The emergency observation and assessment ward

A recent development to reduce ED crowding and increase urgent patient admissions is the opening of an Emergency Observation and Assessment Ward (EOA Ward). At these wards urgent patients are temporarily hospitalized until they can be transferred to an inpatient bed. In this paper we present an overflow model to evaluate the effect of employing an EOA Ward on elective and urgent patient admissions

An IR-Selected Galaxy Cluster at z=1.27

We report the discovery of a galaxy cluster at z=1.27. ClG J0848+4453 was found in a near-IR field survey as a high density region of objects with very red J-K colors. Optical spectroscopy of a limited number of 24 < R < 25 objects in the area shows that 6 galaxies within a 90 arcsec (0.49/h Mpc, q_O = 0.1) diameter region lie at z=1.273 +/- 0.002. Most of these 6 member galaxies have broad-band colors consistent with the expected spectral energy distribution of a passively-evolving elliptical galaxy formed at high redshift. An additional 2 galaxies located ~2 arcmin from the cluster center are also at z=1.27. Using all 8 of these spectroscopic members, we estimate the velocity dispersion is 700 +/- 180 km/s, similar to that of Abell R=1 clusters in the present epoch. A deep Rosat PSPC observation detects X-ray emission at the 5 sigma level coincident with the nominal cluster center. Assuming that the X-ray flux is emitted by hot gas trapped in the potential well of a collapsed system (no AGN is known to exist in the area), the resulting X-ray luminosity in the rest frame 0.1-2.4 keV band of L_x = 1.5 x 10^44 ergs/s suggests the presence of a moderately large mass. ClG J0848+4453 is the highest redshift cluster found without targetting a central active galaxy.Comment: Accepted for publication in The Astronomical Journal; 22 pages, 6 figures; corrected titl

Larval Specialization and Phenotypic Variation in Arctopsyche-Grandis (Trichoptera, Hydropsychidae)

Life history, trophic dynamics, abundance, and microdistribution of Arctopsyche grandis (Banks) were investigated in the Flathead River Basin, Montana. Two morphologically and ecological distinct larvae (Type I, with a head stripe and Type II, without a head stripe) were found throughout the drainage except in lower order streams. Type II larvae grew more rapidly and attained a larger size in final instar than Type I larvae. In areas where A. grandis biomass was greatest, Type I larvae were \u3e10 times as abundant as Type II larvae. Type II larvae selected microhabitats characterized by larger interstitial spaces; Type I larvae were more common in tightly compacted substrata. Food items consumed by both larval phenotypes varied between sites, indicating a natural variability in the environment. Significant differences in foods ingested were also observed between larval types within particular riverine locations, suggesting phenotypic differentiation in food habits. Larvae of both phenotypes were reared in laboratory streams. Type I were both male and female, but all Type II were female. We concluded that the presence of Type II larvae increased resource utilization and species fitness

Characteristics of the Menstrual Cycle After Discontinuation of Oral Contraceptives

Background: Menstrual cycle function may continue to be altered after discontinuation of oral contraceptives (OC). Few studies have been published on the effects of recent OC use on menstrual cycle parameters; none have examined characteristics of the menstrual flow or the quality of cervical mucus. The purpose of this retrospective matched cohort study is to assess biomarkers of the menstrual cycle after discontinuation of OCs. Methods: Among a sample of women who daily recorded observations of menstrual cycle biomarkers, 70 women who had recently discontinued OCs were randomly matched by age and parity with 70 women who had not used OCs for at least 1 year. Outcomes investigated included overall cycle length, length of the luteal phase, estimated day of ovulation, duration of menstrual flow, menstrual intensity, and mucus score. Differences between recent OC users and controls were assessed using random effects modeling. Results: Recent OC users had statistically significantly lower scores for mucus quality for cycles 1 and 2. Additionally, OC users had a later estimated day of ovulation that was statistically significant in cycle 2 and a decreased intensity of menstrual flow that was significant in the first four cycles (difference = −0.48 days). In random effects modeling, all these parameters were significantly different for the first six cycles combined. Conclusions: Menstrual cycle biomarkers are altered for at least two cycles after discontinuation of OCs, and this may help explain the temporary decrease in fecundity associated with recent OC use

Discovery of a Color-Selected Quasar at z=5.50

We present observations of RD J030117+002025, a quasar at z=5.50 discovered from deep, multi-color, ground-based observations covering 74 square arcmin. This is the most distant quasar or AGN currently known. The object was targeted as an R-band dropout, with R(AB)>26.3 (3-sigma limit in a 3 arcsec diameter region), I(AB)=23.8, and z(AB)=23.4. The Keck/LRIS spectrum shows broad Lyman-alpha/NV emission and sharp absorption decrements from the highly-redshifted hydrogen forests. The fractional continuum depression due to the Lyman-alpha forest is D(A)=0.90. RD J030117+002025 is the least luminous, high-redshift quasar known (M(B)~-22.7).Comment: 9 pages, 2 figures; to appear in the The Astrophysical Journal Letter

Summer and Winter Spatial Habitat Use by the Lake Erie Watersnake

In an effort to provide information to guide habitat management for the Lake Erie watersnake Nerodia sipedon insularum, a federally threatened and Ohio state endangered species, we used radiotelemetry to obtain spatial habitat data for adult snakes during the summer active season and during winter hibernation. During the summer active season, terrestrial habitat use was limited to a narrow band of shoreline. Among individuals, maximum distance inland from shore ranged from 1 to 50 m (mean = 8 m) and linear extent of shoreline ranged from 30 to 1,360 m (mean = 261 m). Winter hibernation occurred at varying distances inland with individual hibernation sites ranging from 1 to 580 m (mean = 29 m) from shore. Habitat use did not differ between males and females. Existing U.S. Fish and Wildlife Service habitat management guidelines suggest that ground-disturbing activities within potential hibernation areas (defined as terrestrial habitat within 161 m of shore) should be avoided in winter to prevent harm to hibernating snakes. They suggest further that excavation and removal of shrubs, standing or downed trees, root masses, animal burrows, piled rocks, cliffs, or bedrock within 21 m of shore should be avoided in summer to prevent harm to active snakes. Given that Lake Erie watersnakes have recovered to the point where delisting is being proposed, these habitat guidelines appear to be sufficient. However, maintaining voluntary compliance with habitat guidelines and meeting the need for continued public outreach will be vital to ensure long-term persistence

Nurse-Midwives’ Knowledge and Promotion of Lactational Amenorrhea and Other Natural Family-Planning Methods for Child Spacing

The purpose of this study was to describe and assess certified nurse-midwives’ (CNMs) knowledge and promotion of two modalities for child spacing, natural family-planning (NFP) and the lactational amenorrhea method (LAM). One thousand two hundred CNMs were randomly selected from a national membership list and mailed a 24-item questionnaire on NFP and LAM. Of the 514 respondents (42.8% return rate), 450 (87.5%) were currently practicing as CNMs. Respondents had an average age of 46 years, with an average of 10 years of practice. CNMs ranked NFP as the ninth most used and the eighth most effective family-planning method in their practice, with an average perceived method-effectiveness of 88% and use-effectiveness of 70%. Although most respondents felt somewhat prepared during their education program to provide NFP, only 22% would offer NFP as a family-planning option for child spacing