Effect of Family Medicine Groups on Visits to the Emergency Department among Diabetics in Quebec between 2000 and 2011: A Population-Based Segmented Regression Analysis of an Interrupted Time Series

Poster Presentation Background: Family Medicine Groups (FMG) were introduced in Quebec in 2002 to reorganize primary care practices and encourage team-based and inter-professional approaches to service delivery. We measured the effect of this reform on the rate of emergency department (ED) visits among patients diagnosed with diabetes. Methods: Administrative databases were used to derive the weekly rate of ED visits between April 1, 2000 and March 31, 2012. We performed an interrupted segmented regression analysis to derive the estimated and extrapolated rates of visits in the years following the initial reform implementation. We employed an outcome control series of diabetics visiting the ED to treat appendicitis to strengthen the study’s internal validity. Results: A gradual decline in the rate of visits was observed for short term diabetes related complications and total ED visits. After 9 years of reform implementation, we observed a reduction of 1.42 and 1.70 ED visits per 10,000 diabetics to treat short term complications in urban and rural areas, respectively. A steady decrease was also observed in the total rate of ED visits in urban areas where we observed a reduction of 6.72 visits per 10,000 diabetics 9 years following the reform. Visits coded for appendicitis showed no clinically relevant changes over the study period. Interpretation: Our results suggest that the decreases in the rate of ED visits are attributed to the implementation of the FMG model across the province. The steady decline in the rate of total ED visits in urban areas is of particular relevance where overutilization of the ED is a problem. Evidence of these decreases despite the low-intensity nature of the FMG reform suggests the potential for this model to act as a future platform for implementing comprehensive care models for chronic disease management

Les fondements de la distinction entre l’expropriation et la réglementation en droit international

Dans cet article, l’auteure propose des éléments de réponse à la question de savoir ce qui distingue l’expropriation indirecte de la réglementation en droit international. Selon elle, et contrairement à ce qu’affirment certains auteurs, il n’existe pas de vide juridique sur cette question. Toutefois, un retour aux sources du droit international est nécessaire afin d’identifier des éléments de réponse porteurs. La thèse principale de cet article est que la notion de propriété, combinée à d’autres éléments, est déterminante dans la recherche de la ligne de démarcation entre l’expropriation et la réglementation.This article explores possible approaches to the distinction between indirect expropriation and regulation in international law. Contrary to what some authors have suggested, international law does provide solutions to this problem, although this requires a return to the fundamentals of law. This leads to a reconsideration of the concept of property, combined with other elements, as the key to differentiating between expropriation and regulation

Characterization of Streptococcus thermophilus Host Range Phage Mutants

To investigate phage-host interactions in Streptococcus thermophilus, a phage-resistant derivative (SMQ-301R) was obtained by challenging a Tn917 library of phage-sensitive strain S. thermophilus SMQ-301 with virulent phage DT1. Mutants of phages DT1 and MD2 capable of infecting SMQ-301 and SMQ-301R were isolated at a frequency of 10(−6). Four host range phage mutants were analyzed further and compared to the two wild-type phages. Altogether, three genes (orf15, orf17, and orf18) contained point mutations leading to amino acid substitutions and were responsible for the expanded host range. These three proteins were also identified in both phages by N-terminal sequencing and/or matrix-assisted laser desorption ionization-time-of-flight mass spectrometry. The results suggest that at least three phage structural proteins may be involved in phage-host interactions in S. thermophilus

Bacterial strains and plasmids used in this study.

a<p>Em^r, erythromycin resistance; Cm^r, chloramphenicol resistance; Km^r, kanamycin resistance.</p

Characterization of the Fst-Sm/srSm TA system in <i>E. coli</i>.

<p>Cells of LMG194 containing pSK1 (Fst-Sm), pSK2 (Fst-Sm/srSm), and pSK8 (NT-Fst) were grown to mid-log phase, at which time arabinose (induced) and glucose (uninduced control) were added. After induction, appropriate dilutions were plated on LB agar for determination of the number of CFU per ml. The curves presented are the averages and standard deviations of results from three independent cultures.</p

Effects of mild-overexpression of Fst-Sm/srSm type I TA system on <i>S. mutans</i> persister formation.

<p>Oxacillin-treated (<b>A</b>), cefotaxime-treated (<b>B</b>), and vancomycin-treated (<b>C</b>) cells were removed at the indicated time points, serially diluted, spot plated onto THYE agar plates, and the number of CFU per ml was determined from plate counts. The curves presented are the averages and standard deviations of results from three independent cultures.</p

<i>S. mutans</i> toxicity assay based on natural competence.

a<p>The transformation efficiency was expressed as the percentage of chloramphenicol-resistant transformants divided by the total number of recipient cells. All experiments were performed in triplicate from three independent experiments. Statistical significance: * WT(pSK9) vs. WT(pIB166); ^¶ΔIGR176(pSK9) vs. ΔIGR176(pIB166).</p