The use of cusum analysis in the early detection and management of hospital bed occupancy crises

Objective: To assess the value of cusum analysis in hospital bed management. Design: Comparative analysis of medical patient flows, bed occupancy, and emergency department admission rates and access block over 2 years. Setting: Internal Medicine Services and Emergency Department in a teaching hospital. Interventions: Improvements in bed use and changes in the level of available beds. Main outcome measures: Average length of stay; percentage occupancy of available beds; number of patients waiting more than 8 hours for admission (access block); number of medical patients occupying beds in non-medical wards; and number of elective surgical admissions. Results: Cusum analysis provided a simple means of revealing important trends in patient flows that were not obvious in conventional time-series data. This prompted improvements in bed use that resulted in a decrease of 9500 occupied bed-days over a year. Unfortunately and unexpectedly, after some initial improvement, the levels of access block, medical ward congestion and elective surgical admissions all then deteriorated significantly. This was probably caused by excessive bed closures in response to the initial improvement in bed use. Conclusion: Cusum analysis is a useful technique for the early detection of significant changes in patient flows and bed use, and in determining the appropriate number of beds required for a given rate of patient flow.

Effects of the herbicide diuron on the early life history stages of coral

The effects of the herbicide diuron on the early life history stages of broadcast spawning and brooding corals were examined in laboratory experiments. Fertilisation of Acropora millepora and Montipora aequituberculata oocytes were not inhibited at diuron concentrations of up to 1000 mu gl(-1). Metamorphosis of symbiont-free A. millepora larvae was only significantly inhibited at 300 mu gl(-1) diuron. Pocillopora damicornis larvae, which contain symbiotic dinoflagellates, were able to undergo metamorphosis after 24h exposure to diuron at 1000 mu gl(-1). Two-week old P. damicornis recruits on the other hand were as susceptible to diuron as adult colonies, with expulsion of symbiotic dinoflagellates (bleaching) evident at 10 mu gl(-1) diuron after 96 h exposure. Reversible metamorphosis was observed at high diuron concentrations, with fully bleached polyps escaping from their skeletons. Pulse amplitude modulation (PAM) chlorophyll fluorescence techniques demonstrated a reduction in photosynthetic efficiency (Delta F/F'(m)) in illuminated P. dami- cornis recruits after a 2h exposure to 1 mu gl(-1) diuron. The dark-adapted quantum yields (F-v/F-m also declined, indicating chronic photoinhibition and damage to photosystem H. Crown Copyright (c) 2004 Published by Elsevier Ltd. All rights reserved.

An educational workshop on the early detection of prostate cancer

The authors have developed an education program for GPs to facilitate informed choice about PSA testing.

Volcanic resurfacing and the early terrestrial crust: Zircon U-Pb and REE constraints from the Isua Greenstone Belt, southern West Greenland

The oldest known bona fide succession of elastic metasediments Occurs in the Isua Greenstone Belt. SW Greenland and consists of a variety of mica schists and rare metaconglomerates. The metasediments are in direct contact with a felsic metavolcanic lithology that has previously been dated to 3.71 Ga. Based on trace element geochemical data for 30 metasediments, we selected the six samples with highest Zr concentrations for zircon extraction. These samples all yielded very few or no zircon, Those extracted from mica schists yielded ion probe U/Pb ages between 3.70 and 3,71 Ga. One metaconglomerate sample yielded just a single zircon of 3.74 Ga age. The mica schist hosted zircons have U/Pb ages. Th/U ratios, REE patterns and Eu anomalies indistinguishable from zircon in the adjacent 3.71 Ga felsic metavolcanic unit. Trace element modelling requires the bulk of material in the metasediments to be derived from variably weathered mafic lithologies but some metasediments contain substantial contribution from more evolved source lithologies. The paucity of zircon in the mica schists is thus explained by incorporation of material from largely zircon-free volcanic lithologies. The absence of older zircon in the mica schists and the preponderance of mafic source material imply intense, mainly basaltic resurfacing of the early Earth. The implications of this process are discussed, Thermal considerations suggest that horizontal growth of Hadean crust by addition of mafic ultramafic lavas must have triggered self-reorganisation of the protocrust by remelting. Reworking oft Hadean crust may have been aided by burial of hydrated (weathered) metabasalt due to semi-continuous addition of new voluminous basalt Outpouring,;, This process Causes a bias towards eruption of Zr-saturated partial melts at the surface with O-isotope corn posit ion,, potentially different from the mantle. The oldest zircons hosted in sediments would have been buried to substantial depth or formed in plutons that crystallised at some depth from which it took hundreds of millions of years for them to be exhumed and incorporated into much younger sediments. (C) 2005 Elsevier B.V.All rights reserved.

Integrated Pb- and S-isotope investigation of sulphide minerals from the early Archaean of southwest Greenland

We present high-spatial resolution secondary ion mass spectrometry (SIMS) measurements of Pb and S isotopes in sulphides from early Archaean samples at two localities in southwest Greenland. Secondary pyrite from a 3.71 Ga sample of magnetite-quartz banded iron formation in the Isua Greenstone Belt, which has previously yielded unradiogenic Pb consistent with its ancient origin, contains sulphur with a mass independently fractionated (MIF) isotope signature (Delta(33)S =+3.3 parts per thousand). This reflects the secondary mineralization of remobilized sedimentary S carrying a component modified by photochemical reactions in the early Archaean atmosphere. It further represents one of the most extreme positive excursions so far known from the early Archaean rock record. Sulphides from a quartz-pyroxene rock and an ultramafic boudin from the island of Akilia, in the Godth (a) over circle bsfjord, have heterogeneous and generally radiogenic Pb isotopic compositions that we interpret to represent partial re-equilibration of Pb between the sulphides and whole rocks during tectonothermal events at 3.6, 2.7 and 1.6 Ga. Both these samples have Delta(33)S=0 (within analytical error) and therefore show no evidence for MIF sulphur. These data are consistent with previous interpretations that the rock cannot be proven to have a sedimentary origin. Our study illustrates that SIMS S-isotope measurements in ancient rocks can be used to elucidate early atmospheric parameters because of the ability to obtain combined S and Pb-isotope data, but caution must be applied when using such data to infer protolith. When information from geological context, petrography and chronology (i.e. by Pb isotopes) is combined and fully evaluated, Delta(33)S signatures from sulphides and their geological significance can be interpreted with a higher degree of confidence. (c) 2005 Elsevier B.V All rights reserved.

Direct seeding to restore rainforest species: Microsite effects on the early establishment and growth of rainforest tree seedlings on degraded land in the wet tropics of Australia

Reforestation in tropical areas is usually attempted by planting seedlings but, direct seeding (the artificial addition or sowing of seed) may be an alternative way of accelerating forest recovery and successional processes. This study investigated the effects of various sowing treatments (designed to create different microsite conditions for seed germination) and seed sizes on the early establishment and growth of directly sown rainforest tree species in a variety of experimental plots at three sites in the wet tropical region of north-cast Queensland, Australia. The different sowing treatments were found to have significant effects on seedling establishment. Broadcast sowing treatments were ineffective and resulted in very poor seedling establishment and high seed wastage. Higher establishment rates occurred when seeds were buried. Seed size was found to be an important factor affecting establishment in relation to micro-site condition. In general, larger seeded species had higher establishment rates at all three sites than species of small and intermediate seed size, but only in sowing treatments where seeds were buried. Overall these results suggest that direct sowing of seed can be used as a too] to accelerate recolonisation of certain rainforest tree species on degraded tropical lands, but initial success will be dependent on the choice of sowing method and its suitability for the seed types selected. The results also indicate that the recruitment of naturally dispersed tree species at degraded sites is likely to be severely limited by the availability of suitable microsites for seed germination. Consequently the natural recovery of degraded sites via seed rain can be expected to be slow and unpredictable, particularly in areas where soil compaction has occurred. (c) 2006 Elsevier B.V. All rights reserved.

Need for systematic synthetic phonics teaching within the early reading curriculum

Both the New Zealand Ministry of Education's Literacy Experts Group and the Australian National Inquiry into the Teaching of Literacy have recently acknowledged the centrality of systematic instruction in synthetic phonics to early reading instruction, but this conclusion remains contentious in some circles. This paper briefly summarises empirical research in basic psychology and evidence-based evaluation studies supporting the inclusion of systematic synthetic phonics instruction within the early reading curriculum, allowing practising psychologists to develop an informed opinion on this issue.

The imaging of Samoa in illustrated magazines and serial encyclopedias in the early 20th-century

Drawing on English language sources and material relating to the colonial administrations of Western Samoa (now Samoa) and American Samoa, this examination of photographically illustrated serial encyclopaedias and magazines proposes an alternative historical analysis of the colonial imaging of Samoa, the most extensively covered field in Oceanic photographic studies. Though photographs published between 1890s and World War II were often 'recycled', without acknowledging the fact that they were taken much earlier, and despite claims in the text of illustrated publications of an unchanged, enduring, archaic tradition in Samoa, the amazing variety of photographic content often offered contradictory evidence, depicting a modern, adaptive and progressive Samoa. Contrary to orthodox historical analysis, the images of Samoa in illustrated magazines and encyclopaedias were not limited to a small repetitive gallery of partially clothed women and costumed chiefs; and the ways in which readers understood Samoa from photographs and text raises questions still to be explored.

Impact of mycophenolate mofetil loading on drug exposure in the early posttransplant period

Achieving adequate therapeutic levels of immunosuppressive medications is important in rejection prevention. This study examined exposure to mycophenolic acid (MPA) in kidney transplant patients within the first 5 days posttransplantation. Methods. This single-center, nonrandomized study of first solitary kidney allograft recipients receiving cyclosporine (n = 116) or tacrolimus (n = 50) included patients who received either 1 g or 1.5 g of mycophenolate mofetil twice daily starting postoperatively. Exposure to MPA was measured at days 3 and 5 posttransplant using published limited sampling time equations. Results. There were no significant differences in exposure in the cyclosporine-treated patients receiving 3-g (n = 22) compared to 2-g (n = 94) daily doses (AUC([0-12]) 33.8 +/- 10.0 mg*h/L versus 30.1 +/- 9.7 mg*h/L, P =.20, respectively). About half the patients in both groups had AUC([0-12]) < 30 mg*h/L on days 3 and 5 posttransplant. On the other hand, there was significantly greater exposure on day 3 in the tacrolimus-treated patients receiving 3 g (n = 21) compared to 2 g (n = 29) daily (AUC([0-12]) 43.1 +/- 9.0 mg*h/L versus 36.8 +/- 11.1 mg*h/L, P =.016, respectively). On day 3 one (4.8%) patient receiving 3 g had an AUC([0-12]) of < 30 mg*h/L; whereas, eight (27.5%) receiving 2 g were below this level (P =.068). The AUC([0-12]) levels were not different on day 5. Conclusions. Loading with higher doses of mycophenolate mofetil results in greater exposure and a trend toward more patients in the therapeutic window within the first week for tacrolimus- but not for cyclosporine-treated patients.

I-Spi: innovative shared practical ideas: a support guide for literacy and numeracy in the early years of schooling, for home tutor/supervisors in distance education

Innovative Shared Practical Ideas (I-Spi) is a guide to help you and your children learn together. It is designed to affirm, support and strengthen your role as home tutor/supervisors in your daily learning sessions with your children. In this guide particular emphasis is given to the value of talk, formal and informal early literacy and numeracy practices (including ideas from distance school lessons, from home tutor/supervisors, research, and beyond), assessment of these practices together with informal assessment ideas for gauging your children’s literacy and numeracy progress, and stepping in and building on strategies