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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.
Background: The pathophysiology of subarachnoid hemorrhage (SAH) is complex and includes disruption of the blood-brain barrier (BBB). We freshly isolated BBB endothelial cells (BECs) by 2 distinct methods after experimental SAH and then interrogated their gene expression profiles with the goal of uncovering new therapeutic targets. Methods: SAH was induced using the prechiasmatic blood injection mouse model. BBB permeability studies were performed by administering intraperitoneal cadaverine dye injections at 24h and 48h. BECs were isolated either by sequential magnetic-based sorting for CD45-CD31+ cells or by fluorescence-activated cell sorting (FACS) for Tie2+Pdgfrb- cells. Total RNA was extracted and analyzed using Affymetrix Mouse Gene 2.0 ST Arrays. Results: BBB impairment occurred at 24h and resolved by 48h after SAH. Analysis of gene expression patterns in BECs at 24h reveal clustering of SAH and sham samples. We identified 707 (2.8%) significant differentially-expressed genes (403 upregulated, 304 downregulated) out of 24,865 interrogated probe sets. Many significantly upregulated genes were involved in inflammatory pathways. These microarray results were validated with real-time polymerase chain reaction (RT-PCR). Conclusions: This study is the first to investigate in an unbiased manner, whole genome expression profiling of freshly-isolated BECs in an SAH animal model, yielding targets for novel therapeutic intervention.
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: Understanding physician human resources in British Columbia’s (BC) emergency settings is essential to plan for training, recruitment and professional development programs. In 2014 we conducted an online and phone survey to the site leads for the 95 Emergency Departments (ED) attached to hospitals in BC. Methods: A one-page survey was developed by the authors (JC and JM). Each hospital listed on the BC Ministry of Health’s website was contacted to confirm that they had a functioning ED attached to the hospital and to determine who their site lead was. Each ED site lead was then emailed the questionnaire and up to three more follow-up emails and direct phone requests were performed as needed. Results: 92 of the 95 EDs completed the survey and we discovered that just over 1000 physicians deliver emergency care in BC with approximately half doing so in combination with family practice. There was an estimated shortfall of 199 physicians providing emergency care in 2014 and an anticipated shortfall of 287 by 2017 and 399 by 2019. Slightly more than half had formal certification, with 28% through the Royal College of Canada and 70% with the College of Family Physicians of Canada. Conclusion: More than 1000 physicians care for patients in EDs across BC but there is a significant and growing need for more physicians. There is tremendous variation across health authorities in emergency medicine certification, but approximately half of those who deliver emergency care have formal certification. Despite limitations of a survey method, this provides the most accurate and current estimate of emergency practitioner resources and training in BC and will be important in guiding discussions to address the identified gaps.
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.
The Commission has been fortunate in being able to continue its work during the last triennium with a minimum of effort, and thanks for this should go largely to the Director of the Bureau, Dr B.G. Marsden, for his untiring dedication, as well as to the Smithsonian Astrophysical Observatory for its general support. If any question has arisen, it was where the line should be drawn between paid and unpaid contributions to the Circulars. This involves a somewhat delicate balance of interests between, on the one hand, the encouragement given to certain types of observations which have traditionally been published in the Circulars, (e.g. accurate positions of comets), and, on the other, the income on whi h the continued successful operation of the Bureau depends. The position will therefore have to be kept under review at all times. At present all evidence points to general satisfaction with current policy.