Purpose The positive rate of head CT in non-trauma patients presenting to the Emergency Department (ED) is low. Currently, indications for imaging are based on the individual experience of the treating physician, which contributes to overutilization and variability in imaging utilization. The goals of this study are to ascertain the predictors of positive head CT in non-trauma patients and demonstrate feasibility of a clinical scoring algorithm to improve yield. Methods We retrospectively reviewed 500 consecutive ED non-trauma patients evaluated with non-contrast head CT after presenting with headache, altered mentation, syncope, dizziness, or focal neurologic deficit. Medical records were assessed for clinical risk factors: focal neurologic deficit, altered mental status, nausea/vomiting, known malignancy, coagulopathy, and age. Data was analyzed using logistic regression and receiver operator characteristic (ROC) curves and 3 derived algorithms. Results Positive CTs were found in 51 of 500 patients (10.2%). Only two clinical factors were significant. Focal neurologic deficit (adjusted OR 20.7; 95% CI 9.4–45.7) and age >55 (adjusted OR 3.08; CI 1.44–6.56). Area under the ROC curve for all 3 algorithms were of 0.73–0.83. In proposed Algorithm C, only patients with focal neurologic deficit (major risk factor) or ≥2 of the five minor risk factors (altered mental status, nausea/vomiting, known malignancy, coagulopathy, and age) would undergo CT imaging. This may reduce utilization by 34% with only a small decrease in sensitivity (98%). Conclusion Our simple scoring algorithm utilizing multiple clinical risk factors could help to predict the non-trauma patients who will benefit from CT imaging, resulting in reduced radiation exposure without sacrificing sensitivity.

The heterogeneous chemistry of surface-adsorbed polycyclic aromatic hydrocarbons (PAHs) plays key roles in nanoscience, environmental science, and public health. Experimental evidence shows that the substrate can influence the heterogeneous oxidation of surface-bound PAHs, however, a mechanistic understanding of the role of the surface is still lacking. We examine the effects of the PAH-substrate interaction on the oxidation of surface-adsorbed anthracene, pyrene, and benzo[a]pyrene by ozone (O(3)) using density functional theory. We find that some O(3) oxidation mechanisms for these planar PAH molecules lead to nonplanar intermediates or products, the formation of which may necessitate partial desorption or "lift-off" from a solid substrate. The energy penalty for partial desorption of each PAH from the surface is estimated for four different substrate types on the basis of literature data and accounted for in the thermodynamic analysis of the reaction pathways. We find that the attractive PAH-substrate interaction may render oxidation pathways involving nonplanar intermediates or products thermodynamically unfavorable. The influence of the PAH-substrate interaction could contribute in part to the variations in PAH oxidation kinetics and product distributions that have been observed experimentally. Our choice of test molecules enabled us to identify trends in reactivity and product formation for four types of potentially reactive site (zigzag, armchair, bridge, and internal), allowing us to infer products and mechanisms of O(3) oxidation for PAHs of larger sizes. Implications for atmospheric chemistry and the stability of graphene in the presence of O(3) are discussed.

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The YIPS is a brief, yet reliable, instrument that addresses such psychosocial issues as coping, control, and acceptance of incontinence.

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