1,066 research outputs found
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 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 . 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
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
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