The tyrosine transporter of Toxoplasma gondii is a member of the newly defined apicomplexan amino acid transporter (ApiAT) family.

Apicomplexan parasites are auxotrophic for a range of amino acids which must be salvaged from their host cells, either through direct uptake or degradation of host proteins. Here, we describe a family of plasma membrane-localized amino acid transporters, termed the Apicomplexan Amino acid Transporters (ApiATs), that are ubiquitous in apicomplexan parasites. Functional characterization of the ApiATs of Toxoplasma gondii indicate that several of these transporters are important for intracellular growth of the tachyzoite stage of the parasite, which is responsible for acute infections. We demonstrate that the ApiAT protein TgApiAT5-3 is an exchanger for aromatic and large neutral amino acids, with particular importance for L-tyrosine scavenging and amino acid homeostasis, and that TgApiAT5-3 is critical for parasite virulence. Our data indicate that T. gondii expresses additional proteins involved in the uptake of aromatic amino acids, and we present a model for the uptake and homeostasis of these amino acids. Our findings identify a family of amino acid transporters in apicomplexans, and highlight the importance of amino acid scavenging for the biology of this important phylum of intracellular parasites.

Building and Sustaining a Culture of Innovation in an Academic Health Centre.

Although innovative organizations have the advantage of superior performance, the idea of adopting innovative practices and embracing risk taking at work can be intimidating, especially for those working in healthcare. When responsible for the health and safety of others, healthcare workers tend to gravitate away from ideas that could result in failure. The challenge of promoting innovation in a healthcare context can be addressed by creating an organizational culture of innovation - where innovative thinking is normalized, rewarded and even expected of employees. In this article, we share our journey and outline lessons learned in creating a culture of innovation at Holland Bloorview, Canada's largest pediatric rehabilitation hospital. It is our hope that those seeking to create a culture of innovation within their organization can learn from and apply these lessons in their own contexts.

A design thinking approach to evaluating interprofessional education.

The complex challenge of evaluating the impact of interprofessional education (IPE) on patient and community health outcomes is well documented. Recently, at the Radcliffe Institute for Advanced Study in the United States, leaders in health professions education met to help generate a direction for future IPE evaluation research. Participants followed the stages of design thinking, a process for human-centred problem solving, to reach consensus on recommendations. The group concluded that future studies should focus on measuring an intermediate step between learning activities and patient outcomes. Specifically, knowing how IPE-prepared students and preceptors influence the organisational culture of a clinical site as well as how the culture of clinical sites influences learners' attitudes about collaborative practice will demonstrate the value of educational interventions. With a mixed methods approach and an appreciation for context, researchers will be able to identify the factors that foster effective collaborative practice and, by extension, promote patient-centred care.

BDNF deletion or TrkB impairment in amygdala inhibits both appetitive and aversive learning.

Brain-derived neurotrophic factor (BDNF) is known to have an integral role in establishing stable memories after learning events. The neuroplasticity induced by Pavlovian fear conditioning has likewise been shown to rely on interactions between BDNF and its principal receptor, tyrosine kinase receptor B (TrkB), in the amygdala after training. Although the necessity of amygdala bdnf expression and TrkB activation for associative learning within aversive contexts has been explored, it is unclear to what extent this interaction is involved in appetitive learning. It is also unclear whether the noted increases in amygdala BDNF after fear conditioning are due to local gene transcription and translation or anterograde transmission from cortical regions. To address both of these questions, we used two lentiviral approaches in mice, using both fear conditioning and cocaine-conditioned place preference (CPP), during acquisition and extinction. First, we decreased expression of bdnf mRNA in the amygdala of homozygous floxed mice with a Cre-expressing virus. In a second set of studies, we infused a virus that expressed a dominant-negative TrkB isoform into the same region. These approaches significantly impaired consolidation of fear conditioning and cocaine-CPP, as well as extinction of CPP. Together, these data suggest that BDNF-TrkB signaling is critical for amygdala-dependent learning of both appetitive and aversive emotional memories.

Simulation for System Change: Holland Bloorview's Experience Using Simulation to Enhance the Use of Technology at the Point-Of-Care.

Simulation has the potential to invigorate teaching practices, facilitate professional development and impact client care. However, there is little literature on using simulation at the level of organizational change in healthcare. In this paper, the authors explore Holland Bloorview Kids Rehabilitation Hospital's experience using simulation to enhance the use of technology at the point-of-care. The simulation event demonstrated documentation using technology in two typical practice environments and allowed learners to discuss the challenges and opportunities. Participant feedback was positive overall, and this article reveals important lessons to support the future use of simulation as an educational tool for organizational change.

Moving from policy to implementation: a methodology and lessons learned to determine eligibility for healthy food financing projects.

Public health obesity prevention experts have recently emphasized a policy systems and environmental change approach. Absent, however, are studies describing how practitioners transition from policy adoption to implementation. In the realm of food policy, financing programs to incentivize healthy food retail development in communities classified as "underserved" are underway at the local, state, and national levels. Implementing these policies requires a clear definition of eligibility for program applicants and policy administrators. This article outlines a methodology to establish eligibility for healthy food financing programs by describing the work of The Food Trust to coadminister programs in 3 distinct regions. To determine program eligibility, qualitative assessments of community fit are needed and national data sources must be locally verified. Our findings have broad implications for programs that assess need to allocate limited public/private financing resources.

Effect of bike lane infrastructure improvements on ridership in one New Orleans neighborhood.

BACKGROUND: Incorporating cycling into daily life is one way to increase physical activity. PURPOSE: This study examined the impact of building new bike lanes in New Orleans to determine whether more people were cycling on the street and with the flow of traffic after bike lanes were built. METHODS: Through direct observation of one intervention and two adjacent streets, observers counted cyclists riding on the street and sidewalk, with and against traffic, before and after installation of the lanes. Data were tallied separately for adults, children, males, females, and by race for each location. RESULTS: There was an increase in cyclists on all three streets after the installation of the bike lanes, with the largest increase on the street with the new lane. Additionally, the proportion of riders cycling with traffic increased after the lanes were striped. CONCLUSIONS: Bike lanes can have a positive impact in creating a healthy neighborhood.

Rethinking programme evaluation in health professions education: beyond 'did it work?'.

CONTEXT: For nearly 40 years, outcome-based models have dominated programme evaluation in health professions education. However, there is increasing recognition that these models cannot address the complexities of the health professions context and studies employing alternative evaluation approaches that are appearing in the literature. A similar paradigm shift occurred over 50 years ago in the broader discipline of programme evaluation. Understanding the development of contemporary paradigms within this field provides important insights to support the evolution of programme evaluation in the health professions. METHODS: In this discussion paper, we review the historical roots of programme evaluation as a discipline, demonstrating parallels with the dominant approach to evaluation in the health professions. In tracing the evolution of contemporary paradigms within this field, we demonstrate how their aim is not only to judge a programme's merit or worth, but also to generate information for curriculum designers seeking to adapt programmes to evolving contexts, and researchers seeking to generate knowledge to inform the work of others. DISCUSSION: From this evolution, we distil seven essential elements of educational programmes that should be evaluated to achieve the stated goals. Our formulation is not a prescriptive method for conducting programme evaluation; rather, we use these elements as a guide for the development of a holistic 'programme of evaluation' that involves multiple stakeholders, uses a combination of available models and methods, and occurs throughout the life of a programme. Thus, these elements provide a roadmap for the programme evaluation process, which allows evaluators to move beyond asking whether a programme worked, to establishing how it worked, why it worked and what else happened. By engaging in this process, evaluators will generate a sound understanding of the relationships among programmes, the contexts in which they operate, and the outcomes that result from them.

Principles-Focused Evaluation: A Promising Practice in the Evaluation of Continuing Professional Development.

ABSTRACT: Outcome-based evaluations still dominate in continuing professional development (CPD) despite the availability of evaluation approaches that address program processes and contexts. Our continued reliance on outcomes-based evaluation fails to respect the importance of complexity and the human element of program planning and implementation. Therefore, it is time that the field of CPD embrace complementary approaches to program evaluation that consider the complexity and maturity of programs and their contexts, while providing credible and relevant information to inform strategic decisions regarding the future of a program. Principles-focused evaluation provides a complement to traditional evaluation approaches through the articulation of a program's values that can be actioned. These "actionable values," known as principles, become the focus of the evaluation for the purposes of program decision-making. This paper describes how one CPD program, designed as a response to growing opioid-related harms, adopted a principles-focused evaluation to inform ongoing iteration of the program. The process used to design the principles, how the principles are informing the transportability of the program, and implications for CPD evaluation are discussed.

Delivery and evaluation of simulations to promote authentic and meaningful engagement in childhood disability research.

BACKGROUND: In 2019, our interdisciplinary team of researchers, family members, and youth co-designed four simulation training videos and accompanying facilitation resources to prepare youth, family members, trainees, and researchers to build the knowledge and skills to engage in patient-oriented research (POR) authentically and meaningfully. Videos covered challenges in aspects of the research process including (1) forming a project team; (2) identifying project objectives and priorities; (3) agreeing on results; and (4) carrying out knowledge translation. METHODS: The purpose of the study was to deliver four simulation training videos across 2 two-hour facilitated workshops with researchers, trainees, and family partners. We evaluated whether the training videos and facilitated discussion of the simulations helped to improve knowledge and attitudes about authentic and meaningful partnership in research and self-perceived ability to engage in POR. An explanatory sequential two-phase mixed methods design was used. Phase 1 (quantitative) included two training workshops and a pre/post-training survey. Phase 2 (qualitative) included two qualitative focus groups. Results of each phase were analyzed separately and then combined during interpretation. RESULTS: Sixteen individuals (including researchers/research staff, trainees, family members, clinicians) took part in this research study. Overall, participants were highly receptive to the training, providing high scores on measures of acceptability, appropriateness, and feasibility. While the training videos and facilitated discussion of the simulations were found to increase participants' knowledge and ability to engage in authentic and meaningful POR, we found no significant change in attitude or intent. Recommendations about the simulation content and delivery were provided to inform for future use. CONCLUSIONS: The simulations were found to be a positive and impactful way for collaborative research teams to build knowledge and ability to engage in authentic and meaningful POR. Recommendations for future work include covering different content areas with varying levels of nuance; and offering the training to stakeholders in a variety of roles, such as those higher-ranked academic positions.

In 2019, our team of researchers, family members, and youth worked together to design and develop four digitally recorded simulation videos that can be used to train youth, caregivers/families, trainees, and researchers to engage with each other in research so that all parties feel supported and valued. This paper describes how the four simulation videos were packaged in the training and then delivered to 16 participants (researchers, trainees, and caregivers/families). We used multiple ways to evaluate the videos and training, including a survey before and after the training, focus groups with participants after the training, and written reflections shared by the training facilitators after the training was finished. We found that the simulation videos increased participants' knowledge on engagement and their self-reported ability to engage in authentic and meaningful patient-oriented research. Participants rated their belief in engagement and their intent to engage in collaborative research highly at the pre-test and this remained consistent at the post-test. Participants liked that the simulations focused on challenges in research engagement and that the training was offered to researchers and family partners together. They provided valuable feedback on what we should change about the simulations, including the content, which should have less exaggerated lessons and to add more topics. They also suggested it would be helpful if stakeholders other than just the research team complete the training in the future, especially those who are in higher positions of academic power.

Effect of changes to the neighborhood built environment on physical activity in a low-income African American neighborhood.

INTRODUCTION: Obesity is a public health problem that is due in part to low levels of physical activity. Physical activity levels are influenced by the built environment. We examined how changes in the built environment affected residents' physical activity levels in a low-income, primarily African American neighborhood in New Orleans. METHODS: We built a 6-block walking path and installed a school playground in an intervention neighborhood. We measured physical activity levels in this neighborhood and in 2 matched comparison neighborhoods by self-report, using door-to-door surveys, and by direct observations of neighborhood residents outside before (2006) and after (2008) the interventions. We used Pearson χ² tests of independence to assess bivariate associations and logistic regression models to assess the effect of the interventions. RESULTS: Neighborhoods were comparable at baseline in demographic composition, choice of physical activity locations, and percentage of residents who participated in physical activity. Self-reported physical activity increased over time in most neighborhoods. The proportion of residents observed who were active increased significantly in the section of the intervention neighborhood with the path compared with comparison neighborhoods. Among residents who were observed engaging in physical activity, 41% were moderately to vigorously active in the section of the intervention neighborhood with the path compared with 24% and 38% in the comparison neighborhoods at the postintervention measurement (P < .001). CONCLUSION: Changes to the built environment may increase neighborhood physical activity in low-income, African American neighborhoods.

Abortion care in the time of COVID-19: an illustration of how to adapt medical care during a pandemic.

Shortly after the first lockdown was announced in March 2020, a comprehensive guideline was released by the Royal College of Obstetrics and Gynaecologists documenting the changes that were acceptable to enable this essential service to continue to provide care to women. Abortion care providers had to act quickly to adapt their services; increasing the use of telemedicine and reducing the number of visits to hospitals and clinics in order to reduce risk to women requesting termination of pregnancy and making safe abortion accessible. Important changes to legislation were paramount in making this possible, as were changes to the tests done prior to an early medical abortion including omission of routine ultrasound scan and blood tests in low risk women. Medication to induce abortion along with analgesia and contraception were sent by post to eligible women to enable early medical abortion at home. Despite some initial concerns, studies have shown these changes to be safe and there is hope amongst abortion care providers that these changes could be here to stay.

The group priority sort: a participatory decision-making tool for healthcare leaders.

Healthcare leaders have long expressed the need to effectively engage all members of their organizations in the process of decision-making. The group priority sort is an innovation in healthcare leadership that supports both consensus building and effective consultation.

Developmental Evaluation: six ways to get a grip on the potential of education scholarship to serve innovation.

In March 2020, COVID-19 challenged health and educational systems across the country. The rapid reallocation of resources to ensure public safety had taken priority over educational obligations. Healthcare students were removed from clinical environments as their learning came to a grinding halt. While academic institutions were pivoting and transforming teaching and learning experiences, students responded to the pandemic with innovation, attending to gaps in patient care. As educators, we must understand how we can further support students and faculty to unleash innovative thinking during a crisis. To begin to address this educational need, academic institutions now have an opportunity to broaden the practice of education scholarship in accordance with best practices to nurture innovation and innovative thinking. What framework can aid us in this endeavor? In times of instability, Developmental Evaluation is an approach that can support the implementation of innovations within medical education. Using an example of an innovation in medical education, we offer six practical tips to begin to use Developmental Evaluation to support and enable learners and faculty in the creation of innovations and contribute to a broader definition of education scholarship.

En mars 2020, la COVID-19 a bouleversé les systèmes de santé et d'éducation de tout le pays. La réaffectation rapide des ressources pour assurer la sécurité du public avait pris le pas sur les obligations éducatives. Les étudiants en santé ont été retirés des environnements cliniques et leur apprentissage a connu un arrêt net. Les établissements universitaires ont introduit des ajustements qui ont transformé les expériences d'enseignement et d'apprentissage. De leur côté, réagissant à la pandémie de manière innovante, les étudiants sont intervenus pour combler les besoins en soins aux patients. Il serait pertinent pour nous, éducateurs, de trouver les façons de mieux aider les étudiants et le corps enseignant à laisser libre cours à leur originalité dans les situations de crise. En vue de répondre à ce besoin éducatif, les établissements universitaires ont l'occasion d'aligner la recherche en éducation sur les meilleures pratiques pour favoriser l'innovation et la pensée novatrice. Quel cadre adopter pour nous aider dans cette entreprise? L'évaluation évolutive fait partie des approches qui peuvent soutenir la mise en œuvre d'innovations dans l'éducation médicale en période d'instabilité. À l'aide d'un exemple d'innovation dans le domaine, nous proposons six conseils pratiques pour faire de l'évaluation évolutive un facilitateur de l'innovation par les apprenants et les enseignants et un levier pour élargir la portée de la recherche en éducation.

Intersections of creativity in the evaluation of the Wilson Centre Fellowship Programme.

OBJECTIVES: Comprehensive programme evaluation frameworks are increasingly important to inform the development of sophisticated programmes that educate the next generation of health professions education researchers. This paper highlights an innovative process undertaken by the Wilson Centre for Research in Education to evaluate its fellowship programme. This process incorporates the principles of programme theory and a framework drawn from the field of organisational development. METHODS: During the iterative and dynamic process of articulating the programme's theory, a hidden tension between structured and unstructured components of the fellowship programme was unearthed. This necessitated a secondary process beyond traditional programme evaluations involving the use of a method called 'Polarity Management®'. RESULTS: The use of this model allowed the team to identify priority actions for balancing both the structured and unstructured components, along with indicators which can serve as an early warning system to alert observers to any imbalance between the components. DISCUSSION: Lessons learned and implications for other health education programming and the practice of programme evaluation are discussed.

From knowledge translation theory to practice: developing an evidence to care hub in a pediatric rehabilitation setting.

Purpose: Ensuring evidence-informed care happens systematically and consistently is not easy in complex health facilities. This paper describes the evolution of knowledge translation infrastructure (Evidence to Care) within a pediatric rehabilitation hospital to address barriers to evidence-informed decision-making and accelerate research uptake to influence clinical care.Methods: Development of Evidence to Care involved a series of steps integrating knowledge translation principles, best evidence and stakeholder needs. Key aspects included: recognizing health system drivers and organizational enablers; establishing organizational structures and processes; building and operationalizing a strategic vision through activities and demonstration projects; and evaluating impact.Results: By way of a fully realized working model, two large-scale demonstration projects aligned with the Knowledge-to-Action Cycle have been completed. Audit findings demonstrate tangible examples of improving healthcare quality through investment in knowledge translation resources, processes and tailored evidence products. Critical enablers of this infrastructure include strong leadership commitment and ongoing direction, a dedicated expert team, alignment with strategic priorities and situated within organizational structures to link research, clinical care and education.Conclusions: With a replicable model, Evidence to Care addresses established health system barriers related to time, resources, skill and knowledge through dedicated knowledge translation specialists and knowledge brokers to facilitate knowledge translation practice.Implications for rehabilitationDeveloping dedicated knowledge translation infrastructure is both novel and relatively new in healthcare.Sharing step by step processes helps other organizations learn from field-tested experiences of what works and what doesn't in a particular setting.Involving stakeholders at all levels of an organization is key to valuing knowledge translation and fostering an evidence-friendly culture.Co-creating tailored knowledge products and planning for dissemination and uptake fosters inter-disciplinary collaboration and joint problem-solving among clients, families and providers.

The impact of an online interprofessional course in disaster management competency and attitude towards interprofessional learning.

A recent national assessment of emergency planning in Canada suggests that health care professionals are not properly prepared for disasters. In response to this gap, an interprofessional course in disaster management was developed, implemented and evaluated in Toronto, Canada from 2007 to 2008. Undergraduate students from five educational institutions in nursing, medicine, paramedicine, police, media and health administration programs took an eight-week online course. The course was highly interactive and included video, a discussion forum, an online board game and opportunity to participate in a high fidelity disaster simulation with professional staff. Curriculum developers set interprofessional competency as a major course outcome and this concept guided every aspect of content and activity development. A study was conducted to examine change in students' perceptions of disaster management competency and interprofessional attitudes after the course was completed. Results indicate that the course helped students master basic disaster management content and raised their awareness of, and appreciation for, other members of the interdisciplinary team. The undergraduate curriculum must support the development of collaborative competencies and ensure learners are prepared to work in collaborative practice.