Re: Emergency Room Season 1 720p Torrent
Takeshi Krueger
Background: Air pollution constitutes a significant stimulus of asthma exacerbations; however, the impacts of exposure to major air pollutants on asthma-related hospital admissions and emergency room visits (ERVs) have not been fully determined.
The series shows how emergency operations cooperate in Tokyo. We still see problems of that in the past and today in other parts of the world. Especially during the 1993 World Trade Center bombing when it was discovered the FDNY did not have compatible radios to coordinate with the NYPD and PAPD. The series here shows at first how the MER would often but heads with the TMPD and the Tokyo Fire and Rescue before both organizations would pay their respects because of the zero-death mission goal.
With that said, the show is an entertaining one. I do believe we don't need a second season because MER was already approved by the Health Minister despite going against it. What I do believe though is a prequel should be produced, showing Kitami traveling the world, that incident with Tsubaki in Latin America, and Kitami's arrest in New York.
With the colder months peeking through, flu season is near. But where do you go if flu happens to strike you? Your instinct might be to go to your primary doctor to have your symptoms checked but going to your regular doctor or emergency room may have a long waiting period. Have no worries because we will talk about the ways our Urgent Care CAREPLUS services can help you during this fall flu season.
Urgent Care centers are usually cheaper than going to the emergency room when you don't have a very serious problem, like the flu. At Clinicas we make it easy to understand your coverage or the cost. We also offer a sliding fee for those that qualify. This means you won't have to pay as much from your own pocket compared to going to the ER. So, going to Urgent Care can help you save both time and money while making sure you still get really good care without spending too much of your own money. It's a win-win!
Urgent Care CAREPLUS has two locations in Ventura County. We have an Urgent Care location in Oxnard at our RSJ health center. We have another Urgent Care location in Simi Valley at our East Simi Valley health center. If you live in East County or West County you can bet that quality care is near you when you need it most. Visit us during this flu season to check for symptoms, get tested or get vaccinated.
Here we seek to replicate and expand the evidence of heat-health effects in children across the US, leveraging a very large healthcare claims database with information on ED visits in children with health insurance living across the US. Specifically, we sought to characterize the association between warm-season temperatures and risk of ED visits for all causes and a series of specific causes among children aged
We used a conditional logistic regression model to estimate the association between daily maximum temperature percentile and the relative risk of ED visits. We applied a well-established distributed lag non-linear modeling framework to allow for both non-linear exposure-response functions and non-linear lag-response functions [44]. As in prior studies, we modeled exposure-response functions using a quadratic B-spline with one internal knot placed at the 50th percentile of the county-specific warm-season temperature distribution and modeled the lag-response function using a natural cubic B-spline with two knots placed at equal intervals on the log scale of lags up to five days [45]. We additionally adjusted for a natural spline function with 3 of freedom for daily mean relative humidity and federal holidays (as an indicator variable) in all models. We report odds ratios (OR) and 95% confidence intervals (CI) of ED visits associated with a day of extreme heat (defined as ambient temperature above the county-specific 95th percentile temperature distribution) versus a typical daily temperature (defined as the 50th percentile county-specific temperature) [44, 45].
To examine potential differences in susceptibility, we evaluated whether the association between warm-season temperature and risk of ED visits varied across strata defined by age, sex, and NCA4 region, as defined above. We used the Wald test to assess whether the associations were homogeneous across strata [46]. All analyses were conducted using R version 4.0.2 with the 'survival' (version 3.1.12) and 'dlnm' (version 2.4.2) statistical packages [47, 48].
Warm-season daily maximum temperatures vary considerably across the US, with higher temperatures typically observed across the Southwest and Southeastern regions of the US (figure 2(A)). Our study population included approximately 4.7 million unique children with commercial health insurance on any given day, accounting for approximately 6.5% of the 2019 US resident population aged
Figure 2. Maps showing the spatial distribution of the definition of days of extreme heat (A) and the number of ED visits included in the analyses (B). Figure (A) shows the warm- season (MJJAS) 95th percentile of daily maximum temperature (F) observed at the same location from 2016 to 2019. Figure (B) shows the total number of warm-season ED visits per county among children aged
Warm-season temperatures were not positively associated with higher rates of all-cause ED visits but were associated with higher rates of ED visits for heat-related illnesses (figure 3(A)). For example, a day of extreme heat was associated with a 30% (95% CI: 20%, 40%) higher rate of ED visits for heat-related illnesses versus the local median warm-season temperatures cumulatively over five days of lag. Exposure-response curves for all outcomes by temperature percentile are shown in supplemental figure 1. The increase in risk was highest on the same day (lag 0), with minimal evidence of lagged effects (figure 3(B) and supplemental figure 2).
Warm-season temperatures were also associated with higher rates of ED visits for endocrine, nutritional, and metabolic diseases and otitis media and externa (figure 4). Specifically, a day of extreme heat versus the local median warm-season temperature was associated with a 25% (95% CI: 3%, 50%) higher rate of ED visits for endocrine, nutritional, and metabolic diseases and a 9% (95% CI: 3%, 16%) higher rate for otitis media and externa. We did not observe evidence of a positive association between extreme heat and rates of ED visits for any other specific cause. On the other hand, days of extreme heat were associated with lower rates of ED visits for diseases of the respiratory system, injury and poisoning, and asthma. For ease of comparison to other studies, results were recalculated comparing the 95th percentile to both the 1st percentile and mean of warm-season maximum temperatures (supplemental figures 3 and 4). Results were not materially different in sensitivity analyses in which we varied model parameters (supplemental figure 5).
We assessed whether the associations between warm-season temperature and ED visits for all-cause and heat-related illness varied across subgroups defined by age, sex, and region (figures 5(A) and (B)). Warm-season temperatures were not associated with higher rates of all-cause ED visits in any subgroup (age, sex, and climate region), except in the Midwest. Indeed, in several subgroups, warm-season temperatures were associated with lower rates of all-cause ED visits.
Despite ample evidence that extreme heat poses a significant public health risk in adults, relatively few studies have evaluated the impact of warm-season temperatures on children. We leveraged a large, national dataset of healthcare utilization claims to quantify the association between warm-season temperatures and rates of ED visits for any cause and for specific causes among a large sample of children and adolescents
The limited number of prior studies available in children collectively suggests that extreme heat is associated with higher rates of ED visits for a range of causes [15, 26, 27, 30, 49]. For example, Bernstein et al, used a national dataset of 3.8 million ED visits from 47 children's hospitals across the US, regardless of health insurance coverage, and found an 83% increase in heat-related ED visits associated with days of extreme heat (comparing the 95th versus 1st percentiles of location-specific daily maximum temperature). Similar positive associations between warm-season temperatures and healthcare utilization have been documented among children
Our finding that warm-season temperatures were not associated with higher rates of all-cause ED visits stands in contrast with most prior studies [19, 26, 31, 32]. For example, Bernstein et al found a 17% increase in rates of ED visits for any cause on days of extreme heat (comparing the 95th versus 1st percentile of daily maximum temperatures) [19]. Similarly, among children aged
Children may respond differently to heat than adults. In a previous study, we utilized the same source population and similar methodology to look at the impact of warm-season temperatures on adults [5]. Comparing the results of these two studies reveals both similarities and differences in the impacts of heat. While both studies indicated statistically significant positive associations between temperature and heat-related illness, the excess relative risk was slightly higher in adults versus children (66% vs. 50%, respectively, when comparing 95th vs 1st percentile of temperature). On the other hand, in children, heat was not associated with all-cause ED visits and negatively associated with ED visits for mental health disorders, while in adults heat was positively associated with both endpoints.
Design, Setting, and Participants This case-crossover study used medical claims data obtained from OptumLabs Data Warehouse (OLDW) to identify claims for ED visits with a primary or secondary discharge psychiatric diagnosis during warm-season months (May to September) from 2010 through 2019. Claims for adults aged 18 years or older with commercial or Medicare Advantage health insurance who were living in 2775 US counties were included in the analysis. Emergency department visits were excluded if the Clinical Classifications Software code indicated that the visits were for screening for mental health outcomes and impulse control disorders.
aa06259810