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The national implementation of competency-based medical education (CBME) has prompted an increased interest in identifying and tracking clinical and educational outcomes for emergency medicine training programs. For the 2019 Canadian Association of Emergency Physicians (CAEP) Academic Symposium, we developed recommendations for measuring outcomes in emergency medicine training in the context of CBME to assist educational leaders and systems designers in program evaluation.
We conducted a three-phase study to generate educational and clinical outcomes for emergency medicine (EM) education in Canada. First, we elicited expert and community perspectives on the best educational and clinical outcomes through a structured consultation process using a targeted online survey. We then qualitatively analyzed these responses to generate a list of suggested outcomes. Last, we presented these outcomes to a diverse assembly of educators, trainees, and clinicians at the CAEP Academic Symposium for feedback and endorsement through a voting process.
Academic Symposium attendees endorsed the measurement and linkage of CBME educational and clinical outcomes. Twenty-five outcomes (15 educational, 10 clinical) were derived from the qualitative analysis of the survey results and the most important short- and long-term outcomes (both educational and clinical) were identified. These outcomes can be used to help measure the impact of CBME on the practice of Emergency Medicine in Canada to ensure that it meets both trainee and patient needs.
The suicide rate has increased significantly among US Army soldiers over the past decade. Here we report the first results from a large psychological autopsy study using two control groups designed to reveal risk factors for suicide death among soldiers beyond known sociodemographic factors and the presence of suicide ideation.
Informants were next-of-kin and Army supervisors for: 135 suicide cases, 137 control soldiers propensity-score-matched on known sociodemographic risk factors for suicide and Army history variables, and 118 control soldiers who reported suicide ideation in the past year.
Results revealed that most (79.3%) soldiers who died by suicide have a prior mental disorder; mental disorders in the prior 30-days were especially strong risk factors for suicide death. Approximately half of suicide decedents tell someone that they are considering suicide. Virtually all of the risk factors identified in this study differed between suicide cases and propensity-score-matched controls, but did not significantly differ between suicide cases and suicide ideators. The most striking difference between suicides and ideators was the presence in the former of an internalizing disorder (especially depression) and multi-morbidity (i.e. 3+ disorders) in the past 30 days.
Most soldiers who die by suicide have identifiable mental disorders shortly before their death and tell others about their suicidal thinking, suggesting that there are opportunities for prevention and intervention. However, few risk factors distinguish between suicide ideators and decedents, pointing to an important direction for future research.
The current study examined independent and interactive effects between Apolipoprotein E (APOE) genotype and two types of cognitively-stimulating lifestyle activities (CSLA)—integrated information processing (CSLA-II) and novel information processing (CSLA-NI)—on concurrent and longitudinal changes in cognition. Three-wave data across 6 years of follow-up from the Victoria Longitudinal Study (n=278; ages 55–94) and linear mixed model analyses were used to characterize the effects of APOE genotype and participation in CSLA-II and CSLA-NI in four cognitive domains. Significant CSLA effects on cognition were observed. More frequent participation in challenging activities (i.e., CSLA-NI) was associated with higher baseline scores on word recall, fact recall, vocabulary and verbal fluency. Conversely, higher participation in less cognitively-challenging activities (i.e., CSLA-II) was associated with lower scores on fact recall and verbal fluency. No longitudinal CSLA-cognition effects were found. Two significant genetic effects were observed. First, APOE moderated CSLA-II and CSLA-NI associations with baseline verbal fluency and fact recall scores. Second, APOE non-ɛ4 carriers’ baseline performance were more likely to be moderated by CSLA participation, compared to APOE-ɛ4 carriers. Our findings suggest APOE may be a “plasticity” gene that makes individuals more or less amenable to the influence of protective factors such as CSLA. (JINS, 2014, 20, 1–9)
Our previous work identified deficits in interference processing and learning/memory in past suicide attempters who were currently depressed and medication-free. In this study, we extend this work to an independent sample studied at various stages of illness and treatment (mild symptoms, on average) to determine if these deficits in past suicide attempters are evident during a less severe clinical state.
A total of 80 individuals with a past history of major depression and suicide attempt were compared with 81 individuals with a history of major depression and no lifetime suicide attempts on a battery of neurocognitive measures assessing attention, memory, abstract/contingent learning, working memory, language fluency and impulse control.
Past attempters performed more poorly in attention, memory and working memory domains, but also in an estimate of pre-morbid intelligence. After correction for this estimate, tests that had previously distinguished past attempters – a computerized Stroop task and the Buschke Selective Reminding Test – remained significantly worse in attempters. In a secondary analysis, similar differences were found among those with the lowest levels of depression (Hamilton Depression Rating Scale score <10), suggesting that these deficits may be trait markers independent of current symptomatology.
Deficits in interference processing and learning/memory constitute an enduring defect in information processing that may contribute to poor adaptation, other higher-order cognitive impairments and risk for suicidal behavior.
As part of the HST/ACS Coma Cluster Treasury Survey, we have undertaken a Keck/LRIS spectroscopic campaign to determine membership for faint dwarf galaxies. In the process, we discovered a population of Ultra Compact Dwarf galaxies (UCDs) in the core region of the Coma Cluster. At the distance of Coma, UCDs are expected to have angular sizes 0.01 < Re < 0.2 arcsec. With ACS imaging, we can resolve all but the smallest ones with careful fitting. Candidate UCDs were chosen based on magnitude, color, and degree of resolution. We spectroscopically confirm 27 objects as bona fide UCD members of the Coma Cluster, a 60% success rate for objects targeted with MR < −12. We attribute the high success rate in part to the high resolution of HST data and to an apparent large population of UCDs in Coma. We find that the UCDs tend to be strongly clustered around giant galaxies, at least in the core region of the cluster, and have a distribution and colors that are similar to globular clusters. These findings suggest that UCDs are not independent galaxies, but rather have a star cluster origin.
The current multigenerational study evaluates the utility of the interactionist model of socioeconomic influence on human development (IMSI) in explaining problem behaviors across generations. The IMSI proposes that the association between socioeconomic status (SES) and human development involves a dynamic interplay that includes both social causation (SES influences human development) and social selection (individual characteristics affect SES). As part of the developmental cascade proposed by the IMSI, the findings from this investigation showed that Generation 1 (G1) adolescent problem behavior predicted later G1 SES, family stress, and parental emotional investments, as well as the next generation of children's problem behavior. These results are consistent with a social selection view. Consistent with the social causation perspective, we found a significant relation between G1 SES and family stress, and in turn, family stress predicted Generation 2 (G2) problem behavior. Finally, G1 adult SES predicted both material and emotional investments in the G2 child. In turn, emotional investments predicted G2 problem behavior, as did material investments. Some of the predicted pathways varied by G1 parent gender. The results are consistent with the view that processes of both social selection and social causation account for the association between SES and human development.
We study the thermodynamic properties of solutions of the physically gelling poly(N-isopropylacrylamide-2-hydroxyethyl methacrylate) [poly(NIPPAm-HEMA)]. We construct its phase diagram and characterize its kinetics of phase separation. This material belongs to a class of thermosensitive, “smart” polymers, that exhibit complex phase behavior.
The copolymer studied is liquid at low temperatures and undergoes phase separation near 28°C, with negligible dependence on concentration. Above the transition temperature we observe coexistence between a polymer-dilute solution and a gel. We show that, upon quick heating, liquid solutions form a homogeneous gel that phase separates (shrinks) from a dilute polymer solution. We find that the evolution of the gel volume fraction is well described by a double exponential decay, indicating the presence of two shrinking regimes in a close parallel to the behavior of chemically cross-linked gels. The first stage is characterized by quick water ejection. In the second stage, slower shrinking is observed associated with internal reorganization of the polymers that allows the creation of gel-forming contacts.
Rifleman, or titipounamu Acanthisitta chloris, is New Zealand’s smallest endemic passerine. The species has a fragmented distribution and is threatened in the Rakiura region in the south of the South Island. The only known population of South Island rifleman A. c. chloris in the Rakiura region persisted on Codfish Island/Whenua Hou. To create a second population of rifleman in Rakiura, 30 caught from Codfish Island were reintroduced onto nearby Ulva Island in February 2003, the first translocation of rifleman. Survival and dispersal were monitored for 1 month post-release, and subsequently during the first and second breeding seasons. Mortality was greatest during holding and transfer, with low to moderate post-release mortality. All founding pairs bred in the first breeding season, and both founders and offspring bred in the second season. Dispersal across the island was greater for offspring. A simple deterministic matrix model indicated positive annual population growth (λ = 1.33), and low risk of short-term extinction. Holding/transfer techniques should be improved for future reintroductions, and longer-term monitoring should be undertaken for a more accurate assessment of vital rates. Based on the survival of founding birds, reproduction by the release generation and their offspring, and high probability of population persistence, the rifleman reintroduction was considered to be successful and a good model for future reintroductions of small passerine birds.
Field experiments were conducted across the north-central United States to determine the benefits of various weed control strategies in corn. Weed control, corn yield, and economic return increased when a preemergence (PRE) broad-spectrum herbicide was followed by (fb) postemergence (POST) herbicides. Weed control decisions based on field scouting after a PRE broad-spectrum herbicide application increased weed control and economic return. Application of a PRE grass herbicide fb a POST herbicide based on field scouting resulted in less control of velvetleaf and morningglory species, corn yield, and economic return compared with a PRE broad-spectrum herbicide application fb scouting. Cultivation after a PRE broad-spectrum herbicide application increased weed control and corn yield compared with the herbicide applied alone, but economic return was not increased. An early-postemergence herbicide application fb cultivation resulted in the highest level of broadleaf weed control, the highest corn yield, and the greatest economic return compared with all other strategies. Weed control based on scouting proved to be useful in reducing the effect of weed escapes on corn yield and increased economic return compared with PRE herbicide application alone. However, economic return was not greater than the PRE fb planned POST or total POST strategies.
We present the results and analysis of HST-wfpc2 imagery of the starburst galaxy NGC 1569 (d = 2.2 Mpc), which permit unprecedented resolution (~ 1pc) of the ionized gas and stellar population. The primary data in our analysis consists of images taken through narrow-band filters isolating Hβ, Hα, [O iii]λ5007, and [S ii]λλ6717+30, as part of go Program 8133. A variety of color-coded and grey-scaled maps of the morphology, ionization structure, and dust distribution are presented. Unsharp masks of the Hα images show a very chaotic structure for the ionized gas, with numerous filaments and arc-like bright rim features across the entire galaxy, but without significant large-scale ionization variations. Variations in the ionization and line-of-sight reddening occur on smaller scales (~ 10 – 50 pc), with numerous low-ionization semi-stellar knots seen throughout the main body of the galaxy, even within the ‘hole’ in the ionized gas distribution around the central super star clusters previously noted from H i maps. Several of these features have strong [S ii] emission indicative of being supernova remnants. We combine these data with archival wide-band HST-wfpc2 imagery to quantitatively evaluate the source(s) of the (largely photo-) ionized gas.
We demonstrate that one can detect minuscule amounts of hydrogen diffusion out of a-Si:H under illumination at room temperature, by monitoring the changes in the Raman spectrum of amorphous tungsten oxide as a function of illumination. The Staebler-Wronski effect, the light-induce creation of metastable defects in hydrogenated amorphous silicon (a-Si:H), has been one of the major problems that has limited the performance of such devices as solar cells. Recently, Branz suggested the hydrogen collision model that can explain many aspects of the Staebler-Wronski effect. One of the main predictions of this model is that the photogenerated mobile hydrogen atoms can move a long distance at room temperature. However, light-induced hydrogen motion in a-Si:H has not been experimentally observed at room temperature. We utilized the high sensitivity of the Raman spectrum of electrochromic a-WO3 to hydrogen insertion to probe the long-range motion of hydrogen at room temperature. We deposited a thin (200 nm) layer of a-WO3 on top of a-Si:H, and under illumination, a change in the Raman spectrum was detected. By comparing the Raman signal changes with those for control experiments where hydrogen is electrochemically inserted into a-WO3, we can estimate semiquantitatively the amount of hydrogen that diffuses out of the a-Si:H layer.
When planning a mutation to test some hypothesis, one
crucial question is whether the new side chain is compatible
with the existing structure; only if it is compatible can
the interpretation of mutational results be straightforward.
This paper presents a simple way of using the sensitive
geometry of all-atom contacts (including hydrogens) to
answer that question. The interactive MAGE/PROBE system
lets the biologist explore conformational space for the
mutant side chain, with an interactively updated kinemage
display of its all-atom contacts to the original structure.
The Autobondrot function in PROBE systematically explores
that same conformational space, outputting contact scores
at each point, which are then contoured and displayed.
These procedures are applied here in two types of test
cases, with known mutant structures. In ricin A chain,
the ability of a neighboring glutamate to rescue activity
of an active-site mutant is modeled successfully. In T4
lysozyme, six mutations to Leu are analyzed within the
wild-type background structure, and their Autobondrot score
maps correctly predict whether or not their surroundings
must shift significantly in the actual mutant structures;
interactive examination of contacts for the conformations
involved explains which clashes are relieved by the motions.
These programs are easy to use, are available free for
UNIX or Microsoft Windows operating systems, and should
be of significant help in choosing good mutation experiments
or in understanding puzzling results.
We report the results of long-slit spectroscopy of the wind-blown bubble and photo-evaporating knots around the O6.5IIIf star BD+60°2522 made with the HST-Space Telescope Imaging Spectrograph. The Of star is the primary ionizing source for the H II region NGC 7635, located in the Perseus Arm. The spectra were taken through a 0″.2 x 52″ slit with low and medium resolution gratings covering the wavelength range 2900-6870 Å. Observations with two slit orientations were made; one across the line of embedded knots to the west of the Of star and the second running from the Of star across the bubble to the NE.
The 2D-STIS spectra permit us to subtract the surrounding H II region's diffuse emission from that of the knots and the bubble, and to study the spatial variations in various emission lines in these features to a resolution of ∼ 0″.2, an order of magnitude improvement over the best ground-based spectra of this object in the literature. We present high spatial-resolution emission-line and line-ratio profiles across the bubble and knots, and compare them with the predicted variations from photo-ionization, photo-evaporation, and wind-shock models. We also present an analysis of temperatures, densities, and abundances in the features from higher S/N spectra extracted over selected lengths of the slit.
Recent developments, coupling the scanning electron microscope with image processing and crystallographic analysis, now make it possible to automatically index many thousands of lattice orientations exposed on section planes in polycrystalline materials. Backscattered Kikuchi diffraction patterns obtained from high-gain SIT and CCD cameras are analyzed using the Hough transformation (Cartesian coordinates - polar coordinates) in order to identify diffraction band widths and interplanar angles. From this basic information local lattice orientation can be determined. Information from raw data sets (in excess of 100,000 single orientations in some examples) can be used to construct orientation imaging micrographs which emphasize certain aspects of the exposed field of lattice orientations. Thus, features of the spatial placement of lattice orientation (including grain boundary misorientation, microtexture, and connectivity of the microstructure) are readily studied. In this paper these techniques are reviewed, and recent explorations of the connectivity of grain boundary misorientation structure are presented for an interesting nickel-chromium-iron alloy.