Uncompleted Emergency Department Care (UEDC): A 5-year population-based study in the Veneto Region, Italy

Introduction: Uncompleted visits to emergency departments (UEDC) are a patient safety concern. The purpose of this study was to investigate risk factors for UEDC, describing not only the sociodemographic characteristics of patients who left against medical advice (AMA) and those who left without being seen (LWBS), but also the characteristics of their access to the emergency department (ED) and of the hospital structure. Methods: This was a cross sectional study on anonymized administrative data in a population-based ED database. Results: A total of 9,147,415 patients attended EDs in the Veneto Region from 2011 to 2015. The UEDC rate was 28.7\u2030, with a slightly higher rate of AMA than of LWBS (15.3\u2030 vs 13.4\u2030). Age, sex, citizenship, and residence were sociodemographic factors associated with UEDC, and so were certain characteristics of access, such as mode of admission, type of referral, emergency level, waiting time before being seen, and type of medical issue (trauma or other). Some characteristics of the hospital structure, such as the type of hospital and the volume of patients managed, could also be associated with UEDC. Conclusion: Cases of UEDC, which may involve patients who leave AMA and those who LWBS, differ considerably from other cases managed at the ED. The present findings are important for the purpose of planning and staffing health services. Decision-makers should identify and target the factors associated with UEDC to minimize walkouts from public hospital EDs

Validating the regional estimates of changes in soil organic carbon by using the data from paired-sites: the case study of Mediterranean arable lands

BACKGROUND: Legacy data are unique occasions for estimating soil organic carbon (SOC) concentration changes and spatial variability, but their use showed limitations due to the sampling schemes adopted and improvements may be needed in the analysis methodologies. When SOC changes is estimated with legacy data, the use of soil samples collected in different plots (i.e., non-paired data) may lead to biased results. In the present work, N = 302 georeferenced soil samples were selected from a regional (Sicily, south of Italy) soil database. An operational sampling approach was developed to spot SOC concentration changes from 1994 to 2017 in the same plots at the 0-30 cm soil depth and tested. RESULTS: The measurements were conducted after computing the minimum number of samples needed to have a reliable estimate of SOC variation after 23 years. By applying an effect size based methodology, 30 out of 302 sites were resampled in 2017 to achieve a power of 80%, and an α = 0.05. A Wilcoxon test applied to the variation of SOC from 1994 to 2017 suggested that there was not a statistical difference in SOC concentration after 23 years (Z = - 0.556; 2-tailed asymptotic significance = 0.578). In particular, only 40% of resampled sites showed a higher SOC concentration than in 2017. CONCLUSIONS: This finding contrasts with a previous SOC concentration increase that was found in 2008 (75.8% increase when estimated as differences of 2 models built with non-paired data), when compared to 1994 observed data (Z = - 9.119; 2-tailed asymptotic significance < 0.001). This suggests that the use of legacy data to estimate SOC concentration dynamics requires soil resampling in the same locations to overcome the stochastic model errors. Further experiment is needed to identify the percentage of the sites to resample in order to align two legacy datasets in the same area

Feeding emitters for microirrigation with a digestate liquid fraction up to 25% dilution did not reduce their performance

Irrigation with wastewater can strongly contribute to the reduction of water abstraction in agriculture with an especial interest in arid and semiarid areas. However, its use can have drawbacks to both soil and micro-irrigation systems, especially when the total solids in the wastewater are high, such as in digestate liquid fractions (DLF) from plant material. The aim of this study was thus to evaluate the performances of a serpentine shaped micro-emitter injected with a hydrocyclone filtered DLF (HF-DLF) from corn + barley biomass and evaluate the traits of the liquid released within a 8-h irrigation cycle. HF-DLF was injected at 10%, 25%, and 50% dilution compared to tap water (at pH = 7.84) and the system performances were measured. No clogging was found, which likely depended on both the shape of the emitter and the high-pressure head (200 kPa). HF-DLF dilution at 10%, 25%, and 50% consisted in +1.9%, +3.5, and -4.9% amount of liquid released compared to the control. Fluid temperature during irrigation (from 9:00 to 17:00) did not explain the difference in the released amounts of liquid. In 10% HF-DLF % and 25% HF-DLF, a pH difference of + 0.321 ± 0.014 pH units compared to the control was found, and such difference was constant for both dilutions and at increasing the time. In contrast, 50% HF-DLF increased pH by around a half point and such difference increased with time. Similar differences among treatments were found for the total solids in the liquid. These results indicate that 50% HF-DLF was accumulating materials in the serpentine. These results suggest that a low diluted HF-DLF could directly be injected in irrigation systems with few drawbacks for the irrigation system and contribute to water conservation since such wastewater are available from the late spring to the early fall, when water requirements are high