Implementing emergency department observation units within a multihospital network

BACKGROUND: The proportion of emergency department (ED) chest pain patients who undergo an extended "rule out MI (myocardial infarction)" evaluation beyond the ED determines both the quality and cost of patient care. The higher an organization's rate of such evaluations, the lower the average miss rate for MI. Five of the 13 hospitals in the Voluntary Hospital Association Northeast multihospital network implemented ED observation units by June 1997 for outpatient rule out MI evaluations. RESULTS: Compared with historical and case controls, the five hospitals with ED observation units had a higher observation rate (16% versus 0% [p < .001] and 2% [p < .001]) and a higher rule out MI evaluation rate (61% versus 46% [p < .01] and 45% [p < .01]), without a significantly higher admission rate (47% versus 46% and 45%). For the three hospitals with observation units that collected charge data during 1997 on a consecutive series of chest pain patients who had negative rule out MI evaluations, charges for patient services were lower for patients evaluated in the ED observation unit ($2,214.80 +/- $80.40) than in the hospital ($5,464.30 +/- $393.60). CONCLUSIONS: ED observation units represent a cost-effective restructuring of the diagnostic approach to patients with acute chest pain. In an improvement of quality of patient care, a larger proportion of ED chest pain patients receive an extended evaluation than is possible with hospital admission as the only ED disposition option.     

Replacement of heavy metal containing pigments in PVC

Many companies are facing the challenge of replacing heavy metal containing pigments in their products because of possible legal restrictions as well as toxicological and environmental considerations. Replacing one pigment in a single formulation is not generally an insurmountable problem, but replacing this pigment in hundreds or perhaps thousands of formulations might generate some anxiety. The purpose of this paper is to review some of the techniques useful for pigment selection. Colorimetric properties and physical characteristics form the basis for logical selection. Chromaticity characteristics, data on relative opacity, migration resistance, hat and light stability of more than thirty pigments will be included. Examples of the use of the techniques illustrating the replacement of chromate pigments in five colors will be presented. Comparative performance data will be included. On the basis of the information presented, limitations in making high chroma yellow will be discussed.     

Collaborative study of the International Office of Cocoa, Chocolate and Sugar Confectionery on Salmonella detection from cocoa and chocolate processing environmental samples

A comparative collaborative study was performed in 13 laboratories to evaluate the use of motility enrichment on Modified Semisolid Rappaport-Vassiliadis medium for rapid Salmonella detection from food-processing environmental samples. Artificially contaminated chocolate scrapings and naturally contaminated cocoa bean dust samples were used in the study. Pre-enrichment was performed in buffered peptone water with added casein and malachite green oxalate. Motility enrichment was compared with a conventional cultural procedure using Rappaport-Vassiliadis broth and selenite cystine broth as selective enrichment. The productivity of motility enrichment was 93.5% compared to a productivity of the cultural procedure of 92%. Statistical analysis showed that there was no significant difference between the two procedures. Modified Semisolid Rappaport-Vassiliadis medium is a sensitive and simple diagnostic tool for the microbiological safety evaluation of food-processing environments.     

The methadone clinic: function and philosophy

Utilizing a paromamine-producing mutant of Micromonospora purpurea blocked in the production of gentamicin, bioconversion of various minor gentamicin components into the gentamicin C complex was demonstrated. The compounds tested were structurally related to the gentamicin C's and are found as minor components in the gentamicin fermentation. Based upon the bioconversions detected, a branched pathway for the biosynthesis of the gentamicin C components is proposed.     

Solid-liquid-solid growth mechanism of single-wall carbon nanotubes

Reasons are presented which suggest that the liquefaction of the catalytic particles is a decisive condition for formation of single wall carbon nanotubes (SWNTs) by physical synthesis techniques. It is argued that the SWNT growth mechanism is a kind of solid-liquid-solid graphitization of amorphous carbon or other imperfect carbon forms catalyzed by molten supersaturated carbon-metal nanoparticles. The assumption of low temperature melting of these nanoparticles in contact with amorphous carbon followed by its precipitation in the form of SWNTs allows to explain qualitatively the experimentally observed SWNT growth rates and temperature dependence of the SWNT yield. Guidelines for increasing SWNT yield are proposed.     

Flash hydrogenation of coal. 3. A sample of US coals

The susceptibility of a group of US coals to the production of light gaseous and liquid hydrocarbons during flash hydrogenation is examined. Eight coals ranging from lignite to high-volatile A bituminous and representing five provinces, have been flash heated in 101.3 MPa of flowing hydrogen using a bench scale reactor. A 0.6 s gas phase residence time was provided to hydrocrack the vapour products. Temperatures ranged from 750 to 850°C, where maximum yields of ethane and BTX (benzene+toluene + xylene) are found. The carbon conversion decreased with increasing rank at fixed reaction conditions. Methane yields are highest for lignite. Peak ethane yields range from 6.4 to 9% carbon conversion. BTX yields have a shallow maximum at intermediate ranks, decreasing towards high and low rank coals. Total liquid yields range from 14 to 43%. Although a definite variation of yield with rank is evident, the trends, especially total liquid yields, are attended by considerable scatter. Rank is not the only, and indeed may not be the most significant variable in determining the yield of individual species in flash hydrogenation. To establish the significant variables a stepwise regression procedure was applied to the experimental data using information from the elemental, proximate and petrographic compositions of the coals as independent variables. Two variables are adequate in all cases to correlate species yield and coal properties. Exinite appears to be capable of increasing the amount of liquid obtained from other macerals.     

Individual differences in hypertext browsing strategies

The purpose of this study was to investigate differences in web browsing strategies between older and younger participants and also between individuals displaying verbaliser and imager cognitive styles. Typically, verbalisers process information in word form, whereas imagers process information in terms of images. Ten minutes each were allowed to 58 participants to read information in either a hierarchical or relational hypertext with the expectation of answering questions on this information. Browsing strategies were assessed firstly by using three indices of browsing patterns (number of pages visited, proportion of pages visited and pages revisited) and secondly by analysing assessments of browsing strategies given by independent judges. Differences were found between imagers and verbalisers for the indices of browsing patterns, with verbalisers visiting more pages in the hierarchical architecture and imagers visiting more pages in the relational architecture. Similarly, differences were noted between younger and older participants, with the younger groups visiting more pages in the hierarchical condition and the older groups visiting more pages in the relational condition. No differences were observed for the judge's ratings of browsing strategy. The findings have possible implications for the design of web-based instructional systems.     

Orientation Relationships of Reactively Grown Ba6Ti17O40 and Ba2TiSi2O8 on BaTiO3 (001) Determined by X-ray Diffractometry

Fresnoite grows at 700° and 800°C, and Ba₆Ti₇O₄₀ grows at 1200°C with definite orientations, which are determined by X-ray diffraction pole figure analysis. Partially textured fresnoite is formed at higher temperatures. The SiO₂ films react with the BaTiO₃ crystals, forming the phases Ba₂TiSi₂O₈ (fresnoite) and Ba₆Ti₁₇O₄₀. At 700° and 800°C, both phases grow with definite orientations, which are determined by X-ray diffraction pole figure analysis. Partially textured polycrystalline phases are formed at higher temperatures.