TRIAD zoning in Quebec: Experiences and results after 5 years

The TRIAD approach to forest management involves dividing the forest into 3 zones, each with its own management\ud objectives, but with the overall goal of increasing the ecological and economic sustainability of the forest. For the past 5 years, we have been experimenting with TRIAD zoning in central Quebec, incorporating social interests into the original concept of TRIAD management. Results generally indicate that this approach is economically viable, socially acceptable, and preferable ecologically in this area. Although much remains to be done, thus far the consensus among the\ud various project participants is that this approach may be a good fit for the public forest of Canada

Developing Consensus-Based Outcome Domains for Trials in Children and Adolescents With CKD: An International Delphi Survey

RATIONALE & OBJECTIVE: The inconsistency in outcomes reported and lack of patient-reported outcomes across trials in children with chronic kidney disease (CKD) limits shared decision making. As part of the Standardized Outcomes in Nephrology (SONG)-Kids initiative, we aimed to generate a consensus-based prioritized list of critically important outcomes to be reported in all trials in children with CKD. STUDY DESIGN: An online 2-round Delphi survey in English, French, and Hindi languages. SETTINGS & PARTICIPANTS: Patients (aged 8-21 years), caregivers/family, and health care professionals (HCPs) rated the importance of outcomes using a 9-point Likert scale (7-9 indicating critical importance) and completed a Best-Worst Scale. ANALYTICAL APPROACH: We assessed the absolute and relative importance of outcomes. Comments were analyzed thematically. RESULTS: 557 participants (72 [13%] patients, 132 [24%] caregivers, and 353 [63%] HCPs) from 48 countries completed round 1 and 312 (56%) participants (28 [40%] patients, 64 [46%] caregivers, and 220 [56%] HCPs) completed round 2. Five outcomes were common in the top 10 for each group: mortality, kidney function, life participation, blood pressure, and infection. Caregivers and HCPs rated cardiovascular disease higher than patients. Patients gave lower ratings to all outcomes compared with caregivers/HCPs except they rated life participation (round 2 mean difference, 0.1), academic performance (0.1), mobility (0.4), and ability to travel (0.4) higher than caregivers and rated ability to travel (0.4) higher than HCPs. We identified 3 themes: alleviating disease and treatment burden, focusing on the whole child, and resolving fluctuating and conflicting goals. LIMITATIONS: Most participants completed the survey in English. CONCLUSIONS: Mortality, life participation, kidney function, and blood pressure were consistently highly prioritized by patients, caregivers, and HCPs. Patients gave higher priority to some lifestyle-related outcomes compared with caregivers/HCPs. Establishing critically important outcomes for all trials in children with CKD may improve consistent reporting of survival, kidney health, and clinical and life impact outcomes that are meaningful for decision making

Global Variation of Nutritional Status in Children Undergoing Chronic Peritoneal Dialysis : A Longitudinal Study of the International Pediatric Peritoneal Dialysis Network

While children approaching end-stage kidney disease (ESKD) are considered at risk of uremic anorexia and underweight they are also exposed to the global obesity epidemic. We sought to investigate the variation of nutritional status in children undergoing chronic peritoneal dialysis (CPD) around the globe. The distribution and course of body mass index (BMI) standard deviation score over time was examined prospectively in 1001 children and adolescents from 35 countries starting CPD who were followed in the International Pediatric PD Network (IPPN) Registry. The overall prevalence of underweight, and overweight/obesity at start of CPD was 8.9% and 19.7%, respectively. Underweight was most prevalent in South and Southeast Asia (20%), Central Europe (16.7%) and Turkey (15.2%), whereas overweight and obesity were most common in the Middle East (40%) and the US (33%). BMI SDS at PD initiation was associated positively with current eGFR and gastrostomy feeding prior to PD start. Over the course of PD BMI SDS tended to increase on CPD in underweight and normal weight children, whereas it decreased in initially overweight patients. In infancy, mortality risk was amplified by obesity, whereas in older children mortality was markedly increased in association with underweight. Both underweight and overweight are prevalent in pediatric ESKD, with the prevalence varying across the globe. Late dialysis start is associated with underweight, while enteral feeding can lead to obesity. Nutritional abnormalities tend to attenuate with time on dialysis. Mortality risk appears increased with obesity in infants and with underweight in older children.Peer reviewe

Développement et mise à l’essai du Guide de rétroaction francophone pour l’observation directe des résidents en médecine familiale au Canada

Background: There are no CanMEDS-FM-based milestone tool to guide feedback during direct observation (DO). We have developed a guide to support documentation of feedback for direct observation (DO) in Canadian family medicine (FP) programs. Methods: The Guide was designed in three phases with the collaboration of five Canadian FP programs with at least a French-speaking teaching site: 1) literature review and needs study; 2) development of the SPOD Feedback Guide; 3) testing the Guide in a video simulation context with qualitative content analysis. Results: Phase 1 demonstrated the need for a narrative guide aimed at 1) specifying mutual expectations according to the resident's level of training and the clinical context, 2) providing the supervisor with tools and structure in his observations 3) to facilitate documentation of feedback. Phase 2 made it possible to develop the Guide, in paper and electronic formats, meeting the needs identified. In phase 3, 15 supervisors used the guide for three levels of residence. The Guide was adjusted following this testing to recall the phases of the clinical encounter that were often forgotten during feedback (before consultation, diagnosis and follow-up), and to suggest types of formulation to be favored (stimulating questions). , questions of clarification, reflections). Conclusion: Based on evidence and a collaborative approach, this Guide will equip French-speaking Canadian supervisors performing SPOD in family medicine.Résumé Contexte : Il n’existe aucun outil par jalons reposant sur les CanMEDS-MF pour guider la rétroaction en supervision par observation directe (SPOD). Nous avons développé un guide pour soutenir la documentation de la rétroaction en SPOD en médecine familiale (MF) au Canada. Méthode : La conception du Guide a été effectuée en trois phases avec la collaboration de cinq programmes de MF canadiens ayant minimalement un site d’enseignement francophone : 1) recension des écrits et étude des besoins; 2) élaboration du Guide de rétroaction SPOD; 3) mise à l’essai du Guide en contexte de simulation vidéo avec analyse de contenu qualitative. Résultats : La phase 1 a démontré le besoin d’un guide narratif ayant pour but 1) de préciser les attentes mutuelles selon le niveau de formation du résident et le contexte clinique, 2) d’outiller et structurer le superviseur dans ses observations 3) de faciliter la documentation de la rétroaction. La phase 2 a permis d’élaborer le Guide, en formats papier et électronique, répondant aux besoins identifiés. En phase 3, 15 superviseurs ont utilisé le guide pour trois niveaux de résidence. Le Guide a été ajusté à la suite de cette mise à l’essai pour rappeler les phases de la rencontre clinique souvent oubliées durant la rétroaction (avant la consultation, diagnostic et suivi), et y suggérer des types de formulation à favoriser (questions stimulantes, questions de clarification, réflexions). Conclusion : Issu de données probantes et d’une démarche de concertation, ce Guide outillera les superviseurs et résidents francophones canadiens dans leurs activités de SPOD en médecine familiale

Development and use of a computerized system to track the competency development of family medicine residents: analysis of the convergence between system proposals and assessor decisions

In recent decades, a number of training environments have moved toward program approaches targeting the development of competencies. Because of their complexity, monitoring the development of those competencies is a considerable challenge. Our hypothesis is that a computerized system could help overcome this challenge if it is well accepted by its users. We first summarize the context surrounding the implementation of such approaches. Next, we present a computerized assessment system established in the Family Medicine Residency Program of Laval University (Québec, Canada) that we have developed for tracking the development of residents’competencies. We then present the analysis of interactions between the system and users and the various proposals that were made to improve the system and longitudinal tracking of the development of the targeted competencies. We consider that this research provides useful guidelines for the computerized monitoring of learners’ competencies development and for the design of such systems

Validation d'un outil critérié d'évaluation des compétences des résidents en médecine familiale : étude qualitative du processus de réponse

Contexte : L'implantation de l'approche par compétences prescrit aux programmes de formation médicale postdoctorale un ajustement de leurs stratégies d'évaluation. Un outil critérié d'évaluation des compétences (OCÉC) a été élaboré à partir de jalons ayant fait l'objet d'une validation de contenu, mais le processus de réponse restait à valider avant son implantation. Objectifs : Évaluer le processus de réponse à l'OCÉC et identifier les difficultés rencontrées par ses usagers pouvant introduire des biais dans l'évaluation. Méthodes : Étude qualitative auprès de dix cliniciens-enseignants volontaires. La collecte de données s'est effectuée au cours d'entrevues individuelles utilisant la méthode de la pensée à voix haute. Une analyse de contenu des verbatims a été réalisée par trois chercheurs, ce qui a permis la triangulation des données. La structure de codification se compose de quatre thèmes : compréhension, récupération de l'information, jugement et sélection de la réponse. Résultats : La compréhension et la récupération de l'information posaient généralement peu problème. Des difficultés aux étapes du jugement (indicateurs hétérogènes et évaluation normative) et de sélection de la réponse (échelle de réponse inadéquate) ont été relevées. Discussion et conclusion : Cette étude a permis de vérifier le processus de réponse à l'OCÉC, qui s'est avéré adéquat pour la compréhension et la récupération de l'information, mais à améliorer en regard du jugement et de la sélection de la réponse. L'OCÉC a été révisé en fonction des résultats obtenus avant son implantation. L'évaluation en cours de la structure interne, des relations avec d'autres variables et des conséquences du test complétera le processus de validation de l'OCÉC

Long-term population dynamics in a multi-species assemblage of large herbivores in East Africa

Wildlife population declines in Africa are widespread. However, species-specific population trends and dynamics in mammal community composition have rarely been described over long time periods. To describe population trends of 13 large herbivore species in Lake Manyara National Park (Tanzania) from 1959 to 2016 and to discover whether the herbivore community structure changed, we used general additive models and additional statistical methods to detect structural changes in the time series. Population dynamics were non-linear and population growth rates were not correlated with precipitation anomalies. Relatively steep population declines of three megaherbivores occurred during the 1980s and early 1990s, resulting in severe reductions in African elephant and buffalo populations and the local extinction of black rhinoceros. These declines coincided with reported peaks of illegal hunting of these species and expansion of agriculture at the periphery of the park. Population densities of elephant and buffalo seem to have stabilized in recent times, yet have not recovered to previous densities. In contrast, eight species (giraffe, zebra, waterbuck, wildebeest, warthog, impala, bushbuck, and baboon) have apparently fared well (similar or higher densities in most recent compared to first decade), despite having undergone substantial fluctuations over the past 58 yr. Population fluctuations in these species were likely caused by disease outbreaks, heavy bush encroachment, and reduced competition with buffalo. Possibly, declines in megaherbivore densities (mainly elephants) facilitated bush encroachment. Albeit grazers are still dominating in the herbivore community, the proportion of browsers is currently increasing, likely encouraged by dense vegetation in the shrub layer in large parts of the park. Overall, herbivore biomass density has declined by ~40% compared to the baseline estimate in the first decade of the time series. Our analyses and ancillary information provide evidence that this overall decline in the herbivore assemblage was triggered by human-induced reductions in megaherbivore population densities during the 1980s, either through excessive poaching, insularization of the park, or both. Likely, this had cascading and interacting effects on the vegetation structure and the herbivore assemblage. Thus, legacy effects of ineffective megaherbivore conservation efforts 30 yr ago are likely still affecting the ecology of this national park

Développement et mise à l’essai du Guide de rétroaction francophone pour l’observation directe des résidents en médecine familiale au Canada

Contexte : Il n’existe aucun outil par jalons reposant sur les CanMEDS-MF pour guider la rétroaction en supervision par observation directe (SPOD). Nous avons développé un guide pour soutenir la documentation de la rétroaction en SPOD en médecine familiale (MF) au Canada.Méthode : La conception du Guide a été effectuée en trois phases avec la collaboration de cinq programmes de MF canadiens ayant minimalement un site d’enseignement francophone : 1) recension des écrits et étude des besoins; 2) élaboration du Guide de rétroaction SPOD; 3) mise à l’essai du Guide en contexte de simulation vidéo avec analyse de contenu qualitative.Résultats : La phase 1 a démontré le besoin d’un guide narratif ayant pour but 1) de préciser les attentes mutuelles selon le niveau de formation du résident et le contexte clinique, 2) d’outiller et structurer le superviseur dans ses observations 3) de faciliter la documentation de la rétroaction. La phase 2 a permis d’élaborer le Guide, en formats papier et électronique, répondant aux besoins identifiés. En phase 3, 15 superviseurs ont utilisé le guide pour trois niveaux de résidence. Le Guide a été ajusté à la suite de cette mise à l’essai pour rappeler les phases de la rencontre clinique souvent oubliées durant la rétroaction (avant la consultation, diagnostic et suivi), et y suggérer des types de formulation à favoriser (questions stimulantes, questions de clarification, réflexions).Conclusion : Issu de données probantes et d’une démarche de concertation, ce Guide outillera les superviseurs et résidents francophones canadiens dans leurs activités de SPOD en médecine familiale.Background: There are no CanMEDS-FM-based milestone tool to guide feedback during direct observation (DO). We have developed a guide to support documentation of feedback for direct observation (DO) in Canadian family medicine (FP) programs.Methods: The Guide was designed in three phases with the collaboration of five Canadian FP programs with at least a French-speaking teaching site: 1) literature review and needs study; 2) development of the SPOD Feedback Guide; 3) testing the Guide in a video simulation context with qualitative content analysis.Results: Phase 1 demonstrated the need for a narrative guide aimed at 1) specifying mutual expectations according to the resident's level of training and the clinical context, 2) providing the supervisor with tools and structure in his observations 3) to facilitate documentation of feedback. Phase 2 made it possible to develop the Guide, in paper and electronic formats, meeting the needs identified. In phase 3, 15 supervisors used the guide for three levels of residence. The Guide was adjusted following this testing to recall the phases of the clinical encounter that were often forgotten during feedback (before consultation, diagnosis and follow-up), and to suggest types of formulation to be favored (stimulating questions). , questions of clarification, reflections).Conclusion: Based on evidence and a collaborative approach, this Guide will equip French-speaking Canadian supervisors performing SPOD in family medicine

Rescue of tropomyosin deficiency in Drosophila and human cancer cells by synaptopodin reveals a role of tropomyosin α in RhoA stabilization

Tropomyosins are widespread actin-binding proteins that influence numerous cellular functions including actin dynamics, cell migration, tumour suppression, and Drosophila oocyte development. Synaptopodin is another actin-binding protein with a more restricted expression pattern in highly dynamic cell compartments such as kidney podocyte foot processes, where it promotes RhoA signalling by blocking the Smurf1-mediated ubiquitination of RhoA. Here, we show that synaptopodin has a shorter half-life but shares functional properties with the highly stable tropomyosin. Transgenic expression of synaptopodin restores oskar mRNA localization in Drosophila oocytes mutant for TmII, thereby rescuing germline differentiation and fertility. Synaptopodin restores stress fibres in tropomyosin-deficient human MDA-MB 231 breast cancer cells and TPMα-depleted fibroblasts. Gene silencing of TPMα but not TPMβ causes loss of stress fibres by promoting Smurf1-mediated ubiquitination and proteasomal degradation of RhoA. Functionally, overexpression of synaptopodin or RhoA(K6,7R) significantly reduces MDA-MB 231 cell migration. Our findings elucidate RhoA stabilization by structurally unrelated actin-binding proteins as a conserved mechanism for regulation of stress fibre dynamics and cell motility in a cell type-specific fashion

Développement, validation et implantation d'un outil novateur critérié d'évaluation de la progression des compétences des résidents en médecine familiale

Contexte : Avec l’adoption de son cursus axé sur les compétences, le Collège des médecins de famille du Canada invite les programmes de résidence à fournir aux cliniciens enseignants des outils pour mieux guider l’évaluation formative et sanctionnelle des résidents, tels que des indicateurs de développement observables qui définissent les attentes à des étapes significatives de la formation. But : Développer un outil critérié d’évaluation de la progression du développement des compétences reposant sur les attentes des cliniciens enseignants quant au moment d’acquisition des différentes compétences pour chacun des rôles « CanMEDS-médecine familiale » durant la résidence. Méthodes : Les intervalles attendus pour démontrer diverses compétences ont d’abord été définis par méthodologie Delphi auprès de 33 cliniciens enseignants en médecine familiale de l’Université Laval (Québec, Canada). Les validités de contenu et de convergence ont été vérifiées. Un système informatisé a ensuite été développé pour relier les différents niveaux d’autonomie aux intervalles attendus pour le développement des compétences. Le système identifie, au besoin, les diagnostics pédagogiques possibles et suggère des prescriptions pédagogiques. Résultats : L’outil permet de suivre le développement de 34 compétences réparties sous les sept rôles « CanMEDs-médecine familiale » selon trois niveaux d’autonomie : peu autonome, partiellement autonome et autonome et identifie si la progression de chaque compétence se fait selon les attentes. Conclusions/implications : Cet outil novateur critérié d’évaluation de la progression des compétences des résidents permet non seulement d’apprécier cette progression, mais aussi de guider le développement de leurs compétences. Une étude de validation psychométrique est en cours afin d’évaluer l’impact de l’outil sur la qualité des évaluations, sur la pratique des cliniciens enseignants et sur le parcours des résidents