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OBJECTIVE: To describe primary health care professionals' views on barriers and facilitators for implementing the Ottawa Decision Support Framework (ODSF) in their practice. METHODS: Thirteen focus groups with 118 primary health care professionals were performed. A taxonomy of barriers and facilitators to implementing clinical practice guidelines was used to content-analyse the following sources: reports from each workshop, field notes from the principal investigator and written materials collected from the participants. RESULTS: Applicability of the ODSF to the practice population, process outcome expectation, asking patients about their preferred role in decision making, perception that the ODSF was modifiable, time issues, familiarity with the ODSF and its practicability were the most frequently identified both as barriers as well as facilitators. Forgetting about the ODSF, interpretation of evidence, challenge to autonomy and total lack of agreement with using the ODSF in general were identified only as barriers. Asking about values, health professional's outcome expectation, compatibility with the patient-centered approach or the evidence-based approach, ease of understanding and implementation, and ease of communicating the ODSF were identified only as facilitators. CONCLUSION: These results provide insight on the type of interventions that could be developed in order to implement the ODSF in academic primary care practice. PRACTICE IMPLICATIONS: Interventions to implement the ODSF in primary care practice will need to address a broad range of factors at the levels of the health professionals, the patients and the health care system. [ABSTRACT FROM AUTHOR]

The anatomy of the claustrum (CLA) has been well characterized, but its functional role remains uncertain. The results of recent research suggest that the CLA may be part of a network of structures involved in seizure generalization, and we set out to test this idea. To test persistence, seizures were kindled in the anterior CLA. Following a 14-day suspension of kindling, all rats required only one stimulation to evoke a stage 5 seizure. In another experiment, groups of rats received bilateral lesions of the anterior CLA before and after amygdaloid kindling. We found that small lesions of the anterior CLA retard amygdaloid kindling, but do not block the expression of generalized seizures. Lesions produced after amygdaloid kindling resulted in a shorter seizure duration, but had no marked effect on seizure expression. Another group of rats was tested for transfer of kindling between the anterior CLA and contralateral amygdala. We found an asymmetrical transfer of kindling to the CLA from the amygdala wherein amygdaloid kindling facilitated subsequent kindling of the CLA but kindling of the anterior CLA failed to facilitate kindling of the amygdala. The results add support to the notion that the CLA contributes to the development of generalized limbic seizures. [Copyright &y& Elsevier]

Reacting and responding to an external stimulus is an important component of human performance, and they inform us about a participant's neurophysiological capabilities. Our purpose in this study was to determine whether reaction times (REACT), response times (RT), and countermovement jump (CMJ) performance differ when responding to an auditory (AUD) versus visual (VIS) stimulus. Participants were 17 college-aged volunteers (6 females and 11 males; M age = 23.0, SD = 3.4 years; M height = 174.57, SD = 10.37 cm; M body mass = 73.37, SD = 13.48 kg). Participants performed CMJs on force plates immediately upon receiving an AUD or a VIS stimulus. The AUD stimulus was a beep noise, while the VIS stimulus was a light on a screen in front of the participants. We determined REACT for the tibialis anterior (TA), medial gastrocnemius (GM), vastus lateralis (VL), and biceps femoris (BF) muscles to be the amount of time between stimulus onset and the initiation of the muscle's electromyographic (EMG) signal. We determined RT to be the amount of time between stimulus onset and the beginning of the participant's force production. We assessed CMJ performance via ground reaction forces during the unweighting, braking, and propulsive phases of the jump. We quantified EMG amplitude and frequency during each CMJ phase. We found RT to be faster to the AUD versus the VIS stimulus ( p = .007). VL and BF muscles had faster REACT than TA and GM muscles ( p ≤ .007). The AUD stimulus was associated with faster CMJ unweighting phase metrics ( p ≤ .005). Thus, individuals may react and respond faster to an AUD versus VIS stimulus, with limited improvements in their subsequent physical performance., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

RNA sequencing analysis is an important field in the study of extracellular vesicles (EVs), as these particles contain a variety of RNA species that may have diagnostic, prognostic and predictive value. Many of the bioinformatics tools currently used to analyze EV cargo rely on third-party annotations. Recently, analysis of unannotated expressed RNAs has become of interest, since these may provide complementary information to traditional annotated biomarkers or may help refine biological signatures used in machine learning by including unknown regions. Here we perform a comparative analysis of annotation-free and classical read-summarization tools for the analysis of RNA sequencing data generated for EVs isolated from persons with amyotrophic lateral sclerosis (ALS) and healthy donors. Differential expression analysis and digital-droplet PCR validation of unannotated RNAs also confirmed their existence and demonstrates the usefulness of including such potential biomarkers in transcriptome analysis. We show that find-then-annotate methods perform similarly to standard tools for the analysis of known features, and can also identify unannotated expressed RNAs, two of which were validated as overexpressed in ALS samples. We demonstrate that these tools can therefore be used for a stand-alone analysis or easily integrated into current workflows and may be useful for re-analysis as annotations can be integrated post hoc ., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Wajnberg, Allain, Roy, Srivastava, Saucier, Morin, Marrero, O’Connell, Ghosh, Lewis, Ouellette and Crapoulet.)

The development of wearable technology, which enables motion tracking analysis for human movement outside the laboratory, can improve awareness of personal health and performance. This study used a wearable smart sock prototype to track foot-ankle kinematics during gait movement. Multivariable linear regression and two deep learning models, including long short-term memory (LSTM) and convolutional neural networks, were trained to estimate the joint angles in sagittal and frontal planes measured by an optical motion capture system. Participant-specific models were established for ten healthy subjects walking on a treadmill. The prototype was tested at various walking speeds to assess its ability to track movements for multiple speeds and generalize models for estimating joint angles in sagittal and frontal planes. LSTM outperformed other models with lower mean absolute error (MAE), lower root mean squared error, and higher R -squared values. The average MAE score was less than 1.138° and 0.939° in sagittal and frontal planes, respectively, when training models for each speed and 2.15° and 1.14° when trained and evaluated for all speeds. These results indicate wearable smart socks to generalize foot-ankle kinematics over various walking speeds with relatively low error and could consequently be used to measure gait parameters without the need for a lab-constricted motion capture system., Competing Interests: The authors declare no competing interests exist., (© The Author(s) 2023.)

Motion capture is the current gold standard for assessing movement of the human body, but laboratory settings do not always mimic the natural terrains and movements encountered by humans. To overcome such limitations, a smart sock that is equipped with stretch sensors is being developed to record movement data outside of the laboratory. For the smart sock stretch sensors to provide valuable feedback, the sensors should have durability of both materials and signal. To test the durability of the stretch sensors, the sensors were exposed to high-cycle fatigue testing with simultaneous capture of the capacitance. Following randomization, either the fatigued sensor or an unfatigued sensor was placed in the plantarflexion position on the smart sock, and participants were asked to complete the following static movements: dorsiflexion, inversion, eversion, and plantarflexion. Participants were then asked to complete gait trials. The sensor was then exchanged for either an unfatigued or fatigued plantarflexion sensor, depending upon which sensor the trials began with, and each trial was repeated by the participant using the opposite sensor. Results of the tests show that for both the static and dynamic movements, the capacitive output of the fatigued sensor was consistently higher than that of the unfatigued sensor suggesting that an upwards drift of the capacitance was occurring in the fatigued sensors. More research is needed to determine whether stretch sensors should be pre-stretched prior to data collection, and to also determine whether the drift stabilizes once the cyclic softening of the materials comprising the sensor has stabilized.

The purpose of this study is to compare masks (non-medical/fabric, surgical, and N95 respirators) on filtration efficiency, differential pressure, and leakage with the goal of providing evidence to improve public health messaging. Masks were tested on an anthropometric face filtration mount, comparing both sealed and unsealed. Overall, surgical and N95 respirators provided significantly higher filtration efficiency (FE) and differential pressure (dP). Leakage comparisons are one of the most significant factors in mask efficiency. Higher weight and thicker fabric masks had significantly higher filtration efficiency. The findings of this study have important implications for communication and education regarding the use of masks to prevent the spread of COVID-19 and other respiratory illnesses, specifically the differences between sealed and unsealed masks. The type and fabric of facial masks and whether a mask is sealed or unsealed has a significant impact on the effectiveness of a mask. Findings related to differences between sealed and unsealed masks are of critical importance for health care workers. If a mask is not completely sealed around the edges of the wearer, FE for this personal protective equipment is misrepresented and may create a false sense of security. These results can inform efforts to educate health care workers and the public on the importance of proper mask fit.

Background: Although participation of patients is essential for completing the training of medical residents, little is known about the relationships among patients' level of knowledge about the role and responsibilities of medical residents, their confidence in residents' abilities, and their acceptance toward receiving care from residents. The study sought to clarify if and how these three patient-resident relationship components are interrelated., Methods: This is a cross-sectional study using a self-administered questionnaire distributed in 2016 to a convenience sample of adult patients (≥ 18 years old) visiting a family medicine teaching clinic. Proportions and chi-square statistics were used to describe and compare groups, respectively., Results: Of the 471 patients who answered the questionnaire, only 28% were found to be knowledgeable about the role of family medicine residents. Between 54% and 83% of patients reported being highly confident in the ability of residents to perform five routine tasks. Of the patients surveyed, 69% agreed to see a resident during their next appointments. Patients with a high level of confidence in residents' abilities were more likely to agree to see a resident during future appointments (p <0.0001). There was no significant association between level of knowledge and either confidence or acceptance., Conclusions: Although the majority of patients had poor knowledge about the role of residents, this was not related to their acceptance of being cared for by residents. A higher level of confidence in residents' ability to perform certain tasks was associated with greater acceptance toward seeing a resident during future appointments., Competing Interests: The authors declare that they do not have conflicts of interest, (© 2021 Babin, Cormier, Champagne, MacIntosh, Saucier, Thibault, Barrieau, Bélanger; licensee Synergies Partners.)

Research surrounding the mandated use of non-medical fabric masks is inconsistent and often confusing when compared to the standard N95. A recently published standard from ASTM International and the Centers for Disease Control and Prevention attempts to normalize evaluation procedures. The purpose of this study is to conduct a preliminary evaluation of the new methods for testing filtration efficiency of masks outlined by ASTM International F3502, where results can be directly compared to standards outlined for non-medical fabric masks. Eleven consumer non-medical fabric masks were tested for filtration efficiency and airflow resistance using a face filtration mount in accordance with the newly released ASTM International standard for facial barriers. The mean FE% (SD) ranged from 0.46% (0.44) to 11.80% (2.76) with the 3-layer athletic mesh having the highest performance and the highest deviations. All the masks tested following the procedure failed to meet to minimum FE of 20%; however all masks performed below the minimum upper limits for airflow resistance. Using a non-medical fabric masks as the sole mitigation strategy may not be as effective, as previously reported. With efforts to standardize and regulate the non-medical fabric mask market, this study demonstrates a variety of currently available consumer mask products do not meet the minimum standards nor are these remotely close to the standards of surgical or N95 masks.

Wearable sensors are beneficial for continuous health monitoring, movement analysis, rehabilitation, evaluation of human performance, and for fall detection. Wearable stretch sensors are increasingly being used for human movement monitoring. Additionally, falls are one of the leading causes of both fatal and nonfatal injuries in the workplace. The use of wearable technology in the workplace could be a successful solution for human movement monitoring and fall detection, especially for high fall-risk occupations. This paper provides an in-depth review of different wearable stretch sensors and summarizes the need for wearable technology in the field of ergonomics and the current wearable devices used for fall detection. Additionally, the paper proposes the use of soft-robotic-stretch (SRS) sensors for human movement monitoring and fall detection. This paper also recapitulates the findings of a series of five published manuscripts from ongoing research that are published as Parts I to V of "Closing the Wearable Gap" journal articles that discuss the design and development of a foot and ankle wearable device using SRS sensors that can be used for fall detection. The use of SRS sensors in fall detection, its current limitations, and challenges for adoption in human factors and ergonomics are also discussed., Competing Interests: The authors declare no conflicts of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Ewing sarcoma (EwS) is an aggressive childhood cancer likely originating from mesenchymal stem cells or osteo-chondrogenic progenitors. It is characterized by fusion oncoproteins involving EWSR1 and variable members of the ETS-family of transcription factors (in 85% FLI1). EWSR1-FLI1 can induce target genes by using GGAA-microsatellites as enhancers.Here, we show that EWSR1-FLI1 hijacks the developmental transcription factor SOX6 - a physiological driver of proliferation of osteo-chondrogenic progenitors - by binding to an intronic GGAA-microsatellite, which promotes EwS growth in vitro and in vivo. Through integration of transcriptome-profiling, published drug-screening data, and functional in vitro and in vivo experiments including 3D and PDX models, we discover that constitutively high SOX6 expression promotes elevated levels of oxidative stress that create a therapeutic vulnerability toward the oxidative stress-inducing drug Elesclomol.Collectively, our results exemplify how aberrant activation of a developmental transcription factor by a dominant oncogene can promote malignancy, but provide opportunities for targeted therapy.

Extracellular vesicles, small reservoirs that carry various biomolecules, have gained significant interest from the clinical field in recent years based on the diagnostic, therapeutic and prognostic possibilities they offer. While information abound regarding the clinical potential of such vesicles in diverse conditions, the information demonstrating their likely importance in amyotrophic lateral sclerosis (ALS) is more limited. This review will thus provide a brief introduction to extracellular vesicles, highlight their diagnostic significance in various diseases with a focus on ALS and explore additional applications of extracellular vesicles in the medical field. Overall, this work sheds further light on the clinical importance of extracellular vesicles in diagnostic applications as well as supports the need to better characterize their roles and signatures in patients diagnosed with ALS., (Copyright © 2019 Elsevier B.V. All rights reserved.)

The linearity of soft robotic sensors (SRS) was recently validated for movement angle assessment using a rigid body structure that accurately depicted critical movements of the foot-ankle complex. The purpose of this study was to continue the validation of SRS for joint angle movement capture on 10 participants (five male and five female) performing ankle movements in a non-weight bearing, high-seated, sitting position. The four basic ankle movements-plantar flexion (PF), dorsiflexion (DF), inversion (INV), and eversion (EVR)-were assessed individually in order to select good placement and orientation configurations (POCs) for four SRS positioned to capture each movement type. PF, INV, and EVR each had three POCs identified based on bony landmarks of the foot and ankle while the DF location was only tested for one POC. Each participant wore a specialized compression sock where the SRS could be consistently tested from all POCs for each participant. The movement data collected from each sensor was then compared against 3D motion capture data. R -squared and root-mean-squared error averages were used to assess relative and absolute measures of fit to motion capture output. Participant robustness, opposing movements, and gender were also used to identify good SRS POC placement for foot-ankle movement capture.

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder associated with the progressive death of motor neurons. Mean survival for a patient diagnosed with ALS is between 2 and 5 years. Early and efficient diagnosis of the various forms of ALS remains a significant challenge, resulting in a need to identify clinically-relevant biomarkers in readily accessible body fluids. microRNAs (miRNAs) are short, evolutionarily conserved non-coding RNA molecules involved in post-transcriptional regulation of gene expression that have received interest as disease biomarkers. This study was undertaken to identify an ALS-associated miRNA signature in extracellular vesicles (EVs), which can cross the blood-brain barrier and enter the circulatory system, obtained from plasma samples of persons diagnosed and living with ALS (PALS). Next-generation sequencing was used to identify differentially expressed miRNAs recovered from EVs of PALS and healthy controls. High-throughput sequencing data for select miRNA targets was subsequently validated by droplet digital PCR (ddPCR). This approach revealed elevated levels of 5 miRNAs and reduced levels of 22 miRNAs in EVs collected from PALS as compared with healthy controls subjects. miRNAs with relevance to ALS were found to be deregulated, including miR-9-5p, miR-183-5p, miR-338-3p and miR-1246. MiR-15a-5p and miR-193a-5p were identified for their diagnostic potential of ALS and association with disability progression, respectively. Functional assessment of transcripts targeted by select ALS-associated miRNAs revealed processes such as transcriptional regulation and protein ubiquitination. These data identify an ALS-associated miRNAs signature in EVs of PALS and further strengthen the potential diagnostic relevance of these small molecules for this condition., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Procedural simulation (PS) is increasingly being used worldwide in healthcare for training caregivers in psychomotor competencies. It has been demonstrated to improve learners' confidence and competence in technical procedures, with consequent positive impacts on patient outcomes and safety. Several frameworks can guide healthcare educators in using PS as an educational tool. However, no theory-informed practical framework exists to guide them in including PS in their training programs. We present 12 practical tips for efficient PS training that translates educational concepts from theory to practice, based on the existing literature. In doing this, we aim to help healthcare educators to adequately incorporate and use PS both for optimal learning and for transfer into professional practice.

Utilization of environmental stimuli for growth is the main factor contributing to the evolution of prokaryotes and eukaryotes, independently and mutualistically. Epigenetics describes an organism's ability to vary expression of certain genes based on their environmental stimuli. The diverse degree of dose-dependent responses based on their variances in expressed genetic profiles makes it difficult to ascertain whether hormesis or oncogenesis has or is occurring. In the medical field this is shown where survival curves used in determining radiotherapeutic doses have substantial uncertainties, some as large as 50% (Barendsen, 1990). Many in-vitro radiobiological studies have been limited by not taking into consideration the innate presence of microbes in biological systems, which have either grown symbiotically or pathogenically. Present in-vitro studies neglect to take into consideration the varied responses that commensal and opportunistic pathogens will have when exposed to the same stimuli and how such responses could act as stimuli for their macro/microenvironment. As a result many theories such as radiation carcinogenesis explain microscopic events but fail to describe macroscopic events (Cohen, 1995). As such, this review shows how microorganisms have the ability to perturb risks of cancer and enhance hormesis after irradiation. It will also look at bacterial significance in the microenvironment of the tumor before and during treatment. In addition, bacterial systemic communication after irradiation and the host's immune responses to infection could explain many of the phenomena associated with bystander effects. Therefore, the present literature review considers the paradigms of hormesis and oncogenesis in order to find a rationale that ties them all together. This relationship was thus characterized to be the microbiome., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Sex- and season-specific modulation of hippocampal size and function is observed across multiple species, including rodents. Other non-hippocampal-dependent behaviors exhibit season and sex differences, and whether the associated brain regions exhibit similar variation with sex and season remains to be fully characterized. As such, we examined the brains of wild-caught Richardson's ground squirrels (RGS; Urocitellus richardsonii) for seasonal (breeding, non-breeding) and sex differences in the volumes of specific brain areas, including: total brain volume, corpus callosum (CC), anterior commissure (AC), medial prefrontal cortex (mPFC), total neocortex (NC), entorhinal cortex (EC), and superior colliculus (SC). Analyses of variance and covariance revealed significant interactions between season and sex for almost all areas studied, primarily resulting from females captured during the breeding season exhibiting larger volumes than females captured during the non-breeding season. This was observed for volumes of the AC, mPFC, NC, EC, and SC. Where simple main effects of season were observed for males (the NC and the SC), the volume advantage favoured males captured during the NBr season. Only two simple main effects of sex were observed: males captured in the non-breeding season had significantly larger total brain volume than females captured in the non-breeding season, and females captured during the breeding season had larger volumes of the mPFC and EC than males captured in the breeding season. These results indicate that females have more pronounced seasonal differences in brain and brain region sizes. The extent to which seasonal differences in brain region volumes vary with behaviour is unclear, but our data do suggest that seasonal plasticity is not limited to the hippocampus and that RGS is a useful mammalian species for understanding seasonal plasticity in an ecologically relevant context., (Copyright © 2015 IBRO. Published by Elsevier Ltd. All rights reserved.)

Sex and reproductive status affect hippocampal neurogenesis and dentate gyrus (DG) size in rodents. Relatively few studies, however, address these two effects simultaneously and even fewer studies address this issue in wild populations. Here, we examined seasonal and sex differences in neurogenesis and DG size in a wild, polygynous and social rodent, Richardson's ground squirrel (Uriocitellus richardsonii). Based on the behavioral ecology of this species, we predicted that both neurogenesis and DG size would be sexually dimorphic and the degree of dimorphism would be greatest in the breeding season. Using unbiased stereology and doublecortin (DCX) immunohistochemistry, we found that brain volume, DG size and number of DCX cells varied significantly between breeding and non-breeding seasons, but only brain volume and the number of DCX labeled cells differed between the sexes. Both sex and seasonal differences likely reflect circulating hormone levels, but the extent to which these differences relate to space use in this species is unclear. Based on the degree of seasonal differences in neurogenesis and the DG, we suggest that ground squirrels could be considered model species in which to examine hippocampal plasticity in an ecologically valid context., (Copyright © 2014 IBRO. Published by Elsevier Ltd. All rights reserved.)

Objectives: The development of professional competence is the main goal of residency training. Clinical supervision is the most commonly used teaching and learning method for the development of core competencies (CCs). The literature provides little information on how to encourage the learning of CCs through supervision. We undertook an exploratory study to describe if and how CCs were addressed during supervision in a family medicine residency programme., Methods: We selected a participatory action research design to engage participants in exploring their precepting practices. Eleven volunteer faculty staff and six residents from a large family medicine residency programme took part in a 9-month process which included three focus group encounters alternating with data gathering during supervision. We used mostly qualitative methods for data collection and analysis, with thematic content analysis, triangulation of sources and of researchers, and member checking., Results: Participants realised that they addressed all CCs listed as programme outcomes during clinical supervision, albeit implicitly and intuitively, and often unconsciously and superficially. We identified a series of factors that influenced the discussion of CCs: (i) CCs must be both known and valued; (ii) discussion of CCs occurs in a constant adaptation to numerous contextual factors, such as residents' characteristics; (iii) the teaching and learning of CCs is influenced by six challenges in the preceptor-resident interaction, such as residents' active engagement, and (iv) coherence with other curricular elements contributes to learning about CCs. Differences between residents' and preceptors' perspectives are discussed., Conclusions: This is the first descriptive study focusing on the teaching of CCs during clinical supervision, as experienced in a family medicine residency programme. Content and process issues were equally influential on the discussion of CCs. Our findings led to a representation of factors determining the teaching and learning of CCs in supervision, and suggest directions for research, for faculty development, and for interventions with learners., (© Blackwell Publishing Ltd 2012.)

Background and Objectives: Despite a record of excellence, Canadian family medicine residency programs must respond to the changing face of health care and the needs of the population. A working group was established by the College of Family Physicians of Canada to review the current curriculum and make recommendations for change., Methods: Literature reviews of current evidence regarding strategies in postgraduate medical education were carried out, and recent developments in medical education internationally were studied. After recommendations for curriculum change were drafted, workshops, presentations, and peer consultations were conducted over a 4-year period to test ideas and obtain stakeholder feedback., Results: The core recommendation of the working group is: Residency programs in family medicine are to establish a competency-based curriculum that is comprehensive, focused on continuity, and centered in family medicine--The Triple C Competency-based Curriculum. The working group developed a new framework for family medicine competency in Canada, CanMEDS-FM, to support the transition., Conclusions: The Triple C Competency-based Curriculum was developed to redesign Canadian family medicine residencies based on a solid rationale. Recommendations for curricular change, as well as the competency framework, CanMEDS-FM, have been accepted enthusiastically by stakeholders. Implementation and evaluation phases are underway.

Background: Peristomal skin alterations under ostomy barrier wafers are a commonly reported problem. While a number of interventions to manage this issue have been reported, the use of a topically applied cyanoacrylate has received little attention. This case series describes the use of a topical cyanoacrylate for the management of peristomal skin alterations in persons living with an ostomy., Case Presentations: Using a convenience sample, the topical cyanoacrylate dressing was applied to 11 patients with peristomal skin disruption under ostomy wafers in acute care and outpatient settings. The causes of barrier function interruption were also addressed to enhance outcomes. Patients were assessed for wound discomfort using a Likert Scale, time to healing, and number of appliance changes. Patient satisfaction was also examined., Conclusion: Average reported discomfort levels were 9.5 out of 10 at the initial peristomal irritation assessment visit decreased to 3.5 at the first wafer change and were absent by the second wafer change. Wafers had increasing wear time between changes in both settings with acute care patients responding faster. Epidermal resurfacing occurred within 10.2 days in outpatients and within 7 days in acute care patients. Because of the skin sealant action of this dressing, immediate adherence of the wafer was reported at all pouch changes.

Accurate measures of muscular strength can yield insights about children's growth and development. The purpose of this study was to examine grip strength performances by boys and girls ages 5 to 19 years. A Jamar dynamometer was used to measure grip strength by 736 boys and girls ages 5 to 19 years. Multiple regression equations were applied to analyze the data. Overall, age-sex trends were similar to previous reports as boys and girls increased their performances across age levels. After age 12, boys' mean grip strength increased at a faster rate than girls'. However, participants in the present study performed better in the upper age ranges (13-19 yr.) than did boys and girls tested a generation ago. Potential associations between activity choices and grip strength are discussed.

The present study investigates the effects of a weak (+/-200 microT(pk)), pulsed, extremely low frequency magnetic field (ELF MF) upon the human electroencephalogram (EEG). We have previously determined that exposure to pulsed ELF MFs can affect the EEG, notably the alpha frequency (8-13 Hz) over the occipital-parietal region of the scalp. In the present study, subjects (n = 32) were exposed to two different pulsed MF sequences (1 and 2, used previously) that differed in presentation rate, in order to examine the effects upon the alpha frequency of the human EEG. Results suggest that compared to sham exposure, alpha activity was lowered over the occipital-parietal regions of the brain during exposure to Sequence 1, while alpha activity over the same regions was higher after Sequence 2 exposure. These effects occurred after approximately 5 min of pulsed MF exposure. The results also suggest that a previous exposure to the pulsed MF sequence determined subjects' responses in the present experiment. This study supports our previous observation of EEG changes after 5 min pulsed ELF MF exposure. The results of this study are also consistent with existing EEG experiments of ELF MF and mobile phone effects upon the brain., ((c) 2008 Wiley-Liss, Inc.)

The neural representation of peripersonal space may be distinct from the representation of extrapersonal space. Sex differences in the performance of motor tasks might relate to proximity to the body. In the spatial domain, females excel at tasks performed in peripersonal space, like the Object Location Memory Task (OLMT), whereas males excel at tasks performed in extrapersonal space, such as navigation. We compared performance on the OLMT in peripersonal space with performance on the same task in extrapersonal space (using a between-subjects design). As predicted, the typical female advantage was observed for the peripersonal OLMT. However, for the extrapersonal OLMT, the female advantage disappeared and males actually outperformed females. These results suggest that the sex differences observed in the OLMT, and potentially other tasks that exhibit sex differences in performance, may be related to sex differences to spatial-motor systems that are preferentially tuned to proximity.

Postgraduate residency programs must ensure that residents are properly trained in all core competencies. The CanMEDS framework of the Royal College of Physicians and Surgeons of Canada has established seven such competencies: medical expert, communicator, collaborator, manager, health advocate, scholar, and professional. The authors describe an integrated, one-month multispecialty rotation for first-year residents, Introduction to CanMEDS Core Competencies, at Laval University, Quebec, Canada. The goal of the rotation was to offer an in-depth and simultaneous training in each of the seven competencies. A pilot rotation was offered from February 9 to March 7, 2004 and involved 42 residents from seven programs and 30 faculty. It addressed 12 content areas related to the core competencies, through teaching formats promoting experiential and reflective learning. It involved three significant innovations: an intensive month-long format, during which residents were freed from most clinical duties; a multispecialty teaching and socialization strategy between peers and with faculty; and an integrated reflective approach, to ensure residents' understanding of the relevance and application of the core competencies in their own specialty. Although demanding to organize, the pilot rotation was well received. Residents were rapidly introduced to all competencies, and they developed an integrated perspective of them. An evaluation of impact is underway.

In 2002, we published a review of the cognitive and physiological effects of extremely low frequency magnetic fields (ELF MFs) and ELF-modulated radiofrequency fields associated with mobile phones. Since the original preparation of that review, a significant number of studies have been published using techniques such as electroencephalography, event-related potentials and positron emission tomography to investigate electromagnetic field effects upon human physiology and various measures of performance (cognitive, perceptual, behavioral). We review these recent studies, and when effects were observed, we reference the time course of observed effects (immediate or delayed). In our concluding remarks, we discuss a number of variables that are not often considered in human bioelectromagnetics studies, such as personality, individual differences and the specific laterality of ELF MF and mobile phone exposure over the brain. We also consider the sensitivity of various physiological assays and performance measures in the study of biological effects of electromagnetic fields., ((c) 2006 Wiley-Liss, Inc.)

Objective: To investigate family physicians' views on factors that make health care decisions difficult for patients, interventions family physicians use to support patients making decisions, and interventions proposed by the Ottawa Decision Support Framework (ODSF)., Design: Thirteen group discussions., Setting: Five family practice units., Participants: One hundred twenty family physicians., Interventions: The multifaceted implementation intervention consisted of feedback from participants, a reminder at point of care, and an interactive workshop. During the workshop, family physicians were asked about their views on 2 videos both showing the concluding phase of a simulated clinical encounter with a woman facing a decision about hormone therapy. One video showed usual care; the other showed use of the ODSF process and related tools. Content was analyzed using observations by non-participants, field notes, material collected from participants during workshops, evaluation forms completed at the end of workshops, and comments written on exit questionnaires from the implementation trial., Main Outcome Measures: Family physicians' views on the types of difficult decisions their patients face, the factors that make decisions difficult for patients, the interventions family physicians use to support patients' decisions, and the interventions proposed by the ODSF., Results: The 2 most frequently cited factors making decisions difficult for patients were experiencing uncertainty and fears about adverse outcomes. Before being introduced to the ODSF, participants had used mostly information-related strategies to provide decision support. After learning about the ODSF, participants overwhelmingly identified assessing patients' values as a priority. At the end of the workshop, the 5 changes in practice participants most frequently intended to make were, in order of importance, to assess patients' values, to ask about patients' preferred role in decision making, to screen for decisional conflict, to assess support or undue pressure on patients, and to increase patients' involvement in decision making., Conclusion: The ODSF process and related tools have the potential to broaden family physicians' views on supporting patients facing difficult decisions.

The major impediments to axonal regeneration in the central nervous system are growth-inhibitory proteins present in the myelin sheath, and Nogo-A is one of the most potent inhibitors synthesized by oligodendrocytes. However, neuronal expression of Nogo-A during development suggests that it may have an additional role. The spatio-temporal regulation of both Nogo-A mRNA and protein expression was examined by in situ hybridization and immunohistochemistry in the developing rat olfactory system. During embryonic and postnatal development (from E13 to P6), Nogo-A mRNA and protein were strongly expressed by differentiating neurons in the olfactory epithelium and in the olfactory bulb. From the second postnatal week, a progressive down-regulation of both Nogo-A mRNA and protein occurred, such that only a weak expression persisted in the adult olfactory system. Using double-immunostainings in the adult olfactory epithelium, we determined that Nogo-A was preferentially expressed by immature olfactory receptor neurons extending axonal processes toward the olfactory bulb. At all developmental stages, Nogo-A protein was preferentially targeted in olfactory axons emerging from the olfactory epithelium. Using an in vitro model of olfactory axon growth, we demonstrated that, in addition to its presence along the entire axon length, Nogo-A accumulated in axonal growth cone and at axonal branching points, with a distribution similar to that of microtubule-associated proteins. Moreover, Nogo-A was transiently expressed in dendritic processes in the postnatal olfactory bulb. Together, our data suggest that, in non-pathological conditions, Nogo-A may be involved in the processes of axonal growth and dendritic modeling through the regulation of microtubule dynamics.

Febrile convulsions are common among preschool children and are studied experimentally with hyperthermia in rat pups. Although heat-induced convulsions (HC+) can affect behaviors in adulthood, to date no one has examined the effects on behavior in the neonatal period. We examined the effects of HC+ on ultrasonic vocalizations (USVs) and mother-pup interactions in P10- and P12-aged rat pups. On P7, 34 pups were subjected to HC+ (32 controls, HC-) and behaviors were observed on P10 and P12. For mother-pup interactions, a trend for a sex x treatment interaction was found, with HC- females and HC+ males interacting more often with their dam. Further, HC+ pups vocalized more than controls (HC-) and male pups vocalized more than females. Interestingly, females and HC+ pups displayed less efficient USVs. However, mother-pup interactions did not significantly differ between HC+ and HC- pups, despite greater vocalization. Thus, dams differentiate among their pups, perhaps through USVs.