Fuel poverty in Scotland: Refining spatial resolution in the Scottish Fuel Poverty Indicator using a GIS-based multiple risk index

Fuel poverty describes a complex interaction between households with low income and energy inefficiency. The Scottish Executive has charged local Scottish authorities with the task of eradicating fuel poverty by 2016. In order to direct investment and tackle fuel poverty, a local authority must know which areas are more likely to contain fuel poor households. Currently, local area fuel poverty indicators, based on small area statistics, are used to identify target areas. This paper proposes an innovative methodology for refinement of the Scottish Fuel Poverty Indicator using GIS as a framework for integrating census data with georeferenced energy efficiency data on local housing stock. This allows a multi-scale mapping of fuel poverty risk at both a census output area level and an individual dwelling level. The proposed methodology highlights small areas, and households, possibly susceptible to fuel poverty previously masked by the aggregation of statistics to large geographic units.     

Radiocirculography in congenital heart disease in children with intracardiac shunts

A modification of radiocirculography suitable for the investigation of children suffering from congenital heart disease was developed and tested in 55 children with intracardiac shunts. Comparison of data derived from radiocirculography with the data obtained by conventional cardiac catheterisation showed radiocirculography has a high degree of accuracy when it is used to assess shunt size. Pulmonary arterial and capillary pressures and pulmonary resistance values were derived from radiocirculography findings and compared with those obtained from catheterisation studies: only in children of school age could the two be closely correlated. In cyanotic heart disease morphological analysis of the radiocirculographic curves proved an especially helpful diagnostic aid. The close agreement between the assessment of aortic override when using angiography and radiocirculography was demonstrated.     

医院药费监控策略与指标

本文介绍了医院内药费控制的指标及措施：根据现代医疗卫生工作效能的概念，讨论控制医院内药费开支的必要性与重要性，说明临床用药要兼顾疗效与经济学两方面因素，并运用药物经济学的原理与方法评价临床用药，以最低药费获得最佳疗效。     

Measurement of cerebral vascular extraction fractions in the rat using intracarotid injection techniques

A small volume (5 μl) common carotid arterial injection method is described for the quantitation of cerebral vascular extraction fractions (E_t) of diffusion limited tracer molecules in the rat. The method is a modification of a technique diffusion duced by Oldendorf and widely used for the study of blood-brain barrier phenomena. While the Oldendorf technique has proven valuable for estimating the relative permeabilities of substances, it is limited in measuring E_t under conditions of physiologically or pharmacologically altered permeability or blood flow. The method described in this paper — using a small volume (5 μl) common carotid injection, a freely diffusible reference tracer, [¹⁴C]butanol, and a 5 sec circulation time — allows for measurements of E_t that reflect changes in blood flow and small differences in permeability. The modified method is important for the study of the regulation of cerebral vascular permeability and flow in an inexpensive animal model.     

Antimicrobial prescribing at a university hospital: justified or 'just in case': testing a new scoring system as a key quality indicator

OBJECTIVE: To evaluate the quality of antimicrobial drug prescribing at a university hospital in the Department of Medicine, by using a new scoring system as a quality indicator. METHODS: Design: a prospective, longitudinal survey, during a 21-week period. The necessity of antimicrobial treatment of all in-patients at the Department of Medicine, to whom new antimicrobials were prescribed, was assessed by using a scoring system based on the presence of signs and symptoms of an infection. If the sum's total score was 3 or more, the antimicrobial treatment was deemed justifiable; if the score was less than 3, the antimicrobial treatment was regarded as questionable. Setting: Department of Medicine (279 hospital-beds) at the University Hospital Center Rijeka, a 1200-patient-bed teaching hospital in Croatia. RESULTS: Antimicrobials were prescribed to 15% of the total patients. They were given as a treatment to 89% of the patients, and in 67% of the cases, this treatment was administered empirically. According to the scoring system, 29% of the patients did not have a justified indication for antimicrobial treatment. CONCLUSION: The proposed quality indicator (scoring system) that we used is a simple method for the quality assessment of antimicrobial use. It has indicated areas that require in-depth analysis.     

The quality of the quality indicator of pain derived from the minimum data set

OBJECTIVE: To examine facility variation in data quality of the level of pain documented in the minimum data set (MDS) as a function of level of hospice enrollment in nursing homes (NHs). DATA SOURCE: Clinical assessments on 3,469 nonhospice residents from 178 NHs were merged with On-line Survey Certification and Reporting data of 2000, Medicare Claims data of 2000 and the MDS of 2000-2002. STUDY DESIGN: Using the same assessment protocol, NH staff and study nurses independently assessed 3,469 nonhospice residents. Study nurses' assessments being gold standard, we quantified and compared quality of NH staff's pain rating across NHs with high, medium, or low hospice use. Multilevel models were built to assess the effect of NH hospice use levels on the occurrence of false positive (FP) and false negative (FN) errors in NH-rated "severe pain." PRINCIPAL FINDINGS: Of 178 NHs, 25 had medium and 41 high hospice use. NHs with higher hospice use had lower sensitivities. In multilevel analysis, we found a significant facility-level variation in the probability of FP and FN errors in facility-rated "severe pain." Resident characteristics only explained 4 and 0 percent of the facility variation in FP and FN, respectively; characteristics and locations (state) of NHs further explained 53 and 52 percent of the variance. After controlling for resident and NH characteristics, staff in NHs with medium or high hospice use were less likely to have FP or FN errors in their MDS documentation of pain than were staff in NHs with low or no hospice use. CONCLUSIONS: The examination of data quality of pooled MDS data from multiple NHs is insufficient. Multilevel analysis is needed to elucidate sources of heterogeneity in the quality of MDS data across NHs. Facility characteristics, e.g., hospice use or NH location, are systematically associated with overrated/underrated pain and may bias pain quality indicator (QI) comparisons. To ensure the integrity of QI comparison in the NH setting, the government may need to institute regular audits of MDS data quality.     

Intracellular [Na+], Na+ pathways, and fluid transport in cultured bovine corneal endothelial cells

The mechanism of fluid transport across corneal endothelium remains unclear. We examine here the relative contributions of cellular mechanisms of Na+ transport and the homeostasis of intracellular [Na+] in cultured bovine corneal endothelial cells, and the influence of ambient Na+ and HCO3- on the deturgescence of rabbit cornea. Bovine corneal endothelial cells plated on glass coverslips were incubated for 60 min with 10 microm of the fluorescent Na+ indicator SBFI precursor in HCO3- HEPES (BH) Ringer's solution. After loading, cells were placed in a perfusion chamber. Indicator fluorescence (490 nm) was determined with a Chance-Legallais time-sharing fluorometer. Its voltage output was the ratio of the emissions excited at 340 and 380 nm. For calibration, cells were treated with gramicidin D. For fluid transport measurements, rabbit corneas were mounted in a Dikstein-Maurice chamber, and stromal thickness was measured with a specular microscope. The steady-state [Na+]i in BH was 14.36+/-0.38 mM (n = mean+/-s.e.). Upon exposure to Na+ -free BH solution (choline substituted), [Na+]i decreased to 1.81+/-0.20mM (n = 19). When going from Na+ -free plus 100 microm ouabain to BH plus ouabain, [Na+]i increased to 46.17+/-2.50 (n = 6) with a half time of 1.26+/-0.04 min; if 0.1 microm phenamil plus ouabain were present, it reached only 21.78+/-1.50mm. The exponential time constants (min-1) were: 0.56+/-0.04 for the Na+ pump; 0.39+/-0.01 for the phenamil sensitive Na+ channel; and 0.17+/-0.02 for the ouabain-phenamil-insensitive pathways. In HCO3- free medium (gluconate substituted), [Na+]i was 14.03+/-0.11mM; upon changing to BH medium, it increased to 30.77+/-0.74 mm. This last [Na+]i increase was inhibited 66% by 100 microm DIDS. Using BH medium, corneal thickness remained nearly constant, increasing at a rate of only 2.9+/-0.9 microm hr-1 during 3 hr. However, stromal thickness increased drastically (swelling rate 36.1+/-2.6 microm hr-1) in corneas superfused with BH plus 100 microm ouabain. Na+ -free, HCO3- free solution and 100 microm DIDS also led to increased corneal swelling rates (17.7+/-3.6, 14.4+/-1.6 and 14.9+/-1.2 microm hr-1, respectively). The present results are explained by the presence of a DIDS-inhibitable Na+-HCO3- cotransporter and an epithelial Na+ channel, both previously found in these cells. On the other hand, the quantitative picture presented here appears a novelty. The changes we observe are consistent with pump-driven rapid exchange of intracellular Na+, and recirculation of fully 70% of the Na+ pump flux via apical Na+ channels.     

The measurement of liver blood flow: a review of experimental and clinical methods

Changes in hepatic blood flow reflect adaptive responses of the liver to injury, regeneration, and the development of disease states. The measurement of hepatic blood flow is, however, technically challenging and although theoretically useful has not become routine in clinical work. The different techniques that have been developed for quantitative measurement of hepatic blood flow require careful interpretation of the results obtained but are frequently applied without careful considerations of their technical limitations. In particular, many noninvasive techniques depend on good hepatocellular function and are thus irrelevant under most clinical conditions. Many other potentially useful techniques are poorly validated and standardized and there is a need for further research into smethodology. This review summarizes the salient technical features of the different techniques for quantitative measurement of hepatic blood flow. The techniques are divided into invasive, minimally invasive, and noninvasive categories and the relevance of each technique to both routine clinical application or research is discussed.     

Common loon eggs as indicators of methylmercury availability in North America

Increased anthropogenic mercury (Hg) deposition since pre-industrial times, and subsequent transformation of inorganic Hg to methylmercury (MeHg) in aquatic environments, has created areas in North America where Hg poses a relatively high risk to wildlife, especially long-lived, piscivorous species. From 1995 to 2001, we opportunistically collected 577 eggs abandoned by Common Loons from eight states. Egg-Hg concentrations ranged from 0.07 to 4.42 µg/g (ww) or 0.10 to 19.40 µg/g (dw). Mercury was higher in eastern than in western North America. Female blood-Hg concentrations strongly correlated with those of eggs from the same territory even though the mean intraclutch Hg difference was 25%. In New England, egg volume declined significantly as egg-Hg concentrations increased. Fertility was not related to egg-Hg concentrations. Based on existing literature and this study's findings, egg-Hg risk levels were established and applied to our US data set and an existing Canadian data set. Regionally, we found the greatest risk levels in northeastern North America. With few exceptions, loon eggs are suitable indicators of methylmercury availability on lakes with territorial pairs.     

The validity of self-reported leisure time physical activity,and its relationship to serum cholesterol,blood pressure and body mass index. A population based study of 332,182 men and women aged 40-42 years

The importance of leisure time physical activity as a health indicator became more obvious after the results of large prospective studies were published. The validity of these results depends upon both the selection of the active individuals and to what extent self-reported physical activity reflects the individual's true activity. The purpose of this paper is to describe the changes in self-reported physical activity, and to assess the relation between this variable and other biological risk factors such as blood lipids, blood pressure and body mass index (BMI). This report also aims at corroborating the validity of self-reported physical activity by assessing the consistency of the associations between these biological risk factors and physical activity during a 25-years period. The basis for this analysis is a long lasting observational study with a questionnaire as the most important research instrument, in addition to physiological and biological factors such as BMI, blood pressure and blood lipids. The study population consists of 332,182 individuals, aged 40–42 from different counties in Norway who were invited to participate in health survey during 1974–1999. The objectives of this study are (1) to describe changes in self-reported physical activity from 1974 to 1999; (2) to assess the relation between physical activity and the biological variables; and (3) to corroborate the validity of the variable physical activity by assessing the consistency of the above analysis. The results of the analyses of association between decade of birth and self-reported physical activity show that physical activity among 40-aged individuals decreased during 1974–1999. This trend is stronger among the men. Multivariate analyses revealed differences in BMI and serum cholesterol between levels of self-reported physical activity, gender, smoking habits and decade of birth. The explained percentage of the total variance ranged from 6% for BMI to 7% for serum cholesterol. The similar shape of serum cholesterol and BMI according to physical activity indicates that the validity of self-reported physical activity has remained stable over these 25 years. Furthermore, the analysis of covariance showed that the slopes relating year of birth and serum cholesterol and BMI are parallel for self-reported physical activity thus the validity of the variable is confirmed.