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Introduction: Quality improvement and patient safety (QIPS) are increasingly recognized as integral to the provision and advancement of emergency medicine (EM) care. In 2015, QIPS were added to the Canadian Medical Education Directives for Specialists (CanMEDS) framework. However, the level of QIPS education and support that Canadian EM residents receive is unknown. In order to better plan national QIPS efforts aimed at enabling EM residents to improve their local care settings, we sought to assess the current state of QIPS education and support in Canadian EM residency programs. Methods: This was a descriptive, cross-sectional electronic survey that was disseminated to all current Canadian EM residents from both Royal College (RC) and Family Medicine - EM training streams. Residents were recruited either directly or through their program's administrative assistant. The survey consisted of multiple-choice, Likert and free-text entry questions. Themes included a) familiarity with QIPS; b) local opportunities for QIPS projects and mentorship; and c) desire for further QIPS education and involvement. The survey was open for a five-week period, with formal reminders after the first and third weeks. Descriptive statistics are reported. Results: 189 (35%) of 535 current EM residents completed the survey, representing all 17 medical schools. 77% of respondents were from the RC stream. 54.7% of respondents reported being “somewhat” or “very” familiar with QIPS. 47.2% of respondents reported “not knowing” or “not having readily available” QIPS projects to participate in their local environment, and 51.5% had equivalent responses with respect to QIPS mentorship opportunities. Only 17.5% of respondents reported that QIPS methodologies were already formally taught in their residency program, and 66.9% indicated a desire for increased QIPS teaching. The majority of respondents were “slightly” (35.9%), “moderately” (23.2%) or “very” (11.3%) interested in becoming involved with QIPS training and initiatives. Conclusion: Responding Canadian EM residents are interested in obtaining greater QIPS education as well as project and mentorship opportunities, but many perceive that they do not have adequate access to these at the current time. As the importance of QIPS increases in the EM community, supporting residents with more robust educational infrastructures may be necessary. Future efforts may include the standardizing of QIPS postgraduate curricula and improving access to QIPS opportunities across the country.
Introduction: When presenting to the Emergency Department (ED), the care of elderly patients residing in Long Term Care (LTC) can be complicated by threats to patient safety created by ineffective transitions of care. Though standardized inpatient handover tools exist, there has yet to be a universal tool adopted for transfers to the ED. In this study, we surveyed relevant stakeholders and identified what information is essential in the transitions of care for this vulnerable population. Methods: We performed a descriptive, cross sectional electronic survey that was distributed to physicians and nurses in ED and LTC settings, paramedics, and patient advocates in two Canadian cities. The survey was kept open for a one month period with weekly formal reminders sent. Questions were generated after performing a literature review which sought to assess the current landscape of transitional care in this population. These were either multiple choice or free text entry questions aimed at identifying what information is essential in transitional periods. Results: A total of 191 health care providers (HCP) and 22 patient advocates (PA) responded to the survey. Within the HCPs, 38% were paramedics, 38% worked in the ED, and 24% were in LTC. In this group, only 41% of respondents were aware of existing handover protocols. Of the proposed informational items in transitional care, 100% of the respondents within both groups indicated that items including reason for transfer and advanced care directives were essential. Other areas identified as necessary were past medical history and baseline functional status. Furthermore, the majority of PAs identified that items such as primary language, bowel and bladder incontinence and spiritual beliefs should be included. Conclusion: This survey demonstrated that there is a need for an improved handover culture to be established when caring for LTC patients in the ED. Education needs to be provided surrounding existing protocols to ensure that health care providers are aware of their existence. Furthermore, we identified what information is essential to transitional care of these patients according to HCPs and PAs. These findings will be used to generate a simple, one page handover form. The next iteration of this project will pilot this handover form in an attempt to create safer transitions to the ED in this at-risk population.
Cal 87 was observed with with XMM-Newton in April of 2003. The source shows a rich emission spectrum, where lines can be identified if they are red-shifted by 700-1200 km s –1. These lines seem to have been emitted in a wind from the system. The eclipse is observed to be shifted in phase by 0.03 ϕorb, where ϕorb is the phase of the optical light curve.
Applying sufficient tensile strain to Ge leads to a direct bandgap group IV semiconductor, which emits in the mid-infrared (MIR) wavelength range. However, highly strained-Ge cannot be directly grown on Si because of its large lattice mismatch. In this work, we have developed a process based on Ge micro-bridge strain redistribution intentionally landed to the Si substrate. Traction arms were then partially etched to keep locally strained-Ge micro-blocks. Large tunable uniaxial stresses up to 4.2% strain were demonstrated in Ge, which was bonded on Si. Our approach allows envisioning integrated strained-Ge on Si platform for MIR-integrated optics. Silicon photonics merge optical and electronic components that can be integrated together onto a single microchip.
Cannabis use shows a robust dose-dependent relationship with psychosis risk among the general population. Despite this, it has been difficult to link cannabis use with risk for transitioning to a psychotic disorder among individuals at ultra-high risk (UHR) for psychosis. The present study examined UHR transition risk as a function of cannabis use characteristics which vary substantially between individuals including age of first use, cannabis abuse severity and a history of cannabis-induced attenuated psychotic symptoms (APS).
Participants were 190 UHR individuals (76 males) recruited at entry to treatment between 2000 and 2006. They completed a comprehensive baseline assessment including a survey of cannabis use characteristics during the period of heaviest use. Outcome was transition to a psychotic disorder, with mean time to follow-up of 5.0 years (range 2.4–8.7 years).
A history of cannabis abuse was reported in 58% of the sample. Of these, 26% reported a history of cannabis-induced APS. These individuals were 4.90 (95% confidence interval 1.93–12.44) times more likely to transition to a psychotic disorder (p = 0.001). Greater severity of cannabis abuse also predicted transition to psychosis (p = 0.036). However, this effect was mediated by higher abuse severity among individuals with a history of cannabis-induced APS.
Findings suggest that cannabis use poses risk in a subpopulation of UHR individuals who manifest cannabis-induced APS. Whether this reflects underlying genetic vulnerability requires further study. Nevertheless, findings reveal an important early marker of risk with potentially significant prognostic utility for UHR individuals.
We present the results of a deep, optical/IR wide field imaging survey of selected fields in the nearby (d~ 140 pc) Taurus star-forming region. We report the discovery of 9 new members with spectral types M5.75–M9.5. We derive an Initial Mass Function encompassing 54% of the known members in Taurus. Comparison with dense regions like the Trapezium Cluster in Orion shows that Taurus has produced x2 less brown dwarfs. We suggest that the lower frequency of brown dwarfs in Taurus may result from the low-density star-forming environment, leading to larger minimum Jeans masses.
The values given below are those published in each annual report of the international latitude work. They were calculated from the observations at five stations, except the last part of 1934 which was made without Kitab, because the observation books from Kitab since November 1934 have arrived too late at the Central Bureau.
We analyzed the soft X-ray background (SXRB) source intensity distribution of the ¾ keV and ¼ keV photons by correlating the public ROSAT PSPC All-Sky Survey data with the new Leiden/Dwingeloo HI Survey. We found that the ¾ keV and ¼ keV distant background source intensity distribution can be modelled by an isothermal (T = 1.5.106 K) disk-like (scale length A1 = 15 kpc) X-ray halo in addition to the radiation of the extragalactic X-ray background.
Diffuse excess ¼ keV soft X-ray emission was found to be positionally correlated with the column density distribution of the high velocity cloud (HVC) complex C (Kerp et al. 1996). Here we point out that the detected diffuse X-ray emission is indeed associated with the HVC phenomenon. For this purpose we study the ¼ keV radiation transfer as well as the H I column density distribution of HVCs and intermediate velocity clouds (IVCs) towards HVC complex C in detail. We present evidence that on arcmin scales the ¾ keV soft X-ray emission is positionally anticorrelated with the HVC column density distribution of an individual HVC filament of complex C.
The recent launch of the International Ultraviolet Explorer (IUE) satellite and its spectrographic instruments (Boggess et al. 1978a,b) suddenly made accessible large numbers of diverse types of binary systems. These range from the luminous hot supergiants with compact companions that produce copious amounts of X-rays to the dwarf solar like stars of W UMa-type. For systems such as these and many others the IUE is a new and unique tool with which to probe the structure of extended stellar atmospheres, the presence and acceleration of a stellar wind, and the appearance of stellar chromospheres and coronae.
Spectra of AM Herculis taken with IUE show a continuum which is partially eclipsed in phase with the X-ray eclipse and can be separated into two components; a black-body component (kTBB = 25 − 30 eV) which accounts for the ¼ keV X-rays and the eclipsed UV continuum; and a component roughly described by Fν ∂ ν−1 which is not eclipsed.