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Hypertension is the leading risk factor for global disease burden. Self-management of high blood pressure (BP) through self-monitoring and self-titration of medications, has proved to be one successful and cost-effective tool to achieve better BP control in many high-income countries but not much is known about its potential in low- and middle-income countries (LMICs). We used semi-structured questionnaires and focus groups in three LMICs; Peru, Cameroon and Malawi to examine perceptions and attitudes of patients diagnosed with essential hypertension towards living with hypertension, BP measurement and treatment, patient–physician relationship and opinions about self-management of high blood pressure. Results in all three countries were comparable. Patients showed varied levels of health literacy related to hypertension. BP measurement habits were mostly affected by resources available and caregiver support. Treatment and adherence to it were primarily affected by cost. Most patients were welcoming of the idea of self-management but skeptical about the ability to do self-monitoring accurately and the safety involving self-titration of medications.
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.
Introduction: Capitalizing on the success of Simulation-Based Education (SBE) in residency-training programs, simulation has been gradually integrated into Continued Professional Development (CPD) programs for Emergency Physicians (EPs) in Canada. This study sought to characterize how Canadian academic emergency medicine (EM) departments have implemented SBE for CPD. Methods: We conducted two national surveys: 1) the National Faculty Simulation Status Assessment Survey, administered by telephone to the simulation directors (or equivalent) at 20 Canadian academic EM sites and 2) the Faculty Simulation Needs Assessment Survey administered online to all full-time EPs across 9 Canadian academic EM sites. Results: The response rates for the National Status and Needs Assessment Surveys were 100% (20/20), and 40% (252/635), respectively. The majority (60%) of Canadian academic EM sites reported utilizing SBE for CPD, though only 30% reported dedicated funding support. EPs reported participating in a median of 3 hours per year of SBE (IQR 1-6 hours). Reported incentivization offered in the form of continued medical education credits varied between simulation directors (67%) and EPs (44%). Simulation directors identified several significant barriers to SBE including a lack of faculty time, fear of peer judgment, and faculty inexperience. In contrast, EP-identified barriers included time commitments outside of shift, lack of opportunities, and lack of departmental. The three most common topics of interest for SBE by EPs were performance of rare procedures, pediatric resuscitation, and neonatal resuscitation. Interprofessional involvement in SBE CPD was valued by both simulation directors and EPs, with most EPs (79%) indicating it is useful. Conclusion: Most Canadian EPs and simulation directors recognize the value of SBE for CPD, yet it is only utilized, infrequently, by 67% of Canadian academic EM departments for this purpose. This may be explained, in part, by poor incentivization for participation. Simulation directors and EPs noted different barriers to SBE implementation for CPD suggesting the need for dialogue to improve utilization. As SBE for CPD is incorporated more frequently, and at more sites, content should be guided by local needs assessments with an emphasis on interprofessional participation.
Miner et al. (2018) do an excellent job of bringing the issue of gender disparity within STEM to the forefront of I-O psychology. However, we believe the focus on STEM is woefully inadequate and urge I-O psychologists to think bigger, better, and broader. There are clear problems with the way women are viewed and treated within the workforce, within the United States, and globally. In narrowing the discussion of the problem to target only STEM, we dramatically limit our understanding of and potential impact on the multifaceted and complex gender disparity problem in the world of work. Furthermore, we assert there are additional legitimizing myths that must be addressed in order to yield a more complete picture of the dilemma and allow us to move forward to make an impact.
The chemical-vapor deposition conditions for the growth of pure boron (PureB) layers on silicon at temperatures as low as 400°C were investigated with the purpose of optimizing photodiodes fabricated with PureB anodes for minimal B-layer thickness, low dark current and chemical robustness. The B-deposition is performed in a commercially-available Si epitaxial reactor from a diborane precursor. In-situ methods commonly used to improve the cleanliness of the Si surface before deposition are tested for a deposition temperature of 450°C and PureB layer thickness of 3 nm. Specifically, high-temperature baking in hydrogen, and exposure to HCl are tested. Both material analysis and electrical diode characterization indicate that these extra cleaning steps degrade the properties of the PureB layer and the fabricated diodes.
Aguinis et al. (2017) highlighted the gender disparity in authorship of publications within the field of industrial and organizational (I-O) psychology. We agree with the authors that this is a troubling finding and think that this gender disparity within our field is the most critical implication of the focal article. I-O psychologists are specifically trained to address employment issues, including gender disparities at work. To see such disconcerting findings in our area of expertise is akin to a sports team losing to a competitor when they have the home court advantage. Namely, we are left feeling deflated and asking ourselves, “What went wrong?”
Americans consume Na in excess of daily recommendations. Most dietary Na comes from packaged foods, and bread is a major contributor. In the UK, national Na reduction strategies contributed to lower Na levels in packaged foods and lower population Na intake. Similar initiatives are emerging in the USA and require surveillance to assess effectiveness. We aimed to examine Na levels in bread products in the USA and compare levels with similar UK products.
Na data for bread products were obtained from the US Label Insight Open Data Initiative (n 4466) and the FoodSwitch UK database (n 1651). Mean, median and range of Na content, and proportion of products meeting Na targets established by the National Salt Reduction Initiative (NSRI) and the UK Department of Health (DH) were calculated overall, by bread type and by country.
Mean (sd) Na content in bread was 455 (170) mg/100 g in the USA and 406 (179) mg/100 g in the UK. In both countries, savoury bread had the highest mean Na (USA=584 mg/100 g, UK=543 mg/100 g) and fruit bread the lowest mean Na (USA=345 mg/100 g, UK=277 mg/100 g). Na content of US bread products was 12 % higher than in the UK, with 21 % of US bread products and 31 % of UK bread products meeting the NSRI and DH targets, respectively.
US bread products have, on average, 12 % more Na than similar products in the UK. Variation in Na content within product categories, and between countries, suggests the feasibility of manufacturing products with lower Na to lower dietary Na intake.
Accurate models of X-ray absorption and re-emission in partly stripped ions are necessary to calculate the structure of stars, the performance of hohlraums for inertial confinement fusion and many other systems in high-energy-density plasma physics. Despite theoretical progress, a persistent discrepancy exists with recent experiments at the Sandia Z facility studying iron in conditions characteristic of the solar radiative–convective transition region. The increased iron opacity measured at Z could help resolve a longstanding issue with the standard solar model, but requires a radical departure for opacity theory. To replicate the Z measurements, an opacity experiment has been designed for the National Facility (NIF). The design uses established techniques scaled to NIF. A laser-heated hohlraum will produce X-ray-heated uniform iron plasmas in local thermodynamic equilibrium (LTE) at temperatures
eV and electron densities
. The iron will be probed using continuum X-rays emitted in a
diameter source from a 2 mm diameter polystyrene (CH) capsule implosion. In this design,
of the NIF beams deliver 500 kJ to the
mm diameter hohlraum, and the remaining
directly drive the CH capsule with 200 kJ. Calculations indicate this capsule backlighter should outshine the iron sample, delivering a point-projection transmission opacity measurement to a time-integrated X-ray spectrometer viewing down the hohlraum axis. Preliminary experiments to develop the backlighter and hohlraum are underway, informing simulated measurements to guide the final design.
Positive psychological constructs have been associated with reduced suicidal ideation, and interventions to cultivate positive feelings have the potential to reduce suicide risk. This study compares the efficacy of a 6-week, telephone-based positive psychology (PP) intervention against a cognition-focused (CF) control intervention among patients recently hospitalized for depression and suicidal ideation or behavior.
A total of 65 adults with a current major depressive episode reporting suicidal ideation or a recent suicide attempt were enrolled from participating in-patient psychiatric units. Prior to discharge, participants were randomized to the PP (n = 32) or CF (n = 33) intervention. In both interventions, participants received a treatment manual, performed weekly PP (e.g. gratitude letter) or CF (e.g. recalling daily events) exercises, and completed weekly one-on-one telephone sessions over 6 weeks. Between-group differences in hopelessness (primary outcome), depression, suicidality and positive psychological constructs at 6 and 12 weeks were tested using mixed-effects models accounting for intensity of post-hospitalization psychiatric treatment.
Compared with PP, the CF intervention was associated with significantly greater improvements in hopelessness at 6 weeks (β = −3.15, 95% confidence interval −6.18 to −0.12, effect size = −0.84, p = 0.04), but not 12 weeks. Similarly, the CF intervention led to greater improvements in depression, suicidal ideation, optimism and gratitude at 6 and 12 weeks.
Contrary to our hypothesis, the CF intervention was superior to PP in improving hopelessness, other suicide risk factors and positive psychological constructs during a key post-discharge period among suicidal patients with depression. Further study of this CF intervention is warranted in populations at high suicide risk.
Maize in Canada is grown mainly in the south-eastern part of the country. No comprehensive studies on Canadian maize yield levels have been done so far to analyse the barriers of obtaining optimal yields associated with cultivar, environmental stress and agronomic management practices. The objective of the current study was to use a modelling approach to analyse the gaps between actual and potential (determined by cultivar, solar radiation and temperature without any other stresses) maize yields in Eastern Canada. The CSM–CERES–Maize model in DSSAT v4·6 was calibrated and evaluated with measured data of seven cultivars under different nitrogen (N) rates across four sites. The model was then used to simulate grain yield levels defined as: yield potential (YP), water-limited (YW, rainfed), and water- and N-limited yields with N rates 80 kg/ha (YW, N-80N) and 160 kg/ha (YW, N-160N). The options were assessed to further increase grain yield by analysing the yield gaps related to water and N deficiencies. The CSM–CERES–Maize model simulated the grain yields in the experiments well with normalized root-mean-squared errors <0·20. The model was able to capture yield variations associated with varying N rates, cultivar, soil type and inter-annual climate variability. The seven calibrated cultivars used in the experiments were divided into three grades according to their simulated YP: low, medium and high. The simulation results for the 30-year period from 1981 to 2010 showed that the average YP was 15 000 kg/ha for cultivars with high yield potential. The YP is generally about 6000 kg/ha greater than the actual yield (YA) at each experimental site in Eastern Canada. Two-thirds of this gap between YP and YA is probably associated with water stress, as a gap of approximately 4000 kg/ha between the YW and the YP was simulated. This gap may be reduced through crop management, such as introducing irrigation to improve the distribution of available water during the growing season. The simulated yields indicated a gap of about 3000 and 1000 kg/ha between YW and YW,N-80N for cultivars with high YP and low YP, respectively. The gap between YW and YW,N-160N decreased to <2000 kg/ha for high Yp cultivars with little difference for the low Yp cultivars. The different yield gaps among cultivars suggest that cultivars with high YP require high N rates but cultivars with low YP may need only low N rates.
An obesity paradox has been proposed in many conditions including HIV. Studies conducted to investigate obesity and its effect on HIV disease progression have been inconclusive and are lacking for African settings. This study investigated the relationship between overweight/obesity (BMI≥25 kg/m2) and HIV disease progression in HIV+ asymptomatic adults not on antiretroviral treatment (ART) in Botswana over 18 months. A cohort study in asymptomatic, ART-naïve, HIV+ adults included 217 participants, 139 with BMI of 18·0–24·9 kg/m2 and seventy-eight participants with BMI≥25 kg/m2. The primary outcome was time to event (≥25 % decrease in cluster of differentiation 4 (CD4) cell count) during 18 months of follow-up; secondary outcomes were time to event of CD4 cell count<250 cells/µl and AIDS-defining conditions. Proportional survival hazard models were used to compare hazard ratios (HR) on time to events of HIV disease progression over 18 months. Higher baseline BMI was associated with significantly lower risk of an AIDS-defining condition during the follow-up (HR 0·218; 95 % CI 0·068, 0·701; P=0·011). Higher fat mass at baseline was also significantly associated with decreased risk of AIDS-defining conditions during the follow-up (HR 0·855; 95 % CI 0·741, 0·987; P=0·033) and the combined outcome of having CD4 cell count≤250/µl and AIDS-defining conditions, whichever occurred earlier (HR 0·918; 95 % CI 0·847, 0·994; P=0·036). All models were adjusted for covariates. Higher BMI and fat mass among the HIV-infected, ART-naïve participants were associated with slower disease progression. Mechanistic research is needed to evaluate the association between BMI, fat mass and HIV disease progression.
A waterhemp population (McLean County resistant, MCR) from McLean County,
Illinois is resistant to both mesotrione and atrazine by elevated rates of
herbicide metabolism. Research was conducted to investigate the inheritance
of these resistance traits. Resistant and sensitive plants were crossed to
obtain reciprocal F1 populations, which were then used to create
pseudo-F2 and backcross (to sensitive parent; BCS)
populations. The various populations were evaluated with whole-plant
herbicide efficacy studies in a greenhouse. The responses of the
F1 populations to both mesotrione and atrazine were
intermediate when compared with parental populations. In the case of
atrazine, BCS and F2 populations segregated 1 : 1 and
1 : 3, respectively, for susceptibility (S) : resistance (R), at a dose that
controlled the sensitive parent but not the F1 or resistant
parent. For mesotrione, variability was observed within the F1
populations, suggesting that mesotrione resistance is multigenic and the
resistant parents used in the cross were not homozygous at the resistance
loci. Furthermore, at low mesotrione doses, more F2 plants
survived than expected on the basis of a single-gene trait, whereas at high
doses, fewer F2 plants survived than expected. Dry weight data
confirmed the conclusions obtained from survival data. Specifically,
atrazine responses segregated into two discrete classes (R and S) in both
the F2 and BCS populations, whereas mesotrione
responses showed continuous distributions of phenotypes in F2 and
BCS populations. We conclude that metabolism-based atrazine
resistance in MCR is conferred by a single major gene, whereas inheritance
of mesotrione resistance in this population is complex.
Newer generation antidepressant drugs, with improvements in safety and tolerability, have replaced tricyclic antidepressants as first-line treatment of depressive illness. However, no single antidepressant drug from any class has distinguished itself as the obvious first-line treatment of major depression. The choice of therapy is driven primarily by patient choice, with informed consent for the risks of adverse effects. Cost has become an additional factor in this decision as several of the newer antidepressant drugs are now available in generic form. Several augmentation and drug-switching strategies have demonstrated benefit in refractory illness. While no single strategy distinguished itself as superior to the others, some have been more rigorously tested. Ongoing efforts at improving effectiveness, time to response, and tolerability have led to novel drug therapies. Efforts at characterizing predictors of treatment outcomes now include pharmacogenetic studies.
An antigenic mimic of the Ebola glycoprotein was synthesized and tested for its ability to be recognized by an anti-Ebola glycoprotein antibody. Epitope-mapping procedures yielded a suitable epitope that, when presented on the surface of a nanoparticle, forms a structure that is recognized by an antibody specific for the native protein. This mimic-antibody interaction has been quantitated through ELISA and QCM-based methods and yielded an affinity (Kd = 12 × 10−6 M) within two orders of magnitude of the reported affinity of the native Ebola glycoprotein for the same antibody. These results suggest that the rational design approach described herein is a suitable method for the further development of protein-based antigenic mimics with potential applications in vaccine development and sensor technology.