Innovation Concept: EM Sim Cases is an innovative, open-access website that was created in 2015 to publish medical simulation resources including standardized, peer-reviewed simulation cases. Herein we describe our interim analysis. Methods: We performed a massive online needs assessment using a methodology previously described by Chan et. al. to determine how we can shape EM Sim Cases to meet the needs of learners and educators who use it. We engaged with simulation experts from the Emergency Medicine Simulation Education Research Collaborative to design a Google Forms survey using best practices in survey design. We distributed the survey to our target community of practice via Twitter, email, and a blog post published on emsimcases.com. Curriculum, Tool, or Material: We received 81 responses from simulation educators representing 8 medical specialties and 13 countries. Most survey respondents identified themselves as staff physicians (n = 44) and specialized in emergency medicine (n = 39). They had 0-21+ years of experience. 37% of respondents (n = 30) stated that material from EM Sim Cases makes up 25% or more of their simulation curriculum. Several respondents noted that using this content made them feel more confident and more current. Respondents praised EM Sim Cases for a well-organized case format, the proper level of detail, consistency between case designs, and the wide variety of cases. Suggested improvements included an opportunity to directly comment on cases and more cases in pediatric, rural, and advanced airway management situations. Suggestions were made to improve the navigability of the website. Respondents wanted to see additional blog content on debriefing strategies and self-made task/skill trainers. Conclusion: EM Sim Cases is a novel, free open-access simulation resource. Using a massive online needs assessment we were able to determine future directions including case topics, website reorganization, and educational material. We were also able to capture how impactful a resource like this can be to clinical and educational practice outside of the simulation setting.

Innovation Concept: A major barrier to the development of a national simulation case repository and multi-site simulation research is the lack of a standardized national case template. This issue was recently identified as a priority research topic for Canadian simulation based education (SBE) research in emergency medicine (EM). We partnered with the EM Simulation Education Researchers Collaborative (EM-SERC) to develop a national simulation template. Methods: The EM Sim Cases template was chosen as a starting point for the consensus process. We generated feedback on the template using a three-phase modified nominal group technique. Members of the EM-SERC mailing list were consulted, which included 20 EM simulation educators from every Canadian medical school except Northern Ontario School of Medicine and Memorial University. When comments conflicted, the sentiment with more comments in favour was incorporated. Curriculum, Tool or Material: In phase one we sought free-text feedback on the EM Sim Cases template via email. We received 65 comments from 11 respondents. An inductive thematic analysis identified four major themes (formatting, objectives, debriefing, and assessment tools). In phase two we sought free-text feedback on the revised template via email. A second thematic analysis on 40 comments from 12 respondents identified three broad themes (formatting, objectives, and debriefing). In phase three we sought feedback on the penultimate template via focus groups with simulation educators and technologists at multiple Canadian universities. This phase generated 98 specific comments which were grouped according to the section of the template being discussed and used to develop the final template (posted on emsimcases.com). Conclusion: We describe a national consensus-building process which resulted in a simulation case template endorsed by simulation educators from across Canada. This template has the potential to: 1. Reduce the replication of effort across sites by facilitating the sharing of simulation cases. 2. Enable national collaboration on the development of both simulation cases and curricula. 3. Facilitate multi centre simulation-based research by removing confounders related to the local adoption of an unfamiliar case template. This could improve the rigour and validity of these studies by reducing inter-site variability. 4. Increase the validity of any simulation scenarios developed for use in national high-stakes assessment.

Introduction: We examined persons transported to hospital after police use of force to determine whether Emergency Department (ED) assessment and/or mode of transport could be predicted. Methods: A multi-site prospective consecutive cohort study of police use of force with data on ED assessment for individuals ≥18 yrs was conducted over 36 months (Jan 2010-Dec 2012) in 4 cities in Canada. Police, EMS and hospital data were linked by study ID. Stepwise logistic regression examined the relationship between the police call for service and subject characteristics on subsequent ED assessment and mode of transport. Results: In 3310 use of force events, 86.7% of subjects were male, median age 29 yrs. ED transport occurred in 26% (n=726). Odds of ED assessment increased by 1.2 (CI 1.1, 1.3) for each force modality >1. Other predictors of ED use: if the nature of police call was for Mental Health Act (MHA) (Odds 14.3, CI 10.6, 19.2), features of excited delirium (ExD) (Odds 2.7, CI 1.9, 3.7), police-assessed emotional distress (EDP) not an MHA (Odds 2.1, CI 1.5, 3.0) and combined drugs, alcohol and EDP (Odds 1.7, CI 1.9, 3.7). Those with alcohol impairment alone were less likely to go to ED from the scene: OR 0.6 (CI 0.5, 0.7). EMS transported 55% of all patients (n=401), although police transported ~100 people who EMS attended at the scene but did not subsequently transport. For patients brought to the ED, 70% had a retrievable chart (512/726) with a discernible primary diagnosis: 25% for physical injury, 32% for psychiatric and 43% for drug and/or alcohol intoxication. For use of force events that began as MHA calls, patient transport was more often by police car than ambulance OR 1.8 (CI 1.2, 2.5), while those with drug intoxication or ≥3 ExD features were more often brought by ambulance: odds of police transport 0.5 (CI 0.3, 0.9) and 0.4 (CI 0.3, 0.7). Violence or aggression did not predict mode of transport in our study. Conclusion: About one quarter of police use of force events lead to ED assessment; 1 in 4 patients transported had a physical injury of some description. Calls including the Mental Health Act or individuals with drug intoxication or excited delirium features are most predictive of ED use following police use of force. In MHA calls with use of force, persons are nearly twice as likely to go to ED by police car than by ambulance.

By expressing the discounted net loss process as a randomly weighted sum, we investigate the finite-time ruin probabilities for the Poisson risk model with an exponential Lévy process investment return and heavy-tailed claims. It is found that in finite time, however, the extreme of insurance risk dominates the extreme of financial risk, but, for the case of dangerous investment (see Klüppelberg and Kostadinova (2008) for an accurate definition of dangerous investment), the extreme of financial risk has more and more of an effect on the total risk, and as time passes, the extreme of financial risk finally dominates the extreme of insurance risk.

Stochastic processes with Student marginals and various types of dependence structure, allowing for both short- and long-range dependence, are discussed in this paper. A particular motivation is the modelling of risky asset time series.

We present a necessary and sufficient condition for a stochastic exponential to be a true martingale. It is proved that the criteria for the true martingale property are related to whether a related process explodes. An alternative and interesting interpretation of this result is that the stochastic exponential is a true martingale if and only if under a ‘candidate measure’ the integrand process is square integrable over time. Applications of our theorem to problems arising in mathematical finance are also given.

This paper aims at enhancing the understanding of long-range dependence (LRD) by focusing on mechanisms for generating this dependence, namely persistence of signs and/or persistence of magnitudes beyond what can be expected under weak dependence. These concepts are illustrated through a discussion of fractional Brownian noise of index H ∈ (0,1) and it is shown that LRD in signs holds if and only if ½ < H < 1 and LRD in magnitudes if and only if ¾ ≤ H < 1. An application to discrimination between two risky asset finance models, the FATGBM model of Heyde and the multifractal model of Mandelbrot, is given to illustrate the use of the ideas.

A class of continuous-time models is developed for modelling data with heavy tails and long-range dependence. These models are based on the Green function solutions of fractional differential equations driven by Lévy noise. Some exact results on the second- and higher-order characteristics of the equations are obtained. Applications to stochastic volatility of asset prices and macroeconomics are provided.

The geometric Brownian motion (Black–Scholes) model for the price of a risky asset stipulates that the log returns are i.i.d. Gaussian. However, typical log returns data shows a leptokurtic distribution (much higher peak and heavier tails than the Gaussian) as well as evidence of strong dependence. In this paper a subordinator model based on fractal activity time is proposed which simply explains these observed features in the data, and whose scaling properties check out well on various data sets.

Long-range dependence has usually been defined in terms of covariance properties relevant only to second-order stationary processes. Here we provide new definitions, almost equivalent to the original ones in that domain of applicability, which are useful for processes which may not be second-order stationary, or indeed have infinite variances. The ready applicability of this formulation for categorizing the behaviour for various infinite variance models is shown.

Estimation of parameters in diffusion models is usually handled by maximum likelihood and involves the calculation of a Radon–Nikodym derivative. This methodology is often not available when minor changes are made to the model. However, these complications can usually be avoided and results obtained under more general conditions using quasi-likelihood methods. The basic ideas are explained in this paper and are illustrated through discussion of the Cox–Ingersoll–Ross model and a modification of the Langevin model.