Neurometabolites and sport-related concussion: From acute injury to one year after medical clearance.

Sport-related concussion is associated with acute disturbances in neurometabolic function, with effects that may last weeks to months after injury. However, is presently unknown whether these disturbances resolve at medical clearance to return to play (RTP) or continue to evolve over longer time intervals. Moreover, little is known about how these neurometabolic changes correlate with other measures of brain physiology.

Distinguishing cognitive effort and working memory load using scale-invariance and alpha suppression in EEG.

Despite being intuitive, cognitive effort has proven difficult to define quantitatively. Here, we proposed to study cognitive effort by investigating the degree to which the brain deviates from its default state, where brain activity is scale-invariant. Specifically, we measured such deviations by examining changes in scale-invariance of brain activity as a function of task difficulty and posited suppression of scale-invariance as a proxy for exertion of cognitive effort.

Inconsistent role modeling of professionalism in family medicine residency: Resident perspectives from 2 Ontario sites.

Objective: To explore how family medicine (FM) residents experience role modeling of professionalism by FM preceptors.

Design: Qualitative design using semistructured, one-on-one interviews.

Setting: Two FM teaching units at the University of Toronto in Ontario.

Remote ischemic conditioning improves outcome independent of anesthetic effects following shockwave-induced traumatic brain injury.

Traumatic brain injury due to primary blast exposure is a major cause of ongoing neurological and psychological impairment in soldiers and civilians. Animal and human evidence suggests that low-level blast exposure is capable of inducing white matter injury and behavioural deficits. There are currently no effective therapies to treat the underlying suspected pathophysiology of low-level primary blast or concussion.

Sex Differences in Cerebral Blood Flow Associated with a History of Concussion.

Growing evidence suggests that a history of sport concussion may lead to long-term changes in brain physiology, with cerebral blood flow (CBF) being particularly sensitive to injury. However, it is unknown whether these changes are sex specific. The goal of this study was to evaluate sex differences in CBF of asymptomatic athletes, with and without a history of concussion (HOC) using arterial spin labeling (ASL).

Patient perspectives on routinely being asked about their race and ethnicity: Qualitative study in primary care.

Objective: To understand patients' perspectives on responding to a question about their race and ethnicity in a primary care setting.

Design: Qualitative study using semistructured individual interviews conducted between May and July 2016.

Setting: An academic family health team in Toronto, Ont, where collection of sociodemographic data has been routine since 2013.

Quality of primary care among individuals receiving treatment for opioid use disorder.

Objective: To determine if people receiving opioid agonist treatment (OAT), a long-term treatment approach, are also receiving high-quality primary care.

Design: Retrospective cohort study.

Setting: Ontario.

Machine learning for MEG during speech tasks.

We consider whether a deep neural network trained with raw MEG data can be used to predict the age of children performing a verb-generation task, a monosyllable speech-elicitation task, and a multi-syllabic speech-elicitation task. Furthermore, we argue that the network makes predictions on the grounds of differences in speech development. Previous work has explored taking 'deep' neural networks (DNNs) designed for, or trained with, images to classify encephalographic recordings with some success, but this does little to acknowledge the structure of these data.

Cancer screening rates among transgender adults: Cross-sectional analysis of primary care data.

Objective: To compare rates of cervical, breast, and colorectal cancer screening between patients who are transgender and those who are cisgender (ie, nontransgender).

Design: Cross-sectional study.

Setting: A multisite academic family health team in Toronto, Ont, serving more than 45 000 enrolled patients.

White matter during concussion recovery: Comparing diffusion tensor imaging (DTI) and neurite orientation dispersion and density imaging (NODDI).

Concussion pathophysiology in humans remains incompletely understood. Diffusion tensor imaging (DTI) has identified microstructural abnormalities in otherwise normal appearing brain tissue, using measures of fractional anisotropy (FA), axial diffusivity (AD), and radial diffusivity (RD). The results of prior DTI studies suggest that acute alterations in microstructure persist beyond medical clearance to return to play (RTP), but these measures lack specificity.

Evaluating Cerebrovascular Reactivity during the Early Symptomatic Phase of Sport Concussion.

Cerebrovascular reactivity (CVR) indexes the ability of blood vessels to respond to vasoactive stimuli and may be a sensitive biomarker of concussion. However, alterations in whole-brain CVR remain poorly understood during the early symptomatic phase of injury. In this study, CVR was assessed using blood-oxygenation-level dependent functional magnetic resonance imaging (BOLD fMRI) combined with a respiratory challenge paradigm; resting cerebral blood flow (CBF) was also evaluated using arterial spin labeling (ASL).

Connectomic markers of symptom severity in sport-related concussion: Whole-brain analysis of resting-state fMRI.

Concussion is associated with significant adverse effects within the first week post-injury, including physical complaints and altered cognition, sleep and mood. It is currently unknown whether these subjective disturbances have reliable functional brain correlates. Resting-state functional magnetic resonance imaging (rs-fMRI) has been used to measure functional connectivity of individuals after traumatic brain injury, but less is known about the relationship between functional connectivity and symptom assessments after a sport concussion.

Framework for building primary care capacity to address the social determinants of health.

Problem Addressed: Family physicians have long understood that social factors influence the health of individuals and communities; however, most primary care organizations have yet to develop the capacity to specifically address these social determinants of health (SDOH).

Objective Of Program: To support SDOH interventions and foster an organizational culture in which addressing SDOH is considered part of high-quality primary care.

Program Description: An academic family health team in Toronto, Ont, established a committee comprising a diverse group of health professionals focused on the SDOH.

First-line medications for alcohol use disorders among public drug plan beneficiaries in Ontario.

Objective: To examine use of first-line alcohol use disorder (AUD) medications (naltrexone and acamprosate) among public drug plan beneficiaries in the year following an AUD diagnosis.

Design: Retrospective population-based cohort study.

Setting: Ontario.

Does transport time of out-of-hospital cardiac arrest patients matter? A systematic review and meta-analysis.

Background: Despite increasing evidence for specialized cardiac arrest centers, the impact of transport time on out-of-hospital cardiac arrest (OHCA) patients' outcome remains unclear. We systematically reviewed the prognostic impact of transport time in OHCA patients.

Methods: We searched PubMed, Embase, the Cochrane Library, and Web of Science from inception to May 2016 for studies that had reported the relationship between transport time and outcome in OHCA patients.

Bone-Marrow-Derived Endothelial Progenitor Cell Treatment in a Model of Lateral Fluid Percussion Injury in Rats: Evaluation of Acute and Subacute Outcome Measures.

Traumatic brain injury (TBI) continues to be a serious health care issue while therapies to treat TBI remain elusive. Promising results from the use of endothelial progenitor cells (EPCs) in numerous disease states highlight the pleiotropic capacity of this cell type. We have previously demonstrated that EPC-conditioned media reduces axonal degeneration subsequent to in vitro oxygen-glucose deprivation insult and concurrently improves white matter and microvascular outcome in vivo after mid-line fluid percussion injury.

The first week after concussion: Blood flow, brain function and white matter microstructure.

Concussion is a major health concern, associated with short-term deficits in physical function, emotion and cognition, along with negative long-term health outcomes. However, we remain in the early stages of characterizing MRI markers of concussion, particularly during the first week post-injury when symptoms are most severe. In this study, 52 varsity athletes were scanned using Magnetic Resonance Imaging (MRI), including 26 athletes with acute concussion (scanned 1-7 days post-injury) and 26 matched control athletes.

Determining rates of overweight and obese status in children using electronic medical records: Cross-sectional study.

Objective: To determine the prevalence of overweight and obese status in children by age, sex, and visit type, using data from EMRALD (Electronic Medical Record Administrative data Linked Database).

Design: Heights and weights were abstracted for children 0 to 19 years of age who had at least one well-child visit from January 2010 to December 2011. Using the most recent visit, the proportions and 95% CIs of patients defined as overweight and obese were compared by age group, sex, and visit type using the World Health Organization growth reference standards.

Research projects in the Surgeon-Scientist and Clinician-Investigator programs at the University of Toronto (1987-2016): a cohort study.

Background: Physicians have traditionally been at the forefront of medical research, bringing clinical questions to the laboratory and returning with ideas for treatment. However, we have anecdotally observed a decline in the popularity of basic science research among trainees. We hypothesized that fewer resident physicians have been pursuing basic science research training over time.

The Functional Segregation and Integration Model: Mixture Model Representations of Consistent and Variable Group-Level Connectivity in fMRI.

The brain consists of specialized cortical regions that exchange information between each other, reflecting a combination of segregated (local) and integrated (distributed) processes that define brain function. Functional magnetic resonance imaging (fMRI) is widely used to characterize these functional relationships, although it is an ongoing challenge to develop robust, interpretable models for high-dimensional fMRI data. Gaussian mixture models (GMMs) are a powerful tool for parcellating the brain, based on the similarity of voxel time series.