Management of children visiting the emergency department during out-of-office hours: An observational study

Background The aim was to study the characteristics and management of children visiting the emergency department (ED) during out-of-office hours. Methods We analysed electronic health record data from 119 204 children visiting one of five EDs in four European countries. Patient characteristics and management (diagnostic tests, treatment, hospital admission and paediatric intensive care unit admission) were compared between children visiting during office hours and evening shifts, night shifts and weekend day shifts. Analyses were corrected for age, gender, Manchester Triage System urgency, abnormal vital signs, presenting problems and hospital. Results Patients presenting at night were younger (median (IQR) age: 3.7 (1.4–8.2) years vs 4.8 (1.8–9.9)), more often classified as high urgent (16.3% vs 9.9%) and more often had ≥2 abnormal vital signs (22.8% vs 18.1%) compared with office hours. After correcting for disease severity, laboratory and radiological tests were less likely to be requested (adjusted OR (aOR): 0.82, 95% CI 0.78– 0.86 and aOR: 0.64, 95% CI 0.60–0.67, respectively); treatment

Biomechanical analysis of drop and countermovement jumps

For 13 subjects the performance of drop jumps from a height of 40 cm (DJ) and of countermovement jumps (CMJ) was analysed and compared. From force plate and cine data biomechanical variables including forces, moments, power output and amount of work done were calculated for hip, knee and ankle joints. In addition, electromyograms were recorded from five muscles in the lower extremity. The results obtained for DJ appeared to depend on jumping style. In a subgroup of subjects making a movement of large amplitude (i. e. bending their hips and knees considerably before pushing off) the push-off phase of DJ closely resembled that of CMJ. In a subgroup of subjects making a movement of small amplitude, however, the duration of the push-off phase was shorter, values for moments and mean power output at the knees and ankles were larger, and the mean EMG activity of m. gastrocnemius was higher in DJ than in CMJ. The findings are attributed to the influences of the rapid pre-stretch of knee extensors and plantar flexors after touch-down in DJ. In both subgroups, larger peak resultant reaction forces were found at the knee and ankle joints, and larger peak forces were calculated for the Achilles tendon in DJ than in CMJ

HLA associations in narcolepsy type 1 persist after the 2009 H1N1 pandemic

We aimed to compare HLA-DQB1-associations in narcolepsy type 1 (NT1) patients with disease onset before and after the 2009 H1N1 pandemic in a large Dutch cohort 525 NT1 patients and 1272 HLA-DQB1*06:02-positive healthy controls were included. Because of the discussion that has arisen on the existence of sporadic and post-H1N1 NT1, HLA-DQB1-associations in pre- and post-H1N1 NT1 patients were compared. The associations between HLA-DQB1 alleles and NT1 were not significantly different between pre- and post-H1N1 NT1 patients. Both HLA-DQB1-associations with pre- and -post H1N1 NT1 reported in recent smaller studies were replicated. Our findings combine the results of studies in pre- and post-H1N1 NT1 and argue against considering post-H1N1 NT1 as a different entity

Skin temperature as a predictor of on-the-road driving performance in people with central disorders of hypersomnolence

Excessive daytime sleepiness is the core symptom of central disorders of hypersomnolence (CDH) and can directly impair driving performance. Sleepiness is reflected in relative alterations in distal and proximal skin temperature. Therefore, we examined the predictive value of skin temperature on driving performance. Distal and proximal skin temperature and their gradient (DPG) were continuously measured in 44 participants with narcolepsy type 1, narcolepsy type 2 or idiopathic hypersomnia during a standardised 1-h driving test. Driving performance was defined as the standard deviation of lateral position (SDLP) per 5?km segment (equivalent to 3?min of driving). Distal and proximal skin temperature and DPG measurements were averaged over each segment and changes over segments were calculated. Mixed-effect model analyses showed a strong, quadratic association between proximal skin temperature and SDLP (p?<?0.001) and a linear association between DPG and SDLP (p?<?0.021). Proximal skin temperature changes over 3 to 15?min were predictive for SDLP. Moreover, SDLP increased over time (0.34?cm/segment, p?<?0.001) and was higher in men than in women (3.50?cm, p?=?0.012). We conclude that proximal skin temperature is a promising predictor for real-time assessment of driving performance in people with CDH