bluuebunny/crossref_metadata_2025 huggingface dataset:
Magnetic Resonance Imaging in Patients with Mechanical Low Back Pain Using a Novel Rapid-Acquisition Three-Dimensional SPACE Sequence at 1.5-T: A Pilot Study Comparing Lumbar Stenosis Assessment with Routine Two-Dimensional Magnetic Resonance Sequences
Authors: Swami Vimarsha G. , Katlariwala Mihir , Dhillon Sukhvinder , Jibri Zaid , Jaremko Jacob L.
Published: May 2016

Purpose

To minimize the burden of overutilisation of lumbar spine magnetic resonance imaging (MRI) on a resource-constrained public healthcare system, it may be helpful to image some patients with mechanical low-back pain (LBP) using a simplified rapid MRI screening protocol at 1.5-T. A rapid-acquisition 3-dimensional (3D) SPACE (Sampling Perfection with Application-optimized Contrasts using different flip angle Evolution) sequence can demonstrate common etiologies of LBP. We compared lumbar spinal canal stenosis (LSCS) and neural foraminal stenosis (LNFS) assessment on 3D SPACE against conventional 2-dimensional (2D) MRI.

Methods

We prospectively performed 3D SPACE and 2D spin-echo MRI sequences (axial or sagittal T1-weighted or T2-weighted) at 1.5-T in 20 patients. Two blinded readers assessed levels L3-4, L4-5 and L5-S1 using: 1) morphologic grading systems, 2) global impression on the presence or absence of clinically significant stenosis (n = 60 disc levels for LSCS, n = 120 foramina for LNFS). Reliability statistics were calculated.

Results

Acquisition time was ∼5 minutes for SPACE and ∼20 minutes for 2D MRI sequences. Interobserver agreement of LSCS was substantial to near perfect on both sequences (morphologic grading: kappa [k] = 0.71 SPACE, k = 0.69 T2-weighted; global impression: k = 0.85 SPACE, k = 0.78 T2-weighted). LNFS assessment had superior interobserver reliability using SPACE than T1-weighted (k = 0.54 vs 0.37). Intersequence agreement of findings between SPACE and 2D MRI was substantial to near perfect by global impression (LSCS: k = 0.78 Reader 1, k = 0.85 Reader 2; LNFS: k = 0.63 Reader 1, k = 0.66 Reader 2).

Conclusions

3D SPACE was acquired in one-quarter the time as the conventional 2D MRI protocol, had excellent agreement with 2D MRI for stenosis assessment, and had interobserver reliability superior to 2D MRI. These results justify future work to explore the role of 3D SPACE in a rapid MRI screening protocol at 1.5-T for mechanical LBP.
Cuerpo y sentidos: el análisis sociológico de la percepción
Authors: Sabido Ramos Olga
Published: May 2016

El objetivo de este artículo es mostrar el contexto en el que se inscribe la “sociología de los sentidos” contemporánea y la pertinencia de un análisissociológico de la percepción. Igualmente se recuperan algunas líneas de trabajo sociológicas precursoras en diálogo con propuestassociológicas contemporáneas. El escrito expone dichos aportes a partir de la propuesta de dos niveles analíticos para el análisis sociológico de la percepción: el interaccional y el individual disposicional. El primero permite observar el papel de lossentidos en la mutua percepción que se lleva a cabo en las interacciones. El segundo posibilita observar cómo se construyen y aprenden formas de percepción. Se realizará un énfasis particular en el papel que juega el género en ambos niveles analíticos.
Connecting Malfunctioning Glial Cells and Brain Degenerative Disorders
Authors: Kaminsky Natalie , Bihari Ofer , Kanner Sivan , Barzilai Ari
Published: May 2016

The DNA damage response (DDR) is a complex biological system activated by different types of DNA damage. Mutations in certain components of the DDR machinery can lead to genomic instability disorders that culminate in tissue degeneration, premature aging, and various types of cancers. Intriguingly, malfunctioning DDR plays a role in the etiology of late onset brain degenerative disorders such as Parkinson’s, Alzheimer’s, and Huntington’s diseases. For many years, brain degenerative disorders were thought to result from aberrant neural death. Here we discuss the evidence that supports our novel hypothesis that brain degenerative diseases involve dysfunction of glial cells (astrocytes, microglia, and oligodendrocytes). Impairment in the functionality of glial cells results in pathological neuro-glial interactions that, in turn, generate a “hostile” environment that impairs the functionality of neuronal cells. These events can lead to systematic neural demise on a scale that appears to be proportional to the severity of the neurological deficit.
Functions of PARylation in DNA Damage Repair Pathways
Authors: Wei Huiting , Yu Xiaochun
Published: May 2016

Protein poly ADP-ribosylation (PARylation) is a widespread post-translational modification at DNA lesions, which is catalyzed by poly(ADP-ribose) polymerases (PARPs). This modification regulates a number of biological processes including chromatin reorganization, DNA damage response (DDR), transcriptional regulation, apoptosis, and mitosis. PARP1, functioning as a DNA damage sensor, can be activated by DNA lesions, forming PAR chains that serve as a docking platform for DNA repair factors with high biochemical complexity. Here, we highlight molecular insights into PARylation recognition, the expanding role of PARylation in DDR pathways, and the functional interaction between PARylation and ubiquitination, which will offer us a better understanding of the biological roles of this unique post-translational modification.
DNA End Resection: Facts and Mechanisms
Authors: Liu Ting , Huang Jun
Published: May 2016

DNA double-strand breaks (DSBs), which arise following exposure to a number of endogenous and exogenous agents, can be repaired by either the homologous recombination (HR) or non-homologous end-joining (NHEJ) pathways in eukaryotic cells. A vital step in HR repair is DNA end resection, which generates a long 3′ single-stranded DNA (ssDNA) tail that can invade the homologous DNA strand. The generation of 3′ ssDNA is not only essential for HR repair, but also promotes activation of the ataxia telangiectasia and Rad3-related protein (ATR). Multiple factors, including the MRN/X complex, C-terminal-binding protein interacting protein (CtIP)/Sae2, exonuclease 1 (EXO1), Bloom syndrome protein (BLM)/Sgs1, DNA2 nuclease/helicase, and several chromatin remodelers, cooperate to complete the process of end resection. Here we review the basic machinery involved in DNA end resection in eukaryotic cells.
Direct versus indirect climate controls on Holocene diatom assemblages in a sub-tropical deep, alpine lake (Lugu Hu, Yunnan, SW China)
Authors: Wang Qian , Yang Xiangdong , Anderson Nicholas John , Dong Xuhui
Published: May 2016

The reconstruction of Holocene environmental changes in lakes on the plateau region of southwest China provides an understanding of how these ecosystems may respond to climate change. Fossil diatom assemblages were investigated from an 11,000-year lake sediment core from a deep, alpine lake (Lugu Hu) in southwest China, an area strongly influenced by the southwest (or the Indian) summer monsoon. Changes in diatom assemblage composition, notably the abundance of the two dominant planktonic species, Cyclotella rhomboideo-elliptica and Cyclostephanos dubius, reflect the effects of climate variability on nutrient dynamics, mediated via thermal stratification (internal nutrient cycling) and catchment-vegetation processes. Statistical analyses of the climateediatom interactions highlight the strong effect of changing orbitally-induced solar radiation during the Holocene, presumably via its effect on the lake’s thermal budget. In a partial redundancy analysis, climate (solar insolation) and proxies reflecting catchment process (pollen percentages, C/N ratio) were the most important drivers of diatom ecological change, showing the strong effects of climateecatchmentevegetation interactions on lake functioning. This diatom record reflects long-term ontogeny of the lake-catchment ecosystem and suggests that climatic changes (both temperature and precipitation) impact lake ecology indirectly through shifts in thermal stratification and catchment nutrient exports.
LO080: Performance and proximity: exploring resident factors that impact the quality of work-based assessments
Authors: Cheung W. , Dudek N. , Wood T.J. , Frank J.R.
Published: June 2016

Introduction: Much of the literature investigating the challenges associated with completing high quality work-based assessments (WBAs) have raised specific concerns over the appropriate documentation of assessments of underperforming trainees or trainees in difficulty. The purpose of this study was to examine the relationship between resident performance and the quality of assessments documented by supervisors on Daily Encounter Cards (DECs). The effect of trainee proximity (i.e. on-service versus off-service status) on this relationship was also examined. Methods: A series of DECs from the Department of Emergency Medicine at the University of Ottawa was scored by two raters using the Completed Clinical Evaluation Report Rating (CCERR). The CCERR is a 9-item instrument that has previously demonstrated reliable ratings and the ability to discriminate the quality of completed DECs. A proxy measure of resident performance was calculated by averaging the scores across performance items on the DEC to produce a “mean DEC rating”. Linear regression analysis was conducted with “mean DEC rating” as the independent measure and CCERR score as the dependent measure. Separate linear regression analyses were repeated for DECs completed for on-service versus off-service residents. Results: Linear regression analysis demonstrated a small but significant inverse relationship between mean DEC rating and CCERR score (p<0.001, r=-0.184), suggesting that when residents performed poorly, their supervisors tended to document higher quality assessments, and conversely, when residents performed well, their supervisors provided lower quality assessments. Further analysis demonstrated that this relationship was present for the on-service group (p<0.001, r=-0.24). However, no relationship was observed in the off-service group (p=0.62, r=-0.05). Conclusion: Resident performance and trainee proximity are important factors impacting the quality of documented clinical performance assessments. Greater attention needs to be given to determining ways of improving the quality of assessments reported for residents who are appropriately progressing in their clinical competence as well as for off-service trainees.
MP015: Daily encounter cards: evaluating the quality of documented assessments
Authors: Cheung W. , Dudek N. , Wood T.J. , Frank J.R.
Published: June 2016

Introduction: In response to concerns in the literature over the quality of completed work-based assessments (WBAs), faculty development and rater training initiatives have been developed. The Completed Clinical Evaluation Report Rating (CCERR) was designed to evaluate these interventions by providing a measure of the quality of documented assessments on In-Training Evaluation Reports (ITERs). Daily Encounter Cards (DECs) are a common form of WBA used in the Emergency Department setting. A tool to evaluate initiatives aimed at improving the quality of completion of this widely used WBA is also needed. The purpose of this study was to provide validity evidence to support using the CCERR to assess the quality of DEC completion. Methods: This study was conducted in the Department of Emergency Medicine at the University of Ottawa. Six experts in resident assessment grouped 60 DECs into three quality categories (high, average, poor) based on their perception of how informative each DEC was for reporting judgments of the resident’s performance. Eight clinical supervisors (blinded to the expert groupings) scored the 10 most representative DECs in each group using the CCERR. Mean scores were compared using a univariate ANOVA to determine if the CCERR was able to discriminate DEC quality. Reliability for the CCERR scores was determined using a generalizability analysis. Results: Mean CCERR scores for the high (37.3, SD=1.2), average (24.2, SD=3.3), and poor (14.4, SD=1.4) quality groups differed (p<0.001). A pairwise comparison demonstrated that differences between all three quality groups were statistically significant (p<0.001), indicating that the CCERR was able to discriminate DEC quality as judged by experts. A generalizability study demonstrated the majority of score variation was due to differences in DECs. The reliability with a single rater was 0.95. Conclusion: There is strong validity evidence to support the use of the CCERR to evaluate DEC quality. It can be used to provide feedback to supervisors for improving assessment reporting, and offers a quantitative measure of change in assessor behavior when utilized as a program evaluation instrument for determining the quality of completed DECs.
P013: Inter-facility transfers for CT scans from a rural emergency department: a pilot study
Authors: Bergeron C. , Lavallée-Bourget I. , Tounkara F.K. , Fleet R.
Published: June 2016

Introduction: Rural emergency departments (EDs) are an important gateway to care for the 20% of Canadians who live in rural areas. We recently reported that fewer than 15% of rural EDs in Canada have access to a CT scanner. Lack of CT scanners in rural hospitals can result in frequent inter-facility transfers and delays in diagnosing and treating life-threatening conditions. No recent study has examined this issue. Objective: With a future larger study in mind, we did a pilot assessment of inter-facility transfers for CT scans from one rural ED and evaluated the quality of the data and feasibility. Methods: This pilot study was part of our province-wide study on rural emergency care. Criteria were having 24/7 physician coverage and acute-care hospitalization beds. The hospital was also selected for its proximity and local interest. Two medical students collected data from hospital databases to determine annual number of ED visits, ED transfers, proportion of transfers for CT scans, reasons for examinations, and transfer times from April 1, 2010 to March 31, 2015. Descriptive statistics were reported as well as data quality and feasibility indicators. Results: For each year from 2010 to 2014, there was an average of 13,341 ED visits, 444 inter-facility transfers, and 125 CT scans. Over the five years an average of 28% of the inter-facility transfers were for CT scans, and the majority were abdominal CT scans. Inter-facility transfer data was 100% accessible through hospital databases but inter-facility transfer times and final diagnoses were not. Conclusion: More than a quarter of inter-facility transfers were for CT imaging. The limited electronic data in this Quebec rural ED precluded analysis of inter-facility times. While further cost-benefit analysis is required, preliminary data suggests local CTs may save time, money and lives.
P026: Pilot-testing an adverse drug event documentation form prior to its implementation in an electronic health record
Authors: Chruscicki A. , Badke K. , Peddie D. , Small S. , Balka E. , Hohl C.M.
Published: June 2016

Introduction: Adverse drug events (ADEs), harmful and unintended consequences of medications, account for 1.7M emergency department (ED) visits in Canada each year. Up to 30% are due to unintentional re-prescribing of culprit drugs, partly due to lack of accessible, succinct, and comprehensible ADE information at the time of prescribing. Through a systematic review and workshops with physicians and pharmacists, we designed new ADE documentation fields. Our objective was to pilot-test the fields to anticipate and address problems prior to their integration into an electronic medical record (EMR). Methods: We seek to introduce structured ADE documentation into an EMR and PharmaNet, BC’s medication-dispensing database, to generate patient-level alerts when attempts to re-prescribe culprit drugs are made. We conducted this qualitative study in the EDs and on the wards of two BC hospitals. The ADE fields collect information about the culprit drug, its effect on the patient, treatment and outcome. We recruited a convenience sample of pharmacists, and distributed paper forms with the ADE fields to them before data collection shifts. We recorded how pharmacists evaluated patients for ADEs and completed the forms. We collected completed forms, and conducted semi-structured interviews for feedback. We analyzed data for common themes using inductive reasoning and constant comparison methods. Results: We observed 6 pharmacists documenting 24 ADEs. The field design was perceived as simple, clear, with sufficient detail to capture ADE information. Users identified fields to be omitted (e.g., excess details of culprit drug), modified (e.g., reporting options), or needing clarification (e.g., treatment details). Users were uncertain about what to report when the differential diagnosis included an ADE, but diagnostic uncertainty remained. Thus, ADE fields should enable communication about suspected events and potential alternative diagnoses. Pharmacists required follow-up in some cases to complete their determination (e.g., C. difficile toxin assay), emphasizing the need to be able to modify an ADE report. Conclusion: Paper-based pilot testing uncovered barriers to ADE documentation, and allowed us to plan for modifications and required linkages between electronic systems. In order to be functional, electronic ADE documentation must be dynamic, representing a departure from previous reporting platforms.
P027: Emergency medical services (EMS) assist-requiring hypoglycemia in Southwest Ontario
Authors: Peddle M. , Liu S. , Reid H. , Columbus M. , Mahon J. , Dukelow A. , Spaic T.
Published: June 2016

Introduction: Hypoglycemia is a common treatment consequence in diabetes mellitus (DM) and the second most common cause of Emergency Department (ED) visits for adverse drug events. Prior studies have examined the rates of ED visits and inpatient hospitalizations for hypoglycemia. These represent only a small proportion of severe hypoglycemic events, as many do not present to hospital. To date, there have been no Canadian population-based studies examining the rates of EMS assist-requiring hypoglycemia in DM patients in the pre-hospital setting. The objective of this study was to determine the prevalence and describe the EMS assist-requiring hypoglycemia in DM patients in Southwestern Ontario. Methods: A population-based retrospective cohort study was conducted on all EMS calls for diabetic emergency from 2008-2014 in Southwestern Ontario, Canada. Data was extracted from the electronic ambulance call records for 11 EMS services in the region. Results: There were 9,265 EMS calls for a diabetic emergency (mean age 59 ± 20 years, 57% male, 82% DM). For 223 calls (2.4%) patients were younger than 19 years of age. The mean blood glucose level on presentation was 2.49 ± 1.02 mmol/L and 2,116 (24%) call subjects had initial GCS score less than 9. Treatment (intravenous glucose or IM glucagon) was given in 7,126 (77%) calls. There were 3,884 (51 %) hypoglycemia episodes with documented insulin use and 1,436 (19 %) documented oral hypoglycemia agents use. Between 2008 and 2014, rates of calls increased by 7.4% (p<0.0001). Prevalence of hypoglycemia calls during the study period was estimated at 189 per 10,000 diabetes patients per year. In 2,297 (24.8%) instances, the patient refused transport to the ED. Conclusion: The rates of EMS assist-requiring hypoglycemia are almost double the rates of hospitalization/ED visits for acute DM complications in our region. Many life threatening episodes of hypoglycemia may go unreported and subsequently not followed by the patient's primary health care provider. Further assessment and proper education following those episodes may help decrease the rate of severe hypoglycemia.
P045: What do we know about pediatric palliative care patients who consult the emergency department?
Authors: Gaucher N. , Humbert N. , Gauvin F.
Published: June 2016

Introduction: There is very little data about pediatric palliative care (PPC) patients’ visits to the emergency department (ED). This study’s goal was to determine the characteristics of PPC patients who consult the ED. Methods: A five-year retrospective chart review, conducted at a tertiary care pediatric university-affiliated hospital. Eligible patients initially consulted with the PPC team between April 1st 2007 and March 31st 2012. For each eligible patient, ED visits between these dates were included, using the ED’s electronic data system. Data about each visit was drawn from the electronic data system and the patient’s medical chart. This study was IRB approved. Results: During the study period, 290 new patients were followed by the PPC team; of these, 94 (32.4%) consulted the ED at least once (total of 219 visits). The median number of visits per patient was 2 (range: 1-8). Patient median age was 7 years 5 months (range: 1 month-22 years) and most common baseline diagnoses were: oncological diagnosis (39.4%), encephalopathy (27.7%) or genetic/chromosomal anomaly (13.8%). No patients died in the ED, but 36 (38.3%) died during the episode of care following one of their ED visits and 18 (19.1%) of them died within 72h of admission. PPC patients presented to the ED 219 times acutely ill: 11.4% of visits were triaged CTAS (Canadian Triage and Acuity Scale) level 1, 39.3% CTAS 2, 39.3% CTAS 3 and 10% CTAS 4 or 5. Many patients (37.9%) arrived by ambulance, 24.2% were admitted to the resuscitation room. Most patients consulted during day (45.2%) or evening (41.1%) shifts. Median length of stay was 3h50min (range: 13min - 15h10min). Reasons for consultation were respiratory distress/dyspnea (30.6%), pain (12.8%), seizure (11.4%), fever (9.1%), gastrointestinal symptoms (8.2%), fatigue (7.3%) and technical issues with catheters (5.9%). Most (79%) patients had investigations in the ED; 61.2% were admitted to wards, 7.3% to the PICU, and 20.5% were discharged. Two-thirds of patients (65.7%) had previously signed an advanced care directive at the time of their ED visit; discussions about goals of care were present in 37.4% of medical charts. Conclusion: Most PPC patients presented to the ED acutely ill, requiring work-up and admission. One-third presented in their end of life. Understanding the characteristics of PPC patients who consult the ED is the first step in offering better care for these complex patients.
P074: Impact of wearing a helmet on the risk of hospitalization after a sport injury
Authors: Le Sage N. , Prévost M. , Batomen Kuimi B. , Gagnon A. , Bergeron-Larose V. , Émond M. , Tardif P.
Published: June 2016

Introduction: Six Canadian provinces recently made bicycle helmet mandatory and subsequent data concerning hospitalization rates after head injuries in cyclists were controversial. Furthermore, there remains an important proportion of participants who don’t wear a helmet in sporting activity. We thus wanted to estimate the impact of helmet use in sport injuries on the risk of hospitalization. Methods: Study participants were patients of all age presenting at the emergency department of the Hôpital de l’Enfant-Jésus du CHU de Québec for a trauma that occurred in a sport in which it’s possible to wear a helmet. Data were collected from information provided by the patient and from the Canadian Hospitals Injury Reporting and Prevention Program’ (CHIRPP) database. Descriptive and multivariate analyses have been carried out using these data. We performed binomial logistic regression analyzes to estimate the risk adjusted for potentially confounding variables: age, sex and number of injuries. Results: Most patients included in the study (n=169) were males (69.8%) aged between 10 and 30 years (50.3%). Sports most frequently involved in trauma were cycling (31.4%), downhill skiing (18.3%), snowboarding (14.8%), hockey (11.8%), and skateboarding (5.9%). Overall, 70.4% of patients were wearing a helmet at the time of injury. Helmet use in sports was associated with a reduction of 52% of the risk of hospitalization (RR: 0.48 [CI: 95%: 0.25-0.93]) after a trauma. In addition, patients not wearing a helmet had higher proportions of intracranial hemorrhage (10% vs. 1.7%) and skull fracture (8% vs 2.5%). Conclusion: Results suggest that helmet use decreases the risk of hospitalization for trauma sustained in sports in which it’s possible to wear a helmet.
P077: Subcutaneous fentanyl administration for pain management in prehospital setting
Authors: Lebon J. , Bégin F. , Fleet R. , Tanguay A.B.
Published: June 2016

Background: Intravenous (IV) and Intranasal (IN) route for analgesic administration cannot always be used to provide adequate pain management in pre-hospital setting. Objective: In a rural and suburban pre-hospital setting, studying the feasibility, safety and effectiveness of the subcutaneous (SC) route for fentanyl administration by Basic Life Service-Emergency Medical Technician (BLS-EMT) for pain management, with the support of an online medical control (OLMC) center. Methods: Retrospective study of patients who received subcutaneous fentanyl and were transported by BLS-EMT to an emergency department (ED). Safety and feasibility were characterized by collecting vital signs, Ramsey sedation scores and adverse events following fentanyl administration, and effectiveness was evaluated by changes in pain scores. Parametric and non-parametric tests were used for statistical analyses comparing age groups (<70 & ≥70 years old) regarding transport time. Results: Pain scores ≥7 were found in 288 patients (14-93 years old) who were eligible for analgesia. 249 (86.5%) of the 284 (98.6%) who received subcutaneous fentanyl were included for analysis. At baseline, no difference (p>0.05) in pain scores pre-fentanyl between groups even if patients<70 years old received a significant higher dose of fentanyl than those ≥70 years old (1.4±0.3 v/s 0.8±0.2mcg/kg, p<0.05). Post-administration pain score decreased significantly while proportion of patients achieving a pain relief increased significantly (p<0.05) regarding transport time (15, 30 or 45min) to ED. Adverse events were present in 1.6% of the patients [hypotension (n=2; 0.8%), nausea (n=1; 0.4%), and Ramsey score>3 (n=1; 0.4%)]. Conclusion: Under the supervision of an OLMC center, subcutaneous fentanyl administration by BLS-EMT for pain management seems to be a feasible approach, with a safe and effective route without major adverse event in pre-hospital setting. Pain relief increased with longer transport time. Further studies are needed to determine the benefits of SC route when compared to other administration routes in EMS.
LO006: Interarm blood pressure differential as a clinical marker for acute aortic dissection in the emergency department
Authors: Um S.W. , Ohle R. , Perry J.J.
Published: June 2016

Introduction: Acute Aortic Dissection (AAD) is life threatening, requiring early diagnosis. Although previous literature suggest interarm BP differential is an independent predictor of AAD, up to 20% of a healthy population can have a significant differential. Our objectives were to assess the rate of bilateral BP measurement in acute non-traumatic truncal pain patients, and the association of BP differential with non-traumatic AAD. Methods: This is a historical matched case control study: participants were adults >18 years old presenting to two tertiary care EDs with a triage diagnosis of truncal (i.e. chest, abdominal, flank, back) pain. Cases were selected based on an ED or in-hospital diagnosis of non-traumatic AAD confirmed by CT or Echo. Controls were from a single calendar year matched in a 1:1.5 ratio by sex and age within 5 years. ED and referral consult BP measurements were used. Exclusion criteria: clear diagnosis on basic investigation (i.e. UTI, pneumonia, pneumothorax, acute fracture) or pain >14 days/no pain. Sample size of 126 cases and 183 controls was calculated based on 20% exposure in controls (80% power and alpha of 5%), to detect an OR >2. P-values were calculated using chi square analysis. Results: A total of 294 (119 cases, 175 controls) patients were included (mean 66+/-14.5yrs, 59.5% male). Cases (199 potential: 119 included; 80 excluded). Controls (8239 potential: 305 reviewed; 175 included; 130 excluded). Bilateral BP was measured in 70.6% of cases (n=84, mean difference=15.5mmHg) versus 31.3% of controls (n=55, mean difference=10.9mmHg). Among included controls, most common diagnoses were: Unspecified Chest (36.0%) or Abdominal (9.7%) Pain, ACS (12.6%), Muscular Back Pain (5.1%), and Renal Colic (4.0%). BP differential >10mmHg was found in 58.8% of cases and 40.7% of controls (P=0.10). A BP differential >20mmHg was found in 31.3% of cases and 22.2% of controls (P=0.37). BP differential >20mmHg did not significantly increase the odds of AAD (OR 2.0 (95%CI 0.82-4.90), p<0.129). Conclusion: Interarm BP differential is not routinely measured in ED patients with acute non-traumatic truncal pain, and there is no significant difference in the presence or magnitude of differentials in patients with or without AAD. Therefore, physicians should not rely on BP differentials to aid in their diagnosis or exclusion of AAD.
LO021: Use of health services among non-institutionalized frail elderly with fracture: preliminary results
Authors: Fillion V. , Jean S. , Sirois M. , Gamache P.
Published: June 2016

Introduction: Frail older adults experience an increased risk of a number of adverse health outcomes such as comorbidity, disability, dependency, institutionalization, falls, fractures, hospitalization, and mortality. Identification of frail adults is important. The objective of this study is to examine the association between frailty and use of health services (emergency, general practitioner, hospitalization) prior to and following a visit for a fracture in non-institutionalized seniors. Methods: This study is a population-based cohort build from the Quebec Integrated Chronic Disease Surveillance System, an innovative chronic disease surveillance system linking five health care administrative databases. Algorithms using data from this system are accurate and reliable for identifying fractures. The sample includes 179,734 seniors ≥ 65 years old, non-institutionalized in the year before the fracture. Their frailty status was measured using the elderly risk assessment index. Poisson regression models were used to compare use of health services (emergency, general practitioner, hospitalization) 1 year before and 1 year after a visit for a fracture (adjusting for age, sex, comorbidities, social deprivation, material deprivation and site of fracture). Results: Overall, preliminary results show that the use of health services increased significantly in the year following the fracture in frail non-institutionalized elderly vs the non-frail one (p < 0.05). Conclusion: This study suggests that frail seniors with a fracture require more health services after their incident fracture. Furthermore, using a frailty assessment index in health administrative databases can help identify seniors that are at high risk of needing more health services and, therefore, improve their care.
LO056: Perceptions and provision of analgesia for acutely painful conditions in children: a multi-centre prospective survey of caregivers
Authors: Wonnacott D. , Poonai C. , Wright B. , Ali S. , Bhat C. , Todorovich S. , Mishra A. , Canton K. , Rajagopal M. , Thompson G.C. , Stang A.S. , Poonai N.
Published: June 2016

Introduction: The suboptimal management of children’s pain in the emergency department (ED) is well described. Although surveys of physicians show improvements in providing analgesia, institutional audits suggest otherwise. One reason may be patient refusal. Our objectives were to determine the proportion of caregivers that offered analgesia prior to arrival to the ED, accept analgesia in the ED, and identify reasons for withholding analgesia. Our results will inform knowledge translation initiatives to improve analgesic provision to children. Methods: A novel survey was designed to test the hypothesis that a large proportion of caregivers withhold and refuse analgesia. Over a 16-week period across two Canadian paediatric EDs, we surveyed caregivers of children aged 4-17 years with an acutely painful condition (headache, otalgia, sore throat, abdominal pain, or musculoskeletal injury). The primary outcome was the proportion of caregivers who offered analgesia up to 24 hours prior to ED arrival and accepted analgesia in the ED. Results: The response rate was 568/707 (80.3%). The majority of caregivers were female (426/568, 75%), aged 36 years or older (434/568, 76.4%), and had a post-secondary education (448/561, 79.9%). Their children included 320 males and 248 females with a mean age of 10.6 years. Most (514/564, 91.1%) reported being “able to tell when their child was in pain”. On average, children rated their maximal pain at 7.4/10. A total of 382/561 (68.1%) caregivers did not offer any form of analgesia prior to arrival. Common reasons included lack of time (124/561, 22.1%), fear of masking signs and symptoms (74/561, 13.2%) or the seriousness of their child’s condition (72/561, 12.8%), and lack of analgesia at home (71/561, 12.7%). Analgesia was offered to 328/560 (58.6%) children in the ED and 283/328 (72.6%) caregivers accepted. The most common reason for not accepting analgesia was child refusal (20/45, 44.4%). Conclusion: Most caregivers do not offer analgesia to their child prior to arriving in the ED despite high levels of pain and an awareness of it. Despite high rates of acceptance of analgesia in the ED, misconceptions are common. Knowledge translation strategies should dispel caregiver misconceptions, and highlight the impact of pain on children and the importance of analgesia at home.
Rethinking format: An examination of requests
Authors: Fox Barbara , Heinemann Trine
Published: June 2016

This study explores the formulation of requests in an American English-speaking shoe repair shop. Taking prior work on request formats as our starting point, we explore the two primary syntactic moods (declarative and interrogative) in our collection and two of the commonly noted subtypes of these moods,need/want-declaratives andcan-interrogatives. While our findings in very general terms match those of previous studies, we also find significant grammatical variation within each of these formats, and note interactional uses for each variation. Our examination yields insight into facets of requesting that were previously undescribed. We offer an Emergent Grammar perspective on the complexity of lexicosyntax in the social action of requesting. (Requests, formats, Emergent Grammar, Conversation Analysis, American English, service encounters)*
Validation of an instrument to measure registered dietitians’/nutritionists’ knowledge, attitudes and practices of an intuitive eating approach
Authors: Schaefer Julie T , Zullo Melissa D
Published: June 2016

Objective

The purpose of the present study was to develop and assess the construct validity of a tool to measure knowledge, attitudes and practices of registered dietitians/nutritionists (RD/N) regarding an intuitive eating lifestyle.

Design

Cross-sectional study design that utilized a survey administered to a random sample and remaining full population of RD/N.

Setting

A national survey conducted via online survey software.

Subjects

A random sample of 10 % of all RD/N in the USA (n8834) was invited to participate. Survey completion rate was 22·2 % (n1897). After initial validation, the survey was distributed to the remaining 90 % of RD/N to confirm validation.

Results

After removing items with insufficient factor loadings, results were consistent with a four-factor solution: (i) knowledge of intuitive eating; (ii) attitudes towards intuitive eating; (iii) traditional and restrictive practices; and (iv) non-restrictive and intuitive eating practices. Confirmatory factor analysis provided further evidence of the validity of the four factors and the factors had strong reliability.

Conclusions

Unlike the hypothesized three-factor solution (knowledge, attitudes and practices), validation analysis revealed that the survey measures knowledge of intuitive eating, attitudes towards intuitive eating, use of traditional and restrictive weight-management practices, and use of non-restrictive and intuitive eating practices. With the landscape of weight management and health promotion undergoing a shift towards a health centred, size acceptance approach, this instrument will provide valuable information regarding the current knowledge, attitudes and practices of RD/N and other health promotion professionals.
John H. Jackson: Pioneer and Visionary
Authors: STEGER DEBRA P.
Published: June 2016

John Jackson pioneered international trade law, helped to establish the WTO, and taught legions of professors and trade policy officials who continue to promote his goals of a multilateral trading system based on the rule of law, transparency, fairness, and non-discrimination. A great man, he was also a very dear man – humble, quiet, unassuming, kind, and private. In his writings, he had the unique ability to distill very complex issues down to a few, readily comprehensible paragraphs for students and readers.
An adapted imaginal exposure approach to traditional methods used within trauma-focused cognitive behavioural therapy, trialled with a veteran population
Authors: Kaur Manveer , Murphy Dominic , Smith Kirsten V.
Published: June 2016

Trauma-focused cognitive behavioural therapy (TF-CBT) is beneficial for individuals with post-traumatic stress disorder (PTSD); however, a subset of clients struggle to engage with traditional methods, due to high levels of avoidance and dissociation. This paper aims to describe an adapted approach to imaginal reliving and prolonged exposure, to facilitate subsequent cognitive updating. The paper demonstrates the technique with veterans, who are a client group that may struggle with some aspects of traditionally implemented TF-CBT. Two case studies are described, both with PTSD symptoms stemming from traumatic military experiences. An adapted exposure technique is utilized to address the barriers of high dissociation, poor access to trauma-related cognitions and fixed intrusive imagery. The approach involved three stages: (1) reliving the trauma outdoors, (2) manipulating the perspectives of the imagery, and (3) restructuring the narrative with new perspectives. Both clients showed decreased dissociation and improved toleration of their traumatic imagery. Improvement of PTSD symptoms and quality-of-life functioning was observed for both clients on objective measures. Adapting TF-CBT to have a stronger emphasis on grounding and allocentric processing may be helpful for a subset of patients with PTSD that present with high levels of dissociation and avoidance. Further research and investigation into alternative populations is needed.
Characteristics of Youth With Combined Histories of Violent Behavior, Suicidal Ideation or Behavior, and Gun-Carrying
Authors: Logan Joseph E. , Vagi Kevin J. , Gorman-Smith Deborah
Published: June 2016

Abstract. Background: Youth reporting combined histories of nonfatal violence, suicidal ideation/behavior, and gun-carrying (VSG) are at risk for perpetrating fatal interpersonal violence and self-harm. Aims: We characterized these youth to inform prevention efforts. Method: We analyzed 2004 data from 3,931 seventh-, ninth-, and 11–12th-grade youth and compared VSG youth (n = 66) with non-gun carrying youth who either had no histories of violence or suicidal thoughts/behavior (n = 1,839), histories of violence (n = 884), histories of suicidal thoughts/behaviors (n = 552), or both (n = 590). We compared groups based on demographic factors, risk factors (i.e., friends who engage in delinquency, peer-violence victimization, depressive symptoms, illicit substance use), and protective factors (i.e., school connectedness, parental care and supervision). Regression models identified factors associated with VSG youth. Results: Illicit substance use and having friends who engage in delinquency were more common among VSG youth in all comparisons; almost all VSG youth had high levels of these factors. Depressive symptoms were positively associated with VSG youth versus youth without either violent or suicide-related histories and youth with violent histories alone. School connectedness and parental supervision were negatively associated with VSG youth in most comparisons. Conclusion: Family-focused and school-based interventions that increase connectedness while reducing delinquency and substance use might prevent these violent tendencies.
Suppressor of IKKɛ is an essential negative regulator of pathological cardiac hypertrophy
Authors: Deng Ke-Qiong , Wang Aibing , Ji Yan-Xiao , Zhang Xiao-Jing , Fang Jing , Zhang Yan , Zhang Peng , Jiang Xi , Gao Lu , Zhu Xue-Yong , Zhao Yichao , Gao Lingchen , Yang Qinglin , Zhu Xue-Hai , Wei Xiang , Pu Jun , Li Hongliang
Published: June 2016

Although pathological cardiac hypertrophy represents a leading cause of morbidity and mortality worldwide, our understanding of the molecular mechanisms underlying this disease is still poor. Here, we demonstrate that suppressor of IKKɛ (SIKE), a negative regulator of the interferon pathway, attenuates pathological cardiac hypertrophy in rodents and non-human primates in a TANK-binding kinase 1 (TBK1)/AKT-dependent manner. Sike-deficient mice develop cardiac hypertrophy and heart failure, whereas Sike-overexpressing transgenic (Sike-TG) mice are protected from hypertrophic stimuli. Mechanistically, SIKE directly interacts with TBK1 to inhibit the TBK1-AKT signalling pathway, thereby achieving its anti-hypertrophic action. The suppression of cardiac remodelling by SIKE is further validated in rats and monkeys. Collectively, these findings identify SIKE as a negative regulator of cardiac remodelling in multiple animal species due to its inhibitory regulation of the TBK1/AKT axis, suggesting that SIKE may represent a therapeutic target for the treatment of cardiac hypertrophy and heart failure.
Characterizing the boundary lateral to the shear direction of deformation twins in magnesium
Authors: Liu Y. , Li N. , Shao S. , Gong M. , Wang J. , McCabe R. J. , Jiang Y. , Tomé C. N.
Published: June 2016

The three-dimensional nature of twins, especially the atomic structures and motion mechanisms of the boundary lateral to the shear direction of the twin, has never been characterized at the atomic level, because such boundary is, in principle, crystallographically unobservable. We thus refer to it here as the dark side of the twin. Here, using high-resolution transmission electron microscopy and atomistic simulations, we characterize the dark side of "Equation missing" deformation twins in magnesium. It is found that the dark side is serrated and comprised of "Equation missing" coherent twin boundaries and semi-coherent twist prismatic–prismatic "Equation missing" boundaries that control twin growth. The conclusions of this work apply to the same twin mode in other hexagonal close-packed materials, and the conceptual ideas discussed here should hold for all twin modes in crystalline materials.
Design of a bioactive small molecule that targets r(AUUCU) repeats in spinocerebellar ataxia 10
Authors: Yang Wang-Yong , Gao Rui , Southern Mark , Sarkar Partha S. , Disney Matthew D.
Published: June 2016

RNA is an important target for chemical probes of function and lead therapeutics; however, it is difficult to target with small molecules. One approach to tackle this problem is to identify compounds that target RNA structures and utilize them to multivalently target RNA. Here we show that small molecules can be identified to selectively bind RNA base pairs by probing a library of RNA-focused small molecules. A small molecule that selectively binds AU base pairs informed design of a dimeric compound (2AU-2) that targets the pathogenic RNA, expanded r(AUUCU) repeats, that causes spinocerebellar ataxia type 10 (SCA10) in patient-derived cells. Indeed, 2AU-2 (50 nM) ameliorates various aspects of SCA10 pathology including improvement of mitochondrial dysfunction, reduced activation of caspase 3, and reduction of nuclear foci. These studies provide a first-in-class chemical probe to study SCA10 RNA toxicity and potentially define broadly applicable compounds targeting RNA AU base pairs in cells.
Fast escape of a quantum walker from an integrated photonic maze
Authors: Caruso Filippo , Crespi Andrea , Ciriolo Anna Gabriella , Sciarrino Fabio , Osellame Roberto
Published: June 2016

Escaping from a complex maze, by exploring different paths with several decision-making branches in order to reach the exit, has always been a very challenging and fascinating task. Wave field and quantum objects may explore a complex structure in parallel by interference effects, but without necessarily leading to more efficient transport. Here, inspired by recent observations in biological energy transport phenomena, we demonstrate how a quantum walker can efficiently reach the output of a maze by partially suppressing the presence of interference. In particular, we show theoretically an unprecedented improvement in transport efficiency for increasing maze size with respect to purely quantum and classical approaches. In addition, we investigate experimentally these hybrid transport phenomena, by mapping the maze problem in an integrated waveguide array, probed by coherent light, hence successfully testing our theoretical results. These achievements may lead towards future bio-inspired photonics technologies for more efficient transport and computation.
Observation of coherent delocalized phonon-like modes in DNA under physiological conditions
Authors: González-Jiménez Mario , Ramakrishnan Gopakumar , Harwood Thomas , Lapthorn Adrian J. , Kelly Sharon M. , Ellis Elizabeth M. , Wynne Klaas
Published: June 2016

Underdamped terahertz-frequency delocalized phonon-like modes have long been suggested to play a role in the biological function of DNA. Such phonon modes involve the collective motion of many atoms and are prerequisite to understanding the molecular nature of macroscopic conformational changes and related biochemical phenomena. Initial predictions were based on simple theoretical models of DNA. However, such models do not take into account strong interactions with the surrounding water, which is likely to cause phonon modes to be heavily damped and localized. Here we apply state-of-the-art femtosecond optical Kerr effect spectroscopy, which is currently the only technique capable of taking low-frequency (GHz to THz) vibrational spectra in solution. We are able to demonstrate that phonon modes involving the hydrogen bond network between the strands exist in DNA at physiologically relevant conditions. In addition, the dynamics of the solvating water molecules is slowed down by about a factor of 20 compared with the bulk.