Electric scooter related injuries in Calgary emergency departments.

OBJECTIVES: Electric scooters (e-scooters) have contributed to a rise in injury burden and emergency department (ED) utilization since their local introduction 3 years ago. This study is a novel collaboration between the City of Calgary's Department of Transportation and emergency medicine researchers to better understand the nature and frequencies of e-scooter injuries. It quantifies the incidence and characteristics of e-scooter related injuries treated in Calgary EDs/urgent care centres (UCCs). METHODS: Administrative data from electronic medical records of all patients presenting to Adult Emergency Departments and one Urgent Care Centre in Calgary with an e-scooter related injury between July 8, 2019, and Oct 1, 2019, and May 22, 2020, and September 30, 2020 were collected. Additional data were obtained from paper EMS reports. Descriptive statistics were used to characterize injury-specific variables and comparisons were drawn between ED visits for other transportation modalities. RESULTS: 1272 ED/urgent care visits were attributed to an e-scooter related incident. The majority of incidents occurred between 20:00 and 24:00 (47%). Most injuries occurred to the lower limb (54.8%), followed by facial injuries (42.9%). The overwhelming majority of injuries happened to the e-scooter drivers (97.6%). E-scooter injuries made up approximately 15% of all trauma presentations to Calgary area adult EDs during the e-scooter season and 1 in 1400 e-scooter rides resulted in a visit to an ED/UCC. CONCLUSIONS: Traumatic ED visits related to e-scooter use represent an increasing burden of preventable injuries. This study identified specific characteristics to focus future education and public policy efforts on.

RéSUMé: OBJECTIFS: Les scooters électriques (e-scooters) ont contribué à une augmentation du fardeau des blessures et de l'utilisation des services d'urgence (SU) depuis leur introduction locale il y a trois ans. Cette étude est une nouvelle collaboration entre le Département des transports de la Ville de Calgary et des chercheurs en médecine d'urgence afin de mieux comprendre la nature et la fréquence des blessures causées par le scooter électrique. Il quantifie l'incidence et les caractéristiques des blessures liées aux scooters électriques traitées dans les services d'urgence/soins d'urgence de Calgary. MéTHODES: Données administratives provenant des dossiers médicaux électroniques de tous les patients se présentant aux services d'urgence pour adultes et à un centre de soins d'urgence de Calgary avec une blessure liée à un scooter électrique entre le 8 juillet 2019 et le 1er octobre 2019 et entre le 22 mai 2020 et le 30 septembre 2020. Des données supplémentaires ont été obtenues à partir des rapports papier des SMU. Des statistiques descriptives ont été utilisées pour caractériser les variables spécifiques aux blessures et des comparaisons ont été établies entre les visites aux urgences pour les autres modes de transport. RéSULTATS: 1 272 visites aux urgences ou aux soins d'urgence ont été attribuées à un incident lié à un scooter électrique. La majorité des incidents se sont produits entre 20 h 00 et 24 h 00 (47 %). La plupart des blessures se sont produites au niveau des membres inférieurs (54,8 %), suivies des blessures au visage (42,9 %). La grande majorité des blessures sont survenues chez les conducteurs de scooters électriques (97,6 %). Les blessures liées aux scooters électriques représentent environ 3,5 % de toutes les présentations de traumatismes dans les services d'urgence pour adultes de la région de Calgary et 1 sur 1 400 trajets en scooter électrique a entraîné l'admission dans un service d'urgence. CONCLUSIONS: Les visites aux urgences traumatiques liées à l'utilisation des scooters électriques représentent une charge croissante de blessures évitables. Cette étude a identifié des caractéristiques spécifiques sur lesquelles il convient de concentrer les efforts futurs en matière d'éducation et de politique publique.

Impact of the ICD-9-CM to ICD-10-CM transition on the incidence of severe maternal morbidity among delivery hospitalizations in the United States.

BACKGROUND: Surveillance of maternal mortality and severe maternal morbidity is important to identify temporal trends, evaluate the impact of clinical practice changes or interventions, and monitor quality of care. A common source for severe maternal morbidity surveillance is hospital discharge data. On October 1, 2015, all hospitals in the United States transitioned from the International Classification of Diseases, Ninth Revision, Clinical Modification to the International Classification of Diseases, Tenth Revision, Clinical Modification coding for diagnoses and procedures. OBJECTIVE: This study aimed to evaluate the impact of the transition from the International Classification of Diseases, Ninth Revision, Clinical Modification to the International Classification of Diseases, Tenth Revision, Clinical Modification coding systems on the incidence of severe maternal morbidity in the United States in hospital discharge data. STUDY DESIGN: Using data from the National Inpatient Sample, obstetrical deliveries between January 1, 2012, and December 31, 2017, were identified using a validated case definition. Severe maternal morbidity was defined using the International Classification of Diseases, Ninth Revision, Clinical Modification (January 1, 2012, to September 30, 2015) and the International Classification of Diseases, Tenth Revision, Clinical Modification (October 1, 2015, to December 31, 2017) codes provided by the Centers for Disease Control and Prevention. An interrupted time series and segmented regression analysis was used to assess the impact of the transition from the International Classification of Diseases, Ninth Revision, Clinical Modification to the International Classification of Diseases, Tenth Revision, Clinical Modification coding on the incidence of severe maternal morbidity per 1000 obstetrical deliveries. RESULTS: From 22,751,941 deliveries, the incidence of severe maternal morbidity in the International Classification of Diseases, Ninth Revision, Clinical Modification coding era was 19.04 per 1000 obstetrical deliveries and decreased to 17.39 per 1000 obstetrical deliveries in the International Classification of Diseases, Tenth Revision, Clinical Modification coding era (P<.001). The transition to International Classification of Diseases, Tenth Revision, Clinical Modification coding led to an immediate decrease in the incidence of severe maternal morbidity (-2.26 cases of 1000 obstetrical deliveries) (P<.001). When blood products transfusion was removed from the case definition, the magnitude of the decrease in the incidence of SMM was much smaller (-0.60 cases/1000 obstetric deliveries), but still significant (P<.001). CONCLUSION: After the transition to the International Classification of Diseases, Tenth Revision, Clinical Modification coding for health diagnoses and procedures in the United States, there was an abrupt statistically significant and clinically meaningful decrease in the incidence of severe maternal morbidity in hospital discharge data. Changes in the underlying health of the obstetrical population are unlikely to explain the sudden change in severe maternal morbidity. Although much work has been done to validate the International Classification of Diseases, Ninth Revision, Clinical Modification codes for severe maternal morbidity, it is critical that validation studies be undertaken to validate the International Classification of Diseases, Tenth Revision, Clinical Modification codes for severe maternal morbidity to permit ongoing surveillance, quality improvement, and research activities that rely on hospital discharge data.

Surgical errors and complications following cesarean delivery in the United States.

BACKGROUND: Cesarean delivery is the most common inpatient surgery performed internationally. Although cesarean delivery is typically performed to prevent adverse maternal and fetal outcomes, there is still a risk of surgical errors and complications. This study examined maternal and hospital risk factors associated with errors and complications following cesarean delivery in the United States. OBJECTIVE: To determine the prevalence of, and associated individual- and hospital-level risk factors for, surgical errors and complications following cesarean delivery in the United States. MATERIALS AND METHODS: Data were obtained from the 2012-2014 National Inpatient Sample. Surgical errors (eg,. foreign body retained during surgery, anesthetic error) can be the result of human error, whereas complications (eg, mortality, postpartum hemorrhage) can be due to external factors such as pre-existing comorbidities. The overall prevalence of surgical errors and complications in cesarean delivery was calculated. Multilevel logistic regression models were used to examine the association between individual and hospital characteristics and surgical errors/complications. RESULTS: Among 648,584 cesarean delivery hospitalizations, 1.98% (95% confidence interval, 1.95-2.01%) and 8.43% (95% confidence interval, 8.40-8.46%) of women had an error or complication, respectively. The most common errors were anesthetic errors, errors involving blood vessels, and errors involving the bladder. The most common complications were postpartum hemorrhage, infection, and hysterectomy. Both individual- and hospital-level factors were associated with errors and complications. Women with Medicaid insurance had increased odds of errors (odds ratio, 1.40; 95% confidence interval, 1.37-1.43) but lower odds of complications (odds ratio, 0.89; 95% confidence interval, 0.88-0.90) compared to women with private insurance. Compared to non-Hispanic white women, women of all races had lower odds of error, and only non-Hispanic black women had greater odds of complications (odds ratio, 1.14; 95% confidence interval, 1.13-1.16). Similarly, rural hospitals had lower odds of surgical errors (odds ratio, 0.59; 95% confidence interval, 0.56-0.62) and complications (odds ratio, 0.61; 95% confidence interval, 0.59-0.62), whereas hospitals with a large bed number had greater odds of errors and complications than medium-bed size hospitals, at 1.13 (95% confidence interval, 1.09-1.17), and 1.13 (95% confidence interval, 1.11-1.15), respectively. CONCLUSION: This study identified specific risk factors for errors and complications that can be further examined through quality improvement frameworks to reduce the prevalence of adverse maternal events during cesarean delivery.

A Cross-Sectional Study of the Awareness and Implementation of the National Standard of Canada for Psychological Health and Safety in the Workplace in Canadian Employers.

OBJECTIVES: The National Standard of Canada for Psychological Health and Safety in the Workplace (the Standard) was released in 2013. The objectives of this study were to 1) estimate the proportion of Canadian employers who were aware of the Standard, 2) examine the extent to which the Standard has been implemented, and 3) describe perceived barriers to implementing the Standard in Canadian organizations. METHODS: A cross-sectional survey in Canadian employers was conducted between February 2015 and January 2017. A random sample of Canadian employers was selected, and the individuals who were knowledgeable about the occupational health policies of the organizations were interviewed by telephone. The participants answered questions about the awareness, implementation, perceived effects, and barriers to implementation. Descriptive statistics and chi-square tests were used to characterize the results. RESULTS: A total of 1010 companies participated in the study. Overall, 17.0% reported that they were aware of the Standard; 1.7% and 20.3% reported that their organizations had implemented the entirety or elements of the Standard, respectively; and 71.4% of participants believed that elements of the Standard would be implemented within the next year. The perceived effects associated with implementation of the Standard included increased job satisfaction and employee retention while the greatest barrier to implementing the Standard was the belief that psychological health and safety are irrelevant in the workplace. CONCLUSIONS: Many Canadian employers are still unaware of the Standard's existence; however, most Canadian employers are positively inclined toward the Standard in its potential to help employee productivity and job satisfaction.

Superabsorbent hydrogel based on sulfonated-starch for improving water and saline absorbency.

The agriculture sectors in many developing countries have been suffering from water shortage and decreasing crop yields. Thus, an increasing interest has been emerged to develop much-needed solutions for a more sustainable management of water resources. Agricultural hydrogel that absorbs many times of its weight in water has been used to distribute into dry regions in order to improve the soil's ability to absorb and retain water. Here, amphoteric superabsorbent hydrogel is prepared by indirect method based on anionic starch bearing sulfonate groups. Anionic starch derivatives were graft-polymerized with acrylonitrile (AN) and hydrolyzed by alkaline by which nitrile groups were converted to hydrophilic functional groups. The hydrolyzed sodium starch sulfate-g-polyacrylonitrile (HSSS-g-PAN) copolymer exhibited improved water and saline absorbencies compared to that of native starch-based hydrogel. The co-polymerization was conducted for 60min polymerization time, 0.75% (wt/wt) ammonium persulfate (APS) associated with sodium bisulfite, SBS, (50% (wt/wt) of APS), 65°C for polymerization temperature and double molar ratio of acrylonitrile to the starch derivatives. The hydrogel based on the sulfonated starch derivatives 1 and 2 showed superior water absorbency for both distilled (250% and 190% respectively) and saline (90% and 70%) solutions over that of the native starch.

Evaluation of vitamin D status bone mineral density and dental health in children with cholestasis.

BACKGROUND: Hepatic osteodystrophy caused by vitamin D and calcium malabsorption is thought to develop in children with cholestatic liver disease leading to secondary hyperparathyroidism and rickets or osteomalacia. The aim of this study was to evaluate the dental and bone mineral densities and the serum level of vitamin D in cholestatic infants and children and to correlate this process with clinical and laboratory parameters. METHODS: This is a cross-sectional study that include 50 patients presenting with cholestasis. Thirty age and sex matched controls recruited not complaining of liver disease. All cases were subjected to full history taking, clinical and dental examination, 25(OH)D level, ALT, AST, bilirubin, albumin, GGT, alkaline phosphatase, PT, INR, calcium, corrected calcium, phosphorus and DXA scan to those above 5 years old. Controls were subjected to measuring the serum levels of 25(OH)D, total bilirubin, direct bilirubin, ALT, GGT, AST, PT, INR, alkaline phosphatase, albumin, calcium and phosphorus. RESULTS: Out of the 50 cases; 23 were females (46%), with a mean age of 6.17±3.9 years ranging from 1.1 to 17 years. Twenty-eight of the cases had signs of rickets (56%), 6 of them had bone fracture (12%) and 42.8% had milky teeth caries. The level of 25(OH) vitamin D was below normal range in around half of the patients. There was significant difference between cases and controls in calcium and phosphorus levels, ALT and alkaline phosphatase. Low bone mineral density (BMD) was present in 50% and 5 cases (17.9%) were diagnosed as having osteoporosis. There was a negative correlation between the Z-score, BMD of total body, BMD and bone mineral content (BMC) of spine and total and direct bilirubin. There was a positive correlation between (BMD of total body, spine and BMC of spine) and serum phosphorus, alkaline phosphatase and albumin. There was a positive correlation between the Z-score of total body and serum calcium. CONCLUSION: Decreased level of 25-OH vitamin D is present in more than half of cholestatic patients, and is correlated positively to serum calcium. Decreased BMD was present in more than half of studied cholestatic patients correlated to the low serum calcium rather than the vitamin D level. The decreased BMD and the dental affection in cholestatic children is related to the level of hyperbilirubinemia.

New technique in starch nanoparticles synthesis.

Starch nanoparticles (StNPs) were previously prepared using severe mechanical, physical and/or chemical conditions that takes too long time to produce a little yield of uncontrolled large size of StNP. The current work presents a new technique for the synthesis of StNPs based on the combination between sodium hydroxide and glycerol in aqueous medium during the synthesis process while the precipitation of the StNPs is performed under homogenization at ambient conditions. The new technique is based on three assumptions: 1) the dual impact of sodium hydroxide and glycerol on the swelling and gelatinization of starch as a pre-stage of the synthesis of (StNPs1), 2) the dual impact of glycerol and cooking of starch on the swelling and gelatinization of starch as a pre-stage of the formation of (StNPs2), and 3) the precipitation under homogenization at ambient conditions and its effect on breaking the H- bonds of the starch molecule in both StNPs1 and StNPs2. The importance of this technique arises from the ease of the process, the eco-friendly chemicals and the combination between the mechanical and chemical processes. NS (native starch), StNPs1 and StNPs2 were characterized using FTIR, XRD, TGA and TEM. TEM of StNPs1 showed a well-defined round particles uniformly distributed with size of about 62.5nm. StNPs2 showed a non-specific shape starch particles.

A novel photo-grafting of acrylamide onto carboxymethyl starch. 1. Utilization of CMS-g-PAAm in easy care finishing of cotton fabrics.

The photosensitized grafting of vinyl monomers onto a range of polymeric substrates has been the subject of particular interest in the recent past. Carboxymethyl starch (CMS)-poly acrylamide (PAAm) graft copolymer (CMS-g-PAAm) with high graft yield was successfully prepared by grafting of acrylamide onto CMS using UV irradiation in the presence of the water soluble 4-(trimethyl ammoniummethyl) benzophenone chloride photoinitiator. CMS-g-PAAm with nitrogen content of 8.3% and grafting efficiency up to 98.9% was obtained using 100% AAm, a material: liquor ratio of 1:14 and 1% photinitiator at 30°C for 1h of UV irradiation. The synthesis of CMS-g-PAAm was confirmed by FTIR and Nitrogen content (%). Surface morphology of CMS and surface morphological changes of CMS after grafting with AAm were studied using SEM. Thermal properties of both CMS and CMS-g-PAAm were studied using TGA and DSC. To impart easy care finishing to cotton fabrics, aqueous formulations of: CMS-g-PAAm, dimethylol dihydroxy ethylene urea (DMDHEU), CMS-g-PAAm-DMDHEU mixture or methylolated CMS-g-PAAm were used. Cotton fabrics were padded in these formulations, squeezed to a wet pick up 100%, dried at 100°C for 5min, cured at 150°C for 5min, washed at 50°C for 10min and air-dried. CRA (crease recovery angle) of untreated fabrics and fabrics finished with a mixture of 2% CMS-g-PAAm and 10% DMDHEU or methylolated CMS-g-PAAm (10% formaldehyde) were: 136°, 190°, 288° respectively. Increasing the number of washing cycles up to five cycles results in an insignificant decrease in the CRA and a significant decrease in RF (releasable formaldehyde) of finished fabric samples. The morphologies of the finished and unfinished cotton fabrics were performed by SEM.

Enhancement of flame retardancy and water repellency properties of cotton fabrics using silanol based nano composites.

Environmental concerns related to fluorinated and organophosphorus compounds led to a consideration of the methods for imparting flame retardancy and water/oil repellency to textiles. A simple and facile method for fabricating the cotton fabric with superhydrophobicity and flame retardancy is described in the present work. Complex coating with amino-functionalized silica nano-particles on epoxy-functionalized cotton accompanied with ZnO nano-particles coating are carried out. In This context, new preparation techniques were used to prepare both aminated silica and ZnO nano-particles. The particle size was investigated using Transition Electron Microscope (TEM) and the chemical structure was investigated using FT-IR analysis and other analytical techniques. Cotton was functionalized with epoxy and carboxyl via grafting cotton with nano-emulsion consisted of mixture of glycidyl methacrylate (GMA) and acrylic acid (AA), and then treated for functional finishing through conventional pad-dry-cure method. The treated fabrics showed good water repellency and excellent flame retardant properties as determined by the standard test methods.