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Emergency Department Visits for Chest Pain and Abdominal Pain: United States, 1999–2008 Farida A. Bhuiya, M.P.H.; Stephen R. Pitts, M.D., M.P.H., F.A.C.E.P.; and Linda F. McCaig, M.P.H., Division of Health Care Statistics Key findings Data from the National Hospital Ambulatory Medical Care Survey: 1999–2008 • The number of noninjury emergency department (ED) visits in which abdominal pain was the primary reason for the visit increased 31.8%. • The percentage of ED visits for which chest pain was the primary reason decreased 10.0%. • Use of advanced medical imaging increased strongly for ED visits related to abdominal pain (122.6%) and chest pain (367.6%). Chest and abdominal pain are the most common reasons that persons aged 15 years and over visit the emergency department (ED) (1). Because EDs provide both emergency and nonemergency care (2,3), visits for these symptoms may vary in their acuity. Advanced medical imaging is often ordered to assist in both diagnosing and ruling out serious illness associated with these symptoms (4,5). This report describes trends in visits for chest and abdominal pain in adults and the seriousness of illness and use of imaging in these visits. All data shown are for persons aged 18 and over whose visit was not injury related. Keywords: National Hospital Ambulatory Medical Care Survey • advanced medical imaging • reason for visit Are ED visits for chest or abdominal pain increasing?
A 4-year-old boy was brought to the emergency department with a long history of constipation and recent onset of abdominal pain. His mother stated that he did not have diarrhea, vomiting, or fever, but noted that “his belly is getting hard.” He had a small bowel movement 2 days previously. On the day of presentation, he woke up with abdominal pain. The patient previously had been in good health and had regularly seen his pediatric primary care physician. He had never had surgery or an illness requiring hospitalization. Physical Examination On examination, the following vital signs were obtained: oral temperature, 98.5°F; heart rate, 145 bpm; respiratory rate, 30 breaths/min; blood pressure, 108/59 mm Hg. He was pale and appeared to be uncomfortable due to the abdominal pain. The abdominal examination revealed a large mass in the right side of his abdomen. The mass was firm and slightly tender. He also had guarding. He had bilaterally descended testicles and no evidence of inguinal hernias. His musculoskeletal and neurologic examinations showed normal results, and skin examination revealed decreased turgor and coolness of peripheral extremities, with no rashes, bruising, or petechiae.
Copyright © 2006 Ulrich R. Orth and Keven Malkewitz All rights reserved Ulrich R. Orth, Prof. Dr. habil. (primary contact) Agribusiness & Food Marketing Professor College of Business Oregon State University Bexell Hall 330, Corvallis, OR 97331-2603 Phone: (503) 678 1264, x44 Fax: (503) 678 5986 E-mail: email@example.com Keven Malkewitz, PhD Assistant Professor of Marketing College of Business Oregon State University 410 Bexell Hall, Corvallis, OR 97331-2603 Phone: (541) 737 3688 E-mail: firstname.lastname@example.org The authors wish to thank Andrea Marks, Jay Thompson, and Joseph Cote for their comments during this research, Cindy Lederer for providing access to the Oregon Consumer Panel and numerous professional designers for their input. Financial support and assistance in collecting the data was provided in part by Willamette Valley Vineyards, particularly Jim Bernau, Shelby Zadow, and Jon Mason. Please direct all inquiries to the first author.
In this paper, we examine a number of SQL and socalled “NoSQL” data stores designed to scale simple OLTP-style application loads over many servers. Originally motivated by Web 2.0 applications, these systems are designed to scale to thousands or millions of users doing updates as well as reads, in contrast to traditional DBMSs and data warehouses. We contrast the new systems on their data model, consistency mechanisms, storage mechanisms, durability guarantees, availability, query support, and other dimensions. These systems typically sacrifice some of these dimensions, e.g. database-wide transaction consistency, in order to achieve others, e.g. higher availability and scalability. Note: Bibliographic references for systems are not listed, but URLs for more information can be found in the System References table at the end of this paper. Caveat: Statements in this paper are based on sources and documentation that may not be reliable, and the systems described are “moving targets,” so some statements may be incorrect. Verify through other sources before depending on information here. Nevertheless, we hope this comprehensive survey is useful! Check for future corrections on the author’s web site cattell.net/datastores. Disclosure: The author is on the technical advisory board of Schooner Technologies and has a consulting business advising on scalable databases.
Organizations that collect large amounts of unstructured data are increasingly turning to nonrelational databases, now frequently called NoSQL databases. M any organizations collect vast amounts of customer, scientific, sales, and other data for future analysis. Traditionally, most of these organizations have stored structured data in relational databases for subsequent access and analysis. However, a growing number of developers and users have begun turning to various types of nonrelational—now frequently called NoSQL—databases. Nonrelationa l dat a ba ses— including hierarchical, graph, and object-oriented databases—have been around since the late 1960s. However, new types of NoSQL databases are being developed. And only now are they beginning to gain market traction. Different NoSQL databases take different approaches. What they have in common is that they’re not relational. Their primary advantage is that, unlike relational databases, they handle unstructured data such as word-processing files, e-mail, multimedia, and social media efficiently. They are also easier to work with for the many developers not familiar 12 r2tec.indd 12 computer with the structured query language. SQL is the programming language used for querying and updating relational databases. Some NoSQL databases can function in a distributed setting. Users could thus scale a single database by running it across additional inexpensive machines rather than by having to run it on a single more powerful and costly machine.
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Both Abu Musab al-Zarqawi, who founded Jamaat al-Tawhid wa-l-Jihad ( JTWJ) in 1999 (see Table 1 for the history of ISIS names), and al-Qaeda head Usama bin Laden came of age during the Afghan jihad against the Soviet Union in the 1980s, but their respective organizations have distinct genetic material, attributable in part to their different backgrounds, leadership styles, and aims. This is the case even though the two groups formed a marriage of convenience beginning in 2004. One key difference involves the socioeconomic background of the groups’ founders. Whereas bin Laden and his cadre grew up in at least the upper middle class and had a university education, Zarqawi and those closest to him came from poorer, less educated backgrounds. Zarqawi’s criminal past and extreme views on takf ir (accusing another Muslim of heresy and thereby justifying his killing) created major friction3 and distrust with bin Laden when the two first met in Afghanistan in 1999.