Prenatal Programming Of Hepatic Glucose And Cholesterol Regulation In Male Rat Offspring By Chronic Intermittent Hypoxia, Waseem Iqbal

Electronic Thesis and Dissertation Repository

Obstructive sleep apnea (OSA) is a chronic disorder involving repetitive interruptions in breathing during sleep. Sufferers of OSA are exposed to chronic intermittent hypoxia (CIH), characterized by cyclical reductions in oxygen availability. A number of studies have established a link between OSA and various cardiovascular and metabolic comorbidities in adulthood, including hypertension, obesity, and type II diabetes. While the consequences of OSA in adults have been well described, the cross-generational impact of this condition and potential effects on fetal development are not known. Epidemiological and animal studies have demonstrated that physiological insults during pregnancy lead to diminished growth of offspring …

Measuring The Sixth Vital Sign: A Descriptive Analysis Of Distress In Individuals With Head And Neck Cancer And Their Caregivers, Catherine C. Bornbaum

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Introduction: Distress has become so problematic in oncology that it has been recognized as the “sixth vital sign” implying that distress monitoring should occur as routinely as the monitoring of one’s temperature or blood pressure. The research reported herein investigated the impact of head and neck cancer on levels of distress, commonly reported problems, and perceptions of quality of life in individuals with head and neck cancer and their caregivers.

Method: Two distinct studies were conducted; the first explored the patient experience of distress and quality of life while the second assessed the caregiver experience of these same constructs. A …

Effect Of Fluid Loss Following Hemodialysis On Tibialis Anterior Muscle Strength In People With End-Stage Renal Disease, Anuradha Sawant

Electronic Thesis and Dissertation Repository

ABSTRACT

PURPOSE: The purpose of this study was to evaluate the effect of fluid loss following hemodialysis (HD) on tibialis anterior (TA) strength in participants with end-stage renal disease. Issues concerning measures of skeletal muscle hydration and efficacy of exercise as an anabolic intervention were also addressed.

METHODS: Data from published literature were combined in a meta-analysis to establish efficacy of exercise in participants on HD. Three clinical studies were undertaken using data acquired from healthy volunteers and participants on HD. Hydration of the calf muscles was estimated using bioelectrical impedance spectroscopy (BIS) [extracellular (ECF) and intracellular (ICF) fluid] …

Development And Assessment Of An Impact Apparatus And High-Speed Camera Motion Tracking System To Quantify The Effect Of Static Muscle Loads On Fracture Threshold Measures In The Distal Radius, Jacob M. Reeves

Electronic Thesis and Dissertation Repository

Distal radius fractures are prevalent, debilitating, and costly. This thesis conducts an in vitro investigation of these injuries, examining the role of static muscle loading on fracture threshold measures (i.e., force, impulse, energy). Initially, an impact apparatus and custom LabVIEW colour-thresholding program were designed and assessed for repeatability and accuracy in quantifying fracture measures and impact kinematics. These tools were then used to test six pairs of cadaveric forearms, with static muscle loads simulated in one specimen from each pair. Distal radius fractures were achieved in 5 pairs, with perilunate dislocations in the remaining pair. None of the …

A Randomized Controlled Trial Comparing Arthroscopic Surgery To Conservative Management Of Femoroacetabular Impingement, Heather C. Klaus

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OBJECTIVE: To determine whether patients with femoroacetabular impingement (FAI) who undergo arthroscopic hip surgery experience similar outcomes at two years post-operative with respect to physical function, pain, and health related quality of life, compared to similar patients who receive conservative management, including medication and physiotherapy. This thesis is an interim analysis of ten participants who are six-months post-randomization. METHODS: Participants were randomized to either operative treatment (6) or conservative treatment (4), and completed general and region specific quality of life questionnaires, including the Hip Outcome Score (HOS), Lower Extremity Functional Scale (LEFS), Modified Harris Hip Score (MHHS), Non-Arthritic Hip Score …

The Impact Of Lateral Electron Disequilibrium On Stereotactic Body Radiation Therapy Of Lung Cancer, Brandon Disher

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Stereotactic Body Radiation Therapy (SBRT) is an effective treatment option for patients with inoperable early-stage lung cancer. SBRT uses online image-guidance technology [e.g. cone-beam CT (CBCT)] to focus small-fields of high energy x-rays onto a tumour to deliver ablative levels of radiation dose (e.g. 54 Gy) in a few treatment fractions (e.g. 3). For the combination of these treatment parameters and a low density lung, lateral electron disequilibrium (LED) can potentially occur, reducing lung and tumour doses. The goal of this thesis was to determine the impact of LED on stereotactic body radiation therapy for lung cancer.

The effect of …

Alignment, Mass And Orthoses In Medial Compartment Knee Osteoarthritis, Rebecca Moyer

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Biomechanical factors during locomotion are important contributors to knee osteoarthritis (OA). A better understanding of their potential role in intervention strategies is required. The overall purpose of this thesis was to examine the interaction between lower limb alignment and body mass on dynamic knee joint loading, and to examine the effects of knee and foot orthoses, in patients with knee OA. The thesis included three studies. Chapter 2 was a cross-sectional study using three-dimensional gait analysis and full limb radiographs in 487 patients. Using sequential (hierarchical) linear regression, results indicated a statistical interaction between lower limb alignment and body mass …

Design And Development Of A Novel Expanding Pedicle Screw For Use In The Osteoporotic Lumbar Spine, Parham Rasoulinejad

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Pedicle screws are commonly utilized in spinal surgery; however, traditional designs often do not provide adequate fixation in osteoporotic spines. The objective of this thesis was to develop a novel expanding screw for use in osteoporotic lumbar pedicles. Helical screws capable of expanding post insertion were built on a rapid prototype machine. A materials testing machine performed axial load to failure tests in both Sawbones and cadaveric specimens comparing the new design to traditional screws (rate = 10mm/min to 20 mm). Output parameters included yield load, ultimate load, stiffness, energy to failure and total energy. The expanding screw showed a …

A Model To Reduce The Proportion Of Inappropriate Referrals To Surgery For Patients With Osteoarthritis: A Pilot Study, Laura K. Churchill

Electronic Thesis and Dissertation Repository

A significant proportion of patients referred for total knee arthroplasty are inappropriate candidates for surgery, which warrants remediation of the referral process to reduce wait times for the initial consult. We conducted a prospective feasibility investigation involving 166 patients referred from their general practitioner for a consultation with an orthopaedic surgeon at a joint replacement clinic. The aim of this study was to improve the validity of data collection forms and to improve the feasibility of collecting data in a clinical setting. We also wanted to strengthen our estimate of the sample size to inform the timeline. We were able …

Complex Shoulder Instability: The Role Of The Latarjet Coracoid Transfer, Ryan Degen

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Recurrent anterior shoulder instability is a common clinical entity often requiring surgical stabilization. Recurrence rates following soft-tissue stabilization procedures are moderately high and have been attributed to associated bony defects of either the glenoid or humeral head. Complex shoulder instability, defined as instability associated with bony defects around the shoulder, is a challenging clinical problem. The Latarjet coracoid transfer has been proposed as a treatment option and its resultant stabilizing effects have been explored in this biomechanical cadaver-based study.

For both glenoid and humeral head defects, the Latarjet coracoid transfer adequately stabilized the shoulder, outperforming other procedures often utilized for …

Optimization Of A Boundary Element Approach To Electromagnet Design With Application To A Host Of Current Problems In Magnetic Resonance Imaging, Chad T. Harris

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Magnetic resonance imaging (MRI) has proven to be a valuable methodological approach in both basic research and clinical practice. However, significant hardware advances are still needed in order to further improve and extend the applications of the technique. The present dissertation predominantly addresses gradient and shim coil design (sub-systems of the MR system).

A design study to investigate gradient performance over a set of surface geometries ranging in curvature from planar to a full cylinder using the boundary element (BE) method is presented. The results of this study serve as a guide for future planar and pseudo-planar gradient systems for …

Patency And Complication Rates Of The Arteriovenous Fistula: A Systematic Review, Ahmed A. Al-Jaishi

Electronic Thesis and Dissertation Repository

Advantages of fistulas, which include long patency and low complication rates, were ascertained over two decades ago and may not apply to the contemporary dialysis population. We conducted a systematic review to summarize the patency and complication rates of fistulas from literature published after 1999. We screened 7,008 citations and 62 articles met our criteria. The risk of primary failure was 27% (95% confidence interval (CI): 23–32%). When primary failures were included, the primary and secondary patency rates were 59% (CI 53–64%) and 66% (CI 58–74%) at one year, respectively. The median rates of infection, ischemic steal syndrome, and thrombosis …

Secular Trends In Ischemic Stroke Subtypes, Chrysi Bogiatzi

Electronic Thesis and Dissertation Repository

Background: With an aging population and an increasing prevalence of therapy for atherosclerosis, it might be expected that stroke subtypes would be changing over time. Limited information exists on the ischemic stroke subtypes in adults in Canada.

Methods: Patients referred to the Urgent TIA Clinic, in London, Ontario, between 2002-2012 were included. Secular trends were analyzed using Poisson regression with spline trend function. Ischemic stroke subtype classification was validated.

Results: 3,445 consecutive patients (mean age + SD 64.8 + 14.9) were included. Cardioembolic strokes/TIAs increased from 21% in 2002 to 56% in 2012, whereas all other ischemic stroke subtypes …

Fetal And Neonatal Exposure To Nicotine Augments Hepatic Fatty Acid Synthesis In Rat Offspring Long-Term, Noelle L. Ma

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While nicotine replacement therapy (NRT) is presumed to be a safer alternative to smoking in pregnancy, the long-term consequences in offspring are still largely unknown. Animal studies now suggest that maternal nicotine exposure during pregnancy and lactation (MNE-PL) leads to a wide variety of adverse outcomes for the offspring, including increased adiposity. The focus of this study was to investigate how MNE-PL in rats may lead to liver dysfunction long-term in offspring through alterations in gene expression and epigenetic modifications. Postnatal day 180 (PND180) offspring exposed to nicotine during pregnancy and lactation (1mg/kg/day) exhibited increased circulating and hepatic triglycerides concomitant …

Causes Of Post Stroke Falls Along The Care Continuum: Implications For Improving Patient Safety, Mona Madady

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In Western countries stroke is responsible for 10-12% of all deaths. In 2000, strokes cost $3.6 billion for the Canadian healthcare system and lost productivity due to premature death and long-term disability. Falls are a frequent occurrence at all stages of post-stroke recovery and can have significant negative impacts. While information about the incidence and risk factors of falling among stroke survivors is available, considerably less is known about the specific factors contributing to falls and the circumstances surrounding these adverse events. The purpose of this project was to identify similarities between systemic factors of falls in stroke survivors across …

The Effect Of Selective Hypothermia On Stroke Volume, Thomas K. Mattingly

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Hypothermia is a well-established neuroprotectant. Selective hypothermia to the ischemic area may eliminate side effects while improving induction time. We studied the effect of selective hypothermia on stroke volumes in adult domestic swine. Under general anesthesia, one MCA was occluded transcranially for 3 hours followed by 3 hours of reperfusion. In half the animals, hypothermia was induced during reperfusion via a dual-lumen balloon occlusion catheter placed in the carotid ipsilateral to the ischemic region. Following reperfusion, the animals were sacrificed. Brain MRI and histology were evaluated blinded to the intervention. In a series of animals, the mean temperature achieved was …

Adverse Drug Events And Renal Function, Matthew A. Weir

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The objective of this thesis was to use health administrative data to investigate two important adverse drug reactions (ADRs) related to renal function. The first study examined the risk of hyperkalemia associated with the antibiotic trimethoprim-sulfamethoxazole (TMP-SMX) and its interaction with beta-adrenergic receptor blockers (“beta blockers”). The second study evaluated the effect of impaired kidney function on the risk of hypoglycemia conferred by the anti-diabetic drug glyburide. The simultaneous use of beta adrenergic receptor blockers (β-blockers) and trimethoprim-sulfamethoxazole (TMP-SMX) may confer a high risk of hyperkalemia. We conducted two nested case-control studies to examine the association between hospitalization for hyperkalemia …

Governing Occupation Through Constructions Of Risk: The Case Of The Aging Driver, Silke Dennhardt

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Risk and risk-management have become increasingly pervasive features of modern society and governmentality scholars have highlighted various ways risk discourses are taken up to govern citizens and their everyday conduct. Thus, attending to risk is imperative to advance an understanding of how everyday occupation is shaped and governed within contemporary society. Within this study, the example of driving in later life is drawn upon to address two objectives: 1. to advance the understanding of how risk is taken up to govern everyday occupation, and 2. to explicate how risk is taken up in discourses to constitute particular subjectivities and their …

Targeted Sirna Delivery Methods For Rnai-Based Therapies, Di Chen

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RNAi has great potential in future therapeutics as it has the ability to regulating many disease-related genes. However, many barriers prevent practical applications. To overcome the barriers, the specific targeting, efficient delivery system, the validated gene and the potent siRNA sequence are all vital important. The studies throughout this thesis have been focued on examining the validation of three RNAi therapies for two different disease models: allergic contact dermatitis and melanoma. For allergic contact dermatitis, I developed and tested a novel topical delivery system for siRNAs targeting TNFα (siTNFα) and MyD88 siRNA (siMyD88). While siRNAs applied without the transdermal enhancer …

What Shapes Family Physicians' Patterns Of Care For Community Patients At End Of Life?, Joshua D. Shadd

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Family physicians (FPs) care for the majority of community patients approaching end of life. Variations among FPs in care activities for these patients have potential implications for equitable access to care. This thesis used mixed methods to explore how FPs in southwestern Ontario, Canada care for these patients, and what shapes the variations. In the primary study, using grounded theory based on in-depth interviews, FPs reported differing in the timing, location and purpose of their activities. These variations were shaped by a process of ‘making it fit’, in which FPs weighed the implications of choices in their unique contexts. In …