30921 research outputs found
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Developing a set of performance measures to monitor and evaluate delirium care quality for older adults in the emergency department
No full textBackground. Older adults are at high-risk of developing delirium in the emergency department (ED). However, it often goes undetected or undertreated. Performance measures (PMs) are needed to identify variations in delirium care quality and to help guide improvement strategies.
Purpose. The purpose of this research was to develop a set of guideline-based PMs to monitor and evaluate delirium care quality for older ED patients.
Methods. Research was conducted in two sequential phases, such that knowledge from Phase 1 was used to inform Phase 2. In the first phase, I conducted an umbrella review to identify and synthesize clinical practice guideline (CPG) recommendations for delirium care in older adults. The results of Phase 1 were used to develop a preliminary set of PMs, as well as their necessary precursory ‘quality statements’. In the second phase, I conducted a 3-round modified e-Delphi to reach clinical expert consensus on a final set of ED quality statements that are important and actionable for delirium care of older ED patients, and PMs that are necessary to evaluate this care.
Results. In Phase 1, 5 of 10 CPGs met criteria for inclusion in the synthesis. Included recommendations (n = 78) were grouped into four categories: screening, diagnosis, risk reduction, and management. None of the included CPGs were ED-specific but many recommendations incorporated evidence from this setting. From this synthesis, a preliminary set of 10 quality statements and 24 PMs were developed. Twenty-two experts participated in Phase 2. Panelists reached consensus at or slightly below a priori criteria on nine quality statements, nine structure PMs, and 14 process PMs.
Conclusion. This research created 23 PMs that a diverse group of experts agree should be used to monitor and evaluate delirium care quality for older adults in the ED. Developing this set of PMs advances the knowledge base by demonstrating how to develop new ED PMs instead of deriving them from previous work, as well as providing an example of rigorous methods to develop guideline-based PMs. Future research will test the feasibility of using these metrics to provide baseline data and guide delirium care improvement efforts in the ED.Canadian Nurses Foundation (CNF) Dr. Ann C. Beckingham award
Manitoba Training Program in Health Services Research Studentship
Dean of the Faculty of Health Sciences Graduate Student Achievement Prize
University of Manitoba Graduate Fellowship
Dean of Graduate Studies Student Achievement Prize
University of Manitoba Faculty of Graduate Studies Tri-Agency Top-Up AwardMay 202
Who is school fundraising desirable for? Understanding social class differences in parental fundraising
No full textThis dissertation explores how parents engage with school fundraising in the public education system; specifically, it examines parental fundraising at elementary schools in River North School Division (pseudonym), a large public school division in Winnipeg, Manitoba, Canada. Previous research has shown that fundraising allows parents to engage and hold influence in schools, but it also creates inequities between communities of different socioeconomic status and fundraising capacity. However, few explored the question: Why and how does parental engagement with fundraising differ between elementary schools, especially in the prairie provinces of Canada? This dissertation focuses on four major aspects of fundraising: (1) the relationships parent fundraisers have with administrators and staff at their schools, (2) parents’ motivations for getting involved, (3) the resources parents draw from to be successful, and (4) the barriers parents face in their fundraising efforts. Drawing on the theories of Pierre Bourdieu and Annette Lareau, and using a comparative case study approach, data was gathered by interviewing nine individuals associated with River North Division elementary schools, analyzing over 200 documents related to fundraising in these schools, and using Statistics Canada census data to create community profiles for each school’s catchment. While there were some similarities across all River North schools, clear social class differences in fundraising practices emerged. Parental fundraising is becoming an increasingly normalized way for parents to engage with schools in the highest socio-economic communities, allowing them to generate significantly greater resources for their schools. This dissertation argues that more must be done to ensure that community wealth and parental contributions do not determine what resources and supports students can access in the public education system.February 202
Engineered floating wetlands as a secondary oil spill remediation strategy for freshwater shorelines
No full textConventional oil spill recovery methods are not desirable for sensitive freshwater shorelines due to damage caused from physical recovery efforts. This, in addition to the residual oil, causes long term impacts to the environment. With increasing production and transport of oil across Canada, there is a need for non-invasive alternatives for oil spill remediation. This thesis has assessed the use of Engineered Floating Wetlands (EFW) as a non-invasive strategy for remediating oil spills in sensitive habitats, through a series of in-lake model oil spill and microcosm experiments conducted at the International Institute for Sustainable Development Experimental Lakes Area. The in-lake experiments monitored changes to the EFW root microbial community upon exposure to model spills of diluted bitumen and conventional heavy crude oil following primary recovery in shoreline enclosures. These experiments found that EFWs support a diverse microbial community, with high richness and evenness of prokaryotes, and variable dominance of eukaryotes. While direct roles in degradation were not assessed, total polycyclic aromatic compounds (PACs) declined to near background conditions in the aqueous environment after ~60-70 days, likely a result of various biotic and abiotic processes. To confirm whether plants can enhance removal of PACs, a microcosm experiment was conducted to assess the removal of 1 mg/L phenanthrene by three emergent plants from freshwater over 21 days. All treatments resulted in successful removal of phenanthrene (≥ 89% from initial measured concentration). Typha sp. had a greater removal rate than Carex lasiocarpa, but not C. utriculata. However, the control with no vegetation also resulted in successful phenanthrene removal, likely from biostimulation. There were no differences between the control and planted microcosms, however Typha generally had greater removal rates than the control. While all treatments had successful removal, it was clear there were plant specific functions influencing water quality and removal. This thesis has demonstrated that EFWs may be a successful alternative to conventional strategies for sensitive environments. A number of recommendations are made throughout this thesis to help advance knowledge in this field to protect freshwater ecosystems. Specifically, future research is recommended to further identify factors driving successful bioremediation mediated by EFWs.Mitacs Accelerate (IT15202)
IISD Experimental Lakes AreaOctober 202
Connection between Alzheimer’s Dementia and Postmenopausal Women: A Literature Review Assessing the Impact of Hormone Replacement Therapy on Cognition
No full textBackground: Dementia has been labelled an epidemic by the Alzheimer’s Society of Canada and is a significant public health concern for the aging population. Compared to the rest of the population, postmenopausal women are significantly impacted by Alzheimer’s Dementia (AD). Estrogen is a protective factor for brain atrophy, and low estrogen levels have been linked to a decline in cognition. Although studies have identified hormone replacement therapy (HRT) to be helpful for vasomotor symptoms (i.e. hot flashes) and genitourinary syndrome, there is no clear answer as to whether improving estrogen levels with HRT in postmenopausal women will prevent cognitive decline.
Methods: The literature review includes English text articles from the PubMed database using the search terms ‘Hormone Replacement Therapy’ AND ‘Dementia’ AND ‘Post menopause’. Only RCT and clinical trials from 1999-2024 were included in this study. A total of ten articles were included and analyzed for this study,
Results: Most studies used a reliable and valid cognitive assessment tool to assess cognitive function pre-and post-treatment. Conjugated equine estrogen (CEE) and 17 beta-estradiol were the most common. The studies have mixed results on how HRT impacts cognitive function.
Conclusions: Given the number of mixed results from each study, the variability of HRT (i.e. dose, route, duration) and uncontrolled variable risk factors for dementia, the outcomes of this relationship need to be further investigated. Due to the heterogeneity of each study, further clinical trials will need to explore how HRT impacts cognitive performance in postmenopausal women
Ant colony optimization with distributed colonies for dynamic environments on multiple GPUs
No full textDynamic environments pose many challenges as the search space is irregular, un-
structured, with the data and problem space changing over time. The algorithms
executing on these environments should adapt to the varying dynamic conditions.
In this research we consider Ant Colony Optimization algorithm (ACO), a technique
inspired by real ants in nature and therefore, should be adaptable to dynamic environ-
ments. However, some studies in the literature show the contrary. Population-based
ACO was introduced, a hybrid technique that combines concepts from Genetic Algo-
rithms for solving problems in dynamic environments. In this thesis, we argue and
show that ACO is as good as PACO or even better in some cases, by incorporating lo-
cal search techniques to exploit the search space, tuning parameters in the algorithm
to explore the search space and, using migration between multiple colonies (or island
model) for convergence. The multiple colonies are implemented on multiple GPUs
for efficiency. We perform various experiments on a dynamic travelling salesperson
dataset and compare ACO and PACO with local search and island model. We also
show that the parameter tuning has a significant influence on the accuracy.October 202
Postbiotics from Saccharomyces cerevisiae fermentation stabilize microbiota in rumen liquid digesta during grain-based subacute ruminal acidosis (SARA) in lactating dairy cows
No full textAbstract
Background
Subacute ruminal acidosis (SARA) is a common metabolic disorder of high yielding dairy cows, and it is associated with dysbiosis of the rumen and gut microbiome and host inflammation. This study evaluated the impact of two postbiotics from Saccharomyces cerevisiae fermentation products (SCFP) on rumen liquid associated microbiota of lactating dairy cows subjected to repeated grain-based SARA challenges. A total of 32 rumen cannulated cows were randomly assigned to 4 treatments from 4 weeks before until 12 weeks after parturition. Treatment groups included a Control diet or diets supplemented with postbiotics (SCFPa, 14 g/d Original XPC; SCFPb-1X, 19 g/d NutriTek; SCFPb-2X, 38 g/d NutriTek, Diamond V, Cedar Rapids, IA, USA). Grain-based SARA challenges were conducted during week 5 (SARA1) and week 8 (SARA2) after parturition by replacing 20% DM of the base total mixed ration (TMR) with pellets containing 50% ground barley and 50% ground wheat. Total DNA from rumen liquid samples was subjected to V3–V4 16S rRNA gene amplicon sequencing. Characteristics of rumen microbiota were compared among treatments and SARA stages.
Results
Both SARA challenges reduced the diversity and richness of rumen liquid microbiota, altered the overall composition (β-diversity), and its predicted functionality including carbohydrates and amino acids metabolic pathways. The SARA challenges also reduced the number of significant associations among different taxa, number of hub taxa and their composition in the microbial co-occurrence networks. Supplementation with SCFP postbiotics, in particular SCFPb-2X, enhanced the robustness of the rumen microbiota. The SCFP supplemented cows had less fluctuation in relative abundances of community members when exposed to SARA challenges. The SCFP supplementation promoted the populations of lactate utilizing and fibrolytic bacteria, including members of Ruminococcaceae and Lachnospiraceae, and also increased the numbers of hub taxa during non-SARA and SARA stages. Supplementation with SCFPb-2X prevented the fluctuations in the abundances of hub taxa that were positively correlated with the acetate concentration, and α- and β-diversity metrics in rumen liquid digesta.
Conclusions
Induction of SARA challenges reduced microbiota richness and diversity and caused fluctuations in major bacterial phyla in rumen liquid microbiota in lactating dairy cows. Supplementation of SCFP postbiotics could attenuate adverse effects of SARA on rumen liquid microbiota
A randomized pragmatic feasibility trial to promote student perspective-taking on client physical activity level: a collaborative project
No full textBackground
Health-care practitioners have opportunities to talk with clients about unhealthy behaviors. How practitioners approach these conversations involves skill to be effective. Thus, teaching health-care students to communicate empathetically with clients should promote effective client-practitioner conversations about health behavior change. The primary objective of this pilot trial was to assess the feasibility, acceptability, and appropriateness of a theoretically informed intervention designed to improve perspective-taking.
Methods
For inclusion in this randomized mixed-methods parallel two-arm trial, participants needed to be a student at the investigators’ Canadian university and have completed course content on behavior change communication. Using a 1:1 allocation ratio, participants in Respiratory, Physical, and Occupational Therapy; Nurse Practitioner; and Kinesiology programs were randomly assigned to full or partial intervention conditions. Full intervention participants completed a perspective-taking workshop and practiced perspective-taking prior to an in-lab dialogue with a client-actor (masked to condition) about physical activity. Partial intervention participants received the workshop after the dialogue. We assessed feasibility and appropriateness by comparing recruitment rates, protocol, and psychometric outcomes to criteria. We assessed acceptability (secondary outcome) by analyzing exit interviews.
Results
We screened and randomized 163 participants (82 = full intervention; 81 = partial intervention). We fell slightly short of our recruitment success criteria (10–15 participants per program) when 2/50 Occupational Therapy students participated. We met some but not all of our protocol criteria: Some full intervention participants did not practice perspective-taking before the dialogue, because they did not see anyone during the practice period or did not have a practice opportunity. Psychometric outcomes met the criteria, except for one measure that demonstrated ceiling effects and low reliability (Cronbach’s alpha < .70). There were no adverse events related to participation.
Conclusions
The intervention should be largely feasible, appropriate, and acceptable to deliver. We suggest changes that are large enough to warrant conducting another pilot study. We outline recommended improvements that are applicable to researchers and educators interested in recruitment, adherence to home practice, and online uptake of the intervention.
Trial registration
This trial was registered retrospectively on November 8, 2023, at
https://clinicaltrials.gov/study/NCT06123507
A multi-country comparative study of two treponemal tests for the serodiagnosis of syphilis amongst men who have sex with men (MSM): Chemo-luminescent assay vs Treponema pallidum particle agglutination assay
No full textAbstract
Introduction
International guidelines recommend routine screening for syphilis (aetiological agent: Treponema pallidum subspecies pallidum) amongst key populations and vulnerable populations using tests detecting treponemal and non-treponemal antibodies. Whilst treponemal tests have high sensitivities and specificities, they differ regarding subjective or objective interpretation, throughput and workload. Chemiluminescence immunoassays (CLIAs) are cost- and time-effective automated methods for detecting treponemal antibodies. The Treponema pallidum particle agglutination assay (TPPA) has been considered the “gold standard” treponemal assay, however, this includes a highly manual procedure, low throughput and subjective interpretation. The present multi-country study evaluated the ADVIA Centaur® Syphilis CLIA (Siemens Healthcare) assay compared to the reference SERODIA-TP·PA® (Fujirebio Diagnostics) for the serodiagnosis of syphilis amongst men who have sex with men (MSM).
Method
1,485 MSM were enrolled in Brighton (UK), Malta, and Verona (Italy) as part of a larger WHO multi-country and multi-site ProSPeRo study. Ethical approval was obtained. Serum was tested with the ADVIA Centaur® Syphilis CLIA assay and SERODIA-TP·PA®, in accordance with the manufacturers’ instructions, for a first round of validation. A second round of validation was carried out for discrepant results that were additionally tested with both Western Blot (Westernblot EUROIMMUN®) and an Immunoblot (INNO-LIA, Fujirebio Diagnostics).
Sensitivity, specificity, positive and negative predictive value (PPV and NPV), likelihood ratios (positive/negative), and the Diagnostic Odds Ratio (DOR)/pre-post-test probability (Fagan's nomogram) were calculated.
Results
Out of 1,485 eligible samples analysed in the first phase, the SERODIA-TP·PA® identified 360 positive and 1,125 negative cases. The ADVIA Centaur® Syphilis CLIA assay (Siemens) identified 366 positives, missclassifying one TPPA-positive sample. In the second phase, the ADVIA Centaur® Syphilis CLIA resulted in 1 false negative and 4 false positive results. Considering the syphilis study prevalence of 24% (95% CI: 22–26.7), The sensitivity of the ADVIA Centaur® Syphilis CLIA assay was 99.7% (95% CI: 98.5–100), and the specificity was 99.4% (95% CI: 98.7–99.7). The ROC area values were 0.996 (95% CI: 0.992–0.999), and both the PPV and NPV values were above 98% (PPV 98.1%, 95% CI: 96.1–99.2; NPV 99.9%, 95% CI: 99.5–100).
Conclusions
The ADVIA Centaur® Syphilis CLIA assay showed similar performance compared to the SERODIA-TP·PA®. Considering the study is based on QUADAS principles and with a homogeneous population, results are also likely to be generalisable to MSM population but potentially not applicable to lower prevalence populations routinely screened for syphilis. The automated CLIA treponemal assay confirmed to be accurate and appropriate for routine initial syphilis screening, i.e. when the reverse testing algorithm is applied
The effect of heparin type & symptom duration on noncritically ill patients hospitalized for COVID-19: secondary analyses of an international multiplatform RCT
No full textIn patients with COVID-19, hospitalization is associated with progression to the need for ICU-level organ support and mortality. It is important to have effective treatments to slow or halt progression and to identify patients at high risk of progressing. Therapeutic-dose heparin reduces progression to organ support and mortality in noncritically ill patients hospitalized for COVID-19, however, the differential treatment effects for various heparin types are unknown. Symptom duration prior to hospitalization may impact disease progression and treatment effects of therapeutic-dose heparin.
This thesis evaluated 3 objectives: 1) differential treatment effects of therapeutic-dose heparin by heparin type, 2) effects of symptom duration on disease progression, and 3) effects of symptom duration on heparin treatment.
We analyzed heparin type in noncritically ill patients hospitalized for COVID-19 by performing a secondary analysis of patients enrolled in the ATTACC and ACTIV-4a randomized controlled trials. Analyses of symptom duration only included patients from ATTACC. Patients were enrolled between May 2020 and January 2021 in Brazil, Canada, Mexico, Spain, and the US. Patients were randomized to either usual care venous thromboprophylaxis or therapeutic-dose heparin. Treatment effects were modeled using proportional odds logistic regression within a Bayesian framework. The primary ordinal outcome consisted of 1) survival without organ support, 2) survival with organ support, and 3) death.
Analysis of heparin type comprised 832 patients assigned to usual care venous thromboprophylaxis and 987 to therapeutic-dose heparin (total n=1819), of whom 90% were administered enoxaparin (n=887). Therapeutic-dose enoxaparin likely reduced progression to organ support and mortality compared to usual care venous thromboprophylaxis (adjusted odds ratio [OR] 1.19 95% credible interval [CrI] 0.94-1.52, posterior probability [Pr] 92.5%). Analysis of non-enoxaparin heparins was limited by small sample sizes.
Analyses of symptom duration consisted of 499 patients assigned to usual-care venous thromboprophylaxis and 638 assigned therapeutic-dose heparin (total n=1137). Shorter symptom duration prior to admission was associated with increased progression to organ support and mortality (adjusted OR for 1 day less of symptoms 1.08, 95% CrI 1.04-1.13, Pr >99.9%) but likely did not modify treatment effects of therapeutic-dose heparin (Pr 27.2%).October 202
An autoethnographic exploration of disability and access in Manitoba correctional facilities
No full textThis thesis examines the issue of disability and access in correctional facilities in Manitoba, aiming to shed light on the challenges faced by incarcerated inmates with disabilities and propose strategies for improving their access to essential services and facilities. The study explores the intersectionality of disability and incarceration, recognizing the unique needs and rights of disabled inmates within the criminal justice system.
I begin by providing an overview of the prevalence of disability among incarcerated populations, highlighting the representation of individuals with disabilities in Manitoba prisons. I, explore various types of disabilities, including physical, sensory, cognitive, and mental health impairments. I focus on the barriers encountered to access to healthcare, education, vocational training, and other essential services that other able-bodied inmates benefit from.
Reflecting on my interactions and experience with disabled inmates, I try to understand the impact of inaccessibility on their quality of life and social inclusion. I also reflect on my own personal experience related to disability, particularly how culture impacts disability and accessibility. My focus is how the Manitoba Corrections facilities are not enabling disabled people’s participation to enjoy the social benefits of corrections.
This study also explores the challenges faced by correctional staff in implementing these policies and the potential for systemic improvements, comprehensive assessments, and individualized care plans to address the unique needs of disabled individuals within the correctional system.October 202