A systematic review of triage-related interventions to improve patient flow in emergency departments

Background Overcrowding in emergency departments is a worldwide problem. A systematic literature review was undertaken to scientifically explore which interventions improve patient flow in emergency departments. Methods A systematic literature search for flow processes in emergency departments was followed by assessment of relevance and methodological quality of each individual study fulfilling the inclusion criteria. Studies were excluded if they did not present data on waiting time, length of stay, patients leaving the emergency department without being seen or other flow parameters based on a nonselected material of patients. Only studies with a control group, either in a randomized controlled trial or in an observational study with historical controls, were included. For each intervention, the level of scientific evidence was rated according to the GRADE system, launched by a WHO-supported working group. Results The interventions were grouped into streaming, fast track, team triage, point-of-care testing (performing laboratory analysis in the emergency department), and nurse-requested x-ray. Thirty-three studies, including over 800,000 patients in total, were included. Scientific evidence on the effect of fast track on waiting time, length of stay, and left without being seen was moderately strong. The effect of team triage on left without being seen was relatively strong, but the evidence for all other interventions was limited or insufficient. Conclusions Introducing fast track for patients with less severe symptoms results in shorter waiting time, shorter length of stay, and fewer patients leaving without being seen. Team triage, with a physician in the team, will probably result in shorter waiting time and shorter length of stay and most likely in fewer patients leaving without being seen. There is only limited scientific evidence that streaming of patients into different tracks, performing laboratory analysis in the emergency department or having nurses to request certain x-rays results in shorter waiting time and length of stay.

Övervakning och pulsad laddning av bly-syra batterier

Arvika som en följd av samtal kring möjligheten att anpassa deras strömpulsbaserade rekonditioneringssystem, utvecklat för större truckbatterier, till att kunna återvinna förlorad kapacitet även i mindre batterier. Idén grundar sig bland annat i att åldring av batterier ofta är en primär begränsning för funktionen hos fristående solcellssystem. Studien, som till stor del är en sammanställning av vetenskapliga artiklar, syftar till att bidra med bättre grundläggande förståelse för hur pulsad laddning verkar på bly-syra batterier och deras elektrokemi. I synnerhet har grundläggande skillnader mellan större öppna batterier och mindre slutna batterier pekats ut, och ett antal parametrar som bestämmer pulsprocessens verkan identifierarats; frekvens, pulsspänning och laddningsgrad. Förhoppningen är att den mer teoretiska sammanställningen i förlängningen skall kunna bidra till att de företag i regionen som arbetar med denna teknik kan optimera funktionen i sina produkter. För att kunna säkra funktionen hos ett batteri så måste man kunna bedöma batteriets hälsotillstånd, och identifiera degradering på ett relativt tidigt stadium. En andra del av förstudien berör därför möjliga tillvägagångsätt att via mätningar på batteriets två poler kunna bestämma dess hälsotillstånd – och framförallt peka på de begränsningar dessa metoder har. Syftet är att bidra med grunden till en eventuell utveckling av ett enkelt batteriövervakningssystem som skall kunna ge användaren en tydlig och tidig signal om att det är dags för service. Sannolikt krävs det att man mäter en kombination av flertalet parametrar för att kunna åstadkomma detta, och i synnerhet blir förutsättningarna bättre om parametrar kan loggas över tid. Sammanfattningsvis diskuteras i mer övergripande och spekulativa ordalag den utmaning som den brokiga samling mindre batteri i många utvecklingsländer innebär. För att trygga funktionen behöver en organisation för batteriservice med kunniga tekniker byggas upp tillsammans med tekniska produkter för exempelvis övervakning.

The Movement of the Gastrop Littorina Littorea in the Intertidal Zone during the Onset of Winter

The movement of the snail Littorina littoreaon the North Atlantic coast is poorly understood. Most research has concentrated on the vertical distribution of the snail, and suggests that it prefers the low intertidal zone where its food source is most plentiful. In the winter, this distribution is reinforced by a documented seaward migration of snails from the high intertidal zone in response to falling temperatures. From October 14, 2006 to January 22, 2007, I examined the individual movements and recovery of snails in response to the onset of winter. I proposed that falling water and air temperatures drive the majority of snail movement within the intertidal zone, and that water temperature had the greater effect. I also examined the possibility that, in addition to a seaward migration, winter weather patterns in the Gulf of Maine and their effect on the ocean may encourage the wintertime vertical distribution of snails. Finally, I examined the possibility that populations of snails in the comparatively inhospitable high intertidal zone may endure the winter if given access to proper resources.

Verdi's Settings of Shakespeare : from Play to Liberetto to Opera

As a Senior Scholar pursuing the topic, Verdi's Settings of Shakespeare: From Play to Libretto to Opera, I have endeavoured to study a project relevant to my majors, Music and English. During first semester, I carefully analysed Shakespeare's plays, Macbeth, Othello and Falstaff. The highlight of my project was in January when I travelled to New York City and spent the day working with the Metropolitan Opera Guild. I was also able to see a performance of Verdi's Othello with Jon Vickers in the lead role. During the second semester, I studied the musical aspects of the compositions. I spent time analysing musical passages and relating them to the plays and the operas. I was also able to continue my study of Italian, which I find extremely beneficial while studying Verdi's libretti. On Monday, 13th May, 1974, I gave a lecture presentation of my project. At this time, I showed slides of Metropolitan productions of the operas, presented my own rendition of five arias (in costume) and talked about comparisions between the plays and the operas. I applied for a Rotary Fellowship to take my project to Europe and am presently waiting to hear the results. If I do receive the fellowship, I am planning to spend a year studying the plays and operas in England and Italy. Afterwards, I hope to publish a paper explaining my findings. The paper is divided into six sections. The first section is an introduction which explains the period of Romanticism and its relationship to Shakespeare and Verdi. The second section is devoted to discussing the librettist for Macbeth, Francesco Piave. Following this section the opera Macbeth is discussed. Arrigo Boito, the librettist for Otello and Falstaff is discussed in the fourth section. The last two sections deal with Otello and Falstaff. I have also included a number of musical selections to better explain certain passages. My project has been invaluable to me. My Senior Scholar project has allowed me the freedom of independent study as well as a means of tying my majors together.