Student internships and work placements: approaches to risk management in higher education.

The increased use of student internships and other forms of work placements in higher education programmes brings recognised benefits to students but also changes the risks for higher education institutions (HEIs) globally. This paper responds to the under-addressed problem for HEI managers of understanding the varying levels of risk of harm to students and HEIs, and the HEIs' strategic responsibilities to understand how to mitigate the risk for both parties. We develop a typology of the main types of internship placements and theorise their associated levels of risk according to the HEI's levels of responsibility and operational control. The risk types are then plotted in a model of risk mitigation, mapped against the frequency of their occurrence and the severity of their impact, with a focus on HEIs and students. We conclude with practical and policy implications for HEIs and their managers. Our paper argues that HEIs must balance their risks and responsibilities with the costs and benefits of student internships and work placements, and contributes to understanding potential gaps between HEI strategic decision-making and operational practice at the programme level, along with solutions to address these.

Spatial control of oxygen delivery to three-dimensional cultures alters cancer cell growth and gene expression.

Commonly used monolayer cancer cell cultures fail to provide a physiologically relevant environment in terms of oxygen delivery. Here, we describe a three-dimensional (3D) bioreactor system where cancer cells are grown in Matrigel in modified six-well plates. Oxygen is delivered to the cultures through a polydimethylsiloxane (PDMS) membrane at the bottom of the wells, with microfabricated PDMS pillars to control oxygen delivery. The plates receive 3% oxygen from below and 0% oxygen at the top surface of the media, providing a gradient of 3-0% oxygen. We compared growth and transcriptional profiles for cancer cells grown in Matrigel in the bioreactor, 3D cultures grown in 21% oxygen, and cells grown in a standard hypoxia chamber at 3% oxygen. Additionally, we compared gene expression of conventional two-dimensional monolayer culture and 3D Matrigel culture in 21% oxygen. We conclude that controlled oxygen delivery may provide a more physiologically relevant 3D system.

Patient Relations Measurement and Reporting to Improve Quality and Safety: Lessons from a Pilot Project.

BACKGROUND: Effective patient relations can improve the patient experience and the safe delivery of care. Recent Ontario policy and legislative changes have increased accountabilities for healthcare organizations and expanded Health Quality Ontario's mandate to measure and report on patient relations. The purpose of this pilot project was to support improved care by validating standardized measures, data submission processes and prototype reporting of patient relations indicators for the hospital, home and community care and long-term care sectors across Ontario. METHODS: Health Quality Ontario identified potential indicators and best practices by performing a comprehensive environmental scan and consulting with experts, including patients and caregivers. It shortlisted indicators based on alignment to best practices and Ontario legislative requirements. A provincial advisory group then used a modified Delphi process to prioritize and recommend five patient relations indicators for province-wide measurement and comparative public reporting. Through the pilot project, these indicators were validated using facility-level data for fiscal year (FY) 2015-2016 from 29 hospitals, home and community care organizations and long-term care homes across Ontario. RESULTS: In June 2016, Health Quality Ontario recruited 34 organizations for the pilot project. Twenty-nine sites successfully submitted summary-level data on patient relations indicators. More than 90% of the required data were retrieved from existing papers or electronic systems. All sites mapped facility-level "complaint" and "action taken" categories to the provincial standardized categories. Across the three health sectors, "care and treatment" was the top complaint category in FY 2015-2016. CONCLUSIONS: This pilot project reinforced the value of measuring patient relations and reporting feedback to support facility- and system-level improvement. The pilot sites and provincial advisory group recommended phased implementation. This would permit healthcare organizations to standardize data collection and align with provincial indicators and categories. The next step would be voluntary data submission to Health Quality Ontario in advance of any reporting. To facilitate voluntary implementation, Health Quality Ontario included one indicator, "complaints acknowledged," in the annual Quality Improvement Plans beginning in FY 2018-2019. This will allow organizations to monitor and report on the percentage of complaints acknowledged within 2, 5 and 10 days. Implementation will evolve based on input from patients, health sector organizations, Local Health Integration Networks and the Patient Ombudsman.

Listening to Improve: Transforming Patient Relations Measurement and Reporting in Ontario.

Effective patient relations are important to improve patient experience and deliver better care. Policy and legislative changes in Ontario have increased accountabilities for patient relations and expanded Health Quality Ontario (HQO)'s mandate. In response, HQO collaborated with patients, health sector organizations, associations and the Ministry of Health and Long-Term Care to co-design a patient relations measurement and reporting approach. Informed by an environmental scan, broad consultations, a multi-sector survey and a provincial advisory group, the approach includes standardized patient relations indicators to support measurement and public reporting across the hospital, home and long-term care sectors. Pilot testing with 29 sites across three sectors will inform province-wide implementation.

Integrated People-Centred Care in Canada - Policies, Standards, and Implementation Tools to Improve Outcomes.

INTRODUCTION: Despite the national and international policy commitment to implement integrated health systems, there is an absence of national standards that support evidence-based design, implementation, and monitoring for improvement. Health Standards Organization (HSO)'s CAN/HSO 76000:2021 - Integrated People-Centred Health Systems (IPCHS) National Standard of Canada (NSC) has been developed to help close this gap. This manuscript outlines the policy context and the process taken to develop the IPCHS standard. DESCRIPTION: The IPCHS standard is built around 10 design principles with detailed, action-oriented criteria and guidance for policy makers and health system partners. The IPCHS standard was co-designed with a technical committee that included balanced representation of policy makers, health system decision-makers, Indigenous leaders, providers, patients, caregivers, and academics. Additional feedback was received from a diverse audience during two public review periods and targeted consultation via interviews. This qualitative feedback, combined with the evidence reviews completed by the technical committee, informed the final content of the IPCHS standard. DISCUSSION: The IPCHS standard was developed through a co-design process and complements existing frameworks by providing 66 detailed, action-oriented criteria, with specific guidance. The co-design process and consultations resulted in increased awareness and capacity among policy makers and health system partners. Supplementary tools are also in development to facilitate implementation and monitoring of progress and outcomes. This manuscript was developed in collaboration with technical committee members and HSO staff who led the targeted consultation and adoption of the IPCHS standard in six integrated care networks. CONCLUSION: Implementing integration strategies requires that we create and sustain a culture of continuous improvement and learning. Key lessons from the development process focused on the importance of co-design, embedding people-centred practices throughout the standard, formal yet iterative methodology inclusive of broad consultation, clear accountability for both policy makers and system partners, tools that support action and can be adapted to local context and level of integrated system maturity.

Prevalence and determinants of oral and cervicogenital HPV infection: Baseline analysis of the Michigan HPV and Oropharyngeal Cancer (MHOC) cohort study.

We determined baseline oral and cervicogenital human papillomavirus (HPV) prevalence and determinants of infection in the Michigan HPV and Oropharyngeal Cancer (MHOC) study. We enrolled 394 college-age and older participants of both sexes in Ann Arbor, Michigan and the surrounding area. All participants provided an oral sample at baseline, and 130 females provided a cervicogenital sample. Samples were tested for 18 HPV genotypes using polymerase chain reaction (PCR) MassArray. Participants filled out sociodemographic and behavioral questionnaires. Prevalence ratios for HPV oral or cervicogenital prevalence by predictor variables were estimated in univariable log-binomial models. Analysis was conducted 2018-20. In the full cohort, baseline oral HPV prevalence was 10.0% for any detected genotype (among the 338 valid oral tests at baseline) and 6.5% for high-risk types, and cervicogenital prevalence was 20.0% and 10.8%, respectively (among the 130 first valid cervicogenital tests). Oral HPV prevalence did not vary by sex, with 10.5% of women and 9.0% of men having an infection. We found a high prevalence of oral and cervicogenital HPV infection in college-age participants reporting no lifetime sexual partners. Reporting a single recent partner was associated with a lower oral HPV prevalence (PR 0.39, 95% CI: 0.16, 0.96) than reporting no recent (but at least one ever) partner. No similar protective effect was seen for cervicogenital HPV. Both oral and cervicogenital prevalence increased with the number of recent partners for most sexual behaviors. We observed an ecological fallacy masking the direction of impact of vaccination on HPV prevalence in the full cohort compared to the college-aged and the age 23+ populations considered separately. Substance use was not significantly associated with oral or cervicogenital HPV infection. Many studies report substantially higher oral HPV infection prevalence in men than in women. That difference may not be uniform across populations in the US.

Data that makes a difference in quality improvements in primary health care: approaches through a pan-Canadian voluntary electronic medical record source.

Primary Health Care (PHC) is the most common health care experienced by Canadians and is an important source of chronic disease prevention and management; however, PHC providers say they have little information about their patient populations, especially groups of patients with multiple conditions. The Canadian Institute for Health Information in collaboration with 50 PHC providers examined the ability to extract and use a subset of PHC EMR data from four disparate environments in an agreed and privacy sensitive manner. Findings describing the feasibility of clinician engagement, EMR data extraction, EMR content standards and data utility gaps, information system requirements, and systemic enablers and barriers are described in this paper. Ability to collect and use discrete and standardized clinical and administrative information is fundamental to improving practice efficiency, optimal use of information, and patient quality of care. Improving quality of EMR data captured at the point of service will considerably enable our ability to measure and understand PHC across Canada; promote dialogue to identify priority information needs; and support health system information uses for clinical program and health system management, research, and population surveillance.

Development of a draft pan-Canadian primary health care electronic medical record content standard.

In collaboration with a broad range of stakeholders, the Canadian Institute for Health Information (CIHI) led the development of the draft pan-Canadian primary health care (PHC) electronic medical record (EMR) content standard to be used in EMR applications across the country to support PHC data capture and information use and improved health system management. To achieve this goal, CIHI initiated the following activities: stakeholder engagement, information requirements gathering and adoption and implementation promotion of the common content standard for wide-spread use. The resulting pan-Canadian standardized data set will allow consistent data capture that will improve understanding and ability to report on PHC utilization and access, chronic disease prevention and management, health promotion, medication usage, patient safety, quality of care including patient safety and outcomes. The standard will improve patient care information by providing the structured comparable information needed to care for patients over time and across the continuum of care. Standards support clinical practice reminders and alerts, improvements in operating efficiencies, onscreen feedback reports to PHC providers and the ability to look at clinical trends over time. This standard will improve the flow of information by providing standardized information to providers at points on the continuum of care leading to better coordination of care and a reduction of repeat tests. Lastly, a common content standard will improve the health system use of data; by enabling aggregation and analysis of comparable standardized health information, clinicians, jurisdictions, and regions can benefit from using this data for more effective planning and policy decisions. The jurisdictions and clinicians, supported by CIHI and Canada Health Infoway will continue to work together with other key stakeholders, such as vendors to support the adoption and implementation of this standard into future jurisdictional EMR vendor specifications.

Opportunities to improve diabetes prevention and care in Canada.

The prevalence of diabetes in Canada is expected to more than double by 2030. Additionally, the costs associated with diabetes have nearly doubled between 2000 and 2010 and will continue to rise unless improvements are made. Fortunately, more effective policies and programs can reduce both the prevalence of diabetes and the complications associated with the disease. We used responses from the Canadian Community Health Survey to assess whether Canadians with diabetes report (1) receiving from healthcare professionals the recommended tests to screen for complications, (2) performing sufficient self-care for their diabetes and, (3) for those in lower-income households, receiving less recommended care. The results show that only one in three (32%) Canadian adults with diabetes reported having received all four recommended tests during the previous year. Lower-income Canadians were more likely to report having diabetes and less likely to report receiving the four diabetes care tests. Only half of adults with diabetes reported checking their blood sugar levels daily, and only two in five reported checking their feet for injuries and ulcers. Improvements to adherence to diabetes care guidelines are needed to reduce the likelihood that Canadians, especially lower-income Canadians, will develop complications from diabetes. Bending the cost curve downward is possible through more effective policies and programs that prevent diabetes in the first place and that ensure Canadians with diabetes get both recommended care from their healthcare providers and enough support for effective self-care.

Surgical caps displaying team members' names and roles improve effective communication in the operating room: a pilot study.

BACKGROUND: Teamwork in the operating theatre is a complex emergent phenomenon and is driven by cooperative relationships between staff. A foundational requirement for teamwork is the ability to communicate effectively, and in particular, knowing each other's name. Many operating theatre staff do not know each other's name, even after formal team introductions. The use of theatre caps to display a staff member's name and role has been suggested to improve communication and teamwork. METHODS: We hypothesized that the implementation of scrub hats with individual team members' names and roles would improve the perceived quality and effectiveness of communication in the operating theatre. A pilot project was designed as a pre-/post-implementation questionnaire sent to 236 operating room staff members at a general hospital in suburban Melbourne, Victoria, Australia, between November 6 to December 18, 2018. Participants included medical practitioners (anaesthetists, surgeons, obstetricians and gynaecologists), nurses (anaesthetic, scrub/scout and paediatric nurses), midwives and theatre technicians. The primary outcome was a change in perceived teamwork score, measured using a five position Likert scale. RESULTS: Of 236 enrolled participants, 107 (45%) completed both the pre and post intervention surveys. The median perceived teamwork response of four did not change after the intervention, though the number of low scores was reduced (p = 0.015). In a pre-planned subgroup analysis, the median perceived teamwork score rose for midwives from three to four (p < 0.001), while for other craft groups remained similar. The median number of staff members in theatre that a participant did not know the name of reduced from three to two (p < 0.001). Participants reported knowing the names of all staff members present in the theatre more frequently after the intervention (31% vs 15%, p < 0.001). The reported rate of formal team introductions was not significantly different after the intervention (34.7% vs 47.7% p = 0.058). CONCLUSIONS: In this study, we found that wearing caps displaying name and role appeared to improve perceived teamwork and improve communication between staff members working in the operating theatre.

Permafrost Dynamics Observatory-Part I: Postprocessing and Calibration Methods of UAVSAR L-Band InSAR Data for Seasonal Subsidence Estimation.

Interferometric synthetic aperture radar (InSAR) has been used to quantify a range of surface and near surface physical properties in permafrost landscapes. Most previous InSAR studies have utilized spaceborne InSAR platforms, but InSAR datasets over permafrost landscapes collected from airborne platforms have been steadily growing in recent years. Most existing algorithms dedicated toward retrieval of permafrost physical properties were originally developed for spaceborne InSAR platforms. In this study, which is the first in a two part series, we introduce a series of calibration techniques developed to apply a novel joint retrieval algorithm for permafrost active layer thickness retrieval to an airborne InSAR dataset acquired in 2017 by NASA's Uninhabited Aerial Vehicle Synthetic Aperture Radar over Alaska and Western Canada. We demonstrate how InSAR measurement uncertainties are mitigated by these calibration methods and quantify remaining measurement uncertainties with a novel method of modeling interferometric phase uncertainty using a Gaussian mixture model. Finally, we discuss the impact of native SAR resolution on InSAR measurements, the limitation of using few interferograms per retrieval, and the implications of our findings for cross-comparison of airborne and spaceborne InSAR datasets acquired over Arctic regions underlain by permafrost.

Atrioventricular Block in Pregnancy: 15.8 Seconds of Asystole.

Atrioventricular (AV) block in pregnancy is infrequently encountered and there is little management guidance available. We present a case of a 24-year-old G3P1011 at 24 weeks' gestation who presented to the obstetrics and gynecology clinic complaining of palpitations, fatigue, and dyspnea on exertion. Cardiology workup including an electrocardiogram (ECG) and Holter monitor detected second-degree type II (Mobitz) AV block with the longest asystole event lasting 15.8 seconds.  A St. Jude's dual-chamber pacemaker (Abbott Laboratories, Abbott Park, IL) was implanted immediately. Standard radiation precautions were taken with additional shielding for the fetus. The patient experienced significant improvement in her symptoms. The patient went into labor at 37 3/7 weeks. Due to non-reassuring fetal heart tones, a cesarean section was performed, and a healthy baby girl was born.  The management of heart block in pregnancy can be divided into involving those who are symptomatic and those who are asymptomatic. Symptoms of heart block can include palpitations, fatigue, dyspnea, and/or syncope; the presence of these symptoms warrants the placement of a pacemaker, preferably during pre-pregnancy or during the first two trimesters, as high-grade heart block is associated with significant mortality. Those who are in their last trimester or postpartum should consider the use of a temporary pacemaker as heart block could be due to pregnancy-related cardiovascular changes.  For women with heart block, labor and delivery could result in worsening of bradycardia due to uterine contractions displacing blood into the central circulation. Most women with heart block do well in labor and delivery and having a pacemaker is not necessarily an indication for a cesarean section.

Capturing pan-Canadian Primary Health Care indicator data using multiple approaches for data collection.

The Canadian Institute for Health Information (CIHI), in collaboration with diverse stakeholders, led the development of pan-Canadian indicators to measure primary health care. In 2006, CIHI released a set of 105 pan-Canadian Primary Health Care (PHC) indicators that were developed with the assistance of national, provincial and territorial representatives, clinicians and researchers. Additionally, data gaps were identified in a series of reports. In 2006 and 2007, CIHI assessed options for closing the data gaps so that the indicators could be measured and reported. CIHI then began a program to build the data infrastructure needed for the PHC indicators. The program included the development of content standards for electronic medical records, a prototype of a voluntary reporting system, enhancements to surveys, and the development of reports. In 2006, fewer than 10% of the 105 indicators could be calculated with existing data sources. Now, four projects have begun and over 50% of the indicators are being captured. Important relationships have been established with key collaborators. These relationships will lead to the development of a reporting system prototype and to the refinement of PHC indicators and electronic medical record (EMR) content standards. The project for pan-Canadian PHC indicators has encouraged consultation and synergy. It has motivated CIHI to establish an information program to fill data gaps and to make PHC indicators available.

Development of electronic medical record content standards to collect pan-Canadian Primary Health Care indicator data.

In 2006 the Canadian Institute for Health Information (CIHI) released a set of 105 pan-Canadian Primary Health Care (PHC) indicators. This was followed by an assessment of data gaps, which prevented the calculation of the indicators, and the data collection options available to close the gaps. A quality review of Electronic Medical Record (EMR) data indicated a requirement for content standards. In order to assist the provinces as they developed requests for proposal for PHC-based EMRs, the EMR content standards project was born. Considerable effort was made to identify standards for the Electronic Health Record (EHR) including existing national and international EHR content. As well, CIHI attempted to align the content standards with those of other projects such as the Physician Office System Requirements (POSR). The outcome of this project was a set of EMR content standards for 12 pan-Canadian PHC indicators. The standards will be used to develop a prototype of a PHC reporting system that collects and analyzes data to generate clinical quality indicators for regional and longitudinal comparisons. In late 2008, CIHI will release the pan-Canadian PHC Core Reporting Data Set. This project has developed EMR content standards to better understand PHC in Canada.

Comparison of Compressive Myofascial Release and the Graston Technique for Improving Ankle-Dorsiflexion Range of Motion.

CONTEXT: Restricted dorsiflexion (DF) at the ankle joint can cause acute and chronic injuries at the ankle and knee. Myofascial release and instrument-assisted soft tissue mobilization (IASTM) techniques have been used to increase range of motion (ROM); however, evidence directly comparing their effectiveness is limited. OBJECTIVE: To compare the effects of a single session of compressive myofascial release (CMR) or IASTM using the Graston Technique (GT) on closed chain ankle-DF ROM. DESIGN: Randomized controlled trial. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: Participants were 44 physically active people (53 limbs) with less than 30° of DF. INTERVENTION(S): Limbs were randomly assigned to 1 of 3 groups: control, CMR, or GT. Both treatment groups received one 5-minute treatment that included scanning the area and treating specific restrictions. The control group sat for 5 minutes before measurements were retaken. MAIN OUTCOME MEASURE(S): Standing and kneeling ankle DF were measured before and immediately after treatment. Change scores were calculated for both positions, and two 1-way analyses of variance were conducted. RESULTS: A difference between groups was found in the standing ( F2,52 = 13.78, P = .001) and kneeling ( F2,52 = 5.85, P = .01) positions. Post hoc testing showed DF improvements in the standing position after CMR compared with the GT and control groups (both P = .001). In the kneeling position, DF improved after CMR compared with the control group ( P = .005). CONCLUSIONS: Compressive myofascial release increased ankle DF after a single treatment in participants with DF ROM deficits. Clinicians should consider adding CMR as a treatment intervention for patients with DF deficits.

Dynamics and Determinants of HPV Infection: The Michigan HPV and Oropharyngeal Cancer (M-HOC) Study.

INTRODUCTION: Human papillomavirus (HPV) is the primary cause of cervical and other anogenital cancers and is also associated with head and neck cancers. Incidence of HPV-related oropharyngeal squamous cell cancers (OPSCCs) is increasing, and HPV-related OPSCCs have surpassed cervical cancer as the most common HPV-related cancer in the USA. Given the multisite nature of HPV, there is strong interest in collecting data from both genital and oral sites, as well as associated data on social and sexual behaviours. The overarching goal of this study is to evaluate patterns of oral HPV infection incidence, clearance and persistence and their relationship to sexual behaviour history. METHODS AND ANALYSIS: Participants are recruited from two populations: college students at a large public university and general population from the surrounding area. At the first study visit, participants complete a detailed sexual history, health and behaviour questionnaire. Follow-up visits occur every 3-4 months over 3 years, when participants complete an abbreviated questionnaire. All participants provide a saliva sample at each visit, and eligible participants may provide a cervicovaginal self-swab. Genetic material isolated from specimens is tested for 15 high-risk and 3 low-risk HPV types. Statistical analyses will examine outcome variables including HPV prevalence, incidence, persistence and clearance. Logistic regression models will be used to estimate odds ratios and 95% confidence intervals for associations between the outcomes of interest and demographic/behavioural variables collected in the questionnaires. The longitudinal HPV infection data and detailed sexual history data collected in the questionnaires will allow us to develop individual-based network models of HPV transmission and will be used to parameterise multiscale models of HPV-related OPSC carcinogenesis. ETHICS AND DISSEMINATION: This study has been approved by the University of Michigan Institutional Review Board. All participants are consented in person by trained study staff. Study results will be disseminated through peer-reviewed publications.

Stepping Up to the Plate: An Agenda for Research and Policy Action on Electronic Medical Records in Canadian Primary Healthcare.

Building on a previous study, which identified gaps in primary healthcare electronic medical record (emr) research and knowledge, a one-day conference was held to facilitate a strategic discussion of these issues. This paper offers a multi-faceted research agenda and suggestions for policy actions as a way forward in bridging the gaps. one facet focuses on the need for research. The second facet focuses on harnessing the knowledge of primary healthcare emr stakeholders. finally, the third facet focuses on policy actions. this paper offers consensus-based suggestions with a view to improving the overall primary healthcare emr landscape in canada.