Female genital cutting/circumcision/mutilation (FGC) is found predominantly in the Sahel, Northern Africa, removing parts/all of the clitoris, labia minora and majora in girls. Cutting the highly innervated external genitalia may change sensory processing leading to chronic pain. Fourteen Somali women in the Greater Toronto Area (21-46, Type III FGC) completed qualitative, quantitative and psychophysical methods to evaluate pain. Interviews analyzed by interpretive phenomenology form the core method, examining circumcision stories and present, embodied life. The second Short Form McGill Pain Questionnaire and quantitative sensory testing with a vulvalgesiometer form secondary components. Somali women with FGC have pain-filled stories about circumcision and daily life. Socio-cultural considerations are central for women to comprehend how their own bodies feel. SF-MPQ-2 indicates low intensity or no pain symptoms; however, many body regions were indicated. QST reveals low vulvar pressure-pain thresholds. Reports from three measures suggest that FGC may cause sensory changes including chronic pain.

Loss of the renal microvasculature is a common feature of almost all forms of chronic kidney disease (CKD). Here we explored the role of the angiogenic chemokine stromal cell-derived factor-1-alpha (SDF-1) and its cognate receptor CXCR4 in experimental and human CKD. CXCR4 was present on endothelial cells and podocytes, while SDF-1 was detectable on podocytes, arteriolar smooth muscle cells, interstitial fibroblasts and occasional endothelial cells. CXCR4 mRNA was elevated in the kidneys of rats with CKD and chronic antagonism of CXCR4 accelerated renal decline and capillary loss. Acute SDF-1 infusion activated glomerular endothelial nitric oxide synthase (eNOS) in vivo, while functional response to SDF-1 was impaired in glomerular endothelial cells derived from eNOS-/- mice. Finally, CXCR4 mRNA was also found to be increased in biopsies of patients with secondary focal segmental glomerulosclerosis. These observations indicate that local eNOS-dependent SDF-1/CXCR4 signaling exerts a compensatory reno-protective effect in the setting of CKD.

Health risk assessment tools compute an individual’s risk of developing a disease. They are potentially useful in chronic disease prevention mediated by family physicians. We sought to learn family physicians’ awareness, and perspectives on the usefulness, usability and feasibility of implementation of risk assessment tools. Focus groups, discussion with key informants, and usability testing with an EMR-embedded risk assessment tool were conducted with family physicians (n=30) from academic and community-based practices. Analysis following grounded theory methodology was used to generate categories and themes. Our findings indicate that participants are aware of the implications of risk assessment calculations though very few tools are used regularly. Tool integration with EMR systems was felt to be essential in assisting tool usability, uptake and efficiency of use. Results provide insight into current risk assessment tool use and the facilitation of wider implementation of risk assessment tools in family practice settings.

There is a dearth of research that explores the lives and experiences of trans-identified parents. The goal of this study was to explore the experiences of trans people who sought or accessed AHR services in Ontario between 2007 and 2010. Qualitative data that was collected from 7 qualitative interviews with 9 trans people and their partners was analyzed for the present analysis. Results from this study indicate that AHR providers do not possess sufficient knowledge about trans people, trans identities and trans lives to adequately address the needs of trans service users. Specific provider practices that trans people experienced as being unhelpful are illuminated and implications for improving clinical practices are discussed.

Non-Small-Cell-Lung Cancer (NSCLC) patients with mutations in EGFR have greater response rates and survival when treated with the tyrosine kinase inhibitor erlotinib. To elucidate how erlotinib inhibits EGFR, this study included: 1) inhibiting an EGFR mutant cell line to reveal EGFR regulated phosphotyrosine (pY) sites; 2) comparing erlotinib sensitive and insensitive cell lines to reveal functionally important pY sites; 3) revealing novel pY sites. Observations were collected using the LTQ-Orbitrap mass spectrometer. This study identified five new EGFR regulated pY sites and five pY sites that correlated with erlotinib sensitivity; the majority of them are related to cell-cell interactions. By comparing all observed pY sites to the Phosphosite and PhosphoELM database, our results included 67 unregistered sites. This study has identified novel biomarkers and potential therapeutic targets, many of which were associated with cell migration and adhesion function. Further functional validation is necessary.

The objective of this thesis was to examine the role of ps20 in virus infections. We provide evidence that MHV-1 infection resulted in increased lung viral titers in ps20-/- mice. These data highlight an antiviral role for ps20 in MHV-1 infection. We also observed an increase in the percentage of GR1+ neutrophils infiltrating the BAL and in the lung draining lymph node of ps20-/- mice, on day 2 post-infection. In vitro, gene expression analysis identified an increase in expression of CXCL1 and CXCL2 in MHV-1 infected ps20-/- fibroblasts. These data suggest a role for ps20 in regulating neutrophil chemotactic factors, and migration. Next, we examined influenza A/WSN/33, and provide evidence that ps20 functions as a proviral factor. In vivo, ps20-/- mice infected with influenza A/WSN/33 exhibited decreased lung viral titers. These data suggest that ps20 functions as either a proviral or antiviral agent, dependent on the infecting virus.

There is limited information regarding the provision of rehabilitation services in long-term care (LTC) to meet the needs of residents living with stroke. This project assessed service availability within Ontario-based homes and examined the relationship between service comprehensiveness and functional outcome for residents with rehabilitation potential. The first phase involved survey development and distribution to a sample of homes to assess comprehensiveness. The second phase linked survey findings and administrative data to determine whether comprehensiveness (measured using an index score derived from survey responses) was correlated with change in functional status using linear regression modeling. There was marked variability in service comprehensiveness across responding homes (n=32 of 154 homes; 21%). No significant linear correlation was shown between comprehensiveness and change in ADL function (n=178). Although our study failed to show an association, rehabilitation should be considered an important aspect of LTC programming and should adhere to practice standards where possible.

Objectives: CDUs have been implemented to address ED wait times. The objectives of this study were to investigate ED team members’ perceptions on the implementation of CDUs as well as the impact of CDUs on the delivery of emergency care. Methods: A case study design and change theories found in the literature were used to investigate the implementation of CDUs in four hospitals. Semi-structured interviews with ED team members led to the creation of themes for analysis. Results: Analysis demonstrated that patient flow, work processes and communication contribute to the type of CDU set-up, whether it is a co-located or virtual CDU. The sustainability of CDUs relies on communication and a common vision in the fulfillment of purposes and goals. Conclusions: This study contributes to the understanding of the implementation of CDUs. The application of change frameworks assists with the identification of key success factors for implementing and sustaining change.

Female genital cutting/circumcision/mutilation (FGC) is found predominantly in the Sahel, Northern Africa, removing parts/all of the clitoris, labia minora and majora in girls. Cutting the highly innervated external genitalia may change sensory processing leading to chronic pain. Fourteen Somali women in the Greater Toronto Area (21-46, Type III FGC) completed qualitative, quantitative and psychophysical methods to evaluate pain. Interviews analyzed by interpretive phenomenology form the core method, examining circumcision stories and present, embodied life. The second Short Form McGill Pain Questionnaire and quantitative sensory testing with a vulvalgesiometer form secondary components. Somali women with FGC have pain-filled stories about circumcision and daily life. Socio-cultural considerations are central for women to comprehend how their own bodies feel. SF-MPQ-2 indicates low intensity or no pain symptoms; however, many body regions were indicated. QST reveals low vulvar pressure-pain thresholds. Reports from three measures suggest that FGC may cause sensory changes including chronic pain.

Health risk assessment tools compute an individual’s risk of developing a disease. They are potentially useful in chronic disease prevention mediated by family physicians. We sought to learn family physicians’ awareness, and perspectives on the usefulness, usability and feasibility of implementation of risk assessment tools. Focus groups, discussion with key informants, and usability testing with an EMR-embedded risk assessment tool were conducted with family physicians (n=30) from academic and community-based practices. Analysis following grounded theory methodology was used to generate categories and themes. Our findings indicate that participants are aware of the implications of risk assessment calculations though very few tools are used regularly. Tool integration with EMR systems was felt to be essential in assisting tool usability, uptake and efficiency of use. Results provide insight into current risk assessment tool use and the facilitation of wider implementation of risk assessment tools in family practice settings.