Change to costs and lengths of stay in the emergency department and the Brisbane protocol: An observational study

- Objective To compare health service cost and length of stay between a traditional and an accelerated diagnostic approach to assess acute coronary syndromes (ACS) among patients who presented to the emergency department (ED) of a large tertiary hospital in Australia. - Design, setting and participants This historically controlled study analysed data collected from two independent patient cohorts presenting to the ED with potential ACS. The first cohort of 938 patients was recruited in 2008–2010, and these patients were assessed using the traditional diagnostic approach detailed in the national guideline. The second cohort of 921 patients was recruited in 2011–2013 and was assessed with the accelerated diagnostic approach named the Brisbane protocol. The Brisbane protocol applied early serial troponin testing for patients at 0 and 2 h after presentation to ED, in comparison with 0 and 6 h testing in traditional assessment process. The Brisbane protocol also defined a low-risk group of patients in whom no objective testing was performed. A decision tree model was used to compare the expected cost and length of stay in hospital between two approaches. Probabilistic sensitivity analysis was used to account for model uncertainty. - Results Compared with the traditional diagnostic approach, the Brisbane protocol was associated with reduced expected cost of $1229 (95% CI −$1266 to $5122) and reduced expected length of stay of 26 h (95% CI −14 to 136 h). The Brisbane protocol allowed physicians to discharge a higher proportion of low-risk and intermediate-risk patients from ED within 4 h (72% vs 51%). Results from sensitivity analysis suggested the Brisbane protocol had a high chance of being cost-saving and time-saving. - Conclusions This study provides some evidence of cost savings from a decision to adopt the Brisbane protocol. Benefits would arise for the hospital and for patients and their families.

Directional dominance on stature and cognition in diverse human populations

Homozygosity has long been associated with rare, often devastating, Mendelian disorders1, and Darwin was one of the first to recognize that inbreeding reduces evolutionary fitness2. However, the effect of the more distant parental relatedness that is common in modern human populations is less well understood. Genomic data now allow us to investigate the effects of homozygosity on traits of public health importance by observing contiguous homozygous segments (runs of homozygosity), which are inferred to be homozygous along their complete length. Given the low levels of genome-wide homozygosity prevalent in most human populations, information is required on very large numbers of people to provide sufficient power3, 4. Here we use runs of homozygosity to study 16 health-related quantitative traits in 354,224 individuals from 102 cohorts, and find statistically significant associations between summed runs of homozygosity and four complex traits: height, forced expiratory lung volume in one second, general cognitive ability and educational attainment (P < 1 × 10−300, 2.1 × 10−6, 2.5 × 10−10 and 1.8 × 10−10, respectively). In each case, increased homozygosity was associated with decreased trait value, equivalent to the offspring of first cousins being 1.2 cm shorter and having 10 months’ less education. Similar effect sizes were found across four continental groups and populations with different degrees of genome-wide homozygosity, providing evidence that homozygosity, rather than confounding, directly contributes to phenotypic variance. Contrary to earlier reports in substantially smaller samples5, 6, no evidence was seen of an influence of genome-wide homozygosity on blood pressure and low density lipoprotein cholesterol, or ten other cardio-metabolic traits. Since directional dominance is predicted for traits under directional evolutionary selection7, this study provides evidence that increased stature and cognitive function have been positively selected in human evolution, whereas many important risk factors for late-onset complex diseases may not have been.

Efecto de benomyl en el desarrollo de mustia hilachosa causada por el hongo Thanatephorus cucumeris (Frank) Donk en cuatro variedades de frijol común (Phaseolus vulgaris L.)

Se realizó un estudio en la finca experimental La Compañía ubicada en el departamento de Carazo, Nicaragua, durante la época de primera de 1989. Con los objetivos siguientes; determinar la dosis de benomyl óptima en el control de la mustia hilachosa, Determinar la afectación de los rendimientos por efecto de la enfermedad en cuatro variedades de frijol común. Se obtuvieron 3 dosis de benomyl. 0.3, 0.6, 1.0 gramo por litro de agua y las variedades, 9ª. Talamanca, BAT 1155, Revolución 81 y Revolución 79A.. Los resultados mostraron que los porcentajes de severidad por la enfermedad alcanzaron hasta un 33 por ciento como máximo. Las dosis de Benomyl aplicadas para proteger el cultivo tuvieron un efecto marginal sobre la severidad de la enfermedad y los rendimientos. Así mismo estas aplicaciones no tuvieron efectos económicos. Talamanca y Revolución 81 presentaron menores porcentajes de severidad que BAT 1155 Revolución 79A.. Siendo Talamanca la variedad que obtuvo los más altos rendimientos, sin embargo fue la única variedad afectada por la enfermedad resultando una relación inversa entre severidad y rendimiento.

En las raíces ideológicas de Montoneros : John William Cooke lee a Gramsci en Cuba

Desde 1945 la izquierda argentina no pudo resolver el enigma planteado por el hecho de que la clase obrera era peronista. Varios intentos teóricos fracasaron antes de que John William Cooke hiciera el suyo a mediados de los años sesenta. Influenciado por Gramsci, consideró que la clase obrera es una categoría histórica, por lo que el peronismo era la experiencia histórica de la clase obrera argentina y, como tal, revolucionario. Neutralizó el papel político de Perón convirtiéndolo en el símbolo de la identidad peronista. Por esto, la teoría de Cooke fue clave para que guerrilleros de izquierda se declararan peronistas sin que les importaran las opiniones e intenciones políticas de Perón. Las limitaciones de esa teoría quedaron expuestas cuando el general regresó a la Argentina y fue electo presidente por tercera vez.

Report of the 2004 Workshop on In Situ Iron Enrichment Experiments in the Eastern and Western Subarctic Pacific

Foreword 1. BACKGROUND AND OBJECTIVES (pdf, 0.1 Mb) 2. 2004 WORKSHOP SUMMARY (pdf, < 0.1 Mb) 2.1. What have we learned from the enrichment experiments? 2.2 What are the outstanding questions? 2.3 Recommendations for SEEDS-II 3. EXTENDED ABSTRACTS OF THE 2004 WORKSHOP 3.1 Synthesis of the Iron Enrichment Experiments: SEEDS and SERIES (pdf, 0.5 Mb) Iron fertilization experiment in the western subarctic Pacific (SEEDS) by Atsushi Tsuda The response of N and Si to iron enrichment in the Northeast Pacific Ocean: Results from SERIES by David Timothy, C.S. Wong, Yukihiro Nojiri, Frank A. Whitney, W. Keith Johnson and Janet Barwell-Clarke 3.2 Biological and Physiological Responses (pdf, 0.2 Mb) Zooplankton responses during SEEDS by Hiroaki Saito Phytoplankton community response to iron and temperature gradient in the NW and NE subarctic Pacific Ocean by Isao Kudo, Yoshifumi Noiri, Jun Nishioka, Hiroshi Kiyosawa and Atsushi Tsuda SERIES: Copepod grazing on diatoms by Frank A. Whitney, Moira Galbraith, Janet Barwell-Clarke and Akash Sastri The Southern Ocean Iron Enrichment Experiment: The nitrogen uptake response by William P. Cochlan and Raphael M. Kudela 3.3 Biogeochemical Responses (pdf, 0.5 Mb) What have we learned regarding iron biogeochemistry from iron enrichment experiments? by Jun Nishioka, Shigenobu Takeda and W. Keith Johnson Iron dynamics and temporal changes of iron speciation in SERIES by W. Keith Johnson, C.S. Wong, Nes Sutherland and Jun Nishioka Dissolved organic matter dynamics during SEEDS and SERIES experiments by Takeshi Yoshimura and Hiroshi Ogawa Formation of transparent exopolymer particles during the in-situ iron enrichment experiment in the western subarctic Pacific (SEEDS) by Shigenobu Takeda, Neelam Ramaiah, Ken Furuya and Takeshi Yoshimura Atmospheric measurement by Mitsuo Uematsu 3.4 Prediction from Models (pdf, 0.3 Mb) Modelling iron limitation in the North Pacific by Kenneth L. Denman and M. Angelica Peña A proposed model of the SERIES iron fertilization patch by Debby Ianson, Christoph Voelker and Kenneth L. Denman 4. LIST OF PARTICIPANTS FOR THE 2004 WORKSHOP (pdf, < 0.1 Mb) APPENDIX 1 Report of the 2000 Planning Workshop on Designing the Iron Fertilization Experiment in the Subarctic Pacific (pdf, 1 Mb) APPENDIX 2 Terms of Reference for the Advisory Panel on Iron fertilization experiment in the subarctic Pacific Ocean (pdf, < 0.1 Mb) APPENDIX 3 Historical List of Advisory Panel Members on Iron fertilization experiment in the subarctic Pacific Ocean (pdf, < 0.1 Mb) APPENDIX 4 IFEP-AP Annual Reports (pdf, 0.1 Mb) APPENDIX 5 PICES Press Articles (pdf, 0.6 Mb) (194 page document)

Canal diggers in Panama, 1904 to 1928

Leonard Carpenter Panama Canal Collection. Publication: The Canal Diggers in Panama 1904 to 1928 [Box 1] from the Special Collections & Area Studies Department, George A. Smathers Libraries, University of Florida. (10 page document)

Proceedings of the 1998 Science Board Symposium on The Impacts of the 1997/98 El Niño Event on the North Pacific Ocean and Its Marginal Seas

Preface [pdf, 0.01 Mb] James J. O'Brien The big picture - The ENSO of 1997-98 [pdf, 0.01 Mb] James E. Overland, Nicholas A. Bond & Jennifer Miletta Adams Atmospheric anomalies in 1997: Links to ENSO? [pdf, 0.54 Mb] Vladimir I. Ponomarev, Olga Trusenkova, Serge Trousenkov, Dmitry Kaplunenko, Elena Ustinova & Antonina Polyakova The ENSO signal in the northwest Pacific [pdf, 0.47 Mb] Robert L. Smith, A. Huyer, P.M. Kosro & J.A. Barth Observations of El Niño off Oregon: July 1997 to present (October 1998) [pdf, 1.31 Mb] Patrica A. Wheeler & Jon Hill Biological effects of the 1997-1998 El Niño event off Oregon: Nutrient and chlorophyll distributions [pdf, 1.13 Mb] William T. Peterson Hydrography and zooplankton off the central Oregon coast during the 1997-1998 El Niño event [pdf, 0.26 Mb] William Crawford, Josef Cherniawsky, Michael Foreman & Peter Chandler El Niño sea level signal along the west coast of Canada [pdf, 1.25 Mb] Howard J. Freeland & Rick Thomson The El Niño signal along the west coast of Canada - temperature, salinity and velocity [pdf, 0.49 Mb] Frank A. Whitney, David L. Mackas, David W. Welch & Marie Robert Impact of the 1990s El Niños on nutrient supply and productivity of Gulf of Alaska waters [pdf, 0.06 Mb] Craig McNeil, David Farmer & Mark Trevorrow Dissolved gas measurements at Stn. P4 during the 97-98 El Niño [pdf, 0.13 Mb] Kristen L.D. Milligan, Colin D. Levings & Robert E. DeWreede Data compilation and preliminary time series analysis of abundance of a dominant intertidal kelp species in relation to the 1997/1998 El Niño event [pdf, 0.05 Mb] S.M. McKinnell, C.C. Wood, M. Lapointe, J.C. Woodey, K.E. Kostow, J. Nelson & K.D. Hyatt Reviewing the evidence that adult sockeye salmon strayed from the Fraser River and spawned in other rivers in 1997 [pdf,0.03 Mb] G.A. McFarlane & R.J. Beamish Sardines return to British Columbia waters [pdf, 0.34 Mb] Ken H. Morgan Impact of the 1997/98 El Niño on seabirds of the northeast Pacific [pdf, 0.06 Mb] Thomas C. Royer & Thomas Weingartner Coastal hydrographic responses in the northern Gulf of Alaska to the 1997-98 ENSO event [pdf, 0.76 Mb] John F. Piatt, Gary Drew, Thomas Van Pelt, Alisa Abookire, April Nielsen, Mike Shultz & Alexander Kitaysky Biological effects of the 1997/98 ENSO in Cook Inlet, Alaska [pdf, 0.22 Mb] H.J. Niebauer The 1997-98 El Niño in the Bering Sea as compared with previous ENSO events and the "regime shift" of the late 1970s [pdf, 0.10 Mb] A.S. Krovnin, G.P. Nanyushin, M.Yu. Kruzhalov, G.V. Khen, M.A. Bogdanov, E.I. Ustinova, V.V. Maslennikov, A.M. Orlov, B.N. Kotenev, V.V. Bulanov & G.P. Muriy The state of the Far East seas during the 1997/98 El Niño event [pdf, 0.15 Mb] Stacy Smith & Susan Henrichs Phytoplankton collected by a time-series sediment trap deployed in the southeast Bering Sea during 1997 [pdf, 0.21 Mb] Cynthia T. Tynan Redistributions of cetaceans in the southeast Bering Sea relative to anomalous oceanographic conditions during the 1997 El Niño [pdf, 0.02 Mb] Akihiko Yatsu, Junta Mori, Hiroyuki Tanaka, Tomowo Watanabe, Kazuya Nagasawa, Yikimasa Ishida, Toshimi Meguro, Yoshihiko Kamei & Yasunori Sakurai Stock abundance and size compositions of the neon flying squid in the central North Pacific Ocean during 1979-1998 [pdf, 0.11 Mb] O.B. Feschenko A new point of view concerning the El Niño mechanism [pdf, 0.01 Mb] Nathan Mantua 97/98 Ocean climate variability in the northeast Pacific: How much blame does El Niño deserve? [pdf, 0.01 Mb] Vadim P. Pavlychev Sharp changes of hydrometeorological conditions in the northwestern Pacific during the 1997/1998 El Niño event [pdf, 0.01 Mb] Jingyi Wang Predictability and forecast verification of El Niño events [pdf, 0.01 Mb] (Document contains 110 pages)

Collecção das Leis do Império do Brasil de 1856

Parte 1 - Atos do Poder Legislativo

Relatório da Commissão Mixta Brasileiro-Peruana de Reconhecimento do Alto Purús : notas complementares do commissario brasileiro : 1904-1905

Relatório assinado por Euclides da Cunha

Collecção das Leis da República dos Estados Unidos do Brazil de 1904

Parte 1 - Atos do Poder Legislativo.

Fallas do throno : 1826 a 1856

Discursos pronunciados pelos Imperadores D. Pedro I e D. Pedro II nas sessões de abertura e encerramento da Assembleia Nacional, no período de 1826 a 1856.

郭永怀先生诞辰九十周年纪念文集

目录

Synopose dos trabalhos da Camara dos Srs. Deputados : relativos ao anno de 1904 : acompanhados de differentes documentos : organisados na Secretaria da mesma Camara

Sinopse dos trabalhos da Câmara dos Deputados, em 1904.

Electron injection by a nanowire in the bubble regime

The triggering of wave-breaking in a three-dimensional laser plasma wake (bubble) is investigated. The Coulomb potential from a nanowire is used to disturb the wake field to initialize the wave-breaking. The electron acceleration becomes more stable and the laser power needed for self-trapping is lowered. Three-dimensional particle-in-cell simulations were performed. Electrons with a charge of about 100 pC can be accelerated stably to energy about 170 MeV with a laser energy of 460 mJ. The first step towards tailoring the electron beam properties such as the energy, energy spread, and charge is discussed. (C) 2007 American Institute of Physics.