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Introduction: Simulation has assumed an integral role in the Canadian healthcare system with applications in quality improvement, systems development, and medical education. High quality simulation-based research (SBR) is required to ensure the effective and efficient use of this tool. This study sought to establish national SBR priorities and describe the barriers and facilitators of SBR in Emergency Medicine (EM) in Canada. Methods: Simulation leads (SLs) from all fourteen Canadian Departments or Divisions of EM associated with an adult FRCP-EM training program were invited to participate in three surveys and a final consensus meeting. The first survey documented active EM SBR projects. Rounds two and three established and ranked priorities for SBR and identified the perceived barriers and facilitators to SBR at each site. Surveys were completed by SLs at each participating institution, and priority research themes were reviewed by senior faculty for broad input and review. Results: Twenty SLs representing all 14 invited institutions participated in all three rounds of the study. 60 active SBR projects were identified, an average of 4.3 per institution (range 0-17). 49 priorities for SBR in Canada were defined and summarized into seven priority research themes. An additional theme was identified by the senior reviewing faculty. 41 barriers and 34 facilitators of SBR were identified and grouped by theme. Fourteen SLs representing 12 institutions attended the consensus meeting and vetted the final list of eight priority research themes for SBR in Canada: simulation in CBME, simulation for interdisciplinary and 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. Conclusion: Conclusion: This study has summarized the current SBR activity in EM in Canada, as well as its perceived barriers and facilitators. We also provide a consensus on priority research themes in SBR in EM from the perspective of Canadian simulation leaders. This group of SLs has formed a national simulation-based research group which aims to address these identified priorities with multicenter collaborative studies.
We calculate the extended X-ray absorption fine structure by treating the ejected photoelectron as a spherical wave which expands in the lattice and is partially scattered by neighbors of the absorbing atom. The neighboring atoms are treated as point scattered and the total scattered wave is summed from the waves scattered by each atom. The fine structure is determined from the dipole transition matrix between the initial K-state and the final photoelectron state. Calculations compare favorably with experimental data.
Multicaloric materials show thermal changes that can be driven simultaneously or sequentially by more than one type of external field. The use of more than one driving field can induce larger thermal changes, with smaller field magnitudes, over wider ranges of operating temperature, and can also eliminate hysteresis in one control parameter by transferring it to another. The thermodynamics behind multicaloric effects is well established, but only a small number of multicaloric materials have been experimentally studied to date. Here, we describe the fundamentals of multicaloric effects and discuss the performance of representative multicaloric materials. Exploiting multicaloric effects could aid the future development of cooling devices, where key challenges include energy efficiency and the span of the operating temperature.
The total amount of dietary protein available for absorption is dependent on the flow of dietary nitrogen (N) to the duodenum and its intestinal digestibility. Variation in intestinal digestion among protein supplements has been reported in vivo (Stern et al., 1985) and in situ (Hvelplund, 1985). Obtaining estimates of protein digestion in the small intestine is expensive, labour intensive and requires the use of surgically prepared animals. The objective of this study was to develop a reliable in vitro technique to estimate intestinal digestion of proteins in ruminants.
During the last two decades, there has been increased interest in planting halophytes in the salty agricultural regions of central Iran for improved animal production and environmental protection. The aim of this study was to determine the chemical composition and protein digestibility of some halophytes (Atriplex sp., Sauda sp., Kochia sp. and Gamanthus sp.) using in vitro technique, and mobile nylon bag and three step procedures.
This paper describes a new, environmentally friendly drilling technique for making short-and long-term access boreholes in shelf glaciers using lightweight drills. The new drilling technique was successfully developed for installation of small-diameter sensors under the Ross Ice Shelf through ~ 193 m thick ice at Windless Bight, McMurdo Ice Shelf, Antarctica. The two access boreholes were drilled and sensors installed in 110 working hours. The total weight of the drilling equipment including the power system and fuel is <400 kg. Installation of small-diameter sensors was possible for 1.8– 6 hours after penetration through the glacier into the sea water beneath. The new drilling technique does not require drilling fluid and therefore has minimal environmental impact. It should permit access through ice-shelf ice up to 350 m thick, or glaciers on grounded ice or subglacial lakes if there is no water-permeable interface at the base. Modifications, presented in this work, of the drilling equipment and protocol will allow for (1) ~ 21 working hours for penetration through 200 m of ice, (2) installation of sensors up to 120 mm in diameter and (3) drilling long-term open boreholes through 400 m thick ice in 100 working hours.
Suicide is a devastating public health problem and very few biological treatments have been found to be effective for quickly reducing the intensity of suicidal ideation (SI). We have previously shown that a single dose of ketamine, a glutamate N-methyl-d-aspartate (NMDA) receptor antagonist, is associated with a rapid reduction in depressive symptom severity and SI in patients with treatment-resistant depression.
We conducted a randomized, controlled trial of ketamine in patients with mood and anxiety spectrum disorders who presented with clinically significant SI (n = 24). Patients received a single infusion of ketamine or midazolam (as an active placebo) in addition to standard of care. SI measured using the Beck Scale for Suicidal Ideation (BSI) 24 h post-treatment represented the primary outcome. Secondary outcomes included the Montgomery–Asberg Depression Rating Scale – Suicidal Ideation (MADRS-SI) score at 24 h and additional measures beyond the 24-h time-point.
The intervention was well tolerated and no dropouts occurred during the primary 7-day assessment period. BSI score was not different between the treatment groups at 24 h (p = 0.32); however, a significant difference emerged at 48 h (p = 0.047). MADRS-SI score was lower in the ketamine group compared to midazolam group at 24 h (p = 0.05). The treatment effect was no longer significant at the end of the 7-day assessment period.
The current findings provide initial support for the safety and tolerability of ketamine as an intervention for SI in patients who are at elevated risk for suicidal behavior. Larger, well-powered studies are warranted.
The behavioral and psychological symptoms associated with dementia (BPSD) can be burdensome to informal/family caregivers, negatively affecting mental health and expediting the institutionalization of patients. Because the dementia patient–caregiver relationship extends over long periods of time, it is useful to examine how BPSD impact caregiver depressive symptoms at varied stages of illness. The goal of this study was to assess the association of BPSD that occur during early stage dementia with subsequent caregiver depressive symptoms.
Patients were followed from the early stages of dementia every six months for up to 12 years or until death (n = 160). Caregiver symptoms were assessed on average 4.5 years following patient's early dementia behaviors. A generalized estimating equation (GEE) extension of the logistic regression model was used to determine the association between informal caregiver depressive symptoms and BPSD symptoms that occurred at the earliest stages dementia, including those persistent during the first year of dementia diagnosis.
BPSD were common in early dementia. None of the individual symptoms observed during the first year of early stage dementia significantly impacted subsequent caregiver depressive symptoms. Only patient agitation/aggression was associated with subsequent caregiver depressive symptoms (OR = 1.76; 95% CI = 1.04–2.97) after controlling for concurrent BPSD, although not in fully adjusted models.
Persistent agitation/aggression early in dementia diagnosis may be associated with subsequent depressive symptoms in caregivers. Future longitudinal analyses of the dementia caregiving relationship should continue to examine the negative impact of persistent agitation/aggression in the diagnosis of early stage dementia on caregivers.
NASA's NuSTAR observatory is the first focusing hard X-ray telescope. Launched in June 2012, NuSTAR is sensitive in the 3–79 keV range with unprecedented ~17″ FWHM angular resolution above 12 keV, a result of its multilayer-coated optics and 10-m focal length. With its large effective area (900 cm2 at 10 keV), NuSTAR has point-source sensitivity ~100 times better than previous hard X-ray telescopes. Here we describe NuSTAR and its planned work on rotation-powered pulsars and magnetars during its nominal 2-yr baseline mission that has just commenced.
A defining characteristic of many rainfed tropical agricultural systems is their vulnerability to weather variability. There is now increased attention paid to climate-agriculture links as the world is focused on climate change. This has shown the need for increased understanding of current and future climate and the links to agricultural investment decisions, particularly farmers’ decisions, and that integrated strategies for coping with climate change need to start with managing current climate risk. Research, largely from an Association for Strengthening Agricultural Research in Eastern and Central Africa (ASARECA) project to demonstrate the value of such increased understanding, is presented in this issue of the journal. Key lessons from this research are as follows:
1.Statistical methods of analysis of historical climate data that are relevant to agriculture need not be complex. The most critical point is to describe the climate in terms of events of direct relevance to farming (such as the date of the start of a rainy season) rather than simple standard measures (such as annual total rainfall).
2.Analysis requires access to relevant data, tools and expertise. Daily climate data, both current and historical, are primarily the responsibility of national meteorological services (NMS). Accessing such data, particularly daily data, is not always easy. Including staff from the NMS as research partners, not just data providers, can reduce this problem.
3.Farmers’ perceptions of climate variation, risk and change are complex. They are keenly aware of variability, but there is evidence that they over-estimate risks of negative impacts and thereby fail to make use of good conditions when they occur. There is also evidence that multiple causes of changes are confounded, so farmers who observe decreasing crop production may not be distinguishing between rainfall change and declining soil fertility or other conditions. Hence any project working with farmers’ coping and adaptation to climate must also have access to analyses of observed climate data from nearby recording stations.
4.Mechanisms for reducing and coping with risks are exemplified in pastoral systems that exist in the most variable environments. New approaches to risk transfer, such as index-based insurance, show potential for positive impact.
5.Skilful seasonal forecasts, which give a better indication of the coming season than a simple average, would help farmers take decisions for the coming cropping season. Increasing meteorological knowledge shows that such forecasting is possible for parts of Africa. There are institutional barriers to farmers accessing and using the forecast information. Furthermore, the skill of the forecasts is currently limited so that there are maybe still only a few rational choices for a farmer to make on the basis of a forecast.
With the justified current interest in climate and agriculture, all stakeholders including researchers, data providers, policy developers and extension workers will need to work together to ensure that interventions are based on a correct interpretation of a valid analysis of relevant data.
Rainfall variability, both within and between seasons, is reflected in highly variable crop growth and yields in rainfed agriculture in sub-Saharan Africa and results in varying degrees of weather-induced risk associated with a wide range of crop, soil and water management innovations. In addition there is both growing evidence and concern that changes in rainfall patterns associated with global warming may substantively affect the nature of such risk. Eighty-nine years of daily rainfall data from a site in southern Zambia are analysed. The analyses illustrate approaches to assessing the extent of possible trends in rainfall patterns and the calculation of weather-induced risk associated with the inter- and intra-seasonal variability of the rainfall amounts. Trend analyses use monthly rainfall totals and the number of rain days in each month. No simple trends were found. The daily data were then processed to examine important rain dependent aspects of crop production such as the date of the start of the rains and the risk of a long dry spell, both following planting and around flowering. The same approach is used to assess the risk of examples of crop disease in instances when a ‘weather trigger’ for the disease can be specified. A crop water satisfaction index is also used to compare risks from choices of crops with different maturity lengths and cropping strategies. Finally a different approach to the calculations of these risks fits a Markov chain model to the occurrence of rain, with results then derived from this model. The analyses shows the relevance of this latter approach when relatively short daily rainfall records are available and is illustrated through a comparison of the effects of El Niño, La Niña and Ordinary years on rainfall distribution patterns.