FROM INTUITION TO PROFESSIONALIZATION: A QUALITATIVE STUDY ABOUT THE DEVELOPMENT OF TEACHER IDENTITY IN INTERNAL MEDICINE SENIOR RESIDENTS

Objectives: Professional identity can be defined as a developmental process. Literature suggests that residents aiming to practice in a teaching institution should receive support for the development of teaching competencies as much as they do for medical competencies, but there is limited data on how to recognize teacher identity development in residents. Our study focused on the manifestations of teacher identity development in a group of senior residents in a four-week optional pedagogy rotation. In particular, we were interested in seeing teacher identity development towards the end of the residency program, at a time when clinician identity begins to consolidate.  Methods: A qualitative and exploratory approach guided our study design. Participants were internal medicine residents, (from Yr4 to Yr6) at University of Montréal, who intended working in a university setting and were interested in developing a teaching project. Focus groups were held at three separate moments: 1) before rotation, 2) after rotation and, 3) six months after rotation. Direct content analysis was chosen to analyze our findings. Results: We observed the emergence and the evolution of teacher identity and furthermore, we identified six development pathways, which underpin the development of teacher professional identity: 1) From awkward and stereotyped usage to mastery of concepts and teaching techniques, 2) From the reproduction of implicit norms of the clinical setting to the establishment of pedagogical norms 3) From the feeling of powerlessness in teaching to a feeling of mastery and taking initiatives 4) From teaching intuitively to reasoning pedagogically 5) From a teacher based paradigm to the discovery of the learner-centered paradigm and 6) From an emerging identity as a clinician to the simultaneous construction of twin identities: clinician and teacher. Six development indicators providing operational cues to help recognize different facets of teacher identity development were then identified. Conclusion: The identity development pathways allowed us to gain deeper insights about how teacher identity develops in internal medicine residents toward the end of a pedagogical rotation. It is our hope that these findings will help educators recognize and support the development of teacher identity in their residents

Beneficial effects of reconstituted high-density lipoprotein (rHDL) on circulating CD34+ cells in patients after an acute coronary syndrome

Background: High-density lipoproteins (HDL) favorably affect endothelial progenitor cells (EPC). Circulating progenitor cell level and function are impaired in patients with acute coronary syndrome (ACS). This study investigates the short-term effects of reconstituted HDL (rHDL) on circulating progenitor cells in patients with ACS. Methods and Findings: The study population consisted of 33 patients with recent ACS: 20 patients from the ERASE trial (randomized to receive 4 weekly intravenous infusions of CSL-111 40 mg/kg or placebo) and 13 additional patients recruited as controls using the same enrolment criteria. Blood was collected from 16 rHDL (CSL-111)-treated patients and 17 controls at baseline and at 6–7 weeks (i.e. 2–3 weeks after the fourth infusion of CSL-111 in ERASE). CD34+ and CD34+/kinase insert domain receptor (KDR+) progenitor cell counts were analyzed by flow cytometry. We found preserved CD34+ cell counts in CSL-111-treated subjects at follow-up (change of 1.6%), while the number of CD34+ cells was reduced (-32.9%) in controls (p = 0.017 between groups). The level of circulating SDF-1 (stromal cell-derived factor-1), a chemokine involved in progenitor cell recruitment, increased significantly (change of 21.5%) in controls, while it remained unchanged in CSL-111-treated patients (p = 0.031 between groups). In vitro exposure to CSL-111 of early EPC isolated from healthy volunteers significantly increased CD34+ cells, reduced early EPC apoptosis and enhanced their migration capacity towards SDF-1. Conclusions: The relative increase in circulating CD34+ cells and the low SDF-1 levels observed following rHDL infusions in ACS patients point towards a role of rHDL in cardiovascular repair mechanisms

Non-steroidal anti-inflammatory drugs (NSAIDs) for cancer-related pain in children and adolescents

Background Pain is a common feature of childhood and adolescence around the world, and for many young people, that pain is chronic. The World Health Organization (WHO) guidelines for pharmacological treatments for persisting pain in children acknowledge that pain in children is a major public health concern of high significance in most parts of the world. Views on children's pain have changed over time and relief of pain is now seen as important. In the past, pain was largely dismissed and was frequently left untreated, and it was assumed that children quickly forgot about painful experiences. We designed a suite of seven reviews in chronic non-cancer pain and cancer pain (looking at antidepressants, antiepileptic drugs, non-steroidal anti-inflammatory drugs, opioids, and paracetamol as priority areas) to review the evidence for children's pain using pharmacological interventions. As one of the leading causes of mortality and morbidity for children and adolescents in the world today, childhood cancer (and its associated pain) is a major health concern. Specific mortality and morbidity data relating to children are not currently identified. All childhood cancer rates are on the rise; for example, in the USA approximately 10,380 children aged under 15 years were expected to be diagnosed with cancer by the end of 2016. However, with survival rates also increasing, over 80% of paediatric cancer patients are expected to survive for five years or more, thus identifying the need to address pain management in this population. Cancer pain in infants, children, and adolescents is primarily nociceptive pain with negative long term effects. Cancer-related pain is generally caused directly by the tumour itself such as compressing on the nerve or inflammation of the organs. Cancer-related pain generally occurs as a result of perioperative procedures, nerve damage caused by radiation or chemotherapy treatments, or mucositis. However, this review focused on pain caused directly by the tumour itself such as nerve infiltration, external nerve compression, and other inflammatory events. Non-steroidal anti-inflammatory drugs (NSAIDs) are used to treat pain, reduce fever, and for their anti-inflammatory properties. They are commonly used within paediatric pain management. NSAIDs are currently licensed for use in western countries, however not approved for infants aged under three months. Primary adverse effects include gastrointestinal issues and possible renal impairment with long term use. Other adverse effects in children include diarrhoea, headache, nausea, constipation, rash, dizziness, and abdominal pain. Objectives To assess the analgesic efficacy, and adverse events, of non-steroidal anti-inflammatory drugs (NSAIDs) used to treat cancer-related pain in children and adolescents aged from birth and 17 years, in any setting. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) via the Cochrane Register of StudiesOnline, MEDLINE via Ovid, and Embase via Ovid from inception to 21 February 2017. We also searched the reference lists of retrieved studies and reviews, and searched online clinical trial registries. Selection criteria Randomised, double-blind trials of any dose, and any route, treating cancer-related pain in children and adolescents, comparing NSAIDs with placebo or an active comparator. Data collection and analysis Two review authors independently assessed studies for eligibility. We planned to use dichotomous data to calculate risk ratio and number needed to treat for one additional event, using standard methods. We assessed GRADE (Grading of Recommendations Assessment, Development and Evaluation) and planned to create a 'Summary of findings' table. Main results No studies were eligible for inclusion in this review (very low quality evidence). We downgraded the quality of evidence by three levels due to the lack of data reported for any outcome. Authors' conclusions There is no evidence from randomised controlled trials that non-steroidal anti-inflammatory drugs (NSAIDs) reduce cancer-related pain in children and adolescents. This means that no reliance or conclusions can be made about efficacy or harm in the use of NSAIDs to treat chronic cancer-related pain in children and adolescents

Pest categorisation of non-EU Acleris spp

The Panel on Plant Health performed a pest categorisation of non-EU Acleris spp. Acleris is a welldefined insect genus in the family Tortricidae (Insecta: Lepidoptera). Species can be identified using taxonomic keys based on adult morphology and genitalia. The genus includes 261 species attacking conifers and non-conifer plants in many areas in the world, among which 40 species are present in the EU. The non-EU species are collectively listed in Annex IAI of Council Directive 2000/29/EC as Acleris spp. (non-European). Some species are important defoliators in North America, mainly on conifers but also on several broadleaf trees. Females lay eggs on the leaves or on the bark. The larvae bind together with silk the leaves upon which they feed. Pupation occurs in leaves attached with silk or in the soil. Some species are univoltine; others are bivoltine or multivoltine. Flight capacity is not documented, but outbreak expansion suggests that the adults can probably fly long distances. The main pathways for entry are host plants for planting with or without soil, cut branches, fruits of host plants (including cones), round wood with bark and bark. The presence of host plants and suitable EU climate would allow the establishment of the known non-EU harmful species. In the literature, nine non-EU Acleris species are reported as pests on various host plants, namely A. gloverana, A. variana, A. minuta, A. nishidai, A. issikii, A. semipurpurana, A. robinsoniana, A. senescens and A. nivisellana. These non-EU Acleris spp. satisfy all the criteria to be considered as Union quarantine pests. Concerning the other 212 non-EU Acleris species, there is scarce information on host plants, pests status and climatic suitability. Measures are in place to prevent the introduction of non-EU Acleris spp. through the pathways described in the document. As non-EU Acleris spp. are not present in the EU and plants for planting are not the major pathway for spread, non-EU Acleris spp. do not meet the criteria to be considered as regulated non-quarantine pests

Pest categorisation of Pseudopityophthorus minutissimus and P. pruinosus

The Panel on Plant Health performed a pest categorisation of Pseudopityophthorus minutissimus and Pseudopityophthorus pruinosus, two well-defined insect species in the family Curculionidae, subfamily Scolytinae (Insecta: Coleoptera). They can be identified using taxonomic keys. P. minutissimus is present in parts of Canada and the USA, and P. pruinosus is present in parts of the USA, Guatemala, Honduras and Mexico. The main host plants of the two species are Quercus spp., but they also attack several other genera. The two species mostly colonise weakened or dead branches but can also attack the stems. They are mostly secondary pests but they vector the oak wilt fungus, Bretziella fagacearum, which causes heavy damage in American Quercus spp. populations. The fungus is mainly transmitted by the young adults during their maturation feeding on twigs, leaf petioles and young acorn stems. The beetles are polygamous and have two generations per year in most of their range. The main pathways are wood, bark, plants for planting, cut branches, chips and wood waste. These pathways are fully or partly regulated for the genera Quercus, Castanea and Prunus. However, the pathways are not regulated for the following genera: Carpinus, Fagus, Hamamelis, Alnus. P. minutissimus and P. pruinosus meet all the criteria assessed by EFSA for consideration as potential Union quarantine pest. The criteria for considering P. minutissimus and P. pruinosus as potential Union regulated non-quarantine pests are not met since neither species are known to be present in the EU

Pest categorisation of Scaphoideus luteolus

The Panel on Plant Health performed a pest categorisation of Scaphoideus luteolus, a well-defined phloem sap-feeding insect species in the family Cicadellidae (Insecta: Hemiptera). It can be identified using taxonomic keys. S. luteolus is only present in the eastern part of the USA. The main host plants of S. luteolus are species of the genus Ulmus (U. americana, U. alata, U. bergmanianna, U. szechuanica, U. rubra), but specimens have also been collected on Vitis sp., Salix sp. and Populus sp. The species does not cause damage by itself, but it is the only confirmed vector of the phytoplasma Candidatus Phytoplasma ulmi (CPu), which is present in North America where it causes heavy damage to the local elms, as well as in some European countries where the local elms are considered less susceptible. S. luteolus has three developmental stages (egg, nymph, adult). It overwinters in the egg stage, takes 36–42 days to complete nymphal stage, and adults are found throughout the summer period. Both nymphs and adults are capable of transmitting CPu and, after acquiring the pathogen, remain infective for the rest of their life. The main pathways are cut branches and plants for planting. These pathways are not regulated for the main host, Ulmus, though requirements are in place in relation to other pests on Ulmus. These pathways are also not regulated for Salix. Establishment would be favoured by the wide coverage of Ulmus spp. in the EU territory and by climatic conditions comparable to those of the pest’s native range. S. luteolus meets all the criteria assessed by EFSA for consideration as potential Union quarantine pest. The criteria for considering it as a potential Union regulated non-quarantine pest are not met since the species is absent from the EU

Pest categorisation of Arrhenodes minutus

The Panel on Plant Health performed a pest categorisation of Arrhenodes minutus, a well-defined wood-boring insect species in the family Brentidae (Insecta: Coleoptera). It can be identified using taxonomic keys. A. minutus is only present in southern Canada and eastern USA down to Florida. The main host plants of A. minutus are species of the genera Quercus, Ulmus, Fagus and Populus. The pest larvae bore galleries in the wood, causing structural damage to the timber. The pest is also a vector of the quarantine pest Breziella (Ceratocystis) fagacearum. A. minutus most often lays its eggs in wounded parts of the trees where sap is oozing. The female bores minute holes with her snout and deposits one egg in each of them. The larvae bore a straight gallery against the grain. When the gallery nearly reaches the other side of the bole, it makes a sharp U-turn towards the point of origin. These galleries cause structural damage to the timber. The life cycle lasts generally 3 years, but some individuals develop in 2 years and a few require 4 years. The main pathways are wood and possibly plants for planting. Specific phytosanitary requirements exist for Quercus and Populus only, while Ulmus is regulated in relation to other pests. Establishment would be favoured by the wide distribution of host trees in the EU territory and by climatic conditions locally comparable to those of the pest’s native range. A. minutus meets all the criteria assessed by EFSA for consideration as potential Union quarantine pest. The criteria for considering it as a potential Union regulated non-quarantine pest are not met since the species is absent from the EU

Teaching of English in French-Canada

Thesis (Ed.M.)--Boston University, 1935. This item was digitized by the Internet Archive

Effects of the high-density lipoprotein mimetic agent CER-001 on coronary atherosclerosis in patients with acute coronary syndromes: a randomized trial†

Aim High-density lipoproteins (HDLs) have several potentially protective vascular effects. Most clinical studies of therapies targeting HDL have failed to show benefits vs. placebo. Objective To investigate the effects of an HDL-mimetic agent on atherosclerosis by intravascular ultrasonography (IVUS) and quantitative coronary angiography (QCA). Design and setting A prospective, double-blinded, randomized trial was conducted at 51 centres in the USA, the Netherlands, Canada, and France. Intravascular ultrasonography and QCA were performed to assess coronary atherosclerosis at baseline and 3 (2-5) weeks after the last study infusion. Patients Five hundred and seven patients were randomized; 417 and 461 had paired IVUS and QCA measurements, respectively. Intervention Patients were randomized to receive 6 weekly infusions of placebo, 3 mg/kg, 6 mg/kg, or 12 mg/kg CER-001. Main outcome measures The primary efficacy parameter was the nominal change in the total atheroma volume. Nominal changes in per cent atheroma volume on IVUS and coronary scores on QCA were also pre-specified endpoints. Results The nominal change in the total atheroma volume (adjusted means) was −2.71, −3.13, −1.50, and −3.05 mm3 with placebo, CER-001 3 mg/kg, 6 mg/kg, and 12 mg/kg, respectively (primary analysis of 12 mg/kg vs. placebo: P = 0.81). There was also no difference among groups for the nominal change in per cent atheroma volume (0.02, −0.02, 0.01, and 0.19%; nominal P = 0.53 for 12 mg/kg vs. placebo). Change in the coronary artery score was −0.022, −0.036, −0.022, and −0.015 mm (nominal P = 0.25, 0.99, 0.55), and change in the cumulative coronary stenosis score was −0.51, 2.65, 0.71, and −0.77% (compared with placebo, nominal P = 0.85 for 12 mg/kg and nominal P = 0.01 for 3 mg/kg). The number of patients with major cardiovascular events was 10 (8.3%), 16 (13.3%), 17 (13.7%), and 12 (9.8%) in the four groups. Conclusion CER-001 infusions did not reduce coronary atherosclerosis on IVUS and QCA when compared with placebo. Whether CER-001 administered in other regimens or to other populations could favourably affect atherosclerosis must await further study. Name of the trial registry: Clinicaltrials.gov; Registry's URL: http://clinicaltrials.gov/ct2/show/NCT01201837?term=cer-001&rank=2; Trial registration number: NCT0120183