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Introduction: Low acuity patients have been controversially tagged as a source of emergency department (ED) misuse. Authorities for many Canadian health regions have set up policies so these patients preferably present to walk-in clinics (WIC). We compared the cost and quality of the care given to low acuity patients in an academic ED and a WIC of Québec City during fiscal year 2015-16. Methods: We conducted an ambidirectional (prospective and retrospective) cohort study using a time-driven activity-based costing method. This method uses duration of care processes (e.g., triage) to allocate to patient care all direct costs (e.g., personnel, consumables), overheads (e.g., building maintenance) and physician charges. We included consecutive adult patients, ambulatory at all time and discharged from the ED or WIC with a diagnosis of upper respiratory tract infection (URTI), urinary tract infection (UTI) or low back pain. Mean cost [95%CI] per patient per condition was compared between settings after risk-adjustment for age, sex, vital signs, number of regular medications and co-morbidities using generalized log-gamma regression models. Proportions [95%CI] of antibiotic prescription and chest X-Ray use in URTI, compliance with provincial guidelines on use of antibiotics in UTI, and column X-Ray use in low back pain were compared between settings using a Pearson Chi-Square test. Results: A total of 409 patients were included. ED and WIC groups were similar in terms of age, sex and vital signs on presentation, but ED patients had a greater burden of comorbidities. Adjusted mean cost (2016 CAN$) of care was significantly higher in the ED than in the WIC (p < 0.0001) for URTI (78.42[64.85-94.82] vs. 59.43[50.43-70.06]), UTI (78.88[69.53-89.48] vs. 53.29[43.68-65.03]), and low back pain (87.97[68.30-113.32] vs. 61.71[47.90-79.51]). For URTI, antibiotics were more frequently prescribed in the WIC (44.1%[34.3-54.3] vs. 5.8%[1.2-16.0]; p < 0.0001) and chest X-Rays, more frequently used in the ED (26.9%[15.6-41.0] vs. 13.7%[7.7-22.0]; p = 0.05). No significant differences were observed in the compliance with guidelines on use of antibiotics in UTI and in the use of column X-Ray in low back pain. Conclusion: Total cost of care for low acuity patients is lower in walk-in clinics than in EDs. However, our results suggest that quality-of-care issues should be considered in determining the best alternate setting for treating ambulatory emergency patients.
Late-life depression (LLD) is associated with a decline in physical activity. Typically this is assessed by self-report questionnaires and, more recently, with actigraphy. We sought to explore the utility of a bespoke activity monitor to characterize activity profiles in LLD more precisely.
The activity monitor was worn for 7 days by 29 adults with LLD and 30 healthy controls. Subjects underwent neuropsychological assessment and quality of life (QoL) (36-item Short-Form Health Survey) and activities of daily living (ADL) scales (Instrumental Activities of Daily Living Scale) were administered.
Physical activity was significantly reduced in LLD compared with controls (t = 3.63, p < 0.001), primarily in the morning. LLD subjects showed slower fine motor movements (t = 3.49, p < 0.001). In LLD patients, activity reductions were related to reduced ADL (r = 0.61, p < 0.001), lower QoL (r = 0.65, p < 0.001), associative learning (r = 0.40, p = 0.036), and higher Montgomery–Åsberg Depression Rating Scale score (r = −0.37, p < 0.05).
Patients with LLD had a significant reduction in general physical activity compared with healthy controls. Assessment of specific activity parameters further revealed the correlates of impairments associated with LLD. Our study suggests that novel wearable technology has the potential to provide an objective way of monitoring real-world function.
We have undertaken an adaptive optics imaging survey of extra-solar planetary systems and stars showing interesting radial velocity trends from high precision radial velocity searches. Adaptive Optics increases the resolution and dynamic range of an image, substantially improving the detectability of faint close companions. This survey is sensitive to objects less luminous than the bottom of the main sequence at separations as close as 1″. We have detected stellar companions to the planet bearing stars HD 114762 and Tau Boo. We have also detected a companion to the non-planet bearing star 16 Cyg A.
Near-infrared, JHKL, observations of 595 Mira variables in two fields on either side of the centre of our Galaxy, confirm that the Bulge is not spherically symmetric about its axis of rotation, but is elongated so that the part to the east of the centre is closer to us. The shape of the Bulge about its axis of rotation is not uniquely defined by these data, but the shape that deviates least from circular symmetry has an axis ratio xo/yo = 1.7, with a major axis at an angle, θ = 58° ± 7, to the plane of the sky, for a galactic centre distance, R0 = 9.4 ± 0.5 kpc. This is based on an assumed scale length in galactic coordinates of bo = 375 pc and lo/bo = 2.0.
The past few years have witnessed a great increase in the amount of work done on meteors and in the number of observers. At several observatories programmes of work have been undertaken in the hope of solving specific problems. Several countries now have flourishing meteor societies, or sections of larger astronomical societies, devoted to this field. To solve the problems that have arisen the help of other scientists, especially in physics, geology, and meteorology, has been enlisted to the mutual benefit of all. Historical research, particularly in Asia, has added much to our knowledge of meteor showers for the past thousand or more years.
During the past four years the most important events in meteoric astronomy have been the good showers of the Leonids in 1930 and 1931. When these observations are added to the predictions based on computations of the perturbations, there is good reason to hope for an even better shower in 1932, perhaps rivalling that of 1866. As to the study of meteors in general, there has been an increasing revival of interest. Meteor Notes are now regular features of many scientific journals. Never before have so many people been working in this branch of science. A very brief outline of such activities follows.
The aim of this paper is to show that historical technical archives and complementary physico-chemical studies can be combined to obtain relevant information on the materials and processes used in the manufacturing of a Breguet 765 Sahara airplane. This will be useful both in history of sciences and technology and in the renovation of this more than fifty years old airplane.
The Breguet 765 Sahara plane is the last version of a family of French double-deck transport aircraft produced by Breguet between 1948 and 1960. The gathering of multi-disciplinary information from the literature of the period of production with laboratory investigations has revealed that a “new” aluminum-copper-magnesium alloy was used in the rivets of the Breguet 765. The A-U3G alloy was developed to meet properties requirements of the aeronautical industry for joining sheets of aluminum and was used in the Breguet 765 Sahara to strengthen the joints. Analytical techniques included TEM, EPMA microprobe and metallography.
In the context of the preservation of the cultural heritage, it is important to understand the alteration mechanisms of the materials constituting historical monuments and architecture. Limestone especially is widely used in many French monuments exposed to an urban aggressive atmosphere affecting their durability. To better understand the alteration mechanisms, the first step is to characterize at different scales the stone material properties. In one hand, the pore network that drives the fluids transfer inside the materials was characterized. And on the other hand, the alteration layer formed on several decades aged materials was studied. Results on this fine-scale characterization are discussed.
The excavation of a large circular dished earthwork near Carnforth,
North Lancashire, in 1982, has revealed a substantial Bronze Age funerary
monument. The earliest structure was a sub-rectangular enclosure of
limestone boulders dated to c. 1740–1640 BC cal. and
associated with parts of two poorly preserved inhumation burials lying on
the previously cleared ground surface. Both burials were accompanied by
typologically early metalwork. The central inhumation was associated with
a flat axe and dagger, suggesting an individual of high status as well as
providing an important link between the early stages of development of
both bronze types. The subsequent overlying cairn of smaller stones
included eleven fairly discrete concentrations of inhumed bone, and seven
of cremated bone and pottery. All this material was extremely
fragmentary, and was probably derived from later re-use of the
We theoretically and experimentally investigate a novel modulation concept on silicon (Si) based on the combination of quantum confinement and plasmon enhancement effects. We experimentally study the suitability of Ge/SiGe quantum wells (QWs) on Si as the active material for a plasmon-enhanced optical modulator. We demonstrate that in QW structures absorption and modulation of light with transverse magnetic (TM) polarization are greatly enhanced due to favorable selection rules. Later, we theoretically study the plasmon propagation at the metal-Ge/SiGe QW interface. We design a novel Ge/SiGe QW structure that allows maximized overlap between the plasmonic mode and the underlying Ge/SiGe QWs.
Here we present the installation and successful commissioning of an L'-band Annular Groove Phase Mask (AGPM) coronagraph on VLT/NACO. The AGPM is a vector vortex coronagraph made from diamond subwavelength gratings tuned to the L' band. The vector vortex coronagraph enables high contrast imaging at very small inner working angle (here 0″.09, the diffraction limit of the VLT at L'), potentially being the key to a new parameter space. During technical and science verification runs, we discovered a late-type companion at two beamwidths from an F0V star (Mawet et al. 2013), and imaged the inner regions of β Pictoris down to the previously unexplored projected radius of 1.75 AU. The circumstellar disk was also resolved from ≃ 1″ to 5″ (see J. Milli et al., these proceedings). These results showcase the potential of the NACO L-band AGPM over a wide range of spatial scales.
Fifty years after the hyporheic zone was first defined (Orghidan, 1959), there are still gaps in the knowledge regarding the role of biodiversity in hyporheic processes. First, some methodological questions remained unanswered regarding the interactions between biodiversity and physical processes, both for the study of habitat characteristics and interactions at different scales. Furthermore, many questions remain to be addressed to help inform our understanding of invertebrate community dynamics, especially regarding the trophic niches of organisms, the functional groups present within sediment, and their temporal changes. Understanding microbial community dynamics would require investigations about their relationship with the physical characteristics of the sediment, their diversity, their relationship with metabolic pathways, their interactions with invertebrates, and their response to environmental stress. Another fundamental research question is that of the importance of the hyporheic zone in the global metabolism of the river, which must be explored in relation to organic matter recycling, the effects of disturbances, and the degradation of contaminants. Finally, the application of this knowledge requires the development of methods for the estimation of hydrological exchanges, especially for the management of sediment clogging, the optimization of self-purification, and the integration of climate change in environmental policies. The development of descriptors of hyporheic zone health and of new metrology is also crucial to include specific targets in water policies for the long-term management of the system and a clear evaluation of restoration strategies.
In view of the increasing importance of the transportation of newborn and premature infants in distress, we have felt the need to create a mobile unit for pediatric reanimation. Therefore, it was important to build a very well-defined and specially adapted mobile unit for these kinds of particularly delicate transportations.
For this purpose, and with the agreement of the pediatricians, we have adopted a solution that seems compatible with this kind of work.
A combination of small angle scattering (SAS) and neutron spin-echo (NSE) spectroscopy is used to characterize the structure and dynamics of polymeric silica aerogels during sintering. The SAS data indicate that densification at short length scales precedes the densification at longer scales (comparable to that of the pore structure). Interpreted within the fracton model, the NSE data are consistent with an initial decrease in connectivity during relatively early stages of densification.
The Mössbauer spectroscopy is an efficient experimental tool to study lithium insertion mechanisms in negative electrodes of Li-ion batteries at the atomic scale. However, a quantitative interpretation of the experimental data is often difficult due to the complexity of the spectra and we propose to use first-principle calculations of the hyperfine parameters. Three different types of negative electrode materials are considered. First, the experimental 119Sn Mössbauer spectrum obtained for the insertion of 3.5 Li into SnO is compared to the theoretical spectrum, which clearly establishes the existence of Li-Sn stable phases. Then, the analysis of the 121Sb Mössbauer spectra for metal antimonides at the end of the first discharge shows different behaviours depending on the lithium rate. Finally, tin and iron doped titanates are considered to study changes in Ti local environments during lithium insertion.
This work aims at attaining a more complete understanding of the principles governing resistive contrast imaging (RCI) of copper/low-k interconnects used for dielectric breakdown studies in a nanoprober scanning electron microscope (SEM) system. RCI is employed in such in situ dielectric breakdown studies to facilitate the localization of interconnect defect sites related to various stages in the degradation process of the low-k dielectric material. This work shows that RCI is suitable for detecting high-resistance sites, like opens, in copper/low-k interconnects. Moreover, RCI demonstrates potential in locating defects that lie deep in the test structure and are, thus, not detectable by SEM. A model is also proposed to explain the formation of RCI images of specific interconnect test structures with complex layout.
The copper precursor N,N'-diisopropylacetamidinate has been decomposed at low temperature (80-110°C) in a liquid process under a moderate H2 pressure. Depending on the choice of the solvent, the process leads to a colloidal solution of well controlled copper nanoparticles or the deposition of composite Cu-SiO2 films on the surfaces. The latter layer is highly adhesive to silica surface, behaves as an active seed layer for electroless copper deposition and allows a conformal covering inside deep trenches.