Waiting Times in Emergency Department After Using the Emergency Severity Index Triage Tool

Background: Hospital emergency departments (EDs) are as barometers of the health care system. Crowded EDs threaten delivery of timely care. Prolonged ED wait times reduce the quality of care and increase adverse and sometimes irreversible events. Objectives: The purpose of this study was to determine the patients' waiting time at Namazi and Shahid Faghihi hospitals in Shiraz, Iran. Patients and Methods: This analytical cross-sectional study was conducted in two phases from December 2012 to May 2013. First, the researcher attended the EDs of the two hospitals and recorded the information of 900 patients who entered the ED, including arrival time, level of triage, and time of first visit by physician. Then, among patients admitted to the ED units, 273 were followed and waiting times for the first physician order in the referral unit and the commencement of clinical interventions (defined as check time by the nurse) were recorded. Results: The median waiting time from arrival to first visit by physician for the 900 patients included in the study was 8 (5-14) minutes [median (interquartile range)]. For the patients admitted to referral units, waiting time was 84 (43-145) minutes for the physician order and 85 (45-147) minutes for the commencement of first clinical intervention; 75% of the patients in triage level I, 84.6% in triage level II, and 95.6% in triage level III were visited within the target time limit. Conclusions: Waiting time for commencement of clinical action in patients admitted to the EDs was considerably high for patients with higher priorities; so, rapid care of critically ill patients, identified during the triage process, should be emphasized

Safety Issues Improvement in Ceramic Lined Composite Pipe Produced Using SHS Method

Abstract Self-Propagating High-Temperature Synthesis (SHS) or combustion synthesis (CS) is an advanced method for producing high temperature materials such as refractory materials, intermetallics, and cermets. Combustion synthesis is characterized by extremely heating rate, high temperatures, and short reaction times. Centrifugal force densification was employing to produce dense ceramic-lined steel pipes. The centrifugal force facilitates phase separation of multi-component products during the process. In this research the safety matters in producing ceramiclined composite pipes from Fe 2 O 3 -Al powder mixture is studied. A SHS centrifugal machine with the acceleration up to a = 350g was developed. Thermite reaction of Fe 2 O 3 and Al was occurred inside the pipe to produce Al 2 O 3 ceramic in the innermost layer and Fe layer at a region between the outer steel pipe and the ceramic layer

Modes of symmetric composite defects in two-dimensional photonic crystals

We consider the modal fields and resonance frequencies of composite defects in two-dimensional photonic crystals (PCs). Using an asymptotic method based on Green's functions, we show that the coupling matrices for the composite defect can be represented as circulant or block-circulant matrices. Using the properties of these matrices, specifically that their eigenvectors are independent of the values of the matrix elements, we obtain modal properties such as dispersion relations, modal cutoff, degeneracy, and symmetry of the mode fields. Using our formulation, we investigate defects arranged on the vertices of regular polygons as well as PC ring resonators with defects arranged on the edges of polygons. Finally, we discuss the impact of band-edge degeneracies on composite-defect modes

The Influences of Chromium Supplementation on Metabolic Status in Patients with Type 2 Diabetes Mellitus and Coronary Heart Disease

This investigation was conducted to determine the effects of chromium supplementation on metabolic status in diabetic patients with coronary heart disease (CHD). This randomized, double-blind, placebo-controlled trial was performed in 64 diabetic patients with CHD between October 2017 and January 2018. Patients were randomly divided into two groups to obtain either 200 μg chromium (n = 32) or placebo (n = 32) for 12 weeks. Chromium supplementation significantly reduced body weight (� 0.9 ± 1.6 vs. + 0.1 ± 0.8 kg, P = 0.001), BMI (� 0.4 ± 0.7 vs. + 0.1 ± 0.3 kg/m2, P = 0.002), fasting glucose (β � 11.03 mg/dL; 95 CI, � 18.97, � 3.09; P = 0.007), insulin (β � 1.33 μIU/mL; 95 CI, � 1.90, � 0.76; P < 0.001), and insulin resistance (β � 0.44; 95 CI, � 0.62, � 0.25; P < 0.001) and significantly increased insulin sensitivity (β 0.007; 95 CI, 0.003, 0.01; P < 0.001) compared with the placebo. In addition, taking chromium led to a significant reduction in serum high-sensitivity C-reactive protein (hs-CRP) (β � 0.49 mg/L; 95 CI, � 0.91, � 0.06; P = 0.02) and plasma malondialdehyde (MDA) levels (β � 0.22 μmol/L; 95 CI, � 0.35, � 0.10; P = 0.001); also, a significant rise in total antioxidant capacity (TAC) (β 84.54 mmol/L; 95 CI, 31.05, 138.02; P = 0.002) was observed in comparison with placebo. Additionally, chromium administration significantly reduced diastolic blood pressure (DBP) (β � 5.01 mmHg; 95 CI, � 9.04, � 0.97; P = 0.01) compared with the placebo. Overall, the 12-week supplementation of chromium to diabetic patients with CHD had beneficial impacts on weight, BMI, glycemic control, hs-CRP, TAC, MDA, and DBP. Trial Registration www.irct.ir: http://www.irct.ir: IRCT20170513033941N30. © 2019, Springer Science+Business Media, LLC, part of Springer Nature

Frosted branch angiitis caused by Varicella Zoster virus in an immunocompetent patient

Introduction: Frosted branch angiitis(FBA) is a panuveitis with sheating of all retinal vesssels. Case presentation: Herein we report an immunocompetent person who presented with fever, headache, atypical rash, and hazy vision. Ophthalmoscopy of both eyes revealed perivascular sheathing with frosted branch angiitis pattern in veins, patchy retinal hemorrhages. Aqueous PCR analysis turned positive for VZV. Discussion: This case illustrates that VZV should be considered in the differential diagnosis of retinal perivasculitis. Since a rapid and accurate diagnosis is crucial for prompt administration of antiviral therapy, PCR-based analysis of aqueous humor is a valuable tool for detecting viruses. © 2015, IRAN. J. MICROBIOL. All rights reserved

Double-heterostructure cavities: from theory to design

We derive a frequency-domain-based approach for radiation (FAR) from double-heterostructure cavity (DHC) modes. We use this to compute the quality factors and radiation patterns of DHC modes. The semi-analytic nature of our method enables us to provide a general relationship between the radiation pattern of the cavity and its geometry. We use this to provide general designs for ultrahigh quality factor DHCs with radiation patterns that are engineered to emit vertically

Moving zero-gap Wannier-Mott excitons in graphene

We demonstrate the possibility of existence of indirect moving Wannier-Mott excitons in graphene. Electron-hole binding is conditioned by the trigonal warping of conic energy spectrum. The binding energies are found for the lowest exciton states. These energies essentially depend on the value and direction of exciton momentum and vanish when the exciton momentum tends to the conic points. The ways to observe the exciton states are discussed. The opportunity of experimental observation of zero-gap excitons by means of external electron scattering is examined.Comment: 6 pages, 7 figure

Attitude and Belief of Healthcare Professionals Towards Effective Obesity Care and Perception of Barriers : An Updated Systematic Review and Meta-analysis

Funding Information: This work was supported by the Iran University of Medical Sciences.Peer reviewedPublisher PD

Photon bound state dynamics from a single artificial atom

The interaction between photons and a single two-level atom constitutes a fundamental paradigm in quantum physics. The nonlinearity provided by the atom leads to a strong dependence of the light–matter interface on the number of photons interacting with the two-level system within its emission lifetime. This nonlinearity unveils strongly correlated quasiparticles known as photon bound states, giving rise to key physical processes such as stimulated emission and soliton propagation. Although signatures consistent with the existence of photon bound states have been measured in strongly interacting Rydberg gases, their hallmark excitation-number-dependent dispersion and propagation velocity have not yet been observed. Here we report the direct observation of a photon-number-dependent time delay in the scattering off a single artificial atom—a semiconductor quantum dot coupled to an optical cavity. By scattering a weak coherent pulse off the cavity–quantum electrodynamics system and measuring the time-dependent output power and correlation functions, we show that single photons and two- and three-photon bound states incur different time delays, becoming shorter for higher photon numbers. This reduced time delay is a fingerprint of stimulated emission, where the arrival of two photons within the lifetime of an emitter causes one photon to stimulate the emission of another

Spin-photon interface and spin-controlled photon switching in a nanobeam waveguide

Access to the electron spin is at the heart of many protocols for integrated and distributed quantum-information processing [1-4]. For instance, interfacing the spin-state of an electron and a photon can be utilized to perform quantum gates between photons [2,5] or to entangle remote spin states [6-9]. Ultimately, a quantum network of entangled spins constitutes a new paradigm in quantum optics [1]. Towards this goal, an integrated spin-photon interface would be a major leap forward. Here we demonstrate an efficient and optically programmable interface between the spin of an electron in a quantum dot and photons in a nanophotonic waveguide. The spin can be deterministically prepared with a fidelity of 96\%. Subsequently the system is used to implement a "single-spin photonic switch", where the spin state of the electron directs the flow of photons through the waveguide. The spin-photon interface may enable on-chip photon-photon gates [2], single-photon transistors [10], and efficient photonic cluster state generation [11]