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Predictors of hyperkalemia among patients on maintenance hemodialysis transported to the emergency department by ambulance
No full textBackground
Hyperkalemia is common among patients on maintenance hemodialysis (HD) and is associated with mortality. We hypothesized that clinical characteristics available at time of paramedic assessment before emergency department (ED) ambulance transport (ambulance-ED) would associate with severe hyperkalemia (K≥6 mmol/L). Rapid identification of patients who are at risk for hyperkalemia and thereby hyperkalemia-associated complications may allow paramedics to intervene in a timely fashion, including directing emergency transport to dialysis-capable facilities.
Methods
Patients on maintenance HD from a single paramedic provider region, who had at least one ambulance-ED and subsequent ED potassium from 2014 to 2018, were examined using multivariable logistic regression to create risk prediction models inclusive of prehospital vital signs, days from last dialysis, and the presence of prehospital electrocardiogram (ECG) features of hyperkalemia. We used bootstrapping with replacement to validate each model internally, and performance was assessed by discrimination and calibration.
Results
Among 704 ambulance-ED visits, severe hyperkalemia occurred in 75 (11%); 26 patients with ED hyperkalemia did not have a prehospital ECG. Younger age at transport, longer HD vintage, more days from last hemodialysis session (OR=49.84; 95% CI, 7.72 to 321.77 for ≥3 days versus HD the same day [before] ED transport), and prehospital ECG changes (OR=6.64; 95% CI, 2.31 to 19.12) were independently associated with severe ED hyperkalemia. A model incorporating these factors had good discrimination (c-statistic 0.82; 95% CI, 0.76 to 0.89) and, using a cutoff of 25% probability, correctly classified patients 89% of the time.
Conclusions
Characteristics available at the time of ambulance-ED were associated with severe ED hyperkalemia. An awareness of these associations may allow health care providers to define novel care pathways to ensure timely diagnosis and management of hyperkalemia
A spatiotemporal analysis of the COVID‐19 pandemic in North Africa
No full textSpatial panel-data models are estimated to identify the factors of the prevalence of the coronavirus outbreak in North Africa. Using daily data on the number of cases collected between March 2020 and December 2021, three types of general models are investigated, and they include spatial spillovers between the neighboring countries of the region. In one model the spatial dependence is accounted for by adding a spatial lag of the dependent variable (SAR model). In an alternative specification, spatially correlated error terms are considered in the model (SEM), and in the third model a spatial lag dependent variable and spatially correlated errors are both added (SAC). To deal with unobservable individual heterogeneity, random and fixed individual effects specification are investigated in each of these models. The results of the maximum likelihood and generalized method of moments' estimations show that the lift of travel restrictions had an important impact on the spike in the numbers of COVID-19 cases in North Africa and that the effects of endogenous interactions between the countries are strongly significant. It is found that spatial spillovers and a change in the travel policy are the main factors that can explain the mechanism of spread the coronavirus pandemic in North Africa. However, more data on socio-demographic and behavioral variables and on vaccination rates are needed to better understand what caused the recent surge in the number of infections in the region
Association of topical glaucoma medications with lacrimal drainage obstruction and eyelid malposition
No full textBackground/objectives
Adverse effects of topical glaucoma medications (TGMs) may include development of ocular adnexal disorders. We undertook a study to determine the effect of TGMs on the risk of developing lacrimal drainage obstruction (LDO) and eyelid malposition.
Subjects/methods
All patients 66 years of age and older in Ontario, Canada initiating TGM and all patients diagnosed with glaucoma/suspected glaucoma but not receiving TGM from 2002 to 2018 were eligible for inclusion in this retrospective cohort study. Using validated healthcare administrative databases, cohorts were identified with TGM and no TGM patients matched 1:2 on sex and birth year. The effect of TGM treatment on risk of surgery for LDO and lid malpositions was estimated using Kaplan–Meier and Cox proportional hazards models.
Results
Cohorts included 122,582 patients in the TGM cohort and 232,336 patients in the no TGM cohort. Among the TGM cohort there was decreased event-free survival for entropion (log-rank P < 0.001), trichiasis (P < 0.001), and LDO (P = 0.006), and increased ectropion-free survival (P = 0.007). No difference in ptosis-free survival was detected (P = 0.78). For the TGM cohort there were increased hazards for entropion (hazard ratio [HR] 1.24, 95% confidence interval [CI] 1.12–1.37; P < 0.001), trichiasis (HR 1.74, 95% CI 1.57–1.94; P < 0.001), and LDO (at 15 years: HR 2.39, 95% CI 1.49–3.85; P = 0.004), and a decreased hazard for ectropion (HR 0.89, 95% CI 0.81–0.97; P = 0.008). No association between TGM treatment and ptosis hazard was detected (HR 0.99, 95% CI 0.89–1.09; P = 0.78).
Conclusions
TGMs are associated with an increased risk of undergoing surgery for LDO, entropion, and trichiasis.ICE
Making virtual global learning transformative and inclusive: A critical reflective study on high-impact practices in higher education
No full textThe COVID-19 pandemic has highlighted the importance of global competence, agility, empathy, and innovation in managing opportunities, crises, and problems. Global learning and engagement in higher education is the pathway towards developing learners' intercultural competence, fostering an appreciation of diversity, inclusion, and equity, and empowering individual agency towards collective wellbeing and sustainability. Digital transformation and available tools have expanded the scope and depth of global learning in virtual environments. This article reports a critical reflective study on virtual global learning and shares high-impact, evidenced-based strategies to make virtual global learning more equitable, inclusive, meaningful, and relevant to all learners in higher education
A thirty-fifth successful year for the Journal of Thermophysics and heat transfer
No full textREADERSHIP and support of the Journal of Thermophysics and Heat Transfer (JTHT) from the thermophysics and heat transfer community continues to be strong. Over the past year, between 1 October 2020 and 30 September 2021, 241 original papers were submitted to JTHT. During this same time period, over 500 reviews were completed by volunteers. The average time between the receipt of a manuscript submitted in the time period listed above and the first decision (accept, revise, reject) on the manuscript was 1.3 months. Fifty percent of the final decisions made during the time frame were made in less than 43 days. The average time between receipt in production and online publication was 2.7 months in 2021. The number of pages was 893. All four issues of Volume 35 were on schedule
Enhanced mass transfer and water discharge in a proton exchange membrane fuel cell with a raccoon channel flow field
No full textThe cathode flow channel plays an important role in the water management of proton exchange membrane (PEM) fuel cells. In order to improve mass transfer and water management in traditional channels, this paper presents a new wavy flow field to increase the fuel cell performance and overall efficiency. A raccoon channel with various waviness parameters is numerically studied by a three-dimensional two-phase PEM fuel cell model. The electrochemical current-voltage performance results confirm that the PEM fuel cell's performance with the raccoon design is higher than a conventional straight channel at high current densities. The effects of uniform gas distribution, removal of the accumulated water, and sufficient water content in the membrane are crucial factors for improving cell performance. A parametric analysis is also performed by considering the amplitude and wavelength of the raccoon pattern on the fuel cell performance. The results show that the output power improves in the raccoon channel by increasing the amplitude or increasing the wavelength. The raccoon channel's output power with amplitude of 0.5 mm and a wavelength of 2 mm is enhanced by about 20%. The increase of performance in the raccoon channel is significantly higher than in the past reported studies
Socially aware robot navigation framework: Where and how to approach people in dynamic social environments
No full textThis paper proposes a human approaching robot navigation framework that enables a mobile service robot to (i) estimate a socially optimal approaching pose, and (ii) navigate safely and socially to the estimated approaching pose. In the first stage, the robot estimates potential approaching poses of a human or a human group, which the robot can safely and socially approach, using the dynamic social zone model. In the second stage, the proposed framework selects a socially optimal approaching pose, then estimate a socially optimal trajectory of the robot using the proposed goal-oriented timed elastic band (GTEB) model. The developed GTEB model takes into account the current robot's states, robot dynamics, dynamic social zone, regular obstacles and potential approaching poses to generate the socially optimal robot trajectory from the robot's current pose to the selected optimal approaching pose. The motion control command extracted from the socially optimal trajectory is then utilized to drive the mobile robot to approach the individual humans or human groups, while safely and socially avoiding regular obstacles, human and human groups during the navigation process. The proposed approaching human framework is verified in the both simulation and real robots. The results illustrate that, the mobile robot equipped with our developed GTEB model is able to safely and socially approach and avoid individual humans and human groups, while guaranteeing the comfortable safety for the humans and socially acceptable behaviors for the robot.Vietnam National Foundation for Science and Technology Development (NAFOSTED
Pathology in practice
No full textIn collaboration with the American College of Veterinary Pathologist
“You can't fix your brain”: Exploring concussion experiences of children and parents
No full textPurpose
To explore the experiences, information needs and preferences of children who have had a concussion and their parents who have cared for them.
Design
Qualitative description.
Methods
Semi-structured qualitative interviews were conducted via Zoom with children who have had a concussion between ages 5 and 16 years and parents who have cared for a child with a concussion. Interviews were audio-recorded and transcribed.
Results
Fourteen interviews were conducted with children and parents who have experiences with concussion. Four major themes were identified: (1) mechanism of injury and concussion symptoms experienced by children, (2) parent concerns, emotions, and health care experience with child's concussion, (3) concussions affect more than just your head and, (4) health information seeking, and preferences of parents and children related to concussion. Children and their parents have unique experiences, information needs and preferences regarding concussion.
Practice Implications
This information offers valuable insights about developing resources about childhood concussion that parents and children will find useful and relevant. This research has direct relevance to healthcare professionals who may encounter children with concussion in their daily practice so they can ensure the needs of children and families are being met. Our findings will be used to create the content for an innovative knowledge translation tool about pediatric concussion.Canadian Institutes of Health Researc