Despite controlling for multiple factors, the presence of a physician-family LB was associated with a higher rate of resource utilization for diagnostic studies and increased ED visit times. Additional study is recommended to explore the reasons for these differences and ways to provide care more efficiently to non-English-speaking patients.

BackgroundEnteric Escherichia coli survives the highly acidic environment of the stomach through multiple acid resistance (AR) mechanisms. The most effective system, AR2, decarboxylates externally-derived glutamate to remove cytoplasmic protons and excrete GABA. The first described system, AR1, does not require an external amino acid. Its mechanism has not been determined. The regulation of the multiple AR systems and their coordination with broader cellular metabolism has not been fully explored.ResultsWe utilized a combination of ChIP-Seq and gene expression analysis to experimentally map the regulatory interactions of four TFs: nac, ntrC, ompR, and csiR. Our data identified all previously in vivo confirmed direct interactions and revealed several others previously inferred from gene expression data. Our data demonstrate that nac and csiR directly modulate AR, and leads to a regulatory network model in which all four TFs participate in coordinating acid resistance, glutamate metabolism, and nitrogen metabolism. This model predicts a novel mechanism for AR1 by which the decarboxylation enzymes of AR2 are used with internally derived glutamate. This hypothesis makes several testable predictions that we confirmed experimentally.ConclusionsOur data suggest that the regulatory network underlying AR is complex and deeply interconnected with the regulation of GABA and glutamate metabolism, nitrogen metabolism. These connections underlie and experimentally validated model of AR1 in which the decarboxylation enzymes of AR2 are used with internally derived glutamate.Electronic supplementary materialThe online version of this article (doi:10.1186/s12918-016-0376-y) contains supplementary material, which is available to authorized users.

Abstract. Objective: To examine differences in the evaluation, management, and outcomes for patients seen in an on-site ''fast track'' (FT) vs the main ED. Methods: Over a three-month period, patients presenting to an urban pediatric ED were prospectively assessed. Patients included were: triaged as ''nonurgent''; aged 2 months to 10 years; not chronically ill; and had fever, or complaint of vomiting, diarrhea, or decreased oral intake. Evening and weekend care was provided in the FT; at all other times these low-acuity patients were seen in the ED. Seven days after the visit, families were interviewed by telephone. Results: Four hundred seventy-nine and 557 patients were seen in the FT and ED, respectively. The patients in the two settings did not differ in age, clinical condition, race, or commercial insurance status. Patient mean test charges were $27 and $52 for the FT and ED, respectively (p < 0.01). Twenty-four percent of the FT patients vs 41% of the ED patients had tests performed (p < 0.01). Average length of stay was 28 minutes shorter in the FT (95% CI = 19 to 36, p < 0.01). Follow-up was completed for 480 of 755 families with telephones (64%). The FT and ED patients did not differ at follow-up: 90% vs 88% had improved conditions (p = 0.53), 18% vs 15% had received unscheduled follow-up care (p = 0.44), and 94% of the families in both groups were satisfied with the visit (p = 0.98). Conclusions: Compared with those in the main ED, the study patients seen in the FT had fewer tests ordered and had briefer lengths of stay. These findings were not explained by differences in patient ages, vital signs, or demographic characteristics. No difference in final outcomes or satisfaction was detected among the families contacted for follow-up. Key words: fast track; resource utilization; outcomes; urgent care. ACADEMIC EMERGENCY MEDICINE 1999; 6:1153-1159 M ANY URBAN pediatric EDs provide care for a large number of nonemergent, ambulatory patients, particularly during the winter season.1,2 Assessment and management of these children may strain resources and increase waiting times for all patients. In response, many EDs have established on-site alternative locations to facilitate care of these nonacute cases, thus increasing capacity in the general ED for more acute or complicated patients.3-5 These units are often staffed by experienced practitioners, who manage a large volume of patients rapidly.6 As such, they are commonly known as ''fast tracks'' (FTs) or ''urgent care'' units. Fast tracks have been shown to decrease waiting times, and are generally regarded as a more efficient alternative to the main ED for care of uncomplicated patients with low-acuity concerns. 7,8 What has not been well-studied, however, are the differences in care provided in these settings. Specifically, it is unclear whether such patients are investigated and managed differently than they would have been in the main ED, and more important, whether such differences affect patient outcomes.We undertook this study to determine whether the...

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