Time Of Entrance Research Articles

Daily Chlorhexidine Bath for Health Care Associated Infection Prevention (CLEAN-IT): protocol for a multicenter cluster randomized crossover open-label trial.

Critically ill patients are at increased risk of health care-associated infections due to various devices (central line-associated bloodstream infection, catheter-associated urinary tract infection, and ventilator-associated pneumonia), which pose a significant threat to this population. Among several strategies, daily bathing with chlorhexidine digluconate, a water-soluble antiseptic, has been studied as an intervention to decrease the incidence of health care-associated infections in the intensive care unit; however, its ability to reduce all health care-associated infections due to various devices is unclear. We designed the Daily Chlorhexidine Bath for Health Care Associated Infection Prevention (CLEAN-IT) trial to assess whether daily chlorhexidine digluconate bathing reduces the incidence of health care-associated infections in critically ill patients compared with soap and water bathing. The CLEAN-IT trial is a multicenter, open-label, cluster randomized crossover clinical trial. All adult patients admitted to the participating intensive care units will be included in the trial. Each cluster (intensive care unit) will be randomized to perform either initial chlorhexidine digluconate bathing or soap and water bathing with crossover for a period of 3 to 6 months, depending on the time of each center's entrance to the study, with a 1-month washout period between chlorhexidine digluconate bathing and soap and water bathing transitions. The primary outcome is the incidence of health care-associated infections due to devices. The secondary outcomes are the incidence of each specific health care-associated infection, rates of microbiological cultures positive for multidrug-resistant pathogens, antibiotic use, intensive care unit and hospital length of stay, and intensive care unit and hospital mortality. The CLEAN-IT trial will be used to study feasible and affordable interventions that might reduce the health care-associated infection burden in critically ill patients.

Estimation of Serum Zinc and Copper in Children with Acute Diarrhea

Diarrhoea is a disease related to nutrition as it involves the loss of fluid and electrolytes. The death rate in children due to diarrhoea is high because of undernutrition, even if they are well-hydrated. In this examination, we sought out the concentrations of copper and zinc in the serum of children diseased with acute diarrhoea, before and after the therapy of standard ORS (oral rehydration solution) therapy and associated it with the severity of diarrhoea and its period. Children involved in the examination were 110 in number, who were diseased with acute diarrhoea. The concentrations of zinc and copper in the serum of children with acute diarrhoea were noted before (at the time of entrance) and after treating them with standard oral rehydration solution (ORS) therapy. This research showed that the levels of zinc and copper in the serum of children diseased with acute diarrhoea, declined significantly to 13% and 12.8%, respectively, from their normal serum concentrations. After treatment with ORS therapy, a further decrease of 22.4% and 22.6% is seen in the concentration of zinc and copper, respectively. Our research showed that the children who were having a very low level of zinc and copper in the plasma were more prone to be diseased with acute diarrhoea and even more severely and with longer duration.

Estimation of University Education Effectiveness according to Individual Characteristics and Institutional Variables using Performance Indicators: Focusing on Student Satisfaction, GPA, and Job Search Efficacy

본 연구의 목적은 대학 교육 효과성의 의미를 살펴보고, 성과지표를 활용하여 개인 특성 및 기관 변인에 따른 대학 교육의 효과성을 추정하는 것이다. 선행연구를 통하여 대학 교육의 효과성 분석을 위한 주요 개인 특성 및 기관 변인을 선정한 후, 위계적 선형 모형(Hierarchical Linear Modeling, HLM)을 활용하여 분석을 수행하였다. 이를 위하여 한국고용정보원의 2018년도 대졸자 직업이동 경로 조사(Graduates Occupational Mobility Survey, 2018 GOMS) 자료를 활용하였다. 분석 결과는 다음과 같다. 첫째, 대학 수준 변인으로서 고려한 설립기준 및 소재지는 대학 교육 성과 변수 가운데 대학 만족도, 학과 만족도 및 학점에 대하여 대체로 유의미한 영향력을 가지고 있음을 알 수 있다. 둘째, 삶의 만족도는 모든 대학 교육 성과 변수에 대한 정적(+)인 영향력을 가지는 것은 대학 교육 효과성에 대한 주관적 인식에 개인의 삶의 태도가 그대로 반영되어 나타날 수 있음을 시사한다. 셋째, 대학 입학 시점을 포함한 교육 경험 변인은 더욱 다양하게 대학 교육의 성과에 영향을 주면서 효과성 추정의 근거로 활용될 가능성을 보여주고 있다. 넷째, 교육환경 변인은 대부분 대학 교육 성과 변수에 정적(+)인 영향력을 가지고 있음을 확인할 수 있다. 이러한 결과는 학령기 감소 및 4차 산업 시대의 도래를 맞이하여 새로운 교육환경에 대처하기 위한 고등교육의 역할을 모색하고 향후 발전 방향 수립을 위한 근거자료로 활용될 것으로 기대한다.This research tries to estimate the college education effectiveness by measuring the effect of individual characteristics and institutional components to the performance indicators of university based on Hierarchical Linear Model(HLM). This study used 2018 GOMS data for the research purpose. The main results show following results. First, institutional sector and location significantly affect to the college satisfaction, major satisfaction, and academic performance in general. Second, the life satisfaction gives positive impact on performance indicators of university and it could reflect the personal attitude of life to the effectiveness of university education. Third, variables of educational experience, including the time of college entrance, affect the performance of college education more diversely, showing the possibility of being used as a basis for estimating effectiveness. Fourth, it can be confirmed that educational environment variables have a positive influence on most college education performance indicators. Those results provide new institutional role and further direction for the postsecondary institutions dealing in shortage of student number and needs of 4th industry era.

A Quantum Approach to the Problem of Charging Electric Cars on a Motorway

In this paper, the problem of charging electric motor vehicles on a motorway is considered. Charging points are located alongside the motorway. It is assumed that there are a number of vehicles on a given section of a motorway. In the motorway, there are several nodes, and for each vehicle, the entering and the leaving nodes are known, as well as the time of entrance. For each vehicle, we know the total capacity of its battery, and the current amount of energy in the battery when entering the motorway. It is also assumed that for each vehicle, there is a finite set of speeds it can use when traveling the motorway. The speed is chosen when entering the motorway, and cannot be changed before reaching the charging station. For each speed, there is given a corresponding power usage; the higher the speed, the larger the power usage. Each vehicle can only use one charger, and when its battery is full, the amount of energy is sufficient for reaching the outgoing node. We look for a feasible solution to the problem, i.e., a solution in which no vehicle has to wait for a charger. The problem is formulated as a problem of scheduling independent, nonpreemptable jobs in parallel, unrelated machines under an additional doubly constrained resource, which is power. Quantum approaches to solve the defined problem are proposed. They use the quantum approximate optimization algorithm and the quantum annealing technique. A computational experiment is presented and discussed. Some conclusions and directions for future research are given.

Comparison of the Effect of Forced-air Warming and Warmed Intravenous Fluid on the Comfort and Prevention of Shivering After Spinal Anesthesia in Patients Undergoing Orthopedic Surgery

PurposeThis study aimed to compare the effect of forced-air warming and warmed intravenous fluid on the comfort and prevention of shivering after spinal anesthesia in patients undergoing orthopaedic surgery. DesignRandomized controlled clinical trial. MethodsA total of 120 patients were randomly divided into three groups: forced-air warming (38°C), warmed intravenous fluid (37°C), and the control group. Patients' comfort and severity of shivering were measured and recorded five times (immediately and 15 minutes after spinal anesthesia, end of the surgery, time of entrance to the recovery room, and 15 minutes after entering the recovery room), and compared with each other. FindingsThere was a significant difference between the three groups in terms of comfort at all points of evaluation times (P < .001). The comfort score in the control group was significantly higher than the two intervention groups (P < .001). Moreover, the comfort score in the warmed intravenous fluid group was significantly higher than the forced-air warming group (P < .001). In addition, there was a significant difference in shivering severity between the three groups at the end of the surgery, entrance to the recovery room, and 15 minutes after surgery (P < .001). The majority of patients in the forced-air warming group (90%) had no shivering at all three times, while the warmed IV fluid and control groups was 65% and 30% respectively. ConclusionsNon-pharmacological methods such as forced-air warming and warmed intravenous fluid can provide comfort and prevent shivering in orthopaedic patients undergoing spinal anesthesia. However, the use of forced-air warming is more effective than warmed intravenous fluid in providing comfort and preventing shivering in these patients. It is recommended that these methods be used in the operating room to provide comfort and prevent shivering in these patients.

The impact of time of entrance to center-based care on children’s general, language, and behavioral development

There are contrasting results of the association between center-based care attendance and child development, mainly related to how the time of entry and permanence in the program relates to developmental outcomes. Using latent class analysis in a nationally representative sample of Chilean children between 6 and 35 months old (n = 3,992), and controlling for the child’s age, maternal education, mother’s marital status, and household income, we identify three different timings of entrance in center-based care programs. The three timings of entrance were defined as early-entry (16%), those children who are more likely to enter before they are 6 months old; middle-entry (16%), those who are more likely to enter when they are between 6 and 18 months old; and late-entry (68%), those children with a low probability of enrollment any time before they are 35 months old. We found that children from the early- and middle-entry classes had higher language development when compared with children from the late-entry class. Still, only those from the middle-entry class showed higher general development in the Battelle test. In contrast, children in the early- and middle-entry classes presented higher scores in the Child Behavior Checklist’s externalizing behavior scale than children in the late-entry class. Our findings highlight the existence of a likely linkage between the timing of entry to center-based care and child development. It is essential to understand the potential advantages of center-based care in younger children, especially in enhancing their vocabulary and general development, and the potential negative association of early-entry with problematic behavior.

Mini-resectoscope vs morcellator for in-office hysteroscopic myomectomy: Evaluation of results and patient satisfaction

IntroductionThe development of hysteroscopic techniques has led to an advance in submucous myoma treatment, offering a safe and effective minimally invasive alternative. Our objective was to compare the results of hysteroscopic myomectomy when using whether the mini-resectoscope or the MyoSure morcellator, as well as patient satisfaction after the procedure. Material and methodsA prospective, cross-sectional, observational study including 80 patients distributed into two groups: Mini-Resectoscope group (MRG) or MyoSure group (MSG), depending on the instrument used for the in-office hysteroscopic myomectomy. Resection time, pain during entry, pain during resection, number of resections required, complete resection, and total satisfaction were recorded. ResultsMSG had statistically significant shorter time of entrance. There were no other statistically significant differences between groups. ConclusionsIn-office hysteroscopic myomectomy is associated with high levels of patient satisfaction, without differences between the mini-resectoscope or the MyoSure, allowing high rates of complete resection using both instruments. Thus, it is a feasible technique which could be performed with both instruments, depending on the operator’s expertise.

Effects of the Two Doses of Dexmedetomidine on Sedation, Agitation, and Bleeding During Pediatric Adenotonsillectomy

BackgroundDue to the importance of dexmedetomidine and its different dosages, here, we aimed to investigate and compare the effectiveness of the doses of 1 µg/kg and 2 µg/kg of dexmedetomidine in sedation, agitation, and bleeding in pediatrics undergoing adenotonsillectomy.MethodsThis double-blinded randomized clinical trial was performed on 105 pediatric patients that were candidates for adenotonsillectomy. Then, the patients were divided into three groups receiving dexmedetomidine at a dose of 2 µg/kg, diluted dexmedetomidine at 1 µg/kg, and normal saline. The drugs were administered 15 minutes before operations via the intravenous method. The duration of extubation, mean arterial pressure (MAP), heart rate (HR), and SPO2 in the recovery were recorded. We also collected data regarding patients’ sedation and agitation every 15 minutes.ResultsOur data showed no significant differences between the groups of patients regarding MAP, HR, and SPO2. However, the mean sedation score was significantly higher in patients receiving dexmedetomidine (2 µg/kg), and this score was lowest in the control group at the time of entrance to the recovery room. The patients that received dexmedetomidine at a dose of 1 µg/kg had the lowest agitation score after 45 minutes of being in the recovery room, and the patients treated with dexmedetomidine at a dose of 2 µg/kg had the lowest agitation score after 60 minutes of being in the recovery compared to other groups of patients.ConclusionsThe use of the doses of 1 µg/kg and 2 µg/kg of dexmedetomidine was associated with proper sedation and a significant reduction in agitation. The patients also had lower amounts of bleeding. We recommend that anesthesiologists should pay more attention to dexmedetomidine at a dose of 2 µg/kg, especially in pediatric surgical procedures.

Comparison of the Effect of Ketamine, Ketamine-Midazolam and Ketamine-Propofol on Post-Tonsillectomy Agitation in Children.

BackgroundEmergence agitation (EA) in children is one of the most common complications following anaesthesia. We aimed to compare the effect of ketamine, ketamine-midazolam and ketamine-propofol on EA after tonsillectomy.MethodsThis study was a randomised, double-blind clinical trial conducted on 162 children undergoing adenotonsillectomy surgery. The participants were randomly divided into three groups of receiving ketamine (0.5 mg/kg) (N = 54), ketamine (0.5 mg/kg) + propofol (1 mg/kg) (N = 54) and ketamine (0.5 mg/kg) + midazolam (0.01 mg/kg) (N = 54) 10 min before the end of the operation. At the time of the patients’ entry into the post-anaesthesia care unit (PACU) and at intervals of 5 min, 10 min and 20 min after that, consciousness, mobility, breathing, circulation and SpO2 were recorded. Modified Aldrete recovery score (MARS), the objective pain score (OPS) and Richmond agitation-sedation scale (RASS) were also evaluated.ResultsAt the time of entrance to the PACU and 5 min later, the ketamine-midazolam and ketamine-propofol groups had lower RASS scores than the ketamine group (P < 0.001); after 10 min and 20 min, the ketamine-propofol group showed the lowest RASS score (P < 0.001). Ketamine-propofol group had a significantly lower MARS score at all-time points (P < 0.001). Recovery time was the longest for the ketamine-propofol group (P = 0.008).ConclusionThe ketamine-midazolam group had lower RASS, greater haemodynamic stability and MARS values without delayed awakening.

Optimal exit choice during highway tunnel evacuations based on the fire locations.

In the case of a fire, the choice of exit in the highway tunnel is strictly limited by fire location, which seriously affects the evacuation time. A spontaneous or disorderly exit choice might result in a decreased evacuation efficiency and utilization rate of exits. In this paper, we propose a strategy to obtain the optimal exit choice based on fire location during highway tunnel evacuations. In our strategy, first, the vehicle distributions and locations of evacuating occupants are determined in the traffic simulation program VISSIM. The evacuation simulation software BuildingEXODUS is employed to obtain the corresponding parameters of the evacuation process and analyze the impacts of different fire locations on the evacuation time. During the analysis, the optimal productivity statistics (OPS) is selected as the evaluation index. Then, the feature points of the crowding occupants are captured by the fuzzy c-means (FCM) cluster algorithm. Next, based on the feature points, the relationship between the location of the fire and boundary of the optimal exit choice under the optimal OPS is obtained through the polynomial regression model. It is found that the R-squared(R2) and sum of squares for error (SSE) of the polynomial regression model, reflecting the accuracy estimation, are 98.02% and 2.79×10-4, respectively. Moreover, different fire locations impact the evacuation time of tunnel entrance and evacuation passageway. This paper shows that the location of the fire and boundary of optimal exit choice have a negative linear correlation. Taking the fire 110 m away from the evacuation passageway as an example, the OPS of our strategy can be decreased by 35.6% when compared with no strategies. Our proposed strategy could be applied to determine the location of variable evacuation signs to help evacuating occupants make optimal exit choices.

ESTIMATION OF PREVALENCE OF ANAEMIA, VITAMIN B12, VITAMIN D &amp; FOLIC ACID DEFICIENCY IN FIRST YEAR MBBS STUDENTS OF A TERTIARY MEDICAL COLLEGE IN EASTERN INDIA

Medical students are more vulnerable to develop nutritional anemia ( i.e. haemoglobin, iron , vit B12, folate deciency) &amp; vitamin D deciency due to irregular eating habits &amp; hectic study schedule. Anemia among this age group has signicant health consequences ( e.g. poor cognition, decreased attention span , depressed immunity, repeated infections, increased fatigue etc) . So the present study was planned to ascertain the prevalence of anemia , iron , folic acid ,vit B12 &amp; D deciency among young adult female &amp; male st medical 1 year MBBS students of Medical College Kolkata,( batch 2019-2020) ,West Bengal,India and to suggest intervention strategies. 63 % &amp; 37% female &amp; male students respectively were found to be anaemic &amp; low level of hemoglobin is signicantly associated with type of family as 22% of study subject's belonged to joint family and 78% subjects belong to nuclear family. (p=0.002) &amp; there came out to be no signicant association between socio-economic status and anemia (p=0.213) . Among these subjects with anemia 12 had iron deciency . Serum folic acid levels were normal in the 100 study subjects . 30% students had low serum levels of vitamin B12 , and there was no gender preference (9 suffered from severe deciency, 21 students were in low normal range) . In this study, moderate Vitamin D deciency was found to be present in 42% subjects, mild insufciency in 57% subjects, and adequate serum Vitamin D levels in just 1%. Periodical and routine health check-up and haemoglobin estimation of the students at the time of entrance to Medical Colleges should be done. Iron and folic acid tablets and deworming drugs in therapeutic doses should be provided to the anaemic students. Students should be motivated and educated to take balanced diet, rich in green leafy vegetables and fruits.

Spatial-temporal response patterns of tourist flow under entrance tourist flow control scheme

This paper explores the relationship between tourists' information demand about entrance tourist flow control schemes (ETFCS) and tourists' entrance transfer decision-making behavior, using the case study of the Summer Palace, one of the most important resort destinations in Beijing, China. After discussing tourists' decision-making behavior under ETFCS information, a revealed preference and stated preference survey (N = 1742 valid observations) were created and a joint choice model of tourist's entrance transfer and diversion entrance selection was established. Results show how various ETFCS are formulated and affect tourists' decision-making behavior under different traffic congestion. Sensitivity analysis reveals that tourists' entrance transfer decision-making behavior is related to the entry time of current crowded entrance and the time saved from the diversion entrance. Hence it is possible to formulate ETFCS in terms of tourist's spatial-temporal distribution in order to anticipate the levels of tourist intensity, especially during peak periods.

ESTIMATION OF PREVALENCE OF ANAEMIA, VITAMIN B12, FOLIC ACID &amp; VITAMIN D DEFICIENCY IN FIRST YEAR MBBS STUDENTS OF A TERTIARY MEDICAL COLLEGE IN EASTERN INDIA

Medical students are more vulnerable to develop nutritional anemia ( i.e. haemoglobin, iron , vit B12, folate deficiency) &amp; vitamin D deficiency due to irregular eating habits &amp; hectic study schedule. Anemia among this age group has significant health consequences ( e.g. poor cognition, decreased attention span , depressed immunity, repeated infections, increased fatigue etc) . So the present study was planned to ascertain the prevalence of anemia , iron , folic acid ,vit B12 &amp; D deficiency among young adult female &amp; male medical 1st year MBBS students of Medical College Kolkata,( batch 2019-2020) ,West Bengal,India and to suggest intervention strategies. 63 % &amp; 37% female &amp; male students respectively were found to be anaemic &amp; low level of hemoglobin is significantly associated with type of family as 22% of study subject’s belonged to joint family and 78% subjects belong to nuclear family. (p=0.002) &amp; there came out to be no significant association between socio-economic status and anemia (p=0.213) . Among these subjects with anemia 12 had iron deficiency . Serum folic acid levels were normal in the 100 study subjects . 30% students had low serum levels of vitamin B12 , and there was no gender preference (9 suffered from severe deficiency, 21 students were in low normal range) . In this study, moderate Vitamin D deficiency was found to be present in 42% subjects, mild insufficiency in 57% subjects, and adequate serum Vitamin D levels in just 1%. Periodical and routine health check-up and haemoglobin estimation of the students at the time of entrance to Medical Colleges should be done. Iron and folic acid tablets and deworming drugs in therapeutic doses should be provided to the anaemic students. Students should be motivated and educated to take balanced diet, rich in green leafy vegetables and fruits.

Effects of different dark chocolate diets on memory functions and brain corticosterone levels in rats under chronic stress

Introduction: Stress influences cognitive behavior adversely, whereas dark chocolate exhibits positive effects on memory processes. This study investigated the effects of different dark chocolate diets on various aspects of brain functions in rats under chronic stress Methods: Thirty-five rats were randomly allocated into five groups: control, stress, stress with different (compulsory, optional and restricted) dark chocolate diets. Latency, dark stay (DS) time and the number of entrance to the dark compartment were respectively evaluated as memory, memory consolidation and locomotor activity by passive avoidance test. Results: There were significant differences between initial latency and latency after 1 day in all groups. In the stress-compulsory and restricted dark chocolate diet groups, latency after 1 day increased significantly. Moreover, the DS time was not significantly higher in the stressed group than the control group. The DS time and number of entrance to dark compartment decreased significantly in the stress-compulsory dark chocolate diet group compared to the stressed group. Furthermore, the number of entrance to dark compartment was significantly higher for the stress- optional dark chocolate diet compared to those with the compulsory diet. Additionally, serum and hippocampal corticosterone levels, except in the frontal cortex, were significantly lower only in the stress-compulsory dark chocolate diet group compared to the stressed group. Conclusion: Different dark chocolate diets had various effects on brain functions under chronic stress. Respectively, the compulsory and optional dark chocolate diets had the best and least effects on brain function improvement. Only the compulsory dark chocolate diet could improve brain functions such as memory, memory consolidation and locomotor activity.

A simple and convenient method for determination of entrance into dormancy in woody plants

BACKGROUND: Bud dormancy is a quantitative condition that is gradually acquired and lost. Better and more convenient methods for assessment of the time of dormancy entrance of woody plants are highly needed. OBJECTIVE: To demonstrate a simple and convenient method for determination of dormancy in woody plants. METHODS: We employed a seasonal series of soft tipping of vigorously growing annual shoots and used the loss of ability of subtending lateral buds to break and grow as a measure of entrance into dormancy. RESULTS: There was a gradual decline in the ability of the buds to burst and grow during the month of July and early August, culminating with a complete loss of this ability. This coincided with the known time of growth cessation and dormancy induction in shoots of intact plants and occurred in the berry shrubs raspberry and black currant and the forest tree silver birch. CONCLUSIONS: The decline and loss of ability of the buds to grow during late summer is a direct expression of the entrance of buds into the state of endodormancy, rendering the tipping method a simple and convenient method for precise determination of the time of entrance into dormancy in woody plants.

Subject variety and incentives to learn: Evidence from public high school admission policies in Japan

This paper provides evidence on whether mandating wider subject variety on high school entrance exams affects long-term educational achievement using Japanese historical experiences. In Japan, where high school education is non-compulsory, prefectural boards of education have retained the freedom to set admission criteria for public high schools within their prefecture, including the number of subjects tested on entrance exams. Using prefectural-level panel data, we estimate the effect of the number and choice of subjects tested at the time of high school entrance on the probability of college attendance three years later. We find that the variety of subjects tested has a positive effect on the later college enrollment. Our findings are broadly consistent with the incentive theory of testing (Lazear, 2006) and the empirical results from other countries.

“Ne riday Mene, Mati” (“Do not mourn Me, Mother”): poetics, liturgics, hymnography

“Ne riday Mene, Mati” (“Do not mourn Me, Mother”): poetics, liturgics, hymnography

Kronik Subdural Hematom Cerrahisinde Ameliyathanenin Etkin Kullanımı Hakkındaki Görüşler

Aim: Chronic subdural hematoma is one of the most common extracerebral hemorrhages that causes significant morbidity with increasing human life. Associations with mild head trauma are reported in 60-80% of the literature. The aim of this study is to investigate whether local and general anesthesia performed in the operation of chronic subdural hematoma patients make a difference in terms of operative time, operation cost and total times for using the operating room.Material and Methods: The records of 27 patients who were operated with diagnosis of unilateral chronic subdural hematoma between the years 2016 and 2018 in Duzce University Medical Faculty Training and Research Hospital, Neurosurgery Department were reviewed retrospectively. Age, gender, ASA score, operative time, time between entry and exit to the operating room, length of hospital stay and operating costs were recorded.Results: It was found that the operating cost and total time between entry and exit to the operating room were shorter in patients undergoing local anesthesia, and the difference between patients undergoing general anesthesia was found statistically significant (both p values are &amp;lt;0.001).Conclusion: In our study, a significant difference was found between the time of entrance and exit of patients who underwent local and general anesthesia. In the general anesthesia group, the costs were significantly higher. In patients with chronic subdural hematoma, local anesthesia is a more useful method in terms of efficient use of hospital operating room and reduction of operating costs. We believe that this practice will also contribute to the national economy.

Social competence in the 1st grade predicts school adjustment two years later

ABSTRACT This study examined whether social competence at the time of entrance to elementary school predicted school adjustment two years later. The sample consisted of 389 children followed from the 1st to the 3rd grade in Lithuanian urban schools. In the 3rd-grade school adjustment was measured by assessing popularity in class, student-teacher relationships, involvement in bullying, school anxiety, and academic achievement. All school adjustment variables assessed in the 3rd grade were linked to learning-related social competence, while the interpersonal aspect of social competence was related to all indicators of school adjustment except for involvement in bullying in the 3rd grade. Results of structural equation modeling indicated that learning-related social competence measured during the 1st year of schooling was the strongest predictor for academic achievement and teacher-student conflict in the 3rd grade, while interpersonal social competence was the strongest predictor of student-teacher closeness and social school anxiety two years later.

Characteristics of ED crowding in the Lazio Region (Italy) and short-term health outcomes

The effect of emergency department (ED) crowding on patient care has been studied for several years in the scientific literature. We evaluate the association between ED crowding and short-term mortality and hospitalization in the Lazio region (Italy) using two different measures. A cohort of visits in the Lazio region ED during 2012–2014 was enrolled. Only discharged patients were selected. ED crowding was estimated using two measures, length of stay (LOS), and Emergency Department volume (EDV). LOS was defined as the interval of time from entrance to discharge; EDV was defined at the time of each new entrance in ED. The outcomes under study were mortality and hospitalization within 7 days from ED discharge. A multivariate logistic model was performed (Odds Ratios, ORs, 95% CI). The cohort includes 2,344,572 visits. ED crowding is associated with an increased risk of short-term hospitalization using both LOS and EDV as exposures (LOS 1–2 h: OR = 1.71, 95% CI 1.66–1.76, LOS 2–5 h: OR = 1.38, 95% CI 1.34–1.43, LOS > 5 h OR = 1.45 95% CI 1.40–1.50 compared to patients with 1 h of LOS; EDV 75°–95° percentile: OR = 1.02, 95% CI 0.99–1.05 and EDV > 95° percentile: OR = 1.06, 95% CI 1.01–1.11 compared to patients with a EDV < 75° percentile upon arrival). Increased risk of short-term mortality is found with increasing level of LOS. High levels of EDV at the time of patients’ arrival and longer LOS in ED are associated with greater risks of hospitalization for patients discharged 7 days before. LOS in ED is also associated with an increased risk of mortality.