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Summary Nurse managed triage in an emergency department has not yet been formally evaluated in France. Method: We have adapted the reception and waiting area as well as trained all the nurses to patient triage using a “Nurse Classification of Emergency Patients” (NCEP). This classification is based on an evaluation of a patient's clinical stability and need for medical care as defined in the clinical classification of emergency patients used by French emergency physicians. By analogy with this latter classification, the NCEP is made up of five classes corresponding with increasing priority at need for medical care (1 : low priority; 5 : high priority). We have compared -with the same staff- the duration of management and the satisfaction of patients consulting on Mondays between 8.30 AM and 12 PM before and after the creation of the triage nurse position. The duration of patient management was the sum of the waiting time within the reception area (between registration and medical examination) and the duration of the medical consultation itself. Patient satisfaction was evaluated in real time using questionnaires. We also have evaluated the workload during each period, using nursing, medical and medico-technique care ratings. Results: The workload was comparable without (n = 296) and with (n = 303) a triage nurse. Waiting time at the reception was significantly longer without than with a triage nurse for unstable patients class 3 (43 ± 39 min vs 32 ± 28 min) and class 4 (47 ± 59 min vs 12 ± 18 min) of the NCEP (p Conclusion: Creation of a triage nurse position allows a significant reduction of the waiting time for unstable patients and increases the satisfaction of the patients as a whole.

The inelastic neutron scattering spectrum of CD3CONHCD3 recorded on the TFXA spectrometer is compared with the calculated intensities using the program CLIMAX. A new approach to the proton dynamics is proposed, in agreement with the S(Q,ω) map measured using the MARI spectrometer.

Inelastic neutron-scattering (INS) spectra of three isotopic derivatives of polyglycine I (-COCH2NH-)n, (-COCD2NH-)n, and (-COCH2ND-)n at 20 K are presented from 30 to 4000 cm(-1). The band frequencies are compared to those observed in the infrared and Raman. Assignments in terms of group vibrations are proposed. These mostly resemble previous assignment schemes, except for the amide bands. The INS intensities reveal that the proton dynamics for the (N)H proton are totally different from those proposed previously. They are independent of the molecular frame and the valence bond approach is not consistent with observation. A phenomenological approach is proposed in terms of localized modes. The calculated intensities reveal that the (N)H stretching mode has two components at approximately 1377 and 1553 cm(-1). This is a dramatic change compared to all former assignments at approximately 3280 cm(-1) based on infrared and Raman data. These proton-dynamics are associated with a weakening of the NH bond due to the ionic character of the hydrogen bond (N(delta-)...H+...O(delta'-)) and proton transfer. The infrared and Raman spectra are re-examined and a new assignment scheme is proposed for the amide bands; the amide A and B bands are re-assigned to the overtones of the stretching modes. A symmetric double-minimum potential for the proton is consistent with all the observations.

Apres une presentation du site du Tricastin et du complexe nucleaire qui doit y etre edifie, les auteurs analysent les principaux problemes — d'ordre social, economique ou administratif — souleves par l'implantation du chantier et decrivent les solutions mises en œuvre pour y faire face. Le plus grand chantier d'Europe, notent-ils en conclusion, devrait se derouler jusqu'a son terme au mieux des interets des collectivites locales, des maitres d'ouvrage et des populations concernees.