Medical Student POCUS Peer-to-Peer Teaching: Ready for Mainstream

Background: Point of care ultrasound (POCUS) is changing the face of clinical practice and medical education. Worldwide consensus based on expert opinion has advocated for POCUS teaching in undergraduate medical school curricula. Significant barriers, including lack of available instructors and limited resources, prevents medical learners from acquiring core competencies at most institutions. Here, we describe a peer-to-peer learning POCUS workshop and advocate for the use of this type of training to meet the demands of POCUS learning. Methods: A two-day POCUS workshop was held in Toronto, Ontario with twenty-six medical student participants. The workshop was structured according to a graduated model of POCUS skill development, beginning with didactic teaching, then progressing to hands-on peer-to-peer teaching, and finishing with competency evaluation by POCUS experts. Participants completed pre-and post-workshop surveys regarding prior POCUS teaching and exposure, self-reported skill development, and feedback on the workshop itself. Results: Of the 20 respondents to the questionnaire, 70% had prior POCUS exposure, with 85% of these individuals having less than 5 hours of prior POCUS education. Eighty-five percent of students reported that the organization of the course allowed them to participate fully, and 95% of participants indicated that peer-to-peer learning was effective. Conclusion: These findings suggest that peer-to-peer POCUS teaching is an effective learning method to acquire and consolidate well-established POCUS competencies. This initiative is scalable and could be applied to all learners in various disciplines. As such, we recommend medical schools consider integration of peer-to-peer POCUS teaching into longitudinal clerkship training programs, and transition-to-residency courses

Enseignement de l'échographie au chevet à l'aide d'une technique de visioconférence

Implication Statement Point-of-care ultrasound (POCUS) has usually been taught using a hands-on, in-person approach. We present a novel approach to delivering POCUS virtually using a dual image videoconferencing technique. We outline an easily implementable approach and summarize medical students’ experience and feedback. This form of delivery has potential to improve instructional delivery in resource restricted settings or during pandemic restrictions where a hands-on approach may not be possible.Énoncé des implications de la recherche L'échographie au chevet fait généralement l’objet d’un enseignement pratique, en personne. Nous présentons une nouvelle approche, virtuelle, pour son enseignement, par visioconférence à double flux vidéo. L’approche que nous décrivons est facile à mettre en œuvre. Nous résumons l'expérience et les commentaires des étudiants en médecine sur cette modalité qui est susceptible d'améliorer l'enseignement dans des contextes où les ressources sont limitées ou en cas de pandémie, lorsque l’approche pratique n'est pas possible

Canny good, or quite canny? The semantic-syntactic distribution of canny in the North East of England

The word canny has long been associated with the dialects of the North East of England, most typically in its adjectival sense. However, it has four distinct functions (adjective, adverb, intensifier and modifier in quantifying expressions), which this paper tracks in a diachronic speech corpus. Although the intensifier (e.g. it’s canny good) is documented in the Survey of English Dialects (Upton, Parry and Widowson 1994), it appears in the corpus later than expected with the profile of an incoming form. Results from a judgement task corroborate the corpus trends and show that people’s intuitions about intensifier canny correlate with age as well as the semantics and position of the following adjective, in such a way that shows the intensifier is not fully delexicalised. The present research highlights the value of combining production and perception data in establishing how the origins of a linguistic item affect its distribution in its new function

Nutrition and frailty:Opportunities for prevention and treatment

Frailty is a syndrome of growing importance given the global ageing population. While frailty is a multifactorial process, poor nutritional status is considered a key contributor to its pathophysiology. As nutrition is a modifiable risk factor for frailty, strategies to prevent and treat frailty should consider dietary change. Observational evidence linking nutrition with frailty appears most robust for dietary quality: for example, dietary patterns such as the Mediterranean diet appear to be protective. In addition, research on specific foods, such as a higher consumption of fruit and vegetables and lower consumption of ultra-processed foods are consistent, with healthier profiles linked to lower frailty risk. Few dietary intervention studies have been conducted to date, although a growing number of trials that combine supplementation with exercise training suggest a multi-domain approach may be more effective. This review is based on an interdisciplinary workshop, held in November 2020, and synthesises current understanding of dietary influences on frailty, focusing on opportunities for prevention and treatment. Longer term prospective studies and well-designed trials are needed to determine the causal effects of nutrition on frailty risk and progression and how dietary change can be used to prevent and/or treat frailty in the future

Replication competent retrovirus testing (RCR) in the National Gene Vector Biorepository: No evidence of RCR in 1,595 post-treatment peripheral blood samples obtained from 60 clinical trials

The clinical impact of any therapy requires the product be safe and effective. Gammaretroviral vectors pose several unique risks, including inadvertent exposure to replication competent retrovirus (RCR) that can arise during vector manufacture. The US FDA has required patient monitoring for RCR, and the National Gene Vector Biorepository is an NIH resource that has assisted eligible investigators in meeting this requirement. To date, we have found no evidence of RCR in 338 pre-treatment and 1,595 post-treatment blood samples from 737 patients associated with 60 clinical trials. Most samples (75%) were obtained within 1 year of treatment, and samples as far out as 9 years after treatment were analyzed. The majority of trials (93%) were cancer immunotherapy, and 90% of the trials used vector products produced with the PG13 packaging cell line. The data presented here provide further evidence that current manufacturing methods generate RCR-free products and support the overall safety profile of retroviral gene therapy

Neighbourhood Socioeconomics Status Predicts Non-Cardiovascular Mortality in Cardiac Patients with Access to Universal Health Care

BACKGROUND: Although the Canadian health care system provides essential services to all residents, evidence suggests that socioeconomic gradients in disease outcomes still persist. The main objective of our study was to investigate whether mortality, from cardiovascular disease or other causes, varies by neighbourhood socioeconomic gradients in patients accessing the healthcare system for cardiovascular disease management. METHODS AND FINDINGS: A cohort of 485 patients with angiographic evidence of coronary artery disease (CAD) and neighbourhood socioeconomic status information was followed for 13.3 years. Survival analyses were completed with adjustment for potentially confounding risk factors. There were 64 cases of cardiovascular mortality and 66 deaths from non-cardiovascular chronic diseases. No socioeconomic differentials in cardiovascular mortality were observed. However, lower neighbourhood employment, education, and median family income did predict an increased risk of mortality from non-cardiovascular chronic diseases. For each quintile decrease in neighbourhood socioeconomic status, non-cardiovascular mortality risk rose by 21-30%. Covariate-adjusted hazard ratios (95% confidence interval) for non-cardiovascular mortality were 1.21 (1.02-1.42), 1.21 (1.01-1.46), and 1.30 (1.06-1.60), for each quintile decrease in neighbourhood education, employment, and income, respectively. These patterns were primarily attributable to mortality from cancer. Estimated risks for mortality from cancer rose by 42% and 62% for each one quintile decrease in neighbourhood median income and employment rate, respectively. Although only baseline clinical information was collected and patient-level socioeconomic data were not available, our results suggest that environmental socioeconomic factors have a significant impact on CAD patient survival. CONCLUSIONS: Despite public health care access, CAD patients who reside in lower-socioeconomic neighbourhoods show increased vulnerability to non-cardiovascular chronic disease mortality, particularly in the domain of cancer. These findings prompt further research exploring mechanisms of neighbourhood effects on health, and ways they may be ameliorated

Molecular analysis of the myosin gene family in Arabidopsis thaliana

Myosin is believed to act as the molecular motor for many actin-based motility processes in eukaryotes. It is becoming apparent that a single species may possess multiple myosin isoforms, and at least seven distinct classes of myosin have been identified from studies of animals, fungi, and protozoans. The complexity of the myosin heavy-chain gene family in higher plants was investigated by isolating and characterizing myosin genomic and cDNA clones from Arabidopsis thaliana . Six myosin-like genes were identified from three polymerase chain reaction (PCR) products (PCR1, PCR11, PCR43) and three cDNA clones (ATM2, MYA2, MYA3). Sequence comparisons of the deduced head domains suggest that these myosins are members of two major classes. Analysis of the overall structure of the ATM2 and MYA2 myosins shows that they are similar to the previously-identified ATM1 and MYA1 myosins, respectively. The MYA3 appears to possess a novel tail domain, with five IQ repeats, a six-member imperfect repeat, and a segment of unique sequence. Northern blot analyses indicate that some of the Arabidopsis myosin genes are preferentially expressed in different plant organs. Combined with previous studies, these results show that the Arabidopsis genome contains at least eight myosin-like genes representing two distinct classes.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/43437/1/11103_2004_Article_BF00040695.pd

Emerging environmental, molecular, and genetic risk factors in stable coronary artery disease

Both environmental and inherited risk factors make significant contributions to coronary artery disease, however susceptibility and age of disease onset for individuals with similar risk profiles varies widely. Novel biomarkers may yet be found which could improve detection of high-risk individuals, and highlight new areas of research for treatment discovery. This thesis explores risk factors for coronary artery disease and cardiovascular mortality. The first study investigates one specific environmental variable—neighbourhood socioeconomic status—in a cohort of patients who underwent selective coronary angiography. In patients with coronary artery disease, neighbourhood-level disparities contributed to risk of non-cardiovascular mortality, particularly to deaths from cancer, but did not influence cardiovascular mortality risk. Although disparities in health and access to care may persist, these findings suggest other risk factors should be explored to improve cardiovascular patient risk assessment. Inflammation and oxidative stress contribute to all stages of atherosclerosis, and subsequent chapters focus on contributions of these pathways to cardiovascular risk. Interleukin-6 and C-reactive protein haplotypes were compared to plasma concentrations for prediction of coronary artery disease and cardiovascular mortality. Significant relationships observed between haplotypes, plasma concentrations, angiographic disease, and cardiovascular mortality did not demonstrate causality, which underscores the challenge of distinguishing causal from confounding pathways. Plasma oxidative stress biomarkers were measured to evaluate their utility for risk prediction, compared to conventional cardiovascular risk factors. Elevated plasma myeloperoxidase predicted coronary artery disease and cardiovascular mortality risk, independent of conventional risk factors and disease severity. Polymorphisms in candidate oxidative stress genes were also explored for associations with coronary artery disease, and effects on plasma biomarkers. A compound genotype of five polymorphisms predicted angiographic coronary artery disease and elevations in plasma myeloperoxidase. Following validation, these polymorphisms may be useful markers of lifetime oxidative stress burden and cardiovascular disease risk. Novel cardiovascular risk markers are explored in this thesis, and tested for association with angiographic coronary artery disease, conventional risk factors, and risk of mortality. New questions are raised regarding how disease susceptibility is influenced by environmental and inherited factors, and ideas for future research are discussed.Medicine, Faculty ofPathology and Laboratory Medicine, Department ofGraduat