Associations of Emergency Department Length of Stay With Publicly Reported Quality-of-care Measures.

OBJECTIVE: The Institute of Medicine identified emergency department (ED) crowding as a critical threat to patient safety. We assess the association between changes in publicly reported ED length of stay (LOS) and changes in quality-of-care measures in a national cohort of hospitals. METHODS: Longitudinal analysis of 2012 and 2013 data from the American Hospital Association (AHA) Survey, Center for Medicare and Medicaid Services (CMS) Cost Reports, and CMS Hospital Compare. We included hospitals reporting Hospital Compare timeliness measure of LOS for admitted patients. We used AHA and CMS data to incorporate hospital predictors of interest. We used the method of first differences to test for relationships in the change over time between timeliness measures and six hospital-level measures. RESULTS: The cohort consisted of 2,619 hospitals. Each additional hour of ED LOS was associated with a 0.7% decrease in proportion of patients giving a top satisfaction rating, a 0.7% decrease in proportion of patients who would definitely recommend the hospital, and a 6-minute increase in time to pain management for long bone fracture (p \u3c 0.01 for all). A 1-hour increase in ED LOS is associated with a 44% increase in the odds of having an increase in left without being seen (95% confidence interval = 25% to 68%). ED LOS was not associated with hospital readmissions (p = 0.14) or time to percutaneous coronary intervention (p = 0.14). CONCLUSION: In this longitudinal study of hospitals across the United States, improvements in ED timeliness measures are associated with improvements in the patient experience

Positron emission tomography imaging of endometrial cancer using engineered anti-EMP2 antibody fragments.

PurposeAs imaging of the cell surface tetraspan protein epithelial membrane protein-2 (EMP2) expression in malignant tumors may provide important prognostic and predictive diagnostic information, the goal of this study is to determine if antibody fragments to EMP2 may be useful for imaging EMP2 positive tumors.ProceduresThe normal tissue distribution of EMP2 protein expression was evaluated by immunohistochemistry and found to be discretely expressed in both mouse and human tissues. To detect EMP2 in tumors, a recombinant human anti-EMP2 minibody (scFv-hinge-C(H)3 dimer; 80 kDa) was designed to recognize a common epitope in mice and humans and characterized. In human tumor cell lines, the antibody binding induced EMP2 internalization and degradation, prompting the need for a residualizing imaging strategy. Following conjugation to DOTA (1,4,7,10-tetraazacyclododecane-N,N',N',N'″-tetraacetic acid), the minibody was radiolabeled with (64)Cu (t (1/2) = 12.7 h) and evaluated in mice as a positron emission tomography (PET) imaging agent for human EMP2-expressing endometrial tumor xenografts.ResultsThe residualizing agent, (64)Cu-DOTA anti-EMP2 minibody, achieved high uptake in endometrial cancer xenografts overexpressing EMP2 (10.2 ± 2.6, percent injected dose per gram (%ID/g) ± SD) with moderate uptake in wild-type HEC1A tumors (6.0 ± 0.1). In both cases, precise tumor delineation was observed from the PET images. In contrast, low uptake was observed with anti-EMP2 minibodies in EMP2-negative tumors (1.9 ± 0.5).ConclusionsThis new immune-PET agent may be useful for preclinical assessment of anti-EMP2 targeting in vivo. It may also have value for imaging of tumor localization and therapeutic response in patients with EMP2-positive malignancies

Automatic Reconstruction of Neural Morphologies with Multi-Scale Tracking

Neurons have complex axonal and dendritic morphologies that are the structural building blocks of neural circuits. The traditional method to capture these morphological structures using manual reconstructions is time-consuming and partly subjective, so it appears important to develop automatic or semi-automatic methods to reconstruct neurons. Here we introduce a fast algorithm for tracking neural morphologies in 3D with simultaneous detection of branching processes. The method is based on existing tracking procedures, adding the machine vision technique of multi-scaling. Starting from a seed point, our algorithm tracks axonal or dendritic arbors within a sphere of a variable radius, then moves the sphere center to the point on its surface with the shortest Dijkstra path, detects branching points on the surface of the sphere, scales it until branches are well separated and then continues tracking each branch. We evaluate the performance of our algorithm on preprocessed data stacks obtained by manual reconstructions of neural cells, corrupted with different levels of artificial noise, and unprocessed data sets, achieving 90% precision and 81% recall in branch detection. We also discuss limitations of our method, such as reconstructing highly overlapping neural processes, and suggest possible improvements. Multi-scaling techniques, well suited to detect branching structures, appear a promising strategy for automatic neuronal reconstructions

A Mild, Palladium-Catalyzed Method for the Dehydrohalogenation of Alkyl Bromides: Synthetic and Mechanistic Studies

We have exploited a typically undesired elementary step in cross-coupling reactions, β-hydride elimination, to accomplish palladium-catalyzed dehydrohalogenations of alkyl bromides to form terminal olefins. We have applied this method, which proceeds in excellent yield at room temperature in the presence of a variety of functional groups, to a formal total synthesis of (R)-mevalonolactone. Our mechanistic studies have established that the rate-determining step can vary with the structure of the alkyl bromide and, most significantly, that L_2PdHBr (L = phosphine), an intermediate that is often invoked in palladium-catalyzed processes such as the Heck reaction, is not an intermediate in the active catalytic cycle

Intelligent Metasurfaces with Continuously Tunable Local Surface Impedance for Multiple Reconfigurable Functions

Electromagnetic metasurfaces can be characterized as intelligent if they are able to perform multiple tunable functions, with the desired response being controlled by a computer influencing the individual electromagnetic properties of each metasurface inclusion. In this paper, we present an example of an intelligent metasurface which operates in the reflection mode in the microwave frequency range. We numerically show that without changing the main body of the metasurface we can achieve tunable perfect absorption and tunable anomalous reflection. The tunability features can be implemented using mixed-signal integrated circuits (ICs), which can independently vary both the resistance and reactance, offering complete local control over the complex surface impedance. The ICs are embedded in the unit cells by connecting two metal patches over a thin grounded substrate and the reflection property of the intelligent metasurface can be readily controlled by a computer. Our intelligent metasurface can have significant influence on future space-time modulated metasurfaces and a multitude of applications, such as beam steering, energy harvesting, and communications.Comment: 10 pages, 8 figure

Phytopathogen type III effector weaponry and their plant targets

Phytopathogenic bacteria suppress plant innate immunity and promote pathogenesis by injecting proteins called type III effectors into plant cells using a type III protein secretion system. These type III effectors use at least three major strategies to alter host responses. One strategy is to alter host protein turnover, either by direct cleavage or by modulating ubiquitination and targeting to the 26S proteasome. Another strategy involves alteration of RNA metabolism by transcriptional activation or ADP-ribosylation of RNA-binding proteins. A third major strategy is to inhibit the kinases involved in plant defence signalling, either by removing phosphates or by direct inhibition. The wide array of strategies bacterial pathogens employ to suppress innate immunity suggest that circumvention of innate immunity is critical for bacterial pathogenicity of plants

Phytopathogen type III effector weaponry and their plant targets

Phytopathogenic bacteria suppress plant innate immunity and promote pathogenesis by injecting proteins called type III effectors into plant cells using a type III protein secretion system. These type III effectors use at least three major strategies to alter host responses. One strategy is to alter host protein turnover, either by direct cleavage or by modulating ubiquitination and targeting to the 26S proteasome. Another strategy involves alteration of RNA metabolism by transcriptional activation or ADP-ribosylation of RNA-binding proteins. A third major strategy is to inhibit the kinases involved in plant defence signalling, either by removing phosphates or by direct inhibition. The wide array of strategies bacterial pathogens employ to suppress innate immunity suggest that circumvention of innate immunity is critical for bacterial pathogenicity of plants

Uncertainty Updating in the Description of Coupled Heat and Moisture Transport in Heterogeneous Materials

To assess the durability of structures, heat and moisture transport need to be analyzed. To provide a reliable estimation of heat and moisture distribution in a certain structure, one needs to include all available information about the loading conditions and material parameters. Moreover, the information should be accompanied by a corresponding evaluation of its credibility. Here, the Bayesian inference is applied to combine different sources of information, so as to provide a more accurate estimation of heat and moisture fields [1]. The procedure is demonstrated on the probabilistic description of heterogeneous material where the uncertainties consist of a particular value of individual material characteristic and spatial fluctuations. As for the heat and moisture transfer, it is modelled in coupled setting [2]

Choosing Suitable Indicators for the Assessment of Urban Air Mobility: A Case Study of Upper Bavaria, Germany

Technological advances are disrupting mobility patterns and transport technologies, both on the ground and in the air. The latter has been recently observed in the research community of urban air mobility (UAM). Research in this area has studied several areas of its implementation, such as vehicle concepts, infrastructure, transport modeling, or operational constraints. Few studies however have focused on evaluating this service as an alternative among existing transportation systems. This research presents an approach for the selection of indicators for a multi-criteria analysis for the assessment of UAM, in a case study of Upper Bavaria, Germany. A 5-stage approach is showcased including an expert assessment for the relevance and feasibility of indicators, based on two rating scales. A threshold for selection is presented, applied and validated for both scales. The results included a list of indicators for assessing the potentials of UAM integration to existing public transportation systems; the chosen indicators were then compared against existing ones for sustainable urban mobility. A high match between resulting indicators and previous ones further validate the results, and suggest that there is a need for an iterative approach in the assessment of disruptive transport technologies