Changes in medical care due to the absence of internal medicine physicians in emergency departments

Objective Especially in emergency departments (EDs), a lack of internal medicine (IM) residents in charge causes difficulties in medical care and ED overcrowding. Thus, protocols without IM residents in EDs is needed. This study aimed to investigate changes in medical care when emergency medicine residents replaced the roles of IM residents. Methods This study was conducted at a single-site ED of a university medical center. The study group contained patients admitted to the IM department between September and December 2015, during which IM residents were absent in the ED. The control group contained patients admitted to the IM department between September and December 2014, during which IM residents were present in the ED. Changes in medical care between the presence and absence of IM residents in the ED were studied by comparing admission rates from the ED, length of ED stay, duration of hospitalization, and concordance of diagnoses between admission and discharge by the IM department. Results The study group contained 2,341 patients; the control group contained 2,215 patients. Admission rates from the ED increased by 53.4% (95% confidence interval [CI], P<0.001); lengths of stay decreased by 15.1% (95% CI, P<0.001); and durations of hospitalization in the pulmonology department decreased by 38.4% (95% CI, P=0.001). Concordance of diagnoses between admission and discharge decreased by 14.2% in the cardiology department (95% CI, P=0.021). Conclusion Lengths of stay were reduced without critical declines in diagnostic concordance rates when emergency medicine physicians, instead of IM residents in the ED, decided upon admissions of IM patients

Far-Ultraviolet Cooling Features of the Antlia Supernova Remnant

We present far-ultraviolet observations of the Antlia supernova remnant obtained with Far-ultraviolet IMaging Spectrograph (FIMS, also called SPEAR). The strongest lines observed are C IV 1548,1551 and C III 977. The C IV emission of this mixed-morphology supernova remnant shows a clumpy distribution, and the line intensity is nearly constant with radius. The C III 977 line, though too weak to be mapped over the whole remnant, is shown to vary radially. The line intensity peaks at about half the radius, and drops at the edge of the remnant. Both the clumpy distribution of C IV and the rise in the C IV to C III ratio towards the edge suggest that central emission is from evaporating cloudlets rather than thermal conduction in a more uniform, dense medium.Comment: 9 pages, 4 figures, will be published in ApJ December 1, 2007, v670n2 issue. see http://astro.snu.ac.kr/~jhshinn/ms.pd

Development of Field Pollutant Load Estimation Module and Linkage of QUAL2E with Watershed-Scale L-THIA ACN Model

The Long Term Hydrologic Impact Assessment (L-THIA) model was previously improved by incorporating direct runoff lag time and baseflow. However, the improved model, called the L-THIA asymptotic curve number (ACN) model cannot simulate pollutant loads from a watershed or instream water quality. In this study, a module for calculating pollutant loads from fields and through stream networks was developed, and the L-THIA ACN model was combined with the QUAL2E model (The enhanced stream water quality model) to predict instream water quality at a watershed scale. The new model (L-THIA ACN-WQ) was applied to two watersheds within the Korean total maximum daily loads management system. To evaluate the model, simulated results of total nitrogen (TN) and total phosphorus (TP) were compared with observed water quality data collected at eight-day intervals. Between simulated and observed data for TN pollutant loads in Dalcheon A watershed, the R2 and Nash–Sutcliffe efficiency (NSE) were 0.81 and 0.79, respectively, and those for TP were 0.79 and 0.78, respectively. In the Pyungchang A watershed, the R2 and NSE were 0.66 and 0.64, respectively, for TN and both statistics were 0.66 for TP, indicating that model performed satisfactorily for both watersheds. Thus, the L-THIA ACN-WQ model can accurately simulate streamflow, instream pollutant loads, and water quality

A 3D flexible neural interface based on a microfluidic interconnection cable capable of chemical delivery

The demand for multifunctional neural interfaces has grown due to the need to provide a better understanding of biological mechanisms related to neurological diseases and neural networks. Direct intracerebral drug injection using microfluidic neural interfaces is an effective way to deliver drugs to the brain, and it expands the utility of drugs by bypassing the blood–brain barrier (BBB). In addition, uses of implantable neural interfacing devices have been challenging due to inevitable acute and chronic tissue responses around the electrodes, pointing to a critical issue still to be overcome. Although neural interfaces comprised of a collection of microneedles in an array have been used for various applications, it has been challenging to integrate microfluidic channels with them due to their characteristic three-dimensional structures, which differ from two-dimensionally fabricated shank-type neural probes. Here we present a method to provide such three-dimensional needle-type arrays with chemical delivery functionality. We fabricated a microfluidic interconnection cable (µFIC) and integrated it with a flexible penetrating microelectrode array (FPMA) that has a 3-dimensional structure comprised of silicon microneedle electrodes supported by a flexible array base. We successfully demonstrated chemical delivery through the developed device by recording neural signals acutely from in vivo brains before and after KCl injection. This suggests the potential of the developed microfluidic neural interface to contribute to neuroscience research by providing simultaneous signal recording and chemical delivery capabilities. © 2021, The Author(s).1

Development of a Watershed-Scale Long-Term Hydrologic Impact Assessment Model with the Asymptotic Curve Number Regression Equation

In this study, 52 asymptotic Curve Number (CN) regression equations were developed for combinations of representative land covers and hydrologic soil groups. In addition, to overcome the limitations of the original Long-term Hydrologic Impact Assessment (L-THIA) model when it is applied to larger watersheds, a watershed-scale L-THIA Asymptotic CN (ACN) regression equation model (watershed-scale L-THIA ACN model) was developed by integrating the asymptotic CN regressions and various modules for direct runoff/baseflow/channel routing. The watershed-scale L-THIA ACN model was applied to four watersheds in South Korea to evaluate the accuracy of its streamflow prediction. The coefficient of determination (R2) and Nash–Sutcliffe Efficiency (NSE) values for observed versus simulated streamflows over intervals of eight days were greater than 0.6 for all four of the watersheds. The watershed-scale L-THIA ACN model, including the asymptotic CN regression equation method, can simulate long-term streamflow sufficiently well with the ten parameters that have been added for the characterization of streamflow

Effects of photowashing treatment on electrical properties of an AlGaN/GaN heterostructure field-effect transistor

The changes in atomic composition and surface states at the surface of AlGaN caused by photowashing treatment were studied by synchrotron radiation photoemission spectroscopy (SRPES). The effect of surface treatment on the electrical properties of AlGaN/GaN HFETs was examined by both current-voltage (I-V) and transconductance dispersion measurements. From these, the origin of changes in electrical properties caused by the photowashing treatment was proposed.open0

Intra-wave-phase cross-shore profile modelling by using boundary-fitted slowly moving grid

Coastal bed profile change is described by bed load, pick-up, and settling on a boundary-fitted moving grid. Existing bed load formula is modified by changing threshold bed shear stress to reflect local bed slope. A numerical model system adopting the above function is developed to simulate cross-shore sediment transport around swash zone with steep bed slope as well as surf zone. The model system adopts a moving boundary grid which fits bed boundary slope, and other horizontal grid lines are parallel to the bed grid line. The model system is composed of flow module and sediment transport module. The flow module solves continuity equation and Reynolds-average Navier-Stokes momentum equations in intra-wave-phase manner. The flow module provides detailed flow information including near-bed fluid velocity which varies asymmetrically within a regular wave period near sea-bed and wave-phase average undertow profile of main fluid body including wave boundary layer. The sediment transport module solves sediment mass conservation equation. Exchange of sediment mass between bed itself and fluid column containing suspended sediment happens through pick-up and deposition. Wild bed level undulation is controlled by using a smoothing method. Model system is applied to two extreme cases of sand experiments by Kajima et al., and reasonable agreements between measurements and computations are obtained for both onshore-dominant and offshore-dominant cases

Vibrio cholerae non-O1,non-O139 Isolated from Pleural Effusion Following Total Gastrectomy

We isolated non-O1, non-O139 Vibrio cholerae from pleural effusion in a patient with recurred advanced gastric caner after total gastrectomy. We also recovered the organism from the patient's stool culture. The patient did not experience gastrointestinal symptoms such as diarrhea except heartburn and epigastric discomfort from stomach cancer before admission. The suspected route of infection is directly from the gastrointestinal tract through the previous surgical wounds. After antibiotic treatment, no more V. cholerae was isolated and the patient was well discharged from the hospital. This is the first report of V. cholerae infection associated with pleural effusion in a long-term latent carrier of the organism