Characterizing the vulnerability of frequent emergency department users by applying a conceptual framework: a controlled, cross-sectional study.

BACKGROUND: Frequent emergency department (ED) users meet several of the criteria of vulnerability, but this needs to be further examined taking into consideration all vulnerability's different dimensions. This study aimed to characterize frequent ED users and to define risk factors of frequent ED use within a universal health care coverage system, applying a conceptual framework of vulnerability. METHODS: A controlled, cross-sectional study comparing frequent ED users to a control group of non-frequent users was conducted at the Lausanne University Hospital, Switzerland. Frequent users were defined as patients with five or more visits to the ED in the previous 12 months. The two groups were compared using validated scales for each one of the five dimensions of an innovative conceptual framework: socio-demographic characteristics; somatic, mental, and risk-behavior indicators; and use of health care services. Independent t-tests, Wilcoxon rank-sum tests, Pearson's Chi-squared test and Fisher's exact test were used for the comparison. To examine the -related to vulnerability- risk factors for being a frequent ED user, univariate and multivariate logistic regression models were used. RESULTS: We compared 226 frequent users and 173 controls. Frequent users had more vulnerabilities in all five dimensions of the conceptual framework. They were younger, and more often immigrants from low/middle-income countries or unemployed, had more somatic and psychiatric comorbidities, were more often tobacco users, and had more primary care physician (PCP) visits. The most significant frequent ED use risk factors were a history of more than three hospital admissions in the previous 12 months (adj OR:23.2, 95%CI = 9.1-59.2), the absence of a PCP (adj OR:8.4, 95%CI = 2.1-32.7), living less than 5 km from an ED (adj OR:4.4, 95%CI = 2.1-9.0), and household income lower than USD 2,800/month (adj OR:4.3, 95%CI = 2.0-9.2). CONCLUSIONS: Frequent ED users within a universal health coverage system form a highly vulnerable population, when taking into account all five dimensions of a conceptual framework of vulnerability. The predictive factors identified could be useful in the early detection of future frequent users, in order to address their specific needs and decrease vulnerability, a key priority for health care policy makers. Application of the conceptual framework in future research is warranted.

Founding Plaque Programme

A programme for the 1969 ceremony unveiling the Founding Plaque.

Founding Plaque Unveiling

The plaque commemorating the history of Brock is unveiled outside Thistle Complex.

Founding Plaque Unveiling

Dr. Gibson speaks during the unveiling of a historical plaque at Brock.

Founding Plaque Unveiling

Pictured here from left to right are: Dr. Gibson, President of Brock University; James N. Allen, Chairman of the Niagara Parks Commision; MacKenzie Chown, Mayor; and Prof J. M. S. Careless co-chairman of the provinces archaelogical and historic sites board and professor at U of T.

Vulnerability to adverse consequences of drinking and problem drinker status as predicted by risky drinking behaviours, drug use, sex differences and affect : a test of multiple models /

Although alcohol problems and alcohol consumption are related, consumption does not fully account for differences in vulnerability to alcohol problems. Therefore, other factors should account for these differences. Based on previous research, it was hypothesized that risky drinking behaviours, illicit and prescription drug use, affect and sex differences would account for differences in vulnerability to alcohol problems while statistically controlling for overall alcohol consumption. Four models were developed that were intended to test the predictive ability of these factors, three of which tested the predictor sets separately and a fourth which tested them in a combined model. In addition, two distinct criterion variables were regressed on the predictors. One was a measure of the frequency that participants experienced negative consequences that they attributed to their drinking and the other was a measure of the extent to which participants perceived themselves to be problem drinkers. Each of the models was tested on four samples from different populations, including fIrst year university students, university students in their graduating year, a clinical sample of people in treatment for addiction, and a community sample of young adults randomly selected from the general population. Overall, support was found for each of the models and each of the predictors in accounting for differences in vulnerability to alcohol problems. In particular, the frequency with which people become intoxicated, frequency of illicit drug use and high levels of negative affect were strong and consistent predictors of vulnerability to alcohol problems across samples and criterion variables. With the exception of the clinical sample, the combined models predicted vulnerability to negative consequences better than vulnerability to problem drinker status. Among the clinical and community samples the combined model predicted problem drinker status better than in the student samples.

The relationship between early age of first sexual intercourse and vulnerability to depression among adolescents

Past empirical literature has provided conflicted results regarding the association between adolescent coitus and depression. While some studies conclude that those youth who are sexually active may be at risk for depression, others provide contrary results, or findings that are only representative of high-risk sexual behaviors such as intercourse without a condom. Thus, the results are unclear as to whether depression results directly from coitus, or if this relationship is spurious; that is, there may be biological, psychological, or sociological variables that may predict both depression and early sexual intercourse. Using the Add Health restricted dataset, I analyzed the depressive symptomatology of adolescents over a seven-year time period. The final sample (n=6,51O) was comprised of 49.35% male (n=3,213) and 50.65% female (n=3,297) participants. Results indicated that the relationship between earlier adolescent sexual intercourse and later depressive symptomatology is spurious. Although an earlier age of first coitus is predictive of later depressive symptomatology, both variables appear to be concomitant outcomes of the biopsychosocial process. Thus, while one may be able to use early coitus as a marker for subsequent depressive symptomatology, it does not occur because of early coitus. Furthermore, the reverse relationship was not found to be significant in this study. That is, higher levels of depressive symptomatology do not predict an earlier age of first sexual intercourse in adolescents.

Plaque for Poppy Lounge, Morlan Residence Hall, Chapman College, Orange, California

Plaque for Poppy Lounge, Morlan Residence Hall, Chapman College, Orange, California. Text: "DOROTHY BELLE POPPY LOUNGE - this student lounge is the gift of Dorothy Belle Poppy who served students for forthy-five years as a decidcated teacher of latin and english. - 1868 - 1962"

The convergence of psychopathy, self-rated vulnerability, and other-rated vulnerability

Previous research has found that victims of crime tend to exhibit asynchronous movement (e.g. Grayson & Stein, 1981), and the fact that victims display different body language suggests that they may be sending inadvertent signals to their own vulnerability (e.g. Murzynski & Degelman, 1996). Body language has also be en linked with s e l f identification as a victim (Wheeler et aI., 2009), and self-identification has be en found to act as a proxy for more severe victimization (Baumer, 2002) and greater fear of crime (Greenberg & Beach, 2004). The first prediction in the present study, then, was that self-perceived vulnerability would be correlated with body language, while number of previous victimizations mayor may not show the same relationship. Findings from the present study indicate that self-perceived vulnerability exhibits a positive correlation with the body language cues that approaches significance r (10) = .45,p =.07, one-tailed. Different types of victimization, however, were not significantly correlated with these cues. A second goal of the study was to examine the relationship between psychopathic traits and accuracy in judgments of vulnerability. Seventy male participants rated the vulnerability of 12 female targets filmed walking down a hallway who had provided selfratings of vulnerability. Individuals scoring higher on Factor 2 and total psychopathy were significantly less discrepant from target self-rat~ngs of vulnerability, r (64) = - .39,p < .001; r (64) = - .29,p >.01, respectively. The final purpose of this study was to determine which body language cues were mos t salient to raters when making judgments of vulnerability. Participants rated the apparent vulnerability of a target in 7 video clips portraying each body language cue in isolation and a natural walk. Results of repeated measures analyses indicate that the videos rated as most vulnerable to victimization were those displaying low energy and l a ck of synchrony, followed by wide stride, short stride, and stiffknees, while the video displaying ne ck stiffness did not receive significantly different ratings from the mode l ' s natural walk. Replication with a larger sample size is necessary to increase confidence in findings and implications.

World War I Memorial Plaque

World War I Memorial Plaque (17 ½ cm in diameter). This is a bronze plate encased in a 26 ½ cm x 24 cm wooden frame. The inscription on the plate is “He died for freedom and honour, Samuel DeVeaux Woodruff”. [In 1916 the British Government decided to issue a memorial plaque to be given to the relatives of those who died in the Great War. On the plaque is a figure of Britannia who is facing left and holding a laurel wreath over the box where the serviceman’s name is placed. In her right hand she holds a trident which represents Britain’s sea power. There are 2 dolphins facing her on her left and right hand sides. A lion stands in front of her. He faces left with a menacing growl. A very small lion that faces right is located below the larger lion’s feet. He is biting into a winged creature which represents the German Imperial eagle. Near the lion’s right paw there are the initials E CR P which stand for Mr. E. Carter Preston who designed the plate. Some of the plaques include a stamped batch number in front of the lion’s rear left paw. This plaque was produced in batch 17].

Validation in-vivo des techniques d’élastographie ultrasonore, invasive et non-invasive, à l’aide d’un modèle porcin

Il est maintenant admis que la composition de la plaque athérosclérotique est un déterminant majeur de sa vulnérabilité à se rompre. Vu que la composition de la plaque affecte ses propriétés mécaniques, l'évaluation locale des propriétés mécaniques de la plaque d'athérome peut nous informer sur sa vulnérabilité. L'objectif est de comparer les techniques d’élastographie ultrasonores endovasculaire (EVE) et non-invasive (NIVE) en fonction de leur potentiel à identifier les composantes calcifiées et lipidiques de la plaque. Les acquisitions intravasculaire et extravasculaire ont été effectuées sur les artères carotidiennes de neuf porcs hypercholestérolémiques à l’aide d’un cathéter de 20 MHz et d'une sonde linéaire de 7.5 MHz, respectivement. Les valeurs de déformation radiale et axiale, rapportés par EVE et NIVE, ont été corrélées avec le pourcentage des zones histologiques calcifiées et lipidiques pour cinq plaques. Nos résultats démontrent une bonne corrélation positive entre les déformations et les composantes calcifiées (r2 = 0.82, P = 0.034 valeur par EVE et r2 = 0.80, P = 0.041 valeur par NIVE). Une forte corrélation entre les déformations axiales et les contenus lipidiques par NIVE (r2 = 0.92, P-value = 0.010) a été obtenue. En conclusion, NIVE et EVE sont des techniques potentielles pour identifier les composants de la plaque et aider les médecins à diagnostiquer précocement les plaques vulnérables.

Characterization of Carotid Plaques with Ultrasound Non-Invasive Vascular Elastography (NIVE) : Feasibility and Correlation with High-Resolution Magnetic Resonance Imaging

L’accident vasculaire cérébral (AVC) est une cause principale de décès et de morbidité dans le monde; une bonne partie des AVC est causée par la plaque d’athérosclérose carotidienne. La prévention de l’AVC chez les patients ayant une plaque carotidienne demeure controversée, vu les risques et bénéfices ambigus associés au traitement chirurgical ou médical. Plusieurs méthodes d’imagerie ont été développées afin d’étudier la plaque vulnérable (dont le risque est élevé), mais aucune n’est suffisamment validée ou accessible pour permettre une utilisation comme outil de dépistage. L’élastographie non-invasive vasculaire (NIVE) est une technique nouvelle qui cartographie les déformations (élasticité) de la plaque afin de détecter les plaque vulnérables; cette technique n’est pas encore validée cliniquement. Le but de ce projet est d’évaluer la capacité de NIVE de caractériser la composition de la plaque et sa vulnérabilité in vivo chez des patients ayant des plaques sévères carotidiennes, en utilisant comme étalon de référence, l’imagerie par résonance magnétique (IRM) à haute-résolution. Afin de poursuivre cette étude, une connaissance accrue de l’AVC, l’athérosclérose, la plaque vulnérable, ainsi que des techniques actuelles d’imagerie de la plaque carotidienne, est requise. Trente-et-un sujets ont été examinés par NIVE par ultrasonographie et IRM à haute-résolution. Sur 31 plaques, 9 étaient symptomatiques, 17 contenaient des lipides, et 7 étaient vulnérables selon l’IRM. Les déformations étaient significativement plus petites chez les plaques contenant des lipides, avec une sensibilité élevée et une spécificité modérée. Une association quadratique entre la déformation et la quantité de lipide a été trouvée. Les déformations ne pouvaient pas distinguer les plaques vulnérables ou symptomatiques. En conclusion, NIVE par ultrasonographie est faisable chez des patients ayant des sténoses carotidiennes significatives et peut détecter la présence d’un coeur lipidique. Des études supplémentaires de progression de la plaque avec NIVE sont requises afin d’identifier les plaques vulnérables.