The effect of an emergency department clinical “triggers” program based on abnormal vital signs

AbstractObjectiveTo determine the effect of a clinical triggers program in the Emergency Department (ED) setting that utilized predetermined abnormal vital signs to activate a rapid assessment by an emergency physician led multidisciplinary team.MethodsA retrospective, separate sample, pre-post intervention study following implementation of an ED triggers program. Abnormal vital sign criteria that warranted a trigger response included: heart rate <40 or >130 beats/min, respiratory rate <8 or >30 respirations/min, systolic blood pressure <90 mm Hg, or oxygen saturation <90% on room air. The primary outcome investigated was time to physician evaluation with secondary outcomes being the time to disposition decision and time to first critical therapeutic intervention.ResultsThe median time to physician evaluation was reduced by 25% from 28 min to 21 min (P<0.05). The median time to disposition decision was decreased by 12% from 154 minutes to 135 minutes (P<0.05). The median time to first intervention was 46 min and 43 min (P=0.33) in the before and after groups, which did not represent a statistically significant difference.ConclusionsIn our model, the implementation of an ED triggers program resulted in a modest decreased time to physician evaluation and disposition decision but not time to intervention

Uncertainty analysis of the use of a retailer fidelity card scheme in the assessment of food additive intake

International audienceThe feasibility of using a retailer fidelity card scheme to estimate food additive intake has been investigated in an earlier study. Fidelity card survey information was combined with information provided by the retailer on levels of the food colour Sunset Yellow (E110) in the foods to estimate a daily exposure to the additive in the Swiss population. As with any dietary exposure method the fidelity card scheme is subject to uncertainties and in this paper the impact of uncertainties associated with input variables including amounts of food purchased, levels of E110 in food, proportion of food purchased at retailer, rate of fidelity card usage, proportion of foods consumed outside of home and bodyweights and with systematic uncertainties has been assessed using a qualitative, deterministic and probabilistic approach. An analysis of the sensitivity of the results to each of the probabilistic inputs was also undertaken. The analysis was able to identify the key factors responsible for uncertainty within the model and demonstrate how the application of some simple probabilistic approaches can be used to quantitatively assess uncertainty

Heavy Quark Spectroscopy and Matrix Elements: A Lattice Study using the Static Approximation

We present results of a lattice analysis of the $B$ parameter, $B_B$, the decay constant $f_B$, and several mass splittings using the static approximation. Results were obtained for 60 quenched gauge configurations computed at $\beta=6.2$ on a lattice size of $24^3\times48$. Light quark propagators were calculated using the $O(a)$-improved Sheikholeslami-Wohlert action. We find \Bbstat(m_b) = 0.69\er{3}{4} {\rm(stat)}\er{2}{1} {\rm(syst)}, corresponding to \Bbstat = 1.02\er{5}{6}\er{3}{2}, and \fbstat = 266\err{18}{20}\err{28}{27} \mev, f_{B_s}^2 B_{B_s}/f_B^2 B_B = 1.34\er{9}{8}\er{5}{3}, where a variational fitting technique was used to extract \fbstat. For the mass splittings we obtain M_{B_s}-M_{B_d} = 87\err{15}{12}\err{6}{12} \mev, M_{\Lambda_b}-M_{B_d} = 420\errr{100}{90}\err{30}{30} \mev and M_{B^*}^2-M_B^2 = 0.281\err{15}{16}\err{40}{37} \gev^2. We compare different smearing techniques intended to improve the signal/noise ratio. From a detailed assessment of systematic effects we conclude that the main systematic uncertainties are associated with the renormalisation constants relating a lattice matrix element to its continuum counterpart. The dependence of our findings on lattice artefacts is to be investigated in the future.Comment: 40 pages, uuencoded compressed tar file, containing one LaTeX file and 14 postscript files (to be included with epsf). Minor change in the value of the B parameter. Contains corrected value for the B*-B mass splitting. Version accepted for publication in Phys. Rev.

Determinants of Restaurant Systematic Risk: A Reexamination

This study reexamines determinants of the systematic risk or beta of restaurant firms based on the financial data of 75 U.S. restaurant firms from 1996 through 1999. Our weighted least-squares regression analysis found that restaurant systematic risk correlated negatively with assets turnover but positively with quick ratio. The findings suggest that high efficiency in generating sales revenue helps lower the systematic risk, while excess liquidity tends to increase the risk

Impact of maternal body mass index and gestational weight gain on pregnancy complications : an individual participant data meta-analysis of European, North American and Australian cohorts

Objective To assess the separate and combined associations of maternal pre-pregnancy body mass index (BMI) and gestational weight gain with the risks of pregnancy complications and their population impact. Design Individual participant data meta-analysis of 39 cohorts. Setting Europe, North America, and Oceania. Population 265 270 births. Methods Information on maternal pre-pregnancy BMI, gestational weight gain, and pregnancy complications was obtained. Multilevel binary logistic regression models were used. Main outcome measures Gestational hypertension, pre-eclampsia, gestational diabetes, preterm birth, small and large for gestational age at birth. Results Higher maternal pre-pregnancy BMI and gestational weight gain were, across their full ranges, associated with higher risks of gestational hypertensive disorders, gestational diabetes, and large for gestational age at birth. Preterm birth risk was higher at lower and higher BMI and weight gain. Compared with normal weight mothers with medium gestational weight gain, obese mothers with high gestational weight gain had the highest risk of any pregnancy complication (odds ratio 2.51, 95% CI 2.31- 2.74). We estimated that 23.9% of any pregnancy complication was attributable to maternal overweight/obesity and 31.6% of large for gestational age infants was attributable to excessive gestational weight gain. Conclusions Maternal pre-pregnancy BMI and gestational weight gain are, across their full ranges, associated with risks of pregnancy complications. Obese mothers with high gestational weight gain are at the highest risk of pregnancy complications. Promoting a healthy pre-pregnancy BMI and gestational weight gain may reduce the burden of pregnancy complications and ultimately the risk of maternal and neonatal morbidity.Peer reviewe

Fish and seafood consumption during pregnancy and the risk of asthma and allergic rhinitis in childhood: a pooled analysis of 18 European and US birth cohorts

Background: It has been suggested that prenatal exposure to n-3 long-chain fatty acids protects against asthma and other allergy-related diseases later in childhood. The extent to which fish intake in pregnancy protects against child asthma and rhinitis symptoms remains unclear. We aimed to assess whether fish and seafood consumption in pregnancy is associated with childhood wheeze, asthma and allergic rhinitis. Methods: We pooled individual data from 60 774 mother-child pairs participating in 18 European and US birth cohort studies. Information on wheeze, asthma and allergic rhinitis prevalence was collected using validated questionnaires. The time periods of interest were: infancy (0-2 years), preschool age (3-4 years), and school age (5-8 years). We used multivariable generalized models to assess associations of fish and seafood (other than fish) consumption during pregnancy with child respiratory outcomes in cohort-specific analyses, with subsequent random-effects meta-analyses. Results: The median fish consumption during pregnancy ranged from 0.44 times/week in The Netherlands to 4.46 times/week in Spain. Maternal fish intake during pregnancy was not associated with offspring wheeze symptoms in any age group nor with the risk of child asthma [adjusted meta-analysis relative risk (RR) per 1-time/week = 1.01, 95% confidence interval 0.97-1.05)] and allergic rhinitis at school age (RR = 1.01, 0.99-1.03). These results were consistently found in further analyses by type of fish and seafood consumption and in sensitivity analyses. Conclusion: We found no evidence supporting a protective association of fish and seafood consumption during pregnancy with offspring symptoms of wheeze, asthma and allergic rhinitis from infancy to mid childhood.This work was supported by the European Community’s Seventh Framework Program [EU- FP7- HEALTH-2009-single-stage-241604]. Details of funding per cohort are available at IJE online

Maternal body mass index, gestational weight gain, and the risk of overweight and obesity across childhood: An individual participant data meta-analysis

Maternal obesity and excessive gestational weight gain may have persistent effects on offspring fat development. However, it remains unclear whether these effects differ by severity of obesity, and whether these effects are restricted to the extremes of maternal body mass index (BMI) and gestational weight gain. We aimed to assess the separate and combined associations of maternal BMI and gestational weight gain with the risk of overweight/obesity throughout childhood, and their population impact</p

Study on the prevalence of drug use, including intravenous drug use, and blood-borne viruses among the Irish prisoner population.

Accurate up-to-date data on the extent of drug use and the prevalence of blood-borne viruses among the prisoner population are a necessary pre-requisite for health and social service planning and policy development. The most recent national study assessing the prevalence of blood-borne viruses, along with self-reported drug use within Irish prisons (Allwright et al., 1999),was carried out over a decade ago. This study was commissioned by the National Advisory Committee on Drugs (NACD)* in 2010 with the following objectives: to describe the nature, extent and pattern of consumption for different drugs among the prisoner population; to describe methods of drug use, including intravenous drug use, among the prisoner population; to estimate the prevalence of blood-borne viruses among the prisoner population and to identify associated risk behaviours; and to measure the uptake of individual drug treatment and harm reduction interventions (including hepatitis B vaccination)in prison