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ED Agitation, Imaging, and Injury: An Evidence Synthesis for Imaging Access in Agitated Trauma Patients
No full textBackground
Agitated adult trauma patients are common in Canadian emergency departments. Cooperation and monitoring constraints can delay essential imaging and risk missed injury.
Objective
To synthesize current guidance and evidence into an educational framework for timely, safe imaging when the trauma exam is unreliable due to agitation.
Methods
Narrative review using targeted searches of guideline/agency sources and peer-reviewed trials/meta-analyses on agitation control, extended Focused Assessment with Sonography in Trauma (eFAST), and selective versus whole-body computed tomography (CT). Outputs were a conceptual evidence map and a worked case.
Results
Current research prioritizes parallel resuscitation with early eFAST. Unstable, eFAST-positive patients usually proceed to hemorrhage control rather than CT. For stable or stabilized adults with an unreliable exam, brief, monitored behavioural control creates a one-trip imaging window under continuous SpO₂/NIBP/ECG (± capnography). Teams select an up-front imaging approach: selective CT once cooperation returns and injuries localize, or whole-body CT when multi-region injury is likely or unreliability persists. The scanner-side bundle includes named monitoring responsibility, an airway plan, and dose-optimized protocols. Downstream steps include interventional radiology--supported non-operative strategies for eligible solid-organ injury, a 24-48 hour tertiary trauma survey, and a structured psychiatry handoff to limit re-sedation.
Conclusions
In agitated adult trauma, a single, monitored trip to obtain the necessary imaging after brief, guideline-aligned behavioural control may improve safety and throughput. For clinicians, the framework clarifies roles. For patients, it may shorten time to definitive imaging and reduce complications. Prospective, multi‑centre evaluation aligned with local policy is needed to measure effects on time‑to‑CT, adverse events, and missed injuries.
Sense of Belonging as Experienced in Recovery from Serious Mental Illness: An Integrative Review
No full textObjectives: The desire to belong is a fundamental aspect of human nature that drives behavior and decision-making. Belonging is not only a need but also a powerful source of motivation. This review aims to contribute to the knowledge regarding recovery from serious mental illness (SMI) and the sense of belonging, by describing how studies understand and incorporate the concept of sense of belonging in mental health practices related to recovery. This topic is important for practitioners, policymakers, people with lived experience, their supporters, and the population in general, as understanding and addressing a sense of belonging should be taken into consideration when effectively supporting and promoting the wellbeing of people with SMI.
Research Design and Methods: This integrative review screened peer-reviewed articles from the past 10 years that addressed the sense of belonging involving adult populations experiencing mental suffering.
Results: The final sample included 23 empirical studies. These studies revealed the sense of belonging as an experiential, personal, and relational experience involving the following themes: “I can be myself”, “I am a part of the pie”, "I am wanted”, “It’s a mutual thing”, and “There’s trust”.
Conclusions: This review emphasizes the important role that a sense of belonging plays in the recovery process, highlighting that inclusion alone is insufficient without a sense of meaningful, reciprocal connections that foster trust. The findings call for further research across disciplines and communities, aiming to genuinely support and embrace people living with SMI
Dimension Reduction Approaches for Two-Phase Subsample Selection with High-Dimensional Covariates
No full textIntroduction: Two-phase sampling is widely used to reduce the cost of studies involving expensive data collection. In phase one, inexpensive variables are observed for all individuals and a strategic subsample is selected for phase two, where costly covariates are measured. When high-dimensional auxiliary covariates (HACs) are involved, common selection methods may underperform due to overlooked nonlinearities and noise. This study investigates how dimension reduction methods can better inform phase two selection by transforming HACs into univariable predictors that retain essential signals.
Methods: We investigated four-dimension reduction methods to extract low-dimensional representations of HACs—Principal Component Analysis (PCA), Uniform Manifold Approximation and Projection (UMAP), Adaptive Lasso, and a Meta-Visualization ensemble recently proposed by Ma, R. (2023). Using a simulation framework, we evaluated these methods under different data-generating scenarios. Phase two selection was informed by residual-dependent sampling, and semiparametric maximum likelihood estimation (SMLE) was applied for effect estimation.
Results: Across 60 simulation scenarios, Meta-Visual consistently achieved the lowest bias and IRMSE. UMAP and PCA showed moderate performance, while Adaptive Lasso performed best in sparse settings but exhibited high variability. Nonlinear methods outperformed others under complex structures, supporting their use in high-dimensional two-phase study designs.
Discussion: Dimension reduction shows promise for leveraging high-dimensional data in two-phase designs. These findings suggest that aligning reduction strategies with data complexity may support more effective subsample selection and estimation
Le recueil et la construction de l’image d’auteur : Ronsard et Herrera, le poète manie la lyre d’Apollon
No full textRenaissance authors often attempt to fashion their authorial image by their arrangement of texts and engravings at the beginning of their books, by giving careful thought to editorial questions, or by attending to the architecture of their works–that is, to the organization of texts within a book. They also tend to ground this self-fashioning by associating themselves with a mythical figure. Two examples of this are Ronsard and Fernando de Herrera, in Les Amours (1552) and Algunas Obras (1582) respectively. This article attempts to show how Ronsard, by integrating references to the mythic Cassandra into the depiction of his beloved, fashions his own image after that of the god who falls in love with the Trojan prophetess. Similarly to Ronsard, Herrera arranges the poems in his book in such a way as to make his voice echo that of Apollo. However, instead of utilizing the love poetry in his collection to achieve this effect, he makes use of texts written in honour of Ferdinand III, the city of Seville, and its artistic heritage.Les auteurs renaissants tâchent souvent de forger leurs images d’auteur en disposant des textes et des gravures au seuil des livres, en s’occupant soigneusement de leur édition ou en prenant soin de l’architecture des œuvres, c’est-à-dire l’organisation des textes à l’intérieur du livre. Ces auteurs essayent également de fonder cette image en l’associant à une figure mythique. C’est le cas de Ronsard et de Fernando de Herrera, respectivement dans Les Amours (1552) et Algunas Obras (1582). Comme nous cherchons à le montrer, le Français, en entremêlant sa bien-aimée à la figure mythique de la Cassandre troyenne, rapproche son image de celle du dieu qui tombe amoureux d’elle. Comme Ronsard, Herrera dispose les poèmes de son livre de façon à faire résonner sa voix comme la voix du dieu musagète. Néanmoins, le Sévillan, au lieu d’utiliser les poèmes d’amour de son recueil dans ce processus, se sert des textes en hommage à Ferdinand III, de la ville de Séville et de l’art local
Introduction: Critical Perspectives and New Trends in Arabic Sociolinguistics
No full textThis special issue of Toronto Working Papers in Linguistics (TWPL), “Critical perspectives and new trends in Arabic sociolinguistics,” features research presented at the international workshop Arabic Sociolinguistics: New Trends and Perspectives, held virtually at the University of Toronto on November 23, 2024. The workshop brought together junior and senior scholars in Arabic sociolinguistics to foster transnational and cross-generational dialogue, amplify underrepresented voices, and highlight innovative methodological and theoretical approaches, including quantitative, qualitative, and experimental research. Reflecting the theme of the special issue, the selected papers critically engage with current sociolinguistic questions, addressing variation, language ideology, identity, and the social functions of Arabic varieties in diverse contexts. Of the eight contributions presented at the workshop, four are included in this special issue, exemplifying the field’s breadth, rigor, and evolving directions
Unmasking the Silent Threat: Cholesteatoma to Cancer - a Case Report
No full textTemporal bone squamous cell carcinoma is a rare, aggressive malignancy often misdiagnosed due to its nonspecific symptoms resembling chronic ear infections. Malignant transformation from long-standing cholesteatoma, though rare, has been reported. Early diagnosis remains challenging due to the tumour’s deep location, histological heterogeneity, and biopsy limitations.
A 61-year-old man with a history of childhood cholesteatoma surgery and chronic otorrhea presented with a postauricular ulcer and severe otalgia. Initial biopsy of an external auditory canal mass was inconclusive, delaying diagnosis. Imaging revealed extensive temporal bone destruction and a temporal lobe abscess. A repeat biopsy confirmed temporal bone squamous cell carcinoma, with metastatic spread to the lungs and liver. He received palliative chemotherapy but succumbed to the disease.
Chronic inflammation from cholesteatoma may contribute to malignant transformation. Tumour-related inflammation, anatomical constraints, and histological heterogeneity complicate diagnosis. Multiple biopsies are often required, but false negatives are common due to sampling challenges. Advanced imaging techniques, such as apparent diffusion coefficient mapping, may improve lesion characterization and biopsy accuracy. This case highlights the difficulty of diagnosing temporal bone squamous cell carcinoma in patients with chronic ear disease. Persistent otorrhea and otalgia should prompt heightened clinical vigilance. Early intervention, multidisciplinary management, and integrating advanced imaging techniques could facilitate timely diagnosis and improve outcomes