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UNSTRUCTURED Canada is a progressive nation which endeavours to provide comprehensive, universal, and portable healthcare to all its citizens. This is a challenge for a country which has a population of 38 million living within a land expanse of 10 million km2 and where 18% are living in rural or extremely remote locations. The combined population of Yukon, Northwest Territories and Nunavut is only 128,959 living within 3.92 million km2 and many of these citizens live in isolated communities with unique health needs and social issues. The current solutions to providing healthcare in the most remote locations have been to transport the patient to the healthcare provider or vice versa, which incurs considerable financial strain on our healthcare system and personal stress to the patient and provider. The recent deployment of Low Earth Orbit communication satellites (LEO-ComSats) globally will change the practice and availability of virtual medicine everywhere in the world, especially northern Canada. The deployment of LEO-ComSats could result in disruptive but positive changes in medical care for underserved communities in remote geographic locations across Canada. LEO-ComSats can be used to demonstrate the utility of virtual medical encounters between a patient and a doctor in Canada separated by thousands of kilometers. Most certainly the academic medical centers in lower Canada could perform virtual tele-mentored medical care to our northern communities in a manner similar to the virtual care provided to many Canadians during the COVID-19 pandemic.

Although John Scopes and his famous “Monkey Trial” strongly influenced the ongoing evolution-creationism controversy, relatively little is known about Scopes’s post-trial life. Moreover, many questions about his trial remain unanswered (e.g., did he actually teach evolution in Dayton?). This paper answers these questions with new information from a previously ignored source – his family and friends.

Just before his death in 1970, John Scopes claimed that his famous trial “had no other effect upon my family” than his sister Lela losing her teaching job in Paducah, Kentucky. He was wrong. My interviews with John Scopes's family members and descendants – most of whom have never talked about their famous relative until now – reveal that the legacy of the Scopes Trial continues.

Cold renal perfusion (CRP) with 4°C crystalloid fluids has been described as a method to reduce renal injury during open surgical repair of complex aortic aneurysms (cAAs) (those requiring at least a suprarenal clamp site). We performed a meta-analysis to ascertain whether CRP improves kidney-related outcomes after open surgical cAA repair.Patients of any age or gender who had undergone open surgical repair of cAAs were included. Primary outcomes were the presence of postoperative kidney injury, the need for dialysis and mortality related to kidney injury. We compared patients who were treated with any intraoperative CRP strategy to a control population without CRP. We used a fixed-effects model to analyze derived odds ratios (ORs) and assess heterogeneity. We performed risk of bias analysis to identify potential confounding elements.Among the 935 studies screened, 5 primary articles met the inclusion criteria. Cold renal perfusion significantly reduced postoperative acute kidney injury (OR 0.46 [95% confidence interval 0.32-0.68],This meta-analysis showed reduced postoperative acute kidney injury with the use of CRP during open cAA repair. A prospective randomized controlled trial to perform further subgroup analysis and research the various types of CRP solutions may be warranted to identify further possible benefits.

To characterize the longstanding impact of an emergency endovascular aneurysm repair (EVAR) protocol for ruptured abdominal aortic aneurysm (rAAA) on 30-day mortality.All adult patients with an rAAA who underwent a surgical or endovascular intervention at a tertiary care center between March 2001 and December 2018 were evaluated. An emergency EVAR protocol was introduced in January 2004. The primary outcome was 30-day mortality, which was calculated using risk-adjusted logistic regression for the preprotocol and postprotocol periods. A risk-adjusted cumulative sum analysis examined changes in 30-day mortality after protocol implementation.We identified 376 patients with rAAA between 2001 and 2018 (75 preprotocol and 301 postprotocol), with a decreasing incidence of rAAA during the study period. The introduction of the protocol in 2004 was associated with increased EVAR use (63.6% vs 6.7%; P .001). Patients managed according to the protocol were more frequently unstable (systolic blood pressure [SBP] of ≤80 mm Hg, 46.5% postprotocol vs 22.7% preprotocol; P 0.001), with a lower average SBP (87.4 mm Hg postprotocol vs 106 mm Hg preprotocol; P .001) and worse renal function (estimated glomerular filtration rate 61.5 mL/min postprotocol vs 83.2 mL/min preprotocol; P .001). The risk-adjusted 30-day mortality was 23.2% with the emergency EVAR protocol, versus 35.8% preprotocol (P = .0727). A subgroup analysis demonstrated improved the 30-day mortality for unstable patients (SBP of ≤80 mm Hg) at 38.0% (vs 62.4% preprotocol introduction; P = .0190). A cumulative sum analysis demonstrated worse than expected mortality outcomes in the preprotocol period, and stability of surgical performance over 15 years after protocol introduction.On reflection of a 17-year experience with EVAR for rAAA, the implementation of an emergency EVAR protocol demonstrated stable surgical performance for all patients with an rAAA and evidence of improved 30-day mortality for unstable patients with an rAAA. Since the protocol introduction, EVAR has become a mainstay intervention and, despite an increase in comorbid patients, the overall incidence of rAAA is declining. EVAR should be considered the first-line intervention for the appropriate patient unstable with an rAAA.

Background The Galápagos archipelago is known worldwide for its contributions to Charles Darwin’s theory of evolution by natural selection, and the islands continue to support studies in evolutionary biology. Yet despite the strong association of Galápagos with evolutionary biology, it is unknown if tourists—approaching 200,000 individuals annually—come to Galápagos with a specific interest in learning about evolution. Prior work has established that Galápagos National Park guides are proud of the association between the islands and evolution, yet on average do not do well on a test of basic evolutionary concepts. The work described herein is an attempt to clarify, via in-person surveys on tourists during the summer of 2016, whether tourists are motivated to visit Galápagos by an interest in evolution. Results Of the 109 tourists who answered the question “How interested were you in this trip to Galápagos?” all but one indicated that they were interested or extremely interested in their trip. Only two mentioned a specific interest in learning about evolution or the relationship between the islands and the history of evolutionary thought. For most people, seeing animals—in general or specifically identified animals such as the giant tortoises—was the primary motivation for coming to Galápagos. Unusual animals, snorkeling, and visiting a remote location all averaged above 4.0 on a 5.0-point scale, indicating that these aspects of the archipelago are very-to-extremely appealing to tourists. When average responses for 22 items were ranked from most to least appealing, evolution-related items came in 14th, 17th, 18th, and 20th. However, consequences of evolutionary processes, such as unusual animals and biodiversity, rank higher than either of the four evolution-specific items. Conclusions Given tourists’ primary interest in the islands’ endemic wildlife, we find little reason for concern over the guides’ lack of specific evolution-related content knowledge. More critical to both guides and tourists are the impacts of population growth and increased tourism to the islands. Stakeholders can best serve the interests of the growing tourist population and the vigor of the Galápagos economy via conservation efforts—by developing and supporting programs that mediate the concerns raised by ecologists, protecting the islands’ fragile habitat, and regulating commercial land use. In addition, a better understanding of tourists’ motivations may provide opportunities to explore connecting evolutionary concepts to visitor interests.

Background Evolution is everywhere in Galápagos, especially regarding the role the islands have played in the history of evolutionary thought. In turn, the Galápagos National Park guides are in a unique position as informal science educators, as they are the primary points-of-contact for the islands’ ~ 200,000 tourists per year. Our goal was to assess the guides’ knowledge and acceptance of the theory of evolution, in addition to learning more about their perceptions of the connection between the islands and evolution. Methods We surveyed 63 guides in three towns on three of the archipelago’s populated islands. Surveys included items targeting the guides knowledge of evolution (via the Knowledge of Evolution Exam, or the KEE) and acceptance of the theory of evolution (via the Measure of Acceptance of the Theory of Evolution, or the MATE). Additional, novel items gauged the guides’ perceptions of the islands, insofar as Galápagos is connected to evolution and the history of evolutionary thought. Results Although acceptance of evolution was high, knowledge was relatively low. However, the guides are proud of the islands’ association with the history of evolutionary thought, and enjoy talking about evolution while giving tours. On open-ended responses, guides claimed to especially enjoy talking with tourists about geology and island culture, and a few voiced concerns about the conflict between evolution and religion. Finally, the overwhelming majority of the guides agreed or strongly agreed with the statement, “I would like to learn more about Galápagos and the history of evolutionary thought.” Conclusions Galápagos guides display a disconnect between what is felt about evolution, and what is known about how evolution actually works. We can probably trace their fondness for, and acceptance of, evolution to the clear connection between evolution, tourism, and the guides’ livelihoods. We can trace their lack of knowledge to their schooling, as prior work detected similarly low knowledge of evolution in the islands’ schoolteachers. However, the guides are a receptive audience for professional development pertaining to our contemporary understanding of the mechanics of biological evolution. Improving guides’ understanding of biological evolution could, in turn, inform the evolutionary understanding of thousands of tourists each year.

Objectives: Prudent dry needling techniques are commonly practiced with the intent to avoid large neurovascular structures, thereby minimizing potential excessive bleeding and neural injury. Patient position is one factor thought to affect the size of the safe zone during dry needling of some muscles. This study aimed to compare the size of the needle safe zone of the iliacus muscle during two different patient positions using ultrasound imaging. Methods: The distance from the anterior inferior iliac spine (AIIS) to the posterior pole of the femoral nerve was measured in 25 healthy participants (11 male, 14 female, mean age = 40) in both supine and sidelying positions using a Chison Eco1 musculoskeletal ultrasound unit. The average distance was calculated for each position and a two-tailed, paired t-test (α

Many biology teachers visit Dayton, Tennessee, to experience “ground zero” of the evolution–creationism controversy. This article provides concise descriptions, addresses, and GPS coordinates for the trial-related sites in and around Dayton.

The alleged “man tracks” beside dinosaur tracks near Glen Rose, Texas, are among the most enduring pieces of evidence used by young-Earth creationists to reject evolution. Despite the tracks’ fame, their most persistent advocate – that is, Carl Baugh of the Creation Evidence Museum – has published neither (1) peer-reviewed papers in scientific journals about the tracks nor (2) clear, convincing, unenhanced photographs of unaltered tracks taken during an excavation. I participated in an excavation sponsored by Baugh’s Creation Evidence Museum that uncovered three “man tracks” that Baugh and his assistants verified as being made by humans. These “tracks” are presented here and are among the first clear, unenhanced photographs of freshly uncovered “man tracks” taken during a Baugh-led excavation. They look no different than any of the countless other scuffs, cracks, and erosion marks in the area.

Students regard evolutionary theory differently than science in general. Students’ reported confidence in their ability to understand science in general (e.g., posing scientific questions, interpreting tables and graphs, and understanding the content of their biology course) significantly outweighed their confidence in understanding evolution. We also show that those students with little incoming confidence in their understanding of evolution demonstrated more confidence and the most improved performance by the end of the semester. Collectively, our data indicate that regardless of prior experiences with evolution education, and in spite of myriad social challenges to teaching evolution, students can learn evolution.

Introduction In the hyperacute phase of ischemic stroke, a 0° position is recommended to increase cerebral perfusion in nonhypoxic patients able to tolerate lying flat. However, use of 0° positioning is not uniformly applied in clinical practice, most likely due to concerns of aspiration pneumonia. We aimed to determine the risk of pneumonia associated with 0° head of bed positioning in acute stroke patients treated with thrombolytic therapy. Methods A retrospective descriptive study was conducted using prospectively collected, consecutive acute ischemic stroke patients treated with IVtPA whose head of bed was positioned at 0° for the first 24 h. Rates of hospital-acquired pneumonia were determined using a strict adjudication process to insure accuracy of pneumonia diagnoses. Quantitative characteristics were analyzed in SPSS to compare differences between “true” pneumonia cases and nonpneumonia cases. Results Twenty-four of 333 (7.2%) patients had mention the diagnosis of pneumonia in the registry and/or medical record. Of these cases, only 15 (4.5%) met evidence-based diagnostic criteria for hospital-acquired pneumonia. The 15 adjudicated cases had similar median admission NIHSS scores to nonpneumonia cases (10 vs. 9, respectively; P = ns), but were older (74 ± 15 vs. 64 ± 17 years; mean difference 9.889, 95 CI = 1.2–18.6; P = 0.026). A total of eight patients with pneumonia were intubated and mechanically ventilated, and one patient received bilevel positive airway pressure ventilation during the 0° positioning period. Pneumonia cases had significantly longer hospitalizations (14.5 ± 12 vs. 6.6 ± 9 days; mean difference 7.97, 95% CI = 1.1–14.8; P = 0.026) and higher median discharge mRS score (4 vs. 3: P = 0.003). Conclusions Zero-degree head of bed positioning in the first 24 h following an acute ischemic stroke treated with IV-tPA was associated with acceptable rates of pneumonia. Rates for pneumonia may be further reduced by eliminating use of a 0° protocol in intubated/mechanically ventilated patients.