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Introduction: Renal colic is a common presentation which exerts a significant burden on healthcare infrastructure. A significant proportion of patients managed with observation may return to the Emergency Department (ED) prior to spontaneous passage due to inadequate analgesia. It is unclear whether early urologist consultation would limit the burden of renal stones by reducing returns to the ED. We wished to determine whether urologist referral from the ED department is associated with fewer returns to the ED with renal colic. Methods: We conducted a retrospective chart review using RECORD methodology of consecutive patients diagnosed with CT-confirmed, ureteric or renal calculi in our ED over a two-year period. Disposition was categorized as either hospital admission, outpatient urologist referral, follow up with primary care, or no follow up. The primary outcome was the 30-day ED re-presentation for renal colic. Multivariate logistic regression was used to identify predictors for ED-return. Results: In total, 232 patients met our inclusion criteria. Urgent or outpatient urologist referral was not associated with a significantly lower ED return rate when compared to patients with no follow-up. Surprisingly, urologic intervention and stent placement were both independent predictors for ED return (OR: 2.03; 95% CI: (1.06-3.88); p:0.03) and (OR:2.08; 95% CI: (1.07-4.05). Conclusion: A significant proportion of patients who underwent urologist-led intervention returned to the ED with renal colic. Further study may help clarify the role of early urologist referral for renal calculi, as this may not reduce ED return rates when compared to conservative management.
Introduction: Although use of point of care ultrasound (PoCUS) protocols for patients with undifferentiated hypotension in the Emergency Department (ED) is widespread, our previously reported SHoC-ED study showed no clear survival or length of stay benefit for patients assessed with PoCUS. In this analysis, we examine if the use of PoCUS changed fluid administration and rates of other emergency interventions between patients with different shock types. The primary comparison was between cardiogenic and non-cardiogenic shock types. Methods: A post-hoc analysis was completed on the database from an RCT of 273 patients who presented to the ED with undifferentiated hypotension (SBP <100 or shock index > 1) and who had been randomized to receive standard care with or without PoCUS in 6 centres in Canada and South Africa. PoCUS-trained physicians performed scans after initial assessment. Shock categories and diagnoses recorded at 60 minutes after ED presentation, were used to allocate patients into subcategories of shock for analysis of treatment. We analyzed actual care delivered including initial IV fluid bolus volumes (mL), rates of inotrope use and major procedures. Standard statistical tests were employed. Sample size was powered at 0.80 (α:0.05) for a moderate difference. Results: Although there were expected differences in the mean fluid bolus volume between patients with non-cardiogenic and cardiogenic shock, there was no difference in fluid bolus volume between the control and PoCUS groups (non-cardiogenic control 1878 mL (95% CI 1550 – 2206 mL) vs. non-cardiogenic PoCUS 1687 mL (1458 – 1916 mL); and cardiogenic control 768 mL (194 – 1341 mL) vs. cardiogenic PoCUS 981 mL (341 – 1620 mL). Likewise there were no differences in rates of inotrope administration, or major procedures for any of the subcategories of shock between the control group and PoCUS group patients. The most common subcategory of shock was distributive. Conclusion: Despite differences in care delivered by subcategory of shock, we did not find any significant difference in actual care delivered between patients who were examined using PoCUS and those who were not. This may help to explain the previously reported lack of outcome difference between groups.
Introduction: Point of care ultrasound has been reported to improve diagnosis in non-traumatic hypotensive ED patients. We compared diagnostic performance of physicians with and without PoCUS in undifferentiated hypotensive patients as part of an international prospective randomized controlled study. The primary outcome was diagnostic performance of PoCUS for cardiogenic vs. non-cardiogenic shock. Methods: SHoC-ED recruited hypotensive patients (SBP < 100 mmHg or shock index > 1) in 6 centres in Canada and South Africa. We describe previously unreported secondary outcomes relating to diagnostic accuracy. Patients were randomized to standard clinical assessment (No PoCUS) or PoCUS groups. PoCUS-trained physicians performed scans after initial assessment. Demographics, clinical details and findings were collected prospectively. Initial and secondary diagnoses including shock category were recorded at 0 and 60 minutes. Final diagnosis was determined by independent blinded chart review. Standard statistical tests were employed. Sample size was powered at 0.80 (α:0.05) for a moderate difference. Results: 273 patients were enrolled with follow-up for primary outcome completed for 270. Baseline demographics and perceived category of shock were similar between groups. 11% of patients were determined to have cardiogenic shock. PoCUS had a sensitivity of 80.0% (95% CI 54.8 to 93.0%), specificity 95.5% (90.0 to 98.1%), LR+ve 17.9 (7.34 to 43.8), LR-ve 0.21 (0.08 to 0.58), Diagnostic OR 85.6 (18.2 to 403.6) and accuracy 93.7% (88.0 to 97.2%) for cardiogenic shock. Standard assessment without PoCUS had a sensitivity of 91.7% (64.6 to 98.5%), specificity 93.8% (87.8 to 97.0%), LR+ve 14.8 (7.1 to 30.9), LR- of 0.09 (0.01 to 0.58), Diagnostic OR 166.6 (18.7 to 1481) and accuracy of 93.6% (87.8 to 97.2%). There was no significant difference in sensitivity (-11.7% (-37.8 to 18.3%)) or specificity (1.73% (-4.67 to 8.29%)). Diagnostic performance was also similar between other shock subcategories. Conclusion: As reported in other studies, PoCUS based assessment performed well diagnostically in undifferentiated hypotensive patients, especially as a rule-in test. However performance was similar to standard (non-PoCUS) assessment, which was excellent in this study.
Capgras delusion is scientifically important but most commonly reported as single case studies. Studies analysing large clinical records databases focus on common disorders but none have investigated rare syndromes.
Identify cases of Capgras delusion and associated psychopathology, demographics, cognitive function and neuropathology in light of existing models.
Combined computational data extraction and qualitative classification using 250 000 case records from South London and Maudsley Clinical Record Interactive Search (CRIS) database.
We identified 84 individuals and extracted diagnosis-matched comparison groups. Capgras was not ‘monothematic’ in the majority of cases. Most cases involved misidentified family members or close partners but others were misidentified in 25% of cases, contrary to dual-route face recognition models. Neuroimaging provided no evidence for predominantly right hemisphere damage. Individuals were ethnically diverse with a range of psychosis spectrum diagnoses.
Capgras is more diverse than current models assume. Identification of rare syndromes complements existing ‘big data’ approaches in psychiatry.
The relationships between paid work and informal care are critical to understanding how paid work is made possible. An extensive source of childcare in the UK is the intergenerational care grandparents provide. Using data from the UK's Millennium Cohort Study, a nationally representative sample of children born in 2000, biprobit and instrumental variables (IV) analysis of mothers’ participation (given the social construction of caring responsibility) identifies a significant causal effect of grandparents’ childcare in that it:
(i)raises the labour force participation of mothers with a child of school entry age on average by 12 percentage points (the average marginal effect);
(ii)raises the participation of the group of mothers who use grandparent childcare by 33 percentage points compared to the situation if they did not have access to this care (the average treatment effect on the treated).
Thus grandparent-provided childcare has a substantial impact on the labour market in the UK, an impact that may not be sustainable with forthcoming changes to the state pension age. Grandparents’ childcare increases the labour force participation of lone and partnered mothers at all levels of educational qualifications but by different degrees. Grandparents’ childcare enables mothers to enter paid work rather than extending their hours of paid work.
The effects of N2O gas addition on the properties of zinc oxide films grown on a-plane (11-20) sapphire (a-Al2O3) substrates were investigated, using a chemical vapor deposition method based on the reaction between dimethylzinc and high-energy H2O produced by a Pt-catalyzed H2-O2 reaction. By employing an optimal N2O gas pressure, both the film crystallinity and crystal orientation were improved. Subsequent to treatment with N2O, the electron mobility of films at room temperature increased from 207 to 234 cm2/Vs while the electron concentration decreased at low temperatures. In addition, the photoluminescence peak intensity of the nearband-edge emission was increased.
Zinc oxide (ZnO) with excellent crystallinity and large electron mobility was grown on aplane (11-20) sapphire (a-Al2O3) substrates by a new chemical vapor deposition method via the reaction between dimethylzinc (DMZn) and high-energy H2O produced by a Pt-catalyzed H2-O2 reaction. The electron mobility at room temperature increased from 30 cm2/Vs to 189 cm2/Vs with increasing film thickness from 0.1 μm to approximately 3 μm. Electron mobility increased significantly with decreasing temperature to approximately 110 – 150 K, but decreased at temperatures less than 100 K for films greater than 500 nm in thickness. On the other hand, the mobility hardly changed with temperature for films lesser than 500 nm in thickness. Based on the dependence of the electrical properties on the film thickness, the ZnO films grown on a-Al2O3 substrates are considered to consist of an interfacial layer with a high defect density (degenerate layer) generated due to a large lattice mismatch between ZnO and Al2O3 substrates and an upper layer with a low defect density.
Methanol or ethylene glycol ingestion may result in significant morbidity or death without prompt treatment. Despite traditional and widespread use of intravenous ethanol as an antidote, its safety is not well described. An evaluation of the safety and ease of titrating ethanol infusions is necessary given the availability of an alternative antidote.
To evaluate the safety and ease of titrating ethanol infusions for the treatment of methanol or ethylene glycol ingestion.
We reviewed the hospital records of adults treated with ethanol at The Ottawa Hospital for methanol or ethylene glycol ingestion over a 9-year period. Using a standardized case report form, a single reviewer identified prespecified adverse events that developed after the start of ethanol therapy and classified dose adjustments during ethanol therapy as appropriate or inappropriate based on a priori criteria.
Forty-nine cases of methanol or ethylene glycol ingestion treated with ethanol were included in the analysis, of which 45 underwent hemodialysis, 38 were admitted to the intensive care unit, and 4 died. At least one adverse event was identified in 45 (92%) cases, including 35 (71%) with agitation requiring chemical or physical restraints and 10 (20%) with a depressed level of consciousness treated with intubation. The median number of ethanol concentration measurements per treatment course was 6 (range 0–24), of which only 27% were within the target range of 22 to 30 mmol/L and 47% were below. When measured concentrations were outside the target, the adjustment in ethanol dosing (or lack thereof) was deemed inappropriate 59% of the time, including 69% of the time during hemodialysis.
Based on actual practice in a large academic centre, adverse events occur frequently with intravenous ethanol infusions, and ethanol titration is inefficient. The safety profile and therapeutic drug monitoring considerations for ethanol should be considered when choosing an antidote for methanol or ethylene glycol ingestion.
We have investigated the hexagonal graphene network (GNW) structure for the possible opening of the graphene bandgap. We have fabricated GNW by nanoimprint lithography and compared with previous GNW results based on electron beam (EB) lithography. Hall-bar device with GNW was successfully fabricated using nanoimprint lithography and verified mobility of 1,220 cm2 V-1 s-1 with graphene nanoribbon (GNR) width of 40 nm. The mobility improvement compared with GNW by EB lithography indicates the effectiveness of nanoimprint method for the hexagonal GNW approach.
We have investigated an InAs channel Hall-bar structure with ferromagnetic spin injector in one of the current terminals. After magnetizing the Fe electrode, spin polarized electrons are injected through the edge of the isolation mesa structure and the anomalous Hall voltage is observed, when electrons are injected from the ferromagnetic terminal. However, when electrons are injected from the non-magnetic metal (Ti/Au) of opposite terminal, the Hall voltage disappeared to the variation error level due to the fabrication imperfections. This result suggests the possibility that out-of-plane spin injection from the channel edge lead to perpendicular nuclear magnetic field. It is presumably caused by nuclear spin polarization in InAs channel near the spin source edge through Overhauser effect. The estimated internal magnetic field was 2000 Gauss.
There are a number of factors that prolong patients’ stay in the recovery room (RR), which are related to system or clinical issues. However, less has been discovered from the RR nurses about reasons for prolonged patient stay and recommendations to solve this issue. Prolonged patient stay of more than 2 hours in the RR interferes with the primary role of the RR nurse, which is to provide care to immediate postanaesthesia patients. Consequently, this could affect the operating room schedule, normal flow of patients to the RR and discharge to the nursing units.
A new chemical vapor deposition method for the growth of ZnO films using the reaction between dimethylzinc (DMZn) and thermally excited H2O produced by a Pt-catalyzed H2–O2 reaction was investigated. The thermally excited H2O molecules formed by the exothermic reaction of H2 and O2 on the catalyst were ejected from a fine nozzle into the reaction zone and allowed to collide with DMZn ejected from another fine nozzle. The ZnO films were grown directly on a-plane (11-20) sapphire substrates at substrate temperatures of 773-873 K with no buffer layer. X-ray diffraction patterns exhibited intense (0002) and (0004) peaks from the ZnO(0001) index plane. The smallest full width at half maximum (FWHM) value of the ω- rocking curve of ZnO(0002) was less than 0.1º. The largest Hall mobility and the smallest residual carrier concentration of the ZnO films were 169 cm2V−1s−1 and 1.7×1017 cm−3, respectively. Photoluminescence (PL) spectra at room temperature exhibited a band edge emission at 3.29 eV, with a FWHM of 104 meV. Green luminescence from deeper levels was generally about 1.5% of the band edge emission intensity. PL spectra at 5 K showed a strong emission peak at 3.3603 eV, attributed to the neutral donor-bound exciton Dºx. The FWHM was as low as 1.0 meV. Free exciton emissions also appeared at 3.3757 eV (FXA, n=1) and 3.4221 eV (FXA, n=2).
A 55-year-old man presented to the emergency department (ED) following 2 episodes of typical cardiac chest pain and nonspecific electrocardiogram findings. His serial cardiac marker assays revealed an elevated total creatine kinase (CK) and 2 negative cardiac troponin levels. Because of a high clinical suspicion of acute coronary syndrome, a total creatine kinase MB mass was obtained and found to be elevated. Subsequent cardiac angiography demonstrated a significantly flow-limiting coronary artery lesion, and stenting was performed. This case demonstrates that simultaneous CK and troponin measurements may have utility in selected ED patients with chest pain. The interpretation of discordant CK and troponin levels is discussed.
Processes of biodegradable molded products were developed. However, to make commercial products to adapted each purpose is still under going. So, this time, to improve the molded products properties, we tested to blend with PLA (polylactic acid) or PBSA (Poly butylenes succinate adipate) into CGM(Corn gluten meal) based agro by-products ingredient.
Molded samples were able to make from all tested material and each sample had each physical properties. Finally, we selected suitable condition for practical field test of Large Sapling Pot for Persimmon saplings. Such application will be addressed in our talk and general situation of biodegradable products by biomass resources in Japan will be also introduced.
Donsker-Varadhan’s type large deviation will be discussed for the pinned motion of a radial random walk on a homogeneous tree. We shall prove that the rate function corresponding to the large deviation is associated with a new Markov chain constructed from the above random walk through a harmonic transform based on a positive principal eigenfunction for the generator of the random walk.
Political representatives in Canada have traditionally been selected
using a first-past-the-post electoral system. The major problem with this
process of determining “who governs” is that larger parties
are often rewarded the majority of seats in legislatures without winning a
majority of popular support. Recently, the debate on electoral reform in
Canada has begun to gain steam, as several provinces have started to look
more seriously at alternatives (Milner 2004).
Declining voter turnout may explain why even governments that benefit from
the current electoral system are finding it increasingly difficult to
simply sideline this issue. But what accounts for the Canadian
public's more recent frustration with their traditional electoral
system?We would like to thank Nicki Doyle
for her research assistance and Concordia University for its financial
The current epidemic of diabetes likely reflects marked changes in environmental factors, although genetic susceptibility plays a powerful role in the occurrence of diabetes in certain populations. We investigated whether long-term sucrose-drinking causes hyperglycaemia in male Wistar-Imamichi littermates (n 32), which are not genetically susceptible to diabetes or obesity. Each litter was divided equivalently into two groups, the sucrose group and the control group. The sucrose group received 300 g/l sucrose water and the control group received regular water until 42 weeks of age. Rats were weighed every 1 or 2 weeks. Oral glucose tolerance tests were performed at 28 and 36 weeks of age. Plasma glucose and insulin concentrations were measured. Body weights were significantly greater in the sucrose group than in the control group in 18-week-old rats (P<0·05), and the difference between the two groups reached 163 g by the end of the study (P<0·01). The 120 min post-load plasma glucose concentration in the sucrose group was 11·4 (sd 2·8) mmol/l in 28-week-old rats and 12·7 (sd 2·2) mmol/l in 36-week-old rats, while that of the control group remained approximately 7·3–7·7 mmol/l. In the sucrose group, the plasma insulin peak occurred 30 min post-load at 28 weeks of age; but the peak disappeared and hyperinsulinaemia was prolonged at 36 weeks of age. In conclusion, long-term sucrose-drinking causes increased body weight and glucose intolerance in normal male rats.
The crystal growth of SiC films on (100) Si and thermally oxidized Si (SiO2/Si) substrates by hot-mesh chemical vapor deposition (HMCVD) using monomethylsilane as a source gas was investigated. A mesh structure of hot tungsten (W) wire was used as a catalyzer. At substrate temperatures above 750°C and at a mesh temperature of 1600°C, 3C-SiC crystal was epitaxially grown on (100) Si substrates. From the X-ray rocking curve spectra of the (311) peak, SiC was also epitaxially grown in the substrate plane. On the basis of the X-ray diffraction (XRD) measurements, on the other hand, the growth of (100)-oriented 3C-SiC films on SiO2/Si substrates was determined to be achieved at substrate temperatures of 750-800°C, while polycrystalline SiC films, at substrate temperatures above 850°C. From the dependence of growth rate on substrate temperature and W-mesh temperature, the growth mechanism of SiC crystal by HMCVD was discussed.