An Individualized Multi-Modal Approach for Detection of Medication "Off" Episodes in Parkinson's Disease via Wearable Sensors.

The primary treatment for Parkinson's disease (PD) is supplementation of levodopa (L-dopa). With disease progression, people may experience motor and non-motor fluctuations, whereby the PD symptoms return before the next dose of medication. Paradoxically, in order to prevent wearing-off, one must take the next dose while still feeling well, as the upcoming off episodes can be unpredictable.

The Influence of Social Media on the Perception of Autism Spectrum Disorders: Content Analysis of Public Discourse on YouTube Videos.

Background: Little is known about how social media shapes the public's perception of autism spectrum disorder (ASD). We used a media content analysis approach to analyze the public's perception of ASD.

Methods: We conducted a YouTube search in 2019 using keywords related to ASD.

infection triggers epigenetic changes that are enriched in a type I IFN signature.

Tuberculosis, a deadly infectious lung disease caused by (Mtb), remains the leading cause of bacterial disease-related deaths worldwide. Mtb reprograms and disables key antibacterial response pathways, many of which are regulated by epigenetic mechanisms that control the accessibility of chromatin to the transcriptional machinery. Recent reports suggest that host phosphatases, such as PPM1A, contribute to regulating chromatin accessibility during bacterial infections.

Accuracy of a Prehospital Triage Protocol in Predicting In-Hospital Mortality and Severe Trauma Cases among Older Adults.

: Prehospital trauma triage tools are not tailored to identify severely injured older adults. Our trauma triage protocol based on a three-tier trauma severity grading system (A, B, and C) has never been studied in this population. The objective was to assess its accuracy in predicting in-hospital mortality among older adults (≥65 years) and to compare it to younger patients.

Stereotactic Body Radiotherapy (SBRT) in Very Limited-Stage Small Cell Lung Cancer (VLS-SCLC).

Small cell lung cancer (SCLC) is an aggressive neuroendocrine tumour with metastatic propensity. Stereotactic body radiation therapy (SBRT) is an emerging therapeutic option for SCLC, despite limited supporting evidence. By evaluating the use of SBRT in very limited stage (VLS) SCLC at our institution, we aimed to contribute to the existing knowledge in this area while establishing a basis for further research.

Decline in Other Instrumental Activities of Daily Living as Indicators of Driving Risk in Older Adults at an Academic Memory Clinic.

Background: Decisions around driving retirement are difficult for older persons living with cognitive decline and their caregivers. In many jurisdictions, physicians are responsible for notifying authorities of driving risks. However, there are no standardized guidelines for this assessment.

Predicting chemoresponsiveness in epithelial ovarian cancer patients using circulating small extracellular vesicle-derived plasma gelsolin.

Background: Resistance to chemotherapy continues to be a challenge when treating epithelial ovarian cancer (EOC), contributing to low patient survival rates. While CA125, the conventional EOC biomarker, has been useful in monitoring patients' response to therapy, there are no biomarkers used to predict treatment response prior to chemotherapy. Previous work in vitro showed that plasma gelsolin (pGSN) is highly expressed in chemoresistant EOC cell lines, where it is secreted in small extracellular vesicles (sEVs).

Blunt and Penetrating Airway Trauma.

Airway injury, be that penetrating or blunt, is a high-stakes high-stress management challenge for any airway manager and their team. Penetrating and blunt airway injury vary in injury patterns requiring prepracticed skills and protocols coordinating care between specialties. Variables including patient cooperation, coexisting injuries, cardiorespiratory stability, care location (remote vs tertiary care center), and anticipated course of airway injury (eg, oxygenating well and comfortable vs increasing subcutaneous emphysema) all play a role in determining airway if and when airway management is required.

Canadian evidence-based guideline for frontline treatment of chronic lymphocytic leukemia: 2022 update.

Chronic lymphocytic leukemia (cll) is the most common adult leukemia in North America. In 2018, the first unified national guideline in Canada was developed for the front-line treatment of cll that helped guide treatment across the country. As an update in 2022, a group of clinical experts from across Canada came together to provide input and guidance that included new and innovative treatments and approaches that will continue to provide health care professionals with clear guidance on the first-line management of cll.

Intense FDG Uptake in the Common Bile Duct Post-ERCP Mimics Acute Infectious Cholangitis.

In patients with obstructive pancreatitis due to choledocholithiasis, endoscopic retrograde cholangiopancreatography (ERCP) is the standard of care. ERCP-induced inflammation or infection of the common bile duct (i.e.

Case 309: Autoimmune Glial Fibrillary Acidic Protein Astrocytopathy.

A 64-year-old man presented with a 6-month history of lightheadedness and intermittent balance and coordination difficulties. Two months before admission, symptoms became more substantial and persistent, with a worsening sense of disequilibrium and unsteady gait. He reported difficulties pronouncing words and mild word-finding difficulties.

Transcultural adaptation and psychometric validation of the Thai-Brief Resilient Coping Scale: a cross-sectional study during the coronavirus disease 2019 pandemic in Thailand.

This study aimed to examine the transcultural adaptation, construct validity, and psychometric properties of the Thai-Brief Resilient Coping Scale (BRCS) among the general population and college students through the coronavirus disease 2019 (COVID-19) pandemic in Thailand. We invited the 4004 participants to complete sets of anchor-based measurement tools, including depressive symptoms, anxiety symptoms, perceived stress, well-being, and perceived social support. The scale factor structure of the Thai-BRCS was assessed using factor analysis, and nonparametric item response theory (IRT) analysis.

Stress and conflict from tacit culture forges professional identity in newly graduated independent physicians.

To transition successfully into independent practice, newly graduated independent physicians (new "attendings") undergo a process of professional identity formation (PIF) as a clinician within a new community of practice (CoP). PIF is crafted by socialization within a CoP including transfer of tacit knowledge. While certain tacit knowledge is critical for professional identity, we understand little how it shapes PIF.

Effect of inpatient antibiotic treatment among older adults with delirium found with a positive urinalysis: a health record review.

Background: Among older adults with delirium and positive urinalysis, antibiotic treatment for urinary tract infection is common practice, but unsupported by literature or guidelines. We sought to: i) determine the rate of antibiotic treatment and the proportion of asymptomatic patients (other than delirium) in this patient population, and ii) examine the effect of antibiotic treatment on delirium resolution and adverse outcomes.

Methods: A health record review was conducted at a tertiary academic centre from January to December 2020.

The Association between Intertwin Difference in First Trimester Crown-Rump Length, Nuchal Translucency, and Birth Weight Discordance in Twin Pregnancies: A Retrospective Cohort Study.

Background: Discordant birth weight in twins is linked to poor outcomes and predicting this discrepancy may lead to enhanced screening and surveillance. Our purpose was to quantify the relationship between intertwin nuchal translucency (NT) and crown-rump length (CRL) discordance with birth weight discrepancies ≥ 20%.

Methods: We conducted a retrospective cohort study of 887 live twin births delivering at a Canadian tertiary care center over a 7-year period who opted for integrated prenatal screening.

Clinical Manifestations of Chiari I Malformation.

Chiari 1 malformation (CM1) includes a spectrum of clinical manifestations. These signs and symptoms result from compression at the cervicomedullary junction and alteration in cerebrospinal fluid dynamics thus affecting several structures above, at, and below the cervicomedullary junction. Differences in presentation exist among different age groups and high clinical suspicion should be present in younger children.

Intimate Partner Violence and Human Trafficking: Trauma We May Not Identify.

Intimate partner violence and human trafficking commonly affect patients presenting to the emergency department including the trauma bay. Although these forms of violence and exploitation are not always the underlying cause of that particular emergency department encounter, screening is important regardless of the presenting condition because this presentation may be the only opportunity to receive help and ultimately plants the seed for future access to help regardless of what a patient chooses to do following this first encounter. There are important medical care considerations in these patients beyond trauma bay procedures that can make the difference in saving a life.

Heterogeneity in pragmatic randomised trials: sources and management.

Background: Pragmatic trials aim to generate evidence to directly inform patient, caregiver and health-system manager policies and decisions. Heterogeneity in patient characteristics contributes to heterogeneity in their response to the intervention. However, there are many other sources of heterogeneity in outcomes.

Psychological Resilience and Adverse Mental Health Issues in the Thai Population during the Coronavirus Disease 2019 Pandemic.

In light of the coronavirus disease 2019 (COVID-19) pandemic and the enormous amount of uncertainty caused by it, mental health issues have become a great concern. Evidence regarding the effects of psychological resilience on the Thai population is scarce. We evaluated psychological resilience during the first wave of the COVID-19 pandemic and its association with the risk of mental health outcomes, such as depression, anxiety, stress, and health-related well-being.

Cancer Patients First Treated with Chemotherapy: Are They More Likely to Receive Surgery in the Pandemic?

Due to the ramping down of cancer surgery in early pandemic, many newly diagnosed patients received other treatments first. We aimed to quantify the pandemic-related shift in rate of surgery following chemotherapy. This is a retrospective population-based cohort study involving adults diagnosed with cancer between 3 January 2016 and 7 November 2020 in Ontario, Canada who received chemotherapy as first treatment within 6-months of diagnosis.

Facing hierarchy: a qualitative study of residents' experiences in an obstetrical simulation scenario.

Background: Residents in surgical specialties face a steep hierarchy when managing medical crises. Hierarchy can negatively impact patient safety when team members are reluctant to speak up. Yet, simulation has scarcely been previously utilized to qualitatively explore the way residents in surgical specialities navigate this challenge.

A regional approach to reduce postoperative opioid prescribing in Ontario, Canada.

Background: Opioid-related morbidity and mortality continue to rise in the province of Ontario. We implemented a provincial campaign to reduce the number of opioid pills prescribed at discharge after surgery in the Ontario Surgical Quality Improvement Network (ON-SQIN).

Methods: Activities related to the provincial campaign were implemented between April 2019 and March 2020 and between October 2020 and March 2021.

Cancer and stroke: What do we know and where do we go?

Cancer is an increasingly recognized cause for ischemic stroke, with recent acknowledgement of cancer-related stroke as an emerging stroke subtype with unique pathophysiologic mechanisms. In addition, cancer-related stroke may differ from stroke in the general population as cancer patients may not receive guideline-recommended stroke care, and the occurrence of stroke may also preclude patients from receiving optimal cancer treatments. Due to the high degree of morbidity and mortality associated with both conditions, understanding the relationship between stroke and cancer is crucial.

Continuity of care for older adults in a Canadian long-term care setting: a qualitative study.

Background: Continuity of care has been shown to improve health outcomes and increase patient satisfaction. Goal-oriented care, a person-centered approach to care, has the potential to positively impact continuity of care. This study sought to examine how a goal-oriented approach impacts continuity of care in a long-term care setting.