Triage at the Emergency Department: association between triage levels and patient outcome

AbstractOBJECTIVEIdentify association between sociodemographic, clinical and triage categories with protocol outcomes developed at Hospital São Paulo (HSP).METHODSRetrospective cohort study conducted with patients older than 18 years submitted to the triage protocol in August 2012. Logistic regression was used to associate the risk categories to outcomes (p-value ≤0,05).RESULTSMen with older age and those treated in clinical specialties had higher rates of hospitalization and death. Patients in the high-priority group had hospitalization and mortality rates five and 10.6 times, respectively (p < 0.0001).CONCLUSIONThe high-priority group experienced higher hospitalization and mortality rates. The protocol was able to detect patients with more urgent conditions and to identify risk factors for hospitalization and death.

Human large granular lymphocytes contain an esterase activity usually considered as specific for the myeloid series.

A cytochemical marker such as alpha-naphthyl acetate esterase (ANAE) has been found useful for the morphological identification of the subset of T lymphocytes having receptors for Fcμ (TM cells). ANAE reaction on TM cells gives a typical pattern of one to four positive spots, whereas this pattern is not found on T cells with receptors for Fcγ (TG cells). ANAE is abundant in monocytes but not detectable in granulocytes. Herein another type of esterase activity, naphthol-AS-D chloroacetate esterase (NCAE), is described; it is known to be abundant in granulocytes and was found to give a specific pattern of reactivity with the subpopulation of large granular lymphocytes (LGL). This pattern of fine granular staining was observed not only on LGL present in the TG cell subpopulation but also in LGL present in the non-T, non-B cells. Fractions of peripheral blood mononuclear cells which were ènriched up to 80% in LGL by Percoll discontinuous density gradient gave a similar percentage of specific NCAE pattern. In addition, among the different fractions from Percoll gradient, there was a good correlation (r = 0.94) between the number of NCAE-positive cells and the natural killer activity against the natural killer susceptible K562 target cells. It will be important to determine whether or not this enzymatic activity plays a role in the cytotoxic activities of LGL.

Dimensions of national culture and the accounting environment -The Spanish case-

Gray (1988) has put forward a hypothesis on how a national accountingenvironment might reflect the cultural dimensions identified by Hofstede (1980, 1983). A number of studies have tested Gray's hypothesis, including one by Pourjalali and Meek (1995) which identified a match between changes in cultural dimensions and the accounting environment in Iran following the revolution. In this paper we replicate this work in the context of Spain following the death of Franco in 1975 and the emergence of a democratic constitution in 1978. Specifically, we: 1) Consider Gray's hypothesis built on Hofstede's cultural dimensions and review some empirical tests of the hypotheses.2) Building on the work of Hofstede and Gray, we: put forward some hypotheses on how we would expect cultural dimensions to change in Spain with the transition to democracy.3) Review developments in accounting in Spain following the transition to democracy, in order to identify how well these fit with our hypotheses.

ZNRD1 (zinc ribbon domain-containing 1) is a host cellular factor that influences HIV-1 replication and disease progression.

BACKGROUND: Human immunodeficiency virus (HIV) takes advantage of multiple host proteins to support its own replication. The gene ZNRD1 (zinc ribbon domain-containing 1) has been identified as encoding a potential host factor that influenced disease progression in HIV-positive individuals in a genomewide association study and also significantly affected HIV replication in a large-scale in vitro short interfering RNA (siRNA) screen. Genes and polymorphisms identified by large-scale analysis need to be followed up by means of functional assays and resequencing efforts to more precisely map causal genes. METHODS: Genotyping and ZNRD1 gene resequencing for 208 HIV-positive subjects (119 who experienced long-term nonprogression [LTNP] and 89 who experienced normal disease progression) was done by either TaqMan genotyping assays or direct sequencing. Genetic association analysis was performed with the SNPassoc package and Haploview software. siRNA and short hairpin RNA (shRNA) specifically targeting ZNRD1 were used to transiently or stably down-regulate ZNRD1 expression in both lymphoid and nonlymphoid cells. Cells were infected with X4 and R5 HIV strains, and efficiency of infection was assessed by reporter gene assay or p24 assay. RESULTS: Genetic association analysis found a strong statistically significant correlation with the LTNP phenotype (single-nucleotide polymorphism rs1048412; [Formula: see text]), independently of HLA-A10 influence. siRNA-based functional analysis showed that ZNRD1 down-regulation by siRNA or shRNA impaired HIV-1 replication at the transcription level in both lymphoid and nonlymphoid cells. CONCLUSION: Genetic association analysis unequivocally identified ZNRD1 as an independent marker of LTNP to AIDS. Moreover, in vitro experiments pointed to viral transcription as the inhibited step. Thus, our data strongly suggest that ZNRD1 is a host cellular factor that influences HIV-1 replication and disease progression in HIV-positive individuals.

Regulation of catecholamine release and tyrosine hydroxylase in human adrenal chromaffin cells by interleukin-1beta: role of neuropeptide Y and nitric oxide.

Adrenal chromaffin cells synthesize and secrete catecholamines and neuropeptides that may regulate hormonal and paracrine signaling in stress and also during inflammation. The aim of our work was to study the role of the cytokine interleukin-1beta (IL-1beta) on catecholamine release and synthesis from primary cell cultures of human adrenal chromaffin cells. The effect of IL-1beta on neuropeptide Y (NPY) release and the intracellular pathways involved in catecholamine release evoked by IL-1beta and NPY were also investigated. We observed that IL-1beta increases the release of NPY, norepinephrine (NE), and epinephrine (EP) from human chromaffin cells. Moreover, the immunoneutralization of released NPY inhibits catecholamine release evoked by IL-1beta. Moreover, IL-1beta regulates catecholamine synthesis as the inhibition of tyrosine hydroxylase decreases IL-1beta-evoked catecholamine release and the cytokine induces tyrosine hydroxylase Ser40 phosphorylation. Moreover, IL-1beta induces catecholamine release by a mitogen-activated protein kinase (MAPK)-dependent mechanism, and by nitric oxide synthase activation. Furthermore, MAPK, protein kinase C (PKC), protein kinase A (PKA), and nitric oxide (NO) production are involved in catecholamine release evoked by NPY. Using human chromaffin cells, our data suggest that IL-1beta, NPY, and nitric oxide (NO) may contribute to a regulatory loop between the immune and the adrenal systems, and this is relevant in pathological conditions such as infection, trauma, stress, or in hypertension.

The changing relationship between tax and financial reporting in Spain

The degree of connection between tax and financial reporting is regarded as a key factor in the study of international accounting differences. The position for Spain is briefly outlined in previous research but without examination of any specific accounting issues except, in outline only, depreciation and the tax-free revaluation of assets from 1977 to 1983. The absence of a detailed study of the major tax/accounting linkages for Spain is of particular importance because the relationship is regarded as having changed dramatically in the early 1990s, from a position of tax dominance. In order to measure the links between tax and financial reporting, we adopt the methodology of Lamb et al. (1998) by assessing major accounting topics using a five-case classification shown as Table 1. We refute the proposition that suggests that the link between tax/accounting has been reduced substantially.

Reporting intellectual capital in Spain

This study reports on the analysis of annual reports from 14- listed companies in Spainover a five-year period, from 1998 to 2002. Companies in the sample are selected on thebasis of their knowledge-based assets and incentives to report on Intellectual Capital.The empirical analysis is twofold:1) Firstly, we analyse the value of intellectual capital using a value-based approach,through the difference between market and book value over the period considered. Results show that there is a general decrease in the 'hidden value' of these companies, probably due to the general trend in stock markets.2) Secondly, we carry out a content-based analysis of the complete annual reports of the companies over the five year period. Preliminary findings seem to suggest that although the level of disclosure has increased over time, this is mainly in the form of narrative. Overall, the level of disclosure of intellectual capital remains low.

Spanish auditors and the 'true and fair view'

In 1990 a new Spanish 'Plan General de Contabilidad' (PGC) implementedthe requirements of the EU 4th and 7th Directives in Spain. Included in the PGC is the requirement, derived from the 4th Directive, that accounts should present a 'true and fair view', in Spanish 'imagen fiel'. Where the term has been used in English speaking jurisdictions it has proved to have a variety of shades of meaning, and to have had strikingly different impact in different countries. Within the European Union the term has been seen as a 'Trojan horse', inserted into the 4th Directive to inject an Anglo-Saxon approach of flexibility and judgement dependent accounting into a Continental European accounting tradition of detailed prescription and uniformity. In this paper we report on a survey of the views and experience of Spanish auditors relating to 'imagen fiel'. Specifically, we:1) Review the English language literature on 'true and fair view' to identify the key areas of controversy.2) Consider the significance of the 'true and fair view' within the EU 4th Directive.3) Report on the experience of Spanish auditors in working with this concept, their views on the value of the term, and their experience in use of the true and fair view 'override'.

Teaching, research and service: Experience and opinions of accounting Spanish academics

Research, teaching and service are the main activities carried out in almost all European universities. Previous research, which has been mainlycentred in North-American universities, has found solid results indicatingthat research and teaching are not equally valued when deciding on facultypromotion. This conclusion creates a potential conflict for accountingacademics on how to distribute working time in order to accomplish personalcareer objectives. This paper presents the results of a survey realisedin two European countries: Spain and the United Kingdom, which intendedto explore the opinions and personal experience of accounting academicsworking in these countries. Specifically, we focus on the following issues:(i) The impact of teaching and service on time available for research;(ii) The integration of teaching and research; (iii) The perceived valueof teaching and research for career success and (iv) The interaction betweenprofessional accounting and accounting research. The results show thatboth in Spain and in the United Kingdom there is a conflict between teachingand research, which has its origin in the importance attached to researchactivities on promotion decisions. It also seems evident that so far, theconflict is being solved in favour of research in prejudice of teaching.

A portrait of the Spanish accounting community

This study presents a portrait of the Spanish academic accountingcommunity in 1995, based upon a questionnaire circulated to Spanishaccounting academics in 1995 and upon an analysis of authorship andcitations in the main Spanish accounting journals. The approach tothese analyses is grounded in similar studies which have been carriedout in the United States, Spain and elsewhere. but the combination oftechniques used in this study is particularly broad in range.The results of the study are used to describe a range ofcharacteristics of Spanish accounting academics, for example,publications records and length of academic experience. The analysisof publications produces a ranking by institutional affiliation ofthe most significant contributors to current debates on accounting.Citation analysis is used to identify the range and extent ofinternational influences upon the Spanish academic accountingcommunity, and to provide an additional ranking by institutionalaffiliation of the most frequently cited sources A significantfinding was that the nature and extent of international influence hadchanged very little over the ten year period since Spain entered theEuropean Union and started to implement European Directives.Perceptions of journal quality were elicited by questionnaire. Fortyfive journals, Spanish and international are included in a listranked for perceived importance as outlets for publication. and assources of support for teaching and research. The results of thisexercise show that Spanish journals were ranked low relative tojournals published in the United Kingdom and United States.Finally the study examines the extent of purpose upon Spanishaccounting academies to publish, by presenting results of a questionabout criteria for promotion, and also by examining and increasingtendency to publish co-authored work.

Measuring intangibles' productivity. Empirical evidence from Spanish firms

As companies and shareholders begin to note the potential repercussions of intangible assets uponbusiness results, the inability of the traditional financial statement model to reflect these new waysof creating business value has become evident. Companies have widely adopted newmanagement tools, covering in this way the inability of the traditional financial statement model toreflect these new ways of creating business value.However, there are few prior studies measuring on a quantifiable manner the level of productivityunexplained in the financial statements. In this study, we measure the effect of intangible assets onproductivity using data from Spanish firms selected randomly by size and sector over a ten-yearperiod, from 1995 to 2004. Through a sample of more than 10,000 Spanish firms we analyse towhat extent labour productivity can be explained by physical capital deepening, by quantifiedintangible capital deepening and by firm s economic efficiency (or total factor productivity PTF).Our results confirm the hypothesis that PTF weigh has increased during the period studied,especially on those firms that have experienced a significant raise in quantified intangible capital,evidencing that there are some important complementary effects between capital investment andintangible resources in the explanation of productivity growth. These results have significantdifferences considering economic sector and firm s dimension.

The case for a new accounting research agenda in Spain

In Spain both accounting practice and accounting research have been strongly influenced by accounting practices developed in the Englishspeaking world. This paper:1) Summarizes a seminal English paper, the 'Corporate Report', that identified the potential for accounting reports to serve a wide range of users.2) Identifies the ways in which English language accounting conceptual frameworks have paid lip service to a range of user needs, but in practice have excluded users other than investors and creditors.3) Argues that for Spain the ideas put forward in the Corporate Report have a particular relevance, and might usefully form the basis for a new research agenda.

Variations in national management accounting approaches

During the 1990's studies of management accounting practices in Europe and in Latin America have given us data on 23 countries. In this paper we use this data to identify five distinct aspects of national management accounting culture being:1. The influence of regulations on official recommendations;2. The source of management accountants;3. Influence from one country to another;4. Variations in use of specific techniques;5. Variations in the objectives of the management accounting system.We then identify seven significant implications of the manager operating in the multinational environment.

The struggle against creative accounting: Is "true and fair view" part of the problem or part of the solution?

Creative accounting is a growing issue of interest in Spain. In this article we argue that the concept true and fair view can limit or promote the use of creative accounting depending upon its interpretation. We review the range of meanings that true and fair view can take at an international level and compare the experience of the United Kingdom with the Australian one by analysing the use of true and fair view to limit creative accounting. Finally, we suggest lines of action to be considered by the Spanish accounting standards-setting institutions.