Do scenic amenities foster economic growth in rural areas?

Rural areas in the Tenth District are experiencing a period of renewed economic growth in the 1990s. After a decade of lackluster performance in the 1980s, rural areas are enjoying stronger employment and income growth. Employment growth in rural areas has averaged almost 2 percent per year from 1990 to 1995,while incomes have risen just less than 1 percent per year. ; While the district's rural economy has rebounded in the 1990s, only about a third of all rural counties have shared in the recovery. There may be a number of reasons for the uneven recovery, but analysts have noted than many of the high-growth rural counties enjoy high levels of scenic amenities. In addition, research has shown that rural counties near urban areas experience stronger growth than more remote counties. In fact, over three-fourths of the high-growth rural counties in the Tenth District either have high levels of scenic amenities or are near an urban area. The impact of scenic amenities on economic performance has been discussed for years, but to date no formal study has been conducted. ; This article examines the recent economic performance of scenic rural counties in the Tenth District. The article begins by defining scenic rural counties and then compares economic performance in these counties with other rural counties. The results show that scenic rural counties have experienced higher employment and income growth than other rural areas. Moreover, scenic rural counties near urban areas have enjoyed higher employment and income growth than more remote scenic places.Federal Reserve District, 10th ; Rural areas

Perhaps we used to, but we don’t anymore: The Habitual Past in Oregonian English

From a dialectological perspective, the Pacific Northwest has been massively understudied in comparison to other areas of the U.S. Recent years have seen a growing attention to expanding our knowledge of regional dialects in this part of the country, with a number of research projects and publications beginning to address speech and variation within the Pacific Northwest. However, the vast bulk of this recent work has focused on the (socio)phonetics of the region and very little recent work has examined regional variation in morphosyntax in the Pacific Northwest. Motivated by work in York, England by Tagliamonte and Lawrence (2000, “I used to dance, but I don’t dance now: The habitual past in English,” Journal of English Linguistics 28.4), the present study examines variability in the realization of past habituality in Oregonian English. Unlike previous studies, we find extremely low rates of the form used to relative to would and preterit forms. We explore the internal and external constraints that influence the realization of these forms, and, more broadly, consider possible reasons that account for these rates of use

Emergency Department Ultrasound Is not a Sensitive Detector of Solid Organ Injury

Objective: To estimate the sensitivity and specificity of emergency department (ED) ultrasound for the detection of solid organ injury following blunt abdominal trauma.Methods: A prospective cohort study performed in the ED of an urban Level I trauma center on patients who sustained blunt abdominal trauma. Following initial standard trauma evaluation, patients underwent a secondary ultrasound examination performed specifically to identify injury to the liver or spleen, followed by computed tomography (CT) scan of the abdomen. Ultrasound examinations were performed by emergency medicine residents or attending physicians experienced in the use of ultrasound for detecting hemoperitoneum. Ultrasonographers prospectively determined the presence or absence of liver or spleen injury. CT findings were used as the criterion standard to evaluate the ultrasound results.Results: From July 1998 through June 1999, 152 patients underwent secondary ultrasound examination and CT. Of the 152 patients, nine (6%) had liver injuries and 10 (7%) had spleen injuries. Ultrasound correctly detected only one of the liver injuries for a sensitivity of 11% (95% CI: 0%-48%) and a specificity of 98% (95% CI: 94%-100%). Ultrasound correctly detected eight spleen injuries for a sensitivity of 80% (95% CI: 44%-98%) and a specificity of 99% (95% CI: 95%-100%).Conclusion: Emergency ultrasound is not sensitive or specific for detecting liver or spleen injuries following blunt abdominal trauma.[WestJEM. 2009;10:1-5.

Interhospital variation in the RATPAC trial (Randomised Assessment of Treatment using Panel Assay of Cardiac markers)

Background: The RATPAC trial showed that using a point-of-care panel of CK-MB(mass), myoglobin and troponin at baseline and 90 min increased the proportion of patients successfully discharged home, leading to reduced median length of initial hospital stay. However, it did not change mean hospital stay and may have increased mean costs per patient. The aim of this study was to explore variation in outcome and costs between participating hospitals. Methods: RATPAC was a pragmatic multicentre randomised controlled trial (N=2243) and economic analysis comparing diagnostic assessment using the panel to standard care for patients with acute chest pain due to suspected myocardial infarction at six hospitals. The difference in the proportion of patients successfully discharged (primary outcome) and mean costs per patient between the participating hospitals was compared. Results: Point-of-care assessment led to a higher proportion of successful discharges in four hospitals, a lower proportion in one and was equivocal in another. The OR (95% CI) for the primary outcome varied from 0.12 (0.01 to 1.03) to 11.07 (6.23 to 19.66) with significant heterogeneity between the centres (

Blunt Abdominal Trauma Patients Are at Very Low Risk for Intra-Abdominal Injury after Emergency Department Observation

<p>Introduction: Patients are commonly admitted to the hospital for observation following blunt abdominal trauma (BAT), despite initially negative emergency department (ED) evaluations. With the current use of screening technology, such as computed tomography (CT) of the abdomen and pelvis, ultrasound, and laboratory evaluations, it is unclear which patients require observation. The objective of this study was to determine the prevalence of intra-abdominal injury (IAI) and death in hemodynamically normal and stable BAT patients with initially negative ED evaluations admitted to an ED observation unit and to define a low-risk subgroup of patients and assess whether they may be discharged without abdominal/pelvic CT or observation. Methods: This was a retrospective cohort study performed at an urban level 1 trauma center and included all BAT patients admitted to an ED observation unit as part of a BAT key clinical pathway. All were observed for at least 8 hours as part of the key clinical pathway, and only minors and pregnant women were excluded. Outcomes included the presence of IAI or death during a 40-month follow-up period. Prior to data collection, low-risk criteria were defined as no intoxication, no hypotension or tachycardia, no abdominal pain or tenderness, no hematuria, and no distracting injury. To be considered low risk, patients needed to meet all low-risk criteria. Results: Of the 1,169 patients included over the 2-year study period, 29% received a CT of the abdomen and pelvis, 6% were admitted to the hospital from the observation unit for further management, 0.4% (95% confidence interval [CI], 0.1%–1%) were diagnosed with IAI, and 0% (95% CI, 0%–0.3%) died. Patients had a median combined ED and observation length of stay of 9.5 hours. Of the 237 (20%) patients who met low-risk criteria, 7% had a CT of the abdomen and pelvis and 0% (95% CI, 0%–1.5%) were diagnosed with IAI or died. Conclusion: Most BAT patients who have initially negative ED evaluations are at low risk for IAI but still require some combination of observation and CT. A subgroup of BAT patients may be safely discharged without CT or observation after the initial evaluation. [West J Emerg Med. 2011;12(4):496–504.]</p

LunaNet: a Flexible and Extensible Lunar Exploration Communications and Navigation Infrastructure

NASA has set the ambitious goal of establishing a sustainable human presence on the Moon. Diverse commercial and international partners are engaged in this effort to catalyze scientific discovery, lunar resource utilization and economic development on both the Earth and at the Moon. Lunar development will serve as a critical proving ground for deeper exploration into the solar system. Space communications and navigation infrastructure will play an integral part in realizing this goal. This paper provides a high-level description of an extensible and scalable lunar communications and navigation architecture, known as LunaNet. LunaNet is a services network to enable lunar operations. Three LunaNet service types are defined: networking services, position, navigation and timing services, and science utilization services. The LunaNet architecture encompasses a wide variety of topology implementations, including surface and orbiting provider nodes. In this paper several systems engineering considerations within the service architecture are highlighted. Additionally, several alternative LunaNet instantiations are presented. Extensibility of the LunaNet architecture to the solar system internet is discussed

The agreement between a portable contact-mat and force-plates during bilateral vertical jumps

Force plates are commonly used when assessing vertical jumping performance but are not always affordable or practical tools for all testing situations. Twenty-four participants volunteered to take part in a study investigating the agreement between bilateral force plates and a new commercially available contact mat that records jump height, flight-time (FT), and FT of individual limbs during both countermovement (CMJ) and squat (SJ) jumps. Each participant performed six jumps of each type while standing on a contact mat placed upon a pair of in-ground force plates. When compared to the force plate via ordinary least products regression, the contact mat agreed with force plate CMJ and SJ jump height, individual limb FT during CMJs, and left-leg FT during SJs. The bilateral contact mat provided valid assessment of individual limb FT during CMJs, but not SJs. Practitioners can therefore use a bilateral contact mat interchangeably with bilateral force plates to measure SJ and CMJ performance

Randomised controlled trial of the Limit of Detection of Troponin and ECG Discharge (LoDED) strategy versus usual care in adult patients with chest pain attending the emergency department: Study protocol

© 2018 Author(s). Published by BMJ. Introduction Observational data suggest a single high-sensitivity troponin blood test taken at emergency department (ED) presentation could be used to rule out major adverse cardiac events (MACE) in 10%-60% of ED patients with chest pain. This is done using an 'undetectable' cut-off (the Limit of Detection: LoD). We combined the LoD cut-off with ECG findings to create the LoDED strategy. We aim to establish whether the LoDED strategy works under real-life conditions, when compared with existing strategies, in a way that is cost-effective and acceptable to patients. Methods and analysis This is a parallel-group pragmatic randomised controlled trial across UK EDs. Adults presenting to ED with suspected cardiac chest pain will be randomised 1:1. Existing rule-out strategies in current use across study centres, using serial high-sensitivity troponin testing, will be compared with the LoDED strategy. The primary outcome is successful early discharge (discharge from hospital within 4 hours of arrival) without MACE occurring within 30 days. Secondary outcomes include initial length of hospital stay; comparative costs; patient satisfaction and acceptability to patients. To detect a 9% difference between the early discharge rates (assuming an 8% rate in the standard care group) with 90% power, 594 patients need to be recruited, assuming a 95% follow-up rate. Ethics and dissemination The study has been approved by the Frenchay Research Ethics Committee (reference 18/SW/0038). Results will be published in an international peer-reviewed journal. Lay summaries will be made available to patients