bluuebunny/crossref_metadata_2025 huggingface dataset:
Overview of Resistive Random Access Memory (RRAM): Materials, Filament Mechanisms, Performance Optimization, and Prospects
Authors: Wang Hong , Yan Xiaobing
Published: May 2019

Because conventional nonvolatile memory is limited by process technology and physical size, resistive random access memory (RRAM) gradually enters the field of view due to its simple structure, fast program/erase speed, low power consumption, and so on. This review article summarizes the materials, filament mechanisms, performance optimization, and application prospects of RRAM structures to provide readers with a reference for future investigation. The filament mechanisms, which involve the electrochemical metallization mechanism (ECM), valence change mechanism (VCM), and thermochemical mechanism (TCM), of RRAM devices are particularly highlighted. The parameters that determine the RRAM characteristics such as operating voltages, ON/OFF ratio, endurance, and data retention are improved by incorporating the three methods: 1) “interface engineering”, 2) element doping of functional materials, and 3) introduction of low‐dimensional materials. In the last section, a brief introduction to the future RRAM application prospects and challenges is provided.
High‐throughput quantification of drugs of abuse in biofluids via 96‐solid‐phase microextraction–transmission mode and direct analysis in real time mass spectrometry
Authors: Vasiljevic Tijana , Gómez‐Ríos Germán Augusto , Li Frederick , Liang Paul , Pawliszyn Janusz
Published: May 2019

Rationale

The workload of clinical laboratories has been steadily increasing over the last few years. High‐throughput (HT) sample processing allows scientists to spend more time undertaking matters of critical thinking rather than laborious sample processing. Herein we introduce a HT 96‐solid‐phase microextraction (SPME) transmission mode (TM) system coupled to direct analysis in real time (DART) mass spectrometry (MS).

Methods

Model compounds (opioids) were extracted from urine and plasma samples using a 96‐SPME‐TM device. A standard voltage and pressure (SVP) DART source was used for all experiments. Examination of SPME‐TM performance was done using high‐resolution mass spectrometry (HRMS) in full scan mode (100–500 m/z), whereas quantitation of opioids was performed using triple quadrupole MS in multiple reaction monitoring mode and by using a matrix‐matched internal standard correction method.

Results

Thirteen points (0.5 to 200 ng mL−1) were used to establish a calibration curve. Low limits of quantitation (LOQ) were obtained (0.5 to 25 ng mL−1) for matrices used. Acceptable accuracy (71.4–129.4%) and repeatability (1.1–24%) were obtained for validation levels tested (0.5, 30 and 90 ng mL−1). In less than 1.5 hours, 96 samples were extracted, desorbed and processed using the 96‐SPME‐TM system coupled to DART‐MS.

Conclusions

A rapid HT method for detection of opioids in urine and plasma samples was developed. This study demonstrated that ambient ionization mass spectrometry coupled to robust sample preparation methods such as SPME‐TM can rapidly and efficiently screen/quantify target analytes in a HT context.
Determination of the triple oxygen and carbon isotopic composition of CO2 from atomic ion fragments formed in the ion source of the 253 Ultra high‐resolution isotope ratio mass spectrometer
Authors: Adnew Getachew A. , Hofmann Magdalena E.G. , Paul Dipayan , Laskar Amzad , Surma Jakub , Albrecht Nina , Pack Andreas , Schwieters Johannes , Koren Gerbrand , Peters Wouter , Röckmann Thomas
Published: May 2019

Rationale

Determination of δ17O values directly from CO2 with traditional gas source isotope ratio mass spectrometry is not possible due to isobaric interference of 13C16O16O on 12C17O16O. The methods developed so far use either chemical conversion or isotope equilibration to determine the δ17O value of CO2. In addition, δ13C measurements require correction for the interference from 12C17O16O on 13C16O16O since it is not possible to resolve the two isotopologues.

Methods

We present a technique to determine the δ17O, δ18O and δ13C values of CO2 from the fragment ions that are formed upon electron ionization in the ion source of the Thermo Scientific 253 Ultra high‐resolution isotope ratio mass spectrometer (hereafter 253 Ultra). The new technique is compared with the CO2‐O2 exchange method and the 17O‐correction algorithm for δ17O and δ13C values, respectively.

Results

The scale contractions for δ13C and δ18O values are slightly larger for fragment ion measurements than for molecular ion measurements. The δ17O and Δ17O values of CO2 can be measured on the 17O+ fragment with an internal error that is a factor 1–2 above the counting statistics limit. The ultimate precision depends on the signal intensity and on the total time that the 17O+ beam is monitored; a precision of 14 ppm (parts per million) (standard error of the mean) was achieved in 20 hours at the University of Göttingen. The Δ17O measurements with the O‐fragment method agree with the CO2‐O2 exchange method over a range of Δ17O values of −0.3 to +0.7‰.

Conclusions

Isotope measurements on atom fragment ions of CO2 can be used as an alternative method to determine the carbon and oxygen isotopic composition of CO2 without chemical processing or corrections for mass interferences.
Photocatalytic Degradation of Rhodamine B Dye Using Biogenic Hybrid ZnO‐MgO Nanocomposites under Visible Light
Authors: Vijai Anand Kabali , Aravind Kumar Jagadeesan , Keerthana Kamalakannan , Deb Paribrita , Tamilselvan Selvaraj , Theerthagiri Jayaraman , Rajeswari Velayutham , Sekaran Sekaran Muthamil Selvan , Govindaraju Kasivelu
Published: May 2019

In the present investigation, single step, economic and environmentally friendly preparation of ZnO‐MgO nanocomposites (ZnO, Zn25Mg75O, Zn50Mg50O, Zn75Mg25O and MgO) as photocatalyst using marine brown alga (Turbinaria ornata) as a stabilizing agent is carried out. The green route synthesized nanocomposites were analysed using various spectroscopy and microscopy techniques. The efficiency of the prepared nanocomposites materials were assessed by photocatalytic degradation of Rhodamine B (RhB) as model dye under visible light illumination. The nanocomposites displayed an improved visible light induced photocatalytic degradation of RhB. Among which, Zn50Mg50O nanocomposite sample exhibited better photocatalytic degradation performance than others samples (ZnO, MgO, Zn25Mg75O and Zn75Mg25O) which might be due to the positive synergistic effect and also by a reduced recombination of charge carriers. Further, the transient photocurrent and electrochemical impedance spectroscopy (EIS) analysis revealed that the Zn50Mg50O nanocomposite has quicker migration of light induced charge‐carriers.
A Novel Amphiphilic AIE Molecule and Its Application in Thermosensitive Liposome
Authors: Zhao Yun‐Hui , Luo Yueyang , Guo Tao , Tang Zilong , Zhou Zhihua
Published: May 2019

A novel amphiphilic aggregation induced emission (AIE) molecule was prepared from tetraphenyl ethylene unit modified with long chain and carboxylic acid. It acted as an effective ingredient to form liposomes through self‐assembly with phospholipids. The smart nanomaterial exhibited good aggregation‐induced emission (AIE) characteristic and excellent response to temperature below 50 °C. Moreover, in vitro imaging shows that it has the potential to be used in biomedical field as drug delivery system.
The Feasibility and Advantages of Subxiphoid Uniportal Video‐Assisted Thoracoscopic Surgery in Pulmonary Lobectomy
Authors: Yang Xueying , Wang Linlin , Zhang Chenxi , Zhao Danyang , Lu Yao , Wang Zelong
Published: May 2019

Background

Uniportal video‐assisted thoracoscopic surgery (VATS) lobectomy has emerged as a promising and exciting approach for minimally invasive thoracic surgeries. However, nearly all reported uniportal VATS lobectomies are performed via an intercostal route, and chest wall trauma remains an issue. Here, we report the use of a novel uniportal VATS technique involving a subxiphoid route for pulmonary lobectomies.

Methods

We retrospectively analyzed perioperative data for patients who underwent subxiphoid uniportal and traditional three‐port VATS lobectomies from January 2016 to January 2017 at our hospital.

Results

During the study period, 37 patients successively underwent subxiphoid uniportal VATS lobectomies, including three synchronous bilateral pulmonectomies; 68 patients underwent traditional three‐port VATS. There were no surgical or 30‐day postoperative mortalities, and no significant between‐group differences were found in the number of retrieved lymph nodes, number of explored nodal stations, blood loss, drainage time, postoperative complications, or length of hospital stay. Operative time was longer in the subxiphoid uniportal VATS group than in the traditional three‐port VATS group (P < 0.001). Visual analog scale (VAS) pain scores after surgery were significantly lower in the subxiphoid uniportal VATS group (P < 0.05).

Conclusions

Subxiphoid uniportal VATS lobectomy is a safe and feasible surgical procedure associated with reduced surgical trauma and postoperative pain as well as improved cosmetic results compared with traditional VATS. Moreover, this procedure is better suited for patients receiving synchronous bilateral pulmonectomy. Further long‐term follow‐up analyses involving more patients are ongoing.

Trial registry number

ClinicalTrials.gov NCT03051438.
Predicting microRNA‐disease association based on microRNA structural and functional similarity network
Authors: Ding Tao , Gao Jie , Zhu Shanshan , Xu Junhua , Wu Min
Published: May 2019

Background

Increasing evidences indicate that microRNAs (miRNAs) are functionally related to the development and progression of various human diseases. Inferring disease‐related miRNAs can be helpful in promoting disease biomarker detection for the treatment, diagnosis, and prevention of complex diseases.

Methods

To improve the prediction accuracy of miRNA‐disease association and capture more potential disease‐related miRNAs, we constructed a precise miRNA global similarity network (MSFSN) via calculating the miRNA similarity based on secondary structures, families, and functions.

Results

We tested the network on the classical algorithms: WBSMDA and RWRMDA through the method of leave‐one‐out cross‐validation. Eventually, AUCs of 0.8212 and 0.9657 are obtained, respectively. Also, the proposed MSFSN is applied to three cancers for breast neoplasms, hepatocellular carcinoma, and prostate neoplasms. Consequently, 82%, 76%, and 82% of the top 50 potential miRNAs for these diseases are respectively validated by the miRNA‐disease associations database miR2Disease and oncomiRDB.

Conclusion

Therefore, MSFSN provides a novel miRNA similarity network combining precise function network with global structure network of miRNAs to predict the associations between miRNAs and diseases in various models.
LO66: Solid organ donation from the emergency department: A death review
Authors: McCallum J. , Yip R. , Dhanani S. , Stiell I.
Published: May 2019

Introduction: A significant gap exists between the number of people waiting for an organ and donors. There are currently 1,628 people awaiting organ donation in Ontario alone. In 2018 to date, 310 donors have donated 858 organs. The purpose of this study was to determine whether there were missed donors in the Emergency Department (ED) and by what percent those missed donors would increase organ donation overall. Methods: This was a health records and organ donation database review of all patients who died in the ED at a large academic tertiary care center with 2 campuses and 160,000 visits per year. Patients were included from November 1, 2014 – October 31, 2017. We collected data on demographics, cause of death, and suitability for organ donation. Data was cross-referenced between hospital records and the provincial organ procurement organization called Trillium Gift of Life Network (TGLN) to determine whether patients were appropriately referred for consideration of donation in a timely manner. Potential missed donors were manually screened for suitability according to TGLN criteria. We calculated simple descriptive statistics for demographic data and the primary outcome. The primary outcome was percentage of potential organ donors missed in the Emergency Department (ED). Results: There were 606 deaths in the ED from November 1, 2014 – October 31, 2017. Patients were an average of 71 years old, 353 (58%) were male, and 75 (12%) died of a traumatic cause. TGLN was not contacted in 12 (2%) of cases. During this period there were two donors from the ED and 92 from the ICU. There were ten missed potential donors. They were an average of 67 years, 7 (70%) were male, and 2 (20%) died of a traumatic cause. In all ten cases, patients had withdrawal of life sustaining measures for medical futility prior to TGLN being contacted for consideration of donation. There could have been an addition seven liver, six pancreatic islet, four small bowel, and seven kidney donors. The ten missed ED donors could have increased total donors by 11%. Conclusion: The ED is a significant source of missed organ donors. In all cases of missed organ donation, patients had withdrawal of life sustaining measures prior to TGLN being called. In the future, it is essential that all patients have an organ procurement organization such as TGLN called prior to withdrawal of life sustaining measures to ensure that no opportunity for consideration of organ donation is missed.
P023: The BC Emergency Medicine Network: Evaluation approach and early findings
Authors: Marsden J. , Drebit S. , Lindstrom R. , MacKinnon C. , Archibald C. , Abu-Laban R. , Eggers K. , Ho K. , Khazei A. , Lund A. , Martin E. , Christenson J.
Published: May 2019

Introduction: September 2017 saw the launch of the British Columbia (BC) Emergency Medicine Network (EM Network), an innovative clinical network established to improve emergency care across the province. The intent of the EM Network is to support the delivery of evidence-informed, patient-centered care in all 108 Emergency Departments and Diagnostic & Treatment Centres in BC. After one year, the Network undertook a formative evaluation to guide its growth. Our objective is to describe the evaluation approach and early findings. Methods: The EM Network was evaluated on three levels: member demographics, online engagement and member perceptions of value and progress. For member demographics and online engagement, data were captured from member registration information on the Network's website, Google Analytics and Twitter Analytics. Membership feedback was sought through an online survey using a social network analysis tool, PARTNER (Program to Analyze, Record, and Track Networks to Enhance Relationships), and semi-structured individual interviews. This framework was developed based on literature recommendations in collaboration with Network members, including patient representatives. Results: There are currently 622 EM Network members from an eligible denominator of approximately 1400 physicians (44%). Seventy-three percent of the Emergency Departments and Diagnostic and Treatment Centres in BC currently have Network members, and since launch, the EM Network website has been accessed by 11,154 unique IP addresses. Online discussion forum use is low but growing, and Twitter following is high. There are currently 550 Twitter followers and an average of 27 ‘mentions’ of the Network by Twitter users per month. Member feedback through the survey and individual interviews indicates that the Network is respected and credible, but many remain unaware of its purpose and offerings. Conclusion: Our findings underscore that early evaluation is useful to identify development needs, and for the Network this includes increasing awareness and online dialogue. However, our results must be interpreted cautiously in such a young Network, and thus, we intend to re-evaluate regularly. Specific action recommendations from this baseline evaluation include: increasing face-to-face visits of targeted communities; maintaining or accelerating communication strategies to increase engagement; and providing new techniques that encourage member contributions in order to grow and improve content.
P051: Interventions to improve emergency department consultation processes: a systematic review
Authors: Gaudet L. , Kirkland S. , Keto-Lambert D. , Rowe B.
Published: May 2019

Introduction: Emergency Department (ED) consultations are often necessary for safe and effective patient care. Delays in throughput related to ED consultations can increase a patient's ED length of stay (LOS) and contribute to ED crowding. This review aimed to characterize and evaluate interventions to improve consultation metrics. Methods: Eight primary literature databases and the grey literature were comprehensively searched. Comparative studies of interventions to improve ED consultation metrics were included. Unique citations were screened for relevance and the full-texts of relevant articles were reviewed by two independent reviewers. Data on study characteristics and outcomes were extracted in duplicate onto standardized forms. Disagreements were resolved through consensus. Categorical variables are reported as proportions. Continuous variables are reported as the median of the means and total range. Results: After screening 2632 unique citations and 19 from the grey literature items, 24 studies were included. Seventeen interventions targeted specific conditions or speciality services, while the remainder targeted all ED presentations. Interventions fell into three broad categories: strategies to expedite patient care, including clinical pathways (42%); interventions to improve consultant responsiveness (33%); and addition of a specialized care team to the ED (25%). Overall, eight studies reported on the overall proportion of consults in the ED, of which six reported an increase in the consultation proportion (median: +0.6%, range: −11.3% to +49.6%). Six studies reported the proportion of consulted patients who were admitted, of which four reported an increase (median: +1.1%, range: −5.9% to +3.5%). On the other hand, six of seven studies reporting on time from request to consult arrival reported a decrease (median: −25 minutes, range: −66 to +3.8 minutes). Similarly, overall ED LOS was reported to be lower in 17/19 studies reporting this metric (median: −47.6 minutes, range: −600 minutes to +59 minutes). Conclusion: A variety of strategies have been employed to improve ED consultation processes and outcomes. Neither the proportion of consulted patients in the ED nor the proportion of admissions were improved; however, interventions appeared successful at improving consultant arrival times and overall ED LOS. Improvements in consultation processes may be an effective strategy to improve ED throughput and thereby reduce ED crowding.
P059: Early mobilization of trauma patients admitted to intensive care units: a systematic review and meta-analysis
Authors: Higgins S. , Erdogan M. , Coles J. , Green R.
Published: May 2019

Introduction: Previous systematic reviews suggest early mobilization in the intensive care unit (ICU) population is feasible, safe, and may improve outcomes. Only one review investigated mobilization specifically in trauma ICU patients and failed to identify any relevant articles. The objective of the present systematic review was to conduct an up-to-date search of the literature to assess the effect of early mobilization in adult trauma ICU patients on mortality, length of stay (LOS) and duration of mechanical ventilation. Methods: We performed a systematic search of four electronic databases (Ovid MEDLINE, Embase, CINAHL, Cochrane Library) and the grey literature. To be included, studies must have compared early mobilization to delayed or no mobilization among trauma patients admitted to the ICU. Meta-analysis was performed to determine the effect of early mobilization on mortality, hospital LOS, ICU LOS, and duration of mechanical ventilation. Results: The search yielded 2,975 records from the 4 databases and 7 records from grey literature and bibliographic searches; of these, 9 articles met all eligibility criteria and were included in the analysis. There were 7 studies performed in the United States, 1 study from China and 1 study from Norway. Study populations included neurotrauma (3 studies), blunt abdominal trauma (2 studies), mixed injury types (2 studies) and burns (1 study). Cohorts ranged in size from 15 to 1,132 patients (median, 63) and varied in inclusion criteria. Most studies used some form of stepwise progressive mobility protocol. Two studies used simple ambulation as the mobilization measure, and 1 study employed upright sitting as their only intervention. Time to commencement of the intervention was variable across studies, and only 2 studies specified the timing of mobilization initiation. We did not detect a difference in mortality with early mobilization, although the pooled risk ratio (RR) was reduced (RR 0.90, 95% CI 0.74 to 1.09). Hospital LOS and ICU LOS were decreased with early mobilization, though this difference did not reach significance. Duration of mechanical ventilation was significantly shorter in the early mobilization group (mean difference −1.18. 95% CI −2.17 to −0.19). Conclusion: Our review identified few studies that examined mobilization of critically ill trauma patients in the ICU. On meta-analysis, early mobilization was found to reduce duration of mechanical ventilation, but the effects on mortality and LOS were not significant.
P060: State of the evidence for prehospital use of point-of-care lactate in patients with sepsis: A report from the Prehospital Evidence Based Practice (PEP) program
Authors: Greene J. , Carter A. , Goldstein J. , Jensen J. , Swain J. , Brown R. , Leroux Y. , Lane D.
Published: May 2019

Introduction: Early and accurate diagnosis of critical conditions is essential in emergency medical services (EMS). Serum lactate testing may be used to identify patients with worse prognosis, including sepsis. Recently, the use of a point-of-care lactate (POCL) test has been evaluated in guiding treatment in patients with sepsis. Operating as part of the Prehospital Evidence Based Practice (PEP) Program, the authors sought to identify and describe the body of evidence for POCL use in EMS and the emergency department (ED) for patients with sepsis. Methods: Following PEP methodology, in May 2018, PubMed was searched in a systematic manner. Title and abstract screening were conducted by the program coordinator. These studies were collected, appraised and added to the existing body of literature contained within the PEP database. Evidence appraisal was conducted by two reviewers who assigned both a level of evidence (LOE) on a novel three tier scale and a direction of evidence (supportive, neutral or opposing; based on primary outcome). Data on setting and study design were also extracted. Results: Eight studies were included in our analysis. Three of these studies were conducted in the ED setting; each investigating the POCL test's ability to predict severe sepsis, ICU admission or death. All three studies found supportive results for POCL. A systematic review on the use of POCL in the ED determined that this test can also improve time to treatment. Five of the total 8 studies were conducted prehospitally. Two of these studies were supportive of POCL use in the prehospital setting; in terms of feasibility and the ability to predict sepsis. Both of these study sites used this early information as part of initiating a “sepsis alert” pathway. The other three prehospital studies provide neutral support for POCL. One study demonstrated moderate ability of POCL to predict severe illness. Two studies found poor agreement between prehospital POCL and serum lactate values. Conclusion: Limited low and moderate quality evidence suggest POCL may be feasible and helpful in predicting sepsis in the prehospital setting. However, there is sparse and inconsistent support for specific important outcomes, including accuracy.
P068: Significance of asymptomatic oxygen desaturation in elderly ED patients: A pilot study
Authors: Johnston L. , Innes G.
Published: May 2019

Introduction: Pulse oximetry is a standard component of Emergency Department (ED) patient monitoring. Pulse oximetry measures peripheral capillary oxygen saturation (SpO2) levels and can be used to monitor cardiorespiratory conditions. The normal SpO2 level for adults is approximately 96%. Oxygen saturations of <92% are considered problematic and levels <90% may indicate cardiorespiratory disease. However, low oxygen saturations are often seen in elderly patients with comorbidities. This research investigated the significance of hypoxia in asymptomatic older ED patients with no apparent acute illness. Methods: ED patients >75 years with a documented room air pulse oximetry reading <92% were eligible. Exclusion criteria included dyspnea, chest pain, SBP <100mmHg, HR >120 or <50; sustained tachypnea (RR > 20); acute cardiopulmonary conditions, delirium or acutely altered mentation. Eligible patients were separated into two groups: 1) Sustained hypoxia: two or more SpO2 readings <92% 2) Unsustained hypoxia: one SpO2 reading <92%. 30-day adverse events were tracked using a Sunrise Emergency Care record review. Adverse outcomes investigated included death, MI, CHF, PE, cardioversion, ICU admission, intubation, ED revisit or re-hospitalization. Patient characteristics studied were age, sex, arrival mode, triage complaint, CTAS level, pulse, BP, RR, weight, residence (independent, assisted living, facility), comorbidities, PHN, referral, disposition, and test results (CXR, troponin, ECG, CT). Follow-up phone calls were completed after 30 days to assess patient status and confirm ED revisit. Results: A total of 876 ED patients >75 years were screened and 30-day follow-up data was analyzed for 34 enrolled patients. The sustained hypoxia group (n = 23) showed higher rates of 30-day adverse outcomes of death, ED re-visitation, MI, CHF, a severe episode of COPD, PE and ICU stays compared to the unsustained hypoxia group (n = 11). Administrative data of 31,095 patients >75 years from four Calgary EDs in 2017 was also analyzed and 7,771 (20%) were hypoxic at triage (SpO2 <92%). Adverse outcomes and mortality were significant in discharged hypoxic patients (especially if SpO2 <90%). Conclusion: ED re-visits, cardiorespiratory complications, and mortality were significant in discharged sustained hypoxic patients, especially if O2 sat <90%. Pulse oximetry assessment of oxygen saturation in seniors’ care facilities and physicians’ offices may be important in screening for future adverse health outcomes in elderly patients.
P080: What is the impact of post-intubation hypotension on mortality and in-hospital length of stay?
Authors: Lachance-Perreault D. , Turgeon J. , Boucher V. , Émond M.
Published: May 2019

Introduction: Hypotension is known to severely impact the prognosis of patients in need of acute care. Endotracheal intubation (EI) is a procedure that is often used in the emergency room for patients with severe conditions. Post-intubation hypotension (PHI) is a well-known adverse effect of EI, although the impact of PHI on mortality is still unclear. The objective of this study was therefore to evaluate the association between post-intubation hypotension (PIH) and in-hospital mortality rates and length of stay (LOS). Methods: Design: A historical cohort of patients admitted in a university-affiliated emergency department (ED) between 06/2011 and 05/2016 was constituted. Population: Patients aged ≥16 were included if pre-EI vital signs were available, if their intubation was performed in the resuscitation room, if no surgical access was needed and if EI was performed in ≤3 attempts. Measures: All clinical data including vitals were prospectively recorded using the software ReaScribe. Hypotension was defined as a systolic blood pressure ≤90 mmHg. The occurrence of PIH was assessed at 5, 15, 30 minutes and any time after intubation. Main outcomes were in-hospital mortality and hospital length of stay. Analyses: Univariate and multivariate analyses assessed the relation between PHI and outcomes. Results: A total of 497 patients were included in our analyses. Of these patients, 63 (12.7%) suffered from PIH at 5 minutes, 120 (24,1%) at 15 minutes, 168 (33,8%) at 30 minutes and 209 (42%) at any moment after intubation. Mortality rates were 42.9% (n = 27), 35.8% (n = 43), 33.9% (n = 57) and 30.6%(n = 64) for patients who presented PIH at the 4 time periods, respectively, while 26.74% patients died in the normotensive group. PIH at 5 (p = 0.006), 15 (p = 0.04) and 30 minutes (p = 0.05) was associated with a significant increase in overall post-intubation mortality. Mean LOS for patients who suffered from PIH was 16.7, 18.9, 17.3, 17.4 days compared to 19.5 (p = 0.22) days for the normotensive group. Conclusion: Early post-intubation hypotension at 5 minutes was strongly associated with an increased mortality. As for the in-hospital length of stay, PIH was not associated with an increased LOS. Our results show that PIH within 30 minutes of intubation is associated with an increased mortality rate and should therefore be aggressively treated or prevented.
P084: The sky is not the limit! Protocol for a rapid systematic review on the use of drones in emergency medicine
Authors: Lapointe L. , Buisson C. , Fleet R.
Published: May 2019

Introduction: Drones are already being used in medicine. They are employed to transport blood products and laboratory samples in rural and remote areas and they are increasingly being tested to deliver external defibrillators outside the hospital to patients with cardiac arrest. As this technology rapidly develops and attracts the attention of the scientific community, we present a rapid systematic review protocol that aims to synthesize the scientific evidence that has tested the use of drones to provide emergency medical care. Methods: A search strategy incorporating the concepts of ‘drone’ and ‘emergency medicine’ was launched in 52 bibliographic databases, including CINAHL and PubMed. Using the artificial intelligence module included in DistillerSR, a reviewer completed the first screening phase by reading the title and abstract of the retrieved articles. To be included, articles had to report empirical research projects that tested the potential uses of drones to improve the quality and accessibility of emergency medical care. These selection criteria were applied to the full text of the included articles during the second screening phase by a single reviewer. The results of these two screening phases will be validated by a second independent reviewer. The bibliography of included studies, relevant scientific journals and literature reviews will be manually searched for relevant articles. Results: The search strategy retrieved 1809 articles, of which 22 met our inclusion criteria in the first and second screening phases. Of these, one study used an empirical research design (qualitative interviews) to evaluate the usefulness of drones in emergency medicine, 17 used simulations or scenarios, and four were comprehensive literature reviews on the use of drones to provide healthcare. The final review will synthesize evidence related to the use of drones in emergency medicine and its impact on emergency medical services: nature of the emergency situation (cardiac arrest, blood transfusion), type of drone (fixed wing, quadcopter), tasks performed by drones (transport, surveillance), improvement in access or quality of care (patient's health, time saved in providing services). Conclusion: Drone technology is evolving rapidly and the indications for its use in providing emergency care is increasing. This rapid systematic review will focus on scientific studies aimed at testing the effectiveness of drones to improve the quality and access to emergency medical care.
P111: Introduction of an ECPR protocol to paramedics in Atlantic Canada; a pilot knowledge translation project
Authors: Rouse C. , Mekwan J. , Atkinson P. , Fraser J. , Gould J. , Rollo D. , Middleton J. , Pishe T. , Howlett M. , Legare J. , Chanyi S. , Tutschka M. , Hassan A. , Lutchmedial S.
Published: May 2019

Introduction: There is currently no protocol for the initiation of extra corporeal cardiopulmonary resuscitation (ECPR) in out of hospital cardiac arrest (OHCA) in Atlantic Canada. Advanced care paramedics (ACPs) perform advanced cardiac life support in the prehospital setting often completing the entire resuscitation on-scene. Implementation of ECPR will present a novel intervention that is only available at the receiving hospital, altering how ACPs manage selected patients. Our objective is to determine if an educational program can improve paramedic identification of ECPR candidates. Methods: An educational program was delivered to paramedics including a short seminar and pocket card coupled with simulations of OHCA cases. A before and after study design using a case-based survey was employed. Paramedics were scored on their ability to correctly identify OHCA patients who met the inclusion criteria for our ECPR protocol. Scores before and after the education delivery were compared using a two tailed t-test. A 6-month follow-up is planned to assess knowledge retention. Qualitative data was also collected from paramedics during simulation to help identify potential barriers to implementation of our protocol in the prehospital setting. Results: Nine advanced care paramedics participated in our educational program. Mean score pre-education was 9.7/16 (61.1%) compared to 14/16 (87.5%) after education delivery. The mean difference between groups was 4.22 (CI = 2.65-5.80, p = 0.0003). There was a significant improvement in the paramedics’ ability to correctly identify ECPR candidates after completing our educational program. Conclusion: Paramedic training through a didactic session coupled with a pocket card and simulation appears to be a feasible method of knowledge translation. 6-month retention data will help ensure knowledge retention is achieved. If successful, this pilot will be expanded to train all paramedics in our prehospital system as we seek to implement an ECPR protocol at our centre.
P149: Benign headache management in Alberta emergency departments: a chart review study to explore gaps in practice
Authors: Gouda J. , Runham N. , Krebs L. , Couperthwaite S. , Rowe B.
Published: May 2019

Introduction: Variation in medication management and image ordering for HA presentation to emergency departments (ED) has been documented. This study examined benign HA (i.e., migraine, cluster, tension) management in order to identify the consistency and appropriateness of HA management in EDs in Alberta. Methods: Patients were identified by primary discharge diagnosis in the National Ambulatory Care Reporting System using ICD-10-CA codes for benign HA (G43, G44, R51). Patients presenting to study sites from January 1, 2017 to September 30, 2017 were eligible for inclusion, provided they were adults (≥18 years), were not transferred from another institution or directly admitted to a service, and had an active HA at presentation. One hundred eligible patients were randomly selected for chart review. Data were extracted on standardized forms. Preliminary data on 50 patients (n = 150) from three Edmonton study sites is presented. Results: Most patients arrived to the ED via personal transportation (93%) and were assigned a Canadian Triage and Acuity Scale (CTAS) score of 3 (71%). The majority of patients were female (75%); mean age was 45 years (standard deviation: 18). Triage pain score was not documented for 21%. When documented, pain scores were most frequently between 4 and 7 (49%). Nearly 10% of patients left without being seen. For those who were assessed, physicians most frequently used ketorolac and metoclopramide as first or second line treatments or as a combination treatment. Consults were infrequent (14%). Nearly half of the patients (47%). had computed tomography (CT) in the ED. Pain re-assessment was completed for 69% of patients. Most patients were discharged from the ED (88%) and given some form of discharge instruction (78%). The most common instructions were to return to ED as needed (45%) and follow-up with their primary care physician (28%). Across all patients, 13% returned to the ED with headache within 30 days. Conclusion: Physicians treat patients with benign headaches appropriately and hospitalization is infrequent; however, one in eight patients relapse. Missing pain scale documentation reveals a potential problem for ED clinicians in assessing management effectiveness and ensuring patients leave the ED following pain relief. Half of the patients received a CT scan, highlighting the urgent need for an intervention to address CT overuse for patients with benign HA within this geographic region.
LO20: Naloxone dosing for suspected opioid and ultra-potent opioid overdoses: A systematic review
Authors: Moe J. , Godwin J. , Purssell R. , O'Sullivan F. , Hau J. , Purssell E. , Curran J. , Doyle-Waters M. , Brasher P. , Buxton J. , Hohl C.
Published: May 2019

Introduction: Optimizing naloxone dosing in the context of increasing fentanyl and ultra-potent opioid (UPO) prevalence is an important consideration for emergency health care providers. The goal of this systematic review was to evaluate the association between initial and cumulative naloxone doses on effective reversal and adverse events in undifferentiated and fentanyl/UPO overdoses. Methods: We searched Embase, MEDLINE, Cochrane Central Register of Controlled Trials, DARE, CINAHL, Science Citation Index, reference lists, toxicology websites, and conference proceedings from July to October 2018 and back to 1972. Our search included pertinent indexing terms for UPOs. We included interventional and observational studies reporting on naloxone administration for opioid toxicity reversal in people ≥12 years old. Additionally, we accessed non-traditional evidence sources (case reports and series) given this rapidly changing field. We conducted inclusion screens, data extraction and quality assessments in duplicate. We summarized study characteristics and where reported, analyzed number of patients with clinical response. Response was defined as not receiving further naloxone doses and remaining alive. Results: We included 174 studies (108 case reports and series, 55 observational, 9 interventional) with 26,660 subjects (median age 35.1; 74.2% male). We observed lower response among patients exposed to fentanyl/UPO versus heroin for initial naloxone doses ≤0.4mg (56.8% versus 80.2%) and > 0.4mg (27.0% versus 82.1%). Mean cumulative doses were higher for fentanyl/UPO (2.10 mg, SD 1.80 mg) versus heroin (1.48 mg, SD 1.68 mg) overdoses. In North American studies the median cumulative dose used was higher for fentanyl/UPO versus heroin overdoses. A dose-response curve for fentanyl/UPO studies showed marked variability in doses among responders, indicating heterogeneity. Adverse events reporting was inconsistent; 10% of subjects experienced withdrawal based on studies in which they were reported. Conclusion: This is the first systematic review to summarize proportion of patients with clinical response by naloxone dose provided. While variable reporting, study quality, heterogeneity, and our outcome definitions limit the conclusions we can draw, it appears that higher initial doses and in some cases, higher cumulative naloxone doses were used and may be necessary to reverse toxicity due to fentanyl/UPO compared to other opioids. High-quality prospective studies assessing effectiveness and safety are needed.
Convection in an internally heated stratified heterogeneous reservoir
Authors: Limare Angela , Jaupart Claude , Kaminski Edouard , Fourel Loic , Farnetani Cinzia G.
Published: May 2019

The Earth’s mantle is chemically heterogeneous and probably includes primordial material that has not been affected by melting and attendant depletion of heat-producing radioactive elements. One consequence is that mantle internal heat sources are not distributed uniformly. Convection induces mixing, such that the flow pattern, the heat source distribution and the thermal structure are continuously evolving. These phenomena are studied in the laboratory using a novel microwave-based experimental set-up for convection in internally heated systems. We follow the development of convection and mixing in an initially stratified fluid made of two layers with different physical properties and heat source concentrations lying above an adiabatic base. For relevance to the Earth’s mantle, the upper layer is thicker and depleted in heat sources compared to the lower one. The thermal structure tends towards that of a homogeneous fluid with a well-defined time constant that scales with $Ra_{H}^{-1/4}$, where $Ra_{H}$ is the Rayleigh–Roberts number for the homogenized fluid. We identified two convection regimes. In the dome regime, large domes of lower fluid protrude into the upper layer and remain stable for long time intervals. In the stratified regime, cusp-like upwellings develop at the edges of large basins in the lower layer. Due to mixing, the volume of lower fluid decreases to zero over a finite time. Empirical scaling laws for the duration of mixing and for the peak temperature difference between the two fluids are derived and allow extrapolation to planetary mantles.
State Ownership and “State-Sharing”: The Role of Collective Identities and the Sociopolitical Cleavage between Ethnic Macedonians and Ethnic Albanians in the Republic of North Macedonia
Authors: Piacentini Arianna Maria
Published: May 2019

The article analyzes, from a historical and institutional perspective, the sociopolitical cleavages existing between ethnic Macedonians and ethnic Albanians in the Republic of North Macedonia. Although primarily ethnic, the division between the two groups is deeply connected to state ownership and the official status each group occupies and wishes to occupy in it. By scrutinizing both groups’ claims, standpoints, and dissatisfactions, the article asserts that the implementation of consociationalism in 2001, through the de facto institutionalization of ethnicity, has partly soothed both groups’ frustrations, using the pragmatic exploitation of the existing ethnic divide as a proxy for “state sharing” in addition to power sharing.
Outside Options and the Logic of Security Council Action
Authors: Voeten Erik
Published: May 2019

I examine if and how a superpower can use its asymmetric power to achieve favorable outcomes in multilateral bargaining between states that have conflicting interests and veto power. Using a game-theoretic framework, I show that the ability to act outside, either unilaterally or with an ally, helps the superpower to reach agreements that would be vetoed in the absence of the outside option. These agreements, however, are usually not at the superpower's ideal point. Under some conditions, uncertainty about the credibility of the outside option can lead to unilateral action that all actors prefer to avoid. In other circumstances, this uncertainty results in multilateral actions that the superpower (and the ally) would not initiate without multilateral authorization. The model provides useful insights that help explain patterns of decision-making in the United Nations Security Council in the 1990s, including the failed attempt to reach agreement over the Kosovo intervention.
Realignment and Macropartisanship
Authors: Meffert Michael F. , Norpoth Helmut , Ruhil Anirudh V. S.
Published: May 2019

Aggregate party identification (macropartisanship) has exhibited substantial movement in the U.S. electorate over the last half century. We contend that a major key to that movement is a rare, massive, and enduring shift of the electoral equilibrium commonly known as a partisan realignment. The research, which is based on time-series data that employ the classic measurement of party identification, shows that the 1980 election triggered a systematic growth of Republican identification that cut deeply into the overwhelming Democratic lead dating back to the New Deal realignment. Although short-term fluctuations in macropartisanship are responsive to the elements of everyday politics, neither presidential approval nor consumer sentiment is found responsible for the 1980 shift.
Agency and Ethics: The Politics of Military Intervention. By Anthony F. Lang, Jr. Albany: State University of New York Press, 2001. 256p. $65.50 cloth, $21.95 paper.
Authors: Mansbach Richard W.
Published: May 2019

Anthony F. Lang's Agency and Ethics is an effort to reinterpret international intervention from a normative perspective, normative in this instance referring to activities that construct identities and provide policy guidance. Although he describes himself as a “realist” (p. 3), Lang sets out to explain the outcome of military intervention in terms of the interaction between the normative dimension and the “political,” which he defines as the competitive elements in a situation. He argues that states intervene in one another's affairs owing to what they believe are the norms that define their role(s) in international politics, and he shows how norms produce conflict as well as cooperation. In the cases that follow, Lang focuses on three norms—liberalism, colonialism, and humanitarianism: The first focuses on democracy, individual rights, and national self-determination; the second on responsibility for politically and economically less developed societies; and the third on assisting those in need. He ascribes the failure of intervention to normative disagreement among both friends and adversaries within and between participating countries, and he uses what Alexander George calls a “focused comparison” of cases to illustrate his claim.
Reforming Parliamentary Committees: Israel in Comparative Perspective. By Reuvan Y. Hazan. Columbus: Ohio State University Press, 2001. 216p. $50.00.
Authors: Jacobsohn Gary Jeffrey
Published: May 2019

This book is the result of a five-year research project that had as its goal the reform of the committee system in the Israeli Knesset. It had the full support of the leadership and members of that legislative body, and was conducted under the sponsorship of an important Israeli think tank, the Israel Democracy Institute. In undertaking this investigation, Reuvan Y. Hazan quickly discovered an additional reason for devoting so much time to this subject—the challenge of addressing “a flagrant deficiency in the political science literature” (p. 2), the dearth of comparative literature on parliamentary reform of committees.
Democracy in Divided Societies: Electoral Engineering for Conflict Management. By Benjamin Reilly. Cambridge: Cambridge University Press, 2001. 232p. $60.00 cloth, $22.00 paper.
Authors: Mozaffar Shaheen
Published: May 2019

Benjamin Reilly makes an important contribution to the debate on the appropriate institutional design of electoral systems for mitigating conflict and sustaining democracy in ethnically plural societies. The dominant position in this debate posits the importance of proportional representation (PR) systems. An alternative position, less widely accepted largely because of an ostensible absence of empirical examples, posits the importance of majoritarian preferential systems that encourage cross-ethnic vote pooling. Reilly extends this debate by drawing on heretofore unknown or understudied cases to examine the operation of both majoritarian (the alternative vote or AV and the supplementary vote or SV) and proportional (single-transferable vote or STV) preferential systems in different social contexts and in different elections (legislative and presidential).
The Ramparts of Nations: Institutions and Immigration Policies in France and the United States. By Jeffrey M. Togman. Westport, CT: Praeger Publishers, 2001. 176p. $49.00.
Authors: Haus Leah
Published: May 2019

Faced with similar economic circumstances, France and the United States adopted different immigration policies at various times in the twentieth century. Jeffrey Togman asks why. To account for this variation in public policy outcome, he points to the different structure of political institutions in the two countries.