bluuebunny/crossref_metadata_2025 huggingface dataset:
Can Vertical GPS Displacements Serve As Proxies for Climate Variability in North America?
Authors: Wdowinski Shimon , van Dam Tonie M.
Published: May 2020

Vertical crustal displacements induced by atmospheric, hydrological, cryospheric, and oceanic load changes are detectable with sub-cm accuracy by precise continuous GPS measurements. Areas subjected to rapid load changes due to ice sheet melt, drought, massive groundwater extraction, or lake level drop, are characterized by a dominant non-linear vertical signal. Here, we investigate possible relations between vertical crustal movements and climate change by analyzing the relations between observed GPS vertical movements, predicted movements, and climatic indices, where we have long GPS time series (>20 years). Applying our analysis to GPS records from western and eastern North America indicates different load change characteristics. In the western US, the seasonal and climatic signals are dominated by hydrological load changes and, consequently, the GPS signal correlates well with the Palmer Severe Drought Index (PSDI) calculated for the same region. However, vertical crustal movements in eastern North America, as detected by long GPS time series, reveal poor correlation with PSDI and other climatic indices. Our results suggest that long continuous GPS observations of vertical crustal displacements primarily driven by climate related changes in water storage can serve as independent measures of regional-scale climate change in some cases, mainly in western north America.
Über mediale Präsenz und Prominenz DNA-gestützter Vergangenheitsforschung
Authors: Samida Stefanie
Published: May 2020

Die Molekulargenetik bietet seit ein paar Jahren völlig neue Zugänge zur menschlichen Vergangenheit. Das noch junge und sehr dynamische Forschungsfeld der Archäogenetik (auch Paläogenetik oder Genetic History) nimmt für sich in Anspruch, Geschichte schreiben zu können, und zwar über alte DNA. Durch zahlreiche beachtenswerte Veröffentlichungen hat es viel Aufmerksamkeit erzeugt und erfahren – nicht nur im wissenschaftlichen Diskurs, sondern auch in den Medien. Allerdings erfährt die mediale Berichterstattung von der Forschung bisher wenig Beachtung. Auch der Forumsbeitrag kann dieses Desiderat nicht beheben, sucht aber – mit einem exemplarischen Blick auf die Presseberichterstattung – erste Tendenzen einzufangen. Dies geschieht anhand von drei Thesen, sie lauten: Erfolgsgeschichten erzählen, Grenzen ziehen und konformistisch schreiben.
Pathologie der Mamillenregion
Authors: Streng Agathe , Gutjahr Ewgenija , Aulmann Sebastian , Flechtenmacher Christa , Toberer Ferdinand , Heil Jörg , Böcker Werner , Sinn Peter
Published: May 2020

Der klassische M. Paget der Mamille ist histologisch charakterisiert durch eine intraepidermale Tumorinfiltration, die von einem intraduktalen oder invasiven Mammakarzinom ausgeht, immunhistologisch durch eine regelhafte Überexpression von HER2 und klinisch durch ekzemartige Veränderungen von Mamille und Areola. Zu den Varianten mit davon abweichenden histologischen, immunhistologischen und klinischen Erscheinungsformen gehören der isolierte M. Paget der Mamille, der anaplastische M. Paget, der M. Paget mit Invasion und der pigmentierte M. Paget der Mamille. Differenzialdiagnostisch ist der M. Paget der Mamille abzugrenzen gegenüber benignen Veränderungen, insbesondere der Toker-Zell-Hyperplasie, dem Mamillenekzem und seltenen Dermatosen.
Cryoballoon pulmonary vein isolation-mediated rise of sinus rate in patients with paroxysmal atrial fibrillation
Authors: Wagner Lara , Darche Fabrice F. , Thomas Dierk , Lugenbiel Patrick , Xynogalos Panagiotis , Seide Svenja , Scholz Eberhard P. , Katus Hugo A. , Schweizer Patrick A.
Published: May 2020

Background

Modulation of the cardiac autonomic nervous system by pulmonary vein isolation (PVI) influences the sinoatrial nodal rate. Little is known about the causes, maintenance and prognostic value of this phenomenon. We set out to explore the effects of cryoballoon PVI (cryo-PVI) on sinus rate and its significance for clinical outcome.

Methods and results

We evaluated 110 patients with paroxysmal atrial fibrillation (AF), who underwent PVI using a second-generation 28 mm cryoballoon by pre-, peri- and postprocedural heart rate acquisition and analysis of clinical outcome. Ninety-one patients could be included in postinterventional follow-up, indicating that cryo-PVI resulted in a significant rise of sinus rate by 16.5% (+ 9.8 ± 0.9 beats/min, p < 0.001) 1 day post procedure compared to preprocedural acquisition. This effect was more pronounced in patients with initial sinus bradycardia (< 60 beats/min.) compared to patients with faster heart rate. Increase of rate was primarily driven by ablation of the right superior pulmonary vein and for a subset of patients, in whom this could be assessed, persisted ≥ 1 year after the procedure. AF recurrence was neither predicted by the magnitude of the initial rate, nor by the extent of rate change, but postprocedural sinus bradycardia was associated with higher recurrence of AF in the year post PVI.

Conclusions

Cryo-PVI causes a significant rise of sinus rate that is more pronounced in subjects with previous sinus bradycardia. Patient follow-up indicates persistence of this effect and suggests an increased risk of AF recurrence in patients with postprocedural bradycardia.

Graphic abstract
Measurement in opaque flows: a review of measurement techniques for dispersed multiphase flows
Authors: Poelma Christian
Published: May 2020

A review is presented of measurement techniques to characterise dispersed multiphase flows, which are not accessible by means of conventional optical techniques. The main issues that limit the accuracy and effectiveness of optical techniques are briefly discussed: cross-talk, a reduced signal-to-noise ratio, and (biased) data drop-out. Extensions to the standard optical techniques include the use of fluorescent tracers, refractive index matching, ballistic imaging, structured illumination, and optical coherence tomography. As the first non-optical technique, a brief discussion of electrical capacitance tomography is given. While truly non-invasive, it suffers from a low resolving power. Ultrasound-based techniques have rapidly evolved from Doppler-based profiling to recent 2D approaches using feature tracking. The latter is also suitable for time-resolved flow studies. Magnetic resonance velocimetry can provide time-averaged velocity fields in 3D for the continuous phase. Finally, X-ray imaging is demonstrated to be an important tool to quantify local gas fractions. While potentially very powerful, the impact of the techniques will depend on the development of acquisition and measurement protocols for fluid mechanics, rather than for clinical imaging. This requires systematic development, aided by careful validation experiments. As theoretical predictions for multiphase flows are sparse, it is important to formulate standardised ‘benchmark’ flows to enable this validation.
The nature of multiple boron-nitrogen bonds studied using electron localization function (ELF), electron density (AIM), and natural bond orbital (NBO) methods
Authors: Mierzwa Grzegorz , Gordon Agnieszka J. , Berski Slawomir
Published: May 2020

Local nature of the boron-nitrogen (BN) bonding with different formal multiplicities (B≡N, B=N, B-N) have been investigated for 25 experimentally established organoboron molecules in both real and the Hilbert space, using topological analysis of electron localization function (ELF), electron density (AIM), and natural bond orbital (NBO) method. Each BN bond has been represented (ELF) by the bonding disynaptic attractor V(B,N), with the basin electron population between 5.72e and 1.83e, confirming possible existence of all the three bond types. A covalent character of bonding can be associated with the dative mechanism due to the V(B,N) bonding basin formed mainly (91–96%) by the N electron density. Similarly, the NBO method shows 2-center natural orbitals, consisting largely of the hybrids from the N atom. The AIM analysis yields the features typical for shared (H(3,−1)(r) < 0) and closed-shell (∇2ρ(3,−1)(r) > 0) interactions. The delocalization indices, describing electron exchanges between B and N quantum atoms, are smaller than 1.5, even for formally very short triple B≡N bonds.
Molecular and cellular mechanisms underlying brain metastasis of breast cancer
Authors: Hosonaga Mari , Saya Hideyuki , Arima Yoshimi
Published: May 2020

Metastasis of cancer cells to the brain occurs frequently in patients with certain subtypes of breast cancer. In particular, patients with HER2-positive or triple-negative breast cancer are at high risk for the development of brain metastases. Despite recent advances in the treatment of primary breast tumors, the prognosis of breast cancer patients with brain metastases remains poor. A better understanding of the molecular and cellular mechanisms underlying brain metastasis might be expected to lead to improvements in the overall survival rate for these patients. Recent studies have revealed complex interactions between metastatic cancer cells and their microenvironment in the brain. Such interactions result in the activation of various signaling pathways related to metastasis in both cancer cells and cells of the microenvironment including astrocytes and microglia. In this review, we focus on such interactions and on their role both in the metastatic process and as potential targets for therapeutic intervention.
High Recreational Gamblers Show Increased Stimulatory Effects of an Acute Laboratory Gambling Challenge
Authors: Miller L. , Gordh A. Söderpalm
Published: May 2020

Gambling in moderation is a socially acceptable behavior and over 60% of the Swedish population gambles every year. It has been seen that slot machines are one of the most addictive and problematic forms of gambling and contribute highly to an addictive behavior.
It is unclear why some individuals intensify their gambling behavior over time to extreme levels while others do not. Initial positive response of a drug or as in this case a gambling behavior, most likely influences the likelihood of continuing use in non-addicted individuals. Therefore, we wanted to investigate if recreational gamblers show an altered subjective response to an online gambling challenge, e.g. to casino gambling. The present study was designed to examine the subjective effects after an acute gambling challenge, in healthy recreational gamblers compared with non-gamblers. Eighty-two subjects participated in the study. They were challenged with an acute online slot machine gambling challenge and self-report questionnaires of mood and blood pressure were taken before and after gambling. The gamblers, and more specifically the high recreational gamblers, reported increased stimulative effects after the gambling challenge in comparison to the non-gamblers. Findings suggests that gamblers experience significantly higher arousal effects to an acute online slot machine challenge. This response may be a uniquely predictive behavior for increased risk of gambling addiction.
Changes in Turkish- and Resettler-origin Adolescents’ Acculturation Profiles of Identification: A Three-year Longitudinal Study from Germany
Authors: Jugert Philipp , Pink Sebastian , Fleischmann Fenella , Leszczensky Lars
Published: May 2020

Little is known on how ethnic minority adolescents develop acculturation profiles of identification (i.e., how they combine their ethnic and national identification, such as being high on both and thus rather “integrated” or high on ethnic and low on national and thus rather “separated”). In a first step, this 3-year longitudinal study classified Turkish (n = 344) and resettler-origin (n = 121) ethnic minority adolescents living in Germany (Mage = 14.2, SD = 1.54, 51.6% female) according to their levels of ethnic and national identification. Latent profile analyses identified four profiles (separated, integrated, medium-ethnic, low-ethnic) for the former and three profiles (separated, integrated, low-and-medium ethnic) for the latter group. Latent transition analyses revealed considerable instability of profile attributions over time. Integration declined among both groups and results provided no evidence that national group boundaries are more permeable for resettler-origin than for Turkish-origin adolescents. Additional analyses revealed that perceived ethnic discrimination affected the probability to be in a particular profile but did not moderate transition probabilities. Overall, results suggest that during early-to-mid adolescence it is increasingly difficult to uphold a dual identity.
Cytoplasmic diversity of potato relatives preserved at Plant Breeding and Acclimatization Institute in Poland
Authors: Smyda-Dajmund Paulina , Śliwka Jadwiga , Janiszewska Marta , Zimnoch-Guzowska Ewa
Published: May 2020

Among different types of potato cytoplasmic genomes, some are associated with male sterility or affect agronomic traits. The goal of this study was to analyze types of chloroplast and mitochondrial genomes of selected potato relatives originating from collection of the Institute of Plant Industry, Saint Petersburg, Russia, and preserved in Poland. Using chloroplast and mitochondrial markers the cytoplasm types were determined for 401 genotypes belonging to 43 seed accessions of 28Solanumspecies. Among characterized genotypes, 201 (50.1%), 156 (38.9%) and 44 (11%) had cytoplasm types W, D, M, respectively. No accessions with the T, P or A cytoplasm were found. Within cytoplasm W, genotypes with the subtypes: W/α and W/β were identified, but not with W/γ. InS. famatinae, we detected unusual product of the T marker with 65 bp insertion earlier seen exclusively inS. vernei. Among the genotypes ofS. leptophyes, two profiles of the ALM_4/ALM_5 marker were observed.S. famatinaeandS. verneicome from Argentina, provinces Catamarca and Tucumán. Possibly the insertion in marker T occurred independently in two species, or the accessions were misidentified. Segregation of the ALM_4/ALM_5 marker withinS. leptophyesindicates that potato seed accessions are heterogeneous not only due to nuclear DNA polymorphisms but have diversified cytoplasm, too. Our findings are important for exploitation of the tested material in potato breeding. Male-fertile cytoplasm types give a chance of avoiding fertility problems and widening the range of crosses in future generations of breeding materials.
Are suicide terrorists different from ‘regular militants’?
Authors: Sabri Amir , Schulze Günther G.
Published: May 2020

We analyze the differences in the socioeconomic profiles between suicide terrorists and ‘regular’ militants using a dataset of 1596 militants (including 209 suicide terrorists) from Hamas and Palestinian Islamic Jihad (PIJ). We find that suicide terrorists are better educated, younger, less likely to be married or have children, and less likely to live in the Gaza strip than their non-suicide counterparts. Moreover, although the profiles of Hamas and PIJ militants are distinctively different, the suicide terrorists are very similar to one another.
How do banks interact with fintech startups?
Authors: Hornuf Lars , Klus Milan F. , Lohwasser Todor S. , Schwienbacher Armin
Published: May 2020

The increasing pervasiveness of technology-driven firms that offer financial services has led to growing pressure on traditional banks to modernize their core business activities and services. Many banks tackle the challenges of digitalization by cooperating with startup firms that offer technology-driven financial services and novel service packages (fintechs). In this article, we examine which banks typically collaborate with fintechs, how intensely they do so, and which form of alliance they prefer. Using hand-collected data covering the largest banks from Canada, France, Germany, and the United Kingdom, we provide detailed evidence on the different forms of alliances occurring in practice. We show that banks are significantly more likely to form alliances with fintechs when they pursue a well-defined digital strategy and/or employ a chief digital officer. Moreover, in line with incomplete contract theory, we find that banks more frequently invest in small fintechs but often build product-related collaborations with larger fintechs.
Abstract relations: bibliography and the infra-structures of modern mathematics
Authors: Barany Michael J.
Published: May 2020

Beginning at the end of the nineteenth century, systematic scientific abstracting played a crucial role in reconfiguring the sciences on an international scale. For mathematicians, the 1931 launch of theZentralblatt für Mathematikand 1940 launch ofMathematical Reviewsmarked and intensified a fundamental transformation, not just to the geographic scale of professional mathematics but to the very nature of mathematicians’ research and theories. It was not an accident that mathematical abstracting in this period coincided with an embrace across mathematical research fields of a distinctive form of symbolic and conceptual abstraction. This essay examines the historical, institutional, embodied, and conceptual bases of mathematical abstracting and abstraction in the mid-twentieth century, placing them in historical context within the first half of the twentieth century and then examining their consequences and legacies for the second half of the twentieth century and beyond. Focused on scale, media, and the relationship between mathematical knowledge and its forms of articulation, my analysis connects the changing social structure of modern mathematical research communities to their changing domains of investigation and resources for representation and collective understanding.
Autoethnography as an Authentic Learning Activity in Online Doctoral Education: an Integrated Approach to Authentic Learning
Authors: Lee Kyungmee
Published: May 2020

Under the constructivist learning paradigm, which emphasises authenticity as a required condition for learning, distance educators have been striving to create authentic learning environments that reflect the real world. However, it is inevitably challenging to make an online learning environment authentic for learners when it is ultimately separated from their real-life contexts. Particularly, in online doctoral education, given the diversity among online learners, even defining “what is real and to whom” is a difficult task. This paper argues that the epistemological approach to authentic learning, based on the constructivist learning paradigm, is not sufficient to make online learning “authentically” meaningful. The paper introduces an alternative, ontological approach stemming from the transformative learning paradigm, and suggests autoethnography as one authentic learning activity that can effectively integrate the epistemological and ontological approaches to authentic learning in online doctoral education. Such a comprehensive conceptualisation of authentic learning, as an integrated process of both knowing and becoming, allows each doctoral student to become a more authentic self across their learning and living environments.
Virtual Reality Therapy in Social Anxiety Disorder
Authors: Emmelkamp Paul M. G. , Meyerbröker Katharina , Morina Nexhmedin
Published: May 2020

Purpose of Review

This review provides an overview of current methods and important aspects to consider when applying virtual worlds in the treatment of social anxiety disorder (SAD).

Recent Findings

Different aspects such as dialogs between avatars and patients have been investigated as well as virtual audiences, emotional facial expression, and verbal interaction with avatars. Results of these studies are promising. Few randomized controlled trials (RCTs) have investigated the efficacy of virtual reality exposure therapy (VRET) in SAD. Unfortunately, most RCTs into the efficacy of VRET in comparison with exposure in vivo in SAD have been conducted with a combination of cognitive interventions and VRET. No differences between these conditions were found, but the pure effect of VRET as a stand-alone treatment has only been investigated in one RCT, wherein VRET was not superior to exposure in vivo.

Current research into different facets of SAD and VRET has produced promising results with respect to technological aspects. No differences in efficacy between cognitive behavior therapy and VRET were found, but there is a clear need for studies investigating the efficacy of VRET as a stand-alone treatment and the therapeutic processes involved before this therapy can be disseminated in routine clinical practice.
Shear degradation model of HPAM solutions for the design of regulator valves in polymer flooding EOR
Authors: Díaz F. A. , Torné J. P. , Prada A. , Perez G.
Published: May 2020

Polymer flooding for enhanced oil recovery is increasingly in demand in countries such as Colombia, where ECOPETROL has taken major steps in applying this technique to revitalize mature oil fields. The purpose of injecting polymer into reservoirs is to increase the viscosity of the aqueous phase to enhance the mobility ratio. Several aspects can affect and weaken the performance of a polymer flooding operation, however, most of them can be controlled. One of the most important factors is the degradation of the polymer by shear, which causes a reduction in the aqueous phase viscosity. This study was based on work related to the degradation of HPAM solutions induced by the use of regulator valves to control flow and pressure in multiple zones in the same well or multiple wells connected to the same pump. Several tests were completed in a facility designed and prepared to perform regulator valves testing. The results obtained during the initial phase of the testing were compared to computational fluid dynamics simulations, obtaining a shear degradation model which can be used to optimize the design of regulator valves or any other flow control device.
Lattice–Boltzmann simulations for complex geometries on high-performance computers
Authors: Lintermann Andreas , Schröder Wolfgang
Published: May 2020

Complex geometries pose multiple challenges to the field of computational fluid dynamics. Grid generation for intricate objects is often difficult and requires accurate and scalable geometrical methods to generate meshes for large-scale computations. Such simulations, furthermore, presume optimized scalability on high-performance computers to solve high-dimensional physical problems in an adequate time. Accurate boundary treatment for complex shapes is another issue and influences parallel load-balance. In addition, large serial geometries prevent efficient computations due to their increased memory footprint, which leads to reduced memory availability for computations. In this paper, a framework is presented that is able to address the aforementioned problems. Hierarchical Cartesian boundary-refined meshes for complex geometries are obtained by a massively parallel grid generator. In this process, the geometry is parallelized for efficient computation. Simulations on large-scale meshes are performed by a high-scaling lattice–Boltzmann method using the second-order accurate interpolated bounce-back boundary conditions for no-slip walls. The method employs Hilbert decompositioning for parallel distribution and is hybrid MPI/OpenMP parallelized. The parallel geometry allows to speed up the pre-processing of the solver and massively reduces the local memory footprint. The efficiency of the computational framework, the application of which to, e.g., subsonic aerodynamic problems is straightforward, is shown by simulating clearly different flow problems such as the flow in the human airways, in gas diffusion layers of fuel cells, and around an airplane landing gear configuration.
Associations among attitudes towards motherhood, pet-keeping, and postpartum depression symptoms
Authors: Temesi Andrea , Bunford Nóra , Miklósi Ádám
Published: May 2020

Certain companion animals’ relationship to humans is analogous to child–parent attachment. Further, pet-keeping is associated with less physical and psychological health problems and animal-assisted interventions ameliorate depressive symptoms. Accordingly, cognitive representations of pet-keeping and parenthood may be related, and pet-keeping may protect against postpartum depression symptoms (PPDS). To test these hypotheses, we examined cognitive representations of pet-keeping and motherhood as well as various cognitive correlates of those in 715 women in an online questionnaire. Results indicate that among women who perceive maternity as a burdensome role, pet ownership is associated with an increased likelihood of having had PPDS. Among women with children, pet owners perceive maternity as more burdensome than non-owners and pet owners with a more positive attitude towards their pets are more likely to find maternity as a burdensome role. These findings suggest a relationship between women’s thoughts regarding pets and motherhood and also that, to some degree, women perceive pets as playing a similar role as children. Importantly, childless women who own a pet perceived motherhood as less difficult; this effect of pet-keeping can be capitalized upon in the treatment of women whose psychological characteristics play a role in their infertility.
CRISPR Screens Identify Essential Cell Growth Mediators in BRAF Inhibitor-Resistant Melanoma
Authors: Li Ziyi , Wang Binbin , Gu Shengqing , Jiang Peng , Sahu Avinash , Chen Chen-Hao , Han Tong , Shi Sailing , Wang Xiaoqing , Traugh Nicole , Liu Hailing , Liu Yin , Wu Qiu , Brown Myles , Xiao Tengfei , Boland Genevieve M. , Shirley Liu X.
Published: May 2020

BRAF is a serine/threonine kinase that harbors activating mutations in ∼7% of human malignancies and ∼60% of melanomas. Despite initial clinical responses to BRAF inhibitors, patients frequently develop drug resistance. To identify candidate therapeutic targets for BRAF inhibitor resistant melanoma, we conduct CRISPR screens in melanoma cells harboring an activating BRAF mutation that had also acquired resistance to BRAF inhibitors. To investigate the mechanisms and pathways enabling resistance to BRAF inhibitors in melanomas, we integrate expression, ATAC-seq, and CRISPR screen data. We identify the JUN family transcription factors and the ETS family transcription factor ETV5 as key regulators of CDK6, which together enable resistance to BRAF inhibitors in melanoma cells. Our findings reveal genes contributing to resistance to a selective BRAF inhibitor PLX4720, providing new insights into gene regulation in BRAF inhibitor resistant melanoma cells.
Acute upper limb ischemia in a patient with COVID-19
Authors: Kaur Parminder , Qaqa Firas , Ramahi Amr , Shamoon Yezin , Singhal Monisha , Shamoon Fayez , Maroules Michael , Singh Balraj
Published: May 2020

Patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection mainly present with upper and lower respiratory tract symptoms, with complications related to cytokine storm syndrome and acute respiratory distress syndrome. It has also been described to predispose to venous and arterial thromboembolism; however, limited published data is available regarding thrombosis in coronavirus disease 2019 (COVID-19). Here we are presenting a case of arterial thrombosis in a patient with COVID-19 and a systematic review on coagulopathy associated with COVID-19.
Priorities and Preferences of Patients with Head and Neck Cancer for Discussing and Receiving Information About Sexuality and Perception of Self-Report Measures
Authors: Rhoten Bethany A. , Davis Amanda J. , Baraff Breanna N. , Holler Kelly H. , Dietrich Mary S.
Published: May 2020

Background

Head and neck cancer and its treatment can cause impairment in survivors’ sexuality. Previous studies show a need for education and psychological support.

Aim

To examine patients’ priorities and preferences for discussing and receiving information about sexuality and to examine patient perceptions of existing self-report measures used in research.

Methods

This descriptive, cross-sectional, Web-based study recruited adults with a current or previous diagnosis of head and neck cancer. Participants answered questions about their priority and preference for receiving information about sexuality and reviewed 4 self-report measures commonly used in the research of this population.

Results

More than 80% (n = 61) of participants reported that it was important to receive information about sexual issues. Participants chose “at the time of diagnosis” as the most frequent answer for preferred time to receive this information. Half of the participants (n = 35) indicated that they prefer discussing sexual issues with a health-care provider. The most frequent answer for the method of receiving information was through discussions. Participants endorsed 4 themes not addressed by self-report surveys: (i) elicitation of important information, (ii) symptom burden issues, (iii) psychological issues, and (iv) physical barriers.

Clinical Implications

Providers, regardless of specialty, must attempt or facilitate discussions around these issues at various times within the treatment and recovery phases.

Strengths & Limitations

Although limited by sample representation and cross-sectional design, this study addresses an important patient-centered issue that is a critical aspect of quality of life.

Conclusions

Patients prefer to discuss sexual issues in person with their health-care providers at the time of diagnosis. Participants reacted positively to the self-report measures, but they felt that important issues faced by patients with head and neck cancer were not fully addressed.
Psychophysiological Stress Response of Novice Cavers in a Speleology Route
Authors: Tornero-Aguilera José Francisco , Sanchez-Molina Joaquín , Fernández-Elías Valentín E. , Clemente-Suárez Vicente Javier
Published: May 2020

Introduction

Speleology/Caving is a recreational outdoor activity that has drawn an increasing number of participants in recent years, but there is little information on the physiological and psychological demands of this outdoor activity. This research aimed to analyze the psychophysiological response of novice cavers to a caving route.

Methods

Modifications in autonomic modulation, ratings of perceived exertion, and perceived stress were evaluated in physically active participants before, during, and after a caving route of 3-h duration.

Results

Eighteen participants were assessed. We found an anticipatory anxiety response in the participants before starting the route and significant increases in the ratings of perceived exertion, stress perception, autonomous sympathetic modulation as evaluated by heart rate variability while on the route, and sympathetic modulation 30 min after finishing the caving route.

Conclusions

A speleology route produced an anticipatory anxiety response, an increase in the sympathetic stress response, fatigue symptoms at the autonomic nervous system level, and low perception of stress and effort compared with the autonomic stress response. This information could help to better prepare participants for this demanding event, potentially avoiding accidents and injuries and increasing safety for cavers.
LO51: Emergency department use by pregnant women: a population-based study within a universal healthcare system
Authors: Varner C. , Park A. , Little D. , Ray J.
Published: May 2020

Introduction: Emergency Department (ED) utilization during pregnancy may be common, but data specific to universal healthcare systems like Canada are lacking, where pregnancy care is supposed to be standardized. The objective of this study was to quantify and characterize ED utilization among all Ontarian women who had a recognized pregnancy, including by trimester and within 42 days after pregnancy, and further stratified by pregnancy outcome. Methods: Utilizing provincial administrative health databases, this retrospective population-based cohort study included all recognized pregnancies in Ontario conceived between April 1, 2002 and March 31, 2017. Peri-pregnancy ED utilization was defined as any ED visit from 0-42 weeks’ gestation, or within 42 days after the end of pregnancy. Modified Poisson regression was used to generate relative risks (RR) and 95% confidence intervals (CI) for the outcome of any peri-pregnancy ED utilization in association with maternal characteristics. Results: Peri-pregnancy ED utilization occurred among 1,075,991 of 2,728,236 recognized pregnancies (39.4%), including among 35.8% of livebirths, 47.3% of stillbirths, 73.7% of miscarriages, and 84.8% of threatened abortions. There were 22,802 (0.84%) ectopic pregnancies among all pregnancies in the cohort. ED utilization peaked in the first trimester and in the first week postpartum. A dose-response effect was seen in the number of peri-pregnancy ED visits in relation to certain maternal characteristics. Women residing in rural areas had an odds ratio (OR) of 3.44 (95% CI 3.39 to 3.49) for ≥ 3 ED visits, compared to those in urban areas. Women with 3-5 (OR 1.99 95% CI 1.97-2.01), 5-6 (OR 3.55, 95% CI 3.49 to 3.61), or ≥ 7 (OR 7.59, 95% CI 7.39 to 7.78) pre-pregnancy comorbidities were more likely to have ≥ 3 peri-pregnancy ED visits than those with 0-2 comorbidities. Of all recognized pregnancies in the cohort, only 106,989 (3.9%) had an injury-related ED visit. Conclusion: Peri-pregnancy ED utilization occurs in nearly 40% of pregnancies, notably in the first trimester and immediately postpartum. Efforts are needed to streamline rapid access to ambulatory obstetrical care during these peak periods, when women are vulnerable to either a miscarriage, or a complication after a livebirth.
LO55: Comparison of the age-adjusted D-dimer, clinical probability-adjusted D-dimer, and Wells rule with D-dimer for diagnosing deep vein thrombosis in the emergency department.
Authors: Sharif S. , Kearon C. , Eventov M. , Sneath P. , Li M. , deWit K.
Published: May 2020

Introduction: Diagnosing deep vein thrombosis (DVT) is of critical importance because of its associated morbidity and mortality. Diagnosing DVT can be challenging in the Emergency Department (ED) due to inconsistent adherence to, and utilization of the Wells rule. Both the age-adjusted and clinical probability adjusted D-dimer have been shown to decrease ultrasound (US) utilization rates. We aimed to compare the safety and efficacy of the Wells score with D-dimer to the age-adjusted and clinical probability-adjusted D-dimer in Canadian ED patients tested for DVT. Methods: This was a health records review of ED patients investigated for DVT at two EDs over a two-year period. Inclusion criteria were ED physician ordered duplex ultrasonography or D-dimer for investigation of lower limb DVT. Patients under the age of 18 were excluded. DVT was considered to be present during the ED visit if DVT was diagnosed on duplex ultrasonography and was treated for acute DVT, or if the patient was subsequently diagnosed with pulmonary embolism (PE) or DVT during the next 30 days. Trained researchers extracted anonymized data. The Wells D-dimer, age-adjusted D-dimer, and the clinical probability-adjusted D-dimer rules were applied retrospectively. The rate of duplex ultrasonography imaging and the false negative rate was calculated for each rule. Results: Between April 1st 2013 and March 31st 2015, there were 1,198 patients tested for DVT. Of the low and moderate clinical pretest probability patients (Wells score ≤ 2), only 436 had a D-Dimer test and were eligible for our analysis. The average age of the patients was 59, 56% were female, and 4% had a malignancy. 207/436 patients (47.4%, 95%CI 42.8-52.2%) would have had US imaging for DVT if the age-adjusted D-dimer rule was used. 214/436 patients (49.1%, 95%CI 44.4-53.8%) would have had imaging for DVT if the clinical probability-adjusted D-dimer was used. If the Wells rule was used with the standard D-dimer cutoff of 500, 241/436 patients (55.2%, 95%CI 50.6-59.9%) would have had imaging for DVT. The false-negative rate for the Wells rule was 1.5% (95%CI 0.5-4.4%). The false-negative rate for the age-adjusted D-dimer rule was 1.3% (95%CI 0.4-3.8%). The false-negative rate for the clinical-probability adjusted D-Dimer was 1.8% (95%CI 0.7-4.5%). Conclusion: In comparison with the approach of the Wells score and D-dimer, both the age-adjusted and clinical probability-adjusted D-dimer diagnostic strategies could reduce the proportion of patients who require US imaging.
LO66: Strengthening team communication may decrease medico-legal risk for physicians in the emergency department
Authors: MacIntyre A. , Yang Q. , Gorter R. De , Lee S. , Calder L.
Published: May 2020

Introduction: In a busy emergency department (ED), effective communication is integral to the provision of safe medical care. Physicians working in the ED interact with multiple team members including patients, allied healthcare professionals and other physicians, who all need to understand their verbal and written instructions. Our study's objective was to identify and describe communication problems occurring in the ED setting, and how these problems contributed to patient safety events and increased medico-legal risk for physicians. Methods: The Canadian Medical Protective Association (CMPA) is a not-for-profit, medico-legal organization which represented over 97,000 physicians at the time of this study. We conducted a retrospective descriptive analysis where we extracted five years (2013-2017) of CMPA data describing closed medico-legal cases occurring in the ED involving physicians (any specialty) who experienced complaints due to communication issues. We then applied an internal contributing factor framework to identify data themes. Data were summarized using descriptive statistics. Results: We identified 517 eligible cases involving 521 patients (some cases involved >1 patient). We found that 99.8% (520/521) of patients experienced some form of healthcare-related harm in the ED. Specifically, there was poor communication between: the physician and patient or patient's family (202/517, 39.1%); two or more physicians (79/517, 15.3%), and physicians and other healthcare providers (55/517, 10.6%). Inadequate documentation was observed in more than half of the cases (324/517, 62.7%) and poor team communication affected physicians’ decision making process (326/517, 63%) in areas such as deficient assessments, inadequate investigations, failure or delay to attend to the patient, and disposition decisions. Conclusion: Team communication issues are prevalent among physician medico-legal cases occurring in the ED. Efforts to strengthen communication skills may enhance patient safety and reduce medico-legal risk.
LO67: Alcohol-related emergency department visits by youth aged 12-24: demographics and resource utilization at Kingston Health Sciences Centre
Authors: Murray H. , Erlikhman L. , Graham T. , Walker M.
Published: May 2020

Introduction: Recent evidence shows an increase in alcohol-related emergency department (ED) visits among youth. We sought to quantify the impact of ED visits (type and frequency, patient characteristics and resource use) related to alcohol in our centre. Methods: This was a chart review of patients aged 12-24 with alcohol-related ED visits between Sept 2013-Aug 2017. The National Ambulatory Care Reporting System (NACRS) database was searched for visits alcohol related ICD-10 codes. The Canadian Hospital Injury Reporting and Prevention Program (CHIRPP) database was also searched using the keyword alcohol. Duplicate visits were removed. Visits were excluded if patients had a history of psychosis, were held in the ED for psychiatric assessment, were homeless, were inmates from a correctional institute, if alcohol use was not mentioned and for complaints of sexual assault/intimate partner violence. Data was abstracted by two reviewers using a standard form with predetermined variables. Differences were resolved with third party adjudication. Interrater reliability of the reviewers was assessed with Kappa scores through duplicate review of 10% of randomly selected charts. A further 10% were assessed by a 3rd reviewer for extraction accuracy. Results: 3,256 ED visits were identified with 777 removed via predefined exclusion criteria. 2,479 visits were reviewed with a male predominance (54.3%). More than half of all patients (50.9%) arrived via ambulance. Assigned CTAS levels were Resuscitation: 1% Emergent: 9.9% Urgent: 48.2% Less Urgent: 35.7% Non-Urgent: 4.2% (missing 1%). The median LOS was 2.9 hrs (IQR 1.8-4.6). All visits were subclassified into mutually exclusive categories: injury (51.8%), acute intoxication (45.1%) and mental health issue (3.2%). Males were more likely to present with injury (62.4% vs 42.6%, p < 0.01). Females were more likely to present with acute intoxication (53.3% vs 46.7%, p <0.01) and mental health issues (59.5% vs 40.5%, P = 0.01). ED resource use was notable: 483 (19.4%) had imaging tests and 1216 (49.1%) had some medical intervention (blood test, fluids or medication). 57 (2.3%) patients were admitted and there was one death from an alcohol related MVC. Conclusion: Alcohol-related ED visits by youth are common in our centre and utilize substantial prehospital and in-hospital resources. Identification of effective harm reduction strategies should be a research priority.
LO89: Describing the evolution of post-concussion symptoms after sports-related mTBI
Authors: Beauchamp F. , Boucher V. , Neveu X. , Ouellet V. , Archambault P. , Berthelot S. , Chauny J. , de Guise E. , Émond M. , Frenette J. , Lang E. , Lee J. , Mercier É. , Moore L. , Ouellet M. , Perry J. , Le Sage N.
Published: May 2020

Introduction: Mild traumatic brain injury (mTBI) is a serious public health issue and as much as one third of mTBI patients could be affected by persistent post-concussion symptoms (PPCS) three months after their injury. Even though a significant proportion of all mTBIs are sports-related (SR), little is known on the recovery process of SR mTBI patients and the potential differences between SR mTBI and patients who suffered non-sports-related mTBI. The objective of this study was to describe the evolution of PPCS among patients who sustained a SR mTBI compared to those who sustained non sport-related mTBI. Methods: This Canadian multicenter prospective cohort study included patients aged ≥ 14 who had a documented mTBI that occurred within 24 hours of Emergency Department (ED) visit, with a Glasgow Coma Scale score of 13-15. Patients who were hospitalized following their ED visit or unable to consent were excluded. Clinical and sociodemographic information was collected during the initial ED visit. Three follow-up phone interviews were conducted by a research nurse at 7, 30 and 90 days post-injury to assess symptom evolution using the validated Rivermead Post-concussion Symptoms Questionnaire (RPQ). Adjusted risk ratios (RR) were calculated to demonstrate the impact of the mechanism of injury (sports vs non-sports) on the presence and severity of PPCS. Results: A total of 1676 mTBI patients were included, 358 (21.4%) of which sustained a SR mTBI. At 90 days post-injury, patients who suffered a SR mTBI seemed to be significantly less affected by fatigue (RR: 0.70 (95% CI: 0.50-0.97)) and irritability (RR: 0.60 (95% CI: 0.38-0.94)). However, no difference was observed between the two groups regarding each other symptom evaluated in the RPQ. Moreover, the proportion of patients with three symptoms or more, a score ≥21 on the RPQ and those who did return to their normal activities were also comparable. Conclusion: Although persistent post-concussion symptoms are slightly different depending on the mechanism of trauma, our results show that patients who sustained SR-mTBI could be at lower risk of experiencing some types of symptoms 90 days post-injury, in particular, fatigue and irritability.
LO90: Predictors of post-concussion syndrome in adults with acute mild traumatic brain injury presenting to the emergency department: a secondary analysis of a randomized controlled trial
Authors: Varner C. , Thompson C. , de Wit K. , Borgundvaag B. , Houston R. , McLeod S.
Published: May 2020

Introduction: The emergency department (ED) is the first point of health care contact for most head injured patients. Although early and spontaneous resolution occurs in most patients with mild traumatic brain injury (MTBI), between 15-30% develop post-concussion syndrome (PCS). To date, clinical prediction tools do not yet exist to accurately identify adult MTBI patients at risk of PCS. The objective of this study was to identify predictors of PCS within 30 days in adults with acute MTBI presenting to the ED. Methods: This was a secondary analysis of a randomized controlled trial conducted in three Canadian EDs evaluating prescribed light exercise compared to standard care. Adult (18-64 years) patients with a MTBI sustained within the preceding 48 hours were eligible for enrollment. Participants completed follow-up questionnaires at 7, 14, and 30 days. The primary outcome was the presence of PCS at 30 days, defined as the presence of ≥ 3 symptoms on the Rivermead Post-concussion Symptoms Questionnaire (RPQ) at 30 days. Backward, stepwise, multivariable logistic regression with a removal criterion probability of 0.05 was conducted to determine predictor variables independently associated with PCS at 30 days. Likelihood ratio tests were used to determine appropriate inclusion of variables in the multivariable model. Results are reported as odds ratios (OR) with 95% confidence intervals (CIs). Results: A total of 367 patients were enrolled, 18 (4.9%) withdrew, and 108 (29.4%) were lost to follow-up. Median (IQR) age was 32 (25 to 48) years, and 201 (57.6%) were female. Of the 241 patients who completed follow-up, 49 (20.3%) had PCS at 30 days. Headache at ED presentation (OR = 6.59; 95% CI: 1.31 to 33.11), being under the influence of drugs or alcohol at the time of injury (OR = 4.42; 95% CI: 1.31 to 14.88), the injury occurring via bike or motor vehicle collision (OR = 2.98; 95% CI: 1.39 to 6.40), history of anxiety or depression (OR = 2.49; 95% CI: 1.23 to 5.03), and the sensation of numbness or tingling at ED presentation (OR = 2.25; 95% CI: 1.04 to 4.88), were independently associated with PCS at 30 days. Conclusion: Five variables were found to be significant predictors of PCS. Although MTBI is a self-limited condition in the majority of patients, patients with these risk factors should be considered high risk and flagged for early follow-up. There continues to be an urgent need for a clinical prognostic tool that accurately identifies adult patients at risk for PCS early in their injury.