Effects of environmental factors on the number of emergency admissions to the Hospital Complex Juan Canalejo in La Coruña: creation of a prediction model

BACKGROUND: This study is aimed at establishing the possible associations between the number of admissions through the emergency room at the "Juan Canalejol" Hospital in Corunna in 1994-1994 due to organic, circulatory and respiratory reasons and the weather variables introduced as being exogenous for the purpose of preparing a prediction model. METHODS: The Box-Jenkins methodology is used for obtaining univariate ARIMA models of the time-based series taken into consideration. Cross-Correlation Functions (CCF's) are established among the series of residuals which afford the possibility of establishing weights and lags among the variables for a subsequent modeling by means of multivariate ARIMA models which include environmental variables. RESULTS: The emergency admissions for organic reasons significantly increase 0-2 days following a rise in temperature. The admissions due to respiratory ailments are associated with drops in temperature with 10-14 lags, whilst the admissions for circulatory reasons increase significantly due to long-lasting spells of hot weather (10 lags). For people over age 65, significant increases in emergency admissions for circulatory reasons are also recorded with cold snaps. The multivariate ARIMA models that take into account the effect of environmental variables provided the best adjustment for all of the admissions variables. CONCLUSIONS: The number of emergency room admissions at the "Juan Canalejo" Medical Center Complex in Corunna due to organic, respiratory and circulatory causes shows a seasonal behavior pattern. The admissions for respiratory reasons are associated with a drop in temperature, whilst the admissions for circulatory reasons are affected fundamentally by hot weather, although also by cold weather as regards people over age 65. The multivariate ARIMA models including climate-related variables provide a system for predicting admissions in terms of said variables that can be useful from the standpoint of hospital management.     

Effects of Endodontic Infections on the Maxillary Sinus: A Case Series of Treatment Outcome

This article shows the follow-up of several cases of maxillary sinusitis of dental (usually endodontic) origin, with different manifestations, diagnostic challenges, and outcomes.Cases from 14 patients from 3 countries and treated by 7 different endodontists are presented, all of them with inflammatory sinus changes represented by mucositis, osteoperiostitis, and/or partial/full obstruction. All cases showed dental and/or sinus signs/symptoms that resolved after dental management. In 13 cases, the sinus condition had an endodontic origin, 4 of them concurrently with periodontal involvement. In 1 case, sinusitis was caused by trauma to the face. All cases but 1 had a satisfactory response of the periradicular tissues and maxillary sinus to treatment that consisted of root canal therapy, root amputation, extraction, or trauma management.The successful management of most cases reported in this article emphasizes the importance of endodontics as a specialty engaged in saving teeth and promoting health not only in the oral cavity but also in other areas that may be affected by infections of endodontic origin, including the maxillary sinus.     

Comparative ecotoxicity of single and binary mixtures exposures of cadmium and zinc on growth and biomarkers of Lemna gibba

In the present study, single and mixture effects of cadmium (Cd) and zinc (Zn) on Lemna gibba were analyzed and compared using growth parameters, based on frond number and fresh weight, and biochemical parameters, such as pigment, protein content and activity of antioxidant enzymes. Plants were exposed for 7 days to these metals in nutrient solution. Single and mixture exposures affected plant growth and the biomarkers of the antioxidant response. Considering the growth parameters, Cd was found to be much more toxic than Zn. IC50-7d, based on growth rate calculated on frond number, were 17.8 and 76.73 mg/L, and on fresh weight were 1.08 and 76.93 mg/L, for Cd and Zn respectively. For Cd, LOEC values were obtained at 2.06 and 1.03 mg/L, for frond number and fresh weight respectively; while for Zn, at 20.1 and 74.6 mg/L. A high toxicity effect, considering the same response variables, was observed in plants exposed to the mixtures. Three fixed ratios, based on toxic units (TU) were assayed, ratio 1: 2/3 Cd−1/3 Zn, ratio 2: 1/2 Cd−1/2 Zn and ratio 3: 1/3 Cd−2/3 Zn. Ratio 3 (where Zn was added in higher proportion) was the less toxic. All concentrations of Ratio 1 and 2 significantly inhibited plant growth, showing a 100% inhibition of growth rate at the highest concentrations when based on frond number. Catalase (CAT; EC 1.11.1.6), ascorbate peroxidase (APOX; EC 1.11.1.11) and guaiacol peroxidase (GPOX; EC 1.11.1.7) activities in single metals assays were higher than controls. In mixture tests, the activity of APOX and GPOX was significantly stimulated in plants exposed to all evaluated combinations, while CAT was mainly stimulated in Ratio 3. It was observed that the activity of the enzymes was increased in the mixtures compared with similar concentrations evaluated individually. APOX activity was observed to fit the CA model and following a concentration-response pattern. The response of this antioxidant enzyme could serve as a sensitive stressor biomarker for Cd–Zn interactions. Frond number in Cd–Zn mixtures was not well predicted from dissolved metal concentration in solution using concentration addition (CA) as reference model, as results showed that toxicity was more than additive, with an average of ΣTU = 0.75. This synergistic effect was observed up to 50 mg Zn/L in the mixture, but when it was present in higher concentrations a less than additive effect was observed, indicating a protective effect of Zn. A synergistic and dose-ratio deviations from CA model were also observed.     

On the necessary defense of dignity

As a critique to a television program, the author concludes: if the proposed values propounded in this television episode being commented on consist in ridiculing problems such as sexual dependence and violence committed against women, then effectively the program is proposing a society in which "Here no one will be able to survive".     

Use of poisson regression and box-jenkins models to evaluate the short-term effects of environmental noise levels on daily emergency admissions in Madrid,Spain

The relationship between environmental factors and hospital admissions has usually been analysed without taking into account the influence of a factor closely related to traffic in big cities, that is, environmental noise levels. We analysed the relationship between environmental noise and emergency admissions, for all causes and specific causes in Madrid (Spain), for the study period 1995–1997, using two statistical methods for the analysis of epidemiological time series data: Poisson autoregressive models and Box–Jenkins (ARIMA) methodology. Both methods produce a clear association between emergency admissions for all and specific causes and environmental noise levels. We found very similar results from both methods for all and circulatory causes, but slightly different for respiratory causes. Around 5% of all emergency admissions can be attributed to high noise levels, with a lower figure for specific causes. Current levels of environmental noise have a considerable epidemiological impact on emergency admissions in Madrid. A reduction of environmental noise levels could be accompanied by a possible reduction in the number of emergency admissions.     

Role of inducible nitric oxide synthase in the pathogenesis of experimental leptospirosis

Nitric oxide (NO) produced by inducible nitric oxide synthase (iNOS) is a radical effector molecule of the innate immune system that can directly inhibit pathogen replication. In order to study subsequent iNOS kidney expression in experimental leptospirosis, Golden Syrian hamsters and C3H/HeJ mice were infected intraperitoneally with 10² or 10⁷ virulent Leptospira interrogans serovar Copenhageni (LIC) strain Fiocruz L1-130. Results showed increased levels of iNOS mRNA and protein in kidneys of infected animals when compared to that in mock-infected animals. To get a deeper insight into the role of iNOS in experimental leptospirosis, both subject species were treated or not treated with 4-aminopyridine (4-AP, 0.3 mg/kg), an iNOS inhibitor. Treatment of infected hamsters with 4-AP accelerated the mortality rate to 100% by one day and increased the mortality rate from 20 to 60% in mice at 14 days post-infection. In kidney tissues, 4-AP treatment increased the bacterial burden, as demonstrated through leptospiral DNA quantification by real-time PCR, and aggravated tubulointerstitial nephritis. In addition, iNOS inhibition reduced the specific humoral response against LIC when compared to that in untreated infected animals. According to these results, iNOS expression and the resulting NO have an important role in leptospirosis.     

CAD in mammography: lesion-level versus case-level analysis of the effects of prompts on human decisions

Object

To understand decision processes in CAD-supported breast screening by analysing how prompts affect readers’ judgements of individual mammographic features (lesions). To this end we analysed hitherto unexamined details of reports completed by mammogram readers in an earlier evaluation of a CAD tool.

Material and methods

Assessments of lesions were extracted from 5,839 reports for 59 cancer cases. Statistical analyses of these data focused on what features readers considered when recalling a cancer case and how readers reacted to CAD prompts.

Results

About 13.5% of recall decisions were found to be caused by responses to features other than those indicating actual cancer. Effects of CAD: lesions were more likely to be examined if prompted; the presence of a prompt on a cancer increased the probability of both detection and recall especially for less accurate readers in subtler cases; lack of prompts made cancer features less likely to be detected; false prompts made non-cancer features more likely to be classified as cancer.

Conclusion

The apparent lack of impact reported for CAD in some studies is plausibly due to CAD systematically affecting readers’ identification of individual features, in a beneficial way for certain combinations of readers and features and a damaging way for others. Mammogram readers do not ignore prompts. Methodologically, assessing CAD by numbers of recalled cancer cases may be misleading.