Medicine and Health Sciences Commons^™

The Effects Of Maternal Delta-9-Tetrahydrocannabinol And Cannabidiol Exposure On Fetal Heart Development In Mice, Gregory Robinson

Electronic Thesis and Dissertation Repository

Up to 22.6% of pregnant women consume cannabis during pregnancy despite the uncertainty of teratogenicity of the main ingredients in cannabis, delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). This study tested the hypothesis that gestational THC and CBD exposure leads to heart abnormalities. Daily, oral THC exposure induced heart abnormalities in 68% of offspring with three main phenotypes including thickened semilunar valves, ventricular myocardial hypertrophy and hypoplastic coronary arteries in fetuses, and postnatal cardiac dysfunction. Altered gene expression of key cardiogenic regulators, increased proliferation, and reduced epicardial epithelial-to-mesenchymal-transition were demonstrated implicating potential mechanisms responsible for these abnormalities. Also, maternal CBD exposure resulted …

Perspectives Of Canadian University Coaches On Integrating Sport Psychology And Mental Performance Consultants In Varsity Programs, Federico Cisneros Sánchez

Electronic Thesis and Dissertation Repository

Recently, sport psychology has become a more popular resource for athletes and coaches when looking to increase performance. It is unknown how many Canadian universities utilize sport psychology services in their athletic programs. Semi-structured interviews were conducted with coaches of Canadian university varsity teams to learn about their opinions on sport psychology and mental performance consultants (MPCs). The research was approached from a pragmatic perspective. Results showed that MPCs are important to enhance performance and provide mental health resources. MPCs provide athletes with personal and leadership development, mental skills training, and mental health support. MPCs can also be a resource …

Regional Integration: Physician Perceptions On Electronic Medical Record Use And Impact In South West Ontario, Sadiq Raji

Electronic Thesis and Dissertation Repository

Regional initiatives in the health care context in Canada are typically organized and administered along geographic boundaries or operational units. Regional integration of Electronic Medical Records (EMR) has been continuing across Canadian provinces in recent years, yet the use and impact of regionally integrated EMRs are not routinely assessed and questions remain about their impact on and use in physicians’ practices. Are stated goals of simplifying connections and sharing of electronic health information collected and managed by many health services providers being met? What are physicians’ perspectives on the use and impact of regionally integrated EMR? In this thesis, I …

Risk Stratification For Treatment Decisions In People At Ultra-High Risk For Psychosis: A Cost-Effectiveness Analysis, Olajumoke Marissa Ologundudu

Electronic Thesis and Dissertation Repository

People with psychotic disorders have long-term negative health outcomes and contribute large health system costs. Intervening among those at ultra-high risk (UHR) for psychosis may prevent or mitigate risk for psychotic disorder; however, it is unclear if we should treat all UHR individuals or only those above a certain risk threshold. The objectives were to systematically review the literature on the cost-effectiveness of UHR programs, and to conduct an economic evaluation of a risk stratification strategy, where treatment decisions are based on the probability of transitioning to psychotic disorder. Our systematic review found that UHR programs are potentially cost-effective. The …

Assessment Of Landing Biomechanics And Rehabilitation After Anterior Cruciate Ligament Reconstruction, Sheila S. Gagnon

Electronic Thesis and Dissertation Repository

Aberrant landing biomechanics increase the risk of anterior cruciate ligament (ACL) injury and are a focus of rehabilitation after ACL reconstruction. The purpose of the present thesis was to develop and evaluate methods of assessing landing mechanics and investigate the effects of different rehabilitation strategies after ACL reconstruction. Three studies were conducted. The first study used a Delphi process to develop the content of a Clinician-Rated Drop Vertical Jump Scale to evaluate jump landing mechanics during rehabilitation after ACL reconstruction. Twenty experts participated in four rounds of questioning, resulting in 92% agreement for knee valgus collapse, lateral trunk lean, insufficient …

The Effect Of Pigmentation On Latex And Non-Latex Orthodontic Elastics, Dustin Wilson

Electronic Thesis and Dissertation Repository

Background: Intraoral Elastics have been widely used in Orthodontics for well over 100 years. Changes in material composition, manufacturing and addition of color to elastics has shown to effect force levels over time.

Aim: The purpose of the study was to determine the effect of pigmentation on force levels and their degradation over time in both Latex and Non-Latex orthodontic intraoral elastics.

Materials & Methods: Groups consisted of elastics in Latex from American Orthodontics in both natural and four different colors, American Orthodontics Non-Latex in natural, Ormco Latex in both natural and four different colors, Auradonics Latex in both natural …

Reducing Length Of Stay After Total Hip And Knee Arthroplasty: Assessing Cost-Effectiveness, Caregiver Involvement And Surgical Approach, Bryn O. Zomar

Electronic Thesis and Dissertation Repository

Purpose

The overall purpose of this dissertation was to evaluate factors related to reducing length of stay after total hip and knee arthroplasty (THA and TKA).

Methods

Study 1 was a randomized controlled trial (RCT) to investigate the cost-effectiveness of outpatient THA compared to standard overnight stay. Study 2 was a prospective cohort study to assess patient- and caregiver-related factors and how they may relate to caregiver strain and level of assistance when caring for patients undergoing THA and TKA. Finally, Study 3 was a 2x2 factorial RCT to compare the trajectory of early functional recovery between the medial parapatellar …

Intersectional Social Inequalities And Cognitive Functioning Among Community-Dwelling Older Adults In England: A Decomposition Analysis Of The Mediating Role Of Loneliness, Chantel Walwyn

Electronic Thesis and Dissertation Repository

Normative cognitive decline is an emerging public health issue for older adult populations. It is necessary that we take an intersectional approach to examining heterogeneity in cognitive health outcomes. Using complex longitudinal survey data from the English Longitudinal Study of Ageing (ELSA), multiple linear regression models were used to examine the relationship between intersectional group membership based on age, education, and sex, and change in cognitive functioning domains (memory function, and executive function) over an 8-year period. Three-way decomposition analysis was also used to examine the mediating effect of loneliness on the association between intersectional group membership and the change …

A Novel Spatio-Temporal Examination Of Children's Accessibility, Exposure, And Engagement To Parks And Recreation Spaces In Middlesex-London, Ontario, Malcolm K. Little

Electronic Thesis and Dissertation Repository

Children are spending more free time engaged in activities indoors, rather than in outdoor environments such as parks and recreation spaces. Parks and recreation spaces provide amenities that promote physical, cognitive, and social health among children. As it relates to the complexities of children’s living situations, properly measuring children’s levels of interactions with these spaces is poorly understood in geography research.

By examining various attributes of children, this thesis improves on the measurement of children’s levels of interactions with parks and recreation spaces. Research herein utilized household survey data, a high-resolution GIS dataset of environmental factors, and GPS logs from …

Population-Based Studies On Medications And Fall-Related Injury In Older Adults, Yu Ming

Electronic Thesis and Dissertation Repository

Background: Fall-related injuries in older adults result in serious consequences to individuals and health care system, especially with the increasing aging population. The purpose of this study was to (1) describe medication prescription patterns within one year prior to fall-related injuries; (2) identify medication classes prescribed within 30 days prior to the injury that were associated to fall-related injury; and (3) examine the association between fall-related injuries and continuous use or new initiation of most commonly prescribed medications.

Methods: Studies used administrative health care data in Ontario. Study 1 described the frequency of medications prescribed to older adults within one …

The Role Of Timp3 In Microvascular Endothelial Cell-Extracellular Matrix Interaction And Regulation Of Microvascular Barrier Function, Nidhi Kulkarni

Electronic Thesis and Dissertation Repository

Pulmonary microvascular endothelial cell (PMVEC) interactions with the extracellular matrix (ECM) mediates PMVEC barrier function. Further, data suggests an association between decreased PMVEC-ECM interactions under proinflammatory conditions and PMVEC barrier dysfunction. Tissue inhibitor of metalloproteinases 3 (TIMP3) may also regulate barrier function, as PMVEC from Timp3^-/-mice show increased leak. Studies in the developing lung also showed TIMP3 regulating PMVEC-ECM interactions. Based on this, I hypothesized that TIMP3 maintains PMVEC barrier function by promoting PMVEC-ECM interactions.

Using the XperT-permeability assay, Timp3^-/-PMVEC demonstrated enhanced leak vs. WT PMVEC, particularly under proinflammatory conditions, and this was associated with decreased …

Correlates Of Preventable Emergency Department Visits In Canada: Evidence From The Literature And The Canadian Community Health Survey, Tammy Lau

Electronic Thesis and Dissertation Repository

Emergency department (ED) visits for primary healthcare-treatable conditions are preventable and indicate barriers to primary healthcare. The goal of this thesis was to explore the prevalence and key correlates of preventable ED visits among adults in Canada. Our systematic review found that the prevalence of these visits ranged from 4.3% to 59.1% and were associated with younger age, low education, low income, rural residence, and worse self-rated health. Our analysis of data from the 2015-2016 Canadian Community Health Survey found that 39.9% of adults with a regular healthcare provider considered their last ED visit to be preventable. In addition to …

Detection And Quantification Of Cells Using Magnetic Particle Imaging And Magnetic Microspheres, Kierstin P. Melo

Electronic Thesis and Dissertation Repository

Magnetic particle imaging (MPI) is an emerging imaging modality that specifically detects superparamagnetic iron oxide nanoparticles (SPIOs). Our lab has shown that cell tracking with magnetic resonance imaging (MRI) has very high sensitivity, but low specificity and quantification of iron labeled cells is difficult. MPI cell tracking could overcome these limitations. A Momentum^TM MPI system was installed at Robarts in August 2019 and this is the first project to be completed using MPI. In Chapter 2 a series of in vitro experiments are reported which tested the repeatability and reproducibility of imaging SPIO labeled cell samples. There are no …

Improving Hydrid Pet/Mri Cardiovascular Imaging With Improved Hardware Design And Attenuation Correction Coefficient, Adam Helmy Farag

Electronic Thesis and Dissertation Repository

According to the World Health Organization (WHO) report in 2019, cardiovascular diseases (CVD) cause 52% of all illness-related deaths globally and are considered to be the second most common cause of death in Canada. CVD is also estimated to cost the Canadian economy about $21.2 billion in direct and indirect costs. With these figures, it is vital to develop the most effective and accurate methods and tools to diagnose accurately CVD and their causes. One of the promising tools for accurate diagnostic and therapeutic of CVD is the integrated Positron Emission Tomography (PET) and Magnetic Resonance Imaging (MRI) PET/MRI technology, …

Evidence Of An Antigen Presenting Cell Phenotype In Granular Cell Tumours, Benjamin J W A Rogala

Electronic Thesis and Dissertation Repository

Granular Cell Tumours (GCTs) are rare subepithelial lesions that are believed to develop from Schwann cells and are characterized by large polygonal cells with abundant lysosomes. Pilot studies from our laboratory showing unexpected HLA-DR immunoreactivity in GCTs lead us to hypothesize that GCTs have an antigen presenting cell (APC) phenotype.

To test our hypothesis, we assessed immunoreactivity of GCT lesions to APC phenotype markers, including CD68, HLA-DR, CD163, CD40 and CD11c. In addition, we assessed markers of neural crest cell (NCC) origin S100, SOX10, NSE and GAP43. Samples subjected to these studies included 23 cases of GCTs and 10 cases …

The Experiences Of Family Medicine Teachers And Family Medicine Residents In Multimorbidity Care And Education, Julie A. Copeland

Electronic Thesis and Dissertation Repository

Aim: This thesis explored the experiences of family medicine preceptors and family medicine residents regarding multimorbidity care and education.

Methods: Two qualitative descriptive studies were conducted using semi structured interviews with family medicine preceptors and focus groups with family medicine residents. Interviews and focus groups were audio-taped and transcribed verbatim. Data analysis was iterative and interpretive in nature and done both independently and as a team.

Findings: Multimorbidity care is predominantly provided by family physicians yet there is little focus on multimorbidity education in the medical education curriculum. Multimorbidity education is informal and experiential in nature. There are both facilitators …

Trends And Factors Associated With Suicide Deaths In Older Adults, Eada Novilla-Surette

Electronic Thesis and Dissertation Repository

Suicide in older adults is a significant overlooked problem worldwide; particularly in Canada where a national suicide prevention strategy has not yet been established. This population-level study utilized and analyzed linked administrative health care databases (from 2011-2015) that were available at ICES (provincial health care administrative data steward), to build a better understanding of suicide (rate; trends; risks/preventive factors) in older adults living in Ontario, Canada. The findings suggest that suicide remains a persistent cause of death in older adults (with an average annual suicide rate of 0.1 per 1000 people over 5 years; the risks include being male, living …

Frailty, Clinical Outcomes, And Cost In Patients Undergoing Trans-Catheter Aortic Valve Implantation (Tavi), Zhe Li

Electronic Thesis and Dissertation Repository

The objective of this doctoral was three-fold: 1) to systematically review frailty measures and prognosis of frail patients undergoing TAVI, 2) to examine the performance of frailty indices in predicting clinical outcomes after TAVI, and 3) to examine the performance of frailty indices in predicting one-year costs of TAVI and high-cost TAVI patients.

For the first objective, we systematically reviewed the literature published in 2006 or later. We found that frailty instruments varied across studies, leading to a wide range of frailty prevalence estimates for TAVI recipients and substantial heterogeneity.

For the second objective, we utilized data from the CorHealth …

Kidney Injury Molecule-1 Mediated Phagocytosis And Its Therapeutic Application In Ameliorating Renal Transplant Ischemia Reperfusion Injury, Ji Yun Lee

Electronic Thesis and Dissertation Repository

Renal transplantation is a life-saving procedure for patients with end-stage renal disease. Persistent graft inflammation and fibrosis due to injury from repeated insults - both alloantigen-dependent and -independent - lead to chronic allograft dysfunction and long-term graft loss. Ischemia-reperfusion injury (IRI) to the graft is an inescapable consequence of transplantation and can result in significant delayed graft function (DGF). Tissue damage and graft dysfunction resulting from transplant-associated IRI have been correlated with acute rejection and long-term graft loss. During IRI, dying renal proximal tubular epithelial cells (TECs) release pro-inflammatory mediators, worsening tissue damage and further potentiating injury by initiating an …

The Examination Of Expectations In Day-Surgery Patients And The Development Of A Patient Satisfaction Questionnaire For Day-Surgery Patients, Tishara M. Wijayanayaka

Electronic Thesis and Dissertation Repository

Patient satisfaction has become a growing area of study within health care. Existing hospital- wide satisfaction tools don’t provide the specificity that various departments require to truly get a sense of where they stand in terms of patient satisfaction. Further, many of these tools fail to consider an important component associated with satisfaction, patient expectations. Currently, there is no patient satisfaction tool specific to adult day-surgery patients that has been developed through a careful exploration of patient expectations. In this qualitative study, we conducted a series of semi-structured interviews on patients undergoing outpatient surgery to explore expectations. We performed a …

An Investigation On The Influences Of Radial Head Hemiarthroplasty Stem Fixation Techniques On Articular Mechanics, Jakub Szmit

Electronic Thesis and Dissertation Repository

Radial head hemiarthroplasty design has been extensively studied with a focus on utilizing the geometrical characteristics of the native radial dish as a guide of implant placement and design. Although implant design has been studied, optimal radial head implant fixation technique remains unknown. This thesis focused on the effect of stem fit on radiocapitellar contact mechanics, using both finite element and experimental bench-top approaches. Additionally, investigation into the impact of varus/valgus malalignment of the radial head in both the native state and following hemiarthroplasty was conducted. It was found that loose fitting a smooth stem axisymmetric radial head implant through …

Neurocognitive Impairment Across The Continuum Of Critical Illness: Exploration Of Acute Insults, Functional Risk Factors, And Clinical Monitoring Tools., Marat Slessarev

Electronic Thesis and Dissertation Repository

Critically ill patients of all ages suffer from high burden of neurocognitive impairment during (i.e. delirium) and following (i.e. long term cognitive impairment) critical illness that is associated with worse patient and healthy system outcomes. Ischemia has emerged as a plausible mechanism given the high prevalence of hypotension and shock, ischemic injury on neuroimaging, and impairment of cerebral autoregulation in these patients. However, the burden of ischemic insults during critical illness and mechanisms responsible for these insults are poorly described. Furthermore, while baseline impairment in cerebrovascular function can render patients more vulnerable to ischemia, such baseline functional assessments in patients …

Developing Competencies For Public Policy Advocacy: A Comparative Case Analysis, Amy L. Lewis

Electronic Thesis and Dissertation Repository

While health care and social service students in Ontario are expected to graduate with competencies in policy advocacy, the lack of knowledge and skills negatively impacts their participation as licensed providers. This study used an exploratory, comparative case study methodology with a critical theory lens to identify the process of how community-based organizations engaged in public policy advocacy to create educational competencies for undergraduate curricula. Eight organizational leaders participated in semi-structured interviews that were transcribed and analyzed both inductively and deductively using major concepts from Kingdon’s multiple streams theory to distinguish the policy advocacy process and Bloom’s taxonomy to identify …

An Exploration Of Audiologists' Readiness To Adopt Connected Hearing Healthcare For Remote Hearing Aid Fitting, Luisa Natalia Perez Velez

Electronic Thesis and Dissertation Repository

Background: Globally, the increasing prevalence of hearing loss and need for improved access to hearing healthcare services, highlights the growing need for alternative service delivery models. A Connected Health model emerges as a solution for this need, focusing on the use of telecommunication technologies. This model, extended to audiology, can help to better ‘connect’ a patient to their own care process and to their provider during audiological diagnostics, treatment, and management services, at a distance and in an effective and timely manner. The strong capacity for and underutilization of Connected Audiology within current aural (re)habilitation service models have led to …

The Effect Of Mtor Inhibitor Rapamycin On A Dietary Drosophila Melanogaster Model Of Calcium Oxalate Nephrolithiasis, Michael T. Pignanelli

Electronic Thesis and Dissertation Repository

Impaired cellular tolerance of reactive oxygen species (ROS) has been suggested as a common mechanistic link associated with aging in both metabolic syndrome and nephrolithiasis. The mechanistic (mammalian) target of rapamycin (mTOR) activity is characteristic of metabolic syndrome. When nutrients are abundant, mTOR is active. Conversely, fasting inhibits mTOR. Metabolic syndrome is correlated with an increased risk of self-reported or imaging findings of nephrolithiasis. At the individual level, patients with a higher BMI have an increased prevalence of recurrent symptomatic nephrolithiasis, 24-hour urinary excretion of oxalate, sodium, uric acid, calcium, and phosphorous as well as lower pH. Calcium oxalate crystals …

An Exploration Of Facial Skin Scarring, Its Impact And Contemporary Evaluation, Michael G. Brandt

Electronic Thesis and Dissertation Repository

Facial skin cancer secondary to surgical treatment may be distressing due to the malignancy itself and from the consequences of its treatment. A visible postsurgical scar is an obvious reminder of the condition. This investigation sought to broaden our understanding of facial scarring and develop a novel tool for its objective evaluation. To this end, skin cancer as the most common etiology of facial scarring was reviewed. The scar scale literature was evaluated in the context of assessing scars through a biopsychosocial lens. Finally, the development of a novel scar scale was presented. Thirty-four individuals completed 13,056 ratings using a …

Impact Of Graded Passive Cycling On Hemodynamics, Cerebral Blood Flow, And Heart Function In Healthy Adults And Septic Icu Patients, Jennifer Chen

Electronic Thesis and Dissertation Repository

Sepsis is a life-threatening dysregulation of host response to an infectious insult, which often leads to multi-organ failure. Sepsis survivors suffer from post-intensive care syndrome in part due to their prolonged bed rest and lack of mobility. Although early mobilization has been championed as a mechanism to counter the adverse effects associated with ICU immobility, due to sedation and mechanical ventilation, active early mobilization is not often administered in septic patients due to worries of hemodynamic instability and potential for inducing adverse events. Passive exercise is a mobilization modality that circumvents the need for patients to be conscious and participatory …

Understanding Physical Activity Behaviour In Ontario, Canada: A Cross-Sectional Cohort Analysis Of Carrot Rewards App Users, David D. Mchugh

Electronic Thesis and Dissertation Repository

Little device-measured data are available to describe the physical activity (PA) of rural-dwelling individuals living with chronic disease. PURPOSE: From accelerometer data collected using a smartphone app (‘Carrot Rewards’), we sought to provide mean daily step counts for app users in general and by age and gender for those living in rural/urban areas and those self-reporting a chronic disease or not. METHODS: This cross-sectional cohort study used device-assessed data from Ontario app users (i.e., PA data collected over a 7-day period for each user) who completed an in-app chronic disease survey from December 2018 to April 2019. A …

Deciphering The Ck2-Dependent Phosphoproteome And Its Integration With Regulatory Ptm Networks, Teresa Nunez De Villavicencio Diaz

Electronic Thesis and Dissertation Repository

Protein functions are regulated by the post-translational addition of covalent modifications on certain amino acids. Depending on their distance within the 3-dimensional structure, addition/removal of individual post translational modifications (PTMs) can be impacted by others. This PTM interplay constitutes an essential regulatory mechanism that interconnects the molecular networks in the cell. Protein CK2, a clinically relevant acidophilic Ser/Thr kinase, may be responsible for 10-20% of the human phosphoproteome. Such estimates agree with the number of known substrates, which continues to expand. Furthermore, the demonstration that CK2 participates in hierarchical phosphorylation and has similar sequence determinants to caspases suggest extensive PTM …

Development Of Water-Soluble Polyesters For Tissue Engineering Applications, Trent Gordon

Electronic Thesis and Dissertation Repository

The development of tunable polymers has become increasingly important for both tissue engineering and drug delivery. This thesis investigates the development of water-soluble polyesters that contain both natural and synthetic components. These polymers offer tunable chemical structures, as well as functional groups for the conjugation of crosslinking moieties or cell signaling molecules. The first series of polymers was synthesized from poly(ethylene glycol) (PEG) and aspartic acid (Asp) via a titanium catalyzed transesterification method to provide polymers with molar masses of 12 kg/mol. After deprotection, the pendent functional groups of Asp were reacted with methacrylic, maleic, and itaconic anhydride to introduce …