Mistriaged Advanced Life Support Patients in a Two-Tiered, Suburban Emergency Medical Services System

Introduction: Emergency medical services (EMS) systems exist to provide prehospital care in diverse environments throughout the world. Advanced Life Support (ALS) services can provide advanced care including 12-lead electrocardiogram (ECG), endotracheal intubation and parenteral medication administration. Basic Life Support (BLS) can provide basic care such as splinting, wound care and cardiopulmonary resuscitation. ALS can release patients to BLS for transport to the hospital, and this is an area of high risk. Our study examines patients who were triaged and admitted to a critical care location, including an intensive care unit (ICU), cardiac catheterization laboratory, or operating room (OR).Methods: The analysis included data from 2007–2015 of all patients who were triaged. We evaluated demographics, admission diagnoses, and dispositions using descriptive statistics. Diagnoses were grouped into categories based on the system.Results: We found that 372/17,639 (2%) of patients were mistriaged to BLS and admitted to a critical care location. The average age was 64. The most common diagnosis categories were neurological (24%), gastrointestinal (GI)/abdominal pain (15%), respiratory (12%), and cardiac (12%).Conclusion: It is uncommon for patients triaged from ALS to BLS to be admitted to an ICU, catheterization lab or OR, with a rate of 2%. Neurological, GI, sepsis, and trauma diagnoses were the most frequent categories of patient complaints that were mistriaged. This study should lead to further studies to examine this patient population

176— Comparison of Using a Schmidt Hammer to Evaluate Strength of Rock to Conventional Methods

A Schmidt hammer is a device designed to test the strength of concrete. More recently, the hammer has been used as a preliminary measure of rock strength. We took readings from the outcrop at Seth Green Drive, Rochester, NY and compared them to a more conventional measurement of strength, fracture density. The correlation of the best fit line relating the Schmidt hammer readings to fractures density was weak (R2=.076). As a result, we concluded that, at least for the strata examined there is no correlation between rock strength as measured by the Schmidt Hammer and fracture density

Nonparametric Copula Models for Mixed Data with Informative Missingness

Modern datasets commonly feature both substantial missingness and variables of mixed data types, which present significant challenges for estimation and inference. Complete case analysis, which proceeds using only the observations with fully-observed variables, is often severely biased, while model-based imputation of missing values is limited by the ability of the model to capture complex dependencies and accommodate mixed data types. To address these challenges, we develop a novel Bayesian mixture copula for joint and nonparametric modelling of count, continuous, ordinal, and unordered categorical variables, and deploy this model for inference, prediction, and imputation of missing data. Most uniquely, we introduce a new and efficient strategy for marginal distribution estimation, which eliminates the need to specify any marginal models yet delivers strong posterior consistency for both the marginal distributions and the copula parameters even in the presence of informative missingness (i.e., missingness-at-random). Extensive simulation studies demonstrate exceptional modeling and imputation capabilities relative to competing methods, especially with mixed data types, complex missingness mechanisms, and nonlinear dependencies. We conclude with a data analysis that highlights how improper treatment of missing data can distort a statistical analysis, and how the proposed approach offers a resolution.Comment: 60 pages, 18 figures, 2 table

A Case of Sarcoidosis Disseminated to Skeletal Tissues

Sarcoidosis is a systemic granulomatous disease of unknown etiology that typically affects young adults. Diagnostic criteria for sarcoidosis include involvement of two or more of the following organ systems: 1) pulmonary infiltrates; 2) bilateral hilar adenopathy; and 3) skin and/or eye lesions. Musculoskeletal system is less commonly involved. For that reason potential presenting symptoms can vary and make the diagnosis very challenging; particularly if a patient has symptoms that mimic other conditions. Musculoskeletal involvement for example can mimic malignancy. The following case describes a patient with known history of primary metastatic mediastinal Germ Cell Tumor (GCT) with teratomatous elements who is diagnosed with sarcoidosis involving skeletal tissues

Open to Exploitation: American Shoppers Online and Offline

Most Americans who use the Internet have little idea how vulnerable they are to abuse by online and offline marketers and how the information they provide can be used to exploit them. That is one conclusion from this unprecedented national phone survey conducted by the Annenberg Public Policy Center. The study indicates that many adults who use the internet believe incorrectly that laws prevent online and offline stores from selling their personal information. They also incorrectly believe that stores cannot charge them different prices based on what they know about them. Most other internet-using adults admit that they simply don’t know whether or not laws protect them. The survey further reveals that the majority of adults who use the internet do not know where to turn for help if their personal information is used illegally online or offline. The study\u27s findings suggest a complex mix of ignorance and knowledge, fear and bravado, realism and idealism that leaves most internet-using adult American shoppers open to financial exploitation by retailers

Open to Exploitation: America\u27s Shoppers Online and Offline

Most Americans who use the Internet have little idea how vulnerable they are to abuse by online and offline marketers and how the information they provide can be used to exploit them. That is one conclusion from this unprecedented national phone survey conducted by the Annenberg Public Policy Center. The study indicates that many adults who use the internet believe incorrectly that laws prevent online and offline stores from selling their personal information. They also incorrectly believe that stores cannot charge them different prices based on what they know about them. Most other internet-using adults admit that they simply don’t know whether or not laws protect them. The survey further reveals that the majority of adults who use the internet do not know where to turn for help if their personal information is used illegally online or offline. The study\u27s findings suggest a complex mix of ignorance and knowledge, fear and bravado, realism and idealism that leaves most internet-using adult American shoppers open to financial exploitation by retailers