Differences in healthcare service utilization in patients with polypharmacy according to their risk level by adjusted morbidity groups: a population-based cross-sectional study.

BACKGROUND: Patients with polypharmacy suffer from complex medical conditions involving a large healthcare burden. This study aimed to describe the characteristics and utilization of primary care (PC) and hospital care (HC) and factors associated in chronic patients with polypharmacy, stratifying by adjusted morbidity groups (AMG) risk level, sex and age, and comparing with non-polypharmacy. METHODS: Cross-sectional study conducted in a Spanish basic healthcare area. Studied patients were those over 18 years with chronic diseases identified by the AMG tool from Madrid electronic clinical record, which was the data source. Sociodemographic, sociofunctional, clinical and healthcare utilization variables were described and compared by risk level, sex, age and having or not polypharmacy. Factors associated with healthcare utilization in polypharmacy patients were determined by a negative binomial regression model. RESULTS: In the area studied, 61.3% patients had chronic diseases, of which 16.9% had polypharmacy vs. 83.1% without polypharmacy. Patients with polypharmacy (vs. non-polypharmacy) mean age was 82.7 (vs. 52.7), 68.9% (vs. 60.7%) were women, and 22.0% (vs. 1.2%) high risk. Their average number of chronic diseases was 4.8 (vs. 2.2), and 95.6% (vs. 56.9%) had multimorbidity. Their mean number of annual healthcare contacts was 30.3 (vs. 10.5), 25.9 (vs. 8.8) with PC and 4.4 (vs. 1.7) with HC. Factors associated with a greater PC utilization in patients with polypharmacy were elevated complexity, high risk level and dysrhythmia. Variables associated with a higher HC utilization were also increased complexity and high risk, in addition to male sex, being in palliative care, having a primary caregiver, suffering from neoplasia (specifically lymphoma or leukaemia) and arthritis, whereas older age and immobilization were negatively associated. CONCLUSIONS: Polypharmacy population compared to non-polypharmacy was characterized by a more advanced age, predominance of women, high-risk, complexity, numerous comorbidities, dependency and remarkable healthcare utilization. These findings could help healthcare policy makers to optimize the distribution of resources and professionals within PC and HC systems, aiming for the improvement of polypharmacy management and rational use of medicines while reducing costs attributed to healthcare utilization by these patients.

Study of the Feasibility of Decoupling Temperature and Strain from a ϕ-PA-OFDR over an SMF Using Neural Networks.

Despite several existing techniques for distributed sensing (temperature and strain) using standard Single-Mode optical Fiber (SMF), compensating or decoupling both effects is mandatory for many applications. Currently, most decoupling techniques require special optical fibers and are difficult to implement with high-spatial-resolution distributed techniques, such as OFDR. Therefore, this work's objective is to study the feasibility of decoupling temperature and strain out of the readouts of a phase and polarization analyzer OFDR (ϕ-PA-OFDR) taken over an SMF. For this purpose, the readouts will be subjected to a study using several machine learning algorithms, among them Deep Neural Networks. The motivation that underlies this target is the current blockage in the widespread use of Fiber Optic Sensors in situations where both strain and temperature change, due to the coupled dependence of currently developed sensing methods. Instead of using other types of sensors or even other interrogation methods, the objective of this work is to analyze the available information in order to develop a sensing method capable of providing information about strain and temperature simultaneously.

Performance Monitoring of Mast-Mounted Cup Anemometers Multivariate Analysis with ROOT.

This paper analyzes the field performance of two cup anemometers installed in Zaragoza (Spain). Data acquired over almost three years, from January 2015 to December 2017, were analyzed. The effect of the different variables (wind speed, temperature, harmonics, wind speed variations, etc.) on two cup anemometers was studied. Data analysis was performed with ROOT, an open-source scientific software toolkit developed by CERN (Conseil Européen pour la Recherche Nucléaire) for the study of particle physics. The effects of temperature, wind speed, and wind dispersion (as a first approximation to atmospheric turbulence) on the first and third harmonics of the anemometers' rotation speed (i.e., the anemometers' output signature) were studied together with their evolution throughout the measurement period. The results are consistent with previous studies on the influence of velocity, turbulence, and temperature on the anemometer performance. Although more research is needed to assess the effect of the anemometer wear and tear degradation on the harmonic response of the rotor's angular speed, the results show the impact of a recalibration on the performance of an anemometer by comparing this performance with that of a second anemometer.

Costes derivados del uso de servicios sanitarios y bajas laborales en pacientes fumadores: estudio en una comunidad urbana / Health care costs and work absenteeism in smokers: study in an urban community

Introducción: La mayor morbilidad ocasionada por el tabaquismo puede generar un incremento del coste sanitario. Analizamos la existencia de diferencias en el uso de recursos sanitarios, gasto sanitario y bajas laborales entre pacientes fumadores y no fumadores. Métodos: Estudio observacional transversal en pacientes fumadores y no fumadores de edad entre 45 y 74 años atendidos en una zona de salud urbana. Variables estudiadas: edad, sexo, consumo de alcohol, actividad física, obesidad, presencia de enfermedades, frecuentación a las consultas de atención primaria e interconsultas, asistencia a urgencias hospitalarias, días de hospitalización, consumo de fármacos y días de baja laboral. Se calculó el coste anual según el coste unitario de cada servicio (costes directos) y los costes indirectos según el número de días de baja. Se calcularon los riesgos crudos y ajustados mediante regresión logística. Resultados: Se analizaron 500 pacientes, el 50% fueron fumadores; 74% (372) hombres, 26% (128) mujeres. Los pacientes fumadores utilizaron más recursos sanitarios, consumieron más fármacos y tuvieron más días de baja laboral que los no fumadores. Los costes directos e indirectos en fumadores fueron respectivamente 848,64 euros (IQ 25-75: 332,65-1517,10) y 2.253,90 (IQ 25-75: 1.024,50-13.113,60); y en no fumadores 474,71 euros (IQ 25-75: 172,88-979,59) y 1.434,30 euros (IQ 25-75: 614,70-4.712,70); ser fumador incrementó más del doble la probabilidad de tener coste sanitario elevado (OR = 2,14; IC 95%: 1,44-3,19). Conclusión: Invertir más recursos en la prevención y el tratamiento del tabaquismo como una prioridad de política sanitaria contribuiría a la reducción en el medio plazo del sobrecoste que supone el consumo de tabaco

Introduction: Higher morbidity caused by smoking-related diseases could increase health costs. We analyzed differences in the use of healthcare resources, healthcare costs and days of work absenteeism among smokers and non-smokers. Methods: Cross-sectional study in smokers and non-smokers, aged between 45 and 74 years, from one urban health area. The variables studied were: age, sex, alcohol intake, physical activity, obesity, diseases, attendance at primary care clinics and hospital emergency rooms, days of hospitalization, prescription drug consumption and work absenteeism (in days). Annual cost according to the unit cost of each service (direct costs), and indirect costs according to the number of days missed from work was calculated. Crude and adjusted risks were calculated using logistic regression. Results: Five hundred patients were included: 50% were smokers, 74% (372) men and 26% (128) women. Smokers used more healthcare resources, consumed more prescription drugs and had more days off work than non-smokers. Respective direct and indirect costs in smokers were 848.64 euros (IQ 25-75: 332.65-1517.10) and 2253.90 euros (IQ 25-75: 1024.50-13113.60), and in non-smokers were 474.71 euros (IQ 25-75: 172.88-979.59) and 1434.30 euros (IQ 25-75: 614.70-4712.70). The likelihood of generating high healthcare costs was more than double for smokers (OR = 2.14; 95% CI: 1.44-3.19). Conclusion: More investment in programs for the prevention and treatment of smoking, as a health policy priority, could help to reduce the health and social costs of smoking

Health care costs and work absenteeism in smokers: study in an urban community.

INTRODUCTION: Higher morbidity caused by smoking-related diseases could increase health costs. We analyzed differences in the use of healthcare resources, healthcare costs and days of work absenteeism among smokers and non-smokers. METHODS: Cross-sectional study in smokers and non-smokers, aged between 45 and 74 years, from one urban health area. The variables studied were: age, sex, alcohol intake, physical activity, obesity, diseases, attendance at primary care clinics and hospital emergency rooms, days of hospitalization, prescription drug consumption and work absenteeism (in days). Annual cost according to the unit cost of each service (direct costs), and indirect costs according to the number of days missed from work was calculated. Crude and adjusted risks were calculated using logistic regression. RESULTS: Five hundred patients were included: 50% were smokers, 74% (372) men and 26% (128) women. Smokers used more healthcare resources, consumed more prescription drugs and had more days off work than non-smokers. Respective direct and indirect costs in smokers were 848.64 euros (IQ 25-75: 332.65-1517.10) and 2253.90 euros (IQ 25-75: 1024.50-13113.60), and in non-smokers were 474.71 euros (IQ 25-75: 172.88-979.59) and 1434.30 euros (IQ 25-75: 614.70-4712.70). The likelihood of generating high healthcare costs was more than double for smokers (OR=2.14; 95% CI: 1.44-3.19). CONCLUSION: More investment in programs for the prevention and treatment of smoking, as a health policy priority, could help to reduce the health and social costs of smoking.

Accurate simulation of MPPT methods performance when applied to commercial photovoltaic panels.

A new, simple, and quick-calculation methodology to obtain a solar panel model, based on the manufacturers' datasheet, to perform MPPT simulations, is described. The method takes into account variations on the ambient conditions (sun irradiation and solar cells temperature) and allows fast MPPT methods comparison or their performance prediction when applied to a particular solar panel. The feasibility of the described methodology is checked with four different MPPT methods applied to a commercial solar panel, within a day, and under realistic ambient conditions.

Static and dynamic experimental analysis of the galloping stability of porous H-section beams.

The phenomenon of self-induced vibrations of prismatic beams in a cross-flow has been studied for decades, but it is still of great interest due to their important effects in many different industrial applications. This paper presents the experimental study developed on a prismatic beam with H-section. The aim of this analysis is to add some additional insight into the behaviour of the flow around this type of bodies, in order to reduce galloping and even to avoid it. The influence of some relevant geometrical parameters that define the H-section on the translational galloping behaviour of these beams has been analysed. Wind loads coefficients have been measured through static wind tunnel tests and the Den Hartog criterion applied to elucidate the influence of geometrical parameters on the galloping properties of the bodies under consideration. These results have been completed with surface pressure distribution measurements and, besides, dynamic tests have been also performed to verify the static criterion. Finally, the morphology of the flow past the tested bodies has been visualised by using smoke visualization techniques. Since the rectangular section beam is a limiting case of the H-section configuration, the results here obtained are compared with the ones published in the literature concerning rectangular configurations; the agreement is satisfactory.

Wind tunnel analysis of the aerodynamic loads on rolling stock over railway embankments: the effect of shelter windbreaks.

Wind-flow pattern over embankments involves an overexposure of the rolling stock travelling on them to wind loads. Windbreaks are a common solution for changing the flow characteristic in order to decrease unwanted effects induced by the presence of cross-wind. The shelter effectiveness of a set of windbreaks placed over a railway twin-track embankment is experimentally analysed. A set of two-dimensional wind tunnel tests are undertaken and results corresponding to pressure tap measurements over a section of a typical high-speed train are herein presented. The results indicate that even small-height windbreaks provide sheltering effects to the vehicles. Also, eaves located at the windbreak tips seem to improve their sheltering effect.

Mathematical analysis of the effect of rotor geometry on cup anemometer response.

The calibration coefficients of two commercial anemometers equipped with different rotors were studied. The rotor cups had the same conical shape, while the size and distance to the rotation axis varied. The analysis was based on the 2-cup positions analytical model, derived using perturbation methods to include second-order effects such as pressure distribution along the rotating cups and friction. The comparison with the experimental data indicates a nonuniform distribution of aerodynamic forces on the rotating cups, with higher forces closer to the rotating axis. The 2-cup analytical model is proven to be accurate enough to study the effect of complex forces on cup anemometer performance.

Primary leptomeningeal histiocytic sarcoma in a patient with a good outcome: a case report and review of the literature.

INTRODUCTION: Histiocytic sarcoma is a rare neoplasm with few cases reported in the literature of which some were diagnosed in animals. This neoplasm arises from abnormal reticuloendothelial system cell proliferation of histiocytes and has an aggressive behavior especially if located in the central nervous system. We present the first case of a patient with histiocytic sarcoma that involved the meninges and had a good course after multidisciplinary treatment. CASE PRESENTATION: Our patient was a 41-year-old Caucasian woman with no previous history of disease who started with systemic symptoms such as headache and chills. Magnetic resonance imaging with gadolinium contrast of the brain suggested a mass 1.5×2cm in diameter in the temporal lobe with a non-uniform vasogenic edema. This lesion was implanted in the meninges and surgery was the first treatment. The histological findings revealed a histiocytic sarcoma. The patient received concomitant chemoradiotherapy after surgery with good tolerance and currently lives without disease. CONCLUSION: Although histiocytic sarcomas in the brain present an unusual location and have a poorer prognosis, we have identified the first primary leptomeningeal histiocytic sarcoma with a disease-free survival greater than 3 years following multidisciplinary treatment with surgery and chemotherapy and radiotherapy.

Aerodynamic analysis of cup anemometers performance: the stationary harmonic response.

The effect of cup anemometer shape parameters, such as the cups' shape, their size, and their center rotation radius, was experimentally analyzed. This analysis was based on both the calibration constants of the transfer function and the most important harmonic term of the rotor's movement, which due to the cup anemometer design is the third one. This harmonic analysis represents a new approach to study cup anemometer performances. The results clearly showed a good correlation between the average rotational speed of the anemometer's rotor and the mentioned third harmonic term of its movement.

Efficiency of hysteresis rods in small spacecraft attitude stabilization.

A semiempirical method for predicting the damping efficiency of hysteresis rods on-board small satellites is presented. It is based on the evaluation of dissipating energy variation of different ferromagnetic materials for two different rod shapes: thin film and circular cross-section rods, as a function of their elongation. Based on this formulation, an optimum design considering the size of hysteresis rods, their cross section shape, and layout has been proposed. Finally, the formulation developed was applied to the case of four existing small satellites, whose corresponding in-flight data are published. A good agreement between the estimated rotational speed decay time and the in-flight data has been observed.

Childhood discoid lupus in identical twins.

We report the exceptional case of 11-year-old identical male twins who both developed discoid lupus erythematosus lesions. Although systemic lupus erythematosus has often been reported in identical twins, discoid lupus erythematosus has only occasionally been described, with only one other case in twin children, as far as we are aware.

Perforating neutrophilic and granulomatous dermatitis of the newborn--a clue to immunodeficiency.

We report two newborns with a widespread cutaneous eruption consisting of discrete papules which evolved into vesicles, pustules, crusts, and ulcers. These healed over a 2-week period with scarring. Histopathology showed three main features--histiocytic granulomas, neutrophilic infiltration, and transepidermal elimination of degenerated collagen and debris through hair follicles. Both patients had congenital immunodeficiency. This skin condition of the newborn, with distinct clinical and histopathologic features, is a manifestation of immunodeficiency that has not been previously described.