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Medical Education 2011: : 95-106 One hundred years after the Flexner report remade medical education in North America, many countries are reviewing the purpose and organisation of medical education. In Canada, a national study is being undertaken to define important issues and challenges for the future of medical education. The objectives of this paper are to describe the process of conducting an empirical environmental scan at a national level, and to present the research findings of this scan. Thirty national key informant interviews were conducted, transcribed and coded to identify key themes. Interview data were triangulated with data sourced from 34 commissioned literature reviews and a series of national focus groups. Ten key issues or priorities were identified and used to generate detailed review papers used by the Association of Faculties of Medicine of Canada to create a blueprint for the evolution of medical education. The new priorities have major implications for areas ranging from admissions, curriculum content, educational process and the need to articulate the purpose and responsibilities of medical schools in society. This research provides a case study of how an empirical research approach can be used to identify and validate priorities for changes in medical education at a national level. This approach may be of interest in other countries. [ABSTRACT FROM AUTHOR]

Child homicides are rare occurrences, but when they occur, they often cause significant outrage. This paper examines the role of varying degrees of intimacy between victims and perpetrators in determining characteristics in child homicide cases. Focusing on 533 cases of child homicide between 1985 and 2012 in Ontario, Canada, characteristics of intrafamilial and extrafamilial cases, biological and step/foster parents, and maternal and paternal perpetrators are compared. Results show that characteristics of the child homicide vary depending on the degree of intimacy between victims and perpetrators, including: perpetrator and victim age, weapon use, suicide following the offence, sexual violence and use of excessive force. These findings provide support for developmental victimology and a routine activities theoretical perspective. Suggestions for future research and policy implications are also discussed. 'Examines the role of varying degrees of intimacy between victims and perpetrators in determining characteristics in child homicide cases' Key Practitioner Messages: Younger children are at a greater risk of homicide from family members, while older children are at a greater risk of homicide from individuals outside the family.Developmental victimology and routine activities theory can contribute to a better understanding of the dynamics between victims and perpetrators in child homicide.Collaboration should take place between researchers, child death review committees, mental health services, social services and policymakers to improve child homicide prevention and intervention initiatives. [ABSTRACT FROM AUTHOR]

This paper models the demand for assets and liabilities by a life insurers. As one step toward the implementation of a utility-dependent portfolio methodology, the paper empirically estimates a family of flexible functional form utility functions (defined over mean and variance). On empirical grounds, in general, the square root quadratic utility function best fits the data. Having determined that utility function the paper then generates estimated mean and variance elasticities for financial assets (liabilities) demand. Broadly speaking, the square root quadratic approximation yields signs for the elasticities of substitution that are consistent with the theory and intuition. The substitutability measures provided (via expected return and variance) among assets within life insurer portfolios provide important information on the impact of regulation of such institutions on their portfolio risk. In addition those measures provide information on the effect of government-induced changes in supply on equilibrium asset yields. Finally, the model also permits a comparison of stock and mutual insurers. The commonly held belief that mutual insurers take a riskier position in the way they discount their business is supported by the results. [ABSTRACT FROM AUTHOR]

Medical Education 2010: 44: 864–873 Objectives Ethical reasoning in medicine is not well understood and medical educators often find it difficult to justify what and how they teach and assess in medical ethics. To facilitate the development of moral values and professional conduct, a model of ethical reasoning was created. The purposes of this paper are to describe the ethical reasoning model and to indicate how it can be used to foster moral and ethical behaviours. Methods The ethical reasoning model was created from information derived from two sources: (i) an examination of different ethical models described in the literature, and (ii) think-aloud interviews with ethical experts in Taiwan and Canada. All the components and cognitive steps used by experts in ethical decision making were extracted and categorised. Interview subjects consisted of 16 voluntary ethics experts. The ethical reasoning models reported in the literature were divided into two groups according to whether they were justification-based or task-based models. Neither of the two types represented the ‘whole picture’ of ethical reasoning in medicine. This analysis enabled us to identify five universal cognitive steps and the gaps between ‘logical decision’ and ‘action’. Results The think-aloud interviews verified the multi-dimensional components or steps used by experts when resolving ethical problems. The resulting model, designated the Medical Ethical Reasoning (MER) Model, reflects interactions within three domains: medical and ethical knowledge; cognitive reasoning processes, and attitude. Conclusions The MER Model accurately reflects how doctors resolve ethical dilemmas and is seen to be helpful in identifying what and how educators should teach and assess in ethical reasoning. The model can also serve as a communication framework for curricular design. A ‘humane’ doctor is competent in providing quality, ethical patient care. Making an appropriate ethical decision is the foundation for subsequent ethical behaviours. By contrast with the abundant evidence cited in previous research describing how doctors solve medical problems, there is little empirical evidence indicating how doctors make appropriate ethical decisions. Thus, the cognition of ethical reasoning in medicine is not well understood. This paper represents a step towards overcoming this problem. [ABSTRACT FROM AUTHOR]

Although sucrose is widely administered to hospitalized infants for single painful procedures, total sucrose volume during the entire neonatal intensive care unit (NICU) stay and associated adverse events are unknown. In a longitudinal observation study, we aimed to quantify and contextualize sucrose administration during the NICU stay. Specifically, we investigated the frequency, nature, and severity of painful procedures; proportion of procedures where neonates received sucrose; total volume of sucrose administered for painful procedures; and incidence and type of adverse events. Neonates <32 weeks gestational age at birth and <10 days of life were recruited from four Canadian tertiary NICUs. Daily chart reviews of documented painful procedures, sucrose administration, and any associated adverse events were undertaken. One hundred sixty‐eight neonates underwent a total of 9093 skin‐breaking procedures (mean 54.1 [±65.2] procedures/neonate or 1.1 [±0.9] procedures/day/neonate) during an average NICU stay of 45.9 (±31.4) days. Pain severity was recorded for 5399/9093 (59.4%) of the painful procedures; the majority (5051 [93.5%]) were heel lances of moderate pain intensity. Sucrose was administered for 7839/9093 (86.2%) of painful procedures. The total average sucrose volume was 5.5 (±5.4) mL/neonate or 0.11 (±0.08) mL/neonate/day. Infants experienced an average of 7.9 (±12.7) minor adverse events associated with pain and/or sucrose administration that resolved without intervention. The total number of painful procedures, sucrose volume, and incidence of adverse events throughout the NICU stay were described addressing an important knowledge gap in neonatal pain. These data provide a baseline for examining the association between total sucrose volume during NICU stay and research on longer‐term behavioral and neurodevelopmental outcomes. [ABSTRACT FROM AUTHOR]

Context The shift from a time-based to a competency-based framework in medical education has created a need for frequent formative assessments. Many educational programmes use some form of written progress test to identify areas of strength and weakness and to promote continuous improvement in their learners. However, the role of performance-based assessments, such as objective structured clinical examinations ( OSCEs), in progress testing remains unclear. Objective The aims of this paper are to describe the use of an OSCE to assess learners at different stages of training, describe a structure for reporting scores, and provide evidence for the psychometric properties of different rating tools. Methods A 10-station OSCE was administered to internal medicine residents in postgraduate years ( PGYs) 1-4. Candidates were assessed using a checklist ( CL), a global rating scale ( GRS) and a training level rating scale ( TLRS). Reliability was calculated for each measure using Cronbach's alpha. Differences in performance by year of training were explored using analysis of variance ( anova). Correlations between scores obtained using the different rating instruments were calculated. Results Sixty-nine residents participated in the OSCE. Inter-station reliability was greater (0.88) using the TLRS compared with the CL (0.84) and GRS (0.79). Using all three rating instruments, scores varied significantly by year of training (p < 0.001). Scores from the different rating instruments were highly correlated: CL and GRS, r = 0.93; CL and TLRS, r = 0.90, and GRS and TLRS, r = 0.94 (p < 0.001). Candidates received feedback on their performance relative to examiner expectations for their PGY level. Conclusions Scores were found to have high reliability and demonstrated significant differences in performance by year of training. This provides evidence for the validity of using scores achieved on an OSCE as markers of progress in learners at different levels of training. Future studies will focus on assessing individual progress on the OSCE over time. [ABSTRACT FROM AUTHOR]

Debris flows carry a tremendous potential for physical destruction as well as a threat to human lives. Quantitative analysis of their frequency and magnitude relation is key to the development of mitigation measures to reduce hazard and risk. Yet, the data available for such analysis are typically very sparse, leading to point estimates for return levels that are too imprecise to be of practical value. The aim of the paper is to demonstrate how additional sources of information, in particular, expert judgment which uses physical causes and the size of the active area producing loose sediments, can be incorporated to produce more precise estimates with a smaller upper endpoint of interval estimates of extreme return levels. A Bayesian framework for extreme value analysis is used. We provide a rationale for the prior choice and discuss how its parameters can be elicited from the expert's knowledge. A case study of debris flows at Capricorn Creek in Western Canada is used to illustrate our methodology. [ABSTRACT FROM AUTHOR]

In the current paper, we examine the role of vertical individualism in determining revenge behavior following an injustice. Drawing on existing theory and research, we hypothesized that victims who are more vertically individualistic will be more likely than those who are less vertically individualistic to engage in revenge following the experience of injustice as a means of restoring self-esteem. The results from three studies-employing different methodologies and operationalizations of revenge-support our reasoning. Moreover, two of the studies provide support for the proposed self-esteem maintenance mechanism underlying the relation between vertical individualism and revenge. Although much research in psychology and organizational justice has demonstrated that the experience of injustice can threaten one's identity, our data are the first to demonstrate that responding to injustice can restore people's self-esteem to homeostasis. The present studies thus demonstrate that in some instances revenge may have an intrapsychic benefit for the victim, which helps to explain why some people engage in revenge despite possible negative interpersonal consequences. We discuss implications of our findings for social and organizational justice theory and for potentially mitigating revenge reactions to injustice. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Janjua et al. (2012) Transmission dynamics and risk factors for pandemic H1N1-related illness: outbreak investigation in a rural community of British Columbia, Canada. Influenza and Other Respiratory Viruses 6(3), e54-e62. Objective To characterize the first-wave epidemiologic features of influenza-like illness (ILI) associated with the novel pandemic A/H1N1 [A(H1N1)pdm09] virus. Methods We used generalized linear mixed models (GLMM) to assess risk factors and non-parametric and/or parametric distributions to estimate attack rates, secondary attack rates (SAR), duration of illness, and serial interval during a laboratory-confirmed community outbreak of A(H1N1)pdm09 clustered around on-reserve residents and households of an elementary school in rural British Columbia, Canada, in late April/early May 2009. ILI details were collected as part of outbreak investigation by community telephone survey in early June 2009. Results Overall, 92/408 (23%) of participants developed ILI and 36/408 (9%) experienced medically attended ILI (MAILI). The overall SAR in households was 22%: highest among participants 1-4 years of age (yoa) (50%) followed by <1 yoa (38%), 5-8 yoa (20%), 10-19 yoa (13%), 20-49 yoa (20%), and 50-64 yoa (0%). The median serial interval was estimated at 3·5 days (95% CI: 2·1-5·1). In multivariable GLMM analysis, having a chronic condition (OR: 2·58; 95% CI: 1·1-6·04), younger age [1-8 yoa: OR: 4·63; 95% CI: 2·25-9·52; 9-19 yoa: OR: 1·95; 95% CI: 0·97-3·9 (referent: ≥20 yoa)] and receipt of 2008-2009 influenza vaccine (OR: 2·68; 95% CI: 1·37-5·25) were associated with increased risk of ILI. Median duration of illness was 9 days, longer among those with chronic conditions (21 days). Median time to seeking care after developing illness was 4·5 days. On-reserve participants had higher chronic conditions, household density, ILI, MAILI, and SAR. Conclusions During a community outbreak of A(H1N1)pdm09-related illness, we identified substantial clinical ILI attack rates exceeding 20% with secondary household attack rates as high as 50% in young children. The serial interval was short suggesting a narrow period to prevent transmission. [ABSTRACT FROM AUTHOR]

Attitudes drive practice, perhaps more than evidence The objective of this study was to determine if the new generation of Canadian obstetricians has attitudes differing from those of their predecessors. Employing a cross-sectional, Internet, and paper-based survey, we conducted an in-depth study of obstetricians responding to the Canadian National Maternity Care Attitudes Survey. Of the 800 Canadian obstetricians providing intrapartum care, 549 (68.6%) responded. Participants were stratified by age less than or equal to 40 years compared with those over 40 years; 81 percent of those 40 years or younger were women versus 40 percent over 40 years of age. Younger obstetricians were significantly more likely to favor use of routine epidural analgesia and believed that it did not interfere with labor or lead to instrumentation; were more concerned and feared the perineal and pelvic floor consequences of vaginal birth compared with cesarean section; and were significantly less supportive of vaginal birth after prior cesarean section, home birth, birth plans, routine episiotomy, and routine electronic fetal monitoring as providing maternal or fetal benefits. They were less positive than the older generation about a range of approaches to reducing the cesarean section rate, the importance of maternal choice and role in their own birth, and peer review, and they were more likely to believe that women having a cesarean section were not missing an important experience. No significant generational differences were found for ambivalent attitudes to vaginal breech birth. Younger obstetricians were more evidence-based for some issues and less for others. In general younger obstetricians were more supportive of the role of birth technology in normal birth, including routine epidural analgesia, and they were less appreciative of the role of women in their own birth. They saw cesarean section as a solution to many perceived labor and birth problems. Results suggest a need to examine how obstetricians acquire their favorable attitudes to birth technology in normal birth. (BIRTH 38:2 June 2011) [ABSTRACT FROM AUTHOR]

Ethno-racial minority families who come in contact with child protection services face unique challenges that include different ideas about appropriate child rearing practices, possibly different definitions of child maltreatment, the possibility of racial biases and service provision that does not address their particular needs. Ethno-racial minority immigrants encounter additional barriers to services associated with the challenges of settlement in a new cultural environment. Although considerable research has explored these issues, knowledge of the experiences of ethno-racial families who have been in contact with child protection is limited. The current paper provides insights from a qualitative study that explored the experiences of one ethno-racial group (South Asians) in Canada. Findings suggest a variety of reasons that families come into contact with the child protection system, and the characteristics of the sample highlight their difficult financial and employment circumstances. Themes include participants' desire to be better informed about the reasons for child protection involvement and about what they can expect from the worker and the agency. They also identified a wish for services that not only recognize their cultural diversity but also respond to the needs of the whole family. In-home services were especially appreciated. The findings reveal the resilience and personal agency among participants that can be enhanced through strength-based approaches to practice. Helping others, establishing community networks and developing needed services were avenues of resilience identified. [ABSTRACT FROM AUTHOR]

Examination of factors related to the retention or voluntary turnover of Registered Nurses (RNs) has mainly focused on urban, acute care settings. This paper explored predictors of intent to leave (ITL) a nursing position in all rural and remote practice settings in Canada. Based on the conceptual framework developed for this project, potential predictors of ITL were related to the individual RN worker, the workplace, the community context, and satisfaction related to both the workplace and the community(s) within which the RN lived and worked. A national cross-sectional mail survey of RNs in rural and remote Canada provided the data (n = 3,051) for the logistic regression analysis of predictors of ITL. We found that RNs were more likely to plan to leave their nursing position within the next 12 months if they: were male, reported higher perceived stress, did not have dependent children or relatives, had higher education, were employed by their primary agency for a shorter time, had lower community satisfaction, had greater dissatisfaction with job scheduling, had lower satisfaction with their autonomy in the workplace, were required to be on call, performed advanced decisions or practice, and worked in a remote setting. The statistical evidence for predictors of ITL supported our framework with determinants related to the individual, the workplace, the community, and satisfaction levels. The importance of community makes this framework uniquely relevant to the rural health context. Our findings should guide policy makers and employers in developing retention strategies. [ABSTRACT FROM AUTHOR]

This paper uses both the univariate and multivariate techniques to discover whether liquidity, leverage, payout, activity, and profitability ratios can distinguish non-taken-over, domestic taken-over and foreign taken-over firms in Canada. The results indicate that the three categories of firms emanate from the same population, and the article concludes that even if a connection between historical accounting information and the firm's expected cash flows were to be hypothesized, the semi-strong efficient capital market would ensure that accounting information would be impounded in the prices of securities of target firms. [ABSTRACT FROM AUTHOR]

Background: Echocardiographic speckle tracking strain has gained clinical importance. However, the comparability of measurements between different software systems is not well defined. Methods: In 47 healthy subjects left ventricular (LV) two-dimensional (2D) peak strain and time to peak strain (TTP) generated by EchoPAC (2DS) and velocity vector imaging (VVI) were compared. For each type of strain (longitudinal [LS], circumferential [CS], and radial strain [RS]) we compared global, anatomical level and segmental values. Results: When comparing 2DS to VVI, Pearson correlation coefficients (r) of global LS, CS, and RS were 0.68, 0.44, and 0.59, respectively (all P < 0.05). Correlation of global TTP was higher: 0.81(LS), 0.80 (CS), and 0.68 (RS), all P < 0.01. Segmental peak strain differed significantly between 2DS and VVI in 8/18 (LS), 17/18 (CS), and 15/18 (RS) LV segments (P < 0.05). However, segmental TTP significantly differed only in 5/18 (LS), 7/18 (CS), and 4/18 (RS) of LV segments. Similar strain gradients were found for both systems: apical strain was higher than basal and midventricular strain in LS and CS, with a reversed pattern for RS (P < 0.05). Conclusion: TTP strain as well as strain gradients were comparable between VVI and 2DS, but most peak strain values were not. The software-dependency of peak strain values must be considered in clinical application. Further studies comparing the diagnostic and prognostic accuracy of strain values generated by different software systems are mandatory. (Echocardiography 2011;28:539-547) [ABSTRACT FROM AUTHOR]

The higher consumption of fruit and vegetables is considered to be an indicator of healthy eating and the protective effects of fruit and vegetable (FV) consumption for noncommunicable diseases have been investigated extensively. The present study aimed to investigate the association between fruit and vegetable intake (FVI), health behaviours and socio-demographic factors among adult Canadians. This analysis was based on the information from the Canadian Community Health Survey, Cycle 3.1. Daily intake of fruit and vegetables from a total number of 15 512 apparently healthy individuals, aged 18-64 years, were assessed using a structured questionnaire, which included 20 questions on the frequency of consumption of different types of fruit and vegetables. Multiple logistic regression models were used to determine the association between FVI and some socio-economic factors and lifestyle behaviour among adult Canadians. In total 77% of Canadian adults consumed fruit and vegetables less than five times per day. Females were more likely to consume more fruit [odds ratio (OR) 2.05; 95% confidence interval (CI) 1.75-2.4], vegetables (OR 1.95; 95% CI 1.65-2.29) and FV (OR 2.52; 95% CI 2.20-2.90) than males. Single/never married individuals, individuals with higher levels of education, never smokers, former drinkers and older people reported more consumption of fruit and vegetables than others. The results obtained in the present study indicate an association between FVI and some socio-economic and healthy lifestyle behaviours, and that a substantial gap exists between the recommended level and the actual intake of the FV among the Canadian population. Because a higher intake of FV improves public health, it is imperative to tailor nutrition education at the individual and community levels in Canadian populations. [ABSTRACT FROM AUTHOR]

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Objectives: The objective was to evaluate the effects of direct‐access physiotherapy on patients presenting with a musculoskeletal disorder (MSKD) to the emergency department (ED) on clinical outcomes and use of health care resources. Methods: We conducted a randomized controlled trial in an academic ED in Québec City, Canada. We included patients aged 18 to 80 years with minor MSKD. The intervention group had direct access to a physiotherapist (PT) in the ED immediately after triage and prior to physician assessment, and the control group received usual care by the emergency physician without PT intervention. The key variables included clinical outcomes (pain, interference of pain on function) and resources use (ED return visit, medications, diagnostic tests, additional consultations). They were analyzed using descriptive statistics and compared between groups using two‐way analyses of variance, log‐linear analysis, and chi‐square tests. Results: Seventy‐eight patients suffering from MSKDs were included (40.2 ± 17.6 years old; 44% women). For the primary clinical outcome, participants in the PT group (n = 40) had statistically lower levels of pain and pain interference at 1 and 3 months. In terms of resource use, participants in the PT group returned significantly less often to the ED. At baseline and 1 month, less prescription medication was used, including opioids, but there were no differences at 3 months. Although over‐the‐counter medication was recommended more at baseline in the PT group, there were no differences in use at 1 month, and the PT group had used them less at 3 months. There were no differences between groups at follow‐up for imaging tests, other professionals consulted, and hospitalization rates. Conclusion: Patients presenting with a MSKD to the ED with direct access to a PT had better clinical outcomes and used less services and resources than those in the usual care group after ED discharge and up to 3 months after discharge. [ABSTRACT FROM AUTHOR]

Objective: This questionnaire‐based survey assessed the attitudes of dental hygiene students towards treating elderly patients. Methods: The 14‐item UCLA 14‐item Geriatrics Attitudes Scale (GAS‐14) questionnaire was used in this survey. A further set of nine questions evaluated the opinions of the students towards the existing geriatric curriculum in their respective institutions. Students from five dental hygiene schools from three countries (Switzerland, Belgium and Canada) participated in this survey. General demographic information from the participants was collected. Mean GAS‐14 scores were calculated; ANOVA and Bonferroni's tests were used for statistical analyses (p < 0.05). Results: Three hundred eighty‐five students (Switzerland: n = 157, mean age = 25.38 ± 4.6 years; Belgium: n = 82, mean age = 27.58 ± 12.8 years; Canada: n = 146, mean age = 25.95 ± 12.3 years) completed the survey for a response rate of 86.3%. The overall GAS‐14 scores for Switzerland, Belgium and Canada were 3.61 ± 0.42, 3.24 ± 0.37 and 3.32 ± 0.36, respectively. Switzerland scored significantly higher than Belgium and Canada (p < 0.0001). Overall scores revealed a significant effect of progressive training (p = 0.010). The GAS‐14 score was influenced by the nationality of the participants (p < 0.0001), but not influenced by sex, age, origin, religion, or marital and accommodation statuses. Majority of the students (75.8%) agreed that geriatric dentistry was an important part of their education. 77.4% agreed that they would like hands on experience in treating the elderly patient during their education. 85.1% of the participants considered mobile dental clinics as a good solution for the provision of dental care to the institutionalized elders. Conclusions: The general attitudes of DH students towards treating the elderly patients are on an acceptable level and improved as they progressed through their dental hygiene academic programmes. [ABSTRACT FROM AUTHOR]

Background: Food intake varies among long‐term care (LTC) residents and, as a result, some residents are at risk for protein‐energy malnutrition and its consequences, such as sarcopenia. The present study aimed to determine whether eating occasions, as well as other factors that may vary with eating occasions (e.g. family/volunteer presence), were associated with energy and protein intake at meals and snacks. Methods: The present study comprised a secondary analysis of the cross‐sectional Making the Most of Mealtimes study, including 630 residents (median age 88.00 years, range 62–107 years; 197 males) from 32 Canadian LTC homes. An analysis of variance compared protein and energy intake at meals and snacks. Mixed repeated measures linear regression testing for meal and relevant covariates (e.g. family/volunteer presence) was also conducted. Results: Energy and protein intake was significantly associated with eating occasions (F = 44.31, P < 0.001; F = 12.72, P < 0.001), with the greatest energy intake at breakfast, and the greatest protein intake at dinner. Regression analysis confirmed these findings when considering other factors. Covariates associated with higher intake included: being male (+79 kcal; +3.4 g protein), living on a dementia care unit (+39 kcal; +2.1 g protein) and family/volunteer presence at meals (+58 kcal; +2.5 g protein). Intake was lowest in the oldest age group (−59 kcal; −3.6 g protein) and for those sometimes requiring eating assistance (−36 kcal; −2.0 g protein). Conclusions: Energy and protein intake appears to be associated with eating occasions. Based on these exploratory findings, LTC homes may consider providing more protein‐dense foods at breakfast. Protein and energy dense snacks could also be used more extensively to support intake. [ABSTRACT FROM AUTHOR]

The capturing of movements by means of wearable sensors has become increasingly popular in order to obtain sport performance measures during training or competition. The purpose of the current study was to investigate the feasibility of using body worn accelerometers to identify previous highlighted performance related biomechanical changes in terms of substantial differences across skill levels and skating phases. Twenty-two ice hockey players of different caliber were equipped with two 3D accelerometers, located on the skate and the waist, as they performed 30 m forward skating sprints on an ice rink. Two measures of the temporal stride characteristics (contact time and stride time) and one measure of the propulsive power (stride propulsion) of a skating stride were calculated and checked for discriminating effects across (i) skill levels and (ii) sprint phases as well as for their (iii) strength of association with the sprint performance (total sprint time). High caliber players showed an increased stride propulsion (+22%, P < 0.05) and shorter contact time (−5%, P < 0.05). All three analysed variables highlighted substantial biomechanical differences between the accelerative and constant velocity phases (P < 0.05). Stride propulsion of acceleration strides primarily correlated to total sprint time (r = −0.57, P < 0.05). The results demonstrate the potential of accelerometers to assess skating technique elements such as contact time or elements characterizing the propulsive power such as center of mass acceleration, to gauge skating performance. Thus, the findings of this study might contribute to establishing wearable sensors for in-field ice hockey skating performance analysis. [ABSTRACT FROM AUTHOR]

Objectives The aim of this study was to investigate whether twice-daily use of a rotating-oscillating power toothbrush (Oral-B Professional Care 1000™) in nursing home ( NH) residents over a 6-week period, compared to usual care (UC), would reduce periodontal inflammation. Methods In this repeated measures single-blinded randomized controlled trial, 59 residents of one NH in Winnipeg, Canada, were randomized to receive either twice-daily tooth brushing with a rotating-oscillating power toothbrush ( PB) or UC by caregivers. Consent was obtained from residents or their proxies. Participants had some natural teeth, periodontal inflammation, non-aggressive behaviour, no communicable diseases, were non-smokers and non-comatose. Outcomes were measured at baseline and 6 weeks, which included: inflammation ( MGI, Lobene), bleeding ( PBI, Loesche) and Plaque (Turesky). Comparisons of group changes in outcomes were analysed using an ANOVA with a repeated measure. Results Of 59 original study participants, one withdrew, one died prior to study commencement and three died before study completion. All oral parameters improved significantly for the remaining 54 residents over time ( P<.0001), with no differences between groups. Conclusions These results demonstrate that it is possible for caregivers to improve periodontal inflammation of residents over a 6-week period. Despite no significant group differences, periodontal inflammation of all study participants improved significantly, particularly in the reduction of bleeding, a direct measure of periodontal inflammation, which is a unique finding. [ABSTRACT FROM AUTHOR]

Background: It has been suggested that public awareness of aphasia is vital for extending services, research support, social inclusion and targeted raising of awareness. Earlier studies show that knowledge of aphasia varies across a range of variables, but is very low compared with other conditions. Aims: To report a series of surveys of public awareness of aphasia from six countries, the largest study conducted this far. Methods & Procedures: Surveys were conducted in Argentina ( N = 800), Canada ( N = 831), Croatia ( N = 400), Greece ( N = 800), Norway ( N = 251) and Slovenia ( N = 400) using the same methodology requesting information on age, sex and occupation, asking whether respondents had heard of aphasia and where they had heard of it. Respondents were tested on their levels of knowledge of aphasia. Outcomes & Results: Results revealed low levels of awareness of aphasia in countries surveyed with marked variability that appeared to interact with occupation, country, age and sex. We surveyed 3483 respondents (mean age = 43.16; SD = 17.68). Between 60% (Croatia) and 16% (Slovenia) said they had heard of aphasia (37.1% overall), but those with actual knowledge ranged from 13.9% (Norway) to 1.0% (Argentina). The combined mean of those with basic knowledge was 9.2%. Those who had heard of aphasia were younger; and females had higher levels of awareness. We also found associations between socio-economic status and awareness. Those working in health, social and educational spheres had the highest levels. Respondents mainly heard about aphasia through the media and work or personal contact with aphasia. Conclusions & Implications: Levels of awareness are low everywhere in absolute terms, and relative to the awareness of other conditions, with significant variability between countries, sex and socio-economic status. We examine how surveys can be utilized to plan ways to increase understanding and discuss the comparison of awareness of aphasia with other conditions. [ABSTRACT FROM AUTHOR]

The degree of return predictability is measured for seven Latin American stock markets and those in Canada and the United States using three finite-sample variance ratio tests. Daily data for the period beginning in February 1994 and ending in December 2011 are used in a fixed-length rolling window to capture short-lived predictability, track changes in predictability through time and rank markets by relative predictability. Overall, the degree of return predictability varies widely. The most predictable are those located in Chile and Peru; the least predictable are in Argentina and Brazil. Predictability has decreased for all of those stock markets examined, except those located in Ecuador and the United States. Predictability largely coincides with times of crisis. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Evidence associates anorexia nervosa (AN) with epigenetic alterations that could contribute to illness risk or entrenchment. We investigated the extent to which AN is associated with a distinct methylation profile compared to that seen in normal-eater women. Method Genome-wide methylation profiles, obtained using DNA from whole blood, were determined in 29 women currently ill with AN (10 with AN-restrictive type, 19 with AN-binge/purge type) and 15 normal-weight, normal-eater control women, using 450 K Illumina bead arrays. Results Regardless of type, AN patients showed higher and less-variable global methylation patterns than controls. False Discovery Rate corrected comparisons identified 14 probes that were hypermethylated in women with AN relative to levels obtained in normal-eater controls, representing genes thought to be associated with histone acetylation, RNA modification, cholesterol storage and lipid transport, and dopamine and glutamate signaling. Age of onset was significantly associated with differential methylation in gene pathways involved in development of the brain and spinal cord, while chronicity of illness was significantly linked to differential methylation in pathways involved with synaptogenesis, neurocognitive deficits, anxiety, altered social functioning, and bowel, kidney, liver and immune function. Discussion Although pre-existing differences cannot be ruled out, our findings are consistent with the idea of secondary alterations in methylation at genomic regions pertaining to social-emotional impairments and physical sequelae that are commonly seen in AN patients. Further investigation is needed to establish the clinical relevance of the affected genes in AN, and, importantly, reversibility of effects observed with nutritional rehabilitation and treatment. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:874-882) [ABSTRACT FROM AUTHOR]

Background The body of literature on narratives of bilingual children with and without specific language impairment (SLI) is growing. However, little is known about the narrative abilities of bilingual preschool children with SLI and their patterns of growth. Aims To determine the similarities and differences in narrative abilities between preschoolers with and without SLI who are either monolingual or bilingual at two time points. Methods & Procedures Forty children completed a narrative retell task in English at two test points. The mean ages were 52 and 58 months at Times 1 and 2, respectively. We examined performance on measures of narrative macrostructure (narrative information) and microstructure (sentence length, number of different words, verb accuracy, first mentions) in monolingual and bilingual children with and without SLI. The bilingual children were from diverse first-language backgrounds and all spoke English most of the time. Outcomes & Results A series of repeated-measures analyses of variance was used with language ability (typical development or SLI) and bilingual status (monolingual versus bilingual) as the between-subjects factors and time (Times 1 or 2) as the within-subjects factor. Results indicated a significant main effect of time for four measures (i.e., Information Score, lexical diversity, sentence length and verb accuracy). The between-subjects analyses indicated a significant difference between the typically developing children and the children with SLI in all measures and a significant difference between monolingual and bilingual children for verb accuracy only. Conclusions & Implications This study showed that all four groups of children showed growth over a 6-month period and that bilingual children exposed predominantly to English in the home performed similarly to their monolingual peers in measures of narrative information, sentence length, number of different words and first mentions. [ABSTRACT FROM AUTHOR]

The own-age bias ( OAB) in face recognition (more accurate recognition of own-age than other-age faces) is robust among young adults but not older adults. We investigated the OAB under two different task conditions. In Experiment 1 young and older adults (who reported more recent experience with own than other-age faces) completed a match-to-sample task with young and older adult faces; only young adults showed an OAB. In Experiment 2 young and older adults completed an identity detection task in which we manipulated the identity strength of target and distracter identities by morphing each face with an average face in 20% steps. Accuracy increased with identity strength and facial age influenced older adults' (but not younger adults') strategy, but there was no evidence of an OAB. Collectively, these results suggest that the OAB depends on task demands and may be absent when searching for one identity. [ABSTRACT FROM AUTHOR]

Objectives The objective was to characterize the variations in practice in the diagnosis and management of children admitted to hospitals from Canadian pediatric emergency departments ( EDs) with suspected appendicitis, specifically the timing of surgical intervention, ED investigations, and management strategies. Methods Twelve sites participated in this retrospective health record review. Children aged 3 to 17 years admitted to the hospital with suspected appendicitis were eligible. Site-specific demographics, investigations, and interventions performed were recorded and compared. Factors associated with after-hours surgery were determined using generalized estimating equations logistic regression. Results Of the 619 children meeting eligibility criteria, surgical intervention was performed in 547 (88%). After-hours surgery occurred in 76 of the 547 children, with significant variation across sites (13.9%, 95% confidence interval = 7.1% to 21.6%, p < 0.001). The overall perforation rate was 17.4% (95 of 547), and the negative appendectomy rate was 6.8% (37 of 547), varying across sites (p = 0.004 and p = 0.036, respectively). Use of inflammatory markers (p < 0.001), blood cultures (p < 0.001), ultrasound (p = 0.001), and computed tomography (p = 0.001) also varied by site. ED administration of narcotic analgesia and antibiotics varied across sites (p < 0.001 and p = 0.001, respectively), as did the type of surgical approach (p < 0.001). After-hours triage had a significant inverse association with after-hours surgery (p = 0.014). Conclusions Across Canadian pediatric EDs, there exists significant variation in the diagnosis and management of children with suspected appendicitis. These results indicate that the best diagnostic and management strategies remain unclear and support the need for future prospective, multicenter studies to identify strategies associated with optimal patient outcomes. [ABSTRACT FROM AUTHOR]

Using intravenous infusion, we separated the physiologic consequences of 3% body mass dehydration from the conscious awareness of fluid replacement on time trial ( TT) performance in the heat. Eleven trained cyclists performed 90 min of steady-state (50% [ABSTRACT FROM AUTHOR]

Context The multiple mini-interview ( MMI), used to facilitate the selection of applicants in health professional programmes, has been shown to be capable of generating reliable data predictive of success. It is a process rather than a single instrument and therefore its psychometric properties can be expected to vary according to the stations generated, the alignment between the stations and the qualities an institution prioritises, and the outcomes used. The purpose of this study was to explore the MMI's test characteristics when station type is manipulated. Methods A 12-station MMI was established in which four stations were presented in three different ways. These included: situational judgement ( SJ) stations, in which applicants were asked to imagine what they would do in specific situations; behavioural interview ( BI) stations, in which applicants were asked to recall what they did in experienced situations, and free form ( FF) stations, which were unstructured in that the examiner was simply given a brief explanation of the intent of the station without further guidance on how to conduct the discussion. Four circuits of the 12 stations were run with one examiner within each station. Candidates and examiners were surveyed regarding their experience. The reliability of the scores derived from the assessment was analysed separately for each station type. Results A total of 41 medical school candidates participated after completing the regular admission process. Although the score assigned did not differ across station type, BI stations more reliably differentiated between candidates ( g = 0.77) than did the other station types ( SJ, g = 0.69; FF, g = 0.66). The correlation between actual MMI scores and BI stations was also greatest ( BI, r = 0.57; SJ, r = 0.45; FF, r = 0.42). Candidates' opinions indicated that FF stations were more anxiety-provoking, less clear, and more difficult than structured stations ( SJ and BI stations). Examiner opinions indicated equivalence on these measures. Conclusions The results suggest that structuring stations has value, although that value was gained only through the use of BI stations, in which candidates were asked to recall and discuss a specific experience of relevance to the purpose of the interview station. [ABSTRACT FROM AUTHOR]

Context Learners can focus on mastery (i.e. task orientation) or on learning relative to others (i.e. ego orientation). Previous research suggests task orientations are optimal for learning, a benefit usually linked to the suggestion that qualitative comments are better for learning than quantitative comparisons (i.e. grades). Yet, it is not clear if the observed effects are attributable to the feedback orientation (i.e. task versus ego), feedback format (i.e. comments versus numerical scores), or an interaction between the two. Here, we aimed to clarify the effects of feedback orientation and feedback format during simulation-based training in endotracheal intubation. Methods Forty-one medical students were randomly assigned to four feedback conditions: Task-oriented Numerical; Ego-oriented Numerical; Task-oriented Comment, and Ego-oriented Comment. Participants performed a total of 20 trials of endotracheal intubation. Pre-test, post-test and retention test assessments included the use of hand motion analysis and a global rating scale ( GRS). Participants rated feedback credibility, self-assessment and self-confidence using Likert-type scales. Analyses of variance were used to examine group differences. Results Participants' performance did not differ significantly on the easiest (p > 0.2) or two complex variations of intubation (p > 0.3). For the moderately difficult variation, analyses of hand motion and GRS data revealed significant group differences at post-test (p < 0.05), but no differences on the retention test. Analysis of participants' perceptions showed significant interactions whereby the Ego-oriented Numerical group rated feedback credibility (p < 0.01) higher than the Task-oriented Numerical group; the two Comment groups did not differ. Some participants recounted negative experiences with the feedback they received. Conclusions Medical students responded to feedback in ways that challenge previous education research. Specifically, students preferred and improved more in the short term (but not at retention) when receiving Ego-oriented feedback in Numerical form. Although learning retention did not differ significantly across feedback conditions, students' perceptions of themselves and of the teacher and training environment did differ and the implications for trainees' future learning must be considered. [ABSTRACT FROM AUTHOR]

Objectives To determine optimal repositioning frequency of nursing home ( NH) residents at risk for pressure ulcers (PrUs) when cared for on high-density foam mattresses. Design Multisite, randomized, clinical trial, known as Turning for Ulcer ReductioN ( TURN Study). Settings NHs in the United States (n = 20) and Canada (n = 7) using high-density foam mattresses. Participants Consenting residents (N = 942) aged 65 and older without PrUs at moderate (scores 13-14) or high (scores 10-12) risk of PrUs according to the Braden Scale. Intervention Participants were randomly allocated using risk stratification (moderate vs high) to a repositioning schedule (2, 3, or 4 hour) for 3 weeks. Blinded assessors assessed skin weekly. Measurements PrU incidence (coccyx or sacrum, trochanter, heels). Results Participants were mostly female (77.6%) and Caucasian (80.5%) and had a mean age of 85.1 ± 7.7. The most common diagnoses were cardiovascular (76.9%) and dementia (72.5%). Nineteen (2.0%) participants developed superficial PrUs. There was no significant difference (Wilcoxon test for ordered categories) in PrU incidence ( P = .68) according to repositioning group (2 hour, 8/321, 2.5%; 3 hour, 2/326, 0.6%; 4 hour, 9/295, 3.1%), nor was there a statistically significant difference in the incidence of PrU between the high and moderate-risk groups ( P = .79). Also, PrU incidence was not statistically significantly different between high-risk participants based on repositioning schedule (6/325, 1.8%, P = .90) or between moderate-risk participants based on repositioning schedule (13/617, 2.1%, P = .68). Conclusion There was no difference in PrU incidence over 3 weeks of observation between those turned at 2-, 3-, or 4-hour intervals in this population of residents using high-density foam mattresses at moderate and high risk of developing PrUs when they were repositioned consistently and skin was monitored. This finding has major implications for use of nursing staff and cost of NH care. [ABSTRACT FROM AUTHOR]

The study investigated adolescents' moral emotion expectancies for actions versus inactions across cultures ( Chinese vs. Canadian) and different moral rule contexts (rules that prohibit antisocial behaviour vs. rules that prescribe prosocial actions) while controlling for judgements of obligatoriness of moral actions. The sample consisted of 372 teenagers from three grade levels (7-8, 10-11, and 1st-2nd year university). Participants were provided with scenarios depicting moral and immoral actions of self or others. Moral emotion expectancies were assessed following each scenario by asking participants to rate the intensity of various emotions they anticipate for themselves in the given situation. Actions were related to stronger self-evaluative and other-evaluative moral emotion expectancies than inactions in both cultures. Whereas perceived obligatoriness of moral actions was associated with moral emotion expectancies, it did not account for the actor effect. Moreover, Chinese adolescents tended to report stronger negatively charged other-evaluative emotions when observing others engaging in antisocial behaviour and less positive emotions for moral actions. Overall, the study indicates that moral emotion expectancies hinge upon universal moral principles (as exemplified by the actor effect) that interact with cultural values and individuals' moral judgement in complex ways. [ABSTRACT FROM AUTHOR]

Modern society is rife with inequality. People's interpretations of these inequalities, however, vary considerably: Different people can interpret, for example, the existing gender gap in wages as being the result of systemic discrimination, or as being the fair and natural result of genuine differences between men and women. Here, we examine one factor that may help explain differing interpretations of existing social inequalities: perceptions of system stability. System justification theory proposes that people are often motivated to rationalize and justify the systems within which they operate, legitimizing whatever social inequalities are present within them. We draw on theories and evidence of rationalization more broadly to predict that people should be most likely to legitimize inequalities in their systems when they perceive those systems as stable and unchanging. In one study, participants who witnessed stability, rather than change, in the domain of gender equality in business subsequently reported less willingness to support programs designed to redress inequalities in completely unrelated domains. In a second study, exposure to the mere concept of stability, via a standard priming procedure, led participants to spontaneously produce legitimizing, rather than blaming, explanations for existing gender inequality in their country. This effect, however, emerged only among politically liberal participants. These findings contribute to an emerging body of research that aims to identify the conditions that promote, and those which prevent, system-justifying tendencies. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The current study examined gender differences in mothers' and fathers' internal state language (ISL), children's use of ISL, and whether ISL was related to parents' ratings of the children's social skills. Fifty-seven (28 boys, 29 girls) toddler/preschool children ( M age = 32.5 months, SD = 5.38 months) were observed separately with their mothers and fathers in their homes while they discussed pictures of children's facial expressions of emotions. Parents completed a questionnaire concerning their child's social-emotional behaviours (i.e. BASC-2). Parents used more ISL with sons compared with daughters, and sons used more ISL with mothers than with fathers. No overall differences were found between mothers' and fathers' ISL. Children's social skills as rated by mothers were predicted by mothers' ISL comments, whereas children's social skills as rated by fathers were predicted by children's age and fathers' ISL clarifications. Implications and limitations of the study are discussed. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

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ABSTRACT Aim To model variables influencing the dissemination of evidence-based practices to addiction service providers and administrators. Design A discrete-choice conjoint experiment. We systematically varied combinations of 16 dissemination variables that might influence the adoption of evidence-based practices. Participants chose between sets of variables. Setting Canadian agencies ( n = 333) providing addiction services to women. Participants Service providers and administrators ( n = 1379). Measurements We estimated the relative importance and optimal level of each dissemination variable. We used latent class analysis to identify subsets of participants with different preferences and simulated the conditions under which participants would use more demanding professional development options. Findings Three subsets of participants were identified: outcome-sensitive (52%), process-sensitive (29.6%) and demand-sensitive (18.2%). Across all participants, the number of clients who were expected to benefit from an evidence-based practice exerted the most influence on dissemination choices. If a practice was seen as feasible, co-worker and administrative support influenced decisions. Client benefits were most important to outcome-sensitive participants; type of dissemination process (e.g. active versus passive learning) was more important to process-sensitive participants. Brief options with little follow-up were preferred by demand-sensitive participants. Simulations predicted that initiatives selected and endorsed by government funders would reduce participation. Conclusions Clinicians and administrators are more likely to adopt evidence-based addiction practices if the practice is seen as helpful to clients, and if it is supported by co-workers and program administration. [ABSTRACT FROM AUTHOR]

Medical Education 2012: 46: 409-416 Context Video-based observational practice can extend simulation-based learning outside the training space. This study explores the value of collaborative feedback provided during observational practice to the acquisition of clinical skills. Methods Nursing students viewed a video demonstrating the proper ventrogluteal injection technique before performing a videotaped pre-test trial on a simulator. They were then assigned randomly to one of three observational practice groups: a group that observed the expert demonstration (EO group); a group that viewed the expert demonstration, self-assessed their individual pre-test and contrasted their self-assessments with expert feedback (ESO group), and a group that observed the expert demonstration, self-assessed and contrasted their assessments with those of an expert, and formed a community that engaged in peer-to-peer feedback (ESPO group). The observation of all videos, the provision of assessments and all networking occurred via an Internet-mediated network. After 2 weeks, participants returned for post-tests and transfer tests. Results The pre-test-post-test analyses revealed significant interactions (global rating scale: F(2,22) = 4.00 [p = 0.033]; checklist: F(2,22) = 4.31 [p = 0.026]), which indicated that post-test performance in the ESPO group was significantly better than pre-test performance. The transfer analyses revealed main effects for both the global rating scale ( F(2,23) = 6.73; p = 0.005) and validated checklist ( F(2,23) = 7.04; p = 0.004) measures. Participants in the ESPO group performed better on the transfer test than those in the EO group. Conclusions The results suggest that video-based observational practice can be effective in extending simulation-based learning, but its effectiveness is mediated by the amount of time the learner spends engaged in the practice and the type of learning activities the learner performs in the observational practice environment. We speculate that increasing collaborative interactivity supports observational learning by increasing the extent to which the educational environment can accommodate learners' specific needs. [ABSTRACT FROM AUTHOR]

In five experiments, we tested segmentation of word forms from natural speech materials by 8-month-old monolingual infants who are acquiring Canadian French or Canadian English. These two languages belong to different rhythm classes; Canadian French is syllable-timed and Canada English is stress-timed. Findings of Experiments 1, 2, and 3 show that 8-month-olds acquiring either Canadian French or Canadian English can segment bi-syllable words in their native language. Thus, word segmentation is not inherently more difficult in a syllable-timed compared to a stress-timed language. Experiment 4 shows that Canadian French-learning infants can segment words in European French. Experiment 5 shows that neither Canadian French- nor Canadian English-learning infants can segment two syllable words in the other language. Thus, segmentation abilities of 8-month-olds acquiring either a stress-timed or syllable-timed language are language specific. [ABSTRACT FROM AUTHOR]

Background: Cesarean delivery on maternal request is a worldwide growing phenomenon. The goal of this study was to describe young nulliparous women's attitudes about cesarean delivery on maternal request. Methods: A total of 140 nulliparous women in Canada aged between 18 and 24 years and attending school from the vocational ( n = 53), college ( n = 61), and university ( n = 18) levels ( n = 8 other) participated in the survey. The self-administered questionnaire consisted of 23 open-ended questions. The outcome measure was the participant's attitude toward cesarean delivery on maternal request. Descriptive, bivariate, and multiple regression analyses were performed. Results: Many of the respondents (63%) had previously heard about cesarean delivery on maternal request, and of these women 28.6 percent had a favorable attitude toward the procedure. Sociodemographic variables were not associated with participants' attitudes toward cesarean delivery on maternal request except for place of residence and type of professional preferred for pregnancy care. Thinking that vaginal birth was more painful than cesarean delivery ( p = 0.012) and had more consequences for the mother ( p < 0.001) were related to a positive attitude toward cesarean delivery on maternal request. A positive attitude by peers was also associated with participants' favorable attitude toward cesarean delivery on maternal request ( p < 0.001). The overall predictive success of the model was 66.5 percent. Conclusions: Young women are spreading the word about cesarean delivery on maternal request and may influence one another about their preferred delivery method. During prenatal visits practitioners need to address women's fear of vaginal birth and its consequences for the mother, counseling, and women's understanding of the consequences of cesarean delivery. This study supports the urgent need to systematically document cesarean delivery on maternal request as a medical procedure and to study its prevalence and related factors. (BIRTH 39:1 March 2012) [ABSTRACT FROM AUTHOR]

The analysis of the impact of climate change (CC) on flood peaks has been the subject of several studies. However, a flood is characterized not only by its peak, but also by other characteristics such as its volume and duration. Little effort has been directed towards the study of the impact of CC on these characteristics. The aim of the present study is to evaluate and compare flood characteristics in a CC context, in the watershed of the Baskatong reservoir (Province of Québec, Canada). Comparisons are based on observed flow data and simulated flow series obtained from hydrological models using meteorological data from a regional climate model for a reference period (1971-2000) and a future period (2041-2070). To this end, two hydrological models HSAMI and HYDROTEL are considered. Correlations, stationarity, change-points, and the multivariate behaviour of flood series were studied. The results show that, at various levels, all flood characteristics could be affected by CC. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Medical Education 2011: 45: 1209-1219 Context Globalisation initiatives in medical education are premised on a universal model of medical education. This study was conducted to challenge this premise by empirically examining the impact of culture on the practice of medical education in anaesthesia residency training programmes in Thailand and Canada. Methods Using a mixed-methods comparative case study research approach, one Thai and one Canadian anaesthesia residency training programme were examined with respect to curriculum, educational practices and teacher beliefs. Data sources included observations of academic and clinical teaching, programme document analysis, surveys and faculty interviews. Recruitment resulted in a 76% survey response rate and 13 interview participants at the Thai site and a 61% survey response rate and 16 interview participants at the Canadian site. Multiple linear regression analysis was used to compare survey responses between the two programmes. The qualitative analysis consisted of primary coding, clustering into pattern codes, and identifying themes and sub-themes. The integration of quantitative and qualitative data for each case was followed by a cross-case analysis. Results The two programmes were similarly organised and had similar curricular content. However, important differences emerged in curricular emphasis, educational practices, and teacher beliefs and values. Thai faculty staff emphasised knowledge and scholarship, described the faculty-resident relationship as 'familial' and focused on 'teaching methods'. Canadian faculty members emphasised clinical abilities, described the faculty-resident relationship as 'collegial' and focused on 'learning environments'. These findings were related to broader cultural differences that influenced how the curriculum was interpreted and enacted at each site. Conclusions This study shows that although the scientific and knowledge base of medical education is universal, its enactment may be influenced by culture and context. Globalisation initiatives in medical education must be tempered by recognition of these considerations. [ABSTRACT FROM AUTHOR]

Responding to calls to contextualize social psychological variables in history, the present research examines the relationship between collective relative deprivation and collective esteem using a historical perspective. We hypothesized that collective relative deprivation perceived to be experienced during an important low-point in a group's history serves to define the group's current collective identity, which is in turn associated with collective esteem. In Study 1, cultural narrative interviews were conducted with Francophone and Anglophone Quebecers in order to identify key historical chapters for these groups and to examine the extent to which historical low-points were identity-defining features of their narratives. In Study 2, using the information obtained from these narratives, collective relative deprivation was explored across group members' perceived histories and related to current in-group entitativity and collective esteem. The relationship between collective relative deprivation thought to be experienced by one's group during a historical low-point and collective esteem was positive for both Anglophone and Francophone Quebecers and was mediated by in-group entitativity. Collective relative deprivation perceived to be experienced during a historical low-point serves to define one's collective identity, which is in turn associated with greater collective esteem. [ABSTRACT FROM AUTHOR]

Common experience of injustice can be a potent motivator of collective action and efforts to achieve social change - and of such efforts becoming more widespread. In this research, we propose that the effects of co-victimization on collective action are a function of inclusive social identity. Experiment 1 ( N= 61) demonstrated that while presence (compared to absence) of co-victimization positively predicted consumer (i.e., participants) willingness to act collectively in solidarity with sweatshop workers, this effect was mediated by inclusive social identity. In Experiment 2 ( N= 120), the salience of inclusive social identity was experimentally manipulated and interacted with co-victimization to predict collective action. When inclusive social identity was salient, co-victimization enhanced collective action, including willingness to pay extra for products made ethically and in support of fair wages for workers. In contrast, collective action was attenuated when co-victimization took place in the absence of inclusive social identity. Implications for understanding when co-victimization is transformed into common fate and political solidarity with the disadvantaged are discussed. [ABSTRACT FROM AUTHOR]

Background: Women need access to evidence-based information to make informed choices in pregnancy. A search for health information is one of the major reasons that people worldwide access the Internet. Recent years have witnessed an increase in Internet usage by women seeking pregnancy-related information. The aim of this study was to build on previous quantitative studies to explore women's experiences and perceptions of using the Internet for retrieving pregnancy-related information, and its influence on their decision-making processes. Methods: This global study drew on the interpretive qualitative traditions together with a theoretical model on information seeking, adapted to understand Internet use in pregnancy and its role in relation to decision-making. Thirteen asynchronous online focus groups across five countries were conducted with 92 women who had accessed the Internet for pregnancy-related information over a 3-month period. Data were readily transferred and analyzed deductively. Results: The overall analysis indicates that the Internet is having a visible impact on women's decision making in regards to all aspects of their pregnancy. The key emergent theme was the great need for information. Four broad themes also emerged: 'validate information,''empowerment,''share experiences,' and 'assisted decision-making.' Women also reported how the Internet provided support, its negative and positive aspects, and as a source of accurate, timely information. Conclusion: Health professionals have a responsibility to acknowledge that women access the Internet for support and pregnancy-related information to assist in their decision-making. Health professionals must learn to work in partnership with women to guide them toward evidence-based websites and be prepared to discuss the ensuing information. (BIRTH 38:4 December 2011) [ABSTRACT FROM AUTHOR]

ABSTRACT Aims To investigate whether differences in gender-income equity at country level explain national differences in the links between alcohol use, and the combination of motherhood and paid labour. Design Cross-sectional data in 16 established market economies participating in the Gender, Alcohol and Culture: An International Study (GenACIS) study. Setting Population surveys. Participants A total of 12 454 mothers (aged 25-49 years). Measurements Alcohol use was assessed as the quantity per drinking day. Paid labour, having a partner, gender-income ratio at country level and the interaction between individual and country characteristics were regressed on alcohol consumed per drinking day using multi-level modelling. Findings Mothers with a partner who were in paid labour reported consuming more alcohol on drinking days than partnered housewives. In countries with high gender-income equity, mothers with a partner who were in paid labour drank less alcohol per occasion, while alcohol use was higher among working partnered mothers living in countries with lower income equity. Conclusion In countries which facilitate working mothers, daily alcohol use decreases as female social roles increase; in contrast, in countries where there are fewer incentives for mothers to remain in work, the protective effect of being a working mother (with partner) on alcohol use is weaker. These data suggest that a country's investment in measures to improve the compatibility of motherhood and paid labour may reduce women's alcohol use. [ABSTRACT FROM AUTHOR]

Predicting Arrhythmia Recurrence Post-PVAI. Introduction: Pulmonary vein antrum isolation (PVAI) is an accepted treatment for atrial fibrillation (AF) refractory to medical therapy. The purpose of this study was to identify the patient, procedural, and follow-up factors associated with arrhythmia recurrences following PVAI. Methods and Results: Clinical data were prospectively collected on all 385 consecutive patients who had 530 PVAI (age 58 ± 11 years, 63% paroxysmal AF-PAF, follow-up 2.8 ± 1.2 years) between February 2004 and March 2009. ECGs were recorded at each follow-up visit with Holter monitoring 1, 3, 6, and 12 months following PVAI and every 6 months thereafter. Recurrences < 3 months post-PVAI were defined as early, 3 months-1 year post-PVAI as late, and > 1 year post-PVAI as very late. Relationship between predictor variables and outcomes was modeled using Cox proportional hazards analysis. Late recurrences occurred in 42% with a lower rate among PAF versus non-PAF patients (39% vs 56%, P = 0.001). Of the 256 patients with ≥ 1-year follow-up, 121 (47%) had no arrhythmia off antiarrhythmic drugs (AADs) 1 year post-PVAI; 36 (30%) of these had a very late recurrence. In multivariate analysis, non-PAF, hypertension, and prior AAD failure predicted recurrence. When entered into the model, early recurrences remained the only predictor of late recurrences. Conclusion: Patients with non-PAF, hypertension, and prior failure of multiple AAD were more likely to experience arrhythmia recurrence post-PVAI. Early recurrences were the strongest predictor of late recurrences. Late and very late recurrences following PVAI were common and should be considered when planning long-term AF patient management. (J Cardiovasc Electrophysiol, Vol. pp. 1-9) [ABSTRACT FROM AUTHOR]

Objectives To determine the incidence of, risk factors for, and outcomes of subsyndromal delirium ( SSD) in older long-term care ( LTC) residents and, secondarily, to explore the use of a more-restrictive definition of SSD. Design Cohort study with repeated weekly assessments for up to 6 months. Setting Seven LTC facilities in Montreal and Quebec City, Canada. Participants One hundred four LTC residents aged 65 and older and free of delirium core symptoms at baseline. Measurements The Mini-Mental State Examination ( MMSE), Confusion Assessment Method ( CAM), Delirium Index ( DI), Hierarchic Dementia Scale ( HDS), and Barthel Index ( BI) were completed at baseline. The MMSE, CAM, and DI were repeated weekly for 6 months. SSD1 required one or more CAM core symptoms; SSD2, a more-restrictive definition, required two or more CAM core symptoms. Outcomes at 6 months were decline on the MMSE, HDS, and BI; mortality; and a composite outcome. Results Sixty-eight of 104 residents had SSD1. In survival analysis, the incidence was 5.2 (95% confidence interval ( CI) = 4.1-6.7) per 100 person-weeks of follow-up. In multivariate analysis, risk factors were male sex and more-severe cognitive impairment at baseline. The differences in outcomes between residents with and without SSD1 were small and not statistically significant. SSD2 had a lower incidence (1.3, 95% CI = 0.9-1.9), similar risk factors, and statistically significantly worse cognitive outcomes. Conclusion SSD2 appears to be a clinically important disorder in older LTC residents. Despite limited statistical power, these findings have potentially important implications for clinical practice and research in LTC settings. [ABSTRACT FROM AUTHOR]

This study was designed to examine whether infants acquiring languages that place a differential emphasis on nouns and verbs, focus their attention on motions or objects in the presence of a novel word. An infant-controlled habituation paradigm was used to teach 18- to 20-month-old English-, French-, and Japanese-speaking infants' novel words for events. Infants were habituated to two word-event pairings and then presented with new combinations that involved a familiar word with a new object or motion, or both. Children could map the novel word to both the object and the motion, despite the differential salience of object and motion words in their native language. A control experiment with no label confirmed that both object and motion changes were detectable. [ABSTRACT FROM AUTHOR]

Background: In Canada maternity care is publicly funded, and although women may choose their care providers, choices may be limited. The purpose of this study was to compare perceptions of maternity outcomes and experiences of those who received care from midwives with those who received care from other providers. Methods: Based on the 2006 Canadian census, a random sample of women ( n = 6,421) who had recently given birth in Canada completed a computer-assisted telephone interview for the Maternity Experiences Survey. The sample was stratified according to province or territory where birth occurred, age, rural or urban residence, and presence of other children in the home. Those who were 15 years of age and older, gave birth to a singleton baby, and were living with their infant were eligible for inclusion. Results: Women whose primary prenatal providers were midwives had fewer ultrasounds and were more likely to attend prenatal classes and have at least five or more prenatal visits. They were also more likely to rate satisfaction with their maternity experience as 'very positive' and be satisfied with information provided on a variety of pregnancy and birth topics if their primary prenatal provider was a midwife. They were almost half as likely to experience induction and 7.33 times more likely to experience a medication-free delivery. They were more likely to initiate and maintain breastfeeding at 3 and 6 months. Conclusions: Evidence shows that midwifery outcomes and levels of satisfaction meet or exceed Canadian maternity care standards. Facilitation of the continuing integration of midwives as autonomous practitioners throughout Canada is recommended. (BIRTH 38:3 September 2011) [ABSTRACT FROM AUTHOR]

Background: The Baby-Friendly Hospital Initiative (BFHI) promotes the World Health Organization International Code of Marketing of Breast-milk Substitutes (WHO Code) and the WHO/UNICEF's Ten Steps to Successful Breastfeeding (Ten Steps). The purpose of this study is to describe and compare maternity hospitals' adherence to the BFHI in 1993 and 2007 for Canada and for each province and territory. Methods: A survey of all Canadian maternity hospitals was conducted in 1993 and 2007 on routine maternity care practices and policies including infant feeding. Results: The overall response rate was 91 percent ( n = 523/572 hospitals) in 1993 and 92 percent ( n = 323/353 hospitals) in 2007. Eighty-two percent (415/507) of hospitals in 1993 and 68 percent (198/292) in 2007 had exclusive contracts with formula companies. Fifty-eight percent (302/517) of hospitals in 1993 and 90 percent (289/322) in 2007 never gave breastfeeding mothers sample packs containing formula. Fifty-eight percent (296/507) in 1993 and 85 percent (273/321) in 2007 had written breastfeeding policies (Step 1); 97 percent (503/518) in 1993 and 99 percent (320/322) in 2007 allowed mothers to breastfeed, on cue, whenever the babies indicated an interest 24 hours a day (Step 8); 24 percent (126/519) in 1993 and 64 percent (206/321) in 2007 reported that they did not provide soothers (Step 9); 58 percent (297/513) in 1993 and 68 percent (215/316) in 2007 always offered information on breastfeeding support groups and/or advice at time of discharge (Step 10). Conclusions: In the 14 years separating the two surveys, Canadian maternity hospitals substantially improved their implementation of the WHO Code and their adherence to the WHO/UNICEF Ten Steps. (BIRTH 38:3 September 2011) [ABSTRACT FROM AUTHOR]