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SUMMARY A simple and reliable radioimmunoassay has been developed for a new gut hormone, HPP. In the primate 93 % of the total PP was found in the pancreas with a small amount throughout the remaining gastrointestinal tract. HPP has been shown to be produced by a number of pancreatic apudomas and their metastases. The immunoreactive PP from these tumours and from normal pancreas was chromatographically indistinguishable from the pure peptide. The plasma PP concentration rose rapidly after a meal in normal subjects and was still raised six hours later. Fasting plasma PP levels in patients with PP cell containing pancreatic endocrine tumours were higher than even the postprandial level in normal subjects. PP measurement is thus useful in diagnosis of pancreatic endocrine tumours.In the course of purifying chicken insulin Kimmel extracted and purified a 36 amino acid, straight chain, peptide which he named avian pancreatic polypeptide (Kimmel et al., 1971). Chance isolated a similar peptide from bovine pancreas (BPP) and subsequently the pig (PPP), sheep (OPP), and man (HPP) (Lin and Chance, 1974a). These latter three peptides differ from BPP in only one or two amino acid residues at positions 2, 6, or 23 (Lin and Chance, 1974b). PP has been detected by immunofluorescence to occur in specific endocrine cells of the pancreas and intestine and has been found to have a wide spectrum of pharmacological actions on the gastrointestinal tract (Lin and Chance, 1974b).HPP is present in high concentration in human endocrine neoplasms of the pancreas and in metastases of such tumours (Polak et al., 1976). Plasma concentrations of HPP were also found to be raised in patients whose tumours produced the peptide (Floyd et al., 1975;Polak et al., 1976). The distribution of PP has not been previously reported, although reference has been made to the finding of PP cells in the intestines of some species (Larrson et al., 1975). Furthermore, there is no information on the possible multiple molecular forms of PP. We have investigated these problems and also established the normal fasting PP levels in man and the response to a meal.

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Objective: To describe the process and results of a process redesign based on task analysis and lean thinking approaches aimed at improving emergency department (ED) efficiency.Methods: Before-and-after study comparing 12-month periods before and after the process redesign for total episodes of ambulance bypass, waiting times (overall and by triage category) and total ED time (overall and by triage category). Time data were analysed using non-parametric methods. Results:The years were broadly comparable, with the exception that there was an 8.4% increase in total hours of care delivered (a marker of ED workload) in the year after the change. Episodes of ambulance bypass reduced by 55% (120 v 54). There were statistically significant waiting times reductions for triage categories 3 and 5 (median reductions 5 and 11 minutes respectively). There was an increase in total ED time for triage category 3 (median increase 7 min) and a decrease for categories 4 and 5 (median reduction 14 and 18 min, respectively). EMERGENCY DEPARTMENT (ED) OVERCROWDING is a growing problem in Australia and around the world. 1-3 Current understanding is that it is a complex interaction of hospital, ED, patient and ambulance factors. The results can be longer waiting times for patients, increased episodes of ambulance bypass, patients spending long periods "boarding" in the ED awaiting ward beds, and increased clinical risk. [4][5][6][7][8] Access block (shortage of available hospital beds to accommodate emergency patients requiring admission) seems to be the major contributor to ED overcrowding, 1,9,10 and a lot of work has been going into hospital systems to better manage beds. That said, there might be processes within EDs that also contribute to overcrowding. ConclusionThe aim of this project was to analyse ED patient flow processes using a task analysis and lean thinking approach, 11 and re-engineer these processes to improve flow through the ED for all groups of patients. MethodsThis project was undertaken in the ED of Western Hospital, a 300-bed, community teaching hospital in Melbourne, Australia. The ED treats adult patients only and has an annual census of about 32 000. It has two adjacent but separate treatment zones and 26 treatment spaces. It is staffed by a mixture of emergency physicians, registrars in training and other junior medical officers. Indicative admission rates by triage category for the study hospital are National Triage Scale (NTS) 1, 46%; NTS 2, 44%; NTS 3, 32%; NTS 4, 16% and NTS 5, 6%. The project had three main steps: patient flow and task a na lysis using lea n thinking approaches, 11 process redesign, and implementation and evaluation.

Dyspnea is a common symptom in ED patients contributing substantially to ED, hospital, and ICU workload. It is also associated with significant mortality. There are a wide variety of causes however chronic disease accounts for a large proportion.