Standard Canadian Research Articles

Brain glutathione may be associated with white matter hyperintensities in patients with cardiovascular disease

AbstractBackgroundWhite matter hyperintensity (WMH) is a marker of age‐related cerebrovascular damage and is correlated with cognitive impairment; ischemia and inflammatory mechanisms have been proposed to be involved in its pathogenesis. These processes are associated with oxidative stress (OS), which may impair cellular function and affect antioxidant balance; however, the role of central antioxidant responses is still unclear.MethodPatients (age 55‐85) with ≥2 vascular risk factors or a previous vascular event were assessed at baseline for an exercise rehabilitation program. All participants completed the Montreal Cognitive Assessment (MoCA). Baseline WHM severity was determined using the standardized Canadian Dementia Imaging Protocol and semiautomatic protocols. Brain glutathione (GSH) at baseline was obtained in the anterior cingulate (AC) and occipital region (OC) using 1H magnetic resonance spectroscopy (MEscher–GArwood Point Resolved Spectroscopy). Spectroscopic analysis was completed using the Gannet toolkit (vers. 3.1) in Matlab (vers. 2020b).ResultOf 30 participants (mean age: 66.2 ± 7.42 SD; 80% male) currently enrolled, brain volumetric measurements were completed for 25 participants. Lower MoCA score was associated with greater total WMH volume, controlling for age (b[SE] = ‐0.017 [0.005], t(22) = ‐3.24, p = 0.004); this relationship remained significant when controlling for years of education separately (b[SE] = ‐0.016 [0.006], t(22) = ‐2.86, p = 0.01). Correcting for cerebrospinal fluid volume, lower AC‐GSH level was associated with higher deep WMH volume in the medial middle frontal (MMF) region of interest (b[SE] = ‐0.056 [0.023], t(23) = ‐2.38, p = 0.026), but not with MMF paraventricular WMH volume. After controlling for age, the model was no longer significant (F (2, 22) = 2.87, p = 0.078). No significant associations were found between OC‐GSH and occipital lobe WMH.ConclusionAs expected, total white matter hyperintensity volume was associated with poorer global cognition. In the medial middle frontal (MMF) region of interest, higher deep WMH was associated with lower GSH levels, suggesting altered brain antioxidant levels may be associated with the presence or formation of WMH. Recruitment is ongoing, and additional participants are needed to reinforce findings and to control for confounders in the analysis.

Efficacy and Tolerance of Isatuximab, Cyclophosphamide, Bortezomib, and Dexamethasone (Isa-CBD) Induction Chemotherapy in Newly Diagnosed, Transplant Eligible Multiple Myeloma: Report of the Phase 2 Multi-Centre, Open Label Canadian Myeloma Research Group (CMRG)-008 Prospective Clinical Trial

Background: The previous standard Canadian approach to autologous stem cell transplantation (ASCT) included CyBorD induction and single-agent lenalidomide maintenance until progression (Cote J, et al. ASH 2022: abstract 117). In an effort to improve outcomes, the current Canadian Myeloma Research Group (CMRG)–008 trial aimed to assess the efficacy and tolerance of a regimen of isatuximab-CyBorD (Isa-CyBorD) induction, stem cell mobilization/collection, high-dose melphalan with ASCT, followed by continuous maintenance with isatuximab and lenalidomide in newly diagnosed multiple myeloma (NDMM) patients eligible for transplant. We now report the first planned analysis of Isa-CyBorD induction and stem cell mobilization and collection. Methods: This is a multi-centre phase 2 prospective study conducted in 8 centres in which transplant-eligible NDMM (TE-NDMM) patients received isatuximab added to four cycles of standard induction CyBorD chemotherapy (cyclophosphamide 300 mg/m 2 PO, bortezomib 1.5 mg/m 2 SC, and dexamethasone 40 mg PO, all given on days 1, 8, 15 and 22 of a 28-day cycle along with isatuximab 10 mg/kg IV days 1, 8, 15 and 22 of cycle 1 and days 1 and 15 of cycles 2-4). Isatuximab premedication also included acetaminophen, H2-antagonist (ranitidine) or proton pump inhibitor and montelukast. No thromboprophylaxis required per protocol. After the completion of induction treatment, subjects achieving ≥ stable disease (SD) proceeded to mobilization and collection of hematopoietic stem cells (SCs) per local institutional standards. Eligible patients with successful SC collection then proceeded to high-dose melphalan 200 mg/m 2 followed by ASCT. Maintenance treatment commenced at 100 days (+/- 7 days) post-ASCT and continued until disease progression. Maintenance treatment consisted of 28-day cycles of isatuximab (10 mg/kg IV on days 1, 8, 15 and 22 of cycle 1; days 1 and 15 of cycles 2-3; then day 1 of each subsequent cycle) administered with lenalidomide (10 mg daily on days 1-21). Results: Between December 2022-January 2023, 71 patients with ECOG ≤ 2 were enrolled: 25 females, 46 males; median age 61 years (range: 31-73); 46.5%, 35.2% and 18.3% were ISS stages I, II and III, respectively. High-risk cytogenetics were documented in 20.6% of evaluable patients (13/63). All completed Isa-CyBorD induction therapy. The treatment was well-tolerated with rare grade 3 - 4 adverse events: neutropenia (8.2%), anemia (8.2%) and febrile neutropenia (4.1%). Common side-effects (All grades combined, ≥20%) included nausea (50%), constipation (28%), fatigue (28%), peripheral neuropathy (27% - all ≤ grade 2 with no dose holds for neuropathy), insomnia (24%), diarrhea (22%), infusion-related reaction (22%). Response assessment at the end of induction was available for 57 pts by the data cut-off date (June 1 st, 2023). All patients had clinical improvement with no primary progressive disease. Complete response (CR), very good partial response (VGPR) and partial response (PR) were documented in 7%, 52.6% and 33.3%, respectively. Four patients (7%) had <50% improvement of M-protein (SD). Three patients did not proceed to stem cell transplantation due to patient / physician choices. SC mobilization utilized cyclophosphamide in 10 (15.4%) and plerixafor in 12 (18.5%) patients; mobilization was successful in all 65 patients mobilized so far with 1-3 apheresis (median 2). The median number of CD34+ cells collected was 5.3 x10^6/kg (range: 2.25-7.28). Conclusion: Isa-CyBorD with weekly bortezomib is an effective induction therapy in patients with NDMM (93% ≥ PR with no progression and no mobilization failures). The treatment was well-tolerated with a side-effect profile comparable to our Canadian prior experience with CyBorD alone. All patients who proceeded to mobilization had successful collection of adequate number of SCs. Further follow-up is ongoing to assess long-term outcomes with this approach.

Evaluation of DNA extraction methods for the detection of Shiga toxin producing Escherichia coli in food by polymerase chain reaction

Reported food-borne outbreaks of Shiga toxin producing Escherichia coli (STEC) have involved a very diverse range of foods. Contemporary analytical methods for the detection of STEC in foods typically include PCR screening of enrichment media. However, PCR inhibitors present in food enrichments can produce false negative results when screening for DNA sequences associated with the pathogen. To avoid false negative results in enrichment screening, it is advantageous to have DNA extraction methods that are effective at removing PCR inhibitors from a wide range of foods. The standard Canadian STEC method MFLP-52 uses Bio-Rad Instagene Matrix for DNA extraction. In this study, three DNA extraction protocols using commercial kits (Instagene Matrix with Beckman Coulter Ampure XP Beads; Qiagen Gentra Puregene Yeast/Bact. Kit; Qiagen DNeasy Blood & Tissue) were assessed as alternative DNA extraction methods for the detection of the Shiga toxin gene by PCR in enrichments from sixteen different foods inoculated with STEC O157. The inoculated foods were bean sprouts, blackberries, blue cheese, cilantro, cocoa powder, coleslaw, cream of mushroom dried soup mix, cream of vegetable dried soup mix, flaxseed, guacamole, peanut butter, soft cheese, soy butter, spinach, walnut, and wheat flour. Two of the protocols, Instagene Matrix with Ampure XP Beads, and Gentra Puregene Yeast/Bact, produced no false-negative or false positive results in the analysis of triplicate enrichment samples from sixteen inoculated foods.

Development of a standardized Canadian undergraduate medical education ophthalmology curriculum

ObjectiveTo create a standardized undergraduate medicine ophthalmology curriculum for Canadian medical schools. DesignTwo-stage modified Delphi technique. ParticipantsUndergraduate ophthalmology leads at all the medical schools in Canada and 6 nonophthalmologist physicians with medical education expertise. MethodsIn stage 1, a preliminary list of curricular objectives was developed using the 2018 Association of University Professors in Ophthalmology's list of curricular objectives as a foundation. Subsequently, an online survey was sent to 24 individuals (18 ophthalmology undergraduate curriculum leads and 6 non-ophthalmology medical educators) at 17 institutions to evaluate the objectives using a 5-point Likert-type scale. In stage 2, the ophthalmology curriculum leads were invited to participate in a virtual meeting during which the list of curricular objectives was discussed and finalized by consensus. ResultsIn stage 1, a preliminary list of 76 learning objectives organized into 10 overarching topics was developed. A total of 21 survey responses were received (87.5% response rate), allowing for the creation of a revised list. In stage 2, five participants from four schools met, achieving consensus following one round of feedback. The final undergraduate ophthalmology curriculum contained 10 topics and 75 objectives; it covered common presentations of a variety of acute and chronic eye diseases that were felt to be relevant to a wide medical audience. ConclusionsThe consensus obtained on a comprehensive list of undergraduate medicine ophthalmology curricular objectives identified in this study is the first of its kind in Canada. These objectives can be used by medical schools across Canada to standardize undergraduate ophthalmology teaching.

The Influence of Accent Distance on Perceptual Adaptation in Toddlers and Adults

ABSTRACT Foreign accents can vary considerably in the degree to which they deviate from the listener’s native accent, but little is known about how the relationship between a speaker’s accent and a listener’s native language phonology mediates adaptation. Using an artificial accent methodology, we addressed this issue by constructing a set of three artificial accents (Near, Far, and Farther), varying in the number and magnitude of pronunciation deviations from standard Canadian English. These accents were presented to toddlers and adults in an eye-tracking task. Regardless of accent type, adults readily adapted to the exposed pronunciation change. Adults exposed to the Farther accent were also more willing to accept novel pronunciation changes. Young toddlers exposed to Far or Farther accents showed no evidence of acquiring the exposed pronunciation change and demonstrated worse word recognition for standard Canadian-accented words. These findings suggest that when a speaker’s accent deviates substantially from a young toddler’s native accent, this may lead to a significant decrement in their ability to recognize not only an unfamiliar accent but also native-accented speech. Overall, these findings provide a well-controlled test of competing models of accent adaptation and generate multiple hypotheses to be examined in the future using more ecologically valid stimuli.

Motor block and hypotension following a high thoracic erector spinae plane block.

Dear Editor, Erector spinae plane blocks (ESPBs) are becoming more prevalent in clinical practice for postoperative pain control following truncal procedures. ESPBs are often quoted as being easy to perform and having few complications. We describe a patient with a thoracic epidural spread after administering an ultrasound-guided unilateral high thoracic ESPB for a video-assisted thoracoscopic procedure (VATS). A 62-year-old woman with chronic smoking, hypertension, and asthma was scheduled for an elective right VATS upper lobectomy for a malignant lesion. Her body weight was 78 kg, and she had no functional limitations. After obtaining informed consent, standard Canadian Anesthesia Society monitors were applied. She received preprocedural 1 mg of intravenous midazolam. The block was performed in the block room by an anesthesia resident under an experienced attending anesthesiologist’s supervision. In a sitting position, right ESB was performed using a linear ultrasound transducer oriented in the parasagittal plane. An out-of-plane approach was used due to the shorter needling distance, thus mitigating discomfort. After contacting the T4 TP, 20 ml of 0.5% ropivacaine was injected, and a local anesthetic was seen spreading deep to the erector spinae muscle. She was transferred to the operating room following an uneventful 10 min of monitoring in the block room. Upon directing the patient to move from the stretcher to the operating table, she noted having decreased bilateral lower limb sensation and motor weakness. Physical exam revealed decreased strength in hip flexion and a bilateral truncal sensory from T4 to L4 dermatomes. Her blood pressure had dropped to 73/36. She did not have any shortness of breath, chest pain, or light headedness. An awake radial arterial line was placed, and a phenylephrine infusion was initiated at 20 mcg/min. With her blood pressure stabilized, the decision was made to proceed with surgery. With surgical stimulation, she was able to wean off the phenylephrine infusion. She had no motor weakness or sensory loss following an uncomplicated 3 h long VATS lobectomy. In the post-anesthetic care unit (PACU), Pain scores were between 4 and 6, and blood pressure was 99/66. In a review, the incidence of complications of ESPBs is 0.2%, including bilateral lower limb weakness, motor block, transient apathy, aphasia, dizziness, loss of consciousness due to systemic toxicity and pneumothorax.[1] Selvi et al.[2] reported an unexpected motor weakness following bilateral T11 ESPB, and De Cassai et al.[3] reported near-complete lower extremity immobility following bilateral L3 ESPB for lumbar laminectomy. Our patient experienced bilateral motor and sensory block along with significant hypotension 15 min after a high unilateral thoracic ESPB. Given the symmetrical nature of the blockade and its resolution, we postulated that the local anesthetic injected had spread to the epidural space via the costotransverse foramen.[3] This may be related to the orientation and the angulation of the needle. Such a precipitous and unexpected drop in blood pressure could result in hemodynamic instability and cardiac compromise in some patients. Although seemingly rare, caution must be taken. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Examining social media peer support and improving psychosocial outcomes for young women with breast cancer.

162 Background: Young women with breast cancer (YWBC) have unique survivorship needs due to life stage at point of diagnosis. Peer support sought by YWBC through social media channels appears to be rising. We aimed to understand the unmet needs of YWBC in order to develop a tailored peer support program to improve young women’s breast cancer experience and ultimately reduce psychosocial morbidity long-term. Methods: Using qualitative inquiry, we conducted semi-structured interviews with YWBC survivors and clinicians using purposive sampling. Inclusion criteria were women aged 40 years or younger at diagnosis, stage 0-IV disease. Survivors were minimum one year post-diagnosis and with active treatment complete. Interviews were recorded and transcribed verbatim and data was analyzed using Thorne’s Interpretive Description. Themes were reviewed with study team throughout data analysis. Results: Thirty-six participants were interviewed from ten centers across seven Canadian provinces; mean age 36 years. Participant reported demographics:18% ‘visible minority’, 9% ‘born outside Canada’, 7% ‘Indigenous’ and 54% of patients’ household income at or below Canadian average. At point of diagnosis 69% married, 44% had children and 9% pregnant or postpartum. Themes from YWBC interviewed focused on coping needs: feeling alone, misunderstood by professionals and misplaced among peers. Participants described all-age peer support groups risked triggering anxieties, lacked convenience and were comprised of women at later life stages with differing needs. YWBC reported lack of young age breast cancer-specific peer support. YWBC frequently found support through social media de novo, by following young-age breast cancer survivor pages, blogs and forums as well as virtual support groups. YWBC also report benefit from identifying similar life and cancer stage survivors globally and forming individual relations virtually, through direct messaging. Additionally, benefits described from age-specific social media support included unique shared experience and understanding, hope from positive outcomes of similar life stage diagnoses, and increased confidence and healthcare navigation for YWBC. Women unanimously requested one on one peer support program development - a survivor mentorship scheme specifically for YWBC that would provide the convenience of online support without the obligations or emotionally overwhelming nature of structured support groups. Conclusions: We have identified unique support needs from this young cohort of women that are not currently being met within standard Canadian healthcare pathways. We aim to develop a novel one on one peer support program for YWBC, to optimize psychosocial support and improve young women’s empowerment and autonomy in managing the effects of cancer long-term.

Gross motor development of Thai healthy full-term infants aged from birth to 14 months using the Alberta Infant Motor Scale: Inter individual variability

BackgroundThe gross motor percentiles of the Alberta Infants Motor Scale (AIMS) have been commonly referenced in research. Cross-cultural assessment of gross motor development during the first year of life is suggested as diverse child-rearing practices can cause inter-variability. The main aim of this study was to develop an AIMS percentile curve for typically developing home-raised infants in the northeastern part of Thailand. The AIMS scores of these infants were also compared with the standard Canadian norms. MethodsThe gross motor development of 574 full-term infants aged 15 days to 14 months was assessed using the Thai version of the AIMS. Percentile curves of their gross motor ability were developed. The Thai infants' mean AIMS scores were compared with the Canadian norm using the one-sample t-test. ResultsThe percentile curve of gross motor development of healthy Thai infants showed that mean AIMS scores increased with age. Large inter-variability was present from the 7th to 10th months. The mean AIMS scores of Thai infants were significantly lower than the standard Canadian means during the first three months (P < 0.05), but significantly higher in three age groups: 7–<8 months, 11–<12 months, and 13–14 months. ConclusionThe developed percentile curve of gross motor development is applicable for infants from the same demographic and environmental context. According to the study, infants from diverse cultures display a natural inter-variability in gross motor development between the 7th and 10th months.

What is a clinically meaningful survival benefit in refractory metastatic colorectal cancer?

Assessment of the clinical benefit of cancer treatments can be highly subjective, influenced by both perspective and context. Such assessments are required in regulatory and policy decision-making, but consistency between jurisdictions is often lacking. Clear and consistent standards for determining when a treatment offers a meaningful benefit, relative to the current standard of care, can help to address issues of equity and transparency in health technology assessment. For metastatic colorectal cancer (mcrc), no standardized Canadian definition of clinically meaningful benefit has yet been proposed. Colorectal Cancer Canada therefore convened a group of medical oncologists expert in colorectal cancer to review the literature about clinical significance. The resulting consensus is intended to apply to any therapeutic agent being considered in the setting of chemotherapy-refractory mcrc. It was agreed that overall survival is the appropriate measure of clinical efficacy in chemorefractory mcrc. As quantitative targets for efficacy, an improvement of 2 months or more in median overall survival or a hazard ratio for survival of 0.75 or lower (or both) are proposed as the threshold for clinically meaningful benefit. That threshold could be influenced by a treatment's effect on quality of life. Treatment toxicity is also relevant to the assessment of clinical benefit in this setting, specifically when significant differences in treatment tolerability are evident.

A Doctor’s Foreign Accent Affects Perceptions of Competence

ABSTRACTMany doctors work or train in foreign countries and speak with a foreign accent. People sometimes assume that a person who speaks with a foreign accent possesses negative traits and personality characteristics. The purpose of this study is to test if doctors who speak with a foreign accent are perceived as less competent than doctors who speak with a standard accent. Both Caucasian Canadian and Chinese Canadian undergraduates rated the competence of a doctor speaking English with either a standard Canadian accent or a Chinese accent. The doctor was delivering either good or bad news about the patient’s cholesterol levels or cancer. Previous research has shown that when reminded of death, participants favor in-group members. We found that the Chinese-accented doctor’s competence was judged more negatively than the standard Canadian accented doctor by all participants. Both doctors were deemed less competent when delivering bad news than good news. These results suggest that foreign-accented doctors face biases about their competence from their patients.

ANALISIS KUALITAS PERAIRAN UNTUK BUDIDAYA KERANG HIJAU DI KABUPATEN CIREBON PROVINSI JAWA BARAT

Abstract. Cirebon regency is one of the regencies supplying marine products in West Java Province. However, there are now many issues concerning the degradation of the quality of the waters that are sourced from community activities that dump their waste into the waters. This study aims to determine the quality of waters (water and sediments) of Cirebon Regency in terms of physical and chemical parameters. The method used in this study is quantitative descriptive analysis using primary data and secondary data designed to describe the physical and chemical conditions of the waters. For the status of pollutants using the STORET method. The results showed that the measurement of physical and chemical condition of waters TSS and BOD has exceeded the quality standard for marine biota (Kepmen-LH No. 51 Year 2004). While the results of heavy metals measurements on sediment concentrations of Pb and Cd have exceeded the CCME quality standard (Canadian Council of Ministers of Environment). The pollutant status of Cirebon Regency is categorized as sterile until polluted fallow.

Stillbirth and large for gestational age at birth

Aim: A previous large case-control study had documented association between large for gestational age birth weight and stillbirth. We sought to replicate this novel finding.Methods: Retrospective cohort with nested case-control analyses. The data source was a large Canadian perinatal database. Stillbirth was defined as no signs of life at delivery ≥23-weeks gestation. Small and large for gestational age at birth weights were defined using standard Canadian, American, and ultrasound norms.Results: The study population was comprised of 693,186 live births and 3275 stillbirths. Using population norms, large for gestational age (LGA) at birth was not associated with stillbirth in adjusted analysis (OR 0.57, 95% CI [0.45, 0.71]). A statistically significant interaction between pre-existing diabetes and LGA was observed (OR 2.48, 95% CI [1.20, 5.15]). Further case-control analysis found if ultrasound norms were used and controls were selected by date of delivery then LGA was associated with stillbirth (OR 1.91, 95% CI [1.64–2.22]). However, if controls were matched by gestational age at birth then the association was no longer apparent (OR 0.98, 95% CI [0.85–1.13]).Conclusions: Large for gestational age at birth is not associated with stillbirth in the general population. Previously reported association between LGA and stillbirth was likely an artifact of the sampling strategy. LGA may increase the risk of stillbirth in pregnancies complicated by pre-existing and gestational diabetes.

Evaluation of subcutaneous rituximab administration on Canadian systemic therapy suites.

Non-Hodgkin lymphoma (nhl) is the most common hematologic malignancy. Diffuse large B-cell lymphoma (dlbcl) and follicular lymphoma (fl) constitute 55% of new nhl cases and are initially treated with rituximab-based chemoimmunotherapy. Relative to intravenous (IV) rituximab, a subcutaneous (sc) formulation approved in 2016 has comparable pharmacokinetics, efficacy, and safety, and a greatly reduced administration time; it is also preferred by patients. The objective of the present study was to estimate the effect (on systemic therapy suite time and on the costs of drug acquisition and administration) of implementing sc rituximab in the initial chemoimmunotherapy for fl and dlbcl over 3 years in the Canadian market. An Excel (Microsoft Corporation, Redmond, WA, U.S.A.)-based model was created with a population size based on epidemiologic data and current rituximab use, duration of use considering initial therapy, time savings for sc rituximab administration from published studies, costs from standard Canadian sources, and assumed uptake in implementing provinces of 65%, 75%, and 80% over 3 years. Key parameters and sensitivity analysis values were validated by clinical experts located in various Canadian jurisdictions. Costs are reported in 2017 Canadian dollars from the perspective of the health care system. More than 3 years after implementation of sc rituximab, we estimated that 5762 Canadians would be receiving sc rituximab, resulting in savings of 128,715 hours in systemic therapy suite time and approximately $40 million in drug and administration costs. Sensitivity analyses suggest that the model is most sensitive to sc market uptake, number of induction therapy cycles, and eligible patients. Subcutaneous administration of rituximab can significantly reduce systemic therapy suite time and achieve substantial savings in drug and administration costs.

The Land Suitability Rating System Is a Spatial Planning Tool to Assess Crop Suitability in Canada

The Land Suitability Rating System (LSRS) is a rule-based set of algorithms that integrates soil, climate and landscape factors to calculate a classed suitability rating for a given landscape to support commercial field crop production. The attributes used to define each of the factors are based on their proven ability to affect crop growth, their ability to be measured (or estimated by proxy) and their availability in accessible databases. The LSRS was first published in 1995 by Agriculture and Agri-Food Canada as a site-specific, manual calculator for spring-seeded small grains that incorporated sets of attribute point deduction curves based on expert knowledge. Since that time the system has been expanded to include additional crop modules and all data handling and calculations are automated through a set of web-based applications. The current version of LSRS (version 5) is implemented in Ruby on Rails® software as a suite of web services. The system runs against any soil map with standardized Canadian Soil Information Service soil data tables to process soil attributes and calculate limitations to crop growth. A climate factor rating is based on crop-specific agro-climatic indices and thresholds. Climatic indices have historically beene calculated from 30 year climate normal periods using monthly data but LSRS can now also utilize daily data records which facilitate trend analyses within annual historic records. Outputs from Global Circulation Models can also be used to assess potential impacts of climate change on crop suitability. Gridded climate datasets enable direct overlay and extraction of climate attributes to the spatial extent of soil map polygons. Finally, the system incorporates a landscape factor related to land erodibility and constraints to management. Each of the three suitability factors is assigned a class rating between 1 (no limitations) and 7 (unsuitable) with the final overall rating being the most limiting of the three factors. Recent improvements in the ability of the system to process multiple climate datasets have resulted in LSRS used increasingly as a spatial research tool in assessing climate change impacts on agricultural crop distributions at both national and regional scales.

Sex Differences in Cardiac Troponin Testing in Patients Presenting to the Emergency Department with Chest Pain.

Elevated cardiac troponin (cTn), with signs/symptoms of ischemia, is a key element in a diagnosis of myocardial infarction (MI). Underdiagnosis of MI in women has been attributed to atypical symptoms, inconsistent ECG findings, and less diagnostic testing. We sought to determine if there are sex differences in cTn testing following presentation to the emergency department (ED) with a chief complaint of ischemic chest pain (CP) and if presentation affects diagnostic assessment. All adults presenting to six hospital EDs in the Vancouver, Canada with a chief complaint of ischemic CP from 2009 to 2013 were included. The highest cTn level within 24 hours of ED presentation was used. CP was classified into cardiac- or respiratory dominant based on standard Canadian Emergency Department Triage and Acuity Scale coding. Chi-square testing was used to test for sex differences in CP categories and cTn testing within 24 hours. Logistic regression models were used to examine the association between sex, cTn testing, and CP categories. Of 27,063 patients with ischemic CP, cardiac presentation was more common in men than women, irrespective of age. Among cardiac CP, 24.7% of men were <50 years compared to 18.2% of women; however, more women (19.9%) than men (11.6%) were >80 years. Overall, women were 1.8% less likely to have cTn testing; in patients <50 years, testing was markedly lower in women compared to men [odds ratio, OR (95% confidence intervals, CI) 0.78 (0.70-0.87)]. The odds of cardiac catheterization within 90 days of ED presentation were lower in women [OR, (95% CI) 0.52 (0.44-0.63)]. Even with cardiac CP, 17.7% of women versus 32.7% of men had cardiac catheterization. In men and women presenting to the ED with ischemic CP, cTn testing overall is similar except among young women under 50 years old, where it is markedly lower. Women undergo less cardiac catheterization, irrespective of CP type.

PSY33 - Evaluation of Subcutaneous Rituximab Administration Impacts on Canadian Systemic Therapy Suites

Non-Hodgkin lymphoma (NHL) is the most common hematologic malignancy. Diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL) comprise 55% of new NHL cases and are initially treated with rituximab-based chemoimmunotherapy. Relative to intravenous (IV) rituximab, a subcutaneous (SC) formulation approved in 2016 has comparable pharmacokinetics, efficacy and safety, with greatly reduced administration time, and is preferred by patients. The objective of this study was to estimate the impact of implementing rituximab SC with initial chemoimmunotherapy for FL and DLBCL over three years in the Canadian market on systemic therapy suite time and costs of drug acquisition and administration. An excel-based model was used with population size based on epidemiologic data and current rituximab use; duration of use considering initial therapy; time savings for rituximab SC administration from published studies; costs from standard Canadian sources; and uptake for implementing provinces assumed to be 65%, 75% and 80% over the 3 years. Key parameters and sensitivity analysis values were validated by clinical experts located in various jurisdictions of Canada. Costs are reported in 2017 Canadian dollars using a healthcare system perspective. Over 3 years after rituximab SC implementation, we estimated 5,762 Canadians using rituximab SC, with savings of 128,715 hours in systemic therapy suite time and approximately $40 million in drug and administration costs. Sensitivity analysis suggests the model is most sensitive to SC market uptake values, number of induction therapy cycles and eligible patients. SC administration of rituximab with initial chemoimmunotherapy can significantly reduce systemic therapy suite time and substantially save drug and administration costs.

Making Kids Count ( breakout presentation )

Organizations across Canada are developing new strategies to collect and use data about school travel patterns and attitudes, which will improve the abilities of communities to identify and overcome barriers to active school travel. HASTe has evolved the standard Canadian School Travel Planning (STP) survey toolkit to help practitioners find meaningful correlations in transportation data and gain more insights into barriers to active and safe trips to school, and opportunities to overcome them. Our presentation will focus on 3 new methods currently in use in BC: The first is these development is in mapping. Employing the standard Canadian STP toolkit and open source GIS software, HASTe uses baseline survey data to create heat and cluster maps to help STP communities prioritize interventions and infrastructure investments. The second is the refinement of the survey tools. HASTe has evolved the standard Canadian STP take-home survey and data entry templates to automatically correlate independent elementary of the survey data set. The new template produces useful and presentable survey results for STP communities to help them better understand their schools’ transportation activities and barriers. The third is the development of a qualitative data coding system. HASTe has developed a simple template and method to allow STP communities to sort and code qualitative survey data, helping them turn input from the school community into actionable information that can inform the school travel planning and implementation process. This presentation will be of use to anyone looking to support and encourage more active school travel. HASTe has used freeware spreadsheet and GIS software to evolve tools available through a publicly available toolkit; the tools and methods are easily accessible and replicable by practitioners and community members.

Assessing the Training Effectiveness of an Intelligent Tutoring System for Marksmanship Skills

The development of embedded trainers and intelligent tutoring systems (ITS) may allow modern militaries to maintain high proficiency in marksmanship skills despite limitations on training personnel and resources. A system embedding an ITS in a future rifle concept was developed to examine the potential of such technologies. This system was based on two main concepts: 1) instance-based learning and practice that uses a Smart Sight System to present a perceptual cue adjusted for the target’s properties and environmental variables and 2) rule-based learning that relies on artificial intelligence algorithm that delivers training tips and feedback to participants. The experimental task involved engaging moving targets on a virtual shooting range. Three types of training were compared: a control group that received no additional training, a standard Canadian Armed Forces (CAF) training group, and an advanced training group that received ITS training. The results showed that additional training—both CAF and ITS—improved shooting accuracy. The performance in the ITS condition was consistently better than in the Control group or in the CAF training group on selected measures of performance.

Performance of Emerging Technologies for Measuring Solid and Liquid Precipitation in Cold Climate as Compared to the Traditional Manual Gauges

AbstractPrecipitation amount, type, and snow depth ) have been analyzed using data collected during the 4Wing Cold Lake Research Project in northeastern Alberta, Canada. The instruments used include the Vaisala present weather detector PWD22 and present weather sensor (FS)11P, the OTT Pluvio2 automatic catchment-type gauge, the manual standard Canadian Nipher (CN) and Type B rain gauges, and a snow ruler. Both the PWD22 and FS11P performed well at detecting snow, rain, and drizzle events as compared to the human observer. The sensors predicted a higher frequency of ice pellet cases than the human observer. Segregation of precipitation phase using temperature alone appeared unrealistic at near-freezing temperatures. All the sensors agreed well at measuring liquid precipitation, but the Pluvio2 gauge with a single Alter shield underestimated the snowfall amount by 40%, mostly due to wind effects. After correcting the CN gauge catch efficiency (CE) due to wind effects, the CE of the Pluvio2 relative to the CN gauge was found dependent on wind speed (ws). Using these data, a new transfer function (TF) for the Pluvio2 as a function of ws has been developed. The new TF was used to correct the Pluvio2 gauge, and the corrected data agreed well with the PWD22 measurements. Using the and corrected CN data, snow density ratios ( were derived, varying from 4.2 to 35 with a mean value of 12.2. The mean value derived in this study is higher than the 10:1 ratio usually assumed for converting to snow water equivalent in Canada. On average increases with increasing temperature and the 10:1 ratio appears to be more appropriate for warmer temperatures.

High-dose inactivated influenza vaccine is associated with cost savings and better outcomes compared to standard-dose inactivated influenza vaccine in Canadian seniors

ABSTRACTSeasonal influenza infects approximately 10–20% of Canadians each year, causing an estimated 12,200 hospitalizations and 3,500 deaths annually, mostly occurring in adults ≥65 years old (seniors). A 32,000-participant, randomized controlled clinical trial (FIM12; Clinicaltrials.gov NCT01427309) showed that high-dose inactivated influenza vaccine (IIV-HD) is superior to standard-dose vaccine (SD) in preventing laboratory-confirmed influenza illness in seniors. In this study, we performed a cost-utility analysis (CUA) of IIV-HD versus SD in FIM12 participants from a Canadian perspective. Healthcare resource utilization data collected in FIM12 included: medications, non-routine/urgent care and emergency room visits, and hospitalizations. Unit costs were applied using standard Canadian cost sources to estimate the mean direct medical and societal costs associated with each vaccine (2014 CAD). Clinical illness data from the trial were mapped to quality-of-life data from the literature to estimate differences in effectiveness between vaccines. Time horizon was one influenza season, however, quality-adjusted life-years (QALYs) lost due to death during the study were captured over a lifetime. A probabilistic sensitivity analysis (PSA) was also performed. Average per-participant medical costs were $47 lower and societal costs $60 lower in the IIV-HD arm. Hospitalizations contributed 91% of the total cost and were less frequent in the IIV-HD arm. IIV-HD provided a gain in QALYs and, due to cost savings, dominated SD in the CUA. The PSA indicated that IIV-HD is 89% likely to be cost saving. In Canada, IIV-HD is expected to be a less costly and more effective alternative to SD, driven by a reduction in hospitalizations.