Accessibility and demand at an Emergency Care Unit: the user's perspective

AIM: To analyze the search for Emergency Care (EC) in the Western Health District of Ribeirão Preto (São Paulo), in order to identify the reasons why users turn to these services in situations that are not characterized as urgencies and emergencies. METHODS: A qualitative and descriptive study was undertaken. A guiding script was applied to 23 EC users, addressing questions related to health service accessibility and welcoming, problem solving, reason to visit the EC and care comprehensiveness. RESULTS: The subjects reported that, at the Primary Health Care services, receiving care and scheduling consultations took a long time and that the opening hours of these services coincide with their work hours. At the EC service, access to technologies and medicines was easier. CONCLUSION: Primary health care services have been unable to turn into the entry door to the health system, being replaced by emergency services, putting a significant strain on these services' capacity.

Strong iron demand during hypoxia-induced erythropoiesis is associated with down-regulation of iron-related proteins and myoglobin in human skeletal muscle

[EN] Iron is essential for oxygen transport because it is incorporated in the heme of the oxygen-binding proteins hemoglobin and myoglobin. An interaction between iron homeostasis and oxygen regulation is further suggested during hypoxia, in which hemoglobin and myoglobin syntheses have been reported to increase. This study gives new insights into the changes in iron content and iron-oxygen interactions during enhanced erythropoiesis by simultaneously analyzing blood and muscle samples in humans exposed to 7 to 9 days of high altitude hypoxia (HA). HA up-regulates iron acquisition by erythroid cells, mobilizes body iron, and increases hemoglobin concentration. However, contrary to our hypothesis that muscle iron proteins and myoglobin would also be up-regulated during HA, this study shows that HA lowers myoglobin expression by 35% and down-regulates iron-related proteins in skeletal muscle, as evidenced by decreases in L-ferritin (43%), transferrin receptor (TfR; 50%), and total iron content (37%). This parallel decrease in L-ferritin and TfR in HA occurs independently of increased hypoxia-inducible factor 1 (HIF-1) mRNA levels and unchanged binding activity of iron regulatory proteins, but concurrently with increased ferroportin mRNA levels, suggesting enhanced iron export. Thus, in HA, the elevated iron requirement associated with enhanced erythropoiesis presumably elicits iron mobilization and myoglobin down-modulation, suggesting an altered muscle oxygen homeostasis.

Significance of non‐sinking particulate organic carbon and dark CO2 fixation to heterotrophic carbon demand in the mesopelagic northeast Atlantic

[EN] It is generally assumed that sinking particulate organic carbon (POC) constitutes the main source of organic carbon supply to the deep ocean's food webs. However, a major discrepancy between the rates of sinking POC supply (collected with sediment traps) and the prokaryotic organic carbon demand (the total amount of carbon required to sustain the heterotrophic metabolism of the prokaryotes; i.e., production plus respiration, PCD) of deep-water communities has been consistently reported for the dark realm of the global ocean. While the amount of sinking POC flux declines exponentially with depth, the concentration of suspended, buoyant non-sinking POC (nsPOC; obtained with oceanographic bottles) exhibits only small variations with depth in the (sub)tropical Northeast Atlantic. Based on available data for the North Atlantic we show here that the sinking POC flux would contribute only 4–12% of the PCD in the mesopelagic realm (depending on the primary production rate in surface waters). The amount of nsPOC potentially available to heterotrophic prokaryotes in the mesopelagic realm can be partly replenished by dark dissolved inorganic carbon fixation contributing between 12% to 72% to the PCD daily. Taken together, there is evidence that the mesopelagic microheterotrophic biota is more dependent on the nsPOC pool than on the sinking POC supply. Hence, the enigmatic major mismatch between the organic carbon demand of the deep-water heterotrophic microbiota and the POC supply rates might be substantially smaller by including the potentially available nsPOC and its autochthonous production in oceanic carbon cycling models.

A GIS based model for solving the planar Huff problem considering different demand distributions and forbidden regions

[EN] In this paper, we have used Geographical Information Systems (GIS) to solve the planar Huff problem considering different demand distributions and forbidden regions. Most of the papers connected with the competitive location problems consider that the demand is aggregated in a finite set of points. In other few cases, the models suppose that the demand is distributed along the feasible region according to a functional form, mainly a uniform distribution. In this case, in addition to the discrete and uniform demand distributions we have considered that the demand is represented by a population surface model, that is, a raster map where each pixel has associated a value corresponding to the population living in the area that it covers...

Improved ground motion intensity measures for reliability-based demand analysis of structures

In Performance-Based Earthquake Engineering (PBEE), evaluating the seismic performance (or seismic risk) of a structure at a designed site has gained major attention, especially in the past decade. One of the objectives in PBEE is to quantify the seismic reliability of a structure (due to the future random earthquakes) at a site. For that purpose, Probabilistic Seismic Demand Analysis (PSDA) is utilized as a tool to estimate the Mean Annual Frequency (MAF) of exceeding a specified value of a structural Engineering Demand Parameter (EDP). This dissertation focuses mainly on applying an average of a certain number of spectral acceleration ordinates in a certain interval of periods, Sa,avg (T1,…,Tn), as scalar ground motion Intensity Measure (IM) when assessing the seismic performance of inelastic structures. Since the interval of periods where computing Sa,avg is related to the more or less influence of higher vibration modes on the inelastic response, it is appropriate to speak about improved IMs. The results using these improved IMs are compared with a conventional elastic-based scalar IMs (e.g., pseudo spectral acceleration, Sa ( T(¹)), or peak ground acceleration, PGA) and the advanced inelastic-based scalar IM (i.e., inelastic spectral displacement, Sdi). The advantages of applying improved IMs are: (i ) "computability" of the seismic hazard according to traditional Probabilistic Seismic Hazard Analysis (PSHA), because ground motion prediction models are already available for Sa (Ti), and hence it is possibile to employ existing models to assess hazard in terms of Sa,avg, and (ii ) "efficiency" or smaller variability of structural response, which was minimized to assess the optimal range to compute Sa,avg. More work is needed to assess also "sufficiency" and "scaling robustness" desirable properties, which are disregarded in this dissertation. However, for ordinary records (i.e., with no pulse like effects), using the improved IMs is found to be more accurate than using the elastic- and inelastic-based IMs. For structural demands that are dominated by the first mode of vibration, using Sa,avg can be negligible relative to the conventionally-used Sa (T(¹)) and the advanced Sdi. For structural demands with sign.cant higher-mode contribution, an improved scalar IM that incorporates higher modes needs to be utilized. In order to fully understand the influence of the IM on the seismis risk, a simplified closed-form expression for the probability of exceeding a limit state capacity was chosen as a reliability measure under seismic excitations and implemented for Reinforced Concrete (RC) frame structures. This closed-form expression is partuclarly useful for seismic assessment and design of structures, taking into account the uncertainty in the generic variables, structural "demand" and "capacity" as well as the uncertainty in seismic excitations. The assumed framework employs nonlinear Incremental Dynamic Analysis (IDA) procedures in order to estimate variability in the response of the structure (demand) to seismic excitations, conditioned to IM. The estimation of the seismic risk using the simplified closed-form expression is affected by IM, because the final seismic risk is not constant, but with the same order of magnitude. Possible reasons concern the non-linear model assumed, or the insufficiency of the selected IM. Since it is impossibile to state what is the "real" probability of exceeding a limit state looking the total risk, the only way is represented by the optimization of the desirable properties of an IM.

A multimedia system to produce and deliver video fragments on demand on parliamentary websites

[EN]Parliamentary websites have become one of the most important windows for citizens and media to follow the activities of their legislatures and to hold parliaments to account. Therefore, most parliamentary institutions aim to provide new multimedia solutions capable of displaying video fragments on demand on plenary activities. This paper presents a multimedia system for parliamentary institutions to produce video fragments on demand through a website with linked information and public feedback that helps to explain the content shown in these fragments. A prototype implementation has been developed for the Canary Islands Parliament (Spain) and shows how traditional parliamentary streaming systems can be enhanced by the use of semantics and computer vision for video analytics...

Urban water demand model: the case study of Emilia Romagna (Italy)

Water is the driving force in nature. We use water for washing cars, doing laundry, cooking, taking a shower, but also to generate energy and electricity. Therefore water is a necessary product in our daily lives (USGS. Howard Perlman, 2013). The model that we created is based on the urban water demand computer model from the Pacific Institute (California). With this model we will forecast the future urban water use of Emilia Romagna up to the year of 2030. We will analyze the urban water demand in Emilia Romagna that includes the 9 provinces: Bologna, Ferrara, Forli-Cesena, Modena, Parma, Piacenza, Ravenna, Reggio Emilia and Rimini. The term urban water refers to the water used in cities and suburbs and in homes in the rural areas. This will include the residential, commercial, institutional and the industrial use. In this research, we will cover the water saving technologies that can help to save water for daily use. We will project what influence these technologies have to the urban water demand, and what it can mean for future urban water demands. The ongoing climate change can reduce the snowpack, and extreme floods or droughts in Italy. The changing climate and development patterns are expected to have a significant impact on water demand in the future. We will do this by conducting different scenario analyses, by combining different population projections, climate influence and water saving technologies. In addition, we will also conduct a sensitivity analyses. The several analyses will show us how future urban water demand is likely respond to changes in water conservation technologies, population, climate, water price and consumption. I hope the research can contribute to the insight of the reader’s thoughts and opinion.

Automated Analysis Methods for the Assessment of Bicycle Infrastructure and Demand

A first phase of the research activity has been related to the study of the state of art of the infrastructures for cycling, bicycle use and methods for evaluation. In this part, the candidate has studied the "bicycle system" in countries with high bicycle use and in particular in the Netherlands. Has been carried out an evaluation of the questionnaires of the survey conducted within the European project BICY on mobility in general in 13 cities of the participating countries. The questionnaire was designed, tested and implemented, and was later validated by a test in Bologna. The results were corrected with information on demographic situation and compared with official data. The cycling infrastructure analysis was conducted on the basis of information from the OpenStreetMap database. The activity consisted in programming algorithms in Python that allow to extract data from the database infrastructure for a region, to sort and filter cycling infrastructure calculating some attributes, such as the length of the arcs paths. The results obtained were compared with official data where available. The structure of the thesis is as follows: 1. Introduction: description of the state of cycling in several advanced countries, description of methods of analysis and their importance to implement appropriate policies for cycling. Supply and demand of bicycle infrastructures. 2. Survey on mobility: it gives details of the investigation developed and the method of evaluation. The results obtained are presented and compared with official data. 3. Analysis cycling infrastructure based on information from the database of OpenStreetMap: describes the methods and algorithms developed during the PhD. The results obtained by the algorithms are compared with official data. 4. Discussion: The above results are discussed and compared. In particular the cycle demand is compared with the length of cycle networks within a city. 5. Conclusions

Entwicklung und Charakterisierung eines Drop-on-Demand-Aerosolgenerators für die Probenzuführung kleinster Flüssigkeitsmengen in der analytischen Atomspektroskopie

Die pneumatische Zerstäubung ist die häufigste Methode der Probenzuführung von Flüssigkeiten in der Plasmaspektrometrie. Trotz der bekannten Limitierungen dieser Systeme, wie die hohen Probenverluste, finden diese Zerstäuber aufgrund ihrer guten Robustheit eine breite Anwendung. Die flussratenabhängige Aerosolcharakteristik und pumpenbasierte Signalschwankungen limitieren bisher Weiterentwicklungen. Diese Probleme werden umso gravierender, je weiter die notwendige Miniaturisierung dieser Systeme fortschreitet. Der neuartige Ansatz dieser Arbeit basiert auf dem Einsatz modifizierter Inkjet-Druckerpatronen für die Dosierung von pL-Tropfen. Ein selbst entwickelter Mikrokontroller ermöglicht den Betrieb von matrixkodierten Patronen des Typs HP45 mit vollem Zugriff auf alle essentiellen Betriebsparameter. Durch die neuartige Aerosoltransportkammer gelang die effiziente Kopplung des Tropfenerzeugungssystems an ein ICP-MS. Das so aufgebaute drop-on-demand-System (DOD) zeigt im Vergleich zu herkömmlichen und miniaturisierten Zerstäubern eine deutlich gesteigerte Empfindlichkeit (8 - 18x, elementabhängig) bei leicht erhöhtem, aber im Grunde vergleichbarem Signalrauschen. Darüber hinaus ist die Flexibilität durch die große Zahl an Freiheitsgraden des Systems überragend. So ist die Flussrate über einen großen Bereich variabel (5 nL - 12,5 µL min-1), ohne dabei die primäre Aerosolcharakteristik zu beeinflussen, welche vom Nutzer durch Wahl der elektrischen Parameter bestimmt wird. Das entwickelte Probenzuführungssystem ist verglichen mit dem pneumatischen Referenzsystem weniger anfällig gegenüber Matrixeffekten beim Einsatz von realen Proben mit hohen Anteilen gelöster Substanzen. So gelingt die richtige Quantifizierung von fünf Metallen im Spurenkonzentrationsbereich (Li, Sr, Mo, Sb und Cs) in nur 12 µL Urin-Referenzmaterial mittels externer Kalibrierung ohne Matrixanpassung. Wohingegen beim pneumatischen Referenzsystem die aufwändigere Standardadditionsmethode sowie über 250 µL Probenvolumen für eine akkurate Bestimmung der Analyten nötig sind. Darüber hinaus wird basierend auf der Dosierfrequenz eines dualen DOD-Systems eine neuartige Kalibrierstrategie vorgestellt. Bei diesem Ansatz werden nur eine Standard- und eine Blindlösung anstelle einer Reihe unterschiedlich konzentrierter Standards benötigt, um eine lineare Kalibrierfunktion zu erzeugen. Zusätzlich wurde mittels selbst entwickelter, zeitlich aufgelöster ICP-MS umfangreiche Rauschspektren aufgenommen. Aus diesen gelang die Ermittlung der Ursache des erhöhten Signalrauschens des DOD, welches maßgeblich durch das zeitlich nicht äquidistante Eintreffen der Tropfen am Detektor verursacht wird. Diese Messtechnik erlaubt auch die Detektion einzeln zugeführter Tropfen, wodurch ein Vergleich der Volumenverteilung der mittels ICP-MS detektierten, gegenüber den generierten und auf optischem Wege charakterisierten Tropfen möglich wurde. Dieses Werkzeug ist für diagnostische Untersuchungen äußerst hilfreich. So konnte aus diesen Studien neben der Aufklärung von Aerosoltransportprozessen die Transporteffizienz des DOD ermittelt werden, welche bis zu 94 Vol.-% beträgt.

Money is not enough: exploring the impact of social and cultural resources on youth health

Findings on socioeconomic health differentials in youth remain fragmented with the role of cumulative and interaction effects of different forms of health resources not well understood.