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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.
The older Finnish Twin Cohort (FTC) was established in 1974. The baseline survey was in 1975, with two follow-up health surveys in 1981 and 1990. The fourth wave of assessments was done in three parts, with a questionnaire study of twins born during 1945–1957 in 2011–2012, while older twins were interviewed and screened for dementia in two time periods, between 1999 and 2007 for twins born before 1938 and between 2013 and 2017 for twins born in 1938–1944. The content of these wave 4 assessments is described and some initial results are described. In addition, we have invited twin-pairs, based on response to the cohortwide surveys, to participate in detailed in-person studies; these are described briefly together with key results. We also review other projects based on the older FTC and provide information on the biobanking of biosamples and related phenotypes.
Shiga toxin-producing Escherichia coli (STEC) infection can cause serious illness including haemolytic uraemic syndrome. The role of socio-economic status (SES) in differential clinical presentation and exposure to potential risk factors amongst STEC cases has not previously been reported in England. We conducted an observational study using a dataset of all STEC cases identified in England, 2010–2015. Odds ratios for clinical characteristics of cases and foodborne, waterborne and environmental risk factors were estimated using logistic regression, stratified by SES, adjusting for baseline demographic factors. Incidence was higher in the highest SES group compared to the lowest (RR 1.54, 95% CI 1.19–2.00). Odds of Accident and Emergency attendance (OR 1.35, 95% CI 1.10–1.75) and hospitalisation (OR 1.71, 95% CI 1.36–2.15) because of illness were higher in the most disadvantaged compared to the least, suggesting potential lower ascertainment of milder cases or delayed care-seeking behaviour in disadvantaged groups. Advantaged individuals were significantly more likely to report salad/fruit/vegetable/herb consumption (OR 1.59, 95% CI 1.16–2.17), non-UK or UK travel (OR 1.76, 95% CI 1.40–2.27; OR 1.85, 95% CI 1.35–2.56) and environmental exposures (walking in a paddock, OR 1.82, 95% CI 1.22–2.70; soil contact, OR 1.52, 95% CI 2.13–1.09) suggesting other unmeasured risks, such as person-to-person transmission, could be more important in the most disadvantaged group.
I use new data on employment and job placements during WWII to characterize the wartime surge in female work and its subsequent impact on female employment in the United States. The geography of female wartime work was primarily driven by industrial mobilization, not drafted men’s withdrawal from local labor markets. After the war, returning veterans and sharp cutbacks in war-related industries displaced many new female entrants, despite interest in continued work. As a result, areas most exposed to wartime work show limited overall effects on female labor force participation in 1950 and only marginal increases in durables manufacturing employment.
The accurate replication in vitro of bovine mammary gland function would be of enormous benefit to studies investigating the control of milk synthesis and secretion. However, progress towards this end has been slow, partially because of the biological variability in the cell preparations produced to date. In particular, the heterogeneous nature of primary cultures of mammary epithelial cells (MEC) makes them unstable for repeated experimentation over time, while for immortalised cell lines in vitro the level of milk protein production is either very low or non existent; if it does occur it has been independent of in vivo factors known to regulate mammary growth and milk secretion. The aim of this project was to establish a bovine MEC non-immortal clone, which is both responsive to mitogens and functionally responsive to lactogenic hormones and an appropriate extracellular matrix.
Whether monozygotic (MZ) and dizygotic (DZ) twins differ from each other in a variety of phenotypes is important for genetic twin modeling and for inferences made from twin studies in general. We analyzed whether there were differences in individual, maternal and paternal education between MZ and DZ twins in a large pooled dataset. Information was gathered on individual education for 218,362 adult twins from 27 twin cohorts (53% females; 39% MZ twins), and on maternal and paternal education for 147,315 and 143,056 twins respectively, from 28 twin cohorts (52% females; 38% MZ twins). Together, we had information on individual or parental education from 42 twin cohorts representing 19 countries. The original education classifications were transformed to education years and analyzed using linear regression models. Overall, MZ males had 0.26 (95% CI [0.21, 0.31]) years and MZ females 0.17 (95% CI [0.12, 0.21]) years longer education than DZ twins. The zygosity difference became smaller in more recent birth cohorts for both males and females. Parental education was somewhat longer for fathers of DZ twins in cohorts born in 1990–1999 (0.16 years, 95% CI [0.08, 0.25]) and 2000 or later (0.11 years, 95% CI [0.00, 0.22]), compared with fathers of MZ twins. The results show that the years of both individual and parental education are largely similar in MZ and DZ twins. We suggest that the socio-economic differences between MZ and DZ twins are so small that inferences based upon genetic modeling of twin data are not affected.
This paper introduces a new way to investigate in situ processes, the wireless multi-sensor probe, as part of an environmental sensor network. Instruments are housed within a ‘probe’ which can move freely and so behave like a clast. These were deployed in the ice and till at Briksdalsbreen, Norway. The sensors measure temperature, resistivity, case stress, tilt angle and water pressure and send their data to a base station on the glacier surface via radio links. These data are then forwarded by radio to a reference station with mains power 2.5 km away, from where they are sent to a web server in the UK. The system deployed during 2004/05 was very successful and a total of 859 probe days worth of data from the ice and till were collected, along with GPS, weather and diagnostic data about the system.
The present study examined the impacts of native, fermented or enzymatically treated peas (Pisum sativum L.) inclusion in broiler diets, on growth performance and nutrient digestibility. For the fermentation process, Madonna pea was mixed with water (1/1) containing 2.57×108Bacillus subtilis (GalliPro®) spores/kg pea and then, incubated for 48 h at 30 °C. For the enzymatic treatment process, the used water for dough production contained three enzymes, AlphaGalTM (α-galactosidase), RONOZYME® ProAct and VP (protease and pectinases respectively – DSM, Switzerland) and the pea dough incubated for 24 h at 30°C. Nine corn-wheat-soybean diets were formulated by supplying 10%, 20% and 30% of the required CP with either native, fermented or enzymatically treated peas. Performance was recorded weekly and at the end of the experiment (day 35), apparent ileal digestibility (AID) of CP, amino acids (AA), crude fat, starch, Ca, P and K were determined. Data were subjected to ANOVA using GLM procedure with a 3×3 factorial arrangement of treatments. Both processes reduced α-galactosides, phytate, trypsin inhibitor activity and resistant starch in peas. Increasing levels of pea products up to 300 g/kg diet, reduced BW gain and feed intake (P⩽0.05). Broilers fed diets containing enzymatically treated pea had the best feed conversion ratio at day 35. Different types of pea product and their inclusion levels had no effect on AID of all nutrients. The interaction between type of the pea products and inclusion levels was significant for AID of starch. For native pea diets, 10% group showed similar AID of starch to 20% native pea but it had higher AID than 30% native pea. For fermented and enzymatically treated groups, all three levels displayed similar AID of starch. In conclusion, enzymatic treatment and fermentation could improve the nutritional quality of pea. Inclusion of enzymatically treated pea in broiler diets could improve broiler performance compared with other pea products while, it displayed neither positive nor negative impact on nutrient digestibility. The present findings indicate the feasibility of these processes, particularly enzymatic treatment, for improving the nutritional quality of pea as a protein source for broiler nutrition.
OH/IR stars and carbon stars are examples of evolved stars known to lose mass rapidly. In a recent paper (Rose 1987) we have described calculations of infrared continuum radiation from dust in stellar winds from red giants. We compare calculated radiative models with recent infrared measurements and estimate the total contribution of evolved stars to the mid-infrared background radiation observed from the Milky Way and M31.
Extensive radio echo-sounding has mapped the part of West Antarctica between Byrd Station, the Whitmore Mountains, the Transantarctic Mountains, and the Ross Ice Shelf. The ice sheet in this area is dominated by five major sub-parallel ice streams (A–E), which are up to 100 km wide and extend inland from the grounding line of the Ross Ice Shelf for about 400 km. Their positions have been determined by crevassing seen on radio echo-sounding records, trimetrogon photographs, and Landsat imagery. The ice streams are characterized by their flat transverse cross-sections, while the intervening ice sheet exhibits domes and ridges. Ice flow lines are defined from the ice-surface contour pattern and the trend of the ice streams. It is apparent from this work that the flow line passing through Byrd Station joins ice stream D.
The bedrock of the area is relatively smooth near the Ross Ice Shelf, becoming rougher near Byrd Station and especially so near the Whitmore Mountains. Bedrock troughs, which control the positions of the ice streams, are believed to have a tectonic origin.
In this paper the role of the ice streams in the glaciological regime of West Antarctica is investigated from radio-echo data and estimates of balance velocity, basal shear stress, and basal temperatures.
There is limited evidence for effective interventions in the treatment of post-traumatic stress symptoms within individuals diagnosed with schizophrenia. Clinicians have concerns about using exposure treatments with this patient group. The current trial was designed to evaluate a 16-session cognitive restructuring programme, without direct exposure, for the treatment of post-traumatic stress symptoms specifically within individuals diagnosed with schizophrenia.
A multicentre randomized controlled single-blinded trial with assessments at 0 months, 6 months (post-treatment) and 12 months (follow-up) was conducted. A total of 61 participants diagnosed with schizophrenia and exhibiting post-traumatic stress symptoms were recruited. Those randomized to treatment were offered up to 16 sessions of cognitive–behaviour therapy (CBT, including psychoeducation, breathing training and cognitive restructuring) over a 6-month period, with the control group offered routine clinical services. The main outcome was blind rating of post-traumatic stress symptoms using the Clinician Administered PTSD Scale for Schizophrenia. Secondary outcomes were psychotic symptoms as measured by the Positive and Negative Symptom Scale and the Psychotic Symptom Rating Scale.
Both the treatment and control groups experienced a significant decrease in post-traumatic stress symptoms over time but there was no effect of the addition of CBT on either the primary or secondary outcomes.
The current trial did not demonstrate any effect in favour of CBT. Cognitive restructuring programmes may require further adaptation to promote emotional processing of traumatic memories within people diagnosed with a psychotic disorder.
The concept of quality of urban life (QoUL) can be interpreted quite differently across different cultures. Little evidence has shown that the measure of QoUL, which is based on Western culture, can be applied to populations cross-culturally. In the current study, we use data from the 2006 Assessing Happiness and Competitiveness of World Major Metropolises study to identify underlying factors associated with QoUL as well as assess the consistency of the QoUL measurement among adults, aged 60 and older, in ten world major metropolises (i.e. New York City, Toronto, London, Paris, Milan, Berlin, Stockholm, Beijing, Tokyo and Seoul). Exploratory factor analysis and multiple-group confirmatory factor analysis (CFA) are used to analyse the data. Findings of the study suggest that the measure of QoUL is sensitive to socio-cultural differences. Community factor and intrapersonal factor are two underlying structures that are related to QoUL among older adults in ten metropolises cross-culturally. Results from the CFA indicate that Toronto is comparable with Beijing, New York City, Paris, Milan and Stockholm in QoUL, while other cities are not. The results provide insights into the development of current urban policy and promotion of quality of life among older residents in major metropolitan areas. Future researchers should continue to explore the relationship between QoUL and socio-cultural differences within international urban settings, while remaining cautious when making cross-cultural comparisons.
Jets are known to be emitted from the centers of active galaxies and quasars. In two recent papers (Rose, 1987, 1989) calculations of magnetic fields generated in jets because electrons drift with respect to protons have been described. Electron drift velocities can result from interaction with the cosmic background radiation or with ambient gas. We describe how magnetic fields can be generated in jets and radio galaxies.
The Union Catalog of Art Images (UCAI) is a research and development project located at the University of California, San Diego, and is funded by the Andrew W. Mellon Foundation. The first phase explored the barriers, both practical and theoretical, to creating a union catalogue and tackled problems such as the mapping of non-standardized metadata to a common record and the ingest of those records into a prototype union catalogue. Two of the biggest challenges were record clustering (using automated techniques to identify duplicate or closely-related records and bring them together), and working with hierarchical records (works and their surrogate images). The second phase, now under way and ending in mid-2005, will move the prototype union catalogue closer to production-level quality.
Topographic and morphologic models based on detailed Digital Elevation Models (DEM) of the Rur Graben, in particular a 33 km section of the Rurrand Fault, proved to be essential in preliminary investigations for the site selection of a trench for detailed paleoseismological investigations. The entire DEM in the 33 km Jülich-Düren area displayed as a color-shaded terrain map clearly illustrates the main features of the eastern border fault of the Rur Graben. As investigations concentrated on the 8x6 km Stetternich-Hambach section of the Rurrand fault, the use of contoured topographic, gray-shaded terrain and terrain slope maps helped delineate the main features of the surface fault expression. On the basis of topographic profiles constructed from the DEM, no fault scarp could be identified; however, the detailed surveying results from two geophysical profiles correlated well with the topographic data.
There were several possibilities open to a man entering the secular clergy in the later middle ages. Among these were careers as a royal, papal, or episcopal servant, as a teacher or scholar, or as the rector or vicar of a parish church. If he did not set his hopes high, he could join the ranks of the chaplains of his diocese, helping the incumbents of the parish churches with the administration of their benefices and with the cure of souls, serving chapels and perpetual chantries, and serving oratories in noble and gentry households. Whatever his ambitions and aspirations, however, the secular priest’s situation depended entirely upon the charity and good will of those in a position to exercise patronage: family and friends, the beneficed clergy, the bishop and his familia, and the established, landed families of the area. And whether the possibilities became opportunities in the form of the patronage desired depended to a large extent upon the social position of the priest’s family, the proper connections, and the extent of his education. These were the realities faced universally by the clergy of the universal church, but each region had its own particular system of patronage, varying with the needs and structure of society. As a case in point, the lives and success of the clergy of the northern English diocese of Carlisle, despite the mission and aims held in common with the clergy of the entire church, were dictated to a degree by the rural nature of the diocese and its location on the Anglo-Scottish border.
The twelfth century was a period of both political and ecclesiastical settlement in the north-west of England, when the conquerors were seeking to establish Anglo-Norman institutions in an area as much Celtic and Norse as Anglo-Saxon. The church was re-vitalised, monasticism re-established, and parish churches were built and re-built to an extent previously unknown. The response of Cumbrian’ society was favourable, but a ‘national’ flavour of the diverse elements making up that society was retained. When in 1092 William Rufus marched into the north-west, seized Carlisle, and drove out the ‘ruler’, Dolfin son of earl Gospatric of Dunbar, he was enacting the final phase of the Norman conquest of England. The border between England and Scotland was established, and this only deviated when David I brought the district back under Scottish control during the reign of Stephen. At one time part of the kingdom of Northumbria and then of the kingdom of Strathclyde, by the eleventh century the north-west had become a political no-man’s-land, the kings of England and Scotland each regarding it as belonging to his respective realm. Church life had been greatly eroded, and monastic communities, as in the rest of northern England, had totally disappeared, due as much to the unstable political situation over the previous two centuries as to the lack of any strong spiritual control. The region itself was in a depressed condition, depopulated and devastated by the invasions of king Edmund in 945, Ethelred in 1000, and most recently by early Gospatric in 1070.