bluuebunny/crossref_metadata_2025 huggingface dataset:
Dynamic control strategy based on passenger choice behavior with real-time information
Authors: Wang Wensi , Tian Zhihui , Jiang Yonglei , Wu Lan , Gao Jianqiao
Published: December 2017

Real-time control strategies are important methods for high-frequency transit to counteract the effects of bus bunching in passenger waiting time. This paper extends previous literature with the development of an optimization model for multiple lines in a corridor capable of executing a dynamic control strategy based on passenger choice behavior with real-time information. The bi-level model integrates “passenger perceptions,”“service selection,” and “control strategy” effectively. The upper level model is a control model with the objective of minimizing the total waiting time of passengers in the system composed of common lines to decide whether a bus arriving at the hub should be held and its holding time. The lower level model is an allocation model with the utilization of a Nested Logit model to study passenger choice behavior. In addition, a heuristic algorithm is introduced to solve the problem. The effectiveness of the model is evaluated with the data of two lines in Dalian city of China. The results show that the control strategy proposed in this paper outperforms the simple control strategy without passenger choice behavior, where the waiting time of passengers, the number of buses that need to hold, and bus holding time are all reduced.
Event-triggered based distributed H∞ consensus filtering for discrete-time delayed systems over lossy sensor network
Authors: Wang Shenquan , Wang Yuenan , Jiang Yulian , Li Yuanchun
Published: December 2017

This paper investigates the issue of event-triggered distributed H∞ consensus filtering for discrete time-varying delay systems over lossy sensor networks with stochastic switching topologies. For each sensor node, the event-triggering mechanism is given by an event detector, which determines whether to transmit the output measurement or not. The communication links between the event detector and the distributed filter are assumed to be over a lossy network, and the missing probability is governed by a set of random variables. Through available output measurements from not only the individual sensor but also its neighbouring sensors, according to the interconnection topology to estimate the system states, a sufficient condition is established for the desired distributed filter to ensure that the overall filtering dynamics are stochastically stable and achieve a prescribed distributed H∞ average performance. Meanwhile, the corresponding solvability conditions for the desired distributed filter gains are characterized in terms of feasibility linear matrix inequalities. Finally, a simulation example is provided to demonstrate the effectiveness of the proposed approaches.
How Variations in State Policies and Practices Impact Student Outcomes: What Principals and Professors Need to Know
Authors: Owings William , Kaplan Leslie S. , Myran Steve , Doyle Patrick
Published: December 2017

American high school graduates’ readiness for higher education or employment in the global economy may depend on the state where they live. Since the 10th Amendment to the United States Constitution makes education a state function, the 50 states and the District of Columbia vary significantly in their policies and practices for (a) preschool access and enrollment, (b) compulsory attendance, (c) instructional standards, (d) school funding, and (e) student outcomes. The variance in state requirements and student outcomes is a high-stakes equity issue. If every child is to be well educated and prepared to live productively in the 21st century, principals, professional associations, and allies can assess their own states’ policies and outcomes on these five criteria and determine where their advocacy may be needed to strengthen them.
Dietary patterns of households in Scotland: Differences by level of deprivation and associations with dietary goals
Authors: Whybrow S , Craig LCA , Macdiarmid JI
Published: December 2017

Background:

Foods tend to be consumed in combinations, and dietary pattern analysis and diet-quality scores are often more appropriate methods of assessing overall diet quality than is intakes of individual foods or nutrients.

Aim:

The aim of this study was to evaluate dietary patterns from the food and drink purchases of households in Scotland, and to identify any dietary patterns that were associated with closer adherence to the Revised Dietary Goals for Scotland (RDGS).

Methods:

We carried out a cross-sectional study of estimated food and drink intakes using Kantar WorldPanel household purchase data in Scotland collected during 2012. The amounts of food and drink purchased were converted to estimated amounts available for consumption per person by adjusting for household waste, household size and composition ( n = 720). Dietary patterns were identified using principal components analysis. A Diet Quality Index (DQI), based on the RDGS, was calculated.

Results:

The mean DQI score was low at 38 out of a possible maximum of 100, indicating that, on average, few of the dietary goals were being met. Six dietary patterns were identified, which explained 35% of the total variance in estimated food and drink intake. Three dietary patterns showed statistically significant associations with lower DQI scores (less healthy diets), and one with significantly higher DQI scores (healthier diets).

Conclusions:

Investigating dietary patterns to show which foods tend to be purchased together may assist in targeting dietary habits by focussing on key food groups, and in gaining the greatest improvement in diet quality from the most achievable change in diet.
Competitive intelligence in Spain
Authors: Muñoz-Cañavate Antonio , Alves-Albero Pricila
Published: December 2017

This study presents the main results of a survey of a sample of Spanish firms which include competitive intelligence and/or technology watch (TW) services in their organigrams or which are consumers of such intelligence products. The objectives were to acquire information on (i) the model (whether centralized or decentralized) of their intelligence services and personnel and their consumption of external intelligence consulting services and TW platforms; (ii) the methods they use to determine what information they need; (iii) the means they use to obtain that information; (iv) areas in which they seek information (competitors, consumers, economic situation, etc.); (v) their methods of analysis; (vi) the products generated by that analysis; and (vii) how they promote intelligence tasks internally. The results and the main conclusions are provided in the corresponding sections.
Biopower imagined: Biotechnological art and life engineering
Authors: Šlesingerová Eva
Published: December 2017

We are witnessing profound changes in our societies via biosciences, biotechnologization, and digitalization. The influence and application of specific engineering rationality and cybernetic perspectives to the complex systems of living structures and to the language of biology are integral parts of our cultural environment. The biotechnological reproduction of life, bodies and cells, as well as AI-equipped machines, has become normal and sometimes even technically routine in contemporary societies. The biotechnologization of society and the engineering of life have also significantly influenced contemporary art fields, practices and projects. The crucial analytical scope for this article is a specific biotechnological art field – bio art. Bio art includes the works of artists who are intrigued by working with living or semi-living tissues and biotechnologies. Using specific artworks, mainly by Louis Bec, Heather Dewey-Hagborg, and Biononymous, the text investigates current forms of power over life – biopower – that imagine, classify, and govern our societies today, even on molecular and genetic levels. The text analyzes artistic reflections of the processes by which people are governed mainly as the derivatives of the body, biological and genetic data sets. In this context, the article explores artworks inspired by specific biopolitical engineering rationality and surveillance practices enabling naming, fabricating and dealing with life which is synthesized, ethnicized and monitored.
Evaluation of the water disinfection by-product dichloroacetonitrile-induced biochemical, oxidative, histopathological, and mitochondrial functional alterations: Subacute oral toxicity in rats
Authors: Dong Ying , Li Fang , Shen Haijun , Lu Rongzhu , Yin Siqi , Yang Qi , Li Zhuangfa , Wang Suhua
Published: December 2017

Dichloroacetonitrile (DCAN), an emerging nitrogenous disinfection by-product, is more genotoxic and cytotoxic than the currently regulated carbonaceous disinfection by-products such as haloacetic acids. Few mechanistic studies have been conducted on the hepatic and renal toxicities of DCAN. This study examined the clinical biochemical, hematological, histopathological, oxidative, and mitochondrial functional alterations to evaluate the systematic toxicity after subacute oral exposure of 11 or 44 mg/kg/day in rats for 28 days. Body and spleen weights were lower, and organ-to-body weight ratios of the liver and kidney were higher in rats administered 44-mg/kg DCAN than in controls. The activities of serum alanine aminotransferase and alkaline phosphatase, and concentrations of blood serum urea nitrogen and retinol-binding protein were increased in rats administered 44-mg/kg DCAN compared with those of controls, thereby indicating hepatic and renal damage in this group. This was confirmed by histopathological alterations, including hepatic sinus dilation, extensive hemorrhage, vacuolar degeneration in the liver and glomerulus hemorrhage, and renal tubular swelling, in DCAN-exposed rats. Exposure to 44-mg/kg DCAN induced hepatic oxidative damage shown by the significant increase in malonaldehyde levels, a poisonous product of lipid peroxidation. Exposure to 44-mg/kg DCAN significantly increased hepatic glutathione content and mitochondrial bioenergy as noted by the elevation of mitochondrial membrane potential and cytochrome c oxidase activity, which might be attributed to compensatory pathophysiologic responses to DCAN-induced hepatic mitochondrial damage.
New social risk groups, industrial relations regimes and union membership
Authors: Shin Young-Kyu , Ylä-Anttila Tuomas
Published: December 2017

The literature on new social risk (NSR) groups, such as single parents and temporary workers, has argued that they are less likely to join trade unions than other employees. It has been suggested that this is due to the unions’ incapacity or unwillingness to promote policies that mediate NSRs. We argue that there are differences in unionization between different NSR groups, and that country-level institutional structures, operationalized here as industrial relations (IR) regimes, have effects on how likely NSR groups are to unionize. Our multilevel logistic models using European Social Survey (ESS) data produce three main results: (1) family policy-related NSR groups (single parents, female employees with children and female caregivers) are more – not less – unionized than the average worker; (2) precarious workers (low-skilled service employees, temporary employees and part-timers) are, indeed, less unionized than average but (3) this result concerns mostly the liberal and transitional IR regimes.
Nordic eldercare – Weak universalism becoming weaker?
Authors: Szebehely Marta , Meagher Gabrielle
Published: December 2017

This article builds on recent research on the fortunes of universalism in European social policy by tracing the development of eldercare policy in four Nordic countries: Denmark, Finland, Norway and Sweden. Six dimensions of universalism are used to assess whether and how eldercare has been universalized or de-universalized in each country in recent decades and the consequences of the trends thereby identified. We find that de-universalization has occurred in all four countries, but more so in Finland and Sweden than in Denmark and Norway. Available data show an increase in for-profit provision of publicly funded care services (via policies promoting service marketization), and an increase of family care (re-familialization), as well as of services paid out-of-pocket (privatization). These changes have occurred without an explicit attack on universalism or retrenchment of formal rights. Nevertheless, the changes threaten the class- and gender-equalizing potential of Nordic welfare states.
Distribution regimes and redistribution effects during retrenchment and crisis: A cui bono analysis of unemployment replacement rates of various income categories in 31 welfare states
Authors: Jahn Detlef
Published: December 2017

This article analyses redistribution effects during retrenchment and crisis in 31 welfare states using a new data set from a refined analysis of unemployment replacement rates of low-, middle- and high-income levels (Comparative Welfare Entitlements Dataset 2 (CWED2)). Starting by identifying four distribution regimes before the economic crisis, the analysis shows that these regimes determine the redistribution of unemployment benefits during the period of retrenchment. As expected, equality-oriented capitalism redistributes in favour of the low-income levels and status-oriented and competitiveness-oriented capitalism have no redistribution effects. More interesting is the redistribution effect of a fourth regime type which favours high-income groups and which is present in both Western (Mediterranean) and Central and Eastern European countries. Another intriguing finding is that – with some notable exceptions – the period of retrenchment has been characterized by sparing the low-income groups from severe cuts. This has changed in the current economic crisis where this group has experienced severe cuts in their benefits. The reaction to the crisis is also more strongly determined by immediate needs and is not as well explained by the distribution regimes.
Prediction of calorific values, moisture, ash, carbon, nitrogen, and sulfur content of pine tree biomass using near infrared spectroscopy
Authors: Saha Uttam K , Sonon Leticia , Kane Michael
Published: December 2017

Loblolly ( Pinus taeda) and slash ( Pinus elliottii) pine tree biomass are significant renewable energy resources for bioenergy industries in the Southeastern United States. There is a great need for evaluation of their properties (relevant to production and evaluation-screening for bioenergy extraction) by rapid but accurate analytical methods like near infrared reflectance (NIR) spectroscopy. However, no attempts have been made so far to develop useful NIR spectroscopic calibration models for analyzing biomass of these two species. In this study, acceptable NIR spectroscopic calibration models were developed for: gross calorific value, GCV ( n = 181; R2 = 0.83; ratio of standard error of cross-validation to deviation, RSCD = 2.32; ratio of standard error of cross-validation to inter-quartile distance, RSCIQ = 2.68); net calorific value, NCV ( n = 184; R2 = 0.83; RSCD = 2.31; RSCIQ = 2.69); ash-free calorific value, AFCV ( n = 184; R2 = 0.83; RSCD = 2.24; RSCIQ = 2.49); moisture ( n = 181; R2 = 0.85; RSCD = 2.54; RSCIQ = 2.30); ash ( n = 180; R2 = 0.86; RSCD = 2.65; RSCIQ = 2.62); total carbon, C ( n = 101; R2 = 0.95; RSCD = 3.01; RSCIQ = 5.66); total nitrogen, N ( n = 87; R2 = 0.95; RSCD = 4.24; RSCIQ = 4.76); and total sulfur, S ( n = 83; R2 = 0.97; RSCD = 4.17; RSCIQ = 3.05) contents of these biomasses though the calibration models for NCV and AFCV are indirect calibration. Prediction of the independent validation sets yielded good agreement between the NIR spectroscopic predicted values and the laboratory reference values for each of: GCV ( n = 92; r2 = 0.89; ratio of performance to deviation; RPD = 3.01; ratio of performance to inter-quartile distance, RPIQ = 3.16); NCV ( n = 91; r2 = 0.83; RPD = 2.43; RPIQ = 3.06); AFCV ( n = 91; r2 = 0.80; RPD = 2.25; RPIQ = 2.83); moisture ( n = 92; r2 = 0.82; RPD = 2.38; RPIQ = 2.40); ash ( n = 89; r2 = 0.81; RPD = 2.30; RPIQ = 2.66); C ( n = 43; r2 = 0.90; RPD = 3.14; RPIQ = 3.23); N ( n = 44; r2 = 0.95; RPD = 4.33; RPIQ = 5.96); and S ( n = 42; r2 = 0.93; RPD = 3.67; RPIQ = 3.24) contents, indicating that all eight calibration models had good quantitative information. The standard errors of prediction for all models were less than twice the corresponding standard error of laboratory. Therefore, precise, accurate, and rapid analysis of calorific values and C, N, S contents of these biomasses can be done using these novel NIR spectroscopic calibration models developed.
Determinants of the Productivity Change for the Banking Sector in Egypt
Authors: Jreisat Ammar , Hassan Hassan , Shankar Sriram
Published: December 2017

This study aims to undertake an evaluation and examination of the productivity change of the Egyptian banking sector, using a novel data set which covers 14 banks operating in the Egyptian market from 1997 to 2013. We use a non-parametric approach Data Envelopment Analysis (DEA) based analysis to investigate the productivity change in the Egyptian banking sector. Input-oriented Malmquist indices of productivity change are estimated with DEA to measure total factor productivity (TFP) change. The TFP changes are decomposed into the product of technological change and technical efficiency change (catch up). In the second stage, potential determinants of productivity change are studied using a regression model. We find that the Egyptian banking sector as a whole shows a productivity regress of 0.9 per cent per year, which is mainly due to the technological improvements. The estimated regression model identifies some variables which significantly influence the productivity of banks in Egypt. The banks with higher loans to deposit ratio and higher returns on equity have higher productivity growth reflecting on their strong strategic and managerial skills. The size of bank seems to be associated with an increase in productivity. The maturity of a bank (measured by age) is associated with higher productivity. The net interest margin (NIM) and non-interest expense over total assets (NIETA) variables do not seem to be affecting the productivity of banks. Surprisingly, our results reveal that the financial crisis is negatively and statistically insignificant which means there are no effects on the Egyptian banks.
Emergency Management North of the Shenzhen River
Authors: Chung CH , Siu AYC , Lai KK
Published: December 2017

A study was carried out in a district hospital located close to the Hong Kong ‐ Shenzhen border, in order to get a picture of the epidemiology of diseases and injuries sustained by Hong Kong residents in China. The emergency medical treatment provided and the degree of patient satisfaction were also analysed. The majority of the patients were adult males. Trauma constituted more than 50% of the attendance, with traffic accident and common assault being the leading causes. This group of Hong Kong residents preferred to be treated in Hong Kong hospitals because of perceived better quality of care. There was a high demand on the local ambulance service and this might have financial and resource implications.
A Study of Patients who Leave an Accident & Emergency Department against Medical Advice
Authors: Wong TW , Lee KM , Chan R , Lau CC
Published: December 2017

Patients leaving an Accident & Emergency Department against medical advice are often considered a high‐risk group. A prospective study was carried out in an Accident & Emergency Department (ED) to determine the characteristics of this distinct group of patients, their reasons for leaving against medical advice (AMA), and their subsequent outcome. Telephone or personal interview of patients by a clerk was attempted within 48 hours of the visit for all patients who left Against Medical Advice (AMA) based on a pre‐set questionnaire. A follow‐up call was used to ascertain health outcomes after the discharge. There were 210 AMA cases during the study period giving an incidence of 0.95%. Interview was successful in 186 (88.6%) patients. The mean age of the AMA group was around 36 years but there was no significant difference in sex. The major reasons for AMA included wanting to observe symptoms at home (78 of 186, 42 %), non‐medical personal reason (64 of 186, 34%) and symptoms have abated (21 of 186, 11%). Eighteen (9.7%) patients left AMA because they wanted to seek treatment from other providers and among them three had private insurance coverage. Of the 5 (2.7%) patients who were dissatisfied with the management in ED, four disagreed with the diagnosis and treatment offered and the remaining one was unhappy with the attitude of the attending physician. About 12% (22) of patients returned within 48 hours for further treatment and 8 (36%) were admitted. The remaining 22% (40 of 186) sought further medical treatment from other sources. No formal patient complaint was received during the study period from this group.
Artifacts in Computed Radiography
Authors: Tan LTH , Ong KL
Published: December 2017

Computed radiography offers many advantages over the conventional radiography. With new technological breakthroughs and the development of systems that are more cost‐effective, there has been an increase in its use in the recent years. However, like all imaging modalities, one must be aware of the various artifacts that are likely to lead to misdiagnosis. In this article, we illustrate the potential hardware and software artifacts that are associated with its use.
Proctitis and Pyrexia Caused by Body Packing of Cannabis Resin
Authors: Cocks RA , Green PF
Published: December 2017

We report the case of a 48 year old man who attended the Accident and Emergency Department after smuggling a large number of pellets of cannabis resin in his gastro‐intestinal tract. Five days after ingesting the pellets, which were wrapped in portions of rubber condom, he developed abdominal pain and proctitis. He continued to exhibit a pyrexia even after the removal of the majority of the pellets, and was investigated for pyrexia of unknown origin (PUO). The importance of obtaining a good history from sick travellers, and the need for thorough physical examination, are emphasized.
The Limitations of Evidence Based Practice for Emergency Medicine
Authors: Kelly AM , Horsley C
Published: December 2017

Evidence based practice (EBP), also known as evidence based medicine, has been suggested as a more suitable basis for decision‐making in clinical practice than the traditional ‘expert’ based approach. Central to EBP is the application of evidence (as found in the published literature) to an individual clinical problem. EBP, however, has limitations that may raise questions regarding its applicability to particular types of clinical situations including many of the problems encountered in Emergency Medicine. This article discusses the background and limitations of EBM and suggests some ways that the principles can be incorporated into Emergency Medicine practice.
Severe Trauma Presenting to the Resuscitation Room of a Hong Kong Emergency Department
Authors: Rainer Th , Chan Sy , Kwok K , Suen Dtk , Lam W , Cocks Ra
Published: December 2017

Background

Little is known about the epidemiology or mortality associated with trauma in Hong Kong or of its demands on the service of emergency departments. This study describes both the quantity and quality of trauma presenting to an emergency department in Hong Kong.

Methods

In a retrospective study conducted from January to June 1997 there were 100,000 new patient attendances at the emergency department of the Prince of Wales Hospital of which 227 trauma patients (0.002%) were triaged to the Resuscitation Room. Patient records were scrutinised for types and mechanisms of injury, times of injury and arrival at the emergency department, role of alcohol, and scored using an injury severity score. Important outcomes were mortality and duration of hospital stay.

Results

Data was available on 221 (97%) subjects (male to female ratio 3.7:1) of which there were 203 adults and 18 children. Blunt injury accounted for 199/215 (92.6%) cases and penetrating for 16/215 (7.4%) cases. Motor vehicle crashes accounted for 113/205 (55%) cases, falls for 47/205 (23%) cases and assault for 18/205 (9%) cases. 51/224 (23%) cases presented between the hours of midnight and 8 am. The median injury severity score (ISS) was 9 (mean 11; range 1–59). 32/227 (14%) patients died, the majority resulting from road traffic accidents or falls.

Conclusion

Patterns of ‘severe’ trauma in Hong Kong primarily affect male adults, include a preponderance of motor vehicle crashes and falls, and significant mortality.
Patient with Chest Pain of Obscure Origin: Can AMI be Recognised Early at AED? - A Review of Diagnostic Methods and a Suggested Protocol for the Local A&E Department
Authors: Man CY , Cheung Wl
Published: December 2017

Chest pain is a common presentation to Accident and Emergency departments (AED). There are many causes ranging from the most trivial, an example of which is costochondritis to the life-threatening examples such as acute myocardial infarction (AMI). It is not uncommon for acute myocardial infarction to present as atypical chest pain or discomfort, or non-diagnostic electrocardiogram (ECG). The various common diagnostic methods for AMI in patients with atypical chest pain are reviewed and a suggested protocol for managing patient with chest pain of obscure origin at AED is presented. The recent introduction of rapid bedside troponin assay is likely to bring a major impact on the management of atypical chest pain in future.
Bedside Ultrasonography at Emergency Department - “New Kids on the Block” and “Echoes of Future”
Authors: Lee Fl
Published: December 2017

Bedside ultrasonography is increasingly being performed by emergency physician in Hong Kong. Nearly every Accident and Emergency department in Hong Kong is equipped with an ultrasound machine. Ultrasonographic examination is a powerful clinical tool as it is non-invasive, safe, reliable and inexpensive. It has a high diagnostic accuracy in an experience hand. The practice of performing ultrasonography by local emergency physician is just at the early stage. This article aims to review the characteristic, scope and limitation of bedside ultrasonography at emergency department setting. The issue of training and certification, cost effectiveness and medico-legal implication of this tool is also discussed. The goal of bedside ultrasonography program in Hong Kong is to provide round the clock ultrasound examination and interpretation by well-trained and qualified emergency physician. Establishment of the scope of emergency ultrasound examination and implementation of quality improvement audit on the services is necessary. Training and research in the area of ultrasound imaging should be encouraged. With the maturation of our specialty and the effort of our local emergency physicians, bedside emergency ultrasonography will soon emerge as the “Echoes of the future”.
Case Report: Gamma-Hydroxybutyrate Poisoning
Authors: Sia Ys , Wong Yt
Published: December 2017

Substance abuse is a common presentation to Emergency Departments (ED). A case of gamma-hydroxybutyrate (GHB) presented to our ED is reported, its clinical history and findings, biochemical and toxicity is discussed. This drug affects the neurological, muscular, biochemical and sexual function.
Prehospital Resuscitation of Out‐of‐Hospital Cardiac Arrest in Queen Mary Hospital
Authors: Leung LP , Lo CM , Tong HK
Published: December 2017

Management of out‐of‐hospital cardiac arrest is a major task of the accident and emergency department. The aim of this study is to evaluate the efficacy of prehospital resuscitation of out‐of‐hospital cardiac arrest in Hong Kong and identify areas for improvement. It was a prospective descriptive study of adults with non‐traumatic out‐of‐hospital cardiac arrest who were admitted to the Accident and Emergency Department of Queen Mary Hospital by the ambulance service from March 15, 1999 to October 15, 1999. Patient characteristics and the response times of the ambulance service were recorded according to the Utstein style. One hundred and thirty patients were included. The overall immediate survival rate was 14.6% and the overall survival to discharge rate was 1.54%. The outcome of out‐of‐hospital cardiac arrest is poor. Every link in the chain of survival has to be improved.
Reflections on Twenty Years of Prehospital Care
Authors: Cocks RA
Published: December 2017

Although Accident and Emergency staff may feel that prehospital care is the province of the ambulance service alone, their interest in this area is important. Both A&E doctors and nurses have an important role to play in the training of paramedics, and in some circumstances in the direct provision of prehospital care. Physician involvement in routine prehospital care, whether by land or helicopter transport, is still controversial. This paper reviews some of the issues involved in prehospital care over the last twenty years, in addition to a personal perspective from the author. In the absence of a firm evidence base to lead the way to future development in Hong Kong, more research will be needed by doctors, nurses and ambulance staff.
Emergency Department Misuse and Administrative Interventions
Authors: Chung CH
Published: December 2017

Introduction

Notwithstanding the primary mission of managing sudden unexpected illnesses, major injuries and life‐threatening conditions, emergency departments have been forced to deal with primary care and even social problems nowadays. Emergency department (ED) overcrowding is a worldwide problem. Hong Kong is not immune, although the causes may be somewhat different. Excessive and unlimited patient volume threatens quality and timely emergency care. A review of the epidemiology of local ED attendance, causes of ED overcrowding and possible solutions may guide the future direction of healthcare in Hong Kong.

Methods

Medical literature on ED overcrowding and ED misuse were searched from the Medline, HealthSTAR and EMBASE. Relevant full text articles were retrieved through hospital library network. Local emergency medicine publications including the Hong Kong Journal of Emergency Medicine and Emergi‐News were reviewed. Local statistics were obtained from the Hong Kong Government information website, Hospital Authority Executive Information System (EIS) and Hospital Authority Accident & Emergency Service data files.

Results

There has been a steadily rising trend of ED attendance per thousand population. Causes of ED overcrowding include easy access, quality emergency care, barriers to primary care, barriers to specialist care, patient education, human right and free service. There are two approaches to the problem ‐ decreasing the demand or increasing the funding. Usual administrative measures aim at reducing inappropriate use of ED service. These include improved community and primary care, improved specialist support, patient education, financial barriers, patient refusal and even lowering ED service standard. Another approach is augmenting the resources and productivity of emergency departments to cater for the increasing demand.

Conclusions

There is no single effective solution that will apply in all circumstances. Broadly speaking, overcrowding is the result of inadequate funding for emergency health care services during a period of increasing demand.
Chronic Myeloid Leukaemia Presenting as Traumatic Haemoperitoneum and Duodenal Injury
Authors: Au HP , Mak YK , Luk SH , Cheung CC , Kam CW , Lee ACW
Published: December 2017

A 13‐year‐old boy presented with an acute abdomen after a dubious blunt abdominal injury. Evaluation at the accident and emergency department revealed the presence of haemoperitoneum. CT scan and a subsequent duodenography confirmed an accompanying duodenal hematoma and splenomegaly, but no solid organ injury was detected. As the child remained haemodynamically stable, a conservative management was adopted. Leucocytosis and thrombocytopenia were found on further investigation, which led to a final diagnosis of Philadelphia chromosome positive chronic myeloid leukaemia. We speculate that the underlying haematological malignancy in this case might have contributed to the florid intra‐abdominal signs of injury. A careful search for a systemic illness would be useful in the management of childhood abdominal trauma, especially when the account of injury is dubious or apparently trivial.
The Possible Impact on Patient Attendance and Expectation after Imposing a Fee on Semi-Urgent and Non-Urgent Cases Utilising the Accident and Emergency Service
Authors: Tsoi Lch , Chung Ch
Published: December 2017

A survey was conducted in a district hospital's Emergency Department (ED) to estimate the possible impact of levying fees on non-urgent and semi-urgent cases. Three hundred and eighty-three subjects in the non-urgent and semi-urgent categories were successfully recruited for analysis. Among them, 14.4% and 31.3% said they would not come to the ED when the proposed fees were $100 and $150 respectively. The mean consultation fee deemed appropriate for non-urgent and semi-urgent cases was $97.7 (95% C.I. 90.3, 105.2). The effect of a nearby clinic - ‘Pilot Medical Centre’ - was also examined. Among the respondents, 56.1% said they would go to a nearby clinic for medical treatment if the fees were comparable in the two places; and 50.4% said they would not come to ED for treatment if the ED charged more than the nearby clinic. However, although 84.6% of the subjects rated the present ED service as satisfactory, 62.4% expected better service when they have to pay a fee. This will put the already stretched frontline staff under higher pressure. Without defining the scope of ED service, imposing a fee on a previously free service will put the ED in a difficult position.
Unusual Cause of Fever in a 35-Year-Old Man
Authors: Yuen Ecp
Published: December 2017

A Chinese man presented to our Accident and Emergency (A&E) department repeatedly for fever and respiratory symptoms. He was finally diagnosed to have polymyositis. Fever and respiratory symptoms are common presenting complaints to our A&E department and this case illustrates the importance of establishing a diagnosis in a patient with fever but without an obvious septic focus.
Factors Influencing the Hospital Admission Decision of Low-Risk Patients with Community Acquired Pneumonia: Evaluating the Usefulness of a Prediction Rule
Authors: Chan Ssw , Cheung Wl , Cocks Ra
Published: December 2017

Introduction

The Pneumonia Patient Outcomes Research Team (PORT) derived and validated a Prediction Rule to identify low-risk patients with community-acquired pneumonia (CAP).1 This prediction rule was implemented in the Accident & Emergency (A&E) Department of Prince of Wales Hospital to help select patients suitable for outpatient treatment.

Materials & Methods

A retrospective study of all cases of CAP admitted from A&E, age above 14, over a six-month period (the period of implementation of the Prediction Rule) was performed. Patients belonging to the low-risk categories were identified after review of the records. Factors likely to influence the admission decision were noted. Descriptive statistics was generated.

Results

Eighty-five patients were identified, 61 (71.8%) females and 24 (28.2%) males. The mean age was 59.1 years (±17.3 years, SD). Fifty-three (62.3%) patients had at least one significant comordid condition (e.g. chronic lung disease, diabetes). Of the remaining patients, 20 (23.5%) had at least one identifiable factor (e.g. haemoptysis, multilobar infiltrates in chest radiograph) influencing the hospitalisation decision; and only 12 (14.1%) had no reason, identifiable retrospectively, to justify hospitalised care.

Conclusions

A substantial number of low-risk patients with CAP (classified according to the Prediction Rule) were admitted. Most of these patients had identifiable comorbid conditions and prognostic factors that had not been accounted for by the Prediction Rule guidelines. Further evaluation of the significance of these additional variables is required in order to give the guidelines a better predictive value.
Reducing Anterior Shoulder Dislocation by the Spaso Technique
Authors: Yuen Mc , Tung Wk
Published: December 2017

Anterior shoulder dislocation is the commonest major joint dislocation seen in the Accident and Emergency departments. Spaso Miljesic has described a new technique for anterior shoulder dislocation in 1998. The technique is applied in reduction of anterior shoulder dislocations in the Accident and Emergency Department of Kwong Wah Hospital. We report the application of the Spaso technique on 2 patients (anterior shoulder dislocation with fracture greater tuberosity, anterior shoulder dislocation with fracture surgical neck of humerus) and discuss the potential advantages of using the Spaso technique.
Lethal Tricyclic Antidepressant Overdose
Authors: Choy Ch , Kitchell Akb , Kam Cw
Published: December 2017

Tricyclic antidepressant remains widely prescribed despite its dangerous cardiovascular and neurological effects in overdosed patients. We present a case of lethal dothiepin overdose and discuss the major complications and its management strategies.
A Randomised Controlled Trial on Health Promotion Program for Re-Injury Prevention in Young Children Treated in Emergency Department
Authors: Tsoi Lch
Published: December 2017

A prospective, randomised, controlled study was undertaken to examine the effect of a health promotion program in an Accident and Emergency Department (ED) for childhood accident prevention. All children eligible for the study were randomised into three groups: one control and two intervention groups (Prevention Program One (PP1): nurse counseling and pamphlets; Prevention Program Two (PP2): PP1 plus a videotape to bring home). Of the 296 cases valid for analysis, there were 10, 3 and 2 cases of re-injury in the control (n=106), PP1 (n=97) and PP2 (n=93) groups over a period of 2 months' follow-up respectively. Ten out of the 15 incidents (66.7%) returned to ED for treatment. The re-injury rate was 56.6 (95% CI: 19.1, 94.1) per 100 per year for the control group. The intervention groups had lower re-injury rate. The videotape had no additional effect on the intervention. The relative risk reduction (RRR) was 72.1% (95% CI: 69.2%, 74.8%) and the number-needed-to-treat (NNT) was 15 (95% CI: 8,463) for the combined intervention group in a 2-month period. This prevention program using simple means was deemed cost-effective and feasible in the ED setting.
A Survey of Medical Social Services in Local Accident and Emergency Departments
Authors: Wong Tw , Chung M , Chan C
Published: December 2017

This study is a structured questionnaire survey on all doctors and nurses working in 14 local Accident & Emergency Departments (EDs) on medical social services. The objectives of this study are to find out: (1) service provision and referral patterns in local EDs; (2) perceptions of doctors and nurses on the present service. In addition to routine referrals during office hours, nearly half of the respondents reported availability of on-site services per request, phone consults during office hours, and support during disaster activation. The most common social problems that doctors would refer to medical social service included child abuse, battered spouse, rape/sexual assault, deliberate self-harm and elderly patients with discharge problem. Over half of the doctors and nurses said the existing services were inadequate and the main shortcoming was no after office hours coverage. In cases of crisis intervention, 56% of doctors and 36% of nurses felt that medical social workers would only be helpful if they were available at short notice most time of the day. To improve the existing service, 62% of doctors and 43% of nurses thought that medical social workers should provide adequate feedback. Other areas for improvement included on-site service, 24-hour coverage and more experienced workers. (Hong Kong j.emerg.med. 2001;8:135–139)
An Upsurge in Melatonin Overdose: Case Reports
Authors: Chung Ch
Published: December 2017

Within a period of 6 weeks, three patients attended the emergency department of a public district hospital after committing suicide by taking an overdose of melatonin. Their hospital stay was uneventful. This attested to the safety of melatonin. As melatonin is recently available over the counter as a “sleeping pill”, it is expected that physicians will see more and more such overdose cases.
The Percutaneous Transtracheal Jet Ventilation in a Patient with Partial Upper Airway Obstruction
Authors: Fung KY , Yuen MC , Tung WK
Published: December 2017

Difficult airway is a challenging emergency problem for emergency physicians. We reported a patient with partial upper airway obstruction managed by percutaneous transtracheal jet ventilation (PTJV) before definite airway was secured. The development, the set up, the advantages, and the precautions of using PTJV are briefly described.
Biological Warfare: The Facts
Authors: Yuen ECP
Published: December 2017

Recent international situation has brought our attention back to the imminent threat of biological weapon. Contrary to other weapons of mass destruction, biological warfare is relatively silent and invisible. This review will examine the history and characteristic of biological warfare. Several biological agents like Anthrax, Plaque, Smallpox, Tularemia and Viral Haemorrhagic Fever will be discussed in details.
A Study on the Use of Abdominal X-Ray in an Emergency Department
Authors: Choi Sy , Wong Tw , Lau Cc , Liang E , Fu Yk , Khoo J
Published: December 2017

Objective

1) To study the current use of abdominal X-rays (AXR) in our emergency department (ED). 2) To evaluate the clinical predictors for positive AXR findings.

Methods

During the 40 days study period, all patients who had taken abdominal X-rays were included. The attending doctor filled in a questionnaire on demographic data, clinical features and outcome. The three radiologists who participated in this study reported the films and consultant emergency physicians then commented on the appropriateness of the request. The clinical features, which were predictive of positive radiological findings, were sorted out using univariate analysis.

Results

64 patients were included in the 40 days study period. The rate for AXR request was 3.4 per 1000 patients. The most common presenting complaints were abdominal pain (85.9%) and constipation (45.3%). The most frequent clinical findings were abdominal distension (35.9%) and hyperactive bowel sound (31.3%). Only two of the clinical features, including vomiting and rebound tenderness, were found to have significant correlation with positive X-ray findings. Most of the AXR requests and interpretations by ED doctors were considered to be appropriate.
Case Report: Life Threatening Bleeding following Maxillofacial Injury
Authors: Tsui Kl , Yau Hh , Kam Cw
Published: December 2017

Maxillofacial injury is commonly seen in the practice of emergency medicine. Major maxillofacial injury itself can be life threatening. Apart from the danger of potential airway compromise, severe haemorrhage from branches of carotid artery causing haemorrhagic shock can occur. Blind techniques, such as packing or ligation of external carotid artery are the usual methods employed to stop the bleeding. However blind techniques carry a significant failure rate. A patient with severe maxillofacial injury and torrential haemorrhage is reported. The bleeding could not be controlled by oral and nasal packing. Emergency selective carotid angiography was performed to identify the source of bleeding and embolization of the bleeding branches successfully arrested the haemorrhage. Interventional radiology could be as effective, if not superior, as an operation in controlling bleeding in selective cases.
Study on the Discrepancies between the Admitting Diagnoses from the Emergency Department and the Discharge Diagnoses
Authors: Lim GH , Seow E , Koh G , Tan D , Wong HP
Published: December 2017

Objective

To study the extent of diagnostic discrepancies at admission (diagnoses made by doctors in the Emergency Department) and discharge (final diagnoses at the ward) in our Emergency Department (ED) where the doctors have direct admitting rights; and how such discrepant diagnoses affected inter-departmental transfer of patients after their admission.

Method

A non-concurrent cohort study was performed on admissions through our ED between 24th to 30th April 1997. The admitting and discharge diagnoses and units were recorded. The reasons for the unmatched diagnoses and inter-departmental transfers were studied. The significance of transfers amongst patients who had matched and unmatched diagnoses was compared using the Chi-test at 95% confidence interval.

Results

Three hundred and sixty-one admissions were recorded during the study period. There were 314 (86.7%) and 47 (13.3%) admissions with matched and unmatched diagnoses respectively. Nine of the 47 admissions with unmatched diagnoses and 16 of the 314 admissions with matched diagnoses were transferred (p=0.001).

Conclusion

The ED doctors achieved a high level of diagnostic accuracy. The most common reason for unmatched diagnosis was because of the difficulty of diagnosing the patient's complex medical problem in the short contact time in the ED. The level of accuracy should increase with the advent of more diagnostic modalities and increased contact time with the patients in the ED.
Prehospital Response to Hazmat Incidents
Authors: Yeung RSD , Chan JTS , Ho ST
Published: December 2017

Hazmat incidents rarely occur, but when they do they may cause tremendous casualties and terror among the community. The chemical leakage in Bhopal of India in 1984 resulted in 2500 deaths and injured more than 150,000.1 The Sarin attack in Tokyo subway station caused more than 10 deaths and 5,000 people were affected.2 Therefore, both industrial chemical leakage and terrorist attack using chemical agents is a major concern to any cosmopolitan city. To best manage these incidents, we need a well written contingency response plan involving local government departments, the Police Department, the Fire Service Department and the receiving hospitals.
Analysis of Drug Overdose in Teenagers
Authors: Wong SK
Published: December 2017

This is a retrospective study to analyze the pattern of drug overdose in teenagers. Between 1/7/98 to 30/6/01, there were 100 patients between the age of 13 to 19 attending Alice Ho Miu Ling Nethersole Hospital emergency department for drug overdose. Eighty-three cases were included for analysis. The majority was female (71 cases, 86%). The most frequent drugs were panadol and drugs for treatment of flu (43%), sleeping pills (18%), diazepam (18%). Panadol, drugs for treatment of flu and sleeping pills were usually bought over the counter. Diazepam was obtained from friends or bought in China. The common reasons for drug overdose were “unhappy boyfriend/girlfriend relationship” (40%), “unhappy relationship with family” (25%), “unhappiness at school” (14%). Thirty-one percent of cases had suicidal ideas. Many of them had poor family relationships, poor school performance or were unemployed.
Case Report: Acute Inferior Myocardial Infarction with Single-Lead ST Segment Elevation
Authors: Sia YS , Wong YT
Published: December 2017

This article illustrates a patient who presented with acute inferior myocardial infarction with only isolated ST segment elevation in Lead III. Brief review on the electrocardiographic interpretation was discussed. Early recognition and management is the key to prevent morbidity and mortality.