Statewide retrospective study of low acuity emergency presentations in New South Wales, Australia: who, what, where and why?

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/Abstract Objective The present study aims to use a statewide population-based registry to assess the prevalence of low acuity emergency department (ED) presentations, describe the trend in presentation rates and to determine whether they were associated with various presentation characteristics such as the type of hospital as well as clinical and demographic variables. Design and setting This was a retrospective analysis of a population-based registry of ED presentations in New South Wales (NSW). Generalised estimating equations with log links were used to determine factors associated with low acuity presentations to account for repeat presentations and the possibility of clustering of outcomes. Participants Patients were included in this analysis if they presented to an ED between January 2010 and December 2014. The outcomes of interest were low acuity presentation, defined as those who self-presented (were not transported by ambulance), were assigned a triage category of 4 or 5 (semiurgent or non-urgent) and discharged back to usual residence from ED. Results There were 10.7 million ED presentations analysed. Of these, 45% were classified as a low acuity presentation. There was no discernible increase in the rate of low acuity presentations across NSW between 2010 and 2014. The strongest predictors of low acuity ED presentation were age <40 years of age (OR 1.77); injury or musculoskeletal administrative and non-urgent procedures (OR 2.96); ear, nose and throat, eye or oral (OR 5.53); skin or allergy-type presenting problems (OR 2.84). Conclusions Low acuity ED presentations comprise almost half of all ED presentations. Alternative emergency models of care may help meet the needs of these patients

Centro de Educacion Inicial en Punta Hermosa

El terreno de nuestro anteproyecto está localizado en el Perú, Ciudad de Lima, distrito de Punta Hermosa, en la urbanización El Carmen. Su área total es de 6,040.071 m2. Tiene una topografía poco accidentada con una pendiente de 1%. El tema de investigación está dentro del campo de la educación inicial en Punta Hermosa. Está dirigida a un sector de la población que vive en el distrito permanentemente. El concepto principal es el de una ‘ciudad para los niños’ en escala reducida. El anteproyecto tiene capacidad para 131 alumnos de 0 a 6 años, compuesta por un conjunto de aulas independientes, 5 al nivel del suelo y 6 elevadas, además de secciones separadas para los espacios adicionales de oficinas, teatro, comedor, cocina y sala de juegos. El N.P.T. de estas varia de 0.00 mt. A 1.50 mt. Utilizando acabados de colores neutros con poco contraste y estructuras de concreto y acero.Tesi

Instrumento para evaluar niveles de problemas o dificultades estresantes, los esfuerzos que se realizan para dominarlos y lo que se logra con los esfuerzos

En el presente artículo reportamos un instrumento sencillo que hemos creado para evaluar en una persona los niveles de: problemas estresantes que se le presentan (problemas); los esfuerzos que realiza intentando dominarlos (afrontamientos); y lo que consigue con esos esfuerzos (logros). Y a los resultados obtenidos con el instrumento en un grupo de pacientes ambulatorios les hemos buscado posibles relaciones con los obtenidos empleando también instrumentos validados para medir niveles de estrés social y depresión, habiendo encontrado una interesante correlación con los niveles de depresión obtenidos empleando el Inventario de la Depresión de Beck

Estrés emocional, depresión e hipercolesterolemia

Objetivo. El presente trabajo fue llevado a cabo pensando en la posibilidad de que el estrés de tipo psicológico y la depresión, al inducir hipercortisolismo, pudieran ser factores determinantes de la elevación del colesterol sanguíneo.Material y métodos. Se estudiaron 416 sujetos, con edades de 18 a 78 años (media: 35,5 años), 206 (49,5%) de sexo masculino y 210 (50,5%) de sexo femenino, atendidos por control preventivo de salud en una clínica privada de Lima, y en los cuales se determinó sus niveles de colesterol sanguíneo. Para medir el estrés de tipo psicológico se empleó la Escala para Evaluar Reajuste Social (Social Readjustment Rating Scale, SRRS) de Holmes y Rahe; y, para medir la depresión, el Inventario de la Depresión de Beck (Beck Depression Inventory, BDI). Resultados. En 97 de los 416 (23,3%) sujetos se encontró estrés psicológico significativo y en 39 (9,4%), depresión. Los niveles de colesterol sanguíneo no fueron significativamente diferentes en los sujetos con estrés que en los que no lo tenían (118-298 mg/dL, con una media ± DE de 192,3 ± 41,9 mg/dL, vs. 118-311 mg/dL, con una media ± DE de 194,5 ± 42,5 mg/dL, respectivamente); pero, sí significativamente mayores en los sujetos con depresión moderada-severa vs. los sujetos con depresión leve y con los que no la tenían (135-299 mg/dL, con una media ± DE de 229,6 ± 44,2 mg/dL vs. 144-263 mg/dL, con una media ± DE de 201 ± 50,6 mg/dL, y vs. 118-311 mg/dL, con una media ± DE de 191,7 ± 40,9 mg/dL). Conclusión: Los acontecimientos estresantes no son el problema en sí, sino el problema es la forma cómo los afrontamos: la depresión, como su consecuencia, sí parece ser negativa, ya que se asocia con uno de los principales factores de riesgo cardiovascular, que es la dislipidemia

Diagnostic accuracy of calculated serum osmolarity to predict dehydration in older people: adding value to pathology lab reports

Objectives: To assess which osmolarity equation best predicts directly measured serum/plasma osmolality and whether its use could add value to routine blood test results through screening for dehydration in older people. Design: Diagnostic accuracy study Participants: Older people (≥65 years) in 5 cohorts: Dietary Strategies for Healthy Ageing in Europe (NU-AGE, living in the community), Dehydration Recognition In our Elders (DRIE, living in residential care), Fortes (admitted to acute medical care), Sjöstrand (emergency room) or Pfortmueller cohorts (hospitalised with liver cirrhosis). Reference standard for hydration status: Directly measured serum/plasma osmolality: current dehydration (serum osmolality >300mOsm/kg), impending/current dehydration (≥295mOsm/kg). Index tests: 39 osmolarity equations calculated using serum indices from the same blood draw as directly measured osmolality. Results: Across five cohorts 595 older people were included, of whom 19% were dehydrated (directly measured osmolality >300mOsm/kg). Of 39 osmolarity equations, five showed reasonable agreement with directly measured osmolality and three had good predictive accuracy in subgroups with diabetes and poor renal function. Two equations were characterized by narrower limits of agreement, low levels of differential bias and good diagnostic accuracy in ROC plots (areas under the curve >0.8). The best equation was osmolarity =1.86 × (Na+ + K+) + 1.15 × glucose + urea + 14 (all measured in mmol/L). It appeared useful in people aged ≥65 years with and without diabetes, poor renal function, dehydration, in men and women, with a range of ages, health, cognitive and functional status. Conclusions: Some commonly used osmolarity equations work poorly, and should not be used. Given costs and prevalence of dehydration in older people we suggest use of the best formula by pathology laboratories using a cutpoint of 295mOsm/L (sensitivity 85%, specificity 59%), to report dehydration risk opportunistically when serum glucose, urea and electrolytes are measured for other reasons in older adults

Initial adherence of EPEC, EHEC and VTEC to host cells

Initial adherence to host cells is the first step of the infection of enteropathogenic Escherichia coli (EPEC), enterohaemorrhagic Escherichia coli (EHEC) and verotoxigenic Escherichia coli (VTEC) strains. The importance of this step in the infection resides in the fact that (1) adherence is the first contact between bacteria and intestinal cells without which the other steps cannot occur and (2) adherence is the basis of host specificity for a lot of pathogens. This review describes the initial adhesins of the EPEC, EHEC and VTEC strains. During the last few years, several new adhesins and putative colonisation factors have been described, especially in EHEC strains. Only a few adhesins (BfpA, AF/R1, AF/R2, Ral, F18 adhesins) appear to be host and pathotype specific. The others are found in more than one species and/or pathotype (EPEC, EHEC, VTEC). Initial adherence of EPEC, EHEC and VTEC strains to host cells is probably mediated by multiple mechanisms

Civil: "nulidad de contrato" y Administrativo: "protección al consumidor"

Materia: Nulidad de Contrato Nº de Expediente: 18347-2009-0-1801-JR-CI-37 El presente informe resume e informa respecto de un Proceso Judicial de Demanda de Nulidad de Contrato de Mutuo por Falta de Manifestación de Voluntad y por No Revestir la Forma Prescrita Bajo Sanción de Nulidad. El Proceso cuenta con Resoluciones de Primera y Segunda instancia, así como una Casación que Reforma las resoluciones señaladas anteriormente. Materia: Protección al Consumidor Nº de Expediente: 1339-2013/PS3 El presente informe resume e informa respecto de un Procedimiento Administrativo Sancionador llevado ante INDECOPI contra Inverdesa Perú S.A.C. (gimnasios Bodytech) por supuesto incumplimiento al deber de idoneidad recogido en el artículo 19 del Código de Protección y Defensa del Consumidor

Parametric Healing Environments in the AMC building: Computational design in the context of healing spaces

The following project is an exploration of computational tools, parametric design and robotic fabrication in the context of the AMC hospital. This multi-functional and complex structuralist building is due for renovation, both in terms of sustainability but also innovation, technology and place-making. It was an ideal testing ground for the way these new technologies can improve the healing qualities of space, quantitatively and qualitatively (i.e thermal comfort, acoustics, light properties, vegetation, ergonomics, etc). My design consists of a parasitic intervention or pavilion within the public areas of the AMC that integrates several parameters through variable scales and porosity and can be materialized through additive manufacturing. It also displays the interesting dynamic of how non-standard architecture can enhance standard architecture. The research and methods utilized can be transferred to other fields as well, since the scripting and algorithms developed are applicable through a wide array of projects.Architecture, Urbanism and Building Sciences | Robotic Buildin