Changes in Emergency Department Care Intensity from 2007-16: Analysis of the National Hospital Ambulatory Medical Care Survey

Introduction: Emergency departments (ED) in the United States (US) have increasingly taken the central role for the expedited diagnosis and treatment of acute episodic illnesses and exacerbations of chronic diseases, allowing outpatient management to be possible for many conditions that traditionally required hospitalization and inpatient care. The goal of this analysis was to examine the changes in ED care intensity in this context through the changes in ED patient population and ED care provided.Methods: We analyzed the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2007-2016. Incorporating survey design and weight, we calculated the changes in ED patient characteristics and ED care provided between 2007 and 2016. We also calculated changes in the proportion of visits with low-severity illnesses that may be safely managed at alternative settings. Lastly, we compared ED care received and final ED dispositions by calculating adjusted relative risk (aRR) comparing ED visits in 2007 to 2016, using survey weighted multivariable logistic regression.Results: NHAMCS included 35,490 visits in 2007 and 19,467 visits in 2016, representing 117 million and 146 million ED visits, respectively. Between 2007 and 2016, there was an increase in the proportion of ED patients aged 45-64 (21.0% to 23.6%) and 65-74 (5.9% to 7.5%), while visits with low-severity illnesses decreased from 37.3% to 30.4%. There was a substantial increase in the proportion of Medicaid patients (22.2% to 34.0%) with corresponding decline in the privately insured (36.2% to 28.3%) and the uninsured (15.4% to 8.6%) patients. After adjusting for patient and visit characteristics, there was an increase in the utilization of advanced imaging (aRR 1.29; 95% confidence interval [CI], 1.17-1.41), blood tests (aRR 1.16; 95% CI, 1.10-1.22), urinalysis (aRR 1.22; 95% CI, 1.13-1.31), and visits where the patient received four or more medications (aRR 2.17; 95% CI, 1.88-2.46). Lastly, adjusted hospitalization rates declined (aRR 0.74; 95% CI, 0.64-0.84) while adjusted discharge rates increased (aRR 1.06; 95%CI 1.03-1.08). Conclusion: From 2007 to 2016, ED care intensity appears to have increased modestly, including aging of patient population, increased illness severity, and increased resources utilization. The role of increased care intensity in the decline of ED hospitalization rate requires further study

Breaking Binary Being in the Future Fiction of Star Trek

Understanding gender is more complicated than traditional views of the male sex equating to being a man, and female sex equating to being a woman. This gender binary coding does not accurately represent a large number of people who identify as agender (not of a gender), or gender-fluid (not having a fixed gender.) I am investigating to what extent Star Trek (which is a science fiction often accredited with the premise of representing humanity\u27s more equitable future society) reproduces traditional gender roles or offers alternate gender identities. I look at literature from other scholars about gender performances in Star Trek, as well as analyze an episode form ST:TNG, The Outcast , looking at how the production treats a species of androgynous beings, and ultimately seeking whether Star Trek breaks deeply embedded ideas of binary gender, or portrays a future state of humanity as more inclusive of different types of gender identity

Closing the knowledge gap between virtual design and product manufacturing : using 3D printing for the ninth grade

This action research investigates the impact of using 3D printing for a Technology Education course in a ninth grade classroom in general, and the effectiveness of students\u27 ability to connect virtual design and manufacturing concepts in particular. There is a current gap in 3D printing research involving the link between designing products virtually using CADD software and the manufacturing processes necessary to create real life products. This action research attempts to fill the current research gap between computer-aided design and product manufacturing for ninth grade students. Within the three weeks of this experimental design research, as a teacher who teaches Introduction to Manufacturing, I collected both qualitative and quantitative data. I also continually modified the action research project to meet the needs of my students and their instruction. It was found that the use of 3D printers really enhanced student engagement and learning. 3D printers can close students\u27 knowledge gap between virtual design and product manufacturing

Breaking Binary Being in the Future Fiction of Star Trek

Understanding gender is more complicated than traditional views of the male sex equating to being a man, and female sex equating to being a woman. This gender binary coding does not accurately represent a large number of people who identify as agender (not of a gender), or gender-fluid (not having a fixed gender.) I am investigating to what extent Star Trek (which is a science fiction often accredited with the premise of representing humanity\u27s more equitable future society) reproduces traditional gender roles or offers alternate gender identities. I look at literature from other scholars about gender performances in Star Trek, as well as analyze an episode form ST:TNG, The Outcast , looking at how the production treats a species of androgynous beings, and ultimately seeking whether Star Trek breaks deeply embedded ideas of binary gender, or portrays a future state of humanity as more inclusive of different types of gender identity

Reducing Tillage In Small-Scale Permanent Bed Organic Vegetable Production Systems

The response of field-grown vegetable crops to reduced tillage and mulching in permanent beds was evaluated through measuring crop yields, weed pressure, earthworm counts, and soil basal respiration. Two vegetable crops (“Bush Delicata” squash and “Farao” cabbage) were started in April and May of 2016 and 2017 respectively, transplanted in late June, and harvested on 15-Sep-2016 and 25-Aug-2017. Fruit number and weight of squash, and head weight and feeding damage of cabbage were measured. These results suggest that intensive tillage (8” rototill every year) can be successfully reduced to alternating years of shallow (2”) rototilling and a less intensive form of tillage (e.g. biotill or DZT) without loss of yields. No-till as practiced in this experiment experienced major yield losses, while no-till accompanied by pre-season tarping was capable of yields that equaled or exceeded any tilled treatment. Mulching crops has a positive effect on crop yields, with a 3” compost mulch yielding the highest of any tillage/mulch combination regardless of tillage type, and with straw-mulched treatments usually yielding higher than unmulched plots but lower than compost-mulched plots. Weed populations were also sampled once each year in the same plots, with number of weeds, percent leaf area, and number of species in a 0.25 m2 quadrant collected for each plot. Tilled treatments had similar weed pressure regardless of tillage intensity, with the exception of 2” Rototill. Weed populations were highest in No-till plots in both seasons, and lowest in Tarped plots. Compost-mulched plots had the best weed control, followed by Straw and Unmulched plots. Straw-mulched plots were inconsistent in their weed control and had major insect problems in 2017. Most plots had similar weed species, with the exception of Tarped plots, which had no perennial weeds and significantly lower weed diversity. No-till plots appeared to be shifting towards aggressive or perennial weeds, while tarping combined with compost mulch almost completely eliminated weed populations. Soil health was measured through earthworm counts and basal soil respiration on three of the tillage treatments. Earthworm counts were performed by hand sorting at the start of the 2017 growing season, and revealed that earthworms favored plots that had high quantities of plant residue (straw-mulch). Soil respiration was measured during the growing season of 2017, utilizing the 24-hour Solvita™ basal respiration test, which was performed on minimally disturbed field-moist soil. Respiration during the growing season was not limited by temperature, but was influenced by low moisture. No-till plots had higher respiration than tilled or Tarped plots, perhaps due to diverse early-season root mass in the No-till plots. We concluded that reducing tillage is possible from the perspective of both yields and weed pressure, especially when combined with mulches, while no-till is impractical without pre-season weed control. The best yield and weed results were found in Tarped and Compost-mulched plots. Earthworms showed clear preferences for crop residues and less disturbance, while soil respiration was controlled by moisture and may have been influenced by root presence/absence

On the Lebesgue Integral

We look from a new point of view at the definition and basic properties of the Lebesgue measure and integral on Euclidean spaces, on abstract spaces, and on locally compact Hausdorff spaces. We use mini sums to give all of them a unified treatment that is more efficient than the standard ones. We also give Fubini\u27s theorem a proof that is nicer and uses much lighter technical baggage than the usual treatments

Development of a human visual system with the ability to detect inconsistent events

Current research has shown that it is possible to create a general purpose learning system that models the first few layers of the human visual system. The goal of this thesis is to build upon that idea and produce a computational model capable of learning different aspects of visual information. Simulations show that the system is capable of learning and distinguishing different types of motion. Results also give one explanation, consistent with current experiments, explaining how the human visual system learns information and as such may produce the capability to predict behavior in future experiments

Polarimetric Enhancements to Electro-Optical Aided Navigation Techniques

Navigation in indoor and urban environments by small unmanned systems is a topic of interest for the Air Force. The Advanced Navigation Technology Center at the Air Force Institute of Technology is continually looking for novel approaches to navigation in GPS deprived environments. Inertial sensors have been coupled with image aided concepts, such as feature tracking, with good results. However, feature density in areas with large, flat, smooth surfaces tends to be low. Polarimetric sensors have been used for surface reconstruction, surface characterization and outdoor navigation. This thesis combines aspects of some of these algorithms along with a realistic, micro-facet polarimetric model and a Kalman filter approach to determine surface structure and platform orientation in an indoor environment. A series of graphical user interfaces were developed to estimate surface material parameters. A more complex simulation software package was used to estimate camera attitude. A physical polarimeter was also designed and built to test the algorithms in a realistic environment. An improvement in attitude estimation of up to 50% was demonstrated