bluuebunny/crossref_metadata_2025 huggingface dataset:
Variations of lumbrical muscle innervation patterns in the hand, focusing on the dual innervation of the third lumbrical muscle
Authors: Hur Mi‐sun
Published: June 2016

Introduction: This study was conducted to clarify the innervation patterns of the lumbrical muscles by identifying the origin of the nerve fascicles innervating these muscles. Methods: The lumbricals in the hand were investigated in 50 specimens of embalmed Korean adult cadavers. Results: Dual innervation of the third lumbrical was most frequently observed in 64.0%. The third lumbrical was innervated by a branch arising from the median nerve (MN) distal to site at which the superficial branch of the ulnar nerve (sUN) joins the MN in 34%. When separating and tracing the nerve fascicles from the MN distal to the communicating branch from the sUN to MN, the fascicles contained parts of the MN and sUN in 18% and part of the MN in 16%. Conclusions: These results will be helpful for accurate diagnoses, surgical procedures, and electrophysiological examinations in lesions of the MN and ulnar nerve in the hand. Muscle Nerve, 2016 Muscle Nerve 55: 160–165, 2017
Partial target coverage to extend the lifetime in wireless multi‐role sensor networks
Authors: Castaño Fabián , Bourreau Eric , Rossi André , Sevaux Marc , Velasco Nubia
Published: June 2016

This article studies the effect of partial coverage to extend the lifetime of wireless sensor networks and introduces a hybrid exact solution strategy that efficiently maximizes network lifetime. We consider a set of sensors used to provide coverage of discrete targets and transfer the information to the sink node via multi‐hop wireless communication. An active sensor has one of the two roles: it is a source when it senses and transfers data; it is a relay if it only transfers data. Network lifetime is extended through the use of covers representing sensors role allocation and network topology. A hybrid column generation is used to identify the optimal operation schedules and roles allocation that maximize network lifetime. A constraint programming strategy is provided to identify profitable network configurations leading to extend network lifetime and to prove optimality of the solutions found. Moreover, an evolutionary algorithm is proposed to boost up the solution process and accelerate convergence. Extensive computational results demonstrate the effectiveness of the proposed approach. © 2016 Wiley Periodicals, Inc. NETWORKS, Vol. 68(1), 34–53 2016
Mixed Lagrangian formulation for size‐dependent couple stress elastodynamic and natural frequency analyses
Authors: Deng Guoqiang , Dargush Gary F.
Published: June 2016

Couple stress formulations have been given much attention lately because of the possibility to explain cases, when the classical theory of elasticity fails to describe adequately the mechanical behavior. Such cases may include size‐dependent stiffness, high stress gradients, and the response of materials with microstructure. Here, a new mixed Lagrangian formulation is developed for elastodynamic response within consistent size‐dependent skew‐symmetric couple stress theory. With a specific choice of mixed variables, the formulation can be written with only C0 continuity requirements, without the need to introduce a Lagrange multiplier or penalty method. Furthermore, this formulation permits, for the first time, the determination of natural frequencies within the consistent couple stress theory. Details for the strong form of the equilibrium equations, constitutive model relations, boundary conditions, and the corresponding weak form are provided. In addition, the discrete forms are also discussed with two approaches for reducing variables. Several simple two‐dimensional computational example problems are then examined, along with a brief investigation of the effect of couple stress on natural frequencies, which exhibit size‐dependence for most, but not all, modes. Copyright © 2016 John Wiley & Sons, Ltd.
Faculty Mentors' Perspectives on E‐Mentoring Post‐Professional Occupational Therapy Doctoral Students
Authors: Doyle Nancy , Jacobs Karen , Ryan Cathryn
Published: June 2016

E‐mentoring is a viable option for mentoring students in occupational therapy educational programs. The objective of this study was to investigate faculty perspectives of faculty‐to‐student e‐mentoring in an online post‐professional doctor of occupational therapy program. In a retrospective mixed‐method design, nine faculty members described features and outcomes of e‐mentoring 48 doctoral students. Online survey results were analysed quantitatively for descriptive statistics; transcripts from structured interviews were analysed using qualitative content analysis. The results showed that successful, satisfactory e‐mentoring is student‐centered, flexible, frequent, academically and psychosocially supportive; faculty members must be skilled in adapting e‐mentoring to the needs and objectives of each mentee; e‐mentoring provides opportunities for faculty members and students to achieve academic and professional objectives and growth. The findings suggest that implementation of e‐mentoring may be a useful model in other occupational therapy programs. There is a need for future studies with broader participant pool, observable measures of e‐mentoring, standardized measures of satisfaction and success and comparison between e‐mentoring with and without web camera. Copyright © 2016 John Wiley & Sons, Ltd.
Flammability and flame‐retardant mechanism of high density polyethylene/wood fiber/modified ammonium polyphosphate composite
Authors: Liu Wenlong , Wang Dongxia , Zhang Yin , Bai Ting , Li Jing
Published: June 2016

Fabrication and characterization of a novel high density polyethylene/wood fiber/modified ammonium polyphosphate (HDPE/WF/MAPP) composite have been carried out. The flammability of the composite is characterized by the limiting oxygen index (LOI), vertical burning test (UL‐94), and cone calorimetry. The flame‐retardant mechanism is investigated by Fourier transform‐infrared (FT‐IR), X‐ray photoelectron spectroscopy (XPS), and scanning electronic micrograph (SEM).The results indicate that, with the optimum formulation, the LOI and UL‐94 of the HDPE/WF/MAPP composite are 38.0% and V‐0 rating, respectively. Comparing with HDPE/WF, the peak of heat release rate (PHRR) of the HDPE/WF/MAPP composite decreases from 432 to 166 kW m−2, and total heat release (THR) decreases from 66 to 33 MJ m−2. Cone calorimeter analysis suggest that the smoke production rate (SPR), total smoke production (TSP), mass loss rate (MLR), and time to ignition (TTI) of the HDPE/WF/MAPP system significantly decrease. In addition, the thermal stabilities of the composite are studied by thermo gravimetric analysis (TGA), which shows there are two stages decomposition during the thermal degradation process. With the addition of MAPP, char residue of the composite increase from 12.06% to 34.67%. The char residue containing P‐OH, P‐N‐C, P‐O‐P, P‐O‐C, and aryl groups can directly affect the flame retardance. The flexural modulus of the HDPE/WF/MAPP system is improved greatly in the presence of MAPP. POLYM. COMPOS., 39:1192–1199, 2018. © 2016 Society of Plastics Engineers
Effectiveness of airway clearance techniques in children hospitalized with acute bronchiolitis
Authors: Van Ginderdeuren F. , Vandenplas Y. , Deneyer M. , Vanlaethem S. , Buyl R. , Kerckhofs E.
Published: June 2016

Objective

To evaluate the effectiveness of two airway clearance techniques (ACT's) in children <24 months hospitalized with mild to moderate bronchiolitis.

Design

One hundred and three children were randomly allocated to receive one 20‐min session daily, either assisted autogenic drainage (AAD), intrapulmonary percussive ventilation (IPV), or bouncing (B) (control group), ninety‐three finished the study.

Outcome measures

Mean time to recovery in days was our primary outcome measure. The impact of the treatment and the daily improvement was also assessed by a validated clinical and respiratory severity score (WANG score), heart rate (HR), and oxygen saturation (SaO2).

Results

Mean time to recovery was 4.5 ± 1.9 days for the control group, 3.6 ± 1.4 days, P < 0.05 for the AAD group and 3.5 ± 1.3 days, P = 0.03 for the IPV group. Wang scores improved significantly for both physiotherapy techniques compared to the control group.

Conclusion

Both ACT's reduced significantly the length of hospital stay compared to no physiotherapy. Pediatr Pulmonol. 2017;52:225–231. © 2016 Wiley Periodicals, Inc.
Lipopeptides from a novel Bacillus methylotrophicus 39b strain suppress Agrobacterium crown gall tumours on tomato plants
Authors: Frikha‐Gargouri Olfa , Ben Abdallah Dorra , Ghorbel Imen , Charfeddine Ikram , Jlaiel Lobna , Triki Mohamed Ali , Tounsi Slim
Published: June 2016

BACKGROUND

This study aims to characterise the antibacterial activity of a novel Bacillus methylotrophicus strain named 39b against tumourigenic Agrobacterium tumefaciens C58 and B6 strains. It also aims to identify the compound that is responsible for its activity and to evaluate its efficiency to control crown gall disease in tomato plants.

RESULTS

B. methylotrophicus strain 39b was found to stop the growth of phytopathogenic A. tumefaciens strains in in vitro experiments. Lipopeptides – surfactins, iturins and fengycins – were detected under various isoforms by mass spectrometry analysis of the methanolic extract. The active principle acting against Agrobacterium strains was isolated from TLC plates and identified by mass spectrometry as surfactin. The strain was effective in reducing the weight and the number of galls induced by A. tumefaciens strains on tomato plants. Total inhibition of gall formation was observed using the antibacterial compounds.

CONCLUSION

B. methylotrophicus strain 39b exhibited antibacterial activity against phytopathogenic A. tumefaciens C58 and B6 both in vitro and in vivo. Lipopeptides are the main compounds that confer the biocontrol ability. This strain has the potential to be developed as a biological control agent for crown gall disease. © 2016 Society of Chemical Industry
Downstream Regime Relations for Single‐Thread Channels
Authors: Thayer J. B.
Published: June 2016

New empirically derived downstream hydraulic geometry relations are developed for single‐thread gravel/cobble‐bed and sand‐bed channels using the independent variables bankfull discharge, channel slope, and median bed grain size. Differences in channel response to the controlling variables are observed between gravel/cobble‐bed and sand‐bed channels. It is found that the inclusion of channel slope into regime relations is necessary for accurate channel geometry predictions and that bed grain size becomes an unnecessary variable. Accuracy of predictions is superior to many existing relations and comparable with those that already include slope as an independent variable. Variability of prediction errors is comparable with existing relations. Applications and implications of the new relations are discussed. Copyright © 2016 John Wiley & Sons, Ltd.
Unexpected Fe‐enriched compounds observed in Mg–Ce alloy: An atomic‐scale STEM investigation
Authors: Zheng Jingxu , Chen Bin
Published: June 2016

This paper investigates into the unexpected nanosize Fe‐enriched particles with defects incorporated, using EDS under STEM mode and atomic‐resolution HAADF. The particle that locates between eutectic Mg12Ce phase and α‐Mg phase is identified as CeFe2Si2 compound. Two types of defects are incorporated: Type‐I defect is Ce‐Si in a simple cubic lattice; Type‐II defect is Ce in a FCC lattice. The interface between the defect‐free CeFe2Si2 and the defects is fully coherent. In addition, another two Ce/Fe/Si‐enriched particles are observed, proving that the enrichment of Ce, Fe, and Si is not an accidental phenomenon. The observed formation of Ce/Fe/Si‐enriched particles provides a possible explanation for the improvement in corrosion resistance and the purification effect induced by addition of rare earth elements into alloys. In addition, the present study demonstrates an advanced application of Cs‐corrected HAADF by successfully directly imaging the dislocation and complex defects incorporated in the compound and by achieving a one‐angstrom resolution. SCANNING 38:783–791, 2016. © 2016 Wiley Periodicals, Inc.
Relationship between grain boundary diffusion in nanocrystals and amorphous microstructure
Authors: Sun Lin‐lin , Wang Jun , Kou Hong‐chao , Li Jin‐shan , Zhang Ping‐xiang
Published: June 2016

The effects of microstructure on diffusion behaviors of Ni in Zr48Cu36Ag8Al8 alloy were investigated by transmission electron microscope and secondary ion mass spectrum. The temperature dependence of Ni diffusivities in Zr48Cu36Ag8Al8 alloy with different states (metallic glass, nanocrystals and coarse crystals) has been measured in the temperature range of 693–723 K. The results show that diffusion behavior is microstructure dependence, and the relations between the microstructure and diffusion are discussed. The activity energy of the grain boundary diffusion in nanocrystals calculated by the Suzuoka solution is about 1.433 eV/atom. It is equivalent with that of metallic glass, which is attributed to the similar microstructure between the two. Copyright © 2016 John Wiley & Sons, Ltd.
A Miniaturized Hemoretractometer for Blood Clot Retraction Testing
Authors: Li Zida , Li Xiang , McCracken Brendan , Shao Yue , Ward Kevin , Fu Jianping
Published: June 2016

Blood coagulation is a critical hemostatic process that must be properly regulated to maintain a delicate balance between bleeding and clotting. Disorders of blood coagulation can expose patients to the risk of either bleeding disorders or thrombotic diseases. Coagulation diagnostics using whole blood is very promising for assessing the complexity of the coagulation system and for global measurements of hemostasis. Despite the clinic values that existing whole blood coagulation tests have demonstrated, these systems have significant limitations that diminish their potential for point‐of‐care applications. Here, recent advancements in device miniaturization using functional soft materials are leveraged to develop a miniaturized clot retraction force assay device termed mHemoRetractoMeter (mHRM). The mHRM is capable of precise measurements of dynamic clot retraction forces in real time using minute amounts of whole blood. To further demonstrate the clinical utility of the mHRM, systematic studies are conducted using the mHRM to examine the effects of assay temperature, treatments of clotting agents, and pro‐ and anti‐coagulant drugs on clot retraction force developments of whole blood samples. The mHRM's low fabrication cost, small size, and consumption of only minute amounts of blood samples make the technology promising as a point‐of‐care tool for future coagulation monitoring.
Rh Nanoparticle Anchoring on Metal Phosphates: Fundamental Aspects and Practical Impacts on Catalysis
Authors: Machida Masato
Published: June 2016

Metal phosphates stabilize Rh nanoparticles on their surface via Rh–O–P bonds, in contrast to the Rh–O–M bonds formed on metal oxides (MOx). The local structure, electronic structure, and redox properties of Rh nanoparticles anchored on metal phosphates, and their practical impacts on catalysis, are reviewed based on recent publications from the author's research group. Because of the covalency of the Rh–O–P bond, Rh oxide is readily reduced to metallic Rh having a higher catalytic activity, whereas Rh oxide on metal oxide supports is more difficult to reduce with an increase of the anchoring strength. Furthermore, Rh metal shows a higher tolerance to reoxidation when supported on metal phosphates because the Rh–O–P bond is preserved under reducing atmospheres. The electron deficiency of Rh metal is another feature that affects its catalytic properties, and the extent of the electron deficiency can be tuned by replacing the metal in the metal phosphate with one of higher basicity. Further impacts on practical performance (thermal stability, poisoning stability, and lean NOx purification) in automobile catalyst applications are also described.
Enhancing student explanations of evolution: Comparing elaborating and competing theory prompts
Authors: Donnelly Dermot F. , Namdar Bahadir , Vitale Jonathan M. , Lai Kevin , Linn Marcia C.
Published: June 2016

In this study, we explore how two different prompt types within an online computer‐based inquiry learning environment enhance 392 7th grade students’ explanations of evolution with three teachers. In the elaborating prompt condition, students are prompted to write explanations that support the accepted theory of evolution. In the competing prompt condition, students are prompted to write explanations that differentiate two views of evolution associated with Darwin and Lamarck. Data sources included a pretest and posttest, an embedded item, observations, logged teacher guidance, and teacher interviews. Findings show similar pretest to posttest gains in students’ understanding of evolution for both conditions, but this pattern was not uniform across all three teachers. For one teacher, students who received competing theory prompts produced significantly higher gains than those who received elaborating theory prompts. A closer look at embedded student work reveals a higher degree of teacher participation (i.e., grading and guidance) than for the other teachers. Our findings illustrate how helping students distinguish between competing scientific claims can support learning in an inquiry unit, but may require a higher degree of teacher participation and reinforcement. We discuss the implications of these findings for enhancing students’ scientific explanations. © 2016 Wiley Periodicals, Inc. J Res Sci Teach 53: 1341–1363, 2016
Remember, remember the fifth of November: Was that thunder I heard or not?
Authors: Owens M. J.
Published: June 2016

‘Thunder days’ are simple records of thunderstorm activity, logging whether a human observer heard thunder on a particular day or not. Despite their low dynamic range and inherent subjectivity, thunder days are invaluable as the only long‐term observations of thunderstorm occurrence, with some records stretching back into the nineteenth century. Thunder days, however, are potentially susceptible to false positives, particularly from explosions. Thus one might expect UK thunder days to show anomalously high counts on New Year's Eve and the days around 5 November, Bonfire Night, both of which are celebrated with large firework displays across the country. It is demonstrated that UK Met Office records of thunder days between 1980 and 2010 do not show any significant increase in thunder reporting around 5 November or 31 December. In fact, the days around 5 November exhibit the largest reduction in the amount of reported thunder relative to annual climatology. While meteorological variability cannot be completely ruled out, this result is suggestive of observer bias; it is speculated that human observers, armed with a priori knowledge of the likelihood of false positives, ‘second guess’ themselves to a greater degree around 5 November than the rest of the year. In fact, the data suggest they should trust in their ability to correctly discriminate between thunder and fireworks.
Orthopedic Activity in Field Hospitals Following Earthquakes in Nepal and Haiti
Authors: Bar‐On Elhanan , Blumberg Nehemia , Joshi Amit , Gam Arnon , Peyser Amos , Lee Evgeny , Kashichawa Shree Krishna , Morose Alexander , Schein Ophir , Lehavi Amit , Kreiss Yitshak , Bader Tarif
Published: June 2016

Background

Field hospitals have been deployed by the Israel Defense Forces (IDF) Medical Corps in numerous disaster events. Two recent deployments were following earthquakes in Haiti in 2010 and in Nepal in 2015. Despite arrival in similar timetables, the mode of operation was different—independently in Haiti and in collaboration with a local hospital in Nepal. The pathology encountered in the two hospitals and the resultant treatment requirements were significantly different between the two events. The purpose of this study was to analyze these differences and their implications for preparation and planning of future deployments.

Methods

Data were obtained from IDF records and analyzed using SPSS™ software.

Results

1686 patients were treated in Nepal versus 1111 in Haiti. The caseload in Nepal included significantly less earthquake‐related injuries (26 vs. 66 %) with 28 % of them sustaining fractures versus 47 % in Haiti. Femoral fractures accounted for 7.9 % of fractures in Nepal versus 26.4 % in Haiti with foot fractures accounting for 23.8 and 6.4 %, respectively. The rate of open fracture was similar at 29.4 % in Nepal and 27.5 % in Haiti. 18.1 % of injured patients in Nepal underwent surgery, and 32.9 % of which was skeletal compared to 32 % surgical cases (58.8 % skeletal) in Haiti. 74.2 % of patients in Nepal and 34.3 % in Haiti were treated for pathology unrelated to the earthquake.

Conclusions

The reasons for the variability in activities between the two hospitals include the magnitude of the disaster, the functionality of the local medical system which was relatively preserved in Nepal and destroyed in Haiti and the mode of operation which was independent in Haiti and collaborative with a functioning local hospital in Nepal. Emergency medical teams (EMTs) may encounter variable caseloads despite similar disaster scenarios. Advance knowledge of the magnitude of the disaster, the functionality of the local medical system, and the collaborative possibilities will help in planning and preparing EMTs to function optimally and appropriately. However, as this information will often be unavailable, EMTs should be capable to adapt to unexpected conditions.
Significant Improvement in Outcomes of Patients with Intrahepatic Cholangiocarcinoma after Surgery
Authors: Yoh Tomoaki , Hatano Etsuro , Nishio Takahiro , Seo Satoru , Taura Kojiro , Yasuchika Kentaro , Okajima Hideaki , Kaido Toshimi , Uemoto Shinji
Published: June 2016

Background

The prognosis of intrahepatic cholangiocarcinoma (ICC) remains poor despite improvements in treatment and post‐operative clinical management. We review our experiences and evaluate our current surgical approaches by comparing patients from two consecutive treatment periods.

Methods

One hundred forty‐four patients who underwent hepatectomy for ICC between 1993 and 2014 were divided into groups that received treatment before (n = 65, first period) and after 2006 (n = 79, second period), when new treatment options such as adjuvant chemotherapy and multimodal therapy for recurrence were introduced. Clinicopathological characteristics and survival outcomes were compared between the groups.

Results

First‐period patients exhibited more advanced tumor characteristics, including larger tumors, higher serum carbohydrate antigen 19–9 levels, and vascular invasion. Median overall survival (OS) durations of the first‐ and second‐period groups were 21.4 and 57.7 months, respectively (p < 0.001); corresponding median disease‐free survival (DFS) durations were 12.2 and 16.6 months, respectively (p = 0.027). Multivariate analysis found an independent association of the treatment time period with OS and DFS. Notably, second‐period patients with N1 disease achieved a longer OS and DFS (median OS time: 12.4 and 26.0 months, p = 0.0018, and median DFS: 4.7 and 10.7 months p = 0.019, respectively). Among recurrent patients (first, n = 50 and second, n = 44), second‐period patients had a significantly longer survival after recurrence (8.0 vs. 22.3 months, p < 0.001).

Conclusion

ICC patients, particularly those with N1 disease, achieved significant survival improvements that were partly attributable to patient selection, adjuvant chemotherapy, and multimodal treatment after recurrence.
Maternal Flaxseed Oil During Lactation Enhances Bone Development in Male Rat Pups
Authors: Pereira Aline D'Avila , Ribeiro Danielle Cavalcante , de Santana Fernanda Carvalho , de Sousa dos Santos Aline , Mancini‐Filho Jorge , do Nascimento‐Saba Celly Cristina Alves , Velarde Luis Guillermo Coca , da Costa Carlos Alberto Soares , Boaventura Gilson Teles
Published: June 2016

Flaxseed oil is an alpha linolenic acid source important in the growth and body development stage; furthermore, this acid acts on adipose tissue and bone health. The aim of this study was to evaluate body composition, fatty acid composition, hormone profile, retroperitoneal adipocyte area and femur structure of pups at weaning, whose mothers were fed a diet containing flaxseed oil during lactation. After birth, pups were randomly assigned: control (C, n = 12) and flaxseed oil (FO, n = 12), rats whose mothers were treated with diet containing soybean or flaxseed oil. At 21 days, the pups were weaned and body mass, length, body composition, biochemical parameter, leptin, osteoprotegerin, osteocalcin, fatty acids composition, intra‐abdominal fat mass and femur structure were analyzed. FO showed (p < 0.05): higher body mass (+12 %) and length (+9 %); body fat mass (g, +45 %); bone mineral density (+8 %), bone mineral content (+55 %) and bone area (+35 %), osteocalcin (+173 %) and osteoprotegerin (+183 %). Arachidonic acid was lower (p < 0.0001), alpha‐linolenic and eicosapentaenoic were higher (p < 0.0001). Intra‐abdominal fat mass was higher (+25 %), however, the retroperitoneal adipocytes area was lower (−44 %). Femur mass (+10 %), distance between epiphyses (+4 %) and bone mineral density (+13 %) were higher. The study demonstrates that adequate flaxseed oil content during a lactation diet plays an important role in the development of pups.
Impact of Microwave Assisted Infusion on the Quality and Volatile Composition of Olive Oil Aromatized with Rosemary Leaves
Authors: Benmoussa Hasnia , Elfalleh Walid , Farhat Asma , Servili Maurizio , Algabr Methaq , Romdhane Mehrez
Published: June 2016

Olive oil with rosemary leaves by microwave assisted infusion (MAI) as an alternative to conventional infusion (CI) was evaluated. Microwave heating was applied to the mixture in order to accelerate diffusion of the rosemary volatile compounds into the olive oil. The volatile components of the aromatized oils were quantified by HS‐SPME/GC–MS, as well as several quality indexes such as free fatty acids (FFA), peroxide value (PV), specific coefficients of extinction, chlorophyll and carotenoid content, and color assessment. Fatty acid profiles of the oils aromatized by MAI were compared to those produced by CI. Results showed that the infusion time is reduced from 12 h to 10 min when utilizing MAI in place of CI. MAI treatment caused a slight increase in FFA levels, and specific extinction coefficient indices (K232 and K270). PV during MAI remained unchanged for the first 3 min, after which there was an observable increase. All physico‐chemical values were found to be well below the maximum permitted limits. The MAI treatment reduced chlorophyll and carotenoid levels during the final step of aromatization, thus affecting final color. The MAI aromatized oil was characterized by its clear green color (L*, a*, b* parameters). Fatty acid analysis showed that MAI slightly changed the fatty acid composition of the olive oil. This study indicates that MAI appears to be a viable and rapid method to flavor olive oil with rosemary leaves.
LO063: Adverse events in a pediatric emergency department: a prospective, cohort study
Authors: Plint A. , Dalgleish D. , Aglipay M. , Barrowman N. , Calder L.A.
Published: June 2016

Introduction: Data regarding adverse events (AEs) (unintended harm to a patient related to health care provided) among children treated in the emergency department (ED) have not been collected despite identification of the setting and population as high risk. The objective of our study was to estimate the risk and type of AEs, as well as their preventability and severity, for children seen in a pediatric ED. Methods: This prospective cohort study examined outcomes of patients presenting to a paediatric ED. Research assistants (RA) recruited patients < 18 yrs old during 28 randomized 8-hr shifts (over 1 yr). Exclusion criteria included unavailability for follow-up and insurmountable language barrier. RAs collected demographics, medical history, ED course, and systems level data. A RA administered a structured telephone interview to all patients at day 7, 14, and 21 to identify flagged outcomes (such as repeat ED visits, worsening/new symptoms, etc). Admitted patients' health records were screened with a validated trigger tool. A RA created narrative summaries for patients with flagged outcomes/triggers. Three ED physicians independently reviewed summaries to determine if an AE occurred. Primary outcome was the proportion of patients with an AE within 3 weeks of their ED visit. Results: We enrolled 1367 (70.3%) of 1945 eligible patients. Median age was 4.3 yrs (range 2 months-17.95 yrs); 676 (49.5%) were female. Most (n= 1279; 93.9%) were discharged. Top entrance complaints were fever (n=206,15.1%), cough (n=135, 9.9%), and difficulty breathing (n=108, 7.9%). Eight eighty (6.5%) patients were triaged as CTAS 1 or 2, 689 (50.6%) as CTAS 3, and 585 (42.9%) as CTAS 4 or 5. Only 44 (3.2%) were lost to follow-up. Flagged outcomes/triggers were identified for 498 (36.4%) patients. Thirty three (2.4%) patients suffered at least one AE within 3 weeks of ED visit; 30 (90.9%) AEs were related to ED care. Most AEs (n= 28; 84.8%) were preventable. Management (n=18, 54.5%) and diagnostic issues (n=15, 45.5%) were the most common AE types. The most frequent clinical consequences were need for medical intervention (n=15;45.5%) and another ED visit (n=13,39.4%). In univariate analysis, age (p=0.005) and weekday presentation (p=0.02) were associated with AEs. Conclusion: We found a lower risk of AEs than that reported among inpatient paediatric and adult ED studies utilizing similar methodology. A high proportion of AEs were preventable.
LO071: Influenza and pneumococcal vaccinations in the emergency department
Authors: Taylor J.A. , Vu E.N. , Dawar M. , Li Brubacher J. , Leon A.
Published: June 2016

Introduction: Influenza and pneumococcal disease are vaccine preventable diseases that account for significant morbidity and mortality in Canada. Influenza vaccination has been shown to reduce mortality and pneumococcal vaccination reduces invasive pneumococcal disease. Previous studies have shown that emergency department (ED) patients are often at high risk for influenza and pneumococcal disease and willing to be vaccinated during their ED stay. Our study set out to determine what proportion of adult patients in the ED qualify for and are willing to be vaccinated against influenza and pneumococcus during their ED visit. Methods: Our study used a convenience sample of patients presenting to the ED at a large Canadian tertiary care centre (Vancouver General Hospital). Inclusion criteria were: adult patients (19 years or greater); consenting to be screened for immunization status; and able to communicate in English. The exclusion criteria were: critically ill patients and patients in severe pain. The primary outcome was the proportion of patients presenting to the ED that could be immunized for influenza and pneumococcus (member of a high risk group, unvaccinated and willing to be vaccinated). Secondary outcomes included additional demographic characteristics and patient attitudes regarding vaccination. Results: We screened 413 patients of which 55 did not meet inclusion/exclusion criteria and 104 declined participation. A total of 254 patients completed the survey for a response rate of 71%. Our primary outcome was present in 20% of patients for influenza (high risk for complications, unvaccinated and willing to be vaccinated in the ED). For pneumococcus, 15% were at high risk, unvaccinated and willing to be vaccinated in the ED. In our population, 83% were at high risk of complications from influenza and 58% were at high risk of complications from pneumococcus. In total, 53% of patients would accept influenza vaccine and 44% would accept pneumococcal vaccine. Conclusion: Our study demonstrates that there is a significant high-risk population that is otherwise unreached and are willing to be vaccinated for influenza and pneumococcus in the ED. Our patient population has a very high prevalence of risk factors for complications of pneumonia and influenza. This data suggests that ED patients are a high-risk population and could be a target group for vaccination campaigns.
LO072: Fever in the returning traveller: a systematic review and critical appraisal of existing clinical practice guidelines and approaches to returning travellers presenting with fever
Authors: Collier A. , Perry J.J. , Nath A.
Published: June 2016

Introduction: Fever in the returning traveller is a common ED presentation; however approaches and level of comfort with tropical diseases vary widely. This project aimed to conduct a systematic review and critical appraisal of existing clinical practice guidelines and approaches, to guide an ED approach, in Canada, to fever in the returning traveller. Methods: A literature review was conducted of peer reviewed papers, national and international practice guidelines, and practice statements presenting approaches to fever in the returning traveller. A literature search was conducted using MEDLINE and Embase (1947-Dec 2014), with librarian assistance to optimize strategy. The databases of guideline clearing houses, CMA, PHAC, WHO, CDC, and the Cochrane library were searched, along with a google scholar search. References of included articles were hand searched. Article titles and abstracts were reviewed by the author for inclusion. Key elements of the guidelines and approaches were identified and grouped by theme and where appropriate, the quality of guidelines were assessed by two reviewers using the AGREEII tool. Results: The search returned 1598 titles. 72 full manuscripts were reviewed based on inclusion from title and abstract, with 24 manuscripts included for final analysis. Common elements suggested by the guidelines or approaches were identified and grouped within three themes (key historical features, physical exam findings, investigations). Most manuscripts presented tables of important clinical information, but limited guidance on how to approach diagnosis in a focused manner. When evaluated by AGREEII, only one guideline (D’Acremont et al) scored > 50% overall quality rating. Unlike other approaches, this guideline proposes a stepwise approach to diagnosis and treatment based on the presence of key exposures, signs/symptoms, and eosinophilia. Conclusion: The guideline by D’Acremont et al was identified as the most rigorous existing practice guideline. This guideline, combined with other elements identified by thematic review, forms the basis of a suggested ED approach to fever in the returning traveller, which will be further refined using the AGREEII model to propose a practice guideline for Canadian EDs.
LO077: A restrictive transfusion strategy decreases mortality, re-bleeding and adverse events in hemodynamically stable patients with acute upper gastrointestinal bleeding: findings from a systematic review and meta-analysis of randomized controlled trials
Authors: Ahn J. , Soril L.J. , Leggett L.E. , Holmes R. , Grigat D. , Lang E. , Clement F.
Published: June 2016

Introduction: Acute upper gastrointestinal bleeding is a potentially life-threatening medical emergency that frequently requires red blood cell (RBC) transfusions. However, the optimal hemoglobin thresholds for transfusion is controversial. The objective of this study was to establish the most efficacious transfusion threshold. Methods: A systematic review of the published literature was completed. MEDLINE, Health technology assessment database, Cochrane central register, Cochrane database of systematic reviews, and EMBASE were searched from inception to May 2015 using search terms including “blood transfusions”, “hemoglobin”, and “red blood cell”. Studies were included if they: reported original data, were peer-reviewed, studied adult populations, were randomized controlled clinical trials and primarily focused on clinical efficacy or effectiveness of liberal and restrictive pre-transfusion hemoglobin level thresholds. Quality was assessed using the Cochrane Risk of Bias tool. Data were extracted and meta-analysis was conducted using a random effects model to determine the risk ratio for: all-cause mortality, further bleeding and any adverse events. All steps were completed independently by two reviewers. Results: The literature search identified 4037 unique abstracts. Of these, 156 abstracts proceeded to full text review. 154 articles were excluded during full-text review resulting in 2 articles for final analysis. The total number of participants included was 701. The hemoglobin threshold to transfuse RBC varied between 70-80g/L versus 90-100g/L in restrictive and liberal policies, respectively. Both studies were at low risk of bias. Meta-analysis resulted in a pooled decreased risk of all-cause mortality (RR 0.65, 95% CI 0.44-0.96), re-bleeding (RR 0.63, 95% CI 0.46-0.85) and adverse events (RR 0.83, 95% CI 0.73-0.95) in the restrictive blood transfusion group versus the liberal blood transfusion group. Conclusion: While the evidence is limited, the risk of death is lower and there is no significant harm for a restrictive strategy. In this context, there is a decreased risk of transfusion associated adverse events among those receiving a restrictive strategy and should be considered for its impact on patient safety and health system resources.
LO084: Text messaging research participants as a follow-up strategy to decrease emergency department study attrition
Authors: Varner C. , McLeod S.L. , Nahiddi N. , Borgundvaag B.
Published: June 2016

Introduction: Collecting patient-reported follow-up data for prospective studies in the emergency department (ED) is challenging in this acute care, minimal continuity setting. Follow-up is frequently attempted using telephone contact and in some instances mail correspondence. The objective of this study was to determine if text messaging study participants involved in an ongoing randomized trial resulted in a lower rate of attrition as compared to conventional telephone follow-up. Methods: This was a secondary analysis of research participants enrolled in a randomized controlled trial assessing head injury discharge instructions. Adult (18-64 years) patients presenting to an academic ED (annual census 65,000) with chief complaint ‘head injury’ occurring within 24 hours of ED visit were contacted by telephone 2 and 4 weeks post ED visit to complete a symptom questionnaire. During the first 4 months of study follow-up, participants were contacted by a conventional telephone call. Attrition was higher than anticipated, thus we received subsequent ethics approval for the final 3 months of follow-up duration to contact participants by text message on the day of the first telephone attempt as a reminder of the telephone interview scheduled later that day. The proportion of patients lost to follow-up at 2 and 4 weeks post ED visit was compared between participants not receiving and receiving reminder text messages. Results: 118 patients were enrolled in the study (78 underwent conventional follow-up and 40 received text messages). Mean (SD) age was 35.2 (13.7) years and 43 (36.4%) were male. During the period of conventional follow-up, 3 participants withdrew from the study. Of the remaining 75 participants, 24 (32.0%) at 2 weeks and 32 (42.7%) at 4 weeks were unable to be contacted. Of the 40 participants receiving a reminder text message, 4 (10.0%) at 2 weeks and 10 (25.0%) at 4 weeks were unable to be contacted. Overall, text messaging study participants decreased attrition by 22% (95% CI: 5.9%, 34.7%) and 17.7% (95% CI: -0.8%, 33.3%) at 2 and 4 week follow-up, respectively. Conclusion: In this young ED cohort participating in a randomized trial, text message reminders of upcoming telephone follow-up interviews decreased the rate of attrition. Text messaging is a viable, low-cost communication strategy that can improve follow-up participation in prospective research studies.
LO088: Development of a simulation-based curriculum for ultrasound-guided internal jugular central venous catheterization
Authors: Woodcroft M. , Holden M. , Chaplin T. , Rang L. , Jaeger M. , Rocca N. , Ungi T. , Fichtinger G. , McGraw R.
Published: June 2016

Introduction / Innovation Concept: Insertion of an internal jugular (IJ) central venous catheter (CVC) under ultrasound guidance (USG) is a complex skill that requires considerable practice in order to achieve technical proficiency. Simulation allows novices to engage in structured and high volume repetitive practice of USG IJ CVC insertion and to work through a predictable pattern of errors prior to real patient encounters. Based on earlier work on learning curves for CVC insertion, this curriculum uses a model of simulation-based high volume deliberate practice of the fundamental skills of USG CVC insertion, and was designed with careful consideration of the conditions associated with optimal learning and improvement of performance. Methods: Eight residents (post graduate year 2) from the Departments of Emergency Medicine and Anesthesiology engaged in deliberate practice of USG CVC insertion during three two-hour sessions, at 2-week intervals. Progress of the residents was monitored with direct observation and regular hand motion analysis (HMA), which was compared to performance metrics set by a local expert. Curriculum, Tool, or Material: Students reviewed online introductory ultrasound video and articles outlining internal jugular (IJ) and femoral CVC insertion prior to the first session. Session 1 focused on ultrasound skills including knobology, transducer movement, and needle tracking. This was followed by 60 minutes of deliberate practice of the skills of USG CVC insertion on both femoral and IJ models. During sessions 2/3, students practiced complete gowning and draping using sterile technique. This was followed again by deliberate practice of the skills of USG CVC insertion on both femoral and IJ models. Students received coaching and feedback throughout all sessions, with HMA assessment of USG IJ CVC insertion at the beginning and end of each session. After three training sessions, consisting of 85 total attempts, 5/8 residents surpassed the expert benchmark for probe hand motion, 6/8 for needle hand motion, and 1/8 for total procedure time, with the remaining residents approaching the expert benchmark for each metric. Conclusion: We have successfully developed a simulation-based curriculum for USG IJ CVC placement. Residents demonstrated continuous improvement in each session, approaching or exceeding the expert benchmarks by the end of the third session.
LO095: Developing and implementing an interprofessional in-situ simulation program in an academic, tertiary-care emergency department: barriers, successes and the Ottawa Hospital experience
Authors: Poulin C. , Weitzman B. , Mastoras G. , Norman L. , Pozgay A. , Frank J.R.
Published: June 2016

Introduction / Innovation Concept: During Emergency Department (ED) resuscitation of critically ill patients, effective teamwork and communication among various healthcare professionals is essential to ensure favorable patient outcomes and to minimize threats to patient safety. However, numerous individual and system factors create barriers to effective team functioning. Simulation center- based training has been used to improve Crisis Resource Management skills among physician and nursing trainees, but in-situ simulation is a relatively new concept in adult Emergency Medicine in North America. Methods: To enhance patient care and team effectiveness, an ED nursing and physician group was created to develop and implement a novel interprofessional in-situ simulation program in two Canadian, academic tertiary-care emergency departments. Departmental approval and financial support was obtained and sessions commenced in January 2015. Curriculum, Tool, or Material: Monthly high-fidelity simulation sessions are held in the ED resuscitation rooms at both campuses of our hospital. Each session is facilitated and debriefed by simulation-trained Emergency Medicine faculty and senior residents, a nurse educator and a research assistant. Technical support is provided by our simulation center staff. Participants are recruited from the physicians, residents, nurses, respiratory therapists and other support staff working in the ED. To minimize the impact on patient care, two additional nurses are scheduled to cover nursing assignments on “sim days”. Simulations are limited to fifteen minutes, followed by a twenty minute debriefing. Conclusion: We have successfully developed and implemented an interprofessional in-situ simulation program in our ED. Participant feedback has been overwhelmingly positive. Lack of financial support, reluctance of staff to participate, and overwhelmed resources are some of the challenges to running a program like this in a busy ED environment. However, there are clear benefits: empowering team members, culture change, identification of latent safety threats, and a perception of improved teamwork and communication.
LO096: Comfortable with your thoracotomy skills? An innovative simulation-based curriculum to teach rare procedures in emergency medicine
Authors: Gray S.H. , Owen J. , Petrosoniak A.
Published: June 2016

Introduction / Innovation Concept: Emergency medicine (EM) residents must demonstrate proficiency in several rare, life-saving procedures but few clinical opportunities exist to practice and master these skills. Currently no standardized curricula exist for the instruction of these skills during EM residency. Accordingly, many residents graduate without the experience to perform these critical procedures confidently. We developed a novel, simulation-based curriculum for six rare, life-saving, EM skills that integrates deliberate practice and Kolb’s theory of experiential education. Methods: We used existing EM training objectives and a recent national resident needs assessment to develop a simulation-based technical skills curriculum. The six station curriculum was underpinned by the pedagogical framework of experiential education and deliberate practice. Instructor and participant feedback directed subsequent curriculum modifications. Curriculum, Tool, or Material: This one-day intensive curriculum was successfully implemented at two Canadian EM residency programs for 54 EM residents, from both CCFP-EM and FRCP-EM streams. Participant feedback was highly favorable. An iterative approach to curriculum implementation at two separate residency programs effectively allowed educators to respond to participant needs. Conclusion: A novel simulation-based curriculum for rare procedures in EM is feasible, practical, and highly valued by participants. Ongoing work is underway to refine the curriculum and assess its efficacy in creating competence. Deliberate practice and Kolb’s theory of experiential education provide useful frameworks for technical skills training.