Introduction: Low acuity patients have been controversially tagged as a source of emergency department (ED) misuse. Authorities for many Canadian health regions have set up policies so these patients preferably present to walk-in clinics (WIC). We compared the cost and quality of the care given to low acuity patients in an academic ED and a WIC of Québec City during fiscal year 2015-16. Methods: We conducted an ambidirectional (prospective and retrospective) cohort study using a time-driven activity-based costing method. This method uses duration of care processes (e.g., triage) to allocate to patient care all direct costs (e.g., personnel, consumables), overheads (e.g., building maintenance) and physician charges. We included consecutive adult patients, ambulatory at all time and discharged from the ED or WIC with a diagnosis of upper respiratory tract infection (URTI), urinary tract infection (UTI) or low back pain. Mean cost [95%CI] per patient per condition was compared between settings after risk-adjustment for age, sex, vital signs, number of regular medications and co-morbidities using generalized log-gamma regression models. Proportions [95%CI] of antibiotic prescription and chest X-Ray use in URTI, compliance with provincial guidelines on use of antibiotics in UTI, and column X-Ray use in low back pain were compared between settings using a Pearson Chi-Square test. Results: A total of 409 patients were included. ED and WIC groups were similar in terms of age, sex and vital signs on presentation, but ED patients had a greater burden of comorbidities. Adjusted mean cost (2016 CAN$) of care was significantly higher in the ED than in the WIC (p < 0.0001) for URTI (78.42[64.85-94.82] vs. 59.43[50.43-70.06]), UTI (78.88[69.53-89.48] vs. 53.29[43.68-65.03]), and low back pain (87.97[68.30-113.32] vs. 61.71[47.90-79.51]). For URTI, antibiotics were more frequently prescribed in the WIC (44.1%[34.3-54.3] vs. 5.8%[1.2-16.0]; p < 0.0001) and chest X-Rays, more frequently used in the ED (26.9%[15.6-41.0] vs. 13.7%[7.7-22.0]; p = 0.05). No significant differences were observed in the compliance with guidelines on use of antibiotics in UTI and in the use of column X-Ray in low back pain. Conclusion: Total cost of care for low acuity patients is lower in walk-in clinics than in EDs. However, our results suggest that quality-of-care issues should be considered in determining the best alternate setting for treating ambulatory emergency patients.

The aerodynamic performance of a multi-element high-lift system has a critical influence on the direct operating cost of a subsonic civil transport aircraft. A thorough understanding of the aerodynamic characteristics of these multi-element aerofoils and wings allows aircraft companies to design and build more competitive aircraft with high-lift systems that are less complex and lighter for given high-lift performance or that have improved lift and drag characteristics for given system complexity and weight. Flight experiments on NASA Langley's B737-100 aircraft have been conducted to further enhance the understanding of the complex flows about multi-element high-lift systems at full-scale flight conditions. In this paper, an overview of the flight program is provided, followed by highlights of experimental results and computational analysis. Measurements included surface pressures on the slats, main element and flap elements using flush pressure ports and pressure belts, surface shear stresses using Preston tubes, off-surface velocity distributions using boundary layer/wake rakes, aeroelastic deformations of the flap elements using an optical positioning system, and boundary layer transition detection using hot-film anemometers and an infrared imaging system. Boundary layer transition measurements on the slat using hot-film sensors are correlated with the flow visualisation results from an infrared imaging technique. Extensive application of several computational techniques and comparisons with flight measurements are shown for a limited number of cases. This program has generated an extensive set of data, much of which are still being analysed.

Hand, foot and mouth disease (HFMD) is generally a benign febrile exanthematous childhood disease caused by human enteroviruses. The route of transmission is postulated to be faeco-oral in developing areas but attributed more to respiratory droplet in developed areas. Transmission is facilitated by the prolonged environmental survival of these viruses and their greater resistance to biocides. Serious outbreaks with neurological and cardiopulmonary complications caused by human enterovirus 71 (HEV-71) seem to be commoner in the Asian Pacific region than elsewhere in the world. This geographical predilection is unexplained but could be related to the frequency of intra- and inter-typic genetic recombinations of the virus, the host populations' genetic predisposition, environmental hygiene, and standard of healthcare. Vaccine development could be hampered by the general mildness of the illness and rapid genetic evolution of the virus. Antivirals are not readily available; the role of intravenous immunoglobulin in the treatment of serious complications should be investigated. Monitoring of this disease and its epidemiology in the densely populated Asia Pacific epicentre is important for the detection of emerging epidemics due to enteroviruses.

We find evidence for dust in the intervening QSO absorbers from the spectra of QSOs in the Sloan Digital Sky Survey Data Release 1. No evidence is found for the 2175 Å feature which is present in the Milky Way dust extinction curve.

The ABO blood group is the most important blood group system in transfusion medicine. Since the ABO gene was cloned and the molecular basis of the three major alleles delineated about 10 years ago, the gene has increasingly been examined by a variety of DNA-based genotyping methods and analysed in detail by DNA sequencing. A few coherent observations emerge from these studies. First, there is extensive sequence heterogeneity underlying the major ABO alleles that produce normal blood groups A, B, AB and O when in correct combination with other alleles. Second, there is also extensive heterogeneity underlying the molecular basis of various alleles producing ABO subgroups such as A2, Ax and B3. There are over 70 ABO alleles reported to date and these alleles highlight the extensive sequence variation in the coding region of the gene. A unifying system of nomenclature is proposed to name these alleles. Third, extensive sequence variation is also found in the non-coding region of the gene, including variation in minisatellite repeats in the 5′ untranslated region (UTR), 21 single nucleotide polymorphisms (SNPs) in intron 6 and one SNP in the 3′ UTR. The haplotypes of these variations reveal a specific relationship with the major ABO alleles. Fourth, excluding the common alleles, about half of the remaining alleles are due to new mutations and the other half can better be explained by intragenic recombination (both crossover and gene conversion) between common alleles. In particular, the recombination sites in hybrid alleles can be quite precisely defined through haplotype analysis of the SNPs in intron 6. This indicates that recombination is equally as important as point mutations in generating the genetic diversity of the ABO locus. Finally, a large number of ABO genotyping methods are available and are based on restriction analysis, allele specific amplification, mutation screening techniques or their combinations.

We used spoligotyping to study 500 randomly selected pretreatment Mycobacterium tuberculosis (MTB) strains isolated in Hong Kong during the 2 year period 1998–9. It was found that amongst all MTB strains studied, the ‘Beijing’ genotype strains were highly prevalent in our geographic area, representing about 70% of the isolates. Unlike previous observations in Vietnam, no significant associations were found either between ‘Beijing’ genotype strains and all other anti-tuberculosis drug resistance phenotypes, or with particular patients' age groups, except for a weak association with isoniazid susceptibility. Eighteen of these strains exhibited spoligotype patterns that were similar but not identical to the ‘Beijing’ specific pattern. This is the first geographical area where genetic diversity among ‘Beijing’ genotype of MTB strains has been observed on this scale.

This study is part of our effort to map recombination hotspots in two regions (site A, 18 kb; site B, 40 kb) of the human phosphoglucomutase PGM1 gene. Twenty-two PCR amplified fragments comprising six groups, covering about 5.2 kb, were screened for single nucleotide polymorphisms (SNPs) using non-isotopic single stranded conformation polymorphism (SSCP) analysis. Fourteen fragments were variable and seven of these showed common polymorphism. Our strategy for screening for polymorphic sites in the PGM1 gene was based on the results of allelic association analysis between each new marker and the sites of the classical isozyme polymorphism (2/1 in exon 4 and +/− in exon 8). Samples from four populations (Caucasian, Chinese, Vietnamese and New Guinean) were typed for each of the seven polymorphic markers. Between two and four common alleles were found in each case, together with a few rare alleles. Co-dominant inheritance patterns were demonstrated by family studies. The molecular basis of each new marker was determined by direct sequencing of the PCR products: most were SNPs except two that were small insertions/deletions. Direct sequence analysis of a 2.1 kb segment in sixteen individuals revealed no additional nucleotide variation indicating a very high level of efficiency of the SSCP screening method used in this study. The overall nucleotide diversity (θ) for PGM1 was estimated as 0.9×10−3 based on 33 segregating sites in a sequence of 5187 nt and a sample size of 614 individuals.

Zinc Oxide crystals have historically been grown in hydrothermal autoclaves with a basic mineralizer; however, doubts have been raised about the quality of such crystals because they have often exhibited large x-ray rocking curve widths and low photoluminescence (PL) yield with large linewidths. Several ZnO crystals were grown hydrothermally and sliced parallel to the c-plane. This resulted in opposite surfaces (the C+ and C−) exhibiting pronounced chemical and mechanical differences. Different surface treatments were investigated and compared by PL both at room temperature and liquid helium temperatures, and by double axis X-ray rocking curve measurements. The high quality of hydrothermally-grown ZnO is substantiated by the narrow rocking curve widths and sharp PL peaks obtained. A critical factor in obtaining these results was found to be surface preparation.

Zinc Oxide crystals have historically been grown in hydrothermal autoclaves with a basic mineralizer; however, doubts have been raised about the quality of such crystals because they have often exhibited large x-ray rocking curve widths and low photoluminescence (PL) yield with large linewidths. Several ZnO crystals were grown hydrothermally and sliced parallel to the c-plane. This resulted in opposite surfaces (the C+ and C-) exhibiting pronounced chemical and mechanical differences. Different surface treatments were investigated and compared by PL both at room temperature and liquid helium temperatures, and by double axis X-ray rocking curve measurements. The high quality of hydrothermally-grown ZnO is substantiated by the narrow rocking curve widths and sharp PL peaks obtained. A critical factor in obtaining these results was found to be surface preparation.

Using off-axis reactive rf sputtering, we have grown extremely smooth, nearly epitaxial, (001) oriented ZnO films on c-axis sapphire substrates. Atomic Force Microscopy was used to determine that these films are extremely smooth, having an rms roughness of only a few tenths of a nanometer. Based on high resolution x-ray diffraction (HXRD), the ZnO is highly oriented, with a rocking curve width of less than 400 arc seconds for the (006) diffraction peak, and only somewhat larger for the (112) reflection. HXRD Phi scans show that the ZnO (112) reflection is rotated in the a-b plane by 30 degrees from the sapphire (113) direction. These two measurements indicate excellent in-plane orientation. We are investigating the use of these buffer layers for subsequent GaN growth. Electrical resistivities of the films exceeded 100 kΩ-cm making ZnO a potential candidate as an insulating buffer layer.