Severity of Pain is not associated with Urgency of Diagnosis in ED Patients with Abdominal Pain

Background Abdominal Pain is the most common cause of visits to US Emergency Departments (EDs) and the causes range from urgent to non-urgent diagnoses. Distinguishing urgent versus non-urgent causes of abdominal pain is done through the use of clinical exam, lab studies and diagnostic imaging such as CT scans. There are no validated clinical decision rules to assist physicians in discriminating urgent from non-urgent causes of abdominal pain or which patient needs a CT scan. There is controversy regarding the use of CT scans for patients with abdominal pain due to the increased cost, radiation exposure and length of stay. Objective The objective of this study is to compare the demographics, pain score and CT utilization for patients with urgent versus non-urgent causes of abdominal pain. Methods At an academic ED, a convenience sample of patients with abdominal pain was prospectively enrolled by research assistants during the ED visit. Research assistants abstracted treatment information from the electronic medical record for the ED and hospitalization if applicable. Finally, enrollees were telephoned 2 weeks after the index ED visit to ascertain symptom resolution and treatment outcomes. Following establishment of final diagnosis, patients were classified as having an urgent or non-urgent diagnosis based upon published peer-reviewed criteria. Risk differences in pain severity, CT scan utilization and demographics were compared to urgency of diagnosis and a paired t-test was used to estimate differences in initial clinical characteristics. Results In a model of 725 patients, 144 had urgent diagnoses and 561 had non-urgent diagnoses. There was no distinction in insurance type, income level, mean age or pain score in the two groups. Ct scan utilization was higher in patients with urgent diagnoses (42.4% versus 16.4%.) Conclusion 20.4% of patients had an urgent diagnosis for the abdominal pain. There was no difference in the pain score for patients with urgent versus non-urgent diagnosis. While work-up bias is a potential limitation, CT scan utilization was higher in patients with an urgent diagnosis suggesting appropriate clinical judgement. Future studies will need to look at ways to target the testing to more high-risk patients who present with undifferentiated abdominal pain

What is psychosis? A meta-synthesis of inductive qualitative studies exploring the experience of psychosis

Qualitative studies have played an important role in elucidating the lived experience of psychosis and there has recently been an increase in the number of such studies. There is now an urgent need to draw together the findings of these studies. This paper performed a meta-synthesis of inductive qualitative peer-reviewed research into psychosis. Ninety-eight articles were identified for systematic appraisal. Four themes, ‘Losing’, ‘Identifying a need for, and seeking, help’, ‘Rebuilding and reforging’, and ‘Better than new: gifts from psychosis’, were identified. The important implications these themes for clinicians and future research are examined upon. These findings also highlight that the experience of psychosis is much more than simply just hallucinations and/or delusions

Exploratory Pollen Analysis of the Ditch of the 1665 Turf Fort, Jamestown, Virginia

Pollen analysis of subsoil, slopewash, episodic fill, plowzone, and archaeological backdirt deposits in a core from a ditch associated with the 1665 Turf (earthwork) Fort at Jamestown, Virginia, record bare, slightly weedy local conditions around 17th-century artisan dwellings on the Jamestown waterfront and register the Virginia forest in the background before construction of the fort. Goosefoot dominated the earthwork slope; close relatives of the goldenrods were initially the most prominent plants in the open-ditch period. Pollen percolation rates adjusted for plowing and applied to ragweed-type (Ambrosia-type) percentages suggest that cultivation over the ditch began ca. 1729. Cultural matrix depostition, slopewash, and pollen percolation were crticial to the preservation of this record, and serve to emphasize the importance of evaluating pollen record formation processes in cultural landscape studies

SEGUE-2 Limits on Metal-Rich Old-Population Hypervelocity Stars In the Galactic Halo

We present new limits on the ejection of metal-rich old-population hypervelocity stars from the Galactic center (GC) as probed by the SEGUE-2 survey. Our limits are a factor of 3-10 more stringent than previously reported, depending on stellar type. Compared to the known population of B-star ejectees, there can be no more than 30 times more metal-rich old-population F/G stars ejected from the GC. Because B stars comprise a tiny fraction of a normal stellar population, this places significant limits on a combination of the GC mass function and the ejection mechanism for hypervelocity stars. In the presence of a normal GC mass function, our results require an ejection mechanism that is about 5.5 times more efficient at ejecting B-stars compared to low-mass F/G stars.Comment: 18 pages including 5 figures; Submitted to Ap