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Hoedeman, F., P. J. Puiman, A. W. Smits, M. I. Dekker, H. Diderich-Lolkes de Beer, S. Laribi, D. Lauwaert, et al. "Recognition of child maltreatment in emergency departments in Europe: Should we do better?" PLOS ONE 16, no. 2 (February 5, 2021): e0246361. http://dx.doi.org/10.1371/journal.pone.0246361.
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Objectives To evaluate the different policies to recognize child maltreatment in emergency departments (EDs) in Europe in order to define areas of improvement. Methods A survey was conducted on the recognition of child maltreatment in EDs in European countries with a focus on screening methods, parental risk factors, training and hospital policies. The survey was distributed through different key members from the EUSEM, REPEM and the EuSEN. A summary score based on the NICE guideline (4 questions on child characteristics, 4 questions on parental characteristics and 5 questions on hospital policy) was calculated. Results We analysed 185 completed surveys, representing 148 hospitals from 29 European countries. Of the respondents, 28.6% used a screening tool, and 31.8% had guidelines on parental risk factors. A total of 42.2% did not follow training based on child characteristics, and 57.6% did not follow training on parental characteristics. A total of 71.9% indicated that there was a need for training. 50.8% of the respondents reported a standardized policy for the detection of child maltreatment. Translating the survey results to NICE summary scores of the EDs in Europe, we found that 25.6% (34/133) met most, 22.6% (30/133) met some and 51.9% (69/133) met few of the NICE guideline recommendations. More specifically, with respect to hospital policies, 33.8% (45/133) met most, 15.0% (20/133) met some and 51.1% (68/133) met few of the NICE guideline recommendations. Conclusion There is high variability regarding policies for child maltreatment detection and only a quarter of the EDs met most of the NICE guideline recommendations for child maltreatment. There is a need for the use of screening tools, training of ED staff and implementation of local hospital policies.
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Sundgot-Borgen, Jorunn. "Eating Disorders, Energy Intake, Training Volume, and Menstrual Function in High-level Modern Rhythmic Gymnasts." International Journal of Sport Nutrition 6, no. 2 (June 1996): 100–109. http://dx.doi.org/10.1123/ijsn.6.2.100.
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This study examined clinical and subclinical eating disorders (EDs) in young Norwegian modern rhythmic gymnasts. Subjects were 12 members of the national team, age 13-20 years, and individually matched nonathletic controls. All subjects participated in a structured clinical interview for EDs, medical examination, and dietary analysis. Two of the gymnasts met the DSM-III-R criteria for anorexia nervosa, and 2 met the criteria for anorexia athletica (a subclinical ED). AH the gymnasts were dieting in spite of the fact that they were all extremely lean. The avoidance of maturity, menstrual irregularities, energy deficit, high training volume, and high frequency of injuries were common features among the gymnasts. There is a need to learn more about risk factors and the etiology of EDs in different sports. Coaches, parents, and athletes need more information about principles of proper nutrition and methods to achieve ideal body composition for optimal health and athletic performance.
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Ding, Qinglan, Robin Whittemore, and Nancy Redeker. "Excessive Daytime Sleepiness in Stroke Survivors." Biological Research For Nursing 18, no. 4 (January 19, 2016): 420–31. http://dx.doi.org/10.1177/1099800415625285.
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Excessive daytime sleepiness (EDS) is a prevalent symptom among stroke survivors. This symptom is an independent risk factor for stroke and may reduce stroke survivors’ quality of life, cognitive functioning, and daytime functional performance. The lack of a universally accepted definition of EDS makes it difficult to measure EDS and synthesize research. The purpose of this integrative review is to describe poststroke EDS, ascertain conceptual and operational definitions of EDS, identify factors that contribute to EDS in stroke survivors, and explore outcomes associated with EDS in stroke survivors. We searched the following databases: PubMed and MEDLINE (OvidSP 1946—April; Week 2, 2015), Embase (OvidSP 1974—March; Week 1, 2015), and PsycINFO (OvidSP 1967—April; Week 2, 2015). Our search yielded 340 articles, 27 of which met inclusion criteria. The literature reveals EDS to be a multidimensional construct that is operationalized with both subjective and objective measures. Choosing measures that can quantify both the objective and subjective components is useful for gaining a comprehensive understanding of EDS. The antecedents of EDS are stroke, sleep-disordered breathing, reversed Robin Hood syndrome, and depression. The outcomes associated with EDS in stroke patients are serious and negative. Via synthesis of this research, we propose a possible framework for poststroke EDS, which may be of use in clinical practice and in research to identify valid quantifying methods for EDS as well as to prevent harmful outcomes in stroke survivors.
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Kapsetaki, Marianna E., and Charlie Easmon. "Eating Disorders in Non-Dance Performing Artists: A Systematic Literature Review." Medical Problems of Performing Artists 32, no. 4 (December 1, 2017): 227–34. http://dx.doi.org/10.21091/mppa.2017.4039.
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PURPOSE: Previous literature on dancers and athletes has shown a large impact of eating disorders (EDs) on these individuals, but there is limited research on EDs affecting non-dance performing artists (i.e., musicians, actors, etc.). This systematic review aimed to identify and evaluate the literature on EDs in non-dance performing artists. METHODS: A systematic review of the literature was performed on 24 databases, using search terms related to EDs and non-dance performing artists. All results from the databases were systematically screened for inclusion and exclusion criteria. RESULTS: The initial search returned 86,383 total articles, which after screening and removal of duplicates and irrelevant papers yielded 129 results. After screening the 129 full-text results for eligibility, 10 studies met criteria for inclusion: 6 papers addressed EDs in musicians, and 4 papers addressed EDs in theatre performers. Most studies used questionnaires and body mass index (BMI) as diagnostic tools for EDs. Most were small-scale studies and participants were mostly students. Because of the studies’ heterogeneity and varying quality, the results obtained were often contradictory and questionable. CONCLUSIONS: Although there has been a lot of literature in dancers, we found relatively few studies associating EDs with other performing artists, and most were inconsistent in their information.
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Nataraj, Jonathon, James Stempien, Stuart Netherton, Mark Yosri Wahba, and Taofiq Olusegun Oyedokun. "Emergency department referrals from a provincial medical call centre: Is it more than just 1-800-go-to-emerg?" CJEM 22, no. 2 (October 24, 2019): 241–44. http://dx.doi.org/10.1017/cem.2019.420.
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ABSTRACTObjectiveHealthLine is Saskatchewan's provincial 24-hour health information and support telephone line. A proportion of HealthLine's callers are referred to the emergency department (ED) for further assessment. The purpose of this study was to gain insight into the appropriateness of these referrals and assess whether they increased the burden on an already strained ED system.MethodsA list of callers referred from HealthLine to Saskatoon EDs from January 1, 2014, to March 31, 2014 was obtained. This list was cross-referenced with Saskatoon Health Region registration data to determine which of those callers had been registered in one of the three Saskatoon EDs within 48 hours of the original call.ResultsDuring the 90-day time period in question, 707/3,938 (17.9%) of callers were referred by HealthLine to the ED. Out of those referred, 601 were identifiable and 358 attended the ED. Hospital charts were pulled for full data extraction and analysis of the 276 who met inclusion criteria. Of those who presented to the ED and met inclusion criteria, 60% had investigations performed while 66% received some form of treatment. The overall admission rate for the patient population studied was 12.0% v. 16% for non-referred patients. Referred pediatric patients had fewer investigations and treatments with a lower admission rate compared with the adult patients.ConclusionThe Saskatchewan HealthLine is doing an effective job at directing callers both to and away from EDs in Saskatoon and not overburdening our local EDs with unnecessary referrals.
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Alzahrani, Naif, Russell Jones, Amir Rizwan, and Mohamed E. Abdel-Latif. "Safety attitudes in hospital emergency departments: a systematic review." International Journal of Health Care Quality Assurance 32, no. 7 (August 12, 2019): 1042–54. http://dx.doi.org/10.1108/ijhcqa-07-2018-0164.
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Purpose The purpose of this paper is to perform and report a systematic review of published research on patient safety attitudes of health staff employed in hospital emergency departments (EDs). Design/methodology/approach An electronic search was conducted of PsychINFO, ProQuest, MEDLINE, EMBASE, PubMed and CINAHL databases. The review included all studies that focussed on the safety attitudes of professional hospital staff employed in EDs. Findings Overall, the review revealed that the safety attitudes of ED health staff are generally low, especially on teamwork and management support and among nurses when compared to doctors. Conversely, two intervention studies showed the effectiveness of team building interventions on improving the safety attitudes of health staff employed in EDs. Research limitations/implications Six studies met the inclusion criteria, however, most of the studies demonstrated low to moderate methodological quality. Originality/value Teamwork, communication and management support are central to positive safety attitudes. Teamwork training can improve safety attitudes. Given that EDs are the “front-line” of hospital care and patients within EDs are especially vulnerable to medical errors, future research should focus on the safety attitudes of medical staff employed in EDs and its relationship to medical errors.
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Garrido Clua, M., M. Kruhlak, S. Kirkland, C. Villa-Roel, A. Elwi, B. O'Neill, A. Brisebois, S. Duggan, and B. Rowe. "P072: Comparing met vs. unmet palliative care needs in patients with end-stage conditions presenting to two Canadian emergency departments." CJEM 21, S1 (May 2019): S89. http://dx.doi.org/10.1017/cem.2019.263.
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Introduction: Patients with end-stage conditions require integrated physical, spiritual, psychological and social care. Despite efforts to provide comprehensive community care, those with severe symptoms often present to emergency departments (EDs) with palliative care (PC) needs. The objective of this study was to identify patients with end-stage diagnoses presenting to EDs, and to document and compare their PC needs. Methods: A four-month prospective cohort study was conducted in two Canadian EDs. Using a modified PC screening tool, volunteer emergency physicians identified adult patients with end-stage illnesses and documented their PC needs. This tool has the ability to classify patients as having met vs. unmet PC needs based on the documentation of risk factors. Research assistants documented demographic information, severity at presentation (Canadian Triage and Acuity Scale {CTAS}), disposition and revisits from an electronic repository. Bivariate comparisons between patients with met vs. unmet PC needs were completed. Results: Overall, 663 patients were enrolled, of which 78% (n = 518/663) were identified as having unmet PC needs according to the screening tool. Cancer was the most prevalent condition in each group (43% unmet needs, 37% met needs). There was no significant difference between the two groups in terms of age, sex or CTAS score. The unmet PC needs group was more likely to be admitted (68% vs. 50%; p = 0.0001) when compared to patients with PC needs assessed as being met. No significant difference was noted in terms of time to physician assessment or ED length of stay. The two groups did not significantly differ in the proportion of return visits within 30 days (34% vs. 32%) or the average number of return visits (3 vs. 2 visits). A higher proportion of patients with unmet PC needs made at least one visit to the ED in the 6 months prior to their index visit compared to patients with met PC needs (74% vs. 51%, p < 0.001); yet, the average number of ED visits was similar between the groups (3 visits). Conclusion: This study revealed that patients with end-stage diagnoses, especially cancer, commonly have unmet PC needs. They are also more likely to present to the ED and to require hospitalization than patients in whom PC needs have been met. Further investigations into their clinical profile and health care utilization may clarify the impact of their unmet PC needs on the healthcare system.
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Bristow, E., A. Kinnaird, T. Schuler, P. Pang, S. Couperthwaite, C. Villa-Roel, and B. H. Rowe. "LO015: A multi-centered regional emergency department study of renal colic management using medical expulsion therapy." CJEM 18, S1 (May 2016): S35. http://dx.doi.org/10.1017/cem.2016.52.
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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.
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Boeve, Angelica, Tanis J. Ferman, Jeremiah Aakre, Erik St. Louis, Michael Silber, Mary Machulda, Julie Fields, et al. "Excessive Daytime Sleepiness in Major Dementia Syndromes." American Journal of Alzheimer's Disease & Other Dementiasr 34, no. 4 (February 10, 2019): 261–64. http://dx.doi.org/10.1177/1533317519828046.
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There has been no comparison of excessive daytime sleepiness (EDS) in patients with Alzheimer’s disease dementia (AD), dementia with Lewy bodies (DLB), and behavioral variant frontotemporal dementia (bvFTD). We identified patients with mild dementia who met criteria for these disorders who also had the Epworth Sleepiness Scale (ESS) completed. The sample included 17 bvFTD, 111 AD, and 31 DLB. An ESS score ≥10 was considered abnormal and consistent with EDS. Analyses with age and sex as covariates revealed higher mean ESS scores for DLB compared to the other groups (DLB 13.9 [5], bvFTD 9.6 [8], AD 8.8 [5], P < .05). An ESS score ≥10 was significantly more likely to occur in DLB compared to bvFTD or AD (DLB 81% vs bvFTD 47% vs AD 45%, P < .01). In patients with mild dementia, EDS is greatest in DLB and comparably lower in bvFTD and AD.
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Almoaber, Basmah, and Daniel Amyot. "A Review on the Contribution of Emergency Department Simulation Studies in Reducing Wait Time." International Journal of E-Health and Medical Communications 8, no. 3 (July 2017): 1–21. http://dx.doi.org/10.4018/ijehmc.2017070101.
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Background: Because of the important role of hospital emergency departments (EDs) in providing urgent care, EDs face a constantly large demand that often results in long wait times. Objective: To review and analyze the existing literature in ED simulation modeling and its contribution in reducing patient wait time. Methods: A literature review was conducted on simulation modeling in EDs. Results: A total of 41 articles have met the inclusion criteria. The papers were categorized based on their motivations, modeling techniques, data collection processes, patient classification, recommendations, and implementation statuses. Real impact is seldom measured; only four papers (~10%) have reported the implementation of their recommended changes in the real world. Conclusion: The reported implementations contributed significantly to wait time reduction, but the proportion of simulation studies that are implemented is too low to conclude causality. Researchers should budget resources to implement their simulation recommendations in order to measure their impact on patient wait time.
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Mignot-Evers, Lisette, Vivian Raaijmakers, Gerba Buunk, Steffie Brouns, Lorenzo Romano, Thijs van Herpt, Arvind Gharbharan, Jeanne Dieleman, and Harm Haak. "Comparison of SIRS criteria and qSOFA score for identifying culture-positive sepsis in the emergency department: a prospective cross-sectional multicentre study." BMJ Open 11, no. 6 (June 2021): e041024. http://dx.doi.org/10.1136/bmjopen-2020-041024.
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ObjectiveTo compare the daily practice of two emergency departments (ED) in the Netherlands, where systemic inflammatory response syndrome (SIRS) criteria and quick Sequential Organ Failure Assessment (qSOFA) score are used differently as screening tools for culture-positive sepsis.DesignA prospective cross-sectional multicentre study.SettingTwo EDs at two European clinical teaching hospitals in the Netherlands.Participants760 patients with suspected infection who met SIRS criteria or had a qualifying qSOFA score who were treated at two EDs in the Netherlands from 1 January to 1 March 2018 were included.MethodsSIRS criteria and qSOFA score were calculated for each patient. The first hospital treated the patients who met SIRS criteria following the worldwide Surviving Sepsis Campaign protocol. At the second hospital, only patients who met the qualifying qSOFA score received this treatment. Therefore, patients could be divided into five groups: (1) SIRS+, qSOFA−, not treated according to protocol (reference group); (2) SIRS+, qSOFA−, treated according to protocol; (3) SIRS+, qSOFA+, treated according to protocol; (4) SIRS−, qSOFA+, not treated according to protocol; (5) SIRS−, qSOFA+, treated according to protocol.Primary and secondary outcome measuresTo prove culture-positive sepsis was present, cultures were used as the primary outcome. Secondary outcomes were in-hospital mortality and intensive care unit (ICU) admission.Results98.9% met SIRS criteria and 11.7% met qSOFA score. Positive predictive values of SIRS criteria and qSOFA score were 41.2% (95% CI 37.4% to 45.2%) and 48.1% (95% CI 37.4% to 58.9%), respectively. HRs were 0.79 (95% CI 0.40 to 1.56, p=0.500), 3.42 (95% CI 1.82 to 6.44, p<0.001), 18.94 (95% CI 2.48 to 144.89, p=0.005) and 4.97 (95% CI 1.44 to 17.16, p=0.011) for groups 2–5, respectively.ConclusionqSOFA score performed as well as SIRS criteria for identifying culture-positive sepsis and performed significantly better for predicting in-hospital mortality and ICU admission. This study shows that SIRS criteria are no longer necessary and recommends qSOFA score as the standard for identifying culture-positive sepsis in the ED.Trial registration numberNL8315.
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Suzuki, K., M. Miyamoto, T. Miyamoto, T. Matsubara, Y. Inoue, M. Iijima, S. Mizuno, et al. "Cerebrospinal fluid orexin-A levels in systemic lupus erythematosus patients presenting with excessive daytime sleepiness." Lupus 27, no. 11 (May 31, 2018): 1847–53. http://dx.doi.org/10.1177/0961203318778767.
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Objective Involvement of the hypothalamus is rare in patients with systemic lupus erythematosus (SLE). In this study, we measured cerebrospinal fluid (CSF) orexin-A levels in SLE patients with hypothalamic lesions to investigate whether the orexin system plays a role in SLE patients with hypothalamic lesions who present with excessive daytime sleepiness (EDS). Methods Orexin-A levels were measured in CSF from four patients with SLE who presented with hypothalamic lesions detected by MRI. Three patients underwent repeated CSF testing. All patients met the updated American College of Rheumatology revised criteria for SLE. Results Tests for serum anti-aquaporin-4 antibodies, CSF myelin basic protein and CSF oligoclonal bands were negative in all patients. All patients presented with EDS. Low to intermediate CSF orexin-A levels (92–180 pg/ml) were observed in three patients in the acute stage, two of whom (patients 1 and 2) underwent repeated testing and showed increased CSF orexin-A levels, reduced abnormal hypothalamic lesion intensities detected by MRI and EDS dissipation at follow-up. In contrast, CSF orexin-A levels were normal in one patient (patient 4) while in the acute stage and at follow-up, despite improvements in EDS and MRI findings. Patient 4 showed markedly increased CSF interleukin-6 levels (1130 pg/ml) and a slightly involved hypothalamus than the other patients. Conclusions Our findings suggest that the orexinergic system has a role in EDS in SLE patients with hypothalamic lesions. Furthermore, cytokine-mediated tissue damage might cause EDS without orexinergic involvement.
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Stopyra, Michał, and Andrzej Kiełbus. "The Influence of Various Etchants on the Quantitative Analysis of Microstructure of Mg-Nd Alloy." Solid State Phenomena 197 (February 2013): 192–97. http://dx.doi.org/10.4028/www.scientific.net/ssp.197.192.
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The paper presents the results of the influence of various etchants on the quantitative analysis of microstructure of Mg-Nd master alloy. The methodology of quantitative analysis of these alloys’ microstructure were also presented. Qualitative analysis were done using light and scanning electron microscopes, chemical composition was investigated using EDS method. Seven types of etchants were used. Having chosen suitable images, quantitative analysis were done using Met-Ilo program. Comparison of results showed that chosen etchants didn’t make the significant influence on the quantitative analysis results of the microstructure, despite visible dissimilarities.
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Arsentev, Vadim G., Tamara I. Kadurina, and Larisa N. Abbakumova. "New principles of diagnosis and classification of the Ehlers-Danlos syndrome." Pediatrician (St. Petersburg) 9, no. 1 (March 15, 2018): 118–25. http://dx.doi.org/10.17816/ped91118-125.
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Ehlers-Danlos syndrome (EDS) is a heterogeneous group of monogenic diseases caused by a violation of collagen metabolism, the structure and function of myomatrix and the synthesis of proteoglycans. This pathology is characteri zed by hyperelasticity of the skin, subcutaneous globules, overextension of the joints, tissue vulnerability and hemorrhagic syndrome. EDS is one of the seven hereditary connective tissue disorders for which international diagnostic criteria are met. More than 30 years ago, the so-called Berlin nosology of hereditary connective tissue disorders was first compiled and approved (1986). For a long time, doctors used the “Villefranche Nosology” classification of EDS, adopted in 1998 and divided the disease into 6 types. The new criteria were published by the International Committee of Experts in 2017. In the clinical classification of EDS, 13 types with different inheritance, clinical features and biochemical defects are described. In most cases, it is inherited by an autosomal dominant type. True prevalence is unknown due to the complexity of verification and a large number of light forms, the frequency of diagnosed cases is 1 : 5000 births, severe forms are rare (1 : 100 000). Diagnosis of this syndromeis also based on the diagnostic criteria of the international classification. The lecture presents new data on classification diagnostic criteria of EDS, polymorphism of the clinical picture, genetic heterogeneity, the main principles of treatment of the disease. The new classification criteria take into account, in the main, the features of the clinical picture, they did not simplify the diagnosis, but they increased the specificity and increased the significance of the clinical and anamnestic features. The scope of the examination is determined by the presence of leading clinical signs. The genealogical examination and molecular genetic methods of diagnostics are of great importance.
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Andruchow, J., D. Grigat, A. McRae, G. Innes, and E. Lang. "P008: Implementation of a voluntary provincial knowledge translation intervention project to improve the appropriateness of CT imaging for patients with mild traumatic brain injury and suspected pulmonary embolism." CJEM 19, S1 (May 2017): S80. http://dx.doi.org/10.1017/cem.2017.210.
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Introduction: Utilization of CT imaging has risen dramatically with increases in availability, but without corresponding improvements in patient outcomes. Previous attempts to improve imaging appropriateness via guideline implementation have met with limited success, with commonly cited barriers including a lack of confidence in patient outcomes, medicolegal risk, and patient expectations. The objective of this project is to improve CT utilization and appropriateness by addressing common barriers through clinical decision support (CDS) embedded in clinical practice. Methods: This matched-pair cluster-randomized trial saw 12 Alberta EDs with CT scanners randomized to receive CDS for diagnostic imaging. After extensive site engagement to recruit emergency medicine and diagnostic imaging leadership and stakeholders and understand local contexts, half of the sites received CDS for mild traumatic brain injury (MTBI) based on the Canadian CT Head Rule, while the remainder received CDS for suspected pulmonary embolism (PE), including the Pulmonary Embolism Rule-out Criteria (PERC), Wells Score, age-adjusted D-dimer and CT pulmonary angiography (CTPA) use. Hardcopy CT order forms including quantitative decision support, source literature and patient handouts were developed and adapted and integrated into workflow as per local site preference. Regular physician and site report cards on CT utilization and CDS use were also provided. The primary outcome was diagnostic imaging utilization for patients with MTBI and suspected PE. Results: During the study period, 144 emergency physicians at 6 EDs saw 3,278 patients with MTBI and 146 emergency physicians at six matched comparison EDs saw 18,606 patients with suspected PE. Use of CDS was highly variable by site, ranging from 0% to 29% of CT orders for MTBI and from 13% to 75% of CTPA orders for suspected PE. Impact on CT utilization, appropriateness, diagnostic yield is currently under investigation, but is expected to be limited at many sites given the variable adoption of decision support. Conclusion: A comprehensive CDS intervention to improve evidence-based imaging has met with variable uptake. Meaningful and widespread sustained improvements in practice will likely require incentives, accountability measures and leadership authority to enforce change.
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Tecuta, Lucia, Giovanni Andrea Fava, and Elena Tomba. "An innovative approach for the assessment of mood disturbances in patients with eating disorders." CNS Spectrums 25, no. 1 (April 15, 2019): 71–78. http://dx.doi.org/10.1017/s1092852919000798.
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Objective.Assessment of mood in eating disorders (EDs) has important clinical implications, but the current standard psychiatric classification (DSM-5) has limitations. The aim of the current study is to broaden the evaluation of depressive symptomatology by providing a comprehensive and innovative assessment approach in EDs through instruments that capture clinical phenomena of demoralization, subclinical distress, and psychological well-being.Methods.Seventy-nine patients who met diagnostic criteria for EDs of the Diagnostic and Statistical Manual of Mental Disorders – Fifth edition (DSM-5) were evaluated for depressive symptoms through Paykel’s Clinical Interview for Depression, the Structured Clinical Interview for DSM-5 for major depressive episode and persistent depressive disorder, and the Diagnostic Criteria for Psychosomatic Research (DCPR) interview for demoralization. Further, self-report inventories encompassing psychological well-being and distress were used.Results.Guilt, abnormal reactivity to social environment, and depressed mood were the most common depressive symptoms in the sample. DSM-defined depressive disorders were found in 55.7% of patients. The DCPR-demoralization criteria identified an additional 20.3% of the sample that would have been undetected with DSM criteria. Both DSM and DCPR diagnostic categories were associated with compromised psychological well-being and distress. Demoralization, unlike depression, was not associated with the severity of ED symptomatology.Conclusion.The findings indicate that a standard psychiatric approach, DSM-5-based, captures only a narrow part of the spectrum of mood disturbances affecting patients with EDs. A broadened clinimetric assessment unravels the presence of demoralization and yields clinical distinctions that may entail prognostic and therapeutic differences among patients who would be otherwise simply labeled as depressed.
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Bloom, Benjamin Michael, Jason Pott, Stephen Thomas, David Ramon Gaunt, and Thomas C. Hughes. "Usability of electronic health record systems in UK EDs." Emergency Medicine Journal 38, no. 6 (March 3, 2021): 410–15. http://dx.doi.org/10.1136/emermed-2020-210401.
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BackgroundThe large volume of patients, rapid staff turnover and high work pressure mean that the usability of all systems within the ED is important. The transition to electronic health records (EHRs) has brought many benefits to emergency care but imposes a significant burden on staff to enter data. Poor usability has a direct consequence and opportunity cost in staff time and resources that could otherwise be employed in patient care. This research measures the usability of EHR systems in UK EDs using a validated assessment tool.MethodsThis was a survey completed by members and fellows of the Royal College of Emergency Medicine conducted during summer 2019. The primary outcome was the System Usability Scale Score, which ranges from 0 (worst) to 100 (best). Scores were compared with an internationally recognised measure of acceptable usability of 68. Results were analysed by EHR system, country, healthcare organisation and physician grade. Only EHR systems with at least 20 responses were analysed.ResultsThere were 1663 responses from a total population of 8794 (19%) representing 192 healthcare organisations (mainly UK NHS), and 25 EHR systems. Fifteen EHR systems had at least 20 responses and were included in the analysis. No EHR system achieved a median usability score that met the industry standard of acceptable usability.The median usability score was 53 (IQR 35–68). Individual EHR systems’ scores ranged from 35 (IQR 26–53) to 65 (IQR 44–80).ConclusionIn this survey, no UK ED EHR system met the internationally validated standard of acceptable usability for information technology.
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Shi, Fei, Lu An, and Bao Min Sun. "Experimental Investigation of Biomass Slag Deposit on the Surface of Super-Heaters." Advanced Materials Research 724-725 (August 2013): 248–52. http://dx.doi.org/10.4028/www.scientific.net/amr.724-725.248.
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Growing attention had been drawn to the use of biomass as fuel for electricity generation in China. However, as a fairly new imported technology in localization, it had met serious problems with slagging and fouling of the super-heaters. The slag deposit on the first super-heaters in a biomass boiler was characterized by XRD, SEM-EDS and XRF to make clear the reason for the slag deposit. According to the results, alkali metal such as K, Na and Ca were predominant in the slag deposit. NaCl and KCl in the form of halite and sylvite were confirmed by XRD.
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He, Shuangchi, Melvyn Sim, and Meilin Zhang. "Data-Driven Patient Scheduling in Emergency Departments: A Hybrid Robust-Stochastic Approach." Management Science 65, no. 9 (September 2019): 4123–40. http://dx.doi.org/10.1287/mnsc.2018.3145.
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Emergency care necessitates adequate and timely treatment, which has unfortunately been compromised by crowding in many emergency departments (EDs). To address this issue, we study patient scheduling in EDs so that mandatory targets imposed on each patient’s door-to-provider time and length of stay can be collectively met with the largest probability. Exploiting patient flow data from the ED, we propose a hybrid robust-stochastic approach to formulating the patient scheduling problem, which allows for practical features, such as a time-varying patient arrival process, general consultation time distributions, and multiple heterogeneous physicians. In contrast to the conventional formulation of maximizing the joint probability of target attainment, which is computationally excruciating, the hybrid approach provides a computationally amiable formulation that yields satisfactory solutions to the patient scheduling problem. This formulation enables us to develop a dynamic scheduling algorithm for making recommendations about the next patient to be seen by each available physician. In numerical experiments, the proposed hybrid approach outperforms both the sample average approximation method and an asymptotically optimal scheduling policy. This paper was accepted by Yinyu Ye, optimization.
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Vermeir, René. "Ida Nijenhuis, Joke Roelevink, Ronald Sluijter (eds.), De leeuw met de zeven pijlen. Het gewest in het landelijk bestuur." BMGN - Low Countries Historical Review 127, no. 2 (June 25, 2012): 32. http://dx.doi.org/10.18352/bmgn-lchr.7497.
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Buller, David B., Peter A. Andersen, Barbara J. Walkosz, Michael D. Scott, Gary R. Cutter, Mark B. Dignan, Ilima L. Kane, and Xiao Zhang. "Enhancing Industry-Based Dissemination of an Occupational Sun Protection Program with Theory-Based Strategies Employing Personal Contact." American Journal of Health Promotion 26, no. 6 (July 2012): 356–65. http://dx.doi.org/10.4278/ajhp.110113-quan-22.
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Purpose. Industry-based strategies for dissemination of an evidence-based occupational sun protection program, Go Sun Smart (GSS), were tested. Design. Two dissemination strategies were compared in a randomized trial in 2004–2007. Setting. The North American ski industry. Subjects. Ski areas in the United States and Canada (n = 69) and their senior managers (n = 469). Intervention. Employers received GSS through a basic dissemination strategy (BDS) from the industry's professional association that included conference presentations and free starter kits. Half of the areas also received the enhanced dissemination strategy (EDS), in which project staff met face-to-face with managers and made ongoing contacts to support program use. Measures. Observation of program materials in use and managers' reports on communication about sun protection. Analysis. The effects of two alternative dissemination strategies were compared on program use using PROC MIXED in SAS, adjusted for covariates using one-tailed p values. Results. Ski areas receiving the EDS used more GSS materials (x̄ = 7.36) than those receiving the BDS (x̄ = 5.17; F = 7.82, p < .01). Managers from more areas receiving the EDS reported communicating about sun protection in employee newsletters/flyers (x̄ = .97, p = .04), in guest e-mail messages (x̄ = .75, p = .02), and on ski area Web sites (x̄ = .38, p = .02) than those receiving the BDS (x̄ = .84, .50, .15, respectively). Conclusion. Industry professional associations play an important role in disseminating prevention programs; however, active personal communication may be essential to ensure increased implementation fidelity.
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Akgül, Sinem, Devrim Akdemir, Mahmut Kara, Orhan Derman, Füsun Çuhadaroğlu Çetin, and Nuray Kanbur. "The understanding of risk factors for eating disorders in male adolescents." International Journal of Adolescent Medicine and Health 28, no. 1 (February 1, 2016): 97–105. http://dx.doi.org/10.1515/ijamh-2014-0078.
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Abstract Objective: The study aimed to describe the medical, psychiatric, and cultural features of adolescent males with an eating disorder (ED). Materials and methods: This retrospective evaluation took place at Hacettepe University, İhsan Doğramacı Children’s Hospital, Ankara, Turkey, and covered a 4-year period between 2010 and 2013. Sixty adolescents were diagnosed with an ED during this period, 47 (78.3%) were females and 13 were males (21.7%) male. All 13 male patients who met full criteria for an ED according to the DSM criteria were included. Medical and psychiatric records of male patients treated for an ED were re-evaluated. Results: The most striking finding of the study was that the female to male ratio became 3.6:1, with the increasing number of male adolescents with an ED. In our study, medical findings and complications of males with ED were similar to those seen in females. However, the most predominant gender difference was the co occurrence of a comorbid physical or mental illness. Conclusion: It is imperative to raise awareness of EDs in males. Although the medical findings of the study suggest that male and female adolescents with EDs are clinically similar to each other, the understanding of certain gender-specific risk factors shown in our study, such as a medical illness and/or obesity and co-morbid psychiatric diagnosis, are essential in raising suspicion. Further studies that especially evaluate cultural and social factors that affect parenting styles for boys are important in addessing possible risk factors for the development of EDs in males within different societies.
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Fauconnier, Marie, Morgane Rousselet, Paul Brunault, Elsa Thiabaud, Sylvain Lambert, Bruno Rocher, Gaëlle Challet-Bouju, and Marie Grall-Bronnec. "Food Addiction among Female Patients Seeking Treatment for an Eating Disorder: Prevalence and Associated Factors." Nutrients 12, no. 6 (June 26, 2020): 1897. http://dx.doi.org/10.3390/nu12061897.
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The concept of “food addiction” (FA) has aroused much focus because of evidence for similarities between overeating and substance use disorders (SUDs). However, few studies have explored this concept among the broad spectrum of eating disorders (ED), especially in anorexia nervosa (AN). This study aimed to assess FA prevalence in ED female patients and to determine its associated factors. We recruited a total of 195 adult women with EDs from an ED treatment center. The prevalence of FA diagnosis (Yale Food Addiction Scale) in the whole ED sample was 83.6%; AN restrictive type (AN-R), 61.5%; AN binge-eating/purging type (AN-BP), 87.9%; bulimia nervosa (BN), 97.6%; and binge-eating disorder (BED), 93.3%. The most frequently met criteria of FA were “clinically significant impairment or distress in relation to food”, “craving” and “persistent desire or repeated unsuccessful attempts to cut down”. An FA diagnosis was independently associated with three variables: presence of recurrent episodes of binge eating, ED severity, and lower interoceptive awareness. In showing an overlap between ED and FA, this study allows for considering EDs, and AN-R in particular, from an “addictive point of view”, and thus for designing therapeutic management that draws from those proposed for addictive disorders.
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Jo, Seung Bin, Hyun Kyung Kim, Hae Nim Lee, Yu-Jin Kim, Kapil Dev Patel, Jonathan Campbell Knowles, Jung-Hwan Lee, and Minju Song. "Physical Properties and Biofunctionalities of Bioactive Root Canal Sealers In Vitro." Nanomaterials 10, no. 9 (September 4, 2020): 1750. http://dx.doi.org/10.3390/nano10091750.
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Calcium silicate-based bioactive glass has received significant attention for use in various biomedical applications due to its excellent bioactivity and biocompatibility. However, the bioactivity of calcium silicate nanoparticle-incorporated bioactive dental sealer is not much explored. Herein, three commercially available bioactive root canal sealers (Endoseal MTA (EDS), Well-Root ST (WST), and Nishika Canal Sealer BG (NBG)) were compared with a resin-based control sealer (AH Plus (AHP)) in terms of physical, chemical, and biological properties. EDS and NBG showed 200 to 400 nm and 100 to 200 nm nanoparticle incorporation in the SEM image, respectively, and WST and NBG showed mineral deposition in Hank’s balanced salt solution after 28 days. The flowability and film thickness of all products met the ISO 3107 standard. Water contact angle, linear dimensional changes, and calcium and silicate ion release were significantly different among groups. All bioactive root canal sealers released calcium ions, while NBG released ~10 times more silicon ions than the other bioactive root canal sealers. Under the cytocompatible extraction range, NBG showed prominent cytocompatibility, osteogenecity, and angiogenecity compared to other sealers in vitro. These results indicate that calcium silicate nanoparticle incorporation in dental sealers could be a potential strategy for dental periapical tissue regeneration.
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Zhou, Jiaming, Longlei Dong, Jian Yan, and Wei Guan. "Optimization design framework: Guiding the design of nonlinear structures with experimental data and machine learning." International Journal of Applied Electromagnetics and Mechanics 64, no. 1-4 (December 10, 2020): 853–59. http://dx.doi.org/10.3233/jae-209398.
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The optimization design of complex nonlinear structures mainly relies on expert experiences and trial and error. In this paper, we proposed an optimization design framework for nonlinear structures by combining experimental data and machine learning. The framework can search the entire design space and guide the next experiment by machine learning model until the optimization targets are met. To demonstrate the effectiveness and practicability of this framework, we have optimized the damping efficiency and principal resonance frequency (PRF) of an Electricity Distribution System (EDS) with eight rubber isolators. The results show that the design targets of the optimized structure are consistent with the experimental results after two iterations. This framework is able to guide and accelerate nonlinear structure design and has significant value for engineering applications.
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Eppler, K., D. Wang, T. P. Pollak, and E. S. Lang. "P047: Prevalence and severity of hypertension presenting to Calgary area emergency departments." CJEM 20, S1 (May 2018): S73. http://dx.doi.org/10.1017/cem.2018.245.
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Introduction: Hypertension is common and a major cause of morbidity and mortality. Because it is asymptomatic, its diagnosis is often delayed. For many Canadians the Emergency Department (ED) is the only point of entry to the health care system, and therefore the recognition of undiagnosed and untreated hypertension in the ED is increasingly important. This study sought to evaluate the prevalence and severity of hypertension in patients presenting to Calgary area EDs, as well as to determine whether medical therapy was initiated and if patients had primary care providers for follow-up. Methods: Multi-centre electronic medical record (EMR) review of all adult patients presenting to Calgary area EDs from January 1, 2016 to December 31st, 2016. Hypertension was coded electronically by triage nurses and defined as systolic blood pressure SBP 140 mmHg and/or diastolic blood pressure DBP 90 mmHg. Hypertensive urgency was defined as SBP 180 mmHg and/or DBP 120 mmHg. Descriptive data was used to show patient demographics and hypertension prevalence. Primary care provider status, previous diagnosis of hypertension, chief complaint, and ED diagnoses were extracted and the EMRs were manually searched to determine whether treatment was initiated in the ED. Results: Of 304392 patients presenting to all Calgary sites, 43055 (14%) were found to have hypertension; mean age 52 (range 18 to 104), female 42%. Of these, 32986 (77%) had no known previous hypertension and 31% lacked a primary care provider. 0.2% had documentation of treatment initiated in the ED. 16% met criteria for hypertensive urgency. Conclusion: Many patients presenting to the ED have hypertension, often previously undiagnosed and at times severe. Many lack access to primary care. EDs may play an important role in the early recognition of hypertension. Dedicated management and follow-up pathways are indicated for this high-risk population.
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KITLV, Redactie. "Book reviews." Bijdragen tot de taal-, land- en volkenkunde / Journal of the Humanities and Social Sciences of Southeast Asia 168, no. 4 (2012): 519–72. http://dx.doi.org/10.1163/22134379-90003556.
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Tony Day and Maya H.T. Liem (eds), Cultures at war: The Cold War and cultural expression in Southeast Asia (Manneke Budiman) Fox, Richard, Critical reflections on religion and media in contemporary Bali (Martin Ramstedt) Faisal S. Hazis, Domination and contestation: Muslim bumiputera politics in Sarawak (Gerhard Hoffstaedter) Liesbeth Hesselink, Healers on the colonial market: Native doctors and midwivesin the Dutch East Indies (Leo van Bergen) May Ingawanij and Benjamin McKay (eds), Glimpses of freedom: Independent cinema in Southeast Asia (Katinka van Heeren Laura Jarnagin (ed.), The making of the Luso-Asian world: Intricacies of engagement (Hans Hägerdal) J.J.P. de Jong, Avondschot: Hoe Nederland zich terugtrok uit zijn Aziatisch imperium (William H. Frederick) Eben Kirksey, Freedom in entangled worlds: West Papua and the architecture of global power (Pieter Drooglever) Lev, Daniel S., No concessions: The life of Yap Thiam Hien, Indonesian human rights lawyer (Gerry van Klinken) Rémy Madinier, L’Indonésie, entre démocratie musulmane et Islam intégral: Histoire du parti Masjumi (1945-1960) (Chiara Formichi) Rod Nixon, Justice and governance in East Timor: Indigenous approaches and the ‘New Subsistence State’ (Hans Hägerdal) Philippe M.F. Peycam, The birth of Vietnamese political journalism: Saïgon 1916-1930 (Pierre Brocheux) Harry Poeze, Madiun 1948: PKI bergerak (Avsi Warman Adam) Ronit Ricci, Islam translated: Literature, conversion, and the Arabic cosmopolis of South and Southeast Asia (William Cummings) Sokhieng Au, Mixed medicines: Health and culture in French colonial Cambodia (Leo van Bergen) Kobkua Suwannathat-Pian, Palace, political party and power: A story of the sociopolitical development of Malay Kingship (A.J. Stockwell) G. Teitler, Op het koloniale oorlogspad; De strijd tegen Moslim-fundamentalisten ter Westkust van Sumatra (1817-1838), vergeleken met de Russische verovering van Tjetsjenië en Dagestan (1817-1859) (Joshua Gedacht) Gerard Termorhuizen, Realisten en reactionairen: Een geschiedenis van de Indisch-Nederlandse pers 1905-1942 (Pieter Drooglever) Tjien Oei (ed.), Memoirs of Indonesian doctors and professionals 2; More stories that shaped the lives of Indonesian doctors (Vivek Neelakantan) Tomomi Ito, Modern Buddhism and Buddhadāsa Bhikkhu: A social history (Justin McDaniel) Geoff Wade and Li Tana (eds), Anthony Reid and the study of the Southeast Asian past (Henk Schulte Nordholt) Roxana Waterson and Kwok Kian-Woon (eds), Contestations of memory in Southeast Asia (Kevin Blackburn)
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Schull, Michael, Marian Vermeulen, Astrid Guttmann, and Therese Stukel. "Better performance on length-of-stay benchmarks associated with reduced risk following emergency department discharge: an observational cohort study." CJEM 17, no. 3 (February 9, 2015): 253–62. http://dx.doi.org/10.1017/cem.2014.39.
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AbstractIntroductionEmergency department (ED) crowding is associated with adverse outcomes. Several jurisdictions have established benchmarks and targets for length-of-stay (LOS) to reduce crowding. An evaluation has been conducted on whether performance on Ontario’s ED LOS benchmarks is associated with reduced risk of death or hospitalization.MethodsA retrospective cohort study of discharged ED patients was conducted using population-based administrative data from Ontario (April 2008 to February 2012). For each ED visit, the proportion of patients seen during the same shift that met ED LOS benchmarks was determined. Performance was categorized as <80%, 80% to <90%, 90% to <95%, and 95%–100% of same-shift ED patients meeting the benchmark. Logistic regression models analysed the association between performance on ED LOS benchmarks and 7-day death or hospitalization, controlled for patient and ED characteristics and stratified by patient acuity.ResultsFrom 122 EDs, 2,295,256 high-acuity and 1,626,629 low-acuity visits resulting in discharge were included. Deaths and hospitalizations within 7 days totalled 1,429 (0.062%) and 49,771 (2.2%) among high-acuity, and 220 (0.014%) and 9,005 (0.55%) among low-acuity patients, respectively. Adverse outcomes generally increased among patients seen during shifts when a lower proportion of ED patients met ED LOS benchmarks. The adjusted odds ratios (and 95% confidence intervals) among high- and low-acuity patients seen on shifts when <80% met ED benchmarks (compared with ≥95%) were, respectively, 1.32 (1.05–1.67) and 1.84 (1.21–2.81) for death, and 1.13 (1.08–1.17) and 1.40 (1.31–1.49) for hospitalization.ConclusionsBetter performance on Ontario’s ED LOS benchmarks for each shift is associated with a 10%–45% relative reduction in the odds of death or admission 7 days after ED discharge.
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KITLV, Redactie. "Book Reviews." Bijdragen tot de taal-, land- en volkenkunde / Journal of the Humanities and Social Sciences of Southeast Asia 158, no. 1 (2002): 95–144. http://dx.doi.org/10.1163/22134379-90003788.
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-Stephen J. Appold, Heidi Dahles ,Tourism and small entrepreneurs; Development, national policy, and entrepreneurial culture: Indonesian cases. Elmsford, New York: Cognizant Communication Corporation, 1999, vi + 165 pp., Karin Bras (eds) -Jean-Pascal Bassino, Peter Boothroyd ,Socioeconomic renovation in Vietnam; The origin, evolution and impact of Doi Moi. Singapore: Institute of Southeast Asian Studies, 2001, xv + 175 pp., Pham Xuan Nam (eds) -Peter Boomgaard, Patrick Vinton Kirch, The wet and the dry; Irrigation and agricultural intensification in Polynesia. Chicago: The University of Chicago Press, 1994, xxii + 385 pp. -A.Th. Boone, Chr.G.F. de Jong, De Gereformeerde Zending in Midden-Java 1931-1975; Een bronnenpublicatie. Zoetermeer: Boekencentrum, 1997, xxiv + 890 pp. [Uitgaven van de Werkgroep voor de Geschiedenis van de Nederlandse Zending en Overzeese Kerken, Grote Reeks 6.] -Okke Braadbaart, Colin Barlow, Institutions and economic change in Southeast Asia; The context of development from the 1960s to the 1990s. Cheltenham: Edward Elgar, xi + 204 pp. -Freek Colombijn, Abidin Kusno, Behind the postcolonial; Architecture, urban space, and political cultures in Indonesia. London: Routledge, 2000, xiv + 250 pp. -Raymond Corbey, Michael O'Hanlon ,Hunting the gatherers; Ethnographic collectors, agents and agency in Melanesia, 1870s -1930s. Oxford: Bergahn Books, 2000, xviii + 286 pp. [Methodology and History in Anthropology 6.], Robert L. Welsch (eds) -Olga Deshpande, Hans Penth, A brief histroy of Lan Na; Civilizations of North Thailand. Chiang Mai: Silkworm Books, 2000, v + 74 pp. -Aone van Engelenhoven, I Ketut Artawa, Ergativity and Balinese syntax. Jakarta: Badan Penyelenggaran Seri NUSA, Universitas Katolik Indonesia Atma Jaya, 1998, v + 169 pp (in 3 volumes). [NUSA Linguistic Studies of Indonesian and Other Languages in Indonesia 42, 43, 44.] -Rens Heringa, Jill Forshee, Between the folds; Stories of cloth, lives, and travels from Sumba. Honolulu: University of Hawai'i Press, 2001, xiv + 266 pp. -Roy E. Jordaan, Marijke J. Klokke ,Fruits of inspiration; Studies in honour of Prof. J.G. de Casparis, retired Professor of the Early History and Archeology of South and Southeast Asia at the University of Leiden, the Netherlands on the occasion of his 85th birthday. Groningen: Egbert Forsten, 2001, xxiii + 566 pp. [Gonda Indological Studies 11.], Karel R. van Kooij (eds) -Gerrit Knaap, Germen Boelens ,Natuur en samenleving van de Molukken, (met medewerking van Nanneke Wigard). Utrecht: Landelijk Steunpunt Educatie Molukkers, 2001, 375 pp., Chris van Fraassen, Hans Straver (eds) -Henk Maier, Virginia Matheson Hooker, Writing a new society; Social change through the novel in Malay. Leiden: KITLV Press (in association with the Asian Studies Association of Australia), 2000, xix + 492 pp. -Niels Mulder, Penny van Esterik, Materializing Thailand. Oxford: Berg, 2000, xi + 274 pp. -Jean Robert Opgenort, Ger P. Reesink, Studies in Irian Languages; Part II. Jakarta: Badan Penyelenggara Seri NUSA, Universitas Katolik Indonesia Atma Jaya. [NUSA Linguistic Studies of Indonesian and Other Languages in Indonesia 47.] 2000, iv + 151 pp. -Gerard Termorshuizen, Kester Freriks, Geheim Indië; Het leven van Maria Dermoût, 1888-1962. Amsterdam: Querido, 2000 (herdurk 2001), 357 pp. -Donald Tuzin, Eric Kline Silverman, Masculinity, motherhood, and mockery; Psychoanalyzing culture and the naven rite in New Guinea. Ann Arbor: University of Michigan Press, 2001, vi + 243 pp. -Alexander Verpoorte, Jet Bakels, Het verbond met de tijger; Visies op mensenetende dieren in Kerinci, Sumatra. Leiden: Research School of Asian, African, and Amerindian Studies (CNWS), 2000, XV + 378 pp. [CNWS Publications 93.] -Sikko Visscher, Twang Peck Yang, The Chinese business elite in Indonesia and the transition to independence, 1940-1950. Kuala Lumpur: Oxford University Press, 1998, xix + 372 pp. -René Vos, Gerard Termorshuizen, Journalisten en heethoofden; Een geschiedenis van de Indisch-Nederlandse dagbladpers, 1744-1905. Amsterdam: Nijgh en Van Ditmar, Leiden: KITLV Uitgeverij, 2001, 862 pp. -Edwin Wieringa, Marijke J. Klokke, Narrative sculpture and literary traditions in South and Southeast Asia. Leiden: Brill, 2000, xiv + 127 pp. [Studies in Asian Art and Archaeology (continuation of: Studies in South Asian Culture) 23.] -Catharina Williams-van Klinken, Mark Donohue, A grammar of Tukang Besi. Berlin: Mouton de Gruyter, 1999, xxvi + 576 pp. [Mouton Grammar Library 20.] -Kees Zandvliet, Thomas Suárez, Early mapping of Southeast Asia. Singapore: Periplus Editions, 1999, 280 pp. -Claudia Zingerli, Bernhard Dahm ,Vietnamese villages in transition; Background and consequences of reform policies in rural Vietnam. Passau: Department of Southeast Asian Studies, University of Passau, 1999, xiv + 224 pp. [Passau Contributions to Southeast Asian Studies 7.], Vincent J.H. Houben (eds)
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KITLV, Redactie. "Book Reviews." Bijdragen tot de taal-, land- en volkenkunde / Journal of the Humanities and Social Sciences of Southeast Asia 160, no. 4 (2004): 563–620. http://dx.doi.org/10.1163/22134379-90003725.
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-Johann Angerler, Achim Sibeth, Vom Kultobjekt zur Massenware; Kulturhistorische und kunstethnologische Studie zur figürlichen Holzschnitzkunst der Batak in Nordsumatra/Indonesien. Herbolzheim: Centaurus, 2003, 416 pp. [Sozialökonomische Prozesse in Asien und Afrika 8.] -Greg Bankoff, Eva-Lotta E. Hedman ,Philippine politics and society in the twentieth century; Colonial legacies, post colonial trajectories. London: Routledge, 2000, xv + 206 pp. [Politics in Asia Series.], John T. Sidel (eds) -Peter Boomgard, Andrew Dalby, Dangerous tastes; The story of spices. London: British Museum Press, 2002, 184 pp. -Max de Bruijn, G.J. Schutte, Het Indisch Sion; De Gereformeerde kerk onder de Verenigde Oost-Indische Compagnie. Hilversum: Verloren, 2002, 254 pp. [Serta Historica 7.] -Laura M. Calkins, Jacqueline Aquino Siapno, Gender, Islam, nationalism and the state in Aceh; The paradox of power, co-optation and resistance. London: RoutledgeCurzon, 2002, xxi + 240 pp. -H.J.M. Claessen, Deryck Scarr, A history of the Pacific islands; Passages through tropical time. Richmond: Curzon, 2001, xviii + 323 pp. -Matthew Isaac Cohen, Sean Williams, The sound of the ancestral ship; Highland music of West Java. Oxford: Oxford University Press, 2001, xii + 276 pp. -Freek Colombijn, Raymond K.H. Chan ,Development in Southeast Asia; Review and prospects. Aldershot: Ashgate, 2002, xx + 265 pp., Kwan Kwok Leung, Raymond M.H. Ngan (eds) -Heidi Dahles, Shinji Yamashita, Bali and beyond; Explorations in the anthropology of tourism. Translated and with an introduction by J.S. Eades, New York: Berghahn, 2003, xix + 175 pp. [Asian Anthropologies.] -Frank Dhont, Hans Antlöv ,Elections in Indonesia; The New Order and beyond. With contributions by Hans Antlöv, Syamsuddin Haris, Endang Turmudi, Sven Cederroth, Kaarlo Voionmaa. London: RoutledgeCurzon, 2004, xii + 164 pp. [Nordic Institute of Asian Studies Monograph Series 88.], Sven Cederroth (eds) -Frank Dhont, Aris Ananta ,Indonesian electoral behaviour; A statistical perspective. Singapore: Institute of Southeast Asian Studies, 2004, xli + 429 pp. [Indonesia's Population Series 2.], Evi Nurvida Arifin, Leo Suryadinata (eds) -Hans Hägerdal, Arnaud Leveau, Le destin des fils du dragon; L'influence de la communauté chinoise au Viêt Nam et en Thaïlande. Paris: L'Harmattan, Bangkok: Institut de Recherche sur l'Asie de Sud Est Contemporaine, 2003, xii + 88 pp. -Han Bing Siong, A.W.H. Massier, Van recht naar hukum; Indonesische juristen en hun taal, 1915-2000. (Privately published), 2003, xiii + 234 pp. [PhD thesis, Leiden University.] -David Hicks, Andrew Berry, Infinite tropics; An Albert Russel Wallace anthology, with a preface by Stephen Jay Gould. London: Verso, 2002, xviii + 430 pp. -Carool Kersten, J. van Goor, Indische avonturen; Opmerkelijke ontmoetingen met een andere wereld. Den Haag: Sdu Uitgevers, 2000, 294 pp. -Lisa Migo, Robert Martin Dumas, 'Teater Abdulmuluk' in Zuid-Sumatra; Op de drempel van een nieuwe tijdperk. Leiden: Onderzoekschool CNWS, School voor Aziatische, Afrikaanse en Amerindische Studies, 2000, 345 pp. -John N. Miksic, Claude Guillot ,Historie de Barus, Sumatra; Le site de Lobu Tua; II; Étude archéologique et documents. Paris: Association Archipel, 2003, 339 pp. [Cahier d'Archipel 30.], Marie-France Dupoizat, Daniel Perret (eds) -Sandra Niessen, Traude Gavin, Iban ritual textiles. Leiden: KITLV Press, 2003, xi + 356 pp. [Verhandelingen 205.] -Frank Okker, Jan Lechner, Uit de verte; Een jeugd in Indië 1927-1946. Met een nawoord van Gerard Termorshuizen. Leiden: KITLV Uitgeverij, 2004, 151 pp. [Boekerij 'Oost en West'.] -Angela Pashia, William D. Wilder, Journeys of the soul; Anthropological studies of death, burial and reburial practices in Borneo. Phillips ME: Borneo Research Council, 2003, vix + 366 pp. [Borneo Research Council Monograph Series 7.] -Jonathan H. Ping, Huub de Jonge ,Transcending borders; Arabs, politics, trade and Islam in Southeast Asia. Leiden: KITLV Press, 2002, viii + 246 pp. [Proceedings 5.], Nico Kaptein (eds) -Anton Ploeg, William C. Clarke, Remembering Papua New Guinea; An eccentric ethnography. Canberra: Pandanus Books, Research School of Pacific and Asian Studies, Australian National University, 2003, 178 pp. -Nathan Porath, Gerco Kroes, Same hair, different hearts; Semai identity in a Malay context; An analysis of ideas and practices concerning health and illness. Leiden: Research School of Asian, African and Amerindian Studies (CNWS), Universiteit Leiden, 2002, 188 pp. -Guido Sprenger, Grant Evans, Laos; Culture and society. Chiang Mai: Silkworm Books, 1999, xi + 313 pp. -Gerard Termorshuizen, Dik van der Meulen, Multatuli; Leven en werk van Eduard Douwes Dekker. Nijmegen: SUN, 2002, 912 pp. -Paige West, Karl Benediktsson, Harvesting development; The construction of fresh food markets in Papua New Guinea. Copenhagen: Nordic Institute of Asian Studies/Ann Arbor: University of Michigan Press, 2002, xii + 308 pp. -Edwin Wieringa, Amirul Hadi, Islam and state in Sumatra; A study of seventeenth-century Aceh. Leiden: Brill, 2004, xiii + 273 pp. [Islamic History and Civilization, 48.] -Robin Wilson, Pamela J. Stewart ,Remaking the world; Myth, mining and ritual change among the Duna of Papua New Guinea. Washington: Smithsonian Institution Press, 2002, xvi + 219 pp. [Smithsonian Series in Ethnographic Enquiry.], Andrew Strathern (eds)
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Vlahaki, Dean, Majed Fiaani, and William Ken Milne. "A door-to-needle time of 30 minutes or less for myocardial infarction thrombolysis is possible in rural emergency departments." CJEM 10, no. 05 (September 2008): 429–33. http://dx.doi.org/10.1017/s1481803500010502.
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ABSTRACTObjective:The Canadian Emergency Cardiac Care Coalition, the American Heart Association and similar groups have established a benchmark for the administration of thrombolytics in acute myocardial infarction (AMI) care as a door-to-needle (DTN) time of 30 minutes or less. Previous research suggests that this goal is not being achieved in Canada. The purpose of this study was to determine whether the target DTN time of 30 minutes or less for thrombolysis could be met in 2 rural Ontario emergency departments (EDs).Methods:We conducted a retrospective chart review and obtained descriptive data for each case, including demographic information and the Canadian Emergency Department Triage and Acuity Scale (CTAS) score. Visit timeline data were also collected and included the time during which patients saw a physician, had an electrocardiogram (ECG), received thrombolytic therapy and were discharged from the ED. Relevant time intervals, such as the median DTN time, were calculated.Results:A total of 454 charts were reviewed for patients with a diagnosis of AMI who were seen between 1996 and 2007. The final sample consisted of 101 patients who received thrombolytics (63% men) whose median age was 67 years and median CTAS score was Level II (Emergent). The median door-to-ECG time was 6 minutes, door-to-physician time was 8 minutes and DTN time was 27 minutes; 58% of patients received thrombolytics within 30 minutes.Conclusion:A DTN time of 30 minutes or less is achievable in rural EDs.
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Choi, Kyungseon, Sola Han, and Hae Sun Suh. "Emergency department visits and hospitalisations for emergent asthmatic symptoms from 2014 to 2016: cross-sectional study in Korea." BMJ Open 10, no. 8 (August 2020): e036237. http://dx.doi.org/10.1136/bmjopen-2019-036237.
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ObjectiveTo evaluate the characteristics of emergent patients with asthma who visited emergency departments (EDs) in Korea, and the consequences of these visits.DesignRetrospective cross-sectional study.SettingWe used data from the National Emergency Department Information System database from 2014 to 2016. The data included reports collected from 408 EDs in Korea.ParticipantsWe analysed the ED cases for asthma-related emergent symptoms that met the following inclusion criteria: (1) had a main diagnosis code of asthma (International Classification of Diseases 10th Revision code: J45/J46), and (2) recorded as an emergent symptom in the EDs.ResultsDuring 2014–2016, there were 58 713 ED visits related to an asthma diagnosis with emergent symptoms. Following an ED visit, 31.69% were hospitalised, of which 89.88% were admitted to the general wards, and 10.12% to the intensive care units (ICUs). More than 50% of the hospitalised cases included in the group ≥70 years of age. The incidence of death during hospitalisation generally increased with age and the proportion of death in ICU exceeded 10% among the group ≥70 years. The ratio of ICU/general ward admission at the arrival time of 0–03:00, in the ≥60 years age group was the highest compared with other times of the day and age groups.ConclusionsWe found that among all age groups, ED visits by older patients resulted in more ICU admissions. Our results can help in providing a better understanding of medical resource utilisation by emergent patients with asthma.
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Nunn, J., C. Cassidy, D. Chiasson, S. MacPhee, and J. Curran. "P094: Meeting patient expectations in the emergency department: preliminary findings from the preparing emergency patients and providers study." CJEM 19, S1 (May 2017): S110. http://dx.doi.org/10.1017/cem.2017.296.
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Introduction: Effective communication to develop a shared understanding of patient expectations is critical in establishing a positive medical encounter in the emergency department (ED). However, there is limited research examining patient/caregiver expectations in the ED, and their impact on the beliefs, attitudes and behaviours during and after an ED visit. The objective of this study is to examine patient/caregiver expectations and satisfaction with care in the ED using a patient expectation questionnaire and a follow up survey. Methods: As a part of a larger 3-phase study on patient/caregiver expectations in adult and pediatric EDs, a 7-item, paper-based questionnaire was distributed to all patients and/or caregivers who presented to one of four EDs in Nova Scotia with a Canadian Triage and Acuity Scale (CTAS) score of 2 to 5. A follow-up survey was distributed to all willing participants via email to determine their satisfaction with care received in ED. Descriptive statistics were used to analyze responses. Results: Phase 1 was conducted from January to September 2016. In total, 24,788 expectation questionnaires were distributed to ED patients/caregivers, 11,571 were collected (47% response rate), and 509 patients were contacted for a follow-up survey. Preliminary analysis of 4,533 questionnaires shows the majority of patients (67.1%) made the decision by themselves to present to the ED, while others were advised by a family/friend (22%). Respondents were most worried about an injury (17.8%) followed by illness (15.6%) and expected to talk to a physician (69.9%) and receive an x-ray (39.3%). The majority of physicians (53.3%) reported the expectation tool helped in caring for the patient and 87.5% felt they met patient expectations. There were 147 patient/caregiver responses to a follow-up survey (29% response rate) and 87.1% of responders reported that ED clinicians met their expectations. Conclusion: Patient/caregivers have a variety of concerns, questions, and expectations when presenting to the ED. Obtaining expectations early in the patient encounter may provide opportunities for improved communication between clinicians and patients while enhancing satisfaction with care received. Further analysis is needed to determine the impact of the expectation questionnaire on productivity in the ED.
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Inayet, N., J. O. Hayat, A. Kaul, M. Tome, A. Child, and A. Poullis. "Gastrointestinal Symptoms in Marfan Syndrome and Hypermobile Ehlers-Danlos Syndrome." Gastroenterology Research and Practice 2018 (July 29, 2018): 1–8. http://dx.doi.org/10.1155/2018/4854701.
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Objective. Marfan syndrome (MS) is a multisystem disorder caused by a mutation in FBN1 gene. It shares some phenotypic features with hypermobile Ehlers-Danlos syndrome (EDS) such as joint hypermobility. EDS is a group of inherited heterogenous multisystem disorders characterized by skin hyperextensibility, atrophic scarring, joint hypermobility, and generalized tissue fragility. Hypermobile EDS (hEDS) is thought to be the most common type. Recent studies have suggested an association between connective tissue hypermobility and functional gastrointestinal disorders (FGDs). The aim of this study is to determine the prevalence of gastrointestinal symptoms in patients with Marfan syndrome and hypermobile EDS. Method. Patients with a diagnosis of either MS or hEDS attending cardiology or rheumatology outpatients at our hospital were asked to complete SF36 RAND and Rome IV Diagnostic questionnaires. Questionnaires were also completed by patients who are members of Marfan Association UK. The same questionnaires were also completed by age- and gender-matched controls attending fracture clinic without existing diagnoses of MS or hEDS. Results. Data were collected from 45 MS patients (12 males and 33 females, age range 19–41 years, mean 28 years) and 45 hEDS patients (6 males and 39 females, age range 18–32 years, mean 24 years). None had a previous organic gastrointestinal diagnosis. The control group was matched for age and sex (18 males and 72 females, age range 18–45, mean 29 years). Both MS and hEDS groups showed a higher prevalence of abdominal symptoms compared to the control group; however, the hEDS group not only showed a higher prevalence but more frequent and severe symptoms meeting Rome IV criteria for diagnosis of FGIDs. Nearly half of the hEDS patients met the criteria for more than one FGID. The hEDS group also scored lower on quality of life (QOL) scores in comparison to either of the other groups with a mean score of 48.6 as compared to 54.2 in the Marfan group and 78.6 in the control group. Conclusion. FGIDs are reported in both Marfan syndrome and hypermobile Ehlers-Danlos syndrome but appear to be more common and severe in hEDS. These patients score lower on quality of life scores as well despite hypermobility being a common feature of both conditions. Further work is needed to understand the impact of connective tissue disorders on gastrointestinal symptoms.
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O’Gorman, C., A. Jones, M. J. Thorpy, and H. Tabuteau. "0739 Efficacy and Safety of AXS-12 in the Treatment of Narcolepsy: Results from a Phase 2, Double-Blind, Placebo-Controlled, Crossover Trial." Sleep 43, Supplement_1 (April 2020): A281. http://dx.doi.org/10.1093/sleep/zsaa056.735.
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Abstract Introduction Narcolepsy is a chronic, debilitating, neurological disease characterized by excessive daytime sleepiness (EDS), cataplexy, and sleep-wake dysregulation. Existing treatments are limited, provide variable efficacy, and have significant tolerability issues. AXS-12 (reboxetine) is a potent, and highly selective norepinephrine reuptake inhibitor with potential for therapeutic differentiation in narcolepsy. Methods The CONCERT study was a Phase 2, double-blind, randomized, placebo-controlled, crossover trial of AXS-12 in narcolepsy subjects exhibiting moderate and severe symptoms of cataplexy and EDS. Subjects were randomized (1:1) to treatment with AXS-12 followed by placebo, or placebo followed by AXS-12. AXS-12 dosing was 8mg/day for week 1, escalated to 10mg/day for week 2. Crossover occurred after a one-week down-titration/washout. The primary endpoint was the change in weekly cataplexy attacks from baseline, averaged over the 2-week treatment period for overall treatment effect. Secondary endpoints included improvements in EDS, cognitive function, sleep quality and sleep-related symptoms. Results Twenty-one subjects were randomized. The baseline mean weekly number of cataplexy attacks was 30.0 and mean ESS score was 18.1, reflecting moderate and severe illness on both core symptoms. AXS-12 met the prespecified primary endpoint, demonstrating a statistically significantly greater reduction in the mean number of weekly cataplexy attacks (-13.0 with AXS-12 vs -0.3 with placebo; p<0.001) over 2 weeks of treatment. Statistically significant reductions in EDS were observed for AXS-12 compared to placebo, assessed by changes in the Epworth Sleepiness Scale (-6.0 vs -3.1; p=0.003), number of weekly inadvertent naps (-5.88 vs -0.98; p<0.001). AXS-12 was associated with improved cognitive function (p<0.002) and sleep quality (p<0.007), and reduced night awakenings (p<0.05). Rapidity of effect was observed with significant symptomatic improvements occurring as early as week 1 starting at the lower 8mg dose. AXS-12 was safe and well-tolerated with no serious adverse events or discontinuations due to adverse events. Conclusion AXS-12 is a novel approach for the treatment of narcolepsy with the potential for comprehensive clinical symptom management compared to current treatments. In this Phase 2 study, AXS-12 resulted in statistically significant improvements in cataplexy, excessive sleepiness, cognitive function and night awakenings in patients with narcolepsy with a favorable safety profile. Support Axsome Therapeutics.
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Dugas, Andrea F., Yu-Hsiang Hsieh, Frank LoVecchio, Gregory J. Moran, Mark T. Steele, David A. Talan, Richard E. Rothman, et al. "Derivation and Validation of a Clinical Decision Guideline for Influenza Testing in 4 US Emergency Departments." Clinical Infectious Diseases 70, no. 1 (May 21, 2019): 49–58. http://dx.doi.org/10.1093/cid/ciz171.
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Abstract Background An accurate diagnosis of influenza is essential for appropriate antiviral treatment, in accordance with Centers for Disease Control and Prevention (CDC) guidelines. However, no clear guidance exists on which patients should be tested. We sought to develop a clinical decision guideline (CDG) to inform influenza testing decisions for those adult emergency department (ED) patients deemed appropriate for antiviral treatment by CDC guidelines. Methods A prospective cohort study was performed at 4 US EDs. From November 2013 to April 2014, we enrolled adult ED patients with fever or respiratory symptoms who met criteria for antiviral treatment, per 2013 CDC guidelines. All patients were tested for influenza using polymerase chain reaction. Data were randomly split into derivation (80%) and validation (20%) data sets. A discrete set of independent variables was selected by logistic regression, using the derivation set to create a scoring system, with a target sensitivity of at least 90%. The derived CDG was then validated. Results Of 1941 enrolled participants, 183 (9.4%) had influenza. The derived CDG included new or increased cough (2 points), headache (1 point), subjective fever (1 point), and triage temperature >100.4°C (1 point), with a score of ≥3 indicating influenza testing was warranted. The CDG had a sensitivity and specificity of 94.1% and 36.6%, respectively, in the derivation set and of 91.5% and 34.6%, respectively, in the validation set. Conclusions A CDG with high sensitivity was derived and validated. Incorporation into practice could standardize testing for high-risk patients in adult EDs during influenza seasons, potentially improving diagnoses and treatment. Clinical Trial Registration NCT01947049.
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Sample, S., D. Quinlan, K. Willis, D. Casement, K. Lutz-Graul, and M. Welsford. "P036: Sensitivity and false negatives in the use of a prehospital sepsis alert." CJEM 22, S1 (May 2020): S77. http://dx.doi.org/10.1017/cem.2020.243.
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Introduction: Prehospital sepsis alerts assist paramedics in identifying patients with sepsis and in communicating this diagnosis to receiving facilities. Following the prospective implementation study of our regional systemic inflammatory response syndrome-based alert criteria (Alert), the purpose of this sub-study was to determine the cause of Alert false negatives (patients without an Alert that subsequently met sepsis criteria in the Emergency Department (ED)). Additionally, the sensitivity of the Alert for detecting sepsis was compared to the Quick Sequential Organ Failure Assessment (qSOFA) and Hamilton Early Warning Score (HEWS). Methods: This study was an additional analysis of the prospective Alert implementation study. Included patients were ≥ 18 years old, transported by a regional Emergency Medical Service and met severe sepsis or septic shock criteria (SS/SS, 2012 Surviving Sepsis Guidelines) in regional EDs in 2013. False negative patients were identified prospectively and reviewed by comparing paramedic determined Alert status to the retrospective application of the Alert criteria to Paramedic Call Report (PCR) data. The Alert sensitivity was first calculated from prospective data, then retrospective sensitivities of the Alert, qSOFA and HEWS were calculated by retrospectively applying these tools to PCRs, using ED diagnosis of SS/SS as reference standard. Results: In 2013, 229 patients met SS/SS criteria in the ED and had PCRs available; 115 (50.2%) were male and median age [interquartile range] was 76.0 [63.0-84.0]. Of 229, 149 (65.0%) arrived in the ED without an Alert (false negatives) and 46 (30.9%) of these met Alert criteria retrospectively and were therefore missed by paramedics. Sensitivity of the Alert was 34.9% when applied by paramedics and 41.5% when applied retrospectively to PCRs. The retrospective sensitivities of the qSOFA and HEWS were 37.6% and 67.7%, respectively. Conclusion: In ED patients diagnosed with SS/SS who arrived with no Alert, the majority (69.1%) were missed by the Alert criteria, rather than by paramedic application of the tool. The Alert had a sensitivity of 34.9%. When applied retrospectively and compared to the Alert, qSOFA had similar sensitivity and HEWS had increased sensitivity. Future research should focus on deriving improved alerts or implementing those with higher accuracy, such as HEWS.
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Liu, Yu Qi, Yue Bin Feng, Xin Ying Wang, Jing Wang, and Xiao Jun Xu. "Treatment Mechanisms and Operation Conditions of Arsenic Removal from Copper Smelting Effluent Using Combined Process of Aeration Micro-Electrolysis and Flocculation." Advanced Materials Research 610-613 (December 2012): 2307–18. http://dx.doi.org/10.4028/www.scientific.net/amr.610-613.2307.
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An effective combined process of aeration micro-electrolysis and flocculation was utilized to treat arsenic that incoming contaminate level was 153 mgL-1 from the metallurgical effluent. Treatment mechanisms and operation conditions were discussed which influenced the removal efficiency of arsenic. Under the optimal technological conditions, it was found that the removal efficiencies of COD and As were 92.5% and 99.7% respectively. The remain arsenic concentration in the treated wastewater was only 0.43mgL-1 and met National Wastewater Discharge Standard(GB8978-1996) in China. Analysis by SEM and EDS revealed that using combined process, most of As(III) could be oxidized to As(V), which led to the high efficiency of arsenic removal. In the meantime, most of other heavy metals, such as Cu, Pb and Ni, had been removed. Therefore, the combined process is regarded as a promising technology in the treatment of arsenic from copper smelting effluent. It has bright future in application.
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Ding, Wen Feng, Jiu Hua Xu, J. L. Huang, Z. Z. Chen, H. H. Su, and Y. C. Fu. "Preparation and Characterization of Self-Lubrication CBN Grinding Wheel Containing Graphite as Lubricant." Advanced Materials Research 325 (August 2011): 85–90. http://dx.doi.org/10.4028/www.scientific.net/amr.325.85.
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Self-lubrication CBN abrasive composite blocks and corresponding grinding wheels were made through the sintering process of CBN grains, graphite particles and Cu-Sn-Ti alloy at 920° for 30 min. The mechanical strength of the composite blocks was measured by means of the three-point bending experiments. Scanning electron microscope (SEM), energy dispersive spectrometer (EDS) and X-ray diffraction (XRD) were employed to characterize the fracture morphology and the interfacial microstructure of the composite blocks. Dressing experiments were carried out and the graphite film on the CBN grain surface was observed. The results obtained show that the bending strength of the composite blocks with 5 wt.% graphite particles reached 116 MPa, which met the mechanical requirements of the working layer of the grinding wheels. Chemical joining has taken place at the interface of CBN/Cu-Sn-Ti and graphite/Cu-Sn-Ti during the sintering process. Graphite film has been formed and spread to the grain surface after dressing.
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Gabriëls, A. J. C. M. "A.M.J.A. Berkvens, J. Hallebeek en A.J.B. Sirks (eds.), Het Franse Nederland: de inlijving 1810-1813. De juridische en bestuurlijke gevolgen van de ‘Réunion’ met Frankrijk." BMGN - Low Countries Historical Review 128, no. 2 (June 21, 2013): 40. http://dx.doi.org/10.18352/bmgn-lchr.8432.
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Delany, Catherine, Julia Crilly, and Jamie Ranse. "Drug and Alcohol Related Patient Presentations to Emergency Departments during Sporting Mass-Gathering Events: An Integrative Review." Prehospital and Disaster Medicine 35, no. 3 (March 25, 2020): 298–304. http://dx.doi.org/10.1017/s1049023x20000357.
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AbstractBackground:Drug and alcohol consumption at sporting mass-gathering events (MGEs) has become part of the spectator culture in some countries. The direct and indirect effects of drug and alcohol intoxication at such MGEs has proven problematic to in-event health services as well as local emergency departments (EDs). With EDs already under significant strain from increasing patient presentations, resulting in access block, it is important to understand the impact of sporting and other MGEs on local health services to better inform future planning and provision of health care delivery.Aim:The aim of this review was to explore the impact of sporting MGEs on local health services with a particular focus on drug and alcohol related presentations.Method:A well-established integrative literature review methodology was undertaken. Six electronic databases and the Prehospital and Disaster Medicine (PDM) journal were searched to identify primary articles related to the aim of the review. Articles were included if published in English, from January 2008 through July 2019, and focused on a sporting MGE, mass-gathering health, EDs, as well as drug and alcohol related presentations.Results:Seven papers met the criteria for inclusion with eight individual sporting MGEs reported. The patient presentation rate (PPR) to in-event health services ranged from 0.18/1,000 at a rugby game to 41.9/1,000 at a recreational bicycle ride. The transport to hospital rate (TTHR) ranged from 0.02/1,000 to 19/1,000 at the same events. Drug and alcohol related presentations from sporting MGEs contributed up to 10% of ED presentations. Alcohol was a contributing factor in up to 25% of cases of ambulance transfers.Conclusions:Drug and alcohol intoxication has varying levels of impact on PPR, TTHR, and ED presentation numbers depending on the type of sporting MGE. More research is needed to understand if drug and alcohol intoxication alone influences PPR, TTHR, and ED presentations or if it is multifactorial. Inconsistent data collection and reporting methods make it challenging to compare different sporting MGEs and propose generalizations. It is imperative that future studies adopt more consistent methods and report drug and alcohol data to better inform resource allocation and care provision.
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Islam, A., K. Koger, S. VandenBerg, D. Wang, and E. Lang. "P081: The summer of the e-scooter: a multicenter evaluation of the emergency department impact of rentable motorized scooters in Calgary." CJEM 22, S1 (May 2020): S93. http://dx.doi.org/10.1017/cem.2020.287.
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Introduction: Calgary's introduction of rentable electronic scooters (e-scooters) in July of 2019 was met with wild popularity, representing the third most popular launch after Tel-Aviv and Paris. The present study aims to characterize the injury burden seen in all Calgary Emergency Departments (EDs) and Urgent Care Centres (UCCs) attributable to e-scooters since their 2019 introduction. Methods: We retrospectively reviewed all electronic medical records of patients presenting to Calgary EDs or UCCs with the term “scooter” in the triage note, where exclusion criteria are considered for non e-scooter injuries (e.g: non-motorized scooters). Trends in scooter injuries will be compared between April - October 2018 (control arm preceding e-scooter introduction) and April - October 2019. Injury incidence, types, patient demographics, and relative risk compared to bicycle-related injuries will be determined. Descriptive statistics will be calculated. Moreover, 33 ED visits were brought in by EMS and provide information about injury types and locations of injuries involving EMS transport. Results: Preliminary data reveals 540 scooter-related visits (3.10% admitted/transferred) between July 8th and September 30th 2019 (mean age of 28, 56.30% male). Conversely, the number of bicycle-related visits and motor vehicle related injuries were 1482 and 586 (9.90% and 9.70% admitted/transferred) respectively over the same time period suggesting a greater burden but likely a lower per-ride incidence of injury requiring ED or UCC care. Moreover, between July 8th to October 1st 2019, 33 e-scooter presentations involved EMS (21.21% admitted to hospital), where 12.12% involved upper extremity injury, 21.21% were lower extremity injuries, and 6.06% were head injuries (mean age of 34, 48.48% male). Conversely, estimated EMS transfers to EDs or UCCs for bicycle injuries and motor vehicle injuries were 197 and 463 respectively over the same time period. ICU admissions or fatality were not recorded. Conclusion: Representing the most comprehensive study of e-scooter injury patterns in Canada to date, we here demonstrate a significant injury burden attributable to e-scooters following their introduction in Calgary in 2019. Bicycle-related and motor vehicle injuries were both more prevalent in this time period, and required more EMS visits. Further characterization of injury types, injuries and comparison with injury patterns prior to e-scooter introduction is yet to be determined.
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Robinson, P., K. Sharanowski, N. Lalani, S. Harenberg, and K. Lyster. "P109: Identifying patients who may benefit from extracorporeal membrane oxygenation (ECMO) after cardiac arrest in the urban emergency departments of Saskatchewan." CJEM 18, S1 (May 2016): S114—S115. http://dx.doi.org/10.1017/cem.2016.284.
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Introduction: Emergency physician-initiated Extracorporeal Membrane Oxygenation (ECMO/ECPR/ECLS) is gaining critical mass as a successful rescue strategy for patients requiring resuscitation. Wang et al. (2014), Bellezzo et al. (2012) and others have demonstrated promising results of survival to discharge with good neurological function in patients who were resistant to existing treatment protocols after out-of-hospital cardiac arrest. As Saskatchewan does not yet utilize ECMO for cardiac arrest, the objective of this study was to examine the number of adult cardiac arrest patients in the urban emergency departments (EDs) of Saskatchewan who may benefit from the use of ECMO. Methods: Using a retrospective review, we identified 401 patients who died after presenting with cardiac arrest between January 1st, 2013 and December 31st, 2014. Of the original 401, 136 were female and 264 were male, with a mean age of 60.1±20.2 years. The charts of 22 (5.5%) trauma patients were excluded because the suitability of ECMO in these patients is uncertain. Results: For the 379 non-trauma patients, the mean resuscitation length was 41.6±32.8 minutes (median=42 minutes) and 125 of these patients received prehospital mechanical CPR. We applied Bellezzo et al.’s (2012) inclusion and exclusion criteria to identify prospective candidates for ECMO. In total, 53 patients (14.0%) with a mean age of 57.1±13.4 years old, represent suitable candidates for ECMO. 260 (68.6%) were deemed unsuitable either because they failed the inclusion criteria or met explicit exclusion criteria. The remainder (66 [17.4%]) were unsuitable because of age. Conclusion: With 1 in 7 patients potentially representing suitable candidates for ECMO, this is a technique that warrants consideration for implementation in the EDs of Saskatchewan.
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KITLV, Redactie. "Book reviews." Bijdragen tot de taal-, land- en volkenkunde / Journal of the Humanities and Social Sciences of Southeast Asia 166, no. 1 (2010): 107–83. http://dx.doi.org/10.1163/22134379-90003627.
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Syed Muhd Khairudin Aljunied, Rethinking Raffles; A study of Stamford Raffles’ discourse on religions amongst Malays. (Nathan Porath) Walter Angst, Wayang Indonesia; Die phantastische Welt des indonesischen Figurentheaters/The fantastic world of Indonesian puppet theatre. (Dick van der Meij) Adrienne Kappler and others, James Cook and the exploration of the Pacific. (H.J.M. Claesen) Aurel Croissant, Beate Martin and Sascha Kneip (eds), The politics of death; Political violence in Southeast Asia. (Freek Colombijn) Frank Dhont, Kevin W. Fogg and Mason C. Hoadley (eds), Towards an inclusive democratic Indonesian society; Bridging the gap between state uniformity and multicultural identity patterns. (Alexander Claver) Bronwen Douglas and Chris Ballard (eds), Foreign bodies; Oceania and the science of race, 1750-1940. (H.J.M. Claesen) Ricky Ganang, Jay Crain, and Vicki Pearson-Rounds, Kemaloh Lundayeh-English dictionary and bibliographic list of materials relating to the Lundayeh-Lun Bawang-Kelabit and related groups of Sarawak, Sabah, Brunei and East Kalimantan. (Michael Boutin) Jeffrey Hadler, Muslims and matriarchs; Cultural resilience in Indonesia through Jihad and Colonialism. (Franz von Benda-Beckmann) Uli Kozok, Kitab undang-undang Tanjung Tanah: Naskah Melayu yang tertua. (Arlo Griffiths) Alfonds van der Kraan, Murder and mayhem in seventeenth-century Cambodia; Anthony van Diemen vs. King Ramadhipati I. (Jeroen Rikkerink) Jean Michaud, ‘Incidental’ ethnographers; French Catholic missions on the Tonkin-Yunnan frontier, 1880-1930. (Nicholas Tapp) M.C. Ricklefs, Polarising Javanese society; Islamic and other visions (c. 1830-1930). (Matthew Isaac Cohen) Stuart Robson, Arjunawiwāha; The marriage of Arjuna of Mpu Kaṇwa. (Andrea Acri) László Székely and István Radnai, Dit altijd alleen zijn; Verhalen over het leven van planters en koelies in Deli (1914-1930). (Adrienne Zuiderweg) Patricia Tjiook-Liem (Giok Kiauw Nio Liem), De rechtspositie der Chinezen in Nederlands-Indië 1848-1942; Wetgevingsbeleid tussen beginsel en belang. (Mary Somers Heidhues) Zhou Daguan, A record of Cambodia: the land and its people. (Un Leang) REVIEW ESSAY Longitudinal studies in Javanese performing arts Benjamin Brinner, Music in Central Java; Experiencing music, expressing culture. Barbara Hatley, Javanese performances on an Indonesian stage; Contesting culture, embracing change. Felicia Hughes-Freeland, Embodied communities; Dance traditions and change in Java. (Matthew Isaac Cohen) REVIEW ESSAY Development and reform in Vietnam Stéphanie Balme and Mark Stephanie (eds), Vietnam’s new order; International perspectives on the state and reform in Vietnam. Sujian Guo, The political economy of Asian transition from communism. Ian Jeffries, Vietnam: a guide to economic and political developments. Pietro Masina, Vietnam’s development strategies. (Tran Quang Anh) KORTE SIGNALERINGEN Ulbe Bosma, Indiëgangers; Verhalen van Nederlanders die naar Indië trokken. Clara Brinkgreve, Met Indië verbonden; Een verhaal van vier generaties 1849-1949. Jack Botermans en Heleen Tichler, Het vergeten Indië; Stille getuigen van het dagelijks leven in het Indië van toen. Robin te Slaa en Edwin Klijn, De NSB; Ontstaan en opkomst van de Nationaal-Socialistische Beweging, 1931-1935. Mark Loderichs, Margaret Leidelmeijer, Johan van Langen en Jan Kompagnie, Verhalen in Documenten; Over het afscheid van Indië, 1940-1950. Frederik Erens en Adrienne Zuiderweg, Linggadjati, brug naar de toekomst; Soetan Sjahrir als een van de grondleggers van het vrije Indonesië. Peter Schumacher, met medewerking van Gerard de Boer, De zaak Aernout; Hardnekkige mythes rond een Indische moord ontrafeld. Cas Oorthuys, Een staat in wording; Fotoreportage van Cas Oorthuys over het Indonesië van 1947. René Kok, Erik Somers en Louis Zweers, Koloniale oorlog 1945-1949; Van Indië tot Indonesië. H.F. Veenendaal en J.P.W. Kelder, ZKH; Hoog spel aan het hof van Zijne Koninklijke Hoogheid; De geheime dagboeken van mr.dr.L.G. van Maasdijk. Ons Indië; 400 jaar Nederlandse sporen in Insulinde, de strijd om de onafhankelijkheid & 60 jaar Indonesië. (Harry A. Poeze)
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Gao, L. H., Z. G. Liu, and M. S. Chu. "Smelting separation behaviors and mechanisms of high-alumina rich-manganese ore obtained from metallic reduction and magnetic separation." Journal of Mining and Metallurgy, Section B: Metallurgy 55, no. 3 (2019): 331–42. http://dx.doi.org/10.2298/jmmb181217040g.
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In this paper the smelting separation of high-alumina rich-manganese ore prepared with selective reduction and magnetic separation was proposed to produce the high carbon ferromanganese alloy (HCFeMn). The rational smelting separation parameters for high-alumina rich-manganese ore included the FC/O of 1.1, the smelting temperature of 1550?C, the smelting time of 60 min, and the basicity of 0.7. The smelting separation of high-alumina rich-manganese ore was achieved successfully. The content of Fe, C, Si and other impurities (P, S) were 12.13%, 6.73%, 0.17% and 0.14, 0.008, respectively. Especially, the recovery and the content of Mn reached 80.47% and 76.76%. The obtained high carbon ferromanganese alloy met the higher standard (FeMn78C8) of ferromanganese alloy, especially the content of Si P and S in the HCFeMn alloy was far below the standard value. Based on the SEM-EDS, XRD and thermodynamic calculation, the smelting and separation mechanisms of high-alumina rich-manganese ore was proposed to more effectively explain the effect of smelting parameters on slag/metal separation behaviors during the process of smelting HCFeMn alloys.
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Pichard-Jolicoeur, A., M. Mbakop-Nguebou, Joyce Dogba, J. Labrie, F. K. Tounkara, and R. Fleet. "P104: Literature review of telemedicine for trauma patients in rural areas." CJEM 18, S1 (May 2016): S113. http://dx.doi.org/10.1017/cem.2016.280.
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Introduction: Trauma is the leading cause of death among people under 40. With more than 7 million Canadians living over one hour’s travel from a level 1 or 2 trauma center, access to quality trauma care in Canada is a major concern. We recently reported that more than 40% of rural EDs across Canada were more than 300 km from levels 1 and 2 trauma centers. Direct transportation to trauma centers is therefore unusual and most trauma cases are initially managed in rural EDs. Assistance from trauma centers via telemedicine could thus be valuable in optimizing initial stabilization and inter-facility transfers. Objective: Is telemedicine a potentially effective intervention for improving rural trauma care? Methods: We conducted a literature review to examine the potential impact (number of transfers, transfer times, length of hospital stays and mortality) of telemedicine on rural trauma care. Two reviewers independently searched PubMed, Embase and Cochrane databases with key words / concept combinations: telemedicine, trauma and rural. Articles included in the final review had to address the question with specific methodologies. After duplicate removal, 312 articles were found relevant. After independent review of titles and abstracts, only 25 articles pertained to the specific question. Only three studies met inclusion criteria. Results: These studies reported 187 successful teleconsultations in the context of rural trauma care, 29 of which involved significant interventions (8 interventions potentially lifesaving). Some unnecessary inter-facility transfers were avoided. However, transfer times to trauma centers and length of hospital stays appeared slightly longer with telemedicine. Conclusion: The literature on the efficacy of telemedicine in trauma care is scarce, with only three studies addressing the question. Conclusions generally favor telemedicine, but additional research must should determine its impact and better understand the barriers/facilitators to the implementation of telemedicine for rural trauma care.
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McColl, Tamara, Mathieu Gatien, Lisa Calder, Krishan Yadav, Ryan Tam, Melody Ong, Monica Taljaard, and Ian Stiell. "Implementation of an Emergency Department Sepsis Bundle and System Redesign: A Process Improvement Initiative." CJEM 19, no. 2 (September 9, 2016): 112–21. http://dx.doi.org/10.1017/cem.2016.351.
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AbstractBackgroundIn 2008–2009, the Canadian Institute for Health Information reported over 30,000 cases of sepsis hospitalizations in Canada, an increase of almost 4,000 from 2005. Mortality rates from severe sepsis and septic shock continue to remain greater than 30% in Canada and are significantly higher than other critical conditions treated in the emergency department (ED). Our group formed a multidisciplinary sepsis committee, conducted an ED process of care analysis, and developed a quality improvement protocol. The objective of this study was to evaluate the effects of this sepsis management bundle on patient mortality.MethodsThis before and after study was conducted in two large Canadian tertiary care EDs and included adult patients with suspected severe infection that met at least two systemic inflammatory response syndrome (SIRS) criteria. We studied the implementation of a sepsis bundle including triage flagging, RN medical directive, education campaign, and a modified sepsis protocol. The primary outcomes were 30-day all-cause mortality and sepsis protocol use.ResultsWe included a total of 167 and 185 patients in the pre- and post-intervention analysis, respectively. Compared to the pre-intervention group, mortality was significantly lower in the post-intervention group (30.7% versus 17.3%; absolute difference, 13.4%; 95% CI 9.8–17.0; p=0.006). There was also a higher rate of sepsis protocol use in the post-intervention group (20.3% versus 80.5%, absolute difference 60.2%; 95% CI 55.1–65.3; p<0.001). Additionally, we found shorter time-intervals from triage to MD assessment, fluid resuscitation, and antibiotic administration as well as lower rates of vasopressor requirements and ICU admission.InterpretationThe implementation of our multidisciplinary ED sepsis bundle, including improved early identification and protocolized medical care, was associated with improved time to achieve key therapeutic interventions and a reduction in 30-day mortality. Similar low-cost initiatives could be implemented in other EDs to potentially improve outcomes for this high-risk group of patients.
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Deiana, V., E. Diana, F. Pinna, M. G. Atzeni, F. Medda, D. Manca, E. Mascia, et al. "Clinical features in insulin-treated diabetes with comorbid diabulimia, disordered eating behaviors and eating disorders." European Psychiatry 33, S1 (March 2016): S81. http://dx.doi.org/10.1016/j.eurpsy.2016.01.029.
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Adherence to self-management and medication regimens is required to achieve blood glucose control in diabetic patients. Therefore, diabulimia, the deliberate insulin restriction/omission to lose weight, and other disordered eating behaviors (DEBs) or eating disorders (EDs), place these patients at risk of complications.We aimed to establish the frequency of diabulimia, DEBs and EDs among patients with type 1 and 2 diabetes (T1DM and T2DM) and their association with other clinical features.A total of 211 insulin-treated diabetic patients (13–55 years old) answered the Diabetes Eating Problem Survey-Revised (DEPS-R), a diabetes-specific screening tool for DEBs, and the Eating Disorders Inventory-3 (EDI-3). SCID-I modified according to DSM-5 criteria was used to diagnose EDs.At the DEPS-R, 20.8% of the sample scored above the cutoff, more frequently females (P = 0.005), patients with T1DM (P = 0.045), with a diagnosis of ED (P < 0.001), positive to the EDI-3 (P ≤ 0.001), with physical comorbidities (P = 0.003), with HbA1c > 7% (P = 0.020). Combining data from the interview with the results at the DEPS-R, 60.2% of the sample presented diabulimia. Dividing the sample by gender, we found that diabulimic females more frequently used diet pills (P = 0.006), had significantly higher HbA1c (P = 0.019) and STAI-Y1 scores (P = 0.004). Other DEBs comprised dietary restraint (51.8% of the sample), binge eating (42.2%), vomiting (6.2%), diet pills (7.1%) or laxatives (1.9%) or diuretics use (4.3%). Overall, 21.8% of the sample, mostly females (P < 0.001) met criteria for at least one DSM-5 diagnosis of ED.Diabetic patients, especially women, should be carefully monitored for the presence of diabulimia, BEDs and EDs.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Nunn, J., D. Chiasson, C. Cassidy, S. MacPhee, B. Rose-Davis, and J. Curran. "P095: Preparing emergency patients and providers study: Clinician and patient satisfaction with communication tool." CJEM 21, S1 (May 2019): S98. http://dx.doi.org/10.1017/cem.2019.286.
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Introduction: Effective communication to develop a shared understanding of patient/caregiver (P/C) expectations is critical during emergency department (ED) encounters. However, there is limited research examining the use of communication tools of P/C expectations to improve communication in the ED. The objective of this study was to examine satisfaction with a patient expectations questionnaire, known as the PrEPP tool, and its impact on communication and management of patients in the ED. Methods: The PrEPP tool collected P/C expectations over 3 phases of the study. In phase1, the PrEPP tool was distributed to all P/Cs (CTAS score of 2 to 5) in four EDs in Nova Scotia. In phase 2 the PrEPP tool was refined to a 5-item questionnaire. In phase 3 the PrEPP tool was re-implemented over a six-month period. Follow-up surveys were distributed to P/Cs via email (phase 1, 3) and HCPs on iPads in the ED (phase 3) to determine the impact of the tool on communication and management of patients. Entries were compiled on a REDCap database and descriptive statistics were used to analyze responses related to satisfaction.The PrEPP tool collected P/C expectations over 3 phases of the study. In phase1, the PrEPP tool was distributed to all P/Cs (CTAS score of 2 to 5) in four EDs in Nova Scotia. In phase 2 the PrEPP tool was refined to a 5-item questionnaire. In phase 3 the PrEPP tool was re-implemented over a six-month period. Follow-up surveys were distributed to P/Cs via email (phase 1, 3) and HCPs on iPads in the ED (phase 3) to determine the impact of the tool on communication and management of patients. Entries were compiled on a REDCap database and descriptive statistics were used to analyze responses related to satisfaction. Results: In Phase 1, 11418 PrEPP tools and 147 surveys (29% response rate) were collected from January-June 2016. The majority of P/Cs found the PrEPP questionnaire easy to complete (95.9%) and felt HCPs met their expectations (87.1%). In Phase 3, 951 P/C (31.1% response rate) and 128 HCP surveys were collected. Of P/C respondents 45.9% felt PrEPP helped to communicate expectations, while 49.7% said that they would like to use it on future ED visits. The majority of P/C respondents (75.4%) indicated their expectations were met during their visit to the ED. Of those whose expectations were not met, 69% felt their expectations were not discussed. The majority of HCP respondents (90.4%) indicated they used the PrEPP tool at least sometimes. Also, 78.4% said it influenced patient communication and 42% indicated the tool influenced management of patients at least sometimes. Conclusion: Obtaining expectations early in the patient encounter may provide opportunities for improved communication in the ED. P/Cs found the PrEPP tool easy to use to communicate their expectations and HCPs felt it influenced communication and management of patients in the ED. Further qualitative thematic analysis is needed to explore how the PrEPP tool impacted ED visits.
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Jarvis, Alison, Kate Fennell, and Annette Cosgrove. "Are adults in need of support and protection being identified in emergency departments?" Journal of Adult Protection 18, no. 1 (February 8, 2016): 3–13. http://dx.doi.org/10.1108/jap-06-2015-0016.
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Purpose – Frequent attendance at emergency departments (ED) has been identified in adult protection reviews as a potential warning sign of the escalation of someone’s vulnerability. Concern has been expressed about the engagement of the National Health Service (NHS) in adult protection and the small number of NHS adult protection referrals. More specifically ED departments have been identified as an area of high patient through put where there has been little evidence around how well adult support and protection (ASP) was being delivered. The paper aims to discuss these issues. Design/methodology/approach – A series of audits were undertaken in three different hospitals across a large Scottish Health Board accessing ED at different times of day on different days of the week to test out whether NHS staff working in EDs are identifying adults who meet the criteria of “an adult at risk”. Findings – The audits identified a total of 11 patients from a total sample of 552 records examined who may have met the criteria to be considered an adult at risk, although further information would have been required to make a fully informed decision. Research limitations/implications – The main study limitation is that the hospitals are all within a single Health Board. The EDs have a large number of admissions and it is possible that a less pressurised area, might have a lower threshold of “risk” than the practitioners involved in the audits. The decision as to whether an adult was considered to meet the three-point test by the three people undertaking the audit was dependent on the quality of information recorded on the patients’ electronic hospital record. Practical implications – It is essential that NHS Boards proactively support practice in ED settings so staff are able to identify adults at risk of harm under the ASP legislation so that ED staff are responsive to ASP needs. Originality/value – The research evidence around adult protection in the UK is still emerging. The development of good practice based on the Scottish Government’s ASP legislation is still being shaped. In England and Wales, the principles of identification and multi-agency working underpinning the safeguarding of vulnerable individuals are broadly similar to Scotland. These audits add to the literature by challenging the assumption that patients who would benefit from local authority investigation and possible support are not being identified within EDs.