversity and abundance, especially within lichens, is likely to decrease under arctic climate warming. Given the many ecosystem processes affected by cryptogams in high latitudes (e.g. carbon sequestration, N2-fixation, trophic interactions), these changes will have important feedback consequences for ecosystem functions and climate.

Villefranche MedSeA mesocosm experiment 2013: perturbation studies and field studies

A joint mesocosm experiment took place in February/March 2013 in the bay of Villefranche in France as part of the european MedSeA project. Nine mesocosms (52 m**3) were deployed over a 2 weeks period and 6 different levels of pCO2 and 3 control mesocosms (about 450 µatm), were used, in order to cover the range of pCO2 anticipated for the end of the present century. During this experiment, the potential effects of these perturbations on chemistry, planktonic community composition and dynamics including: eucaryotic and prokaryotic species composition, primary production, nutrient and carbon utilization, calcification, diazotrophic nitrogen fixation, organic matter exudation and composition, micro-layer composition and biogas production were studied by a group of about 25 scientists from 8 institutes and 6 countries. This is one of the first mesocosm experiments conducted in oligotrophic waters. A blog dedicated to this experiment can be viewed at: http://medseavillefranche2013.obs-vlfr.fr.

Mineral composition and experimental results from XRD analyses of sediments from ODP Leg 190 sites

X-ray diffraction analyses of the clay-sized fraction of sediments from the Nankai Trough and Shikoku Basin (Sites 1173, 1174, and 1177 of the Ocean Drilling Program) reveal spatial and temporal trends in clay minerals and diagenesis. More detrital smectite was transported into the Shikoku Basin during the early-middle Miocene than what we observe today, and smectite input decreased progressively through the late Miocene and Pliocene. Volcanic ash has been altered to dioctahedral smectite in the upper Shikoku Basin facies at Site 1173; the ash alteration front shifts upsection to the outer trench-wedge facies at Site 1174. At greater depths (lower Shikoku Basin facies), smectite alters to illite/smectite mixed-layer clay, but reaction progress is incomplete. Using ambient geothermal conditions, a kinetic model overpredicts the amount of illite in illite/smectite clays by 15%-20% at Site 1174. Numerical simulations come closer to observations if the concentration of potassium in pore water is reduced or the time of burial is shortened. Model results match X-ray diffraction results fairly well at Site 1173. The geothermal gradient at Site 1177 is substantially lower than at Sites 1173 and 1174; consequently, volcanic ash alters to smectite in lower Shikoku Basin deposits but smectite-illite diagenesis has not started. The absolute abundance of smectite in mudstones from Site 1177 is sufficient (30-60 wt%) to influence the strata's shear strength and hydrogeology as they subduct along the Ashizuri Transect.

Nicotinamide nucleotide and adenylate concentrations in mante, siphon and gill tissue of old and young Laternula elliptica individuals under control and experimental conditions

Future oceans are predicted to contain less oxygen than at present. This is because oxygen is less soluble in warmer water and predicted stratification will reduce mixing. Hypoxia in marine environments is thus likely to become more widespread in marine environments and understanding species-responses is important to predicting future impacts on biodiversity. This study used a tractable model, the Antarctic clam, Laternula elliptica, which can live for 36 years, and has a well-characterized ecology and physiology to understand responses to hypoxia and how the effect varied with age. Younger animals had a higher condition index, higher adenylate energy charge and transcriptional profiling indicated that they were physically active in their response to hypoxia, whereas older animals were more sedentary, with higher levels of oxidative damage and apoptosis in the gills. These effects could be attributed, in part, to age-related tissue scaling; older animals had proportionally less contractile muscle mass and smaller gills and foot compared with younger animals, with consequential effects on the whole-animal physiological response. The data here emphasize the importance of including age effects, as large mature individuals appear to be less able to resist hypoxic conditions and this is the size range that is the major contributor to future generations. Thus, the increased prevalence of hypoxia in future oceans may have marked effects on benthic organisms' abilities to persist and this is especially so for long-lived species when predicting responses to environmental perturbation.

Intermediate band materials for more efficient solar energy use: quantum modelling and experimental realizations

The intermediate band (IB) solar cell (Fig. 1) has been proposed [1] to increase photovoltaic efficiency by a factor above 1.5, based on the absorption of two sub-bandgap photons to promote an electron across the bandgap. To realize this principle, that can be applied also to obtain efficient photocatalysis with sunlight, we proposed in recent years several materials where a metal or heavy element, substituting for an electropositive atom in a known semiconductor that has an appropriate band gap width (around 2 eV), forms inside the gap the partially filled levels needed for this aim

On the flexural vibration of cylinders under axial loads:Numerical and experimental study

The flexural vibration of a homogeneous isotropic linearly elastic cylinder of any aspect ratio is analysed in this paper. Natural frequencies of a cylinder under uniformly distributed axial loads acting on its bases are calculated numerically by the Ritz method with terms of power series in the coordinate directions as approximating functions. The effect of axial loads on the flexural vibration cannot be described by applying infinitesimal strain theory, therefore, geometrically nonlinear strain–displacement relations with second-order terms are considered here. The natural frequencies of free–free, clamped–clamped, and sliding–sliding cylinders subjected to axial loads are calculated using the proposed three-dimensional Ritz approach and are compared with those obtained with the finite element method and the Bernoulli–Euler theory. Different experiments with cylinders axially compressed by a hydraulic press are carried out and the experimental results for the lowest flexural frequency are compared with the numerical results. An approach based on the Ritz formulation is proposed for the flexural vibration of a cylinder between the platens of the press with constraints varying with the intensity of the compression. The results show that for low compressions the cylinder behaves similarly to a sliding–sliding cylinder, whereas for high compressions the cylinder vibrates as a clamped–clamped one.

Crack width control in RC elements with recycled steel fibres and applications to integral structures : theoretical and experimental study

El presente trabajo trata de elementos reforzados con barras de armadura y Fibras Metálicas Recicladas (FMR). El objetivo principal es mejorar el comportamiento a fisuración de elementos sometidos a flexión pura y a flexión compuesta, aumentando en consecuencia las prestaciones en servicio de aquellas estructuras con requerimientos estrictos con respecto al control de fisuración. Entre éstas últimas se encuentran las estructuras integrales, es decir aquellas estructuras sin juntas (puentes o edificios), sometidas a cargas gravitatorias y deformaciones impuestas en los elementos horizontales debidas a retracción, fluencia y temperatura. Las FMR son obtenidas a partir de los neumáticos fuera de uso, y puesto que el procedimiento de reciclado se centra en el caucho en vez que en el acero, su forma es aleatoria y con longitud variable. A pesar de que la eficacia del fibrorefuerzo mediante FMR ha sido demostrada en investigaciones anteriores, la innovación que representa este trabajo consiste en proponer la acción combinada de barras convencionales y FMR en la mejora del comportamiento a fisuración. El objetivo es por tanto mejorar la sostenibilidad del proyecto de la estructura en HA al utilizar materiales reciclados por un lado, y aumentando por el otro la durabilidad. En primer lugar, se presenta el estado del arte con respecto a la fisuración en elementos de HA, que sucesivamente se amplía a elementos reforzados con barras y fibras. Asimismo, se resume el método simplificado para el análisis de columnas de estructuras sin juntas ya propuesto por Pérez et al., con particular énfasis en aquellos aspectos que son incompatibles con la acción de las fibras a nivel seccional. A continuación, se presenta un modelo para describir la deformabilidad seccional y la fisuración en elementos en HA, que luego se amplía a aquellos elementos reforzados con barras y fibras, teniendo en cuenta también los efectos debidos a la retracción (tension stiffening negativo). El modelo es luego empleado para ampliar el método simplificado para el análisis de columnas. La aportación consiste por tanto en contar con una metodología amplia de análisis para este tipo de elementos. Seguidamente, se presenta la campaña experimental preliminar que ha involucrado vigas a escala reducida sometidas a flexión simple, con el objetivo de validar la eficiencia y la usabilidad en el hormigón de las FMR de dos diferentes tipos, y su comportamiento con respecto a fibras de acero comerciales. Se describe a continuación la campaña principal, consistente en ensayos sobre ocho vigas en flexión simple a escala 1:1 (variando contenido en FRM, Ø/s,eff y recubrimiento) y doce columnas a flexión compuesta (variando contenido en FMR, Ø/s,eff y nivel de fuerza axil). Los resultados obtenidos en la campaña principal son presentados y comentados, resaltando las mejoras obtenidas en el comportamiento a fisuración de las vigas y columnas, y la rigidez estructural de las columnas. Estos resultados se comparan con las predicciones del modelo propuesto. Los principales parámetros estudiados para describir la fisuración y el comportamiento seccional de las vigas son: la separación entre fisuras, el alargamiento medio de las armaduras y la abertura de fisura, mientras que en los ensayos de las columnas se ha contrastado las leyes momento/curvatura, la tensión en las barras de armadura y la abertura de fisura en el empotramiento en la base. La comparación muestra un buen acuerdo entre las predicciones y los resultados experimentales. Asimismo, se nota la mejora en el comportamiento a fisuración debido a la incorporación de FMR en aquellos elementos con cuantías de armadura bajas en flexión simple, en elementos con axiles bajos y para el control de la fisuración en elementos con grandes recubrimientos, siendo por tanto resultados de inmediato impacto en la práctica ingenieril (diseño de losas, tanques, estructuras integrales, etc.). VIIIComo punto final, se presentan aplicaciones de las FMR en estructuras reales. Se discuten dos casos de elementos sometidos a flexión pura, en particular una viga simplemente apoyada y un tanque para el tratamiento de agua. En ambos casos la adicción de FMR al hormigón lleva a mejoras en el comportamiento a fisuración. Luego, utilizando el método simplificado para el análisis en servicio de columnas de estructuras sin juntas, se calcula la máxima longitud admisible en casos típicos de puentes y edificación. En particular, se demuestra que las limitaciones de la práctica ingenieril actual (sobre todo en edificación) pueden ser aumentadas considerando el comportamiento real de las columnas en HA. Finalmente, los mismos casos son modificados para considerar el uso de MFR, y se presentan las mejoras tanto en la máxima longitud admisible como en la abertura de fisura para una longitud y deformación impuesta. This work deals with elements reinforced with both rebars and Recycled Steel Fibres (RSFs). Its main objective is to improve cracking behaviour of elements subjected to pure bending and bending and axial force, resulting in better serviceability conditions for these structures demanding keen crack width control. Among these structures a particularly interesting type are the so-called integral structures, i.e. long jointless structures (bridges and buildings) subjected to gravitational loads and imposed deformations due to shrinkage, creep and temperature. RSFs are obtained from End of Life Tyres, and due to the recycling process that is focused on the rubber rather than on the steel they come out crooked and with variable length. Although the effectiveness of RSFs had already been proven by previous research, the innovation of this work consists in the proposing the combined action of conventional rebars and RSFs to improve cracking behaviour. Therefore, the objective is to improve the sustainability of RC structures by, on the one hand, using recycled materials, and on the other improving their durability. A state of the art on cracking in RC elements is firstly drawn. It is then expanded to elements reinforced with both rebars and fibres (R/FRC elements). Finally, the simplified method for analysis of columns of long jointless structures already proposed by Pérez et al. is resumed, with a special focus on the points that conflict when taking into account the action of fibres. Afterwards, a model to describe sectional deformability and cracking of R/FRC elements is presented, taking also into account the effect of shrinkage (negative tension stiffening). The model is then used to implement the simplified method for columns. The novelty represented by this is that a comprehensive methodology to analyse this type of elements is presented. A preliminary experimental campaign consisting in small beams subjected to pure bending is described, with the objective of validating the effectiveness and usability in concrete of RSFs of two different types, and their behaviour when compared with commercial steel fibres. With the results and lessons learnt from this campaign in mind, the main experimental campaign is then described, consisting in cracking tests of eight unscaled beams in pure bending (varying RSF content, Ø/s,eff and concrete cover) and twelve columns subjected to imposed displacement and axial force (varying RSF content, Ø/s,eff and squashing load ratio). The results obtained from the main campaign are presented and discussed, with particular focus on the improvement in cracking behaviour for the beams and columns, and structural stiffness for the columns. They are then compared with the proposed model. The main parameters studied to describe cracking and sectional behaviours of the beam tests are crack spacing, mean steel strain and crack width, while for the column tests these were moment/curvature, stress in rebars and crack with at column embedment. The comparison showed satisfactory agreement between experimental results and model predictions. Moreover, it is pointed out the improvement in cracking behaviour due to the addition of RSF for elements with low reinforcement ratios, elements with low squashing load ratios and for crack width control of elements with large concrete covers, thus representing results with a immediate impact in engineering practice (slab design, tanks, integral structures, etc.). Applications of RSF to actual structures are finally presented. Two cases of elements in pure bending are presented, namely a simple supported beam and a water treatment tank. In both cases the addition of RSF to concrete leads to improvements in cracking behaviour. Then, using the simplified model for the serviceability analysis of columns of jointless structures, the maximum achievable jointless length of typical cases of a bridge and building is obtained. In XIIparticular, it is shown how the limitations of current engineering practice (this is especially the case of buildings) can be increased by considering the actual behaviour of RC supports. Then, the same cases are modified considering the use of RSF, and the improvements both in maximum achievable length and in crack width for a given length and imposed strain at the deck/first floor are shown.

Effects of precooling and degreening treatments on the susceptibility of peach and citrus to handling damage.

Mechanical damage to fruits results from a combination of fruit properties and of damage inflicting effects by the handling equipment. Treatments were applied to fruits which affect mechanical damage susceptibility: precooling for stone fruits and degreening to citrus fruits. Laboratory tests (compression, impact, tumbling, abrasion) and field tests (damage in the handling lines) were applied to (3) peach, (2) apricot, (2) orange and (1) lemon varieties. Hydroor-air-cooling influence positively peach and apricot firmness and cause a significant reduction in: number of bruised fruits, and size of visible bruise, when combined with a low level of loading during handling. Degreening also affects the resistance of citrus fruits to handling, when compared to green fruits.

Development and experimental evaluation of a complete solar thermophotovoltaic system

We present a practical implementation of a solar thermophotovoltaic (TPV) system. The system presented in this paper comprises a sunlight concentrator system, a cylindrical cup-shaped absorber/emitter (made of tungsten coated with HfO2), and an hexagonal-shaped water-cooled TPV generator comprising 24 germanium TPV cells, which is surrounding the cylindrical absorber/emitter. This paper focuses on the development of shingled TPV cell arrays, the characterization of the sunlight concentrator system, the estimation of the temperature achieved by the cylindrical emitters operated under concentrated sunlight, and the evaluation of the full system performance under real outdoor irradiance conditions. From the system characterization, we have measured short-circuit current densities up to 0.95 A/cm2, electric power densities of 67 mW/cm2, and a global conversion efficiency of about 0.8%. To our knowledge, this is the first overall solar-to-electricity efficiency reported for a complete solar thermophotovoltaic system. The very low efficiency is mainly due to the overheating of the cells (up to 120 °C) and to the high optical concentrator losses, which prevent the achievement of the optimum emitter temperature. The loss analysis shows that by improving both aspects, efficiencies above 5% could be achievable in the very short term and efficiencies above 10% could be achieved with further improvements.

Numerical and experimental study of the parametric rolling of a fisihing vessel in regular head waves

The dynamic behaviour of a fishing vessel in waves is studied in order to reveal its parametric rolling characteristics. This paper presents experimental and numerical results in longitudinal regular waves. The experimental results are compared against the results of a time-domain non-linear strip theory model of ship motions in six degrees-of-freedom. These results contribute to the validation of the parametric rolling prediction method, so that it can be used as an assessment tool to evaluate both the susceptibility and severity of occurrence of parametric rolling at the early design stage of these types of vessels.

Numerical and experimental study of overtopping and failure of rockfill dams

This paper aims to present and validate a numerical technique for the simulation of the overtopping and onset of failure in rockfill dams due to mass sliding. This goal is achieved by coupling a fluid dynamic model for the simulation of the free surface and through-flow problems, with a numerical technique for the calculation of the rockfill response and deformation. Both the flow within the dam body and in its surroundings are taken into account. An extensive validation of the resulting computational method is performed by solving several failure problems on physical models of rockfill dams for which experimental results have been obtained by the authors.