The effect of a staged, emergency department specific rapid response system on reporting of clinical deterioration

BACKGROUND: Despite emerging evidence regarding clinical deterioration in emergency department (ED) patients, the widespread uptake of rapid response systems (RRS) in EDs has been limited. AIMS: To evaluate the effect of an ED RRS on reporting of clinical deterioration and determine if there were differences between patients who did, and did not, deteriorate during ED care. METHODS: A retrospective cross sectional design was used to conduct this single site study in Melbourne, Australia. Stratified random sampling identified 50 patients with shortness of breath, chest pain or abdominal pain per each year studied (2009-2012) giving a total of 600 patients. The intervention was an ED RRS implemented in stages. RESULTS: The frequency of clinical deterioration was 14.8% (318 episodes/89 patients). Unreported deterioration decreased each year (86.7%; 68.8%; 55.3%; 54.0%, p=0.141). Patients who deteriorated during ED care had a longer median ED length of stay (2.8h; p<0.001), were 31.9% more likely to need hospital admission (p<0.001) and 4.9% more likely to die in hospital (p=0.044). CONCLUSIONS: A staged ED specific RRS decreased the frequency of unreported clinical deterioration. Controlled multi-site studies of ED specific RRSs are needed to examine the effect of formal ED RRSs on patient outcomes.

How does microfinance enhance entrepreneurial outcomes in emerging economies? The mediating mechanisms of psychological and social capital

In this article, a conceptual framework and research propositions are developed to explain how microfinance provision can translate into new venture creation and existing venture growth in an emerging economy context by engendering higher levels of psychological and social capital in clients. In doing this, the extent to which microfinance institutions provide business support and opportunities for social interaction are identified as factors which may strengthen the impact of microfinance provision on psychological and social capital, especially for poor entrepreneurs in resource-constrained settings. The conceptual framework and research propositions developed will be of use to academics in designing an agenda for future empirical research. In addition, they will help policymakers and microfinance providers to better design microfinance initiatives that enhance the well-being of clients and maximise their entrepreneurial outcomes. © The Author(s) 2013.

Obesity in adults: an emerging problem in urban areas of Ho Chi Minh City, Vietnam

OBJECTIVE: To assess the prevalence of overweight, obesity and underweight among Vietnamese adults living in urban areas of Ho Chi Minh City (HCMC), Vietnam. DESIGN: This cross-sectional survey was conducted in the local health stations of 30 randomly selected wards, which represent all 13 urban districts of HCMC, over a period of 2 months from March to April 2004. SUBJECTS: A total of 1488 participants aged 20-60 years completed the interview, physical examination and venous blood collection. MEASUREMENTS: Anthropometric measurements of body weight, height, waist and hip circumference were taken to construct indicators of adiposity including body mass index (BMI), waist circumference, and waist-to-height and waist-to-hip ratios. Both systolic and diastolic blood pressure and biochemical indicators of cardiovascular disease and type II diabetes risk (lipid profile and fasting blood glucose) were also measured. RESULTS: The age and sex standardized prevalence of overweight and obesity using Asian specific BMI cutoffs of 23.0 and 27.5 kg/m2 was 26.2 and 6.4%, respectively. The prevalence of overweight and obesity was slightly higher in females (33.6%) than males (31.6%), and progressively increased with age. The age and sex-standardized prevalence of underweight (BMI <18.5 kg/m2) among Vietnamese adults living in HCMC was 20.4%. The prevalence was slightly higher in males (22.0%) than in females (18.9%), and there was a much higher prevalence in all underweight categories in younger women than in men but this was reversed for older men. CONCLUSION: The adult population in HCMC Vietnam is in an early 'nutrition transition' with approximately equal prevalence of low and high BMI. The prevalence of overweight and obesity of Vietnamese urban adults was lower than that reported for other east and southeast Asian countries.

Identifying emerging hotel preferences using emerging pattern mining technique

Hotel managers continue to find ways to understand traveler preferences, with the aim of improving their strategic planning, marketing, and product development. Traveler preference is unpredictable for example, hotel guests used to prefer having a telephone in the room, but now favor fast Internet connection. Changes in preference influence the performance of hotel businesses, thus creating the need to identify and address the demands of their guests. Most existing studies focus on current demand attributes and not on emerging ones. Thus, hotel managers may find it difficult to make appropriate decisions in response to changes in travelers' concerns. To address these challenges, this paper adopts Emerging Pattern Mining technique to identify emergent hotel features of interest to international travelers. Data are derived from 118,000 records of online reviews. The methods and findings can help hotel managers gain insights into travelers' interests, enabling the former to gain a better understanding of the rapid changes in tourist preferences.

Urbanization, openness, emissions, and energy intensity: a study of increasingly urbanized emerging economies

This paper analyses the impact of urbanization and trade openness on emissions and energy intensity in twenty-two increasingly urbanized emerging economies. We employ three second-generation heterogeneous linear panel models as well as recently developed nonlinear panel estimation techniques allowing for cross-sectional dependence. The empirical results show that population density and affluence increase emissions and energy intensity while renewable energy seems to be dormant in these emerging economies, but non-renewable energy increases both CO2 emissions and energy intensity. In addition, openness significantly reduces both pollutant emissions and energy intensity whereas urbanization significantly increases energy intensity, but it is insignificant in increasing emissions. This may be, in part, due to the recent increasing trend in adopting cleaner technologies in these increasingly urbanized developing economies.