Age and its impact on crisis management performance and learning after simulation-based education by acute care physicians: a multicentre prospective cohort study.

Background: Physiological changes associated with ageing could negatively impact the crisis resource management skills of acute care physicians. This study was designed to determine whether physician age impacts crisis resource management skills, and crisis resource management skills learning and retention using full-body manikin simulation training in acute care physicians.

Methods: Acute care physicians at two Canadian universities participated in three 8-min simulated crisis (pulseless electrical activity) scenarios.

Effects of gamma irradiation on the sensory and metabolic profiles of two peach cultivars.

Background: The suitability of commercial peaches for minimal processing (MP) is limited, mainly due to shortened shelf-life. Gamma irradiation has emerged in MP fruits as a promising technology. This study aimed to investigate the effects of gamma irradiation on the sensory and metabolic profiles of MP peaches from two cultivars - 'Forastero' (FT) and 'Ruby Prince' (RP) - and evaluate the relationship between both profiles.

Death determination by neurologic criteria-what do families understand?

Purpose: Currently, there is little empirical data on family understanding about brain death and death determination. The purpose of this study was to describe family members' (FMs') understanding of brain death and the process of determining death in the context of organ donation in Canadian intensive care units (ICUs).

Methods: We conducted a qualitative study using semistructured, in-depth interviews with FMs who were asked to make an organ donation decision on behalf of adult or pediatric patients with death determination by neurologic criteria (DNC) in Canadian ICUs.

The experiences of family members of deceased organ donors and suggestions to improve the donation process: a qualitative study.

Background: Decisions about organ donation are stressful for family members of potential organ donors. We sought to comprehensively explore the donation process from interviews conducted with family members of patients admitted to pediatric and adult intensive care units in Canada.

Methods: We conducted a qualitative study using semistructured, in-depth interviews with 271 family members asked to make an organ donation decision.

Setting and Titrating Positive End-Expiratory Pressure.

Although maintaining some amount of positive end-expiratory pressure (PEEP) seems essential, selecting and titrating a specific level for patients with ARDS remains challenging despite extensive research on the subject. Although an "open lung" approach to ventilation is popular and has some degree of biological plausibility, it is not without risk. Furthermore, there is no clear evidence-based guidance regarding initial PEEP settings or how to titrate them early in the course of the illness.

A new experimental design to study inflammation-related versus non-inflammation-related depression in mice.

Background: Major depressive disorder (MDD) represents a major public health concern, particularly due to its steadily rising prevalence and the poor responsiveness to standard antidepressants notably in patients afflicted with chronic inflammatory conditions, such as obesity. This highlights the need to improve current therapeutic strategies, including by targeting inflammation based on its role in the pathophysiology and treatment responsiveness of MDD. Nevertheless, dissecting the relative contribution of inflammation in the development and treatment of MDD remains a major issue, further complicated by the lack of preclinical depression models suitable to experimentally dissociate inflammation-related vs.

Noninvasive respiratory support following extubation in critically ill adults: a systematic review and network meta-analysis.

Purpose: Systematic review and network meta-analysis to investigate the efficacy of noninvasive respiratory strategies, including noninvasive positive pressure ventilation (NIPPV) and high-flow nasal cannula (HFNC), in reducing extubation failure among critically ill adults.

Methods: We searched databases from inception through October 2021 for randomized controlled trials (RCTs) evaluating noninvasive respiratory support therapies (NIPPV, HFNC, conventional oxygen therapy, or a combination of these) following extubation in critically ill adults. Two reviewers performed screening, full text review, and extraction independently.

Artificial intelligence for the measurement of vocal stereotypy.

Both researchers and practitioners often rely on direct observation to measure and monitor behavior. When these behaviors are too complex or numerous to be measured in vivo, relying on direct observation using human observers increases the amount of resources required to conduct research and to monitor the effects of interventions in practice. To address this issue, we conducted a proof of concept examining whether artificial intelligence could measure vocal stereotypy in individuals with autism.

Mapping the Expert Mind: Integration Method for Revising the ACES Medical Simulation Curriculum.

Purpose: This article shares our experience developing an integrated curriculum for the ACES (Acute Critical Event Simulation) program. The purpose of the ACES program is to ensure that health care providers develop proficiency in the early management of critically ill patients. The program includes multiple different types of educational interventions (mostly simulation-based) and targets both specialty and family physicians practicing in tertiary and community hospitals.

Patient-centred and family-centred care of critically ill patients who are potential organ donors: a qualitative study protocol of family member perspectives.

Introduction: In a patient-centred and family-centred approach to organ donation, compassion is paramount. Recent guidelines have called for more research, interventions and approaches aimed at improving and supporting the families of critically ill patients. The objective of this study is to help translate patient-centred and family-centred care into practice in deceased organ donation.

Evaluating the Implementation of Ontario's Organ and Tissue Donation Physician Leadership Model: Mapping a Way Forward.

Background: The demand for solid organ transplantation has spurred countries around the world to search for innovative policies and practices to increase the supply of organs. Spain has become a global reference point for organ donation with the highest transplantation rates. In Ontario, Canada the Ontario Trillium Gift of Life (TGLN) has sought to replicate some of the successes in Spain.

Fatal Necrotizing Soft-Tissue Infection Caused by in an Injecting Drug User: A Case Report.

The aim of this brief report is to raise awareness of necrotizing soft-tissue infections caused by in intravenous drug users, highlight the potentially unique dangers of this infection in this specific patient population, and outline the course of treatment currently considered the standard of care.

Prognostic accuracy of the Hamilton Early Warning Score (HEWS) and the National Early Warning Score 2 (NEWS2) among hospitalized patients assessed by a rapid response team.

Background: Rapid response teams (RRTs) respond to hospitalized patients experiencing clinical deterioration and help determine subsequent management and disposition. We sought to evaluate and compare the prognostic accuracy of the Hamilton Early Warning Score (HEWS) and the National Early Warning Score 2 (NEWS2) for prediction of in-hospital mortality following RRT activation. We secondarily evaluated a subgroup of patients with suspected infection.

Necrotizing fasciitis caused by in an immunocompromised patient.

This case report describes an immunocompromised patient with a skin boil that progressed to necrotizing fasciitis. The aim of this brief report is to raise awareness regarding necrotizing soft tissue infections caused by an unusual organism, , a typically non-pathogenic organism, and outline the course of treatment currently considered to be the standard of care.

Comparison of simulation debriefs with traditional needs assessment methods: a qualitative exploratory study in a critical care community setting.

Objective: To better understand the potential of a needs assessment approach using qualitative data from manikin-based and virtual patient simulation debriefing sessions compared with traditional data collection methods (ie, focus groups and interviews).

Design: Original data from simulation debrief sessions was compared and contrasted with data from an earlier assessment of critical care needs in a community setting (using focus groups and interviews), thus undertaking secondary analysis of data. Time and cost data were also examined.

A Multicenter Qualitative Investigation of the Experiences and Perspectives of Substitute Decision Makers Who Underwent Organ Donation Decisions.

Background: Organ donation research has centered on improving donation rates rather than focusing on the experience and impact on substitute decision makers. The purpose of this study was to document donor and nondonor family experiences, as well as lasting impacts of donation.

Methods: We used a qualitative exploratory design.

A multicentre investigation of organ and tissue donation education for critical care residents.

Purpose: To describe critical care medicine residents' training, expertise, and skills regarding organ and tissue donation processes and procedures.

Methods: We undertook a qualitative multicentre study and employed a purposive sample of program directors, physicians, nurses, residents, and organ donation leaders from all nine academic intensive care unit (ICU) training centres (five adult, four pediatric) in Ontario (n = 71). Interviews, conducted by telephone between December 2015 and March 2016, were audio-recorded and transcribed verbatim.

Using Single-Case Designs in Practical Settings: Is Within-Subject Replication Always Necessary?

Behavior analysts have widely adopted and embraced within-subject replication through the use of reversal and multielement designs. However, the withdrawal of treatment, which is central to these designs, may not be desirable, feasible, or even ethical in practical settings. To examine this issue, we extracted 501 ABAB graphs from theses and dissertations to examine to what extent we would have reached correct or incorrect conclusions if we had based our analysis on the initial AB component only.

Does the age of acute care physicians impact their (1) crisis management performance and (2) learning after simulation-based education? A protocol for a multicentre prospective cohort study in Toronto and Ottawa, Canada.

Introduction: The proportion of older acute care physicians (ACPs) has been steadily increasing. Ageing is associated with physiological changes and prospective research investigating how such age-related physiological changes affect clinical performance, including crisis resource management (CRM) skills, is lacking. There is a gap in the literature on whether physician's age influences baseline CRM performance and also learning from simulation.

Understanding of evaluation capacity building in practice: a case study of a national medical education organization.

Introduction: Evaluation capacity building (ECB) is a topic of great interest to many organizations as they face increasing demands for accountability and evidence-based practices. ECB is about building the knowledge, skills, and attitudes of organizational members, the sustainability of rigorous evaluative practices, and providing the resources and motivations to engage in ongoing evaluative work. There exists a solid foundation of theoretical research on ECB, however, understanding what ECB looks like in practice is relatively thin.

Hypoxemic Respiratory Failure from Acute Respiratory Distress Syndrome Secondary to Leptospirosis.

Acute respiratory distress syndrome (ARDS), characterized by hypoxemic respiratory failure, is associated with a mortality of 30-50% and is precipitated by both direct and indirect pulmonary insults. Treatment is largely supportive, consisting of lung protective ventilation and thereby necessitating Intensive Care Unit (ICU) admission. The most common precipitant is community-acquired bacterial pneumonia, but other putative pathogens include viruses and fungi.

Using a Visual Structured Criterion for the Analysis of Alternating-Treatment Designs.

Although visual inspection remains common in the analysis of single-case designs, the lack of agreement between raters is an issue that may seriously compromise its validity. Thus, the purpose of our study was to develop and examine the properties of a simple structured criterion to supplement the visual analysis of alternating-treatment designs. To this end, we generated simulated data sets with varying number of points, number of conditions, effect sizes, and autocorrelations, and then measured Type I error rates and power produced by the visual structured criterion (VSC) and permutation analyses.

Adipocyte cannabinoid receptor CB1 regulates energy homeostasis and alternatively activated macrophages.

Dysregulated adipocyte physiology leads to imbalanced energy storage, obesity, and associated diseases, imposing a costly burden on current health care. Cannabinoid receptor type-1 (CB1) plays a crucial role in controlling energy metabolism through central and peripheral mechanisms. In this work, adipocyte-specific inducible deletion of the CB1 gene (Ati-CB1-KO) was sufficient to protect adult mice from diet-induced obesity and associated metabolic alterations and to reverse the phenotype in already obese mice.