The Development of Competencies in Interprofessional Health Care for Use in Health Science Educational Programs

Background: The Health Education Technology Research Unit (HETRU) at the University of Ontario Institute of Technology (UOIT) has developed an interprofessional framework for use as a learning map to create computer-based simulations that can automatically assess interprofessional competencies of undergraduate health sciences students.Methods: Our interprofessional competency framework was developed through an iterative process of competency mapping. Each iteration involved: 1) a literature review of interprofessional competencies, 2) the mapping of these competencies within a meaningful taxonomy, and 3) the review of the mapping by an expert panel of educators and clinicians.Findings and Conclusions: After three iterations, the research team developed a competency taxonomy that mapped interprofessional competencies from our literature reviews into six competency domains and three cross-cutting themes for each domain. The competency matrix was then used as a learning map to define learning resources related to interprofessional education and learning activities associated with such resources to help students develop competencies in interprofessional healthcare planning and delivery. Interactive, computer-based clinical simulations were then developed to portray opportunities in which the learning resources and activities could be explored and to provide more realistic exposure to complexities in healthcare planning and delivery

Homeostasis, injury, and recovery dynamics at multiple scales in a self-organizing mouse intestinal crypt.

The maintenance of the functional integrity of the intestinal epithelium requires a tight coordination between cell production, migration, and shedding along the crypt-villus axis. Dysregulation of these processes may result in loss of the intestinal barrier and disease. With the aim of generating a more complete and integrated understanding of how the epithelium maintains homeostasis and recovers after injury, we have built a multi-scale agent-based model (ABM) of the mouse intestinal epithelium. We demonstrate that stable, self-organizing behaviour in the crypt emerges from the dynamic interaction of multiple signalling pathways, such as Wnt, Notch, BMP, ZNRF3/RNF43, and YAP-Hippo pathways, which regulate proliferation and differentiation, respond to environmental mechanical cues, form feedback mechanisms, and modulate the dynamics of the cell cycle protein network. The model recapitulates the crypt phenotype reported after persistent stem cell ablation and after the inhibition of the CDK1 cycle protein. Moreover, we simulated 5-fluorouracil (5-FU)-induced toxicity at multiple scales starting from DNA and RNA damage, which disrupts the cell cycle, cell signalling, proliferation, differentiation, and migration and leads to loss of barrier integrity. During recovery, our in silico crypt regenerates its structure in a self-organizing, dynamic fashion driven by dedifferentiation and enhanced by negative feedback loops. Thus, the model enables the simulation of xenobiotic-, in particular chemotherapy-, induced mechanisms of intestinal toxicity and epithelial recovery. Overall, we present a systems model able to simulate the disruption of molecular events and its impact across multiple levels of epithelial organization and demonstrate its application to epithelial research and drug development

Bowing gestures classification in violin performance: a machine learning approach

Gestures in music are of paramount importance partly because they are directly linked to musicians' sound and expressiveness. At the same time, current motion capture technologies are capable of detecting body motion/gestures details very accurately. We present a machine learning approach to automatic violin bow gesture classification based on Hierarchical Hidden Markov Models (HHMM) and motion data. We recorded motion and audio data corresponding to seven representative bow techniques (Détaché, Martelé, Spiccato, Ricochet, Sautillé, Staccato, and Bariolage) performed by a professional violin player. We used the commercial Myo device for recording inertial motion information from the right forearm and synchronized it with audio recordings. Data was uploaded into an online public repository. After extracting features from both the motion and audio data, we trained an HHMM to identify the different bowing techniques automatically. Our model can determine the studied bowing techniques with over 94% accuracy. The results make feasible the application of this work in a practical learning scenario, where violin students can benefit from the real-time feedback provided by the system.This work has been partly sponsored by the Spanish TIN project TIMUL (TIN 2013-48152-C2-2-R), the European Union Horizon 2020 research and innovation programme under grant agreement No. 688269 (TELMI project), and the Spanish Ministry of Economy and Competitiveness under the Maria de Maeztu Units of Excellence Programme (MDM-2015-0502)

Homozygous/compound heterozygote RYR1 gene variants: Expanding the clinical spectrum.

The ryanodine receptor 1 (RYR1) is a calcium release channel essential for excitation-contraction coupling in the sarcoplasmic reticulum of skeletal muscles. Dominant variants in the RYR1 have been well associated with the known pharmacogenetic ryanodinopathy and malignant hyperthermia. With the era of next-generation gene sequencing and growing number of causative variants, the spectrum of ryanodinopathies has been evolving with dominant and recessive variants presenting with RYR1-related congenital myopathies such as central core disease, minicore myopathy with external ophthalmoplegia, core-rod myopathy, and congenital neuromuscular disease. Lately, the spectrum was broadened to include fetal manifestations, causing a rare recessive and lethal form of fetal akinesia deformation sequence syndrome (FADS)/arthrogryposis multiplex congenita (AMC) and lethal multiple pterygium syndrome. Here we broaden the spectrum of clinical manifestations associated with homozygous/compound heterozygous RYR1 gene variants to include a wide range of manifestations from FADS through neonatal hypotonia to a 35-year-old male with AMC and PhD degree. We report five unrelated families in which three presented with FADS. One of these families was consanguineous and had three affected fetuses with FADS, one patient with neonatal hypotonia who is alive, and one individual with AMC who is 35 years old with normal intellectual development and uses a wheelchair. Muscle biopsies on these cases demonstrated a variety of histopathological abnormalities, which did not assist with the diagnostic process. Neither the affected living individuals nor the parents who are obligate heterozygotes had history of malignant hyperthermia

Thoracic imaging of coronavirus disease 2019 (COVID-19) in children: a series of 91 cases

Background: Pulmonary infection with SARS-CoV-2 virus (severe acute respiratory syndrome coronavirus 2; COVID-19) has rapidly spread worldwide to become a global pandemic. Objective: To collect paediatric COVID-19 cases worldwide and to summarize both clinical and imaging findings in children who tested positive on polymerase chain reaction testing for SARS-CoV-2. Materials and methods: Data were collected by completion of a standardised case report form submitted to the office of the European Society of Paediatric Radiology from March 12 to April 8, 2020. Chest imaging findings in children younger than 18 years old who tested positive on polymerase chain reaction testing for SARS-CoV-2 were included. Representative imaging studies were evaluated by multiple senior paediatric radiologists from this group with expertise in paediatric chest imaging. Results: Ninety-one children were included (49 males; median age: 6.1 years, interquartile range: 1.0 to 13.0 years, range: 9 days–17 years). Most had mild symptoms, mostly fever and cough, and one-third had coexisting medical conditions. Eleven percent of children presented with severe symptoms and required intensive unit care. Chest radiographs were available in 89% of patients and 10% of them were normal. Abnormal chest radiographs showed mainly perihilar bronchial wall thickening (58%) and/or airspace consolidation (35%). Computed tomography (CT) scans were available in 26% of cases, with the most common abnormality being ground glass opacities (88%) and/or airspace consolidation (58%). Tree in bud opacities were seen in 6 of 24 CTs (25%). Lung ultrasound and chest magnetic resonance imaging were rarely utilized. Conclusion: It seems unnecessary to perform chest imaging in children to diagnose COVID-19. Chest radiography can be used in symptomatic children to assess airway infection or pneumonia. CT should be reserved for when there is clinical concern to assess for possible complications, especially in children with coexisting medical conditions