Medicine and Health Sciences Commons^™

Characterizing The Function Of B Cells That Accumulate In The Inflamed Central Nervous System In Anti-Myelin Autoimmunity, Lika Chowdhury

Electronic Thesis and Dissertation Repository

While the role of autoimmune T cells has been extensively studied in anti-myelin

autoimmunity, little is known about the function of B cells in multiple sclerosis (MS), a chronic inflammatory disease of the central nervous system (CNS). B cells form clusters with T cells in the meninges directly adjacent to demyelinating lesions. Previous studies have shown that disease progression is dependent on the depletion of specific populations of B cells, but it is not clear which contributes to pathology or how. The purpose of this thesis is to characterize the population of meningeal B cells to determine how they differ …

Rapid Rhino Vs. Merocel: A Retrospective Analysis Of Patients With Anterior Epistaxis Visiting Emergency Rooms In London, Ontario, Dhatri Shukla

Electronic Thesis and Dissertation Repository

When patients present to an emergency room (ER) with a nosebleed, one technique that physicians employ is the application of nasal packing. Merocel is a common nasal pack utilized in ER because of their low cost. Rapid Rhino is a nasal packing that is more comfortable for patients but is more costly than Merocel. Costing for epistaxis treatment is more than initial treatment costs and needs to consider rebleed rates. Using a retrospective cohort study design with covariates adjusted by propensity scores, we compared the costs associated with Merocel, and Rapid Rhino from the hospital and provincial healthcare perspectives. Merocel …

S100a7 As A Biomarker For Predicting Transformation In A Potentially Malignant Lesion: Lichen Planus., Jeff J. Lovell

Electronic Thesis and Dissertation Repository

Oral Lichen Planus (OLP) is a potentially malignant disorder that has a malignant transformation rate of approximately 1%. Current management includes incisional biopsy and grading of dysplasia, if present. This may not be a reliable predictive tool for malignant transformation. Tissue biomarkers such as S100A7 may provide a more accurate method of risk determination. The proposed mechanism is an association between S100A7 and the MAPK signalling pathway. Paraffin embedded sections of OLP that progressed and did not progress on serial biopsy were selected. The tissues were stained via S100A7 immunohistochemistry. S100A7 was quantified using an Immunoreactivity score, QuPath and StraticyteÔ. …

Examining The Socio-Economic And Gendered Structure Of Canada's Live-In Caregiver Program: A Qualitative Study Of Filipina Women's Health Experiences, Andrea Bobadilla

Electronic Thesis and Dissertation Repository

The primary aim of this critical ethnographic study was to examine how Filipina women in the Canadian live-in caregiver program (LCP) negotiate their own physical and mental well-being while managing the complex health needs of their clients. Using global care chain and postcolonial theoretical frameworks, I also sought to identify how multi-scalar forces including caregiving and migrant policies in Canada and South East Asia exacerbate pre-existing gendered and labour inequities faced by these women. The distressing impact of this precarious form of employment on family dynamics and relationships among family members in the Philippines was also explored. Data collection took …

Monitoring Intraventricular Hemorrhage In Preterm Infants, Lilian Mn Kebaya

Electronic Thesis and Dissertation Repository

Germinal Matrix-Intraventricular hemorrhage (GMH-IVH) remains a significant cause of adverse neurodevelopmental outcomes in preterm infants. Current management options for GMH-IVH rely on serial 2-dimensional cranial ultrasound (2D cUS) ventricular measurements and clinical signs. A need exists for reliable biomarkers to aid in the early detection of posthemorrhagic ventricular dilatation (PHVD) and cerebral palsy (CP). We incorporated 3-dimensional cranial US (3D cUS) and functional infrared spectroscopy (fNIRS) to monitor ventricle volumes (VV) and spontaneous functional connectivity (sFC) in preterm infants with GMH-IVH. Infants with severe GMH-IVH who underwent cerebrospinal fluid diversion showed larger VV, which correlated with decreased sFC. Our findings …

Fertility Preservation Discussions With Transgender People In Canada Prior To Beginning Medical Gender Affirmation, Emily K. Sanders

Electronic Thesis and Dissertation Repository

Background. Prevalence of fertility preservation discussions and procedures, participant characteristics associated with discussions, and prevalence of desire to parent are described.

Methods. Describes, for a clinical sample of < 16-year-olds: medical chart-recorded discussion and procedure prevalence, and desire to parent longitudinally. Describes self-reported discussion prevalence for a community sample of 14- to 39-year-olds. Bivariate and multivariable modified Poisson analyses were conducted for this sample.

Results. Discussion prevalence was confirmed for approximately 80% of the clinical sample, with approximately 20% unconfirmed. Self-reported discussion prevalence was 45% in the community sample. Non-binary gender with female sex at birth, greater family religiosity, and diagnosed mental health condition excluding depression or anxiety were crudely associated with less discussions. Multivariable analyses revealed no statistically significant predictors. Desire to parent was fairly consistent over time.

Conclusion. Discussions should be standard practice for …

Association Of Socioeconomic, Racial, And Regional Factors With In-Hospital Management And Outcomes Of Acute Myocardial Infarction Patients In The United States: National Analyses Of 2.8 Million Admissions, Olivia Haldenby

Electronic Thesis and Dissertation Repository

Social determinants of health contribute to variations in clinical outcomes among acute myocardial infarction (AMI) patients. Using the National Inpatient Sample, we conducted retrospective cohort analyses to evaluate the association of income, race, and geography with in-hospital mortality and revascularization procedures among AMI admissions in the United States from 2015 to 2019. Multilevel logistic regression models were used while accounting for hospital clustering and relevant predictors. A sequential model-building approach produced model 1 (unadjusted patient-level exposures), model 2 (lifestyle factors), model 3 (clinical characteristics), and model 4 (fully adjusted hospital-level factors). We identified 2,798,225 AMI hospitalizations (≥18 years) with 1,567,575 …

Secretion Of Salivary Proteins And Their Interactions, Karla Tonelli Bicalho Crosara

Electronic Thesis and Dissertation Repository

Saliva’s clinical application for disease diagnosis and monitoring is limited by incomplete knowledge of salivary protein interactions, the effect of stimulation on the salivary proteome, and if these factors impact protein identification. This thesis expands knowledge of the salivary interactome and effects of stimulation intensity and duration on parotid saliva’s proteome. First, previous in vitro studies identified 43 proteins in the histatin 1-protein network and demonstrated histatin 1’s increased stability in whole saliva when interacting with amylase. We hypothesized that protein-protein-interaction databases could enlarge the histatin 1-protein network. A comprehensive histatin 1-protein network was created using STRING database, merging previous …

Development Of An On-Call Assessment Tool For Competency-Based Surgical Training, Eric C. Mitchell

Electronic Thesis and Dissertation Repository

Introduction: A central tenet of competency-based medical education is formative assessment of trainees. There are no assessments examining resident competence on-call, despite this being a significant component of resident training and characterized by less supervision compared to daytime.

Methods: A national survey was conducted to evaluate the state of assessment in Canadian Plastic and Reconstructive Surgery programs. An on-call assessment tool was developed based on a consensus group and was piloted over six months. Validity of the tool was examined through qualitative and quantitative methods.

Results: There were 63 tools completed across ten residents and seven staff physicians. Tool reliability …

Social Determinants Of Access To Primary Care In Canada, Feben W. Alemu

Electronic Thesis and Dissertation Repository

Despite the promise of universal care, many Canadians report having unmet healthcare needs. We conducted two studies: (1) a systematic review of studies on social determinants of health (SDH) and unmet need; and (2) a secondary analysis using the Canadian Longitudinal Study on Aging (CLSA) to investigate the association of SDH and (2a) self-reported unmet need and (2b) having a family physician. The review (n=40) found a positive association between unmet need and lower income, mental health and chronic conditions, and negative association with older age, better perceived health and having a family physician. The CLSA analysis found the odds …

Simulated And Experimental Approaches To The Development Of Novel Test Phantoms For Radiofrequency Heating Of Implanted Medical Devices, Amgad M. Louka

Electronic Thesis and Dissertation Repository

Magnetic resonance imaging (MRI) has cemented itself as the gold standard for imaging of soft tissues and is only increasing in popularity. Given the rising number of MRI scanners and medical device being implanted into patients, it is becoming increasingly likely that patients undergoing MRI will have an implanted medical device (IMD). The presence of an elongated metallic IMD inside a scanner could result in dangerous interactions with the radiofrequency fields during MRI, thus some of these IMDs preclude the patients from being scanned.

Orthopedic devices typically fall into this category due to their high potential for RF induced heating, …

The Traumatic Injuries Distress Scale: Manual And Questionnaire, David Walton

Physical Therapy Publications

No abstract provided.

Indocyanine Green Angiography In Pediatric Colorectal Surgery, Robin B. Wigen

Electronic Thesis and Dissertation Repository

Hirschsprung Disease (HD) and Anorectal Malformations (ARM) are congenital colorectal conditions that necessitate surgical correction via bowel resection with the creation of an anastomosis. Surgical complications, thought to be in part due to malperfusion of the bowel anastomosis, are frequent, as revealed by the retrospective review enclosed. Indocyanine Green Angiography (ICGA) is a process in which water-soluble dye (ICG) is used to assess perfusion of tissue, and it has been employed with success in adult populations to reduce rates of anastomotic leak during colorectal surgery. The systematic review conducted within confirms that this tool has not been extensively studied in …

Noninvasive Quantification Of Tissue Sodium Concentration In The Kidney Disease Spectrum Using 23na Magnetic Resonance Imaging, Fabio R. Salerno

Electronic Thesis and Dissertation Repository

Chronic kidney disease (CKD), especially when requiring kidney replacement therapy (hemodialysis (HD) and peritoneal dialysis (PD)), is associated with extracellular water expansion with increased total body sodium. Sodium can also be accumulated in tissues independently of extracellular water. Sodium-23 magnetic resonance imaging (²³Na MRI) can quantify the concentration of sodium nuclei in tissues. Applied to the human leg, quantification of tissue sodium concentrations mainly at the skin and muscle level is possible. We hypothesized that increased tissue sodium concentrations exert toxic effects in CKD and dialysis. We aimed to (1) compare tissue sodium concentrations in adults, children and …

Severe Lower Extremity Trauma In Ontario: A Linked Population-Based Analysis, Stephanie M. Kim

Electronic Thesis and Dissertation Repository

Open tibia fractures (OTF) are a management challenge. Admission to a trauma center (TC) and a coordinated approach to bony fixation and soft-tissue reconstruction (STR) have been shown to improve outcomes. The objective of this study was to describe patients who had OTF in Ontario and analyze their outcomes. Linked population data pertaining to patients who had OTF between the years 2009-2020 were examined. Demographic information, admission location, and management course were collected. 4240 patients were found. The mean age was 47, and majority were males. Patients admitted to TC had greater proportion of having Injury Severity Score >15, and …

Evaluating Public Participation In A Deliberative Dialogue: A Single Case Study., Tiffany Scurr, Rebecca Ganann, Shannon L Sibbald, Ruta Valaitis, Anita Kothari

Health Studies Publications

BACKGROUND: Deliberative dialogues (DDs) are used in policy-making and healthcare research to enhance knowledge exchange and research implementation strategies. They allow organized dissemination and integration of relevant research, contextual considerations, and input from diverse stakeholder perspectives. Despite recent interest in involving patient and public perspectives in the design and development of healthcare services, DDs typically involve only professional stakeholders. A DD took place in May 2019 that aimed to improve the social environment (eg, safety, social inclusion) and decrease social isolation in a rent-geared-to-income housing complex in a large urban community. Tenants of the housing complex, public health, primary care, …

Examining The Barriers, Facilitators And Attitudes Towards Covid-19 Vaccine And Public Health Measures For Black Communities In Canada: A Qualitative Study Protocol., Obidimma Ezezika, Bethelehem Girmay, Toluwalope Adedugbe, Isaac Jonas, Yanaminah Thullah, Chris Thompson

Health Studies Publications

INTRODUCTION: Black communities claim the highest number of cases and deaths due to COVID-19 in Canada. Generating culturally/contextually appropriate public health measures and strategies for vaccine uptake in black communities within Canada can better support the disproportionate impact of this pandemic. This study explores the barriers and enablers to public health measures limited to mask-wearing, disinfection, sanitation, social distancing and handwashing, as well as the barriers and attitudes towards COVID-19 vaccines among the black community.

METHODS AND ANALYSIS: We will use qualitative approaches informed by the widely accepted Consolidated Framework for Implementation Research (CFIR) to aid our investigation. We will …

Data-Driven Neuroanatomical Subtypes In Various Stages Of Schizophrenia: Linking Cortical Thickness, Glutamate, And Language Functioning, Liangbing Liang

Electronic Thesis and Dissertation Repository

The considerable variation in the spatial distribution of cortical thickness changes has been used to parse heterogeneity in schizophrenia. We aimed to recover a ‘cortical impoverishment’ subgroup with widespread cortical thinning. We applied hierarchical cluster analysis to cortical thickness data of three datasets in different stages of psychosis and studied the cognitive, functional, neurochemical, language and symptom profiles of the observed subgroups. Our consensus-based clustering procedure consistently produced a subgroup characterized by significantly lower cortical thickness. This ‘cortical impoverishment’ subgroup was associated with a higher symptom burden in a clinically stable sample and higher glutamate levels with language impairments in …

Fetal Sex Impacts Birth To Placental Weight Ratio And Umbilical Cord Oxygen Values With Implications For Regulatory Mechanisms, Bryan S. Richardson, Akasham Rajagopaul, Barbra De Vrijer, Genevieve Eastabrook, Timothy R.H. Regnault

Obstetrics & Gynaecology Publications

Background: We determined the effect of fetal sex on birth/placental weight and umbilical vein and artery oxygen values with implications for placental efficiency and regulatory mechanisms underlying fetal–placental growth differences. Methods: A hospital database was used to obtain birth/placental weight, cord PO2 and other information on patients delivering between Jan 1, 1990 and Jun 15, 2011 with GA > 34 weeks (N = 69,836). Oxygen saturation was calculated from the cord PO2 and pH data, while fractional O2 extraction was calculated from the oxygen saturation data. The effect of fetal sex on birth/placental weight, cord PO2, O2 saturation, and fractional O2 …

Expression And Localization Of Nrf2/Keap1 Signalling Pathway Genes In Mouse Preimplantation Embryos Exposed To Free Fatty Acids., Grace Dionne, Michele D. Calder, Dean H Betts, Basim Abu Rafea, Andrew J Watson

Obstetrics & Gynaecology Publications

Obese women experience greater incidence of infertility, with reproductive tracts exposing preimplantation embryos to elevated free fatty acids (FFA) such as palmitic acid (PA) and oleic acid (OA). PA treatment impairs mouse preimplantation development in vitro, while OA co-treatment rescues blastocyst development of PA treated embryos. In the present study, we investigated the effects of PA and OA treatment on NRF2/Keap1 localization, and relative antioxidant enzyme (Glutathione peroxidase; Gpx1, Catalase; Cat, Superoxide dismutase; Sod1 and γ-Glutamylcysteine ligase catalytic unit; Gclc) mRNA levels, during in vitro mouse preimplantation embryo development. Female mice were superovulated, mated, and embryos cultured in the presence …

Assessing Cerebral Blood Flow, Oxygenation And Cytochrome C Oxidase Stability In Preterm Infants During The First 3 Days After Birth, Ajay Rajaram, Daniel Milej, Marianne Suwalski, Lilian Kebaya, Matthew Kewin, Lawrence Yip, Sandrine De Ribaupierre, Victor Han, Mamadou Diop, Soume Bhattacharya, Keith St. Lawrence

Paediatrics Publications

A major concern with preterm birth is the risk of neurodevelopmental disability. Poor cerebral circulation leading to periods of hypoxia is believed to play a significant role in the etiology of preterm brain injury, with the first three days of life considered the period when the brain is most vulnerable. This study focused on monitoring cerebral perfusion and metabolism during the first 72 h after birth in preterm infants weighing less than 1500 g. Brain monitoring was performed by combining hyperspectral near-infrared spectroscopy to assess oxygen saturation and the oxidation state of cytochrome c oxidase (oxCCO), with diffuse correlation spectroscopy …

Principles Of Dormancy Evident In High-Grade Serous Ovarian Cancer, Trevor G. Shepherd, Frederick A. Dick

Paediatrics Publications

In cancer, dormancy refers to a clinical state in which microscopic residual disease becomes non-proliferative and is largely refractory to chemotherapy. Dormancy was first described in breast cancer where disease can remain undetected for decades, ultimately leading to relapse and clinical presentation of the original malignancy. A long latency period can be explained by withdrawal from cell proliferation (cellular dormancy), or a balance between proliferation and cell death that retains low levels of residual disease (tumor mass dormancy). Research into cellular dormancy has revealed features that define this state. They include arrest of cell proliferation, altered cellular metabolism, and unique …

Ecological Interchangeability: Supporting Team Adaptive Expertise In Moments Of Disruption, Sayra Cristancho, Emily Field, Lorelei Lingard, Taryn Taylor, Kathryn Hibbert, Graham Thompson, William Hibbert

Obstetrics & Gynaecology Publications

While undesirable, unexpected disruptions offer unique opportunities to enact adaptive expertise. For adaptive expertise to flourish, individuals and teams must embrace both efficiency and adaptation. While some industries do it readily, others continue to struggle with the tension between efficiency and adaptation, particularly when otherwise stable situations are unexpectedly disrupted. For instance, in healthcare settings, the efficiency mandate for strict compliance with scopes of practice can deter teams from using the adaptive strategy of making their members interchangeable. Yet, interchangeability has been hinted as a key capacity of today’ teams that are required to navigate fluid team structures. Because interchangeability …

Engaging Clinical End Users In The Development Of An Outcome Measurement Protocol For Pediatric Communicative Health Systems, Victoria Sherman, Danielle Glista, Barbara Jane Cunningham

PRECISe Preschool Speech and Language Publications

Purpose: To develop a conceptual framework of the factors likely to influence clinicians' use of a new participation-focused outcome measurement protocol in a large paediatric speech-language pathology program.Method: A convenience sample of 27 end users (clinicians, managers) were recruited from Ontario, Canada's Preschool Speech and Language Program. Participants engaged in one virtual concept mapping session in groups of five to six during which they learned about the new protocol, and generated statements in response to a prompt asking them to identify factors that would influence their use of the protocol. Following all sessions, participants asynchronously sorted and …

Comparison Of Hip Navigation System Accuracy In Direct Anterior Approach, Jeremy Loh

Electronic Thesis and Dissertation Repository

Introduction

Malposition of the acetabular component has been thought to have an influence on increasing increase the risk instability, impingement, and ultimately revision surgery. Hip navigation technology has been developed to provide the surgeon with real time intraoperative metrics to make critical decisions in implant placement. The goal of this study was to compare the accuracy of acetabular component positioning in direct anterior approach hip replacements using conventional fluoroscopy only technique, fluoroscopic image dependent navigation, and imageless navigation.

Methods

A retrospective data collection and prospective analysis was conducted for this study. After sample size calculations, fifty patients were collected for …

Postexercise Executive Function Benefits And Cerebral Blood Flow: In The Lab And At Home, Benjamin Tari

Electronic Thesis and Dissertation Repository

A single bout of aerobic exercise improves executive function; however, the mechanism, or mechanisms, supporting this improvement remain unclear. One candidate mechanism is an exercise-mediated increase in cerebral blood flow (CBF) that enhances the efficiency of executive-related frontoparietal networks. To evaluate the link between exercise, CBF and executive function, three separate experiments were conducted. In the first study, separate 10-min sessions of moderate-to-heavy-intensity aerobic exercise, and a hypercapnic environment (i.e., 5% CO₂) were implemented. The hypercapnic condition was included because it increases CBF independent of the metabolic demands of exercise. The second study investigated whether exercise intensity-specific changes …

Encouraging Movement Opportunities Through Theory-Informed Video Education In Undergraduate Students: The Move Study, Carmen T. Labadie

Electronic Thesis and Dissertation Repository

This mixed methods randomized control trial explored the impact of a tailored, Health Belief and Transtheoretical Model informed educational video on undergraduate students’: (1) motivational readiness, self-efficacy, and decisional balance about changing sedentary behaviour; (2) levels of sedentary time; and (3) perceptions of sedentary behaviour over time and when compared to a control condition. Students (N = 160) were randomly assigned to the intervention or control group. Participants completed: two previously validated questionnaires at baseline, immediate post-intervention, and one-month follow-up; and open-ended questions at post-intervention (intervention group only). Linear mixed models and inductive content analysis were used. Significant differences …

A Long-Term Follow-Up Of The Stability Study: Multicenter Rct Comparing Anterior Cruciate Ligament Reconstruction With And Without Lateral Extra-Articular Tenodesis In Individuals At High Risk Of Graft Failure, Katelyn M. Inch

Electronic Thesis and Dissertation Repository

One hundred and ninety-six patients at the Fowler Kennedy Sport Medicine Clinic (FKSMC) undergoing anterior cruciate ligament (ACL) reconstruction (ACLR) were randomized as part of the multi-center STABILITY study to receive either an isolated ACLR or ACLR with a lateral extra-articular tenodesis (LET). The STABILITY study followed these patients up to two years postoperative, and a long-term follow-up protocol was initiated afterwards. Eighty-two patients from this center were seen at three, five and seven years postoperative as part of a long-term follow-up. Our primary outcome was a composite outcome of instability and graft failure. Secondary outcomes included patient-reported outcome measures …

Speech-Language Pathologists’ Treatment Goals For Preschool Language Disorders: An Icf Analysis, Elaine Yl Kwok, Peter Rosenbaum, Barbara Jane Cunningham

PRECISe Preschool Speech and Language Publications

Purpose: The World Health Organization's International Classification of Functioning, Disability and Health (ICF) provides a comprehensive framework to conceptualise clinical services. This study explored how speech-language pathologists (SLPs) conceptualised therapy goals for preschoolers with language difficulties and disorders within the ICF framework.Method: An online survey was distributed to SLPs practising in a publicly funded Preschool Speech and Language program in Ontario, Canada. SLPs rated their familiarity with the ICF framework, and then reported all therapy goals for one child with language difficulty/disorder on their caseload. For each reported goal, SLPs indicated the ICF component(s) they felt the …

The Effect Of Oral And Topical Antibiotics On Foreskin Inflammation And Hiv Target Cells In Ugandan Men., Zhongtian (Eric) Shao

Electronic Thesis and Dissertation Repository

Penile circumcision reduces HIV susceptibility by up to 60% in men; however, many men prefer to remain uncircumcised for personal or cultural reasons. Penile circumcision protects against HIV by reducing anaerobic bacteria on the penis. Penile anaerobes cause local inflammation and the recruitment of HIV-susceptible CD4+CCR5+ cells, increasing the likelihood that exposure to HIV during intercourse results in infection. To determine if a non-surgical intervention can reduce penile anaerobes and HIV target cells, we randomized men to antimicrobial treatment prior to circumcision. To be able to quantify the effect of antimicrobials, we developed a novel deep-learning algorithm to quantify HIV …