Multi-source qualitative analysis of emergency medicine residency programmes in Chile:A case study

Resumen: Introducción: la Medicina de Urgencia (MDU) es una especialidad en desarrollo a nivel mundial. En Chile se inició hace más de 2 décadas y aún está avanzando académicamente. Objetivo: explorar el estado actual del desarrollo curricular de la MDU en Chile e identificar formas de estandarizarlo y mejorarlo. Métodos: se realizó un estudio de caso cualitativo para explorar las perspectivas sobre el desarrollo del currículo de la MDU a través de entrevistas a residentes, graduados y directores de programas y análisis documental. Ambos conjuntos de datos fueron evaluados a través de análisis temático. Resultados: se analizaron 4 documentos y se realizaron 8 entrevistas. Surgieron 4 temas principales: estructura curricular, influencia del contexto, expectativas de un médico de urgencia, perspectivas de la MDU. Los programas actuales se centran en el aprendizaje en el lugar de trabajo y tiempo protegido para el aprendizaje; sin embargo, difieren en la exposición clínica y la calidad de la capacitación. Como prioridad, se identificó la colaboración, enfatizando la necesidad de que los programas trabajen juntos para garantizar la calidad. Conclusión: este estudio identifica el estado de situación del desarrollo curricular de la MDU en Chile, identificando similitudes y diferencias entre los programas y las áreas de mejora. Existe acuerdo sobre la necesidad de un currículo mínimo, considerando el contexto local y las necesidades de la sociedad. Abstract: Background: Emergency medicine (EM) is a developing specialty worldwide. In Chile, it has been developing for 25 years, however, there is a need for further progress. Aim: We aimed to explore the current postgraduate curriculum in Chile and identify ways to standardise and improve it. Methods: A qualitative case study approach was used to explore perspectives on EM curriculum development via interviewing residents, graduates and programme directors and documentary analysis of academic and governmental guidelines. Both data sets were evaluated through thematic analysis. Results: Four documents were analyzed, and eight interviews were conducted. Four main themes emerged: curricular structure, influence of context, expectations of an emergency physician, EM perspectives. Current programs focus on workplace learning and protected time for learning; however, they differ in clinical exposure and quality of training. Collaboration was identified as a priority, emphasizing the need for programs to work together to ensure quality. Conclusion: This study identifies the state of curriculum development of EM in Chile. It identifies similarities and differences between programs and areas for improvement. There is agreement on the need for a standardized curriculum, considering local context and societal needs

Maternal HIV Illness and its Impact on Children’s Well-being and Development in Haiti

Little is known about the impact of parental HIV illness on children’s well-being and development in the island nations of the Caribbean. Study objectives were to examine mothers’ experiences of impact of HIV illness on their children’s well-being and development in Haiti. Baseline interviews were conducted between 2006 and 2007 with 25 HIV-positive mothers as part of a larger study that examined the feasibility of a psychosocial support group intervention for HIV-affected youth and their caregivers in central Haiti. Interviews were transcribed verbatim and coded for topical themes by two investigators. Main themes related to impact of maternal HIV illness on children’s well-being were the lack of mothers’ physical strength to take care of their children, and their difficulties in providing housing and food for their children. Children’s school enrollment, attendance, and performance were also affected by their mother’s illness. Mothers reported that although their children were HIV-negative, children were distressed by HIV-related stigma that they and their mothers experienced. Findings suggest that children living in HIV-affected families in this region face disadvantages in nutritional, educational, and psychological outcomes. These considerations should be taken into account when designing interventions to support children living in HIV-affected families in this setting

Disclosure and Impact of Maternal HIV+ Serostatus on Mothers and Children in Rural Haiti

Mothers living with HIV (MLWHs) in the United States have reported that one of their main challenges is the decision to disclose their HIV serostatus to their children and the potential consequences of their disclosure. Little is known about the experiences of MLWHs regarding disclosing their HIV serostatus to their children and the impact of maternal HIV disclosure in the island nations of the Caribbean. Study objectives were to identify the factors influencing maternal HIV disclosure, examine the breadth of maternal HIV disclosure, and understand the impact of disclosure on mothers and the children

Crop Updates 2011 - Nutrition, Precision Agriculture & Climate and Forecasting

This session covers sixteen papers from different authors: Nutrition 1. Balance® used in conventional cropping practice with half of the upfront fertiliser rate can sustain crop yield and build soil biological fertility, Deb Archdeacon1, Andrew Gulliver2 and David Cullen2, 1Agronomica, Wellington Mill, WA, 2Custom Composts, Nambeelup, WA 2. Effects of potassium (K) supply on plant growth, potassium uptake and grain Yield in wheat grown in grey sand, Qifu Ma1, Richard Bell1, Ross Brennan2 and Craig Scanlan2, 1School of Environmental Science, Murdoch University, 2Department of Agriculture and Food 3. Improving fertiliser management: redefining the relationship between soil tests and crop responses for wheat in WA, Wen Chen1, 2, Ross Brennan2, Geoff Anderson2, Richard Bell1 and Mike Bolland2, 1School of Environmental Science, Murdoch University, 2Department of Agriculture and Food 4. Improved phosphorus and potassium management: redefining the soil test and lupin response relationships in WA, Wen Chen1, 2, Ross Brennan2, Geoff Anderson2, Richard Bell1 and Mike Bolland2, 1School of Environmental Science, Murdoch University, Western Australia, 2Department of Agriculture and Food 5. Converting phosphorus retention index (PRI) to phosphorus buffering index (PBI) for Western Australian soils, Peter Rees and Sandy Alexander, Summit Fertilizers 6. Variability of radiometric potassium and Colwell potassium relationships across the Great Southern, Frank D’Emden, Precision Agronomics Australia 7. Rotary spading and mouldboard ploughing of water-repellent sandplain soils fulfils promise, Stephen Davies, Craig Scanlan and Breanne Best, Department of Agriculture and Food 8. Soil nitrous oxide (N2O) fluxes are low from a grain legume crop grown in a semi-arid climate Louise Barton1, Klaus Butterbach-Bahl2, Ralph Kiese2 and Daniel Murphy1, 1 School of Earth & Environment, University of Western Australia, 2 Karlsruhe Institute of Technology, Institute for Meteorology & Climate Research, Garmisch-Partenkirchen, Germany, 9. Mouldboard ploughing of sandplain soils – more grain, fewer weeds, Peter Newman Department of Agriculture and Food Precision Agriculture 10.What’s preventing growers from implementing precision agriculture (PA)? Roger Mandel1, Roger Lawes2 and Michael Robertson2, 1Curtin University, 2CSIRO 11. On how many paddocks does precision agriculture (PA) deliver a return? Roger Lawes1, Michael Robertson1 and Roger Mandel2, 1CSIRO Ecosystem Sciences, Floreat, WA, 2Curtin University 12. Demonstration pf precision agriculture (PA) principles in the Great Southern, Western Australia, Derk Bakker1, Jeremy Lemon1, Alison Lacey1, John Paul Collins1, Roger Mandel2, Frank D’Emden3, Glen Riethmuller1, 1Department of Agriculture and Food, 2Curtin University, 3Precision Agronomics Australia Climate and Forecasting 13. Statistical seasonal rainfall forecasts for south west Australia, Fiona H Evans Department of Agriculture of Food 14. How has changing climate recently affected Western Australia’s capacity to increase crop productivity and water use efficiency? David Stephens, Department of Agriculture and Food 15. Is Yield Prophet® a useful tool in Western Australia? — an agribusiness perspective, Caroline Peek, Department of Agriculture and Food 16. A season of Yield Prophet® — how it saw the dry, Tim Scanlon and Caroline Peek Department of Agriculture of Foo

Crop Updates 2005 - Farming Systems

This session covers forty four papers from different authors: PLENARY 1. 2005 Outlook, David Stephens and Nicola Telcik, Department of Agriculture FERTILITY AND NUTRITION 2. The effect of higher nitrogen fertiliser prices on rotation and fertiliser strategies in cropping systems, Ross Kingwell, Department of Agriculture and University of Western Australia 3. Stubble management: The short and long term implications for crop nutrition and soil fertility, Wayne Pluske, Nutrient Management Systems and Bill Bowden, Department of Agriculture 4. Stubble management: The pros and cons of different methods, Bill Bowden, Department of Agriculture, Western Australia and Mike Collins, WANTFA 5. Effect of stubble burning and seasonality on microbial processes and nutrient recycling, Frances Hoyle, The University of Western Australia 6. Soil biology and crop production in Western Australian farming systems, D.V. Murphy, N. Milton, M. Osman, F.C. Hoyle, L.K Abbott, W.R. Cookson and S. Darmawanto, The University of Western Australia 7. Urea is as effective as CAN when no rain for 10 days, Bill Crabtree, Crabtree Agricultural Consulting 8. Fertiliser (N,P,S,K) and lime requirements for wheat production in the Merredin district, Geoff Anderson, Department of Agriculture and Darren Kidson, Summit Fertilizers 9. Trace element applications: Up-front verses foliar? Bill Bowden and Ross Brennan, Department of Agriculture 10. Fertcare®, Environmental Product Stewardship and Advisor Standards for thee Fertiliser Industry, Nick Drew, Fertilizer Industry Federation of Australia (FIFA) SOIL AND LAND MANAGEMENT 11. Species response to row spacing, density and nutrition, Bill Bowden, Craig Scanlan, Lisa Sherriff, Bob French and Reg Lunt, Department of Agriculture 12. Investigation into the influence of row orientation in lupin crops, Jeff Russell, Department of Agriculture and Angie Roe, Farm Focus Consultants 13. Deriving variable rate management zones for crops, Ian Maling, Silverfox Solutions and Matthew Adams, DLI 14. In a world of Precision Agriculture, weigh trailers are not passé, Jeff Russell, Department of Agriculture 15. Cover crop management to combat ryegrass resistance and improve yields, Jeff Russell, Department of Agriculture and Angie Roe, Farm Focus Consultants 16. ARGT home page, the place to find information on annual ryegrass toxicity on the web, Dr George Yan, BART Pty Ltd 17. Shallow leading tine (SLT) ripper significantly reduces draft force, improves soil tilth and allows even distribution of subsoil ameliorants, Mohammad Hamza, Glen Riethmuller and Wal Anderson, Department of Agriculture PASTURE ANS SUMMER CROP SYSTEMS 18. New annual pasture legumes for Mediteranean farming systems, Angelo Loi, Phil Nichols, Clinton Revell and David Ferris, Department of Agriculture 19. How sustainable are phase rotations with Lucerne? Phil Ward, CSIRO Plant Industry 20. Management practicalities of summer cropping, Andrea Hills and Sally-Anne Penny, Department of Agriculture 21. Rainfall zone determines the effect of summer crops on winter yields, Andrea Hills, Sally-Anne Penny and David Hall, Department of Agriculture 22. Summer crops and water use, Andrea Hills, Sally-Anne Penny and David Hall, Department of Agriculture, and Michael Robertson and Don Gaydon, CSIRO Brisbane 23. Risk analysis of sorgum cropping, Andrea Hills and Sally-Anne Penny, Department of Agriculture, and Dr Michael Robertson and Don Gaydon, CSIRO Brisbane FARMER DECISION SUPPORT AND ADOPTION 24. Variety release and End Point Royalties – a new system? Tress Walmsley, Department of Agriculture 25. Farming system analaysis using the STEP Tool, Caroline Peek and Megan Abrahams, Department of Agriculture 26. The Leakage Calculator: A simple tool for groundwater recharge assessment, Paul Raper, Department of Agriculture 27. The cost of Salinity Calculator – your tool to assessing the profitability of salinity management options, Richard O’Donnell and Trevor Lacey, Department of Agriculture 28. Climate decision support tools, Meredith Fairbanks and David Tennant, Department of Agriculture 29. Horses for courses – using the best tools to manage climate risk, Cameron Weeks, Mingenew-Irwin Group/Planfarm and Richard Quinlan, Planfarm Agronomy 30. Use of seasonal outlook for making N decisions in Merredin, Meredith Fairbanks and Alexandra Edward, Department of Agriculture 31. Forecasts and profits, Benefits or bulldust? Chris Carter and Doug Hamilton, Department of Agriculture 32. A tool to estimate fixed and variable header and tractor depreciation costs, Peter Tozer, Department of Agriculture 33. Partners in grain: ‘Putting new faces in new places’, Renaye Horne, Department of Agriculture 34. Results from the Grower group Alliance, Tracey Gianatti, Grower Group Alliance 35. Local Farmer Group Network – farming systems research opportunities through local groups, Paul Carmody, Local Farmer Group Network GREENHOUSE GAS AND CLIMATE CHANGE 36. Changing rainfall patterns in the grainbelt, Ian Foster, Department of Agriculture 37. Vulnerability of broadscale agriculture to the impacts of climate change, Michele John, CSIRO (formerly Department of Agriculture) and Ross George, Department of Agriculture 38. Impacts of climate change on wheat yield at Merredin, Imma Farré and Ian Foster, Department of Agriculture 39. Climate change, land use suitability and water security, Ian Kininmonth, Dennis van Gool and Neil Coles, Department of Agriculture 40. Nitrous oxide emissions from cropping systems, Bill Porter, Department of Agriculture, Louise Barton, University of Western Australia 41. The potential of greenhouse sinks to underwrite improved land management in Western Australia, Richard Harper and Peter Ritson, CRC for Greenhouse Accounting and Forest Products Commission, Tony Beck, Tony Beck Consulting Services, Chris Mitchell and Michael Hill, CRC for Greenhouse Accounting 42. Removing uncertainty from greenhouse emissions, Fiona Barker-Reid, Will Gates, Ken Wilson and Rob Baigent, Department of Primary Industries - Victoria and CRC for Greenhouse Accounting (CRCGA), and Ian Galbally, Mick Meyer and Ian Weeks, CSIRO Atmospheric Research and CRCGA 43. Greenhouse in Agriculture Program (GIA), Traci Griffin, CRC for Greenhouse Accounting 44. Grains Greenhouse Accounting framework, D. Rodriguez, M. Probust, M. Meyers, D. Chen, A. Bennett, W. Strong, R. Nussey, I. Galbally and M. Howden CONTACT DETAILS FOR PRINCIPAL AUTHOR

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Assessment of the Use of Geographically Weighted Regression for Analysis of Large On-Farm Experiments and Implications for Practical Application

On-farm experimentation (OFE) is a farmer-centric process that can enhance the adoption of digital agriculture technologies and improve farm profitability and sustainability. Farmers work with consultants or researchers to design and implement experiments using their own machinery to test management practices at the field or farm scale. Analysis of data from OFE is challenging because of the large spatial variation influenced by spatial autocorrelation that is not due to the treatment being tested and is often much larger than treatment effects. In addition, the relationship between treatment and yield response may also vary spatially. We investigate the use of geographically weighted regression (GWR) for analysis of data from large on-farm experiments. GWR estimates local regressions, where data are weighted by distance from the site using a distance-decay kernel. It is a simple approach that can be easily explained to farmers and their agronomic advisors. We use simulated data to test the ability of GWR to separate yield variation due to treatment from any underlying spatial variation in yield that is not due to treatment; show that GWR kernel bandwidth can be based on experimental design to accurately separate the underlying spatial variability from treatment effects; and demonstrate a step-wise model selection approach to determine when the response to treatment is global across the experiment or locally varying. We demonstrate our recommended approach on two large-scale experiments conducted on farms in Western Australia to investigate grain yield response to potassium fertiliser. We discuss the implications of our results for routine practical application to OFE and conclude that GWR has potential for wide application in a semi-automated manner to analyse OFE data, improve farm decision-making, and enhance the adoption of digital technologies

Crop Updates 2011 - Nutrition, Precision Agriculture & Climate and Forecasting

This session covers sixteen papers from different authors: Nutrition 1. Balance® used in conventional cropping practice with half of the upfront fertiliser rate can sustain crop yield and build soil biological fertility, Deb Archdeacon1, Andrew Gulliver2 and David Cullen2, 1Agronomica, Wellington Mill, WA, 2Custom Composts, Nambeelup, WA 2. Effects of potassium (K) supply on plant growth, potassium uptake and grain Yield in wheat grown in grey sand, Qifu Ma1, Richard Bell1, Ross Brennan2 and Craig Scanlan2, 1School of Environmental Science, Murdoch University, 2Department of Agriculture and Food 3. Improving fertiliser management: redefining the relationship between soil tests and crop responses for wheat in WA, Wen Chen1, 2, Ross Brennan2, Geoff Anderson2, Richard Bell1 and Mike Bolland2, 1School of Environmental Science, Murdoch University, 2Department of Agriculture and Food 4. Improved phosphorus and potassium management: redefining the soil test and lupin response relationships in WA, Wen Chen1, 2, Ross Brennan2, Geoff Anderson2, Richard Bell1 and Mike Bolland2, 1School of Environmental Science, Murdoch University, Western Australia, 2Department of Agriculture and Food 5. Converting phosphorus retention index (PRI) to phosphorus buffering index (PBI) for Western Australian soils, Peter Rees and Sandy Alexander, Summit Fertilizers 6. Variability of radiometric potassium and Colwell potassium relationships across the Great Southern, Frank D’Emden, Precision Agronomics Australia 7. Rotary spading and mouldboard ploughing of water-repellent sandplain soils fulfils promise, Stephen Davies, Craig Scanlan and Breanne Best, Department of Agriculture and Food 8. Soil nitrous oxide (N2O) fluxes are low from a grain legume crop grown in a semi-arid climate Louise Barton1, Klaus Butterbach-Bahl2, Ralph Kiese2 and Daniel Murphy1, 1 School of Earth & Environment, University of Western Australia, 2 Karlsruhe Institute of Technology, Institute for Meteorology & Climate Research, Garmisch-Partenkirchen, Germany, 9. Mouldboard ploughing of sandplain soils – more grain, fewer weeds, Peter Newman Department of Agriculture and Food Precision Agriculture 10.What’s preventing growers from implementing precision agriculture (PA)? Roger Mandel1, Roger Lawes2 and Michael Robertson2, 1Curtin University, 2CSIRO 11. On how many paddocks does precision agriculture (PA) deliver a return? Roger Lawes1, Michael Robertson1 and Roger Mandel2, 1CSIRO Ecosystem Sciences, Floreat, WA, 2Curtin University 12. Demonstration pf precision agriculture (PA) principles in the Great Southern, Western Australia, Derk Bakker1, Jeremy Lemon1, Alison Lacey1, John Paul Collins1, Roger Mandel2, Frank D’Emden3, Glen Riethmuller1, 1Department of Agriculture and Food, 2Curtin University, 3Precision Agronomics Australia Climate and Forecasting 13. Statistical seasonal rainfall forecasts for south west Australia, Fiona H Evans Department of Agriculture of Food 14. How has changing climate recently affected Western Australia’s capacity to increase crop productivity and water use efficiency? David Stephens, Department of Agriculture and Food 15. Is Yield Prophet® a useful tool in Western Australia? — an agribusiness perspective, Caroline Peek, Department of Agriculture and Food 16. A season of Yield Prophet® — how it saw the dry, Tim Scanlon and Caroline Peek Department of Agriculture of Foo