Medicine and Health Sciences Commons^™

Authorizing Medical Cannabis For Children., Michael Rieder

Paediatrics Publications

No abstract provided.

Determining A Bayesian Predictive Power Stopping Rule For Futility In A Non-Inferiority Trial With Binary Outcomes., Anna Heath, Martin Offringa, Petros Pechlivanoglou, Juan David Rios, Terry P Klassen, Naveen Poonai, Eleanor Pullenayegum

Paediatrics Publications

Background/Aims: Non-inferiority trials investigate whether a novel intervention, which typically has other benefits (i.e., cheaper or safer), has similar clinical effectiveness to currently available treatments. In situations where interim evidence in a non-inferiority trial suggests that the novel treatment is truly inferior, ethical concerns with continuing randomisation to the "inferior" intervention are raised. Thus, if interim data indicate that concluding non-inferiority at the end of the trial is unlikely, stopping for futility should be considered. To date, limited examples are available to guide the development of stopping rules for non-inferiority trials.

Methods: We used a Bayesian predictive power approach to …

A Systematic Review For The Management Of The Genetically Defined Il-1-Mediated Autoinflammatory Diseases, Caps, Traps, Mkd And Dira, R. Berard, M. Romano, Zs Arici, D. Piskin, O. Jones, K. Durrant, R. Goldbach-Mansky, M. Gattorno, E. Demirkaya

Paediatrics Publications

No abstract provided.

Olive Oil Diet In Mild Pre-Gestational Diabetes Impacts Offspring Β-Cell Development., Bushra Taqui, Farsad Asadi, Evangelina Capobianco, Daniel Barry Hardy, Alicia Jawerbaum, Edith Juliana Arany

Physiology and Pharmacology Publications

Maternal diabetes impairs fetal development and increases the risk of metabolic diseases in the offspring. Previously, we showed maternal dietary supplementation with 6% of olive oil prevents diabetes-induced embryo and fetal defects, in part, through the activation of peroxisome proliferator-activated receptors (PPARs). In this study we examined the effects of this diet on neonatal and adult pancreatic development in both male and female offspring. A mild diabetic model was developed by injecting neonatal rats with streptozotocin (90 mg/kg). During pregnancy these dams were fed a chow diet supplemented or not with 6% olive oil. Dual immunohistochemistry was performed to detect …

Inflammation Profiling Of Critically Ill Coronavirus Disease 2019 Patients., Douglas D Fraser, Gediminas Cepinskas, Marat Slessarev, Claudio Martin, Mark Daley, Michael R Miller, David B O'Gorman, Sean E Gill, Eric K Patterson, Claudia C Dos Santos

Physiology and Pharmacology Publications

Objectives: Coronavirus disease 2019 is caused by severe acute respiratory syndrome-coronavirus-2 infection to which there is no community immunity. Patients admitted to ICUs have high mortality, with only supportive therapies available. Our aim was to profile plasma inflammatory analytes to help understand the host response to coronavirus disease 2019.

Design: Daily blood inflammation profiling with immunoassays.

Setting: Tertiary care ICU and academic laboratory.

Subjects: All patients admitted to the ICU suspected of being infected with severe acute respiratory syndrome-coronavirus-2, using standardized hospital screening methodologies, had daily blood samples collected until either testing was confirmed negative on ICU day 3 (coronavirus …

The Impact Of Covid-19 On Canadian Urology Residents, Ernest Pang Chan, Leandra Stringer, Peter Z.T. Wang, Sumit Dave, Jeffrey D. Campbell

Paediatrics Publications

No abstract provided.

Excess Mortality From Covid-19: A Commentary On The Italian Experience, Paolo Pasquariello, Saverio Stranges

Epidemiology and Biostatistics Publications

No abstract provided.

Sol-Gel Derived Tertiary Bioactive Glass–Ceramic Nanorods Prepared Via Hydrothermal Process And Their Composites With Poly(Vinylpyrrolidone-Co-Vinylsilane), Dibakar Mondal, Andrei Zaharia, Kibret Mequanint, Amin S. Rizkalla

Bone and Joint Institute

© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). Bioactive glass (BG) nanoparticles have wide applications in bone repair due to their bone-bonding and biodegradable nature. In this work, nanometric rod-shaped ternary SiO2-CaO-P2O5 bioactive glass particles were prepared through sol-gel chemistry followed by a base-induced hydrothermal process at 130 ◦C and 170 ◦C for various times up to 36 h. This facile, low-temperature and surfactant-free hydrothermal process has shown to be capable of producing uniform nanorods and nanowires. …

The Role Of Poly(Methyl Methacrylate) In Management Of Bone Loss And Infection In Revision Total Knee Arthroplasty: A Review, Leyla Hasandoost, Omar Rodriguez, Adel Alhalawani, Paul Zalzal, Emil H. Schemitsch, Stephen D. Waldman, Marcello Papini, Mark R. Towler

Bone and Joint Institute

© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). Poly(methyl methacrylate) (PMMA) is widely used in joint arthroplasty to secure an implant to the host bone. Complications including fracture, bone loss and infection might cause failure of total knee arthroplasty (TKA), resulting in the need for revision total knee arthroplasty (rTKA). The goals of this paper are: (1) to identify the most common complications, outside of sepsis, arising from the application of PMMA following rTKA, (2) to discuss …

Treatment After Anterior Cruciate Ligament Injury: Panther Symposium Acl Treatment Consensus Group, Theresa Diermeier, Benjamin B. Rothrauff, Lars Engebretsen, Andrew D. Lynch, Olufemi R. Ayeni, Mark V. Paterno, John W. Xerogeanes, Freddie H. Fu, Jon Karlsson, Volker Musahl, Charles H. Brown, Terese L. Chmielewski, Mark Clatworthy, Stefano Della Villa, Lucio Ernlund, Christian Fink, Alan Getgood, Timothy E. Hewett, Yasuyuki Ishibashi, Darren L. Johnson, Jeffrey A. Macalena, Robert G. Marx, Jacques Menetrey, Sean J. Meredith, Kentaro Onishi, Thomas Rauer

Bone and Joint Institute

© The Author(s) 2020. Treatment strategies for anterior cruciate ligament (ACL) injuries continue to evolve. Evidence supporting best-practice guidelines for the management of ACL injury is to a large extent based on studies with low-level evidence. An international consensus group of experts was convened to collaboratively advance toward consensus opinions regarding the best available evidence on operative versus nonoperative treatment for ACL injury. The purpose of this study was to report the consensus statements on operative versus nonoperative treatment of ACL injuries developed at the ACL Consensus Meeting Panther Symposium 2019. There were 66 international experts on the management of …

Valgus Stress Radiography Following Superficial Medial Collateral Ligament Reconstruction Using A Modified Laprade Technique With Adjustable Loop Femoral Fixation, Aad Dhollander, Michael Sellan, Andrew Daniel Firth, Alan Getgood

Bone and Joint Institute

Purpose of this study was to assess postoperative laxity of MCL reconstructions utilizing a modified LaPrade superficial MCL reconstruction. We retrospectively reviewed post-operative valgus stress radiographs in 23 multiligament injured patients who underwent concurrent sMCL and cruciate ligament reconstruction by a single surgeon. Post- operatively, 23 patients underwent valgus stress radiographs that were assessed at a mean of 8.7 months (range: 4-13 months), and mean SSD was 0.64mm ± 0.42mm. Eight patients underwent both pre- and post-operative valgus stress radiographs. Post-operative (0.09mm ± 0.63mm) SSD was found to be significantly reduced compared to pre-operative (2.07mm ± 0.44mm) SSD (mean diff. …

Diffusion Dispersion Imaging: Mapping Oscillating Gradient Spin-Echo Frequency Dependence In The Human Brain., Aidin Arbabi, Jason Kai, Ali R Khan, Corey A Baron

Brain and Mind Institute Researchers' Publications

PURPOSE: Oscillating gradient spin-echo (OGSE) diffusion MRI provides information about the microstructure of biological tissues by means of the frequency dependence of the apparent diffusion coefficient (ADC). ADC dependence on OGSE frequency has been explored in numerous rodent studies, but applications in the human brain have been limited and have suffered from low contrast between different frequencies, long scan times, and a limited exploration of the nature of the ADC dependence on frequency.

THEORY AND METHODS: Multiple frequency OGSE acquisitions were acquired in healthy subjects at 7T to explore the power-law frequency dependence of ADC, the "diffusion dispersion." Furthermore, a …

What Explains The Relationship Between Spatial And Mathematical Skills? A Review Of Evidence From Brain And Behavior, Zachary Hawes, Daniel Ansari

Brain and Mind Institute Researchers' Publications

There is an emerging consensus that spatial thinking plays a fundamental role in how people conceive, express, and perform mathematics. However, the underlying nature of this relationship remains elusive. Questions remain as to how, why, and under what conditions spatial skills and mathematics are linked. This review paper addresses this gap. Through a review and synthesis of research in psychology, neuroscience, and education, we examine plausible mechanistic accounts for the oft-reported close, and potentially causal, relations between spatial and mathematical thought. More specifically, this review targets candidate mechanisms that link spatial visualization skills and basic numerical competencies. The four explanatory …

Multi-Dose Oral Ondansetron For Pediatric Gastroenteritis: Study Protocol For The Multi-Dose Oral Ondansetron For Pediatric Acute Gastroenteritis (Dose-Age) Pragmatic Randomized Controlled Trial, Stephen B Freedman, Sarah Williamson-Urquhart, Anna Heath, Petros Pechlivanoglou, Gareth Hopkin, Serge Gouin, Amy C Plint, Andrew Dixon, Darcy Beer, Gary Joubert, Christopher Mccabe, Yaron Finkelstein, Terry P Klassen

Paediatrics Publications

BACKGROUND: There are limited treatment options that clinicians can provide to children presenting to emergency departments with vomiting secondary to acute gastroenteritis. Based on evidence of effectiveness and safety, clinicians now routinely administer ondansetron in the emergency department to promote oral rehydration therapy success. However, clinicians are also increasingly providing multiple doses of ondansetron for home use, creating unquantified cost and health system resource use implications without any evidence to support this expanding practice.

METHODS/DESIGN: DOSE-AGE is a randomized, placebo-controlled, double-blinded, six-center, pragmatic clinical trial being conducted in six Canadian pediatric emergency departments (EDs). In September 2019 the study began …

Vascular Risk Reduction In Obesity Through Reduced Granulocyte Burden And Improved Angiogenic Monocyte Content Following Bariatric Surgery., David A Hess, Justin Z Trac, Stephen A Glazer, Daniella C Terenzi, Adrian Quan, Hwee Teoh, Mohammed Al-Omran, Deepak L Bhatt, C David Mazer, Ori D Rotstein, Subodh Verma

Physiology and Pharmacology Publications

Bariatric surgery, in addition to the benefit of sustained weight loss, can also reduce cardiometabolic risk and mortality. Lifelong vessel maintenance is integral to the prevention of cardiovascular disease. Using aldehyde dehydrogenase activity, an intracellular detoxifying enzyme present at high levels within pro-vascular progenitor cells, we observed an association between chronic obesity and "regenerative cell exhaustion" (RCE), a pathology whereby chronic assault on circulating regenerative cell types can result in adverse inflammation and diminished vessel repair. We also describe that, at 3 months following bariatric surgery, systemic inflammatory burden was reduced and pro-angiogenic macrophage precursor content was improved in subjects …

Overexpression Of Mig-6 In The Cartilage Induces An Osteoarthritis-Like Phenotype In Mice, Melina Bellini, Michael A. Pest, Manuela Miranda-Rodrigues, Ling Qin, Jae Wook Jeong, Frank Beier

Physiology and Pharmacology Publications

© 2020 The Author(s). Background: Osteoarthritis (OA) is the most common form of arthritis and characterized by degeneration of the articular cartilage. Mitogen-inducible gene 6 (Mig-6) has been identified as a negative regulator of the epidermal growth factor receptor (EGFR). Cartilage-specific Mig-6 knockout (KO) mice display increased EGFR signaling, an anabolic buildup of the articular cartilage, and formation of chondro-osseous nodules. Since our understanding of the EGFR/Mig-6 network in the cartilage remains incomplete, we characterized mice with cartilage-specific overexpression of Mig-6 in this study. Methods: Utilizing knee joints from cartilage-specific Mig-6-overexpressing (Mig-6 over/over ) mice (at multiple time points), we …

Kindness As An Intervention For Student Social Interaction Anxiety, Affect, And Mood: The Kiss Of Kindness Study, Katie Shillington, Andrew Johnson, Tara Mantler, Jennifer Irwin

Health Studies Publications

No abstract provided.

Demographic And Socioeconomic Characteristics Of Canadian Medical Students: A Cross-Sectional Study., Rishad Khan, Tavis Apramian, Joel Hosung Kang, Jeffrey Gustafson, Shannon Sibbald

Health Studies Publications

BACKGROUND: While the importance of medical students' demographic characteristics in influencing the scope and location of their future practice is recognized, these data are not systematically collected in Canada. This study aimed to characterize and compare the demographics of Canadian medical students with the Canadian population.

METHODS: Through an online survey, delivered in 2018, medical students at 14 English-speaking Canadian medical schools provided their age, sex, gender identity, ethnicity, educational background, and rurality of the area they grew up in. Respondents also provided information on parental income, occupation, and education as markers of socioeconomic status. Data were compared to the …

Creating The London Field Hospital

Data and Test Instruments

No abstract provided.

Creation And Validation Of The 4-Item Briefpcs-Chronic Through Methodological Triangulation, David M. Walton, Swati Mehta, Wonjin Seo, Joy C. Macdermid

Bone and Joint Institute

© 2020 The Author(s). Background: The Pain Catastrophizing Scale (PCS) is a widely used self-report tool to evaluate pain related catastrophizing. The PCS was developed using classical test theory and has been shown to be psychometrically sound among various populations. However, it's current three subscales are rarely used in clinical practice, offering potential for an abbreviated version that reduces administrative burden and can be used to estimate full scale scores, yet is not bound by the inclusion of items from each subscale. Hence, the aim of the current study was to develop a unidimensional abbreviated version of the PCS through …

Histone Deacetylase 1 And 2 Drive Differentiation And Fusion Of Progenitor Cells In Human Placental Trophoblasts, Gargi Jaju Bhattad, Mariyan J. Jeyarajah, Megan G. Mcgill, Vanessa Dumeaux, Hiroaki Okae, Takahiro Arima, Patrick Lajoie, Nathalie G. Bérubé, Stephen J. Renaud

Paediatrics Publications

Cell fusion occurs when several cells combine to form a multinuclear aggregate (syncytium). In human placenta, a syncytialized trophoblast (syncytiotrophoblast) layer forms the primary interface between maternal and fetal tissue, facilitates nutrient and gas exchange, and produces hormones vital for pregnancy. Syncytiotrophoblast development occurs by differentiation of underlying progenitor cells called cytotrophoblasts, which then fuse into the syncytiotrophoblast layer. Differentiation is associated with chromatin remodeling and specific changes in gene expression mediated, at least in part, by histone acetylation. However, the epigenetic regulation of human cytotrophoblast differentiation and fusion is poorly understood. In this study, we found that human syncytiotrophoblast …

Covid 19 On 21 Apr 2020: Behind The Numbers, Vivian Mcalister

Data and Test Instruments

When President Mike Hoare asked me to write a piece for this issue on the COVID-19 pandemic, I objected saying that I was not an expert. On reflection, I realize that we have all become experts on the pandemic, not only from living through it, but also from the information constantly being given to us. I offered to write about my struggles trying to understand the numbers that are presented daily, in ever enlarging red dots. It is no surprise to conclude that these numbers mislead us in many ways. This article does aim not reduce our fascination with the …

Late Referrals Of Pediatric Patients With Elevated Blood Pressure, Guido Filler, Laura Torres-Canchala

Paediatrics Publications

Editorial Commentary

Comparative Analysis Of American Heart Association And European Society Of Hypertension Ambulatory Blood Pressure Thresholds For Diagnosing Hypertension In Children., Ajaya Sharma, Luis Altamirano-Diaz, Michael Grattan, Guido Filler, Ajay P Sharma

Paediatrics Publications

Introduction: The influence of using 24-hour ambulatory blood pressure (ABP) thresholds recommended by the American Heart Association (AHA) (24-hour mean ABP >95th percentile and ABP load >25%) or the European Society of Hypertension (ESH) (mean 24-hour ABP >95th percentile or >130/80 mm Hg if mean ABP 95th percentile exceeds 130/80 mm Hg) on the diagnosis of pediatric hypertension has been understudied.

Methods: In a cross-sectional, retrospective study of 159 children from a tertiary care outpatient clinic, we classified office blood pressure (OBP) as normotension or hypertension based on the OBP thresholds recommended by the American Academy of Pediatrics (AAP) and …

Seizure Freedom Improves Health-Related Quality Of Life After Epilepsy Surgery In Children., Puneet Jain, Mary Lou Smith, Kathy Speechley, Mark Ferro, Mary Connolly, Rajesh Ramachandrannair, Salah Almubarak, Andrea Andrade, Elysa Widjaja

Paediatrics Publications

AIM: To determine whether epilepsy surgery improved health-related quality of life (HRQoL) and whether seizure freedom after surgery mediated the improvement in HRQoL.

METHOD: This multicenter cohort study compared HRQoL after epilepsy surgery to pharmacological management in children with drug-resistant epilepsy (DRE). HRQoL was measured using the Quality of Life in Childhood Epilepsy (QOLCE) questionnaire at baseline and 1-year follow-up. The mediator between treatment type and HRQoL was seizure freedom.

RESULTS: Two hundred and thirty-seven patients were recruited (surgery group: n=147 [92 males, 45 females]; pharmacological group: n=90 [53 males, 37 females]). Mean age at seizure onset was 6 years …

Standards Of Care For Children In Emergency Departments: Executive Summary., Rodrick K Lim, Baljit Cheema, Catherine Cartman, Ffion Davies, Marianne Gausche-Hill, Felix Hay

Paediatrics Publications

No abstract provided.

Age At Migration And The Risk Of Psychotic Disorders: A Systematic Review And Meta-Analysis., Kelly K. Anderson, Jordan Edwards

Epidemiology and Biostatistics Publications

OBJECTIVE: To conduct a systematic review and meta-analysis of the existing evidence on the association between age at migration and the risk of psychotic disorders.

METHODS: Observational studies were eligible for inclusion if they presented data on the association between age at migration and the risk of psychotic disorders among first-generation migrant groups. We used two random effects meta-analyses to pool effect estimates for each stratum of age at migration relative to (i) a native-born reference category and (ii) the youngest age stratum (0 to 2 years).

RESULTS: Ten studies met inclusion criteria, and five were included in the meta-analysis. …

A Systematic Review Of Occupational Therapy Interventions In The Transition From Homelessness, Roxanne Isard Ms., Carrie Anne Marshall, Leonie Boland, Lee Ann Westover, Sharon A. Gutman

Occupational Therapy Publications

Background: Although systematic and scoping reviews have identified a range of interventions for persons experiencing homelessness, no known reviews have captured the range and quality of intervention studies aimed at supporting a transition from homelessness. Objectives: To capture the range and quality of occupational therapy intervention studies aimed at supporting a transition to housing following homelessness. Method: Using Joanna Briggs Institute (JBI) guidelines, we conducted a systematic review including a critical appraisal and narrative synthesis of experimental studies. Results: Eleven studies were included. Critical appraisal scores ranged from 33.3 to 88.9 of a possible score of 100 (Mdn = 62.5; …

Delays In Hospital Admissions In Patients With Fractures Across 18 Low-Income And Middle-Income Countries (Inormus): A Prospective Observational Study, Panthea Pouramin, Chuan Silvia Li, Jason W. Busse, Sheila Sprague, P. J. Devereaux, Jagnoor Jagnoor, Rebecca Ivers, Mohit Bhandari, Gordon Guyatt, Brad Petrisor, Lehana Thabane, Respicious L. Boniface, Bruce Browner, Fernando De La Huerta, Rebecca Q. Ivers, Theodore Miclau, Paul Moroz, Andrew Pollak, Gerard Slobogean, Parag Sancheti, Emil Schemitsch, Junlin Zhou, Paula Mckay, Raman Mundi, Nathan O'Hara, Diane Heels-Ansdell, Lisa Buckingham, Nicole Simunovic, Robyn Norton, Jing Zhang, Maoyi Tian, Soumyadeep Bhaumik, Samina Parveen

Bone and Joint Institute

© 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Background: The Lancet Commission on Global Surgery established the Three Delays framework, categorising delays in accessing timely surgical care into delays in seeking care (First Delay), reaching care (Second Delay), and receiving care (Third Delay). Globally, knowledge gaps regarding delays for fracture care, and the lack of large prospective studies informed the rationale for our international observational study. We investigated delays in hospital admission as a surrogate for accessing timely fracture care and explored factors associated with delayed hospital admission. …

Heterogeneous Baroreflex Control Of Sympathetic Action Potential Subpopulations In Humans, Stephen A. Klassen, M. Erin Moir, Charlotte W. Usselman, J. Kevin Shoemaker

Bone and Joint Institute

© 2020 The Authors. The Journal of Physiology © 2020 The Physiological Society Key points: Emission patterns in muscle sympathetic nerve activity stem from differently sized action potential (AP) subpopulations that express varying discharge probabilities. The mechanisms governing these firing behaviours are unclear. This study investigated the hypothesis that the arterial baroreflex exerts varying control over the different AP subpopulations. During baseline, medium APs expressed the greatest baroreflex slopes, while small and large APs exhibited weaker slopes. On going from baseline to lower body negative pressure (LBNP; simulated orthostatic stress), baroreflex slopes for some clusters of medium APs expressed the …