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Summary Objective To explore the relationship between the number of patients presenting to the Emergency Department and the weather. To determine if the number of non-urgent cases presenting to the ED is affected by the weather. Methods Retrospective review of all presentations to the ED of a tertiary referral hospital in the south-west of Sydney, Australia over a 1year period. Total daily numbers of patient presentations and their triage acuity were correlated with temperature, rainfall, day of the week and the absence or presence of a Public holiday. Results During the study period 46,903 patients presented to the ED with an average of 128.5 patients a day. Rainfall occurred on 135days. There was a positive correlation between day of the week ( P P P =0.04). Daily rainfall did not significantly influence ED attendance numbers ( P =0.07). The presence of a Public holiday was the only significant variable affecting the numbers of non-urgent presentations ( P =0.003). Conclusions Meteorological factors such as rainfall and temperature impact minimally on ED attendances. Day of the week and Public holidays are more important variables impacting on total ED workload and resource planning should be guided by this.

Sunitinib malate (SU11248/Sutent; Pfizer) is a multitargeted tyrosine kinase inhibitor that has potent anti-angiogenic and antitumour activities. Definitive efficacy has been demonstrated in advanced renal cell carcinoma and in gastrointestinal stromal tumours that are refractory or intolerant to imatinib (Gleevec; Novartis), which has provided the basis for the recent regulatory approvals for these indications. This article summarizes the discovery and development of sunitinib, and discusses key issues for the multitargeted approach in cancer treatment, such as markers of response and development of resistance, and their significance for the future development of sunitinib and other multikinase inhibitors.

To determine the clinical and environmental variables associated with frequent presentations by adult patients to a remote Australian hospital emergency department (ED) for reasons other than chronic health conditions.Unmatched case-control study of all adult patients attending Katherine Hospital ED between 1 January and 31 December 2012.Cases were defined as frequent attenders (FAs) without a chronic health condition who presented to the ED six or more times during the 12-month period. A single presentation was randomly selected for data collection. Controls were patients who presented on only one occasion.Basic demographic data were collected, including clinical outcomes, Indigenous status, living arrangements, and whether alcohol and violence contributed to the presentation. Environmental variables were extracted from the Bureau of Meteorology database and mapped to each presentation.FAs were much more likely to be homeless (odds ratio [OR], 16.4; P0.001) and to be Aboriginal (OR, 2.16; P0.001); alcohol as a contributing factor was also more likely (OR, 2.77; P = 0.001). FAs were more likely to present in hotter, wetter weather, although the association was statistically weak. Clinical presentations by cases and controls were similar; the annual death rates for both groups were high (3.6% and 1.5%, respectively).There was a strong association between FA and Aboriginal status, homelessness and the involvement of alcohol, but alcohol was more likely to contribute to presentation by non-Aboriginal FAs who had stable living conditions. FAs and non-FAs had similar needs for emergency medical care, with strikingly higher death rates than the national average in both groups. As a result of this study, Katherine Hospital has initiated a Frequent Attender Pathway that automatically triggers a dedicated ED service for those at greatest clinical risk. Homelessness is a serious problem in the Northern Territory, and is associated with poor health outcomes.

The EXIT (Ex-Utero Intrapartum Treatment) procedure is an extremely valuable tool in providing time to secure the airway in infants with large fetal neck masses and abnormalities of the upper airway which impede resuscitation. The fetus is partially delivered while maintaining utero-placental-fetal circulation. We report the use of this technique in a case of huge cystic hygromas of the neck and chest due to a nuchal bleb-lethal dysplasia. Although severe pulmonary hypoplasia precluded an optimal outcome, this report shows that this procedure is technically feasible. We believe this to be the first case performed and reported in Louisiana.

The rapid targeting system (RTS) has been in operation at the Combined Air Operations Center (CAOC) in Vicenza, Italy since June 1996. RTS provides sensor-to-shooter support to the CAOC Battle Staff Director. Since June 1996, RTS has been involved in over 200 operational training sorties flown for Operation Decisive Endeavour and the newly created Operation Deliberate Guard. Training sorties have been run with U.S. Air Force F- 15Es, U.S. Navy F/A-18Ds and A-6s, and U.S. Marine Corps F/A- 18D aircraft. RTS provides these aircraft with near-real-time imagery of mobile and stationary targets from the U-2, JSTARS, Predator UAV, GNAT, Tactical Reconnaissance, and National Reconnaissance sensors. In response to Air South requests, RTS was recently used in conjunction with the 48th Fighter Wing, 492nd Fighter Squadron during a two week deployment from Lakenheath Air Base, UK to Aviano Air Base, Italy.© (1997) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.