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Introduction: September 2017 saw the launch of the British Columbia (BC) Emergency Medicine Network (EM Network), an innovative clinical network established to improve emergency care across the province. The intent of the EM Network is to support the delivery of evidence-informed, patient-centered care in all 108 Emergency Departments and Diagnostic & Treatment Centres in BC. After one year, the Network undertook a formative evaluation to guide its growth. Our objective is to describe the evaluation approach and early findings. Methods: The EM Network was evaluated on three levels: member demographics, online engagement and member perceptions of value and progress. For member demographics and online engagement, data were captured from member registration information on the Network's website, Google Analytics and Twitter Analytics. Membership feedback was sought through an online survey using a social network analysis tool, PARTNER (Program to Analyze, Record, and Track Networks to Enhance Relationships), and semi-structured individual interviews. This framework was developed based on literature recommendations in collaboration with Network members, including patient representatives. Results: There are currently 622 EM Network members from an eligible denominator of approximately 1400 physicians (44%). Seventy-three percent of the Emergency Departments and Diagnostic and Treatment Centres in BC currently have Network members, and since launch, the EM Network website has been accessed by 11,154 unique IP addresses. Online discussion forum use is low but growing, and Twitter following is high. There are currently 550 Twitter followers and an average of 27 ‘mentions’ of the Network by Twitter users per month. Member feedback through the survey and individual interviews indicates that the Network is respected and credible, but many remain unaware of its purpose and offerings. Conclusion: Our findings underscore that early evaluation is useful to identify development needs, and for the Network this includes increasing awareness and online dialogue. However, our results must be interpreted cautiously in such a young Network, and thus, we intend to re-evaluate regularly. Specific action recommendations from this baseline evaluation include: increasing face-to-face visits of targeted communities; maintaining or accelerating communication strategies to increase engagement; and providing new techniques that encourage member contributions in order to grow and improve content.
Among the solar proxies, κ1 Cet, stands out as potentially having a mass very close to solar and a young age. We report magnetic field measurements and planetary habitability consequences around this star, a proxy of the young Sun when life arose on Earth. Magnetic strength was determined from spectropolarimetric observations and we reconstruct the large-scale surface magnetic field to derive the magnetic environment, stellar winds, and particle flux permeating the interplanetary medium around κ1 Cet. Our results show a closer magnetosphere and mass-loss rate 50 times larger than the current solar wind mass-loss rate when Life arose on Earth, resulting in a larger interaction via space weather disturbances between the stellar wind and a hypothetical young-Earth analogue, potentially affecting the habitability. Interaction of the wind from the young Sun with the planetary ancient magnetic field may have affected the young Earth and its life conditions.
Solar Orbiter will provide, at very high spatial (35 km pixel size) and temporal resolution, novel observations of the solar atmosphere and unexplored inner heliosphere, which will be made in the heliosynchronous segments of the orbits at heliocentric distances near 45 solar radii and out of the ecliptic plane at high heliographic latitudes up to 38°. The Solar Orbiter will achieve its wide-ranging scientific aims with a suite of sophisticated instruments through an innovative orbit design.
Introduction: Atrial fibrillation and flutter (AFF) are the most common arrhythmias presenting to the emergency department. A coordinated ED AFF electronic order-set and management pathway was developed in collaboration with cardiologists at our institution. The primary objective of this study was to compare the ED length of stay pre and post pathway implementation. Secondary objectives included comparison of the following outcomes pre and post-pathway (PRE & POST): AFF Clinic referral rates, ED return rates, and mortality. Methods: This was a retrospective case series of patients presenting to our quarternary care ED with AFF pre and post AFF pathway implementation. Cases were identified using an administrative database covering 120 000 annual ED visits. Trained research assistants and the primary investigator extracted data from the electronic medical record. 20% of all charts were double collected to ensure accuracy (k=0.85). Descriptive variables were described using counts, means, medians and confidence intervals. Chi-square statistics of dependent samples were calculated for the primary outcome. Results: We examined 307 cases of AFF presenting to our ED (n=130 PRE; n=177 POST). Demographic variables were similar PRE and POST: mean age (66.0 [95%CI 63.8-68.3] PRE; 65.0 [63.0-67.0] POST), % male (59.2% PRE; 59.3% POST), presenting rhythm (66.2% A.fib [58.0-74.3] A. flutter 29.2% [21.4-37.0] PRE; 61.0% A.fib [53.8-68.1] A. flutter 17.5% [11.9-23.1] POST), and CHADS2VASC score (2.1 [1.8-2.4] PRE; 1.9 [1.7-2.1] POST). The mean ED LOS decreased by 72.5 minutes (95% CI -22.9 to -122.1; P < 0.001). AFF clinic referral rates increased from 16.9% PRE to 25.4% POST (not significant). ED return rates within 30 days for AFF, CHF, major bleeding and CVA were unchanged. 30 day mortality rates were not statistically different (1.5% PRE vs. 2.8% POST). Conclusion: A coordinated ED AFF pathway was associated with a significant reduction in ED LOS without significant changes in ED return rates or mortality.
Introduction: Atrial fibrillation and flutter (AFF) are the most common arrhythmias presenting to the emergency department. Without anticoagulation, AFF increases stroke risk; individuals with paroxysmal AFF have a similar prognosis. A coordinated ED AFF electronic order-set and management pathway was developed at our institution. The primary objective of this study was to measure rates of appropriate anticoagulation (AAC) on discharge from the ED for patients presenting with AFF not previously on antithrombotic or anticoagulant medications. Secondary objectives included comparison of the following outcomes pre and post-pathway (PRE & POST): AFF Clinic referral rates, ED return rates, and mortality. Methods: This was a retrospective case series of patients presenting to our quarternary care ED with AFF pre and post AFF pathway implementation. Cases were identified using an administrative database covering 120 000 annual ED visits. Trained research assistants and the primary investigator extracted data from the electronic medical record. 20% of all charts were double collected to ensure accuracy (k=0.85). Descriptive variables were described using counts, means, medians and confidence intervals. Chi-square statistics of dependent samples were calculated for the primary outcome. Results: We examined 307 cases of AFF presenting to our ED (n=130 PRE; n=177 POST). Demographic variables were similar PRE and POST: mean age (66.0 [95%CI 63.8-68.3] PRE; 65.0 [63.0-67.0] POST), % male (59.2% PRE; 59.3% POST), presenting rhythm (66.2% A.fib [58.0-74.3] A. flutter 29.2% [21.4-37.0] PRE; 61.0% A.fib [53.8-68.1] A. flutter 17.5% [11.9-23.1] POST), and CHADS2VASC score (2.1 [1.8-2.4] PRE; 1.9 [1.7-2.1] POST). The rate of AAC rose from 39.1% PRE to 77.8% POST (P < 0.01). AFF clinic referral rates increased from 16.9% PRE to 25.4% POST (not significant). ED return rates within 30 days for AFF, CHF, major bleeding and CVA were unchanged. 30 day mortality rates were not statistically different (1.5% PRE vs. 2.8% POST). Conclusion: The implementation of a coordinated ED AFF pathway was associated with significant improvements in the proportion of patients discharged with appropriate anticoagulation who had not previously been on antithrombotic or anticoagulant medications. ED return rates and mortality did not change significantly.
Introduction: Vancouver Coastal Health (VCH) emergency physicians have been on contract based funding models for two decades. On October 1, 2015, physicians at one hospital (SPH) switched to fee-for-service (FFS) payments. Conventional wisdom is that FFS physicians are motivated to see more patients quickly and achieve higher throughput. Our hypothesis was that FFS payment would reduce patient wait times. Methods: This interrupted time series analysis with concurrent control was performed in VCH Region, where there are two tertiary EDs. During the 20-week study period (July 15-Nov 30), VGH remained on contract, while SPH converted to FFS (the intervention). VCH administrative data was aggregated by week. Our primary outcome was median wait time to MD. Secondary outcomes were ED LOS and left-without-being-seen (LWBS) rates. Results: Interrupted time series plots will be presented for the data. Data from 67,214 ED visits were analyzed (31,733 SPH, 35,481 VGH). Figure 1 shows that baseline wait time was 74 minutes at the control and 53 minutes at the intervention site. During the pre-intervention period, there was a non-significant downward trend of 0.4 minutes per week at the intervention hospital relative to control (p=0.26). After FFS conversion, there was a 4.1 minute increase in wait time at the control site (p=0.18), and a significant downward trend of 1.4 minutes per week (p=0.001). After FFS conversion, wait times at the intervention site increased by 4.8 minutes more than control (p-value for the difference=0.27), and the wait time trend increased significantly by 1.3 minutes per week relative to the expected counterfactual trend (p=0.02). Baseline EDLOS for discharged patients was 227 minutes at the control hospital and 193 minutes at the intervention site. There were similar pre-intervention LOS increases at both hospitals. Post-intervention, both sites saw significant increases in EDLOS, followed by a similar downward trends of -2.68 minutes per week (p=0.001). Baseline LWBS rate was 3.86% at the control hospital and 3.56% at the intervention site. Pre-intervention trends, and post-intervention level/trend changes did not differ by site. Conclusion: Conversion to FFS payment was associated with an increase in wait time trend of 1.3 minutes per week relative to control. There were no significant changes in EDLOS or LWBS rates. In this preliminary analysis, FFS payment had little effect on wait times or patient throughput.
In the past triennium members of the Commission 20 have been very active in studying positions and motions of minor planets, comets and satellites including rings by observational and theoretical investigations, as it is described in this report In fact observers have been producing tremendous amount of astrometric data, much more than we could imagine twenty years ago, when we heard many complains and appeals to observers for needs of more observations, particularly, for minor planets and satellites. Technically, several new devices to detect faint objects and to measure their positions more effectively, have been developed. Theoreticians have faced many interesting and important problems to explain observational facts with several powerful methods developed recently.
Since July 1996, 815 new names on features on bodies in the Solar System have been assigned by the WGPSN and approved at the IAU General Assembly in Kyoto in 1997. Of these names, 666 were for Venus, 17 for Mars, 3 for the Moon, 125 for the Galilean satellites, 3 for the Uranian satellite Miranda, and 1 for the minor planet Ida. 71 additional names mostly on Venus have been selected and have been given or are awaiting provisional approval by the IAU Executive Committee (EC). These names are up for final approval at the next IAU General Assembly.
This Comm. 20 triennial report is prepared as a short summary of the scientific progress in the fields of interest, where, by necessity, only a few highlights are to be mentioned. On the Comm. 20 webpage, the interested reader may find a more complete list of recent references to the relevant literature. Its URL at the time of writing (October 1999) is www.astro.uu.se/IAU/c20/, but mirror sites are expected to have been set up at the time of appearance of these Transactions.
Interest in minor planets and comets continued to grow during the triennium, sparked in part by the highly successful 1983 mission of the Infrared Astronomy Satellite (IRAS) as well as by activities associated with the return of P/Halley and the first spacecraft missions to comets. A trial of the Astrometry Network of the International Halley Watch (IHW) on P/Crommelin was quite successful. Yet with an increasing need for precise ephemerides, there continued to be concern for acquisition and timely reporting of astrometric observations of even the best known comets.
Current guidelines for image-guided cervical cancer brachytherapy planning recommend both computed tomography (CT) and magnetic resonance imaging (MRI) for adequate visualisation of the applicator and soft tissues, respectively. MRI-only planning would be ideal as it would save time within the patient pathway and avoid the concomitant CT exposures. However, applicator visualisation on MRI is usually achieved using fluid-filled fiducial marker tubes, which can be awkward to use and suffer from unwanted air bubble artefacts. Therefore, a new fiducial-free imaging technique was developed.
A dual echo time (TE) turbo spin echo sequence was used, at 1·5 T, to provide both T2-weighted images (100 ms TE) for tissue visualisation and strongly proton density-weighted images (17 ms TE) for improved applicator visualisation. In-house software was used to automatically segment the applicator in the short TE images (using Otsu's method) and transfer the information to the long TE images to provide a single fused dataset.
The method was evaluated successfully using titanium applicators in three patient cases and using a plastic applicator in a tissue-equivalent gel phantom.
The dual-echo technique provides a simple and efficient method for improving the visualisation of brachytherapy applicators in cervical cancer MRI images without the need for marker tubes.
IAU Commission 6 “Astronomical Telegrams” had a single business meeting during the Beijing General Assembly of the IAU. It took place on Friday, August 24, 2012. The meeting was attended by five C6 members (N. N. Samus; D. W. E. Green; S. Nakano; J. Ticha; and H. Yamaoka). Also present was Prof. F. Genova as a representative of the IAU Division B. She told the audience about the current restructuring of IAU Commissions and Divisions and consequences for the future of C6.
κ1 Cet (HD 20630, HIP 15457, d = 9.16 pc, V = 4.84) is a dwarf star approximately 30 light-years away in the equatorial constellation of Cetus. Among the solar proxies studied in the Sun in Time, κ1 Cet stands out as potentially having a mass very close to solar and a young age. On this study, we monitored the magnetic field and the chromospheric activity from the Ca II H & K lines of κ1 Cet. We used the technique of Least-Square-Deconvolution (LSD, Donati et al. 1997) by simultaneously extracting the information contained in all 8,000 photospheric lines of the echelogram (for a linelist matching an atmospheric model of spectral type K1). To reconstruct a reliable magnetic map and characterize the surface differential rotation of κ1 Cet we used 14 exposures spread over 2 months, in order to cover at least two rotational cycles (Prot ~9.2 days). The Least Square deconvolution (LSD) technique was applied to detect the Zeeman signature of the magnetic field in each of our 14 observations and to measure its longitudinal component. In order to reconstruct the magnetic field geometry of κ1 Cet, we applied the Zeeman Doppler Imaging (ZDI) inversion method. ZDI revealed a structure in the radial magnetic field consisting of a polar magnetic spot. On this study, we present the fisrt look results of a high-resolution spectropolarimetric campaign to characterize the activity and the magnetic fields of this young solar proxy.
In November 2009, we initiated a multistate investigation of Salmonella Montevideo infections with pulsed-field gel electrophoresis pattern JIXX01.0011. We identified 272 cases in 44 states with illness onset dates ranging from 1 July 2009 to 14 April 2010. To help generate hypotheses, warehouse store membership card information was collected to identify products consumed by cases. These records identified 19 ill persons who purchased company A salami products before onset of illness. A case-control study was conducted. Ready-to-eat salami consumption was significantly associated with illness (matched odds ratio 8·5, 95% confidence interval 2·1–75·9). The outbreak strain was isolated from company A salami products from an environmental sample from one manufacturing plant, and sealed containers of black and red pepper at the facility. This outbreak illustrates the importance of using membership card information to assist in identifying suspect vehicles, the potential for spices to contaminate ready-to-eat products, and preventing raw ingredient contamination of these products.
As earlier, the main activity of the Commission was performed by the Central Bureau for Astronomical Telegrams (CBAT), effectively directed by Dan Green. These three years were a difficult period for the Bureau and thus for the Commission because the Bureau unexpectedly had to move from the Smithsonian Astrophysical Observatory, its home since 1965, to the Harvard University's Department of Earth and Planetary Sciences. This move caused many serious administrative and logistical problems, effectively solved by the CBAT Director, Dan Green, and CBAT Director Emeritus, Brian Marsden. A great shock, not only for our commission but for the whole astronomical community, was Brian's death on November 18, 2010.