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Quality Indicators for Older Persons’ Transitions in Care: A Systematic Review and Delphi Process
- Kaitlyn Tate, Sarah Lee, Brian H Rowe, Garnet E Cummings, Jayna Holroyd-Leduc, R Colin Reid, Rowan El-Bialy, Jeffrey Bakal, Carole A Estabrooks, Carol Anderson, Greta G Cummings
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- Journal:
- Canadian Journal on Aging / La Revue canadienne du vieillissement / Volume 41 / Issue 1 / March 2022
- Published online by Cambridge University Press:
- 03 June 2021, pp. 40-54
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We identified quality indicators (QIs) for care during transitions of older persons (≥ 65 years of age). Through systematic literature review, we catalogued QIs related to older persons’ transitions in care among continuing care settings and between continuing care and acute care settings and back. Through two Delphi survey rounds, experts ranked relevance, feasibility, and scientific soundness of QIs. A steering committee reviewed QIs for their feasible capture in Canadian administrative databases. Our search yielded 326 QIs from 53 sources. A final set of 38 feasible indicators to measure in current practice was included. The highest proportions of indicators were for the emergency department (47%) and the Institute of Medicine (IOM) quality domain of effectiveness (39.5%). Most feasible indicators were outcome indicators. Our work highlights a lack of standardized transition QI development in practice, and the limitations of current free-text documentation systems in capturing relevant and consistent data.
Addressing Communication Breakdowns during Emergency Care Transitions of Older Adults: Evaluation of a Standardized Inter-Facility Health Care Communication Form
- Patrick McLane, Kaitlyn Tate, R. Colin Reid, Brian H. Rowe, Carole Estabrooks, Greta G. Cummings
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- Journal:
- Canadian Journal on Aging / La Revue canadienne du vieillissement / Volume 41 / Issue 1 / March 2022
- Published online by Cambridge University Press:
- 21 May 2021, pp. 15-25
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Transitions for older persons from long-term care (LTC) to the emergency department (ED) and back, can result in adverse events. Effective communication among care settings is required to ensure continuity of care. We implemented a standardized form for improving consistency of documentation during LTC to ED transitions of residents 65 years of age or older, via emergency medical services (EMS), and back. Data on form use and form completion were collected through chart review. Practitioners’ perspectives were collected using surveys. The form was used in 90/244 (37%) LTC to ED transitions, with large variation in data element completion. EMS and ED reported improved identification of resident information. LTC personnel preferred usual practice to the new form and twice reported prioritizing form completion before calling 911. To minimize risk of harmful unintended consequences, communication forms should be implemented as part of broader quality improvement programs, rather than as stand-alone interventions.
LO09: Role of hospitalization for detection of serious adverse events among emergency department patients with syncope: a propensity-score matched analysis of a multicenter prospective cohort
- R. Krishnan, M. Mukarram, B. Ghaedi, M. Sivilotti, N. Le Sage, J. Yan, P. Huang, M. Hegdekar, E. Mercier, M. Nemnom, L. Calder, A. McRae, B. Rowe, G. Wells, 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, p. S10
- Print publication:
- May 2020
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Introduction: Selecting appropriate patients for hospitalization following emergency department (ED) evaluation of syncope is critical for serious adverse event (SAE) identification. The primary objective of this study is to determine the association of hospitalization and SAE detection using propensity score (PS) matching. The secondary objective was to determine if SAE identification with hospitalization varied by the Canadian Syncope Risk Score (CSRS) risk-category. Methods: This was a secondary analysis of two large prospective cohort studies that enrolled adults (age ≥ 16 years) with syncope at 11 Canadian EDs. Patients with a serious condition identified during index ED evaluation were excluded. Outcome was a 30-day SAE identified either in-hospital for hospitalized patients or after ED disposition for discharged patients and included death, ventricular arrhythmia, non-lethal arrhythmia and non-arrhythmic SAE (myocardial infarction, structural heart disease, pulmonary embolism, hemorrhage). Patients were propensity matched using age, sex, blood pressure, prodrome, presumed ED diagnosis, ECG abnormalities, troponin, heart disease, hypertension, diabetes, arrival by ambulance and hospital site. Multivariable logistic regression assessed the interaction between CSRS and SAE detection and we report odds ratios (OR). Results: Of the 8183 patients enrolled, 743 (9.0%) patients were hospitalized and 658 (88.6%) were PS matched. The OR for SAE detection for hospitalized patients in comparison to those discharged from the ED was 5.0 (95%CI 3.3, 7.4), non-lethal arrhythmia 5.4 (95%CI 3.1, 9.6) and non-arrhythmic SAE 6.3 (95%CI 2.9, 13.5). Overall, the odds of any SAE identification, and specifically non-lethal arrhythmia and non-arrhythmia was significantly higher in-hospital among hospitalized patients than those discharged from the ED (p < 0.001). There were no significant differences in 30-day mortality (p = 1.00) or ventricular arrhythmia detection (p = 0.21). The interaction between ED disposition and CSRS was significant (p = 0.04) and the probability of 30-day SAEs while in-hospital was greater for medium and high risk CSRS patients. Conclusion: In this multicenter prospective cohort, 30-day SAE detection was greater for hospitalized compared with discharged patients. CSRS low-risk patients are least likely to have SAEs identified in-hospital; out-patient monitoring for moderate risk patients requires further study.
LO08: A randomized, controlled comparison of electrical versus pharmacological cardioversion for emergency department patients with atrial flutter
- I. Stiell, M. Sivilotti, M. Taljaard, D. Birnie, A. Vadeboncoeur, C. Hohl, A. McRae, B. Rowe, R. Brison, V. Thiruganasambandamoorthy, L. Macle, B. Borgundvaag, J. Morris, E. Mercier, C. Clement, J. Brinkhurst, E. Brown, M. Nemnom, G. Wells, J. Perry
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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, p. S9
- Print publication:
- May 2020
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Introduction: For rhythm control of acute atrial flutter (AAFL) in the emergency department (ED), choices include initial drug therapy or initial electrical cardioversion (ECV). We compared the strategies of pharmacological cardioversion followed by ECV if necessary (Drug-Shock), and ECV alone (Shock Only). Methods: We conducted a randomized, blinded, placebo-controlled trial (1:1 allocation) comparing two rhythm control strategies at 11 academic EDs. We included stable adult patients with AAFL, where onset of symptoms was <48 hours. Patients underwent central web-based randomization stratified by site. The Drug-Shock group received an infusion of procainamide (15mg/kg over 30 minutes) followed 30 minutes later, if necessary, by ECV at 200 joules x 3 shocks. The Shock Only group received an infusion of saline followed, if necessary, by ECV x 3 shocks. The primary outcome was conversion to sinus rhythm for ≥30 minutes at any time following onset of infusion. Patients were followed for 14 days. The primary outcome was evaluated on an intention-to-treat basis. Statistical significance was assessed using chi-squared tests and multivariable logistic regression. Results: We randomized 76 patients, and none was lost to follow-up. The Drug-Shock (N = 33) and Shock Only (N = 43) groups were similar for all characteristics including mean age (66.3 vs 63.4 yrs), duration of AAFL (30.1 vs 24.5 hrs), previous AAFL (72.7% vs 69.8%), median CHADS2 score (1 vs 1), and mean initial heart rate (128.9 vs 126.0 bpm). The Drug-Shock and Shock only groups were similar for the primary outcome of conversion (100% vs 93%; absolute difference 7.0%, 95% CI -0.6;14.6; P = 0.25). The multivariable analyses confirmed the similarity of the two strategies (P = 0.19). In the Drug-Shock group 21.2% of patients converted with the infusion. There were no statistically significant differences for time to conversion (84.2 vs 97.6 minutes), total ED length of stay (9.4 vs 7.5 hours), disposition home (100% vs 95.3%), and stroke within 14 days (0 vs 0). Premature discontinuation of infusion (usually for transient hypotension) was more common in the Drug-Shock group (9.1% vs 0.0%) but there were no serious adverse events. Conclusion: Both the Drug-Shock and Shock Only strategies were highly effective and safe in allowing AAFL patients to go home in sinus rhythm. IV procainamide alone was effective in only one fifth of patients, much less than for acute AF.
PL02: A randomized, controlled comparison of electrical versus pharmacological cardioversion for emergency department patients with recent-onset atrial fibrillation
- I. Stiell, J. Perry, D. Birnie, L. Macle, A. Vadeboncoeur, V. Thiruganasambandamoorthy, B. Borgundvaag, R. Brison, C. Hohl, A. McRae, B. Rowe, M. Sivilotti, J. Morris, E. Mercier, C. Clement, J. Brinkhurst, M. Taljaard, G. Wells
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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. S5
- Print publication:
- May 2019
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Introduction: For rhythm control of acute atrial fibrillation (AAF) in the emergency department (ED), choices include initial drug therapy or initial electrical cardioversion (ECV). We compared the strategies of pharmacological cardioversion followed by ECV if necessary (Drug-Shock), and ECV alone (Shock Only). Methods: We conducted a randomized, blinded, placebo-controlled trial (1:1 allocation) comparing two rhythm control strategies at 11 academic EDs. We included stable adult patients with AAF, where onset of symptoms was <48 hours. Patients underwent central web-based randomization stratified by site. The Drug-Shock group received an infusion of procainamide (15mg/kg over 30 minutes) followed 30 minutes later, if necessary, by ECV at 200 joules x 3 shocks. The Shock Only group received an infusion of saline followed, if necessary, by ECV x 3 shocks. The primary outcome was conversion to sinus rhythm for ≥30 minutes at any time following onset of infusion. Patients were followed for 14 days. The primary outcome was evaluated on an apriori-specified modified intention-to-treat (MITT) basis excluding patients who never received the study infusion (e.g. spontaneous conversion). Data were analyzed using chi-squared tests and logistic regression. Our target sample size was 374 evaluable patients. Results: Of 395 randomized patients, 18 were excluded from the MITT analysis; none were lost to follow-up. The Drug-Shock (N = 198) and Shock Only (N = 180) groups (total = 378) were similar for all characteristics including mean age (60.0 vs 59.5 yrs), duration of AAF (10.1 vs 10.8 hrs), previous AF (67.2% vs 68.3%), median CHADS2 score (0 vs 0), and mean initial heart rate (119.9 vs 118.0 bpm). More patients converted to normal sinus rhythm in the Drug-Shock group (97.0% vs 92.2%; absolute difference 4.8%, 95% CI 0.2-9.9; P = 0.04). The multivariable analyses confirmed the Drug-Shock strategy superiority (P = 0.04). There were no statistically significant differences for time to conversion (91.4 vs 85.4 minutes), total ED length of stay (7.1 vs 7.7 hours), disposition home (97.0% vs 96.1%), and stroke within 14 days (0 vs 0). Premature discontinuation of infusion was more common in the Drug-Shock group (8.1% vs 0.6%) but there were no serious adverse events. Conclusion: Both the Drug-Shock and Shock Only strategies were highly effective and safe in allowing AAF patients to go home in sinus rhythm. A strategy of initial cardioversion with procainamide was superior to a strategy of immediate ECV.
LO10: Associations between ED crowding metrics and 72h-hour ED re-visits: Which crowding metrics are most highly associated with patient-oriented adverse outcomes?
- A. McRae, G. Innes, M. Schull, E. Lang, E. Grafstein, B. Rowe, R. Rosychuk
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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. S10
- Print publication:
- May 2019
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Introduction: Emergency Department (ED) crowding is a pervasive problem and is associated with adverse patient outcomes. Yet, there are no widely accepted, universal ED crowding metrics. The objective of this study is to identify ED crowding metrics with the strongest association to the risk of ED revisits within 72 hours, which is a patient-oriented adverse outcome. Methods: Crowding metrics, patient characteristics and outcomes were obtained from administrative data for all ED encounters from 2011-2014 for three adult EDs in Calgary, AB. The data were randomly divided into three partitions for cross-validation, and further divided by CTAS category 1, 2/3 and 4/5. Twenty unique ED crowding metrics were calculated and assigned to each patient seen on each calendar day or shift, to standardize the exposure. Logistic regression models were fitted with 72h ED revisit as the dependent variable, and an individual crowding metric along with a common list of confounders as independent variables. Adjusted odds ratios (OR) for the 72h return visits were obtained for each crowding metric. The strength of associations between 72h revisits and crowding metrics were compared using Akaike's Information Criterion and Akaike weights. Results: This analysis is based on 1,149,939 ED encounters. Across all CTAS groups, INPUT metrics (ED census, ED occupancy, waiting time, EMS offload delay, LWBS%) were only weakly associated with the risk of 72h re-visit. Among THROUGHPUT metrics, ED Length of Stay and MD Care Time had similar adjusted ORs for 72h ED re-visit (range 0.99-1.15). Akaike weights ranging from 0.3/1.00 to 0.4/1.00 indicate that both THROUGHPUT metrics are reasonable predictors of 72h ED re-visits. All OUTPUT metrics (boarding time, # of boarded patients, % of beds occupied by boarded patients, hospital occupancy) had statistically significant ORs for 72h ED re-visits. The median boarding time had the highest adjusted OR for 72h ED re-visit (adjusted OR 1.40, 95% CI 1.33-1.47) and highest Akaike weight (0.97/1.00) compared to all other OUTPUT metrics, indicating that median boarding time had the strongest association with 72h re-visits. Conclusion: ED THROUGHPUT and OUTPUT metrics had consistent associations with 72h ED re-visits, while INPUT metrics had little to no association with 72h re-visits. Median boarding time is the strongest predictor of 72h re-visits, indicating that this may be the most meaningful measure of ED crowding.
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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- 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).
Putnisite, SrCa4Cr83+ (CO3)8SO4(OH)16·25H2O, a new mineral from Western Australia: description and crystal structure
- P. Elliott, G. Giester, R. Rowe, A. Pring
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- Mineralogical Magazine / Volume 78 / Issue 1 / February 2014
- Published online by Cambridge University Press:
- 05 July 2018, pp. 131-144
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Putnisite, SrCa4Cr83+ (CO7)8SO4(OH)16·25H2O, is a new mineral from the Polar Bear peninsula, Southern Lake Cowan, Western Australia, Australia. The mineral forms isolated pseudocubic crystals up to 0.5 mm in size in a matrix composed of quartz and a near amorphous Cr silicate. Putnisite is translucent, with a pink streak and vitreous lustre. It is brittle and shows one excellent and two good cleavages parallel to {100}, {010} and {001}. The fracture is uneven and the Mohs hardness 1½−2. The measured density is 2.20(3) g/cm3 and the calculated density based on the empirical formula is 2.23 g/cm3. Optically, putnisite is biaxial negative, with α = 1.552(3), β = 1.583(3) and γ = 1.599(3) (measured in white light). The optical orientation is uncertain and pleochroism is distinct: X pale bluish grey, Y pale purple, Z pale purple. Putnisite is orthorhombic, space group Pnma, with a = 15.351(3), b = 20.421(4) Å, c = 18.270(4) Å, V = 5727(2) Å3 (single-crystal data), and Z = 4. The strongest five lines in the X-ray powder diffraction pattern are [d(Å)(I)(hkl)]: 13.577 (100) (011), 7.659 (80) (200), 6.667 (43) (211), 5.084 (19) (222, 230), 3.689 (16) (411). Electron microprobe analysis (EMPA) gave (wt.%): Na2O 0.17, MgO 0.08, CaO 10.81, SrO 5.72, BaO 0.12, CuO 0.29, Cr2O3 31.13, SO3 3.95, SiO2 0.08, Cl− 0.28, CO2calc 17.94, H2Ocalc 30.30, O=Cl−0.06, total 100.81. The empirical formula, based on O + Cl = 69, is: Cr8.023+Ca3.78Sr1.08Na0.11Cu0.072+Mg0.04Ba0.02[(SO4)0.96(SiO4)0.03]0.99 (CO3)7.98(OH)16.19Cl0.15·24.84H2O. The crystal structure was determined from single-crystal X-ray diffraction data (MoKα, CCD area detector and refined to R1 = 5.84% for 3181 reflections with F0 > 4σF. Cr(OH)4O2 octahedra link by edge-sharing to form an eight-membered ring. A 10-coordinated Sr2+ cation lies at the centre of each ring. The rings are decorated by CO3 triangles, each of which links by corner-sharing to two Cr(OH)4O2 octahedra. Rings are linked by Ca(H2O)4O4 polyhedra to form a sheet parallel to (100). Adjacent sheets are joined along [100] by corner-sharing SO4 tetrahedra. H2O molecules occupy channels that run along [100] and interstices between slabs. Moderate to weak hydrogen bonding provides additional linkage between slabs.
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.
P008: Hereditary Angioedema Rapid Triage Tool (HAE-RT): translating clinical research into clinical practice
- S. Betschel, E. Avilla, S. Waserman, J. Badiou, K. Binkley, R. Borici-Mazi, J. Hebert, L. Howlett, A. Kanani, P. Keith, G. Lacuesta, W. Yang, A. Rowe, P. Waite
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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. S59
- Print publication:
- May 2018
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Introduction: Hereditary angioedema (HAE) patients (both diagnosed and undiagnosed) commonly present to the emergency department (ED). Presenting symptoms (swelling and pain) may be erroneously attributed to common allergic and gastrointestinal conditions resulting in major delays in diagnosis and appropriate treatment. No published tools currently exist for HAE screening and management in undiagnosed disease. The overall goal of the study was to develop a HAE-RT tool for ED settings. Methods: A two-phase mixed methods approach was used to develop the HAE-RT Tool including: Phase 1: A Delphi Study [HAE specialists (N=9) and National Patient Advocacy Group Members (N=3)] was conducted to reach consensus (80% agreement) on predictor variables to include. Phase 2: A retrospective chart review was conducted to assess the predictive findings of the predictor variables. A convenient sample of patients presenting with angioedema (with and without HAE) between January 2012 January 2017 were included in the study. Results: Of the 12 experts invited, 9 (75%) participated in the Delphi study. Of 8 HAE-specific predictive variables, 4 reached consensuses including: (1) recurrent angioedema; (2) absence of urticaria; (3) past recurrent abdominal pain/swelling; (4) response to allergic therapy. The retrospective study included 85 patients (N=46 with HAE; N=39 non-HAE; overall 72% female). HAE patients were significantly more likely to have a family history of HAE (72% vs 0%; P<0.0001); previous recurrent angioedema (96%; P<0.009); present with no hives (91%; P<0.036); previous recurrent abdominal pain (80%; P<0.0001); and only 2% responded positively to allergy treatments (P<0.0001). Conclusion: Our study emphasizes the importance of key stakeholder involvement and feedback to facilitate the prioritization of important information that must be included in the design of an HAE-RT tool. The next step is to observe the effect of the HAE-RT tool on patient triage in the ED.
Ferrivauxite, a new phosphate mineral from Llallagua, Bolivia
- G. Raade, J. D. Grice, R. Rowe
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- Journal:
- Mineralogical Magazine / Volume 80 / Issue 2 / April 2016
- Published online by Cambridge University Press:
- 02 January 2018, pp. 311-324
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Ferrivauxite, ideally Fe3+ Al2(PO4)2(OH)3·5H2O, is an oxidized equivalent of vauxite, Fe2+ Al2(PO4)2(OH)2·6H2O, and forms oxidation pseudomorphs after that mineral. It occurs in association with sigloite and crandallite at the Llallagua tin deposit, Bolivia. It is triclinic, space group P1̄, with a = 9.198(2), b = 11.607(3), c = 6.112(2) Å, α = 98.237(9), β = 91.900(13), γ = 108.658(9)°, V = 609.7(5) Å3, Z = 2. Strongest reflections of the powder X-ray diffraction pattern are [dobs in Å(Iobs)(hkl)]: 10.834(100)(010), 8.682(24)(100), 8.242 (65)(110), 6.018(28)(001), 5.918(23)(1̄10), 5.491 (30)(1̄20), 4.338(26)(200), 2.898 (32)(300). The structure was refined to R1 = 0.0369 for 3244 observed reflections. Twinning occurs on {010}. Ferrivauxite is isotypic with vauxite but with positional disorder of the Fe1 site and some of the oxygen sites. Disorder is also indicated by the infrared spectrum. One of the water molecules in vauxite is deprotonated in conjunction with the oxidation process and becomes a hydroxyl group. Ferrivauxite is translucent to transparent, has a golden brown colour with a pale yellow-brown streak and vitreous lustre. It is brittle with an irregular fracture and shows no cleavage. The Mohs hardness is estimated to be ∼3½ by comparison with vauxite. D(calc.) is 2.39 g cm–3 for the empirical formula Fe3+0.94Mn0.01Al1.98P2.05O8(OH)3 · 5H2O, obtained by electron-microprobe analysis in wavelength dispersive spectroscopy mode. The mineral is optically biaxial negative with α = 1.589(1), β = 1.593(1), γ = 1.596(1); the refractive indices are higher than those of vauxite.
LO39: Healthcare costs among homeless and/or substance using adults presenting to the emergency department: a single centre study
- V.V. Puri, K. Dong, B.H. Rowe, S.W. Kirkland, C. Vandenberghe, G. Salvalaggio, R. Cooper, A. Newton, C. Wild, S. Gupta, J.K. Khangura, C. Villa-Roel, C. McCabe
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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. S41
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- May 2017
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Introduction: Active substance use and unstable housing are both associated with increased emergency department (ED) utilization. This study examined ED health care costs among a cohort of substance using and/or homeless adults following an index ED visit, relative to a control ED population. Methods: Consecutive patients presenting to an inner-city ED between August 2010 and November 2011 who reported unstable housing and/or who had a chief presenting complaint related to acute or chronic substance use were evaluated. Controls were enrolled in a 1:4 ratio. Participants’ health care utilization was tracked via electronic medical record for six months after the index ED visit. Costing data across all EDs in the region was obtained from Alberta Health Services and calculated to include physician billing and the cost of an ED visit excluding investigations. The cost impact of ED utilization was estimated by multiplying the derived ED cost per visit by the median number of visits with interquartile ranges (IQR) for each group during follow up. Proportions were compared using non-parametric tests. Results: From 4679 patients screened, 209 patients were enrolled (41 controls, 46 substance using, 91 unstably housed, 31 both unstably housed and substance using (UHS)). Median costs (IQR) per group over the six-month period were $0 ($0-$345.42) for control, $345.42 ($0-$1139.89) for substance using, $345.42 ($0-$1381.68) for unstably housed and $1381.68 ($690.84-$4248.67) for unstably housed and substance using patients (p<0.05). Conclusion: The intensity of excess ED costs was greatest in patients who were both unstably housed and presenting with a chief complaint related to substance use. This group had a significantly larger impact on health care expenditure relative to ED users who were not unstably housed or who presented with a substance use related complaint. Further research into how care or connection to community resources in the ED can reduce these costs is warranted.
Aerospace applications of luminescent paint: Part one: Pressure measurement
- J. R. Kingsley-Rowe, G. D. Lock, A. G. Davies
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- The Aeronautical Journal / Volume 107 / Issue 1077 / November 2003
- Published online by Cambridge University Press:
- 04 July 2016, pp. 637-648
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Luminescent paints allow non-intrusive measurement of pressure and temperature at high spatial resolution without prior knowledge of the flow-field. Experiments have demonstrated that a ‘standard’ luminescent paint technique, developed by BAE Systems, can simultaneously measure steady pressure and temperature. This is achieved through knowledge of the paint phosphorescence lifetime rather than the absolute intensity, which increases the measurement accuracy. In addition, a new ‘fast’ paint has been calibrated at the University of Bath for the measurement of unsteady pressure using a variable frequency pulsing air jet. Pressure measurements were made with both paints in the wake of various excrescences, sized to produce vortex shedding in the frequency range 500–4,200Hz, in a transonic tunnel. The extent of the wakes was determined from a flow visualisation technique. Time-averaged measurements, using both luminescent paints, and transient measurements of the unsteady pressure field, made with the fast paint, were compared with transducer data. For all cases the luminescent paint data compared well with the conventional measurements and the Strouhal number agreed well with data from the literature. The use of luminescent paint for the simultaneous measurement of pressure and temperature over a NACA 0012 aerofoil, as well as the quantification of convective heat transfer is examined in Part 2.
Aerospace applications of luminescent paint: Part two: Heat transfer measurement
- J. R. Kingsley-Rowe, G. D. Lock, A. G. Davies
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- Journal:
- The Aeronautical Journal / Volume 107 / Issue 1077 / November 2003
- Published online by Cambridge University Press:
- 04 July 2016, pp. 649-656
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A heat transfer measurement technique has been developed, which utilised a laser to heat a spot of the ‘standard’ luminescent paint on an insulated metal wind tunnel model. The convective heat transfer coefficient was determined from the experimental quasi steady-state surface temperature, and solutions obtained from radial and axial conduction in a numerical heat transfer model. The convective heat transfer coefficient variation over both a flat plate and a NACA 0012 aerofoil have been measured in transonic flow. Measurements obtained from the flat plate were seen to agree well with correlation data from the literature. Measurements on the NACA 0012 aerofoil indicated the point of transition from laminar to turbulent boundary layer as well as the location of shock boundary layer interaction. The luminescent paint provided simultaneous measurements of pressure and temperature (see Part 1). The distribution of pressure over the NACA 0012 aerofoil was shown to be in excellent agreement with conventional transducer data, although the luminescent paint data provided greater spatial resolution. The position of the shock determined from the heat transfer measurements was shown to be in excellent agreement with the pressure measurements.
P106: Healthcare utilization among homeless and/or substance using adults presenting to the ED
- V.V. Puri, K. Dong, B.H. Rowe, S.W. Kirkland, C. Vandenberghe, G. Salvalaggio, R. Cooper, A. Newton, C. Wild, S. Gupta, J.K. Khangura, C. Villa-Roel, C. McCabe
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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. S114
- Print publication:
- May 2016
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Introduction: Substance use and unstable housing are associated with heavy use of the Emergency Department (ED). This study examined the impact of substance use and unstable housing on the probability of future ED use. Methods: Case-control study of patients presenting to an urban ED. Patients were eligible if they were unstably housed for the past 30 days, and/or if their chief complaint was related to substance use. Following written informed consent, patients completed a baseline survey and health care use was tracked via electronic medical records for the next six months. Controls were enrolled in a 1:4 ratio. More than 2 ED visits during the follow-up was pre-specified as a measure of excess ED use. Descriptive analyses included proportions and medians with interquartile ranges (IQR). Binomial logistic regression models were used to estimate the impact of housing status, high-risk alcohol use (AUDIT) and drug use (DUDIT), and combinations of these factors on subsequent acute care system contacts (ED visits + admissions). We controlled for age, gender, comorbidities at baseline, and baseline presenting acuity. Results: 41 controls, 46 substance using, 91 unstably housed, and 31 both unstably housed and substance using patients were enrolled (n = 209). Median ED visits during follow up were 0 (IQR: 0-1.0) for controls, 1.0 (IQR: 0-3.3) for substance using, 1.0 (IQR: 0-4.0) for unstably housed and 4 (IQR: 2-12.3) for unstably housed and substance using patients. The median acute care system contacts over the same period was 1.0 (IQR 0-2.0) for controls, 1.0 (IQR: 0-4.0) for substance using, 1.0 (IQR: 0-5.0) for unstably housed and 4.5 (IQR: 2.8-14.3) for unstably housed and substance using patients. Being unstably housed was the factor most strongly associated with having > 2 ED visits (b=3.288, p<0.005) followed by high-risk alcohol and drug use (b=2.149, p<0.08); high risk alcohol use alone was not significantly associated with ED visits (b=1.939, p<0.1). The number of comorbidities present at baseline was a small but statistically significant additional risk factor (b=0.478, p<0.05). The model correctly predicted 70.1% of patients’ ED utilization status. Conclusion: Unstable housing is a substantial risk factor for ED use; high-risk alcohol and drug use, and comorbidities at baseline increased this risk. The intensity of excess ED use was greatest in patients who were unstably housed and substance using.
LO087: Emergency department patients’ connection to primary care providers: reasons for lack of connection
- L. Krebs, S.W. Kirkland, K. Crick, C. Villa-Roel, A. Davidson, B. Voaklander, B. Holroyd, E. Cross, T. Nikel, R. Chetram, S. Couperthwaite, G. Cummings, D. Voaklander, 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. S60
- Print publication:
- May 2016
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Introduction: Some non-urgent/low-acuity Emergency Department (ED) presentations are considered convenience visits and potentially avoidable with improved access to primary care services. This study surveyed patients who presented to the ED and explored their self-reported reasons and barriers for not being connected to a primary care provider (PCP). Methods: Patients aged 17 years and older were randomly selected from electronic registration records at three urban EDs in Edmonton, Alberta (AB), Canada. Following initial triage, stabilization, and verbal informed consent, patients completed a 47-item questionnaire. Data from the survey were cross-referenced to a minimal patient dataset consisting of ED and demographic information. The questionnaire collected information on patient characteristics, their connection to a PCP, and patients' reasons for not having a PCP. Results: Of the 2144 eligible patients, 1408 (65.7%) surveys were returned and 1402 (65.4%) were completed. The majority of patients (74.4%) presenting to the ED reported having a family physician; however, the ‘closeness’ of the connection to their family physician varied greatly among ED patients with the most recent family physician visit ranging from 1 hour before ED presentation to 45 years prior. Approximately 25% of low acuity ED patients reported no connection with a family physician. Reasons for a lack of PCP connection included: prior physician retired, left, or died (19.8%), they had never tried to find one (19.2%), they had recently moved to Alberta (18.0%), and they were unable to find one (16.5%). Conclusion: A surprisingly high proportion of ED patients (25.6%) have no identified PCP. Patients had a variety of reasons for not having a family physician. These need to be understood and addressed in order for primary care access to successfully contribute to diverting non-urgent, low acuity presentations from the ED.
LO091: Non-urgent presentations to the emergency department: patients’ reasons for presentation
- L. Krebs, R. Chetram, S.W. Kirkland, T. Nikel, B. Voaklander, A. Davidson, B. Holroyd, E. Cross, C. Villa-Roel, K. Crick, S. Couperthwaite, C. Alexiu, G. Cummings, D. Voaklander, 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. S61
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- May 2016
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Introduction: Some low acuity Emergency Department (ED) presentations are considered non-urgent or convenience visits and potentially avoidable with improved access to primary care. This study explored self-reported reasons why non-urgent patients presented to the ED. Methods: Patients, 17 years and older, were randomly selected from electronic registration records at three urban EDs in Edmonton, Alberta (AB), Canada during weekdays (0700 to 1900). A 47-item questionnaire was completed by each consenting patient, which included items on whether the patient believed the ED was their best care option and the rationale supporting their response. A thematic content analysis was performed on the responses, using previous experience and review of the literature to identify themes. Results: Of the 2144 eligible patients, 1408 (65.7%) questionnaires were returned, and 1402 (65.4%) were analyzed. For patients who felt the ED was their best option (n = 1234, 89.3%), rationales included: safety concerns (n = 309), effectiveness of ED care (n = 284), patient-centeredness of ED (n = 277), and access to health care professionals in the ED (n = 204). For patients who felt the ED was not their best care option (n = 148, 10.7%), rationales included a perception that: access to health professionals outside the ED was preferable (n = 39), patient-centeredness (particularly timeliness) was lacking in the ED (n = 26), and their health concern was not important enough to require ED care (n = 18). Conclusion: Even during times when alternative care options are available, the majority of non-urgent patients perceived the ED to be the most appropriate location for care. These results highlight that simple triage scores do not accurately reflect the appropriateness of care and that understanding the diverse and multi-faceted reasons for ED presentation are necessary to implement strategies to support non-urgent, low acuity care needs.
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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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- The Cambridge Dictionary of Philosophy
- Published online:
- 05 August 2015
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- 27 April 2015, pp ix-xxx
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- By Howard Belzberg, Elizabeth R. Benjamin, Charles Best, Mark W. Bowyer, Demetrios Demetriades, Heidi L. Frankel, Rondi Gelbard, Daniel J. Grabo, Peter Hammer, Kenji Inaba, Emilie Joos, Mark Kaplan, Edward Kwon, Lydia Lam, Jackson Lee, Kazuhide Matsushima, Nicholas Nash, Daniel Oh, Eric Pagenkopf, Vincent L. Rowe, Lisa L. Schlitzkus, Jennifer Smith, Matthew D. Tadlock, Peep Talving, Pedro G. Teixeira, Stephen Varga, George Velmahos, Kelly Vogt, Gabriel Zada, Scott Zakaluzny
- Edited by Demetrios Demetriades, Kenji Inaba, George Velmahos
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- Atlas of Surgical Techniques in Trauma
- Published online:
- 05 April 2015
- Print publication:
- 05 March 2015, pp ix-x
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