Septic patients arriving with emergency medical services: a seriously ill population

Objective Sepsis is a serious condition with high mortality. Early treatment improves outcome and can be initiated by emergency medical services (EMS) personnel. The primary aim of our study was to investigate how many sepsis patients are transported by EMS to the internist at the emergency department (ED). The secondary aims were to compare these EMS patients with patients who arrived at the ED otherwise and to investigate how these patients were managed. We further investigated how often the diagnosis sepsis/infection was documented by EMS. Patients and methods We retrospectively retrieved all ED and EMS data of patients with sepsis who were assessed by the internist between March 2011 and March 2012. Results Half (48.0%) of 654 sepsis patients were transported by EMS. These patients were more seriously ill (more severe grades of sepsis, more admittances to the hospital/ICU) than patients who were transported otherwise. Mortality within 28 days was 19.4% compared with 6.5% in the other patients. Nevertheless, half of the EMS transports were considered not urgent, even in 34.6% of the patients with septic shock. Assessment of vital signs was not routinely performed and treatment was started in only 43.6%. The diagnosis sepsis/infection was documented in 63.4% of patients. Conclusion Half of the patients with sepsis arrive at the ED by EMS. These patients are seriously ill, and although these patients are likely to benefit from early treatment, they are often transported with nonurgent rides and both assessment of vital signs and early start of treatment are not routinely performed. (C) 2014 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins

Investigating medieval village formation in the Netherlands: An assessment of the output of 10 years of development-led archaeology

For the Dutch Cultural Heritage Agency (RCE), the state of knowledge on medieval village formation in the Netherlands was investigated based on the output of a decade of ‘Malta-archaeology’. The project made clear that the huge amount of development-led archaeological research has brought only limited progress on this particular theme, because of the scale of the excavations, the focus of the observations and a general lack of research frameworks at village level and regional frameworks specifically addressing village formation from which targeted research questions can be derived. In addition, very little research has been undertaken within presently inhabited villages, resulting in a major bias in the dataset towards deserted medieval settlements. To increase our understanding on village formation and the development of villages, archaeological research needs to be conducted within municipal research agendas based on an historical-geographical framework which provide specific hypotheses and questions to test and explore. Moreover, syntheses would greatly benefit from a continuity of knowledge in the region and complementary (academic) observations within existing historical villages

Beyond isolation: understanding past human-population variability in the Dutch town of Oldenzaal through the origin of its inhabitants and its infrastructural connections

This study presents a first attempt to assess the mechanisms and potential controls behind past residential mobility through the integration of isotopic data from human inhumations and spatial infrastructural information pertaining to the settlement containing these inhumations. Strontium (87Sr/86Sr) and oxygen (δ18OPDB) isotope data are derived from 200 (post)medieval individuals from the town of Oldenzaal in the present-day Netherlands. Reconstructions of historical route networks show that Oldenzaal was well-connected interregionally throughout the Middle Ages and early-modern times (ca. AD 800–1600). Although the working hypothesis was that in the past a high degree of spatial connectivity of settlements must have been positively related to a highly variable geographical origin of its inhabitants, the isotopic data from Oldenzaal indicate a population characterized by a low variability in terms of their origin. This unexpected result may be caused by (a combination of) various factors, related to (1) biases in the isotopic dataset, (2) interpretative limitations regarding the results of isotopic analyses and (3) the impact of broader socio-cultural factors that cannot be traced through isotopic analyses, such as infrastructural connectivity, socio-economics and political factors. The human oxygen isotope dataset presented here provides a first step towards a δ18OPDB reference dataset, against which future samples can be compared without the need to convert the data. This paper establishes that although in archaeology a biomolecular approach potentially provides a detailed reconstruction of the development of past populations in terms of palaeodemography and geographical/cultural origin, such studies should be performed in a transdisciplinary context in order to increase the understanding of the wider controlling factors of past population change

Archeologisch onderzoek aan de Beekseweg te Lieshout (gemeente Laarbeek, Noord-Brabant)

Lit.opg