Medicine and Health Sciences Commons^™

Assessing The Structural Validity Of The Measure Of Processes Of Care (Mpoc-20) In Children With Epilepsy, Kariym Christopher Joachim

Electronic Thesis and Dissertation Repository

The goal of this thesis was to determine whether the 20-item Measure of Processes of Care (MPOC-20) questionnaire remains structurally/factorially valid among children with epilepsy, and to propose adaptations if it did not. Establishing the MPOC-20’s structural validity in this population makes it possible to draw conclusions on the potential effects of parent-perceived Family-Centred Care (FCC) on health outcomes within this population. Data came from the Health-related Quality of Life for Children with Epilepsy Study (HERQULES). Confirmatory Factor Analysis (CFA) indicated that the original five factor model fit poorly in children with epilepsy. An exploratory analysis within a CFA framework …

A Comparison Of Clinical Trial And Model-Based Cost Estimates In Glaucoma – The Case Of Repeat Laser Trabeculoplasty In Ontario, Omar Akhtar

Electronic Thesis and Dissertation Repository

Background and objective: For cost-effectiveness analyses (CEA) of glaucoma interventions to be of use they require valid and accurate cost and effectiveness data. Costs remain understudied relative to effectiveness. The impact of cost estimation methods on resultant estimates is unknown in glaucoma. Direct measurement of costs is labour-intensive and expensive. Decision-analytic modelling of costs using literature sources, expert opinion, institutional experience and assumptions provides a quicker, less laborious alternative to empirical costing. A lack of long-term effectiveness data in chronic diseases like glaucoma means that modelling is widespread and inevitable, both for CEAs and budget impact projections. The same problem …

Quality Of Life And Health-Related Quality Of Life In Children With Duchenne Muscular Dystrophy, Yi Wei

Electronic Thesis and Dissertation Repository

Quality of life studies in Duchenne Muscular Dystrophy are scarce. This study explores the relationship between the broad concept of quality of life and the more focused concept of health-related quality of life and examines the relationships between patient and family characteristics and health-related quality of life. Participants were recruited from the Canadian Neuromuscular Disease Registry, 98 parents and 85 children completed the Quality of My Life and Pediatric Quality of Life Inventory questionnaires. Simple regression was used to examine the relationship between quality of life and health-related quality of life. Multivariable linear regressions were used to determine child and …

Quantitative Mri Correlates Of Hippocampal And Neocortical Pathology In Intractable Temporal Lobe Epilepsy, Maged Goubran

Electronic Thesis and Dissertation Repository

Intractable or drug-resistant epilepsy occurs in over 30% of epilepsy patients, with many of these patients undergoing surgical excision of the affected brain region to achieve seizure control. Advances in MRI have the potential to improve surgical treatment of epilepsy through improved identification and delineation of lesions. However, validation is currently needed to investigate histopathological correlates of these new imaging techniques. The purpose of this work is to investigate histopathological correlates of quantitative relaxometry and DTI from hippocampal and neocortical specimens of intractable TLE patients. To achieve this goal I developed and evaluated a pipeline for histology to in-vivo MRI …

The Effect Of Fixation Plate Length On Spinal Instability Following Anterior Cervical Plate Fixation For The Repair Of In Vitro Flexion-Distraction Injuries, Abdulaziz J. Al-Kuwari

Electronic Thesis and Dissertation Repository

Abstract:

The Effect of Fixation Plate Length on Spinal Instability Following Anterior Cervical Plate Fixation for the Repair of in Vitro Flexion-Distraction Injuries

Introduction: Anterior cervical decompression and fusion with a plate (ACDFP) is a commonly performed treatment following a traumatic injury to the subaxial cervical spine. The purpose of the presented work was to determine the biomechanical effect of plate length on cervical spine kinematic stability following ACDFP stabilization for a simulated traumatic injury.

Methods: Eleven fresh-frozen cadaveric C5-C6 and C6-C7 motion segments were examined in this study. To assess kinematics, flexibility testing was performed on each specimen …

Role Of Sirt1 In Vascular Complications Of Diabetes, Rokhsana Mortuza

Electronic Thesis and Dissertation Repository

Chronic diabetic complications are significant causes of morbidity. In diabetes, as the cellular changes are similar to aging, we investigated the role of sirtuins (SIRTs) in chronic diabetic complications.

We examined glucose and aging-induced changes in the endothelial cells (ECs), the primary targets of chronic diabetic complications. ECs in high glucose showed evidences of early senescence, being more pronounced in microvascular ECs in association with decreased SIRT1 and FOXO1-dependent reduction in antioxidant gene expressions. A regulatory relationship of deacetylator SIRT1 and histone acetylator p300 was identified. Renal and retinal tissues of diabetic animals showed similar results.

Having established such changes, …

Blood Conservation In Total Hip Arthroplasty: Interim Analysis Of The Tranexamic Acid Comparison In Hip Replacement (Teach-R) Trial, Richard P. Nadeau

Electronic Thesis and Dissertation Repository

Intravenous tranexamic acid (TEA) is used in total hip arthroplasty (THA) to reduce blood loss. Concern of increased thromboembolic risk has prompted the search for treatment alternatives. The Tranexamic Acid Comparison in Hip Replacement (TeACH-R) trial is a prospective randomized controlled trial comparing the efficacy of intravenous and topical TEA in reducing perioperative blood loss. For interim data analysis, 52 of the planned 144 participants had completed the initial phase of the TeACH-R trial. No significant differences were identified between the intravenous and topical TEA treatment arms for delta-hemoglobin (ΔHgb; 34.81±13.78 vs. 35.65±15.54 mg/dL; p=0.840), calculated blood loss (1548±509 …

Cell Death Regulates Injury And Inflammation During Renal Allograft Transplantation, Arthur Lau

Electronic Thesis and Dissertation Repository

Renal transplantation invariably results in tissue injury resulting from ischemia reperfusion injury (IRI), inflammation, drug toxicity, and rejection. Tubular epithelial cells (TEC) comprise the majority of renal parenchyma and are susceptible to cell death and injury during diverse forms of inflammation, which has direct and indirect effects on long term allograft function. Renal TEC have the unique ability to attenuate inflammation and alloimmune injury through the expression of various mediators of cell death and inflammatory molecules. Inhibition of cell death pathways in renal allografts may influence outcomes of alloimmune responses and graft survival. In this body of investigation, alteration of …

Investigating Barriers To Access And Delivery Of Palliative Care For Persons With Dementia In London, Ontario, Emily M. Hill

Electronic Thesis and Dissertation Repository

Dementia is a syndrome that is progressive, degenerative and terminal. The palliative care philosophy aims to maximize quality of life for the dying individual and has been recognized in the literature as being both beneficial and under-used in persons dying with dementia. The purpose of this study was to investigate the experiences of staff delivering palliative care to individuals with dementia to determine how care was delivered, to learn which assessment tools were used, and whether policies were affected the delivery of palliative care. Twenty-two staff participants were interviewed. Data were interpreted using phenomenological methodology. Findings yielded three themes: confusion, …

Functional Assessment And Potential Therapeutic Role Of Carbon Monoxide Releasing Molecule-­‐3 In A Rodent Model Of Compartment Syndrome, Al Walid Hamam

Electronic Thesis and Dissertation Repository

Compartment syndrome (CS) is a life and limb threatening condition resulting in long term morbidity. Gold standard treatment of CS is surgical fasciotomy. Long-term morbidity is common post fasciotomy. We tested a gait analysis system (CatWalk™) to see if we could detect functional effects of CS in our rodent model. We also investigated the effects of carbon monoxide releasing molecule-3 (CORM-3) on the function of gait in rodents post CS.

The CatWalkTM system was able to detect abnormalities in a rodent’s gait post CS. CORM-3 was also found to alleviate the functional deficits following CS. Multiple dose but not single …

Introduction Of A Mobile Device Based Tertiary Survey Application Reduces Missed Injuries: A Multi-Center Prospective Study, Bradley S. Moffat

Electronic Thesis and Dissertation Repository

Missed injuries in trauma patients are a significant source of preventable morbidity. The tertiary survey is a head-to-toe physical exam performed within 24 hours of admission to identify any injuries which may have been missed during initial assessment and resuscitation. The Physician Assist Trauma Software (PATS) is an electronic program designed to guide users through a thorough tertiary survey and document the results. This thesis project was designed to study the impact of implementing this novel mobile device based electronic tertiary survey program on missed injuries. The first phase of this study involved quantifying and characterizing the missed injury rate …

Efficacy Of Novel Antifouling/Antimicrobial Coatings For The Prevention Of Urinary Device Associated Infection And Encrustation, Thomas O. Tailly

Electronic Thesis and Dissertation Repository

Device associated urinary tract infections are a very important healthcare issue. Despite best efforts in preventing and treating these infections, many patients and physicians are still confronted with this problem. Our research group is involved in testing and evaluating new stent coatings for the prevention of device associated infections and device encrustation. In the current project, we tested two new coating copolymers, both based on a long chain polymer backbone and mussel adhesive protein to this purpose in a rabbit and porcine model. The results demonstrate efficiency of one copolymer in preventing infections in the rabbit model. Interestingly there is …

Overall Survival And Biochemical Failure-Free Survival Comparison Of Brachytherapy Treatment Options Versus External Beam Radiation Therapy For Both Low And Intermediate-Risk Prostate Cancer: A Propensity-Score Matched Analysis, Graham D. Smith

Electronic Thesis and Dissertation Repository

Purpose: This study compares overall survival (OS) and biochemical failure-free survival (bFFS) in low- and intermediate-risk prostate cancer patients that received brachytherapy [low-dose-rate brachytherapy (LDR-BT) or high-dose-rate brachytherapy with external beam radiation therapy (HDR-BT+EBRT)] versus external beam radiation therapy (EBRT) alone.

Materials/Methods: Patient data was obtained from the ProCaRS database, which contains 7974 prostate cancer patients treated at four Canadian institutions. Propensity score (PS) matching was used to generate matched cohorts with balanced baseline prognostic factors.

Results/Conclusions: Final PS matches included two 1:1 intermediate-risk patient matches, LDR-BT vs. EBRT (total n = 254) and HDR-BT+EBRT vs. EBRT (total n=388), and …

Polycomb Repressive Complex 2 Regulates Mir-200b In Retinal Endothelial Cells: Possible Implications In Diabetic Retinopathy, Michael A. Ruiz

Electronic Thesis and Dissertation Repository

Glucose-induced augmented vascular endothelial growth factor (VEGF) production is a key event in diabetic retinopathy. We have previously demonstrated that downregulation of miR-200b increases VEGF, mediating structural and functional changes in the retina in diabetes. However, mechanisms regulating miR-200b in diabetes are not known. Histone methyltransferase complex, Polycomb Repressive Complex 2 (PRC2), has been shown to repress miRNAs in neoplastic process. We hypothesized that, in diabetes, PRC2 represses miR-200b through its histone H3 lysine-27 trimethylation mark. We show that human retinal microvascular endothelial cells exposed to high levels of glucose regulate miR-200b repression through histone methylation, and that inhibition of …

The Repair, Reconstruction And Replacement Of The Coronoid Process, Bashar Alolabi

Electronic Thesis and Dissertation Repository

The coronoid process is the most important articular stabilizer of the elbow. While most large coronoid fractures are treated surgically with open reduction and internal fixation, there is limited data on the most effective fixation method. The strengths of five different coronoid fixation methods were assessed using a materials testing machine. Plate fixation proved to be stronger than screw fixation; two screws, regardless of the orientation, were stronger than one; and suture fixation was unreliable. In the setting of an unfixable coronoid fracture, reconstruction of the coronoid using the tip of the olecranon has been described. However, this technique has …

Mri Relaxation Rates: A Quantitative Approach To Track Tumour Cells Expressing Maga, Anindita Sengupta

Electronic Thesis and Dissertation Repository

Using magnetic resonance imaging, relaxation rate measurements were

performed in cancer cells overexpressing a magnetotactic bacterial gene, MagA.

Measurements of magnetic resonance relaxation rates in this expression

system is important for optimizing cell detection and specificity, for developing

quantification methods, and for refinement of gene-based iron contrast using

magnetosome associated genes. We measured the total transverse

relaxation rate (R2^*), its irreversible and reversible components (R2 and R2^′,

respectively) and the longitudinal relaxation rate (R1) in MDA-MB-435 tumor cells.

Clonal lines overexpressing MagA were cultured in the presence and absence of

iron supplementation, and mounted in a …

Managing Uncertainty In Young-Onset Parkinson's Disease, Michael J. Ravenek

Electronic Thesis and Dissertation Repository

Typically considered a disease of old-age, Parkinson’s disease can affect those younger in life, i.e., before the age of 55, when it is referred to as young-onset Parkinson’s disease (YOPD). Using constructionist grounded theory, this research sought to understand how, and why, individuals with YOPD became informed about their disease over time. A total of 39 individuals, who self-identified as living with YOPD, took part in this study which was organized according to four cycles of data collection. These cycles utilized focus groups, in-depth interviews and a private online discussion board, supplemented by 14 autobiographies written by individuals living with …

The Role Of Rotator Interval Closure In Bankart Lesion Repair, Lauren L. Rainsford

Electronic Thesis and Dissertation Repository

Twenty-nine patients who had sustained an anterior shoulder dislocation were randomly assigned to receive Bankart lesion repair, or Bankart lesion repair with rotator interval closure. External rotation range of motion with 90° of abduction external rotation range of motion with no abduction, and forward flexion range of motion were measured preoperatively, and at three and six months postoperatively. Quality of life, function, and pain were measured preoperatively, and at three, six, 12 and 24 weeks postoperatively. We found no significant differences between groups for any outcome but the confidence intervals were wide and definitive conclusions could not be made. This …

Cortisol And Testosterone In Hair As Biological Markers Of Systolic Heart Failure, Justin Chan

Electronic Thesis and Dissertation Repository

Congestive heart failure (CHF) is associated with increased stress and alterations in metabolism, favoring catabolism over anabolism. Hormonal profiles of patients with heart failure have been assessed using serum and saliva as matrices, which are only point measurements and do not provide long-term information. Scalp hair is a novel matrix that allows for measurement of hormones over a period of several months. We aimed to evaluate whether levels of cortisol and testosterone and their ratio (C/T) in hair correlate with severity of heart failure. We conducted a prospective study in ambulatory male patients with a left ventricular ejection fraction (LVEF) …

Validation Of A Novel Methodology For Evaluating Surgical Tissue Plane Identification, Syed T. Ali

Electronic Thesis and Dissertation Repository

Introduction: The ability to identify tissues planes is a fundamental surgical skill. This study attempts to validate a previously developed test for assessing this ability.

Methods: 48 video captured images from laparoscopic right hemicolectomies were presented on an iPad to 18 surgeons who were grouped based on experience (Consultants (C), Senior trainees (S), and the Junior trainees (J)). Subjects were asked to draw a line indicating the tissue plane of dissection. Lines were compared by a modified Hausdorff measure. Within group variability represented group precision and trainee accuracy was determined from comparison to Consultants.

Results: Within group comparisons demonstrated Consultants …

Pathophysiology Of Compartment Syndrome, Abdel-Rahman Lawendy

Electronic Thesis and Dissertation Repository

Acute limb compartment syndrome (CS), a potentially devastating complication of musculoskeletal trauma, is characterized by increased pressure within a closed osseofascial compartment, resulting in muscle-threatening and ultimately limb-threatening ischemia. Urgent fasciotomy remains the only effective treatment and a current gold-standard surgical therapy. Despite a large body of literature dedicated to understanding the pathophysiology of CS, the mechanisms of CS-induced tissue damage are rather poorly understood. The established view is that increasing compartmental pressure compromises microcirculatory perfusion, restricting oxygen and nutrient delivery to vital tissues, resulting in cellular anoxia and severe tissue necrosis. However, unlike complete ischemia, CS causes myonecrosis in …

Ultra High Field (7t) Magnetic Resonance Imaging Of Intracranial Vessel Wall, Pablo Lopez-Ojeda

Electronic Thesis and Dissertation Repository

Intracranial vessel wall imaging may be accomplished with high-field (7T) magnetic resonance (MRI). To determine its feasibility, a 7T MR protocol was defined using Polyvinyl-alcohol cryogel (PVA-C) phantom vessels and healthy subjects.

A 2D matrix construct of PVA-C vessel phantoms of different diameters and wall thicknesses was scanned. Three observers measured the phantom images, one of which three times. Physical measurements were performed using a digital caliper. Ten volunteers were scanned using three different MRI sequences (TSE-3D, FLAIR, MPRAGE). Imaging assessment was performed in different circle of Willis (COW) segments. Reliability and accuracy of the measurements was analyzed by inter …

Multiparametric Imaging And Mr Image Texture Analysis In Brain Tumors, Harish A. Sharma

Electronic Thesis and Dissertation Repository

Discrimination of tumor from radiation injured (RI) tissues and differentiation of tumor types using noninvasive imaging is essential for guiding surgical and radiotherapy treatments are some of the challenges that clinicians face in the course of treatment of brain tumors. The first objective in this thesis was to develop a method to discriminate between glioblastoma tumor recurrences and radiation injury using multiparametric characterization of the tissue incorporating conventional magnetic resonance imaging signal intensities and diffusion tensor imaging parameters. Our results show significant correlations in the RI that was missing in the tumor regions. These correlations may aid in differentiating between …

Image Fusion And Axial Labeling Of The Spine, Brandon Miles

Electronic Thesis and Dissertation Repository

In order to improve radiological diagnosis of back pain and spine disease, two new algorithms have been developed to aid the 75% of Canadians who will suffer from back pain in a given year. With the associated medical imaging required for many of these patients, there is a potential for improvement in both patient care and healthcare economics by increasing the accuracy and efficiency of spine diagnosis. A real-time spine image fusion system and an automatic vertebra/disc labeling system have been developed to address this. Both magnetic resonance (MR) images and computed tomography (CT) images are often acquired for patients. …