Defining health and economic burden of Invasive Meningococcal Disease (IMD) in Canada is critical to inform Public Health Policy around immunization programs. A comprehensive literature review was conducted to assess available studies, a lack of comprehensive Canadian data to allow evaluation of total economic burden of IMD was identified in Canada. Thus, this dissertation proposes a prospective cost collection methodology tailored to Canadian data and healthcare utilization (HCU). All patient-related HCU is considered and outlined. HCU is then categorized as direct or indirect and relevant direct and indirect healthcare costs are detailed. Intangible costs are described and methodology for capturing these costs using validated quality of life instruments is proposed. As all published economic evaluations of this disease lack prospective collection of data, this study proposes the use of a patient diary to serve as a memory aid during patient cost-collection interviews.

For pathogenic microorganisms, heme uptake and degradation is a critical mechanism for iron acquisition that enables multiplication and survival within hosts they invade. While the bacterial proteins involved in heme transport had been identified at the initiation of our investigation, the fate of heme once it reached the cytoplasm was largely uncharacterized. Here we report the first crystal structures of two members of the heme utilization operon from the human pathogen Escherichia coli O157:H7. These are the heme oxygenase ChuS in its apo and heme-complexed forms, and the apo form of heme binding protein ChuX. Surprisingly, despite minimal sequence similarity between the N- and C-terminal halves, the structure of ChuS is a structural repeat. Furthermore, the ChuS monomer forms a topology that is similar to the homodimeric structure of ChuX. Based on spectral analysis and carbon monoxide measurement by gas chromatography, we demonstrated that ChuS is a heme oxygenase, the first to be identified in any E. coli strain. We also show that ChuS coordinates heme in a unique fashion relative to other heme oxygenases, potentially contributing to its enhanced activity. As ChuS and ChuX share structural homology, we extended the structural insight gained in our analysis of ChuS to purport a hypothesis of heme binding for ChuX. Furthermore, we demonstrated that ChuX may serve to modulate cytoplasmic stores of heme by binding heme and transferring it to other hemoproteins such as ChuS. Based on sequence and structural comparisons, we designed a number of site-directed mutations in ChuS and ChuX to probe heme binding sites and mechanisms in each. ChuS and ChuX mutants were analyzed through reconstitution experiments with heme and functional analyses, including enzyme catalysis by ChuS and mutants, and in culture development during heme challenge experiments by ChuX and mutants. Taken together, our results suggested that ChuX acts upstream of ChuS, and regulates heme uptake through ChuX-mediated heme binding and release. ChuS can degrade heme as a potential iron source or antioxidant, thereby contributing directly to E. coli O157:H7 pathogenesis. Functional implications that may be revealed from sequence and structure based information will be addressed as they pertained to our evaluation of ChuS and ChuX. / Thesis (Ph.D, Biochemistry) -- Queen's University, 2007-04-27 11:34:50.272

Background: Considerable amount of inappropriate antibiotic utilization has been observed in both acute and non-acute care hospitals. Literature has shown that strategies such as an order entry (OE) and computer decision support system (DSS) have improved prescribing practices in acute care settings. However, there is limited research on the effect of OE on antibiotic utilization in non-acute care settings. Objective: To determine the relationship between OE with DSS and antibiotic utilization in a complex continuing care and rehabilitation hospital. Methods: A retrospective analysis of OE and Pharmacy dispensing data, prospectively collected between July 1, 1999 and December 31, 2005, was conducted. Dispensing events for oral and intravenous antibiotics were merged with corresponding OE’s (when present) to form a final database of 4,739 dispensing events with 2,397 OE’s. The presence of OE and the proportion of OE to dispensing events formed the exposure variable while antibiotic utilization in defined daily dose (DDD) was calculated using dose and number of doses of an antibiotic. Antibiotic utilization was examined at the hospital and individual service in-patient unit levels (complex continuing care/CCC and rehabilitation medicine/REH). Statistical analysis consisting of multiple regression modeling was conducted to determine the association between use of OE and antibiotic utilization. Results: A best-fit model using multiple regression analysis at hospital level indicated a significant positive relationship between the presence of OE and antibiotic utilization when service, patient age, gender and antibiotic classes were accounted for. This model explained 11% of the variation in antibiotic utilization. No significant associations were found in the CCC in-patient unit while in the REH in-patient unit a significant positive relationship between the presence of OE and antibiotic utilization was observed. Similarly, antibiotic utilization increased significantly with increase in the proportion of OE to dispensing events at the hospital and REH in-patient unit levels but not in the CCC in-patient unit. Conclusion: The results of this study demonstrate that antibiotic utilization increased over the years following the inception of the OE system with DSS at the study hospital. Further research is required to examine the effect of OE with a rudimentary DSS on antibiotic utilization management in non-acute care. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2007-07-13 10:47:38.035

Background: Dementia leads to progressive cognitive and functional decline. Population aging is a concern, and the healthcare system must refocus its limited resources to keep up with service demands. Three cholinesterase inhibitors (ChEIs) – donepezil, galantamine and rivastigmine – have been approved for the treatment of dementia and are covered under Ontario’s formulary plan, but there has been little research regarding their economic impact. Methods: The purpose of this study was to describe the patterns of use of ChEIs, and to assess associated health resource utilization and costs to Ontario’s healthcare system. Anonymized patient-level data from seven provincial administrative databases were linked at the Institute for Clinical and Evaluative Sciences at Queen’s University. First-time users of ChEIs aged 66 years and older were identified between April 1st, 2004 and March 31st, 2009, and were followed until treatment discontinuation or up to one year following their index date. Health resource use was classified into six care categories: prescription drugs, physicians, long-term care, home care nursing, emergency department, and hospitalizations. Chi-square, Kruskal-Wallis ANOVA and linear regression were employed to compare resource use between users of the three ChEIs. Results: In the cohort (N=40,057), the majority were prescribed donepezil (n=24,347), were female (60.5%) and had at least one other co-morbid disease. The odds of discontinuation were 1.47 (1.36, 1.60) and 1.26 (1.17, 136), higher for rivastigmine users than galantamine and donepezil users, respectively. Between 2005 and 2008, overall healthcare costs increased from $95.2 million to $106.1 million. Prescription drugs comprised 33% of all healthcare costs. ChEIs accounted for half of all prescription drug costs. Overall mean annual healthcare system cost per patient was $12,679.47 ($12,510.86, $12,848.08). Predictors of overall healthcare costs included long-term care, co-morbidity status, hospitalization and hip fractures. Conclusions: Prescription drugs account for a substantial proportion of healthcare costs for patients with dementia, and the amount attributable to ChEIs alone is significant. Knowing the health service utilization patterns for dementia patients can help healthcare professionals and decision-makers plan patient care and timely resource allocation. The results stress the utility of administrative databases and the need for further research for this disease. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2011-11-01 15:49:58.417

Background: A significant number of laryngeal cancer patients are diagnosed with advanced-stage disease. Since stage at diagnosis is an important prognostic factor, it is necessary to understand the characteristics of individuals at risk of being diagnosed at an advanced stage. Objectives: (1) Compare usual health care utilization between laryngeal cancer patients and the general population. (2) Evaluate the association between usual health care utilization and stage at diagnosis in laryngeal cancer. Methods: The study population included 1,702 laryngeal cancer patients diagnosed from 2005–2008, and 8,510 matched-controls from the general population. Demographic, clinical, and health administrative data from Ontario were used to measure usual health care utilization in a two-year period (i.e. frequency of encounters, continuity of care, primary care model enrolment, and preventive services use), stage at diagnosis, and covariates. Results: Laryngeal cancer patients had fewer health care encounters and a greater propensity for using preventive services than the general population. Comparisons of usual health care utilization among laryngeal cancer patients showed significant trends across Stage I–IV for the frequency of encounters (p=0.002), continuity of care (p=0.02), and preventive services use (p<0.0001). Stage I patients were less likely than Stage II–IV patients to have a low frequency of encounters (10%), low continuity of care (28%), and no preventive services use (28%). In adjusted multivariable analyses, low continuity of care was marginally associated with an increased risk of advanced-stage laryngeal cancer (RR [95% CI]: 1.17 [1.01, 1.34]). Stratification by subsite showed a marginally significant association between continuity of care and stage in glottic cancer (RR [95% CI]: 1.25 [0.98, 1.58]), but no association in supraglottic cancer (RR [95% CI]: 1.01 [0.89, 1.15]). Conclusions: Laryngeal cancer patients’ patterns of usual health care utilization differ from the general population. There was little evidence of an effect of usual health care use on the risk of advanced-stage laryngeal cancer in multivariable analyses adjusting for confounders. Multinomial regression may be needed to fully elucidate the effects of health care utilization across Stage I–IV. Understanding health care utilization among laryngeal cancer patients is important for improving early detection and warrants further research. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2012-04-26 10:50:05.976

No description available.

No description available.

<p>It was hypothesized that South African FA and brine could sequester CO2 through mineral carbonation. A statistical approach was undertaken to optimize the % CaCO3 formed from FA/brine/CO2 interaction with input parameters of temperature, pressure, particle size and solid/liquid ratio (S/L) being varied. The ranges adopted for the input parameters were: temperature of 30 &ordm / C or 90 &ordm / C / pressure of 1 Mpa or 4 Mpa / four particle sizes namely bulk ash, &gt / 150 &mu / m, &lt / 20 &mu / m and 20 &mu / m- 150 &mu / m particle size range / S/L ratios of 0.1, 0.5 or 1. The FA/ brine dispersions were carbonated in a high pressure reactor varying the above mentioned input parameters. The fresh Secunda FA of various size fractions was characterized morphologically using scanning electron microscopy, chemically using X-ray fluorescence and mineralogically using qualitative X-ray diffraction. The carbonated solid residues on the other hand were characterized using quantitative X-ray diffraction, scanning electron microscopy, thermal gravimetic analysis and Chittick tests. The raw brine from Tutuka together with the carbonation leachates were characterized using inductively coupled mass spectrometry and ion chromatography. Total acid digestion was carried out to evaluate the differences in the total elemental content in both the fresh ash and the carbonated solid residues. The results suggested that South African FA from Secunda belongs to class F based on the CaO content as well as the total alumina, silica and ferric oxide content, while the RO brine from Tutuka were classified as NaSO4 waters...</p>

<p>This qualitative study was conducted from June to November 2009, using designed questionnaires for sixty three (63) registered students and five (5) HIV program staff .The main reason for this study was to understand the underlying factors for why students may utilize or may not utilize the available HIV services on campus. The willingness of students to express their views was a positive finding in this study. Majority students who answered the questionnaires were quite aware of these HIV services. They also agreed that services provided are good. The study also found out that females utilized these services more than males and majority of students learnt of the HIV services from the HIV programs pamphlets and website thus indicating that the HIV program at UWC is function. However the research study also found out that the though students are aware of these services few utilize them and majority are females thus leaves a question why males do not utilize.</p>

<p>It is not mandatory for the student to declare a pregnancy to her educational institution. It does however become more complicated for the student nurse, because she has to provide a health service while she is a student during her clinical placement. The researcher has noticed that student nurses do fall pregnant during their undergraduate studies at the University of the Western Cape. The researcher was unsure why this phenomenon is occurring amongst undergraduate nursing students. He identified the need to measure the level of knowledge of pregnancy prevention amongst undergraduate nurses, their level of utilization of such services and their attitudes towards falling pregnant during their studies. This study is of a quantitative nature whereby the researcher made use of a descriptive design. The method of data collection utilized was an anonymous self administered questionnaire form. The population under study was the registered undergraduate nursing students in 2008 at the University of the Western Cape. This population consisted of 1031 individuals. Their ethnic background represents the South African demography. An exhaustive sampling approach was used and 401 individuals gave consent to participate in the study. Through this research the researcher hypothysed and proved that the level of knowledge of contraception amongst undergraduate student nurses is indeed inadequate and that this low level of knowledge on the subject area leads to incorrect and inconsistent and non use of contraception in their own lives.</p>