Association of Clinical Characteristics With Variation in Emergency Physician Preferences for Patients.

Importance:Much of the wide variation in health care has been associated with practice variation among physicians. Physicians choosing to see patients with more (or fewer) care needs could also produce variations in care observed across physicians. Objective:To quantify emergency physician preferences by measuring nonrandom variations in patients they choose to see. Design, Setting, and Participants:This cross-sectional study used a large, detailed clinical data set from an electronic health record system of a single academic hospital. The data set included all emergency department (ED) encounters of adult patients from January 1, 2010, to May 31, 2015, as well as ED visits information. Data were analyzed from September 1, 2018, to March 31, 2019. Exposure:Patient assignment to a particular emergency physician. Main Outcomes and Measures:Variation in patient characteristics (age, sex, acuity [Emergency Severity Index score], and comorbidities) seen by emergency physicians before patient selection, adjusted for temporal factors (seasonal, weekly, and hourly variation in patient mix). Results:This study analyzed 294 915 visits to the ED seen by 62 attending physicians. Of the 294 915 patients seen, the mean (SD) age was 48.6 (19.8) years and 176 690 patients (59.9%) were women. Many patient characteristics, such as age (F = 2.2; P < .001), comorbidities (F = 1.7; P < .001), and acuity (F = 4.7; P < .001), varied statistically significantly. Compared with the lowest-quintile physicians for each respective characteristic, the highest-quintile physicians saw patients who were older (mean age, 47.9 [95% CI, 47.8-48.1] vs 49.7 [95% CI, 49.5-49.9] years, respectively; difference, +1.8 years; 95% CI, 1.5-2.0 years) and sicker (mean comorbidity score: 0.4 [95% CI, 0.3-0.5] vs 1.8 [95% CI, 1.7-1.8], respectively; difference, +1.3; 95% CI, 1.2-1.4). These differences were absent or highly attenuated during overnight shifts, when only 1 physician was on duty and there was limited room for patient selection. Compared with earlier in the shift, the same physician later in the shift saw patients who were younger (mean age, 49.7 [95% CI, 49.4-49.7] vs 44.6 [95 % CI, 44.3-44.9] years, respectively; difference, -5.1 years; 95% CI, 4.8-5.5) and less sick (mean comorbidity score: 0.7 [95% CI, 0.7-0.8] vs 1.1 [95% CI, 1.1-1.1], respectively; difference, -0.4; 95% CI, 0.4-0.4). Accounting for preference variation resulted in substantial reordering of physician ranking by care intensity, as measured by ED charges, with 48 of 62 physicians (77%) being reclassified into a different quintile and 9 of 12 physicians (75%) in the highest care intensity quintile moving into a lower quintile. A regression model demonstrated that 22% of reported ED charges were associated with physician preference. Conclusions and Relevance:This study found preference variation across physicians and within physicians during the course of a shift. These findings suggest that current efforts to reduce practice variation may not affect the variation associated with physician preferences, which reflect underlying differences in patient needs and not physician practice

A review of automatic vehicle location technologies and applications to commercial transportation

Thesis (M.S.)--Massachusetts Institute of Technology, Dept. of Civil and Environmental Engineering, 1995.Includes bibliographical references (leaves 147-149).by Ziad Y. Kanaan.M.S

Retropharyngeal Abscess in Adults: Five Case Reports and Review of the Literature

Retropharyngeal abscesses are rare in adults. They occur mostly in immunocompromised patients or as a foreign body complication. We report 5 cases of retropharyngeal abscess collected in the ENT Department of CHU Mohammed VI of Marrakech, during a two-year period (December 2008 to December 2009). Local trauma by foreign body ingestion was the aetiology in four patients. The presenting symptoms, for all patients, were fever, odynophagia, torticollis, and trismus, and the clinical examination showed bulging of the posterior wall of the oropharynx. The radiography of cervical spine showed prevertebral thickening in all cases, this thickening was associated with an aspect of vertebral lysis of the fourth cervical vertebra in one case. A CT scan was performed in all our cases and showed features of retropharyngeal abscess which was associated, in one case, with spondylodiscitis. The biological assessment found one case of diabetes. The intradermal reaction to the tuberculin was clearly positive in one case. Endobuccal abscess puncture was practiced in 4 cases; only one organism was identified by culture: Staphylococcus aureus treatment was based on triple intravenous antibiotics and anti-Koch's therapy (in one case), and the surgical drainage under general anesthesia was also performed in the case of the diabetes patient which required also the correction of hyperglycemia in intensive care unit. The outcome was good in all our patients. The diagnosis of retropharyngeal abscess can be difficult and one must seek a comorbidity; a tuberculosis aetiology must be considered in countries with a high prevalence. The management of these cases is based on antibiotics and surgical drainage

A new method for voice signal features creation

Digital audio is one of the most important types of data at present. It is used in several applications, such as human knowledge and many security and banking applications. A digital voice signal is usually of a large size where the acoustic signal consists of a set of values distributed in one column (one channel) (mono signal) or distributed in two columns (two channels) (stereo signal), these values usually are the results of sampling and quantization of the original analogue voice signal. In this paper we will introduce a method which can be used to create a signature or key, which can be used later to identify or recognize the wave file. The proposed method will be implemented and tested to show the accuracy and flexibility of this method

Neutrophil-derived microparticles are released into the coronary circulation following percutaneous coronary intervention in acute coronary syndrome patients.

To evaluate (i) local coronary and systemic levels of microparticles (MP) in acute coronary syndrome (ACS) and stable angina pectoris (SAP) patients and (ii) their release after plaque disruption with percutaneous coronary intervention (PCI). MP are small vesicles originating from plasma membranes of cells after activation or apoptosis and are implicated in the pathogenesis of atherosclerosis. Neutrophils play a role in plaque destabilization and shed neutrophil-derived MP that have the potential to drive significant proinflammatory and thrombotic downstream effects. Eight ACS and eight SAP patients were included. Coronary sinus (CS) samples pre-intervention (CS1), 45 s following balloon angioplasty (CS2) and at 45 s intervals following stent deployment (CS3, CS4 and CS5), together with peripheral vein samples, pre- and post-PCI were analysed for neutrophil-derived (CD66b+), endothelial-derived (CD144+), platelet-derived (CD41a+), monocyte-derived (CD14+) and apoptotic (Annexin V+) MP. ELISA for interleukin (IL)-6, myeloperoxidase (MPO) and P-selectin was also performed. CD66b+ MP levels were similar in both groups pre-intervention. Post-PCI, CS levels rose significantly in ACS but not SAP patients (ACS area under the curve (AUC): 549 ± 83, SAP AUC: 24 ± 29, P<0.01). CS CD41a+, CD144+, CD14+ and Annexin V+ MP levels did not differ between groups. Acute neutrophil-derived MP release post-PCI occurs in ACS compared with stable patients, likely to be reflective of plaque MP content in vulnerable lesions

Synthesis and Evaluation of Antibacterial and Antifungal Activities of 1,3-Disubstituted-4-thioxoimidazolidin-2-one Derivatives

1,3-Disubstituted-4-thioxoimidazolidin-2-one derivatives with various substituents at N1 and N3 were synthesized with high yields and excellent purity by the reaction of various N-arylcyanothioformamide derivatives with isocyanate derivatives. The activity of these products as antibacterial and antifungal agents was studied to through some light on structural activity relationship. Some of synthesized compounds showed significant antibacterial and antifungal activities. Most of the imidazole derivatives possess significant antifungal activity aginst S. cerevisiae (MIC 1–10 µg mL–1). As comparision with ketoconazole, most of the imidazole derivatives showed activity ranging from 50 % less activity to fourfold activity. This work is licensed under a Creative Commons Attribution 4.0 International License

In situ photoluminescence study of uncapped in As/GaAs quantum dots

We present a study of photoluminescence (PL) from uncapped non-oxidized and oxidized InAs quantum dots (QDs) on GaAs substrate as a function of the thickness of a GaAs capping layer. A photoluminescence system in ultra-high vacuum that was coupled onto a molecular beam epitaxy chamber was used in order to avoid the oxidation of the quantum dot surface. We report for the first time a PL emission obtained from uncapped as-grown (non-oxidized) InAs QDs. We also report a dramatic change in the energy position and intensity of the PL as the quantum dots get closer to the top surface of the structure and make a direct comparison between the PL from non-oxidized and oxidized uncapped InAs/GaAs QDs. On the basis of these observations, we offer a physical explanation, based on oxidized versus non-oxidized uncapped QDs, for the discrepancies between previously reported results

ASTEP South: An Antarctic Search for Transiting ExoPlanets around the celestial South pole

ASTEP South is the first phase of the ASTEP project (Antarctic Search for Transiting ExoPlanets). The instrument is a fixed 10 cm refractor with a 4kx4k CCD camera in a thermalized box, pointing continuously a 3.88 degree x 3.88 degree field of view centered on the celestial South pole. ASTEP South became fully functional in June 2008 and obtained 1592 hours of data during the 2008 Antarctic winter. The data are of good quality but the analysis has to account for changes in the point spread function due to rapid ground seeing variations and instrumental effects. The pointing direction is stable within 10 arcseconds on a daily timescale and drifts by only 34 arcseconds in 50 days. A truly continuous photometry of bright stars is possible in June (the noon sky background peaks at a magnitude R=15 arcsec-2 on June 22), but becomes challenging in July (the noon sky background magnitude is R=12.5 arcsec?2 on July 20). The weather conditions are estimated from the number of stars detected in the field. For the 2008 winter, the statistics are between 56.3 % and 68.4 % of excellent weather, 17.9 % to 30 % of veiled weather and 13.7 % of bad weather. Using these results in a probabilistic analysis of transit detection, we show that the detection efficiency of transiting exoplanets in one given field is improved at Dome C compared to a temperate site such as La Silla. For example we estimate that a year-long campaign of 10 cm refractor could reach an efficiency of 69 % at Dome C versus 45 % at La Silla for detecting 2-day period giant planets around target stars from magnitude 10 to 15. This shows the high potential of Dome C for photometry and future planet discoveries. [Short abstract