bluuebunny/crossref_metadata_2025 huggingface dataset:
Cooling rates of pyroclastic deposits inferred from mineral magnetic investigations: a case study from the Pleistocene Mýtina Maar (Czech Republic)
Authors: Lied Philipp , Kontny Agnes , Nowaczyk Norbert , Mrlina Jan , Kämpf Horst
Published: May 2020

Tephra layers of the Mýtina Maar, Czech Republic, contain ferrimagnetic Mg–Al-rich titanomagnetite, which is suggested to originate from a fractionated alkaline CO2-rich lithospheric mantle melt. We investigated the magnetic mineralogy and Curie temperature (TC) from tephra deposits of two drill cores (< 9 m depth). TC calculated (208 ± 14 °C) from chemical composition (Fe2+0.8Mg0.5Fe3+1.1Al0.3Ti0.3O4) is in accordance with TC retrieved from cooling curves of temperature-dependent magnetic susceptibility measurements (195–232 °C). However, thermomagnetic curves are irreversible either with lower (type I) or higher (type II) TC in the heating curve. All curves show transition temperatures above ca. 390 °C, indicating maghemitization. We interpret the irreversibility of TC (∆TC) in terms of different degrees of cation ordering, overprinted or masked by different degrees of maghemitization, which is a low-temperature phenomenon. Negative ∆TC indicates that original deposited titanomagnetite has cooled faster and, therefore, has stored a lower degree of cation ordering compared to heating/cooling rate of 11 °C/min in the Kappabridge. Type II with positive ∆TC indicates higher degree of cation ordering, and, therefore, slower cooling rate. The central part of this deposit shows most severe maghemitization, indicating rather wet emplacement. We, therefore, suggest different eruption styles for deposition of type I pyroclastics with more phreatomagmatic and type II pyroclastics with more phreato-Strombolian eruption styles. Our study is a new approach to discriminate different cooling histories in maar deposits using the Curie temperature of titanomagnetite. We suggest that this method has the potential to discriminate different emplacement modes resulting from different eruption styles.
Der familiäre Hintergrund „suchtbelastete Familie“ und dessen Auswirkung auf Mentalisierungsprozesse fremduntergebrachter Kinder
Authors: Springer Nadja , Lueger-Schuster Brigitte
Published: May 2020

Studien über Bindung weisen auf Schwierigkeiten drogenabhängiger Eltern hinsichtlich ihrer Reaktion auf die emotionalen Signale der Kinder und die daraus abzuleitenden Verhaltensweisen hin. Dies lässt auf eine reduzierte Mentalisierungsfähigkeit schließen. Mentalisieren bedeutet die grundlegende menschliche Fähigkeit, Verhalten in Bezug auf Gedanken und Gefühle zu verstehen.

Um diese Fähigkeit bei fremduntergebrachten Kinder (6–12 Jahre) aus suchtbelasteten Familien und deren aktuellen Bezugspersonen zu untersuchen, wurde eine auf dem Konzept der Mentalisierung basierende Gruppenintervention entwickelt, die das Wissen über Drogenabhängigkeit erweitern und soziale und affektive Fähigkeiten verbessern soll.

Erhebungsinstrumente: Skala des Reflective Functioning (RF-Score) für das Adult Attachment Interview und für das Child Attachment Interview, Inventar der Sozialkompetenzen (ISK), Coloured Progressive Matrices (CPM), Child Behavior Checklist (CBCL/6-18R), „Patte-Noire“-Test, Einstellungen zum Drogenkonsum (EBDD Bewertungsinstrument).

An Hand zweier Fallbeispiele aus dieser laufenden Pilotstudie, werden der diagnostische Prozess sowie beobachtbare und messbare Veränderungen über den Untersuchungszeitraum von mehr als 12 Monaten exemplarisch dargestellt und diskutiert.
Whole genome sequence analysis of Cupriavidus campinensis S14E4C, a heavy metal resistant bacterium
Authors: Abbaszade Gorkhmaz , Szabó Attila , Vajna Balázs , Farkas Rózsa , Szabó Csaba , Tóth Erika
Published: May 2020

Cupriavidus sp. are model organisms for heavy metal(loid) resistance and aromatic compound’s degradation studies and these characteristics make them a perfect candidate for biotechnological purposes. Bacterial strain S14E4C (identified as Cupriavidus campinensis) was isolated from a playground by enrichment method in a 0.25 mM containing medium. The analysis revealed that this bacterium is able to tolerate high concentrations of heavy metal(loid)s: Cd up to 19.5 mM, Pb to 9 mM, Hg to 5.5 mM and As to 2 mM in heavy metal(loid) salt containing nutrient medium. The whole genome data and analysis of the type strain of C. campinensis CCUG:44526T have not been available so far, thus here we present the genome sequencing results of strain S14E4C of the same species. Analysis was carried out to identify possible mechanisms for the heavy metal resistance and to map the genetic data of C. campinensis. The annotation pipelines revealed that the total genome of strain S14E4C is 6,375,175 bp length with a GC content of 66.3% and contains 2 plasmids with 295,460 bp (GC content 59.9%) and 50,483 bp (GC content 63%). In total 4460 coding sequences were assigned to known functions and 1508 to hypothetical proteins. Analysis proved that strain S14E4C is having gene clusters such as czc, mer, cus, chr, ars to encode various heavy metal resistance mechanisms that play an important role to survive in extreme environments.
A Mineralogical Investigation of Sintering in Cu-Rich Polymetallic Concentrates During Roasting in Inert Atmosphere
Authors: Prasad Pande Nishant , Lennartsson Andreas , Samuelsson Caisa
Published: May 2020

Four different Cu-rich polymetallic concentrates (additionally comprising Zn, Pb and impurity elements As, Sb) from various deposits in Sweden are examined, in particular for the sintering tendency during roasting in inert atmosphere. Experiments performed in a laboratory-scale roasting setup between 200 °C and 700 °C in intervals of 100 °C revealed that significant sintering initiates from 500 °C for all four concentrates. Two sintering mechanisms are determined from the examination of the sintered calcines: (1) solid-state assimilation of Cu-, Zn- and Fe-bearing main sulphide minerals to form a high-temperature solid solution, the iss phase belonging to the Cu-Fe-Zn-S system; (2) low-melting liquid phase formation due to partial melting of galena facilitated by the presence of impurity-bearing minerals, mainly the arsenopyrite and Sb sulphosalts such as tetrahedrite. Galena also forms a melt below 700 °C with the iss phase. Therefore, the presence of galena in polymetallic concentrates generally increases the susceptibility to early sintering. These experiments in inert atmosphere facilitate a fundamental study with practical relevance to the roasting in low oxidation potential environments, favourable for volatilization of impurity elements such as As and Sb.
A Novel Evidence That Mannan Binding Lectin (MBL) Pathway of Complement Cascade Activation is Involved in Homing and Engraftment of Hematopoietic Stem Progenitor Cells (HSPCs)
Authors: Adamiak Mateusz , Cymer Monika , Anusz Krzysztof , Tracz Michał , Ratajczak Mariusz Z.
Published: May 2020

Delayed homing and engraftment of hematopoietic stem progenitor cells (HSPCs) or even failure to engraft at all is significant clinical problem after hematopoietic transplant. Therefore, in order to develop more efficient homing and engraftment facilitating strategies it is important to learn more about this process. Our team has postulated that myeloablative conditioning for transplantation induces in bone marrow (BM) microenvironment a state of sterile inflammation in which elements of innate immunity activated by radio- or chemotherapy conditioning for transplant play an important role. In frame with this claim we reported that a significant role in this process plays activation of complement cascade (ComC). Accordingly, mice that that lack a fifth component (C5) of ComC turned out to engraft poorly with normal syngeneic BM cells as compared to normal control animals. In extension of our previous studies we provide for first time evidence that mannan binding lectin (MBL) pathway is involved in activation of ComC in myeloablated transplant recipient BM and thus plays an important role in homing and engraftment of HSPCs. To support this MBL-KO mice show significant defect in hematopoietic reconstitution after hematopoietic transplantation. This correlates with a decrease in expression of stromal derived factor-1 (SDF-1) and impaired activation of Nlrp3 inflammasome in irradiated BM of these mice.
Long-term Effects of a Mindfulness-Based Childbirth and Parenting Program—a Randomized Controlled Trial
Authors: Lönnberg Gunilla , Jonas Wibke , Bränström Richard , Nissen Eva , Niemi Maria
Published: May 2020

Objectives

The aim of the present study was to investigate long-term effects of Mindfulness-Based Childbirth and Parenting (MBCP) during pregnancy on women’s perceived stress and depressive symptoms during the first year postpartum.

Methods

Women (n = 193) who were pregnant with their first child and at risk for perinatal depression were randomized to MBCP or an active control condition, which consisted of a Lamaze childbirth class. The women provided self-reported data on perceived stress, depressive symptoms, positive states of mind, and the Five Facets of Mindfulness Questionnaire at baseline, postintervention, and at 3, 9, and 12 months postpartum.

Results

Linear mixed model analysis showed that the intervention group had a larger decrease in stress (p = 0.04) and depression scores (p = 0.004) and larger increase in positive states of mind (p < 0.001) and mindfulness scores (p < 0.001) from baseline to postintervention (10–12 weeks later), compared with the active control group. These initial effects were not sustained during the follow-up period. However, analyses restricted to mothers in the MBCP condition showed that those who reported continued mindfulness practice during the follow-up period (n = 50) had a greater initial effect of the intervention and sustained the effects to a larger degree, compared with mothers who did not continue practicing mindfulness (n = 21).

Conclusions

This study gives partial support for providing MBCP for pregnant women. Although the initial beneficial effects from MBCP were not sustained during the postpartum period, the findings warrant further investigations since the improvements take place in a time that is crucial for the mother–infant dyad.

Trial Registration

ClinicalTrials.gov ID: NCT02441595.
Carotenoids: Potent to Prevent Diseases Review
Authors: Bhatt Takshma , Patel Kirtan
Published: May 2020

Carotenoids are the phytochemicals known for their biological activities. They are found in nature in the form of plants, algae, fungi and in microorganisms. This is the major group having two different structure one with oxygen and without oxygen. The Present article aims to present these molecules as a new therapeutic agent, as it has unrealized efficiency to prevent and reduce the symptoms of many diseases like cancer, neurodegenerative diseases such as Alzheimer, cerebral ischemia, diabetes associated with obesity and hypertension, ophthalmic diseases and many more. It can be utilized in the form of dietary supplement as nutraceutical and pharmaceutical compounds. Yet more research and developing test knowledge is needed to make it available to the humans. In this article its sources, biosynthesis, properties, applicability and commercialization of pigments from naturally produced sources are discussed.

Graphic Abstract
Probiotics and the Microbiota-Gut-Brain Axis: Focus on Psychiatry
Authors: Mörkl Sabrina , Butler Mary I , Holl Anna , Cryan John F , Dinan Timothy G
Published: May 2020

Purpose of Review

Probiotics are living bacteria, which when ingested in adequate amounts, confer health benefits. Gut microbes are suggested to play a role in many psychiatric disorders and could be a potential therapeutic target. Between the gut and the brain, there is a bi-directional communication pathway called the microbiota-gut-brain axis. The purpose of this review is to examine data from recent interventional studies focusing on probiotics and the gut-brain axis for the treatment of depression, anxiety and schizophrenia.

Recent Findings

Probiotics are likely to improve depression but not schizophrenia. Regarding anxiety, there is only one trial which showed an effect of a multispecies probiotic. However, determinants like the duration of treatment, dosage and interactions have not been thoroughly investigated and deserve more scientific attention.

Microbiome-based therapies such as probiotics could be cautiously recommended for depression to enhance beneficial bacteria in the gut and to improve mood through the gut-brain axis.
Laser transmission welding of absorber-free semi-crystalline polypropylene by using a quasi-simultaneous irradiation strategy
Authors: Nguyen Nam-Phong , Behrens Stefan , Brosda Maximilian , Olowinsky Alexander , Gillner Arnold
Published: May 2020

Unlike other joining techniques, laser transmission welding offers unique advantages such as selective and contactless energy deposition. This enables the fabrication of flexible seam geometries at low mechanical and thermal stresses. However, the use of absorbing additives for the lower joining partner such as carbon black is crucial as most polymers are transparent in the spectral range of typical beam sources (800–1100 nm). A novel approach is the application of beam sources emitting radiation within the polymeric intrinsic absorption bands between 1500 and 2000 nm. This enables absorber-free laser welding of transparent polymers for medical or microfluidic applications such as Lab-on-a-Chip devices. The main drawback on the other hand is the large heat affected zone (HAZ) due to the volume absorption which is extending over the entire cross section. A possible way to overcome this disadvantage is a quasi-simultaneous irradiation strategy. It could be proved in the past that the HAZ of polycarbonate (PC) can be reduced in the vertical direction by up to 30% compared with contour welding. Since the effects of light scattering on the absorber-free quasi-simultaneous irradiation strategy are still unknown, the beam propagation was simulated in polypropylene (PP). Based on the results, a thermal simulation of the welding process was carried out using the finite element method (FEM). The simulation model was then evaluated by comparing the results with experimental trials.
Effect of increased yield strength, R-ratio, and plate thickness on the fatigue resistance of high-frequency mechanical impact (HFMI)–treated steel joints
Authors: Leitner M. , Barsoum Z.
Published: May 2020

In 2016, the International Institute of Welding (IIW) published a recommendation for high-frequency mechanical impact (HFMI) treatment for improving the fatigue strength of welded joints. Since the publication of the HFMI recommendations, numerous of studies have been published with a considerable amount of new fatigue test data focusing on various aspects of the improvement; influence of base material yield strength, and loading and thickness effects. Since the data was scarce covering some of the aspects when the recommendation was published, re-evaluating the recommendation with these new test data, presented within this work, will further validate and extend the recommendations. The analysis reveals that the recommended improvement of fatigue classes based on the base material yield strength is well applicable. In addition, the reduction of fatigue classes for higher R-ratios up to the defined value of R = 0.52 is well considered. Finally, the practicability of the thickness correction factor is also confirmed by leading to a conservative fatigue assessment. The ratio of the statistically evaluated FAT class to the recommended value is shown to be conservative with a value of above one for almost every data set; however, even the ratio is below one in some minor cases, every single test data point in this study is assessed conservatively validating the applicability of the recommendation.
Kinetic separation of CO2/CH4 mixtures with Ni-MOF-74@Al2O3 core–shell composites
Authors: Otter D. , Ernst S.-J. , Krätz L. , Bart H.-J.
Published: May 2020

A novel core–shell species for the adsorption-based separation of carbon dioxide (CO2) from methane (CH4) is introduced by hydrothermal synthesis of Ni-MOF-74 on mesoporous spherical Al2O3 carrier substrate. The material was characterized and the shell thickness determined by means of optical and scanning electron microscopy as well as volumetric adsorption and fluid displacement experiments. Kinetic experiments with Ni-MOF-74@Al2O3 core–shell composites carried out at 303.15 K and at pressures up to 10 bar expose remarkably dominating uptake rates for CO2 over CH4. In the contrary Ni-MOF-74@Al2O3 appears to be unselective according to equilibrium data at the same conditions. Dynamic breakthrough experiments of binary CH4/CO2-mixtures (at 303.15 K and 5 bar) prove the prevailing effect of adsorption kinetics and the storage function of the mesoporous core. This statement is supported by a considerable boost in CO2-selectivity and capacity compared to adsorption equilibria measured on pure Ni-MOF-74 by the factor of 55.02 and up to 2.42, respectively.
The longitudinal associations among perceived discrimination, social initiative, and depressive symptoms in Chinese rural left‐behind adolescents☆
Authors: Zhao Jingxin , Wang Qian , Xue Xiangjuan
Published: May 2020

Introduction

Perceived discrimination is a significant stressor in the lives of Chinese rural left‐behind adolescents. Although some research has examined the effects of perceived discrimination on left‐behind adolescents’ psychosocial functioning, the majority of existing research is cross‐sectional, which limits the understanding of the underlying mechanism of these effects. The current study used a longitudinal design to explore how perceived discrimination is associated with psychosocial functioning (i.e., depressive symptoms and social initiative) over time in Chinese rural left‐behind adolescents.

Methods

A total of 1011 rural left‐behind adolescents (54% boys) were involved in an ongoing longitudinal study. At Time 1 (Mage = 12.93, SD = 0.86), adolescents completed measures of perceived discrimination, depressive symptoms, and social initiative. At Time 2 (one year later), adolescents again reported on their depressive symptoms and social initiative.

Results

Perceived discrimination was concurrently and longitudinally associated with left‐behind adolescents’ depressive symptoms and social initiative. The effect of perceived discrimination on depressive symptoms was partially mediated by social initiative, while the effect of perceived discrimination on social initiative was fully mediated by depressive symptoms. The associations applied equally to adolescents with two migrant parents and adolescents with only a migrant father.

Conclusions

These findings suggest the harmful impact of perceived discrimination on rural left‐behind adolescents' social initiative and depressive symptoms and underscore the importance of eliminating discrimination in the rural left‐behind adolescents’ intervention program.
Synthetic photometric landmarks used for absolute navigation near an asteroid
Authors: Knuuttila O. , Kestilä A. , Kallio E.
Published: May 2020

The need for autonomous location estimation in the form of optical navigation is an essential requirement for forthcoming deep space missions. While crater-based navigation might work well with larger bodies littered with craters, small sub-kilometer bodies do not necessarily have them. We have developed a new pose estimation method for absolute navigation based on photometric local feature extraction techniques thus making it suitable for missions that cannot rely on craters. The algorithm can be used by a navigation filter in conjunction with relative pose estimation such as visual odometry for additional robustness and accuracy. To estimate the position and orientation of the spacecraft in the asteroid-fixed coordinate frame, it uses navigation camera images in combination with other readily available information, such as orientation relative to the stars and the current time for an initial estimate of the asteroid rotation state. Evaluation of the algorithm when using different feature extractors is performed, on one hand, using Monte Carlo simulations and, on the other hand, using actual images taken by the Rosetta spacecraft orbiting the comet 67P/Churyumov–Gerasimenko. Our analysis, where four different feature extraction methods (AKAZE, ORB, SIFT, SURF) were compared, showed that AKAZE is most promising in terms of stability and accuracy.
LO45: Women's perspectives on early pregnancy complications and supportive care needs: a qualitative multi-site study
Authors: Dainty K. , Seaton B. , Rojas-Luengas V. , McLeod S. , Tunde-Byass M. , Tolhurst E. , Varner C.
Published: May 2020

Introduction: Women experiencing early pregnancy loss or threatened loss frequently seek care in emergency departments (ED) or early pregnancy clinics (EPC). The dearth of existing qualitative studies has left understudied questions about how these women perceive their healthcare and which strategies best meet their supportive care needs, particularly in the Canadian context. The objective of this study was to deepen our understanding of these women's experiences and gain insight into how clinicians and healthcare services can lessen the impact of this traumatic event on patients and their families. Methods: We conducted a descriptive qualitative study of women who presented to the ED or EPC at an urban tertiary care hospital and an urban community hospital for early pregnancy loss or threatened loss. Purposive sampling was used to recruit patients for in-depth, one-on-one telephone interviews conducted 4-6 weeks after the index visit. Data collection and analysis were concurrent and continued until thematic saturation had occurred. Data analysis was led by two qualitative researchers with support from a multi-disciplinary research team following standard thematic analysis techniques. Results: Interviews were completed with 59 women between July 2018 and August 2019. Participants ranged in age from 22 to 47 years and reflect the diversity of the multicultural city where the study occurred. Our analysis revealed that the medicalization and normalization of early pregnancy complications among ED and EPC clinicians is at odds with women's general lack of knowledge about the frequency, personal risk, causation, duration, and physical intensity of the miscarriage experience. Women identified the value of rapid access to appointments, point of care ultrasound, detailed care plans, and knowledgeable advice as key to lessening the physical and emotional trauma related to early pregnancy loss. Conclusion: This research highlights the physical, emotional, and psychological complexity of a medical situation frequently minimized within the current healthcare system. The results impart important knowledge about which aspects of ED and EPC care are most valued by women experiencing early pregnancy loss or threatened loss and demonstrate the clear need for women and their families to be provided with more education about the totality of the early pregnancy experience, including the possibility of pregnancy complications and loss.
LO46: Prognostic value of single serum progesterone in the evaluation of symptomatic pregnant patients: a systematic review and meta-analysis
Authors: Ghaedi B. , Ameri S. , Abdulkarim K. , Thiruganasambandamoorthy V.
Published: May 2020

Introduction: Pain and bleeding complicate 30% of pregnancies threatening viability. The objective of this systematic review is to evaluate the role of a single progesterone level in predicting viability. Methods: We comprehensively searched MEDLINE, Embase (OVID), CINAHL and Cochrane databases from inception to July 2019. We included English language studies that enrolled symptomatic first trimester pregnant patients, measured progesterone and reported viability (miscarriage, ectopic or viable). We excluded studies with patients who had progesterone treatment, or conception after induced ovulation/invitro fertilization. We extracted patient characteristics, study setting, mean progesterone, the cut off value and outcome (viability). The quality of the included studies was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. We extracted data for 2X2 tables and report mean, standard deviation (SD), sensitivity, specificity, positive and negative predictive values (PPV, NPV). Results: Of the 689 studies screened, 51 studies with 15783 patients were included (1 randomized control trial, 36 prospective, 9 retrospective, 5 prospective case control studies) and 7553 were viable pregnancies. Of the 31 studies (n = 10998) that reported ectopic, 1661 patients were diagnosed with ectopic pregnancy. In 35 studies (n = 6003) that reported mean and SD, the levels were higher in viable (26.7 ± 11.2ng/ml) than non-viable (9.5 ± 5.9ng/ml; p < 0.001) or ectopic pregnancy 9.5 ± 6.8ng/ml (p < 0.001). The pooled diagnostic characteristics at different cut-off values were: <6.3ng/mL (9 studies; N = 6033) sensitivity 65.0% (95%CI 63.5,66.5), specificity 97.3% (95%CI 95.5, 98.5), PPV 99.4% (95%CI 99.1,99.7) and NPV 27.4 (95%CI 26.6,28.4); <10 ng/mL (12 studies with 5743 participants) sensitivity 65.0% (95% CI 63.5, 66.5), specificity of 97.3% (95%CI 95.5, 98.5), PPV 99.4% (95% CI 99.1, 99.7) and NPV 27.4% [95% CI 26.5, 29.4); 11-20 ng/mL (24 studies with 7141 participants) sensitivity 77.3% (95% CI 76.2,78.4), specificity 64.6% (95% CI 63.2, 65.9), PPV 73.2% [95% CI 72.3, 73.9) and NPV 69.5% (95% CI 70.7, 72.5). There was low risk of bias for patient selection, index test and low concern regarding applicability. The highest risk (82% of studies) was due to outcome ascertainment bias due to non-blinding of index and additional tests. Conclusion: A single progesterone value is useful in predicting viability of pregnancy among symptomatic patients.
LO52: Distraction in the ED using Virtual reality for Intravenous Needs in Children to Improve comfort- DEVINCI - a pilot RCT
Authors: Trottier E. D. , Osmanlliu E. , Bailey B. , Lagacé M. , Certain M. , Khadra C. , Sanchez M. , Thériault C. , Paquin D. , Cotes-Turpin C. , Le May S.
Published: May 2020

Introduction: Venipuncture is a frequent cause of pain and distress in the pediatric emergency department (ED). Distraction, which can improve patient experience, remains the most studied psychological intervention. Virtual reality (VR) is a method of immersive distraction that can contribute to the multi-modal management of procedural pain and distress. Methods: The main objectives of this study were to determine the feasibility and acceptability of Virtual Reality (VR) distraction for pain management associated with venipunctures and to examine its preliminary effects on pain and distress in the pediatric ED. Children 7-17 years requiring a venipuncture in the pediatric ED were recruited. Participants were randomized to either a control group (standard care) or intervention group (standard of care + VR). Principal clinical outcome was the mean level of procedural pain, measured by the verbal numerical rating scale (VNRS). Distress was also measured using the Child Fear Scale (CFS) and the Procedure Behavior Check List (PBCL) and memory of pain using the VNRS. Side effects were documented. Results: A total of 63 patients were recruited. Results showed feasibility and acceptability of VR in the PED and overall high satisfaction levels (79% recruitment rate of eligible families, 90% rate of VR game completion, and overall high mean satisfaction levels). There was a significantly higher level of satisfaction among healthcare providers in the intervention group, and 93% of those were willing to use this technology again for the same procedure. Regarding clinical outcomes, no significant difference was observed between groups on procedural pain. Distress evaluated by proxy (10/40 vs 13.2/40, p = 0.007) and memory of pain at 24 hours (2.4 vs 4.2, p = 0.027) were significantly lower in the VR group. Venipuncture was successful on first attempt in 23/31 patients (74%) in the VR group and 15/30 (50%) patients in the control group (p = 0.039). Five of the 31 patients (16%) in the VR group reported side effects Conclusion: The addition of VR to standard care is feasible and acceptable for pain and distress management during venipunctures in the pediatric ED. There was no difference in self-reported procedural pain between groups. Levels of procedural distress and memory of pain at 24 hours were lower in the VR group.
LO53: Emergency department visits for hyperglycemia: through the eyes of the patient
Authors: Yan J. , Azzam D. , Liu S. , Spaic T. , Columbus M. , Van Aarsen K. , Shepherd L.
Published: May 2020

Introduction: Patients with poorly-controlled diabetes often visit the emergency department (ED) for treatment of hyperglycemia. While previous qualitative studies have examined the patient experience of diabetes as a chronic illness, there are no studies describing patients’ perceptions of ED care for hyperglycemia. The objective of this study was to explore the patient experience regarding ED hyperglycemia visits, and to characterize perceived barriers to adequate glycemic control post-discharge. Methods: This study was conducted at a tertiary care academic centre in London, Ontario. A qualitative constructivist grounded theory methodology was used to understand the experience of adult patient partners who have had an ED hyperglycemia visit. Patient partners, purposively sampled to capture a breadth of age, sex, disease and presentation frequency were invited to participate in a semi-structured individual interview to probe their experiences. Sampling continued until a theoretical framework representing key experiences and expectations reached sufficiency. Data were collected and analyzed iteratively using a constant comparative approach. Results: 22 patients with type 1 or 2 diabetes were interviewed. Participants sought care in the ED over other options because of their concern of having a potentially life-threatening condition, advice from a healthcare provider or family member, or a perceived lack of convenient alternatives to the ED based on time and location. Participants’ care expectations centred around symptom relief, glycemic control, reassurance and education, and seeking referral to specialist diabetes care post-discharge. Finally, perceived system barriers that challenged participants’ glycemic control included affordability of medical supplies and medications, access to follow-up and, in some cases, the transition from pediatric to adult diabetes care. Conclusion: Patients with diabetes utilize the ED for a variety of urgent and emergent hyperglycemic concerns. In addition to providing excellent medical treatment, ED healthcare providers should consider patients’ expectations when caring for those presenting with hyperglycemia. Future studies will focus on developing strategies to help patients navigate some of the barriers that exist within our current limited healthcare system, enhance follow-up care, and improve short- and long-term health outcomes.
LO56: Rate of delirium recognition by nurses and physicians in a cohort of 1584 older emergency department patients: how many would have been sent home?
Authors: Lee J.
Published: May 2020

Introduction: Unrecognized delirium in the ED remains common despite a 3 fold mortality increase for those discharged home. But previous studies have not assessed delirium recognition rate in a multicenter study nor assessed the management plans of ED staff when they fail to recognize delirium. Objectives: To document 1) the rate of delirium recognition by nurses and MDs in a national sample and 2) the intended management plans for patients with unrecognized delirium. Methods: This is a planned sub-study of a randomized clinical trial at 5 EDs in 4 provinces conducted in English and French. We included people ≥ 65 years old. We excluded those with an ED stay < 4 hours, critical illness, visual impairment or from a nursing home. Research assistants (RAs) assessed delirium using the validated Confusion Assessment Method. RAs then asked ED nurses and physicians if the patient had delirium according to their clinical assessment. RAs also asked how confident they were that the patient could be safely discharged home using a 10 point Likert scale. We report proportions and 95% confidence intervals. RAs notified all ED staff of unrecognized CAM + ve patients prior to actual discharge for safety reasons. Results: We recruited 1584 older people; 1496 (92.5%) had complete data. Mean age was 76.5; 49% were female. Nurses performed 1465 delirium assessments. There were 76 CAM + ve patients in our sample (5.2%, 95% CI 4.2 to 6.5%). Nurses recognized delirium in 34/76 (44.7%, 95% CI: 33.3 to 56.6%). MDs assessed 20 CAM + ve patients and recognized the delirium in 10/20 (50.0%, 95% CI: 27.2 to 72.8). Nurses felt that 11/42 patients with unrecognized delirium could be discharged (26.2% 95% CI: 13.9 to 42.0%). Their median confidence in the safety of their plan was 7.0/10. MDs felt that 2/10 patients with unrecognized delirium could be discharged (20.0% 95% CI: 2.5 to 55.0%). Their median confidence in the safety of their plan was 7.5/10. Conclusion: Despite the potential Hawthorne effect raising initial delirium recognition rates above clinicians’ usual practice outside of a study, delirium recognition by both nurses and MDs remains poor in a national sample of ED patients. We also showed that a significant number of these patients could have been discharged with unrecognized delirium. Further research to find novel ways to improve delirium recognition is needed.
LO59: Reliability of patient reported exposure and outcome data in a prospective cohort study of older adults presenting to the emergency department
Authors: Selvanayagam N. , Soomro A. , Varner C. , McLeod S. , Clayton N. , de Wit K.
Published: May 2020

Introduction: Participant interviews are often considered the ‘gold standard’ for measuring outcomes in diagnostic and prognostic studies. Participant exposure data are frequently collected during study interviews, but the reliability of this information often remains unknown. The objective of this study was to compare patient-reported medication exposures and outcomes to data extracted from electronic medical records (EMRs) to determine reliability. Methods: This was a secondary data analysis from a prospective observational cohort study enrolling older (≥ 65 years) patients who presented to one of three emergency departments after a fall. After patients had consented to participate in the study, they were asked about their use of antiplatelet and anticoagulation medications (exposures of interest). During follow up, participants were asked if a physician had told them they had bleeding in their head (diagnosis of intracranial hemorrhage). Patient-reported responses were compared to data extracted from a structured EMR review. Trained research assistants extracted medication exposure and outcome data from the hospital EMRs in duplicate for all visits to any hospital within 42 days. Inter-rater agreement was estimated using Cohen's kappa (K) statistics with 95% confidence intervals (CIs). Results: 1275 patients completed study interviews. 1163 (91%) responded to questioning about antiplatelet use and 1159 (91%) to anticoagulant use. Exact agreement between patient reported antiplatelet use compared to EMR review was 77%, with K = 0.50 (95% CI: 0.44 to 0.55). For anticoagulation use, exact agreement was 87%, with K = 0.68 (95% CI: 0.63 to 0.72). 986 (78%) patients had a follow up interview after 42 days. Exact agreement between patient reported intracranial bleeding and EMR review was 95%, with K = 0.30 (95% CI: 0.15 to 0.45). Using the EMR review as the reference standard, the sensitivity and specificity of patient reported intracranial bleeding was 34% (95% CI: 20 to 52%) and 97% (95% CI: 96 to 98%), respectively. Conclusion: In this population of older adults who presented to the ED after a fall, patient reported use of antiplatelet and anticoagulant medications was not a reliable method to identify medication use. Patients who were diagnosed with intracranial bleeding were particularly poor at reporting this diagnosis.
LO61: A modified Delphi study to identify trauma care modifiers for older adults
Authors: Yadav K. , Boucher V. , Le Sage N. , Malo C. , Mercier E. , Voyer P. , Clement J. , Emond M.
Published: May 2020

Introduction: Older (age >=65 years) trauma patients suffer increased morbidity and mortality. This is due to under-triage of older trauma victims, resulting in lack of transfer to a trauma centre or failure to activate the trauma team. There are currently no Canadian guidelines for the management of older trauma patients. The objective of this study was to identify modifiers to the prehospital and emergency department (ED) phases of major trauma care for older adults based on expert consensus. Methods: We conducted a modified Delphi study to assess senior-friendly major trauma care modifiers based on national expert consensus. The panel consisted of 24 trauma care providers across Canada, including medical directors, paramedics, emergency physicians, emergency nurses, trauma surgeons and trauma administrators. Following a literature review, we developed an online Delphi survey consisting of 16 trauma care modifiers. Three online survey rounds were distributed and panelists were asked to score items on a 9-point Likert scale. The following predetermined thresholds were used: appropriate (median score 7–9, without disagreement); inappropriate (median score 1–3; without disagreement), and uncertain (any median score with disagreement). The disagreement index (DI) is a method for measuring consensus within groups. Agreement was defined a priori as a DI score <1. Results: There was a 100% response rate for all survey rounds. Three new trauma care modifiers were suggested by panelists. Of 19 trauma care modifiers, the expert panel achieved consensus agreement for 17 items. The prehospital modifier with the strongest agreement to transfer to a trauma centre was a respiratory rate <10 or >20 breaths/minute or needing ventilatory support (DI = 0.24). The ED modifier with the strongest level of agreement was obtaining a 12-lead electrocardiogram following the primary and secondary survey for all older adults (DI = 0.01). Two trauma care modifiers failed to reach consensus agreement: transporting older patients with ground level falls to a trauma centre and activating the trauma team based solely on an age >=65 years. Conclusion: Using a modified Delphi process, an expert panel agreed upon 17 trauma care modifiers for older adults in the prehospital and ED phases of care. These modifiers may improve the delivery of senior-friendly trauma care and should be considered when developing local and national trauma guidelines.
LO64: A systematic review of interventions to influence opioid prescribing from the emergency department
Authors: Tran M. , Thompson C. , Walsh C. , McLeod S. , Borgundvaag B.
Published: May 2020

Introduction: The opioid crisis has reached epidemic levels in Canada, driven in large part by prescription drug use. Emergency physicians are frequent prescribers of opioids; therefore, the emergency department (ED) represents an important setting for potential intervention to encourage rational and safe prescribing. The objective of this study was to systematically review the literature on interventions aimed to influence opioid prescribing in the ED. Methods: Electronic searches of Medline and Cochrane were conducted and reference lists were hand-searched. All quantitative studies published in English from 2009 to 2019 were eligible for inclusion. Two reviewers independently screened the search output to identify potentially eligible studies, the full texts of which were retrieved and assessed for inclusion. Outcomes of interest included opioid prescribing rate (proportion of ED visits resulting in an opioid prescription at discharge), morphine milligram equivalents per prescription and variability among prescribers. Results: The search strategy yielded 797 potentially relevant citations. After eliminating duplicate citations and studies that did not meet eligibility criteria, 34 potentially relevant studies were retrieved in full text. Of these, 28 studies were included in the review. The majority (26, 92.9%) of studies were based in the United States and two (7.1%) were from Australia. Four (14.3%) were randomized controlled trials. The interventions were classified into six categories: prescribing guidelines (n = 10), regulation/rescheduling of opioids (n = 6), prescribing data transparency (n = 4), education (n = 4), care coordination (n = 3), and electronic medical record changes (n = 1). The majority of interventions reduced the opioid prescribing rate from the ED (21/28, 75.0%), although regulation/rescheduling of opioids had mixed effectiveness, with 3/6 (50%) studies reporting a small increase in the opioid prescribing rate post-intervention. Education had small yet consistent effects on reducing the opioid prescribing rate. Conclusion: A variety of interventions have attempted to improve opioid prescribing from the ED. These interventions include prescribing guidelines, regulation/rescheduling, data transparency, education, care coordination, and electronic medical record changes. The majority of interventions reduced the opioid prescribing rate; however, regulation/rescheduling of opioids demonstrated mixed effectiveness.
LO73: Are women under-represented in emergency medicine residency programs across Canada?
Authors: Lien K. , Yau L. , Aarsen K. Van , Wakabayashi A. , Bhimani M.
Published: May 2020

Introduction: 2018 data from the Canadian Medical Association website shows that of practicing emergency physicians country-wide, only 31% were female. While there are some studies that examine the number and proportion of Canadian female applicants applying to surgical specialties, there are very few studies that are specific to emergency medicine (EM), and none that are Canadian in scope. Given the changing gender ratio of graduating medical students in Canada, the primary objective of this study is to assess the mean proportion and trends in proportion of females who applied and matched to English-language Canadian EM programs including Canadian College of Family Physicians emergency medicine certificate (CCFP-EM) and Fellow of the Royal College of Physicians of Canada emergency medicine (FRCPC-EM), family medicine (CCFP) programs, and all specialties combined. Methods: A retrospective data analysis on residency match results from 2013-2019 inclusively was performed. Data was accessed through a freedom of information request from the Canadian resident matching service (CaRMS). The mean proportions and trends in the proportions of females applying and matching to CCFP-EM, FRCPC-EM, CCFP, and all specialties were computed. Cochrane-Armitage trend of test was used for analysis. Results: From 2013-2019, the mean (SD) percentage of females who applied and matched respectively were as follows: CCFP-EM [44.4 (3.5);46.0(4.5)]; FRCPC-EM [41.3(4.1);44.0 (4.5], CCFP [56.5(1.3);61.0(1.9)], all specialties [54.0(1.1);55.5(0.9)]. There was a significant increase in the proportion of female applying to the FRCPC-EM (p < 0.0001), CCFP (p = 0.0002), and all disciplines (p = 0.0013). There was no significant change in the proportion of females applying for the CCFP-EM program (p = 0.6435). Conclusion: Our study shows that there is an increasing trend in the percentage of female applicants in all programs except the CCFP-EM program, where it remained statistically the same over time. There was a consistent percentage of applied versus matched female applicants over time for both CCFP-EM and FRCPC-EM programs. However, the percentage of females applying or matching to both CCFP-EM and FRCPC-EM programs remained less than 50%. Further research could focus on evaluating reasons for program choice, in order to further increase the percentage of female medical students and residents applying and matching to both emergency medicine programs.
LO81: The use of in situ simulation to improve emergency department staff comfort with the management of high acuity, low occurrence cases
Authors: Bilic M. , Hassall K. , Hastings M. , Fraser C. , Rutledge G. , Hanel E.
Published: May 2020

Introduction: In the emergency department (ED), high-acuity presentations encountered at low frequencies are associated with reduced staff comfort. Previous studies have shown that simulation can improve provider confidence with practical skills and management of presentations in various fields of medicine. The present study examined the effect of in situ simulation on interprofessional provider comfort with the identification and management of high-acuity low-frequency events in the ED. It further assessed the feasibility of implementing weekly simulation as an interprofessional education initiative in a high-volume ED. Methods: This was a retrospective pre-test post-test quasi-experimental design. Weekly in situ simulation events were facilitated by an interdisciplinary team in a high-volume ED in Hamilton, Ontario that sees an average of 185 patients per day. To date, 34 simulation events were held between January 18, 2019 and November 22, 2019, and included neonatal, paediatric and obstetric emergencies, and adult codes. There was an average of 20 patients presenting to the ED during these events. Events included a debrief, and typically lasted 60 minutes in total. Participants included individuals from various disciplines working on shift at the time of the event. Questionnaires were administered via email following the event, in which participants were asked to rank their comfort with emergency codes before and after the simulation using two 5-point Likert scales. The data from 39 questionnaires was analyzed. T-tests were used to analyze differences in self-reported comfort scores. Results: Questionnaire responders included nurses (41%), respiratory therapists (26%), resident physicians (10%), paramedics (3%), attending physicians (3%), students of various disciplines (10%) and other (7%). 38% of participants reported increases in comfort following simulation when compared to prior. Using the 5-point scale, the average reported score for comfort pre-simulation was 3.59 (95% CI 3.30–3.88), and the average post-simulation score was 3.97 (95% CI 3.76–4.19, p = 0.03). Conclusion: Our results demonstrate that weekly interprofessional in situ simulation is feasible in a high-volume ED, and significantly improves self-reported provider comfort with the identification and management of high-acuity, low-frequency events. This warrants the implementation of this simulation design to improve staff confidence and has implications for its potential role in improving team dynamics and patient safety.