The Rising Challenge of Training Physician-Scientists: Recommendations From a Canadian National Consensus Conference.

Physician-scientists are individuals who actively participate in patient care, have undergone additional research training, and devote the majority of their time to research. Physician-scientists are traditionally the primary catalysts in bridging the translational gap-that is, the failure to link fundamental new knowledge in the pathobiology of disease with advances in health care and health policy in a timely manner. However, there has been a shift away from training physician-scientists, and financial support for the physician-scientist is diminishing globally, causing the translational gap to grow. Given its socialized health care system and cultural and geographic diversity, Canada can serve as a unique case study in understanding how to address this phenomenon as a national priority. To this end, a Canadian national consensus conference was convened to develop recommendations for training programs and early-career supports for physician-scientists. Five recommendations were generated: (1) Establish an independent, national council whose mandate is to provide pan-Canadian oversight of physician-scientist training programs; (2) develop capacity for funding and mentorship support for physician-scientists; (3) develop coherent networks across a broad range of clinician-scientists, including physician-scientists, to reflect the unique cultural and geographic diversity of Canada and to reflect the interdisciplinarity of health research; (4) ensure that medical school curricula integrate, as a core curriculum feature, an understanding of the scientific basis of health care, including research methodologies; and (5) ensure that the funding of the physician-scientist trainee is viewed as portable and distinct from the operational funding provided to the training program itself.

The Future of Postgraduate Medical Education in Canada.

The Future of Medical Education in Canada Postgraduate (FMEC PG) Project was launched in 2010 by a consortium of four organizations: the Association of Faculties of Medicine of Canada, the Collège des Médecins du Québec, the College of Family Physicians of Canada, and the Royal College of Physicians and Surgeons of Canada. The FMEC PG study set out to review the state of the Canadian postgraduate medical education (PGME) system and make recommendations for improvements and changes. The extensive process included literature reviews, commissioned papers, stakeholder interviews, international consultations, and dialogue with the public and learners. The resulting key findings and 10 recommendations, published in a report in 2012, represent the collective vision of the consortium partner organizations for PGME in Canada. Implementation of the recommendations began in 2013 and will continue beyond 2016.In this article, the authors describe the complex process of developing the recommendations, highlight several recommendations, consider implementation processes and issues, and share lessons learned to date. They reflect on the ways in which the transformation of a very complex and complicated PGME system has required many stakeholders to work together on multiple interventions simultaneously. Notwithstanding the challenges for the participating organizations, changes have been introduced and sustainability is being forged. Throughout this process, the consortium partners and other stakeholders have continued to address the social accountability role of all physicians with respect to the public they serve.

Spontaneous rupture of a rare adrenal artery aneurysm mimicking a ruptured abdominal aortic aneurysm.

Spontaneous adrenal artery aneurysm rupture is an exceedingly rare but life-threatening condition that requires emergent treatment. We report on an 80-year-old male who underwent an emergent exploratory laparotomy and repair of a ruptured adrenal artery aneurysm and highlight the role of both vascular surgery and interventional radiology in the management of this scenario.

Electrostatic layer-by-layer assembly of CdSe nanorod/polymer nanocomposite thin films.

Electrostatic layer-by-layer assembly was the basis for the synthesis of multilayer nanorod/polymer composite films. Cationic and water-soluble CdSe nanorods (NRs) were synthesized and partnered with anionic polymers including poly(sodium 4-styrenesulfonate) (PSS) and two polythiophene-based photoactive polymers, sodium poly[2-(3-thienyl)-ethoxy-4-butylsulfonate (PTEBS) and poly[3-(potassium-6-hexanoate)thiophene-2,5-diyl] (P3KHT). Controlled multilayer growth is shown through UV-vis spectroscopy, cross-sectional SEM and surface analytical techniques including atomic force microscopy. The formation of an intimate nanorod/conducting polymer bulk heterojunction is confirmed through cross-sectional SEM, TEM, and scanning Auger analysis. A series of photovoltaic devices was fabricated on ITO electrodes using CdSe NRs in combination with PTEBS or P3KHT. A thorough device analysis showed that performance was limited by low short circuit current although charge transfer was confirmed in the ELBL nanocomposite thin films.

Surface area characterization of obliquely deposited metal oxide nanostructured thin films.

The glancing angle deposition (GLAD) technique is used to fabricate nanostructured thin films with high surface area. Quantifying this property is important for optimizing GLAD-based device performance. Our group has used high-sensitivity krypton gas adsorption and the complementary technique of cyclic voltammetry to measure surface area as a function of deposition angle, thickness, and morphological characteristics for several metal oxide thin films. In this work, we studied amorphous titanium dioxide (TiO(2)), amorphous silicon dioxide (SiO(2)), and polycrystalline indium tin oxide (ITO) nanostructures with vertical and helical post morphologies over a range of oblique deposition angles from 0 to 86 degrees. Krypton gas sorption isotherms, evaluated using the Brunauer-Emmettt-Teller (BET) method, revealed maximum surface area enhancements of 880 +/- 110, 980 +/- 125, and 210 +/- 30 times the footprint area (equivalently 300 +/- 40, 570 +/- 70, and 50 +/- 6 m(2) g(-1)) for vertical posts TiO(2), SiO(2), and ITO. We also applied the cyclic voltammetry technique to these ITO films and observed the same overall trends as seen with the BET method. In addition, we applied the BET method to the measurement of helical films and found that the surface area trend was shifted with respect to that of vertical post films. This revealed the important influence of the substrate rotation rate and film morphology on surface properties. Finally, we showed that the surface area scales linearly with film thickness, with slopes of 730 +/- 35 to 235 +/- 10 m(2) m(-2) microm(-1) found for titania vertical post films deposited at angles from 70 to 85 degrees. This characterization effort will allow for the optimization of solar, photonic, and sensing devices fabricated from thin metal oxide films using GLAD.

Optical interference effects in the design of substrates for surface-enhanced Raman spectroscopy.

This paper presents results showing that the design of substrates used for surface-enhanced Raman spectroscopy (SERS) can impact the apparent enhancement factors (EFs) obtained due to optical interference effects that are distinct from SERS, providing additional enhancement of the Raman intensity. Thus, a combination of SERS and a substrate designed to maximize interference-based enhancement is demonstrated to give additional Raman intensity above that observed for SERS alone. The system explored is 4-nitroazobenzene (NAB) and biphenyl (BP) chemisorbed on a nanostructured silver film obtained by vacuum deposition of Ag on thermally oxidized silicon wafers. The enhancing silver layer is partially transparent, enabling a standing wave to form as a result of the combination of the incident light and light reflected from the underlying Si substrate (i.e., light that passes through the Ag and the intervening dielectric layer of SiO(x)). The Raman intensity is measured as a function of the thickness of the thermal oxide layer in the range from approximately 150 to approximately 400 nm, and despite a lack of morphological variation in the silver films, there is a strong dependence of the Raman intensity on the oxide thickness. The Raman signal for the optimal SiO(x) interlayer thickness is 38 times higher than the intensity obtained when the Ag particles are deposited directly onto Si (with native oxide). To account for the trends observed in the Raman intensity versus thickness data, calculations of the relative mean square electric field (MSEF) at the surface of the SiO(x) are carried out. These calculations are also used to further optimize the experimental setup.

Thienylsilane-modified indium tin oxide as an anodic interface in polymer/fullerene solar cells.

The generation and characterization of a robust thienylsilane molecular layer on indium tin oxide substrates was investigated. The molecular layer was found to reduce the oxidation potential required for the electrochemical polymerization of 3,4-ethylenedioxythiophene. The resulting electrochemically prepared poly(3,4-ethylenedioxythiophene):poly(p-styrenesulfonate) (ePEDOT:PSS) films were found to be more uniform in coverage with lower roughness and higher conductivity than analogous films fabricated with bare ITO. A relative improvement in the efficiency of 2,5-diyl-poly(3-hexylthiophene) (P3HT)/[6,6]-phenyl-C(61)-butyric acid methyl ester (PCBM) bulk heterojunction solar cells was observed when devices were formed on thienylsilane-modified ITO electrodes, rather than unmodified ITO control electrodes.

Canadian Cardiovascular Society Consensus Conference: peripheral arterial disease - executive summary.

This Consensus Conference has been supported by the Canadian Cardiovascular Society. The process is dynamic, with intentional structure that requires peer review and feedback from cardiovascular specialists across Canada. The writing and review panel encompassed a broad range of specialists caring for the patient with peripheral arterial disease (PAD). PAD is an often asymptomatic, underdiagnosed, under-recognized and undertreated condition. It is associated with significant morbidity and cardiac mortality. Until recently, little attention has focused on the evaluation and treatment of the disease process itself. The goal of the present paper is to ensure better treatment, to reduce both morbidity and mortality in the patient with vascular disease and, importantly, to serve as a guide to the busy clinician. Although the focus is PAD, there are chapters on thoracic and abdominal aortic disease, renal arterial disease and the evidence supporting management. Screening and diagnostic techniques including history and physical examination as well as noninvasive imaging techniques are reviewed. Medical management for patients with vascular disease including prevention and risk reduction is graded based on evidence, including both pharmacological and nonpharmacological management strategies, followed by an introduction to newer percutaneous techniques. Finally, surgical treatment for claudication including new concepts on the perioperative risk assessment for patients undergoing major vascular surgery is discussed.

Human rhinovirus capsid dynamics is controlled by canyon flexibility.

Quantitative enzyme accessibility experiments using nano liquid chromatography electrospray mass spectrometry combined with limited proteolysis and isotope-labeling was used to examine the dynamic nature of the human rhinovirus (HRV) capsid in the presence of three antiviral compounds, a neutralizing Fab, and drug binding cavity mutations. Using these methods, it was found that the antivirals WIN 52084 and picovir (pleconaril) stabilized the capsid, while dansylaziridine caused destabilization. Site-directed mutations in the drug-binding cavity were found to stabilize the HRV14 capsid against proteolytic digestion in a manner similar to WIN 52084 and pleconaril. Antibodies that bind to the NIm-IA antigenic site and penetrate the canyon were also observed to protect the virion against proteolytic cleavage. These results demonstrate that quantifying the effects of antiviral ligands on protein "breathing" can be used to compare their mode of action and efficacy. In this case, it is apparent that hydrophobic antiviral agents, antibodies, or mutations in the canyon region block viral breathing. Therefore, these studies demonstrate that mobility in the canyon region is a major determinant in capsid breathing.

Quantitative analysis with desorption/ionization on silicon mass spectrometry using electrospray deposition.

Desorption/ionization on silicon mass spectrometry (DIOS-MS) is demonstrated as a quantitative analytical tool when coupled to electrospray deposition (ESD). In this study, we illustrate the utility of DIOS-MS in the quantitative analysis of a peptide and two amino acids with deuterated and structural analogues used as internal standards. An important feature of this approach is the incorporation of ESD to improve sample homogeneity across the porous silicon surface. ESD allowed for a marked improvement in quantitative analysis due to its applicability to LC-DIOS, and because of the absence of matrix, sample can be deposited at very low flow rates (150 nL/min). Experiments comparing the traditional dried droplet and ESD methods show that ESD samples exhibit significantly improved quantitation and much higher sample-to-sample reproducibility.