Background: Spinal Muscular Atrophy (SMA) is an autosomal recessive neurodegenerative disease. In June 2017, Health Canada approved Nusinersen, currently the only available drug for SMA. Since 2016, patients in Ontario have been treated clinically with Nusinersen through different access programs. Methods: Retrospective case series of patients with SMA treated clinically with Nusinersen in Ontario, describing clinical characteristics and logistics of intrathecal Nusinersen administration. Results: Twenty patients have been treated across four centres. To date, we have reviewed 8 cases at one centre (seven SMA Type I, one SMA Type II). Age at first dose ranged from 3-156 months and disease duration 9-166 months. Patients had received 4-7 doses at last evaluation. Three patients with scoliosis (2 with spinal rods) required fluoroscopy-guided radiologist administration, and 4 required general anesthesia. No complications/adverse events were reported. At last follow up, 5/8 families reported improved daily activities. Of 5 patients with baseline and follow up motor function testing, 3 demonstrated improved scores. One patient died due to respiratory decline at age 9 months, despite improved motor outcome scores. Conclusions: We describe the first Canadian post-marketing experience with Nusinersen. Timely dissemination of this information is needed to guide clinicians, hospital administrators, and policy-makers.

Introduction: Diagnosing pulmonary embolism (PE) can be challenging because the signs and symptoms are often non-specific. Studies have shown that evidence-based algorithms are not always adhered to in the Emergency Department (ED) and are often not used correctly, which leads to unnecessary CT scanning. The YEARS diagnostic algorithm, consisting of three items (clinical signs of deep vein thrombosis, hemoptysis, and whether pulmonary embolism is the most likely diagnosis) and D-dimer, is a novel and simplified way to approach suspected acute PE. The purpose of this study was to 1) evaluate the use of the YEARS algorithm in the ED and 2) to compare the rates of testing for PE if the YEARS algorithm was used. Methods: This was a health records review of ED patients investigated for PE at two emergency departments over a two-year period (April 2013-March 2015). Inclusion criteria were ED physician ordered CT pulmonary angiogram, ventilation-perfusion scan, or D-dimer for investigation of PE. Patients under the age of 18 and those without a D-dimer test were excluded. PE was considered to be present during the emergency department visit if PE was diagnosed on CT or VQ (subsegmental level or above), or if the patient was subsequently found to have PE or deep vein thrombosis during the next 30 days. Trained researchers extracted anonymized data. The rate of CT/VQ imaging and the false negative rate was calculated. Results: There were 1,163 patients that were tested for PE and 1,083 patients were eligible for our analysis. Of the total, 317/1,083 (29.3%; 95%CI 26.6-32.1%) had CT/VQ imaging for PE, and 41/1,083 (3.8%; 95%CI 2.8-5.1%) patients were diagnosed with PE at baseline. Three patients had a missed PE, resulting in a false negative rate of 0.4% (95%CI 0.1-1.2%). If the YEARS algorithm was used, 211/1,083 (19.5%; 95%CI 17.2-22.0%) would have required imaging for PE. Of the patients who would not have required imaging according to the YEARS algorithm, 8/872 (0.9%; 95%CI 0.5-1.8%) would have had a missed PE. Conclusion: If the YEARS algorithm was used in all patients with suspected PE, fewer patients would have required imaging with a small increase in the false negative rate.

Introduction: Diagnosing pulmonary embolism (PE) can be challenging because the signs and symptoms are often non-specific. Studies have shown that evidence-based algorithms are not always adhered to in the Emergency Department (ED), which leads to unnecessary CT scanning. The pulmonary embolism rule-out criteria (PERC) can identify patients who can be safely discharged from the ED without further investigation for PE. The purpose of this study is to evaluate the use of the PERC rule in the ED and to compare the rates of testing for PE if the PERC rule was used. Methods: This was a health records review of ED patients investigated for PE at two emergency departments over a two-year period (April 2013-March 2015). Inclusion criteria were ED physician ordered CT pulmonary angiogram, ventilation-perfusion scan, or D-dimer for investigation of PE. Patients under the age of 18 were excluded. PE was considered to be present during the emergency department visit if PE was diagnosed on CT or VQ (subsegmental level or above), or if the patient was subsequently found to have PE or deep vein thrombosis during the next 30 days. Trained researchers extracted anonymized data. The rate of CT/VQ imaging and the negative predictive value was calculated. Results: There were 1,163 patients that were tested for PE and 1,097 patients were eligible for our analysis. Of the total, 330/1,097 (30.1%; 95%CI 27.4-32.3%) had CT/VQ imaging for PE, and 48/1,097 (4.4%; 95%CI 3.3-5.8%) patients were diagnosed with PE. 806/1,097 (73.5%; 95%CI 70.8-76.0%) were PERC positive, and of these, 44 patients had a PE (5.5%; 95%CI 4.1-7.3%). Conversely, 291/1,097 (26.5%; 95%CI 24.0-29.2%) patients were PERC negative, and of these, 4 patients had a PE (1.4%; 95%CI 0.5-3.5%). Of the PERC negative patients, 291/291 (100.0%; 95%CI 98.7-100.0%) had a D-dimer test done, and 33/291 (11.3%; 95%CI 8.2-15.5%) had a CT angiogram. If PERC was used, CT/VQ imaging would have been avoided in 33/1,097 (3%; 95%CI 2.2-4.2%) patients and the D-dimer would have been avoided in 291/1,097 (26.5%; 95%CI 24.0-29.2%) patients. Conclusion: If the PERC rule was used in all patients with suspected PE, fewer patients would have further testing. The false negative rate for the PERC rule was low.

Outpatient parenteral antimicrobial therapy (OPAT) programmes facilitate hospital discharge, but patients remain at risk of complications and consequent healthcare utilisation (HCU). Here we elucidated the incidence of and risk factors associated with HCU in OPAT patients. This was a retrospective, single-centre, case–control study of adult patients discharged on OPAT. Cases (n = 63) and controls (n = 126) were patients that did or did not utilise the healthcare system within 60 days. Characteristics associated with HCU in bivariate analysis (P ≤ 0.2) were included in a multivariable logistic regression model. Variables were retained in the final model if they were independently (P < 0.05) associated with 60-day HCU. Among all study patients, the mean age was 55 ± 16, 65% were men, and wound infection (22%) and cellulitis (14%) were common diagnoses. The cumulative incidence of 60-day unplanned HCU was 27% with a disproportionately higher incidence in the first 30 days (21%). A statin at discharge (adjusted odds ratios (aOR) 0.23, 95% confidence intervals (CIs) 0.09–0.57), number of prior admissions in past 12 months (aOR 1.48, 95% CIs 1.05–2.10), and a sepsis diagnosis (aOR 4.62, 95% CIs 1.23–17.3) were independently associated with HCU. HCU was most commonly due to non-infection related complications (44%) and worsening primary infection (31%). There are multiple risk factors for HCU in OPAT patients, and formal OPAT clinics may help to risk stratify and target the highest risk groups.

Introduction: Diagnosing pulmonary embolism (PE) can be challenging because the signs and symptoms are often non-specific. Studies have shown that evidence-based diagnostic algorithms are not always adhered to in the Emergency Department (ED), which leads to unnecessary CT scanning. In 2013, the American College of Chest Physicians identified CT pulmonary angiography as one of the top five avoidable tests. One solution is to use a clinical prediction rule combined with the D-dimer, which safely reduces the use of CT scanning. The objective of this study was to compare the proportion of patients tested for PE in two emergency departments, who 1) had a CT-PE and 2) whose diagnosis of PE was missed. We compared these rates to those if the Wells rule and D-dimer had been applied as standard. Methods: This was a retrospective chart review of ED patients investigated for PE at two hospitals from April 2013 to March 2015 (24 months). Inclusion criteria were the ED physician ordered CT-PE, Ventilation-Perfusion (VQ) scan or D-dimer for investigation of PE. Patients under the age of 18 were excluded. PE was defined as CT/VQ diagnosis of acute PE or acute PE/DVT in 30-day follow-up. Trained researchers extracted anonymized data. The rate of CT/VQ imaging and the false-negative rates were calculated. The false-negative rate was calculated as the number of patients diagnosed with PE within 30 days as a proportion of those patients who did not have a CT/VQ scan at initial presentation. Results: There were 1,189 patients included in this study. 55/1,189 patients (4.6%; 95%CI 3.6-6.0%) were ultimately diagnosed with PE within 30 days. 397/1,189 patients (33.4%; 95%CI 30.8-36.1%) had CT/VQ scans for PE. 3 out of 792 who were not scanned had a missed PE resulting in a false-negative rate of 0.4% (95% CI 0.1-1.1%). 80 patients had an elevated D-dimer or high Wells score but were not imaged. Furthermore, 75 patients who did not have an elevated D-dimer nor a high Wells score were imaged. Had Wells rule/D-dimer been adhered to, 402/1,189 patients (33.8%; 95%CI 31.9-36.6%) would have undergone imaging and the false negative rate would be 0/727, 0% (95%CI 0.0-0.5%). Conclusion: If the Wells rule and D-dimer was used in all patients tested for PE, a similar proportion would have a CT scan but fewer PEs would be missed.

Introduction: Diagnosing pulmonary embolism (PE) in the emergency department can be challenging due to non-specific signs and symptoms; this often results in the over-utilization of CT pulmonary angiography (CT-PA). In 2013, the American College of Chest Physicians identified CT-PA as one of the top five avoidable tests. Age-adjusted D-dimer has been shown to decrease CT utilization rates. Recently, clinical-probability adjusted D-dimer has been promoted as an alternative strategy to reduce CT scanning. The aim of this study is to compare the safety and efficacy of the age-adjusted D-dimer rule and the clinical probability-adjusted D-dimer rule in Canadian ED patients tested for PE. Methods: This was a retrospective chart review of ED patients investigated for PE at two hospitals from April 2013 to March 2015 (24 months). Inclusion criteria were the ED physician ordered CT-PA, Ventilation-Perfusion (VQ) scan or D-dimer for investigation of PE. Patients under the age of 18 were excluded. PE was defined as CT/VQ diagnosis of acute PE or acute PE/DVT in 30-day follow-up. Trained researchers extracted anonymized data. The age-adjusted D-dimer and the clinical probability-adjusted D-dimer rules were applied retrospectively. The rate of CT/VQ imaging and the false negative rates were calculated. Results: In total, 1,189 patients were tested for PE. 1,129 patients had a D-dimer test and a Wells score less than 4.0. 364/1,129 (32.3%, 95%CI 29.6-35.0%) would have undergone imaging for PE if the age-adjusted D-dimer rule was used. 1,120 patients had a D-dimer test and a Wells score less than 6.0. 217/1,120 patients (19.4%, 95%CI 17.2-21.2%) would have undergone imaging for PE if the clinical probability-adjusted D-dimer rule was used. The false-negative rate for the age-adjusted D-dimer rule was 0.3% (95%CI 0.1-0.9%). The false-negative rate of the clinical probability-adjusted D-dimer was 1.0% (95%CI 0.5-1.9%). Conclusion: The false-negative rates for both the age-adjusted D-dimer and clinical probability-adjusted D-dimer are low. The clinical probability-adjusted D-dimer results in a 13% absolute reduction in CT scanning compared to age-adjusted D-dimer.

Research on close binary systems has continued at a high level during the past triennium, although the rate of growth is noticeably slower – probably reflecting the cutbacks in funds to which many of us are subject. There have also been changes of emphasis within the field, which are commented on in the pages that follow. These reflect both changing opportunities for observation and the natural development of the subject. In many areas, the time is ripe for a more critical look at ideas that previously seemed adequate.

Thirty five grants were made during the triennium October 1, 1996 to September 30, 1999. The astronomer, home country, and host country are listed below.

The objectives of this three-phased investigation were to (1) characterize existing recreational programming opportunities for tenants residing in assisted living (AL) and (2) gather perceptions on factors influencing activity program planning and delivery. Using an integrated knowledge translation framework during a one-year collaboration, we targeted 51 publicly funded AL sites from two health authorities in British Columbia. We conducted an activity calendar review, staff survey, and interactive symposia to identify factors that enabled or restricted recreational programming. From the information obtained, we determined that all AL sites delivered recreational programming. Although exercise and physical activity opportunities were perceived as having high importance, most activities were social. Staff reported confidence in delivering this type of programming and believed it met the holistic needs of tenants, including their mental well-being, and fostered a sense of community. Future avenues for increasing physical activity of AL tenants should address individual, site, and organizational characteristics.

Varicella is a common and highly contagious childhood disease which impacts the public worldwide. Hong Kong children can only be vaccinated against the disease in private practice. The varicella vaccination rate of local children in preschool is uncertain. Therefore a cross-sectional kindergarten-based parent-administered questionnaire survey was conducted in Hong Kong during 2012. Twelve kindergartens were randomly selected from a complete school list from the Education Bureau of Hong Kong. In total, 1285/1538 (83·6%) parents consented to join the study and completed the questionnaires. The overall varicella infection rate was 19·5% and the uptake of varicella vaccination rate was 57·6%. Barriers against varicella vaccination were mostly due to parental uncertainties about the effectiveness of vaccine, lack of recommendations from doctors or government, and adverse side-effects of the vaccine. The government and healthcare professional bodies are strongly recommended to further enhance health education among healthcare professionals, encouraging their active promotion of varicella vaccination for their patients. Furthermore, health education through various stakeholders is crucial to enhance parental awareness of varicella, as well as the effectiveness and safety of varicella vaccine.

Hemodynamics is a complex problem with several distinct characteristics; fluid is non-Newtonian, flow is pulsatile in nature, flow is three-dimensional due to cholesterol/plague built up, and blood vessel wall is elastic. In order to simulate this type of flows accurately, any proposed numerical scheme has to be able to replicate these characteristics correctly, efficiently, as well as individually and collectively. Since the equations of the finite difference lattice Boltzmann method (FDLBM) are hyperbolic, and can be solved using Cartesian grids locally, explicitly and efficiently on parallel computers, a program of study to develop a viable FDLBM numerical scheme that can mimic these characteristics individually in any model blood flow problem was initiated. The present objective is to first develop a steady FDLBM with an immersed boundary (IB) method to model blood flow in stenoic artery over a range of Reynolds numbers. The resulting equations in the FDLBM/IB numerical scheme can still be solved using Cartesian grids; thus, changing complex artery geometry can be treated without resorting to grid generation. The FDLBM/IB numerical scheme is validated against known data and is then used to study Newtonian and non-Newtonian fluid flow through constricted tubes. The investigation aims to gain insight into the constricted flow behavior and the non-Newtonian fluid effect on this behavior.

One viable approach to the study of haemodynamics is to numerically model this flow behavior in normal and stenosed arteries. The blood is either treated as Newtonian or non-Newtonian fluid and the flow is assumed to be pulsating, while the arteries can be modeled by constricted tubes with rigid or elastic wall. Such a task involves formulation and development of a numerical method that could at least handle pulsating flow of Newtonian and non-Newtonian fluid through tubes with and without constrictions where the boundary is assumed to be inelastic or elastic. As a first attempt, the present paper explores and develops a time-accurate finite difference lattice Boltzmann method (FDLBM) equipped with an immersed boundary (IB) scheme to simulate pulsating flow in constricted tube with rigid walls at different Reynolds numbers. The unsteady flow simulations using a time-accurate FDLBM/IB numerical scheme is validated against theoretical solutions and other known numerical data. In the process, the performance of the time-accurate FDLBM/IB for a model blood flow problem and the ease with which the no-slip boundary condition can be correctly implemented is successfully demonstrated.

Potassium (K) ions have been implanted in hydrothermally grown ZnO to a dose of 1 × 1015 cm-2, followed by isochronal annealing in a tube furnace (30min) and by rapid thermal annealing (30s) on two separate samples. For annealing temperatures below 700°C, only a minor redistribution of Li is observed behind the projected range of the K+ ions. At temperatures between 700 and 750°C, however, both annealing treatments show a wide region behind the implantation peak which is depleted of Li, and this depletion is used as a tracer to monitor diffusion of intrinsic defects like the Zn interstitial. The results are interpreted as Zn interstitials being released from the implanted region in a burst at temperatures above ∼700°C, followed by rapid migration, replacement of Li on Zn site through the kick-out mechanism, and migration of Li away from the active region.

With economic development, non-communicable diseases replace infectious diseases as the leading cause of death; how such transition occurs for infectious diseases with long latency has rarely been considered. We took advantage of a Chinese population with rapid economic development in the mid-20th century to study changing patterns of infection-related cancers. We used sex-specific Poisson regression to estimate age, period and cohort effects on adult deaths 1976–2005 from eight infection-related cancers in Hong Kong. Cervical, head and neck, and oesophageal cancers, associated with sexually transmitted infections, decreased for the first birth cohorts with sexual debut in a more developed environment. Leukaemia and non-Hodgkin's lymphoma, associated with vertically transmitted infections, decreased for the first cohorts born into a more developed environment. Birth cohort patterns were unclear for nasopharyngeal, stomach and liver cancers. Mortality rates for cancers related to early infections may depend on population history, with delayed reductions for some infection-related cancers.