Medicine and Health Sciences Commons^™

Voice Analysis With Iphones: A Low Cost Experimental Solution, Benjamin Van Der Woerd

Electronic Thesis and Dissertation Repository

Background:

Acoustic voice analysis requires a resource intensive setup, including a soundproof booth. This project evaluates smartphone microphone and recording environment impacts on voice sample collection for acoustic voice analysis. A proprietary analysis algorithm is presented for validation.

Methods:

Microphone and recording environment were evaluated using previously collected voice samples presented in four conditions to test two microphones and two recording environments. Prospective samples were used to test the proprietary algorithm, whereby samples were analyzed using this and Praat.

Results:

Microphone and recording environment had small, clinically unimportant impacts on most measurements. The proprietary algorithm reliably analyzed sustained vowels, with …

Biomechanics Analysis Of Anterior Cortical Perforation In Antegrade Femoral Nailing, Michael Ching

Electronic Thesis and Dissertation Repository

Hip and femur fractures are a common problem in an aging population. The number of hip and femur fractures are on the rise in Canada. Cephalomedullary fixation is a common method of treating hip and femur fractures, with a known complication of anterior cortical perforation of the distal femur. The literature describes risk factors, such as the influence of the start point at the greater trochanter, but there is no consensus on management. Some cases are treated with restricted weightbearing and other cases with revision surgery. Restricted weightbearing increases perioperative complications including mortality and decreases functional outcomes.

We analyze the …

Preventive Strategies For Acute Kidney Injury Among Patients Undergoing Abdominal Aortic Aneurysm Repair, Michaela Fernandes

Electronic Thesis and Dissertation Repository

Strategies for preventing acute kidney injury (AKI) in patients undergoing abdominal aortic aneurysm (AAA) repair were explored in a secondary data analysis of 601 patients from a randomized controlled trial (RCT). Bivariate analyses identified an association between intraoperative hypotension and postoperative AKI and suggested IV fluids as the best treatment option over inotropes/vasopressors which increased the odds of AKI (OR_crude=2.5 95%CI 1.2-5.0), however, our multivariable analysis was non-significant (OR_adjusted=1.7 95%CI 0.8-3.7). Further analysis found angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker use within 24 hours prior to repair were not associated with postoperative AKI (OR …

Applications Of Hair As A Record Of Systemic Exposure To Cortisol, Jeffrey Matthew Levine

Electronic Thesis and Dissertation Repository

Hair cortisol content (HCC) is a novel biomarker that uniquely captures retrospective systemic cortisol exposure. This thesis aimed to assess how different hair growth rates effect HCC timelines in Cushing’s and Addison’s patients, investigate the relationship between HCC and age, puberty, sex and BMI in healthy children and adolescents, and assess novel methods to improve cortisol extraction and recovery. Retrospective HCC timelines derived from a 0.75 cm/month growth rate best matched 50% of patients’ medical records rather than the historically assumed 1 cm/month. HCC correlated positively with age (p<0.0001), puberty status (p<0.001), and BMI (p<0.01) in males and females 7-17 years old. Nitrogen evaporation resulted in greater cortisol recovery than air evaporation (p=0.0003), and hair digestion using NaOH resulted in more rapid extraction of cortisol. These results provide incremental improvements to previous methods and assumptions for HCC analysis and elucidate normal HCC changes in children and adolescents.

Japanese Patients' Preference For Patient-Centered Medicine And Its Association With The Satisfaction Of Patients With Their Family Physicians, Tesshu Kusaba

Electronic Thesis and Dissertation Repository

Aims: This thesis explored Japanese patients’ preference for Patient-centered medicine, which was one of the core principles of family medicine, and its association with the satisfaction of patients with their family physicians.

Method: A cross-sectional study was conducted to examine Japanese patients’ preference for 3 factors of Patient-centered medicine and their satisfaction with the practice by family physicians, using patient questionnaires pre and post consultation.

Findings: The majority of Japanese patients preferred all 3 of the factors of Patient-centered medicine: Communication, Partnership and Health Promotion. The more vulnerable the patients, the more their expressed preference. A high proportion of patients …

The Standardization Of Outpatient Procedure (Stop) Narcotics: A Prospective Non-Inferiority Study To Reduce Opioid Use In Outpatient General Surgical Procedures, Luke B. Hartford

Electronic Thesis and Dissertation Repository

Surgeons play a significant role in the opioid crisis. A standardized, multipronged analgesia protocol was implemented with the objective of providing adequate analgesia while reducing opioids after outpatient breast and anorectal surgery.

A prospective, pre- and post-intervention study was designed to demonstrate non-inferiority for patient-reported post-operative pain. The intervention included patient and provider education, and multimodal perioperative analgesic strategies including opioid rescue prescriptions.

We evaluated 266 procedures. After implementation of the STOP Narcotics protocol, average post-operative pain scores in the post-intervention groups was non-inferior compared to the pre-intervention groups [(2.0 vs 2.1/10, p = 0.40, breast procedures) and (2.8 vs …

Neurodevelopmental Outcomes Of Infantile Hydrocephalus: An Fmri Case Study, Ikhlas Ahmed Hashi

Electronic Thesis and Dissertation Repository

Ventricle dilatation caused by infantile hydrocephalus may result in extensive damage of the posterior cortex (parietal and occipital lobes). We hypothesize that pathological changes in the development of the posterior cortex can be linked to non-verbal learning disabilities in children with previous infantile hydrocephalus. This case study will investigate the neurodevelopmental outcomes of 3 treated hydrocephalus patients, when compared to a group of healthy control children (n = 12). Within the hydrocephalus group, patients displayed differences in non-verbal test performance as well as parietal brain activation during an fMRI number comparison task. We associated these differences with clinical variables such …

Academic Center Tiered Operating Room Strategy (Action): Comparing A High Efficiency Or To The Conventional Or, Moaz Bin Yunus Chohan

Electronic Thesis and Dissertation Repository

Canadian healthcare system is under immense economic pressure. In an attempt to resolve the problem, outpatient surgical services were offered to patients presenting with orthopaedic surgical complaints. An observational cohort study was carried out, comparing the conventional surgical setup to the newly designed high-efficiency setup that provided similar care, with a significantly lower operating cost. A total of 200 patients were enrolled in the study. Standardized and unstandardized questionnaires were used to evaluate pre-operative and post-operative patient data that reflected quality of life outcomes. Data was collected at enrolment and during post-operative follow-ups of up to 6 months. Results indicate …

Maternal Nicotine Exposure Induces Congenital Heart Defects In The Offspring Of Mice, Elizabeth Greco

Electronic Thesis and Dissertation Repository

Congenital heart defects are the most prevalent birth defect, and maternal cigarette smoking is a known risk factor. Nicotine replacement therapies are recommended to pregnant women who smoke to aid in smoking cessation, as this alternative is thought to be much safer compared to cigarette smoking. However, these products contain nicotine, and the safety of nicotine on the developing heart is not well known. In this thesis, a mouse model was used to test the hypothesis that maternal nicotine exposure (MNE) during pregnancy leads to congenital heart defects and coronary artery defects in the offspring of mice. MNE resulted in …

Improving The Assessment And Understanding Of Neurogenic Orthostatic Hypotension, Jacquie Baker

Electronic Thesis and Dissertation Repository

Neurogenic Orthostatic Hypotension (NOH) is a cardinal feature of autonomic failure. Patients with NOH experience a persistent and consistent drop in blood pressure when standing due to failure of the autonomic nervous system to reflexively increase sympathetic outflow. NOH affects individuals worldwide, presenting as both a primary feature (i.e. Multiple Systems Atrophy, Pure Autonomic Failure) and secondary to several common disorders including diabetes and Parkinson’s Disease. However, there are still several gaps in our overall understanding and assessment of patients with NOH. Therefore, the six studies presented in this thesis aimed to address some of these gaps in our current …

Neoadjuvant Stereotactic Ablative Radiotherapy To Treat Early Stage Breast Cancer Patients: The Role Of Dce-Mri, Matthew Mouawad

Electronic Thesis and Dissertation Repository

The current standard of breast conserving therapy is lumpectomy followed by whole breast radiotherapy which is prohibitively long for many patients (4-6 weeks). In addition, the need for treating the whole breast has been questioned. The London Regional Cancer Program is enrolling early stage breast cancer patients in a prospective Phase I/II clinical trial (SIGNAL) to assess the safety/efficacy of neoadjuvant stereotactic ablative radiotherapy (SABR) to the tumour alone to reduce treatment times. This provides a unique opportunity to assess tumour response to SABR using non-invasive imaging. Patients received a pre-SABR dynamic contrast-enhanced (DCE)-MRI to guide target volume delineation. A …

Modulation Of Inflammation Driven Wound Healing After Glaucoma Surgery, James J. Armstrong

Electronic Thesis and Dissertation Repository

Dysregulated wound healing contributes to most currently unanswered ophthalmological morbidity. Opacification and structure altering contractures compromise the delicate ocular anatomy upon which ocular function and healthy vision are reliant. Glaucoma filtration surgery, corneal stromal injury, proliferative vitreoretinopathy and age-related macular degeneration are major contributors to ocular morbidity – all with myofibroblast transdifferentiation and pathognomonic scarring activity at their core.

This thesis aims to revaluate the means by which dysregulated ocular wound healing is combated with evidence describing a novel strategy to mitigate its effects. A translational approach was used. An initial retrospective analysis of over ten thousand glaucoma surgeries found …

The Feasibility Of Gathering Patient-Reported Outcome Measures On Individuals With Acute Ankle Sprains In A Busy Clinic Environment, Ryan Reeson

Electronic Thesis and Dissertation Repository

Ankle sprains are the most common sports injury and can lead to long-term deficits. Patient-reported outcome measures (PROMs) may assist clinicians in evaluating the recovery trajectory of patients with ankle sprains. However, before a large-scale study can be performed, it is necessary to determine whether it is feasible to collect PROMs in a busy clinic environment. This study had a narrow recruitment window but the consent rate was 100%. Ten patients at Fowler Kennedy Sport Medicine Clinic were followed for up to six visits. Three PROMs that characterized lower extremity function were measured. The measurement completion rate decreased from 100% …

Assessing The Impact Of Surgical Technique On Implant Migration, Tibiofemoral Contact Kinematics, And Functional Recovery Following Uncemented Total Knee Arthroplasty, Harley A. Williams

Electronic Thesis and Dissertation Repository

The standard of care treatment for end-stage osteoarthritis of the knee joint is a total knee arthroplasty (TKA). As we move towards a younger TKA patient cohort, implant longevity is of increasing concern. Porous hydroxyapatite coated uncemented implants provide a promising alternative to cemented fixation methods. Currently, a lack of consensus exists regarding which surgical technique is best suited to the uncemented TKA procedure. This thesis sought to examine the impact of surgical technique on tibial and femoral component migration. Additionally, we investigated the impact of technique on post-operative kinematics and functional recovery. The results of this thesis indicate no …

Measuring Multimorbidity, Eng Sing E S Lee

Electronic Thesis and Dissertation Repository

Multimorbidity is common. The gaps in multimorbidity research are in the measurement of the prevalence, the levels of multimorbidity and its associated outcomes.

This thesis aimed to provide a uniform definition for multimorbidity, identify instruments for measuring the level of multimorbidity, and describe patient-reported outcomes for different levels of multimorbidity.

Three studies were conducted. The first determined the prevalence rates of multimorbidity and explored whether there were differences among the different age, gender and ethnic groups in the primary care population. Common dyads and triads of conditions were described. The systematic review updated the list of instruments for measuring the …

Examining The Relationship Between Urinary Pathogens, Antibiotic Exposure And Urolithiasis, Jennifer Bjazevic

Electronic Thesis and Dissertation Repository

Urinary stone disease is a highly prevalent urological condition; however, the pathophysiology remains poorly understood. Growing evidence suggests a relationship between urinary tract infections, antibiotic exposure and the development of urolithiasis. In this project, we utilized a dietary Drosophila melanogaster model and a calcium oxalate crystal adhesion assay to further investigate the impact of a urinary pathogen and antibiotics on calcium stone formation. We demonstrated that both a non-urease producing strain of Escherichia coli and the antibiotics, ciprofloxacin and trimethoprim-sulfamethoxazole, increased calcium stone formation. In addition, our preliminary work suggests that biomineralization agents such as osteopontin and zinc appear to …

Ultra-High Field Magnetic Resonance Imaging For Stereotactic Neurosurgery, Jonathan Lau

Electronic Thesis and Dissertation Repository

Stereotactic neurosurgery is a subspecialty within neurosurgery concerned with accurate targeting of brain structures. Deep brain stimulation (DBS) is a specific type of stereotaxy in which electrodes are implanted in deep brain structures. It has proven therapeutic efficacy in Parkinson’s disease and Essential Tremor, but with an expanding number of indications under evaluation including Alzheimer’s disease, depression, epilepsy, and obesity, many more Canadians with chronic health conditions may benefit. Accurate surgical targeting is crucial with millimeter deviations resulting in unwanted side effects including muscle contractions, or worse, vessel injury. Lack of adequate visualization of surgical targets with conventional lower field …

Assessing The Impact Of Collared Versus Collarless Stems On Implant Migration, Patient Activity And Patient Function Following Total Hip Arthroplasty: A Randomized Clinical Trial, Maxwell E. Perelgut

Electronic Thesis and Dissertation Repository

Total hip arthroplasty (THA) is a common procedure used to treat end-stage hip osteoarthritis (OA). Various designs of implants are currently used to successfully perform these procedures. However, the role of these design variations on early implant migration and patient recovery is still being studied. In this study patients were prospectively randomized to receive either a collared or collarless femoral stem. Differences were compared between groups assessing implant migration, patient activity and patient functional differences. Compared to the collarless femoral stem, it is believed that a collared femoral stem provides improved axial stability early in the post-operative timeline. This study …

Easier And Faster Is Not Always Better: Grounded Theory Of A Large-Scale, System Transformation On The Clinical Work Of Emergency Nurses And Physicians, Elaine Zibrowski

Electronic Thesis and Dissertation Repository

Lean Thinking was pioneered during the 1980’s by the Toyota Motor Company as a method of process improvement for their production lines. Since the early 2000’s, there have been published reports of using Lean to redesign healthcare systems. Its effectiveness as a quality improvement method for healthcare has been contested due, in part, to our limited contextual understanding of how Lean affects the working conditions, and clinical workflow, of healthcare professionals. The objective of this dissertation was to explore how a Lean intervention may impact clinical work, and within what contexts.

A realist grounded theory approach was used to explore …

Radial Head Stability In Anterior Monteggia Injuries: An In Vitro Biomechanical Study, Armin Badre

Electronic Thesis and Dissertation Repository

Anterior Monteggia fracture-dislocations are frequently complicated by persistent radial head instability leading to suboptimal outcomes. In this biomechanical investigation using a cadaveric elbow motion simulator, we examined the effects of ulnar extension angulation, soft tissue disruption, biceps loading and elbow motion on radial head translation. Our results showed significant anterior radial head translation with progressive ulnar extension angulation, with greater soft tissue injuries and increased biceps loading (P=.000). There was no significant difference in radial head translation between simulated active and passive elbow flexion (P=.251). These findings support the importance of an anatomic reduction of the ulnar fracture. However, in …

Translational Control Of Stress Induced Breast Cancer Plasticity, Michael Jewer

Electronic Thesis and Dissertation Repository

Cancer cell plasticity, whereby stem-cell-like properties are acquired in response to stress, represents a major challenge in cancer treatment. Using cell line and patient-derived xenograft (PDX) models, we demonstrate that translational reprogramming occurs in response to stresses such as hypoxia and chemotherapy which elicits stem cell properties in breast cancer. Other stresses like chemotherapy demonstrate the translational inhibition that has been well characterized as an integral hypoxic cellular response. The inhibition of translation is primarily regulated at initiation by mTOR/4E-BP1 and PERK/eIF2α signalling. We identify previously undescribed 5’ untranslated regions (5’UTRs) of plasticity-associated genes like NANOG, SNAIL and NODAL. …

Parents As Agents Of Change In The Treatment Of Childhood Obesity And The Promotion Of Children's Health Behaviours, Kristen C. Reilly

Electronic Thesis and Dissertation Repository

The overarching purpose of this dissertation was to investigate the role of parents as agents of change in the treatment of childhood obesity and the promotion of children’s health behaviours. In order to achieve this purpose, four studies were conducted. The purpose of Study 1 was to explore parents’ perceptions of nutritional literacy, as well as their needs for nutritional literacy information, supports, and resources at familial and community levels. Next, Study 2 described the theoretical components and model used in the development and implementation of a parent-focused childhood overweight and obesity intervention (i.e., C.H.A.M.P. Families). The purpose of Study …

The Development And Evaluation Of Resources To Improve The Quality Of Care For Patients With Knee Osteoarthritis, Laura K. Churchill

Electronic Thesis and Dissertation Repository

Purpose: The non-operative management of patients with knee osteoarthritis (OA) is often considered suboptimal. Sub-optimal management includes inadequate use of non-surgical treatments, misuse of diagnostic imaging, and non-operative referrals to surgeons in consideration of total knee replacement (TKR). These inefficiencies result from an interplay of factors involving primary care physicians, patients, and the systems in which they function. The overall purpose of this thesis is to develop a means to optimize the management of patients with knee OA, and the timing and quality of referrals to TKR.

Methods: This thesis includes three studies. In study 1, we identified and cross-validated …

Family Physician's Clinical Inertia In The Management Of Hypoglycemia, Caroline V. Martignoni Rebicki

Electronic Thesis and Dissertation Repository

Though the management of diabetes is widely documented in scientific literature, little is published about how hypoglycemia is managed by family physicians. The objective of this study was to create a measurement for family physician clinical inertia in managing hypoglycemia, and to determine family physicians’ characteristics associated with clinical inertia. The design was a secondary analysis of the data provided by 162 family physicians from the Canadian InHypo-DM Study. The outcome for this thesis was a score for physician clinical inertia. The methods applied were exploratory factor analysis, bivariate analysis and multiple linear regression. Results showed no statistically significant differences …

Characteristics And Outcomes Of Patients Discharged Home From An Emergency Department With Acute Kidney Injury: A Population-Based Cohort Study, Rey Acedillo

Electronic Thesis and Dissertation Repository

We designed a population-based cohort study to describe the characteristics and outcomes of 6346 adults discharged home from an emergency department (ED) with acute kidney injury (AKI). Within 30 days of discharge, 149 (2.3%) patients died (stage 1: 2.1%, stage 2: 5.2%, and stage 3 AKI: 15.9%). We also compared 30-day mortality to patients hospitalized with AKI and patients discharged home with no AKI in two separate propensity score-matched analyses. An ED discharge versus hospitalization was associated with lower 30-day mortality (3.0% vs. 11.9%, relative risk (RR): 0.25, 95% confidence interval (CI): 0.21-0.30). An ED discharge home with AKI versus …