Effect of clinician designation on emergency department fast track performance

Objective To examine the effect of clinician designation on emergency department (ED) fast track performance.
Design and Setting A retrospective audit of patients managed in the fast track area of an ED in metropolitan Melbourne, Australia.
Participants Patients triaged to ED fast track from 1 January 2008 to 31 December 2008 (n=8714).
Main Outcome Measures Waiting times in relation to Australasian triage scale (ATS) recommendations and ED length of stay (LOS) for non-admitted patients were examined for each clinician group.
Results Compliance with ATS waiting time recommendations was highest (82.5%) for emergency nurse practitioners/candidates and lowest (48.2%) for junior medical officers. Median ED LOS was less than 3 h for non-admitted patients, and 85.8% of non-admitted fast track patients (n=6278) left the ED within 4 h. Patients managed by emergency nurse practitioners/ candidates had the shortest ED LOS (median 1.7 h) and patients managed by junior medical officers and locum medical officers the longest ED LOS (median 2.7 h) (x²=498.539, df=6, p<0.001).
Conclusions Clinician designation does impact on waiting times and, to a lesser extent, ED LOS for patients managed in ED fast track systems. Future research should focus on obtaining a better understanding of the relationship between clinician expertise, time-based performance measures and quality of care indicators.

The elimination race in track cycling : patterns and predictors of performance

The track cycling Omnium is a multi-event competition that has recently been expanded to include the Elimination Race (ER), which presents a unique set of physical and tactical demands. The purpose of this research was to characterise the performance attributes of successful and unsuccessful cyclists in the ER, that are also predictive of performance. Video recordings of four international level ERs were analysed. The performance attributes measured related to the cyclists’ velocity and two dimensional position in the peloton. The average velocity of the peloton up to lap 30 (of 50) was relatively high and consistent (52.2±1.5 km/h). After lap 30, there was a significant (p<0.001) change in velocity (49.9±2.4 km/h), characterised by more fluctuations in lap-to-lap velocity. Successful ER cyclists adopted a tactic of remaining in the middle of the peloton, in the lower lanes of the velodrome, thus avoiding the risk of elimination at the rear and the extra effort required to remain on the front of the peloton. Unsuccessful cyclists tended to reside in the rear and upper (higher) portions of the peloton, risking elimination more often and having to ride faster than those in the lower lanes of the velodrome. The physiological demands of the Elimination Race that are determined by velocity, vary throughout the Elimination Race and the pattern of movement within the peloton is different for successful and unsuccessful cyclists. The findings of the present study may confirm some aspects of race tactics that are currently thought to be optimal, but they also reveal novel information that is useful to coaches and cyclists who compete in the Elimination Race.

Evaluation of race distance, track surface and season of the year on exercise-induced pulmonary haemorrhage in flat racing Thoroughbreds in Brazil

Reasons for performing study: To our knowledge no studies evaluating risk factors to EIPH have been undertaken with such a population of horses in Brazil, which is one of the few countries in the racing community to accept the use of frusemide (FUR) as a prerace medication for bleeders. We also compared national results with those already in the literature. Objectives: To verify the influence of variables such as distance of the race, racetrack surface, going and season of the year in the recurrence and severity of EIPH and its effect on the finishing position of flat racing Thoroughbreds in Brazil. Methods: 2118 post race respiratory endoscopies were recorded, in a total of 1003 individual horses. All horses in the study were certified bleeders (deemed positive by registered veterinarians following one or more endoscopies) and were administered FUR prior to each race. Data was analysed using both ordinary logistic regression and multiple logistic regression. Results: The results suggest that race distance, season of the year and racetrack surface affect the recurrence of EIPH. Also, despite the use of FUR, the majority (62%) of horses continued to display some degree of haemorrhage. Conclusions: There was a tendency for horses that remained positive despite the use of FUR to finish unplaced in a race. Horses which had a significant reduction in bleeding and became HPIE negative after the use of FUR, tended to finish in top positions. It was not possible to determine a pattern of severity of EIPH in horses with more than one endoscopy. Further studies are required to improve our understanding of this syndrome and its correlations to performance in the racing Thoroughbred, together with the role of FUR and its possible enhancing performance effects and efficacy in consistently diminishing EIPH. Potential relevance: This study enabled a better understanding of the use of FUR in Brazilian Thoroughbred racehorses and showed there was a tendency towards improvement in performance after administrion of FUR in bleeders. The fact that a large number of horses remained positive for EIPH despite the use of FUR should encourage the scientific community to search for better ways of reducing, or preventing, this syndrome. © 2006 EVJ Ltd.

Assessment of current U.S. Department of Transportation fire safety efforts.

Urban Mass Transportation Administration, Washington, D.C.

Effectiveness of fire control agents on chemical fires : phase I, test methodology and baseline hexane tests : final report ; prepared for U.S. Department of Transportation, United States Coast Guard, Office of Research and Development.

"Report no. CG-D-50-80."

Complete army and navy register of the United States of America, from 1776 to 1887 : containing the names of all officers of the army and navy ; together with the volunteer general staff, during the war with Mexico, and a register of all appointments by the President in the volunteer service during the rebellion ; also, a military history of the Department of War and of each staff department of the army /

Mode of access: Internet.

The Michigan forest fire experiment station: what it is and what it is doing. Division of field administration, Michigan Department of conservation and Lake states forest experiment station, Forest service, United States Department of agriculture cooperating. 1932.

Mode of access: Internet.

Report of the Department of state fire marshall of the Commonwealth of Pennsylvania for the year ... 1913-1917.

At head of title: Commonwealth of Pennsylvania.

Annual report of the Department of State Fire Marshal.

Mode of access: Internet.

Ralph Craig, UM track, start of 100-meter race at 1912 Olympic Games

[Craig winning 2nd from right]

Ralph Craig, UM track, just after start of 100-meter race at 1912 Olympic Games

[Craig winning 2nd from right]

Carrol Haff, UM track, finish of 400-meter race at 1912 Olympic Games

[Haff, in lane 4, finished fifth, gold medal won by C.D. Reidpath of U.S.]