A simple tool to predict admission at the time of triage

Aim To create and validate a simple clinical score to estimate the probability of admission at the time of triage. Methods This was a multicentre, retrospective, cross-sectional study of triage records for all unscheduled adult attendances in North Glasgow over 2 years. Clinical variables that had significant associations with admission on logistic regression were entered into a mixed-effects multiple logistic model. This provided weightings for the score, which was then simplified and tested on a separate validation group by receiving operator characteristic (ROC) analysis and goodness-of-fit tests. Results 215 231 presentations were used for model derivation and 107 615 for validation. Variables in the final model showing clinically and statistically significant associations with admission were: triage category, age, National Early Warning Score (NEWS), arrival by ambulance, referral source and admission within the last year. The resulting 6-variable score showed excellent admission/discharge discrimination (area under ROC curve 0.8774, 95% CI 0.8752 to 0.8796). Higher scores also predicted early returns for those who were discharged: the odds of subsequent admission within 28 days doubled for every 7-point increase (log odds=+0.0933 per point, p&#60;0.0001). Conclusions This simple, 6-variable score accurately estimates the probability of admission purely from triage information. Most patients could accurately be assigned to ‘admission likely’, ‘admission unlikely’, ‘admission very unlikely’ etc., by setting appropriate cut-offs. This could have uses in patient streaming, bed management and decision support. It also has the potential to control for demographics when comparing performance over time or between departments.</p

Economic impacts of climate change on water resources in the coterminous United States

A national-scale simulation-optimization model was created to generate estimates of economic impacts associated with changes in water supply and demand as influenced by climate change. Water balances were modeled for the 99 assessment sub-regions, and are presented for 18 water resource regions in the United States. Benefit functions are developed for irrigated agriculture, municipal and domestic water use, commercial and industrial water use, and hydroelectric power generation. Environmental flows below minimal levels required for environmental needs are assessed a penalty. As a demonstration of concept for the model, future climate is projected using a climate model ensemble for two greenhouse gas (GHG) emissions scenarios: a business-as-usual (BAU) scenario in which no new GHG controls are implemented, and an exemplary mitigation policy (POL) scenario in which future GHG emissions are mitigated. Damages are projected to grow less during the 21st century under the POL scenario than the BAU scenario. The largest impacts from climate change are projected to be on non-consumptive uses (e.g., environmental flows and hydropower) and relatively lower-valued consumptive uses (e.g., agriculture), as water is reallocated during reduced water availability conditions to supply domestic, commercial, and industrial uses with higher marginal values. Lower GHG concentrations associated with a mitigation policy will result in a smaller rise in temperature and thus less extensive damage to some water resource uses. However, hydropower, environmental flow penalty, and agriculture were shown to be sensitive to the change in runoff as well.United States. Environmental Protection Agency. Office of Atmospheric Programs (Contract #EP-W-07-072

The Non-Protein Amino Acid BMAA Is Misincorporated into Human Proteins in Place of l-Serine Causing Protein Misfolding and Aggregation

Mechanisms of protein misfolding are of increasing interest in the aetiology of neurodegenerative diseases characterized by protein aggregation and tangles including Amyotrophic Lateral Sclerosis (ALS), Alzheimer's disease (AD), Parkinson's disease (PD), Lewy Body Dementia (LBD), and Progressive Supranuclear Palsy (PSP). Some forms of neurodegenerative illness are associated with mutations in genes which control assembly of disease related proteins. For example, the mouse sticky mutation sti, which results in undetected mischarging of tRNAAla with serine resulting in the substitution of serine for alanine in proteins causes cerebellar Purkinje cell loss and ataxia in laboratory animals. Replacement of serine 422 with glutamic acid in tau increases the propensity of tau aggregation associated with neurodegeneration. However, the possibility that environmental factors can trigger abnormal folding in proteins remains relatively unexplored. We here report that a non-protein amino acid, β-N-methylamino-L-alanine (BMAA), can be misincorporated in place of l-serine into human proteins. We also report that this misincorporation can be inhibited by l-serine. Misincorporation of BMAA into human neuroproteins may shed light on putative associations between human exposure to BMAA produced by cyanobacteria and an increased incidence of ALS. © 2013 Dunlop et al

EXPLORATORY ANALYSIS OF RECIDIVISM OF UNREGULATED CIRCULAR MIGRATION AMONG ZIMBABWEAN IRREGULAR FEMALE LABOUR MIGRANT DEPORTEES

Employing an exploratory analysis using a sample of 20 female Zimbabwean deportees from South Africa, the paper looks into the main factors which stimulate repeat of unregulated circular migration. Besides this, the study aimed at providing deep insights into the lived experiences of the deportees who have a preference for repeat migration in its unregulated form with implications for policy to Zimbabwe as well as South Africa. The study showed the importance of cost and benefit analysis as an important argument in circular migration decisions by the female deportees.  Findings also show that young women showed strong desire to embark on unregulated circular migration and made up to 35 % of the respondents. Factors such as unpaid salaries from former employers, lack of access to documentation,  attachment with destination country, educational qualifications, experience in circular migrations, unfinished projects at home are some of the factors pushing the deportees to unregulated circular migration.  Despite xenophobia being a threat to most migrants in South Africa, 60 % of the respondents expressed little worry about this societal ill. JEL classification:  j01, j15, j61,i38 Key words: Deportees, Circular Migration, Recidivism, South Africa, Zimbabw

TOWARDS A PERSPECTIVE FOR UNDERSTANDING ANALYSIS OF IRREGULAR MIGRATION OF FEMALE LABOUR FROM ZIMBABWE TO SOUTH AFRICA

The main objective of this paper was to give a broader perspective of irregular migration of female labour from Zimbabwe to South Africa. The paper is premised on a broader study carried out on three provinces of Zimbabwe, namely Masvingo, Manicaland and Matabeleland. Employing a qualitative approach, the paper shows the multidimensional perspectives of migration in general and the specific perspectives relating to irregular migration of female labour from Zimbabwe to South Africa. The paper shows how irregular migration can be understood as a flow process. Furthermore, we come up with a   Ten Ideas Matrix for defining and understanding irregular migration. In the paper, we also develop a comprehensive framework which is an amalgamation of GIS, theoretical as well as empirical literature to help us to hypothesize probable drivers of irregular migration of female labour from Zimbabwe to South Africa.

A personal interpretation of the facial expression

The drawings and paintings of facial expressions executed for thesis presentation were derived from my ordinary observation of contemporary society. While they are self-evident manifestations of experiences by man everywhere in the universe, it has been my aim to render a microcosm of these experiences. Whether they were initiated by outside forces or by profound psychological differences, the visible manifestation of experience and feeling was what I intended to render. Although the rendition of these experiences necessitated both the psychic and physiological changes that take place in an expression, I found that they acquired a certain universality. On the other hand, they evolved from my personal inquiry into the diverse encounters, conflicts, and dilemmas experienced by mankind

A simulation-based design method to transfer surface mount RF system to flip-chip die implementation

The flip-chip technology is a high chip density solution to meet the demand for very large scale integration design. For wireless sensor node or some similar RF applications, due to the growing requirements for the wearable and implantable implementations, flip-chip appears to be a leading technology to realize the integration and miniaturization. In this paper, flip-chip is considered as part of the whole system to affect the RF performance. A simulation based design is presented to transfer the surface mount PCB board to the flip-chip die package for the RF applications. Models are built by Q3D Extractor to extract the equivalent circuit based on the parasitic parameters of the interconnections, for both bare die and wire-bonding technologies. All the parameters and the PCB layout and stack-up are then modeled in the essential parts' design of the flip-chip RF circuit. By implementing simulation and optimization, a flip-chip package is re-designed by the parameters given by simulation sweep. Experimental results fit the simulation well for the comparison between pre-optimization and post-optimization of the bare die package's return loss performance. This design method could generally be used to transfer any surface mount PCB to flip-chip package for the RF systems or to predict the RF specifications of a RF system using the flip-chip technology