Impact of Deferring Critically Ill Children Away from Their Designated Pediatric Critical Care Unit: A Population-Based Retrospective Cohort Study

BACKGROUND: The impact of deferring critically ill children in referral hospitals away from their designated pediatric critical care unit (PCCU) on patients and the healthcare system is unknown. We aimed to identify factors associated with deferrals and patient outcomes and to study the impact of a referral policy implemented to balance PCCU bed capacity with regional needs. METHODS: We conducted a population-based retrospective cohort study of admissions to a PCCU following inter-facility transport from 2004 to 2016 in Ontario, Canada. RESULTS: Of 10,639 inter-facility transfers, 24.8% (95% confidence interval [CI]: 23.5-26.1%) were deferred during pre-implementation and 16.0% (95% CI: 15.1-16.9%) during post-implementation of a referral policy. Several factors, including previous intensive care unit admissions, residence location, presenting hospital factors, patient co-morbidities, specific designated PCCUs and winter (versus summer) season, were associated with deferral status. Deferrals were not associated with increased mortality. CONCLUSIONS: Deferral from a designated PCCU does not confer an increased risk of death. Implementation of a referral policy was associated with a consistent referral pattern in 84% of transfers

Epilepsy Risk Following Bariatric Surgery for Weight Loss

Background and objectives: A previous study reported finding that epilepsy risk is elevated following bariatric surgery for weight loss; however, this association has not been adequately explored. Our objectives were to (1) estimate the risk of epilepsy following bariatric surgery for weight loss relative to a non-surgical cohort of patients with an obesity diagnosis, and (2) identify epilepsy risk factors among bariatric surgery recipients. Methods: We conducted a population-based retrospective cohort study using linked health administrative databases in Ontario, Canada. Participants were accrued between July 1, 2010, and December 31, 2016, and followed until December 31, 2019. All Ontario residents 18 years of age and older who had bariatric surgery during the accrual period were eligible for inclusion in our exposed cohort. Patients hospitalized with a diagnosis of obesity and who did not have bariatric surgery during the accrual period were eligible for inclusion in our unexposed cohort. We excluded patients with a history of seizures, epilepsy, various seizure or epilepsy risk factors, psychiatric disorders, or drug or alcohol abuse/dependence. In our primary analysis, we used inverse probability of treatment weighting to control for confounding. A marginal Cox proportional hazards model was then used to estimate the risk of epilepsy associated with bariatric surgery. A Cox model was also used to identify epilepsy risk factors among exposed participants. Results: The final sample included 16,958 exposed participants and 622,514 unexposed participants. Following inverse probability of treatment weighting, the estimated rates of epilepsy were 50.1 and 34.1 per 100,000 person-years among those who did and did not have bariatric surgery, respectively. The hazard ratio for developing epilepsy after bariatric surgery was 1.45 (95% CI=1.35, 1.56). Among participants who received bariatric surgery, stroke during follow-up increased epilepsy risk (HR=14.03, 95% CI=4.26, 46.25). Discussion: In this study, we found that patients with a history of bariatric surgery were at increased risk of developing epilepsy. These findings suggest that epilepsy is a long-term risk associated with bariatric surgery for weight loss

Is Prosocial Behavior Associated with Increased Registration for Deceased Organ Donation? A Cross-sectional Study of Ontario, Canada

Background. A community that promotes prosocial behaviors such as organ donor registration or charitable giving could reinforce those behaviors among its residents. Understanding the nature of the relationship between prosocial behaviors at the community level and an individual\u27s decision to engage in prosocial behavior can help in the targeting of communities with lower rates of prosocial activities. The objective of this study was to assess if the likelihood that an individual is a registered deceased organ donor in Ontario, Canada, is associated with community-level charitable giving. Methods. This cross-sectional population-based study involved individual- and community-level data from multiple administrative data sources from ICES and Statistics Canada. To assess the unadjusted and adjusted effects of community-level charitable giving on organ donor registration, we ran 4 sequential multilevel random intercept logistic regression models and used a number of individual- and community-level confounding factors. Results. Statistically significant between-community variance (0.322, SE = 0.020) and interclass correlation coefficient (0.089) suggest that substantial variation in organ donor registration can be attributed to the between-community differences. Community-level charitable giving was correlated with organ donor registration (odds ratios, 1.351; 95% confidence intervals, 1.245-1.466) in the model containing only individual-level confounding factors. However, this relationship became statistically nonsignificant (odds ratios, 0.982; 95% confidence intervals, 907-1.063) when a series of community-level confounding factors were added to the model. Among these confounding factors, individuals\u27 immigration status and community-level ethnic/immigrant concentration had the most pronounced association with organ donor registration. Conclusion. The identification of the characteristics of populations and communities with low organ donor registration rates may inform future initiatives in the area of organ donation awareness and promotion to make them more effective among those particular groups

Comparison of mean temperature taken between commercial and prototype thermal sensor in estimating mean temperature of oil palm fresh fruit bunches

Thermal imaging is widely utilized in agricultural applications such as examining plant physiology, yield prediction, irrigation scheduling, bruises and pathogen determination in fruits and vegetables. There is a need for a cost effective thermal device for this wide range of applications. In this study, a low-cost prototype thermal device was used to measure the temperature of FFBs at three maturity levels, that are under-ripe, ripe and over-ripe. The experiment was repeated using a commercial thermal camera. Then, the mean temperature obtained from both the prototype and commercial thermal sensors was compared. Our results showed the prototype thermal device is capable of estimating the mean temperature of oil palm FFBs with the values analogous to the mean temperature from commercial thermal camera with R2 = 0.71

The risk of new-onset epilepsy and refractory epilepsy in older adult stroke survivors

Research Summary: Key Findings Stroke is a common cause of epilepsy in older adults, but little is known about stroke-related epilepsy or its outcomes in this population. 1.1% of older adult stroke survivors developed epilepsy in this study, of whom 12.9% developed refractory epilepsy, indicating that this population is particularly responsive to treatment. Over 85% of deaths in this population are not due to stroke or epilepsy.https://ir.lib.uwo.ca/neuruprojectsummaries/1000/thumbnail.jp

Trends in Psychotropic Dispensing Among Older Adults with Dementia Living in Long-Term Care Facilities: 2004-2013.

OBJECTIVE: Guidelines worldwide have cautioned against the use of antipsychotics as first-line agents to treat neuropsychiatric symptoms of dementia. We aimed to investigate the changes over time in the dispensing of antipsychotics and other psychotropics among older adults with dementia living in long-term care facilities. METHODS: We used drug claims data from Ontario, Canada, to calculate quarterly rates of prescription dispensing of six psychotropic drug classes among all elderly (≥65 years of age) long-term care residents with dementia from January 1, 2004, to March 31, 2013. Psychotropic drugs were classified into the following categories: atypical and conventional antipsychotics, non-sedative and sedative antidepressants, anti-epileptics, and benzodiazepines. We used time-series analysis to assess trends over time. RESULTS: The study sample increased by 21% over the 10-year study period, from 49,251 patients to 59,785 patients. The majority of patients (within the range of 75%-79%) were dispensed at least one psychotropic medication. At the beginning of the study period atypical antipsychotics (38%) were the most frequently dispensed psychotropic, followed by benzodiazepines (28%), non-sedative antidepressants (27%), sedative antidepressants (17%), anti-epileptics (7%), and conventional antipsychotics (3%). Dispensing of anti-epileptics (2% increase) and conventional antipsychotics (1% decrease) displayed modest changes over time, but we observed more pronounced changes in dispensing of benzodiazepines (11% decrease) and atypical antipsychotics (4% decrease). Concurrently, we observed a substantial growth in the dispensing of both sedative (15% increase) and non-sedative (9% increase) antidepressants. The proportion of patients dispensed two or more psychotropic drug classes increased from 42% in 2004 to 50% in 2013. CONCLUSIONS: Utilization patterns of psychotropic drugs in institutionalized patients with dementia have changed over the past decade. Although their use declined slightly over the study period, atypical antipsychotics continue to be used at a high rate. A decline in the use of benzodiazepines along with an increased use of sedative and non-sedative antidepressants suggests that the latter class of drugs is being substituted for the former in the management of neuropsychiatric symptoms. Psychotropic polypharmacy continues to be highly prevalent in these patient samples

Dominant Media of a Community-Based Organization for Disseminating Sustainable Agriculture Knowledge and Information

Abstract Co mmun ication is the key to transforming Malaysia's conventional agricu ltural systems to sustainable agriculture systems. The objective of this paper is to identify the dominant and most effective med iu m for co mmunication as it is implemented by the Qadhijah Natural Farm -a co mmun ity-based organization located in Parit Buntar, Perak, Malaysia. Rapid Appraisal Agricultural Knowledge Systems analysis indicated that the "face-to-face" communicat ion is the dominant and most effect ive mediu m fo r transfer of knowledge/information by the Qadhijah Natural Farm among all co mmunication med ia types studied

Rapid analysis of risk assessment using developed simulation of chemical industrial accidents software package.

The environmental consequences are defined as consequences of accidental release of hazardous substances to the natural environment. This release can lead to many hazards depending on the material stored. The consequences of these hazards to the environment are widespread and have significant importance to human communities living in the surroundings. The mathematical models are extremely useful tools to predict the impacts of chemical process accidents. The objective of this paper is to develop a software package for accident simulation and damage potential estimation. The software is coded in visual basic and is compatible with windows working environments. The software is called simulation of chemical industrial accident. This application is a comprehensive software package which can be integrated with geographical information system to predict and display the consequence of chemical hazards. The software is a user-friendly and effective tool for evaluating the consequences of major chemical accidents, process decision making for land-use planning, namely locating suitable hazardous installations, hazardous waste disposal areas and emergency response plan

Time Series Analysis of Variance of Sunspots in January till September 2010 and Correlation with Sunspots Areas

Abstract This paper analyzed theoretically the short period variability of the sunspot activity beginning from January 2010 till September 2010. Sunspot data are taken fro m Solar Influences Data Analysis Center (SIDC). We focused on the number of sunspots each month and correlate it with sunspot are aparameter. Fro m the analysis, it is found that there is a litt le correlation between the amplitude of a cycle. The pattern shown an almost linear relat ionship between both parameters. It also showed that the highest sunspot number per day that has been recorded is in May. The Sun was found to be most active in August and passive in April according to the nu mber o f sunspots. Uniquely, there is also no sunspot at all in a day. Th is study gives some interesting and potentially important clues especially in understanding the physical processes responsible for the solar activity and the solar cycle phenomena. Based on our analysis, we found that the average relation between sunspot number, R and sunspot area, A is A = 5.179R

Involuntary hospitalization among young people with early psychosis: A population-based study using health administrative data.

OBJECTIVE: Early psychosis is an important window for establishing long-term trajectories. Involuntary hospitalization during this period may impact subsequent service engagement in people with newly diagnosed psychotic disorder. However, population-based studies of involuntary hospitalization in early psychosis are lacking. We sought to estimate the proportion of people aged 16 to 35 years with early psychosis in Ontario who are hospitalized involuntarily at first admission, and to identify the associated risk factors and outcomes. METHODS: Using linked population-based health administrative data, we identified incident cases of non-affective psychosis over a five-year period (2009-2013) and followed cases for two years to ascertain the first psychiatric hospitalization. We used modified Poisson regression to model sociodemographic, clinical, and service-related risk factors, and compared service-related outcomes for cases admitted on an involuntary versus voluntary basis. RESULTS: Among 17,725 incident cases of non-affective psychosis, 38% were hospitalized within two years, and 81% of these admissions occurred on an involuntary basis (26% of cohort). Sociodemographic factors associated with an increased risk of involuntary admission included younger age (16-20), and first-generation migrant status. The strongest risk factors were poor illness insight, recent police involvement, and admission to a general (versus psychiatric) hospital. Outcomes associated with involuntary admission included increased likelihood of control intervention use and a shorter length of stay. CONCLUSIONS: One in four young people with first-episode psychosis will have an involuntary admission early in the course of their illness. Our findings highlight areas for intervention to improve pathways to care for people with psychotic disorder