fall-risk assessment tools exist that show moderate to good validity and reliability in most health service delivery areas. However, few tools were tested more than once or in more than one setting. Therefore, no single tool can be recommended for implementation in all settings or for all subpopulations within each setting.

; for the SpecTRA Study Group IMPORTANCE Sex differences have been described in the presentation, care, and outcomes among people with acute ischemic strokes, but these differences are less understood for minor ischemic cerebrovascular events. The present study hypothesized that, compared with men, women are more likely to report nonfocal symptoms and to receive a stroke mimic diagnosis. OBJECTIVE To evaluate sex differences in the symptoms, diagnoses, and outcomes of patients with acute transient or minor neurologic events. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study of patients with minor ischemic cerebrovascular events or stroke mimics enrolled at multicenter academic emergency departments in Canada between December 2013 and March 2017 and followed up for 90 days is a substudy of SpecTRA (Spectrometry for Transient Ischemic Attack Rapid Assessment). In total, 1729 consecutive consenting patients with acute transient or minor neurologic symptoms were referred for neurologic evaluation; 66 patients were excluded for protocol violation (n = 46) or diagnosis of transient global amnesia (n = 20). EXPOSURES The main exposure was female or male sex. MAIN OUTCOMES AND MEASURES The main outcome was the clinical diagnosis (cerebral ischemia vs stroke mimic). Secondary outcomes were 90-day stroke recurrence and 90-day composite outcome of stroke, myocardial infarction, or death. The association between presenting symptoms (focal vs nonfocal) and clinical diagnosis was also assessed. Research hypotheses were formulated after data collection. RESULTS Of 1648 patients included, 770 (46.7%) were women, the median (interquartile range) age was 70 (59-80) years, 1509 patients (91.6%) underwent brain magnetic resonance imaging, and 1582 patients (96.0%) completed the 90-day follow-up. Women (522 of 770 [67.8%]) were less likely than men (674 of 878 [76.8%]) to receive a diagnosis of cerebral ischemia (adjusted risk ratio [aRR], 0.88; 95% CI, 0.82-0.95), but the 90-day stroke recurrence outcome (aRR, 0.90; 95% CI, 0.48-1.66) and 90-day composite outcome (aRR, 0.86; 95% CI, 0.54-1.32) were similar for men and women. No significant sex differences were found for presenting symptoms. Compared with patients with no focal neurologic symptoms, those with focal and nonfocal symptoms were more likely to receive a diagnosis of cerebral ischemia (aRR, 1.28; 95% CI, 1.15-1.39), but the risk was highest among patients with focal symptoms only (aRR, 1.45; 95% CI, 1.34-1.53). Sex did not modify these associations. CONCLUSIONS AND RELEVANCE The results of the present study suggest that, despite similar presenting symptoms among men and women, women may be more likely to receive a diagnosis of stroke mimic, but they may not have a lower risk than men of subsequent vascular events, indicating potentially missed opportunities for prevention of vascular events among women.

Despite continued cases of sudden in-custody death in subjects who are restrained, little is understood about the incidence of sudden death, its underlying pathophysiology, or its actual relationship to subject positioning. This paper reports data from 4828 consecutive use of force events (August 2006-March 2013 in 7 Canadian police agencies in 4 cities including Eastern and Western Canada. Methods: Human subjects committee approval was obtained in each city with approval for enrolment of subjects without consent. Consecutive subjects aged >18 years who were involved in a police use of force event were included regardless of the cause or outcome. Officers prospectively documented the final resting position of the subject, whether there was knowledge or suspicion that the subject was intoxicated with alcohol and/or drugs, suffering from emotional distress or any combination of those, the number and nature of a standardized list of features of excited delirium present, and the use of all force modalities alone or in combination. Our outcome of interest was sudden, unexpected in-custody death. Confidence intervals for differences were considered significant if the 95% confidence interval for the difference did not include zero. Assuming an alpha error of 5%, a beta error of 20%, a sample size of 1945 subjects per group gives our study 80% power to detect a difference of 0.5% in sudden death between the prone and not prone position. Results: During the study there were over 3.25 million consecutive police-public interactions; use of force occurred in 4,828 subjects (0.1% of police public interactions; 95% CI = 0.1%, 0.1%). 90% of subjects had complete information on positioning; none of the subjects without documentation of positioning died. Subjects were usually male (87.5%); median age 32 years. Subjects were abnormal with 81.5% of subjects documented to have one or more of alcohol and/or drug intoxication, and/or psychiatric/emotional distress at the scene. Significantly more subjects remained in a non-prone vs. prone position; yet over 2000 subjects remained prone. Although 5.3% more subjects with any assessed comorbidity were in the "not-prone" position, over 1500 with any assessed comorbidity were prone. Significantly more individuals with >3 features of excited delirium were not-prone while significantly more subjects with drug intoxication alone were in prone. There was no difference in CEW deployment in any mode between the positions. One individual died suddenly and unexpectedly; the individual was in the not prone position and exhibited all 10 features of excited delirium. No subject died in the prone position. In a worst case scenario our confidence intervals indicate, with a high degree of precision, that 99.8% of subjects would be expected to survive being in either the prone or notprone position following police use of force. Conclusions: Prone positioning is common following police-public interactions. In this study no subject died among thousands who remained in the prone position after po...

Background: There is a lack of understanding about the patterns and rates of CAM use among older adults owing to a lack of research on specific types of CAM. Objectives: This study examines several dimensions of self-care deemed to be associated with CAM. Unmet health care needs, self-care attitudes, and spirituality are interpreted as health belief structures underlying CAM. Methods: Logistic regression analysis was used to examine use of three groups of practitioner-based CAM: (a) chiropractic; (b) massage, and (c) acupuncture, homeopathy and/or naturopathy use. We analyze a subsample of 4,401 older adults drawn from the 1996/1997 and 1998/1999 waves of the Canadian National Population Health Survey. Results: The logistic regression analyses indicate that self-care attitude and spirituality represent important predictors of practitioner-based CAM use. The associations for unmet health care needs were not supported. The strongest factors associated with CAM use were the illness context variables, which suggest that measures of need are key factors in leading individuals to seek other forms of health care. Discussion: Practitioner-based CAM use among older adults is influenced by self-care attitude and spirituality, in addition to health status, but to varying degrees depending on the type of CAM. Support of these self-care facets suggests that there is a desire on the part of consumers to exercise choice and to participate in health care decisions when considering CAM.

Univariate analyses suggest insulin-like growth factor-binding protein 3 and serum paraoxonase/lactonase 3 are reliable and reproducible biomarkers for TIA status. Logistic regression models indicated L-selectin, apolipoprotein B-100, coagulation factor IX, and thrombospondin-1 to be significant multivariate predictors of TIA. We discuss multivariate feature subset analyses as an exploratory technique to better understand a panel's full predictive potential.