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Effectiveness of tranexamic acid for acute traumatic hemorrhage and epistaxis in settings without immediate surgical support: a literature review
Get PDFBackground: Tranexamic acid has been widely used for the management of acute hemorrhage. Although results remain conflicting on its benefits, several more studies have been produced since the first 2010 publication of the CRASH-2 trial. The purpose of this literature review is to examine available evidence on the efficacy of tranexamic acid for acute hemorrhage due to trauma, isolated traumatic brain injury, and epistaxis. Of particular interest is the utility of tranexamic acid in settings without immediate surgical support, such as in certain rural and remote locations of Canada.
Methods: A literature review was conducted using the PubMed database as a source for trials comparing the efficacy of tranexamic acid as a means to improve morbidity and mortality from acute hemorrhage due to trauma, traumatic brain injury, and epistaxis.
Results: A total of 195 studies were identified from the PubMed database search. After removing duplicates and applying inclusion/exclusion criteria, 18 unique studies were included in the review. There were 5 on trauma, 7 on traumatic brain injury, and 6 on epistaxis. All 18 articles were reviewed in detail, but to keep within the scope of this capstone project, a focus on 2 key studies for each topic (trauma, traumatic brain injury, epistaxis) was performed. Although intravenous tranexamic acid administered within 3 hours of injury appeared to reduce 28-day mortality due to trauma, 28-day mortality due to traumatic brain injury and longer-term neurological outcomes at 6 months were not improved for either. Efficacy of topical tranexamic acid for epistaxis management remains conflicting.
Conclusions: Tranexamic acid can be a medication used to reduce mortality in the context of acute hemorrhage due to trauma when given intravenously within 3 hours of injury. This can be especially relevant in the prehospital setting, and in rural or remote settings of Canada where there is no immediate surgical support. As there is no mortality or morbidity benefit seen when used for isolated traumatic brain injury, tranexamic acid currently has little role in its management. There is still conflicting evidence as to what further benefit tranexamic acid provides within our current armamentarium when given topically for epistaxis management. As a result, its use for this cannot be recommended for or against at this time
An examination of Dietary Inflammatory Index scores in a Canadian nationally representative sample
Get PDFThere is growing recognition that diet can influence an individual’s inflammation level and ultimately, their risk for developing disease (Minihane et al., 2015; Prasad et al., 2012). The Dietary Inflammatory Index (DII) was developed to assess the inflammatory potential of an individual’s diet and pro-inflammatory diets have been linked to numerous chronic diseases (Phillips et al., 2019). That said, there is a paucity of research examining the inflammatory nature of diets in Canada.
The current project used data from the Canadian Community Health Survey – Nutrition 2015. The study sample consisted of adults aged 18-65, who were not pregnant. 24-hour dietary recalls were used to calculate DII and Health Eating Index – Canada (HEI-C) scores. Adherence to food guide recommendations was assessed using Health Canada’s four-tiered, grading system. The association between DII and HEI-C scores, as well as adherence to the Canadian Food Guide recommendations were measured. The influence of personal and external factors that influence diet and DII scores was examined using a structural equation modelling approach.
Results indicated that there was an inverse relationship between adherence to food guide recommendations and DII scores; however, no significant relationship was observed for HEI-C scores. Higher DII scores were noted for individuals who were not married or had lower levels of education or income. The best fitting structural equation model included variables for sex, income, number of foods consumed and length of time since immigration.
The findings in this thesis indicated that certain Canadian populations have significantly higher DII scores and this knowledge could lead to the development of effective interventions to promote the consumption of an anti-inflammatory diet.May 202
Evaluation of the long-term effects of anaerobic digestion on bovine manure resistomes and mobilomes and the molecular and microbial mechanisms involved
Get PDFAnaerobic digestion (AD) has shown the potential to reduce the abundance of antimicrobial resistance genes (ARGs) and mobile genetic elements (MGEs) in animal manures. It stands as a promising option to reduce the risk of the spread of antimicrobial resistance (AMR) due to livestock production and manure applications. However, the underlying mechanisms driving these changes still need to be fully understood. This multidisciplinary study aimed to utilize metagenomics to investigate the molecular and microbial mechanisms associated with the evolution of ARGs and MGEs during the anaerobic digestion (AD) of bovine dairy manure. The research focused on three main aspects: 1) examining the long-term effects of mesophilic (MAD) and thermophilic (TAD) anaerobic digestion on the entire set of ARGs (resistome) and MGEs (mobilome) in manure; 2) comparing the impact of alternative manure treatments, such as storage and solid-liquid separation, on resistomes and mobilomes; 3) identifying microbial groups potentially associated with ARGs and MGEs and microbial shifts potentially driving changes in resistomes and mobilomes. A meta-analysis conducted early in this research informed the primary focus of this research.
Two anaerobic digesters operating at mesophilic (36 °C) and the other at thermophilic (55 °C) temperatures were set up, operated, monitored, and studied for 4 and 2 years, respectively. Metagenomics analyses were used to evaluate resistomes, mobilomes, and microbiomes in the mesophilic and thermophilic digesters operating under steady state and in the bovine manure used as substrate. The results indicated that MAD and TAD lowered ARG levels in fresh cattle manure by over 50% and MGEs by over 65%. Surprisingly, TAD did not outperform MAD at reducing ARGs and MGEs. Co-occurrence analysis indicated a strong association between microbial groups from the phyla Bacillota (e.g., Jeotgalicoccus, Streptococcus, Enterococcus), Actinomycetota (e.g., Brevibacterium, Rhodococcus), and Pseudomonadota (e.g., Acinetobacter, Comamonas) with these AMR elements. The decline in the abundance of aerobic and facultative anaerobes likely linked to hydrolytic functions was suggested as one of the main drivers of the changes in resistomes and mobilomes. The proximity of toxin-antitoxin systems and transposon structures to specific ARGs (e.g., Erm, tet, Ant(6)-la) was discovered, which could explain the persistence of such ARGs in digestates. The study of the effects of other manure treatments, such as aerobic storage in an open tank and solid-liquid separation, revealed that they are less efficient in reducing ARGs and MGEs from manures than AD. In this study, the high levels of ARGs and genes conferring resistance to heavy metals in a farm operating in an antibiotic-free environment suggested that other antimicrobials, such as foot bathing solutions, may be causing the indirect selection of ARGs.
Overall, this research made several contributions to understanding AMR in the context of anaerobic digestion of animal manure that could be extrapolated to other manure treatments. These contributions not only bridge existing gaps in the literature but also pave the way for future research, providing valuable insights that can be used to inform the development of more effective strategies to mitigate the dissemination of AMR associated with manure management, application, and disposal.October 202
Strategies for detoxifying vomitoxin (DON) using innovative chemical and biological approaches in post-weaning piglets
Get PDFDeoxynivalenol (DON) presents a significant concern due to its potential to cause extensive economic losses and health risks to humans and animals. Swine, especially piglets, are particularly vulnerable to DON contamination than other livestock. While sodium metabisulfite (SMBS) shows promise in neutralizing DON through chemical reactions, its effectiveness is hindered in acidic conditions. Meanwhile, Bacillus sp. LS100, isolated from chicken digesta, has shown in vitro capability to detoxify DON, though its ability to detoxify DON in pigs remains unverified. This thesis aimed to fabricate SMBS-infused microparticles and nanofibers by encapsulation techniques and assess the efficacy of these fabricated products and Bacillus sp. LS100 in detoxifying DON in vitro and in vivo. SMBS-containing hydrogenated palm oil (HPO) microparticles were fabricated, showing stability in simulated gastric fluid (SGF) and facilitating a gradual release of SMBS in simulated intestinal fluid (SIF). The released SMBS in the SIF effectively detoxified DON, which was evidenced by fewer adverse effects in IPEC-J2 cells. Adding 0.45% SMBS-containing HPO microparticles to 3.3 mg/kg DON-contaminated diets could maintain the growth performance but decreased the gene expressions of inflammatory cytokines in the jejunum of weaned piglets. Given the slow release of SMBS in SIF observed with the SMBS-containing HPO microparticles, SMBS-containing Eudragit L100-55 nanofibrous mats were fabricated to enhance SMBS release in SIF. The electrospun nanofibrous mats exhibited rapid SMBS release in SIF and effectively alleviated the toxic effects of DON in IPEC-J2 cells. However, these mats were unsuitable for animal trials due to low production and mechanical constraints. Instead, SMBS-containing Eudragit L100-55 microparticles were fabricated. These microparticles safeguarded SMBS in SGF, with subsequent release in SIF, effectively mitigating negative impacts of DON in IPEC-J2 cells and weaned piglets. Finally, this study assessed Bacillus sp. LS100’s detoxification potency at two concentrations (1×109 and 1×1010 CFU/pig/gavage) in weaned piglets. The gavage administration of two levels of Bacillus sp. LS100 on days 10 and 12 did not significantly impact the growth performance of weaned piglets exposed to the 3.3 mg/kg DON-contaminated diets. In conclusion, SMBS-containing Eudragit L100-55 microparticles have potential for use in detoxifying DON in the swine industry.Canadian Swine Research and Development Cluster III (Agriculture and Agri-Food Canada, #1794),
Manitoba Pork Council (C. Yang, 50832),
the Natural Sciences and Engineering Research Council of Canada (NSERC) Discovery Grant (RGPIN-2019-06094),
Canada Foundation for Innovation.October 202
Three essays in spatial econometrics
Get PDFThis dissertation consists of three essays in the field of spatial econometrics. Incorpo- rating spatial interaction effects into the model can improve the explanatory power of econometric models. Additionally, employing spatial econometrics is an effective strategy for addressing the spatial dependence of variables, which could introduce endogeneity. In Chapter 1, the impact of P M2.5 on sleeplessness in Chinese cities is examined using novel Weibo data and spatial econometric models. Despite no direct effect of PM2.5 on sleeplessness, a significant negative impact is observed in adjacent cities during severe pollution in winter, indicating spatial spillover effects. Chapter 2 investigates the Real-Time Air Pollution Monitoring Policy’s influence on corporate responsibility in China, revealing spatial spillover effects of the policy. While no direct treatment effect of the policy on CSR or CER scores within treated cities is found, a significant indirect treatment effect of the policy on untreated neighboring cities is noted, possibly due to supply chain alterations. Chapter 3 investigates the impact of the minimum wage on employment in Chinese cities, while accounting for endogeneity arising from spatial heterogeneity, and spatial dependencies among variables. The findings indicate a notable positive direct effect and a considerable negative indirect effect of the minimum wage on employment rates.May 202
A systematic review protocol: health economic evaluations of immunotherapy and biologics for food allergy management
Get PDFA randomized trial evaluating the utility of non-targeted biopsies for colorectal neoplasia detection in adults with inflammatory bowel disease: a pilot study protocol
Get PDFBackground
Persons with inflammatory bowel diseases are at increased risk of developing colorectal cancer and require frequent colonoscopy surveillance. Guidelines recommend taking 30 to 40 non-targeted biopsies throughout the colorectum to detect “invisible” neoplasia in this setting, despite a lack of evidence supporting this practice. We sought to assess the utility of this practice through a randomized controlled trial. We first propose an internal pilot study to assess recruitment potential, protocol adherence and data capture to guide the full trial.
Methods
We have designed a multi-centre, parallel-group, non-inferiority randomized controlled trial to test the utility of non-targeted biopsies as an adjunct to colonoscopy surveillance for neoplasia detection in persons with inflammatory bowel disease involving the colorectum in routine clinical practice. Participants are randomized 1:1, stratified by study site, to either standard of care high-definition white-light colonoscopy with 32 to 40 non-targeted biopsies of non-neoplastic-appearing mucosa along with a sampling of abnormal-appearing mucosa (control group) or modified colonoscopy with targeted sampling alone (intervention group). The primary outcome for the full trial will be the proportion of persons with ≥ 1 neoplastic focus detected during colonoscopy. For the pilot phase, we will assess the feasibility of recruiting a minimum of 15% of the estimated sample size within 1 year, under identical conditions as the full trial, while maintaining ≥ 90–95% rate of protocol adherence and data capture. These participants will contribute data to the full trial. The trial is being conducted at 12 centres across Canada, with a total sample size of 1952 persons.
Discussions
The trial protocol has been approved by the ethics committees of all participating sites, and the pilot study has received funding through the Canadian Institutes of Health Research (PJT 159607). If feasibility metrics are met during the pilot phase, we will complete the full trial. The trial outcomes will contribute to update the practice guidelines in this area.
Trial registration
ClinicalTrials.gov, NCT04067778
Massive unsourced random access based on bilinear generalized vector approximate message passing
No full textThis thesis introduces a new algorithmic solution to the massive unsourced random access (mURA) problem. The proposed uncoupled compressed
sensing (UCS)-based scheme relies on slotted transmissions and takes advantage of the inherent coupling provided by the users’ spatial signatures in the form of channel correlations across slots to completely eliminate the need for concatenated coding. As opposed to all existing methods, the proposed solution combines the steps of activity detection, channel estimation, and data decoding into a unified mURA framework. It capitalizes on the bilinear generalized vector approximate message passing (BiG-VAMP) algorithm, tailored to fit the inherent constraints of mURA. To account for the quantization effects, we incorporate an output denoising module into the algorithm. Furthermore, this work presents a novel approach for handling a coarse quantized massive MIMO system by integrating activity detection, channel estimation, and data decoding within a unified framework. The proposed quantized mURA algorithm is evaluated using low-precision analog-to-digital converters (ADCs). Additionally, a state evolution algorithm is developed to validate the performance of both the proposed unquantized and quantized algorithms, demonstrating their consistency in the asymptotic regime. Furthermore, exhaustive computer simulations reveal that the proposed scheme shows promising results even in challenging scenarios.May 202
Beyond LGBT: a qualitative exploration of the primary healthcare experiences and needs of underrepresented 2SLGBTQIA+ young adults in Manitoba
Get PDFBackground: Though growing, the body of 2SLGBTQIA+ health research is small and privileges the experiences of white, gay and bisexual men, and lesbians. Further, research regarding the healthcare experiences of transgender individuals is dominated by binary gender identities, and little is known about the true prevalence of gender diversity. Research with the 2SLGBTQIA+ community has found this population is at increased risk for adverse health outcomes such as problematic drug use, domestic violence, depression, anxiety, and suicidal ideation. Primary healthcare cannot be utilized as a pathway to risk reduction if primary care practitioners (PCPs) are operating under heterocisnormative assumptions. Young adults (ages 19-30) have a whole life of healthcare needs ahead of them. Examining their unique experiences as young adults and members of the 2SLGBTQIA+ community can help to improve the quality of care they receive from their providers. Decreased utilization of primary healthcare because of barriers, such as discrimination, results in a reduction of preventative care that can be offered to patients. By dismantling barriers early in the life course, patients can safely engage with primary care and improve their long-term health outcomes.
Objectives:
Significant knowledge gaps exist in the research literature with regards to who among the 2SLGBTQIA+ community is represented in health research. No studies in the literature review specifically investigated the experiences of demisexual, asexual, pansexual, or polysexual individuals and none contained any consideration of romantic identity as a separate identity. The present study sought to begin to fill these gaps by listening to the voices of historically underrepresented 2SLGBTQIA+ community members by including a broader range of gender identities, sexual orientations, and romantic orientations, asking the research question:
What are the primary healthcare experiences and needs of underrepresented young adults of the 2SLGBTQIA+ community in Manitoba?
Methods: The study consisted of two phases. In phase one, 20 one-one-on interviews were conducted. Interviews were thematically coded using interpretive phenomenology analysis (IPA). In phase two, the themes that arose from the IPA coding were developed into a survey instrument. A draft version of the survey was shared via e-mail with interview participants to initially validate the captured themes and survey questions.
Findings: The study revealed seven themes related to the primary healthcare experiences of underrepresented 2SLGBTQIA+ young adult patients: medical gaslighting, managing identity, the adverse impact of heterocisnormativity, frustration with medical education, rurality exasperating adverse experiences, navigating provider level factors to access affirming care, and the power of community care. Sixteen of the twenty participants in this study were either partially or fully closeted from their primary healthcare provider. Participants also provided recommendations for improving the quality of care that 2SLGBTQIA+ patients receive from their primary healthcare provider, which included mandatory 2SLGBTQIA+ education, licensing requirements, structural and system changes, and patient-centered care.
Significance: The health literature to-date represents a narrow definition of the 2SLGBTQIA+ community. The inclusive nature of this study allowed for a wider range of identity expressions, including sexual/romantic orientation, and gender identity. This allowed for a deeper understanding of what it means to be a part of the 2SLGBTQIA+ community, and to further examine how these identities intersect with others in the primary healthcare context. Study findings may inform clinical guidelines to improve the quality of and access to healthcare for those in the 2SLGBTQIA+ community. Further, the study findings may also provide clinicians with an increased understanding of the complex needs of 2SLGBTQIA+ individuals and improve timeliness of recommending patients to appropriate secondary healthcare options.October 202
Leader's cognitive process and investment decisions: evidence from the U.S.
Get PDFThis study addresses how a leader's cognitive process affects a firm's strategic decision in investment made by the U.S. publicly listed companies. Findings indicate that when sales are below aspirations, decision-makers are more likely to make investments in fixed assets and innovation only in the long run, but they are less likely to invest in innovation when a firm's accounting profitability is below aspirations. Consistent results are found in robustness tests, and both theoretical and practical implications are discussed.May 202