Medical Students in the Emergency Department and Patient Length of Stay

Quantitative assessments of how trainees affect patient care have been limited, especially in the emergency department (ED). A US study by Pitts et al found that supervised resident visits were associated with greater resource use, including longer length of stay (LOS) in the ED. As EDs host more core clerkship courses, less experienced students have become involved in bedside care. This study examined the association between the presence of medical students in the ED and patient LOS, an established patient-centered outcome and marker of ED performance

Targeted Next-Generation Sequencing Analysis of 1,000 Individuals with Intellectual Disability.

To identify genetic causes of intellectual disability (ID), we screened a cohort of 986 individuals with moderate to severe ID for variants in 565 known or candidate ID-associated genes using targeted next-generation sequencing. Likely pathogenic rare variants were found in ∼11% of the cases (113 variants in 107/986 individuals: ∼8% of the individuals had a likely pathogenic loss-of-function [LoF] variant, whereas ∼3% had a known pathogenic missense variant). Variants in SETD5, ATRX, CUL4B, MECP2, and ARID1B were the most common causes of ID. This study assessed the value of sequencing a cohort of probands to provide a molecular diagnosis of ID, without the availability of DNA from both parents for de novo sequence analysis. This modeling is clinically relevant as 28% of all UK families with dependent children are single parent households. In conclusion, to diagnose patients with ID in the absence of parental DNA, we recommend investigation of all LoF variants in known genes that cause ID and assessment of a limited list of proven pathogenic missense variants in these genes. This will provide 11% additional diagnostic yield beyond the 10%-15% yield from array CGH alone.Action Medical Research (SP4640); the Birth Defect Foundation (RG45448); the Cambridge National Institute for Health Research Biomedical Research Centre (RG64219); the NIHR Rare Diseases BioResource (RBAG163); Wellcome Trust award WT091310; The Cell lines and DNA bank of Rett Syndrome, X-linked mental retardation and other genetic diseases (member of the Telethon Network of Genetic Biobanks (project no. GTB12001); the Genetic Origins of Congenital Heart Disease Study (GO-CHD)- funded by British Heart Foundation (BHF)This is the final version of the article. It first appeared from Wiley via http://dx.doi.org/10.1002/humu.2290

The Relationship between Antimicrobial Use and Antimicrobial Resistance in Europe

In Europe, antimicrobial resistance has been monitored since 1998 by the European Antimicrobial Resistance Surveillance System (EARSS). We examined the relationship between penicillin nonsusceptibility of invasive isolates of Streptococcus pneumoniae (an indicator organism) and antibiotic sales. Information was collected on 1998-99 resistance data for invasive isolates of S. pneumoniae to penicillin, based on surveillance data from EARSS and on outpatient sales during 1997 for beta-lactam antibiotics and macrolides. Our results show that in Europe antimicrobial resistance is correlated with use of beta-lactam antibiotics and macrolides

Adaptive Tracking Techniques in Non-Stationary Environments

The continuously changing environments have been the main challenge for classical GNSS receiver implementations, as they can have a great impact on signal tracking performance and positioning. For this reason techniques capable of mitigating the impact of time-varying phenomena by adapting to changing conditions, thus improving performance are of great interest. This study reports the benefits of using adaptive techniques for standalone GNSS receivers in three different scenarios. The first scenario compares an adaptive Kalman filter against a classical DLL/PLL architecture in interference environments with user dynamics. The second scenario uses a multipath propagation channel to test alternative carrier tracking architectures which provide better results in terms of robustness. The third scenario uses the same multipath propagation channel to test the adaptive switching technique, 2-Step, in order to evaluate its capacity of guaranteeing and maintaining unambiguous tracking for BOC-type modulations. In order to assess the performance of these techniques a semi-analytical platform has been used. The results presented here show the benefits and trade-offs of different techniques taking into account different propagation channels and scenarios

Trading Uncertainty and Market Form.

This paper examines purely random multilateral matching among a large number of informationally isolated individuals who desire to trade. The structure of links among traders is characterized by means of random graphs, defined by a parameter that is chosen by prospective traders. Trading groups of all sizes (including pairs as a special case) result, but the size distribution may contain a mass point at infinity. That is, within a certain subset of the entire economy, trading uncertainty is entirely eliminated. The equilibrium price distribution consists of a mass point and of a mixture of densities. Copyright 1990 by Economics Department of the University of Pennsylvania and the Osaka University Institute of Social and Economic Research Association.

Behaviour of EHD films subjested to lateral oscillations

In many machine elements working in the elastohydrodynamic lubrication regime the components are subjected to low amplitude oscillatory motions, which disturb the conditions for optimum formation of the lubricant film. Most of these applications involve combined vibrations in both vertical and longitudinal directions. For example, in gears and rolling element bearings vertical vibrations may be caused by changes in load, speed or geometry at the contact point, while the longitudinal vibration is often a direct result of the torsional vibrations of the shaft. Vibrations also transmit to these machine elements from other parts of the assembly or from the surrounding environment. Vibrations are usually harmful because they reduce the accuracy of motion and may impede the formation of a lubricant film, thus affecting the durability of machine components.The aim of this is study is to investigate the behaviour of EHD films during lateral oscillatory motion using the optical interferometry technique

Experimental investigation into the response of elastohydrodynamic films to harmonic vibrations

Many machine components, which work in the Elastohydrodynamic (EHD) lubrication regime, including transportation bearings, reciprocating engines, geared transmissions experience vibrations, which result in a rapid variation of contact load or entrainment speed. The bearings supporting the main spindle of machine tools are subjected to vibrations generated by the cutting process, the gearbox, geometrical inaccuracies and also vibrations from the surrounding environment. It is very important to understand how these vibrations affect the lubrication and functioning of the bearings supporting the main spindle, in order to maintain the desired precision and accuracy of the cutting process