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Simulation plays an integral role in the Canadian healthcare system with applications in quality improvement, systems development, and medical education. High-quality, simulation-based research will ensure its effective use. This study sought to summarize simulation-based research activity and its facilitators and barriers, as well as establish priorities for simulation-based research in Canadian emergency medicine (EM).
Simulation-leads from Canadian departments or divisions of EM associated with a general FRCP-EM training program surveyed and documented active EM simulation-based research at their institutions and identified the perceived facilitators and barriers. Priorities for simulation-based research were generated by simulation-leads via a second survey; these were grouped into themes and finally endorsed by consensus during an in-person meeting of simulation leads. Priority themes were also reviewed by senior simulation educators.
Twenty simulation-leads representing all 14 invited institutions participated in the study between February and May, 2018. Sixty-two active, simulation-based research projects were identified (median per institution = 4.5, IQR 4), as well as six common facilitators and five barriers. Forty-nine priorities for simulation-based research were reported and summarized into eight themes: simulation in competency-based medical education, simulation for inter-professional learning, simulation for summative assessment, simulation for continuing professional development, national curricular development, best practices in simulation-based education, simulation-based education outcomes, and simulation as an investigative methodology.
This study summarized simulation-based research activity in EM in Canada, identified its perceived facilitators and barriers, and built national consensus on priority research themes. This represents the first step in the development of a simulation-based research agenda specific to Canadian EM.
For this study, we adapted the Montgomery Borgatta Caregiver Burden Scale, used widely in the United States, to the Saudi Arabian context. To produce an Arabic, culturally sensitive version of the scale, we conducted semi-structured interviews with 20 Saudi family caregivers. The Arabic version of the scale was tested, and participants were asked to comment on the appropriateness of items for the construct of “caregiver burden” using the repertory grid technique and laddering procedure – two constructivist methods derived from personal construct theory. From interview findings, we examined the content of the items and the caregiver burden construct itself. Our findings suggest that the use of constructivist methods to refine constructs and quantitative instruments is highly informative. This strategy is feasible even when little is known about the investigated constructs in the target culture and further elucidates our understanding of cross-cultural variations or invariance of different versions of the scale.
Identifying clinical features that predict conversion to bipolar disorder (BD) in those at high familial risk (HR) would assist in identifying a more focused population for early intervention.
In total 287 participants aged 12–30 (163 HR with a first-degree relative with BD and 124 controls (CONs)) were followed annually for a median of 5 years. We used the baseline presence of DSM-IV depressive, anxiety, behavioural and substance use disorders, as well as a constellation of specific depressive symptoms (as identified by the Probabilistic Approach to Bipolar Depression) to predict the subsequent development of hypo/manic episodes.
At baseline, HR participants were significantly more likely to report ⩾4 Probabilistic features (40.4%) when depressed than CONs (6.7%; p < .05). Nineteen HR subjects later developed either threshold (n = 8; 4.9%) or subthreshold (n = 11; 6.7%) hypo/mania. The presence of ⩾4 Probabilistic features was associated with a seven-fold increase in the risk of ‘conversion’ to threshold BD (hazard ratio = 6.9, p < .05) above and beyond the fourteen-fold increase in risk related to major depressive episodes (MDEs) per se (hazard ratio = 13.9, p < .05). Individual depressive features predicting conversion were psychomotor retardation and ⩾5 MDEs. Behavioural disorders only predicted conversion to subthreshold BD (hazard ratio = 5.23, p < .01), while anxiety and substance disorders did not predict either threshold or subthreshold hypo/mania.
This study suggests that specific depressive characteristics substantially increase the risk of young people at familial risk of BD going on to develop future hypo/manic episodes and may identify a more targeted HR population for the development of early intervention programs.
Geography, Occupations and Social Classes
Andrew R. Holmes, Lecturer in Modern Irish History, Queen's University Belfast,
Eugenio F. Biagini, Professor of Modern and Contemporary History in the University of Cambridge and a Fellow of Sidney Sussex College Cambridge
The Protestants of Ireland are a complex community, made so by social, denominational, political, economic and geographical factors. Since the early seventeenth century, there have been tensions between, on the one hand, Church of Ireland Protestants in the south, the self-styled natural leaders of Ireland with their ties to the land and the state, and, on the other, Presbyterian-dominated Ulster with its tenant farmers, industrial character and often cantankerous disposition. Of course, this simplistic dichotomy obscures social and economic divisions within both communities and the numerically small but dynamic subculture of Protestant churches and sects that have contributed much to the development of the island. Given its often bewildering variety, historians have struggled to describe the complexity of this group.
Confessional State, Enlightenment and Rebellion, 1740–1800
Ireland in the 1740s, according to S. J. Connolly, was an ancien régime society in which religious inequalities were inseparable from social hierarchy and landownership. The dominance of the members of the established episcopal Church of Ireland was predicated on the rights of landed property, not the rights of numbers. The religious allegiance of the Irish population had been determined in the previous century by population movements rather than conversion. Three-quarters to four-fifths of the population were Catholic and though various Protestants were at certain times compelled to make common cause, Irish religious divisions were not simply binary – tensions between Protestants were as important and contributed to the remarkable events of 1798 when Presbyterian rebels in Ulster joined with Catholic insurgents in the south to overthrow in part the political, social and economic ascendancy of episcopal Protestants. The confessional divisions expressed during the Williamite wars had largely subsided by the 1740s. The Age of Reason had cooled somewhat the religious temperature of the previous century, though it was the ‘good behaviour’ of Irish Catholics during the Jacobite risings of 1715 and 1745 that is perhaps more important. The penal laws played their part, but those against Catholic religious practice quickly entered abeyance whereas those concerned with landownership were rigorously enforced.
The Protestant portion of the population of the north of Ireland experienced an extraordinary outburst of religious fervour in 1859. This article provides a critical overview of some of the interpretations of the revival offered by scholars and suggests a number of hitherto ignored themes under three headings: causes, controversies and consequences. The first section moves beyond questions of social and economic determinism to outline the sense of expectancy for revival that was created through the Evangelical reform movement amongst Presbyterians in the north of Ireland. The second considers the controversies of the revival, especially the various physical phenomena that accompanied some conversions, and the Evangelical critique of the revival offered by William McIlwaine and Isaac Nelson. The final section shows how the revival consolidated religious identities in Ulster and contributed to obscuring the dominance of conservative Evangelicalism within the Presbyterian Church.