bluuebunny/crossref_metadata_2025 huggingface dataset:
A tacit tudás jelentősége a globalizált vállalati kultúrában
Authors: Sápiné Duduk Ildikó
Published: July 2016

A tanulmány a globalizáció egyik elemét, a globális kultúra kérdéseit vizsgálja vállalati szempontból. Rámutat a magyarországi leányvállalatok és anyacégeik kulturális különbségeiből adódó eltérő tacit tudás átadásának fontosságára és lehetőségeire, összekapcsolva a vállalati versenyképesség, a vállalati kultúra és a hallgatólagos tudás fogalmát és kérdéseit. Bemutatja, hogy a szervezetek miként hoznak létre új tudást és hogyan tudják azt átadni. Következtetésként megfogalmazza, hogy amennyiben a tudásmenedzsmentre kellő hangsúlyt fektetnek, a munkavállaló távozásával a tudás a szervezeten belül marad, így a vállalat nem veszít versenyképességéből.

Journal of Economic Literature (JEL) kódok: D23, D61, D83, L21, M21, O31, O33
Siker és motiváció a magyar vállalkozó-kutatók körében
Authors: Novotny Ádám
Published: July 2016

A tanulmány 80 magyar egyetemi vállalkozó (spin-off cég) empirikus vizsgálatának eredményeit mutatja be. Célja a vállalkozásindítás motivációinak és a vállalkozói siker kapcsolatának az elemzése. A vizsgáltmotivációk a jólét iránti igény, a teljesítményvágy, a függetlenségvágy, valamint a vállalkozásindítás kutatási tevékenységgel összefüggő haszna. A cikk a vállalkozói sikert objektív és szubjektív oldalról egyaránt méri. Az objektív siker alkalmazott mérőszámai a bevétel és növekedése, az alkalmazottak száma, valamint a vállalkozás kora. A szubjektív siker a vállalkozó-kutatók önértékelésére utal. Az eredmények szerint a vállalkozásindítás legerősebb motivációja az anyagi kényszer, az egyetemi fizetéssel való elégedetlenség. A vizsgált motivációk a jövedelemkiegészítés kényszere kivételével mind szignifikáns kapcsolatban vannak a szubjektív sikerérzettel, amely az objektív siker kapcsán már nem mondható el. A kutatási tevékenység gyakorlati irányba való kiterjesztése fontos vállalkozói motiváció az egyetemi szférában, hiszen nemcsak a szubjektív sikerérzettel, hanem a cég bevételével és a bevétel növekedésével is szignifikánsan összefügg.

Journal of Economic Literature (JEL) kódok: L26; I23; O32
Global Value Chains and Upgrading – Experiences of Hungarian Firms in the Machinery Industry
Authors: Éltető Andrea , Magasházi Anikó , Szalavetz Andrea
Published: July 2016

Global production networks and global value chains have become widespread today. In these cases firms locate the various stages of their value adding activities across different countries. The activities of global value chains form a new phase of globalization characterized by fragmented production, transfer of technology, and decreasing transport costs (Kaplinsky 2013). Developing countries are involved in these production networks, perceiving this as an important (if not the only) way to develop. The Central European countries have taken an active part in the chains of multinational firms since the nineties. The benefit derived from this participation varies across sectors and firms. In this article we analyze the experiences of Hungarian companies in the machinery industry. The structure of the article is the following. After a description of the basic research question and methodology, a literature review is provided. In the following section we introduce the companies surveyed and review their product-, process- and functional upgrading experiences. Finally, we discuss our findings and suggest some managerial and policy implications.

Journal of Economic Literature (JEL) codes: F23, M21
A kis- és középvállalkozások hitelezésének aktuális tapasztalatai
Authors: Zsombori Zsolt
Published: July 2016

A magyarországi bankok vállalkozáshitelezési aktivitásának a fokozása aktuális kérdés, olyannyira, hogy a Magyar Nemzeti Bank is fókuszban tartja, elsősorban a Növekedési Hitelprogram biztosítása révén. Jelen tanulmány keretei között Borsod-Abaúj-Zemplén megyei székhelyű, működő, a kis- és középvállalkozások (kkv-k) körébe tartozó gazdasági társaságokat elemzünk, méghozzá primer kvantitatív kutatás segítségével. A kétlépcsős, kvótás és elbírálásos mintavételi módszerek kombinációjával előállított mintán végzett vizsgálat révén megállapításokat teszünk a kkv-k aktuális forráspreferenciáit és hitelkeresletét illetően, külön kitérve a támogatott hitelekre, valamint a hitelezést akadályozó tényezőkre a kkv-k mint hitelkeresleti oldal megítélése alapján.

Journal of Economic Literature (JEL) kódok: G30; G32; G39
The correlation between the level of 25-hydroxyvitamin D [25(OH)D] and residency of multiple sclerosis patients in Montenegro – higher levels only in men in the north of the country
Authors: Vujisic Slavica , Vodopic Sanja , Idrizovic Zilha , Radulovic Ljiljana
Published: July 2016

Background/Aim. Multiple Sclerosis (MS) is a chronic neurological disease associated with low serum levels of 25-hydroxyvitamin D [25(OH)D]. The aim of this study was to determine the association between serum levels of 25(OH)D and the latitude as well as clinical MS severity and progression expressed by expanded disability status scale (EDSS) and multiple sclerosis severity score (MSSS). Methods. A total of 196 patients, from North and South of Montenegro, aged 18 to 65 years, with confirmed diagnosis of MS were recruited for the study. Serum samples were collected for 25(OH)D measurement. Control group consisted of 196 health controls, randomly selected from medical staff employed in health centers from three cities in North and Clinical Centre of Montenegro from the South. Results. The serum levels of 25(OH)D were significantly lower in MS patients compared to controls (p < 0.001). The serum levels of 25(OH)D were significantly different in regard to gender, with women showing lower levels. Although in the entire group of patients there was no statistical correlation between the levels of 25(OH)D and their residence, the significantly higher levels of 25(OH)D were detected in men from the North compared to women. The course of the disease had an impact on the 25(OH)D serum levels. 25(OH)D levels also significantly correlated with clinical parameters of both, disability (Spearman''s r = -0.23, p = 0.001) and progression (Spearman''s r = -0.25, p = 0.0004) of MS. Conclusion. Serum levels of 25(OH)D were associated with disability and progression in MS patients. Lower levels of 25(OH)D were detected in female patients from the North. The low level of 25(OH)D cannot be solely explained with unfavorable latitude and insufficient sun exposure, therefore further genetic analysis is needed.
Severe agitation following deep brain stimulation for parkinsonism
Authors: Rose Nicholas G.W. , Mostrenko Michael , McMaster Jacqueline , Honey Christopher R.
Published: July 2016

The use of deep brain stimulation has become increasingly common for the treatment of movement disorders, including Parkinson disease. Although deep brain stimulation is generally very successful in alleviating the extrapyramidal symptoms of Parkinson disease, side effects can occur. This case report describes a patient presenting to the emergency department in a state of extreme aggression 3 days after a change in the parameters of his bilateral subthalamic nucleus stimulator. We review the complications of deep brain stimulation relevant to the emergency physician and provide some practical information on stimulator adjustment in an emergency.
Use of personal protective equipment in Canadian pediatric emergency departments
Authors: Reid Sarah M. , Farion Ken J. , Suh Kathryn N. , Audcent Tobey , Barrowman Nicholas J. , Plint Amy C.
Published: July 2016

Objective:

Numerous barriers to maintaining infection control practices through the use of personal protective equipment (PPE) exist in the emergency department (ED). This study examined the knowledge, self-reported behaviours, and barriers to compliance with infection control practices and the use of PPE in Canadian pediatric EDs.

Methods:

A self-administered survey instrument consisting of 21 questions was developed and piloted for this study. The survey was mailed to all individuals listed in the Pediatric Emergency Research Canada database of physicians practicing pediatric emergency medicine in Canada.

Results:

A total of 186 physicians were surveyed, and 123 (66%) participated. Twenty-two percent of participants reported that they had never received PPE training and 32% had not been trained in the previous 2 years. Fifty-three percent reported being very or somewhat comfortable with their knowledge of transmission-based isolation practices. Participants were correct on a mean of 4.9 of 11 knowledge-based questions (SD 1.7). For scenarios assessing self-reported use of PPE, participants selected answers that reflected PPE use in accordance with national infection control standards in a mean of 1.0 of 6 scenarios (SD 1.0). Participants reported that they would be more likely to use PPE if patients were clearly identified prior to physician assessment, equipment was accessible, and PPE use was made a priority in their ED.

Conclusions:

Knowledge and self-reported adherence to recommended infection control practices among Canadian pediatric emergency physicians is suboptimal. Early identification of patients requiring PPE, convenient access to PPE, and improved education regarding isolation and PPE practices may improve adherence.
Emergency medicine training in Canada: a survey of medical students' knowledge, attitudes, and preferences
Authors: Hillier Morgan , McLeod Shelley , Mendelsohn Danny , Moffat Bradley , Smallfield Audra , Arab Akram , Brown Ashley , Sedran Robert
Published: July 2016

Objectives:

The objective of this study was to assess medical students' knowledge of and attitudes toward the two Canadian emergency medicine (EM) residency programs (Fellow of the Royal College of Physicians of Canada [FRCPC] and Certificant of the College of Family Physicians-Emergency Medicine [CCFP-EM]). Additionally, medical students interested in EM were asked to select factors affecting their preferred choice of residency training program and their intended future practice.

Methods:

Medical students enrolled at The University of Western Ontario for the 2008–2009 academic year were invited to complete an online 47-item questionnaire pertaining to their knowledge, opinions, and attitudes toward EM residency training.

Results:

Of the 563 students invited to participate, 406 (72.1%) completed the survey. Of the respondents, 178 (43.8%) expressed an interest in applying to an EM residency training program, with 85 (47.8%) most interested in applying to the CCFP-EM program.

The majority of respondents (54.1%) interested in EM believed that there should be two streams to EM certification, whereas 18.0% disagreed. Family life and control over work schedule appeared to be common priorities seen as benefits of any career in EM. Other high-ranking factors influencing career choice differed between the groups interested in CCFP-EM and FRCPC. The majority of students interested in the CCFP-EM residency program (78%) reported that they intend to blend their EM with their family medicine practice. Only 2% of students planned to practice only EM with no family medicine.

Conclusions:

This is the first survey of Canadian medical students to describe disparities in factors influencing choice of EM residency stream, perceptions of postgraduate work life, and anticipated practice environment.
The daunting task of “clearing” the cervical spine
Authors: Grunau Brian E. , Dibski Daniel , Hall Jeremy
Published: July 2016

The evaluation of the cervical spine in the emergency department is a common and often challenging task. We report the case of a 70-year-old female who presented intoxicated with evidence of a recent fall. A 64-slice computed tomographic (CT) scan with sagittal and coronal reconstructions revealed no acute injury. The patient was reexamined when alert and had persistent neck pain. Flexionextension static views revealed severe subluxation of C5 on C6 with jumped facets, and subsequent magnetic resonance imaging confirmed significant ligamentous injury. The evidence available suggests that although CT with reconstruction is highly sensitive for clinically significant cervical injury, the possibility of severe injury remains.
Bedside emergency department ultrasonography availability and use for blunt abdominal trauma in Canadian pediatric centres
Authors: Cardamore Robin , Nemeth Joe , Meyers Christine
Published: July 2016

Objectives:

To quantify the current availability and use of bedside emergency department ultrasonography (EDUS) for blunt trauma at Canadian pediatric centres and to identify any perceived barriers to the use of bedside EDUS in such centres.

Methods:

An electronic survey was sent to 162 pediatric emergency physicians and 12 site directors from the 12 pediatric emergency departments across Canada.

Results:

Ninety-two percent (11 of 12) of centres completed the survey. The individual physician response rate was 65% (106 of 162), with 100% of site directors responding. Ultrasound machines were available in 45% (5 of 11) of centres. Forty-two percent (32 of 77) of emergency physicians working in equipped pediatric centres used bedside EDUS to evaluate blunt abdominal trauma (BAT). In the subgroup of staff who also worked at adults sites, the frequency of ultrasonography use for the evaluation of pediatric BAT was 75%. In the 55% (6 of 11) of centres without ultrasonography, 88% of staff intend to incorporate its use in the future and 81% indicated that they believed the incorporation of ultrasonography would have a positive impact on patient care. The main perceived barriers to the use of ultrasonography in the evaluation of BAT were a lack of training (41%) and a lack of equipment (26%).

Conclusion:

Bedside EDUS is currently used in almost half of pediatric trauma centres, a frequency that is significantly lower than adult centres. Physicians in pediatric centres who use ultrasonography report that it has a high utility, and a great majority of physicians at pediatric centres without EDUS plan to incorporate it in the future. The main reported barriers to its use are a lack of training and a lack of equipment availability.
Emergency physician workload modeling
Authors: Dubinsky Isser
Published: July 2016

Background:

A variety of models are used by hospitals, provincial governments, and departments of emergency medicine to “predict” the number of physician hours of coverage necessary to staff emergency departments. These models have arisen to meet specific requirements—some for the purpose of determining hourly rates of compensation, others to determine the amount of funding that will be provided to “purchase” physician coverage, and others to determine the number of hours of coverage necessary to maintain patient waits within “acceptable” limits. All such models have their strengths and weaknesses and have been criticized as not reflecting the “real” needs of any given department.

Objective:

In the article that follows, a review of existing models is presented, annotating their strengths and weaknesses to derive the characteristics of an “ideal” workload model.

Conclusion:

None of the models currently used to measure emergency department workload can be relied on to accurately predict the number of staffed hours necessary. Models that may achieve this objective are suggested.
Feasibility and speed of insertion of seven supraglottic airway devices under simulated airway conditions
Authors: Robak Oliver , Leonardelli Marco , Zedtwitz-Liebenstein Konstantin , Rützler Kurt , Schuster Ernst , Vaida Sonia , Salem Ramez , Frass Michael
Published: July 2016

Objectives:

Endotracheal intubation (ETI) is considered the gold standard for protecting the airway. Alternative devices for airway protection have been developed that can be used by untrained personnel, by those with less experience, and for when ETI is not possible. The main goals of our study were to evaluate the success rate and speed of insertion of different supraglottic airway devices and to determine whether the devices could be properly inserted under simulated critical conditions.

Methods:

Fifty medical students used an airway simulation trainer (Laerdal SimMan 3G) to assess the success rate and time used to insert seven different supraglottic airway devices under simulated physiologic and pathologic conditions in two different runs.

Results:

Although all airway devices could be inserted without problems, only the Combitube and the EasyTube could be successfully inserted in simulations of trismus, limited mobility of the cervical spine, or a combination of pathologic conditions such as trismus plus limited mobility of the spine and trismus plus tongue edema. The insertion time was significantly longer with LMA Unique, Fastrach, and I-Gel devices in both the first and second runs.

Conclusion:

The Combitube and the EasyTube were most easily inserted under simulated conditions such as trismus, limited mobility of the cervical spine, and combined pathologic conditions. Although all devices are useful for establishing an airway by nontrained medical students in standard simulations, we suggest that the Combitube and the EasyTube may offer advantages in difficult airway situations.
Core competencies for emergency medicine clerkships: results of a Canadian consensus initiative
Authors: Penciner Rick , Woods Robert A. , McEwen Jill , Lee Richard , Langhan Trevor ,   Canadian Association of Emergency Physicians Undergraduate Education Committee
Published: July 2016

Objectives:

There is no consensus on what constitutes the core competencies for emergency medicine (EM) clerkship rotations in Canada. Existing EM curricula have been developed through informal consensus and often focus on EM content to be known at the end of training rather than what is an appropriate focus for a time-limited rotation in EM. We sought to define the core competencies for EM clerkship in Canada through consensus among an expert panel of Canadian EM educators.

Methods:

We used a modified Delphi method and the CanMEDS 2005 Physician Competency Framework to develop a consensus among expert EM educators from across Canada.

Results:

Thirty experts from nine different medical schools across Canada participated on the panel. The initial list consisted of 152 competencies organized in the seven domains of the CanMEDS 2005 Physician Competency Framework. After the second round of the Delphi process, the list of competencies was reduced to 62 (59% reduction). A complete list of competencies is provided.

Conclusion:

This study established a national consensus defining the core competencies for EM clerkship in Canada.
Spontaneous low cerebrospinal fluid pressure headache: an emergency medicine perspective
Authors: Ahn Justin S. , Akincioglu Cigdem , Gulka Irene , Coome Grant
Published: July 2016

Spontaneous low cerebrospinal fluid pressure headaches are a rare but treatable cause of debilitating headaches. The condition is characterized by a postural headache in the absence of any recent spinal procedures and is exacerbated when upright and relieved when supine. Diagnosis and treatment are often delayed, however, due to a lack of recognition and awareness, as illustrated by this case report of a patient who had multiple emergency department visits before further investigations were sought.
Adverse events are rare among adults 50 years of age and younger with flank pain when abdominal computed tomography is not clinically indicated according to the emergency physician
Authors: Epstein Norman , Rosenberg Paul , Samuel Marianne , Lee Jacques
Published: July 2016

Objective:

Many emergency physicians (EPs) order “confirmatory” abdominal computed tomography (CT) in young flank pain patients, despite a high clinical suspicion of renal colic and the risk of radiation exposure. We measured the adverse outcome rate among flank pain patients identified as not requiring abdominal CT by the EP on a data form, regardless of whether CT was eventually ordered. Our secondary objective was to describe diagnoses other than renal colic identified by CT in this population.

Methods:

We conducted a prospective observational study at two community EDs. We asked staff EPs to complete a data sheet on patients ages 18 to 50 years with a first episode of flank pain, recording 1) if the flank pain was consistent with renal colic and 2) if the EP felt abdominal CT was indicated. Adverse outcomes (defined a priori as urgent surgical procedures, disability, or death) were assessed by research assistants at 4 weeks using telephone follow-up and a hospital records search.

Results:

We enrolled 389 patients; 353 completed follow-up (91%). The average age was 38.8 years, and 72.0% were male. Of 212 patients identified in the “CT not indicated” group, 2 had another diagnosis identified (unruptured diverticulitis and a ruptured ovarian cyst), but none had adverse outcomes (95% CI 0-1.4).

Conclusions:

Adverse events were rare (< 1.5%) among patients < 50 years old with flank pain when CT was not required according to the clinical assessment of the EP. Future research should assess the adverse outcomes of withholding CT in low-risk patients using a larger patient sample.
Transport outcomes and dispatch determinants in a paramedic long-term care program: a pilot study
Authors: Jensen Jan L. , Travers Andrew H. , Bardua Darrell J. , Dobson Thomas , Cox Bruce , McVey Jennifer , Cain Ed , Merchant Robert , Carter Alix J.E.
Published: July 2016

Objectives:

Long-term care (LTC) patients are often sent to emergency departments (EDs) by ambulance. In this novel extended care paramedic (ECP) program, specially trained paramedics manage LTC patients on site. The objective of this pilot study was to describe the dispatch and disposition of LTC patients treated by ECPs and emergency paramedics.

Methods:

Data were collected from consecutive calls to 15 participating LTC facilities for 3 months. Dispatch determinants, transport rates, and relapse rates were described for LTC patients attended by ECPs or emergency paramedics. ECP involvement in end-of-life care was identified.

Results:

Of 238 eligible calls, 140 (59%) were attended by an ECP and 98 (41%) by emergency paramedics. Although the top three determinants were the same in each group, the overall distribution of dispatch determinants and acuity differed. In the ECP cohort, 98 of 140 (70%) were treated and released, 33 of 140 (24%) had “facilitated transfer” arranged by an ECP, and 9 of 140 (6%) were immediately transported to the ED by ambulance. In the emergency paramedic cohort, 77 of 98 (79%) were immediately transported to the ED and 21 of 98 (21%) were not transported. In the ECP group, 6 of 98 (6%) patients not transported triggered a 911 call within 48 hours for a related clinical reason, although none of the patients not transported by emergency paramedics relapsed.

Conclusion:

ECP involvement in LTC calls was found to reduce transports to the ED with a low rate of relapse. These pilot data generated hypotheses for future study, including determination of appropriate populations for ECP care and analysis of appropriate and safe nontransport.
Prehospital resuscitation of a man with excited delirium and cardiopulmonary arrest
Authors: Maher Patrick Joseph , Walsh Mimi , Burns Thomas , Strote Jared
Published: July 2016

Features consistent with the syndrome known as excited delirium (ExDS) have been associated with law enforcement restraint-related death. The pathophysiology and exact causative factors of restraint-related death associated with ExDS remain unclear. We present a case of successful field resuscitation of a man with ExDS who experienced cardiopulmonary arrest while being restrained by law enforcement officers. Despite the presence of a severe lactic acidosis on emergency department admission, the patient recovered following prehospital treatment with advanced cardiac life support measures and intravenous sodium bicarbonate, likely in part due to early recognition of the disease process.
Utility of computed tomography and derivation and validation of a score to identify an emergent outcome in 2,315 patients with suspected urinary tract stone
Authors: Aubrey-Bassler F. Kris , Lee Scott D. , Barter Richard B. , Asghari Shabnam , Cullen Richard , Godwin Marshall
Published: July 2016

Objective:

Because a majority of urinary tract stones (UTSs) pass spontaneously and clinically significant alternative pathology is rare, we hypothesize that many computed tomographic (CT) scans to diagnose them are likely unnecessary. We sought to measure the impact of renal CT scans on resource use and to justify a prospective study to derive a score that predicts an emergent diagnosis in patients with suspected UTS by doing so in our retrospective series.

Methods:

We conducted a retrospective study of ED patients who had noncontrast CT of the abdomen for suspected UTS. A split-sample was used to derive and validate a score to predict the presence of an emergent diagnosis on CT.

Results:

Of the 2,315 patients (50.8% female, mean age 45 years), 49 (2.1%) had an emergent outcome observed on CT. An additional 12 (0.5%) patients had an urgent outcome and 239 (10.6%) had a urologic procedure within 8 weeks of the CT. Serum white blood cell count, highest temperature, urine red blood cell count, and the presence of abdominal pain were significant predictors of the primary outcome. A score derived using these predictors had a potential range of 22 (0.26% predicted risk, 0.5% actual risk of the outcome) to 6 (52% predicted risk). The score was moderately discriminatory with c-statistics of 0.752 (derivation) and 0.668 (validation) and accurate with Hosmer-Lemeshow statistics of 10.553 (p = 0.228, derivation) and 9.70 (p = 0.286, validation).

Conclusions:

A sensible, relevant score derived and validated on all patients presenting with symptoms suggestive of renal colic could be useful in reducing abdominal CT scan ordering.
The Canadian National EMS Research Agenda: a mixed methods consensus study
Authors: Jensen Jan L. , Bigham Blair L. , Blanchard Ian E. , Dainty Katie N. , Socha Doug , Carter Alix , Brown Lawrence H. , Travers Andrew H. , Craig Alan M. , Brown Ryan , Morrison Laurie J.
Published: July 2016

Introduction:

Research is essential for the development of evidence-based emergency medical services (EMS) systems of care. When resources are scarce and gaps in evidence are large, a national agenda may inform the growth of EMS research in Canada. This mixed methods consensus study explores current barriers and existing strengths within Canadian EMS research, provides recommendations, and suggests EMS topics for future study.

Methods:

Purposeful sampling was employed to invite EMS research stakeholders from various roles across the country. Study phases consisted of 1) baseline interviews of a subsample, 2) roundtable discussion, and 3) an online Delphi survey, in which participants scored each statement for importance. Consensus was defined a priori and met if 80% scored a statement as “important” or “very important.”

Results:

Fifty-three stakeholders participated, representing researchers (37.7%), EMS administrators (24.6%), clinicians/ providers (20.7%), and educators (17.0%). Participation rates were as follows: interviews, 13 of 13 (100%); roundtable, 47 of 53 (89%); survey round 1, 50 of 53 (94%); survey round 2, 47 of 53 (89%); and survey round 3, 40 of 53 (75%). A total of 141 statements were identified as important: 20 barriers, 54 strengths/opportunities, 31 recommendations, and 36 suggested topics for future research. Like statements were synthesized, resulting in barriers (n 5 10), strengths/opportunities (n 5 24), and recommendations (n 5 19), which were categorized as time, opportunities, and funding; education and mentorship; culture of research and collaboration; structure, process, and outcome of research; EMS and paramedic practice; and the future of the EMS Research Agenda.

Conclusions:

Consensus-based key messages from this agenda should be considered when designing, funding, and publishing EMS research and will advance EMS research locally, regionally, and nationally.
Defining, quantifying, and characterizing adult frequent users of a suburban Canadian emergency department
Authors: Moe Jessica , Bailey Allan L. , Oland Ryan , Levesque Linda , Murray Heather
Published: July 2016

Introduction:

Frequent emergency department (ED) users are inconsistently defined and poorly studied in Canada. The purpose of this study was to develop uniform definitions, quantify ED burden, and characterize adult frequent users of a suburban community ED.

Methods:

We retrospectively reviewed the administrative database of the WestView ED in Alberta for patients ≥ 18 years of age presenting during the fiscal year of 2010. Adult frequent users and extreme frequent users were defined as patients with yearly visit numbers greater than the 95th and 99th percentiles, respectively. Demographic information including age, sex, ED length of stay, diagnoses, Canadian Triage and Acuity Scale (CTAS) level, and disposition were collected and stratified by ED frequency of use categories.

Results:

The study included 22,333 ED visits by 14,223 patients. Frequent users represented 3.1% of patients and 13.8% of visits. Extreme frequent users represented 0.8% of patients, 5.4% of visits, and 568,879 cumulative ED minutes (395 days). Nonfrequent users had one to four, frequent users had five or more, and extreme frequent users had eight or more visits over a 12-month period. Frequent users and extreme frequent users had a significantly longer ED length of stay overall and in most age categories. Alcohol-related behavioural disorders, anxiety, nausea/vomiting, and chronic obstructive pulmonary disease were prominent diagnoses, suggesting that psychiatric, somatic, and chronic illnesses may underlie recurrent visits. Admission rates were significantly higher for frequent compared to nonfrequent users.

Conclusions:

We propose reproducible definitions for adult frequent and extreme frequent ED users and provide information on the characteristics and burden of care of these groups at a community Canadian suburban ED. Adoption of these definitions would allow comparison across centres in future research and facilitate targeted interventions for frequent and extreme frequent ED users.
“Bath salts” intoxication: a new recreational drug that presents with a familiar toxidrome
Authors: Hall Christine , Heyd Christopher , Butler Chris , Yarema Mark
Published: July 2016

It is important for emergency physicians to be aware of new psychoactive agents being used as recreational drugs. “Bath salts,” which include 3,4-methylenedioxypyrovalerone (MDPV), mephedrone, and methylone, are the newest recreational stimulants to appear in Canada. There are currently more than 12 synthetic cathinones marketed as bath salts and used with increasing frequency recreationally. Although these drugs are now illegal in Canada, they are widely available online. We present a case report and discuss bath salts intoxication and its anticipated sympathomimetic toxidrome, treatment strategies, and toxicologic analysis, Treatment should not rely on laboratory confirmation. Since the laboratory identification of such drugs varies by institution and toxicologic assay, physicians should not misconstrue a negative toxicology screen as evidence of no exposure to synthetic cathinones. Illicit bath salts represent an increasing public health concern that involves risk to the user, prehospital personnel, and health care providers.
Derivation of a risk scale and quantification of risk factors for serious adverse events in adult emergency department syncope patients
Authors: Thiruganasambandamoorthy Venkatesh , Wells George A. , Hess Erik P. , Turko Ekaterina , Perry Jeffrey J. , Stiell Ian G.
Published: July 2016

Background:

Determining the appropriate disposition of emergency department (ED) syncope patients is challenging. Previously developed decision tools have poor diagnostic test characteristics and methodological flaws in their derivation that preclude their use. We sought to develop a scale to risk-stratify adult ED syncope patients at risk for serious adverse events (SAEs) within 30 days.

Methods:

We conducted a medical record review to include syncope patients age ≥ 16 years and excluded patients with ongoing altered mental status, alcohol or illicit drug use, seizure, head injury leading to loss of consciousness, or severe trauma requiring admission. We collected 105 predictor variables (demographics, event characteristics, comorbidities, medications, vital signs, clinical examination findings, emergency medical services and ED electrocardiogram/ monitor characteristics, investigations, and disposition variables) and information on the occurrence of predefined SAEs. Univariate and multiple logistic regression analyses were performed.

Results:

Among 505 enrolled patient visits, 49 (9.7%) suffered an SAE. Predictors of SAE and their resulting point scores were as follows: age ≥ 75 years (1), shortness of breath (2), lowest ED systolic blood pressure < 80 mm Hg (2), Ottawa Electrocardiographic Criteria present (2), and blood urea nitrogen > 15 mmol/L (3). The final score calculated by addition of the individual scores for each variable (range 0–10) was found to accurately stratify patients into low risk (score < 1, 0% SAE risk), moderate risk (score 1, 3.7% SAE risk), or high risk (score > 1, ≥ 10% SAE risk).

Conclusion:

We derived a risk scale that accurately predicts SAEs within 30 days in ED syncope patients. If validated, this will be a potentially useful clinical decision tool for emergency physicians, may allow judicious use of health care resources, and may improve patient care and safety.
Quality assurance evaluation of a simple linear protocol for the treatment of impending status epilepticus in a pediatric emergency department 2 years postimplementation
Authors: Tourigny-Ruel Geneviève , Diksic Dubravka , Mok Elise , McGillivray David
Published: July 2016

Objective:

To evaluate the efficacy and safety of a simple linear midazolam-based protocol for the management of impending status epilepticus in children up to 18 years of age.

Methods:

This is a descriptive, quality assessment, retrospective chart review of children presenting with the chief complaint of seizure disorder in the emergency department (ED) of a tertiary care pediatric hospital and a triage category of resuscitation or urgent from April 1, 2009, to August 31, 2011. In children with at least one seizure episode in the ED treated according to the linear protocol, three main outcomes were assessed: compliance, effectiveness, and complications.

Results:

Of the 128 children meeting the above study criteria, 68 had at least one seizure episode in the ED, and treatment was required to terminate at least one seizure episode in 46 of 68 patients (67.6%). Fifty-five seizure episodes were treated in the 46 patients: 51 of 55 seizure episodes were treated with midazolam (92.7%) and 4 of 55 with lorazepam or diazepam (7.3%). Of those treated with midazolam, 86.3% (44 of 51) were successfully treated with one or two doses of midazolam. The median seizure duration for all treated patients was 6 minutes. Of the 42 patients treated with midazolam, 7 required either continuous positive airway pressure or intubation, and two patients were treated for hypotension. One patient died of pneumococcal meningitis.

Conclusion:

This simple linear protocol is an effective and safe regimen for the treatment of impending status epilepticus in children.
Radiological errors in the Canadian Journal of Emergency Medicine
Authors: McEachern James D. , Leswick David A. , Stoneham Grant W. , Mohr Karen L. , Stempien James E.
Published: July 2016

Objectives:

To systematically evaluate the accuracy of text descriptions and labeling of radiologic images published in theCanadian Journal of Emergency Medicine (CJEM). Error detection by radiologists and emergency physicians and the clinical significance and educational value of these errors were assessed. Errors were also correlated with radiologist involvement in publication and imaging modality.

Methods:

Thirty-three issues of CJEM were examined from January 2003 to May 2008. Electronic copies of all radiologic images published were obtained with their caption and description from the text. Identifying information was removed to present images in an anonymous fashion. Images were presented to two radiologists who, working in consensus, critically appraised each image and accompanying text. Images were then presented to two emergency department physicians who, working in consensus, critically appraised each image and accompanying text. All images with errors detected by either radiology or emergency physicians were then discussed to determine if errors would have affected clinical management or educational value. The emergency physicians also identified “underlabeled” images where it was felt that further labeling would enhance their educational value.

Results:

Forty-five articles with 82 images were obtained. At least one error was observed in 18 (40%) articles and 20 (24%) images. Two errors were present in three images, resulting in 23 errors. Of the 23 errors, 17 were image description errors and 6 were labeling errors. Five errors were detected by both radiology and emergency physicians, whereas 15 were detected only by radiologists and 3 were detected only by emergency physicians. Of these errors, 12 (52%) were rated as potentially affecting both clinical management and educational value, 5 (22%) as only affecting educational value, and 6 (26%) as nonsignificant. Radiologists were involved in six articles, including 12 images that contained no errors. There was no official radiologist involvement in 39 articles, including 70 images, 18 (26%) of which contained errors. In addition, 26 images were identified by emergency physicians as potentially benefiting from enhanced labeling to improve educational value.

Conclusions:

Radiologic images published in the CJEM are generally of high quality; however, 23 errors were found in 82 images, 18 (78%) of which were rated as potentially affecting clinical management, educational value, or both. Radiologist involvement in the publication process may be of assistance as no errors were seen in articles that included radiologists as authors.
Effects of aqueous and ethanolic extracts of Aegle marmelos (BAEL) leaves on chronic inflammation in rats
Authors: Rahman Sharmin , Eva Eliza Omar , Quader Rezaul , Tasrin Muqbula , Khan Md Ismail
Published: July 2016

Aegle Marmelos Linn (Rutaceae) is used as ethno medicine against various human ailments. Several curde extracts from various parts (Leaves, flower, stem, root etc) of the plant A. marmelos Linn have shown variable anti-inflammatory effects in acute and chronic inflammation in animal models. The anti-inflammatory effects of A marmelos linn may be of special advantage compared to conventional anti-inflammatory drugs. The present study has therefore been undertaken with the objective to evaluate the anti inflammatory effect of aqueous and ethanolic extracts of A. marmelos leaves, compared to a standard anti-inflammatory drug (indomethacin) in chronic inflammatory conditions. The anti-inflammatory effect was studied in rats using cotton pellet implantation, where granuloma formation was used as an index of chronic inflammation. Aqueous and ethanolic extracts of A. marmelos leaves were given orally for 7 days daily at doses of 100 mg/kg body weight. The percent inhibition of granuloma formation following treatment with aqueous and ethanolic extracts of A. marmelos leaves, and indomethacin compared to control were 16.5%, 25.72%, and 39.37% respectively. The differences were statistically significant (p<0.05 in case of aqueous and ethanolic extracts and p<0.001 in case of indomethacin). The results suggest that in case of chronic inflammation, both aqueous and ethanolic extracts of A. marmelos have significant anti- inflammatory effect. The ethanolic extracts compared to aqueous extract produced greater anti- inflammatory effects.Ibrahim Med. Coll. J. 2015; 9(2): 52-54
Disseminated melioidosis involving skin and joint: a case report
Authors: Afroze Samira Rahat , Rahim Muhammad Abdur , Barai Lovely , Uddin Khwaja Nazim
Published: July 2016

Melioidosis is an infectious disease that can cause serious morbidity and may result in death if not treated early. Its causative organism, Burkholderia pseudomallei is present in soil and water. Here, we report a case of disseminated melioidosis involving skin and joint in a farmer residing in an area where the organism has been found in the soil.Ibrahim Med. Coll. J. 2015; 9(2): 55-57
Assessing Tumor Response to Treatment in Patients with Lung Cancer Using Dynamic Contrast-Enhanced CT
Authors: Strauch Louise , Eriksen Rie , Sandgaard Michael , Kristensen Thomas , Nielsen Michael , Lauridsen Carsten
Published: July 2016

The aim of this study was to provide an overview of the literature available on dynamic contrast-enhanced computed tomography (DCE-CT) as a tool to evaluate treatment response in patients with lung cancer. This systematic review was compiled according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Only original research articles concerning treatment response in patients with lung cancer assessed with DCE-CT were included. To assess the validity of each study we implemented Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). The initial search yielded 651 publications, and 16 articles were included in this study. The articles were divided into groups of treatment. In studies where patients were treated with systemic chemotherapy with or without anti-angiogenic drugs, four out of the seven studies found a significant decrease in permeability after treatment. Four out of five studies that measured blood flow post anti-angiogenic treatments found that blood flow was significantly decreased. DCE-CT may be a useful tool in assessing treatment response in patients with lung cancer. It seems that particularly permeability and blood flow are important perfusion values for predicting treatment outcome. However, the heterogeneity in scan protocols, scan parameters, and time between scans makes it difficult to compare the included studies.
Matrix Metalloproteinases in Non-Neoplastic Disorders
Authors: Tokito Akinori , Jougasaki Michihisa
Published: July 2016

The matrix metalloproteinases (MMPs) are zinc-dependent endopeptidases belonging to the metzincin superfamily. There are at least 23 members of MMPs ever reported in human, and they and their substrates are widely expressed in many tissues. Recent growing evidence has established that MMP not only can degrade a variety of components of extracellular matrix, but also can cleave and activate various non-matrix proteins, including cytokines, chemokines and growth factors, contributing to both physiological and pathological processes. In normal conditions, MMP expression and activity are tightly regulated via interactions between their activators and inhibitors. Imbalance among these factors, however, results in dysregulated MMP activity, which causes tissue destruction and functional alteration or local inflammation, leading to the development of diverse diseases, such as cardiovascular disease, arthritis, neurodegenerative disease, as well as cancer. This article focuses on the accumulated evidence supporting a wide range of roles of MMPs in various non-neoplastic diseases and provides an outlook on the therapeutic potential of inhibiting MMP action.
Carbon Nanotube Based Groundwater Remediation: The Case of Trichloroethylene
Authors: Jha Kshitij , Liu Zhuonan , Vijwani Hema , Nadagouda Mallikarjuna , Mukhopadhyay Sharmila , Tsige Mesfin
Published: July 2016

Adsorption of chlorinated organic contaminants (COCs) on carbon nanotubes (CNTs) has been gaining ground as a remedial platform for groundwater treatment. Applications depend on our mechanistic understanding of COC adsorption on CNTs. This paper lays out the nature of competing interactions at play in hybrid, membrane, and pure CNT based systems and presents results with the perspective of existing gaps in design strategies. First, current remediation approaches to trichloroethylene (TCE), the most ubiquitous of the COCs, is presented along with examination of forces contributing to adsorption of analogous contaminants at the molecular level. Second, we present results on TCE adsorption and remediation on pure and hybrid CNT systems with a stress on the specific nature of substrate and molecular architecture that would contribute to competitive adsorption. The delineation of intermolecular interactions that contribute to efficient remediation is needed for custom, scalable field design of purification systems for a wide range of contaminants.
Getting Lost in the Field
Authors: Bødker Mads
Published: July 2016

This article explores the notion of "meditations" or a "meditative stance" in fieldwork, understood as shorthand for the simple practices of walking and sensing. I advocate an understanding of meditations as an alternative embodied mode of research that seeks to contemplate how a reflective
attention to walking as a reflective engagement in a sensory landscape may be enrolled as embodied ways of knowing. Meditation performs the touristic and mobile body as a porous and affective site. Moving around on foot creates a sensibility that is often ignored when researchers and practitioners
in information technology (IT) attend to the field to learn about tourism in ways that seek to inform design. This article attempts to open a discussion around what kinds of fieldwork and subsequent representations emphasize embodiment in the design of tourism technologies—how, in other
words, researchers can attend to, and represent, the affective, vital qualities of living with technology and why this might be an increasingly relevant question to ask in the field that has become known as digital tourism. Stressing the inherent openness and contingency of meditation, the
article hopes to stir the imaginative registers of scholars and to engender a postdisciplinary dialogue that challenges the field of IT design and information systems research to engage with vulnerable and open discourses in nonrepresentational theory, theories of affect, and place that have
been consistently raised in human—or cultural—geography as well as anthropology in the past decades. The article weaves empirical incidents from fieldwork into a postdisciplinary theoretical landscape that spans mobilities, affect, the sensual, and embodiment. Emphasizing learning
through the senses and the body and their importance to a sensory apprenticeship, the article suggests alternative routes to knowing and representation in the study of, and ultimately the design for, the digital tourist.
EXPECTATION ON OBSERVATION OF SUPERNOVA REMNANTS WITH THE LHAASO PROJECT
Authors: Liu Ye , Cao Zhen , Chen Songzhan , Chen Yang , Cui Shuwang , He Huihai , Huang Xingtao , Ma Xinhua , Yuan Qiang , Zhang Xiao ,   (On behalf of the LHAASO Collaboration)
Published: July 2016

Supernova remnants (SNRs) are believed to be the most important acceleration sites for cosmic rays (CRs) below ∼1015 eV in the Galaxy. High-energy photons, either directly from the shocks of the SNRs or indirectly from the interaction between SNRs and the nearby clouds, are crucial probes for the CR acceleration. Big progresses on observations of SNRs have been achieved by space- and ground-based γ-ray facilities. However, whether γ-rays come from accelerated hadrons or not, as well as their connection with the CRs observed at Earth, remains in debate. Large High Altitude Air Shower Observatory (LHAASO), a next-generation experiment, is designed to survey the northern part of the very high energy γ-ray sky from ∼0.3 TeV to PeV with the sensitivity of ≲1% of the Crab Nebula flux. In this paper, we indicate that LHAASO will be dedicated to enlarging the γ-ray SNR samples and improving the spectral and morphological measurements. These measurements, especially at energies above 30 TeV, will be important for us to finally understand the CR acceleration in SNRs.