Building National Forest and Land-Use Information Systems: Lessons from Cameroon, Indonesia, and Peru

This working paper examines the institutional, human resources, and financial capacities of three countries that have developed a forest and land-use information system, and highlights common enabling factors and challenges

The advancement of medical education through innovative research and simulation learning: A discussion with Dr. Viren Naik, medical director of the University of Ottawa’s Skills and Simulation Centre

A B S T R A C T The spotlight of UOJM’s 4th issue is medical education. We met with Dr. Viren Naik, anesthesiologist, associate professor at the University of Ottawa (uOttawa), and Medical Director of the University of Ottawa Skills and Simulation Centre (uOSSC). He is also a core team member of the Academy of Innovation in Medical Education (AIME), uOttawa’s centre for advancing medical education research. Dr. Naik is actively involved in research, with over 60 peer-reviewed publications and grants. He was also the previous chair of the Written Examination in Anesthesia with the Royal College of Physicians and Surgeons of Canada. In this interview, we discuss the advancement of medical education with the skills and simulation centre, the future of the medical curriculum, and how to be involved in medical education as students.   R É S U M É Dans cette 4e édition du JMUO, le sujet mis en lumière est l’éducation médicale. Nous avons rencontré le Dr Viren Naik, anesthésiologiste, professeur agrégé de l’Université d’Ottawa (uOttawa) et directeur médical du Centre de compétences et simulation de l’Université d’Ottawa (CCSUO). C’est aussi un membre important de l’Académie pour l’innovation en éducation médicale (AIME), le centre de l’Université d’Ottawa qui a pour but de faire avancer la recherche en éducation médicale. Dr Naik est un chercheur très dynamique qui a plus de 60 publications et subventions évaluées par les pairs à son actif. Dans le passé, il a aussi présidé l’examen écrit en anesthésiologie du Collège royal des médecins et chirurgiens du Canada. Durant l’entrevue, nous avons discuté de l’avancement de l’éducation médicale au Centre de compétences et simulation, de l’avenir du cursus médical et de la façon que les étudiants peuvent participer à l’éducation médicale

Preface

UOJM Volume 4 Issue 2 marks a significant milestone for UOJM. For the first time, UOJM has sustained activity over the summer due to increased interest and submissions, which has resulted in the release of multiple issues in a year. Our second issue reflects an increase in awareness and support for UOJM both internally at the University of Ottawa and externally. We have made several infrastructure upgrades to accommodate the high volume of submissions, including the implementation of the Open Journal Systems platform hosted through the University of Ottawa Library as a peer review management platform, content manager, and digital archive. We have also expanded our effort to use social media platforms such as Facebook, Twitter, LinkedIn and Google+ to provide day-to-day communication to our followers around the world

Maximize How You Supervise: Report of the 2016 ASHA Ad Hoc Committee on Supervision Training

The success of existing and future audiologists and speech-language pathologists is dependent on skilled supervision. This session presents the findings of the ASHA Ad Hoc Committee on Supervision Training, including resources to enhance supervisor/preceptor skills and strategies for growing a culture of expectation for such training

An Overview of Research and Evaluation Designs for Dissemination and Implementation

The wide variety of dissemination and implementation designs now being used to evaluate and improve health systems and outcomes warrants review of the scope, features, and limitations of these designs

Effect of Broccoli Sprouts and Live Attenuated Influenza Virus on Peripheral Blood Natural Killer Cells: A Randomized, Double-Blind Study

Enhancing antiviral host defense responses through nutritional supplementation would be an attractive strategy in the fight against influenza. Using inoculation with live attenuated influenza virus (LAIV) as an infection model, we have recently shown that ingestion of sulforaphane-containing broccoli sprout homogenates (BSH) reduces markers of viral load in the nose. To investigate the systemic effects of short-term BSH supplementation in the context of LAIV-inoculation, we examined peripheral blood immune cell populations in non-smoking subjects from this study, with a particular focus on NK cells. We carried out a randomized, double-blinded, placebo-controlled study measuring the effects of BSH (N = 13) or placebo (alfalfa sprout homogenate, ASH; N = 16) on peripheral blood mononuclear cell responses to a standard nasal vaccine dose of LAIV in healthy volunteers. Blood was drawn prior to (day-1) and post (day2, day21) LAIV inoculation and analyzed for neutrophils, monocytes, macrophages, T cells, NKT cells, and NK cells. In addition, NK cells were enriched, stimulated, and assessed for surface markers, intracellular markers, and cytotoxic potential by flow cytometry. Overall, LAIV significantly reduced NKT (day2 and day21) and T cell (day2) populations. LAIV decreased NK cell CD56 and CD158b expression, while significantly increasing CD16 expression and cytotoxic potential (on day2). BSH supplementation further increased LAIV-induced granzyme B production (day2) in NK cells compared to ASH and in the BSH group granzyme B levels appeared to be negatively associated with influenza RNA levels in nasal lavage fluid cells. We conclude that nasal influenza infection may induce complex changes in peripheral blood NK cell activation, and that BSH increases virus-induced peripheral blood NK cell granzyme B production, an effect that may be important for enhanced antiviral defense responses

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

UOJM: Preface

On behalf of the entire editorial team, we are very pleased to present you with the fourth issue of the University of Ottawa Journal of Medicine (UOJM). This edition marks the first of two installments in Volume 4. Since its re-launch in 2011, UOJM has continued its growth thanks to the collective efforts of the UOJM Leadership Team and our enthusiastic editors. The UOJM is a student-run, peer-reviewed journal that is dedicated to showcasing the wide variety of ideas and achievement of the Faculty of Medicine students. We accept many types of articles in both English and French, including scientific and non-scientific pieces. Our goals for this year were to increase both medical and graduate student involvement with the journal, and to promote our journal to different departments within the University of Ottawa and externally to other universities. Our ambitions were successfully accomplished this year with an editorial team size of 47 members and a record number of submission

UOJM editor training: results from the 2013 editor satisfaction survey and highlights from 2013-2014 training workshops

BACKGROUND UOJM recognizes that editor competency and preparedness directly impacts the quality of peer review, which holds the key to producing a great publication. We believe that success of our journal is based on a central goal of promoting physician competency in medical communication and developing leaders in medicine. In the age of evidence-based medicine, there are surprisingly few, if at all, opportunities for medical trainees to gain formal training in scientific writing and critical appraisal. Over the last two years, the UOJM has aimed to address these gaps and worked on developing a training program to equip participants with these important skills. Indeed, the merits of involvement in a peer reviewed journal at this stage of medical/research training have been recognized by its trainee participants, and have been reviewed extensively by Kevin Lee [1]. Following the success of the 2013 issue, UOJM made considerable strides to further improve the quality of content in the journal. In 2012-2013, 30 students participated as reviewers on the editorial board and received a practical experience in peer reviewed research. We conducted a year-end survey to identify issues and areas for improving the editor experience