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Delays in triage processes in the emergency department (ED) can compromise patient safety. The aim of this study was to provide proof-of-concept that a self-check-in kiosk could decrease the time needed to identify ambulatory patients arriving in the ED. We compared the use of a novel automated self-check-in kiosk to identify patients on ED arrival to routine nurse-initiated patient identification.
We performed a prospective trail with random weekly allocation to intervention or control processes during a 10-week study period. During intervention weeks, patients used a self-check-in kiosk to self-identify on arrival. This electronically alerted triage nurses to patient arrival times and primary complaint before triage. During control weeks, kiosks were unavailable and patients were identified using routine nurse-initiated triage. The primary outcome was time-to-first-identification, defined as the interval between ED arrival and identification in the hospital system.
Median (interquartile range) time-to-first-identification was 1.4 minutes (1.0–2.08) for intervention patients and 9 minutes (5–18) for control patients. Regression analysis revealed that the adjusted time-to-first-identification was 13.6 minutes (95% confidence interval 12.8–14.5) faster for the intervention group.
A self-check-in kiosk significantly reduced the time-to-first-identification for ambulatory patients arriving in the ED.
California and Washington recently replaced traditional partisan elections with nonpartisan “top-two” election procedures. Some reform advocates hoped that voters would behave in a way to support moderate candidates in the primary stage; the limited evidence for this behaviour has led some scholars to conclude that the reform has little chance to change meaningful policy outcomes. Yet we find that the nonpartisan procedure has predictable and disparate political consequences: the general elections between two candidates of the same party, called copartisan general elections, tend to occur in districts without any meaningful crossparty competition. Furthermore, copartisan elections are more likely to occur with open seats, when a new legislator will begin building a network of relationships. The results, viewed through the lens of the Advocacy Coalition Framework, suggest that opportunities exist for coalitional rearrangement over time.
Governments face different incentives when they reorganize many administrative agencies at one time rather than making infrequent, case-by-case changes. This article develops a theory of mass administrative reorganizations, which posits that the politics of reorganization is focused on government accountability. Viewing mass reorganization as a structured decision, it argues that choices about independence, agency organization and functional disposition have different impacts on the political costs of administrative policy making. Analyzing novel data from a recent British reorganization with sequential logistic statistical models provides substantial support for these claims. The study challenges the focus on organizational survival in the existing literature. By eschewing more fundamental political questions of democratic accountability, the prevailing approach masks essential politics, and in the context of this study, all influence of conflict due to party and agency policy positions.
The effects of krill oil as an alternative source of n-3 long-chain PUFA have been investigated recently. There are conflicting results from the few available studies comparing fish oil and krill oil. The aim of this study was to compare the bioavailability and metabolic fate (absorption, β-oxidation and tissue deposition) of n-3 fatty acids originating from krill oil (phospholipid-rich) or fish oil (TAG-rich) in rats of both sexes using the whole-body fatty acid balance method. Sprague–Dawley rats (thirty-six male, thirty-six female) were randomly assigned to be fed either a krill oil diet (EPA+DHA+DPA=1·38 mg/g of diet) or a fish oil diet (EPA+DHA+DPA=1·61 mg/g of diet) to constant ration for 6 weeks. The faeces, whole body and individual tissues were analysed for fatty acid content. Absorption of fatty acids was significantly greater in female rats and was only minimally affected by the oil type. It was estimated that most of EPA (>90 %) and more than half of DHA (>60 %) were β-oxidised in both diet groups. Most of the DPA was β-oxidised (57 and 67 % for female and male rats, respectively) in the fish oil group; however, for the krill oil group, the majority of DPA was deposited (82–83 %). There was a significantly greater deposition of DPA and DHA in rats fed krill oil compared with those fed fish oil, not due to a difference in bioavailability (absorption) but rather due to a difference in metabolic fate (anabolism v. catabolism).