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Canadian Association of Chiefs of Police (CACP) Executive Global Studies 2020–2022 cohort members share the challenges, fears, and pride experienced while exploring the future of policing…for police.

The article focuses on the benefits of involving both experienced GPs and GP registrars in the teaching of medical students. Topics include the advantages of near-peer teaching in general practice, the potential for improving recruitment and retention in the field, and the results of a 2023 pilot program that assessed GP registrar involvement in medical student placements.

Neutropenic enterocolitis is a clinical condition characterized by inflammation of the colic mucosa, usually the caecum, associated with bowel wall thickening in patients with compromised immune system due to chemotherapy treatments. It can occur as well in other clinical conditions that lead to immunosuppression. Clinically, patients present with abdominal pain, fever, and neutropenia on blood tests. A number of major and minor criteria have been suggested for the clinical diagnosis of typhlitis. The most sensitive radiological investigation is represented by a computed tomography scan. There are no guidelines for treatment, but some factors may lead the clinician to medical treatments or prompt surgery as the best choice in that particular patient. The most implicated chemotherapeutic regimens are those based on taxanes. Here, we present a clinical case of a young patient with breast cancer and a review of the state of the art of knowledge regarding neutropenic enterocolitis in adult patients undergoing chemotherapy for the treatment of solid tumors.

The use of biomarkers that influence a targeted choice in cancer treatments is the future of medical oncology. Within this scenario, in recent years, an important role has been played by knowledge of microsatellite instability (MSI), a molecular fingerprint that identifies defects in the mismatch repair system. This knowledge has changed clinical practice in the adjuvant setting of colon cancer, and its role in the neoadjuvant setting in gastric tumours is becoming increasingly interesting, as well as in endometrial cancers in both early and advanced diseases. Furthermore, it has undoubtedly conditioned the first lines of treatment in the metastatic setting in different types of cancers. The incidence of MSI is different in different cancer types, as well as in early cancers versus metastatic disease. Knowing the incidence of MSI in the various histologies can provide insight into the potential use of this biomarker considering its prognostic value, especially in the early stages, and its predictive role with respect to treatment response. In particular, MSI can guide the choice of chemotherapy treatments in the adjuvant setting of colon and perioperative setting in gastric tumours, which could lead to immunotherapy treatments in these patients in both the early stages of the disease and the metastatic setting where the response to immunotherapy drugs in diseases with MSI is now well established. In this review, we focus on colon, gastric and endometrial cancers, and we briefly discuss other cancer types where MSI could have a potential role in oncological treatment decisions.

The purpose of this study is to examine intergenerational learning behaviour within ten Hong Kong families between Generation X parents and their Generation Y children. It tries to investigate intergenerational knowledge exchange, identify the characteristics of learning behaviour and culture in their "learning families". A narrative inquiry approach is adopted asking participants to recall and tell stories describing their personal intergenerational learning experiences. Results indicate that 80% of the participants thought their family is a 'learning family', and intergenerational family learning is happy experience and can be bi-directional. A positive family learning culture facilitates intergenerational learning especially in the Generation Y ? X direction. Learning methodology differs between the two generations due to societal changes and differences in their upbringing. A conceptual framework of intergenerational family learning in relation to lifelong learning is developed. The government and public should re-define teaching and learning practise and promote intergenerational learning even in schools.

Background: Non-communicable diseases, the major cause of death and disability, are susceptible to modifiable and non-modifiable risk factors. Atrial fibrillation (AF) increases the risk of stroke by 4 to 5 times and can lead to cardiovascular mortality. This study was conducted to assess the effects of different sociodemographic and socioeconomic factors on stroke development in patients with AF. Methods: A cross-sectional study was conducted between January and June 2018 on patients recruited from Lebanese community pharmacies. The CHA 2DS 2-VASc scoring system is utilized as a stroke risk stratification tool in AF patients. Participants with a previous physician diagnosis of AF, documented on medical records, were included in this study. Data was collected through a survey that was distributed to all eligible patients. Results: A total of 524 patients were enrolled in the study with a mean age (± SD) of 58.75 ± 13.59 years with hypertension (78.4%) being the most predominant disease. The results showed that obesity (Beta=0.61, p-value =0.011), retirement and unemployment compared to employment (Beta=1.44 and 1.44, p-value=0.001 respectively), divorced/widow compared to married (Beta=1.38, p-value =0.001) were significantly associated with higher CHA 2DS 2-VASc scores whereas high versus low socio-economic status (Beta=-1.03, p=0.009) and high school education versus primary education level (Beta=-0.49, p-value=0.025) were significantly associated with lower CHA 2DS 2-VASc scores. Conclusions: The study highlights that the CHA 2DS 2-VASc score is affected by the presence of various sociodemographic and socioeconomic characteristics in patients with AF. Thus, screening for those factors may predict the progression of cardiovascular disease and may provide an optimal intervention.

In recent years, precision medicine has taken an increasing place in various branches of medical oncology, including colorectal cancer. Among the potentially relevant mutations for this cancer is the KRAS mutation, initially defined as “untargetable”; today, we see the birth of new molecules that target one of the variants of the KRAS mutation, KRAS G12C, having a significant impact on the therapeutic options for other malignancies, such as metastatic lung cancer. This fundamental step forward has stimulated scientific research on other potential targets of KRAS, both indirect and direct, and combination treatments aiming to overcome the mechanisms of resistance to these drugs that decrease in efficacy in colorectal cancer. What was once a negative predictive marker of response to anti-EGFR drugs today has become a potential target for targeted treatments. In turn, the prognostic role of the mutation has become extremely interesting, making it a potentially useful element in therapeutic decision-making, not only regarding oncological treatments but also in a more complex and complete manner within a global vision of the patient, involving other figures on the multidisciplinary team, such as surgeons, radiotherapists, and interventional radiologists.

Background: Non-communicable diseases, the major cause of death and disability, are susceptible to modifiable and non-modifiable risk factors. Atrial fibrillation (AF) increases the risk of stroke by 4-5 times and can lead to cardiovascular mortality. This study was conducted to assess the effects of different sociodemographic factors on stroke development in patients with AF. Methods: A cross-sectional study was conducted between January and June 2018 on patients recruited from Lebanese community pharmacies. The CHA 2DS 2-VASc scoring system is utilized as a stroke risk stratification tool in AF patients. Participants with a previous physician diagnosis of AF, documented on medical records, were included in this study. Results: A total of 524 patients were enrolled in the study with a mean age of 58.75 (± SD) ± 13.59 years with hypertension (78.38%) being the most predominant disease. The results showed that obesity (Beta=0.610, p-value =0.011), retirement and unemployment compared to employment (Beta=1.440 and 1.440, p-value=0.001 respectively), divorced/widow compared to married (Beta=1.380, p-value =0.001) were significantly associated with higher CHA 2DS 2-VASc scores whereas high versus low socio-economic status (Beta=-1.030, p=0.009) and high school education versus primary education level (Beta=-0.490, p-value=0.025) were significantly associated with lower CHA 2DS 2-VASc scores. Conclusions: The study highlights that the CHA 2DS 2-VASc score is affected by the presence of various sociodemographic and socioeconomic characteristics in patients with AF. Thus, screening for those factors may predict the progression of cardiovascular disease and may provide an optimal intervention.

Abstract Background Early seizures have been recognized as serious complications of ischemic strokes where the data are limited among Lebanese patients. This study aimed to assess the incidence and risk factors of early seizures postischemic stroke and to determine the effect of early seizures on functional outcome among Lebanese stroke patients. Methods This was a retrospective observational study conducted between January 2017 and March 2020 on patients with acute ischemic strokes at two tertiary hospitals in Lebanon. Data were collected from patients’ medical records at each site through a well‐designed data collection sheet. Early seizures were defined as seizures occurring within 7 days after acute stroke. Functional outcome was assessed at discharge, according to modified Rankin scale (mRS). Results Of 140 enrolled patients, early seizure developed in 12 patients (8.6%) with mean age of 68.42 ± 9.89 years and 8 (67%) were females. Independent risk factors for early seizure development were female gender and cortical involvement. Moreover, early seizure development was not associated with higher disability and mortality at hospital discharge. Conclusion The findings of the study highlight that early seizures occurred more commonly in patients with cortical involvement and female gender. In addition, early seizures did not impair functional outcome in our study, however; further studies are needed to predict patients at risk of early seizure so that appropriate prevention and treatment strategies can be implemented promptly.

Older adults with normal hearing or with age-related hearing loss face challenges when listening to speech in noisy environments. To better serve individuals with communication difficulties, precision diagnostics are needed to characterize individuals' auditory perceptual and cognitive abilities beyond pure tone thresholds. These abilities can be heterogenous across individuals within the same population. The goal of the present study is to consider the suprathreshold variability and develop characteristic profiles for older adults with normal hearing (ONH) and with hearing loss (OHL). Auditory perceptual and cognitive abilities were tested on ONH (n = 20) and OHL (n = 20) on an abbreviated test battery using portable automated rapid testing. Using cluster analyses, three main profiles were revealed for each group, showing differences in auditory perceptual and cognitive abilities despite similar audiometric thresholds. Analysis of variance showed that ONH profiles differed in spatial release from masking, speech-in-babble testing, cognition, tone-in-noise, and binaural temporal processing abilities. The OHL profiles differed in spatial release from masking, speech-in-babble testing, cognition, and tolerance to background noise performance. Correlation analyses showed significant relationships between auditory and cognitive abilities in both groups. This study showed that auditory perceptual and cognitive deficits can be present to varying degrees in the presence of audiometrically normal hearing and among listeners with similar degrees of hearing loss. The results of this study inform the need for taking individual differences into consideration and developing targeted intervention options beyond pure tone thresholds and speech testing. [ABSTRACT FROM AUTHOR]

Women migrant domestic workers (WMDWs) constitute 7.7 per cent of migrant workers worldwide, of whom more than a quarter work in the Arab region under the exploitative Kafala , system. In this article, we center employers as key actors in the making of the discursive meaning of Kafala. Utilizing data from a mixed-methods study on Lebanese employers of live-in WMDWs, we investigate whether practices that violate the rights and freedoms of workers are determined by the employers' knowledge of what Kafala and local legal obligations entail versus other factors. The findings reveal that, although knowledge of legal obligations increases compliance with basic worker rights, employers shape the meaning of Kafala through practices that resonate with their discriminatory attitudes and financial interests. Thus, whilst benefit may accrue from enhancing employers' knowledge of local legal obligations, only anti-racism advocacy that addresses deep-seated discriminatory attitudes and mobilizes employer morality would improve the rights and freedoms of WMDWs. The article does not abrogate Kafala as an exploitative system but calls for centering employers who, through their daily practices, contribute to shaping its meaning and reinforcing its power. [ABSTRACT FROM AUTHOR]

Purpose: This report provides the experimental, clinical, theoretical, and historical background that motivated a patented transitional intervention and its implementation and evaluation in a field trial for mitigation of debilitating loudness based hyperacusis (LH). Background and Rationale: Barriers for ameliorating LH, which is differentiated here from other forms of hyperacusis, are delineated, including counterproductive management and treatment strategies that may exacerbate the condition. Evidence for hyper-gain central auditory processes as the bases for LH and the associated LH-induced distress and stress responses are presented. This presentation is followed by an overview of prior efforts to use counseling and therapeutic sound as interventional tools for recalibrating the hyper-gain LH response. We also consider previous efforts to use output-limiting sound protection devices in the management of LH. This historical background lays the foundation for our transitional intervention protocol and its implementation and evaluation in a field trial. Conclusions: The successful implementation and evaluation of a transitional intervention, which we document in the outcomes of a companion proof-of concept field trial in this issue, build on our prior efforts and those of others to understand, manage, and treat hyperacusis. These efforts to overcome significant barriers and vexing long-standing challenges in the management and treatment of LH, as reviewed here, are the pillars of the transitional intervention and its primary components, namely, counseling combined with protective sound management and therapeutic sound, which we detail in separate reports in this issue. [ABSTRACT FROM AUTHOR]

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Depopulation is one of the important interventions for the outbreak of animal diseases. Simulation models using actual case scenarios conclude that early depopulation is the most efficient in preventing the spread of foot-and-mouth disease (FMD). However, the long delay in its initiation was often seen in the actual cases and the theoretical analyses of FMD epidemiology with depopulation needs further elaboration. Here, we investigated the qualitative features of epidemic models when depopulation at a fixed capacity was delayed. We built a simple deterministic model for FMD based on state-transition, the SEIIR model whose unit is a single farm. The model settings and parameters were determined using the data from the 2010 epidemic in Miyazaki, Japan. By numerical calculation, we showed the existence of the threshold phenomenon with respect to delays in the initiation of depopulation and if the initiation of full-fledged depopulation surpasses the certain critical timing, the final size of the epidemic rapidly increases leading to a "catastrophic situation". We also revealed the mechanism of the threshold phenomenon from the relationship between the depopulation capacity and the increasing rate of infection. Although it can be delayed with lower transmission coefficients, the threshold phenomenon still exists. Thus, the existence of the critical timing for depopulation appears to be a universal feature of FMD epidemiology when depopulation is used as the main treatment for disease control.