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Item Longitudinal screening of retail milk from Canadian provinces reveals no detections of influenza A virus RNA (April–July 2024): leveraging a newly established pan-Canadian network for responding to emerging viruses(Canadian Science Publishing, 2024-11-27) Wallace, Hannah L.; Wight, Jordan; Baz, Mariana; Dowding, Barbara; Flamand, Louis; Hobman, Tom; Jean, Francois; Joy, Jeffrey B.; Lang, Andrew S.; MacParland, Sonya; McCormick, Craig; Noyce, Ryan; Russell, Rodney S.; Sagan, Selena M.; Snyman, Jumari; Rzeszutek, Gabriela J.; Jafri, Mustafa S.; Bogoch, Issac; Kindrachuk, Jason; Rasmussen, AngelaHighly pathogenic avian influenza (HPAI) H5N1 has caused the deaths of more than 100 million birds since 2021, and human cases since 1997 have been associated with significant morbidity and mortality. Given recent detections of HPAI H5N1 in dairy cattle and H5N1 RNA detections in pasteurized retail milk in the United States, we established the pan-Canadian Milk Network in April 2024. Through our network of collaborators from across Canada, retail milk was procured longitudinally, approximately every 2 weeks, and sent to a central laboratory to test for the presence of influenza A virus RNA. Between 29 April and 17 July 2024, we tested 109 retail milk samples from all 10 Canadian provinces (NL, NS, PEI, NB, QC, ON, MB, SK, AB, and BC). All samples tested negative for influenza A virus RNA. This nationwide initiative was established for rapid retail milk screening as per the earliest reports of similar undertakings in the United States. Our independent testing results have aligned with reporting from federal retail milk testing initiatives. Despite no known HPAI infections of dairy cattle in Canada to date, H5N1 poses a significant threat to the health of both humans and other animals. By performing routine surveillance of retail milk on a national scale, we have shown that academic networks and initiatives can rapidly establish nationwide emerging infectious disease surveillance that is cost-effective, standardized, scalable, and easily accessible. Our network can serve as an early detection system to help inform containment and mitigation activities if positive samples are identified and can be readily reactivated should HPAI H5N1 or other emerging zoonotic viruses be identified in agricultural or livestock settings, including Canadian dairy cattle.Item Precision medicine within health professions education:Defining a research agenda for emergency medicine using aforesight and strategy technique (FaST) review(Wiley, 2024-05-19) Chan, Teresa M.; Thoma, Brent; Finnell, John T.; Gordon, Bradley D.; Farrell, Susan; Pusic, Martin; Cabrera, Daniel; Gisondi, Michael A.; Caretta-Weyer, Holly A.; Stave, Christopher; Ankel, FelixBackground Precision medicine, sometimes referred to as personalized medicine, is rapidly changing the possibilities for how people will engage health care in the near future. As technology to support precision medicine exponentially develops, there is an urgent need to proactively improve our understanding of precision medicine and pose important research questions (RQs) related to its inclusion in the education and training of future emergency physicians. Methods A seven-step process was employed to develop a research agenda exploring the intersection of precision and emergency medicine education/training. A literature search of articles about precision medicine was conducted first, which informed the creation of future four scenarios in which trainees and practicing physicians regularly discuss and incorporate precision medicine tools into their discussions and work. Based on these futurist narratives, potential education RQs were generated by an expert panel. A total of 59 initial questions were subsequently categorized and refined to a priority list through a nominal group voting method. The top/priority questions were presented at the 2023 SAEM Consensus Conference on Precision Medicine, Austin, Texas, for further input. Results Eight high-value education RQs were developed, reflecting a holistic view of the challenges and opportunities for precision medicine education in the knowledge, skills, and attitudes relevant to emergency medicine. These questions contend with topics such as most effective pedagogical methods; intended resulting outcomes and behaviors; the generational differences between practicing emergency physicians, educators, and future trainees; and the desires and expectations of patients. Conclusions Emergency medicine and emergency physicians must be prepared to understand precision medicine and incorporate this information into their “toolbox” of thinking, problem solving, and communication with patients and colleagues. This research agenda on how best to educate future emergency physicians in the use of personalized data to provide optimal health care is the focus of this article.Item Competence By Design: a transformational national model of time-variable competency-based postgraduate medical education(Ubiquity Press, 2024-03-18) Frank, Jason R.; Sherbino, Jonathan; Atkinson, Adelle; Snell, Linda; Atkinson, Adelle; Oswald, Anna; Hall, Andrew Koch; Cooke, Lara; Dojeiji, Sue; Richardson, Denyse; Cheung, Warren J.; Cavalcanti, Rodrigo B.; Dalseg, Timothy; Thoma, Brent; Flynn, Leslie; Gofton, Wade; Dudek, Nancy; Bhanji, Farhan; Wong, Brian M.-F.; Razak, Saleem; Anderson, Robert; Dubois, Daniel; Boucher, Andree; Gomes, Marcio M.; Taber, Sarah; Gorman, Lisa J.; Fulford, Jane; Naik, Viren; Harris, Kenneth A.; Croix, Rhonda St.; Melle, Elaine VanPostgraduate medical education is an essential societal enterprise that prepares highly skilled physicians for the health workforce. In recent years, PGME systems have been criticized worldwide for problems with variable graduate abilities, concerns about patient safety, and issues with teaching and assessment methods. In response, competency based medical education approaches, with an emphasis on graduate outcomes, have been proposed as the direction for 21st century health profession education. However, there are few published models of large-scale implementation of these approaches. We describe the rationale and design for a national, time-variable competency-based multi-specialty system for postgraduate medical education called Competence by Design. Fourteen innovations were bundled to create this new system, using the Van Melle Core Components of competency based medical education as the basis for the transformation. The successful execution of this transformational training system shows competency based medical education can be implemented at scale. The lessons learned in the early implementation of Competence by Design can inform competency based medical education innovation efforts across professions worldwide.Item The 2023 World delirium awareness and quality Survey: A Canadian substudy(Elsevier, 2025-03) Krewulak, Karla D.; Lee, Laurie A.; Strayer, Kathryn; Armstrong, Jennifer; Baig, Nadia; Brouillette, Judith; Deemer, Kirsten; Jaworska, Natalia; Kissel, Katherine A.; MacDonald, Christine; Mailhot, Tanya; Rewa, Oleksa; Sy, Eric; Nydahl, Peter; von Haken, Rebecca; Lindroth, Heidi; Liu, Keibun; Fiest, KirstenObjective This study aimed to evaluate the proportion of screened patients with delirium and the strategies used for its management in Canadian hospitals caring for critically ill children or adults. Methods This is a secondary analysis of a cross-sectional study completed on World Delirium Awareness Day (March 15, 2023). Respondents completed a 35-question survey on the proportion of screened patients with delirium (at 8:00 am and 8:00 pm), treatment, and management strategies employed. Results A total of 27 ICUs (22 adult and 5 pediatric) participated. Among adult ICU patients assessed for delirium, 18 % (n = 34/194) had delirium at 8:00 am and 18 % (32/181) had delirium at 8:00 pm. In pediatric ICUs, the proportion of screened patients with delirium was higher, with 50 % (n = 8/16) at 8:00 am and 44 % (n = 7/16) at 8:00 pm. Delirium management strategies varied: with non-pharmacological approaches such as multi-professional rounds (100 %), pain management (96 %), and mobilization (85 %) being most common. The most reported written delirium management protocols included spontaneous breathing trials in adult ICUs and physical restraint and sedation management in PICUs. Few ICUs reported written protocols for family engagement and empowerment. Conclusions Delirium remains a prevalent issue in Canadian ICUs, with variability in assessment and management strategies. Gaps in family engagement and pediatric-specific protocols persist. Addressing barriers like staff shortages and lack of training is critical to improving care. Implications for Clinical Practice: Improving delirium management requires standardized protocols, especially in PICUs, and better integration of family engagement in care. Addressing workforce challenges (e.g., staff shortages and educating new staff on delirium) will be crucial for enhancing delirium prevention and treatment in Canadian ICUs. Further research should focus on pediatric-specific interventions and pharmacological management.Item Causes of embryo implantation failure: A systematic review and metaanalysis of procedures to increase embryo implantation potential(Frontiers, 2025-02-14) Bulletti, Francesco M.; Sciorio, Romualdo; Conforti, Alessandro; De Luca, Roberto; Bulletti, Carlo; Palagiano, Antonio; Berrettini, Marco; Scaravelli, Giulia; Pierson, Roger A.Introduction: Infertility is characterized by the failure to conceive after 12 months of unprotected sexual intercourse. In assisted reproduction technologies (ARTs), in-vitro fertilization and embryo transfer (IVF-ET) are pivotal, with the quality of embryo quality essential for successful implantation. Objective: This systematic review with meta-analysis aimed to explore the prevalence of embryonic factors involved in the implantation process, concentrating on the following research inquiries: 1) the implantation rates of euploid versus untested embryo transfers; 2) the efficiency of transferring good embryos in different age groups; 3) the impact of age on good embryo transfers to gestational carriers; and 4) the transfer of donated gametes/embryos. The goal is to identify critical points in implantation to improve therapies. Methods: A comprehensive literature search identified 1474 relevant papers, 11 of which met the inclusion criteria. The information was gathered using a standardized form, and the risk of bias was evaluated. A meta-analysis of subgroups to determine euploid embryo transfer efficiency was conducted to synthesize and explore the results. Furthermore, data extracted from registries document the persistent secondary role of extraembryonic determinants in successful implantation. Results: The meta-analysis demonstrated that preimplantation genetic testing for aneuploidy (PGT-A) significantly increased the odds of implantation. Age was found to influence extraembryonic factors, with older women experiencing reduced embryo implantation as gestational carriers. However, the overall incidence of extraembryonic factors was low. This review highlights the need to focus on PGT-A, diagnostic hysteroscopy, and endometrial receptivity for improving implantation rates. Conclusion: Implantation success in ARTs largely depends on embryo euploidy. While achieving three euploid embryos greatly increases success rates, it is challenging in older women. Extraembryonic factors, although present, have a marginal impact. Subsequent studies ought to concentrate on modulating endometrial responses immunologically and developing algorithms to improve the precision of predicting implantation success; as well as the timing of endometrial receptivity and the occurrence of dormant embryo phenomena also warrants further investigation.Item Ultrasound Based Endometrial Receptivity Scoring Improves In Vitro Fertilization Pregnancy Rates(American Society for Reproductive Medicine, 2021) Pierson, Hannah E.; Cadesky, Kenneth; Meriano, James; Invik, Jesse; Laskin, Carl A.; Pierson, Roger A.Background: The endometrium is a key factor in establishment of pregnancy. In IVF therapy, endometrial investigation is generally limited to thickness measurements or occasionally invasive biopsy-based procedures. A non-invasive endometrial receptivity diagnostic (usER test; Matris™, Synergyne Imaging Technologies Inc., Canada.) has recently become available. We performed a retrospective chart review study to test the hypothesis that routine implementation of the ultrasound- based Endometrial Receptivity (usER) diagnostic test would improve pregnancy rates in IVF cycles. Methods: All patients undergoing IVF at one Canadian reproductive medicine clinic in the 2018 calendar year were considered (n=1521). Patients received either standard of care endometrial thickness and pattern assessments (n=1205) or diagnostic usER testing (n=316) prior to planned embryo transfer. In the usER group, patients with usER scores of 7.0 or above proceeded to embryo transfer (ET; n=246); patients with scores <6.5 (n=70) had their planned embryo transfer deferred and embryos cryopreserved, or retained in cryopreservation, for use in future cycles. Pregnancy (positive beta-hCG) rates were calculated for fresh, frozen-thaw, and aggregate (combined fresh and frozen) ET cycles. Results: Aggregate pregnancy rates for the usER group were 12% higher than for the Standard of Care group (p=0.0005; 52.0% versus 40.0% respectively). The pregnancy rate for fresh embryo transfer cycles in the usER group was 20.0% higher than that of the Standard of Care group (p=0.0005; 54.9% versus 34.9%, respectively). In frozen embryo transfer cycles, a 9.4% higher pregnancy rate was observed in the usER group than the Standard of Care group (p=0.017; 51.3% versus 41.9% respectively). Implementation of usER resulted in conservation of 64 cryopreserved embryos through deferral of low-probability of pregnancy cycles. Discussion & Context: This ‘real world’/‘all patients’ retrospective analysis demonstrates that usER testing may be implemented to improve pregnancy rates and conserve embryo potential.Item Causes of embryo implantation failure: A systematic review and metaanalysis of procedures to increase embryo implantation potential(Frontiers, 2025-02) Bulletti, Francesco M.; Sciorio, Romualdo; Conforti, Alessandro; De Luca, Roberto; Bulletti, Carlo; Palagiano, Antonio; Berrettini, Marco; Scaravelli, Giulia; Pierson, Roger A.Introduction: Infertility is characterized by the failure to conceive after 12 months of unprotected sexual intercourse. In assisted reproduction technologies (ARTs), in-vitro fertilization and embryo transfer (IVF-ET) are pivotal, with the quality of embryo quality essential for successful implantation. Objective: This systematic review with meta-analysis aimed to explore the prevalence of embryonic factors involved in the implantation process, concentrating on the following research inquiries: 1) the implantation rates of euploid versus untested embryo transfers; 2) the efficiency of transferring good embryos in different age groups; 3) the impact of age on good embryo transfers to gestational carriers; and 4) the transfer of donated gametes/embryos. The goal is to identify critical points in implantation to improve therapies. Methods: A comprehensive literature search identified 1474 relevant papers, 11 of which met the inclusion criteria. The information was gathered using a standardized form, and the risk of bias was evaluated. A meta-analysis of subgroups to determine euploid embryo transfer efficiency was conducted to synthesize and explore the results. Furthermore, data extracted from registries document the persistent secondary role of extraembryonic determinants in successful implantation. Results: The meta-analysis demonstrated that preimplantation genetic testing for aneuploidy (PGT-A) significantly increased the odds of implantation. Age was found to influence extraembryonic factors, with older women experiencing reduced embryo implantation as gestational carriers. However, the overall incidence of extraembryonic factors was low. This review highlights the need to focus on PGT-A, diagnostic hysteroscopy, and endometrial receptivity for improving implantation rates. Conclusion: Implantation success in ARTs largely depends on embryo euploidy. While achieving three euploid embryos greatly increases success rates, it is challenging in older women. Extraembryonic factors, although present, have a marginal impact. Subsequent studies ought to concentrate on modulating endometrial responses immunologically and developing algorithms to improve the precision of predicting implantation success; as well as the timing of endometrial receptivity and the occurrence of dormant embryo phenomena also warrants further investigation.Item Expanding the primary care workforce by integrating genetic counselors in multidisciplinary care teams(Family Practice, 2024-10-23) Vanneste, Rachel; Bauer, Sasha A; Borle, Kennedy; Dreikorn, ErikaCollectively, rare diseases are common, affecting approximately 8% of the population in Canada and the USA. Therefore, the majority of primary care (PC) clinicians will care for patients who are affected or at risk for a genetic disease. Considering the increasing ways in which genetics is being implemented into all areas of healthcare, one way to address these needs and expand the capacity of the PC workforce is through the integration of genetic counselors (GCs) into PC multidisciplinary teams. GCs are Masters-educated allied health professionals with specialized training in molecular genetics, communication, and short-term psychotherapeutic counseling. The current models of GCs in PC mimic other multidisciplinary models. Complex tasks related to genetics, such as pre- and post-test counseling, genetic test selection, and results interpretation, are conducted by GCs, which, in turn, allows physicians, nurse practitioners, and other PC providers to work at the top of their scope of practice. Quality genetics services provided by GCs improve clinical outcomes for patients and their families; the simultaneous provision of genetic education and psychological support by a GC is associated with an increase in patient knowledge, perceived personal control, decrease in distress, and can lead to positive health behavior changes, all of which are aligned with the goals of primary healthcare. With their extensive training in clinical care, medical communication, and psychotherapeutic counseling, integrating GCs into PC care teams will improve the care patients receive and allow PC clinicians to ensure their patients are at the forefront of the personalized medicine revolution.Item Activity in the pontine reticular nuclei scales with handgrip force in humans(American Physiological Society, 2024-04-23) Danielson, Tyler L.; Gould, Layla A.; DeFreitas, Jason; MacLennan, Rob; Ekstrand, Chelsea; Borowsky, Ron; Farthing, Jonathan P.; Andrushko, Justin W.The neural pathways that contribute to force production in humans are currently poorly understood, as the relative roles of the corticospinal tract and brainstem pathways, such as the reticulospinal tract (RST), vary substantially across species. Using functional magnetic resonance imaging (fMRI), we aimed to measure activation in the pontine reticular nuclei (PRN) during different submaximal handgrip contractions to determine the potential role of the PRN in force modulation. Thirteen neurologically intact participants (age: 28 ± 6 yr) performed unilateral handgrip contractions at 25%, 50%, 75% of maximum voluntary contraction during brain scans. We quantified the magnitude of PRN activation from the contralateral and ipsilateral sides during each of the three contraction intensities. A repeated-measures ANOVA demonstrated a significant main effect of force (P = 0.012, η2p = 0.307) for PRN activation, independent of side (i.e., activation increased with force for both contralateral and ipsilateral nuclei). Further analyses of these data involved calculating the linear slope between the magnitude of activation and handgrip force for each region of interest (ROI) at the individual-level. One-sample t tests on the slopes revealed significant group-level scaling for the PRN bilaterally, but only the ipsilateral PRN remained significant after correcting for multiple comparisons. We show evidence of task-dependent activation in the PRN that was positively related to handgrip force. These data build on a growing body of literature that highlights the RST as a functionally relevant motor pathway for force modulation in humans. NEW & NOTEWORTHY In this study, we used a task-based functional magnetic resonance imaging (fMRI) paradigm to show that activity in the pontine reticular nuclei scales linearly with increasing force during a handgrip task. These findings directly support recently proposed hypotheses that the reticulospinal tract may play an important role in modulating force production in humans.Item Clozapine, Relapse, and Adverse Events: A 10-Year Electronic Cohort Study in Canada: Commentary, Author Response(2024) Halayka, Shawn; Balbuena, LloydWe agree with Kikuchi that the diversity of diagnoses may have obscured clozapine’s risk-benefit balance in our paper (1). Hence, our findings may have reflected the lower range of the overall benefit of clozapine. Table 1 shows the expected count of rehospitalization events stratified by index diagnosis in adult patients. These were calculated using flexible survival models implemented in the STPM3 Stata package (2). The above figures show that clozapine had fewer relapse events compared to other drugs in patients with schizophrenia and schizoaffective disorders. In patients with bipolar disorder, the relapse events were the same, but clozapine had higher adverse events. The reverse was true in schizoaffective disorder patients: lower relapse events for clozapine but the same adverse event counts as other drugs. The child and youth cohort could not be stratified by diagnosis because of low numbers. We agree with Kikuchi that the adverse events analysis was tilted in favor of other antipsychotics. Suicide attempts and deaths were not available in the data, so clozapine’s benefit is probably underestimated (3) while adverse events more specific to other drugs are probably underestimated. The decision to exclude unmedicated periods was deliberate, since our objective was a head-to-head comparison of medications. In a previous paper (4) we found that over a five-year period, schizophrenia patients, on average, spent 11 months without medication and only 17 days in clozapine. Within-person analysis was considered, but this technique discards the records of people who did not switch from other drugs to clozapine or vice-versa. In our data, these patients made up the majority. In summary, our register-based study shows that clozapine is an effective medication, with benefits and risks that require balancing.Item SASKATOON HIV PROGRAM EVALUATION FINAL REPORT 2024(2024) Spence, Cara; Zettl, Mary; Morin, EmmannuelleItem General unemployment and serious workplace injury rates: workers compensation claims analysis from the Canadian province of Saskatchewan, 2007-2018(Springer, 10/15/2024) Essien, Samuel Kwaku; Feng, Cindy; Trask, CatherineAbstract Objectives There is conflicting published evidence that unemployment impacts workplace safety. Some studies suggest that the workplace injury rate decreases during economic contractions, while others propose an increased rate of injuries during periods of economic contractions. This study investigated the association between unemployment rates and traumatic work-related non-fatal injury (WRNFI) in Saskatchewan, 2007–2018, in order to provide new insight into injury prevention. Methods Saskatchewan’s retrospective linked workplace claims data from 2007 to 2018 were grouped by year, season, and worker characteristics (e.g., age and sex). Total employment, total labour force, and the number of unemployed workers from the Statistics Canada Labour Force Survey were grouped by year, season, sex, and age. These data were linked to the worker’s compensation board injury claim data to determine the number of people at risk, serving as the denominator (offset term) for WRNFI rates, calculated as WRNFI cases per total employed workers. A negative binomial generalized additive model was used to examine the association between unemployment rates and WRNFI, adjusted for age, sex, industry types, and seasons. Results The WRNFI rate has declined since 2007. On average, workers aged 20–29 years had the highest WRNFI rate (541.6 ± 84.8/100,000). Men had 3.2 times higher WRNFI risk than women (RR = 3.2, 95% CI 3.12–3.22), with the highest WRNFI risk observed in the manufacturing (RR = 1.68, 95% CI 1.63–1.73) and construction (RR = 1.67, 95% CI 1.63–1.72) industries. WRNFI risk decreased non-linearly with an increasing unemployment rate, indicating a pro-cyclic pattern. Conclusion This analysis showed that WRNFI rates tracked unemployment rates. This suggests a need to increase prevention strategies and reduce disincentives for under-reporting during an economic downturn.Item Head circumference values among Inuit children in Nunavut, Canada: A retrospective cohort study(Canadian Medical Association Journal, 2024-10) Joyal, Kristina; Collins, Sorcha; Miners, Amber; Barrowman, Nick; Sucha, Ewa; Allen, Jean; Edmunds, Sharon; Caughey, Amy; Doucette, Michelle; Khatun, Selina; Akearok, Gwen Healey; Arbour, Laura; Venkateswaran, SunitaBackground: Inuit children from Nunavut have been observed to have high rates of macrocephaly, which sometimes leads to burdensome travel for medical evaluation, often with no pathology identified upon assessment. Given reports that World Health Organization (WHO) growth charts may not reflect all populations, we sought to compare head circumference measurements in a cohort of Inuit children with the WHO charts. Methods: We extracted head circumference data from a previous retrospective cohort study where, with Inuit partnership, we reviewed medical records of Inuit children (from birth to age 5 yr) born between Jan. 1, 2010, and Dec. 31, 2013, and residing in Nunavut. To create a cohort of Inuit children similar to the cohorts used in the development of the WHO growth charts, we excluded children with preterm birth, documented neurologic or genetic disease, and most congenital anomalies. We compared head circumference values with the 2007 WHO charts using centiles estimated with a generalized additive model. Results: We analyzed records of 1960 Inuit children (8866 data points), of whom 993 (50.8%) were female. Most data were from ages 0 to 36 months. At all age points, we found that the study cohort had statistically significantly larger head circumferences than WHO medians, with most z scores for head circumference measurements among Inuit children falling 0.5–1 standard deviations above the WHO reference (p < 0.001). At age 12 months, median head circumferences were 1.3 cm and 1.5 cm larger for male and female Inuit children, respectively. Using WHO growth curves, macrocephaly was significantly overdiagnosed and microcephaly was underdiagnosed (p < 0.001). Interpretation: Our results support the observation that Inuit children from Nunavut have larger head circumferences than other populations, and use of the WHO charts may thus lead to overdiagnosis of macrocephaly and underdiagnosis of microcephaly. Population-specific growth curves for Inuit children should be considered to provide timely and appropriate diagnoses of microcephaly and avoid overinvestigation of macrocephaly.Item Enabling Implementation of Competency Based Medical Education through an Outcomes-Focused Accreditation System(Ubiquity Press, 2/6/2024) Dalseg, Timothy; Thoma, Brent; Wycliffe-Jones, Keith; Frank, Jason; Taber, SarahCompetency based medical education is being adopted around the world. Accreditation plays a vital role as an enabler in the adoption and implementation of competency based medical education, but little has been published about how the design of an accreditation system facilitates this transformation. The Canadian postgraduate medical education environment has recently transitioned to an outcomes-based accreditation system in parallel with the adoption of competency based medical education. Using the Canadian example, we characterize four features of an accreditation system that can facilitate the implementation of competency based medical education: theoretical underpinning, quality focus, accreditation standards, and accreditation processes. Alignment of the underlying educational theories within the accreditation system and educational paradigm drives change in a consistent and desired direction. An accreditation system that prioritizes quality improvement over quality assurance promotes educational system development and progressive change. Accreditation standards that achieve the difficult balance of being sufficiently detailed yet flexible foster a high fidelity of implementation without stifling innovation. Finally, accreditation processes that recognize the change process, encourage program development, and are not overly punitive all enable the implementation of competency based medical education. We also discuss the ways in which accreditation can simultaneously hinder the implementation of this approach. As education bodies adopt competency based medical education, particular attention should be paid to the role that accreditation plays in successful implementation.Item Sharing Is Caring: Helping Institutions and Health Organizations Leverage Data for Educational Improvement(Ubiquity Press, 10/7/2024) Sebok-Syer, Stefanie S.; Smirnova, Alina; Duwell, Ethan; George, Brian; Triola, Marc; Feddock, Christopher; Chahine, Saad; Rubright, Jonathan D.; Thoma, BrentCompetency-based medical education (CBME) has produced large collections of data, which can provide valuable information about trainees and medical education systems. Many organizations continue to struggle with accessing, collecting, governing, analyzing, and visualizing their clinical and/or educational data. This hinders data sharing efforts within and across organizations, which are foundational in supporting system-wide improvements. Challenges to data sharing within medical education include variability in legislation, existing data policies, heterogeneity of data, inadequate data infrastructure, and various intended purposes or uses. In this eye opener, the authors describe four case studies to illustrate some of the aforementioned challenges and characterize the complexity of data sharing within medical education along two dimensions: organizational (single vs. multiple) and data type (clinical and/or educational). With the goal of better supporting data sharing initiatives, the authors introduce an action-oriented blueprint that includes a three-stage process (i.e., preparation, execution, and iteration) to highlight crucial aspects of data sharing. This evidence-informed model incorporates current best practices and aims to support data sharing initiatives within their own organizations and across multiple organizations. Finally, organizations can use this model to conceptually guide and track their progression throughout the data sharing process.Item Translating the Interplay of Cognition and Physical Performance in COPD and Interstitial Lung Disease(CHEST Journal, 2024-10) Rozenberg, Dmitry; Reid, W Darlene; Camp, Pat; Campos, Jennifer L.; Dechman, Gail; Davenport, Paul W; Egan, Helga; Fisher, Jolene H.; Guenette, Jordan A.; Gold, David; Goldstein, Roger S.; Goodridge, Donna; Janaudis-Ferreira, Tania; Kaplan, Alan G.; Langer, Daniel; Pepin, Veronique; Marciniuk, Darcy D.; Moore, Barbara; Orchanian-Cheff, Ani; Otoo-Appiah, Jessica; Rassam, Peter; Rotenberg, Shlomit; Ryerson, Chris; Spruit, Martijn A.; Stanbrook, Matthew B.; Stickland, Michael K.; Tom, Jeannie; Wentlandt, KirstenTopic Importance Cognitive and physical limitations are common in individuals with chronic lung diseases, but their interactions with physical function and activities of daily living are not well characterized. Understanding these interactions and potential contributors may provide insights on disability and enable more tailored rehabilitation strategies. Review Findings This review summarizes a 2-day meeting of patient partners, clinicians, researchers, and lung associations to discuss the interplay between cognitive and physical function in people with chronic lung diseases. This report covers four areas: (1) cognitive-physical limitations in patients with chronic lung diseases; (2) cognitive assessments; (3) strategies to optimize cognition and motor control; and (4) future research directions. Cognitive and physical impairments have multiple effects on quality of life and daily function. Meeting participants acknowledged the need for a standardized cognitive assessment to complement physical assessments in patients with chronic lung diseases. Dyspnea, fatigue, and age were recognized as important contributors to cognition that can affect motor control and daily physical function. Pulmonary rehabilitation was highlighted as a multidisciplinary strategy that may improve respiratory and limb motor control through neuroplasticity and has the potential to improve physical function and quality of life. Summary There was consensus that cognitive function and the cognitive interference of dyspnea in people with chronic lung diseases contribute to motor control impairments that can negatively affect daily function, which may be improved with pulmonary rehabilitation. The meeting generated several key research questions related to cognitive-physical interactions in individuals with chronic lung diseases.Item The Relative Risk of COVID-19 in Solid Organ Transplant Recipients Over Waves of the Pandemic(Frontiers Media S.A., 9/5/2024) Vinson, Amanda J.; Anzalone, Alfred J.; Schissel, Makayla; Dai, Ran; Agarwal, Dr Gaurav; Lee, Stephen B.; Olex, Amy; Mannon, Roslyn B.Solid organ transplant recipients (SOTR) are at increased risk from COVID-19. Over time, the absolute risk of adverse outcomes after COVID-19 has decreased in both the non-immunosuppressed/immunocompromised (non-ISC) general population, and amongst SOTR. Using the N3C, we examined the absolute risk of mortality, major adverse renal or cardiac events, and hospitalization after COVID-19 diagnosis amongst non-ISC and SOTR populations over five waves of the pandemic (Wave 1: Ancestral COVID; Wave 2: Alpha; Wave 3: Delta; Wave 4: Omicron; Wave 5: Omicron). Within each wave, we determined the relative risk of each outcome for SOTR versus the non-ISC population based on crude event rates, and then used multivariable cox proportional hazards models and logistic regression to determine the adjusted risk of each outcome based on SOT status. Throughout the pandemic, including during the Omicron wave (Wave 5), SOTR were at greater absolute risk for each outcome than non-ISC patients (p-values all <0.001). The adjusted risk of SOT status for each outcome was relatively stable over time (aHR 1.28–1.61 for mortality; aHR 1.31–1.47 for MACE; aHR 1.72–1.90 for MARCE; aHR 1.75–2.07 for AKI; and aOR 1.53–1.81 for hospitalization). Despite a reduction in the absolute risk of COVID-19 complications, the relative risk for SOTR versus the non-ISC population has not improved.Item Educator's blueprint: Key considerations for using social media in survey-based medical education research(Wiley, 9/4/2024) Ogle, Kathleen Y.; Hill, Jeffery; Santen, Sally A.; Gottlieb, Michael; Artino Jr., Anthony R.; Thoma, BrentIn this paper, we present a set of recommendations for using social media as a tool for participant recruitment in survey-based medical education research. Drawing from a limited but growing body of literature, we discuss the opportunities and challenges inherent to social media recruitment. This article builds on the authors’ previous educator's blueprints about survey design and administration. We highlight the advantages of social media, including its wide reach, cost-effectiveness, and capability to access diverse and geographically dispersed populations, which can significantly enhance the representativeness of research samples. However, we also caution against potential pitfalls, such as ethical concerns, sampling bias, and the fluid nature of social media platforms. Our recommendations are informed by both empirical evidence and best practices, aiming to provide researchers with practical advice for effectively leveraging social media in survey-based medical education research. We emphasize the importance of selecting suitable platforms and engaging with targeted demographics thoughtfully. By sharing our insights, we hope to assist fellow medical education researchers in navigating the complexities of social media recruitment, thereby enriching the quality and impact of survey-based research in this field.Item Clozapine, relapse, and adverse events: a 10-year electronic cohort study in Canada(The British Journal of Psychiatry, 2024-09) Balbuena, Lloyd; Halayka, Shawn; Lee, Andrew; AHMED, AG; Hinz, Tamara; Kolla, Nathan; Pylypow, JennaBackground Clozapine is the most effective medication for treatment-resistant psychoses, but the balance of benefits and risks is understudied in real-world settings. Aims To examine the relative re-hospitalisation rates for mental health relapse and adverse events associated with clozapine and other antipsychotics in adult and child/youth cohorts. Method Data were obtained from the Canadian Institute of Health Information for adults (n = 45 616) and children/youth (n = 1476) initially hospitalised for mental health conditions in British Columbia, Manitoba and Saskatchewan from 2008 to 2018. Patient demographics and hospitalisations were linked with antipsychotic prescriptions dispensed following the initial visit. Recurrent events survival analysis for relapse and adverse events were created and compared between clozapine and other antipsychotics. Results In adults, clozapine was associated with a 14% lower relapse rate versus other drugs (adjusted hazard ratio: 0.86, 95% CI: 0.83–0.90) over the 10-year follow-up. In the first 21 months, the relapse rate was higher for clozapine but then reversed. Over 1000 person-months, clozapine-treated adults could be expected to have 38 relapse hospitalisations compared with 45 for other drugs. In children/youth, clozapine had a 38% lower relapse rate compared with other antipsychotic medications (adjusted hazard ratio: 0.62, 95% CI: 0.49–0.78) over the follow-up period. This equates to 29 hospitalisations for clozapine and 48 for other drugs over 1000 person-months. In adults, clozapine had a higher risk for adverse events (hazard ratio: 1.34, 95% CI: 1.18–1.54) over the entire follow-up compared with other antipsychotics. This equates to 1.77 and 1.30 hospitalisations over 1000 person-months for clozapine and other drugs, respectively. Conclusions Clozapine was associated with lower relapse overall, but this was accompanied by higher adverse events for adults. For children/youth, clozapine was associated with lower relapse all throughout and had no difference in adverse events compared with other antipsychotics.Item To stop or not to stop an asthma biologic, that is the question(Elsevier, 2024-09) Philipenko, Brianne S.; Davis, Beth; Cockcroft, Donald W.During a time when anti-asthma biologics are readily accessible, the article by Brightling et al1 in the current issue provides additional much needed evidence to discuss with patients with severe asthma when the inevitable question arises of “How long do I need to continue on my asthma biologic therapy?” With now 6 biologics available, including most recently tezepelumab that can be prescribed without biomarker restrictions, it has become increasingly easy to prescribe these medications. After achieving good asthma control, physicians are left to contemplate the question of “now what?” Are these medications lifelong therapies?