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Arrival
Kinds of Arrival Terms modified by Arrival Selected AbstractsThe Epidemiology of Tuberculosis Among Primary Refugee Arrivals in Minnesota Between 1997 and 2001JOURNAL OF TRAVEL MEDICINE, Issue 1 2007Prathibha Varkey MD Background Minnesota (MN) is home to one of the highest number of refugees in the United States. The primary objective of this study was to evaluate the prevalence of latent and active tuberculosis (TB) infection in primary refugee arrivals to MN. Secondary objectives were to determine the association of TB infection with gender, age, and ethnicity of the refugees. Methods A retrospective study of primary refugee arrivals to MN between January 1, 1997, and December 31, 2001, was conducted. Chi-square tests and logistic regression analyses were used to assess the association of TB infection with gender, age, and ethnicity. Results Of the 9,842 refugees who had Mantoux test results, 4,990 (50.7%) had a positive test. A positive test was more common in men [odds ratio (OR) = 1.6; p < 0.0001], in Africans (OR = 1.6, p = <0.0001), and increased with 10-year age intervals (OR = 1.4; p < 0.0001). A total of 116 (0.8%) refugees received treatment for active TB. Active TB was more common in men (OR = 1.7; p = 0.006), African ethnicity (OR = 4.3; p < 0.0001), and increased with 10-year age intervals (OR = 1.1; p = 0.05). Conclusions Screening and treatment for latent and active TB should be actively managed among refugees resettling in the United States, as this is common and can have significant public health implications. [source] Departures, Arrivals and a VacancyANTIPODE, Issue 1 2008Noel Castree No abstract is available for this article. [source] The Impact of a Brief Expectation Survey on Parental Satisfaction in the Pediatric Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 12 2006Christopher D. Spahr MD Abstract Objectives To determine the effect of physician knowledge of parental expectations on satisfaction with emergency department (ED) care. Methods This was a prospective, controlled, interventional trial involving parents of children presenting to a children's hospital ED. Parents completed an expectation survey on arrival, which was either immediately placed back in the enrollment envelope (control) or shown to the physician caring for the child (intervention). The physician was instructed to initial the expectation survey to acknowledge receipt of the survey. Parents then completed a satisfaction survey at discharge. The primary outcomes were differences in satisfaction with physician review of the expectation survey, as measured by 1) parental ratings of overall care and 2) their willingness to recommend the ED to others. A third (baseline) group completed only a satisfaction survey at discharge. Results A total of 614 (66%) of the 930 enrolled parents completed the study. Intention-to-treat analysis did not show a significant increase in parental satisfaction ratings for either overall care or recommend the ED; however, only 42% of the intervention group surveys had documented physician review. When these initialed surveys were compared with the control group in a per-protocol analysis, there was a significant improvement in parental satisfaction. There were no differences between the control and baseline groups, indicating no effect of the expectation survey completion on satisfaction. Conclusions Physician knowledge of written parental expectations may improve parental satisfaction during an ED visit. Further work is needed to overcome the barriers to physician review of the expectation survey to maximize parent satisfaction. [source] Protein crystal nucleation: Recent notionsCRYSTAL RESEARCH AND TECHNOLOGY, Issue 1 2007Christo N. Nanev Abstract The nucleation of protein crystals is reconsidered taking into account the specificity of the protein molecules. In contrast to the homogeneous surface properties of small molecules, the protein molecule surface is highly inhomogeneous. Over their surfaces proteins exhibit high anisotropic distribution of patches, which are able to form crystalline bonds, the crystallization patch representing only a small fraction of the total surface of the protein molecule. Therefore, an appropriate spatial orientation of the colliding protein molecules is required in order to create a crystalline cluster. This scenario decreases considerably the success ratio of the attempt frequency for crystal nucleation. On the other hand a heterogeneous nucleation of (protein) crystals may be accelerated due to the arrival on some support of under-critical clusters that are formed in bulk solution; when arriving there they may acquire the property of critical nuclei. Thus, a plausible explanation of important peculiarities of protein crystal nucleation, as inferred from the experimental data, is suggested. (© 2007 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim) [source] Characteristics of Medical Surge Capacity Demand for Sudden-impact DisastersACADEMIC EMERGENCY MEDICINE, Issue 11 2006Samuel J. Stratton MD Objectives To describe the characteristics of the demand for medical care during sudden-impact disasters, focusing on local U.S. communities and the initial phases of sudden-impact disasters. Methods Established databases and published reports were used as data sources. Data were obtained to describe the baseline capacity of the U.S. medical system. Information for the initial phases of a sudden-impact disaster was sought to allow for characterization of the length of time before a U.S. community can expect arrival of outside assistance, the expected types of medical surge demands, the expected time for the peak in medical-care demand, and the expected health system access points. Results The earliest that outside assistance arrived for a community subject to a sudden-impact disaster was 24 hours, with a range from 24 to 96 hours. After sudden-impact disasters, 84% to 90% of health care demand was for conditions that were managed on an ambulatory basis. Emergency departments (EDs) were the access point for care, with peak demand time occurring within 24 hours. The U.S. emergency care system was functioning at relatively full capacity on the basis of data collected for the study that showed that annually, 90% of EDs were boarding admitted inpatients, and 75% were diverting ambulances. Conclusions As part of planning for sudden-impact disasters, communities should be expected to sustain medical services for 24 hours, and up to 96, before arrival of external resources. For effective medical surge-capacity response during sudden-impact disasters, there should be a priority for emergency medical care with a focus on ambulatory injuries and illnesses. [source] Clinical and Economic Factors Associated with Ambulance Use to the Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 8 2006Jennifer Prah Ruger PhD Background: Concern about ambulance diversion and emergency department (ED) overcrowding has increased scrutiny of ambulance use. Knowledge is limited, however, about clinical and economic factors associated with ambulance use compared to other arrival methods. Objectives: To compare clinical and economic factors associated with different arrival methods at a large, urban, academic hospital ED. Methods: This was a retrospective, cross-sectional study of all patients seen during 2001 (N= 80,209) at an urban academic hospital ED. Data were obtained from hospital clinical and financial records. Outcomes included acuity and severity level, primary complaint, medical diagnosis, disposition, payment, length of stay, costs, and mode of arrival (bus, car, air-medical transport, walk-in, or ambulance). Multivariate logistic regression identified independent factors associated with ambulance use. Results: In multivariate analysis, factors associated with ambulance use included: triage acuity A (resuscitation) (adjusted odds ratio [OR], 51.3; 95% confidence interval [CI] = 33.1 to 79.6) or B (emergent) (OR, 9.2; 95% CI = 6.1 to 13.7), Diagnosis Related Group severity level 4 (most severe) (OR, 1.4; 95% CI = 1.2 to 1.8), died (OR, 3.8; 95% CI = 1.5 to 9.0), hospital intensive care unit/operating room admission (OR, 1.9; 95% CI = 1.6 to 2.1), motor vehicle crash (OR, 7.1; 95% CI = 6.4 to 7.9), gunshot/stab wound (OR, 2.1; 95% CI = 1.5 to 2.8), fell 0,10 ft (OR, 2.0; 95% CI = 1.8 to 2.3). Medicaid Traditional (OR, 2.0; 95% CI = 1.4 to 2.4), Medicare Traditional (OR, 1.8; 95% CI = 1.7 to 2.1), arrived weekday midnight,8 AM (OR, 2.0; 95% CI = 1.8 to 2.1), and age ,65 years (OR, 1.3; 95% CI = 1.2 to 1.5). Conclusions: Ambulance use was related to severity of injury or illness, age, arrival time, and payer status. Patients arriving by ambulance were more likely to be acutely sick and severely injured and had longer ED length of stay and higher average costs, but they were less likely to have private managed care or to leave the ED against medical advice, compared to patients arriving by independent means. [source] Profiles in Patient Safety: Antibiotic Timing in Pneumonia and Pay-for-performanceACADEMIC EMERGENCY MEDICINE, Issue 7 2006Jesse M. Pines MD The delivery of antibiotics within four hours of hospital arrival for patients who are admitted with pneumonia, as mandated by the Joint Commission for the Accreditation of Healthcare Organizations and the Centers for Medicare and Medicaid Services, has gained considerable attention recently because of the plan to implement pay-for-performance for adherence to this standard. Although early antibiotic administration has been associated with improved survival for patients with pneumonia in two large retrospective studies, the effect on actual patient care and outcomes for patients with pneumonia and other emergency department patients of providing financial incentives and disincentives to hospitals for performance on this measure currently is unknown. This article provides an in-depth case-based description of the evidence behind antibiotic timing in pneumonia, discusses potential program effects, and analyzes how the practical implementation of pay-for-performance for pneumonia conforms to American Medical Association guidelines on pay-for-performance. [source] Maternal prenatal anxiety, postnatal caregiving and infants' cortisol responses to the still-face procedureDEVELOPMENTAL PSYCHOBIOLOGY, Issue 8 2009Kerry-Ann Grant Abstract This study prospectively examined the separate and combined influences of maternal prenatal anxiety disorder and postnatal caregiving sensitivity on infants' salivary cortisol responses to the still-face procedure. Effects were assessed by measuring infant salivary cortisol upon arrival at the laboratory, and at 15-, 25-, and 40-min following the still-face procedure. Maternal symptoms of anxiety during the last 6 months of pregnancy were assessed using clinical diagnostic interview. Data analyses using linear mixed models were based on 88 women and their 7-month-old infants. Prenatal anxiety and maternal sensitivity emerged as independent, additive moderators of infant cortisol reactivity, F (3, 180),=,3.29, p,=,.02, F (3, 179),=,2.68, p,=,.05 respectively. Results were independent of maternal prenatal depression symptoms, and postnatal symptoms of anxiety and depression. Infants' stress-induced cortisol secretion patterns appear to relate not only to exposure to maternal prenatal anxiety, but also to maternal caregiving sensitivity, irrespective of prenatal psychological state. © 2009 Wiley Periodicals, Inc. Dev Psychobiol 51: 625,637, 2009 [source] Where do Swainson's hawks winter?DIVERSITY AND DISTRIBUTIONS, Issue 5 2008Satellite images used to identify potential habitat ABSTRACT During recent years, predictive modelling techniques have been increasingly used to identify regional patterns of species spatial occurrence, to explore species,habitat relationships and to aid in biodiversity conservation. In the case of birds, predictive modelling has been mainly applied to the study of species with little variable interannual patterns of spatial occurrence (e.g. year-round resident species or migratory species in their breeding grounds showing territorial behaviour). We used predictive models to analyse the factors that determine broad-scale patterns of occurrence and abundance of wintering Swainson's hawks (Buteo swainsoni). This species has been the focus of field monitoring in its wintering ground in Argentina due to massive pesticide poisoning of thousands of individuals during the 1990s, but its unpredictable pattern of spatial distribution and the uncertainty about the current wintering area occupied by hawks led to discontinuing such field monitoring. Data on the presence and abundance of hawks were recorded in 30 × 30 km squares (n = 115) surveyed during three austral summers (2001,03). Sixteen land-use/land-cover, topography, and Normalized Difference Vegetation Index (NDVI) variables were used as predictors to build generalized additive models (GAMs). Both occurrence and abundance models showed a good predictive ability. Land use, altitude, and NDVI during spring previous to the arrival of hawks to wintering areas were good predictors of the distribution of Swainson's hawks in the Argentine pampas, but only land use and NDVI were entered into the model of abundance of the species in the region. The predictive cartography developed from the models allowed us to identify the current wintering area of Swainson's hawks in the Argentine pampas. The highest occurrence probability and relative abundances for the species were predicted for a broad area of south-eastern pampas that has been overlooked so far and where neither field research nor conservation efforts aiming to prevent massive mortalities has been established. [source] Telemetry Monitoring during Transport of Low-risk Chest Pain Patients from the Emergency Department: Is It Necessary?ACADEMIC EMERGENCY MEDICINE, Issue 10 2005Adam J. Singer MD Abstract Background: Low-risk emergency department (ED) patients with chest pain (CP) are often transported by nurses to monitored beds on telemetry monitoring, diverting valuable resources from the ED and delaying transport. Objectives: To test the hypothesis that transporting low-risk CP patients off telemetry monitoring is safe. Methods: This was a secondary analysis of a prospective, observational cohort of ED patients with low-risk chest pain (no active chest pain, normal or nondiagnostic electrocardiogram, normal initial troponin I) admitted to a non,intensive care unit monitored bed who were transported off telemetry monitor by nonclinical personnel. A protocol allowing transportation of low-risk CP patients off telemetry monitoring to a monitored bed was developed, and an ongoing daily log of patients transported off telemetry was maintained for the occurrence of any adverse events en route to the floor. Adverse events requiring treatment included dysrhythmias, hypotension, syncope, and cardiac arrest. The study population included patients who presented during September,October 2004, whose data were abstracted from the medical records using standardized methodology. A subset of 10% of the medical records were reviewed by a second investigator for interrater reliability. Death, syncope, resuscitation, and dysrhythmias during transport or immediately on arrival to the floor were the outcomes measured. Descriptive statistics and confidence intervals (CIs) were used in data analysis. Results: During the study period, 425 patients had CP of potentially ischemic origin, of whom 322 (75.8%) were low risk and met the inclusion criteria and were transported off monitors. Their mean (±standard deviation) age was 58.3 (±16.0) years; 48.1% were female. During transport from the ED, there was no patient with any adverse events requiring treatment and there was no death (95% CI = 0% to 0.93%). Conclusions: Transportation of low-risk ED chest pain patients off telemetry monitoring by nonclinical personnel to the floor appears safe. This may reduce diversion of ED nurses from the ED, helping to alleviate nursing shortages. [source] Patterns of endemic extinctions among island bird speciesECOGRAPHY, Issue 6 2002Eric Biber The relationship between island biogeography and the vulnerability of island biota to extinction as a result of human activities was examined. In particular, this study analyzed whether island area, maximum elevation of an island, isolation from the nearest continental landmass, or date of human colonization had statistically significant relationships with the proportion of endemic island bird species that have become endangered or extinct. The study examined islands or island groups with endemic bird species, and which have never been connected to a continental landmass. Both modern and fossil bird species were incorporated into the analysis. Islands that were colonized by humans earliest had the lowest proportion of modern species alone, and modern and fossil species combined, that have gone extinct. However, date of human arrival was not correlated with the proportion of modern species that are endangered. Maximum elevation of an island was negatively correlated with the proportion of modern species that are extinct, and was positively correlated with the proportion of modern species that are endangered. Area was negatively correlated with the proportion of modern species that are endangered. Isolation of islands was not significantly correlated with the proportion of modern species extinct or endangered, but was positively correlated with the proportion of modern and fossil species combined that have gone extinct. These results indicate that the initial spasm of island bird extinctions due to human contact may have, in part, passed. They also indicate that bird species on islands colonized earliest by humans may have had more time to adapt to the presence of man and his commensal species, resulting in reduced extinction rates. [source] Local hydrologic effects of introducing non-native vegetation in a tropical catchmentECOHYDROLOGY, Issue 1 2008Maite Guardiola-Claramonte Abstract This study investigates the hydrologic implications of land use conversion from native vegetation to rubber (Hevea brasiliensis) in Southeast Asia. The experimental catchment, Nam Ken (69 km2), is located in Xishuangbanna Prefecture (22°N, 101°E), in the south of Yunnan province, in southwestern China. During 2005 and 2006, we collected hourly records of 2 m deep soil moisture profiles in rubber and three native land-covers (tea, secondary forest and grassland), and measured surface radiation above the tea and rubber canopies. Observations show that root water uptake of rubber during the dry season is controlled by day-length, whereas water demand of the native vegetation starts with the arrival of the first monsoon rainfall. The different dynamics of root water uptake in rubber result in distinct depletion of soil moisture in deeper layers. Traditional evapotranspiration and soil moisture models are unable to simulate this specific behaviour. Therefore, a different conceptual model, taking in account vegetation dynamics, is needed to predict hydrologic changes due to land use conversion in the area. Copyright © 2008 John Wiley & Sons, Ltd. [source] Local floral composition and the behaviour of pollinators: attraction to and foraging within experimental patchesECOLOGICAL ENTOMOLOGY, Issue 5 2010AMPARO LÁZARO 1. Understanding how foraging decisions take place at the local scale is relevant because they may directly affect the fitness of individual plants. However, little is known about how local diversity and density affect the foraging behaviour of most pollinator groups. 2. By introducing two potted plant species (Salvia farinacae and Tagetes bonanza) into two populations of Taraxacum officinale, we investigated how plant identity, the mixtures of these plant species, and total plant density affected the attraction to and the foraging within a patch for six pollinator groups. 3. The foraging behaviour was mainly driven by the availability of the preferred plant species, and secondly by patch diversity and density. In general, dense patches and those containing the three-species mixture were preferred by all insect groups for arrival, although muscoid and hover flies responded less to local floral composition than bees. Local diversity and density had, however, a weaker effect on foraging behaviour within patches. Site dependence in response to floral treatments could be attributable to differences between sites in pollinator assemblage and Taraxacum density. 4. Studies like ours will help to understand how foraging decisions occur at the local scale and how foraging patterns may differ between pollinators and sites. [source] Effects of competition, cannibalism and intra-guild predation on larval development of the European coccinellid Adalia bipunctata and the invasive species Harmonia axyridisECOLOGICAL ENTOMOLOGY, Issue 1 2009REMY WARE Abstract 1.,Resource competition and intra-guild predation (IGP) are important determinants of the structure of aphidophagous guilds. The likelihood and outcome of IGP is influenced by the density of extra-guild prey and the characteristics of the species involved. 2.,The nature of intra-guild interactions between alien and indigenous coccinellids often determines the success of coccinellid invasions, as exemplified by Adalia bipunctata in Japan and Harmonia axyridis in North America and Europe. 3.,Harmonia axyridis has negatively impinged on indigenous species in its introduced range, and its recent arrival in Britain poses a threat for members of native aphidophagous guilds. IGP and inter-specific competition between H. axyridis and British coccinellids are predicted to occur. However, the results of such interactions have been little studied. 4.,Here we investigate the effects of different diets, designed to mimic possible conditions in the wild, on the survival, development, and adult size of H. axyridis and A. bipunctata. Results demonstrate a skew in the consequences of IGP between the two species: the supplementation of a limited aphid diet with non-conspecific eggs leads to a significant advantage for H. axyridis in respect of all parameters assessed, but gives no benefit to A. bipunctata. 5.,We conclude that IGP of A. bipunctata by H. axyridis will contribute to the spread and increase of H. axyridis in Britain. 6.,We further conclude that the skewed nature of IGP between A. bipunctata and H. axyridis at least in part explains the limited spread of A. bipunctata in Japan. [source] Parasites lost , do invaders miss the boat or drown on arrival?ECOLOGY LETTERS, Issue 4 2010Catriona J. MacLeod Ecology Letters (2010) 13: 516,527 Abstract Host species that colonize new regions often lose parasite species. Using population arrival and establishment data for New Zealand's introduced bird species and their ectoparasitic chewing lice species, we test the relative importance of different processes and mechanisms in causing parasite species loss. Few lice failed to arrive in New Zealand with their hosts due to being missed by chance in the sample of hosts from the original population (missing the boat). Rather, most lice were absent because their hosts or the parasite themselves failed to establish populations in their new environment. Given they arrived and their host established, parasite persistence was more strongly related to factors associated with transmission efficiency (number of host individuals introduced, host body size, host sociality and parasite suborder) than parasite propagule pressure and aggregation. Such insights into parasite success are invaluable to both understanding and managing their impact. [source] A Declaration of IndependenceECONOMIC AFFAIRS, Issue 4 2000David Graham Television was a true mass medium, its ,classic' output located within the concerns and lives of ordinary people. Television was also the amphitheatre of the nation, in which great events were played out. As a result of its massive power, regulation was imposed on it. By the 1970s, the unitary power of national channels was beginning to break down, first with the arrival of the VCR, then with satellite and cable. Along with this, came a growing separation of the broadcasting from the creative or programme making function driven by ,independent' producers. This divergence is now being hastened by the end of ,spectrum scarcity'. Creative companies and teams will strive to control their work and share in the rewards of their success in a way that will create a very different kind of entertainment industry in the 21st Century. [source] The dimensionality of alcohol use disorders and alcohol consumption in a cross-national perspectiveADDICTION, Issue 2 2010Guilherme Borges ABSTRACT Aims To replicate the finding that there is a single dimension trait in alcohol use disorders and to test whether the usual 5+ drinks for men and 4+ drinks for women and other measures of alcohol consumption help to improve alcohol use disorder criteria in a series of diverse patients from emergency departments (EDs) in four countries. Design Cross-sectional surveys of patients aged 18 years and older that reflected consecutive arrival at the ED. The Composite International Diagnostic Interview Core was used to obtain a diagnosis of DSM-IV alcohol dependence and alcohol abuse; quantity and frequency of drinking and drunkenness as well as usual number of drinks consumed during the last year. Setting Participants were 5195 injured and non-injured patients attending seven EDs in four countries: Argentina, Mexico, Poland and the United States (between 1995,2001). Findings Using exploratory factor analyses alcohol use disorders can be described as a single, unidimensional continuum without any clear-cut distinction between the criteria for dependence and abuse in all sites. Results from item response theory analyses showed that the current DSM-IV criteria tap people in the middle,upper end of the alcohol use disorder continuum. Alcohol consumption (amount and frequency of use) can be used in all EDs with the current DSM-IV diagnostic criteria to help tap the middle,lower part of this continuum. Even though some specific diagnostic criteria and some alcohol consumption variables showed differential item function across sites, test response curves were invariant for ED sites and their inclusion would not impact the final (total) performance of the diagnostic system. Conclusions DSM-IV abuse and dependence form a unidimensional continuum in ED patients regardless of country of survey. Alcohol consumption variables, if added, would help to tap patients with more moderate severity. The DSM diagnostic system for alcohol use disorders showed invariance and performed extremely well in these samples. [source] Alkanethiols Modified Gold Electrodes for Selective Detection of Molecules with Different Polarity and Molecular Size.ELECTROANALYSIS, Issue 3-5 2009Application to Vitamin B2 Analysis Abstract The cyclic voltammetry behavior of several molecules with different polarity and molecular size on gold electrodes modified with nonfunctionalized alkanethiols of different chain length, usually employed as chromatographic stationary phases, are studied. The redox systems hexacyanoferrate(II/III), ferrocene/ferrocine and hydroquinone/quinone are chosen as template molecules. As modifiers, ethanethiol, 1-octanethiol and di- n -octadecyldisulfide are selected. We can conclude that polar molecules can reach the electrode surface through channels created by the modifiers. However, when nonpolar compounds are analyzed, the nonpolar interactions between the analyte and the terminal group of the modifier lead to retention of the compound, retarding its arrival to the electrode surface. A molecule with polar and nonpolar part was used for the application of this conclusion. If the gold electrode is modified with di- n -octadecyldisulfide, the electrochemical behavior of vitamin B2 becomes simpler than that observed on a bare one. This result allows a sensitive and selective procedure to be developed for direct determination of vitamin B2 in pharmaceutical formulations. [source] Emergency Physician,Verified Out-of-hospital Intubation: Miss Rates by ParamedicsACADEMIC EMERGENCY MEDICINE, Issue 6 2004James H. Jones MD Abstract Objectives: To prospectively quantify the number of unrecognized missed out-of-hospital intubations by ground paramedics using emergency physician verification as the criterion standard for verification of endotracheal tube placement. Methods:The authors performed an observational, prospective study of consecutive intubated patients arriving by ground emergency medical services to two urban teaching hospitals. Endotracheal tube placement was verified by emergency physicians and evaluated by using a combination of direct visualization, esophageal detector device (EDD), colorimetric end-tidal carbon dioxide (ETCO2), and physical examination. Results: During the six-month study period, 208 out-of-hospital intubations by ground paramedics were enrolled, which included 160 (76.9%) medical patients and 48 (23.1%) trauma patients. A total of 12 (5.8%) endotracheal tubes were incorrectly placed outside the trachea. This comprised ten (6.3%) medical patients and two (4.2%) trauma patients. Of the 12 misplaced endotracheal tubes, a verification device (ETCO2 or EDD) was used in three cases (25%) and not used in nine cases (75%). Conclusions: The rate of unrecognized, misplaced out-of-hospital intubations in this urban, midwestern setting was 5.8%. This is more consistent with results of prior out-of-hospital studies that used field verification and is discordant with the only other study to exclusively use emergency physician verification performed on arrival to the emergency department. [source] Accuracy of triage nurses in predicting patient dispositionEMERGENCY MEDICINE AUSTRALASIA, Issue 4 2007Anna Holdgate Abstract Objective:, Increasing demand to reduce patient waiting times and improve patient flow has led to the introduction of a number of strategies such as fast track and patient streaming. The triage nurse is primarily responsible for identifying suitable patients, based on prediction of likely admission or discharge. The aim of the present study was to explore the accuracy with which triage nurses predict patient disposition. Methods:, Over two separate 1-week periods, triage nurses at two urban tertiary hospitals electronically recorded in real time whether they thought each patient would be admitted or discharged. The patient's ultimate disposition (admission or discharge), age, sex, diagnostic group, triage category and time of arrival were also recorded. Results:, In total, 1342 patients were included in the study, of which 36.0% were subsequently admitted. Overall, the triage nurse correctly predicted the disposition in 75.7% of patients (95% CI: 73.2,78.0). Nurses were more accurate at predicting discharge than admission (83.3%,vs 65.1%,,P = 0.04). Triage nurses were most accurate at predicting admission in patients with higher triage categories and most accurate at predicting discharge in patients with injuries and febrile illnesses (89.6%, 95% CI: 85.6,92.6). Predicted discharge was least accurate for patients with cardiovascular disease, with 41.1% (95% CI: 26.4,57.8) of predicted discharges in this category subsequently requiring admission. Conclusion:, Triage nurses can accurately predict likely discharge in specific subgroups of ED patients. This supports the role of triage nurses in appropriately identifying patients suitable for ,fast track' or streaming. [source] The effect of travel time on oviposition behavior and spatial egg aggregation: experiments with DrosophilaENTOMOLOGIA EXPERIMENTALIS ET APPLICATA, Issue 3 2007Kazuo H. Takahashi Abstract A higher degree of spatial egg aggregation is often observed in environments where resource patches are more sparsely distributed. This suggests a higher probability of species coexistence when resource distribution is sparse. However, it is still unclear how the degree of spatial egg aggregation increases. I propose a model to explain this phenomenon, which assumes that (i) egg load (the number of mature eggs in ovaries) increases in the travel period between resource patches and (ii) the retention of eggs in the ovaries is harmful (egg load pressure). With these assumptions, a female would lay accumulated eggs on arrival at a new resource patch, resulting in a higher degree of spatial egg aggregation. Laboratory experiments with three drosophilid species, Drosophila simulans Surtevant, Drosophila auraria Peng, and Drosophila immigrans Sturtevant, support the model. This study provides evidence that host availability affects the spatial egg aggregation via egg load. [source] Faunal make-up, host range and infestation rate of weevils and tephritid flies associated with flower heads of the thistle Cirsium (Cardueae: Astaraceae) in JapanENTOMOLOGICAL SCIENCE, Issue 4 2004Akinori NAKAMURA Abstract From 1988 to 1998, we collected flower heads of 39 thistle taxa (35 taxa of Cirsium, one species each of Breea, Synurus, Saussurea and Arctium; Cardueae; Astaraceae) in Japan, mainly from Hokuriku and other parts of central Honshu, and kept them in the laboratory to breed weevils and tephritid flies, the core fauna. We report the faunal make-up, host plants, geographic distribution and the attack levels of the insects. Results indicated that (i) three Larinus species (Curculionidae) and three species of tephritid flies (Tephritis, Urophora and Xyphosia) comprised the core fauna; (ii) two insect species belonging to the same taxonomic group (either Curculionidae (Larinus) or Tephritidae) tended to use different host plant species; (iii) two sympatric Larinus species (L. latissimus and L. meleagris) segregated the host plants seasonally in central Honshu (Cirsium blooming in spring and autumn, respectively); and (iv) two tephritid fly species, Xyphosia punctigera and Urophora sachalinensis, segregated geographically (the former on the Japan Sea side and the latter on the Pacific Ocean side). In comparison with their European counterparts, the weevils and tephritids of the Japanese Cirsium are characterized by a lower species richness and a lower degree of specialization in usage of the thistle flower heads, with gall-formers being distinctly under-represented, and callus tissue-feeders being absent. This reflects the fact that Japanese thistles are so closely related that hybridization frequently occurs, and also that the thistles have had a short history of interaction with the insects since the thistles' arrival in Japan. [source] Spatial,temporal marked point processes: a spectrum of stochastic modelsENVIRONMETRICS, Issue 3-4 2010Eric Renshaw Abstract Many processes that develop through space and time do so in response not only to their own individual growth mechanisms but also in response to interactive pressures induced by their neighbours. The growth of trees in a forest which compete for light and nutrient resources, for example, provides a classic illustration of this general spatial,temporal growth-interaction process. Not only has its mathematical representation proved to be a powerful tool in the study and analysis of marked point patterns since it may easily be simulated, but it has also been shown to be highly flexible in terms of its application since it is robust with respect to incorrect choice of model selection. Moreover, it is highly amenable to maximum likelihood and least squares parameter estimation techniques. Currently the algorithm comprises deterministic growth and interaction coupled with a stochastic arrival and departure mechanism. So for systems with a fixed number of particles there is an inherent lack of randomness. A variety of different stochastic approaches are therefore presented, from the exact event,time model through to the associated stochastic differential equation, taking in time-increment and Tau- and Langevin-Leaping approximations en route. The main algorithm is illustrated through application to forest management and high-intensity packing of hard particle systems, and comparisons are made with the established force biased approach. Copyright © 2009 John Wiley & Sons, Ltd. [source] Increased Plasma Levels of Pro- and Anti-inflammatory Cytokines in Patients with Febrile SeizuresEPILEPSIA, Issue 8 2002Miia Virta Summary: ,Purpose: Pro- and antiinflammatory cytokines regulate the febrile response during infection. Febrile seizures (FSs) conversely are associated with rapid onset of high fever. Activation of the cytokine network has been shown in previous studies of FSs and cytokines. In this study, the association between cytokines and FSs was further investigated. Methods: Interleukin-1, (IL-1,), interleukin-1 receptor antagonist (IL-1RA), interleukin-6 (IL-6), interleukin-10, and tumor necrosis factor-, plasma levels were measured with enzyme-linked immunosorbent assay in 55 children with FSs and in 20 age-matched febrile controls immediately on arrival at the hospital. Cerebrospinal fluid cytokine levels also were measured in 16 FS children. Results: The plasma IL-1RA/IL-1, ratio (mean, 2,133 vs. 119; median, 790 vs. 105; p < 0.0001) and plasma IL-6 (mean, 41.7 pg/ml vs. 16.1 pg/ml; median, 19.6 pg/ml vs. 10.5 pg/ml; p = 0.005) were significantly higher in FS patients compared with control children. Logistic regression analysis was used to find the most significant predisposing factors for FSs. In this analysis, the high plasma IL-1RA/IL-1, ratio was the most significant factor connected to FSs (OR, 41.5; 95% CI, 4.9,352.8), but high plasma IL-6 also was significantly associated with FSs (OR, 5.3; 95% CI, 1.4,20.3). Conclusions: Present results support the hypothesis that the cytokine network is activated and could have a role in the pathogenesis of FS. [source] Effects of Predation Threat on the Structure and Benefits from Vacancy Chains in the Hermit Crab Pagurus bernhardusETHOLOGY, Issue 11 2009Mark Briffa Vacancy chains occur when individuals occupy discrete re-useable resource units, which once abandoned by the current owner can then be occupied by a new owner. In order to enter the newly vacated resource the new owner must first vacate its current resource unit, such that a vacancy chain consists of a series of linked moves between resource units of different value, equivalent to different ,strata' in the chain. Vacancy chains may represent an important route by which resources are distributed through populations. Indeed, the arrival of a new resource has the potential to initiate a series of moves propagating beyond the individual that encounters the new resource unit. Thus, the chain participants as a whole may experience ,aggregate benefits' from the arrival of the new resource unit. The extent of these benefits, however, may not necessarily be evenly distributed between all chain participants; some individuals could receive greater than average benefits by moving through more than one stratum (,skipping') and some individuals could experience a reduction in resource value by moving to a resource unit of lower quality than that occupied initially (a ,backward move'). Such moves represent deviations from the ,ideal' vacancy chains assumed by theory. Here we analyse the aggregate benefits and benefits to individuals participating in vacancy chains of empty gastropod shells in the hermit crab Pagurus bernhardus. We also investigate the effect of predation risk on these two levels of benefits and on chain structure. Adding a new shell at the top of the chain causes an overall increase in shell quality after 24 h but the distribution of benefits between strata in the chain varies with the presence and absence of the predator cue. Although there was significant concordance between chain structure in the presence and absence of the predator cue, the structure was significantly different from an ideal vacancy chain in the absence but not the presence of the predator cue. [source] Incubation Behaviour in Northern Lapwings: Nocturnal Nest Attentiveness and Possible Importance of Individual Breeding QualityETHOLOGY, Issue 3 2004Terje Lislevand Previous studies of sex roles in the polygynous Northern Lapwing Vanellus vanellus have shown that males incubate less than females, perhaps suggesting that sexual selection is important in shaping the parental behaviour of this species. The purpose of this study was to (1) examine for the first time the possibility that males compensate for low diurnal nest attentiveness by increasing their nocturnal assistance and (2) evaluate the hypotheses that sexual selection and individual breeding quality determines incubation behaviour in lapwings. Males were never found incubating at night in 19 nests, although median diurnal male attentiveness was 15.3% in 16 of the same pairs. Nor were there any differences among monogamous and polygynous males in the time spent in four categories of behaviour (incubation, guarding, maintenance and mating activities). The time males spent in mating and incubation behaviours was weakly negatively correlated, and the time spent incubating varied considerably among males (0,74%). Further, female body condition was positively related with male nest attentiveness and there was a negative relationship between nest attentiveness and date of arrival to the study area in monogamous, but not in polygynous, males. We argue that sexual selection could not alone explain all sides of Northern Lapwing incubation, and suggest that individual differences in breeding quality may also be important. [source] A cross-national meta-analysis of alcohol and injury: data from the Emergency Room Collaborative Alcohol Analysis Project (ERCAAP)ADDICTION, Issue 9 2003Cheryl J. Cherpitel ABSTRACT Aims, To examine the relationship of acute alcohol consumption with an injury compared to a non-injury event in the emergency room across ERs in five countries. Design, Meta-analysis was used to evaluate the consistency and magnitude of the association of a positive blood alcohol concentration (BAC) at the time of arrival in the ER and self-reported consumption within 6 hours prior to the event with admission to the ER for an injury compared to a non-injury, and the extent to which contextual (socio-cultural and organizational) variables explain effect sizes. Findings, When controlling for age, gender and drinking five or more drinks on an occasion at least monthly, pooled effect size was significant and of a similar magnitude for both BAC and self-reported consumption, with those positive on either measure over half as likely again to be admitted to the ER with an injury compared to a medical problem. Effect sizes were found to be homogeneous across ERs for BAC, but not for self-report. Trauma center status and legal level of intoxication were positively predictive of self-reported consumption effect size on injury. Conclusions, These data suggest a moderate, but robust association of a positive BAC and self-report with admission to the ER with an injury, and that contextual variables also appear to play a role in the alcohol,injury nexus. [source] Investor Attention and Time-varying ComovementsEUROPEAN FINANCIAL MANAGEMENT, Issue 3 2007Lin Peng G14 Abstract This paper analyses the effect of an increase in market-wide uncertainty on information flow and asset price comovements. We use the daily realised volatility of the 30-year treasury bond futures to assess macroeconomic shocks that affect market-wide uncertainty. We use the ratio of a stock's idiosyncratic realised volatility with respect to the S&P500 futures relative to its total realised volatility to capture the asset price comovement with the market. We find that market volatility and the comovement of individual stocks with the market increase contemporaneously with the arrival of market-wide macroeconomic shocks, but decrease significantly in the following five trading days. This pattern supports the hypothesis that investors shift their (limited) attention to processing market-level information following an increase in market-wide uncertainty and then subsequently divert their attention back to asset-specific information. [source] Development of glutamate receptors in auditory neurons from long-term organotypic cultures of the embryonic chick hindbrainEUROPEAN JOURNAL OF NEUROSCIENCE, Issue 2 2009Carmen Diaz Abstract We used long-range organotypic cultures of auditory nuclei in the chick hindbrain to test the development of glutamate receptor activity in auditory neurons growing in a tissue environment that includes early deprivation of peripheral glutamatergic input, subsequent to removal of the otocyst. Cultures started at embryonic day (E)5, and lasted from 6 h to 15 days. Neuronal migration, clustering and axonal extension from the nucleus magnocellularis (NM) to the nucleus laminaris (NL) partially resembled events in vivo. However, the distinctive laminar organization of the NL was not observed. Glutamate receptor (GluR) activity was tested with optical recordings of intracellular Ca2+ in the NM. ,-Amino-3-hydroxy-5-methyl-4-isoxazoleproprionic acid (AMPA)/kainate receptors had Ca2+ responses with a time course similar to that in control slices. Peak amplitude, however, was significantly lower. N -methyl- d -aspartate (NMDA)-mediated Ca2+ responses were higher in 2-day cultures (E5 + 2d) than in E7 explant controls, returning later to control values. Metabotropic GluRs did not elicit Ca2+ responses at standard agonist doses. Blocking NMDA or AMPA/kainate receptors with specific antagonists for 10 days in culture did not limit neuronal survival. Blocking metabotropic GluRs resulted in complete neuronal loss. Thus, ionotropic GluRs are not required for NM neuronal survival. However, their activity during development is affected when neurons grow in an in vitro environment that includes prevention of arrival of peripheral glutamatergic input. [source] Postnatal innervation of the rat superior colliculus by axons of late-born retinal ganglion cellsEUROPEAN JOURNAL OF NEUROSCIENCE, Issue 7 2002Elizabeth J. Dallimore Abstract Rat retinal ganglion cells (RGCs) are generated between embryonic day (E) 13 and E19. Retinal axons first reach the superior colliculus at E16/16.5 but the time of arrival of axons from late-born RGCs is unknown. This study examined (i) whether there is a correlation between RGC genesis and the timing of retinotectal innervation and (ii) when axons of late-born RGCs reach the superior colliculus. Pregnant Wistar rats were injected intraperitoneally with bromodeoxyuridine (BrdU) on E16, E18 or E19. Pups from these litters received unilateral superior colliculus injections of fluorogold (FG) at ages between postnatal (P) day P0 and P6, and were perfused 1,2 days later. RGCs in 3 rats from each BrdU litter were labelled in adulthood by placing FG onto transected optic nerve. Retinas were cryosectioned and the number of FG, BrdU and double-labelled (FG+/BrdU+) RGCs quantified. In the E16 group, the proportion of FG-labelled RGCs that were BrdU+ did not vary with age, indicating that axons from these cells had reached the superior colliculus by P0/P1. In contrast, for the smaller cohorts of RGCs born on E18 or E19, the proportion of BrdU+ cells that were FG+ increased significantly after birth; axons from most RGCs born on E19 were not retrogradely FG-labelled until P4/P5. Thus there is a correlation between birthdate and innervation in rat retinotectal pathways. Furthermore, compared to the earliest born RGCs, axons from late-born RGCs take about three times longer to reach the superior colliculus. Later-arriving axons presumably encounter comparatively different growth terrains en route and eventually innervate more differentiated target structures. [source] | |||||||||||||||||||||||||||||||