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Background: Emergency department (ED) crowding is a recognized issue and it has been suggested that it can affect clinician decision-making.Objectives: Our objective was to determine whether ED census was associated with changes in triage or disposition decisions made by ED nurses and physicians.Methods: We performed a retrospective study using one year of data obtained from a US academic center ED (65,065 patient encounters after cleaning). Using a cumulative logit model, we investigated the association between a patient's acuity group (low, medium, and high) and ED census at triage time. We also used multivariate logistic regression to investigate the association between the disposition decision for a patient (admit or discharge) and the ED census at the disposition decision time. In both studies, control variables included census, age, gender, race, place of treatment, chief complaint, and certain interaction terms.Results: We found statistically significant correlation between ED census and triage/disposition decisions. For each additional patient in the ED, the odds of being assigned a high acuity versus medium or low acuity at triage is 1.011 times higher (95% confidence interval [CI] for Odds Ratio [OR] = [1.009,1.012]), and the odds of being assigned medium or high acuity versus low acuity at triage is 1.009 times higher (95% CI for OR = [1.008,1.010]). Similarly, the odds of being admitted versus discharged increases by 1.007 times (95% CI for OR = [1.006,1.008]) per additional patient in the ED at the time of disposition decision.Conclusion: Increased ED occupancy was found to be associated with more patients being classified as higher acuity as well as higher hospital admission rates. As an example, for a commonly observed patient category, our model predicts that as the ED occupancy increases from 25 to 75 patients, the probability of a patient being triaged as high acuity increases by about 50% and the probability of a patient being categorized as admit increases by around 25%. [ABSTRACT FROM AUTHOR]

An experiment was conducted to test the hypothesis that the enhanced yield possible with grafted tomato ( Solanum lycopersicum L.) under field conditions will also increase the nitrogen (N) crop nutritional requirement (CNR). Determinate ‘Florida 47’ tomatoes were grafted onto interspecific hybrid rootstocks (‘Multifort’ or ‘Beaufort’) and grown in a sandy soil with six N rates (56, 112, 168, 224, 280, and 336 kg ha −1 ) under plastic mulched bed and drip-irrigation systems during the spring seasons of 2010 (March–June) and 2011 (April–July). The N-CNR for grafted and non-grafted tomatoes was assessed using five yield response functions: exponential, linear-plateau, quadratic-plateau, quadratic, and square root. Over the two seasons, the estimated N-CNR ranged from 165 kg ha −1 with the quadratic-plateau model to 324 kg ha −1 with the square root model. Confidence intervals (CI) around these N-CNR ranged from 125 to 585 kg ha −1 using the bootstrap method and from 98 to 440 kg ha −1 using the delta method. Analysis of these CIs gave N-CNR rates of 239–246 kg N ha −1 for grafted plants, and 196–197 kg N ha −1 for non-grafted plants. Predicted maximum marketable yields were similar between the models, ranging from 56 -71 Mg ha −1 for grafted plants, and 43–53 Mg ha −1 for non-grafted plants, over the two seasons. Overall, while the actual N-CNR is likely to vary with season, soil types, and management practices, the results indicated that grafted tomato plants had a greater N-CNR than non-grafted plants together with an increase in predicted marketable yield. The yield response curves also showed that at a fixed marketable yield goal within the estimated range, the N fertilization rate required was lower for the grafted tomato plants as compared with the non-grafted plants. This study demonstrated that N fertilization program for optimizing tomato production may be modified when grafted plants are used. [ABSTRACT FROM AUTHOR]