Introduction: Opioid overdoses (OODs) have become a public health emergency, yet little is known about their long-term outcomes following an OD. We determined the one-year all-cause mortality and associated risk factors in a cohort of patients treated in an urban emergency department (ED) for an OOD. Methods: We reviewed records of all patients who visited St. Paul's Hospital ED from January 2013 to August 2017 and had a discharge diagnosis of OOD or had received naloxone in the ED as per pharmacy records. Patients with a suspected OOD were identified on structured chart review. A patient's first visit for an OOD during the study period was used as the index visit, with subsequent visits excluded. The primary outcome was mortality during the year after the index visit. Mortality was assessed by linking patient electronic medical records with Vital Statistics data. Deaths that occurred in the ED on the index visit were excluded. Patients admitted to hospital following ED treatment were included in this study. We described patient characteristics, calculated mortality rates, and used Cox regression to identify risk factors. Results: A total of 2239 patients visited the ED for an OOD during the study period, with a median patient age of 37 years (IQR 29, 49). Males comprised 73% of patients, while 28% had no fixed address, and 21% received take-home naloxone at the index visit. In total, 137 patients (6.1%) died within 1 year of the index visit. Eighty-one deaths (3.6%) occurred within 6 months, including 24 deaths (1.1%) that occurred within 1 month. The highest mortality rate occurred in 2017, with 8.0% of patients entering the cohort that year dying within 1 year. Gender did not significantly impact mortality risk. A Cox regression analysis controlled for gender, housing status, and whether take-home naloxone was provided at the index visit indicated that advancing age (adjusted hazards ratio [AHR] 1.03; 95%CI: 1.01-1.04 for each year increase in age) and the index visit calendar year (AHR 1.30; 95%CI: 1.10-1.54 for each yearly increase in the study period) were significant factors for mortality within 1 year. Conclusion: The mortality rate following an opioid OD treated in the ED is high, with over 6% of patients in our study dying within 1 year. The rising mortality risk with increasing calendar year may reflect the growing harms of fentanyl-related OODs. Patients visiting the ED for an OOD should be considered high risk and offered preventative treatment and referrals prior to discharge.

Introduction: Substance and opioid misuse are growing public health concerns in Canada. Substance use disorders affect 21.6% of Canadians and accounted for $267 million in healthcare costs in 2011. Opioid misuse is a current public health crisis. The extent of the rise in substance and opioid misuse-related Emergency Department (ED) visits in Canada and the demographic groups in which the rise is concentrated have not been elaborated. Alberta has one of the most complete provincial ED visit records and provides an important understanding of national trends. The objective of this study was to evaluate trends in substance and opioid misuse-related ED visits in Alberta from 2010/11 to 2014/5 within demographic cross-sections of the population using administrative ED visit data from the National Ambulatory Care Reporting System (NACRS). Methods: All visits made by adult patients (18 years old) to any of more than 100 Albertan EDs for a substance misuse-related presentation between 2010/11 and 2014/15 were analyzed. Visits were classified as being related to substance or opioid misuse if the primary and/or secondary visit diagnoses were among an a priori determined group of ICD-10 codes. Annual substance misuse-related visits were compared as visits per 100,000 adult population in Alberta to standardize for population growth. Linear regression was used to assess whether ED visits increased significantly over time. A cross-sectional time-series analysis was employed to examine trends within subgroups defined by sex and age categories (18-29, 30-39, 40-49, 50-59, and 60 years) over a 60-month period. Results: 149,719 substance misuse-related visits were made by 65,089 patients and 8768 opioid misuse-related visits were made by 5763 patients. From 2010/11 to 2014/15, substance misuse-related ED visits in Alberta increased by 38% from 811 to 1119 visits per 100,000 population. Opioid misuse-related ED visits increased significantly (64%) from 44 to 72 per 100,000 population. Conversely, total ED visits per 100,000 population did not increase significantly. Substance and opioid misuse-related visits rose more in non-rural than rural areas. Cross-sectional time-series analysis showed that the greatest increase in substance and opioid misuse-related ED visits occurred in males and in the 18-29 year age category, in which visit increases for opioid misuse appeared exponential. Conclusion: Substance and opioid misuse-related ED visits increased significantly from 2010/11 to 2014/15 in Alberta, with the most dramatic increases occurring in young patients and males. These findings have important implications for targeting urgent preventative public health interventions to stem the rise of this epidemic.

We apply a novel pre-flare tracking of sunspot groups towards improving the estimation of flare onset time by focusing on the evolution of the 3D magnetic field construction of AR 11429. The 3D magnetic structure is based on potential field extrapolation encompassing a vertical range from the photosphere through the chromosphere and transition region into the low corona. The basis of our proxy measure of activity prediction is the so-called weighted horizontal gradient of magnetic field (WGM) defined between spots of opposite polarities close to the polarity inversion line of an active region. The temporal variation of the distance of the barycenter of the opposite polarities is also found to possess potentially important diagnostic information about the flare onset time estimation as function of height similar to its counterpart introduced initially in an application at the photosphere only in Korsós et al. (2015). We apply the photospheric pre-flare behavioural patterns of sunspot groups to the evolution of their associated 3D-constructed AR 11429 as function of height. We found that at a certain height in the lower solar atmosphere the onset time may be estimated much earlier than at the photosphere or at any other heights. Therefore, we present a tool and recipe that may potentially identify the optimum height for flare prognostic in the solar atmosphere allowing to improve our flare prediction capability and capacity.

The longitudinal distribution of solar active regions shows non-homogeneous spatial behaviour, which is often referred to as Active Longitude (AL). Evidence for a significant statistical relationships between the AL and the longitudinal distribution of flare and coronal mass ejections (CME) occurrences is found in Gyenge et al. 2017 (ApJ, 838, 18). The present work forecasts the spatial position of AL, hence the most flare/CME capable active regions are also predictable. Our forecast method applies Autoregressive Integrated Moving Average model for the next 2 years time period. We estimated the dates when the solar flare/CME-capable longitudinal belts face towards Earth.

In this paper, we investigate the inhomogeneous spatial distribution of solar faculae. The focus is on the latitudinal and longitudinal distributions of these highly localised features covering ubiquitously the solar surface. The statistical analysis is based on white light observations of the Solar and Heliospheric Observatory (SOHO) and Solar Dynamics Observatory (SDO) between 1996 and 2014. We found that the fine structure of the latitudinal distribution of faculae displays a quasi-biennial oscillatory pattern. Furthermore, the longitudinal distribution of photospheric solar faculae does not show homogeneous behaviour either. In particular, the non-axisymmetric behaviour of these events show similar properties as that of the active longitude (AL) found in the distribution of sunspots. Our results, preliminary though, may provide a valuable observational constrain for developing the next-generation solar dynamo model.

Introduction: Medical conditions that impair perception, cognition or motor skills may make people unfit to drive. Reporting unfit drivers to licensing authorities is seen by many as a public health obligation. This study investigates physician knowledge, attitudes and practice around the management of medically unfit drivers. Methods: We used an online survey to explore physician knowledge of fitness to drive issues and their attitudes and practice with regard to counselling and reporting unfit drivers. Email invitations to participate in the survey were sent to all physicians in BC through DoctorsofBC and to all emergency physicians (EPs) in the UBC Department of Emergency Medicine. Results: We received responses from 242 physicians (47% EPs, 40% GPs, 13% others). The majority (78%) reported little/no knowledge on determining driver fitness and 94% had little/no training around guidelines, reporting, and laws involving fitness to drive. Most (88%) agreed that physicians should be obligated to advise medically unfit patients not to drive, and 74% reported that they often warn patients not to drive. The majority of physicians also chart their opinion of patients’ fitness to drive (67% do so more than twice per year). Most respondents (70%) indicated that it is “always appropriate” to report definitely unfit drivers whereas only 25% indicated that it is “always appropriate” to report potentially unfit drivers. However, in practice physicians see far more unfit drivers than they report to licensing authority: 67% of physicians encounter definitely unfit drivers more than twice per year but only 19% report definitely unfit drivers more than twice per year and 34% never report definitely unfit drivers. Compared to other physicians, EPs reported less knowledge and training about criteria for determining fitness to drive, were more likely to feel that reporting unfit drivers was not their responsibility, and were less likely to report unfit drivers to licensing authorities. Conclusion: Our findings indicate a need for more education and information resources to help physicians, particularly EPs, identify and manage medically unfit drivers. Although most physicians warn unfit drivers not to drive and document this in medical records, many medically unfit drivers are not reported to licensing authorities, a potential public health problem that should be further investigated.

Introduction: Most medically unfit drivers are not reported to licensing authorities. In BC, physicians are only obligated to report unfit drivers who continue to drive after being warned to stop. This study investigates barriers to and incentives for physician reporting of medically unfit drivers. Methods: We used an online survey to study physician-reported barriers to reporting medically unfit drivers and their idea of incentives that would improve reporting. Email invitations to participate in the survey were sent to all physicians in BC through DoctorsofBC and to all emergency physicians (EPs) in the UBC Department of Emergency Medicine. Results: We received responses from 242 physicians (47% EPs, 40% GPs, 13% others). The most common barrier to reporting was not knowing which unfit drivers continue to drive (79% of respondents). Other barriers included lack of time (51%), lack of knowledge of the process, guidelines, or legal requirement for reporting (51%, 50%, 45% respectively), fearing loss of rapport with patients (48%), pressure from patients not to report (34%), lack of remuneration (27%), and pressure from family members not to report (25%).EPs were significantly less likely than other physicians to cite loss of rapport, pressure from patients, or pressure from family as barriers, but more likely to cite not being aware of drivers who continue to drive after being warned, lack of knowledge (regarding legal requirements to report, guidelines for determining fitness, and the reporting process), and lack of time. Factors that would increase reporting unfit drivers included better understanding of criteria for fitness to drive (70%), more information regarding how to report (67%), more information on when to report (65%), and compensation (43%).Free text comments from respondents identified other barriers/incentives. Reporting might be simplified by telephone hotlines or allowing physician designates to report. Physicians feared legal liability and suggested the need for better medico-legal protection. Loss of patient rapport might be minimized by public education. Failure of response from licensing authorities to a report (long wait times, lack of feedback to physician) was seen as a barrier to reporting. Conclusion: We identified barriers to physician reporting of medically unfit drivers and incentives that might increase reporting. This information could inform programs aiming to improve reporting of unfit drivers.

During the AIDJEX pilot study 1972 in the Beaufort Sea, the tilt changes of the fluid ocean surface and of the sea ice were measured with a hydrostatic level. Preliminary results indicate a tilt range of ± 5 μrad for the water surface and of ± 30 (μrad for the sea ice. The tilt change of the sea ice Δ δ appears to be directly proportional to the component of the velocity change of the ice drift parallel to the hydrostatic level ΔUd, according to the relationship Δ δ = 180ΔUdμrad m-1 s. It is conclugerd that the ice tilt is wind induced, and that the ice sheet tilts downward in the drift direction as a result of the moment exerted on it by wind and water drag. It is postulated that this tilt causes the ice to break at right angles to the drift direction. The tilt is a function of the length of an ice floe (or of the unbroken distance between two cracks), of the average ice thickness, of the average drag coefficients, and of wind and current velocities. Calculation of the ice tilt using a simple mogerl of a floating, rigid ice slab gives values which are very much smaller than the observed tilts. If the discrepancy between theory and observation can be resolved, or if an empirical formula between wind velocity and tilt angle can be gerduced freom continuous tilt observations which will be carried out during the AIDJEX main experiment, it will be possible, for a given wind, to estimate the maximum length of an unbroken ice sheet freom its estimated thickness, drag coefficients, and tensile strength. It should also be possible to calculate the average drag coefficients of a freee-floating ice pan, or of an ice island, freom tilt, wind, and current measurements. The curious relationship between tilt angle and atmospheric pressure gradient that Browne and Crary observed on the ice island T-3 in 1952 is explained as being the wind-induced tilt of the ice island rather than that of the fluid ocean surface.

The design optimization and analysis of charged particle beam systems employing intense beams requires a robust and accurate Poisson solver. This paper presents a new type of Poisson solver which allows the effects of space charge to be elegantly included into the system dynamics. This is done by casting the charge distribution function into a series of basis functions, which are then integrated with an appropriate Green's function to find a Taylor series of the potential at a given point within the desired distribution region. In order to avoid singularities, a Duffy transformation is applied, which allows singularity-free integration and maximized convergence region when performed with the help of Differential Algebraic methods. The method is shown to perform well on the examples studied. Practical implementation choices and some of their limitations are also explored.

We give a short and elementary proof of an inverse Bernstein-type inequality found by S. Khrushchev for the derivative of a polynomial having all its zeros on the unit circle. The inequality is used to show that equally-spaced points solve a min–max–min problem for the logarithmic potential of such polynomials. Using techniques recently developed for polarization (Chebyshev-type) problems, we show that this optimality also holds for a large class of potentials, including the Riesz potentials $1/r^{s}$ with $s>0.$

Classic traditions have linked dreams to memory (e.g., “dreaming is another kind of remembering” [Freud 1918/1955]) and modern notions like implicit memory subsume dreaming by definition. Llewellyn develops the more specific thesis that rapid eye movement (REM) dreams, because of their similarities to mnemonic techniques, have the function of elaboratively encoding episodic memories. This proposal is premature, requiring exigent testing. Other analogs of dreams, for example, jokes, do not invoke function but do contribute to dream science.

This paper interprets late medieval religious culture by considering lay expectations of and attitudes towards the clergy. The analysis is prompted by and framed around a convent controversy, which was extensively documented in the course of an ecclesiastical trial. Contemporary ‘convent reform’ is not conceived as an ecclesiastical event, but rather as a symptom of the changing relationship between town and convent. The description of religious provision in the town shows that there was a strong lay demand for the clergy and the rituals performed by them, and that parishioners were ready to invest financially in maintaining local priests, even if it involved considerable additional expenses. The conflict between town and convent can therefore be considered as a result of a liturgical deficit in the spiritual market of the town. The parishioners' behaviour is interpreted as a symptom of the eucharistic and penitential devotional culture of the time, which was regulated in practice by the principle of intercession and the institution of good works. The paper argues that the divergent strands of late medieval religious culture generated a ‘consumption’ of the sacred. The mendicant friars had a special role in the late medieval religious market as they provided opportunities for religious experiences which differed in kind from parish observances.

There is increasingly strong observational evidence that slow magnetoacoustic modes arise in the solar atmosphere. Solar magneto-seismology is a novel tool to derive otherwise directly un-measurable properties of the solar atmosphere when magnetohydrodynamic (MHD) wave theory is compared to wave observations. Here, MHD wave theory is further developed illustrating how information about the magnetic and density structure along coronal loops can be determined by measuring the frequencies of the slow MHD oscillations. The application to observations of slow magnetoacoustic waves in coronal loops is discussed.

Let n be the collection of all (Littlewood) polynomials of degree n with coefficients in {−1, 1}. In this paper we prove that if (P2ν) is a sequence of cyclotomic polynomials P2ν ∈ 2ν, thenfor every q > 2 with some a = a(q) > 1/2 depending only on q, whereThe case q = 4 of the above result is due to P. Borwein, Choi and Ferguson. We also prove that if (P2ν) is a sequence of cyclotomic polynomials P2ν ∈ 2ν, thenfor every 0 < q < 2 with some 0 < b = b(q) < 1/2 depending only on q. Similar results are conjectured for Littlewood polynomials of odd degree. Our main tool here is the Borwein–Choi Factorization Theorem.