Higher Inpatient Medical Surgical Bed Occupancy Extends Admitted Patients’ Stay

Objective: Determine the effect that increased medical surgical (med/surg) bed occupancy has on the time interval from admission order to arrival in the bed for the patients admitted from the emergency department (ED).Methods: This retrospective observational study compares the total hospital bed occupancy rate and the medical surgical inpatient bed occupancy rate to daily averages for the time interval from admission order (patient posting for admission) to the patient’s arrival in the inpatient bed. Medical surgical inpatient bed occupancy of 92% was chosen because beyond that rate we observed more frequent extended daily transfer times. The data is from a single large tertiary care institute with 590 beds and an annual ED census of 80,000.Results: Group 1 includes 38 days with (med/surg) inpatient bed occupancy rate of less than 92%, with an average ED daily wait of 2.5 hrs (95% confidence interval 2.23-2.96) for transfer from the ED to the appropriate hospital bed. Group 2 includes 68 days with med/surg census greater than 92% with an average ED daily wait of 4.1 hours (95% confidence interval 3.7-4.5). Minimum daily average for the two groups was 1.2 hrs and 1.3 hrs, respectively. The maximum average was 5.6 hrs for group 1 and 8.6 hrs for group 2. Comparison of group 1 to 2 for wait time to hospital bed yielded p <0.01. Total reported hospital occupied capacity shows a correlation coefficient of 0.16 to transfer time interval, which indicates a weak relationship between total occupancy and transfer time into the hospital. Med/surg occupancy, the beds typically used by ED patients, has a 0.62 correlation coefficient for a moderately strong relationship.Conclusions: Med/surg bed occupancy has a better correlation to extended transfer times, and occupancy over 92% at 5 AM in our institution corresponds to an increased frequency of extended transfer times from the ED. The process of ED evaluation, hospital admission, and subsequent transfer into the hospital are all complex processes. This study begins to demonstrate one variable, med/surg occupancy, as one of the intervals that can be followed to evaluate the process of ED admission and hospital flow. [WestJEM. 2009;10:93-96.

Credible threat: Perceptions of pandemic coronavirus, climate change and the morality and management of global risks

Prior research suggests that the pandemic coronavirus pushes all the “hot spots” for risk perceptions, yet both governments and populations have varied in their responses. As the economic impacts of the pandemic have become salient, governments have begun to slash their budgets for mitigating other global risks, including climate change, likely imposing increased future costs from those risks. Risk analysts have long argued that global environmental and health risks are inseparable at some level, and must ultimately be managed systemically, to effectively increase safety and welfare. In contrast, it has been suggested that we have worry budgets, in which one risk crowds out another. “In the wild,” our problem-solving strategies are often lexicographic; we seek and assess potential solutions one at a time, even one attribute at a time, rather than conducting integrated risk assessments. In a U.S. national survey experiment in which participants were randomly assigned to coronavirus or climate change surveys (N = 3203) we assess risk perceptions, and whether risk perception “hot spots” are driving policy preferences, within and across these global risks. Striking parallels emerge between the two. Both risks are perceived as highly threatening, inequitably distributed, and not particularly controllable. People see themselves as somewhat informed about both risks and have moral concerns about both. In contrast, climate change is seen as better understood by science than is pandemic coronavirus. Further, individuals think they can contribute more to slowing or stopping pandemic coronavirus than climate change, and have a greater moral responsibility to do so. Survey assignment influences policy preferences, with higher support for policies to control pandemic coronavirus in pandemic coronavirus surveys, and higher support for policies to control climate change risks in climate change surveys. Across all surveys, age groups, and policies to control either climate change or pandemic coronavirus risks, support is highest for funding research on vaccines against pandemic diseases, which is the only policy that achieves majority support in both surveys. Findings bolster both the finite worry budget hypothesis and the hypothesis that supporters of policies to confront one threat are disproportionately likely also to support policies to confront the other threat.publishedVersio

Left ventricular rotational mechanics in children after heart transplantation

Background: Left ventricular (LV) dysfunction after orthotopic heart transplantation (OHT) is multifactorial and can be an indicator of graft rejection or coronary artery vasculopathy. Analysis of rotational mechanics may help in the early diagnosis of ventricular dysfunction. Studies describing the left ventricular rotational strain in children after OHT are lacking. It is important to establish the baseline rotational mechanics in pediatric OHT to pursue further studies in this population. Methods and Results: Rotational strain measured by speckle tracking was compared in 32 children after OHT, with no evidence of active rejection or coronary artery vasculopathy with 35 age-matched normal controls. Twelve OHT patients and 13 controls underwent moderate exercise with pre- and postexercise echocardiography. Torsion, slope of the systolic limb of the torsion–radial displacement loop, and the untwist rate were significantly higher in OHT patients (torsion: median 2.7°/cm [Q1–Q3, 2.3–3.2] versus 2.3°/cm [Q1–Q3, 1.9–2.7]; P=0.03, torsion–radial displacement loop: 2.7°/mm [Q1–Q3, 2.1–3.6] versus 2.0°/mm [Q1–Q3, 1.6–2.7]; P=0.008, indexed peak untwist rate: −21.6°/s/cm [Q1–Q3, −24.3 to −15.7] versus −17.1°/s/cm [Q1–Q3, −19.6 to −13.3]; P=0.01). Contrary to controls, OHT recipients were unable to increase torsion with exercise (OHT: 2.8°/cm [2.7–3.2] versus 3°/cm [2.4–3.5]; P=0.81, controls: 2.2°/cm [2–2.6] versus 3°/cm [2.4–3.7]; P=0.01, pre and post exercise, respectively). The systolic slope of the torsion–radial displacement loop relationship decreased with exercise in most OHT patients. Conclusions: Baseline rotational strain in OHT patients is higher than normal with a blunted response to exercise. The slope of torsion–radial displacement loop, and its response to exercise, may serve as a marker of left ventricular dysfunction in OHT patients

Thermal and plasma enhanced atomic layer deposition of ultrathin TiO2 on silicon from amide and alkoxide precursors: growth chemistry and photoelectrochemical performance

Due to its low cost and suitable band gap, silicon has been studied as a photoanode material for some time. However, as a result of poor stability during the oxygen evolution reaction (OER), Si still remains unsuitable for any extended use. Ultra-thin titanium dioxide (TiO2) films have been used as protective coatings and are shown to enhance Si photoanode lifetime with added solar to hydrogen performance improvements through distancing the oxidation reaction away from the Si photoanode surface and improved charge transport through the anode. This study details the nucleation, growth chemistry, and performance of TiO2 thin films prepared via thermal and plasma enhanced atomic layer deposition (ALD) using both titanium isopropoxide and tetrakis(dimethylamido)titanium as the precursor material. The effect of post ALD treatments of plasma and air annealing was also studied. Films were investigated using photoelectrochemical cell testing to evaluate photoelectrochemical performance, and in-vacuum cycle-by-cycle x-ray photoelectron spectroscopy was used as the primary characterisation technique to study nucleation mechanisms and film properties contributing to improvements in cell performance. TiO2 grown by plasma enhanced ALD results in cleaner films with reduced carbon incorporation. However, despite increased carbon incorporation, thermally grown films showed improved photocurrent as a result of oxygen vacancies in these films. Post deposition annealing in a H2 ambient is shown to further improve photocurrent in all cases, while annealing in atmosphere leads to uniform film chemistry and enhanced photocurrent stability in all cases

The effects of baseline characteristics, glycaemia treatment approach, and glycated haemoglobin concentration on the risk of severe hypoglycaemia: post hoc epidemiological analysis of the ACCORD study

Objectives To investigate potential determinants of severe hypoglycaemia, including baseline characteristics, in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial and the association of severe hypoglycaemia with levels of glycated haemoglobin (haemoglobin A1C) achieved during therapy

Free will is not a testable hypothesis

Much recent work in neuroscience aims to shed light on whether we have free will. Can it? Can any science? To answer, we need to disentangle different notions of free will, and clarify what we mean by ‘empirical’ and ‘testable’. That done, my main conclusion is, duly interpreted: that free will is not a testable hypothesis. In particular, it is neither verifiable nor falsifiable by empirical evidence. The arguments for this are not a priori but rather are based on a posteriori consideration of the relevant neuroscientific investigations, as well as on standard philosophy of science work on the notion of testability

Free will is not a testable hypothesis

Much recent work in neuroscience aims to shed light on whether we have free will. Can it? Can any science? To answer, we need to disentangle different notions of free will, and clarify what we mean by ‘empirical’ and ‘testable’. That done, my main conclusion is, duly interpreted: that free will is not a testable hypothesis. In particular, it is neither verifiable nor falsifiable by empirical evidence. The arguments for this are not a priori but rather are based on a posteriori consideration of the relevant neuroscientific investigations, as well as on standard philosophy of science work on the notion of testability

A Pleistocene legacy structures variation in modern seagrass ecosystems

Distribution of Earth's biomes is structured by the match between climate and plant traits, which in turn shape associated communities and ecosystem processes and services. However, that climate-trait match can be disrupted by historical events, with lasting ecosystem impacts. As Earth's environment changes faster than at any time in human history, critical questions are whether and how organismal traits and ecosystems can adjust to altered conditions. We quantified the relative importance of current environmental forcing versus evolutionary history in shaping the growth form (stature and biomass) and associated community of eelgrass (Zostera marina), a widespread foundation plant of marine ecosystems along Northern Hemisphere coastlines, which experienced major shifts in distribution and genetic composition during the Pleistocene. We found that eelgrass stature and biomass retain a legacy of the Pleistocene colonization of the Atlantic from the ancestral Pacific range and of more recent within-basin bottlenecks and genetic differentiation. This evolutionary legacy in turn influences the biomass of associated algae and invertebrates that fuel coastal food webs, with effects comparable to or stronger than effects of current environmental forcing. Such historical lags in phenotypic acclimatization may constrain ecosystem adjustments to rapid anthropogenic climate change, thus altering predictions about the future functioning of ecosystems.This work was supported by the US NSF (OCE-1031061, OCE-1336206, OCE0-1336741, OCE-1336905) and the Smithsonian Institution. F.T. was supported by José Castillejo Award CAS14/00177. A.H.E. was supported by the FCT (Foundation for Science and Technology) through Project UIDB/04326/2020 and Contract CEECINST/00114/2018. This is Contribution 106 from the Smithsonian’s MarineGEO and Tennenbaum Marine Observatories Network and Contribution 4105 of the Virginia Institute of Marine Science, College of William & Mary