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Background Integrating a sex and gender lens is increasingly recognized as important in health research studies. Past failures to adequately consider sex in drug development, for example, led to medications that were metabolized differently, proved harmful, or ineffective, for females. Including both males and females in study populations is important but not sufficient; health, access to healthcare, and treatment provided are also influenced by gender, the socially mediated roles, responsibilities, and behaviors of boys, girls, women and men. Despite understanding the relevance of sex and gender to health research, integrating this lens into study designs can still be challenging. Identified here, are nine opportunities to address sex and gender and thereby strengthen research proposals. Methods Ontario investigators were invited to submit a draft of their health research proposal to the Sex and Gender Research Support Service (SGRSS) at Women’s College Hospital in Toronto, Ontario. The service works to build capacity on the integration of sex, gender, and other identity factors, in health research. Using the SAGER Guidelines and the METRICS for the Study of Sex and Gender in Human Participants as guides, proposals were reviewed to enhance their sex and gender considerations. Content analysis of the feedback provided these investigators was subsequently completed. Results Nearly 100 hundred study proposals were reviewed and investigators provided with suggestions on how to enhance their proposal. Analyzing the feedback provided across the reviewed studies revealed commonly overlooked opportunities to elevate consideration of sex and gender. These were organized into nine suggestions to mirror the sections of a research proposal. Conclusion Health researchers are often challenged on how to integrate a sex and gender lens into their work. Reviews completed across a range of health research studies show there are several commonly overlooked opportunities to do better in this regard. Nine ways to improve the integration of a sex and gender lens in health research proposals have been identified.

ObjectivesEvaluate gender differences in authorship of COVID-19 articles in high-impact medical journals compared with other topics.DesignCross-sectional review.Data sourcesMedline database.Eligibility criteriaArticles published from 1 January to 31 December 2020 in the seven leading general medical journals by impact factor. Article types included primary research, reviews, editorials and commentaries.Data extractionKey data elements were whether the study topic was related to COVID-19 and names of the principal and the senior authors. A hierarchical approach was used to determine the likely gender of authors. Logistic regression assessed the association of study characteristics, including COVID-19 status, with authors’ likely gender; this was quantified using adjusted ORs (aORs).ResultsWe included 2252 articles, of which 748 (33.2%) were COVID-19-related and 1504 (66.8%) covered other topics. A likely gender was determined for 2138 (94.9%) principal authors and 1890 (83.9%) senior authors. Men were significantly more likely to be both principal (1364 men; 63.8%) and senior (1332 men; 70.5%) authors. COVID-19-related articles were not associated with the odds of men being principal (aOR 0.99; 95% CI 0.81 to 1.21; p=0.89) or senior authors (aOR 0.96; 95% CI 0.78 to 1.19; p=0.71) relative to other topics. Articles with men as senior authors were more likely to have men as principal authors (aOR 1.49; 95% CI 1.21 to 1.83; pConclusionsWomen were substantially under-represented as authors among articles in leading medical journals; this was not significantly different for COVID-19-related articles. Study limitations include potential for misclassification bias due to the name-based analysis. Results suggest that barriers to women’s authorship in high-impact journals during COVID-19 are not significantly larger than barriers that preceded the pandemic and that are likely to continue beyond it.PROSPERO registration numberCRD42020186702.

Background There has been increased attention on reducing hospital readmission rates. However, little is known about any difference in readmission rates in heart failure by sex, although evidence exists demonstrating differences in the etiology of heart failure. As a result, strategies to optimize readmission reduction programs and care strategies for women and men remain unclear. Purpose (1) To identify studies examining readmission rates according to sex, and (2) to provide a qualitative overview of possible considerations for the impact of sex or gender. Methods A scoping protocol was developed using the Arksey and O'Malley framework and the Joanna Briggs Institute methodology. Our search strategy was reviewed according to the peer-review of electronic search strategy (PRESS) checklist. Full text articles published between 2002 and 2017 and drawn from multiple databases (i.e. MEDLINE, EMBASE), grey literature (i.e. National Technical Information, Duck Duck Go), and experts were consulted for additional articles. Screening criteria were established a priori. Once an acceptable inter-rater agreement was established at 80% by two independent reviewers, articles were screened for potential eligibility. A descriptive analytical method was employed to chart primary research articles. Articles were considered relevant if the cohort consisted of adult heart failure patients who were readmitted after an index hospitalization and a sex/gender-based analysis was performed. Results The literature search yielded 5887 articles, of which 746 underwent full text assessment for eligibility. Of 164 eligible articles, 34 studies addressed the primary outcome, 103 studies considered sex differences as a secondary outcome and 25 studies included disaggregated data for sex but no subsequent interaction was reported. Good inter-rater agreement was reached: 83% for title and abstract screening; 88% for full text review; kappa: 0.69 (95% CI: 0.526–0.851). Twelve of 34 studies included for the primary outcome reported higher readmission rates for men compared to five studies reporting higher readmission rates for women. However, there were differential readmission rates that were dependent on duration of follow-up. Women were more likely to experience higher readmission rates than men when time to event was less than one year. Readmission rates for men were higher when follow-up was longer than one year. Conclusion Sex differences in readmission rates were dependent on follow up time. Most studies used composite outcomes and had short times to event, which may mask underlying effects of sex on readmission. Acknowledgement/Funding Ontario SPOR Support Unit

Janice Du Mont,1,2 Daisy Kosa,3 Sheila Macdonald,3 Robin Mason1,21Women’s College Research Institute, Women’s College Hospital, 2Dalla Lana School of Public Health, University of Toronto, 3Ontario Network of Sexual Assault/Domestic Violence Treatment Centres, Toronto, ON, CanadaHealthcare providers and trainees often lack the requisite knowledge and skills to address sexual violence in the clinical setting.1–3 To address this gap, we developed and evaluated an innovative and evidence-informed online curriculum designed to improve the competence of those working in healthcare settings to respond to the needs of women who present with past histories of sexual assault.

This paper outlines an approach to designing a course entirely in learning objects. It provides a theoretical basis for the design and then presents evaluation data from a master’s level course using this design. It also describes several re-uses of the learning objects on other courses and in different contexts. Each learning object is conceived as a whole learning experience, thus avoiding many of the problems associated with assembling components of disparate kinds.

Background Sexual assault in adolescence and adulthood is a pervasive crime often resulting in trauma to survivors. Despite its considerable consequences, relatively few survivors disclose the sexual assault to formal support providers (e.g., health care providers). The literature suggests there are several factors associated with reduced disclosure to formal support providers (e.g., self-blame). If survivors do disclose to formal support providers, they receive more negative social reactions (e.g., victim blame) than if they disclose to informal support providers (e.g., friends). Furthermore, survivors holding marginalized identities (e.g., sexual minority) appear more likely to receive negative reactions from formal support providers than those holding more dominant identities (e.g., white, heterosexual). To date, little work has provided a theoretical examination of how sexual assault stigmatization impacts the disclosure experiences of survivors or how those effects may be compounded for those who hold (multiple) marginalized identities. Objectives Grounded in intersectionality (e.g., intersection of racism, sexism), this study explores the role of stigma in the decision to disclose to formal support providers and how stigma shapes the disclosure encounter. Methods This study employs a computer-mediated discourse analysis of posts by sexual assault survivors to the website Reddit. Results This study is currently in the data analysis stage. Preliminary results suggest that being a sexual assault survivor constitutes a concealable, stigmatized identity. Survivors experience stigma (e.g., internal, cultural) in both the decision to disclose to formal support providers and during the disclosure encounter, and holding (multiple) marginalized identities impacts how this stigma is experienced. Emergent themes include the seeking of help in online communities for those whom (intersectional) stigma acts as a barrier to seeking in-person help from formal support providers, the use of online support concomitantly with formal help-seeking, and the influence of the #metoo movement on (non)disclosure to formal support providers.

There has been a rapid expansion of online teaching and learning - over 10 million students now study online, and millions more use educational multimedia products and services from commercial and broadcasting organizations. However, in the rush to get online teachers, educators and developers often complain about the lack of solid theory underpinning the end materials. This book is the first to present a wide range of experience and research findings from leading practitioners and organizations around the world and will be invaluable for researchers, developers and teachers, as well as anyone with a critical interest in developing successful online teaching and learning.

Health Promotion (HP), a continuously evolving field, is riddled with complexities as experts and community members develop new approaches to researching social behaviours, addressing health concerns and advocating for the values of equity, empowerment and healthy public policy. Similarly complex is the field of knowledge translation (KT), putting research into action for the purpose of changing behaviours, policy and practice. Similar values, methods and techniques govern these two practices. This paper is based on a series of discussions between two young professionals who found themselves navigating the complexities of HP and KT and attempting to understand their chosen fields of practice. The discussions considered such issues as discipline-based silos, the use and purpose of new terminologies and languages in research, and whether or not existing practices are simply being renamed or branded in order to appear innovative and new.

Due to many adverse health effects, victims of domestic violence are frequently seen in the health care system. Yet, health care providers may lack the training to assist them. Online curricula can be an effective instructional tool. Our competency-based, serious video game, Responding to Domestic Violence in Clinical Settings, was designed to address health care providers' knowledge gaps through 17 modules, each a half hour in length. Nearly 9,000 participants completed at least one module; nursing students completed the most modules, approximately five hours of instruction. This serious video game-based curriculum is useful in helping health providers and students learn about Domestic Violence.

Objectives To improve the value of research for older adults, we examine sex-specific reporting of data from drug trials for the management of dementia. These data are important because they may influence considerations ranging from the health of populations to shared decision-making by individual patient and caregiver about the risk and benefit of a drug therapy. Methods Randomized controlled trials of cholinesterase inhibitors (i.e., donepezil, rivastigmine, or galantamine) with clinical outcomes were identified from searches of MEDLINE, EMBASE, and the Cochrane Library. Sex-specific data were extracted from nine sections (title, abstract, introduction, methods, outcomes, results, discussion, limitations, and conclusion). Among the donepezil trials only, more detailed harms data were obtained. Findings Thirty-three randomized controlled trials were identified evaluating 15,971 participants (9,103 (57%) female). Trials were highly cited (median citations 158, interquartile range 62–441) and published in high impact journals (median impact factor 7.4, interquartile range 3.4–8.2). Sex was not mentioned in the title, introduction, limitations, or conclusion section of any trial. Only three trials (9%) mentioned sex in the abstract (all as a demographic characteristic), and 8 (24%) in the methods. Almost all (32 (97%)) trials mentioned sex in the results as a demographic variable. One trial reported a sex difference for a secondary outcome. Among the 16 trials studying donepezil, adverse events were frequently reported and often dose-related. No trial provided sex-specific reporting of adverse events. Conclusions There is an almost complete lack of sex-specific reporting of data in clinical trials for dementia drug therapies, and no sex-specific reporting of adverse events. Sex-specific reporting of data should be required in drug trials to increase research value and ultimately inform more tailored prescribing for older adults.

Research from the United States suggests that Latin American immigrant and refugee women are one of the groups most greatly impacted by intimate partner violence (IPV) and associated mental health consequences including higher rates of depression than women from other ethno-racial groups. In Canada, little is known about the experience of IPV and mental health among this population. Even in the broader North American context, how Latin American women themselves perceive the connection between IPV and depression is unknown. This paper presents the findings of a pilot study that examined the perceived relationship between IPV and depression among Spanish-Speaking Latin American Women in Toronto, Canada. The theoretical framework guiding this qualitative study combined an ecological model for understanding gender based violence and mental health with critical intersectionality theory. Using a convenience and snowball sampling method, semi-structured interviews (n = 12) were conducted and thematic content analysis was completed supported by Nvivo9(®) qualitative data management software. All participants had experienced some form of IPV in their adult lives, with psychological violence being the most common. Women perceived a powerful connection between IPV and depression, a link made stronger by the accumulation of other adverse life experiences including childhood abuse, war traumas and migration. The results suggest that IPV is just one of the challenges experienced by Latin American refugee and immigrant women. IPV is experienced in the context of other traumatic experiences and social hardships that may work to intensify the association of IPV and depression in this population.

Integrating sex and gender in health research is essential to produce the best possible evidence to inform health care. Comprehensive integration of sex and gender requires considering these variables from the very beginning of the research process, starting at the proposal stage. To promote excellence in sex and gender integration, we have developed a set of metrics to assess the quality of sex and gender integration in research proposals. These metrics are designed to assist both researchers in developing proposals and reviewers in making funding decisions. We developed this tool through an iterative three-stage method involving 1) review of existing sex and gender integration resources and initial metrics design, 2) expert review and feedback via anonymous online survey (Likert scale and open-ended questions), and 3) analysis of feedback data and collective revision of the metrics. We received feedback on the initial metrics draft from 20 reviewers with expertise in conducting sex- and/or gender-based health research. The majority of reviewers responded positively to questions regarding the utility, clarity and completeness of the metrics, and all reviewers provided responses to open-ended questions about suggestions for improvements. Coding and analysis of responses identified three domains for improvement: clarifying terminology, refining content, and broadening applicability. Based on this analysis we revised the metrics into the Essential Metrics for Assessing Sex and Gender Integration in Health Research Proposals Involving Human Participants, which outlines criteria for excellence within each proposal component and provides illustrative examples to support implementation. By enhancing the quality of sex and gender integration in proposals, the metrics will help to foster comprehensive, meaningful integration of sex and gender throughout each stage of the research process, resulting in better quality evidence to inform health care for all.

Few adolescent and adult women seek out formal support services in the acute period (7 days or less) following a sexual assault. Instead, many women choose to disclose weeks, months, or even years later. This delayed disclosure may be challenging to support workers, including those in health-care settings, who lack the knowledge and skills to respond effectively. We conducted a systematic literature review of health-care providers’ responses to delayed disclosure by adolescent and adult female sexual assault survivors. Our primary objective was to determine how health-care providers can respond appropriately when presented with a delayed sexual assault disclosure in their practice. Arising out of this analysis, a secondary objective was to document recommendations from the articles for health-care providers on how to create an environment conducive to disclosing and support disclosure in their practice. These recommendations for providing an appropriate response and supporting disclosure are summarized.

Background As the number of laparoscopic adjustable gastric bands (LAGBs) placed has increased, the number of patients requiring removal of the device has also increased. Methods The data from our institution, a U.S. university medical center, were reviewed to determine the feasibility, patient characteristics, and early results of converting patients from LAGB to laparoscopic Roux-en-Y gastric bypass. Results A total of 350 patients underwent LAGB placement at our institution from 2001 to 2008. Of these, 26 required conversion to laparoscopic Roux-en-Y gastric bypass for the following reasons: slippage, poor weight loss, LAGB intolerance, esophageal dilation, infection, and gastric ischemia. All conversions were completed laparoscopically. The average operating time and length of stay was 160 minutes and 3 days, respectively. Three complications developed. The average interval to conversion was 29 months. The average follow-up after conversion was 18 months. The average percentage of excess body weight loss at conversion was 23%. At 12 months after conversion, the patients had achieved an average percentage of excess body weight loss of 56% from their pre-LAGB weight. Conclusion The increasing popularity of the LAGB has led to a considerable number of revisions of the device. Our early experience has shown that converting patients from LAGB to laparoscopic Roux-en-Y gastric bypass is feasible and safe and can offer patients substantial additional weight loss.

Claims have been made that the traditional classroom/lecture-room mode of teaching is under threat with the future being purely online-based. There is no doubt that the impact of ICT systems and services have and will continue to transform teaching practice. From PowerPoint slides introduced to enliven lectures to virtual reality models accessed remotely, technology is bringing about new educational paradigms. The result is the emergence of new forms of distance learning with terms such as flexible learning, blended learning and full online instruction. All are making major contributions to the student experience, allowing access to more information and greater resources as well as opportunities for learning in a manner and timescale that is more attuned to their aims, abilities and lifestyles. In dental education the transition is providing undergraduates, postgraduates and CPD students with a greater variety of courses, access to more expertise and the opportunity for lifetime learning.

In the search for a cost-effective method of delivering teaching to dispersed groups of students, webcasting is proving successful. By taking video streams and transmitting them over the Internet it allows events such as lectures, seminars, webinars and tuition sessions to be made accessible to participants in many different, remote locations. Moreover, the webcasts can be stored on a normal PC to give, those unable to see the original broadcast, the opportunity to watch it at a later, more convenient time; similarly it can be used by students for revision purposes. New developments have allowed a useful level of interactivity between presenters and students, and between students themselves. As part of a recent project at a UK dental school, webcasting was trialed amongst undergraduates and postgraduates to measure its value for dental education. The results have been very encouraging, with the latter group especially benefiting from being able to see the webcasts in their own time, on their PCs at home or work. However, as befits an ever-changing scenario, a new web-oriented facility is beginning to play a role in education: podcasting provides a more personal, individual interaction with the web.boxed-text

Videoconferencing has been widely used to provide distant advice in many healthcare specialties across the world. However, videoconferencing has been further extended to support distance learning and has been evaluated through a number of educational projects. The use of the technology has been integrated as a core method of delivering training and education at all levels in dentistry. Advances in systems, services and standards have produced equipment and telecommunications links that are user-friendly, reliable, affordable and offer better quality image resolution. In addition, a wide range of peripheral devices can be connected to basic videoconferencing equipment to introduce a variety of teaching aids and material into a session. Projects such as PROVIDENT (Postgraduate Regional Online Videoconferencing in Dentistry)1 and DUET (Dental Undergraduate Education by Teleconferencing)2 have demonstrated that videoconferencing teaching sessions are as effective as traditional face-to-face lectures in both on-campus and off-campus teaching and reduce travel time and costs for both tutors and students. This paper describes how videoconferencing systems and services have developed and their benefits and applications in dentistry. It then goes on to describe the PROVIDENT and DUET projects as case studies.boxed-text

This paper describes the use of a range of Web 2.0 technologies to support the development of community for a newly formed Land Trust on the Isle of Lewis, in NW Scotland. The application of social networking tools in text, audio and video has several purposes: informal learning about the area to increase tourism, community interaction, ‘ownership’ of the Trust's website and pride in the local landscape. The paper provides background theory related to informal learning and Web 2.0 technologies and describes an innovative application of them to a sparsely populated rural community.

Background Untold numbers of women worldwide are survivors of intimate partner violence (IPV) with a substantial number of these experiencing co-occurring mental health and substance use problems. Despite the complex interconnections among these problems, funding mechanisms and organizational structures and mandates have been designed to address just a single, focal problem. One of the challenges for frontline providers is the lack of effective, evidence-informed inter-professional education or training to help them identify and appropriately respond to co-occurring problems. We developed an evidence-informed, competency-based curriculum to address this gap. In this paper we report on its effectiveness in increasing knowledge, changing beliefs and enhancing skills of frontline workers from all three sectors. Methods The curriculum consists of multiple elements: a text manual; an interactive, online series of modules; and, an in-person workshop. Frontline workers (n = 1111) in the violence against women (VAW) (n = 499), mental health (n = 229), addiction treatment (n = 167), and associated sectors (n = 149) were recruited to attend the workshop and instructed to read the manual or complete the online modules before attending. Some failed to respond (n = 67). Online pre- and post-tests were used to assess changes in knowledge, beliefs and skills; evaluations of the workshop were also collected. Results Matched pre- and post-tests were available for over half of the participants (n = 624). Results show statistically significant improvements across all six competency domains from pre to post-test (p

Sexual violence is experienced by women of every age, country, social class, culture and religion. In a recent American survey for example, an estimated 18% of women reported having been raped and an additional 45% experienced other forms of sexual violence at some point during their lifetime.1 The detrimental effects of sexual assault can be short-lived or persist for a lifetime. In addition to any immediate physical injuries sustained, sexually assaulted women can experience other negative sequelae such as HIV and other sexually transmitted infections; unwanted or intended pregnancies; psychological challenges such as anxiety, sleep disturbances, and attempted or completed suicide; difficulties in interpersonal relationships;as well as adverse life events including further future victimizations.2-3 Not surprisingly, women who have been sexually assaulted are more likely than those who have not to perceive their health as poorer and more frequently access health services.2 Thus, healthcare providers are often the first professional contact for survivors of sexual assault.4 While sexually assaulted women access the healthcare system, they do not necessarily disclose any information about the assault to their providers. In fact, a recent systematic review of disclosure of sexual assault to healthcare providers reported that across eight studies, just 6% to 27% of women ever disclosed to a health provider.5 In the one study to ask survivors to whom they first disclosed, 5% reported the first disclosure was to a physician.6 Disclosing sexual assault can be challenging due to a host of barriers including distrust of formal systems, concerns about confidentiality, and judgmental attitudes by healthcare providers which can exacerbate survivors’ feelings of embarrassment, self-blame, shame, and guilt.7,8 Yet not disclosing sexual assault has been associated with chronic negative mental health problems such as post-traumatic stress and depression.9 Most women eventually do tell someone about the sexual assault but fewer than half disclose within the first few days and approximately one third wait more than a year before disclosing.10-13 From competencies to curriculum Given the prevalence of sexual assault and the numerous associated negative health outcomes, it is clear that all health providers should have the requisite knowledge and skills to respond appropriately when a disclosure is made and to facilitate disclosure when indicators suggest the possibility of past sexual assault. Knowing how to do so is a matter of education and training and, in 2012, this was deemed a priority by the government of Ontario, Canada. In response, we undertook the development of an online curriculum suited to diverse health and allied healthcare providers. As the approach to health education is increasingly competency-based,developing core competencies to inform the curriculum was a necessary first step.14-16 In developing the competencies for our curriculum, we followed a method we had employed in developing other curricula.17 We started with a systematic literature search of OVID Medline, EMBASE, PsycInfo, and PubMed databases, limited to English language records published between 1985 and 2013 to determine what was known about disclosure of sexual assault to health providers.6 The findings clustered into two major categories, “Helpful Practices” and “Unhelpful Practices” and within these several minor themes were revealed. For example, “Helpful Practices” included: “Tangible Aid”, “Validating Disclosure”, and “Providing Emotional Support.” Within each of these, important behaviours were identified (e.g., “listening in an active or responsive way”, “telling the survivor she was not to blame”). These findings were presented for discussion and review to members of an expert advisory committee formed to assist with the development of the curriculum. Members of the advisory committee had extensive expertise in the delivery of health care for victims of interpersonal violence and represented a range of disciplines and philosophical perspectives. After confirming the relevancy of our findings to clinical practice, the advisory committee provided further suggestions for providing competent care. For example, it was noted that “a stronger emphasis should be placed on providers examining their own values, beliefs, and experiences… as these often further victimize survivors”. The agreed upon desirable behaviours, practices, and necessary knowledge were then rewritten in the form of competencies, sorted and aggregated following the updated version of Bloom’s taxonomy,18 and loosely organized as “know (factual knowledge), know oneself (self-reflection), know how (procedural knowledge)” items. Two overarching domains were identified: “Create an environment that supports disclosure” and “Respond appropriately to women who disclose”. Within each of these several specific behaviours were outlined, for example in the first domain were noted such behaviours as: “Recognise individual, relational, and societal barriers to disclosing sexual assault”; Create a physical environment that supports disclosure (e.g., use posters, pamphlets, ensure privacy)”, “Recognize how your own experiences, values, beliefs, and attitudes may influence your interactions with patients”. Working with the competencies a framework for the curriculum incorporating the key elements in the provision of care to women who have experienced past sexual assault - whether or not they choose to disclose - was developed. The framework acknowledges the need to address misconceptions or myths about sexual assault and its victims before introducing new practice behaviours and simultaneously recognizes that despite the development of knowledge and understanding, the introduction of new practices may face challenges from within the work environment (e.g. lack of funding to produce pamphlets or posters that support disclosure). The next step was to prepare a series of scripts for interactive case scenarios and videos and submit these for review to subject matter experts in nursing, medicine, and occupational therapy. Working with a software development firm and a number of actors, the scripts were programmed, animated, uploaded, and piloted to determine whether they successfully engaged learners in achieving the competencies. Quizzes were incorporated into the online modules and a pre-test and post-test developed to track success in meeting the learning objectives and outcomes. Our knowledge transfer strategy included bringing together the provincial leads of diverse health disciplines (e.g., medical technicians, midwives, physical therapists, occupational therapists, and nurses) to advise on how best to introduce the curriculum to their members. With their help, we developed postcards, advertisements, and presentations which were shared across the province. The curriculum, Addressing Past Sexual Assault in Clinical Settings, was launched May 1, 2015.19 By Sept. 1, 2015 more than 1200 learners had completed the curriculum. Feedback from a very diverse group of health care professionals including nurses, therapists, radiation technologists, and addiction counsellors, has been extremely positive and generated comments such as; “just completed the excellent module”, “a great resource for all health care professionals” and “a great resource with lots of information that I will be using in my work with clients”. Future examination of pre- and post-test data will determine whether the curriculum has effected significant improvements in health providers’ knowledge, attitudes and skills when caring for women who may have experienced a past sexual assault. What is already clear is that this curriculum has addressed an identified gap in the education of health professionals and that by combining evidence gathered through the published literature with the tacit knowledge and expertise of frontline experts, the resulting curriculum is relevant, meaningful and useful to medical and other practitioners. This process of curriculum development can be readily applied to other topics and may improve learners’ engagement and achievement of educational outcomes.

Globally, intimate partner violence (IPV) is a pervasive and insidious human rights problem with significant adverse physical health outcomes for women. Intimate partner violence has also been closely associated with poor mental health and substance use problems. However, little is known about the relationship among these co-occurring problems and how to best intervene or manage them. Here, we present findings from recent systematic reviews and meta-analyses (where available) to highlight developments in understanding and managing the complex co-occurring problems of intimate partner violence and mental health and substance use in women.

It is recognised that issues persist concerning the digital divide, and the importance of gender and cultural differences in Internet use. The uptake and use of broadband (and the Internet in general) is not simply related to education, age, or income. Because the innovative and entrepreneurial uses tend to be individual, there has been little dissemination of new ideas and good practice. From considerable research in e-learning and e-business we recognise that a much greater attention to the design of online activities is required at the outset. Solutions that simply try to copy offline practices to the online environment are fated to be less successful. There is a lack of strategic coordination in planning for the adoption and application of broadband in almost every sector (schools, higher education, health, public and voluntary

The use of virtual learning environments (VLEs) has become increasingly common in most higher education (HE) institutions. Recent developments have proposed the interoperability of software systems and content, to create component VLEs in contrast with the integrated, monolithic ones that are currently prevalent. This paper examines the student experience of two VLEs, one integrated approach and the other component. In general, students preferred the component system, although this may have been influenced by other factors such as performance. Although the study is limited to one cohort of student it makes a number of suggestions relevant to anyone deploying a VLE. These are that the component approach is a viable one from a student perspective, the broader context in which the VLE operates is important in student perception and that poor system performance may have unpredictable consequences for the learning experience.

This paper examines how four innovative Internet technologies were incorporated into one course at The UK Open University. The technologies were: blogging, audio conferencing, instant messaging and Harvard's Rotisserie system. Each of the technologies is addressed, and details from the student evaluation are provided. The student feedback on all the technologies was positive. The role of the learning object based course design is examined and it is suggested that this approach facilitates the incorporation of innovative technologies into a course. The authors suggest that as students become increasingly accustomed to standard communication tools such as asynchronous bulletin boards, there will be a shift towards implementing a range of technologies, each offering particular affordances for different forms of communication.

H3Africa is developing capacity for health-related genomics research in Africa

Electronic information resources are increasingly in use for courses at all levels of Higher Education. They may be employed as reference material when researching particular topics for assignments, as part of a conventionally structured course, or alternatively their use may be a central part of resource based course philosophy. Whilst the use of these resources may offer many advantages in terms of developing more independent learners, there are also information handling skills which students must acquire. This paper discusses the relevance of these skills and the factors influencing their acquisition for students on two networked resource based courses at the UK Open University.

Videoconferencing is an established method for providing medical education over long distances. Our aims were to assess the feasibility of videoconferencing in dental postgraduate education, to evaluate its practicability, teacher satisfaction and evaluate equipment. Twenty-seven teachers from the 4 London Dental Schools provided 41 postgraduate dental education sessions on a range of topics to regional postgraduate centres and dental practices as part of the Thames Health Region's programme. Videoconferencing was carried out using a relatively inexpensive personal computer system link using ISDN2 telephone lines and Z350 protocol. Presenter views and assessment were obtained by questionnaire, interview and videotape. Teachers felt that minimal additional preparation time was required for videoconferencing and 21/27 preferred it to in-person teaching, most noting the saving in travel time. Only 3 of the teachers were dissatisfied with their ability to communicate, 4 were equivocal and 20 were either pleased or very pleased. The teachers largely enjoyed the experience and performed well in the new medium. However, sound quality proved inadequate in 5/41 links and most sessions included some periods of suboptimal sound. Only 4 teachers were satisfied with their ability to perform question and answer interaction with the audience. We conclude that experienced teachers adapt readily to videoconferencing and learn to communicate effectively very quickly. Teachers were positive about the medium despite its shortcomings and improvements in sound quality would allow a rapid expansion of postgraduate dental education by videoconference.

The purpose of this article is to inform users, regulators, and economists about the basic economics of the Internet, focusing on regulation of its infrastructure. It defines the Internet and describes its development and organization. It analyses the regulatory and competition issues associated with conveyance on the Internet. It then discusses three current puzzles of economic interest. While the article reaches several conclusions, the overall message is that much more work is needed in this area.

It is widely recognised that pricing is required to control congestion on the Internet. One lesson that has emerged from many proposals is that any price system should be simple and robust to competition. This is highlighted in the question currently under debate in the market for Internet services: should usage prices should be employed at all? In a duopoly model with overall positive network effects, it is shown that flat rate pricing can occur in equilibrium, even when the costs of measuring variable demand are very small.

The UK Open University (OU) was founded 30 years ago as a print-based distance teaching institution. It is gradually transforming itself into an electronic university. This article describes some of the steps along the way, focusing on the use of computer conferencing and the Web for course delivery and support of students. Many of the barriers and problems are analysed, as well as the successes and key turning points. The research issues related to this change are also highlighted, as are some of the evaluation studies carried out at the university on its use of new technologies.

This paper attempts to provide an economic framework for assessing why and how Internet telephony may affect the international accounting rate system in particular, and communication over circuit switched networks in general. It reviews the regulatory treatment of Internet telephony, and compares the costs and prices of making international calls over the Internet and the public switched telephone network (PSTN). It argues that Internet telephony is unlikely to prove central to the downfall of the international system; other technologies, such as resale, will play a larger role. The paper also suggests a general framework in which to analyse competition between networks (such as the Internet and the PSTN). This framework indicates that differences in the preferences of end users for congestion will drive networks to specialise.

In an earlier article in this journal (Mason and Swanson 1996) we argued that one of the primary causes of long tail insurance risks was the system of incentives for strategic liquidation inherent within a limited liability system. In effect limited liability makes available a loophole for the appropriation of societal rents by appropriately structured firms. This argument was based upon the previous analysis of the American savings and loan crisis undertaken by Akerlof and Romer (1993) in which they stylised the use of strategic bankruptcy for the appropriation of rents as "looting". In that earlier paper we extended and generalised their analysis, and identified the structure of firms that would make the "looting strategy" available. In this paper our objective is to set forth our conclusions from this previous analysis regarding the appropriate means of regulation of firms structured in a manner to make available the possibility of strategic liquidation. That is, we are addressing the question: How does a society regulate for looting? Looting is a phenomenon with which most people are now familiar. It has taken two very noticeable forms recently. In the US, the thrifts crisis has been estimated to have generated societal losses in the amount of US$140 billion. According to Akerlof and Romer, this crisis resulted from the deliberate relaxation of the regulation system regarding the savings and loan industry when a slowdown in the housing market was causing concern about the viability of some sectors of this industry. The regulators reduced reserves requirements and relaxed monitoring, and this then produced the loophole

This paper analyses the experiences and experiments of the U.K. Open University in the use of computer conferencing over 10 years. It provides a framework for considering educational uses of the medium, as well as describing several innovative applications. Highlights of the main issues involved in implementing this technology are given. The paper focuses on the twin questions of generalizing from OU experience and scaling up use of the system across a whole institution.

Background New tools are required for the diagnosis of pre-symptomatic leprosy towards further reduction of disease burden and its associated reactions. To address this need, two new skin test antigens were developed to assess safety and efficacy in human trials. Methods A Phase I safety trial was first conducted in a non-endemic region for leprosy (U.S.A.). Healthy non-exposed subjects (n = 10) received three titrated doses (2.5 µg, 1.0 µg and 0.1 µg) of MLSA-LAM (n = 5) or MLCwA (n = 5) and control antigens [Rees MLSA (1.0 µg) and saline]. A randomized double blind Phase II safety and efficacy trial followed in an endemic region for leprosy (Nepal), but involved only the 1.0 µg (high dose) and 0.1 µg (low dose) of each antigen; Tuberculin PPD served as a control antigen. This Phase II safety and efficacy trial consisted of three Stages: Stage A and B studies were an expansion of Phase I involving 10 and 90 subjects respectively, and Stage C was then conducted in two parts (high dose and low dose), each enrolling 80 participants: 20 borderline lepromatous/lepromatous (BL/LL) leprosy patients, 20 borderline tuberculoid/tuberculoid (BT/TT) leprosy patients, 20 household contacts of leprosy patients (HC), and 20 tuberculosis (TB) patients. The primary outcome measure for the skin test was delayed type hypersensitivity induration. Findings In the small Phase I safety trial, reactions were primarily against the 2.5 µg dose of both antigens and Rees control antigen, which were then excluded from subsequent studies. In the Phase II, Stage A/B ramped-up safety study, 26% of subjects (13 of 50) showed induration against the high dose of each antigen, and 4% (2 of 50) reacted to the low dose of MLSA-LAM. Phase II, Stage C safety and initial efficacy trial showed that both antigens at the low dose exhibited low sensitivity at 20% and 25% in BT/TT leprosy patients, but high specificity at 100% and 95% compared to TB patients. The high dose of both antigens showed lower specificity (70% and 60%) and sensitivity (10% and 15%). BL/LL leprosy patients were anergic to the leprosy antigens. Interpretation MLSA-LAM and MLCwA at both high (1.0 µg) and low (0.1 µg) doses were found to be safe for use in humans without known exposure to leprosy and in target populations. At a sensitivity rate of 20–25% these antigens are not suitable as a skin test for the detection of the early stages of leprosy infection; however, the degree of specificity is impressive given the presence of cross-reactive antigens in these complex native M. leprae preparations. Trial Registration ClinicalTrails.gov NCT01920750 (Phase I), NCT00128193 (Phase II), Author Summary Clinically useful skin test reagents should be safe and sufficiently sensitive to detect infection prior to physical manifestations of leprosy disease. While in these small scale human studies, leprosy reagents were safe for use in humans, they failed in respect of sensitivity at a rate of 20–25% in the key indicator group, BT/TT leprosy patients. Specificity in terms of leprosy vs. tuberculosis at a rate of 95–100% was surprisingly high in light of the extensive presence of cross-reactive antigens in the complex native M. leprae preparations. These results could justify a further trial at lower dosages.

While health promotion practitioners are engaging increasingly in research, there has been little examination of the practical dilemmas theymay face in negotiating and collaborating with academics and community members in action research projects.This paper analyses how the practice of health promotion can interact with action research, and considers issues that arise for organizationally based health promotion practitioners and professional researchers. The ¢rst section charts types of action research along three dimensions (power, goals/values, resources). The second section examines some of the issues and practical dilemmas which arise in negotiating and researching collaborative projects in community health promotion. The discussion includes the diiering perspectives of: practitioners (managerial and frontline), community members and academic researchers. The ¢nal section outlines a hybrid model of action research, developed in our work with community members, organizationally based health promoters and academy-based researchers. It combines the re£ective practice of practice-based action research with the community participation and control of participatory research. The model is called community re£ective action research.

This paper argues that the combination of limited liability, the productive characteristics of many polluting industries, and the long-term nature of certain environmental damages, presents shareholders of limited liability corporations with an incentive to liquidate their firm before large future liabilities are realised. A formal model is developed, and then parameterised, to indicate the types of firms that will engage in this (and other) behaviour; concrete examples of each type are given. The policy implications are explored, concentrating on the need for separate, ex ante regulation to address the distinct problem of strategic liquidation.

This paper investigates the take-up of various types of video by open and distance education institutions in Europe. It looks briefly at the potential for students to become video producers rather than merely consumers. It then concentrates on the use of videoconferencing as a support technology in three open universities. Lessons learned and tips for improving the quality of video tutorials are included.

Background: The past decades have occasioned an explosion of research on Domestic Violence and the health care response. It has become clear that abused women are frequently seen in emergency departments, yet despite the research, the prevalence of the issue among patients, its serious health consequences, and the need for training acknowledged by numerous medical organizations, there is no standardized curriculum for training health care providers, nor an articulated set of competencies to guide curricular development. Objectives: To develop evidence-based competencies on Domestic Violence relevant to health care providers, particularly those in emergency department settings. Methods: Following a modified Delphi process, we completed a literature review for the years 2001-2006 to determine evidence-based practices. Next, an expert panel extracted relevant competencies from the reviewed literature. The competencies were confirmed through consultation with 66 stakeholders across the province of Ontario. Results: Forty-four respondents provided concrete feedback on the competencies, confirming their importance and validity. Conclusion: This paper describes a comprehensive methodological approach to the challenge of developing competencies in DV relevant to health care providers practicing in emergency department settings. The development of competencies is an important first step in the development of a common, standardized, evidence-based medical curriculum.

In this article we explore Sri Lankan Tamil immigrant women's views on factors contributing to intimate partner violence (IPV). We conducted eight focus groups with young, midlife, and senior women and women who experienced IPV. Three main themes emerged: postmigration sources of stress and conflict, patriarchal social norms that dictated gendered behavior, and individual male attributes and behaviors. Study participants recognized gender inequality and financial dependence as contributing factors and the role of women in promoting marital harmony. Findings suggest that pre- and postmigration factors need to be considered in the prevention of IPV in newcomer communities.

Recent declines in Japanese land and stock market prices have thrown in doubt the financial well-being of the Japanese banking system and the adequacy of its deposit insurance system. In this study, we apply the pricing models of Fries and Perraudin (1993a) and Merton (1977) to value the Japanese authorities′ deposit guarantees for 16 city, trust, and long-term credit banks. Both models are estimated using exact maximum-likelihood techniques that fully allow for time aggregation and the fact that observed quantities such as stock market values are nonlinear functions of underlying driving processes. J. Japan. Int. Econ., December 1993, 7 (4), pp. 356–386. International Monetary Fund; Department of Applied Economics, University of Cambridge, Cambridge CB3 9DE; and CEPR.

The Bangkok Project, which recently linked educational computer networks world wide, was a successful application of the new international electronic mail and computer conferencing networks to support professional development and reflection by members of the distance education community. This article discusses the Project's rationale and operational details. The authors conclude that this medium offers an exceptionally cost‐and learning‐effective means of providing inservice support to distance educators on a global scale.

Utilising the benefits of web 2 applications allows greater interaction than has previously been possible in online education—between the tutor and students, between the students, and between all participants in the selection of core learning resources. When approached with a positive perspective this enables participants to utilise new ways of constructing knowledge relating to learning activities and then to share these resources with a wider range of people over a longer time frame. It permits structured high-quality educational experiences outwith the normal framework of higher education institutions, yet it enables institutions the flexibility to embed this “disruptive technology” within their own ICT systems. This form of design requires the educationalist to re-think the process of course design in a more flexible format than has previously been common. Part of this flexibility comes from re-using existing educational resources—web pages, journal articles, video and audio clips etc.—rather than being required to re-invent courses on every subject area from the scratch. This chapter describes our experiences of designing different models of higher education courses using open educational resources (OER) and proposes a theoretical framework for the democratisation of education through inter-institutional sharing of the different stages of design and delivery of university courses.

Major changes are occurring in British higher education which will continue over the next decade. These include widening access to higher education, e.g. among mature adults and people from other European countries; developing distance and open learning for use in parallel with face-to-face teaching and the expansion of CAL to support various forms of pedagogy. These trends may conflict. Expanding the pedagogic uses of information technology, e.g. unless designed very carefully, may create new barriers to access for some potential students. Educational policy makers, course designers and teachers must address such potential conflicts. This paper draws on recent experience at the Open University (OU) of expanding the use of home-based computers for distance education students. In 1988 the OU implemented a policy in which students on specified courses were required to provide extensive access to personal computers in order to study their course material. By 1990 over 13,500 students were doing this. The experience of these students has been monitored and evaluated and lessons from it indicate some of the major issues such a strategy would involve for any institution considering similar developments.

During the process of learning teachers and/or students interact with each other on a personal level. However, in e-learning the process is achieved through the intermediary of an information and communication technology (ICT) system or service. Descriptions of these ICT-human interface devices are given in this paper. Successful interaction depends not just on personal relationships, but also on understanding and the ability to use computers and communications equipment effectively. Interactivity, when using ICT, may as a result be different from that in a traditional classroom. The computer is the main man-machine interface and modulates people's ability to interact. Newer, mobile technology will extend the ability to interact in terms of time and place, as is illustrated by the use of portable digital assistants for dental teaching in clinics. The paper concludes that it is very important that both teachers and students should understand how to interact optimally with current and future ICT systems and devices.