Background: Our prior six-year review (n=2165) revealed 24% of patients undergoing posterior decompression surgeries (laminectomy or discectomy) sought emergency department (ED) care within three months post-surgery. We established an integrated Spine Assessment Clinic (SAC) to enhance patient outcomes and minimize unnecessary ED visits through pre-operative education, targeted QI interventions, and early post-operative follow-up. Methods: We reviewed 13 months of posterior decompression data (n=205) following SAC implementation. These patients received individualized, comprehensive pre-operative education and follow-up phone calls within 7 days post-surgery. ED visits within 90 days post-surgery were tracked using provincial databases and compared to our pre-SAC implementation data. Results: Out of 205 patients, 24 (11.6%) accounted for 34 ED visits within 90 days post-op, showing a significant reduction in ED visits from 24% to 11.6%, and decreased overall ED utilization from 42.1% to 16.6% (when accounting for multiple visits by the same patient). Early interventions including wound monitoring, outpatient bloodwork, and prescription adjustments for pain management, helped mitigate ED visits. Patient satisfaction surveys (n=62) indicated 92% were “highly satisfied” and 100% would recommend the SAC. Conclusions: The SAC reduced ED visits after posterior decompression surgery by over 50%, with pre-operative education, focused QI initiatives, and its individualized, proactive approach.

Distinct pathophysiology has been identified with disorders of gut-brain interactions (DGBI), including functional constipation (FC)(1,2), yet the causes remain unclear. Identifying how modifiable factors (i.e., diet) differ depending on gastrointestinal health status is important to understand relationships between dietary intake, pathophysiology, and disease burden of FC. Given that dietary choices are culturally influenced, understanding ethnicity-specific diets of individuals with FC is key to informing appropriate symptom management and prevention strategies. Despite distinct genetic and cultural features of Chinese populations with increasing FC incidence(3), DGBI characteristics are primarily described in Caucasian populations(2). We therefore aimed to identify how dietary intake of Chinese individuals with FC differs to non-Chinese individuals with FC, relative to healthy controls. The Gastrointestinal Understanding of Functional Constipation In an Urban Chinese and Urban non-Chinese New Zealander Cohort (GUTFIT) study was a longitudinal case-control study using systems biology to investigate the multi-factorial aetiology of FC. Here we conducted a cross-sectional dietary intake assessment, comparing Chinese individuals with FC (Ch-FC) against three control groups: a) non-Chinese with FC (NCh-FC) b) Chinese without FC (Ch-CON) and c) non-Chinese without FC (NCh-CON). Recruitment from Auckland, New Zealand (NZ) identified Chinese individuals based on self-identification alongside both parents self-identifying as Chinese, and FC using the ROME IV criteria. Dietary intake was captured using 3-day food diaries recorded on consecutive days, including one weekend day. Nutrient analysis was performed by Foodworks 10 and statistical analysis with SPSS using a generalised linear model (ethnicity and FC status as fixed factors). Of 78 enrolled participants, 66 completed the study and 64 (39.4 ± 9.2 years) completed a 3-day food diary at the baseline assessment. More participants were female (84%) than male (16%). FC and ethnicity status allocated participants into 1 of 4 groups: Ch-FC (n = 11), Ch-CON (n = 18), NCh-FC (n = 16), NCh-CON (n = 19). Within NCh, ethnicities included NZ European (30%), non-Chinese Asian (11%), Other European (11%), and Latin American (2%). Fibre intake did not differ between Ch-FC and NCh-FC (ethnicity × FC status interaction p>0.05) but was independently lower overall for FC than CON individuals (21.8 ± 8.7 versus 27.0 ± 9.7 g, p<0.05) and overall for Ch than NCh (22.1 ± 8.0 versus 27.0 ± 10.4 g, p<0.05). Carbohydrate, protein, and fat intakes were not different across groups (p>0.05 each, respectively). In the context of fibre and macronutrient intake, there is no difference between Ch-FC and NCh-FC. Therefore, fibre and macronutrients are unlikely to contribute to potential pathophysiological differences in FC between ethnic groups. A more detailed assessment of dietary intake concerning micronutrients, types of fibre, or food choices may be indicated to ascertain whether other dietary differences exist.

Children need to be repeatedly and consistently exposed to a variety of vegetables from an early age to achieve an increase in vegetable intake. A focus on enjoyment and learning to like eating vegetables at an early age is critical to forming favourable lifelong eating habits. Coordinated work is needed to ensure vegetables are available and promoted in a range of settings, using evidence-based initiatives, to create an environment that will support children’s acceptance of vegetables. This will help to facilitate increased intake and ultimately realise the associated health benefits. The challenges and evidence base for a new approach are described.

Suicidal thoughts and behaviors (STBs) are major public health concerns among adolescents, and research is needed to identify how risk is conferred over the short term (hours and days). Sleep problems may be associated with elevated risk for STBs, but less is known about this link in youth over short time periods. The current study utilized a multimodal real-time monitoring approach to examine the association between sleep problems (via daily sleep diary and actigraphy) and next-day suicidal thinking in 48 adolescents with a history of STBs during the month following discharge from acute psychiatric care. Results indicated that specific indices of sleep problems assessed via sleep diary (i.e., greater sleep onset latency, nightmares, ruminative thoughts before sleep) predicted next-day suicidal thinking. These effects were significant even when daily sadness and baseline depression were included in the models. Moreover, several associations between daily-level sleep problems and next-day suicidal thinking were moderated by person-level measures of the construct. In contrast, sleep indices assessed objectively (via actigraphy) were either not related to suicidal thinking or were related in the opposite direction from hypothesized. Together, these findings provide some support for sleep problems as a short-term risk factor for suicidal thinking in high-risk adolescents.

We evaluated whether the association between deviant peer affiliation and onset of substance use is conditional upon sex and sympathetic nervous system (SNS) reactivity as measured by pre-ejection period (PEP). Community-sampled adolescents (N = 251; M = 15.78 years; 53% female; 66% White, 34% Black) participated in three waves. PEP reactivity was collected during a mirror star-tracer stress task. Alcohol, marijuana, tobacco, or any substance use, as well as binge drinking and sexual activity involving substance use were outcomes predicted by affiliation with deviant peers and two- and three-way interactions with sex and PEP reactivity. Probability of substance use increased over time, but this was amplified for adolescents with greater deviant peer affiliation in conjunction with blunted PEP reactivity. The same pattern of results was also found for prediction of binge drinking and sexual activity involving substance use. Findings are discussed in the context of biosocial models of adolescent substance use and health risk behaviors.

Background: Burgeoning EEG demand has largely gone unmet with insufficient supply of manpower and equipment. Quantitative EEG (QEEG) may help compress large volumes of data for expedited review. We sought to determine the current use of QEEG in Canada through a national EEG technologist survey. Methods: A 10-item questionnaire was administered to participants at the 2016 meeting of the Canadian Association of Electroneurophysiology Technologists, which occurred in parallel with the Canadian Neurological Sciences Federation meeting. Results: A response rate of 63% (14/22) represented 12 institutions (11 adult, 6 paediatric) over six provinces with 73% of the national population. Only academic institutions (9/12) used QEEG, representing five provinces with 70% of the national population. Most institutions generated QEEG either real-time or retrospectively in the critical care and epilepsy monitoring units for long-term monitoring and automated seizure detection. The most used trends were spectrographic, seizure detection, and artifact detection. Montage use, QEEG duration, and timebase settings were highly variable. Conclusions: QEEG is in surprisingly frequent use across Canada. There is no consensus on optimal QEEG use, which mirrors uncertainty in the literature. The relative ubiquity of QEEG in Canada offers promise for collaborative multicentre research into unlocking the full potential of QEEG in enhancing patient care.

Common mental disorders (CMDs) are highly prevalent in the working population, and are associated with long-term sickness absence and disability. Workers on sick leave with CMDs would benefit from interventions that enable them to successfully return to work (RTW). However, the effectiveness of RTW interventions for workers with a CMD is not well studied. The objective of this review is to assess the effectiveness of existing workplace and clinical interventions that were aimed at enhancing RTW. A systematic review of studies of interventions for improving RTW in workers with a CMD was conducted. The main outcomes were proportion of RTW and sick-leave duration until RTW. Randomized controlled trials (RCTs) were identified from Medline/PubMed, PsycINFO, EMBASE, SocINDEX, and Human resource and management databases from January 1995 to 2016. Two authors independently selected studies, assessed risk of bias and extracted data. We pooled studies that we deemed sufficiently homogeneous in different comparison groups and assessed the overall quality of the evidence. We reviewed 2347 abstracts from which 136 full-text articles were reviewed and 16 RCTs were included in the analysis. Combined results from these studies suggested that the available interventions did not lead to improved RTW rates over the control group [pooled risk ratio 1.05, 95% confidence interval (CI) 0.97–1.12], but reduced the number of sick-leave days in the intervention group compared to the control group, with a mean difference of −13.38 days (95% CI −24.07 to −2.69).

A solution of the problem of the initial flow in the entrance region of a pipe has been given by Atkinson and Goldstein. In this note the authors compute this solution in greater detail, and compare their results with those of Atkinson and Goldstein. The range of the validity of the solution is shown to be smaller than originally thought.

Atkinson and Goldstein considered the equations for the steady flow of an incompressible viscous fluid into a straight circular pipe of radius a. The flow is supposed to have axial symmetry, u being the velocity component parallel to the axis x, and v the radial velocity. The, distance from the axis is denoted by r.

Introduction: Pharyngitis is a common presenting complaint at the emergency department (ED). Historically, acute pharyngitis has been overdiagnosed as the result of a bacterial etiology, leading to over-prescription of antibiotics, and overuse of throat culturing. This study attempts to quantify the current management of acute pharyngitis in the ED, and compare to the theoretical management using a modified Centor score. Methods: This was a retrospective chart review of 1640 patients who presented to four EDs in the central zone of the Nova Scotia Health Authority that received a diagnosis of pharyngitis, bacterial pharyngitis or tonsillitis. The primary outcome was the observed rate of each diagnosis in the study population, the rate of antibiotic prescription, and the rate of throat swab cultures performed. The secondary outcomes were the rate of antibiotics and throat swabs ordered using a modified Centor score. Antibiotics as first-line treatment were indicated if the Centor score was three or greater, and throat cultures were indicated if the Centor score was two or greater. Results: A total of 1596 patients were included in the analysis. Antibiotics were given in 893 patients (0.559; 95% CI: {0.535, 0.584}). Cultures were sent on 863 patients (0.541 CI: {0.516, 0.565}). Using the modified Centor thresholds, we would have prescribed antibiotics as the first-line treatment in 77 cases (0.048 CI: {0.038, 0.060}), potentially saving 786 prescriptions, and ordered throat swabs on 502 patients (0.315, CI: {0.292, 0.338}), saving 361 cultures. The most commonly prescribed antibiotic was penicillin, and the least prescribed was metronidazole. Conclusion: Over half of patients that present with acute pharyngitis receive an antibiotic, and over half have a throat swab culture performed. Utilizing a modified Centor score would result in decreased antibiotic prescription rate, and a diminished rate of throat cultures. Incorporation of these Centor criteria could result in diminished antibiotic prescription rates for acute pharyngitis in the ED.

The Southern Alps – Ligurian basin junction is one of the most active seismic areas in Western Europe countries. The topographic and the structural setting of this region is complex because of (i) its position between the high topography of the Southern Alps and the deep, narrow Ligurian oceanic basin, and (ii) the large number of structures inherited from the Alpine orogeny. Historical seismicity reveals about twenty moderate-size earthquakes (up to M=6.0), mostly distributed along the Ligurian coast and the Vésubie valley. A recent geodetic experiment shows a significant strain rate during the last 50 years in the area between the Argentera massif and the Mediterranean coastline. Results of this experiment suggest a N-S shortening of about 2-4 mm/yr over the network, this shortening direction is consistent with the seismological (P-axes of earthquakes) and the microtectonic data. The Pennic front (E-NE of the Argentera massif) and the northern Ligurian margin are the most seismically active areas. In the Nice arc and in the Argentera massif, some seismic lineaments correspond to faults identified in the field (such as theTaggia-Saorge fault or the Monaco-Sospel fault). In the western part of the Alpes Maritimes, no seismic activity is recorded in the Castellane arc. In the field, geological evidence, such as offsets of recent alluvial sediments, recent fault breccia, speleothem deformations, radon anomalies and others indicates recent deformation along these faults. Nevertheless, to this date active fault scarps have not been identified: this probably results from a relatively high erosion rate versus deformation rate and from the lack of Quaternary markers. We also suspect the presence of two hidden active faults, one in the lower Var valley (Nice city area) and the other one at the base of the Argentera crustal thrust-sheet. Offshore, along the northern Ligurian margin, the seismic reflection data shows traces of Quaternary extensional deformation, but the accuracy of the data does not yet allow the construction of a structural map nor does it allow the determination of the continuity between the offshore and onshore structures. From these data set we propose a preliminary map of 11 active faults and we discuss the questions which remain unsolved in the perspective of seismic hazard evaluations.