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Abstract Background Primary care providers (PCPs) are typically the primary contact for patients with obesity seeking medical and surgical weight loss interventions; however, previous studies suggest that fewer than 7% of eligible adult patients are referred to publically funded medical and surgical weight loss interventions (MSWLI). Methods We performed an anonymous survey study between October 2017 and June 2018 to explore the knowledge, experiences, perceptions, and educational needs of PCPs in Southeastern Ontario in managing patients with class II and III obesity. Results Surveys were distributed to 591 PCPs (n = 538 family physicians; n = 53 nurse practitioners) identified as practicing in the Southeastern Ontario and 92 (15.6%) participated. PCPs serving a rural population estimated that 14.2 ± 10.9% of patients would qualify for MSWLI compared to 9.9 ± 8.5% of patients of PCPs serving an urban population (p = .049). Overall, 57.5% of respondents did not feel competent prescribing MSWLI to patients with class II/III obesity, while 69.8% stated they had ‘good’ knowledge of the referral criteria for MSWLI. 22.2% of respondents were hesitant to refer patients for bariatric surgery (BS) due to concerns about postoperative surgical complications and risks associated with surgery. Only 25% of respondents were comfortable providing long-term follow up after BS, and only 39.1% had participated in continuing education on management of patients with class II/III obesity in the past 5 years. Conclusion The majority of PCPs believe there is a need for additional education about MSWLI for patients with class II/III obesity. Future studies are needed to develop and compare the effectiveness of additional education and professional development around risks of contemporary BS, indications to consider referral for MSWLI, management and long-term follow-up of patients after BS.

Background: General practices have had difficulty recruiting and retaining enough general practitioners to keep up with increasing demand for primary health care in recent years. Proposals to increase workforce capacity include a policy-driven strategy to employ additional numbers and a wider range of health professionals. Objectives: Our objective was to conduct a comprehensive study of the scale, scope and impact of changing patterns of practitioner employment in general practice in England. This included an analysis of employment trends, motivations behind employment decisions, staff and patient experiences, and how skill mix changes are associated with outcome measures and costs. Design: NHS Digital workforce data (2015–19) were used to analyse employment changes and to look at their association with outcomes data, such as the General Practitioner Patient Survey, General Practitioner Worklife Survey, prescribing data, Hospital Episode Statistics, Quality and Outcomes Framework and NHS payments to practices. A practice manager survey (August–December 2019) explored factors motivating general practices’ employment decisions. An in-depth case study of five general practices in England (August–December 2019) examined how a broader range of practitioners is experienced by practice staff and patients. Results: We found a 2.84% increase in reported full-time equivalent per 1000 patients across all practitioners during the study period. The full-time equivalent of general practitioner partners decreased, while the full-time equivalent of salaried general practitioners, advanced nurse practitioners, clinical pharmacists, physiotherapists, physician associates and paramedics increased. General practitioners and practice managers reported different motivating factors regarding skill mix employment. General practitioners saw skill mix employment as a strategy to cope with a general practitioner shortage, whereas managers prioritised potential cost-efficiencies. Case studies demonstrated the importance of matching patients’ problems with practitioners’ competencies and ensuring flexibility for practitioners to obtain advice when perfect matching was not achieved. Senior clinicians provided additional support and had supervisory and other responsibilities, and analysis of the General Practitioner Worklife Survey data suggested that general practitioners’ job satisfaction may not increase with skill mix changes. Patients lacked information about newer practitioners, but felt reassured by the accessibility of expert advice. However, General Practitioner Patient Survey data indicated that higher patient satisfaction was associated with a higher general practitioner full-time equivalent. Quality and Outcomes Framework achievement was higher when more practitioners were employed (i.e. full-time equivalent per 1000 patients). Higher clinical pharmacist full-time equivalents per 1000 patients were associated with higher quality and lower cost prescribing. Associations between skill mix and hospital activity were mixed. Our analysis of payments to practices and prescribing costs suggested that NHS expenditure may not decrease with increasing skill mix employment. Limitations: These findings may reflect turbulence during a period of rapid skill mix change in general practice. The current policy of employing staff through primary care networks is likely to accelerate workforce change and generate additional challenges. Conclusions: Skill mix implementation is challenging because of the inherent complexity of general practice caseloads; it is associated with a mix of positive and negative outcome measures. Future work: Findings from this study will inform future funding applications for projects that seek to examine the nature and impact of evolving multiprofessional teams in primary care. Funding: This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 9. See the NIHR Journals Library website for further project information.

BACKGROUND: The burgeoning use of opioids and the lack of attention to the safe prescribing, storage, and disposal of these drugs remains a societal concern. Education plays a critical role in providing a comprehensive response to this crisis by closing the training gaps and empowering the next generation of physicians with the knowledge, skills, and resources needed to diagnose, treat and manage pain and substance use. Curricular Development: The Association of Faculties of Medicine of Canada (AFMC) developed a competency-based, bilingual curriculum for undergraduate medical students to be implemented in all Canadian medical schools. The authors describe the principles and framework for developing a national curriculum. The curriculum design process was situated in the Knowledge to Action theoretical framework. Throughout the development of this curriculum, different stakeholder groups were engaged, and their needs and contexts were considered. CONCLUSION: The curriculum ensures that consistent information is taught across all medical schools to educate future physicians on pain management, opioid stewardship and substance use disorder.

In September 2016, Queen’s University launched the first, fully online, 4-year Bachelor of Health Science degree program in Canada. This paper reports on the developmental structure, implementation philosophy, and challenges in the development of this competency-based program. All stakeholders directly involved in program development were invited to participate in this qualitative case study. Thirty-five interviews and three focus groups (n=14) were conducted. Interviews and focus groups were transcribed verbatim and data were analyzed using thematic design. Themes included: program vision; desired program outcomes; administrative processes for funding and recruitment; uniqueness of the program; local, regional and international impact of the program; communication and collaborations for program development; and uncertainty in long term outcomes. Findings suggest that during program development, an explicit vision of program goals encouraged buy-in at most levels of the university. There was consensus that the overarching outcome should be to provide a rigorous, high quality program with pathways to professional, basic science, global health and advocacy-based health professions. The online modality was expected to improve accessibility to degree programs, as well as address diverse student learning needs. Innovation played a vital role in the program’s development and was founded in educational theory and curriculum development practices. En septembre 2016, l’Université Queen’s a lancé le premier programme de 4 ans menant à un diplôme, le baccalauréat en sciences de la santé, entièrement en ligne. Cet article présente un rapport sur la structure du développement, la philosophie de mise en oeuvre et les défis qui se sont présentés lors du développement de ce programme basé sur la compétence. Toutes les parties prenantes qui avaient été directement impliquées dans le développement de ce programme ont été invitées à participer à cette étude de cas qualitative. Trente-cinq entrevues ont été menées et trois groupes de discussion (n=14) ont été organisés. Ce qui a été dit pendant les entrevues et les groupes de discussion a été transcrit verbatim et les données ont été analysées en utilisant la conception thématique. Les thèmes étaient les suivants : vision du programme, résultats désirés du programme, processus administratifs pour le financement et le recrutement, aspect unique du programme, impacts local, régional et international du programme, communications et collaborations pour le développement du programme, incertitudes concernant les résultats à long terme. Les résultats suggèrent qu’au cours de la phase de développement du programme, une vision explicite des objectifs du programme avait encouragé l’acceptation à tous les niveaux de l’université. Tout le monde était d’accord sur le fait que le résultat global devait être de fournir un programme rigoureux de haute qualité qui mènerait vers les professions de sciences de base, les professions de santé globale et les professions de santé basées sur la défense des intérêts. La modalité en ligne devait améliorer l’accessibilité à des programmes menant à un diplôme et devait également répondre à divers besoins d’apprentissage des étudiants et des étudiantes. L’innovation a joué un rôle primordial dans le développement du programme, elle était fondée sur la théorie de l’éducation et sur les pratiques de développement de programmes d’études.

Hydrogel-based bioinks are the main formulations used for Articular Cartilage (AC) regeneration due to their similarity to chondral tissue in terms of morphological and mechanical properties. However, the main challenge is to design and formulate bioinks able to allow reproducible additive manufacturing and fulfil the biological needs for the required tissue. In our work, we investigated an innovative Manuka honey (MH)-loaded photocurable gellan gum methacrylated (GGMA) bioink, encapsulating mesenchymal stem cells differentiated in chondrocytes (MSCs-C), to generate 3D bioprinted construct for AC studies. We demonstrated the beneficial effect of MH incorporation on the bioink printability, leading to the obtainment of a more homogenous filament extrusion and therefore a better printing resolution. Also, GGMA-MH formulation showed higher viscoelastic properties, presenting complex modulus G∗ values of ∼1042 ​Pa, compared to ∼730 ​Pa of GGMA. Finally, MH-enriched bioink induced a higher expression of chondrogenic markers col2a1 (14-fold), sox9 (3-fold) and acan (4-fold) and AC ECM main element production (proteoglycans and collagen).

The use of quantitative intercoder reliability measures in the analysis of qualitative research data has often generated acrimonious debates among researchers who view quantitative and qualitative research methodologies as incompatible due to their unique ontological and epistemological traditions. While these measures are invaluable in many contexts, critics point out that the use of such measures in qualitative analysis represents an attempt to import standards derived for positivist research. Guided by extant research and our experience in qualitative research, we argue that it is possible to develop a qualitative-based measure of intercoder reliability that is compatible with the interpretivist epistemological paradigm of qualitative research. We present eight qualitative research process-based guidelines for evaluating and reporting intercoder reliability in qualitative research and anticipate that these recommendations will particularly guide beginning researchers in the coding and analysis processes of qualitative data analysis.

Background: The direct observation and assessment of learners’ resuscitation skills by an attending physician is challenging due to the unpredictable and time-sensitive nature of these events. Multisource feedback (MSF) may address this challenge and improve the quality of assessments provided to learners. We aimed to describe the similarities and differences in the assessment rationale of attending physicians, registered nurses, and resident peers in the context of a simulation-based resuscitation curriculum. Methods: We conducted a qualitative content analysis of narrative MSF of medical residents in their first postgraduate year of training who were participating in a simulation-based resuscitation course at two Canadian institutions. Assessments included an entrustment score and narrative comments from attending physicians, registered nurses, and resident peers in addition to self-assessment. Narrative comments were transcribed and analyzed thematically using a constant comparative method. Results: All 87 residents (100%) participating in the 2017-2018 course provided consent. A total of 223 assessments were included in our analysis. Four themes emerged from the narrative data: 1) Communication, 2) Leadership, 3) Demeanor, and 4) Medical Expert. Relative to other assessor groups, feedback from nurses focused on patient-centred care and communication while attending physicians focused on the medical expert theme. Peer feedback was the most positive. Self-assessments included comments within each of the four themes. Conclusions: In the context of a simulation-based resuscitation curriculum, MSF provided learners with different perspectives in their narrative assessment rationale and may offer a more holistic assessment of resuscitation skills within a competency-based medical education (CBME) program of assessment.

This work presents a computational model to study the degradation behavior of polyester-based three-dimensional (3D) functionalized scaffolds for bone regeneration. As a case study, we investigated the behavior of a 3D-printed scaffold presenting a functionalized surface with ICOS-Fc, a bioactive protein able to stimulate bone regeneration and healing, inhibiting osteoclast activity. The aim of the model was to optimize the scaffold design to control its degradation and thus the release of grafted protein over time and space. Two different scenarios were considered: (i) a scaffold without macroporosity presenting a functionalized external surface; and (ii) a scaffold presenting an internal functionalized macroporous architecture with open channels to locally deliver the degradation products.

Bone adhesives offer distinct advantages over the use of screws to attached internal fixation plates (IFPs). As the chemical composition of bone is similar to dentine, it is possible that the types of monomers used to make dentine adhesives could be utilised to affix IFPs to bone. The ability to attach a bio-resorbable IFP to porcine bone was assessed for the monomer 10-methacryloyloxydecyl dihydrogen phosphate (MDP), used either as a homopolymer or a copolymer with urethane dimethacrylate (MDP + U). Additionally, the addition of a priming step (MDP + U + P) was evaluated. The chemical interactions of the monomers with bone were assessed using XRD and imaged using TEM, revealing the formation of nano-layered structures with the MDP primer, something we believe has not been reported on bone. In a 6-week artificial aging study both MDP + U and MDP + U + P demonstrated adequate shear bond strength to affix bio-resorbable IFPs. The cytotoxicity profiles of the adhesive formulations were determined using indirect and direct contact with MC3T3 cells, with indirect conditions suggesting the MDP + U + P is as cytocompatible as the resorbable IFP. The findings of this study suggest our newly developed adhesive has the potential to be used as a bone adhesive to affix bioresorbable IFPs.

This paper reports on a study involving 74 third and 17 fourth year student teachers enrolled in a Bachelor of Education (Primary) course at an Australian regional, multi-campus university. These pre-service primary teachers completed the single semester, compulsory subject Managing the Learning Environment, which involves the application of behaviour management theory and research into the primary school classroom. The aim of the study was to investigate the experiences of student teachers using blogs whilst on professional placement and more specifically, the effectiveness of blogs to facilitate reflection on behaviour management. Data were drawn from focus group interviews and blog postings. There were mixed responses to the use of blogs as a learning tool; those who found it useful saw its utility in developing behaviour management strategies, venting emotions and supporting each other, while others considered blogs a time imposition and questioned the usefulness of peer advice. While blog postings demonstrated some evidence of reflection and aligning theory and practice, they were overwhelmingly used for the sharing of behaviour management "tips".

A-level psychology teachers (N=109) responded to a questionnaire asking about their academic background, their experience of and views about A-level psychology. Teachers were also asked about the scientific status of psychology as a discipline and about the nature of science in general. Most respondents thought that the A-level course provides students with good preparation for university but overall they tended to disagree that the A-level should be a pre-requisite for university study. A-level topic options taught least often (e.g. biological, cognitive) were amongst those previously identified as areas where incoming undergraduate students could be better prepared (Banister, 2003). Compared with previous research (Maras & Bradshaw, 2007) a greater proportion of psychology teachers thought psychology is a science but this was qualified by the belief that psychology is not as scientific as "harder sciences" such as physics or chemistry. (Contains 4 tables.)

p-Carboxylatocalix[n]arenes have emerged as useful building blocks for the construction of a diverse range of supramolecular assemblies. A convenient route to a p-carboxylatocalix[4]arene that is locked in a partial-cone conformation is presented. The conformation gives the molecule markedly different topological directionality relative to those previously used in self- and metal-directed assembly studies.

Quaternary phosphonium salts are popular candidates used in many chemical transformations and synthetic chemistry, notably in catalysis. We have examined the single crystals of two bulky phosphonium compounds, tetra([1,1′-biphenyl]-4-yl) phosphonium dicyanamide (C48H36P+·N(CN)2−, compound 1), and tetra([1,1′-biphenyl]-4-yl) phosphonium bromide hydrate (C48H36P+·Br−, CH3CN, H2O, compound 2), and herein report the structural properties for the compounds with an emphasis on the influence of the ion-ion interaction towards self-assembly; the overall self-assembly for both structures is very similar, with subtle differences in the cell parameters. The symmetrical tetra ([1,1′-biphenyl]-4-yl) phosphonium cations in both compounds self-assembled to form robust stacked columns in the solid-state, with voids occupied by anions or solvent molecules. Quantitative examination of intermolecular interactions using Hirshfeld surface analysis found that classical and non-classical hydrogen bonding appears to be the dominant contributor in stabilizing the self-assembly in both cases. The present work can not only benefit in understanding the mutual interaction between the sterically encumbered tetra ([1,1′-biphenyl]-4-yl) phosphonium cations and between counterions, but also provide insights for the self-assembled arrays in the solid-state.

PLLA, PCL and PHBV are aliphatic polyesters which have been researched and used in a wide range of medical devices, and all three have advantages and disadvantages for specific applications. Blending of these materials is an attractive way to make a material which overcomes the limitations of the individual polymers. Both PCL and PHBV have been evaluated in polymer blends with PLLA in order to provide enhanced properties for specific applications. This paper explores the use of PCL and PHBV together with PLLA in ternary blends with assessment of the thermal, mechanical and processing properties of the resultant polymer blends, with the aim of producing new biomaterials for orthopaedic applications. DSC characterisation is used to demonstrate that the materials can be effectively blended. Blending PCL and PHBV in concentrations of 5–10% with PLLA produces materials with average modulus improved by up to 25%, average strength improved by up to 50% and average elongation at break improved by 4000%, depending on the concentrations of each polymer used. PHBV impacts most on the modulus and strength of the blends, whilst PCL has a greater impact on creep behaviour and viscosity. Blending PCL and PHBV with PLLA offers an effective approach to the development of new polyester-based biomaterials with combinations of mechanical properties which cannot be provided by any of the materials individually.

The presence and diversity of marine non-native species, the number of new invasions, and the impact on native communities and habitats are important metrics used to assess the health of marine ecosystems. Monitoring for marine non-native species, using traditional approaches such as rapid assessment surveys (RASs), requires taxonomic expertise and may still fail to detect rare or inconspicuous species. This study reports a validation process for a quantitative PCR (qPCR) assay based on the cytochrome oxidase 1 gene, designed to detect highly invasive tunicate Didemnum vexillum by targeting environmental DNA (eDNA) present in water samples. The D. vexillum qPCR assay showed high sensitivity, with the threshold limit of detection (LOD) and modeled LOD3 (based on triplicate qPCR reactions) estimated as 9.187 and 1.117 copies reaction–1, respectively and the limit of quantification (LOQ) was calculated as 18 copies reaction–1. Analyses of water samples collected from selected Pacific oyster farms and recreational marinas in Scotland showed 100% concordance between the historical data on presence of D. vexillum from RASs and detection of D. vexillum eDNA. Consistency of detection of D. vexillum eDNA among different sampling points within each infected sampling site varied, ranging between 100% positive throughout the site to some sampling points testing “negative” or only as “suspected” for D. vexillum. Sites with lower within-site detection consistency included sites with a low density of D. vexillum as reported by RASs or were sites undergoing D. vexillum management. The present pilot monitoring program demonstrates the potential to generate important data on presence of D. vexillum. This program will be scaled up across large geographic regions and used in the first instance to focus and target the traditional RASs to D. vexillum eDNA-positive sites in a cost-effective way, with an aim to verify the species presence by visual observation and direct Sanger sequencing of positive qPCR products.

Background: Residents’ accurate self-assessment and clinical judgment are essential for optimizing their clinical skills development. Evidence from the medical literature suggests that residents generally do poorly at self-assessing their performance, often due to factors relating to learners’ personal backgrounds, cultures, the specific contexts of the learning environment and rater bias or inaccuracies. We evaluated the accuracy of anesthesiology residents’ self-assessed Global Entrustment scores and determined whether differences between faculty and resident scores varied by resident seniority, faculty leniency, and/or year of assessment. Methods: We employed variance components modeling techniques and analyzed 329 pairs of faculty and self-assessed entrustment scores among 43 faculty assessors and 15 residents. Using faculty scores as the gold standard, we compared faculty scores with residents’ scores (xi(faculty)–xi(resident)), and determined residents’ accuracy, including over- and under-confidence. Results: The results indicate that residents were respectively over- and under-confident in 10.9% and 54.4% of the assessments but more consistent in their individual self-assessments (rho = 0.70) than faculty assessors. Faculty scores were significantly higher (α = 0.396; z = 4.39; p < 0.001) than residents’ self-assessed scores. Being a lenient/dovish (β = 0.121, z = 3.16, p < 0.01) and a neutral (β = 0.137, z = 3.57, p < 0.001) faculty assessor predicted a higher likelihood of resident under-confidence. Senior residents were significantly less likely to be under-confident compared to junior residents (β = -0.182, z =-2.45, p < 0.05). The accuracy of self-assessments did not significantly vary during the two years of the study period. Conclusions: The majority of residents’ self-assessments were inaccurate. Our findings may help identify the sources of such inaccuracies.