Background: Canadian Emergency Departments (EDs) are overburdened. Understanding the drivers for postoperative patients to attend the ED allows for targeted interventions thereby reducing demand. We sought to identify “bounce back” patterns for subsequent QI initiatives. Methods: From April 1, 2016 to March 31, 2022, all provincial ED datasets (EDIS, STAR, Meditech) identified patients presenting within 90 days post-spine surgery. Using Canadian Classification of Health Interventions codes, laminectomies (1SC80) and discectomies (1SE87) demonstrated the highest ED visit rates. Comprehensive chart reviews were conducted identifying surgical and medical reasons for presentation within this timeframe. Results: Reviewing a cohort of 2165 post-decompression patients, 42.1% presented to the ED (n=912) with 62.8% of these directly related to surgery. Primary reasons included wound care (31.6%), pain management (31.6%), and bladder issues (retention or UTI, 11.0%). Simple wound evaluation constituted 49.7% of wound-related visits, with surgical site infection 37.6% and dehiscence 6.6% accounting for the remainder. Pain-related presentations resulted in 72.3% discharge with additional medications, and 27.7% necessitating hospital admission. New or worsening neurologic deficits were reported in 8.9% of ED visits. Conclusions: These findings illuminate crucial aspects of postoperative care and ED utilization patterns. Prioritizing patient education, pain management, and wound care could help alleviate the national ED crisis.

Background: Surgical site infections (SSIs) are among the most common healthcare-associated infections (HAIs) in low- and middle-income countries (LMICs). SSI surveillance can be challenging and resource-intensive to implement in LMICs. To support feasible LMIC SSI surveillance, we piloted a multisite SSI surveillance protocol using simplified case definitions and methodology in Sierra Leone. Methods: A standardized evaluation tool was used to assess SSI surveillance knowledge, capacity, and attitudes at 5 proposed facilities. We used simplified case definitions restricted to objective, observable criteria (eg, wound purulence or intentional reopening) without considering the depth of infection. Surveillance was limited to post-cesarean delivery patients to control variability of patient-level infection risk and to decrease data collection requirements. Phone-based patient interviews at 30-days facilitated postdischarge case finding. Surveillance activities utilized existing clinical staff without monetary incentives. The Ministry of Health provided training and support for data management and analysis. Results: Three facilities were selected for initial implementation. At all facilities, administration and surgical staff described most, or all, infections as “preventable” and all considered SSIs an “important problem” at their facility. However, capacity assessments revealed limited staff availability to support surveillance activities, limited experience in systematic data collection, nonstandardized patient records as the basis for data collection, lack of unique and consistent patient identifiers to link patient encounters, and no quality-assured microbiology services. To limit system demands and to maximize usefulness, our surveillance data collection elements were built into a newly developed clinical surgical safety checklist that was designed to support surgeons’ clinical decision making. Following implementation and 2 months of SSI surveillance activities, 77% (392 of 509) of post-cesarean delivery patients had a checklist completed within the surveillance system. Only 145 of 392 patients (37%) under surveillance were contacted for final 30-day phone interview. Combined SSI rate for the initial 2-months of data collection in Sierra Leone was 8% (32 of 392) with 31% (10 of 32) identified through postdischarge case finding. Discussion: The surveillance strategy piloted in Sierra Leone represents a departure from established HAI strategies in the use of simplified case definitions and implementation methods that prioritize current feasibility in a resource-limited setting. However, our pilot implementation results suggest that even these simplified SSI surveillance methods may lack sustainability without additional resources, especially in postdischarge case finding. However, even limited phone-based patient interviews identified a substantial number of infections in this population. Although it was not addressed in this pilot study, feasible laboratory capacity building to support HAI surveillance efforts and promote appropriate treatment should be explored.

Funding: None

Disclosures: None

Populations of native North American parasitoids attacking Agrilus Curtis (Coleoptera: Buprestidae) species have recently been considered as part of an augmentative biological control programme in an attempt to manage emerald ash borer, Agrilus planipennis Fairmaire, a destructive wood-boring beetle discovered in North America in 2002. We evaluate trapping methods to detect and monitor populations of two important native larval parasitoids, Phasgonophora sulcata Westwood (Hymenoptera: Chalcididae) and Atanycolus Förster (Hymenoptera: Braconidae) species, attacking emerald ash borer in its introduced range. We found that purple prism traps captured more P. sulcata than green prism traps, yellow pan traps, and log samples and thus were considered better for detecting and monitoring P. sulcata populations. Trap type did not affect the number of captures of Atanycolus species. Surprisingly, baiting prism traps with a green leaf volatile or manuka oil did not significantly increase captures of P. sulcata or Atanycolus species. Based on these results, unbaited purple prism traps would be optimal for sampling these native emerald ash borer parasitoids in long-term management programmes.

The growth of continuously generated, large-scale datasets, and new analytics to handle them, has created expectations, in some quarters, that new insights can be generated that will help us address the biggest challenges that face us as a species and therefore can shape future societal outcomes. It is hoped that these new technologies will lead not just to new discoveries but also to new questions and thinking that will deliver significant scientific advances. Perhaps there will be some genuine scientific advances but since many of the challenges that face us reside in the human world and depend upon how humans behave, we need to turn to the humanities and the social sciences as well as the natural sciences and look at the role Big Data could play there in adding to, or shaping, our future. And here, what concerns us is not just the assumptions guiding the new analytic techniques for data mining, data merging, linking and analysis, born out of smarter AI algorithms, it is a more fundamental issue about the constraints and limitations of the kind of data inputs and outputs being appealed to in Big Data systems and whether they are well served to provide an understanding of the human world.

Despite weak partisanship and considerable political change in the wake of the 2002 election, three-quarters of Brazilian voters supported a presidential candidate in 2006 from the same party they had backed in 2002. This article assesses the factors causing both electoral stability and electoral change with a transition model, a model testing whether the effects of respondents' evaluative criteria depend on their initial vote choices. Social context—personal discussion networks, neighborhood influences, and the interactions of social networks and municipal context—is the major force promoting stability and change, while the impact of partisanship is limited to a small share of voters.

A fossil assemblage containing molluscs, mammals, insects, ostracodes, and plants has been recovered from a silt-filled depression near Lima, in west-central Illinois. The reversed remanent magnetic signature of the sediments and the temporal ranges of two mammals, Microtus paroperarius and Lasiopodomys deceitensis, constrain the age of the assemblage to between 730,000 and 830,000 yr B.P. The extent of isoleucine epimerization in the molluscan shell is consistent with this age interpretation. The fauna includes at least 43 taxa of beetles from 11 families, 35 nominal species of molluscs, and two genera of ostracodes. The mammals include two shrews, three rodents, and a rabbit. The plant macrofossils (no pollen recovered) include 25 species of seed plants and four kinds of terrestrial or wetland mosses. Most of the plant species identified still occur in the upper Midwest, although a few of the taxa are found mainly to the north of the site. The fauna is characterized by an almost total absence of true aquatic taxa. The association of both boreal and thermophilous faunal and floral elements suggest that summer temperatures were not greatly different from present ones, but cooler, moist areas must have been available to support the boreal elements. Local conditions were probably similar to those now found in northeastern Iowa, where rains blocks, fissures, and joints in carbonate bedrock serve as traps for debris accumulations, provide shade, and are kept cool and moist during the hot summer months by cold-air drainage and groundwater seepage. Summer mean temperature in these microhabitats was probably between 18 and 20°C, similar to temperatures that now occur near the northern hardwood spruce-fir transition in the eastern United States.

A fossil assemblage containing molluscs, ostracodes, and fish has been recovered from lacustrine sediments from near Connersville, southeastern Indiana. The reversed remanent magnetic signature of the sediments and the extent of isoleucine epimerization in molluscan shell protein indicate a pre-Illinoian age for the fossils. The fauna includes four taxa of fish, Coregonus sp., cf. Prosopium sp., cf. Thymallus arcticus, and Catostomus sp.; four taxa of ostracodes, Cytherissa lacustris, Candona caudata, Cyclocypris ampla, and Candona sp.; and 28 taxa of molluscs. Elements of the aquatic molluscs, fish, and ostracodes suggest a cool-water lake (8° to 16°C). The terrestrial molluscs include boreal species that now reach the southern limits of their range in the Great Lakes region near the north shore of Lake Superior and imply average summer temperatures of about 15°C near the lake margins. The lake may have been formed when West Lebanon ice advanced into the Anderson-New Castle Buried Valley system which drained northwest as a tributary of the Lafayette Bedrock Valley System.

Previously undescribed plant and animal fossils from the Whidbey Formation represent two environments. An upper sand unit contains predominantly terrestrial molluscs (4 taxa), insects, and a vole (cf. Phenacomys), whereas a lower clay unit contains ostracodes (9 taxa), freshwater molluscs (6 taxa), insects (9 taxa), freshwater plant seeds (6 taxa), and fish (cf. Gasterosteus : stickleback). These taxa are compatible with interglacial climatic conditions on a coastal plain environment. The inferred freshwater and terrestrial environments of the Whidbey Formation imply local tectonic subsidence of the regional since the last interglaciation.