<p> Background: Health Care Transition (HCT) describes the purposeful, planned movement of adolescents from child to adult-orientated care. The purpose of this phenomenological study is to uncover the meaning of transition to adult centered care as experienced by Young Adults with Cerebral Palsy (YA-CP) through the research question: What are the lived experiences of young adults with cerebral palsy transitioning from pediatric to adult healthcare? Method: 6 females and 3 males, aged 19 -25 years of age, who identified as carrying the diagnosis of cerebral palsy without cognitive impairment were interviewed. Giorgi's (1985) method for analysis of phenomenology was the framework for the study and guided the phenomenological reduction. Results: The lived experiences of YA-CPs transition to adult health care, expressed from the data is expert novices with evidence and experience based expectations, negotiating new systems (effective/ineffective) interdependently (parents and provider support) accepting less than was expected. Conclusions: More information and support is needed for the YA-CP during transition to ensure a well-organized move to appropriate adult-oriented health care that is considerate of the lifelong impact of the disorder. Nursing's role as advocate, mentor and guide can optimize the individual's response to the transition process.</p>

Cell adhesion molecules (CAM) have been implicated in the process of cancer metastasis. However, the interactions of metastatic tumor cells with organ parenchymal cells-hepatocytes particularly the relevance of tumor-cell-hepatocyte adhesion to liver metastasis is still not fully understood. We have investigated the role of tumor cell-hepatocyte interaction in liver metastasis using liver metastatic subline H-59 of the Lewis lung carcinoma. A monoclonal antibody (MAb) C-11 was produced which was highly specific to liver metastatic H-59 cells. Our in vitro studies showed that this MAb and its F(ab)2 fragments could block tumor H-59 cell adhesion to hepatocytes. The molecule detected by MAb C-11 on H-59 cells as well as on hepatocytes was a 64-71 kDa plasma membrane glycoprotein (designated C-11 BP). We found that this molecule contains approximately 43% of N-linked carbohydrates which were not involved in MAb C-11 recognition, but participated in the adhesion process. MAb C-11 could also block the stimulatory effect of hepatocytes on tumor cell proliferation indicating that the adhesion of H-59 cells to hepatocytes may be necessary for tumor cell growth. The in vivo role of the C-11 BP was subsequently tested and it was shown that MAb C-11 and its F(ab)2 fragments could significantly reduce the number of hepatic metastases when used to pretreat H-59 cells before intrasplenic injection, or when inoculated directly into the animals by the intraperitoneal and intravenous routes. This inhibitory effect resulted in an increase in the survival time of tumor-inoculated mice. In additional studies, a second molecule namely the membrane-associated endoplasmic reticulum protein ERp-72 was also implicated in the adhesion of H-59 cells to the hepatocytes, however its role in vivo remains to be confirmed. Our results suggest that CAM involved in tumor-hepatocyte adhesion play an important role in liver metastasis. Monoclonal antibody against tumor cell surface adhesion molecul

Introduction. Preliminary studies found that discordance between the patients' and physicians' assessments of disease activity in systemic lupus erythematosus (SLE) exists. We investigated the factors associated with discordance and explored the impact of discordance on medication adherence and complementary/alternative medicine (CAM) use. / Methods. Part I investigated the factors associated with discordance, defined as the patient visual analog scale (VAS) minus the physician VAS for global disease activity. Data were extracted from the Montreal General Hospital Lupus Registry. Potential covariates included the Medical Outcomes Studies SF-36, the Systemic Lupus Activity Measure (SLAM), and a lupus damage index. The first visit data were analyzed using multiple regression. Unbalanced repeated measures analysis of variance was used to analyze follow-up data and to investigate the influence of time. / Part II used a patient questionnaire to measure adherence and CAM use, which was then linked to discordance data from the Registry. The associations between discordance and non-adherence and CAM use were tested using multivariable logistic regression. Non-linear relationships were tested by generalized additive models (GAM). / Results. Clinically important discordance occurred in nearly 30% of the visits. The SF-36 scales for Bodily Pain and Vitality were important variables for predicting discordance. SLAM-Skin and -Musculoskeletal components were also associated with discordance. The mean discordance tended to increase over time. While both the patients' and physicians' VAS scores tended to decrease over time, the decrease was more pronounced in the physicians' VAS scores. / Non-adherence and CAM use occurred in 32% and 55% of the subjects, respectively. Patients who scored much lower disease activity than their physicians were more likely to be non-adherent than concordant patients (odds ratio = 2.25, 95% confidence interval: 0.32, 15.96). GAM testing supported this finding. Odds ratios for discordance and use of CAM therapies ranged from 0.89 to 1.48 (all non-significant), and GAM showed a non-linear relationship represented by an inverted U-shaped curve. / Conclusion. Patient-physician discordance exists in SLE. Factors such as bodily pain and fatigue increase discordance while clinically visible signs, such as skin manifestations, reduce discordance. Clinically important discordance appears to be associated with patient self-care behaviour, particularly, medication nonadherence.

The purpose of this thesis is two-fold: (1) to refine understanding of the relationship between anticonvulsant therapy during the first trimester of pregnancy in women with epilepsy and the risk of congenital malformation among their offspring; and (2) to assess the utility of the Saskatchewan Prescription Drug and Hospital Services databases for studies of maternal drug use and certain reproductive outcomes. / In the first meta-analysis the malformation risks associated with the use of anticonvulsants in general by women with epilepsy were quantified and clarified. Comparison of the congenital malformation risk among offspring of mothers with epilepsy with first trimester anticonvulsant exposure ("exposed") relative to offspring of non-epileptic parents yielded a summary estimate of relative risk (RR) of 2.6 (95% confidence interval (CI) 2.1-3.2). (All RR's in this abstract are study-stratified Mantel-Haenszel summary estimates.) Congenital malformation risk among the offspring of exposed women with epilepsy compared to unexposed women with epilepsy yielded a summary RR of 2.9 (CI = 2.0-4.2). No evidence of increased risk to unexposed women with epilepsy compared to non-epileptic women was evident (RR = 0.9, CI = 0.5-1.6). / In the second meta-analysis the risks associated with specific types of anticonvulsant therapy were qualitatively synthesized. The analysis demonstrated the inadequacies of many study reports--vague descriptions of methods often restricted assessment of study quality and incomplete reporting of results as largely responsible for restricting the analysis to 31 studies. Women with epilepsy treated with anticonvulsant monotherapy experienced increased risk of congenitally malformed children relative to both unexposed women with epilepsy (RR = 1.8, CI = 0.8-4.8), and unexposed non-epileptic women (RR = 2.5, CI = 1.8-4.0). Insufficient data were available to demonstrate statistically significant differences in malformation risk among specific commonly-used anticonvulsant monotherapies, although phenobarbital and carbamazepine appeared to have the lowest risks. Two-drug therapy was associated with a 20% increase in risk relative to monotherapy, but three-drug therapy was associated with more than twice the risk of one-drug therapy (RR = 2.2, CI = 1.3-3.7). Although the potential role of confounding by type and severity of epilepsy could not be evaluated, the analysis suggests that avoiding therapy with three or more anticonvulsants during the first trimester would be prudent. / The second component of the thesis was a large record linkage study utilizing information from the databases of Saskatchewan Health. An essentially population-based database of maternal drug use and reproductive outcomes was created which included 104,534 livebirths and 13,685 non-livebirth outcomes occurring between April 1977 and March 1984 linked to 299,152 prescriptions dispensed to the mothers in the year preceding the pregnancy outcome. A study of anticonvulsant use during pregnancy and birth outcome was completed using the created database. The study yielded results with respect to congenital malformation risk generally consistent with the conclusions or the meta-analyses. / Evaluation of the database of maternal drug use and reproductive outcomes raised questions about the utility of Saskatchewan Health's databases for pharmacoepidemiologic research into congenital malformations. (Abstract shortened by UMI.)

A model was developed to account for the static elastic behaviour of the lung tissue strip in terms of distributions of collagen and elastin fibers. Distributions of collagen fiber lengths and elastin fiber stiffnesses were determined by fitting the model to data from dog lung tissue strips. These distributions followed 1/f power-laws for more than 95% of the data. Computer simulations of two dimensional tissue strip models with 1/f distributions of collagen fiber lengths also predicted realistic stress-strain curves. The simulations illustrated the gradual development of geometric and stress heterogeneity throughout the tissue as the collagen fibers were recruited during stretch. This model suggests a mechanistic basis for the shape of the pressure-volume curve of whole lung. It also indicates how this curve may be affected by changes in tissue collagen and elastin similar to the changes occurring in the diseases of pulmonary emphysema and fibrosis. Nonparametric block-structured nonlinear models for describing both the static and dynamic stress-strain behaviour of the lung were applied to dog lung tissue strips and to whole rat lungs in vivo. Both the Wiener and Hammerstein models accounted for more than 99% of the tissue strip data, although the Hammerstein model was more consistently accurate across a range of perturbation amplitudes and operating stresses. Plastic dissipation of energy within the lung tissue strip was estimated at less than 20% of the total dissipation during slow sinusoidal cycling. The Hammerstein model was also the best of those investigated for describing the rat lung data in vivo, although there were dependencies of the model parameters on perturbation amplitude and operating point that indicate that a more complicated model is required for the whole lung. Finally, construction of a fiber recruitment model for the dynamic mechanical behaviour of lung tissue strips was attempted. However accurate reproduction of measured behaviour was no

<p> It is widely acknowledged that the preceptorship model is the primary mode of transmission of clinical knowledge within the profession of midwifery. It is natural that a power imbalance resides between preceptor and student; however, research has revealed that this inequality bears not only the potential for facilitating the conveyance of wisdom, but as well for mishandling. The concept of power within the student-preceptor relationship of Direct-Entry Midwives (DEMs) within the U.S. has not been explored through existing literature, despite the fact that increased understanding of this educational relationship may impact the institution of DEM education. Qualitative inquiry was conducted in collaboration with individuals who recently concluded a course of DEM education, and phenomenological analysis of the findings was performed. A summary of themes was compiled, eliciting insight into the nature of power within this relationship and as well the implications of this dynamic upon the profession. </p>

Stereotactic radiosurgery with several static conformal beams shaped by a micro multileaf collimator (muMLC) is used for treating small irregularly shaped brain lesions. Specific requirements for this technique are a precise localization and positioning of the target (1mm) and a precise (1mm) and numerically accurate (+/-5%) dose delivery. In this work, a pencil beam algorithm based treatment planning software BrainScan 5.2 (Brainlab, Germany) is validated against measurements (diode, radiographic films) and Monte Carlo simulations (BEAMnrc and XVMC codes). The latter is required because of difficulties in obtaining precise and accurate dose measurements for small fields. A dedicated muMLC component module for the BEAMnrc code was developed as part of this project. Results show that Monte Carlo calculations agree with measured dose distributions to within 2% and/or 1 mm except for field sizes smaller than 1.2 cm where agreement is within 5% due to uncertainties in measured output factors. Comparison with the pencil beam algorithm calculations were performed for square and irregularly shaped fields at different incidence angles on rectangular and humanoid homogeneous phantoms. Results show that the pencil beam algorithm is suitable for radiosurgery although some differences were found in the comparison of interleaf leakage and beam profile penumbras.

<p> The purpose of this study is to analyze the effect of email communication between providers and patients. The research also tests for the frequency of email usage in different provider settings. The following study performs a secondary data analysis on the Electronic Medical Records data retrieved from the (2009) National Ambulatory Medical Survey (NAMCS) to test for the following five hypotheses: (a) Use of email consults with patients will decrease in-patient visits, (b) Use of email consults will decrease telephone consults, (c) Hospital systems use higher email consults compared to that in solo practices and group practices, (d) Medical practices with an implemented electronic medical records system use higher email consults, and (e) Practices with greater private insurance reimbursements use higher email consults. A chi-squared analysis is performed to test for the association between the use of email consultations and its effects on other factors. The results showed that there is a reasonable association between use of email consults and hospital visits, email consults and telephone consults, email consults and implementation of electronic medical records (EMR), and email consults and the type of payers. On the contrary, there was no significant association between email consults and the type of medical practice. Although electronic communication can improve efficiency, accessibility and quality of healthcare, not every medical practice has integrated it into their care delivery.</p>

<p>This review evaluates the current understanding of research on the impact of physical activity in the prevention of colorectal cancer. Current biological mechanisms implicated in physical activity and colorectal cancer risk reduction are blood glucose regulation, insulin sensitivity, leptin and adiponectin profiles, inflammation as well as secreted protein acidic and rich in cysteine (SPARC), an exercise induced myokine. Recent literature indicates that 30-60 minutes of moderate to vigorous activity a day is effective against colorectal cancer development, and there is convincing evidence of aerobic exercise as differently beneficial in recruiting mechanisms identified as preventative against colorectal cancer. This article provides a critical review of the evidence-based literature concerning the benefits of physical activity in reducing the risk for colorectal cancer. Further well designed animal and clinical trials testing differing exercise protocols are recommended for future research to enable better understanding of the currently implicated mechanisms in colorectal cancer development.

<p>Using Action Research, Implementation Science, and Institutional Ethnography, this practice-focused research explored inhibiting and promoting factors related to implementing buprenorphine treatment within HIV primary care while simultaneously developing, installing and initially implementing an interdisciplinary buprenorphine treatment/practice. Data was collected and analyzed using constructivist grounded theory method strategies. Data collection/generation included documentary analysis, key informant interviews, field data from collaborative interdisciplinary team processes, researcher reflective practice, a patient focus group, and an interdisciplinary buprenorphine treatment/practice manual. </p><p> The research had several achievements. It identified three key implementation inhibiting categories, (1) significant and persistent bias, (2) plaguing and difficult questions, and (3) buprenorphine expectionalism. It also developed countering implementation promoting categories, (1) be an educated advocate and dispel myths, (2) identify core components of interdisciplinary buprenorphine treatment and uniformity of care, and (3) dementionalizing interdisciplinary treatment/practice. It exposed scope of practice issues and mapped out the specifics of the types of services each discipline would provide, the detail of those practices, their coordination, as well as the areas of practice where there was joint responsibility and overlap. It increased the capacity and competences of the research organization and the 18 interdisciplinary buprenorphine team members. It also explicated the many forms of power operating in the study and the importance of power sharing, adapting treatment, leadership support, structural components and resources on the development and implementation process. </p><p> This study shed light on the reality that prescribing buprenorphine and taking up the practice of treating opioid dependence/addiction means that clinicians must be prepared and skilled to provide care where issues of life and death, emotional distress, and significant uncertainties are part of the landscape. The study findings also highlight that balancing safety (both patient and staff) with control and authority is an important aspect of buprenorphine treatment. An interdisciplinary focus expanded the concept of treatment and addressed many important aspects of caring for people with opioid dependence/addiction that often go unaccounted for and/or unnoticed. Without an interdisciplinary frame, patients are at risk for receiving substandard care. This study demonstrated that the interdisciplinary practices needed to provide quality care and improve health outcomes are interdependent. </p>