Evaluating the transitions in care for children presenting with acute asthma to emergency departments: a retrospective cohort study

Background Acute asthma is a common presentation to emergency departments (EDs) worldwide and, due to overcrowding, delays in treatment often occur. This study deconstructs the total ED length of stay into stages and estimates covariate effects on transition times for children presenting with asthma. Methods We extracted ED presentations in 2019 made by children in Alberta, Canada for acute asthma. We used multivariable Cox regressions in a multistate model to model transition times among the stages of start, physician initial assessment (PIA), disposition decision, and ED departure. Results Data from 6598 patients on 8270 ED presentations were extracted. The individual PIA time was longer (i.e., HR < 1) when time to the crowding metric (hourly PIA) was above 1 h (HR = 0.32; 95% CI:0.30,0.34), for tertiary (HR = 0.65; 95% CI:0.61,0.70) and urban EDs (HR = 0.77; 95% CI:0.70,0.84), for younger patients (HR = 0.99 per year; 95% CI:0.99,1.00), and for patients triaged less urgent/non-urgent (HR = 0.89; 95% CI:0.84,0.95). It was shorter for patients arriving by ambulance (HR = 1.22; 95% CI:1.04,1.42). Times from PIA to disposition decision were longer for tertiary (HR = 0.47; 95% CI:0.44,0.51) and urban (HR = 0.69; 95% CI:0.63,0.75) EDs, for patients triaged as resuscitation/emergent (HR = 0.51; 95% CI:0.48,0.54), and for patients arriving by ambulance (HR = 0.78; 95% CI:0.70,0.87). Times from disposition decision to ED departure were longer for patients who were admitted (HR = 0.16; 95% CI:0.13,0.20) or transferred (HR = 0.42; 95% CI:0.35,0.50), and for tertiary EDs (HR = 0.93; 95% CI:0.92,0.94). Conclusions All transition times were impacted by ED presentation characteristics. The sole key patient characteristic was age and it only impacted time to PIA. ED crowding demonstrated strong effects of time to PIA but not for the transition times involving disposition decision and ED departure stages.

The Temporal-Spatial Pattern and Coupling Coordination of the Green Transition of Farmland Use: Evidence from Hubei Province

The green transition of farmland use is a future trend in China’s modern agriculture and green development. However, its research framework, including its evaluation system, temporal-spatial distribution, and driving mechanisms, has not been established in the existent literature. With the 17 cities in Hubei Province as an example, we evaluated the green transition of farmland use and explore the characteristics and driving mechanisms of the temporal and spatial evolution from 2000–2019. The findings were as follows: First, the green transition of farmland use in Hubei Province is in infancy, but it has great potential. Second, the growth rate of the green transition of farmland use has noticeable regional differences in the east, central, and western areas of the province. Third, the three dimensions of spatial transition, functional transition, and model transition in the green transition of farmland use have significant spatial differences in coupling and coordination, and decoupling is becoming increasingly prominent. Based on the research findings, we put forward targeted countermeasures and suggestions.

Effect of magnetic field on the steady nanofluid flow past obstacle

The fluid flow and heat transfer of a nanofluid past a circular cylinder in a rectangular duct under a strong transverse magnetic field is studied numerically using a quasitwo-dimensional model. Transition from laminar flow with separation to creeping laminar flow is determined as a function of Hartmann number and the volume fraction of nanoparticle, as are critical Hartmann number, and the heat transfer from the heated wall to the fluid. Downstream cross-stream mixing induced by the cylinder wake was found to increase heat transfer. The successive changes in the flow pattern are studied as a function of the Hartmann number. Suppression of vortex shedding occurs as the Hartmann number increases.

Elastic and Inelastic form factors with inclusion 2-body short-range correlations effect

The charge distributions and elastic electron form factors for ¹⁸O, ^42,44Ca,⁵⁸Ni, and ¹¹⁸Sn nuclei are considered using the cluster extension of the 1- and 2-body terms. Inelastic electron form factors to 2+ states with Core-Polarization effects studied where the nuclear collective modes beside to the shell model transition density are considered. The influence of SRC's be calculated by the parameter β which is introduced into the ground state charge distribution concluded the Jastrow function. It is found that the inclusion of 2-body correlations are necessary to describe the observed data of elastic and inelastic form factor at high range of momentum transfer q > 3 fm^-1.

Intercomparison of thermal–optical carbon measurements by Sunset and Desert Research Institute (DRI) analyzers using the IMPROVE_A protocol

Thermal–optical analysis (TOA) is a class of methods widely used for determining organic carbon (OC) and elemental carbon (EC) in atmospheric aerosols collected on filters. Results from TOA vary not only with differences in operating protocols for the analysis, but also with details of the instrumentation with which a given protocol is carried out. Three models of TOA carbon analyzers have been used for the IMPROVE_A protocol in the past decade within the Chemical Speciation Network (CSN). This study presents results from intercomparisons of these three analyzer models using two sets of CSN quartz filter samples, all analyzed using the IMPROVE_A protocol with reflectance charring correction. One comparison was between the Sunset model 5L (Sunset) analyzers and the Desert Research Institute (DRI) model 2015 (DRI-2015) analyzers using 4073 CSN samples collected in 2017. The other comparison was between the Sunset and the DRI model 2001 (DRI-2001) analyzers using 303 CSN samples collected in 2007. Both comparisons showed a high degree of inter-model consistency in total carbon (TC) and the major carbon fractions, OC and EC, with a mean bias within 5 % for TC and OC and within 12 % for EC. Relatively larger and diverse inter-model discrepancies (mean biases of 5 %–140 %) were found for thermal subfractions of OC and EC (i.e., OC1–OC4 and EC1–EC3), with better agreement observed for subfractions with higher mass loadings and smaller within-model uncertainties. Optical charring correction proved critical in bringing OC and EC measurements by different TOA analyzer models into agreement. Appreciable inter-model differences in EC between Sunset and DRI-2015 (mean bias ±SD of 21.7 %±12.2 %) remained for ∼5 % of the 2017 CSN samples; examination of these analysis thermograms revealed that the optical measurement (i.e., filter reflectance and transmittance) saturated in the presence of strong absorbing materials on the filter (e.g., EC), leaving an insufficient dynamic range for the detection of carbon pyrolysis and thus no optical charring correction. Differences in instrument parameters and configuration, possibly related to disagreement in OC and EC subfractions, are also discussed. Our results provide a basis for future studies of uncertainties associated with the TOA analyzer model transition in assessing long-term trends of CSN carbon data. Further investigations using these data are warranted, focusing on the demonstrated inter-model differences in OC and EC subfractions. The within- and inter-model uncertainties are useful for model performance evaluation.

Omnichannel Retail and Business Model Transformation

Due to new technological developments and the ongoing digitalization, the traditional retail sector is currently exposed to major challenges. Digital Retail started with the development of e-commerce, when online companies, such as Amazon, began selling products online. These major online global players are still growing much faster than their smaller European retail competitors. As the absorption of buying power through online retailers, is dominated by global players based in Asia (Alibaba, Rakuten) and the United States (Amazon, eBay), Europe is experiencing a loss in revenue. In this highly competitive market, traditional European brick-and-mortar retailers face hard challenges. However, studies show that most customers currently do not prefer pure online retailers, but a hybrid model, since traditional stores provide them with the opportunity to experience products and to receive personal advice from experts. This paper is a contribution to on-going research on the business model transition to include digital channels in traditional retail companies and to integrate various channels that support and streamline personal customer requirements. Thus, the paper explores challenges and opportunities for omnichannel management in the digital retail industry.