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Introduction: It is critical for planning, clinical care and resource optimization to understand patterns of emergency department (ED) utilization. Individuals who have experienced adverse childhood experiences (ACE) are known to have more unhealthy behaviors and worse health outcomes as adults and therefore may be more frequent ED users. Adverse childhood experiences include physical, sexual and emotional abuse or neglect, substance abuse in the family, witnessing violence, having a parent incarcerated or parents getting divorced or separated. To date there are few studies exploring the relationship between ACE and ED utilization. Methods: This a mixed qualitative and quantitative study. It includes analysis of data collected through a survey, a retrospective chart review and focus group discussions. The survey was administered to a convenience sample of adult patients (CTAS 2 -5) presenting to EDs in Kingston Ontario, and consisted of two validated tools that measured exposure to ACE and resiliency. Demographic data and ED utilization frequency for 12 months prior to the index visit were extracted from an electronic medical record for each patient completing the survey. A sample of participants with a high ACE burden (ACE score > 4) were invited to participate in focus groups to explore their experiences of care in the ED. Demographic, ED utilization and health status data were summarized and statistically significant patterns between high ACE and lower ACE patients were determined using Chi2t or t-tests. Transcripts from the focus groups were thematically analyzed using NVivo software by 2 independent researchers. Results: 1693 surveys were collected, 301 (18%) were deemed to have a high ACE score, data analysis is ongoing. The primary outcome is the relationship between ACE and the frequency of ED utilization among adult patients presenting to EDs in Kingston, ON. Secondary outcomes include evaluating the role of resilience as a potential mitigating factor, describing the demographics of high ACE burden frequent ED visitors, and the experiences of care for individuals with high ACE burden in the ED. These outcomes will be utilized to inform hypotheses for future studies and potential interventions aimed at optimizing ED utilization and patient care experience. Conclusion: This study provides novel insight into the relationship between ACE burden and ED utilization while also describing the demographics and experiences of care for ED patients with a high ACE score. Data analysis is on-going.
Studies have consistently shown that subthreshold depression is associated with an increased risk of developing major depression. However, no study has yet calculated a pooled estimate that quantifies the magnitude of this risk across multiple studies.
We conducted a systematic review to identify longitudinal cohort studies containing data on the association between subthreshold depression and future major depression. A baseline meta-analysis was conducted using the inverse variance heterogeneity method to calculate the incidence rate ratio (IRR) of major depression among people with subthreshold depression relative to non-depressed controls. Subgroup analyses were conducted to investigate whether IRR estimates differed between studies categorised by age group or sample type. Sensitivity analyses were also conducted to test the robustness of baseline results to several sources of study heterogeneity, such as the case definition for subthreshold depression.
Data from 16 studies (n = 67 318) revealed that people with subthreshold depression had an increased risk of developing major depression (IRR = 1.95, 95% confidence interval 1.28–2.97). Subgroup analyses estimated similar IRRs for different age groups (youth, adults and the elderly) and sample types (community-based and primary care). Sensitivity analyses demonstrated that baseline results were robust to different sources of study heterogeneity.
The results of this study support the scaling up of effective indicated prevention interventions for people with subthreshold depression, regardless of age group or setting.
We describe the investigation of two temporally coincident illness clusters involving salmonella and Staphylococcus aureus in two states. Cases were defined as gastrointestinal illness following two meal events. Investigators interviewed ill persons. Stool, food and environmental samples underwent pathogen testing. Alabama: Eighty cases were identified. Median time from meal to illness was 5·8 h. Salmonella Heidelberg was identified from 27 of 28 stool specimens tested, and coagulase-positive S. aureus was isolated from three of 16 ill persons. Environmental investigation indicated that food handling deficiencies occurred. Colorado: Seven cases were identified. Median time from meal to illness was 4·5 h. Five persons were hospitalised, four of whom were admitted to the intensive care unit. Salmonella Heidelberg was identified in six of seven stool specimens and coagulase-positive S. aureus in three of six tested. No single food item was implicated in either outbreak. These two outbreaks were linked to infection with Salmonella Heidelberg, but additional factors, such as dual aetiology that included S. aureus or the dose of salmonella ingested may have contributed to the short incubation periods and high illness severity. The outbreaks underscore the importance of measures to prevent foodborne illness through appropriate washing, handling, preparation and storage of food.
Social facilitation has been observed in the stabled horse with access to forage (Sweeting et al. 1985). Socially facilitated feeding behaviour has not been investigated through the provision of concentrates. It is likely that the motivation to ingest a concentrate feed is different to that of forage. In a variety of species social facilitation will only occur when presented with a novel food. Therefore it has been proposed that a function of social facilitation is to increase the acceptance of novel feeds. The first objective of this study therefore, was to investigate if social facilitation occurs with the horse’s standard concentrate feed and or a standard concentrate feed plus a novel flavour.
Visual contact has been found to be a necessary component in the facilitation of forage ingestion. Increasing visual contact between stables improves awareness of conspecifics, which has been linked to a decrease in abnormal behaviour. There has, however, been limited investigation into the relationship between neighbouring stabled horses especially during potentially stressful periods such as meal times. The second objective of this study was to investigate the effects on behaviour of the presence or absence of a familiar horse during meal times.
The problem of understanding the deformation occurring along the Pacific-North American plate boundary in the western United States depends upon understanding the forces which drive the plates in this region. One of the primary sources of our knowledge concerning these forces lies in their manifestation as relative displacements which occur throughout the broad zone of deformation surrounding the San Andreas fault system. It is information concerning the spatial and temporal distribution of these motions which will be of greatest benefit in helping to determine which of several possible mechanisms is responsible for driving contemporary plate motions in this region.
Introduction: Some low acuity Emergency Department (ED) presentations are considered non-urgent or convenience visits and potentially avoidable with improved access to primary care. This study explored self-reported reasons why non-urgent patients presented to the ED. Methods: Patients, 17 years and older, were randomly selected from electronic registration records at three urban EDs in Edmonton, Alberta (AB), Canada during weekdays (0700 to 1900). A 47-item questionnaire was completed by each consenting patient, which included items on whether the patient believed the ED was their best care option and the rationale supporting their response. A thematic content analysis was performed on the responses, using previous experience and review of the literature to identify themes. Results: Of the 2144 eligible patients, 1408 (65.7%) questionnaires were returned, and 1402 (65.4%) were analyzed. For patients who felt the ED was their best option (n = 1234, 89.3%), rationales included: safety concerns (n = 309), effectiveness of ED care (n = 284), patient-centeredness of ED (n = 277), and access to health care professionals in the ED (n = 204). For patients who felt the ED was not their best care option (n = 148, 10.7%), rationales included a perception that: access to health professionals outside the ED was preferable (n = 39), patient-centeredness (particularly timeliness) was lacking in the ED (n = 26), and their health concern was not important enough to require ED care (n = 18). Conclusion: Even during times when alternative care options are available, the majority of non-urgent patients perceived the ED to be the most appropriate location for care. These results highlight that simple triage scores do not accurately reflect the appropriateness of care and that understanding the diverse and multi-faceted reasons for ED presentation are necessary to implement strategies to support non-urgent, low acuity care needs.
Introduction: Some non-urgent/low-acuity Emergency Department (ED) presentations are considered convenience visits and potentially avoidable with improved access to primary care services. This study surveyed patients who presented to the ED and explored their self-reported reasons and barriers for not being connected to a primary care provider (PCP). Methods: Patients aged 17 years and older were randomly selected from electronic registration records at three urban EDs in Edmonton, Alberta (AB), Canada. Following initial triage, stabilization, and verbal informed consent, patients completed a 47-item questionnaire. Data from the survey were cross-referenced to a minimal patient dataset consisting of ED and demographic information. The questionnaire collected information on patient characteristics, their connection to a PCP, and patients' reasons for not having a PCP. Results: Of the 2144 eligible patients, 1408 (65.7%) surveys were returned and 1402 (65.4%) were completed. The majority of patients (74.4%) presenting to the ED reported having a family physician; however, the ‘closeness’ of the connection to their family physician varied greatly among ED patients with the most recent family physician visit ranging from 1 hour before ED presentation to 45 years prior. Approximately 25% of low acuity ED patients reported no connection with a family physician. Reasons for a lack of PCP connection included: prior physician retired, left, or died (19.8%), they had never tried to find one (19.2%), they had recently moved to Alberta (18.0%), and they were unable to find one (16.5%). Conclusion: A surprisingly high proportion of ED patients (25.6%) have no identified PCP. Patients had a variety of reasons for not having a family physician. These need to be understood and addressed in order for primary care access to successfully contribute to diverting non-urgent, low acuity presentations from the ED.
Increasing evidence shows attachment security influences symptom expression and adaptation in people diagnosed with schizophrenia and other psychoses.
To describe the distribution of secure and insecure attachment in a cohort of individuals with first-episode psychosis, and to explore the relationship between attachment security and recovery from positive and negative symptoms in the first 12 months.
The study was a prospective 12-month cohort study. The role of attachment, duration of untreated psychosis (DUP), baseline symptoms and insight in predicting and mediating recovery from symptoms was investigated using multiple regression analysis and path analysis.
Of the 79 participants, 54 completed the Adult Attachment Interview (AAI): 37 (68.5%) were classified as insecure, of which 26 (48.1%) were insecure/dismissing and 11 (20.4%) insecure preoccupied. Both DUP and insight predicted recovery from positive symptoms at 12 months. Attachment security, DUP and insight predicted recovery from negative symptoms at 12 months.
Attachment is an important construct contributing to understanding and development of interventions promoting recovery following first-episode psychosis.
The excavations of the cemetery groups at Balneaves, Loanleven and Park of Tongland facilitate an examination of many aspects of Bronze Age burial practices in Scotland. They are notable as much for the differences in burial ritual they imply as for the very narrow chronological period in which they were used. The three sites produced a total of seventeen 14C dates, two of which are aberrant, with means of the remaining fifteen falling within a period of 250 years (3370–3610 bp in radiocarbon years). The excavations were sponsored by Historic Scotland (formerly Historic Buildings and Monuments, Scotland).
At Balneaves, a penannular ditch enclosed sixteen features, including a group of seven pits with cremation burials, four of which were associated with a distinctive assemblage of collared urns. The cremated bone was well preserved. At least one large standing stone had been erected on the site, and this was buried in the medieval period.
At Loanleven, only a segment of the enclosing ring-ditch survived, within which were four cists, two containing inhumations and two cremations, one of the latter (Cist 2) associated with a fragment of a food vessel. A decorated slab, in so-called ‘Passage Grave Style’, was recovered from Cist 1, and the same cist produced palynological evidence for grave furnishings in the form of a mat of plant material which probably underlay the body. 14C dates give a terminus ante quem of 3620±50 bp (GU–2543) for the re-use of the decorated slab, and a terminus post quem of 3410±50 bp (GU–2542) for the food vessel grave.
Park of Tongland, regarded as a Four-Poster stone circle, was excavated after the fall of a standing stone. It was shown to be of multi-period construction, consisting of a cairn which overlay seven pits containing fragmentary cremation burials, two associated with collared urns. The standing stones may not all have been erect at the same time. A series of 14C dates fell within the range of 1480–1530 bc.
A summary of previous gravity and magnetic field interpretations is presented along with a review of the LOWNET and LISPB models. Recently acquired seismological data are compared with the LISPB upper crustal model. The LISPB Layer 1 is found to represent an average of lower velocity (VP = 3·0–3·7 km s−1) Carboniferous and Upper Old Red Sandstone sediments, and higher velocity (VP = 4·0–5·5 km s−1) Lower Old Red Sandstone and Lower Palaeozoic sediments.
On the basis of high P-wave velocities along strike (VP = 60·6–1 km s−1), the LISPB Layer 2 S of Glasgow and Edinburgh is re-interpreted as a quartzofeldspathic crystalline layer of igneous or metamorphic origin, which is also seen to cross the surface of the Southern Uplands fault at around 2·5 km depth.
This interpretation implies that within the southern part of the Midland Valley, the Lower Palaeozoic sediments are nowhere thicker than about 3 km, as postulated under the Silurian inliers, and generally much less.
Orientation ordered high-Tc oxide films of Y1Ba2Cu3O7 were prepared by molecular beam epitaxy on SrTiO3 substrates. A combination of effusion cells and e-beam evaporators was used with the addition of an oxygen jet. The superconducting phase is formed by further O2 anneal at temperatures ≥800° C. For SrTiO3 (100), the Y1Ba2Cu3O7 films grow in the orientation of either the c-axis or the a-axis perpendicular to the film plane. Films with predominant “c⊥” orientation exhibit a high degree of crystalline order with a rocking curve 0.3° wide. The Jc is about two times higher than those with the “a⊥” orientation of a comparable Tc (R=0). For a typical film of 9000Å thickness, a Tc (R=O) of 87K, and a Jc of 7 × 104 A/cm2 at 77K were reproducibly achieved. For SrTiO3 (110), X-ray showed twinning of (110) and (103) orientations in Y1Ba2Cu3O7, thus precluding the observation of anisotropy expected for the in-plane axes of  and .
The continuing shrinkage of feature size and environmental concerns regarding the use of lead containing solder are major driving forces in the search for alternative technologies for metal interconnects in electronic packaging. Electrically conductive adhesives are considered a potential substitute for the lead-tin solder. This study concentrated on interfacial properties of eutectic solder and silver-filled epoxy adhesives. A freeze fracture technique was employed in order to preserve interfacial information. The chemical composition of the fractured faces varied; the adhesive side was rich in tin, whereas the eutectic solder side showed lead-rich characteristics.
Diamond based power device structures such as resistor, capacitor, Schottky diode, p-n diode, thyristor, and field emitters are being investigated. Diamond resistors similar to standard thick film components in form and dimension were fabricated of polycrystalline diamond film. Using PECVD (plasma-enhanced chemical vapor deposition) processing to achieve diamond dielectric layers, high power, high energy density capacitors have been built. Despite grain boundaries and defects of polycrystalline diamond film, electronic devices such as field-effecttransistors and Schottky diodes have been developed. We have fabricated micro-patterned microtip arrays with this versatile new diamond technology as electron emitters. This paper will review diamond technology and results of this work.