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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.
Throughout the British Empire, visiting and immigrating professional actors ‘from the old country’ realized and reinforced for settler cultures a dominant imperial identity. In Australia, Alfred Dampier (1843–1908) and his company exploited the opportunities that this cultural milieu offered by staging austere, ‘reverential’, well-elocuted Shakespearean productions which raised their artistic status and asserted their respectability while enabling Dampier to offer as well, without censorship or public condemnation, dramatizations of sensational and controversial bushranger and convict narratives.
Introduction: Depending on the time and day of initial Emergency Department (ED) presentation, some patients may require a return to the ED the following day for ultrasound examination. Return visits for ultrasound may be time and resource intensive for both patients and the ED. Qualitative experience suggests that a percentage of return ultrasounds could be performed at a non-ED facility. Our objective was to undertake a retrospective audit of return for ultrasound usage, patterns and outcomes at 2 academic EDs. Methods: A retrospective review of all adult patients returning to the ED for ultrasound at both LHSC ED sites in 2016 was undertaken. Each chart was independently reviewed by two emergency medicine consultants. Charts were assessed for day and time of initial presentation and return, type of ultrasound ordered, and length of ED stay on initial presentation and return visit. Opinion based questions were considered by reviewers, including urgency of diagnosis clarification required, if symptoms were still present on return, and if any medical or surgical treatment or follow up was arranged based on ultrasound results. Agreement between reviewers was assessed. Results: After eliminating charts for which the return visit was not for a scheduled ultrasound examination, 328 patient charts were reviewed. 63% of patients were female and median [IQR] age was 40 years [27-56]. Abdomen/pelvis represented 50% of the ultrasounds; renal 24%; venous Doppler 15.9%. Symptoms were still present and documented in 79% of cases. 22% of cases required a medical intervention and 9% an immediate surgical intervention. 11% of patients were admitted to hospital on their return visit. Outpatient follow-up based on US results was initiated in 29% of cases. Median [IQR] combined LOS was 479.5 minutes [358.5-621.75]. Agreement between reviewers for opinion based questions was poor (63%-96%). Conclusion: Ideally, formal ultrasound should be available on a 24 hour basis for ED patients in order to avoid return visits. A percentage of return for ultrasound examinations do not result in any significant change in treatment. Emergency departments should consider the development of pathways to avoid return visits for follow up ultrasound when possible. The low incidence of surgical treatment in those returning for US suggests that this population could be served in a non-hospital setting. Further research is required to support this conclusion.
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.
The script of Louis XI used as the basis for this edition is the only known surviving version, a typescript on lined foolscap held in the National Archives of Australia, Canberra, in the Copyright Applications Series CRS A1336/1 item 14,222. It appears to have been typed from an earlier script that has not survived — probably a much-amended manuscript given numerous transcription errors, and was not subsequently corrected. As a consequence, it retains traces of that earlier version. Its title, typed in caps at the top of each page, is ‘SHELL SHOCK’, but on the first page this has been crossed through and ‘Louis XI’ written in heavy black ink, followed by ‘written and produced by GP Hanna at Cremorne Theatre Brisbane/1924’.
Pat Hanna's Famous Diggers, a professional vaudeville theatre troupe comprising ex-Great War Anzac soldiers (initially, mainly New Zealanders, as Hanna was himself) played for nearly two years (1923–24) at the old Cremorne Theatre in Brisbane. One item Hanna premiered at the Cremorne was Louis XI, a short (ten-minute) comic sketch he wrote himself. Modernism in the inter-war years, given its usual location within avant-garde aesthetics, high culture, internationalism and radical politics, is not — with the notable exception of Brecht's cabaret work in the 1920s — usually associated with popular theatre. While one comic playlet hardly challenges that positioning, Louis XI was a direct result of the Great War's profound reshaping of modern life. Many of the dramatised sketches performed by Hanna's company, including Louis XI, were structured around a contrast between events as they had occurred in the trenches and as they were portrayed in a utopian or dystopian fantasy, sometimes triggered by shell shock or a dream. Several, again including Louis XI, involve the past, and express the curiosity and cultural dislocation Australian- and New Zealand-born soldiers felt as they moved for the first time through real-life landscapes and architecture they had known only from popular history and romance.
Wireless charging is emerging as a viable technology in many industries, including consumer, medical, and sensor electronics. An investigation of design principles is conducted for a wireless charging platform that is designed to charge devices of different sizes and technologies, using only through vias. It is shown that at a 5 mm separation distance, a coupling coefficient can be achieved which varies from 0.12 to 0.37 when staggered hexagonal transmitter coils (approximately 5 cm across) are used with an unstaggered square receiver coil, which declines to 0.06–0.11 at 2 cm separation. Without design measures, the coupling coefficient will approach zero at certain positions. The quality factors of the coils can be improved by stacking the coils in parallel, enabling the use of only through-vias, while the inductance can be controlled horizontally by increasing the number of turns in the inductor.
The spatially uneven nature of the impacts of the Irish Famine have been recognised by both historians and geographers and research that has examined the Famine at various spatial scales has shed much light on its uneven impact on the human landscape of mid-1840s Ireland. However, the regionally varied nature of the event makes it difficult to understand its impacts at the national scale. This is because of the difficulty of assessing the extent to which local processes that may have contributed to the worsening of conditions for people in different areas operated at the national scale. The emphasis on local areas that characterises much of the literature on the Irish Famine in part contributes to this difficulty. We have much detailed research for particular villages, parishes, poor law unions and counties, but little comparative or national analysis. Recent research has attempted to bridge the gap between local and national perspectives on the Famine by constructing a geographical information systems (GIS) database of local attributes at electoral division (ED) level for the entire island. Electoral divisions are administrative units first introduced to Ireland in the mid-1840s for the purposes of rate collection and were also used as the unit for census data collection. There were 3,439 such divisions in Ireland at this time.
The numbers in the margins of Cicero's speeches are generally treated as a convenient referencing system and no more. The fact that there are two apparently independent sets of numbers, the shorter usually referred to as ‘sections’ (§§), and the longer as ‘chapters’ (cc.), can lead to confusion, and fashions have changed over the years as to which of the sets to use in references, without apparent discussion. Modern editors feel no obligation to follow them when deciding where to put their own paragraph-breaks. One scholar, Glucker, traced their origin out of curiosity, but then dismissed them as having no value other than as a referencing system, claiming that they often ‘ignore the beginning of proper new sections’. This article will test his claim by examining the placement of the numbers at various points in Cicero's Pro Murena.
In the paper ‘NO News’, Preston et al. (2004) make a number of erroneous assumptions regarding nitrogen oxide chemistry. These authors also present some very significant misinterpretations of previous research into the effects of various nitrogen oxides on germination of post-fire followers. Methodological differences between the study by Preston et al. (2004) and previous work are also problematic, such as using NO-donors in solution versus the use of direct application of various nitrogen oxides in the gaseous phase. A closer review of these studies, with the proper understanding of nitrogen oxide chemistry, and interpretations of the available literature, would lead to the conclusion that, contrary to the authors' assertions, the Preston et al. (2004) study supports, rather than refutes, earlier findings by Keeley and Fotheringham (1997, 1998a, b, 2000).