Canadian Association of Emergency Physicians

[Voir la version anglaise de l’article ici : www.cmaj.ca/lookup/doi/10.1503/cmaj.250758][1] Un homme âgé de 88 ans aux prises avec une maladie vasculaire périphérique, une néphropathie chronique, des antécédents de tabagisme de 60 ans et la goutte (pour laquelle il prenait de la colchicine

Under high pressure, the group-VB transition metals vanadium (V) and niobium (Nb) exhibit simple crystal structures but complex physical behaviors, such as anomalous compression-induced softening and heating-induced hardening (CISHIH). Meanwhile, the impact of lattice thermal expansion-induced softening at elevated temperatures on HIH is yet to be investigated. Therefore, this study utilized ab initio (AIMD) and machine learning molecular dynamics (MLMD) to investigate the melting and abnormal mechanical softening-hardening behaviors of V and Nb under high pressure. Simulations reveal that the high-temperature Pnma phase of Nb reported in previous experimental studies is highly susceptible to mechanical instability and reverts to the body-centered cubic (BCC) phase. This discovery prompted a revised determination of the high-pressure melting line of Nb. The melting temperature of Nb significantly exceeds the existing theoretical and experimental estimate compared with that of V. AIMD simulations demonstrate that atomic thermal displacements have a greater influence on the HIH of V and Nb than pure electron temperature effects. In addition, the temperature-dependent anomalous elastic properties of V and Nb were investigated within a pressure range of 0-250 GPa using MLMD. The mechanical properties of V and Nb transitioned from HIH to heating-induced softening, elucidating the competition between thermal-expansion-induced softening and HIH. This study advances fundamental understanding of V and Nb physics, providing crucial theoretical foundations for establishing accurate equations of state and constitutive models for these metals.

<p>Objectives: To define the important elements of an emergency department (ED) consultation request and to develop a simple model of the process.</p> <p>Methods: From March to September 2010, 61 physicians (21 emergency medicine [EM], 20 general surgery [GS], 20 internal medicine [IM]; 31 residents, 30 attending staff) were questioned about how junior learners should be taught about ED consultation. Two investigators independently reviewed focus group and interview transcripts using grounded theory to generate an index of themes until saturation was reached. Disagreements were resolved by consensus, yielding an inventory of themes and subthemes. All transcripts were coded using this index of themes; 30% of transcripts were coded in duplicate to determine the agreement.</p> <p>Results: A total of 245 themes and subthemes were identified. The agreement between reviewers was 77%. Important themes in the process were as follows: initial preparation and review of investigations by EM physician (overall endorsement 87% [range 70-100% in different groups]); identification of involved parties (patient and involved physicians) (100%); hypothesis of patient's diagnosis (75% [range 62-83%]) or question for the consulting physician (70% [range 55-95%]); urgency (100%) and stability (74% [range 62-80%]); questions from the consultant (100%); discussion/communication (98% [range 95-100%]); and feedback (98% [range 95-100%]). These components were reorganized into a simple framework (PIQUED). Each clinical specialty significantly contributed to the model (χ2 = 7.9; p value = 0.019). Each group contributed uniquely to the final list of important elements (percent contributions: EM, 57%; GS, 41%; IM, 64%).</p> <p>Conclusions: We define important elements of an ED consultation with input from emergency and consulting physicians. We propose a model that organizes these elements into a simple framework (PIQUED) that may be valuable for junior learners.</p>

A landmark editorial appeared in CMAJ as part of a coordinated global call to action alongside 220 respected health journals worldwide, including Lancet , BMJ and NEJM .[1][1] The initiative consolidates the growing voice of health care providers globally, providing education on the risks to the

ABSTRACT Purpose: Gastric cancer is one of the world's leading cancers. Despite the availability of testing, patients often present with advanced (stage III or stage IV) gastric cancer. These patients are always in a state of malnutrition and will be sarcopenic secondary to pain, loss of appetite, nausea, vomiting and dysphagia. Treatment for this cancer includes radical surgery, sometimes chemotherapy and rarely radiotherapy. It is already well documented that nutrition is critical to patient outcomes during chemotherapy, surgery and healing; because of this, many measures are already in place to improve nutrition in these patients. This literature review will look directly at the use of enteral feeding (EN) of gastric cancer patients prior to or in conjunction with neoadjuvant chemotherapy (NACT). Methods: Research was focused on the keywords: nutrition, gastric cancer, enteral feeding and neoadjuvant nutrition. Several electronic journals were reviewed, National Center for Biotechnology Information (NCBI), PubMed, QxMD Read, Science Direct, as well, a search was conducted through Alberta Health Services Knowledge Resource Service (KRS). Results: The combined information within each of the articles reviewed all recognized that early nutrition supplementation had positive impacts on maintaining albumin levels, an increase in the patient's immunity, improved healing and shortened length of hospital stay. Conclusion: All patients receive nutrition throughout their hospital stay; research indicates that the earlier nutrition is given to a patient, the better the overall outcomes of chemotherapy, surgery, shortened length of stay, and quality of life. Keywords: nutrition, gastric cancer, enteral feeding and neoadjuvant nutrition.

The compounds in this study are insensitive to impact and more energetic than TNT, giving new insights into gem-dinitro-derived compounds.

To achieve the seamless integration of 3D assembly design and kinematics and dynamics analysis for the development of mechanical products, an automatic generation method of kinematic joint model from 3D assembly model is proposed, which can extract the same mechanism information from different assembly constraint models of the same mechanical product. Firstly, an assembly constraint graph was constructed to represent the 3D assembly constraint model, and an equivalent constraint substitution method was employed to simplify the assembly constraint graph for extracting its intrinsic kinematic closed-chains. Secondly, the screw theory was introduced to recognize the kinematic joint induced by a combination of assembly constraints between two adjacent parts, so that the assembly constraint graph could be converted to kinematic joint graph. subsequently, several identification rules of sub-assemblies which consist of several adjacent parts was established, and the sub-assemblies in the geometric constraint model were identified by using the analysis of degree of freedom, geometric contact analysis and graph search algorithm. In such a way, an assembly constraint model could be converted to a kinematic joint model automatically. Finally, two typical examples have been given to validate the correctness and effectiveness of the proposed method.

In December 2017, the National Academy of Neuropsychology convened an interorganizational Summit on Population Health Solutions for Assessing Cognitive Impairment in Geriatric Patients in Denver, Colorado. The Summit brought together representatives of a broad range of stakeholders invested in the care of older adults to focus on the topic of cognitive health and aging. Summit participants specifically examined questions of who should be screened for cognitive impairment and how they should be screened in medical settings. This is important in the context of an acute illness given that the presence of cognitive impairment can have significant implications for care and for the management of concomitant diseases as well as pose a major risk factor for dementia. Participants arrived at general principles to guide future screening approaches in medical populations and identified knowledge gaps to direct future research. Key learning points of the summit included:recognizing the importance of educating patients and healthcare providers about the value of assessing current and baseline cognition;emphasizing that any screening tool must be appropriately normalized and validated in the population in which it is used to obtain accurate information, including considerations of language, cultural factors, and education; andrecognizing the great potential, with appropriate caveats, of electronic health records to augment cognitive screening and tracking of changes in cognitive health over time.Summit Participants Deb Adler1, Christopher Alban, MD, MBA2, Mark Bondi, PhD3, Michelle Braun, PhD4, Xavier Cagigas, PhD5, Morgan Daven6, Robert L. Denney, PsyD7,8, Lisa Drozdick, PhD9, Norman L. Foster, MD10,11, Ula Hwang, MD12–15, Laurie Ivey, PsyD16, Grant Iverson, PhD7,17, Joel Kramer, PsyD18, Laura Lacritz, PhD7,19, Melinda Lantz, MD20, Lisa Latts, MD, MSPH, MBA21, Shari M. Ling, MD22, Ana Maria Lopez, MD23–26, Michael Malone, MD27,28, Lori Martin-Plank, PhD, MSN, MSPH, RN29, Katie Maslow, MSW30, Don Melady, MSc(Ed), MD31–33, Melissa Messer34, John Meyers, PsyD7, Charles E. McConnel, PhD19, Randi Most, PhD36, Margaret P. Norris, PhD37, William Perry, PhD7,85,39, Neil Pliskin, PhD40, David Shafer, MBA41, Nina Silverberg, PhD42, Tresa Roebuck-Spencer, PhD43,44, Colin M. Thomas, MD, MPH45, Laura Thornhill, JD46, Jean Tsai, MD, PhD10,47, Nirav Vakharia, MD48, Martin Waters, MSW49Organizations RepresentedAlzheimer’s Association, Chicago, ILAMA/CPT Health Care Professionals Advisory Committee, Chicago, ILAmerican Academy of Clinical Neuropsychology (AACN), Ann Arbor, MIAmerican Academy of Neurology (AAN), Minneapolis, MNAmerican Association of Geriatric Psychiatry (AAGP), McLean, VAAmerican Association of Nurse Practitioners (AANP), Austin, TXAmerican Board of Professional Neuropsychology (ABN), Sarasota, FLAmerican College of Emergency Physicians (ACEP), Philadelphia, PAAmerican College of Physicians (ACP), Philadelphia, PAAmerican Geriatrics Society (AGS), New York, NYAmerican Psychological Association (APA), Washington, DCBeacon Health Options, Boston, MACanadian Association of Emergency Physicians, Ottawa, ON, Canada Collaborative Family Healthcare Association (CFHA), Rochester, New YorkGerontological Society of America, Washington, DCHispanic Neuropsychological Society (HNS), Los Angeles, CAIBM Watson Health, Denver, COInternational Federation of Emergency Medicine, West Melbourne, AustraliaInternational Neuropsychological Society (INS), Salt Lake City, UTNational Academy of Neuropsychology (NAN), Denver, COOptum of UnitedHealth Group, Minneapolis, MNPearson, New York City, New YorkPsychological Assessment Resources, Inc, Lutz, FLSociety for Clinical Neuropsychology, Washington, DCU.S. Department of Veterans Affairs, Washington, DC*Please note that participation in the Summit does not constitute organizational endorsement of this report

The 2018 update of the Canadian Stroke Best Practice Recommendations for Acute Stroke Management, 6th edition, is a comprehensive summary of current evidence-based recommendations, appropriate for use by healthcare providers and system planners caring for persons with very recent symptoms of acute stroke or transient ischemic attack. The recommendations are intended for use by a interdisciplinary team of clinicians across a wide range of settings and highlight key elements involved in prehospital and Emergency Department care, acute treatments for ischemic stroke, and acute inpatient care. The most notable changes included in this 6th edition are the renaming of the module and its integration of the formerly separate modules on prehospital and emergency care and acute inpatient stroke care. The new module, Acute Stroke Management: Prehospital, Emergency Department, and Acute Inpatient Stroke Care is now a single, comprehensive module addressing the most important aspects of acute stroke care delivery. Other notable changes include the removal of two sections related to the emergency management of intracerebral hemorrhage and subarachnoid hemorrhage. These topics are covered in a new, dedicated module, to be released later this year. The most significant recommendation updates are for neuroimaging; the extension of the time window for endovascular thrombectomy treatment out to 24 h; considerations for treating a highly selected group of people with stroke of unknown time of onset; and recommendations for dual antiplatelet therapy for a limited duration after acute minor ischemic stroke and transient ischemic attack. This module also emphasizes the need for increased public and healthcare provider's recognition of the signs of stroke and immediate actions to take; the important expanding role of paramedics and all emergency medical services personnel; arriving at a stroke-enabled Emergency Department without delay; and launching local healthcare institution code stroke protocols. Revisions have also been made to the recommendations for the triage and assessment of risk of recurrent stroke after transient ischemic attack/minor stroke and suggested urgency levels for investigations and initiation of management strategies. The goal of this updated guideline is to optimize stroke care across Canada, by reducing practice variations and reducing the gap between current knowledge and clinical practice.