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Introduction: The elderly (65 yo and more) increase in Canada is well documented along with a disproportionate use of Emergency Departments after a minor injury. These patients requires specific care given a 16% risk of functional decline following a visit to ED. To prevent functional decline, a multidimensional assessment of the elderly is recommended in the emergency department. Objective: To determine if ED grip strength can predict functional decline at 3 or 6 months post-injury. Methods: A multicentre prospective study in 5 ED across Canada was realized between 2013 and 16. Patients 65 years old and over, autonomous in daily living activities and consulting the emergency department for minor trauma were recruited 7 days a week. Clinical-demographic data, functional status, fear of falling, number of falls in the last month, grip strength measurement were collected in the ED. Functional decline (loss of at least points to functional status) was calculated at 3 and 6 months. Descriptive statistics and linear regression model with repeated measurements were used to determine if the grip strength was predictive of functional decline at 3 or 6 months. Results: 387 patient were recruited. Mean age was 74 ± 7 years old, 52% were male. XXX experienced a fall in the last month. The initial maximum grip strength was (24 ± 10 intervention vs. 28 ± 13 control; p ≤ 0.05). grip strength is associated with pre-injury functional status (p < 0.0001) and fear of falling (p = 0.0001) but does not predict 3 or 6 month functional decline. Conclusion: Given the strong association with fear of falling and functional status at initial ED evaluation, we recommend that grip strength measurement could be included in a multidisciplinary geriatric emergency department assessment as needed.
Introduction: The Canadian C-Spine rule (CCR) was validated for use by paramedics to selectively immobilize stable trauma patients. However, the CCR “Dangerous Mechanism” is highly prevalent in sports. Our objective was to compare the CCR performance in sport-related vs. non-sport-related injuries and describe sport-related mechanisms of injury. Methods: We reviewed data from the prospective paramedic CCR validation and implementation studies in 7 Canadian cities, which already included identification of sport-related injuries. A single trained reviewer further categorized mechanisms of injury using a pilot-tested standardized form, with the aid of a sport medicine physician in 15 ambiguous cases. We compared the CCR's recommendation to immobilize sport-injured versus non-sport-injured patients using chi-square and relative risk statistics with 95% confidence intervals. Results: There were 201 amateur sport-injuries among the 5,978 patients. Sport-injured patients were younger (mean age 36.2 vs. 42.4) and more predominantly male (60.5% vs 46.8%) than non-sport-injured patients. Paramedics did not miss any c-spine injuries when using the CCR. Although cervical spine injury rates were similar between sport (2/201; 1.0%) and non-sport injured patients (47/5,777; 0.8%), the absolute number of sport-related injuries was very small. Although CCR recommended immobilization equally between the two groups (46.4% vs 42.5% p = 0.29; RR 1.17 95%CI 0.87-1.57), the reason for immobilization was more likely to be a dangerous mechanism in sport injuries (68.6% vs 54.5%, p = 0.012). Although we observed a wide range of mechanisms, the most common dangerous mechanism responsible for immobilization in sport was axial load. Conclusion: The CCR identified all significant c-spine injuries in a cohort of patients assessed and transported by paramedics. Although an equal proportion of sport and non-sports related injuries were immobilized, a dangerous mechanism was most often responsible for immobilization in sport-related cases. These findings do not address the potential impact of using the CCR to evaluate all sport-related injuries in collegiate or pro athletes evaluated by sport medicine therapists and physicians, as these patients are rarely assessed by paramedics or transported to a hospital. It does support the safety and benefit of using the CCR in sport-injured patients for which paramedics are called.
Introduction: While negative consequences of incident delirium on functional and cognitive decline have been widely studied, very limited data is available regarding functional and cognitive outcomes in Emergency Department (ED) patients. The aim of this study was therefore to evaluate the impact of ED stay-associated delirium on older patient's functional and cognitive status at 60 days post-ED visit. Methods: This study is a planned sub-analysis of a large multicentre prospective cohort study (the INDEED study). This project took place between March and July of the years 2015 and 2016 within 5 participating EDs across the province of Quebec. Independent non-delirious patients aged □65, with an ED stay at least 8hrs were monitored until 24hrs post-ward admission. A 60-day follow-up phone assessment was also conducted. Participants were screened for delirium using the validated Confusion Assessment Method (CAM) and the severity of its symptoms was measured using the Delirium Index. Functional and cognitive status were assessed at baseline as well as at the 60-day follow-up using the validated OARS and TICS-m. Results: A total of 608 patients were recruited, 393 of which completed the 60-day follow-up. Sixty-nine patients obtained a positive CAM during ED-stay or within the first 24 hours following ward admission. At 60-days, those patients experienced a loss of 3.1 (S.D. 4.0) points on the OARS scale compared to non-delirious patients who lost 1.6 (S.D. 3.0) (p = 0.03). A significant difference in cognitive function was also noted at 60-days, as delirious patients’ TICS-m score decreased by 2.1 (S.D. 6.2) compared to non-delirious patients, who showed a minor improvement of 0.5 (S.D. 5.8) (p = 0.01). Conclusion: People who developed ED stay-associated delirium have lower baseline functional and cognitive status than non-delirious patients and they will experience a more significant decline at 60 days post-ED visit.
Introduction: Mild traumatic brain injury (mTBI) with intracranial hemorrhage (ICH) is a common cause of Emergency Department (ED) visits. Over the past years, several authors have debated the relevance of radiological and clinical follow-up of these patients, as the main challenge is to identify patients at risk of clinical deterioration. Objectives: To determine whether demographic, clinical or radiological variables can predict patient deterioration. Methods: Design: An historical cohort was constituted in two level-1 trauma centers (Chu de Quebec - Hôpital de l'Enfant-Jésus (Québec City) and Hôpital du Sacré-Coeur (Montréal)). Participants: Medical records of mTBI patients aged ⩾16 with an ICH were reviewed using a standardized data collection tool. Consecutive medical records were reviewed from the end of 2017 backwards until sample saturation. Measures: Deterioration was defined as either death, deterioration of the control CT scan according to the radiologist, clinical deterioration or neurosurgical intervention. Analyses: Logistic regression analyses were performed to ascertain predictors of deterioration. Interobserver agreement was calculated. Results: A total of 274 patients were included in our analyses. Mean age was 60.8 and 68.9% (n = 188) were men. Four variables were found to be associated with all outcomes: radiological deterioration, clinical deterioration, death, and neurosurgical intervention. Diabetes (odds ratio (OR) = 2.6, 95% CI [0.97-6.94]), confusion as an initial symptom (OR = 2.8, 95% CI [1.42-5.61]), anticoagulation (OR = 2.8, 95% CI [1.01-7.84]) and significant subdural hemorrhage (≥4 mm) (OR = 3.4, 95% CI [1.42-5.61]) seen on the first computed tomography scan were strongly associated with these outcomes. Age had a neutral effect (OR = 1.01, 95% CI [0.99-1.03]) while high initial Glasgow Coma score seemed to have a protective effect (OR = 0.4, 95% CI [0.24-0.69]). Radiological deterioration was not systematically associated with clinical deterioration. As for the 46 patients with a deterioration of CT scan, only 30.4% vs. 69.5% without deterioration (p = 0.0035) showed a clinical deterioration. Conclusion: Diabetes, anticoagulation, significant subdural hemorrhage and confusion as an initial symptom seem to be predictors of deterioration following a mild traumatic brain injury with positive CT scan.
Introduction: The radiological and clinical follow-up of patients with a mild traumatic brain injury (mTBI) and an intracranial hemorrhage (ICH) is often heterogeneous, as there is no official guideline for CT scan control. Furthermore, public sector health expenditure has increased significantly as the number of MRI and CT scan almost doubled in Canada in the last decade. Therefore, the main objective of this study was to describe the current management practices of mTBI patients with intracranial hemorrhage at two level-1 trauma centers. Methods: Design: An historical cohort was created at the CHU de Québec – Hôpital de l'Enfant-Jésus (Québec City) and Hôpital du Sacré-Coeur (Montréal). Consecutive medical records were reviewed from the end of 2017 backwards until sample saturation using a standardized checklist. Participants: mTBI patients aged ⩾16 with an ICH were included. Measures: The main and secondary outcomes were the presence of a control CT scan and neurosurgical consultation/admission. Analyses: Univariate descriptive analyses were performed. Inter-observer measures were calculated. Results: Two hundred seventy-four patients were included, of which 51.1% (n = 140) came from a transfer. Mean age was 60.8 and 68.9% (n = 188) were men. Repeat CT scan was performed in 73.6% (n = 201) of our patients as 12.5% showed a clinical deterioration. The following factors might have influenced clinician decision to proceed to a repeat scan: anticoagulation (association of 87.1% with scanning; n = 27), antiplatelet (84.1%; 58), GCS of 13 (94.1%; 16), GCS of 14 (75%; 72) and GCS of 15 (70.2%; 111). 93.0% (n = 254) of patients had a neurosurgical consultation and only 6.7% (17) underwent a neurosurgical intervention. Conclusion: The management of mild traumatic brain injury with hemorrhage uses a lot of resources that might be disproportionate with regards to risks. Further research to identify predictive factors of deterioration is needed.
Introduction: Delirium is a frequent pathology in the elderly presenting to the emergency department (ED) and is seldom recognised. This condition is associated with many medical complications and has been shown to increase the hospital length-of-stay. The objective of this study was to identify the predictor factors of developing delirium in this high-risk population. Methods: Design: This study was part of the multicenter prospective cohort INDEED study. Participants: Patients aged 65 and older, initially free of delirium and with an ED stay of 8h or longer, were followed up to 24h after ward admission. Measures: Clinical and demographic variables were collected by interview and chart review. A research professional assessed their delirium status twice daily using the Confusion Assessment Method (CAM). Analyses: A classification tree was used to select predictors and cut-points that minimized classification error of patients with incident delirium. After literature review, nineteen predictors were considered for inclusion in the model (eight non-modifiable and eleven modifiable factors). Results: Among the 605 patients included in this study, incident delirium was detected by the CAM in 69 patients (11.4%). In total, fourteen variables were included in a preliminary model, of which six were intrinsic to the patient and eight were modifiable in the ED. Variables with the greatest impact in the prediction of delirium includes age, cognitive status, ED length of stay, autonomy in daily activities, fragility and mobility during their hospital stay. The diagnostic performance of the model applied to the study sample gave a sensitivity of 78.3% (95% CI: 66.7 to 87.3), a specificity of 100.0% (95% CI: 99.3 to 100.0), a PPV of 100.0% (95% CI: 93.4 to 100.0) and a NPV of 97.3% (95% CI: 95.6 to 98.5). Conclusion: The delirium risk model developed in this study shows promising results with elevated sensitivity and specificity values. Considering the limited ability to predict and detect delirium among physicians, the potential increase in sensitivity provided by this tool could be beneficial to patients. This model will ultimately serve to identify high-risk patients with the goal of developing strategies to alter modifiable risk factors and subsequently decrease the incidence of delirium in this population.
To evaluate the relationships between maternal fish consumption and pregnancy outcomes in a large, population-based sample of women in the USA.
We collected average fish consumption prior to pregnancy using a modified version of the semi-quantitative Willett FFQ. We estimated adjusted OR (aOR) and 95 % CI for associations between different levels of fish consumption and preterm birth (<37 weeks), early preterm birth (<32 and <35 weeks) and small-for-gestational-age infants (SGA; <10th percentile).
The National Birth Defects Prevention Study (NBDPS).
Control mother–infant pairs with estimated delivery dates between 1997 and 2011 (n 10 919).
No significant associations were observed between fish consumption and preterm birth or early preterm birth (aOR = 0·7–1·0 and 0·7–0·9, respectively). The odds of having an SGA infant were elevated (aOR = 2·1; 95 % CI 1·2, 3·4) among women with daily fish consumption compared with women consuming fish less than once per month. No associations were observed between other levels of fish consumption and SGA (aOR = 0·8–1·0).
High intake of fish was associated with twofold higher odds of having an SGA infant, while moderate fish consumption prior to pregnancy was not associated with preterm or SGA. Our study, like many other studies in this area, lacked information regarding preparation methods and the specific types of fish consumed. Future studies should incorporate information on nutrient and contaminant contents, preparation methods and biomarkers to assess these relationships.
In general terms, parasites that cause malaria are injected into the skin by mosquitoes. They then travel into the bloodstream and then to the liver where they invade liver cells and mature into forms called schizonts. Within each schizont, cell division produces thousands of tiny new forms called merozoites, each of which, when released into the bloodstream, is capable of infecting a red blood cell. This “traditional” pathway for malarial parasites may not be the only way these parasites travel through the body. Using some increasingly more powerful immuno-imaging tools, Rogerio Amino, Sabine Thiberge, Béatrice Martin, Susanna Celli, Spencer Shorte, Friedrich Frischknecht, and Robert Ménard have demonstrated an additional route that could have profound implications for developing effective vaccines for this major worldwide disease.
Schistosomes are digenean flukes, parasitic of birds, mammals and crocodiles. The family Schistosomatidae contains species of considerable medical and veterinary importance, which cause the disease schistosomiasis. Previous studies, both morphological and molecular, which have provided a good deal of information on the phylogenetics of this group, have been limited in the number of species investigated or the type or extent of molecular data used. This paper presents the most comprehensive phylogeny to date, based on the sequences of 3 genes, complete ribosomal small subunit rRNA and large ribosomal subunit rRNA, and mitochondrial cytochrome oxidase 1, sequenced from 30 taxa including at least 1 representative from 10 of the 13 known genera of the Schistosomatidae and 17 of the 20 recognized Schistosoma species. The phylogeny is examined using morphological characters, intermediate and definitive host associations and biogeography. Theories as to the origins and spread of Schistosoma are also explored. The principal findings are that Ornithobilharzia and Austrobilharzia form a sister group to the Schistosoma; mammalian schistosomes appear paraphyletic and 2 Trichobilharzia species, T. ocellata and T. szidati, seem to be synonymous. The position of Orientobilharzia within the Schistosoma is confirmed, as is an Asian origin for the Schistosoma, followed by subsequent dispersal through India and Africa.
The seroprevalence of canine parvovirus (CPV), canine distemper
virus (CDV), canine
adenovirus (CAV) and canine herpesvirus (CHV) infections in red
foxes (Vulpes vulpes) was
determined in fox sera collected between 1991 and 1995. A total of 500
sera were selected and
the seroprevalences were estimated to be 13% (65 of 500 sera) for CPV,
4·4% (17 of 383 sera)
for CDV, 3·5% (17 of 485 sera) for CAV, and 0·4%
(2 of 485 sera) for CHV, respectively. No
statistically significant differences were observed between the two (rural
and suburban) areas
Parvovirus DNA sequences were amplified from tissues of free-ranging
foxes and compared
to those of prototype viruses from dogs and cats. We report here a parvovirus
indicative of a true intermediate between the feline panleukopenia virus-like
viruses and the
canine parvovirus-like viruses. The red fox parvoviral sequence, therefore,
appears to represent
a link between those viral groups. The DNA sequence together with a significant
seroprevalence of parvovirus infections in foxes supports the hypothesis
that the sudden
emergence of canine parvovirus in the domestic dog population may have
interspecies transmission between wild and domestic carnivores.
This paper summarizes our recent study of NiAI+Fe+B alloy ribbons containing 4 to 20% Fe and doped with 300 wt ppm B. Alloy ribbons were successfully fabricated by rapid solidification via melt spinning. The alloys with 8% Fe and 34% Al-equivalent [=Al%+(Fe%)/2] showed the best bend ductility at room temperature. The ribbons exhibited a reversible martensite (body-centered orthorombic structure) to B2 transformation as evidenced by DSC, X-ray and TEM studies. The shape-memory effect, as characterized by measuring the recovery of bend angles with temperature, is sensitive to alloy composition, with the best recovery observed in SMA-15 (B-doped Ni-27% Al-14% Fe). Annealing at 600°C causes aging embrittlement; in particular, in alloys containing 12% Fe.
Possible mechanisms for protective roles of milk components on footand-mouth disease virus present in the milk of infected cows were examined. Light scattering bands collected from Ficoll-sucrose gradient fractions of skim-milk contained membrane-limited structures but these were non-infectious for bovine kidney cells, lnfectivity titres in buttermilk higher than those of the original cream or butter suggested association of virus with milk fat globules. Increased infectivity titres in skim-milk after treatment with SDS suggested release of virus particles from dissociated casein micelle subunits. Chelating agents, de-emulsifying agents and trypsin, which alter the structure of the individual milk components casein, lipid and milk fat globule membrane were without effect on infectivity titres.
Density measurements of eight silicate liquids containing substantial amounts of Fe2O3 have been made over a range of 250 °C. These have been combined with published density measurements on multicomponent silicate liquids to yield (by multiple regression) partial molar volumes of SiO2, TiO2, Al2O3, Fe2O3, FeO, MgO, CaO, Na2O, and K2O. The data on Fe2O3-liquids are neither precise nor abundant enough to show a compositional dependence of . In a liquid of constant composition and temperature, the pressure dependence of the oxygen fugacity is given by
which, if ΔV is independent of pressure, necessitates an increase in fO2 with increasing pressure of about 1 log10 unit for 10 kbars.
Combining an equation relating oxygen fugacity to composition, T, and Fe2O3 at 1 bar (Sack et al., 1980) with the results for partial molar volumes, the oxygen fugacity of any magma can be calculated as a function of P and T. If basic magmas have their Fe2O3/FeO set in the source regions, and ascend isochemically, then the calculated oxygen fugacities in the mantle increase as pressure increases and silica activity decreases. A P-T grid has been constructed to show the calculated oxygen fugacities in a source region which has equilibrated with some common lava types, based on their FeO and Fe2O3 contents.