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3. Gemini: A Family of Highly Capable Multimodal Models.

Author

Rohan Anil, Sebastian Borgeaud, Yonghui Wu, Jean-Baptiste Alayrac, Jiahui Yu, Radu Soricut, Johan Schalkwyk, Andrew M. Dai, Anja Hauth, Katie Millican, David Silver, Slav Petrov, Melvin Johnson, Ioannis Antonoglou, Julian Schrittwieser, Amelia Glaese, Jilin Chen, Emily Pitler, Timothy P. Lillicrap, Angeliki Lazaridou, Orhan Firat, James Molloy, Michael Isard, Paul Ronald Barham, Tom Hennigan, Benjamin Lee, Fabio Viola, Malcolm Reynolds, Yuanzhong Xu, Ryan Doherty, Eli Collins, Clemens Meyer, Eliza Rutherford, Erica Moreira, Kareem Ayoub, Megha Goel, George Tucker, Enrique Piqueras, Maxim Krikun, Iain Barr, Nikolay Savinov, Ivo Danihelka, Becca Roelofs, Anaïs White, Anders Andreassen, Tamara von Glehn, Lakshman Yagati, Mehran Kazemi, Lucas Gonzalez, Misha Khalman, Jakub Sygnowski, and et al.

Published
2023
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4. Investigating foaming solutions generated by NaOH extraction of plant materials

Author

Hudson, Paul Ronald

Subjects
660, TP Chemical technology
Abstract

This thesis covers extraction of hay with NaOH to produce foaming solutions which might be used to substitute or reduce the need for, oil based surfactant in detergents. Extraction time, temperature and NaOH concentration were found to have varying levels of influence on the properties of the extract solutions. Models were constructed to describe their effects on the% mass extracted from the hay, as well as extract solution absorbance, viscosity, and contact angle using response surface, experimental design methodology. The hay extract foam was examined along with other types of foaming solutions, using cryogenic SEM. Hay, rice straw and horse chestnut leaf extract foams were found to be particle stabilised and interesting images were captured showing their microstructures. Foaming was found to be due to lignin-carbohydrate complexes in hay extract solutions and proteins in horse chestnut leaf extract solutions. Finally correlations were sought between foaming of hay extract solutions and their other properties, e.g. Foaming of the hay solutions is due to lignin derivatives, hence solution absorbance correlates positively with foaming; and foaming is improved by increased solution viscosity hence its positive correlation with solution viscosity and % mass extracted from hay.

Published
2014

7. Structure and function of enteric pathogen glyceraldehyde-3-phosphate dehydrogenases

Author

Elliott, Paul Ronald and Moody, Peter

Subjects
572.8
Abstract

The availability of published genomes from all domains of life has provided insight into biochemical processes for many organisms. Frequently the mapping of classical pathways onto genome-derived data is used to deduce metabolic pathways in an otherwise uncharacterised system. Whilst this method may be sufficient as a prelude to further biochemical analysis, the function of genes may be assigned by extrapolation from homologs, and this may not be correct. This study highlights the dangers of such a process, focusing on the glycolytic/gluconeogenic enzymes glyceraldehyde 3-phosphate dehydrogenase (GAPDH) from the human pathogenic species Helicobacter pylori and Campylobacter jejuni. H. pylori has two genes encoding GAPDH (gapA and gapB). These are both annotated as NAD+- dependent glyceraldehyde 3-phosphate dehydrogenases. This study has demonstrated enzymatically and structurally that gapA encodes a NADP-dependent GAPDH, whilst gapB encodes a NAD+-dependent GAPDH, furthermore GAPDHB is a better phosphorylating erythrose-4-phosphate dehydrogenase. Structural analysis of GAPDHA and GAPDHB showed key residues providing specificity for the coenzyme NADP+ over NAD+ and this finding was used to search for other putative NADP+-dependent GAPDHs within the Campylobacterales order. Other NADP+-dependent GAPDHs were identified; including that of C. jejuni, which has only one annotated GAPDH-encoding gene. Structural and enzymatic analysis confirmed C. jejuni's GAPDH is NADP+ dependent, although dual specificity is observed. This further shows the importance of experimental data to describe a system. Finally, a mutagenic approach was undertaken to determine the mechanism underlying the differing substrate specificities between GAPDHA and GAPDHB. Whilst the structural analysis was unable to provide a determinant of substrate specificity, these structures provided clear evidence for a reaction mechanism used by all phosphorylating GAPDHs. The significance of the findings is discussed in the context of the metabolism of these pathogens. This work demonstrates the importance of the synergy between structural and genomic analysis.

Published
2009

8. The Management of Children and Youth With Pediatric Mental and Behavioral Health Emergencies

Author

Saidinejad, Mohsen, primary, Duffy, Susan, additional, Wallin, Dina, additional, Hoffmann, Jennifer A., additional, Joseph, Madeline, additional, Schieferle Uhlenbrock, Jennifer, additional, Brown, Kathleen, additional, Waseem, Muhammad, additional, Snow, Sally K., additional, Andrew, Madeline, additional, Kuo, Alice A., additional, Sulton, Carmen, additional, Chun, Thomas, additional, Lee, Lois K., additional, Conners, Gregory P., additional, Callahan, James, additional, Gross, Toni, additional, Lee, Lois, additional, Mack, Elizabeth, additional, Marin, Jennifer, additional, Mazor, Suzan, additional, Paul, Ronald, additional, Timm, Nathan, additional, Dietrich, Ann M., additional, Alade, Kiyetta H., additional, Amato, Christopher S., additional, Atanelov, Zaza, additional, Auerbach, Marc, additional, Barata, Isabel A., additional, Benjamin, Lee S., additional, Berg, Kathleen T., additional, Chang, Cindy, additional, Chow, Jessica, additional, Chumpitazi, Corrie E., additional, Claudius, Ilene A., additional, Easter, Joshua, additional, Foster, Ashley, additional, Fox, Sean M., additional, Gausche-Hill, Marianne, additional, Gerardi, Michael J., additional, Goodloe, Jeffrey M., additional, Heniff, Melanie, additional, Homme, James (Jim) L., additional, Ishimine, Paul T., additional, John, Susan D., additional, Joseph, Madeline M., additional, Lam, Samuel Hiu-Fung, additional, Lawson, Simone L., additional, Lee, Moon O., additional, Li, Joyce, additional, Lin, Sophia D., additional, Martini, Dyllon Ivy, additional, Mellick, Larry Bruce, additional, Mendez, Donna, additional, Petrack, Emory M., additional, Rice, Lauren, additional, Rose, Emily A., additional, Ruttan, Timothy, additional, Saidinejad, Mohsen, additional, Santillanes, Genevieve, additional, Simpson, Joelle N., additional, Sivasankar, Shyam M., additional, Slubowski, Daniel, additional, Sorrentino, Annalise, additional, Stoner, Michael J., additional, Sulton, Carmen D., additional, Valente, Jonathan H., additional, Vora, Samreen, additional, Wall, Jessica J., additional, Walls, Theresa A., additional, Woolridge, Dale P., additional, Brandt, Cam, additional, Kult, Krisi M., additional, Milici, Justin J., additional, Nelson, Nicholas A., additional, Redlo, Michele A., additional, Curtis Cooper, Maureen R., additional, Redlo, Michele, additional, Kult, Krisi, additional, Logee, Katherine, additional, Bryant, Dixie Elizabeth, additional, Cooper, Maureen Curtis, additional, and Cline, Kristen, additional

Published
2023
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12. The Struggles of the Coal Miners in Britain.

Author

Paul, Ronald

Subjects
*COAL miners, *STRIKES & lockouts, *MINERS, *MINES & mineral resources
Abstract

The article discusses the struggles of coal miners in Great Britain. Topics include pivotal strikes involving the miners such as the General Strike of 1926, the 1974 national miners' strike, and the Great Strike of 1984-1985, history of the miners and mining in Great Britain, and key political lessons that can be learned from the strikes.

Published
2023
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14. Developing Educational and Entertaining Virtual Humans Using Elckerlyc

Author

Reidsma, Dennis, van Welbergen, Herwin, Paul, Ronald C., van de Laar, Bram, Nijholt, Anton, Hutchison, David, editor, Kanade, Takeo, editor, Kittler, Josef, editor, Kleinberg, Jon M., editor, Mattern, Friedemann, editor, Mitchell, John C., editor, Naor, Moni, editor, Nierstrasz, Oscar, editor, Pandu Rangan, C., editor, Steffen, Bernhard, editor, Sudan, Madhu, editor, Terzopoulos, Demetri, editor, Tygar, Doug, editor, Vardi, Moshe Y., editor, Weikum, Gerhard, editor, Yang, Hyun Seung, editor, Malaka, Rainer, editor, Hoshino, Junichi, editor, and Han, Jung Hyun, editor

Published
2010
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24. The effect of protean careers on talent retention:examining the relationship between protean career orientation, organizational commitment, job satisfaction and intention to quit for talented workers

Author

Redundo, Raquel, Sparrow, Paul Ronald, Hernández-Lechuga, Gabriela, Redundo, Raquel, Sparrow, Paul Ronald, and Hernández-Lechuga, Gabriela

Abstract

To study the effect of protean careers on talent retention, operationalized as the intention to quit, this study explores two pathways between protean career orientation and intention to quit: a direct pathway, and an indirect pathway via organizational commitment and job satisfaction. The study draws upon a sample of 306 talented workers selected from 17 Spanish and Mexican multinational organizations. Protean orientation should be expected to be widespread among talented individuals which might represent a threat to those that seek to develop and retain highly valued employees. We found that highly protean talented individuals show higher organizational commitment and higher job satisfaction, but contrary to expectations do not show a higher intention to quit. The total effect of protean career orientation on intention to quit is shown to not be significant because the positive direct effects are neutralized by negative indirect effects. The results help complement current knowledge of protean careers and a better understanding of organizational attitudes in the protean career context will help practitioners to show the importance of avoiding stereotyping talented employees based on a protean orientation as they do not comprise an extra risk for the organization in terms of commitment and turnover intention.

Published
2021

25. The effect of protean careers on talent retention : examining the relationship between protean career orientation, organizational commitment, job satisfaction and intention to quit for talented workers

Author

Redundo, Raquel, Sparrow, Paul Ronald, Hernández-Lechuga, Gabriela, Redundo, Raquel, Sparrow, Paul Ronald, and Hernández-Lechuga, Gabriela

Abstract

To study the effect of protean careers on talent retention, operationalized as the intention to quit, this study explores two pathways between protean career orientation and intention to quit: a direct pathway, and an indirect pathway via organizational commitment and job satisfaction. The study draws upon a sample of 306 talented workers selected from 17 Spanish and Mexican multinational organizations. Protean orientation should be expected to be widespread among talented individuals which might represent a threat to those that seek to develop and retain highly valued employees. We found that highly protean talented individuals show higher organizational commitment and higher job satisfaction, but contrary to expectations do not show a higher intention to quit. The total effect of protean career orientation on intention to quit is shown to not be significant because the positive direct effects are neutralized by negative indirect effects. The results help complement current knowledge of protean careers and a better understanding of organizational attitudes in the protean career context will help practitioners to show the importance of avoiding stereotyping talented employees based on a protean orientation as they do not comprise an extra risk for the organization in terms of commitment and turnover intention.

Published
2021

28. Access to Optimal Emergency Care for Children

Author

Brown, Kathleen M., primary, Ackerman, Alice D., additional, Ruttan, Timothy K., additional, Snow, Sally K., additional, Conners, Gregory P., additional, Callahan, James, additional, Gross, Toni, additional, Joseph, Madeline, additional, Lee, Lois, additional, Mack, Elizabeth, additional, Marin, Jennifer, additional, Mazor, Suzan, additional, Paul, Ronald, additional, Timm, Nathan, additional, Dietrich, Ann M., additional, Alade, Kiyetta H., additional, Amato, Christopher S., additional, Atanelov, Zaza, additional, Auerbach, Marc, additional, Barata, Isabel A., additional, Benjamin, Lee S., additional, Berg, Kathleen T., additional, Brown, Kathleen, additional, Chang, Cindy, additional, Chow, Jessica, additional, Chumpitazi, Corrie E., additional, Claudius, Ilene A., additional, Easter, Joshua, additional, Foster, Ashley, additional, Fox, Sean M., additional, Gausche-Hill, Marianne, additional, Gerardi, Michael J., additional, Goodloe, Jeffrey M., additional, Heniff, Melanie, additional, Homme, James (Jim) L., additional, Ishimine, Paul T., additional, John, Susan D., additional, Joseph, Madeline M., additional, Lam, Samuel Hiu-Fung, additional, Lawson, Simone L., additional, Lee, Moon O., additional, Li, Joyce, additional, Lin, Sophia D., additional, Martini, Dyllon Ivy, additional, Mellick, Larry Bruce, additional, Mendez, Donna, additional, Petrack, Emory M., additional, Rice, Lauren, additional, Rose, Emily A., additional, Ruttan, Timothy, additional, Saidinejad, Mohsen, additional, Santillanes, Genevieve, additional, Simpson, Joelle N., additional, Sivasankar, Shyam M., additional, Slubowski, Daniel, additional, Sorrentino, Annalise, additional, Stoner, Michael J., additional, Sulton, Carmen D., additional, Valente, Jonathan H., additional, Vora, Samreen, additional, Wall, Jessica J., additional, Wallin, Dina, additional, Walls, Theresa A., additional, Waseem, Muhammad, additional, Woolridge, Dale P., additional, Brandt, Cam, additional, Kult, Krisi M., additional, Milici, Justin J., additional, Nelson, Nicholas A., additional, Redlo, Michele A., additional, Curtis Cooper, Maureen R., additional, Redlo, Michele, additional, Kult, Krisi, additional, Logee, Katherine, additional, Bryant, Dixie Elizabeth, additional, Cooper, Maureen Curtis, additional, and Cline, Kristen, additional

Published
2021
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32. Contributors

Author

Abrahamian, Fredrick M., primary, Abramo, Thomas J., additional, Acosta, Robert, additional, Agosto, Paula, additional, Allen, Coburn, additional, Alpern, Elizabeth R., additional, Arroyo, Jesus M., additional, Aschkenasy, Miriam, additional, Auerbach, Peter S., additional, Babl, Franz E., additional, Bachman, Michael C., additional, Bair-Merritt, Megan H., additional, Band, Roger A., additional, Barata, Isabel, additional, Barcega, Besh, additional, Baren, Jill M., additional, Bauman, Beverly H., additional, Benjamin, Lee S., additional, Beno, Suzanne M., additional, Berkowitz, Deena, additional, Bernad, Jason E., additional, Biesbroeck, Daan, additional, Blake, Jeffrey S., additional, Blum, Frederick C., additional, Aram, Boura'a Bou, additional, Brancato, John C., additional, Brennan, Daniel F., additional, Brennan, John A., additional, Brewer, Allison V., additional, Briskin, Kenneth B., additional, Brown, Kathleen, additional, Brown, Lance, additional, Brown, Linda L., additional, Burg, Michael D., additional, Bush, Sean P., additional, Callahan, James M., additional, Cantor, Richard M., additional, Carbonell, Nicole P., additional, Carter, Eric T., additional, Cassidy, David D., additional, Catallozzi, Marina, additional, Chen, Esther H., additional, Chinnock, Richard E., additional, Cho, Christine S., additional, Chun, Thomas H., additional, Clark, Mark C., additional, Cloutier, Robert L., additional, Coco, Teresa J., additional, Cooper, Arthur, additional, D'Agostino, James, additional, Datner, Elizabeth M., additional, Delgado, Sergio V., additional, Denmark, T. Kent, additional, DePiero, Andrew, additional, Doniger, Stephanie J., additional, Donoghue, Aaron J., additional, Enns, Gregory M., additional, Farah, Mirna M., additional, Fein, Joel A., additional, Foltin, George L., additional, Friedlaender, Eron Y., additional, Fuchs, Susan, additional, Garra, Gregory, additional, Gausche-Hill, Marianne, additional, Gilmore, Barry G., additional, Givens, Timothy G., additional, Glaser, Nicole, additional, Glynn, Theodore E., additional, Goldman, Ran D., additional, Gorelick, Marc H., additional, Grant, Vincent J., additional, Green, Steven M., additional, Gregg, Victoria S., additional, Grupp-Phelan, Jacqueline, additional, Herman, Martin I., additional, Hicks, Marilyn P., additional, Holecek, Nancy E., additional, Hostetler, Mark A., additional, Hwang, Vivian, additional, Inaba, Alson S., additional, Isaak, Sean F., additional, Ishimine, Paul, additional, Jacobstein, Cynthia R., additional, Jacome, Gloria Cecelia C., additional, Jaffe, David M., additional, John, David P., additional, Joseph, Madeline Matar, additional, Keogh, Kelly A., additional, Khan, Nazeema, additional, Kim, Grace J., additional, Kim, Tommy Y., additional, King, Brent R., additional, King, Christopher R., additional, Kissoon, Niranjan, additional, Kizewic, Craig A., additional, Klasner, Ann, additional, Klassen, Terry P., additional, Knazik, Stephen R., additional, Kolecki, Paul, additional, Krauss, Baruch, additional, Kriwanek, Kelly L., additional, Kuppermann, Nathan, additional, Kwon, Kenneth T., additional, Levi, Steve, additional, Levine, Deborah A., additional, Lewena, Stuart, additional, Liebelt, Erica L., additional, Linares, Marc Y.R., additional, Luten, Robert, additional, Mace, Sharon E., additional, Macias, Charles G., additional, Maconochie, Ian, additional, Mallon, William K., additional, Mann, Courtney H., additional, Mann, Deborah J., additional, Marr, Jonathan, additional, Martinez, Nestor, additional, Mason, Andrew D., additional, Mastrovitch, Todd A., additional, Mayer, Thom A., additional, McCarthy, James J., additional, McCollough, Maureen, additional, McCormick, Ryan S., additional, McDevitt, Barbara E., additional, McDonnell, William M., additional, McIntosh, Mark S., additional, Mencl, Francis, additional, Migita, Russell, additional, Mills, Angela M., additional, Minasyan, Lilit, additional, Mistry, Rakesh D., additional, Mody, Ameer P., additional, Mollen, Cynthia J., additional, Moynihan, James A., additional, Muñiz, Antonio E., additional, Murray-Taylor, Stacey, additional, Muszynski, Michael J., additional, Nadel, Frances M., additional, Nager, Alan L., additional, O'Brien, John F., additional, Okada, Pamela J., additional, Olympia, Robert P., additional, Osterhoudt, Kevin C., additional, Padlipsky, Patricia S., additional, Pagane, Joe, additional, Pannell, Ruth Ann, additional, Paradis, Norman A., additional, Paul, Ronald I., additional, Garcia Peña, Barbara M., additional, Pershad, Jay, additional, Platt, Shari L., additional, Posner, Jill C., additional, Puchalski, Amy L., additional, Reisdorff, Earl J., additional, Roback, Mark G., additional, Rogers, Steven C., additional, Roosevelt, Genie E., additional, Rosales, Lazaro G., additional, Roth, Kimberly R., additional, Rothrock, Steven G., additional, Sacchetti, Alfred, additional, Sadowitz, Peter D., additional, Sampayo, Esther Maria, additional, Santamaria, John P., additional, Schamban, Neil, additional, Schultz, Carl H., additional, Schwab, Sandra H., additional, Schwartz, Fred, additional, Scott, Deborah, additional, Seibel, Matthew A., additional, Shah, Samir S., additional, Sharieff, Ghazala Q., additional, Shih, Richard D., additional, Shoenberger, Jan M., additional, Shrier, Ian, additional, Singer, Jonathan I., additional, Smith, Sharon R., additional, Souid, Abdul-Kader, additional, Spirko, Blake, additional, Sroufe, Nicole S., additional, Stanley, Rachel M., additional, Steele, Robert, additional, Steere, Mardi, additional, Stewart, Gail M., additional, Sweeney-McMahon, Patricia, additional, Talan, David A., additional, Taylor, Todd B., additional, Teach, Stephen J., additional, ten Napel, Sieuwert-Jan C., additional, Terndrup, Thomas E., additional, Thompson, Tonya M., additional, Thorp, Andrea, additional, Tien, Irene, additional, Tilelli, John A., additional, Tsarouhas, Nicholas, additional, Tunik, Michael G., additional, Vaillancourt, Christian, additional, Valente, Jonathan H., additional, Viccellio, Peter, additional, Wackett, Andrew, additional, Walls, Ron M., additional, Waxler, Jennifer L., additional, Weiner, Evan J., additional, Weiss, Stuart B., additional, Wilde, James A., additional, Williams, Kristine G., additional, Witt, Michael, additional, Wohl, Aaron, additional, Woodward, Tony, additional, Wright, Robert Bruce, additional, Wylie, Todd, additional, Young, Kelly D., additional, Zorc, Joseph J., additional, and Zouros, Alexander, additional

Published
2008
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37. Background rejection in gas detectors

Author

Ratcliff, Paul Ronald

Subjects
539.7, Radiation detection/monitoring
Abstract

Investigations have been made on the minimisation of the background count rate detected in proportional counters, while maximising the signal detection efficiency. Two methods of background rejection have been developed, based on the time profile of the shaped detector pulses and on the lateral extent of the induced charge distribution on the cathode. Both these systems have proved highly efficient, and the former has been applied to a multiwire proportional chamber designed as a monitor for plutonium lung contamination, an application where high efficiency detection is critical. This instrument, which incorporates full six-sided "massless" guard cells, and utilises real-time data acquisition and handling by microcomputer, has been developed, optimised, and assessed as a possible competitor to the phoswich detectors in use at present and the solid state detectors under development. Results indicate that the counter is likely to offer no more than a marginal improvement in sensitivity, insufficient to justify its increased compexity and higher costs.

Published
1988

38. Hausdorff measure functions

Author

Goodey, Paul Ronald

Subjects
515, Mathematics
Abstract

In many works on Hausdorff Measure Theory it has been the practice to place certain restrictions on the measure functions used. These restrictions usually ensure both the monotonloity and the continuity of the functions The aim of the first four chapters of this thesis is to find conditions under which the restrictions of continuity and monotonicity may be relaxed. In the first chapter we deal with the monotonicity condition with respect to both measures and pre-measures. The second and third chapters are concerned with an investigation of the continuity condition with regard to measures and pre-measures, respectively. Then, having found conditions under which these restrictions may or may not be relaxed, we are able, in the fourth chapter, to generalize some known results to the case of discontinuous and non-mono tonic functions. Some of the results of the first four chapters prompted an Investigation of the properties of measures corresponding to sequences of measure functions, and this is incorporated in the fifth chapter. The main purpose of the final chapter is to determine whether or not some of the results of the earlier chapters may be extended to Hilbert space.

Published
1971

40. Plan de marketing para servicios de mantenimiento postventa de clientes de la empresa Subaru - 2019

Author

Alderete Campos, Paul Ronald, Gilio Calagua, Liliana Elizabeth, Ugaz Urviola, Mirella del Rosario, and Solano Morales, José Miguel

Subjects
Marketing, Administración de empresas, Planificación estratégica, purl.org/pe-repo/ocde/ford#5.02.04 [https]
Abstract

El presente trabajo busca asegurar y maximizar las ventas del Servicio Postventa Subaru a fin de cubrir y compensar el impacto generado por la caída en la unidad de negocio de vehículos nuevos sobre los ingresos de la empresa, a través de un plan de marketing. Cabe señalar que el margen bruto del Servicio Post Venta Subaru es de 59%, muy por encima del margen de ventas de vehículos nuevos que es del 18%, lo cual hace estratégico para la organización centrar esfuerzos en la unidad de negocio de postventa. De la misma manera la retención de clientes en post venta es un indicador que muestra una importante oportunidad de crecimiento y de asegurar la permanencia de los clientes actuales en los talleres de servicio post venta Subaru. Tesis

Published
2019

42. Effect of urine latex agglutination tests on the treatment of children at risk for invasive bacterial infection

Author

Adcock, Penny M., Paul, Ronald I., and Marshall, Gary S.

Subjects
Agglutination tests -- Evaluation, Bacterial infections -- Diagnosis, Fever in children -- Causes of
Abstract

The use of urine latex agglutination (ULA) tests does not appear to affect treatment of children suspected of having serious bacterial infections. The ULA test, which can be performed rapidly and on-site, can be used to rule out infection with Haemophilus influenzae, Streptococcus pneumoniae, and group B streptococcus. A group of 1629 pediatric patients at a single hospital had ULA testing, of whom 1492 had cultures of blood, cerebrospinal fluid, or urine taken as well. Overall, 4.9% had positive cultures for one of the above three bacterial organisms. The ULA test predicted the absence of infection with a certainty of 97% or better. Despite this, 1211 children with negative ULA tests were admitted to the hospital, and a random sample of 10% of them revealed that 81% were treated with injected antibiotics., Background. Identifying febrile children with invasive bacterial infection is difficult in the absence of telltale physical findings. Urine latex agglutination (ULA) tests have been used for rapid, on-site identification of such children. Objectives. To study the performance of ULA tests in identifying children with Haemophilus influenzae, Streptococcus pneumoniae, and group B streptococcus infection and to examine how the results of ULA tests affect patient treatment. Design. Retrospective review. Setting. Urban children's hospital. Patients. All emergency department and hospital patients tested by ULA in 1990, excluding patients in the neonatal units. Results. Of 1629 patients, 36 had positive tests (20 H influenzae, 5 S pneumoniae, and 11 group B streptococcus). Thirteen of these were false positive based on culture results. Although ULA tests demonstrated excellent specificity, their sensitivity was poor. Positive predictive values for bacteremia ranged from 0.346 to 0.600, and negative predictive values ranged from 0.972 to 0.997. The decision to treat with antibiotics was made before ULA test results were available in 19 (53%) of the 36 patients with positive test results. Of 1593 patients with negative test results, 1211 (76%) were admitted to the hospital, and approximately 81% were empirically treated with parenteral antibiotics. Conclusions. In clinical practice, treatment and disposition decisions are frequently made without regard to ULA test results. Pediatrics 1995;96:951-954; occult bacteremia, serious bacterial infection, latex agglutination test, Haemophilus influenzae, Streptococcus pneumoniae, group B streptococcus., ABBREVIATIONS. CSF, cerebrospinal fluid; ULA, urine latex agglutination; GBS, group B streptococcus. Identifying febrile children who have serious bacterial infections can be problematic, especially when diagnostic physical findings are absent. [...]

Published
1995

44. Foreign body ingestions in children: risk of complication varies with site of initial health care contact

Author

Paul, Ronald I., Christoffel, Katherine Kaufer, Binns, Helen J., and Jaffe, David M.

Subjects
Children's accidents -- Care and treatment, Ingestion -- Accidents
Abstract

The incidence of complications among children who swallow foreign objects may vary depending on where they receive treatment. Among 244 children between five months and 14 years old suspected of swallowing a foreign object, 132 went to a pediatric emergency room at a tertiary care hospital, 48 were referred by their physician or another hospital to a pediatric emergency room at a tertiary care hospital and 64 were treated at a private physician's office. Foreign objects were recovered from 45% of the patients. Coins were the most common object recovered from the patients, and others included food items, toys and jewelry. Of 221 patients, 24% underwent a procedure to remove a foreign object and 22% developed complications. Complications occurred in 63% of the patients referred by a physician to an emergency room, compared with 13% of those who went without a referral and 7% of those treated by a private physician., Current recommendations for the management of pediatric foreign body ingestions are based on studies of patients cared for at tertiary care hospitals; they call for aggressive evaluation because of a high incidence of complications. Two hundred forty-four children with suspected foreign body ingestions were prospectively followed to analyze adverse outcomes, ie, procedures, complications, and hospitalizations. Patient enrollment into the study was from three sources: (1) patients who referred themselves to a tertiary pediatric emergency department, (2) patients referred to the same tertiary pediatric emergency department after an initial evaluation by another hospital or physician, and (3) patients who reported their foreign body ingestions to a private pediatric practitioner participating in the study. Most children were well toddlers in normal circumstances, under parent supervision at the time of ingestion. Coins were the most common item ingested (46%). Procedures were done in 53 (24%) of 221 patients and complications occurred in 48 (22%) of 221. Complications were higher in patients referred to the emergency department (63%) than in emergency department self-referred patients (13%) or private practice patients (7%) ([X.sup.2], P < .01). These findings demonstrate the risk of drawing conclusions regarding a universal standard of care from studies involving only hospital-based patients. Pediatrics 1993; 91:121-127; foreign body, coin, ingestion, standard of care.

Published
1993

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