Socio-demographic and clinical characteristics of re-presentation to an Australian inner-city emergency department: implications for service delivery

BACKGROUND: People who have complex health care needs frequently access emergency departments for treatment of acute illness and injury. In particular, evidence suggests that those who are homeless, or suffer mental illness, or have a history of substance misuse, are often repeat users of emergency departments. The aim of this study was to describe the socio-demographic and clinical characteristics of emergency department re-presentations. Re-presentation was defined as a return visit to the same emergency department within 28 days of discharge from hospital. METHODS: A retrospective cohort study was conducted of emergency department presentations occurring over a 24-month period to an Australian inner-city hospital. Characteristics were examined for their influence on the binary outcome of re-presentation within 28 days of discharge using logistic regression with the variable patient fitted as a random effect. RESULTS: From 64,147 presentations to the emergency department the re-presentation rate was 18.0% (n = 11,559) of visits and 14.4% (5,894/40,942) of all patients. Median time to re-presentation was 6 days, with more than half occurring within one week of discharge (60.8%; n = 6,873), and more than three-quarters within two weeks (80.9%; n = 9,151). The odds of re-presentation increased three-fold for people who were homeless compared to those living in stable accommodation (adjusted OR 3.09; 95% CI, 2.83 to 3.36). Similarly, the odds of re-presentation were significantly higher for patients receiving a government pension compared to those who did not (adjusted OR 1.73; 95% CI, 1.63 to 1.84), patients who left part-way through treatment compared to those who completed treatment and were discharged home (adjusted OR 1.64; 95% CI, 1.36 to 1.99), and those discharged to a residential-care facility compared to those who were discharged home (adjusted OR 1.46: 95% CI, 1.03 to 2.06). CONCLUSION: Emergency department re-presentation rates cluster around one week after discharge and rapidly decrease thereafter. Housing status and being a recipient of a government pension are the most significant risk factors. Early identification and appropriate referrals for those patients who are at risk of emergency department re-presentation will assist in the development of targeted strategies to improve health service delivery to this vulnerable group

Dopamine and inhibitory action control: evidence from spontaneous eye blink rates

The inhibitory control of actions has been claimed to rely on dopaminergic pathways. Given that this hypothesis is mainly based on patient and drug studies, some authors have questioned its validity and suggested that beneficial effects of dopaminergic stimulants on response inhibition may be limited to cases of suboptimal inhibitory functioning. We present evidence that, in carefully selected healthy adults, spontaneous eyeblink rate, a marker of central dopaminergic functioning, reliably predicts the efficiency in inhibiting unwanted action tendencies in a stop-signal task. These findings support the assumption of a modulatory role for dopamine in inhibitory action control

Physical training in boys with Duchenne Muscular Dystrophy: the protocol of the No Use is Disuse study

Contains fulltext : 89740.pdf (publisher's version ) (Open Access)BACKGROUND: "Use it or lose it" is a well known saying which is applicable to boys with Duchenne Muscular Dystrophy (DMD). Besides the direct effects of the muscular dystrophy, the increasing effort to perform activities, the fear of falling and the use of personal aids indirectly impair leg and arm functions as a result of disuse. Physical training could oppose this secondary physical deterioration. The No Use is Disuse (NUD) study is the first study in human subjects with DMD that will examine whether a low-intensity physical training is beneficial in terms of preservation of muscle endurance and functional abilities. The study consists of two training intervention studies: study 1 "Dynamic leg and arm training for ambulant and recently wheelchair-dependent boys with DMD and, study 2 "Functional training with arm support for boys with DMD who have been confined to a wheelchair for several years". This paper describes the hypotheses and methods of the NUD study. METHODS: Study 1 is an explorative randomized controlled trial with multiple baseline measurements. Thirty boys with a DNA-established diagnosis of DMD will be included. The intervention consists of a six-months physical training during which boys train their legs and arms with active and/or assisted cycling training equipment. The primary study outcomes are muscle endurance and functional abilities, assessed with a Six-Minute Bicycle Test and the Motor Function Measure. Study 2 has a within-group repeated measurements design and will include ten boys with DMD who have already been confined to a wheelchair for several years. The six-months physical training program consists of 1) a computer-assisted training and 2) a functional training with an arm support. The primary study outcome is functional abilities of the upper extremity, assessed with the Action Research Arm Test. DISCUSSION: The NUD study will fill part of the gap in the current knowledge about the possible effects of training in boys with DMD and will increase insight into what type of exercise should be recommended to boys with DMD. The study will finish at the end of 2010 and results are expected in 2011. TRIAL REGISTRATION: The Netherlands National Trial Register1631

On the Existence of Two-Dimensional, Localized, Rotating, Self-Similar Vortical Structures

We prove that a Gaussian monopole, also known as the Lamb-Oseen vortex, is the only localized, rotating, self-similar solution to the two-dimensional, incompressible Navier-Stokes equations where level sets of vorticity and corotating streamfunction coincide. Our definition of self-similarity is restricted to the natural linear combination of space, time and viscous diffusion. We arrive at this conclusion by analytically determining the azimuthal Fourier modes for all possible solutions to this problem and then proving that the amplitude of all but the first (axisymmetric) is zero. Since coherent vortex multipoles are observed to be in a state where lines of vorticity and corotating streamfunction correspond, this casts doubt on the existence of any self-similar asymptotic structure other than the monopole

A Model of Coupled Heat and Moisture Transport in an Annular Clay Barrier

The design of repository seals for deeply buried high-level radioactive wastes incorporates densely compacted clayey barriers around metallic waste canisters. In this paper, a mathematical model that is based on conservation of thermal energy and mass is developed to describe the locations of moisture and temperature fronts within a barrier, around a cylindrical waste canister of 1-meter radius, containing radionuclides with half-lives that range from 100 – 10,000 years. The solution developed is axisymmetric: the moisture fraction, w, and temperature T, vary only with time t, and radial distance r from the axis of the cylindrical waste canister. The model produces parabolic partial differential equations (PDEs). The spatial domain is discretized such that ordinary differential equations (ODEs) that result are solved. Computations using a uniform mesh of 0.1 meters and a cooling coefficient of 6.7 x 10 -2 with assumed but typical data on material properties, indicate that coupling of transport processes would be negligible in the case of radionuclides with long half-lives. Also, a quasi-steady vaporization front can form and propagate outward over the course of several decades after waste emplacement. The evolution of the front is somewhat insensitive to the half-life used and the permeability of the clayey barrier material

Redox interplay of oxo-thio-tungsten centers with sulfur-donor co-ligands

Differences in the redox properties of Mo and W and the degree to which they participate in M−S redox impact their behavior in biological systems. Here, we report the synthesis and characterization of the oxo−thio−W(VI) complexes, Tp*WVIOS(S2PR2-S) (I) and Tp*WVIOS(pyS-S) (II), and aspects of their redox chemistry. These complexes are less susceptible to reduction than their Mo “counterparts” and are stable in the absence of WS···S interactions. They are reduced to the corresponding oxo−thio−W(V) anions and oxidized to (dithio)oxo−W(V) complexes in induced internal redox reactions