On-scene discharge by Emergency Care Practitioners – a viable option for South Africa?

Background: In South Africa, the national public health sector provides healthcare to the majority of the population, yet many hospitals are in a state of crisis. On-scene discharge or patient non-conveyance to hospital by Emergency Care Practitioners (ECP) may serve as a means for patients to access healthcare services while alleviating the burden on the hospitals. Aim: The aim of this study was to determine the number of patients being transported by ambulance to a public sector Emergency Department (ED) who could have potentially been managed and discharged on-scene by a South African pre-hospital ECP. Methods: This was a prospective, descriptive and quantitative study of patients brought to the ED by ambulance over a 72-hour weekend period. The medical care that was provided in the ED was compared to the existing ECP scope of practice. The patients’ disposition was also used as a surrogate to determine whether transportation to hospital was required.Results: A total of 118 patients were transported to the ED by ambulance, and 85 of these patients consented to participate in the study. Overall, 62.4% of these patients were ultimately discharged from the hospital (60.4% of discharged patients being trauma-related). Most of the treatment modalities prescribed for the discharged patients were within the ECP scope of practice.Conclusion: Pre-hospital on-scene discharge by ECPs may be a mechanism to alleviate hospital overcrowding in a failing public healthcare system. However, if an ambulance service condones the concept of on-scene discharge, they need to implement monitoring strategies to assess the subsequent outcomes for those patients discharged at the scene

The cost-effectiveness of upfront point-ofcare testing in the emergency department : a secondary analysis of a randomised, controlled trial

Abstract: Background: Time-saving is constantly sought after in the Emergency Department (ED), and Point-of-Care (POC) testing has been shown to be an effective time-saving intervention. However, when direct costs are compared, these tests commonly appear to be cost-prohibitive. Economic viability may become apparent when the timesaving is translated into financial benefits from staffing, time- and cost-saving. The purpose of this study was to evaluate the cost-effectiveness of diagnostic investigations utilised prior to medical contact for ED patients with common medical complaints. Methods: This was a secondary analysis of data from a prospective, randomised, controlled trial in order to assess the cost-effectiveness of upfront, POC testing. Eleven combinations of POC equivalents of commonly-used special investigations (blood tests (i-STAT and complete blood count (CBC)), electrocardiograms (ECGs) and x-rays (LODOX® (Low Dose X-ray)) were evaluated compared to the standard ED pathway with traditional diagnostic tests. The economic viability of each permutation was assessed using the Incremental Cost Effectiveness Ratio and Cost- Effectiveness Acceptability Curves. Expenses related to the POC test implementation were compared to the control group while taking staffing costs and time-saving into account. Results: There were 897 medical patients randomised to receive various combinations of POC tests. The most costeffective combination was the i-STAT+CBC permutation which, based on the time saving, would ultimately save money if implemented. All LODOX®-containing permutations were costlier but still saved time. Non-LODOX® permutations were virtually 100% cost-effective if an additional cost of US$50 per patient was considered acceptable. Higher staffing costs would make using POC testing even more economical. Conclusions: In certain combinations, upfront, POC testing is more cost-effective than standard diagnostic testing for common ED undifferentiated medical presentations – the most economical POC test combination being the i- STAT + CBC. Upfront POC testing in the ED has the potential to not only save time but also to save money

"Do You Know Who I Am?": Identities and Experiences of Undocumented 1.5-Generation Immigrants

This dissertation draws on participant observation, observation, and interviews with forty-five undocumented 1.5-generation immigrants to investigate how DREAMer activists use narratives to construct their identities, as a mechanism to understand their complex experiences with illegality, and as a tactic in social movement activism. Undocumented 1.5-generation immigrants channeled their assimilation into American culture into successful social movement activism. While their activist strategies were successful in garnering support for the DREAMer movement and creating a collective identity around the 1.5-generation experience, their narratives inadvertently perpetuated stereotypes, obscured intra-group inequalities, and silenced experiences with violence and trauma. Undocumented youth were taught by other activists how to talk about their experiences to convince non-immigrant audiences to support immigration reform. Activist coaching helped these youth craft narratives that accomplished specific goals. Undocumented 1.5-generation immigrants deployed their narratives in diverse settings, such as protests, legislative hearings, and theater performances, in ways that communicated messages about identity to different audiences. Although these narrative strategies garnered political success and aided in the creation of collective identity, they came at personal costs. Undocumented youth avoided narrating experiences that did not fit into dominant movement discourses, which reproduced inequality in interaction. In particular, their public narratives obscured experiences with family violence. Undocumented youth publicly silenced narratives of family violence to avoid perpetuating negative stereotypes about Latinos, but this silence had the unfortunate effect of maintaining gendered inequality in undocumented immigrant families. By analyzing multiple sources of narrative construction (participant observation, observation, and interviews), I began to understand what was or was not being said in different contexts. Ultimately, undocumented 1.5-generation immigrants challenged hegemonic, racist narratives about undocumented immigrants while simultaneously reproducing intra-group inequalities. This research shows how marginalized groups reproduce broader cultural narratives while constructing new, more inclusive discourses. This work contributes to the literature on illegality, undocumented 1.5-generation immigrants, narrative and identity, and social movements

Hypothermia in trauma patients arriving at an emergency department by ambulance in Johannesburg, South Africa : a prospective study

Abstract: Introduction: Normal body temperature is considered to be between 36 and 38°C. Temperatures that are too low may negatively affect physiological functions. In trauma cases, factors that promote the development of hypothermia include concomitant hypoxia, hypotension, decreased levels of consciousness, contact with cold surfaces, exposure to low ambient temperatures and the administration of cold fluids. Studies on emergency department related hypothermia in Africa are sparse. This study investigated instances of hypothermia in a sample of trauma cases arriving by ambulance to an emergency department in Johannesburg, South Africa. Methods: Core body temperatures of 140 trauma cases were measured upon arrival and 30 minutes later. Ambient temperatures outside the hospital, inside the ED and in the resuscitation areas were also recorded. Additional information was gathered describing the equipment available to the ambulance crews for temperature, control and rewarming. Results: Seventy-two (51%) of the cases were found to have core body temperatures less than 36°C upon arrival. Twenty-nine (21%) the cases were considered clinically hypothermic (core temperatures of less than <35°C). After 30 minutes, 79 (56%) of the participants had core body temperatures of less than 36°C and 39 (28%) remained lower than 35°C. Patients were not warming up in the ED as expected. Rather, some had become colder. The study also found that the ambient temperature in the triage area fluctuated and was recorded as less than the recommended 21°C in 95 (68%) of the cases. In addition, the majority of ambulances that transported these cases lacked appropriate equipment on board to properly facilitate temperature control and rewarming. Conclusion: Fifty-one percent of the trauma cases arriving by ambulance had core temperature <36°C. Many became even colder in the ED. Attention needs to be given to the early identification of hypothermia, the regulation of ambient temperatures inside the ED including the provision of appropriate heating and rewarming devices on ambulances

Paroles de Bernard Lambert : un paysan révolutionnaire

Le texte publié est la transcription des paroles prononcées par Bernard Lambert le 4 mai 1981 au séminaire « Luttes dans et pour l'espace rural » de Françoise Bourquelot et Nicole Mathieu à l'EHESS. Un récit de trente ans d'histoire du syndicalisme paysan, qui montre une pensée d'avant-garde, une ouverture sur les problèmes internationaux, une capacité de se projeter dans l'avenir. A former union member testimony and commitment The history of French farmers' unions since thirty years is related by Bernard LAMBERT (1931-1984), a long-time trade unionist, founder member of the union « Paysans travailleurs » and author of the book entitled Les paysans dans la lutte des classes (1970). Bernard LAMBERT's talk to a seminar held in Paris on May 4th 1981 at the EHESS, reveals, through debates put back in their context, his avant-garde ideas, his concern for international problems and his will to anticipate the future

Chronicles of Oklahoma

Notes and Documents section from Volume 92, Number 1, Spring 2014. It includes Nicole Harvey's "From “Grand Excursion” to the “Fall of Babylon”: Oklahoma City’s First Fourth of July Celebration" which explores Oklahoma's first celebration of the Fourth of July in 1889. It also includes Paul Lambert's "The Oklahoma Historians Hall of Fame: Kenny L. Brown and Loretta Y. Jackson" which honors two of the 2014 inductees into the Oklahoma Historians Hall of Fame

De l'Abbittibbi-Témiskaming

Ouvrage contenant les études suivantes: Jean Laflamme, «Naissance de la traite des fourrures en Abitibi et au Témiscamingue, 1673-1708». Nicole De Lachevrotière, «Cadillac 1971». Laurent Deshaies, «Le développement économique de l'Abitibi-Témiscamingue. Essai de prospective ou esquisse d'une géographie du futur de la région. Deuxième partie». Daniel Samson, «Étude de l'évolution de la population d'un milieu rural: Sainte-Germaine-de-Boulé, Abitibi-Ouest». Guy Perreault, «Visages de l'Abitibi-Témiscamingue». Thérèse Beaudoin, Suzanne Boutin et Louise Lambert, «Aménagement et animation touristique du Fort Témiscamingue»

Doctors’ perceptions of the impact of upfront point-of-care testing in the emergency department

Abstract: Objectives Special investigations (e.g. blood tests, electrocardiograms, x-rays) play an integral role in patient management in the emergency department (ED). Having results immediately available prior to assessing a patient may lead to improved efficiency. This could be instituted by utilizing point-of-care (POC) testing with an alternative ED workflow, but the implementation would be dependent on acceptance by the end-users. The aim of this study was to assess doctors’ perceptions of POC testing in the ED when the normal treatment pathway was modified to use upfront POC tests performed prior to doctor evaluation in an effort to decrease treatment times. Methods A prospective, randomized, controlled trial was performed in the ED where medical patients received either the normal ED workflow pathway or one of the enhanced workflow pathways with POC tests in various combinations prior to doctor evaluation. At the end of the study period, doctors were invited to participate in an anonymous survey to gauge their opinions on the implementation of the early POC testing. Results Overall, the doctors surveyed were very satisfied with use of upfront POC in the ED. One hundred per cent of the 28 doctors surveyed found it helpful to assess patients who already had test results available and would want it to be permanently available. Normalized satisfaction scores were more favorable for combinations of 3 or more tests (0.7–1.0) as opposed to combinations with 2 or less tests (0.3–0.7). There was a preference for combinations that included comprehensive blood results. Conclusion The implementation of workflow changes to assist doctors in the ED can potentially make them more productive. End-user buy-in is essential in order for the change to be successful..

RNA Bind-n-Seq: Quantitative Assessment of the Sequence and Structural Binding Specificity of RNA Binding Proteins

Specific protein-RNA interactions guide posttranscriptional gene regulation. Here, we describe RNA Bind-n-Seq (RBNS), a method that comprehensively characterizes sequence and structural specificity of RNA binding proteins (RBPs), and its application to the developmental alternative splicing factors RBFOX2, CELF1/CUGBP1, and MBNL1. For each factor, we recovered both canonical motifs and additional near-optimal binding motifs. RNA secondary structure inhibits binding of RBFOX2 and CELF1, while MBNL1 favors unpaired Us but tolerates C/G pairing in motifs containing UGC and/or GCU. Dissociation constants calculated from RBNS data using a novel algorithm correlated highly with values measured by surface plasmon resonance. Motifs identified by RBNS were conserved, were bound and active in vivo, and distinguished the subset of motifs enriched by CLIP-Seq that had regulatory activity. Together, our data demonstrate that RBNS complements crosslinking-based methods and show that in vivo binding and activity of these splicing factors is driven largely by intrinsic RNA affinity.National Science Foundation (U.S.) (0821391