What impact did a Paediatric Early Warning system have on emergency admissions to the paediatric intensive care unit? An observational cohort study

Summary The ideology underpinning Paediatric Early Warning systems (PEWs) is that earlier recognition of deteriorating in-patients would improve clinical outcomes. Objective To explore how the introduction of PEWs at a tertiary children's hospital affects emergency admissions to the Paediatric Intensive Care Unit (PICU) and the impact on service delivery. To compare ‘in-house’ emergency admissions to PICU with ‘external’ admissions transferred from District General Hospitals (without PEWs). Method A before-and-after observational study August 2005–July 2006 (pre), August 2006–July 2007 (post) implementation of PEWs at the tertiary children's hospital. Results The median Paediatric Index of Mortality (PIM2) reduced; 0.44 vs 0.60 (p < 0.001). Fewer admissions required invasive ventilation 62.7% vs 75.2% (p = 0.015) for a shorter median duration; four to two days. The median length of PICU stay reduced; five to three days (p = 0.002). There was a non-significant reduction in mortality (p = 0.47). There was no comparable improvement in outcome seen in external emergency admissions to PICU. A 39% reduction in emergency admission total beds days reduced cancellation of major elective surgical cases and refusal of external PICU referrals. Conclusions Following introduction of PEWs at a tertiary children's hospital PIM2 was reduced, patients required less PICU interventions and had a shorter length of stay. PICU service delivery improved

Could the Pioneer anomaly have a gravitational origin?

If the Pioneer anomaly has a gravitational origin, it would, according to the equivalence principle, distort the motions of the planets in the Solar System. Since no anomalous motion of the planets has been detected, it is generally believed that the Pioneer anomaly can not originate from a gravitational source in the Solar System. However, this conclusion becomes less obvious when considering models that either imply modifications to gravity at long range or gravitational sources localized to the outer Solar System, given the uncertainty in the orbital parameters of the outer planets. Following the general assumption that the Pioneer spacecraft move geodesically in a spherically symmetric spacetime metric, we derive the metric disturbance that is needed in order to account for the Pioneer anomaly. We then analyze the residual effects on the astronomical observables of the three outer planets that would arise from this metric disturbance, given an arbitrary metric theory of gravity. Providing a method for comparing the computed residuals with actual residuals, our results imply that the presence of a perturbation to the gravitational field necessary to induce the Pioneer anomaly is in conflict with available data for the planets Uranus and Pluto, but not for Neptune. We therefore conclude that the motion of the Pioneer spacecraft must be non-geodesic. Since our results are model independent within the class of metric theories of gravity, they can be applied to rule out any model of the Pioneer anomaly that implies that the Pioneer spacecraft move geodesically in a perturbed spacetime metric, regardless of the origin of this metric disturbance.Comment: 16 pages, 6 figures. Rev. 3: Major revision. Accepted for publication in Phys. Rev. D. Rev. 4: Added two reference

Metric of a tidally perturbed spinning black hole

We explicitly construct the metric of a Kerr black hole that is tidally perturbed by the external universe in the slow-motion approximation. This approximation assumes that the external universe changes slowly relative to the rotation rate of the hole, thus allowing the parameterization of the Newman-Penrose scalar $\psi_0$ by time-dependent electric and magnetic tidal tensors. This approximation, however, does not constrain how big the spin of the background hole can be and, in principle, the perturbed metric can model rapidly spinning holes. We first generate a potential by acting with a differential operator on $\psi_0$. From this potential we arrive at the metric perturbation by use of the Chrzanowski procedure in the ingoing radiation gauge. We provide explicit analytic formulae for this metric perturbation in spherical Kerr-Schild coordinates, where the perturbation is finite at the horizon. This perturbation is parametrized by the mass and Kerr spin parameter of the background hole together with the electric and magnetic tidal tensors that describe the time evolution of the perturbation produced by the external universe. In order to take the metric accurate far away from the hole, these tidal tensors should be determined by asymptotically matching this metric to another one valid far from the hole. The tidally perturbed metric constructed here could be useful in initial data constructions to describe the metric near the horizons of a binary system of spinning holes. This perturbed metric could also be used to construct waveforms and study the absorption of mass and angular momentum by a Kerr black hole when external processes generate gravitational radiation.Comment: 17 pages, 3 figures. Final PRD version, minor typos, etc corrected. v3: corrected typo in Eq. (35) and (57

Phemeranthus rugospermus (Holz.) Kiger

https://thekeep.eiu.edu/herbarium_specimens_byname/20844/thumbnail.jp

Meningococcal disease in children in Merseyside, England:a 31 year descriptive study

Meningococcal disease (MCD) is the leading infectious cause of death in early childhood in the United Kingdom, making it a public health priority. MCD most commonly presents as meningococcal meningitis (MM), septicaemia (MS), or as a combination of the two syndromes (MM/MS). We describe the changing epidemiology and clinical presentation of MCD, and explore associations with socioeconomic status and other risk factors. A hospital-based study of children admitted to a tertiary children's centre, Alder Hey Children's Foundation Trust, with MCD, was undertaken between 1977 to 2007 (n = 1157). Demographics, clinical presentations, microbiological confirmation and measures of deprivation were described. The majority of cases occurred in the 1-4 year age group and there was a dramatic fall in serogroup C cases observed with the introduction of the meningococcal C conjugate (MCC) vaccine. The proportion of MS cases increased over the study period, from 11% in the first quarter to 35% in the final quarter. Presentation with MS (compared to MM) and serogroup C disease (compared to serogroup B) were demonstrated to be independent risk factors for mortality, with odds ratios of 3.5 (95% CI 1.18 to 10.08) and 2.18 (95% CI 1.26 to 3.80) respectively. Cases admitted to Alder Hey were from a relatively more deprived population (mean Townsend score 1.25, 95% CI 1.09 to 1.41) than the Merseyside reference population. Our findings represent one of the largest single-centre studies of MCD. The presentation of MS is confirmed to be a risk factor of mortality from MCD. Our study supports the association between social deprivation and MCD

Towards Combining Individual and Collaborative Work Spaces under a Unified E-Portfolio

Proceedings of: 11th International Conference on Computational Science and Applications (ICCSA 2011). Santander, Spain, June 20-23, 2011E-portfolios in learning environments have been attributed numerous benefits and their presence has been steadily increasing. And so has the variety of environments in which a student participates. Collaborative learning requires communication and resource sharing among team members. Students may participate in multiple teams throughout a long period of time, sometimes even simultaneously. Conventional eportfolios are oriented toward showcasing individual achievements, but they need to also equally reflect collaborative achievements. The approach described in this paper has the objective of offering students an e-portfolio as a local folder their personal computer containing a combined view of their individual and collaborative work spaces. The content of this folder can be synchronized with a remote server thus achieving resource sharing and publication of a clearly identified set of resources.Work partially funded by the Learn3 project, “Plan Nacional de I+D+I TIN2008- 05163/TSI”, the Consejo Social - Universidad Carlos III de Madrid, the Acción Integrada Ref. DE2009-0051, and the “Emadrid: Investigación y desarrollo de tecnologías para el e-learning en la Comunidad de Madrid” project (S2009/TIC-1650).Publicad

Orbital dependent nucleonic pairing in the lightest known isotopes of tin

By studying the 109Xe-->105Te-->101Sn superallowed alpha-decay chain, we observe low-lying states in 101Sn, the one-neutron system outside doubly magic 100Sn. We find that the spins of the ground state (J = 7=2) and first excited state (J = 5=2) in 101Sn are reversed with respect to the traditional level ordering postulated for 103Sn and the heavier tin isotopes. Through simple arguments and state-of-the-art shell model calculations we explain this unexpected switch in terms of a transition from the single-particle regime to the collective mode in which orbital-dependent pairing correlations, dominate.Comment: 5 pages 3 figure

Blue-headed fantail

5 p. : 1 ill ; 24 cm.Includes bibliographical references (p. 5)

Nitric oxide synthase 2A (NOS2A) polymorphisms are not associated with invasive pneumococcal disease

<p>Abstract</p> <p>Background</p> <p><it>Streptococcus pneumoniae </it>(pneumococcus) is responsible for over one million deaths per year, with young children, the elderly and immunocompromised individuals being most at risk. Approximately half of East African children have been reported to be asymptomatic carriers of pneumococcus with invasive infection occurring after the disruption of the respiratory membrane which is believed to be caused by the host immune response. Racial incidence of invasive pneumococcal disease (IPD) is higher in certain populations even after adjusting for environmental factors suggesting a genetic component to disease susceptibility. The nitric oxide synthase 2A (NOS2A) gene is responsible for the production of nitric oxide under pathological conditions including host defence against bacterial infection. Nitric oxide is a modulator of apoptotic and inflammatory cascades and endothelial permeability. We hypothesised that genetic variants within this gene may predispose to disease risk and survival.</p> <p>Methods</p> <p>A cohort of 299 children with IPD (221 meningitis, 41 pneumonia and 37 with bacteraemia) and 931 age matched controls from Malawi were used in this study. We investigated nine haplotype tagging single nucleotide polymorphisms within the NOS2A gene and compared the presence or absence of the minor alleles in cases and controls and survivors and non-survivors within the cases.</p> <p>Results</p> <p>We observed no significant associations between cases and controls or with survival in either all IPD cases or in the separate analysis of meningitis cases. A near significant association was obtained for the comparison of rs8078340 in cases and controls (p-value, 0.078). However, results were unadjusted for multiple testing.</p> <p>Conclusion</p> <p>Our results suggest that polymorphic variation within the NOS2A gene does not influence invasive pneumococcal disease susceptibility or survival.</p