Unintentional injury deaths associated with sport and recreation in Québec, Canada, 2006-2019.

OBJECTIVES: This study examined trends in the frequencies and rates of deaths associated with unintentional injuries in sport and recreation in Québec, Canada, for the period January 2006-December 2019. METHODS: In this descriptive retrospective study, data were extracted from the database of the Bureau du coroner du Québec. Incidence rates were calculated using participation data from the Étude des blessures subies au cours de la pratique d'activités récréatives et sportives au Québec (ÉBARS) and Canadian census population data. Poisson regression was used to investigate changes in death rates over the 14-year period by estimating incidence rate ratios. RESULTS: There were 1937 unintentional injury deaths and the population-based death rate was 1.72 per 100 000 person-years. The participation-based rate was 1.40 per 100 000 participant-years, considering the 24 matching activities in both ÉBARS' editions. Using both population-based and participation-based denominators, separate analyses consistently showed declining death rates in non-motorised navigation and cycling. Deaths related to all-terrain vehicles, snowmobiles, swimming, cycling, motorised navigation and non-motorised navigation activities accounted for 80.2% of all deaths. Drowning was documented as a cause of death in 39.3% of all fatalities. Males represented 86.8% of all deaths, with males aged 18-24 years and 65 and over having the highest rates. CONCLUSION: The death rates of unintentional injury deaths associated with non-motorised navigation and cycling declined, from January 2006 to December 2019. The characteristics and mechanisms of drowning deaths and fatalities that occurred in activities associated with higher death frequencies and rates need to be further investigated.

Hospital length of stay after admission for traumatic injury in Canada: a multicenter cohort study.

OBJECTIVE: To describe acute care length of stay (LOS) over all consecutive hospitalizations for the injury and according to level of care [intensive care unit (ICU), intermediate care, general ward], compare observed and expected LOS, and identify predictors of LOS. BACKGROUND: Prolonged LOS has important consequences in terms of costs and outcome, yet detailed information on LOS after trauma is lacking. METHODS: This multicenter retrospective cohort study was based on adults discharged alive from a Canadian trauma system (1999-2010; n = 126,513). Registry data were used to calculate index LOS (LOS in trauma center with highest designation level) and were linked to hospital discharge data to calculate total LOS (all consecutive hospitalizations for the injury). Expected LOS was obtained by matching general provincial discharge statistics to study data by year, age, and sex. Potential predictors of LOS were evaluated using linear regression. RESULTS: Mean index and total LOS were 8.6 and 9.4 days, respectively. ICU, intermediate care unit, and general ward care constituted 8.9%, 2.5%, and 88.6% of total hospital days. Observed mean index and ICU LOS in our trauma patients were 2.9 and 1.3 days longer than expected LOS (P < 0.0001). The strongest determinants of index LOS were discharge destination, age, transfer status, and injury severity. CONCLUSIONS: Results suggest that acute care LOS after injury is underestimated when only information on the index hospitalization is used and that ICU or intermediate care constitute an important part of LOS. This information should be used to inform the development of an informative and actionable quality indicator.

Rates, patterns, and determinants of unplanned readmission after traumatic injury: a multicenter cohort study.

OBJECTIVE: This study aimed to (i) describe unplanned readmission rates after injury according to time, reason, and place; (ii) compare observed rates with general population rates, and (iii) identify determinants of 30-day readmission. BACKGROUND: Hospital readmissions represent an important burden in terms of mortality, morbidity, and resource use but information on unplanned rehospitalization after injury admissions is scarce. METHODS: This multicenter retrospective cohort study was based on adults discharged alive from a Canadian provincial trauma system (1998-2010; n = 115,329). Trauma registry data were linked to hospital discharge data to obtain information on readmission up to 12 months postdischarge. Provincial admission rates were matched to study data by age and gender to obtain expected rates. Determinants of readmission were identified using multiple logistic regression. RESULTS: Cumulative readmission rates at 30 days, 3 months, 6 months, and 12 months were 5.9%, 10.9%, 15.5%, and 21.1%, respectively. Observed rates persisted above expected rates up to 11 months postdischarge. Thirty percent of 30-day readmissions were due to potential complications of injury compared with 3% for general provincial admissions. Only 23% of readmissions were to the same hospital. The strongest independent predictors of readmission were the number of prior admissions, discharge destination, the number of comorbidities, and age. CONCLUSIONS: Unplanned readmissions after discharge from acute care for traumatic injury are frequent, persist beyond 30 days, and are often related to potential complications of injury. Several patient-, injury-, and hospital-related factors are associated with the risk of readmission. Injury readmission rates should be monitored as part of trauma quality assurance efforts.

Capacitors go optical: wavelength independent broadband mode cavity.

Fabry-Perot resonators or interferometers (FPI) have existed for a long time and act as light accumulators. However, their applications have been limited to the allowed resonance modes in the cavity, which are defined by the specific free-spectral range of the FPI. We show here a novel concept involving a light "capacitor" capable of accumulating light over a wide spectral range, at any given repetition frequency. This device is actually an FPI in which a high chirped mirror (chirped fiber Bragg grating or chirp multi-layer coated mirror) is added to remove the wavelength dependence of the mode resonances, enabling a single very large broad-band mode. This "modification" does not affect the amount of light which can be accumulated, i.e. it does not reduce the Q-factor of the cavity. We show here the theoretical concept of such a device and experimental results demonstrating this principle.

Fabrication of high quality, ultra-long fiber Bragg gratings: up to 2 million periods in phase.

The fabrication and characterization of high quality ultra-long (up to 1m) fiber Bragg gratings (FBGs) is reported. A moving phase mask and an electro-optic phase-modulation (EOPM) based interferometer are used with a high precision 1-meter long translation stage and compared. A novel interferometer position feedback scheme to simplify the fabrication process is proposed and analyzed. The ultra-long uniform FBGs show near perfect characteristics of a few picometers bandwidth, symmetrical, near theory-matching group-delay and transmission spectra. Grating characterization using optical backscattering reflectometry and chirped FBGs are also demonstrated. Limitations of the schemes are discussed.

Making smart phones smarter with photonics.

Smart phones and tablets have become ubiquitous. Corning® Gorilla® Glass is well-known to provide durability and scratch-resistance to many smart phones and other mobile devices. Using femtosecond lasers, we report high quality photonic devices, such as a temperature sensor and an authentication security system, we believe for the first time. It was found that this kind of glass is an exceptional host for three dimensional waveguides. High quality multimode waveguides are demonstrated with the lowest measured loss value (0.027 dB/cm loss) to our knowledge in any glass using fs laser inscription. High quality (0.053 dB/cm loss) single-mode waveguides have been also fabricated using a fs laser scan speed of 300 mm/s, the fastest fabrication speed reported to date. The longest high quality waveguides (up to 1m) are also reported. Experiments reveal that Gorilla Glass seems to be an ideal glass to write waveguides just below the surface, which is of great interest in sensing applications.

Fiber Bragg gratings for low-temperature measurement.

We demonstrate the use of fiber Bragg gratings (FBGs) as a monolithic temperature sensor from ambient to liquid nitrogen temperatures, without the use of any auxiliary embedding structure. The Bragg gratings, fabricated in three different types of fibers and characterized with a high density of points, confirm a nonlinear thermal sensitivity of the fibers. With a conventional interrogation scheme it is possible to have a resolution of 0.5 K for weak pure-silica-core FBGs and 0.25 K using both boron-doped and germanium-doped standard fibers at 77 K. We quantitatively show for the first time that the nonlinear thermal sensitivity of the FBG arises from the nonlinearity of both thermo-optic and thermal expansion coefficients, allowing consistent modeling of FBGs at low temperatures.

Harnessing the fiber fuse for sensing applications.

A simple refractive index sensor based on a small section of fiber damaged by the fiber fuse is proposed and demonstrated with a sensitivity of 350.58 nm/refractive index unit (RIU). For comparison, a hetero-core structure fiber sensor composed of a short no-core fiber (NCF) sandwiched between two pieces of single-mode fibers is demonstrated with a sensitivity of 157.29 nm/RIU. The fiber fuse technique can allow mass production of sensors by incorporating small sections of the damaged fiber of any type into each device. We believe this is the first application of the periodic damage tracks in optical fibers formed by the fiber fuse.

Random fiber Bragg grating Raman fiber laser.

We demonstrate for the first time to our knowledge a Raman random fiber laser (RRFL) based on a long random fiber Bragg grating (RFBG-RRFL). Unlike other recently demonstrated random fiber lasers that rely on incoherent Rayleigh scattering feedback, the present scheme uses randomly distributed phase shifts inside a fiber-meter long Bragg grating as a random coherent feedback mechanism. The laser is pumped at 1480 nm and emits a CW signal at 1576 nm. The emission spectrum is dependent on pump intensity and is shown to exhibit single and multi-mode characteristics. The RRFL shows a relatively low threshold (2.2 W) and a ∼430 kHz FWHM linewidth.

Capturing reflected cladding modes from a fiber Bragg grating with a double-clad fiber coupler.

We present a novel measurement scheme using a double-clad fiber coupler (DCFC) and a fiber Bragg grating (FBG) to resolve cladding modes. Direct measurement of the optical spectra and power in the cladding modes is obtained through the use of a specially designed DCFC spliced to a highly reflective FBG written into slightly etched standard photosensitive single mode fiber to match the inner cladding diameter of the DCFC. The DCFC is made by tapering and fusing two double-clad fibers (DCF) together. The device is capable of capturing backward propagating low and high order cladding modes simply and efficiently. Also, we demonstrate the capability of such a device to measure the surrounding refractive index (SRI) with an extremely high sensitivity of 69.769 ± 0.035 µW/RIU and a resolution of 1.433 × 10(-5) ± 8 × 10(-9) RIU between 1.37 and 1.45 RIU. The device provides a large SRI operating range from 1.30 to 1.45 RIU with sufficient discrimination for all individual captured cladding modes. The proposed scheme can be adapted to many different types of bend, temperature, refractive index and other evanescent wave based sensors.

Surface plasmon resonance sensor interrogation with a double-clad fiber coupler and cladding modes excited by a tilted fiber Bragg grating.

We present a novel optical fiber surface plasmon resonance (SPR) sensor scheme using reflected guided cladding modes captured by a double-clad fiber coupler and excited in a gold-coated fiber with a tilted Bragg grating. This new interrogation approach, based on the reflection spectrum, provides an improvement in the operating range of the device over previous techniques. The device allows detection of SPR in the reflected guided cladding modes and also in the transmitted spectrum, allowing comparison with standard techniques. The sensor has a large operating range from 1.335 to 1.432 RIU, and a sensitivity of 510.5 nm/RIU. The device shows strong dependence on the polarization state of the guided core mode which can be used to turn the SPR on or off.

[Suicide prevention from a public health perspective]. / Perspectives de la santé publique pour la prévention du suicide.

Suicide and suicide prevention represent major public health challenges. The public health perspective juxtaposes a multifactor understanding of society's health phenomena to a mobilization around determinants on which actions can be taken. Public health has encountered success with infectious diseases as well as chronic diseases such as hypertension. In this article, the phenomenon of suicide is detailed with data drawn from Quebec, Canada and international research. Population-based suicide prevention policies are generally multimodal, and often involve strategies aiming at improving mental health services. The success of these strategies lies in their steady application and in the close surveillance of this application.

Firearms regulation and declining rates of male suicide in Quebec.

OBJECTIVES: To examine whether significant changes in method-specific male suicide rates occurred in the province of Quebec after stronger firearms regulations were introduced in Canada in 1991; to ascertain whether more stringent firearms regulations influence firearms and total suicide trends among men and to determine whether different results are obtained according to the statistical methods used. STUDY DESIGN: Descriptive analyses of time trends in method-specific suicide rates for men from 1981 to 2006 using Joinpoint regression models and pre-post firearms regulation analyses. SETTING: Quebec (Canada). PATIENTS OR SUBJECTS: Men who have commited suicide aged 15-34, 35-64 and 65 years and over, based on the Quebec mortality database, 1981-2006. INTERVENTIONS: A national firearms control initiative enacted in 1991. RESULTS: The Joinpoint regression models suggest that firearm suicide rates declined towards the end of the 1990 s. Since 1996, the pace of decline was twice as great in men aged 15-34 years (annual percentage change (APC) -11.1%) compared with men aged 35-64 years (APC -5.6%). Total suicide rates also declined among men aged 15-34 and 35-64 years during this period. Pre-post firearms regulation Poisson regression analyses failed to detect the specific point in time when significant changes in the trend occurred. CONCLUSIONS: Male firearm suicide rates declined following the introduction of restrictive firearms regulations in Canada. Whether this represents a causal relationship requires further study.

Demonstration of a 3 mW threshold Er-doped random fiber laser based on a unique fiber Bragg grating.

We demonstrate a novel random laser based on a single fiber Bragg grating. A long fiber Bragg grating fabrication technique allows the insertion of a large number of randomly distributed phase errors in the structure of the grating which induces light localization. By writing such a grating in a polarisation maintaining Er-doped fiber, a random laser is demonstrated by pumping the fiber with 976 and 1480 nm pump lasers. The number of emitted modes is observed to be a function of the length of the grating and of the pump power and single-mode operation is shown to be possible. The random fiber laser shows low-threshold (approximately 3 mW) and measured approximately 0.5 pm emission linewidth at a wavelength of around 1534 nm.

Deprivation and unintentional injury hospitalization in Quebec children.

Injuries disproportionately affect children from deprived areas. This study examines the links between the material and social dimensions of deprivation and injury hospitalizations in children aged 14 years or under from 2000 to 2004. Hospitalization data are from the Quebec hospital administrative data system, whereas socio-economic characteristics of individuals were estimated based on the smallest geographic areas for which Canadian census data were disseminated. The Poisson regression model was used to calculate the relative risks of hospitalization for seven categories of unintentional injury. A total of 24 540 injury hospitalizations were examined. Hospitalization in children is associated with both dimensions of deprivation. Injuries to pedestrians and motor vehicle occupants and injuries related to burns and poisonings are clearly associated with both dimensions of deprivation. These inequalities should be considered in the development of preventive measures.

How to Convince Clinicians that 'Soft' Skills Save Lives? Practical Tips to Use Clinical Studies to Teach Physicians' Roles.

This article was migrated. The article was marked as recommended. The implementation of competency-based medical education is hampered by unsupported arguments like 'soft' skills are important, but they don't save lives. When implementing teaching and assessment methods targeting non-medical expert roles, student and physician buy-in is crucial. These intrinsic roles (e.g. collaborator or professional) are unfortunately misinterpreted and underused by supervisors, in part because of the false assumption that those skills have minimal impact on patient outcomes. On the contrary, although not worded in those terms, many clinical studies prove the impact of those roles on patient mortality, morbidity, readmission rate, or compliance. Whereas physicians feel that they are properly trained to give feedback, they struggle in making this connection between clinical studies and intrinsic roles in their everyday teaching habits. In this article, we provide practical tips on why and how to use high-impact clinical studies to enlighten supervisors and trainees about the educational and clinical importance of those skills. A slide kit, to be presented in clinical settings, provides a selection of 30 examples of 'hard' evidence on those so-called 'soft' skills, reinforcing the fact that intrinsic roles are intertwined with the medical expert role to improve patient care.

Novel custom fiber Bragg grating fabrication technique based on push-pull phase shifting interferometry.

A new UV-writing technique is proposed for fabricating custom fiber Bragg gratings (FBGs). A continuously moving fringe pattern is generated by use of two electro-optical UV modulators and synchronized with a moving fiber. This scheme potentially enables the fabrication of infinitely long FBGs with arbitrary profiles and chirp without any mechanical perturbation of the writing interferometer. Preliminary results of this technique are presented and discussed.

Regional Variations in Suicide and Undetermined Death Rates among Adolescents across Canada.

OBJECTIVE: Trends in rates of adolescent suicide and undetermined deaths in Canada from 1981 to 2012 were examined, focusing specifically on variations between Canadian regions. Exploratory hypotheses were formulated for regional variability in adolescent suicide rates over time in Canada. METHODS: A descriptive time trend analysis using public domain vital statistics data was performed. All deaths from 1981 to 2012 among 15 to 19 year olds coded as suicides or undetermined intent according to the International Classification of Diseases, 9th and 10th Revisions were included. RESULTS: While there was an overall stability in adolescent suicide and undetermined death rates across Canada, regional analyses showed that Quebec experienced a 7.6% annual reduction between 2001 and 2012 while the Prairies and Atlantic provinces experienced significant annual increases since 2001. Ontario and British Columbia have had non-significant fluctuations since 2001. The trends remained similar overall when excluding undetermined deaths from the analyses. CONCLUSIONS: Variations in adolescent suicide trends across provinces were found. Factors such as provincial suicide action and prevention legislation contributing to these variations remain to be studied, but these regional differences point towards the need for better consistency of suicide prevention strategies across the country.

OBJECTIF: Les tendances des taux de suicide adolescent et des décès indéterminés au Canada de 1981 à 2012 ont été examinées, en mettant spécialement l'accent sur les variations entre les régions canadiennes. Des hypothèses exploratoires ont été formulées pour la variabilité régionale des taux de suicide adolescent avec le temps au Canada. MÉTHODES: Une analyse descriptive de l'évolution dans le temps utilisant les données des statistiques vitales du domaine public a été menée. Tous les décès de 1981 à 2012 chez les 15 à 19 ans codés comme suicides ou de cause indéterminée selon la Classification internationale des maladies, 9e et 10e révisions, étaient inclus. RÉSULTATS: Même s'il y avait une stabilité générale des taux de suicide adolescent et des décès indéterminés au Canada, les analyses régionales montraient que le Québec a connu une diminution annuelle de 7,6 % entre 2001 et 2012 alors que les Prairies et les provinces de l'Atlantique ont enregistré des hausses annuelles significatives depuis 2001. L'Ontario et la Colombie-Britannique ont eu des fluctuations non significatives depuis 2001. Les tendances sont demeurées semblables généralement en excluant les décès indéterminés des analyses. CONCLUSIONS: Des variations des tendances du suicide adolescent entre les provinces ont été constatées. Les facteurs contribuant à ces variations demeurent à étudier, comme les plans d'action et les mesures législatives provinciales de prévention du suicide. Ces différences régionales indiquent le besoin d'une meilleure cohésion des stratégies de prévention du suicide dans tout le pays.

Performance of International Classification of Diseases-based injury severity measures used to predict in-hospital mortality and intensive care admission among traumatic brain-injured patients.

BACKGROUND: The International Classification of Diseases (ICD) is the main classification system used for population-based traumatic brain injury (TBI) surveillance activities but does not contain direct information on injury severity. International Classification of Diseases-based injury severity measures can be empirically derived or mapped to the Abbreviated Injury Scale, but no single approach has been formally recommended for TBI. OBJECTIVE: The aim of this study was to compare the accuracy of different ICD-based injury severity measures for predicting in-hospital mortality and intensive care unit (ICU) admission in TBI patients. METHODS: We conducted a population-based retrospective cohort study. We identified all patients 16 years or older with a TBI diagnosis who received acute care between April 1, 2006, and March 31, 2013, from the Quebec Hospital Discharge Database. The accuracy of five ICD-based injury severity measures for predicting mortality and ICU admission was compared using measures of discrimination (area under the receiver operating characteristic curve [AUC]) and calibration (calibration plot and the Hosmer-Lemeshow goodness-of-fit statistic). RESULTS: Of 31,087 traumatic brain-injured patients in the study population, 9.0% died in hospital, and 34.4% were admitted to the ICU. Among ICD-based severity measures that were assessed, the multiplied derivative of ICD-based Injury Severity Score (ICISS-Multiplicative) demonstrated the best discriminative ability for predicting in-hospital mortality (AUC, 0.858; 95% confidence interval, 0.852-0.864) and ICU admissions (AUC, 0.813; 95% confidence interval, 0.808-0.818). Calibration assessments showed good agreement between observed and predicted in-hospital mortality for ICISS measures. All severity measures presented high agreement between observed and expected probabilities of ICU admission for all deciles of risk. CONCLUSIONS: The ICD-based injury severity measures can be used to accurately predict in-hospital mortality and ICU admission in TBI patients. The ICISS-Multiplicative generally outperformed other ICD-based injury severity measures and should be preferred to control for differences in baseline characteristics between TBI patients in surveillance activities or injury research when only ICD codes are available. LEVEL OF EVIDENCE: Prognostic study, level III.

Performance of International Classification of Diseases-based injury severity measures used to predict in-hospital mortality: A systematic review and meta-analysis.

BACKGROUND: The International Classification of Diseases (ICD) is the main classification system used for population-based injury surveillance activities but does not contain information on injury severity. ICD-based injury severity measures can be empirically derived or mapped, but no single approach has been formally recommended. This study aimed to compare the performance of ICD-based injury severity measures to predict in-hospital mortality among injury-related admissions. METHODS: A systematic review and a meta-analysis were conducted. MEDLINE, EMBASE, and Global Health databases were searched from their inception through September 2014. Observational studies that assessed the performance of ICD-based injury severity measures to predict in-hospital mortality and reported discriminative ability using the area under a receiver operating characteristic curve (AUC) were included. Metrics of model performance were extracted. Pooled AUC were estimated under random-effects models. RESULTS: Twenty-two eligible studies reported 72 assessments of discrimination on ICD-based injury severity measures. Reported AUC ranged from 0.681 to 0.958. Of the 72 assessments, 46 showed excellent (0.80 ≤ AUC < 0.90) and 6 outstanding (AUC ≥ 0.90) discriminative ability. Pooled AUC for ICD-based Injury Severity Score (ICISS) based on the product of traditional survival proportions was significantly higher than measures based on ICD mapped to Abbreviated Injury Scale (AIS) scores (0.863 vs. 0.825 for ICDMAP-ISS [p = 0.005] and ICDMAP-NISS [p = 0.016]). Similar results were observed when studies were stratified by the type of data used (trauma registry or hospital discharge) or the provenance of survival proportions (internally or externally derived). However, among studies published after 2003 the Trauma Mortality Prediction Model based on ICD-9 codes (TMPM-9) demonstrated superior discriminative ability than ICISS using the product of traditional survival proportions (0.850 vs. 0.802, p = 0.002). Models generally showed poor calibration. CONCLUSION: ICISS using the product of traditional survival proportions and TMPM-9 predict mortality more accurately than those mapped to AIS codes and should be preferred for describing injury severity when ICD is used to record injury diagnoses. LEVEL OF EVIDENCE: Systematic review and meta-analysis, level III.