Optimal use of coronary care units: A review

Patients at a low probability of acute cardiac pathology constitute a considerable proportion in many coronary care units (CCUs), such that physicians should consider more effective alternatives than CCU admission “to rule out myocardial infarction.” In this article, strategies to increase the efficiency of managing patients with acute chest pain are reviewed. Algorithms aiming to improve the diagnostic accuracy of the general practitioner have been developed but require an electrocardiogram recorded at the home of the patient. Another method of triage encompasses the identification in the emergency room of the hospital of patients at a low probability of acute cardiac pathology by using predictive models that include laboratory assessments. A third strategy includes alternatives to CCUs for patients at a low risk of acute cardiac pathology, such as the creation of a simple observation unit. Finally, some investigators have sought to identify patients with good prognosis for early transfer from the CCU to lower levels of care. It is concluded that a combination of these approaches will be most efficient, and that the most appropriate choice will be determined by local circumstances

Project manager-to-project allocations in practice: an empirical study of the decision-making practices of a multi-project based organization

Empirical studies that examine how managers make project manager-to-project (PM2P) allocation decisions in multi-project settings are currently limited. Such decisions are crucial to organizational success. An empirical study of the PM2P practice, conducted in the context of Botswana, revealed ineffective processes in terms of optimality in decision-making. A conceptual model to guide effective PM2P practices was developed. The focus of this study is on deploying the model as a lens to study the PM2P practices of a large organization, with a view to identify and illustrate strengths and weaknesses. A case study was undertaken in the mining industry, where core activities in terms of projects are underground mineral explorations at identified geographical regions. A semi-structured interview protocol was used to collect data from 15 informants, using an enumeration. Integrated analysis of both data types (using univariate descriptive analysis for the quantitative data, content and thematic analysis for the qualitative data) revealed strengths in PM2P practices, demonstrated by informants’ recognition of some important criteria to be considered. The key weaknesses were exemplified by a lack of effective management tools and techniques to match project managers to projects. The findings provide a novel perspective through which improvements in working practices can be made

Region of Excessive Flux of PeV Cosmic Rays in the Direction Toward Pulsars PSR J1840+5640 and LAT PSR J1836+5925

An analysis of arrival directions of extensive air showers (EAS) registered with the EAS MSU and EAS-1000 prototype arrays has revealed a region of excessive flux of PeV cosmic rays in the direction toward pulsars PSR J1840+5640 and LAT PSR J1836+5925 at significance level up to 4.5sigma. The first of the pulsars was discovered almost 30 years ago and is a well-studied old radio pulsar located at the distance of 1.7pc from the Solar system. The second pulsar belongs to a new type of pulsars, discovered by the space gamma-ray observatory Fermi, pulsations of which are not observed in optical and radio wavelengths but only in the gamma-ray range of energies (gamma-ray-only pulsars). In our opinion, the existence of the region of excessive flux of cosmic rays registered with two different arrays provides a strong evidence that isolated pulsars can give a noticeable contribution to the flux of Galactic cosmic rays in the PeV energy range.Comment: 14 pages; v.2: a few remarks to match a version accepted for Astronomy Letters added. They can be found by redefining the \NEW command in the preamble of the LaTeX fil

X-Ray and Radio Observations of Bright GeV Sources

We present X-ray and radio studies of sources which are brightabove 1 GeV (F_{>1GeV} > 4e-8 ph/cm^2/s. Only 11 out of ~30 of these gamma-ray sources have been identified with lower energy counterparts: 5 blazars and 6 pulsars. Three of these pulsars are surrounded by radio pulsar wind nebulae (PWN), two of which are also seen as bright, extended X-ray synchrotron nebulae. The ASCA X-ray telescope has observed 28 of the bright GeV sources, revealing an excess of F_{2-10keV} > 10e-12 ergs/cm^2/s sources within the {\it EGRET} error contours of the unidentified sources. Although several supernova remnants are positionally coincident with these sources, we find no X-ray evidence of high energy particle production in SNR shell shocks consistent with the GeV positions. We also present initial results from follow on radio imaging studies of several fields containing unidentified sources. We have discovered new X-ray/radio nebulae in three of these fields which are strong candidates for PWN. These sources, along with a similar nebula in CTA 1 and the PWN around PSR B1853+01 in W44, are all positionally coincident with variable EGRET sources. This suggests a class of variable gamma-ray sources associated with synchrotron emitting regions powered by the winds of young pulsars.Comment: 18 pages, 26 figures, To appear in the proceedings of the workshop: "The Nature of the Unidentified Galactic Gamma-Ray Sources" held at INAOE, Mexico, October 2000, (A.Carraminana, O. Reiner and D. Thompson,

The clustering of ultra-high energy cosmic rays and their sources

The sky distribution of cosmic rays with energies above the 'GZK cutoff' holds important clues to their origin. The AGASA data, although consistent with isotropy, shows evidence for small-angle clustering, and it has been argued that such clusters are aligned with BL Lacertae objects, implicating these as sources. It has also been suggested that clusters can arise if the cosmic rays come from the decays of very massive relic particles in the Galactic halo, due to the expected clumping of cold dark matter. We examine these claims and show that both are in fact not justified.Comment: 13 pages, 8 figures, version in press at Phys. Rev.

New hadrons as ultra-high energy cosmic rays

Ultra-high energy cosmic ray (UHECR) protons produced by uniformly distributed astrophysical sources contradict the energy spectrum measured by both the AGASA and HiRes experiments, assuming the small scale clustering of UHECR observed by AGASA is caused by point-like sources. In that case, the small number of sources leads to a sharp exponential cutoff at the energy E<10^{20} eV in the UHECR spectrum. New hadrons with mass 1.5-3 GeV can solve this cutoff problem. For the first time we discuss the production of such hadrons in proton collisions with infrared/optical photons in astrophysical sources. This production mechanism, in contrast to proton-proton collisions, requires the acceleration of protons only to energies E<10^{21} eV. The diffuse gamma-ray and neutrino fluxes in this model obey all existing experimental limits. We predict large UHE neutrino fluxes well above the sensitivity of the next generation of high-energy neutrino experiments. As an example we study hadrons containing a light bottom squark. These models can be tested by accelerator experiments, UHECR observatories and neutrino telescopes.Comment: 17 pages, revtex style; v2: shortened, as to appear in PR