The effects of ambulance ramping on Emergency Department length of stay and mortality

Background: Ambulance ramping within the Emergency Department (ED) is a common problem both internationally and in Australia. Previous research has focused on various issues associated with ambulance ramping such as access block, ED overcrowding and ambulance bypass. However, limited research has been conducted on ambulance ramping and its effects on patient outcomes. ----- ----- Methods: A case-control design was used to describe, compare and predict patient outcomes of 619 ramped (cases) vs. 1238 non-ramped (control) patients arriving to one ED via ambulance from 1 June 2007 to 31 August 2007. Cases and controls were matched (on a 1:2 basis) on age, gender and presenting problem. Outcome measures included ED length of stay and in-hospital mortality. ----- ----- Results: The median ramp time for all 1857 patients was 11 (IQR 6—21) min. Compared to nonramped patients, ramped patients had significantly longer wait time to be triaged (10 min vs. 4 min). Ramped patients also comprised significantly higher proportions of those access blocked (43% vs. 34%). No significant difference in the proportion of in-hospital deaths was identified (2%vs. 3%). Multivariate analysis revealed that the likelihood of having an ED length of stay greater than eight hours was 34% higher among patients who were ramped (OR 1.34, 95% CI 1.06—1.70, p = 0.014). In relation to in-hospital mortality age was the only significant independent predictor of mortality (p < 0.0001). ----- ----- Conclusion: Ambulance ramping is one factor that contributes to prolonged ED length of stay and adds additional strain on ED service provision. The potential for adverse patient outcomes that may occur as a result of ramping warrants close attention by health care service providers.

A Reliability test system for educational purposes-basic data

The IEEE Reliability Test System (RTS) developed by the Application of Probability Method Subcommittee has been used to compare and test a wide range of generating capacity and composite system evaluation techniques and subsequent digital computer programs. A basic reliability test system is presented which has evolved from the reliability education and research programs conducted by the Power System Research Group at the University of Saskatchewan. The basic system data necessary for adequacy evaluation at the generation and composite generation and transmission system levels are presented together with the fundamental data required to conduct reliability-cost/reliability-worth evaluation

Metabolomics coupled with proteomics advancing drug discovery toward more agile development of targeted combination therapies

To enhance the therapeutic efficacy and reduce the adverse effects of traditional Chinese medicine, practitioners often prescribe combinations of plant species and/or minerals, called formulae. Unfortunately, the working mechanisms of most of these compounds are difficult to determine and thus remain unknown. In an attempt to address the benefits of formulae based on current biomedical approaches, we analyzed the components of Yinchenhao Tang, a classical formula that has been shown to be clinically effective for treating hepatic injury syndrome. The three principal components of Yinchenhao Tang are Artemisia annua L., Gardenia jasminoids Ellis, and Rheum Palmatum L., whose major active ingredients are 6,7-dimethylesculetin (D), geniposide (G), and rhein (R), respectively. To determine the mechanisms underlying the efficacy of this formula, we conducted a systematic analysis of the therapeutic effects of the DGR compound using immunohistochemistry, biochemistry, metabolomics, and proteomics. Here, we report that the DGR combination exerts a more robust therapeutic effect than any one or two of the three individual compounds by hitting multiple targets in a rat model of hepatic injury. Thus, DGR synergistically causes intensified dynamic changes in metabolic biomarkers, regulates molecular networks through target proteins, has a synergistic/additive effect, and activates both intrinsic and extrinsic pathways.

Nanopowder management and plasma parameters in nanofabrication of low-dimensional quantum structures in reactive silane-based plasmas

Management of nanopowder and reactive plasma parameters in a low-pressure RF glow discharge in silane is studied. It is shown that the discharge control parameters and reactor volume can be adjusted to ensure lower abundance of nanopowders, which is one of the requirements of the plasma-assisted fabrication of low-dimensional quantum nanostructures. The results are relevant to micro- and nanomanufacturing technologies employing low-pressure glow discharge plasmas of silane-based gas mixtures.

Excitation of surface plasmon-polariton waves at a semiconductor-metal interface

The excitation of surface plasmon-polariton waves propagating across an external magnetic field (Voigt geometry) in a semiconductor-metal structure by means of the attenuated total reflection method is investigated. The phase matching conditions for the surface waves excitation in the Kretchmann configuration are derived and analyzed. The effect of different nonlinearities on the excitation of the surface waves is studied as well.

Bistability and hysteresis in inductively coupled plasmas

The transition between the two stable operation regimes (E and H discharge modes) in inductively coupled argon plasmas has been studied experimentally and theoretically. Analogy with other physical phenomena exhibiting hysteresis has been drawn. Analysis of power balance, electromagnetic field, plasma parameters, densities of the excited states, and optical emission spectra shows that the hysteresis may be due to nonlinearities associated with step-wise ionization through excited states of the argon atoms.

Turning points, power transfer, and frequency response of mode transitions in RF plasmas

Turning points for transitions between the electrostatic and electromagnetic discharge modes in low-frequency (∼ 500 kHz) inductively coupled plasmas have been identified and cross-referenced using time-resolved measurements of the plasma optical emission intensities, RF coil current, and ion saturation current collected by a single RF-compensated Langmuir probe. This enables one to monitor the variation of the plasma parameters, power transfer efficiency, which accompany the discharge hysteresis. The excitation conditions for the pure and hybrid modes in the plasma are considered, and the possibility of the TMmnl → TEm'n'l' transitions at higher frequencies are discussed.

Cord blood vitamin D and neurocognitive development are nonlinearly related in toddlers

Background Little is known about the relation between vitamin D status in early life and neurodevelopment outcomes. Objective This study was designed to examine the association of cord blood 25-hydroxyvitamin D [25(OH)D] at birth with neurocognitive development in toddlers. Methods As part of the China-Anhui Birth Cohort Study, 363 mother-infant pairs with completed data were selected. Concentrations of 25(OH)D in cord blood were measured by radioimmunoassay. Mental development index (MDI) and psychomotor development index (PDI) in toddlers were assessed at age 16–18 mo by using the Bayley Scales of Infant Development. The data on maternal sociodemographic characteristics and other confounding factors were also prospectively collected. Results Toddlers in the lowest quintile of cord blood 25(OH)D exhibited a deficit of 7.60 (95% CI: −12.4, −2.82; P = 0.002) and 8.04 (95% CI: −12.9, −3.11; P = 0.001) points in the MDI and PDI scores, respectively, compared with the reference category. Unexpectedly, toddlers in the highest quintile of cord blood 25(OH)D also had a significant deficit of 12.3 (95% CI: −17.9, −6.67; P < 0.001) points in PDI scores compared with the reference category. Conclusions This prospective study suggested that there was an inverted-U–shaped relation between neonatal vitamin D status and neurocognitive development in toddlers. Additional studies on the optimal 25(OH)D concentrations in early life are needed.

Combining meta- and mega-analytic approaches for multi-site diffusion imaging based genetic studies: From the enigma-DTI working group

Meta-analyses estimate a statistical effect size for a test or an analysis by combining results from multiple studies without necessarily having access to each individual study's raw data. Multi-site meta-analysis is crucial for imaging genetics, as single sites rarely have a sample size large enough to pick up effects of single genetic variants associated with brain measures. However, if raw data can be shared, combining data in a "mega-analysis" is thought to improve power and precision in estimating global effects. As part of an ENIGMA-DTI investigation, we use fractional anisotropy (FA) maps from 5 studies (total N=2, 203 subjects, aged 9-85) to estimate heritability. We combine the studies through meta-and mega-analyses as well as a mixture of the two - combining some cohorts with mega-analysis and meta-analyzing the results with those of the remaining sites. A combination of mega-and meta-approaches may boost power compared to meta-analysis alone.