Emergency department length of stay for patients requiring mechanical ventilation: a prospective observational study

BACKGROUND: Recommendations for acceptable emergency department (ED) length of stay (LOS) vary internationally with ≤ 8 h generally considered acceptable. Protracted ED LOS may place critically ill patients requiring mechanical ventilation at increased risk of adverse events as most EDs are not resourced for longitudinal delivery of critical care. Our objective was to quantify the ED LOS for mechanically ventilated patients (invasive and/or non-invasive ventilation [NIV]) and to explore patient and system level predictors of prolonged ED LOS. Additionally, we aimed to describe delivery and monitoring of ventilation in the ED. METHODS: Prospective observational study of ED LOS for all patients receiving mechanical ventilation at four metropolitan EDs in Toronto, Canada over two six-month periods in 2009 and 2010. RESULTS: We identified 618 mechanically ventilated patients which represented 0.5% (95% CI 0.4%–0.5%) of all ED visits. Of these, 484 (78.3%) received invasive ventilation, 118 (19.1%) received NIV; 16 received both during the ED stay. Median Kaplan-Meier estimated duration of ED stay for all patients was 6.4 h (IQR 2.8–14.6). Patients with trauma diagnoses had a shorter median (IQR) LOS, 2.5 h (1.3–5.1), compared to ventilated patients with non-trauma diagnoses, 8.5 h (3.3–14.0) (p <0.001). Patients requiring NIV had a longer ED stay (16.6 h, 8.2–27.9) compared to those receiving invasive ventilation exclusively (4.6 h, 2.2–11.1) and patients receiving both (15.4 h, 6.4–32.6) (p <0.001). Longer ED LOS was associated with ED site and lower priority triage scores. Shorter ED LOS was associated with intubation at another ED prior to transfer. CONCLUSIONS: While patients requiring mechanical ventilation represent a small proportion of overall ED visits these critically ill patients frequently experienced prolonged ED stay especially those treated with NIV, assigned lower priority triage scores at ED presentation, and non-trauma patients

Bereavement and marriage are associated with antibody response to influenza vaccination in the elderly

Stressful life events exposure including bereavement, an event commonly experienced by elderly people, social support, marital status and satisfaction were examined in relation to antibody response to the annual trivalent influenza vaccination in an elderly community sample (N = 184). Antibody response was assessed at baseline, and at one and 12 months following vaccination. Taking into account baseline antibody titer, overall life events exposure and social support were not associated with response to any of the influenza strains. However, bereavement in the year prior to vaccination was negatively associated with the one-month response to the A/Panama and B/Shangdong strains. Being married and having higher marital satisfaction was also associated with higher peak responses to the A/Panama influenza strain at one month. The positive association between marital satisfaction and A/Panama response was particularly evident in the younger half of the married sample. These associations largely withstood adjustment for potential confounders. Thus, in the elderly, peak antibody response was associated with bereavement and marriage, and not the more general factors, life events and social support, related to antibody response in student samples. This suggests the importance of taking a life course approach to examining relationships between psychosocial factors and immunity, and that interventions to modify the impact of these factors should address those most salient for each age group

Experimental feasibility of measuring the gravitational redshift of light using dispersion in optical fibers

This paper describes a new class of experiments that use dispersion in optical fibers to convert the gravitational frequency shift of light into a measurable phase shift or time delay. Two conceptual models are explored. In the first model, long counter-propagating pulses are used in a vertical fiber optic Sagnac interferometer. The second model uses optical solitons in vertically separated fiber optic storage rings. We discuss the feasibility of using such an instrument to make a high precision measurement of the gravitational frequency shift of light.Comment: 11 pages, 12 figure

The Footprint of F-theory at the LHC

Recent work has shown that compactifications of F-theory provide a potentially attractive phenomenological scenario. The low energy characteristics of F-theory GUTs consist of a deformation away from a minimal gauge mediation scenario with a high messenger scale. The soft scalar masses of the theory are all shifted by a stringy effect which survives to low energies. This effect can range from 0 GeV up to ~ 500 GeV. In this paper we study potential collider signatures of F-theory GUTs, focussing in particular on ways to distinguish this class of models from other theories with an MSSM spectrum. To accomplish this, we have adapted the general footprint method developed recently for distinguishing broad classes of string vacua to the specific case of F-theory GUTs. We show that with only 5 fb^(-1) of simulated LHC data, it is possible to distinguish many mSUGRA models and low messenger scale gauge mediation models from F-theory GUTs. Moreover, we find that at 5 fb^(-1), the stringy deformation away from minimal gauge mediation produces observable consequences which can also be detected to a level of order ~ +/- 80 GeV. In this way, it is possible to distinguish between models with a large and small stringy deformation. At 50 fb^(-1), this improves to ~ +/- 10 GeV.Comment: 85 pages, 37 figure

Lifetime cardiovascular management of patients with previous Kawasaki disease.

Kawasaki disease (KD) is an inflammatory disorder of young children, associated with vasculitis of the coronary arteries with subsequent aneurysm formation in up to one-third of untreated patients. Those who develop aneurysms are at life-long risk of coronary thrombosis or the development of stenotic lesions, which may lead to myocardial ischaemia, infarction or death. The incidence of KD is increasing worldwide, and in more economically developed countries, KD is now the most common cause of acquired heart disease in children. However, many clinicians in the UK are unaware of the disorder and its long-term cardiac complications, potentially leading to late diagnosis, delayed treatment and poorer outcomes. Increasing numbers of patients who suffered KD in childhood are transitioning to the care of adult services where there is significantly less awareness and experience of the condition than in paediatric services. The aim of this document is to provide guidance on the long-term management of patients who have vascular complications of KD and guidance on the emergency management of acute coronary complications. Guidance on the management of acute KD is published elsewhere

Coupled Dipole Method Determination of the Electromagnetic Force on a Particle over a Flat Dielectric Substrate

We present a theory to compute the force due to light upon a particle on a dielectric plane by the Coupled Dipole Method (CDM). We show that, with this procedure, two equivalent ways of analysis are possible, both based on Maxwell's stress tensor. The interest in using this method is that the nature and size or shape of the object, can be arbitrary. Even more, the presence of a substrate can be incorporated. To validate our theory, we present an analytical expression of the force due to the light acting on a particle either in presence, or not, of a surface. The plane wave illuminating the sphere can be either propagating or evanescent. Both two and three dimensional calculations are studied.Comment: 10 pages, 8 figures and 3 table

Commentary: COVID in Care Homes—Challenges and Dilemmas in Healthcare Delivery

The COVID-19 pandemic has disproportionately affected care home residents internationally, with 19–72% of COVID-19 deaths occurring in care homes. COVID-19 presents atypically in care home residents and up to 56% of residents may test positive whilst pre-symptomatic. In this article, we provide a commentary on challenges and dilemmas identified in the response to COVID-19 for care homes and their residents. We highlight the low sensitivity of PCR testing and the difficulties this poses for blanket screening and isolation of residents. We discuss quarantine of residents and the potential harms associated with this. Personal Protective Equipment (PPE) supply for care homes during the pandemic has been suboptimal and we suggest that better integration of procurement and supply is required. Advance care planning has been challenged by the pandemic and there is a need to for healthcare staff to provide support to care homes with this. Finally, we discuss measures to implement augmented care in care homes, including treatment with oxygen and subcutaneous fluids, and the frameworks which will be required if these are to be sustainable. All of these challenges must be met by healthcare, social care and government agencies if care home residents and staff are to be physically and psychologically supported during this time of crisis for care homes