Harmonising evidence-based medicine teaching: a study of the outcomes of e-learning in five European countries

BACKGROUND: We developed and evaluated the outcomes of an e-learning course for evidence based medicine (EBM) training in postgraduate medical education in different languages and settings across five European countries. METHODS: We measured changes in knowledge and attitudes with well-developed assessment tools before and after administration of the course. The course consisted of five e-learning modules covering acquisition (formulating a question and search of the literature), appraisal, application and implementation of findings from systematic reviews of therapeutic interventions, each with interactive audio-visual learning materials of 15 to 20 minutes duration. The modules were prepared in English, Spanish, German and Hungarian. The course was delivered to 101 students from different specialties in Germany (psychiatrists), Hungary (mixture of specialties), Spain (general medical practitioners), Switzerland (obstetricians-gynaecologists) and the UK (obstetricians-gynaecologists). We analysed changes in scores across modules and countries. RESULTS: On average across all countries, knowledge scores significantly improved from pre- to post-course for all five modules (p < 0.001). The improvements in scores were on average 1.87 points (14% of total score) for module 1, 1.81 points (26% of total score) for module 2, 1.9 points (11% of total score) for module 3, 1.9 points (12% of total score) for module 4 and 1.14 points (14% of total score) for module 5. In the country specific analysis, knowledge gain was not significant for module 4 in Spain, Switzerland and the UK, for module 3 in Spain and Switzerland and for module 2 in Spain. Compared to pre-course assessment, after completing the course participants felt more confident that they can assess research evidence and that the healthcare system in their country should have its own programme of research about clinical effectiveness. CONCLUSION: E-learning in EBM can be harmonised for effective teaching and learning in different languages, educational settings and clinical specialties, paving the way for development of an international e-EBM course

Global mean surface temperature and climate sensitivity of the early Eocene Climatic Optimum (EECO), Paleocene–Eocene Thermal Maximum (PETM), and latest Paleocene

Accurate estimates of past global mean surface temperature (GMST) help to contextualise future climate change and are required to estimate the sensitivity of the climate system to CO2 forcing through Earth's history. Previous GMST estimates for the latest Paleocene and early Eocene (∼57 to 48 million years ago) span a wide range (∼9 to 23 ∘C higher than pre-industrial) and prevent an accurate assessment of climate sensitivity during this extreme greenhouse climate interval. Using the most recent data compilations, we employ a multi-method experimental framework to calculate GMST during the three DeepMIP target intervals: (1) the latest Paleocene (∼57 Ma), (2) the Paleocene–Eocene Thermal Maximum (PETM; 56 Ma), and (3) the early Eocene Climatic Optimum (EECO; 53.3 to 49.1 Ma). Using six different methodologies, we find that the average GMST estimate (66 % confidence) during the latest Paleocene, PETM, and EECO was 26.3 ∘C (22.3 to 28.3 ∘C), 31.6 ∘C (27.2 to 34.5 ∘C), and 27.0 ∘C (23.2 to 29.7 ∘C), respectively. GMST estimates from the EECO are ∼10 to 16 ∘C warmer than pre-industrial, higher than the estimate given by the Intergovernmental Panel on Climate Change (IPCC) 5th Assessment Report (9 to 14 ∘C higher than pre-industrial). Leveraging the large “signal” associated with these extreme warm climates, we combine estimates of GMST and CO2 from the latest Paleocene, PETM, and EECO to calculate gross estimates of the average climate sensitivity between the early Paleogene and today. We demonstrate that “bulk” equilibrium climate sensitivity (ECS; 66 % confidence) during the latest Paleocene, PETM, and EECO is 4.5 ∘C (2.4 to 6.8 ∘C), 3.6 ∘C (2.3 to 4.7 ∘C), and 3.1 ∘C (1.8 to 4.4 ∘C) per doubling of CO2. These values are generally similar to those assessed by the IPCC (1.5 to 4.5 ∘C per doubling CO2) but appear incompatible with low ECS values (<1.5 per doubling CO2)

An interdisciplinary cruise dedicated to understanding ocean eddies upstream of the Prince Edward Islands

A DETAILED HYDROGRAPHIC AND BIOLOGical survey was carried out in the region of the South-West Indian Ridge during April 2004. Altimetry and hydrographic data have identified this region as an area of high flow variability. Hydrographic data revealed that here the Subantarctic Polar Front (SAF) and Antarctic Polar Front (APF) converge toform a highly intense frontal system. Water masses identified during the survey showed a distinct separation in properties between the northwestern and southeastern corners. In the north-west, water masses were distinctly Subantarctic (>8.5°C, salinity >34.2), suggesting that the SAF lay extremely far to the south. In the southeast corner water masses were typical of the Antarctic zone, showing a distinct subsurface temperature minimum of <2.5°C. Total integrated chl-a concentration during the survey ranged from 4.15 to 22.81mgchl-am–2,with the highest concentrations recorded at stations occupied in the frontal region. These data suggest that the region of the South-West Indian Ridge represents not only an area of elevated biological activity but also acts as a strong biogeographic barrier to the spatial distribution of zooplankton

What are the long-term symptoms and complications of COVID-19: a protocol for a living systematic review

Although the majority of patients with COVID-19 will experience mild to moderate symptoms and will recover fully, there is now increasing evidence that a significant proportion will experience persistent symptoms for weeks or months after the acute phase of the illness. These symptoms include, among others, fatigue, problems in breathing, lack of smell and taste, headaches, and also depression and anxiety. It has also become clear that the virus has lasting effects not only on the respiratory system but also on other parts of the body, including the heart, liver, and the nervous system. In this paper we present a protocol for a living systematic review that aims to synthesize the evidence on the prevalence and duration of symptoms and clinical features of post-acute COVID-19 and its long-term complications. The living systematic review will be updated regularly, initially monthly with update cycles under continuous review as the pace of new evidence generated develops through the pandemic. We will include studies that follow up with COVID-19 patients who have experienced persistent mild, moderate or severe symptoms, with no restrictions regarding country, setting, or language. We will use descriptive statistics to analyse the data and our findings will be presented as infographics to facilitate transcription to lay audiences. Ultimately, we aim to support the work of policy makers, practitioners, and patients when planning rehabilitation for those recovering from COVID-19. The protocol has been registered with PROSPERO (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=211131, CRD42020211131, 25/09/2020)

Similarities between the tropical Atlantic seasonal cycle and ENSO: An energetics perspective

The tropical Pacific and Atlantic Oceans have similar mean states - easterly winds and a zonally sloping thermocline which shoals in the east - but strikingly different sea surface temperature..

An interdisciplinary cruise dedicated to understanding ocean eddies upstream of the Prince Edward Islands

A detailed hydrographic and biological survey was carried out in the region of the South-West Indian Ridge during April 2004. Altimetry and hydrographic data have identified this region as an area of high flow variability. Hydrographic data revealed that here the Subantarctic Polar Front (SAF) and Antarctic Polar Front (APF) converge to form a highly intense frontal system. Water masses identified during the survey showed a distinct separation in properties between the northwestern and southeastern corners. In the north-west, water masses were distinctly Subantarctic (>8.5°C, salinity >34.2), suggesting that the SAF lay extremely far to the south. In the southeast corner water masses were typical of the Antarctic zone, showing a distinct subsurface temperature minimum of <2.5°C. Total integrated chl-a concentration during the survey ranged from 4.15 to 22.81 mg chl-a m[superscript (-2)], with the highest concentrations recorded at stations occupied in the frontal region. These data suggest that the region of the South-West Indian Ridge represents not only an area of elevated biological activity but also acts as a strong biogeographic barrier to the spatial distribution of zooplankton

Workshop report: PlioWest-drilling Pliocene lakes in western North America

The Pliocene Epoch is a focus of scientific interest as a period of sustained global warmth, with reconstructed CO2 concentrations and a continent configuration similar to modern. Numerous studies suggest that the Pliocene was warmer and largely wetter than today, at least in the subtropics, which contrasts with the long-Term hydroclimatic response of drying conditions predicted by most climate model simulations. Two key features of Pliocene warmth established from sea surface temperature reconstructions could affect dynamic changes that influence the hydrologic cycle: (1) a weaker Pliocene zonal gradient in sea surface temperature (SST) between the western and eastern equatorial Pacific resembling El Niño-like conditions and (2) polar-Amplified Pliocene warmth, supporting a weaker Equator-To-pole temperature gradient. The distribution of wet conditions in western North America and the timing of late Pliocene-Quaternary aridification offer the potential to evaluate the relative roles of these two external forcings of the climate in western North America, with broader global implications for Mediterranean-Type climate (MTC) regions. We convened a virtual ICDP workshop that spanned a 2-week period in September 2021, to choose optimal drill sites and legacy cores to address the overall scientific goals, flesh out research questions, and discuss how best to answer them. A total of 56 participants from 12 countries (17 time zones), representing a wide range of disciplines, came together virtually for a series of plenary and working group sessions. We have chosen to study five basins (Butte Valley, Tule Lake, Lake Idaho, Searles Lake, and Verde Valley) that span 7g of latitude to test our hypotheses and to reconstruct the evolution of western North American hydroclimate with special focus on the time ranges of 4.5-3.5 and 3-2.5gMyr. Although individual Pliocene lake records occur in many areas of the world, the western North American basins are unique and globally significant as deep perennial freshwater Pliocene lakes latitudinally arrayed in a MTC region and are able to capture a response to Pacific forcing. We propose new drill cores from three of these basins. During the workshop, we discussed the stratigraphy and subsurface structure of each basin and revised the chronological frameworks and the basin-To-basin correlations. We also identified the best-suited proxies for hydroclimate reconstructions for each particular basin and put forward a multi-Technique strategy for depth-Age modeling. Reconstructions based on data from these sites will complement the SST reconstructions from global sites spanning the last 4.5gMa and elucidate the large-scale hydrological cycle controls associated with both global warming and cooling

Characterising long COVID: a living systematic review

BACKGROUND: While it is now apparent clinical sequelae (long COVID) may persist after acute COVID-19, their nature, frequency and aetiology are poorly characterised. This study aims to regularly synthesise evidence on long COVID characteristics, to help inform clinical management, rehabilitation strategies and interventional studies to improve long-term outcomes. METHODS: A living systematic review. Medline, CINAHL (EBSCO), Global Health (Ovid), WHO Global Research on COVID-19 database, LitCovid and Google Scholar were searched till 17 March 2021. Studies including at least 100 people with confirmed or clinically suspected COVID-19 at 12 weeks or more post onset were included. Risk of bias was assessed using the tool produced by Hoy et al. Results were analysed using descriptive statistics and meta-analyses to estimate prevalence. RESULTS: A total of 39 studies were included: 32 cohort, 6 cross-sectional and 1 case-control. Most showed high or moderate risk of bias. None were set in low-income countries and few included children. Studies reported on 10 951 people (48% female) in 12 countries. Most included previously hospitalised people (78%, 8520/10 951). The longest mean follow-up time was 221.7 (SD: 10.9) days post COVID-19 onset. Over 60 physical and psychological signs and symptoms with wide prevalence were reported, most commonly weakness (41%; 95% CI 25% to 59%), general malaise (33%; 95% CI 15% to 57%), fatigue (31%; 95% CI 24% to 39%), concentration impairment (26%; 95% CI 21% to 32%) and breathlessness (25%; 95% CI 18% to 34%). 37% (95% CI 18% to 60%) of patients reported reduced quality of life; 26% (10/39) of studies presented evidence of reduced pulmonary function. CONCLUSION: Long COVID is a complex condition with prolonged heterogeneous symptoms. The nature of studies precludes a precise case definition or risk evaluation. There is an urgent need for prospective, robust, standardised, controlled studies into aetiology, risk factors and biomarkers to characterise long COVID in different at-risk populations and settings. PROSPERO REGISTRATION NUMBER: CRD42020211131

A model‐data comparison of the hydrological response to Miocene warmth: Leveraging the MioMIP1 opportunistic multi‐model ensemble

The Miocene (23.03–5.33 Ma) is recognized as a period with close to modern-day paleogeography, yet a much warmer climate. With large uncertainties in future hydroclimate projections, Miocene conditions illustrate a potential future analog for the Earth system. A recent opportunistic Miocene Model Intercomparison Project 1 (MioMIP1) focused on synthesizing published Miocene climate simulations and comparing them with available temperature reconstructions. Here, we build on this effort by analyzing the hydrological cycle response to Miocene forcings across early-to-middle (E2MMIO; 20.03–11.6 Ma) and middle-to-late Miocene (M2LMIO; 11.5–5.33 Ma) simulations with CO2 concentrations ranging from 200 to 850 ppm and providing a model-data comparison against available precipitation reconstructions. We find global precipitation increases by ∼2.1 and 2.3% per degree of warming for E2MMIO and M2LMIO simulations, respectively. Models generally agree on a wetter than modern-day tropics; mid and high-latitude, however, do not agree on the sign of subtropical precipitation changes with warming. Global monsoon analysis suggests most monsoon regions, except the North American Monsoon, experience higher precipitation rates under warmer conditions. Model-data comparison shows that mean annual precipitation is underestimated by the models regardless of CO2 concentration, particularly in the mid- to high-latitudes. This suggests that the models may not be (a) resolving key processes driving the hydrological cycle response to Miocene boundary conditions and/or (b) other boundary conditions or processes not considered here are critical to reproducing Miocene hydroclimate. This study highlights the challenges in modeling and reconstructing the Miocene hydrological cycle and serves as a baseline for future coordinated MioMIP efforts

A Model-Data Comparison of the Hydrological Response to Miocene Warmth: Leveraging the MioMIP1 Opportunistic Multi-Model Ensemble

The Miocene (23.03–5.33 Ma) is recognized as a period with close to modern-day paleogeography, yet a much warmer climate. With large uncertainties in future hydroclimate projections, Miocene conditions illustrate a potential future analog for the Earth system. A recent opportunistic Miocene Model Intercomparison Project 1 (MioMIP1) focused on synthesizing published Miocene climate simulations and comparing them with available temperature reconstructions. Here, we build on this effort by analyzing the hydrological cycle response to Miocene forcings across early-to-middle (E2MMIO; 20.03–11.6 Ma) and middle-to-late Miocene (M2LMIO; 11.5–5.33 Ma) simulations with CO2 concentrations ranging from 200 to 850 ppm and providing a model-data comparison against available precipitation reconstructions. We find global precipitation increases by ∼2.1 and 2.3% per degree of warming for E2MMIO and M2LMIO simulations, respectively. Models generally agree on a wetter than modern-day tropics; mid and high-latitude, however, do not agree on the sign of subtropical precipitation changes with warming. Global monsoon analysis suggests most monsoon regions, except the North American Monsoon, experience higher precipitation rates under warmer conditions. Model-data comparison shows that mean annual precipitation is underestimated by the models regardless of CO2 concentration, particularly in the mid- to high-latitudes. This suggests that the models may not be (a) resolving key processes driving the hydrological cycle response to Miocene boundary conditions and/or (b) other boundary conditions or processes not considered here are critical to reproducing Miocene hydroclimate. This study highlights the challenges in modeling and reconstructing the Miocene hydrological cycle and serves as a baseline for future coordinated MioMIP efforts