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The eastern population of harlequin duck Histrionicus histrionicus in Canada has been designated a species of special concern since 2001 and as endangered from 1991 to 2001, largely due to low and declining wintering numbers detected in the 1980s. Our objectives were to summarize the current state of knowledge of harlequin duck abundance and distribution in Eastern Canada, and assess trends in wintering abundance across regions over the past 30+ years. Abundance estimates were generated from targeted surveys with thorough spatial coverage of major wintering areas on insular Newfoundland (NL), Nova Scotia (NS), and New Brunswick (NB) between 2015 and 2018, complemented by regional trends estimated from Christmas Bird Count (CBC) data collected at 12 sites across the same wintering range between 1988 and 2021. Overall, targeted surveys indicated that numbers have increased and distributions have expanded beyond historically surveyed regions, particularly in NS. This was supported by trends from CBC data, with steep average increases (mean λ > 1.05) on most CBC circles in Eastern Canada since 1988 or later. Using localized annual rates of mean population change from CBC data to project counts from dedicated surveys, we suggest wintering areas in the provinces of NL, NS, and NB may currently be supporting a combined total of 5682 birds (95% CI 5065-6354) in 2022, well exceeding the recovery target of 3000 individuals listed in the 2007 management plan. Our findings indicate that the eastern population is in recovery, but also emphasize that a consistent, dedicated monitoring program would enable managers to confidently evaluate management actions, and to respond most effectively should regional trends slow or reverse.

Background: Despite a higher prevalence of traumatic spinal cord injury (TSCI) amongst Canadian Indigenous peoples, there is a paucity of studies focused on Indigenous TSCI. We present the first Canada-wide study comparing TSCI amongst Canadian Indigenous and non-Indigenous peoples. Methods: This study is a retrospective analysis of prospectively-collected TSCI data from the Rick Hansen Spinal Cord Injury Registry (RHSCIR) from 2004-2019. We divided participants into Indigenous and non-Indigenous cohorts and compared them with respect to demographics, injury mechanism, level, severity, and outcomes. Results: Compared with non-Indigenous patients, Indigenous patients were younger, more female, less likely to have higher education, and less likely to be employed. The mechanism of injury was more likely due to assault or transportation-related trauma in the Indigenous group. The length of stay for Indigenous patients was longer. Indigenous patients were more likely to be discharged to a rural setting, less likely to be discharged home, and more likely to be unemployed following injury. Conclusions: Our results suggest that more resources need to be dedicated for transitioning Indigenous patients sustaining a TSCI to community living and for supporting these patients in their home communities. A focus on resources and infrastructure for Indigenous patients by engagement with Indigenous communities is needed.

Introduction: The objective of the study was to evaluate the acute pain intensity evolution in ED discharged patients using Group-based trajectory modeling (GBTM). This method identified patient groups with similar profiles of change over time without assuming the existence of a particular pattern or number of groups. Methods: This was a prospective cohort study of ED patients aged ≥18 years with an acute pain condition (≤ 2 weeks) and discharged with an opioid prescription. Patients completed a 14-day diary assessing daily pain intensity level (0-10 numeric rating scale) and pain medication use. Results: Among the 372 included patients, six distinct post-ED pain intensity trajectories were identified: two started with severe levels of pain, one remained with severe pain intensity (12.6% of the sample) and the other ended with moderate pain intensity level (26.3%). Two other trajectories had severe initial pain, one decreased to mild pain (21.7%) and the other to no-pain (13.8%). Another trajectory had moderate initial pain which decreased to a mild level (15.9%) and the last one started with mild pain intensity and had no pain at the end of the 14-day (9.7%). The pain trajectory patterns were significantly associated with age, type of painful conditions, pain intensity at ED discharge, and with opioid consumption. Conclusion: Acute pain resolution following an ED visit seems to progress through six different trajectory patterns that are more informative than simple linear models and could be useful to adapt acute pain management in future research.

Introduction: Near-infrared spectroscopy (NIRS) can be used to monitor the oxygen saturation of hemoglobin in any given superficial tissue. However, the measurements provided by different oximeters can vary a lot. Little is known about the specific patient characteristics that could affect the inter-device agreement of tissular oximeters. This study aimed to evaluate the association between the quantity of subcutaneous fat (assessed by skinfold thickness) and the inter-device agreement of two tissue oximeters, the INVOS 5100c and the Equanox 7600. Methods: In this prospective cohort study, tissue saturations and skinfold thickness were measured at four different sites on both sides of the body in healthy adult (≥18 years old) volunteers. The association between the quantity of subcutaneous fat (assessed by skinfold thickness) and the inter-device agreement (absolute difference between the oximetry values provided by the two oximeters) was first assessed with a Pearson's correlation and a scatter plot. Subsequently, a linear mixed model was used to evaluate the impact of the subcutaneous fat and other covariables (age, sex) on the inter-device agreement while adjusting for the repeated measurements across different sites for the same volunteers. Results: From January to March 2015, 53 healthy volunteers were included in this study with ages ranging between 20 and 81 years old, on which a total of 848 measures were taken. Higher skinfold measures were associated with an increase in the difference between measures provided by both oximeters (Slope = -0.59, Pearson correlation coefficient = -0.51, p < 0.001). This observed association persisted in a linear mixed model (-0.48 [95% confidence interval {CI}-0.61 to -0.36], p < 0.001). The sex of the volunteers also influenced the inter-oximeter agreement (Women:-5.77 [95%CI -8.43 to -3.11], p < 0.001), as well as the forearm sites (Left forearm: −7.16 [95%CI -9.85 to –4.47], p < 0.001; right forearm: −7.01 [95%CI -9.61 to −4.40], p < 0.001). Conclusion: The quantity of subcutaneous fat, as well as the sex of the volunteers and the measurement sites, impacted the inter-device agreement of two commonly used oximeters. Given these findings, monitoring using tissue oximetry should be interpreted with great care when there is a significant quantity of subcutaneous fat.

Background: Cervical sponylotic myelopathy (CSM) may present with neck and arm pain. This study investiagtes the change in neck/arm pain post-operatively in CSM. Methods: This ambispective study llocated 402 patients through the Canadian Spine Outcomes and Research Network. Outcome measures were the visual analogue scales for neck and arm pain (VAS-NP and VAS-AP) and the neck disability index (NDI). The thresholds for minimum clinically important differences (MCIDs) for VAS-NP and VAS-AP were determined to be 2.6 and 4.1. Results: VAS-NP improved from mean of 5.6±2.9 to 3.8±2.7 at 12 months (PConclusions: This study suggests that neck and arm pain responds to surgical decompression in patients with CSM and reaches the MCIDs for VAS-AP and VAS-NP at 12 months.

Introduction: Opioid side effects are common when treating chronic pain. However, the rate of opioid side effects for acute pain has rarely been examined, particularly in the post emergency department (ED) setting. The objective of this study was to evaluate the short-term incidence of opioid induced side effects (constipation, nausea/vomiting, dizziness, and drowsiness) in patients discharged from the ED with an opioid prescription. Methods: This was a prospective cohort study of patients aged ≥18 years that visited the ED for an acute pain condition (≤ 2 weeks) and were discharged with an opioid prescription. Patients completed a 14-day diary assessing daily pain medication use and side effects. Results: Mean age of the 386 patients included was 55 ± 16 years; 50% were women. During the 2-week follow-up, 80% of patients consumed at least one dose of opioids. Among the patients who used opioids, 38% (95%CI: 33-48) reported constipation, 27% (95%CI:22-32) nausea/vomiting, 30% (95%CI:25-35) dizziness, 51% (95%CI:45-57) drowsiness, and 77% (95%CI:72-82) reported any side effects. Adjusting for age, sex, and pain condition, patients who used opioids were more likely to report any side effect (OR 7.5, 95%CI:4.3-13.3) and constipation (OR 7.5, 95%CI:3.1-17.9). A significant dose response effect was observed for constipation but not for the other side effects. Nausea/vomiting (OR 2.0, 95%CI:1.1-3.6) and dizziness (OR 1.9, 95%CI:1.1-3.4) were associated with oxycodone compared to morphine. Conclusion: Similar to chronic pain, opioid side effects are highly prevalent during short-term treatment for acute pain. Physicians should be aware and inform patients about those side effects.

Introduction: Studies suggest that acute pain evolution after an emergency department (ED) visit has been associated with the development of chronic pain. Using group-based trajectory modeling (GBTM), we aimed to evaluate if ED discharged patients with similar pain intensity profiles of change over 14 days are associated with chronic pain at 3 months. Methods: This is a prospective cohort study of patients aged 18 years or older who visited the ED for an acute pain condition (≤2 weeks) and were discharged with an opioid prescription. Patients completed a 14-day diary in which they listed their daily pain intensity level (0-10 numeric rating scale). Three months post-ED visit, participants were interviewed by phone to report their pain intensity related to the initial pain. Results: A total of 305 patients were retained at 3 months (mean age ± SD: 55 ± 15 years, 49% women). Using GBTM, six distinct pain intensity trajectories were identified during the first 14 days of the acute pain period; two linear one with moderate or severe pain during the follow-up (representing almost 40% of the patients) and four cubic polynomial order trajectories, with mild or no-pain at the end of the 14 days (low final pain). Twelve percent (11.9; ±95%CI: 8.2-15.4) of the patients had chronic pain at 3 months. Controlling for age, sex and types of pain condition, patients with trajectories of moderate or severe pain and those with only severe pain were 5.1 (95%CI: 2.2-11.8) and 8.2 (95%CI: 3.4-20.0) times more likely to develop chronic pain at 3 months, respectively, compared to the low final pain group. Conclusion: Trajectories could be useful to early identification of patients at risk of chronic pain.

Introduction: Biphasic anaphylactic reactions are a concern in emergency medicine. Risk factors associated with this type of reaction remain ill-defined. The aim of this study was to investigate elements associated with biphasic anaphylactic reactions and to determine the impact of anaphylaxis treatments on biphasic reactions. Methods: From the multicenter Cross-Canada Anaphylaxis Registry prospective cohort, we selected adults (≥18 years) with a visit to the emergency department (ED) of Sacré-Cœur Hospital, an urban tertiary-care hospital. Then, a structured chart review was done to collect additional information on types and timing of treatments for the initial anaphylactic reaction, presence and treatment of biphasic reactions during the initial ED visit or upon patients’ return. Biphasic reactions were defined by the recurrence of any anaphylaxis symptoms within 72 hours of a resolved anaphylaxis episode. Potential factors associated with biphasic reactions were studied using Chi-Square and Mann-Whitney tests. Results: Patients with anaphylaxis were enrolled between April 2014 and February 2018. From the cohort, 401 adult patients were identified. We found 37 patients who developed a biphasic reaction. Amongst them, 33 received treatments and 9 required more than one dose of intramuscular epinephrine. None of the biphasic reaction patients required intravenous epinephrine, other vasopressors, ICU admission, or endotracheal intubation. Biphasic reactions appeared in a median time of 13.3h after the initial reaction ranging from 1.1h to 69.6h (IQR 30.2). There was no difference in age or gender of patients who developed a biphasic reaction compared those who did not. Pertinent past medical history, daily medications, mean of arrival to the ED, allergen type, ingestion route, or initial symptoms during the anaphylaxis episode were not significantly different in the two groups. Treatment with corticosteroids was similar in the two groups (9.0% vs. 8.1% p = 0.82). Treatment, dose and route of administration of epinephrine was not different in the two groups but longer delays before treatment with the first dose of epinephrine was more frequent in biphasic reaction patients (median delay of 64 minutes, p = 0.015). Conclusion: No patient characteristic, allergen, route of ingestion, symptom, nor treatment with corticosteroids has shown to be significantly different in patients with and without biphasic reactions. Delayed treatment with epinephrine is significantly associated with biphasic reactions.

Governments in the Lower Mekong Basin (LMB) face decisions that involve trade-offs between the economic benefits from hydropower generation and potentially irreversible negative impacts on the ecosystems that provide livelihoods and food security to the rural poor. As a means of comparing these trade-offs, a sensitivity analysis of the benefit-cost analysis of certain Basin Development Plan (BDP) scenarios was undertaken. By changing some key assumptions in the BDP about discount rates, the value of lost capture fisheries, future aquaculture production in the LMB, and the value of lost ecosystem services from wetlands to reflect the full range of uncertainty, at the extremes, there could be a reversal of the Net Present Value (NPV) estimates of the scenarios from a positive $33 billion to negative $274 billion. This report recommends when dealing with large-scale, complex projects: a more comprehensive, integrated human and natural systems framework and adaptive management approach to LMB planning and development that deals with the entire watershed; a more comprehensive analysis and treatment of risk and uncertainty; a more thorough assessment of the value of direct and indirect ecosystem services; a broader set of scenarios that embody alternative models of development, broader stakeholder participation; and better treatment of the effects of infrastructure construction on local cultures and the poor.

New hatchery management strategies in the Columbia River Basin focus on conservation of naturally spawning populations as an equal priority to providing fish for harvest—a difficult halance to achieve. The Hatchery Scientific Review Group (HSRG) assessed 178 hatchery programs and 351 salmonid populations to determine how to achieve managers’ goals for conservation and sustainable fisheries. Modeling determined the best strategy, using an approach based on best available science, goal identification, scientific defensibility, and adaptive management to refocus from an aquaculture paradigm to a renewable natural resource paradigm. We concluded that hatcheries and natural populations must be managed with the same biological principles. HSRG solutions improved the conservation status of many populations (25% for steelhead trout, more than 70% for Chinook and coho salmons) while also providing increased harvest. Natural-origin steelhead trout and coho salmon spawners increased by 6,000 to 10,000; Chin...

During a three-year period 145 consecutive patients with bleeding from oesophageal varices underwent immediate endoscopic sclerotherapy, by para- or intra- and paravascular injection of 4-40 ml 0.5% polidocanol. If the bleeding was not stopped within 15 minutes, a Linton-Nachlas tube was introduced. In case of bleeding recurrences from gastric varices or oesophageal ulcerations a gastro-oesophageal disconnection (after Hassab-Paquet) was performed as an emergency measure or electively. During the bleeding-free interval shunt criteria were examined and, if positive, an elective shunt operation was recommended. Hospital mortality was 16.5%, overall mortality during the period of the study was 29.5%. The results indicate that immediate sclerotherapy of bleeding oesophageal varices improves the prognosis, but it should be undertaken only in centres equipped for emergency endoscopy by an experienced immediately available team.

A portable streamside rearing facility was designed and used by the Little River Band of Ottawa Indians during efforts to rehabilitate a remnant population of lake sturgeon Acipenser fulvescens in the Big Manistee River, Michigan, beginning in 2004. The streamside rearing facility facilitates rearing of wild-caught lake sturgeon larvae in their natal water. This rearing approach provides a cost-effective technique for small batch rearing, incorporates aspects of genetic conservation, and addresses concerns about imprinting and spawning site fidelity. This rearing method may be an important management tool for restoring remnant lake sturgeon populations. Successful rearing of lake sturgeon during the first 3 years of operation indicates that this portable design may be adapted and modified for other locations and fish species. Other management agencies in the Great Lakes basin are currently using this technology for lake sturgeon rehabilitation because of the demonstrated operational success of th...

Das Fach Anasthesie mit seinen Hauptbereichen klinische Anasthesie, operative Intensivmedizin, Rettungs-/Notfallmedizin und Schmerztherapie stellt im klinischen Alltag benotigte interdisziplinare Techniken und Kenntnisse zur Verfugung, die naturlich auch dem seefahrenden Arzt nutzlich sein konnen. Die groste Bedeutung durften dabei die notfallmedizinischen Fertigkeiten haben, die in der klinischen Anasthesie relativ gefahrlos erlernt werden konnen, wie Atemwegssicherung, Narkosefuhrung, Kreislaufunterstutzung und Beurteilung und Behandlung der Lebensfunktionen. Grundsatzlich sind alle Verfahren der klinischen Anasthesie, Allgemeinanasthesien wie Regionalverfahren auch auf See denkbar. Die Anasthesietatigkeit eines einzelnen Schiffsarztes wird sich allerdings meist nur auf Notfallnarkosen erstrecken.

But: Revoir notre methode depistage des patients ayant un risque de developper un carcinome hepatocellulaire (CHC), et rapporter notre experience des resections hepatiques pour petit CHC (

A 50% reduction in pain intensity difference (50%PID) between baseline and follow-up evaluation is commonly accepted as adequate pain relief in emergency departments (EDs). However, 50%PID seems to be problematic with the 11-point numerical rating scale (NRS) since even baseline values are more divisible by 2 (50% reduction) than odd baseline values. This study evaluated the impact of this bias and integrated time between baseline and follow-up measurements, hypothesizing that the slope of relative pain intensity difference (SRPID) is a more accurate gauge of pain relief that can decrease bias and incorporate the time component of pain relief.A post-hoc analysis of real-time data on an adult population from an urban ED identified 3199 consecutive patients who received an analgesic, had baseline NRS 3 and a follow-up NRS within 2 h. Primary outcome was the percentage of patients with pain relieved from the 50%PID and the 50%SRPID criteria.Results showed that with 50%PID, even pain intensity levels on baseline NRS comprised a higher percentage of patients [60.7%; 95% confidence interval (CI): 58.8-63.0] with pain relief compared to odd pain intensity levels (51.7%; 95% CI: 48.8-54.6; p 0.001), underestimating pain-relieved patients by 9% [95% CI: 0.05-0.13; effect size (ES) = 0.09]. The percentage of pain-relieved subjects with the 50%SRPID criteria was not affected by baseline NRS values (59.7% for whole sample; 95% CI: 58.0-61.4; ES = 0.02).The 50%PID method with an 11-point NRS for assessing adequate pain relief is significantly biased for specific baseline pain intensity level. In the particular context of ED acute pain, the SRPID seems less biased.

A three-layer feedforward neural network was successfully used to model and predict the pH of cheese curd at various stages during the cheese-making process. An extended database, containing more than 1800 vats over 3 yr of production of Cheddar cheese with eight different starters, from a large cheese plant was used for model development and parameter estimation. Neural network models were developed with inputs selected among 33 quantitative and qualitative process variables for final pH of cheese, pH at cutting, and acidity at whey drawing-off and at pressing. In all cases, very high correlation coefficients, ranging from 0.853 to 0.926, were obtained with the validation data. A sensitivity analysis of neural network models allowed the relative importance of each input process variable to be identified. The sensitivity analysis in conjunction with a priori knowledge permitted a significant reduction in the size of the model input vector. A neural network model using only nine input process variables was able to predict the final pH of cheese with the same accuracy as for the complete model with 33 original input variables. This significant decrease in the size of neural networks is important for applications of process control in cheese manufacturing.

BackgroundThe best way to manage generalized peritonitis complicating sigmoid diverticulitis is controversial. This randomized clinical trial involved a comparison of primary resection and suture, drainage with proximal colostomy followed by secondary resection.MethodsFrom January 1989 to December 1996, 105 patients of mean(s.d.) age 66(14) (range 32–91) years were randomized to undergo primary or secondary resection. The main endpoint was occurrence of generalized or localized postoperative peritonitis. The Mannheim Peritonitis Index score was calculated for each patient to check for comparability of groups.ResultsPostoperative peritonitis occurred less often after primary than secondary resection whether considering the first procedure only (one of 55 patients versus ten of 48; P < 0·01) or all procedures (one of 55 versus 12 of 48; P < 0·001). Likewise, early reoperation was performed less often following primary resection than secondary resection (two of 55 versus nine of 48 (P < 0·02) and two versus 11 (P < 0·01)), leading to a shorter median first hospital stay for patients having primary resection (15 days) than for those undergoing secondary resection (24 days) (P < 0·05). The mortality rate did not differ significantly with regard to operative policy (primary resection 24 per cent versus secondary resection 19 per cent) or type of peritonitis (faeculent 27 per cent versus purulent 19 per cent). No patient died following a second or third procedure.ConclusionPrimary resection is superior to secondary resection in the treatment of generalized peritonitis complicating sigmoid diverticulitis because of significantly less postoperative peritonitis, fewer reoperations and shorter hospital stay.

SummaryThe authors provide a retrospective analysis of long-term results over 26 years of 256 cases of hepaticojejunostomy for benign biliary stricture. With the advent of laparoscopic te

To determine the effect of carbohydrate (CHO) status on immune responses after long-duration exercise, on two occasions, 10 men completed a glycogen-depleting bout of cycle ergometry followed by 48 h of either a high-CHO diet (HiCHO; 8.0 g CHO/kg) or a low-CHO diet (LoCHO; 0.5 g CHO/kg). After the 48 h, subjects completed a 60-min ride at 75% maximal O2 uptake (EX). Blood samples were taken predepletion, pre-EX, post-EX, and 2 and 24 h post-EX and were assayed for leukocyte number and function, glucose, glutamine, and cortisol. The glucose responses were significantly higher in the HiCHO (4.62 ± 0.26 mM) vs. the LoCHO (3.19 ± 0.15 mM) condition post-EX, and glutamine was significantly higher in the HiCHO (0.472 ± 0.036 mM) vs. the LoCHO (0.410 ± 0.025 mM) condition throughout. Cortisol levels were significantly greater in the LoCHO (587 ± 50 nM) vs. the HiCHO (515 ± 62 nM) condition throughout the trial. Lymphocyte proliferation (phytohemagglutinin) was significantly depressed after exercise. However, there was no difference between conditions, and the depression was not correlated with elevations in cortisol. Circulating numbers of leukocytes, neutrophils, lymphocytes, and lymphocyte subsets were significantly greater in the LoCHO vs. the HiCHO condition at the post-EX and 2 h post-EX time points. These data indicate that the exercise and diet manipulation altered the number of circulating leukocytes but did not affect the decrease in lymphocyte proliferation that occurred after exercise.