30921 research outputs found
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Addressing musculoskeletal curricular inadequacies within undergraduate medical education
No full textBackground
Musculoskeletal (MSK) injuries and diseases place a significant burden on the health care system. Despite this, research indicates that physician training in the area of MSK medicine has historically been inadequate, with a majority of medical students feeling that their training in MSK medicine is lacking. The goal of this investigation was to evaluate the efficacy of a new preclinical MSK curriculum that was implemented within a nationally accredited allopathic medical program.
Methods
Retrospective analysis was completed on five consecutive years (2017–2021) of preclinical MSK curricular data for 549 medical students, including mid and end-of-course examinations and end-of-course student satisfaction surveys. Both parametric and non-parametric methods of analysis were used to examine within and between class differences (P < 0.05).
Results
The new MSK curriculum covered 15 of 16 “core or must know” topics in MSK medicine, and academic performance was consistently high over the 5-year period of analysis (final course marks ranged from 76.6 ± 7.1 to 81.4 ± 8.1; failures/year: range from 0 to 4), being equal or above levels of student performance observed for other courses delivered during preclinical studies. Likert data from end-of-course surveys demonstrated that feedback was overwhelmingly positive (overall course satisfaction ranged from a low of 3.07/4.00 to a high of 3.56/4.00) and indicated that students felt that the new preclinical MSK curriculum did effectively support medical student learning and knowledge retention.
Conclusion
Results are expected to help advance the current body of knowledge that is dedicated to improving physician learning and knowledge retention in the area of MSK medicine and provides a curricular model that could be used by other nationally accredited medical programs to help enhance MSK learning at the preclinical levels of physician training
Views and perspectives toward implementing the Global Spine Care Initiative (GSCI) model of care, and related spine care program by the people in Cross Lake, Northern Manitoba, Canada: a qualitative study using the Theoretical Domain Framework (TDF)
No full textAbstract
Background
Back pain is very common and a leading cause of disability worldwide. Due to health care system inequalities, Indigenous communities have a disproportionately higher prevalence of injury and acute and chronic diseases compared to the general Canadian population. Indigenous communities, particularly in northern Canada, have limited access to evidence-based spine care. Strategies established in collaboration with Indigenous peoples are needed to address unmet healthcare needs, including spine care (chiropractic and movement program) services. This study aimed to understand the views and perspectives of Cross Lake community leaders and clinicians working at Cross Lake Nursing Station (CLNS) in northern Manitoba regarding the implementation of the Global Spine Care Initiative (GSCI) model of spine care (MoC) and related implementation strategies.
Method
A qualitative exploratory design using an interpretivist paradigm was used. Twenty community partners were invited to participate in semi-structured interviews underpinned by the Theoretical Domains Framework (TDF) adapted to capture pertinent information. Data were analyzed deductively and inductively, and the interpretation of findings were explored in consultation with community members and partners.
Results
Community leaders (n = 9) and physicians, nurses, and allied health workers (n = 11) emphasized: 1) the importance of contextualizing the MoC (triaging and care pathway) and proposed new services through in-person community engagement; 2) the need and desire for local non-pharmacological spine care approaches; and 3) streamlining patient triage and CLNS workflow. Recommendations for the streamlining included reducing managerial/administrative duties, educating new incoming clinicians, incorporating follow-up appointments for spine pain patients, and establishing an electronic medical record system along with a patient portal. Suggestions regarding how to sustain the new spine care services included providing transportation, protecting allocated clinic space, resolving insurance coverage discrepancies, addressing misconceptions about chiropractic care, instilling the value of physical activity for self-care and pain relief, and a short-term (30-day) incentivised movement program which considers a variety of movement options and offers a social component after each session.
Conclusion
Community partners were favorable to the inclusion of a refined GSCI MoC. Adapting the TDF to unique Indigenous needs may help understand how best to implement the MoC in communities with similar needs
Characterization of sex-related differences in a steroid-unresponsive allergen recall model
No full textAsthma is a chronic inflammatory disease of the airways, which can cause narrowing of the airways, resulting in difficulty breathing. A key characteristic of asthma is airway inflammation, with infiltration of various immune cells into the lungs. One of these cell types is neutrophils, and a higher abundance of neutrophils in the lungs is associated with severe, chronic asthma which can be unresponsive to current treatments such as inhaled corticosteroids. Patients with treatment-unresponsive severe asthma represent 10-15% of all asthmatics but account for over 50% of healthcare-associated costs. This is due to more severe and more frequent exacerbations, requiring hospitalizations and emergency medications. Previous studies have shown that asthma prevalence and severity exhibit a sex bias, being more severe in adult females. In particular, asthma associated with neutrophilic airway inflammation is skewed towards adult females. However, the specific differences between males and females, especially in the immune response against common asthma-associated allergens which drive inflammation, are not well understood. Therefore, the overall goal of my project was to characterize sex-related differences in the steroid-unresponsive allergen recall response. To do so, I utilized a mouse model sensitized with a combination of a common allergen (house dust mite) and low concentration of lipopolysaccharide, which following allergen recall challenge induces a neutrophil-skewed airway inflammation with enhancement of cytokines related to steroid-unresponsive asthma. I examined the accumulation of immune cells within the bronchoalveolar lavage fluid (BALF), cytokine profiles within both BALF and lung tissue, and performed independent validation of select cytokine targets using ELISA. I measured neutrophil activity by assessing abundance of neutrophil activation markers and examined HDM-specific IgE levels in serum. My results showed that neutrophil accumulation is greater in females, along with IL-17 and IL-33 levels in the lungs, compared to males in response to allergen. Thus, females demonstrated a heightened immune response associated with steroid-unresponsive severe asthma. I also examined the relationship between sex steroids and neutrophil chemoattractant production by human bronchial epithelial cells. My findings suggested that sex steroids by themselves are not sufficient for differential production of neutrophil chemoattractants in bronchial epithelial cells. Overall, understanding sex-related differences in steroid-unresponsive airway inflammation will help to develop new strategies to control severe asthma. My project highlights the importance of biological sex as a variable in biomedical research.Canadian Institutes of Health Research (CIHR): Canada Graduate Scholarships - Master's (CGS-M)October 202
What factors are associated with the research productivity of primary care researchers in Canada? A qualitative study
No full textBackground
Research evidence to inform primary care policy and practice is essential for building high-performing primary care systems. Nevertheless, research output relating to primary care remains low worldwide. This study describes the factors associated with the research productivity of primary care researchers.
Methods
A qualitative, descriptive key informant study approach was used to conduct semi-structured interviews with twenty-three primary care researchers across Canada. Qualitative data were analyzed using reflexive thematic analysis.
Results
Twenty-three primary care researchers participated in the study. An interplay of personal (psychological characteristics, gender, race, parenthood, education, spousal occupation, and support), professional (mentorship before appointment, national collaborations, type of research, career length), institutional (leadership, culture, resources, protected time, mentorship, type), and system (funding, systematic bias, environment, international collaborations, research data infrastructure) factors were perceived to be associated with research productivity. Research institutes and mentors facilitated collaborations, and mentors and type of research enabled funding success. Jurisdictions with fewer primary care researchers had more national collaborations but fewer funding opportunities. The combination of institutional, professional, and system factors were barriers to the research productivity of female and/or racialized researchers.
Conclusions
This study illuminates the intersecting and multifaceted influences on the research productivity of primary care researchers. By exploring individual, professional, institutional, and systemic factors, we underscore the pivotal role of diverse elements in shaping RP. Understanding these intricate influencers is imperative for tailored, evidence-based interventions and policies at the level of academic institutions and funding agencies to optimize resources, promote fair evaluation metrics, and cultivate inclusive environments conducive to diverse research pursuits within the PC discipline in Canada
Translating Interprofessional Education to Practice: The experiences of Physician Assistants within the first years of practice
No full textIn response to the importance and demand of interprofessional collaboration (IPC) in healthcare settings, the World Health Organization acknowledged the need for Interprofessional Education (IPE) when training healthcare professionals. The University of Manitoba (U of M) implemented an IPE course to physician assistant (PA), medical, dentistry, nursing, pharmacy, and rehabilitation sciences students in 2016. Since then, no studies have been conducted to determine whether the IPC program impacted the practice of working PAs. We distributed the Interprofessional Socialization and Valuing Scale (ISVS) survey to graduate PAs from U of M Master of Physician Assistant Studies (MPAS) who did and did not complete a curriculum-integrated IPC course (classes of 2010-2022). The results were compared to ISVS surveys completed by MPAS graduates during their training (classes of 2018-2022) using the Mann-Whitney U-test. From the ISVS part A questions, “I feel comfortable in accepting responsibility delegated to me within a team” had a significant difference between the two groups of practicing PAs (p=0.024). From the part B questions, “I have gained an enhanced awareness of my own role on a team” (p=0.003) and “I feel comfortable being the leader in a team situation” (p=0.002) were significant between the three groups. Although the study did not provide conclusive answers regarding IPE during the MPAS curriculum, practicing PAs who completed IPE were shown to have gained an enhanced awareness of their role on a team. This is consistent with studies demonstrating that IPE can enhance a students’ knowledge of their role within a multidisciplinary team, as well as the roles of other healthcare professionals
Le patriarcat et la marginalisation de la femme chez Amadou Amal et Samia Sharrif
No full textThis master’s thesis focuses on patriarchy and its consequences for young female protagonists in Les impatientes de Djailli Amadou Amal and Le voile de la peur by Samia Sharrif. Focusing on on the concept of patriarchy across different aspects of feminism, including Islamic feminism, this thesis examines the oppression and violence faced by young Muslim women in their respective families. The thesis is divided into three chapters. The first chapter examines various trends of feminism, and the concept of patriarchy as explained by Solati Fariba and Samuel Okafor. The second chapter focuses on the institution of patriarchal order in Les impatientes and Le voile de la peur. This chapter is divided into two parts. In the first part, we examine the impact of the Muslim religion on the lives of young girls. We discuss religion as a tool for manipulation and violence. Secondly, we examine the hierarchical family structure and gender inequality in both texts. Our last chapter deals with the consequences of patriarchy and the resilience of female characters in both texts. In this chapter, we analyze the suppression of young women’s aspirations in texts, polygamy as a consequence of patriarchy and finally, the impact of patriarchy on the mental health of young girls and their various ways of resisting the patriarchal system. This resistance to patriarchy allows these young women toFebruary 202
Three essays on the labour market integration of immigrants in Canada
No full textThe first chapter “Family Immigration Policy and Women’s Employment” co-authored with Dr. Janice Compton examined the impact of a change in Canadian immigration policy on women’s employment. We use the Canadian Longitudinal Administrative Database (LAD) and a triple difference model to estimate the impact of a policy shift away from family-based immigration on the employment of immigrant women previously arrived. The results indicate that the reduction in family class immigration resulted in participation rates for immigrant mothers with young children that were 2.4 to 14.8 percentage points lower than expected.
The second chapter “Internal Migration and Economic Outcomes: Evidence Among Young Adult Immigrants’’ employs the Canadian Longitudinal Immigration Database (IMDB) to estimate the impact of parental internal migration on the economic outcomes of young adult immigrants. I use Heckman's two-stage selection model and a linear probability model to estimate the coefficients. The results show that internal migration reduces employment earnings by 8.9 percentage change and increases the probability of low-income status by 3.5 percentage points among young adults whose parents entered the country through the refugee program, compared to those who entered through the economic class program.
The final chapter “Requirements for Credential Recognition and Economic Outcomes of International Medical Graduates’’ employs information and data sources from the websites of the Colleges of Physicians and Surgeons of Canada, email correspondences, and Statistics Canada’s Longitudinal Administrative Database (LAD) to address two research questions on IMGs in Canada. A review of medical regulations for IMGs across the ten provinces in Canada suggests a protectionist motive behind these regulations. The second question examines the economic outcomes of immigrant IMGs in Canada. Analysis of the trends in the growth rate of employment earnings of immigrant IMGs from the first to the twentieth year in Canada shows an overall upward trend (except New Brunswick and Manitoba), with occasional fluctuations and periods of both increase and decrease. Regression results indicate a correlation between the province of residence and both the probability of positive employment income and employment earnings.May 202
Bone quality, bone loss and biomechanics in the second metacarpals of medieval and post-medieval Danes
No full textSet amidst Denmark’s tumultuous medieval and post-medieval periods, and using computer tomographic (CT) images, the cross-sectional properties of human second metacarpals were assessed for strength, rigidity, bone quality and age-related cortical bone loss. These parameters were evaluated across time (medieval/post-medieval), space (rural/urban), age and sex in two skeletal samples-the rural cemetery of Tirup (12th-14th century) and the urban cemetery of Black Friars (13th-17th century).
Temporal shifts in urban conditions (social status, nutrition) contributed to decreased bone volume in young post-medieval males. Such influences were less pronounced in young females. Lower bone volume in older medieval males was linked to the presence of mendicant friars. Changes in behavioural parameters (total area and Imax) were consistent with a change in women’s activities by the post-medieval period. Consistencies in these parameters among males reflected a temporal consistency in their activity.
Greater medullary area in young urban females indicated improved rural health and nutrition. Similarities among young males suggested improved rural health and higher urban socioeconomic status. Active lifestyles conserved bone mass in older rural males, while the friar’s lifestyle contributed to pronounced bone loss in medieval males. Older rural and urban females were comparable likely due to inadequate samples. No inter-site differences in behavioural parameters were observed in males or females, at any age, suggesting similar mechanical loading between rural and urban settings.
Age-related findings at Tirup and post-medieval Black Friars (PMBF) suggested that active lifestyles mitigated age-related bone loss. Overall, despite cortical bone loss, strength and rigidity were maintained by the redistribution of bone mass along the central diaphyseal axis. At Tirup, behavioural parameters implied age-based divisions of labour.
Sex-based comparisons revealed reduced bone volume in young females across all sites likely due to reproductive history. Menopause-induced bone loss was detected in older PMBF females. At Tirup and medieval Black Friars, greater age-related bone loss occurred in males likely due to limited samples of older females. Biomechanical evidence indicated a sexual division of labour in younger individuals at PMBF and in all age categories at Tirup. At medieval BF biomechanical evidence implies a similar history of mechanical loading for the sexes.SSHRC insight grant awarded to Dr. Hoppa (#435-2017-729)
Senator Thomas Alexander Crerar ScholarshipMay 202
Choice, risk, and responsibility in Manitoba’s self and family managed home care program
No full textEnhancing choice in home care has become part of a national discourse that aligns with aging in place strategies. Choice in home care is best realized through the mechanism of direct funding (DF), where the client and/or a family member is given funding to make their own decisions about their care services. Having more choice is generally accepted as automatically beneficial, but choice also involves making decisions and accepting any risks involved in taking on that responsibility. The literature indicates there are several benefits for working-age adults who take responsibility for their own care, but there are a number of gaps in our understanding of the ways older adults and their caregivers experience having more choice over their home care services. The objectives of this dissertation are to identify whether and how having choice in home care may have policy implications, and to explore and describe experiences of choice, risk, and responsibility among clients and families using DF home care. This is a thesis by publication presenting findings from three qualitative studies conducted in the context of Manitoba’s home care system. Each study examines different aspects of choice and risk and each uses different means of collecting and analyzing data. Nevertheless, all three studies are conceptually linked by the overall research objective and are philosophically linked by feminist care ethics following Tronto’s political ethics of care and Mol’s logic of care. Together, the research presented in this dissertation provides new insight into the way clients and families experience the responsibilities and risks of having choice in home care. This dissertation concludes with a set of recommendations to improve home care services in Manitoba.May 202
Investigation of the impacts of hybrid substrates and compaction on the properties of mycelium-based materials
No full textExpanded polystyrene (EPS) is a type of plastic packaging widely used by the packaging industry for over 50 years. However, EPS has posed a threat to our environment, including depletion of natural resources, greenhouse gas emissions, and difficulty in degrading in the natural environment. Since 2016, many countries have passed legislation prohibiting the use of EPS worldwide. Therefore, academia and the packaging industries actively seek alternatives.
Mycelium-based materials (MBMs) have gradually gained attraction due to their sustainability and foam-like characteristics. However, concerns about the physical and mechanical properties of MBMs and the availability and cost of substrates have made both the packaging industry and customers hesitant to adopt them. This study aimed to address these concerns by upcycling waste paper and blending it with hemp hurds to reduce costs and improve certain properties. The compaction method was also explored in the study to enhance the MBMs’ properties.
In the study, lower-value waste paper, a more readily available and cost-effective resource, was blended with hemp hurds to create MBMs. The physical and mechanical characteristics of the resulting samples were assessed and compared to those made of pure hemp substrates. The results showed that samples based on hybrid substrates had higher density, appeared to have better water resistance at 60% but worse at 80% RH than pure hemp hurds-based samples, but had higher values of compressive strength and Young’s modulus than those made of pure hemp hurds.
In addition, the compaction method before the cultivation was used for seven protocols, and its effects on the properties of final products were assessed, with compacted and uncompacted samples for each protocol. Dry density, water absorption, and compressive properties were compared between samples with compaction and those without compaction. Compacted samples showed a 9.57-34.29% increase in dry density, a 28.57-129.63% increase in compressive strength at 10% strain, and a 37.32-139.42% increase at 35% strain, and a 27.66-142.35% increase in compressive Young’s modulus. The impact of compaction on the water absorption of samples varied depending on the samples’ recipes in this study.October 202