Efficient, one-pot synthesis of 14-aryl-14Hdibenzo[a, j]xanthenes in aqueous medium catalyzed by bis-piperidinium compounds

A novel procedure for the synthesis of 14-aryl-14Hdibenzo[a,j]xanthenes through one-pot condensation of b-naphthol with aryl halides in aqueous media catalyzed by bis-piperidinium compounds is described. The method resulted in good to excellent yields in short reaction times

Identifying predictors for focused CT scanning in the ED

Background Appropriate imaging for major trauma patients, in particular deciding between imaging of a single body region or whole body CT (WBCT), is an important aspect of clinical decision making in these patients. This study aimed to identify predictors of injury to a single scan region in major trauma patients. Discussion These findings suggest that patients with examination findings isolated to a single body region may only need isolated imaging to the affected area. These factors, used in conjunction with a clinical decision rule for WBCT may help decide on the appropriate imaging for patient who do not need WBCT imaging

Do Clinical Guidelines for Whole Body Computerised Tomography in Trauma Improve Diagnostic Accuracy and Reduce Unnecessary Investigations? A Systematic Review and Narrative Synthesis.

Introduction Whole body computerised tomography has become a standard of care for the investigation of major trauma patients. However, its use varies widely, and current clinical guidelines are not universally accepted. We undertook a systematic review of the literature to determine whether clinical guidelines for whole body computerised tomography in trauma increase its diagnostic accuracy. Materials and methods A systematic review of Medline, Cinhal and the Cochrane database, supplemented by a manual search of relevant papers was undertaken, with narrative synthesis. Studies comparing clinical guidelines to physician gestalt for the use of whole body computerised tomography in adult trauma were included. Results A total of 887 papers were identified from the electronic databases, and 1 from manual searches. Of these, seven papers fulfilled the inclusion criteria. Two papers compared clinical guidelines with routine practice: one found increased diagnostic accuracy while the other did not. Two papers investigated the performance of established clinical guidelines and demonstrated moderate sensitivity and low specificity. Two papers compared different components of established triage tools in trauma. One paper devised a de novo clinical decision rule, and demonstrated good diagnostic accuracy with the tool. The outcome criteria used to define a ‘positive’ scan varied widely, making direct comparisons between studies impossible. Conclusions Current clinical guidelines for whole body computerised tomography in trauma may increase the sensitivity of the investigation, but the evidence to support this is limited. There is a need to standardise the definition of a ‘clinically significant’ finding on CT to allow better comparison of diagnostic studies

Falling down a flight of stairs: the impact of age and intoxication on injury pattern and severity

Background Falling down a flight of stairs is a common injury mechanism in major trauma patients, but little research has been undertaken into the impact of age and alcohol intoxication on the injury patterns of these patients. Objectives The objective of this study was to compare the impact of age and alcohol intoxication on injury pattern and severity in patients who fell down a flight of stairs. Methods This was a retrospective observational study of prospectively collected trauma registry data from a major trauma centre in the United Kingdom comparing older and younger adult patients admitted to the Emergency Department following a fall down a flight of stairs between July 2012 and March 2015. Results Older patients were more likely to suffer injuries to all body regions, and sustained more severe injuries to the spine (AIS 2[IQR 2 – 3] vs AIS 2 [IQR 2 – 2] p<0.001). They were also more likely to suffer polytrauma (23.6% vs 10.6%; p<0.001). Intoxicated patients were more likely to suffer injuries to the head and neck (42.9% vs 30.5%; p=0.006) and were significantly younger than sober patients (53 years vs 69 years; p<0.001). Conclusion Older patients who fall down a flight of stairs are significantly different from their younger counterparts, with a different injury pattern and a greater likelihood of polytrauma. In addition, alcohol intoxication also affects injury pattern in people who have fallen down a flight of stairs, increasing the risk of traumatic brain injury. Both age and intoxication should be considered when managing these patients

BET 3: Peripheral metaraminol infusion in the emergency department

Three-part question In (adult patients presenting to the ED with sepsis resulting in persistent hypotension not responding to fluid replacement) is a (peripheral metaraminol infusion as effective as central catecholamine infusion) for (maintaining a blood pressure capable of effective organ perfusion)? Clinical scenario A previously fit and well 36-year-old male returns from a holiday to Greece 48 hours ago and presents to the ED complaining of headache, malaise and feeling generally unwell. While waiting to be seen, the patient’s headache rapidly worsens, he spikes a high temperature of 38.9°C, becomes increasingly agitated and starts vomiting. He is taken to a resuscitation cubicle and has a HR of 135 bpm and BP of 71/45 mm Hg. Examination of the patient reveals several small non-blanching petechiae. You manage the patient as suspected meningitis and commence appropriate sepsis management. After administrating 3 L of intravenous fluid, the patient remains with a systolic BP <80 mm Hg. The intensive care doctor informs you that they are trying to make a space available in the intensive treatment unit for this patient but are struggling to step anyone down and the patient must remain in the resuscitation department. The resuscitation nurse asks you to prescribe more fluid. You wonder whether a peripheral metaraminol infusion would be more effective at increasing arterial pressure and maintaining organ perfusion

Methylation of the imprinted GNAS1 gene in cell-free plasma DNA : equal steady-state quantities of methylated and unmethylated DNA in plasma

Background Genomic DNA sequences in cell-free plasma are biomarkers of cancer prognosis, where characteristic changes in methylation of tumour suppressor or oncogene DNA regions are indicative of changes in gene activity. Also, cell-free fetal DNA can be distinguished, by its methylation status, from the maternal DNA in the plasma of pregnant women, hence providing DNA biomarkers for the proposed minimally-invasive diagnosis of fetal aneuploidies, including Down's syndrome. However, the production and clearance of cell-free DNA from plasma in relation to its methylation status, are poorly understood processes. Methods We studied the methylation status of DNA derived from the imprinted GNAS1 locus, in cell-free plasma DNA of healthy adults. Heterozygotes were identified that carried the SNP rs1800905 in the imprinted region. The parent-of-origin-dependent DNA methylation was analysed by bisulfite conversion, followed by cloning and sequencing. Results Genomic DNA molecules derived from both the methylated, maternal, allele and the unmethylated, paternal, allele were found in plasma. Methylated and unmethylated DNA molecules were present in equal numbers. Conclusions Our data indicate that the methylation status of a DNA sequence has no effect on its steady state concentration in the cell-free DNA component of plasma, in healthy adults

History of Human Rights in Canada

Sheridan College, like all post-secondary institutions in Canada, is bound by the obligations set out in federal and provincial human rights legislation. Students and employees also have rights and responsibilities under human rights law. This legal framework informs the EDI work that Sheridan is doing including training, education, research, consultations, dispute resolution and compliance. Yet, human rights protections, as we know them, are a relatively recent development in Canada’s history. It wasn’t until after World War II that laws protecting people from human rights violations really gained traction in this country. Please join us for an informative session on the history of human rights in Canada. Learn about the important role these protections play in creating a just and equal society for everyone

Multi-process modelling approach to complex organisation design

Present day markets require manufacturing enterprises (MEs) to be designed and run in a flexibly structured yet optimised way. However, contemporary approaches to ME engineering do not enable this requirement to capture ME attributes such that suitable processes, resource systems and support services can be readily implemented and changed. This study has developed and prototyped a model-driven environment for the design, optimisation and control of MEs with an embedded capability to handle various types of change. This so called Enriched-Process Modelling (E-MPM) Environment can support the engineering of strategic, tactical and operational processes and comprises two parts: (1) an E-MPM Method that informs, structures, and guides modelling activities required at different stages of ME systems design; and (2) an E-MPM Modelling Framework that specifies interconnections between modelling concepts necessary for the design and run time operation of ME systems. [Continues.

Regenerative endodontics: chart review of treated cases

Immature permanent teeth may develop pulpal pathosis due to caries or trauma and preserving these young teeth is quintessential. The general consensus for clinical treatment of immature teeth with non-vital pulps is Apexification. However, this treatment modality does not result in further root development and increase incidence of root fractures in teeth after apexification. Regenerative Endodontics has been defined as biologically based procedures designed to replace damaged structures such as dentin, root structures, and cells of the pulp-dentin complex. The advantages of pulp revascularization lie in the possibility of further root development and reinforcement of dentinal walls by deposition of hard tissue, thus strengthening the root against fracture. This retrospective study evaluated treated cases by regenerative endodontic procedures performed by Endodontists/endodontic residents in the United States/Canada with a minimum of 1-year recall. The participating Endodontists evaluated the regeneration success parameters as defined by the AAE and filled out a Data Collection Form for each patient. 27 of the 28 submitted cases showed absence of clinical symptoms and apical resolution of pathology at the time of one year follow up; 19 cases showed increase in the root width; 15 cases showed increase in the root length; However none of the cases showed any positive response to pulp vitality tests. The results obtained are promising and prove that pulp regeneration/revascularization is indeed a viable treatment option. Further investigation should be considered with a larger sample size for a valid statistical analysis