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Marcucci P.A.,Electrical Safety Authority | Smith S.,on | Gomez M.,St Johns Rehab Hospital | Fish J.S.,University of Toronto
Journal of Burn Care and Research | Year: 2010

The purpose of this study was to determine the circumstances of electrical burn injuries caused by the use of multimeters among electricians and electrical apprentices in Ontario and to develop a burn prevention program to reduce them. A survey to investigate electrical injuries caused by multimeters was mailed in June 2004 to 5000 Ontario electricians and electrical apprentices. A high voltage laboratory tested the effectiveness of fused leads to reduce multimeters malfunction. The results of the survey and laboratory tests helped to implement a burn prevention program. Then, a mail fused leads multimeter exchange program was implemented, and proposals to improve the multimeters standard were made to the Canadian Standards Association. Nine hundred (18%) workers responded the survey. There were 801 (89%) electricians, 81 (9%) electrical apprentices, and 27 (3%) with other qualifications. Ninety-nine (11%) had a multimeter fail during use, and half of them suffered critical burns. Causes of the injury were operator error (59%), wrong category rating (21%), defective equipment (18%), and others (2%). More than 2000 electrical contractors acquired the new fused leads multimeters. There were no critical injuries caused by multimeters in the years 2006, 2007, and 2008 (January to August) in Ontario. Understanding the cause of electrical burn injuries by multimeters and engaging members of the integrated electrical safety system in a multifaceted prevention program were effective in reducing electrical burn injuries. Fused leads multimeters proved to be effective in preventing most common user errors and electrical burn injuries caused by multimeters. © 2010 by the American Burn Association.

Kalbfleisch M.,Microbiology and Immunology | Yang Y.X.,Matthew Mailing Center for Translational Transplant Studies | Bihari R.,on | Lobb I.,Microbiology and Immunology | And 3 more authors.
BJU International | Year: 2012

OBJECTIVE • To determine the protective role of supplemental hydrogen sulphide (H 2 S) in prolonged warm renal ischaemiareperfusion injury (IRI) using real-time intravital microscopy (IVM). MATERIALS AND METHODS • Uninephrectomised Lewis rats underwent 1 h of warm ischaemia and 2 h of reperfusion during intraperitoneal treatment with phosphate buffer saline (IRI, n =10) or 150 μ mol/L NaHS (IRI + H 2 S, n =12) and were compared with shamoperated rats ( n =9). • Blood was collected for measurement of serum creatinine (Cr), alanine aminotransferase (ALT) and aspartate aminotransferase (AST). • IVM was performed to assess renal and hepatic microcirculation. • Kidneys were sectioned for histology and real-time quantitative polymerase chain reaction for markers of infl ammation. RESULTS • The mean ( SD ) Cr concentration raised to 72.8 (2.5) μ mol/L after IRI from 11.0 (0.7) μ mol/L (sham) but was partially inhibited with H 2 S to 62.8 (0.9) μ mol/L ( P < 0.05). • H 2 S supplementation during IRI increased renal capillary perfusion on IVM, and improved acute tubular necrosis and apoptotic scores on histology ( P < 0.05). • Supplemental H 2 S decreased expression of the pro-infl ammatory markers toll-like receptor 4, tumour necrosis factor α , interleukin 8, C-C chemokine receptor type 5, interferon γ and interleukin 2 ( P < 0.05). • Distant organ (liver) dysfunction after renal IRI was limited with H 2 S supplementation: blunting of the ALT and AST surge, decreased hepatic sinusoidal vasodilation, and decreased leukocyte infiltration in post-sinusoidal venules ( P < 0.05). • H 2 S supplementation directly inhibited interleukin 8-induced neutrophil chemotaxis in vitro ( P < 0.05). CONCLUSIONS • These findings are the first to show the real-time protective role of supplemental H 2 S in prolonged periods of warm renal IRI, perhaps acting by decreasing leukocyte migration and limiting infl ammatory responses. • The protective effects of H 2 S suggest potential clinical applications in both donors after cardiac death models of renal transplantation and oncological practices requiring vascular clamping. © 2012 THE AUTHORS.

Trubiani G.,Toronto Health Economics and Technology | Wang X.,ON | Wang X.,Institute for Clinical Evaluative science | Mitsakakis N.,Institute for Clinical Evaluative science | And 6 more authors.
Circulation: Heart Failure | Year: 2013

Background-Multidisciplinary heart failure (HF) clinics are efficacious in clinical trials. Our objectives were to compare real-world outcomes of patients with HF treated in HF clinics versus usual therapy and identify HF clinic features associated with improved outcomes. Methods and Results-The service components at all HF clinics in Ontario, Canada, were quantified using a validated instrument and categorized as high/medium/low intensity. We used propensity-scores to match HF clinic and control patients discharged alive after a HF readmission in 2006-2007. Outcomes were mortality, and both all-cause and HF readmission. Cox-proportional hazard models were used to evaluate HF clinic-level characteristics associated with improved outcomes. We identified 14 468 patients with HF, of whom 1288 were seen in HF clinics. Within 4 years of follow-up, 52.1% of patients treated at a HF clinic died versus 54.7% of control patients (P=0.02). Patients treated at HF clinics had increased readmissions (87.4% versus 86.6% for all-cause [P=0.009]; 58.7% versus 47.3% for HF related [P<0.001]). There was no difference between high, medium, or low intensity clinics in terms of mortality, all-cause, or HF readmissions. HF clinics with greater frequency of visits (>4 contacts of significant duration for 6 months) were associated with lower mortality (hazard ratio, 0.14; P<0.0001) and hospitalization (hazard ratio, 0.69; P=0.039). More intensive medication management was associated with lower all-cause (hazard ratio, 0.46; P<0.001) and HF readmission (hazard ratio, 0.42; P<0.001). Conclusions-In this real-world population-based study, we found that multidisciplinary HF clinics are associated with a decrease in mortality, but an increase in readmissions. © 2013 American Heart Association, Inc.

Filion K.B.,Jewish General Hospital | Filion K.B.,McGill University | Azoulay L.,Jewish General Hospital | Azoulay L.,McGill University | And 23 more authors.
New England Journal of Medicine | Year: 2016

BACKGROUND: There is concern that antidiabetic incretin-based drugs, including dipeptidyl peptidase 4 (DPP-4) inhibitors and glucagon-like peptide 1 (GLP-1) analogues, can increase the risk of heart failure. Ongoing clinical trials may not have large enough samples to effectively address this issue. METHODS: We applied a common protocol in the analysis of multiple cohorts of patients with diabetes. We used health care data from four Canadian provinces, the United States, and the United Kingdom. With the use of a nested case-control analysis, we matched each patient who was hospitalized for heart failure with up to 20 controls from the same cohort; matching was based on sex, age, cohort-entry date, duration of treated diabetes, and follow-up time. Cohort-specific hazard ratios for hospitalization due to heart failure among patients receiving incretin-based drugs, as compared with those receiving oral antidiabetic-drug combinations, were estimated by means of conditional logistic regression and pooled across cohorts with the use of random-effects models. RESULTS: The cohorts included a total of 1,499,650 patients, with 29,741 hospitalized for heart failure (incidence rate, 9.2 events per 1000 persons per year). The rate of hospitalization for heart failure did not increase with the use of incretin-based drugs as compared with oral antidiabetic-drug combinations among patients with a history of heart failure (hazard ratio, 0.86; 95% confidence interval [CI], 0.62 to 1.19) or among those without a history of heart failure (hazard ratio, 0.82; 95% CI, 0.67 to 1.00). The results were similar for DPP-4 inhibitors and GLP-1 analogues. CONCLUSIONS: In this analysis of data from large cohorts of patients with diabetes, incretin-based drugs were not associated with an increased risk of hospitalization for heart failure, as compared with commonly used combinations of oral antidiabetic drugs. Copyright © 2016 Massachusetts Medical Society.

Carruba V.,Paulista University | Huaman M.,Paulista University | Domingos R.C.,National Institute for Space Research | Roig F.,ON
Astronomy and Astrophysics | Year: 2013

Context. Close encounters with (1) Ceres and (4) Vesta, the two most massive bodies in the main belt, are known to be a mechanism of dynamical mobility able to significantly alter proper elements of minor bodies, and they are the main source of dynamical mobility for medium-sized and large asteroids (D > 20 km, approximately). Recently, it has been shown that drift rates caused by close encounters with massive asteroids may change significantly on timescales of 30 Myr when different models (i.e., different numbers of massive asteroids) are considered. Aims. So far, not much attention has been given to the case of diffusion caused by the other most massive bodies in the main belt: (2) Pallas, (10) Hygiea, and (31) Euphrosyne, the third, fourth, and one of the most massive highly inclined asteroids in the main belt, respectively. Since (2) Pallas is a highly inclined object, relative velocities at encounter with other asteroids tend to be high and changes in proper elements are therefore relatively small. It was thus believed that the scattering effect caused by highly inclined objects in general should be small. Can diffusion by close encounters with these asteroids be a significant mechanism of long-term dynamical mobility? Methods. By performing simulations with symplectic integrators, we studied the problem of scattering caused by close encounters with (2) Pallas, (10) Hygiea, and (31) Euphrosyne when only the massive asteroids (and the eight planets) are considered, and the other massive main belt asteroids and non-gravitational forces are also accounted for. Results. By finding relatively small values of drift rates for (2) Pallas, we confirm that orbital scattering by this highly inclined object is indeed a minor effect. Unexpectedly, however, we obtained values of drift rates for changes in proper semi-major axis a caused by (10) Hygiea and (31) Euphrosyne larger than what was previously found for scattering by (4) Vesta. These high rates may have repercussions on the orbital evolution and age estimate of their respective families. © 2013 ESO.

PubMed | ON, University of Toronto, U.S. National Institute of Diabetes and Digestive and Kidney Diseases, University of Waterloo and McMaster University
Type: | Journal: Scientific reports | Year: 2016

Forkhead-associated (FHA) domains are phosphopeptide recognition modules found in many signaling proteins. The Saccharomyces cerevisiae protein kinase Rad53 is a key regulator of the DNA damage checkpoint and uses its two FHA domains to interact with multiple binding partners during the checkpoint response. One of these binding partners is the Dbf4-dependent kinase (DDK), a heterodimer composed of the Cdc7 kinase and its regulatory subunit Dbf4. Binding of Rad53 to DDK, through its N-terminal FHA (FHA1) domain, ultimately inhibits DDK kinase activity, thereby preventing firing of late origins. We have previously found that the FHA1 domain of Rad53 binds simultaneously to Dbf4 and a phosphoepitope, suggesting that this domain functions as an AND logic gate. Here, we present the crystal structures of the FHA1 domain of Rad53 bound to Dbf4, in the presence and absence of a Cdc7 phosphorylated peptide. Our results reveal how the FHA1 uses a canonical binding interface to recognize the Cdc7 phosphopeptide and a non-canonical interface to bind Dbf4. Based on these data we propose a mechanism to explain how Rad53 enhances the specificity of FHA1-mediated transient interactions.

Butt K.,Fredericton | Lim K.,Vancouver | Bly S.,Ottawa | Cargill Y.,Ottawa | And 6 more authors.
Journal of Obstetrics and Gynaecology Canada | Year: 2014

Objective: To assist clinicians in assigning gestational age based on ultrasound biometry. Outcomes: To determine whether ultrasound dating provides more accurate gestational age assessment than menstrual dating with or without the use of ultrasound. To provide maternity health care providers and researchers with evidence-based guidelines for the assignment of gestational age. To determine which ultrasound biometric parameters are superior when gestational age is uncertain. To determine whether ultrasound gestational age assessment is cost effective. Evidence: Published literature was retrieved through searches of PubMed or MEDLINE and The Cochrane Library in 2013 using appropriate controlled vocabulary and key words (gestational age, ultrasound biometry, ultrasound dating). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies written in English. There were no date restrictions. Searches were updated on a regular basis and incorporated in the guideline to July 31, 2013. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. Values: The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). Benefits, harms, and costs: Accurate assignment of gestational age may reduce post-dates labour induction and may improve obstetric care through allowing the optimal timing of necessary interventions and the avoidance of unnecessary ones. More accurate dating allows for optimal performance of prenatal screening tests for aneuploidy. A national algorithm for the assignment of gestational age may reduce practice variations across Canada for clinicians and researchers. Potential harms include the possible reassignment of dates when significant fetal pathology (such as fetal growth restriction or macrosomia) result in a discrepancy between ultrasound biometric and clinical gestational age. Such reassignment may lead to the omission of appropriate-or the performance of inappropriate-fetal interventions. © 2014 Society of Obstetricians and Gynaecologists of Canada.

Al-Omair A.,University of Toronto | Smith R.,ON | Kiehl T.-R.,University of Toronto | Lao L.,University of Toronto | And 5 more authors.
Journal of Neurosurgery: Spine | Year: 2013

Spine stereotactic radiosurgery (SRS) is increasingly being used to treat metastatic spinal tumors. As the experience matures, high rates of vertebral compression fracture (VCF) are being observed. What is unknown is the mechanism of action; it has been postulated but not confirmed that radiation itself is a contributing factor. This case report describes 2 patients who were treated with spine SRS who subsequently developed signal changes on MRI consistent with tumor progression and VCF; however, biopsy confirmed a diagnosis of radiation-induced necrosis in 1 patient and fibrosis in the other. Radionecrosis is a rare and serious side effect of high-dose radiation therapy and represents a diagnostic challenge, as the authors have learned from years of experience with brain SRS. These cases highlight the issues in the new era of spine SRS with respect to relying on imaging alone as a means of determining true tumor progression. In those scenarios in which it is unclear based on imaging if true tumor progression has occurred, the authors recommend biopsy to rule out radiation-induced effects within the bone prior to initiating salvage therapies. © 2013 AANS.

PubMed | on and Queen's University
Type: Journal Article | Journal: Clinical and experimental dermatology | Year: 2015

Pemphigus is a rare autoimmune blistering disease, reported to be associated with other coexisting and autoimmune diseases, including thyroid diseases, rheumatoid arthritis, alopecia areata, vitiligo, systemic lupus erythematosus, scleroderma and rare entities such as myasthenia gravis.To identify and describe patients with pemphigus with a diagnosed comorbidity, and to quantify the risk of additional comorbidities.This was a cross-sectional study of patients with pemphigus treated at a tertiary referral centre. Prevalence rates of 15 comorbid diseases were calculated. Age-standardized prevalence ratio (SPR) and 95% CI were calculated in comparison with prevalence rates in the general Canadian population using data from the Canadian Community Health Survey. Data were analysed using SAS software.In total, 295 patients were identified. An increased risk of hypothyroidism (n=38, SPR=1.53, 95% CI 1.08-2.10) and inflammatory bowel disease (IBD) (SPR=1.48, 95% CI 0.40-3.80), and a two-fold increased risk of diabetes (SPR=2.20, 95% CI 1.64-2.87) were observed.Patients with pemphigus have a higher incidence of hypothyroidism, IBD and diabetes compared with the general population. As part of pemphigus investigations and surveillance, investigating for these conditions may be considered.

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