Background: The type and number of symptoms in emergency patients differ widely.

ObjectivesValidation of acute morbidity as a novel outcome in emergency medicine.MethodsConstruct validity of acute morbidity was established by comparison to other outcomes using linear and logistic regression models.ResultsData of 4608 patients were analysed. 1869 patients (40.6%) fulfilled the criteria for acute morbidity. Using multivariate analyses, acute morbidity was associated with outcomes such as hospitalisation (OR: 11, 95%-CI 9–13), mortality (OR 15, 95%-CI 6–49), and ICU admission (OR: 46, 95%-CI 25–96). Reliability of the construct “acute morbidity” was estimated using Cohens Kappa, which was 0.96 for intra-rater and 0.94 for inter-rater reliability.ConclusionReliability of the framework for acute morbidity was high. Construct validity was shown by associations with hospitalisation, mortality, and ICU admission.

The selective accumulation of both DNA components of a bipartite geminivirus, Abutilon mosaic virus, was recorded during early systemic infection of Nicotiana benthamiana plants. Purified nuclei were diagnosed for viral DNA using hybridization specific for DNA A or DNA B to detect these individual genome components either alone or both simultaneously by dual-color staining. Although this virus needs both components for symptomatic infection, DNA A alone was transported to upper leaves, where it was imported into phloem nuclei and replicated autonomously. The coinfection with DNA A and DNA B revealed an independent spread of both molecules, which resulted in a stochastic distribution of DNA A-and DNA A/B-infected nuclei. A population genetics evaluation of the respective frequencies was compared to a model computation. This elucidated a surprisingly simple relationship between the initial frequencies of the viral DNA components and the number of susceptible cells during the course of early systemic infection. IMPORTANCEFor bipartite begomoviruses, DNA B-independent long-distance spread of DNA A has been described before, but it has never been shown whether viral DNA A alone invades nuclei of systemic tissues and replicates therein. This is demonstrated now for the first time. During infection with DNA A and DNA B, a similar solitary spread of DNA A can be recognized at early stages. We describe a population genetics model of how the hit probabilities of DNA A and DNA B for susceptible cells determine the relative frequencies of either genome component during the course of infection.

Patients referred by EMS have higher odds of admission to hospital and ICU, a longer ED LOS, and higher short- and long-term mortalities than the general ED population.

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