Comparing the spatial attractiveness of hospitals using zero-inflated spatial models

Policy makers increasingly rely on hospital competition to incentivize patients to choose high-value care. Amongst all possible drivers, the travel distance without any doubt is one of the most important. In this paper we propose the use of a spatial Bayesian hierarchical model to assess the impact of distance on the number of patient admissions in hospitals, and thereby, compare hospital attractiveness. To this aim a MCMC sampler has been designed. We apply our methodology to patient admissions for asthma in four hospitals located in the Hérault department of France. Results indicate that the most attractive hospital is the CHU Montpellier.     

Childhood polybrominated diphenyl ether (PBDE) exposure and executive function in children in the HOME Study

Prenatal exposure to polybrominated diphenyl ethers (PBDEs) have been reported to impair executive function in children, but little is known whether childhood PBDE exposures play a role. Using the Health Outcomes and Measures of the Environment (HOME) Study, a prospective birth cohort in the greater Cincinnati area, we investigated the association between repeated measures of PBDEs during childhood and executive function at 8 years in 208 children and whether effect modification by child sex was present. We used child serum collected at 1, 2, 3, 5, and 8 years to measure PBDEs. The Behavior Rating Inventory of Executive Function was completed by parents to assess executive function at 8 years. We used multiple informant models to examine childhood PBDEs during several exposure windows. Null associations were observed between early childhood PBDEs and executive function. However, we observed significant adverse associations between a 10-fold increase in concurrent concentrations of BDE-28 (β = 4.6, 95% CI 0.5, 8.7) and BDE-153 (β = 4.8, 95% CI 0.8, 8.8) with behavioral regulation. In addition, PBDEs at 8 years were significantly associated with poorer emotional and impulse control. No associations were noted between childhood PBDEs and metacognition or global executive function. However, child sex significantly modified the associations, with significantly poorer executive function among males with higher concurrent BDE-153, and null associations in females. Our study findings suggest that concurrent PBDE exposures during childhood may be associated with poorer executive function, specifically behavior regulation. Males may also be more sensitive to adverse associations of concurrent PBDEs on executive function.     

A rapid diagnosis of anaerobic infection in the oro-maxillary region by gas-liquid chromatography

The relationship between volatile fatty acids (VFAs) in pus and infecting bacterial species was examined in order to establish a rapid identification system for anaerobic microorganisms in purulent inflammation in the oro-maxillary region. VFAs were detected by the direct injection of pus into gas-liquid chromatography (GLC). Bacterial examination was carried out by anaerobic culture using blood agar plates. The bacterial identification was carried out mainly according to the VPI manual. Analysis of the direct VFA patterns of each sample resulted in 5 groups. The following bacterial species were the main isolates in each group: Streptococcus intermedius in Group A, Peptostreptococcus micros in Group B, Fusobacterium nucleatum in Group C, Bacteroides gingivalis in Group D, and Peptostreptococcus anaerobius in Group E. The profile of VFAs produced in the PYG culture medium of the above isolated bacteria was compared with the direct VFA patterns. Agreement ratios between direct and PYG VFA patterns were as follows: Group A, 47.1%; Groups B and C, 45.0%; Group D, 87.5%; and Group E, 62.9%. The acetic acid concentration was more than 14 x 10(-4) meq/ml in Group B, the butyric acid concentration was more than 7 x 10(-4) meq/ml in Group C, and the iso-caproic acid concentration was more than 14 x 10(-4) meq/ml in Group E. In these cases, it was found that the agreement ratios between the direct and PYG FVA pattern were high. In Group D, irrespective of the concentration of iso-valeric acid detected, the agreement ratio was very high. The antibiotic susceptibility of the isolates was studied. Efficiency rates of ABPC, PIPC, CCL, CEZ, CMZ, SBT/CPZ, JM, CLDM, MINO and GM were relatively low and resistant rates were high for the gram-negative rods.     

Chemiluminescence of neutrophils from patients with Beh?et's disease and its correlation with an increased proportion of uncommon serotypes of Streptococcus sanguis in the oral flora

Zymosan-induced chemiluminescence was investigated in whole blood and in neutrophils: in both, the peak count was frequently elevated in Beh?et's disease, and was significantly higher than in healthy controls; similarly the peak time was shorter. There were more uncommon serotypes of Streptococcus sanguis in the oral flora of patients with Beh?et's disease. Common serotypes were present in the flora of healthy controls, but not in patients with the disease. The percentage of Strep. sanguis in the oral flora was significantly correlated with the level of chemiluminescence response. Thus infection with uncommon serotypes of Strep. sanguis may play a role in the aetiology of Beh?et's disease.