To evaluate the daily output measures of the emergency department (ED) in association with seasonality and the day of the week. A retrospective cohort of ED visits to tertiary medical centers between ...2016 and 2020. The research unit was each day during the study period. The independent variables were season and day of the week. The dependent variables were ED visits, admission and dropout rates, and duration of ED discharge. The comparison of means was evaluated using ANOVA. Statistical significance was set at P < .05. There were 1826 days, 792 thousand visits, 58% were female. Admission rate 28%, duration to discharge 3.8 h, dropout rate 2%. The average daily visits by season ranged from 101% of the overall average in autumn to 97% in spring. Average daily visits by day of the week were significantly different, with the highest on Sunday (Israel's first working day of the week), 124% of the overall daily average, and the lowest on Saturday (weekly day off) with 70%. Saturdays had the highest admission rate of 30% and 28% of the overall rate. There was a moderate dependency between the ED duration and discharge, with a dropout rate of r2 = 0.19. The average daily visits were not affected by season but differed considerably by day of the week. Admission rates varied slightly by season but were similar by day of the week apart from Saturdays. This may be attributable to the case mix on Saturdays or less restriction to admit when the number of visits is low. We recommended each Emergency Department to evaluate its daily output measures dependency with seasonality and day of the week for operational optimization.
In many countries around the globe, private freehold lands cover large areas. Conservation on these private lands, next to statutory protected areas, promises to play a critical role in efforts for ...reaching internationally agreed environmental protection targets. Lying at the heart of an emerging land system science, in which ecology, economics, geography, psychology, and other social sciences interact, private land conservation is reflecting the intertwined and multiscalar processes of our rapidly transforming world. Situated at this disciplinary meeting point, private land conservation invites a great breadth of approaches and cross-disciplinary work that offer deep insights into social and environmental change, often from surprising angles. Although many questions remain in private land conservation, we can now build on a large body of recent high-quality studies as we push this field forward in both research and practice. The Special Feature “Private Land Conservation - Landowner Motives, Policies, and Outcomes of Conservation Measures in Unprotected Landscapes” brings together contributions that explore the diversity of recent advances in private land conservation science. As an introduction to this Special Feature, first we are reviewing recent dynamics in important social-ecological drivers with bearing on private land conservation science. We go on to introduce the individual contributions to this Special Feature and then examine common themes as they are emerging from these papers, including the need for flexibility in conservation approaches, pursuit of community cobenefits of conservation, increasing consideration of environmental justice questions, and acknowledgment of the importance of social psychology in shaping private land conservation. We conclude with identification of knowledge gaps and recommendations for future research, as we advance from diagnostics to normative work in private land conservation science.
•Over-diagnosis of infections could lead to antibiotic overprescription.•One third of ED pneumonias were discordant to the internal medicine diagnosis.•The assistance of radiologists might help in ...reducing over diagnosis.•Reducing over-diagnosis consequently minimizes antibiotic overprescription.
Achieving a high degree of diagnostic accuracy of infections in the emergency department (ED) is crucial since a delay in diagnosis can lead to increased mortality, whereas overdiagnosis can lead to antibiotic overprescription. Limited data are available as to ED diagnostic accuracy of infections. The aim of this study was to demonstrate the degree of discordance of an ED diagnosis of pneumonia in relation to an internal medicine ward’s discharge diagnosis of hospitalized adults.
We reviewed the records of all adults hospitalized in internal wards from November 2017-January 2018 diagnosed with an acute infection by an ED physician. The primary outcome was the discordance degree of an ED pneumonia diagnosis compared to the internal ward discharge diagnosis. The influence comorbidities and clinical characteristics on the diagnostic discordance were also evaluated.
The study included 875 adults; 434 were admitted with an ED diagnosis of a specific infection. Pneumonia was the most frequent ED diagnosis (n = 195, 45%), of them, 56 (29%) were discordant diagnosis in the internal ward.
Interpretation of chest X-rays with the assistance of a radiologist might help in reducing overdiagnosis and minimize antibiotic overprescription, thus improving the ED diagnostic accuracy of pneumonia.
Land conversion for agriculture, residential developments and infrastructure expansion is one of the main problems in environmental conservation. Government policies for public lands alone are ...unlikely to stem these dynamics. It is increasingly recognized that private land conservation is an essential part of environmental protection and especially properties of non-farm, private landowners are interesting for conservation purposes. However, non-farm, private landowners are less likely to respond to traditional motivators for environmental conservation and little is known about the conservation attitudes and values of this group. To gain a better understanding of private land conservation, the current study explored the relationships of 13 non-farm, private landowners with their land and its natural environment. Interpretive Phenomenological Analysis was used as the approach because of its practical ability to reveal how personal contexts and experiences shape these relationships and how personal meaning is created. The results indicate that private landowners can have strong, affective relationships with their land that are associated with childhood histories of rural living and the enjoyment of natural spaces. These relationships increase quality of life, give a sense of belonging, and motivate a desire to protect the land against environmental degradation. The present private landowners expressed a well-developed conservation ethic. However, future conservation approaches for these properties are less clear, but might be achieved through conservation easement programs.
Projections of future climate suggest increases in global temperatures that are especially pronounced in winter in cold-temperate regions. Thermal insulation provided by snow cover to litter, soil, ...and overwintering plants will likely be affected by changing winter temperatures and might influence future species composition and ranges. We investigated effects of changing snow cover on seed germination and sapling survival of several cold-temperate tree species using a snow manipulation approach. Post-winter seed germination increased or decreased with increasing snow cover, depending on species; decreased seed germination was found in species that characteristically disperse seed in summer or fall months prior to snowfall. Post-winter sapling survival increased with increasing snow cover for all species, though some species benefitted more from increased snow cover than others. Sapling mortality was associated with root exposure, suggesting the possibility that soil frost heaving could be an important mechanism for observed effects. Our results suggest that altered snow regimes may cause re-assembly of current species–habitat relationships and may drive changes in species' biogeographic range. However, local snow regimes also vary with associated vegetation cover and topography, suggesting that species distribution patterns may be strongly influenced by spatial heterogeneity in snow regimes and complicating future projections.
The detection of haemorrhage in trauma casualties may be delayed owing to compensatory mechanisms. This study aimed to evaluate whether the cardiovascular reserve index (CVRI) on arrival detects ...massive haemorrhage and predicts haemorrhage development in trauma casualties.
This was an observational prospective cohort study of adult casualties (≥18 years) who were brought to a single level-1 trauma centre, enroled upon arrival and followed until discharge. Vital signs were monitored on arrival, from which the CVRI and shock index were retrospectively calculated (blinded to the caregivers). The outcome measure was the eventual haemorrhage classification group: massive haemorrhage on arrival (MHOA) (defined by massive transfusion on arrival of ≥6 O+ packed cells units), developing haemorrhage (DH) (defined by a decrease in haemoglobin >1 g/dl in consecutive tests), and no significant haemorrhage noted throughout the hospital stay. The means of each variable on arrival by haemorrhage group were evaluated using the analysis of variance. The authors evaluated the detection of MHOA in the entire population and the prediction of DH in the remainders (given that MHOA had already been detected and treated) by C-statistic predefined strong prediction by area under the curve (AUC) greater than or equal to 0.8, P less than or equal to 0.05.
The study included 71 patients (after exclusion): males, 82%; average age 37.7 years. The leading cause of injuries was road accident (61%). Thirty-nine (54%) patients required hospital admission; distribution by haemorrhage classification: 5 (7%) MHOA, 5 (7%) DH, and 61 (86%) no significant haemorrhage. Detection of MHOA found a strong predictive model by CVRI and most variables (AUC 0.85-1.0). The prediction of DH on arrival showed that only lactate (AUC=0.88) and CVRI (0.82) showed strong predictive model.
CVRI showed a strong predictive model for detection of MHOA (AUC>0.8) as were most other variables. CVRI also showed a strong predictive model for detection of DH (AUC=0.82), only serum lactate predicted DH (AUC=0.88), while all other variables were not found predictive. CVRI has advantages over lactate in that it is feasible in pre-hospital and mass casualty settings. Moreover, its repeatability enables detection of deteriorating trend. The authors conclude that CVRI may be a useful additional tool in the evaluation of haemorrhage.
Abstract
Background
Electric bikes (E-bikes) and powered scooters (P-scooters) have become increasingly popular modes of public transportation, but they have been associated with injuries of all ...kinds, including dental trauma. Helmet use is promoted as a means of reducing injuries in accidents involving motorized and unmotorized vehicles. The aim of the study was to evaluate the impact of helmet use on the number and severity of oral and maxillofacial injuries caused by E-bikes and P-scooters.
Methods
A retrospective cross-sectional study design was used. The cohort included all patients referred to the emergency department of a tertiary medical center in 2014–2020 with oral and maxillofacial injuries involving E-bikes or P-scooters. Data were collected from the medical files on demographics, types of injuries, circumstances of occurrence, work-up, treatment, and outcome. Use of a helmet was recorded in each case.
Results
Of the total 1417 patients referred to the emergency department for E-bike and P-scooter-related trauma, 62 had oral and maxillofacial injuries, including 57 riders and 5 pedestrians. All had hard- or soft-tissue injuries; 20 (32.2%) had head injuries and 22 (35.5%) had dentoalveolar injuries. Eleven riders had worn a helmet at the time of injury (17.7%). Helmet use was associated with time of injury (weekday/weekend, daytime/night-time), type of motorized vehicle (E-bike or P-scooter), head injury, and number of bone fractures. Head injuries occurred more often on the weekend (57.9%) than during the week (20.9%) and were more likely to occur in riders who were not protected by a helmet (37.3% vs 18.2%). Patients who used helmets also had a lower rate of fractured bones (18.2%) and dentoalveolar injuries (23.7%) than patients who did not (68.8 and 37.3%, respectively). Interestingly, helmet use had no protective effect on soft-tissue injuries.
Conclusions
Helmet use by E-bike and P-scooter riders decreased the probability of head injury and of hard tissue and dentoalveolar injuries. These results may provide guidance for effective legislation and regulation of helmet use and improved treatment protocols for general and dental physicians.
Intensive agriculture is a main factor of biodiversity and ecosystem services loss globally. It is therefore of great importance to understand how rural landowners are managing their lands and how ...environmental stewardship behaviors could be strengthened. Farming and non-farming rural landowners are often considered a homogenous group. In reality, however, they vary by their histories, attitudes, interests, and resources. While many rural landowners manage their lands with environmental values in mind, others may struggle to do so. Ignoring this diversity poses the risk that planning and policy for sustainable agriculture are less effective than they could be. Hence, it is of interest to understand the variety of environmental perceptions and stewardship behaviors across these varied groups. To help addressing this knowledge gap, we conducted a survey of 1,200 farming and non-farming rural landowners, using Ontario as a case study. We specifically investigated whether farming landowners differed from non-farming landowners in expressed environmental concerns and stewardship behaviors, as well as what the roles are of participation in conservation incentive programs, demographic factors, and landholding characteristics. We analyzed survey answers with logistic regression and text analysis. Our results suggest that farming landowners are generally less environmentally concerned than non-farming landowners. However, it appears that this difference may be less driven by farm ownership than by contextual factors, such as landowner age and participation in conservation programs. Participation in conservation programs was more pronounced for non-farming landowners and was associated with higher likelihood of environmental concerns and engaging with stewardship behaviors. In contrast, higher age emerged as predictor of lower environmental concerns. In addition, we found that cost factors and knowledge needs were important barriers for stewardship behaviors across farming and non-farming rural landowners. Based on our results, we are making recommendations for increasing the effectiveness of agricultural sustainability planning and policy in Ontario, focusing on reducing financial and knowledge barriers to pro-environmental land management behaviors.
Fecal occult blood testing (FOBT) was developed to detect microscopic bleeding caused by colorectal neoplasms. The role of FOBT in the emergency department (ED) is typically used for 5 different ...clinical workups: trauma, anemia, syncope, hypotension, and before the administration of systemic anticoagulants or thrombolytics.
We scrutinized the literature to assess the utility of FOBT for its 5 most common applications in the emergent setting.
Logic and clinical evidence advocating for FOBT usage in the aforementioned situations are lacking. The test itself requires specific drug and dietary restrictions that are often violated or never met when patients present to the ED with acute pathologies. In addition, the poor sensitivity and specificity of the test in these scenarios dictate that neither a negative nor positive FOBT should change the subsequent clinical workup of patients presenting to the ED.
Clinical decision making should seldom be predicated on the results of a FOBT in the ED setting.
PDF
