Impact of opening a new emergency department on healthcare service and patient outcomes : analyses based on linking ambulance, emergency and hospital databases

Background Emergency department (ED) crowding caused by access block is an increasing public health issue and has been associated with impaired healthcare delivery, negative patient outcomes and increased staff workload. Aim To investigate the impact of opening a new ED on patient and healthcare service outcomes. Methods A 24-month time series analysis was employed using deterministically linked data from the ambulance service and three ED and hospital admission databases in Queensland, Australia. Results Total volume of ED presentations increased 18%, while local population growth increased by 3%. Healthcare service and patient outcomes at the two pre-existing hospitals did not improve. These outcomes included ambulance offload time: (Hospital A PRE: 10 min, POST: 10 min, P < 0.001; Hospital B PRE: 10 min, POST: 15 min, P < 0.001); ED length of stay: (Hospital A PRE: 242 min, POST: 246 min, P < 0.001; Hospital B PRE: 182 min, POST: 210 min, P < 0.001); and access block: (Hospital A PRE: 41%, POST: 46%, P < 0.001; Hospital B PRE: 23%, POST: 40%, P < 0.001). Time series modelling indicated that the effect was worst at the hospital furthest away from the new ED. Conclusions An additional ED within the region saw an increase in the total volume of presentations at a rate far greater than local population growth, suggesting it either provided an unmet need or a shifting of activity from one sector to another. Future studies should examine patient decision making regarding reasons for presenting to a new or pre-existing ED. There is an inherent need to take a ‘whole of health service area’ approach to solve crowding issues.

Indigenous health: Embracing and enacting the spirit of change. Opening keynote address

In speaking at the Cardiac Society this morning, I am conscious of this year’s 60th Anniversary. It is 60 years since motivated and impassioned people travelled to form the organisation that became the Cardiac Society. They started an organisation and a movement of sorts which was joined by many others over the years and which brings us to this room on this morning. This started in 1952. What were you doing in 1952? Where you just born and for some of you were? Others here were not born and may be your parents hadn’t even met yet. I want you to gain a sense of this time, of 60 years ago.

Opening digital learning to deeper inquiry

This chapter presents an historical narrative on the recent evolution of information and communications technology (ICT) that has been, and is, utilized for purposes of learning. In other words, it presents an account of the development of e-learning supported through the Web and other similar virtual environments. It does not attempt to present a definitive account; as such an exercise is fraught with assumptions, contextual bias, and probable conjecture. The concern here is more with contextualizing the role of inquiry in learning and the evolving digital tools that enable interfaces that promote and support it. In tracking this evolution, both multi-disciplinary and trans-disciplinary research has been pursued. Key historical developments are identified as well as interpretations of the key drivers of e-learning over time and into what might be better described as digital learning. Innovations in the development of digital tools are described as dynamic and emergent, evolving as a consequence of multiple, sometimes hidden drivers of change. But conflating advancements in learning technologies with e-learning seems to be pervasive. As is the push for the “open” agenda – a growing number of initiatives and movements dominated by themes associated with access, intellectual property, public benefit, sharing and technical interoperability. Openness is also explored in this chapter, however, more in terms of what it means when associated with inquiry. By investigating opportunities for the stimulation and support of questioning online – in particular, why-questioning – this chapter is focused on “opening” content – not just for access but for inquiry and deeper learning.

Solid-state optical absorption from optimally tuned time-dependent range-separated hybrid density functional theory

We present a framework for obtaining reliable solid-state charge and optical excitations and spectra from optimally tuned range-separated hybrid density functional theory. The approach, which is fully couched within the formal framework of generalized Kohn-Sham theory, allows for the accurate prediction of exciton binding energies. We demonstrate our approach through first principles calculations of one- and two-particle excitations in pentacene, a molecular semiconducting crystal, where our work is in excellent agreement with experiments and prior computations. We further show that with one adjustable parameter, set to produce the known band gap, this method accurately predicts band structures and optical spectra of silicon and lithium fluoride, prototypical covalent and ionic solids. Our findings indicate that for a broad range of extended bulk systems, this method may provide a computationally inexpensive alternative to many-body perturbation theory, opening the door to studies of materials of increasing size and complexity.

Birkenhead Sixth Form College: Opening up remote access to the college network brings wider benefits to all

Birkenhead Sixth Form College implemented a virtual network to open up remote access to the college network for its students, staff and governors. In particular, for childcare students on work placements, this has meant 24/7 secure access to their work and resources, and the ability to make timely updates to their work evidence logs. The impact is better continuity of learning and a dramatic increase in the hand-in rate for work. For the staff, governors and college as a whole, the benefits of anytime-access to the network are more than were envisaged at the outset; not only is it saving them valuable time and eliminating the need for large print runs, it is expected to bring cost-savings to the College in the long term.

Development of a time and space resolved sampling probe diagnostic for engine exhaust hydrocarbons

In order to understand how unburned hydrocarbons emerge from SI engines and, in particular, how non-fuel hydrocarbons are formed and oxidized, a new gas sampling technique has been developed. A sampling unit, based on a combination of techniques used in the Fast Flame Ionization Detector (FFID) and wall-mounted sampling valves, was designed and built to capture a sample of exhaust gas during a specific period of the exhaust process and from a specific location within the exhaust port. The sampling unit consists of a transfer tube with one end in the exhaust port and the other connected to a three-way valve that leads, on one side, to a FFID and, on the other, to a vacuum chamber with a high-speed solenoid valve. Exhaust gas, drawn by the pressure drop into the vacuum chamber, impinges on the face of the solenoid valve and flows radially outward. Once per cycle during a specified crank angle interval, the solenoid valve opens and traps exhaust gas in a storage unit, from which gas chromatography (GC) measurements are made. The port end of the transfer tube can be moved to different locations longitudinally or radially, thus allowing spatial resolution and capturing any concentration differences between port walls and the center of the flow stream. Further, the solenoid valve's opening and closing times can be adjusted to allow sampling over a window as small as 0.6 ms during any portion of the cycle, allowing resolution of a crank angle interval as small as 15°CA. Cycle averaged total HC concentration measured by the FFID and that measured by the sampling unit are in good agreement, while the sampling unit goes one step further than the FFID by providing species concentrations. Comparison with previous measurements using wall-mounted sampling valves suggests that this sampling unit is fully capable of providing species concentration information as a function of air/fuel ratio, load, and engine speed at specific crank angles. © Copyright 1996 Society of Automotive Engineers, Inc.

The Surface Modification of Hydroxyapatite Nanoparticles by the Ring Opening Polymerization of gamma-Benzyl-L-glutamate N-carboxyanhydride

The surface modification of hydroxyapatite (HA) nanoparticles by the ring opening polymerization (ROP) of gamma-benzyl-L-glutamate N-carboxyanhydride (BLG-NCA) was proposed to prepare the poly(gamma-benzyl-L-glutamate) (PBLG)-grafted HA nanoparticles (PBLG-g-HA) for the first time. HA nanoparticles were firstly treated by 3-aminopropylthriethoxysilane (APS) and then the terminal amino groups of the modified HA particles initiated the ROP of BLG-NCA to obtain PBLG-g-HA. The process was monitored by XPS and FT-IR. The surface grafting amounts of PBLG on HA ranging from 12.1 to 43.1% were characterized by thermal gravimetric analysis (TGA). The powder X-ray diffraction (XRD) analysis confirmed that the ROP only underwent on the surface of HA nanoparticles without changing its bulk properties. The SEM measurement showed that the PBLG-g-HA hybrid could form an interpenetrating net structure in the self-assembly process.

Synthesis, characterization and ring-opening polymerization of cyclic (arylene phosphonate) oligomers

A series of cyclic (arylene phosphonate) oligomers were prepared by reaction of phenylphosphonic dichloride (PPD) with various bisphenols under pseudo-high dilution conditions via interfacial polycondensation. The yield of cyclic (arylene phosphonate) oligomers is over 85% by using hexadecyltrimethylammonium bromide as phase transfer catalyst (PTC) at 0 degreesC. The structures of the cyclic oligomers were confirmed by a combination of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) and IR analysis. These cyclic oligomers undergo facile ring-opening polymerization in the melt by using potassium 4,4'-biphenoxide as the initiator to give linear polyphosphonate. Free-radical ring-opening polymerization of cyclic(arylene phosphonate) oligomers containing sulfur linkages was also performed in the melt using 2,2'-dithiobis(benzothiazole) (DTB) as the initiator at 270degreesC and the resulting polymer had a M-w of 8 x 10(3) with a molecular weight distribution of 4. Ring-opening copolymerization of these cyclic oligomers with cyclic carbonate oligomers was also achieved. The average molecular weight of the resulting copolymer is higher than the corresponding, homopolymer and the thermal stability of the copolymer is better than the corresponding homopolymer.

Ring-opening polymerization and block copolymerization of L-lactide with divalent samarocene complex

Divalent samarocene complex [(C5H9C5H4)(2)Sm(tetrahydrofuran)(2)] was prepared and characterized and used to catalyze the ring-opening polymerization of L-lactide (L-LA) and copolymerization of L-LA with caprolactone (CL). Several factors affecting monomer conversion and molecular weight of polymer, such as polymerization time, temperature, monomer/catalyst ratio, and solvent, were examined. The results indicated that polymerization was rapid, with monomer conversions reaching 100% within 1 h, and the conformation of L-LA was retained. The structure of the block copolymer of CL/L-LA was characterized by NMR and differential scanning calorimetry. The morphological changes during crystallization of poly(caprolactone) (PCL)-b-P(L-LA) copolymer were monitored with real-time hot-stage atomic force microscopy (AFM). The effect of temperature on the morphological change and crystallization behavior of PCL-b-P(L-LA) copolymer was demonstrated through AFM observation.

Synthesis, structure and ring-opening polymerization of phenolphthalein macrocyclic polyarylates

Phenolphthalein based polyarylate macrocyclic oligomers were selectively synthesized by an interfacial polycondensation reaction of o-phthaloyl dichloride with phenolphthalein. The high selectivity benefits from the role of phenolphthalein as a color indicator, an efficient phase transfer catalyst, acid a preferred conformation of the starting materials as indicated by analyzing a single-crystal X-ray structure of an analogous macrocycle. The melt ROP of phenolphthalein polyarylate cyclic dimer was studied using nucleophilic initiators, The molecular weight of the resulting polymers builds up very rapidly at the very early stage of polymerization but decreases with time. During the ROP of cyclic dimer, analogous macrocycles with higher degree of polymerization (n greater than or equal to 3) and linear oligomers were produced by backbiting reaction especially at later stage of polymerization. Conversion of cyclic dimer is very fast at the earlier stage of polymerization and then increases slowly with time as analyzed by gel permeation chromatography. However, the total amount of cyclic oligomers in the ROP system increases with time at the later stage of polymerization because of the formation of larger macrocycles. The resulting polymers are amorphous. Glass transition temperatures (T(g)s) of these polymers are influenced by the polymerization time, type of initiator, and initiator concentration.

Ring-opening polymerization of epsilon-caprolactone by lanthanocene catalysis

Ring-opening polymerization of epsilon-caprolactone (CL) catalyzed by lanthanocenes, O(C2H4C5H3CH3)(2)YCl (Cat-YCl) and Me2Si[(CH3)(3)SiC5R3](2)NdCl (Cat-NdCl) has been carried out for the first time. It has been found that both yttrocene and neodymocene are very efficient to catalyze the polymerization of CL, giving high molecular weight poly(epsilon-caprolactone) (PCL). The effects of [cat]/[epsilon-CL] molar ratio, polymerization temperature and time, as well as solvents were investigated and polymerization temperature is found to be the most important factor affecting the polymerization. The bulk polymerization gives higher molecular weight PCL and higher conversion than that in solution polymerization. NaBPh4 was found to promote the polymerization of epsilon-caprolactone, and thus to increase both the polymerization conversion and MW of poly(epsilon-caprolactone).

Ring-opening polymerisation of silver-diphosphine [M2L3] coordination cages to give [M2L3](infinity) coordination polymers

[M2L3] coordination cages and linear [M2L3]infinity polymers of the rigid, bridging diphosphines bis(diphenylphosphino)acetylene (dppa) and trans-1,2-bis(diphenylphosphino)ethylene (dppet) with silver(I) salts have been investigated in the solution and solid states. Unlike flexible diphosphines, 1:1 dppa/AgX mixtures do not selectively form discrete [Ag2(diphos)2(X)2] macrocycles; instead dynamic mixtures of one-, two- and three-coordinate complexes are formed. However, 3:2 dppa/AgX ratios (X = SbF6. BF4, O3SCF3 or NO3) do lead selectively to new [M2L3] triply bridged cage complexes [Ag2(dppa)3(X)2] 1a-d (X = SbF6 a, BF4 b, O3SCF3 c, NO3 d), which do not exhibit Ag-P bond dissociation at room temperature on the NMR time scale (121 MHz). Complexes la-d were characterised by X-ray crystallography and were found to have small internal cavities, helical conformations and multiple intramolecular aromatic interactions. The nucleophilicity of the anion subtly influences the cage shape: Increasing nucleophilicity from SbF6 (1a) through BF4 (1b) and O3SCF3 (1c) to NO3 (1d) increases the pyramidal distortion at the AgP3 centres, stretching the cage framework (with Ag...Ag distances increasing from 5.48 in 1a to 6.21 A in 1d) and giving thinner internal cavities. Crystal packing strongly affected the size of the helical twist angle, and no correlation between this parameter and the Ag-Ag distance was observed. When crystalline 1c was stored in its supernatant for 16 weeks, conversion occured to the isostoichiometric [M2L3]infinity coordination polymer [Ag(dppa)2Ag(dppa)(O3SCF3)2]infinity (1c'). X-ray crystallography revealed a structure with ten-membered Ag2(dppa)2 rings linked into infinite one-dimensional chains by a third dppa unit. The clear structural relationship between this polymer and the precursor cage 1c suggests a novel example of ring-opening polymerisation. With dppet, evidence for discrete [M2L3] cages was also found in solution, although 31P NMR spectroscopy suggested some Ag-P bond dissociation. On crystallisation, only the corresponding ring-opened polymeric structures [M2L3]infinity could be obtained. This may be because the greater steric bulk of dppet versus dppa destabilises the cage and favours the ring-opening polymerisation.

Opening the Frontier: The Gubbio-Perugia Frontier in the Course of History.

The frontier between Gubbio (ancient Umbria) and Perugia (ancient Etruria), in the northeast part of the modern region of Umbria, was founded in the late sixth century BC. The frontier endured in different forms, most notably in the late antique and medieval periods, as well as fleetingly in 1944, and is fossilized today in the local government boundaries. Archaeological, documentary and
philological evidence are brought together to investigate different scales of time that vary from millennia to single days in the representation of a frontier that captured a watershed of geological origins. The foundation of the frontier appears to have been a product of the active agency of the Etruscans, who projected new settlements across the Tiber in the course of the sixth century BC,
protected at the outer limit of their territory by the naturally defended farmstead of Col di Marzo. The immediate environs of the ancient abbey of Montelabate have been studied intensively by targeted, systematic and geophysical survey in conjunction with excavation, work that is still in progress. An overview of the development of the frontier is presented here, employing the data currently available.

Coherently Opening a High-Q Cavity

We propose a general framework to effectively `open' a high-Q resonator, that is, to release the quantum state initially prepared in it in the form of a traveling electromagnetic wave. This is achieved by employing a mediating mode that scatters coherently the radiation from the resonator into a one-dimensional continuum of modes such as a waveguide. The same mechanism may be used to `feed' a desired quantum field to an initially empty cavity. Switching between an `open' and `closed' resonator may then be obtained by controlling either the detuning of the scatterer or the amount of time it spends in the resonator. First, we introduce the model in its general form, identifying (i) the traveling mode that optimally retains the full quantum information of the resonator field and (ii) a suitable figure of merit that we study analytically in terms of the system parameters. Then, we discuss two feasible implementations based on ensembles of two-level atoms interacting with cavity fields. In addition, we discuss how to integrate traditional cavity QED in our proposal using three-level atoms.

The immediate effects of atlanto-occipital joint manipulation and suboccipital muscle inhibition technique on active mouth opening and pressure pain sensitivity over latent myofascial trigger points in the masticatory muscles

DESIGN: A randomized controlled trial.OB JECTIVE: To investigate the immediate effects on pressure pain thresholds over latent trigger points (TrPs) in the masseter and temporalis muscles and active mouth opening following atlanto-occipital joint thrust manipulation or a soft tissue manual intervention targeted to the suboccipital muscles. BACKGROUND : Previous studies have described hypoalgesic effects of neck manipulative interventions over TrPs in the cervical musculature. There is a lack of studies analyzing these mechanisms over TrPs of muscles innervated by the trigeminal nerve. METHODS: One hundred twenty-two volunteers, 31 men and 91 women, between the ages of 18 and 30 years, with latent TrPs in the masseter muscle, were randomly divided into 3 groups: a manipulative group who received an atlanto-occipital joint thrust, a soft tissue group who received an inhibition technique over the suboccipital muscles, and a control group who did not receive an intervention. Pressure pain thresholds over latent TrPs in the masseter and temporalis muscles, and active mouth opening were assessed pretreatment and 2 minutes posttreatment by a blinded assessor. Mixed-model analyses of variance (ANOVA) were used to examine the effects of interventions on each outcome, with group as the between-subjects variable and time as the within-subjects variable. The primary analysis was the group-by-time interaction. RESULTS: The 2-by-3 mixed-model ANOVA revealed a significant group-by-time interaction for changes in pressure pain thresholds over masseter (P<.01) and temporalis (P =.003) muscle latent TrPs and also for active mouth opening (P<.001) in favor of the manipulative and soft tissue groups. Between-group effect sizes were small. CONCLUSIONS: The application of an atlanto-occipital thrust manipulation or soft tissue technique targeted to the suboccipital muscles led to an immediate increase in pressure pain thresholds over latent TrPs in the masseter and temporalis muscles and an increase in maximum active mouth opening. Nevertheless, the effects of both interventions were small and future studies are required to elucidate the clinical relevance of these changes. LEVEL OF EVIDENCE : Therapy, level 1b. J Orthop Sports Phys Ther 2010;40(5):310-317. doi:10.2519/jospt.2010.3257. KEYWORDSDS: cervical manipulation, muscle trigger points, neck, TMJ, upper cervical.