Open Access Journals University of Manitoba
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Physician Assistant Involvement in Health Advocacy, Health Promotion and Disease Prevention: A Scoping Review
Get PDFOBJECTIVES:Physician Assistants (PAs) have been integrated into the Canadian healthcare system to improve patient access and clinical efficiency. The CanMEDS-PA framework describes the PA as a health advocate, but the current extent of PA involvement in health advocacy has not been delineated. A scoping review was conducted to investigate PA participation in health advocacy, health promotion and disease prevention initiatives.METHODS: An electronic literature search was conducted using Web of Science, PubMed, CINAHL, OVID (Embase and MEDLINE) and Cochrane databases. Broad eligibility criteria were used to include publications involving PAs or PA students who participated in health advocacy, health promotion and disease prevention initiatives globally.RESULTS:297 records were identified; 14 met the inclusion criteria.  Publications included cross-sectional studies, surveys, program evaluations, clinical framework development, and patient education handouts. Topics included cancer screening, chronic disease management, adolescent health promotion and stroke prevention.  All records were published in the United States. There was an overall positive contribution of PAs to health advocacy, health promotion and disease prevention. Several specific limitations were noted related to procedural techniques and continuity of practice.CONCLUSION:Global research on PA involvement in health advocacy, health promotion and disease prevention is limited and focuses on a small subset of medicine (cancer screening) in one geographical area (United States). Data show that PAs are effective health advocates but more reporting is needed to guide expansion of the PA role and to inform policy in Canada and globally
Challenges with Medical Directives for Physician Assistants in Ontario
Get PDFPhysician Assistants (PAs) in Ontario are unregulated health professionals with no legislation directly authorizing them to perform controlled acts. Â PAs have the legal authority to perform their healthcare role primarily through a process of delegation known as medical directives (MedD). Â This process of delegation and requirement for MedD was set in a policy written by the College of Physicians and Surgeons of Ontario (CPSO) before the introduction of PAs into Ontario. Â Through examination of MedD currently in use, several challenges have been identified when this policy is applied to create MedD for PAs. Â The primary issue is the large number of permissible orders a PA requires to fulfill their job requirements. Â Each order within the MedD requires a corresponding comprehensive list of indications and contraindications. Â The resulting document is exceptionally long and time consuming to create such that every organization employing a PA cannot reasonably devote the resources necessary to create such a document. Â A second issue identified is that the CPSO policy was written to reflect situations where the clinical context is fixed. Â In actuality, PAs work in a variety of clinical contexts and often with evolving clinical context. Â Additional problems identified include ambiguity in the criteria outlined for MedD in the CPSO policy, and an inherent delay when clinical practice guidelines are updated before they can be reflected in the MedD. Â To cope with some of these challenges, several approaches have been observed. Â Ultimately it seems that PAs in Ontario function in a role with less autonomy and a smaller scope of practice when compared to PAs in Manitoba, New Brunswick, or the Canadian Armed Forces. Â It is reasonable to conclude that differences in legislation and the massive administrative burden to create thorough MedD would lead to a diminished scope of practice and less autonomy. Â We recommend either updating legislation to specifically address controlled acts performed by PAs in Ontario or updating the CPSO policy to reflect the level of training and role(s) of PAs. Â As an interim improvement, a group of PAs in Ontario will work towards developing standardized MedD to alleviate some of the administrative burden on employers. Â With these proposed changes, the aim is to reduce barriers such that PAs may function in their intended healthcare role and thereby increase the medical services provided to Ontarians
Blue jays (Cyanocitta cristata) do not spontaneously eavesdrop on red squirrel (Tamiasciurus hudsonicus) squeals to locate food
Get PDFOrganisms often eavesdrop on the cues and signals produced by other species to obtain information about their environment. Blue jays have dietary overlap with red squirrels, and learn to associate novel stimuli with food rewards in an experimental setting. Red squirrels produce “squeals†when contesting food resources with conspecifics. We tested whether blue jays eavesdrop on red squirrels by playing back red squirrel squeals, red squirrel rattles, white noise, and chick-a-dee calls to blue jays in Winnipeg, Manitoba. Additionally we examined the response of passerine birds in general to the playbacks, and attempted to condition free-living blue jays to respond to the playback of the squeal treatments. Results of the playbacks suggested that neither blue jays nor other passerines eavesdrop on vocalizations emitted in the context of red squirrel disputes over food. Conditioning trials did not produce any conditioned responses from blue jays; however, the limited number of trials performed does not constitute a robust test of the possible acquisition of a classically-conditioned response. Blue jays may also refrain from eavesdropping on red squirrel squeals as they are not reliable indicators of food resources, or because in an urban environment, blue jays readily learn the locations of bird feeders or other reliable food sources without eavesdropping on red squirrels
The duckweed Lemna minor recovers following 7, 14, 21, and 28 day exposures to atrazine at environmental concentrations
Get PDFWe characterized the ability of the duckweed Lemna minor to recover from 7, 14, 21, and 28-day exposures to the herbicide atrazine. Static renewal assays were performed for each duration (with an exposure series of 0, 10, 20, 40, 80, 160 and 320 µg/L atrazine) followed by a 7-day recovery period in clean media. We observed full recovery (no statistical difference from control) in dry mass, frond number, and plant number growth rates at concentrations typically found in the environment ( ≥80 µg/L atrazine), regardless of the exposure duration. The USEPA currently regulates atrazine on an aquatic plant Concentration Equivalent Level of Concern of 10 µg/L (60-day average concentration) and our data support this decision
Grey wolf selection for moose calves and factors influencing prey species consumption in southeastern Manitoba
Get PDFMoose populations in southern Manitoba have declined in recent years, and although the cause of the decline is yet unknown, wolf predation has been suggested as a potential contributing factor. We used fecal analysis combined with telemetry data to test the influences of social structure, relative prey abundance, and season on wolf consumption of moose and other prey species. We tested for influences of social structure, relative prey abundance, and summer time period specifically on consumption of moose calves in summer, and compared consumption of moose calves to the relative occurrence of calves in the overall moose population. Wolves hunting in a pack were more likely to consume moose than solitary wolves, while solitary wolves were more likely to consume other non-ungulate prey. Solitary wolves were more likely to eat deer in areas where deer were more abundant, but we found no difference in consumption of moose by solitary wolves between areas of greater moose abundance. Beaver were consumed more in summer, but consumption of other prey species did not differ seasonally. We found no effect of social structure, relative prey abundance, or summer time period on consumption of moose calves. Wolves killed calves preferentially, in excess of their relative abundance, only in late summer. Management of wolves aimed at decreasing wolf numbers in southeastern Manitoba may also reduce predation on adult moose by decreasing pack sizes and interrupting the social organization
Cloning, Expression and Purification of the Antimicrobial Targets EtfB and EtfDh of Burkholderia cenocepacia
Get PDFBurkholderia cenocepacia is a pathogenic bacterium that causes life-threatening infections in cystic fibrosis patients (Shommu, Vogel, & Storey, 2015). Through a conditional growth mutant library, two essential genes of this bacterium, etfB and etfDh, encoding an electron transfer flavoprotein unit and an etf dehydrogenase respectively, have been identified. While the essential role of these proteins in B. cenocepacia is unknown, protein characterization and interaction analysis will aid in the development of their capacity as antimicrobial targets. The experimental goal of this study was to clone, express and purify etfB and etfDh. Both genes were separately cloned into the bacterial plasmid pE-SUMO and transformed into E. coli BL21-DE3 GOLD. Protein expression of EtfB and EtfDh was induced by isopropyl β-D-1-thiogalactopyranoside (IPTG), and the soluble and insoluble protein fractions were analyzed. EtfB was found in the soluble fraction, which is expected as ETFs are cytoplasmic proteins (Winsor, Khaira, Van Rossum, Lo, Whiteside, & Brinkman, 2008). EtfDh was mainly present in the insoluble fraction suggesting that the B. cenocepacia EtfDh is a membrane-bound dehydrogenase (Winsor et al., 2008). The protein purification process has resulted in a highly pure EtfB and EtfDh samples, which can be used to raise antibodies. Consequently, antibodies raised against these proteins will allow immunofluorescence and coimmunoprecipitation studies of EtfB and EtfDh. The results of the current work provide the tools to address the hypothesis of an intracellular interaction between cytoplasmic EtfB and membrane-bound EtfDh to further understand their role and essentiality in B. cenocepacia
Variation in snowshoe hare density near Churchill, Manitoba estimated using pellet counts
Get PDFSnowshoe hares (Lepus americanus) are a keystone species in the Boreal Forest of Canada and their well-characterized population cycles can strongly influence the abundance of their predators. We examined annual variation in snowshoe hare density near Churchill, Manitoba, using counts of hare fecal pellets from 2012 to 2015. We used a regression formula to estimate the density of snowshoe hares based on fecal pellet density. Our estimates of snowshoe hare densities were highest in the first year of study, which may reflect a bias due to pellets accumulating from previous years, and we found no difference in hare density estimates in the subsequent three years. These results suggest the forest-tundra ecozone may be marginal habitat for snowshoe hares, precluding rapid increases in hare density, so population densities of snowshoe hares in Churchill may not cycle in their historic 10-year intervals. However, the northward advancement of the tree line with climate warming may improve habitat conditions for snowshoe hares, and thus the predator populations they typically support
Are aquatic snails reservoirs and vectors of microbes bearing antibiotic resistant genes?
Get PDFThe role of Stagnicola elodes, a freshwater snail, as a reservoir and vector for transporting antibiotic resistant genes (ARGs) was explored under laboratory conditions. We hypothesized that ARG-bearing microorganisms would become part of the snail gut microbiome allowing ARGs to be spread from their initial point of origin should snails be transported or the input of pharmaceuticals cease. We exposed snails in jars for 14 days wherein they grazed on biofilms that contained microbes resistant to the antibiotic sulfamethoxazole (SMX). Snails were then transferred to fresh media with no SMX for either a 7-day hibernation or depuration period. SMX-related ARGs were quantified in the 14-day treatment and 7-day depuration and hibernation systems. On day 14, treated jars had 6.6% of SMX resistant genes in the water phase, and the 7-day hibernation and depuration vessels had an average of 3.9% and 1.4%, respectively, relative to the total water-borne microbial community. Methods of extracting snail samples for SMX-related ARGs were unsuccessful. This was attributed to the snails’ having extensive mucus sugars that interfere with extraction. Our findings suggest that ARGs could be transferred to new environments from snails excreting gut flora in their feces, warranting further investigation