Emergency Department Crowding: Factors Influencing Flow

Background: The objective of this study was to evaluate those factors, both intrinsic and extrinsic to the emergency department (ED) that influence two specific components of throughput: “door-to-doctor” time and dwell time.Methods: We used a prospective observational study design to determine the variables that played a significant role in determining ED flow. All adult patients seen or waiting to be seen in the ED were observed at 8pm (Monday-Friday) during a three-month period. Variables measured included daily ED volume, patient acuity, staffing, ED occupancy, daily admissions, ED boarder volume, hospital volume, and intensive care unit volume. Both log-rank tests and time-to-wait (survival) proportional-hazard regression models were fitted to determine which variables were most significant in predicting “door-to-doctor” and dwell times, with full account of the censoring for some patients.Results: We captured 1,543 patients during our study period, representing 27% of total daily volume. The ED operated at an average of 85% capacity (61-102%) with an average of 27% boarding. Median “door-to-doctor” time was 1.8 hours, with the biggest influence being triage category, day of the week, and ED occupancy. Median dwell time was 5.5 hours with similar variable influences.Conclusion: The largest contributors to decreased patient flow through the ED at our institution were triage category, ED occupancy, and day of the week. Although the statistically significant factors influencing patient throughput at our institution involve problems with inflow, an increase in ED occupancy could be due to substantial outflow obstruction and may indicate the necessity for increased capacity both within the ED and hospital. [West J Emerg Med. 2010; 11(1):10-15

Spatially-resolved Thermal Continuum Absorption against the Supernova Remnant W49B

We present sub-arcminute resolution imaging of the Galactic supernova remnant W49B at 74 MHz (25") and 327 MHz (6"), the former being the lowest frequency at which the source has been resolved. While the 327 MHz image shows a shell-like morphology similar to that seen at higher frequencies, the 74 MHz image is considerably different, with the southwest region of the remnant almost completely attenuated. The implied 74 MHz optical depth (~ 1.6) is much higher than the intrinsic absorption levels seen inside two other relatively young remnants, Cas A and the Crab Nebula, nor are natural variations in the relativistic electron energy spectra expected at such levels. The geometry of the absorption is also inconsistent with intrinsic absorption. We attribute the absorption to extrinsic free-free absorption by a intervening cloud of thermal electrons. Its presence has already been inferred from the low-frequency turnover in the integrated continuum spectrum and from the detection of radio recombination lines toward the remnant. Our observations confirm the basic conclusions of those measurements, and our observations have resolved the absorber into a complex of classical HII regions surrounded either partially or fully by low-density HII gas. We identify this low-density gas as an extended HII region envelope (EHE), whose statistical properties were inferred from low resolution meter- and centimeter-wavelength recombination line observations. Comparison of our radio images with HI and H_2CO observations show that the intervening thermal gas is likely associated with neutral and molecular material as well.Comment: 18 pages, LaTeX with AASTeX-5, 5 figures in 7 PostScript files; accepted for publication in the Ap

Did VV~29 collide with a dark Dark-Matter halo?

Westerbork Radio Synthesis Telescope observation of the galaxy VV29=Arp188=UGC10214 shows that there are at least three distinct dynamical components whose kinematics can be traced in 21cm line emission. The system appears to be the result of a galaxy-galaxy interaction. We identify a sufficient number of dynamical elements containing baryons (stars and neutral gas) that there is no compelling reason to postulate the presence of an additional dark matter halo that is devoid of detectable baryons. The central galaxy VV29a is massive (V_rot = 330 km/s) and gas rich (M_HI} = 6x10^9 Msolar). The distinctive optical plume (VV29b), which extends eastward from the main galaxy, is also gas rich (M_HI = 3x10^9 Msolar) and has a very low gradient in line of sight velocity (<30 km/s) over 70kpc. On the western side, there is an HI feature of M_HI = 4x10^8 Msolar that participates strongly in orbital motion about the host in the same sense of rotation as the VV29a itself. A blue, less massive, gas-rich galaxy "VV29c" (M_HI = 9x10^8 Msolar) appears clearly in the HI maps as an 170 km/s wide spectral feature, seen in projection against or, more likely, behind the west side of the host disk. Its high recessional velocity is counter to the host rotation direction. The optical images of Trentham et al (2001) show signs of this blue dwarf against the redder VV29a disk. The companion galaxy CGCG27-021=MGC09-26-54 (at projected distance 115 kpc) is not detected in 21cm line emission (M_HI<10^9Msolar).Comment: 7 pages, 13 figures, accepted for publication in Astronomy and Astrophysic

The Murchison Widefield Array: Design Overview

The Murchison Widefield Array (MWA) is a dipole-based aperture array synthesis telescope designed to operate in the 80-300 MHz frequency range. It is capable of a wide range of science investigations, but is initially focused on three key science projects. These are detection and characterization of 3-dimensional brightness temperature fluctuations in the 21cm line of neutral hydrogen during the Epoch of Reionization (EoR) at redshifts from 6 to 10, solar imaging and remote sensing of the inner heliosphere via propagation effects on signals from distant background sources,and high-sensitivity exploration of the variable radio sky. The array design features 8192 dual-polarization broad-band active dipoles, arranged into 512 tiles comprising 16 dipoles each. The tiles are quasi-randomly distributed over an aperture 1.5km in diameter, with a small number of outliers extending to 3km. All tile-tile baselines are correlated in custom FPGA-based hardware, yielding a Nyquist-sampled instantaneous monochromatic uv coverage and unprecedented point spread function (PSF) quality. The correlated data are calibrated in real time using novel position-dependent self-calibration algorithms. The array is located in the Murchison region of outback Western Australia. This region is characterized by extremely low population density and a superbly radio-quiet environment,allowing full exploitation of the instrumental capabilities.Comment: 9 pages, 5 figures, 1 table. Accepted for publication in Proceedings of the IEE

Closing the gap between science and management of cold-water refuges in rivers and streams

Human activities and climate change threaten coldwater organisms in freshwater eco-systems by causing rivers and streams to warm, increasing the intensity and frequency of warm temperature events, and reducing thermal heterogeneity. Cold-water refuges are discrete patches of relatively cool water that are used by coldwater organisms for thermal relief and short-term survival. Globally, cohesive management approaches are needed that consider interlinked physical, biological, and social factors of cold-water refuges. We review current understanding of cold-water refuges, identify gaps between science and management, and evaluate policies aimed at protecting thermally sensitive species. Existing policies include designating cold-water habitats, restricting fishing during warm periods, and implementing threshold temperature standards or guidelines. However, these policies are rare and uncoordinated across spatial scales and often do not consider input from Indigenous peoples. We propose that cold-water refuges be managed as dis-tinct operational landscape units, which provide a social and ecological context that is relevant at the watershed scale. These operational landscape units provide the founda-tion for an integrated framework that links science and management by (1) mapping and characterizing cold-water refuges to prioritize management and conservation actions, (2) leveraging existing and new policies, (3) improving coordination across jurisdictions, and (4) implementing adaptive management practices across scales. Our findings show that while there are many opportunities for scientific advancement, the current state of the sciences is sufficient to inform policy and management. Our proposed framework pro-vides a path forward for managing and protecting cold-water refuges using existing and new policies to protect coldwater organisms in the face of global change. behavioral thermoregulation, climate change adaptation, lotic ecosystem management, refugia, salmonids, temperature, thermal heterogeneity, thermal refugespublishedVersio

New research directions on disparities in obesity and type 2 diabetes

Obesity and type 2 diabetes disproportionately impact U.S. racial and ethnic minority communities and lowâ income populations. Improvements in implementing efficacious interventions to reduce the incidence of type 2 diabetes are underway (i.e., the National Diabetes Prevention Program), but challenges in effectively scalingâ up successful interventions and reaching atâ risk populations remain. In October 2017, the National Institutes of Health convened a workshop to understand how to (1) address socioeconomic and other environmental conditions that perpetuate disparities in the burden of obesity and type 2 diabetes; (2) design effective prevention and treatment strategies that are accessible, feasible, culturally relevant, and acceptable to diverse population groups; and (3) achieve sustainable health improvement approaches in communities with the greatest burden of these diseases. Common features of guiding frameworks to understand and address disparities and promote health equity were described. Promising research directions were identified in numerous areas, including study design, methodology, and core metrics; program implementation and scalability; the integration of medical care and social services; strategies to enhance patient empowerment; and understanding and addressing the impact of psychosocial stress on disease onset and progression in addition to factors that support resiliency and health.This report discusses a workshop convened by the National Institutes of Health to understand how to (1) address socioeconomic and other environmental conditions that perpetuate disparities in the burden of obesity and type 2 diabetes; (2) design effective prevention and treatment strategies that are accessible, feasible, culturally relevant, and acceptable to diverse population groups; and (3) achieve sustainable health improvement approaches in communities with the greatest burden of these diseases.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154507/1/nyas14270_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154507/2/nyas14270.pd

Using decision analysis to support proactive management of emerging infectious wildlife diseases

Despite calls for improved responses to emerging infectious diseases in wildlife, management is seldom considered until a disease has been detected in affected populations. Reactive approaches may limit the potential for control and increase total response costs. An alternative, proactive management framework can identify immediate actions that reduce future impacts even before a disease is detected, and plan subsequent actions that are conditional on disease emergence. We identify four main obstacles to developing proactive management strategies for the newly discovered salamander pathogen Batrachochytrium salamandrivorans (Bsal). Given that uncertainty is a hallmark of wildlife disease management and that associated decisions are often complicated by multiple competing objectives, we advocate using decision analysis to create and evaluate trade-offs between proactive (pre-emergence) and reactive (post-emergence) management options. Policy makers and natural resource agency personnel can apply principles from decision analysis to improve strategies for countering emerging infectious diseases

Field Deployment of Prototype Antenna Tiles for the Mileura Widefield Array--Low Frequency Demonstrator

Experiments were performed with prototype antenna tiles for the Mileura Widefield Array--Low Frequency Demonstrator (MWA-LFD) to better understand the widefield, wideband properties of their design and to characterize the radio frequency interference (RFI) between 80 and 300 MHz at the site in Western Australia. Observations acquired during the six month deployment confirmed the predicted sensitivity of the antennas, sky-noise dominated system temperatures, and phase-coherent interferometric measurements. The radio spectrum is remarkably free of strong terrestrial signals, with the exception of two narrow frequency bands allocated to satellite downlinks and rare bursts due to ground-based transmissions being scattered from aircraft and meteor trails. Results indicate the potential of the MWA-LFD to make significant achievements in its three key science objectives: epoch of reionziation science, heliospheric science, and radio transient detection.Comment: Accepted by AJ. 17 pages with figure