Impact of an Expeditor on Emergency Department Patient Throughput

Objective: Our hypothesis was that an individual whose primary role was to assist with patient throughput would decrease emergency department (ED) length of stay (LOS), elopements and ambulance diversion. The objective of this study was to measure how the use of an expeditor affected these throughput metrics.Methods: This pre- and post-intervention study analyzed ED patients > 21-years-old between June 2008 and June 2009, at a level one trauma center in an academic medical center with an annual ED census of 40,000 patients. We created the expeditor position as our study intervention in December 2008, by modifying the job responsibilities of an existing paramedic position. An expeditor was on duty from 1PM-1AM daily. The pre-intervention period was June to November 2008, and the post-intervention period was January to June 2009. We used multivariable to assess the impact of the expeditor on throughput metrics after adjusting for confounding variables.Results: We included a total of 13,680 visits in the analysis. There was a significant decrease in LOS after expeditor implementation by 0.4 hours, despite an increased average daily census (109 vs. 121, p<0.001). The expeditor had no impact on elopements. The probability that the ED experienced complete ambulance diversion during a 24-hour period decreased from 55.2% to 16.0% (OR:0.17, 95%CI:0.05-0.67).Conclusion: The use of an expeditor was associated with a decreased LOS and ambulance diversion. These findings suggest that EDs may be able to improve patient flow by using expeditors. This tool is under the control of the ED and does not require larger buy-in, resources, or overall hospital changes. [West J Emerg Med. 2011;12(2):198-203.

Remodelling of human atrial K+ currents but not ion channel expression by chronic β-blockade

Chronic β-adrenoceptor antagonist (β-blocker) treatment in patients is associated with a potentially anti-arrhythmic prolongation of the atrial action potential duration (APD), which may involve remodelling of repolarising K+ currents. The aim of this study was to investigate the effects of chronic β-blockade on transient outward, sustained and inward rectifier K+ currents (ITO, IKSUS and IK1) in human atrial myocytes and on the expression of underlying ion channel subunits. Ion currents were recorded from human right atrial isolated myocytes using the whole-cell-patch clamp technique. Tissue mRNA and protein levels were measured using real time RT-PCR and Western blotting. Chronic β-blockade was associated with a 41% reduction in ITO density: 9.3 ± 0.8 (30 myocytes, 15 patients) vs 15.7 ± 1.1 pA/pF (32, 14), p &#60; 0.05; without affecting its voltage-, time- or rate dependence. IK1 was reduced by 34% at −120 mV (p &#60; 0.05). Neither IKSUS, nor its increase by acute β-stimulation with isoprenaline, was affected by chronic β-blockade. Mathematical modelling suggested that the combination of ITO- and IK1-decrease could result in a 28% increase in APD90. Chronic β-blockade did not alter mRNA or protein expression of the ITO pore-forming subunit, Kv4.3, or mRNA expression of the accessory subunits KChIP2, KChAP, Kvβ1, Kvβ2 or frequenin. There was no reduction in mRNA expression of Kir2.1 or TWIK to account for the reduction in IK1. A reduction in atrial ITO and IK1 associated with chronic β-blocker treatment in patients may contribute to the associated action potential prolongation, and this cannot be explained by a reduction in expression of associated ion channel subunits

The Central Timna Valley Project: 5 Years of Ongoing Textile Research

In its initial five years of activity the Central Timna Valley Project has dedicated its efforts to the excavation of several Late Bronze and Iron Age sites (13th-9th centuries BC) in the southern Arabah Valley of Israel (fig. 1).1 The project, headed by Erez Ben-Yosef of Tel Aviv University, explores the ancient exploitation of copper ores at Timna; these were utilised for the production of copper ingots that were traded throughout the southern Levant and possibly the greater Mediterranean region. It is within the strata of several newly excavated sites that a few hundred individual textile, cordage and rope fragments were uncovered

Measuring changes in human tumour vasculature in response to therapy using functional imaging techniques

Antiangiogenic and antivascular agents provide new approaches to treating tumours. These may avoid many of the problems experienced with current approaches such as inherent and acquired resistance to treatment. Tumours do not grow beyond 1–2 mm3in size without the development of new vessels (Folkman, 1971). Such neo-vascularization (angiogenesis) allows tumour cells to increase their nutrient supply, survive and proliferate despite the new vessels often having structural and functional differences compared to normal tissue vasculature. Treatments targeted at tumour vasculature have produced impressive results in animal models (Lindsay et al, 1996; Watson et al, 1996; O’Reilly, 1997; Horsman et al, 1998). These therapies are now entering clinical trials. However, the successful introduction of these therapies into clinical practice will require the development of reliable ways to assess angiogenesis and its modification or inhibition in vivo. Here we discuss some of the emerging imaging techniques that may be useful. © 2001 Cancer Research Campaign  http://www.bjcancer.co

Toward a unified description of hadro- and photoproduction: S-wave pi- and eta-photoproduction amplitudes

The Chew-Mandelstam parameterization, which has been used extensively in the two-body hadronic sector, is generalized in this exploratory study to the electromagnetic sector by simultaneous fits to the pion- and eta-photoproduction S-wave multipole amplitudes for center-of-mass energies from the pion threshold through 1.61 GeV. We review the Chew-Mandelstam parameterization in detail to clarify the theoretical content of the SAID hadronic amplitude analysis and to place the proposed, generalized SAID electromagnetic amplitudes in the context of earlier employed parameterized forms. The parameterization is unitary at the two-body level, employing four hadronic channels and the gamma-N electromagnetic channel. We compare the resulting fit to the MAID parameterization and find qualitative agreement though, numerically, the solution is somewhat different. Applications of the extended parameterization to global fits of the photoproduction data and to global fits of the combined hadronic and photoproduction data are discussed.Comment: 9 pages, 9 figures; added figures and tex

Precise Measurement of Sigma Beam Asymmetry for Positive Pion Photoproduction on the Proton from 800 to 1500 Mev

The Sigma beam asymmetry for positive pion photoproduction on the proton has been measured over an angular range of 40-170 deg at photon energies from 0.8 to 1.5 GeV. The resulting data set includes 237 accurate points, 136 of these belonging to an almost unexplored domain above 1.05 GeV. Data of such high precision provide severe constraints for partial wave analyses. The influence of this experiment on the GW multipole analysis is demonstrated. Significant changes are found in multipoles connected to the S31(1620) and P13(1720) resonances. Comparisons using the MAID analysis are also presented.Comment: 11 pages, 4 eps figures. to be published in Physics Letters

Minimally Invasive Pharmacokinetic and Pharmacodynamic Technologies in Hypothesis-Testing Clinical Trials of Innovative Therapies

Clinical trials of new cancer drugs should ideally include measurements of parameters such as molecular target expression, pharmacokinetic (PK) behavior, and pharmacodynamic (PD) endpoints that can be linked to measures of clinical effect. Appropriate PK/PD biomarkers facilitate proof-of-concept demonstrations for target modulation; enhance the rational selection of an optimal drug dose and schedule; aid decision-making, such as whether to continue or close a drug development project; and may explain or predict clinical outcomes. In addition, measurement of PK/PD biomarkers can minimize uncertainty associated with predicting drug safety and efficacy, reduce the high levels of drug attrition during development, accelerate drug approval, and decrease the overall costs of drug development. However, there are many challenges in the development and implementation of biomarkers that probably explain their disappointingly low implementation in phase I trials. The Pharmacodynamic/Pharmacokinetic Technologies Advisory committee of Cancer Research UK has found that submissions for phase I trials of new cancer drugs in the United Kingdom often lack detailed information about PK and/or PD endpoints, which leads to suboptimal information being obtained in those trials or to delays in starting the trials while PK/PD methods are developed and validated. Minimally invasive PK/PD technologies have logistic and ethical advantages over more invasive technologies. Here we review these technologies, emphasizing magnetic resonance spectroscopy and positron emission tomography, which provide detailed functional and metabolic information. Assays that measure effects of drugs on important biologic pathways and processes are likely to be more cost-effective than those that measure specific molecular targets. Development, validation, and implementation of minimally invasive PK/PD methods are encourage