Prescribing competency assessment for Canadian medical students: a pilot evaluation

Background: The knowledge and ability to prescribe safely and effectively is a core competency for every graduating medical student. Our previous research suggested concerns about medical student prescribing abilities, and interest in a standardized assessment process. Methods: A multi-year cross-sectional study evaluating the feasibility, acceptability, and discriminative ability of an online prescribing competency assessment for final year Canadian medical students was conducted. Students at nine sites of four Ontario medical schools were invited to participate in an online one-hour exam of eight domains related to prescribing safely. Student feedback on perceived fairness, clarity, and ease of use formed the primary outcome. Exam performance and parity between schools were the secondary outcome.  Results: A total of 714 students completed the assessment during spring final review courses between 2016 and 2018. Student feedback was more favourable than not for appropriateness of content (53.5% agreement vs 18.3% disagreement), clarity of questions (65.5% agreement vs 11.6% disagreement), question layout and presentation (70.8% agreement vs 12.2% disagreement), and ease of use of online interface (67.1% agreement vs 13.6% disagreement). Few (23.6% believed their course work had prepared them for the assessment. Mean total exam score was 70.0% overall (SD 10.4%), with 47.6% scoring at or above the pass threshold of 70%. Conclusion: Our prescribing competency assessment proved feasible, acceptable, and discriminative, and indicated a need for better medical school training to improve prescribing competency. Further evaluation in a larger sample of medical schools is warranted

Atmospheric and ionospheric coupling phenomena related to large earthquakes

This paper explores multi-instrument space-borne observations in order to validate physical concepts of Lithosphere-Atmosphere-Ionosphere Coupling (LAIC) in relation to major seismic events. In this study we apply already validated observation to identify atmospheric and ionospheric precursors associated with some of recent most destructive earthquakes: M8.6 of March 25, 2005 and M8.5 September 15, 2007 in Sumatra, and M7.9 May 12, 2008 in Wenchuan, China. New investigations are also presented concerning these three earthquakes and for the M7.3 March 2008 in the Xinjiang-Xizang border region, China (the Yutian earthquake). It concerns the ionospheric density, the Global Ionospheric Maps (GIM) of the Total Electron Content (TEC), the Thermal Infra-Red (TIR) anomalies, and the Outgoing Longwave Radiation (OLR) data. It is shown that all these anomalies are identified as short-term precursors, which can be explained by the LAIC concept proposed by Pulinets and Ouzounov (2011)

Atmospheric and Ionospheric Coupling Phenomena Associated with Large Earthquakes

This paper explores multi-instrument space-borne observations in order to validate physical concepts of Lithosphere-Atmosphere-Ionosphere Coupling (LAIC) in relation to a selection of major seismic events. In this study we apply some validated techniques to observations in order to identify atmospheric and ionospheric precursors associated with some of recent most destructive earthquakes: M8.6 of March 28, 2005 and M8.5 of Sept. 12, 2007 in Sumatra, and M7.9 of May 12, 2008 in Wenchuan, China. New investigations are also presented concerning these three earthquakes and for the M7.2 of March 2008 in the Xinjiang-Xizang border region, China (the Yutian earthquake). It concerns the ionospheric density, the Global Ionospheric Maps (GIM) of the Total Electron Content (TEC), the Thermal Infra-Red (TIR) anomalies, and the Outgoing Longwave Radiation (OLR) data. It is shown that all these anomalies are identified as short-term precursors, which can be explained by the LAIC concept proposed in [S. Pulinets, D. Ouzounov, J. Asian Earth Sci. 41, 371 (2011)]

Atmospheric and ionospheric coupling phenomena associated with large earthquakes

This paper explores multi-instrument space-borne observations in order to validate physical concepts of Lithosphere-AtmosphereIonosphere Coupling (LAIC) in relation to a selection of major seismic events. In this study we apply some validated techniques to observations in order to identify atmospheric and ionospheric precursors associated with some of recent most destructive earthquakes: M8.6 of March 28, 2005 and M8.5 of Sept. 12, 2007 in Sumatra, and M7.9 of May 12, 2008 in Wenchuan, China. New investigations are also presented concerning these three earthquakes and for the M7.2 of March 2008 in the Xinjiang-Xizang border region, China (the Yutian earthquake). It concerns the ionospheric density, the Global Ionospheric Maps (GIM) of the Total Electron Content (TEC), the Thermal InfraRed (TIR) anomalies, and the Outgoing Longwave Radiation (OLR) data. It is shown that all these anomalies are identified as short-term precursors, which can be explained by the LAIC concept proposed in [S. Pulinets, D. Ouzounov, J. Asian Earth Sci. 41, 371 (2011)]

Social Media, Gender and the Mediatisation of War: Exploring the German Armed Forces’ Visual Representation of the Afghanistan Operation on Facebook

Studies on the mediatisation of war point to attempts of governments to regulate the visual perspective of their involvements in armed conflict – the most notable example being the practice of ‘embedded reporting’ in Iraq and Afghanistan. This paper focuses on a different strategy of visual meaning-making, namely, the publication of images on social media by armed forces themselves. Specifically, we argue that the mediatisation of war literature could profit from an increased engagement with feminist research, both within Critical Security/Critical Military Studies and within Science and Technology Studies that highlight the close connection between masculinity, technology and control. The article examines the German military mission in Afghanistan as represented on the German armed forces’ official Facebook page. Germany constitutes an interesting, and largely neglected, case for the growing literature on the mediatisation of war: its strong antimilitarist political culture makes the representation of war particularly delicate. The paper examines specific representational patterns of Germany’s involvement in Afghanistan and discusses the implications which arise from what is placed inside the frame of visibility and what remains out of its view

Analysis combining correlated glaucoma traits identifies five new risk loci for open-angle glaucoma

Open-angle glaucoma (OAG) is a major cause of blindness worldwide. To identify new risk loci for OAG, we performed a genome-wide association study in 3,071 OAG cases and 6,750 unscreened controls, and meta-analysed the results with GWAS data for intraocular pressure (IOP) and optic disc parameters (the overall meta-analysis sample size varying between 32,000 to 48,000 participants), which are glaucoma-related traits. We identified and independently validated four novel genome-wide significant associations within or near MYOF and CYP26A1, LINC02052 and CRYGS, LMX1B, and LMO7 using single variant tests, one additional locus (C9) using gene-based tests, and two genetic pathways - “response to fluid shear stress” and “abnormal retina morphology” - in pathway-based tests. Interestingly, some of the new risk loci contribute to risk of other genetically-correlated eye diseases including myopia and age-related macular degeneration. To our knowledge, this study is the first integrative study to combine genetic data from OAG and its correlated traits to identify new risk variants and genetic pathways, highlighting the future potential of combining genetic data from genetically-correlated eye traits for the purpose of gene discovery and mapping

Evaluation of a Novel Audit Tool for Medication Reconciliation at Hospital Discharge

ABSTRACTBackground: Discharge medication reconciliation (MedRec) is designed to reduce medication errors and inform patients and key postdischarge providers, but it has been difficult to implement routinely in Canadian hospitals.Objectives: To evaluate and optimize a new discharge MedRec quality audit tool and to use it at 3 urban teaching hospitals.Methods: The discharge MedRec quality audit tool, developed by the Canadian Patient Safety Institute and the Institute for Safe Medication Practices Canada, was assessed and modified to improve comprehensiveness, clarity, and quality. The modified tool was then used to evaluate the quality of the discharge MedRec process for adult patients discharged to home from the general internal medicine service at 3 academic hospitals. Postdischarge telephone interviews were conducted with consenting patients, their community pharmacists, and their family doctors.Results: The audit tool required modification to include aspects of admission MedRec, high-risk medication discrepancies, and direct communication of discharge MedRec to key follow-up providers. Thirty-five patients (mean age 67.7 years, standard deviation [SD] 18.0 years; 17 [49%] women), with a mean of 8.8 (SD 4.5) prescribed medications at discharge, participated in the discharge MedRec evaluation. Documentation of any discharge MedRec was found for only 1 patient (3%), and no discharge MedRec was carried out by pharmacists. Postdischarge follow-up interviews elicited major gaps in communication with community pharmacists and with family physicians, which could lead to serious medication errors.Conclusions: The modified audit tool was useful for identifying gaps in the quality of discharge MedRec.RÉSUMÉContexte : Le bilan comparatif des médicaments (BCM) au moment du congé est conçu pour réduire les erreurs médicamenteuses et informer les patients ainsi que les principaux prestataires de soins de santé après le congé, mais sa mise en œuvre systématique dans les hôpitaux canadiens s’est heurtée à de grandes difficultés.Objectifs : Évaluer et optimiser un nouvel outil d’évaluation de la qualité du BCM au moment du congé et l’utiliser dans trois hôpitaux universitaires urbains.Méthodes : Cet outil développé par l’Institut canadien pour la sécurité des patients (ICSP) et l’Institut pour la sécurité des médicaments aux patients du Canada (ISMP) a fait l’objet d’une évaluation et d’une modification visant à améliorer son exhaustivité, sa clarté et sa qualité. L’outil modifié a ensuite servi à évaluer la qualité du processus du BCM pour des patients adultes ayant obtenu leur congé après un séjour dans un service général de médecine interne dans trois hôpitaux universitaires. Des entretiens téléphoniques après le congé ont été menés avec les patients consentants, leur pharmacien communautaire et leur médecin de famille.Résultats : L’outil d’évaluation a dû être modifié pour inclure le BCM au moment de l’admission, des écarts de médication à haut risque et une communication directe du BCM aux prestataires de soins de santé principaux chargés du suivi après le congé. Trente-cinq patients (âge moyen : 67,7 ans; écart type [ET] 18 ans; 17 [49 %] femmes), chacun ayant reçu en moyenne 8,8 (ET 4,5) médicaments prescrits, ont participé à l’évaluation du BCM au congé de l’hôpital. Au moment du congé, on n’a trouvé de renseignements relatifs au BCM que pour un seul patient (3 %) et aucun BCM n’avait été préparé par les pharmaciens. Le suivi après le congé a généré des écarts de communication importants entre les pharmaciens communautaires et les médecins de famille, ce qui pourrait entraîner des erreurs médicamenteuses importantes.Conclusions : L’outil d’évaluation modifié a été utile pour déterminer les écarts relatifs à la qualité du BCM au moment du congé.

Atmospheric and ionospheric coupling phenomena related to large earthquakes

This paper explores multi-instrument space-borne observations in order to validate physical concepts of Lithosphere-Atmosphere-Ionosphere Coupling (LAIC) in relation to major seismic events. In this study we apply already validated observation to identify atmospheric and ionospheric precursors associated with some of recent most destructive earthquakes: M8.6 of March 25, 2005 and M8.5 September 15, 2007 in Sumatra, and M7.9 May 12, 2008 in Wenchuan, China. New investigations are also presented concerning these three earthquakes and for the M7.3 March 2008 in the Xinjiang-Xizang border region, China (the Yutian earthquake). It concerns the ionospheric density, the Global Ionospheric Maps (GIM) of the Total Electron Content (TEC), the Thermal Infra-Red (TIR) anomalies, and the Outgoing Longwave Radiation (OLR) data. It is shown that all these anomalies are identified as short-term precursors, which can be explained by the LAIC concept proposed by Pulinets and Ouzounov (2011)