A landscape analysis of leadership training in postgraduate medical education training programs at the University of Ottawa

Background: There is growing recognition of the importance of physician leadership in healthcare. At the same time, becoming an effective leader requires significant training. While educational opportunities for practicing physicians exist to develop their leadership skills, there is a paucity of leadership opportunities for post graduate trainees. In response to this gap, both the Royal College of Physicians and Surgeons of Canada and the Association of Faculties of Medicine of Canada have recommended that leadership training be considered a focus in Post Graduate Medical Education (PGME). However, post-graduate leadership curricula and opportunities in PGME training programs in Canada are not well described. The goal of this study was to determine the motivation for PGME leadership training, the opportunities available, and educational barriers experienced by PGME programs at the University of Ottawa. Methods: An electronic survey was distributed to all 70 PGME Program Directors (PDs) at the University of Ottawa. Two PDs were selected, based on strong leadership programs, for individual interviews.Results: The survey response rate was 55.7%. Seventy-seven percent of responding PDs reported resident participation in leadership training as being “important,” while only 37.8% of programs incorporated assessment of resident leadership knowledge and/or skills into their PGME program. Similarly, only 29.7% of responding residency programs offered chief resident leadership training.Conclusions: While there is strong recognition of the importance of training future physician leaders, the nature and design of PGME leadership training is highly variable. These data can be used to potentially inform future PGME leadership training curricula

Classroom and blended-media : a case study of training delivery methods in Ontario child protection

Within the last year, there have been 31,231 children in the care of Ontario Children’s Aid Societies (GACAS, 2004). This represents a 65% increase in the number of children in care since the implementation of the Ontario Risk Assessment Model (ORAM) in 1998. Collectively, Children’s Aid Societies (CAS) in Ontario spent $1.085 billion net expenditures for the fiscal year 2003/2004. This would be a 100% increase in net expenditures since 1998-1999 (OACAS, 2004). Furthermore, CAS protection workers received 157,883 referrals in 2003-2004. Of these referrals, 73,190 were assessed but required no further investigation. The remaining 84,693 referrals resulted in investigations. There were 26,959 open protection cases as of March 30, 2004. In summary, this noticeable and dramatic increase in the number of children and families who have become involved with CAS has affected the child welfare system as a whole. In order to ensure that all children and families continue to receive quality service delivery, there is a need to investigate the most appropriate means to train child protection workers

Evaluating a natural horsemanship program in relation to the ISES first principles of horse training

The ISES training principles provide an excellent starting point for professionals and horse owners. Currently, there does not seem to be an accepted protocol for evaluating horse training programs against the ISES principles. We suggest an approach to this, using Parelli Natural Horsemanship as our subject for evaluation. This initial pilot study (single-subject / n=1), trials two analytical methods, as applied to the current, video-based teaching materials from Parelli (latest DVD set, published and commercially available from 2015, supplied by Parelli for use in this study). The two methods used were: (i) ethology-based video observation / logging and (ii) discourse analysis of the language used to teach. The ethology-based approach uses an ethogram, which lists the behavioural characteristics of a human trainer adhering to the ISES principles. Computer-based ‘continuous sampling’ of Parelli video clips was used to log the frequencies of ISES principles. Inter Observer Reliability of the analysis to date was assessed using a two-way, mixed, absolute agreement, average-measures ICC (Intra Class Correlation). This evaluated observer agreement in the frequency count ratings for the ISES principles. Discourse analysis is a qualitative research methodology, applied across many domains including politics and health. Discourse analysis allows us to study transcripts of horse training materials, codifying the words, phrases and linguistic structures. Understanding the context within which training language is used, and its meaning to both the speaker and audience, makes it possible to evaluate compatibility with the ISES principles. Results for the ethology-based observations found all ISES principles present (1-10). High frequency counts for principles 2 & 10. Low counts for principles 5 & 7. Inter Observer Reliability (2 observers) was in the ‘excellent’ range (ICC=0.79). The high ICC value suggests that a minimal amount of measurement error was introduced by the independent observers, and therefore statistical power is not substantially reduced. At this stage (without an ICC value closer to 1.0 or further calibrating observers), increasing the evidence against random effects would require more extensive trials (p=0.16). The interim results from the discourse analysis shows consistent congruence between the Parelli materials and the ISES principles, particularly in the areas of: training according to the horse’s ethology and cognition, using learning theory appropriately, forming consistent habits, avoiding flight responses and ensuring that the horse should always be as calm as possible (1, 2, 7, 9 and 10)

An ethogram for Equitation Science First Principles of Horse Training

This ethogram is based on Equitation Science’s ‘First Principles of Horse Training’. This is related to: North, S. 2016. Software Program: IPTEK (ISES Principles Training Evaluation Kit). DOI: 10.5281/zenodo.54821. Available from: http://dx.doi.org/10.5281/zenodo.54821 North, S., Hemingway, A., McLean, A. N., Laurie, H. & Ellis-Hill, C. 2016. How does Parelli measure up? (poster). In Proceedings of the 12th International Society for Equitation Science Conference (ISES2016) (ifce - institut français du cheval et de l’équitation, Saumur, France. June 23-25 2016). International Society for Equitation Science. http://dx.doi.org/10.13140/RG.2.1.3055.0644 North, S., Hemingway, A., McLean, A. N., Laurie, H. & Ellis-Hill, C. 2016. Evaluating a natural horsemanship program in relation to the ISES first principles of horse training. In Proceedings of the 12th International Society for Equitation Science Conference (ISES2016) (ifce - institut français du cheval et de l’équitation, Saumur, France. June 23-25 2016). International Society for Equitation Science. http://dx.doi.org/10.5281/zenodo.54733 North, S., Hemingway, A., McLean, A. N., Laurie, H. & Ellis-Hill, C. 2016. Evaluating a natural horsemanship program in relation to the ISES first principles of horse training. Journal of Veterinary Behavior: Clinical Applications and Research, 15, September–October, p.87. http://dx.doi.org/10.1016/j.jveb.2016.08.040. ISSN: 1558-7878 The ethogram for Equitation Science First Principles of Horse Training is intended to evaluate a method of horse training, ideally, from video recordings. It should be noted that each behavior in the ethogram is followed by its inverse: “INCORRECTLY describing or demonstrating…”. This allows logged observations to include examples that contradict the ISES ‘First Principles’ (should any be present). This is important because, whereas the absence of a specific principle might simply be a matter of differing emphasis, contradiction might indicate a more serious discongruity. The proposed ethogram is of human behaviour during horse training. It does not consider the horse-human dyad, during training interactions. Of course the horse’s response to human training is very informative. This ethogram maps directly to equitation science’s ‘first principles’, which only describe the human aspects of an idealised horse / horsemanship training program. Therefore, horse behaviours do not feature in the ethogram

Brain structural features of myotonic dystrophy type 1 and their relationship with CTG repeats

Background: Few adequately-powered studies have systematically evaluated brain morphology in adult-onset myotonic dystrophy type 1 (DM1). Objective: The goal of the present study was to determine structural brain differences between individuals with and without adult-onset DM1 in a multi-site, case-controlled cohort. We also explored correlations between brain structure and CTG repeat length. Methods: Neuroimaging data was acquired in 58 unaffected individuals (29 women) and 79 individuals with DM1 (50 women). CTG repeat length, expressed as estimated progenitor allele length (ePAL), was determined by small pool PCR. Statistical models were adjusted for age, sex, site, and intracranial volume (ICV). Results: ICV was reduced in DM1 subjects compared with controls. Accounting for the difference in ICV, the DM1 group exhibited smaller volume in frontal grey and white matter, parietal grey matter as well as smaller volume of the corpus callosum, thalamus, putamen, and accumbens. In contrast, volumes of the hippocampus and amygdala were significantly larger in DM1. Greater ePAL was associated with lower volumes of the putamen, occipital grey matter, and thalamus. A positive ePAL association was observed for amygdala volume and cerebellar white matter. Conclusions: Smaller ICV may be a marker of aberrant neurodevelopment in adult-onset DM1. Volumetric analysis revealed morphological differences, some associated with CTG repeat length, in structures with plausible links to key DM1 symptoms including cognitive deficits and excessive daytime somnolence. These data offer further insights into the basis of CNS disease in DM1, and highlight avenues for further work to identify therapeutic targets and imaging biomarkers

Mechanisms of Action of Currently Prescribed and Newly Developed Antiepileptic Drugs

Clinically available antiepileptic drugs (AEDs) decrease membrane excitability by interacting with neurotransmitter receptors or ion channels. AEDs developed before 1980 appear to act on sodium (Na) channels, -y-aminobutyric acid A (GABA A ) receptors, or calcium (Ca) channels. Benzodiazepines and barbiturates enhance GABA A -receptor-mediated inhibition. Phenytoin, car-bamazepine and, possibly, valproate (VPA) decrease high-frequency repetitive firing of action potentials by enhancing Na channel inactivation. Ethosuximide and VPA reduce a low threshold (T-type) Ca-channel current. The mechanisms of action of recently developed AEDs are less clear. Lamotrigine may decrease sustained high-frequency repetitive firing of voltage-dependent Na action potentials, and gabapentin (GBP) appears to bind to a specific binding site in the CNS with a restricted regional distribution. However, the identity of the binding site and the mechanism of action of GBP remain uncertain. The antiepileptic effect of felbamate may involve interaction at the strychnine-insensitive glycine site of the Af-methyl-D-aspartate receptor, but the mechanism of action is not yet proven.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65554/1/j.1528-1157.1994.tb05955.x.pd

Relationship between haemagglutination inhibition titre and immunity to influenza in ferrets

AbstractOur understanding of the antigenic evolution of the human influenza virus is chiefly derived from experiments in which serum from influenza infected ferrets is tested against panels of virus isolates in the haemagglutination inhibition (HI) assay. The interpretation of these results has been much aided by the development of antigenic mapping techniques, which suppose that the antigenic distance between two different influenza viruses is directly proportional to their fold-difference in titre in this assay. Yet, antigenic distance is not necessarily the same as cross-protection, and high levels of protection have been observed in humans against strains to which they have low HI titres. However, no study has previously addressed the relationship between HI titre and cross-protection in ferrets: the standard animal model. This study fills this gap by analysing published data where pre-challenge HI titres are available for individual ferrets, and post-challenge outcomes have been recorded. Ultimately, this work confirms that it is the absolute, rather than relative, HI titre that determines the extent of immunity and that there is a threshold HI titre beyond which ferrets are completely protected from infection. Nevertheless, this titre is much higher in ferrets than has been suggested for humans. Further, we are consequently able to show that using distance between strains within an antigenic map to predict cross-protection between influenza viruses can be misleading

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London