Medicine and Health Sciences Commons^™

Models Of Shared Care For The Management Of Psychotic Disorder After First Diagnosis In Ontario., Joshua C. Wiener, Rebecca Rodrigues, Jennifer N S Reid, Kelly K. Anderson

Epidemiology and Biostatistics Publications

OBJECTIVE: To describe the provision of care for young people following first diagnosis of psychotic disorder.

DESIGN: Retrospective cohort study using health administrative data.

SETTING: Ontario.

PARTICIPANTS: People aged 14 to 35 years with a first diagnosis of nonaffective psychotic disorder in Ontario between 2005 and 2015 (N=39,449).

MAIN OUTCOME MEASURES: Models of care, defined by psychosis-related service contacts with primary care physicians and psychiatrists during the 2 years after first diagnosis of psychotic disorder.

RESULTS: During the 2-year follow-up period, 29% of the cohort received only primary care, 30% received only psychiatric care, and 32% received both primary and …

Access To A Regular Primary Care Physician Among Young People With Early Psychosis In Ontario, Canada, Rebecca Rodrigues, Jennifer N S Reid, Joshua C. Wiener, Suzanne Archie, Richard G Booth, Chiachen Cheng, Arlene G Macdougall, Lena Palaniyappan, Bridget L Ryan, Aristotle Voineskos, Paul Kurdyak, Saadia Hameed Jan, Kelly K. Anderson

Epidemiology and Biostatistics Publications

AIM: Access to a primary care physician in early psychosis facilitates help-seeking and engagement with psychiatric treatment. We examined access to a regular primary care physician in people with early psychosis, compared to the general population, and explored factors associated with access.

METHODS: Using linked health administrative data from Ontario (Canada), we identified people aged 14-35 years with a first diagnosis of nonaffective psychotic disorder (n = 39 449; 2005-2015). We matched cases to four randomly selected general population controls based on age, sex, neighbourhood, and index date (n = 157 796). We used modified Poisson regression to estimate prevalence …

Data-Driven Decision Support Tool Co-Development With A Primary Health Care Practice Based Learning Network, Jacqueline K. Kueper, Jennifer Rayner, Sara Bhatti, Kelly Angevaare, Sandra Fitzpatrick, Paulino Lucamba, Eric Sutherland, Daniel J. Lizotte

Epidemiology and Biostatistics Publications

Background: The Alliance for Healthier Communities is a learning health system that supports Community Health Centres (CHCs) across Ontario, Canada to provide team-based primary health care to people who otherwise experience barriers to care. This case study describes the ongoing process and lessons learned from the first Alliance for Healthier Communities’ Practice Based Learning Network (PBLN) data-driven decision support tool co-development project.

Methods: We employ an iterative approach to problem identification and methods development for the decision support tool, moving between discussion sessions and case studies with CHC electronic health record (EHR) data. We summarize our work to date in …

Multi-Arm Randomized Control Trials In Inflammatory Bowel Disease: A Literature Review And An Illustration Of Methods For Analysis, Sahiba Saini

Electronic Thesis and Dissertation Repository

This thesis aimed to review the literature on multiple-arm randomized control trials in inflammatory bowel disease (IBD) and to illustrate how to analyze these trials, focusing on appropriately controlling the type 1 error rates. The literature review found 247 trials published from the inception of each database to April 2014, of which 122 (49%) trials were multiple-arm trials and of those, 59 (48%) trials were on ulcerative colitis and 63 (52%) on Crohn’s disease. A published assessment tool was adopted to assess whether controlling of Type I error rates was needed. Despite the common use of this trial design and …

Corrosion Of Implant Materials In The Human Body, Maedeh Barzmehri

Corrosion Research

This paper extensively examines the complex problem of implant corrosion occurring within the human body. The corrosion of implants gives rise to substantial challenges, encompassing compromised implant durability, patient safety concerns, and potential adverse impacts on the long-term functionality of the medical device. The study's primary objectives include offering a concise overview of the various corrosion mechanisms that impact a range of implant materials and outlining health complications linked to the byproducts of implant corrosion. Furthermore, it delves into a cost analysis specific to hip or knee revision arthroplasty, which has become a prevalent scenario in implant failure cases on …

Inaugural Artificial Intelligence For Public Health Practice (Ai4php) Retreat: Ontario, Canada, Jacqueline K. Kueper, Laura C. Rosella, Richard G. Booth, Brent D. Davis, Sarah Nayani, Maxwell J. Smith, Dan Lizotte

Computer Science Publications

The Artificial Intelligence (AI) for Public Health Practice Retreat was a hybrid event held in October 2022 in London, Ontario to achieve three main goals: 1) Identify both the goals of public health practitioners and the tasks that they undertake as part of their practice to achieve those goals that could be supported by AI, 2) Learn from existing examples and the experience of others about facilitators and barriers to AI for public health, and 3) Support new and strengthen existing connections between public health practitioners and AI researchers. The retreat included a keynote presentation, group brainstorming exercises, breakout group …

Patient And Physician Factors Associated With First Diagnosis Of Non-Affective Psychotic Disorder In Primary Care, Joshua C. Wiener, Rebecca Rodrigues, Jennifer N S Reid, Suzanne Archie, Richard G Booth, Chiachen Cheng, Saadia Hameed Jan, Paul Kurdyak, Arlene G Macdougall, Lena Palaniyappan, Bridget L Ryan, Kelly K. Anderson

Epidemiology and Biostatistics Publications

Primary care physicians play a central role in pathways to care for first-episode psychosis, and their increased involvement in early detection could improve service-related outcomes. The aim of this study was to estimate the proportion of psychosis first diagnosed in primary care, and identify associated patient and physician factors. We used linked health administrative data to construct a retrospective cohort of people aged 14-35 years with a first diagnosis of non-affective psychosis in Ontario, Canada between 2005-2015. We restricted the sample to patients with help-seeking contacts for mental health reasons in primary care in the six months prior to first …

Evaluating The Feasibility And Potential Impacts Of A Recovery-Oriented Psychosocial Rehabilitation Toolkit In A Health Care Setting In Kenya: A Mixed-Methods Study, Regina Casey, Joshua C. Wiener, Terry Krupa, Rosemary Lysaght, Marlene Janzen Le Ber, Ruth Ruhara, Elizabeth Price, Romaisa Pervez, Sean Kidd, Victoria Mutiso, David M Ndetei, Arlene G Macdougall

Epidemiology and Biostatistics Publications

OBJECTIVES: This pilot study evaluated the feasibility and potential impacts of delivering the Psychosocial Rehabilitation (PSR) Toolkit for people with serious mental illness within a health care setting in Kenya.

METHOD: This study used a convergent mixed-methods design. Participants were people with serious mental illness (n = 23), each with an accompanying family member, who were outpatients of a hospital or satellite clinic in semirural Kenya. The intervention consisted of 14 weekly group sessions of PSR cofacilitated by health care professionals and peers with mental illness. Quantitative data were collected from patients and family members using validated outcome measures before …

Cancer Incidence And Stage At Diagnosis Among People With Psychotic Disorders: Systematic Review And Meta-Analysis., Jared C Wootten, Joshua C Wiener, Phillip S Blanchette, Kelly K. Anderson

Epidemiology and Biostatistics Publications

Research regarding the incidence of cancer among people with psychotic disorders relative to the general population is equivocal, although the evidence suggests that they have more advanced stage cancer at diagnosis. We conducted a systematic review and meta-analysis to examine the incidence and stage at diagnosis of cancer among people with, relative to those without, psychotic disorders. We searched the MEDLINE, EMBASE, PsycINFO, and CINAHL databases. Articles were included if they reported the incidence and/or stage at diagnosis of cancer in people with psychotic disorders. Random effects meta-analyses were used to determine risk of cancer and odds of advanced stage …

Cancer Incidence And Stage At Diagnosis Among People With Recent-Onset Psychotic Disorders: A Retrospective Cohort Study Using Health Administrative Data From Ontario, Canada., Jared C Wootten, Lucie Richard, Phillip S Blanchette, Joshua C. Wiener, Kelly K. Anderson

Epidemiology and Biostatistics Publications

OBJECTIVE: Prior evidence on the relative risk of cancer among people with psychotic disorders is equivocal. The objective of this study was to compare incidence and stage at diagnosis of cancer for people with psychotic disorders relative to the general population.

METHOD: We constructed a retrospective cohort of people with a first diagnosis of non-affective psychotic disorder and a comparison group from the general population using linked health administrative databases in Ontario, Canada. The cohort was followed for incident diagnoses of cancer over a 25-year period. We used Poisson and logistic regression models to compare cancer incidence and stage at …

Respiratory Pattern Analysis For Covid-19 Digital Screening Using Ai Techniques, Annita Tahsin Priyoti

Electronic Thesis and Dissertation Repository

Corona Virus (COVID-19) is a highly contagious respiratory disease that the World Health Organization (WHO) has declared a worldwide epidemic. This virus has spread worldwide, affecting various countries until now, causing millions of deaths globally. To tackle this public health crisis, medical professionals and researchers are working relentlessly, applying different techniques and methods. In terms of diagnosis, respiratory sound has been recognized as an indicator of one’s health condition. Our work is based on cough sound analysis. This study has included an in-depth analysis of the diagnosis of COVID-19 based on human cough sound. Based on cough audio samples from …

Rheological Characterization Of Blood-Mimicking Fluids For Use In Particle Image Velocimetry, Anorin S. Ali

Undergraduate Student Research Internships Conference

Blood-mimicking fluids (BMFs) are often used to investigate blood flow using physical replicas of vessels with cardiovascular disease. Particle image velocimetry (PIV) is used with silicone poly-dimethyl siloxane (PDMS) vascular models to visualize this flow. The challenge is creating a blood-mimicking fluid that matches the viscosity profile, viscoelasticity, and density of whole blood while also matching the refractive index (RI) of PDMS. Water-glycerol solutions are commonly used with sodium iodide (NaI) added to increase the RI without changing viscosity. However, NaI is expensive, stains easily, and turns fluids from optically clear to yellow in less than a day. Furthermore, without …

Reporting Standards For Machine Learning Research In Type 2 Diabetes, Grace Kang

Undergraduate Student Research Internships Conference

In this project, three people scored 90 papers on machine learning predictive models for type 2 diabetes to assess their adherence to TRIPOD, MI-CLAIM, and DOME reporting guidelines.

Producing And Measuring Oscillatory Shear In A Novel Microfluidic Chip, Sanaz Lordfard, Daniel Lorusso, Tamie L. Poepping, Hristo N Nikolov, Kayla Soon, Stephen Sims, Jeffrey Dixon, David Holdsworth

Undergraduate Student Research Internships Conference

Purpose: To demonstrate the effectiveness of a novel microfluidic device mimicking oscillatory blood flow, allowing cell biologists to examine how endothelial cells respond to a range of oscillatory shear stress levels.

Methods: The microfluidic chip consists of a circular-shaped reservoir, leading to a rectangular channel that is examined under a microscope. The plunger is connected to a speaker system and oscilloscope, allowing the plunger to apply a range of frequencies (5-60Hz) and voltages (5-10 V, leading to a variety in oscillation amplitudes) to the reservoir region. 1.1 um fluorescent particles diluted in distilled water were used for tracking. Processing was …

Sex And Gender Differences In Symptoms Of Early Psychosis: A Systematic Review And Meta-Analysis, Brooke Carter, Jared Wootten, Suzanne Archie, Amanda L Terry, Kelly K. Anderson

Epidemiology and Biostatistics Publications

First-episode psychosis (FEP) can be quite variable in clinical presentation, and both sex and gender may account for some of this variability. Prior literature on sex or gender differences in symptoms of psychosis have been inconclusive, and a comprehensive summary of evidence on the early course of illness is lacking. The objective of this study was to conduct a systematic review and meta-analysis of the literature to summarize prior evidence on the sex and gender differences in the symptoms of early psychosis. We conducted an electronic database search (MEDLINE, Scopus, PsycINFO, and CINAHL) from 1990 to present to identify quantitative …

Developing Artificial Intelligence And Machine Learning To Support Primary Care Research And Practice, Jacqueline K. Kueper

Electronic Thesis and Dissertation Repository

This thesis was motivated by the potential to use "everyday data", especially that collected in electronic health records (EHRs) as part of healthcare delivery, to improve primary care for clients facing complex clinical and/or social situations. Artificial intelligence (AI) techniques can identify patterns or make predictions with these data, producing information to learn about and inform care delivery. Our first objective was to understand and critique the body of literature on AI and primary care. This was achieved through a scoping review wherein we found the field was at an early stage of maturity, primarily focused on clinical decision support …

Magnetic Resonance Systems Development For Point-Of-Care Mri Platforms, Eric J. Lessard

Electronic Thesis and Dissertation Repository

Magnetic resonance imaging utilizes electromagnets to produce anatomical images in both clinical and research settings. In the race towards increasing performance head-optimized scanners have begun playing a significant role in providing high quality imaging of the head. However, they are implemented using smaller geometries and as such fail to allow entrance of the patient past their shoulders. This is overcome by designing asymmetric gradient coils which have their imaging region located towards one end of the gradient coil, as opposed to the geometric center, allowing brain imaging. There exists interest in compact configurations which allow imaging further into the cervical …

The Prevalence And Impact Of Adolescent Hospitalization To Adult Psychiatric Units., Samantha Mcrae, Jordan Edwards, Kathy N Speechley, Javeed Sukhera, Guangyong Zou, Kelly K. Anderson

Epidemiology and Biostatistics Publications

BACKGROUND: With increasing psychiatric hospitalizations among adolescents and constrained hospital resources, there are times when youth are hospitalized in adult inpatient psychiatry units. Evidence on the prevalence of this practice and associated impacts is lacking.

AIMS: We sought to explore the prevalence, determinants, and outcomes related to the hospitalization of adolescents aged 12-17 years on adult inpatient psychiatry units in Ontario.

METHODS: Using health administrative data, we constructed a cohort of adolescents with an inpatient psychiatric admission in Ontario (2007-2011). We classified adolescents as having an admission to an adult psychiatry unit or to other inpatient units. Multivariable regression models …

An Implementation Of Integrated Information Theory In Resting-State Fmri, Idan E. Nemirovsky

Electronic Thesis and Dissertation Repository

Integrated Information Theory (IIT) is a framework developed to explain consciousness, arguing that conscious systems consist of interacting elements that are integrated through their causal properties. In this study, we present the first application of IIT to functional magnetic resonance imaging (fMRI) data and investigate whether its principal metric, Phi, can meaningfully quantify resting-state cortical activity patterns. Data was acquired from 17 healthy subjects who underwent sedation with propofol, a short acting anesthetic. Using PyPhi, a software package developed for IIT, we thoroughly analyze how Phi varies across different networks and throughout sedation. Our findings indicate that variations in Phi …

Development Of A Low Field Mri-Based Approach For Observation Of Water Penetration Into Clay: Preliminary Results, Shivam Gupta

Undergraduate Student Research Internships Conference

Magnetic resonance imaging (MRI) are considered one of the most efficient and non-invasive methods of observing water content in permeable substances. MRI can visualize and quantify the movement of water in real time. In this study, MRI was used to observe the water penetration through clay. Furthermore, MRI can acquire three-dimensional data due to its radio-frequency signals from any orientation. The contrast of the images produced by MRI is a display of the fluid concentration. As such, any change in the contrast intensity is interpreted as a regional change in the concentration of fluid. This report summarizes the preliminary results …

Simulating 129-Xe Hyperpolarization, Jacob F. Abiad

Undergraduate Student Research Internships Conference

Hyperpolarized 129-Xe is an important resource in many fields of medical physics and MRI research. The physics of the efficient production of hyperpolarized 129-Xe is therefore equally worth investigation. The main process of hyperpolarizing 129-Xe is Spin Exchange Optical Pumping (SEOP) and is dependent on several physical factors that can be difficult to constantly change in a lab setting. Physical modelling of 129-Xe hyperpolarization allows for the more efficient testing of hyperpolarization physics in a wide array of experimental setups to better determine the optimal values for hyperpolarization. This research project attempted to create a working model for 129-Xe hyperpolarization …

The Right To Repair: (Re)Building A Better Future, Jumana Labib

Undergraduate Student Research Internships Conference

The goal of this research project was to take a multi-faceted, interdisciplinary approach to research and examine the Right to Repair movement’s progress, current repair practices, impediments, and imperatives, and the various large-scale implications (environmental, economic, social, etc.) stemming from diminished consumer freedom as a result of increased corporate greed and lack of governmental regulations with regards to repair and the environment. This poster exhibits the highlights of my general research project on the Right to Repair movement over the course of this four month internship, and aims to disseminate information about the movement to the wider public in an …

Comparing Semi-Automated Segmentation Of Traditional-Resolution And High-Resolution Hyperpolarized 129xe Mri On Covid-19 Survivors, Tingting Wu

Undergraduate Student Research Internships Conference

Hyperpolarized gas MRI using inert gases like Xe is a valuable tool in visualizing lung ventilation in patients, and can be used as a longitudinal monitoring tool for patients with lung diseases. However, use of this method requires segmentation and quantification of parameters such as ventilation defect percentage (VDP), which is often very subjective depending on the observer. This study aimed to determine the accuracy and consistency of VDP calculation using the same MRI scans from COVID-19 patients, but with high resolution and low (traditional) resolution versions. Using a MATLAB script developed previously, it was found that in general, using …

Optimizing Hospital Capacity To Deal With Hallway Medicine, Megan Wismer

Undergraduate Student Research Internships Conference

A model adapted from Hillier and Liebermann, 2017 that optimizes hospital capacity to deal with hallway medicine.

Nature, Nurture, Or Both? Study Of Sex And Gender And Their Effects On Pain, Maryam Ghodrati

Electronic Thesis and Dissertation Repository

As a pain researcher, in order to have a better understanding of pain, we should adopt a multidimensional view, such as the biopsychosocial (BPS) model and consider physical, psychological, and social elements altogether. The studies in this dissertation are part of the bigger project of SYMBIOME in which the aim is to help to create and develop a prognostic clinical phenotype in people post musculoskeletal (MSK) trauma. Chapter 2 presents a Confirmatory Factor Analysis (CFA) in order to assess the structural validity of the first section of the new Gender Pain and Expectation Scale (GPES). Our analysis indicated a 3-factor …

Mental Health Services Provision In Primary Care And Emergency Department Settings: Analysis Of Blended Fee-For-Service And Blended Capitation Models In Ontario, Canada., Thyna Vu, Kelly K Anderson, Nibene H Somé, Amardeep Thind, Sisira Sarma

Epidemiology and Biostatistics Publications

Treating mental illnesses in primary care is increasingly emphasized to improve access to mental health services. Although family physicians (FPs) or general practitioners are in an ideal position to provide the bulk of mental health care, it is unclear how best to remunerate FPs for the adequate provision of mental health services. We examined the quantity of mental health services provided in Ontario's blended fee-for-service and blended capitation models. We evaluated the impact of FPs switching from blended fee-for-service to blended capitation on the provision of mental health services in primary care and emergency department using longitudinal health administrative data …

Addressing Bias In Non-Experimental Studies Assessing Treatment Outcomes In Prostate Cancer, David E. Guy

Electronic Thesis and Dissertation Repository

We evaluated the ability of matching techniques to balance baseline characteristics between treatment groups using non-experimental data. We identified a set of balance diagnostics that assessed key differences in baseline covariates with potential for confounding. These diagnostics were used in a novel systematic approach to developing and evaluating models for use in propensity score matching that optimized balance and data retention. We then compared the performance of propensity score and coarsened exact matching strategies in optimizing balance and data retention, using non-experimental data from a pan-Canadian prostate cancer database. Both matching techniques balanced baseline covariates adequately and retained approximately 70% …

Quality Of Diabetes Care In Blended Fee-For-Service And Blended Capitation Payment Systems., Mary Aderayo Bamimore, Rose Anne Devlin, Gregory S Zaric, Amit X Garg, Sisira Sarma

Epidemiology and Biostatistics Publications

OBJECTIVES: In the middle to late 2000s, many family physicians switched from a Family Health Group (FHG; a blended fee-for-service model) to a Family Health Organization (FHO; a blended capitation model) in Ontario, Canada. The evidence on the link between physician remuneration schemes and quality of diabetes care is mixed in the literature. We examined whether physicians who switched from the FHG to FHO model provided better care for individuals living with diabetes relative to those who remained in the FHG model.

METHODS: Using longitudinal health administrative data from 2006 to 2016, we investigated the impact of physicians switching from …

Interplay Between Social Media Use, Sleep Quality, And Mental Health In Youth: A Systematic Review, Rea Alonzo, Junayd Hussain, Saverio Stranges, Kelly K. Anderson

Epidemiology and Biostatistics Publications

Social media applications are increasingly prominent among youth. This systematic review provides a comprehensive assessment of the literature on the relationship between active social media use, sleep quality, and common mental health outcomes (anxiety, depression, and psychological distress) among youth. MEDLINE, PsychINFO, EMBASE and Scopus were searched for observational studies investigating this relationship among youth (aged 16–25). Thirty-six cross-sectional studies and six prospective cohort studies met the inclusion criteria. Among cross-sectional studies, significant associations between excessive social media use with poor mental health outcomes (n = 33), poor sleep quality (n = 24), and significant associations between poor sleep quality …

Emergency Department Use Following Incentives To Provide After-Hours Primary Care: A Retrospective Cohort Study., Michael Hong, Amardeep Thind, Gregory S Zaric, Sisira Sarma

Epidemiology and Biostatistics Publications

BACKGROUND: Access to primary care outside of regular working hours is limited in many countries. This study investigates the relation between the after-hours premium, an incentive for primary care physicians to provide services after hours, and less-urgent visits to the emergency department in Ontario, Canada.

METHODS: We analyzed a retrospective cohort of a random sample of Ontario residents from April 2002 to March 2006, and a subcohort of patients followed from April 2005 to March 2016. We linked patient and primary care physician data with emergency department visit data. We used fixed-effects regression models to analyze the association between the …