An environmental scan of wellness initiatives and programs at Canadian academic emergency medicine programs: How far have we come?

Objectives We sought to conduct a major objective of the Canadian Association of Emergency Physicians (CAEP) Wellness Committee, an environmental scan of the academic emergency medicine programs across the 17 Canadian medical schools. Methods An 89-question questionnaire was distributed to academic heads or wellness leads. The responses were verified by the lead author to ensure that the questions were answered completely and consistently. Results While formal wellness programs may exist in varying degrees across the 17 universities, most were found to exist only at local, divisional, or departmental levels. A broad variability of established leadership positions exists. Shift practices varied greatly. In day to day practice, availability for food and debriefing were high and childcare, sleep rooms, and follow-up following critical incidents were low. Sabbaticals existed in the majority of centers. Roughly 50% of departments have gender equity program and annual retreats. Centers report programs for the initiation of leaves (82%), onboarding (64%), and reorientation (94%). Support of health benefits (76%) and pensions (76%) depended on type of appointment and relationship to the university. Fiscal transparency was reported in 53% of programs. Conclusion Wellness and burnout are critical issues for emergency medicine in Canada. This comprehensive review of wellness programs identifies areas of strength, but also allows identification of areas of improvement for future work. Individual centers can identify common options when developing or expanding their wellness programs

Emergency medicine physician burnout and wellness in Canada before COVID19: A national survey

Introduction Emergency medicine (EM) is a high-risk specialty for burnout. COVID-19 has had and will continue to have important consequences on wellness and burnout for EM physicians in Canada. Baseline data are crucial to monitor the health of EM physicians in Canada, and evaluate any interventions designed to help during and after COVID-19.Objectives To describe the rates of burnout, depression, and suicidality in practicing EM physicians in Canada, just before the COVID-19 pandemic.Methods A modified snowball method was used for survey distribution. Participants completed the Maslach Burnout Inventory - Health Services Tool (MBI-HSS), a screening measure for depression (PHQ-9), and a question regarding if the physician had ever or in the past 12 months contemplated suicide.Results A total of 384 respondent surveys were included in the final analysis: 86.1% (329/382) met at least one of the criteria for burnout, 58% (217/374) scored minimal to none on the PHQ-9 screening tool for depression, 14.3% (53/371) had contemplated suicide during their staff career in EM, and of those, 5.9% (22/371) had actively considered suicide in the past year.Conclusion Canadian EM physicians just before the COVID-19 pandemic had an alarming number of respondents meet the threshold for burnout, confirming EM as a high-risk specialty. This important baseline information can be used to monitor the physical and mental risks to EM physicians during and after COVID-19, and evaluate support for mental health and wellness, which is urgently needed now and post pandemic

Evaluation of intensified behaviour change communication strategies in an artemisinin resistance setting

Background: In Cambodia, behaviour change communication (BCC) represents an integral component of malaria efforts aimed at fighting artemisinin resistant parasites and achieving elimination. The multi-pronged BCC interventions include interpersonal communication through village health volunteers (VHVs) and village malaria workers (VMWs), broadcasting malaria prevention, diagnosis and treatment messages via TV, radio and mobile broadcasting units (MBUs), distributing information education and communication (IEC) materials and introducing mobile malaria workers (MMWs) in endemic villages. Methods: This was a cross sectional household survey using a stratified multi-stage cluster sampling approach, conducted in December 2012. A stratified multi-stage cluster sampling approach was used; 30 villages were selected (15 in each stratum) and a total of 774 households were interviewed. This survey aimed to assess the potential added effect of 'intense' BCC interventions in three Western provinces. Conducted 2 years after start of these efforts, 'non-intense' BCC (niBBC) interventions (e.g., radio or TV) were compared to "intense" BCC (iBBC) implemented through a set of interpersonal communication strategies such as VMWs, VHVs, mobile broadcasting units and listener viewer clubs. Results: In both groups, the knowledge of the mode of malaria transmission was high (96.9 vs 97.2 %; p = 0.83), as well as of fever as a symptom (91.5 vs 93.5 %; p = 0.38). Knowledge of local risk factors, such as staying in the forest (39.7 vs 30.7 %; p = 0.17) or the farm (7.1 vs 5.1 %; p = 0.40) was low in both groups. Few respondents in either group knew that they must get tested if they suspected malaria (0.3 vs 0.1; p = 0.69). However, iBBC increased the discussions about malaria in the family (51.7 vs 35.8 %; p = 0.002) and reported prompt access to treatment in case of fever (77.1 vs 59.4 %; p < 0.01). Conclusion: The use of iBCC supported positive improvements in both attitudes and behaviours among the population with regard to malaria compared to mass media (niBCC) only. The significantly increase in people seeking treatment for fever in iBCC villages supports Objective Five of the Strategic Plan in the Cambodia Malaria Elimination Action Framework (2016-2020). Therefore, this study provides evidence for the planning and implementation of future BCC interventions to achieve the elimination of artemisinin resistant Plasmodium falciparum malaria

Reactive case-detection of malaria in Pailin Province, Western Cambodia: lessons from a year-long evaluation in a pre-elimination setting.

BACKGROUND: As momentum towards malaria elimination grows, strategies are being developed for scale-up in elimination settings. One prominent strategy, reactive case detection (RACD), involves screening and treating individuals living in close proximity to passively detected, or "index" cases. This study aims to use RACD to quantify Plasmodium parasitaemia in households of index cases, and identify risk factors for infection; these data could inform reactive screening approaches and identify target risk groups. METHODS: This study was conducted in the Western Cambodian province of Pailin between May 2013 and March 2014 among 440 households. Index participants/index cases (n = 270) and surrounding households (n = 110) were screened for Plasmodium infection with rapid diagnostic tests (RDT), microscopy and real-time polymerase chain reaction (PCR). Participants were interviewed to identify risk factors. A comparison group of 60 randomly-selected households was also screened, to compare infection levels of RACD and non-RACD households. In order to identify potential risk factors that would inform screening approaches and identify risk groups, multivariate logistic regression models were applied. RESULTS: Nine infections were identified in households of index cases (RACD approach) through RDT screening of 1898 individuals (seven Plasmodium vivax, two Plasmodium falciparum); seven were afebrile. Seventeen infections were identified through PCR screening of 1596 individuals (15 P. vivax, and 22 % P. falciparum/P. vivax mixed infections). In the control group, 25 P. falciparum infections were identified through PCR screening of 237 individuals, and no P. vivax was found. Plasmodium falciparum infection was associated with fever (p = 0.013), being a member of a control household (p ≤ 0.001), having a history of malaria infection (p = 0.041), and sleeping without a mosquito net (p = 0.011). Significant predictors of P. vivax infection, as diagnosed by PCR, were fever (p = 0.058, borderline significant) and history of malaria infection (p ≤ 0.001). CONCLUSION: This study found that RACD identified very few secondary infections when targeting index and neighbouring households for screening. The results suggest RACD is not appropriate, where exposure to malaria occurs away from the community, and there is a high level of treatment-seeking from the private sector. Piloting RACD in a range of transmission settings would help to identify the ideal environment for feasible and effective reactive screening methods

Shared midgut binding sites for Cry1A.105, Cry1Aa, Cry1Ab, Cry1Ac and Cry1Fa proteins from Bacillus thuringiensis in two important corn pests, Ostrinia nubilalis and Spodoptera frugiperda

First generation of insect-protected transgenic corn (Bt-corn) was based on the expression of Cry1Ab or Cry1Fa proteins. Currently, the trend is the combination of two or more genes expressing proteins that bind to different targets. In addition to broadening the spectrum of action, this strategy helps to delay the evolution of resistance in exposed insect populations. One of such examples is the combination of Cry1A.105 with Cry1Fa and Cry2Ab to control O. nubilalis and S. frugiperda. Cry1A.105 is a chimeric protein with domains I and II and the C-terminal half of the protein from Cry1Ac, and domain III almost identical to Cry1Fa. The aim of the present study was to determine whether the chimeric Cry1A.105 has shared binding sites either with Cry1A proteins, with Cry1Fa, or with both, in O. nubilalis and in S. frugiperda. Brush-border membrane vesicles (BBMV) from last instar larval midguts were used in competition binding assays with 125I-labeled Cry1A.105, Cry1Ab, and Cry1Fa, and unlabeled Cry1A.105, Cry1Aa, Cry1Ab, Cry1Ac, Cry1Fa, Cry2Ab and Cry2Ae. The results showed that Cry1A.105, Cry1Ab, Cry1Ac and Cry1Fa competed with high affinity for the same binding sites in both insect species. However, Cry2Ab and Cry2Ae did not compete for the binding sites of Cry1 proteins. Therefore, according to our results, the development of cross-resistance among Cry1Ab/Ac, Cry1A.105, and Cry1Fa proteins is possible in these two insect species if the alteration of shared binding sites occurs. Conversely, cross-resistance between these proteins and Cry2A proteins is very unlikely in such case

The character and trends of atmospheric precipitation in Latvia

Maģistra darbā tiek aplūkotas un analizētas atmosfēras nokrišņu sadalījuma likumsakarības un izmaiņu tendences Latvijā laika periodā no 1948. līdz 2005. gadam. Pasaulē ir vērojams klimata pārmaiņu process, un nokrišņu daudzuma izmaiņas ir stipri atšķirīgas dažādos pasaules reģionos. Nokrišņu daudzuma raksturu, to izmaiņas pasaulē un Latvijā lielā mērā nosaka globālā atmosfēras cirkulācija, kas ir viens no galvenajiem faktoriem to mainībai. Darbā tiek dots īss pārskats par iepriekš veiktajiem nokrišņu izmaiņu pētījumiem dažādos pasaules reģionos, lai detalizēti varētu izvērtēt nokrišņu izmaiņu tendenču kopsakarības Latvijas teritorijā. Maģistra darbā tika aplūkota un analizēta dažādu cirkulācijas tipu, apkārtējā reljefa, kā arī Baltijas jūras un Rīgas līča ietekme uz atmosfēras nokrišņu sadalījumu Latvijā. Literatūras analīzē tika apskatīta arī Rīgas pilsētas telpiskās struktūras loma nokrišņu daudzuma sadalījumā un mainībā ilglaicīgā skatījumā. Darba pētnieciskajā daļā, pēc apstrādātiem meteoroloģisko staciju un hidroloģisko posteņu novērojumu datiem, tiek analizētas atmosfēras nokrišņu ilgtermiņa izmaiņu tendences Latvijas fizioģeogrāfiskajos rajonos. Pēc ilggadīgām novērojumu rindām tika iegūtas vidējās svērtās nokrišņu summas vērtības, kas kartogrāfiskā veidā attēlotas, labi parāda un raksturo nokrišņu gada un sezonālo sadalījumu Latvijā laikā no 1948. līdz 2005. gadam. Pielietojot Mann-Kendalla testa un lineārās regresijas metodes, tika izpētītas gada nokrišņu summas izmaiņu tendences visā pētāmajā laika periodā (1948.-2005.), normas periodā (1961.-1990.) un laika periodā no 1991. līdz 2005. gadam. Pēc iegūtajiem Mann-Kendalla testa rezultātiem tika izanalizētas nokrišņu izmaiņu tendences sezonālā un mēneša griezumā. Lai izvērtētu nokrišņu sadalījuma teritoriālās atšķirības, darbā ir analizēta savstarpējo sakarību korelācijas matrica starp visām 43 meteoroloģiskajām stacijām un hidroloģiskajiem posteņiem. Statistiski nozīmīgas nokrišņu izmaiņu tendences ir konstatētas normas periodā (1961.-1990.), kad nokrišņu daudzums visā Latvijā ir palielinājies. Sezonālā griezumā būtiskas nokrišņu pieauguma tendences ir vērojamas ziemā. Darba atslēgas vārdi: atmosfēras nokrišņi, nokrišņu gada un sezonālais sadalījums, ilgtermiņa izmaiņu tendences, Latvija.In the Master thesis the author is investigating and analyzing regularities of precipitation distribution and trends in precipitation taking place in Latvia in the period between 1948 and 2005. The process of climate change is taking place all over the world and the changes of the amount of precipitations vary in different regions. The characteristics and changes of the precipitation amount in Latvia and in the whole World to a large extent are determined by global atmospheric circulation as one of the major factors. The thesis provides short summary of the recent studies of precipitation amount changes in different regions in order to implement detailed analysis of the tendency regularities of the changing precipitation amount in Latvia. In the Master thesis the author investigates and analyzes the influence of different types of circulations, surrounding relief as well as of the Baltic Sea and the Gulf of Riga on the precipitation distribution in Latvia. In the literature analysis the impact of the Riga’s dimensional structure on the precipitation distribution and its changes is being considered in long-term perspective. In the seventh part of the thesis the author analyzes the long-term trends concerning atmospheric precipitation in physiogeographic regions of Latvia according to the processed data of observations implemented by meteorological stations and hydrological posts. After the number of long-standing observations weighted mean values of overall amount of precipitations had been studied out; these figures, being cartographically depicted, perfectly reflect and characterize annual and seasonal precipitation distribution taking place in Latvia within the period from 1948 to 2005. Applying the methods of Mann-Kendall test and linear regression the author explores the trends of overall precipitations amount during the whole studied period (1948-2005), the norm period (1961-1990) and the time between 1991 and 2005. According to the results of Mann-Kendall test, the precipitation trends were analyzed in the sectional view of seasons and months. In order to comprehend the territorial differences of precipitation distribution the author of the Master thesis analyzes the interconnections correlation matrix containing data from all 43 meteorological stations and hydrological posts. Statistically significant precipitations trends date back to the norm period (1961-2005) when the amount of precipitation had increased. In seasonal view the most significant trends in precipitation increase take place in winter. Key words: atmospheric precipitation, annual and seasonal precipitation distribution, long-term trends, Latvia

Lactobacillus reuteri Maintains a Functional Mucosal Barrier during DSS Treatment Despite Mucus Layer Dysfunction

Treatment with the probiotic bacterium Lactobacillus reuteri has been shown to prevent dextran sodium sulfate (DSS)-induced colitis in rats. This is partly due to reduced P-selectin-dependent leukocyte-and platelet-endothelial cell interactions, however, the mechanism behind this protective effect is still unknown. In the present study a combination of culture dependent and molecular based T-RFLP profiling was used to investigate the influence of L. reuteri on the colonic mucosal barrier of DSS treated rats. It was first demonstrated that the two colonic mucus layers of control animals had different bacterial community composition and that fewer bacteria resided in the firmly adherent layer. During DSS induced colitis, the number of bacteria in the inner firmly adherent mucus layer increased and bacterial composition of the two layers no longer differed. In addition, induction of colitis dramatically altered the microbial composition in both firmly and loosely adherent mucus layers. Despite protecting against colitis, treatment with L. reuteri did not improve the integrity of the mucus layer or prevent distortion of the mucus microbiota caused by DSS. However, L. reuteri decreased the bacterial translocation from the intestine to mesenteric lymph nodes during DSS treatment, which might be an important part of the mechanisms by which L. reuteri ameliorates DSS induced colitis