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Aim: To assess trends in medical imaging requests before and after the 4-hour rule commenced and to assess the imaging time component of emergency department (ED) length of stay (LOS).Materials and Methods: Retrospective analysis of ED patients and imaging requests 1 year prior to and 3 years after implementation of the 4-hour rule (April to December for 2011-2014) was performed at a single adult tertiary referral Level 1 trauma hospital with Level 6 ED. Logistic regression was used to evaluate trends in the number of ED patient presentations, patient triage categories, and imaging requests for these patients. The imaging component of the total ED LOS was compared for patients who met the 4-hour target and patients who did not.Results: Compared to 2011 (before the 4-hour rule), ED presentations increased 4.74% in 2012, 12.7% in 2013, 21.28% in 2014 (p<0.01). Total imaging requests increased 23.05% in 2012, 48.04% in 2013, 60.77% in 2014 (p<0.01). For patients breaching the 4-hour rule, the mean time before radiology request was 2.4-2.8 hours; mean time from imaging request to completion was 1.2-1.3 hours; mean time from imaging completion to discharge from ED was the longest component of ED LOS (4.9-5.9 hours).Conclusions: There has been a significant increase in imaging requests, with a trend towards more CT and less radiography requests. Imaging requests for patients who breached the 4-hour target were made on average 2.4-2.8 hours after triage and average time after imaging in itself, exceeded 4 hours. Imaging is not likely a causative factor for patients breaching the 4-hour target. [ABSTRACT FROM AUTHOR]

Demands for plant-based food and beverage products have escalated in recent years. However, many commercial coffee creamers are still being made using dairy derivatives such as sodium caseinate. Therefore, there is a need to investigate the replacement of dairy based proteins with plant-based alternatives. This study was carried out to systematically investigate the properties of model O/W emulsions stabilized by either sodium caseinate (0.25 to 1.5%) or soy lecithin (0.5 to 1.5%). The model emulsions were made of 10% medium chain triglyceride (MCT) oil-in-water emulsions at pH 7. All model O/W emulsions exhibited whitish appearances similar to that of commercial creamers and were effective at lightening black coffee, except those containing the lowest emulsifier concentrations i.e. , 0.25% caseinate or 0.5% lecithin. The lightness of the model emulsions depended on the type and level of emulsifier used, with soy lecithin-stabilized emulsions having similar lightening power compare to that stabilized by sodium caseinate. No feathering or free oil were observed in the whitened coffees at the highest emulsifier level used. Mixtures of caseinate and lecithin emulsifiers were also used and model O/W emulsions with similar physical properties to that stabilized by sodium caseinate alone were produced. The mixed emulsifier-stabilized model emulsions had similar lightness when added to coffee than those stabilized by the individual emulsifiers, suggesting similar stabilization mechanisms using these emulsifiers alone or in combination. Unlabelled Image • Demands for plant-based milk and creamer products have escalated recently. • Model creamers were fabricated using soy lecithin and/or sodium caseinate • These creamers had similar physical properties to conventional dairy-based creamers. • The creamers were stable to aggregation and feathering after added to hot, acidic coffee. [ABSTRACT FROM AUTHOR]

Aims Modern chemoradiotherapy used for the treatment of anal cancer has significant acute toxicity. Intensity-modulated radiotherapy (IMRT) may reduce these side-effects. We report our experience implementing IMRT with simultaneous boost at the Sydney Cancer Centre and Royal North Shore Hospital. Materials and methods We retrospectively collected acute toxicity data on all consecutive patients treated definitively with IMRT between January 2008 and December 2011. Patients received concurrent 5-fluorouracil and mitomycin-C. The radiotherapy dose varied by stage in accordance with the Radiation Therapy Oncology Group (RTOG) 0529 protocol. The first 30 plans were evaluated for adherence to RTOG 0529 dose specifications. Locoregional control and survival outcomes were analysed in July 2014. Results We included 42 patients (stage I 12%; II 41%; III 45%) with a median follow-up time of 43 months. At 3 years the locoregional control was 94% (95% confidence interval: 78–99), overall survival was 92% (95% confidence interval: 78–97), disease-free survival was 89% (95% confidence interval: 73–96), metastasis-free survival was 89% (95% confidence interval: 73–96) and colostomy-free survival was 89% (95% confidence interval: 72–96). There was no acute grade 4 toxicity. Acute grade 3 toxicity rates were: dermatological (33%), gastrointestinal (14%) and haematological (19%). Twenty-six per cent of patients were hospitalised for treatment-related toxicity. Only 12% required a treatment break greater than 3 days. All patients achieved RTOG 0529 planning target volume dose specifications. Most critical organ dose constraints were either met or met with minor deviation. The exception was 76% major deviation in small bowel constraints. Despite this no increase in gastrointestinal toxicity was observed. Conclusions IMRT with simultaneous integrated boost is safe and well tolerated in an unselected population. Most dose specifications are achievable. Excellent locoregional control and survival outcomes are achievable outside of a clinical trial setting. [ABSTRACT FROM AUTHOR]