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Introduction: The Canadian Computed Tomography Head Rules (CCTHR) is a validated and well-known head injury clinical decision rule that allows Emergency Room Physicians (ERPs) to determine which patients are most likely to benefit from a diagnostic CT. However, this clinical decision rule is not uniformly adhered to and a number of preventable CT scans are ordered. Choosing Wisely Canada has ranked decreasing unnecessary head CT scans as the number one priority for Emergency Departments (ED). As such, the purpose of this study was to investigate if an educational intervention for ERPs would increase adherence to the CCTHR. Methods: In September 2015 the CCTHR were presented and discussed at three ED departmental meetings at Kelowna General Hospital (KGH) a large tertiary hospital in the interior of British Columbia, Canada. Educational materials were distributed to the ERPS and a CTTHR checklist was made available throughout the ED. Rates of adherence to the CCTHR criteria were calculated from MHI patients that were seen in the four years prior to the educational intervention and were compared to rates of adherence for patients 12 months post educational intervention. Only patients that agreed to participate in the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) were included in this analysis. Differences in adherence rates were tested using the chi-squared test. Results: 477 patients were included in the analysis for the pre-education cohort (control) and 257 for the post-education cohort(intervention). In the control cohort, 348 of the 477 (73%) of the patients were managed in accordance to the CCTHR compared to 194 of the 257 (75%) in the intervention cohort. There was no statistically significant difference in rates of adherence (p=0.457).In the control cohort, 44 of the 321 (14%) of patients received a CT that did not meet any CCTHR criteria compared to 15 of the 163 (9%) in the intervention cohort. The overall CT imaging rate was 24% in each patient cohort. Conclusion: Although adherence rates between the two cohorts were not statistically different, a greater proportion of patients had a CTAS of 2 or 3 and met criteria in the intervention cohort suggesting a higher level of acuity. Imaging rates remained constant at 24%, which was lower than expected if there was full adherence to the CCTHR. Further study is required to determine if educational interventions can improve adherence to the CCTHR.
Introduction: The Canadian CT Head Rules (CCTHR) is the gold standard clinical decision rule for minor head injuries (MHIs) & has been shown to have 100% sensitivity in identifying patients that would have an abnormal CT scan. Within the CCTHR age 65+ is considered to be an independent risk factor for abnormal head CT. However, a previously published Italian study indicated that the rate of pathological findings in otherwise low risk MHI patients under the age of 79 was less than 1% & significantly lower than those over the age of 80, which brings to question whether the traditional age cut off of 65 as a factor in the CCTHR is too conservative when considering the appropriateness for imaging. Therefore this study aimed to quantify the extent to which low risk MHI patients between the ages of 65-79 present with abnormal CT findings or require neurosurgical intervention when compared to patients over 80 years of age as one of the criteria used in the CCTHR is the age threshold of 65. A secondary objective of this study was to explore abnormal CT rates across these age groupings for otherwise low risk patients on anticoagulants. Methods: A retrospective chart review was conducted on all patients over the age of 65 that received a head CT for a MHI in the Kelowna General Hospital ED between 2006-2016. The imaging results for all patients that had no other risk criteria of the CCTHR other than age were reviewed & rates of pathological findings were compared between patients ages 65-79 & 80+ for both patients on anticoagulants & those not on anticoagulants. Differences in rates by age were compared for statistical significance using the chi-squared & Fisher’s exact test. Results: To date 248 patients have been reviewed & meet the criteria of being >65 & with no other CCTHR criteria. 65% of patients were female & 30% of patients were on anticoagulants. For the patients that were not on anticoagulants, 6 of the 75 (8%) individuals between 65-79 & 9 of the 94 (10%) of those over 80 had abnormal findings on CT (p=0.128). Conclusion: Preliminary results of this study population indicate that there are a significant number of abnormal CT findings in patients under the age of 80 suggesting that patients ages 65-79 without any other CCTHR criteria may still benefit from a head CT. Chart reviews are ongoing & updated results including findings for anti-coagulated patients will be presented at CAEP 2017.
The aim of this study was to elucidate the relationship between the urinary metabolic fingerprint and the effects of cocoa and cocoa fibre on body weight, hormone metabolism, intestinal immunity and microbiota composition. To this effect, Wistar rats were fed, for 3 weeks, a diet containing 10 % cocoa (C10) or two other diets with same the proportion of fibres: one based on cocoa fibre (CF) and another containing inulin as a reference (REF) diet. The rats’ 24 h urine samples were analysed by an untargeted 1H NMR spectroscopy-based metabonomic approach. Concentrations of faecal IgA and plasma metabolic hormones were also quantified. The C10 diet decreased the intestinal IgA, plasma glucagon-like peptide-1 and glucagon concentrations and increased ghrelin levels compared with those in the REF group. Clear differences were observed between the metabolic profiles from the C10 group and those from the CF group. Urine metabolites derived from cocoa correlated with the cocoa effects on body weight, immunity and the gut microbiota. Overall, cocoa intake alters the host and bacterial metabolism concerning energy and amino acid pathways, leading to a metabolic signature that can be used as a marker for consumption. This metabolic profile correlates with body weight, metabolic hormones, intestinal immunity and microbiota composition.
Searches have been made for the normal and quadratic Zeeman effect and broad-band circular polarization in white dwarf stars. A positive effect has been found in Grw + 70°8247 whose continuum shows both linear and circular polarization.
The polarizer is briefly described. The polarization of the whole pulse is not significantly different from zero (-0.15 ± 0.70 per cent). Polarization measurements of the leading edge and trailing edge of the main pulse are also given.
A method is proposed for polishing fast aspherics with a lap whose shape is continuously changed under computer control as it moves over a rigid mirror blank. The required changes of radius, astigmatism and coma in a circular lap are made with edge bending levers and tensioning members with screw actuators. This method of bending has been demonstrated in the laboratory.
The alloy composed of zirconium has been used effectively for over 50 years in claddings of nuclear fuel, especially for PWR type reactors. However, to increase fuel enrichment with the aim of rising the burning and maintaining the safety of nuclear plants, is of great relevance the study of new materials that can replace safely and efficiently zircaloy cladding. Among several proposed material, silicon carbide (SiC) has a potential to replace zircaloy as fuel cladding material due to its high-temperature tolerance, chemical stability and a low absorption cross-section for thermal neutrons. In this paper, the goal is to expand the study with silicon carbide cladding, checking its behavior when submitted to an environment with burnable poison variations, the impact on multiplication factor and reactivity coefficients to both claddings: zircaloy and silicon carbide. The neutronic analysis was made using the SCALE 6.0 (Standardized Computer Analysis for Licensing Evaluation) code. This code system is widely accepted and used worldwide for safety analysis, and criticality of nuclear reactors has been utilized to model a typical fuel element of a PWR.
During the course of two observational programs to search for magnetic fields in white dwarfs (Angel and Landstreet, 1970a; Kemp, 1970), it was discovered by Kemp and Swedlund (Kemp et al., 1970b) that the continuum optical radiation from the λ4135 type white dwarf Grw + 70° 8247 is circularly polarized. This circular polarization was measured in a broad band from about 4000 to 7000 Å a number of times; in this band the circular polarization does not appear to vary from its mean value of 3.29% with an amplitude of more than about 0.1% (or 3% of the measured mean polarization) on any time scale from 24 seconds to 2 weeks (Angel and Landstreet, 1970b).
A rocket-borne X-ray polarimeter was flown to search for polarization in Taurus X-1. Although a result consistent with zero polarization was obtained, the statistics were such that X-ray polarization comparable in magnitude and direction to that of radio and optical continuum emission cannot be excluded.
A search in many small regions of the Crab Nebula has resulted in the detection of a small component of circular polarization. The variation of the sign and magnitude with position in the Nebula indicates that the polarization is of interstellar origin. On the basis of the polarity, strength, and colour dependence, it is concluded that the composition of the aligned grains causing this polarization is dielectric. Metallic particles are clearly ruled out.
In the last year there have been several proportional counter observations of Sco X-1 which give an indication of an emission feature at around 7 keV (Holt et al., 1969; Acton et al., 1970). The emission lines of Fe+24 and Fe+25, which are very strong in radiation from solar flares of comparable plasma temperature, may be responsible for this feature. Two factors, poor energy resolution and the steeply varying continuum spectrum whose shape is not known in detail, make it impossible to obtain with proportional counters an unambiguous identification of emission features. For this reason we have constructed a Bragg crystal spectrometer to scan the spectrum of Sco X-1. The instrument, flown successfully aboard an Aerobee-170 rocket in April 1970 in conjunction with the Kitt Peak National Observatory, scanned the spectral range from 2.4–2.9 keV which includes the Lyman-α line of hydrogenic sulphur (2.62 keV). The spectrum obtained shows no feature at this energy. The sensitivity of the instrument may be judged from the upper limit (3σ) of 0.08 photon/cm2/s which we are able to place on the line intensity. This value can be compared with the flux of 0.55 photon/cm2/s predicted by Tucker (1967) for the S+15 line intensity from an isothermal, optically thin plasma at 5× 107K. If the line had had this theoretical intensity, we would have observed a 21-σ signal.
One of the outstanding problems in X-ray astronomy is the detection and understanding of a number of important phenomena that are expected at photon energies in the range from 100 eV to 1000 eV. One expects to be able to detect interstellar matter in both absorption and emission. It is of critical importance to cosmology to determine the spectrum, isotropy and intensity of extragalactic radiation in this energy region. It is also expected that a large number of discrete sources with temperatures in the range from 105K to 106K will be detected. Such sources could result from neutron stars that are cooling or from the accretion of interstellar matter onto condensed objects. Matter falling into ‘black holes’ may be heated sufficiently to be detectable at long X-ray wavelengths. Extended objects, such as the Cygnus Loop and the Magellanic clouds, are known to be luminous at low X-ray energies (Grader et al., 1970; Gorenstein, 1970); other such objects are almost certainly present. There may be local sources of diffuse radiation. Finally, it should be possible to detect X-ray zodiacal light.
Biodegradable Normal Human Osteoblast (NHOst) cells were inoculated into the polymer scaffolds of poly(β-hydroxybutyrate) (PHB) obtained from a specially developed strain of Azotobacter vinelandii. Cell adhesion is essential to promote growth on scaffolds for tissue engineering. Thus, in this research we focused on the adhesion of osteoblast cells to PHB scaffolds produced by solution casting and electrospinning. Cell viability was also investigated up to 168 hrs. Water contact angle on the PHB scaffolds was determined prior to the cells inoculation. The contact angle is usually related to the ability of different cell strains to adhere to a given material. The as cast film exhibited a contact angle α=72° whereas for the electrospun membrane α=102°, thus in theory cell adhesion would be greater for the cast film. Biological testing was carried out on plates of 24 wells; cell viability was determined by Trypan Blue, cell morphology by optical microscopy, and cell nuclei integrity by staining with Acridine orange. Parallel studies were carried out on control (empty) wells. Microscopy observations 168 hrs after cell inoculation showed larger quantities of osteoblast cells in the wells containing PHB scaffolds and the cell nuclei were still active. Moreover, it was found that the cells grew inside the PHB scaffolds and the cell viability was slightly greater for the electrospun scaffold. Interestingly, the time to remove the cells from the scaffolds (film and membranes) was increasing function of the cell culture time, therefore suggesting that PHB promotes adhesion of Normal Human Osteoblast cells to its surface.
We present the results of 1.3 and 3.6 cm radio continuum emission toward the NGC 2071IR star-forming region, carried out with the VLA in its A configuration. We detect continuum emission toward the infrared sources IRS 1 and IRS 3 at both wavelengths. In particular, IRS 1 breaks up into three continuum peaks (IRS 1E, 1C, and 1W), aligned in the east-west direction, being IRS 1 the central source. The morphology of the condensation IRS 1W is very interesting, which has an elongated structure and shows a significant curvature towards the north. We suggest that this morphology could be explained as the impact of a high-velocity wind or jetlike outflow from IRS 1 on a close companion or other obstruction, which also explains the strong water maser emission observed toward IRS 1W.
Hip fracture is very common among older patients, who are characterized by increased co-morbidities, including cognitive impairment. These patients have an increased risk of falls and fractures, poorer functional recovery and lower survival both in hospital and 12 months after discharge. We review the survival and functional outcomes of older patients with cognitive impairment and hip fracture managed in orthogeriatric units, and highlight the gaps in our knowledge of the efficacy and efficiency of specific orthogeriatric programmes for such patients and the future research perspectives in this field.