Health insurance status and the use of emergency and other outpatient services by adults with sickle cell disease

STUDY OBJECTIVE: To evaluate insurance status and frequency of use of emergency services in adults with sickle cell disease. DESIGN: Retrospective analysis of visits. SETTING: Emergency department and outpatient clinics of an urban university hospital. PARTICIPANTS: One hundred seventy-two subjects, who made 771 visits to the ED during 1990. RESULTS: Of the 172 subjects, 31 were covered by commercial insurance, 32 were covered by Medicare, and 109 were covered by Medicaid or were uninsured. Insurance status and frequency of use of emergency services were independent (P > .05). On discriminant analysis, Medicaid-covered and uninsured subjects were correctly classified, but commercially insured and Medicare subjects were not. Medicaid and uninsured subjects were more likely to be younger and to live closer to the hospital (P < .00005). High-frequency users of emergency services were discriminated from low-frequency users. High-frequency users were more likely to be younger, to be users of primary-care services, and to live closer to the hospital (P = .0004). CONCLUSION: Provision of primary-care services or stable insurance in the form of commercial insurance or Medicare did not decrease use of emergency services in subjects with sickle cell disease in a group of patients selected from one urban academic ED.     

The role of oncostatin M in animal and human connective tissue collagen turnover and its localization within the rheumatoid joint

OBJECTIVE: To study the interaction of interleukin-1alpha (IL-1alpha) and oncostatin M (OSM) in promoting cartilage collagen destruction. METHODS: Bovine, porcine, and human cartilage and human chondrocytes were studied in culture. The levels of collagenase (matrix metalloproteinase 1 [MMP-1]) and tissue inhibitor of metalloproteinases 1 (TIMP-1) were measured by bioassay and enzyme-linked immunosorbent assay (ELISA). The levels of OSM in rheumatoid synovial fluid were measured by ELISA. RESULTS: When combined with OSM, IL-1alpha, IL-1beta, and tumor necrosis factor alpha released proteoglycan and collagen from cartilage. OSM was the only member of the IL-6 family to have this effect. Human tendon also responded to IL-1alpha and OSM. OSM increased the production of MMP-1 and TIMP-1 but when combined with IL-1alpha, synergistically promoted MMP-1 production in human chondrocytes and synovial fibroblasts. High levels of OSM were found in human rheumatoid synovial fluids, and confocal microscopy showed that OSM was produced by macrophages in rheumatoid synovial tissue. CONCLUSION: These results highlight an important new mechanism by which there is irreversible loss of collagen from cartilage.     

Novel methods for rapid assessment of tool performance in milling

The paper examines the effectiveness of two innovative techniques designed to rapidly optimize a milling application. One of them relates to quantifying the relative wear of different insert grades concurrently in a single cutting test, by mounting the inserts in the same cutter, for a quick comparative performance evaluation. Experimental results that illustrate the validity and limitation of this concept, and a scheme for enhancing the reliability of the test method are presented. The other technique refers to rapid identification of the optimum feed/tooth that corresponds to maximum tool life. This entails a test wherein individual inserts in the cutter are subject to feed/tooth that are multiples of a base value, by selectively leaving appropriate number of consecutive insert pockets unoccupied. These novel techniques complement known accelerated tool life tests, and are expedient for industries that engage short production runs, in terms of selecting a suitable insert grade for an application, and determining optimal cutting conditions for the selected grade.     

Cancer pain management in developing countries: a mosaic of complex issues resulting in inadequate analgesia

OBJECTIVE: To determine the prevalence of suicidal ideation and the symptomatic profile as well as to identify the sociodemographic characteristics highlighting female adolescents with the highest scores on suicidal ideation in adolescents living in Mexico City: students and suicidal patients. MATERIAL AND METHODS: A cross-sectional and ex-post-facto study was carried out in order to analyze information from two samples: 1,712 junior and junior high school women students (representative student sample in Mexico City), and 30 adolescents inpatient hospitalized for her suicide attempts (clinical sample). RESULTS: Prevalence of presence as well as persistence of suicidal ideation were higher in the clinical sample, nevertheless 11.8% of the school sample had everyone of the symptoms in a range of 1 to 7 days. The most persistent of the ideation symptoms was: "My family would be better if I were dead"; and in the clinical sample it was "I thought about killing myself". Finally, the sociodemographic characteristics that best matched the student girls having the highest scores in suicidal ideation were: to be on junior high school, to get low grades, to acknowledge school performance as bad and to have interrupted her studies. The characteristics that highlight the girls with a first attempt were analyzed in the clinic sample in comparison with those ones with two or more attempts. It was significant that girls in the second group were living only with one parent and they thought in the last attempt that their dead would be possible or certain. CONCLUSIONS: The prevalence of suicidal ideation was important in the school sample. If it is considered that this psychological construct has a strong association with suicidal attempt, and multiple suicide conduct, then is a priority to detect adolescents in risk and to make preventive efforts, considering the sociodemographic characteristics that configurate in risk for suicidal ideation.     

Trace Elements in the Si Furnace-Part II: Analysis of Condensate in Carbothermal Reduction of Quartz

Silicon feedstock for production of solar-grade silicon should be as pure as possible to decrease the cost of manufacturing of solar cells. Impurities in quartz, carbonaceous materials, electrodes, and refractories are mostly present in the form of oxides. These oxides can be reduced to volatile gaseous compounds in presence of SiO(g) and CO(g) atmosphere and potentially leave the furnace or stay in the condensed reaction products, metal, and slag. This work investigates the conditions under which volatile impurities report to the gas phase in laboratory experiments with lumpy and pelletized mixtures of SiO₂, SiC, and Si at 1923 K and 2123 K (1650 °C and 1850 °C), respectively, were carried out. The volatile compounds were generated by the reduction of quartz and collected in the form of condensate. The effects of the reaction temperature, quartz type, charge composition, pellets, and lumps on the composition of the condensate were studied. The trace elements in the charge input, reacting charge, and condensate were analyzed using inductively coupled plasma (ICP)-mass spectroscopy (MS) and X-ray diffraction (XRD). CO(g) and SiO(g), which are the major components in reduction reactions, formed four types of condensate: white, brown, green, and orange. The condensate constituents were amorphous SiO₂, 3C:SiC, Si, and α-quartz. Each impurity present in the quartz charge entered the gas phase during quartz reduction and was detected in the condensate. Al and Fe show limited volatility. The volatility of Mn, P, and B depends on the charge mix: a higher P_CO enhances the concentration of these elements in the gas phase. Fluid inclusions, common in hydrothermal quartz, enhance the distribution of the contaminants to the gas phase. Industrial campaigns on Si and Fe-Si production confirm the experimental results.     

Interfacial Reactions Between BaAl2Si2O8 and Molten Al Alloy at 850°C

A corrosion cup test was undertaken using BaAl₂Si₂O₈ and Al4.1Zn3.2Mg alloy, heated in air for 150 h at 850°C. Electron probe microanalysis, X‐ray diffraction, and scanning electron microscopy coupled with energy dispersive spectroscopy were used to identify the mineralogical and microstructural changes at the interfaces. The microstructural results revealed three microstructural areas: (1) Spinel layer with large numbers of Al alloy channels; (2) interfacial area with mainly alumina, spinel, and BaAl₂Si₂O₈; and (3) interdiffusion zone chemically close to barium hexaaluminate. The principal observations are:

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Simultaneous multi-objective optimization of stainless steel clad layer on pressure vessels using genetic algorithm

Metal cladding is a process of depositing a filler material to enhance the surface properties of base material using a suitable welding process. In this work the clad specimens are produced by surfacing a layer of filler material using weld cladding process to minimize the heat loss across the walls of the pressure vessels. It is done by depositing a low thermal conductivity austenitic stainless steel grade of 316L on structural steel plates used for boiler construction using flux cored arc welding process. The experimental study is carried out as per design of experiments availed for five factors five levels central composite design using response surface methodology. The mathematical models are developed for the prediction of clad layer height, clad layer width and depth of penetration. These models are employed in formulating fitness functions for multi-objective optimization of clad layer dimensions using genetic algorithm (GA). The set of optimal solutions suggested by response surface optimizer and genetic algorithm are compared and discussed. Conformity tests are conducted to validate the prediction capability of developed models and optimum settings. Optimum clad layer dimensions have been arrived and optimized stainless steel clad specimen has been produced. The heat transfer analysis is planned to be conducted in the next phase. The findings can be used in energy efficient design of pressure vessels.     

Pyrochlore type semiconducting ceramic oxides in Ca-Ce-Ti-M-O system (M = Nb or Ta)—Structure, microstructure and electrical properties

A new series of pyrochlore type ceramic semiconducting oxides in Ca-Ce-Ti-M-O (M = Nb or Ta) system has been synthesized by the conventional ceramic route. The electrical conductivity measurements show that these oxides exhibit semiconducting behavior and the conductivity increases with the Ce content in the compound. Activation energy of the current carriers is in the range of 0.5-1.6 eV. The electrical conductivity in these oxides is due to the presence of Ce³⁺, which remains in the reduced state without being oxidized to Ce⁴⁺ by structural stabilization. The photoluminescence and X-ray photoelectron spectroscopy analysis corroborate the presence of Ce in the 3+ state. Impedance spectral analysis is carried out to evaluate the transport properties and indicates that the conduction in these compounds is mainly due to electronic contribution. The X-ray powder diffraction and Raman spectroscopy analysis establishes that these oxides belong to a cubic pyrochlore type structure.     

Selection of Accelerometer Location on Bricklayers Using Decision Trees

Abstract: Preliminary investigations on accelerometer‐based activity recognition in construction have shown that it has good potential to be utilized for recognizing categories of work in a construction trade. Selecting the accelerometer locations is an important consideration in activity recognition studies, but currently it is decided primarily on the basis of comfort requirements. This article proposes a methodology for selecting the location of accelerometers using video annotations and decision trees. A video annotation tool is used to track the movement of body segments and decision tree algorithm helps to prioritize the relevant body segments for classifying activities. A two‐phase experimental study was conducted to assess the methodology. In the first phase, video annotation studies were carried out on four bricklayers, and based on decision tree analysis three locations: right lower arm, left lower arm, and waist were selected. In the second phase, an activity recognition study was conducted on another group of bricklayers with accelerometers attached at the selected locations. The results of study show that the location of accelerometer has a significant influence on accuracy and the proposed methodology is effective in selecting accelerometer locations. In the current study only bricklaying activity was considered, however, the methodology is generic and has the potential to be applied to objectively evaluate accelerator placement location for a wide range of structured activities.     

Synthesis of nanoparticles of barium lanthanum hafnium oxide by a modified combustion process

Barium lanthanum hafnium oxide, a complex perovskite ceramic, has been synthesized as nanoparticles by a modified combustion process for the first time. The Ba, La, and Hf ions required for the formation of Ba2LaHfO5.5 were obtained in solution by dissolving in boiling nitric acid a stoichiometric mixture of BaCO3, La2O3, and HfO2 that had been heated at 1200 degrees C for 4 h. By complexing the ions with citric acid and using ammonia as fuel, it was possible to get Ba2LaHfO5.5 as nanoparticles in a single-step combustion process. The powder obtained by the present combustion process was characterized by X-ray diffraction, BET surface area analysis, differential thermal analysis, thermogravimetric analysis, infrared spectroscopy, and scanning and high-resolution transmission electron microscopy. According to the results of X-ray and electron diffraction, the powder synthesized through the combustion process showed single-phase barium lanthanum hafnium oxide. The transmission electron microscopic investigations showed a grain size of 42 nm, with a standard deviation of 8 nm. The nanoparticles of Ba2LaHfO5.5 synthesized by the present combustion technique could be sintered to > 97% of the theoretical density at a relatively low temperature of 1425 degrees C. Scanning electron microscopic studies on the sintered Ba2LaHfO5.5 samples showed that the final grain size of the sintered specimen was < 500 nm.