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Understanding the relationship between family income and conduct problems: findings from the mental health of children and young people survey
- P. J. Piotrowska, C. B. Stride, B. Maughan, T. Ford, N. A. McIntyre, R. Rowe
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- Journal:
- Psychological Medicine / Volume 53 / Issue 9 / July 2023
- Published online by Cambridge University Press:
- 21 March 2022, pp. 3987-3994
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Background
Children from low-socioeconomic backgrounds exhibit more behavioural difficulties than those from more affluent families. Influential theoretical models specify family stress and child characteristics as mediating this effect. These accounts, however, have often been based on cross-sectional data or longitudinal analyses that do not capture all potential pathways, and therefore may not provide good policy guidance.
MethodsIn a UK representative sample of 2399 children aged 5–15, we tested mediation of the effect of household income on parent and teacher reports of conduct problems (CP) via unhealthy family functioning, poor parental mental health, stressful life events, child physical health and reading ability. We applied cross-lagged longitudinal mediation models which allowed for testing of reciprocal effects whereby the hypothesised mediators were modelled as outcomes as well as predictors of CP.
ResultsWe found the predicted significant longitudinal effect of income on CP, but no evidence that it was mediated by the child and family factors included in the study. Instead, we found significant indirect paths from income to parental mental health, child physical health and stressful life events that were transmitted via child CP.
ConclusionThe results confirm that income is associated with change in CP but do not support models that suggest this effect is transmitted via unhealthy family functioning, parental mental health, child physical health, stressful life events or reading difficulties. Instead, the results highlight that child CP may be a mediator of social inequalities in family psychosocial functioning.
MP07: Identification of barriers and facilitators for implementation of the Canadian Syncope Risk Score
- N. Hudek, B. Rowe, J. Brehaut, B. Ghaedi, P. Nguyen, J. Presseau, A. McRae, J. Yan, R. Ohle, C. Fabian, N. Le Sage, E. Mercier, M. Hegdekar, P. Archambault, M. Sivilotti, V. Thiruganasambandamoorthy
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 22 / Issue S1 / May 2020
- Published online by Cambridge University Press:
- 13 May 2020, pp. S44-S45
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- May 2020
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Introduction: Wide variability exists in emergency department (ED) syncope management. The Canadian Syncope Risk Score (CSRS) was derived and validated to predict the probability of 30-day serious outcomes after ED disposition. The objective was to identify barriers and facilitators among physicians for CSRS use to stratify risk and guide disposition decisions Methods: We conducted semi-structured interviews with physicians involved in ED syncope care at 8 Canadian sites. We used purposive sampling, contacting ED physicians, cardiologists, internists, and hospitalists until theme saturation was reached. Interview questions were designed to understand whether the CSRS recommendations are consistent with current practice, barriers and facilitators for application into practice, and intention for future CSRS use. Interviews were conducted via telephone or videoconference. Two independent raters coded interviews using an inductive approach to identify themes, with discrepancies resolved through consensus. Our methods were consistent with the Knowledge to Action Framework, which highlights the need to assess barriers and facilitators for knowledge use and for adapting new interventions into local contexts. Results: We interviewed 14 ED physicians, 7 cardiologists, and 10 hospitalists/internists across 8 sites. All physicians reported the use of electrocardiograms for patients with syncope, a key component in the CSRS criteria. Almost all physicians reported that the low risk recommendation (discharge without specific follow-up) was consistent with current practice, while less consistency was seen for moderate (15 days outpatient monitoring) and high risk recommendations (outpatient monitoring and/or admission). Key barriers to following the CSRS included a lack of access to outpatient monitoring and uncertainty over timely follow-up care. Other barriers included patient/family concerns, social factors, and necessary bloodwork. Facilitators included assisting with patient education, reassurance of their clinical gestalt, and optimal patient factors (e.g. reliability to return, support at home, few comorbidities). Conclusion: Physicians are receptive to using the CSRS tool for risk stratification and decision support. Implementation should address identified barriers, and adaptation to local settings may involve modifying the recommended clinical actions based on local resources and feasibility.
LO06: Development of practice recommendations for ED management of syncope by mixed methods
- V. Thiruganasambandamoorthy, M. Taljaard, N. Hudek, J. Brehaut, B. Ghaedi, P. Nguyen, M. Sivilotti, A. McRae, J. Yan, R. Ohle, C. Fabian, N. Le Sage, E. Mercier, M. Hegdekar, P. Huang, M. Nemnom, A. Krahn, P. Archambault, J. Presseau, I. Graham, B. Rowe
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 22 / Issue S1 / May 2020
- Published online by Cambridge University Press:
- 13 May 2020, pp. S8-S9
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- May 2020
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Introduction: Emergency department (ED) syncope management is extremely variable. We developed practice recommendations based on the validated Canadian Syncope Risk Score (CSRS) and outpatient cardiac monitoring strategy with physician input. Methods: We used a 2-step approach. Step-1: We pooled data from the derivation and validation prospective cohort studies (with adequate sample size) conducted at 11 Canadian sites (Sep 2010 to Apr 2018). Adults with syncope were enrolled excluding those with serious outcome identified during index ED evaluation. 30-day adjudicated serious outcomes were arrhythmic (arrhythmias, unknown cause of death) and non-arrhythmic (MI, structural heart disease, pulmonary embolism, hemorrhage)]. We compared the serious outcome proportion among risk categories using Cochran-Armitage test. Step-2: We conducted semi-structured interviews using observed risk to develop and refine the recommendations. We used purposive sampling of physicians involved in syncope care at 8 sites from Jun-Dec 2019 until theme saturation was reached. Two independent raters coded interviews using an inductive approach to identify themes; discrepancies were resolved by consensus. Results: Of the 8176 patients (mean age 54, 55% female), 293 (3.6%; 95%CI 3.2-4.0%) experienced 30-day serious outcomes; 0.4% deaths, 2.5% arrhythmic, 1.1% non-arrhythmic outcomes. The serious outcome proportion significantly increased from low to high-risk categories (p < 0.001; overall 0.6% to 27.7%; arrhythmic 0.2% to 17.3%; non-arrhythmic 0.4% to 5.9% respectively). C-statistic was 0.88 (95%CI0.86–0.90). Non-arrhythmia risk per day for the first 2 days was 0.5% for medium-risk, 2% for high-risk and very low thereafter. We recruited 31 physicians (14 ED, 7 cardiologists, 10 hospitalists/internists). 80% of physicians agreed that low risk patients can be discharged without specific follow-up with inconsistencies around length of ED observation. For cardiac monitoring of medium and high-risk, 64% indicated that they don't have access; 56% currently admit high-risk patients and an additional 20% agreed to this recommendation. A deeper exploration led to following refinement: discharge without specific follow-up for low-risk, a shared decision approach for medium-risk and short course of hospitalization for high-risk patients. Conclusion: The recommendations were developed (with online calculator) based on in-depth feedback from key stakeholders to improve uptake during implementation.
MP54: The prevalence and pattern of drugs detected in injured drivers in four Canadian provinces
- J. Brubacher, H. Chan, J. Lee, B. Rowe, K. Koger, P. Davis, C. Vaillancourt, I. Wishart
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 21 / Issue S1 / May 2019
- Published online by Cambridge University Press:
- 02 May 2019, p. S62
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- May 2019
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Introduction: Many drugs, including cannabis and alcohol, cause impairment and contribute to motor vehicle collisions (MVCs). Policy makers require knowledge of the prevalence of drug use in crash-involved drivers, and types of drugs used in order to develop effective prevention programs. This issue is particularly relevant with the recent legalization of cannabis. We aim to study the prevalence of alcohol, cannabis, sedating medications, and other drugs in injured drivers from 4 Canadian Provinces. Methods: This prospective cohort study obtained excess clinical blood samples from consecutive injured drivers who attended a participating Canadian trauma centre following a MVC. Blood samples were analyzed using a broad spectrum toxicology screen capable of detecting cannabinoids, cocaine, amphetamines (including their major analogues), and opioids as well as psychotropic pharmaceuticals (including antihistamines, benzodiazepines, other hypnotics, and sedating antidepressants). Alcohol and cannabinoids were quantified. Health records were reviewed to extract demographic, medical, and MVC information using a standardized data collection tool. Results: This study has been collecting data in 4 trauma centres in British Columbia (BC) since 2011 and was launched in 2 trauma centres in Alberta (AB), 1 in Saskatchewan (SK), and 2 in Ontario (ON) in 2018. In preliminary results from BC (n = 2412), 8% of injured drivers tested positive for THC and 13% for alcohol. Preliminary results from other provinces (n = 301) suggest a regional variation in prevalence of drivers testing positive for THC (10% - 27%), alcohol (17% - 29%), and other drugs. By May 2018, an estimated 4500 cases from BC, 600 from AB, 150 from SK, and 650 from ON will have been analyzed. We will report the prevalence of positive tests for alcohol, THC, other recreational drugs, and sedating medications, pre and post cannabis legalization. The number of cases with alcohol and/or THC levels above Canadian per se limits will also be reported. Results will be reported according to province, driver sex, age, single vs. multi vehicle crashes, and requirement for hospital admission. Conclusion: This will be among the largest international datasets on drug use by injured drivers. Our findings will provide patterns of drug and alcohol impairment in 4 Canadian provinces pre and post cannabis legalization. The significance of these findings and implication for impaired driving policy and prevention programs in Canada will be discussed.
The mineralogy and crystal chemistry of alkaline pegmatites in the Larvik Plutonic Complex, Oslo rift valley, Norway. Part 1. Magmatic and secondary zircon: implications for petrogenesis from trace-element geochemistry
- P. C. Piilonen, A. M. McDonald, G. Poirier, R. Rowe, A. O. Larsen
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- Journal:
- Mineralogical Magazine / Volume 76 / Issue 3 / June 2012
- Published online by Cambridge University Press:
- 05 July 2018, pp. 649-672
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A detailed electron microprobe (EMP) and laser-ablation inductively coupled plasma mass spectrometry (LA-ICP-MS) study of zircon from six types of miaskitic and agpaitic alkaline pegmatite from the Larvik Plutonic Complex, Oslo rift valley, Norway, was undertaken to shed light on the pegmatite petrogenesis. Detailed rare earth element (REE) analyses indicate important differences between the zircon from each type of pegmatite. Primary zircon from miaskitic Stavern-, Tvedalen- and Stålaker-type pegmatites has a mean ΣREE = 704 ppm, is depleted in LREE and has a significant positive Ce anomaly (Ce/Ce* = 44–67) and negative Eu anomaly (Eu/Eu* = 0.15–0.18). Secondary Tvedalen-type zircon is REE-enriched (ΣREE = 5035 ppm), with a flatter REE pattern, Ce/Ce* = 0.97 and a Eu anomaly similar to primary Tvedalen-type zircon (Eu/Eu* = 0.21). Secondary zircon from agpaitic Langesundsfjord-type pegmatites display a distinctive flat REE pattern characterized by overall REE enrichment (ΣREE = 967), Ce/Ce* = 1.92, and a minor negative Eu anomaly (Eu/Eu* = 0.37). Zircon from agpaitic Bratthagen-type pegmatites occurs as both altered primary and secondary phases and is strongly enriched in REE relative to other zircon (ΣREE = 4178 and 8388, respectively). Primary Bratthagen-type zircon has a similar REE pattern to miaskitic zircon, with a steeper HREE profile and smaller Ce and Eu anomalies (Eu/Eu* = 0.73; Ce/Ce* = 6.22). Secondary Bratthagen-type zircon is strongly enriched in LREE compared to primary zircon, does not display a positive Ce anomaly and has Eu/Eu* = 0.56. The altered primary and secondary Bratthagen-type zircons have elevated Th/UN ratios, suggesting a different melt source for Bratthagen-type agpaitic pegmatites. Zircon from external pegmatites has trace-element signatures similar to Stavern-, Tvedalen- and Staålaker-type primary zircon with Ce/Ce* = 214 and Nb/Ta and Th/U ratios that are similar to those of secondary Langesundsfjord- and Bratthagen-type zircon. It is suggested that the parental melt of the external pegmatites is the same as the miaskitic pegmatites, but that it has undergone alteration by hydrothermal fluids derived from the host basalt, or by post-magmatic F-rich fluids which mobilize Nb and Th. On the basis of texture, morphology and geochemistry, two populations of zircon can be recognized: (1) primary zircon from miaskitic pegmatites; and (2) secondary zircon from post-magmatic, hydrothermal assemblages. The U–Th–Pb isotope analyses indicate that the secondary and altered zircon are depleted in 238U, and enriched in LREE. Interaction of a post-magmatic hydrothermal fluid with an externally derived meteoric fluid is suggested to have influenced the REE signatures, and in particular the Eu and Ce anomalies of the late-stage zircons.
Brumadoite, a new copper tellurate hydrate, from Brumado, Bahia, Brazil
- D. Atencio, A. C. Roberts, P. A. Matioli, J. A. R. Stirling, K. E. Venance, W. Doherty, C. J. Stanley, R. Rowe, G. J. C. Carpenter, J. M. V. Coutinho
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- Mineralogical Magazine / Volume 72 / Issue 6 / December 2008
- Published online by Cambridge University Press:
- 05 July 2018, pp. 1201-1205
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Brumadoite, ideally Cu3Te6+O4(OH)4-5H2O, is a new mineral from Pedra Preta mine, Serra das Eguas. Brumado, Bahia, Brazil. It occurs as microcrystalline aggregates both on and, rarely, pseudomorphous after coarse-grained magnesite, associated with mottramite and quartz. Crystals are platy, subhedral. 1—2 μm in size. Brumadoite is blue (near RHS 114B), has a pale blue streak and a vitreous lustre. It is transparent to translucent and does not fluoresce. The empirical formula is (Cu2.90Pb0.04Ca0.01)Σ2.95 (Te0.936+Si0.05)Σ0.98O3.92(OH)3.84.5.24H2O. Infrared spectra clearly show both (OH) and H2O. Microchemical spot tests using a KI solution show that brumadoite has tellurium in the 6+ state. The mineral is monoclinic, P2/m or P21. Unit-cell parameters refined from X-ray powder data are a 8.629(2) Å, b 5.805(2) Å, c 7.654(2) Å,β 0 103.17(2)°, F 373.3(2) Å3, Z= 2. The eight strongest X-ray powder-diffraction lines [d in Å,(I),(hkl)] are: 8.432,(100),(100); 3.162,(66),(2̄02); 2.385,(27),(220); 2.291,(12),(l̄22); 1.916,(11),(312); 1.666,(14),(4̄22,114); 1.452,(10),(323,040); 1.450,(10),(422,403). The name is for the type locality, Brumado, Bahia, Brazil. The new mineral species has been approved by the CNMNC (IMA 2008-028).
Arisite-(La), a new REE-fluorcarbonate mineral from the Aris phonolite (Namibia), with descriptions of the crystal structures of arisite-(La) and arisite-(Ce)
- P. C. Piilonen, A. M. McDonald, J. D. Grice, M. A. Cooper, U. Kolitsch, R. Rowe, R. A. Gault, G. Poirier
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- Mineralogical Magazine / Volume 74 / Issue 2 / April 2010
- Published online by Cambridge University Press:
- 05 July 2018, pp. 257-268
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Arisite-(La), ideally NaLa2(CO3)2[F2x(CO3)1–x]F, is a new layered REE-fluorcarbonate mineral from miarolitic cavities within the Aris phonolite, Namibia (IMA no. 2009-019). It occurs as distinct chemical zones mixed with its Ce-analogue, arisite-(Ce). Crystals are vitreous, transparent beige, beige-yellow, light lemon-yellow to pinkish, and occur as tabular prisms up to 1.5 mm. Arisite-(La) is brittle, has conchoidal fracture, poor cleavage perpendicular to (001), a Mohs hardness of ~3–3½, is not fluorescent in either long- or shortwave UV radiation, dissolves slowly in dilute HCl at room temperature and sinks in methylene iodide, Dcalc. = 4.072 g cm–3. Arisite-(La) is uniaxial negative, has sharp extinction, with both ω and ε exhibiting a range of values within each grain: ω = 1.696–1.717(4) and ε = 1.594–1.611(3), a result of chemical zoning attributed to both Ce ⇌ La and Na ⇌ Ca substitutions. The crystal structure of both arisite-(Ce) and arisite-(La) were solved by direct methods and refined to R = 1.66%, wR2 = 4.31% (Ce) and R = 2.09%, wR2 = 5.26% (La), respectively. Arisite is hexagonal, Pm2, Z = 1, with unit-cell parameters of a = 5.1109(2) Å, c = 8.6713(4) Å, V = 196.16(6) Å3 for arisite-(Ce), and a = 5.1131(7) Å, c = 8.6759(17) Å, V = 196.43(5) Å3 for arisite-(La). Arisite-(Ce) and arisite-(La) are members of the layered, flat-lying REE-fluorcarbonate group which have crystal structures characterized by separate layers of triangular planar groups that parallel the overall layering of the structure, F, REE and alkali or alkaline-earthelements. Overall, the arisite structure can be defined by three distinct layers which parallel (001): (1) ∞[REE(CO3)2F] slabs, (2) sheets of Naϕ9 polyhedra, and (3) ∞[2F/CO3]2–. Based on its (M+F)/C ratio, arisite can further be described as having a dense, flat-lying fluorcarbonate structure, a classification which includes the structurally related mineral species cordylite, kukharenkoite, cebaite, lukechangite, huanghoite, and one incompletely characterized synthetic phase, NaY2(CO3)3F.
P110: A prospective cohort study to evaluate sex differences in presentations and management for patients presenting to emergency departments with atrial fibrillation and flutter
- B. H. Rowe, S. Patrick, P. Duke, K. Lobay, M. Haager, B. Deane, C. Villa-Roel, M. Nabipoor
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 20 / Issue S1 / May 2018
- Published online by Cambridge University Press:
- 11 May 2018, pp. S95-S96
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- May 2018
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Introduction: Atrial fibrillation and flutter (AFF) represent the most common arrhythmia presentations to emergency departments (EDs). Some research suggests that women with AFF experience different symptoms, receive different treatment and have worse outcomes than men. This study explored sex differences in risk factors, medication, and outcomes before and after ED visits for acute AFF. Methods: Adult patients presenting to the one of three hospitals affiliated with the University of Alberta with acute AFF were enrolled. Following informed consent, each patient completed a survey administered by a trained researcher, administrative ED information (e.g., ED times) was collected from the ED information system, a chart review on treatments was conducted and patients were contacted for follow-up at 7 days via telephone. Descriptive (median and interquartile range {IQR} and proportions) and simple (Wilcoxon-Mann-Whitney, chi-square, z-proportion) statistics are presented for continuous and dichotomous outcomes. Results: Overall, 217 patients were enrolled; the median age was 64 years (IQR: 55, 73) and 39% were female. Males presenting to the ED with AFF were 10 years younger than females (p<0.001); however, females weighed significantly less (median weight 69 vs. 95 kg; p<0.001), consumed less alcohol (12 vs 60 drinks/year; p<0.001) and were less likely to be ex-smokers (p=0.022) than men with AFF. Women arrived by Emergency Medical Services (EMS) (p=0.037), experienced palpitations (p=0.042), and reported a history of hypertension (p=0.022) more frequently than men. Females were more often prescribed oral anticoagulants before (p= 0.041) and after (p=0.011) the ED visit, and females with a history of AFF were less likely to present without anticoagulant/antiplatelet therapy (p=0.015). Overall, both sexes had similar attempts at cardioversion (59.4% vs. 61.3%) and hospitalizations (12.5% vs. 8.6%), respectively. If initial chemical cardioversion failed, females were more likely to receive subsequent electrical cardioversion (60.0% vs. 26.7%, p=0.036) than men. Conclusion: Overall, both women and men present frequently to the ED with AFF. Compared to men with AFF, women present with symptoms 10 years later, have different risk factors, experience more severe symptoms and use EMS more commonly; however, outcomes were similar. Unexplained sex-based variations in-ED and post-ED management are evident and these differences warrant further scrutiny.
P127: A prospective study of the management and outcomes of patients with symptomatic atrial fibrillation and/or flutter presenting to emergency departments
- B. H. Rowe, P. Duke, S. Patrick, K. Lobay, M. Haager, B. Deane, C. Villa-Roel, M. Nabipoor
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 20 / Issue S1 / May 2018
- Published online by Cambridge University Press:
- 11 May 2018, pp. S101-S102
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- May 2018
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Introduction: Patients with new onset and chronic atrial fibrillation and/or flutter (AFF) present to emergency departments (ED) with symptoms requiring acute management decisions. Most research has focused on patients with acute (<48 hours and/or <7 days with adequate anticoagulation) presentations of AFF and for whom rhythm control is considered safe. This study explored the demographic characteristics, risk factors, anticoagulant/anti-platelet prescription, and outcomes for patients with symptomatic AFF. Methods: A convenience sample of adult patients presenting to the one of three hospitals affiliated with the University of Alberta with symptoms of acute AFF were enrolled, within a fee-for-service billing environment. Following informed consent, a trained researcher administered a survey to each patient, recorded administrative details (e.g., triage, times, laboratory tests) from the ED information system, a chart review on treatments was conducted and patients were contacted for follow-up at 7 days via telephone. Descriptive (median and interquartile range {IQR} and proportions) and simple (t-tests, chi-square) statistics are presented for continuous and dichotomous outcomes, respectively. Results: Overall, 217 patients were enrolled; the median age was 64 (IQR: 55, 73) and 132 (61%) were male. Overall, 42 (19.4%) patients arrived by ambulance; 8 (4%) spontaneously converted or were diagnosed with another arrhythmia between arrival and obtaining an ECG. A prior history of AFF was common 152 (71%), as were the following cardiovascular and other risk factors: 176 (81.1%) consumed alcohol, 104 (48%) were current or former smokers, 86 (39.6%) had hypertension, 22 (10%) had CAD, and 10 (5%) had COPD. These patients most commonly reported palpitations 183 (84%) as their dominant symptom. Anti-platelets and anticoagulants were common prior to the ED 145 (67%), and 36 (17%) of patients were discharged from the ED without one of these medications. Overall, 80 (37%) patients had chronic AFF or an unknown timeline; no efforts were made to restore NSR in these patients. A dominant pattern for electrical cardioversion was observed; of 129 cases where cardioversion was attempted, 84 (65%) had electrical first and 45 (35%) had chemical first cardioversion attempts. Overall, 22 (49%) of 45 patients receiving chemical first were successfully converted to NSR. Patients with AFF history who were cardioverted were less likely hospitalized than those not-cardioverted (3% vs. 16%, p=0.006); 21 (10%) were admitted to hospital. Conclusion: In this center, patients with AFF often present to the ED with high acuity, with severe symptoms and receive aggressive care. The use of anticoagulants suggests an appreciation of thrombo-embolic risks, both in the community and ED settings. Like many EDs, this center appears to have a signature for AFF management, related to evidence gaps, physician preferences, and perhaps funding models.
P083: Developing an interview guide to explore physicians perceptions about unmet palliative care needs in Albertas emergency departments
- M. Kruhlak, C. Villa-Roel, B. H. Rowe, P. McLane
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 20 / Issue S1 / May 2018
- Published online by Cambridge University Press:
- 11 May 2018, p. S86
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- May 2018
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Introduction: Many patients with advanced or end-stage diseases spend months or years in need of optimal physical, spiritual, psychological, and social care. Despite efforts to provide community care, those with severe illness often present to emergency departments (EDs). This abstract presents preliminary results on the qualitative component of an ED-based mixed methods pilot study. The objective of this qualitative component is to develop and test an interview guide to collect qualitative data on physicians perceptions about unmet palliative care (PC) and end of life care (EOLC) needs in EDs. Methods: A scan of the literature on PC and EOLC in EDs was conducted to develop propositions about what might be expected through the clinician interviews, as well as an interview guide. The interview guide will be piloted with up to four ED physicians. During the interview each physician will describe a case where a PC patient had unmet care needs and the impacts they believe these unmet needs had on patients and families. Interview transcripts will be coded descriptively and then conceptually themed by the researcher who conducted the interview. Interpretations drawn from the interview data, with supporting quotations and comparison to initial propositions, will be presented to members of the research team with experience providing ED care, for further interpretation. Advice of a second trained qualitative researcher will be sought on the richness and relevance of data obtained and how the interview guide could be improved to elicit richer and/or more relevant data. A revised interview guide will be produced alongside rationales for why the proposed revisions will elicit richer data. Results: After reviewing 27 articles on PC and EOLC, propositions and an initial interview guide were developed based on themes from the literature and the study groups experiences. One of the primary results of this pilot work will be an enhanced understanding of PC and EOLC in our local ED context, as reflected in an interview guide revised to elicit richer data than achieved through the initial interview guide. Conclusion: The comparison between our propositions and the study findings will help identify how biases may have influenced interview questions and/or the interpretation of the data. This pilot work to develop an interview guide enhances the rigour of this qualitative work on unmet PC and EOLC needs in EDs.
P101: Quality of life in patients discharged from the emergency department with atrial fibrillation or flutter (AF/AFL): a prospective cohort study
- S. Patrick, P. Duke, K. Lobay, M. Haager, B. Deane, S. Couperthwaite, C. Villa-Roel, B.H. Rowe
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 19 / Issue S1 / May 2017
- Published online by Cambridge University Press:
- 15 May 2017, p. S112
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- May 2017
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Introduction: Following an emergency department (ED) presentation for acute atrial fibrillation and/or flutter (AF/AFL), patients often experience anxiety, depression and impaired health-related quality of life (QoL). Emergency physicians may prescribe appropriate thrombo-embolic (TE) prophylaxis upon discharge; however, the QoL of these patients is unclear. This study measured the QoL of patients with AF/AFL following discharge to determine the factors associated with QoL. Methods: Patients ≥18 years of age identified by the attending physician as having a diagnosis of acute AF/AFL confirmed by ECG were prospectively enrolled from three Edmonton, AB EDs. Using standardized enrollment forms, trained research assistants collected data on patient demographics factors and management both in the ED and at discharge. Patients’ health-related QoL was assessed up to 20 days after their initial ED visit by a telephone interview based on six domains of the short-form 8 health survey. Results: From a total of 196 enrolled patients, 121 (62%) were male and the mean age was 63 years (standard deviation ±14). Most patients had previous history of AF/AFL (71%), and emergency physicians had the opportunity to treat or revise TE prevention therapy in 19% of the patients. The majority (89%) were discharged with prescriptions for antiplatelet or anticoagulant agents, and 188 (96%) were contacted by telephone at a median of 7 days. Most patients rated their overall health between good and excellent (70%); however, 30% assessed their health as fair or very poor. Many also reported having physical limitations (54%), difficulties completing their daily work (42%), bodily pain (32%) and limitations in social activities (32%). Finally, some patients reported having low energy (25%). At follow up, patients receiving adequate TE prevention rated their health to be similar to those without adequate TE prevention (30% vs 23%; p=0.534). Conclusion: Overall, patients with acute, symptomatic AF/AFL seen in the ED have impairments in health-related QoL following discharge from the ED. Many factors contribute to this impairment; however, providing patients with appropriate TE prophylaxis at discharge did not explain these findings. Further research is required to explore the impact of AF/AFL on patient’s health-related QoL after discharge from the ED.
P050: A prospective cohort study to evaluate discharge care for patients with atrial fibrillation and flutter (AF/AFL)
- P. Duke, S. Patrick, K. Lobay, M. Haager, B. Deane, S. Couperthwaite, C. Villa-Roel, B.H. Rowe
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 19 / Issue S1 / May 2017
- Published online by Cambridge University Press:
- 15 May 2017, pp. S94-S95
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- May 2017
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Introduction: Atrial fibrillation and flutter (AF/AFL) are the most common arrhythmias encountered in the emergency department (ED); however, little information exists regarding the preventive management of patients with AF/AFL by emergency physicians (EPs). This study explored whether patients with AF/AFL received the recommended thrombo-embolic (TE) prophylaxis at discharge from the ED; patients’ TE risks, bleeding risks, and TE prophylaxis upon discharge from the ED were examined following assessment for symptomatic acute AF/AFL. Methods: Patients ≥18 years of age identified by the EP as having a diagnosis of acute AF/AFL confirmed by ECG were prospectively enrolled from three urban Canadian EDs. Using standardized patient enrollment forms, trained research assistants collected data on the patient’s demographics, TE risk (using the CHADS2 and CHA2DS2-VASc score), bleeding risk (using the HAS-BLED score), and management both in the ED and at discharge. Treating physicians were surveyed on their use of risk scores when making TE prophylaxis decisions as well as their estimate of the patient’s stroke and bleeding risk. Descriptive analyses were performed. Results: From a total of 196 patients, 62% were male and the mean age was 63 years (standard deviation [SD] ±14). Most patients had previous history of AF/AFL (71%); hypertension was documented in 40% of them and ≤10% had other risk factors (e.g., congestive heart failure, vascular disease, diabetes, previous stroke, transient ischemic attack). Based on the CHADS2 score and previous management, there was opportunity for new or revised antiplatelet/anticoagulant treatment by EPs in 19% of the patients. Consultations were requested in 28% of the patients, and the majority (89%) were discharged with anticoagulant or antiplatelet agents. EPs expressed concerns that an increased risk of falls, lack of access to facilities for INR monitoring, and significant cognitive impairment would affect their willingness to prescribe anticoagulation. Conclusion: Most patients in the ED with acute AF/AFL are receiving the recommended TE prophylaxis; however, given the significant morbidity and mortality associated with AF/AFL, improved short-term prescribing practices for anticoagulants would benefit 1 in 5 ED patients. More research on barriers to EPs prescribing anticoagulants is required to improve clinician comfort in treating this high-risk population.
MP17: Improving Communications during Aged Care Transitions (IMPACT): lessons learned
- P. McLane, K. Tate, B.H. Rowe, C. Estabrooks, G., Cummings
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 19 / Issue S1 / May 2017
- Published online by Cambridge University Press:
- 15 May 2017, pp. S70-S71
- Print publication:
- May 2017
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Introduction: When patients transition from long term care (LTC) to emergency departments (ED), communication among clinicians in different settings is often poor. We pilot tested a transfer form to facilitate communications of handover information among LTCs, emergency medical services (EMS), and EDs regarding LTC residents transitioning to and from the ED. We interpret implementation challenges in light of the “theoretical domains” implementation framework in order to produce lessons for future healthcare communication interventions. Methods: We provided setting specific training and a user guide to 13 participating sites, collected 90 forms to assess completion rates, and assessed perspectives on the form from 266 surveys of healthcare providers. Throughout the study, staff kept detailed notes on implementation of the form. We retrospectively categorized implementation challenges reported by survey respondents, and/or recorded in staff implementation notes, according to the theoretical domains framework. Results: The LTC patient transfer forms were used in 36.4% of transitions (90/247), and were completed most often by staff in the LTC (57/90, 63%). Survey results indicated that ED and EMS staff felt the information on the form was useful to them, although they rarely completed their sections of the form. Implementation challenges included low awareness/recognition of the form among healthcare providers, belief that the form distracted from patient care, lack of time for form completion, negative reinforcement for LTC staff (who saw little return for the time they invested in completing the form), and mistrust among clinicians who work in different settings. Conclusion: Future efforts to improve healthcare communications must be acceptable for all clinicians. Innovation should balance the workload required among sites/clinicians and the benefits that the intervention offers to sites/clinicians should be explicitly tracked and reported. For this intervention, more effort should be made to inform LTC sites that the transfer information they provide is useful for EMS and ED clinicians. Moreover, gaps in perspectives and lack of trust among clinicians who work in different settings must be recognized and addressed in any multi-site communication intervention.
The Epidemiology of Traumatic Spinal Cord Injury in Alberta, Canada
- Donna M. Dryden, L. Duncan Saunders, Brian H. Rowe, Laura A. May, Niko Yiannakoulias, Lawrence W. Svenson, Donald P. Schopflocher, Donald C. Voaklander
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- Journal:
- Canadian Journal of Neurological Sciences / Volume 30 / Issue 2 / May 2003
- Published online by Cambridge University Press:
- 16 December 2016, pp. 113-121
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Objectives:
To describe the incidence and pattern of traumatic spinal cord injury and cauda equina injury (SCI) in a geographically defined region of Canada.
Methods:The study period was April 1, 1997 to March 31, 2000. Data were gathered from three provincial sources: administrative data from the Alberta Ministry of Health and Wellness, records from the Alberta Trauma Registry, and death certificates from the Office of the Medical Examiner.
Results:From all three data sources, 450 cases of SCI were identified. Of these, 71 (15.8%) died prior to hospitalization. The annual incidence rate was 52.5/million population (95% CI: 47.7, 57.4). For those who survived to hospital admission, the incidence rate was 44.3/million/year (95% CI: 39.8, 48.7). The incidence rates for males were consistently higher than for females for all age groups. Motor vehicle collisions accounted for 56.4% of injuries, followed by falls (19.1%). The highest incidence of motor vehicle-related SCI occurred to those between 15 and 29 years (60/million/year). Fall-related injuries primarily occurred to those older than 60 years (45/million/year). Rural residents were 2.5 times as likely to be injured as urban residents.
Conclusion:Prevention strategies for SCI should target males of all ages, adolescents and young adults of both sexes, rural residents, motor vehicle collisions, and fall prevention for those older than 60 years.
A randomised, single-blind comparison of high-level disinfectants for flexible nasendoscopes
- B Hitchcock, S Moynan, C Frampton, R Reuther, P Gilling, F Rowe
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- Journal:
- The Journal of Laryngology & Otology / Volume 130 / Issue 11 / November 2016
- Published online by Cambridge University Press:
- 27 September 2016, pp. 983-989
- Print publication:
- November 2016
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Objectives:
To compare the microbiological efficacy, turnaround time, cost, convenience, and patient and user tolerance of Tristel Trio Wipes, PeraSafe solution and Cidex OPA solution for the high-level disinfection of flexible nasendoscopes.
Methods:Flexible nasendoscopes were used in routine clinical encounters. They were then disinfected with one of the three disinfectant methods. Surveillance cultures were taken before and after each disinfection process. Data relating to each of the study parameters were recorded.
Results:Positive bacterial cultures were discovered on nasendoscopes disinfected with PeraSafe and Cidex OPA. Tristel Trio Wipes have no capital outlay cost, the lowest running cost, the greatest convenience and the fastest turnaround time. PeraSafe had a faster turnaround time than Cidex OPA, and lower running costs.
Conclusion:Tristel Trio Wipes are equal to PeraSafe and Cidex OPA in terms of microbiological efficacy. Turnaround time and cost are dramatically reduced when using Tristel Trio Wipes compared to the other disinfectant methods.
LO015: A multi-centered regional emergency department study of renal colic management using medical expulsion therapy
- E. Bristow, A. Kinnaird, T. Schuler, P. Pang, S. Couperthwaite, C. Villa-Roel, B.H. Rowe
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 18 / Issue S1 / May 2016
- Published online by Cambridge University Press:
- 02 June 2016, p. S35
- Print publication:
- May 2016
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Introduction: Patients with renal colic present frequently to the emergency department (ED). Existing literature suggests management with medical expulsion therapy (MET) may improve outcomes, especially for those with stones > 5 mm in size. This study evaluates the use of MET in the management of adult patients seen in regional EDs with a diagnosis of renal colic. Methods: A multi-centered medical chart review study was conducted in seven Edmonton-Zone EDs. Approximately 100 cases from each site were randomly selected from administrative data from the 2014 calendar year, no repeat cases were permitted. Using a standardized data collection process and trained research assistance, data were abstracted from medical charts. Medians and inter-quartile ranges (IQR), proportions, and odds ratios (OR) with 95% confidence intervals (CIs) are reported. Results: Overall, 656 patient charts were included in the review; median age was 46 years (IQR: 35, 46) and 249 (38%) were female. Few (10%) arrived by ambulance or were on MET therapy at presentation; however, many (51%) reported a previous episode of renal colic. Many (191 {29%}) received no initial ED imaging; CT (236 {36%}) was favoured over ultrasound (39 {6%}) for initial imaging, either alone or with plain radiographs (8%). Plain radiographs were frequently ordered (204 {31%}). Only 198 (31%) of charts contained documentation of the use of MET at discharge and the median duration of therapy was 10 days (IQR: 7, 14). Initiation of MET therapy did not vary based on older age (OR = 0.8; 95% CI: 0.57, 1.14); sex (OR = 0.9; 95% CI: 0.67, 1.33); resident involvement (OR = 1.1; 95% CI: 0.63, 2.0); presentation to an academic centre (OR = 1.4; 95% CI: 0.96, 1.95) or stone size (OR = 1.3; 95% CI: 0.76, 2.06). Conclusion: Management of renal colic with MET is uncommon in this region and practice variation appears driven by physician preference rather than evidence. Practice guidelines with standardized order sets are urgently needed to improve care.
Contributors
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- By Mitchell Aboulafia, Frederick Adams, Marilyn McCord Adams, Robert M. Adams, Laird Addis, James W. Allard, David Allison, William P. Alston, Karl Ameriks, C. Anthony Anderson, David Leech Anderson, Lanier Anderson, Roger Ariew, David Armstrong, Denis G. Arnold, E. J. Ashworth, Margaret Atherton, Robin Attfield, Bruce Aune, Edward Wilson Averill, Jody Azzouni, Kent Bach, Andrew Bailey, Lynne Rudder Baker, Thomas R. Baldwin, Jon Barwise, George Bealer, William Bechtel, Lawrence C. Becker, Mark A. Bedau, Ernst Behler, José A. Benardete, Ermanno Bencivenga, Jan Berg, Michael Bergmann, Robert L. Bernasconi, Sven Bernecker, Bernard Berofsky, Rod Bertolet, Charles J. Beyer, Christian Beyer, Joseph Bien, Joseph Bien, Peg Birmingham, Ivan Boh, James Bohman, Daniel Bonevac, Laurence BonJour, William J. Bouwsma, Raymond D. Bradley, Myles Brand, Richard B. Brandt, Michael E. Bratman, Stephen E. Braude, Daniel Breazeale, Angela Breitenbach, Jason Bridges, David O. Brink, Gordon G. Brittan, Justin Broackes, Dan W. Brock, Aaron Bronfman, Jeffrey E. Brower, Bartosz Brozek, Anthony Brueckner, Jeffrey Bub, Lara Buchak, Otavio Bueno, Ann E. Bumpus, Robert W. Burch, John Burgess, Arthur W. Burks, Panayot Butchvarov, Robert E. Butts, Marina Bykova, Patrick Byrne, David Carr, Noël Carroll, Edward S. Casey, Victor Caston, Victor Caston, Albert Casullo, Robert L. Causey, Alan K. L. Chan, Ruth Chang, Deen K. Chatterjee, Andrew Chignell, Roderick M. Chisholm, Kelly J. Clark, E. J. Coffman, Robin Collins, Brian P. Copenhaver, John Corcoran, John Cottingham, Roger Crisp, Frederick J. Crosson, Antonio S. Cua, Phillip D. Cummins, Martin Curd, Adam Cureton, Andrew Cutrofello, Stephen Darwall, Paul Sheldon Davies, Wayne A. Davis, Timothy Joseph Day, Claudio de Almeida, Mario De Caro, Mario De Caro, John Deigh, C. F. Delaney, Daniel C. Dennett, Michael R. DePaul, Michael Detlefsen, Daniel Trent Devereux, Philip E. Devine, John M. Dillon, Martin C. Dillon, Robert DiSalle, Mary Domski, Alan Donagan, Paul Draper, Fred Dretske, Mircea Dumitru, Wilhelm Dupré, Gerald Dworkin, John Earman, Ellery Eells, Catherine Z. Elgin, Berent Enç, Ronald P. Endicott, Edward Erwin, John Etchemendy, C. Stephen Evans, Susan L. Feagin, Solomon Feferman, Richard Feldman, Arthur Fine, Maurice A. Finocchiaro, William FitzPatrick, Richard E. Flathman, Gvozden Flego, Richard Foley, Graeme Forbes, Rainer Forst, Malcolm R. Forster, Daniel Fouke, Patrick Francken, Samuel Freeman, Elizabeth Fricker, Miranda Fricker, Michael Friedman, Michael Fuerstein, Richard A. Fumerton, Alan Gabbey, Pieranna Garavaso, Daniel Garber, Jorge L. A. Garcia, Robert K. Garcia, Don Garrett, Philip Gasper, Gerald Gaus, Berys Gaut, Bernard Gert, Roger F. Gibson, Cody Gilmore, Carl Ginet, Alan H. Goldman, Alvin I. Goldman, Alfonso Gömez-Lobo, Lenn E. Goodman, Robert M. Gordon, Stefan Gosepath, Jorge J. E. Gracia, Daniel W. Graham, George A. Graham, Peter J. Graham, Richard E. Grandy, I. Grattan-Guinness, John Greco, Philip T. Grier, Nicholas Griffin, Nicholas Griffin, David A. Griffiths, Paul J. Griffiths, Stephen R. Grimm, Charles L. Griswold, Charles B. Guignon, Pete A. Y. Gunter, Dimitri Gutas, Gary Gutting, Paul Guyer, Kwame Gyekye, Oscar A. Haac, Raul Hakli, Raul Hakli, Michael Hallett, Edward C. Halper, Jean Hampton, R. James Hankinson, K. R. Hanley, Russell Hardin, Robert M. Harnish, William Harper, David Harrah, Kevin Hart, Ali Hasan, William Hasker, John Haugeland, Roger Hausheer, William Heald, Peter Heath, Richard Heck, John F. Heil, Vincent F. Hendricks, Stephen Hetherington, Francis Heylighen, Kathleen Marie Higgins, Risto Hilpinen, Harold T. Hodes, Joshua Hoffman, Alan Holland, Robert L. Holmes, Richard Holton, Brad W. Hooker, Terence E. Horgan, Tamara Horowitz, Paul Horwich, Vittorio Hösle, Paul Hoβfeld, Daniel Howard-Snyder, Frances Howard-Snyder, Anne Hudson, Deal W. Hudson, Carl A. Huffman, David L. Hull, Patricia Huntington, Thomas Hurka, Paul Hurley, Rosalind Hursthouse, Guillermo Hurtado, Ronald E. Hustwit, Sarah Hutton, Jonathan Jenkins Ichikawa, Harry A. Ide, David Ingram, Philip J. Ivanhoe, Alfred L. Ivry, Frank Jackson, Dale Jacquette, Joseph Jedwab, Richard Jeffrey, David Alan Johnson, Edward Johnson, Mark D. Jordan, Richard Joyce, Hwa Yol Jung, Robert Hillary Kane, Tomis Kapitan, Jacquelyn Ann K. Kegley, James A. Keller, Ralph Kennedy, Sergei Khoruzhii, Jaegwon Kim, Yersu Kim, Nathan L. King, Patricia Kitcher, Peter D. Klein, E. D. Klemke, Virginia Klenk, George L. Kline, Christian Klotz, Simo Knuuttila, Joseph J. Kockelmans, Konstantin Kolenda, Sebastian Tomasz Kołodziejczyk, Isaac Kramnick, Richard Kraut, Fred Kroon, Manfred Kuehn, Steven T. Kuhn, Henry E. Kyburg, John Lachs, Jennifer Lackey, Stephen E. Lahey, Andrea Lavazza, Thomas H. Leahey, Joo Heung Lee, Keith Lehrer, Dorothy Leland, Noah M. Lemos, Ernest LePore, Sarah-Jane Leslie, Isaac Levi, Andrew Levine, Alan E. Lewis, Daniel E. Little, Shu-hsien Liu, Shu-hsien Liu, Alan K. L. Chan, Brian Loar, Lawrence B. Lombard, John Longeway, Dominic McIver Lopes, Michael J. Loux, E. J. Lowe, Steven Luper, Eugene C. Luschei, William G. Lycan, David Lyons, David Macarthur, Danielle Macbeth, Scott MacDonald, Jacob L. Mackey, Louis H. Mackey, Penelope Mackie, Edward H. Madden, Penelope Maddy, G. B. Madison, Bernd Magnus, Pekka Mäkelä, Rudolf A. Makkreel, David Manley, William E. Mann (W.E.M.), Vladimir Marchenkov, Peter Markie, Jean-Pierre Marquis, Ausonio Marras, Mike W. Martin, A. P. Martinich, William L. McBride, David McCabe, Storrs McCall, Hugh J. McCann, Robert N. McCauley, John J. McDermott, Sarah McGrath, Ralph McInerny, Daniel J. McKaughan, Thomas McKay, Michael McKinsey, Brian P. McLaughlin, Ernan McMullin, Anthonie Meijers, Jack W. Meiland, William Jason Melanson, Alfred R. Mele, Joseph R. Mendola, Christopher Menzel, Michael J. Meyer, Christian B. Miller, David W. Miller, Peter Millican, Robert N. Minor, Phillip Mitsis, James A. Montmarquet, Michael S. Moore, Tim Moore, Benjamin Morison, Donald R. Morrison, Stephen J. Morse, Paul K. Moser, Alexander P. D. Mourelatos, Ian Mueller, James Bernard Murphy, Mark C. Murphy, Steven Nadler, Jan Narveson, Alan Nelson, Jerome Neu, Samuel Newlands, Kai Nielsen, Ilkka Niiniluoto, Carlos G. Noreña, Calvin G. Normore, David Fate Norton, Nikolaj Nottelmann, Donald Nute, David S. Oderberg, Steve Odin, Michael O’Rourke, Willard G. Oxtoby, Heinz Paetzold, George S. Pappas, Anthony J. Parel, Lydia Patton, R. P. Peerenboom, Francis Jeffry Pelletier, Adriaan T. Peperzak, Derk Pereboom, Jaroslav Peregrin, Glen Pettigrove, Philip Pettit, Edmund L. Pincoffs, Andrew Pinsent, Robert B. Pippin, Alvin Plantinga, Louis P. Pojman, Richard H. Popkin, John F. Post, Carl J. Posy, William J. Prior, Richard Purtill, Michael Quante, Philip L. Quinn, Philip L. Quinn, Elizabeth S. Radcliffe, Diana Raffman, Gerard Raulet, Stephen L. Read, Andrews Reath, Andrew Reisner, Nicholas Rescher, Henry S. Richardson, Robert C. Richardson, Thomas Ricketts, Wayne D. Riggs, Mark Roberts, Robert C. Roberts, Luke Robinson, Alexander Rosenberg, Gary Rosenkranz, Bernice Glatzer Rosenthal, Adina L. Roskies, William L. Rowe, T. M. Rudavsky, Michael Ruse, Bruce Russell, Lilly-Marlene Russow, Dan Ryder, R. M. Sainsbury, Joseph Salerno, Nathan Salmon, Wesley C. Salmon, Constantine Sandis, David H. Sanford, Marco Santambrogio, David Sapire, Ruth A. Saunders, Geoffrey Sayre-McCord, Charles Sayward, James P. Scanlan, Richard Schacht, Tamar Schapiro, Frederick F. Schmitt, Jerome B. Schneewind, Calvin O. Schrag, Alan D. Schrift, George F. Schumm, Jean-Loup Seban, David N. Sedley, Kenneth Seeskin, Krister Segerberg, Charlene Haddock Seigfried, Dennis M. Senchuk, James F. Sennett, William Lad Sessions, Stewart Shapiro, Tommie Shelby, Donald W. Sherburne, Christopher Shields, Roger A. Shiner, Sydney Shoemaker, Robert K. Shope, Kwong-loi Shun, Wilfried Sieg, A. John Simmons, Robert L. Simon, Marcus G. Singer, Georgette Sinkler, Walter Sinnott-Armstrong, Matti T. Sintonen, Lawrence Sklar, Brian Skyrms, Robert C. Sleigh, Michael Anthony Slote, Hans Sluga, Barry Smith, Michael Smith, Robin Smith, Robert Sokolowski, Robert C. Solomon, Marta Soniewicka, Philip Soper, Ernest Sosa, Nicholas Southwood, Paul Vincent Spade, T. L. S. Sprigge, Eric O. Springsted, George J. Stack, Rebecca Stangl, Jason Stanley, Florian Steinberger, Sören Stenlund, Christopher Stephens, James P. Sterba, Josef Stern, Matthias Steup, M. A. Stewart, Leopold Stubenberg, Edith Dudley Sulla, Frederick Suppe, Jere Paul Surber, David George Sussman, Sigrún Svavarsdóttir, Zeno G. Swijtink, Richard Swinburne, Charles C. Taliaferro, Robert B. Talisse, John Tasioulas, Paul Teller, Larry S. Temkin, Mark Textor, H. S. Thayer, Peter Thielke, Alan Thomas, Amie L. Thomasson, Katherine Thomson-Jones, Joshua C. Thurow, Vzalerie Tiberius, Terrence N. Tice, Paul Tidman, Mark C. Timmons, William Tolhurst, James E. Tomberlin, Rosemarie Tong, Lawrence Torcello, Kelly Trogdon, J. D. Trout, Robert E. Tully, Raimo Tuomela, John Turri, Martin M. Tweedale, Thomas Uebel, Jennifer Uleman, James Van Cleve, Harry van der Linden, Peter van Inwagen, Bryan W. Van Norden, René van Woudenberg, Donald Phillip Verene, Samantha Vice, Thomas Vinci, Donald Wayne Viney, Barbara Von Eckardt, Peter B. M. Vranas, Steven J. Wagner, William J. Wainwright, Paul E. Walker, Robert E. Wall, Craig Walton, Douglas Walton, Eric Watkins, Richard A. Watson, Michael V. Wedin, Rudolph H. Weingartner, Paul Weirich, Paul J. Weithman, Carl Wellman, Howard Wettstein, Samuel C. Wheeler, Stephen A. White, Jennifer Whiting, Edward R. Wierenga, Michael Williams, Fred Wilson, W. Kent Wilson, Kenneth P. Winkler, John F. Wippel, Jan Woleński, Allan B. Wolter, Nicholas P. Wolterstorff, Rega Wood, W. Jay Wood, Paul Woodruff, Alison Wylie, Gideon Yaffe, Takashi Yagisawa, Yutaka Yamamoto, Keith E. Yandell, Xiaomei Yang, Dean Zimmerman, Günter Zoller, Catherine Zuckert, Michael Zuckert, Jack A. Zupko (J.A.Z.)
- Edited by Robert Audi, University of Notre Dame, Indiana
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- Book:
- The Cambridge Dictionary of Philosophy
- Published online:
- 05 August 2015
- Print publication:
- 27 April 2015, pp ix-xxx
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Difficult risks and capital models: A report from the Extreme Events Working Party
- R. Frankland, S. Eshun, L. Hewitt, P. Jakhria, S. Jarvis, A. Rowe, A. D. Smith, A. C. Sharp, J. Sharpe, T. Wilkins
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- Journal:
- British Actuarial Journal / Volume 19 / Issue 3 / September 2014
- Published online by Cambridge University Press:
- 29 August 2014, pp. 556-616
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This paper is a report from the Extreme Events Working Party. The paper considers some of the difficulties in calculating capital buffers to cover potential losses. This paper considers the reasons why a purely mechanical approach to calculating capital buffers may bot be possible or justified. A range of tools and techniques is presented to help address some of the difficulties identified.
Functional significance of elaborate secondary sexual traits and their evolution in the water strider genus Rheumatobates1
- Locke Rowe, Kathleen P. Westlake, Douglas C. Currie
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- Journal:
- The Canadian Entomologist / Volume 138 / Issue 4 / August 2006
- Published online by Cambridge University Press:
- 02 April 2012, pp. 568-577
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Sexual conflict may drive the evolutionary elaboration of sexually antagonistic traits that function in mating interactions. One of the most striking cases of elaboration of male morphology occurs in the water strider genus Rheumatobates Bergroth (Hemiptera: Gerridae). The functional significance of the bizarre modifications of appendages in this group is not known. Here we focus on one of the more elaborate of the species, R. rileyi Bergroth. We conduct observational and experimental studies aimed at determining the general sequence of mating behaviour, the role of females in the outcome of sexual interactions, and the functional significance of the highly modified appendages of males. We also map these traits on a known phylogeny of the genus to determine their pattern of evolution. Males repeatedly harass females and females respond with evasive skating or, if the male successfully grasps her, with a premating struggle. The dynamics of the struggle determine the success of mating attempts. Short struggles typically lead to mating, and long struggles typically result in disengagement of the pair. Following a short period of copulation, males withdraw their genitalia and dismount. Females that have been isolated from males for a period of time become less reluctant to mate. During the premating struggle, the antennae of males are used to grasp the females around the head, and the rear legs are used to lift the females' rear legs off the water surface. Neither antennae nor rear legs are used during copulation, thus they are not used for copulatory courtship. Mapping of these traits on the phylogeny indicates multiple independent origins and a pattern of escalation (16 origins, 7 losses). We conclude that these bizarre traits of males are sexually antagonistic and have evolved repeatedly in the genus.
Presentations to emergency departments for chronic obstructive pulmonary disease in Alberta: a population-based study
- Rhonda J. Rosychuk, Donald C. Voaklander, Ambikaipakan Senthilselvan, Terry P. Klassen, Thomas J. Marrie, Brian H. Rowe
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 12 / Issue 6 / September 2010
- Published online by Cambridge University Press:
- 21 May 2015, pp. 500-508
- Print publication:
- September 2010
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Objective:
Chronic obstructive pulmonary disease (COPD) is a widespread illness with an increasing prevalence in older adults; exacerbations resulting in visits to the emergency department (ED) are common. We sought to determine the epidemiology of COPD presentations to EDs by older adults in Alberta.
Methods:Administrative databases were used to examine all ED encounters for COPD from April 1999 to March 2005 in Alberta. Data included demographics of patients and timing of ED visits. Data analysis included descriptive summaries and age–sex directly standardized visit rates (DSVRs).
Results:There were 85 330 ED visits for acute COPD made by 38 638 patients 55 years of age or older during the study period. More men (53.2%) presented, and the mean age at presentation was 72 years. The age–sex DSVRs remained stable from 2000/01 (24.4/1000) to 2004/05 (25.6/1000). Presentation rates differed among population subgroups. Overall, 67% of visits resulted in discharge from the ED.
Conclusion:Chronic obstructive pulmonary disease is a common presentation in Alberta EDs; however, the rates of presentation were stable during the study period, and monthly and hourly trends exhibited similar patterns for each year. Disparities based on age, sex, and socio-economic and cultural statuses were identified. Targeted interventions could be implemented to reduce future ED visits for COPD.